MEDICAL TUESDAY . |
NEWSLETTER |
Community For Better Health Care |
Vol IX, No 24,
|
In This Issue:
1.
Featured Article:
Duty Hours: Where Do
We Go From Here?
2.
In
the News: Is
Your Job an Endangered Species?
3.
International Medicine: British Med
Assn proposes the first walkout by
doctors since 1975
4.
Medicare: Talk Doesn’t Pay, So
Psychiatry Turns Instead to Drug Therapy
5.
Medical Gluttony:
Gouging on the
Hospital Laboratory Bill
6.
Medical Myths: ObamaCare with Increased
Taxes will solve our Healthcare Problems
7.
Overheard in the Medical Staff Lounge: ObamaCare Sooners
8.
Voices of Medicine: Medicaid Is Worse
Than No Coverage at All
9.
The Bookshelf: Legal Academia and an Overlawyered America
10.
Hippocrates
& His Kin: Subsidizing
Students, Housing, and Healthcare are the same
11.
Related Organizations: Restoring
Accountability in Medical Practice and Society
Words of Wisdom, Recent
Postings, In
Memoriam . . .
* * * * *
Remember: 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.
Thus we must also remember that ObamaCare has nothing to do with
appropriate healthcare; it was similarly projected to gain loyalty by making
American citizens dependent on the government and eliminating their choice and
chance in improving their welfare or quality of healthcare. Socialists know
that once people are enslaved, freedom seems too risky to pursue.
* * * * *
1.
Featured
Article: Duty Hours: Where Do
We Go From Here?
Paul
H. Rockey, MD,
In this issue of Mayo Clinic Proceedings,
[two] articles explore the effects that limiting resident physician duty hours
have had on the learning environment and patient care.1,2
These articles will prompt discussion among resident physicians and their
faculty and evoke memories for those of us who completed residency training in
an earlier era. In this regard, I am no exception.
As a “rotating” intern at
Although these schedules were arduous, I never felt
alone or abandoned. A seasoned resident was always on service with me, and my
learning curve was steep. I have no regrets and still revere the experience.
This crucible, shared by many in my generation, taught me that a good and
effective learning environment has many aspects—and that hours worked is only
one. (But that is enough personal nostalgia; there is no way we will return to
such schedules.)
Journalist Sidney Zion brought the issue of resident
duty hours to public attention after the death of his 18-year-old daughter,
Libby, at a
Despite a tenuous link to the quality of patient care,
resident hours have become the all-too convenient explanation for a variety of
systemic ills and inefficiencies in health care. Outside agencies have
pressured the Accreditation Council for Graduate Medical Education (ACGME) to
limit duty hours as a way to improve patient care, even though the number of
hours that residents work is only one aspect of their clinical learning
environment. Furthermore, frequent changes to the duty hour requirements have
made the evaluation of the actual effect of past changes almost impossible. . .
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entire Mayo Clinic report . . .
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* * * * *
2.
In the News: Is Your Job an Endangered
Species?
So where the heck are all the jobs? Eight-hundred billion in stimulus and
$2 trillion in dollar-printing and all we got were a lousy 36,000 jobs last
month. That's not even enough to absorb population growth.
You can't blame the fact
that 26 million Americans are unemployed or underemployed on lost housing jobs
or globalization—those excuses are played out. To understand what's going on,
you have to look behind the headlines. That 36,000 is a net number. The Bureau
of Labor Statistics shows that in December some 4,184,000 workers (seasonally
adjusted) were hired, and 4,162,000 were "separated" (i.e., laid off
or quit). This turnover tells the story of our economy—especially if you focus
on jobs lost as a clue to future job growth.
With a heavy regulatory
burden, payroll taxes and health-care costs, employing people is very
expensive. In January, the Golden Gate Bridge announced that it will have zero
toll takers next year: They've been replaced by wireless FastTrak payments and
license-plate snapshots.
Technology is eating
jobs—and not just toll takers.
Tellers, phone operators,
stock brokers, stock traders: These jobs are nearly extinct. Since 2007, the
New York Stock Exchange has eliminated 1,000 jobs. And when was the last time
you spoke to a travel agent? Nearly all of them have been displaced by
technology and the Web. Librarians can't find 36,000 results in 0.14 seconds,
as Google can. And a snappily dressed postal worker can't instantly deliver a
140-character tweet from a plane at 36,000 feet.
So which jobs will be
destroyed next? Figure that out and you'll solve the puzzle of where new jobs
will appear.
Forget blue-collar and white- collar. There are two types of workers in our
economy: creators and servers. Creators are the ones driving
productivity—writing code, designing chips, creating drugs, running search
engines. Servers, on the other hand, service these creators (and other servers)
by building homes, providing food, offering legal advice, and working at the
Department of Motor Vehicles. Many servers will be replaced by machines, by
computers and by changes in how business operates. It's no coincidence that
Google announced it plans to hire 6,000 workers in 2011.
But even the label
"servers" is too vague. So I've broken down the service economy
further, as a guide to figure out the next set of unproductive jobs that will
disappear. (Don't blame me if your job is listed here; technology spares no
one, not even writers.) . . .
Read
the entire article in the WSJ – Subscription required . . .
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* * * * *
3.
International
Medicine: British Medical
Assn considers the first walkout by
doctors since 1975
| 23 Mar 2011
Dr Mark Porter said the
“brutal” cuts being made to the NHS would lead to the rationing of treatment
and hospitals becoming “financially unviable” as they are undermined by private
competitors.
He also accused the
Government of breaking its promises not to meddle in the health service, and
said ministers’ “stubborn” refusal to listen to expert critics suggested they
were motivated by “ideology”.
His claims came as
consultants in the British Medical Association, which last week called on the
controversial health bill to be withdrawn but agreed to continue negotiations,
took the first steps towards a ballot for industrial action over their pay and
pensions.
It could lead to the
first walkout by doctors since 1975, as opposition grows towards the plan to
abolish two tiers of management and allow private firms to treat more patients
at the same time as the NHS is under orders to save £20billion over three
years.
In his speech to the
annual BMA consultants conference on Wednesday, Dr Porter said reminded
delegates that the Coalition had promised to give GPs and patients more power
as well as ending top-down reorganisations of the health service. . .
“That truth is that this
Bill aims to transform the NHS by making the development of a market in health
care the most important priority in the NHS.” . . .
“It seems that on the
most conservative commissioning assumptions about reducing low-priority
services, 58 hospital trusts will be unable to cover the costs of entire
service departments. . .
“This government’s stubborn
and obdurate refusal to listen is starting to look as if the purpose in this
Bill is more the exercise of ideology and authority, than a desire to engage
doctors in improving healthcare.” . . .
Read
the entire article in The Telegraph . .
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Canadian
Medicare does not give timely access to healthcare, it only gives access to a
waiting list.
The National
Health Service is equally bad and their doctors appear to be at war!
http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
* * * * *
4.
Medicare: Talk Doesn’t Pay, So
Psychiatry Turns Instead to Drug Therapy
DOYLESTOWN,
But the psychiatrist, Dr. Donald Levin, stopped him
and said: “Hold it. I’m not your therapist. I could adjust your medications,
but I don’t think that’s appropriate.”
Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part
because of changes in how much insurance will pay, no longer provides talk
therapy, the form of psychiatry popularized by Sigmund
Freud that dominated the profession for decades. Instead, he
prescribes medication, usually after a brief consultation with each patient. So
Dr. Levin sent the man away with a referral to a less costly therapist and a
personal crisis unexplored and unresolved.
Medicine is rapidly changing in the
Trained as a traditional psychiatrist at
Then, like many psychiatrists, he treated 50 to 60
patients in once- or twice-weekly talk-therapy sessions of 45 minutes each.
Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits
for prescription adjustments that are sometimes months apart. Then, he knew his
patients’ inner lives better than he knew his wife’s; now, he often cannot
remember their names. Then, his goal was to help his patients become happy and
fulfilled; now, it is just to keep them functional. . .
Dr. Levin has found the transition difficult. He now
resists helping patients to manage their lives better. “I had to train myself
not to get too interested in their problems,” he said, “and not to get
sidetracked trying to be a semi-therapist.” . . .
On a recent day, a 50-year-old man visited Dr. Levin
to get his prescriptions renewed, an encounter that took
about 12 minutes.
Two years ago, the man developed rheumatoid arthritis and became severely
depressed. His family doctor prescribed an antidepressant, to
no effect. He went on medical leave from his job at an insurance company,
withdrew to his basement and rarely ventured out.
“I became like a bear hibernating,” he said.
He looked for a psychiatrist who would provide talk
therapy, write prescriptions if needed and accept his insurance. He found none.
He settled on Dr. Levin, who persuaded him to get talk therapy from a
psychologist and spent months adjusting a mix of medications that now includes
different antidepressants and an antipsychotic. The man
eventually returned to work and now goes out to movies and friends’ houses.
The man’s recovery has been gratifying for Dr. Levin,
but the brevity of his appointments — like those of all of his patients —
leaves him unfulfilled. . . .
Recent studies suggest that talk therapy may be as
good as or better than drugs in the treatment of depression, but fewer than half of depressed
patients now get such therapy compared with the vast majority 20 years ago.
Insurance company reimbursement rates and policies that discourage talk therapy
are part of the reason. . .
Read
the entire article at the New York Times . . .
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Government is not the solution to our
problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical
Gluttony: Gouging
on the Hospital Laboratory Bill
Mrs. Trudy came
in two weeks ago stating that she went to the hospital the evening before our
office visit. Her asthma wasn’t much worse than the previous days but her
daughter, who was living approximately 50 miles away, felt that she should go
to the hospital emergency room and get checked out. Otherwise she would worry
about her all night and she wouldn’t get any rest. Not breathing normally, she
maintained, was really a bona fide emergency if anything ever was. She was sure
her mother’s insurance covered emergencies.
The patient was
breathing rather well when seen by the ER physician who simply ordered an extra
nebulized treatment, which she had already administered twice that day. After
four hours, the RN told the doctor that all the laboratory work was normal, the
patient was doing well and he advised her to be discharged.
Although the
minimal treatment spoke volumes that this was not an emergency, what caught my
eye were the outpatient laboratory charges she had in her hand.
The charges
listed are as follows. Medicare
payment for similar services in the office.
Emergency Dept
visit $1,515 $64
Electrocardiogram $465 $18
Chest x-ray $755 $36
Complete blood
count $240 $28
Urinalysis $101 $
3
Obtaining the
samples $ 9 $ 0
Metabolic blood
panel $915 $
not done in offices, sent out for about $65
Total Claim $4,000 $140
Medicare paid
the provider for this claim $244
The patient
pointed out to me that, in addition to these costs, her ambulance ride to the
hospital was $1500.
Conversely, the
automobile mileage to our office at 35¢ per mile for three miles = $1.05
Much of the
public’s frustrations with health care are the exorbitant charges that bear no
relationship to either cost, value, or expected payment, unless you’re without
insurance. The person without insurance will be sent to collections for failure
to pay. The largest defense to keep from going broke from health care is to
have any insurance to provide a shield against the hospital and practitioners
who send patients to collections. No one without insurance can traverse the
health care charges where price and value are in a total disconnect. If there
was patency in health care charges, someone without insurance could traverse
the health care market place rather well. This may prove to be the biggest
drive to socialized medicine since patients and their doctors feel so helpless.
Patency would
become instantly apparent if the patient had to pay a co-payment on every
hospital charge. When the patient registers, the charges would have to be
patent or visible so the ten percent or any appropriate percentage would be
seen by the patient on admission. The patient would instantly police his or her
own costs. In our research, by asking the patient as in the illustration above
if she had known that the ER co-payment would be 20 percent of the average ER
charge of $1500, or a minimal charge of $300, she more than likely would have
made a better assessment of her illness, realizing that she was really no worse
than the previous day, and a co-payment of 20 percent on a $150 office call is
only $30, a lot less than the $300 ER visit. Our research has also shown that
if Welfare or Medicaid patients had one-tenth of the private patient’s co-payment,
or $30 for the ER visit and $3 for the office visit, they would have come to
the same conclusion—the office is the best deal in medicine.
In either case,
there would have been a 90 percent savings in health care cost. Health care
inflation, or medical gluttony, or rising insurance premiums would have been
stopped in their tracts.
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Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on
Every Service.
* * * * *
6.
Myths: ObamaCare
with Increased Taxes will solve our Healthcare Problems
OPINION WSJ
| MARCH 22, 2011
Today, the Ronald Reagan
Presidential Foundation, the Manhattan Institute and The Wall Street Journal
will host a morning seminar concerning the economic legacy of Ronald Reagan.
The get-together couldn't be timelier.
Reagan came into the
White House facing an economy as troubled as ours—one that had even higher
unemployment, catastrophic interest rates (18% for mortgages) and a stock
market that in real terms had fallen 60% from its mid-1960s levels. When he
left office eight years later, the U.S. had become an economic miracle: 18
million new jobs had been created; Silicon Valley had blossomed, becoming a
global symbol for innovation; and the stock market was experiencing a bull run
that, despite dramatic ups and downs, didn't end until the turn of the 21st
century, after the Dow had expanded 15-fold. The expansion of the U.S. economy
exceeded the entire size of West Germany's economy, then the world's
third-largest.
How did this happen? You
could make the case that Reagan's economic miracle had its origins at a
Washington, D.C., restaurant in 1974. That December night, 34-year-old
University of Chicago professor, Art Laffer, scribbled a single—and now
legendary—curve on a cocktail napkin to illustrate to a group of President
Ford's advisers why a proposed plan to raise taxes would not increase
government revenues. Mr. Laffer posited that deep cuts in existing tax rates
would stimulate the economy and ultimately lead to far higher government
revenues. Conversely, increase the tax burden and government receipts would
fall below expectations because of a weaker economy.
Mr. Laffer's curve headed
off the tax boost, but the Ford people did not accept the conclusion that big
reductions in tax rates were just what the anemic U.S. economy needed. However,
when Reagan met with Mr. Laffer and other like-minded thinkers several years
later, he quickly grasped the Laffer Curve's fundamental message.
The concept that a free
market unencumbered by barriers, government regulation and taxation will create
the most growth-friendly economic environment was simple but radical. After
taking the oath of office, Reagan went to work to convince the American people
of the benefits of supply-side economics: lower taxes, less regulation, and
less government spending, as well as a monetary policy focused on ridding us of
the seemingly incurable disease of ever-rising inflation.
Reagan's program was a
resounding success. Its centerpiece was the Economic Recovery Tax Act of 1981,
which dramatically cut income tax rates for everyone. He managed to pass the
bill during his first eight months in office, with bipartisan support in a
divided Congress.
Critics howled that
Reagan was being financially irresponsible, but the president pressed on. Once
his cuts were fully phased-in and the hard fight against inflation was won, the
economy took off like a rocket. Reagan's achievements set up a great, long boom
in the U.S. and the world that didn't end until the economic crash in 2007.
(Yes, there were periods of slower growth rates before that year, but none can
be compared to the crash of 2007.)
At the same time,
Reagan's British counterpart, Prime Minister Margaret Thatcher, was
accomplishing similar feats by taking an axe to Britain's draconian tax system.
Almost overnight, Britain went from being Europe's economic weak link to being
the continent's most vibrant large economy. . .
Mr. Forbes, chairman
and editor in chief of Forbes Media, is co-author of "How Capitalism Will
Save Us: Why Free People and Free Markets Are the Best Answer in Today's
Economy" (Crown Business, 2009). He is also a trustee of the Ronald Reagan
Presidential Foundation.
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Medical Myths Originate When Someone Else Pays The Medical Bills.
ObamaCare will originate more Myths.
Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments
on Every Service.
* * * * *
7.
Overheard
in the Medical Staff Lounge: ObamaCare Sooners and they’re not from Oklahoma
Dr. Rosen: States are taking the lead and implementing ObamaCare
piece by piece and swelling the ranks of Medicaid. This is making health care
less rather than more available to the poor and downtrodden. The increasing
numbers are adding to the waiting lists and not receiving improved care.
Dr. Edwards: I’ve noticed that I’m having increasing difficulties
getting my Medicaid patients to surgeons and other specialties.
Dr. Milton: We’re seeing a number of Medicaid patients that are
now part of a managed care IPA. Surgeons who formerly took the managed care
patients are not taking the Medicaid/Managed Care patient. So the integration
of the poor into regular society is not working.
Dr. Kaleb: I think two-tiered healthcare has always been more
efficient. It is absolutely necessary in the developing countries. There is no
way that all the poor could be integrated into regular care. These countries
are leading the way with superior medical centers equal to any in the world;
but their prices are sometimes one-fourth or less than in the advanced
societies.
Dr.
Michelle: Medical tourism is really
taking off. In some cases, the cost of the trip to
Dr. Kaleb: Of course none of these countries have the
overwhelming regulations that you see in
Dr. Paul: So doesn’t that make health care more available for
the poor in
Dr. Kaleb: You have to remember that your poor are rich in
comparison to our poor. Our poor can’t even dream of cars or televisions like
your poor have.
Dr. Paul: Are you sure? Have you been back recently?
Dr. Kaleb: Just this past year. Many of our poor still don’t
have waterproof houses over their heads like your poor.
Dr. Paul: Don’t you keep up with our homeless?
Dr. Kaleb: I saw a homeless in my office last week. He has a red
Honda bike with accessories you would never have in
Dr. Rosen: So, our so-called poor who are now in Medicaid have
available health care in the Medicaid group. These ranks are swelling two years
before implementation because of state action before ObamaCare kicks in during
2014. So, can you imagine what our waiting lists will be like in 2014? Much
like the rest of the world, including
Dr. Kaleb: So we have the best available care by comparison with
any other country. So why aren’t our local societies, state societies and the
AMA fighting for our patients and pointing this out?
Dr. Rosen: They have a different agenda. They publish the
Dr. Edwards:
That seems more like harassment
rather than progress or our professional organization supporting doctors. In
fact, they supported ObamaCare, which will destroy private practice.
Dr. Milton: I understand they see this future realignment as an
even greater need to represent us in Medicare, Medicaid and government.
Dr. Kaleb: Dream on, AMA.
Dr. Edwards: Oh, to have Dr. Edward Annis back again as our
president.
Dr. Rosen: Dr. Annis was in some respect like President Reagan.
The socialists couldn’t wait for him to get out of office so they could reverse
his tax reductions which increased revenue. That is certainly beyond the
socialist’s mental capacity. They can’t comprehend how reducing taxes increased
the economy so greatly that the lower taxes bring in much greater revenue than
the exorbitantly high taxes did. Isn’t that the Socialist’s dream—more tax
money?
Dr. Milton: Dreams and logic are not socialistic bedfellows.
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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
* * * * *
8.
Voices of
Medicine: A Review of Articles by Physicians
Across the
country, cash-strapped states are leveling blanket cuts on Medicaid providers
that are turning the health program into an increasingly hollow benefit.
Governors that made politically expedient promises to expand coverage during
flush times are being forced to renege given their imperiled budgets. In some
states, they've cut the reimbursement to providers so low that beneficiaries
can't find doctors willing to accept Medicaid.
Washington
contributes to this mess by leaving states no option other than
across-the-board cuts. Patients would be better off if states were able to
tailor the benefits that Medicaid covers—targeting resources to sicker people
and giving healthy adults cheaper, basic coverage. But federal rules say that
everyone has to get the same package of benefits, regardless of health status,
needs or personal desires.
These rules
reflect the ambition of liberal lawmakers who cling to the dogma that Medicaid
should be a "comprehensive" benefit. In their view, any tailoring is
an affront to egalitarianism. Because states are forced to offer everyone
everything, the actual payment rates are driven so low that beneficiaries often
end up with nothing in practice.
Dozens of recent medical studies show that Medicaid
patients suffer for it. In some cases, they'd do just as well without health
insurance. Here's a sampling of that research: . . .
• Major surgical procedures: A 2010
study of 893,658 major surgical operations performed between 2003 to 2007,
published in the Annals of Surgery, found that being on Medicaid was associated
with the longest length of stay, the most total hospital costs, and the highest
risk of death. Medicaid patients were almost twice as likely to die in the
hospital than those with private insurance. By comparison, uninsured patients
were about 25% less likely than those with Medicaid to have an
"in-hospital death." Another recent study found similar outcomes for
Medicaid patients undergoing trauma surgery.
• Poor
outcomes after heart procedures: A 2011 study of 13,573 patients, published in
the American Journal of Cardiology, found that people with Medicaid who
underwent coronary angioplasty (a procedure to open clogged heart arteries)
were 59% more likely to have "major adverse cardiac events," such as
strokes and heart attacks, compared with privately insured patients. Medicaid
patients were also more than twice as likely to have a major, subsequent heart
attack after angioplasty as were patients who didn't have any health insurance
at all. . .
So why do Medicaid patients fare so
badly? Payment to providers has been reduced to literally pennies on each
dollar of customary charges because of sequential rounds of indiscriminate rate
cuts, like those now being pursued in states like New York and Illinois. As a
result, doctors often cap how many Medicaid patients they'll see in their
practices. Meanwhile, patients can't get timely access to routine and
specialized medical care.
The liberal solution to these woes has
been to expand Medicaid. Advocacy groups like Families USA imagine that once
Medicaid becomes a middle-class entitlement, political pressure from
middle-class workers will force politicians to address these problems by
funneling more taxpayer dollars into this flawed program.
President
Barack Obama's health plan follows this logic. Half of those gaining health
insurance under ObamaCare will get it through Medicaid; by 2006, one in four
Americans will be covered by the program. A joint analysis from the Republican
members of the Senate Finance and House Energy and Commerce Committees
estimates that this will force an additional $118 billion in Medicaid costs
onto the states.
We need an
alternative model. One option is to run Medicaid like a health program—rather
than an exercise in political morals—and let states tailor benefits to the
individual needs of patients, even if that means abandoning the unworkable myth
of "comprehensive" coverage.
Democratic
and Republican governors are pleading with the president for flexibility to do
just this. At least so far, this has been a nonstarter with an Obama health
team so romanced by Medicaid's cozy fictions that it neglects the health
coverage that Medicaid really offers, and the indecencies it visits on the
poor.
Read
Dr. Gottlieb’s entire article in the WSJ,
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VOM
Is an Insider's View of What Doctors are Thinking, Saying and Writing about.
* * * * *
9.
Book
Review: Schools for Misrule -
Legal Academia and an Overlawyered America
by Walter Olson
BOOKSHELF
| John O. McGinnis | WSJ | MARCH 21, 2011
The British
economist John Maynard Keynes famously observed, 75 years ago, that statesmen
who think that they are pursuing policies of their own devise are really
showing themselves to be "the slaves of some defunct economist." In
America today statesmen are more likely to be the slaves of some defunct legal
theorist. Our litigation-prone culture and complex legal structure—not least
the matrix of overlapping state and federal powers—regularly translate
questions of policy into questions of law. As a result, American law schools
wield more social influence than any other part of the American university.
In
"Schools for Misrule," Walter Olson offers a fine dissection of these
strangely powerful institutions. One of his themes is that law professors serve
the interests of the legal profession above all else; they seek to enlarge the
scope of the law, creating more work for lawyers even as the changes themselves
impose more costs on society. By keeping legal rules in a state of endless
churning, lawyers undermine a stable rule of law and make legal outcomes less
predictable; the result is more litigation and, not incidentally, more billable
hours for lawyers, who must now be consulted about the most routine matters of
business practice and social life.
Mr. Olson
reminds us that the mere presence of law schools on college campuses was deeply
controversial at the turn of the last century. Thorstein Veblen said that law
schools belonged in the academy no more than schools of dancing or fencing,
because their practical, vocational training detracted from the enterprise of
intellectual discovery. Thus if law teachers wanted to become members of the
professoriate, they had to do more than merely impart the content of legal
doctrine. They had to find arguments implicit in academic trends and critique
the law's very architecture. To meet the need for intellectual respectability,
Mr. Olson implies, professors became engineers of reform.
Mr. Olson
shows that the reforms that had the most baleful effects were those that
coincided with the expansionist interests of lawyers. Legal theorists
dismissed, for instance, concerns that a wider use of "equitable
relief"—a doctrine that judges properly employed to enforce school
desegregation—would dissolve the difference between politics and judging. But
the concerns we were well placed: Courts ended up playing an important role in
managing schools, prisons and welfare agencies. Law professors also helped to
develop the class action into an extortionate threat: Companies now pay out
million-dollar settlements rather than bet their very existence on a single
trial that might well impose massive liability.
Mr. Olson superbly describes the rise
of legal clinics, the law-school component ostensibly designed to give students
hands-on training. He notes that the charitable foundations that first funded
these clinics were more concerned with creating turbines of social change than
with educating students. These days, many more clinics engage in
public-interest litigation (defined by a rather predictable liberal agenda)
than devote themselves to matters like the legal ordeals of small businesses,
though thinking about a deli's contract dispute with a supplier would be more
relevant to a law student's future working life. Some of these public-interest
litigation shops have substantial funds. Mr. Olson observes that the budget of
Brennan Center at New York University alone comes to roughly 80% of that of the
Federalist Society, the national organization of legal conservatives that is
routinely vilified by Democratic politicians for its inordinate—and, of course,
pernicious—effect on our legal culture. . .
Mr. McGinnis
is a professor at the Northwestern University School of Law.
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the entire book review at the WSJ (subscription required) . . .
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Book Review Section Is an Insider’s View of What Doctors are Reading about.
* * * * *
10. Hippocrates & His Kin: Subsidizing
Students, Housing, and Healthcare are the same problem
Are
College Students Learning?
In their first two years of college, 45 percent of
students made no significant improvement in skills related to critical
thinking, complex reasoning and communication... After the full four years, 36
percent still had not substantially improved those skills.
Automatic class advancement and grade inflation is the
corruption of education to qualify for aid.
Government money (loans) inflated tuition out of sight and decreased
the quality of education.
Is
the Middle Class disappearing?
The government decides to
try to increase the middle class by subsidizing things that middle class people
have: If middle-class people go to college and own homes, then surely if more
people go to college and own homes, we’ll have more middle-class people. But
homeownership and college aren’t causes of middle-class status, they’re markers
for possessing the kinds of traits - self discipline, the ability to defer
gratification, etc. - that let you enter, and stay, in the middle class.
Subsidizing the markers doesn’t produce the traits; if anything, it undermines
them.
Law
professor Glenn Reynolds on his InstaPundit blog, Sept. 23, 2010
Obama
Care is as popular as Prohibition once was
When the first OPEC oil
shock hit the U.S. in 1973, President Nixon encouraged Americans as a voluntary
gas-saving measure to drive 55 mph on the interstate. Not long after, the
infamous "double nickel" became mandatory as Congress made states choose
between adopting the lower speed limit and losing millions in federal aid. For
two decades, most Americans voted with their gas pedals and flagrantly ignored
the federal speed limit. It had become the least respected law since
Prohibition by the time President Clinton repealed it in December 1995.
Now, as we learn more
about ObamaCare, the odds are good that it will ultimately rank right down
there with Prohibition and the double nickel in public esteem.
Voluntary encouragement
to drive 55 mph was more effective than government mandating 55 mph.
Columnist Janet Daley writing in London's Telegraph, March 19:
But the history of this ignominious
chapter in American foreign policy is already being re-written in Washington
with an enthusiastic chorus of support from Obama fans here: on Friday, Labour
backbenchers and the
Even if we
take this wildly charitable interpretation at face value, what does it say
about the role that America is choosing to adopt on the global stage? That in
the future, we can expect it to follow rather than lead? That it has abdicated
its role as defender and standard bearer for the principle of freedom—the idea
that all men are born with inalienable rights to "life, liberty and the
pursuit of happiness," that the great founding documents of the United
States declare to be universal and not simply the birthright of residents of
one nation? If America is now to make its commitment to those values
conditional—even when the oppressed populations of totalitarian countries are
putting their lives at risk to embrace them—then we are living in a very
different world from the one to which we have been accustomed. WSJ March 21, 2011
How Sad . . .
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read more HHK . . .
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Hippocrates
and His Kin / Hippocrates Modern Colleagues /
The Challenges of Yesteryear, Today & Tomorrow
* * * * *
11. Professionals Restoring Accountability
in Medical Practice, 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.
•
Medi-Share Medi-Share is based on the biblical principles of
caring for and sharing in one another's burdens (as outlined in Galatians 6:2).
And as such, adhering to biblical principles of health and lifestyle are
important requirements for membership in Medi-Share.
This is not insurance.
•
•
PRIVATE NEUROLOGY is
a Third-Party-Free Practice in
•
•
To read the rest
of this section, please go to www.medicaltuesday.net/org.asp.
•
Michael J.
Harris, MD - www.northernurology.com
- an active member in the American Urological Association, Association of
American Physicians and Surgeons, Societe' Internationale D'Urologie, has an
active cash'n carry practice in urology in Traverse City, Michigan. He has no
contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is
nationally recognized for his medical care system reform initiatives. To
understand that Medical Bureaucrats and Administrators are basically Medical
Illiterates telling the experts how to practice medicine, be sure to savor his
article on "Administrativectomy:
The Cure For Toxic Bureaucratosis."
•
Dr Vern Cherewatenko concerning success in restoring private-based
medical practice which has grown internationally through the SimpleCare model
network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service,
the "Cash-Based Revolution." The patient pays in full before leaving.
Because doctor charges are anywhere from 25–50 percent inflated due to
administrative costs caused by the health insurance industry, you'll be paying
drastically reduced rates for your medical expenses. In conjunction with a
regular catastrophic health insurance policy to cover extremely costly
procedures, PIFATOS can save the average healthy adult and/or family up to
$5000/year! To read the rest of the story, go to www.simplecare.com.
•
Dr David
MacDonald started Liberty Health
Group. To compare the traditional health insurance model with the
•
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.
•
ReflectiveMedical Information Systems
(RMIS), delivering
information that empowers patients, is a new venture by Dr. Gibson, one of our
regular contributors, and his research group which will go far in making health
care costs transparent. This site
provides access to information related to medical costs as an informational and
educational service to users of the website. This site contains general
information regarding the historical, estimates, actual and Medicare range of
amounts paid to providers and billed by providers to treat the procedures
listed. These amounts were calculated based on actual claims paid. These
amounts are not estimates of costs that may be incurred in the future. Although
national or regional representations and estimates may be displayed, data from
certain areas may not be included. You may want to
follow this development at www.ReflectiveMedical.com.
During your visit you may wish to enroll your own data to attract patients to
your practice. This is truly innovative and has been needed for a long time.
Congratulations to Dr. Gibson and staff for being at the cutting edge of
healthcare reform with transparency.
•
Dr
Richard B Willner,
President, Center Peer Review Justice Inc, states: We are a group of
healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have
experienced and/or witnessed the tragedy of the perversion of medical peer
review by malice and bad faith. We have seen the statutory immunity, which is
provided to our "peers" for the purposes of quality assurance and
credentialing, used as cover to allow those "peers" to ruin careers
and reputations to further their own, usually monetary agenda of destroying the
competition. We are dedicated to the exposure, conviction, and sanction of any
and all doctors, and affiliated hospitals, HMOs, medical boards, and other such
institutions, who would use peer review as a weapon to unfairly destroy other
professionals. Read the rest of the story, as well as a wealth of information,
at www.peerreview.org.
•
Semmelweis
Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD,
FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD,
Secretary-Treasurer; is
named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician
who has been hailed as the savior of mothers. He noted maternal mortality of
25-30 percent in the obstetrical clinic in
To view some horror stories of atrocities against physicians and
how organized medicine still treats this problem, please go to www.semmelweissociety.net.
•
Dennis
Gabos, MD, President of
the Society for the Education of Physicians and Patients (SEPP), is
making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms
and Responsibilities of Patients and Health Care Professionals. For more
information, go to www.sepp.net.
•
Robert
J Cihak, MD, former
president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an informative
Medicine Men column at NewsMax, have now retired. Please log on to
review the archives. He now
has a new column with Richard Dolinar, MD, worth reading at www.thenewstribune.com/opinion/othervoices/story/835508.html.
•
The
Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private
Physicians since 1943, representing physicians in their struggles against
bureaucratic medicine, loss of medical privacy, and intrusion by the government
into the personal and confidential relationship between patients and their
physicians. Be sure to read News of the Day in Perspective: Governors, You Can Say No
to the Feds! Don't miss the
"AAPS News," written by Jane Orient, MD, and archived on this
site which provides valuable information on a monthly basis. Browse the
archives of their official organ, the Journal
of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a
neurologist in
The AAPS California
Chapter is an unincorporated
association made up of members. The Goal of the AAPS California Chapter is to
carry on the activities of the Association of American Physicians and Surgeons
(AAPS) on a statewide basis. This is accomplished by having meetings and
providing communications that support the medical professional needs and
interests of independent physicians in private practice. To join the AAPS
California Chapter, all you need to do is join national AAPS and be a physician
licensed to practice in the State of
Go to California
Chapter Web Page . . .
Bottom
line: "We are the best deal Physicians can get from a statewide physician
based organization!"
PA-AAPS is the Pennsylvania Chapter of the Association of
American Physicians and Surgeons (AAPS), a non-partisan professional
association of physicians in all types of practices and specialties across the
country. Since 1943, AAPS has been dedicated to the highest ethical standards
of the Oath of Hippocrates and to preserving the sanctity of the
patient-physician relationship and the practice of private medicine. We welcome
all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors
and other medical professionals are welcome to join as professional associate
members. Staff members and the public are welcome as associate members. Medical
students are welcome to join free of charge.
Our motto, "omnia pro aegroto"
means "all for the patient."
I fear we are developing a group of
competent technicians, treating disease, but not treating the whole patient.
All medicine is judgment. I can bring anybody in off the street and teach him
how to cut and sew in three months. It is knowing when to operate and when not
to operate that matters. –
The twentieth century will be remembered
chiefly, not as an age of political conflicts and technical inventions, but as
an age in which human society dared to think of the health of the whole human
race as a practical objective. –
Euthanasia is a long, smooth-sounding
word, and it conceals its danger as long, smooth words do, but the danger is
there, nevertheless. –Pearl S. Buck
To save a man’s life against his will is
the same as killing him. –Horace
Some Recent
Postings
In The March 8 Issue:
1. Featured Article: Taming the Wild
2.
In the News: Artificial intelligence is
developing much more rapidly than most of us realize.
3.
International Medicine: Here’s the ugly truth about
government-controlled health care
4.
Medicare: Medicare Newsletters
may be more important to read than Medical Journals
5.
Medical Gluttony: ER visits are
becoming a separate circular practice which is gluttonous
6.
Medical Myths: The Practice of Medicine
is a Myth to most attorneys
7.
Overheard in the Medical Staff Lounge: Professional
Organizations
8.
Voices
of Medicine: ObamaCare
Is Already Damaging Health Care
9.
The Bookshelf: Stammering George the
Sixth
10.
Hippocrates & His Kin: Troopers Hunt
for Wisconsin Senators
11.
Related Organizations: Restoring Accountability in HealthCare, Government
and Society
Words of Wisdom,
Recent Postings, In Memoriam . . .
By ERIC GIBSON
ARTS &
ENTERTAINMENT | WSJ | MARCH 24, 2011
It's not
every day that the passing of an art historian becomes a media event. But then
Leo Steinberg, whose death in New York on March 13 at age 90 was widely
reported in the print media and blogosphere, was no ordinary art historian.
Nominally he was a University of Pennsylvania professor whose specialty was
Renaissance and Baroque art, the work of Michelangelo in particular. (He
retired in 1991.) But he spoke to a far wider public through his writings, and
in doing so changed the way an entire generation looked at and thought about
art.
During the
1950s and '60s the reigning orthodoxy, articulated by Clement Greenberg, the
most influential art critic of the day, held that what mattered in a work of
modern art were its formal qualities—color, form and their disposition across
the flat canvas support. Subject matter and symbolism were considered of no
account.
By contrast,
Steinberg's own experience of art, and his academic training, had persuaded him
that works of art are far more complex than such a reading allowed, a point
that informed his lectures and published works.
An example
was "The Philosophical Brothel," a two-part article on Picasso's
"Les Demoiselles d'Avignon" (1907) that Steinberg published in
ARTnews magazine in the fall of 1972. For decades "Les Demoiselles"
had been referred to as the "first Cubist picture" because of the way
its fragmented forms and crystalline spaces broke with 500 years of eye-fooling
illusionism that began with the Renaissance. Its narrative content, a brothel
scene, was mentioned only in passing.
Without discounting the stylistic revolution the painting
heralded, Steinberg argued that the brothel subject was central to its form and
meaning. The painting, he said, was about the sexual confrontation between the
five prostitutes staring out from the painting and the viewer standing in front
of it.
But it was in
"Other Criteria: Confrontations With Twentieth-Century Art,"
published a few months later, that Steinberg's aesthetic outlook found its
fullest expression. An anthology of 18 articles and essays, the book
constituted a thoroughgoing alternative to the accepted way of seeing. It's
hard to overstate the impact it had when it appeared. It was as if someone had
opened a window in a dark, airless room, and brought works of art back to life
again.
At its core were two pieces, the title essay and another,
"The Eye Is a Part of the Mind," that offered the most sweeping
argument against Greenbergian formalism. Drawing on examples from the Old
Masters to modern art, he showed that the ways works of art are made and
experienced are too sophisticated, too multilayered to be easily reduced to the
two-dimensional schema Greenberg proposed. Today the length of these
pieces—some 20,000 words between them—might seem like overkill. Yet it is a measure
of how firmly the formalist aesthetic was entrenched that such an all-out
assault was required.
But Steinberg was more than a polemicist; he led by
example. The remaining pieces in "Other Criteria" are on artists or
artworks—among them Picasso, Rodin, Jasper Johns, Monet's water-lily paintings.
Undergirding his examinations was the question, "What is the artist trying
to tell us?" In his quest for answers Steinberg didn't limit himself to
the history of art, but looked at popular and material culture as well. He
would even adopt the posture of a depicted figure, the better to understand it.
He seemed to
transform every work of art he wrote about; you never looked at one the same
way after reading what Steinberg wrote about it. The three essays on Picasso
were ahead of their time in seeing the artist's career as a unity of motifs,
themes and obsessions spread across eight decades, rather than, as had long
been the practice, in narrowly stylistic
terms—"Cubism-and-everything-else." His essay on Rodin remains the
best introduction to the artist yet published.
Besides
possessing a keen eye, wide-ranging intellect and stubborn resistance to
received wisdom, Steinberg was a born writer—and English was his third
language. (He spoke Russian and German first.) In place of the desiccated,
impersonal drone of most academic writing, we get a voice—a flesh-and-blood
personality—and a fluid, impassioned and nuanced prose stylist. He didn't just
illuminate a work of art; he captured the experience. The 186 figures on Rodin's
"Gates of Hell," he wrote, "drift and writhe like leashed flying
kites." . . .
Mr. Gibson is the Journal's Leisure &
Arts features editor.
Read
the entire obituary/feature on the WSJ
(Subscription required) . . .
On This Date in
History - March 22
On this date in 1882, Edwards Law outlawed
polygamy in the U.S. It was aimed at dissident Mormons who were clinging
to that sect’s earlier belief in the idea of multiple wives. It was a time when
nice people did not talk about sex, women didn’t have many rights and the
opponents of polygamy were convinced that they were striking a mighty blow for
morality. The solution adopted in our own times has been a different version of
multiple wives—or husbands. To phrase it in electrical terms, it is now done in
series instead of in parallel.
On this date in 1621, Governor John Carver
of
After Leonard and Thelma
Spinrad
* * * * *
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The Annual World Health Care Congress
Advancing solutions for business and health care
CEOs to implement new models for health care affordability, coverage and
quality.
In partnership with MedicalTuesday.net, the 7th
Annual World Health Care Congress was the most prestigious meeting of chief
and senior executives from all sectors of health care. The 2010 conference
convened 2,000 CEOs, senior executives and government officials from the
nation's largest employers, hospitals, health systems, health plans,
pharmaceutical and biotech companies, and leading government agencies.
Please watch this section for further reports in the future as well as www.HealthPlanUSA.net.
The 8th Annual
World Health Care Congress will be held April 4-6, 2011
www.worldhealthcarecongress.com
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