MEDICAL TUESDAY . NET

NEWSLETTER

Community For Better Health Care

Vol VI, No 7, July 10, 2007

 

In This Issue:


1.      Featured Article: The Declaration of Independence, WSJ, by Joyce Lee Malcolm

2.      In the News: Look At Health Data, Not Propaganda, Baltimore Sun, By Grace-Marie Turner

3.      International Medicine: The Collapse Of Morale in the NHS, The Telegraph

4.      Medicare: Government and Health Care – Are They Compatible ooOr Are They Adversaries?

5.      Medical Gluttony: I Have Two Electric Wheelchairs!

6.      Medical Myths: More Health Care Is Always Better

7.      Overheard in the Medical Staff Lounge: Do Doctors Agree with “Moore” on Healthcare?

8.      Voices of Medicine: Michael Moore on Healthcare Reform, by Jim Murtagh, MD

9.      From the Physician Patient Movie/Bookshelf: SiCKO

10.  Hippocrates & His Kin: Happy Independence Day

11.  Related Organizations: Restoring Accountability in HealthCare, Government and Society

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The Annual World Health Care Congress, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. Last year it was 50 percent, indicating open forums such as these are critically important. The 4th Annual World Health Congress was held April 22-24, 2007 in Washington, D.C. This year many of the world leaders in healthcare concluded that top down reforming of health care, whether by government or insurance carrier, is not and will not work. We have to get the physicians out of the trenches because reform will require physician involvement. The World Health Care Congress - Middle East will be held in Dubai, United Arab Emirates, on November 12-14, 2007. The World Health Care Congress - Asia will be held in Singapore on May 21-23, 2008. The 4th Annual World Health Care Congress - Europe 2008 will meet in Barcelona on March 3-5, 2008. The 5th Annual World Health Care Congress will be held April 21-23, 2008 in Washington, D.C. For more information, visit www.worldcongress.com.

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1.      Featured Article: 'Wonderfully Spared' By JOYCE LEE MALCOLM, WSJ, July 3, 2007

[With the celebration of the Fourth of July last week, we pause to reflect how this unique experiment in human freedom came about.]


"You and I have been wonderfully spared," Thomas Jefferson wrote John Adams in 1812. "Of the signers of the Declaration of Independence I see now living not more than half a dozen on your side of the Potomak, and, on this side, myself alone." Jefferson and Adams were not merely signers of the Declaration. Both sat on the committee that drafted the document, and Jefferson wrote it. And while they later became bitter political opponents, they reconciled in their last years.

Adams, the Yankee lawyer, revolutionary, Founding Father and ex-president, was 77 in 1812; Jefferson, the Southern aristocrat, revolutionary, Founder and ex-president, was 69. Both were mentally acute but frail. Jefferson spent three to four hours a day on horseback and could scarcely walk, Adams walked three to four miles a day and could scarcely ride.

They would never see each other again. But from a modest farm in Quincy, Mass., and a plantation in Virginia they corresponded and reminisced about the days when they were "fellow laborers in the same cause, struggling for what is most valuable to man, his right of self-government."

It's easy now, in a nation awash with complaints about what our Founders did not do, what imperfect humans they seem to 21st century eyes, to overlook how startlingly bold their views and actions were in their own day and are, in fact, even today. Who else in 1776 declared, let alone thought it a self-evident truth, that all men were created equal, entitled to inalienable rights, or to any rights at all? How few declare these views today or, glibly declaring them, really intend to treat their countrymen or others as equal, entitled to life, liberty and the pursuit of happiness?

Certainly not America's 20th century enemies, the Nazis and communists; certainly not today's Islamic radicals, who consider infidels unworthy to live and the faithful bound by an ancient and brutal code of law. We are fortunate that the Founders of our nation were enlightened, generous, jealous of their rights and those of their countrymen, and prepared to risk everything to create a free republic. To read more, please go to www.medicaltuesday.net/index.asp.

Breaking with Britain was a risky and distressing venture; could the American colonies go it alone and survive in a world of great European powers? If not, what better empire than the British? It took a year of fighting before the Continental Congress and the states were prepared to declare independence. "We might have been a free and a great people together," Jefferson sighed.

But if we were angry at British treatment, we were also lucky that Britain was our mother country. The British taught us respect for the rights of individuals, for limited government, for the rule of law and how such values could be realized. "An Englishman is the unfittest person on earth to argue another Englishman into slavery," Edmund Burke insisted, pleading our cause before Parliament in March, 1775.

Scores of distinguished British officers refused commissions to fight against us. Some, who were willing, were reluctant to press their advantage over our literally rag-tag army. The British parliament wrangled day after day over the fitful progress of the war. And when it was over and, thanks to French assistance, we had won, Britain was careful in negotiating the peace treaty for fear we would fall under the influence and control of the French or the Spanish. We would fight against Britain again, but over the centuries the common heritage that connects our two peoples has brought us together as close allies.

We were lucky in our generals. Unlike the commanders of nearly all revolutionary armies before and since, George Washington resisted the temptation to seize power. After England's civil war between King Charles I and parliament, Oliver Cromwell, Parliament's leading general, evicted what remained of parliament and made himself "Lord Protector." The great expectations of the French Revolution ended when Napoleon Bonaparte staged a coup against the republican government and later crowned himself emperor.

Not only do victorious generals have a nasty habit of taking over, but once an army becomes entangled in politics it is extraordinarily difficult to remove it from public affairs. Numerous modern countries have tried to control their armies and failed.

Washington prevented a coup by his officers; and when the war was over, he bid a moving farewell to his men and staff before appearing before Congress to resign his commission: "Having now finished the work assigned to me, I retire from the great theatre of Action . . . and take my leave of all the employments of public life." Then he hurried off to spend Christmas with Martha and their family. Although it sounds sentimental, trite even, it happened that way. . .

In 1825 Jefferson wrote to congratulate Adams on the election of his son John Quincy to the presidency -- an election so close it was decided in the House of Representatives. "So deeply are the principles of order, and of obedience to law impressed on the minds of our citizens generally that I am persuaded there will be as immediate an acquiescence in the will of the majority," Jefferson assured him, "as if Mr. Adams had been the choice of every man." . . .

On July 4 the following year, as the nation celebrated the 50th anniversary of the Declaration of Independence, its two frail signers died within hours of each other. Their cause, "struggling for what is most valuable to man, his right of self-government," continues in the nation they launched, still fraught with aspirations and anxieties, flaws and divisions but, one hopes, with the ability to reconcile as they did, to work together for the joint venture.

To read the entire historical review, go to (subscription required)  http://online.wsj.com/article_print/SB118342548176556098.html.

Ms. Malcolm teaches legal history at George Mason University School of Law and is the author of several books, including "Stepchild of the Revolution: A Slave Child in Revolutionary America," forthcoming from Yale University Press.

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2.      In the News: Look At Health Data, Not Propaganda, By Grace-Marie Turner, The BaltimoreSun.com, June 29, 2007

America's health care woes all could be solved with a government-run universal-coverage system. Or so says Michael Moore in his new film, Sicko, which claims that even Cuba's health care system is superior to ours.

Although it's easy to dismiss Mr. Moore as a radical propagandist, his message is gaining traction in the policy community. The Commonwealth Fund, a prominent health policy research foundation, has produced a new study that also portrays government-run health systems as far superior to ours.

Unfortunately, the Commonwealth Fund study and Mr. Moore's film are based almost entirely on anecdotal evidence.

Rather than use hard data for its study, the Commonwealth Fund report relies on public opinion surveys to conclude that Australia, Canada, Germany, New Zealand and the United Kingdom all provide better care than the United States - and for less money. Patients and doctors were called and asked if they were happy with the quality, access, efficiency, equity and outcomes offered by their government-managed health care systems. But phone calls do nothing to offer scientific data about whether these nations' systems outperform the U.S. system.

Consider access to timely care. Britain has more than 1 million citizens on its waiting lists for medical care, according to London-based Nurses for Reform. In Canada, a study found that more than 800,000 citizens are in the queue for medical procedures - and some will die, waiting for months and sometimes more than a year to get surgeries or treatments they need. . . To read more, please go to www.medicaltuesday.net/news.asp.

In America, we're used to speedy service. So it's hardly surprising that in a public opinion survey, we would complain about any wait at all. But waiting lists like those in Britain and Canada would be a national scandal here. We simply wouldn't tolerate it.

And what about access to the latest treatments? In government-managed systems, bureaucrats and politicians decide which surgeries and new medicines will be available. In Britain, for example, two new drugs for kidney cancer are being denied to cancer sufferers because they're too expensive, according to news reports. The Canadian government also refuses to purchase newer drugs until they've been on the market for years. From 1997 to 1999, for instance, 100 drugs were introduced in America, while only 43 of those drugs became available in Canada.

In the interest of national budgets, state-administered health systems have an incentive to put saving money before saving lives. This affects more than just drugs. Each year, shortages of funds, personnel and facilities force the British system to cancel as many as 100,000 operations.

These shortages directly affect a nation's quality of care, yet the Commonwealth Fund study neglects important comparisons of clinical effectiveness among health care systems.

Consider cancer. In the United States, the survival rate is 90 percent for patients diagnosed with Stage I colon cancer. In Britain, it's just 70 percent.

For American women diagnosed with Stage I breast cancer, 97 percent are still alive after five years. In Britain, it's only 78 percent. Indeed, when adjusted for age, U.S. cancer deaths have fallen 1 percent per year since 1991.

The data show that if you are sick, the United States is where you want to be. We spend more in this country on health care, and we get more medical care as a result.

But look at America's outcomes, cry the Michael Moores of the world. Despite the highest per capita spending in the world, Americans die younger. On average, Americans live two years less than Canadians.

But life expectancy is affected by poverty, lack of education, obesity, teen pregnancy, drug and alcohol abuse and other unhealthful lifestyles, and even homicide rates and traffic accidents. What people do or don't do to care for themselves has a much bigger impact on the health of the population than spending on medical care does.

America's health care system certainly has its problems, and we must do much more to cover the uninsured. But if you judge a health care system by how well it serves people when they're actually sick, America's is without equal.

If Michael Moore's waistline ever puts him in the hospital for heart surgery, it will be interesting to see where he goes for medical care - the Mayo Clinic, or Cuba?

www.baltimoresun.com/news/opinion/oped/bal-op.sicko29jun29,1,1570837.story?ctrack=1&cset=true

Grace-Marie Turner is the founder and president of the Galen Institute, a free-market-oriented health policy research organization. www.galen.org

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3.      International Medicine: The Collapse Of Morale in the NHS

We got it wrong, Health Secretary tells NHS By Graeme Wilson, Political Correspondent, www.telegraph.co.uk, 06/07/2007

Alan Johnson, the new Health Secretary, passed a damning judgment on his predecessor yesterday by conceding the Government was to blame for the collapse of morale in the NHS.

In an admission of the damage caused by Patricia Hewitt's two years in charge, Mr Johnson said that despite record investment and major recruitment, doctors and nurses were not "happy bunnies".

Asked who was to blame for the problems, he attempted to offer an olive branch to disgruntled staff by saying: "The buck stops with us."

In a further attempt to placate doctors and nurses, Mr Johnson ruled out any more Whitehall-driven overhauls of the health service and unveiled a wide-ranging review of the NHS to be carried out by Professor Ara Darzi, the leading surgeon who was appointed a health minister by Gordon Brown last week.

Critics claimed the review - which will report back next year - was designed to give Mr Johnson time to win over rebellious health service staff. . . To read more, please go to www.medicaltuesday.net/intlnews.asp.

Mr Johnson also announced an extra £50 million to help front line staff step up the fight against infections such as MRSA and C difficile. The number of special hit squads to help the worst-performing hospitals tackle infection will be doubled.

While there has been speculation that Mr Brown was considering creating an independent board to run the NHS instead of ministers, Mr Johnson rejected the idea of putting the health service in the hands of a "giant quango".

However, it was his candid comments about the low levels of morale in the health service which underlined the Government's desperation to repair relations with NHS staff.

In a statement to the Commons, Mr Johnson admitted that doctors and nurses were "fed up with top down instructions and weary of restructuring."

He said their "lack of confidence" in the Government's approach in recent years had started to undermine the health service's performance.

"If the morale and goodwill of the profession dissipates, then our capacity for bringing about improvement for patients diminishes," he told MPs.

However, Mr Johnson dropped a passage in his speech which went even further and conceded that the Government had "not managed to keep the profession on board as we have steered a path through the turbulent waters of change".

But he returned to the theme later at a briefing for journalists in which he admitted that NHS staff had been "overwhelmed" by the endless cycle of restructuring and reform . . . 

To read the entire report, go to www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/05/npols205.xml

The NHS does not give timely access to health care, it only gives access to a waiting list.

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4.      Medicare: Government and Health Care - Are They Compatible or Are They Adversaries?

How Maker of Stents for Kids Ran Afoul of FDA By THOMAS M. BURTON and SHELLY BANJO, WSJ, July 5, 2007

HOPKINTON, N.Y. -- To doctors who treat babies with congenital heart defects, Allen Tower is the go-to guy. For years, Mr. Tower's little company, NuMED Inc., has made and delivered cardiological devices within hours to treat infants and small children who could have died if their aortas hadn't been widened or their heart valves opened.

But a run-in with the Food and Drug Administration is making it more difficult for Mr. Tower to deliver his custom-made catheters and therapeutic balloons and stents, even though the government hasn't questioned the safety of the company's devices. Doctors world-wide are worried that the devices could become even harder to get if the criminal investigation -- conducted by the FDA with federal prosecutors in Delaware -- results in a large fine against NuMED or other steps that could hamper the company's ability to sell the devices. To read more, please go to www.medicaltuesday.net/medicare.asp.

 If that happens many doctors and hospitals would have to treat their young patients with devices designed for adults. Physicians say those devices can be less safe than NuMED's. Meanwhile, more than 580 cardiologists and parents in the U.S. and countries from South Africa to Slovenia and Sweden have signed a petition urging U.S. authorities to be lenient. The petition says action against the company could cause "a devastating loss to patients...should Mr. Tower be relieved of his freedom or ability to continue his work."

William E. Hellenbrand, chief of pediatric cardiology at New York-Presbyterian Hospital/Columbia, calls Mr. Tower "by far the best person in the world to supply devices for children with congenital defects. You tell him what you need, and in 24 hours he gives you a prototype."

The NuMED case offers a window into a crucial dilemma involving pediatric heart devices. Infants have tiny hearts and arteries in which adult devices are at best clumsy and at worst dangerous. Moreover, heart deformities vary so much from child to child that it's difficult to perform a large clinical trial to test pediatric devices. The FDA normally insists on large studies in which scores or hundreds of patients are randomly assigned to a new therapy and others receive standard care or a placebo. Partly as a result, big companies have shied away from producing pediatric heart devices. . .

The devices in the NuMED case are approved for sale in Europe, but not in the U.S. Doctors and others familiar with the matter say NuMED ran afoul of the maze of intricate FDA marketing regulations. Essentially, Mr. Tower failed to file proper documents with the FDA in a number of cases in Wilmington, Del., before 2004. . .

Many doctors tell stories about Mr. Tower going the extra mile. Michael Tynan's involves two special-order balloons he needed in a week to open up a heart valve in a fetus in the mother's womb. Dr. Tynan, now emeritus professor of pediatric cardiology at King's College, London, says Mr. Tower called him back two hours after the order was placed. "The first one's made," Mr. Tower said. "They'll both be on the plane tomorrow morning."

"Allen Tower's greatest asset is his biggest problem," says Charles E. Mullins, emeritus professor of pediatrics at Baylor College of Medicine. "He doesn't know how to say no."

Mr. Tower's troubles stem from events that occurred through 2004 in Wilmington, where his customers included cardiologists at the DuPont Hospital for Children. He delivered more than 30 stents to two doctors there. The devices in this instance were, as is often the case with pediatric devices, not approved by the FDA for general sale. But, according to a 2004 hospital report to the FDA, a doctor sometimes termed the cases emergencies, and NuMED supplied them as "custom devices." . . .

The devices in question range in cost from $100 to $1,200 each. But people who know Mr. Tower don't believe money was a key motivator. "This didn't happen because Allen Tower wanted to make a fortune," says Larry Latson, director of the congenital cardiac catheterization lab at the Cleveland Clinic. "Most of the time, he forgets to charge. That's the way he is." . . .

To many like Dr. Latson, the NuMED case highlights the pitfalls of what he calls "terrible" FDA rules. He says families who can afford it now often go to Europe to get therapy. He even tells of a case where a child died of a ruptured aorta because a certain type of NuMED Teflon-covered metal stent couldn't be used because of the FDA's scrutiny of the company.

"The FDA wants more data, yet there are few patients to acquire the data," Dr. Latson says. "The FDA's system does not work well for fields like ours, where there are small numbers of widely varying patients."

Mr. Tower and his company are negotiating with federal prosecutors over possible charges that he marketed unapproved stents used in children. The investigation could lead to a multimillion-dollar fine and limits on Mr. Tower's ability to do business. The U.S. attorney could in theory ban the sale of some devices, a possibility that concerns doctors most. People familiar with the case say it's unlikely that Mr. Tower will be charged with a felony, but that could change.

To read the entire report (subscription required), go to http://online.wsj.com/article_print/SB118358925427957528.html.

Government is not the solution to our problems, government is the problem.

- Ronald Reagan

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5.      Medical Gluttony: I Have Two Electric Wheelchairs.

Last week I saw a patient with advanced COPD who bragged that he had two electric wheelchairs.

He had one for going around the neighborhood and to the store. He had the other one for navigating the tight hallways in his house.

Yet he walked from the waiting room to the exam room with a standard walker to steady his gait. To read more, please go to www.medicaltuesday.net/gluttony.asp. 

When asked if Medicare paid for either electric wheelchair, he replied that Medicare paid for the indoor one. But the outdoor one personally cost him over $5000 and was really his roadster.

Is health insurance, including Medicare, sometimes just an alternate source of personal wealth?

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6.      Medical Myths: In Health Care, More Is Always Better. More Durable Medical Equipment (DME) Always Improves Health and Quality of Life (QOL)?

In the 1970s, pulmonary rehabilitation was just getting off the ground. Without any formal programs or rehab facilities to provide bicycles and treadmills, increasing exercise was the key element of the program. Encouraging walking to the point of dyspnea was important. Patients were encouraged to walk to endurance and then sit down and catch their breath, then resume their walking or other activity. One could encourage patients to walk in the parks or woods and when exhausted, sit on a log for a few minutes, and then resume. This is a key difference between cardiac and pulmonary patients. Cardiac patients should stop before they have a coronary; this is not a frequent consideration in pulmonary patients. One recommendation was for patients to park at the end of a parking lot and walk its length to their office or store. They were advised that the disability stickers were for those with missing arms or legs, or those wheelchair- bound due to diseases such as rheumatoid arthritis. Not emphysema. To read more, please go to www.medicaltuesday.net/myths.asp.

During this time, I had gone from a solo practice to 8 pulmonologists over eight years. We were the largest pulmonary group in the country. I had an associate who felt he was a patient advocate. He argued that his pulmonary patients were as important and disabled as those for whom the disabled zones were established. So, he started handing out a lot of disability requests, which were generally accepted. This caused competition among the emphysema patients and soon all had one. They could get through the day without huffing and puffing. But is huffing and puffing bad for health? For emphysema patients it's a way of life. (It is of interest that the San Francisco Society of Pulmonologists was known as the “Huff & Puff” club.)

Health care, however, is not one of benefits only. What are the medical consequences of everyone having a disability sticker? Is it beneficial to be able to park next to the store or office? Does decreasing the amount of walking and increasing the use of electric wheelchairs improve the patient's quality of life?

Not only patients, but essentially all of us need to be prodded from time to time to exercise. Making it part of our shopping or daily routine is an easy way to keep active. Obesity clinics also recommend that their clients park a block away. It makes a healthy routine more palatable.

Most of us expend maybe five percent of our energy walking. As we decondition, this may increase to 10 percent or more. Emphysema patients may require 50 percent of their energy just to walk. I've seen emphysema patients who are totally inactive and watch their leg and thigh muscles deteriorate to essentially nothing. One patient didn't have enough muscle left to get to a standing position without being lifted by his spouse or children. When examining his legs and thighs, I could get my thumb and middle finger totally around his thigh. There was hardly any perceptible muscle left. He said he had been too weak to walk for years. Thus, a 100 percent use of his muscles was not even enough to stand. Lack of walking increased the energy required of his muscles for simple walking from five percent to more than 100 percent, which was still not enough to have a reasonable QOL. The pain and exhaustion of walking would have improved his QOL.

So, if you're able, you might consider giving up that disability zone sticker or the electric wheelchair. Your overall QOL might actually improve.

Health Care Benefits May Be Detrimental To Your Health.

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7.      Overheard in the Medical Staff Lounge:  Do Doctors Agree with Michael Moore on Healthcare? Michael Moore is Going to Have His Coronary Artery Bypass Graft in Cuba.

Dr. Rosen: Have you seen Michael Moore's SiCKO? It's playing in the Sacramento theaters.

Dr. Yancy: No, and I'm not about to. He distorts all the facts and finds people that would make anyone shed tears.

Dr. Jim: But he does provide a service in raising the public consciousness, doesn't he?

Dr. Yancy: He sheds no light on the subject. It's all subterfuge. The public will always be interested in anything that is free.

Dr. Milton: With health care being one of the larger items in anyone's budget, making it free will easily double the cost of care. To read more, please go to www.medicaltuesday.net/lounge.asp.

Dr. Ruth: But all these propagandists keep saying the government can do it cheaper than competition.

Dr. Rosen: Well, we have Medicare to prove them wrong. This program covers those 50 million or so over 65 and it is constantly in financial straights. How can anyone seriously accept the comment that the government can cover the other 250 million Americans and do it cheaper? Medicare overruns are on the order of 40% to 400% over projections. And Medicare costs are not sustainable.

Dr. Yancy: Medicare can't even administer its own program. It has to hire private insurance companies to manage the program for them. That tells us something. They even trick the old folks into giving up Medicare for an HMO that saves them money. Then it's the HMO that begins acting like the NHS or Canadian Medicare and begins denying service.

Dr. Milton: That's part of the government's subterfuge. By shifting the blame to private carriers that act like the NHS or Canadian Medicare, no one equates the two. And to call the HMOs free enterprise or competitive, is a total reversal of facts. They are under absolute government control. The few degrees of variance between HMOs are not medically significant.

Dr. Edwards: The NY Times reported after the SiCKO viewing that Michael Moore makes a good case for government medicine and how we should be able to take care of everyone that is sick.

Dr. Yancy: And they're calling it a documentary. It's nothing more than anecdotal stories that serves his purpose. He was very cagey at catching Kaiser discharge one of their patients. A video can be very damming. He was very shrewd in having these kinds of informants videotape actual scenes. Those are hard to refute. Then it becomes damage control. I bet Kaiser wishes they had bought that woman a house and given her free nursing care for a year. It would probably be much cheaper in the long run.

Dr. Rosen: What gets me is that they're selling us as the only industrial country without national health insurance. It was Otto von Bismarck of Germany who introduced the first Medicaid program in the late 19th century. Not so much as a concern for the health of people but more for control of the worker. My family escaped German national health insurance at that time for the freedom of America. Why do we want to re-introduce servitude to the state?

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8.      Voices of Medicine: America Needs "Moore" Health Freedom

Why a growing number of Conservatives agree with Michael Moore on Healthcare Reform By James J. Murtagh, M.D.

(James Murtagh spent 20 years as an Intensive Care Unit physician. Dr. Murtagh is a member of Semmelweis Society International and has hosted several Congressional forums on the Healthcare Integrity Project.)

Michael Moore and Al Gore now are the most influential political film makers of all time. A dynamic duo, Gore and Moore sound an alarm, as once did Winston Churchill, "The era of procrastination, is coming to a close. We are entering a period of consequences." Our heads must come out of the sand, or our children will amazedly wonder why America slept as the coming storm darkened the sky.

Now for a shocker. Conservatives (of whom I sometimes am a fellow traveler), are actually starting to agree with Michael Moore's film SiCKO. Medical reform is necessary to protect conservative values! We need to put good faith back into medicine. To read more, please go to www.medicaltuesday.net/voicesofmedicine.asp.

Lee Iacocca bluntly states, "our once-great companies are getting slaughtered by health care costs."  Iacocca asks: "Where the hell is our outrage? We should be screaming bloody murder. This is America, not the damned Titanic." Lee, like Gore and Moore, faces up to inconvenient truths.

Margaret Thatcher would say we are not, "getting value for money." We spend one of six dollars of the entire U.S. economy (16%!) for health care- 2.1 trillion a year- ten times the entire budget of the United States was in 1976. It is unfathomable how much money. Soon, one quarter of every dollar in your pocket will be consumed by health care. This is a lot more than what we spent on World War II, or anything else in American history.

To read the entire OpEd article, please go www.healthcarecom.net/JM_Profile.htm .to (please post under Dr. Murtagh and enter the URL and remove from here to the * below)

This is just un-American. The medical system is choking the business of America, which is business. Skyrocketing and ineffective medical costs choke out enterprise, initiative and innovation. People can't afford to be pioneers, or to even criticize their corporations for fear of losing health benefits.

On top of it all, more than 40% of our health care spending goes to administration, not to help sick people, or to paying the doctor or nurse.

People used to be afraid that health care reform would lead to socialism. Now, we need health care reform to save us from the de facto socialized current anti-capitalistic health care system.

The American Medical Association (AMA) hasn't caught on yet, but now less than 25% of doctors are card-carrying members of the AMA. The AMA, now represents Big Medicine HMOs, and is no longer the voice of Marcus Welby-like doctors. New groups, like the Semmelweis society, are springing up to represent the true voice of American doctors

Conservatives don't like Moore's style, appearance, or theatrics, but there are conservative ideas at the heart of his movie. Sure, the boat trip to Cuba was off-putting to some. But hey, it is a movie, and Moore needed to sell tickets. No capitalist could criticize Moore for needing to make a buck.

I think Moore can and should broaden his appeal. Think of 1968 college students scrubbing up to "get clean for Gene," so their candidate, Eugene J. "Gene" McCarthy would have national appeal. Moore's work is so valuable, I hope he would consider small style changes so his substance would shine brighter. Moore is such a talented film maker that he could win over both the right and left wings of the nation. If we are going to get the airplane of reform off the ground, we are going to need both wings.

Ronald Reagan believed, "your freedom to swing your fist ends at my nose." It follows no one has the freedom to sneeze an unhealthy bug up my nose. Multi-drug resistant TB, and dozens of other lethal bugs, incubate in people lacking health care. Don't forget, a homegrown Influenza strain in 1918-1919 killed 50-100 million people, in the worst medical holocaust in history, dwarfing the bloodshed of World War I. No bioterrorist could inflict that kind of devastation unless we help by continuing a warped medical system.

A country divided against itself on access to health cannot stand. When pandemic comes, do not send to ask for whom the bell tolls, since every one suffers and foots the bill from pandemic.

Look at the social cost of sleep disorders. 25% of Americans suffer from sleep disorder, mostly untreated, and then everyone is at risk from huge traffic and industrial accidents. Sleep apnea causes more car accidents than alcohol. It takes a nation to create a healthy, productive work force, and if we want people to pull themselves up by their bootstraps, they need to be healthy first. Our security depends on it.

Who would agree with Scrooge that Tiny Tim should die to "decrease the surplus population?" Conservatives believe in the right to life. Surely, the persons with compassion for Linda Shiavo would not pull the plug on Tiny Tim.

Dr. Linda Peeno (my friend, and a member of Semmelweis) testified in SiCKO that Big Medicine HMOs in America rip off the public, and let people die.

Ronald Reagan hated "waste, fraud and corruption." Martin Luther King declared ""Of all the forms of inequality, injustice in health care is the most shocking and inhumane." This issue is ripe for bipartisan cooperation.

Could a bipartisan "dream team" bring real reform? Could business heavyweights like Lee Iacocca team up with Gore and Moore before it is too late?

This is not a time for sunshine patriots. Now, the right and the left to unite for love of our country. In ten years, let's not wonder why America Slept. Instead, this can and will be America's finest hour.  Frankly, we don't have any choice but to face the coming storm now.

* Doctors for Integrity in Healthcare urge bipartisan discussion of this important film.

James J. Murtagh Jr., MD, Atlanta GA 30329

Be sure to read Grace-Marie Turners comments in Section 2 above concerning the same movie.


To see an example of an Un-Holy Alliance of the right and the left striking out for freedom, read Dan Weintraub:  Supreme Court strikes a blow for political speech

. . . In Federal Elections Commission v. Wisconsin Right to Life, the court's 5-4 ruling breathed new life into the First Amendment, finding that Congress had overstepped its authority to regulate political speech.

Don't be fooled by the anti-abortion group at the center of the case. The winning side also included the American Civil Liberties Union, the AFL-CIO and the Alliance for Justice, an association of environmental, civil rights, mental health, women's, children's and consumer advocacy organizations.

All of these groups, plus the U.S. Chamber of Commerce, the National Rifle Association and the NARAL Pro-Choice American Foundation, were united in their belief that it was unconstitutional for Congress to restrict their right to air political issue advertisements in the weeks before an election. . .

www.sacbee.com/weintraub/v-print/story/253286.html

* * * * *

9.      Book/Movie Review: 'Sicko': Heavily Doctored, By Kurt Loder

Is Michael Moore's prescription worse than the disease?

Michael Moore may see himself as working in the tradition of such crusading muckrakers of the last century as Lincoln Steffens, Ida Tarbell and Upton Sinclair — writers whose dedication to exposing corruption and social injustices played a part in sparking much-needed reforms. In his new movie, "Sicko," Moore focuses on the U.S. health-care industry — a juicy target — and he casts a shocking light on some of the people it's failed.

There's a man who mangled two of his fingers with a power saw and learned that it would cost $12,000 to save one of them, but $60,000 to save the other. He had no health insurance and could only scrape together enough money to salvage the $12,000 finger.

There's a woman whose husband was prescribed new drugs to combat his cancer, but couldn't get their insurance company to pay for them because the drugs were experimental. Her husband died.

Then there's a woman who made an emergency trip to a hospital for treatment and subsequently learned her insurance company wouldn't pay for the ambulance that took her there — because it hadn't been "pre-approved." And there's a middle-aged couple — a man, who suffered three heart attacks, and his wife, who developed cancer — who were bankrupted by the cost of co-payments and other expenses not covered by their insurance, and have now been forced to move into a cramped, dismal room in the home of a resentful son. There's also a 79-year-old man who has to continue working a menial job because Medicare won't cover the cost of all the medications he needs. To read more, please go to www.medicaltuesday.net/bookreviews.asp.

Moore does a real service in bringing these stories to light — some of them are horrifying, and then infuriating. One giant health-maintenance organization, Kaiser Permanente, is so persuasively lambasted in the movie that, on the basis of what we're told, we want to burst into the company's executive suites and make a mass citizen's arrest. This is the sort of thing good muckrakers are supposed to do.

Unfortunately, Moore is also a con man of a very brazen sort, and never more so than in this film. His cherry-picked facts, manipulative interviews (with lingering close-ups of distraught people breaking down in tears) and blithe assertions (how does he know 18,000* people will die this year because they have no health insurance?) are so stacked that you can feel his whole argument sliding sideways as the picture unspools. The American health-care system is in urgent need of reform, no question. Some 47 million people are uninsured (although many are only temporarily so, being either in-between jobs or young enough not to feel a pressing need to buy health insurance). There are a number of proposals as to what might be done to correct this situation. Moore has no use for any of them, save one.

As a proud socialist, the director appears to feel that there are few problems in life that can't be solved by government regulation (that would be the same government that's already given us the U.S. Postal Service and the Department of Motor Vehicles). In the case of health care, though, Americans have never been keen on socialized medicine. In 1993, when one of Moore's heroes, Hillary Clinton (he actually blurts out the word "sexy!" in describing her in the movie), tried to create a government-controlled health care system, her failed attempt to do so helped deliver the U.S. Senate and House of Representatives into Republican control for the next dozen years. Moore still looks upon Clinton's plan as a grand idea, one that Americans, being not very bright, unwisely rejected. (He may be having second thoughts about Hillary herself, though: In the movie he heavily emphasizes the fact that, among politicians, she accepts the second-largest amount of political money from the health care industry.)

The problem with American health care, Moore argues, is that people are charged money to avail themselves of it. In other countries, like Canada, France and Britain, health systems are far superior — and they're free. He takes us to these countries to see a few clean, efficient hospitals, where treatment is quick and caring; and to meet a few doctors, who are delighted with their government-regulated salaries; and to listen to patients express their beaming happiness with a socialized health system. It sounds great. As one patient in a British hospital run by the country's National Health Service says, "No one pays. It's all on the NHS. It's not America."

That last statement is even truer than you'd know from watching "Sicko." In the case of Canada — which Moore, like many other political activists, holds up as a utopian ideal of benevolent health-care regulation — a very different picture is conveyed by a short 2005 documentary called "Dead Meat," by Stuart Browning and Blaine Greenberg. These two filmmakers talked to a number of Canadians of a kind that Moore's movie would have you believe don't exist:

A 52-year-old woman in Calgary recalls being in severe need of joint-replacement surgery after the cartilage in her knee wore out. She was put on a wait list and wound up waiting 16 months for the surgery. Her pain was so excruciating, she says, that she was prescribed large doses of Oxycontin, and soon became addicted. After finally getting her operation, she was put on another wait list — this time for drug rehab.

A man tells about his mother waiting two years for life-saving cancer surgery — and then twice having her surgical appointments canceled. She was still waiting when she died.

A man in critical need of neck surgery plays a voicemail message from a doctor he'd contacted: "As of today," she says, "it's a two-year wait-list to see me for an initial consultation." Later, when the man and his wife both needed hip-replacement surgery and grew exasperated after spending two years on a waiting list, they finally mortgaged their home and flew to Belgium to have the operations done there, with no more waiting.

Rick Baker, the owner of a Toronto company called Timely Medical Alternatives, specializes in transporting Canadians who don't want to wait for medical care to Buffalo, New York, two hours away, where they won't have to. Baker's business is apparently thriving.

And Dr. Brian Day, now the president of the Canadian Medical Association, muses about the bizarre distortions created by a law that prohibits Canadians from paying for even urgently-needed medical treatments, or from obtaining private health insurance. "It's legal to buy health insurance for your pets," Day says, "but illegal to buy health insurance for yourself." (Even more pointedly, Day was quoted in the Wall Street Journal this week as saying, "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years.")

Actually, this aspect of the Canadian health-care system is changing. In 2005, the Canadian Supreme Court ruled in favor of a man who had filed suit in Quebec over being kept on an interminable waiting list for treatment. In striking down the government health care monopoly in that province, Chief Justice Beverley McLachlin said, "Access to a waiting list is not access to health care." Now a similar suit has been filed in Ontario.

What's the problem with government health systems? Moore's movie doesn't ask that question, although it does unintentionally provide an answer. When governments attempt to regulate the balance between a limited supply of health care and an unlimited demand for it they're inevitably forced to ration treatment. This is certainly the situation in Britain. Writing in the Chicago Tribune this week, Helen Evans, a 20-year veteran of the country's National Health Service and now the director of a London-based group called Nurses for Reform, said that nearly 1 million Britons are currently on waiting lists for medical care — and another 200,000 are waiting to get on waiting lists. Evans also says the NHS cancels about 100,000 operations each year because of shortages of various sorts. Last March, the BBC reported on the results of a Healthcare Commission poll of 128,000 NHS workers: two thirds of them said they "would not be happy" to be patients in their own hospitals. James Christopher, the film critic of the Times of London, thinks he knows why. After marveling at Moore's rosy view of the British health care system in "Sicko," Christopher wrote, "What he hasn't done is lie in a corridor all night at the Royal Free [Hospital] watching his severed toe disintegrate in a plastic cup of melted ice. I have." Last month, the Associated Press reported that Gordon Brown — just installed this week as Britain's new prime minister — had promised to inaugurate "sweeping domestic reforms" to, among other things, "improve health care."

To read the entire review, please go to www.mtv.com/movies/news/articles/1563758/story.jhtml#.

* * * * *

10.  Hippocrates & His Kin: Happy Independence Day

Linus: Today's a holiday. So I guess the courthouse is closed.

Lawyer: I know. I'll have to go all day without suing somebody.

Linus: Attorneys look pathetic when the courthouse is closed.

Lawyer: Yes, twenty-four hours down the drain. 

After Charles Schulz


Sign on the door of a law office: Hire an attorney. Get a second one free.

(You suppose the third one is half price?)

To read more vignettes, please go to www.medicaltuesday.net/hhk.asp.


Live & Learn: I saw a patient in pulmonary consultation who spoke no English. He handed us a card from an interpreter agency and motioned for us to call them. About two weeks later, we received a bill from the agency for an interpretation fee, for which the two-hour minimum was $130 and the mileage charge $11, for a total of $141. Expected reimbursement for the consultation is about $96. Such a deal. Spend twice as much as you get paid to see a patient and for helping him with his asthma. He was from the Ukraine where, I understand, such deals are the norm.

To read the HHK Archives, please go to www.healthcarecom.net/hhkintro.htm.

To read the HMC Archives, please go to www.delmeyer.net/HMC.htm. 

* * * * *

11.  Organizations Restoring Accountability in HealthCare, Government and Society:


 

•                      The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports. This month, be sure to read the latest dire Medicare reports, Past, Present and Future at www.ncpa.org/pub/st/st299/.

•                      Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may subscribe at www.pacificresearch.org/pub/hpp/index.html or access their health page at www.pacificresearch.org/centers/hcs/index.html. Just released: A Briton objects to Michael Moore's depiction of the NHS as being free. He thinks it's very costly. Read more at http://news.bostonherald.com/editorial/view.bg?articleid=1008392&format=&page=1.

•                      The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government: Start with an overview at www.mercatus.org/research_area/cfilter.1/researcharea_list.asp.

•                      The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. www.nahu.org/publications/hiu/index.htm. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business. Be sure to review the current articles listed on their table of contents at hiu.nahu.org/paper.asp?paper=1.

•                      The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. A new study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels. In addition to Grace-Marie's report in section 2 above, be sure to read another report that can be accessed either from her page or directly at www.mtv.com/movies/news/articles/1563758/story.jhtml#.

•                      Greg Scandlen, an expert in Health Savings Accounts (HSAs) has embarked on a new mission: Consumers for Health Care Choices (CHCC). To read the initial series of his newsletter, Consumers Power Reports, go to www.chcchoices.org/publications.html. To join, go to www.chcchoices.org/join.html. Be sure to read Prescription for change:  Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn at www.chcchoices.org/publications/cpr9.pdf.

•                      The Heartland Institute, www.heartland.org, publishes the Health Care News. Read the late Conrad F Meier on What is Free-Market Health Care?. You may sign up for their health care email newsletter at www.heartland.org/Article.cfm?artId=10478.

•                      The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling, PhD, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. This month, be sure to read the editorial The Goal Is Freedom: Tax Tyranny.

•                      The Council for Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse." This month, be sure to read Is Michael Moore's prescription worse than the disease?.

•                      The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter at www.i2i.org/healthcarecenter.aspx.  Read her latest newsletter at www.i2i.org/hcpcjune2004.aspx, which includes a section on PC Medicine and Euthanasia.

•                      Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read CAPITALISM: THE ONLY MORAL SOCIAL SYSTEM.

•                      The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section at www.fraserinstitute.ca/health/index.asp?snav=he. This month, be sure to read California Dreaming: The Fantasy of a Canadian-Style Health Insurance Monopoly in the United States.

•                      The Heritage Foundation, www.sheritage.org/, founded in 1973, is a research and educational institute whose mission is to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site.

•                      The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. This month read Liberty versus Democracy By Rose Wilder Lane at www.mises.org/story/2602. You may also log on to Lew's premier free-market site at www.lewrockwell.com to read some of his lectures to medical groups. To learn how state medicine subsidizes illness, see www.lewrockwell.com/rockwell/sickness.html; or to find out why anyone would want to be an MD today, see www.lewrockwell.com/klassen/klassen46.html.

•                      CATO. The Cato Institute (www.cato.org) was founded in 1977 by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio at www.cato.org/people/cannon.html. This month, read Promoting a Better Understanding of the Benefits of Liberty.

•                      The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.

•                      The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]

•                      The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, war time allows the federal government grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in war time we have to push for limited government—while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to www.stcroixreview.com.

•                      Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read Arlan Gilbert, the college historian at www.hillsdale.edu/news/imprimis.asp. The last ten years of Imprimis are archived.

• 

The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. www.nahu.org/publications/hiu/index.htm. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business. Be sure to review the current articles listed on their table of contents at hiu.nahu.org/paper.asp?paper=1.

•To read the rest of this column, please go to www.medicaltuesday.net/org.asp.

•The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. A new study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels. In addition to Grace-Marie's report in section 2 above, be sure to read another report that can be accessed either from her page or directly at www.mtv.com/movies/news/articles/1563758/story.jhtml#.

•Greg Scandlen, an expert in Health Savings Accounts (HSAs) has embarked on a new mission: Consumers for Health Care Choices (CHCC). To read the initial series of his newsletter, Consumers Power Reports, go to www.chcchoices.org/publications.html. To join, go to www.chcchoices.org/join.html. Be sure to read Prescription for change:  Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn at www.chcchoices.org/publications/cpr9.pdf.

•The Heartland Institute, www.heartland.org, publishes the Health Care News. Read the late Conrad F Meier on What is Free-Market Health Care?. You may sign up for their health care email newsletter at www.heartland.org/Article.cfm?artId=10478.

•The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling, PhD, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. This month, be sure to read the editorial The Goal Is Freedom: Tax Tyranny.

•The Council for Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse." This month, be sure to read Is Michael Moore's prescription worse than the disease?.

•The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter at www.i2i.org/healthcarecenter.aspx.  Read her latest newsletter at www.i2i.org/hcpcjune2004.aspx, which includes a section on PC Medicine and Euthanasia.

•Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read CAPITALISM: THE ONLY MORAL SOCIAL SYSTEM.

•The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section at www.fraserinstitute.ca/health/index.asp?snav=he. This month, be sure to read California Dreaming: The Fantasy of a Canadian-Style Health Insurance Monopoly in the United States.

•The Heritage Foundation, www.sheritage.org/, founded in 1973, is a research and educational institute whose mission is to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site.

•The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. This month read Liberty versus Democracy By Rose Wilder Lane at www.mises.org/story/2602. You may also log on to Lew's premier free-market site at www.lewrockwell.com to read some of his lectures to medical groups. To learn how state medicine subsidizes illness, see www.lewrockwell.com/rockwell/sickness.html; or to find out why anyone would want to be an MD today, see www.lewrockwell.com/klassen/klassen46.html.

•CATO. The Cato Institute (www.cato.org) was founded in 1977 by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio at www.cato.org/people/cannon.html. This month, read Promoting a Better Understanding of the Benefits of Liberty.

•The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.

•The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]

•The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, war time allows the federal government grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in war time we have to push for limited government—while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to www.stcroixreview.com.

•Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read Arlan Gilbert, the college historian at www.hillsdale.edu/news/imprimis.asp. The last ten years of Imprimis are archived.

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Del Meyer

Del Meyer, MD, Editor & Founder

DelMeyer@MedicalTuesday.net

www.MedicalTuesday.net

6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608

Words of Wisdom

A government that robs Peter to pay Paul can always depend on the support of Paul. -George Bernard Shaw

Government is the great fiction, through which everybody endeavors to live at the expense of everybody else. -Frederic Bastiat, French Economist (1801-1850)

The art of government consists of taking as much money as possible from one party of citizens to give to the other. -Voltaire (1764)

Change leaders should starve problems and feed opportunities. -Peter Drucker, The Daily Drucker

Some Recent Postings

Politicians Cannot Manage a Health Care System by David J. Gibson, MD  www.healthplanusa.net/DGPoliticiansCannotManager.htm

The CMA [California Medical Association] has become part of the problem by David J. Gibson, MD   www.healthplanusa.net/DGReformingCMA.htm

David J. Gibson, MD   www.healthplanusa.net/DavidGibson.htm

In Memoriam

Anne Elizabeth Jane Claiborne, a fashion revolutionary, died on June 26th, aged 78. She grasped exactly what American women needed as the aproned housewife of the 1950s morphed into the professional of the 1970s. Good tailoring, classic styling, quality material, mix-and-match colours, a dash of panache: just the tops and trousers and skirts, set off with a Claiborne scarf and a Claiborne leather tote, in which to stride down Fifth Avenue or into the halls of power. To read the entire story, go to www.economist.com/obituary/displaystory.cfm?story_id=9432832.

On This Date in History - July 10

On this date in 1509, John Calvin, one of the most influential religious leaders of all time, was born. Although born in the French town of Noyon, he left a tremendous mark upon this country of ours. John Calvin's religious ideas had the greatest influence on the ethical development of Puritanism, the Protestant work ethic and the belief in the austerity of life. The founding fathers in this new land lived that way as they built their Puritan Heritage. When the chips are down, that heritage remains a bedrock of American strength.

On this date in 1908, William Jennings Bryan was nominated for the third time for the Presidency of the United States. As in 1896 and again in 1900, it was his third attempt and he struck out. This still holds as the record number of nominations for the highest U.S. office.

After Leonard and Thelma Spinrad


MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE

Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the truth about socialized medicine. Clements' strategy is to release the documentary this summer when Michael Moore's pro-socialized medicine movie "Sicko" is released. Clements is seeking 200 doctors willing to make a tax-deductible donation of $5K. Clements is also seeking American doctors willing to perform operations for Canadians on wait lists. Clements is the former publisher of "American Venture" magazine who made news in 2005 for a property rights project against eminent domain called the "Lost Liberty Hotel." For more information or to review a trailer, visit www.sickandsickermovie.com or email logan@freestarmovie.com.

Logan plans to release the movie before the end of July 2007. He is currently reviewing distribution plans and seeking distributors for various media and territories. Join the e-mail alert list to get first notice of the movie's release date.

SICK AND SICKER is a feature-length movie, currently in post-production, that explores the ethics and realities of a government take over of the medical profession.

SICK AND SICKER will investigate whether government intervention in the U.S. medical system is the cause of, or the solution to, our problems and whether Canada is really the health care utopia that politicians tell us it is.  

This won't be a dry documentary that will put you to sleep. Logan Darrow Clements will bring the abstract concepts to life in dramatic and surprising ways. If he can show how a monkey with darts can beat the investment return of Social Security, then you know it will be a movie you won't forget.