1. Featured Article: Our jerry-rigged health-care system contains many models that reformers can build on.

Getting There from Here

How should Obama reform health care? by Atul Gawande, New Yorker, January 26, 2009

In every industrialized nation, the movement to reform health care has begun with stories about cruelty. The Canadians had stories like the 1946 Toronto Globe and Mail report of a woman in labor who was refused help by three successive physicians, apparently because of her inability to pay. In Australia, a 1954 letter published in the Sydney Morning Herald sought help for a young woman who had lung disease. She couldn't afford to refill her oxygen tank, and had been forced to ration her intake "to a point where she is on the borderline of death." In Britain, George Bernard Shaw was at a London hospital visiting an eminent physician when an assistant came in to report that a sick man had arrived requesting treatment. "Is he worth it?" the physician asked. It was the normality of the question that shocked Shaw and prompted his scathing and influential 1906 play, "The Doctor's Dilemma." The British health system, he charged, was "a conspiracy to exploit popular credulity and human suffering."

The stories become unconscionable in any society that purports to serve the needs of ordinary people, and, at some alchemical point, they combine with opportunity and leadership to produce change. Britain reached this point and enacted universal health-care coverage in 1945, Canada in 1966, Australia in 1974. The United States may finally be there now. In 2007, fifty-seven million Americans had difficulty paying their medical bills, up fourteen million from 2003. On average, they had two thousand dollars in medical debt and had been contacted by a collection agency at least once. Because, in part, of underpayment, half of American hospitals operated at a loss in 2007. Today, large numbers of employers are limiting or dropping insurance coverage in order to stay afloat, or simply going under—even hospitals themselves. . .

Many would-be reformers hold that "true" reform must simply override those fears. They believe that a new system will be far better for most people, and that those who would hang on to the old do so out of either lack of imagination or narrow self-interest. On the left, then, single-payer enthusiasts argue that the only coherent solution is to end private health insurance and replace it with a national insurance program. And, on the right, the free marketeers argue that the only coherent solution is to end public insurance and employer-controlled health benefits so that we can all buy our own coverage and put market forces to work.

Neither side can stand the other. But both reserve special contempt for the pragmatists, who would build around the mess we have. The country has this one chance, the idealist maintains, to sweep away our inhumane, wasteful patchwork system and replace it with something new and more rational. So we should prepare for a bold overhaul, just as every other Western democracy has. True reform requires transformation at a stroke. But is this really the way it has occurred in other countries? The answer is no. And the reality of how health reform has come about elsewhere is both surprising and instructive.

No example is more striking than that of Great Britain, which has the most socialized health system in the industrialized world. Established on July 5, 1948, the National Health Service owns the vast majority of the country's hospitals, blood banks, and ambulance operations, employs most specialist physicians as salaried government workers, and has made medical care available to every resident for free. The system is so thoroughly government-controlled that, across the Atlantic, we imagine it had to have been imposed by fiat, by the coercion of ideological planners bending the system to their will.

But look at the news report in the Times of London on July 6, 1948, headlined "FIRST DAY OF HEALTH SERVICE." You might expect descriptions of bureaucratic shock troops walking into hospitals, insurance-company executives and doctors protesting in the streets, patients standing outside chemist shops worrying about whether they can get their prescriptions filled. Instead, there was only a four-paragraph notice between an item on the King and Queen's return from a holiday in Scotland and one on currency problems in Germany.

The beginning of the new national health service "was taking place smoothly," the report said. No major problems were noted by the 2,751 hospitals involved or by patients arriving to see their family doctors. Ninety per cent of the British Medical Association's members signed up with the program voluntarily—and found that they had a larger and steadier income by doing so. The greatest difficulty, it turned out, was the unexpected pent-up demand for everything from basic dental care to pediatric visits for hundreds of thousands of people who had been going without.

The program proved successful and lasting, historians say, precisely because it was not the result of an ideologue's master plan. Instead, the N.H.S. was a pragmatic outgrowth of circumstances peculiar to Britain immediately after the Second World War. The single most important moment that determined what Britain's health-care system would look like was not any policymaker's meeting in 1945 but the country's declaration of war on Germany, on September 3, 1939.

As tensions between the two countries mounted, Britain's ministers realized that they would have to prepare not only for land and sea combat but also for air attacks on cities on an unprecedented scale. And so, in the days before war was declared, the British government oversaw an immense evacuation; three and a half million people moved out of the cities and into the countryside. The government had to arrange transport and lodging for those in need, along with supervision, food, and schooling for hundreds of thousands of children whose parents had stayed behind to join in the war effort. It also had to insure that medical services were in place—both in the receiving regions, whose populations had exploded, and in the cities, where up to two million war-injured civilians and returning servicemen were anticipated.

As a matter of wartime necessity, the government began a national Emergency Medical Service to supplement the local services. Within a period of months, sometimes weeks, it built or expanded hundreds of hospitals. It conducted a survey of the existing hospitals and discovered that essential services were either missing or severely inadequate—laboratories, X-ray facilities, ambulances, care for fractures and burns and head injuries. The Ministry of Health was forced to upgrade and, ultimately, to operate these services itself.

The war compelled the government to provide free hospital treatment for civilian casualties, as well as for combatants. In London and other cities, the government asked local hospitals to transfer some of the sick to private hospitals in the outer suburbs in order to make room for victims of the war. As a result, the government wound up paying for a large fraction of the private hospitals' costs. Likewise, doctors received government salaries for the portion of their time that was devoted to the new wartime medical service. When the Blitz came, in September, 1940, vast numbers of private hospitals and clinics were destroyed, further increasing the government's share of medical costs. The private hospitals and doctors whose doors were still open had far fewer paying patients and were close to financial ruin.

Churchill's government intended the program to be temporary. But the war destroyed the status quo for patients, doctors, and hospitals alike. Moreover, the new system proved better than the old. Despite the ravages of war, the health of the population had improved. The medical and social services had reduced infant and adult mortality rates. Even the dental care was better. By the end of 1944, when the wartime medical service began to demobilize, the country's citizens did not want to see it go. The private hospitals didn't, either; they had come to depend on those government payments.

By 1945, when the National Health Service was proposed, it had become evident that a national system of health coverage was not only necessary but also largely already in place—with nationally run hospitals, salaried doctors, and free care for everyone. So, while the ideal of universal coverage was spurred by those horror stories, the particular system that emerged in Britain was not the product of socialist ideology or a deliberate policy process in which all the theoretical options were weighed. It was, instead, an almost conservative creation: a program that built on a tested, practical means of providing adequate health care for everyone, while protecting the existing services that people depended upon every day. No other major country has adopted the British system—not because it didn't work but because other countries came to universalize health care under entirely different circumstances. . .

Switzerland, because of its wartime neutrality, escaped the damage that drove health-care reform elsewhere. Instead, most of its citizens came to rely on private commercial health-insurance coverage. When problems with coverage gaps and inconsistencies finally led the nation to pass its universal-coverage law, in 1994, it had no experience with public insurance. So the country—you get the picture now—built on what it already had. It required every resident to purchase private health insurance and provided subsidies to limit the cost to no more than about ten per cent of an individual's income.

Every industrialized nation in the world except the United States has a national system that guarantees affordable health care for all its citizens. Nearly all have been popular and successful. But each has taken a drastically different form, and the reason has rarely been ideology. Rather, each country has built on its own history, however imperfect, unusual, and untidy.

Social scientists have a name for this pattern of evolution based on past experience. They call it "path-dependence." In the battles between Betamax and VHS video recorders, Mac and P.C. computers, the QWERTY typewriter keyboard and alternative designs, they found that small, early events played a far more critical role in the market outcome than did the question of which design was better. . .

With path-dependent processes, the outcome is unpredictable at the start. Small, often random events early in the process are "remembered," continuing to have influence later. And, as you go along, the range of future possibilities gets narrower. It becomes more and more unlikely that you can simply shift from one path to another, even if you are locked in on a path that has a lower payoff than an alternate one.

The political scientist Paul Pierson observed that this sounds a lot like politics, and not just economics. When a social policy entails major setup costs and large numbers of people who must devote time and resources to developing expertise, early choices become difficult to reverse. And if the choices involve what economists call "increasing returns"—where the benefits of a policy increase as more people organize their activities around it—those early decisions become self-reinforcing. America's transportation system developed this way. The century-old decision to base it on gasoline-powered automobiles led to a gigantic manufacturing capacity, along with roads, repair facilities, and fuelling stations that now make it exceedingly difficult to do things differently.

There's a similar explanation for our employment-based health-care system. Like Switzerland, America made it through the war without damage to its domestic infrastructure. Unlike Switzerland, we sent much of our workforce abroad to fight. This led the Roosevelt Administration to impose national wage controls to prevent inflationary increases in labor costs. Employers who wanted to compete for workers could, however, offer commercial health insurance. That spurred our distinctive reliance on private insurance obtained through one's place of employment—a source of troubles (for employers and the unemployed alike) that we've struggled with for six decades. . .

This legislation aimed to expand the Medicare insurance program in order to provide drug coverage for some ten million elderly Americans who lacked it, averaging fifteen hundred dollars per person annually. The White House, congressional Republicans, and the pharmaceutical industry opposed providing this coverage through the existing Medicare public-insurance program. Instead, they created an entirely new, market-oriented program that offered the elderly an online choice of competing, partially subsidized commercial drug-insurance plans. It was, in theory, a reasonable approach. But it meant that twenty-five million Americans got new drug plans, and that all sixty thousand retail pharmacies in the United States had to establish contracts and billing systems for those plans.

On January 1, 2006, the program went into effect nationwide. The result was chaos. There had been little realistic consideration of how millions of elderly people with cognitive difficulties, chronic illness, or limited English would manage to select the right plan for themselves. Even the savviest struggled to figure out how to navigate the choices: insurance companies offered 1,429 prescription-drug plans across the country. People arrived at their pharmacy only to discover that they needed an insurance card that hadn't come, or that they hadn't received pre-authorization for their drugs, or had switched to a plan that didn't cover the drugs they took. Tens of thousands were unable to get their prescriptions filled, many for essential drugs like insulin, inhalers, and blood-pressure medications. The result was a public-health crisis in thirty-seven states, which had to provide emergency pharmacy payments for the frail. We will never know how many were harmed, but it is likely that the program killed people.

This is the trouble with the lure of the ideal. Over and over in the health-reform debate, one hears serious policy analysts say that the only genuine solution is to replace our health-care system (with a single-payer system, a free-market system, or whatever); anything else is a missed opportunity. But this is a siren song.

Yes, American health care is an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat. But hundreds of millions of people depend on it. The system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions. It represents a sixth of our economy. There is no dry-docking health care for a few months, or even for an afternoon, while we rebuild it. Grand plans admit no possibility of mistakes or failures, or the chance to learn from them. If we get things wrong, people will die. This doesn't mean that ambitious reform is beyond us. But we have to start with what we have.

That kind of constraint isn't unique to the health-care system. A century ago, the modern phone system was built on a structure that came to be called the P.S.T.N., the Public Switched Telephone Network. This automated system connects our phone calls twenty-four hours a day, and over time it has had to be upgraded. But you can't turn off the phone system and do a reboot. It's too critical to too many. So engineers have had to add on one patch after another.

The P.S.T.N. is probably the shaggiest, most convoluted system around; it contains tens of millions of lines of software code. Given a chance for a do-over, no self-respecting engineer would create anything remotely like it. Yet this jerry-rigged system has provided us with 911 emergency service, voice mail, instant global connectivity, mobile-phone lines, and the transformation from analog to digital communication. It has also been fantastically reliable, designed to have as little as two hours of total downtime every forty years. As a system that can't be turned off, the P.S.T.N. may be the ultimate in path-dependence. But that hasn't prevented dramatic change. The structure may not have undergone revolution; the way it functions has. The P.S.T.N. has made the twenty-first century possible.

So accepting the path-dependent nature of our health-care system—recognizing that we had better build on what we've got—doesn't mean that we have to curtail our ambitions. The overarching goal of health-care reform is to establish a system that has three basic attributes. It should leave no one uncovered—medical debt must disappear as a cause of personal bankruptcy in America. It should no longer be an economic catastrophe for employers. And it should hold doctors, nurses, hospitals, drug and device companies, and insurers collectively responsible for making care better, safer, and less costly.

We cannot swap out our old system for a new one that will accomplish all this. But we can build a new system on the old one. On the start date for our new health-care system—on, say, January 1, 2011—there need be no noticeable change for the vast majority of Americans who have dependable coverage and decent health care. But we can construct a kind of lifeboat alongside it for those who have been left out or dumped out, a rescue program for people like Starla Darling.

In designing this program, we'll inevitably want to build on the institutions we already have. That precept sounds as if it would severely limit our choices. But our health-care system has been a hodgepodge for so long that we actually have experience with all kinds of systems. The truth is that American health care has been more flotilla than ship. Our veterans' health-care system is a program of twelve hundred government-run hospitals and other medical facilities all across the country (just like Britain's). We could open it up to other people. We could give people a chance to join Medicare, our government insurance program (much like Canada's). Or we could provide people with coverage through the benefits program that federal workers already have a system of private-insurance choices (like Switzerland's).

These are all established programs, each with advantages and disadvantages. The veterans' system has low costs, one of the nation's best information-technology systems for health care, and quality of care that (despite what you've heard) has, in recent years, come to exceed the private sector's on numerous measures. But it has a tightly limited choice of clinicians—you can't go to see any doctor you want, and the nearest facility may be far away from where you live. Medicare allows you to go to almost any private doctor or hospital you like, and has been enormously popular among its beneficiaries, but it costs about a third more per person and has had a hard time getting doctors and hospitals to improve the quality and safety of their care. Federal workers are entitled to a range of subsidized private-insurance choices, but insurance companies have done even less than Medicare to contain costs and most have done little to improve health care (although there are some striking exceptions). . .

It won't necessarily be clear what the final system will look like. Maybe employers will continue to slough off benefits, and that lifeboat will grow to become the entire system. Or maybe employers will decide to strengthen their benefits programs to attract employees, and American health care will emerge as a mixture of the new and the old. We could have Medicare for retirees, the V.A. for veterans, employer-organized insurance for some workers, federally organized insurance for others. The system will undoubtedly be messier than anything an idealist would devise. But the results would almost certainly be better. . .

It will be no utopia. People will still face co-payments and premiums. There may still be agonizing disputes over coverage for non-standard treatments. Whatever the system's contours, we will still find it exasperating, even disappointing. We're not going to get perfection. But we can have transformation—which is to say, a health-care system that works. And there are ways to get there that start from where we are.

Read the entire article at www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande.

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2. In the News: Health Information Technology By Greg Scandlen

As part of the federal government's economic stimulus package, Congress has authorized spending about $20 billion on health information technology (health IT) and another $1 billion on comparative effectiveness research. These provisions achieved wide bipartisan support in Congress and in the health care industry, based on the hope that the investment will help improve efficiency, cut costs, and result in better care. The reality is likely to be far different.

Proponents of this spending rely heavily on a short RAND Corporation analysis from 2005 that predicted $77 billion in annual savings and improved outcomes. RAND estimated "implementation would cost around $8 billion per year, assuming adoption by 90 percent of hospitals and doctors offices over 15 years." It said, "The benefits can include dramatic efficiency savings, greatly increased safety, and health benefits."

Unfortunately, RAND assumed an error-free system that is quickly and enthusiastically adopted by virtually the entire health care system. That might happen, but it is an absolute best-case scenario. Even then, instead of "dramatic savings," the $77 billion hoped-for savings amounted to a mere 4.5 percent of total costs, placed at $1.7 trillion by RAND.

Far more likely is that every penny of the $20 billion will be wasted on systems that don't work and can never be implemented. That was the outcome of federal attempts to upgrade technology at the IRS, the FBI, and the air traffic control system. And these are all relatively simple enterprises involving single federal agencies. Health IT is vastly more complex and must include hundreds of thousands of private organizations that have invested in legacy systems that work reasonably well and are as varied as there are providers.

This also has been the experience of the United Kingdom, which has been trying to adopt a similar information technology upgrade for its National Health Service (NHS) since 2002. This plan was far less ambitious than the U.S. version, involving merely 30,000 physicians and 300 hospitals, all of whom are already employed by the NHS. Originally estimated to cost 2.3 billion pounds, it is already at 12.7 billion pounds-$18.4 billion, or about as much as provided in the stimulus package for the entire United States. A recent report to Parliament admitted the program is four to five years late and may never be implemented as envisioned. The project has lost two of the four vendors who were working on it, and some of the elements that have been installed are not meeting expectations.

This is not to say health IT is a bad idea or that hopes for it are unwarranted. Quite the opposite. The health care system sorely needs better management tools and better application of technology. There is currently a vast amount of entrepreneurial energy, innovation, and money being invested in developing, refining, and marketing the tools the system needs to come into the twenty-first century.

The danger is that massive federal intrusion will bring all that innovation to a screeching halt. Systems work best when they are developed from the ground up, not imposed from on high. In ground-up development, flaws can be detected and eliminated without much systemwide damage. Poor vendors can be removed without disruption to the whole system.

We do not yet know what the optimal system will be. Imposing federal standards on health IT in 2009 means the entire system will be locked in to those standards for very long time to come and innovation will not be rewarded.

The RAND study said "market forces" are an obstacle to health IT. Just the opposite is true. The market is the best way to test and refine new ideas. The process of repeated testing and refinement may seem slow to people who want instant solutions and shortcuts, but the failure to engage in that process often results in massive mistakes and wasted billions.

The following articles address some of these concerns and examine health IT from a free-market perspective.

Read the entire article and related matters as well as references at www.heartland.org/article/24761/Research_Commentary_Health_Information_Technology.html

(Thanks to Scot Silverstein, MD of Drexel University and Linda Gorman of the Independence Institute for helping develop this listing).

Can HIT Lower Costs and Improve Quality?
RAND Corporation, 2005
This is a short issue brief from RAND that is the basis for most of the estimates of systemwide cost savings. It does not look at the possible difficulties at all and claims the cost savings could reach $77 billion a year in 15 years

The National Programme for IT in the NHS: Progress since 2006
The Public Accounts Committee of the UK
"By the end of 2008 the Lorenzo care records software had still not gone live throughout a single Acute Trust. Given the continuing delays and history of missed deadlines, there must be grounds for serious concern as to whether Lorenzo can be deployed in a reasonable timescale and in a form that brings demonstrable benefits to users and patients. Even so, pushing ahead with the implementation of Lorenzo before Trusts or the system are ready would only serve to damage the Programme."

Health IT: Intelligent Evolution
Health Affairs Blog by Esther Dyson
Esther Dyson, the well-known technology investment guru, argues health IT can help bring about improved health care, "But government standards efforts (or magical thinking) won't make it happen. Rather, I think it will pretty much happen by itself-or rather by the decentralized efforts of millions of people and the slightly more centralized or at least clustered efforts of hundreds of companies, mostly start-ups but eventually some larger ones, too."

Health Information Technology: A Few Years of Magical Thinking?
Carol Diamond and Clay Shirky
Argues that the current push by the federal government to perfect standards on health technology has it exactly backwards. "If you computerize an inefficient system, you will simply make it inefficient, faster." The authors write, "[T]echnology and standards alone will not lead to health IT adoption, let alone transform health care. There are serious structural barriers to the use of IT that have nothing to do with technology."

Sociotechnologic Issues in Clinical Computing: Common Examples of Healthcare IT Difficulties
Blog by Scot M. Silverstein, M.D., Drexel University,
College of Information Science & Technology
Dr. Silverstein has developed a Web site that summarizes scores of case studies documenting how various forms of health IT have wasted resources or endangered patient care. He concludes, "The appropriate levels of critical thinking and skepticism essential in a demanding area such as introduction of computer automation in medicine appear largely absent." . . .

For further information on the subject, visit the Health Care issue suite on The Heartland Institute's Web site at www.heartland.org.

Nothing in this message is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. If you have any questions about this issue or the Heartland Web site, you may contact Greg Scandlen, director of Consumers for Health Care Choices at The Heartland Institute, at greg@chcchoices.org.

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3. International Medicine: U.S. Cancer Care Is Number One by Betsy McCaughey, NCPA

During this presidential election season, candidates are urging Americans to radically overhaul our "broken" health care system. Before accepting the premise that the system is broken, consider the impressive evidence from the largest ever international study of cancer survival rates. The data show that cancer patients live longer in the United States than anywhere else on the globe.

Overall Cancer Survival Rates. According to the survey of cancer survival rates in Europe and the United States, published recently in Lancet Oncology: 1

American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared to 56 percent for European women.

American men have a five-year survival rate of 66 percent — compared to only 47 percent for European men.

Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.

For women, only three European countries (Sweden, Belgium and Switzerland) have an overall survival rate of more than 60 percent.

These figures reflect the care available to all Americans, not just those with private health coverage. Great Britain, known for its 50-year-old government-run, universal health care system, fares worse than the European average: British men have a five-year survival rate of only 45 percent; women, only 53 percent.

Survival Rates for Specific Cancers. U.S. survival rates are higher than the average in Europe for 13 of 16 types of cancer reported in Lancet Oncology, confirming the results of previous studies.

Of cancers that affect primarily men, the survival rate among Americans for bladder cancer is 15 percentage points higher than the European average; for prostate cancer, it is 28 percentage points higher. 2

Of cancers that affect women only, the survival rate among Americans for uterine cancer is about 5 percentage points higher than the European average; for breast cancer, it is 14 percentage points higher.

The United States has survival rates of 90 percent or higher for five cancers (skin melanoma, breast, prostate, thyroid and testicular), but there is only one cancer for which the European survival rate reaches 90 percent (testicular).

Furthermore, the Lancet Oncology study found that lung cancer patients in the United States have the best chance of surviving five years — about 16 percent — whereas patients in Great Britain have only an 8 percent chance, which is lower than the European average of 11 percent.

Results for Canada. Canada's system of national health insurance is often cited as a model for the United States. But an analysis of 2001 to 2003 data by June O'Neill, former director of the Congressional Budget Office, and economist David O'Neill, found that overall cancer survival rates are higher in the United States than in Canada: 3

For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.

For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada. . .

Conclusion. International comparisons establish that the most important factors in cancer survival are early diagnosis, time to treatment and access to the most effective drugs. Some uninsured cancer patients in the United States encounter problems with timely treatment and access, but a far larger proportion of cancer patients in Europe face these troubles. No country on the globe does as good a job overall as the United States. Thus, the U.S. government should focus on ensuring that all cancer patients receive timely care, rather than radically overhauling the current system.

Read the entire article at www.ncpa.org/pub/ba596

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: The $34 trillion Ponzi Scheme Is Targeting Physicians. But Eliminating All Physician Payments To Zero Will Not Even Touch One Percent Of The Unfunded Liabilities.

Physicians Beware: Medicare RAC Attacks Coming, by Lawrence R. Huntoon, M.D., Ph.D., F.A.A.N., Editor-in-Chief, Journal of American Physicians and Surgeons, Vol 14, No 1, Spring 2009

Heart attacks, brain attacks, and now, RAC attacks. Medicare's recovery audit contractor (RAC) program, the "bounty hunter program," is now a permanent entity.

As the Medicare program is facing $34 trillion in unfunded liabilities, it is clear that government has promised more in Medicare benefits than taxpayers can afford long-term.

Although physicians currently face a 21 percent cut in Medicare fees in 2010, government is looking to take more money back from physicians via aggressive "bounty hunting" to help slow the financial demise of the Medicare program.

Those physicians who are holding out for a "fix" in the flawed Medicare SGR (sustainable growth rate) payment formula should know that if a "fix" is implemented, it will likely come at the cost of the adoption of a DRG-like system of payment for outpatient encounters (episodes of care). The adoption of a DRG-like system of payment for outpatient encounters will, of course, ensure that patients who present to the physician's office will be given the same type of treatment that patients receive in the hospital under the DRG (diagnosis related group) payment system.

Medicare is a giant Ponzi scheme that, like all such schemes, is destined for collapse. Despite repeated warnings of impending financial collapse by AAPS, the former head of the Government Accountability Office (GAO), the former Secretary of the Department of Health and Human Services, and the chairman of the Federal Reserve, the giant Medicare Ponzi scheme continues, and soon will take on the additional costs of the retiring baby boom generation.

Aggressive RAC attacks are anticipated, and physicians will be targeted for substantial repayments in the coming years. . .

"Reprinted with permission from the Journal of American Physicians and Surgeons Vol. 14 No. 1"

Read the entire editorial at www.jpands.org/vol14no1/huntoon.pdf.

Lawrence R. Huntoon, M.D., Ph.D., is a practicing neurologist and editor-in-chief of the Journal of American Physicians and Surgeons Contact: editor@jpands.org.

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

- Ronald Reagan

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5. Medical Gluttony: Ultimate Gluttony: Trillions for bailouts; Trillions for government medicine; Or How to Destroy Two Birds at the same time.

The current bailout for the down turn in our economy reaches a magnitude that few American's can comprehend. Even financial wizards admit we are entering new territory with an unknown end. The tax and spend party is holding numbers in front of us that are essentially equal to the $1.7 trillion that we spend on health care, including Medicare, Medicaid, VA care, Military care and private care. The media is awash in projections as to where it is ultimately going to end up. Line items are in the $100s of millions of dollars. Obvious frugal spending cannot occur with those numbers.

That same party feels they can take over our health care, make a transition to it and save money. The tax and spend party has always felt that they could throw money at any problem and improve it. It hasn't worked in schools, other government programs such as Medicare, and it will not work in Single-Payer government-controlled health care.

Please see our feature article above by Dr. Gawande that appeared in the New Yorker on how tragic that would be.

At the present time, many patients are very frugal on their purchase of health care when they pay a portion of it. We see patients that will change health plans and consequently doctors for a $20 increase in premiums. Such concern with personal health care will go out the window when $trillions are thrown their way.

The huge difference between 1929 and 2009 is that there were NO ENTITLEMENTS in 1929. Now there are $99 trillions (give or take ten trillion) of ENTITLEMENTS. So who can think that throwing several trillions into mostly pork barrels will have any significant effect? Isn't that like throwing a gallon of water at the ocean?

Our entitlements are not sustainable. Harry Browne has suggested that we should eliminate the Medicaid entitlement and allow the states to run their own welfare programs. The stimulus package is attempting to increase this unfunded entitlement.

Obviously a party that feels they can spend $trillions to save $99 trillion sees no problem in spending a few trillion to take over and destroy the health care industry.

But will the perpetrators be around when the system crashes?

The current spending spree is the Ultimate Gluttony. It may be our undoing.

Medical Gluttony thrives when health care is relatively free.

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

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6. Medical Myths: Will Individual needs be Met?

'Stimulus' Bill May Change Health Care Forever by Amy Menefee, The Washington Times, February 5, 2009

The "stimulus" bill in Congress would fundamentally change the way health care is delivered to all Americans. It would hand over decisions about your care to a group of bureaucrats you won't have the chance to elect.

The "stimulus" establishes a new government body to assess Americans' health care and to make sure drugs and treatments "that are found to be less effective and in some cases, more expensive, will no longer be prescribed." That's how House Appropriations Chairman David Obey (D-Wis.) described it. The words have changed, but the effect stays the same. Where is the outrage?

The predecessor of this new bureaucracy operates in the United Kingdom. The British National Health Service (NHS), revered by fans of government health care, has a body that compares and assesses drugs and treatments. It's called the National Institute for Health and Clinical Effectiveness (not-too-aptly nicknamed NICE). It became infamous for denying cancer patients new drugs that had proven to be effective. They were deemed medically effective - but not cost-effective.

Patients can opt to buy these drugs out of their own pockets, while still paying the taxes that fund the NHS, of course. One man has wanted a similar board to govern the treatment of U.S. patients: Tom Daschle, who just ended his quest to be the new Secretary of Health and Human Services after being investigated for tax evasion. He laid out his entire vision in a book, "Critical: What We Can Do about the Health Care Crisis."

The focus is a federal health board modeled on the Federal Reserve. This board would oversee the entire health sector, including research on drugs and treatments known as comparative effectiveness research. And, like the British version, it would concern itself not only with helping patients, but with the costs of treatment.

"We won't be able to make a significant dent in health-care spending without getting into the nitty-gritty of which treatments are the most clinically valuable and cost effective," Daschle wrote.

Health care spending is indeed a problem. But having the government decide which treatments are acceptable is beyond frightening - and it doesn't make sense. . .

You are a unique human being, with genetic and environmental factors influencing your health. Perhaps Benadryl has the predictable effect of making you drowsy; or, perhaps it does the opposite and keeps you awake. Take that a step further to prescription medicines for serious illnesses. Your sister has severe depression, and she responds only to one antidepressant. What if it isn't the one that works for most people? Or it's the most expensive one?

Peter Pitts, head of the Center for Medicine in the Public Interest and a former FDA associate commissioner, explained why "one-size-fits-all" medicine doesn't work: Most comparative effectiveness studies "don't capture the genetic variations that explain differences in response to medicines by different patients."

Having a board that excludes any treatment on the basis of comparative effectiveness is a danger to the health of those who fall outside the norms - and with the government setting those norms, any of us could end up as outliers.

The "stimulus" bill passed by the House creates this board. It allocates more than $1 billion for comparative effectiveness research. And it gives the new health and human services secretary (whoever that turns out to be) an additional $400 million at his or her discretion.

The supposed purpose of the bill - to "stimulate" the U.S. economy - is long gone.

As The New York Times's Robert Pear so eloquently put it: "For Democrats, it is also a tool for rewriting the social contract with the poor, the uninsured and the unemployed, in ways they have long yearned to do." He noted this was taking place "with little notice and no public hearings."

That fits perfectly with the plan Daschle laid out - he never intended for Americans to know what was happening to their health-care structure. "I do not believe we should draft a bill laying out this vision in excruciating detail," he wrote in "Critical." "I believe a Federal Health Board should be charged with establishing the system's framework and filling in most of the details."

If his plan continues in his absence, this board will "fill in the details" of a completely government-driven health care overhaul.

www.galen.org/component,8/action,show_content/id,13/category_id,2/blog_id,1157/type,33/

Amy Menefee is director of communications for the Galen Institute, a nonprofit research organization that focuses on health policy.

Medical Myths Originate With a Lack of Understanding of Health Care Costs.

Medical Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service which Dramatically Improves Understanding At The Registration Counter before Expensive Services are Rendered.

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7. Overheard in the Medical Staff Lounge: The New Cerner EMR

Dr. Ruth: How are you coming with the new Cerner Millennium Electronic Medical Records (EMR) that was implemented last week?

Dr. Edwards: It's great to be able to retrieve the laboratory, x-rays and scan reports with such ease.

Dr. Ruth: Also the consult reports are right there to read, practically in real time.

Dr. Edwards: It was a struggle for the first several days. Getting all the data on one interface was really neat. After one week I can now do the basics of writing orders and progress notes in a reasonable amount of time.

Dr. Ruth: I think that's the secret - learning one item at a time or whatever is necessary to get today's work done.

Dr. Edwards: Reminds me of when I learned word processing. The typing was easy. Then to print or save or file the document became a priority and seemed to fall in placed.

Dr. Patricia: I made so many mistakes the first few days. Once I though I had all the records, I tossed some documents in the trash. Later on I realized there was some report missing. It was so comforting to have support quickly telling me how to retrieve documents from the trash and make them active again. Sure can't do that with a shredder.

Dr. Dave: I think this is all going to work out just fine. It should make patient files more accurate so we can provide better care. What I'm concerned about is that the big political push for EMR is not for patient care, but for government oversight.

Dr. Sam: You got that right. The Kaiser Permanente EMR is based on the EPIC system. The University Hospital has its own system. The VA has the VISTA system. They all work well within their system. Each system can call up their own records and send them in whole or in summary fashion to any other system that the patient changed to.

Dr. Patricia: But wouldn't it be better if all the EMR were able to communicate with each other?

Dr. Sam: The NHS in UK has been working on a system for the whole country for nearly a decade and the experts now wonder if they will ever have a government-controlled system. They've spent billions. The government should just let the system evolve at its own speed and that will work out the kinks the best.

Dr. Paul: But I don't think Obama will just spend millions on it. He will spend whatever it takes - as he spends $billions, the rest of the world spends $millions. Some of his numbers reach into the $trillions.

Dr. Rosen: We are beginning to see some understanding in isolated places. One school declined the money for a new program to be funded for two years. Their reasoning was that after two years, they didn't know if they would be able to just say goodbye to it or whether they would be pushed to keep adding more to their budget.

Dr. Edwards: Yes, these are hard economic times. This throwing billions around will breed more billions and thus extend our current down turn for an extra decade.

Dr. Rosen: We have an excellent example in California. They are the seventh largest economy in the world. Revenues doubled in the past decade. But the Tax and Spend party kept on spending every cent and when the revenues decreased, they cried for a federal handout.

Dr. Edwards: Yes, that's hard to believe. That's why government is the poorest manager of wealth or money and can't plan anything fiscally sound. And certain people want to trust them with their life savings.

Dr. Rosen: But we can't seem to learn from our own experiences or even that of other government's experiences.

Dr. Sam: Would you trust them with your personal health matters?

Dr. Rosen: Now that's really a paradox. Every time someone mentions Single-Payer Health Care, I look at that person quizzically. Why is he so dumb? Why doesn't his brain synapse?

Dr. Paul: That's because he's a realist. He recognizes the government's power and just wants to get in on the ground floor.

Dr. Rosen: But wouldn't that be tragic? A country founded on the hope of freedom that couldn't hang on to that dream for even two centuries? There's not another frontier on this planet where we can start over with the insight of our forefathers. Looks like we best fight this enslavement with a battle of ideas. That was what our forefathers predicted. We've given you democratic freedom - if you can hang onto it.

The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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

Doctors Demand Justice for Patient Advocate Whistleblower

No one is safe when hospitals put profit before patients. Recent revelations of continued fraud at hospitals belonging to the chain of for-profits known as the Hospital Corporation of America (HCA, formerly known as Columbia-HCA) continue to shock the conscience of a people already reeling from fraud in the banking, mortgage and financial sectors. Will a medical meltdown be next? Public safety advocates have asked Congress to mandate special protections for medical whistleblowers. HCA has faced the largest false claims suits in history, and had paid more than $1.7 Billion dollars in fines for bilking taxpayers and patients. Despite these huge payouts, HCA apparently continues the misconduct that led to its already enormous fines. With 17% of the US GNP devoted to medical care, and with increasing amounts of bailout money going to health, the need for protection has never been greater.

Many prominent public interest groups, including the International Association of Whistleblowers (IAW) and the Semmelweis Society International (SSI), demand justice for one of the most energetic and effective doctor-whistleblowers in the nation, Dr. Lokesh Vuyyuru. This doctor, who has done more to promote public safety and honesty in medicine, has received death threats, and suffered brutal retaliation from a corrupt hospital that used fraud and deceit, and a sham and futile peer reveiw to literally strip this eminent doctor of his medical license and livelihood.

Vuyyuru was a cooperating witness in a prominent FBI investigation of Virginia hospitals in the HCA chain. Vuyyuru produced extensive evidence of false billing, and of patient endangerment and even death in grand jury documents, and in a string of civil suits that are ground-breaking in their defense of the rights of patients to expect quality and safe care, and for taxpayers not to be bilked for improper charges.

Vuyyuru's conscience did not permit him to stop even when he received death threats, and threats on his family. The pressure for him to stop the exposure became so intense that he sent his young child out of the country to avoid danger.

As political pressure apparently slowed the multi-faceted investigation of HCA -Virginia, Vuyyuru went to the next level and started a newspaper, The Virginia Times, to alert the public.

HCA struck back and robbed the patient advocate doctor of his livelihood. Court documents, and independent investigations by the IAW and SSI, reveal that HCA-Virginia has retaliated against Vuyyuru by falsely accusing the esteemed doctor, and using fraud to remove his medical license.

HCA-Virginia claimed that Vuyyuru was at fault in the care of two patients. Review of the charts show the opposite. Evidence shows a shocking alteration of charts, and that HCA-Virginia may actual have put patients in jeopardy in order to frame Dr. Vuyyuru.

Dr. Blake Moore, president of SSI concluded his investigation: "The medical facts in these cases were reviewed by multiple board certified parties. The care provided by Dr. Vuyyuru was deemed to be appropriate and professional. His care of his patients was found to be of a high quality and consistent with all reasonable standards of professional care."

Patient advocacy groups now recognize that frequently peer review matters are not based upon true issues of quality of care but are very commonly motivated by alternative agendas that can include greed or avarice. Dr. Henry Butler, founder of the SSI continued, "Dr. Vuyyuru demonstrates that he had become a very vocal advocate for patient safety and political reform. His actions in convening grand juries to address these concerns certainly generated a climate ripe for personal retaliation. A reasonable individual might conclude that the actions taken by the Virginia Medical Board were not motivated by legitimate concerns for patient safety, but appear to be of a retaliatory nature."

SSI, IAW and other patient advocates strongly endorse efforts to ensure fairness and ethics in peer review matters. The public clearly needs to be protected from dangerous medical care. However, when conscientious physicians who speak up as patient advocates are attacked and their ability to act as vocal advocates for their patients are silenced, it is rather ironically that the public health is even greater threatened.

Dr. Vuyyuru has demonstrated himself to be such a vocal patient advocate. As a newspaper publisher he has attempted to bring attention to quality of care issues. He has mobilized thousands of ordinary citizens to seek action in the furtherance of quality care in Virginia.

Multiple press releases have been issued. "HCA's treatment of Dr. Vuyyuru is so deceitful that it shocks the conscience," concluded Dr. James Murtagh, co-chair of the IAW.

Clearly, Dr. Vuyyuru deserves a medal for his efforts. He took on one of the most corrupt giants in the nation. This is the kind of courage we need in the governor's office of Virginia.

For this reason, I am calling on all persons of good conscience to draft Dr. Vuyyuru for governor of Virginia.

www.opednews.com/articles/Doctors-Demand-Justice-for-by-James-Murtagh-090223-556.html

VOM Is Where Doctors' Thinking is Crystallized into Writing.

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9. Book Review: THE CANCER WARD by Alexander Solzhenitsyn. Translated by Nicholas Bethel and David Burg, Noonday Press, New York, 1974. (Russian edition 1968)

This work of fiction is based on the author's own experiences as a patient in a cancer ward in the 1950's, but it speaks to us more clearly with each passing year as our country grapples with the problem of providing basic health care for all.

As the story opens, Nobel laureate Solzhenitsyn's Soviet world of 40 years ago seems like a strange and foreign place indeed, with its detached, impersonal, "universal free health care" system which serviced frightened powerless patients with competent but distant doctors whose passionless demeanor would have served them as well if they had been engineers or plumbers.

The chapter titled "The Old Doctor," is particularly prophetic. A 75-year-old physician, Dr. Oreshchenkov, mourns the extinction of the family doctor in modern Soviet medicine. He characterizes this practitioner of a bygone era as the "most comforting figure in our lives...a figure without whom the family cannot exist in a developing society. He knows the needs of each member of the family, just as the mother knows their tastes...the kind of person to whom they can pour out the fears they have deeply concealed or even found shameful... But he has been cut down and foreshortened. [It is very difficult] to find a doctor nowadays who is prepared to give you as much time as you need and understands you completely, all of you." A fellow physician and patient responds, "All right, but...they just can't be fitted into our system of universal, free, public health services." Dr Oreshchenkov retorts, "Universal and public--yes. Free, no." The colleague replies, "But the fact that it is free is our greatest achievement."

Dr Oreshchenkov then gives us the real message for our time: "What do you mean by 'free'? The doctors don't work without pay. It's just that the patient doesn't pay them, they're paid out of the public budget. The public budget comes from these same patients. Treatment isn't free, it's just depersonalized. If the cost of it were left with the patient, he'd turn the ten rubles over and over in his hands.

The Author then describes how he feels the health care system should be. He felt that primary treatment should be at the expense of the patient, but hospitalizations or costly procedures should be free. Then patients would be in control of when and how often and from whom they should seek medical treatment. "With the right kind of primary system,... there would be fewer cases altogether, and no neglected ones..." Each patient could be treated as a whole person instead of a collection of diseases, to be tossed from specialist to specialist like a basketball.

Solzhenitsyn's story is a classic - as relevant today in America as it was 30 years ago when it was first published in Russian. Its characterizations are vivid, its situations are hauntingly familiar, and its truths are timeless.

This book review is found at www.healthcarecom.net/bkrev_CancerWard.htm.

To read more book reviews.

To read book reviews topically.

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10. Hippocrates & His Kin: Who's Responsible for our Fiscal Mess?

545 People, Fernley News Report, by Charlie Reese

Politicians are the only people in the world who create problems and then campaign against them.

Have you ever wondered why, if both the Democrats and the Republicans are against deficits, we have deficits? Have you ever wondered why, if all the politicians are against inflation and high taxes, we have inflation and high taxes?

One hundred senators, 435 congressmen, one president and nine Supreme Court justices - 545 human beings out of 300+ million - are directly, legally, morally and individually responsible for the domestic problems that plague this country.

No matter what the lobbyist promises, it is the legislator's responsibility to determine how he votes.

Those 545 human beings spend much of their energy convincing you that what they did is not their fault. They cooperate in this common con game regardless of party.

There are no insoluble government problems. Do not let these 545 people shift the blame to bureaucrats, whom they hire and whose jobs they can abolish; to lobbyists, whose gifts and advice they can reject; to regulators, to whom they give the power to regulate and from whom they can take this power.

Above all, do not let them con you into the belief that there exists disembodied mystical forces like 'the economy,' 'inflation' or 'politics' that prevent them from doing what they take an oath to do.

Those 545 people and they alone, are responsible. They and they alone, have the power. They and they alone, should be held accountable by the people who are their bosses - provided the voters have the gumption to manage their own elected and appointed employees and toss them out.

www.fernleynews.com/1400000/545_People.html

Can we count on you to vote all those con artists out of office?

Charities make telemarketers richer and charities poorer.

If you give to a charity over the phone, there's a growing likelihood that most of your donation will go to the telemarketer instead, according to a Bee analysis of state records.

More than a third of California charity telemarketing campaigns sent less than 20 cents on the dollar to the charities during 2007, the most recent year on record. Those campaigns and a smaller number of charity auctions and concerts raised $93 million for commercial fundraisers, and just $3 million for the charities. In 76 of those campaigns, California charities got no money at all.
www.sacbee.com/capitolandcalifornia/story/1643082.html

I guess it's time to hang up on all telemarketers.

State Attorneys are losing their jobs. Will State Physicians be next when they have a single payer?

The 230 deputy prosecutors, deputy public defenders and child support services lawyers represented by the Sacramento County Attorneys Association hope to avoid the knife.

District Attorney Scully already has eliminated 11 lawyer positions, including two in the slumlord- and inebriate-busting community prosecution unit, two in adult sexual assaults, an elder abuse lawyer and others working on domestic violence and misdemeanors. The DA said the future reductions figure to hit her misdemeanor unit. "It's going to hurt our community," Scully said. "It will impact public safety." "You're going to have to make some decisions on what you're going to prosecute and what you're not going to prosecute," she said. "Of course, serious violent crime is going to be the priority. But the reality is, if there are no consequences for the lower-level crimes - the broken-window thing - people don't fear the consequences and they graduate up to more serious crimes." That's a 5 percent reduction. On the bench side, the executive officer of the court has cut his staff by 10 percent. www.sacbee.com/ourregion/story/1643332-p2.html

Isn't there a message here of what may happen when all physicians are government employees and subject to economic downturns? Instead of crime, disease will increase.

California has a state budget in Feb 2009 that was due on July 1, 2008.

Democratic Senator Lou Correa obtained $35 million annually for Orange County as an incentive to vote for a new state budget. Republican Senator Roy Ashburn got a $10,000 homebuyer tax credit to spur new housing construction. Senator Abel Maldonado, bidding to become the final vote necessary to approve the deal, demanded three state constitutional amendments, including one to benefit his own candidacy for future statewide office. www.sacbee.com/capitolandcalifornia/story/1636268.html

Is there no such thing as bribery in a government job?

To read more HHK, Hippocrates and His Kin.

To read more HMC, Hippocrates Modern Colleagues.

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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 article: STEALTH CARE.

• 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. Just released: Top Ten Myths of American Health Care.

• 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 a resource by Don King on State Health Care Reform: A Resource for Legislators.

• 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. This month continue the tour with Michael Tanner of Health Care Systems Around the World: Greece.

• 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 review why The Single-Payer Remedy Is Worse Than the Disease.

• Greg Scandlen, an expert in Health Savings Accounts (HSAs), embarked on a new mission: Consumers for Health Care Choices (CHCC) The voice of the health care consumer with a series of newsletter, Consumers Power Reports. Greg has joined the Heartland Institute, where his 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, read Greg's report Health Care Honesty And Accountability.

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

• 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, read Should the Government Force You to Buy 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. This month, read the top 15 priorities of the Oregon Health Plan.

• 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 a great Valentine parody: ALL IS NOT FAIR IN LOVE: A PROPOSAL FOR CORRECTING THE UNEQUAL DISTRIBUTION OF LOVE.

• 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. Or in view of our current recession, you may like a history lesson: The Great Depression Part II: Why did it last so long?.

• 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.

• 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 Obama is Wrong About Entrepreneurship. 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. This month, read his relevant OpEd Stimulation by Government.

• 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. Read his current article: Universal Health Care Not Best Option.

• 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.] This month, look at what's happening concerning Fighting the Economic Stimulus.

• 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, 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 rich variety of timely articles in this arena, please go to the table of contents at 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 17^th 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 How Detroit's Automakers Went from Kings of the Road to Roadkill. The last ten years of Imprimis are archived.

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Del Meyer

Del Meyer, MD, Editor & Founder

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Words of Wisdom

"Once you lose your freedom to fail, you also lose your freedom to succeed and you cease to be a free society." -US Rep Jeb Hensarling of Texas.

The State exists simply to promote and to protect the ordinary happiness of human beings in this life. A husband and wife chatting over a fire, a couple of friends having a game of darts in a pub, a man reading a book in his own room or digging in his own garden - that is what the State is there for. And unless they are helping to increase and prolong and protect such moments, all the laws, parliaments, armies, courts, police, economics, etc., are simply a waste of time. -C S Lewis, Mere Christianity, Bk IV, Chap 8, para 10, p 199.

Religion should serve as a critic of society and not as a political force. Therein lies both the strength of the churches as the conscience of society and their incurable weakness as political and social forces of society. Peter F Drucker, The End of Economic Man.

Some Recent Postings

The Real Driving Force behind Health Care Reform, by David J. Gibson, MD and Jennifer Shaw Gibson

A Time for Freedom, by Lynne Cheney

We The People - The Story of Our Constitution, by Lynne Cheney

Why Sister Aloysius "Doubts", by James J. Murtagh, MD

"The Shield": Crime and Punishment, by James J. Murtagh, MD

A Disingenuous Debate on Health Care Policy, by David J. Gibson, MD and Jennifer Shaw Gibson

In Memoriam

Bruno Benziger, 1925-1989

The House Merlot of the Marines' Memorial Club in San Francisco pays tribute to Bruno Benziger, USMC, 3^rd Marine Division, Battle of Iwo Jima, 1945.

A tribute to those who have gone before. A service to those who carry on.

Always Faithful. It's what our father was to his country, to his family, and to our winery. And always faithful is what our wines are to his memory. This wine is a tribute to our father and to all the Marines who have served their country. We farm with respect for the land, we make wines that are genuine reflections of our vineyards and we do it together as a family, just as he wanted. Semper Fidelis.

-Mike Benziger, Benziger Family Winery

This past month we saw two veterans from Iwo Jima in their eighth and ninth decade of life. Even though it took over a year of hospital care in each instance to put their bodies back together so they could walk and work again, they had nothing but praise for their Marines and the Navy Hospitals. One platoon was driven back in their landing craft because of high winds, with six inches of stomach contents from motion sickness in the bottom of the boat. They returned to their ship, showered, cleaned up and went out again the next day. They both made miraculous escapes after being hit by sniper fire. In retrospect, they were happy to have been too sick to make the first day's landing, since the marines of that first landing essentially were all killed.

Semper Fidelis.

On This Date in History - March 10

On this date in 1876, Alexander Graham Bell, a young Scotsman said, "Mr. Watson, come here. I want you." These were the immortal words that were first spoken over a telephone by its inventor to his assistant.

On this date in 1948, the late Jan Masaryk, son of the founder of the Republic of Czechoslovakia and a champion of democratic self-government, died when he "fell" from a window in Prague. Many believed that he was pushed to make it easier for the Reds to consolidate their control of the nation. History is full of mysteries that in themselves seem minor but that can throw considerable light on larger matters.

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.

MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol VII, No 23, Mar 10, 2009