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MEDICAL TUESDAY . NET |
NEWSLETTER |
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Community For Better Health Care |
Vol X, No 22, Feb
28, 2012 |
In This Issue:
1.
Featured Article:
Rick Santorum and
Secular Natural Law
2.
In
the News: A Church president responds
to Obama’s restriction of religious liberty.
3.
International Medicine: The Fight to
stop the reform of the National Health Service
4.
Medicare: Health Care's Coming
Price Revolution
5.
Medical Gluttony:
Have a Clinic in
several cities
6.
Medical Myths: Politicians will fix the
health care system.
7.
Overheard in the Medical Staff Lounge: Musical Chairs
Continue For Mitt and Newt
8.
Voices
of Medicine: Why Doctors Die
Differently
9.
The Bookshelf: The Story of a Family Who
Would Never Give An Inch
10.
Hippocrates
& His Kin: The Cost of
Dying
11.
Related Organizations: Restoring Accountability in Medical Practice and Society
Words of Wisdom, Recent Postings, In
Memoriam, Today in History . . .
* * * * *
Chancellor Otto von Bismarck, the father
of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by
making its citizens dependent on the state by social insurance. Thus socialized
medicine, any single payer initiative, Social Security was born for the benefit
of the state and of a contemptuous disregard for people’s welfare.
We must also remember that
ObamaCare has nothing to do with appropriate healthcare; it was similarly
projected to gain loyalty by making American citizens dependent on the
government and eliminating their choice and chance in improving their welfare
or quality of healthcare. Socialists know that once people are enslaved,
freedom seems too risky to pursue.
* * * * *
1. Featured Article: Rick Santorum and
Secular Natural Law by Peter J. Leithart
First
Things, Feb 24, 2012
Rick Santorum recently criticized Obama’s worldview as a
“phony theology not based on the Bible.” A few days ago, the Drudge Report
resurrected a 2008 speech in which Santorum warned that Satan has it in for the
U.S. Santorum’s blatantly religious comments have already made him an object of
ridicule and will doubtless cost him support. My cynicism meter goes as wild as
anyone’s when politicians talk like this. Still, I find it invigorating. Read more . . .
Politicians are usually careful to couch
their public remarks in a more generic idiom. Romney never criticizes Obama for
failing to follow the instructions of 4 Nephi or for not living up to the
example of Ether 7:11. Christian though he is, Ron Paul mentions von Mises more
than Matthew. It’s an understandable stance. Politicians want votes, and talk
in a way that makes sense to as many people as possible. Besides, we are in a
delicate moment in American history. We need some common norms to be a
functional society, yet no secular consensus has replaced the decayed
Protestant consensus of earlier centuries.
For many conservatives, natural law provides the secular grammar we need for
debating moral issues in a pluralistic society. John Finnis, a leading “new
natural law” theorist, contests the notion that every argument against
homosexual conduct is “a manifestation of purely religious, theological, and
sectarian belief.” Natural law arguments against homosexuality are instead “reflective,
critical, publicly intelligible and rational.” Finnis acknowledges debts to
theologians, especially Germain Grisez, but claims that “the relevant
philosophical arguments and considerations can be distinguished and detached
[from theology] by careful analysis.”
I don’t think so. Natural law theory remains too entangled with the
particularities of theology to do everything natural lawyers want it to do.
That is the thrust of Nicholas Bamforth and David A.J. Richards’ Patriarchal
Religion, Sexuality, and Gender (2007). Bamforth and Richards argue that
“the new natural lawyers’ arguments about sexuality, gender, and the law are
religious.” Natural law theorists “meld” secular and religious motivations and
norms and are “unlikely . . . to be able to draw a clean distinction between
that which is knowable through revelation and that which is graspable by reason
alone.”
For instance, Bamforth and Richards trace Finnis’s argument that marriage is a
“basic good” back to Grisez. In defending his characterization of marriage as a
basic good, Grisez cites the “development in Catholic teaching about marriage”
and particularly John Paul II’s magisterial teaching that marriage is “a unique
kind of communion and form of cooperation.” Using biblical language, Grisez
describes marital sex as “one flesh unity” and marriage as “a covenant” that is
“involved in the covenant with God.” Marriage is “not purely secular.” Grisez’s
very notion of human good is theologically charged: “Every human good realized
on earth will last forever” in some form, enduring after “God creates the new
heavens and the new earth and Jesus hands over his kingdom to his Father.”
Finnis directly borrows Grisez’s biblical notion of marriage as a “one-flesh
communion” when he says that the biological union of a man and woman “is part
of, not merely an instrument of, their personal reality.” Robert
George and Gerard Bradley also say that the good of marital sex is “the basic
good of marriage itself, considered as a two-in-one-flesh communion of persons.”
George knows that natural law arguments will not convince everyone. Anyone who
assumes the “modern conception of human nature and human good would be dubious”
about restrictions on extra-marital sex. Natural law, though, is “an
alternative conception of human nature.” In practice, this “alternative” is
inseparable from biblical claims about the Creator and his creation.
On the plus side, the fact that natural lawyers don’t actually
put revelation and the gospel to the side is much to their credit. In practice,
they resist the pressure to erect a wall between their faith and their public
philosophy. On the down side, this “melding” of secular and religious arguments
undermines their claim that natural law provides a theologically neutral
grammar for a pluralistic society.
Natural law theory has many uses. Using its categories, we explore the contours
of creation to uncover the pathways the Creator has laid out for us. Natural
law reasoning can demonstrate the “fit” between creation and revelation. The fact
that women, not men, bear babies is ethically significant, as is the fact that
human beings talk but animals don’t. Natural law is rhetorically useful for
advancing arguments and purposes that would be rejected out of hand if stated
in overtly religious terms.
Bamforth and Richards don’t accuse natural lawyers of bad faith. They simply
conclude that natural lawyers are more dependent on religion than they realize.
Critics like Bamforth and Richards sniff out the aroma of theology that clings
to natural law arguments, and they are right that Christians should be
transparent about the theological sources of our political convictions.
The fundamental Christian political claim is “Jesus is Lord,” a truth that lies
beyond natural reason. Christians can’t finally talk about politics without
talking about Jesus, and, yes, Satan and the Bible too. We can’t talk politics
without sounding like Rick Santorum, and we shouldn’t try to.
Peter J. Leithart is pastor of Trinity Reformed Church in Moscow, Idaho,
and Senior Fellow of Theology and Literature at New St. Andrews
College. His most recent book is Athanasius
(Baker Academic).
Resource
. . .
Resources: Nicholas Bamforth and David A. J. Richards, Patriarchal
Religion, Sexuality, and Gender: A Critique of New Natural Law
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* * * * *
2.
In the News:
Lutheran Church President
Responds to Pres. Obama’s “Compromise” on HHS Regulations
Cyberbrethren: A Lutheran Blog, February
14th, 2012
In response to President Obama’s announcement
Friday concerning an “accommodation” to a previous mandate that health plans
must cover all forms of birth control (even those that can kill the unborn),
The Lutheran Church—Missouri Synod (LCMS) remains deeply concerned. We strongly
object to the use of drugs and procedures that are used to take the lives of
unborn children, who are persons in the sight of God from the time of
conception. Drugs such as “Plan B” and “Ella,” which are still included in the
mandate, can work post-conception to cause the death of the developing child,
so don’t be fooled by statements to the contrary. Read more . . .
We see President Obama’s action Friday as
significant, in that it appears to have been prompted by the many voices united
in concern over an infringement of our religious liberties. But the
“accommodation” did not expand the exemption for religious employers, nor did
it restrict the mandate in any way. It simply described a temporary enforcement
delay and a possible future change—a change that, unfortunately, would not
adequately protect religious freedom or unborn lives.
We remain opposed to this mandate because it
runs counter to the biblical truth of the sanctity of human life. We are
committed to working to ensure that we remain free to practice the teachings of
our faith, that our religious rights are not violated, and that our rights of
conscience are retained. Freedom of religion extends beyond the practice of our
faith in houses of worship. We must be free to put our faith into action in the
public square, and, in response to Christ’s call, demonstrate His mercy through
our love and compassion for all people according to the clear mandate of Holy
Scripture.
The government has overstepped its bounds.
This controversy is not merely about “birth control” and the Catholic Church’s
views about it. It’s about mandating that we provide medications which kill
life in the womb. And moreover, and perhaps even more ominous, it is about an
overzealous government forcing coercive provisions that violate the consciences
and rights of its citizens. We can no longer expect a favored position for
Christianity in this country. But we can, as citizens of this great nation,
fight for constitutional sanity against secularizing forces. As we have vividly
experienced in discriminatory state legislation with respect to homosexual
adoption, we, and our institutions (and those of other religious citizens of
good will), are being robbed of the right to the free exercise of religion
absent government intrusion or threat. The next assault will come upon
church-related retirement facilities. How much longer will it be legal in this
country to believe and act according to the dictates of biblical and creedal
Christianity?
Jesus bids us, “Render to Caesar the things
that are Caesar’s, and to God the things that are God’s” (Mark 12:17). We will
pray for and support our government where we can, but our consciences and lives
belong to God.
In His peace,
The Rev Dr Matthew C. Harrison
President, The Lutheran Church—Missouri Synod
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* * * * *
3.
International
Medicine: The
Fight to stop the reform of the National Health Service
Labour will turn up the pressure
on the Liberal Democrat leader Nick Clegg on Thursday by
declaring him "one of the few people" who can stop the government's
NHS reforms
The opposition will also
attempt to divide the coalition partners in the Lords by making a public offer
that Labour and Lib Dems could together table and vote for an amendment to drop
the whole third part of the bill – the most incendiary section which would
introduce competition into the health service. . . Read more . . .
In another sign of Lib Dem
strife over the bill, a high-profile senior doctor resigned from the party on
Wednesday and warned that its continued backing for the shakeup is risking
"slow motion disaster for the NHS and for the party". . .
Burnham's letter refers
directly to a letter jointly written by Clegg and Williams this week in which
they promised Lib Dem MPs and peers five new amendments to "rule out
beyond any doubt any threat of a US-style market in the NHS". That move to
head off a backlash at the Lib Dem spring conference next weekend was
undermined by the prime minister's spokesman saying that the changes would be
"not significant". . .
Read
the entire article in The Guardian
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Privatization
of Government Healthcare meets opposition from Bureaucrats Everywhere
* * * * *
4.
Medicare: Health Care's Coming
Price Revolution
The private
sector is moving to give people the information they need to get treatments
that are worth the money. But ObamaCare blocks the way.
OPINION | WSJ | By JOSEPH RAGO | February 23, 2012
The old-line Marxists
used to talk about "heightening the contradictions" of capitalism to
make things worse and hasten the revolution. One of the great ironies of the
Affordable Care Act is that it may be doing just that.
Two years on,
the major achievement of President Obama's new entitlement and its regulatory
apparatus has been to heighten the contradictions and dysfunctions of the
health-care status quo even as it creates multiple new problems. The good—and
less noticed—news is that the growing disruption is driving the industry toward
the solution that prevails in the rest of the economy: the price mechanism. In
the context of American health care, this might be a watershed. Read more . . .
To appreciate
what's wrong with the current system, imagine four patients identical in every
way except for their insurance coverage. They report to the same doctor for a
routine procedure, say, a colonoscopy.
The first
patient is on Medicare, which controls prices. The program's fee formula sets
prices unilaterally for about 7,000 physician services and pays lump sums for
600 general hospital diagnoses, regardless of the quality of care. Medicare
pays twice as much on average for a colonoscopy if it is performed in a
hospital outpatient setting rather than in a doctor's office.
Patients two
and three are covered by private insurers, but those insurers are likely to
reimburse the doctor at different rates—whatever they've negotiated to include
him in their networks. The rate will be higher than competitive to make up for
Medicare's below-cost fees—the gap between public and private rates is now about
40 percentage points. The rate is also likely to be a proprietary trade secret,
or else literally unknowable: The doctor can only generate price information
when he codes his services and bills the insurer.
The fourth
patient is uninsured. If she seeks treatment, she'll be billed directly from a
"chargemaster," a hospital's list of marked-up sticker prices that no
one with coverage will ever pay.
So one
doctor, four patients, four different prices, multiplied times one-sixth of the
economy. Price discrimination, or varied pricing, is common in service
industries with high fixed and low marginal costs: airlines, colleges, hotels,
telecom. But nowhere else but health care are prices so arbitrary, so
disconnected from value. The consensus, on the right and left, is that this
fee-for-service jumble is incoherent.
What liberals
usually mean when they complain, however, is that they'll cook up speculative
and supposedly better payment forms—to pay for "bundles" of care; or
to pay more for treatments the government decides are valuable, and less for
those the government decides are wasteful; or to encourage physicians to
practice this way instead of that way. This is the price-is-"right"
fallacy and it always fails: No matter how expertly designed, price controls always
distort the allocation of resources. The health-care dollar is spent behind a
veil of ignorance, instead of revealing value.
A more
encouraging turn is the gradual emergence of a workable market-driven
alternative to all this in the private sector, which is happening for a simple
reason: There's no money left. . .
For decades businesses merely absorbed health-cost
increases and effectively took them out of employee compensation. But the
erosion of real wage increases that this caused is now too large to ignore.
RAND recently estimated that health care consumed 79% of the dollars that
otherwise would have gone into paychecks for the average U.S. family during the
2000s. Meanwhile, after the enactment of ObamaCare, premiums in
employer-sponsored health plans climbed by 9% in 2011, and they're due to rise
another 9.4% by 2014, according to Medicare's actuaries. They further estimate
that the increase would be 4.4 percentage points lower without ObamaCare's
mandates and rules.
But now insurers are starting to give workers and
businesses the information and tools they need to lower costs. This is, in
fact, a remarkable period of industry innovation and creative thinking. All the
major insurers—UnitedHealth, Aetna, Cigna, WellPoint—are now mining their billing
data and attempting to accurately measure costs and compare them with outcomes.
"Moneyball" is coming to health care for the first time. . .
The other important trend in terms of aligning costs and
incentives is the growing interest by employers in defined-contribution
insurance. Here companies would give their employees a fixed-dollar payment and
allow them to choose from a menu of coverage options and make the trade-offs
themselves, rather than having their bosses do it for them. Workers would pay
the marginal costs of higher-priced plans, much like what Rep. Paul Ryan has
proposed for Medicare.
A recurring theme on insurer earnings calls to analysts
in 2011 was that this shift—much like the migration to 401(k)s from
pensions—may happen within the next decade. As Aetna CEO Mark Bertolini put it
in October, "We have heard a lot of talk. We have actually engaged
employers in very detailed discussions about what it would take to do it. But
we have not seen anybody really interested in pulling the trigger yet."
Aetna recently bought Medicity and WellPoint bought Bloom Health, two start-ups
that are experimenting with this model.
The impulse here is to restore the price signals that
will drive U.S. health care to deliver care that is worth the money. But these gains—in
transparency and efficient pricing, for instance—will need to be consolidated
and expanded to constitute a true revolution. The Affordable Care Act stands in
the way.
ObamaCare's core philosophies are standardization and
centralization, which in practice will mean higher costs for everyone caused by
suffocating price competition. The share of insurance industry revenue that
comes from government now stands at 42%, up from 36% just three years ago, and
that's before the new entitlement kicks in. And a wave of ObamaCare-promoted
provider consolidation is creating hospital monopolies that can demand
higher-than-competitive prices. . .
So a revolution won't come automatically. Still, the
market is naturally creating an ObamaCare alternative, and the moment for
structural reform may be riper than Washington rhetoric suggests.
"Health-care reform" is inevitable. The only question is whether it
will run in the direction of prices and choice or more government control.
Mr. Rago is a member
of the Journal's editorial board.
A version of this article appeared Feb. 23, 2012, on page
A15 in some U.S. editions of The Wall Street Journal, with the headline: Health
Care's Coming Price Revolution.
Read the entire article on the WSJ
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Government is not the solution to our
problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical
Gluttony: Have a
Clinic in several cities
Mrs. Zim, a 52
YO-WMF had Medicaid coverage. She wasn’t destitute but lived with family in
Napa, CA and also in Oroville CA where she owned some property. When she
visited, she usually went to a clinic and asked for whatever she felt she
needed. Her total Social Security disability was based on her spine. Examination
of her back, however, revealed normal full Range of Motion (ROM) with flexion
of 90 degrees, extension of 30 degrees, lateral bending of 45 degrees and
rotation of 90 degrees without any back pain, tenderness of the spine or spasms
of the para-spinal muscles. Read more . . .
She had x-rays of her spine, her sore knee, and ultrasounds
of her liver. In fact she had two ultrasounds of her liver, one in Napa and one
in Oroville, because she read the reports as being abnormal. However, the
official report was benign cyst. She said she had liver cancer and the reports
were not trustworthy.
Medicaid allows all recipients access to health care
where ever they desire. None of the prior tests are available at the new
location. Thus, there is no limitation of duplicative services or unnecessary
medical costs.There isn’t the medical oversight that only a personal physician gatekeeper
can give.
Medicaid patients basically have a blank check or a MasterCard paid by
the US Treasury. Even though it is discounted payment, sooner or later the Bank
Account is depleted or the Credit Limit is reached.
Why doesn’t the US Congress understand
that overdrafts can’t go on forever?
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Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on
Every Service.
For Medicaid it disappears with a personal physician gatekeeper.
* * * * *
6.
Medical
Myths: Politicians
will fix the health care system.
THE BLIND MEN AND THE ELEPHANT
John Godfrey Saxe's (1816-1887)
version of the famous Indian legend.
It was six men of Indostan
To learning much inclined,
Who went to see the Elephant
(Though all of them were blind),
That each by observation
Might satisfy his mind. Read more . . . .
The First approach'd the Elephant,
And happening to fall
Against his broad and sturdy side,
At once began to bawl:
"God bless me! but the Elephant
Is very like a wall!"
The Second, feeling of the
tusk,
Cried, -"Ho! what have we here
So very round and smooth and sharp?
To me 'tis mighty clear
This wonder of an Elephant
Is very like a spear!"
The Third approached the animal,
And happening to take
The squirming trunk within his hands,
Thus boldly up and spake:
"I see," quoth he, "the Elephant
Is very like a snake!"
The Fourth reached out his eager hand,
And felt about the knee.
"What most this wondrous beast is like
Is mighty plain," quoth he,
"'Tis clear enough the Elephant
Is very like a tree!"
The Fifth, who chanced to
touch the ear,
Said: "E'en the blindest man
Can tell what this resembles most;
Deny the fact who can,
This marvel of an Elephant
Is very like a fan!"
The Sixth no sooner had begun
About the beast to grope,
Then, seizing on the swinging tail
That fell within his scope,
"I see," quoth he, "the Elephant
Is very like a rope!"
And so these men of Indostan
Disputed loud and long,
Each in his own opinion
Exceeding stiff and strong,
Though each was partly in the right,
And all were in the wrong!
MORAL.
So oft in political wars,
The disputants, I ween,
Rail on in utter ignorance
Of what each other mean,
And prate about an Elephant
Not one of them has seen!
You suppose that Newt and Mitt should be in
the Donkey Party?
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Medical Myths Originate When Someone with no Medical Experience
Designs the medical plan which none of them understand.
* * * * *
7.
Overheard
in the Medical Staff Lounge: Musical Chairs
Continue For Mitt and Newt
Dr. Rosen: Things
are changing in the political landscape. Rick Santorum still has a musical
chair. Much to everyone’s surprise, Mitt and Newt are still going around the
circle trying to find a free chair.
Dr. Edwards: I think that is good news. But what if Mitt Romney
or Newt Gingrich captures the White House? Read more . . .
Dr. Sam: That
would be tragic, indeed. And I’m not sure most Americans see the implications.
Dr. Dave: I’m not
even sure most physicians realize the implications.
Dr. Paul: As a
Pediatrician, I’m still in Obama’s court. He will continue to get me paid.
Dr. Edwards: That’s because
you are totally in the clutches of the government. Most of your patients are under
some Government program which allows them to get other government handouts such as free lunches, and now,
dinners in grade school.
Dr. Yancy: We surgeons are already under the clutches
of government medicine. It will only get worse unless we have a change in the White
House.
Dr. Milton: But what’s
best for HealthCare in General and Medicine in particular?
Dr. Ruth: Yes, what
is best for our society?
Dr. Sam: There
are two candidates we know we cannot trust. Mitt Romney advanced an Obama-like
plan for Massachusetts which he’s never retracted. In fact, he had an editorial
in the WSJ still supporting his ignominious
health plan in Massachusetts.
Dr. Dave: He still
doesn’t see the problem he caused in Massachusetts.
Dr. Milton: And he has the attitude of “Tell me the problem
and I’ll fix it.” He saw the problem in Massachusetts, which his doctor friends
explained as an Emergency Room problem to him. “He fixed it” but it made health
care less affordable and is causing real fiscal problems. He reminds me of the
six blind men and the elephant. Each went up to the elephant and one who caught
the tail said, “The elephant is much like a rope.” A second one put his hand
around the leg and said, “The elephant is much like a tree.” Another felt the
flanks and said, “The elephant is much like a wall.”
Dr. Dave: Very good, Milton, precisely why Mitt
Romney would be dangerous in the White House. He can’t comprehend the entire
picture. I hope no Doctor considers voting for him.
Dr. Milton: As for Newt Gingrich, no one, maybe not even Newt,
knows where he stands. I’ll never forget when he shared the stage with Nancy
Pelosi. I’m sure he regrets it now, but we need a candidate who knows where he
stands at all times. How else will the voters know where he stands? We don’t
need a Chameleon in the White House.
Dr. Sam: You got that right, Milton. Does that
leave only Rick Santorum? Is he electable?
Dr. Ruth: We
won’t know that until after the elections. But is he the best candidate for
America?
Dr. Edwards: Yes, Ruth, I think he’s the only candidate for
America at this time. He’s had a lot of flak for his basic high moral stance.
And I know many doctors disagree with some of his positions on life issues, but
isn’t that what we need at this time in our history? Don’t you think America is
ready for some reversal of misfortune? Some restoration of our heritage?
Dr. Sam: There’s a more ominous outlook if we
allow the Chicago Mobster Machine to continue to control the White House. Like
Adolf Hitler who was the idol of German youth, Barrack Hussein Obama is the
idol of the university youth.
Dr. Dave: Not
only the University Youth. But also the University faculty.
Dr. Sam: I
really think, with another term, Obama could become a dictator. And what no one
understands is that he could pull this off without ever firing a shot. He’s
making a class society of the Poor vs the Rich which is where President Reagan
found America in the 1980s. Remember the graduated income tax was at 91 percent
before he brought the top level down to 35 percent. It took 40years to reverse
Franklin Roosevelt and now it’s being reinstituted.
Dr. Edwards: Obama’s oratory totally obfuscates the issues. He can almost sound
Reaganesque to lower America’s watch and alertness as he takes over.
Dr. Sam: Remember after the war, free Germany
could not understand why in a weak moment they didn’t comprehend the dangers of
Adolf Hitler?
Dr. Dave: What’s
even more amazing, after the Communists devastated East Germany, it took a
while for the population to understand Freedom. Remember some even wanted to
rebuild the “wall.”
Dr. Sam: Didn’t the same thing happen in the
Soviet Union? After Reagan and Margaret Thatcher won the cold war, many in
Russia wanted to return to dictatorship even though under that system, grocery
shelves were nearly bare.
Dr. Milton: Don’t
you remember the Russian Czars? Obama has installed a number of Czars which
were appointed, not elected. Not even approved by the US Senate, a normal
procedure during our first two centuries.
Dr. Edwards: And the Obama Health Plan fits right in with his scheme. If he’s
re-elected, the entire Government Health plan will be in effect by 2014. It
will then be too late for any revision or reversal. He will have two additional
years with his Czars to establish total control of our nation. There won’t have
to be any additional elections. And I was so looking forward to having a woman
president in 2016 on the one hundredth anniversary of women’s suffrage.
Dr. Patricia: Sarah, where are you when we need you?
Dr. Nichols: With Sarah, there would never be a question on where she stands.
Dr. Michelle: You guys are frightening me. Here I was thinking Obama’s mandates
were good. They were improving quality of health care. They were weeding out
the worst Doctors.
Dr. Sam: Remember
Michelle, every mandate reduces the physician’s control over the health care of
his personal patients. Maybe you think there are some rotten eggs in our
profession. But let me tell you, there are far more rotten eggs in the
political basket, whether you talking about the Senate or the House or any
political candidate.
Dr. Dave: Making
physicians the culprit is just one cog in the Obama wheel or the AMA which
supported him in the last election and is poised to support him this year.
Dr. Sam: The
executive of our own society observed that with every election more physicians always
voted liberal. He felt it will only be a
matter of time before all doctors will fall in line with Single Payer. He
always refrained from using such tainted words as Socialized Medicine.
Sometimes it seemed as if the doctors didn’t understand the difference.
Dr. Dave: Or
the similarities!
Dr. Milton: Or
the identities!
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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
* * * * *
8.
Voices of
Medicine: A
Review of Articles by Physicians
Why
Doctors Die Differently
Careers in medicine have taught them the limits of treatment
and the need to plan for the end
By KEN MURRAY, MD, WSJ
What's unusual about doctors is not how much
treatment they get compared with most Americans,
but how little.
Years ago, Charlie, a
highly respected orthopedist and a mentor of mine, found a lump in his stomach.
It was diagnosed as pancreatic cancer by one of the best surgeons in the
country, who had developed a procedure that could triple a patient's five-year-survival
odds—from 5% to 15%—albeit with a poor quality of life. Read more . . .
Charlie, 68 years old, was uninterested. He went home the
next day, closed his practice and never set foot in a hospital again. He
focused on spending time with his family. Several months later, he died at
home. He got no chemotherapy, radiation or surgical treatment. Medicare didn't
spend much on him.
It's not something
that we like to talk about, but doctors die, too. What's unusual about them is
not how much treatment they get compared with most Americans, but how little.
They know exactly what is going to happen, they know the choices, and they
generally have access to any sort of medical care that they could want. But
they tend to go serenely and gently.
Doctors don't want to
die any more than anyone else does. But they usually have talked about the
limits of modern medicine with their families. They want to make sure that,
when the time comes, no heroic measures are taken. During their last moments,
they know, for instance, that they don't want someone breaking their ribs by
performing cardiopulmonary resuscitation (which is what happens when CPR is
done right).
In a 2003 article,
Joseph J. Gallo and others looked at what physicians want when it comes to
end-of-life decisions. In a survey of 765 doctors, they found that 64% had
created an advanced directive—specifying what steps should and should not be
taken to save their lives should they become incapacitated. That compares to
only about 20% for the general public. (As one might expect, older doctors are
more likely than younger doctors to have made "arrangements," as
shown in a study by Paula Lester and others.)
Why such a large gap
between the decisions of doctors and patients? The case of CPR is instructive.
A study by Susan Diem and others of how CPR is portrayed on TV found that it
was successful in 75% of the cases and that 67% of the TV patients went home.
In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of
patients survived for more than one month. Of these, only about 3% could lead a
mostly normal life. . .
. . . Several years ago, at age 60, my older cousin Torch
(born at home by the light of a flashlight, or torch) had a seizure. It turned
out to be the result of lung cancer that had gone to his brain. We learned that
with aggressive treatment, including three to five hospital visits a week for
chemotherapy, he would live perhaps four months.
Torch was no doctor,
but he knew that he wanted a life of quality, not just quantity. Ultimately, he
decided against any treatment and simply took pills for brain swelling. He
moved in with me.
We spent the next
eight months having fun together like we hadn't had in decades. We went to
Disneyland, his first time, and we hung out at home. Torch was a sports nut,
and he was very happy to watch sports and eat my cooking. He had no serious
pain, and he remained high-spirited.
One day, he didn't
wake up. He spent the next three days in a coma-like sleep and then died. The
cost of his medical care for those eight months, for the one drug he was
taking, was about $20.
As for me, my doctor
has my choices on record. They were easy to make, as they are for most
physicians. There will be no heroics, and I will go gentle into that good
night. Like my mentor Charlie. Like my cousin Torch. Like so many of my fellow
doctors.
—Dr. Murray is
retired clinical assistant professor of family medicine at the University of
Southern California. Adapted from an article originally published on Zocalo
Public Square.
Read
the entire article in the WSJ,
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VOM
Is an Insider's View of What Doctors are Thinking, Saying and Writing about.
* * * * *
9.
Book
Review: Themes of independence,
individualism, and self-sufficiency.
Sometimes a Great Notion:
The Story of a Family Who Would Never Give an
Inch
|
by
Edward W. Younkins |
|
Ken Kesey’s novel, Sometimes
a Great Notion (1964), is a complex and integrated historical background
and relationship study of the Stamper family, a prideful logging clan living
in Wakonda, Oregon. This big story involves a man, his family, a town, the
country, a period of time, and the effects of time. All of the elements of
the novel including its characters, events, settings, symbols, and so on, are
integrated and oriented toward the themes of independence, individualism, and
self-sufficiency. The novel teaches that a person should have the right to
try to be as big as he believes it is in him to be. Sometimes a Great
Notion was made into a 1971 film directed by and starring Paul Newman. In
Britain this film about generations of loggers was called Never Give an
Inch. Read more . . . At the beginning of the 20th century, Jonas Stamper had
traveled from Kansas to Oregon to pursue his American dream of becoming a
successful pioneer in the promising new Western frontier. Jonas begins to
construct a large frame house on a bank of the Wakonda Auga River. Overcome
by the potential of the Oregon climate and wilderness to overpower and destroy
men, the intimidated Jonas leaves his family and goes back to Kansas. Jonas’s son, Henry,
takes command, finishes the house, and commences a continual battle to keep
it from being washed away by the mighty river. Stamper House stands on a
dangerous peninsula on a river bend. All of the other homes in the vicinity
are eventually destroyed by the waters. Henry refuses any help from others in
the community and declines to join the Wakonda Co-op or any other community
association. By 1961, the independent, stubborn, and fierce Henry is widely
recognized as the patriarch of the long-resented Stamper clan. His motto is
“Never Give an Inch.” In the novel, the house built on the river will come to
represent family tradition, the river will symbolize the eroding effects of
time, and Henry will epitomize the family’s link with its pioneering past.
Henry is a man of habit whose philosophy is “to keep on going.” Hank is Henry’s
oldest son. A man of integrity, he is loyal, honest, and courageous, and
possesses a strong will and personality. The toughest man in the region, Hank
was an all-state football player and a veteran of the Korean War as a Marine.
Like his father, Hank is tough, obstinate, self-reliant, and independent. He
is the only character in the novel who is able to swim across the river, his
most powerful and relentless adversary. The aggressive and vital Hank becomes
the leader of the family and has numerous clashes with members of the
community and his own family. Throughout the novel he is portrayed as a
heroic small businessman who is able to deal with and withstand a variety of
pressures. The major action of
the story occurs during a period of several weeks in 1961. At that time Hank
and his cousin and best friend, Joe Ben, are running the Stamper family’s
logging business. Henry does what he can but has recently been injured and
wears a cast on one side of his body. Having captured the market, the big
lumber corporations have been putting pressure on the smaller companies and
the union. The Stamper family owns and operates a company that does not have
a union‒Hank only hires family members. Henry’s goal is to keep the
family logging business alive. The union has the
backing of the whole town except for the Stampers. This does not sit well
with the union workers who feel betrayed. The Stamper family’s decision to
keep working prevents the strike from ending because there is no good reason
for Wakonda Pacific to negotiate and to resolve the dispute when the Stampers
are doing all of the work that the unionized workers would have done. This
large corporation can only meet its own contracts by dealing with men like
Hank Stamper, a man of his word. .. The Stampers will not
succumb to the demands of the union workers to cease working so that they can
gain the benefit of higher wages. One of the townspeople, who is Hank’s
friend and union member, pleads with Hank to stop working during the strike.
He says that if the Stampers don’t stop then he will commit suicide
pretending it was an accident thereby gaining insurance proceeds for his
family. Hank refuses while exhibiting no emotions. His friend later follows
through with his suicide. Hank is determined by principle to fulfill his
commitment to deliver the logs. . . At this point in the
story Hank appears to be ready to give in to the union demands. This has
negative effects on the community, and the townspeople are saddened. His
giving up would disillusion the residents of the community and would destroy
their assurance in confronting life’s challenges. The novel thus illustrates
how an heroic free individual with strength and integrity, like Hank, has a
positive effect on the community. The community benefits from Hank’s free
expression of his self-interest. . . Sometimes a Great
Notion illustrates the value of a family sticking together. Hank,
the product of a frontier culture, has a strong will and work ethic and leads
his family in fighting for what they believe. He is a man of integrity who
has a strong sense of kinship. In association with his family, Hank is able
to withstand a variety of pressures including the forces of nature, (i.e.,
the river and the forest), social pressures exerted by the townspeople, the
conformist pressures brought by the union, and the need to fulfill their
logging contract. Hank represents the joy of an unyielding will in his quest
to deliver the logs to the Wakona Pacific Lumber Company. . . This fine tale of
independence, individualism, and family has been made into a 1971 film. The
roles and actors include: Hank Stamper (Paul Newman), Henry Stamper (Henry
Fonda), Viv Stamper (Lee Remick), Leland Stamper (Michael Sarazin), Joe Ben
Stamper (Richard Jaeckel), Floyd Everwrite (Joe Maross), and Jonathan Draeger
(Roy Poole). Read
the entire book/movie review at http://www.quebecoislibre.org/12/120215-5.html Feedback . . . The Book
Review Section Is an Insider’s View of What Doctors are Reading about. * * * * * |
|
|
|
10. Hippocrates & His Kin: The Cost of
Dying
Notable
& Quotable (WSJ 2-15-12)
What do you call it when someone steals some else’s
money secretly? Theft.
What do you call it when one takes someone else’s
money openly by force? Robbery.
What do you call it when a politician takes someone
else’s money in taxes and gives it to someone who is more likely to vote for
him? Social Justice.
Economist Thomas Sowell writing in his syndicated column, Dec. 27.
Cost of end of life cancer care? (See section 8 above) Read more . . .
A patient with Cancer of the Lung who had everything
done that his medical oncologist and radiation oncologist had recommend brought
in his chemotherapy and x-ray statement he received from his insurance company.
It was more than $200,000. He was given a year to live. That’s 10,000 times the
$20 cost of the patient in section 8 above.
The only way to lower the cost of health care is patient
responsibility. That is only achieved with a patient copayment. Our research
indicates that a10 percent copay on hospital bills such as above would
eliminate 60 to 75 percent of the cost of dying. And it would improve the
quality of that last year of life.
What a logical way to control health
care costs.
Sacramento
approves car park for an arena that is only in the planning stages.
The Sacramento Kings have been courted by Anaheim and
Seattle to move because the 20-year-old Sacramento Arco Arena is dated. But it
still has a regulation size basketball court and the arena is large enough to
seat all the fans that desire to come to a game and leave unhappy.
What if the Kings play another year at Arco Arena 20
miles out of town?
Will a new arena improve the number of wins?
Won’t Parking 20 miles from the Arena be rather
inconvenient?
I understand the shuttle services are behind this. I wonder if they are
already purchasing Vans to transport 20,000 people before and after the games.
Or Buses? Maybe they will fund a new light rail?
Or maybe the attendance will drop to 10,000. Or maybe the sports business
should pay the costs of their facilities rather than taxpayers? Why are
taxpayers on the hook for almost anything?
To read more HHK
. . .
To
read more HMC . . .
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Hippocrates
and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow
* * * * *
11. Professionals Restoring
Accountability in Medical Practice, Government and Society:
•
John and Alieta Eck, MDs, for their first-century solution to twenty-first
century needs. With 46 million people in this country uninsured, we need an
innovative solution apart from the place of employment and apart from the
government. To read the rest of the story, go to www.zhcenter.org and check
out their history, mission statement, newsletter, and a host of other
information. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.
•
Medi-Share Medi-Share is based on the biblical principles of
caring for and sharing in one another's burdens (as outlined in Galatians 6:2).
And as such, adhering to biblical principles of health and lifestyle are
important requirements for membership in Medi-Share.
This is not insurance. Read more . . .
•
PATMOS
EmergiClinic - where Robert Berry,
MD, an emergency physician and internist, practices. To read his story and
the background for naming his clinic PATMOS EmergiClinic - the island where
John was exiled and an acronym for "payment at time of service," go
to www.patmosemergiclinic.com/
To read more on Dr Berry, please click on the various topics at his website. To
review How
to Start a Third-Party Free Medical Practice . . .
•
PRIVATE NEUROLOGY is
a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/)
Dr Huntoon does not allow any HMO or government interference in your medical
care. "Since I am not forced to use CPT codes and ICD-9 codes (coding
numbers required on claim forms) in our practice, I have been able to keep our
fee structure very simple." I have no interest in "playing
games" so as to "run up the bill." My goal is to provide
competent, compassionate, ethical care at a price that patients can afford. I
also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT
THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept
totally private and confidential - in accordance with the Oath of Hippocrates.
Since I am a non-covered entity under HIPAA, your medical records are safe from
the increased risk of disclosure under HIPAA law.
•
FIRM: Freedom
and Individual Rights in Medicine, Lin
Zinser, JD, Founder, www.westandfirm.org,
researches and studies the work of scholars and policy experts in the areas
of health care, law, philosophy, and economics to inform and to foster public
debate on the causes and potential solutions of rising costs of health care and
health insurance. Read Lin
Zinser’s view on today’s health care problem: In today’s proposals for sweeping changes
in the field of medicine, the term “socialized medicine” is never used. Instead
we hear demands for “universal,” “mandatory,” “singlepayer,” and/or
“comprehensive” systems. These demands aim to force one healthcare plan
(sometimes with options) onto all Americans; it is a plan under which all
medical services are paid for, and thus controlled, by government agencies.
Sometimes, proponents call this “nationalized financing” or “nationalized
health insurance.” In a more honest day, it was called socialized medicine.
•
To read the rest
of this section, please go to www.medicaltuesday.net/org.asp.
•
Michael J.
Harris, MD - www.northernurology.com
- an active member in the American Urological Association, Association of
American Physicians and Surgeons, Societe' Internationale D'Urologie, has an
active cash'n carry practice in urology in Traverse City, Michigan. He has no
contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is
nationally recognized for his medical care system reform initiatives. To
understand that Medical Bureaucrats and Administrators are basically Medical
Illiterates telling the experts how to practice medicine, be sure to savor his
article on "Administrativectomy:
The Cure For Toxic Bureaucratosis."
•
Dr Vern Cherewatenko concerning success in restoring private-based
medical practice which has grown internationally through the SimpleCare model
network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service,
the "Cash-Based Revolution." The patient pays in full before leaving.
Because doctor charges are anywhere from 25–50 percent inflated due to
administrative costs caused by the health insurance industry, you'll be paying
drastically reduced rates for your medical expenses. In conjunction with a
regular catastrophic health insurance policy to cover extremely costly
procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year!
To read the rest of the story, go to www.simplecare.com.
•
Dr David
MacDonald started Liberty Health
Group. To compare the traditional health insurance model with the Liberty
high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm.
There is extensive data available for your study. Dr Dave is available to speak
to your group on a consultative basis.
•
David
J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the
free Medical MarketPlace in speeches and writings. His series of articles in Sacramento
Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single
Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.
•
Dr
Richard B Willner, President,
Center Peer Review Justice Inc, states: We are a group of healthcare
doctors -- physicians, podiatrists, dentists, osteopaths -- who have
experienced and/or witnessed the tragedy of the perversion of medical peer
review by malice and bad faith. We have seen the statutory immunity, which is
provided to our "peers" for the purposes of quality assurance and
credentialing, used as cover to allow those "peers" to ruin careers
and reputations to further their own, usually monetary agenda of destroying the
competition. We are dedicated to the exposure, conviction, and sanction of any
and all doctors, and affiliated hospitals, HMOs, medical boards, and other such
institutions, who would use peer review as a weapon to unfairly destroy other
professionals. Read the rest of the story, as well as a wealth of information,
at www.peerreview.org.
•
Semmelweis
Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD,
FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD,
Secretary-Treasurer; is
named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician
who has been hailed as the savior of mothers. He noted maternal mortality of
25-30 percent in the obstetrical clinic in Vienna. He also noted that the first
division of the clinic run by medical students had a death rate 2-3 times as
high as the second division run by midwives. He also noticed that medical
students came from the dissecting room to the maternity ward. He ordered the
students to wash their hands in a solution of chlorinated lime before each
examination. The maternal mortality dropped, and by 1848, no women died in
childbirth in his division. He lost his appointment the following year and was
unable to obtain a teaching appointment. Although ahead of his peers, he was
not accepted by them. When Dr Verner Waite received similar treatment from a
hospital, he organized the Semmelweis Society with his own funds using Dr
Semmelweis as a model: To read the article he wrote at my request for
Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the
California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some
very interesting letters to the editor from the Medical Board of California,
from a member of the MBC, and from Deane Hillsman, MD.
To view some horror stories of atrocities against physicians and
how organized medicine still treats this problem, please go to www.semmelweissociety.net.
•
Dennis
Gabos, MD, President of
the Society for the Education of Physicians and Patients (SEPP), is
making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms
and Responsibilities of Patients and Health Care Professionals. For more
information, go to www.sepp.net.
•
Robert
J Cihak, MD, former
president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an
informative Medicine Men column at NewsMax, have now retired. Please log
on to review the archives.
He now has a new column with Richard Dolinar, MD, worth reading at www.thenewstribune.com/opinion/othervoices/story/835508.html
•
The
Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private
Physicians Since 1943, representing physicians in their struggles against
bureaucratic medicine, loss of medical privacy, and intrusion by the government
into the personal and confidential relationship between patients and their
physicians. Be sure to read News of the Day in Perspective: ?. Don't miss the "AAPS News,"
written by Jane Orient, MD, and archived on this site which provides valuable
information on a monthly basis. This month, be sure to read ? . Browse the
archives of their official organ, the Journal
of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a
neurologist in New York, as the Editor-in-Chief. There are a number of
important articles that can be accessed from the Table of Contents.
The AAPS California Chapter is an unincorporated association made up of members.
The Goal of the AAPS California Chapter is to carry on the activities of the
Association of American Physicians and Surgeons (AAPS) on a statewide basis.
This is accomplished by having meetings and providing communications that
support the medical professional needs and interests of independent physicians
in private practice. To join the AAPS California Chapter, all you need to do is
join national AAPS and be a physician licensed to practice in the State of
California. There is no additional cost or fee to be a member of the AAPS
California State Chapter.
Go to California
Chapter Web Page . . .
Bottom
line: "We are the best deal Physicians can get from a statewide physician
based organization!"
PA-AAPS is the Pennsylvania Chapter of the Association of
American Physicians and Surgeons (AAPS), a non-partisan professional
association of physicians in all types of practices and specialties across the
country. Since 1943, AAPS has been dedicated to the highest ethical standards
of the Oath of Hippocrates and to preserving the sanctity of the
patient-physician relationship and the practice of private medicine. We welcome
all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors
and other medical professionals are welcome to join as professional associate
members. Staff members and the public are welcome as associate members. Medical
students are welcome to join free of charge.
Our motto, "omnia pro aegroto"
means "all for the patient."
Words of Wisdom, Recent Postings, In
Memoriam, Today in History . . .
Words of Wisdom
The road
to hell is paved with good intentions, and then after heavy use it gets
resurfaced with cynicism.
Conservatives
like me were liberals mugged by liberalism.
A true
patriot weeps more often than he brags.
–Aphorisms
from First Things
Some Recent
Postings
From The February 14th Issue: