MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol XI, No 5, Aug 14, 2012

In This Issue:

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Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, any single payer initiative, Social Security was born for the benefit of the state and of a contemptuous disregard for people’s welfare.

We must also remember that ObamaCare has nothing to do with appropriate healthcare; it was similarly projected to gain loyalty by making American citizens dependent on the government and eliminating their choice and chance in improving their welfare or quality of healthcare. Socialists know that once people are enslaved, freedom seems too risky to pursue.

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1. Featured Article: The Supreme Court Healthcare Decision:

Not Good, Not Bad, Just More of The Same Top-Down Thinking

When times change, success demands new thinking. But our brains are wired to repeat what we've done in the past, and so is our government. Hence more top-down thinking is the law of the land in the Affordable Care Act.

Top-down thinking will get us more of the same. Grassroots movements have always been the source of new thinking in the U.S., so why should it stop now? Read more . . .

In order to get people the healthcare they need, we need to get close to the people. That's something even Republicans and Democrats can agree on. A bottom-up method for creating new thinking and doing has been tested and validated in many different healthcare environments. (See Adaptive Healthcare)

Adaptive Design is the top-down decision that management can make to enable a continuous flow of bottom-up solutions. What do you think? What's been your experience? Email info@johnkenagy.com and we can continue the conversation.

John W. Kenagy, MD, MPA, ScD, FACS

Adaptive Design in Healthcare

info@johnkenagy.com

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2. In the News: Resuscitating Medicare

Medicare Reform by John C. Goodman

Health care is the most serious domestic policy problem we have, and Medicare is the most important component of that problem. Every federal agency that has examined the issue has affirmed that we are on a dangerous, unsustainable spending path:

· According to the Medicare Trustees, by 2012 the deficits in Social Security and Medicare will require one out of every 10 income tax dollars.

· They will claim one in every four general revenue dollars by 2020 and almost one in two by 2030.

· Of the two programs, Medicare is by far the most burdensome — with an unfunded liability five times that of Social Security. Read more . . .

· Nor is this forecast the worst that can happen:

· The Congressional Budget Office notes that health care costs overall have been rising for many years at twice the rate of growth of our incomes.

· On the current path, health care spending (mainly Medicare and Medicaid) will crowd out every other activity of the federal government by midcentury.

There are three underlying reasons for this dilemma:

· Since Medicare beneficiaries are participating in a use-it-or-lose-it system, patients can realize benefits only by consuming more care; they receive no personal benefit from consuming care prudently and they bear no personal cost if they are wasteful.

· Since Medicare providers are trapped in a system in which they are paid predetermined fees for prescribed tasks, they have no financial incentives to improve outcomes, and physicians often receive less take-home pay if they provide low-cost, high-quality care.

· Since Medicare is funded on a pay-as-you-go basis, many of today’s taxpayers are not saving and investing to fund their own post-retirement care; thus, today’s young workers will receive benefits only if future workers are willing to pay exorbitantly high tax rates.

To address these three defects in the current system, we propose three fundamental Medicare reforms: . . .

These reforms would dramatically change incentives. Whether in their role as patient, provider or worker/saver, people would reap the benefits of socially beneficial behavior and incur the costs of socially undesirable behavior. Specifically, Medicare patients would have a direct financial interest in seeking out low-cost, high-quality care. Providers would have a direct financial interest in producing efficient, high-quality care. And workers/savers would have a financial interest in a long-term financing system that promotes efficient, high-quality care for generations to come. . .

Read the entire report . . .
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3. International Medicine: Socialized Medicine Is Enough to Chase Away British Doctors

August 30, 2012

Since its inception, the National Health Service (NHS) of Britain has been a constant source of pride and joy to Britons. From an outsider's perspective, one has to wonder where this pride is derived from. At a glance, the long waiting times, denial of care, poor facilities and base pay all make the health care system something to avoid. And that is exactly what doctors in Britain are doing, says Investor's Business Daily.

This phenomenon, known as brain drain, is what the British health care system is currently experiencing.

· More than 8,000 doctors have left Britain since 2008.

· But the problem is not restricted to Britain, as 10 percent of Canadian-trained doctors practice in the United States.

· Additionally, a 1964 study on the NHS found that as early as 1950 -- two years after the establishment of the NHS -- doctors were leaving to find work in other countries.

The flow of talented physicians outside of the country is attributed to many factors, but none more than the socialized medicine. Read more . . .

· Physicians have complained of "extensive goodwill hours" and the long hours they put in.

· Furthermore, some physicians cite higher pay and shorter hours elsewhere as to why they leave.

This problem is to be expected when there is a system of free health care. When the government creates an unlimited demand, the providers (in this case the doctors) can't keep up and are subsequently overworked and underpaid. And as more doctors leave, the strain on the existing providers will increase, causing further problems with the supply of doctors.

The lesson learned from Britain seems to be lost on the United States, as the Obama administration sought a plan that socialized medicine. If steps aren't taken soon, the United States could find itself in the same situation as Britain.

Source: "Socialized Medicine Is Enough to Chase Away British Doctors," Investor's Business Daily, August 28, 2012.

http://www.ncpa.org/sub/dpd/index.php?Article_ID=22312&utm_source=newsletter&utm_medium=email&utm_campaign=DPD

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Government medicine does not give timely access to healthcare; it only gives access to a waiting list.

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4. Medicare: What if Social Security Were Run Like Medicare?

By Greg Scandlen

Filed under Medicare on August 3, 2012 with 16 comments

Medicare and Social Security are often tied together as the two great pillars of America’s commitment to the well-being of our seniors. But, in fact the two programs could hardly be more different.

Medicare is vastly complicated, paying directly for the health care services of some 50 million people and contracting with hundreds of thousands of health care providers. It fixes the prices paid for every service delivered and prohibits any charges above those prices. “Balance billing” is forbidden. Medicare decides what is and is not an appropriate service for coverage purposes, and is increasingly directing providers on how they must provide the services for which they are paid. Other than some strictly defined supplemental insurance, Medicare is a monopoly insurer.

Social Security, on the other hand, is simple. It sends out monthly checks (or electronic transfers) to about 60 million people — period. The amount of the check is based on the money paid into the program, but that maximum is $2,366 per month for people at full retirement age.

Once you receive your monthly benefit, the money is yours and you may spend it on anything you want. Don’t tell Mayor Bloomberg, but you may spend it on Big Gulp sodas. You may spend it on fois gras. You can even buy cigarettes with the money. You can take that money and overpay for things. You can waste it on silly stuff. The government doesn’t care! It’s none of their business. Read more . . .

If you’re on Social Security, not only is balance billing allowed, it is expected. If you want to buy a car and don’t have enough SS money to pay for it, you are perfectly free to add your own funds to make the purchase — neither you nor the car dealer is punished for doing so. Indeed, it is expected that most people will supplement their payments with other money — savings, investments, money earned from working, a private retirement plan, or contributions from family members. It’s all good.

Now many people in Washington think the elderly — and everybody else, for that matter — are incompetent to make their own decisions. “The people” are like fatted calves ready to be slaughtered by greedy profiteers. Regular people are too poorly informed to make good decisions and they are easily manipulated by clever marketing. Plus, they suffer from “information asymmetry” and don’t know much about the things they would like to purchase.

Certainly that is the thinking in the Medicare program, but why should it stop with Medicare? Perhaps Social Security should be run the same way. Why should our government allow people to spend taxpayer money on things that are bad for them? Why should we let them overpay for essential goods and services?

And just imagine the wonderful opportunities that would open up for federal bureaucrats! Why we could solve the unemployment problem by assigning every Social Security recipient a case manager to “help” them spend their money more intelligently! . . .

Now, of course we will have to drop the whole idea of fee-for-service payment because all these providers will want to sell as much stuff as they can. So, we will switch to a “bundled payment” system in which food providers will get a fixed amount of money for each recipient. If they can provide less food, they will get to keep more money. This will be good for people on Social Security, too, because eating too much food is bad for you. I expect there are studies showing that the ideal diet is rice cakes and green tea, so why should anyone need more than that?

This is gonna be GREAT! Utopia is just around the corner.
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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: When Health Plans and Hospitals Don’t Mesh

An increasing problem as health plans become more constricted is patients go to a hospital for emergencies which is not their physician’s or health plan’s primary hospital. This also creates a problem for the patient in being assigned a new doctor who is unfamiliar with the patient, the communication between the hospital and a doctor who may not be on its staff. Read more . . .

There is no incentive for the hospital and its paid “hospitalists” to conserve costs by obtain the patient’s prior records. After all, this takes take and time is money. Thousands of dollars of tests can be done during this wait. And who wants to wait when the hospital charges exceed a thousand dollars a day even if no treatment is rendered.

So the hospitalists stays in tuned with their employer, the hospital foundation, takes over care as if it is the first time this patient’s problem is being evaluated when frequently a large baseline of studies have been completed since the problem for which the patient is being admitted is frequently a mild variant of his previous problems that have been assessed and evaluated by his personal physician which would normally only require a few tests to cover any new information with the reason for admission.

The patients have no interest in conserving costs since patients always think they have something more severe than their doctor uncovered and feel this additional testing will just fill in the loop holes of their medical problems.

The patients don’t see this as medical gluttony. How can more care by a new medical team not be beneficial?

One can over hear patients as saying that stay at the community memorial hospital was every bit as plush as staying at the Ritz Carlton. Only better since the room service three times a day was free.

The hospital bill of $15,000 to $20,000 doesn’t seem unreasonable or gluttonous. Aren’t most hospital bills in that range?

There are two ways to diffuse that cost:

If patients are admitted to the service of their personal physician, all previous testing is known and very few additional tests are required to solve the new medical problem which usually is a variant or extension of previously known problem. This requires that the patients always go to their personal physician’s hospital.

Secondly, MedicalTuesday has always recommended that no health care should be free and there should always be a deductible on any new service and a co-payment on every portion of that service. Our research has determined that the deductible should approximate the first day’s charges and the copayment of 10 percent of the hospital charge will place the patient in charge of policing of his health care treatment in any and all circumstances.

Our research has indicated that this type of plan will reduced health care charges in the United States by 40 percent to 50 percent without any Medicare, private insurance or other government oversight.

This method would preserve Medicare for our children and grandchildren without any additional Medicare reform.

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Medical Gluttony thrives in Government and Health Insurance Programs.

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

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6. Medical Myths: Enhanced Access with the Obama Health Plan

California is getting ready for the Obama Universal Access health plan. As the Medicaid patients are being transferred into the various HMOs, under the Myth that there should be no second class citizens, a whole set of new problems has arisen which the President or Congress did not foresee and still fail to understand.

Under Obama’s total access to healthcare for everyone, welfare recipients are being enrolled in various HMO plans. Our practice had to take its share which was about 600 patients transferred in. We normally have two or three messages on the phone in the morning left by our current 1100 patients. My staff can process these several messages in a few minutes and then get on with the day’s work.

The first morning after these 650 patients were transferred into our HMO, we had 65 messages on the phone that morning. Welfare patients generally do not work and they all have cell phones. They call at any time during the 24 hours that they like. In fact, messages were recorded every hour during the time the office was closed from 6 PM until 9 AM. Read more . . .

It took my staff three hours to tabulate all these messages and another two hours to process these messages. We thought this would be temporary. We are now three months into the first phase of Obama care and not much has changed. Yesterday we still had 60 overnight messages. It still added five hours of work to my practice. At $30 an hour for staff time, it does add up to $150 a day that was added to our cost without any reimbursement from either our HMO or the Obama plan.

Since no one at our HMO or apparently in Washington understands this cost of government medicine, it is time for all physicians to take serious notice. The implementation of Obama’s plan is running a year or two behind schedule. Should Obama get re-elected, this means the entire Obama plan will be fully in operation by 2014. It behooves all physicians to have their alternate plans ready to make a transition by that time.

There is one physician in Orangevale who already has moved to Montana. He is pumping gas and selling cigarettes while he surveys his options. Some of us would think that is a poor use of the quarter million dollars our parents invested in our education. Now, that’s another investment that went belly up, just like our pension plan.

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Medical Myths Originate When Government Runs Healthcare.

Medical Myths Will Disappear When Physicians Regain Control of Healthcare.

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7. Overheard in the Medical Staff Lounge: The Cost of Hospitals Practicing Medicine

Dr. Rosen: Many of our staff have sold their practices to hospital foundations. Any feedback?

Dr. Edwards: I’m still in control of my own practice and, therefore, control costs and charges.

Dr. Milton: I read about the problems in the newspapers. The Wall Street Journal does the best job of keeping us posted. Recently they brought out the data that when hospitals take over a physicians practice the charges increase precipitously. Read more . . .

Dr. Edwards: I think I also read the one you’re referring to. Initially the patients get the same bill the doctor would have rendered. After a while they attach a hospital charge for what they term as the cost of rent, the nurse, and other support.

Dr. Sam: I bet those go up fast. You have non-medical administers in control. Cost is no object to them. They just want the best and finest for their supporters to see.

Dr. Edwards: I have patients that show me the bill for seeing their doctor in hospital medical groups. The basic charge may be about the same, e.g. $150 for an office call. But then the patients all at once get a bill with more than $220 attached for the cost of the room and support.

Dr. Ruth: Physicians have to pay the rent, nurse, and any other charges out of the $150. Why aren’t the AMA and CMA out there telling the public the best deal in health care is a physician’s private practice.

Dr. Edwards: Because they are socialistic minded. They want us to become socialized. They have a different perspective of costs. They want to control doctors.

Dr. Milton: Come on, now, Ed. Most physicians just have the bare essentials required for practice.

Dr. Michelle: There is a doctor in my building that doesn’t have a computer. That doesn’t strike most of us doctors as that odd since it’s only been in the last 5-10 years that we’ve all acquired computers. But there was a lot of pressure to modernize and digitalize earlier. Hospital administrators are unable to comprehend having a practice without them.

Dr. Milton: But let’s give administrators their due, in taking over a medical practice I think all of us would go that route.

Dr. Edwards: The executive director of our medical society almost came unglued when he found out the number of physicians that weren’t electronically up to what he considered his standards.

Dr. Rosen: Wait until we have a traffic jam with the required Electronic Medical Records and the government finds out that they can’t read them all because they thought the Tower of Babel would keep the workers occupied forever.

Dr. Edwards: But the workers are speaking new languages already in their offices and can’t communicate with their colleagues in the next office.

Dr Rosen: Looks like another unintended consequence that wasn’t planned.

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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

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8. Voices of Medicine: A Review of Local and Regional Medical Journals and Articles

A Voice for the Generations by Scott Eberle, MD

The Santa Rosa Reader: A Personal Anthology from the Family Medicine Residency,
by Rick Flinders, MD, Sonoma County Medical Association, 95 pages, $9.95.

Some artists’ work speaks for itself. Some artists’ work speaks for a generation.

--Jack Nicholson, introducing Bob Dylan at the first Live Aid Concert in 1985

I was on faculty at the Santa Rosa Family Medicine Residency from 1989 to 2001. A few years into my tenure, one of the faculty’s more senior members told me that you could only be an effective teacher of residents for about 10 years out from your own training. “After that,” she said, “you’ve forgotten what it’s like to be a resident.” At the time I vowed to never forget, and to stay beyond that 10-year mark. Turned out she was right: I left the faculty after 12 years of teaching. In the flow of residency time, it seems, a generation is about a decade long.

All the more remarkable, then, that Dr. Rick Flinders has been teaching at the residency for more than three decades. With the release of his new book, The Santa Rosa Reader, it becomes clear just why Rick has stayed and why he has continued to flourish--as physician, teacher and writer. Much like his great muse, Bob Dylan, Rick has reinvented himself over and over. The one constant is that he has been a leading voice for the Santa Rosa residency, generation after generation. Read more . . .

I mark the start of Rick’s first “generation” of teaching as 1985. After five years of part-time faculty work, that was the year he became full-time director of the residency’s inpatient medicine service. It’s also the year he wrote “Hour of the Intern,” the first essay in this anthology from Rick the practicing physician.

Clarion (1985-1995)

I know best this phase of Rick’s teaching and writing career. We first met in 1983 at UCSF medical school. I was a fledging medical student, he a fledgling faculty member. At this young age, I had an inkling of an idea about (or maybe it was just a longing for) what it might mean to be a physician. Rick was the first person to give me words to describe this youthful vision. During a small seminar for medical students, Rick offered story after story from his private practice in Petaluma. I can see now how, with each story, he was trying to bring to life the immortal words of poet and physician William Carlos Williams:

“[S]o for me the practice of medicine has become the pursuit of a rare element the patient may reveal at any time. It is always there, just below the surface. From time to time we catch a glimpse--and we are dazzled … it is magnificent, it fills my thoughts, it reaches to the farthest limits of our lives.” Read more . . .

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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: Unaccountable by Marty Makary, MD

Hospital Horrors | Meet 'Shrek,' a doctor
who insists on surgery in every case—and has a surgical-incision infection rate of 20%.

The WSJ Bookshelf | Laura Landro

In organized crime, the principle of omerta prohibits divulging secret information that might incriminate the family. Medicine, too, has a code of silence. It protects incompetent doctors and error-prone hospitals from public exposure. In "Unaccountable," Marty Makary offers a searing indictment from the inside, arguing that the modern health-care industry, unlike almost every other, doesn't disclose its performance or pricing practices to the public and keeps under wraps information about mistakes and substandard quality.

As a surgeon at Johns Hopkins Medicine in Baltimore and a professor of health policy at Hopkins's Bloomberg School of Health, Dr. Makary isn't just a disgruntled whistleblower. He has seen much of what he writes about—and readily confesses his own complicity over the years in concealing the flaws of medical care from those who stand to lose the most when it goes wrong: patients. Read more . . .

In the course of his long career he has encountered all manner of malfeasance. He describes a surgeon who removed half a patient's colon through a large abdominal incision to take out a polyp that could have been removed simply with a wire snare—except the surgeon wanted to do it his way rather than call in a colleague with expertise in the less invasive procedure. During one biopsy surgery, a needle accidentally hits a major blood vessel near a patient's cancer, leading to six hellish weeks in the hospital, which turned out to be six of the patient's last nine weeks on earth. Routinely, Dr. Makary says, hospitals perform unnecessary surgery and harm patients with costly, preventable complications and infections, with no one the wiser.

To be sure, as Dr. Makary acknowledges, most health-care professionals go into medicine to help save lives and deliver quality care. And they do, as anyone who has had her life saved in a hospital can attest. He cites a number of successful efforts to improve care and transparency and gives credit to those who have made patient safety their mission, including colleague Peter Pronovost, with whom Dr. Makary has worked on instituting surgical checklists to prevent errors—a series of enumerated tasks that help to ensure that surgeons never operate on the wrong patient (or wrong body part) and follow evidence-based safety steps. Dr. Makary also cites Lucian Leape, the Harvard expert who first sounded the warning note about impaired and incompetent doctors who are allowed to keep practicing. . .

Dr. Makary gives nicknames to many of the bad actors he describes: a surgeon dubbed Hodad—for "hands of death and destruction," whose popularity belies his botched operations, and another called "the Raptor," whos terrorizes patients and staff with his curt bedside manner and drill-sergeant humiliation of residents. Then there is the doctor, called Shrek for his folded brow and cloddish appearance, who persists in doing open surgeries when minimally invasive procedures would suffice—and has a surgical-incision infection rate of 20%. "So many times during my residency I wanted to tell patients to run away," Dr. Makary confesses.

The industry's perverse payment systems add to the problem. As reimbursements go down in the effort to contain costs, hospitals face mounting pressure to add revenues. The need for revenue, in turn, puts pressure on doctors to step up volume, leading to the overuse of certain procedures and treatments. In many cases, it leads them to push treatments at the end of life that are profitable to the hospital but miserable for the patient. . .

Dr. Makary argues that true reform will only come with full disclosure. When hospitals have to provide data, performance gets better, he notes. After New York state began requiring hospitals to disclose their death rates from coronary-artery bypass surgeries, for example, the hospitals with high mortality rates scrambled to improve, and statewide deaths from heart surgery fell by 41% during the first four years of the program. Without such accountability, hospital problems can pile up until, Dr. Makary writes, "they get so out of hand only a major, punishing scandal can hope to remedy them."

. . . In one recent Hopkins survey, employees at 60 reputable U.S. hospitals were asked: "Would you feel comfortable receiving medical care in the unit in which you work?" At over half the hospitals surveyed, the answer was no.

Ms. Landro writes the Informed Patient column for the Journal.

A version of this article appeared October 4, 2012, on page A23 in the U.S. edition of The Wall Street Journal, with the headline: Hospital Horrors.

The whole book review is found at . . .

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To read book reviews topically . . .

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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: Medicare placing Hospitals between a rock and a boulder.

More than 2,000 hospitals will be penalized by the Centers for Medicare and Medicaid Services (CMS) starting in October 2012 (Federal Fiscal Year 2013) for excess readmissions.Together, these hospitals will forfeit about $280 million in Medicare funds over the next year. . .

The penalties, authorized by the 2010 healthcare law, are part of a multipronged effort by Medicare to use its financial muscle to force improvements in hospital quality.While many hospitals have worked hard to lower their readmission rates, the national average has remained steady at nearly 20 percent for the past several years. ^1,2

Editorial Comment: Hospitals have an army of RNs working at nearly every nursing station to review charts to make sure that discharges are made timely. It is cost effective to pay all these nursing salaries to prevent Medicare from making post discharge denials of care based on lack of medical necessity. If Medicare feels that the last two days of a six-day hospital stay were not medically indicated (or required), the hospitals would then lose two of the six days of charges or about 30 percent of their revenue for work done and not paid or reimbursed. These RNs have apparently been so successful in facilitating discharges by doctors that Medicare is hurting from this loss of 30 percent of “denial of coverage” income. So Medicare is now penalizing discharges that may have been made too early and the patient relapses and needs to be readmitted within six-weeks of discharge which Medicare is penalizing as providing a lower “quality of care.” This gives them the opportunity of levying a penalty for readmissions based on QOC issues. Medicare has made this a “win-win” situation for them and a “lose-lose” situation for doctors and hospitals.

These penalties were authorized by the Obama 2010 health care law, which was so convoluted that Nancy Pelosi, speaker of the House of Representatives, was unable to find enough time to read before she voted for it. She even urged her colleagues to vote for it so they could read it in leisure after it became law. In the real world outside of Congress, that would be considered malfeasance in office or dereliction of responsibility, and cause for prosecution, impeachment or at least termination and fines.

In clinical medicine, it is not always possible to adequately predict the exact course a disease might take whether in the hospital, nursing facility, or at home. A medical bureaucrat would have equal difficulty in looking into the future and make the appropriate predictions. Why do they think doctors can? Haven’t we gotten over the “Doctor is God” complex yet?

You may wish to access the KP report below to see if your hospital is low on “QOC?” But remember that “QOC” is a very nebulous concept in cyberspace that may have no relationship to real humane quality of health care. Hospitals may want to reassess their support of the Obama health care laws which take health care out of clinical medicine and into legal or lawyer controlled medicine.

Doctors, you may want to begin making plans to close your practice if Obama obtains a second term. Since implementation is running about two years behind schedule, 2014/15 may be a good time to leave medicine as the quality of healthcare nose-dives and crashes.

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1, 2 “Medicare to Penalize 2,211 Hospitals for Excess Readmissions,” August 2012. Accessed at http://www.kaiserhealthnews.org/Stories/2012/August/13/medicare-hospitals-readmissions-penalties.aspx on August 14, 2012

Poster in the Democratic Headquarters: “Let Him Finish the Job.”

Passerby: “But he never started it!”

The tax and freedom and enslave your children group are asking us to give Obama time?

We Agree – we think 25 to life would be appropriate. —Jan Leno

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

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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."

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

Words of Wisdom

I’m not what I ought to be. I’m not what I’m, going to be. I’m thankful that I’m not what I use to be. ― John Newton

“We can easily manage if we will only take, each day, the burden appointed to it. But the load will be too heavy for us if we carry yesterday's burden over again today, and then add the burden of the morrow before we are required to bear it.” ― John Newton

"Great minds discuss ideas; average minds discuss events; small minds discuss people." — Eleanor
Roosevelt

Some Recent Postings

In The July Issue:

1. Featured Article: The Wrong Remedy for Health Care

2. In the News: Strained disability program nears cash crunch.

3. International Medicine: British democracy in long-term terminal decline

4. Medicare: A Framework for Medicare Reform

5. Medical Gluttony: HealthCare that we can’t afford now enslaves Patients and Doctors

6. Medical Myths: How reform will clean up hospitals

7. Overheard in the Medical Staff Lounge: What will happen to medicine under Obamacare?

8. Voices of Medicine: Dr. Krauthammer weighs in on the Supreme Court Ruling

9. The Bookshelf: The Man With a Plan

10. Hippocrates & His Kin: The London Olympics

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

In Memoriam

Eugene Louis “Gore” Vidal, novelist, essayist and public intellectual, died on July 31st, aged 86

The Economist | from the print edition | Aug 11th 2012

“MAN of letters” was not how Gore Vidal described himself. He preferred “famous novelist”. Both terms were equally passé. There was a time when wise men, like his beloved Montaigne, wrote essays that people discussed, and a time when American novelists worth the name—Twain, Hawthorne and Melville, rather than the dwarfish fetus-faced Capote or the oafish Mailer—wrote books that the public actually read; but that was long ago. Mr Vidal, a man whose persona breathed east-coast aristocracy, found civilisation crumbling all around him, and roared his indignation. He needled America for decades, first from a Greek revival mansion on the Hudson and then, over 50 years, from high semi-palaces he called home in Rome and in Ravello. Read more . . .

He was an ancient both in thought and predilection, inspired by classicism even more acutely than the founding fathers he revered. Plato was his companion, and “the Agora” his word for the braying marketplace of public taste. Suetonius’s “Twelve Caesars”, he said, persuaded him to be an essayist. His closest avatar was probably the emperor Julian in his novel of 1964, the noble lonely pagan against the Galileans, for whom he fashioned “one last wreath of Apollonian laurel to place upon the brow of philosophy”, before the barbarians smashed the gates. Indeed there was, in his gilded youth, the air of an “archaic Apollo” about him, as one admirer sighed to another in his memoir “Palimpsest”. Therein, as on ancient parchment, he scratched and then erased the names of all the people he had met but never wanted to know—save Jack and Jackie Kennedy, step-relations, whose names he dropped whenever he could.

He wrote 25 novels, some forgettable, others of sweeping scale and scope, in which factual “memoirs” of great men were intercut with asides by onlookers. A stout cluster, covering the history of the Republic from Aaron Burr to Lincoln to the Golden Age, made his name, but never established him as a literary insider. Because he chose not to worship at the altar of middle-class marriage, because he wrote freely about homosexual experience (notably in “The City and the Pillar” in 1948), the New York Times would not review his books for years, and others followed. This irked him not at all, except financially. He became a temporary adventurer in television and in Hollywood, producing the screenplays for “Ben Hur” and “Suddenly Last Summer” and five Broadway plays.

His explorations of “faggotry” in the literary world were wide-ranging. They led him to an unsatisfactory night with Jack Kerouac in the Chelsea Hotel, to delicate examinations of pornography with André Gide, to courtship with Christopher Isherwood. Yet he loathed the word “gay”, felt that human beings were essentially bisexual (a theme pursued in his wildly Bacchic send-up of pornography, “Myra Breckinridge”) and found that this world, too, was one in which he loitered on the edge.

Strawberries with Sitwell

Politics could have been his game: with Senator Thomas Gore as his grandfather, it was in the blood. He had strong opinions, left-wing for a WASP, opposing all foreign wars, decrying the gap between rich and poor, and lamenting the growth of a “national security state” where once had stood a free republic. In 1960 he ran unsuccessfully for Congress in New York’s 29th district. After that, he sniped from the sidelines. Ronald Reagan was “a triumph of the embalmer’s art”. Of George W. Bush, he said: “Monkeys make trouble.” With William F. Buckley, his right-wing nemesis, he disputed so ferociously that, in a better age, it would have gone to pistols.

But writing was his métier from the first. At 14 he had read all of Shakespeare and changed his name to Gore, rather than Gene, because it sounded literary and fine. He already knew, at St Alban’s in Washington, that he sprang from a famous line. Once his mother had remarried to Hugh Auchincloss, wealth was added to fame. He was always at ease in high society, supping on strawberries and lobster with Edith Sitwell and helping Princess Margaret rescue bees from the “grubby” Windsor swimming pool. He was equally cool in the spotlight, joshing with Paul Newman and charming Greta Garbo in Hollywood, before becoming a regular with Johnny Carson on “The Tonight Show”.

Behind the glassy smile there was, he assured people, yet more ice. He was a tremendous hater, with the bile of his lively essays reserved especially for America’s decline into a country of amnesia and hypocrisy, liars and cheats. Love, he would say, was “not my bag”.

This was not strictly true. He lived for 53 years in a chaste, sexless relationship with Howard Austen, but there had been a different, deeper love some years before. This was for Jimmie Trimble, a schoolmate at St Albans: a baseball player to his bookish self, Sparta to his Athens, and in every way that “other half” of which Aristophanes spoke in Plato’s “Symposium”. Trimble was killed at Iwo Jima. Mr Vidal dedicated “Palimpsest” to him, and arranged to be buried close. For all his stern rationality, sometimes he could not help calling out Jimmie’s name; and each time the wind seemed to rise and caress the cheek of the “last famous novelist” in America, and the last true Augustan in the world.

The Economist |from the print edition | Obituary

On This Date in History – August 14

On this date in 1935, Social Security was enacted into law. Under the provisions of that law, which among other things provided for pensions at the age of 65 to those eligible, the Social Security won’t be old enough to retire for some years. But it’s old enough to be in need of some geriatric assistance. The whole concept underlying our social security system cries out for some further examinations.

On this date in 1945, Peace broke out and Japan, battered by two atom bombs, surrendered, ending World War II, remembered since as VJ Day. There was a formal surrender in Tokyo Bay on September 2, 1945, but this was the day the Japanese stopped fighting and gave up. It was a euphoric day for the winning side. Since then, there seems to have been a long time between euphoria’s. We have found new battles to fight. After whipping the entire world twice, we have since given up on winning the peace . . . Maybe the United States of America will regain the title of peace maker after the elections in November from a position of strength with our Navies patrolling the seas much as our Mother Country did two centuries ago and now with the addition of our Air Force patrolling the skies. No nation would ever even dream of starting a regional skirmish threatening humankind.

After Leonard and Thelma Spinrad

* * * * *

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The 10th Anniversary World Health Care Congress

THE INTERSECTION OF STRATEGY, INNOVATION AND EXECUTION

The 10th Annual Congress is committed to improving global health care by bringing together business, political, and academic health care leaders to actively share information and work together to improve the overall quality and cost of health delivery in the US and throughout the world.

The 10^th Annual World Health Care Congress will be held April 8-10, 2013 at the Gaylord Convention Center, Washington DC.
For more information, visit www.worldcongress.com.
The future is occurring NOW.

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