MEDICAL TUESDAY

MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol VII, No 14, Oct 28, 2008

In This Issue:

1. Featured Article: Subsidizing Sickness

2. In the News: The cost of increasing the 16,000 (ICD-9) codes to 155,000 (ICD-10) codes.

3. International Medicine: Failure of Single-Payer Health Care in Canada Is a Lesson for Americans

4. Medicare: Medicare Is Bad for Your Health

5. Medical Gluttony: Lower Wages Will Pay for Obama's Health Care Plan

6. Medical Myths: The Genius to call "Welfare" a "Tax Cut."

7. Overheard in the Medical Staff Lounge: Massachusetts Cancels Medicaid Payments

8. Voices of Medicine: Dr. Lou Vismara Transformed His Life

9. The Physician Patient Bookshelf: Ronald Reagan, Margaret Thatcher and John Paul II

10. Hippocrates & His Kin: Massachusetts Defaults, Who's Next

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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: Subsidizing Sickness by Llewellyn H. Rockwell, Jr.

This speech was delivered before the annual convention of the Association of American Physicians and Surgeons, St. Louis, Missouri, October 26, 2000.
[It is just as relevant to the 2008 election as the 2000 election].

Throughout the 19^th century, socialist ideology gained ground among intellectuals attempting to revive ancient dreams of a total state that managed every aspect of people's lives. The critics, too, weighed in to explain that socialism has ethical and practical limitations. If you abolish private property, which socialism proposes to do, you abolish economic exchange, which is a source of social peace. In addition, you eliminate the profit motive, which is a major factor in spurring people to work and produce.

The major limitations to this dominant mode of criticism is that it was narrowly focused against the idea of completely eliminating private property. In addition, the 19^th century economic criticisms of socialism did not get to the heart of the matter, which is that any attempt to curb the workings of economic exchange forces resources into uneconomic uses. An economy is defined as a system in which human energies and resources are employed toward their most productive purposes. Not only socialism, but all interventions in the free market redirect resources in ways that are counterproductive – away from the voluntary sector of society and into the state sector.

The history of socialist theory is bound up with policies toward the medical marketplace. To control people's access to medical care is to control their very lives, so it is no wonder that this is the goal of every state. In the course of a century we have taken a long march from a largely free system of medical provision to one dominated by unfree programs and mandates.

. . . Privatization of medical provision isn't on the radar screen of the world's politicians, even after manifest failures. Even after the collapse of all-out collectivism in the Soviet Union and Eastern Europe, there has been precious little movement towards reform in the medical sector.

We are a long way from clear thinking on the subject of medical care and the realization that the provision of medical services of every kind is best left to the forces of the market economy and the charitable sector than placed in the hands of the regulating, taxing, intruding state.

Ludwig von Mises was socialism's greatest critic, having written the decisive attack in 1922. His book is usually credited for proving why Soviet-style socialism could never work. But less known is the fact that he attacked the entire panoply of what he called "destructionist" policies, which included the medical policies of the social welfare states in the German-speaking world at the time. Mises has a way of getting to the heart of the matter, so his comments on socialized health insurance apply to our own situation. Reviewers at the time noted his opposition and decried them as the ravings of an extreme classical liberal. If so, I am happy to rave myself.

Allow me to quote his remarks in full:

"To the intellectual champions of social insurance, and to the politicians and statesmen who enacted it, illness and health appeared as two conditions of the human body sharply separated from each other and always recognizable without difficulty or doubt. Any doctor could diagnose the characteristics of 'health.' 'Illness' was a bodily phenomenon which showed itself independently of human will, and was not susceptible to influence by will. There were people who for some reason or other simulated illness, but a doctor could expose the pretense. Only the healthy person was fully efficient. The efficiency of the sick person was lowered according to the gravity and nature of his illness, and the doctor was able, by means of objectively ascertainable physiological tests, to indicate the degree of the reduction of efficiency.

"Now every statement in this theory is false. There is no clearly defined frontier between health and illness. Being ill is not a phenomenon independent of conscious will and of psychic forces working in the subconscious. A man's efficiency is not merely the result of his physical condition; it depends largely on his mind and will. Thus the whole idea of being able to separate, by medical examination, the unfit from the fit and from the malingerers, and those able to work from those unable to work, proves to be untenable. Those who believed that accident and medical insurance could be based on completely effective means of ascertaining illnesses and injuries and their consequences were very much mistaken. The destructionist aspect of accident and health insurance lies above all in the fact that such institutions promote accidents and illness, hinder recovery, and very often create, or at any rate intensify and lengthen, the functional disorders which follow illness or accident.

"Feeling healthy is quite different from being healthy in the medical sense, and a man's ability to work is largely independent of the physiologically ascertainable and measurable performances of his individual organs. The man who does not want to be healthy is not merely a malingerer. He is a sick person. If the will to be well and efficient is weakened, illness and inability to work is caused. By weakening or completely destroying the will to be well and able to work, social insurance creates illness and inability to work; it produces the habit of complaining – which is in itself a neurosis – and neuroses of other kinds. In short, it is an institution which tends to encourage disease, not to say accidents, and to intensify considerably the physical and psychic results of accidents and illnesses. As a social institution it makes a people sick bodily and mentally or at least helps to multiply, lengthen, and intensify disease."

Thus spake Mises. He is observing that there is a moral hazard associated with socialized and subsidized medicine. Because there is no clear line between sickness and health, and where you stand on the continuum is bound up with individual choice, the more medical services are provided by the state as a part of welfare, the more the programs reinforce the conditions that bring about the need to make use of them. This one insight helps explain how socialized medicine takes away the incentive to be healthy, and maximizes the problem of overutilization of resources. Hence, socialized medicine must fail for the same reasons all socialism must fail: it offers no system for rationally allocating resources, and instead promotes overutilization of all resources, ending in bankruptcy.

And now consider the presidential campaign of the year 2000. The most medically dependent group in the country are seniors, who also happen to be, at once, the most government-addicted and financially well-off members of society. Their medical care is largely paid through public dollars. And yet this group is nearly united in the claim that it is not enough. They demand that their drugs be free or at least be as cheap as fruits and vegetables at the grocery store. And the candidates respond not by pointing out the unreality and illegitimacy of their demands, but by competing to see who can provide free drugs more quickly through one or another central plan.

Can anyone doubt that Mises was right, that socialized medicine has led to a sickly frame of mind that has swept and now dominates the culture? The habit of complaining is endemic to this sector of society. Never have so many rich people who have been given so much by government demanded so much more. And the politicians are not pilloried for pandering to them but rewarded to the degree that they can dream up central plans that accommodate the complaining class through ever more freebies.

And when does it stop? When the coffers run dry. Until then, the subsidies work to distort the market and distort people's sense of themselves. And no one has pointed out during this presidential campaign what this program would mean for drug manufacturers. It would essentially nationalize them by mandating that they work first for the government that is subsidizing drug purchases and only second for the consumer. But this is the path that all steps toward socialized medicine take: instead of physicians and patients engaging in cooperative exchange, we get government standing between them and dictating medical care.

Now, it is sometimes said that medical care is too important to be left to the market, and that it is immoral to profit from the illnesses of others. I say medical care is too important to be left to the failed central plans of the political class. And as for profiting from providing medical care, we can never be reminded enough that in a free society, a profit is a signal that valuable services are being rendered to people on a voluntary basis. Profits are merely a by-product of a system of private property and freedom of exchange, two conditions which are the foundation of an innovative and responsive medical sector.

In the recent century, however, these institutions have been attacked and subverted at every level. In the medical-care market, the process began in the late 19^th century with the policies of Germany's Otto von Bismarck, who sought a third way between the old liberalism and communism. As the originator of national socialism designed to foil international socialism, he claimed credit for being the first to establish a national health care system – thus adopting the very socialism he claimed to be combating.

Politicians ever since have followed this lead, continuing with Emperor Francis Joseph of Austria-Hungary, William II of Germany, Nicholas II of Russia, Lenin, Stalin, Salazar of Portugal, Mussolini of Italy, Franco in Spain, Yoshihito and Hirohito of Japan, Joseph Vargas of Brazil, Juan Peron of Argentina, Hitler, and FDR. What a list! As individuals, most have been discredited and decried as dictators. But their medical care policies are still seen as the very soul of compassionate public policy, to be expanded and mandated, world without end.

In each case, the national leader advertised the importance of centralized medical welfare for the health of the nation. But what was always more important was the fact that such policies reward the politicians and parties in power with additional control over the people, while dragging the medical profession – an important and independent sector that is potentially a great bulwark against state power – into a government system of command and control.

Before coming to power, Hitler's party, for example, made statements condemning socialized medicine and compulsory social insurance as a conspiracy to soften German manhood. But once in power, they saw the advantages of the very programs they condemned. As Melchoir Palyi argued, Hitler saw that the system was actually a great means of political demagoguery, a bastion of bureaucratic power, an instrument of regimentation, and a reservoir from which to draw jobs for political favorites. By 1939, Hitler had extended the system of compulsory insurance to small business and tightened the system in Austria. One of his last acts in 1945 was to include workers from irregular types of employment in the system, socializing medical care even in his last days.

After the war, the Social Democratic Party charged with de-Nazification immediately expanded his system to further centralize the medical sector. On the medical care front, Hitler may yet achieve his 1,000-year Reich. . .

What is called health insurance in the US consists of two types: one provided by employers in which the insurer is not permitted to discriminate too severely in light of individual risks. The other is not insurance at all but a straight-out welfare payment mandated by the state: this is Medicare, Medicaid, and the huge range of programs delivering aid to individuals. None has much to do with a free-market provision of medical services.

As a result, the consumer has fewer rights than ever. Physicians are caught up in an awful web of regulations and mandates. Business is saddled with huge burdens that have nothing to do with satisfying consumer demands. And innovation is limited by an array of penalties, subsidies, and regulations. The failures of the present system create constant pressure for ever more legislation that further socializes the system, which produces more failure and so on and so on.

For the most part in the US, the long march toward medical socialism has taken the path of least political resistance. Public outrage at the Hillary Clinton health-plan of 1993 was a beautiful thing to behold, and with the help of the Association of American Physicians and Surgeons (AAPS), this outrage forced the administration to back down. But in the meantime, the regulatory state has taken steps toward imposing some of the mandates Hillary favored.

In some ways, the Republicans are as bad as the Democrats. For instance, throughout the 1990s the GOP has backed legislation that can best be described as Hillary-lite, complete with restrictions on the ability of insurers to discriminate, premium caps on some groups, penalties for noncompliance, mandatory portability, and on and on. As bad as the legislation passed in the 1990s has been, we can be thankful that gridlock prevented a comprehensive plan from passing. . .

Abraham Flexner was hired by the Rockefeller-allied Carnegie Foundation so that the report would not be seen as a Rockefeller initiative. AMA-dominated state medical boards ruled that in order to practice medicine, a doctor had to graduate from an approved school. Post-Flexner, a school could not be approved if it taught alternative therapies, didn't restrict the number of students, or made profits based on student fees.

The Flexner Report was more than an attack on free competition funded by special interests. It was also a fraud. For example, Flexner claimed to have thoroughly investigated 69 schools in 90 days, and he sent prepublication copies of his report to the favored schools for their revisions. So we can see that using lies to advance political goals long predated the Gore campaign. . .

The rest of the story wrote itself. A cartelized profession is one that is easier to control and nationalize. Thus the New Deal brought us massive national subsidies. The Great Society brought us the disastrous welfare systems of Medicare and Medicaid. There were also the HMO subsidies from the Nixon administration's monstrous Health Care Financing Administration. The employer-mandates that make life so difficult for small business and led to the creation of more HMOs resulted from the lobbying of large corporations wanting to impose higher costs on their competitors, and labor unions attempting to cartelize the labor force and keep out low-price labor services.

And today, both major parties say all this apparatus is wonderful and should be protected and expanded until the end of time. It is true that there are some wonderful efforts afoot to resist further socialization of medical care. But there are no active political movements alive that are making any progress toward a fully free market in medicine, toward a full de-Nazification, a complete de-Sovietization, and a total de-AMAization. . .

We need to reject the principles that drive socialized medicine. These include the ideas of equality and universal service as mandated by the state, as well as the view that it is the responsibility of business and not that of the individual to pay the costs of medical care. Above all, we need to get beyond this idea that medical care is a right. It is not. It is service like any other.

What about those who cannot afford much needed services? During the campaign, George W. had finished his speech and a hand shot up from a young lady who proceeded to complain that she could not afford a special device that would permit her to overcome her visual disability. Still relatively new to the campaign trail, Bush asked her how much the device would cost. She responded that it would cost about $400. W. then asked for someone in the audience to help this girl with the expenses, and in a few minutes, there was enough money pledged to make it possible for the girl to purchase the device.

The national press hooted and howled at the incident. They claimed that he missed the point, which was not to provide for the girl's particular need but rather to develop a national plan using the girl as a political prop. Actually, I liked Bush's idea better. He was suggesting that the girl had no natural right to the device. He believed it ought to be provided in the way all such luxuries are provided in a free market – through purchase or charity.

The Future

Judging from his more recent behavior, I don't believe we are justified in being optimistic about his plans for medical care. Neither do I believe that there is much hope in reforms that pretend to use market principles to better distribute medical care in the present system. Realistically, the best we can hope for is legislative gridlock, based on the principle that, first, do no more harm. To live by this principle means that you must ignore the partisan slogans that dominate the rhetoric of any proposed reform. Instead, you must live by this rule: carefully read any legislation before you offer your support.

Quite often some reforms sound great in principle – and I'm thinking here of gimmicks like educational vouchers and social security privatization – but once you look at the details, you find that the legislation would make the present system even worse. This was the case with the Republican health bill of the mid 1990s, which the AAPS fought so valiantly. I have no doubt the same is true of various proposals for Medical Savings Accounts. The power elite love nothing better than to turn a good reform idea into a cover for an increase in state power. Keep a watchful eye, and never believe the rhetoric until you see the bill itself.

So, yes, I am pessimistic about the legislative process. However, in the long term, I am cautiously optimistic about our overall situation. The exploding power of the market economy, and its ability to outrun and outperform the planners, is as evident in medical care as in every other industry. We've already begun to see the way in which the web has presented serious challenges to conventional forms of medical-care delivery.

The future will offer other opportunities. And we should seize each one, on the principle that all forms of welfare and state regulation deserve to be tossed in the dustbin of history along with the ideological system that gave them birth.

Read the entire report at www.lewrockwell.com/rockwell/sickness.html.

Llewellyn H. Rockwell, Jr. [send him mail] is president of the Ludwig von Mises Institute in Auburn, Alabama, editor of LewRockwell.com and author of Speaking of Liberty.

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2. In the News: No one has adequately explained to us why they are planning to increase codes from 16,000 (ICD-9) to 155,000 (ICD-10).

ICD-10-CM Fact Sheet Developed by Coalition Industry News, October 9th, 2008

New ICD-10 study confirms CMS (Center for Medicare and Medicaid Services) underestimates costs and time required to implement complex new code set

The American Academy of Dermatology, American Academy of Professional Coders, American Association of Neurological Surgeons, American Association of Orthopaedic Surgeons, American Clinical Laboratory Association, American College of Physicians, American Medical Association, American Optometric Association, American Physical Therapy Association, American Society of Anesthesiology, and the Medical Group Management Association retained Nachimson Advisors to assess the cost impact of the proposed ICD-10 rule on providers. Nachimson Advisors estimated the cost impact of an ICD-10 mandate on three different provider practices:

A typical "small" practice, comprised of three physicians and two impacted administrative staff.

A typical "medium" practice, comprised of 10 providers, one full-time coder, and six impacted administrative staff.

A typical "large" practice, comprised of 100 providers, with 64 coding staff comprised of 10 full-time coders and 54 impacted medical records staff. No one has adequately explained to us why they are planning to increase codes from 16,000 (ICD-9) to 155,000 (ICD-10).

Total Cost Impact of ICD-10 Mandate on Individual Provider Practices

For a typical small practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as $83,290.

For a typical medium practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as $285,195
For a typical large practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as more than $2.7 million.

Cost Impact of ICD-10 Mandate in Six Key Areas

Requiring five times as many codes as the previous code set, the proposed rule would impact every aspect of business operations for physician practices and clinical laboratories and produce significant added costs in six key areas:

Staff Education & Training. Nachimson Advisors estimates the staff education and training costs associated with an ICD-10 mandate would range from $2,405 for a small practice to $46,280 for a large practice.

2. Business-Process Analysis of Health Plan Contracts, Coverage Determinations & Documentation. Nachimson Advisors estimates the business-process analysis costs associated with an ICD-10 mandate would range from $6,900 for a small practice to $48,000 for a large practice.

3. Changes to Superbills. Nachimson Advisors estimates the changes to new claim form software (superbills) costs associated with an ICD-10 mandate would range from $2,985 for a small practice to $99,500 for a large practice.

4. IT System Changes. Nachimson Advisors estimates the IT costs associated with an ICD-10 mandate would range from $7,500 for a small practice to $100,000 for a large practice.

5. Increased Documentation Costs. Nachimson Advisors estimates the increased documentation costs associated with an ICD-10 mandate would range from $44,000 for a small practice to $1.785 million for a large practice.

6. Cash Flow Disruption. Nachimson Advisors estimates the cash-flow disruption costs associated with an ICD-10 mandate would range from $19,500 for a typical small practice to $650,000 for a typical large practice. . . .

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3. International Medicine: The Failure of Single-Payer Health Care in Canada Is a Lesson for Americans

TORONTO, CANADA-Canada's government monopoly, single-payer health care system is one of the worst ways to achieve universal health insurance coverage and Americans should avoid adopting a similar system, concludes a new study from independent research organization the Fraser Institute.

"Advocates of single-payer health care systems tend to promote the allegedly lower monetary costs, but they ignore the lack of access to medical resources," said Brett Skinner, Fraser Institute Director of Health, Pharmaceutical and Insurance Policy Research and lead author of the study.

The peer-reviewed study, The Hidden Costs of Single Payer Health Insurance: A Comparison of the United States and Canada, compares some of the key aspects of the health care systems in both the U.S. and Canada, including the supply of medical resources, access to technology and effective health insurance coverage.

"The point of the comparison is to show that all of the costs of a single-payer health care system are not as obvious as the dollars spent," Skinner said.

The study shows that health care in Canada appears to cost less because relative to the United States, Canadian public health insurance does not cover many advanced medical treatments and technologies, common medical resources are in short supply, and access to health care is often severely delayed.

"On average, Americans spend more of their incomes on health care but they get better access to superior medical resources," Skinner said.

"If Canadians had access to the same quality and quantity of health-care resources that American patients enjoy, the Canadian health-insurance monopoly would cost a lot more than it currently does."

According to the most recent data, the United States outscores Canada on many key indicators of available health care resources, including:

• Number of MRI units per million population in 2006: US: 26.5; Canada: 6.2
• Number of MRI exams per million population in 2004/05: US: 83,200; Canada: 25,500
• Number of CT Scanners per million population in 2006: US: 33.9; Canada 12
• Number of CT exams per million population in 2004/05: US: 172,500; Canada 87,300
• Number of inpatient surgical procedures per million population in 2004: US: 89,900; Canada: 44,700.

Even on health insurance coverage, the Canadian system does not perform much better than the U.S. when it comes to actually delivering insured access.

"Access to a wait list is not the same thing as access to health care," Skinner said.

The study cites government data showing an estimated 1.7 million Canadians (aged 12 and older) were unable to access a regular family physician in 2007. And it points to other research showing that the actual number of "effectively" uninsured Americans is less than half of the figure usually reported and that being uninsured is usually only a temporary condition.

Based on these figures, the study estimates that the percentage of the population that was "effectively" uninsured for non-emergency, necessary medical services at any given time during 2007 was not significantly different between the two countries: 7.9 percent in the U.S. compared to six percent in Canada.

"When Canadians can't get access to health care because they can't find a physician or wait so long that they are effectively uninsured, they are no better off than uninsured Americans," Skinner said. . .

"With Canada witnessing the failure of its own single-payer health insurance system, why would Americans want to adopt such a system for themselves?" Skinner asked.

"Making everyone eligible for government-administered medical benefits that are fully subsidized by taxpayers is the worst way to achieve universal health insurance coverage."

http://am.eri.ca/newsandevents/news/6217.aspx

Brett J. Skinner
brett.skinner@fraserinstitute.org
(416) 363-6575 ext. 224

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: HEALTH CARE: Medicare Is Bad for Your Health By Philip R. Alper, MD

Hoover fellow Philip R. Alper explains how Medicare's convoluted regulations put the nation's health care system at risk.

Last summer Columbia/HCA teetered on the brink of disaster after the Health Care Financing Administration (HCFA), which administers Medicare, accused the company of massive fraud. On the other side of that continuing fight, HCFA head Bruce Vladek recently resigned, saying he was exhausted by trying to control fraud in the $300 billion Medicare and Medicaid programs.

This battle is really over differing answers to the question "How many CPAs can dance on the head of a syringe?" What's lost in all the bureaucratic and legal mumbo jumbo is a fact that's far more damaging to our nation's health care system: It's too difficult for doctors to do their jobs well while at the same time coping with a proliferating web of fraud-fighting regulations.

Bewildering Regulations

The predicament is a lonely one. My patients don't know that new laws subject physicians to criminal fraud prosecution whenever they disagree with Medicare about when to order a lab test or how to characterize a diagnosis. As an internist specializing in geriatrics, I can't ignore the increasing risk to my own well-being and my family's simply from remaining in practice. But Washington doesn't care that doctors like me do our best to play by the rules and have never had any regulatory problems.

This is surely hard to believe. So here's a test question: If a doctor orders a stool specimen to test for occult blood--which might indicate early colon cancer--is he engaging in good medical practice or criminal behavior?

Answer: It all depends. If the patient doesn't have symptoms and the bill is sent to Medicare, it's a criminal offense because these "preventive services" aren't covered benefits. Thus, billing them to Medicare is considered fraud. The absence of intent to cheat Medicare doesn't matter. Fines of up to $10,000 per "incident" of such "fraud" may be levied on the physician who simply orders the test from a lab at no personal profit.

In contrast, tests are legal when they are used to confirm a suspected diagnosis. But many cases are borderline. And there's a difference between the screening tests that Medicare covers and what's recommended by medical authorities. Sometimes the authorities don't even agree among themselves. For instance, the American Association of Clinical Endocrinologists strongly recommends thyroid screening for elderly patients, but the American College of Physicians doesn't endorse it. That's why the personal physician treating George Bush--who's had access to first-rate health care his entire life--failed to check his thyroid and why Mr. Bush's heart complications were the first clue that something was awry.

I've tried explaining Medicare's rules to patients. Most are bewildered. One patient left me when I asked that she pay for some screening tests herself. Since mammograms, Pap smears, and flu shots are covered and since her friends hadn't been asked to pay for any tests, she figured I must have been up to something funny.

Other doctors concur that ordering a lab test for Medicare patients can be as complicated as obtaining an informed consent for surgery. That's just crazy. In this Alice-in-Wonderland system, patients and doctors are both in trouble. Nobody knows what to do and everyone is afraid to ask.

One regulatory time bomb is now ticking loudly: The HCFA advises labs that don't get a "correct" diagnosis code from the ordering physician to bill either the patient or the doctor for the test--or just do it free. Instead of a bill, patients receive three-page, single-spaced letters advising them of Medicare's action in terms that would take a team of lawyers to decipher. That leaves doctors, patients, and hospitals to fight it out among themselves. And if anything goes wrong, patients may be liable for bills for lab tests and some diagnostic procedures at up to ten times what Medicare will pay.

Given its concern over rising costs, it's extremely odd that Medicare has never attempted to educate doctors on how to order lab tests in cost-effective ways. Instead, in its accelerated anti-fraud mode, HCFA is now instructing labs to "voluntarily" set up their own programs to spy on physicians and to report "suspicious" test-ordering patterns. Labs that cooperate with this spying are told they can expect the HCFA to go easier on them when it is their turn to be audited. A Russian friend told me this reminds him of the Soviet Union. . .

To read the entire report, go to www.hoover.org/publications/digest/3523831.html.

Reprinted from the Wall Street Journal, November 5, 1997, from an article entitled "Free Doctors from Medicare's Shackles." Used with permission. © 1997 Dow Jones & Company, Inc. All rights reserved.
Available from the Hoover Press is the Hoover Essay in Public Policy The Perverse Economics of Health Care and How We Can Fix It, by David R. Henderson. Also available is Do the Right Thing: The People's Economist Speaks, by Walter E. Williams. To order these publications, call 800-935-2882.

Philip R. Alper, M.D., is a clinical professor of medicine at the University of California, San Francisco, and the former Robert Wesson Fellow in Scientific Philosophy and Public Policy at the Hoover Institution.

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

- Ronald Reagan

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5. Medical Gluttony: WHO WILL PAY FOR BARACK OBAMA'S HEALTH CARE PLAN?

The cost of Barack Obama's health care plan will be almost completely borne by workers in the form of lower wages, say experts. . .

Barack Obama's cure for health care is a new payroll tax that employers would have to pay, unless they paid 75 percent of the premiums for an employee health care plan specified by the government. However, the cost of the tax will be almost completely borne by workers in the form of lower wages, says John C. Goodman, president of the National Center for Policy Analysis (NCPA).

This added costs, says Goodman, encourages employers to hire fewer workers, adopt labor saving technology, employ part-time workers and outsource labor to independent contractors and other entities.

Moreover, everything in Obama's health proposal involves higher government taxes, higher government spending and more government regulation:

His National Health Insurance Exchange -- Americans could purchase health insurance and choose among private insurers whose generous plans would cover all "essential" services -- is a very expensive plan that the government (taxpayers) will pay for.
Undoubtedly, this plan will be designed and priced to involve even more government subsidies, to get more people into the trap of socialized medicine, increasing the spending burden further.
His plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold; but this really means that taxpayers would pay for the high costs of all employer plans above an unspecified threshold.
Obama's regulations would also require all plans to be community rated -- everyone has to be charged the same premium, regardless of illness or costs when they first sign up.

For these and other reasons, the costs of Obama's plan would soar, says the American Spectator. The plan is already estimated to add $250 billion in new government spending each year. Like all government run, socialized health care plans, with no market incentives to control costs, it will soon be scrambling for cost control, and could result in government rationing of health care. This is an extremely undesirable situation, adds the Spectator.

Source: Peter Ferrara, "Barack Obama's Health Care Lies," American Spectator, October 15, 2008.

For text: www.spectator.org/archives/2008/10/15/barack-obamas-health-care-lies

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

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6. Medical Myths: OBAMA'S 95 PERCENT ILLUSION

Obama's genius is to call "welfare" a "tax cut," say observers. . .

One of Barack Obama's most potent campaign claims is that he'll cut taxes for no less than 95 percent of "working families." It's a clever pitch, because it lets him pose as a middle-class tax cutter while disguising that he's also proposing one of the largest tax increases ever on the other 5 percent. But how does he conjure this miracle, especially since more than a third of all Americans already pay no income taxes at all? There are several sleights of hand, but the most creative is to redefine the meaning of "tax cut," says the Wall Street Journal.

For the Obama Democrats, a tax cut is no longer letting you keep more of what you earn. In their lexicon, a tax cut includes tens of billions of dollars in government handouts that are disguised by the phrase "tax credit." Obama is proposing to create or expand no fewer than seven such credits for individuals:

A $500 tax credit ($1,000 a couple) to "make work pay" that phases out at income of $75,000 for individuals and $150,000 per couple.
A $4,000 tax credit for college tuition.
A 10 percent mortgage interest tax credit (on top of the existing mortgage interest deduction and other housing subsidies).
A "savings" tax credit of 50 percent up to $1,000.
An expansion of the earned-income tax credit that would allow single workers to receive as much as $555 a year, up from $175 now, and give these workers up to $1,110 if they are paying child support.
A child care credit of 50 percent up to $6,000 of expenses a year.
A "clean car" tax credit of up to $7,000 on the purchase of certain vehicles.

Here's the political catch. All but the clean car credit would be "refundable," which is Washington-speak for the fact that you can receive these checks even if you have no income-tax liability. In other words, they are an income transfer -- a federal check -- from taxpayers to nontaxpayers. Once upon a time we called this "welfare," or in George McGovern's 1972 campaign a "Demogrant." Obama's genius is to call it a tax cut, says the Journal.

Source: Editorial, "Obama's 95% Illusion; It depends on what the meaning of 'tax cut' is," Wall Street Journal, October 13, 2008.

For text: http://online.wsj.com/article/SB122385651698727257.html

For more on Welfare Issues: www.ncpa.org/sub/dpd/index.php?Article_Category=44

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7. Overheard in the Medical Staff Lounge: Massachusetts Cancels Medicaid Payments

State budget cuts will hit two of the state's safety-net hospitals particularly hard. Boston Medical Center has been notified it will not be reimbursed $64 million for care delivered to low-income Medicaid patients last fiscal year, and Cambridge Health Alliance will lose out on $40 million it had been expecting, state and hospital officials said yesterday. . . The governor's decision to cut Medicaid spending means Massachusetts will lose matching federal money. . . John Auerbach, the state's public health commissioner, said his agency has not decided how much of the spending reduction will be carved from childhood immunizations and how much from adult programs. . .

www.boston.com/news/local/articles/2008/10/17/two_safety_net_hospitals_hit_hard_by_budget_cuts/

Dr. Rosen: I guess we've all seen that the State of Massachusetts, where Mitt Romney developed the largest socialized medicine program in this country placing many individuals on Medicaid, reneged on $100 million in Medicaid payments to two hospitals. Not just delayed, but canceled the obligations.

Dr. Milton: These things happen every day with government medicine.

Dr. Michelle: That just shows we need single payer like Obama and Biden will implement.

Dr. Dave: How do you figure?

Dr. Michelle: If we had a national health plan, everyone would be covered and the costs would be less.

Dr. Edwards: Liberal logic completely eludes me. If the Medicaid obligations, which are a government program, cannot be met, by what stretch of your imagination could a greater government obligation of everyone be met?

Dr. Ruth: I think there may be efficiencies in a total Single-Payer plan, but I would have to agree that there may be insurmountable problems.

Dr. Milton: I understand that Medicare is delaying some payments to Hospitals, Clinics and Doctors because of a cash flow problem. How long before they renege?

Dr. Dave: How long before Medicare evaporates?

Dr. Yancy: Governments are all free wheeling and totally irresponsible. In New Zealand, I believe, when they reorganized their health care, they just started over and eliminated the two-year wait list and started a new wait list.

Dr. Dave: One government feels no obligation to carry out the plans and promises of the previous administration. They just brush it off and say we had to do it since there's no money.

Dr. Edwards: I think State workers get a great thrill out of putting a hundred thousand names in a file and then hit delete. I think it makes them squirm. It's like an orgasm for them. It's a sense of accomplishment. Maybe even of a conquest.

Dr. Dave: Did you see in today's paper that the approval rating for Congress dropped to 12 percent?

Dr. Ruth: That's even lower than President Bush.

Dr. Dave: Why would anyone even dream of having an organization with an 88 percent incompetence rating develop a national health plan? Wouldn't that make all of health care incompetent?

Dr. Edwards: Governments don't think they ever have enough money. It's more, more, more and still some more. And they want to raise taxes some more. They consider themselves experts, never incompetent.

Dr. Dave: Don't think that if you raised taxes to 100 percent, the government would think they have enough money. They would then strive to go to 200 percent.

Dr. Dave: Can't we have a math requirement for everyone that wants to be elected to Washington or a State House?

Dr. Milton: I don't think this New Math they're teaching kids helps common sense.

Dr. Dave: If they could tax us 200 percent of what we earn, that would mean their incompetence rating would go to 100 percent and health care would regress a hundred years for what they think is lack of money.

Dr. Rosen: I think the David Gibson, MD, OpEd piece in Sacramento Medicine concerning next week's election that he will vote Democratic for the first time in his life is probably a satire. But what he alludes to would be disastrous. It would take another 100 years in our Republic to correct that damage. www.ssvms.org/articles/0809gibson.asp

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

One dad's fight against autism By Nancy Brands Ward

Devastated when his only son was diagnosed with autism, Dr. Lou Vismara transformed his life and helped launch the world-renowned UC Davis MIND Institute

The thought that something was wrong struck him like a bolt of lightning one workday morning 13 summers ago. Dr. Lou Vismara lay in bed, in that twilight space somewhere between waking and sleep, and heard the sounds of his 16-month-old son chattering away in another room. It hit him: "Gosh, could Mark have autism?"

Mark, Vismara's fourth child and only son, was perfect at birth. As he grew, he thrived. But when he was nearly a year old, he wasn't saying "mama" or "papa" as kids his age typically did. Pediatricians told the Vismaras not to worry, saying all the things parents of autistic children heard so often just a decade ago: "He has three sisters who talk for him." "Einstein didn't talk until he was 5." "Boys develop later than girls."

But Vismara's stroke of insight made him decide to dig deeper. He dusted off his 30-year-old pediatric textbooks from Baylor College of Medicine and began reading. Autism was considered a rare disorder then, afflicting just one of 10,000, and blamed on so-called "refrigerator moms" thought to be incapable of relating with loving warmth to their children. Those are slim chances that his son could be affected, Vismara thought. Besides, Mark was affectionate and cuddly, not aloof and distant like the kids the textbooks described. And language is a natural process, Vismara rationalized; everyone learns to talk. "We'll just wait. Mark's going to be fine."

Less than a month later, though, it was clear that Mark hadn't hit many of the normal developmental markers for his age. By 18 months, Mark had seen a parade of specialists, and their diagnosis was unequivocal: full-spectrum autism.

"That was devastating," the 65-year-old Vismara said in a recent interview, his voice softening and his eyes filling with the memory. "Oh yes, horrific."

Some might think people suffering from autism are like Raymond Babbitt in Rain Man, with his spectacular memory and high-speed arithmetic ability. But savants with "islands of genius" - extraordinary mathematical or musical ability - are rare. Children like Mark, with full-spectrum autism, have difficulty with language and social interaction and often exhibit odd behaviors. As with the Rain Man, many are resistant to change in the environment or daily routines and may exhibit unusual responses to sensory experiences. Autism is a disorder that can range from mild to severe and display varying symptoms in each person who suffers from it.

Autism turned Lou Vismara's life upside down and set him on a path of personal and professional transformation. He gave up his practice as a highly respected cardiologist. Within a few years, he'd join four other Sacramento-area dads of autistic sons to co-found what has become one of the country's leading research centers, the MIND Institute at the UC Davis School of Medicine, for the study of autism and other neurological disorders. Eventually, Vismara would find himself at the center of everything that goes on in the world of autism, when it comes to medical and public policy, for the entire state of California.

Few men in their 50s would have been able and willing to dramatically remake their life's priorities in this way, but Vismara set out on his new journey without looking back. He felt he had no choice. He'd decided to find a cure for his son.

When Mark was diagnosed in the mid-1990s, no one knew what caused autism. A hodgepodge of symptoms defined this disorder without a cure. Autism could not have been more different from the diseases Vismara healed every day as an interventionist cardiologist, using highly technical procedures like cardiac catheterization, stents and angioplasty. That difference threw him for a loop. . .

Autism took over the lives of Vismara, his wife, their young daughter and his two teenage daughters from a first marriage. It also isolated them in important ways. In those early years, Vismara imagined that he was the only dad who took his son to the zoo in Land Park not to see the animals but for the chance it might offer for Mark to interact with other children. Embarrassment led Vismara to turn quickly down an aisle in the supermarket if he spotted friends or patients when Mark was having a bad day. At work, Vismara invented stories to explain to co-workers the bite marks that covered the backs of his hands from Mark's aggressive frustration.

By the time Mark was 2 years old, strangers were coming and going in the Vismara family's home to provide treatment. The standard then was ABA - applied behavioral analysis - a strategy based on continuously rewarding appropriate behavior. The recommendation was for 35 hours of treatment a week; so figuring more had to be better, Mark had 50. Mark and his family traveled to Santa Barbara for treatment and tried an array of regimens, including dietary interventions and nutritional supplements, physical and occupational therapy, extensive medical evaluations and consultations with specialists, video monitoring and hospitalizations for assessments.

Vismara wanted more than a roulette spin of unproven treatments. . .

To read more VOM, go to www.healthcarecom.net/voicemed.htm.

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9. Book Review: Heroes: Ronald Reagan, Margaret Thatcher and John Paul II

Paul Johnson defines a hero as anyone who has been widely, persistently over long periods, and enthusiastically regarded as heroic by a reasonable person, or even an unreasonable one. Johnson has put into this collection one or two heroes and heroines of his own, believing that an element of idiosyncrasy is a legitimate part of hero worship. A hero does not stand still in popular estimations. Hero movements up and down are usually less startling but frequent and continuous.

Tom Jones, in his Whitehall Diaries, quotes Stanley Baldwin, when prime minister, remarking:

Contemporary judgments were illusory; look at Lincoln's case, how in his lifetime he was thought to be a clumsy lumbering countryman, blundering along without knowing where he was going. Since his death his significance has grown steadily. [Woodrow] Wilson, on the other hand, was for a short spell looked up to like a god, and his fame will gradually shrink. Lincoln is Wisdom, and Wilson is Knowledge.

In some cases, heroic categories have been downgraded in their entirety. Livingstone, an outstanding hero of the Victorians, and still venerated in the author's childhood, is now described as a racist. In general, explorers and travelers enjoy fewer kudos than formerly. Amundsen and Peary, even the tragic-heroic Scott of the Antarctic and his self-sacrificing companion Captain Oats, no longer occupy the same rank in the pantheons of schoolboys. All those concerned with the spread of empire - Clive of India, Marshall Lyautey of Morocco, Cecil Rhodes, Lawrence of Arabia - are now suspect.

This book is a small selection of heroes and heroines who still evoke wonder or admiration or respect or in some cases sympathy. Since 2008 is an election year and President Reagan is alluded to by many of the candidates, we shall focus on Section 13, The Heroic Trinity Who Tamed the Bear: Reagan, Thatcher and John Paul II.

According to Paul Johnson, three people won the Cold War, dismantled the soviet empire and eliminated Communism as a malevolent world force: Pope John Paul II, Margaret Thatcher and Ronald Reagan. They worked in unofficial concert and we shall perhaps never know which of the three was most important. John Paul effectively undermined the Evil Empire (Reagan's phrase) in its weakest link, Poland, where the process of disintegration began. Margaret Thatcher reinvigorated the capitalist system by starting a worldwide movement to reduce the public sector by a new term, "privatization," and by destroying militant trade unionism. Reagan gave back to the United States the self-confidence it had lost, and at the same time tested Soviet power to destruction. All were heroes, each in a different way.

In Dr. Johnson's own words: "Reagan interested me the most because he created an entirely new model of statesmanship: well suited to a late twentieth-century media democracy. And he was hugely entertaining to watch in action. He endeared himself to me the first time we met by getting flustered, glancing at the six-by-four cue card he always kept in his left-hand suit pocket, and saying: ‘Good to see you again, Paul.' The second time he shook hands with me in front of a battery of press photographers (I still have the picture) and whispered: ‘Don't look at me-look at the cameras.' Good advice from an old pro. Reagan did not try to smile all the time, like many American politicians. He never smiled at nothing. His smile was an event with meaning, which preceded or followed a joke. Usually he was serious. Government, he seemed to say, was a serious business. So serious we're inclined to take it too seriously. Then would follow a joke, and a laugh. But even when emphasizing the seriousness of it all, Reagan never gave the impression of being nervous, or gloomy, or worried. He was at ease with himself. I have never come across a person, certainly not in public life, who was so thoroughly and fundamentally at ease with himself. By that I do not mean casual or flippant or devil-may-care: he was none of those things. But he was relaxed, unharassed, quietly confident in anything he had to do. And, being like that, you did not have to dig very deep to find happiness. He was a happy hero. He liked, and tried, to communicate his happiness, and normally succeeded. He made me think that happiness ought to be part of the equipment of a hero, even though it usually isn't.

"The United States which Ronald Reagan took over early in 1981 was not at ease with itself. Indeed, it was deeply unhappy at a public level. The strong presidency of Richard Nixon had been destroyed, leaving a vacuum of power. Into that vacuum stepped, insofar as anyone or anything did, a divided and leaderless Congress, abrogating to itself by law or in fact duties which rightly belonged in the executive branch. President Jerry Ford did nothing to stop this unconstitutional larceny. He had never been elected and did not have a sense of rightful authority. He was not at ease with himself-far from it-but he was easygoing, diffident, amiable, anxious to avoid rows that might end in a challenge to his credentials. His successor, Jimmy Carter, was a natural one-term president at a meager time, who found it impossible to strike a national note. Both men ran a low-key presidency, stripping both the White House and its internal motions of any element of grandeur. Ford stopped the Marine band playing ‘Hail to the Chief' when the president arrived. Carter let it be known that he worked in the Oval Office in a sweater, and he encouraged his staff to ‘dress down' (the first time the phrase was used). [He once remarked, "Why should I have reserve parking? I'm no better than other Americans and should have to search out my own parking stall.] All ceremony associated with the White House and presidential movements was cut to the minimum. Gradually the heart of American government acquired a slipshod air. Ford was a non-hero, Carter an anti-hero. ‘Jimmy,' as he liked to be called, despised heroics, or said he did, and anyway, was incapable of them. His was a painfully unheroic presidency, culminating in a humiliating disaster to American arms in Iran. [He also said most people didn't understand the many decisions he had to make in the oval office. What he failed to say, was that he was referring to himself.]

From the start, Ronald Reagan reversed this process of American self-effacement. In his eight years as governor of California, he had raised the administrative profile of the state with the world's eighth-largest economy above the usual seedy city hall level. Now, entering a new role, he determined to play it to the full. He had the best of all precedents in stressing the formality and even the grandeur of the most important elective office in the world-the example of George Washington. He also had an able and enthusiastic assistant, in the shape of John F. W. Rogers, the young official in charge of White House protocol and ceremony. Rogers was an expert on everything to do with presidential history and all that was most seemly. He provided the costume and sets, as it were, for the Reagan presidency. Back came the solemn band music and specially ‘Hail to the Chief.' Back came the Herald Trumpeters, from the U.S. Army, an institute created by General Eisenhower in his White House term. A special ceremonial fanfare was created for them entitled ‘A Salute to a New Beginning.' Under Reagan's benign approval, Rogers rewrote protocol for all White House formal occasions, stressing ceremony, even redesigning the bunting used in presidential platforms. There was huge reviewing of troops by the president personally. All visitors, especially heads of state and government, were now suitably greeted. The internal dress code of the White House went back to "smart" - suits, ties, white shirts. So Reagan began his rule by putting back the clock in a visible, audible way.

"He had certain core beliefs in which he passionately believed, from which he could not be budged, and which had a bearing on all he aspired to do. They were essentially moral beliefs, to do with justice, honesty, fair dealing, courage and what he would call ‘decency.' In political terms they translated into standing up to the Soviets and matching them-if possible, outmatching them-in weapons; cutting taxes; freeing Americans from unnecessary burdens; and enlarging freedom whenever consistent with safety and justice. There was no shifting Reagan on these matters. He clung to his core views with extraordinary obstinacy. They were, by and large, right, and he could communicate them with extraordinary skill.

"After nearly sixty years of writing history, and also of observing contemporary history makers in action, I am convinced that successful government depends less on intelligence and knowledge than on simplicity-that is, the ability to narrow aims to three or four important tasks which are possible, reasonable and communicable. Reagan had that formula, and the fact that he did enabled him to be a success, and a true hero, with few if any of the qualities which most constitutional experts would have rated indispensable.

"He appeared incapable of speaking coherently about the simplest matters without reference to the cue cards in his left pocket. In some ways he was ill-equipped to run anything, let alone the mightiest nation on earth. He was nearly seventy when he got to the White House, and three months later an assassin's bullet just missed his heart. He was deaf and sometimes could not hear what his staff was telling him, even with the volume of his hearing aid switched right up. He was known in showbiz as ‘a quick study,' and as a rule learned his lines well. As a B-movie actor, and a successful and reliable one, he had been a stickler for strict studio discipline, disliking people who were late on the set as ‘disruptive' and ‘unprofessional.' He believed in learning lines and following the script, and obeying directions, so that in some ways his staff found him very compliant and easy to work with. But when tired, as he often was, especially after lunch, he got things wrong."

Margaret Thatcher worked very closely with Ronald Reagan in the 1980s. The Anglo-American alliance was never stronger or the special relationship closer. They saw eye to eye on all the big international issues and each tried to run the same kind of government at home. Each proved that will is all-important in running a country in combination with a few central principles which are just.

But Reagan and Thatcher were very different. Reagan was a very masculine man and Thatcher a very feminine woman. Even though commentators tried to invest her with masculine characteristics, Thatcher was a woman to her inner most core and loved it. She invariably took full advantage of any feminine privilege going from tears to tantrums, while grabbing any rights denied to women which were hers as prime minister. Given a choice, however, she always preferred being with a man rather than with a woman. She would be civil to a woman who was important in her own right. But wives got short shrift.

She was a woman first. Johnson didn't recall ever seeing her wear trousers. She took more trouble over her hair than most women. She was modest like Reagan. When Johnson told her there are only three things a government must do because no one else can: external defense, internal order and running an honest currency, she repeated these often. Her career in the Commons was marked by unusual strokes of good fortune. Her capturing the leadership was a pure stroke of luck. Her luck continued as she took on the militant trade unions. The male predecessors had tried and failed. With a national mandate, she proceeded to cut the unions down to size. Johnson feels that any male would have lost again.

Thatcher was the only British leader since Churchill to have a perceptible influence on world events, both directly and through her high standing in Washington. Her status as hero is unquestionable. She tended to see the world in black-and-white terms and labeled the current cast as "goodies" and "baddies."

Thatcher was on a resolute course of righteous action. That was why she loved Pope John Paul II, the third member of the blessed trinity of heroes who destroyed the Communist monolith. John Paul II may have been the most important of the of blessed trinity because he understood the Soviet empire on the ground in Poland. By giving his moral and, to some extent his physical support to the trades union movement of Lech Walesa, and by making himself the active spiritual leader of the united Polish people, he undermined the empire fatally.

Once his ghostly leadership on the actual soil of Poland was firmly established, there was never any possibility of Soviet imperial rule reestablishing itself without a bloodbath of the kind not even Brezhnev would have been prepared to face, and all his successors flunked totally. In many ways it was the most impressive display of papal political power since the time of Innocent III in the early thirteenth century, and gave the true answer to Stalin's brutal (and foolish) question: "How many divisions has the Pope?"

Johnson does not dwell on the Pope at length since he calls this a book on heroes and not saints. But he does give us a perspective of the current political turmoil in our country and the world. As our current presidency sinks even lower than the ratings of our Congress, both Reagan with the Iran-Contras scandals and Thatcher went out under a cloud. However, both came back with high popularity ratings. It's hard to enter Washington, DC without flying into Reagan International. . .

To read the rest of the review, go to www.delmeyer.net/bkrev_Heroes.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: Massachusetts Defaults, Who's Next?

Massachusetts, with one of the largest welfare Medicaid programs, recently canceled $1 million of payments to two hospitals. It was not a Medicare type of delayed payment for lack of funds, but a forfeit of a legislative mandate.

Looks like another Federal Program is unraveling.

Medicare is delaying payments because of a lack of cash flow from its Sugar Daddy, Uncle Sam. It appears that our excessive tax dollars aren't going to be enough. The word is that it's going belly up in the next decade,

Will Medicare vaporize also?

An Obama supporter came in to assure that everything will be just fine once Obama gets into the office. He's giving tax breaks to everyone except the richest 5 percent. That should solve any financial deficiencies.

I asked another Obama supporter that since the rich already pay three fourths of all taxes, do you think increasing it to 100 percent will solve all financial problems? Can the rich afford to pay 100 percent of their income?

The Obama worshiper said: Certainly. The rich can afford to pay 200 percent. There's an unlimited amount of money we can get from the rich.

I had no idea that the math programs in this country were really that bad.

To read more HHK, go to www.healthcarecom.net/hhkintro.htm.

To read more HMC, go to www.delmeyer.net/hmc2005.htm.

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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.

• 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.emergiclinic.com. To read more on Dr Berry, please click on the various topics at his website.

• 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. Dr. Huntoon practices Neurology at Derby, New York.

• 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.

• 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. To read why he might vote democratic next week, go to www.ssvms.org/articles/0809gibson.asp. When I saw him last month, his tongue appeared to be in his left cheek.

• 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. There are a number of sub-sites that can be accessed from the home page including a popular Life Site.

• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or you may prefer to peruse the archives.

• 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: Which candidate's health plan will hurt the most?. 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 Disruption. They just completed their 65^th annual meeting in Phoenix last month with an international faculty speaking on successes of privatizing medicine in many bastions of socialized medicine. Stay tuned for important reports on the meeting giving new hope for all physicians and their patients everywhere. 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 of the current issue. Don't miss the excellent number of timely articles or the extensive book review section which covers four great books this month.