MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VII, No 21, Feb 10, 2009
In This Issue:
1. Featured Article: The Father Factor
2. In the News: The Best Health Care News of 2009
3. International News: Physicians make good Entrepreneurs?
4. Medicare: Entitlement Reform. Let's Start with Medicare
5. Medical Gluttony: Proactive Health
6. Medical Myths: Government is interested in the health of its citizens. Really?
7. Overheard in the Medical Staff Lounge: The Daschle Fiasco
8. Voices of Medicine: To Give Voice
9. The Bookshelf: Compulsory Health Insurance, the Continuing American Debate
10. Hippocrates & His Kin: Isn't $750 Million bigger than $750 Billion?
11. Related Organizations: Restoring Accountability in HealthCare, Government and Society
* * * * *
The Annual World Health Care Congress, 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 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. The third year it was 50 percent, indicating open forums such as these are critically important. The 4th Annual World Health Congress was held April 22-24, 2007, in Washington, D.C. That year many of the world leaders in healthcare concluded that top down reforming of health care, whether by government or insurance carrier, is not and will not work. We have to get the physicians out of the trenches because reform will require physician involvement. The 5th Annual World Health Care Congress was held April 21-23, 2008, in Washington, D.C. Physicians were present on almost all the platforms and panels. This year it was the industry leaders that gave the most innovated mechanisms to bring health care spending under control. The solution to our health care problems is emerging at this ambitious Congress. Plan to participate: The 6th Annual World Health Care Congress will be held April 14-16, 2009, in Washington, D.C. The 5th Annual World Health Care Congress – Europe 2009, will meet in Brussels, May 23-15, 2009. For more information, visit www.worldcongress.com. The future is occurring NOW.
To read our reports of the last Congress, please go to the archives at www.medicaltuesday.net/archives.asp and click on June 10, 2008 and July 15, 2008 Newsletters.
* * * * *
By Paul Raeburn, Scientific American Mind, February 2009
When my wife, Elizabeth, was pregnant, she had a routine ultrasound exam, and I was astonished by the images. The baby's ears, his tiny lips, the lenses of his eyes and even the feathery, fluttering valves in his heart were as crisp and clear as the muscles and tendons in a Leonardo da Vinci drawing. Months before he was born, we were already squabbling about whom he looked like. Mostly, though, we were relieved; everything seemed to be fine.
Elizabeth was 40, and we knew about all the things that can go wrong in the children of older mothers. We worried about Down syndrome, which is more common in the offspring of older women. Elizabeth had the tests to rule out Down syndrome and a few other genetic abnormalities. That was no guarantee the baby would be okay, but the results were reassuring to us.
The day after Henry was born, while we were still bleary-eyed
from a late-night cesarean delivery, we caught part of a report on the hospital
television about an increased risk of autism in the children of older fathers.
Until then, all we'd thought about was Elizabeth's age—not mine. We'd had no
idea that my age could be an important factor in our baby's health.
Read more . . .
When we got home, I looked up the study. Researchers had analyzed medical records in Israel, where all young men and most women must report to the draft board for mandatory medical, intelligence and psychiatric screening. They found that children born to fathers 40 or older had nearly a sixfold increase in the risk of autism as compared with kids whose fathers were younger than 30. Children of fathers older than 50—that includes me—had a ninefold risk of autism.
The researchers said that advanced paternal age, as they call it, has also been linked to an increased risk of birth defects, cleft lip and palate, water on the brain, dwarfism, miscarriage and "decreased intellectual capacity."
What was most frightening to me, as someone with mental illness in the family, is that older fatherhood was also associated with an increased risk of schizophrenia. The risk rises for fathers with each passing year. The child of a 40-year-old father has a 2 percent chance of having schizophrenia—double the risk of a child whose father is younger than 30. A 40-year-old man's risk of having a child with schizophrenia is the same as a 40-year-old woman's risk of having a child with Down syndrome.
We wouldn't know for two years or so whether Henry had autism. And because schizophrenia does not usually appear until the early 20s, we had decades to wait before we would know if Henry was affected.
Data collected by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention, show that in the U.S. the number of births to men aged 40 to 49 nearly tripled between 1980 and 2004, rising from 120,702 to 328,465. Much of that jump is the result of an increase in the overall population. But there has been a shift over the past generation toward more older fathers beyond what can be accounted for by the growth in population. Birth rates for men in their 40s (a number that takes population growth into account) have risen by up to 40 percent since 1980—whereas birth rates for men younger than 30 have fallen by as much as 21 percent.
The idea that a father's age could affect the health of his children was first hinted at a century ago by an unusually perceptive and industrious doctor in private practice in Stuttgart, Germany. Wilhelm Weinberg was a loner who devoted much of his time to caring for the poor, including delivering 3,500 babies during a 40-year career. He also managed to publish 160 scientific papers without the benefit of colleagues, students or grants. His papers, written in German, did not attract much attention initially; most geneticists spoke English. It was not until years later that some of Weinberg's papers were recognized as landmarks.
One of these was a 1912 study noting that a form of dwarfism called achondroplasia was more common among the last-born children in families than among the first-born. Weinberg didn't know why that was so, but he speculated that it might be related to the age of the parents, who were obviously older when their last children were born. Weinberg's prescient observation was confirmed decades later when research showed that he was half right: the risk of dwarfism rose with the father's age but not the mother's.
Since then, about 20 inherited ailments have been linked to paternal age, including progeria, the disorder of rapid aging, and Marfan syndrome, a disorder marked by very long arms, legs, fingers and toes, as well as life-threatening heart defects. More recent studies have linked fathers' age to prostate and other cancers in their children. And in September 2008 researchers linked older fathers to an increased risk of bipolar disorder in their children . . .
* * * * *
WASHINGTON — When Tom Daschle said he was quitting his lucrative consulting job to become President Obama's health secretary, an old Republican rival from the Senate, Trent Lott, teased him about giving up the good life. . .
For four years, ever since voters in South Dakota turned him out of office, Mr. Daschle has seemed to yearn for the power and prestige of his public life. He vowed not to become a lobbyist, telling friends that salesmanship was beneath him. He spent as many as two days a week working without pay at a liberal research institution on issues like health care and climate change. He had contemplated a run for president in 2008. . .
But Mr. Daschle was also eager for Washington's financial rewards. He had benefited from his wife's pay as an aviation lobbyist; they share a $2 million home in a fancy Washington neighborhood. But with three children from a previous marriage, he aspired to some wealth of his own "to leave his kids and grandkids," said Mr. Coelho, who made his own move to Wall Street.
Those competing ambitions
collided this week, as Mr. Daschle withdrew from consideration for the health
secretary's job amid an uproar over his failure to pay $128,000 in taxes for a
private car and driver provided by a prominent Democratic donor, coupled with
public shock that a man who left the Senate on a $158,000-a-year salary had
gone on to earn $5 million in the four years since leaving office.
Read more . . .
"He got caught in this backlash against high-level compensation," said former Senator Bob Kerrey, now president of New School University in New York. "I think he drew a pretty clear line around what he wanted to do to earn a living — he could have made a lot more money if he had registered as a lobbyist but he didn't want do it — and he carved out a lot of time for forms of public service for which there is no remuneration."
Others said Mr. Daschle's situation marks a loss for Washington and the end of a time when a former lawmaker could go halfway into private enterprise while keeping a hand in public service.
"Once you come out and you get into whatever you're going to do, whether it's a lawyer or a consultant or a lobbyist, you are representing clients who can then be used against you," said Mr. Lott, who has more openly embraced the lobbying life since retiring from the Senate. "In the minds of the people, it's a distinction without a difference. You can't be advising people on how to deal with Congress without, in effect, at least indirectly influencing Congress."
Almost as soon as he had lost to a Republican, John Thune, in 2004 in an election that dispirited Democrats, Mr. Daschle made clear that he would keep a hand in the issues that mattered to him most. He had spent 30 years on Capitol Hill, having been elected to Congress in 1978 after working as a Congressional aide and, before that, an Air Force Intelligence officer. . .
In an interview at the end of 2004, in his elegant chandeliered office on the second floor of the Capitol, with its fabulous view of the Washington monument and its Gilbert Stuart portrait of George Washington, Mr. Daschle addressed the question himself.
He said he intended to work on issues like the global AIDS crisis — he eventually joined hands with a man who had once worked to defeat him, the former Senate Republican leader, Bill Frist, to raise voter awareness of the issue — as well as health care, which had been a passion of his, and the needs of American Indians. But Mr. Daschle said then that he needed to "make a living" as well.
Another former Republican colleague, Bob Dole, recruited him to the law and lobbying firm of Alston & Bird. Mr. Daschle hung up his shingle there, in a spacious office opposite that of Mr. Dole. He displayed an enormous South Dakotan Indian headdress on the wall — his Senate office also had been filled with Native American art — and cast himself, in the words of one friend, as "a rainmaker" who could advise the firm's clients.
He gave paid speeches about public policy for big fees from companies and trade groups in health care and other industries, and he advised a select group of clients about how to navigate the Congressional spending committees, for example, or to build alliances with the agricultural interests he used to represent. . . .
Mr. Daschle also signed on to a less-traditional job as an adviser to an investment fund run by a media mogul and Democratic donor, Leo J. Hindery Jr., who lent the car and driver he kept in Washington to Mr. Daschle, a gift that would later set off the uproar over Mr. Daschle's nomination. In June 2008, Mr. Daschle's spokeswoman said, he became concerned that he might owe taxes on the car. Last month, he paid the taxes with interest.
Some of Mr. Daschle's friends say they marvel that Mr. Daschle did not smell trouble in his $1 million a year job with Mr. Hindery. A rich man from his years as a top cable executive, Mr. Hindery turned his attention first to a hobby racing cars and, later, becoming a Democratic Party insider — "a political groupie," in the words of one Daschle friend — who ran a long-shot campaign for Democratic Party chairman in 2004.
"His aphrodisiac is powerful politicians," one former Democratic Party official who knows both men said of Mr. Hindery. "He decided that politics was the way to be a rock star, and he saw Tom as a way to get there."
Mr. Daschle was also a popular figure at Georgetown University's Public Policy Institute, where he was a visiting professor and host of a lecture series called "Conversations with Daschle." (One of his special guests was a new senator from Illinois named Barack Obama.) . . .
Richard H. Rosenzweig, chief operating officer of the environmental asset management company Natsource, said he got to know Mr. Daschle in conversations about climate change at the Center for American Progress, a liberal research institution where Mr. Daschle spent time as an unpaid fellow, and co-authored a book about health reform. They were, Mr. Rosenzweig said, "two geeky policy guys talking."
Not long before Mr. Daschle was nominated as health secretary, Mr. Rosenzweig recalled, he met with the former senator as a client at his Alston & Bird office. Natsource was seeking advice about working with agricultural interests — close to Mr. Daschle when he was in the Senate — about potential legislation that could reward farmers for crops that reduced greenhouse gases. "We were talking about, ‘How do we engage them? What were the opportunities?' " Mr. Rosenzweig said.
In February 2007, Mr. Daschle took a step that put him back on the path to public service — he endorsed Mr. Obama for president. It was a difficult decision; many of his former Senate colleagues were still in the race for the Democratic nomination, but friends say Mr. Daschle saw in Mr. Obama a kindred spirit.
* * * * *
[If physicians were allowed to become entrepreneurs, would the health care problems be solved?]
Back in June 2008, we published this manifesto to coincide with the launch of the Entrepreneur Country Forums. The world as we know it has changed enormously since then. Is the manifesto still relevant in the current market conditions? Is it perhaps more relevant?
1. That Leaders are those people who create trust in society and their businesses, and that trust is efficient. Success is forged through competition and human greatness is possible precisely because people are not the same and they have the option to choose whether they want to lead or follow.
2. That the Entrepreneur creates intellectual and financial wealth through which the entire society benefits and progresses, and so Entrepreneurs and their teams should be richly rewarded for taking the risks that they do (and which the rest of society chooses not to but from which it still benefits).
3. That the bigger the State grows, the weaker the people become - big government creates dependency.
4. Successful entrepreneurs of hyper growth companies are a subset of entrepreneurs who are a subsector of a strong citizenry who take full accountability for their lives and understand not only their rights but their total responsibilities.
5. That no real,
sustainable wealth creation through entrepreneurship ever owed its success to
Read more . . .
6. That successful entrepreneurs cite common factors that shape their unique drive, self-belief and desire to create and contribute at every stage in life - education, travel, opportunities to test what they can do as individuals, learning how to sell early in life, strong teachers, business role models, parents and mentors who honestly encouraged them to be everything they could be.
7. That it is still counter-cultural to be an entrepreneur in the UK and Europe but it is no longer a niche activity or aspiration; the emergence of serial entrepreneurs and the impact of their wealth and experience is felt in their backing of the next generation of entrepreneurs.
8. That early stage venture capital now has two distinct areas - early early stage venture capital, and late early stage venture capital. The only people who do and can do the former exquisitely well are entrepreneurs backing other entrepreneurs.
9. That world leading firms can just as easily come out of the UK and Europe as well as anywhere else in the world. Historically, UK and European entrepreneurs haven't played on the global stage; not because they are inferior, but because they come from a culture that encourages them not to expect success. This is changing and must change further still.
10. That the financing of entrepreneurship has not kept pace with the high quality and achievements of entrepreneurs in the UK and Europe.
11. That the triple play of the internet, entrepreneurship, and individual capitalism is an unstoppable force around the world, and that Individual Capitalism is the force that will shape the 21st Century.
12. That Talent flocks to great opportunities, and as those companies grow, leaders should have the flexibility to make the right decisions about talent in the firm - not everyone can or needs to make it from start to finish in a start-up, not even the founders.
13. That great people have great ideas and build great teams, and that capital always backs great people with great ideas who build great teams - always has, and always will.
14. That each one of us has a unique contribution to make to the world. It is our responsibility to determine what that is, and to make it.
15. That we are a small group today in Entrepreneur Country who understand and believe these statements, and that these will dictate the future success of the UK and Europe.
Julie Meyer, CEO Ariadne
17 June 2008 London
If these statements resonate with you, then you're probably one of us already.
Please email your endorsement of the manifesto to firstname.lastname@example.org.
American and Canadian Medicare have destroyed medical entrepreneurship and reduced physicians to being the hands of the bureaucrat and lowering the quality of medicine.
* * * * *
The lead article in The Economist last week was that Mr. Obama has repeatedly warned Americans that he will have to do unpleasant things. The Economist feels he needs a plan to shrink government over the long term. Without reform of expensive entitlements, the federal government faces bankruptcy.
The unfunded entitlement liability is an elusive number. By adding up the promised benefits of Social Security, Medicare, Medicare Drug Plan, Medicaid and the SCHIPS program, the liabilities add up to $99 trillion, give or take $10 trillion. The numbers are so large, it exceeds the gross domestic product and thus are fictional in many people's mind.
Medicare reform: Medicare was
designed so that patients would pay 20 percent out of their own pocket on
outpatient care and Medicare would pay the 80 percent. The 20 percent
co-payment was to make sure that each beneficiary would look over the charges
and cost and manage his or her own health care expenses - much as we would look
over any other expense or bill we receive to keep our costs at the lowest
possible dollars. This 20 percent co-payment should be reinstated, and if
Medicare contracts with private insurance companies to handle Medicare through
an HMO, the patient should still be required to pay 20 percent. This is the
single biggest disincentive to overuse. This would essentially eliminate the
whole army of nurses and reviewers who look over our claims to make sure it was
for necessary care. No one would obtain unnecessary care if he or she had to
pay 20 percent up front. This would eliminate essentially most of the 80
percent of ER visits that are considered not emergencies. Patients would not
tolerate a $9,000 ER charge if they had to pay 20 percent up front. Hospitals
would not charge $9,000 for a cardiac workup in the ER unless there was a valid
reason for such extensive testing because their emergency rooms would remain
empty and all patients would only go to the ER that had reasonable charges.
Read more . . .
The patients would not make unnecessary Doctor Visits if they had to pay 20 percent of the fees. Paying $25 on a $125 office call would make sure that all office calls were medically necessary. There would not have to be an army of nurses or reviewers checking over every claim to see if it was medically necessary.
The patients would not request unnecessary laboratory tests and x-rays if they had to pay 20 percent of every $325 laboratory panel, $175 x-ray or $800 CT scan. Excess utilization would stop in its track at the check in counter. There would not have to be an army of nurses or reviewers to check on the medical necessity of every test and x-ray since every patient would do this before obtaining the tests. Actuaries have estimated this would eliminate approximately 30 percent of Medicare costs.
Medicare Part D Drug Plans should be merged with Medicare B outpatient medical care since it covers similar items in health care. In other words, patients would pay 20 percent of all prescriptions or pharmaceutical items. The patients would police their own utilization since they have a stake in all medical decision-making and thus would not utilize more than they needed. They would automatically request generic drugs since their 20 percent share of a proprietary drug costing $150 a month would be $30 per month and their 20 percent share of a generic drug at $15 a month would be $3. Congress and Medicare would not have to limit drugs to generics since they would automatically be selected and costs would be transparent. If a patient demands proprietary drugs, he or she would pay more; but these numbers will be insignificant compared to the costs of policing utilization or the physician's time, which may be equal to an office visit for writing a justification with no remuneration for the time spent. If Medicare contracts with a private carrier to manage this, the patient should always be required to pay the 20 percent - the most effective cost deterrent that could possibly be devised.
Medicare Allowable: One concern about a percentage co-payment has always been a percentage of "what." Medicare has had experience with fair and reasonable charges. This should be defined at that charge that 90 percentile of providers use. This would eliminate the 10 percent that may be exorbitant. Thus, if the average charge for a gallbladder operation is $1500, and a surgeon charged $5,000, the patients would immediately be informed. They could then decide whether to proceed with that surgeon knowing that Medicare would pay 80 percent of the reasonable or 90 percentile charge - 80 percent of $1500 or $1200. That patient would not only have to pay the 20 percent or $300 but also the $3500 in excess. Thus, unreasonable charges would not impact the Medicare program and patients would not utilize those doctors. The $5000 surgeons would either lower their fees if they want the Medicare business or make their income on wealthy non-Medicare patients.
Yearly Deductible: Basic annual care is not an insurable item just as car or home maintenance is not an insurable item. There should be a yearly deductible equivalent to what the average Medicare age group would pay for annual basic care. Thus, the annual physical exam by the physician, which includes rectal, pelvic pap's smear, hematest screen, one follow-up office examination, the required basic laboratory screening such as mammogram, and possibly an x-ray or electrocardiogram, may add up $750 for this age group. Medicare should kick in only after the patient paid the $750. Thus, Medicare would truly become an insurance plan for the elderly and not a welfare program. If that's what is desired for the indigent Medicare patient, they should look to Medicaid coverage which includes the 15 percent indigent or poor.
Hospital Deductible: The current hospital deductible is a fixed amount approaching $1000 annually. The patient once admitted is no longer liable for any extended stay and is not motivated to leave any sooner than absolutely necessary and perhaps will stay a few days longer. This has caused a rather strong arm of Medicare to push patients out of the hospital in a timely, but rather harsh fashion. This is an expensive effort by nurses and other reviewers policing each admission. The hospital deductible should be replaced with a 5 percent co-payment. This entire police force would no longer be required since each patient is fully motivated to leave as soon as he or she can physically be cared for by his or her family.
Medicare Eligibility: When Medicare was founded in 1965, the average life expectancy was about 65. Life expectancy has increased more than ten years. The eligible age should be indexed to life expectancy and immediately ride with Social Security, which begins at age 67 and is slowly being indexed to life expectancy to make it fiscally sound.
The above simple changes would return us to the original design of Medicare and include some simple but major improvements that would salvage the Medicare program for ours and the next generation.
Government is not the solution to our problems, government is the problem.
-- Ronald Reagan
* * * * *
A middle-aged woman who was well dressed and had recently remarried came in as a new patient. She was bright, cheerful, and stated that she wanted to be proactive in health. After a thorough medical interview, she was indeed very healthy. There were no genetic diseases, such as diabetes or cancer of the colon, on the horizon from a detailed Family Medical History. She had no major illness or surgeries. She had no risky habits such as smoking, drinking, overeating, drug use or other promiscuous behaviors. She was on no medications and her physical exam was normal
As I was sitting down with her to
outline an appropriate laboratory evaluation, she interrupted me that she
wanted to be proactive with her health and handed me a list outlining more than
thirty tests, x-rays, CT and MRI scans, Dexascans, whole body scans, ECG,
Echocardiogram, ultrasounds, and the list went on.
Read more . . .
When I asked for the medical reason for each test as she went down the list, I pointed out that each test had to be justified. She responded that was not true. She had insurance and these would not cost her or me anything.
She then responded that she wanted to see a number of specialists to make sure nothing was overlooked. As she went down that list, I found very little symptoms in each organ system she wanted further evaluated. Concerning an orthopedic consult, she said she had a backache a couple of times the past year. I pointed out that the orthopedic examination of her back revealed full range of motion. She was able to flex her spine 90 degrees, extended 40 degrees, lateral flex 40 degrees and rotate 90 degrees bilaterally and there was no paraspinal muscle tenderness or spasm to suggest any disk disease. She became very irritated. She even accused me of working for the insurance company.
After a while, she settled down and we wrote several lab and x-ray requisitions and one consult to ophthalmology that I could justify. She still was not entirely happy. I figured I would never see her again.
I was rather surprised when she returned a month later to go over the tests and chest x-ray. She was rather pleasant and seemed appreciative. After explaining all the normal tests, chest x-ray, and ECG, I was curious as to what happened.
She replied that over the preceding month, she had complained to several of her friends who were aghast that she had a full hour with her doctor for an initial visit and the number of tests that were obtained. Her friends felt they didn't get a complete exam or any significant evaluation in their 20-minute first appointment. She then stated she would like to return to this office should she have any further medical problems and asked when I thought any laboratory tests should be repeated. I told her that medical guidelines with normal levels could not justify yearly tests and every five-year screenings should be appropriate. She didn't seem upset with this either.
I then felt I should inform her that her lists of tests would have cost about $15,000 or more and what we did was about $1500. If doctors didn't modify patient behaviors, insurance premiums would have to double and triple. She said she could understand the reason now. She even thanked me for the extra time spent in providing this information.
It's unfortunate that insurance companies, Medicare, and government agencies don't understand the cost concerns and integrity of physicians in keeping health care reasonable. But insurance companies, Medicare, and Government see it from the opposite perspective. They desire that appointments be as short as possible so doctors see more patients per hour so they can pay us even less per patient. They do not understand the point of diminishing returns may have been met.
Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on Every Service.
* * * * *
of government social insurance, German Chancellor Otto von Bismarck, observed how Napoleon III used state
pensions to buy support for his regime when he was Ambassador to Paris in 1861.
"I have lived in France long enough to know that the faithfulness of most
of the French to their government ... is largely connected with the fact that
most of the French receive a state pension."
Read more . . .
According to Brink Lindsey's article in the journal Reason, the appeal of social insurance for Bismarck was that it bred dependence on, and consequently allegiance to, the state. Thus, Social insurance, whether social security, Medicare, or single-payer medicine, was born with a contemptuous disregard for liberal principles.
What mattered was not the well-being of the patient or workers, but the well-being of the state.
Medical Myths originate when someone else, like Government, pays the medical bills.
Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.
* * * * *
Dr. Paul: Aren't you excited about the new President? Isn't he doing marvelous things?
Dr. Yancy: Whoa! Wait a minute.
Dr. Paul: He'll probably get us universal health care, don't you think?
Dr. Yancy: You pediatricians are all socialists. It hasn't worked in Europe, UK or Canada and it won't work here.
Dr. Paul: But it is working in Europe, UK, or Canada. Everyone has access.
Dr. Dave: If you add up all
the folks that are on the waiting lists in each of those countries, the
percentages add up to more than the 15 percent we have.
Read more . . .
Dr. Michelle: But they are on the list and will get their care in due time.
Dr. Dave: If they don't croak in the meantime. And the 15 percent in America, which everybody groans about, can get care in any emergency room at any time. That's 100 percent access.
Dr. Paul: It's not nearly like you folks make it out to be. I know some friends in Canada that were admitted in a couple of days after they go sick.
Dr. Dave: Did any of them have a ruptured appendix or a hot gallbladder?
Dr. Paul: I didn't ask.
Dr. Rosen: Even in this country, where HMOs are rather like socialized medicine, I had a patient that had a hot appendix and it took me two days to get it authorized. Bureaucratic medicine is the same the world over.
Dr. Michelle: Well, did you patient get operated on in time?
Dr. Rosen: Since I knew it would take days, I put him on antimicrobials, which seemed to keep his abdomen under control.
Dr. Yancy: No patient of mine will ever wait an extra day or two with a hot gallbladder or ruptured appendix. I get them to the operating room within hours.
Dr. Rosen: The rest of the world can't even imagine such efficiency.
Dr. Edwards: We have the highest level of care of anywhere in the world and we have anti-Americans in our own country talking about improving quality all the time.
Dr. Rosen: Bureaucrats can't comprehend that quality is a Doctor's Middle Name. They should get sick overseas.
Dr. Sam: Aren't we lucky that Daschle is out of the picture now?
Dr. Dave: That was a lucky break for the patients in America. He wrote a book on health care and doesn't even comprehend the issues.
Dr. Sam: Does any politician?
Dr. Rosen: I haven't found one yet.
Dr. Milton: The New York Times story really tells us what Daschle was really like. He made $5 million in the four years since he was fired from the Senate by South Dakota. And he told people he had to start thinking about his family and start "making a living."
Dr. Rosen: We can't begin to comprehend the graft in Washington DC.
Dr. Milton: His friends also told him he could double his income by becoming a lobbyist.
Dr. Sam: Can you believe you can double $5 million bribing Congress and it isn't even considered a crime?
Dr. Rosen: But that's what lawmakers do. They legalize crime. They even think they are above the Law of Moses.
Dr. Yancy: I think the Daschle fiasco is only the first fiasco the kid in the big White House is going to make in the next four years.
Dr. Rosen: It took our country 25 years to recover from the 1929 crash. Even after Roosevelt pumped all that money into the system, his own treasurer told him it wasn't working. The stock market didn't recover to the 1929 level until 1954, nine years after Roosevelt died. Do you think the kid in the big White House can beat that with huge entitlements he can't touch that Roosevelt didn't have and he helped create to our detriment today?
Dr. Sam: If you think the 2009 crash is bad, just wait for 2010, 2011, 2012 . . . Let's see. Twenty-five years will be 2034. Will it be Medicare or Social Security that will be sacrificed?
The Staff Lounge Is Where Unfiltered Opinions Are Heard.
* * * * *
2008 CSA Annual Meeting – To Give Voice
Address of CSA President-Elect Michael W. Champeau, M.D.
Thank you, Madame Speaker, and good afternoon. I thought I would dispense with the usual formal salutations today and simply address you all as "friends." . . .
My purpose here today, as
your next president, is to share with you my vision of the CSA's mission and
our collective goals for the upcoming year. During the course of my year as
president-elect, as part of my preparation for assuming the presidency, I attended
a variety of conferences regarding the governance of non-profit associations
and professional societies in general. I must admit that I was somewhat
surprised to learn that there are literally thousands of societies and
associations in this country, ranging from the well-known, such as the American
Cancer Society and the National Rifle Association, to the more obscure, such as
the National Chain Link Fence Manufacturers Association. The core purpose of
all these associations, summed up in three words, is "to give
voice" - to give voice to those who individually are too small, or too
insignificant, to have their voice heard. The individual anesthesiologist, just
like the individual chain link fence manufacturer, simply does not have the
resources to make his or her voice heard in the public arena on matters of
interest to the profession, or to society as a whole. But, by banding together
into societies and associations, by speaking with a united and, sometimes,
louder voice, individuals with common interests have a far better chance of
having their message heard. Each association, regardless of its size, or the
activity with which it is associated, exists to give voice to its members.
Read more . . .
As anesthesiologists, we have the good and great fortune to practice the noblest of professions, for what higher calling could possibly exist than the alleviation of human suffering? We do this so commonly, so routinely, that we do it almost without thought of the miracle it entails. Yet, despite this noble calling, we are locked in a perpetual struggle against those who seek, for their own economic gain, to define our role and our value. Governmental agencies, insurers, hospital administrators, and others hoping to profit from our skill and our compassion all seek to define our role and worth. Without organized anesthesiology, the individual anesthesiologist has no voice in the struggles with these powerful adversaries. But, by banding together, we can have a voice. What happens, though, if we don't agree on what needs to be said? No single issue will be of importance to all anesthesiologists, and many physicians cite this fact as their justification for remaining outside the world of organized medicine. Respect for, and support of, one another's issues is the very essence of speaking with a united voice. We must always resist the temptation to believe that just because the issue of the moment is of minimal significance to us personally that it is unimportant to the profession.
As anesthesiologists, we understand the importance of resisting those who seek to define us to their own advantage. But, unfortunately, the CSA's resources are not infinite. We simply do not have the money, or in some cases even the legal right, to take on billion-dollar insurance companies head-to-head, nor can we conduct multi-million dollar public relations campaigns. But, by pooling our funds with other physician societies, by leveraging our influence, by picking our fights carefully, we can fight the good fight, and we can continue the struggle against those who seek to profit from our noble profession. By partnering with the California Medical Association, and by leveraging our resources through the judgment, skill and influence of our legislative and legal advocates, we will fight these adversaries in Sacramento and, when necessary, in the courts. But, most importantly, and most cost-effectively, we must fight them, day in and day out, in the hearts and minds of our patients, whose suffering we have ameliorated. . .
Were we simply a trade association, our mission would go no further than economic advocacy. We, however, practice a noble profession, so our mission must also be noble. We need to continue to use this voice that we have created to protect our patients and advance their safety. We need to continue to offer high-quality continuing education to both our members and other physicians, so that they may answer the calling of our profession with knowledge and skill.
We need to use our "bully pulpit" to defend the honor and the integrity of the profession, never allowing it to be debased by others, or by ourselves. These, then, are the missions of our society with respect to the outside world. But we also have an internal mission. Those of us here today are heirs to the honored traditions of our Society. Our predecessors have left us with a legacy of integrity and accomplishment. We need to honor that tradition, not by encasing in amber, but rather by adapting the practices and the governance of the society, within that tradition of integrity and accomplishment, to the needs of the current generation of California anesthesiologists. We cannot merely pass the society on to the next generation in the same condition in which it was passed to us. It is our obligation to improve it.
I believe we must strive to provide real value to our members. For too many years, we have relied upon our members' altruistic motivations for joining our society. Most of our members join simply because they think it is the right thing to do. While we certainly do not want to disabuse them of their altruistic notions, we cannot continue to rely purely upon the practice of good citizenship to retain and grow our membership. We need to provide tangible reasons for anesthesiologists to want to be a part of organized anesthesiology. We need to make the CSA the place to which members turn for reliable advice and assistance when the going gets tough. We need to continue to offer both free, relevant CME via our Bulletin and our Web site, and significant discounts to our members at our traditional CME courses. We need to engage our members in the ways they prefer to be engaged, rather than in the way our leadership prefers to engage them. We must change with the times to remain relevant to Generation X and Millennial members who, in their perceived interest in lifework balance, may well view professional society membership quite differently than do our aging Baby Boomer leaders.
We need to take a hard look at many of our time-honored traditions to see if they still pass muster in the Information Age. During the past year, I chaired a task force on leadership development in an attempt to change the way the society goes about identifying and mentoring future leaders. I submitted a resolution to this House of Delegates, in effect asking the delegates themselves to examine the institution to see what could be done to make it more relevant to the society and its members. During the upcoming year, I believe we should take a similar look at our Board of Directors' meetings and at our quarterly Bulletin. In deliberating these issues, we want to employ knowledge-based decision making, which means we need to find out what our members want.
All of us in this room have been touched by a variety of mentors, a handful of whom have made significant impressions upon our lives. One of my mentors, Frank Sarnquist, was among many other things a former member of this House. A few years ago, during an unplanned hiatus between chairmen in the Department of Anesthesia at Stanford, Frank was asked by the Dean to assume the role of acting chair, a role that he filled with distinction for over two years. During that stint, Frank once told me that there were, in his view, two types of leaders: visionaries, and the guys who make the trains run on time. Although without peer in his integrity and in his pursuit of all the adventure that life had to offer, Frank considered himself the latter. I believe that I, too, fall into that category.
So, as we move to improve our society, I ask you to bear in mind that, like the former President Bush, I make no claims to doing "the vision thing." I am asking for your help, your ideas, your engagement and your open minds as we re-examine the workings of the CSA. Let's pull together to make the Society we pass on to the next generation even better than that which we have inherited. . .
To read the entire address, go to www.csahq.org/pdf/bulletin/ann_mtg_57_3.pdf.
VOM Is Where Doctors' Thinking is Crystallized into Writing.
* * * * *
This volume, which appears to be a continuation of
Numbers' prior volume, is also the 11th in a series titled
"Contributions in Medical History," with John Burnham as the series
editor. Numbers gives an historical overview in his preface on compulsory
health insurance beginning with Germany in 1883, spreading to Austria in 1888,
Hungary in 1891, Luxembourg in 1901, Norway in 1909, Serbia in 1910, Great
Britain in 1911, Russia in 1912, Romania also in 1912, and the Netherlands in
1913. In this country, Dr. Rupert Blue, president of the AMA, announced that
compulsory health insurance would "constitute the next great step in
Read more . . .
This volume is a series of essays that explores the historical context for understanding the 60-year-old debate over compulsory health insurance in America. The details in chapter three are typical: Proponents of compulsory health insurance judge the British experiment to be a great success, while opponents, viewing the same evidence, declared it to be a dismal failure. The same pattern of interpretation has been repeated in recent years with our neighbor Canada. The eighth and final chapter is by Wilbur Cohen who has devoted five decades of his life to the field of social legislation. He concluded that after we came out of the problems of the 1980s, the issue of national health insurance would reappear. We haven't. The issue has.
This book review is found at www.delmeyer.net/bkrev_CompulsoryHealthInsurance.htm.
To read more book reviews, go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
To read book reviews topically, go to www.healthcarecom.net/bookrevs.htm.
* * * * *
A Medicaid patient was complaining about the $750 million bailout of the banks and how that would impact her and her family's future. She felt the government should be paying her more than all those rich folks and rich corporations and rich banks. I told her I believe it's more like $750 billion that's being talked about. She asked, "Isn't a million bigger than a billion?"
People on entitlements don't understand money and the amounts are beyond comprehension.
Insurance at the time our country was formed was based on risk.
Ben Franklin had his privately
owned Union Fire Company, which later led to the Philadelphia Insurance of
Houses from Loss by Fire. This company did not believe in Community Rating. It
charged wooden houses triple the premium as brick houses and denied coverage
for houses with trees in front of them. It was under the control of every
homeowner whether to build a wooden or brick house and whether to plant trees
in front of them and so the premium was predicted by the risk the owner
Read more . . .
Obviously, this is the only way any insurance works whether houses, cars or health. We can control our personal risk factors such as overeating, smoking cigarettes, drinking alcohol or unsafe sex. These are the items on which insurance premiums should be doubled or tripled, not a family history of diabetes, heart disease and cancer, items over which we have no control except by not indulging in the aforementioned risk factors.
Health insurance would be affordable if premiums were allocated on the basis of personal risks.
BBC News (2/3, Burnell) reported, "Eighteen months ago the Medicines Health products Regulatory Agency (MHRA) issued four of its Class One emergency recall notices in a matter of days to recoup thousands of packs of" Casodex (bicalutamide), Plavix (clopidogrel bisulfate), and Zyprexa (Olanzapine). The agency "had seized 40,000 of the estimated 70,000 packs of the fake drugs in the supply chain but issued the recalls because the other drugs were not accounted for," according to Mick Deats, MHRA's head of enforcement. "By the time the counterfeits were spotted, they were already in the [National Health Service (NHS)] supply chain, distributed to chemists, doctors, and hospitals and dispensed to patients." Deats added that "you can never tell if you have got it all. And don't forget we're not dealing with lawful manufacturers who know how much their batch contains."
Government health care doesn't seem to have any difficulty hiding lethal mistakes for 18 months.
Government health care to America temporarily interrupted.
This Date 4 Years Ago:
"Republicans spending $42 million on inauguration while troops Die in unarmored Humvees"
"Bush extravagance exceeds any reason during tough economic times"
"Fat cats get their $42 million inauguration party, Ordinary Americans get the shaft"
"Historic Obama Inauguration will cost only $120 million"
"Obama Spends $120 million on inauguration; America Needs A Big Party"
"Everyman Obama shows America how to celebrate"
"Citibank executives contribute $8 million to Obama Inauguration" -Mike Antonovich
Wonder who controls the media?
* * * * *
• 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 article The fastest way to kill a newspaper is to make it dependent on the politicians it is supposed to cover, say observers . . .
• 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: SCHIP, Medicaid expansion brings physicians to the trough. . .
• 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 articles on Government Reform . . .
To read the rest of this column, please go to www.medicaltuesday.net/org.asp .
• 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 'Stimulus' Bill May Change Health Care Forever . . .
• 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 the current issue of Consumer Power Report . . .
• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling, PhD, 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 in which Frédéric Bastiat Explains the Hidden Cost of Stimulus Spending . . .
• 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 Government health insurance not worth paper it is printed on.
• 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, Martin Masse on SPENDING CUTS ARE THE KEY TO RECOVERY.
• 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. Access their Research and Publication Section . . .
• The Heritage Foundation, founded in 1973, was a research and educational institute whose mission was 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. -- 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 consider them as a freedom loving institution.
• 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. This month, focus on The Insolvency of the Fed. . . 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. This month, read his comments on the SCHIPS program . . .
• 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 USNews 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 Do Conservatives Need to Get Beyond Reagan? The last ten years of Imprimis are archived.
* * * * *
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Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Words of Wisdom
I don't think we can outsource to government the problem or joy of helping our fellow man. -Julie Meyer, CEO, Ariadne.
"There is no trick to being a humorist when you have the whole government working for you." -Will Rogers
The bigger the State grows, the weaker the people become - big government creates dependency. -Julie Meyer, CEO, Ariadne
"I don't make jokes. I just watch the government and report the facts." -Will Rogers
Some Recent Postings
Why Sister Aloysius "Doubts" By James J. Murtagh, MD www.healthcarecom.net/JM_Doubts.htm
"The Shield": Crime and Punishment, By James J. Murtagh, MD www.delmeyer.net/JM_TheShield.htm
HOW DOCTORS THINK by Jerome Groopman, MD www.delmeyer.net/bkrev_HowDoctorsThink.htm
A Time for Freedom, by Lynne Cheney: www.delmeyer.net/bkrev_ATimeForFreedom.htm
We The People - The Story of Our Constitution, by Lynne Cheney www.delmeyer.net/bkrev_WeThePeople.htm
Sir John Mortimer, barrister and freedom-fighter, died on January 16th, aged 85
From The Economist print edition, Jan 29th 2009
EVERY true-born Englishman knows that the law is an ass. Rules are better honoured in the breach than the observance. Judges are best represented in a chorus line at the D'Oyly Carte. The English constitution is a vague formulation in someone's head, and that foundation of English liberties, Magna Carta, is best known for banning eel-traps in the Thames. The firm clip of the law is for the other fellow. Behind the furled umbrellas and decorum, Englishmen are anarchists. Or, as John Mortimer liked to think of them, votaries of "my darling" Prince Kropotkin.
Mr Mortimer's great service to his country was to sum up in one person both the weight of the law and a sharp, rollicking scepticism of it. He was an eminent lawyer, entering chambers in 1948 and becoming, in time, a Queen's Counsel and a master of the bar. Few excelled him in cross-examination (the art of which, he liked to say, was "not to examine crossly"). Yet the law was only his day job, giving him the money and the material to write novels. At the bar he dressed scruffily, lest anyone take him for a conventional lawyer. He made fun of the "old sweethearts" on the bench, who would pass a death sentence and then go out for buttered muffins. And as for the law itself, "the great stone column of authority which has been dragged by an adulterous, careless, negligent and half-criminal humanity down the ages",
[it] is a subject which, I may say, never interested me greatly. People in trouble, yes. Bloodstains and handwriting, certainly…Winning over a jury, fascinating. But law! The only honourable way to pass a law exam is to make a few notes on the cuff and take a quick shufti at them during the occasional visit to the bog. . .
On This Date in History - February 10
On this date in 1942, the Normandie capsized at pier in New York.
On this date in 1933, the first singing telegram was sent.
On this date in 1936, the secret police, who observe no law but their own, was given a free hand in Germany. The Gestapo has ever since been synonymous with evil and repression.
After Leonard and Thelma Spinrad
MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE's SiCKO
Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks
funding for a movie exposing the truth about socialized medicine. Clements is
the former publisher of "American Venture" magazine who made news in
2005 for a property rights project against eminent domain called the "Lost
For more information visit www.sickandsickermovie.com or email email@example.com.