MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol VIII, No 12, Oct 27, 2009

In This Issue:

1. Featured Article: Our Health Care Crisis: What's it really about?

2. In the News: Will Unlimited Healthcare Spending Eventually Have Limits?

3. International Medicine: Labour and Conservatives Vow to Outspend Each Other

4. Medicare: For True Reform, Look to Singapore

5. Medical Gluttony: It's even Worse, People Don't Care what it Costs

6. Medical Myths: Spending more on Wellness will enable us to spend less on medical care.

7. Overheard in the Medical Staff Lounge: Doctors Spend Hours Each Day On Minutiae

8. Voices of Medicine: How the U.S. Government Rations Health Care

9. The Bookshelf: How Our Government Is Undermining Democracy

10. Hippocrates & His Kin: Financial incentives to doctors is an insult to their integrity

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

Words of Wisdom, Recent Postings, In Memoriam . . .

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MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE's SiCKO

Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the truth about socialized medicine. Clements is the former publisher of "American Venture" magazine who made news in 2005 for a property rights project against eminent domain called the "Lost Liberty Hotel."
For more information visit www.sickandsickermovie.com or email logan@freestarmovie.com.

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1. Featured Article: Our Health Care Crisis: What's it really about?

Our Health Care Crisis: Age, Obesity, Lawyers
Digital Rules by Rich Karlgaard, Publisher, Forbes, 09.07.09

This is how President Obama should start a speech on health care--
"My fellow Americans: We are old. We are fat. We are afraid of lawyers."

Our PC President would never begin a speech like that. But with his polls plummeting, maybe he should. I think the country is in the mood for such straight talk.

--We are old. Here are the facts about so-called mandatory entitlement spending in the U.S.: Out of a typical year's federal budget about half goes to transfer payments of various sorts--Social Security, Medicare, Medicaid, unemployment compensation, disability programs, etc. Together Social Security and Medicare suck up nearly $1 trillion annually and, because of the country's aging boomer population, are the fastest-growing part of the entitlement pie.

--We are fat. Here are the alarming facts about obesity in the U.S.: Nearly one-third (31%) of Americans are clinically obese (Body Mass Index of 30 or more). According to American Sports Data, "3.8 million people are over 300 pounds, over 400,000 people (mostly males) carry over 400 pounds, and the average adult female weighs an unprecedented 163 pounds!"

Obesity leads to a legion of ills, from heart attacks and strokes to gut cancers and diabetes. The annual cost of treating diabetes and its effects exceeds $200 billion. This number is sure to grow. Adult onset diabetes is of epidemic proportions in some communities and has reached down to hit teenagers, the vast majority of them overweight and underexercised. President Obama should borrow a page from John F. Kennedy and commit our public schools to vigorous fitness goals. And parents: Stop driving your kids to school! Buy a computer game called "Go Outside and Play."

--We are afraid of lawyers. The biggest cost is not malpractice awards, which annually drive up U.S. health care costs by 1% to 2%--$20 billion to $40 billion a year--although that's bad enough. Most costly is the individual doctor's perceived threat of a career-ending malpractice award and his or her incentive, therefore, to practice defensive medicine. This occurs when a doctor, fearing a lawsuit, orders a battery of costly diagnostic tests to rule out the highly improbable, even when the obvious cause of sickness or injury is staring him in the face.

A Massachusetts Medical Society study discovered that in one year Massachusetts wasted $1.4 billion on defensive medicine. Prorated for the entire U.S. population, the cost would be about $66 billion a year. Another study cited by the American Academy of Orthopaedic Surgeons puts the cost of defensive medicine much higher--$100 billion to $178 billion per year. I believe it. . .

Age, obesity and defensive medicine are the trillion-dollar elephants in the room. Whether your preference for health care reform springs from the political left or right, you have to start with these three facts. Otherwise, you're just a political bloviator.

If you want to learn more about market-based solutions to our health care cost crisis, go to the National Center for Policy Analysis (ncpa.org) and read anything written by John Goodman, Ph.D.

Feedback . . .

www.forbes.com/forbes/2009/0907/opinions-rich-karlgaard-digital-rules.html

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2. In the News: Will Unlimited Healthcare Spending Eventually Have Limits?

No-limit health-care spending in U.S. hitting its limits by Bobby Caina Calvan

As medical bills spiral upward, the refrain is ever more common: Health care is costing an arm and a leg.
But how much does that broken arm or that shattered leg cost?

Greg Davis, whose son Jonathan fractured his right leg during football practice, confesses to having little interest in finding out. "Until it hits my pocket, I'm really not concerned about it," said Davis, an MRI supervisor at UC Davis Medical Center. "As far as I'm concerned, my son's broken leg is costing $65: the $50 emergency room co-pay and the $15 for an office visit. Thank God for insurance," he added.

Partly motivated by an effort to contain costs, policymakers are considering a comprehensive overhaul of the country's health care system. But most Americans with quality insurance coverage may have little clue, or concern, about what goes into health care spending, which is expected to grow to $2.5 trillion this year.

That's nearly double the $1.4 trillion the government estimated was spent on health care in 2000 – which was already twice the $714 billion recorded just 10 years earlier.

By 2018, the nation's tab for health care is expected to surge to $4.4 trillion, according to the National Coalition on Health Care.

As the health care reform movement goes into high gear, there is little question that escalating cost is the major factor driving the effort. But there is wide debate about whether health care legislation will reduce health care costs.

Glenn Melnick, an expert in health economics and finances at the University of Southern California, said the proposed plans contain vague notions of improving efficiency and increasing competition. But there's no guarantee that a government-run insurance plan or other overhaul proposals will bring costs down, he noted.

Much of the discussion over rising health care costs has centered on rising insurance premiums, with consumers and employers bemoaning their increasing financial burdens.

A host of factors have contributed to the rising costs, including fear of malpractice lawsuits, expensive new technology and drugs, and high administrative costs for private insurers.

"The rate of health care premiums follows the increase in medical costs," said Patrick Johnston, president of the California Association of Health Plans. "Health premiums are just reflecting the underlying medical costs in our system. Until we address those, we can't achieve sustainable health care coverage in this country." . . .

"By and large, most people have no idea how much medical care costs, and they're not used to paying for it," said USC's Melnick.

Jan Emerson of the California Hospital Association offered a similar view. "American consumers are used to getting whatever health care service they need, when they need it, and don't ask about the cost," Emerson said. "If we're really going to change the system, people are going to have to care." . . .

In recent years, consumers have become more aware of the rising cost of health care. Millions have lost their insurance, or have been required to pay higher premiums or deductibles. This trend has spurred calls for relief.

"Only in the last several years have they seen some of the cost being passed on to them," Melnick said. "It's been a bit of a sticker shock, because they've mostly been shielded from it."

As the ranks of the uninsured have grown – they are now estimated at 46 million – hospitals have responded by shifting expenses to those who are insured, increasing upward pressure on bills. So-called cost shifting has become routine, hospital officials say, in part because of meager government reimbursements for Medicare and Medi-Cal. [There are two errors in this paragraph. The erroneous estimate is given by those with a mission to implement government medicine. The best estimate is more like five million or two percent of our population. See the book review below. The second statement tells the real story of what government medicine really is. If all medicine were extended to Medicare and Medicaid government medicine, we would be in a serious crises. ]

Consumers aren't solely to blame for demanding health care beyond what is necessary, experts said. Doctors worried about malpractice lawsuits are a significant contributor to cost inflation. . .

Hospital care accounts for the largest share of the country's health spending, amounting to nearly a third of expenditures, according to the Kaiser Family Foundation.

A fifth of spending goes to physicians.

Pharmaceuticals comprise 10 percent of all spending, but represent one of the fastest-growing segments of the health care economy, the Kaiser foundation reported.

For many consumers, though, the cost of health care still doesn't matter much, as long as they don't have to pay for it directly.

Carol Silva, a Kaiser Permanente customer, has been limping around with a broken foot, oblivious of how much it cost to mend her fractured bones.

"I absolutely have no clue. I'd be curious, though, how much my foot would cost."

Daniel Rickard, a college senior whose arm is in a cast because of a hit-and-run driver, has attempted to keep up with the national discussion on health care but admits there is much he doesn't understand.

"I'm just lucky my parents have good health insurance," said Rickard, a finance and marketing major at California State University, Sacramento.

As for the cost of his fractured arm?

"When you go to the emergency room," he said, "it's not as if they put up price tags."

Emergency rooms are in fact required by state law to make available the cost of the most common procedures. But in cases of emergency, few have the luxury of skimming through a menu of prices.

Hospitals are also required to file a list of charges with the state Office of Statewide Health Planning and Development. But few would ever pay the amounts filed with the state because insurance companies and hospitals negotiate their own prices.

Davis had no idea what it cost to fix his son's leg, until he asked for a list of charges from UC Davis Medical Center at the request of The Bee.

The tally: $7,415 – $2,845 for the six-hour emergency room visit, $4,366 for X-rays and other radiology services, and $204 for a splint.

"It was lower than I thought," he said. "But would I be thinking that if I were paying out of pocket? Maybe not."

[That' the understatement of the year!]

Feedback . . .

Sacramento Bee Health, Fitness & Medical News / Health & Fitness bcalvan@sacbee.com, Sep. 18, 2009, Call The Bee's Bobby Caina Calvan, (916) 321-1067.

www.sacbee.com/273/story/2191359.html

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3. International Medicine: Labour and Conservatives Vow to Outspend Each Other

Government Medicine vs. the Elderly

By RUPERT DARWALL in London

Rarely has the Atlantic seemed as wide as when America's health-care debate provoked a near unanimous response from British politicians boasting of the superiority of their country's National Health Service. Prime Minister Gordon Brown used Twitter to tell the world that the NHS can mean the difference between life and death. His wife added, "we love the NHS." Opposition leader David Cameron tweeted back that his plans to outspend Labour showed the Conservatives were more committed to the NHS than Labour.

This outbreak of NHS jingoism was brought to an abrupt halt by the Patients Association, an independent charity. In a report, the association presented a catalogue of end-of-life cases that demonstrated, in its words, "a consistent pattern of shocking standards of care." It provided details of what it described as "appalling treatment," which could be found across the NHS.

A few days later, a group of senior doctors and health-care experts wrote to a national newspaper expressing their concern about the Liverpool Care Pathway, a palliative program being rolled out across the NHS involving the withdrawal of fluids and nourishment for patients thought to be dying. Noting that in 2007-08, 16.5% of deaths in the U.K. came after "terminal sedation," their letter concluded with the chilling observation that experienced doctors know that sometimes "when all but essential drugs are stopped, 'dying' patients get better" if they are allowed to.

The usual justification for socialized health care is to provide access to quality health care for the poor and disadvantaged. But this function can be more efficiently performed through the benefits system and the payment of refundable tax credits.

The real justification for socialized medicine is left unstated: Because health-care resources are assumed to be fixed, those resources should be prioritized for those who can benefit most from medical treatment. Thus the NHS acts as Britain's national triage service, deciding who is most likely to respond best to treatment and allocating health care accordingly.

It should therefore come as no surprise that the NHS is institutionally ageist. The elderly have fewer years left to them; why then should they get health-care resources that would benefit a younger person more? An analysis by a senior U.K.-based health-care expert earlier this decade found that in the U.S. health-care spending per capita goes up steeply for the elderly, while the U.K. didn't show the same pattern. The U.K.'s pattern of health-care spending by age had more in common with the former Soviet bloc.

A scarcity assumption similar to the British mentality underlies President Barack Obama's proposed health-care overhaul. "We spend one-and-a-half times more per person on health care than any other country, but we aren't any healthier for it," Mr. Obama claimed in his address to Congress last Wednesday, a situation that, he said, threatened America's economic competitiveness.

This assertion is seldom challenged. Yet what makes health care different from spending on, say, information technology - or any category of consumer service - such that spending on health care is uniquely bad for the American economy? Distortions like malpractice suits that lead to higher costs or the absence of consumer price consciousness do result in a misallocation of resources. That should be an argument for tackling those distortions. But if high health-care spending otherwise reflects the preferences of millions of consumers, why the fuss?

The case for ObamaCare, as with the NHS, rests on what might be termed the "lump of health care" fallacy. But in a market-based system triggering one person's contractual rights to health care does not invalidate someone else's health policy. Instead, increased demand for health care incentivizes new drugs, new therapies and better ways of delivering health care. Government-administered systems are so slow and clumsy that they turn the lump of health-care fallacy into a reality.

According to the 2002 Wanless report, used by Tony Blair's government to justify a large tax hike to fund the higher spending, the NHS is late to adopt and slow to diffuse new technology. Still, NHS spending more than doubled to £103 billion in 2009-10 from £40 billion in 1999-2000, equivalent to an average growth rate of over 7% a year after inflation.

In 1965, economist (and future Nobel laureate) James Buchanan observed of the 17-year old NHS that "hospital facilities are overcrowded, and long delays in securing treatment, save for strictly emergency cases, are universally noted." Forty-four years later, matters are little improved. The Wanless report found that of the five countries it looked at, the U.S. was the only one to be both an early adopter and rapid diffuser of new medical techniques. It is the world's principal engine driving medical advance. If the U.S. gets health-care reform wrong, the rest of the world will suffer too.

Mr. Darwall, a London-based strategist, is currently writing a book on the history of global warming, to be published by Quartet Books in Spring 2010.
Printed in The Wall Street Journal, SEPTEMBER 15, 2009 page A21

http://online.wsj.com/article/SB20001424052970203917304574412680569936844.html#mod=todays_us_opinion

Healthcare utilization is flexible and will expand to all available Healthcare resources.

Government cannot control utilization. Only patients in a free economy can.

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4. Medicare: For True Reform, Look to Singapore

WHAT SINGAPORE CAN TEACH THE WHITE HOUSE

In Singapore they already have universal health coverage. They also have world-class quality care at world-competitive prices. How do they do it, asks William McGurn, a Vice President at the News Corporation who writes speeches for CEO Rupert Murdoch?

The American health system depends on regulation and oversight to accomplish what Singapore tries to do with competition and choice, explains McGurn:

At the high end of accommodation, a patient can choose the Victory suite at the Raffles Hospital, a leading private care facility in downtown Singapore; the cost is about $1,438 per night and that price includes a 24-hour private nurse, a refrigerator stocked with drinks, and an adjoining living room to entertain.
At the other end of the scale, a bed in a six-person room goes for just $99.
The actual care is the same whether a patient decides to stay in a deluxe suite or a dormitory-style room.
But the choice is the patient's; the financial incentives encourage the patient to think about those choices; and the low-priced options help keep the overall costs down.

This is no accident, says Murdock. Like ours, Singapore's system is a mix of public and private care and financing. Unlike ours, Singapore's system is anchored, as the Ministry of Health puts it, on the twin philosophies of individual responsibility and affordable health care for all:

All but the abjectly poor have to pay for some of their care, another downward pressure on prices.
Almost all working Singaporeans are required to put money in a medical savings account that they use for out of pocket expenses.
It's their money, and they control it; as a result, they are careful about spending it.

It seems to be working. According to a Raffles Hospital official:

A knee replacement surgery runs between $12,000 and $14,000; spinal fusion runs between $10,500 and $14,000, and a heart bypass (coronary artery bypass graft) from $23,000 to $26,500.
Conservatively speaking, these prices are less than a third of what the same procedure would cost in the United States -- that is, when you can even get the price.

What makes Singapore's health care work is that it is designed to swim with the market and not against it. In macro terms, that means Singaporeans spend only about 4% of GDP on health care - against 17% for the United States.

Source: William McGurn, "What Singapore Can Teach the White House ," Wall Street Journal, October 19, 2009

For more on Health Issues: www.ncpa.org/sub/dpd/index.php?Article_Category=16

Feedback . . .

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

- Ronald Reagan

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5. Medical Gluttony: It's even Worse, People Don't Care what it Costs.

In the News Item above (Section 2), Greg Davis states, "As far as I'm concerned, my son's broken leg is costing $65; the $50 emergency room co-pay and the $15 for an office visit. Thank God for insurance." He brushes off the $7415 ER bill by saying, "It was lower than I thought. But would I be thinking that if I were paying out of pocket? Maybe not."

He's not sure? This indicates the sad state of affairs of American's knowledge of health care costs or appreciation of their good fortune in health care coverage. Mr Davis brushes off the idea that if he had to pay the $7415 himself, he might not think it was so cheap. What's going on in his head? Just "Maybe not." I can think of about three things. 1) He's so wealthy that he could pay $7415 on his way out of the ER if he had no insurance and treat it as not significant to his financial health. 2) He is so numbed by the cost of medicine he reads in the media that he can't begin to comprehend the problem. $7500, $75 thousand, $75 million all seem to run into each other and so are irrelevant to ordinary people. That's something only the wealth have to think about. Or 3) He's a member of the TSR party (Tax & Spend Radicals) and doesn't understand limits because there will always be enough rich people to pick up the pieces. He doesn't even see that California's reliance on rich people paying exorbitant taxes is the cause of our predicament. When California's rich had a 50 percent drop in income, the state had a similar drop in tax revenue. And now they want to tax the rest of us some more? No problem. The legislature just writes another law to solve the problem.

Rather like the escapee from the Insane Asylum who was driving along the countryside, having a good time. He was totally lost, but he didn't mind - because he was making such good time.

With the attenuated intelligence of the TSR folks, one is tempted to give up and let the TSRs experience failure. But TSRs can't experience failure. They are unable to recognize it. They don't believe in failure. Every step in the Journey of Life is one step closer to Nirvana on Earth. All we need is another law to keep the others in step with us. TSRs don't see this as a restriction of freedom. They see this as the good life.

So responsible people have to keep working diligently, treat humans with respect, cherish the freedoms gained of 1776 for a century and half, and work for the common good of God, Family, and Nation by restoring those freedoms. Utopia is not a place on earth. And the TSRs won't ever build a heaven on earth.

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: Spending more on Wellness will enable us to spend less on medical care.

Myth 8. Spending more on prevention and "wellness" will enable us to spend less on medical care while improving health. AAPS, KAS, August 10, 2009

The idea of having a "wellness" rather than a "disease" orientation is politically appealing, and politicians on both sides of the aisle promise painless savings of "billions" by "incenting doctors" to "keep people healthy."

No-cost and low-cost choices - diet, exercise, avoiding risky behavior - are available to all Americans, without any involvement by health plans or government. The question in the "healthcare reform" debate is the forcible "reallocation" of resources from treatment of the sick and the injured to third-party-funded health programs ranging from smoking-cessation counseling to early detection of disease to drug therapy for blood pressure or lipid levels.

The blame-the-stakeholders approach - "a dollar spent on medical care is a dollar of income for someone" - usually sidesteps or minimizes the issue of denying or delaying care to patients who could immediately benefit, in order to reduce the future burden of illness in hypothetical others.

For the rationale of achieving cost control by this means, it is time to write an obituary, writes John Goodman.

The Obama Administration's options for cost control represent "hope vs. reality," write Theodore Marmor et al. (Ann Intern Med 2009;150:485-489). Emphasis on prevention, better chronic-disease management, outcome-based payment, and comparative effectiveness research are "ineffective as cost-control measures," they conclude.

A review of 599 articles on preventive interventions published between 2000 and 2005 concluded that the vast majority do not save money, notes Victor Fuchs (JAMA 2009;301:963-964). In fact, 80% add more to medical costs than they save (Louise B. Russell, Health Affairs 2009;28:42-45).

Additional information:

· "Research and Its Distortions," by Hilton P. Terrell, M.D., Ph.D., J Am Phys Surg, spring 2004.

· "The Perils of ‘Health Care'," AAPS News, December 2006.

Article originally appeared on TakeBackMedicine (www.takebackmedicine.com/).

See website for complete article licensing information.

Feedback . . .

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: Doctors Spend Hours Each Day On Minutiae

Dr. Milton: Dave, what's new?

Dr. Dave: There's really nothing new. Just the old items rehashed in a new and arbitrary manner to make doctors work an extra two or three hours a day without pay.

Dr. Milton: Isn't that part of the bargain we made in seeking out medicine?

Dr. Edward: Certainly, we all expected to work our tails off and for some of it we would never get paid. But don't you think that has gotten out of hand?

Dr. Milton: That use to be a few phone calls from patients trying to get a free opinion. But now, the phone rings rather persistently.

Dr. Rosen: In the past year, my office assistant spent several hours a day with phone work. She also had plenty of time to do her filing, update the charts, make appointments, and occasionally get a cup of coffee.

Dr. Dave: I think it's the insurance companies that are adding to our work. Yesterday, my office assistant told me she was busy all day managing consult requests and the patients involved.

Dr. Edwards: I overheard my medical assistant ask a patient if she could hold on because she really had to go to the restroom.

Dr. Milton: It's very sad when there isn't enough time in the day to empty a bladder or sigmoid colon.

Dr. Dave: I once asked my insurance broker about the increasing workload and lack of time to empty bladders and bowel?

Dr. Ruth: Yes, I'm waiting.

Dr. Dave: He just politely asked why my staff couldn't empty their bladder and bowels at home.

Dr. Rosen: Don't they always have an answer to any type of question? Today I had to fill out a requisition so a diabetic patient could get her test strips, lancets and syringes. Her insurance doesn't accept my usual prescription with 11 refills for the next year.

Dr. Dave: I thought that was just for some narcotics like Adderall.

Dr. Rosen: That's tolerable. But to take two pages of exact verbiage written by the medical Supply Company and make me recopy all what they have written to another prescription page because it has to be in my own handwriting for something so benign as glucose monitoring supplies every month is really bordering on harassment.

Dr. Edwards: I guess I don't have any diabetics or at least someone with that insurance company.

Dr. Milton: Some days I'm trying to finish the paperwork two or three hours after my last patient . It seems like more and more of it is falling directly on the doctor.

Dr. Rosen: I think one reason that so many doctors are for socialized medicine is because they see our present system as dysfunctional. It's the government mandates that make it dysfunctional. Can you believe that if the entire system were a government monopoly it could possibly get any better?

Dr. Dave: Now that's a scary thought. The government tries to break up monopolies but is trying to establish a monopoly of its own. Won't they have us all by the throat at that time?

Dr. Edwards: Or by the trachea as we're gasping for air. They're cruel. Like Johnny Cash singing, "I just want to see a man die."

Dr. Milton: Don't you think the government is really particularly hostile towards physicians?

Dr. Dave: I certainly think so. That's why they're trying to replace us with Nurse Practitioners.

Dr. Edwards: We've had some presidents that would probably have preferred to travel with their nurse practitioner than with their doctor.

Dr. Rosen: It's a No-Win situation. It's just too hard to not let the incompetents get you down.

Feedback . . .

The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

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8. Voices of Medicine: What Physicians are Saying in the Regional Medical Journals and the Press

How the U.S. Government Rations Health Care

By SCOTT GOTTLIEB, MD

President Barack Obama deflects criticism that his health-care plan will bring on government rationing of medical care by arguing that insurance companies ration care. Everyone knows private payers limit access to some health care. But government does it in far more byzantine and arbitrary ways.

Consider the $450 billion Medicare program. It provides a model for - indeed its bureaucracy could well end up running - the "public option" health plan that Mr. Obama wants to offer all Americans under the age of 65. In recent years, Medicare's staff has been aggressively restricting coverage for costly treatments. Looking for ways to control spending on medical products - and preserve the illusory "trust fund" that pays Medicare claims - is what shapes the culture of the organization and motivates the agency's staff.

This often means limiting access to the costliest technologies. To do this Medicare relies on its rationing and pricing systems. National coverage decisions (NCDs) are assessments issued by Medicare's medical staff that define who is eligible for new but often expensive treatments. Medicare then assigns medical products and procedures with "codes" that determine which regulated category they fall into. Finally, price "schedules" are developed by Medicare's staff each year to assign each unique code with its own updated payment rate. The process for getting a favorable code on a new product is a source of intense lobbying. It can make or break a technology.

For a remote agency like Medicare, far removed from clinical practice, it's easier to try and manage the use of a high-cost but specialty treatment than a much lower-cost but very widely used product. Yet cheaper, more commonly used products can still be mispriced and account for more total cost to the agency. For example, low-tech orthotic devices and other "durable medical equipment" are a known source of wasteful spending. These medical products often evade Medicare's attention in favor of less used but more expensive items such as a biological cancer drug.

Take the agency's tortured decisions concerning the use of implantable defibrillators that jump-start stopped hearts during cardiac arrest. Medicare sharply restricted their use in the 1990s. Mounting research proved that the $30,000 devices could be saving many more lives. So in 2003 Medicare adopted a novel theory to expand coverage to some, but not everyone, who needed one. The agency said only patients with certain measures on their electrocardiograms (called "wide QRS") seemed to benefit.

It was an easily measurable but ultimately imprecise way to allocate the devices. After another major study firmly refuted the QRS theory, Medicare expanded coverage again in 2005, potentially saving 2,500 additional lives according to a press release issued with that decision. . .

Medicare is lately increasing its use of the national coverage process and is becoming more tightfisted. Since 2008, according to my review of Medicare data, it conditioned access in 29% of its reviews and denied new or expanded coverage in fully 53% of cases. . .

Formal patient and provider appeals to Medicare took an average of 21 months, according to a report issued in 2003 by the Government Accountability Office (using 2001 data), with delays in "administrative processing" due to "inefficiencies and incompatibility" of data systems eating up 70% of the time spent processing appeals.

There's nothing inherently wrong with a program like Medicare seeking value for taxpayers. But it shouldn't make up the rules as it goes. When private plans ration care, patients can appeal directly to an insurer's medical staff. Only a small fraction of Medicare's denied claims - about 5% - are ever formally appealed because its process is so impenetrable. People can also switch insurers, and in many cases patients chose a policy because it matched their preferences in the first place. These options don't exist in a government health program.

- Dr. Gottlieb is a resident fellow at the American Enterprise Institute and a former senior official at the Centers for Medicare and Medicaid Services. He is partner to a firm that invests in health-care companies, and he advises health plans.

Printed in The Wall Street Journal, October 1, 2009, page A23

VOM Is Where Doctors' Thinking is Crystallized into Writing.

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9. Book Review: How Our Government is Undermining Democracy

SHAKE DOWN, How Our Government is Undermining Democracy in the Name of Human Rights, by Ezra Levant, McClelland & Stewart LTD, Toronto, © 2009 by Ezra Levant, ISBN: 978-0-7710-4618-6, 216 pp, $28.99 Can/U.S. $25.95.

Ezra Levant was the banquet speaker at the meeting of the Association of American Physicians and Surgeons in October 2009 in Nashville. His book, Shake Down, was available that night and has a lot to say concerning the current infringement on individual liberty in health care, which was an important item on the meeting agenda. The AAPS is probably the only medical society remaining where you can count on 100 percent of its members favoring freedom in health care and opposing government-controlled health care. Many of its members have withdrawn from Medicare reimbursement and bill separately outside the government system to preserve their autonomy in caring for patients.

Marc Steyn, author of America Alone, writes in the Foreword, "If you want to know what this book's about, the easiest place to start is with one brief sound bite from Ezra Levant's interrogation by the Alberta 'Human Rights' Commission. Ezra had chosen to publish the 'Danish cartoons' – the controversial representations of the Prophet Mohammed – in his magazine, The Western Standard, and as a result had found himself summoned before Shirley McGovern, a 'human rights agent' for the Government of Alberta. And, at one point in her inquisition, after listening to Ezra's musings on the outrageousness of what was happening, Agent McGovern looked blandly across the table and shrugged:

'You're entitled to your opinions, that's for sure.'

'If only. . . he were, he wouldn't be there. . . Clichés are the reflex mechanisms of speech – 'Yeah, sure, it's a free country. Everyone's entitled to his opinion, right?' . . . But in Canada you are no longer entitled to your opinion. The cliché is no longer operative. You are only entitled to your opinion if Agent McGovern and her colleagues say you are - 'for sure.' Canadians do not enjoy the right to free speech. They enjoy instead the right to government-regulated, government-licensed, government-monitored, government-approved speech - which is not the same at all. Ezra Levant was of the opinion that he should publish the Danish cartoons. That opinion brought down upon him the full force of the Government of Alberta. I (Marc Steyn) wrote an international bestseller called America Alone, a Number One book in Canada, excerpted in the country's oldest and biggest selling magazine Macleans. The opinions expressed in my book and that magazine excerpt were put on trial for a week in a Vancouver courthouse.

'This is not North Korea or Sudan . . . or Sadam's Iraq. If it were, what's going on would be easier to spot. So if, like hundreds of thousands viewers around the world, you would go to YouTube and look at the videos of Ezra Levant's interrogation, you will find not a jackbooted thug prowling a torture chamber but a dull bureaucrat asking soft-spoken questions in a boring office. Nevertheless, she is engaged in a totalitarian act.

'This is an abomination to a free society. And that's what this book is about."

A BEAUTIFUL IDEA – THAT FAILED.

The author agrees that if you had to come up with the most appealing name possible for a government bureaucracy, Human Rights Commission would be a top contender. Everyone's in favor of human rights, and if there is a commission that's working to promote them, that's a good thing, right? When they were created a generation ago, Canada's human rights commissions were inspired by a narrowly defined goal: to offer victims of true discrimination a quick, low-cost means to fight back against bigoted landlords, employers, and storeowners.

A creature of the civil rights era and its aftermath, human rights commissions (HRCs), were supposed to be equalizers to help the poor and powerless stand up to the rich and powerful. The HRCs were an informal, quasi-judicial structure that could move quickly to assist people in dire need - some kicked out of an apartment in the middle of winter because of prejudice. Unlike regular courts, victims wouldn't have to spend money hiring lawyers - the commissions themselves would investigate problems and put a government lawyer on the file for free. Trials would be relaxed - not bogged down with all the rules of regular courts that lawyers love but nobody else understands. It would be a people's court for the kind of people who used to fall through the cracks.

Who could object to that? Human rights were a beautiful idea - that failed. Canada in the 1960s was much less multicultural than now. In the 1960s, the idea that Canada could have a female prime minister, a Chinese and then a black Governor General, and openly gay cabinet ministers - and that a majority of the citizens of Canada's biggest city would be minorities - would have seemed like a vision from the twenty-second century. Women went from being anomalies at universities to making up 50 percent of Canada's law students and 60 percent of Canada's medical school enrollees. Jews flooded into once restricted country clubs. Blacks and Asians took their rightful place in Parliament and provincial legislatures.

The battle for equality just isn't as urgent any more in a country where a Sikh has been Premier of British Columbia and a woman is the chief justice of the Supreme Court. Canada's HRCs could have declared the war won, and do what happens when the battles are won: The warriors can go home and enjoy themselves.

But they didn't. By the time the battle against bigotry was being decisively won in the late 1980s and 1990s, the human rights industry spawned by Canada's HRCs had become too big to fold up and throw in the recycling bin. So new, previously unknown brands of discrimination had to be found for yesterday's anti-racists and their newly recruited colleagues.

That's where things went off the rails: these once-honourable institutions aimed at correcting historic injustices slid into farce as Levant characterizes it. The complaints now came from crackpot narcissists, angry loners, and professional grievance collectors. Their disputes had nothing to with human rights. But in the absence of legitimate human rights cases, the HRCs took on their causes - with disastrous results. The institution devoted to human rights became the biggest threat to the core liberties - most notably, freedom of speech. HRCs became a parallel legal system, competing with real courts for cases, while lacking all of their institutional expertise and procedural safeguards. Alan Borovoy, the seventy-six-year-old general counsel of the Canadian Civil Liberties Union was one of the 1960s activists who helped draft the laws that created Canada's first HRCs. He has now become disgusted by the manner in which they've been co-opted by radicals. When the Western Standard magazine was hauled before Alberta's Human Rights and Citizenship Commission for publishing Danish cartoons of the prophet Mohammed, Borovoy said, "We never imagine that [HRCs] might ultimately be used against freedom of speech."

George Jonas, now a National Post columnist, who came to Canada in the wake of the Soviet crackdown on Hungary in 1956, was one of the few skeptical voices when Canada's HRCs took to flight. Having fled communism, Jonas knew a thing or two about the natural tendency of government to encroach on every sphere of human activity - often at the expense of individual rights. . . No one listened to him. The author states now we wish we had. . . .

~~Jonas, an old debating partner of Borovoy, shot back with an I-told-you-so column in the~~ ~~Post~~ and recited some of the traditional reasons he's always opposed government intervention in this field. "Human rights laws and tribunals are based on the notion that being hired, promoted, serviced and esteemed is a human right," he wrote. "It isn't. Being hired, promoted, serviced and esteemed is a human ambition. It's a justifiable ambition, but still just an ambition . . . There are attractive ambitions and ugly rights, but the ugliest right still trumps the prettiest ambition." There is little disagreement between them now. Both men think the HRCs have gone too far. Jonas says Borovoy should have known better; Borovoy says he didn't see it coming. But today, both men want to pull the plug.

The complaints to the Alberta Human Rights and Citizenship have actually fallen 15 percent in recent years. In the private sectors, a company that experienced a 15 percent drop in customers in a growing market would either have to lay off staff or go out of business. But it's tough to put the human rights commissions out of business, since they get their money from the government no matter how obsolete their 'product' has become. Also the human rights commission takes more time than ever to achieve a result, having gone from 382 days to 410 days in what was suppose to be a speedy and informal alternative to real courts. What good is a fourteen-month delay to someone who's been kicked out of an apartment in the middle of winter? Isn't there something dishonest about a government agency that has 15 percent less work to do, takes 7 percent more time to do it, and still gets the same cheque each year from the government? The HRCs know this and so they have started a marketing campaign trying to convince Albertans to complain more about one another. There's great confusion about whether office jokes are funny, unfunny, or a violation of human rights. (Answer: If they're not funny, they're discrimination.) Why do the HRCs feel compelled to teach eager new immigrants that the Canadian way is to gripe to the government about any slight, whether real or imagined? That may describe the way of life in some of the countries the new immigrants come from, but it doesn't describe their adopted homeland.

Since Levant began his campaign against HRCs, some of his opponents have attempted to smear him as an enemy of human rights. He defends himself by pointing out that he does not oppose human rights themselves, but the hijacking of these rights by dysfunctional, self-interested government agencies that lost track of what the term means a long time ago.

WHERE DID WE GO WRONG?

The HRCs don't have formal rules and do not follow the Canadian courts' rules that have developed over centuries, stretching back to the Magna Carta, the great charter forced on the King's power. He was no longer able to seize land or people without just cause or to arbitrarily use the law to fill his coffers and impoverish his enemies. Fines and punishment should be proportionate to the offense. And it guaranteed speedy trials.

The HRCs seems so un-Canadian to Levant since they violate the most basic principles of natural justice. As soon as a human rights complaint is filed, the deck is stacked against the accused. (A study of the cases in which the Canadian Human Rights Commission investigated allegations of hate speech, for example, found that 91 percent of the government's targets were too poor to afford lawyers and appeared on their own or with representation by a non-lawyer volunteer.) In other words, it's a turkey shoot for the government, with poor, intimidated targets fighting against the unlimited resources of the state. [Not unlike abusive PEER REVIEW wherein the disenfranchised doctor is fighting the unlimited resources of the hospital-government complex - a turkey shoot for the hospital and government. Only the turkey or physician goes to the national data bank - the permanent tomb for the doctor who may have practiced medicine far superior to that of his accusers but is an economical threat to them.]

Canada's HRCs possess powers that even real police forces don't have. Police must have a search warrant approved by a judge before they can enter your place. In Newfoundland's HRC, under Section 22 of that province's human rights code, any HRC officer can "enter a building, factory, workshop or other premises or place in the province a) to inspect, audit and examine books of account, records, and documents or b) to inspect and view a work, material, machinery, an appliance or article found there." A human rights busybody only has to decide that you have something he or she wants to see - and presto, instant access. And not only that, those same laws give the HRCs the right to have whoever is occupying that building c) answer all questions concerning those matters put to them; and d) produce for inspection the books of account, records, documents, material machinery, appliance or article requested." Levant feels that amazingly, Canada has set up a human rights commission - staffed by people who have no training in police procedures or any substantive legal knowledge of criminal procedure - that has been granted powers real police don't have except in countries such as Iran. [Also in the United States, hospitals can conduct PEER REVIEW trials, without the benefit of the doctor having an attorney present and no presiding judge, to remove his privilege to practice medicine both in the hospital in question and in any other hospital in the United States.]

At the Canadian Human Rights Commission, the abuse of process goes deeper: trial transcripts reveal that the staffs of the CHRC's anti-hate squad, in their bid to entrap alleged hate-mongers, actually have become one of Canada's largest sources of hate speech. The staffs are spending their time becoming members of neo-Nazi websites and writing bigoted comments on the Internet. Their goal is to goad Canadian citizens into replying with their own hateful comments, which the human rights investigators can then prosecute as human rights abuses. Levant says that would be like a police officer setting out lines of cocaine at a party, snorting a few himself, then inviting other people to do the same - and then arresting them when they take him up on his offer. . . .

The HRC staffs have also become members of the U.S. white supremacist sites whipping up anti-black, anti-Semitic, and anti-gay sentiment and encouraging them to organize and get out and be "dangerous." Levant wonders after his investigation of the Stormfront chat group whether anyone in the group was a real neo-Nazi or whether they were all "in on the game."

In the 1980s and the 1990s, Canada's spy agency, the CSIS, planted an operative named Grant Bristow in the middle of the neo-Nazi movement to keep an eye on the violent members. But he didn't act passively as CSIS eyes and ears; he actively helped build the Heritage Front into Canada's largest neo-Nazi group. Bristow - and CSIS - created the biggest racist gang in the country, a project that only ended when Bristow's double identity was about to be discovered. Even in Canada your tax dollars are at work against you.

Levant points out that every generation witnesses some variation on this game: a government agency helps to build up isolated hate-mongers into national menaces and then points to its own handiwork as proof that more government power and tax money is necessary to save us. . . .

The CHRC frequently tries to set up secret trials and exclude the defendant from the trial knowing they can't allow public scrutiny. Levant points out that even Stalin's show trials allowed their political criminals to be in the room when they were being set up.

~~When the hearing for the mighty~~ ~~Maclean~~s ~~magazine was pricked into action, they were able to have an open hearing despite the fierce objections of the HRCs and the parade of witnesses described as a~~ ~~tour de force.~~ ~~To read how three decades of abuse begins to unravel is worth the price of the book alone.~~

There is an old legal maxim that says justice must not only be done; it must be seen to be done. Canada's HRCs have set Canada back in regard to both objectives. Their lawless practices have not only undermined centuries-old principles of due process and natural justice, they have eroded public confidence in the rule of law. They have brought the administration of justice into disrepute, and have turned legitimate police forces into political tools. And amazingly they have done so without most Canadians noticing. Canadians are beginning to wake up.

WILL THE UNITED STATES WAKE UP IN TIME?

There are dozens of other stories of cases that are very interesting and insightful and involve notables. This is an important volume on the lessons to be learned when the government goes too far in an attempt to correct wrongs. We are seeing this in our country at the moment as numerous freedoms are being challenged. We are hearing the same stories about human right to health care that haven't changed materially in 50 years or since the late 1950s. Since that time, the U.S. has provided all the aged from 65-years-old up with unlimited health care known as Medicare. We have also provided poor people with unlimited health care known as Medicaid. In some states, this doesn't just cover the poorest 12-15 percent of the population, the standard definition of poor, but sometimes the lowest 30 percent. Sometimes it even includes people making several times the artificial poverty line. We have also covered the disabled in our country with Medicare Disability for those permanently disabled at any age, from birth to death. We have covered our retired and disable veterans with health care benefits. Thus we have a triple net through which very few can fall.

Many Americans are holding Canada up as the ideal country to emulate in total health care. But on taking a closer look at Canada's 33 million compared to the US 305 million, Canada has more uncovered citizens by percentages and by absolute numbers. Canada has 20 percent of its population on a waiting list, many who will never obtain health care. The Canadian SupremeCourt Decision 2005 SCC 35, [2005] 1 S.C.R. 791 ruled that Canadians DO NOT have UNIVERSAL access to health care coverage, they only have universal access to a waiting list. Some on that list will never obtain health care in their life time.

How does the United States stack up to their 20 percent without access, or about six million Canadians? Eliminate the 14 million or so that are qualified for coverage and will be covered should they ever end up in a hospital that is very skillful in helping people get coverage they already have but never applied for. It has also been shown that many already have Medicaid coverage but told the census bureau that they don't because they do not associate Medicaid with insurance coverage. Eliminate the 19 million college students and new graduates through age 34 who are young and healthy and temporarily have other priorities and are able to pay for routine health care. Eliminate the 18 million uninsured that make more than $50,000 a year but choose not to purchase insurance when many that make $25,000 do purchase a policy that will cover them should they require the high end of care such as expensive hospitalization, and pay for routine care as it comes up. This type of insurance can be purchased for a hundred or two a month. Eliminate the six millions illegal aliens in our country that are frequently added to the exorbitant numbers the radicals keep mentioning. We would find it difficult to confirm that even five million, or less than two percent out of three hundred five million, have a valid problem.

Recently some of our local health and state health directors have taken to the media the problems they have with lack of coverage. Many of those that they highlight as having no coverage had state insurance but were eliminated from these government programs because of fiscal reasons. With the current proposals, we will have huge fiscal problems that could even limit Medicare coverage. Why try to close one government fiscal problem with another more enormous government fiscal problem?

Why would we want to trade our essentially complete access to care for incomplete access to care that every socialized country is experiencing? Many in those countries will never get care. Every American has access to care.

There is no health care emergency problem in the United States. There is just a political problem in denying individual freedoms by taking away our most personal and confidential freedom and making it an open public problem. In government health care, every disease, mental illness, and personal habit can be reviewed to see if it is covered or even necessary. There will be little confidentiality in a government run health care system.

Levant has made us aware of how our rights can easily be usurped by government encroachment, which is the modus operandi of all governments since the beginning of time. To say our government is different is naiveté. All governments are power hungry and want to have control over their subjects as Levant has so ably illustrated. If we end up with a Bismarck health care scheme, we cannot later say, "We didn't see it coming," like the Canadians said when their 'Human Rights' Commission nearly destroyed Freedom of the Press and individual freedom. Our present government is running amok with programs that will limit our freedoms and that will prove disastrous for our patients and our society. Let us heed the warning of Levant before it's too late.

Del Meyer, MD
~~DelMeyer@MedicalTuesday.net~~
~~www.MedicalTuesday.net~~
~~www.HealthPlanUSA.net~~
~~www.DelMeyer.net~~

This book review is found at www.healthcarecom.net/bkrev_MedicalPolitics.htm.

To read more book reviews, go to www.delmeyer.net/PhysicianPatientBookshelf.htm.

To read book reviews topically, go to www.healthcarecom.net/bookrevs.htm.

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10. Hippocrates & His Kin: Financial incentives to doctors is an insult to their integrity

It's been interesting to note how the states react to the expected downturn with the politicians spending projection as if this couldn't occur. Washington: 7,000 jobs eliminated; California: 27,000 teachers laid off; Drivers can no longer register their cars in person; Arizona: 1,000 workers laid off; furloughs of 1-2 days a month; Wisconsin: No birth certificate copies available; Michigan: 38,000 employees facing furloughs; most of state shooting ranges and visitor centers will be closed; Maine: Families cannot apply for food stamps or Medicaid; Maryland: The Highway Administration will be operating half the usual number of traffic patrols; Georgia: 25,000 Employees facing furloughs; Lawyers can't file papers with the State Court of Appeals.

Looks like a couple of states are getting it right - reducing welfare and lawsuit appeals.

The president also said there should be financial incentives to "allow doctors to do the right thing."

This is a total insult to any physician. We are not attorneys working for incentives, fee splitting or contingencies. Integrity is every doctor's middle name and doesn't depend on a bribe from Obama.

Out of touch at the top.

Karl Rove: So our top commander in Afghanistan, Gen. Stanley McChrystal, has told CBS's "60 Minutes" that he has spoken with President Barack Obama only once since June.

This is a troubling revelation. Right now, our commander in chief is preparing to make one of the most important decisions of his presidency - whether to commit additional troops to win the war in Afghanistan. Being detached or incurious about what our commanders are experiencing makes it hard to craft a winning strategy.

HHK: Equally troubling is that the president is making a most important decision that will affect the lives and health of 300 million Americans and he remains so uninformed about health matters. He thinks that Pediatricians perform surgical appendectomies and has the silly notion that he can tell doctors whether to prescribe the yellow, blue or red pill, whichever is cheapest. Will he ruin the health care of 300 million Americans to cover the one or two percent that fall through the safety net?

How sad that the ignorant and uninformed can lead the lambs to slaughter.

For aging Country Singers, 70s is the new 30s

These are fine times for old-timers. To an unprecedented extent, the heroes of country music's past are present and creatively accounted for. Seventy is the new 30 and the septuagenarian set is doing more than rehashing past hits or showing up on weekends for a couple of songs on the Opry. "Kris hasn't lost one iota of his brilliance." Said Bare, 74, speaking of his 73-year-old friend Kristofferson. "People like us don't think of retiring. Why do people retire? So they can travel? Kris and I have already seen all these places." Author, historian and Music Row magazine columnist Robert Oermann noted that the country music genre has always included stars who performed into their 70s and 80s, but he said this current crop of 70-somethings represents something different. It's not just that they're actively working, it's that they're being hyper-creative. . . Bill Anderson is writing songs that are as good or better than anything he ever did." Garth Brooks announced the end of his retirement. . . Some are not just maintaining their achievement; they are extending it. –Peter Cooper, The Tennessean, Nashville

Another argument that President Clinton made a huge economic blunder when he extended Social Security benefits from age 72 for people still making twice the SS benefits to age 65. Since people live 15 to 20 years longer now than when SS was started in 1930s, the retirement aged should have been indexed to life expectancy. In the 1930s, when life expectancy was 62, benefits were primarily for widows who lived beyond age 65 and allowed them a decent old age when their husbands neglected to provide retirement benefits for them. Now when life expectancy is 78, SS benefits should have gradually been indexed to age 75 and SS would have remained on a sound financial basis.

Winners of the 2009 Ig Nobel Awards

The Associated Press Published: Thursday, Oct. 1, 2009

The 2009 Ig Nobel winners, awarded Thursday at Harvard University by the Annals of Improbable Research magazine:

VETERINARY MEDICINE: Catherine Douglas and Peter Rowlinson for showing that cows with names give more milk than unnamed cows.

PEACE: Stephan Bolliger, Steffen Ross, Lars Oesterhelweg, Michael Thali and Beat Kneubuehl for investigating whether it is better to be struck over the head with a full beer bottle or with an empty beer bottle.

ECONOMICS: Executives of four Icelandic banks for showing how tiny banks can become huge banks, and then become tiny banks again.

CHEMISTRY: Javier Morales, Miguel Apatiga and Victor Castano for creating diamonds out of tequila.

MEDICINE: Donald Unger for cracking just the knuckles on his left hand for 60 years to see if knuckle cracking contributes to arthritis.

PHYSICS: Katherine Whitcome, Liza Shapiro and Daniel Lieberman for figuring out why pregnant women don't tip over.

LITERATURE: The Irish national police for issuing 50 tickets to one Prawo Jazdy, which in Polish means "driver's license."

PUBLIC HEALTH: Elena Bodnar, Raphael Lee and Sandra Marijan for inventing a brassiere than can be converted into a pair of gas masks.

MATHEMATICS: Gideon Gono and the Zimbabwean Reserve Bank for printing bank notes in denominations from 1 cent, to $100 trillion.

BIOLOGY: Fumiaki Taguchi, Song Guofu and Zhang Guanglei for demonstrating that bacteria in panda poop can help reduce kitchen waste by 90 percent.

www.sacbee.com/827/story/2224796.html

Obama, the Future-Friendly President, Wins Nobel Peace Prize

BY Kit Eaton Fri Oct 9, 2009

This morning the World had a bit of a surprise: The Nobel Prize Committee announced its choice for the Peace Prize as President Barack Obama (the subject of Fast Company's April 2008 cover story, "The Brand Called Obama"). Few people had suspected this would happen, and only a few rumors swirled beforehand.

Obama's only been in office for nine months, which is partly why this is such a shock. With some slips in his public approval numbers, what can he possibly have done to justify the award? According to the Prize committee it's for his "extraordinary efforts to strengthen international diplomacy and cooperation between peoples." Check out Reuter's video of the announcement:

To allay suspicions that Obama landed the prize for what he may do in the future, versus what he's already done, the chair of the Norwegian Nobel Committee, Thorbjorn Jagland, spoke to the press and said the committee hoped the prize would "enhance what he is trying to do" but that it was definitely awarded for what Obama's already achieved.

Those list of achievements include efforts to reinvigorate the Israeli-Palestine peace talks, talks at the UN Security Council to boost nuclear disarmament, and an openly-broadcast opinion that the future of the World should be nuclear weapon-free. He's also credited by the Nobel Committee with creating a "new climate in international politics."

Lofty stuff for fresh-in-office President, and one that had already promised a science-friendly and future-focused time in office. But it's also a move with attached controversy: American forces are still in action in Afghanistan and Iraq, the President recently cancelled Europe's planned Star Wars defense system, and there're difficult diplomatic wobblings being caused by Iran's missile tests and nuclear aspirations. Worse, the liberal world scratched its head recently when Obama himself apparently shunned a meeting with former Peace Prize recipient the Dalai Lama to appease China. . .

While the Internet's exploded with the news, and commentaries and debates are popping up online and in social nets like Twitter, so far the White House hasn't commented. But one thing's pretty clear: If Obama doesn't promise to donate the upcoming $1.4 million prize to charity pretty damn fast, it'll definitely hurt his public image.

www.fastcompany.com/blog/kit-eaton/technomix/obama-future-friendly-president-wins-nobel-peace-prize?partner=homepage_newsletter

Barack Obama's peace prize starts a fight

Gasps echoed through the Nobel Hall in Oslo yesterday as Barack Obama was unveiled as the winner of the 2009 Peace Prize, sparking a global outpouring of incredulity and praise in unequal measure.

Mr Obama was sound asleep in the White House when the Norwegian Nobel Committee made the shock announcement. It said that he was being honoured for his "extraordinary efforts to strengthen international diplomacy and co-operation between peoples".

In a clear swipe at his predecessor, George W. Bush, the committee praised the "change in the international climate" that the President had brought, along with his cherished goal of ridding the world of nuclear weapons.

"Only very rarely has a person to the same extent as Obama captured the world's attention and given its people hope for a better future," it added.

International reaction ranged from delight to disbelief. The former winners Kofi Annan and Desmond Tutu voiced praise, the latter lauding the Nobel Committee's "surprising but imaginative choice".

But Lech Walesa, the dissident turned Polish President, who won the Peace Prize in 1983, spoke for many, declaring: "So soon? Too early. He has no contribution so far." . . .

Mr Obama's domestic critics leapt on the award as evidence of foreigners fawning over an untested "celebrity" leader. Rush Limbaugh, the US right-wing commentator, said: "This fully exposes the illusion that is Barack Obama."

Speaking later, Mr Obama said that he was "surprised and deeply humbled" by the unexpected decision and announced that he would donate the £880,000 prize, due to be awarded in December, to charity.

"Let me be clear. I do not view it as recognition of my own accomplishments but rather as an affirmation of American leadership on behalf of aspirations held by people in all nations," he said.

The Nobel Peace Prize is a notoriously difficult award to predict, but yesterday's decision was clearly a political choice, with three of the past six peace awards going to Bush adversaries.

In 2002 the prize went to Jimmy Carter as an explicit rejection of the Bush presidency in the build-up to the Iraq war. In 2005 Mohamed ElBaradei, the UN atomic agency chief who had clashed with Washington over the search for weapons of mass destruction in Iraq, was honoured. In 2007 Al Gore received the prize for his warnings on climate change, denounced by President Bush as a liberal myth.

The award is also an example of what Nobel scholars call the growing aspirational trend of Nobel committees over the past three decades, by which awards are given not for what has been achieved but in support of the cause being fought for. . .

Thorbjørn Jagland, the committee chairman, made clear that this year's prize fell in that category. "If you look at the history of the Peace Prize, we have on many occasions given it to try to enhance what many personalities were trying to do," he said. "It could be too late to respond three years from now."

~~But Bobby Muller, who won the Nobel Prize as co-founder of the International Campaign to Ban Landmines, told~~ ~~The Times~~: "I don't have the highest regard for the thinking or process of the Nobel committee. Maybe Norway should give it to Sweden so they can more properly handle the Peace Prize along with all the other Nobel prizes."

www.timesonline.co.uk/tol/news/world/us_and_americas/article6868905.ece

To read more HHK . . .

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Feedback . . .

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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 . . .

• Saul William Seidman, MD, is a retired board-certified neurological surgeon. He did his residency at Yale and Hartford Hospital. He is a lifetime member to the America College of Surgeons and The American Association of Neurological Surgeons. He taught at Yale and University of California San Francisco. He maintained a private practice for 25 years at El Camino Hospital in Mt. View, CA. He has written two books and a column on the current health care issues. To review or order his books . . . To read his column, go to www.examiner.com/x-24508-San-Jose-Health-Care-Examiner. We have two choices. We can follow the delusion of "universal health care" or we can accept a market approach to health care. Putting patients in charge of their medical care is a market approach. It guarantees competence, at least. Universal health care is sickness care administered by politicians, bureaucrats, CEOs and other proven incompetents. None of these "medicrats" knows how medicine is practiced. All these administrators are driven by politics and economics. Excellence is destroyed in the initial stages of what is called "single payer" health care. The destruction of competence follows the destruction of excellence. Medicine was practiced. Medicine was a lifelong learning experience. Medicine was integrated. That was only yesterday. The present bureaucratized, fragmented and disintegrated program called "medical care" bears little resemblance to the practice of medicine. Today's medical care is dysfunctional. Inevitable Incompetence will detail the growing danger and outrageous expenses in medical care... 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," "single payer," 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.

• 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.

• Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.

• 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.

• ReflectiveMedical Information Systems (RMIS), delivering information that empowers patients, is a new venture by Dr. Gibson, one of our regular contributors, and his research group, who will go far in making health care costs transparent. This site provides access to information related to medical costs as an informational and educational service to users of the website. This site contains general information regarding the historical, estimated and actual Medicare range of amounts paid to providers and billed by providers to treat the procedures listed. These amounts were calculated based on actual claims paid. These amounts are not estimates of costs that may be incurred in the future. Although national or regional representations and estimates may be displayed, data from certain areas may not be included. You may want to follow this development at www.ReflectiveMedical.com. During your visit, you may wish to enroll your own data to attract patients to your practice. This is truly innovative and has been needed for a long time. Congratulations to Dr. Gibson and staff for being at the cutting edge of healthcare reform with transparency.

• 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. Be sure to enjoy How Many Bureaucrats Does It Take to Treat a Patient?

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Del Meyer

Del Meyer, MD, Editor & Founder

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Words of Wisdom

Coming together is a beginning. Keeping together is progress. Working together is success. -Henry Ford

Continuity gives us roots; change gives us branches, letting us stretch and grow and reach new heights. -Pauline R Kezer

Government is the great fiction, through which everybody endeavors to live at the expense of everybody else. -Frederic Bastiat, French Economist (1801-1850)

Some Recent Postings

AMERICA ALONE, The End of the World as we Know It, by Mark Steyn

HEALTH CARE CO-OPS IN UGANDA - Effectively Launching Micro Health Groups in African Villages, by George C. Halvorson

A CALL TO ACTION - Taking Back Healthcare for Future Generations by Hank McKinnell

PUTTING OUR HOUSE IN ORDER - A Guide to Social Security & Health Care Reform by George P. Shultz and John B Shoven

In Memoriam

Reinhard Mohn, German media magnate, died on October 3rd, aged 88

The Economist print edition Oct 15th 2009

CAPITALISM red in tooth and claw never seemed to appeal to Reinhard Mohn. Asked to write an essay entitled "My Thoughts on Choosing a Profession", the 16-year-old schoolboy dwelt on his obligations to society, his natural abilities and the desire for a useful life. These concerns, he said, were to stay with him throughout his career. Indeed "co-operation and compassionate leadership" were the key to his success. And success he surely found. Not long before he died, his family-owned company, Bertelsmann, was the world's sixth-biggest media group, with over 100,000 employees in 50-odd countries.

Bertelsmann had been founded in 1835, as a publisher and printer of religious books. It was, and still is, based in Gütersloh, a dozy town in eastern Westphalia, where Mr Mohn's great-great-grandfather, Carl Bertelsmann, was a Protestant lithographer. The firm prospered until the great Weimar inflation cut its workforce from 84 to six in 1921-23. But it bounced back, and was employing 440 people in 1939. Then it did even better, producing quantities of Nazi novels and propaganda. When Mr Mohn came home from the war, though, the buildings had been bombed, so the young would-be engineer persuaded by his father to join the family firm was hardly taking on a thriving business.

Reluctant he may have been, but he had already learned some useful lessons. One, he would claim, was the value of trust. This he came to appreciate as an officer in the Afrika Korps, lying wounded on a hillside in Tunisia. The American soldier who found him helped him down the mountain, instead of suspecting an attempt to escape and shooting him dead. Perhaps this example of humanity was later responsible for Mr Mohn's readiness to give his managers their head (so long as their units were profitable) and his workers a share in the company's profits (though not voting shares). Perhaps not. But never in his day did Bertelsmann have a strike.

A useful captivity

Less open to doubt was the value of being a prisoner-of-war in America. There Mr Mohn learnt English and, more surprising, something of American business practices. In particular, he came to see obstacles as inspirations for opportunities. Thus, if post-war Germans would not go to bookshops to buy relatively expensive books, he would set up a club whose members would receive discounted ones, so long as they agreed to pay for a regular supply - which they did, in their hundreds of thousands. Similarly, when Bertelsmann had bought so many German companies that the anti-competition authorities were calling a halt, he stepped up expansion abroad. In America he bought record labels like Arista and RCA Victor, and publishers like Bantam, Doubleday and, eventually, Random House; in Europe, he acquired 90% of RTL Group, a huge radio and television company. Even the Bertelsmann profit-sharing scheme was partly a response to the scarcity of capital, since some payments were deferred until workers retired, so profits were booked as liabilities, with tax benefits for the company. . .

In 1977 Mr Mohn set up a non-profit foundation, which now holds 76.9% of Bertelsmann's shares, though the voting rights lie with another company, half of whose directors are members of the family. Ultimate control, however, has for some time rested with Liz, Mr Mohn's second wife, whom he met at a company party when she was a 17-year-old switchboard operator. They married 24 years later.

She is seen as a stout defender of the family's interests, seeing off those who might have taken the company public and insisting, in 2006, on buying back a 25% holding sold five years earlier. The borrowing then undertaken to pay the bill of €4.5 billion ($5.7 billion), coupled with falling CD sales and waning book-club revenues, has narrowed Bertelsmann's prospects.

In his heyday, Mr Mohn might have seen all this as another opportunity. A quiet man, he liked to take an hour's walk in the woods around Gütersloh each day during which he pondered his next move. What that would be now, in the face of Bertelsmann's straitened finances, the elusiveness of internet revenues and changes in publishing and advertising, is uncertain.

His avowed belief was to put social responsibility before the amassing of great wealth. As a dictum, it served him well, but it hardly amounts to a business model. In truth, he ran his companies with enterprise, ingenuity and a large dose of red-blooded capitalism. Without more of those, Bertelsmann is unlikely to survive as the media giant he made it. But then he also said he did not want to found a thousand-year Reich. That wish, at least, may well be granted.

On This Date in History - October 27

On this date in 1938, DuPont announced the invention of nylon changing the fabric of life. DuPont Chemical Company with research teams in New York and London led by Dr. Wallace Carothers named their new fabric after the International Cities in which they were based.

On this date in 1975, Menachim Begin and Anwar al-Sadat won the Nobel Peace Prize.

After Leonard and Thelma Spinrad

The 7th Annual World Health Care Congress

Advancing solutions for business and health care CEOs to implement new models for health care affordability, coverage and quality.

The 7^th Annual World Health Care Congress will be held April 12-14, 2010
Washington, DC
www.worldhealthcarecongress.com
Toll Free: 800-767-9499

The Annual World Health Care Congress is the most prestigious meeting of chief and senior executives from all sectors of health care. The 2010 conference will convene 2,000 CEOs, senior executives and government officials from the nation's largest employers, hospitals, health systems, health plans, pharmaceutical and biotech companies, and leading government agencies.