MedicalTuesday

1. Featured Article: To Increase Jobs, Increase Economic Freedom

Business is not a zero-sum game struggling over a fixed pie. Instead it grows and makes the total pie larger, creating value for all of its major stakeholders, including employees and communities.

by John Mackey, co-CEO of Whole Foods Market

The Wall Street Journal, November 16, 2011

Is the United States exceptional? Of course we are! Two hundred years ago we were one of the poorest countries in the world. We accounted for less than 1% of the world’s total GDP[1]. Today our GDP is 23% of the world’s total and more than twice as large as the No. 2 country, China[2].

America became the wealthiest country because for most of our history we have followed the basic principles of economic freedom: property rights, freedom to trade internationally, minimal governmental regulation of business, sound money, relatively low taxes, the rule of law, entrepreneurship, freedom to fail, and voluntary exchange. Read more . . .

The success of economic freedom in increasing human prosperity, extending our life spans, and improving the quality of our lives in countless ways is the most extraordinary global story of the past 200 years. Gross domestic product per capita has increased by a factor of 1,000% across the world and almost 2,000% in the U.S. during these last two centuries[3]. In 1800, 85% of everyone alive lived on less than $1 per day (in 2000 dollars). Today only 17% do[4]. If current long-term trend lines of economic growth continue we will see abject poverty almost completely eradicated in the 21st century. Business is not a zero sum game struggling over a fixed pie. Instead it grows and makes the total pie larger, creating value for all of its major stakeholders—customers, employees, suppliers, investors and communities.

So why is our economy barely growing and unemployment stuck at over 9%? I believe the answer is very simple: Economic freedom is declining in the U.S. In 2000, the U.S. was ranked third in the world behind only Hong Kong and Singapore in the Index of Economic Freedom, published annually by this newspaper and the Heritage Foundation. In 2011, we fell to ninth behind such countries as Australia, New Zealand, Canada and Ireland[5].

The reforms we need to make are extensive. I want to make a few suggestions that, as an independent, I hope will stimulate thinking and constructive discussion among concerned Americans no matter what their politics are.

Most importantly, we need to radically cut the size and cost of government. One hundred years ago the total cost of government at all levels in the U.S.—local, state and federal—was only 8% of our GDP. In 2010, it was 40%[6]. Government is gobbling up trillions of dollars from our economy to feed itself through high taxes and unprecedented deficit spending—money that could instead be used by individuals to improve their lives and by entrepreneurs to create jobs. Government debt is growing at such a rapid rate that the Congressional Budget Office projects that in the next 70 years public money spent on interest annually will grow to almost 41.4% of GDP ($27.2 trillion) from 1.4% of GDP ($204 billion) in 2010. Today interest on our debt represents about a third of the cost of Social Security; in only 20 years it is estimated that it will exceed the cost of that program[7].

Only if we focus on cutting costs in the four most expensive government programs—Defense, Social Security, Medicare and Medicaid, which together with interest account for about two-thirds of the overall budget—can we make a significant positive impact.

Our defense budget now accounts for 43% of all military spending in the entire world—more than the next 14 largest defense budgets combined[8]. It is time for us to scale back our military commitments and reduce our spending to something more in line with our percentage of the world GDP, or 23%. Doing this would save more than $300 billion every year.

Social Security and Medicare need serious reforms to be sustainable over the long-term. The demographic crisis for these entitlement programs has now arrived as 10,000 baby boomers are projected to retire every day for the next 19 years[9]. Retirement ages need to be steadily raised to reflect our increased longevity. These programs should also be means tested. Countries such as Chile and Singapore successfully privatized their retirement programs, making them sustainable. We should move in a similar direction by giving everyone the option to voluntarily opt out of the governmental system into private alternatives, phasing this in over time to help keep the current system solvent.

In addition, tax reform is essential to jobs and prosperity. Most tax deductions and loopholes should be eliminated, combined with significant tax rate reductions. A top tax rate of 15% to 20% with no deductions would be fairer, greatly stimulate economic growth and job creation, and would reduce deficits by increasing total taxes paid to the federal government.

Why would taxes collected go up if rates go down? Two reasons—first, tax shelters such as the mortgage interest deduction used primarily by more affluent taxpayers would be eliminated; and secondly, the taxable base would increase considerably as entrepreneurs create new businesses and new jobs and as people earn more money. Many Eastern European countries implemented low flat tax rates in the past decade, including Russia in 2001 (13%) and Ukraine in 2004 (15%), and experienced strong economic growth and increased tax revenues[10].

Corporate taxes also need to be reformed. According to the Organization for Economic Cooperation and Development, the U.S.’s combined state and federal corporate tax rate of 39.2% became the highest in the world after Japan cut its rates this April[11]. A reduction to 26% would equal the average corporate tax rate in the 15 largest industrialized countries. That would help our companies to use their capital more productively to grow and create jobs in the U.S.

Government regulations definitely need to be reformed. According to the Small Business Administration, total regulatory costs amount to about $1.75 trillion annually, nearly twice as much as all individual income taxes collected last year[12]. While some regulations create important safe guards for public health and the environment, far too many simply protect existing business interests and discourage entrepreneurship. Specifically, many government regulations in education, health care and energy prevent entrepreneurship and innovation from revolutionizing and re-energizing these very important parts of our economy.

A simple reform that would make a monumental difference would be to require all federal regulations to have a sunset provision. All regulations should automatically expire after 10 years unless a mandatory cost-benefit analysis has been completed that proves that the regulations have created significantly more societal benefit than harm. Currently thousands of new regulations are added each year and virtually none ever disappear.

According to a recent poll, more than two-thirds of Americans now believe that America is in “decline[13].” While we are certainly going through difficult times our decline is not inevitable—it can and must be reversed. The U.S. is still an extraordinary country by almost any measure. If we once again embrace the principles of individual and economic freedom that made us both prosperous and exceptional, we can help lead the world towards a better future for all. . .

Mr. Mackey, co-founder and co-CEO of Whole Foods Market, is a member of the Job Creators Alliance, a nonprofit devoted to preserving free enterprise.

Read the entire article at the WSJ – including 444 comments and references –Subscription required . . .
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2. In the News: Studies Could Ease Fears of Medicines for ADHD

By JENNIFER CORBETT DOOREN And RON WINSLOW - WSJ

Ritalin, Adderall and other drugs widely used to treat attention disorders didn't increase the risk of serious heart problems in a major study published Monday that could help ease concerns about the heart-related safety of the medicines. Read more . . .

The findings, from an analysis involving nearly 500,000 adults, come on the heels of a separate study that reached a similar conclusion about the medications' effect in 1.2 million children and young adults. The results don't completely exonerate the drugs, which have other side effects that include a slowing of growth in children and anxiety. But researchers and doctors who treat the condition—known formally as attention deficit-hyperactivity disorder, or ADHD—said that together the reports should generally allay worries about heart risk that have stirred confusion among doctors and patients for several years.

"We don't see any evidence they're increasing risk," said Laura A. Habel, a research scientist at Kaiser Permanente at the big health plan's Northern California operation in Oakland and lead author of the latest study. But she added that the study didn't go as far as to prove the drugs are safe.

About 2.7 million children are prescribed medicines for ADHD, mostly to help control impulsive behavior and an inability to focus and pay attention. More than 1.5 million adults also take the drugs, researchers said. Growth in the medications' use among adults has outpaced that in children during the past decade.

The drugs, including Shire PLC's Adderall, Johnson & Johnson's Concerta, and Novartis AG's Ritalin, as well as generic versions, are associated with modest increases in blood pressure and heart rate. They are also known to be highly effective in managing ADHD symptoms, with more than 80% of patients responding to the medicines, researchers say. . .

At the Mayo Clinic, in Rochester, Minn., cardiologist Michael Ackerman said he knows of students who stopped taking the medicines and went from "high-functioning, straight-A students to F students" after doctors became concerned that the drugs "could kill their patients."

Both doctors, who weren't involved with the research, said they hope the new findings provide reassurance to doctors, patients and parents of children with ADHD that the risk of the medicines, especially in otherwise healthy people, is very low. . .

Read the entire report in the WSJ – subscription required . . .
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3. International Medicine: The cost of Canadian Medicare

The true cost of Medicare for individuals and families in Canada is often misunderstood, with many people thinking it’s either free or covered by our provincial health insurance premiums.

This misconception has many sources. In part, it stems from the fact that health care consumption is free at the point of use, leading many to grossly underestimate the actual cost of care delivered. Furthermore, health care is financed through general government revenues, rather than financed through a dedicated tax, further blurring the true dollar cost of the service. Read more . . .

In addition, health spending numbers are often presented in aggregate, which results in a number so large that it becomes almost meaningless to the average Canadian. For instance, according to the Canadian Institute for Health Information’s latest data release, provincial/territorial governments are estimated to have spent $130.3 billion of our tax dollars on publicly funded health care in Canada in 2011.

A more informative measure of the cost of our health care system is health expenditures per person. The $130.3 billion presented above works out to approximately $3,778 per Canadian. This would be the cost of the public health care insurance plan if every Canadian resident paid an equal share. But some Canadians are children and dependents and thus are not taxpayers, and Canadians certainly do not pay equal amounts.

So how much do we really pay as individuals and families for our Medicare system?

In order to determine a more precise estimate of the cost of public health care insurance for the average Canadian family in 2011, we must determine how much an average family is expected to contribute in taxes to all three levels of government. The percentage of the family’s total tax bill that pays for public health insurance is then assumed to match the share of total government tax revenues (including natural resource revenues) dedicated to health care (estimated to be 24.9 per cent in 2010/2011).

Breaking down the Canadian population into 10 income groups makes it possible to show what families from various income brackets will pay for public health care insurance in 2011. Income figures are pre-tax and based on cash income, which includes wages and salaries, self-employment income (farm and non-farm), interest, dividends, private and government pension payments, old age pension payments, and other transfers from governments (such as universal child care benefit):

· Average cash income of $11,395; $496 paid for public health care insurance

· Average cash income of $25,624; $1,166 paid for public health care insurance

· Average cash income of $34,696; $2,328 paid for public health care insurance

· Average cash income of $43,949; $3,671 paid for public health care insurance

· Average cash income of $54,339; $5,123 paid for public health care insurance

· Average cash income of $67,115; $6,663 paid for public health care insurance

· Average cash income of $80,752; $8,567 paid for public health care insurance

· Average cash income of $98,750; $10,656 paid for public health care insurance

· Average cash income of $124,579; $13,946 paid for public health care insurance

· Average cash income of $241,549; $32,116 paid for public health care insurance

Looking by common family types, this calculation finds that the estimated average payment for public health care insurance in 2011 was:

· $10,707 for the average 2 adult family

· $10,473 for the average 2 adult and 1 child family

· $10,486 for the average 2 adult and 2 child family

· $3,607 for the average unattached (single) individual

It is critical to recognize that these estimates count only the direct costs of Medicare. They do not count administrative costs subsumed by other government departments that support health care through activities such as tax collection, or other privately borne costs related to the financing and operation of Medicare such as tax compliance or the private burden of waiting for health care.

Hopefully these estimates of the cost of Medicare by family will provide Canadians with a clearer picture of just how much they pay for public health care insurance. With a more precise estimate of what they really pay, Canadians will be in a better position to decide whether they are getting a good return on the money they spend.

Read the entire report at the Frazier . . . |
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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: Can Medicare pay for Sex?

A middle-aged male Medicare patient was receiving assisted care in his home to help with his cleaning and cooking. He had rheumatoid arthritis but still could get around reasonably well in his own home. He didn’t like to clean and he didn’t like to cook. He thought Medicare was wonderful. He bragged about the competency of his home care assistant was. Read more . . .

Turns out, her skills included more than cooking and cleaning. We’ve heard many reports of various ways that Medicare pays for sex. Of course it never shows up in the Medicare billing reports. So Medicare has no idea of how often this occurs. This instance was a new approach that we’ve not seen before.

On his second office visit he disclosed that she did more for him than he had stated. After some cajoling he admitted that she provided him with sex. Since his arthritis didn’t allow for very active sexual participation on his part, his attendant was rather aggressive in doing all the activity.

How did all this get started? Did he seduce her?

No he didn’t. She gives him a bath on the three days that she’s there and while soaping him down, he became very aroused. She asked him if he had a lady friend. When he said he didn’t, she observed his arousal and asked if maybe she could give him relief. She stroked him and relief came very quickly. She then started to give him relief three times a week when she was there cleaning his house and doing his laundry and the cooking. After a few weeks, she asked him if she could take her clothes off and do it the right way. He said he didn’t mind. So she did it that way once every week.

She would give him bathtub sex twice a week and in his bed once a week. But what he really highlighted was that she did much more than stroking him in the tub. She gave him oral sex in the tub twice a week. He said this was the most intense sex that he had ever experienced. He said he felt like she had taken him to heaven.

He felt guilty about all this pleasure at taxpayer’s expense. So he asked her if he could pay her extra for her extra services. She declined stating Medicare paid her adequately for the three visits a week. The sex was pro bono. She enjoyed it as much as he did. He then offered her free rent.

He said he hoped he never got well enough to lose his attendant care.

It’s amazing how entitlements can take a totally different direction than Congress planned?

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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: Emergency room visits after a full consultation

When we see a new patient we generally spend an hour doing the history, physical exam, ECG, PFT if needed, ordering lab work and writing prescriptions to last until the next appointment, even if for a year. Read more . . .

However, a few days later, many of these patients end up going to the Emergency Room and all the lab and x-rays we requested are done in the ER. Whereas we had been very judicious in what we ordered, the ER generally ends up ordering and doing far more tests than we thought were necessary.

If the patient hadn’t been to the lab before his ER visit, he would proceed to the lab after his ER visit and have the tests done that we had ordered. Most of these were done in the Hospital ER at a much greater expense than in a private lab or x-ray facility.

The treacherous comment to bring up to the patient is how he caused his health care to double in cost. He may feign ignorance. But in some cases there is overt hostility that a doctor should be concerned about his health care costs. Some even report the physician to their health insurance plan or to the state health department for even thinking that cost is relevant in caring for patients.

Doesn’t everyone know that health care should be free and unconcerned about cost?

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Medical Gluttony thrives in Government and Health Insurance Programs.

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

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6. Medical Myths: Health Insurance monitoring the practice of medicine saves costs.

A 70-year-old man was called by AARP to tell him he was taking too many medications. After he told them off and hung up, he was so incensed that he stopped all of his medications. It included two blood pressure medications. Read more . . .

When he came in a month later, his BP was elevated to 240/120 and he had a headache. His fundi were flat and I quickly gave him some stock beta blocker and let him lie on the exam table for 20 minutes while I saw the next patient.

His BP was down to 200/105 and I felt it safe to allow him to go home. I admonished him never to stop his BP medication again and to monitor it later in that evening.

Health insurance meddling and their practicing medicine could have easily caused a stroke and life-long paralysis in this man.

It’s a myth that health insurance meddling controls costs—it may cost lives instead.

Perhaps the doctor knows best what you should take.

Read more in the Sacramento Bee

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Medical Myths originate when someone else pays the medical bills.

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

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7. Overheard in the Medical Staff Lounge: The Presidential Campaign

Dr. Rosen: It looks like we’re in the midst of an active political season.

Dr. Sam: We certainly are and it doesn’t look too good.

Dr. Dave: Have you found anyone you would vote for? Read more…

Dr. Edwards: There are some good candidates but none can win the presidential elections.

Dr. Rosen: That may be true. But we’re getting a lot of important issues out in the open.

Dr. Sam: Well, it looks like Gingrich and Romney will be the final choice to try to beat the Chicago Mob that took over the White House.

Dr. Dave: But neither is able to do that. Both have too much baggage.

Dr. Edwards: Isn’t it interesting to see a whole raft of candidates talk about limits, decreasing spending, decreasing, taxes, reducing mandates, while the Chicago Mob keeps raising taxes, increasing spending, increasing our debt, and enslaving our children.

Dr. Ruth: I agree it doesn’t look good. I think we’ll have four more years of Tax & Spend that may destroy our country.

Dr. Michelle: I’m resigning myself to four more years of Obama. He’s too smooth and ruthless to be beat.

Dr. Paul: I don’t think there is any question that Obama will win again.

Dr. Rosen: I won’t vote for either Gingrich or Romney. Gingrich simply cannot be trusted. He would never have allowed himself to be photographed with Nancy Pelosi if he had planned to run. Actions speak louder than words. And Romney cannot be trusted ever. What he did in Massachusetts is only Obama “light.” If Romney were to run, I think I would have to vote for Obama to keep Romney from destroying the Republican Party and just like Obama increasing big government at the cost of freedom. The editorial in the WSJ said Romney was to the left of Obama. Hence, Romney is Obama “heavy.” He has never stated that he would repeal ObamaCare. He probably would make it more airtight. If Santorum is the nominee, I have no problem voting for him. But can he win in November. Although I’m registered in a party, I don’t support the party, only candidates that I trust. In Michigan I always registered Independent. There, with voting machines, I could turn the lever and vote in any primary I chose. But we don’t have that choice in California. That’s why I’m in a party I can’t support financially.

Dr. Edwards: It’s truly amazing that we have a president with diminishing support and the Republicans can’t find a leader to unseat him.

Dr. Paul: You got that last part right.

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The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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8. Voices of Medicine: A Review of Regional Medical Journals: Sonoma Medicine

EDITORIAL: Hospital Medicine:

The Good, the Bad and the Ugly

by Rick Flinders, MD

I left private practice for a full-time teaching career in 1985 and have never looked back. For a little less money and a lot fewer headaches, I found something in life that I love doing, and I feel fortunate to have spent most of my life doing it: practicing and teaching medicine to interns and residents caring for the underserved of Sonoma County. Maybe I’m lucky . . . Read more…

Like everyone else in medicine, I’ve noticed that things have changed. From my vantage point inside the hospital, I can think of nowhere else that the tumultuous transformation of medicine in the past decade has been more complete. Patients are sicker. Stays are shorter. Diseases are more complex. And the average cost of a day in the hospital is over $4,000, nearly doubling in the past 10 years. At the same time, those of us who provide care to the hospitalized patient are different. Ten years ago, half the family physicians in Sonoma County admitted their own patients to the hospital when they got sick. With the help of appropriate specialists, family docs and general internists admitted patients from their practices, visited them daily, and discharged them from the hospital when they got better. Then they saw those patients back in their offices throughout their recovery.

Pressures of time, efficiency and productivity in ambulatory practice have rendered those days obsolete. Furthermore, solo and small group practices have been absorbed into large corporate systems of health care, creating a new age of relationships between doctors, hospitals, foundations and HMOs. These relationships dwarf the complexities of the Krebs Cycle that I learned in medical school. Some of the authors in this issue of Sonoma Medicine try to untangle the web. . .

The Good

The good news in the hospital is the emergence of new expertise, awareness and experience of the special needs of hospitalized patients, which has spawned a new breed of uniquely trained physicians to care for them: hospitalists.

Also good is the irreplaceable value of the hospital as classroom, what I call “the crucible of medical learning.” From the perspective of a lifelong medical educator, I insist the practice and teaching of medicine in the hospital remains the single most hands-on, intense, intimate and sustained model we currently have to teach doctoring. Daily I’m asked why we should continue teaching inpatient medicine to a specialty that spends 99% of its time outside the hospital (see Table 1). Anyone who has ever labored through a long night at the bedside of a sick patient doesn’t have to ask. Dude, it’s about doctoring.

Table 1. Top 10 Reasons to Continue Teaching Family Physicians Inpatient Medicine . . .

The Bad

Alas, the new hospital model has not come without a price. Despite advances in expertise and efficiency, as well as improved outcomes, the primary care relationship between doctor and patient has suffered. You’d be surprised by how much effort we hospitalists make to communicate with our patients’ primary physicians, after admission and prior to discharge. You’d be amazed by the barriers encountered in those efforts to communicate. Patients arrive without advance directives or POLST (physician orders for life-sustaining treatment), and our discharge summaries, even in this age of instant electronic communication, are thwarted by user names, passwords, EHR affiliation agreements, and incongruence of availability and schedules. . .

Disruption of continuity and multiple sign-outs and hand-offs, both in care and learning, are a constant threat in the new medicine. The electronic health record, powerful as it is, is not a substitute for the relationship with a patient over time. I try to teach our residents, for example, that the patient’s history is not really complete until you’ve actually spoken with the primary physician. Am I a voice in the wilderness?

The Ugly

In 1998, the Institute of Medicine released a report that attributed nearly 100,000 deaths annually to medication errors in the hospital, drawing national attention to just one of the many known risks of being hospitalized. We must remember that hospital patients--by definition--are already sick and at higher risk of mortality. Still, it remains ironically disturbing that our houses of healing can be hazardous to our health.

The hazards of hospitalization (see Table 2) are now on our daily radar. Blood clots and hospital-acquired infections, especially with hospital-bred superbugs, remain especially significant threats. Early identification and prophylaxis of thromboembolic risk and prudent use of antibiotics are part of hospital-wide initiatives at Sutter, for example, to establish a new “culture of safety” in hospitals. In addition, electronic delivery and verification systems have already produced dramatic reductions in medication errors since 1998. Progress, but …

Table 2. Top 10 Hazards of Hospitalization. . .

You may notice among the hazards in Table 2 one not seen on the usual lists. I added it because it is especially ugly, and especially frightening: bankruptcy. Unpaid medical expenses are among the leading causes of bankruptcy in the United States, especially among the elderly. The biggest fear cited in a recent survey of Americans 65 or older was not war or terrorism; it was financial ruin from medical expenses.

There is inherent risk in what we do in the hospital, and we can only minimize it. But we can also remember that every potential benefit must be weighed against the risk. “Primum non nocere,” Hippocrates said (First do no harm). I sometimes wish our grand old man of Western Medicine hadn’t said it so well. Eloquence, especially when familiar, can become cliché. We all know the words. But do we still really hear them?

Dr. Flinders, a hospitalist who teaches in the Santa Rosa Family Medicine Residency, serves on the SCMA Editorial Board.
Email: flinder@sutterhealth.org

Notis Brevis (1): It should be noted that the high cost of health care causing bankruptcy occurs primarily in that segment of society covered by Medicare or Government Medicine. Why the paradox?

Notis Brevis (2): When patients have accountability at the point of service, e.g. in high deductible health care insurance, the cost of health care drops 40 – 60 percent. Can a hospitalist influence such efficiency?

Notis Brevis (3): How much of that $4,000 per day does the hospitalist manage? How much can hospitalist influence costs? Or is he impotent?

Read the entire Editorial in Sonoma Medicine. . .
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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: Inside the AARP

TRUST BETRAYED - Inside the AARP by Dale Van Atta. Regenery Publishing, Inc. Washington, DC: 1998, 208 pp, $25, ISBN 0-89526-485-4.

Dale Van Atta wrote a syndicated column with Jack Anderson that ran in more than 800 newspapers for over seven years. Today, he is a freelance author and journalist. He dedicates this volume to his aging mother, Vera Van Atta. We should alert our aging parents, even those under age 50, about this volume and the highly charged promotional campaign of the AARP.

The AARP is the second-largest organization in the United States, after the Catholic Church. It has thirty-three million members. Ethel Percy Andrus, a retired schoolteacher, was its founder. Steeped in the American ethos of God, country, and self-reliance, she explicitly stated that the "AARP is not a pressure group, petitioning for special privileges and exemptions because of age and numbers." Read more . . .

Today, the AARP supports higher taxes, disastrous health care legislation that threatens seniors, and other political causes such as attempting to defeat property tax reductions, the very thing that allows many retired seniors to keep their homes. The AARP has numerous business enterprises, including insurance and pharmaceuticals, that it claims are nonprofit services for seniors, but which are revenue engines for AARP causes and profit its business partners. Colonial Penn derives 80% of its profits from the AARP monopoly.

The AARP, with an income of more than $400 million a year, spent $83 million for salaries and benefits in 1994. Nineteen of the AARP's 1,732 employees earn more than $100,000 a year. The executive director, Horace Deets, headlined in a 1997 Fortune magazine profile as Washington's Second Most Powerful Man, making $357,000 a year in salary and benefits ($157,000 more than Washington's Most Powerful Man!) plus $49,000 in expenses. The block-long office building in DC, which some of its members call a Taj Mahal, reputedly cost $117 million. And in 1990, the AARP spent more than twice as much furnishing its posh headquarters than it spent on programs assisting the elderly.

Dr Ethel Percy Andrus, the founder, first spoke out against age discrimination in employment more than 30 years ago. The AARP was instrumental in securing passage of the landmark Age Discrimination in Employment act in 1967, and its attorneys have initiated or participated in high-profile class action age discrimination suits. However, this organization, once run entirely by retired persons, now employs a staff of which 80% are below the age of 50. Even its own members consider this a shameful practice that betrays their true commitment.

Not only is there age discrimination in its employment practices, but there is ethnic discrimination in its membership as well. Only 2% of AARP's members are black, 2% are Hispanic, and 2% are other minorities. With its members being mostly white, better educated, and richer than the average, the AARP explains "It's much more expensive to recruit ethnic groups than it is just your average population."

The AARP is the only lobby so powerful than it can secure legislation, such as the Medicare catastrophic coverage act, and when its own membership rebels, secure its repeal. To maintain such clout, each month the AARP solicits an estimated 40,000 individuals who are too young to join. To maintain their political and business perspective, AARP can remove chapter leaders with or without cause, even for taking a stand on a local political issue without the AARP's approval.

A day of reckoning may be on the horizon. Membership is dropping at such an embarrassing rate that in a closed-door session in July 1995, the Board agreed that they would multiply the number of households by 1.6, which increased membership by more than 2 million in a single day.

For the innocent elderly who look to the AARP to defend seniors' interests, Van Atta has a simple message: Your trust has been betrayed.

This book review is found in the book review section at DelMeyer.net . . .
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The Book Review Section Is an Insider’s View of What Doctors are Reading about.

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10. Hippocrates & His Kin: Political IRAs

The Money Trail:

Sacramento County’s new CEO has taken a shine to his new job. Brad Hudson spent $21,000 to furnish his office including a $78 shoe polisher with “lamb wool buffers.” Can’t he afford to pay for his own shoe shines? Turns out that maybe he could since he is collecting a $200,000 annual retirement benefit from the city Riverside along with his new Sacramento County CEO salary of $258,000 plus benefits. His contract also calls for the County to match up to $9,000 of his annual contributions to Sacramento County’s retirement plan.

What a lucrative trail mix?

The Money Bank:

Mitt Romney is reported to have up to $100,000,000 in his Individual Retirement Account (IRA). It's been reported that this is his Bain investment that went through the roof.

Don’t you feel sorry for him when he has to use it and pay Obama taxes on it?

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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.

• 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.

• 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.

• 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.

• 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?

• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Lawrence W Reed, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. Be sure to read the current lesson on Economic Education at www.fee.org.

• 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.

• 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.

• 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.]

• 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 17^th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month explore Choose recent issues. The last ten years of Imprimis are archived.

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

Words of Wisdom

Forecasting the Future

Anyone who claims to be able to see into the future is often forecasting the past.

Isn’t that how history manages to repeat itself? –Lettie Teague, WSJ

Politicians Planning Financial Regulations

. . . If the 10 smartest financial regulation experts in the world got in a room and wrote an internally consistent set of regulations, if history is any guide, it would not be likely to anticipate, avoid or mitigate whatever the next financial crisis would be . . . –Tony Blankley, Washington Times, 6-16-2009 (WSJ)

Some Recent Postings

From The December Combined Issue:

MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol X, No 19, Jan 17, 2012

The Wall Street Journal, November 16, 2011

By JENNIFER CORBETT DOOREN And RON WINSLOW - WSJ

In Memoriam

Del Meyer