MEDICAL TUESDAY . NET
Community For Better Health Care
Vol IX, No 11, Sept 14, 2010
In This Issue:
11. Related Organizations: Restoring Accountability in HealthCare, Government and Society
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The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 8th Annual World Health Care Congress will be held April 4-6, 2011 at the Gaylord Convention Center, Washington DC. For more information, visit www.worldcongress.com. The future is occurring NOW.
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1. Featured Article: Headgear became mandatory in baseball 51 years after a player was killed
Take Me Out of the Ball Game, By Steve Mirsky, Scientific American, August 2010
Physics and medicine are the biggest players on the diamond
Baseball is a game of trajectories. And as Yogi Berra supposedly said, you can observe a lot just by watching. For example, at Yankee Stadium on May 29, I observed New York slugger Alex Rodriguez hit a pitch by Cleveland Indians David Huff back up the middle and off the pitcher's head. In fact, the ball hit Huff's head so hard that it rolled nearly all the way to the right-field wall. The ball, that is, not Huff's head. He collapsed in a heap and remained face down on the mound for several minutes. Huff eventually left on a stretcher. Home team fans who then watched the Yankees blow a six-run lead left in a huff.
Anyway, many in the crowd feared that Huff was seriously injured. Having observed physics teachers years earlier, however, I was guardedly optimistic—precisely because the ball had ricocheted so far and so fast. Had the ball rebounded from Huff's dome only a few feet straight back toward home plate, I would have been concerned that the poor pitcher had become the second player in major league baseball history to be killed on the job. In that scenario, much of the ball's energy of motion would have been imparted to the pitcher. But said energy appeared to have been expended on sending the ball skittering into the right-field corner, with only a small amount having been transferred to Huff's head.
Indeed, after being checked out at nearby New York–Presbyterian Hospital, Huff returned to the scene of the bean, seemingly little the worse for wear, before the game was even over. He was helped in this effort by the fact that the 13–11 Indians win took an excruciating four hours and 22 minutes, which felt much longer for those of us near the event horizon.
(The only man killed playing major league baseball is Cleveland Indians shortstop Ray Chapman, who, after being struck in the temple by a pitch from Carl Mays of the Yankees in 1920, never regained consciousness. A scant 51 years later the powers-that-were made protective headgear mandatory.)
On the same afternoon as A-Rod's double off Broca's area, a far more serious injury was sustained by Kendry Morales, first baseman for a team somehow seriously referred to as the Los Angeles Angels of Anaheim. Morales hit a game-winning grand-slam home run in the bottom of the ninth, trotted around the bases, leapt onto home plate and shattered his left ankle. He'll need surgery and could miss the rest of the season. Morales is still lucky compared with other world-class athletes that after similar injuries used to be taken out back and shot and more recently are euthanized by large-animal veterinarians. . .
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2. In the News: Senators seek coverage for alternative therapies
The Boston Globe, By Michael Kranish
WASHINGTON - Naturopathic doctors, herbal healers, mind-body specialists, and acupuncturists often have been scorned by the US medical establishment, but growing numbers of Americans are seeking such care, and now an influential group of US senators believes the time has come to embrace an array of alternative therapies.
Senator Tom Harkin, an Iowa Democrat who is a longtime supporter of nontraditional medicine, is at the forefront of the effort to win insurance coverage for such providers as part of national healthcare legislation.
"It's time to end the discrimination against alternative healthcare practices,'' Harkin said at a congressional hearing.
Harkin is the cosponsor of an amendment that says healthcare plans will not be allowed to "discriminate'' against any healthcare provider who has a license issued by a state, an amendment Senate aides said was designed to provide coverage for alternative medicine. Backers of the amendment say it could save tens of billions of dollars in the long run by providing less expensive and better alternatives to drugs and surgery in a variety of cases. The amendment was adopted by a Senate committee writing health legislation, but details are still being negotiated.
With hundreds of disciplines falling under the general category of alternative medicine, and with a variety of sometimes-conflicting studies about their effectiveness, there is much disagreement about the value of including such providers in a national health insurance program.
State by state, there is a wide disparity of coverage of alternative medicine. For example, Massachusetts licenses acupuncturists, and many health insurance plans cover the service, but most do so only on a limited basis, by restricting the number of visits or the dollar amount of coverage. . .
Dr. Harriet Hall, a retired Air Force flight surgeon who examines medical claims for Skeptic magazine, said she worries that ill-informed members of Congress will elevate practitioners of alternative medicine to the same level as medical doctors.
"If it were shown to be truly effective, it would be part of regular medicine,'' she said.
Nonetheless, the federal government has become increasingly involved in the field, funding the National Center for Complementary and Alternative Medicine at the National Institutes of Health, and states are increasingly being lobbied by providers to receive formal approval for the field. . .
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3. International Medicine: Organs of 50 NHS donors are sold to foreigners who pay £75,000 each
Organs of 50 NHS donors are sold to foreigners who pay £75,000 for each operation. By Daniel Martin
Organs from British NHS donors are being given to private foreign patients ahead of desperately-ill Britons, it was revealed last night.
Some 50 livers were given to patients from Cyprus, Greece and other countries last year, even though 259 British patients were waiting for life-saving transplants.
The figures uncovered by freedom of Information requests, triggered outrage. Professor Peter Friend, president of the British Transplantation Society, said: 'While there is a surfeit of UK residents awaiting transplant they should have a priority.
'Were the situation such that there were organs that were not required, it would be appropriate to make them available to other nationals. We do not have a European organ donation system - it is a UK system and I feel the system is there essentially for the benefit of residents of the UK.'
Jane Dodd, whose nine-year-old daughter Rebecca died while waiting for a liver transplant, said: 'Organs donated in this country should go to people from this country. If you sign a donor card in this country you expect someone from this country to get the organ.' . . .
Foreigners pay around £75,000 for a liver transplant. The money is shared between the transplant surgeon, who may get around £20,000, and the hospital trust. The money does not pay for the organ itself, but for hospital accommodation and pre- and post-operative care.
Livers which become available are allocated on the basis of clinical need and blood group, not ability to pay, and the decisions are made by doctors.
But campaigners said it was indefensible that organs should be given to foreign patients when they could save a Briton.
European law says all patients have the right to seek treatment in other EU countries. But it does not say British trusts have to treat them.
Among those that do give EU residents equal transplant access is King's College Hospital in London, which gave livers from British donors to 19 overseas patients last year, and the Royal Free in Hampstead, which gave four.
A spokesman for King's College Hospital said: 'Citizens of the European Union have the same entitlement to treatments under the NHS as UK patients, under European law.'
The documents show that 40 livers were given to people from Greece and Cyprus last year, with a further three going to Malta and the Czech Republic.
The rest went to people from countries outside the EU - livers can be given to non-Europeans only if they are deemed to be not of good enough quality for British patients.
Overall, almost 8,000 Britons are on transplant waiting lists and some hospitals are giving them priority. Dr Mervyn Davies, consultant hepatologist at St James's University hospital in Leeds, said: 'There is a shortage of donors and the system cannot cope with UK demand as it is.' . . .
The National Health Service is Fertile for Graft
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4. Medicare: 3M to Change Health-Plan Options for Workers
3M Co. confirmed it would eventually stop offering its health-insurance plan to retirees, citing the federal health overhaul as a factor.
The changes won't start to phase in until 2013. But they show how companies are beginning to respond to the new law, which should make it easier for people in their 50s and early-60s to find affordable policies on their own. While thousands of employers are tapping new funds from the law to keep retiree plans, 3M illustrates that others may not opt to retain such plans over the next few years.
The St. Paul, Minn., manufacturing conglomerate notified employees on Friday that it would change retiree benefits both for those who are too young to qualify for Medicare and for those who qualify for the Medicare program. Both groups will get an unspecified health reimbursement instead of having access to a company-sponsored health plan. . .
"In addition, health care reform has made it more difficult for employers like 3M to provide a plan that will remain competitive," the memo said. The White House says retiree-only plans are largely exempt from new health insurance regulations under the law. . . .
Sen. Charles Grassley, an Iowa Republican, said that "for all the employees who were promised they'd be able to keep their current benefits after the health-care law passed, I'm worried that the recent changes we've heard about...are just the beginning."
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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5. Medical Gluttony: Gluttony is "Business as Usual"
An English-born wife of a GI with breathlessness asks, "Why don't American's like to pay taxes?"
After regaining my composure, I asked her if she paid taxes. She replied that she was too poor to pay taxes. The government was not paying her enough in living expenses to live comfortably nor was the government paying enough of her medical and homecare expenses. She felt she needed a nurse daily for most of the day to help manage her medications and help with the breathing treatments. Not only that, she had difficulty in making her bed and meals and would like a maid to help her with her cooking and laundry, which she had difficulty doing without getting short of breath. All her American friends also had cleaning ladies and she felt she needed one also. Why should a sick lady have to do her own housework? There are a lot of women out there looking for a job and the government should help them and her by paying them to be her nurse, cook and do laundry and be her housemaid and cleaning lady.
But wouldn't that be three more workers on government salaries? Do you think that all 35 million Medicaid patients need three helpers?
She surmised that probably only half of them needed three helpers. Most of them probably only needed one or two.
If half of the 35 million needed three helpers and the other half only needed one or two, more than 50 million people would have to work for the Medicaid (welfare) recipients. That would be a lot of jobs to take care of sick people.
Well, the government can afford it if the Americans would just pay more taxes. That would also help give poor people jobs.
Then you wouldn't get the exercise you need to maintain your strength and keep your muscles in shape?
Medicaid should send me to physical therapy for that. If I don't have the strength to go in for PT, then the physical therapist should come out to my house at least three days a week to massage and work my muscles to keep them in good shape.
Wouldn't it make more sense to keep your muscles in shape by walking around the house and doing your own chores? Don't you have time to make your own bed even if it takes twice as long as it used to?
That makes me too tired to do anything. If the physical therapist did that for me, I wouldn't always get so exhausted.
If the President is able to put another 35 million semi-poor people into Medicaid, wouldn't those 70 million Americans make a hundred million more jobs? Wouldn't that pull us out of the recession?
Entitlements are implemented, they will always grow until we self-destruct.
Obama's father felt a 100% income tax would be good as long as the government took care of everyone's needs.
Medical Gluttony thrives in Government and Health Insurance Programs.
It Disappears with Appropriate Deductibles and Co-payments on Every Service.
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6. Medical Myths: ObamaCare is not "socialized medicine."
Myth 30. Healthcare reform is not "socialized medicine."
Many critics of the Democrats' "healthcare reform" call it "socialized medicine." Advocates respond, condescendingly, that since the government would not own the means of production, and physicians would not be salaried by the American equivalent of the British National Health Service, this is not socialism. Physicians and hospitals would still be "private," as in Canada.
So let's work backward: Start with the definition, then think of the word. These are the characteristics of the plan. It is: (1) compulsory; (2) redistributive; (3) collectivized; (4) centralized; (5) dictatorial; (6) oppressive; and (7) intrusive.
Even if there is a means of opting out and seeking private care, everyone will be forced to pay, either through "premiums," taxes, or both.
Effective premiums, net of subsidies, will be based on income, and are thus a mechanism for redistributing wealth.
Not only is payment collectivized. The whole ethic of medicine is to be transformed. Physicians are to be held responsible for optimizing the health of the state, and patient care is to be prioritized on that basis. The individual patient may be sacrificed to the good of the whole.
Planning is to be centralized. Thousands of decisions will be delegated to the Secretary of Health and Human Services or other unelected federal executive agencies.
Decisions will be immune from administrative or judicial review, as well as from political influence. The power of the Secretary or Board is supreme and absolute.
Everyone will be subject to constant reporting requirements: to the IRS for determining premiums, subsidies, and compliance with purchasing requirements—and to "health plans" for determining "eligibility." Before each and every encounter, the plan's infrastructure will enable a decision about whether a particular patient is "eligible" to receive a particular treatment from a particular provider at a particular time—as well as the charge and the responsibility for payment. Penalties for failure to report, or inaccurate reporting, are very severe. Clearly, "universal coverage" does not mean universal access to care, but rather barriers and checkpoints at every step.
To enable the detailed calculus of benefits and payments, monitoring will be very intrusive—hence the requirement for everyone to have an electronic "health" record, which could include practically anything of interest to the government, including gun ownership or political attitudes.
The Democrats' "reform" empowers the federal government to control all Americans, whether as patients or medical professionals—and one-sixth of the economy. As most people are willing to spend their last dime for medical treatment that could relieve pain or extend their lives, what better source for extracting the revenue to keep the bankrupt federal government, with its 20 million mostly overpaid employees, functioning for a few more years?
The plan fulfills the fundamental axiom of socialism: from each according to his means, and to each according to his need, with terms defined by the central planners. "Socialized medicine," however, does not adequately describe this plan. It is even more audacious than a Ponzi scheme, as it attempts to postpone the real emergency—the day of reckoning for earlier Ponzi schemes—beyond the next election.
The word is "tyranny."
Medical Myths originate when someone else pays the medical bills.
Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.
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7. Overheard in the Medical Staff Lounge: Progressive/Regressive/Socialistic: It's All the Same
Dr. Rosen: Some of the socialistic members of our staff have complained that we have not been discussing any progressive ideas in our newsletter of late.
Dr. Paul: Yes, why haven't you?
Dr. Rosen: Our entire Newsletter is Progressive. Maybe not in the sense that you think of progressive as wide-open travel in any direction you wish, but always onward.
Dr. Paul: No, I think you're going backwards. Conservatives always look and go backwards.
Dr. Rosen: We always move in a well thought out forward direction. Therefore, we make more progress in moving forward than what you consider progressive or Liberal.
Dr. Paul: We wouldn't have any of the modern programs that the rest of the world considers humane, such as Social Security, Medicare, Medicaid and now ObamaCare.
Dr. Rosen: We need the government to protect us, not to take care of us.
Dr. Paul: The government should do both.
Dr. Rosen: Unfortunately, the government can't do both. If they try, they will be found wanting in both.
Dr. Paul: That's because you want to spend so much on the military. We should reduce the size of our military, our arsenal, and just protect us.
Dr. Milton: But it's the Liberals, or Progressives, or I agree with Rosen, the Regressives that want to spend so much on the social programs that we will no longer are able to protect ourselves.
Dr. Edwards: We could perhaps do what Paul wants by just protecting our shores if we had implemented "Star Wars."
Dr. Paul: How's that?
Dr. Edwards: If Reagan's Star Wars had been fully developed and implemented, we would be able to detect any foreign missile headed in our direction, and send a Star War Missile to blow it up before it reached the United States and destroyed Washington DC or New York or wherever it was headed.
Dr. Paul: Aren't you unrealistic? Russia and China would follow suit.
Dr. Edwards: That wouldn't matter. Even President Reagan stated that once we had our Stars Wars up, we should share the technology and let them develop the same Star Wars. That would show them we had no aggression in mind, only protection from would-be enemies.
Dr. Paul: If we weren't fighting the Bush Wars now, we'd have plenty of money for Medicare, Social Security, Medicaid or whatever was necessary.
Dr. Edwards: Now, you're being unrealistic. When the government protects us, there is an end in sight, like the World Wars, and we all go home and pay off the War Debts and enjoy prosperity. When the government tries to take care of us, there will never be enough. Every Medicare, Medicaid, Social Security and Welfare recipient thinks they need twice their present benefits. Or three times. Greed has no limit. More will never be enough. Our social debt exceeds any War Debt we've ever had. It's time to get our priorities in order.
The Staff Lounge Is Where Unfiltered Opinions Are Heard.
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8. Voices of Medicine: Universal Access to Medical Care: It's Like a Freeway
By Jane M. Orient, MD, Exec Dir, AAPS
Wouldn't it be wonderful to have all the medical care you needed or wanted, without ever worrying about the bill?
And wouldn't it be wonderful to drive to work every day without ever paying a toll or stopping at a red 1ight? "
The second question usually provokes much more critical thought than the first. Before people vote the money to build a freeway through their downtown, a lot of inconvenient objections are raised.
The first is this: Do we want to tear up the main business district of town?
The idea of "comprehensive health care reform" to "assure universal access" should stimulate the same thought process. To build such a system, you start by destroying the insurance and medical system that we already have.
Remember what happened in 1965. Before Medicare was enacted, the majority of senior citizens had insurance. After Medicare, they just had Medicare. Their private insurance policies were all torn up.
At first, that seemed okay, or even wonderful. Everybody seemed to be getting more for less, or even for free. Now, 1edicare is bankrupt, and we're just beginning to see the effects of government rationing; It's as if we built an Interstate into every town and hamlet and then stopped repairing the bridges.
When we build a freeway, we don't necessarily destroy all the other roads. In Britain and Germany, private medicine is allowed to coexist with nationalized medicine. But in Canada, it isn't. If you're a Canadian and want something the government isn't willing to pay for, or you want it now instead of three years from now, you have to go to the United States.
A lot of proponents of "universal access" want to close the private escape hatch. They want no other roads-just the freeway. Of course, there may be some back alleys or secret tunnels or special facilities for Congressmen, but those won't provide American-class medical care to ordinary folk.
Some think we don't need other roads if we have a freeway. But remember what a freeway is: a controlled access road.
That's what "universal" access means too. Sure you have the right to get on the freeway, just as you have the right to medical care in Canada (or the right to comprehensive care in the US if you belong to a "managed-care" plan), But you can only get on the freeway from the on-ramp. There is no tollgate or stoplight—but the traffic might be backed up for miles and moving at a rate that is barely more than 0 miles per hour. (Have you ever been on the Santa Ana Parking Lot when everybody's trying to get to Disneyland?)
In Canada, you don't have to pay to get medical care. In fact, you are not allowed to pay.
Once the global budget is reached in Canada, that's it. The on-ramps are closed. It doesn't matter if you have money. Hospital beds are empty for lack of money to pay nurses, and CT scanners sit idle all night for lack of money to pay a technician. But if some people are allowed to pay, Canadians fear that some people might get better care than others.
(This concern does not apply to dog owners. They can buy a CT scan for their dog, but not for themselves.)
American "managed care" plans—a favorite model for would-be reformers—resemble the Canadian system in that patients don't have to pay at the time of service. (At least, they don't have to pay very much.) But they do have to go through the gatekeeper, who keeps a sharp eye on the budget.
Unlike the people in toll booths on the New Jersey Turnpike, managed-care gatekeepers don't collect the toll. But that doesn't mean that nobody pays.
Even if we abolish payment at the time of service, medical care must still be paid for. The choices are to pay in advance, or to pay later. With government programs, we often borrow money and commit our great grandchildren to pay. If we had a system like Canada's, we'd probably also have a national debt like Canada's (the equivalent of $6 trillion in 1993).
Another problem with the freeway is that you can only go where the freeway goes. If there's a roadblock at your exit, you can't take that exit.
Countries that promise "universal access" are pretty good at paying for well-baby checks and vaccines and doctor visits for the common cold. Those are exactly the things most people should be able to afford for themselves.
The roadblocks are at the exits that lead to the hospital. The global budgeters "contain costs" (put the lid on spending) by denying those things that you do need insurance to pay for: heart surgery, radiation treatments for cancer, hip replacements, things like that. Out of "compassion," reformers may open another exit: the one that leads to the cemetery. Do you think it's accidental that euthanasia and "universal access" are on the agenda at the same time?
Many communities are pretty good at voting down freeways. They should vote this one down too.
Here's a word for universal access to high-quality medical care at an affordable cost, all courtesy of the IRS and other government agencies: it is a fantasy.
If you want to see reality, don't look at Disneyland. Look at the Santa Ana Freeway.
Dr. Orient practices private medicine in Tucson. She is also Executive Director of the Association of American Physicians and Surgeons. www.aapsonline.org/
Editor's note: This was written during the last effort for Universal Health Care by Hilary Clinton and appears as relevant today as 17 years ago. Reality does not change.
VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about.
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9. Book Review: Taking Back Healthcare for Future Generations
A CALL TO ACTION –Taking Back Healthcare for Future Generations, by Hank McKinnell, McGraw-Hill, New York, Chicago, San Francisco © 2005, ISBN: 0-07-144808-X, 218 pp, $27.95.
Hank McKinnel, Chairman & CEO, Pfizer, opens the preface with the question, "Is our healthcare system really in crisis?" He finds the question difficulty to answer because it makes a presumption he doesn't accept. The phrase with which he has trouble is "healthcare system." He agrees there's a crisis, but it isn't in "healthcare"- it's in "sick-care."
He quotes Mohandas Gandhi who had similar difficulty in 1932. He had led a campaign of non-violent disobedience to help colonial India win independence from Britain. After being named Time magazine's "Man of the Year," Gandhi visited London for the first time. The entire world was curious, the press swarmed wherever he went, when one reporter's hastily called-out question became a defining moment, both for him and for the nation, he was trying to set free.
"What do you think of Western civilization?" yelled the reporter.
"I think it would be a good idea," replied Gandhi.
That's what McKinnell thinks about our healthcare system: It would be a good idea.
He maintains we've never had a healthcare system in America. As far as he can tell, neither has any other nation. What we've had - and continue to have - is a system focused on sickness and its diagnosis, treatment, and management. It's a system that is good at delivering procedures and interventions. It's also a system focused on containing costs, avoiding costs, and, failing all else, shifting costs to someone, anyone else. In fact, discussions about better health now take a back seat to arguments about costs. In the United States, a nation already spending nearly $2,000,000,000,000 a year on sick care, tens of millions of people do not have adequate access to the system. In other developed nations, rationing and price controls undermine the patient-physician relationship, degrade the quality of care, and add to the anxiety of individuals struggling with health issues. An aging population around the world clamors for relief from chronic diseases and the cumulative effects of heredity and lifestyle behaviors. Some of these we cannot as yet prevent. Others, such as smoking, we can.
Today, in healthcare, we have it entirely backwards. We're like a community that builds the best fire-fighting capability in the world but stops inspecting buildings or teaching kids abut fire prevention. Fighting fires is sometimes necessary, and we must be prepared to do that with the most modern technology available. But firefighters around the world will tell you that they'd rather prevent fires than fight them.
To put it simply, McKinnell feels that our fixation on the costs of healthcare - instead of the costs of disease - has been a catastrophe for both the health and wealth of nations. By defining the problem strictly as the cost of healthcare, we limit the palette of solutions to those old stand-bys - rationing and cost controls. What if we reframe the debate and consider healthcare not as a cost, but rather an investment at the very heart of a process focused on health? Then other solutions suddenly appear out of the fog.
That's why this book was titled A Call to Action. It represents McKinnell's conviction that the debate on the world's healthcare systems is on the wrong track. Unless we correct our course, we will not be able to make the same promises to our children and grandchildren that our parents and grandparents delivered to us: that you will receive from us a better world than we received from our forebears. He feels that the basic bio-medical research conducted by his company is doing just that. But he's concerned that his and other research-based pharmaceutical companies might lose the capacity to advance the science that can change the lives of our children and grandchildren for the better, just as polio vaccines and cardiovascular medicines and other therapies changed out lives.
McKinnell doesn't believe in surprise endings. Although he loves a good mystery, this book was not meant to be one. The first phase of his book sets up its basic theme - that when our most cherished support systems are at risk, we are called to rethink our most well accepted assumptions. Everywhere in the developed world, people are dissatisfied with the healthcare their families are receiving. The near universal experience is that healthcare is increasingly unaffordable, fragmented, and impersonal. Thus, the first third of the book details the proposition that the current system is profoundly misfocused in three ways. It is preoccupied with the cost of healthcare, it defines the provider as the center of the system, and it regards acute interventions as its primary reason for existence. . .
The Book Review Section Is an Insider's View of What Doctors are Reading about.
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10. Hippocrates & His Kin: The Power of Language
Jerry Rubin, one of the Chicago Seven, said: "The power to define the situation is the ultimate power." This explains how managed care is covertly seeping into physicians' minds and spirits. A rose may smell as sweet when called by another name, because the rose is not affected by what people call it. However, language profoundly affects how people think about themselves and others. The term "provider" does not even imply that one is a human being. It does imply that one provider is equivalent to and interchangeable with any other provider, and is an insensate object to be manipulated and used.
Do not allow yourself to be called a "provider." -Karen Shore, Ph.D., excerpted from speech to American Psychological Assoc, by the AAPS.
Singing to the Choir
The Financial Times reports that President Barack gave a Prime Time address from the Oval Office on September 1, 2010. In regards to the response, Edward Luce of the FT thought he may have gotten a better response if he had talked on "Stamp Collecting."
Do you suppose that Stamp Collectors would be listening?
Why aren't foundations interested in Freedom?
Congressman Reece was squarely on target in his characterization of tax-exempt foundations as being far left. A superb example of that left-wing influence was the role of a foundation in dismembering an outstanding conservative department of economics at the University of Virginia in the 1960s (see W Breit, Economic Inquiry, Oct 1987). Academic freedom succumbed under the leftist foundation influence, forcing future Nobelists James Buchanan and Ronal Coase to depart to George Mason University and the University of Chicago, respectively.
Tax-exempt foundations are far too important for conservatives to leave to the left. -Lawrence Cranberg, PhD, Austin, TX.
The most common cause of disagreement between physicians and Medicare concerns the definition of medical necessity. Every visit involves the choice: think first of the patient, or of the system. Seldom can the two needs be met simultaneously. Opting out [of Medicare] allows the physician to place patient care ahead of the federal regulation.
It empowers him to practice medicine once again. -Robert G Schwartz, MD, Greenville, SC, excerpted from Health Freedom Watch, May/June 1998, by the AAPS.
and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Today & Tomorrow
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• The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports. This month, read the informative article on how Chile's 1981 Social Security Reformed saved their Social Security Benefits.
• Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog. Be sure to read Sally Pipes on The Truth About ObamaCare.
• The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government. This month, treat yourself to an article Veronique de Rugy: Stimulus Spending and Unemployment.
• The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business.
• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly HealSth Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels. This month, you might focus on The consequences of government involvement in health care have become more and more apparent as people have become informed about what the health overhaul law would do. No longer does the government seem to be a fairy godmother but rather a tough enforcer of an avalanche of new mandates, taxes and regulatory requirements.
• Greg Scandlen, an expert in Health Savings Accounts (HSAs), has embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the initial series of his newsletter, Consumers Power Reports. Become a member of CHCC, The voice of the health care consumer. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn. Greg has joined the Heartland Institute, where current newsletters can be found.
• The Heartland Institute, www.heartland.org, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?. This month, with 35 million Medicaid recipients having difficulty finding a physician and Obama placing another 35 million into Medicaid, be sure to read Trapped in the Medicaid Ghetto.
• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Lawrence W Reed, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. Be sure to read the current lesson on Economic Education: The Rise of Government and the Decline of Morality.
• The Council for Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse."
• The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter. Read the latest: 9 of 10 companies anticipate their insurance will be banned.
• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read Libertarians Don't Support Free And Unrestricted Abortion.
• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section.
• The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission was to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. -- However, since they supported the socialistic health plan instituted by Mitt Romney in Massachusetts, which is replaying the Medicare excessive increases in its first two years, and was used by some as a justification for the Obama plan, they have lost sight of their mission and we will no longer feature them as a freedom loving institution and have canceled our contributions. We would also caution that should Mitt Romney ever run for National office again, he would be dangerous in the cause of freedom in health care. The WSJ paints him as being to the left of Barrack Hussein Obama. We would also advise Steve Forbes to disassociate himself from this institution.
• The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. You may also log on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to be an MD today.
• CATO. The Cato Institute (www.cato.org) was founded in 1977, by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio, articles and books at www.cato.org/people/cannon.html.
• The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.
• The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]
• The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, wartime allows the federal government to grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St. Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in wartime, we have to push for limited government - while giving the government the necessary tools to win the war. Robert L. Wichterman warns us, in "Radical Islam Fights On," that radical Islamists remain at war with us. Be sure to read Herbert London: In "The Rise and Fall of a President," he considers why the Democrats lost the midterm elections; in "A Tea Party Beyond Boston," he assesses the grass roots movement. To read a variety of articles in this arena, please go to www.stcroixreview.com.
• Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read Amity Shlaes The Rules of the Game and Economic Recovery at www.hillsdale.edu/news/imprimis/archive/issue.asp?year=2010&month=09. The last ten years of Imprimis are archived.
"Make all you can; Save all you can; Give all you can." -John Wesley, Founder of Methodism
"Who does not economize will have to agonize." -Confucius
"The best way to appreciate your job is to imagine yourself without one." -Oscar Wilde
A wise and frugal government, which shall leave men free to regulate their own pursuits of industry and improvement, and shall not take from the mouth of labor the bread it has earned - this is the sum of good government. -Thomas Jefferson
On This Date in History – September 14
On this date in 1814, Francis Scott Key Wrote "The Star Spangled Banner." Very early in the morning on this day in 1814 words were written that have been uttered at more meetings in the United States than any other phrase known to man. The words of "The Star Spangled Banner" was written by Francis Scott Key in Baltimore Harbor as he watched and waited to see whether the flag would still be there to signal that the United States had turned away the British invaders in the War of 1812. When the words, "Oh say can you see, by the dawn's early light," were written, the British had burned our national capitol in Washington. If they had they succeeded in taking Baltimore, that might have been the end of the United States of America. But the rockets' red glare, bombs bursting in air, gave proof through the night that our flag was still there. . . The United States went on and won two world wars when politics intervened preventing us from winning the wars in the 1950s, 1960s, and the current two wars, which could be won if we wanted to win.
On this date in 1849, Ivan Pavlov, the scientist who pioneered in the study of conditioned reflexes was born in Ryazan, Russia. It was Pavlov who showed how animals could be trained to react in specific ways to specific signals, a dog responding to a particular ring of a bell.
After Leonard and Thelma Spinrad
IN THE 1930s many, if not most, of the graduates from the Southern California School of Architecture ended up wandering the backlots of Hollywood studios. Robert Boyle was one of them. He had dreamed of building apartment complexes, corporate headquarters, modernist town halls. The Depression wiped out the need for any of those.
Instead he found himself supervising the construction of a full-scale model of the arm and torch of the Statue of Liberty for "Saboteur" (1942), on which Robert Cummings and Norman Lloyd could confront each other with deathly smiles while the East river crept below; the whole range of presidential heads from Mount Rushmore, big enough for Cary Grant and Eva Marie Saint to clamber across the brows of, for "North by Northwest" (1959); a lush bordello and a chunk of the Loop for "Chicago, Chicago" (1969); and a quaint shtetl of leaning wooden shacks, hencoops and carts for "Fiddler on the Roof" (1971). The closest he came to the architecture of his college days was the book-lined cantilevered house, allegedly by Frank Lloyd Wright, which was inhabited by silky-smooth James Mason in "North by Northwest". Wright fans were disappointed to be told it did not exist.
The job of art director was then new in cinema. Before the 1930s movies needed little more than a theatre prop-and-set man, but now they were acquiring a "reality" of their own that called for a look and a mood. Mr Boyle's job, in his words, was to control the space in which the film was set. He had to infuse the emotional and psychological requirements of the screenplay into buildings, landscapes, rooms. Ruts in a road, clutter in a house, the paint on a wall, would evoke layers of living and feeling over the years. He had to present all this as real and then, by subtle placing of objects and use of light, draw viewers to see the scene as the director wished them to.
Most directors gave him merely a script and an outline. He worked for many over the years, on films ranging from "Cape Fear" to "Abbott and Costello go to Mars", but it was Hitchcock, he said, who taught him what he knew. At their first meeting in 1941 he found him at his desk making drawings on a little scroll of paper, and was invited, awestruck as he was, to sit down opposite and do the same. It seemed to be a sort of test. Hitchcock, who already held every shot in his head, drew stick men, all to proper image size, and Mr Boyle understood that his job was to give the story an atmosphere that would seem to wrap the figures round, be part of them, and contain their histories, as a small child could make a stick man represent all he felt and knew about mother, brother or friend.
Later, to show what this had led to in "North by Northwest", he would draw two lines meeting at a point with a stick figure standing midway on either side. Nothing else. Thus was born the scene of Roger Thornhill and the Stranger on a road in northern Indiana, actually California, in a landscape almost as blank and psychologically disturbing as white paper, remarking to each other how odd it was that a plane should be crop-dusting, when there were no crops.
Location shooting became the norm over the seven decades Mr Boyle spent in the trade. He had trouble with it, because no place could ever be exactly right for him. He toured Europe before lighting on Croatia as the setting for Norman Jewison's "Fiddler on the Roof", and even then the silhouetted buildings in the opening sequence, as dawn broke over bare "Ukrainian" fields, had been designed and built by Mr Boyle from his own charcoal sketches, in the style of van Gogh and Chagall. Reality, in cinema, was not truthful unless it was entirely controlled by him.
His fishing-town of Bodega Bay in Hitchcock's "The Birds" (1963) could also never be found in one place. It had to be put together from half a dozen towns, a church from here, a school from there, supplemented with mock-ups, masking mattes, blue- and yellow-screen and back-projection. Many of the most terrifying shots in "The Birds" were achieved by filming seagulls from high cliffs and hand-painting each frame on to mattes. Computers, he admitted, might have helped; but he preferred building and layering. The fire in Bodega Bay was a montage of mattes of houses, smoke and birds, with only the fire, in the backlot at Universal, really burning. All through Mr Boyle kept in mind the image of Edvard Munch's "The Scream". . .
He might have gone several different ways in his life. Painting attracted him: in the late 1930s, in Mexico, he had spent his Sunday afternoons with Diego Rivera and Frida Kahlo. In the war he was a combat cameraman, in France and ruined Berlin, for the Army Signal Corps. And then there was architecture, his first love. But after only a little time in Hollywood he had fallen for a different kind of constructive art, the building of "truth" with "magic", and never looked back.
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Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single payer initiative, or any entitlement, was born for the benefit of the state and of a contemptuous disregard for people's welfare.