MEDICAL TUESDAY . NET |
NEWSLETTER |
Community For Better Health Care |
Vol IX, No 11, Sept 14, 2010 |
In This Issue:
1.
Featured Article:
How Protective Headgear became mandatory in baseball
2.
In
the News: Senators
seek coverage for alternative therapies
3.
International Medicine: Organs of 50 NHS
donors are sold to foreigners who pay £75,000
4.
Medicare: 3M
to Change Health-Plan Options for Workers
5.
Medical Gluttony:
Gluttony is "Business
as Usual"
6.
Medical Myths: ObamaCare is not
"socialized medicine."
7.
Overheard in the Medical Staff Lounge: Progressive/Regressive/Socialistic:
All the Same
8.
Voices
of Medicine: Universal Access to
Medical Care: It's Like a Freeway
9.
The Bookshelf: Taking Back Healthcare for
Future Generations
10.
Hippocrates
& His Kin: Do not allow yourself to be called
a "provider."
11.
Related Organizations: Restoring Accountability in HealthCare, Government and Society
Words of Wisdom,
Recent Postings, In Memoriam . . .
*
* * * *
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.
*
* * * *
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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the entire article in Scientific American . . . (Subscription required)
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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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the entire article . . .
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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.' . . .
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The National
Health Service is Fertile for Graft
*
* * * *
4.
Medicare: 3M
to Change Health-Plan Options for Workers
WSJ, By JANET ADAMY
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."
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Government is not the solution to our
problems, government is the problem.
-
Ronald Reagan
* * * * *
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?
Once
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.
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Medical
Gluttony thrives in Government and Health Insurance Programs.
It Disappears with Appropriate Deductibles and
Co-payments on Every Service.
*
* * * *
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."
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Medical Myths originate when someone else pays the
medical bills.
Myths disappear when Patients pay Appropriate
Deductibles and Co-payments on Every Service.
*
* * * *
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.
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The Staff Lounge Is Where Unfiltered Opinions Are
Heard.
*
* * * *
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.
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VOM
Is an Insider's View of What Doctors are Thinking, Saying and Writing about.
*
* * * *
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. . .
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The Book Review Section Is an Insider's View of What
Doctors are Reading about.
*
* * * *
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.
Empowerment
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.
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Hippocrates
and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Today & Tomorrow
*
* * * *
11. Organizations Restoring Accountability in HealthCare,
Government and Society:
•
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.