MEDICAL TUESDAY . NET

NEWSLETTER

Community For Better Health Care

Vol VIII, No 23, Mar 9, 2010

 

In This Issue:


1.                  Featured Article: The Day the PPO Died

2.                  In the News: Whose body needs protecting? Mandates do not protect us.

3.                  International Medicine: The NHS has a mortality rate a third higher than the average

4.                  Medicare: The Costs of Mitt Romney Care in Massachusetts is as elusive as Obama Care

5.                  Medical Gluttony: The most Gluttonous Patients don't see their own Gluttony

6.                  Medical Myths: No one has a right to care in universal health care, just to a waiting list

7.                  Overheard in the Medical Staff Lounge: Where are the cracks in the healthcare net?

8.                  Voices of Medicine: Medicine and the Coroner's Office

9.                  The Bookshelf: Eradicating Morality Through Education

10.              Hippocrates & His Kin: Does Multitasking Shortchange Memory?

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

Words of Wisdom, Recent Postings, In Memoriam . . .

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The Annual World Health Care Congress, a market of ideas, 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 7th Annual World Health Care Congress will be held April 12-14, 2010 in Washington D.C. For more information, visit www.worldcongress.com. The future is occurring NOW. Be sure to attend next month.

Keep in touch with evolving healthcare by subscribing to HPUSA . . .

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1.      Featured Article: The music died on February 3, 1959; the PPO died on January 1, 2010

The Day the PPO Died By David J. Gibson, MD & Jennifer Shaw Gibson

While the music died[1] on February 3, 1959, the PPO died on January 1, 2010.  On that Friday, America's perambulation through the tangent of managed care ended.  That was the day when the realization that the health care market had evolved from a buyer's to a seller's market became apparent.  Physicians no longer need to sell their services under a discounted contract.

On that day, 3,000 Medicare patients who had been getting care at the Glendale Mayo Clinic facility in Arizona had to begin paying out of their own pocket or find another doctor. Patients choosing to continue receiving care at the Clinic were then required to pay $1,500 per year out-of-pocket.

So, why is the Mayo event of national importance?  The answer, it gives permission for doctors across the country who are contemplating a similar move to proceed.  In June of this year President Obama cited the Mayo Clinic and the Cleveland Clinic for offering "the highest quality care at costs well below the national norm."  Furthermore, throughout the health care reform debate this year, the Mayo Clinic has been supportive of health care reform as defined by ObamaCare.

Now it is learned that self-interest and economic survival trumps utopian idealism.  The Mayo Clinic reported that last year its 3,700 staff physicians and scientists treated 526,000 patients. The clinic lost $840 million during that year on Medicare.

In an informal poll, we visited with colleagues in large and small group and individual practices across the country.  All of our contacts in every region of the country indicated that they were either seriously contemplating or about to implement the Mayo business move.

So, what have we learned from this 30-year experience in managed care and network discount contracting; and what does this portend for the future?

1.       Reducing medical services to a commodity structure based upon Current Procedural Terminology (CPT) defined fixed reimbursement rates was an anomaly based upon a temporary buyer's market within health care.  It had no chance of long-term survival.  Furthermore, this payment methodology is foreign to the entire service based economy within the U.S.  No other group of professionals has ever agreed to this structure for reimbursement.

2.       The idea that third parties can manage care and thereby improve quality, rationalize utilization, coordinate care for chronic conditions or stabilize cost has been definitively discredited.  We have further learned that these third parties are incompetent when they insert themselves into clinical decision making.  The only role they can credibly play is to rationalize the rationing of services.

3.       The only segment of the market where PPOs will likely continue to function will be in government financed health care.

4.       The government will continue to have a safety–net role in financing care for the unfortunate and for those covered by entitlement programs and government retirement plans.  However, the care delivered will be well outside the mainstream. 

a.       Mainstreaming has failed in health care just as it has failed in the public school system. 

b.       The private market will no longer tolerate the cross-subsidization required to support the government's inadequate reimbursement for medical services.  This cross-subsidization has financed the mainstreaming of government financed health plans. A report by Milliman published in December 2008 demonstrated that the cost shifting to the private sector totals 15-percent.[2]

c.       The care financed by government will have much more restricted access.  As we have seen in the health care debate this past year, "best practice" guidelines will limit high cost services, particularly for the elderly and those with limited survival rates.  It will lack the breadth of coverage, access to cutting edge technology and service accoutrements delivered to the private sector.

d.       In all likelihood government funded PPO delivery structures will devolve back to the old county hospital systems of yesteryear with take-a-number packed waiting rooms and appended clinics that are staffed by idealistic or elderly employed physicians.

5.       The role that organized medicine will play in the future representing the interests of practicing physicians has been called into question.  Why, because the revenue from licensing fees for the CPT codes has alienated the relationship between the American Medical Association (AMA) and its members.  The AMA now derives a significant portion of its income from revenue generated by the licensing fee for the CPT codes and other proprietary products.  This revenue dependence left the organization vulnerable to extortion from the administration as it relates to support for ObamaCare.  The administration's explicit threat to develop an alternative procedure defining system and move away from the AMA's CPT definitions resulted in the AMA's support for ObamaCare despite significant resistance from the organization's membership.

6.       Unless ObamaCare is enacted, which seems unlikely at this point, all of the health care, Washington centric membership organizations (the AMA, the American Association of Retired Persons (AARP) and as illustrated by the just announced resignation of Billy Tauzin, president of the Pharmaceutical Research and Manufacturers of America) will be marginalized.  Cutting deals with partisans has consequences when you play and lose.  When the Republicans increase their numbers in Congress next year, the likelihood of preventing the 21.2-percent pay cut for physicians called for in 2010 under the 1998 enacted "Sustainable Growth Rate" for physicians participating in Medicare will be problematic.  The AMA is now viewed as any other Democratic special interest group by the Republicans.

Welcome to the new world of American health care.  We predict that managed care will be remembered as a temporary market experiment that had its origin in academic utopianism.

We will be delivering a follow-on article examining the process of dissolution of managed care in the private sector of the market in the next issue of MedicalTuesday.

djgibson@winfirst.com

David Gibson is the president of Reflective Medical, a health care software development company. Jennifer Gibson is an economist specializing in evolving health care markets as well as a futures commodity trader specializing energy.

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2.      In the News: Whose body needs protecting? Mandates do not protect us.

Whose Body Is It? By John Stossel | February 25, 2010

The government should "protect" us less and respect our liberty more

People suffer and die because the government "protects" us. It should protect us less and respect our liberty more.

The most basic questions are: Who owns you, and who should control what you put into your body? In what sense are you free if you can't decide what medicines you will take?

This will be the subject of my Fox Business program tonight.

We'll hear from people like Bruce Tower. Tower has prostate cancer. He wanted to take a drug that showed promise against his cancer, but the Food and Drug Administration would not allow it. One bureaucrat told him the government was protecting him from dangerous side effects. Tower's outraged response was: "Side effects - who cares? Every treatment I've had I've suffered from side effects. If I'm terminal, it should be my option to endure any side effects."

Of course it should be his option. Why, in our "free" country, do Americans meekly stand aside and let the state limit our choices, even when we are dying?


Markets, Not Mandates, by Ronald Bailey | July 28, 2009

How medical markets would improve health care and reduce costs

The New York Times calls it "possibly the most complex legislation in modern history." The health care "reform" currently being hammered out by the Democratic leadership of the House of Representatives already clocks in at $1 trillion and 1,000 pages - and it's nowhere near done. But one thing is clear: the legislation attempts to substitute top-down mandates from a centralized bureaucracy for the distributed decisions made by millions of consumers, physicians, and insurers acting in a marketplace. This will fail.

While congressional reform efforts screech and shudder along, let's take a moment to dream: What would real reform look like? It would be consumer driven, transparent, and competitive.

Right now consumers are locked into the health insurance and health care plans that their employers choose, thanks to previous government meddling with the health care system and the tax code. Consequently, most consumers simply don't have a clue what their health insurance costs. They have no way to reduce those costs, and no incentive to do so, even if they could.

Harvard University business professor Regina Herzlinger is stuck in exactly the same place as most Americans - her employer, in this case, the president of Harvard, buys her health insurance for her. "I wouldn't permit him to buy my house or my clothing or my food for me. Yet as my employer, he could take up to $15,000 of my sala­ry each year and buy my health insurance for me, without knowing anything about my preferences or needs. It's ridiculous." Indeed it is.

Third party payments are the main source of dysfunction in the American health system. "The devil systematically built our health insurance system," once suggested Princeton University health economist Uwe Reinhardt. As evidence, Reinhardt pointed out that it "has the feature that when you're down on your luck, you're unemployed, you lose your insurance. Only the devil could ever have invented such a system."

So the first step toward real reform is to give consumers responsibility for buying their own health insurance. The employer-based health insurance system must be dismantled, and the money spent by employers for insurance should be converted to additional income. This would immediately inject cost consciousness into health insurance decisions.

Since governments have been intervening in and distorting medical markets for more than a century, there are no examples of truly free-market medicine in any of the developed countries. (Switzerland is probably the nearest that any developed country comes to having a free market in health care and health insurance.) So it is impossible to know what might have happened had health care markets been allowed to evolve. While there are hints of what a market system might look like embedded within our current mess, much of what could happen under medical markets is tough to predict. Nevertheless, here's one partial vision of how a system of competitive health care and health insurance might develop if real reform were adopted.

The typical American might purchase high-deductible health insurance policies that would cover expensive treatments for chronic diseases such as heart disease, cancer, AIDS, diabetes, multiple sclerosis, or the catastrophic consequences of accidents. Coverage would also include expensive treatments such as heart surgery, organ transplants, dialysis, radiation therapy, etc.  In addition, Americans would be able to buy health-status insurance that would guarantee that they could purchase health insurance at reasonable prices in the future.

The good news is that such policies are available even now. A quick check on online health insurance clearinghouse eHealthInsurance pulls a quote of $131 per month from Anthem Blue Cross Blue Shield for a single 55-year-old male with a $3,000 annual deductible, no co-pay after the deductible, reasonable pharmaceutical benefits, and lifetime maximum benefits of $7 million. . . That was the cheapest plan, but over 80 other insurance policies were available. Of course, as deductibles went down, the prices for other plans went up. The UnitedHealth Group has begun offering a policy that guarantees purchasers the right to buy an individual medical insurance policy in the future even if they become sick. . .

Once consumers are unleashed, the medical marketplace would be transformed. Most likely, a lot of routine care would be done through retail health centers located in shopping malls, drug store chains, and mega-stores. Such centers would not be staffed with physicians but with nurse practitioners or other qualified personnel. Consumers would generally pay for routine, everyday care directly out of their health savings accounts

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3.      International Medicine: The NHS has a mortality rate a third higher than the national average

The worst NHS wards ... where safety is a lottery byAnushka Asthana and Denis Campbell
The Observer, Sunday 29 November 2009

An explosive report reveals a terrifying picture of many English hospitals, with people dying after being admitted with 'low-risk' conditions.

For Adrian Underwood, it began with a terrifying loss of movement down the left side of his body. A hospital scan in Nottingham identified a benign tumour that if untreated would eventually crush his brain. Yet no one told him about it.

More than 50 miles away in Solihull, Jenny Morgan sat in A&E for 90 minutes after suffering a stroke, before deciding to leave so she could "die at home". Half-blinded and in excruciating pain, she later returned, only to be told the stroke unit was full. And on a ward in Essex, Gillian Flack found her severely disabled son drenched in urine and no nurses in sight. That night Kyle Flack, 20, suffocated after getting his head wedged in the metal bars of the hospital bed. "You think hospitals are safe," said his 54-year-old mother, her voice trembling. "But if I had never taken Kyle to hospital he would have been alive."

Her son died at Basildon University Hospital, where a report last week revealed evidence of dozens of patients dying needlessly in filthy conditions.

The NHS trust was revealed to have a mortality rate a third higher than the national average: about 350 more people died in a year than would be expected.

Today, the Observer can reveal that Basildon is far from alone. A major report has found evidence of systemic failures in patient safety across the NHS in England over the past year. According to Dr Foster, a health information organisation based at Imperial College London, cases such as that of Underwood, Morgan and Flack are just the tip of the iceberg.

The report highlights dozens of cases of surgery carried out on the wrong part of the body and incidents in which "foreign objects" such as gauzes were left inside people. It finds that thousands admitted with "low-risk" conditions went on to die in hospital; hundreds of them were under 65. It exposes the fact that one in five trusts failed to check patients in A&E for the superbug MRSA; that four out of 10 did not investigate unexpected deaths or cases of serious harm on their wards; and that more than a third failed to adopt a "track and trigger" system that monitors acute patients to prevent their condition deteriorating. And it names the trusts which perform as poorly as Basildon.

The Dr Foster Hospital Guide 2009 opens with a question: how safe is your hospital? It closes with a league table of NHS Trusts across England, rating each one's performance on patient safety.

The Essex trust sits at the foot of the table, but 11 others were also given the lowest rating of 1 on a patient safety scale designed by the research team. All were deemed to be "significantly underperforming on basic safety measures". Many had very high mortality rates – with more than 1,000 patients dying who could have been saved in those hospitals alone.

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The NHS does not give timely access to quality healthcare; it only gives access to unsafe healthcare.

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4.      Medicare: The Costs of Mitt Romney Care in Massachusetts is as elusive as Obama Care

The Massachusetts Health Plan: Much Pain, Little Gain, by Aaron Yelowitz and Michael F. Cannon

In 2006, Massachusetts enacted a sweeping health insurance law that mirrors the legislation currently before Congress. After signing the measure, Gov. Mitt Romney (R) wrote, "Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced." But did the legislation achieve these goals? And what other effects has it had? This paper is the first to use Current Population Survey data for 2008 to evaluate the Massachusetts law, and the first to examine its effects on the accuracy of the CPS's uninsured estimates, self-reported health, the extent of "crowd-out" of private insurance for both children and adults, and in-migration of new Massachusetts residents.

We find evidence that Massachusetts' individual mandate induces uninsured residents to conceal their true insurance status. Even setting that source of bias aside, we find the official estimate reported by the Commonwealth almost certainly overstates the law's impact on insurance coverage, likely by 45 percent. In contrast to previous studies, we find evidence of substantial crowd out of private coverage among low-income adults and children. The law appears to have compressed self-reported health outcomes, without necessarily improving overall health. Our results suggest that more than 60 percent fewer young adults are relocating to Massachusetts as a result of the law. Finally, we conclude that leading estimates understate the law's cost by at least one third, and likely more.

Our results hold important lessons for the legislation moving through Congress. As in Massachusetts, there has been no effort to estimate the cost of the private health insurance mandates that legislation would impose on individuals and employers. The costs may therefore be far greater than legislators and voters believe, while the benefits may be smaller than the conventional wisdom about Massachusetts suggests.

Aaron Yelowitz is an associate professor of economics at the University of Kentucky and an adjunct scholar at the Cato Institute. Michael F. Cannon is director of health policy studies at the Cato Institute and coauthor of Healthy Competition: What's Holding Back Health Care and How to Free It.

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

- Ronald Reagan

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5.      Medical Gluttony: The most Gluttonous Patients don't see their own Gluttony.

Recently, a patient and his wife, who are for Obama's mega-gluttonous health care diatribe, said that everybody could have free health care with the things that Obama would save. By trimming $400 billion off of Medicare as I recall (the numbers are so huge now that even my patients are getting millions, billions and trillions all mixed up), that should make health care so much more efficient. Although his demands were so exorbitant that day, I couldn't broach the subject because he was relatively new to the practice. So I spent a few thousand more than I thought was necessary.

When this went on for the next few visits and the spouse reacted the same way, I asked if they still felt the way they did on their first visit - that there was considerable money to be saved by cutting unnecessary care in Medicare. They responded, "Absolutely. We shouldn't let doctors and hospitals get away with gouging the system." I responded, "Do you think that you have received unnecessary care?" Again both responded, "Absolutely not. We're still not cured and we need a lot more tests done."

I pointed out that I sat on some Medical Review Committees and was aware of what reviewing doctors considered unnecessary care. I then pointed out that about one-third of their expenses to Medicare were not needed and my overtures during the previous visit on going easy were not well received by them. Hence, we spent considerable more than necessary and I felt most physicians in my shoes would do the same early in the physician-patient relationship. But it was now time to pull in the reins since both were recovering with about the speed projected and we had to let nature do a little between episodes of treatment.

They weren't too happy when they left and I felt I would never see them again. But they kept returning as directed and never brought up cost containment again.

Maybe at some time in the future, I will feel comfortable enough to see if they are still for Obama's Trillions. The fact that they didn't bring up saving Medicare money again makes me feel rather sure that they are still Obama fans but don't see themselves as socialists.

Oh, that God the gift would give us. To see ourselves as others see us - Robert Burns

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Medical Gluttony thrives in Government and Health Insurance Programs.

It Disappears with Appropriate Deductibles and Co-payments on Every Service.

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6.      Medical Myths: No one has a right to care in universal health care, just a right to a waiting list

Myth 17: Health care reform will establish a right to health care.

DateAAPS - Tuesday, August 25, 2009

Everybody in a country with "universal health care" has a "right" to health care, but Americans do not - or so it is argued. "Health care reform" is supposed to correct a moral deficiency in the United States, and, at long last, grant a fundamental human right to Americans. 

At present, Americans who have purchased insurance have a contractual right, enforceable in court, to whatever benefits are agreed to in the contract. Federal law entitles them to a screening examination and stabilization if they present to an emergency facility, even if they have no ability to pay - and the hospital and on-call physicians are obligated by law to provide the service.

In an American hospital, women in labor will be delivered; patients with a surgical emergency will have an operation; and patients with a life-threatening medical emergency will be admitted. But later, the hospital will try to collect payment. Americans have no right to receive medical services at taxpayer expense. Those enrolled in Medicare, Medicaid, or other government program have an entitlement to certain benefits, determined by politicians and bureaucrats. About half of U.S. medical expenditures are made by government through such programs.

How is the situation different under "universal health care"?

In Canada, patients are entitled to treatment only after they present their insurance card. If they lack a card, say because they are homeless and haven't signed up for the program, treatment will be denied.

One man in Quebec forgot his card at home, and was denied care, even though his name was in their computer. No card, no service. When he went home to get the card, his appendix ruptured, and by the time the ambulance arrived, he was dead. At age 21. As Mark Steyn writes, "He didn't make it to 22 because he accepted the right of a government bureaucrat to deny him medical treatment for which he and his family have been confiscatorially taxed all their lives."

Under "universal health care," one has no right to care that is timely, convenient, or state-of-the-art. Under a "single payer" (government-payer-only) system, one has no right to pay extra to allow the operating room, imaging center, or clinic to stay open longer - even though this would decrease the waiting time for everyone, including those who could not afford to pay more. One has the right to receive only the services that "society" (politicians and bureaucrats) has decided to make available.

Most nations of the world have a private sector that relieves some of the strain on the public system, though people who receive private services have paid twice for medical care - once for the public services that they do not use, and again for the care they do receive. Canada and North Korea have a single payer; Canadians have the right to pay twice if they go abroad for treatment.

Rights that Americans would lose under proposed reforms include: the right to buy true insurance, for which premiums are based on risk; the right to decline to buy a plan they don't want; the right to self insure; the right to reap the benefits of healthful living, hard work, and prudent spending; and the right to keep their medical records confidential. If the reforms evolve into a single payer, as many advocates intend, Americans would lose the liberty to use their own property to prolong or enhance their own lives.

Obligations that reform would impose on Americans include: continually proving that they had paid for coverage that the federal government deems acceptable; paying what the government deems to be their "fair share" for insuring persons below a certain income threshold; paying for procedures they deem to be harmful or immoral if coverage is mandated by government; and paying for expanded, costly bureaucracy.

America's extraordinary prosperity and technological progress occurred in an atmosphere of freedom. The losses resulting from a central chokehold on innovation are incalculable. Advocates of reform often attribute the high cost of American medicine to new drugs, devices, and procedures, and want still-heavier regulation to restrain these advances. Both Americans and the result of the world's peoples will lose if America is no longer the engine of progress.

Americans are being asked to exchange their birthright of freedom for - politicians' promises. And to trade their natural, God-given rights to life, liberty, and property for government-granted privileges or entitlements.

If you have to show a card that proves you are eligible to receive a certain service in a certain facility, you do not have a right, only a privilege. A privilege that can be revoked by bureaucrats calculating the gains and losses to "society" from your treatment.

People have come to trust their government entitlement programs, just as they once trusted Bernie Madoff. However, Americans have no constitutional or contractual right to their Social Security benefits, for which they have been taxed all their lives. This was established decades ago by the U.S. Supreme Court, in the case of a man who was deported for being a Communist after paying Social Security taxes for 19 years. In upholding the 1954 law that revoked the Social Security privilege for such persons, the Court cited the necessity of Section 1104 of the 1935 Act, entitled "Reservation of Power," reads: "The right to alter, amend, or repeal any provision of this Act is hereby reserved to Congress."

The Court ruled: "To engraft upon the Social Security system a concept of accrued property rights would deprive it of the flexibility and boldness in adjustment to ever- changing conditions which it demands...." (AAPS News, August 2008). Remember that Medicare is part of the Social Security Act.

Fundamental rights guaranteed by the U.S. Constitution must be abridged to grant a "right" to taxpayer-funded medical treatment. The tradeoff is of true rights for what is actually a privilege or entitlement.

What the government gives, the government can take away. And of course, whatever it gives was first taken from someone.

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Medical Myths originate when someone else pays the medical bills.

Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.

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7.      Overheard in the Medical Staff Lounge: Where are the cracks in the healthcare net?

Dr. Sam: Aren't you getting tired of all this Obama ranting and raving about the people without health insurance?

Dr. Dave: He sure is hitting a populist theme. Who wouldn't want free care?

Dr. Paul: You conservatives have no conscience. There are a lot of people that fall through the cracks.

Dr. Nicole: I certainly have a lot of patients who don't have health insurance and can't afford to obtain their health care.

Dr. Sam: That's a non-sequitur.

Dr. Paul: No it isn't. I also see a lot of folks without insurance who can't afford to come in to see me.

Dr. Edwards: The line from the liberals hasn't really changed since the 1960s. There will never be enough money to make them happy.

Dr. Rosen: But the population that's being discussed today is a totally different population than the one from the 1960s.

Dr. Paul: How's that?

Dr. Rosen: Since the 1960s, we have Medicare to cover all the old folks from 65 and older. So there are no cracks for anyone over 65 to fall through.

Dr. Paul: Ok! So I'll give you that argument. But there are many pediatric and other folks uncovered.

Dr. Rosen: Since the 1960s, we've covered all the poor people with Medicaid. So the bottom 12-15% of society is covered and there are no cracks for the poor people in our country to fall through.

Dr. Nicole: I don't believe that for a minute.

Dr. Rosen: Since the 1960s we also have Medicare Disability to cover all the people of any age who are disabled for two years.

Dr. Paul: Why doesn't Medicare Disability cover all who are disabled?

Dr. Rosen: Many are temporarily disabled for a variety of reasons including work injuries. The two-year cutoff is an appropriate time to determine if the disability will be permanent.

Dr. Sam: Don't forget the military. All the retired and all the disabled are also covered.

Dr. Edwards: Getting back to the poor people, in some states, Medicaid covers people making $60,000 to $75,000 a year. I find it hard to justify the Obama trillions to cover people that are making $5,000 to $6,000 a month.

Dr. Dave: He's going to have to rob those that have health coverage to give to those that should be able to cover a basic health care policy.

Dr. Paul: How can you say that $6,000 a month is rich?

Dr. Edwards: We're not saying that $6,000 a month is rich. But they don't need taxpayers' money from those that are making $3,000 to $4,000 a month who are managing their lives frugally.

Dr. Nicole: But have you looked at the premiums for health insurance. I have patients paying $15,000 a year.

Dr. Sam: That's $1250 a month. That's not much for what surgeons and hospitals cost.

Dr. Nicole: But what surgeons and hospitals cost is a fact of life.

Dr. Dave: No it is not. In fact, I just saw a policy advertised to cover hospital and surgeons for about $250 a month.

Dr. Paul: But that doesn't cover the cost of going to the doctor.

Dr. Sam: It shouldn't. That's the problem. It shouldn't cover ordinary costs any more than car or house insurance covers ordinary costs. It should just cover catastrophic costs and that's what health insurance should cover.

Dr. Paul: Well, I think health insurance should cover all health care costs.

Dr. Dave: Paul you're not paying any attention. If health insurance is $1250 a month and a hospital surgery plan costs $250. Then the $1000 you save every month will purchase a lot of office calls, blood counts, cholesterols and x-rays. In fact you will have money left over.

Dr. Rosen: Also another thing you're forgetting is when you pay cash, you can ask and frequently bargain. We do this every day in the rest of our lives. When I found out that there was a shirt laundry that did shirts 75 cents cheaper, I started going there. My former cleaners called my office and wanted to know why she hadn't seen me. I pointed out that 75 cents for seven shirts a week if $5 a week or $250 a year. You know, she wanted my business so badly that a few days later she called back and said that she would meet the same price as the competition.

Dr. Dave: Isn't that what the market is all about? Our schools are failing to teach market economics and so many people can't even see how competition lowers cost.

Dr. Rosen: It also works in health care. The lab I was sent to quoted me $375 for my lab requisitioned by my doctor. So I went across the hall and they gave me 20% discount. Who knows, maybe surgeons would start giving discounts. Isn't that better than the insurance companies just arbitrarily cutting your fees in half?

Dr. Paul: But the corporations just gouge the public and keep raising their prices.

Dr. Dave: Paul, you act as if Coke, for instance, could just raise their prices by another 10 cents without a problem.

Dr. Nicole: Well, they could.

Dr. Dave: No they could not. Pepsi wouldn't let them. Pepsi would maintain their prices or even drop them and next month's financial statement could show that Pepsi had overtaken Coke as America's number one soda. You think Coke would take that risk by raising their price?

Dr. Nicole: I think you're making this more complicated than it is.

Dr. Sam: Come on now, Nicole, don't you believe in competition?

Dr. Nicole: Maybe in the soda world. But it wouldn't work in medicine.

Dr. Dave: It especially would work in medicine. If all Internists were paid by the patients instead of insurance companies, we would all find ways of providing better services at reasonable affordable prices.

Dr. Nicole: But you can't cut your office visit charges.

Dr. Dave: I bet I could streamline my office and provide better services and increase my income. With health insurance, the worst internists get paid the same as the best internists. Why not let quality be one determinant factor?

Dr. Nicole: I don't see where you could cut enough to make any difference.

Dr. Sam: If patients paid me directly, I could offer a broad spectrum of services that I can't do at the present.

Dr. Nicole: I'm being spread too thing already.

Dr. Sam: That's because you're still thinking and looking backwards. We're in the Information Technology world now. I could service half of my practice with phone call evaluations at $10 each and email consultations at $25 each which is probably adequate for established patients who have simple questions or simple problems since I have their information on my computer. And most patients would prefer that option for medical questions or brief email discussions that don't require an exam at the moment.

Dr. Nicole: Most insurance companies don't pay for phone and email consultations.

Dr. Dave: That's precisely the point. We're being controlled by companies that are living in the past and are not innovative.

Dr. Nicole: But they would pay if they saw it as more efficient.

Dr. Rosen: Only the individual entrepreneur is able to see efficiency. And if he or she were running the show, he/she would see new efficiencies every day that a large organization would think too risky to venture in. The physicians of tomorrow will have to cut the chains to health insurance so that they can provide more efficient, cost-effective care and solve the health care conundrum. Our present administration in Washington will bury us in the old and stodgy ways of yesteryear's medicine and bankrupt our nation by keeping medicine inefficient for many more years and enslave our children and grandchildren.

Dr. Sam: And if our foreign creditors ever call the bank notes, our children could live in the United Chinese States of America with Peking as our capital.

Dr. Rosen: And we'd all have to learn how to speak Chinese and be foreigners on our own soil.

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

VITAL SIGNS – Journal of The Fresno-Madera And Kern Counties Medical Societies

Medicine and the Coroner's Office, by David Hadden, MD, Fresno County Coroner

The Coroner's morning briefing was well under way when a tall young man abruptly appeared in the room interrupting a lively discussion concerning the need to post a case from the previous day. He was wearing an old pair of dark washable pants and an I'm-going-to-the-mountains kind of shirt with boots to match.

"Who are you?" I said, putting the question to the look on my face.

"I'm a deputy sheriff." 

"Sure you are."

"No, no. I've got some bones with me," said the deputy. "We are going to Dinky Creek to look for the rest of this guy. We think he's a hunter that's been missing for a few weeks."

He thrust a plastic bag at the group. Inside were two clearly visible long bones.

"Are these human?" he asked.

"Looks like. Where did you get them?" Dr. Gopal inquired.

"Between Dinky Creek and the Big Trees," replied the deputy.  "A guy brought them in last evening. If you think they are human, we will go up there today and look for more." "They are clearly human - a tibia and a fibula," opined Dr. Gopal. . .

"How long have they been there and are they male?" were the earnest questions from the deputy.

"You can't tell how old they are after six months," replied Dr. Gopal. "We will have a forensic anthropologist examine them and get back to you in a few days. Let's make sure they are male." The deputy looked distressed. "They are quicker than that on TV."

"Yea," I shot back. "Detectives are better dressed on TV, too." The deputy looked offended. To change the subject he turned the bag over exposing a metal plate on the tibia.

"What's that plate?" he asked. "It's got two lines of numbers." Whoa. That plate was an attention getter that changed everything. This was not just another bag of bones. "That is orthopedic hardware," I said with enthusiasm.

The deputy told us he'd been looking for a missing hunter up in the Dinky Creek area for a couple of months. "We think it's him," he said.

"Call his family and see if he had a leg operation," I directed.  The detective unhooked his radio and called his "boss". In a few minutes it was confirmed that the missing hunter was never under the knife.

In the meantime I called orthopedist Don Huene, MD, with whom I had previously done some forensic work. "Don, we've got old bones with an attached orthopedic plate about five-inches long.  There are six closely placed screw holes," I explained to Don. . .

I was transferred to a somewhat defensive voice identified as Joanna. After I assured her that this was a CSI thing and no trial lawyers were involved, she produced what she said were two pages of addresses from that lot number showing that that particular part was shipped all over California. . .  "Well, there was one shipped to St. Agnes Hospital in Fresno on April 3, 1999." I thanked her profusely and called St. Agnes.  After going through several departments, we were connected to David in the orthopedic department. With the date of operation in hand, he soon identified the patient.

Meanwhile, the Coroner's Office and the sheriff's deputies were searching their memories for Dinky Creek area missing persons. Deputy Coroner Loretta Andrews remembered a 2006 case where a body was recovered and she thought perhaps it had a missing leg. She pulled the record and brought the name to my office just as David called back from St. Agnes with a name – the same name Integrating medicine and the Coroner's Office gave us a match and positive identification in less time than it takes to drive to Dinky Creek.

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9.      Book Review: Eradicating Morality Through Education

CLONING OF THE AMERICAN MIND - Eradicating Morality Through Education, by B. K. Eakman; Huntington House Publishers, Lafayette, LA, 1998, 606 pp, ISBN: 1-56384-147-9

"The educational system should be a sieve, through which all the children of the country are passed. . . It is very desirable that no child escape inspection. . ."
Paul Popenoe, behavioral eugenicist, American Eugenics Society; Editor, 1926

With this quotation, B K Eakman, educator, speech and technical writer, and researcher, sets the tone and the caution of a well researched "call to alarms." She previously wrote the first publication to warn of individually identifiable psychological assessments being given under cover of academic (achievement) testing. That 1991 book, Educating for the "New World Order," was a surprise hit. It revealed that "corrective" curricula were being brought into classrooms under the umbrella of remediation. Youngsters' beliefs and viewpoints were being remediated, not their skills in academic disciplines.

Eakman does a masterful job chronicling three parallel efforts dating over a century--information gathering methodologies, behavioral science, and legislation--and places these in context to provide insight, not only into the times and circumstances surrounding each event, but the ramifications for our present era.  

Cloning of the American Mind centers on America's "illiteracy cartel," a term Eakman coined to describe an out-of-control psychographic consulting industry. Psychographics is a relatively new field that combines elements of demographic and marketing research, where personal, student, and family records assume a commodity that with recent advances in computer technology can be acquired by almost anyone. Psychographics means "the study of social class based upon the demographics . . . income, race, color, religion, and personality traits. . . which can be measured to predict behavior." Their use in persons in captive, compulsory settings like elementary and secondary schools is of serious ethical and civil rights concerns.

This book explores today's behemoth psychographic consulting/information brokerage industry, focusing in particular on state-of-the-art computer technologies and advertising strategies to illustrate how behavioral scientists are combining these with psychiatry to reform education. In the process, Eakman shows us two factions of behavioral science as they evolve, clash, and then come together to accomplish what no extremist group or power elite has been able to do in the history of the world: hold an entire population hostage to a set of quasi-political, psychological criteria by predicating children's job prospects on whether they hold "acceptable" worldviews and opinions. These social engineers, by obtaining personal information about youngsters and their families, also get into the belief system of the students and correct any viewpoints they find distasteful.

As a society we are getting desensitized to divulging personal information. We're no longer sure what "personal" means. Certainly our children don't know. When they're asked questions about the family's medicine cabinet, mental problems, drinking habits, sexual practices, they are only too eager to impress, divulge and exaggerate information to please the teacher, and sound impressive misinterpreting what they see and hear. False information is thereby interspersed with accuracy being of little or no concern to those collecting information. The media, of course, has no stake whatsoever in other people's privacy.

The critical point is that there is a computer model available to predict behavior, simply by deriving a pattern of one's past activities. These activities can include anything from long-distance telephone usage to spending, recreation, and health. These are increasingly available, not only as part of any security background check, but also can now be added to a routine background check. If this is not enough, there is the ever-lurking "information underground' to which even government officials turn when they cannot get their data on us through legitimate channels.

Eakman points out that Jeffrey Rothfeder in his 1992 volume, Privacy For Sale, decided to show just how much information he could obtain about a prominent public figure. He selected former Vice-President Dan Quayle, someone he held in mild contempt. By using his personal computer and telephone, Rothfeder found he could easily gain access to information he wasn't supposed to be able to get. He found more than he bargained for and started sounding alarms. However, Rothfeder was blissfully unaware that techniques identical to those he was describing were being used in the nation's elementary and secondary schools. A database exists that not only has the capability to track and cross-reference generic information about people, their beliefs, family ties, friends' and associates' names, addresses, phone numbers and aliases; political/civic clubs and associations joined; magazine subscriptions; frequent shopping places; political campaigns and causes contributed to; how important a person is by region, state, or city; what potentially embarrassing information one may harbor; but can also predict a person's future action.

Education policy--indeed, all of social policy today--is aimed at dysfunctional people, not toward the backbone of society. When ordinary folk use the term "parents," we mean the majority of upstanding, decent people who care about their children. Statistics show that about one-half of one percent of American youngsters have no responsible adult to care for them. Yet, over the past 30 years, social and domestic policy has focused almost exclusively upon this irresponsible, negligent and abusive element. So when education policy makers hear the term "parents," they're thinking of negligent, abusive, and irresponsible people, or at the very least, of "rank amateurs."

Eakman found that the Educational Quality Assessment (EQA) test was made up of 375 questions covering attitudes, worldviews, and opinions with 30 questions on math and another 30 covering verbal analogies, which amounts to just enough academic questions to appear credible. However, she found the scoring mechanism revealed that points were given only for what were called "minimum positive attitudes"--in other words, state-desired responses, which the parents saw as neither positive nor desirable. It was years before behavior modification, a specialized clinical technique used primarily by licensed psychologists to achieve a therapeutic goal with patients, was the admitted purpose and the EQA was indeed psychological testing.

The National Institutes of Health made a grant to the Western Psychiatric Institute and Clinic for a "Multi-site Multimodal Treatment Study...." Among the significant aspects of this case was that psychological data was being mixed not only with students' education records but also with medical records. This violates the bible of the law profession, Black's Law. There one finds that malpractice has three aspects: ethical violation of the doctor-patient relationship; lack of good-faith; and compensable harm. In this case neither the student nor the parent sought out the doctor or psychologist. Instead the clinic went looking (stalking) for a "patient" (subject) and thus no doctor-patient relationship occurred. There was no informed consent, and, therefore, no good-faith. There was no proof that data on a particular child could not be retrieved at a later time causing compensable harm. In fact, insurance companies, potential employers or even a political candidate find such information useful (e.g. as a child having been seen or treated by a psychiatrist, forced sexual activity, use of a weapon, cruelty to animals, to name a few).

It was the year of the nation's Bicentennial, 1976, when education's high priests finally succeeded in their long-standing struggle to shift schools from academics and scholarship to socialization and guardianship. Teachers threw out stuffy old books, learned how to say "Hey, Man!", exchange their dresses and suits for blue jeans, and dismissed "the value of x." Likewise, student dress codes and rote learning were scrapped, tests and curricula were dumbed down, once-neat rows of desks were traded for "open classrooms," teachers lecturing and grading scales were condemned, and a technique called "behavioral conditioning" began replacing drill and repetition. The teachers became unionized, in some places with legislative mandates, with the NEA and AFT getting a windfall from membership dues. This implemented an us vs them mentality. Principals and superintendents withdrew the traditional disciplinary support teachers had enjoyed for decades. School administrators were no longer expected to have had taught any academic subjects as long as they obtained the requisite administration credentials. They pushed teachers to pass failing students and to "relate to youngsters on their own terms." Teachers now had to forget what little they ever knew of a classical education and change their focus to "humanizing the education process" and "being relevant."

Students loved watching teachers traipse about in cutoffs and listening to "hip" music while doing math. But they quickly became disenchanted when creatures who didn't look much different than they did started getting huffy around mid-term and demanding assignments. Their response frequently was an obscene gesture. Meanwhile educational psychologists in expensive "think tanks" questioned whether the ability to spell correctly was worth the price of a traumatized student. They didn't ask if the license to spell incorrectly was worth the price of a traumatized adult. As time went on, good, responsible parents became less trusting of the schools, and finally apathetic. Statistics began showing that after a child's fourth year of school, parental interest dropped dramatically. . .

Eakman's behind-the-scenes objective look at our bureaucratic education system makes Cloning of the American Mind an indispensable book for parents, educators, physicians, or anyone involved with our children. One can open up this volume to almost any of its 600 pages and find alarming news. In these two pages I have just touch the tip of the iceberg of what Eakman is telling us is happening to our children and the future of our society. We should all purchase our own volume for careful reading and tell all our friends about this book. We should even consider an extra volume for a concerned friend, and one for a member of our local school board. Our country's future is at stake--and our children won't be able to save it unless we take drastic action now.

The epitaph of the 20th century should be: "Here lie the victims of open-mindedness." --Joseph Sobran, syndicated columnist.

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10.  Hippocrates & His Kin: Does Multitasking short change Memory?

IRS Agent Can't Look In the Mirror after What He Does To People

Disgraced Sacramento CPA William Murray once confided to a friend and client that he left a job at the IRS because "I can't look in the mirror after what I do to people." He is now accused by the Government of taking more than $13.3 million from a select clientele of his tax preparation business over the past decade to pay their income taxes but never forwarded the funds to the IRS. He's free on $500,000 bail but may not be for long.

Maybe they should make a cell for him with four walls of mirrors!


Does Multitasking Shortchange Memory?

Multitasking messes with the brain in several ways. At the most basic level, the mental balancing acts that it requires - the constant switching and pivoting - energize regions of the brain that specialize in visual processing and physical coordination and simultaneously appear to shortchange some of the higher areas related to memory and learning. We concentrate on the act of concentration at the expense of whatever it is that we're supposed to be concentration on.

Multitasking is dumbing us down and driving us crazy. . .


Is Mitt Romney a Socialist? Or is that a Rhetorical Question?

Mitt Romney has a new book, No Apology, in which it appears that he is still supporting his socialized medicine plan for Massachusetts while he was governor. His editorial in the Wall Street Journal also said as much. His interview in Parade indicates he did it because he didn't want to be party to saying NO. At the Town Hall meeting with Congressman Dan Lungren, when asked if he should be the party that's always saying no, a lady from the audience shouted, "You should be saying Hell NO." The book subtitle, The Case for American Greatness, is an obvious ploy trying to reverse his image and seduce the American people into thinking that he is a conservative in his efforts to capture the White House. However, those of us in the "People" business know that people don't change all that much over a lifetime. What he did to Massachusetts he would do the United States of America. Hence, the surest way to implement "Constrictive Government Controlled Socialized Medicine" in our country would be to elect a Wolf in Sheepskin to the White House. Mitt would complete what Obama won't be able to complete and no one could stop him before it became a fait accompli.

AMERICANS BEWARE

OR WE MIGHT LOSE WHAT WE HAVE ACCOMPLISHED IN 235 YEARS

UNLESS BARRACK OBAMA BEATS MITT TO THE ARMAGEDDON

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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, read the informative Ten Easy Reforms To Cover Preexisting Conditions.

                      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. Read Sally Pipes on Health reform plans represent financial malpractice.

                      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. This month, treat yourself to an article by Peter Leeson: Two Cheers for Capitalism?  

                      The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. 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.

                      The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels. This month, you might focus on Washington-Knows-Best the Wrong Approach to Health Care Reform.

                      Greg Scandlen, an expert in Health Savings Accounts (HSAs), has embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the initial series of his newsletter, Consumers Power Reports. Become a member of CHCC, The voice of the health care consumer. 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. Greg has joined the Heartland Institute, where current newsletters can be found.

                      The Heartland Institute, www.heartland.org, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?. This month, be sure to read the article: "I quit when medicine was placed under State control, some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun.

                      The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Lawrence W Reed, 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. Be sure to read the current lesson on Economic Education at Healing America: The Free Market Instead of Government Health Care.

                      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."

                      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 the latest newsletter Defend Colorado from Obama Care!

                      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 Ending An Economic Stimulus Package.

                      The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section.

                      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. -- However, since they supported the socialistic health plan instituted by Mitt Romney in Massachusetts, which is replaying the Medicare excessive increases in its first two years, they have lost site of their mission and we will no longer feature them as a freedom loving institution and have canceled our contributions.

                      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. You may also log on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to 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. Read his bio, articles and books at www.cato.org/people/cannon.html.

                      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, was found 43 years ago on the following guiding principles which are as true today as when it was founded:  1) The federal government of the United States is too big; 2) Governments, like individuals, should live within their budgets. 3) A market economy is the only way to ensure prosperity and is harmonious with human nature. 4) We should preserve the value of Western Civilization: The Greco-Roman and Judeo-Christian traditions. St Croix recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, wartime allows the federal government to 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 wartime, we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles supporting these principles, please go to www.stcroixreview.com. This month, read the editorial on Double-Dealing Healthcare Reform; Obama's Plan and Key Battleground; The Death Blow to Climate Change; Healthcare. To experience a rare voice of reason and good sense, why don't you subscribe to a print or web edition or make a donation while perusing the website?

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

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Del Meyer, MD, Editor & Founder

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Words of Wisdom

"Life is an adventure, dare it." - Mother Teresa: Nobel Peace Prize winner

"Only by contending with challenges that seem to be beyond your strength to handle at the moment you can grow more surely toward the stars." - Brian Tracy: Self-help author and lecturer

"All you have to do is know where you're going. The answers will come to you of their own accord." - Earl Nightingale, a motivational speaker and author, a radio personality, and the co-founder of Nightingale-Conant

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Why Government Doesn't Work, By Harry Browne

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In Memoriam

Alexander Meigs Haig, soldier and public servant, died on February 20th, aged 85

From The Economist print edition | Feb 25th 2010

GRANT and Eisenhower aside, America is uneasy about handing civil power to soldiers; and from the very start of the Reagan administration, in 1981, there was nothing Al Haig could do to erase the impression that he wished to take over the country. At his confirmation hearings for the post of secretary of state he rode roughshod over his interrogators ("No one has a monopoly on virtue, not even you, senator"). He let slip that he wanted to be the "vicar" of foreign policy, a word with pope-size pretensions. The press pinned on him the word "arrogant", and never removed it. His picture appeared on the cover of Time, chin high and arms akimbo, above the words "Taking Command".

This portrayal was not without foundation. It was well known that in 1973-74, as Richard Nixon crumbled under the weight of Watergate, General Haig, then chief of staff in succession to the disgraced H.R. Haldeman, kept the administration functioning. He advised Nixon how to deal with his enemies, and when to resign; he suggested to Gerald Ford that he should pardon his predecessor. His power was such that when Nixon appeared to ask him for a way out of his turmoil, "a pistol in the drawer", he immediately ordered the president's doctors to take away his pills.

He had no politicians' sleazy graces, and was proud of that. The brusque attitude and tone had been instilled at West Point, together with the gimlet stare and the preference for dealing with America's adversaries, whether Cubans, Palestinians or leftist Nicaraguans, with a bombing run or an invasion. His duties at the White House, on Henry Kissinger's National Security Council and for Nixon, had been carried out while still under military orders and earned him a dizzy ascent, from colonel to four-star general in four years. His scar tissue came from battles both actual and political.

As a soldier, he believed in certain rules of behaviour. First, the need to keep secrets and not go leaking to the newspapers, for soldiers died when secrets came into the enemy's possession. And second, to follow the chain of command. Foreign policy in particular required a single source, one clear voice speaking for America. The greatest danger in those cold-war years was to show the Soviet enemy a soft, disunited front. The Soviets would surge through then, expanding their troublemaking and missile-rattling round the globe, just as the Chinese and North Koreans had driven through the "foolishly divided" front at the Yalu river in 1950, leaving 12,000 Americans dead or wounded in the ice, when he was a young lieutenant. . .

The moment for which he was best remembered came on March 30th 1981, when Reagan was shot. Sweating and intense, his hands shaking, General Haig declared to the press that "As of now, I am in control here, in the White House, pending return of the vice-president." Hedged words; but he never lived them down.

Some thought he had become unmanageable, and he could give that appearance. But the nub of the matter, as he described it in a calmly lyrical passage of his book, "Caveat", was this:

The [Reagan] White House was as mysterious as a ghost ship; you heard the creak of the rigging and the groan of the timbers and sometimes even glimpsed the crew on deck. But which of the crew had the helm?…It was impossible to know…

If someone evidently had the helm, General Haig saluted. If not, rather than let drift and uncertainty give any comfort to America's enemies, he had acquired the habit of seizing the wheel himself.

Read the entire obituary . . .

On This Date in History - March 9

On this date in 1401, Amerigo Vespucci, the man after whom America is named, was born in Florence, Italy. No one understands why America was given the Christian name of the navigator and mapmaker who placed the continent on a navigational chart. It is hard to imagine the United States of Vespucci.

On this date in 1790, Benjamin Franklin wrote his creed to the Reverend Ezra Stiles who had asked about Dr. Franklin's religious beliefs. "I believe in one God," wrote Franklin, "Creator of the Universe. That he governs it by his Providence. That he ought to be worshipped. That the most acceptable Service we render to him is doing good to his other children."

After Leonard and Thelma Spinrad

We must always remember that Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single payer initiative, was born for the benefit of the state and of a contemptuous disregard for people's welfare.



[1] Our apologies to Buddy Holly, Ritchie Valens, J. P. "The Big Bopper" and Don McLean but the paraphrasing in the title was too good to pass up for this article.  The Day the Music Died was On February 3, 1959, in a small-plane crash near Clear Lake, Iowa. Don McLean immortalized the tragedy in his ballad "American Pie".  We do not foresee a ballad for managed care forthcoming.

[2] http://www.milliman.com/expertise/healthcare/publications/rr/pdfs/hospital-physician-cost-shift-RR12-01-08.pdf