1. Featured Article: Has the AMA forgotten its own mission statement and ethical code?

Why the AMA Wants to Muzzle Your Doctor, By Hal Scherz, MD, WSJ

Without the support of the AMA it is quite possible that the health-care reform initiative would have failed.

The American Medical Association (AMA) is putting the doctors of America on notice. A major cheerleader for ObamaCare, the organization is now trying to silence doctors who oppose it. It is time the American people understood what the AMA is really all about.

Last month, not long after a Florida urologist placed a sign in his door making it clear that patients who voted for President Obama were not welcome in his practice, the AMA issued the following statement: "[P]hysicians might reflect on how to properly balance their obligations as members of the medical profession with their rights as individual citizens who will be affected by reform. In particular, physicians may wonder whether it is appropriate to express political views to patients or their families." The statement goes on to say that while the AMA "supports the right of physicians to free political speech and encourages them to exercise the full scope of their political rights . . . physicians should conduct political communications with sensitivity to patients' vulnerability and desire for privacy."

Many doctors interpreted this as an attempt—albeit with verbal parachutes attached—to keep them from sharing their opinions about health-care reform with their patients. This position is troubling on many levels.

The AMA was not only a major supporter of ObamaCare but also an accomplice in its passage. Without the support of the AMA it is quite possible that the health-care reform initiative would have failed. So why the effort to silence other doctors? The AMA is not only worried about protecting this misguided legislation, it is worried about protecting itself.

In the weeks since passage of this 2,700 page bill, more and more of its policy land-mines have exploded, including rising insurance premiums and admissions of inevitable rationing. Not surprisingly, an increasing number of physicians have expressed alarm over the impact that the legislation will have on their patients. This growing opposition makes the actions of the AMA, which represents only 17% of the doctors in the U.S., look very bad.

It is essential to understand the primary reason the AMA stands alongside President Obama on health-care reform. The organization wants to protect a monopoly that the federal government has created for it—a medical coding system administered by the AMA that every health-care professional and hospital must use if they wish to get paid for the services they provide. This monopoly generates income of $70 million to $100 million annually for the AMA. That makes the AMA less an association looking out for doctors and more a special-interest group beholden to Congress and the White House. . .

Yet doctors who oppose ObamaCare have not relented. Passage of this bill has stirred in them long dormant political emotions. Doctors across the country are educating their patients about how ObamaCare will limit their freedom to make their own health-care decisions. There are 925,000 doctors in America and the average doctor has at least 2,000 patients, with many of us already asking our patients if we can take two minutes to discuss this bill with them. This terrifies Congress and the White House.

Did someone in Washington give the AMA the order to muzzle outspoken doctors? Could it be Democratic Congressman Henry Waxman, the Malibu coastline representative who calls businesses to appear before his Energy and Commerce Subcommittee if in abiding by securities laws they reveal the hidden costs of ObamaCare? Perhaps it was House Speaker Nancy Pelosi, who has staked her speakership on this bill?

The irony is that in supporting ObamaCare and trying to silence doctors the AMA has forgotten its own mission statement and ethical code: "[T]o help doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues." It is always medically ethical to tell patients the truth, which is what doctors are now doing by educating them about ObamaCare. . .

Dr. Scherz, a pediatric urological surgeon at Georgia Urology and Children's Healthcare of Atlanta, serves on the faculty of Emory University Medical School and is president and cofounder of Docs4PatientCare.
Printed in The Wall Street Journal, May 7, 2010,page A17

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2. In the News: White House payoffs to big labor are now routine

Joseph Rago writing in the Wall Street Journal's Political Diary e-newsletter:

White House payoffs to big labor are by now routine, though rarely are they this transparent: This week, Health and Human Services Secretary Kathleen Sebelius rolled out a new program that, scrubbed down, amounts to a slush fund for union health plans.

When Democrats realized that ObamaCare's approval numbers were sagging, they loaded the bill up with "early deliverables"—programs that would go into effect immediately, rather than the five or more years of delay used to hide the bill's true costs. One of those early deliverables was $5 billion in subsidies to early retirees aged 55 to 64 who incur annual health costs over $15,000.

Ms. Sebelius did her best to dress this reinsurance program up in a public-interest blanket, but many of the 3.3 million eligible retirees are ex-union workers who extracted generous benefits from some of America's most hardpressed industries. Businesses that doled out these unaffordable promises will be delighted with the federal handout, taxpayers less so. And also eligible are retired state and local public employees, as well as certain health-care trusts like one recently set up by the United Auto Workers, which has an estimated 30 cents in cash for every dollar of expected claims.

The subsidies will be distributed at Ms. Sebelius's discretion—no prizes for guessing which groups will be "certified." Indeed, an explicit stipulation of GM's health care agreement with the UAW was that GM would join the union in lobbying for a nationalized health care system to eventually transfer its obligation to taxpayers. . .

Printed in The Wall Street Journal, May 7, 2010, page A17

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3. International Medicine: International Trend Toward Self-Directed Care - Health Affairs Blog

Commentary by John C Goodman, April 09, 2010

Critics of consumer-directed health care often argue that patients are not knowledgeable enough and the market is not transparent enough for consumerism to work in health care. But a study by The Commonwealth Fund says there is an international trend toward self-directed care (SDC) and it is focused on a most unlikely group of patients: the frail, the old, the disabled and even the mentally ill.

In the United States, Medicaid "Cash and Counseling" programs - underway for over a decade - allow home-bound, disabled patients to manage their own budgets and choose services that meet their needs.

In Germany and Austria, a cash payment is made to people eligible for long-term care - with few strings attached and little oversight on how the money is used.

In England and the Netherlands, the disabled and the elderly manage budgets in a manner similar to Cash and Counseling in the United States.

Also in this country, Florida and Texas have SDC programs for patients with serious mental illness and the Veterans Administration has an SDC program operating in 20 states for long-term care and mental illness.

Further, it appears that we have barely scratched the surface in taking advantage of patient power opportunities.

Chronic Care. As I wrote at my blog and at the Health Affairs blog, the greatest potential in this area is in the treatment of chronic illness. Studies show that chronic patients can often manage their own care with results as good or better than under traditional care; and if patients are going to manage their own care, it makes sense to allow them to manage the money that pays for that care.

The British National Health Service (NHS) is already contributing to SDC budgets for muscular dystrophy, severe epilepsy, and chronic obstructive pulmonary disease. The NHS believes it is saving money in reduced hospital and nursing home costs. . . .

The advantage of empowering patients and families in this way are straightforward: lower costs, higher quality care and higher patient satisfaction.

Lower Costs. In Germany, long-term care patients are given 50% less than what would have been spent if they agree to manage their own budgets. In the Netherlands, spending is 30% less. In England, long-term care services purchased by individuals cost from 20% to 40% less than equivalent services purchased by local governments. In the Arkansas Cash and Counseling program, participants were given more than what Medicaid would have spent, but an 18% reduction in nursing home use reduced Medicaid's overall costs.

Higher Quality. In Arkansas, Cash and Counseling patients got 100% of their authorized hours of personal care, compared to only 70% for those in traditional Medicaid. In New Jersey, "mentally ill adults with physical disabilities...were less likely to fall, have respiratory infections, develop bed sores, or spend a night in hospital or a nursing home if they were directing their own personal care services." . . .

Higher Satisfaction. In the Netherlands, close to 80 percent of disabled and elderly participants who were eligible for long-term care services and opted for a personal budget had a positive assessment of the services they received, compared with less than 40% in traditional care. In England, 79% of those who employ a personal assistant were very satisfied with the care and support they received, compared to only 26% in traditional care. In the United States, satisfaction rates in the Cash and Counseling programs have hovered in the high 90 percentiles.

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

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4. Medicare: Taking Medicare Money can lead to Prison Time for Doctors

Why I Will Not Take Medicare Money or "How Russ the Plumber got Flushed"

By Jane M. Orient, M.D., Executive Director, AAPS, May 4th, 2010

My reason for not accepting government money is a letter dated Feb 4, 1974, the year I graduated from medical school. My father, who owned a small contracting business, thumb-tacked it over his desk, to remind him not to bid on government jobs.

The letter from Russ Plumbing Company, one of his best subcontractors, reads as follows:

"According to your government, the powers that be have decided that we have exceeded our allowable profits in 1972 at the rate of 1/13th of 1%. . .

Russ had been the low bidder on a government job—which he finished satisfactorily, on time, for the agreed-upon price. Things went unusually well, so he made more profit than expected. The government decided that he had made too much, and not only demanded a refund but also decided to audit all his private contracts. Auditors swarmed over his office. Productive work was shut down. Russ, who was a good plumber, a hard worker, and a decent, honest man, was ruined.

Where did the government get the authority to pass judgment on how much profit a plumber was allowed to earn? Apparently, it just assumed the power and proceeded to exercise it.

I posted a copy of Russ's letter on my wall also, and never accepted a government check after I stopped working for the Veterans Administration and went into private practice. Until 1990, many of my patients filed their own Medicare claims. Since then, the doctor has had to file the claims, even if they are "unassigned" so that the patient receives the check. His signature on the claim means that the doctor agrees to abide by all the rules, of which there are more than 100,000 pages. These include coding requirements and price controls.

Russ got off easy. If a doctor gets overpaid, even through unintentional error, he may have to refund three times the amount, plus pay a civil monetary penalty. That used to be $10,000 per item, recently increased to $11,000, and in the new law to $50,000. Then there can be serious prison time. . .

When doctors begin to understand that much of the projected half-trillion dollars in Medicare "savings" is expected to come from assets accumulated by doctors over decades of hard toil, we are likely to see a mass exodus, especially of older doctors in solo practice, who seem to be the prime targets. . .

Russ was just a plumber, and he got flushed. What can doctors expect, now that they are public enemy #1?

This entry was posted on Tuesday, May 4th, 2010 at 11:06 pm and is filed under health care reform, medicare. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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

- Ronald Reagan

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5. Medical Gluttony: Patients have not yet bought into lean health care.

Today a patient was worried about his health. The last doctor just obtained a CT of the organ involved in his disease. He couldn't understand why the doctor didn't do a whole body CT or a whole body MRI to R/O all diseases in all organs.

That sounds simple and easy. Did he think this should be made available to all patients in the US? Why certainly, he replied. Aren't we interested in the best of health for all people?

Expending thousands of dollars per person on hundreds of millions of Americans that would total hundreds of billions didn't faze him at all. It only brought a somewhat derisive incredulous smile from him that "isn't stamping out disease worth anything it costs?"

But who should pay for it?

Why, the government, who else can afford it?

The government has no money unless they first take it away from you and me.

You sound like a right-wing radical thinking that people can pay for their own healthcare.

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Medical Gluttony thrives in Government and Health Insurance Programs.

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

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6. Medical Myths: Doctors will make the medical decisions in ObamaCare

Myth 20: Doctors, not bureaucrats, make decisions in national health systems.

If true, then why do central planners need extensive data on every patient encounter?

Obama can keep his promise - by turning doctors into bureaucrats.

AAPS, September 17th, 2009

. . . Doctors, it appears, would indeed be making day-to-day decisions about what to do for individual patients. The centralized planning authority, however, would make the decisions on resource constraints and permitted options, within which physicians would have to function.

Physicians would be free—to comply or to accept the penalties for "deviations."

Some American physicians, who have contracted with managed-care plans, long for what they believe is the simplicity and professional autonomy in nationalized systems.

Physicians who actually work in these systems generally do not share this sanguine view.

In Germany, doctors complain, on video with English subtitles, that they are inundated by the masses and cannot focus on the individual. They must work faster and faster, with less and less to show for it. A fundamental change in values has crept in, and the patient/physician relationship is deteriorating. Doctors say they are in a bureaucratic straitjacket. Politicians have them by a nose ring. Drugs and procedures are all constrained by a budget; some treatments simply cannot be offered. Thus, care is expedient, rather than optimal. There are so many forms that "you could paper the office with them." Overall, the situation is "deplorable," "critical," the "worst in 31 years of practice." Physicians conclude that "state medicine is rationed medicine."

Elsewhere in Europe, headlines read: "Belgian Doctors Take to the Streets," "Spanish Physicians Strike for More Time [10 Minutes] with Patients," and "French Doctors Are Burned Out."

According to a poll conducted by Pfizer of 1,741 physicians in 13 countries, 51% of European physicians are concerned about a negative direction for medicine, compared with 44% in the U.S. The majority report spending less time with patients (53% in Europe and 55% in the U.S.); bureaucratic demands were cited, unprompted, as a reason for that by 51% of Europeans and 21% of Americans. In both Europe and America, physicians have a negative view of the politicians' panaceas for efficiency and quality: 83% of American and 61% of European physicians think that treatment guidelines have an adverse effect on patient health, while 70% of Americans and 64% of Europeans think that health technology assessment and evidence-based medicine have a negative impact on quality of care.

Gammon's Law of Bureaucratic Displacement was developed in a London (National Health Service) hospital. Gammon defined bureaucracy as a rigid system "governed by fixed rules and tending to exclude human initiative." He found that bureaucracy was destroying British medical services—not destroying the NHS, he emphasized, as "it is the [NHS] itself which is the destroyer."

It's not just that the number of administrators has increased in a close correlation with a decrease in the number of NHS hospital beds (correlation coefficient a remarkable – 0.99). It's the displacement of productive by nonproductive activity throughout the organization.

"An example is the progressive transformation of nurses from patient-centred carers to administroids whose requirement to produce detailed patient care plans…leaves them little time to attend to patients' basic dietary needs or prevent them from developing pressure ulcers" (Australian Doctors Fund teleconference, Jan 24/25, 2005).

. . . H.R. 3200, establishes some 53 new bureaucratic agencies (Human Events 8/10/09).

Obama can keep his promise—by turning doctors into bureaucrats.

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Medical Myths originate when someone else pays the medical bills.

Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.

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7. Overheard in the Medical Staff Lounge: Did CMA Represent Physicians in ObamaCare?

Dr. Rosen: I have a list here of the CMA (California Med Association) amendments for ObamaCare.

Dr. Dave: Looks like CMA is a socialistic organization in bed with the Feds.

Dr. Yancy: The CMA as well as the AMA and the SMA are all socialistic organizations.

Dr. Sam: They are no longer friends of the practicing physicians.

Dr. Yancy: I've known that since I began the practice of Surgery in Sacramento. That's why I have not joined the local SMA, CMA, or the AMA.

Dr. Kaleb: I joined the local and state medical societies because as a foreigner, I thought it in my best interest to join. Having been a member of the local and state medical societies for three years now, I haven't found that they are working in our best interest.

Dr. Joseph: Since I've retired, I see the workings of organized medicine more objectively. All three levels hire medical bureaucrats, some from government positions, who see the government as the only option to control the practice of medicine. They proceed as if the doctors are all dimwits and need guidance.

Dr. Ruth: I've not been very involved since I have a family and a bureaucratic profession is easier to obtain part time hours, less night work, and weekends off for my children. But recently I've had some second thoughts. I've observe the nurses and their dependence on unions bargaining with the state, and I don't think they are improving their work conditions. The state can pass laws limiting the number of patients and hospital administrators can work all the way around them with a good excuse that the law makes them work that way. Gets the administrators off the hook, I believe.

Dr. Michelle: I understand what Ruth is saying and I've been there. But having practiced for more than 30 years, I've had my fill of medicine and if it becomes too oppressive, I'll just retire and live on my husband's income, and then my pension in another decade, and enjoy being a grandmother. Patients used to love to come to me. Now the office is more like a war zone with patients more demanding of benefits and when their demands for tests and procedures are exorbitant and I try to reduce their health care costs, their response actually frightens me. They are not interested in reducing their health care costs but want what they want regardless. I'm no longer interested in being the Medicare sentry.

Dr. Rosen: What then do you think is the answer? We've talked about voting out all incumbents in Congress and the White House. Shouldn't we get our own house in order? Our pediatric colleague Hal Scherz, MD, in a recent article in the WSJ, argued that without the support of the AMA it is quite possible that the health-care reform initiative would have failed. Obama made the public feel that with the AMA's support, doctors supported it. The public and certainly my patients don't understand that the AMA only represents about 20 percent of American Doctors and well over 65 percent of doctors did not support the Obama initiative and still don't.

Dr. Joseph: Looks like you have a bigger problem that requires you to fire all the administrators and executives of the AMA and state and local societies and regain control for the 65% majority that still believe in private practice.

Dr. Kaleb: Why do the doctors hire such socialists to run their organizations?

Dr. Edwards: Sometimes I think doctors are either too busy or too trusting. They just can't believe their own staff would hoodwink them and frustrate their interest.

Dr. Sam: Now you see why I'm not a member. If I were and I were elected president, I would publicly fire the administrator at the first meeting where I was installed to make a public statement. I'd come in like thunder just like Edward Annis did at the AMA in the 1960s.

Dr. Edwards: But he didn't fire the Exec Vice President. And when his term was up, it went back to socialism as usual.

Dr. Rosen: That's what's so frustrating to me. I can sit here and talk with all of you and you seem to be so private-practice oriented, but then you get busy with your practice and your life and nothing comes of it. I personally do not think that any of the fourteen points mentioned by the CMA as accomplishments were accomplishments at all. They are merely window dressing on the way to full government control to the detriment of our patients. The bureaucrats see this just as small potatoes on the way to socialism to keep the doctors from waking up.

Healthcare Reform 2009-10: What CMA Produced and What It Prevented! San Diego Physician, April 2010

1. CMA amendment requires health plans to direct 85 percent of revenues to direct patient care.

2. CMA amendment requires health plans to have adequate provider networks.

3. CMA strongly advocated for affordable, universal access to care for California's low-income uninsured.

4. CMA advocated for expansion of private insurance coverage vs. Medicaid. Two-thirds of those eligible under the bill will go into private coverage.

5. CMA vigorously promoted a Medicaid payment increase to accompany any Medicaid coverage expansion to ensure Medicaid patients have access to all physician specialties. The final bill provides a rate increase for primary care physicians up to Medicare levels.

6. CMA successfully advocated for 100 percent federal financing for the Medicaid expansion and the Medicaid rate increase to reduce the burden on the state of California.

7. CMA successfully argued for state-based health insurance exchanges rather than one national exchange of private health plan choices.

8. CMA fought for an additional Medicare payment increase for primary care physicians on top of a rate increase for all physicians to bolster primary care in California. Primary care received a 10 percent increase annually for five years (2011–16). . .

Read the rest of what the CMA did and didn't prevent and see if your dues are worthwhile . . .

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The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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

Sonoma Medicine Spring 2010

A Long and Proud History, By Richard Powers, MD, President, Sonoma County Medical Society

The Santa Rosa Family Medicine Residency has been preparing physicians with hands-on postgraduate training for more than 70 years. It was a two-year general practice residency from its origin in 1938 until 1969, when it changed into a three-year program for the new specialty of family medicine. The hospital in Santa Rosa housing the residency was first known as Sonoma County Hospital and then as Community Hospital.

In the early days, most of the teaching was done by physician volunteers from the community; but as reimbursement to physicians was ratcheted down, fewer could spare time to volunteer, so now most of the faculty is paid, and many are full-time. About half the family physicians practicing in Sonoma County are graduates of the residency, as are three-fourths of the family physicians at our local community health centers.

When I entered the program in 1970, it was nationally recognized as a premier residency. The residents were the primary and often the only physician caring for their patients. The training included anesthesia, surgery, obstetrics and pediatrics, as well as acute inpatient medicine plus emergency room. At that time, there were six residents in each year for a total of 18; now there are 12 in each year for a total of 36.

In 1994, the Sonoma County Board of Supervisors was distraught by the negative cash flow of indigent and uninsured care that naturally came to Community Hospital. The cost of care was rising, but the revenue was not. The board wanted someone else to manage the hospital and the residency. They selected Sutter, which assumed management in 1996. A decade later, Sutter announced that without dramatic changes in financial support they had to consider closing the residency. This statement was followed one year later by Sutter's announcement that they wished to cease operating the hospital as well. Fortunately for the residency, Sutter was able to form a new nonprofit organization with multiple community stakeholders, the Santa Rosa Family Residency Consortium.

The Consortium brought together Sutter, Kaiser, Southwest Community Health Center, UCSF, Sonoma County Public Health and Memorial Hospital to provide additional finances, faculty and learning opportunities. Southwest assumed operation of the Family Practice Clinic on Chanate in the fall of 2007. As a federally qualified health center, Southwest was able to improve revenue for outpatient care. Kaiser agreed to provide nearly $3 million per year in additional funding and to bring residents to Kaiser for rotations in pediatrics, musculoskeletal medicine and other subspecialty training. These new rotations substantially increased patient volume . . .

About one-fourth of the graduating medical school students pursuing family medicine residency training in the United States applied to the Santa Rosa residency during 2009, confirming that it remains one of the best of the 450 residency programs in the nation. After its recent reorganization, the residency shines more brightly than at any time during its long and proud history.

Dr. Powers, a Sebastopol family physician, is president of SCMA.

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VOM Is Where Doctors' Thinking is Crystallized in Writing.

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9. Book Review: From our archives: How Medicine is Changing and What it Means to You

THE AMERICAN WAY OF HEALTH - How Medicine is Changing and What it Means to You by Janice Castro, Back Bay Books, (Little, Brown, & Company), Boston, 1994, x & 282 pages, including glossary, notes, & index, $9.95, Paperback.

Janice Castro, senior health-care correspondent at TIME who interviews professionals, patients, and others, opens with "Ask most people what they think about the state of American medicine, and they will tell you about their own doctors, or about something that happened to them during an illness. Chances are, if they see a need for health-care change, it will be very specific, based on personal experience. On the other hand, listen to American leaders discussing health-care reform. They speak of providers. Access. Alliances. Competition. Mandates... The concepts seem impossibly complicated and remote from the experience of one sick person needing help."

She continues, "This book will help the general reader understand how the American health system works, why it costs so much... Medicine is too important, too personal, to be left to economists and politicians... After all, the health-care debate is really about life and death. It is about those times when people need help and about whether it will be there, about one sick patient at a time and the doctor or nurse who provides care... It is fundamentally a moral problem. Viewed in that light, the challenge... begins to come more clearly into focus. It is not really that complicated. We know what we need to do. We need to take care of old people... Children should see doctors and dentists. A pregnant woman should be able to check in with a doctor as the baby grows. People should not be dying in the street... Families shouldn't lose their home over the cost of coping with medical disasters. Breadwinners should not quit good jobs in order to qualify for poor people's insurance... People should take responsibility for their own health and for their family's. Children should not be having children..."

And, "If we are going to ensure that every American has access to decent health care, while also controlling the burgeoning costs, all of us must curb our medical greed. All of us must stop pretending that someone else is paying the bills. 'What do you think most people would say if one of their parents called up and said they needed a hundred and twenty-five thousand dollars for an operation?' asks one economist. 'Do you think that son or daughter would think twice and wonder whether that operation was really necessary? Of course they would. But none of us think we pay for medical care. And of course we all do.' All of us must pay our share..."

Castro then takes us on a tour de force of health-care about our country. She starts at Kaiser Walnut Creek's two delivery rooms where 4,000 infants, mostly delivered by midwives, take their first breath each year. She interviews a midwife who feels that midwives can deliver most women in tents, a practice which is prevented by organized medicine. She then takes us inside the delivery room where the midwife has a complication with a stuck shoulder. Within seconds, an obstetrician and pediatrician come through the delivery room doors and deliver a healthy infant two minutes later. Castro feels it was fortunate this baby was not born in a tent and that the pediatric ICU is only twenty steps from the delivery room. . .

DelMeyer@MedicalTuesday.net

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10. Hippocrates & His Kin: If you're poor just steal - but only from national chain stores

The Reverend Tim Jones, a Church of England priest, proclaimed from the pulpit that shoplifting would be okay if people were truly in need and as long as they did it in the national chain stores and not small businesses.

There was quite uproar from all quarters including the Church of England who said that telling the poor to steal is not the best way to deal with poverty. "Thou shalt not steal" does not contain exceptions for those in difficult situations.

The world is in a sad shape when we can't trust our moral leaders.

Governor Schwarzenegger was caught riding his bike in Downtown Sacramento without a Helmet.

The Governor was accompanied by a uniformed CHP officer on a motorcycle as well as other bicycle riders in plain clothes. Only the CHP officer was wearing a helmet. The Governor's press office later told Fox 40: "The governor loves to ride his bike through Sacramento and always encourages kids to be safe." At least we know the Governor is in town to work on the $20 billion state budget deficit.

You suppose he's worried about a recall since he got into office on Governor Davis' $4 billion deficit?

61 percent of Americans support Arizona's immigration law and favor similar laws in their states.

Arizona Gov Jan Brewer said the boycotts are misguided, primarily because the law mirrors a federal requirement that legal immigrants carry immigration papers. Charges that the law will lead to racial profiling are "just pure rhetoric." Are those that boycott really in favor of illegal immigration?

Maybe we need the Church of England to tell us which laws are okay to break.

Many experienced workers are finding that their jobs have become outdated.

Outmoded work is being wrung out of the economy. Many of the jobs lost during the recession are not coming back. The weak economy has provided an opportunity for employers to do what they would have done inevitably anyway: dismiss millions of people - like file clerks, ticket agents, autoworkers who have become displaced by computers, technology and international trade doing the job more efficiently and cheaply. This "creative destruction" in the job market can benefit the economy. The usual unemployment measures - like jobless benefits and food stamps - can serve as temporary palliatives, but they cannot make workers' skills relevant again.

Anyone still think the recession is going to be short lived?

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11. Organizations Restoring Accountability in HealthCare, Government and Society:

• The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports. This month, read 18 States Refuse To Run Insurance Pools For Those With Preexisting Conditions.

• Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog. Just released: Ramesh Ponnuru advises that the action to repeal Obamacare has to move outside Washington. The good news: It's happening.

• The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government. This month, we congratulate The Honorable Maurice McTigue, QSO, Vice President at the Mercatus Center at George Mason University, who has been named to Virginia Governor Bob McDonnell's Commission on Government Reform and Restructuring. A seasoned expert on government reform, McTigue brings practical experience and scholarly research to the table from his distinguished career as a former cabinet minister and Member of Parliament in his native New Zealand and his decade-long tenure at the Mercatus Center.

• The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business.

• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels. This month, you might focus on the perverse provisions of ObamaCare that Rewards Employers for Dropping Coverage.

• Greg Scandlen, an expert in Health Savings Accounts (HSAs), has embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the initial series of his newsletter, Consumers Power Reports. Become a member of CHCC, The voice of the health care consumer. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn. Greg has joined the Heartland Institute, where current newsletters can be found.

• The Heartland Institute, www.heartland.org, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care? This month, be sure to read Ten Ways Consumer-Driven Health Care Is a Proven Success.

• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Lawrence W Reed, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. Be sure to read the current lesson on Economic Education by Robert G. Anderson who answers the question: Why we don't have a free society? He explains how the political process transfers the cost of the benefits we receive to others, while the role of an effective government is keeping the peace.

• The Council for Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse."

• The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter. Read the Amendment of the Constitution of the State of Colorado to preserve the right to health care choice.

• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read The True Cost Of Obamacare: From a libertarian perspective, Obama's recent triumph in the healthcare reform fight was not cause for celebration. The basis of libertarianism is that no one is allowed to tell competent adults what to do, or to take their property.

• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section. This month read: While cooperation between Canada and the United States has been poor, there are hopeful signs.

• The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission was to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. -- However, since they supported the socialistic health plan instituted by Mitt Romney in Massachusetts, which is replaying the Medicare excessive increases in its first two years, and was used by some as a justification for the Obama plan, they have lost sight of their mission and we will no longer feature them as a freedom loving institution and have canceled our contributions. We would also caution that should Mitt Romney ever run for National office again, he would be dangerous in the cause of freedom in health care. We would also advise Steve Forbes to disassociate himself from this Foundation.

• The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. You may also log on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to be an MD today.

• CATO. The Cato Institute (www.cato.org) was founded in 1977, by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio, articles and books at www.cato.org/people/cannon.html.

• The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.

• The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]

• The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, wartime allows the federal government to grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St. Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in wartime, we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to www.stcroixreview.com.

• Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17^th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month peruse at www.hillsdale.edu/news/imprimis.asp. The last ten years of Imprimis are archived.

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Please note that sections 1-4, 6, 8-9 are entirely attributable quotes and editorial comments are in brackets. Permission to reprint portions has been requested and may be pending with the understanding that the reader is referred back to the author's original site. We respect copyright as exemplified by George Helprin who is the author, most recently, of "Digital Barbarism," just published by HarperCollins. We hope our highlighting articles leads to greater exposure of their work and brings more viewers to their page. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.

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Words of Wisdom

"An enterprising person is one who comes across a pile of scrap metal and sees the making of a wonderful sculpture. An enterprising person is one who drives through an old, decrepit part of town and sees a new housing development. An enterprising person is one who sees opportunity in all areas of life." - Jim Rohn: Author and motivational speaker

"Of all the things that can have an effect on your future, I believe personal growth is the greatest. We can talk about sales growth, profit growth, asset growth, but all of this probably will not happen without personal growth." - Jim Rohn: Author and motivational speaker

From NIGHTINGALE.COM

Some Recent Postings

HealthPlanUSA.net, the Plan that will save Medicare for our seniors. Purchase a copy at www.healthplanusa.net/archives/April10.asp and find out why.

In Memoriam

Alan Sillitoe, writer, died on April 25th, aged 82

From The Economist print edition | Apr 29th 2010

ENGLISH working men had been heard from before. Piers Plowman, chancing one summer day upon a field of folk; John Clare's shepherd, observing cabbage fields and nesting birds; D.H. Lawrence's taciturn miners, washing off their grime before the fire. But the toiler on the assembly line had never spoken up so loudly until Alan Sillitoe, in "Saturday Night and Sunday Morning" (1958), produced Arthur Seaton.

Twenty-one-year-old Arthur, between chamfering and drilling to produce 1,400 parts a day at the Raleigh bicycle factory in Nottingham ("Forty-five bob don't grow on trees"), led a life of rampant cuckoldry with Brenda ("so lush and loving") in Strelley Woods. "Time flies and no mistake," sighed Arthur,

and it's about time it did because I've done another two hundred and I'm ready to go home and get some snap and read the Daily Mirror or look at what's left of the bathing tarts in the Weekend Mail. But Brenda, I can't wait to get at her…And now this chamfer-blade wants sharpening.

This cocky bastard, soon personified in film by Albert Finney, gave English society a shock, besides its first full description of a backstreet abortion with hot gin and boiling bath-water. But Mr Sillitoe spoke too, in the voice of Smith in "The Loneliness of the Long-Distance Runner" (1959), for the petty-criminal underclass, Borstal boys:

I didn't think about anything at all, because I never do when I'm busy, when I'm draining pipes, looting sacks, yaling locks, lifting latches, forcing my bony hands and lanky legs into making something move, hardly feeling my lungs going in-whiff and out-whaff…When I'm wondering what's the best way to get a window open or how to force a door, how can I be thinking?

Mr Sillitoe gave voices and identities to the street-crowds of post-war Britain, working in industries that were already dying, living for football and televisions on the never-never and Saturday-night binges in which pints of ale led rapidly to a fist in the face and the cold, hard pavement. Standing at the lathe as Mr Sillitoe had stood, they dreamed of "marvellous things".

. . . Mr Sillitoe's heroes defied all systems and were part of no class, except "us" versus "them". They kept their own pride, like Seaton's sharp suits for a big night out, or the exhilaration Smith felt, "like the first and last man on the world", when he ran through the fields alone, and wouldn't pander to the Borstal governor by winning a race for him. "It's a fine life, if you don't weaken," was one Sillitoe motto. Another was "Don't let the bastards grind you down."

Writers about the poor tended to be middle-class patronisers. But Mr Sillitoe was a product of those sooty red-brick terraces, where he remembered his mother, beaten yet again by his father, holding her head over a bucket so the blood didn't run on the carpet; . . . At 14 he became a labourer and lathe-operator, as well as a serial lover of the local girls.

His father was illiterate, unable to make sense of the "mystifying jungle" of the world. Hence his violence. . . .

Read the entire obituary . . .

On This Date in History - May 11

Two men were born in Europe who contributed greatly to the American Spirit.

On this date in 1888, Irving Berlin was born in Temum, Russia, and wrote "God Bless America." He also wrote "White Christmas" and "In your Easter Bonnet," lyric celebrations of two great Christian occasions by a Jewish songwriter. Irving Berlin's songs express the hopes, aspirations and attitudes of America from "Oh, How I Hate to Get Up in the Morning" to "You're Not Sick, You're Just in Love." The spirit of America welcomes an immigrant boy and makes him its poet laureate. That is still the spirit we see in our nation today.

On this date in 1854, Ottmar Mergenthaler was born in Hachtel, Germany. He came to the United States when he was 18. As a young man, he invented a machine called the Linotype that set printing type mechanically. In one fell swoop, it changed printing from a hand trade to a great mass production enterprise. This country had an absolute explosion of print in the late nineteenth century. It made possible the great mass circulation daily newspapers and mass-produced books. America is a very inventive land because it is free. It is the place to which inquisitive and inventive people are drawn. Let us hope and do what we can so that this spirit of inventiveness continues.

After Leonard and Thelma Spinrad

Never forget the opposite of inventiveness and freedom is dependency: Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single payer initiative, was born for the benefit of the state and of a contemptuous disregard for people's welfare by making them dependent on welfare.

MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol IX, No 3, May 11, 2010