MEDICAL TUESDAY . NET

NEWSLETTER

Community For Better Health Care

   Vol VII, No 5, June 10, 2008

 

In This Issue:


1.      Featured Article: The Fifth Annual World Health Care Congress

2.      In the News: Health Care Reform Now

3.      International Medicine: Costs Of Prescription Drugs In Canada Is Not To Blame

4.      Medicare: Ted Kennedy vs. Universal Healthcare: A Double Irony

5.      Medical Gluttony: Is MediGap Insurance Good for Seniors?

6.      Medical Myths: Six Unhealthy Truths that aAre Changing the Shape of Health Care

7.      Overheard in the Medical Staff Lounge: Medicare Cuts, Reinstatement, Veto, Overridden

8.      Voices of Medicine: Cackling Politicians

9.      The Physician Patient Bookshelf: Putting Our House in Order

10.  Hippocrates & His Kin: Thirty Percent Co-Payment Controls Health Care Costs

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. The third 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. That 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 5th Annual World Health Care Congress was held April 21-23, 2008 in Washington, D.C. Physicians were present on almost all the platforms and panels. This year it was the industry leaders that gave the most innovated mechanisms to bring health care spending under control. The solution to our health care problems is emerging at this ambitious congress. Plan to participate: The 6th Annual World Health Care Congress will be held April 14-16, 2009 in Washington, D.C. The World Health Care Congress - Asia will be held in Singapore on May 21-23, 2008. The 5th Annual World Health Care Congress – Europe 2009 will meet in Brussels, May 23-15, 2009. For more information, visit www.worldcongress.com. The future is occurring NOW. 

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1.      Featured Article: FIFTH ANNUAL WORLD HEALTH CARE CONGRESS-2008

As the above heading indicates, the most prestigious health care meeting of the world has lived up to its reputation. The leaders in industry, as well as health care executives and physicians, discussed all issues of the current health care conundrum. A premier faculty of hundreds spoke to an audience of more than 15,000 from all fields of health care. There were 11 keynote addresses in open summits as well as ten simultaneous tracks of topics that included International Health, Employer CEO/CFO, health care insurance, evidence-based medicine, pricing and reimbursements etc., over three days.

It was enlightening to hear from Steven Burd, Chairman, President and CEO of Safeway Inc., who spoke knowledgeably about health matters. He states the cost of the healthcare problem is the result of market forces being absent. . .  To read more, please go to www.medicaltuesday.net/index.asp. Both the cost and the coverage problems can be solved by introducing market factors. But one must be aware of the fluidity of health care costs by understanding the following:

Seventy percent of healthcare costs are driven by behavior.

Seventy-four percent of all costs are confined to four chronic diseases. They are cardiovascular, cancer, diabetes and obesity.

Every private sector company can experience savings in their health costs by behavior related incentives.

Eighty percent of diabetes is preventable.

Nearly all cases of obesity can be improved.

By introducing a 30 percent payment by the employees, the costs were controlled and health improved. He felt that the primary source of Safeway's cost reduction was Behavioral Incentives. 

Health care costs are also related to specific conditions: Smoking increases costs by $920 a year; obesity increases costs by $705 a year. High cholesterol increases costs by $320 a year. He noted that by emphasizing to the employees these health care costs, the Hershey chocolates disappeared from all the secretaries' desks and eating habits improved.

Mr. Burd also pointed out that we need transparency in health care costs. Their company had noted a disparity in costs of colonoscopies from $630 to $6500; in arthroscopies from $2200 to $11,853; in deliveries from $7,170 to $12,771. Most of these savings are when the procedures are done in private centers rather than hospitals.

He considers Safeway as a cruise ship. If we spring a leak, we will find it out before any agency will find it. We can then act on it immediately.

www.worldcongress.com/events/HR08000/index.cfm?confCode=HR08000

Steven A. Burd
Chairman, President and Chief Executive Officer
Safeway Inc.

Safeway Inc. is one of the largest food and drug retailers in North America. Headquartered in California, Safeway is a Fortune 50 company, operating 1,767 stores in the United States and Canada. Regarded as one of the best managed food retail companies, Safeway has been ranked by Fortune magazine as one of the "most admired" companies in the food and drug sector.

Upon Mr. Burd's arrival at Safeway in 1992, he spearheaded a significant turnaround that produced industry-leading sales and cost reduction while developing an excellent reputation for superior customer service. In 2003, Mr. Burd launched a strategy to differentiate Safeway's offerings , by fundamentally reinventing its business through its Lifestyle store format, product innovation, operational efficiencies and new growth vehicles. The company has expanded its reach into the prescription drug business with more than 1,300 in-store pharmacies. In addition, it offers a wide range of proprietary products and special features, including an extensive line of private label products, superb perishables restaurant-quality prepared meals, fuel centers, online home delivery and Starbucks coffee cafés.

Mr. Burd is considered a thought leader in advancing sound public policy on issues impacting the retail industry. In 2007, he received the Food Marketing Institute's Glenn P. Woodard Award for his leadership in public affairs. Solving the health care crisis in America is a passion of Mr. Burd's. Under his direction, Safeway has reversed the trend of rising health care costs by implementing an innovative plan that pays 100% of preventive care, rewards good behavior and allows employees to take more control of their health care decisions. Participating employees have a better, more comprehensive health plan while their out-of-pocket costs have decreased 22% to 32% over a two-year period. More than 70% of eligible non-union employees participate in the plan. . .  To read the rest of his bio, go to www.worldcongress.com/speakerBio.cfm?speakerID=1869&confcode=HR08000.


Plan to participate: The 6th Annual World Health Care Congress will be held April 14-16, 2009 in Washington, D.C. For more information, visit www.worldcongress.com. The future is occurring NOW. 

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2.      In the News: Health Care Reform Now, George C. Halvorson, Chairman and CEO,
Kaiser Permanente, World Health Care Congress April 21, 2008

Mr. Halvorson gave a very concise delivery at the WHCC of important issues in health care.

Health Ccare delivery in the U.S. is uncoordinated, unfocused, inconsistent, unmeasured, extremely inefficient, perversely incented, excessively expensive and sometimes dangerous.

Health care delivery is, however, the fastest growing and most profitable segment of the whole U.S. economy.

As an industry - as a business model - health care is winning. It is taking everyone's money with an amazingly low level of accountability for the product it sells.

We need to face the simple reality that -- --Health care will never reform itself.

Smart people do not kill the geese that lay lots of golden eggs. Health care is awash in both golden eggs and very smart people.

In today's world, more efficient and effective caregivers simply deprive themselves of income. . . To read more, please go to www.medicaltuesday.net/news.asp..

Asthma: $200 to prevent; $10,000 to treat. Many Treat; Few Prevent. So what should we do?

Reform care.

One Percent of Population costs 35% of health Care Costs.

Cost Distribution of Care: $300 per month is the average cost for the population as a whole.

The break- even cost of insuring that one percent of the population: $12,000 per month

Total Cost of Care in America: Chronic Care 75% vs. Acute Care 25%

American health care could be transformed fairly quickly if a number of high leverage buyers chose to strategically use their market leverage.

 Health care reform needs to be a "product"-- purchased and paid for by high leverage buyers in a more sophisticated and targeted purchasing strategy.

Health care purchasers have great leverage relative to getting health plans to reform key elements of care.

We Need: 1) Focus 2) Tools 3) Health

Be Well

 

George C. Halvorson
Chairman and CEO
Kaiser Foundation Health Plans and Hospitals

George C. Halvorson is chairman and CEO of Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, headquartered in Oakland, California. Kaiser Permanente is the nation's largest integrated health plan, serving more than 8.4 million members in nine states and the District of Columbia. He has more than 30 years of health care management experience. He was formerly President and CEO of HealthPartners, headquartered in Minneapolis. He is the author of "Epidemic of Care" published in April 2003, and "Strong Medicine." He is currently writing two new books, one about racial prejudice around the world, and another about systematic reform of health care in America.

www.worldcongress.com/speakerBio.cfm?speakerID=318&confcode=HR08000


This prestigious meeting of chief and senior executives from all sectors of health care will reconvene on April 14-16, 2009, in Washington DC. For more information, visit www.worldcongress.com.

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3.      International Medicine:  Costs of prescription drugs in Canada not to blame for unsustainable growth in health care spending - The Frasier Institute

TORONTO, ONTARIO - News Release - April 10, 2008. Government spending on prescription drugs is not responsible for the health system's lack of financial sustainability, according to a new study from independent research organization the Fraser Institute.

"Unsustainable growth in government spending on health is a result of the flawed design of government health and drug insurance programs, not the price of medical treatment or the introduction of new medical technologies like patented drugs," said Brett Skinner, the Institute's Director of Health, Pharmaceutical, and Insurance Policy Research and author of The Misguided War Against Medicines.

"Prescription drugs in general and patented drugs in particular account for a small percentage of government health spending. The fact that government spending on all other areas of health care is growing at unsustainable rates, while accounting for more than 90 per cent of total government health spending, strongly suggests that targeting prescription drugs is misguided."

Skinner's study sets out to examine the often-cited claim that spending on prescription drugs is making the cost of Canadian health care unsustainable. . .  To read more, please go to www.medicaltuesday.net/intlnews.asp.

. "Blaming patented medicines for rising health care costs is a simplistic, knee-jerk reaction based more on anti-business attitudes directed at the pharmaceutical industry than any quantifiable research. It doesn't hold up under scrutiny," Skinner said.

The Misguided War Against Medicines shows that prescription drugs accounted for only 9.3 per cent of total government spending on health in 2006, down from 9.6 per cent in 2005. Patented prescription drugs accounted for only 6.3 per cent of total government health spending in 2006, down from 6.8 per cent in 2005.

After spending on drugs is subtracted, all other areas of health care accounted for 91.4 per cent to 90.7 per cent of total government health spending between 2002 and 2006.

The study also found that annual spending on health professionals between 2002 and 2006 grew at a rate of 6.5 per cent on average while annual spending on hospitals and institutions grew by 6.9 per cent on average, and annual spending on government health, administration, research, and other areas together grew by 7.2 per cent on average.

"These average annual growth rates are between 1.2 and 1.4 times higher than the average annual growth in consolidated provincial revenues over the same time period. It is also between 1.2 and 1.3 times higher than the average annual growth in national GDP and 2.9 to 3.2 times higher than the average annual growth in general inflation," Skinner said.

"This means that even if governments spent nothing on drugs, government spending on all other medical goods and services would still be rising at an unsustainable rate." . . .

Additionally, the study found that Canadian government data showed average prices for existing patented prescription drugs in Canada have grown at a slower annual pace than the general rate of inflation for 17 of the last 19 years.

"Prices for existing patented drugs are increasing at an even slower rate than they are allowed to grow under federal price controls that permit annual price increases matching the general rate of inflation. It also means that after adjusting for inflation, prices for existing patented medicines have declined in real terms in 17 of the last 19 years," Skinner said.

Skinner concludes that the real cause of unsustainable growth in government health spending is the flawed design of government health and drug insurance programs.

"Government interference in health care markets through public insurance programs actually distorts the efficient allocation of medical resources, including prescription drugs. When government health insurance attempts to provide equal access and 100 per cent insurance coverage for any medical need on a universal basis, the system becomes financially unsustainable," Skinner said. . .

To read the entire news release, go to www.fraserinstitute.org/newsandevents/news/5429.aspx#.

The Fraser Institute is an independent research and educational organization based in Canada. Its mission is to measure, study, and communicate the impact of competitive markets and government intervention on the welfare of individuals. To protect the Institute's independence, it does not accept grants from governments or contracts for research.

Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

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4.      Medicare: Ted Kennedy vs. Universal Healthcare: A Double Irony by Richard Parker M.D. 

Senator Ted Kennedy recently underwent an operation to remove a brain tumor at Duke University. Besides Hillary Clinton, no other politician in America has devoted as much of his political career to the enslavement of physicians. The name Ted Kennedy (and Clinton) is nearly synonymous with the anti-concept "Universal Healthcare."  

It was reported that Senator Kennedy chose his surgeon for this difficult operation after very careful research and consultation with his physicians in Boston.  Using his free and independent judgment, Kennedy chose Dr. Allan Friedman, a surgeon renowned for his experience and expertise in the field of neuro-oncological surgery. 

No government regulations restricted the Senator in this extremely important personal choice.  Facing a life threatening illness, no bureaucrat forced the Senator to choose his surgeon nor hospital from a government "approved" list--a list not generated by Kennedy's independent and free judgment, but by "public servants" who's expertise is not Kennedy's life, but the arbitrary and byzantine politics of "pull", of favors owed and collected, of political pressure groups and the bitter reality of healthcare rationing.  No, Kennedy was not forced to sacrifice his life, liberty nor property in the name of the so-called "greater public good." To read more, please go to www.medicaltuesday.net/medicare.asp.

The surgeon he chose, Dr. Allan Friedman, has freely devoted his life to treating patients with neurological tumors.  Dr. Friedman wasn't coerced into medicine; his patient load is not presently rationed nor stipulated by bureaucrats.  Dr. Friedman was still free to accept Senator Kennedy as his patient and was free to choose the best surgical approach for treating the Senator's tumor.  No bureaucrat stipulated how many patients per day, week, month or year Dr. Friedman may accept and treat during the long decades he spent perfecting his life-saving skill.  Dr. Friedman is still relatively free to use his expert judgment in the face of the awesome responsibility he assumes with each patient he treats.

Ironically, however, if Senator Kennedy succeeds in his ambition of forcing a government financed (and therefore government controlled) healthcare system onto the American people, all these life altering and personal freedoms will vanish with the strokes of a few pens in Washington.  This is the reality of any government enforced healthcare system - both patients and physicians will face a vast increase in taxation and the loss of additional property (fines) and liberty (imprisonment) if they violate the morass of arbitrary and contradictory regulations that will descend on a healthcare industry that is already all but crippled with the slow but steady creep of government controls over the past 50 years.

In her novel Atlas Shrugged, Ayn Rand predicted one of the most pernicious aspects of so-called "Universal Healthcare" - the refusal of talented minds to be forced at the point of a gun.  Dr. Hendricks, a neurosurgeon in Atlas Shrugged, describes the indignation that led him to leave medicine:

"Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? . . . I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything -- except the desires of the doctors . . . . I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind--yet what is it that they expect to depend on, when they lie on an operating room table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims.  Well, that is the virtue I have withdrawn."

Ted Kennedy will undoubtedly continue his push for the enslavement of physicians with what remains of his political career. What he will evade, of course, is that his surgeon chose to go to medical school and spend decades training for and practicing neurosurgery in what is still the freest healthcare system in the world.  What Kennedy will refuse to acknowledge is that under his vision of "Universal Healthcare" he would never have had the absolute freedom to choose his surgeon, nor would his surgeon have had the absolute freedom to treat him.

The fact that "Universal Healthcare" will destroy what freedoms in American medicine still remain (and thus all the Dr. Friedman's under whose virtue the fate of Kennedy's brain now lies), will be not only evaded but explicitly denied - never mind that Kennedy chose not to go to one of the many "industrialized countries that provide 'Universal Healthcare'." Apparently, Kennedy ignored Michael Moore's claims of the excellent healthcare provided in other "industrialized" communist and socialist nations that provide "Universal Coverage", albeit this is precisely what Kennedy seeks to bring to America at the point of a gun.

While the successful outcome of Senator Kennedy's operation depended on freedom, Kennedy has devoted his political career to legislating freedom out of existence. This is an irony that America's news media will evade, much less report.

Article address: www.CapMag.com/article.asp?ID=5201

About the Author: Richard Parker is a practicing physician in the Dallas-Fort Worth area. He holds an MD from Brown and MD from Yale University. He has published in the scientific literature and has written Op-Eds for the Ayn Rand Institute and Capitalism Magazine.

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

- Ronald Reagan

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5.      Medical Gluttony: Is MediGap Insurance Good for Seniors?

We have always maintained in these newsletters that it was the Medicare co-pays and deductibles in the original law that best controlled Medicare spending. The responses show that our position has not been fully accepted by the tens of thousands of MedicalTuesday supporters that we've accumulated over the past seven years of our existence. Many Americans have difficulty accepting responsibility for their health care as patients, feeling that it deprives them of necessary and life-saving care. Hence, MediGap insurance was born to make health care largely free of individual responsibility. A recent example came to our office.

Ms. Gladys had just turned 65 and obtained both her Medicare card and her MediGap insurance card, which paid for Medicare Co-pays and Deductibles. She looked about ten years younger, had recently remarried and commanded a very respectable mid-management job. Her husband was successful in his business and they lived and traveled well. . .  To read more, please go to www.medicaltuesday.net/gluttony.asp.

.

She came in to establish herself with a new physician and, as she put it, "was going to be very proactive in her future health care." This was ominous but we thought we would give her the appointment hour to do a complete evaluation, write the appropriate requisitions and give her a chance to make her case. She had a list. She was very articulate about all her wants, desiring to avoid the pitfalls her friends had experienced, as well as the ones she had read about. Her requests were extensive and most were reasonable. We completed all the requests and because of their magnitude, we suggested she make an appointment after she completed them to discuss the results. We could then chart the future.

She did not keep her return appointment. We were suspicious. Anyone who wanted thousands of dollars worth of tests surely would be interested in the results. We called her a few weeks later and she politely thanked us and stated she would be in when she needed our services again. After a couple of months, we composed a letter and copied her chart in case we could not continue with her demands.

She returned about six months later. Again she was very articulate about her wants and as we started to discuss the medical justification for additional tests, she failed to understand why she couldn't have everything she thought was necessary. She had many highly placed friends who were very knowledgeable about health care matters. As we tried to put the breaks on unnecessary spending, she remarked that maybe she hadn't found the right doctor after all.

We told her we agreed with that evaluation. I handed her a copy of her entire chart with the cover letter requesting that she call her insurance carrier in the morning and get reassigned to a new physician. She was flabbergasted that we had both come to the same conclusion and that I had already copied her records for her to give to her next physician. Two days later, I sent her the fully typed copy of our last visit.

What were the issues playing here? We had a very knowledgeable lady who we would normally enjoy having in our practice. However, her insurance carrier rates us on our efficiency and cost per visit. We had already exceeded the acceptable costs by perhaps three- or four-fold on the initial visit. But we accepted that possible risk judging that we could control the costs of future visits. But the second requests were even more costly and not medically necessary. Thus, we decided that we could not meet her needs, or rather demands, in the current health care environment.

This current environment was promoted by Congress to reduce health care costs. Medicare pays HMOs a certain amount per month so that Medicare doesn't have to manage the huge Medicare program. They have shown their incompetence to do so. Congress does not believe Market Forces can control costs. However, it is our position that if all Medicare Beneficiaries had to sign a waiver to never obtain a MediGap policy, the cost to Medicare would have been controlled without the necessity of paying thousands of nurses and other health care workers to police utilization. This has led to the barbaric approach of HMOs denying care, which lowers the quality of care and puts patients at risk by penalizing the doctors who give high quality care at a reasonable cost. Without MediGap, patients would be co-paying 20 percent of the costs - a very effective utilization control. Medicare beneficiaries would supervise their own costs and in the process eliminate all unnecessary Medicare costs. Then the entire program would have continued to be under control.

We wish that Dr. Shultz had discussed this point in his book distributed at the World Health Care Conference (see Item 9: Book Review Section). Mr. Burd from Safeway, discussed in section one above, already understands this concept.

MediGap insurance reduces patient's health care responsibility, increases health care costs, and thus ultimately will not prove beneficial to seniors, or to the rest of our citizens or country.

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6.      Medical Myths: Six Unhealthy Truths that aAre Changing the Shape of Health Care

Kenneth Thorpe gave a succinct presentation at the WHCC: "Six Unhealthy Truths that Tell the Story of the Rise of Chronic Disease and Its Impact on Health and Health Care in the U.S."

Truth #1: Chronic diseases are the #1 cause of death and disability in the U.S.

133 million Americans, representing 45 percent% of the total population, have at least one chronic disease.

Chronic diseases kill more than 1.7 million Americans per year, and are responsible for 7 of 10 deaths in the U.S.

Truth #2: Patients with chronic diseases account for 75 percent % of the nation's health care spending.

During 2005, the U.S. spent almost $2 trillion on health care.

Of every dollar spent . . . …75 cents went towards treating patients with chronic disease. To read more, please go to www.medicaltuesday.net/myths.asp.

In public programs, treatment of patients with chronic diseases constitutes an even higher portion of spending: More than 96 cents in Medicare…and 83  cents in Medicaid.

Truth #3: Two-thirds of the increase in health care spending is due to increased prevalence of treated chronic disease.

Truth #4: The doubling of obesity between 1987 and today accounts for nearly 30% percent of the rise in health care spending.

The percent of children and youth who are overweight has tripled since 1980.

If the prevalence of obesity was the same today as 1987, health care spending in the US would be 10 percent lower per person - about $200 billion. 

Truth #5: The vast majority of cases of chronic disease could be better prevented or managed.

The Centers for Disease Control and Prevention (CDC) estimates… 80% percent of heart disease and stroke; 80% percent of type 2 diabetes; 40 % percent of cancer…could be prevented if only Americans were to do three things: Stop smoking; Start eating healthy; Get in shape.

Management of chronic disease could also be significantly improved: Chronically ill patients receive only 56% percent of the clinically recommended preventive health care services.

Truth #6: Many Americans are unaware of the extent to which chronic disease harms their health –and their wallets.

Two in three (68% percent) Americans underestimate the magnitude of the problem: That in the U.S., chronic diseases represent more than 70% percent of the deaths and 70% percent of health care costs.

Six Unhealthy Truths Tell the Story of the Rise of Chronic Disease and Its Impact on Health and Health Care in the U.S.

Ken Thorpe, PhD
Chair, Department of Health Policy and Management, Rollins School of Public Health, Emory University;
Former Deputy Assistant Secretary, Department of Health and Human Services;
Executive Director, Partnership to Fight Chronic Disease

Dr. Thorpe was the Vanselow Professor of Health Policy and Director, Institute for Health Services Research at Tulane University. He was previously Professor of Health Policy and Administration at the University of North Carolina at Chapel Hill; an Associate Professor and Director of the Program on Health Care Financing and Insurance at the Harvard University School of Public Health and Assistant Professor of Public Policy and Public Health at Columbia University.

Dr. Thorpe was Deputy Assistant Secretary for Health Policy in the U.S. Department of Health and Human Services from 1993 to 1995.

Dr. Thorpe is a frequent commenter on health care issues in the print media and television. He has appeared on Nightline with Ted Koppel, NBC News with Tom Brokow, ABC World News Tonight with Peter Jennings, CNN, CNBC and Newshour with Jim Lehrer.

www.worldcongress.com/speakerBio.cfm?speakerID=2613&confcode=HR08000

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7.      Overheard in the Medical Staff Lounge: Medicare Cuts, Reinstatement, Veto, Overridden

Dr. Milton: The Medicare cuts were really worrisome.

Dr. Sam:  But much of what the government does is worrisome.

Dr. Milton:  Aren't you glad the AMA went to bat to get them reinstated?

Dr. Sam:  Are you asking if winning a small skirmish will win the War Against Doctors and Patients?

Dr. Dave:  Don't you think if we win enough battles, we can eventually win the war?

Dr. Sam: I don't think so. The government will never be our friend. Is the UK government the friend of British doctors? To read more, please go to www.medicaltuesday.net/lounge.asp.

Dr. Edwards: I don't think so. After 60 years, the battles are still the same. Only the issues change from year to year depending on the whims of whoever is currently in charge.

Dr. Rosen: I agree with President Bush that there were enough downsides to the law that it should not have been implemented. The other issues will haunt us in years to come.

Dr. Dave: But with the government, you'll never win. So, we have to get what we can get when we can get it.

Dr. Edwards: There are already cuts planned for 2009.

Dr. Sam: Let the government cut Medicare every year. More and more doctors will opt out of Medicare. When the Medicare folks can't find enough doctors, let them be the bad guys complaining to Congress. As I see it, they have about 40 more free hours a week than I have.

Dr. Milton: So you don't agree with the AMA on their advocacy?

Dr. Sam: Absolutely not. That's why the AMA and our own CMA are losing members because most doctors don't agree with the issues they advocate.

Dr. Ruth: But you can't please everyone.

Dr. Edwards: So that is a good reason why professional organizations should stay away from political issues. They will never be on the side of freedom. Our administrative bureaucrats are just like politicians and have hidden alliances just like members of Congress.

Dr. Ruth: They seem to gearing up to the day when they will be our voice as we become enslaved.

Dr. Rosen: Did you see the article in the paper where the CMA Executive Director was featured along with the various labor and union leaders as wielding influence? Our Execs are no more professional than Union Bosses.

Dr. Yancy: That's why I've never joined the CMA or the AMA or the local Sacramento Medical Society. They don't represent me or my interests or what I think should be the position of physicians and surgeons.

Dr. Edwards: Did you note that the CMA gave $3 million to the election campaigns in addition to the $4 million for lobbying? That's more than two hundred dollars per member or about half our dues.

Dr. Sam: I'm getting more interested in the doctors I read about that have forsaken all insurance and practice for cash and credit cards only. Seems like they are less busy than the rest of us, working only a 50-hr week and enjoying life working only a 50-hour week - like most normal Americans. 

Dr. Michelle: And I understand they are making a good living.

Dr. Yancy: Better than I'm getting. I'm lucky if I get about one-fourth as much for each operation as I did a decade ago.

Dr. Ruth: My income slipped below a $100,000 last year for the first time. At a 3000-hour work year, I make less per hour than a line worker. But he has a retirement plan. I can't even retire.

Dr. Rosen: Join the working crowd. Medicine will become a dead-end job like other laborers who can't wait for the day when they don't have to work and can retire to the couch and die in peace and comfort.

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8.      Voices of Medicine: A Review of Local and Regional Medical Journals

The Bulletin of the Humboldt-Del Norte Country Medical Society, April 2008

IN MY OPINION:  Geese by GEORGE INGRAHAM, M.D.

If you have no iPod and are outside walking early enough, you can hear the world wake up. In February, the geese return. When the sky is clear they fly high and gabble quietly to one another. When the fog

is in they must wait at the refuge out near CR until the fog is high enough to see the landmarks without running into them. Their cackling takes a more nervous note when they aren't sure where the lead goose is going.

Last week I saw two large flocks, one headed due north and the other more easterly, cross paths at the same altitude as they emerged from the mist. Near collisions made the conversation more animated: you could almost understand it:

"Hey, chaps, careful there, eh?" (Canada geese, you see*) . . . To read more, please go to www.medicaltuesday.net/voicesofmedicine.asp.

"You're, um, going the wrong direction, you know: that's the way to Honolulu!"

"Wrong way my (bleep) (Vernacular for the sphincter at the end of the anal canal.): watch out, dummy!" (Canada goose born in the US)

They dodged and swerved, and there were no collisions. . . Some of the birds; lacking, perhaps, confidence in their leaders, changed groups. The flocks diverged and flew off into the fog, the cackling fading into the distance:

"Jeest! I almost hit that guy: scared the crap outta me!"

"Tell me about it: I was right behind you."

This isn't the first year that campaign speeches have touched upon universal medical care: I can remember Dwight Eisenhower mentioning it, and I'm sure the subject came up before that. Early pols were up against the AMA, who probably managed to scuttle the programs without raising a sweat. "Socialized Medicine" was a wonderfully negative buzzword. The drug companies were small potatoes in those days, with campaign contributions to match; and there was hardly any medical insurance industry at all. So, the pols felt safe in getting a little extra applause with the medical care card. They promised nothing. And delivered. But pressure slowly increased as technology improved, becoming more expensive, and Medicare came along in the 1960's.

This political year, so splendid and exciting in so many ways, may also well be the year that the US gets, or begins to get, a universal health plan. Bet on it. Certainly if no program is at least begun during the first term of the next president, he or she will enjoy no second. But, like the geese in the fog, although we are quite clear where we wish to go, we have differing ideas how to get there. The candidates are, however, unworried about the details. They're confident that there will be people willing to consult, and moreover even to construct and operate the new system.

They are right. Even now there are willing, even eager volunteers for the task of overseeing, and eventually controlling, the advent of our new tomorrow. Everybody wants to be the head goose, or at least the navigator. Take, for example, the insurance industry, whose representations to the newly elected Clintons in 1992 that the magical mystical HMO could "save the country money by keeping people well" (Wm. J.  Clinton, 1993) was entirely successful in saving, if not much money, at least the pride of the then new Chief Executive and the possible next new Chief Executive as well.  And if (worst case scenario) it goes against them, they could be entirely eliminated, a la Canada. And how nice it would be to save some of the 12-14% of the money now spent on running insurance companies!

And of course our friends in the drug industry (Ask your doctor if Superpanacea is right for you!," the durable medical goods industry ("ask your doctor if a nifty little electric scooter is right for you!"), and the diagnostic machinery industry ("Come to the mall and have a full body scan: a free Big Mac and fries with every study!") (OK I made up about the Big Mac) can see this coming, and are preparing their political connections to best advantage. . .

And it is quite reasonable for all these folks to be doing this. The future course of their careers, their incomes, and the care of their…our… patients will largely be determined in the next few years. During that time we will be seeing something not far removed from the Oklahoma land rush. For one brief shining moment, everything will be on the table, and our elected officials will be doing their sincere best to come with a system we can all work with and be proud of. . . . So the message is (and always seems to be) it is a good time to be telling our colleagues they should be joining organized medicine.

The only really enjoyable aspect of this is the quite likely confusion in the ranks of the malpractice bar: for should a purely federal system arise in these United States you will search the blueprint in vain for the room, or even closet, labeled "nuisance suits and obscenely generous judgements." Not to worry, though. They'll take a hit, but they'll survive. . .  To read the entire story, go to

www.humboldt1.com/~medsoc/images/bulletins/APRIL%202008%20BULLETIN_for%20web.pdf.

To read more VOM, please go to www.healthcarecom.net/voicemed.htm.

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

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9.      Book Review: Putting Our House in Order By George P. Shultz and John B. Shoven

Putting our House in Order –A Guide to Social Security & Health Care Reform, © 2008, W. W. Norton & Co., New York, www.wwnorton.com/

George Shultz and John Shoven open their Guide Book quoting Fed Chairman Ben Bernanke's Senate testimony concerning the right time to address our entitlement programs, "I think the right time to start is about ten years ago. The projected costs for these programs - Social Security, Medicare, and Medicaid - loom with gathering intensity."

The unease is produced by a feeling that the costs of entitlements are out of control and will overwhelm the budget. This will bring a catastrophe for beneficiaries whose needs will not be served as well as for the fiscal stability of the United States. . .  To read more, please go to www.medicaltuesday.net/bookreviews.asp. But can the entitlement problems be solved? Whether or not the political process can work out sensible changes is certainly an open question but Shultz is confident that progress can be made by reaffirming the wide consensus that the present programs are not sustainable and by showing that there are workable alternatives.

The magnitude of these costs cannot be met by any reasonable projection of future federal government revenues. Can the U.S. Body politic somehow find a way to ensure that systems are in place to provide reasonable income for the elderly that are consistent with fiscal sanity?

Dr. Shultz offers a different approach than the impending catastrophe, which is prevalent in much of the current writing on this subject. He cites informed sources about careful projections of future costs made by the Congressional Budget Office (CBO) which show that entitlement costs alone could reach 28.5 percent of gross domestic product by 2050, clearly an unmanageable level, especially considering that federal revenues have never exceeded 21 percent of GDP in the history of the Republic. And these projections reveal only part of the problems before us. Commitments by state and city governments and by private employers contribute substantially to the looming threat which Shultz calls, "The Iceberg Ahead."

Shultz is optimistic of a positive approach. He relies on America's solid record of economic achievements, which holds promise of continued success in the future. He points out American success on many fronts. The U.S. economy sets the world standard, and its growth is an essential ingredient in the expanding global economy. The creativity and dynamism of the American economy now yield strong gains in productivity (output per man-hour) that surpass the rate of improvement in many prior decades. The U. S. economy produces one of the highest per capita incomes in the world and no other major developed country has been able to keep pace, let alone catch up. So it's clear: We have success on our hands.

The economy is by no means the only area of success. Not only do Americans live longer than ever before, but many are healthier and capable of being productive far longer than at any time in the past. These trends are likely to continue as a result of many breathtaking advances in science and technology. He feels such momentous developments are opportunities to nourish.

The contradiction between this clear evidence of success and the current atmosphere of unease in the United States calls for a change in mind-set. The projected gargantuan shortfalls in the U.S. budget stem largely from the interaction of constantly expanding costs of health care and longer life  spans with relatively inflexible entitlement programs. Increasing longevity and better health are developments to celebrate. The challenge is to adapt income support and health care programs to these changing demographics and health care options.

He feels the difficult problems in financing Social Security and health care commitments must be approached from a realistic perspective based on demography, medical developments, and fundamental economics. In demographic terms, we are retiring earlier and living longer. The result is a growing proportion of people outside the labor force compared with those who are working. Medical treatment options too have expanded. As a consequence, the federal government has increasingly become a mechanism for transferring every-mounting sums of money from younger workers to older retired Americans.

The history of Social Security and health care programs in the United States shows that their structural roots come from an altogether different era, that of the Great Depression and World War II and its aftermath. These programs must be adjusted to better accommodate increased longevity as well as improved and promising medical treatments, which are often costly.

Reform of these programs will not come easily. To touch them, many politicians worry, is to touch a third rail. But well-documented projections of the costs of current programs show that inaction is simply not an option. Everything about the U.S. economy is dynamic except its major entitlement programs. .  Shultz presents how these programs must be modernized so that they are suitable for the twenty-first century, and meet the tests of fairness and fiscal responsibility.

Shultz and Shoven present illustrations, health carse stories, data, and a plausible solution to our retirement and health care conundrum that is worth studying. We may not agree with all their solutions. However, it is a well- researched study with reasonable proposals that bear investigation by those who are serious about the Health Care problems and solutions for the United States.

George P. Shultz
Former U.S. Secretary of State;
Author, A Citizen's Guide to Social Security and Health Care Reform

George Shultz has had a distinguished career in government, in academia, and in business. He held four different cabinet posts, he taught at three of this country's greatest universities, and he was president of a major engineering and construction company.

Mr. Shultz graduated from Princeton University in 1942 with a B.A. in economics and then began his service to the nation as a Marine. He resumed his studies at MIT and earned a Ph.D. in industrial economics in 1949. Early in his career, he served as a senior staff economist on President Eisenhower's Council of Economic Advisors. He taught at MIT and The University of Chicago, where he served as dean of the business school. He resumed public service under President Nixon as Secretary of Labor, Director of the Office of Management and Budget, and Secretary of the Treasury. Mr. Shultz left government service in 1974 to become president and director of the Bechtel Group, Inc.

Mr. Shultz held two key positions in President Reagan's administration: Chairman of the President's Economic Policy Advisory Board (1981-1982), and Secretary of State (1982-1989). His many awards include the Medal of Freedom, the nation's highest civilian honor, and the Seoul Peace Prize. He has been a Distinguished Fellow at the Hoover Institution, Stanford University, since 1989.

 www.worldcongress.com/speakerBio.cfm?speakerID=39&confcode=HR08000

To read more book reviews, go to www.delmeyer.net/PhysicianPatientBookshelf.htm.

To read book reviews topically, go to www.healthcarecom.net/bookrevs.htm.

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10.  Hippocrates & His Kin: Thirty percent co-payment controls health care costs.

Mr Burd of Safeway mentions that a 30 percent employee co-payment reduced the cost of their health care program significantly. That apparently put the health care decision-making process right in the lap of the patients who then controlled their costs. How is that decision made?

Let's take an article from yesterday's paper. Some new chemotherapy additions to cancer chemotherapy improve survival by one or two months with a drug costing $50,000 to $60,000 for the full course of treatment. This then would be the cost of the additional month of life gained.

If government or insurance pays the entire cost, everyone would want the drug, demand it and write their congressman to make sure it is available.

However, if the patients and their families would have to fork over 30 percent of the $50,000 or so, the perspectives change. Most patients, even those that could afford to write an extra $15,000 check, would probably see their final days in a more healthy perspective, accept the inevitable, spend time with spouse and family, and die in peace. They would make the decision that an eleven-month life expectancy is not worth an extra fifty thousand dollars. The family would appreciate a dignified final event without drug side effects, tubes or life support. They would say their final goodbye in their own homes with only loved ones around and maybe a nurse, having thanked their physicians previously in a dignified manner.

Cost savings produced by the 30 percent co-payment is very substantial and beneficial for patients. Even the one-month shortened life may be thought of in a positive perspective.

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


Do Physicians still believe in individual freedom? To practice as they really believe?

Physicians seem to be getting more liberal in the sense of being for more government control over their freedom to practice what is best for their patients. Have they just given up hope for a free and open medical economy? They seem to be gravitating to the other political party that promises everything and delivers little except more control over our private lives. They have traditionally been the profession of the highest ethical principles. Now they seem to go along with anything and everything.

Recently, a physician remarked that he no longer could espouse his upbringing principles. It was useless and hopeless. He said: let the liberals have their say and their way, let the men marry men, let the women marry women, let everyone that wants an abortion have an abortion. He figured that in about three generations, there wouldn't be liberals anymore. Wouldn't that be a great legacy to leave his grandchildren?

Don't you just love it when a plan comes together so well?


To read more HHK, go to www.healthcarecom.net/hhk2001.htm.

To read more HMC, go to www.delmeyer.net/hmc2005.htm.

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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 Dr. Goodman's article on Medicare Markets in the WSJ. Go to http://cdhc.ncpa.org/commentaries/Markets-and-Medicare.

                      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 signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog. This month, be sure to read John Graham's excellent article on Government-Run Health Care A Disaster on Either Side of the Border.

                      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. Be sure to read the 9th Annual Report on Which Federal Agencies Best Inform the Public?.

                      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. 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 in their table of contents for each digital edition. To see my recent column, go to http://hiu.nahu.org/article.asp?article=1660&paper=0&cat=137.

                      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. Be sure to read Mrs. Turner weighing in on Massachusetts Health Reform.

                      Greg Scandlen, an expert in Health Savings Accounts (HSAs) has embarked on a new mission: Consumers for Health Care Choices (CHCC). Scroll down to read the initial series of his newsletter, Consumers Power Reports. There are two levels of membership to receive this newsletter by email and other benefits. 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.

                      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. Be sure to read about the real effects of community rating.

                      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. You might want to read a classic on Why the War on Smoking Will Fail.

                      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, review some of the Basics of Health Insurance.

                      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. Read How High Deductible Health Plan Cuts Emergency Department Use.

                      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 WHY THE GOVERNMENT SHOULD REGULATE THE WEATHER. Now that should keep the lawmakers busy for a decade or two.

                      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 19, 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. Their banner: A free and prosperous world through choice, markets and responsibility. You may want to go directly to their health research section. This month, be forewarned: Canada becoming haven for would be terrorists while politicians look the other way in search of votes.

                      The Heritage Foundation, www.heritage.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 you may want to read of the Feds War on the Middle Class. 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. Learn how state medicine subsidizes illness or find out why anyone would want to be an MD today.

                      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. This month read about Health, Welfare and Entitlements.

                      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, scroll down to read Dick Army on What Happened to the Contract with America. The last ten years of Imprimis are archived.

* * * * *

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Spammator Note: MedicalTuesday uses many standard medical terms considered forbidden by many spammators. We are not always able to avoid appropriate medical terminology in the abbreviated edition sent by e-newsletter. (The Web Edition is always complete.) As readers use new spammators with an increasing rejection rate, we are not always able to navigate around these palace guards. If you miss some editions of MedicalTuesday, you may want to check your spammator settings and make appropriate adjustments. To assure uninterrupted delivery, subscribe directly from the website rather than personal communication:  www.medicaltuesday.net/newsletter.asp

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

If you let other people do it for you, they will do it to you. -Robert Anthony

The purpose of studying economics is not to acquire a set of readymade answers to economic questions, but to learn how to avoid being deceived by economists. -Joan Robinson, Economist, 1903-1983.

A better reason to study economics is to avoid being deceived by politicians; they are the far greater threat to life, liberty, and the pursuit of happiness. When you consider the typical political campaign is little more than a series of confidence games, understanding basic economics is a matter of survival. Without such an understanding one is an easy mark. -Sheldon Richman, Editor, The Freeman

Some Recent or Relevant Postings

Cinematic Reviews: www.delmeyer.net/CinematicOpEdReviews.htm

Book Reviews: www.delmeyer.net/PhysicianPatientBookshelf.htm

Hippocrates Modern Colleagues: www.delmeyer.net/hmc2007.htm

Alexander Solzhenitsyn: http://healthcarecom.net/bkrev_CancerWard.htm

In Memoriam

Yves Saint Laurent, couturier, died on June 1st, aged 71

THE first intimation, apparently, was when three-year-old Yves told his mother that her shoes did not go with her dress. They were at home in Oran, a dull commercial town in French-ruled Algeria, where Yves's father sold insurance and ran a chain of cinemas, and Mrs Mathieu-Saint-Laurent cut an elegant figure in colonial society. Oran had once enjoyed some small renown as the westernmost outpost of the Ottoman Empire, and was to gain more later as the setting for Albert Camus's "The Plague". But after 1936 it had a genius in the making.

So, at any rate, the tribute-payers are saying. "Pure genius", "the world's greatest fashion designer", "the most important designer of the 20th century": such superlatives have been lavished on Yves Saint Laurent (he wisely got rid of the Mathieu) for years, and perhaps they are not meant to be taken at face value. The fashion business is, after all, a part of the entertainment industry, where sycophancy, exaggeration and gushing insincerity are not unknown. Mr Saint Laurent fitted perfectly into it. To read the rest of this tribute, please scroll down at www.medicaltuesday.net/org.asp.

 

He was, for a start, quite literally a showman, a shy and stage-frightened one, but what shows he could put on! Dazzling girls strutted down the catwalk, wearing startling creations of gauze, or velvet, or feathers, or not much at all. He was a celebrity, whose circle included Lauren Bacall, Maria Callas, Rudolf Nureyev, Paloma Picasso, Gettys, Jaggers, Rothschilds and, from almost first to last, Catherine Deneuve. He was an artist, a delicate, attenuated figure who drew his inspiration from the pages of Marcel Proust, the paintings of Braque, Matisse, Picasso and van Gogh, and the counsels of his assistant, Loulou de la Falaise. And he was troubled: by drink, by drugs and by physical frailty. He teetered perpetually on the brink of emotional collapse and sometimes fell over it; his lover, Pierre Bergé, said he had been born with a nervous breakdown.

The great liberator

In 1961, when Mr Saint Laurent set up shop in Paris under his own name, most couturiers were not quite like this. But the times were propitious for something new. He had by then done a stint at the House of Dior, whose reputation he had restored with some dramatic designs and, in 1958, after the famous founder had died, an iconoclastic collection of his own. The summons to do military service, a ghastly mental dégringolade and dismissal from Dior then intervened, and might have cut short a great career had he not gone into partnership with Mr Bergé. As it was, a series of innovations followed, with Mr Saint Laurent responsible for the designs, Mr Bergé for the business, including the scents, scarves, unguents and over 100 other products marketed with a YSL label.

The dress designs now started flying off Mr Saint Laurent's drawing board . . . Many were short-lived, this being fashion and fashion being, by definition, ephemeral. . . But two departures were to last. One was that haute couture . . .  The other was that women should be put into men's clothes - safari outfits, smoking jackets, trench coats and, most enduringly, trouser suits. Women, for some reason, saw this as liberation.

Mr Saint Laurent's young models looked pretty good in his designs, but they would have looked good in anything; older women in the same outfits sometimes seemed more like mutton dressed as ram. He did not confine himself to androgynous clothing, though: he also favoured diaphanous blouses worn without underwear, a fashion that has supposedly returned this year, though most busts still seem to be encased in polystyrene. . .

Yet perhaps he must take some of the blame for the new cacophony. The trouser suit prepared the way for the off-track track suit; and lesser designers, believing they share his flair and originality, now think they have a licence to make clothes that are merely idiotic. Perhaps it would have happened without him. In an industry largely devoid of any sense of the ridiculous, he was usually an exception. He believed in beauty, recognised it in women and, amid the meretricious, created his share of it.

www.economist.com/obituary/PrinterFriendly.cfm?story_id=11487386

 

 

On This Date in History - June 10

On this date in 1940, Italy attacked France.

On this date in 1946, Benito Mussolini was overthrown, and Italy became a republic.

The above two events mark both the low and high point in Italian History. In 1940, Italy joined forces with Nazi Germany in attacking France and declaring war on Great Britain. Under Mussolini's dictatorship, Italy's action was described by President Franklin D. Roosevelt as, ". . . the hand that held the dagger has stuck it into the back of its neighbor." But on the same date in 1946, the same country overthrew its dictator and became a republic.

On this date in 1942, Lidice, Czechoslovakia was wiped out. After Gestapo leader Reinhard Heydrich was killed, Nazi forces wiped out the entire town of Lidice, Czechoslovakia. Even in the midst of the Second World War, this was a shocking event.

On this date in 1922, on a more pleasant note, Frances Ethel Gumm was born in Grand Rapids Minnesota. This young girl changed her name to Judy Garland and became a star before she even entered high school.

On this date in 1948, American test pilot Chuck Yeager exceeds the speed of sound. He flew over the Southern California desert in a Bell XS-1 plane.

After Leonard and Thelma Spinrad

MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE's SiCKO

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 Liberty Hotel."
For more information visit www.sickandsickermovie.com or email
logan@freestarmovie.com.