MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VIII, No 24, Mar 23, 2010
In This Issue:
1. Featured Article: Managed Care Health Insurance Companies are in Deep Trouble
2. In the News: The Incredible Deflation of Barack
3. International Medicine: Government Health Care that Even your doctor can't trust.
4. Medicare: The Problem of available doctors may just be beginning
5. Medical Gluttony: Medical Gluttony in the White House
6. Medical Myths: If these myths are not myths, why did the AARP lose 60,000 members?
7. Overheard in the Medical Staff Lounge: The Health Care Debate – What's next?
8. Voices of Medicine: Physicians can't support change if it puts them out of business
9. The Bookshelf: The story of those with a life not worth living
10. Hippocrates & His Kin: The Legislatures Approval Rating drops to 16 percent
11. Related Organizations: Restoring Accountability in Medical Practice and Society
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Always remember that Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single payer initiative, was born for the benefit of the state and of a contemptuous disregard for people's welfare.
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By David J. Gibson, MD & Jennifer Shaw Gibson
The fundamentals upon which the managed care health insurance companies are built are now under assault at multiple levels by both public and private third-party-payers. These payers have learned over the past 4-decades that managed care has not delivered on any of its promises. HMOs and PPOs have not reduced costs, flattened the inflationary curve for premiums, delivered superior outcomes, managed or coordinated care for those with chronic diseases or increased accessibility compared with less costly product options.
Today, health insurance companies generate their margins on two managed care "cash cow" products that are now slated for extinction. The first is Medicare Advantage (MA) which the Democrats have targeted for elimination. Both the House and Senate bills will cut more than $160 billion over 10 years from the projected growth of Medicare payments for MA products. These reductions represent a significant portion of the funding that is required to finance ObamaCare. Specifically, these MA cuts will help fund the expanded coverage of the uninsured in Medicaid.
The second involves health insurance companies renting out their contracted discount provider networks to private health plans known as either ERISA or Taft-Hartley Trusts. The insurance companies developed and maintain these contracted provider panels to service their own managed care products. Therefore, the rental of the network represents revenue that drops directly to their bottom line. As discussed above, these network contracts are traded by insurance companies across the country in an arbitrage like market.
 The Employee Retirement Income Security Act of 1974 (ERISA). These are health plans sponsored by employers.
2 The Taft-Hartley Labor Act of 1947 is officially known as the Labor-Management Relations Act. This legislation provides the basis for union based health plans.
Gibson is the president of Reflective Medical, a health care software
development company. Jennifer Gibson is an economist specializing in evolving
health care markets as well as a futures commodity trader specializing energy.
Reach him at email@example.com.
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2. In the News: The Incredible Deflation of Barack By Mortimer B. Zuckerman, Editor, US News, Posted January 21, 2010
The air is seeping out of the Obama balloon. He has fallen to below 50 percent in the poll approval ratings, a decline punctuated by his party's shocking loss in the Massachusetts special election. Why?
Barack Obama was undoubtedly sincere in what he promised, even if his promises were within the normal range of political exaggeration. The first trouble is that his gift for inspiration aroused expectations, stoked to unprecedented heights by his own staff, that he would solve the climate crisis on Monday, the jobs crisis on Tuesday, the financial crisis on Wednesday, the education crisis on Thursday, Afghanistan on Friday, Iraq on Saturday, and rest on Sunday. His oratorical skills were highlighted by the contrast with President Bush, who mangled words so much that his incoherence became, as Tina Brown wrote, "a metaphor for incompetence." Expectations were spurred, too, by Obama's recognition that Americans yearned for a new kind of politics, a rejection, as he put it, of "politics as usual."
Perhaps the inevitable outcome was disappointment—and on this Obama has not disappointed. Alas, he has accelerated the deflation of hope with his extraordinary volume of public appearances. In his first six months, he gave three times as many interviews as George W. Bush, four times as many prime-time news conferences as Bill Clinton, and more interviews than both combined: 93 for Obama and 61 for his two immediate predecessors. He appeared on five Sunday talk shows on the same morning, followed the next day by David Letterman, the first-ever presidential appearance on a nighttime comedy show. In another week, he squeezed in addresses to the U.S. Climate Change Summit, the U.N. General Assembly, the U.N. Security Council, and a variety of press conferences.
His promiscuity on TV has made him seem as if he is still a candidate instead of president and commander in chief. He—and his advisers—have failed to appreciate that national TV speeches are best reserved for those moments when the country faces a major crisis or a war. Now he faces the iron law of diminishing novelty.
Despite this apparent accessibility, Obama's reliance on a teleprompter for flawless delivery made for boring and unemotional TV, compounding his cerebral and unemotional style. He has seemed not close but distant, not engaged but detached. Is it any wonder that the mystique of his presidency has eroded so that fewer people have listened to each successive foray? The columnist Richard Cohen wryly observed that he won the Pulitzer Prize for being the only syndicated columnist who did not have an exclusive interview with the president.
Poor results. But Obama's problems are more than a question of style. There is doubt aroused on substance. He sets deadlines and then lets too many pass. He announces a strategic review of Afghanistan, describing it as "a war of necessity," only to become less sure to the point that he didn't even seem committed to the policy that he finally announced. As for changing politics in Washington, he assigned the drafting of central legislative programs not to cabinet departments or White House staff but to the Democratic congressional leadership of Nancy Pelosi and Harry Reid, the very people so mistrusted by the public. Who could be surprised that the critical bills—the stimulus program and healthcare—degenerated under a welter of pork and earmarks that had so outraged the American public in the past?
Pelosi benefited from $54 million to relocate a Bay Area wine train, not to speak of a secret deal with the drug industry lobby to preclude negotiations on Medicaid drug prices and exclude drug imports from Canada, concessions that had previously been strongly rejected by Obama. Reid favored the gambling industry by arranging an earmark for a Los Angeles-to-Las Vegas high-speed monorail, even though it won't be built for years. Some components of the stimulus did help soften the recession, yet only roughly a third of the $787 billion stimulus has been spent, and too much was spent on programs supported by liberal Democrats, which explains why so much of the stimulus money went toward education, health, energy conservation, and other activities, mostly worthy but not geared to achieving recovery and getting people back to work.
Taxpayers have thus come to see politics as usual masquerading as economic recovery. Indeed, both the stimulus and were voted on so quickly that the lawmakers had no time to read the bills. In both cases, the White House created the impression it was interested in passing anything, no matter how ineffectual. This was epitomized by Obama's chief of staff essentially asserting that a healthcare bill would be passed even if all it consisted of was two Band-Aids and an aspirin.
Most critically, Obama misjudged the locus of the country's anxiety: the economy. Instead of concentrating on jobs, jobs, jobs, he made the decision to "boil the ocean" and go for everything, from comprehensive health reform to global warming to a world without nuclear weapons ... and the beat goes on.
This was more than the Congress could absorb and more than the country could understand. Obama, the theoretician in a hurry, made no allowance for the normal resistance to dramatic change and the public's distaste for big government, big spending, and big deficits. He didn't seem to realize that Americans understand in the most personal terms that excessive debt has real consequences, given how many have that exceed the value of a home and credit lines that are too much to carry. Yet this was what the president seemed to be getting us into. Over 60 percent of the country believes that government spending is excessive; Obama's lowest approval ratings come from his mishandling of the present and future deficits.
Delayed stimulus. It is not as if the limited stimulus program has done the job either, since unemployment rates soared over 10 percent (compared with the 8 percent ceiling that was promised). Shelby Steele asked a good question in the Wall Street Journal: "Where is the economic logic behind a stimulus package that doesn't fully click in for a number of years?" Yes, we might have just escaped a depression, but as the Economist magazine observes, voters will not thank the president for averting a depression that did not come but are "more likely to blame him for the recession that did." On top of all this, and not all Obama's fault, a financial crisis usually produces weak recoveries in jobs, so a good number of Americans are likely to remain furious at the spectacle of the financial world doing well while so many ordinary folks lose their jobs and their savings. This anger will not subside while households see net worth slump to where it was 20 years ago and debt reach close to record highs at about 130 percent of disposable , and while the residential real estate crisis continues unabated and the official jobless rate doesn't come close to reflecting the true extent of unemployment and ... and ... and ....
The White House might have at least demonstrated that it cares about fiscal restraint and independence from the leadership in Congress, but consistently Obama has failed to veto spending while centralizing power. A majority of Americans think it a mistake at this time of economic distress to embark on a costly healthcare program. As it was, the program's apparently stalled trip through Congress turned out to be another fiasco of political corruption, with millions of dollars allocated to buy votes, such as those of Louisiana Sen. Mary Landrieu and Nebraska Sen. Ben Nelson. Anger with that process and the bill it produced helped fuel the stunning election of Republican Scott Brown in Massachusetts.
The result is a widespread concern that progressive taxation to pay for the "nanny state" will snuff out future opportunities that Americans believe they deserve for themselves and their children. Obama misjudged the public's appetite for taxpayer-funded solutions; most people believe all the government does is waste . In a recent NBC/Wall Street Journal poll, only 23 percent said they "trusted the government just about always or most of the time"—the smallest proportion in 12 years, and the all-important independent swing voters who decide elections now favor Republicans by 52 percent, up from 30 percent.
Unfortunately, there is not much solace in international affairs either, where, again, expectations were so pumped up. America's image is better, no doubt, but uncertainty and procrastination prevail. One major international political leader recently put it well: "Not only does the leadership of this region not think that Obama is strong enough to confront his enemies; they aren't sure he is strong enough to support his friends." The administration seems "hopelessly naive," according to one Arab foreign minister, and unable to face the full truth about Islamic terrorism. The public frustration over the administration's mismanagement of the latest jihadist attempt to blow up a plane with all its innocent travelers (on Christmas Day) was captured in the New York Daily News headline "Mr. President, it's time to get a grip!"
The consequence is that there isn't a single critical problem on which the president has a positive public rating. Only a minority of Americans now believe the president will make the right decisions for the country. Nor can he any longer take refuge in the rejoinder that "we inherited a terrible situation." Or blame it on fat-cat bankers and insurance companies. Blaming others, including Bush, for the country's predicament is less and less persuasive. "At some point you own your presidency," wrote Peggy Noonan in the Wall Street Journal. "At some point the American people tell you it's yours."
More worrying for the administration is that while Obama gets the approval of 76 percent of non-whites, his approval among whites is down to 41 percent, according to Gallup. This is a huge change that literally puts the Democratic control of Congress at risk. The Republicans have hardly been stellar either, but there is now a renewed openness in the country to hear what they have to say. Obama's political realignment of America is over. We no longer believe that he will "change the world" and "transform the country."
This brings to mind why an adviser to President Roosevelt in the 1930s, Bernard Baruch, told electors to vote for the person who promised them less. In this way, he said, "you would be less disappointed." There is still time for Obama to change and turn things around. But the first year is the critical year, one in which the public defines the president, and it has to be said that broad swaths of the country are deeply disappointed.
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NHS staff lack faith in quality of care, poll finds, By Nicholas Timmins, Public Policy Editor, FT, March 18, 2010
Many hundreds of thousands of patients are being treated in hospitals where at least 20 per cent of the staff have said they would not be happy with the standard of care if a friend or relative needed treatment, an NHS staff survey has found.
Yesterday's figures were described as "deeply worrying" by John Appleby, chief economist at the King's Fund health think-tank.
In the survey, between 300 and 400 staff at all NHS trusts were asked whether they agreed or disagreed with the statement: "If a friend or relative needed treatment, I would be happy with the standard of care provided." . . .
But at 17 NHS trusts and foundation trusts, roughly one in 10 of the total, more than 20 per cent of staff disagreed with the statement. At three of them, Scarborough, West Hertfordshire and Mid-Staffordshire NHS Foundation Trust, where the NHS inspectorate has said a patient died unnecessarily , more than a quarter of staff disagreed.
"That means a large number of patients, potentially millions, are being treated in hospitals at which a significant proportion of staff would not be happy to see their friend or relative treated," Prof Appleby said. . .
The NHS does not give timely access to healthcare. It only gives access to a waiting list for a hospital your doctor can't trust.
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Last September an Investor's Business Daily (IBD)/TIPP Poll showed 45 percent of doctors would consider leaving medicine if a health care takeover passed. A new poll has vindicated those findings, says IBD.
The IBD/TIPP questionnaire went out Aug. 28 to some 25,600 doctors nationwide; of that substantial sample, there were 1,476 responses:
· One hundred of those were retired, leaving 1,376.
· Of the physicians queried, 45 percent said they'd consider closing their practice or retiring early if the overhaul then being considered were enacted.
· Also, 65 percent said they opposed the government's attempts at taking over the health care system.
· Just 33 percent supported it.
Given that the White House and Congress both promised then -- as they do now -- to provide health care coverage for 31 million new patients while at the same time cutting costs from the $2.4 trillion a year we spend on medical care, the poll reveals that doctors won't go along with it, says IBD:
· Of the 800,000 physicians practicing in the United States in 2006, as many as 360,000 might leave the profession.
· So with the proposed overhaul, we'd be trying to cover 31 million more patients with up to 45 percent fewer doctors.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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Americans, including the commander in chief, need to realize that "more care is not necessarily better care," wrote cardiologist Dr. Rita Redberg, editor of Archives of Internal Medicine, in commenting on Obama's recent physical examination.
Too much cancer screening, too many heart tests, too many cesarean sections. A spate of recent reports suggests that many Americans are being overtreated. Maybe even President Barack Obama, champion of an overhaul and cost-cutting of the health care system.
The President's exam included prostate cancer screening and a virtual colonoscopy. The PSA test for prostate cancer is not routinely recommended for any age and colon screening is not routinely recommended for patients younger than 50. Obama is 48. A White House spokesman noted that earlier colon cancer screening is sometimes recommended for high-risk groups, such as African-Americans. . .
Doctors disagree on whether a virtual colonoscopy is the best method. . . Yet Redberg, a doctor with expertise in health policy, takes issue with that test and a heart scan to look for calcium deposits in the president's arteries. She said the calcium check isn't recommended for low-risk men like Obama . . .
"People have come to equate tests with good care and prevention," said Redberg, of the University of California at San Francisco Medical Center. "Prevention is all the things your mother told you - eat right, exercise, get enough sleep, don't smoke - and we've made it into getting a new test."
This week alone, a New England Journal of Medicine study suggested that too many patients are getting angiograms - invasive imaging tests for heart disease - who don't really need them; and specialists convened by the National Institutes of Health said doctors are too often demanding repeat cesarean deliveries for pregnant women after a first C-section.
Last week, the American Cancer Society cast more doubt on routine PSA tests for prostate cancer. And a few months ago, other groups recommended against routine mammograms for women in their 40s, and for fewer Pap tests looking for cervical cancer.
Experts dispute how much routine cancer screening saves lives. It also sometimes detects cancers that are too slow-growing to cause harm, or has false-positive results leading to invasive but needless procedures - and some risks. Treatment for prostate cancer that may be too slow-growing to be life-threatening can mean incontinence and impotence. Angiograms carry a slight risk for stroke or heart attack. . .
Dr. Peter Pronovost, a Johns Hopkins University patient safety expert, said routine testing is often based on bad science, or on guidelines that quickly become outdated as new science emerges.
The recent shift in focus reflects evolving research on the benefits and risks of screening.
While some patients clearly do benefit from screening, others clearly do not, said Dr. Richard Wender, former president of the American Cancer Society.
These include very old patients, who may unrealistically fear cancer and demand a screening test, when their risks are far higher of dying from something else, Wender said.
"Sometimes it's kind of the path of least resistance just to order the test," he said. . .
While many patients also demand routine tests, they're often bolstered by advertisements, medical information online - and by doctors, too, Welch said.
"To some extent we've taught them to demand these things," he said. "We've systematically exaggerated the benefits of early diagnosis," which doesn't always improve survival. "We don't always tell people there might actually be downsides" to testing.
Jennifer Traig, an Ann Arbor, Mich., author of a book about hypochondria, says patients like her often think, "I'm getting better care if we're checking for more things."
Traig has had many costly high-tech tests, including an MRI and several heart-imaging tests, for symptoms that turned out to be nothing. She thinks doctors were right to order those tests, but that counseling could have prevented her from "wasting resources" and getting tests it turned out she didn't need.
Patients seeking screening information have several online resources, including the National Institutes of Health, http://bit.ly/a8c7P0; the American Cancer Society, http://bit.ly/9w0fli; and a nonprofit advocacy group called the Foundation for Informed Medical Decision Making, www.informedmedicaldecisions.org/.
The new guidance from the cancer society last week on PSA testing, echoing others' advice on mammograms, is for doctors and patients to thoroughly discuss testing, including a patient's individual disease risks, general pros and cons of testing and possible harms it may cause. . .
Medical Gluttony thrives in Government and Health Insurance Programs.
Medical Gluttony is also prevalent in high places.
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Thursday, August 27, 2009
The phrase "death panel" does not actually occur in any of the proposed "health care reform" bills. MoveOn.org has seized on Sarah Palin's characterization of the outcome of "reform" in its mass email piece entitled "Top Five Health Care Reform Lies: and How to Fight Back":
"Lie #1: President Obama wants to euthanize your grandma!!!"
When asked about the end-of-life counseling provision at an AARP-sponsored "tele-town hall," Obama grinned and told the woman called "Mary": "I guarantee you, first of all we just don't have enough government workers to talk to everybody to find out how they want to die" (Judi McLeod, Canada Free Press 8/13/09).
This argument is a straw man.
In fact, neither the President nor cadres of government workers would be doing the job personally, and euthanasia is not being discussed. Rather, the bills "incentivize" doctors to "counsel" patients about "options"—which must include orders to withhold life-sustaining "treatment," such as food and water.
While signing a directive to withhold treatment or food and water, or to implement a "do not resuscitate" order, may be voluntary, suggestible patients may bow to white-coated authority, especially when the directive is presented to them to sign immediately. Vulnerable patients may be especially susceptible to guilt-provoking scenarios, such as being a burden on their families.
The counseling provision has been removed from one of the Senate bills, but many believe the enabling legislation for treatment denial is already law, in the Stimulus Package, as comparative effectiveness research. While proponents denied that there was any intention to turn this into cost-effectiveness research, an amendment to codify that reassurance into law was defeated. This "research" program is supposed to collect information on every medical visit by every patient for a national electronic database.
This is the infrastructure for a program like Britain's NICE (National Institute for Clinical Excellence), which determines the dollar value of a Quality Adjusted Life Year (QALY). NICE allows payment for treatments that cost less than that, and disallows treatments that cost more.
Doctors who want to violate the "voluntary guidelines" will likely have to appeal—to a body that is not called a "death panel" (Greg Scandlen, American Spectator 8/13/09).
What are the beliefs and principles of the leading reformers? Obama himself has said, "Maybe you're better off not having the surgery but taking the painkiller."
As Betsy McCaughey points out, prominent Administration advisor Ezekiel Emanuel, M.D., "believes that ‘communitarianism' should guide care. He says that medical care should be reserved for the non-disabled, not given to those ‘who are irreversibly prevented from being or becoming participating citizens.... An obvious example is not guaranteeing health services to patients with dementia' (Hastings Center Report, November/December 1996)" (NY Post 7/24/09).
More recently, Emanuel and others write that they "recommend an alternate system, the ‘complete lives system,' which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, saves the most lives, lottery, and instrumental value principles" (Lancet 2009;273:423-431).
This system "produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated."
Obama's regulatory czar Cass Sunstein, who will play a major role in defining government's role in controlling medical care, prefers the QALY formula (Joseph Ashby, American Thinker 8/15/09).
Seniors are worried. Having lost about 60,000 members, AARP is back-pedaling on its endorsement of the reform push (Wall St J 8/21/09).
It's not just seniors who are worried. There are also the 10 million American cancer patients whose access to expensive treatments may be cut off, as it routinely is in Britain. In addition, progress in treatments may stall because of the likelihood that new technology can never repay the cost of development (Wall St J 7/31/09).
The highly touted Oregon health plan already denies payment for advanced chemotherapy, but offers to buy physician-assisted suicide instead.
Then there's the "Death Book for Veterans," entitled Your Life, Your Choices. The primary author is Robert Pearlman, who in 1996 advocated for physician-assisted suicide before the U.S. Supreme Court in Vacco v. Quill, and is known to support rationing of medical care. The 52-page book presents choices in a way that steers users to predetermined conclusions, like a political "push poll." Withdrawn from the VA by the Bush White House, the book has been resuscitated by the Obama Administration. The only organization listed in the updated version as a resource on advance directives is Compassion and Choices (formerly the Hemlock Society). A July 2009 directive instructs VA primary physicians to raise advance planning issues, using this book, with all patients, not just the aged or debilitated (Jim Towey, Wall St J ).
An angry disabled Marine veteran shared his views at a recent town hall with Congressman Brian Baird.
Hospice Patients Alliance, led by Ron Panzer, is concerned that U.S. federal and state government are already trying to balance budgets by hastening deaths, without raising the issue of explicit euthanasia. In the UK, where euthanasia is illegal, continuous deep sedation (CDS) may account for as many as one in six deaths (BBC News 8/12/09).
Palin quotes NY State Senator Ruben Diaz, a Democrat, chairman of the Aging Committee: "Section 1233 of [H.R.] 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives" (Hawaii Free Press 8/12/09).
To the consternation of the Obama Administration and congressional Democrats, many Americans have shown up at tea parties and town halls with symbols warning about where that slippery slope has led before.
Daniel Greenfield observes the similarity in thoughts expressed by Dr. Ezekiel Emanuel and Dr. Hermann Pfannmüller, who stood trial at Nuremberg for his Starvation Hospitals for those he deemed unfit:
"The idea is unbearable to me that the best, the flower of our youth must lose its life at the front in order that feebleminded and irresponsible asocial elements can have a secure existence in the asylum."
Pfannmüller preferred the "simpler, more natural" method of starvation to poisons or injections, which might supply "inflammatory material" for the foreign press.
"[A]t the heart of the difference between socialized medicine and free market health care," writes Greenfield, is that "in the free market no one gets to class an entire category of people as "Life Unworthy of Life" (Canada Free Press 7/28/09).
Greenfield notes that it takes time for the consequences of changing from an individual to a collective morality to become manifest. "Most systems don't turn monstrous over the weekend. Even Nazi Germany took nearly a decade to follow through on to the logical conclusion...." (Canada Free Press 8/11/09).
General Dwight D. Eisenhower ordered extensive photographs of those consequences to be taken, predicting that in 60 years some would try to deny that the events ever happened.
Medical Myths Originate When Someone Else Pays The Medical Bills.
Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service.
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7. Overheard in the Medical Staff Lounge: Editor's Note: The newsletter is completed by Thursday. It may be passé on MedicalTuesday when you read it. On Sunday when the House votes, will the Freedom-loving Americans may be up in arms or give up?
Dr. Dave: It looks like we're down to the wire on the Health Care Enslavement debate.
Dr. Sam: It's absolutely amazing that Congress with less than a 25 percent approval rating and Nancy Pelosi with less than a 15 percent approval rating, would even be thinking of jamming this health care monstrosity down our throats.
Dr. Edwards: I really think she feels she's doing our country a service and those of us that deliver health care are a little thick skulled.
Dr. Paul: There are a lot of Americans that feel the way that Mrs. Pelosi feels. They genuinely feel that they are saving the uninsured from dying.
Dr. Sam: I frankly don't think she's smart enough to differentiate between being uninsured and being without care.
Dr. Paul: They are essentially the same.
Dr. Rosen: I don't know what Planet you came from Paul, but in this country since 1965, all the old folks are insured with Medicare and no one can fall between the cracks. And all the poor people in the bottom 12-15 percent are covered by Medicaid. All the retired and disabled vets are covered by the VA. And furthermore, all the disabled for two years or more are covered by Social Security Disability and Medicare. So we have a triple net and no one can fall through with untreatable disease.
Dr. Paul: In my pediatric practice, there are a lot of people that fall through the cracks or the net, if you wish.
Dr. Edwards: Not the poor or disabled.
Dr. Ruth: I can see Paul's perspective since a lot of my internal medicine practice would allude to the same thing. But if I spend some time talking about family and friends or follow them to their car, I find they are driving a late model automobile, they have several TV sets in their homes, they eat out in fine restaurants every week and live as well if not better than I do. They just don't think they can afford necessities such as health insurance. But they could.
Dr. Paul: But health insurance is not affordable by most Americans.
Dr. Rosen: I think Obama hit the nail on the head with the Cadillac coverage that may cost a thousand to 1500 dollars a month, which he wants to tax since no one needs that kind of coverage. I don't agree with taxing insurance plans, but everyone just needs a hospital and surgery plan just like the old days of Blue Cross for the hospital and Blue Shield for surgeons and inpatient doctor care for stroke and heart attacks.
Dr. Milton: I recently priced just such a plan and it came to less that $200 a month with a $500 deductible like I have on my car. Surely, these people that make $50,000 to $75,000 a year that the regressive politicians (frequently mislabeled as progressive) feel can't afford health insurance, should be able to afford such a plan out of there $4000 to $6000 income a month?
Dr. Rosen: So with the money you save from a $1500 per month policy to a $200 a month policy ($1300 savings) will certainly pay for a lot of $125 office visits, $50 ECGs, $40 CXRs, which is what Medicare pays me for these. And add $250 worth of lab tests such as cholesterol, PSA, mammograms per year, and one month's savings will pay for a year's worth of testing.
Dr. Sam: The subterfuge delivered to the public by Obama, Reed and Pelosi wasn't interested in a factual approach to health care.
Dr. Paul: Well, you might as well get use to it. We're going that way and you might as well enjoy becoming an employee of the government, just like every other union member. Then we'll have clout like the Public Employees Union or the Federal Employees Unions.
Dr. Dave: You're making a reasonable approach to the future. But the State has always treated these other Unions differently than the doctors' Unions, which as far as I can see have no clout.
Dr. Milton: Just reading the papers and seeing all those state workers making $175,000 to $250,000 a year for a 37.5-hour week makes me want to give up the fight for my patients. But then I could not live with myself.
Dr. Rosen: Not only would we be giving up the fight for our patients, but also the fight for Freedom in this country, something mankind has dreamed about for millennia but only experience for about two centuries.
The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
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Physicians can't support change if it puts them out of business By Dr. Margaret E. Parsons, Special to The Bee, Saturday, Mar. 20, 2010 | Page 13A
As a physician, I find myself awake at night – concerned not about a patient but rather all patients and about the future of medicine. I recognize fully that the rising cost of health care requires that there be modifications to the system and ways to reach those without access to care. The bills currently being debated in Congress are on balance very bad medicine that puts health care at risk in the near and more distant future.
I have had the great good fortune to practice medicine in my hometown in a long-established private practice of three doctors. I love caring for patients. However, I am not only a doctor – I'm also a small-business owner. I contribute to my community's financial health with more than a dozen employees. I have faced an environment of flat or decreased payment for services at a time when the cost to run our practice increases 10 percent to 20 percent a year due to government mandates and increasing requirements. In order to keep the "business" of my medical practice viable, I've continued to see more patients each day and stretch everywhere I can.
The current health reform bill proposes structures and regulations that will push those of us running medical practices beyond the over-stressed levels in which we already practice each day. One of our concerns is the Independent Physician Advisory Board. While this may sound like a "reasonable" idea by its title, it is not. It is an appointed group of 15 individuals who would be creating all future payment methodologies without congressional approval or public accountability. This single change puts the future of a physician's ability to run a practice at risk, and removes the balance of democracy that our wise forefathers laid out. And, due to a political side deal with the White House, hospitals will be exempt from this change. . .
Health care policy is too important to legislate behind closed doors and load up with sweetheart deals.
I can sadly predict that if this bill becomes law, in a few years it is likely many private practices will close. I would likely be forced to consider leaving my hometown and home state. Practicing here, I bear the burden of being in a high-tax state that is unfriendly to employers like me, with more regulation and lower payments than many other regions of the country.
California will also be forced to take on a tremendous Medicaid burden to meet the bill's requirements. To meet those, the California Legislature will be forced to cut education, transportation, and so much more. As a result, there will be a continued outflow of physicians from our state and a dismal ability to attract new physicians to care for Californians.
In case you doubt this prediction, you need look no further than MediCal – where physicians may be paid $13 to see a patient. At that rate, with overhead costs exceeding $50 per appointment, and even taking no wages for the physician's time, a physician loses roughly $40 for every patient seen. You can't make that up in volume . . .
Dr. Margaret E. Parsons is past president of the Sierra Sacramento Valley Medical Society and past president of the California Society of Dermatology and Dermatologic Surgery.
VOM Is Where Doctors' Thinking is Crystallized into Writing.
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Schindler's List by Thomas Keneally, Simon & Schuster, 1982, Touchstone edition, 1993.
LISTS are endless. Appointment LISTS. Grocery LISTS. Things to do LISTS. Life cannot go on without LISTS.
Joe Baltake, film editor at the Sacramento BEE, had his Oscar LIST which included Oskar SCHINDLER'S LIST. Seven OSCARS were indeed awarded . . . for the film "Schindler's List." . . .
Thomas Keneally, the author of the book Schindler's Ark (Simon & Schuster, 1982, Touchstone edition, 1993, with MCI cover of helping hands with Schindler's List of Jews typed across them), states in his Prologue, "This is a story of pragmatic triumph of good over evil, a triumph in eminently measurable, statistical, unsubtle terms." And then confesses, "It is a risky enterprise to have to write of virtue." As Terrance Rafferty states in his "New Yorker" review, this is staggering because "Schindler's List" is a true story about the Holocaust!
This Universal Studio film opens in color and changes to black & white showing two candles at a Sabbath observance and the announcement of September 1939, "Germany defeats Poland." Hitler forces the registration of 10,000 Polish Jews requiring them to wear a Star of David arm band. Thus the first LIST is made.
Enter Oskar Schindler, a German Catholic businessman, who seeks his fortune by buying a Jewish factory (Jews can no longer own factories) and employing Jews at a reduced wage, which, he argues, is better than the alternative.
We watch Jews being killed. A one armed machinist is shot in the head since he is not as productive. The Jews build their own labor camp. A graduate engineer points out a construction defect. The officer asks her for her rationale and then has her shot in the head. As she slumps, he gives the order to implement her recommended construction changes.
Schindler, wearing expensive clothes and accessories, mixes socially with the Nazi officers in a night club, orders expensive wines, gives expensive gifts and mixes with ladies expensively dressed. He has a maid, a mistress, and a secretary with whom he continues a liaison, while his wife remains in Moravia, Czechoslovakia. He persuades the officers into letting him have his own labor sub-camp--just in time before the rest of the ghetto is liquidated.
Spielberg, who directs the movie, is able to capture experiences and emotions on screen. As naked men and women run around in a circle beyond endurance to convince the doctors they can work and not go into the line of those with "lives not worth living." Women puncture their fingers to draw blood to give their cheeks a "healthy" color.
The hiding and escapes are graphic--behind walls, under floors, inside pianos, inside of mattresses; showing kids crawling through privy seat holes and hiding in the liquid feces; to sewer scenes with men crawling into man holes surrounded by dead bodies and leaving other man holes piled high with bodies. Probably the most chilling emotional sequence is when hundreds of women are herded into a "decontamination" concrete bin and the steel doors slam shut like steel prison gates. The women look up at the shower heads awaiting either cold water or lethal gas, when the curdling screams occur.
Oskar complains to the sadistic commandant, Amon Goeth, that his random killing of his workers for target practice is expensive to him by diminishing his work force. In his wine cellar he meets Goeth's Jewish maid who is freaked out from Goeth's random killing of a women working among other women. Schindler tries to comfort her by saying, "He shot the woman, one of many, because she meant nothing to him--neither pleasing him nor offending him. You mean something to him and so he won't kill you."
Later when Goeth makes advances to this Jewish maid, she's repulsed by her memory of his brutality and the consequences are shown graphically. A bullet through her cranium would have been more humane.
Once, Oskar is given a birthday gift by his workers and he gives a thank you kiss to the lady making the presentation. Later he finds himself in prison for violating a "Nazi Law" prohibiting kissing a Jew. His style and money gets him cleared.
But as LISTS go, mistakes are made. Schindler's list to take to his new factory near his home in Czechoslovakia finds only 800 arriving and 300 women end up at Auschwitz. The Nazi's apologize and offer to deliver 300 "fresh Jews." Schindler declines and states he wants his own 300. The Nazi commander says he shouldn't get stuck on names. Schindler puts a handful of diamonds on the desk. The Nazi cautions that Schindler could be hanged for this. Schindler responds that he has friends in high places. The Nazi states, "What I meant is that I'm uncomfortable with these on my desk," as he scoops them up into his pocket. Thereafter, Schindler's 300 Jews go by train herded like livestock up chutes into box cars as truck loads of other Jews are driven off for extermination.
Schindler's final speech is given to his 1100 workers in his factory as the Nazi guards with rifles fill the balcony. He tells his workers, "The War is over. At midnight you are free to look for your relatives in Poland. I don't think you'll find them. I'm a Nazi and will be a hunted criminal and will leave at 5 minutes after midnight. I will flee" He then turns to the guards and says, "They are all here. You can continue to be murderers or you can go home to your families." They looked at each other and slowly one by one they turn to go.
A Russian soldier arrives on horseback AND tells the Jews that they are liberated by Russia. He is asked, "Are there any Jews left in Poland?" He looks shocked. He then advises them it would not be wise to go east. He looks puzzled and then tells them, "It wouldn't be wise to go west either."
In the final black and white scene, Schindler's Jews walk across the countryside when it changes to modern color and the remaining Schindler's Jews coming across the countryside, each accompanied by the actor or actress who played their part in the movie, young boy helping the old man he played 50 years younger, young lady helping the old lady she played 50 years younger, each helping the real life survivors with their crutches or pushing their wheelchairs, as they pass by Schindler's grave (1908-1974) to pay their last homage to the man to whom they owe their lives.
Spielberg mentioned when he received the Oscar for Best Director that he hoped this film will facilitate teaching about the holocaust in all schools rather than to allow it to become a footnote in history. When this non-docudrama appears on Video Disk, I will acquire one for my personal film library and one for each of my two daughters and hopefully for each grandchild to remind us from time to time of the inhumanity of humans to humans.
This book review is found at www.delmeyer.net/bkrev_SchindlerLists.htm.
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Political analyst Tony Quinn noted that the Legislature's public approval rating had fallen to 16 percent in a recent Field Poll.
Why would we trust these untrustworthy politicians with anything important?
Why are public schools so costly?
The Kansas City school board is closing nearly half of the district's schools in a desperate bid to stay afloat. The board's 5-4 decision Wednesday night means 29 out of 61 schools will shut down at the end of the school year. . . The plan, proposed by Superintendent John Covington, also will eliminate about 700 of 3,000 jobs, including 285 teachers. . . Covington's move comes after decades of dropping enrollment but few efforts to reduce buildings or staff. Over the past 40 years, enrollment has dropped from more than 75,000 students to about 17,500. Read more . . .
To maintain the same overhead after three-fourths of their business disappeared could only happen in a government bureaucracy. That's why Private Schools cost less than Government Schools.
Close down government one day every week.
Governor Arnold Schwarzenegger may have found the answer to the state budget deficit. With all state workers on furlough three Fridays a month, give all state workers a furlough every Friday and keep the 20 percent pay cut permanent. All state offices would then be on a four-day week at 80 percent of their prior pay, which would make that their permanent pay. We can do without government every Friday, Saturday and Sunday.
I'm sure we won't miss any public services in a four-day week.
Close down the US Postal Services two days every week.
That would also be a perfect plan for the US Postal Services. Make every Friday and Saturday a furlough day and save 33 percent of salaries. We can adjust to a four-day postal week.
What a way to get the post office efficient and in the black.
Let's close down Congress one day every week and cut the cost of government by 20 percent.
Why don't we carry out this concept to an even more cost-effective solution? Congress can still pass far too many laws during a four-day week. But that would be a nice start to cost control.
Neither your freedom nor your money is safe as long as Congress is in Session.
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• John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to www.delmeyer.net/hmc2004.htm and scroll down to the second article.
• Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .
• PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.patmosemergiclinic.com/ To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .
• PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.
• FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser's view on today's health care problem: In today's proposals for sweeping changes in the field of medicine, the term "socialized medicine" is never used. Instead we hear demands for "universal," "mandatory," "singlepayer," and/or "comprehensive" systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this "nationalized financing" or "nationalized health insurance." In a more honest day, it was called socialized medicine.
• Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."
• Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25–50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com.
• Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/pages.asp?pageid=13237. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.
• Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to http://www.healthplanusa.net/madeleine_cosman.asp to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.
• David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. Read his "Lessons from the Past." For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/articles/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/articles/DGHealthCareInflation.htm.
• ReflectiveMedical Information Systems (RMIS), delivering information that empowers patients, is a new venture by Dr. Gibson, one of our regular contributors, and his research group that will go far in making health care costs transparent. This site provides access to information related to medical costs as an informational and educational service to users of the website. This site contains general information regarding the historical, estimates, actual and Medicare range of amounts paid to providers and billed by providers to treat the procedures listed. These amounts were calculated based on actual claims paid. These amounts are not estimates of costs that may be incurred in the future. Although national or regional representations and estimates may be displayed, data from certain areas may not be included. You may want to follow this development at www.ReflectiveMedical.com. During your visit, you may wish to enroll your own data to attract patients to your practice. This is truly innovative and has been needed for a long time. Congratulations to Dr. Gibson and staff for being at the cutting edge of healthcare reform with transparency.
• Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.
• Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.
To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.
• Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.
• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives. He now has a new column with Richard Dolinar, MD, worth reading at www.thenewstribune.com/opinion/othervoices/story/835508.html.
• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: Beware of Taking Stimulus Money! "If you take their money, they'll tell you how wide to make the door," said W.R. Keith, seventh-grade math teacher, c. 1958, concerning federal aid to education. "When you extend your hand to take the money, that's when they put on the handcuffs," said Robert ("Jag") Jaggard, M.D., c. 1983, regarding Medicare and Medicaid. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read Disparities, Gaps, And Gleichschaltung. Gleichschaltung can be translated as "switching to the same track." Seldom appearing in German dictionaries before the 1930s, the term was generally used in the political sense to refer to the Nazi process of establishing control over all aspects of society - the arts, education, religion, and commerce. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. This month, be sure to read an excellent actuarial analysis by Gerry Smedinghoff: Is No-Fault Insurance a Viable Alternative to Our Professional Liability Insurance System? There are a number of important articles that can be accessed from the Table of Contents, including Dr. Huntoon's Editorial on the ultimate goal of the government's MACE (Medicare Acute Care Episode) attack and a number of excellent book reviews.
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"We are all faced with a series of great opportunities brilliantly disguised as insoluble problems." - John W. Gardner
"Life is not easy for any of us. But what of that? We must have perseverance." - Marie Curie: a pioneer in the field of radioactivity and a two-time Nobel Prize winner
"We can't think narrowly. We have to think in the biggest possible way." - Alice Waters: American chef and author
Some Recent Postings
Gibson & Gibson: The Day the PPO Died www.healthplanusa.net/articles/DGDayPPODied.htm
Gibson & Gibson: Managed Care Health Insurance Companies are in Deep Trouble www.healthplanusa.net/articles/DGManagedCareIns.htm
Fred Morrison 1920-2010
Inventor Spun Famous Toy Frisbee
Fred Morrison put his World War II experience as a fighter pilot to peaceful use by inventing what became known as the Frisbee.
Mr. Morrison, who died Tuesday at age 90, called his earliest flying disks "Whirlo-Way" and "Pluto Platter," to capitalize on the flying saucer craze of the 1950s.
But it wasn't until he licensed the invention to the Wham-O Manufacturing Co. in 1957 that sales took off. Wham-O rechristened the disks Frisbees and removed the flying-saucer-like portholes. Sales eventually reached the hundreds of millions, making it one of the most popular toys of the 20th century.
In the 1960s, the Frisbee became identified with the counter-culture and with movie stars like Richard Burton and Julie Andrews, who affirmed they were fans. The disks even inspired new sports, including Frisbee Golf and Ultimate.
"It is impossible to fathom the impact Fred Morrison has had on the world through the invention of such a simple object know as the Frisbee," said Kevin Givens, executive director of the World Flying Disc Federation. . .
On This Date in History - March 23
On this date in 1964, Dr. Martin Luther King, Jr, said, "We must learn to live together as brothers or perish together as fools." He was voicing what we must regard as the spirit that lies behind the observance today of World Meteorological Day, established by the members of the United Nations. Meteorologists and weather experts know that, regardless of lines of maps or walls that separate the nations, we are all sharing the same cycles of weather. The storm that starts in one country ends up in another; one land's heat wave is another land's drought - and so forth. Nobody yet has found a way of fencing in the air we breathe. Let us keep that in mind on World Meteorological Day - and all year long.
On this date in 1775, at the Virginia convention, a fire-breathing lawyer named Patrick Henry rose and spoke the words that generation after generation of Americans would remember as the heart of our national heritage: "Is life so dear or peace so sweet as to be purchased at the price of chains and slavery? Forbid it, Almighty God! I know not what course others may take, but as for me, give me liberty or give me death!" Do we say less today?
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