MEDICAL TUESDAY . NET

NEWSLETTER

Community For Better Health Care

Vol X, No 11, Sept 13, 2011

 

In This Issue:


1.          Featured Article: I Wish I Never Would Have Won the Lottery. 

2.                  In the News: In Government We Mistrust

3.                  International Medicine: Related to Economic Freedom

4.                  Medicare: $Billions Wasted

5.                  Medical Gluttony: Socialized Universal Healthcare

6.                  Medical Myths: Socialized Medicine Controls Health Care Costs

7.                  Overheard in the Medical Staff Lounge: The Medicare Whip

8.                  Voices of Medicine: How Religion Can Inoculate Against Radicalism

9.                  The Bookshelf:  The Fall of the Faculty, The Rise of the All Administrative University

10.              Hippocrates & His Kin: The fastest growing crime wave: Educational Theft

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

12.Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

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Announcing The 1st Annual World Health Care Congress Latin America, October, 2011 in
São Paulo, Brazil

The World Health Care Congress (WHCC) convenes the most prestigious forum of global health industry executives and public policy makers. Building on the 8th annual event in the United States, the 7th annual event in Europe and the inaugural Middle East event, we are pleased to announce the 1st Annual World Health Care Congress - Latin America to be held in October, 2011 in São Paulo, Brazil.

This prominent international forum is the only conference in which over 500 leaders from all regions of Latin America will convene to address access, quality and cost issues, including Latin American health ministers, government officials, hospital/health system executives, insurance executives, health technology innovators, pharmaceutical, medical device, and supplier executives.

World Health Care Congress Latin America will address escalating challenges such as improving access to quality care, financing and insurance models for health care, driving innovation in health IT, promoting evidence-based medicine and clinical best practices. World Health Care Congress Latin America will feature a series of plenary keynotes, invitational executive Summits, in-depth working group sessions on emerging issues, as well as substantial business development and networking opportunities.

For more information on the World Health Care Congress Latin America . . .

For information on the 9th Annual World Health Care Congress on April 16-18, 2012 . . .

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1.      Featured Article: I Wish I Never Would Have Won the Lottery.

We notice that many of our patients buy lottery tickets. Some will even bring one in to give to the staff so they can get rich and not have to work so hard. They actually believe that a one in fourteen million chance to win one dollar to more than a million dollars is reality. Hence I was surprise to come across a study that interviewed 21 winners of more than a $Million. Twenty stated they wished that they had never won the lottery. I find very few players that believe those stats. The Atlantic published some research on the problem of the super-rich, both the ones who inherited their wealth and those that earned it. I hope the article by Graeme Woods will prove enlightening, especially since our present administration is returning us to a class-based society. –Editor

Secret Fears of the Super-Rich

Does great wealth bring fulfillment? An ambitious study by Boston College suggests not. For the first time, researchers prompted the very rich—people with fortunes in excess of $25 million—to speak candidly about their lives. The result is a surprising litany of anxieties: their sense of isolation, their worries about work and love, and most of all, their fears for their children.

By Graeme Wood - Read more . . .

The October 2008 issue of SuperYacht World confirmed it: money cannot buy happiness. Page 38 of “the international magazine for superyachts of distinction”—if you have to ask what it takes for a yacht to qualify as “super,” you can’t afford to be in the showroom—presented the Martha Ann, a 230-foot, $125 million boat boasting a crew of 20, a master bedroom the size of my house, and an interior gaudy enough to make Saddam Hussein blush. The feature story on the Martha Ann was published just as the S&P 500 suffered its worst week since 1933, shedding $1.4 trillion over the course of the week, or about 2,240 Martha Anns every day. Still, one of the captions accompanying the lavish photos betrayed the status anxiety that afflicts even the highest echelons of wealth. “From these LOFTY HEIGHTS,” the caption promised, “guests will be able to look down on virtually any other yacht.” Virtually any other yacht! One imagines the prospective owner wincing at this disclaimer, pained by the knowledge that the world would still contain superyachts more super than his own, that at least one gazillionaire in Saint-Tropez harbor would likely be able to peer over his gunwales and down at the Martha Ann.

The lesson that Mammon is a false or inadequate god goes back a long way, and a glossy spread in SuperYacht World is just one place to relearn it. Another is Boston College’s Center on Wealth and Philanthropy, which since 1970 has minted a diverse array of studies of the wealthy. For four years, the Gates Foundation has supported an effort by the center to determine exactly how the American wealthy think and live—and in particular how, when, and to what degree they make the shift from accumulating fortunes to giving them away philanthropically. (The John Templeton Foundation, which is concerned with spiritual matters, kicked in additional funding to study correlations between wealth, philanthropy, and religion.) The project has produced one of the most remarkable documents in the center’s history: a survey that invited the very rich to write freely about how prosperity has shaped their lives and those of their children. From the anonymity of their home computers, the respondents wrote anything from a few words to a few pages, volunteering not only their net worth and sources of wealth but also their innermost hopes, fears, and anxieties.

The responses, which run to 500 pages and fill three plastic binders on the fifth floor of Boston College’s McGuinn Hall, constitute what the center’s director, the sociologist Paul G. Schervish, calls “an extraordinary sample of confession, memoir, and apologia” from the super-rich. (The researchers admit that this sample is not representative, being inevitably skewed toward those wealthy people who are willing to offer their confessions to a computer screen.) Roughly 165 households responded, 120 of which have at least $25 million in assets. The respondents’ average net worth is $78 million, and two report being billionaires. The goal, say the survey’s architects, was to weed out all but those at or approaching complete financial security. Most of the survey’s respondents are wealthy enough to ensure that in any catastrophe short of Armageddon, they will still be dining on Chateaubriand while the rest of us are spit-roasting rats over trash-can fires.

The results of the study are not yet public, but The Atlantic was granted access to portions of the research, provided the anonymity of the subjects was strictly maintained. The center expects to present the full conclusions gradually at upcoming conferences and to publish them over the next several months. The study is titled “The Joys and Dilemmas of Wealth,” but given that the joys tend to be self-evident, it focuses primarily on the dilemmas. The respondents turn out to be a generally dissatisfied lot, whose money has contributed to deep anxieties involving love, work, and family. Indeed, they are frequently dissatisfied even with their sizable fortunes. Most of them still do not consider themselves financially secure; for that, they say, they would require on average one-quarter more wealth than they currently possess. (Remember: this is a population with assets in the tens of millions of dollars and above.) One respondent, the heir to an enormous fortune, says that what matters most to him is his Christianity, and that his greatest aspiration is “to love the Lord, my family, and my friends.” He also reports that he wouldn’t feel financially secure until he had $1 billion in the bank.

Such complaints sound, on their face, preposterous. . . Most of us . . . occasionally spoil ourselves with outbursts of deliberate and perhaps excessive consumption: . . . dinner at an expensive restaurant, a shopping spree. In the case of the very wealthy, such forms of consumption can become so commonplace as to lose all psychological benefit: constant luxury is, in a sense, no luxury at all.

Taken together, the survey responses make a compelling case that being fantastically wealthy—especially when the wealth is inherited rather than earned—is not a great deal more fulfilling than being merely prosperous. . . Robert A. Kenny, who has trained as a psychologist and is one of the survey’s architects, says that extreme wealth can take away some of the basic joys of living—for instance, that some wealthy people don’t look forward to the holidays, “because they were always expected to give really good presents.” When you’re a millionaire, Kenny says, expensive gifts merely meet expectations. That was a pretty good present, the recipients might respond. But last year, you gave me a car. . .

Schervish, the center’s sociologist and director, is 64, with three grown children and a book-filled office overlooking the Boston College campus. He’s from Detroit, but his voice bears a slight resemblance to those of Boston’s own “Click and Clack,” the wisecracking auto mechanics on National Public Radio’s Car Talk. . .

Schervish says, adding, “Trump not, lest you be trumped.” The rich, he points out, could easily ask him why he is teaching sociology instead of donning sackcloth, selling his possessions, and giving everything to the poor. “I found that there is no telling people what needs need attending to, because needs are infinite. And they’d be better off channeling their work through inspiration, rather than dictation by others.” . . .

One of the saddest phrases I’ve heard,” Kenny says of his time counseling the wealthy, is when the heir to a fortune is told, “‘Honey, you’re never going to have to work.’” The announcement is often made, Kenny explains, by a rich grandparent to a grandchild—and it rarely sounds as good to the recipient as to the one delivering it. Work is what fills most people’s days, and it provides the context in which they interact with others. A life of worklessness, however financially comfortable, can easily become one of aimlessness, of estrangement from the world. The fact that most people imagine it would be paradise to never have to work does not make the experience any more pleasant in practice.

Career advancement is the standard yardstick by which most people measure success, and without that yardstick, it’s not easy to assess whether one’s time is well spent. “Financial freedom can produce anxiety and hesitancy,” writes one respondent to the Boston College survey. “In my own life, I have been intimidated about my abilities because I inherited money.” If the rich do take jobs, they sometimes find that co-workers resent them on the grounds that they’re “taking away the jobs of people who need them.” The rich also leave jobs more quickly than others, for the simple reason that they can afford to do so. Karen Weisgerber, a senior adviser at the center who also works with Kenny at North Bridge, describes an heir she counseled who had earned an M.B.A. from a top-tier school and was an obviously intelligent man. He nonetheless moved from one high-tech job to another. “At some point, something would happen at each job that those who have to work for an income would learn to tolerate,” Weisgerber says. “And he’d just say, ‘I don’t want to deal with this.’ Eventually he had to say, ‘I don’t have a career.’”

In other cases, wealthy workers find that their work is viewed as a charade. One wealthy survey respondent who worked in the nonprofit sector says she would feel insecure about her position if she resumed working. “If I decided to get a job in the field, I think I would have trouble being seen as a colleague and not a donor,” she writes. As a result, she feels unable to take part fully in the only profession for which she has trained. A similar kind of self-doubt afflicts some of the “sudden” millionaires in the survey, whose wealth arrived seemingly by chance. “I just happened to hit the jackpot by choosing to work for the right company at the right time I have never thought that I in any way earned this amount of wealth,” one writes. “I’m just now feeling like I’m getting the hang of it.”

Just as wealth can aggravate, rather than alleviate, stresses surrounding work, so too can it complicate love, where Kenny says problems are “the rule and not the exception.” Despite the financial security a fortune affords, issues related to money cause the failure of many marriages and significant relationships. In the survey, one wealthy mother writes that she worries that the men in her daughters’ lives could feel “powerless,” and that “their role as provider has been usurped.” Wealthy people of both genders are wary of gold diggers—Does he love me or my money?—but at the same time fear that this wariness might make them mistrustful of genuine affection. Weisgerber describes a client who was handed a prenuptial agreement just two days before his wedding—a standard form, presented to anyone who married into his bride’s family. “It’s like marrying into the royal family,” the psychologist says, with its own rules and practices, to which the groom might be only a legally complicated footnote.

One issue that Kenny says comes up frequently is the question of at what point in a relationship to reveal one’s wealth—a disclosure he makes sound as fraught as telling your date you have herpes. “When do you tell someone that you have got a huge amount of money?” he asks rhetorically. “If you tell them too soon, you are going to worry that they want you for your money. If you wait too long, can the person really trust you?

“Freud was right,” Kenny concludes. “Love and work are the two things you have to do in life.” And great wealth, he says, often undermines both . . .

Graeme Wood is an Atlantic contributing editor.

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2.      In the News: In Government We Mistrust 

Obama said he'd be Reagan in reverse. He was right.

One animating theme of Barack Obama's campaign and early Presidency was that he would repair government's post-Reagan reputation, expanding its role in American life so voters would turn once again to Democrats as the party of government, as they did in 1964 and the 1930s. So how's that working out? Read more . . .

Not so well, judging by a remarkable Gallup poll this week that asked the public about its views of government and various businesses. The federal government dropped to its lowest approval levels ever. Only 17% were positive, 63% negative, for a net approval rating of minus-46%. Government never ranks well, but for the first time since Gallup began asking in 2003 it fell to last place—below even the oil and gas industry, which netted minus-44% approval. . .

In fact, as shown in the bottom chart nearby, the public's hostility to government has climbed to all-time highs under President Obama's tenure. . . .

As Mr. Obama mused during the primaries, he envisioned himself as Ronald Reagan in reverse, making the case that government is the solution and not the problem. His 2009 health-care speech to Congress ended with a soaring peroration about "the perils of too little" government. . . 

REVIEW & OUTLOOK  SEPTEMBER 2, 2011

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3.      International Medicine: Related to Economic Freedom

TORONTO, ONCanada has surpassed the United States for levels of economic freedom, according to a new report released today by the Fraser Institute, Canada’s leading public policy think-tank. Read more . . .

Canada ranks sixth in the world for economic freedom with a score of 7.81 while the United States fell to 10th overall with a score of 7.60, according to the Economic Freedom of the World: 2011 Annual Report.

But Canada’s score actually decreased this year from 7.95 in 2010, part of an overall decline in levels of economic freedom around the globe. This year’s report shows that the average economic freedom score worldwide fell to 6.64 in 2009 (the most recent year for which data are available) from 6.67 in 2008.

“Despite Canada’s relatively high score, there is much cause for concern over the worldwide decline in economic freedom, which dropped to its lowest level in nearly three decades,” said Fred McMahon, Fraser Institute vice-president of international policy research.

“In response to the American and European debt crises, governments around the world are embracing perverse regulations and this has huge, negative implications for economic freedom and financial recovery.”

The United States experienced one of the largest drops in economic freedom, falling to 10th place overall from sixth in 2010. Much of this decline is a result of higher spending and borrowing on the part of the U.S. government, and lower scores for legal structure and property rights.

Hong Kong again topped the rankings of 141 countries, followed by Singapore, New Zealand, Switzerland, and Australia.

Research shows that people living in countries with high levels of economic freedom not only enjoy higher levels of prosperity and greater individual freedoms, but also longer life spans.

“The link between economic freedom and prosperity is undeniable: the countries that score highly in terms of economic freedom also offer their people the best quality of life,” McMahon said.

International rankings

Hong Kong offers the highest level of economic freedom worldwide, with a score of 9.01 out of 10. The other top scorers are Singapore (8.68), New Zealand (8.20), Switzerland (8.03), Australia (7.98), Canada (7.81), Chile (7.77), the United Kingdom (7.71), Mauritius (7.67), and the United States (7.60). . .

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

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

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

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4.      Medicare:  $Billions Wasted

Improper Medicare spending by Peter Suderman, Reason magazine

The federal government spent $509 billion on Medicare payments in 2010, nearly one-tenth of which was improper, according to a March report from the Government Accountability Office (GAO). Read more . . .

Medicare, a federal health insurance program for seniors, is already on an “unsustainable” long-run path, according to the GAO report. In 2010, it says, the system shelled out an estimated $48 billion in payments that were fraudulent or otherwise “improper,” and those in charge of the program aren’t doing nearly enough to avoid making similar mistakes in the future. The $48 billion figure is lower than the full total, because it does not include improper payments under Medicare Part D, which covers prescription drugs. An estimate for that part of the program had not been calculated yet when the report was issued.

This is not the first time the GAO has sounded the alarm about Medicare payments. In 2007 the office found similarly problematic patterns, recommending changes such as developing provider management systems that weed out inefficient payments. But according to the new report, Medicare’s administrators have failed to effectively follow up on many of the GAO’s suggestions.

That failure led the GAO to declare that Medicare suffers from “pervasive internal control deficiencies.” The GAO calls Medicare a “high risk” program, noting that “its complexity and susceptibility to improper payments, combined with its size, have led to serious management challenges.” 

Peter Suderman from the June 2011 issue of REASON
Read more . . .

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

- Ronald Reagan

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5.      Medical Gluttony: Socialized Universal Healthcare is always Gluttonous

Two worlds that will never meet: Private health care and Universal Health Care. Read more . . .

Private health care, in which every participant is in part financially responsible for their health care, has been well shown to be the most cost effective form of health care. Everyone takes responsibility for his own health, both in frequency of doctor visits, ER visits, urgent care visits, or hospital visits when they have to pay a proportion of the cost. If that proportion is paid at the door of the physician, ER, Urgent Care, or hospital visit, one can reasonably estimate the number of people that will turn around and make arrangements for a lower and entirely satisfactory level of care. Estimates of as high as 40 percent costs savings in some studies or actuary estimates are realized.

In relatively free health care, e.g. Medicare, the costs are estimated to be about 50 percent higher than in private health insurance or personally responsive care.

A former chairman of our Editorial Committee disagreed with this assessment. He stated that in all the socialized systems of health care, there was too much freedom allowed. If patients and doctors were fully regimented, we could eliminate all unnecessary care and deliver only the best care to those that needed it and thus save considerable money.

Why were totalitarian states with gendarmes not able to reduce unnecessary care?

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Medical Gluttony thrives in Government and Health Insurance Programs.

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

Gluttony cannot be controlled by gendarmes.

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6.      Medical Myths: Socialized Medicine Controls Health Care Costs

In the early days of managed care, or controlled health care usage, every consult, procedure or high level imaging utilization had to be approved. It was thought by those in charge that this would certainly eliminate excessive care. Excessive care was on occasion defined as the cost of care above the norm. Since half of physicians had profiles in excess of the norm, just eliminating their excessive costs would reduce cost of care considerably. Thus, insurance carries including Medicare and Medicaid hired a number of reviewers to reign in the costs. As this army of nurses and reviewers grew, one health insurer estimated that the costs of the army of nurses, reviewers, and administrative personal exceeded any cost savings. Read more . . .

In the present myth of controlling doctor and hospital costs, the password has become “Quality of Care.” In previous decades, doctors were penalized for ordering too many tests or procedures. In this decade, there is a standard of frequency for diabetic glyco-hemoglobin, cholesterol, stool screening, mammograms, etc., et. al., with a large increase in cost and decreased remuneration. The loss is being offset by increasing the moneys withheld from physicians and then paying them for improved quality of care. This forces the physicians to screen all patients including those that frequently refuse a rectal or pelvic exam or even a lab test.

This has kept the army of nurses, reviewers, and administrators employed with the job of policing doctors who don’t order enough tests or procedures under the ruse of improving quality. Thus, socialized medicine has not been able to control the costs even with doctors being forced to harass patients.

When will doctors rise up and refuse to remain the brunt of the ill-informed army that police them and become the head of the health care team again? If we don’t, our patients will suffer as we go on to greener pastures trying to regain our humanity.

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Medical Myths originate when someone else pays the medical bills.

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

Medical Myths will also disappear when doctors assume charge of the healthcare team.

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7.      Overheard in the Medical Staff Lounge: The Medicare Whip

Dr. Rosen: I understand we must have an updated billing program to accommodate the new Medicare Code requirement. Read more . . .

Dr. Sam: Now isn’t that a pile of rabbit raisins. Rabbit raisins don’t even make good fertilizer.

Dr. Paul: I think that’s the only way they’ll get us to use the new ICD10 codes. More than a 100 thousand new ones to learn in three volumes, rather than two.

Dr. Rosen: Now that’s really coercion. Invest in new software or you won’t get paid. We just got the estimate on our new MediSoft billing program upgrade. It was $3800. Plus our tech ops guy added $400 for installing it on our server and two additional computers.

Dr. Ruth: I guess I better get busy and check out our system. 

Dr. Rosen: My eight-year-old laptop just died last month and I had to replace it. Bank of America reduced my business line of credit. So I had to scrounge to cover the cost of a new laptop. And with the new Windows 7, I had to buy a new upgrade for Microsoft Office, a virus program and a printer. I don’t know how I’m going to cover the MediSoft upgrade.

Dr. Michelle: Looks like I may have a problem also. I’ll have some difficulty covering two and four thousand dollar charges in just a few months. When does this Medicare demand have to be installed?

Dr. Rosen: By December 1, 2011. That’s not far off.

Dr. Michelle: No it isn’t. Might be too soon for my office also.

Dr. Edwards: The stuff that Medicare, Medicaid and, in fact, more insurance carriers throw at us makes medical school look like kindergarten.

Dr. Kaleb: Isn’t that the truth. Blue Cross/Blue Shield is starting to send CDs and DVDs our way and they expect that we have time to spend an hour or two listening to them. DVDs are even worse. Some have managed to put out CD-ROMs that are very involved.

Dr. Paul: And interactive, if you can afford the time and the concentrated effort to digest them.

Dr. Milton: Remember how we used to spend nights for a full quarter reading Cecil and Loeb, the Bible of Internal Medicine?

Dr. Dave: It’s really unbelievable how government bureaucrats think that practicing medicine is only part-time and, therefore, we can become full-time medical students again. They’re probably sitting in the Senate chambers as we speak having a big belly laugh over their control of our time.

Dr. Kaleb: Let’s not blame only Medicare, Medicaid and the Blues; the drug companies are now sending us CDs and DVDs to inform us about their drugs. There’s more information on their DVDs than in Goodman & Gilman’s The Pharmacological Basis of Therapeutics, which was a three-month course at my medical school.

Dr. Sam: The more government interferes with my ability to take care of patients, the closer I get to throwing in the towel. If I could find a good position, I’d begin winding down my practice tomorrow.

Dr. Dave: Me too.

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The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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8.      Voices of Medicine: A Review Articles by Physicians

How Religion Can Inoculate Against Radicalism
The lesson of my retreat from a London University's Islamic Society.
By DR RUSSELL RAZZAQUE

HOUSES OF WORSHIP | WSJ | SEPTEMBER 2, 2011

In the fall of 1989, I arrived as a student at the Royal London Hospital medical college, part of the University of London. I was one of only a handful of Muslim students in my year and, for us, the entire social scene felt alien. It all seemed based around dancing, alcohol and socializing with the opposite sex. We were left in a vacuum that the school's Islamic Society quickly offered to fill. Its members were comradely, welcoming and—crucially—had great food. Read more . . .

They knew we were lost and early on they started to explain how the alienation we felt was something we should cherish rather than try to overcome. The reason they gave was that we were better than the "kufar"—infidels—outside of our gathering. It was at this point that the tone of the Islamic Society's meetings started to change. Our duties to our religion started to merge with a series of geopolitical aims involving the establishment of a global Islamic state and the overthrow of the capitalist/Zionist system.

I soon dropped out of the Islamic Society and widened my social circle to include non-Muslims. But several of my friends had become intoxicated by the whole thing, even dropping out of the university because of it. At first I didn't give this much more thought—until 9/11, that is.

Then, as a practicing psychiatrist, I started to read articles about how radicalization occurs, especially around adolescence and through universities, where ideas like the need to create a global Islamic state—a new Caliphate—were being spoon-fed to vulnerable youngsters. This is what happened in Hamburg when the perpetrators of 9/11 were students there.

Why did I leave the Islamic Society while others stayed—and even, in some cases, wound up in Pakistan networking with fellow Islamists? What was the difference between us? The answer may be found somewhere in our earlier lives.

Those men who were the most opposed to the perverted messages being peddled by the Islamic Society were those who had been brought up by religious parents. One friend, who had been steeped in mainstream Islam as a child, used to tell me that the doctrine being preached at the Islamic Society was, in his view, so aberrant that it risked becoming toxic. He firmly believed that MI5 (British domestic intelligence) ought to be keeping an eye on these guys, and that was 10 years before 9/11. Those who had no exposure to Islam prior to the encounter with extremist recruiters seemed more likely to follow them.

Now there is a growing body of research explaining why that was. Caitlin Spaulding of Trinity University in Texas studied the religious experiences of 84 first-year university students in her home state. She found that the students tended to retain the core faith beliefs instilled in them during their childhood—and that this helped their transition to university life. They appeared to be more confident and better equipped to adapt to their new environment.

In a study by Lorelie J. Farmer of Gordon College in Massachusetts, adult subjects discussed their religious experiences as children. The study found that childhood religious experience tended to give individuals increased compassion for others, as measured in psychological rating scales. This helps explain why it would be harder for such people to follow a supremacist ideology that by definition is uncompassionate towards the "out" group.

Deeper insights into radicalization may spring from developments in what's called Relational Frame Theory, which is based on a body of empirical research pioneered by Steve Hayes of the University of Nevada. The theory focuses on the fact that people constantly derive assumptions and conclusions about things they were never directly taught. In our early years, the theory holds, we learn certain arbitrary ways to compare things to each other (relational framing), and it is through a web of such interlinking comparisons (relational networks) that we then start to make sense of the world around us. . .

Thus contrary to the insistence of some that religion is inherently divisive and harmful, this research suggests that early-life exposure to moderate forms of religion may be a vital inoculator against the dangers of extremist recruitment.

Dr. Razzaque is a British psychiatrist and author of  "Human Being To Human Bomb: Inside The Mind Of A Terrorist" (Totem, 2005).

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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about

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9.      Book Review: The Fall of the Faculty, The Rise of the All Administrative University

By Benjamin Ginsberg, Oxford, 248 pages, $29.95)

Meddle Management

Professors once ran university affairs largely by themselves.
Now they are at the mercy of proliferating 'deanlets.'

By CARL ELLIOTT

BOOKSHELF | WSJ | SEPTEMBER 2, 2011

 

Several years ago, administrators at my university asked the Center for Bioethics, where I work, to create and teach an online course in "interprofessional ethics"—a compulsory, one-stop class for more than a thousand students of dentistry, pharmacy, nursing, medicine, public health and veterinary medicine. The fact that nobody could really think of any ethical problems shared by veterinarians and dentists was not seen as a barrier. It was not even a problem that we had scarcely any knowledge of the subject matter. The proposed course had the backing of the administrative authorities, and we felt pressured to comply.

Predictably, the course was a fiasco. Instructors hated it. Nobody could understand how to make the online platform work. Students regarded the course with a mixture of resentment and terror: The content was laughable, but many of them were convinced that they were going to fail. A fellow instructor and I were so embarrassed that we apologized to the students. Within days we were relieved of our teaching duties. Read more . . .

Most professors have a ready supply of similar stories, but few have quite as many as Benjamin Ginsberg, a distinguished political scientist at Johns Hopkins University. In his lacerating "The Fall of the Faculty," Mr. Ginsberg argues that universities have degenerated into poorly managed pseudo-corporations controlled by bureaucrats so far removed from research and teaching that they have barely any idea what these activities involve. He attacks virtually everyone—from overpaid presidents and provosts down through development officers, communications specialists and human-resource staffers—but he reserves his most bitter scorn for the midlevel "associate deans" and "assistant deans" who often have the most direct control over the faculty. Mr. Ginsberg refers to them as "deanlets," but at my institution they are often called "ass. deans."

From 1975 to 2005, the costs of attending an American university tripled. During that period, faculty-to-student ratios stayed relatively constant, but administrator-to-student ratios ballooned. The number of administrators increased by 85%, and the number of staffers rose by 240%. Administrative salaries shot up as well. Today, 81 university presidents are paid more than half a million dollars a year, and 12 earn more than a million.

Mr. Ginsberg acknowledges that some administrative growth may be due to the fact that universities offer more services than they did in the 1970s. They have a more sophisticated information technology infrastructure, too, and a more extensive lobbying and fund-raising apparatus. But he also notes that entirely new fields of research and scholarship have emerged during that period, such as novel areas of computer science, genetics and physics, without any corresponding increase in faculty numbers. The primary reason for administrative bloat, Mr. Ginsberg believes, is the nature of bureaucracy itself. Bureaucrats measure their status by the number of people who report to them, so their primary mission is to increase the size of their own offices and programs.

This enormous investment in administrators has not translated into a better college education. As administrative numbers have ballooned, teaching has been turned over to the academic equivalent of temp workers—low-paid adjunct professors who must often travel long distances between campuses and who are employed on short-term contracts without benefits. In the 1970s, 67% of faculty members were tenured or tenure-track appointees; today that figure is a mere 30%. Administrators prefer adjuncts not just because they are cheap but because they are less likely to resist administrative overreach.

Forty years ago professors themselves managed university affairs, often spending limited stints in administration as a professional obligation before returning to teaching and research. But as professional administrators have proliferated, professors, having little stomach for endless committee meetings and inane business jargon, have been happy to give up their managerial responsibilities. (Asked if he would continue serving on an especially noxious committee, Mr. Ginsberg replied: "If offered a choice between another year of service and a year of incarceration at Abu Ghraib prison, I would have to give the matter some thought.") As a result, however, professors have sacrificed much of their influence over their own institutions. . .

"The Fall of the Faculty" reads like a cross between a grand-jury indictment and a call to arms. Yet as bracing and darkly pleasurable as this call is, it is hard to imagine professors joining the resistance with so few weapons at their disposal. Even Mr. Ginsberg admits that the solutions he suggests—faculty representation on boards of trustees, appeals to alumni and donors—seem feeble. Making the case for reform to a broader public, especially prospective students and their parents, may be a more promising tack. Fortunately, professors, unlike administrators, write books.

—Mr. Elliott teaches at the University of Minnesota and is the author of "White Coat, Black Hat: Adventures on the Dark Side of Medicine."

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10.  Hippocrates & His Kin: The fastest growing crime wave: Educational Theft

Last year, an African-American mother of two used her father’s address to enroll her two daughters in a better public school outside their neighborhood. She was charged with grand theft and spent nine days behind bars. The single mother was convicted of two felony counts. Not only did this stain her spotless record, but it also threatened her ability to earn the teacher’s license she had been working on.

She caught a break last month when Ohio Gov. John Kasich granted her clemency and reduced her charges to misdemeanors, which allowed her to pursue her teacher’s license. (WSJ)

Out of control government increases the crime rate. Read more . . .


Bakken Oil Fields of Montana and North Dakota: America’s Answer to OPEC

Harold Hamm, the Oklahoma-based founder and CEO of Continental Resources, the 14th largest oil company in America, went to Washington last month to explain to Mr. Obama that the gigantic and prolific Bakken oil fields of Montana and North Dakota could make the United States completely energy independent by the end of the decade. We could be the Saudi Arabia of oil and natural gas in the 21st century. Mr. Obama’s reaction: “Oil and gas will be important for the next few years. But we need to go on to green and alternative energy. Energy Secretary Steven Chu has assured me that within five years, we can have a battery developed that will make a car with the equivalent of 130 miles per gallon.”

Mr. Hamm says Mr. Obama is riding the wrong horse on energy. We can’t come anywhere near the scale of energy production to achieve energy independence by pouring tax dollars into “Green energy; like wind and solar. It has to come from oil and gas.” But he’s seen this sort of thinking before, like Jimmy Carter’s windfall profits tax. (WSJ)

When Ron Susskind asked the President: “Why his team had difficulty creating a policy to deal with unemployment?” The president said some of the reason was that we didn’t have a clean story we wanted to tell against which we would measure various actions.

Peggy Noonan asks, “What is the particular requirement of the president that no one else can do?” The president answers: “What the president can do that nobody else can do, is tell a story to the American people” about where we are as a nation and should be.

How can that be when this president doesn’t know where we are as a nation or where we should be?

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow

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

                      The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports. This month, read the informative article on Why Health Exchanges Don't Work.

                      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. This month read Mr. Graham’s article: Despite the scholarly disputations about health reform, what drives most voters are not questions about the solvency of Medicare or beneficiaries’ access to care, but fear of change. Arguments will not change this fact: People change when the pain of not changing becomes greater than the pain of changing, but not before.

                      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 KEY PRINCIPLES OF CONSTITUTIONAL BUDGET RULE DESIGN.

                      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. Grace-Marie warns us: One of the biggest fears Americans have about the expanding role of government in health care is that bureaucrats — not doctors and patients — will make decisions about what medical care they will, or more likely will not, get. They should be afraid. It’s happening now and getting worse.

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

                      The Heartland Institute, www.heartland.org, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care? This month, be sure to read: RomneyCare Is No Model for the Nation. It Lacks Real Solutions.

                      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. The official line is that President Obama’s 2009 “stimulus” package (tax cuts and spending increases) “created or saved” more than 3.5 million jobs. Is that so? Read the answer . . .  

                      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 a discussion of an excellent question: “How can a government look and function like a private business?”

                      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. Or read some good news: The Canadian dream is well within reach.

                      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. Mr. Obama should consider using Mr. Romney as his running mate next year. We would also advise Steve Forbes to disassociate himself from this institution.  His flat tax initiative would then gain more traction.

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

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

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

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

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

                      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 The Constitution and Limited Government. The last ten years of Imprimis are archived.

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14.Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

Words of Wisdom

Great part of that order which reigns among mankind is not the effect of government. It has its origin in the principles of society and the natural constitution of man. It existed prior to government, and would exist if the formality of government was abolished. The mutual dependence and reciprocal interest which man has upon man, and all the parts of civilised community upon each other, create that great chain of connection which holds it together. The landholder, the farmer, the manufacturer, the merchant, the tradesman, and every occupation, prospers by the aid which each receives from the other, and from the whole. Common interest regulates their concerns, and forms their law; and the laws which common usage ordains, have a greater influence than the laws of government. In fine, society performs for itself almost everything which is ascribed to government. –Thomas Paine (The Rights of Man).


Governments exist to protect you, not to take care of you. –Dr. Charles Stanley


 Some Recent Postings

In The August 23 Issue:

1.      Featured Article: Scientific Research at the Crossroads?

2.      In the News: Spinning Gay Data

3.      International Medicine: Central Money or Medicare –It’s all Funny Stuff

4.      Medicare: Health Care Reform

5.      Medical Gluttony: Six Unnecessary Consultations

6.      Medical Myths: The More Doctors, the better

7.      Overheard in the Medical Staff Lounge: Who is your favorite presidential candidate?

8.      Voices of Medicine: Bad luck? Bad faith? Obama battles with mythical monsters

9.      The Bookshelf: Presidential Malpractice

10.  Hippocrates & His Kin: Another $800 Billion of TARP money!

11.  Related Organizations: Restoring Accountability in Medical Practice and Society

Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .


In Memoriam

The Carpet-Tile Philosopher

Ray Anderson, America’s greenest businessman, died on August 8th, aged 77

WHEN Ray Anderson first encountered the concept at an international conference, it took his breath away. It was so smart, so right. It was flexible, practical, beautiful, and made perfect sense. He knew right then that modular soft-surfaced floor coverings (carpet tiles, in other words), could change the world.

Others thought he was round the bend. Read more . . . When he decided to give up his job at Milliken Carpet in LaGrange, Georgia to set up a 15-person carpet company, and was clearing out his desk that February of 1973, two colleagues looked in. “We don’t think you can do this,” they told him. He replied, in his languid, ever-courteous southern lilt, “The hell you say.” Fifteen years later his company, renamed Interface, was the biggest carpet-tile maker on the planet.

This also made Mr Anderson a considerable plunderer of the earth. He never thought about that at first. To his mind he was no more a thief of Nature than when, a country boy during the Depression, he had hooked 20-pound channel catfish, now long gone, out of the Chattahoochee River. His business complied with government regulations. His product, too, was much less wasteful than broadloom carpet, since you could easily cut the tiles to run cables underneath, and replace them one by one as they wore out. They were, it was true, almost entirely made of petroleum in some form or another. Some pretty bad stuff was used in the dye and the glue. More than 200 smokestacks blackened the sky to produce them. But boardrooms laid with Interface carpet tiles looked and felt a million dollars.

The turning point, his “mid-course correction”, came in 1994. He was 60, but not yet ready to retire to the mountains or chase a little white ball. Under pressure from customers to produce some sort of environmental strategy for his company, he got a small task-force together. Someone gave him a book, Paul Hawken’s “The Ecology of Commerce” to help him prepare his first speech on the subject. Thumbing vaguely through it, he chanced on a chapter called “The Death of Birth”, about the extinction of species. Reading on, he came to a passage about reindeer being wiped out on St Matthew Island in the Bering Sea. Suddenly, the tears were running down his face. A spear-point had jammed into his heart. It was the very same feeling, he said later, as when he had first seen carpet tiles, but orders of magnitude larger. He was to blame for making the world worse. Now he had to make it better.

Interface, he decided, would leave no print on the green-and-blue carpet of the world. By 2020 it would take nothing from the earth that could not be rapidly replenished. It would produce no greenhouse-gas emissions and no waste. That meant using renewables rather than fossil fuel; endeavouring to make carpet tiles out of carbohydrate polymers rather than petroleum; and recycling old-carpet sludge into pellets that could be used as backing.

Some of the technologies Mr Anderson hoped for (and half-envisaged, as a graduate in systems engineering from his much-loved Georgia Tech) had not been invented when he started. Several colleagues thought he had gone round the bend again. He had to bring them along slowly, in his quiet way, until they “got it” by themselves. But by 2007 the company was, he reckoned, about halfway up “Mount Sustainability”. Greenhouse-gas emissions by absolute tonnage were down 92% since 1995, water usage down 75%, and 74,000 tonnes of used carpet had been recovered from landfills. The $400m  he was saving each year by making no scrap and no off-quality tiles more than paid for the R&D . . .

Most satisfying of all, sales had increased by two-thirds since his conversion, and profits had doubled. For Mr Anderson always kept his eye on the bottom line. He could be sentimental, ending his many public speeches with an apologetic poem to “Tomorrow’s Child” written by an employee after one of his pep talks, but he was only half a dreamer. His company was his child, too. Profits mattered. This made some greens snipe at him, but it also made Walmart send two of its senior people round to his factory in LaGrange to see what he was doing right. As a success, he could powerfully influence others.

The forest floor

. . . He was proudest . . .  of Entropy®, a carpet-tile design inspired directly by the forest floor. No two tiles were alike: no two sticks, no two leaves. They could be laid and replaced quite randomly, even used in bits, eliminating waste. And when you lay down on them you might almost be in Mr Anderson’s 86-acre piece of forest near Atlanta, listening to the sparrows in the long-leaf pines, rejoicing in being a non-harming part of the web of life, like him.

On This Date in History - September 13

On this date in 1759, the British under General Wolfe defeated the French under General Montcalm. This battle was a very crucial one in the history of British Canada. It is noteworthy for the fact that it was a battle in which both commanding generals were killed. That is not the normal course of events for a military encounter.

On this date in 1788, Congress decided that the first national election under the Constitution would be held on the first Wednesday in January, 1789.

After Leonard and Thelma Spinrad


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Always remember that 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.