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MEDICAL TUESDAY . NET |
NEWSLETTER |
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Community For Better Health Care |
Vol VIII, No
21, Feb 9, 2010 |
1.
Featured Article:
Change
You Can Believe In Needs a Government You Can Trust
2.
In
the News: Babies With
Ambiguous Genitalia
3.
International Medicine: Paying More,
Getting Less: 2009 Report
4.
Medicare:
Medicare Free For All: Medicare in Free Fall
5.
Medical Gluttony:
Medical Futility
6.
Medical Myths: Nationalized
medicine will reduce medical errors
7.
Overheard in the Medical Staff Lounge: What Does Obama Care Mean?
8.
Voices
of Medicine: An
Important letter to the American Medical Association
9.
The Bookshelf: Spiritual and Medical Perspectives on
Euthanasia and Mortality
10.
Hippocrates
& His Kin: What's the
current cost of purchasing a vote in Congress?
11.
Related Organizations: Restoring Accountability in HealthCare, Government and Society
Words of Wisdom,
Recent Postings, In Memoriam . . .
*
* * * *
The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall
Street Journal, is the most prestigious meeting of chief and senior
executives from all sectors of health care. Renowned authorities and
practitioners assemble to present recent results and to develop innovative
strategies that foster the creation of a cost-effective and accountable U.S.
health-care system. The extraordinary conference agenda includes compelling
keynote panel discussions, authoritative industry speakers, international best
practices, and recently released case-study data. The 7th Annual
World Health Care Congress will be held April 12-14, 2010 in Washington D.C. For more information, visit www.worldcongress.com.
The future is occurring NOW.
*
* * * *
1. Featured Article: Change You Can Believe In Needs a
Government You Can Trust
A year ago, it appeared that
America was heading into a new era of progressivism. The party of government, the Democrats, had just experience two
successive election cycles where their party had attained overwhelming control
of both the Senate and the House of Representatives. They had also successfully elected a President whose activist
credentials were impeccable. What
happened?
We rediscovered the fact
that America does not trust the competence of its governments at both the
federal and state levels. Our
governments have consistently demonstrated their inability to manage the health
care entitlement programs the taxpayers have previously entrusted them to
manage.
President Obama on
September 9, 2009 claimed that his administration could eliminate $500 billion
in fraud fund diversion over the next ten years without taking a single
treatment away from a single Medicare patient.
So, why hasn't the federal government produced this savings before?
In 2010 the Medicare and
Medicaid Programs are projected to generate over $817.7-billion in spending ($499-billion for Medicare
and $319.7-billion
for Medicaid). If one takes the most
conservative estimates for fraud diversion within these programs (10%), the
current annual loss will be over $81-billion with the actual loss more likely
to be twice that amount.
Over the next decade, if
one assumes a growth in cost at 5-percent which is roughly the projected rate
of inflation within health care and further assume that the Medicaid program
will not be expanded as is currently called for within the reform initiative
before Congress, the cost for these programs will be over $13-trillion. That will translate to over $1.3 trillion in
losses to fraud. Using current recovery
statistics, less than
0.55-percent, the government will retrieve less than $71.5-billion.
The fraud problem is
readily fixable but it will require a proactive, data mining approach, rather
than the current reactive, law enforcement approach.
The electorate has
reasonably concluded that before they entrust the government with expanded
responsibilities for health care, the government needs to demonstrate it
capability and objective credibility in efficiently managing the current
programs for which it is responsible.
The place to start that effort is by eliminating fraud within the massive
social welfare programs now in place.
David Gibson is the
president of Reflective Medical, a health care software development company.
Jennifer Gibson is an economist specializing in evolving health care markets as
well as a futures commodity trader specializing energy.
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* * * *
2. In the News: Babies With Ambiguous Genitalia
Going
beyond X and Y By Sally Lehrman
Babies born
with mixed sex organs often get immediate surgery. New genetic studies, Eric Vilain
says, should force a rethinking about sex assignment and gender identity.
When
Eric Vilain began his medical school rotation two decades ago, he was assigned
to France's reference center for babies with ambiguous genitalia. He watched as
doctors at the Paris hospital would check an infant's endowment and quickly
decide: boy or girl. Their own discomfort and social beliefs seemed to drive
the choice, the young Vilain observed with shock. "I kept asking, 'How do
you know?' " he recalls. After all, a baby's genitals might not match the
reproductive organs inside.
By
coincidence, Vilain was also reading the journals of Herculine Barbin, a
19th-century hermaphrodite. Her story of love and woe, edited by famed social
constructionist Michel Foucault, sharpened his questions. He set on a path to
find out what sexual "normality" really meant--and to find answers to
the basic biology of sex differences.
Today
the 40-year-old French native is one of a handful of geneticists on whom
parents and doctors rely to explain how and why sex determination in an infant
may have taken an unusual route. In his genetics
laboratory at the University of California, Los Angeles, Vilain's findings have
pushed the field toward not only improved technical understanding but more
thoughtful treatment as well. "What really matters is what people feel
they are in terms of gender, not what their family or doctors think they should
be," Vilain says. Genital ambiguity occurs in an estimated one in 4,500
births, and problems such as undescended testes happen in one in 100.
Altogether, hospitals across the U.S. perform about five sex-assignment
surgeries every day.
Some
of Vilain's work has helped topple ancient ideas about sex determination that
lingered until very recently. Students have long learned in developmental
biology that the male path of sex development is "active," driven by
the presence of a Y chromosome. In contrast, the female pathway is passive, a
default route. French physiologist Alfred Jost seemed to prove this idea in
experiments done in the 1940s, in which castrated rabbit embryos developed into
females.
In
1990, while at the University of Cambridge, Peter Goodfellow discovered SRY, a
gene on the Y chromosome hailed as the "master switch." Just one base
pair change in this sequence would produce a female instead of a male. And when
researchers integrated SRY into a mouse that was otherwise chromosomally
female, an XX fetus developed as a male.
But
studies by Vilain and others have shaped a more complex picture. Instead of
turning on male development directly, SRY works by blocking an
"antitestis" gene, he proposes. For one, males who have SRY but two
female chromosomes range in characteristics from normal male to an ambiguous
mix. In addition, test-tube studies have found that SRY can repress gene
transcription, indicating that it operates through interference. Finally, in
1994, Vilain's group showed that a male could develop without the gene. Vilain
offers a model in which sex emerges out of a delicate dance between a variety
of promale, antimale, and possibly profemale genes.
Because
researchers have long viewed the development of females as a default pathway,
the study of profemale genes has taken a backseat. Over the past few years,
though, geneticists have uncovered evidence for active female determination.
DAX1, on the X chromosome, seems to start up the female pathway while
inhibiting testis formation--unless the gene has already been blocked by SRY.
With too much DAX1, a person with the XY complement is born a female. Vilain's
group found that another gene, WNT4, operates in a similar way to promote the
formation of a female. The researchers discovered that these two work together
against SRY and other promale factors. "Ovary formation may be just as
coordinated as testis determination, consistent with the existence of an
ovarian switch,' " report geneticist David Schlessinger and his
collaborators in a 2006 review in the journal Bioessays.
Lately Vilain has been exploring molecular
determinants of sex within the brain and whether they may be linked to gender
identity. Despite classic dogma, he is certain that sex hormones do not drive
neural development and behavioral differences on their own. SRY is
expressed in the brain, he points out, suggesting that genes influence brain
sexual differentiation directly. His lab has identified in mice 50 new gene
candidates on multiple chromosomes for differential sex expression. Seven of
them begin operating differently in the brain before gonads form. Vilain's
group is testing these findings using mice and is collaborating with a clinic
in Australia to study expression patterns of the sex-specific genes in
transsexual people.
This work, like much of Vilain's efforts,
treads on fairly touchy ground. He copes by sticking to his findings
conservatively. "You also have to be aware of the social
sensibilities," he explains. Accordingly, he has come to agree with some
gender activists that it is time to revamp the vocabulary used to describe
ambiguously sexed babies.
At the 2005 Intersex Consensus Meeting in
Chicago, he stood before a group of 50 geneticists, surgeons, psychologists and
other specialists and argued that terms such as "hermaphrodite," male
or female "pseudohermaphrodite" and "intersex" were vague
and hurtful. Instead of focusing on a newborn's confusing mix of genitals and
gonads, he urged his colleagues to let the explosion of new genetic findings
point toward a more scientific approach. Rather than using
"hermaphrodite," for instance, he recommended referring to a
"disorder of sexual development" (DSD) and applying the more precise
term of "ovatesticular DSD."
Although the attendees eventually
concurred, not everyone likes the new terminology. Some who prefer
"intersex" feel that a "disorder" is demeaning. Milton
Diamond, who studies sex identity at the University of Hawaii, complains that
it stigmatizes people who have nothing wrong with their bodies.
But the decision to change nomenclature
realizes a 15-year dream for Cheryl Chase, executive director of the Intersex
Society of North America (ISNA). Chase has fought for years against secret,
rushed surgeries intended to comfort parents and adjust anatomy to match an
assigned social gender. Recalling how a doctor once called her "formerly
intersex," she hopes physicians will begin to see mixed sex
characteristics as a lifelong medical condition instead of a problem to be
quickly fixed. "Now that we've accomplished the name change, culture can
accomplish a little magic for us," she predicts. . .
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*
* * * *
3. International Medicine: Paying More, Getting Less: 2009 Report.
Ontario, New Brunswick on pace to spend half of all
revenue on health care by 2014; four other provinces expected to hit 50 per
cent by 2034
(November 30, 2009)
TORONTO, ON—Provincial spending on health care continues to
grow faster than provincial revenues, with six out of 10 provinces projected to
be spending half of all available revenue on health care by 2034, according to
a new report from the Fraser Institute, one of Canada's leading economic
think-tanks.
Ontario and New Brunswick face the biggest crunch, where
health expenditures are on pace to consume half of total provincial revenues by
2014 or earlier.
The study suggests that Prince Edward Island will likely
reach the 50 per cent point within 10 years, followed by Nova Scotia in 15
years, Manitoba in about 17 years, and Quebec in 25 years.
"Health spending has increased at an unsustainable rate
in the majority of provinces over the past decade," said Brett Skinner,
Fraser Institute Director of Bio-Pharma, Health, and Insurance Policy and lead
author of Paying More, Getting Less: 2009 Report.
"Unless provincial governments can devise a better way
to finance health care, they will be forced to either hike taxes, expand
rationing of medical goods and services, or make extensive cut backs in other
government programs."
Paying More, Getting Less: 2009 Report is the Fraser
Institute's sixth annual report on the financial sustainability of provincial
public health insurance. The peer-reviewed study makes projections using
Statistics Canada data on the most recent 10-year trends for provincial
government health expenditures and total available provincial government
revenue from all sources.
Skinner points out that while the 10-year trend confirms the
urgency of the sustainability problem, more recent one-year trends are even
more concerning.
"Over the past year, health spending in Ontario is on
pace to consume 50 per cent of total available revenue in the province by the
end of next year," he said.
The report points out that some provinces have tried to
address the sustainability problem by raising tax burdens. Skinner argues that
this approach is misguided.
"Tax hikes reduce economic growth in the long run,
resulting in job losses and increased demand for government spending on
employment insurance and social assistance programs. Attempting to drive
long-term revenue growth through tax increases is futile, and if introduced at
this time, would only further delay economic recovery from the recession,"
he said.
The report also chronicles how provinces have tried to cut
health spending using blunt, centrally imposed rationing. Provincial
governments are increasingly forcing Canadians to accept less from public
health insurance by reducing the supply of physicians and nurses, allowing
hospital infrastructure to deteriorate, and refusing to cover new medical
technologies. All of which contributes to long wait times for health care
services, Skinner notes.
"Despite these misguided efforts, health spending is
still growing faster than the ability of government to pay for it."
The report concludes that Canada's current public health
insurance system is simply not financially sustainable through public means
alone and recommends several changes: . . .
Read the
rest of the news on Canadian Medicare . . .
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Canadian Medicare does not give timely
access to healthcare, it only gives access to a waiting list.
--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R.
791
http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
*
* * * *
4. Medicare: Medicare Free For All: Medicare in Free Fall
Medicare
at 55 by Andrew J. Rettenmaier
and Thomas R. Saving
Brief Analyses | Health No. 682 Tuesday, December 15,
2009
A
proposal to allow 55- to 64-year-olds to buy Medicare coverage is gaining traction
in the Senate deliberations on health care reform. What will this mean for
Medicare's finances? How much will it cost to buy the coverage? How will this
expansion affect the labor force participation of older Americans?
How Much Will It Cost to Buy Into Medicare? Proponents of the change say that new enrollees will
be charged a premium that reflects the total cost they will add to the Medicare
program. Since Medicare often pays providers less than private payers, Medicare
premiums could be lower than private insurance premiums in principle. However,
Medicare coverage is less complete than what most Americans expect from health
insurance. That is why so many seniors pay a second premium for MediGap
insurance. Unless this Medicare expansion is heavily subsidized the odds are
that very few uninsured near-elderly will opt in.
If Medicare Coverage Is Subsidized, Will the Currently Insured
Near-Elderly Drop Their Private Insurance to Enroll? As of 2008, 12.5 percent of 55- to 64-year-olds were
uninsured, representing less than 10 percent of all uninsured. To induce this
uninsured group to voluntarily buy into Medicare, the premiums would have to be
subsidized in some way. But these subsidies would also make Medicare attractive
for those who currently purchase their own private insurance
Are the Uninsured Near-Elderly More Likely to be Unemployed or to Have
Low Family Incomes? How does the
labor market activity of the uninsured members of the targeted age group differ
from those who have insurance coverage? Figure I shows how labor force
participation and family income vary by type of insurance coverage for the 55
to 64 population. Among the uninsured in this age group, about 57 percent are
in the workforce and 22 percent have family incomes of $60,000 or more. More of
those who purchase their own insurance work and they have higher earnings, but
they account for just over 7 percent of the targeted population. The 60 percent
of this age group covered by private employer-based insurance have the highest
labor market participation rate - almost 80 percent - and 55 percent are in families with income of at least $60,000.
Are the Uninsured Near-Elderly More Likely to Be in Poor Health? The uninsured among the 55- to 64-year-old population
is the target of the proposed Medicare extension. Those who are less healthy
may not be able to find affordable health insurance. Figure II compares the
health status of this age group by insurance coverage:
·
Individuals with
employer-provided or self-purchased health insurance report the best health,
while 64 percent of those covered by Medicare and/or Medicaid report fair or
poor health.
·
By contrast, 76 percent
of the uninsured people in this age group report that their health is good,
very good or excellent, and 24 percent report fair or poor health.
Thus, the evidence suggests
that uninsured older Americans are not uniformly in low-income families nor are
they uniformly in poor health.
Will Subsidized Medicare
Insurance Induce the Near-Elderly to Drop Out of the Labor Market? An unintended consequence of the proposed change is
its impact on the labor force participation of the 23 million baby boomers
between 55 and 64 who currently work. While health insurance coverage should be
portable from job to job, the lack of portability because of the present tax
treatment of health insurance appears to influence the timing of
retirement:
·
Social Security's early
retirement age is 62 and 40 percent start claiming benefits at this age.
·
But there is a second
spike at 65, the age of eligibility for Medicare, when 34 percent join the
Social Security rolls.
This suggests that many
older Americans continue to work until they are eligible for Medicare benefits.
Could the New Program
Add to Medicare's Unfunded Liabilities? Given
that a significant portion of individuals wait to claim Social Security until
they are also eligible for Medicare, the structure of the new reform,
particularly the subsidy rate, will determine how many workers will exit the
labor force if their continued work is not required for health care
coverage. Such a drop in labor force participation will reduce both tax
revenue and output. The ultimate costs of the reform are therefore more than
just the subsidy per capita multiplied by the number of people who buy into
Medicare. Further, subsidy rates in Medicare have a history of growing.
Initially, Medicare's Part B premiums paid by enrollees were to cover 50
percent of the program's costs and taxpayers were to subsidize the other 50
percent, but within 17 years of Medicare's passage taxpayers were subsidizing
75 percent of the cost. However the cost is accounted for, this Medicare
expansion would likely add to the program's unfunded liabilities.
Conclusion. These are some of the foreseeable consequences of
extending Medicare to the 55- to 64-year-old population. If the proposal does
not include generous subsidies, the uninsured probably won't find it
attractive. However, even without subsidies it may induce some current workers
to retire early. But if the proposal does include large enough subsidies that
make it attractive for the uninsured to voluntarily buy-in, then the costs of
covering the uninsured will rise. In addition, the subsidized Medicare will
make early retirement much more attractive for the currently insured working
population. Thus the expansion of Medicare to the 55- to 64-year-old population
is likely to be expensive and counterproductive.
Andrew J. Rettenmaier and Thomas R. Saving are
executive associate director and director, respectively, of the Private Enterprise
Research Center at Texas A&M University and senior fellows with the
National Center for Policy Analysis
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Government
is not the solution to our problems, government is the problem.
-
Ronald Reagan
* * * * *
5. Medical Gluttony: Medical Futility
An effort
to provide a benefit that reason and experience suggest is highly likely to
fail and in rare exceptions cannot be systematically reproduced. –L.
Schneiderman, N. Jecker, A. Jonsen
The Medical Grand Rounds at the University
of California at Davis recently was given by Emeritus Professor of Ethics
titled: "Where Oh Where Has Futility Gone"
This is a topic that has been discussed in
Medicine for more than two decades as the reference below indicates. Because of
legal ramifications, physicians listening to lawyers rather than their own
ethical judgment, it has been difficult to contravene until recently. As more
data has become available, physicians have been able to make their own
decisions in concert with the patient or his/her family or those in charge
based on rational judgment.
Dr. Jonsen cited data that more than 800
patients given bone marrow transplants who had underlying liver and lung
disease requiring a minimum of four hours of ventilator care had zero
survivors. Thus the BM transplant can be categorized at Medical Futility before
implemented rather than afterwards when failure becomes obvious. This averts
the anguish that family members are subjected to and the painful discussion
revolves around the decision to turn off the ventilator and watch a loved on
die.
In my professional experience, when
patients and families have agreed that it would be inappropriate and futile to
intubate, I would rush to the patient's bedside to control the rush to start
life support and stand with the family at the patient's bedside between the
patient and the mechanical devices which were rushed in to begin the
"futile effort." The respiratory therapists sometimes seem to be
pleading to allow them to start life support. This effort was sometimes so
aggressive that if I moved to the foot of the bed, the therapist would rush in
to begin heroic and futile efforts.
This was not fully understood until a
Respiratory Therapist mentioned to me in private that I had just cheated the
hospital out of a lot of money. How much? He stated that the charge for the set
up was $500 and he thought it was about that much for each additional half
hour. Did I cheat the hospital out of $24,000 a day? One therapist could manage
two patients in the ICU on ventilators. Were they really getting $48,000 return
on one employee's work? That was not a bad one-employee return on a $17 an hour
(the RT pay rate at that time.) hospital cost. This of course, could never be
corroborated since hospital charges are not published or made apparent.
Dr. Jonsen also cited data on occasion
where medical futility for the patient is appropriate. A woman who was near
term in her pregnancy suffered a massive stroke. There was no hope of recovery.
However, the decision was reached by the medical team, in concern with her
husband, to keep this brain dead woman on life support until she could be
delivered of her child. Since the fetus was viable, this was accomplished and a
healthy baby was delivered from a dead mother.
Medical Futility: Its Meaning and Ethical
Implications. By L. Schneiderman, N. Jecker, A. Jonsen, Ann Intern Med 1990; 112:949-54.
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Medical Gluttony thrives in Government and Health
Insurance Programs.
It Disappears with Appropriate Deductibles and
Co-payments on Every Service.
*
* * * *
6. Medical Myths: Nationalized medicine will reduce
medical errors
Based on 173 deaths in
the Harvard Medical Practice study, and extrapolating to the entire U.S.
population, the Institute of Medicine (IOM) has been claiming for almost a
decade that as many as 98,000 Americans are killed by medical errors every
year.
Moreover, it is asserted
that Americans have only about a 50/50 chance of receiving "proper health
care."
The proposed solution:
electronic records with constant surveillance of compliance with
government-approved protocols. The IOM claims that its methods could reduce
errors by 50% over 5 years.
The IOM's definition of
error, the assumption that a death was a result of the error and would not have
occurred anyway, and its guesstimate of the number of deaths all lack
independent confirmation. The IOM number is three to seven times higher than a
1998 estimate by the National Safety Council.
Although the IOM
analysis is uncritically accepted by the AMA and other influential bodies,
there is no evidence at all that the proposed solution would result in any
improvement in mortality or other patient outcome measurements. More likely
results are:
·
Choice of therapies not
embraced by mainstream medicine would be much curtailed. Nutritional
approaches, long-term antibiotics for Lyme disease, chelation, hyperbaric
oxygenation, acupuncture, prolotherapy, treatment for multiple chemical
sensitivities, and other innovative, nonstandard, or "alternative"
modalities could become unavailable.
·
Intensified oversight
and rigid protocols might make physicians even less likely to provide adequate relief
for chronic pain. National electronic databases of prescription drugs would
facilitate stigmatizing patients who use controlled substances whether for pain
or mental health reasons.
·
Patients' freedom to
decline "recommended" therapy—such as vaccines and psychotropic
drugs—would be threatened as doctors feared being penalized as
"outliers."
·
"Recommended"
therapy has possibly done more harm than medical errors, and more rapid and
widespread adoption could amplify the harm resulting from a misdirected "guideline."
For example, more than 50,000 individuals are estimated to have died from
encainide (Enkaid) and flecainide (Tambocor), used as directed to treat
abnormal heart rhythms, before their adverse effects were recognized (Kilo CM,
Larson EB. Exploring
the harmful effects of health care. JAMA 2009;302:89-91). A trial
of aggressive blood sugar control was stopped because the "common
wisdom" was apparently wrong: more patients died from the
"improved" treatment (Couzin J. Deaths
in diabetes trial challenge a long-held theory. Science
2008;319:884-885).
·
Guidelines focused on
cost control would deprive patients of newer, more effective drugs. Oncologist
Karol Sikora states that thousands of premature deaths result from the British
National Health Service's restrictions on new drugs through its National
Institute of Clinical Excellence (NICE) (Union
Leader 5/12/09).
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Medical
Myths originate when someone else pays the medical bills.
Myths disappear when Patients pay Appropriate
Deductibles and Co-payments on Every Service.
*
* * * *
7. Overheard in
the Medical Staff Lounge: What Does Obama Care Mean?
Dr.
Rosen: What do the doctors in our
hospital think of Obama care?
Dr.
Yancy: Not much.
Dr.
Paul: It really doesn't make any
difference what we think here at lunch. It's coming and we can have our unions
negotiate the terms.
Dr.
Yancy: So you think we'll all be
union workers?
Dr.
Paul: Certainly. Just like everyone
else.
Dr.
Dave: I don't follow you Paul. It
looks like unions are losing clout and membership all over the country. You
want to be like them?
Dr.
Paul: The union man has a carefree
life. He doesn't have to sweat the decisions. He just has to read the rulebook
and follow along.
Dr.
Edwards: You would be happy to do
that?
Dr.
Paul: Who said anything about
happiness? You look rather down in the mouth yourself. You must not like our
current system.
Dr.
Edwards: Can't say as I do.
Dr.
Paul: So you don't like free-market health
care, do you?
Dr.
Edwards: We don't have free-market
health care by any stretch of the imagination. We have government-dictated
healthcare.
Dr.
Paul: So if the government is
dictating to us, why not be on the same level with forceful negotiation.
Dr.
Edwards: I don't think union leaders
would understand practice issues any more than the government does at this
time.
Dr.
Paul: They don't have to. They just
need to whip the membership into shape and bulldoze those that don't want to go
along out of the way.
Dr.
Rosen: So you think that's what an
advanced society has evolved into? Sounds more feudal to me than a
freedom-loving and kind society built on the Golden Rule.
Dr.
Paul: I know it's difficult for a non
progressive. But you'll get use to it. Then we'll all be in it together and
we'll cooperate much more than we are doing right now.
Dr.
Edwards: I get the impression
cooperation for you is that we're all in the same pot and fighting a common
enemy and it will be us fighting each other.
Dr.
Paul: But we will know who the
villain is. It may be the government, but we'll have power to strike, withhold
care, not furnish coverage and go home at 4:30. And enjoy the good life.
Dr.
Rosen: I guess we'll have to see what
BO can accomplish in his second year. Hopefully more than in his first year.
Maybe Dr. Paul is correct—his stimulus is working.
Obama Stimulus Program Is Working.
It has created 3 new jobs:
One in Virginia,
one in New Jersey, and
one in Massachusetts.
More to come in Illinois.
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*
* * * *
8. Voices of Medicine: An Important letter to the
American Medical Association
TO: Rebecca Patchin, MD, Chair, AMA BoardAs you will recall, I and thousands of other AMA members have committed to resign from the AMA the minute Obamacare is signed into law in any form, placing the blame for that debacle squarely where it belongs, in the hands of AMA leadership and its failure to oppose these bills and to promote the AMA House's will. However it now seems that Obamacare may die, sadly not through any action of the AMA, but at the hands of the MA Senate election, a huge and welcome surprise. I certainly hope so. At any moment though, and until the Congress adjourns at the end of the year, the Senate bill could be passed intact by the House with no other action by the Senate. Pelosi is determined to do just that, but does not have the 218 votes she needs. We charge the AMA to make sure that she never does. If she does the automatic AMA resignations will flood in I can promise you, starting with mine. The AMA must make a strong statement that it does not want the House of Representatives to pass the Senate version of the bill at any time. That is our biggest risk this year. Please act promptly, frequently and aggressively to prevent this possible scenario. In my opinion, AMA must also withdraw its prior support of the bills and insist they be removed from consideration by the House and the Senate in their entirety. Congress must tear them up and start over with consensus, bipartisan discussions or none at all. We need private contracting, expansion of consumer directed health initiatives and HSAs, across state line insurance sales, assigned risk state insurance program expansion, individual ownership of real insurance and tort reform. We need to stop insuring primary care which is inexpensive, routine and inherently not insurable. Patients should pay for primary and much basic office specialty care directly. We need to make sure insurance is used for its intended purpose, large, unpredictable, unexpected, rare illnesses and injuries. Our personally owned health insurance policies should sit unused in the bottom desk drawer at home along with our fire insurance policy with the expectation and hope of never having to use them at all. That is how real insurance works and that is how it is made affordable. We need to stop harping on the SGR fix. The government is broke and may need to ration care by limiting access with these below market public fees to regain solvency. Doctors got along before Medicare and Medicaid and we can again, if we can balance bill our better off patients. We can then also take care of the poor getting partial reimbursement from these failed government programs. Doctors need to be encouraged and taught how to run direct practices outside or partly outside the failed public and employer based insurance systems as concierge doctors are now doing by the tens of thousands. These forms of practice need to be endorsed and encouraged by organized medicine right now and with fervor. It is the only way we will get students again interested in primary care and office practice in general. We who believe in these principles will be watching the AMA very closely to see if it now turns in a rational direction. Dr. Rohack's remarks on balance billing were a small start, but way short of what needs to be said forcefully by the AMA leadership.Thomas W. LaGrelius, MD, FAAFP
Director, LACMA, President, LACMA-9 (Los Angeles Country Medical Society)
Chair and IPP SIMPDKeep up the pressure Tom or let's all get out before Obama tells Americans the AMA is Our Voice.
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VOM
Is an Insider's View of What Doctors are Thinking, Saying and Writing about.
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9. Book Review: Spiritual and Medical Perspectives on
Euthanasia and Mortality
DENIAL OF THE SOUL - Spiritual and Medical
Perspectives on Euthanasia and Mortality, M. Scott Peck, MD, Harmony Books, New York, 1997, xi & 242 pp,
$23, ISBN: 0- 517-70865-5.
Physician, psychiatrist, theologian, and author of the
best-seller, The Road Less Traveled, F Scott Peck, MD, gives us an
in-depth look at the current euthanasia movement and its origins in the
inability of physicians to "pull the plug." Peck states that although
Dr Kevorkian gives him the shivers, he must credit him more than any other
individual for the genesis of this book. Almost single-handedly over the past
five years, Kevorkian has turned the debate over euthanasia into a national
issue within the United States.
But Kevorkian didn't inspire Dr Peck to write this
book–it was the public response to his behavior. Peck was surprised by the
number of people who admire Kevorkian. He was even further surprised by the
larger number who, though they feel no affections for Kevorkian, nevertheless
deeply approve of what he has been doing in assisting the suicides of those who
are ill. Most of all, Peck has been surprised by the huge number of Americans
who do not find Dr Kevorkian's work particularly objectionable.
The whole debate is strangely passionless and
seemingly simplistic. But the subject of euthanasia is far from simplistic - it
involves questions about who, if anyone, has a right to terminate a life;
whether it's the same as or different from suicide or homicide; whether it
differs from merely "pulling the plug;" and what role does pain, both
physical and mental, play in euthanasia decisions. Among the stories he tells,
is one about Tony, a patient of his when he was a psychiatric resident. He felt
Tony's craziness was organic and referred him to neurology where he was found
to have a large frontal brain tumor. The tumor was inoperable and failed to
respond to radiation treatment.
Weeks later when Peck rotated on the neurology
service, Tony, now unresponsive and on a ventilator, reentered his life. He
wondered why anyone would decide to place Tony on life support. Was this
"heroic" medicine, or just a measure to prolong a life that had lost
its essence? Peck asked his chief of neurology at Letterman General Hospital
whether this effort to prevent inevitable death was the right thing to do? The
Colonel commended him, obtained a portable EEG, and found an occasional distorted
brain wave and pronounced that the patient was not yet certifiably brain-dead.
Recalling the anguish of the family in waiting, Peck
looked at Tony for the next 15 minutes, cut the levophed drip in half, went to
the doctor's lounge, smoked a cigarette, returned 10 minutes later, found Tony
dead, and informed the family. As they wept, speaking to each other in Italian,
he could not tell whether they were weeping in grief or relief. He concluded,
probably both. He, of course, had the presence of mind not to tell anyone about
what he had done. . . .
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10. Hippocrates & His Kin: What's the current cost of
purchasing a vote in Congress?
Legislatures favorable
to industry interests raise more money to campaign, to conduct polls, to buy
ads and get elected. Telecom
Immunity: House
Democrats who flipped their positions to favor immunity for telecom firms
received an average of 68 percent more money from AT&T's, Verizon's and Sprint's political action
committees, compared with Democrats who remained opposed to immunity. That's $4,987 to each Democrat who opposed
immunity and $8,359 to each Democrat
who flipped positions to favor telecom firms. Financial Bailout:
House members who voted for the $700 billion bank bailout received 54 percent
more campaign
contributions from banks and securities firms than House members voting
against the bailout. That is an average of $231,877
in bank contributions received by each House member voting "Yes," $150,982 for each member voting
"No." Prescription
drug imports: In the current health care debate in the U.S. Senate, senators voting
to block drug imports from other countries, as drug companies wanted, received
an average of $85,779 each from drug
companies. That's 69 percent more than given to senators who voted to allow
imports.
As
long as you have a government for sale someone will be there to buy . . .
It
also helps politicians like Dr. John Edwards afford a $1250 haircut . . . David
Perel
How big's $1.9 trillion in new
spending? Very big, By
JIM ABRAMS, Associated Press Writer
A
1.9 trillion-mile trip is about the same as 8 million trips to the moon. And
1.9 trillion feet would take you to the top of 29,000-foot Mount Everest 65
million times, or to the bottom of the 36,000-foot Mariana Trench, the deepest
point in the Pacific, about 53 million times.
Unfortunately
the $1.9 trillion in new borrowing authority Senate Democrats are seeking for
the government won't take us quite that far. That amount, raising the national
debt ceiling to $14.3 trillion, may have to be increased again after the fall
election.
But
1.9 trillion is still a lot, no matter how you look at it. In dollars, it's
almost twice all the money America has spent in military operations in Iraq and
Afghanistan since 2001.
That
amount would buy about 422 Nimitz Class aircraft carriers, which run about $4.5
billion apiece. It would be enough to provide Pell grants of $5,000 to some 380
million low-income students, a number exceeding the entire population of the
country.
The
world population is currently about 6.7 billion, so 1.9 trillion people would
be enough to populate some 284 worlds.
In
terms of time, 1.9 trillion seconds adds up to about 60,000 years. And 1.9
trillion hours ago, or almost 220 million years ago, dinosaurs were just
beginning to dominate the Earth.
The
US Supreme Court has struck down a major portion of a 2002 campaign-finance
reform law, saying it violates the free-speech right of corporations to engage
in public debate of political issues. . .
www.csmonitor.com/USA/Justice/2010/0121/Supreme-Court-Campaign-finance-limits-violate-free-speech
Most Republicans and conservatives were pleased.
"This is an encouraging step, and it is my hope that political parties
will one day soon be able to speak as freely as other citizen organizations are
now permitted," said National Republican Senatorial Committee Chairman
John Cornyn, R-Texas.
Conservatives saw the ruling as a victory for free
speech, and a boost to political challengers.
www.sacbee.com/341/story/2480964.html
"Speech about our
government and candidates for elective office lies at the heart of the First Amendment, and the
court's decision vindicates the right of individuals to engage in core
political speech by banding together to make their voices heard."
--Theodore Olson, who
argued the case for Citizens United
www.sacbee.com/341/story/2480964.html
"The text and
purpose of the First Amendment
point in the same direction: Congress
may not prohibit political speech, even if the speaker is a corporation or
union."
--Chief Justice John
Roberts
www.sacbee.com/341/story/2480964.html
"With today's monumental decision, the Supreme
Court took an important step in the direction of restoring the First Amendment
rights of these groups by ruling that the Constitution protects their right to
express themselves about political candidates and issues up until Election
Day."
Senate Republican leader Mitch McConnell of Kentucky
www.sacbee.com/341/story/2480964.html
"Today's ruling protects the First Amendment
rights of organizations across the political spectrum, and is a positive for
the political process and free enterprise."
Robin Conrad, of the U.S. Chamber of Commerce National Chamber Litigation Center www.sacbee.com/341/story/2480964.html
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11. Organizations Restoring Accountability in HealthCare,
Government and Society:
•
The National Center
for Policy Analysis, John C
Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick
wrote Lives at Risk, issues a
weekly Health Policy Digest, a health summary of the full NCPA
daily report. You may log on at www.ncpa.org and register to receive one or more
of these reports. This month, read the informative Why
Massachusetts is not a Model for Health Care Reform . . .
•
Pacific
Research Institute, (www.pacificresearch.org) Sally
C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription
newsletter, which is very timely to our current health care situation. You may
signup to receive their newsletters via email by clicking on the email tab or directly access their health
care blog. Just released Deadly Irony: California's New HMO
Regulations Versus Single-Payer Health Care, by John Graham . . .
•
The Mercatus Center at George Mason University (www.mercatus.org)
is a strong advocate for accountability in government. Maurice McTigue, QSO,
a Distinguished Visiting Scholar, a former member of Parliament and cabinet
minister in New Zealand, is now director of the Mercatus Center's Government
Accountability Project. Join
the Mercatus Center for Excellence in Government. This month, treat yourself to
an alternative
to government bailout . . .
•
The
National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement:
Every American will have access to private sector solutions for health,
financial and retirement security and the services of insurance professionals.
There are numerous important issues listed on the opening page. Be sure to scan
their professional journal, Health
Insurance Underwriters (HIU), for articles of importance in the Health
Insurance MarketPlace. The HIU magazine, with Jim Hostetler as the executive
editor, covers technology, legislation and product news - everything that
affects how health insurance professionals do business.
•
The Galen
Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent
every Friday to which you may subscribe by logging on at www.galen.org.
A study of purchasers of Health Savings Accounts shows that the new health care
financing arrangements are appealing to those who previously were shut out of
the insurance market, to families, to older Americans, and to workers of all
income levels. This month, you might focus on Obama Signals a Dangerous 2010 Strategy.
•
Greg Scandlen, an expert in Health Savings Accounts (HSAs), has
embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the
initial series of his newsletter, Consumers Power Reports.
Become a member of CHCC, The
voice of the health care consumer. Be sure to read Prescription for change:
Employers, insurers, providers, and the government have all taken their turn at
trying to fix American Health Care. Now it's the Consumers turn. Greg has
joined the Heartland Institute, where current newsletters can be found.
•
The Heartland Institute, www.heartland.org,
Joseph Bast, President, publishes the Health Care News and the Heartlander. You
may sign up for their health care
email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?. This month, be sure to
read Act Now to Stop Health Care
Nationalization.
•
The Foundation for
Economic Education, www.fee.org, has
been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for
over 50 years, with Lawrence W Reed, President, and Sheldon Richman as editor. Having
bound copies of this running treatise on free-market economics for over 40
years, I still take pleasure in the relevant articles by Leonard Read and
others who have devoted their lives to the cause of liberty. I have a patient
who has read this journal since it was a mimeographed newsletter fifty years
ago. Be sure to read the current lesson on Economic Education Competition and
Entrepreneurship.
•
The Council for
Affordable Health Insurance, www.cahi.org/index.asp, founded by
Greg Scandlen in 1991, where he served as CEO for five years, is an association
of insurance companies, actuarial firms, legislative consultants, physicians
and insurance agents. Their mission is to develop and promote free-market
solutions to America's health-care challenges by enabling a robust and
competitive health insurance market that will achieve and maintain access to
affordable, high-quality health care for all Americans. "The belief that
more medical care means better medical care is deeply entrenched . . . Our
study suggests that perhaps a third of medical spending is now devoted to
services that don't appear to improve health or the quality of care–and may
even make things worse."
•
The
Independence Institute, www.i2i.org, is a
free-market think-tank in Golden, Colorado, that has a Health Care Policy
Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy
Center Newsletter. Read her latest newsletter: Caldara is calling for an
amendment to the Colorado Constitution that would opt Colorado out of the
onerous health insurance mandates coming out of Washington.
•
Martin Masse, Director of Publications at the Montreal Economic
Institute, is the publisher of the webzine: Le Quebecois Libre. Please
log on at www.quebecoislibre.org/apmasse.htm
to review his free-market based articles, some of which will allow you to brush
up on your French. You may also register to receive copies of their webzine on
a regular basis. This month, read What People Mean When They
Talk About Freedom.
•
The
Fraser Institute, an
independent public policy organization, focuses on the role competitive markets
play in providing for the economic and social well being of all Canadians.
Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying
taxes and started working for themselves. Log on at www.fraserinstitute.ca
for an overview of the extensive research articles that are available. You may
want to go directly to their health
research section. This month check out: Statistical
analysis suggests that increases in health care spending appear to have no
effect on wait times for treatment and may even increase wait times . . .
•
The
Heritage Foundation, www.heritage.org/,
founded in 1973, is a research and educational institute whose mission is to
formulate and promote public policies based on the principles of free
enterprise, limited government, individual freedom, traditional American values
and a strong national defense. The Center for Health Policy Studies supports
and does extensive research on health care policy that is readily
available at their site. - However, since they supported the socialistic health
plan instituted by Mitt Romney in Massachusetts, which is replaying the
Medicare excessive increases in its first two years, they have lost site of
their mission and we will no longer feature them as a freedom loving
institution and have canceled our membership and contributions.
•
The
Ludwig von Mises Institute,
Lew Rockwell, President, is a rich source of free-market materials,
probably the best daily course in economics we've seen. If you read these
essays on a daily basis, it would probably be equivalent to taking Economics 11
and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. You may also log
on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to
be an MD today.
•
CATO. The Cato Institute (www.cato.org) was
founded in 1977, by Edward H. Crane, with Charles Koch of Koch Industries. It
is a nonprofit public policy research foundation headquartered in Washington,
D.C. The Institute is named for Cato's Letters, a series of pamphlets that
helped lay the philosophical foundation for the American Revolution. The
Mission: The Cato Institute seeks to broaden the parameters of public policy
debate to allow consideration of the traditional American principles of limited
government, individual liberty, free markets and peace. Ed Crane reminds us
that the framers of the Constitution designed to protect our liberty through a
system of federalism and divided powers so that most of the governance would be
at the state level where abuse of power would be limited by the citizens'
ability to choose among 13 (and now 50) different systems of state government.
Thus, we could all seek our favorite moral turpitude and live in our comfort zone
recognizing our differences and still be proud of our unity as Americans. Michael
F. Cannon is the Cato Institute's Director of Health Policy Studies. Read
his bio, articles and books at www.cato.org/people/cannon.html.
•
The Ethan
Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state
organizations associated with the State Policy Network (SPN). The mission is to
put into practice the fundamentals of a free society: individual liberty,
private property, competitive free enterprise, limited and frugal government,
strong local communities, personal responsibility, and expanded opportunity for
human endeavor.
•
The Free State Project, with a goal of Liberty in Our
Lifetime, http://freestateproject.org/,
is an agreement among 20,000 pro-liberty activists to
move to New Hampshire, where they will
exert the fullest practical effort toward the creation of a society in which
the maximum role of government is the protection of life, liberty, and
property. The success of the Project would likely entail reductions in taxation
and regulation, reforms at all levels of government to expand individual rights
and free markets, and a restoration of constitutional federalism, demonstrating
the benefits of liberty to the rest of the nation and the world. [It is indeed
a tragedy that the burden of government in the U.S., a freedom society for its
first 150 years, is so great that people want to escape to a state solely for
the purpose of reducing that oppression. We hope this gives each of us an
impetus to restore freedom from government intrusion in our own state.]
•
The St.
Croix Review, a bimonthly
journal of ideas, recognizes that the world is very dangerous. Conservatives
are staunch defenders of the homeland. But as Russell Kirk believed, wartime
allows the federal government to grow at a frightful pace. We expect government
to win the wars we engage, and we expect that our borders be guarded. But St.
Croix feels the impulses of the Administration and Congress are often
misguided. The politicians of both parties in Washington overreach so that we
see with disgust the explosion of earmarks and perpetually increasing spending
on programs that have nothing to do with winning the war. There is too
much power given to Washington. Even in wartime, we have to push for limited
government - while giving the government the necessary tools to win the war. To
read a variety of articles in this arena, please go to www.stcroixreview.com.
•
Hillsdale
College, the premier
small liberal arts college in southern Michigan with about 1,200 students, was
founded in 1844 with the mission of "educating for liberty." It is
proud of its principled refusal to accept any federal funds, even in the form
of student grants and loans, and of its historic policy of non-discrimination
and equal opportunity. The price of freedom is never cheap. While schools
throughout the nation are bowing to an unconstitutional federal mandate that
schools must adopt a Constitution Day curriculum each September 17th
or lose federal funds, Hillsdale students take a semester-long course on the
Constitution restoring civics education and developing a civics textbook, a
Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars,
held every February, or their famous Shavano Institute. Congratulations to
Hillsdale for its national rankings in the US News College rankings. Changes in
the Carnegie classifications, along with Hillsdale's continuing rise to
national prominence, prompted the Foundation to move the College from the
regional to the national liberal arts college classification. Please log on and
register to receive Imprimis, their national speech digest that reaches
more than one million readers each month. This month, read Adam Meyerson on The Generosity of America at www.hillsdale.edu/news/imprimis.asp.
The last ten years of Imprimis are archived.
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"Those who speak most of illness have illness;
those who speak most of prosperity have it, etc." - From the movie The Secret
"When it comes to eating right and exercising,
there is no ‘I'll start tomorrow.' Tomorrow is disease." - V.L. Allineare
Men also
abandoned natural relations with women and were inflamed with lust for one
another. Men committed indecent acts with other men, and received in themselves
the due penalty for their perversion. . . Although they know God's righteous
decree that those who do such things deserve death, they not only continue to
do these very things but also approve of those who practice them. -Paul of
Tarsus to the Romans: 1:27, 32.
Why Government
Doesn't Work, By Harry Browne
The Recession and its Effect on
Healthcare by David Gibson, MD and Jennifer Shaw Gibson
Charity,
Altruism and Free-Market Medicine by the late Madeleine Pelner Cosman, PhD, Esq
. . .
HealthPlanUSA is now a separate
Newsletter devoted to the rapidly evolving field of health plans being promoted
throughout the USA. These are dangerous times. Stay tuned to the current
issues, which we bring quarterly and will increase as staffing permits. Why not
sign up now at www.healthplanusa.net/newsletter.asp?
BY HER own account, Miep
Gies did nothing extraordinary. All she did was bring food, and books, and
news—and, on one fabulous day, red high-heeled shoes—to friends who needed
them. It was nothing dramatic. But she also bought eight people time, and in
that time one of her charges—a teenage girl called Anne Frank, the recipient of
the shoes—wrote a diary of life in the "Annexe". In these four rooms,
above the office of Anne's father, Otto, where Mrs Gies worked as a secretary,
eight Jews hid for 25 months in Amsterdam in 1942-44.
On the warm summer
evening when the Franks went into hiding, Mrs Gies took charge. In subsequent
months she and her trusty bicycle often carried so many bags of vegetables,
bought with forged coupons, that she looked like a pack mule. No one suspected.
Every weekday morning she
would climb two flights of stairs to the Annexe and get the grocery list. Every
afternoon she would deliver the shopping and stay a while to chat—after
composing herself and putting on a cheerful expression. In the cramped, stuffy
rooms, made dim with lace curtains tacked across the windows, everyone had to
whisper. She kept back the worst news: truckloads of other Jews sent to the
camps, shot and gassed, and old friends killed. On their side, the four Franks,
three van Pels and a dentist called Dr Pfeffer tried to conceal their tensions
from her. Nonetheless, she could often feel "the sparks of unfinished
conflicts left sizzling in the air". . .
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On this date in 1773, William Henry Harrison was born. He is the undisputed holder of the record for the
shortest time in office of any U.S. President. He was inaugurated on March 4,
1841, caught cold and died exactly one month later.
Moral: Do what you need to do while you still have breath
before the winds of life change.
Always remember that Chancellor Otto von Bismarck,
the father of socialized medicine in Germany, recognized in 1861
that a government gained loyalty by making its citizens dependent on the state
by social insurance. Thus socialized medicine, or any single payer
initiative, was born for the benefit of the state and of a contemptuous
disregard for people's welfare.