1.
Featured Article:
Can Government be Charitable to some without being Uncharitable to others?
2.
In the News: It is
extremely difficult to bring efficiency to a charity.
3.
International
Medicine: Ontario hospitals
refuse to be identified in report.
4.
Medicare: Does
Medicare Change the Benefit-Risk Equation?
5.
Medical Gluttony: Medicare
Regulations Cause Gluttony
6.
Medical Myths:
Health Care Spending In Africa Improves Health
7.
Overheard in the
Medical Staff Lounge: Senator Barrack Hussein Obama's Speech
8.
Voices of Medicine:
- Medical Staff Self-Governance - Strong Physicians, Better Hospitals
9.
From the Physician
Patient Bookshelf: DIETS DON'T WORK by Bob Schwartz, PhD
10.
Hippocrates &
His Kin: Politicians - Who Are the Ethical Politicians?
11.
Related
Organizations: Restoring Accountability in Medical Practice and Society
MOVIE EXPLAINING SOCIALIZED MEDICINE
TO COUNTER MICHAEL MOORE's SiCKO
Logan Clements,
a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the
truth about socialized medicine. Clements is the former publisher of
"American Venture" magazine who made news in 2005 for a property
rights project against eminent domain called the "Lost Liberty
Hotel."
For more information visit www.sickandsickermovie.com or email logan@freestarmovie.com.
* * * * *
1.
Featured Article:
Can Government be Charitable to some without Being Uncharitable to others?
Not Yours to Give by Davy
Crockett
In
this tale an unidentified narrator relates Davy Crockett's experience when he
was a member of Congress (182731, 18321835). The story is slightly condensed
from The Life of Colonel David Crockett compiled by Edward S. Ellis (Philadelphia: Porter &
Coates, 1884).
First
published as "A Sockdolager" in The Freeman, August 1961, "Not Yours to Give" has been a FEE
favorite for more than 40 years, second in popularity only to "I,
Pencil.". . .
One day
in the House of Representatives, a bill was taken up appropriating money for
the benefit of a widow of a distinguished naval officer. Several beautiful
speeches had been made in its support. The Speaker was just about to put the
question when Crockett arose:
"Mr.
Speaker - I have as much respect for the memory of the deceased, and as much
sympathy for the sufferings of the living, if suffering there be, as any man in
this House, but we must not permit our respect for the dead or our sympathy for
a part of the living to lead us into an act of injustice to the balance of the
living. I will not go into an argument to prove that Congress has no power to
appropriate this money as an act of charity. Every member upon this floor knows
it. We have the right, as individuals, to give away as much of our own money as
we please in charity; but as members of Congress we have no right so to
appropriate a dollar of the public money. Some eloquent appeals have been made
to us upon the ground that it is a debt due the deceased. Mr. Speaker, the
deceased lived long after the close of the war; he was in office to the day of
his death, and I have never heard that the government was in arrears to him.
"Every
man in this House knows it is not a debt. We cannot, without the grossest
corruption, appropriate this money as the payment of a debt. We have not the
semblance of authority to appropriate it as a charity. Mr. Speaker, I have said
we have the right to give as much money of our own as we please. I am the
poorest man on this floor. I cannot vote for this bill, but I will give one
week's pay to the object, and if every member of Congress will do the same, it
will amount to more than the bill asks." To read what
the vote was, please go to www.medicaltuesday.net/index.asp.
He took
his seat. Nobody replied. The bill was put upon its passage, and, instead of
passing unanimously, as was generally supposed, and as, no doubt, it would, but
for that speech, it received but few votes, and, of course, was lost.
Later,
when asked by a friend why he had opposed the appropriation, Crockett gave this
explanation:
"Several
years ago I was one evening standing on the steps of the Capitol with some
other members of Congress, when our attention was attracted by a great light
over in Georgetown. It was evidently a large fire. We jumped into a hack and
drove over as fast as we could. In spite of all that could be done, many houses
were burned and many families made houseless, and, besides, some of them had
lost all but the clothes they had on. The weather was very cold, and when I saw
so many women and children suffering, I felt that something ought to be done
for them. The next morning a bill was introduced appropriating $20,000 for
their relief. We put aside all other business and rushed it through as soon as
it could be done.
"The
next summer, when it began to be time to think about the election, I concluded
I would take a scout around among the boys of my district. I had no opposition
there, but, as the election was some time off, I did not know what might turn
up. When riding one day in a part of my district in which I was more of a
stranger than any other, I saw a man in a field plowing and coming toward the
road. I gauged my gait so that we should meet as he came up to the fence. As he
came up, I spoke to the man. He replied politely, but, as I thought, rather
coldly.
"I
began: Well, friend, I am one of those unfortunate beings called candidates,
and - '
"Yes
I know you; you are Colonel Crockett. I have seen you once before, and voted
for you the last time you were elected. I suppose you are out electioneering
now, but you had better not waste your time or mine. I shall not vote for you
again.'
"This
was a sockdolager . . . I begged him to tell me what was the matter.
"Well,
Colonel, it is hardly worth-while to waste time or words upon it. I do not see
how it can be mended, but you gave a vote last winter which shows that either
you have not capacity to understand the Constitution, or that you are wanting
in the honesty and firmness to be guided by it. In either case you are not the
man to represent me. But I beg your pardon for expressing it in that way. I did
not intend to avail myself of the privilege of the constituent to speak plainly
to a candidate for the purpose of insulting or wounding you. I intend by it
only to say that your understanding of the Constitution is very different from
mine; and I will say to you what, but for my rudeness, I should not have said,
that I believe you to be honest. . . . But an understanding of the Constitution
different from mine I cannot overlook, because the Constitution, to be worth anything,
must be held sacred, and rigidly observed in all its provisions. The man who
wields power and misinterprets it is the more dangerous the more honest he is.'
"I
admit the truth of all you say, but there must be some mistake about it, for I
do not remember that I gave any vote last winter upon any constitutional
question.'
"No,
Colonel, there's no mistake. Though I live here in the backwoods and seldom go
from home, I take the papers from Washington and read very carefully all the
proceedings of Congress. My papers say that last winter you voted for a bill to
appropriate $20,000 to some sufferers by a fire in Georgetown. Is that true?'
"Well,
my friend; I may as well own up. You have got me there. But certainly nobody
will complain that a great and rich country like ours should give the
insignificant sum of $20,000 to relieve its suffering women and children,
particularly with a full and overflowing Treasury, and I am sure, if you had
been there, you would have done just as I did.'
"It
is not the amount, Colonel, that I complain of; it is the principle. In the
first place, the government ought to have in the Treasury no more than enough
for its legitimate purposes. But that has nothing to do with the question. The
power of collecting and disbursing money at pleasure is the most dangerous
power that can be entrusted to man, particularly under our system of collecting
revenue by a tariff, which reaches every man in the country, no matter how poor
he may be, and the poorer he is the more he pays in proportion to his means.
What is worse, it presses upon him without his knowledge where the weight
centers, for there is not a man in the United States who can ever guess how
much he pays to the government. So you see, that while you are contributing to
relieve one, you are drawing it from thousands who are even worse off than he.
If you had the right to give anything, the amount was simply a matter of
discretion with you, and you had as much right to give $20,000,000 as $20,000.
If you have the right to give to one, you have the right to give to all; and,
as the Constitution neither defines charity nor stipulates the amount, you are
at liberty to give to any and everything which you may believe, or profess to
believe, is a charity, and to any amount you may think proper. You will very
easily perceive what a wide door this would open for fraud and corruption and
favoritism, on the one hand, and for robbing the people on the other. No,
Colonel, Congress has no right to give charity. Individual members may give as
much of their own money as they please, but they have no right to touch a
dollar of the public money for that purpose. If twice as many houses had been
burned in this county as in Georgetown, neither you nor any other member of Congress
would have thought of appropriating a dollar for our relief. There are about
two hundred and forty members of Congress. If they had shown their sympathy for
the sufferers by contributing each one week's pay, it would have made over
$13,000. There are plenty of wealthy men in and around Washington who could
have given $20,000 without depriving themselves of even a luxury of life. The
congressmen chose to keep their own money, which, if reports be true, some of
them spend not very creditably; and the people about Washington, no doubt,
applauded you for relieving them from the necessity of giving what was not
yours to give. The people have delegated to Congress, by the Constitution, the
power to do certain things. To do these, it is authorized to collect and pay
moneys, and for nothing else. Everything beyond this is usurpation, and a
violation of the Constitution.
"So
you see, Colonel, you have violated the Constitution in what I consider a vital
point. It is a precedent fraught with danger to the country, for when Congress
once begins to stretch its power beyond the limits of the Constitution, there
is no limit to it, and no security for the people. I have no doubt you acted
honestly, but that does not make it any better, except as far as you are personally
concerned, and you see that I cannot vote for you.'
"I
tell you I felt streaked. I saw if I should have opposition, and this man
should go to talking, he would set others to talking, and in that district I
was a gone fawn-skin. I could not answer him, and the fact is, I was so fully
convinced that he was right, I did not want to. But I must satisfy him, and I
said to him:
"Well,
my friend, you hit the nail upon the head when you said I had not sense enough
to understand the Constitution. I intended to be guided by it, and thought I
had studied it fully. I have heard many speeches in Congress about the powers
of Congress, but what you have said here at your plow has got more hard, sound
sense in it than all the fine speeches I ever heard. If I had ever taken the
view of it that you have, I would have put my head into the fire before I would
have given that vote; and if you will forgive me and vote for me again, if I
ever vote for another unconstitutional law I wish I may be shot.' . . .
"It was one of the luckiest hits of my life that
I met him. He mingled but little with the public, but was widely known for his
remarkable intelligence and incorruptible integrity, and for a heart brimfull
and running over with kindness and benevolence, which showed themselves not
only in words but in acts. He was the oracle of the whole country around him,
and his fame had extended far beyond the circle of his immediate acquaintance.
Though I had never met him before, I had heard much of him, and but for this
meeting it is very likely I should have had opposition, and had been beaten.
One thing is very certain, no man could now stand up in that district under
such a vote. . .
To read the entire article and how this election went,
go to www.fee.org/publications/notes/notes/notYoursToGive.asp?print_view=true.
Foundation for Economic Education
30 South Broadway
Irvington-on-Hudson,
New York, 10533
1-800-960-4FEE 1-914-591-7230
©2007 Foundation for Economic Education. All Rights Reserved.
www.fee.org/publications/notes/notes/notYoursToGive.asp
* * * * *
2.
In the News: It
is extremely difficult to bring efficiency to a charity.
Muhammad Yunus Subprime Lender By EMILY PARKER, WSJ, March 1, 2008 Queens,
N.Y.
In a Jackson Heights shop for colorful saris and
glittering bracelets, several women have gathered to meet with their banker.
They laugh and chat in Bengali. Sultana, a 39-year-old woman wearing a
headscarf, hands him $128 in cash. She is making her first repayment of the
$3,000, six-month loan she'll use to help with her husband's candy store.
Welcome to Grameen America, Muhammad Yunus's brand-new
microfinance venture. Mr. Yunus, along with his Bangladesh-originated Grameen
Bank, won the 2006 Nobel Peace Prize for battling poverty by lending out small
sums of money to the poor. The loans are mainly for income-generating
activities -- from making baskets to raising chickens. Since its establishment
in 1983, Grameen has given out billions of dollars in loans, helping to pull
families out of poverty and inspiring similar operations all over the world. To read more, please go to www.medicaltuesday.net/news.asp.
Mr. Yunus has now brought Grameen to this borough of
New York City. Since taking off in January, Grameen America has lent out a
total of $145,000, with interest rates at around 15% on the declining loan
balance. The money will be used for everything from taxi registrations to
sewing machines. I meet Josefina from the Dominican Republic, who has borrowed
money to buy women's accessories to sell.
Grameen works a little differently from your average
American financial institution. The Grameen banker comes to the borrowers,
either in their homes or businesses. Women borrowers take priority. There is no
need for collateral, credit-history checks, legalities or complicated
paperwork. Just credit, plain and simple. . .
Mr. Yunus, who cheerfully refers to his business as
"sub sub sub subprime," seems unfazed by the U.S. subprime mortgage
collapse and the various tightenings of credit that followed in its wake.
"If subprime cases are risky, Grameen cases are extremely risky," he
says. "Because not only are we poorest, [borrowers] don't have collateral,
they don't have guarantees, they don't have lawyers, nothing. How risky can you
get? Still, our money comes back." Grameen has claimed that over 98% of
their debts are repaid.
I mention that Mr. Yunus's way of doing business seems
like an "old-fashioned" notion of credit, which a few centuries back
was apparently closer to the Latin credere (to believe or trust). To
have "credit" in a community, for example, meant that you could be
trusted to pay back your debts.
"I use to say this in my speeches, in the early
days," he responds. "I said: look at the world, how funny it is. They
took the word credit which means trust, and built a whole edifice of credit
institutions, refined, very sophisticated, entirely based on distrust." At
Grameen, he says, "we went back to the original meaning of credit."
Mr. Yunus would argue that in making credit more
easily accessible, he is helping guarantee a fundamental human right.
"There are certain items that are listed as human rights: right to food,
right to shelter, right to work, right to health . . . but who are going to
implement those human rights?"
Some might say that government is responsible. But
"that doesn't mean that government has to bring a platter full of food
every morning to feed you, that's not what the government could do. Government
could not bring health care to every single citizen or work opportunity for
every single citizen."
Out of all the rights that he listed, Mr. Yunus says
he would put credit as No. 1. "If you agree that each case of receiving
microcredit is a creation of self-employment, then my argument is
self-employment creates income," he explains. "Income is the thing
which brings food. Income is the thing which creates the possibility of
shelter, home. And income is the best medicine."
The collapse of the American subprime market has not
shaken Mr. Yunus's confidence in credit. Rather, he blames the problem on
sloppy business techniques. "They have the collateral, they have the
lawyers, they have the entire legal system behind them . . . But they still
could not protect themselves. What does it say?" he asks. One, "it
says you didn't know how to do business . . . No. 2 . . . you got extra greedy.
You overstepped your territory." . . .
Why is Grameen's debt-repayment rate so high?
"Self-interest," is one reason. "For the first time, she has
been given this opportunity to make money, make an income. Now she has a
choice: she can pay back the loan so that she can continue with this door open
and she can move on step by step. Or she says, enough is enough, I'm not going
to pay back, I'm going to enjoy the money I got. What happens? The door gets closed."
Grameen, crazy as it may sound, "assumes that
every borrower is honest." But it does have ways to help ensure repayment.
Each borrower joins a group of people from similar social and economic
conditions, and the group approves the loan request of each member. In this
way, the group assumes "moral responsibility" for the loan.
Mr. Yunus's use of the female pronoun is not
accidental. He says Grameen Bank's borrowers are 97% women, the result of a
very deliberate policy. It all started when Mr. Yunus complained that
Bangladesh's banks weren't lending to women at all. "I was trying to show
in how many different ways conventional banking went wrong. So when I began I
wanted to make sure that I do not face the same complaint against me. So I
wanted to have 50% of my borrowers as women." . . .
After Grameen got to their desired level, 50% women
borrowers, "we started noticing that money going to the family through
women brought so much more benefit to the family than the same amount of money
going to the family through men . . . So at one point we said, forget about
50-50. Let's focus on women because it changes the family faster." . . .
Mr. Yunus's determination paid off. Grameen, in quiet
ways, is helping to empower women. "Every single of those seven-and-a-half
million borrowers," he says, has a "personal bank account, and they
are accumulating quite a significant amount for themselves." This
"immediately establishes ownership because she is the only one who can
withdraw money. This is her protected territory." . . .
In his new book, "Creating a World Without
Poverty," Mr. Yunus does just that. He defines social business as
"cause-driven" rather than profit-driven. And yet, it is not a
charity: Its owners are entitled to recoup their investments, and the social
business must recover its full costs, or more, even as it concentrates on
creating products or services that provide a social good. It does this by
charging a fee for its products and services. (One example: a business that
manufactures and sells low-priced, nutritious food products to underfed
children. Grameen America is also a social business.)
Mr. Yunus freely acknowledges that the free market has
done a great deal for the poor. "I didn't say that what is there is wrong.
I said the structure was not complete. One piece was missing. We couldn't
express within the business world all the things we want to do for
others."
He argues that in today's world, people whose main
ambition is to help those in need tend to be pushed into philanthropy, which
isn't always the most efficient way to bring about change. In philanthropy, he
says, the "dollar has only one life, you can use it once . . . social
business dollar has endless life, it recycles. And you build
institutions." He continues, "when it's an institution you bring
creativity into it. You bring innovations into it. You bring continuity into
it."
Mr. Yunus argues that it's extremely difficult to
bring efficiency to charity. But "the moment you bring in a business model,
immediately you become concerned about the cost, about the revenue, the
sustainability, the surplus generation, how to bring more efficiency, how to
bring new technology, how to redesign, each year you review the whole thing . .
. charity doesn't have that package.". . .
Mr. Yunus likes to tell a story of going into a
village and meeting one of his borrowers, whose daughter has risen to become a
doctor. "You look at the mother, that illiterate woman who borrowed money
to raise chickens, to buy a cow to send the daughter to school, and now she's a
doctor. And I get the question in my mind: the mother could have been a doctor
too," he says.
"The whole thing is about making those
opportunities available, so that they can change their lives."
To read the entire article, go to http://online.wsj.com/article_print/SB120432950873204335.html.
Ms. Parker is an assistant editorial features editor
at The Wall Street Journal.
* * * * *
TORONTO, ON - Most
Ontarians have no way of knowing if their local hospital is one of the best
performing in Ontario, or one of the worst.
A new study
released today by independent
research organization The Fraser Institute compares the performance of
Ontario's 136 acute care hospitals. But only 29 of the hospitals agreed to be
identified. To
read more, please go to www.medicaltuesday.net/intlnews.asp.
Stratford General
Hospital is the highest ranked of the hospitals that agreed to be identified,
finishing 19th. Stratford has ranked among the top 10 hospitals going back to
2002.
Anonymous Hospital
#10 is the highest
ranked hospital in Ontario and has been a consistent top performer, ranked
first or second since 2002. But its top administrators refused to let the
Fraser Institute divulge its name. The eight lowest-ranked hospitals also
refused to be identified.
These hospitals have consistently been among Ontario's poorest performing
hospitals.
"The hospitals
that agreed to be identified in this report should be commended. These
hospitals are obviously committed to their patients and the public by being
accountable
and transparent regarding their performance," said Nadeem Esmail, Director
of Health System Performance Studies at The Fraser Institute and co-author of
the Hospital Report
Card: Ontario 2008.
In the Institute's
2006 Hospital Report Card, 43 hospitals agreed
to be identified.
"It's
unfortunate that even fewer of Ontario's hospitals appear willing to embrace
the values of accountability and transparency, something I'm sure most people
in Ontario will find unacceptable."
www.fraserinstitute.org/commerce.web/newsrelease.aspx?nID=5200
To read the entire Hospital Report
Card: Ontario 2008 by Nadeem Esmail Maureen Hazel go to www.fraserinstitute.org/commerce.web/publication_details.aspx?pubID=5199.
Canadian Medicare does not
give timely access to healthcare, it only gives access to a waiting list.
--Canadian Supreme Court
Decision 2005 SCC 35, [2005] 1 S.C.R. 791
http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
* * * * *
4.
Medicare: Does
Medicare Change the Benefit-Risk Equation?
Hospital and Surgical Errors
or are they Just Poor Outcomes?
Sacramento had a recent case
of post-op, drug-resistant hip infection at one of the local hospitals. There
was a lot of unhappiness and resentment against the surgeon and the hospital.
The investigation indicated that all the sterile protocols were completed as
outlined. Mistakes, errors and sometimes poor outcomes just happen. But does
anyone go back to the decision-making process? Was this hip replacement really
needed? If it wasn't free with taxpayers' moneys such as Medicare, would the
patient have had it done? To read more,
please go to www.medicaltuesday.net/medicare.asp.
Most patients expect perfect
outcomes despite a list of possible bad results that they read, sign, and don't
believe will ever happen to them. What would put this in perspective? A
percentage co-payment. If a patient had to pay even 10 percent of the hospital
bill of, say $20,000, everything would be in perspective. "Is the pain and
suffering I'm experiencing worth the $2,000 I'll be paying for this
operation?" When I phrase it this way to patients asking the question, I'm
always surprised at the number that state the pain and suffering is not really
that severe and really doesn't interfere with activities significantly enough
to warrant the expense. "I'll wait a few years." At that time, the
risks and cost vs benefit ratio may be entirely different and the operation can
proceed with an entirely new perspective. An adverse outcome will become
acceptable considering the pain and suffering at that time.
With government medicine,
there is no benefit-risk ratio that reaches the level of consciousness.
Everyone expects a perfect outcome. It they are advised to have a surgical
procedure, they assume that is the only option. It is all benefit and the risks
are a fairy tale. The risks are written down, in their estimation, because
some government agency tells doctors and hospitals it must be done. "It
doesn't apply to me." Only when they have a stake in the procedure, not a
fixed dollar co-payment, but a percentage co-payment which forces them to have
a stake in the action from start to finish, will appropriate benefit-risks be
understood. It will never happen in universal health care. That's why health
care costs escalated with Medicare, Medicaid, Government sponsored HMOs, and
will skyrocket with Universal health insurance which will then ration care.
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Medicare Regulations Cause Gluttony
This week, we saw a patient who was convalescing
somewhat slower than he liked after being hospitalized with pneumonia. This was
attributed to his advanced age of 98. The nurse at the "board and
care" facility stated it was difficult supervising his self-care and he
needed to be transferred to a higher level of care. According to Medicare
Regulations, he had to be admitted to the hospital for three days and then sent
to an available nursing facility. For the admission diagnosis, they used the
previous diagnosis of bilateral pneumonia. This got everyone's attention and
intravenous infusions were quickly started. By the time the hospitalist got the
records put together, it was the third day and he was placed in a facility with
a higher level of nursing care. To read more,
please go to www.medicaltuesday.net/gluttony.asp.
The nurse seemed somewhat embarrassed when asked about
the need for these events and shrugged it off as Medicare regulations over
which neither she nor the hospital had any control.
On reflection, the mechanism became more apparent and
more illustrative. The diagnosis was needed to facilitate a major amount of
nursing care. Patients with antibiotic infusions can command thousands of
dollars more in charges over regular patients. They also require more
consultations, immediate x-rays and follow-up x-rays. This higher level of care
eliminates the personal physician from caring for this patient any longer since
the nursing facilities have their own physicians. These physicians are more
pliable to the home nursing program of the hospitals and are more easily
motivated to readmit and utilize other hospital services. They can send patients
to hospital emergency rooms knowing that a large number of unnecessary testing
will be accomplished to increase revenue of the hospital.
Mandates always increase health care costs. What is
not generally appreciated is that all mandates can be gamed for increased
revenue at taxpayers' expense and taxpayers will never be aware of the gaming
operation. We have to continue working towards eliminating all government
mandates and restore health care to the patients as advised by their doctors.
Then with a percentage co-payment, healthcare will again be in a Medical
MarketPlace competitive environment, which will reduce health care costs
astronomically.
* * * * *
6.
Medical
Myths: Health Care Spending In Africa
Improves Health
Health Alert: Saving
Africans from Limousine Liberals and People Who, Although Not as Rich as Barbra
Streisand, Think Just Like She Does; Part II.
My definition of a Hollywood
liberal is someone who believes you can solve all the world's problems without
knowing anything about economics.
(After all, who needs graphs and mathematical symbols, when all you
really need is love?) Unfortunately,
there are way too many people in health policy who think exactly the same
way. They not only resist the economic
way of thinking, they are actually resentful if anyone injects it into the
discussion. To read more, please go to http://www.medicaltuesday.net/myths.asp.
Consider health care
spending in Africa and suppose we had only $1,500 to spend. How should we spend it? Health economist estimate $1,500 would:
Treat
1 HIV positive person for one year.
Prevent
75 people from contracting polio, diphtheria, pertussis, and tetanus.
Treat
150 people with tuberculosis for one year.
Prevent
500 people from contracting tuberculosis each year.
Treat
1,500 people with intestinal worms for one year.
Treat
1,500 people with malaria for one year.
How can we choose among
these alternatives? A common technique employed by health researchers is to
measure the payoff from health care spending in terms of "years of life
saved," which is the number of extra years of life the health intervention
produces.
Sometimes the measurement is
expressed as "quality adjusted life years" or "disability
adjusted life years" (DALY) in recognition of the fact that the goal is
not simply to keep people alive, but to keep them alive and functioning as
healthy human beings.
If we want to maximize
health and well-being in Africa, we certainly would not start out focusing on
AIDS treatment. Consider the
anti-retroviral (ARV) drug treatment for AIDS - currently so popular among rock
stars and politicians. According to the
World Health Organization (WHO):
The
cost of ARV drug treatment for AIDS is $1,500 per DALY.
Yet
if this same amount of money were reallocated to immunizations we could save
214 years of life instead of one year for an AIDS patient.
Two and one-half times as
many Africans die from other preventable diseases as die from AIDS, including
measles, respiratory infections, malaria, tuberculoses, diarrhea and
others. Yet AIDS treatment competes
against these other health care needs.
And in drawing health resources away from areas where they are more
productive, AIDS treatment programs can cost more lives than they save.
If you're disappointed on
the health front, this is only the tip of the iceberg. In last week's Alert, www.john-goodman-blog.com/africaaids/, I noted that 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
spending made? International Monetary
Fund chief economist Raghuram G. Rajan and Arvind Subramian have done comprehensive
testing of a broad array of theories and found that there are no significant
effects (either positive or negative) of foreign aid on economic growth. Specifically:
It
apparently does not matter what aid is used for (health, social sector, technical
assistance, etc.).
It
apparently does not matter who gives the aid (multilateral donors, bilateral
donors, good donors, bad donors, etc.).
It
apparently does not matter to which countries the aid is given (those with good
policies and institutions, those with bad ones, etc.).
It
apparently does not matter when the hoped for impact is supposed to take place
(short term, long term, etc.).
So given this incredibly sad
and depressing record of massive failure on the part of government bureaucrats,
what's the next step for Hollywood?
Give the bureaucrats
complete control over the US health care system, of course. How could you possibly doubt?
To view the comments for
this blog entry:
www.john-goodman-blog.com/saving-africans-from-limousine-liberals-and-people-who-although-not-as-rich-as-barbra-streisand-think-just-like-she-does-part-ii/#comments
Cheers,
John Goodman, President
National Center for Policy
Analysis
12770 Coit Rd., Suite 800,
Dallas, Texas 75251
* * * * *
7.
Overheard in the
Medical Staff Lounge: Senator Barrack Hussein Obama's Speech
Dr. Wilson: Did you hear Senator Obama's wonderful
speech?
Dr. Sharon: I did and didn't think it so wonderful.
Never once did he distance himself from the supposed minister of "God is
Love" who spewed forth hate Sunday after Sunday.
Dr. Wilson: But he raised our level of consciousness
about the racial issue, don't you think?
Dr. Sharon: I think it may have made it worse. There
seems to be an increase in the racial divide as you now look at the polls.
Dr. Sam: Looking at the polls, did you note that if
the general elections were held today that McCain pulled ahead of Obama for the
first time? To read more, please go to www.medicaltuesday.net/lounge.asp.
Dr. Rosen: And Obama's share of the Democratic vote
dropped to 65 percent and McCain's percentage of the Republican vote increased
to 80 percent. That speech may be the best thing that has happened to McCain.
Dr. Sam: It really bothers me that Obama could listen
to those sermons of Hate for twenty years and still support his pastor.
Dr. Dave: And to make things even more interesting on
that side of the isle, Mrs. Clinton was forced to reveal her White House
records.
Dr. Edwards: But did you also note that she released
only 11,000 pages of the two million pages requested? What is she hiding?
Dr. Ruth: Peter Nicholas of the Los Angeles Times
reported today that the material she offered to show indicating she had been an
active first lady offered little support to her assertion that her White House
experience left her best prepared to become president.
Dr. Patricia: Well, I voted for her and I'm wondering
why I don't feel good about doing that?
Dr. Ruth: Maybe Peggy Noonan's comment that Obama gave
the thinking man's speech gives the answer.
Peggy Noonan wrote:
The speech assumed the
audience was intelligent. This was a compliment, and I suspect was received as
a gift. It also assumed many in the audience were educated. I was grateful for
this, as the educated are not much addressed in American politics.
Here I point out an aspect
of the speech that may have a beneficial impact on current rhetoric. It is
assumed now that a candidate must say a silly, boring line -- "And
families in Michigan matter!" or "What I stand for is affordable
quality health care!" -- and the audience will clap. The line and the
applause make, together, the eight-second soundbite that will be used tonight
on the news, and seen by the people. This has been standard
politico-journalistic procedure for 20 years.
Mr. Obama subverted this in
his speech. He didn't have applause lines. He didn't give you eight seconds of
a line followed by clapping. He spoke in full and longish paragraphs that
didn't summon applause. This left TV producers having to use longer-than-usual
soundbites in order to capture his meaning. And so the cuts of the speech you
heard on the news were more substantial and interesting than usual, which made
the coverage of the speech better. People who didn't hear it but only saw parts
on the news got a real sense of what he'd said.
If Hillary or John McCain
said something interesting, they'd get more than an eight-second cut too. But
it works only if you don't write an applause-line speech. It works only if you
write a thinking speech.
To read the rest of Peggy Noonan's Analysis, please go
to (subscription may be required). http://online.wsj.com/article/SB120604775960652829.html?mod=todays_us_weekend_journal
* * * * *
8.
Voices of
Medicine: A Review of Local and Regional Medical Journals and the Press
Southern California
Physician
Part 1 - Medical Staff Self-Governance - Strong Physicians, Better Hospitals By John Hill, MD
An introduction to the three-part series by John Hill,
MD, the physician who was at the center of a major medical staff-hospital
administration conflict.
With pleasure, I provide this introduction as a
preface to a series of articles devoted to medical staff issues and rights. As
one who has been in the vortex of a medical staff-administration maelstrom, I
cannot emphasize enough the importance of knowing your rights as medical staff
members and leaders. Equally important is constant vigilance in guarding and
protecting these rights.
In 2002, the medical staff of Community Memorial
Hospital in Ventura got a jarring reality check when we found that the
traditional role of our medical staff had been subverted by an aggressive and
controlling administrator and a complicit hospital board of directors. The
opening salvo in our crisis was fired when the administrator, for all practical
purposes, cashiered the entire hospital radiology department and replaced it
with unknown locum tenens physicians who were unable to provide the quality
services our patients had previously enjoyed. To read more,
please go to www.medicaltuesday.net/voicesofmedicine.asp.
When we approached our medical staff leaders about
this serious medical quality issue, we received another rude awakening. It was
immediately apparent that the administrator had been successful in co-opting a
significant component of the medical executive committee's leadership - and
that those leaders would not be of help in resolving this or subsequent
problems. We then started to explore our options, first by looking at our
medical staff bylaws. We were again jolted when it became obvious that our
bylaws had been neglected and corrupted. They were so inconsistent that we
couldn't even impeach our medical staff officers without their prior approval.
The medical staff, unfortunately, bore some
responsibility for the genesis of this meltdown. When this situation was
developing, it was a particularly difficult time for practicing physicians. We
were being bombarded by managed care, capitation and medical group
bankruptcies, as well as the alphabet soup of unfunded government mandates,
such as EMTALA and HIPAA. As a result, apathy regarding hospital involvement
had set in and medical staff participation played second fiddle to the economic
survival of our practices. The resulting vacuum provided fertile ground for the
administration's takeover of control from the medical staff. . . .
To read the rest of Dr. Hills' message, go to www.socalphys.com/article/articles/585/1/Part-1---Medical-Staff-Self-Governance---Strong-Physicians-Better-Hospitals/Page1.html/print/585.
To read other Voices of Medicine columns, go to www.healthcarecom.net/voicemed.htm.
To read other VOM columns that appeared in MedicalTuesday,
go to the archives and click on the VOM in any issue.
* * * * *
9.
Book Review: DIETS
DON'T WORK by Bob Schwartz,
PhD,
Breakthru Publishing, Houston, Texas, Third Revised
Edition, 149 pp, $12.95 © 1996, by Bob Schwartz, PhD, ISBN: 0-942540-16-6.
Diets and Exercise
For twenty years, Dr. Schwartz owned a chain of health
clubs across the United States. A large percentage of the people who came to his
clubs wanted to lose weight, and at the time, the answer seemed simple - just
exercise and stick to a diet plan and the pounds will roll off. As he studied
his clientele, he saw that many who went on diets and started an exercise
program in his clubs did not lose all the weight they intended. Almost all of
the ones who did lose, gained it right back - plus some.
Schwartz says that he personally never had a weight
problem, until he decided to experiment with his own weight and diets to
understand his clientele. Thereafter, the weight problem developed. To read more, please go to www.medicaltuesday.net/bookreviews.asp.
He tried one of the popular diets of the day. Losing
weight was easy initially. With his first diet, he felt as though his body told
him it didn't like what was happening. But after one week, he had lost eleven
pounds. When he went off the diet, he regained the weight he had lost. So he
had an excuse to try another of the 26,000 diets floating around.
Diets Don't Work
But with every successive diet, it took longer to get
the weight off. After every diet, the weight came back quicker and quicker.
Thus, he surmised that people couldn't wait to get off of their diets and
resume normal eating. Consequently, they regained their weight. Schwartz tells
how between the ages of thirty and forty, he personally lost over 2,000 pounds
using successive diets. But he also regained 2,001 pounds. Keeping it off
wasn't easy. So he concluded that Diets Don't Work.
He found that statistics bore this out. Out of every
200 people who go on any diet, only ten lose all the weight they set out to
lose. And of those ten dieters, only one keeps it off for any reasonable length
of time - a failure rate of 99.5 percent.
One morning when he couldn't find a pair of pants he
could button, he became desperate. He noticed that joggers were thin. That must
be the answer. "If you jog, you get thin." He considered buying a
jogging outfit and jogging shoes and start jogging east, like Forrest Gump.
Surely, by the time he reached New York he would be thin. Maybe he would
already be thin by the time he jogged through Kansas. He would then catch the
next plane home. But as he considered this option, he decided, "Jogging
wasn't the answer."
Schwartz studied every kind of diet and weight-loss
plan imaginable - including behavior modification, drinking light beer and diet
sodas, and eating diet foods. He talked with people who had gone to extreme
measures, including popping diet pills, taking shots and drinking liquid
protein. [One diet recommended shots of pregnant women's urine. The AMA advised
him not to sponsor that one.] They had meditated, been hypnotized, fussed over,
pleaded with, prayed for and starved. Some even had their teeth wired together
and staples put into their ears and stomachs. Nothing had worked.
No one had the answer to the problem of how to
permanently lose weight. Doctors didn't have it. Diet experts didn't have it.
Psychologists didn't have it. Members of the clergy didn't have it. Politicians
didn't have it.
There are lots of psychologists, doctors, diet
experts, and diet business owners and employees - the Diet Industry - who are
wondering what they'd do with their time if someone let out the secret that diets
don't work. . .
To read the rest of this review, go to www.healthcarecom.net/bkrev_DietsDon'tWork.htm.
For the health book reviews, go to www.healthcarecom.net/bkrev_Health.htm.
To browse the Physician/Patient Bookshelf, go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
* * * * *
10. Hippocrates & His Kin: Politicians - Who Are the
Ethical Politicians?
This being an election
year, we should be aware of the ethical lapses of our elected rulers. Judicial Watch,
the public interest group that investigates and prosecutes government
corruption, released its 2007 list of Washington's "Ten Most Wanted
Corrupt Politicians." The list, in alphabetical order, includes: . .
. To read who these scoundrels are and
what their scandals were, go to www.judicialwatch.org/judicial-watch-announces-list-washington-s-ten-most-wanted-corrupt-politicians-2007.
Any Surprises?
Barack Obama
"My friends, we live in the greatest nation in
the history of the world. I hope you'll join with me as we try to change
it."
Did that come out right?
Eating Candy
I observed a ward clerk at the nursing station reading
"Weight Watchers" as she devoured a "Babe Ruth." I guess
that keeps the scales balanced and the economy moving. It also contributes to
the epidemic in America - 60% of the population is overweight and 30% is obese.
We consumed 15% more calories in 1994 than we did in 1970 and today we dine out
twice as often. High school students are becoming obese and it's invading the
junior high school and grade schools.
If obesity was an infectious disease, we would call it
a national epidemic and a crisis.
To read more,
please go to www.medicaltuesday.net/hhk.asp.
MediCal Backlog Rises
A headline in this week's newspaper indicates that
there is an increasing backlog in MediCal, the government-sponsored Medicaid
program for poor people who can't afford health insurance. The United States
has had a superior safety net for health care than any socialized health care
country. We have no significant waiting beyond a few days. Our pharmacy
formulary exceeds what's available to the well-to-do in the European
Government-controlled health care systems, such as the NHS where the waiting
lists are routinely many weeks, months and sometimes years. But that may be
changing. California Medicaid now can take a few weeks to get approval. This
will be compounded when the MediCal reimbursement is reduced another 10 percent
on July 1, 2008, from the now average reimbursement of about 25 percent of the
usual and customary charges. In addition, payments will be delayed an extra
thirty days.
Looks like Americans are already experiencing the
reduced quality of Socialized Medicine.
Why are more doctors getting
out of the MediCal program?
As the MediCal reimbursement is decreasing to about
half of the average doctor's overhead costs, more are eliminating MediCal from
their practices. A few have an exclusive MediCal practice. How do they do it?
Doctors traditionally have given patients all the time they needed to complete
the evaluation of the medical complaint precipitating the office call. As the
government-sponsored HMOs have taken over, doctors are asked to see three
patients an hour if they previously saw two or four patients an hour if they
previously saw three. One HMO requests five patients an hour. As one wag put
it, I now have two doors in my examination room. I greet the patient at one
door; my writing desk has become an elevated counter to write prescriptions. I
try to keep the momentum going as I lead them out of the other door before my
nurse brings the next patient through the first door and I rush to the next
examination room.
MediCal practices see patients on a five- to
seven-minute basis to increase the volume to maintain a cash flow. There is one
physician who schedules private patients every fifteen minutes and MediCal patients
ever 7 ½ minutes.
If half of the doctors quit seeing MediCal patients,
that should increase the waiting lists to what the British and Europeans have
been experiencing for the past 60 years. Do politicians really see this as
Nirvana rather than lowering quality?
But then Politicians wouldn't recognize Quality if the "Cue" struck
them in the face.
To read more Medical Vignettes, please go to www.delmeyer.net/HMC.htm.
To read the Hippocrates Archives, please go www.healthcarecom.net/hhkintro.htm.
* * * * *
11. Physicians Restoring Accountability in Medical
Practice, Government and Society: