Community For Better Health Care
Vol X, No 13, Oct 14, 2011
In This Issue:
11. Related Organizations: Restoring Accountability in HealthCare, Government and Society
Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .
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Annual World Health Care Congress, a
market of ideas, co-sponsored by The Wall Street Journal, is the most
prestigious meeting of chief and senior executives from all sectors of health
care. Renowned authorities and practitioners assemble to present recent results
and to develop innovative strategies that foster the creation of a
cost-effective and accountable U.S. health-care system. The extraordinary
conference agenda includes compelling keynote panel discussions, authoritative
industry speakers, international best practices, and recently released
case-study data. The
9th Annual World Health Care Congress will be held April 16-18, 2012
at the Gaylord Convention Center, Washington DC. For more
information, visit www.worldcongress.com. The
future is occurring
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1. Featured Article: Nobel Prize in Physiology & Medicine for Innate and Adaptive Immunity
Discoveries Concerning Innate and Adaptive Immunity Win
2011 Nobel Prize
in Physiology or Medicine [Update]
Bruce Beutler, Jules Hoffmann and Ralph Steinman share the prize for their elucidation of the complex workings of the immune system
| Scientific American | October 3, 2011
The 2011 Nobel Prize in Physiology or Medicine was awarded today to Bruce Beutler at the Scripps Research Institute in California, Jules Hoffmann at the French National Center for Scientific Research and Ralph Steinman at The Rockefeller University in New York City. Beutler and Hoffman helped to elucidate innate immunity, the non-specific array of initial responses by the body’s immune system that can recognize invading microorganisms as being foreign and try to destroy them.
Steinman investigated dendritic cells and their key role in adaptive immunity, the specialized response to specific invaders that comes into play when innate immunity isn’t enough. Thanks to adaptive immunity infected cells get wiped out, and exposure to a specific pathogen can leave us with long-standing protection against that pathogen.
The detailed understanding of the immune system provided by the new Nobel laureates has given other researchers the ability to improve vaccines and to attempt to stimulate immune reactions to cancer. Their insights also inform efforts to damp down the immune system when it becomes too zealous, which can lead to excessive inflammation and autoimmunity.
[UPDATE, 1:00 PM ET]
Steinman, 68, died on September 30, three days before today's announcement, after battling pancreatic cancer for four years. "His life was extended using a dendritic-cell based immunotherapy of his own design," The Rockefeller University spokesman Joe Bonner said in a prepared statement.
This unanticipated turn of events raises questions about the status of Steinman's award going forward. According to Nobel Committee rules, the prize can be awarded posthumously only if the laureate dies between the October announcement and the award ceremony, held annually on December 10 in Stockholm, Sweden. The Rockefeller University itself only "learned this morning from Ralph's family that he passed," Marc Tessier-Lavigne, the university's president, said in a prepared statement. Because the committee was apparently unaware of Steinman's death prior to today's announcement, the group will make a decision about the status of the award to Steinman—and associated prize money—shortly. Steinman was listed last year as a likely winner in Thompson Reuter's annual shortlist predictions.
[UPDATE, 4:00 PM ET]
The Nobel foundation has announced that Steinman will remain a prize winner.
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Meeting debates ethics of revealing bad genetic findings to subjects
By Erika Check Hayden of Nature magazine NEW YORK
The question is becoming increasingly pertinent, as thousands of people sign up for studies in which their genomes will be sequenced. But, at present, federal laws in the United States prohibit researchers from telling patients about mutations that might affect them or their families unless a certified clinical lab has confirmed the results--something that is not done in most research projects. This means that patients often do not learn about their mutations until the studies are finally published, a restriction that is meant to ensure they are not misinformed by incomplete research.
The ethical dilemmas became all too real last year for geneticist Gholson Lyon, a geneticist at the Utah Foundation for Biomedical Research in Salt Lake City. He was studying an extended family in which some of the boys had been born with a constellation of symptoms, including thick, wrinkly skin, and who ultimately died of cardiac disease before their first birthdays. By November 2010, Lyon had convincing evidence that a genetic mutation was causing the disease. That's when he learned that one of the women in the family was four months pregnant with a boy.
Lyon knew from his study that the mother carried the mutation. But he was not allowed to tell her, because the analysis had not been performed in a laboratory that was certified under the Clinical Laboratory Improvement Amendments, which aim to ensure that clinical tests are accurate and reliable.
The baby was eventually born with the disease--called Ogden syndrome--and later died, in the same week that Lyon's paper on the causative mutation was published. . .
Genome sequencing is now starting to be used in the clinic to guide diagnosis and treatment decisions. At the Medical College of Wisconsin in Milwaukee, for example, pediatrician and geneticist David Dimmock offers genome sequencing to children with undiagnosed diseases. The program is controversial because many researchers think that too little is known about how most rare genetic mutations contribute to disease for the knowledge to help patients. He points out, however, that a handful of cases have been reported in which sequencing has led to a cure or improved treatment.
Using a clinically certified lab, Dimmock's team sequenced the genome of an infant with acute liver failure, and discovered that she had two mutations in a gene called Twinkle. Earlier research had linked those mutations to progressive eye and neurological conditions, and an associated liver disease. As a result, doctors determined that a liver transplant--a standard treatment for acute liver failure--would not help the infant, and recommended against it. She died when she was 6 months old.
"This was not a happy ending--but in a sense it was," says Dimmock. Disclosing the genetic information spared the infant from spending her remaining few months recovering from a grueling, unnecessary transplant, he says, and saved a scarce liver for a child who might benefit from it more.
This article is reproduced with permission from the magazine Nature. The article was first published on October 4, 2011.
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3. International Medicine: Private Partnership takes over a failed NHS Hospital in Cambridge.
Guest Editorial: Julie Meyer, CEO & Founder, AriadneCapital.com
Every once in a while, something happens which makes you want to let loose a loud "hurrah"! That happened to me last week when I was rushing around getting ready on Thursday morning, and heard on the BBC Breakfast show that Ali Parsa's Circle Partnership has taken over the running of a failed NHS hospital in Cambridge.
What do we know about Circle Partnership? They have a unique model of “incentivizing” their staff by giving them 49.9% of the ownership of the company. They have set up their own private hospitals which seem to be run incredibly well with "Mandarin Oriental" chefs in some situations. They are founded by two entrepreneurs who refuse to believe we have to settle for bad care in certain hospitals. They appear to have guaranteed that the debt that the Cambridge hospital had run up would be repaid within 10 years. In short, they are bucking the trend on several points.
I have to admit - I love excellence. I want to support people who lead their lives by believing in delivering excellence in every situation - not just for the wealthy, but who believe everyone deserves great care, great service, great responsiveness.
Now is not the time to be ideological. Those who would spout ideological arguments about what's wrong with this situation need to force themselves to accept that the NHS has failed in many ways.
That failure is one of not grasping human psychology. People do what it is in their self-interest to do. That self-interest needs to be understood in the broadest sense. People want to do excellent work. They want to help their fellow man. They want to be proud of a day's work, and the fruits of their labour. These things bolster their sense of self, and contribute to a great community. People also want to win. They want to be a part of things with momentum, which are making a difference, which are coming out on top.
It strikes me that the Circle Partnership gets that fundamental psychological make-up much better than the NHS.
Because we tend to be very ideological about the NHS in this country, and people say things like "profit must never have anything to do with healthcare", we end up with a health system which is chronically wasting money, delivering poor care for a section of its constituency, and making decisions without thinking about whether they are sustainable.
Case in point: caesareans. On the 30th of October, the Sunday Times reported that all women in the UK will soon have the right to give birth by caesarean. However, they are £800 more expensive than a natural birth. If we reduced the current rate of the procedure by 1 percentage point a year from the current level of 25% of annual births, the NHS would save £5.6 million a year. But unless you have a stake in the outcome, you don't consider the cost implication of decisions you take. It's human nature to spend your own money differently than you would others. And therein lies the flaw. Until we have every patient understanding that it's "their money", and that it's in "their interest" for them to consider the cost of healthcare decisions, we'll be on a one way ticket to bloated spending in the NHS, and not necessarily the best care through the service either.
If the average Occupy Wall Street protestor or Occupy St Paul's equivalent knew how much money is wasted in public services, they might quickly turn their anger from the bankers to the government and public services. In a word, they'd probably go "ape-shit".
The Daily Mail on the 11th of November reported that "Brussels squandered £3.7 billion". In the article, it was reported that the European Court of Auditors had refused to sign off the spending in the EU's accounts for the 17th year in a row. "In total, 3.7 percent of the £101 billion annual budget was 'materially affected by error", according to the auditors.
17 years in a row? If auditors refused to sign off on accounts of a UK PLC or SME for 2 years in a row, the company would be struck off, closed, or made bankrupt. Why do we tolerate this level of irregularity with "our money"?
Somethings are actually very simple in life, and don't need to be complicated. In every system whether that is a household, company, country or a eurozone, there are revenue centers and cost centers. The net is the profit or loss. If the former outstrips the latter, you're ok. You build through time, a surplus. We seem to act as if we're trust fund children sometimes when we are so uninterested in saving the £3.7 billion of wasted European money or the £5.6 million that we could save by not giving women the right to have caesareans. Are we so wealthy? Turn on the BBC or CNN and watch the news.
But the real damage is to the psyche of the 4.8 million SME's in the UK who have to fight the good fight of building their sustainable businesses. They are the ones who are creating a lot of the top line revenue which will fill the country's coffers through tax revenue. As NESTA, the UK's Innovation Agency shows, the 6% of all UK firms who are described as high-growth create 54% of the new jobs. How must it feel to have someone maxing out your credit cards faster than you can pay them down?
Time to wake up. There is no global sugar daddy in the sky. People, businesses, and countries choose to be rich or poor. Their actions of investing in themselves, living within their means, working for the group win, and not imagining that someone will bail them out create wealthy structures - whether families, firms or trading areas.
As we celebrate Global Entrepreneurship Week this week, we might want to dwell on two thoughts which may seem radical for some:
· Society works best when it's organized around the entrepreneur.
· The UK could open its healthcare industry to entrepreneurs like Ali Parsa, and achieve global excellence in healthcare while also creating massive GDP for the nation.
The NHS does not give timely access to HealthCare; it only gives access to a waiting list.
After half a century, the NHS should give access to HealthCare.
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Medicare reimbursement rates have faced potential cuts
since 2001 as determined by the Sustainable Growth Rate (SGR) which was passed
into law in 1997. Except for 2002 when payments were cut by five percent,
Congress has intervened on 12 separate occasions since then to prevent
additional cuts. Physicians now face a potential 29.5 percent reduction in
Medicare reimbursement as of January 1, 2012. Now, the recent budget and debt
ceiling debates have added a second challenge. As part of the deal to raise the
debt ceiling, $900 million in cuts will be worked out as part of the normal
appropriations process in the coming months.
Though Medicare and Medicaid rates will not be touched during this first round of budget cuts, a Joint Select Committee on Deficit Reduction has been established whose job will be to recommend additional, deeper cuts to all federal programs, including Medicare. Though the cuts would be limited to two percent of total spending for Medicare, benefits and copayments would not be touched, meaning that these cuts and savings would be borne by providers.
Since Medicare reimbursement rates influence private insurance reimbursement rates, these cuts could lead to further reductions in physician reimbursements. In addition, the state of California has proposed a ten percent Medicaid physician payment reduction. The Centers for Medicare and Medicaid have until September 30 to make a determination on this proposal. . .
So now we face a perfect storm of continuously rising medical costs, a poisonous political atmosphere bent on budget reduction and slashing programs and a possible 30 percent reduction in Medicare reimbursement rates. It should be added that most experts do not think that Congress will allow this drastic cut. Regardless of whether and how the SGR is fixed in the upcoming budget negotiations, and despite how data regarding health care costs and health metrics is assessed, we will be facing attempts to lower the costs of health care for the sake of sustainability.
But rather than try to maintain the status quo and continue to simply fight for our share of very limited resources, physicians must become even more proactive in our coming to the table and offering truly innovative ways to reduce health care costs. Ideas to consider include increasing efficiency and productivity using information technology, integrating and restructuring how we organize care, utilizing evidence based medicine, including cost analysis, working with public policy to improve the health and safety of the public, improving access to preventative services, and helping our patients and their families make difficult decisions about the type of care they desire, particularly at the end of life. Costs will continue to rise, but rather than simply respond to political, social and economic changes, we need to drive the discussion and debate. The medical society welcomes your comments and ideas as we work to create a sustainable and just health care system. Ω
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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5. Medical Gluttony: Driving the Rich to Off Shore Medicine or into the Sea
Megaship ahoy! To escape higher taxes, the wealthy could relocate...to open waters
By SCOTT ADAMS. Creator of Dilbert
. . . Reliable people on television have informed me that taxes are the root cause of all behavior. And that means we can predict the future by looking at tax policy. In fact, I hear tax-related predictions every time I accidentally stop thinking about myself long enough to notice that others are talking. What I haven't yet seen is anyone correctly predicting the future based on tax policy. Apparently that burden has fallen to me.
Somewhere in Washington our leaders are furiously planning an economic death spiral. It will start innocently with a modest tax increase on the rich, the same way you might pluck a chicken to give it fair warning before you barbecue it. The final phase will involve a tax rate on the top 1% of earners that is so high it can't be described without the Viking word for pillage. I base my prediction on the fact that the country is out of money, poor people don't have any, rich people do, and the middle class has almost figured out how voting works.
In the old days, every member of the middle class thought he or she had a chance of becoming rich. In that sort of optimistic environment, you don't want to urinate in the pool that you hope to someday swim in. But lately there's more fatalism in the air, thanks to our crushing debt and the hobo militias that I assume are forming all over the country. The middle class will soon trade their unrealistic dreams of wealth for the opportunity to transfer money from total strangers to themselves—a process often referred to as fairness. That's when the rich will get serious about an escape plan . . .
But where can the rich go? Their choices include nations that have swarms of malaria-infested mosquitoes, bad TV, deadly climates, decapitation issues, French people, bland food and other signs of inhospitableness. When you consider these factors plus wars, pollution, terrorism, floods, droughts, earthquakes and tornadoes, I think you'll agree that most of the surveyed land on Earth is unfit for fancy people.
This is where technology trends come in. We've already entered the era of megaships, including plans for island-size vessels with permanent homes and businesses. We'll soon see rapid advances in high-speed Internet for seafaring vessels, floating fisheries, hydroponic gardens, energy generated from waves, and desalination. The only other element needed to trigger mass migration of the wealthy to the oceans is a financial motive. If a billionaire can escape taxation by leaving his dirt-based country behind, he'll save more than enough money to pay for his floating fortress of awesomeness.
Out at sea, you can declare your own sovereign state or form alliances with other island-vessels. Taxes would be a thing of the past. Any government-like decisions can be handled through a Facebook page. The only downside would be listening to Ron Paul nagging you to use Twitter instead to keep government small.
Pirates would be a cause of concern, obviously. But if a billionaire has enough money to buy an island-size vessel, he probably has enough to outfit it with a drone air force, radar, sonar, laser guns, torpedoes, ship-to-ship missiles, and other technology so cool that just thinking about it raises my testosterone count.
If some country with a military tells you to move from its favorite part of the ocean, you can turn off your stabilizers and let the current do the rest. Your island home would be like a Gandhi that floats. (That's not redundant, because I'm almost positive that Gandhi would go straight to the bottom of the pool if he tried to tread water.)
And no nation is going to try to conquer an island vessel for its treasure, because most of the residents' riches will be invested in financial instruments, not stuffed in mattresses on the ship. For a fully equipped military, the cost of attacking an island vessel would exceed the value of the designer handbags and gold toilets it could seize.
The ocean is the safest place on Earth if you play it right. Super hurricanes caused by climate change (allegedly!) are no problem for ships that can relocate at any time. And droughts can't hurt you if you get the desalinization technology right. There's almost no problem so big that it can't be avoided by a billionaire in the middle of an ocean.
You might doubt my vision of the future, but let me ask you two questions: 1) How big is Larry Ellison's yacht? 2) Does his Japanese-style house have paper walls for realism or to make it lighter because he plans to someday lift it with helicopters and move it to his boat?
—Mr. Adams is the creator of "Dilbert."
Medical Gluttony thrives in Government and unlimited taxation.
It Disappears with no taxes so we can afford unlimited health care without insurance
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6. Medical Myths: People should drink at least eight glasses of water a day.
Researchers from the Indiana University School of Medicine made a list of common medical beliefs espoused by physicians and the general public. The study authors, Dr. Rachel C. Vreeman and Dr. Aaron E. Carroll found no scientific evidence for this advice, although they found several unsubstantiated recommendations in the popular press.
The source may be a 1945 article from the National Research Council, part of the National Academy of Sciences, which noted that a “suitable allowance” of water for adults is 2.5 liters a day, although the last sentence noted that much of it is already contained in the food we eat.
“If the last, crucial sentence is ignored, the statement could be interpreted as instruction to drink eight glasses of water a day,” Dr. Vreeman and Dr. Carroll noted. “Existing studies suggest that adequate fluid intake is usually met through typical daily consumption of juice, milk and even caffeinated drinks.”
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: Kitty Werthmann, whose husband was a physician in Austria, stated “practicing medicine under government control was like practicing on a conveyer belt.”
Dr. Rosen: Can we learn from History?
Dr. Dave: I certainly can. I don’t see any doubt about how terrible socialized medicine is and can become. The patients whom we serve just become a commodity.
Dr. Edwards: It takes all that is human and humane out of the practice of medicine and turns us into insensitive Robots. When the people complain of HMOs, they are really talking about the insensitivity of the system to their needs.
Dr. Ruth: I must say that I was hoodwinked when our medical group was taken over by an Independent Practice Association (IPA) and started writing contracts with a number of HMOs. I didn’t think it would turn out this badly. Their intrusion into the practice of medicine was so gradual.
Dr. Kaleb: I certainly did not see it coming. Being a relative newcomer to practice in California, I certainly would not have expected this surge in patient adverse practice.
Dr. Michelle: I never joined the local physician practice group that got swallowed up by the IPA. So my practice has not significantly changed since I went into practice in 1980. I have a fairly busy four day week, a very controlled practice and very little night or weekend work.
Dr. Milton: I was very concerned about the future of medicine and thought the HMOs were the way to provide services to everyone. I have come to realize that this has not provided the outreach to the disenfranchised. They just don’t fit into a private practice. I think most of them would be more at home in the old county hospital system.
Dr. Rosen: You think we got rid of the county hospital system too soon?
Dr. Milton: I don’t think we should have gotten rid of it at all.
Dr. Rosen: Wouldn’t that have given us a two-tier healthcare system?
Dr. Milton: If you think of two-tiered health care as superior vs. an inferior system, you may be correct. But I don’t think the poor and disenfranchised ever meshed with the private insurance or private pay population. They aren’t responsible in keeping appointments, don’t understand appointment time frames, bring all their kids to the appointments like they used to do at the county hospitals, even bring babies in arms. When asked “how can I examine you with a baby in your arms?” they look non-plus. I think some have never had their bodies examined by a physician. It’s hard to navigate a stethoscope between a baby and a woman’s chest to examine the lungs.
Dr. Rosen: I guess most of us graduated before the advent of Medicare and the closure of the county hospital system. Would you volunteer for a month a year to make ward rounds in a county hospital?
Dr. Milton: Certainly. Gladly. With the extra work that the HMOs have created there wouldn’t be any time to volunteer.
Dr. Yancy: As a practicing surgeon, I saw the forceful reduction in my fees as being so ominous that I retreated within the first year. I no longer see any HMO patient.
Dr. Rosen: What type of patients do you see? Medicare and Medicaid?
Dr. Yancy: Neither. I only see private insurance and private pay. I’m not very busy, but my income hasn’t dropped. Not even during the current recession. I enjoy life with family and friends, and take my biannual vacation to Israel.
Dr. Rosen: I don’t see you at the medical society meetings.
Dr. Yancy: They keep inviting me and saying I need their “advocacy.” But I’m seeing them advocate for government medicine, so I think I made the right decision. I’m glad I didn’t waste my time on their non-support of private practice.
Dr. Rosen: Or actually working against the private practice of medicine.
Dr. Milton: Actually they are working in sync with the AMA since they may be considered the county chapter of the AMA.
Dr. Edwards: And while we’re discussing organized medicine, let’s not forget about the state chapter which is also in sync with the AMA just as we’re in sync with both.
Dr. Rosen: So it looks like we agree that organized medicine is not supportive of private practice which is the way all of us around this table make a living.
Dr. Edwards: Not being for private practice is actually very significant. That means they are not in tuned with free enterprise, entrepreneurial endeavors, freedom in general. By extension, it means they prefer the Europeanized health care system and non-representative form of government.
Dr. Rosen: Most of the EU officials are appointed. There is never a correction to the wishes of the people by a vote. That almost takes them back to the Feudal system of the sixteenth century. They didn’t even have rest rooms or running water in those days. It’s unfortunate that the Wall Street Sit Ins don’t comprehend that.
The Staff Lounge Is Where Unfiltered Opinions Are Heard.
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From the Fresno-Madeira Medical Society Newsletter: VITAL SIGNS / SEPTEMBER 2011
Prahalad B Jajodia, MD, Editor
Medical care can be thought of as a luxury item priced somewhere between the cost of an I Love Fresno T-shirt and a trip to the International Space Station. As with any luxury item, its purchase may be deferred when finances are tight and difficult choices must be made. “Honey, we can’t have both, so let’s take that vacation to Rome now. You can have the brain surgery next year.” Setting aside the potentially dire health consequences of deferring needed treatment; quite frankly, fewer office visits means less income for your practice.
The economy is a mess. Unemployment is high. Consumers are tapped out. The federal government is tapped out. There’s gridlock in Washington. The GDP is anemic. Half of the European Union is struggling with default. Austerity is the byword. China is facing its own housing bubble and its central bank has been tightening. All of these factors bode ill for a swift return to the carefree days of filled appointment books.
During years of prosperity, it’s easy to develop a cost structure, both in our business and personal lives, which cannot be sustained in times of trouble. A wise businessman once told me: “The secret to long-term success is to keep your expenses low.
During hard times you’ll survive; during good times you’ll prosper.” This advice is so important that I need to shout it: KEEP YOUR EXPENSES LOW! (Sorry. Didn’t mean to hurt your ears.)
Keeping expenses low involves separating what is necessary from what is merely nice. Each person is different. Each practice is different. Only you are qualified to decide what is necessary and what is nice in your business. And since the economy could just as easily become worse as opposed to better, please don’t wait. You’ll sleep better at night.
The same is true of our personal finances. It’s easy to accumulate what I call parasitic expenses. These are recurring expenses that, once made, constitute a continuing drag on our bank balance. They can be as simple as a subscription to a magazine that’s rarely read or as expensive as that beach house you’re still supporting long after you realized it would be cheaper and easier to rent.
Check out your debit and credit card expenses to see where your money is going – not where you think it’s going, but where it’s really going. Then ask yourself this: When you were struggling through medical school, was your primary objective to make sure that the best restaurant in your town would be successful? That the auto dealership would finally be able to sell that purple Maserati? That a local contractor would realize his lifelong dream of building a mansion with ten bathrooms? All I’m saying here is give your expenses some thought. Maybe it’s time to do some judicious pruning. Maybe it’s time to separate what is necessary from what is merely nice.
Fortunately, there’s a light shining in our economic tunnel that isn’t a locomotive barreling toward us. It’s interest rates. Mortgage interest rates are very low (30-year fixed is 4.375% APR 4.559% at West America Bank). They may go lower in the coming weeks. With a one percent interest rate reduction on a high-balance mortgage, refinancing makes sense. Anything better than that is a no-brainer. For example: If you’re currently in a 400k mortgage at 6% and you refinance at 4%, you could save $178,000 over the life of the loan.
That means more cash in your pocket each and every month. It’s something to think about. And if you have outstanding credit debt at high interest rates that your cash flow can’t seem to hammer down, you may want to consider rolling them in too.
There’s an old saying: No matter how much equity you have, when you run out of cash, you’re out of the game. In the long run, your balance sheet is king, but in the short run (particularly in difficult times), cash flow is most important.
Separate what is necessary from what is nice to keep your monthly expenses low. Pay down or refinance high interest credit cards and mortgages at a lower rate.
If you’re still struggling, make a budget and stick to it. It’s very important to make sure your monthly income exceeds your expenses by a comfortable margin. That margin could erode at any time. Prepare for the worst and hope for the best.
Peace and prosperity to you and yours,
Dr. Jajodia is a practicing gastro-enterologist and liver specialist in Fresno.
If you have any questions, you may call him at (559) 431-8888 or email at firstname.lastname@example.org.
VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about
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[Editor’s note: Dr. Lipsenthal died in late September, shortly after this review was written. He had completed Enjoy Every Sandwich earlier this year and had planned to make a book tour that was scheduled after its scheduled publication in November. When he learned in August that his cancer had returned, he posted online his philosophy of strength in the face of the inevitable: “My meditation practice has eliminated my fear of dying, opening me up to what might come after death and allowing me to just be there for the ride. I am at peace: awake and aware. So, here I am, dying awake.”]
Sonoma Medicine: CURRENT BOOKS: The Healer Within By John Toton, MD
In recent years, two popular works—one text and one video—have addressed the finality of one’s life and demonstrated that the adventure can be so constructive that it might be rationally enjoyed rather than feared.
In Tuesdays with Morrie, published in 1997, Mitch Albom, the onetime pupil of Prof. Morrie Schwartz, reconnects with his spiritual mentor after many years, finding Morrie dying, ever so slowly, from Lou Gehrig’s disease. In weekly meetings that become ever more difficult for both, the old professor teaches the reclaimed student that many of us have become obsessed with the trivialities of life to the expense of our human relationships. The professor’s wisdom encourages Mitch to be attentive to what really matters in life.
Ten years later, in September 2007, Randy Pausch, a professor of computer science at Carnegie Mellon University, gave a lecture to his students titled “Really Achieving Your Childhood Dreams.” Pausch, a young man still in his prime with a family and successful career, and an admired teacher in the developing field of human-computer interaction, had been diagnosed with pancreatic cancer a year earlier. Shortly before his lecture, it was found to be incurable and fatal.
Though Randy appeared to be fit, he knew that this would be his last lecture. His goal was to teach his students all he could about family, encouraging them (and us) to have fun and enjoy everything one does in life, living it to the fullest because one never knows when it can be taken away. He says he would rather have cancer than be hit by a bus, because at least with the cancer he has time to prepare family for his death. The lecture, posted in its entirety on YouTube, became so popular that it was transcribed into a book, remaining on the New York Times bestseller list for almost two years.
Clearly the public is fascinated by the topic of “a good death.” One common thread with Morrie and Randy is that the dying person is a professor who has dedicated his career to teaching.
Physicians are also teachers, with patients/students who seek their experience and knowledge to guide them through life. When the doctor/teacher faces the same challenge as Morrie or Randy, a physician’s perspective can be quite valuable.
In Enjoy Every Sandwich, Dr. Lee Lipsenthal, a Marin County physician known to many of us as a motivational speaker and associate of Dr. Dean Ornish, faces his terminal diagnosis of cancer. He memorializes his challenge and response beginning July 19, 2009, the day he makes himself a bacon, lettuce and tomato sandwich but can’t swallow it. For some unknown reason, it gets stuck in his esophagus. With tongue in cheek, his physician wife reassures him, “It’s just a stricture; forty years of heartburn will do that; you’ve had a hiatal hernia since birth.” A classic medical response, but nonetheless both doctors know intuitively that they need a real diagnosis. With their backdoor access to the medical community, they get a GI consult and endoscopy the next day.
The gastroenterologist specifies an “erosion” as the cause and performs a biopsy. Lipsenthal waits for the result with a sense of apprehension. “I’m a physician,” he says to his gastroenterologist friend, when told he should come to the office to discuss the biopsy report. “What is it?”
It’s an adenoma of the distal esophagus.
At that moment, Dr. Lee Lipsenthal, the prominent physician—whose medical practice consists of treating the sickest cardiac and diabetic patients, encouraging them to what health they can achieve, and supporting them when little or nothing can be done—realizes that he is now, at 52 years of age, a patient with a 90% five-year death sentence. He himself has never seen a patient with this diagnosis survive. His will not be an easy or painless death.
Lipsenthal faces the burden of “how to let one’s wife, let your children down easily.” His physician wife will want every possible treatment, proven and experimental. His son is just starting college and will likely graduate without his father there. Thankfully, his daughter is still at home.
There are also Lipsenthal’s parents back East, who have lived their lives with (and passed on to their children) a paranoia that, “Bad things can happen to the unwary, so watch out.” Lipsenthal has made every effort to beat back this cultural fear over the years, but he knows that telling his parents about his condition will predictably break them. . .
Just like Morrie and Randy, Lipsenthal reaffirms the importance of having a true sense of gratitude for life and for living every day with joy, love, and laughter. He adds for our consideration prayer, meditation, exercise, yoga, art, acceptance and knowledge.
Lipsenthal does undergo a full course of chemotherapy. . . He experiences a temporary physical and emotional recovery, during which he offers a course titled “The Healer Within” to both the general public and the healing professions. Meanwhile, his marriage continues to thrive. As he says in the book’s foreword, “I no longer have a bucket list, I have love in my life”.
Dr. Toton, an orthopedic surgeon, serves on the SCMA Editorial Board.
The Book Review Section Is an Insider’s View of What Doctors are Reading about.
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10. Hippocrates & His Kin: Scars of War
Cities are planning for the 70,000 U.S. Troops scheduled to come home from Iraq and Afghanistan by next summer many struggling with a barrage of challenges: PTS, TBI, Substance abuse, divorce and a desolate job market. Sac Bee (10-17) by Steve Magagnini. 70% of women and 40% of men have been sexually abused.
Looks like putting women in combat alongside men wasn’t such a good idea.
The Cost of Health Care
The cost of health care for a family of three is approaching $14,000. In eight years the cost will be $14,000 each. That’s $14,000 for each man, $14,000 for each woman, and $14,000 for each child.
It’s time for new leadership in the White House and Senate
A One-term President?
President Obama told Diane Sawyer that he would rather be a good one-term president than a mediocre two-term president. Karl Rove in his recent column stated that Mr. Obama missed a more likely possibility; he may be the worse one term President ever.
If Romney is elected, that would be Obama’s second term to finish his destruction of Freedom in Health
The United Nations has declared that the human population will hit seven billion this month. The aging of the Human Race has been faster than anyone could have imagined a few decades ago. The fertility rates have plunged globally and life spans have increased. The graying of society has become a full blown crises. We need more babies, more workers to provide goods and services to huge numbers of pensioners.
The age of pension-hood was 65 when Social Security was proposed by FDR. The median age of death was 62 when FDR began this Ponzi Scheme to secure votes and stay in office longer than any president previously consider consistent with our American Heritage.
Today, the age of pension-hood is 67 and the median age of death is now 78—16 years later. FDR must have reasoned that he could not indexed the age of pension-hood with life-expectancy and remain in office. It took half a century for Congress to face reality to increase the retirement age even two years when it should have been indexed to life-expectancy. See Dr. Krauthammer in the last issue of MedicalTuesday Social Security - Of Course it’s a Ponzi Scheme
So instead of being an appropriate program for widows who lived longer than men and for aged men, it has now become a gravy line for an extra sixteen years of golf or leisure at the working men and women’s expense. Instead of parents helping their children get on their feet, we are now taxing and enslaving their children and grandchildren so healthy people in their 60s and 70s who could and should still be working to support themselves.
When my colleagues in the Business and Professional world turned 65, we expected to work until age 72 when full Social Security benefits would start for us because our salaries would be subtracted from our benefits. Instead, President Clinton made full benefits available at age 65 for everyone, a disastrous mistake. If half of our seniors had continued working until age 72, the rest of society would have soon followed and the earliest age would have been 65 for partial benefits instead of 62, and full benefits would start at age 72. There would be no Social Security crises today. It should now be further indexed to life expectancy so our current crises would never again be experienced.
To save Social Security for our children and grandchildren, the age of benefits for those age 50 and under should immediately be changed to 75 since our life expectancy is approaching 80, and early retirement formerly at age 62 should be come 72. And it should still be indexed as FDR should have done in 1933 to average working life expectancy
If you read the daily obituaries and seen the people that lived into their 90s or more, you will note most of them were gainfully employed into their 80s. Those that are dying in their early 60s, retired at 55 or so.
You will also note that many of them are now dying at home with their families around them rather than in the hospital at two to five thousand dollars a day with so many tubes and machines torturing their bodies that their loved ones can’t get within touching distance.
With indexing, Social Security would never be in jeopardy to provide a secure half decade or more of retirement.
What a great life we would all have.
and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow
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• 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 the informative news that Medicaid is limiting hospital stays. . .
• 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. You may want to read about the parent revolt surging in California
• 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 read about Amazon’s Internet Sales in Perspective.
• To read the rest of this column, please go to www.medicaltuesday.net/org.asp.
• 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 A Brawl over Romneycare by Grace-Marie Turner
• 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 peruse the opening page which will direct you to a vast number of consumer oriented health care options.
• 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 subscribe to their daily email: Every day In brief educates and entertains nearly 6,000 readers. The daily email features links to the most interesting news items of the day, along with brief commentary and "timely classics" from FEE's archive relevant to the issue.
• 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
• 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 about the Perils of Culture Homogeneity.
• 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.
• 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. The WSJ paints him as being to the left of Barrack Hussein Obama. We would also advise Steve Forbes to disassociate himself from this institution.
• 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.
Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state
organizations associated with the State Policy Network (
• 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.]
• McLauren Institute MacLaurinCSF is a community of students, scholars, and thinkers working together to explore and understand the implications of the Christian faith for every field of study and every aspect of life.* Our Mission: MacLaurinCSF bridges church and university in the Twin Cities metropolitan area, bringing theological resources to the university and academic resources to the church. Our goal is to strengthen Christian intellectual life in this region by creating public space for leaders in the academy and church to address enduring human questions together. MacLaurinCSF is grounded in the Christian tradition as articulated in Scripture and summarized by the Apostles’ and Nicene creeds, and our conversations are open to all.
• 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.
• Chapman University: Chapman University, founded in 1861, is one of the oldest, most prestigious private universities in California. Chapman's picturesque campus is located in the heart of Orange County – one of the nation's most exciting centers of arts, business, science and technology – and draws outstanding students from across the United States and around the world. Known for its blend of liberal arts and professional programs, Chapman University encompasses seven schools and colleges: The university's mission is to provide personalized education of distinction that leads to inquiring, ethical and productive lives as global citizens.
• 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 17th 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, read ? Choose recent issues. The last ten years of Imprimis are archived.
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Words of Wisdom
"He who votes does not have power. He who counts the votes has power".—Joseph Stalin (1879-1953): The man who turned the Soviet Union from a backward country into a world superpower at unimaginable human cost. One of the most murderous dictators in history.
"A house is not a home unless it contains food and
fire for the mind as well as the body."
—Benjamin Franklin: was a Founding Father of the United States
"By three methods we
may learn wisdom: First, by reflection, which is noblest;
Second, by imitation, which is easiest; and third by experience, which is the bitterest."
—Confucius: Chinese thinker and social philosopher
Some Recent Postings
In The Sept 27 Issue of MedicalTuesday:
Byron H. Demorest, MD
One of UC Davis Medical School Founders
Dr. Byron H. Demorest, a longtime medical and community leader who was a founding father of UC Davis School of Medicine, died Friday, of multiple myeloma. He was 86.
Dr. Demorest was a widely respected ophthalmologist for more than 50 years. He was active in efforts to start a medical school at the University of California, Davis, and co-founded the ophthalmology program in 1965. As the first department chairman, he helped organize the faculty and created the medical school's first accredited residency program. "Byron was in so many ways a visionary," said Dr. Mark Mannis, UC Davis ophthalmology chairman. "He realized that, in addition to a private-practice community, the state capital needed a strong academic program for training young ophthalmologists."
Dr. Demorest served as an associate examiner for the American Board of Ophthalmology. He was a leader in professional groups, including the American Academy of Ophthalmology and the California Association of Ophthalmology. In 1973, he was president of the Sacramento County Medical Society.
A River Park resident since 1957, he volunteered as president of the Boys Scouts of America Golden Empire Council and chairman of the Sacramento Symphony Association. He was an elder at Fremont Presbyterian Church.
He also was well known in the community during the 1970s as moderator of "Doctor's Notebook," a daily TV news segment on KCRA (Channel 3). Gifted with a broadcaster's voice and an easy bedside manner, he interviewed colleagues and answered questions about medical issues.
"One time he said, 'Parents, if your teenagers love you, then you've been a great failure,'" said his daughter, Susan Gilsdorf. "He had a great sense of humor."
Dr. Demorest worked his way through medical school as a radio announcer. The son of a newspaper editor, he was born in 1925 and raised in Omaha, Neb.
He had three children with his wife of 64 years, Phyllis. Besides collecting stamps and growing vegetables, he enjoyed sailing and snow skiing.
In addition to his private practice, Dr. Demorest attended weekly rounds and trained residents at UC Davis Medical Center. He was chairman of the scholarship committee for the Sierra Sacramento Valley Medical Society until his death and served as master of ceremonies at the group's annual meeting for the last 10 years.
"He had this amazing radio voice and was often called upon to emcee events," society executive director Bill Sandberg said. "We called him 'Golden Throat.' "
Born: May 1, 1925; Died:
Oct. 14, 2011
Survived by: Wife, Phyllis of Sacramento; daughters, Katheryn Brown of Weimar and Susan Gilsdorf of Tucson, Ariz.; son, John of Oceanside; brother, Allan of Des Moines, Iowa; four grandchildren and four great-grandchildren
Services: Memorial, 4 p.m. Saturday, Oct 22, Fremont Presbyterian Church, 5770 Carlson Drive, Sacramento
Words of Remembrance & Thanksgiving by Kathy Brown, John Demorest and Sue Gilsdorf
Robert Miller, MD, on behalf of the UCD Eye
Remembrances: Donations in memory of Dr. Demorest may be made to UC Davis Department of Ophthalmology, 4860 Y St., Sacramento, CA 95817, or to Fremont Presbyterian Church.
On This Date in History – October 14
On this date in 1890, Dwight D. Eisenhower, 34th President of the United States and one of our greatest military commanders, was born. Ike Eisenhower, as he was known, was not regarded as one of his generation’s outstanding public speakers, but he used a very eloquent phrase in his speech at the Bicentennial Celebration of Columbia University in 1954. He refered to “the revolutionary doctrine of the divine rights of the common man.” After the divine right of kings, we are now putting the emphasis where it rightfully belongs.
On this date in 1066, the Battle of Hastings was fought in which William the Conqueror defeated the English and brought about the Norman Conquest, the most historic turning point in the development of England, ultimately imposing unity on what had been a divided land. It brought an infusion of Norman culture that ultimately merged with the Anglo-Saxon mainstream to produce a rich heritage. In the last analysis, conquest by force of arms is less enduring than conquest by force of ideas. Central to the American idea is the fact that we have the freedom to stand up and speak one’s mind.
—After Leonard and Thelma Spinrad
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Del Meyer, MD, Editor & Founder
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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, any single payer initiative, Social Security was born for the benefit of the state and of a contemptuous disregard for people’s welfare.
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.