MEDICAL TUESDAY . NET

NEWSLETTER

Community For Better Health Care

Vol IV, No 24, Mar 28, 2006

 

In This Issue:



 

1.      Featured Article: The Essence of Americanism

Notes from FEE: In 1952, Leonard Read inaugurated a bi-monthly "four-pager," Notes from FEE. After several years on hiatus, it once again offers reflections on the freedom philosophy through short essays by FEE staff members, as well as selected lectures by FEE guest speakers. Notes from FEE is available to anyone upon request, free of charge. To receive this enlightening and relevant newsletter, please to go www.fee.org/publications/signup.asp?rcv_notes=Yes.

 

The Essence of Americanism by Leonard E. Read (18981983)

Someone once said: It isn't that Christianity has been tried and found wanting; it has been tried and found difficult - and abandoned. Perhaps the same thing might be said about freedom. The American people are becoming more and more afraid of, and are running away from, their own revolution. I think that statement takes a bit of documentation.

I would like to go back, a little over three centuries in our history, to the year 1620, which was the occasion of the landing of our Pilgrim Fathers at Plymouth Rock. That little colony began its career in a condition of pure and unadulterated communism. For it made no difference how much or how little any member of that colony produced; all the produce went into a common warehouse under political authority, and the proceeds of the warehouse were doled out in accordance with the authority's idea of need. In short, the Pilgrims began the practice of a principle held up by Karl Marx two centuries later: "From each according to his ability, to each according to his need" - and by force!

Now, there was a good reason why these communalistic practices were discontinued. It was because the members of the Pilgrim colony were starving and dying. As a rule, that type of experience causes people to stop and think about it!

And they did. During the third winter Governor Bradford got together with the remaining members of the colony and said to them, in effect, that this coming spring they would try a new idea: each individual has a right to the fruits of his own labor. And when Governor Bradford said that, he enunciated the foundation of private property as clearly and succinctly as any economist ever had. The next harvest was plentiful. Governor Bradford recorded that: "Any generall wante or famine hath not been amongst them since to this day."

It was putting those very principles of private property into action in this country that started an era of unprecedented growth. Sooner or later it had to lead to revolutionary political ideas. And it did lead to the American Revolution.

Up until 1776 men had been contesting with each other, killing each other by the millions, over the age-old question of which of the numerous forms of authoritarianism - that is, man-made authority - should preside as sovereign over man. And then, in 1776, in the fraction of one sentence written into the Declaration of Independence was stated this new idea, "that all men are created equal; that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the Pursuit of Happiness." That was it. This is the essence of Americanism, an idea which broke with the whole political history of the world. This is the rock upon which the whole "American miracle" was founded. This revolutionary concept was political in implicitly denying that the state is the endower of man's rights, thus declaring that the state is not sovereign.

It was economic in the sense that if an individual has a right to his life, it follows that he has a right to sustain his life - the sustenance of life being nothing more nor less than the fruits of one's own labor.

It is one thing to state such a revolutionary concept as this; it's quite another thing to implement it - to put it into practice. To accomplish this, our Founding Fathers added two political instruments - the Constitution and the Bill of Rights. These two instruments were essentially a set of prohibitions; prohibitions not against the people but against what the people, from their Old World experience, had learned to fear: over-extended government.

Benefits of Limited Government

The U.S. Constitution and the Bill of Rights more severely limited government than government had ever before been limited in the history of the world. And there were benefits that flowed from this severe limitation of the state.

First, there wasn't a single person who turned to the government for security, welfare, or prosperity because government was so limited that it had no power to take from some and give to others. Then where did people turn?

They turned where they should - to themselves. As a result of this discipline Americans developed an admirable quality of character that Emerson called "self-reliance." Second, when government is limited to the inhibition of the destructive actions of men, when it is limited to invoking a common justice - then there is no organized force standing against individual productivity and creativity.

This manifested itself among the people as individual freedom of choice. People had freedom of choice as to how they employed themselves. They had freedom of choice as to what they did with the fruits of their own labor. As a consequence the creative human energy was freed on an unprecedented scale. But something happened to this remarkable idea of ours, this revolutionary concept. It seems that the people we placed in government office as our agents made a discovery. Having acquisitive instincts for affluence and power over others they discovered that the force which inheres in government, and which the people had delegated to them could be used to invade the productive and creative areas in society - one of which is the business sector. They also found that if they incurred any deficits by their interventions, the same government force could be used to collect the wherewithal to pay the bills.

The Lengthening Shadow

I would like to suggest to you that the extent to which government in America has departed from the original design of inhibiting the destructive actions of man and invoking a common justice; the extent to which government has invaded the productive and creative areas; the extent to which the government in this country has assumed the responsibility for the security, welfare, and prosperity of our people is a measure of the extent to which socialism has developed here in this land of ours.

Now then, can we measure this development? Not precisely, but we can get a fair idea of it by looking at individual freedom of choice to use the fruits of one's own labor. Over a century ago the tax take of the government - federal, state, and local - was between 2 and 5 percent of the earned income of the people. It is now way over 35 percent and keeps growing. Many of my friends say to me, "Oh, Read, why get so excited about that? We still have, on the average, 65 percent freedom of choice with our income dollars."

True, on the average, we do have 65 percent freedom of choice with our earned income. But, please take no solace from this fact. Whenever the take of the people's earned income by government reaches a certain level - 20 or 25 percent - it is no longer politically expedient to pay for the costs of government by direct tax levies. Governments then resort to inflation as a means of financing their ventures. By "inflation" I mean increasing the volume of money by the national government's fiscal policy.

Governments resort to inflation with popular support because the people apparently are naive enough to believe that they can have their cake and eat it, too. Many people do not realize that they cannot continue to enjoy so-called "benefits" from government without having to pay for them. They do not appreciate the fact that inflation is probably the most unjust and cruelest tax of all.

What precisely is this disease that causes inflation and all these other troubles? It has many popular names, such as socialism, communism, state interventionism, and welfare statism. It has some local names: New Deal, Fair Deal, New Republicanism, New Frontier, and the like.

A Dwindling Faith in Freedom

If you will take a careful look at these so-called "progressive ideologies," you will discover that each of them has a characteristic common to all the rest: a cell in the body politic that has a cancer-like capacity for inordinate growth. This characteristic takes the form of a rapidly growing belief that the function of government is not to carry out its original purpose of inhibiting the destructive actions of men and invoking a common justice, but to control the productive and creative activity of citizens in society . . .

As this belief in the use of government as a means of creative accomplishment increases, the belief in free individuals - acting freely, competitively, cooperatively, voluntarily - correspondingly diminishes. Increase compulsion, and freedom declines.

Now then, why is this happening in America? I don't know all the reasons. I am not sure that anyone does. If pressed, however, for the most profound one, it would be this: we have forgotten the real source of our rights and are suffering the consequences. Therefore, the solution to this problem must take a positive form: the restoration of a faith in what free men can accomplish.

Leadership for Liberty

The important thing to realize is that ours is not a numbers problem. Were it necessary to bring a majority into a comprehension of the freedom philosophy, the cause of liberty would be utterly hopeless. Every significant movement in history has been led by one or just a few individuals with a small minority of energetic supporters.

The real problem, then, is developing a leadership, identifying and supporting individuals from different walks of life who care about, understand, and can explain liberty.

Let us personalize leadership.

The first level of leadership requires an individual to achieve that degree of understanding which makes it utterly impossible for him to have any hand in supporting or giving encouragement to any form of socialism whatever misleading labels and nicknames it takes.

This level of attainment requires no "original" thinking, writing or talking, but we should not underestimate the enormous influence set in motion by an individual who does absolutely no ideological wrong. His refusal to sanction or promote unsound actions and his faithfulness to free-market ideals - even if he is silent - has a radiating effect and sets high standards for others to follow.

The second level of leadership is reached when an individual achieves that degree of understanding and exposition which makes it possible for him to clearly explain the fallacies of socialism and the principles of freedom to those who come within his own orbit. Not only can such an individual interpret ideas conceived by others, but he also can conceive ideas himself. In short, he becomes a creative thinker, writer, and spokesman for liberty and the free market.

It is at this level that one's attitude toward others becomes of great importance. If the individual is patient until others are ready to listen and share his views, closed minds will open and become receptive.

The third level of leadership requires the individual to achieve that degree of excellence in understanding and exposition of the freedom philosophy that will inspire others to seek him out as a tutor.

I am not at this level but I am aware of it and know some of its imperatives. One imperative is the awareness that the higher the objective is, the more dignified the method must be. If we aspire to such a high objective as advancing individual liberty and the free market, we can resort to no lesser method than the power of attraction, the absolute opposite of using propaganda, indoctrination, and half truths. A good way to test how well one is doing on the objective we have in mind is to observe how many are seeking his counsel. If none, then one can draw his own conclusions!

The sole force that will turn indifference into acceptance is the power of attraction. And this can be achieved only if the eye is cast away from the remaking of others and toward the improvement of self. This effort demanded of each individual is not at all a sacrifice, but rather the best investment one can make in life's highest purpose.

Well, where can we find such individuals? I think we will find them among those who love this country. I think we will find them in this room. I think that one of them is you.

To read this edition of Notes, please go to www.fee.org/pdf/notes/NFF0106.pdf.

 

Raised on a Michigan farm, Leonard E. Read (18981983) became an entrepreneur and, eventually, General Manager of the Los Angeles Chamber of Commerce. His commitment to truth and to the principles of liberty led him to found the Foundation for Economic Education in 1946. For the next 37 years he served as FEE president and labored tirelessly to promote and advance liberty. He was a natural leader who, at a crucial moment in American history, roused the forces defending individual freedom and private property.

Read was the author of 29 books and hundreds of essays - including the classic "I, Pencil." His life is a testament to the power of ideas. As John Stossel of ABC News has commented, "Leonard Read said so much, so well, long before any of us began to try to think clearly about it."

When Leonard E. Read died, FEE received the following telegram from President Ronald Reagan: "We share your sorrow at the loss of a man whose dedication to our cherished principles of liberty burned brightly throughout his life. Our nation and her people have been vastly enriched by his devotion to the cause of freedom, and generations to come will look to Leonard Read for inspiration."

* * * * *

2.      In the News: Old Brains Don't Work That Badly After All, Especially Trained Ones By Sharon Begley, WSJ: March 3, 2006

Maybe I'm guilty of wishful thinking, but more and more research seems to be pointing to a rare bit of good news about aging: Old brains have gotten a bum rap.

Yes, some of the downbeat findings have stood the test of time. Older brains do process information more slowly, probably starting in middle age. As a result, they take a bit longer to make decisions or judgments, and to assimilate complex information.

Older brains are less nimble, too, taking longer to switch from one task to another. Since in "multitasking" you are actually switching among tasks - from driving to chatting to checking the tailgater - in split-second jumps, loss of agility means old brains don't handle simultaneous tasks as well.

But as scientists reassess old results, even findings that have achieved iconic status are being questioned. For one thing, neurons don't abandon ship. "It used to be thought that normal cognitive decline occurred because of loss of neurons throughout the brain," says Marilyn Albert of Johns Hopkins School of Medicine. But new techniques show that most regions hold on to their neurons (and even 70-year-olds produce new neurons), with little to no loss in the hippocampus, where memories form, or the frontal cortex, site of such executive functions as planning and judgment.

One problem with studies comparing old and young brains is that old brains are different not only because they have been around longer. The lives their owners lead are different. The elderly tend to have fewer new experiences, be less physically active and socially engaged, and live in less complex environments. All of these impair the production of new neurons and the maintenance of neural circuitry.

"The trouble with retirement is, there are not a lot of social or intellectual demands," says research psychologist Denise Park of the University of Illinois at Urbana-Champaign. "Life becomes routinized," a recipe for cognitive decline. Some of the decline attributed to aging may therefore reflect not aging per se but factors much more within people's control . . .

The younger brains, as a group, had better recall. More telling, their activity differed. Shown a face, there was higher activity in the "face-seeing" area and little in the "place" area. Shown a scene, the pattern of high and low activity switched. Most of the older brains, though, showed activity in both regions when trying to recall either a face or a scene, suggesting difficulty repressing distractions.

"It suggests they were not filtering out irrelevant information," says neurologist Adam Gazzaley of the University of California, San Francisco, who led the 2005 study, published in Nature Neuroscience.

But one-third of the older volunteers did just as well as the younger adults and, intriguingly, showed the same pattern of focused brain activity. Apparently, trouble inhibiting irrelevant information and blocking distractions, which impairs short-term memory and reasoning, is not as inevitable as had been thought.

What makes these older brains look young? One possibility is training. Attention and focus are top-down functions, in that the prefrontal cortex orders regions that see or hear to pay attention to important stuff and ignore the rest. Top-down activity seems to be among the most trainable mental functions . . .

Yet in a study published online last month in Neurobiology of Aging, Dr. Erickson and Illinois' Arthur Kramer found that old brains can be trained to act like young ones . . .

"This suggests that the brains of older adults remain relatively flexible, able to alter brain circuits in response to training," says Dr. Erickson.

Yes, brains age. But their ability to remake themselves and respond to training is undeniable.

To read the entire article, go to http://online.wsj.com/article_print/SB114133840568987991.html.

You can email Sharon Begley at sciencejournal@wsj.com.

I've missed much of my life worrying - spending it in the shopping mall of my imagination.

* * * * *

3.      International Medicine: From The Economist: Karl Marx's Copybook - Economic Nationalism

PATRIOTISM, said Samuel Johnson, is the last refuge of a scoundrel. That may be unfair to the proper sort of patriot, but it would be an entirely valid comment about politicians today who make a fuss about foreign takeovers in their countries, in the name of "national interests". The truth is that they are not defending their nations' interests at all. They are defending their own interests and (often) those of their cronies.

From the point of view of those who favour open markets for goods, services and capital it is possible to see these political reactions as good news, not bad (see article). They imply, first of all, that there are a lot more cross-border mergers and acquisitions going on than before, notably in Europe, as otherwise there would be nothing to complain about. They may also imply that other refuges of political scoundrels aren't as useful as they once were: trade barriers are hard to erect, especially within the European Union but also more widely thanks to the World Trade Organisation, and the use of public spending to rescue or "create" jobs runs up against state-aid rules, budget-deficit limits and the awkward practical fact that such subsidies don't work for very long. The forces of globalisation, moreover, look much stronger than the measures currently being deployed against them. . . .

What is affected, however, is the ability of governments and of individual politicians to use patronage at favoured (sic) firms to help their friends, to get favours (sic) in return, to support special interests such as trade unions, and, in broad political terms, to paint themselves as patriots. Consumers aren't helped, living standards don't rise, the nation as a whole is not better off. But the political and corporate elite may well be.

www.economist.com/opinion/PrinterFriendly.cfm?story_id=5575262

We enter the world seeking to be loved and settle for power instead.

The power of governmental medicine is the ultimate human destructive force.

* * * * *

4.      Medicare: Medicare Follies By Luther F. Cobb, M.D., President, Humboldt-Del Norte County Medical Society

At last, Medicare is making the head lines. Not because it is ratcheting physicians into the round with declining reimbursements, but because of the ridiculously perverse Medicare drug plan. While this is indeed unfortunate for Medicare beneficiaries, it at least has the virtue of bringing to the attention of the electorate the crises impending in the program.

 

It may be unfair to criticize a political football for being a political football, but the sad truth is that this program has, ever since its inception, been subject to the will and whims of the political class. Originally a shining centerpiece of Lyndon Johnson's Great Society, it has been reworked into just another pork barrel political vehicle, used to reward those who help the ruling politicos, and punish those who don't (or can't). The Part D drug "benefit" is just a really sad example of how this works. The concept of providing prescription drug support for Medicare beneficiaries is certainly a worthy goal, with many logical arguments, which support the concept. Anyone interested in preventive medicine can see the logic of forestalling an acute illness by managing it medically, as an outpatient, and avoiding an expensive hospitalization.

Meanwhile, practicing physicians were getting the short end of the stick, in a big way. Way back in the Sixties, when Medicare was born, its advocates argued that the only thing that would change would be "the signature on the check." Medicare would, and in fact did, at the beginning simply pay billed charges. Imagine that! However, it was soon discovered, as the cost soared from its initial beginnings as a small part of the Social Security program to being the dominant player in the entire health care reimbursement market, that this was a really, really large amount of money, and a large commitment, on the part of the Federal government. And, as is unfortunately the case with any government program, there arrived scammers and vultures, sadly including some physicians, that took advantage of the system to rip it off. Enter the bean counters and fraud-and-abuse guys. Enter DRG's, RBRVS, and most egregiously SGR, the "Sustainable Growth Rate." This truly awful idea noted that the cost of providing physician services to Medicare patients was increasing each year, at a rate greater than the rate of growth of the economy as a whole. Never mind the fact that the population was aging, the proportion of people in the Medicare age groups was increasing (including the increasing number of people, like those with AIDS or chronic renal failure, that became Medicare beneficiaries regardless of age). Never mind that increasing technology made care better, more sophisticated, and safer---but more expensive. Nope. The cost of Medicare was going up, and by golly we'll do something about that! On the assumption that if reimbursement for medical services was decreasing we canny doctors would find some clever way around that, the SGR tied physician reimbursement to the annual change in the Gross National Product! It's about as logical as tying the level of funding for relief for hurricanes to the amount of corn produced annually in Kansas.

What this means, of course, is that reimbursement is set to go down. Way down. Like about 30% over the next six years. . . .

Unfortunately, the only leverage on Capitol Hill that we as practicing physicians have is the discontent of the electorate. And to be effective, this has to be orders or magnitude greater than the lobbyists, because it's really hard to mount an effective grassroots campaign. And, also unfortunately, the only way to make the electorate (our patients, in essence) discontented is to make it much harder, or impossible, to get health care. This or course goes against all our ethical sensibilities, as we went into clinical medicine in the first place to help people and improve their lives. It is our own ethical standards and professionalism that are being used to undermine us, which I think is the dirtiest trick of all.

To read the entire article, please go to

www.humboldt1.com/~medsoc/images/bulletins/FEBRUARY 2006 BULLETIN for web.pdf.

To read about a Medicare Drug Plan that would have market forces keep expenses in check, go to www.delmeyer.net/hmc2005.htm.

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

- Ronald Reagan

* * * * *

5.      Medical Gluttony: Why Can't I have Another MRI?

An airline steward developed a severe headache enroute to Washington, DC. He was given an MRI of his head, which revealed a sinus infection. He was not treated and returned to Sacramento, suffering from the right retro-orbital frontal headache for six more hours.

He came in with his MRI report indicating ethmoid sinusitis. He was given anti-microbial and decongestant therapy and seemed to have fully recovered, including resolution of his headache. He said he would like another MRI just to see if it was clear. He was told that a routine sinus film would indicate that, and it would be considerably cheaper. He said that cost would be no object because he was fully insured.

He was reminded that health care costs were spiraling out of control and I would not be part of a 400% increase in cost. He said that he was entitled to it by his employer, the airline, having paid the premium. Since the discussion wasn't solving the issue, we finally brought the lengthy discussion to a close by telling him he would have to change doctors if he insisted on gouging his employer and the insurance company.

The insurance industry places physicians in the position of policemen and judges by keeping their product outside of market place restraints. If the co-payment were percentages, the patient would have made the decision as to whether he wanted to pay 30 percent of a $300 MRI or 30 percent of a $100 sinus film. Perhaps since he was now well, he would not insist on any procedure simply to satisfy his curiosity. In fact, the follow-up MRI probably would have noted some residual chronic sinus thickening that would never go away. However, being that it was abnormal may have led this patient on a goose chase of a series of MRIs and other useless medical intervention.

Although, he had left very unhappy, I think I gained his ultimate respect and he has become a faithful and reasonable patient. But he still doesn't read MedicalTuesday. Real understanding does take time.

* * * * *

6.      Medical Myths: No Health Insurance Equals No Health Care

To some politicians the terms "no health care" and "no health insurance" are interchangeable. The conventional wisdom among health experts across the ideological spectrum is that people need health insurance to get good health care. Almost as widely accepted is the view that some health plans deliver better health care than others. But the new study shatters those assumptions:
- Among people who seek care (actually see a doctor), there is virtually no difference in the quality of care received by the insured and uninsured.
- There is also very little difference in the care provided by different types of insurance - Medicaid, managed care, fee-for-service and so forth.
Just in case you haven't been following the bidding, there are probably a hundred studies that have claimed to find that uninsured people get less health care than the insured. Almost all of them are bad studies. But the one or two that are methodologically sound failed to distinguish between people who seek care and those who do not. That distinction is crucial.
In Lives at Risk, we observed that among people who seek care in Dallas County, there is no observable difference between the care received by the low-income insured (mainly Medicaid) and the uninsured. We hypothesized that this was probably true nationwide. The NEJM study confirms that conjecture. 
What are the implications?
The entire Medicaid program (at a cost of $1,000 per person for every man, woman and child in the country and a huge crowd out of private insurance) is predicated on the conventional wisdom that being insured matters. Now we know that what really matters is seeing a doctor. Two deterrents are rationing by waiting and physician fees. Both hurdles could be overcome with funded health savings accounts. 
Another conventional wisdom is that the uninsured need sky-is-the-limit coverage just like the United Auto Workers. But since the low-income uninsured have few assets to protect, why do people with modest means need such expensive coverage? They don't. A scaled down plan could give them ample choice of doctors and allow entry into the system for much lower premiums.
John Goodman, National Center for Policy Analysis, 12770 Coit Road, Suite 800, Dallas, Texas 75251 Phone: 972.386.6272; Fax: 972.386.0924. To read the analysis at the NCPA, please go to www.ncpa.org/newdpd/dpdarticle.php?article_id=3060.
To Read the NEJM entire article, please start at http://cdhc.ncpa.org/file_download/2.
Medical Fact: Health Insurance Does Not Improve Healthcare, Seeing A Doctor Does.

* * * * *

7.      Overheard in the Medical Staff Lounge: But Doctor, She Doesn't Qualify for the ICU

Dr Yancy, a general surgeon, was discussing his 85-year-old MediCal patient on whom he had just done a cholecystectomy - urgent removal of a gallbladder. He was called by a nurse administrator and told that his patient did not meet their criteria for ICU placement. Dr Yancy disagreed and asked "Whose criteria?" He was told it was the MEC (Medical Executive Committee) and she would call them in. He stated that he felt the patient needed ICU coverage and if she were to be moved to the general surgery floor, the MEC doctor would have to write the order and take the responsibility.

Dr Yancy stated that this phone call was interrupted by an emergency page from the ICU. His patient was in VTach (Ventricular Tachycardia which can lead to Ventricular Fibrillation, a form of cardiac arrest frequently leading to death.). The patient was immediately treated and survived to discharge. Had the patient not been in the ICU, she very likely would have sustained a cardiac arrest and death.

In Bureaucratic Medicine, Medical Decisions Are Frequently Made For Non-Medical Reasons.


I Want My Carpal Tunnel Surgery Now.

One of my RN patients wanted medical clearance for bilateral carpal tunnel surgery. As with many RN's, with bedside nursing diminishing, the deskwork and computer work is increasing. She did a lot of keyboard work. She was cautioned to rest her hands on a cushion placed in front of the keyboard. She did not feel any improvement over a couple of weeks and wanted to move forward to surgery. Although she was advised to use a more medical approach for another two months, she had the surgery done anyway.

About six months after surgery, she came to the office for treatment of her asthma. She casually remarked that she now wished she had followed my medical recommendations. The tingling in her hands improved while she was off work and recurred after returning to the keyboard. She got better by using a softer cushion and kept her wrists off of surfaces.

Sometimes Simple Medical Treatment Is Much Better Than Complicated Ones.


You Mean That My Ergonomic Chair Is Bad For Me?

A state employee was complaining of numbness in her fourth and fifth fingers in both hands. This is the distribution of ulnar neuropathy. Since this occurred on both sides simultaneously, it suggested a new event in her working life. She had been issued a new ergonomic chair with her last promotion. It had armrests, which her former work chair did not.

She was advised to remove both armrests to eliminate the pressure on her elbows. Although she couldn't initially believe that this sophisticated chair, for which she was eligible because of her status with the state, could possibly be at fault, she was convinced to go without the comfort and prestige of armrests. After three months, she said the numbness in her lateral two fingers was totally resolved.

The Benefits of Status Can Sometimes Be Detrimental To Your Health And Well Being.

* * * * *

8.      Voices of Medicine: Is there a fix for U.S. Medicine? by Ron A Virmani, MD

For thousands of years, medicine was variously practiced as black magic, witchcraft and a form of art. Starting with the renaissance, it became more of a science over a period of many centuries. Here I am referring to Western medicine, specifically the U.S. brand of medicine. A completely new phenomenon took place in this country in the 1960's and 70's. Medicine became big business. Fueled by unparalleled technological advances and human greed both at the same time, the scope and cost of medical system shot through the roof.

Nobody paid any attention to this phenomenon at that time. The concepts of resource limitations and fiscal discipline did not exist. Medical insurance companies wrote generous checks, always with a smile. Doctors, drug companies, hospitals and anybody associated with medical system made oodles of money; some would call it obscene. Human organs were taken out of people's bodies by the millions and lab tests were ordered all as a lucrative business. The lawyers got on the gravy train by suing physicians. There was some awakening when medical insurance costs started soaring and malpractice insurance became high. Government and managed care industry stepped in to check this runaway process in the 1980's.

But the system is still spiraling out of control today. Forty five million Americans lack basic health insurance. Physicians in many states are quitting medical practice because they can not afford the malpractice insurance costs. Some are paying more than $200,000 this year in malpractice premiums. Let me quote from a poignant letter from one Dr. Herman Solomon, of Wichita, Kansas, who decided to retire recently, in the American Medical News, published by AMA: "Even in my dreams, I did not think that I would not be working now, but the nightmares of Medicare and managed care awoke me. Now that I am almost 65, my biggest concerns are about personal care for me, my family and the general future population. Our system is broken. Managed care hasn't solved our problems, and I don't expect the federal government to fix them either".

Contrast that despondent tone with the happy faces of 24-year old graduates of pharmacy schools, who are getting job-offers for $90,000 this year, plus all benefits and signing bonuses too! Also by comparison, a pediatrician (MD), who is about 30 years old after 4 years of sleepless medical school and 3 years of grueling residency, may get a $60,000 salary.

How did we get into this mess? A main reason for the state of medicine today is an empty think tank of the past. This essay is intended to provide some fuel for this tank. To read the essay, please go to www.delmeyer.net/hmc2006.htm.

* * * * *

9.      Book/Cinematic OpEd Review: After Innocence

Does Innocence Matter? An OpEd Review by James J Murtagh, M.D.

 

Warning: movie spoiler alert. If you have not seen After Innocence, consider seeing the film before reading further.

[Note:James Murtagh has spent 20 years as an Intensive Care Unit physician at a major Southeast hospital. Murtagh is also a founder of the medial ethics consulting group "Team Integrity." Murtagh recently chaired a congressional forum "The Health Integrity Project," as reported in Time Magazine in collaboration with Tom Devine at the Washington "Government Accountability Project."]

 

69% of Americans in a 2004 Harris poll supported the death penalty. However, 0% would support the death penalty for the innocent accused.

Why then is the death penalty a hot-button in the culture wars? No one is deterred by the execution of innocents. Both conservatives and liberals must abhor the unbridled power of Big Brother to execute the innocent.

Every American needs to see the film "After Innocence," depicting seven men found guilty beyond a shadow of a doubt. They lived for years and decades on death row, could have been executed, but instead were found completely innocent.

Most wrongly convicted are minority and poor, but not all. Nick Yarris spent 23 years behind bars, some in brutal solitary confinement, forbidden even to speak, and on death row, for a murder he did not commit. DNA testing proved his innocence. Upon his release, he was given no money, no training, no therapy. And no apology.

Even a policeman and an Army sergeant can be wrongly convicted by brothers in blue. Scott Hornoff, a white former Rhode Island policeman, served 6 years for murder and was freed only after the real killer confessed.

More than 175 wrongly convicted persons have been set free since 1992. A landmark Department of Justice study estimates a 5% failure rate in the U.S. justice system, suggesting as many as 100,000 falsely convicted prisoners. Other reports place the estimate as high as 10%.

Most shocking, innocents remain in prison for additional years due to mindless system brutality, even after iron-clad DNA exoneration. Prosecutors, embarrassed by exonerations, actually declare on film that "the finality of the system," "closure for the victims" and "expediency" is more important than the actual guilt or innocence of the convicted.

Many prisoners are filmed counseled by psychologists to accept their guilt and move on. The goal of prison officials is to break the prisoners' spirit. Shades of the "re-education room 101" where Winston Smith famously learned to "love Big Brother" in Orwell's "1984."

Growing up, we believed America's justice was the envy of the entire world. Can we credibly preach human rights and democracy while torture is part of not just our system in Guantanamo, but also in New York? Can faulty middle east intelligence surprise us when we cannot discover (let alone correct) the errors of our own police departments?

To paraphrase George Bailey, not "every heel" (or every evil-doer) is overseas working with the enemy.

"The Exonerated," a predecessor to "After Innocence," has already shown the powerful possibilities of art based on fact bringing social justice.  Former Illinois Gov. George Ryan Ryan saw a special performance in Dec. 2002, and was so moved that he commuted the sentences of 171 inmates on death row.

New balance is needed in our popular culture. Americans love "lock ''em up, throw away the key, make my day, Hasta la vista," films. But can we handle the truth? Should we presume people are "scumbags" before being proved innocent? Can we forgive the brutal police of NYPD Blue because they appear to get results? In reality, our constitution and due process work better than short cuts. Due process keeps citizens safer, as well as protect rights.

Years ago, popular culture icon Perry Mason freed the innocent. "The Fugitive" ran from the awesome power of the state to find the true killer.

When Court TV shows heroes cutting corners, Americans believe justice in the end is done. But how would we feel about a cop threatening "make my day" to an innocent? Or NYPD Blue's Sipowicz  "putting a beating"  to torture an innocent to confess falsely?

Could any innocent look down the barrel of Dirty Harry's 44 Magnum without falsely confessing?

Was Andy Dufresne from the "Shawshank Redemption" pure fantasy? Was the Jim Crowe-wrongly convicted Tom Robinson from "To Kill a Mockingbird" ancient history?

What is rare is the courage of the real-life Andy Dufresnes. The exonerated are really fighting for the rest of us. No one can feel safe in a society that convicts innocents. For every person wrongly convicted, an actual criminal goes free to terrorize other citizens. Tony Soprano remains free while Dufresnes is framed. Enron criminals manufacture the California energy crisis and remain jail free while Tom Robinson hangs himself. Famed criminal justice reformer Frank Serpico should have been made NYPD chief instead of being exiled.

No one wants to fear the knock on the door, "After Innocence," shows the exonerated are a unique resource in improving our system to make prosecutions more just and our society more safe.

The time has come not just for a moratorium on capital punishment, but also for a moratorium on this corner of the culture war.  Until we can be sure that the system is error-free, both conservatives and liberals must agree that the innocent have a right to life, and must not be put to death.


James J. Murtagh Jr., 511 Calibre Woods, Atlanta GA 30329
Tel- 404 633 9715 - Cell- 404 786 1915;
jmurtag@mindspring.com

 

Other movie reviews written by Dr. Murtagh can be accessed from my DelMeyer.net web site.

* * * * *

10.  Hippocrates & His Kin: Saying Goodbye Is Such a Pleasant Thing

My uncle Otto was widowed in his mid sixties. He had several lady friends that he took dancing but took a particular liking to Betty, whom he eventually married. He invited us over to meet her and it was obvious he was quite fond of her. However, she had one habit he just hated. She had to smoke a cigarette after lunch and dinner. So one day, he told her he just had to know, "Do you smoke after sex?"

She replied, "Well, Otto, I don't rightly know. In fact, I don't think that I've ever looked."

Well, they must have worked things out rather well. About fifteen years later at Uncle Otto's funeral, Aunt Betty remarked to my wife, "Otto was such a vital man right up to the end. You know, just the night before he died, he made love to me. It was just so wonderful the next day, as he drew his last breath, he had such a sweet and peaceful smile on his face."

What A Way To Go


Doctors' incomes continue to fall. The current estimate is that after paying over $180,000 in expenses, we make about $150,000 for our 3000-hour year, which is about $50 an hour. About the same as the "handy man" that fixed the skylight and ceiling in my office. Except we had to have an extra 12 years of higher, professional, and postdoctoral education to allow us to make this humongous hourly wage.

What A Way To Make A Living

To read more medical vignettes, please to go www.healthcarecom.net/hhkintro.htm.

* * * * *

11.  Restoring Accountability in HealthCare, Government and Society:


 

                      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.healthplanusa.net/AE-AreYouReallyInsured.htm. "On March 3, 2006, we got word that the Prime Minister of Antigua and Barbuda has signed our letter giving us 90 days to come up with the means to utilize their brand new 200+ bed hospital. He has indicated that he recognizes our compassionate and comprehensive approach to health care and our desire to see the healthcare of the people of Antigua & Barbuda enhance in the process. Our mission will be to bring uninsured people to the island for high quality, low cost surgery utilizing US physicians who are willing to live there for travel there for 2-4 weeks stays. Physicians will be paid a fair price for their services, and enjoy a beautiful resort environment at the same time." You may want to start planning to take a month each year to practice in this resort environment, or even buy a medical timeshare. Their medical board includes John and Alieta Eck, MDs. To read the rest of the proposal, please go to www.zhcenter.org/custom.asp?id=188800&page=3.


 

                      PATMOS EmergiClinic - www.emergiclinic.com - where Robert Berry, MD, an emergency physician and internist practices. "Three years ago, I left ER medicine to establish a primary care clinic in a town of about 15,000 in northeast Tennessee - primarily for the uninsured, but also for anyone willing to pay me for my care at the time of service. I named the clinic PATMOS EmergiClinic - for the island where John was exiled and an acronym for "payment at time of service." I have no third party contracts...not commercial, not Medicare, TennCare or worker's compensation. My practice today has over 4,000 patient charts. My patients are typically between 5-50 years old, but I do have a significant number of Medicare patients. A year ago, over 95 percent of the patients I saw had no insurance. Today, that figure may be 75 percent. But even those with insurance learn a simple lesson when they come to me: health insurance does not equal healthcare, at least not at my clinic. I clearly tell my patients how much a visit will cost. Everything is up front and honest. I will prepare a billing claim for my patients with insurance, for a small fee, but I expect them to pay me when I see them. Because I need only one employee in my office, my costs are low. For the same services, I charge about 60 percent of charges made by other local clinics, 40 percent of what the local urgent care clinic charges and less than 20 percent of what the local ER charges. I am the best bargain in town. If I can do it, caring for the uninsured in a small rural town, any doctor can. To read more on Dr Berry, and take a look at his professional feels and laboratory and pharmacy charges, please click on fee schedule on the left sidebar at www.emergiclinic.com/.

                      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. Ever have a blinding migraine and couldn't even drive to see a doctor? Dr Huntoon even makes house calls. Canadian patients are welcomed. Such a deal.

                      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" at www.northernurology.com/articles/healthcarereform/administrativectomy.html.

                      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 2550 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/Liberty_Solutions.htm. 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, President Medical Equity, 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 www.healthplanusa.net/MPCosman.htm 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. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.

                      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. To read Dr Chalifoux' review of how hospitals were able to obtain absolute power to review, punish, suspend and terminate physicians using procedural due process and not substantive due process, go to www.semmelweis.org/bio_chalifoux.htm.

                      To attend the annual meeting of the Semmelweis Society in Washington, DC, May 7-9, 2006, go to www.semmelweissociety.net/ and click on May Meeting. To read the entire agenda on Where is it Safe to Practice, go to www.semmelweis.org/meeting agenda 2006.pdf.

                      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, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at www.newsmax.com/pundits/Medicine_Men.shtml. This week's column is on "MediTrans: A Transportation Entitlement For Seniors and can be read at www.newsmax.com/archives/articles/2006/3/14/83810.shtml. So, why shouldn't everyone on Medicare have MediTrans, a new car at a 20 percent co-payment?

                      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 scroll down on the left to departments and click on News of the Day. The "AAPS News," written by Jane Orient, MD, and archived on this site, provides valuable information on a monthly basis. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents page of the current issue.

                      To Attend the 63d Annual Meeting of the AAPS, in Phoenix, AZ, September 13-16, please go to www.aapsonline.org/, your gateway to a vast amount of information.


 

* * * * *

Stay Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same.

Please note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.

ALSO NOTE: MedicalTuesday receives no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the twenty hours per week of writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country.

Del Meyer

Del Meyer, MD, Editor & Founder

DelMeyer@MedicalTuesday.net

www.MedicalTuesday.net

6620 Coyle Avenue, Ste 122, Carmichael, CA 95608

Words of Wisdom

John F Kennedy, inauguration, 1961: Let every nation know, whether it wishes us well or ill, that we shall pay any price, bear any burden, meet any hardship, support any friend, oppose any foe to assure the survival and the success of liberty.

Pericles' funeral oration, 431BC: The whole earth is the sepulcher of famous men; and their story is not graven only on stone over their native earth, but lives on far away, without visible symbol, woven into the stuff of other men's lives. For you now it remains to rival what they have done and knowing the secret of happiness to be freedom and the secret of freedom a brave heart, not idly to stand aside from the enemy's onset.

Edward Langley, Artist 1928-1995: What this country needs are more unemployed politicians.

Some Recent Postings

Consumer-Driven Health Care: Are Health Savings Accounts the Answer? http://hiu.nahu.org/article.asp?article=1328&paper=0&cat=137

In Memoriam

Madeleine Pelner Cosman, PhD, JD, Esq:

http://www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html

On This Date in History - March 28

On this date in 1797, the first Washing Machine patent was issued to Nathaniel Briggs of New Hampshire. It took another three hundred years before electricity and human ingenuity produced our modern machines.

On this date in 1930, Constantinople became Istanbul. Name changes occur frequently just as St Petersburg became Leningrad. Names may be less durable than what's underneath.