Community For Better Health Care

Vol XIII, No 6, Sept, 2014


In This Issue:

1.                  Featured Article: The End Result of Medicare and Medicaid is happening NOW.

2.                  In the News: War on Poverty Turns 50: Are We Winning Yet?

3.                  International News: Why Poland Matters

4.                  Medicare: The realities of government Medicine

5.                  Medical Gluttony: Anything valuable, but inexpensive or free, will produce gluttony.

6.                  Medical Myths: Pharmaceutical Management Companies improve the QOC

7.                  Overheard in the Medical Staff Lounge: How can we control health care costs?

8.                  Voices of Medicine: Medicine & Politics

9.                  The Bookshelf: In Search of a New Health Care Model: The Healing of America

10.              Hippocrates & His Kin: Giving up smoking is the easiest thing in the world.

11.              Restoring Accountability in Medicine, Government and Society

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

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The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data The 12th Annual World Health Care Congress will be held March 23-25, 2015 at the Marriot Wardman Park Hotel, Washington DC.   For more information, visit The future is occurring NOW.

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1.      Featured Article: The End Result of Medicare and Medicaid is happening NOW.

Taking the Government Out of Health Care

By Avik Roy | September 8, 2014

The government takeover of our health care system didn't happen with the passage of the Affordable Care Act in 2010, says Avik Roy, senior fellow at the Manhattan Institute. It happened in 1965, he writes, with the creation of Medicare and Medicaid.

Even without the Affordable Care Act (ACA), the federal government would be spending trillions of taxpayer dollars on single-payer health care entitlements: Read more . . .

·                     Even before the passage of the ACA, per-capita spending on health care by the U.S. government     (at $3,967) was higher than per- public spending in all but three countries in the world.

·                     In 2022, federal spending on health entitlements, not including Obamacare, are set to reach $1.5       trillion.

·                     The ACA will increase that spending by 16 percent.

Countries like Switzerland and Singapore, on the other hand, have the lowest per-capita public health spending, with Switzerland spending $1,628 per person and Singapore $813. How do they keep costs so low? According to Roy:

·                     Both countries use the power of private markets.

·                     Switzerland has no government-run insurers, though 20 percent of its population receives     government premium subsidies.

·                     Singapore uses health savings accounts and high-deductible insurance plans to keep costs low.

The systems are hardly perfect, writes Roy, but they are superior to United States' government health care programs. Using Singapore and Switzerland as a model, Roy developed his own plan to replace Obamacare -- as well as Medicare, Medicaid and the Veterans Health Administration. The plan would:

·                     Replace government-run health care programs with a system of tax credits, allowing individuals       to purchase high-deductible health plans with health savings accounts in the private market.

·                     Reduce federal spending by $10.5 trillion over three decades.

·                     Reduce the cost of individual health insurance policies by 17 percent.

·                     Repeal the Obamacare tax hikes as well as the individual mandate.

According to Roy, his model would increase the number of insured Americans by 12 million. However, his plan has also received criticism, with many labeling it a refinement of Obamacare rather than a repeal.

Source: Avik Roy, "Don't Just Replace Obamacare-Replace the Great Society," Weekly Standard, September 4, 2014.  

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2.      In the News: War on Poverty Turns 50: Are We Winning Yet?

by Michael D. Tanner and Charles Hughes

The War on Poverty is 50 years old. Over that time, federal and state governments have spent more than $19 trillion fighting poverty. But what have we really accomplished?  In a new paper, Cato scholars Michael D. Tanner and Charles Hughes argue that while the War on Poverty achieved some initial success, the programs it spawned have long since reached a point of diminishing returns. Read more . . .

Although far from conclusive, the evidence suggests that we have successfully reduced many of the deprivations of material poverty, especially in the early years of the War on Poverty. However, these efforts were more successful among socioeconomically stable groups such as the elderly than low-income groups facing other social problems. Moreover, other factors like the passage of the Civil Rights Act, the expansion of economic opportunities to African Americans and women, increased private charity, and general economic growth may all have played a role in whatever poverty reduction occurred.

However, even if the War on Poverty achieved some initial success, the programs it spawned have long since reached a point of diminishing returns. In recent years we have spent more and more money on more and more programs, while realizing few, if any, additional gains. More important, the War on Poverty has failed to make those living in poverty independent or increase economic mobility among the poor and children. We may have made the lives of the poor less uncomfortable, but we have failed to truly lift people out of poverty.

The failures of the War on Poverty should serve as an object lesson for policymakers today. Good intentions are not enough say Tanner and Hughes. We should not continue to throw money at failed programs in the name of compassion.

Read the entire article in Cato . . .

Did you know that today there are still 126 separate federal anti-poverty programs?

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3.      International News: Why Poland Matters

Why Poland Matters:

Do Your Shopping in Paris, but Back Polish Entrepreneurs

by Julie Meyer CEO, Entrepreneur Country.

I started off the week with a lot of 'other stuff' on my mind. I boarded the flight to Warsaw on Monday morning sort of asking myself how it was that I was going to spend my entire week in Poland. My good friend, Pawel Tomczuk, who is a leading entrepreneur in Poland, having built a financial communications firm and sold it to Publicis, had graciously organised for me to speak at the Innovation Forum in Gdansk and then a series of meetings from Warsaw to Sopot at the annual financial conference EFNI. . .

But was Poland worth a week?

I didn't expect at all to have confronted some of the great questions of history in this country of 40 million people, or to be so massively impressed by its people. How did I miss this before, I was asking myself by Day 2?   Read more . . .

As I stood there in the shipyard where Lech Walesa led the Solidarity movement to bring freedom to Poland as I awaited giving my keynote on stage at the Innovation Forum in Gdansk, I met Anna Hejke, a leading venture capitalist, who happens to have been one of Walesa's interpreters. Now for Americans, Walesa is a hero of freedom, so I was already intrigued. Anna *did* *not* disappoint.

Anna soon realised I was a sponge for historical information, and history I got. Poles broke the Enigma code, and gave it to the Brits. They flew valiantly and to great effect in WWII, and in many cases, made the difference decisively in battles that otherwise would have been lost. They helped Jews to survive and get to freedom. On the 1 of September 1939, the Poles were invaded by Nazi Germany, and 17 days later by Soviet Russia, but despite being divided by these invading enemies, the Poles didn't surrender.

In fact, for 50 years, they didn't surrender. Their government went into exile in the UK for 50 years until it was returned to Lech Walesa in 1989 (less 1/3 of its treasury that the Brits took for the Polish use of British aircraft that the Poles had 'used' in defending Britain)!.. Throughout the entire cold war, the Poles never surrendered.

But this fighting spirit is not new. Despite having been wiped off the face of any map, for more than 120 years, the sense that there was a Polish nation and people continued to live on, only to re-emerge in the 20 century. Talk about living in a reality distortion field.

Many if not most people will say that their country has great people, but the Poles can say this with confidence. I have learned this week that the essence of being Polish is to be unbelievably persistent and determined: to never give up, never accept no, and never go away. Despite what the world may say.

That character has been forged through hardship and tragedy, and it makes a national character worth backing bigtime. As an investor who believes wholeheartedly that capital follows ideas and that history is changed only by ideas, and those who execute them, I will spend a disproportionate amount of my time backing Polish entrepreneurs as they have grit, ambition and stamina.

Oh, and I learned another thing too. This week while I would get ready in my hotel room each morning, there was a backdrop of Hong Kong protestors and French deficit reaching 98% of its GDP leading to strikes on the streets. The average Polish person loves free enterprise in a way that the average French person doesn't I am sad to admit. I lived in France for 7 years, and they don't get it. France manages to sell a vision of the country as a wealthy European leader despite being essentially bankrupt. Its people don't understand why it's got the wealth that it has. Through free enterprise hundreds of years ago, and through its entrepreneurs today and the ingenuity of its business people, France created wealth. But it has been sold a lie by its political establishment that government can take the rough edges off of life, and provide risk-free security. Today, that lie has been exposed. Instead of creating a national identity where its citizens pull together for the greater cause of building France, with everyone willing to sacrifice in order to create a country which works for all, the people squabble over how to 'protect' their rights, oblivious to how the world is changing around it, leaving it in the dust.

And this is why Poland matters.

They have had no silver spoon. Their freedom started in a shipyard. They were treated abominably in WWII and its aftermath. I had tears in my eyes, and I haven't even read Norman Davies and Edward Gibbons yet. Patton tried to march to Moscow, but Roosevelt wouldn't let him finish the job. They have no accumulated capital, so they must rely on their human capital. The world enjoys a Polish joke at their expense occasionally. But they have what Darwin says make you fit: adaptability. The Poles have had to. They know how to fight. They love their freedom. And they understand how wealth is created. . .

Poland is open for business. If we want to be optimistic about the future of Europe, look to Poland.

They are the future – of Europe and the world.

Read the entire article at EntrepreneurCountry . . .

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4.      Medicare: The realities of government Medicine

Numbers You Need to Know About Medicare Advantage Cuts

Submitted by Randall Clough on Mon, 03/17/2014 - 11:41

1.          $420 to $540: Average Annual Premium Increase And/Or Benefit Reduction For Medicare Advantage Enrollee In Florida Due To Proposed Cuts From Obama Administration

2.          78%: Percent Of Seniors In Swing States That Say Medicare Advantage Cuts Will Be One Of The Most Significant Issues In Determining Their Vote If Cost Of Plans Rises

Read more. . .

3.          50: Number Of DEMOCRATS In U.S. House Of Representatives Who Signed Letter To Center Of Medicare Services Out Of 194 Members Citing Concern Over Cuts To Medicare Advantage

4.          18: Number Of DEMOCRATS In U.S. Senate Who Signed Letter To Center Of Medicare And Medicaid Services Out Of 40 Members Citing Concern Over Cuts To Medicare Advantage

5.          74%: Percent Of Seniors In Swing States Expressing Concern That Medicare Advantage Rate Reduction Will Increase Cost Seniors Have To Pay

6.          1: Number Of Candidates For Governor Of Florida Denying That Medicare Advantage Cuts Will Harm Seniors


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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: Anything valuable, but inexpensive or free, will produce gluttony.

Perverse Incentives

There’s been a debate in Sacramento for the last 50 years concerning water that is purchased on the basis of the size of the pipe carrying it to your house. It was relatively inexpensive for a ¾ inch pipe that would easily take care of everyone’s water needs. The T-S-R (tax-spend-regulate) folks wanted everyone to have meters. The costs seemed astronomical. But the T-S-Rs did not think the cost was important.  The law-and- order party fought this as another form of taxation. They knew that once a tax is imposed, there is no limit as to how high the tax can rise. Co-incidentally, that’s how the T-S-Rs looked at it. There has never been a tax that the T-S-Rs didn’t like. They do not believe in limits. Limits will always be exceeded. Read more . . .

I was having a debate with one of the Tax-Spend-Regulate folks and the income tax issue came up which reached about 90% under President Jimmy Carter. When President Reagan took over, he was able to reduce this to about half. My friend saw this as taking money from the poor and allowing the rich to keep it. So I suggested that perhaps he would like to see a 100% income tax. He said, “Yes, Absolutely. The rich can well afford it.” I thought I had a basic T-S-R fallacy going, so I asked, “Perhaps you would like to see the income tax go higher, maybe to 150 or even 200 percent?” He again responded, “Certainly. The rich can well afford that.” This suggested he did not comprehend basic high school economics. I didn’t want to pursue this any further.

The water meters are being installed and ours was installed about three years ago. The total conversion will take another seven years. Our cost of water tripled immediately. We have some majestic red woods, deodars, oak, pines, cedars, camphor, as well as Monterey pines lining our redwood fences that we’ve had for 35 years. They were starting to die in midsummer. So we had to soak a number of trees several times this summer until they started greening again. Our water bill in Sept was $555. Extremely high. But the cost was allocated on the bases of use and we’re in the second year of a major drought. Without the water meters, our water district would have had to pump the Carmichael wells dry. The previous socialized water program, like socialized medicine, allows unlimited use without regard to costs.  But there was a 30% drop in water usage in September indicating that free enterprise is the most efficient conservation mechanism with everyone allowing their trees to be drier, but still keeping them alive.

Please note that this was a voluntary reduction in use without further regulation or policing.

The same thing happens with socialized medicine. Healthcare is touted as being much more important than water care. With such a valuable product being free at the point of use or service, it makes essentially all patients gluttonous users of healthcare which increases much faster than the price of water.

Health insurance companies still give totally free access to many types of procedures to increase sales of the product. Even when preventive care, such as immunizations, papaniculau cancer smears, mammograms, are fully covered, the patient never understands the cost. Therefore the value of these procedures approach zero over time. We see this every day in the number of people that have not had a flu shot, a pap smear, or mammogram in 10 years. Many see this only as an inconvenience and not as a cost or health item.

We also see many patients who demand expensive but unneeded tests such as yearly lipid panels, chest x-rays, electrocardiograms, when the last two have been normal and screening every five is more than adequate. In the current hostile health care environment, the patient evaluates the doctors, and a complaint can go up to the level of state review. Just the time to review the record and write a report to the HMO and insurance company can be up to 5 or 10 hours of the physician’s time. This is a cost that is not reimbursable. There is a similar cost in loss of income during the same 5 to 10 hours of patient appointment time given up with an equal loss of income.  If this includes a Quality of Care (QOC) or a possible legal issue, the cost of each complaint will require an attorney review and cost can be an extra $2,000 to $5,000 per complaint even if they are without substance as 90% of them are.

Hence much of medical gluttony is allowed by physicians since the alternative can be very expensive for the physician in the current hostile health care environment.

We have done studies on our patients which indicate that welfare patients paying $5 an office call and $10 per day on hospital admissions, reduced costs by more than 80%. We found many cases were a $10,000 hospital stay would have been avoided with a $10 per day copay. They would have come to the office to avoid that $10 a day copayment for a $5 office one time copayment.

Why don’t the T-S-R folks want to save such significant healthcare costs, with a rather small copay? They say that some folks can’t afford the $5 or $10. But they are seen with a smart phone or are smoking a $4 pack of cigarettes per day ($120 per month). Hence the $5 or $10 copays are really affordable which would reduce healthcare costs by more than half. This is a very simple and workable solution to health care costs and doesn’t require any further regulation or oversight

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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: Pharmaceutical Management Companies improve the QOC

Pharmacies programs are now making direct contact with our patients causing confusion and questions their personal physician’s (frequently referred to with the derogatory PCP designation) competence. Although these letters, which are shared with the patients, do state that they obviously do not have the entire patient’s record, and the “PCP” is in a better position to determine if the pharmaceutical management company’s recommendations are valid, they do cause questioning of their  “PCP’s” competence. This becomes obvious when the patient becomes irate on the phone, states that we’ve made a mistake and please order what the “pharmacy” recommends.  Read more . . .

This may cause a serious disruption in the physicians work flow. He may be involved in direct patient care and it creates an unkind problem with the patient he’s currently seeing if he reviews the pharmaceutical letter, the patient’s medical record, gets on the phone to explain that he had an adverse reaction of another ACE inhibitor and to use the recommended pharmaceutical that was recommended by a reviewing agency would more likely than not produce the same adverse reaction.

The constant policing of physicians does not improve the Quality of Care (QOC).
But it does diminish physicians, and destroys much of the doctor/patient relationship,
which in turn decreases the QOC.

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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: How can we control health care costs?

Dr. Rosen:      Last week we discussed how dangerous “Repeal and Replace” would be. No one has                                   really outlined a simple replacement for the thousands of pages of Obamacare. What                                    changes would you make? Read more . . .

Dr. Sam:         I think our system was actually rather good. We had Medicare for the seniors over 65 and                those that are disabled. We have Medicaid for the poor who can’t afford private care.                                   Everyone else should be working and thus are covered through standard insurance.

Dr. Yancy:      I think we have the level of what constitutes the poor set too high. It should never include                more than the bottom 12% to 15% of society. I’m sure that income follows a bell curve.                              One could make a case that those that are more than 2 standard deviations out from the                                mean are truly poor.

Dr. Edwards:  That certainly would make more economic sense than just taking items that a group think                 are necessities. The cost of food is easily calculated. Clothes are more difficult. Some                                  will “need” clothes that are twice as expensive as others. There are many factors of taste.                             Having a committee like approach will exceed what is absolutely necessary. There will                                 never be agreement as to what is necessary.

Dr. Milton:      Drinking, smoking and gambling habits are really variable. I have people of welfare                         smoking two or three packs per day. Some that drink a fifth of Vodka a week.

Dr. Ruth:        I have one welfare family that spends one entire welfare check a month on a trip to Reno                             to gamble. I think we have to call that a disease. We had dinner with one couple there and                they were dropping quarters in the slots as we were in line for a buffet. When we got to                                the food he had won one small handful of coins and bragged about his winnings. He                                    totally discounted the money he lost and chalked that up to pleasure and vacation                                         spending.

Dr. Kaleb:       Remember when President Clinton said welfare should be limited to couple of years. We                             saw many of our Medicaid patients obtain a job rather quickly rather than wait out the                                  two years.

Dr. Patricia:    I see many of my patients go to the ER rather than come to my office for routine                                          complaints because of evening conveniences.

Dr. Michelle:   That’s a significant excessive or glutinous cost since ERs are never less than $1500 when                 office calls are about $150.

Dr. Rosen:      What if we had a $50 ER copay and a $5 office copay? How would that change the                                     equation?

Dr. Milton:      I don’t think any of my Medicaid patients would pay $50 to go to the ER. They would                                 see me the following day.

Dr. Edwards:  I second that.

Dr. Rosen:      It seems like we could save about 80% in this segment of society with just a reasonable                                and affordable copayment. If we just keep adding up all these savings, health care costs                               would plummet. At least in the Medicaid portion of society.

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The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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8.      Voices of Medicine: A Review of Regional Medical Journals:  Sonoma Medicine

The magazine of the Sonoma County Medical Association


Rob Nied, MD

Has the current morass in Washington DC inspired you to run for Congress? According to the New York Times, 26 physicians are running for Congress this year, and Kentucky senator Rand Paul, an ophthalmologist, is considered a likely presidential candidate. Compare that with a total of 25 physicians who served in Congress between 1960 and 2004.

Commoditizing physicians and patient care, declining reimbursement, the Affordable Care Act, and increasing bureaucratic regulation have made the business of medicine increasingly unpalatable, so it is understandable that we physicians want to stand up and fight for our profession. Our country’s founding fathers would be proud—more than 10% of the signers of the Declaration of Independence were physicians.  Read more . . .

A few years ago, The Daily Beast published an entertaining article by Dr. Kent Sepkowitz about physician politicians (“Why physicians make crazy politicians,” May 26, 2010). He postulates that physicians are used to taking charge and have a sense of personal responsibility for the world around them. We also share a sometimes outsized belief in our own ability to “fix things.”

Having more physicians in Congress might seem like a good idea, but the ones who are already there don’t necessarily represent the views of physicians in general . . .

The reality is that physicians across the United States have the same disparate views and biases as any group of 600,000 people. Considering that most of a physician Congressperson’s time is spent advocating and deciding on policy matters far removed from their medical training, it may not be in our collective best interest to elect more of them.

Of course, physicians don’t need to hold political office to influence the most important public policy decisions, even at the national level. Politicians know that one thoughtful letter or call from a constituent represents the views of tens or even hundreds of peers who did not bother to publicize their opinions. Personal relationships between physicians and key legislators, forged over a decade of interaction, ultimately led to the “GPCI fix.” The adjustment in the Medicare Geographic Practice Cost Index—which only happened in California—will increase payments to physicians in 14 California counties by $50 million annually and over $400 million in the next decade. Sonoma County physicians will see a 4–9% increase in payments. For other national policy issues, such as repealing the Medicare SGR, personally lobbying our elected representatives is the single most powerful thing we can do.

Some political issues, however, require a more organized, collective effort, such as the current effort to defeat Proposition 46. Organizing a statewide public-relations campaign is too large of a project for one person, one county medical society, or even the largest medical group. The California Medical Association—the collective voice of almost 40,000 physicians—represents our common interests at the state level. The physicians and medical students standing on the California State Capitol steps in support of universal access formed the most lasting image of this year’s Legislative Leadership Conference, which is organized by CMA. To do that work requires people and money. It is important that each of us contribute our share.

Unfortunately, public opinion of organized medicine is not much higher than public opinion of Congress. Corporate medicine has often been guilty of protectionism and favoring special interests. Most people, however, still have a great deal of admiration for individual physicians. A 2011 poll found that 77% of the respondents trust physicians in general and 93% trust their personal physician, a number that is rare in today’s society.

Ultimately, the most effective advocacy for the issues we hold most dear is the clout and respect we have in our own community. We shouldn’t underestimate that. Sonoma County physicians, almost uniquely in California, are embedded in our community. We live and play here. Simply being present and active in our community influences public opinion, effects change and helps educate.

The real question is not whether you should run for Congress. Instead, it’s what are you passionate about? Over the coming year, SCMA will be launching an effort to better connect our members with organizations in Sonoma County that share our common interest in the health and vibrancy of our community. What inspires you? ::

Read the entire editorial in Sonoma Medicine . . .

Dr. Nied, a Santa Rosa family physician, is president of SCMA.

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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing.

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9.      Book Review: In Search of a New Health Care Model: The Healing of America

The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care,

Marin Medicine –

The magazine of the Marin Medical Society


TR Reid, 304 pages, Penguin (2010).


Peter Bretan, MD

The United States spends the largest proportion of GNP (17%) for health care of any country in the world, without providing universal health care. The percentages of GNP for countries that do provide universal care include France (11%), Switzerland (10.8%), Germany (10.4%), Canada (10.1%), UK (8.4%), and Japan (8.1%). Japan spends $3,400 per capita on health care vs. $7,400 for the U.S. . . . Read more . . .

Why is our health care so inefficient and fragmented? More importantly, will we fix it before it collapses? In his book The Healing of America, TR Reid proposes that we cannot begin to answer any of these vital questions unless we know what kind of health care system we have. . . In a[n] attempt to do so, Reid explores health care systems throughout the world to compare government oversight (degree of regulation and support), payer mix, cost efficiencies and many other factors that may elucidate possible solutions to our dysfunctional health care system.

Reid’s contemporary classic is a must-read for all Americans, as health care is now at the forefront of American politics. An inevitable collapse from the growing cost of care will affect everyone. As health care professionals, our patients depend on us for health care policy guidance. Unless all physicians understand basic health care structures, we cannot begin to save our health care system.

In The Healing of America, Reid—a well-known reporter, lecturer and documentary filmmaker—describes four distinct health care systems: the German Bismarck model, the UK’s Beveridge model, Canada’s national health insurance model, and the out-of-pocket model.

The Bismarck model was started by Otto von Bismarck, the first chancellor of Germany, in 1883. Today health insurance in Germany is provided through employers for 82 million citizens and millions of guest workers, both legal and illegal. There are 180 insurance companies, whose income is supplemented by a 15% income tax specifically for health care. Medical education is free. Medical malpractice premiums are less than $1,400 per year, but physician specialists make less than half as much as their American counterparts. Costs are rising and sustainability is questionable. The Japanese and Taiwanese health care systems are similar but less costly because they have more rigid cost controls via a single national fee schedule, at the expense of physicians and hospitals. All these countries have an individual mandate and are happy with their health care.

The UK’s Beveridge model covers 90% of the population via a national 17.5% sales tax and is administered via their National Health Service. The model is single payer and truly socialized. Cuba has a similar system. Primary care physicians are the gatekeepers for most care; pay-for-performance bonuses can double their income. Medical education is free, but certain procedures and tests are only used for high-risk patients. Many cancer drugs are just not covered.

Canada’s national health insurance model began in Saskatchewan in 1946 and spread nationally, culminating in the Medical Care Act, unofficially known as Medicare. The United States later copied this system and name for American citizens 65 and older. The man most responsible for the Canadian system was their national hero, Tommy Douglas, who waited years to get a common orthopedic procedure performed under the old system. The new system covers basic care for everyone and is equally available to both rich and poor. This egalitarian pride sustains the system, but long wait times for elective procedures are common.

In the out-of-pocket model, the rich get medical care, while the poor stay sick and/or die. Most poor countries use this model, including China, which is moving back to out-of-pocket care. In the United States, 20,000 out-of-pocket poor people die annually from easily preventable or treatable diseases.

The United States uses all four of these models. We have Medicare like the Canadians for our elderly population. We have government-run, UK type of care from our veterans and for certain diseases, such as end-stage renal disease. We have multiple insurers, but these companies are not regulated to the same extent as in countries with a Bismarck model. Finally, we have an out-of-pocket model for 23 to 40 million Americans, all of whom suffer from a lack of access to care. This uncoordinated and fragmented health care system has led to inefficient, overlapping care for those with health care coverage, and to no care for millions without any coverage.

The United States is the only developed country in the world with for-profit health care insurers. In single-payer countries, such as Canada and the UK, these companies simply do not exist. In multipayer countries—such as France, Germany, Japan and Taiwan—the insurance companies are all nonprofit, charitable organizations, and are all government regulated and highly efficient, without the enormous bureaucracy found in the United States. Reid makes a compelling argument that “You can’t allow a profit to be made on the basic package of health insurance.”

Reid acknowledges that for those with money to pay for basic health insurance, American medical treatment is the best on the planet. Many Americans, however, go without insurance. Prior to the Affordable Care Act, 45 million Americans (15% of the population) were without any medical insurance. After the ACA is fully implemented, an estimated 23 million Americans (8% of the population) will still be without insurance. These patients constitute a high proportion of the 700,000 Americans who go bankrupt each year from out-of-pocket costs.

Despite our country’s enormous spending on health care, our infant mortality rate is one of the highest in the world at 6.37 per 1,000 births, compared to 2.76 for Japan and 5.0 for the UK. The World Health Organization ranks the U.S. 37th in the world in overall health indexes. Much of the low rating is caused by lack of access to care.

Reid dispels many myths about foreign health care. He refutes untrue statements, made by former New York City mayor Rudy Giuliani and others, that European health care could not work in the U.S. because the Europeans severely ration all care. He also debunks claims that the World Health Organization data is too liberal and that countries listed as more efficient by WHO criteria are all “socialized” in their health care. Reid explains that this is simply not true, pointing out that Japan has more for-profit hospitals than the U.S . . .

This book review is found at .

ED: We had to do a cross check to make sure this wasn’t Harry Reid. This book is out dated and the reviewer is biased. When we go to international meetings, we do not find the physicians from afore mention countries happy with her government regulated or socialize programs. Breton states that Reid dispels many myths about the WHO being too liberal. But we have not found anyone that would even consider going to Columbia, as I recall, for heart surgery which is ranked above the United States. I’m sure this reviewer wouldn’t either.  Breton does get the wait times essentially correct. But he highlights the wrong orthopedic procedure. The orthopedic patient wait that went to the Canadian Supreme court was the ruling that determined that Canadians did not have access to health care. They only had access to a waiting list. That certainly turns everything on its head that Canadian Medicare delivers good healthcare. Prejudices hardly ever die. They don’t even fade away after all these years. Some of these don’t even fade away before the history books are written.

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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10.  Hippocrates & His Kin: Giving up smoking is the easiest thing in the world.

Giving up smoking is the easiest thing in the world. I know, because I’ve done it thousands of times. –Mark Twain.

Thomas, a patient told me that he gave up smoking every evening when he went to bed. He didn’t have another cigarette until breakfast.

Richard, another patient told me that he smoked three packs every day, two packs during the day and one pack during the night. He would wake up about every hour, open up his night shirt, and light up. Why open the night shirt? So if I accidently fall asleep before I finish, it falls on my chest and wakes me up. Doesn’t that burn you? Not that much. That’s better than burning up the bed. Especially since you’re still in it. But that’s only a half pack at night. So you smoke only a ½ pack per night? I guess you’re right. So I must smoke 2 ½ packs during the day since I purchase three packs a day. . . When I examined him, I did confirm several small burn spots and several “loss of hair spots” on his chest.

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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.

                      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

                      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

Sir William Osler: Aphorisms, from his bedside teachings and writings.

Collected by Robert Bennett Bean, MD (1874-1944)

“He was a keen observer, a brilliant clinician. His contributions to medicine and medical education were important.  He was a great teacher. But his main strength lay in the singular and unique charm of his presence, in the sparkling brilliancy of his mind, in the rare beauty of his character and of his life, and in the example that he set to his fellows and to his students. He was a quickening spirit . . . He taught us that the treatment of the patient was the most important element in the treatment of disease, that the patient not the disease was the entity.” –Thayer

The great republic of medicine knows and has known no national boundaries.

In science the credit goes to the man who convinces the world, not to the man to whom the idea first occurs.

It is strange how the memory of man may float to posterity on what he would have himself regarded as the most trifling of his works.

There is no more potent antidote to the corroding influence of mammon than the presence in the community of a body of men devoted to science.

Modern science has made to almost every one of you the present of a few years.

Thucydides it was who said of the Greeks that they possessed “the power of thinking before they acted, and of acting, too.”

Some Recent Postings

In The August Issue:

1.                  Featured Article: A Tale of two Bridges

2.                  In the News: A Tax-limiting Amendment

3.                  International Medicine: The Republic of Georgia chose to outsource regulation.

4.                  Medicare: The Patient Friendly Medicare Program may Not be so Patient Friendly 

5.                  Medical Gluttony: HMOs practicing parallel medicine and interfering with patient care

6.                  Medical Myths: You can keep your insurance and doctor and save money with Obamacare

7.                  Overheard in the Medical Staff Lounge:  Repeal & Replaced are two dangerous words

8.                  Voices of Medicine: The Dilemma of Speaking Up

9.                  The Bookshelf: Extreme Medicine: by Kevin Fong, MD

10.              Hippocrates & His Kin: Doctors Continue to become more irrelevant

11.              Restoring Accountability in Medicine, Government and Society

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

In Memoriam

Eduard Shevardnadze, Soviet foreign minister and then president of Georgia, died on July 7th aged 86 The Economist |Jul 12th 2014 | From the print edition

THE obscure provincial leader was at first sight an unlikely choice to be foreign minister of the world’s largest country. Eduard Shevardnadze did not even want the job: he spoke only his native Georgian and heavily accented Russian, had no important foreign contacts, and had barely travelled abroad. But Mikhail Gorbachev was immovable. The new Soviet leader wanted big changes—and the “Silver Fox”, his friend since the 1950s, to make them. . . Read more . . .

Deeds matched the words. He ended the Soviet Union’s proxy wars in Africa, Latin America and Asia, hurrying the Red Army home from its futile and bloody mission in Afghanistan. At arms-control talks with America knotty negotiating problems unraveled overnight. The danger of nuclear war abated. He buried most of the Soviet empire in Europe, and played midwife to a united Germany, saying allies were better than subjects: “It is time to realise that neither socialism, nor friendship, nor good-neighbourliness, nor respect, can be produced by bayonets, tanks or blood.”

Even hawkish Americans realised that the Soviet Union truly wanted to end the cold war. Mr Shevardnadze forged notable friendships with his American and German counterparts. The hardliners back home, with their grumbling jargon and rigid mindsets, were a greater obstacle.

Seemingly, he was cut from the same cloth. He had joined the party at the height of the Stalin era. A ferocious local official, he brought even the sybaritic Georgians to follow Party discipline. A possibly apocryphal story relates how he called a show of hands on some anodyne motion at a meeting of senior officials, on his first day as anti-corruption chief there. As the grey-clad arms went up, he inspected every wrist—and remarked caustically how strange it was that the servants of the proletariat could afford pricey Western watches. Other tactics were tougher: mass arrests, beatings, torture and executions. He jailed dissidents and cracked down on those trying to defend Georgian language and culture from Russification.

It worked well, for him. Having shown the Kremlin the extent of corruption in Georgia, he was given the republic to run. Control of the best food, wine, scenery and hospitality in the Soviet Union proved a fine way to forge important friendships.

But behind the outward appearance of sycophantic loyalty to a brutal system was a different man. Yes, he had been a true believer, but he also knew that his father had narrowly escaped death in Stalin’s purges. His beloved Nanuli was the daughter of an enemy of the people, but he risked his career and married her anyway—declining to “sacrifice love to hatred”, he wrote later. He secretly shared his despair over the Soviet Union’s failures with the young Mr Gorbachev, his counterpart in the nearby Russian province of Stavropol. Both men saw that only radical change could avert catastrophic collapse.


But unlike Mr Gorbachev, the Georgian went further. Back home he had allowed the making of “Repentance”, an explosive allegorical film (banned by censors) about the crimes of Stalinism. His experiments in economic liberalisation in Soviet Georgia had been successful, but they made him conclude that socialism was unworkable, not reformable. He saw far more clearly than his boss the danger of a hardline backlash. Their friendship frayed. As the shadows darkened over Moscow in the winter of 1990, he spectacularly resigned, with an emotional speech warning of looming dictatorship. For many, that marked the real end of the era of glasnost and perestroika.

After the Soviet collapse in 1991 Mr Shevardnadze headed home to Georgia, where independence had brought bloody strife and economic collapse. Though he became the only politician to have been foreign minister of one country and head of state of another, his record was at best mixed. He eventually ended the fighting, jailing two of the warlords who had put him in power, sidelining the third, and escaping several assassination attempts. . .

There were some successes. New east-west oil and gas pipelines across Georgian territory helped break Russia’s export monopoly, and put the country on America’s map. He encouraged bright young Georgians to study abroad; one of them was his later nemesis, a brash, polygot lawyer called Mikheil Saakashvili. Egregious election-rigging in 2003 sparked the “Rose revolution”, in which an indignant mob, led by the glitzy young English-speakers, hustled a bewildered and indignant “Silver Fox” into retirement. Too much democracy, he said crossly, was a mistake.

On This Month in History - September

On September 1, The Labor Day Season begins. As we approach the end of the rites of summer, we celebrate the big Labor Day Week-end ending on the first Monday of September; we salute the working people of America. But what it has become principally is a celebration of the end of the formal vacation season and a signal that it’s time to go back to work. It has also been a traditional occasion for the kind of oratory that goes with bunting, flags, parades and picnics. Read more . . .

On September 1, 1939, World War II began when Germany invaded Poland. The world of Sept 1, 1939 fell apart and had to be put back together again with blood, sweat, toil and tears. What does that have to do with our world today? That’s a broad question which future historians will have to put together for the next generation since we are unable to understand the present world in real time.

On September 1, 1910, Nan Aspinwall became the first woman to ride across the United states on Horseback, making it from San Francisco to New York City.

On September 1, 1958, a U.S. spy plane was shot down for violating Soviet airspace. George P. Petrochilos and sixteen other crewmen were downed by Soviet MIGs as the plane skimmed the Soviet border.

On the same day in 1983, a Soviet jet fighter shot down a Korean Air Lines Boeing 747 passenger jet over the Sea of Japan. The plane had violated Soviet airspace, which cost 269 passengers and crew their lives.

On September 1, 1969, Colonel Moammar Ghadafi overthrew the Libyan government in a bloodless coup.

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, 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.