1.
Featured Article:
UNDERWORLD AND OVERWORLD, BY JOE
SOBRAN
Just as there is world conspiring to break laws, the
political process works to remake laws to suit itself
We're supposed to smirk automatically at the phrase
"conspiracy theory," as if the very idea of a conspiracy were somehow
outlandish and, well, paranoid. But federal prosecutors seem to have made a
pretty convincing case that Terry Nichols and Timothy McVeigh conspired to blow
up the Alfred P. Murrah Federal Building in Oklahoma City in 1995. At least
nobody is suggesting that all the jurors in the two trials were loco.
The idea of conspiracy is essential to criminal law. It means nothing more than
secret cooperation to commit criminal acts. It's implicit in such common
expressions as "accomplice," "organized crime," and
"getaway car." The alternative is to believe that criminals always
act alone. Yes, and musicians always play solo. . . .
But the most damaging corruption may not consist in
illegal acts. Just as there is a criminal "underworld" that
continuously conspires to break the law, you can think of the political process
as the working of an "overworld" in a sort of continuous conspiracy
to remake the laws to suit itself. To read more,
please go to www.medicaltuesday.net/index.asp.
If the widget industry can get tax subsidies by
persuading legislators to make laws in its favor, no crime has been committed.
And this can be accomplished without gross bribery. Key senators and
congressmen may be receptive to the argument that new, high-tech widgets are
vital to national defense (and might be manufactured in those honorable
gentlemen's states). This patriotic proposal may be transacted over an informal
lunch, immensely boosting the profits of the widget industry, and the taxpayer
never the wiser.
When there are no limits on what the taxing power may be used for, you are
bound to get a whole class of people seeking to have it used in their behalf.
What would otherwise be illegal - taking people's earnings by force - becomes
legal when a government does it (just as inflating the currency, otherwise
known as counterfeiting, becomes "increasing the money supply" when a
government does or authorizes it).
The class of people who live and prosper by discreetly arranging to have their
larceny legalized is what I mean by the "overworld." Their ranks
include politicians, businessmen, educators and many others. Because they
control the legislative process, they not only don't have to commit crimes,
they don't even think of themselves as shady operators.
These folks do share certain characteristic attitudes. They dislike
"extremism," by which they mean any political principle that would
keep government power and activity to a minimum. They are equally opposed to
communism and "cutthroat capitalism"" (whose evils they
impartially equate with those of communism). They believe in an
"affirmative role" for government, "flexible," "compassionate"
and "adapted to today's needs." They tout the virtues of
"compromise." They favor "partnership" between government
and "the private sector," because the modern world is so
"complex" and "interdependent." And of course they are scornful
of "conspiracy theories."
Such people always sound reasonable, and they are the type who control the
government. If their sense of honor isn't very strong, it would also be hard to
catch them doing anything flatly illegal.
They aren't a secret cabal or a closed society. Anyone can join their ranks anyone
who wants to play the angles, to use the government for his own special benefit
at the expense of the unsuspecting taxpayer.
An overworld exists in every society, a parasite class that figures out how to
get others to work for them while keeping the law on their side. In many
societies there are outright lords and slave owners who may directly command
their serfs and bondsmen; in a nominally egalitarian society, a more devious
approach is necessary.
You may be working much of the day to support your neighbor without knowing it.
You know that a lot of your income goes to the government, but you don't
exactly know where it goes from there. That's how the system is designed to
work.
To read the entire article, go to www.liberty-watch.com/volume03/issue06/reactionaryutopian.php.
This is why we need a tax limitation amendment. When a
lion devours its prey, it is satisfied and ends his hunt. There is no such
relaxation in Congress or Legislatures in taxation - it's a sweet tooth and
each new tax just increases its appetite to devour. All public polls on
taxation, including the Readers' Digest poll, always indicate that both rich
and poor people think no one should have to work more than 25 percent of the
time for the government. Our current marginal tax rate is approaching 50
percent. Should the government take over health care; the marginal rate will
approach 75 percent. We would be working 75 percent of our time to feed this
Congressional and Legislative Lion that is never satisfied. We need a
constitution tax limiting amendment.
We propose that each level of government be limited to
two taxes. Congress and Legislatures would not be able to dream up new taxes on
unique activities or endeavors. To come close to the public-accepted limit of
no more than 25 percent of our earnings to feed this avaricious lion, can we be
as bold as to propose the following:
The federal government is limited to a 15 percent
income tax and a 10 percent excise tax on interstate commerce, imports and
international trade?
The state governments are limited to a 5 percent
income tax and a 5 percent sales tax on products purchased or sold within the
state?
The city/county councils would be limited to a one
percent sales tax and a one percent property tax?
I know this doesn't quite meet the 25 percent limit
that most Americans feel is just, but doesn't it come close? At least it would
curb the appetite.
* * * * *
2.
In the News: The Inconvenient Science of Racial DNA Profiling By Melba Newsome 10.05.07
On July 16,
2002, a survey crew from the Department of Transportation found Pam Kinamore's
nude, decomposing body in the area along the banks of the Mississippi known as
Whiskey Bay, just west of Baton Rouge. The police tested the DNA and quickly
realized that they were dealing with a serial killer: the same man who had
killed two other white, middle-class women in the area.
The FBI,
Louisiana State Police, Baton Rouge Police Department and sheriff's departments
soon began a massive search. Based on an FBI profile and a confident
eyewitness, the Multi-Agency Homicide Task Force futilely upended South
Louisiana in search of a young white man who drove a white pick-up truck. They
interrogated possible suspects, knocked on hundreds of doors, held frequent
press conferences and sorted through thousands of tips.
In late
December, after a fourth murder, police set up a dragnet to obtain DNA from
some 1200 white men. Authorities spent months and more than a million dollars
running those samples against the killer's. Still nothing.
In early
March, 2003, investigators turned to Tony Frudakis, a molecular biologist who
said he could determine the killer's race by analyzing his DNA. They were
unsure about the science, so, before giving him the go-ahead, the task force
sent Frudakis DNA swabs taken from 20 people whose race they knew and asked him
to determine their races through blind testing. He nailed every single one. To read more, please go to www.medicaltuesday.net/news.asp.
Still, when
they gathered in the Baton Rouge police department for a conference call with
Frudakis in mid-March, they were not prepared to hear or accept his conclusions
about the killer.
"Your
guy has substantial African ancestry," said Frudakis. "He could be
Afro-Caribbean or African American but there is no chance that this is a
Caucasian. No chance at all."
There was a
prolonged, stunned silence, followed by a flurry of questions looking for doubt
but Frudakis had none. Would he bet his life on this, they wanted to know?
Absolutely. In fact, he was certain that the Baton Rouge serial killer was 85
percent Sub-Saharan African and 15 percent native American.
"This
means we're going to turn our investigation in an entirely different
direction," Frudakis recalls someone saying. "Are you comfortable
with that?"
"Yes. I
recommend you do that," he said. And now, rather than later since, in the
time it took Frudakis to analyze the sample, the killer had claimed his fifth
victim. The task force followed Frudakis' advice and, two months later, the
killer was in custody. . .
Colorblind
CODIS, Genetic Drift
The DNA
forensic products available at the time could only be used to match DNA specimens
in the CODIS, or Combined DNA Index System, database which contains about 5
million DNA profiles. If investigators have a crime scene sample but no
suspect, they run it against those in the database to see if it matches a
sample already on file.
But while
CODIS is good at linking the criminals who are already catalogued from other
crimes, the system is useless in identifying physical characteristics. It says
nothing about race. It has been specifically set up to reveal no racial
information whatsoever, in part so that the test would be consistently accurate
irrespective of race.
But
non-scientific considerations also factored into how the system was
established. When the national DNA Advisory Board selected the gene markers, or
DNA sequences which have a known location on a chromosome, for CODIS, they
deliberately chose not to include markers associated with ancestral geographic
origins to avoid any political maelstrom.
DNAWitness,
the test Frudakis applied in the Baton Rouge case, uses a set of 176 genetic
markers selected precisely because they disclose the most information about
physical characteristics. Some are found primarily in people of African
heritage, while others are found mainly in people of Indo-European, Native
American or South Asian heritage. . .
To read how
the Racial DNA Profile Leads to Killer, go to
www.wired.com/science/discoveries/news/2007/10/dnaprint?currentPage=all.
* * * * *
3.
International
Medicine: Death, Canadian Style, By Bill Steigerwald, FrontPageMagazine.com 9/4/2007
If Canada's national health-care
system is so dang wonderful, why are so many Canadians coming to America to pay
for their own medical care?
Why is the hip replacement center of Canada in Ohio -- at
the Cleveland Clinic, where 10 percent of its international patients are
Canadians?
Why is the Brain and Spine Clinic in Buffalo serving about
10 border-crossing Canadians a week? Why did a Calgary woman recently have to
drive several hundred miles to Great Falls, Mont., to give birth to her
quadruplets?
It's simple. As the market-oriented Fraser Institute in
Vancouver, B.C., can tell you, Canada's vaunted "free" government
health-care system cannot or deliberately will not provide its 33 million
citizens with the nonemergency health care they want and need when they need or
want it.
Courtesy of the institute, here are some unflattering
facts about Canada's sickly system: To read more,
please go to www.medicaltuesday.net/intlnews.asp.
Number of Canadians on waiting
lists for referrals to specialists or for medical services -- 875,000.
Average wait from time of
referral to treatment by a specialist -- 17.8 weeks.
Shortest waiting time -- oncology, 4.9 weeks.
Longest waiting times -- orthopedic surgery, 40.3 weeks.
Average wait to get an MRI -- 10.3 weeks nationally but 28
weeks in Newfoundland.
Average wait time for a surgery considered
"elective," like a hip replacement -- four or more months.
Hello, Cleveland.
The Canadian system is horribly short on consumer choice
and competition. But it isn't all bad -- if you don't mind waiting to access
it. As health policy analyst Nadeem Esmail of the Fraser Institute said last
week, it does "a decent job of saving your life but treats you terribly in
the process."
Esmail says no one knows exactly
how many Canadians go to the United States each year for medical care. His best
estimate for 2006 -- a conservative one -- is 39,282. Whatever the actual
number is, however, it is growing.
Clinics in Detroit and Buffalo
market speedy MRIs, CTs or ultrasounds to Canadians which, by law, cannot be
purchased privately in some provinces, including Ontario.
Ontario residents have three
options: wait months for their free public MRI, travel to a province like
Quebec where it is legal to buy one privately or travel to the U.S.
It's no wonder private medical
and surgical brokers like Timely Medical Alternatives of Vancouver have sprung
into existence. Rick Baker said his three-year-old company refers about 100
Canadians a month to U.S. clinics and hospitals for such things as MRIs and
knee replacements.
Timely Medical's services came in
handy for Lindsay McCreith, a retired auto body shop owner who was told in 2006
he probably had a brain tumor. He needed an MRI fast. But the wait time for a
"free" public one was 4 1/2 months and it was illegal to purchase a
private MRI in Ontario.
McCreith contacted Timely
Medical, which got him an MRI the next day in Buffalo that showed he had a
Titleist-sized tumor. Four and half weeks later, McCreith had received the
brain surgery that could have taken eight months to happen in Canada -- if he
had still been alive. It cost him $28,000 -- for which Canada's government
won't reimburse him.
Stories like McCreith's -- and
the downsides of Canadian and American health care [was] exposed Sept. 14 by
ABC's John Stossel in his "20/20" special, tentatively titled
"Sick in America." Rick Baker hopes Hillary Clinton and her friends
[were] watching.
www.frontpagemag.com/Articles/Read.aspx?GUID=697C1920-90AB-4033-A84C-3629676AE84E
Bill Steigerwald is the
Pittsburgh Tribune-Review's associate editor. Call him at (412) 320-7983.
E-mail him at: bsteigerwald@tribweb.com.
Canadian Medicare does not
give timely access to healthcare, it only gives access to a waiting list.
--Canada's Supreme Court
* * * * *
4.
Medicare: Why Did
We Ever Let Health Care Get out of the Competitive MarketPlace?
When Medicare was implemented in 1966, my father's
Blue Cross/Blue Shield premiums were about $300 a quarter. Without Medicare,
they probably would have tripled to about $1000 a quarter. With Government
taking over the senior's health care, the actual costs of Medicare exceeded
projected costs about 400 percent. In addition, now non-Medicare people are
paying Medicare taxes about equal to what an entire BC/BS policy would be if
Medicare had never happened. For
instance, a worker at age 20 will be paying Medicare taxes equal to what a
BC/BS premium would be for 45 years before he is ever insured by Medicare.
Without Medicare, out health care costs would be manageable by the private
citizen. Medicare is going broke despite 47 million uninsured Americans paying
Medicare payroll taxes and remaining uninsured. To help understand this
phenomenon, let us look at the premier Freedom Foundation expound on the
problem.
The Goal Is Freedom (TGIF): Government Failure, by Sheldon Richman, October 5, 2007
Sheldon
Richman is the editor of The Freeman and "In
brief." TGIF appears Fridays. Comments welcome.
A popular academic rationalization for having government forcibly override
people's economic decisions is the theory of market failure. Advocates of the
free market have long emphasized that the countless self-regarding actions
individuals perform daily in the marketplace generate a larger complex
spontaneous, or undesigned, order -- that is, a high degree of interpersonal
coordination that is remarkably pleasing to consumers. This is the social
cooperation Ludwig von Mises placed at the center of his description of the
market process.
Critics of the market realize this is a powerfully
appealing feature of the economists' case for what these critics deride as the
unfettered marketplace. (On the contrary, the free market, when permitted to
work, is rather severely fettered by free consumer choice.) So this feature has
been among the prime targets of those who would straitjacket or even abolish
the market. Hence the attraction of market-failure theory.
The critics counter the coordination argument by
claiming that market behavior can lead to less-than-favorable phenomena, such
as free-riders (public goods) and prisoner's dilemmas. In theory these have the
following characteristic: rational individual behavior brings about an overall
result that the individuals themselves dislike. . .
To read more, please go to www.medicaltuesday.net/medicare.asp.
Market advocates have often pointed out that the
market itself -- if allowed to work -- contains fixes for these alleged
failures, but an equally important point has gotten less attention. Accepting
the critics' argument for the moment, it is fallacy to assert that any time the
market is expected to generate suboptimal results, government should step in.
Why is that a fallacy?
Because it assumes that the results of government
preemption would be superior to whatever results the market would have
produced. But that cannot be assumed. It has to be proved. And it has not been.
Market critics have had enough time to bring forth the arguments. Where are
they?
Mises and F. A. Hayek left behind a voluminous
literature explaining that calculation and knowledge problems assure that
government-generated outcomes will be inferior to market-generated outcomes. Israel Kirzner has specifically shown that these problems plague not
only full-out central planning, but the regulatory state as well.
David Friedman has elaborated another argument against
government inference. "Market failure," Friedman writes, applies to
government itself in a more egregious form than it applies to the
marketplace. And while the market has built-in corrective features,
government does not.
In a December 2005 Liberty magazine
article, "Do We Need Government?" Friedman wrote, "In order for
government intervention to improve on the market outcome, it is not enough that
there is something government could do that would give a better outcome. There
must also be a reason to expect government to do it. ...[T]he incentives of the
relevant political actors have to be such that it is in their best interest to
act in way that result in the improved outcome."
Have we any grounds to assume that those incentives
exist? Friedman thinks not. Representative democracy, he says, has a perverse
incentive -- a free-rider problem -- right at its core: the voting system. "In
order to figure out both what a politician is doing and whether he should be
doing it, the voter must spend substantial amounts of time and effort studying
the issues and the politician's voting behavior. In doing so, he is producing a
public good -- better laws -- for a very large public. He himself collects only
a tiny fraction of any benefit. Seen from the other side, he is bearing a large
cost for a trivial gain -- an increase of perhaps one chance in a million in
the probability that the right politician will get elected."
Thus even a voter who understands some economics and
who would favor a reduction in government interference with the market has
little incentive to exert much effort. (Bryan Caplan points out that most voters don't understand
economics and are blinded by antimarket biases. The "public goods"
problem Friedman describes gives them no incentive to examine and discard those
biases.)
Friedman generalizes to this conclusion: "[T]here
is no reason to expect individual rationality in that [political] market to
lead to group rationality. In private markets, most of the time, an individual
who makes a decision bears most, although not all, of the resulting costs, and
receives most of the resulting benefits. In political markets that is rarely
true. So we should expect that the market failure that results from A taking an
action most whose costs or benefits are born by B, C, and D should be the
exception in the private market, the rule in the political market. It follows
that shifting control over human activities from the private market to the
political market is likely to increase the problems associated with market
failure, not decrease them" (emphasis added). . .
A final note: I'm uneasy with this problem being
referred to as "market failure" even when it applies to politics. As
Caplan says, we should "drop specious analogies between markets and
politics, between shopping and voting." Markets -- when they are
allowed to work -- are based on consent. Politics is based on force. Using the
same term -- market -- to describe both is confusing and unnecessary. The sort
of failure Friedman discusses obviously is not exclusive to the economy, since
it occurs in the political realm also. Thus it is imprecise to call it market
failure. Maybe it's simply a social failure. Whatever we call it, let's
avoid the qualifier market, for it only prejudices the case and lends an
illusion of credibility to the statists' arguments.
To read the entire report, go to www.fee.org/in_brief/default.asp?id=1619.
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Technology Leads to Gluttony Unless Controlled by Physicians
We have medical illiterates who are running for
president spewing forth all kinds of illogical health schemes to force
Americans into a restrictive, totalitarian, government-controlled health plan
that comes with exorbitant costs, are poorly understood, and completely
eliminates individual freedom. To turn the 47 million Americans who are frugal
with their health care costs into mainstream medical gluttons will more than
double the costs. To pay for preventive medicine, which is not cost effective
when applied to the masses, will totally bankrupt needed health care. Today we
join Professor Michael Wilkes exploring the issue of "If the technology is
there, why can't I have it?"
Lung scans work,
but treatment is tricky, by Dr. Michael Wilkes, Sac Bee, October 6, 2007
Two years ago, after 24 years of smoking, Mr. R quit
his cigarette habit, in part because his kids pressured him and in part because
smoking had become expensive and socially complicated.
He's been told that the smoke destroyed part of his
lung, and he now has emphysema. Still, he feels pretty healthy, but he's
worried about cancer. He tells his doctor that he's heard about a new scan that
is good at detecting lung cancer early -- and he wants it.
His doctor is hesitant to order the test, which has
left Mr. R feeling frustrated because he doesn't understand why, if a test is
available, his doctor won't order it. To read more,
please go to www.medicaltuesday.net/gluttony.asp.
Today in the United States, one-quarter of all cancer
deaths are due to lung cancer -- more than the next four common cancers
combined. For years, there has been a hope that medical technology (X-rays or
saliva studies) might be able to detect lung cancer earlier, before it spreads
and while it is still treatable.
Over the years, several excellent studies randomly
assigned people to a group that received regular X-rays or to a control group
that received only "usual care" based on their symptoms. In both
groups, once a cancer was detected, people had surgery to remove it. This
involves major chest surgery, where five out of every 100 people die as a
result of the surgery and 20 out of every 100 have serious complications.
At the end of these studies, researchers found that
X-rays did a very good job of picking up small cancers. These cancers were
detected much earlier than if people had simply waited until they developed
symptoms.
This might have been the end of the story if our goal
was simply to find cancer early. But the ultimate goal of a screening test is
not simply to find cancer but rather to prolong people's lives or improve the
quality of their lives.
To everyone's surprise, the group with early detection
of their lung cancer didn't live any longer than people who had cancer detected
only after symptoms appeared. In fact, X-rays detected "lung cancers"
in some people who ended up with major surgery, only to be told the
"cancer" wasn't really cancer after all (false positive X-ray
results). . .
So, along comes a relatively new type of scanner that
is proven to detect even smaller lung cancers than traditional X-rays. While
some doctors jumped on board and started to use the scan to screen for lung
cancer in former smokers, others have appropriately asked: Does the scan really
save lives -- particularly since the surgery for these early cancers is so
dangerous?
A recent study suggests that these scans do not save
lives. Again, it's not that the scan is flawed. A far more likely explanation
is that our treatments are primitive and that at the time of detection, the
cancer has already spread.
Unfortunately, we can't be certain that the scans are
not helpful until larger, better-designed studies are completed -- and this
won't happen for few more years.
Until then, it seems far better for Mr. R to wait and
not be screened. It seems unnecessary to cause significant worry, perform risky
surgery and expend large amounts of money before we know that what we're doing
actually saves lives.
A more difficult task is to convince Mr. R that not
ordering the test is really in his best interest and might save his life.
Now that medical information is so readily available,
it is more important than ever to understand that not all technology is in your
benefit. A careful discussion with your doctor is the best way forward.
www.sacbee.com/107/v-print/story/415790.html
Michael Wilkes, M.D., is a
professor of medicine at the University of California, Davis. Identifying
characteristics of patients mentioned in his column are changed to protect
their confidentiality. Reach him at drwilkes@sacbee.com.
[During
my chest residency, we had a patient with a positive sputum cytology (pap
smear). He had an abnormal left lung and a normal right lung on x-ray. However,
the abnormal cytology was on, what appeared to be, his normal right lung.
Since, there was no lesion on the right lung, the surgeons said the left lung
contained the cancer, the bronchoscope had sampled the wrong lung, and they
were chomping at the bit to take out the abnormal left lung. However, Dr.
Robert Green, the Chief of Thoracic Medicine and Professor of Medicine at the University
of Michigan School of Medicine, would not allow the surgeons to operate. He
followed the patient with sputum pap smears every six months for two additional
years, when lo and behold, there developed a lesion in the right lung. This was
then removed and the patient cured with a moderate degree of shortness of
breath for the rest of his life. Had my Chief acquiesced and allowed the
surgeon to remove the abnormal left lung which was free of cancer, the patient
would have been short of breath for these two years and when the real cancer
appeared, he could not have been cured since he needed the cancerous right lung
to live and would have died as it progressed. If this patient would have gotten
the operation because it was available, it would have been a death knell two
years later when he actually acquired the cancer. As
Dr. Wilkes notes above, it is important to follow the advice of your physician
rather than demand a procedure just because it's available.
* * * * *
6. Medical Myths: America Has an Underclass of 47 Million
Poor Citizens with No Health Care
Grace-Marie Turner of the Galen Institute gives us her
experience in Europe and describes their perception of us as uncivilized and
barbaric. The Europeans have no concept of our poor having a better health care
system than their entire socialized state-run system. Very few of our Medicaid
patients have any significant waiting compared to the European, UK and Canadian
uncivilized and barbaric waiting periods. The alleged 47 million without health
insurance are above the welfare level and most choose not to have insurance
because with all the mandates our states impose, it is an increasingly poor use
of money. Here is her recent newsletter. At the URL, you can read more about
the great work that she does at the Galen.
In Rome last week, I debated Italian politicians on
national radio, tried to explain our health system to government and industry
leaders, and spoke at a conference at the Vatican about the fundamental values
of health care and the common good.
Some take-aways: Europeans truly believe that we have a permanent
underclass in the U.S. of 47 million poor citizens who have absolutely no
access to health care. They are shocked at how barbaric we are and that any
civilized country would tolerate such a thing.
When I tried to explain the facts -- through a
translator -- to an Italian senator on RAI radio, he was incensed.
He didn't want to hear that we spend nearly as much as a percentage of our
GDP on public programs -- to cover about one-third of our people -- as many
European countries spend of their GDPs in total on health care. Or that almost
half of our more than $2 trillion in health expenditures are primarily through
these public programs that cover the poor, the aged, the disabled, veterans,
and lower-income children. Or that many of the uninsured are temporarily
without coverage in a system that ties health insurance to the workplace. Or
that the uninsured do get care -- albeit in a far from ideal system -- through
hospitals, private physicians, community health centers, charity clinics, and
other means. Or that Americans value private coverage with its broader access
to new technologies and medicines and faster access to surgeries and
treatments.
It seemed almost as if he wanted people to believe
that there is nothing at all to be learned from Americans so as not to crack
the veneer of socialized systems. To read more,
please go to www.medicaltuesday.net/myths.asp.
Our favorite free-market Italian think tank, the Istituto Bruno Leoni and its dynamic leaders, Alberto Mingardi and Carlo
Stagnaro, arranged the radio interview and a luncheon with government and
industry leaders to provide more detail on how the U.S. system works. Hearing
the details of our complex network of private and public programs, and that the
uninsured cannot be denied care at hospitals, was news to almost everyone there
convinced that Michael Moore was right. Here is a copy of my remarks.
The main reason for my trip to Rome was to speak at a conference
sponsored by the Acton Institute and
the Pontifical Council for Pastoral Health Care at the Pontifical Gregorian University on Health, Technology, and the Common Good.
I said that the common good is achieved by a society
in which individuals are responsible beings in a moral society that
"embraces the truth about the transcendent origin and destiny of the human
person," quoting the Action Institute's important mission statement. This
responsibility extends to our families and communities.
The state purports to assume this role in providing for the common good, but interrupts the
principle of subsidiarity, i.e., not to usurp the proper functions of the
individual, the family, and the doctor-patient relationship.
Pope Benedict XVI wrote in his recent encyclical Deus
Caritas Est, "We do not need a State which regulates and controls
everything, but a State which, in accordance with the principles of
subsidiarity, generously acknowledges and supports initiatives arising from the
different social forces and combines spontaneity with closeness to those in
need."
In a state-controlled system, individual
responsibility in using health care resources most efficiently is replaced by
rationing by the state.
Every country's health care system is unique and each
has its own challenges in moving to a system that respects and supports the
sanctity of the individual. The U.S., while it has many problems that I
described, I believe is further along this path in supporting individual
freedom and rights over health care decisions and destiny. But all countries
have an obligation to look for solutions that move us closer to the goal that
advances the common good by respecting the dignity, the freedom, and the
sanctity of human life.
I am preparing a written transcript of my remarks and
will send you a link in next week's newsletter. Kudos to the Acton Institute,
to its president Fr. Robert Sirico, and the Rome and U.S. Acton teams for
producing this important conference.
www.galen.org/healthabroad.asp?docID=1053
* * * * *
7.
Overheard in the
Medical Staff Lounge: Why Does Medicare Hate Doctors?
Dr. Rosen: Well,
what's the latest on all the physicians that moved out of St George Medical
Center after the 80 percent rent increase starting in June? Anyone getting paid
by Medicare or Medicaid yet?
Dr. Yancy: I
moved out last week. It took me four months to decide where I wanted to go. So
I've gotten paid until last month when I notified Medicare of a change in
address. They want me to fill out a 20-page re-application form as if I was the
new man on the block.
Dr. Patricia: I've
been out three months and no Medicare payment. But I have largely an HMO and
private practice. So I will only experience a 25 percent drop in income. I
think I should be able to survive that.
Dr. Sam: I
moved out within the first month, giving notice as soon as I made arrangements
and gave my 30-day notice in May. So I've been without any Medicare or Medicaid
or co-insurance going on five months. I'm seriously considering dropping out of
Medicare and Medicaid as soon as this fiasco is over.
To read more,
please go to www.medicaltuesday.net/lounge.asp.
Dr. Michelle:
Aren't you concerned about abandoning your Medicare patients?
Dr. Sam:
Certainly. But patients have to wake up to the hostile environment the
government creates in Health Care.
Dr. Milton: It
should be obvious that if the government is getting this vicious with the
physicians who provide the care, can the patients be far behind?
Dr. Rosen: After
four months of non-payment, Medicare sent out a surveillance person to see if I
really had an office and was practicing medicine.
Dr. Michelle: Now,
that really is scary - Medicare cops in our own backyard?
Dr. Dave: I
hope this gives more physicians the incentive to kiss off Medicare. Only if a
critical mass of physicians leave government programs, will we get Medicare
reform or eliminate Medicare and return to efficient low-cost private
healthcare.
Dr. Rosen: But
do we have effective leadership for Medicare reform? Every time the government
does anything, the down side is always a worse program. Just look at Hilary's
plan of 14 years ago. The Republicans put most of that fiasco into the HIPAA
program. So we just traded one intrusion for another.
Dr. Edwards:
You're right. We no longer have an effective counter party to the liberal
Statist party. So both parties are enlarging government and destroying the
practice of medicine.
Dr. Rosen: And
destroying our freedom, the thing that makes our country unique and great.
* * * * *
8. Voices of Medicine: A Review of What Physicians Write
in Regional Journals
VITAL SIGNS, Official Publication of the
Fresno-Madeira Medical Society
NUMBERS + ADVOCACY = STRENGTH, by MOHAMMAD ARAIN, MD, President
Purposeful
survival and progress of any medical society depends on the number of members
and their involvement in day to day workings of the organization.
There
was time when being a member of a medical society directly benefited the
membership. The discount in insurance rates, credentialing of its members and
various contracts with insurance companies, all came with the membership. New
members were anxious to join the society to reap the immediate rewards. With
the evolution of HMOs and emergence of small IPAs, members started getting
their own contracts, many times at much unfavorable terms. Physicians are
inherently poor businessman since they are devoted to their profession and
service to the sick and poor. To read
more, please go to www.medicaltuesday.net/voicesofmedicine.asp.
I have
spoken to many past members and discussed the benefits of joining our medical
society which includes MICRA benefits and legislative support, personal and
practice support, getting to know other colleagues and having a say in the ever
changing practice of medicine.
These physicians either got upset at a trivial
incidence or felt that as long as someone is doing all the work they don't have
to spend their time or money. Nearly 100% of the attorneys belong to their
associations, but less than 35% of the physicians feel the responsibility to be
a member of an organization that relentlessly works to safeguard their
interests. We as physicians have already lost a lot to different interest
groups and are at the verge of losing more. The MICRA bill which saves us
thousands of dollars every year is hanging by a thread (see page 12).
Ordinary clerks and nurses dictate their terms when insurance companies are called
for authorization of a procedure. I will give a small example of their
ignorance. Once I asked for an authorization for repair of a large inguinal
hernia. I was asked if I had exhausted all other medical treatment.
If we don't work together we may be facing the
following situation:
When they
came for the larger medical groups, I didn't care.
When they
came for the specialists with high risk practices, I didn't care.
When they
came with the new laws which take away our freedom of practice and limit payments,
I didn't care.
When they
came for me, I turned around and around and there was nobody left to help me,
and I started working for universal healthcare.
To read the entire
president's message, go to www.fmms.org/pdf/Jul07_VS_Final.pdf.
* * * * *
9.
Book Review:
Communication Gap By John Toton,
MD, Sonoma Medicine, Fall 2007
How Doctors Think, by Jerome Groopman, MD, 320 pages, Houghton Mifflin,
$26.
In How
Doctors Think, the much-published Dr. Jerome Groopman uses multiple case
histories (all of them initially misdiagnosed or mistreated) to highlight the
perceived inability of doctors to think and communicate effectively with their
patients - an issue of great importance in these times of medical stress and
change. Groopman is a reluctant apologist for this issue, and he argues for
corrections that he feels are needed. The case histories he presents are a sad
journal, particularly since - from his perspective - all were preventable.
Groopman also chronicles his own experiences with "aggressive back
surgery" and a long effort to diagnose scaphoid-lunate ligament injury as
the source of his own chronic wrist pain.
After much patient suffering or risky delays, the cases Groopman describes are
almost always resolved by "open communication," including listening,
open-ended questioning, systematic thinking, patient activation and engagement
in the process, and exclusion of good patient-bad patient prejudices. Only
through these methods can the arcane diagnoses of bulimia from celiac disease,
dissecting aortic aneurysm, lymphoma, angina in a healthy athlete, immune
deficiency in a child, and toxicity from an aspirin overdose in an illiterate
patient be diagnosed and successfully treated.
Groopman accepts that we are in a time of rapid change in how we practice the
art and science of medicine. The "older" generation, he explains,
acquired their skills primarily by the Socratic method of sharing knowledge,
questioning and responding, learning from our experience and that of our
mentors, and on-the-job honing of these skills. We trust our experience; we
learn from our errors. We search for the ONE diagnosis that seems to fit the
data and explain the symptoms (Ockham's Razor). We always look for patterns and
similarities so we can shortcut to the diagnosis. From there, it's just a short
leap to developing "confirmation bias," often based on recent
experiences, leading in turn to "diagnostic momentum." As a result,
we sometimes give short shrift to atypical symptoms, especially with alcoholic,
diabetic, or other stereotypical patients. To read more,
please go to www.medicaltuesday.net/bookreviews.asp.
The "younger" generation is in transition, but with much the same
burden. They are taught to depend on algorithms, "diagnostic
certainty," evidence-based diagnosis and treatment, computerized records
and formulas, all available in one nice BOX (PalmPilot or Blackberry). They may
be worshiping the science and ignoring the art of medicine.
Today, Groopman comments, all physicians are challenged to
see more patients faster, like "checking the passengers in the windows of
a train, as you stand watching it speed by, for a one-in-a-thousand
diagnosis." Cost controls, managed care, medical economics, and those
insurance company algorithms that are used to apply a "standard" to
your exceptional case place an even greater responsibility on doctors and
patients to think on the same wavelength.
Pharmaceutical and surgical companies, with perks and advertising, attempt to
influence doctors' and patients' thinking about the care they need or want.
These attempts cause unreasonable demands or expectations that cannot be met
but must be responded to. There is no free lunch, and higher premiums and drug
prices are the predictable result.
Malpractice risk is always in the background of every doctor-patient
interaction, prescription, or treatment. That risk is compounded if there is no
mutual understanding of each others thinking, needs, and issues.
Though Groopman seems to have written How Doctors Think
for a general audience, it may be more appropriately used as a primer for
physicians to focus awareness about problems we have interacting and
communicating with our patients. The case histories Groopman presents emphasize
this issue. However, since his stories emphasize the emotional side more than
the complexities of the diagnostic challenges, I wonder if much of the
importance of his discussion is lost in the tragedy of the patient experiences
he chronicles. . .
To read the entire review, go to www.scma.org/magazine/scp/Fall07/toton.html.
Dr. Toton is an orthopaedic surgeon in
private practice in Healdsburg.
* * * * *
10. Hippocrates & His Kin: A Diabetic saved 95% by
re-using his lancet-needle against advice.
A patient who paid for his diabetic paraphernalia,
glucometer lancets, and testing strips noted that the fancy lancet-needles cost
about one dollar each or three dollars a day if he checked his finger stick
three times a day as was recommended. That calculates out to more than a
thousand dollars a year. He decided to use the alcohol wipes provided to wipe
his fingertip to also wipe the needle on his lancet for re-use. He said he
changed the needle once a month, just like he did his Gillette Mach Three
razor. Thus, he saved more than a thousand dollars a year (365 days x $3 =
$1095; 12 months x $1 = $36 per year; $1095 - $36 = $1059 saved). To read more, please go to www.medicaltuesday.net/hhk.asp.
Physicians and nurses universally criticized this and
stated this was terrible medical practice or the result of lack of government
medicine where all the items are free. However, this one item is an extra
thousand dollars that premiums have to cover if you expect private health
insurance policies to cover, or $1000 in taxes if you want the government to
cover it.
Also, this patient did this on his own. He had health
insurance, but stated this was his effort to keep health costs under control.
Also, he's been doing this for over a year and has not had a single hint of
infection in his fingers as a result of reusing single-user needles. Such
savings maneuvers will never be found in any treatment or best practice
protocol or any algorithm designed by physicians or bureaucrats.
People left to their own ingenuity will save money in
mysterious and unconventional ways. Government regulation will eliminate such
savings and will always cost more. When we have a national health plan, costs
will easily double which means taxes will double and waiting lists will prevent
access to care as experienced in Canada, UK, Europe and all socialized
countries.
No One Can Pay Late Except
The Government.
Wal-Mart is being sued
$millions because it did not pay for lunch breaks or a few minutes of extra
work here and there. One suit was settled for $500 in damages for each instance
of not getting paid within one month.
In Sacramento, many of the
doctors moved out of an office building when the rent was increased by 80
percent. Since these doctors haven't been paid by Medicare going on 200 days,
why can't they get the same $500 damages for each instance of nonpayment? At 10
Medicare patients a day for 200 days, or 2,000 instances of nonpayment at $500
per instance, wouldn't that fine equal about $1 million in damages if the
government treated doctors the same as Wal-Mart employees?
When will doctors understand
that the government bureaucrats simply hate us? When will we begin reality
thinking and eliminate government healthcare?
Picture Headlines: A US Airways Boarding Area: Arrivals Bad to
Worse
With one in four flights
arriving late this year, the government is talking tough. Officials are
considering forcing carriers to shrink their flight schedules or pay more to
fly during peak travel periods, though the traveling public could end up with
higher fares as a result. Why not a non-government mandated solution?
After I experienced four
missed flights on America West and then US Airways because of delays with two
unscheduled overnight delays, I simply quit flying the airline. If everyone
that was inconvenienced did the same, the problem would be resolved in an
amicable rather than a hostile and costly manner. Either the airline would get
its act together, or it would go out of business. The problem would then be
solved. It would not require expensive government interference, lawsuits or
higher fares. It would save us all money.
You have to remember: If you
send an attorney, brotherly love goes out of the window, human kindness takes a
powder, things get expensive at $300 per hour on each side of the Judge's
bench, and the end result is never pleasant and usually worse. It's like sending
in a Doberman or a Rottweiler - those guys get vicious.
The freedom to choose allows
almost all disagreements to be resolved amicably. Government disagreements and
actions always end in hostilities and eliminate brotherly love.
How Can a Community Become a
City Without Any Industry or Revenue?
There's been a spate of
local communities around Sacramento trying to become cities. Citrus Heights is
one of the more recent. Without any industries, a major source of revenue
becomes the speed traps allowing citations and multiple arrests. When this
wasn't enough, they adjusted their speed limit lower than the cities on either
side and they began citing dozens, as documented on a local news program.
To speed up the city-hood
incorporation process of other small bedroom communities between Sacramento and
Carmichael, cities are making contributions of their taxpayer funds. The Sac
BEE reported that Citrus Heights gave $15,000. Using a law based on the
prohibition of governmental bodies from making gifts of public funds, action is
being brought against this free-for-all of taxpayer dollars being used as
bureaucratic gifts.
Taxes Are the Free Spending
Bank Accounts for Bureaucrats.
* * * * *
11. Organizations Restoring Accountability in HealthCare,
Government and Society: