MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VIII, No 8, July 28, 2009
In This Issue:
1. Featured Article: Live Free or Die by Mark Steyn
2. In the News: The SAFE Commission to Control Federal Spending and National Debt
3. International Medicine: Canadian Medicare in Alberta
4. Medicare: Warnings about Medicare's Impending Bankruptcy Could Become Illegal
5. Medical Gluttony: Why Emergency Departments are the most costly.
6. Medical Myths: AAPS Healthcare Reform Mythbusters Series
7. Overheard in the Medical Staff Lounge: The $11 trillion national debt
8. Voices of Medicine: "Primum non nocere " - First, not to do harm
9. The Bookshelf: AMERICA ALONE, The End of the World as we Know It
10. Hippocrates & His Kin: Giving Federal Employees a credit card is like giving whiskey and keys to teenagers.
11. Related Organizations: Restoring Accountability in Medical Practice and Society
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MOVIE EXPLAINING SOCIALIZED MEDICINE
Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks
funding for a movie exposing the truth about socialized medicine. Clements is
the former publisher of "American Venture" magazine who made news in
2005 for a property rights project against eminent domain called the "Lost
For more information visit www.sickandsickermovie.com or email email@example.com.
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The following is adapted from a lecture delivered at Hillsdale College on March 9, 2009.
MY REMARKS are titled tonight after the words of General Stark, New Hampshire's great hero of the Revolutionary War: "Live free or die!" When I first moved to New Hampshire, where this appears on our license plates, I assumed General Stark had said it before some battle or other—a bit of red meat to rally the boys for the charge; a touch of the old Henry V-at-Agincourt routine. But I soon discovered that the general had made his famous statement decades after the war, in a letter regretting that he would be unable to attend a dinner. And in a curious way I found that even more impressive. In extreme circumstances, many people can rouse themselves to rediscover the primal impulses: The brave men on Flight 93 did. They took off on what they thought was a routine business trip, and, when they realized it wasn't, they went into General Stark mode and cried "Let's roll!" But it's harder to maintain the "Live free or die!" spirit when you're facing not an immediate crisis but just a slow, remorseless, incremental, unceasing ratchet effect. "Live free or die!" sounds like a battle cry: We'll win this thing or die trying, die an honorable death. But in fact it's something far less dramatic: It's a bald statement of the reality of our lives in the prosperous West. You can live as free men, but, if you choose not to, your society will die.
My book America Alone is often assumed to be about radical Islam, firebreathing imams, the excitable young men jumping up and down in the street doing the old "Death to the Great Satan" dance. It's not. It's about us. It's about a possibly terminal manifestation of an old civilizational temptation: Indolence, as Machiavelli understood, is the greatest enemy of a republic. When I ran into trouble with the so-called "human rights" commissions up in Canada, it seemed bizarre to find the progressive left making common cause with radical Islam. One half of the alliance profess to be pro-gay, pro-feminist secularists; the other half are homophobic, misogynist theocrats. Even as the cheap bus 'n' truck road-tour version of the Hitler-Stalin Pact, it made no sense. But in fact what they have in common overrides their superficially more obvious incompatibilities: Both the secular Big Government progressives and political Islam recoil from the concept of the citizen, of the free individual entrusted to operate within his own societal space, assume his responsibilities, and exploit his potential.
In most of the developed world, the state has gradually annexed all the responsibilities of adulthood—health care, child care, care of the elderly—to the point where it's effectively severed its citizens from humanity's primal instincts, not least the survival instinct. Hillary Rodham Clinton said it takes a village to raise a child. It's supposedly an African proverb—there is no record of anyone in Africa ever using this proverb, but let that pass. P.J. O'Rourke summed up that book superbly: It takes a village to raise a child. The government is the village, and you're the child. Oh, and by the way, even if it did take a village to raise a child, I wouldn't want it to be an African village. If you fly over West Africa at night, the lights form one giant coastal megalopolis: Not even Africans regard the African village as a useful societal model. But nor is the European village. Europe's addiction to big government, unaffordable entitlements, cradle-to-grave welfare, and a dependence on mass immigration needed to sustain it has become an existential threat to some of the oldest nation-states in the world.
And now the last holdout, the United States, is embarking on the same grim path: After the President unveiled his budget, I heard Americans complain, oh, it's another Jimmy Carter, or LBJ's Great Society, or the new New Deal. You should be so lucky. Those nickel-and-dime comparisons barely begin to encompass the wholesale Europeanization that's underway. The 44th president's multi-trillion-dollar budget, the first of many, adds more to the national debt than all the previous 43 presidents combined, from George Washington to George Dubya. The President wants Europeanized health care, Europeanized daycare, Europeanized education, and, as the Europeans have discovered, even with Europeanized tax rates you can't make that math add up. In Sweden, state spending accounts for 54% of GDP. In America, it was 34%—ten years ago. Today, it's about 40%. In four years' time, that number will be trending very Swede-like.
But forget the money, the deficit, the debt, the big numbers with the 12 zeroes on the end of them. So-called fiscal conservatives often miss the point. The problem isn't the cost. These programs would still be wrong even if Bill Gates wrote a check to cover them each month. They're wrong because they deform the relationship between the citizen and the state. Even if there were no financial consequences, the moral and even spiritual consequences would still be fatal. . .
Mark Steyn is the Eugene C. Pulliam Distinguished Visiting Fellow in Journalism, Hillsdale College.
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According to the nonpartisan Congressional Budget Office (CBO), outlays will top $4 trillion for this year alone and will consume 28.5 percent of our nation's economy. By 2019, CBO estimates that spending will still constitute 24.5 percent of Gross Domestic Product (GDP) - about four percentage points above the historical average. On the revenue side, CBO estimates that the Administration's budget will increase taxes by $1.5 trillion. The proposal would more than double the level of public debt over the 10 year CBO projection - resulting in debt equal to 82 percent of Gross Domestic Product by 2019.
We have a responsibility to avoid passing a massive debt burden on to our children and grandchildren. A doubling of the debt burden over the next 10 years to 82 percent of GDP will impose a significant tax burden on them coupled with the prospect of a lower standard of living. In conjunction with the coming explosion in entitlement spending entailed by the aging of the "baby-boomers," we are simply "kicking the can down the road" for the next generation to address. As both a father and grandfather, this greatly concerns me. The time is long overdue for a holistic look at the budget process which takes into account our immediate needs and which doesn't plant the seeds for the next economic bubble. If nothing else, we must learn from the current crisis that it is not possible to indefinitely live beyond our means.
The SAFE Commission Act (H.R. 1557), bipartisan legislation authored by Congressman Jim Cooper (D-TN) and Congressman Frank Wolf (R-VA), would:
· Establish the Securing America's Future Economy (SAFE) Commission to develop legislation designed to address:
o the unsustainable imbalance between long-term federal spending commitments and projected revenues
o increases in net national savings to provide for domestic investment and economic growth,
o the implications of foreign ownership of federally issued debt instruments, and
o revision of the budget process to place greater emphasis on long-term fiscal issues.
· Require the Commission to:
o develop one or two methods for estimating the cost of legislation as an alternative to the current Congressional Budget Office (CBO) method, and hold at least one town-hall style public hearing within each federal reserve district.
· Require the Commission to submit a legislative proposal to Congress and the President to achieve generational equity and long-term economic stability.
· Authorize the President to submit to Congress an alternative proposal.
· Authorize the Committee on the Budget of either chamber to publish its own alternative proposal in the Congressional Record.
· Require the House and Senate to vote on the legislation within 90 days.
o Require CBO to prepare a long-term cost estimate and have it published in the Congressional Record as expeditiously as possible whenever requested to do so by the Commission, the President, or the chairman or ranking minority member of the Committee on the Budget of either chamber.
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Because it tries to deal with the symptoms of a failing health care program without tackling the cause of that failure, it is difficult to see Alberta's new plan as anything beyond a dismal disappointment.
A few months ago, Alberta Premier Ralph Klein committed to a "Third Way" that would have been a major milestone in the history of Canadian Medicare.
Up to that point, discussions of health care reform had inevitably deteriorated into accusations of promoting a "U.S.-style" health care program in Canada. Klein turned the debate in Alberta by not only realizing but actually publicly stating that there are many other options for reform. Specifically, the Premier proclaimed that he would implement reforms based on the developed world's most successful universal access programs.
So it came as a particular disappointment that the "Third Way" announced Tuesday by his government amounted to little more than a reaffirmation of Alberta's commitment to the status quo.
Consider, for a moment, the current state of Canadian medicare. No nation that guarantees access for all citizens regardless of their ability to pay spends more on health care than this country, on an age-adjusted basis. But Canadians still suffer some of the longest waiting times, experience relatively poor access to doctors and technology, and enjoy only average health outcomes when compared with these other nations. Put simply, the status quo leaves taxpayers dishing out for world-class health care and getting service that ranges from average to terrible.
It seemed, for a while at least, that the Alberta government was prepared to recognize there was a better way -- one that would take its lessons from the health care programs found in Australia, Austria, Belgium, France, Germany, Japan, Luxembourg, Sweden and Switzerland. The programs in those nations deliver superior health outcomes to Canada's, or deliver access to medicare without waiting lists, or both. And while each is unique, all have some very important fundamental policies in common.
Most importantly, all of them revolve around competition and financial incentives. Each of those countries requires patients to be responsible for at least some of the cost of their care, allow care to be delivered competitively by private hospitals and allow patients the opportunity to seek care on their own terms if the public program is unwilling or unable to meet their needs. As a result, these programs make better use of their resources and deliver services in a more patient-focused and patient-oriented setting.
It is these policies, and the fundamental concepts of competition and financial incentives, that should have been at the core of Tuesday's announcement. Klein and Health Minister Iris Evans should have been talking about implementing a cost-sharing arrangement, introducing competitive private provision of publicly funded services and withdrawing all rules and regulations restricting Albertans' freedom to seek all health services (even medically necessary ones) on their own terms. Instead, the government turned away from the promising vision hinted at in Klein's previous discussions of the Third Way, and all the benefits that would have accrued to Albertans as a result. . . .Read the entire article . . .
Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.
--Canadian Supreme Court Decision 2005 SCC 35,  1 S.C.R. 791
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When the Medicare Trustees warn Congress that Medicare is on an unsustainable path to bankruptcy, the Democratic response is not reform the program but to simply silence the trustees.
President Obama has repeatedly claimed that his health care reforms also represent entitlement reform. Not surprisingly, the Congressional Budget Office shows this claim is implausible. They have scored several health care proposals as costing more than $1 trillion in the first decade, and certainly more thereafter. Accordingly, lawmakers are considering substantially raising taxes (during a recession!) to fund their proposals. Of course, health care reforms that are intended to save money usually do not typically require painful tax increases to offset their cost. The reality is that health care reform will substantially worsen the alarming condition of the long-term budget outlook where the biggest problem is Medicare, says the Heritage Foundation.
Rather than deal with Medicare's situation directly, the President and his allies promise to "bend the curve" to achieve savings across the health care spectrum -- including Medicare. If this is true, why then would page 836 (Section 1901) of the House bill repeal the "Medicare trigger" that is intended to force legislative action when Medicare's finances worsen, asks Heritage?
· The Medicare Modernization Act of 2003 had mandated that if more than 45 percent of Medicare expenditures were projected to come from general revenues (as opposed to dedicated revenues, such as payroll taxes and beneficiary premiums) within a seven-year period, the trustees would issue a warning.
· Two consecutive years of this warning would require the President to offer reform legislation and Congress to give that legislation expedited consideration.
This warning has been triggered four consecutive years -- the last three of which would have required legislative action. Yet the Democratic Congress has regularly passed rules suspending their responsibility to address Medicare's unsustainability. Now, the House health care bill would repeal the trigger altogether.
The lesson is clear, says Heritage:
· When the Medicare Trustees warn Congress that Medicare is on an unsustainable path to bankruptcy, the Democratic response is not reform the program, but to simply silence the trustees.
· Consequently, Congress can continue to ignore Medicare's $38 trillion unfunded obligation.
During his campaign for president, Obama had said "we're going to have to take on entitlements, and I think we've got to do it quickly." Instead, he proposed layering an expensive new health care entitlement on top of an entitlement system that was already projected to go bankrupt. That will result in massive deficits and taxes dumped into the laps of our children and grandchildren. If the President accepts the House provision repealing the Medicare trigger, it will be another nail in the coffin of our long-term financial sustainability, says Heritage.
Source: Editorial, "House Health Bill Would Silence Trustee's Medicare Bankruptcy Warnings," Heritage Foundation, July 15, 2009.
For more on Health Issues: www.ncpa.org/sub/dpd/index.php?Article_Category=16
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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Patients with or without insurance go to the Emergency Room of various hospitals to obtain care for a variety of reasons. They may not have a personal physician, it may be more convenient to go after work than to their own physician, they enjoy having the full resources of the highest and most expensive care at their disposal even without health insurance as only a hospital can provide, or it's their social event of the day.
Regarding the latter, I recall the Emergency Room at Kansas City General Hospital where many members of the community congregated every evening. Some were sick, some accompanied others that were sick and some came to see which of their friends might be sick. Frequently there was standing room only but they didn't seem to mind. In fact, they all seemed to be having a grand time.
About 10 PM one evening, the two interns on duty were becoming exhausted and there still was standing room only. They hadn't had an emergency all evening. They were getting tired of treating sniffles and sore throats and earaches, which could have been treated in the patient's personal physician's office earlier or later in the week with no diminution of quality of care.
One of the interns came up with a plan to clear the area of the non-sick. He drew up a huge 50 ml syringe with saline and a spinal needle about five inches long. He made arrangements with the other intern to be very busy doing nothing and a nurse who would come to his aid after he went out into the middle of the waiting room, feigning an epileptic fit. He held the syringe high and stammered into the waiting room yelling, "Who's next?" as he went into a writhing and then tonic, clonic, convulsive reaction. The other intern dropped his black bag and yelled for the nurse to help as they dragged the jerking intern back into the empty examining room.
They then watched as about 50 alleged patients had their social event of the evening interrupted and stumbled over each other to get out of the Kansas City General Hospital Emergency Room. There were only about five patients left that the two interns assumed were really the patients that needed attention. They took care of them and had a nice, steady workload the rest of the night without the stress of having 50 people in line.
This supports the contention that about 85 percent of the care given in the Emergency Room is for routine office-type care and not emergencies. But when highly trained ER physicians practice pediatric and general medicine on a one-time basis with patients whom they have never seen before and probably will never see again, does the patient obtain a good level of care? Does the patient obtain a cost-efficient level of care? No and no.
The patient with costochondritis (inflammation of the ribs at the point of attachment to the sternum), who mentions chest pain to the receptionist, will have the whole triage system for a myocardial infarction immediately implemented. This is not to discredit the ER Specialists, but to emphasize the necessary program for the expected critical emergency care for which the ERs were established. This patient gets a complete cardiac evaluation with the most modern tests available, many of which are hundreds of dollars each. We've seen statements as high as $9,000 for this type of visit where the patient was found to have no heart disease. The patient is seen the next day in the office still complaining of the chest pain. The personal physician then palpates a tender costal-sternal margin, the patient is given two extra-strength Tylenol tablets and the pain is resolved within the hour. Nine cents worth of medicine compared with $9,000 worth of high tech tests. Can the hospital or ER Specialist solve this problem? Probably not because of liability issues involved in a one-time patient who alleges an emergency. But if something goes wrong, the attorneys, judges and jury will look on the outcome if the full evaluation was not done. Why would the hospital or ER specialist risk this type of liability? Why would Medicare or Medicaid interfere and assume the liability? So there can be no cost controls under our present system. There are no effective controls without serious risks in our present socialized government-controlled health care system. The answer has to come from the patient. But the answer won't come from the patient as long as the ER is relatively free. However, if the patient had a ten or twenty percent co-payment, the cost containment would occur at the registration desk as each patient evaluates the cost versus the expected benefit for the perceived risks. If the costs exceed the expected benefits and perceived risks, the patient and his family leave the registration desk, go home and the spouse administers the Extra-strength Tylenol. The patient feels better with nine cents worth of medicine, saving the system $9,000 of high-tech tests.
Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on Every Service.
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It is frequently asserted, especially by groups such as Physicians for a National Health Program (PNHP), that a "single payer" (government) system could "save" enough money on administration to buy coverage for all the uninsured.
The basis for the assertion is the claim that Medicare spends only 2% to 3% of its outlays on administration, compared with private plans' alleged costs of 20% to 25%.
In fact, data from the Congressional Budget Office (CBO) shows that insurance companies spend at least 50% less on administration than government does on its health programs. (The Congressional Budget Office Reports: Comparing health care admin cost: who's less costly?)
CMS (Centers for Medicare and Medicaid Services) divides spending data into care (paid to doctors, hospitals, pharmacies, and others for patient care) and non-care (everything else). For 2009, CMS projects spending on care at $2.13 trillion, and non-care at $424 billion or 16.7% of total spending.
Of the $879 billion projected to be paid in 2009 by private insurance, CMS estimates $128 billion for non-care—12.7%. For all public programs except Medicare, the comparable percentage is 26%, without adjustment for the taxes and assessments paid only by private insurers. Unlike Medicare, other public programs—Medicaid, SCHIP, Veterans Administration, and military programs—are internally administered.
Medicare is externally administered by private companies; its non-care costs are 5.7%. If it were administered like other government programs, administrative cost would increase by $1 trillion over the next 10 years.
There are many reasons why private companies have higher non-care costs for their private plans than for Medicare:
· Private insurance plans must pay government taxes and assessments up to 5% of premiums. When these are factored out, the real net cost of private administration is less than 10%.
· CMS excludes the cost of its own employees who enroll recipients, perform outreach and education, handle customer service, and do auditing and other functions. Private plans include these in overhead.
· Private plans have on average a higher number of claims to process for a given amount of expenditure.
· Insurance companies have to collect premiums. The IRS does that for Medicare.
· Private companies do underwriting; their premiums have to cover their costs. Medicare deficits have to be covered by taxpayers.
· The cost of servicing the public debt is not included in Medicare costs—and Part B is 75% subsidized by general revenues, not beneficiary premiums.
Greg Dattilo and Dave Racer conclude: "Though one has to dig for the truth, the CBO report makes the case: Competition in a private health insurance market saves tens of billions each year that government agencies would waste on administrative cost."
Benjamin Zycher of the Manhattan Institute for Policy Research also notes that it costs the economy more than a dollar to send a dollar to Washington (Wall St J 10/29/07). The lowest plausible assumption for the excess economic cost of the tax burden, 20%, would raise the cost of delivering Medicare benefits to at least 24% to 25% of Medicare outlays, and a more realistic estimate to about 52%, or four to five times the net cost of private insurance.
Other facts to remember about Medicare administration:
· Physicians are subjected to career or life-destroying audits, civil monetary penalties, or criminal prosecutions, over what should be simple billing disputes (Libby RT, The Criminalization of Medicine: America's War on Doctors, Praeger 2008, reviewed in J Am Phys Surg, summer 2008).
Medical Myths Originate When Government Pays The Medical Bills.
Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service.
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Dr. Rosen: The Sacramento Suburban Congressman, Dan Lungren sent out a brochure with his concern about the $11 trillion national debt and that spending continues with no end in sight.
Dr. Dave: I got one also. It's about time Congress wakes up to the damage they're doing to the American people.
Dr. Paul: I got one too, and he's like the typical conservative Republican, worried about the cost of entitlements.
Dr. Edwards: How can you not be worried? Don't you have children that are being enslaved?
Dr. Paul: You guys are always worried about the next generation. We need the problems solved here and now.
Dr. Edwards: Well, I have children. And I think what we are placing on their shoulders is cruel and inhumane.
Dr. Paul: They'll survive. It's just money.
Dr. Dave: I thought we once had a "Tea Party" and "No Taxation Without Representation." And then we whipped the British for taxing us. Haven't you sent tea bags to your congressman and senator?
Dr. Paul: No I haven't and don't plan to. Did you vote in this last election?
Dr. Dave: I certainly did. But I didn't vote for this mess.
Dr. Paul: Then you were represented. It's just that your vote was in the minority.
Dr. Edwards: But isn't there a moral issue involved here? My children and future grandchildren are not able to vote for or against these taxes that they will have to pay. That caused a war of independence. Independence from the Brits and the Europeans.
Dr. Paul: What kind of war do you want to fight? We are independent and subservient to none.
Dr. Rosen: But we are subservient to the government. The war of independence was to put the people in charge of the government, which was to be their servant.
Dr. Paul: But our government is a product of our people and their vote. So they have to do what we elected them to do.
Dr. Edwards: But we didn't vote for the Europeanization of America. Our forefathers left Europe for freedom from the Tyranny of Government. Now we're the slaves of government.
Dr. Rosen: We are going backward in history. For millennia, governments had been oppressive and people had no voice. Now after the first 150 years of the greatest experiment in freedom the world has ever known, why are we giving up this hard fought freedom without firing a shot?
Dr. Paul: Who would you want to shoot?
Dr. Rosen: I guess that's a good question. It looks like if China and Russia call in all the United States notes they hold from our excessive spending, they could take over our country since they hold the mortgage. And they would not have to fire a shot.
Dr. Edwards: I hope those of us that want to keep our freedom wake up before it's too late. Once we're enslaved again, it will take another millennia to restore freedom—if it still can be restored.
The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
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VITAL SIGNS – Journal of The Fresno-Madera And Kern Counties Medical Societies
President's Message by Cynthia Bergmann, MD, "Primum non nocere " – First not to do harm
"Primum non nocere" – First not to do harm – is a phrase often repeated as a basic tenant of medicine and one that most of us believe is a part of the Hippocratic oath. Of course the fact that Hippocrates was a Greek who lived between 460 and 370 BC makes it unlikely that he spoke a Latin phrase to his students. The earliest use of the phrase has been attributed to the 17th Century English physician Thomas Sydenham. The phrase was used sparingly until it was popularized by the Journal of the American Medical Association Editor Morris Fishbein, MD in1930. While this phrase is an appropriate admonition to all physicians to think before they do and perhaps knowing that doing nothing may be the best treatment, I believe it is time to consider adopting a second Latin phrase to guide us as physicians:
Secundus prosum – Second, do good.
We are taught and our ethics dictate that we always do what is best for the patient sitting in front
of us. With the advent of telemedicine and e-medicine, our patient may be sitting in front of a
camera or a computer screen instead of in an exam room.
That patient is our community, and I believe now is the time we consider our duty to the community, which in turn, has a huge impact on the health of our patients, family and friends. The health of our community directly influences our patients, our ability to practice, and even our own health.
For too long we have thought that if we took good care of our patients, we were doing our job, and that if we did volunteer work, any public obligations we had would be satisfied. As we come to have a greater understanding of how health and prevention intertwine, it becomes apparent that the small amount of time we get to spend in direct patient contact is overshadowed by environmental influences on the patient. The air they breathe, the foods they eat, the stresses they encounter in their daily lives and their access to other doctors and health care all have a profound influence on a patient's ability to lead a healthy and productive life. As individual physicians we have little power to change these types of challenges for our patient.
As a group of physicians, however, we have tremendous ability to influence community attitudes. Our air quality work has been instrumental in improving our ability to breathe healthy air. We are being asked to support a new medical school at UC-Merced that would have a patient-centered curriculum and give a combined BS/MD degree in six years rather than the traditional eight. This would decrease the time and money spent by our future doctors as well as giving them a "Valley foundation" in the hopes that they would continue living here as practicing physicians. By sharing healthy life-style messages directly with the public, we re-enforce the healthy living advice they are getting in their personal physician's office.
It is time to "do good" for our community and our selves. Be prepared to say yes when you are asked to participate. Even a small effort can have significant consequences.
VOM Is Where Doctors' Thinking is Crystallized into Writing.
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9. Book Review: AMERICA ALONE, The End of the World as we Know It, by Mark Steyn, Regnery Publishing, Inc, an Eagle Publishing Company, Washington, DC, xxx & 224 pages, $27.95; © 2006 by Mark Steyn. ISBN-13 978-0-89526-078-9
"When people see a strong horse and a weak horse, by nature they will like the strong horse." -Osama Bin Laden, Kandahar, November 2001.
"If we know anything, it is that weakness is provocative." -Donald Rumsfeld, Washington DC 1998.
Steyn begins: "Do you worry? You look like you do. Worrying is the way the responsible citizen of an advanced society demonstrates his virtue: he feels good about feeling bad.
But what to worry about? Iranian nukes? . . . worrying about nukes is so eighties."
So what should we be cowering in terror over? Steyn feels the harrowing nightmares of doom didn't start with Chicken Little and won't end with Al Gore. So, should we forget about the end of the world and head for the hills? Steyn says: Don't head for the hills - they're full of Islamist terrorist camps. He describes a much bigger nutshell. The Western world will not survive the twenty-first century. Many, if not most European countries will effectively disappear in our lifetime. Just as in Istanbul there's still a building known as St. Sophia's Cathedral, but it's not a cathedral: It's merely a designation for a piece of real estate. Likewise, Italy and the Netherlands will merely be designations for real estate. Forget the ecochondriacs's obsessions with rising sea levels that might conceivably hypothetically threaten the Maldive Islands circ 2500; contrary to Francis Fukuyama, it's not the end of history; it's the end of the world as we know it. Whether we like what replaces it depends on whether America can summon the will to shape at least part of the emerging world. If not, then it's the dawn of the new Dark Ages (if darkness can dawn): A planet on which much of the map is re-primitized.
Before you think that Steyn is as nuts as the ecodoom set, he reminds us of Chicken Little's successors in this field:
· Distinguished Scientist Paul Ehrlich declared in his 1968 bestselling book, The Population Bomb, "In the 1970s the world will undergo famines - hundreds of millions of people are going to starve to death."
· In 1976, Lowell Ponte published a huge bestseller called The Cooling: Has the New Ice Age Already Begun? Can We Survive?
· In 1977, Jimmy Carter, president of the United States (incredible as it may seem), confidently predicted that "we could use up all of the proven reserves of oil in the entire world by the end of the next decade."
None of these things occurred. But according to Steyn, here's what did happen between 1970 and 2000: in that period, the developed world declined from just under 30 percent of the global population to just over 20 percent, and the Muslim nations increased from about 15 percent to 20 percent. Is that fact less significant than the fate of some tree or endangered sloth? In 1970, very few non-Muslims outside the Indian subcontinent gave much though to Islam. Even the Palestinian situation was seen within the framework of a more or less conventional ethnic nationalist problem. Yet today it's Islam a-go-go: almost every geopolitical crises takes place on what Sam Huntington, in The Clash of Civilizations, calls "the boundary looping across Eurasia and Africa that separates Muslims from non-Muslims." That boundary loops from Bali, to southern Thailand, to an obscure resource-rich Muslim republic in the Russian Federation, to Madrid, and London before penetrating into the very heart of the West in a little more than a generation.
September 11, 2001, was not "the day everything changed," but the day that revealed how much had already changed. That Tuesday morning the top of the iceberg bobbed up and toppled the Twin Towers.
Steyn says that his book is about the seven-eighths of the iceberg below the surface - the larger forces at play in the developed world that have left Europe too enfeebled to resist its remorseless transformation into Eurabia and that call into question the future of much of the rest of the world, including the United States, Canada and beyond.
He cites three key factors:
· Demographic decline: People Power
· The unsustainability of the Advanced Western social-democratic state: Welfare and Warfare
· Civilizational exhaustion: Fighting vainly the old ennui
1. People Power:
Steyn starts with demography, because everything does. He wonders how many pontificators on the Middle East peace process ever run this number: the median age in the Gaza Strip is 15.8 years. Once you know that, all the rest is details. If you were a "moderate Palestinian" leader, would you want to try to persuade a nation - or pseudo-nation of unemployed poorly educated teenage boys raised in a UN-supervised European-funded death cult to see sense? Any analysis of the "Palestinian problem" that doesn't take into account the most important determinant on the ground is a waste of time.
In a similar fashion, the salient feature of Europe, Canada, Japan and Russia is that they're running out of babies. What's happening in the developed world is one of the fastest demographic evolutions in history. The heart warming ethnic comedies, where a WASPy type dates a gal from a vast, loving, fecund Mediterranean family, so abundantly endowed with sisters and cousins and uncles that you can barely get in the room, are an inversion of the truth. Greece has a fertility rate hovering just below 1.3 births per couple, which is what demographers call the point of "lowest-low" fertility from which no human society has ever recovered. And Greece's fertility rate is the healthiest in Mediterranean Europe: Italy has a fertility rate of 1.2, Spain, 1.1. Insofar as any citizens of the developed world having "big" families these days, it's the Anglo democracies: America's fertility rate is 2.1, New Zealand's a little below. Hollywood should be making a movie on a Sad Greek only child marrying into a big heartwarming New Zealand family where the spouse actually has a sibling.
· Steyn says this isn't a projection - it's actually happening now. But if you do extrapolate, here goes: by 2050, 60 percent of Italians will have no brothers, no sisters, no cousins, no aunts, and no uncles. The big Italian family with papa pouring vino and mama spooning out pasta on an endless table will be gone, no more, dead as the dinosaurs. . .
2. Welfare and Warfare
In this section, Steyn gives us valuable insight into our welfare system. Demographic decline and the unsustainabilty of the social-democratic state are closely related. In America, politicians upset about the federal deficit like to complain that we're piling up debts our children and grandchildren will have to pay off. But in Europe the unaffordable entitlements are in even worse shape: there are no kids or grandkids to stick it to.
Steyn gives several examples of populations peaks and valleys without any harm. In the post-Gold Rush Yukon, one minute the saloons are bustling and the garters of the hoochie-koochie dancers are stuffed with dollar bills; the next they're all shuttered up and everyone's skedaddled out on the last south-bound dogsled. But the territory isn't stuck trying to figure who's going to pay for the hoochie-koochie gals' retirement complex. Unlike the emptying saloons of White Horse and Dawson City, demography is an existential crisis for the developed world, because the twentieth-century social-democratic state was built on a careless model that requires a constantly growing population to sustain it.
Steyn formulates it like this:
· Age + Welfare = Disaster for you
· Youth + Will = Disaster for whoever gets in your way. . .
3. Fighting Vainly the Old Ennui
Steyn then proceeds into the third factor - the enervated state of the Western world, the sense of Civilizational ennui, of nations too mired in cultural relativism to understand what's at stake. To Americans, it doesn't always seem obvious that there's any connection between the "war on terror" and the so-called "pocketbook issues" of domestic politics. But there is a correlation between the structural weaknesses of the social-democratic state and the rise of a globalized Islam. The state has gradually annexed all the responsibilities of adulthood - health care, child care, care of the elderly - to the point where it's effectively severed its citizens from humanity's primal instincts, not least the survival instinct. These programs corrode the citizen's sense of self-reliance to a potentially fatal degree. Big government is a national security threat: it increases your vulnerability to threats like Islamism, and makes it less likely you'll be able to summon the will to rebuff it. We should have learned that lesson on September 11, 2001, when big government flopped big-time and the only good news of the day came from the ad hoc citizen militia of Flight 93. . .
When Osama bin Laden made his observation about people being attracted to the strong horse rather than the weak horse, it was partly a perception issue. You can be, technically, the strong horse - plenty of tanks and bombs and nukes and whatnot - but if you're seen as too feeble ever to deploy them, you'll be kitted out for the weak-horse suit. He wasn't thinking of Europe, whose reabsorption within the caliphate Islamists see as all but complete. Rather, he was considering the hyperpower.
America is the most benign hegemon in history: it's the world's first non-imperial superpower and, at the dawn of the American moment, it chose to set itself up as a kind of geopolitical sugar daddy. By picking up the tab for Europe's defense, it hoped to prevent those countries lapsing into traditional power rivalries. Nice idea. But it also absolved them of the traditional responsibilities of nationhood, turning the alliance into a dysfunctional sitcom family, with one grown-up presiding over a brood of whiny teenagers. American's preference for diluting its power within the UN and other organs of an embryo world government has not won it friends. All dominant powers are hated - Britain was, and Rome - but they're usually hated for the right reasons. America is hated for every reason. The fanatical Muslims despise America because it's all lap-dancing and gay porn; the secular Europeans despise American because it's all born-again Christians hung up on abortion; the anti-Semites despise America because it's controlled by Jews. Too Jewish, too Christian, too godless, America is George Orwell's Room 101: whatever your bugbear you will find it therein; whatever you're against, America is the prime example of it. . . .
So why is a book concerning America's future so relevant and timely for physicians and Health Care? Steyn writes about the future of healthcare as part of all government entitlements. He puts government healthcare into a perspective that few who are still pushing for making it an entitlement understand. He has given up on Europe, calling it Eurabia. He predicts their cradle-to-grave welfare system will totally collapse before 2050, when there won't be enough children to pay for the beneficiaries. Then all healthcare, social security, childcare and government programs will simply disappear; those that believed in entitlements will wonder why they are without benefits. . .
There is a message on how detrimental state healthcare is for our future. He places it in context that even the most arched advocate of government medicine should be able to understand. It is critical for the leaders of our physicians' professional organizations (who are supporting single payer initiatives) to understand. This book has important messages for all physicians, nurses and health administrators. It is urgent, not only for our patients, but for all Americans to comprehend.
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Ten years ago, Congress created a new system of government credit cards for federal employees booking work-related travel. The cards were meant to curb waste and abuse. But since their introduction, charges have doubled - from $4.39 billion in 1999 to $8.28 billion in 2008.
Congress is now trying to create a new system of healthcare for Americans. This government-controlled healthcare is meant to curb waste and abuse. Just as Medicare cost about eight times as much as projected, so controlling all of healthcare should easily drive the United States to bankruptcy.
The Tax & Spend party doesn't believe there are limits to federal spending (or taxing).
Combating Memory Loss
A friend had just purchased the book Combating Memory Loss from Massachusetts General Hospital. He felt it was very helpful. It had a lot of good points to work on. When asked what some of the points were, he replied, "I forgot."
Some people have a hard time remembering yesterday.
Tax the People while they're down.
New York citizens having decreased income during the recession has not hindered the Tax and Spend folks from adding new state and municipal taxes, increasing sales tax, and doubling the beer tax.
And I thought seven taxes on my telephone bill was excessive.
You suppose New Yorkers will ever be able to get up and make enough to pay all those taxes?
Part-Time Congress, Anyone?
Sacramento Suburban Representative Daniel Lungren dislikes the extent to which members of Congress have delegated their work to members of their staff. He is troubled by the compressed work schedule in which the House typically operates frenetically, but only three days a week. And he is disturbed by the acid-laced partisanship that he thinks a longer workweek could help defuse.
Sounds like we should return to a part-time Congress and work frenetically full time three months a year and then go home before we do more damage.
To read more HHK, go to www.healthcarecom.net/hhkintro.htm.
To read more HMC, go to www.delmeyer.net/HMC.htm.
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• John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?" go to www.healthplanusa.net/AE-AreYouReallyInsured.htm. To read their practical guide: Taking charge of your own healthcare, go . . .
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, go . . .
• 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," "single-payer," 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."
• Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm, to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.
• David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/articles/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/articles/DGHealthCareInflation.htm.
• Dr Richard B Willner, President, Center for Peer Review Justice, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.
• Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.
To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.
• Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.
• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives.
• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: House bill would destroy private insurance - and private practice. 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 Get Off the Train. 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. Be sure to read the editor's The Feast of Barhusobam. There are a number of important articles and book reviews that can be accessed from the Table of Contents.
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Computers are incredibly fast, accurate and stupid. Humans are incredibly slow, error prone and brilliant. Together they can do amazing things. -Albert Einstein
He knew at least one true thing: the most dangerous weapon in the world is the human mind. Use it wisely. -Ralf Dahrendorf
"Continuous effort - not strength or intelligence - is the key to unlocking our potential." -Winston Churchill: author, soldier, and the U.K. prime minister
Some Relevant Postings
Ralf, Baron Dahrendorf, thinker and politician, died on June 17th, aged 80 From The Economist print edition, Jun 25th 2009
As a man who spent his life defining and defending liberty, Ralf Dahrendorf treasured the moment when he first felt that "visceral desire not to be hemmed in". He was in prison and in solitary, sent there for being part of a schoolboys' anti-Hitler society. He was not yet 16. Determined to demonstrate his free spirit somehow, he tore a piece of brown paper out of his mattress and wrote down, with a blunt pencil he had cadged from a guard, all the Latin words he could remember. In the preservation of liberty, he wrote later, "We have the weapons we need, our minds".
The advancing Red army eventually freed both him and Germany. For a while, there was neither government nor rules. With a band of young friends, he looted the local shops in Berlin. Through his long and stellar academic career, on his professorial shelves at Tübingen, Konstanz, Columbia, Harvard and the London School of Economics, he kept the few slim volumes of romantic poetry he had filched then, when he suddenly found himself free to take everything, but with almost nothing to take. This, he taught later, was "entitlement without provisions". . .
Liberty, he had discovered the hard way, needed institutions to preserve it. All the apparatus of civil society—courts, parliament, written constitutions, citizenship—was needed to ensure, in a favourite phrase, the greatest number of "life-chances", or choices, for everyone. And the nation state, though he was well aware of its parochial and xenophobic limitations, seemed to be liberty's best incubator.
Conflict-management, too, was necessary. The world was not simple. A bland union of wills and ideas led to totalitarianism; a perfect Arcadia would reduce human talents to a dormant state. Only man's "unsocial sociability", in the words of one of his heroes, Immanuel Kant, could sting society towards progress. And in the words of another hero, Karl Popper, at whose feet he sat at the LSE in 1952-53, since no one had found the grail of ultimate wisdom, "let us make sure above all that it remains possible to give different answers". That was why he confronted Rudi Dutschke, leader of Germany's students, on a trailer in Freiburg at the height of the unrest of 1968 (pictured above): not hiding away like Raymond Aron at the Sorbonne, but vigorously debating, professor with student, as he did all his life. The rest of the story . . .
On This Date in History - July 28
On this date in 1868, the Fourteenth Amendment was ratified. The Fourteen Amendment, which guarantees due process of law to all, was enacted after the Civil War to extend the federal guarantee of due process to govern state as well as federal matters. It was, therefore, an extension of the supremacy of the federal Constitution.
On this date in 1914, World War I began. Within a month after a Serbian activist killed the heir to the throne of Austria-Hungary, Austria-Hungary declared war on Serbia. Within a week, Germany, Russia, France, Belgium and England were in the war. It was the worst war, up to that time, in all history. We must also remember that 25 years later an even worse war began.
On this date in 1945, as World War II was winding down, a U.S. bomber crashed into the Empire State Building in New York. The building stood firm. The bomber was destroyed. The crash occurred on a Saturday, killing 13 people. Fifty-six years later, a Saudi pilot on a suicide and murder mission commandeered an American airliner and purposely crashed it into the World Trade Center, vaporizing himself, his crew and all aboard and bringing the World Trade Center into a heap of ashes, killing 3,000 people.
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
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The 7th Annual World Health Care Congress is the most prestigious meeting of chief and senior executives from all sectors of health care. The 2010 conference will convene 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.
Download a brochure: http://www.worldcongress.com/request_brochure.cfm?confCode=HR09000