MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VII, No 22, Feb 24, 2009
In This Issue:
1. Featured Article: The Real Driving Force behind Health Care Reform
2. In the News: Bailout tops $8 trillion
3. International Medicine: Important Lessons From Canada
4. Medicare: What Medicaid Tells Us About Government Health Care
5. Medical Gluttony: What habit patterns predict excessive health care costs?
6. Medical Myths: Evidence Based Medicine should be easy to Implement
7. Overheard in the Medical Staff Lounge: Evidence Based Medicine
8. Voices of Medicine: A Disingenuous Debate on Health Care Policy
9. The Bookshelf: Why Government Doesn't Work
10. Hippocrates & His Kin: Government lobbying Government
11. Related Organizations: Restoring Accountability in Medical Practice and Society
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Invitation to the National Whistleblower Assembly
"Ending the Dark Ages: Turning on the Lights Together"
International Association of Whistleblowers
National Employment Lawyers Association
National Whistleblowers Center
Project On Government Oversight
University of the District of Columbia David A. Clarke School of Law
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Why the Push for Health Care Reform? By David J. Gibson, MD and Jennifer Shaw Gibson
Reforming the health care system has been a hot button policy issue, at least among Democrats, throughout the election campaign and now as they assume control of policy making within Washington. All sorts of alarmist warnings are coming forward in the public arena. The systems cost is unsustainable (true). Egalitarian health care delivery is a constitutional right (false). Democrats care more about the children than do Republicans (false).
Given the dismal performance of the government in financing and delivering health care services under various entitlement programs in the past, why is the government at both the federal and the state level so determined to expand their footprint within the private health care system?
It is important to understand that none of the '"save the children hype'" is the real driving force behind the health reform initiative. The real driver is saving the Medicaid program. From the inception of both Medicare and Medicare, those knowledgeable as to the economic fundamentals of health care funding have recognized that these two programs were designed by politicians, not actuaries. You can never create a viable insurance funding mechanism where the beneficiaries are elderly, disabled or terminally ill. Insurance based funding requires the vast majority, ninety-five percent or more, of the beneficiaries to be healthy and not using the health care system.
The most acute entitlement program problem is Medicaid. This program is destroying state budgets throughout the United States. The modern health care reform movement can be traced back to the beginning of the Clinton Administration. Remember, Bill Clinton was the Governor of a state prior to ascending to the presidency. At that time, he was also serving as the Chairman of the National Governors Association. Each of the association governors' state budgets were collapsing under the rising cost of Medicaid.
Upon taking office, President Clinton's top priority was to address the economic consequences of Medicaid on state budgets. The whole purpose behind Hillary's health initiative was to address the evolving catastrophe consuming Medicaid.
Since the demise of Hillary's initiative in 1992, every incremental approach to health care reform (increasing income baseline for eligibility, SCHIP funding expansion, increasing SCHIP age for eligibility to age 35, including undocumented children, reducing the age for Medicare eligibility to age 55 and ultimately combining all federal health care entitlement programs under Medicaid) has focused upon increasing the risk pool and thereby relieving the funding burden that the Medicaid program places on the states. All of these initiatives recognize that the only way to save the program is to greatly expand the risk pool within the program thereby allowing transfer of funding from the well to the existing high cost beneficiaries. . .
Improving the stability of the Medicaid program requires three initiatives. The first, discussed above, involves reducing the percent of morbidity of the beneficiary pool by greatly expanding the number of young and healthy adult beneficiaries. The stimulus legislation provides for SCHIP coverage to age 35 and 300-percent of poverty income levels. The second initiative involves reducing the cost per unit of service by imposing Medicaid reimbursement schedules on the expanded program. The final initiative involves limiting the units of service delivered.
The details concerning this last initiative, controlling the number of units of service, are now beginning to manifest themselves. The first indication was presented in former Secretary designate for the Health and Human Services Department, Tom Daschle's recently published book, '"Critical: What we can do about the health-care crisis'". According to Daschle, doctors have to give up autonomy and '"learn to operate less like solo practitioners.'" In his book, Daschle argues for the creation of a Federal Health Board, modeled on the Federal Reserve Board, which could make key decisions relating to therapeutic efficacy, treatment protocols and standards for care.
This new appointed Board will have the power to make the '"tough'" decisions elected politicians won't make. This Board's mission will be to reduce costs and '"guide'" a doctor's decisions thru the establishment of guidelines for care that are both appropriate and cost effective. The goal, Daschle's book explained, is to slow the development and use of new medications and technologies because they are driving up costs. He praises Europeans for being more willing to accept '"hopeless diagnoses'" and '"forgo experimental treatments,'" and he chastises Americans for expecting too much from the health-care system.
Daschle says health-care reform '"will not be pain free.'" Seniors should be more accepting of the conditions that come with age instead of demanding treatment for them. That means the elderly will bear the brunt. Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost-effectiveness standard set by the new Board.
When installed, this new Board will be modeled after a U.K. board which Daschle discusses in his book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.
In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision. Read more . . .
We are discovering anew that elections have profound consequences. This new Administration and their acolytes in Congress are demonstrating that they are more ideological than competent. This bunch needs much more scrutiny as we move forward.
Jennifer Gibson traded energy commodity futures on the Chicago Mercantile Exchange. She is also an economist who trained at the London School of Economics and now specializes in evolving health care markets. David Gibson is the C.E.O. of Reflective Medical Information Systems, a software development and consulting firm.
This OpEd is posted at http://healthplanusa.net/DGWhyPushHCReform.htm.
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Even before Obama's team gets started, the bailout package tops $8.7 trillion in taxpayer commitments for loans, guarantees, and other goodies for businesses and distressed homeowners.
· More than $1.5 trillion in Federal Deposit Insurance Corp. loan guarantees, including a $139 billion assist to the lending arm of General Electric Corp.;
· $1.8 trillion in cash, tax breaks, and loan guarantees doled out from Treasury to taxpayers, financial institutions, and credit companies;
· $300 billion for homeowners from the Federal Housing Authority;
· $25 billion to auto companies from a program overseen by the Energy Department, which is separate from the bailout proposal that failed in the Senate; and
· $5 trillion in new money, loan guarantees, and loosened lending requirements from the Federal Reserve Bank.
Asked how much taxpayers are on the hook for, Bianco Research President James Bianco said: '"I just say you should use the word infinity, because nobody understands these numbers, and I would include the Treasury secretary and the chairman of the Fed.'"
If you total in today's dollars the cost of the New Deal ($500 billion), the Marshall Plan ($115.3 billion), and the Louisiana Purchase ($217 billion), and then add the race to the moon, the savings and loan crisis, the Korean War, the Iraq war, the Vietnam War, and assistance to NASA, you only get $3.92 trillion - not even half the taxpayers' exposure today, Bianco states (Jeanne Cummings, Politico 12/16/08).
Nine rate cuts in 14 months and $1.4 trillion in emergency lending have failed to reverse the economic downturn. The Federal Reserve has stated that it will '"employ all available tools to promote the resumption of sustainable economic growth.'"
Read (or comment on) Story: www.aapsonline.org/newsoftheday/00139
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President Obama and Congressional Democrats are inching the U.S. toward government-run health insurance. Last week's expansion of SCHIP -- the State Children's Health Insurance Program -- is a first step. Before proceeding further, here's a suggestion: Look at Canada's experience.
Health-care resources are not unlimited in any country, even rich ones like Canada and the U.S., and must be rationed either by price or time. When individuals bear no direct responsibility for paying for their care, as in Canada, that care is rationed by waiting.
Canadians often wait months or even years for necessary care. For some, the status quo has become so dire that they have turned to the courts for recourse. Several cases currently before provincial courts provide studies in what Americans could expect from government-run health insurance.
In Ontario, Lindsay McCreith was suffering from headaches and seizures yet faced a four and a half month wait for an MRI scan in January of 2006. Deciding that the wait was untenable, Mr. McCreith did what a lot of Canadians do: He went south, and paid for an MRI scan across the border in Buffalo. The MRI revealed a malignant brain tumor.
Ontario's government system still refused to provide timely treatment, offering instead a months-long wait for surgery. In the end, Mr. McCreith returned to Buffalo and paid for surgery that may have saved his life. He's challenging Ontario's government-run monopoly health-insurance system, claiming it violates the right to life and security of the person guaranteed by the Canadian Charter of Rights and Freedoms.
Shona Holmes, another Ontario court challenger, endured a similarly harrowing struggle. In March of 2005, Ms. Holmes began losing her vision and experienced headaches, anxiety attacks, extreme fatigue and weight gain. Despite an MRI scan showing a brain tumor, Ms. Holmes was told she would have to wait months to see a specialist. In June, her vision deteriorating rapidly, Ms. Holmes went to the Mayo Clinic in Arizona, where she found that immediate surgery was required to prevent permanent vision loss and potentially death. Again, the government system in Ontario required more appointments and more tests along with more wait times. Ms. Holmes returned to the Mayo Clinic and paid for her surgery. . .
These constitutional challenges, along with one launched in British Columbia last month, share a common goal: to win Canadians the freedom to spend their own money to protect themselves from the inadequacies of the government health-insurance system.
The cases find their footing in a landmark ruling on Quebec health insurance in 2005. The Supreme Court of Canada found that Canadians suffer physically and psychologically while waiting for treatment in the public health-care system, and that the government monopoly on essential health services imposes a risk of death and irreparable harm. The Supreme Court ruled that Quebec's prohibition on private health insurance violates citizen rights as guaranteed by that province's Charter of Human Rights and Freedoms.
The experiences of these Canadians -- along with the untold stories of the 750,794 citizens waiting a median of 17.3 weeks from mandatory general-practitioner referrals to treatment in 2008 -- show how miserable things can get when government is put in charge of managing health insurance. . .
Canada's system comes at the cost of pain and suffering for patients who find themselves stuck on waiting lists with nowhere to go. Americans can only hope that Barack Obama heeds the lessons that can be learned from Canadian hardships.
Mr. Esmail, based in Calgary, is the director of Health System Performance Studies at The Fraser Institute.
Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.
--Canadian Supreme Court Decision 2005 SCC 35,  1 S.C.R. 791
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Medicaid provides coverage to poor and disabled Americans, many of whom face the highest burden of chronic disease owing to cultural and socioeconomic challenges. The program beats being uninsured, but it often relegates the poor to inferior care.
Reimbursement rates are so low, and billing the program so complicated, that it is hard for internists like me to get beneficiaries access to specialized care or timely interventions. For my patients as well, many of whom are uneducated or don't speak English, Medicaid is replete with paperwork, regulations and rejections that make the program hard to navigate.
Now Medicaid is to receive a bolus of federal money, probably as part of the fiscal stimulus plan -- the figure whispered in Washington is $100 billion -- with no obligation that the program does anything to reverse its decline.
Accumulating medical data shows that Medicaid recipients' poor health outcomes aren't just a function of their underlying medical problems, but a more direct consequence of the program's shortcomings. Take the treatment of serious heart conditions, which are among the most closely evaluated Medicaid services.
One study published in the Journal of the American College of Cardiology (2005) found that Medicaid patients were almost 50% more likely to die after coronary artery bypass surgery than patients with private coverage or Medicare. The authors suggest this may be a result of poorer long-term, follow-up care. Like other similar studies, this one tried to control for the other social and medical factors that are believed to influence patients' clinical outcomes.
Another study in the journal Ethnicity and Disease (2006) showed that elderly Medicaid patients with unstable angina had worse care, partly because they were less likely to get timely interventions or be treated at higher quality hospitals. Three other recent studies showed that Medicaid patients presenting with heart attacks or unstable angina received cardiac catheterization less often than Medicare or private paying patients. This procedure to open blocked heart arteries has become standard care, with ample evidence showing it improves outcomes.
The same trends can be observed in other diseases. For example, a study of adults with cancer published in the journal Cancer (2005) found that patients on Medicaid were two to three times more likely to die from the disease even after researchers corrected for differences in the location of the tumor and its stage when diagnosed.
The federal and state governments are equally culpable for the program's troubles. The federal government matches state Medicaid spending, paying an average of 57% of costs. States expand enrollment in order to qualify for more federal aid. Insurance coverage has become the end itself, with states spreading resources widely but thinly -- without enough attention to the quality of care, accessibility, or whether coverage was actually improving health. States have no obligation to rigorously measure health outcomes in order to qualify for more federal money.
A government survey in 2002 for the Medicare Payment Advisory Committee found that "approximately 40% of physicians restricted access for Medicaid patients" because reimbursement rates are so low. Only about half of U.S. physicians accept new Medicaid patients, compared with more than 70% who accept new Medicare patients. Several recent studies trace the difficulty in getting Medicaid patients seen by specialists to low fees and payment delays. Technologies are also restricted. Many expensive but important drugs aren't paid for under various state drug formularies. . .
Barack Obama's team and Democratic leaders plan to change the federal matching rate to reduce the amount of state funding that is required for maintaining a given level of federal Medicaid spending. Mr. Obama would give Medicaid tens of billions more in federal dollars as part of the fiscal stimulus bill. And he wants to extend Medicaid to some unemployed workers, with the federal government paying the entire cost -- a watershed expansion of the program.
New money alone won't fix the program's woes. It will simply allow states to siphon off more of what they would have spent on Medicaid to other uses.
For its part, the federal government has often prevented the states from taking steps to fix their own Medicaid programs, such as by devising outcome-based standards for evaluating performance, and de-emphasizing the goal of growing the number of covered people to focus more on improving the health of those served. . .
The troubling evidence about the quality of Medicaid patients' services is a cautionary tale for Mr. Obama as he sets about to administer more of our health care inside government agencies. Turning Medicaid around should be the least we demand before turning over more of our private health-care market to similar government management.
Dr. Gottlieb is a resident fellow at the American Enterprise Institute and a former senior official at the Centers for Medicare and Medicaid Services.
Read the entire article at http://online.wsj.com/article/SB123137487987962873.html.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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Some have said that this section is like a broken record. Patients keep over utilizing health care and it doesn't improve their health care. But the challenge is to determine what type of patient over utilizes health care and why. Is this a character trait? Is it health care anxiety? Or is it simple gluttony for something that is relatively free and may be helpful and if it isn't, it didn't cost anything?
We've tried to sort this out for many years. Further controlled studies are necessary. But looking at the Medicare population, a few things become readily apparent. People that have been productive, working hard all their lives and now have relatively free health care, continue to be frugal as they have always been. Some of my most frugal patients have been from the business and professional community. They understand the cost benefit ratio and realize the cost as they continue to be taxpayers. They will put up with aches and pains longer, wait longer for artificial joints, hernia operations and a host of other ailments that can easily be postponed, and seldom ask for such luxuries as motorized wheelchairs, except as a last resort.
The Medicare population that has been on Medicaid for many years are much more demanding in their health care and easily spend twice as much of other peoples' money (taxpayers) than those that have earned their money during their lifetime. They see no need to be frugal since it isn't their money and it comes from the bottomless benefactor, namely Uncle Sam. They know that Uncle Sam can never run out of money. And when they read in the paper that Uncle Sam is bailing out those rich financial and insurance companies, it only makes them more aggressive in getting what they consider to be their fair share. They ask for motorized wheelchairs when they still can walk and should be doing more of it as their personal physical therapy; sometimes they ask simply because their friends who they feel are less infirmed have one.
Recently we were forced to accept 30 Medicaid patients by our IPA. This helped put things in perspective. One-third did not show up for their appointments. They had flimsy excuses when called essentially saying it was not convenient to come in. Since their health care has been free they have no comprehension that there could be any cost involved in NOT keeping an appointment. They even get upset if one mentions that the overhead is $100 per hour and has to be paid even if there is no patient income that hour. They might even complain to the state that this doctor is more concerned about money than taking care of poor people even though we have always accepted our share of the 15 percent of the indigent population.
As the new administration is thinking about tens of millions people to this population, how long will it be before they adopt the same attitudes? Medicaid pays $18 or about 15 percent of the office-visit costs. Seeing four such patients an hour does not come close to pay the staff and rent for the office, even with a zero income for the doctor. With a 25 to 30 percent '"No Show,'" that's a huge cost. That may be what Congress wants, but the doors of many offices will have to close as many other businesses have done during this recession and will during the coming years of depression. It will be far worse than the one in 1929. Even then, the stock market didn't recover until 1954, twenty-five years later or nine years after Roosevelt's death, despite massive bail outs. Harry Browne has already suggested that we close down Medicaid and let the states each handle their own indigent population. It may come to that. It might also be the most sensitive and humane thing to do, even if it's painful.
Medical Gluttony thrives when health care is relatively free.
Gluttony Disappears with Appropriate Deductibles and Co-payments on Every Service.
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Politicians and others ill informed or inexperienced about how health care is implemented and what drives the cost have a simple flow chart in mind that will direct doctors to the appropriate care and patients will follow it. They have a naοve understanding that patients behave as if they are in kindergarten needing constant guidance and will accept protocols without much question. Not only can children be headstrong, patients can also.
At the Medical Grand Rounds at UC Davis last week, the visiting professor had a presentation on how to unleash the power of Evidenced-Based Medicine (EBM). He pointed out why it frequently is not successful. It's hard to change culture. Written policies and directives may not change the prevailing practice or culture. Sometimes the current practice culture may cause a change in strategy. It may not be the doctor's resistance to the change but the patient's non-acceptance.
For instance, telling patients that they don't need a repeat lipid panel for five years may incur their wrath. They say that all of their friends get these tests every year. After they go home, it may cause a family gathering. A vote by the members present, even without any medical background, may indicate that their doctor has obtained tests every year for 20 years even if all of them were normal. The family may then discuss challenges to the doctor such as reporting him to their insurance company, the Medical Board, changing doctors, or making a scene and paralyzing office productivity, perhaps at an overhead of $100 to $200 an hour, to the point that the doctor no longer wishes to fight and lose another hour of office productivity.
When the insurance company is involved, even though the carrier appreciates the doctor trying to save money with appropriate EBM type of care, the insurance companies treat their patients as members (of the family?) and will insist on the doctor complying with their wishes and thus embarrassing the doctor in front of the patient. Thus, the insurance company's EBM protocols are overruled by the insurance company's medical director.
Thus, the cost involved in forcing EBM into practices may be huge. The cost of changing behavior will frequently exceed the cost of acquiescing. So is there an answer? Yes there is.
Our position in these MedicalTuesday Cyberspace Meetings, that have replaced effective Medical Society meetings, has always been the same. If patients had to pay the appropriate deductibles and co-payments on every service, the patient would reduce the costs faster, more effectively, and be supportive of the endeavor. These comments usually fall on deaf ears unless you've been a member of MedicalTuesday for years.
If the patient had to make a co-payment on the office visit after having paid the deductible, the discussion would have been more pleasant. If the patient had to make a similar co-payment when going to the laboratory for what may be $375 worth of routine tests that have been normal, he would stop at the door of the lab before paying his 20 percent co-payment or $75. The patient may even make another appointment and ask the doctor what his opinion would be on rechecking his lipids. With the reality check, a five-year wait would have been greeted with enthusiasm.
Assuming that the office call may have been $125 and the laboratory charges around $375, that is a 75 percent reduction in health care costs. There is no oversight by Medicare and Medicaid that could begin to match this amount of savings.
This easy answer is never discussed at these conferences. If someone brought it up, the response from the visiting professor may be unkind and the audience may be hostile. Hence, these alternatives are hardly ever discussed.
To reduce health care costs and place medicine in a more cost effective environment, you may want to consider forwarding this edition of MedicalTuesday, or at least this section, to your friends, relatives and associates before the government takes over and makes much of health care unavailable.
You may also want to follow some of the other issues, such as the second one on our current Blog http://medicaltuesday.blogs.com/.
Medical Myths Originate With a Lack of Understanding of Health Care Costs.
Medical Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service which Dramatically Improves Understanding At The Registration Counter before Expensive Services are Rendered.
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Dr. Edwards: We've heard a lot about EBM but I'm not so sure it's everything it's cracked up to be?
Dr. Paul: Well it sure should help streamline medicine so that we're all on the same page.
Dr. Edwards: How do you figure? We all look at the same facts and come up with different conclusions.
Dr. Paul: Well, in Pediatrics we use a lot of nurse practitioners. They seem to do rather well in baby care on the basis of EBM guidelines.
Dr. Edwards: You have the time to put all of your thinking in a nice flow chart that will navigate the course, even for professionals that may not understand the logic of the sequences?
Dr. Paul: If you work with the same nurse practitioner in your office, you will naturally get on the same page and think similarly. And if you're always present in the office when the NP is there, she learns and you extend your imprint on the practice.
Dr. Edwards: Don't you think there is a hazard in rote medicine?
Dr. Paul: There may be, but as the government makes more of our decisions for us, they will have to use the EBM guidelines, even if they are wrong.
Dr. Edwards: But if they are wrong, then we will have a lower quality of care.
Dr. Paul: That may be true, but that's the way things are going and you are not going to stop the train. I for one will be on that train even if some patients get caught under the wheel on the tracks.
Dr. Edwards: You are really accepting mass produced medicine and whatever it may bring with it.
Dr. Paul: I don't think rejecting it is an option. If you reject, then you and the doctors that think like you will also be under the wheel getting cut instantly to the sidelines. You may lose your license and will have no chance to get it restored.
Dr. Edwards: Losing my license may bother me less that losing my integrity. I don't think I could live with myself if I became a Government whore.
Dr. Paul: Your choice.
Dr. Edwards: I think P. J. O'Rourke wrote a whole book on Congress called the Government of Whores wherein he attempts to explain Government. I don't think I want to be party to that scenario.
Dr. Paul: As I said, your choice. Maybe we'll have more Doctors here tomorrow to continue this discussion. I forgot this is President's Day.
Dr. Edwards: We always work on these union holidays since it is the day that many working people can come in more easily.
The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard and then Formulated.
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A Disingenuous Debate on Health Care Policy By David J. Gibson, MD and Jennifer Shaw Gibson
THE POLITICIANS' APPROACH to the health care policy debate during this presidential primary season has devolved into little more than pandering and demagoguery.
In a previously published article, we cited the now defunct candidate John Edwards using the death of 17-year-old Nataline Sarkisyan to further his political agenda.1 Sarkisyan died on December 20, 2007, after Cigna initially denied her coverage for a liver transplant, citing insufficient evidence that the procedure would be safe or effective. Jeffrey Kang, Cigna's chief medical officer, observed that, "it is highly unlikely that any health-care insurance system, nationally or internationally, would have covered this procedure."
At the time of her death, Edwards advocated a government-run health plan open to all Americans, rather than the current private financing system. Implicit in Edwards' posturing, a government system would have paid for this and all other experimental procedures.
The public was presented a false promise. No government-based plan anywhere in the world lives up to such a grandiose promise.
In a more recent example, Senator Hillary Rodham Clinton of New York frequently featured in her campaign stump speeches the story of a health care horror.2 At multiple rallies, she told the story of Trina Bachtel, a 35-year-old who managed a Pizza Hut. This woman was presented as a young, uninsured minimum-wage worker. Clinton would repeatedly say, "The story haunted me. It hurts me that in our country, as rich and good of a country as we are, this young woman and her baby died because she couldn't come up with $100 to see the doctor."
Trina Bachtel did die last August, two weeks after her baby boy was stillborn at the O'Bleness Memorial Hospital in Athens, Ohio. However, Ms. Bachtel was under the care of an obstetrics practice affiliated with the hospital. She was asked to pay the clinic $100 in previously owed billings but was not refused service. Furthermore, she was insured when she sought service from O'Bleness Memorial Hospital.2
Since Ms. Bachtel's baby died at O'Bleness Memorial Hospital, the story implicitly accuses that hospital of turning Ms. Bachtel away, However, the O'Bleness health care system did treat her, both at the hospital and at the affiliated River Rose Obstetrics and Gynecology practice.
O'Bleness Memorial Hospital has now gone on the record. "We reviewed the medical and patient account records of this patient," said Rick Castrop, the health system's chief executive, and any implication that the system was "involved in denying care is definitely not true."
Her campaign acknowledged that Clinton frequently retells stories relayed to her by third parties. However, vetting them was not always possible.
In this case, a spokeswoman for the O'Bleness Memorial Hospital said the Clinton campaign had never contacted the hospital to check the accuracy of the story. The Clinton campaign subsequently withdrew this story from future campaign speeches but did not apologize for prior inaccuracies.
Neither of the above would pass muster with the most junior reporter in a credible news organization.
Why is this deliberate use of unverified information so dangerous? It produces an inaccurately informed voting public that becomes biased against the current private based system. Comparing an imperfect present system with a "perfect" future system is counterproductive. . .
How well does a single payer system perform when compared to our current system? Furthermore, how happy will American physicians be if such a single payer system is adopted?
The answer to these difficult questions depends upon the data used to reach an opinion. Generally positive outcomes data for the Canadian system relates to overall system costs not outcomes.
Furthermore, how would doctors feel about working within a national health care plan if they understood that most of the cost and, therefore, the savings differentiating the Canadian and the American systems relates to differentials in labor costs? Canadian health care workers (including doctors) earn approximately half the amount their counterparts earn within the American system.
The following data, relating to performance and outcomes, are taken from a 1991 National Bureau of Economic Research study.4 The percent of middle-aged Canadian women who have never had a mammogram is double the U.S. rate. The percent of Canadian women who have never had a pap smear is triple the U.S. rate. More than 8 in 10 Canadian men have never had a PSA test, compared with less than half of U.S. men. More than 9 in 10 Canadians have never had a colonoscopy, compared with 7 in 10 in the United States.
These differences in screening may explain why U.S. cancer patients do significantly better than their Canadian counterparts. The mortality rate for breast cancer is 25 percent higher in Canada. The mortality rate for prostate cancer is 18 percent higher in Canada. The mortality rate for colorectal cancer among Canadian men and women is about 13 percent higher than in the United States.
Furthermore, among senior citizens, the percentage of Canadians with asthma, hypertension, and diabetes who are not getting care is twice the rate in the United States. The fraction of Canadian seniors with coronary heart disease who are not being treated is nearly three times the U.S. rate.
The advantage that any underperforming single payer system has over the private competitive model is the ability to dictate the fee providers can charge for health care. Furthermore, such a system can influence utilization by limiting the supply of high cost services. Canada limits the availability of diagnostic and therapeutic modalities along with the availability of hospital beds. . .
However, should we elect to move away from the current model for health care financing and adopt a new system, we will discover that reforming the way we pay for health care is infinitely easier than actually reforming the health care delivery system itself.
The health care policy debate is one of the most important discussions we are now having within the public forum. Health care represents one-seventh of our economy. The infusion of deliberately misleading information by the presidential candidates ill serves the debate. Setting an unattainable level of performance by an alternative financing system against the emphasized shortcomings of our imperfect present system is intentionally misleading. Furthermore, the public's cynicism towards government will only grow when the new system does not meet the unrealistic expectations put forward by politicians today.
David Gibson is a senior partner and Chief Medical Officer at Illumination Medical, Inc., a health care consulting and medical management company. Jennifer Gibson is an economist specializing in evolving health care markets as well as a futures commodity trader specializing in oil and gas.
VOM Is Where Doctors' Thinking is Crystallized into Writing.
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WHY GOVERNMENT DOESN'T WORK, by Harry Browne, St. Martin's Press, New York, © 1995, ISBN: 0-312-13623-4, 245 pp, $19.95.
Review by Del Meyer, MD
A Note from Harry Browne (Also author of How I Found Freedom in An Unfree World)
Most politicians believe in just one thing - winning elections. They'll say anything to get in office and stay there. Today they believe saying "less government" will get them elected, but the last thing they really want is to give up the power that comes from big government.
No matter which party has held the presidency or dominated Congress, no one has delivered on the promise to reduce government. Despite the talk, every year government grows larger and interferes even further in our lives.
I'm not a politician. Like you, I'm sick of seeing government take almost half the national income and then dole it back to us as though we are children on an allowance. I'm tired of politicians using the crime problem as an excuse for seizing property and liberties from innocent citizens. And I'm not fooled by "welfare reform" that doesn't change anything, or by showy "spending cuts" that add up to a bigger government budget. . .
Prologue, the Breakdown of Government (in Harry Browne's own words)
Imagine living in a city where you felt safe walking home at ten in the evening - or even at two in the morning.
Imagine your children going to schools that respect your values; where teachers concentrate on reading, writing, adding, subtracting, and other academic basics; and where no one would dare teach your child a philosophy that's alien to you.
Imagine paying only half the taxes you're paying now. You could move into a better home, finance a more comfortable retirement, send your children to the private school of your choice, support your favorite cause or charity in a way that would make a significant difference, or save up to go into business for yourself.
With much lower taxes, your family could live well on the income of just one spouse - so the other parent could choose to stay home and raise your children in the values you believe, rather than leaving their moral training to strangers.
Is This a Dream?
I'm not describing Utopia. Such a society wouldn't be perfect. But as recently as 1950, it was real. The crime rate was only one fifth of what it is today. Most American school children learned to read, write, and do math competently - and they left school able to make their way in the world. Government was only one-fifth the size it is today.
Government Running Wild
But today's America is quite different. It is a land where crime is a national scandal, schools turn out illiterates, and taxes drive both parents into the job market. The "American Dream" has become a mirage for too many of us.
And to make matters worse, government has grown too large and too bold. It routinely tramples on our property and our liberties:
The federal government was founded by men who warned "Don't tread on me." But that government now pries into your bank account, threatens to destroy you to collect its taxes and tries to herd you into a health-care collective - as though you were a Soviet citizen.
Federal, state, and local governments together take 47% of your earnings through direct and hidden taxes - cutting your standard of living to a fraction of what it could be. . .
No plague descended upon America to halt progress and plunge us into a world of violent crime, poor education, and big government.
So how did it happen? What transformed America from the land of the free into the land of high taxes - from the land of prosperity into the land of debt and bankruptcy - from the land of opportunity to the land of quotas and lawsuits - from the land of free enterprise to the land of regulations, mandates, and government inspectors?
The decline of America has been caused by politicians and reformers who believe that you aren't competent to run your own life, that they know better how to spend the money you've earned, that they understand which products you should be allowed to buy and what wages and job benefits are suitable for you. . .
What Went Wrong?
Once upon a time government budgets were balanced, our money was sound, the cities were safe, and the taxes of federal, state, and local governments combined took less than 10% of our income. The cost of government has grown. Government has intruded deeper and deeper into our lives, making decisions we used to make for ourselves. Government decides which products we're allowed to buy, sets wage floors that force unemployment on teenagers, prevents most small businesses from raising capital, and stops the critically ill from using life-saving medicines while bureaucrats pretend to protect us.
Wasn't government supposed to be our servant, rather than our master? Wasn't government supposed to help only those who can't help themselves - rather than benefiting politicians, lobbyists, and social reformers? . . .
Part I: Understand the Problem
But to understand how government went so wrong, we must first identify exactly what government is and how it operates. Because Part I does this, it may be the most important section of the book. It shows why government programs never seem to produce the results that were promised - why laws to make America "color blind" lead to racial quotas, why programs to improve the economy end in recession and inflation, and why plans to help the poor enlarge their numbers.
Part II: Identify the Solutions
Part II examines specific issues showing how government created the problems the politicians now pretend they can solve, and showing how we can solve these problems. We will see:
· How crime, education, and welfare went from minor problems in the 1950s to major scandals in the 1990s-and how we can end the scandals.
· How to fix Social Security once and for all - to end its periodic crises, and to guarantee that you get everything you pay for.
· How to balance the federal budget immediately and permanently - without raising taxes. . .
· How to cut taxes to a fraction of where they are now.
Today's social and political problems aren't mysterious. They can be fixed. If we understand what caused them, we can cure them. And we can make sure they don't recur. . .
A revolution is sweeping through America today - as Americans have grown impatient with big government, high taxes, meddling politicians and bureaucrats, soaring crime rates and mediocre education. America can be free, peaceful and prosperous again.
Government's Unique Asset
The distinctive feature of government is coercion - the use of force and the threat of force to win obedience. This is how government differs from every other agency in society. The others persuade; government compels.
When someone demands that government help flood victims, he is saying he wants to force people to pay for flood relief. Otherwise, he'd be happy to have the Red Cross and its supporters handle everything. . .
When Congress passes a bill mandating "family leave, it forces every employer to provide time off for family problems - even if its employees want the employer to use payroll money for some other benefit. Otherwise, employers and employees would be free to decide what works best in each situation.
· The government forces someone to pay for something;
· The government forces someone to do something; or
· The government forcibly prevents someone from doing something.
There is no other reason to involve government. And by "force" I mean the real thing - the kind that hurts people . . . Every government program, no matter how benign it may appear, is the same. Coercion is the reason - and the only reason - it is a government program. . .
People seek the help of business groups, charity organizations, and service clubs to urge others to support some cause. People turn to government to force others to support their cause.
Government Defined: An agency of coercion.
Of course, there are other agencies of coercion - such as the Mafia. So to be more precise, government is the agency of coercion that has flags in front of its offices.
Why Government Programs Always Go Astray
Because of government's power, controlling it is the grand prize - the brass ring, the pot of gold, the genie of the lamp. It beckons as the shortcut to riches, to the perfect world you imagine, to imposing your personal tastes on everyone. With government at your disposal, it appears that you can bypass the tedious process of earning a living, spreading the gospel, or persuading others that you're right.
No wonder that most TV news revolves around government. No wonder nearly everyone wants to influence government. Whoever controls it controls us all.
Medicare provides a good example. It was created in 1965 to make it easier for the elderly to get health care. But by reducing the patient's out-of-pocket costs, it increased the demand for doctors and hospitals. And it reduced the supply of those services by requiring doctors and other medical personnel to use their time and attention handling paperwork and complying with regulations - and looking for ways to circumvent these things. So, the price of medical care rose sharply as the demand soared and the supply diminished.
As a result, the elderly now pay from their own pockets over twice as much for health care (after adjusting for inflation) than they did before Medicare began. And most of the elderly now find it harder to get adequate medical service. Naturally, the government points to the higher costs and shortages as proof that the elderly would be lost without Medicare - and that government should be even more deeply involved.
When Medicare was set up in 1965, the politicians projected its cost in 1990 to be $3 billion - which is equivalent to $12 billion when adjusted for inflation to 1990 dollars. The actual cost in 1990 was $98 billion - eight times as much.
· Poverty programs don't reduce the number of poor people. On the contrary, they encourage more people to qualify as poor and get on the gravy train.
· Rules and regulations don't reform society as expected. People respond by looking for ways around the rules they don't like.
· The War on Drugs makes drugs more profitable - increasing the incentive for drug pushers to recruit new customers.
· The underground economy thrives as a means of earning money without losing it to government - reducing the revenues that had been expected to pay for government programs.
Human action is always unpredictable. But you can count on government programs to produce results quite different from those promised by their sponsors. You would think this would cause people to shun government as a way of solving problems. But just the opposite happens - as we'll see.
Why Government Grows & Grows & Grows
The bad consequences of a government program usually don't show up immediately. And the delay may be long enough to hide the connection between the program and its results. So government never has to say it's sorry - never has to take responsibility for the misery it causes. Instead, it can blame everything on personal greed, profit-hungry corporations, and the "private" sector. And the government's cure for the problems is to impose bigger programs, more regulation, and higher taxes. Thus politicians tell us the high cost of Medicare is due to doctors, hospitals, and drug companies charging too much - not that Medicare inflated costs by running up the demand for health care and hindering the supply of it. And, even though government controls over 50% of the money spent on medical care, politicians freely refer to the high cost of a hospital stay as a failure of the free market.
Each government program carries within it the seeds of future programs that will be "needed" to clean up the mess the first program creates. No matter how much mischief it causes, government always shows up in a cavalry uniform - riding in to rescue us from the problems it created. . .
Everyone who comes to the government asking for favors has a plausible request.
Once it's considered proper to use government force to solve one person's problem, force can be justified to solve anyone's problem.
Over time, fewer and fewer requests seem out of bounds. And the grounds for saying "no" become more and more eroded. The pressure on politicians to use coercion to grant favors becomes overwhelming.
The Motives of Public Servants
Lawmakers, bureaucrats, and judges all rejoice in a government that grows and grows and grows. Big government gives lawmakers the power to make or break companies and individuals. People must bow and scrape to obtain favors - or just to keep government from destroying them.
Heath Care - The Problem
The road to Hell is paved with good intentions, the road to big government is paved with small steps - each of which seems harmless in itself.
The pattern rarely changes. . . .
Because politicians refuse to recognize that government doesn't work, they never blame the current problem on the program they passed earlier. Instead, while professing their undying faith in free enterprise, they note regretfully that the market has failed to work in this instance. So they propose to fix it with a larger, more bureaucratic system - and the cycle continues with a compromise, more government, more damage and another proposal.
Health care is an excellent example. From the passage of Medicare in 1965 to a health-care system run completely by the government a few years from now, the politicians have led us along step by innocuous step. Although each step has been presented as the end of the journey, each has added to the problem and made the next step seem necessary. . .
Heath Care - The Solution
In the health-care debate of 1992-1994, words like compassion, right, need, and fairness showed up frequently. But a number of relevant words were ignored.
For example, I never heard the words force or coercion in public discussion about the issue. And yet the Health Security Act, the President's 1993 proposal for universal health insurance, had a great deal to do with force. There are some revealing terms in the proposal - such as prison (which shows up 7 times), penalty (111 times), fine (6), enforce (83), prohibit (47), mandatory (24), limit (231), obligation (51), require (901), and so on. For example, a person withholding information about his medical history could go to prison for five years.
That was the Democrats' proposal. But lest you think the Republicans don't believe in forcing people to do the right thing, their principal proposal included the terms prison (1 time), enforce (37), penalty (64), fine (12), prohibit (19), and require (482).
Even the plan publicized as the most "free market" of the eight major proposals contains the words penalty (5 times), prohibit (5), require (54), enforce (1), and so on.
But coercion is nothing new in government-run health care. Medicare already has plenty of fines and penalties. For example, a Doctor is fined merely for filing the wrong form - or failing to file a form for every visit by a patient.
Is It Compassion or Force?
Browne continues with the welfare problems, social security problems, and how neither of the two parties will save us. Please go to the remainder of part two for an analysis of the problems and solutions. www.amazon.com/Government-Doesnt-Work-Harry-Browne/dp/0965603601
In the Epilogue, Browne gives us a message of hope. For America's first 150 years, force was minimized in social relationships. During the past 60 years, government coercion has become the standard device for settling social questions. Today everything is a political issue - to be decided by the strongest faction at the expense of everyone else. Today political might makes right. The result is an America our grandparents wouldn't recognize.
· Instead of compassion and charity, we have welfare rights.
· Instead of education,
we have schools with metal detectors, drug pushers, social indoctrination, and
kids who can't read their own diplomas.
· Instead of safety, we have doors with multiple locks.
· Instead of civility, we have groups jostling to gain entitlements to the earnings of others.
While private companies have been producing dazzling progress in computers, electronics, pharmaceuticals, and many other areas, everything in the social order has deteriorated. Our public institutions are a wreck. To correct this, we don't have to turn back the clock. We only have to turn away from government - from the idea that we can cure social problems with a gun, from the fairy-tale belief that government can be made to work for anyone but the politicians. Coercion will never be as effective as freedom and cooperation.
Government doesn't work. It is time to stop trying to fix it, and start finding ways to live with as little of it as possible.
Browne closes with a final hope for people of every persuasion - from the young to the elderly, from the minorities to people on welfare, from government employees to reformers, to people of every religion. No one should feel threatened, except maybe the politicians. It's a three-page tour de force on how to get government out of the way. The purchase price is a pittance for those interested in the future of our country and making America free again.
The late Harry Browne is the author of numerous financial books, including three New York Times bestsellers: How You Can Profit from the Coming Devaluation, You Can Profit from a Monetary Crisis, and New Profits from the Monetary Crisis. His book How I Found Freedom in An Unfree World, published in 1973, is a modem classic. He lived with his wife, Pamela, in Tennessee until his death. To visit his Library Museum . . .
This book review is found at www.delmeyer.net/bkrev_WhyGovtDoesntWork.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.
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Local government lobbying costs soar in
California, By Jim
Despite mounting money woes, California's local government agencies continue to spend tens of millions each year to influence state government with taxpayers picking up a rising tab. Far more public funds were paid by cities, counties and school districts during the two-year legislative session that ended Dec. 1 than at any time this decade, records show. . . Lobbying by local government the past two years consumed nearly one-third more money than in any other legislative session of the decade.
It looks like the recession has to get far worse before our lawmakers will understand limits.
Unintelligible physician handwriting has long been the subject of various jokes, cartoons, and studies. Interestingly, physician handwriting has been found to be as legible as the average person's. Berwick DM, Winickoff DE. The truth about doctor's handwriting: a prospective study. BMJ 1996; 313:1657-8
The subject and consequences of a physician's
handwriting is what makes the difference.
Electronic prescribing systems would seem to be the solution to the problem.
NORCAL, a Medical Liability Insurance Company, reports errors and a malpractice claim from errors in Electronic prescribing. Physician checked the wrong box on the computer entry and patient received ten times the expected HS dose - five tablets of 100 mg of Amitriptyline instead of five tablets of 10 mg.
There is no substitute for constant vigilance.
Dozens of California Senate staffers get little-known pay sweetener By Jim Sanders
Dozens of California Senate employees have their pay padded by a combined total of several hundred thousand dollars a year through a little-known method not disclosed publicly as salaries. Sixty-eight employees receive monthly augmentations, including seven whose salaries are six digits without the sweetener and seven whose base pay is $80,000 to $99,000, Senate records show. The padding is not new - it has existed with little public knowledge for many years - but the Senate Rules Committee last month ordered that no additional employees participate in light of the state's $40 billion budget shortfall. Senators traditionally have had discretion to decide whether to award the extra compensation; if so, it is deducted from a $2,000 to $2,500 monthly entitlement each senator receives for office expenses. Employees' pay is public record, but the Senate does not disclose the augmentations of up to $1,000 per participant per month - $12,000 annually - in responding to requests for a list of salaries and bonuses.
If Business or Professionals did what Lawmakers routinely do, we'd be prosecuted.
To read more HHK, go to www.healthcarecom.net/hhkintro.htm.
To read more HMC, go to www.delmeyer.net/HMC.htm.
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John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information.
PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.emergiclinic.com. To read more on Dr Berry, please click on the various topics at his website.
PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.
FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance.
Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."
Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 2550 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story. . .
Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.
Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.
David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.
Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.
Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.
To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.
Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.
The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: Obama's health reforms would save only 1% of the amount promised, says Congressional Budget Office. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read Pay to Play . Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents. Be sure to read The Failure of Vytorin and Statins to Improve Cardiovascular Health.
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Words of Wisdom
"You cannot change your destination overnight, but you can change your direction overnight." -Jim Rohn: Entrepreneur, author, and motivational speaker
"Wisdom is to the soul what health is to the body." -Cιsar Vichard de Saint-Rιal: 17th-century French author
"Live as if you were to die tomorrow. Learn as if you were to live forever." - Mahatma Gandhi: Was an Indian political and spiritual leader
Some Recent Postings
Why Government Doesn't Work: www.delmeyer.net/bkrev_WhyGovtDoesntWork.htm
Why the Push for Health Care Reform? www.healthplanusa.net/DGWhyPushHCReform.htm
A Disingenuous Debate on Health Care Policy. www.healthplanusa.net/DGDisingenuousDebateHC.htm
Anastasia Baburova, a Russian journalist, died on January 19th, aged 25
From The Economist print edition, Feb 5th 2009
IT IS still not clear why Anastasia Baburova was shot in the head. Was she a target - along with Stanislav Markelov, a human-rights lawyer who was shot seconds earlier? Was she an accidental victim, in the wrong place at the wrong time? Or did she try to grab and disarm the killer after he shot her companion?
Both Mr Markelov and Ms Baburova were killed in broad daylight in the centre of Moscow. The next day, a party of Russian nationalists brought champagne to the murder scene to celebrate the '"elimination'" of their enemies. Her death was part of a continuing battle between fascists and anti-fascists in Russia, which is seldom so plainly revealed to the outside world.
Jumping an assassin was part of her nature. At any sign of violence or racism her nerves and muscles instantly responded, hitting out, resisting what was physically intolerable. '"It is hard to look in the eyes of a Korean student who has just been hit on the head by two under-age jerks giving Heil Hitler' salutes'", she wrote in her blog after seeing yet another neo-Nazi attack in Moscow. It was the same blog in which she enthused about roller-blading for the first time: at night, fast, without a helmet.
The fact that she worked at Novaya Gazeta was no coincidence. "Where else?" she asked her colleagues, rhetorically. She was the fourth journalist Novaya Gazeta had lost in the past eight years. But Russia's most critical newspaper, co-founded by Mikhail Gorbachev, the architect of perestroika, was the natural place for her to be. . .
To read the entire obituary, go to www.economist.com/obituary/displaystory.cfm?story_id=13055783.
On This Date in History - February 24
On this date in 1803, the Supreme Court in Marbury v. Madison ruled an Act of Congress unconstitutional. One of the glories of our American heritage is that we have a Constitution that is so unquestionably the supreme law of the land. Over the course of generations, we seem to have come to believe that it was ever thus. But the fact is that we owe a great deal of the supremacy of that law - and the resultant stability of our government system - to a court decision that was handed down on this date in 1803. The case was Marbury v. Madison, known to legal scholars everywhere and studied at school but largely forgotten by the rest of us. In that case for the first time, the Supreme Court voided an Act of Congress because the law that Congress had passed was in violation of the Constitution. This case not only established beyond doubt that the Constitution was supreme but also crystallized the power of the Supreme Court to rule finally on what was or was not Constitutional. So today's anniversary is a landmark worth remembering and a fitting introduction indeed to a consideration of where we are today.
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