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MEDICAL TUESDAY . NET |
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Community For Better Health Care |
Vol VIII, No
20, Jan 26, 2010 |
In This Issue:
1.
Featured Article:
Haiti's Biggest Threat
2.
In
the News: Another Failed
Presidency
3.
International Medicine: The NHS is in deep trouble, mired in scandal and incompetence
4.
Medicare: Mayo
Clinic in Arizona stops accepting Medicare
5.
Medical Gluttony:
Laboratory Gluttony
6.
Medical Myths: The
"status quo" versus the "reform"
7.
Overheard in the Medical Staff Lounge: Does the Massachusetts Election give us Hope?
8.
Voices
of Medicine: A
Transatlantic Malaise
9.
The Bookshelf: A short
course in history as our nation's course changes
10.
Hippocrates & His Kin: Health Insurance Portability and Accountability Act
11.
Related Organizations: Restoring Accountability in Medical Practice and Society
Words of Wisdom,
Recent Postings, In Memoriam . . .
* * * * *
Always remember that Chancellor
Otto von Bismarck, the father of socialized medicine in Germany, recognized
in 1861 that a government gained loyalty by making its citizens
dependent on the state by social insurance. Thus socialized medicine, or any
single payer initiative, was born for the benefit of the state and of a
contemptuous disregard for people's welfare.
* * * * *
1. Featured Article: Mental Health Rather than Infectious
Disease may be Haiti's Biggest Threat
Despite
much concern about diseases spreading through Haiti's earthquake-shattered
areas, one epidemiologist explains that mental health issues will be more
widespread. By Katherine Harmon,
Scientific American, Jan 15, 2010.
As the aftershocks of the January 12 magnitude 7.0 earthquake outside of Port-au-Prince,
Haiti, taper off and the dust settles, new needs are coming to light. The
health of many of the three million residents said to have been shaken by the
quake will be determined in the coming weeks as aid workers and others rush to
treat the wounded, provide food and water, and try to prevent disease outbreaks.
Concern already has run high about the spread of cholera and typhus in a country whose everyday "water
supply and basic sanitation services are still very deficient," according
to the Pan American Health Organization. Many diseases, including malaria, HIV and typhoid, were already widespread
issues in Haiti before the earthquake struck, and the intensely weakened health
care system (established hospitals and clinics having collapsed or been
damaged) and other infrastructure is expected to exacerbate these problems. . .
.
But not all of the human harm from this disaster will
be of the physical variety. For example, many experts have noted that the
multitude of dead bodies—some 50,000 possibly having died in the disaster already,
the Red Cross estimates—don't pose an infectious
disease risk so much as a psychological threat to the survivors.
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* * * * *
2. In the News: Another Failed Presidency By Geoffrey P. Hunt, American Thinker, Jan 17, 2010
Barack Obama is on track to have the most spectacularly failed
presidency since Woodrow Wilson
.
In the modern era, we've seen several failed presidencies--led by
Jimmy Carter and LBJ. Failed presidents have one strong common trait-- they are
repudiated, in the vernacular, spat out. Of course, LBJ wisely took the exit
ramp early, avoiding a shove into oncoming traffic by his own party. Richard Nixon
indeed resigned in disgrace, yet his reputation as a statesman has been
partially restored by his triumphant overture to China. . .
But, Barack Obama is failing. Failing big. Failing fast. And
failing everywhere: foreign policy, domestic initiatives, and most importantly,
in forging connections with the American people. The incomparable Dorothy
Rabinowitz in the Wall Street Journal put
her finger on it: He is failing because he has no understanding of the American
people, and may indeed loathe them. Fred
Barnes of the Weekly Standard
says he is failing because he has lost control of his message, and is
overexposed. Clarice
Feldman of American Thinker produced a dispositive commentary showing that
Obama is failing because fundamentally he is neither smart nor articulate; his
intellectual dishonesty is conspicuous by its audacity and lack of shame.
But, there is something more seriously wrong: How could a new
president riding in on a wave of unprecedented promise and goodwill have
forfeited his tenure and become a lame duck in six months? His poll ratings are
in free fall. In generic balloting, the Republicans have now seized a five
point advantage. This truly is unbelievable. What's going on?
No narrative. Obama doesn't have a narrative. No, not a narrative
about himself. He has a self-narrative, much of it fabricated, cleverly
disguised or written by someone else. But this self-narrative is isolated and
doesn't connect with us. . . We admire those presidents whose narratives
not only touch our own, but who seem stronger, wiser, and smarter than we are.
Presidents we admire are aspirational peers, even those whose politics don't
align exactly with our own: Teddy Roosevelt, FDR, Harry Truman, Ike, Reagan.
But not this president. It's not so much that he's a phony, knows
nothing about economics, is historically illiterate, and woefully small minded
for the size of the task-- all contributory of course. It's that he's not
one of us. And whatever he is, his profile is fuzzy and devoid of content, like
a cardboard cutout made from delaminated corrugated paper. Moreover, he doesn't
command our respect and is unable to appeal to our own common sense. His
notions of right and wrong are repugnant and how things work just don't add up.
They are not existential. His descriptions of the world we live in don't make
sense and don't correspond with our experience.
In the meantime, while we've been struggling to take a measurement
of this man, he's dissed just about every one of us--financiers, energy
producers, banks, insurance executives, police officers, doctors, nurses,
hospital administrators, post office workers, and anybody else who has a
non-green job. . .
Mercifully, the Founders at the Constitutional Convention in 1787
devised a useful remedy for such a desperate state--staggered terms for both
houses of the legislature and the executive. An equally abominable Congress can
get voted out next year. With a new Congress, there's always hope of
legislative gridlock until we vote for president again two short years after
that.
Yes, small presidents do fail, Barack Obama among them. The
coyotes howl but the wagon train keeps rolling along.
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* * * * *
3.
International
Medicine: The UK National Health Service is in deep trouble
Michael Moore has mad view of the NHS by Minette Marrin,
Sunday-Times.co.uk
"You'd
never guess from his film that the NHS is in deep trouble, mired in scandal and
incompetence"
The fourth estate has
always had a bad name, but it seems to be getting worse. Journalism should be
an honest and useful trade, and often still is. But now that journalism has
more power than ever before, it seems to have become ever more disreputable. In
recent years it has been brought lower and lower by kiss-and-tell betrayals, by
"reality" TV, by shockumentaries and by liars, fantasists, hucksters
and geeks of every kind, crowing and denouncing and emoting in a hideous new
version of Bunyan's Vanity Fair.
Outstanding among these
is Michael Moore, the American documentary maker. He specialises in searing
indictments, such as Fahrenheit 9/11 and Bowling for Columbine, and has,
without a doubt, a genius for it. Although his films are crude, manipulative
and one-sided, he is idolised by millions of Americans and Europeans, widely
seen as some sort of redneck Mr Valiant-for-truth.
Nothing could be further
from the truth. His latest documentary, Sicko . . . is a dishonest film. That
is not only my opinion. It is the opinion of Professor Lord Robert Winston, the
consultant and advocate of the NHS. When asked on BBC Radio 4 whether he
recognised the NHS as portrayed in this film, Winston replied: "No, I
didn't. Most of it was filmed at my hospital [the Hammersmith in west London],
which is a very good hospital but doesn't represent what the NHS is like."
I didn't recognise it
either, from years of visiting NHS hospitals. Moore painted a rose-tinted
vision of spotless wards, impeccable treatment, happy patients who laugh away
any suggestion of waiting in casualty, and a glamorous young GP who combines
his devotion to his patients with a salary of £100,000, a house worth £1m and
two cars. All this, and for free.
This, along with an even
rosier portrait of the French welfare system, is what Moore says the state can
and should provide. You would never guess from Sicko that the NHS is in deep
trouble, mired in scandal and incompetence, despite the injection of billions
of pounds of taxpayers' money. . .
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The NHS does
not give timely access to quality healthcare; it only gives access to
incompetence.
* * * * *
4. Medicare: Mayo Clinic in Arizona stops accepting
Medicare
MEDICARE AND THE MAYO CLINIC
President Obama is a great admirer of the Mayo
Clinic. Time and again he has extolled it as an outstanding model of
health care excellence and efficiency. So perhaps the president will give
some thought to the Mayo Clinic's recent decision to stop accepting Medicare
payments at its primary care facility in Glendale, Arizona, says columnist Jeff Jacoby.
Consider:
More than 3,000 patients will have to start paying cash if they
wish to continue being seen by doctors at the clinic; those unable or unwilling
to do so must look for new physicians.
For now, Mayo is limiting the change in policy to its Glendale
facility, but it may be just a matter of time before it drops Medicare at its
other facilities in Arizona, Florida and Minnesota as well.
Why would an institution renowned for providing health
care of "the best quality and the lowest cost" choose to sever its
ties with the government's flagship single-payer insurance program?
Because the relationship is one it can't afford, explains Jacoby:
Last year, the Mayo Clinic lost $840
million on its Medicare patients.
At the Glendale clinic specifically, a spokesman told Bloomberg,
Medicare reimbursements covered only 50 percent of the cost of treating elderly
primary-care patients.
Not even the leanest, most efficient medical organization can
keep doing business with a program that compels it to eat half its costs.
The Centers for Medicare and Medicaid Services, a
branch of the U.S. Department of Health and Human Services, estimated last
month that the Senate bill would squeeze $493 billion out of Medicare over the
next 10 years. As a result, it cautioned, "providers for whom
Medicare constitutes a substantive portion of their business could find it
difficult to remain profitable and… might end their participation in the
program."
Nearly six months ago, the Mayo Clinic tried to sound
an alarm, says Jacoby. Instead of making American health care better and
more affordable, it warned, the legislation working its way through Congress
will do the opposite and the real losers will be the citizens of the United
States.
Source: Jeff Jacoby, "Medicare and the Mayo
Clinic," Jewish
World Review, January 3, 2010.
For text: http://jewishworldreview.com/jeff/jacoby010610.php3
For more on Health Issues: www.ncpa.org/sub/dpd/index.php?Article_Category=16
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Government is not the solution
to our problems, government is the problem.
- Ronald Reagan
* * * * *
5. Medical Gluttony: Laboratory Gluttony
Recently after I saw a patient with a
single disease, I was checking off on the laboratory requisition a CBC, UA,
chemistry and lipid panel, which I thought was basically needed and consistent
with best practices for new patients. The patient asked me if she could have
every test on the requisition. She further stated that she wanted to be
pro-active and make sure she was in the best of health. She stated that she had
insurance and it wouldn't cost her anything.
I pointed out to her that I had to have
medical justification for every test. I explained that these tests I ordered
are similar to what my personal physician orders on me every year and the bill
I receive from the laboratory is $376. I further illustrated that there are
more than one hundred tests on this requisition, plus a dozen multi-test
panels, plus more than 30 tests listed on the bottom of the requisition.
Yes, but I have insurance and I deserve to
have all the tests I think I need, she continued.
I'm sorry, I responded. But isn't that the
reason you have doctors - to make a medical determination on what you need?
But doctors are so stingy with tests and
they miss a lot of things. So I have a legal right to these other tests, she
replied.
But if we obtained the other one hundred
plus tests, that would be tens of thousands of dollars. We ordered common tests
on you that cost the insurance company $376. All these other tests include
endocrine, hormone, and vitamin level tests which may cost 10 to 20 times what
a simple blood count costs. And they would not improve your health.
I'm not asking that they be done every
year, she explained. I just think maybe once every ten years everything
possible should be done. Why do I pay for insurance?
You have insurance to pay ordinary costs
needed for your health care. All these additional extra-ordinary costs are
expensive. For the insurance to pay ten or a hundred times the usual cost would
mean that your insurance premiums would have to increase ten or a hundred times
the present level.
But my employer pays for my health
insurance, she assured.
Your employer won't pay for them long if
the premium goes up so astronomically.
We'll just have President Obama pass a law
to force employers to pay for all health insurance. That'll solve the problem
won't it, she asked?
No it won't. Employers will go out of
business and we'll regress to an agrarian and barter economy. Then we'll
respond to market forces where everyone is reasonable because it's expensive
not to be.
But that will force employers to pay since
they have a lot of money and a lot of profit, she continued.
Employers can't pay beyond their income.
They can't print money like the government and continue to be irresponsible.
Let's just look at how market forces would affect your request for laboratory
tests. First we have to put your insurance plan on the market by making you
responsible for at least a small portion of the cost of laboratory care. Shall
we start with 20 percent? In my case that would mean that I would be paying $76
of my laboratory bill which is the same that I ordered on you. So if I ordered
twice as many tests on you and it costs $750, your copay would be $150. Would
you then want twice as many tests?
No I wouldn't want to be responsible for
that kind of a co-payment, she admitted; but I would want the tests.
The insurance company has no more money
than the premiums we pay. So the more you want, the higher your premiums will
be. If your employer pays the premium, he would just have to deduct twice as
much from you salary for you health care. You can't give him the authority to
print money like Uncle Sam. . .
Having doubled her appointment time, I could see that
I would be unable to educate her even if I tripled her appointment time and so
I moved on to the next patient.
But it does show that we can place health care in a
market environment, which would reduce costs by making the patient a
participant in the health care decision-making process. The mechanism to bring
the patient into this decision-making process is for the patient to have a
percentage co-payment responsibility. This would force the patient to be
interested in the cost of every test or procedure ordered and to understand why
it should be done or if it should be "axed" on the spot. This would
be an instant way to cut health care costs dramatically without any government
or insurance oversight. Freedom in the consultation room would be restored.
Medical costs would plummet. Quality of health care would rise. This would be a
triple winner.
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Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on
Every Service.
* * * * *
6. Medical Myths: The "status quo" versus the
"reform"
AAPS Myth 14: We must choose between the "status quo" and the
Democrats' "reform" plan
The strategy during the August recess was outlined by
Paul Begala, a Democrat strategist close to the White House: "Supporters
of reform have to put the status quo on trial" (Politico.com
7/26/09).
"If somebody told you that there is a plan out
there that is guaranteed to double your health care costs over the next 10
years, that's guaranteed to result in more Americans losing their health care,
and that is by far the biggest contributor to the federal deficit, I think most
people would be opposed to that," Obama said. "Well, that's the
status quo," he claims (ibid.).
Members of Physicians for a National Health Program
(PNHP) identify the 70-some health plans with which they have voluntarily
contracted as the status quo, or even as the "free market," and complain
bitterly about the poor remuneration and costly administrative hassles.
AAPS does not support the status quo, but
over years and decades has advocated fundamental reforms that—unlike the
Democrat plans—
- impose no
new net burdens on the taxpayer;
- do not
hasten the bankruptcy of federal and state governments;
- create no
new bureaucracies or stakeholders; and
- involve no
expansions of government or additional accrual of
unconstitutional powers.
Instead, AAPS supports reforms that:
- improve the quality of
care by encouraging innovation;
- decrease
systems-gaming and nonproductive work related to justifying
price-controlled fees;
- allow physicians to
concentrate on healing rather than constantly changing administrative
rules;
- restore the
patient/physician relationship and the joy of practicing medicine;
- increase supply,
availability, and competition, and thus decrease costs and make it easier
to serve those who are most in need of help; and
- discourage frivolous
or predatory litigation.
Reform can begin immediately at the individual level,
as physicians quit participating in third-party arrangements, and patients fire
health plans that insist on intruding into the patient/physician relationship.
Specific desirable legislative changes include the
following: Read the
changes the AAPS supports . . .
A coalition of state and specialty medical societies has drafted
a letter to Congress espousing a patient-centered system rather than a
government-controlled system—the right kind of change from the status quo.
Additional information:
- AAPS White Paper on
Medical Financing, J Am Phys Surg, Fall 2006.
- Physicians Declaration
of Independence.
- How to Opt Out of
Medicare.
- AAPS White Paper on
Medicare Reform, June 7, 1995.
- Resolutions
adopted at the 1992 annual meeting of AAPS, including repeal of
McCarran-Ferguson.
www.aapsonline.org/newsoftheday/00406
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Medical Myths Originate When Someone Else Pays The Medical Bills.
Myths Disappear When Patients Pay Appropriate Deductibles and
Co-Payments on Every Service.
* * * * *
7. Overheard in the Medical Staff Lounge: Does The
Massachusetts Election give us Hope?
Dr.
Rosen: This has been an eventful
week. The Socialists health care plan may not be a fait accompli after all.
Dr.
Dave: With Scott Brown's victory last
night, the socialists, misnamed as liberals, will be on the run.
Dr.
Yancy: Harry Reid will certainly be
another victim at the regular elections next year. Nevada is against the health
care monstrosity.
Dr.
Sam: I think there are about a dozen
socialist's Senate seats that are up and with the mood of the country returning
to its Constitutional Roots, several of them will be won by Freedom-loving
candidates.
Dr.
Paul: Don't be so sure we'll lose.
The people want free health care. The whole world has free health care. It's a
march that will go on to victory.
Dr.
Ruth: I don't think there is any such
thing as free health care. If it were true, we'd all be working for slave
wages.
Dr.
Paul: My friends in England brag
about their system being so free and universal. That's the humane thing to do.
Dr.
Sam: You must live on a different
planet than I do, Paul. From what I read and what my friends tell me, they wait
for months to get life-saving surgery.
Dr.
Paul: And my friends in the UK make
£130,000. That's not bad for a 40-hour work week and no night work or stress.
Dr.
Yancy: That's about £2500 a week.
Dr.
Ruth: Let's see. A pound is about
$1.40. So that would be $3500 a week. I think my family and I could live on
that.
Dr.
Yancy: And give up the freedom of
managing your own practice and decisions?
Dr.
Ruth: After twenty years of practice,
with my children getting ready for college, I'm getting ready to give up
freedom for security.
Dr.
Yancy: You're also giving up quality
care. You have to follow government-approved protocols that you know are not
the best for your patients. Wouldn't that bother you?
Dr.
Ruth: Yes, it would. But it's not
humanly possible to hold out for the best forever when everything is devolving
into the lowest common denominator.
Dr.
Rosen: What if our great grandparents
had given up the ship in the 1770s and 1780s and we were living under kings and
despots without a voice? Do you want our grandchildren to revert to such a life
that was present for millennia before the great American Experiment in Freedom?
Dr.
Dave: Rosen, you always give us hope.
The election sure gave me hope. I think this should give us the stamina to see
things through and to turn our country and our health care around to greater
freedom for our physicians and our patients and continue the highest quality of
care in the world.
Dr.
Rosen: See, we can do it if we all
set our minds towards the same goals our forbearers had. We don't have to clear
the land like they did. But to clear the socialistic mind sets of so many of
our colleagues and citizens may be a greater challenge than making forests
tillable.
Dr.
Dave: Well, maybe I'll accept the
challenge after all. The stakes are rather high, don't you think.
Dr.
Rosen: Another caveat. The CATO
newsletter received today notes that in 2006, Massachusetts
enacted a sweeping health insurance law that mirrors the legislation currently
before Congress. And Scott Brown voted for it. So we can never be entirely sure
of anybody's credentials any more. Is he a RINO like Mitch Romney?
Dr. Dave:
Maybe he voted for it for political reasons since Romney was Governor. I would
trust Brown more than Romney.
Dr. Rosen:
It's difficult today to separate the RINOs and the DINOs. One has to pay close
attention and sometimes infer from verbal cues. But Romney should never be
allowed to represent us in Washington. He's dangerous and a socialist. If he
were in power, he could be doing the same thing that Obama is doing. A RINO
doing government control is worse that a DINO enslaving us.
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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
* * * * *
8. Voices of Medicine: A Review of Local and Regional
Medical Journals
From Sonoma
Medicine, the Official Journal of the Sonoma County Medical Association,
Winter 2010
A Transatlantic Malaise by John Toton, MD
Physicians receive an overwhelming number of medical journals
and medical newspapers on topics of current interest, usually supported by
advertising. We scan and sometimes read this flood of information, but
occasionally an article or reference stands out, and we follow up on it. Such
was the case with an article about Physician Disempowerment: A Transatlantic
Malaise, a "treatise" on the reality of European medicine from
the physician's perspective.
I
downloaded the treatise from www.cmpi.org, the website for the Center
for Medicine in the Public Interest, an organization that lobbies for a
traditional American approach to medicine. The treatise consists of the full
texts of 12 presentations made at a 2008 conference on physician disempowerment
sponsored by CMPI. Half the presenters were physicians, PhDs and other experts
from the United States, and the other half were from countries with
nationalized health care systems.
Editor
Mark Crane introduces the presentations by affirming the "American
malaise." According to Crane, the United States is losing doctors because
of excess paperwork, retirement, and practices that are overextended and
overworked. He predicts a shortage of 35,000 to 40,000 primary care physicians
by 2025.
"Person
in the street" interviews conducted by CMPI in New York City highlight how
little the public knows about Canadian and European systems. When asked whether
they would want universal health care, the answer was invariably yes; but when
asked how much extra income tax they would pay, a typical response was,
"No, no, no. We want it to be free, like in Europe."
The
keynote speaker, Dr. Francois Sarkozy (brother of French President Nicolas
Sarkozy), addresses what kind of care one gets in France "for free."
He describes the flight of French physicians away from private practice to
salaried positions. He finds a paradox that there are now more physicians per population
than ever before, and that many are seeking "the balanced life" while
practicing only 50% to 75% of the time. Physicians are unionized, and their
medical fees are agreed upon between the government and the union. Having given
up their independence, says Sarkozy, physicians reluctantly accept the
regimentation and loss of collaboration, along with the loss of accountability
and quality assessment.
Sarkozy
identifies a "physician malaise," arguing that all is not well.
Physicians need to recover their respected status and recognition in the
community; they need to relearn the principles of independent practice, to
delegate, to seek efficiency, to collaborate—in short, to redevelop what
they've given up, what American medical practice up to now fights to maintain.
Dr.
Tim Evans, from Great Britain, describes waiting lists that have become
"intolerable." The country has a population of 60 million and a
health care budget exceeding $175 billion per year, yet Great Britain at any
given time has more than 1 million people on an active waiting list for care
and an additional 200,000 trying to get onto that list. Seven million people
also have private medical insurance, and another six million will pay cash to
get their desired or needed care. This situation, says Evans, is a far cry from
a 1948 government promise that "The National Health Service will provide
you with all medical, dental, and nursing care. Everyone, rich or poor, will be
able to use it." Physicians in the NHS now tell patients, in effect, "If
this is an NHS dialogue, you can have 10 minutes. If you want to pay privately,
then we might have a slightly longer, slightly more fruitful
conversation."
Evans
claims that most British physicians now realize that there are only two ways to
organize health care. One is on an entrepreneurial basis, where you serve
customers and create value. The other is to organize care politically and put
the politicians in charge, making physicians "a salaried lackey of the
state."
Jacob
Arfwedson, director of the Paris office of CMPI, describes the issues in
Sweden, a country with a longtime government model of health care. Sweden
recently began offering "choice of care" options with
performance-based pay for medical physician entrepreneurs. The Karolinska
Hospital in Stockholm, known worldwide as a model of state care, now runs
training sessions in private care. The state is naturally opposed to these
developments, but as market-based care models demonstrate improved services,
they are becoming firmly entrenched, according to Arfwedson . . .
Other
presenters rehash our American complaints and observe that American baby
boomers want universal care at no cost to themselves. While American physicians
are acutely aware of our own problems, we are grossly unaware of the European
and Canadian systems. Our fellow physicians in these countries have the
experience to advise us of what is ahead.
The
presenters in Physician Disempowerment speak to a wide range of
government mandated and supervised health care options, all of which appear to weigh
heavily on the backs of physician providers. Although CMPI is clearly an
advocacy organization with a conservative viewpoint, its treatise does offer an
informative window into an experience we may all be facing in the near future.
Dr. Toton, a Healdsburg
orthopedic surgeon, serves on the SCMA Editorial Board.
Back to Sonoma Medicine Winter 2010 Table of
Contents
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VOM Is an Insider's View of What Doctors are Thinking, Saying and
Writing about.
* * * * *
9. Book Review: A short course in history as our
nation's course changes from its historical roots
A
Time For Freedom, by Lynne
Cheney, Simon & Schuster, New York, © 2005, ISBN: 13-978-1-4169-0925-5, 282
pp, $15.95 US, $21.95 CAN.
"No one can fully appreciate the great fortune we
have to be Americans without knowing the events that brought us to where we are
today." –Lynne Cheney
Lynne
Cheney, a teacher, states in her introduction that our freedom and strength are
products of the past, and although the choices made by the brave men and women
who preceded us do not offer sure guidance to the future, they offer the best
guidance that we have.
Unfortunately,
fewer and fewer of us are leaving school knowing the basic facts of our
history. One study found that two thirds of seventeen-year-olds could not
identify the half-century in which the Civil War occurred. A survey of seniors
at elite colleges and universities showed that only one out of five was
familiar with the words of the Gettysburg Address. A significant number of
seniors thought that Ulysses S. Grant was a general in the Revolutionary War.
Facts
alone are not enough for understanding history of course, but without the facts
understanding is impossible. A full appreciation of the achievement represented
by the Nineteenth Amendment, ratified in 1920, requires knowing that women
first organized to work for the right to vote in 1848, more than seventy years
before. Comprehending why the Civil War occurred in the 1860s requires knowing
that our nation expanded dramatically in the 1840s. It was a question of
whether new states would be free or slave that finally made it impossible to
paper over the great moral contradiction that slavery represented in a nation
dedicated to freedom.
Cheney
feels that some dates should be locked in our memory—1492, 1607, 1620, 1776,
and 1787 for starters. But it is equally important to be familiar enough with
the order of events so that one has a sense of the progress of our national
story. We should all understand that when the delegates to the Continental
Congress declared that "all men are created equal," they provided
more than a rationale for independence; they gave inspiration to generations of
men and women whose struggles would make that ideal a reality for more and ever
more Americans.
This
book is a time line of the events in our nation's history. She chose to
highlight our political history rather than many other areas of importance. She
feels the history of the entire world ought to be a subject of interest for
students. But in A Time for Freedom, she chose to start with America.
This is our home—how lucky we are that it is.
We
shall highlight a few dozen of the hundreds of dates she has listed hoping that
will inspire you to obtain a copy of her book and search further.
BEGINNINGS:
1492
Under
the sponsorship of King Ferdinand and Queen Isabella of Spain, Christopher
Columbus and his crew sail three ships, the Niña, the Pinta, and the
Santa Maria, more than three thousand nautical miles across the
Atlantic. Hoping to find the Indies, Columbus lands instead on an island in the
Bahamas that he names San Salvador, or "Holy Savior." Columbus made
four voyages to the New World, which he persisted in believing was the Indies.
He died ignorant of his real accomplishment.
"An age will come after many years when the ocean
will loose the chains of things, and a huge land lie revealed." –A
Prophecy in Seneca's Medea, a play Columbus knew well
"The prophecy was fulfilled by my father the admiral, in the year
1492." –Ferdinand Columbus, writing alongside the prophecy in his father's
copy of Seneca . . .
"Is life so dear, or peace so sweet, as to be
purchased at the price of chains and slavery? Forbid it, Almighty God! I know
not what course others may take; but as for me, give me liberty or give me
death!" –Patrick Henry
British
troops moving to seize a store of arms in Concord, Massachusetts, encountered
militiamen at Lexington, and shooting breaks out, leaving eight colonists dead.
A skirmish at North Bridge forces the British to retreat; by the time they make
it back to Boston, 273 redcoats are killed, wounded or missing.
"Stand your ground. Don't fire unless fired upon,
but if they mean to have war, let it begin here." –Militia Captain John
Parker
One the night of April 18, 1775, both Paul Revere and
William Dawes rode to sound the alarm that the redcoats were coming. They
reached Lexington but then ran into a British patrol. Dawes turned back, and
Revere was arrested, but Dr. Samuel Prescott, who had joined Revere and Dawes,
made it to Concord and alerted the militia there. . .
In
what will become known as the Battle of Bunker Hill, the British attack
American Militiamen dug in on Breed's Hill and drive them off, but only after
suffering more than one thousand casualties.
"I wish [we] could sell them another hill at the
same price." –American General Nathanael Greene
1776
Thomas
Paine's essay Common Sense lays out the case for revolution.
"The period of debate is closed. Arms, as the
last resource, decide the contest . . . The blood of the slain, the weeping
voice of nature cries, 'Tis Time to Part." –Thomas Paine
July 4, 1776
The
Continental Congress formally approves the Declaration of Independence.
"We hold these truths to be self-evident, that
all men are created equal, that they are endowed by their creator with certain
unalienable rights, that among these are life, liberty and the pursuit of
happiness." –The Declaration of Independence
1777
Congress
adopts the Stars and Stripes.
"Resolved, that the flag of the thirteen United
States be thirteen stripes, alternate red and white; that the Union be thirteen
stars, white in a blue field, representing a new constellation."
–Continental Congress
1781
The
Articles of Confederation are ratified and become the governing framework for
the thirteen states.
With
the help of a French fleet and troops, American forces under the command of
General Washington defeat General Charles Cornwallis and his forces at
Yorktown, effectively ending the war.
"Oh God! It is all over." –British Prime
Minister Lord North, according to legend
1783
The
Treaty of Paris formally ends the Revolutionary War.
"The citizens of America . . . are, from this
period, to be considered as the actors on a most conspicuous theater, which
seems to be peculiarly designated by Providence for the display of human
greatness and felicity." –George Washington, Circular to the States
1787
Delegates
meeting in Philadelphia create a new and stronger framework for government, the
Constitution of the United States.
"We the people of the United States, in order to
form a more perfect union, establish justice, insure domestic tranquility,
provide for the common defense, promote the general welfare, and secure the
blessings of liberty to ourselves and our posterity, do ordain and establish
this Constitution for the United States of America." –Preamble to the
Constitution
1789
George
Washington is sworn in as the first president of the United States.
"I walk on untrodden ground." –President
George Washington . . .
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review . . .
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10. Hippocrates & His Kin:
HIPAA Compliance after the Stimulus Package
Brochures are fast arriving to "help"
physicians comply with the new stimulus package. One states that the new
stimulus package has dramatically increased HIPAA compliance requirements. DO
NOT MISS THIS SEMINAR! Bring all your business associates because HIPAA now
applies to all business associates too! Who Should Attend? The brochure lists
30 health care titles that must attend. What will you learn during the six-hour
course? Pay your $219; 2-4, $209 each; 5 or more, $199 each and see. After a
thousand attorneys wrote the new health care bill and stimulus package, it
would take a faculty of attorneys to explain the ramifications. Yes, the course
director and the faculty are all attorneys to explain what they foisted upon
us.
The litigation that will follow should put an extra $100K into each
trial attorney's pocket.
Coding Guidelines to increase you Re-imbursement
Another brochure arrived on
the Massachusetts Senatorial Election Day to fill Senator Kennedy's term. It
was to improve the amount of money you can get out of your insurance company
for every patient you see. This course is taught by non-physicians telling
physicians how to charge for their services to get the most money from the
insurance industry. I also noted the cost to doctors was the same as above.
If everyone were able to rake an extra 20
percent from insurance, wouldn't health care costs soar?
I thought our goal was to decrease health
care costs.
Health Insurance Portability and Accountability Act
I understand there is
another course for attorneys, government officials, and insurance companies to
understand how you can now through HIPAA obtain patient records en mass without
notifying the patient and preventing the doctor or hospital from informing the
patients that their records went out without their permission. Government
agencies and insurance companies now have free right of access. Doctors and
patients thought this had reference to their health insurance being portable to
their new job. They never fully understood that it referred to the medical
record being Portable without Accountability.
The benefit of having attorneys write health
care laws is that only attorneys benefit.
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* * * * *
11.
Professionals Restoring Accountability in Medical Practice, Government
and Society:
•
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.
•
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. During your
visit you may wish to enroll your own data to attract patients to your
practice. This is truly innovative and has been needed for a long time.
Congratulations to Dr. Gibson and staff for being at the cutting edge of
healthcare reform with transparency. Here are some important innovative
presentations for you to read and digest:
LH - Manuscript - The Critical Role Patients Will Play in the
New Financing System for Health Care.pdf
LH - Manuscript - The Critical Role Pharmacists Will Play in
the New Financing System for Health Care.pdf
LH - Manuscript - The Critical Role Doctors Will Play in the
New Financing System for Health Care.pdf
LH - Manuscript
- The Critical Role Doctors Will Play in the New Financing System for Health
Care.pdf
LH2 -
Manuscript - International Hospital Participation in the U.pdf
•
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.
•
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. For starters, read An Open Letter to America's Physicians
Be sure to read News of the Day in
Perspective: Chicago Tribune exposes AMA – "Medical
billing code monopoly explains AMA support for health plan." 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 ClimateGate hit as
1,200 stretch limousines were converging on Copenhagen. 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.
* * * * *
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plans and our pending national challenges, please go to www.healthplanusa.net/newsletter.asp
and enter your email address. Then go to the archives to scan the last several
important HPUSA newsletters and current issues in healthcare.
Please note that sections 1-4, 6, 8-9 are
entirely attributable quotes and editorial comments are in brackets. Permission
to reprint portions has been requested and may be pending with the
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Del Meyer, MD, Editor & Founder
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"The
trouble with Socialism is, sooner or later you run out of other people's
money." -Margaret
Thatcher
"When
you subsidize poverty and failure, you get more of both." -James Dale
Davidson, National Taxpayers Union
"The
more corrupt the state, the more it legislates." -Tacitus
"A
Liberal is a person who will give away everything he doesn't own." -Unknown
Liberals
should be renamed: Socialists
Some Recent
Postings
Politicians Cannot Manage a Health Care System . . . by David Gibson, MD
www.healthplanusa.net/archives/October09.htm
. . . Read the ten-page summary of the 2,000 page worst health care tax
increase legislation before Congress in its two century history
HealthPlanUSA.net/Newsletters.
. . Stay Current with the HealthPlan Debate . . .
In Memoriam
Tsutomu Yamaguchi, a double
nuclear survivor, died on January 6th, aged 93
From
The Economist print edition, Jan 14th 2010
WHEN
he had stopped crying, Tsutomu Yamaguchi would tell you why he called his book
of poems "The Human Raft". It had to do with the day he forgot to
take his personal name-stamp to work, and had to get off the bus. Much was on
his mind that morning. He had to pack his bags to leave Hiroshima after a
three-month assignment as an engineer in the Mitsubishi shipyard; there were
goodbyes to say at the office, then a 200-mile train journey back to Nagasaki
to his wife Hisako and Katsutoshi, his baby son. He was slightly stressed when
he got to his stop, still with half-an-hour's walk ahead of him on a track that
led through featureless potato fields. But it was a beautiful August day; the
sky was clear, his spirits high. And then—readers will feel a tremor, but he
felt none—he noticed an aircraft circling, and two parachutes dropping down.
The
next thing he knew was a blaze of white magnesium light, and a huge ball of
fire. He dived to the ground. The fireball, roaring upwards, sucked him up
again and threw him, blinded, face-down into the mud of the potato field. He
was two miles from the epicentre of the blast, in a rain of flaming scraps of
paper and clothes. His upper body and half his face were badly burned, his hair
gone and his eardrums ruptured. In this state, he made his way back to the
devastated city to try to do what he had meant to do that day: catch the train.
The river bridges were down. But one river was full of carbonised naked bodies
of men, women, children, floating face-down "like blocks of wood",
and on these—part treading, part paddling—he got to the other side. His human
raft.
At
this point in his story he would weep uncontrollably. It was by no means the
end of it. When he reached Nagasaki, barely pausing to get his burns dressed,
he reported for work. His boss was sceptical: how could a single bomb have
destroyed Hiroshima? Then the same white magnesium light blazed in the window,
and Mr Yamaguchi was tossed to the ground again. A reinforced-steel stairwell
saved him. His bandages were blown off, and he spent the next weeks curled
round his raw wounds in a shelter, close to death. His house was destroyed, his
wife and son saved for no reason he could see. But when schoolchildren later
asked him, in awed respect, "What was the most terrible thing?", his
answer was not the dangling tongues and eyeballs, not the skin that hung off
the bodies of the living "like giant gloves"—but the bridge of bodies
on which he had crossed the river. . .
On This Date in
History - January 26
This date in 1778 is known as Australia
Day, commemorating the settlement of British convicts, of whom there were too
many to keep in England, who were diverted from America because of the
Revolutionary War. It is a
comment on both the hardiness and the resilience of disadvantaged people that
from these convict settlers Australia developed into one of the great civilized
lands in the South Pacific. When tested, the goodness of people emerged—and
more good people were attracted. Thus Australia Day gives us today a timely
reminder that faith in people can be well rewarded.
After Leonard and
Thelma Spinrad
The 7th Annual World
Health Care Congress
Advancing solutions for business and health care CEOs to
implement new models for health care affordability, coverage and quality
. The 7th
Annual World Health Care Congress will be held April 12-14, 2010
Washington, DC
www.worldhealthcarecongress.com
Toll Free: 800-767-9499
In partnership with MedicalTuesday.net, the 6th
Annual World Health Care Congress was the most prestigious meeting
of chief and senior executives from all sectors of health care. The 2010
conference will convene 2,000 CEOs, senior executives and government officials
from the nation's largest employers, hospitals, health systems, health plans,
pharmaceutical and biotech companies, and leading government agencies.