MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VI, No 23, Mar 11, 2008
In This Issue:
The Annual World Health Care Congress, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. The third year it was 50 percent, indicating open forums such as these are critically important. The 4th Annual World Health Congress was held April 22-24, 2007 in Washington, D.C. This year many of the world leaders in healthcare concluded that top down reforming of health care, whether by government or insurance carrier, is not and will not work. We have to get the physicians out of the trenches because reform will require physician involvement. The 5th Annual World Health Care Congress will be held April 21-23, 2008 in Washington, D.C. New: The 6th Annual World Health Care Congress will be held April 16-19, 2009 in Washington, D.C. The World Health Care Congress - Asia will be held in Singapore on May 21-23, 2008. The 4th Annual World Health Care Congress Europe 2008 will meet in Berlin on March 10-12, 2008. For more information, visit www.worldcongress.com.
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In The Patient as Person, published almost forty years ago when transplantation technology was still in its early stages, Paul Ramsey considered different ways of procuring organs for transplant. One might invite people to "opt in," to donate organs to be used after their death (or, in the case of a paired organ such as the kidney, even before death). One might require people to "opt out" if they did not wish to have their organs taken after death for transplant, presuming their consent to this taking unless they (while living) or their next of kin (after their death) specifically declined to consent. Or one might establish some kind of system whereby organs needed for transplant could be bought and sold (though he was thinking only of cadaver organs).
The third of these possibilities should, Ramsey believed, be rejected altogether. But his verdict with respect to the first two was more nuanced, a comparison of their relative merits and demerits. "If giving is better than routinely taking organs to prolong the lives of patients needing transplants, then it must also be said that routinely taking them in hospital practice would be better than for us to make medical progress and extend treatment to patients by means of buying and selling cadaver organs. That society is a better and more civilized one, I have said, in which men join together in a consensual community to effect these purposes, than a society in which lives are saved routinely, without the positive consent and will of all concerned to do so. It must also be said, however, that a society would be better and more civilized in which men are joined together routinely in making cadaver organs available to prolong the lives of others than one in which this is done ostensibly by consent to the gift' but actually for the monetary gain of the donor.'"
I recalled this passage when reading of the proposal by Gordon Brown, prime minister of Great Britain, to deal with what he called "an avoidable human tragedy" and encourage more people to "donate" organs. Britain's National Health Service, Brown announced on January 14, 2008, should move to a system in which organs of the deceased would be taken for transplant, with their consent presumed, unless before death they had opted out or, after death, their family members objected to such use of their organs.
Ramsey's comparative analysis might remind us that the Prime Minister's proposal is not the worst we can envision. Ours is a world in which an increasing number of voices support some form of payment for organs (or, sometimes, for organs from specific populations, such as prisoners nearing death)--thereby turning potential donors into vendors and the body into a collection of parts that are available and alienable if the price is right. This would, Ramsey seemed to think, and I am inclined to agree, be worse than what Mr. Brown has in mind.
Nor, I think, will it do to object to Mr. Brown's proposal on the ground that my body is my property alone, no part of which should be taken or used without my explicit consent. There are, after all, occasions - if, for example, an autopsy is deemed necessary - when we allow the needs of the larger society to override the bodily integrity of a deceased individual. More important, though, is the fact that "property" does not seem to be the right way to think of my body's relation to me. Thinking in those terms may, in fact, leave us defenseless in the face of arguments supporting a market in organs.
Nor is the body of the deceased best thought of as property of his surviving family. If their wishes about its disposal ought to be honored, that is not because they own the body. It is because the life they shared with this one who has died obligates them to give his body proper burial - and the rest of us should do nothing that makes their duty more onerous than it of necessity is or that forces them, while grieving, to fight for the right to carry out such a fundamental human duty. "There is," as William F. May once put it, "a tinge of the inhuman in the humanitarianism of those who believe that the perception of social need easily overrides all other considerations."
Still, there are good reasons to draw back from procuring organs for transplant by means of an opt-out system. We need an Orwell among us to note how strained the language of those, like Mr. Brown, becomes when they describe what they have in mind. His aim, he wrote, is "a different consent system" that would "increase donation levels" significantly. But, of course, it is not really "donation" that he has in mind. It is taking, not giving - and a consent that must be presumed is one that only the articulate and the powerful are likely to avoid giving. Those from whom the organs are taken, whose consent is presumed, might better be thought of as useful resources than as donors. Moreover, it would place a special burden upon some groups whose beliefs - often, religious beliefs - lead them (except in special circumstances) to object to the giving or taking of bodily organs after death.
The Prime Minister's language - of "an avoidable human tragedy" that could be averted were more organs available for transplant - is the sort of talk that has come to characterize most discussions of transplantation, and it begs for careful examination. It is the sort of language that can be used to justify almost anything that promises to help avoid the tragedy of death. And this is exactly the sort of language that, we have come to see, has often distorted the practice of medicine, teaching us to suppose that anything that can be done to ward off death must be done. But the deeper moral truth is that how we live, not how long, is what matters most. And among the possible "tragedies" with which we must reckon would be to live longer by means that debased or undermined our humanity.
Why is giving of organs better than taking, even if taking may provide a greater supply for transplant? To look upon potential "donors" chiefly as handy collections of spare parts to be used by others is to lose the sense of the embodied human person as one who, because made finally for God, transcends every location in space and time. A person does not belong, to the whole extent of his being, to any earthly community.
Even the deceased person does not. Why, for example, did an al Qaeda-led group in Iraq release footage of two corpses that it said were those of US soldiers killed in June, 2006? The video showed a decapitated body and several dead bodies being stepped on. This dishonoring of the corpses could have no point were not even the dead body still a reminder of the presence of the person, who can be the "property" of none of us, nor merely a "resource" to be used for our purposes, however important they may be.
To see this, however, is to begin to see the deepest truth of all: even the giving of organs for transplant is not unproblematic. And we can understand why, if organs are used, they should be given rather than taken only if we first see how troubling even the giving is. . .
We will avoid it, though, only to the degree that we cease to be simply cheerleaders in the cause of transplantation and regain, instead, an older wisdom of and about the meaning of the body. Fortified in that way, and aware of what is troubling about all organ transplantation, we will be better able to think about how it may be done rightly and how it should not be done even in the name of avoiding tragedy.
Gilbert Meilaender holds the Duesenberg Chair in Christian Ethics at Valparaiso University
Read the entire article at www.firstthings.com/article.php3?id_article=3852&var_recherche=meilaender+%2B+body+parts.
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If you're worried about your weight and who isn't? you may have the feeling lately that science is really jerking you around.
Consider recent findings: Rats fed saccharin gain weight faster than rats fed sugar. Some overweight humans live longer than skinny ones. Diabetics who drive down their blood sugar to "normal" levels are more likely to die of heart disease.
Even the end result of "just eat less and exercise more" is under scrutiny, as researchers find that some obese people are destined by their genes and metabolism to stay fat.
Maybe it's time to be realistic and play the cards we're dealt.
"The reality is that people have less control over their weight than they realize," said Gina Kolata, whose book "Rethinking Thin" looks at the science of weight loss. "Weight is inherited almost as strongly as height. No matter how much you'd like to be skinny, you may not be able to be as thin as you would like."
Kolata suggests that Americans should stop blaming people for obesity.
"It's just as hard for a thin person to gain 100 pounds as it is for an obese person to lose it or even 50 pounds, or even, I hate to say it, 20 pounds," she said Monday. "It's not that easy to change your weight just because you will yourself to."
Hard as dieting is, losing weight is easier than keeping it off.
Even Oprah Winfrey, one of America's wealthiest women with personal trainers and chefs, struggles with gaining and losing repeatedly, points out UC Davis nutrition professor Judith Stern.
"It's really hard to keep weight off," Stern said. "Some of it has to be biology. Some of it has to be the environment."
And some of it is probably interactions between the two that we don't fully understand. . . To read the entire article, go to www.sacbee.com/health/v-print/story/705326.html.
To read reviews of diet books, click on DIET at www.healthcarecom.net/bkrev_Health.htm.
To obtain Bob Schwartz' book Diets Don't Work, go to www.amazon.com/gp/offer-listing/0942540166/ref=sr_1_olp_2?ie=UTF8&s=books&qid=1204435754&sr=1-2.
To obtain Bob Schwartz' book, Diets Still Don't Work, go to www.amazon.com/Diets-Still-Dont-Work-Schwartz/dp/0942540042/ref=sr_1_4?ie=UTF8&s=books&qid=1204435754&sr=1-4.
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3. International Medicine: Luckily, GPs are wiser than their leaders By Richard Horton, The Sunday Telegraph, 17 Feb 08
GPs are angry. Recent pay freezes (despite a 30 per cent salary increase three years ago that took their average earnings to £110,000), service upheavals, political scapegoating, GP "bashing" in the media, betrayal by their own leaders, and unilaterally imposed changes to contracts by government have all led family doctors to declare that enough is enough.
· News: Families pay £1,200 a year on medical care The average family spends almost £1,200 a year on medical care - on top of the £3,850 contributed annually to the NHS via tax - in a "creeping privatisation", a study has found. (£5,050 approximates $10,000 USD. Socialism still didn't deliver.)
And so their leaders marched the troops into war. At the start of this month, their trade union, the British Medical Association, opposed ministers' plans to open surgeries for an average of three extra hours a week. The BMA may have hoped that public sympathy for GPs, combined with poor political polls for Labour, would force health ministers to surrender. Instead, it was the BMA that had to climb down, days after the Health Secretary wrote directly to GPs. It was a humiliating defeat. And an utterly pointless episode of medical demagoguery.
The Government wants to widen access to GP services to evenings and weekends. And it is prepared to redirect and add extra money to do so. The BMA has argued, crazily, that this idea "could undermine the very basis of the NHS".
For some time, doctors have wanted their leaders to exercise some muscle. The BMA forced out its last chairman, James Johnson, in a brutal putsch, for not doing more to oppose Government reforms. His successor, Dr Hamish Meldrum, has responded in the way many GPs want: by opposing the Government at every step. Meanwhile, the organisation's chief GP, Dr Laurence Buckman, is contemptuous of elected politicians. "They don't care about patients," he says.
But the public cynicism displayed by Doctors Buckman and Meldrum is perplexing. It is also quite at odds with the idealism and selflessness shown by most GPs. Family doctors manage 86 per cent of all health needs in Britain. They make more than 250 million consultations every year. Without GPs, the health of the nation would collapse.
However, one in three patients still finds it hard to see their doctor, the Government reports. Ministers say that four times as many working hours are lost because of visits to the doctor as are lost to strikes. The 2.5 million lost working days mean £1 billion lost to the economy. . .
From the birth of the NHS in 1948 to this latest row, the BMA has been on the wrong side of the winning argument. It passionately opposed the idea of a state-run health service from the start. Sixty years later, it opposed working an average of less than one hour extra each week in return for the best financial settlement GPs have ever been offered.
But while ministers and the public know all too well what the BMA is against, they have little idea what the BMA is for. Meldrum and Buckman predict apocalypse. They claim government wants to destroy general practice. Ministers want privatisation by the back door. Mass resignation from the NHS may be the only way out.
GPs will vote on the Government's proposals later this month. The BMA's leaders say it was forced "to choose between two unacceptable alternatives". They are now recommending that GPs accept the Government's offer: £158 million reinvested into extended hours, greater financial incentives for GPs to provide better access, an average of an extra hour's work for most, and a 1.5 per cent increase in the total value of their contract. Not bad. I have confidence that doctors will do what is best for patients. They will vote overwhelmingly for this plan.
The BMA's strategy of public scare and professional paranoia has driven GPs into a dangerous corner. Its resistance to change is undermining the work of thousands of other doctors, who are trying hard to strengthen standards of care across the NHS.
General practice is the foundation stone of the NHS. But the BMA is stopping the NHS from creating a more personalised service, building care around the needs of patients, rather than around the needs of doctors. The BMA must ask itself: why do we exist? As of today, no one truly knows.
Richard Horton is editor of The Lancet
The NHS does not give timely access to healthcare, it only gives access to a waiting list.
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'Health care crisis' leads to 8-year rise By Dennis Cauchon, USA TODAY
The cost of government benefits for seniors soared to a record $27,289 per senior in 2007, according to a USA TODAY analysis.
That's a 24% increase above the inflation rate since 2000. Medical costs are the biggest reason. Last year, for the first time, health care and nursing homes cost the government more than Social Security payments for seniors age 65 and older. The average Social Security benefit per senior in 2007 was $13,184. . .
The federal government spent $952 billion in 2007 on elderly benefits, up from $601 billion in 2000. It's the biggest function of the federal government. States chipped in $27 billion more in 2007, mostly for nursing homes.
All three major senior programs Social Security, Medicare and Medicaid experienced dramatically escalating costs that outstripped inflation and the growth in the senior population.
Benefits per senior are soaring at a time when the senior population is not. The portion of the U.S. population ages 65 and older has been constant at 12% since 2000.
The senior boom, however, starts big time in 2011, when the first baby boomers 79 million people born between 1946 and 1964 turn 65 and qualify for Medicare health insurance. The oldest baby boomers turn 62 this year and qualify for Social Security at reduced benefits.
USA TODAY used a variety of government data to calculate the cost of providing Social Security, medical benefits and long-term care to an aging population. Billions of dollars paid to non-seniors, the disabled, children and others in the programs were removed to create an estimate that focuses exclusively on seniors.
· Medicare experienced the most explosive growth from 2000 to 2007. The Medicare prescription-drug benefit, started in 2006, accounts for about one-fourth of the increase in Medicare, which provides health benefits for people 65 and older.
· Long-term care costs per senior have declined slightly in the past three years because of a move away from nursing homes to less expensive home care.
· The cost of senior benefits is equal to $10,673 for every non-senior household.
· About 35% of the federal budget is spent on senior benefits, up from 32% in 2004.
Eugene Steuerle, a senior fellow at the non-partisan Urban Institute, notes that the full cost of senior benefits goes beyond Social Security, Medicare and Medicaid. A complete estimate would include other programs for retirees, such as military and civil servant pensions and medical benefits, he says.
The Urban Institute estimates that kids receive an average of about $4,000 per child in benefits, including the child tax credit and other indirect assistance. . . To read the entire article, please go to www.usatoday.com/news/nation/2008-02-14-senior-charticle_N.htm?loc=interstitialskip.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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Much of Medical Gluttony or excessive health care costs is physician induced. Some of it is on the patient's insistence to have more tests and x-rays. Now MRI is the clarion call - MRI of anything, even the lungs. With an open shutter, lung movement would not produce any detail.
Last week, Mr. McHenry, an 82-year-old veteran, decided to get his medications at the VA which offers them essentially free. He had to go to the clinic to get his prescriptions rewritten, however. In the process, he mentioned that he always felt bloated and the doctor on the Front Line decided to get an Ultrasound of the abdomen on the way to the pharmacy. It showed a small aortic aneurysm, 2.8 cm in diameter, considerably smaller than the 4.5 cm when surgery is frequently suggested. This was confirmed on a CT of the abdomen and the veteran was advised he would have to go to the USAF hospital 50 miles away to have his aneurysm repaired. He and his wife came in expecting his aneurysm to explode, at any second, and for him to drop dead any minute. She couldn't bear to spend another night with him for fear he would rupture and die next to her. We reassured them that it was not considered to be in the danger zone and repair at age 82 could possibly shorten his life.
This reminded me of another patient, Mr. George, who had a 4 cm aneurysm of his aorta. He was about 60 when this was found. His vascular surgeon had him come back every six months for an ultrasound to see if it had grown. When it grew to be 4.5 cm, he would immediately operate and insert a Teflon graft. Fortunately, for Mr. George, and unfortunately for Dr. Jones, it never got over 4.0 cm. At age 85, his coronary caught up with him but his aneurysm never did.
Were these 40 abdominal ultrasounds required? His insurance kept paying for them. So Mr. George didn't create a fuss. After about ten years, he was told he should reduce it to once a year, but his vascular surgeon advised him to continue twice a year, which he did. The vascular surgeon did these in his own office, which would be about one-third of what it would have cost in the hospital outpatient department.
It would be very difficult for a personal physician to totally contradict the vascular surgeon and thus there was no good mechanism to reduce this exorbitant cost roughly $300 x 40+ procedures or $12,000 of which more than 30 were unnecessary. He had health insurance, Medicare plus HMO, with a fairly rugged oversight mechanism, which never interfered with this Medical Gluttony. Government oversight seldom interferes with unnecessary expenses but more frequently seems to limit important needed medical procedures.
If this patient would have had the only tenable type of health insurance that controls costs where the patient pays a percentage of every charge, say 20 percent of outpatient procedures, that $60 every six months would have gotten a fairly good discussion going between the patient and his vascular surgeon. After 4 or 5, he would have insisted on maybe once a year. After 4 or 5 years, he would have insisted on perhaps one every other year. After another 4 or 5 ultrasounds he would have insisted on doing them every three or four years. All the discussions would have been two-way friendly interchanges and health care costs would have been reduced by about 75 percent. There would have been no animosity between his several doctors and the patient would have been leading the cost-cutting team.
Although a percentage co-payment would have reduced this cost by 75 percent, the average reduction in health care costs in our experience would have been about one-third to one-half. When looking at $2 trillion per year that is a reduction that even our Congress or President could never hope for in the most rigid and policing efforts ever devised. There is no better cost-control than patient responsibility for a percentage of all costs, which puts him/her at the head of the utilization team.
A percentage co-payment on every health care charge would put all of health care in a market place environment and reduce our national health care costs by 30-50 percent overnight. Why won't the insurance companies do this? Would they lose control of the patient? That would return control to the doctor-patient relationship. Nirvana from one simple change in an insurance plan.
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Health Alert: Saving Africans from Limousine Liberals and People Who, Although Not as Rich as Barbara Streisand, Think Just Like She Does;
Note to Bill Clinton, Elton John, Madonna, Bono, Sting, Ashley Judd and all their Hollywood friends: Stop killing Africans. And here you probably thought that all these people - with their concerts, fundraising campaigns and AIDS awareness activities - were actually doing something good. Welcome to the world of political correctness.
If you're a regular reader of Health Alerts, in all probability you are not a subscriber to the kind of literature that would clue you in on socially acceptable charitable giving. So you can be forgiven for not knowing that (1) AIDS is a politically correct thing to be concerned about (in fact, it is far and away the most politically correct disease) and (2) making a distinction between AIDS prevention and AIDS treatment is boorish, gauche, insensitive, uncaring, unfeeling and completely politically incorrect.
[Aren't you glad you have me to guide you through the nonsyllogistic world of Hollywood thought?]
First things first. It is too bad that all these celebrities did not get involved 25 years ago when virtually all the experts were predicting that AIDS would kill millions of Africans. But, hey, what's the point of getting involved in a cause if none of your friends knows anything about it? Anyway, now that 29 million Africans are HIV positive, what is the best use of scarce health care dollars?
It turns out that most of the hoopla in the West and most of the actual AIDS dollars are focused on AIDS treatment, whereas there is a much better return to be had on AIDS prevention and an even better payoff from the treatment and prevention of other diseases.
Further, by the very act of spending billions of dollars on AIDS treatment, resources will be drawn away from AIDS prevention and other health needs. In this way, African AIDS programs almost certainly cost more lives than they save!
The World Health Organization estimates the cost of treating a patient with AIDS with the "triple drug cocktail" known as highly active antiretroviral therapy is about $1,500 per patient per year; and this treatment adds only 3 to 5 years to each patient's life.
By contrast, a study in the British medical journal, The Lancet, estimates that prevention interventions such as condom distribution, blocking mother-to-child transmission, and voluntary counseling and testing could cost as little as $1 to $20 per year of life saved.
The medicines that cure tuberculosis cost about $10 per case.
A package of interventions designed to prevent maternal and infant deaths costs less than $3 per person.
Worldwide, 3 million children die every year because they do not get vaccines that cost pennies per dose.
A study by Harvard economist Michael Kremer estimates that for every year of life gained by giving antiretroviral therapy to an AIDS patient, 25 to 110 (quality adjusted) years of life could have been saved by spending those same dollars in more productive ways.
Even AIDS prevention is not always cost effective. An article in The Lancet lamented that 5.5 million child deaths could have been prevented using the same money that was aimed at preventing the small number of child deaths due to AIDS.
If all this is ruining your day, I have more bad news. Over the past five decades, the developed countries of the world have given less-developed countries $2.3 trillion in foreign aid. What difference has all this money made? Amazingly, economists aren't sure. How can you spend $2.3 trillion and not have any obvious beneficial effects? That's a subject for next week's Health Alert.
PS #1: I intentionally left Bill Gates off the list. Why? Because he has at least read the four must-read books for anyone contemplating giving money to Africa (and one hopes he learned from them). See, however, Bill Easterly's op-ed on Gates in The Wall Street Journal. http://online.wsj.com/article/SB120235183917849631.html
PS #2: Here are the four must-read books:
William Easterly, The White Man's Burden: www.amazon.com/White-Mans-Burden-Efforts-Little/dp/1594200378
Gregory Clark, A Farewell to Alms: www.amazon.com/Farewell-Alms-Economic-History-Princeton/dp/0691121354/ref=pd_bbs_1?ie=UTF8&s=books&qid=1202489401&sr=1-1
Paul Collier, The Bottom Billion: www.amazon.com/Bottom-Billion-Poorest-Countries-Failing/dp/0195311450/ref=pd_bbs_1?ie=UTF8&s=books&qid=1202489361&sr=1-1
Jeffery Sachs, The End of Poverty: www.amazon.com/End-Poverty-Economic-Possibilities-Time/dp/1594200459
The Sachs book represents conventional - and almost certainly wrong - thinking. I include it only for balance.
These books are summarized along with other material in John Goodman, "Message to Debaters" www.debate-central.org/ and Christa Bieker, "Topic Overview" www.debate-central.org/research/overview-of-the-2007-2008-cx-topic at the NCPA's high school debate site.
To view the comments for this blog entry: www.john-goodman-blog.com/africaaids/#comments
John Goodman, President, National Center for Policy Analysis
12770 Coit Rd., Suite 800, Dallas, Texas 75251
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Dr. John: With the second Super Tuesday completed yesterday, which candidate will be the best for our patients?
Dr Sam: That's easy. Both Obama and Clinton would destroy any freedom in health care.
Dr. Michelle: How's that?
Dr. Sam: Both would force our patients into the same corner that all National Health Plans and Canadian Medicare have forced their patients into.
Dr. Michelle: Hold on for a second. Obama wants to make it semi-voluntary.
Dr. Sam: Semi, just means the gun's chamber is only half full. They're all headed in the same direction. Total forced control.
Dr. Milton: Isn't it amazing that Europe, especially in Sweden and the UK, is facilitating privatization of their National Health Service? Both "L" candidates in our country are trying to force Americans into the same failed systems.
Dr. Edwards: Sweden, the granddaddy of socialized health care, is crumbling and hospitals are being privatized trying to salvage the system.
Dr. Milton: The UK with their NHS for nearly 60 years is beginning to recognize that it hasn't worked and can't work and is looking at its options.
Dr. Rosen: The Canadian system which outlawed private practice is crumbling. Their Supreme Court has ruled that Canadian Medicare gives access to a waiting list, but not to health care.
[Canadian Supreme Court Decision 2005 SCC 35,  1 S.C.R. 791 http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html}
Dr. Sam: Canada has absolutely the worst health care in a relatively free country. The other two that have outlawed private practice are Cuba and North Korea. What a group for Canada to be in!
Dr. Dave: But many Canadian's don't understand their system. They think its fine until they experience American Health Care. I had a patient last week who moved to the states because his wife wanted to return to California. He said he had always thought the Canadian Medicare was the norm. He just assumed everyone throughout the world had to wait weeks, months and years to get such things as an MRI. He was astounded to experience obtaining an MRI the day after it was ordered.
Dr. Sam: Ignorance is Bliss, isn't it?
Dr. Rosen: Yes it is, I've had similar feedback from Britons who were in the US for a period of time. They couldn't believe that they could have an operation, even a heart operation, the very same day as the need arose. They just assumed it would take six months of wait.
Dr. Sam: This general ignorance is what ultimately will get people to implement what they will regret forever. That's how political solutions always work.
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8. Voices of Medicine: Cops and Doctors By Dr SCOTT GOTTLIEB, WSJ, February 27, 2008
The death of actor Heath Ledger from an accidental overdose of six pain and anxiety medicines -- including the narcotics OxyContin and Vicodin -- has prompted warnings about misuse of prescription drugs, which ranks as one of the fastest growing segments of drug abuse. Nobody disputes the problem. But the strategies for tackling it aren't changing the trends, they are just hobbling doctors and patients, and may retard the development of new medications.
The Drug Enforcement Administration is, sensibly enough, targeting the small number of physicians who inappropriately prescribe drugs in violation of current laws, the "patients" who doctor shop for painkillers and hoard drugs to abuse or sell them, and the criminal diversion of these medications from pharmacies and distribution centers. But the DEA is also trying to influence clinical decisions about when these drugs are prescribed.
This is a mistake. Clinical issues are not the expertise of the DEA. Placing more restrictions on the legitimate prescribers can harm real patients and ethical physicians.
Innovative new drugs such as OxyContin that have been developed in the last two decades provide targeted relief for intractable pain. While they have helped innumerable patients, they have also been abused. The DEA response?
One was to try and get the power (now exclusively vested in the FDA) to have a final say over whether new narcotic medications should come to the market. Legislation to do so was temporarily passed in 2004 and the DEA sought its reauthorization in 2005 -- as a "rider" attached to its appropriations bill, without Congressional debate. At one time, the DEA even sent out solicitations to hire clinicians to review new drug applications for narcotics, a role reserved for the FDA. The DEA has stepped back from that effort -- at least for now.
There have also been efforts to place additional restrictions on existing drugs. The DEA is carving out a role for itself in the creation of risk-management programs that manage how new narcotics are used. These programs often place burdens on doctors and patients that can discourage legitimate prescriptions, for example by requiring additional reporting by physicians who dispense these drugs, as well as certification that they received additional training in handling them.
The DEA is leading a campaign to "reschedule" drugs like Vicodin into a stricter classification -- placing them under the same restrictions as opium, methadone and morphine. It is widely believed that the DEA has also been quietly pressuring the FDA to reach a similar conclusion. The hope is that tighter controls will help control illegal diversion -- although medical studies show that determined abusers don't typically get their drugs through legal channels.
But there's a danger that the DEA will wade into areas that involve appropriate clinical practice. There will always be some trade-off between access and enforcement -- between the docs and the cops. The ensuing tension helps ensure the right balance between enabling legitimate prescribing, and maintaining restrictions that aid in reasonable enforcement efforts. The problem is when DEA activities end up influencing legitimate prescribing.
For one thing, they prompt some law-abiding doctors to think twice before writing legitimate scripts. A 2001 study of California doctors found that 40% of primary-care physicians said fear of investigation affected how they treated chronic pain. A recent survey of physicians by the Center for Addiction and Substance Abuse found that one-third worry "a great deal" or "somewhat" about review of their own prescribing of controlled drugs by law enforcement agencies; and 44% report that this actually influences which medications they prescribe. . .
As prescription-drug abuse and criminal diversion escalates, there is a need for stepped-up law enforcement. But when it comes to managing legitimate medical practice issues, the cops should step aside. The risk is a return to an era when pain often went unrecognized, treated patients were commonly undermedicated, and doctors were reluctant to prescribe powerful narcotics -- sometimes out of fear of those looking over their shoulder.
Dr. Gottlieb, a resident fellow at the American Enterprise Institute, was deputy commissioner of the Food and Drug Administration from 2005 to 2007.
See all of today's editorials and op-eds, plus video commentary, on Opinion Journal1.
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From the Orange Country Register www.desertdispatch.com/opinion/buckley_2690___article.html/national_review.html
Just a listing of his accomplishments is a bit wearying, causing one to marvel that he packed so much into what in context seems like a mere 82 years of William F. Buckley Jr.'s life. The godfather of modern American conservatism wrote at least 55 books, ranging from serious political treatises to spy novels to celebrations of the oceanic sailing he enjoyed so much.
There were about 5,600 newspaper columns, the TV discussion program "Firing Line," which ran 1966-99, the magazine National Review, which he founded and edited until 1999. Just in the past year, he published a political novel, a book musing on National Review's history and a personal memoir of Barry Goldwater, due in April.
And he did it all with a twinkle in his eye and gave off the sense that it was all effortless.
In 1955, when National Review was founded, the intellectual climate was so unrelentingly geared toward modern "liberalism" and socialism that the critic Lionel Trilling was able to write in 1950 that "it is the plain fact that there are no conservative or reactionary ideas in general circulation." Buckley had help, of course, but it is not too great an exaggeration to say that he changed that situation almost single-handedly. As George Will wrote in 1980, "All great biblical stories begin with Genesis. And before there was Ronald Reagan, there was Barry Goldwater, and before there was Barry Goldwater there was National Review, and before there was National Review there was Bill Buckley with a spark in his mind, and the spark in 1980 has become a conflagration."
Fowlerspeak-Goodspeak By William F. Buckley Jr.
In the debate Thursday night, Hillary Clinton pronounced herself glad that Barack Obama had brought up the subject of foreign affairs. The technique is common. It says to the audience that Clinton is aware of a deficiency in Obama and intends to exploit it for all it is worth. The danger is that it gives Obama an opportunity to turn the score on Clinton by saying that he just happens to have made his living for three years by writing on foreign affairs for the Encyclopaedia Britannica.
These verbal traps are widely used and widely counter-used. The best collection of them appears in the last few pages of Fowler's Modern English Usage, but of course that section is only a small part of his great work. It is worth acquainting the reader with the teeming harvest of Fowler's analysis.
He offers us, for instance, a list of words owing their vogue to the joy of showing that one has acquired them: allergic, ambience, ambivalent, catalyst, complex, equate, global, idiosyncrasy, protagonist, repercussion, seminal, streamlined.
He gives another list of words taken up merely as novel variants on a more common word: adumbrate for sketch, blueprint for plan, breakthrough for achievement, built-in for solid, ceiling for limit, claim for assert, integrate for combine, intrigue for interest, liquidate for destroy, reaction for opinion, optimistic for hopeful, redundant for superfluous, rewarding for satisfying, significant for important, sabotage for wreck, target for objective, smear for calumny.
And there are words owing their vogue to some particular occasion, plus "popularized technicalities" (words legitimately used in some scientific discipline, but brought carelessly into general use): acid test, coexistence, exponential growth, geometric progression, iron curtain, psychological moment, winds of change. And words of rhetorical appeal: archetypal, challenging, dedicated, fabulous, fantastic, massive, overtones, sensational, unthinkable.
My reluctance to quote at such length from the great Fowler is mitigated by my serious wish that students of the English language would themselves take the initiative of familiarizing themselves with the profundities and niceties of the points being made by Mr. Fowler.
So Sen. Clinton will tell us that Sen. Obama has no first-hand executive experience. Obama in turn will imply that the kind of experience one gets as first lady is not of the same order as one gets as president, and that he has felt as keenly as she the pulse beat that resonates only in Congress, not in executive offices.
The viewer will have noted that it is expressions of this kind - i.e., personalized derogation and hauteur - that elicit the most vivid response from the audience. Presidential candidates no longer even try to sound like the Lincoln-Douglas debates, yet it is not bad occasionally to subject them to such analysis, to learn what it is that is not being said.
The matter of health care that has been primary in Mrs. Clinton's public career lends itself to special attention. She put forth an ambitious program when her husband was in his first term as president. But there were serious defects in that program, which her opponents were able to locate precisely because of their experience in the practical world of politics that she sought to gainsay. Those opponents, led by Rep. Newt Gingrich, were able to derail the program the Clinton administration had billed as its most important domestic initiative. And yet in Thursday night's debate Mrs. Clinton cited that plan - which she implied she would revive unchanged - as one of her principal claims to the presidency.
The two performers in the debate struck the observant conservative as intelligent, resourceful, and absolutely uninterested in the vector of political force. Both contenders should spend time on the problem of omnipotent government, and both, while entitled to criticize what has happened under President Bush, are obliged to an alert audience to speak the kind of language Fowler preached and preached in.
To purchase God & Man & Yale by Wm F Buckley, Jr, go to www.amazon.com/God-Man-Yale-William-Buckley/dp/089526692X.
A memorial service for the writer and editor William F. Buckley Jr. will be held on April 4 at 10 a.m. at St. Patrick's Cathedral in Manhattan, his family said. The service will be open to the public. Mr. Buckley's son, the writer Christopher Buckley, and Henry A. Kissinger, the former secretary of state, will speak. www.nytimes.com/2008/03/06/nyregion/06buckley.html?_r=1&ref=nyregion&oref=slogin
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Mrs. Clinton states that she will implement her failed health care proposal from 1992-93 as soon as she's elected president. However, she has not significantly revised the plan. But she thinks her experience as the first lady will stand her in good favor as the No 1 Lady.
Does she really think she can fool the American people twice? But then, this is a new century.
Mr. Obama reacted to Mrs. Clinton's criticism of no experience in international affairs by saying he's been writing about international experience for an encyclopedia for several years.
If you want to be president, read and write about your future duties. Experience is not necessary.
Mr. McCain states he's had war experience and Washington experience. He's sorry he ever hooked up with Feingold in Washington. He's best as an outsider.
What does the International Press think of Mrs. Clinton? The Financial Times has an insightful article on her sincerity. Check the UK perspective on Hillary Clinton gets it sincerely wrong by Clive Crook, FT.
Are the media and her party really tired of her?
The Other Side of Home Assistance
A veteran was seen last week for disability evaluation. When asked about his needs for living alone, he stated that he was managing just fine with all his disabilities. If he were provided aid, he saw himself becoming more dependent on the assistance and would lose his independence. Thank you, but No.
Home Health Aids Often Breed Dependency and Decrease Well Being.
The Other Side of a Psychiatric Admission
On reviewing a request by the Department of Disability Service, the psychiatric admission summary caught my eye. He was admitted for suicide precaution. After three days of a clean room and good food, he said that he really was not suicidal but had been evicted from his apartment and needed lodging and food. He saw no other way to obtain this than to make the call that his life was not worth living and he was contemplating suicide. He thanked the staff for being so kind to him for three days. He was now able to face homelessness where all his friends were and he could obtain a good shoot of heroin.
Free Health Care, Spending Other People's Money, Certainly Provides Many Comforts.
To read more vignettes, please go to www.healthcarecom.net/hhkintro.htm.
To peruse other Hippocrates Columns, go to www.delmeyer.net/HMC.htm.
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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. He also wrote Twenty Myths, which we ran for our first 20 weeks when we started six years ago. We still feature his Health Alerts as he continues to explode Medical Myths in our Medical Myth section.
Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may subscribe or access their health page. This month, be sure to read ABC's John Stossel's "20/20" report examining America's education system in a segment called "Stupid in America." It wasn't pretty.
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: Mercatus Center research seeks to understand the consequences both intended and unintended of public sector management processes, such as funding and management decisions by state and federal governments, and improve the state of knowledge to which these processes refer, thereby fostering solutions that promote a freer, more prosperous, and civil society. Research focus includes: tax and fiscal policy, government accountability, the contracting process, government reform, and congressional oversight. Explore the research at www.mercatus.org/research_area/cfilter.1/researcharea_list.asp.
The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. www.nahu.org/publications/hiu/index.htm. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business. Review the current articles listed on their table of contents at hiu.nahu.org/paper.asp?paper=1. To read what HIU is doing with the Single Payer issue go to www.nahu.org/legislative/single/index.cfm. To see my recent column, go to http://hiu.nahu.org/article.asp?article=1660&paper=0&cat=137.
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. Imagine if the government passed a law requiring that any automobile sold in the United States had to be outfitted with a GPS navigation system, satellite radio, heated leather seats and a gasoline-electric hybrid engine. Such a scenario would mean that only the wealthy would be able to afford cars. Sound far-fetched? In the lunatic world of America's health insurance market, though, this kind of political micromanagement is a troubling reality. And it is a primary reason many people can't afford health insurance. Read the whole story at www.galen.org/component,8/action,show_content/id,13/category_id,9/blog_id,1026/type,33/.
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. To join, go to www.chcchoices.org/join.html. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn.
The Heartland Institute, www.heartland.org, publishes the Health Care News. Read the late Conrad F Meier on What is Free-Market Health Care? at www.heartland.org/Article.cfm?artId=10333 You may sign up for their health care email newsletter at www.heartland.org/Article.cfm?artId=10478.
The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling, PhD, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. Go to the table of contents for the January issue to view a large number of important articles of Free Market issues and excellent book reviews.
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 careand may even make things worse." Review their 2008 Presidential Candidates At-A-Glance.
The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter at www.i2i.org/healthcarecenter.aspx. Read the magic of Single Payer.
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 Martin Masse's editorial on The Value of Spectrum.
The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section at www.fraserinstitute.ca/health/index.asp?snav=he. The Canadian Supreme Court has ruled that Canadian Medicare does not give access to medical care - it only gives access to a waiting list. To keep up with the wait, go to www.fraserinstitute.org/researchandpublications/researchtopics/health.htm.
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. Review their strategy for Health Care.
The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. This month read Thomas Paine on Society is a Blessing but Government is Evil at www.mises.org/story/2897. You may also log on to Lew's premier free-market site at www.lewrockwell.com to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or find out why anyone would want to be an MD today.
CATO. The Cato Institute (www.cato.org) was founded in 1977 by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio at www.cato.org/people/cannon.html. Consider enrolling in the Cato University Home Study Course at www.cato.org/university/.
The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.
The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]
The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, war time allows the federal government grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in war time we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to www.stcroixreview.com.
Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read William Tucker on Terrestrial Energy. The last ten years of Imprimis are archived. Read their tribute to Wm Buckley, Jr. Read all of Wm Buckley, Jr., works.
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Words of Wisdom
"Our subconscious minds have no sense of humor, play no jokes and cannot tell the difference between reality and an imagined thought or image. What we continually think about eventually will manifest in our lives." -Robert Collier, an inspirational author.
Some Recent Postings
Or go to www.ssvms.org/articles/0801gibson.asp.
Read another series of VOM at www.ssvms.org/articles/0801vom.asp.
May We Not Lose His Kind by Peggy Noonan
He was sui generis, wasn't he? The complete American original, a national treasure, a man whose energy was a kind of optimism, and whose attitude toward life, even when things seemed to others bleak, was summed up in something he said to a friend: "Despair is a mortal sin."
I am not sure conservatives feel despair at Bill Buckley's leaving--he was 82 and had done great work in a lifetime filled with pleasure--but I know they, and many others, are sad, and shaken somehow. On Wednesday, after word came that he had left us, in a television studio where I'd gone to try and speak of some of his greatness, a celebrated liberal academic looked at me stricken, and said he'd just heard the news. "I can't imagine a world without Bill Buckley in it," he said. I said, "Oh, that is exactly it."
It is. What a space he filled.
It is commonplace to say that Bill Buckley brought American conservatism into the mainstream. That's not quite how I see it. To me he came along in the middle of the last century and reminded demoralized American conservatism that it existed. That it was real, that it was in fact a majority political entity, and that it was inherently mainstream. This was after the serious drubbing inflicted by Franklin D. Roosevelt and the New Deal and the rise of modern liberalism. Modern liberalism at that point was a real something, a palpable movement formed by FDR and continued by others. Opposing it was . . . what exactly? Robert Taft? The ghost of Calvin Coolidge? Buckley said in effect, Well, there's something known as American conservatism, though it does not even call itself that. It's been calling itself "voting Republican" or "not liking the New Deal." But it is a very American approach to life, and it has to do with knowing that the government is not your master, that America is good, that freedom is good and must be defended, and communism is very, very bad.
He explained, remoralized, brought together those who saw it as he did, and began the process whereby American conservatism came to know itself again. And he did it primarily through a magazine, which he with no modesty decided was going to be the central and most important organ of resurgent conservatism. National Review would be highly literate, philosophical, witty, of the moment, with an ιlan, a teasing quality that made you feel you didn't just get a subscription, you joined something. You entered a world of thought.
I thought it beautiful and inspiring that he was open to, eager for, friendships from all sides, that even though he cared passionately about political questions, politics was not all, cannot be all, that people can be liked for their essence, for their humor and good nature and intelligence, for their attitude toward life itself. He and his wife, Pat, were friends with lefties and righties, from National Review to the Paris Review. It was moving too that his interests were so broad, that he could go from an appreciation of the metaphors of Norman Mailer to essays on classical music to an extended debate with his beloved friend the actor David Niven on the best brands of peanut butters. When I saw him last he was in a conversation with the historian Paul Johnson on the relative merits of the work of the artist Raeburn.
His broad-gaugedness, his refusal to be limited, seemed to me a reflection in part of a central conservative tenet, as famously expressed by Samuel Johnson. "How small of all that human hearts endure / That part which laws or kings can cause or cure." When you have it right about laws and kings, and what life is, then your politics become grounded in the facts of life. And once they are grounded, you don't have to hold to them so desperately. You can relax and have fun. Just because you're serious doesn't mean you're grim.
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Buckley was a one-man refutation of Hollywood's idea of a conservative. He was rising in the 1950s and early '60s, and Hollywood's idea of a conservative was still Mr. Potter, the nasty old man of "It's a Wonderful Life," who would make a world of grubby Pottersvilles if he could, who cared only about money and the joy of bullying idealists. Bill Buckley's persona, as the first famous conservative of the modern media age, said no to all that. Conservatives are brilliant, capacious, full of delight at the world and full of mischief, too. That's what he was. He upended old clichιs.
This was no small thing, changing this template. Ronald Reagan was the other who changed it, by being a sunny man, a happy one. They were friends, admired each other, had two separate and complementary roles. Reagan was in the game of winning votes, of persuading, of leading a political movement that catapulted him to two terms as governor of California, the nation's biggest state, at a time when conservatives were seemingly on the defensive but in retrospect were rising to new heights. He would speak to normal people and persuade them of the efficacy of conservative solutions to pressing problems. Buckley's job was not reaching on-the-ground voters, or reaching voters at all, and his attitude toward his abilities in that area was reflected in his merry answer when asked what he would do if he won the mayoralty of New York. "Demand a recount," he famously replied. His role was speaking to those thirsting for a coherent worldview, for an intellectual and moral attitude grounded in truth. He provided intellectual ballast. Inspired in part by him, voters went on to support Reagan. Both could have existed without the other, but Buckley's work would have been less satisfying, less realized, without Reagan and his presidency, and Reagan's leadership would have been more difficult, and also somehow less satisfying, without Buckley.
To read the entire piece, please go to http://online.wsj.com/article_print/SB120423170697200693.html.
On This Date in History - March 11
On this date in 1941, President Franklin D. Roosevelt signed the Lend-Lease Law, which was a device for giving aid to England and other nations fighting Nazi Germany in World War II without going to war ourselves. Were we really neutral, simply non-belligerent, or were we indeed mentally in a state of War?
On this date, the blizzard of 1888 began and continued till March 14, piling up snow in record proportions in the northeastern United States.
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 email@example.com.