MEDICAL TUESDAY . NET
Community For Better Health Care
Vol IX, No 20, Jan 25, 2011
In This Issue:
11. Related Organizations: Restoring Accountability in Medical Practice and Society
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OBAMACARE, DOCTORS NEEDED TO SCREEN LOCALLY
A new movie has Canadian doctors, patients, journalists and others warning Americans about the final destination of ObamaCare. The producer, Logan Darrow Clements, hopes people will understand that ObamaCare isn't about reforming health insurance but a complete government takeover of the medical system. Clements is hoping doctors across American can help him screen the movie through a revolutionary new distribution system whereby doctors can become instant distributors. For a flat fee of $500, they can buy a screening license and show the movie in their community, keeping all ticket revenues. The process is simple. Doctors can download a high-resolution version of the movie overnight to their laptop computer. They can then take their laptop anywhere and connect it to a projector or purchase one at a local office supply store. Whenever possible, the producer plans to be available for question and answer sessions after screening by phone or webcam. A personal DVD can be purchased or a version of the movie can be purchased and instantly downloaded at www.sickandsickermovie.com/. Mr. Clements can be reached in Los Angeles through his production company Freestar Movie, LLC at 310-795-2509.
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1. Featured Article: How the new sciences of human nature can help make sense of a life.
Researchers have made strides in understanding the human mind, filling the hole left by the atrophy of theology and philosophy.
. . . Occasionally, you meet a young, rising member of this [Composure Class] at the gelato store, as he hovers indecisively over the cloudberry and ginger-pomegranate selections, and you notice that his superhuman equilibrium is marred by an anxiety. Many members of this class, like many Americans generally, have a vague sense that their lives have been distorted by a giant cultural bias. They live in a society that prizes the development of career skills but is inarticulate when it comes to the things that matter most. The young achievers are tutored in every soccer technique and calculus problem, but when it comes to their most important decisions—whom to marry and whom to befriend, what to love and what to despise—they are on their own. Nor, for all their striving, do they understand the qualities that lead to the highest achievement. Intelligence, academic performance, and prestigious schools don't correlate well with fulfillment, or even with outstanding accomplishment. The traits that do make a difference are poorly understood, and can't be taught in a classroom, no matter what the tuition: the ability to understand and inspire people; to read situations and discern the underlying patterns; to build trusting relationships; to recognize and correct one's shortcomings; to imagine alternate futures. In short, these achievers have a sense that they are shallower than they need to be.
Help comes from the strangest places. We are living in the middle of a revolution in consciousness. Over the past few decades, geneticists, neuroscientists, psychologists, sociologists, economists, and others have made great strides in understanding the inner working of the human mind. Far from being dryly materialistic, their work illuminates the rich underwater world where character is formed and wisdom grows. They are giving us a better grasp of emotions, intuitions, biases, longings, predispositions, character traits, and social bonding, precisely those things about which our culture has least to say. Brain science helps fill the hole left by the atrophy of theology and philosophy.
A core finding of this work is that we are not primarily the products of our conscious thinking. The conscious mind gives us one way of making sense of our environment. But the unconscious mind gives us other, more supple ways. The cognitive revolution of the past thirty years provides a different perspective on our lives, one that emphasizes the relative importance of emotion over pure reason, social connections over individual choice, moral intuition over abstract logic, perceptiveness over I.Q. It allows us to tell a different sort of success story, an inner story to go along with the conventional surface one.
To give a sense of how this inner story goes, let's consider a young member of the Composure Class, though of course the lessons apply to members of all classes. I'll call him Harold. His inner-mind training began before birth. Even when he was in the womb, Harold was listening for his mother's voice, and being molded by it. French babies cry differently from babies who've heard German in the womb, because they've absorbed French intonations before birth. Fetuses who have been read "The Cat in the Hat" while in the womb suck rhythmically when they hear it again after birth, because they recognize the rhythm of the poetry.
As a newborn, Harold, like all babies, was connecting with his mother. He gazed at her. He mimicked. His brain was wired by her love (the more a rat pup is licked and groomed by its mother, the more synaptic connections it has). Harold's mother, in return, read his moods. A conversation developed between them, based on touch, gaze, smell, rhythm, and imitation. When Harold was about eleven months old, his mother realized that she knew him better than she'd ever known anybody, even though they'd never exchanged a word. . .
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Barack Obama appointed GE's Jeff Immelt to head up his advisory panel to create jobs. No doubt Immelt knows how to do it. GE's employment is up by 36% since he was named boss back in 2000. Next time, however, Obama might want to think about putting someone in charge who creates jobs in this country.
Immelt takes over at GE in 2000: 131,000
USA jobs, 92,000 Jobs in other countries.
Immelt at GE today: 134,000 USA jobs, 171,000 Jobs in other countries.
I understand that you disagree with the President's choice. I agree with you on that. But tell us why you headed your article with the name "Bamo?" --Chet
Because it seemed to appropriately reflect how little respect I have for the man.
Appointing the head of the company that is (1) the poster child for trashing American manufacturing having killed over 100,000 jobs, but (2) spends more on lobbying than any other American company reflects just how little respect Obama deserves.
Note that I am not scorning the office of the Presidency of the United States - just the mockery this particular man has made of that office.
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3. International Medicine: Our health care delusion
One study ranked Canada dead last in timeliness and quality care
A distraught 41-year-old man from West Kelowna, B.C., arrived at the emergency department of Kelowna General Hospital on the night of Dec. 28. "He was broken mentally," his wife later told the local Daily Courier. "He wanted help." By her account, he waited 90 minutes without seeing a doctor, minor by today's emergency room standards. Kelowna RCMP put the wait at just 45 minutes. Regardless, he snapped, warning staff that he'd drive his truck into the hospital if he didn't get treatment. When threats didn't get results, he stormed out and returned at the wheel of his Chevy Blazer. As promised, he smashed through the ER's double doors, narrowly missing two elderly people (one assumes they were elderly before their wait in emergency) and came to a halt in a hospital hallway.
Police arrived to find him waiting co-operatively in his truck. The bed he was assigned that night was in the RCMP detachment cell; he faces several charges including dangerous operation of a motor vehicle. While his strategy was extreme, his cry for attention resonates with many who've had the misfortune to trade germs and waste time in one of Canada's overstressed emergency wards.
It's a Canadian conceit that ours is one of the best public health care systems in the world, a defining characteristic of nationhood; something that separates us from the Americans. In a poll by Angus Reid Public Opinion in June, 69 per cent of Canadians said they're proud of the health care system, edging out the state of Canadian democracy, multiculturalism and bilingualism.
Yet the reality, based on any number of international comparisons, shows that pride in a supposedly world-beating standard of care is often misplaced, an "illusion," as Liberal MP and medical doctor Keith Martin puts it. The sorry state of the nation's emergency wards is just one indicator of trouble today and trouble to come. ERs are just "the canary in the coal mine," says Dr. John Ross, Nova Scotia's adviser on emergency care.
Martin, a former family and emergency room doctor and an MP from Vancouver Island, has been saying as much since he entered federal politics 17 years ago as a Reform party member. He practised medicine part-time until about three years ago, experiencing the same things that first spurred him into politics: the indignity of examining patients on gurneys in hospital hallways; people enduring such agonizing waits for hip or knee replacements that they suffered heart attacks; tumours that grew to inoperable sizes as people waited months for diagnostic scans. "Those," he says, "are the casualties of our health care system, and the casualties of the inaction of modernizing the system, that people don't talk about."
Emergency wards are all too often the first point of contact with the health care system, a problem exacerbated by the fact that five million Canadians don't have a family physician, and because acute-care beds are often stuffed with elderly patients who would be better served in long-term care facilities. Often the waits are excruciating. For a man in the throes of a mental breakdown, driving to, and through, the ER of Kelowna General should have been the last, worst option. "He was at the end of his rope," his wife said. "You can't see a psychiatrist. It takes a while to get an appointment. That's why people go to the hospital."
And what they often find in maxed-out ERs is a chaotic environment and waits, of six, eight hours and more. The consequences can be deadly. In Edmonton's Royal Alexandra Hospital this September, Shayne Hay reported to the hospital's emergency ward, telling staff he was suicidal. He was placed in a room on an emergency stretcher and checked periodically, though repeated requests to see a counsellor went unanswered, his family says. Some 12 hours later he was found dead, hanging from a strap of his backpack. In Montreal, long waits in the ER at Maisonneuve-Rosemont hospital were blamed by families for contributing to the deaths of two people last year. Mariette Fournier, 86, spent four days on a stretcher in the hallway waiting for a bed in the geriatric department. She contracted pneumonia, developed a blood clot, and died on Feb. 23, a day after finally getting a bed. That same month, 75-year-old Mieczyslaw Figiel died beside the triage nursing station, with his daughter banging on the station's window as he gasped for breath. The ER was at 180 per cent capacity. . .
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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4. Medicare: Repeal and Replace: 10 Necessary Changes
There are 10 structural flaws in the Affordable Care Act (ACA). Each is so potentially damaging, Congress will have to resort to major corrective action even if the critics of the ACA are not involved. Further, each must be addressed in any new attempt to create workable health care reform.
1) An Impossible Mandate
Problem: The ACA requires individuals to buy a health insurance plan whose cost will grow at twice the rate of growth of their incomes. Not only will health care claim more and more of every family's disposable income, the act takes away many of the tools the private sector now uses to control costs.
Solution: 1) Repeal the individual and employer mandates, 2) offer a generous tax subsidy to people to obtain insurance, but 3) allow them the freedom and flexibility to adjust their benefits and cost-sharing in order to control costs.
2) A Bizarre System of Subsidies
Problem: The ACA offers radically different subsidies to people at the same income level, depending on where they obtain their health insurance - at work, through an exchange or through Medicaid. The subsidies (and the accompanying mandates) will cause millions of employees to lose their employer plans and may cause them to lose their jobs as well. At a minimum, these subsidies will cause a huge, uneconomical restructuring of American industry.
Solution: Offer people the same tax relief for health insurance, regardless of where it is obtained or purchased . . .
3) Perverse Incentives for Insurers
Problem: The ACA creates perverse incentives for insurers and employers (worse than under the current system) to attract the healthy and avoid the sick, and to overprovide to the healthy (to encourage them to stay) and underprovide to the sick (to encourage them to leave).
Solution: Instead of requiring insurers to ignore the fact that some people are sicker and more costly to insure than others, adopt a system that compensates them for the higher expected costs - ideally making a high-cost enrollee just as attractive to an insurer as low-cost enrollee.
4) Perverse Incentives for Individuals
Problem: The ACA allows individuals to remain uninsured while they are healthy (paying a small fine or no fine at all) and to enroll in a health plan after they get sick (paying the same premium everyone else is paying). No insurance pool can survive the gaming of the system that is likely to ensue.
Solution: People who remain continuously insured should not be penalized if they have to change insurers; but people who are willfully uninsured should not be able to completely free ride on others by gaming the system.
5) Impossible Expectations/A Tattered Safety Net
Problem: The ACA aims to insure as many as 34 million uninsured people. Economic studies suggest they will try to double their consumption of medical care. Yet the act creates not one new doctor, nurse or paramedical personnel. We can expect as many as 900,000 additional emergency room visits every year - mainly by new enrollees in Medicaid - and 23 million are expected to remain uninsured. Yet, as was the case in Massachusetts, not only is there no mechanism to ensure that funding will be there for safety net institutions that will shoulder the biggest burdens, their "disproportionate share" funds are slated to be cut.
Solution: 1) Liberate the supply side of the market by allowing nurses, paramedics and pharmacists to deliver care they are competent to deliver; 2) allow Medicare and Medicaid to cover walk-in clinics at shopping malls and other unconventional care - paying market prices; 3) free doctors to provide lower-cost, higher-quality services in the manner described below; and 4) redirect unclaimed health insurance tax credits (for people who elect to remain uninsured) to the safety net institutions in the areas where they live - to provide a source of funds in case they cannot pay their own medical bills.
6) Impossible Benefit Cuts for Seniors
Problem: The ACA's cuts in Medicare are draconian. By 2017, seniors in such cities as Dallas, Houston and San Antonio will lose one-third of their benefits. By 2020, Medicare nationwide will pay doctors and hospitals less than what Medicaid pays. Seniors will be lined up behind Medicaid patients at community health centers and safety net hospitals unless this is changed. Either 1) these cuts were never a serious way to fund the ACA, because Congress will cave and restore them, or 2) the elderly and the disabled will be in a separate (and inferior) health care system.
Solution: Many of the cuts to Medicare will have to be restored. However, Medicare cost increases can be slowed by empowering patients and doctors to find efficiencies and eliminate waste in the manner described below.
7) Impossible Burden for the States
Problem: Even as the ACA requires people to obtain insurance and fines them if they do not, the states will receive no additional help if the estimated 10 million currently Medicaid-eligible people decide to enroll. Although there is substantial help for the newly eligible enrollees, the states will still face a multibillion dollar, unfunded liability the states cannot afford.
Solution: States need the opportunity and flexibility to manage their own health programs - without federal interference. . .
8) Lack of Portability
Problem: The single biggest health insurance problem for most Americans is the lack of portability. If history is a guide, 80% of the 78 million baby boomers will retire before they become eligible for Medicare. Two-thirds of them have no promise of postretirement health care from an employer. If they have above-average incomes, they will receive little or no tax relief when they try to purchase insurance in the newly created health insurance exchange. To make matters worse, the ACA appears to encourage employers to drop the postretirement health plans that are now in place.
Solution: 1) Allow employers to do something they are now barred from doing: purchase personally-owned, portable health insurance for their employees. Such insurance should travel with the individual - from job to job and in and out of the labor market; 2) Give retirees the same tax relief now available only to employees; and 3) Allow employers and employees to save for postretirement care in tax-free accounts.
9) Over-Regulated Patients
Problem: The ACA forces people to spend their premium dollars on first-dollar coverage for a long list of diagnostic tests. Yet if everyone in America takes advantage of all of the free preventative care the ACA promises, family doctors will be spending all their time delivering care to basically healthy people - with no time to do anything else. At the same time, the ACA encourages the healthy to over consume care, it leaves chronic patients trapped in a third-party payment system that is fragmented, uncoordinated, wasteful and designed for everyone other than the patient. . .
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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5. Medical Gluttony: Emergency Room Visits for Non Emergent Medical Problems
Have you every tried to do a complete medical evaluation in the ER when one that took years has already been done?
My last 10 patients with chest pain of concern to their spouses or children because they interpret this as impending death were seen for follow up exam in the office. In all ten cases, no heart disease was found and a brief exam confirmed that the diagnosis was completely missed.
When they arrived at the Emergency Department and said "chest pain," the staff to full attention for an acute "heart attack." However, even a cursory evaluation by a physician should have given the appropriate diagnosis within minutes. A physician, or a nurse, laying his or her hands on the sternum and upper abdomen would have determined that the diagnosis was costochondritis (tenderness of the costal cartilages of the ribs) or GERD (gastroesophageal reflux disease). The first would take a moderate analgesic pill about 15-30 minutes to relieve and the latter would take some liquid antacids a couple of minutes to relieve.
If this had been done, the acute myocardial infarction evaluation would not have been necessary. What is the savings in costs?
Hospital costs are difficult to assess. Patients bring in their statement of thousands of dollars to show how valuable the care was that they received. One patient had a $78,000 statement for two days in the Intensive Care Unit with about $50,000 written off with the remainder paid by his insurance. Since the $50,000 was not a legitimate bill before it was written off, it did not even go to "money heaven" as in bankruptcy with real debts.
We have a patient who works in the Emergency Department of one of the hospitals. She tells us the average charge of an acute myocardial infarction evaluation is about $9,000. She says that every patient that says "chest pain" gets the same evaluation that is implemented as an emergency prior to a doctor seeing the patient.
When the patient is seen in the office the next day, the clinician lays his hand on the chest and palpates the sternum or breastbone. If it is tender, the diagnosis of costochondritis is confirmed. If negative, the clinician proceeds to palpate the upper abdomen or epigastrium. If tender, the diagnosis of GERD is then made. In either case, it is treated as above and symptoms are promptly relieved. The patients generally stare in awe that it was so simple and easy. They are greatly relieved. However, they no longer remember or think of the $9,000 of unnecessary medical costs incurred.
There is no oversight by the insurance carrier or by any government agency that would interrupt this sequence. The only rational reduction in health care costs in the emergency situation would be to place health care in the free enterprise zone, whereby there is a proportionate co-payment on any health care that is rendered. Thus, if a patient had a 20 percent co-payment on ER visits, they would quickly learn the symptoms and signs of the commonly self-treated health care problems. They would implement them at home and if their discomfort were resolved, they would return to watching TV or to bed or whatever their former activity might have been.
This free enterprise technique also works in the middle of an evaluation. We have seen a number of patients who have a legitimate reason for an emergency evaluation. The initial treatment relieves the shortness of breath and the initial battery of tests eliminates the possibility of an acute myocardial infarction (heart attack). This portion of the evaluation is about $3,000, or one-third of the entire evaluation normally given. Patients with a 20 percent co-payment will decide not to proceed further since their co-payment of 20 percent of $3,000 is $600, which they put on their credit card. If the patient does not interrupt the diagnostic evaluation protocol, 20 percent of the entire $9,000 may exceed the credit card limit (20 percent of $9,000 is $1800). In each of the cases observed, the patient made the correct decision to interrupt the protocol and did well. What is never mentioned or appreciated, is that these patients in the free enterprise and responsible health care zone also save two-thirds of the cost of medical care.
That is why our research with our Ideal Health Plan for the US has actuarial estimates of 30 to 50 percent savings in health care costs. If you are an entrepreneur, you may want to purchase a copy of the Business Plan at www.HealthPlanUSA.net and be part of the disruptive enterprise.
There is no other way to reduce our health care costs sensibly.
Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on Every Service.
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6. Medical Myths: The health care reform will improve health care in the US
The AAPS filed suit to invalidate the new massive health care bill.
The Association of American Physicians & Surgeons ("AAPS") fought Hillary Care in the early 1990's and won!
On March 26th, 2010 AAPS filed suit to invalidate the new massive health care bill, which passed the House by only 4 votes on a party-line vote (with 34 Democrats voting against it). Forcing patients to buy insurance that may not even cover the care they need is wrong for patients, physicians, and our nation, and is unconstitutional.
Medical Myths Originate When Someone Else Pays The Medical Bills.
Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service.
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7. Overheard in the Medical Staff Lounge: The repeal of ObamaCare
Dr. Rosen: The House voted to repeal ObamaCare and the Senate voted to sustain the previous vote. Is this a hopeless cause?
Dr. Yancy: I don't think so. They should keep doing it every month. Sooner or later there should be five senators coming to their senses and voting for repeal.
Dr. Paul: Then what? Don't you think it's time to give up?
Dr. Yancy: When five senators come to their senses and there is a majority for repeal, it will go to the president's desk.
Dr. Paul: And then what? You don't really think the president will sign it, do you?
Dr. Yancy: We will then have his decision on record. That record can then be used for the next six years. That would spoil his chance of reelection.
Dr. Paul: I don't think that would dissuade him.
Dr. Yancy: As this country goes broke and we become insolvent, China could call her notes. We then become a colony without firing a shot.
Dr. Paul: You're not a realist Yancy. Nobody would take over the United States.
Dr. Yancy: You're a dreamer. They would in a heart beat.
Dr. Paul: We'd let them without firing a shot or a rocket or a bomb?
Dr. Yancy: Who would fire a shot or a rocket? The socialists in Washington wouldn't dream of going to war.
Dr. Paul: If our freedom was at stake?
Dr. Yancy: Our freedom is at stake with the current socialistic administration.
Dr. Paul: They're just trying to get us in step with the rest of the world.
Dr. Yancy: You're right, that's their goal. But, it is neither mine nor the believers in our constitution.
Dr. Paul: I believe in the Constitution. But that doesn't keep me from believing in free health care.
Dr. Yancy: There is no such thing as free health care. The nursing, medical profession, hospitals and laboratories will always get paid. It's just impersonal. It's routed through the government. So you get hoodwinked into believing it's free.
Dr. Rosen: There's enough here for the rest of the decade. Why don't we take this up next week? Maybe we'll have a demonstration by that time in Washington like they having in Cairo now. We need a regime change.
The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
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When New York Rep. Peter King, the new chairman of the House Committee on Homeland Security, called for congressional hearings on radical Islam in America this fall, the reaction from the official Muslim community was swift. Ibrahim Hooper, president of the Council on American- Islamic Relations, said he feared the hearings would become an "anti-Muslim witch hunt." Abed A. Ayoub of the American-Arab Anti-Discrimination Committee asserted that Mr. King's proposal had "bigoted intentions."
While Mr. King has a reputation for adopting polarizing positions—particularly when it comes to immigration—his hearings deserve serious consideration. "There has to be an honest discussion of the role of the Muslim community—what they are doing, what they're not doing," he explained to the New York Observer in a Nov. 30 article. "I talk to law enforcement people across the country; they will tell me. . . . They don't feel any sense of cooperation."
These concerns are reasonable. Histrionic objections to them only deter Muslims from fulfilling a fundamental Islamic obligation: Meeting our duty to the society in which we live.
According to Islamic law, Muslims are obligated to three entities: the self, God and society. This last has been overlooked too often by Muslims and their adopted societies.
Similar to the Christian obligation to "render unto Caesar what is Caesar's," the Quran and the derived corpus of Islamic jurisprudence support Muslims' engagement with those to whom power is entrusted. Chapter 4, verse 59 of the Quran reads: "Verily, Allah commands you to give over the trusts to those entitled to them, and that, when you judge between men, you judge with justice."
That patriotic majority has a duty not only to follow the laws of the United States, but to make sure that their fellow Muslims do the same. Islam calls this duty "commanding the right and forbidding the wrong." It is an obligation that is sourced widely in Islamic scripture, beginning with the Quran. The scriptures even underline that this duty is shared by both men and women.
In one verse, Muslims are instructed: "Let there be one community of you, calling good and commanding right and forbidding wrong" (3:110). Another instructs: "Believers, the men and the women, are friends of one another; they command right, and forbid wrong" (9:71). Impartiality is critical to fulfilling this duty. As it is written: "And let not the hatred of others to you make you swerve to wrong and depart from justice" (5:8).
The holy texts of Islam emphasize that one's greatest allegiance should be to justice—superseding family and co-religionist ties. "Be strict in observing justice, and be witness for Allah, even though it be against yourselves or against your parents or kindred," the Quran says in chapter 4, verse 36.
Justice is the cornerstone of Islamic life—despite the appalling reality of many Muslim-majority countries today. Every faithful Muslim must contribute to the preservation of justice within their society.
How we respond to possible hearings on radicalism will reveal our own commitment to Islam. Cooperation can take the form of expert testimony, informing on radical entities, and perhaps foremost, educating ourselves about our religion. Lest any doubt remain as to how Muslims must respond to Mr. King's call, an anecdote from the hadith (the Prophet's sayings) makes it explicit. . . .
Dr. Ahmed is author of "In the Land of Invisible Women: A Female Doctor's Journey in the Saudi Kingdom" (Sourcebooks, 2008).
VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about.
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9. Book Review: The Slippery Slope From Assisted Suicide to Legalized Murder
FORCED EXIT - The Slippery Slope From Assisted Suicide to Legalized Murder, by Wesley J Smith, Times Books, div of Random House, New York, 1997, xxvi, & 291 pp. ISBN: 0-8129-2790-7
Wesley J Smith, author of No Contest: Corporate Lawyers and the Perversion of Justice in America, opens his prologue of Forced Exit with the story of a dear friend who spent years planning her suicide and after inviting friends to the event, none of whom came, exited this life quietly. Smith, an Oakland attorney, contacted the executrix and obtained her suicide file wherein he found newsletters and other scurrilous documents from the Hemlock Society that thoroughly sickened him.
This motivated Smith to research into death, the inventing of the right to die that is driving people to embrace the death culture, and euthanasia's betrayal of medicine. He finds that a society that believes in nothing can offer no argument even against death. Seen in this light, support for euthanasia is not a cause but rather a symptom of the broad breakdown of "community" and the ongoing unraveling of our mutual interconnectedness. The consequences of this moral Balkanization can be seen in the disintegration of family cohesiveness; in the growing nihilism among young people that has led to a rise in suicides, drug use, and other destructive behaviors; in the growing belief that the lives of sick, disabled, and dying people are so meaningless that helping them kill themselves can be countenanced and even encouraged.
Smith calls acceptance of euthanasia "terminal nonjudgmentalism." He finds a good example in A Chosen Death by Lonny Shavelson, an emergency physician, who describes "Gene" who has had strokes and depression but is not terminal. Sarah, from the Hemlock Society, is given the task of assisting in his death. Sarah found her first killing experience tremendously satisfying and powerful, "the most intimate experience you can share with a person... More than sex. More than birth." Sarah gives Gene the poisonous brew as if she were handing him a beer. Gene drinks the liquid, falls asleep on Sarah's lap who then places a plastic bag over his head and croons, "See the light. Go to the light." But Gene, suddenly faced with the prospect of immediate death, changes his mind and screams out . . . and tries to rip the bag off his face. Sarah won't allow it, catches Gene's wrist and holds it. Gene's body thrust upwards and Sarah lays across Gene's shoulders . . . pinning him down, twisting the bag to seal it tight. Gene's body stops moving.
Smith says what happened to Gene is murder. He further feels that the ethical thing for Dr Shavelson to have done was to knock Sarah off the helpless man and then dial 911 for an ambulance and the police. Shavelson describes his thoughts on whether to act or observe the death, and Smith calls this non-decision "terminal nonjudgmentalism," or TNJ. He feels that what Shavelson and other death fundamentalists miss is that so-called protective guidelines for the "hopelessly ill" are meaningless; they provide only a veneer of respectability. Once killing is deemed an appropriate response to suffering, the threshold dividing "acceptable" from "unacceptable" killing will be continually under siege. But the fiction of control, essential to the public's acceptance of euthanasia, will have to be maintained, so the definition of what will be seen as "legitimate" killing will be expanded continually.
I personally observed this attitude at the last international meeting of my professional society as I spoke with pulmonologists from The Netherlands, Belgium, and other Western European countries who admitted that "killing patients" occurs rather frequently--sometimes the sickest in the hospital is killed simply to open a bed for a new admission.
As we are beginning to comprehend the holocaust; as African Americans are searching for the relics of their slavery, like the neck irons with their torture springs and who say that this was the real holocaust; when doctors are able to kill thousands of the millions that lie on beds of mercy every day, we will see the epithet of Shindler's List, when doctors directed those whose lives weren't worth living into lines toward the chambers. What was thought to be the efficient killing by the Nazis and the communist doesn't hold a candle to what a free misguided society can do as we open up pandora's box for doctors to kill patients whose only crime was being ill, or alive with a life not thought to be worth living, We must act before it is too late. Otherwise those who do act, will be considered alive, but will not be after their first accident or illness that brings them in contact with ruthless bureaucratic state controlled doctors, a horror we can't imagine, or a thrill, that not even Stalin or Hitler could envision.
The Book Review Section Is an Insider's View of What Doctors are Reading.
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10. Hippocrates & His Kin: Doctor's scales can make you cry.
Little girl who watched her mommy get weighed in the doctor's office tells her friend who was about to get on the scale: "Don't step on it. It'll make you cry."
Patient: Doctor, you only marked eight tests and I would like every test that's on this requisition. I have the best insurance that my boss provides. First class PPO Triple Plus. No deductibles. No co-pays.
Doctor: But I need a reason for every test I order. Why don't you take that requisition home with you and write on each line the medical reason you want the test.
Patient: What do you think that would cost my insurance company?
Doctor: I've never figured up the total cost and the costs aren't that transparent. But I'm told that they would add up to more than $100,000.
Patient: I think that I'm worth it.
Doctor: What if everyone in the country had your attitude? If only 200 million Americans wanted what you want, that would be $20 trillion or ten times the health care cost of the entire country.
and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Today & Tomorrow
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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. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.
• Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .
• 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.patmosemergiclinic.com/ To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .
• 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. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. 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. Read Lin Zinser's view on today's health care problem: In today's proposals for sweeping changes in the field of medicine, the term "socialized medicine" is never used. Instead we hear demands for "universal," "mandatory," "singlepayer," and/or "comprehensive" systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this "nationalized financing" or "nationalized health insurance." In a more honest day, it was called socialized medicine.
• 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 25–50 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, go to www.simplecare.com.
• 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.
• 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.
• ReflectiveMedical Information Systems (RMIS), delivering information that empowers patients, is a new venture by Dr. Gibson, one of our regular contributors, and his research group which will go far in making health care costs transparent. This site provides access to information related to medical costs as an informational and educational service to users of the website. This site contains general information regarding the historical, estimates, actual and Medicare range of amounts paid to providers and billed by providers to treat the procedures listed. These amounts were calculated based on actual claims paid. These amounts are not estimates of costs that may be incurred in the future. Although national or regional representations and estimates may be displayed, data from certain areas may not be included. You may want to follow this development at www.ReflectiveMedical.com.
• 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: Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. 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.
The AAPS California
Chapter is an unincorporated
association made up of members. The Goal of the AAPS California Chapter is to
carry on the activities of the Association of American Physicians and Surgeons
(AAPS) on a statewide basis. This is accomplished by having meetings and
providing communications that support the medical professional needs and
interests of independent physicians in private practice. To join the AAPS
California Chapter, all you need to do is join national AAPS and be a physician
licensed to practice in the State of California. There is no additional cost or
fee to be a member of the AAPS California State Chapter.
Go to California Chapter Web Page . . .
Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"
PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.
Our motto, "omnia pro aegroto" means "all for the patient."
"Seek not to change the world, but choose to
change your mind about the world. What you see reflects your thinking. And your
thinking but reflects your choice of what you want to see."
— Quote from A Course in Miracles
"Never let what you cannot do stop you from doing what you CAN do!" — Stephen Pierce: Internet marketer and author
"There's lots of people in this world who spend so much time watching their health that they haven't the time to enjoy it." — Josh Billings: 19th century humorist
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The Economist | Jan 20th 2011 | from PRINT EDITION
WHEN everyone else at the airline counter for the flight from Hicksville to Washington was sighing, checking their watches and using their elbows on their neighbours, Alfred Kahn would be smiling. And later, cramped in his seat between some 20-stone wrestler and a passenger whose "sartorial, hirsute and ablutional state" all offended him, snacking from a tiny packet of peanuts that had cost him a dollar, he would sometimes allow the smile to spread under his Groucho Marx moustache into a big, wide, gloating grin.
For Mr Kahn had made this crowd and packed this aircraft. His deregulation of America's airlines in the 1970s opened up the skies to the people, for better and worse. And though, being an economist, he could not help muttering about the imperfection of societies and systems and the absurdity of predictions—and though, being an inveterate puncturer of himself, he would demand a paternity test if anyone called him the father of the deregulated world—his adventures with airlines led on to the freeing of the trucking, telecoms and power industries, and heralded the Thatcherite and Reaganite revolutions.
When he took over the Civil Aeronautics Board for President Jimmy Carter in 1977 air travel was regulated to the hilt, with prices, routes and returns all fixed and aircraft, which could compete only on the number of flights and the meals they served, flying half-full. Mr Khan, furiously resisted by companies, pilots and unions, removed the rules. As an academic, author of "The Economics of Regulation" in two stout volumes, he was eager to see those elusive and fascinating things, marginal costs, brought into play: to let prices follow the constantly shifting value of an aircraft seat as demand changed or departure time loomed, or indeed as shiny new jet planes depreciated above him, just "marginal costs with wings".
He had no idea what would happen when he took the restraints off, except that, at a time of raging inflation, he was pretty sure fare prices would fall. The great wave of mergers, predations and bankruptcies that followed shocked him; the reconcentration of the industry into giant hub-and-spoke operations scandalised him; the disappearance of the humble Allegheny Airlines flight that used to take him to work, transformed into USAir's transcontinental ambitions, annoyed him; but he could only be delighted that by 1986 90% of Americans were flying on discounts, and that the savings to consumers were reckoned at around $20 billion a year.
His success was all the more surprising because he was an old-fashioned Democrat, from his shiny pate to the stockinged feet in which, like a lizard, he would pad around the office. (His party piece was Stephen Sondheim's "Send in the Clowns", dedicated to the Reagan administration.) Yet his thinking had scarcely a shred of Keynesianism in it. Mr Kahn sometimes talked wistfully of price caps, especially when he was appointed Mr Carter's "inflation tsar" in 1978, a thankless, staffless, hopeless job which he threw in after 15 months, inflation riding high as ever, declaring that no one else would be fool enough to do it. But politics always ran second to economics, and his economics was the classical kind, in which everything was left to the markets. The government, if it couldn't be useful, should get the hell out of the way. And this, as a federal bureaucrat, he did, enthusiastically undermining his own agency until it ceased to be.
Really, he said, he was a show-off and a ham; he loved the spotlight, and if he hadn't been such a brain at school and college, steaming effortlessly (if short-sightedly) towards the economics department at Cornell, he would have gone in for musicals. The songs of Cole Porter and Irving Berlin were on his lips, as well as numbers from "The Pirates of Penzance" and "The Yeoman of the Guard", in which he sang and danced until his 80s.
Breezily, too, he winged his way in government. He was an academic, after all; he had nothing to lose, so he would speak his mind. Asked once by a reporter if he could defend the defence budget, he said "No". Told off for using the word "depression" in public, he replaced it with "banana", and announced that the country was heading for its worst banana in 45 years. Told off by the head of United Fruit for using "banana", he made it "kumquat". As the oil price continued to soar he called the Arab producers "schnooks", earning yet another rebuke; but he didn't care. He could always go back to being dean of Cornell's College of Arts and Sciences, as he did in 1980, even though "dean is to faculty as a hydrant is to a dog."
His great passion was to set things free: not just the airlines, not just his own wickedly candid tongue, but also the English language. In a famous memo at the start of his stint at the CAB he begged staff to write drafts as if they were destined for their children or their friends; to eschew "herein" and "regarding" and "prior to" in favour of "here", and "about" and "before". Away with gobbledygook and pomposity, though "a final example of pomposity, perhaps, is this memorandum itself." No airs and graces, and preferably no "Alfred" either: just Fred, jetting here and there, round and about, with his discount ticket and his warm, wide, proud, unstoppable smile.
On This Date in History - January 25
On this date in 1890, Elizabeth Cochrane, who wrote for The New York World as Nellie Bly, completed her fantastic trip around the world in the amazing time of 72 days, 6 hours, 11 minutes.
On this date in 1915, Alexander Graham Bell completed the first transcontinental phone call, from New York to San Francisco, inaugurating a new era in speedy communication.
On this date in 1959, a simple priest, who became Pope John XXIII, took a giant step toward bringing the world closer together by calling for an ecumenical council to explore ways to promote unity among human kind.
After Leonard and Thelma Spinrad
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