MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol XI, No 4, July 10, 2012

In This Issue:

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July 4, the 236 Birthday Anniversary of these United States of America:
What is unique about America is not its wealth, its size, its natural resources, its democratic government, its ethnic diversity or the popularity of its arts. What is unique is to have all these in a single country. No nation has ever contributed more inventions to the world or accepted more immigrants from the rest of the world. No Nation educates as high a proportion of its citizenry through high school, college and higher professional and graduate schools. No nation has freedom of movement through more thousands of miles of its territory. No nation has longer peaceful and unarmed borders. No nation has an older political party than the Democrats. But not all the superlatives are necessarily signs of health. No nation has more psychiatrists. No nation has more good food—or more junk food. No nation’s scientists have probed more of the universe. Some countries, it has been said, are punctuated by a question mark. For America, the best punctuation is an exclamation point!

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1. Featured Article: The Wrong Remedy for Health Care

The Affordable Care Act will exacerbate the problems with our current health-care system. Fortunately, market reforms are still possible.

BY JOHN F. COGAN, R. GLENN HUBBARD AND DANIEL P. KESSLER, WSJ

In upholding the Affordable Care Act, the Supreme Court has allowed the president and Congress to put the country's health policy on a path that will restrict individual choices, stifle innovation and sharply increase health-care costs. Now the only recourse is to repeal the law through the legislative process and replace it with policies that rely on the power of the markets. Read more . . .

The American health-care system's principal strength is its ability to produce ever more impressive innovations. The U.S. has no equal in developing new medical technologies, surgical procedures and pharmaceuticals. These extraordinary advances are not the product of government.

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

Congress Unwilling to Address Disability Plan’s Shortfall

By Brian Faler, May 29, 2012

A U.S. government entitlement program is headed for insolvency in four years, and it’s not the one members of Congress are talking about most.

The Social Security disability program’s trust fund is projected to run out of cash far sooner than the better-known Social Security retirement plan or Medicare. That will trigger a 21 percent cut in benefits to 11 million Americans -- disabled people, their spouses and children -- many of whom rely on the program to stay out of poverty. Read more . . .

“It’s really striking how rapidly this is growing, how big it’s become and how D.C. is just afraid of it,” said Mark Duggan, a University of Pennsylvania economist and adviser to the Social Security Administration.

Part of the reason for the burgeoning costs is that the 77 million baby boomers projected to swamp federal retirement plans will reach the disability program first. That’s because almost all boomers are at least 50 years old, the age at which someone is most likely to become disabled.

The growing costs are also a result of the economy, because when people can’t find work and run through their jobless benefits, many turn to disability for assistance.

“They’re desperate,” said Ken Nibali, a retired associate commissioner of the program. “Some who are marginal and struggling to have a low-paying job now literally have no options.” So, he said, “they figure, ‘I do have trouble working and I’m going to apply and see if I’m eligible.’”

Senator Tom Coburn, an Oklahoma Republican, said he has tried to interest fellow lawmakers in the issue, so far without much luck.

‘Going Bankrupt’

“Nobody wants to touch things where they can be criticized,” Coburn said, adding, “the fund is going bankrupt” and “then what are we going to do?”

Applications to the disability program have risen more than 30 percent since 2007 -- the last recession started in December of that year -- and the number of Americans receiving disability benefits is up 23 percent.

More Americans receive disability benefits than 20 years ago though people are less likely to have physically demanding jobs, health care has improved and the Americans With Disabilities Act bans discrimination against the handicapped.

“The weird thing is disability enrollment is going up like crazy” when “we should be able to help keep people in the workforce,” Duggan said.

Two Programs

Social Security is comprised of two separate programs: the retirement plan supporting 40 million senior citizens and 6 million survivors, and the disability insurance program created during the Dwight Eisenhower administration to prevent sick and injured workers from becoming destitute.

The disability program currently pays benefits averaging $1,111 a month, with the money coming from the Social Security payroll tax taken out of workers’ paychecks.

The program cost $132 billion last year, more than the combined annual budgets of the departments of Agriculture, Homeland Security, Commerce, Labor, Interior and Justice.

That doesn’t include an additional $80 billion spent because disability beneficiaries become eligible for Medicare, regardless of their age, after a two-year waiting period.

The disability program, which has been spending more than it receives in revenue for four consecutive years, is projected to exhaust its trust fund in 2016, according to a Social Security trustees report released last month. By comparison, the separate trust fund financing senior citizens’ Social Security benefits is projected to run out in 2035 while Medicare’s primary fund will be exhausted in 2024.

$600 Billion

The retirement portion of Social Security costs $600 billion a year, while Medicare costs $560 billion annually.

Once the disability program runs through its reserve, incoming payroll-tax revenue will cover only 79 percent of benefits, according to the trustees. Because the plan is barred from running a deficit, aid would have to be cut to match revenue.

Duggan said the disability plan has been running on autopilot for decades and lawmakers could find savings to help avoid the scheduled cuts. While federally financed, the program is administered by the states and disability rates among them vary widely. West Virginia topped the list in 2010, with 9 percent of residents between ages 18 and 64 receiving aid. Utah and Alaska had the lowest rates at 2.8 percent.

Subjective Conditions

People whose benefit applications are rejected can appeal to administrative law judges, and statistics show some judges are far more likely to approve benefits than others. One reason is that the program, which once focused largely on people who suffered from strokes, cancer and heart attacks, increasingly supports those with depression, back pain, chronic fatigue syndrome and other comparatively subjective conditions. . .

Statistics show that once people enter the program they are unlikely to leave, with fewer than 1 percent rejoining the workforce. Many worked “menial” jobs that didn’t offer health insurance and the program gives them an opportunity to join Medicare long before they might otherwise qualify, Nibali said.

“Many want to be on the disability rolls not necessarily for the cash income but for the medical coverage,” he said. “That’s a real plus for them.”

Review Backlog

The agency faces a backlog of 1.4 million reviews it’s supposed to periodically conduct to ensure beneficiaries are entitled to stay on the rolls. The agency has said it doesn’t have the money to do the reviews.

Lawmakers haven’t made major cuts in the program since President Ronald Reagan’s administration, and Congress reversed those changes after a public outcry.

Amid concerns about increasing disability rolls and wasteful spending, the agency in 1981 began stricter screening of beneficiaries. It halted aid to hundreds of thousands.

Lawmakers were besieged with constituents’ complaints of unfairly being cut off. Some people lost their homes or killed themselves after being dropped.

“Government Gets Tough on the Disabled,” the Miami Herald said on its front page on Jan. 16, 1983. “Vietnam-Era Hero Falls Victim to Cuts in Social Security,” the Washington Post reported in a May 27, 1983, article about a Medal of Honor winner who was dropped from the disability rolls. The veteran’s benefits were later reinstated by a judge who considered the case on appeal. . .

“The administration believes that disability insurance is a vital lifeline for millions of Americans,” Kenneth Baer, a spokesman for the White House budget office, said in an e-mail. “The president remains willing to work with Congress on a bipartisan basis to strengthen Social Security and protect the millions of beneficiaries.”

Screening Beneficiaries

He added that lawmakers didn’t fully fund the administration’s request for more money to screen beneficiaries. . .

“One thing at a time,” said Baucus, a Montana Democrat. “There are other things that are more imminent.”

To contact the reporter on this story: Brian Faler in Washington at bfaler@bloomberg.net

To contact the editor responsible for this story: Jodi Schneider at jschneider50@bloomberg.net

Read the entire article . . .

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

Corporate power, unrepresentative politicians and apathetic voters leave UK 'increasingly unstable' Juliette Jowit, political correspondent, guardian.co.uk,

A study into the state of democracy in Britain over the last decade warns it is in "long-term terminal decline" as the power of corporations keeps growing, politicians become less representative of their constituencies and disillusioned citizens stop voting or even discussing current affairs. Read more . . .

The report by Democratic Audit shared exclusively with the Guardian notes there have been many positive advances over the last 10 years: stronger select committees of MPs holding ministers and civil servants to account; devolution of power to Northern Ireland, Scotland and Wales, and publication of much more information about politicians' expenses and party donors. But it found evidence of many other areas where Britain appeared to have moved further away from its two benchmarks of representative democracy: control over political decision-making, and how fairly the system reflects the population it represents – a principle most powerfully embedded in the concept of one person, one vote.

Among its concerns, identified from databases of official statistics and public surveys, were that Britain's constitutional arrangements are "increasingly unstable" owing to changes such as devolution; public faith in democratic institutions "decaying"; a widening gap in the participation rates of different social classes of voters; and an "unprecedented" growth in corporate power, which the study's authors warn "threatens to undermine some of the most basic principles of democratic decision-making".

In an interview with the Guardian, Stuart Wilks-Heeg, the report's lead author, warned that Britons could soon have to ask themselves "whether it's really representative democracy any more?"

"The reality is that representative democracy, at the core, has to be about people voting, has to be about people engaging in political parties, has to be about people having contact with elected representatives, and having faith and trust in elected representatives, as well as those representatives demonstrating they can exercise political power effectively and make decisions that tend to be approved of," said Wilks-Heeg.

"All of that is pretty catastrophically in decline. How low would turnout have to be before we question whether it's really representative democracy at all?" The UK's democratic institutions were strong enough to keep operating with low public input, but the longer people avoided voting and remained disillusioned, the worse the problem would get, said Wilks-Heeg.

"Over time, disengagement skews the political process yet further towards those who are already more advantaged by virtue of their wealth, education or professional connections. And without mass political participation, the sense of disconnection between citizens and their representatives will inevitably grow."

Membership of political parties and election turnout has fallen significantly in the last decade, with only 1% of the electorate belonging to a party, and just over six out of 10 eligible voters going to the ballot box in the 2010 general election and barely one in three in European and local elections. But the depth of public disillusionment and the range of ways voters are turning away from politics revealed by the latest study could shock even those involved. . .

http://www.guardian.co.uk/uk/2012/jul/06/british-democracy-decline-report#start-of-comments

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

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

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

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4. Medicare: A Framework for Medicare Reform

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: Read more . . .

· 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.

· 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:

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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: HealthCare that we can’t afford now enslaves Patients and Doctors

A Surgeon Cuts to the Heart of the ObamaCare Nightmare

By Stella Paul

“I've actually had a lot of experience working in all different types of environments," he began. "I've worked in a government-run socialized medical care system, and I saw the waste and inefficiency.

"The longer people worked in that system, the less work they wanted to do, because the more you wanted to do, the more they dumped on you. So after a while you stop doing it, because they're not paying you to do more. Why should you do a difficult case, a difficult surgery that will take you hours and hours to do?

"You might start out wanting to do it, but after a while, you just run out of energy, because there's no incentive. You'd have to be a superhuman being to continue to work in that system and not be worn down by it. Read more . . .

"Because nobody wanted to work, it would take an hour to turn over the surgical room. In my private practice now, it takes ten minutes.

"And I saw tremendous waste: closets of stuff that never got used. Nobody cared.

"Capitalism has completely transformed my sub-specialty. When I was in training, a common procedure that I do now took 40 minutes, and people needed a month of recovery. Now it takes 10 minutes, and people can go back to work almost immediately.

"And all these improvements were driven by the financial incentive. Capitalism has had a tremendously positive effect on patient care and outcome in my specialty.

"But when I go to meetings now, I see that there's very little innovation going on. Everything's being impacted by ObamaCare, which, among other things, raises taxes on medical devices.

"You know, doctors are people, and we're being hammered on all sides here.
It's the paperwork; it's insurance; it's transitioning to electronic medical records, so the government can get their mitts into your practice. It's lawsuits; it's rising overhead and decreasing compensation; it's stress upon stress upon stress.

"And a lot of doctors are going to say, 'Forget it. I don't want to do this anymore.' Guys that are 5 or 10 years older than me are just going to give up and walk away.

"Why should I be a slave to the government? You know, it used to be that doctors would do charity work at a charity hospital. Nobody wants to do it anymore, because we're too overwhelmed.

"I work 60 to 70 hours a week, so how am I supposed to fight back against this? Most doctors don't have the time to lobby their congressman or go to Washington. If you're a doctor in the trenches, you've got a stressful job; you've got a family. You're seeing the same number of patients and making half the income you used to make. People are litigious these days, so you've got to worry about lawsuits. When are you going to find time to lobby a politician?

"And the American Medical Association threw us all under the bus, even though only 18% of doctors belong to it. These people are ivory-tower academics, and they're liberals. Most of them are in academic medicine; they get a salary with some sort of incentive bonus. They show up to work and go home. They're not in the trenches like me, figuring out how to compete with other doctors and pay for malpractice insurance and how to hire four people I need to implement the electronic medical records and two people I need to deal with insurance.

"And as a doctor, I get it handed to me both ways. My taxes are raised, and my fees are lowered.

"You know, young people today who go to medical school -- I don't know what to tell them. You couldn't pay me to go to medical school today. Some doctors are going to graduate with $500,000 in debt, and how are they going to make a living?

"You're 32 or 33 years old by the time you finish your training; you're married with little kids. You've been an apprentice for 16 years, and now you're faced with socialized medicine. That's the reality on the ground. How are you supposed to manage that?

"Fortunately, I still love what I do. But I don't know what's going to happen. I think we'll wind up with a two-tiered medical system: a private one for the rich who pay cash and a mediocre one for everyone else.

"When my dad was 91, he had a heart attack and ended up with a stent. He had two more good years after that before he died. After ObamaCare, some government employee is going to decide that he is too old for this and not 'approve' for him to have that procedure.

"It's just a feeling of helplessness. The only organizations that are fighting for doctors are the Association of American Physicians and Surgeons, and Docs4 Patient Care."

After he hung up, I went to the website of Docs4 Patient Care and found this statement from its president, Dr. Hal Scherz:

The Supreme Court disappointed the majority of Americans who have voiced their opposition to Obamacare, by upholding significant portions of this truly abysmal law. Their decision has left Americans now wondering what it is that the Federal Government can't compel them to do. This is perhaps the worst decision in the history of the Supreme Court and emphasizes the importance of making the correct decision for chief executive, who controls who sits on this bench.

If you want to cure the sickness that's killing America, you'll find a powerful remedy in the voting booth in November.

Write Stella Paul at Stellapundit@aol.com.
Read more: http://www.americanthinker.com/2012/06/a_surgeon_cuts_to_the_heart_of_the_obamacare_nightmare.html#ixzz1zJFxa8LZ

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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: How reform will clean up hospitals

hospitalimpact.org

The Patient Protection and Affordable Care Act promises to bring millions of new patients into our healthcare system. This is an exciting outcome that will eliminate the estimated 45,000 deaths per year caused by lack of insurance.

However, if we don't improve the efficiency of care, universal coverage will be Rome prohibitively expensive. Currently, we spend approximately $8,000 per capita and devote more than 18 percent of our Gross Domestic Product (GDP) to healthcare. Read more . . .

If care efficiency doesn't improve, how will we afford to add the nearly 40 million people who currently lack healthcare insurance? We must eliminate the waste in our system; economists and quality experts agree that 30 percent to 40 percent of healthcare expenses represent waste. . .

Too often, new equipment and cutting-edge technologies are quickly embraced, despite only incremental benefits. They are promoted as being cost-saving and life-saving, but this frequently does not prove to be the case; alternatively, these new technologies may benefit a very specific group of patients.

Because of enhanced reimbursement, physicians may utilize the procedure for patients who are less likely to benefit. Examples abound, but two of the most notorious are the overuse of CAT scans and cardiac catheterization. . .

Other forms of waste abound, including inefficient use of personnel. In healthcare, the solution to delays has been to add employees. Often, the more cost-effective approach would be to reduce wasteful, overly complex processes. Many in healthcare forget that production capacity = work - waste. By eliminating wasteful systems of care, we can improve productivity without increasing the number of caregivers and support staff.

By avoiding misdiagnoses and preventing errors, we can reduce patient injuries and reduce costs. A single hospital-acquired infection increases costs by thousands of dollars. A misdiagnosis delays appropriate therapy and prolongs hospitalization at the very least; at worst, it can result in a fatal outcome.

How do we eliminate waste? We need to follow the examples of high-performing manufacturing companies like Toyota and Alcoa, as well as the airline and nuclear energy industries. These industries have empowered those on the frontlines to generate hypotheses and test new ways of doing things.

By employing the scientific method, each healthcare worker can be part of the solution. By continually making small improvements, the entire system will steadily get better, leading to large reductions in waste and marked improvements in the quality of care.

For this to happen, administrators and physicians, those presently at the top of the hierarchy, must lower the power gradient and create an atmosphere where all employees are respected and encouraged to lead. Leadership cannot come only from the top; it also must come from those who are intimately familiar with each process.

Waste reduction is not glamorous and will not generate big headlines. However, by empowering those on the frontlines to actively improve the efficiency of our systems of care, we can provide healthcare to everyone and simultaneously reduce our nation's healthcare expenditures. By reducing waste, we can afford the Affordable Care Act.

Frederick Southwick, M.D., is a Professor of Medicine at the University of Florida and manages New Quality and Safety Initiatives for the University of Florida and Shands Health Care System. He also is the author of "Critically Ill: A 5 Point Plan to Cure Healthcare Delivery."

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Medical Myths Originate When Someone Else Pays The Medical Bills.

Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service.

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

Dr. Rosen: How is the Obama plan affecting your practice even before its implemented?

Dr. Dave: I see the noose growing tighter and tighter. And it’s strangling quality of care.

Dr. Milton: With more doctors accepting the transfers of welfare patients into their HMOs, we no longer can trust referral sources. Doctors, who formerly took any patient we referred, now are getting choosy.

Dr. Edwards: We accepted all insurances in the past. Now we’re getting burned by people who we thought were MediCal but now are HMO/MC unobtrusively entering our practice under the radar. We weren’t cognizant of this until we started seeing the loss of revenue. Read more . . .

Dr. Paul: Don’t they pay the same as MediCal?

Dr. Edwards: They were supposed to pay more than MediCal, but when we started reviewing the claims, we didn’t see any difference. We checked with our HMO and were told we were getting a 10 percent increase. When we looked a little closer, sure enough it was there. Our $18 office calls were now making $19.80. So we now understood why we didn’t see a bump in our deposits. The bump was so small that our Medicalwagen couldn’t feel it.

Dr. Ruth: I’m so glad we didn’t accept this new hybrid insurance. It was very duplistic in the way it was presented and I see now in the way it was implemented.

Dr. Sam: I’m glad that I got out of MediCal five years ago. It seems to be getting worse every year.

Dr. Yancy: As a surgeon, it’s even worse. The insurance carrier told me that it was fine with him if I dropped out. He could always find a more desperate surgeon down the street who would accept patients even if the reimbursement were lower.

Dr. Patricia: I don’t pay much attention to the individual receipts. I accept whatever I get and go home to my family.

Dr. Rosen: Would the receipts ever get so low that you would consider getting out of medicine?

Dr. Patricia: I suppose they could. But since my husband also practices, I let him decide if I should retire to my home and family.

Dr. Rosen: So what’s the answer for the rest of us?

Dr. Edwards: With the turmoil in DC and the future in healthcare up for grabs, I think we have to seriously consider getting out of the practice of medicine as soon as possible.

Dr. Rosen: When do you think it would be a good time to look elsewhere?

Dr. Milton: If Obama wins the elections, the timing will be imminent.

Dr. Rosen: It appears that the implementation is running a year to two behind?

Dr. Edwards: So if it isn’t implemented in 2014 as initially planned, it looks as if we have until 2015 or maybe even until 2016 to find another avocation. How sad after all that our parents invested in our education. If you’re not sure what we’ll be like in 2016, you need to see the film: 2016 which is playing at theaters now. Don’t miss it.

Dr. Rosen: The really sad part is to see all these welfare patients with their hopes up that they be would now in mainstream medicine and not in second class welfare or Medicaid then find themselves on a lower rung of the ladder even though they thought they were now first class citizens. Obama couldn’t tax them into prosperity. Everyone is worse off. Only some don’t realize it yet.

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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

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

Charles Krauthammer: Why Chief Justice John Roberts did it

By Charles Krauthammer, MD

WASHINGTON -- It's the judiciary's Nixon-to-China: Chief Justice John Roberts joins the liberal wing of the Supreme Court and upholds the constitutionality of Obamacare. How? By pulling off one of the great constitutional finesses of all time. He managed to uphold the central conservative argument against Obamacare while at the same time finding a narrow definitional dodge to uphold the law -- and thus prevented the court from being seen as having overturned, presumably on political grounds, the signature legislation of this administration. Read more . . .

Why did he do it? Because he carries two identities. Jurisprudentially, he is a constitutional conservative. Institutionally, he is chief justice and sees himself as uniquely entrusted with the custodianship of the court's legitimacy, reputation and stature.

As a conservative, he is as appalled as his conservative colleagues by the administration's central argument that Obamacare's individual mandate is a proper exercise of its authority to regulate commerce.

That makes congressional power effectively unlimited. Mr. Jones is not a purchaser of health insurance. Mr. Jones has therefore manifestly not entered into any commerce. Yet Congress tells him he must buy health insurance -- on the grounds that it is regulating commerce. If government can do that under the Commerce Clause, what can it not do?

"The Framers ... gave Congress the power to regulate commerce, not to compel it," writes Roberts. Otherwise you "undermine the principle that the federal government is a government of limited and enumerated powers."

That's Roberts, philosophical conservative. But he lives in uneasy coexistence with Roberts, custodian of the court, acutely aware that the judiciary's arrogation of power has eroded the esteem in which it was once held. Most of this arrogation occurred under the liberal Warren and Burger courts, most egregiously with Roe v. Wade. More recently, however, few decisions have occasioned more bitterness and rancor than Bush v. Gore, a 5-4 decision split along ideological lines. Roberts seems determined that there be no recurrence with Obamacare. Roberts' concern was that the court do everything it could to avoid being seen, rightly or wrongly, as highhandedly overturning sweeping legislation passed by both houses of Congress and signed by the president.

How to reconcile the two imperatives -- one philosophical and the other institutional? Assign yourself the task of writing the majority opinion. Find the ultimate finesse that manages to uphold the law but only on the most narrow of grounds -- interpreting the individual mandate as merely a tax, something generally within the power of Congress.

Result? The law stands, thus obviating any charge that a partisan court overturned duly passed legislation. And yet at the same time the Commerce Clause is reined in.

Law upheld, Supreme Court's reputation for neutrality maintained. Commerce Clause contained, constitutional principle of enumerated powers reaffirmed.

That's not how I would have ruled. I think the "mandate is merely a tax" argument is a dodge, and a flimsy one at that. (The "tax" is obviously punitive, regulatory and intended to compel.) Perhaps that's not how Roberts would have ruled had he been just an associate justice, and not the chief. But that's how he did rule.

Obamacare is now essentially upheld. There's only one way it can be overturned. The same way it was passed -- elect a new president and a new Congress. That's undoubtedly what Roberts is saying: Your job, not mine. I won't make it easy for you.

Charles Krauthammer is a Washington Post columnist.

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

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9. Book Review: The Man With a Plan

A warrior who helped lead the Allies to victory armed with charts, graphs and a meticulous attention to detail.

By JONATHAN W. JORDAN, WSJ

'World War II," wrote Adm. William Leahy, President Roosevelt's wartime chief of staff, "was the best-charted war ever fought. Everybody had charts for everything. We even had a section of the Government devoted solely to telling the rest of the Government how to make charts." The ubiquitous charts—together with such equally mundane cousins as tables, memoranda and staff studies—were the first weapons that America's high command wielded against the three Axis empires. Through them, men were drafted and trained, uniforms and equipment were procured, and Allied strategy took form amid a vast stew of logistical, political and industrial considerations.

The generals who ponder these crucial questions have always been less heralded than those who led through smoke and fire. This makes John J. McLaughlin's study of one of the U.S. Army's key planners all the more welcome. Read more . . .

Albert Coady Wedemeyer (1897-1989) was from an upper-middle-class family in Omaha, Neb. Fascinated by European history and the grand strategy of empires as a youth, he was inexorably drawn to the life of a soldier and graduated from West Point in 1919. He foresaw another war with Germany and, in the late 1930s, attended the German army's prestigious general-staff school, the Kriegsakademie. There he learned the art of blitzkrieg alongside his future enemies. He watched Nazi brownshirts strut around Berlin, venting their hatred against Jews. He was in Vienna during the Anschluss, and he saw the Czechoslovakian crisis unfold from the German perspective.

Wedemeyer's report summarizing German tactics and organization brought him to the attention of George C. Marshall, who in 1939 became the Army's chief of staff. Marshall assigned Wedemeyer to the War Plans Division and tasked him with reducing America's mobilization requirements to a single document. In the summer of 1941, in response to a request from Roosevelt, Wedemeyer's team expanded this into a blueprint on how to defeat America's likely enemies in a future war.

Completed in an astonishing 90 days, this plan laid down all the critical politico-military-industrial assumptions for the looming conflict, correctly identifying America's adversaries and where the main fighting would take place and estimating the industrial capacity needed to feed the war machines of China, the Soviet Union, Great Britain and the United States and how much war materiel could be spared to allies. Wedemeyer proposed overrunning Germany and Japan with an army of nearly nine million draftees, a number that he concluded would leave sufficient factory workers and farmers back home to feed the troops and keep the tanks, bombers and artillery shells rolling off assembly lines. He also called for an invasion of Europe in 1943, before Germany could strengthen its defenses.

Wedemeyer's work was combined with the Navy's estimates and a civilian industrial plan to become the "Victory Program." But when the U.S. entered the war, its strategists found their British counterparts vehemently opposed to one of the plan's key components—the early invasion of Europe. Winston Churchill and his lieutenants were convinced that a cross-Channel invasion in 1943 would only end in disaster. Better, they said, to strangle Germany slowly, through prolonged air bombardment, naval blockade, propaganda, conquest of the Mediterranean and possibly an offensive in northern Italy or the Balkans—the supposed "soft underbelly" of Europe . . .

The U.S. service chiefs saw no hope of success without wholehearted British support and backed down. Roosevelt, sensing a public need to see American troops engaged with Germans as soon as possible, ordered an invasion of North Africa for late 1942. Wedemeyer, to the end of his days, insisted that the Allies lost an opportunity to win the war a year earlier, to save American lives and, perhaps, to have staved off Soviet hegemony over Eastern Europe.

Mr. McLaughlin asserts that Churchill did more than just win the debate with Wedemeyer over an invasion of North Africa. The prime minister, he claims, "got his pound of flesh by dispatching his nemesis to a seemingly dead-end assignment in the China-Burma-India theater." There is little direct evidence that Wedemeyer was sent east at Churchill's insistence. Marshall continued to hold a high opinion of him, and he was given key commands in Asia: serving as chief of staff to Louis Mountbatten, the China-Burma-India theater commander, and succeeding Joseph Stilwell as chief of staff to the Chinese leader Chiang Kai-shek. The Nebraskan would ride out the war under Chiang, then turn his considerable analytical skills toward the quandaries of postwar China and the 1948 Berlin blockade.

The overriding argument of this biography is that an American visionary was sacrificed on the altar of Allied harmony. Historians such as the late John Keegan have praised Wedemeyer as "one of the most farsighted and intellectual military minds America has ever produced." But others are skeptical. Jim Lacey, for instance, devotes a chapter of his perceptive work "Keep From All Thoughtful Men: How U.S. Economists Won World War II" to refuting the importance of the "Victory Program" and notes that many of the claims for it originated with Wedemeyer himself—in his own postwar writings or in books indebted to interviews with him. Yet if Mr. McLaughlin is an unabashed Wedemeyer partisan, he is to be applauded for shining a light on one of the least known U.S. commanders of the war.

Mr. Jordan is the author of "Brothers, Rivals, Victors: Eisenhower, Patton, Bradley, and the Partnership That Drove the Allied Conquest in Europe."

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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: The London Olympics

Sexing the games - The evolution of Olympic events for men and women

The Economist online

WOMEN first competed in the Olympics in 1900, when they played golf and tennis in single-sex competitions, and participated alongside men in sailing events and croquet. Nowadays, the only discipline in which men and women can compete directly against each other is on horseback. Indeed, women have competed in dressage since 1952 (notable also as the first year the event was open to riders other than officers). All six equestrian events this year are open to both sexes. As can be seen in our graphic, there is still a long way to go before women have as many chances to win a gold medal as men. There are 131 events for women compared with 163 for men. Some disparities are easier to fathom than others: male boxers have ten events, women (who box for the first time at this games) have three. Movements are being made towards parity, though: in 2008 men had 11 cycling events and women seven; this year they are split evenly. Read more . . .

Piling up the prizes - How many athletes does it take to win a medal?

The Economist online

IN THE 1970s and 1980s the summer Olympics were dominated by athletes from communist countries. The combination of talent, dedication, state intervention and some dubious training regimes often left Western competitors on the starting blocks. The effectiveness of the methods used can be seen in our charts below, which examined the records of all the countries (or territories) that ever sent teams to a summer Olympics, including several that no longer exist. East Germany won a medal for every 3.3 of the 409 competitors it sent to five games between 1968 and 1988. Those unathletic West Germans had to send six more. Indeed, with a population of less than 20m the GDR came second in the gold-medal table in 1976, 1980 and 1988, behind the Soviet Union each time. And while some countries owe their medals to success across a variety of sports, others have benefited from specialisation. Ethiopia's 38 medals, for example, have all come on the track and at distances of 3000m or longer.

The global games - The shifting pattern of national participation in the modern Olympics

The Economist online

SINCE becoming an independent state in June 2011, South Sudan has had more important things to worry about than the establishment of an Olympic organising committee. So its marathon runner, Guor Marial, will have to compete under the five rings of the Olympic flag at this year's games, together with three athletes from the Netherlands Antilles. This quartet can consider themselves unfortunate, as athletes from 204 other countries will compete under national flags at London 2012. The timeline below, the first in our series of Olympic daily charts, shows how these numbers have changed since the days of the first modern games. Just 245 athletes from 14 countries headed to Athens in 1896. The one-man Australian team, in particular, punched well above its weight: Edwin Flack won both the 800m and 1500m, and came third (playing with an Englishman) in the tennis doubles.

Read the entire section, charts, maps and infographic details . . .

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

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11. Restoring Accountability in Medical Practice, Healthcare, 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."

• 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. 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

If you think health care is expensive now, wait until you see what it costs when it’s free. –P. J. O’Rourke

The Art of Government consists of taking as much money as possible from one party of citizens to give to give to any other. Voltaire (1764)

The Government is like a baby’s alimentary canal… with a happy appetite at one end and no responsibility at the other. –Ronald Reagan

We content that for a nation to try to tax itself into prosperity is like man standing in a bucket and trying to lift himself up by the handle. –Winston Churchill

Some Recent Postings

In The Last Issue:

1. Featured Article: Strong American Women vs. Julia

2. In the News: It is not whether government is good or evil, but what government does.

3. International Medicine: Foreign-Trained Doctors

4. Medicare: How does Medicare’s payment system hinder innovation in health care?

5. Medical Gluttony: Hospital Consolidation Increases healthcare costs

6. Medical Myths: Decreasing Deductibles and Co-Payments Lowers the cost of Healthcare

7. Overheard in the Medical Staff Lounge: Tax & Spend & Mortgage our Children’s Future

8. Voices of Medicine: The Snake and I by Michael Sergeant, MD, Sonoma Medicine

9. The Bookshelf: PRICELESS . . . The Female Brain . . .

10. Hippocrates & His Kin: Today, Tomorrow and Next Week in History

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

In Memoriam

Yitzhak Shamir, a fighter for Israel, died on June 30th, aged 96

From the print edition | The Economist | July 14th 2012

THE tributes paid to Yitzhak Shamir after he had died called him “stone”, “granite”, “basalt” and “cast rock”. These, though, sounded too monumental. This tiny, square-built, bushy-browed man saw himself as something smaller and sharper. Shamir meant a thorn—as from any shrub of the Judean desert—that when brushed would stab back, and when hidden in a shoe would keep pricking. Read more . . .

This word was also precious to him because it was on the forged ID papers of his undercover life. He had been born Yernitsky, in what was then Poland, but discarded it in the 1940s when dragnets in British-administered Palestine. Those years—as a member and then leader of Lehi, better known as the Stern Gang—he considered the best of his life. In his autobiography he wrote wistfully of weapons-training among the orange groves outside Tel Aviv, of his night-time forays disguised in rabbinical black, of “singular comradeship” and of the assassinations he ordered. One of his many points of difference with the courtly, intellectual Menachem Begin, who ran Irgun, the main Jewish paramilitary force, was that Mr Shamir was much more convinced he could create a state, and change history, with pistols.

The ambition he had then was simple, and he never deviated from it: to secure and protect a Jewish majority in the whole Land of Israel, Eretz Yisrael, and to give back to the Arabs nothing that had been gained. The whole land included the West Bank, Judea and Samaria to him; it could also have enfolded Sinai, as far as he was concerned, until the Camp David accords of 1979 with Egypt limply gave that away. Small as he was (though always ready to defend himself, packing a knife in his pocket, as a student in Warsaw, against anti-Semitic hoodlums), he was obsessed with the smallness of Israel, its vulnerability, the hostility of its neighbours. Certainly there was no room, in such a tiny territory, for a Palestinian state.

The boy Shamir had dreamed of this place so much—educated in Hebrew in the depths of the Polish forest, his mind teeming with Old Testament heroes—that when he arrived there in 1935, aged 20 and alone, he was immediately at home. He wanted millions of other Jews, especially Soviet Jews living undercover lives like his own, to make the same aliyah, or ascent, to populate and settle the young country. As prime minister he presided over the arrival of 350,000 immigrants in 1990-91 alone and, in 1991, airlifted 14,000 Ethiopian Jews out of their collapsing country in 36 hours.

Generally, however, he was not a man for showy adventures. Silence, patience and cunning were more his style. After Lehi had been disbanded in 1948 he had moved eventually to Mossad, Israel’s foreign-intelligence service, organising assassinations of German scientists who worked for Egypt’s missile programme. Undercover, fighting for Israel, for a decade he was in his element again.

When he entered the Knesset in 1973 many thought him dull and boorish, and were surprised that he made a decent Speaker and, in 1980, a foreign minister with a genuine and knowledgeable interest in foreign affairs. He was surprised himself when, in 1983, Begin suddenly left political life and he became prime minister. But nothing hinted to him that he should change. He distrusted emotional rhetoric, like Begin’s, and refused for years to talk about the Holocaust in which his whole family had been killed, his father stoned to death by neighbours. His life was private, austere, honest; his persona straight-thinking and straight-shooting, wary, and on occasion warm. He worked in an office that was almost bare, except for the Israeli flag.

A man of his convictions would never compromise and never concede. After the 1984 and 1988 elections, having won no majority for his right-wing Likud party, he agreed to lead national governments in coalition and rotation with Labour’s Shimon Peres. They could not get on. Mr Peres was happy to take part in international conferences to try to resolve the Palestinian problem; Mr Shamir was not, believing that Israel had to look after itself. He rejected the agreement of 1987 with Jordan, thereby disastrously sparking off the first Palestinian intifada. At the Madrid conference in 1991 he deliberately dragged his heels. When Binyamin Netanyahu took over the leadership of Likud from him in 1993, Mr Shamir was horrified by his willingness, lukewarm though it was, to contemplate talks with the Palestinians.

An audience of heroes

He was scandalised, too, by Mr Netanyahu’s pursuit of his own self-interest. Mr Shamir had no interests, save Israel’s. For him, Nablus, Hebron and Jerusalem were places “of the heart”, not names on a map. To protect them, as all Israeli settlements, he would deal with the Arabs only from a position of overriding superiority in numbers, land and arms. Until that point was reached, he preferred endless prevarication to anything called peace. . .

Read the entire obituary . . .

On This Date in History – July 10

On this date in 1908, William Jennings Bryan was nominated the third time for the presidency by the Democratic Party. As in 1896, and again in 1900, Bryan did not win, but after his third try, he struck out. Bryan won election to the U.S. House of Representatives in 1890 and served until 1895, championing Populist causes such as the free coinage of silver, national income tax, and direct election of senators. President Woodrow Wilson selected Bryan, one of the elder statesmen of the Democratic Party, as his Secretary of State following the 1912 presidential election.

On this date in 1509, in the French town of Noyon, John Calvin, one of the most influential religious leaders of all time was born leaving an indelible mark upon this country. John Calvin’s religious ideas, which bear his name are known as Calvinism, had the greatest influence on the ethical development of Puritanism—the Protestant work ethic. Calvin believed in the austerity of life and the founding fathers in this new land lived that way as they built their Puritan heritage. When the chips are down, that heritage remains a bedrock of American strength.

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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