Community For Better Health Care

Vol XII, No 12, Mar, 2014


In This Issue:

1.                  Featured Article: Life Lessons From Navy SEAL Training

2.                  In the News: State Tax Collections

3.                  International Medicine: Measuring the Unfunded Obligations of European Countries

4.                  Medicare: Is Uncle Sam Bankrupt?

5.                  Medical Gluttony: ICD 10 replacing ICD 9 codes on October 1, 2015 - Part II

6.                  Medical Myths: If I don’t have insurance, I am unable to pay for medical care.

7.                  Overheard in the Medical Staff Lounge: Patients are the big losers in Obamacare.

8.                  Voices of Medicine: Roll On, Bob Dylan

9.                  The Bookshelf: The Lost Cause: The Trials of Frank and Jesse James

10.              Hippocrates & His Kin: Why do administrators get paid so much?

11.              Restoring Accountability in Medicine, Government and Society

12.              Words of Wisdom, Recent Postings, In Memoriam, this month in History . . .

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The Annual World Health Care Congress

In April, the most forward-thinking health insurance, employer, hospital and health system executives and top health care thought leaders will come together to discuss  transformative trends such as consolidation, transparency , quality metrics, engagement and procedural costs, payment model innovations.


As the national leadership forum to transform health care costs and quality, the 11th Annual World Health Care Congress drills down to find solutions to the challenges and issues facing health care executives in an unprecedented, peer-driven forum of open discussion and debate. 


SEVEN dedicated, educational Summits provide focused presentations, along with interactive discussion on emerging trends and solutions.  Join many organizations already sending their executive teams to cover all seven summits that include:


·                     Health Insurer and Payer Summit for VP, SVP, and C-Level Executives

·                     Health Reform & Policy Summit on Exchanges, Duals, Medicaid, & Medicare 

·                     Network & Contract Management Summit for Providers & Insures

·                     Hospital, Health System & Physician Executive Summit for VP, SVP, C-Level Executives

·                     Health Information & Technology Summit for Insurers & Providers

·                     Business of Women’s Health Summit for Provider Marketing, Sales, & Strategy Executives

·                     Benefits, HR, & Wellness Executive Summit on Improving Employee Engagement, Health, &    Wellness


These Summits take place April 7-9, 2014, at the 11th Annual World Health Care Congress (WHCC) in National Harbor, Maryland – the only health care meeting that simultaneously convenes all stakeholders to share global strategies and offers targeted summits focused on each health care sector.  Please take a moment to download the printable agenda (PDF)

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1.      Featured Article: Life Lessons From Navy SEAL Training

Adm. William H. McRaven, commander of U.S. Special Operations Command, gave a commencement address . . . that graduates, and their parents, won't soon forget.


The University of Texas slogan is "What starts here changes the world."

I have to admit—I kinda like it.

"What starts here changes the world."

Tonight there are almost 8,000 students graduating from UT.

That great paragon of analytical rigor, Ask.Com, says that the average American will meet 10,000 people in their lifetime.

That's a lot of folks. But if every one of you changed the lives of just 10 people, and each one of those folks changed the lives of another 10 people—just 10—then in five generations, 125 years, the class of 2014 will have changed the lives of 800 million people.

Eight-hundred million people—think of it: over twice the population of the United States. Go one more generation and you can change the entire population of the world—eight billion people.

If you think it's hard to change the lives of 10 people, change their lives forever, you're wrong.

I saw it happen every day in Iraq and Afghanistan. Read more . . .

A young Army officer makes a decision to go left instead of right down a road in Baghdad and the 10 soldiers with him are saved from close-in ambush.

In Kandahar province, Afghanistan, a noncommissioned officer from the Female Engagement Team senses something isn't right and directs the infantry platoon away from a 500-pound IED, saving the lives of a dozen soldiers.

But, if you think about it, not only were these soldiers saved by the decisions of one person, but their children yet unborn were also saved. And their children's children were saved.

Generations were saved by one decision, by one person.

But changing the world can happen anywhere and anyone can do it.

So, what starts here can indeed change the world, but the question is: What will the world look like after you change it?

Well, I am confident that it will look much, much better, but if you will humor this old sailor for just a moment, I have a few suggestions that may help you on your way to a better a world.

And while these lessons were learned during my time in the military, I can assure you that it matters not whether you ever served a day in uniform. It matters not your gender, your ethnic or religious background, your orientation, or your social status. Our struggles in this world are similar and the lessons to overcome those struggles and to move forward—changing ourselves and the world around us—will apply equally to all.

I have been a Navy SEAL for 36 years. But it all began when I left UT for Basic SEAL training in Coronado, Calif.

Basic SEAL training is six months of long, torturous runs in the soft sand, midnight swims in the cold water off San Diego, obstacle courses, unending calisthenics, days without sleep and always being cold, wet and miserable.

It is six months of being constantly harassed by professionally trained warriors who seek to find the weak of mind and body and eliminate them from ever becoming a Navy SEAL.

But, the training also seeks to find those students who can lead in an environment of constant stress, chaos, failure and hardships. To me basic SEAL training was a lifetime of challenges crammed into six months.

So, here are lessons I learned from basic SEAL training that hopefully will be of value to you as you move forward in life.

1. Every morning in basic SEAL training, my instructors, who at the time were all Vietnam veterans, would show up in my barracks room and the first thing they would inspect was your bed. If you did it right, the corners would be square, the covers pulled tight, the pillow centered just under the headboard and the extra blanket folded neatly at the foot of the rack—that's Navy talk for bed.

It was a simple task, mundane at best. But every morning we were required to make our bed to perfection. It seemed a little ridiculous at the time, particularly in light of the fact that we’re aspiring to be real warriors, tough battle hardened SEALs, but the wisdom of this simple act has been proven to me many times over.

If you make your bed every morning you will have accomplished the first task of the day. It will give you a small sense of pride and it will encourage you to do another task and another and another. By the end of the day, that one task completed will have turned into many tasks completed. Making your bed will also reinforce the fact that little things in life matter.

If you can't do the little things right, you will never do the big things right.

And if by chance you have a miserable day, you will come home to a bed that is made—that you made—and a made bed gives you encouragement that tomorrow will be better.

If you want to change the world, start off by making your bed.

2. During SEAL training the students are broken down into boat crews. Each crew is seven students—three on each side of a small rubber boat and one coxswain to help guide the dingy. Every day, your boat crew forms up on the beach and is instructed to get through the surfzone and paddle several miles down the coast.

In the winter, the surf off San Diego can get to be 8 to 10 feet high and it is exceedingly difficult to paddle through the plunging surf unless everyone digs in. Every paddle must be synchronized to the stroke count of the coxswain. Everyone must exert equal effort or the boat will turn against the wave and be unceremoniously tossed back on the beach.

For the boat to make it to its destination, everyone must paddle.

You can't change the world alone—you will need some help—and to truly get from your starting point to your destination takes friends, colleagues, the goodwill of strangers and a strong coxswain to guide them.

If you want to change the world, find someone to help you paddle.

3. Over a few weeks of difficult training my SEAL class, which started with 150 men, was down to just 42. There were now six boat crews of seven men each . . . Read more . . .

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2.      In the News: Map of State Tax Collections

New York collected $2,289 per person in individual state and local income tax collections in 2011, according to a new map from the Tax Foundation's Liz Malm and Richard Borean.

Using 2011 figures, the most recent tax data available, Malm and Borean calculated each state's per capita income taxes, including both state and local collections. The average collection -- which included wage and salary taxes as well as investment income taxes -- was $918 per person. Read more . . .

·                     Six states (Alaska, Florida, Nevada, South Dakota, Texas, Washington, and Wyoming) do not have an individual income tax, while New Hampshire and Tennessee only tax investment income.

·                     New York collected the most of all the states, at $2,289 per capita. Behind New York was Maryland (at $1,823 per capita), Connecticut ($1,806), Massachusetts ($1,761), Oregon ($1,426), Minnesota ($1,404), Delaware ($1,360), California ($1,347), New Jersey ($1,204), and Virginia ($1,182).

·                     Tennessee collects just $30 per person, and New Hampshire collects only $63, as the states only tax investment income. Of the states with broader income taxes, Arizona collects the least amount of taxes, at $445 per capita. Mississippi ($470), Louisiana ($527), and New Mexico ($529) follow behind Arizona.

·                     Ninety-one percent of state and local tax collections are state-level taxes. Only 13 states collect local income taxes, including Maryland, where local income tax collections represent 30.4 percent of local tax revenue.

The National Center for Policy Analysis has developed a State Tax Calculator that allows an individual to calculate his personal tax burden and determine whether he would save or lose money by moving to another state.

Source: Liz Malm and Richard Borean, "Map: State and Local Individual Income Tax Collections Per Capita," Tax Foundation, May 8, 2014.

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3.      International Medicine: Eliminating use of monetary policy to achieve country-specific goals.


Measuring the Unfunded Obligations of European Countries

Policy Report No. 319 by Jagadeesh Gokhale, PhD

Europe is undergoing two major transitions. On the demographic front, many European countries are undergoing rapid population aging as their Baby Boom generations enter retirement, senior citizens live longer and fertility rates remain well below the population replacement level. On the economic front, 15 European countries have adopted the euro as a common currency, eliminating the ability to use monetary policy to achieve country-specific economic goals. Both transitions will place tremendous, conflicting pressures on the domestic national budgets of European countries.

Executive Summary Read more . . .

These countries remain politically committed to maintaining fiscal discipline, but large portions of their government budgets are funded on a pay-as-you-go basis. That means that no real resources are set aside and invested each year by government or individuals to prefund future expenditures on such programs. Spending on promised retirement and health-care benefits for the elderly will increase. But there will be fewer workers to pay benefits as the bills come due, and the growth of income from which to extract taxes to support these programs will slow. As a result, all European countries have large unfunded liabilities — the difference between the projected cost of continuing current government programs and net expected tax revenues. In general:

■ The average EU country would need to have more than four times (434 percent) its current annual gross domestic product (GDP) in the bank today, earning interest at the government’s borrowing rate, in order to fund current policies indefinitely.

■ At the low end, Spain would need to have almost two and one-half times (244.3 percent) its annual GDP invested.

■ At the high end, Poland would need to have 15 times its GDP invested in real assets, forever!

No EU government has made the necessary investment. As an alternative, the next-best option is for these countries immediately to gradually but significantly increase saving and investment. In particular, the average EU country could fund its projected budget shortfall through the middle of this century if it put aside 8.3 percent of its GDP each and every year. Despite this adjustment, a budget shortfall is likely to emerge after 2050, requiring additional fiscal reforms.

What will happen if EU countries do not set aside these funds? Unless they reform their health and social welfare programs, they will have to meet these unfunded obligations by increasing tax burdens as the larger benefit obligations come due. Although spending averages 40 percent of GDP today:

■ By 2020, the average EU country will need to raise the tax rate to 55 percent of national income to pay promised benefits.

■ By 2035, a tax rate of 57 percent will be required.

■ By 2050, the average EU country will need more than 60 percent of its GDP to fulfill its obligations.

In some countries, the projected shortfalls are lower than the average. In other countries, they are higher. This is the result of several factors. For instance, life expectancy at birth (in 2004) ranges from a low of 71.2 years in Latvia to a high of 80.7 in Sweden, indicating higher age-related costs in older EU countries than in newer, Eastern countries. Another demographic factor is fertility, which is below the rate of 2.1 births per woman required to maintain populations. However, fertility rates in the EU range from a low of 1.18 in the Czech Republic to a high of just 1.93 in Ireland — indicating that the Czech Republic is closer to a population implosion. Partly as a result of these demographic differences, economic growth rates also differ widely, from a contracting economy in Malta, with a –1.6 percent rate of growth in GDP per capita (averaged over the period from 1996 to 2005), to a 5.7 percent growth rate in Estonia.

In comparison, the United States’ shortfall for Social Security and Medicare alone has been somewhat smaller than the EU average, at 6.5 percent of future GDP. But as a result of the expansion of the Medicare program to cover prescription drugs, the U.S. fiscal imbalance is now 8.2 percent of future GDP. Putting this in perspective, to close its fiscal imbalance:

■ The United States would need to save and invest an amount equal to 8.2 percent of its GDP beginning now and continuing every year forever to pay expected future benefits without future tax increases.

■ This could be accomplished by more than doubling the current 15.3 percent payroll tax on employers and employees, immediately and forever.

■ Alternatively, the federal government could immediately stop spending nearly four out of every five dollars on programs other than Social Security and Medicare — eliminating most discretionary spending on such programs as education, national defense, environmental protection and welfare — forever. Each year that the United States does not take action to reduce the projected shortfall, it grows by more than $1.5 trillion, after adjusting for inflation.

About the Author

Jagadeesh Gokhale is a senior fellow with the Cato Institute in Washington, D.C. His research focuses on U.S. fiscal policy, entitlement reforms, intergenerational redistribution, national saving, and labor productivity and compensation. He works with Cato’s Project on Social Security Choice to develop reforms for programs such as Social Security and Medicare. Dr. Gokhale served in 2002 as a consultant to the U.S. Department of the Treasury and in 2003 as a visiting scholar with the American Enterprise Institute (AEI). Earlier, he was senior economic adviser to the Federal Reserve Bank of Cleveland. His most recent book, Fiscal and Generational Imbalances: New Budget Measures for New Budget Priorities, coauthored with Kent Smetters, drew widespread attention when it was published by AEI. He has also authored numerous papers in such economic journals as the American Economic Review, Journal of Economic Perspectives and the Quarterly Journal of Economics. Gokhale holds a Doctor of Philosophy degree in economics from Boston University.

Read the entire policy report No 319 . . .

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

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4.      Medicare: Is Uncle Sam Bankrupt?

by Laurence J. Kotlikoff, Sn Fellow, NCPA

Brief Analyses No 689 | Federal Spending | Government

When it comes to nondisclosure, the United States government is the father of all financial malfeasants.  Indeed, Uncle Sam has been misrepresenting the nation's finances for decades.  In the process, he has run up an undisclosed bill that makes the financial bailout and economic stimulus spending look paltry. Read more . . .

Federal Financial Obligations.  According to David M. Walker, former chief comptroller general of the United States, the federal government's current liabilities to Medicare, Social Security and the federal debt total $56.4 trillion.  To put this in perspective:

·                     The average Social Security, Medicare and Medicaid benefit payment per retiree is currently $30,250 - or about 80 percent of per capita U.S. gross domestic product (GDP).

·                     In 20 years, when the baby boomers are fully retired, the average benefit per retiree will be the equivalent of $50,000 today (adjusted for inflation).  [See the figure.]

·                     Multiplied by 78 million (the approximate number of baby boomers in the United States), the total would be equivalent to $4 trillion per year today.

But the $50,000 estimate assumes that the Medicare plus Medicaid real average benefit will grow at only 3.6 percent per year, whereas between 1970 and 2002 the average level of real Medicare plus Medicaid age-specific benefits grew at a rate of 4.6 percent annually.  In contrast, real per capita GDP grew at a rate of only 2 percent per year. 

Estimating the Fiscal Gap Using Generational Accounting.  Generational accounting is a well-established methodology to measure the burden of government.  A generational account for any given generation measures the generation's remaining lifetime net tax bill as a present value - what the generation will pay net of what it will receive, all valued as of today.  If the generational accounts of all current and future generations are added together, assuming no change in fiscal policy, the sum amounts to what all current and future citizens are going to pay, on net, in taxes to the government (measured as a present value).  This amount has to cover the government's official debt plus the present value of all future government purchases of goods and services (discretionary spending). 

The fiscal gap is the difference between the government's official debt plus discretionary spending and the amount of taxes current and future citizens will pay.  It incorporates all of the government's fiscal activities - including its financial obligations under Medicare, Medicaid, Social Security, welfare, unemployment, and interest and principal on government debt. 

Taking into consideration all of the government's financial liabilities and projected future tax receipts, the current fiscal gap in the United States is estimated by Jagadeesh Gokhale of the Cato Institute and Kent Smetters of the University of Pennsylvania at $77 trillion - more than five times the United States' present GDP.  In order to close a gap of this size, the Federal Insurance Contribution Act (FICA) payroll tax - currently 15.3 percent - would need to be more than doubled immediately and permanently.

To understand how this figure can be so large, consider:

·                     There are now roughly 33 million adults in the United States receiving retirement benefits.

·                     When the 78 million baby boomers retire, there will be more than twice the number of retirees receiving benefits than there are currently.

·                     While there will be a significant increase in those dependent on government programs like Social Security and Medicare when the boomers retire, there will only be about 2.7 workers per retiree to help pay the benefits - down from 3.28 workers per retiree in 1985 and 3.43 in 2000.

Adjusting for Risk.  There is reason to believe that the $77 trillion figure would be even larger were the government's future cash flow discounted, taking into account that future benefit payment outlays appear to be more certain than do future tax receipts.

For example, according to the Social Security Trustees Report, Social Security is 27 percent underfunded.  That is, achieving long-term solvency would require an immediate and permanent 27 percent increase in the 12.4 percent employer and employee payroll tax rate that funds Social Security. 

Social Security's long-term solvency estimate also fails to adjust for the riskiness of the system's cash flow.  Periods of high unemployment, for example, might require increased borrowing by the Treasury in order to fund benefits.  Preliminary analysis from a recent Boston University study suggests that Social Security's failure to risk-adjust its cash flow understates its long-term financial gap by more than 20 percent.  Thus, if Gokhale's and Smetters' projections of all the federal government's unfunded obligations were risk-adjusted, they would undoubtedly be much higher.

Given the magnitude of the fiscal gap, the country is broke.  The United States is currently short more than $77 trillion and this figure will only increase . . .  The United States government, through its various financial agencies, is assuming away the country's fiscal problems rather than confronting and correcting them. Without dramatic and immediate changes in policy, future generations are likely to face lifetime net tax rates that are twice those imposed now.

Laurence J. Kotlikoff
 is a professor of economics at Boston University and a senior fellow with the National Center for Policy Analysis.  This article is adapted from his forthcoming book,
Jimmy Stewart Is Dead: Ending the World's Ongoing Financial Plague with Limited Purpose Banking.

Read the entire Analysis 689. . .

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

- Ronald Reagan

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5.      Medical Gluttony: ICD 10 replacing ICD 9 codes on October 1, 2015 - Part II


There are two related classifications of diseases with similar titles, and a third classification on functioning and disability.

The International Classification of Diseases (ICD) is the classification used to code and classify mortality data from death certificates.

The International Classification of Diseases, Clinical Modification (ICD-CM) is used to code and classify morbidity data from the inpatient and outpatient records, physician offices, and most National Center for Health Statistics (NCHS) surveys. Read more . . .

NCHS serves as the World Health Organization (WHO) Collaborating Center for the Family of International Classifications for North America and in this capacity is responsible for coordination of all official disease classification activities in the United States relating to the ICD and its use, interpretation, and periodic revision.

The Collaborating Center also is responsible in North America for the WHO Family of International Classifications, which includes the International Classification of Functioning, Disability and Health (ICF).

 International Classification of Diseases, Ninth Revision (ICD-9)

The International Classification of Diseases (ICD) is designed to promote international comparability in the collection, processing, classification, and presentation of mortality statistics.

This includes providing a format for reporting causes of death on the death certificate. The reported conditions are then translated into medical codes through use of the classification structure and the selection and modification rules contained in the applicable revision of the ICD, published by the World Health Organization. These coding rules improve the usefulness of mortality statistics by giving preference to certain categories, by consolidating conditions, and by systematically selecting a single cause of death from a reported sequence of conditions. The single selected cause for tabulation is called the underlying cause of death, and the other reported causes are the non-underlying causes of death. The combination of underlying and non-underlying causes is the multiple causes of death.

The ICD has been revised periodically to incorporate changes in the medical field. To date, there have been 10 revisions of the ICD. The tenth revision is due to be implemented next year in 2015.The years for which causes of death in the United States have been classified by each revision are as follows:


Years Covered






















At the present time making a diagnosis, remains a physician’s domain.  However, inroads are being made. Sometimes these are being made without our awareness. When my present insurance biller started several years ago, she said I could not and had not been paid for my pulmonary function tests. I needed to place “wheezing” as a diagnosis or I would continue not to be paid. So my lack of being reimbursed for years depended not upon an additional diagnosis, since wheezing is a physical finding in the diagnosis of asthma and emphysema, and not a diagnosis in and of itself. I had been denied being paid for an important pulmonary procedure in my specialty of pulmonology, all because of a medical illiterate imposing his or her understanding of healthcare or medicine on those too busy to cross-check every item of coding. In this case an erroneous ICD code was required to pay for a valid CPT code which meant that a correct ICD code negated a valid CPT code which, in turn, cancelled payment for the pulmonary function test.

One of the reasons for the ICD codes was the correct coding of the cause of death. Physicians think in a pathophysiologic sequence of causality. For instance diabetes may cause renal disease which is an etiology of hypertension, which can be the cause of renal failure, stroke and death. If that is the sequence, the physician would normally list them as such. Lay medical examiners, may rearrange this sequence in a non-causative sequence. Or they may insert benign hypertension as causative of death and a sequence to diabetes in the absence of renal disease.

With all these intrusions into the practice of medicine, the massive coding changes of October 1, 2015, may be the best time to close your practice to avoid the risk of coding errors, or errors in coding your patients by medical illiterates, even though not caused by you. In an increasing litigious society, with prosecution for irrelevant variations of irrelevant medical issues, retirement by the date the ICD 10 codes are implemented may prevent retirement to a prison cell.

Those places with cement walls, floors and bars in place of windows sometimes get very cold in winter and warm in summer. Not the most comfortable or healthy retirement villa. But it does help you remember that it all started with an accusation of gluttony for up-coding when you were totally unaware of it.

To be continued next month . . .

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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: If I don’t have insurance, I am unable to pay for medical care.

A patient told my office she couldn’t afford to see me since she didn’t have health insurance. She had applied for ObamaCare and paid the first months premium of $600 but was unable to make the next payment. Therefore, she would be unable to keep her six-month follow up appointment. What she didn’t comprehend was that the two visits to my office per year plus her medications if she purchased them with cash at the discount houses (in Sacramento, these include Walmart, Costco, and Target) would only be approximately $400 per year, less than the first month’s payment on her ObamaCare premium. Read more . . .

Her medical care consisted of management of her mild BP and her anxieties. The discount houses offer nearly 320 drugs for $4 a month or $10 for a three month’s supply. Since she required an anxiety drug which can only be filled for 6 months in California, two medical appointments per year are necessary. At the current rate of $150 per appointment, this would be $300 for the year. The two medications at $20 every three months would equal $80 for the year. Thus her yearly healthcare costs would be only $380 if she paid cash, which was $220 less than the one month of ObamaCare premium she forfeited because she could not make the $600 per month premium for the minimum required three months.

But she replied that didn’t cover her Emergency Room costs which for two visits were $1200 or twice the premium she had to forfeit. Looking over the two ER records indicated that she had no emergency, only anxiety attacks. She didn’t have the presence of mind to take an extra anxiety pill and lay down for an hour to let the anxiety attack resolve itself, which would cost pennies for the extra pill, and would have saved her $1200 of unnecessary ER visits.

She then asked how she could obtain the medicine without insurance. Doesn’t the pharmacy require her to have insurance?

My prescription is your authorization to obtain the medication. Then you have to pay your $10 for a three month’s supply.

She looked at me with unbelieving eyes, shook her head, and said, “Oh well, I’ll have the hospital paid off in six more months.”

Will ObamaCare solve this type of Gluttonous Medical Over Utilization or will the availability of ER & Urgent care visits in their plan just increase the use of after hour conveniences?

Or will the Tax, Spend & Regulate lawmakers (The T, S, & R party) only request more taxes so they can spend more and then regulate the utilization to a minimum?

I’ll wager that the “T S & R” party will continue to dream on.

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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.

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7.      Overheard in the Medical Staff Lounge: Patients are the big losers in Obamacare.

Dr. Edwards:  Anybody feel sorry for our patients in Obamacare?

Dr. Dave:        They voted for it. Why should we feel sorry?

Dr. Edwards:  But they didn’t know what they were voting for.

Dr. Dave:        But they should have known. It was the same garbage that the Tax, Spend, and Regulate (TSR) party has been spewing forth for several elections. Read more . . .

Dr. Rosen:      It’s like so many of our colleagues that have been in the TS&R party who are convinced it’s the progressive way of moving forward. They don’t understand that they are really the Regressive Party and moving backwards.

Dr. Edwards:  That’s like many of our Academic Colleagues.  They want to be the “Liberal” thinkers and don’t realize that the name change to Liberals was exactly the reverse of its intended meaning. They no longer have an open mind.

Dr. Rosen:      Their minds were closed to all progressive ideas. So they were truly regressive—returning to socialistic ideology—the ideas from which our forebears escaped.

Dr. Milton:      They are closed minded to all innovative thinking. And they want to be innovative?

Dr. Edwards: What about our colleagues at the AMA? Why did they support ObamaCare? Why don’t they understand the damage it does to their membership and our patients?

Dr. Rosen:      They are getting to be like the British Medical Association. The BMA is the official bargaining unit for the NHS. They are union workers.

Dr. Milton:      Physicians hopefully will never stoop to union status, collective bargaining, and striking.

Dr. Rosen:      That would be the death knell to us as professionals.

Dr. Dave:        But don’t you think that is the intent of Obama, the TS&R party, CMS, HMOs and others?

Dr. Ruth:        What a horrible thought!

Dr. Dave:        They want us all to be employees. Employees of the government, insurance companies, hospitals, industry, and anybody they can better control.

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The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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

Sonoma Medicine MEDICAL ARTS
The magazine of the Sonoma County Medical Association

Roll on, Bob

By Rick Flinders, MD

I first saw Willie Mays in 1958, when I was 12 years old. I watched him play for 14 years as a San Francisco Giant, through the prime of his career, the greatest baseball player I ever saw. Maybe Roberto Clemente had a better arm. Maybe Barry Bonds was a better hitter. But no one has ever played the game of baseball better than Willie Mays. He was magnificent.

In 1972, Willie was traded to the New York Mets. I watched him flail at the plate, no longer able to catch up with major league fastballs. In center field he was no longer graceful, even once dropping a ball while attempting his signature basket catch. It was painful to watch. He retired in 1973. Read more . . .

I first saw Bob Dylan in 1965, when I was 19 years old. I’d been struck between the eyes with songs like “Masters of War,” “Chimes of Freedom,” and “With God on Our Side.” On stage at the Berkeley Community Theater in December 1965, he stood alone with only an acoustic guitar and harmonica, and he mesmerized us. After intermission, he returned with an electric Stratocaster and four musician friends he called “The Band.” He concluded the show with a song he’d just released, “Like a Rolling Stone.” He was magnificent.

In the past half-century, few artists have had more impact on our language and culture than Dylan. He changed popular music the way Einstein changed modern physics: he changed everything that followed. Dylan took the lyrics of popular music away from the hacks of Tin Pan Alley and placed them in the hands of poets. As Bruce Springsteen said of the influence of Dylan’s music on his generation: “Elvis freed our bodies. Dylan freed our minds.” A recent concordance of legal decisions in U.S courtrooms showed Dylan’s words the most frequently cited lyrics in judicial opinions, from local magistrates to the Supreme Court.

In the years since that first show in Berkeley, I’ve seen Dylan in concert 15 times, each performance as unpredictable as the performer himself, but always worth seeing.

Until now.

This October, at the Greek Theater in Berkeley, it was hard to watch Dylan on stage. Listening was even more painful. His band, still composed of world-class musicians, was only loud and lifeless. His voice, over-amplified to compensate for 50 years of vocal cord injury, echoed only harsh syllables from his former eloquence.

His most recent album had promised more. Called Tempest, the same title as Shakespeare’s final play, it was rumored to be perhaps his final work. Two songs in particular provided proof that Dylan can still bring the poetry. The title track is a poetic vision of the night the Titanic sank, with lyrics sufficiently vivid to bring you to tears. Another song, “Roll on, John,” is a touching tribute to his old friend John Lennon:

Shine your light, move it on

You burned so bright, roll on, John

Though the poet still lives, the voice is gone.

Bob Dylan has earned the right to sing forever. It’s what he does. But, for the first and only time in 50 years, I walked out early from a Dylan concert, the last one I’ll ever attend. How does it feel? Like watching Willie Mays about to drop a routine fly ball from a basket catch. And while it breaks my heart to say it, Bob, I say this with nothing but love and with gratitude for all you’ve given us. May you live long and continue to know and speak the truth as few others have. May your heart always be joyful and your song always be sung. But from that stage where you burned so bright and delivered a lifetime of magnificent lines and transcendent songs, it is time to roll on.

Dr. Flinders, who serves on the SCMA Editorial Board, is a lifelong fan of Bob Dylan.


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9.      Book Review: The Lost Cause: The Trials of Frank and Jesse James,

by James Muehlberger, Esq, Kansas Alumni Magazine, No 3, 2014

True Crime

A lawyer’s successful search for a missing court case sets straight the crooked tale of Frank and Jesse James

By Steven Hill

“The Ballad of Jesse James”

Jesse James we understand
Has killed many a man
He robbed the Union trains
He stole from the rich
And gave to the poor
He’d a hand and a heart and a brain.

James Muehlberger was down to the final day of his three-month sabbatical, and the county clerk’s office in Gallatin, Mo., was due to close in 5 minutes. He had spent the past week hunkered down in the dusty office, rifling through drawer after drawer of legal files. Now it was 4:25 on a Friday, and he still hadn’t found the document he was searching for. In fact, he’d been told he wouldn’t find it.

“The clerk told me I was crazy, that it didn’t exist,” says Muehlberger, c’78, l’82, “and if it had existed it had been stolen or preserved [elsewhere] because anything related to Frank or Jesse was long gone from their files.”

But Muehlberger—a former Johnson County prosecutor who now defends corporate clients as a partner at Shook, Hardy & Bacon (SHB) in Kansas City—looked anyway. As Theresa Hamilton, deputy for the Circuit Court of Daviess County, began buttoning up the office for the weekend, he raced to finish one last file drawer. There, at the very back of the drawer, he recognized the prize he sought, a dusty, barely legible folder that he’s convinced no one has seen since 1870: the lawsuit file for Daniel Smoote v. Frank and Jesse James. Read more . . .

“Finding that was probably the most exciting thing I’ve done as a lawyer,” he says. “Part of what I do is spend months or years looking for the smoking gun document that’s going to make my case, or trying to find witnesses who don’t want to be found. Basically I used the same sort of skills I developed over 30 years of being a lawyer and applied it here.”

The find confirmed a story Muehlberger had heard around SHB’s Kansas City headquarters, that a lawyer named Henry McDougal, associated with a founding partner of the high-profile firm, had once sued the notorious Missouri outlaws.

The case and the crime that spurred it—the murder of a former Union officer and Gallatin bank clerk named John Sheets—marked the first time the James brothers gained notoriety for their crimes, and the media attention was the beginning of the enduring Wild West legend of Jesse James as a “noble robber,” a chivalrous farm boy who fought for Southern honor during the Civil War and after was driven to crime to battle corrupt pro-Union politicians.

The discovery of the lost lawsuit was one in a series that led to Muehlberger’s book, The Lost Cause: The Trials of Frank and Jesse James, a thoroughly researched and carefully argued chronicle of the decade-long quest to bring to justice one of the most feared—and revered—outlaw gangs in the West. The Kansas City Star named it one of the best 100 books of 2013, and the New York Times Book Review credited Muehlberger for creating a story that is “equal parts violent melodrama and meticulous procedural, wrapped in vivid packages with enough bloody action to engage readers enthralled by tales of good versus evil.”

Don’t be fooled by the book’s cover: The jacket features a sepia-toned photograph of a fierce, pistol-brandishing Jesse James, but the true heroes are the lawyers who took on the infamous Missouri outlaw and his brother Frank. . .

Jesse James had a wife
To mourn for his life
Three children, they were brave
But history does record
That coward Robert Ford
Has laid poor Jesse in his grave

Read the entire book review . . .

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The Book Review Section Is an Insider’s View of What Doctors are Reading about.

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10.  Hippocrates & His Kin: The current drought; Administrators get paid more than physicians.

Mechanic to doctor wearing hearing aids picking up his car: “I couldn’t get your brakes fixed so I made your horn louder.”



The California Drought

Cartoon in the Sacramento BEE: Two men with guns approach a lady watering her lawn: YOUR GRASS DIES OR YOU DIE. Read more . . . 

Administrators Get Paid More

So not only are there more administrators than doctors but it turns out they get paid more too. “The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries, according to an analysis performed for The New York Times”. When someone asks you what is wrong with our healthcare system you can start by pointing this out. Personally, I want to puke.

C.E.O. of health/disability insurance firms:                 $583,700
Hospital C.E.O.            :                                                           $386,000
Hospital administrator:                                                 $236,800
General physician:                                                       $185,000
Family-practice physician:                                           $165,300
Physical therapist:                                                        $  78,100
Audiologist:                                                                 $  72,600
Staff nurse:                                                                  $  61,900
Emergency medical technician


Bill Ameen

These figures are right on and a national disgrace. The teaching hospital closest to us (we’re owned by another one) just laid off another few hundred after 900 last year. The CEO, surprisingly a doctor, makes >$2,300,000 including his perks like country club membership. He should be ashamed to show his face in public except, of course, at the country club! (Our owner is laying off quite a few too but of course none at the upper echelon. Seems like a MBA is a magic shield.)

John Stewart, MD

Speaking of non-docs making a lot of cash, did you notice this week that our old buddy John Edwards is back at what he does best-suing doctors. Thirteen million dollar settlement.
Maybe he can afford another love child with a cinematographer while he runs for president.
World’s richest ambulance chaser, and to think he aspired to be the leader of the free world.

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow

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11.  Restoring Accountability in Medical Practice, 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 and register to receive one or more of these reports. This month, read the informative  ?.

                      Pacific Research Institute, ( 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.

                      The Mercatus Center at George Mason University ( 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.

                      To read the rest of this column, please go to

                      The National Association of Health Underwriters, 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 Health Policy Newsletter sent every Friday to which you may subscribe by logging on at 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.

                      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,, 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, be sure to read ?

                      The Foundation for Economic Education,, 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 Council for Affordable Health Insurance,, 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,, 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.

                      Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at 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.

                      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 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,, 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.

                      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 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 ( 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

                      The Ethan Allen Institute,, 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,, 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. To read a variety of articles in this arena, please go to

                      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 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 ? Choose recent issues.  The last ten years of Imprimis are archived.

                      John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to and check out their history, mission statement, newsletter, and a host of other information

                      Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .

                      PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .

                      PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. ( Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law. 

                      FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder,, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser’s view on today’s health care problem:  In today’s proposals for sweeping changes in the field of medicine, the term “socialized medicine” is never used. Instead we hear demands for “universal,” “mandatory,” “singlepayer,” and/or “comprehensive” systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this “nationalized financing” or “nationalized health insurance.” In a more honest day, it was called socialized medicine.

                      Michael J. Harris, MD - - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."

                      David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at To read his "Lessons from the Past," go to For additional articles, such as the cost of Single Payer, go to; for Health Care Inflation, go to

                      Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, which would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at

                      Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see To see Attorney Sharon Kime's response, as well as the California Medical Board response, see Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD. To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to

                      The Association of American Physicians & Surgeons (, The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.

                       The AAPS California Chapter is an unincorporated association made up of members. The Goal of the AAPS California Chapter is to carry on the activities of the Association of American Physicians and Surgeons (AAPS) on a statewide basis. This is accomplished by having meetings and providing communications that support the medical professional needs and interests of independent physicians in private practice. To join the AAPS California Chapter, all you need to do is join national AAPS and be a physician licensed to practice in the State of California. There is no additional cost or fee to be a member of the AAPS California State Chapter.
Go to California Chapter Web Page . . .

            Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"

                      PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.

Our motto, "omnia pro aegroto" means "all for the patient."

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12.  Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

Words of Wisdom

Health is not a condition of matter, but of Mind . . . Mary Baker Eddy, Science and Health, 1908

Early to bed, and early to rise, makes a man health, wealthy and wise. . . Benjamin Franklin, The Way to Wealth, 1757

Health is not valued till sickness comes. . . Thomas Fuller, Gnomologia, 1732

If you mean to keep as well as possible, the less you think about your health the better. Oliver Wendell Holmes, Over the Teacups, 1891

The first medical right of all Americans is care within their means.  Maine Senator Edmund Muskie, May 27, 1971

Some Recent Postings

In The Feb Issue:

Featured Article: :  POTOMAC WATCH

In the News: What Doctors Can Learn From Business Leaders - Forbes

International Medicine: Health Care Reform: Do Other Countries Have the Answers?

Medicare: Uses two obsolete models for coverage.

Medical Gluttony: ICD 10 replacing ICD 9 codes on October 1, 2015

Medical Myths: Cigarettes

Overheard in the Medical Staff Lounge: Benghazi 

Voices of Medicine: A Doctor Leaving Solo Practice

The Bookshelf: What Doctors Feel: How Emotions Affect the Practice of Medicine,

Hippocrates & His Kin: Telehealth

Restoring Accountability in Medicine, Government and Society

Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

In Memoriam

Jerome David Salinger, writer, died on January 28th, aged 91

The ECONOMIST| From the print edition | Feb 4th 2010

PEOPLE kept sneaking year after year to the place on the hill in Cornish, New Hampshire, but the Great American Writer was almost never seen. Ageing rebels, second-year master's students with lacquered nails, broad-shouldered phonies in Norfolk jackets, snappers from Newsweek, all approached the cringing, little house where he had lived, or battened down, or holed up—you, general reader, can choose the word you please—ever since a great wave of fame had broken over him in 1953, two years after he happened to write a book called “The Catcher in the Rye”.

They caught a glimpse of him sometimes, with his haughty head, angular and bug-eyed, getting groceries in the village; but he gave them the slip almost always. The truth of it was that though his book might be on all the syllabuses, picked over by the academicians, hailed as the authentic voice of every teenager who had ever squeezed a pimple or tried, drawing himself up tall, to order a Scotch and soda, his life was nobody's  . . .  business. If his dream was to live in the woods, with a fireplace and a typewriter and sheaves of notes hooked on the wall, almost like a deaf-mute in his dealings with the world, that was his affair.

He was not just away in Cornish, he was also above. (The italics were his own.) From above, Holden Caulfield, the hero of “Catcher”, first entered his story to look down on the distant football game between Saxon Hall and Pencey Prep, all those little running figures of whom he was not one, because he was outside and expelled. The writer who truly lived for his art—who made it, as Mr Salinger did, his religion, along with Vedanta and Zen and the Tao—did not descend and did not integrate. He defended until death, or non-publication, the sanctity of his words. A writer asked to discuss his craft ought just to jump up and declaim, de haut en bas, the names of Flaubert, Tolstoy, Blake, Coleridge, Proust, James. And admit that after Melville there had been no really good American writer until—Salinger. . .

Read the entire obituary in The Economist (subscription required) . . .


J.D. Salinger, 91; 'Catcher in the Rye' author became famous recluse

By Bart Barnes | Special to The Washington Post | Friday, January 29, 2010

J.D. Salinger, 91, the celebrated author and enigmatic recluse whose 1951 novel "The Catcher in the Rye" became an enduring anthem of adolescent angst and youthful rebellion and a classic of 20th-century American literature, died Wednesday at his home in Cornish, N.H.

In a statement issued by Mr. Salinger's literary representative, the author's son confirmed the death to the Associated Press. The cause of death was not reported, although the statement said Mr. Salinger broke his hip last year.

To generations of men and women in the years after World War II, "The Catcher in the Rye" was the singular, tell-it-like-it-is story about the mind-set of a sensitive youth: cynical yet romantic; disdainful of hypocrisy, social convention and conformity; self-conscious and uncomfortable in his own skin; confused and pathetic but also loveable.

The novel is about the adventures and misadventures of Holden Caulfield, a disillusioned 16-year-old who knows he is about to be expelled from his boarding school, Pencey Prep, and decides to run away. Over three days in New York City, he has a run of weird encounters with taxi drivers, nuns, an elevator man, three girls from Seattle, a prostitute and a former teacher. In his eyes, the world is controlled and dominated by "phonies," and he struggles with limited success to come to terms with love, sex and, ultimately, himself. In an encounter with his kid sister, Phoebe, he finds affection and salvation.

In the more than half-century since the novel's publication, Holden Caulfield has joined the ranks of such literary legends as F. Scott Fitzgerald's Jay Gatsby and Mark Twain's Huckleberry Finn as a folk hero of American fiction. Reading the book was often described as a rite of passage for adolescents. . .

Detested the spotlight

In 1953, Mr. Salinger settled in Cornish, where he lived in a hilltop cottage overlooking the Connecticut River. He attended no literary conferences, gave no lectures, and almost invariably spurned all human contact. If anyone approached him in a public street or building, he turned and fled. He was rarely photographed, and he directed his publisher to remove his photograph from the dust jacket of "The Catcher in the Rye." His attorneys and agents were instructed not to answer questions about him.

For nine months in 1972 and 1973, Mr. Salinger had an affair with Joyce Maynard, who dropped out of college during her freshman year at Yale to move in with him. Maynard had written an article for the New York Times Sunday Magazine, "An 18-Year-Old Looks Back on Life," that had caught Mr. Salinger's attention. He wrote to her, and for several weeks, they corresponded before she left Yale to live with him in New Hampshire . . .

Read the entire obit in the Washington Post . . .

On This Month in History - March

Albert Einstein was born on March 14, 1879

Robert Koch announced discovery of the tubercle bacillus, on March 24, 1882.

Amerigo Vespucci was born on March 9, 1451, in Florence, Italy. No one seems to be sure why America was named after him.

After Leonard and Thelma Spinrad

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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, any single payer initiative, or Social Security was born for the benefit of the state and of a contemptuous disregard for people’s welfare.

We must also remember that ObamaCare has nothing to do with appropriate healthcare; it was similarly projected to gain loyalty by making American citizens dependent on the government and eliminating their choice and chance in improving their welfare or quality of healthcare. Socialists know that once people are enslaved, freedom seems too risky to pursue.