Community For Better Health Care

Vol XIII, No 8, Nov, 2014


In This Issue:

1.                  Featured Article: Anglicanism and women bishops

2.                  In the News: The financial pain of Electronic Health Record transition

3.                  International Medicine: The angel of good death opens up his surgery

4.                  Medicare: SSDI Reform: Promoting Gainful Employment

5.                  Medical Gluttony: Education Gluttony

6.                  Medical Myths: Education Myths: Why is “Logan” depressed?

7.                  Overheard in the Medical Staff Lounge: Medicaid patients with HMOs think they’re insured.

8.                  Voices of Medicine: Medicine & Politics

9.                  The Bookshelf: Stanley Fish’s Postmodern Take on Academic Freedom

10.              Hippocrates & His Kin: Red States vs. Blue States

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: Anglicanism and women bishops

Hello ladies, goodbye Communion?

The Economist | Print Edition | Nov 19th 2014 | by B.C

    AMID loud sighs of relief in many quarters, and muffled moans from a traditionalist minority, the Church of England has cleared the last procedural obstacle to the appointment of women bishops. At a meeting on Monday of the church's General Synod, only around 30 of the 480 people present raised their hands against the necessary change in canon law. This means that a woman could be wearing episcopal purple by the end of the year, and a lady could join the ranks of the "lords spiritual"—Anglican prelates who sit in the upper chamber of Parliament—by next spring. Read more . . .

This was a big but expected landmark; a Synod vote two years ago, in which the measure narrowly failed to gain the approval of lay delegates, looks in retrospect like a rather weird anomaly. The change was overwhelmingly favoured by the leadership of the church, the clergy (one-third of which is female), and by public opinion—which matters for a church which aspires to be the spiritual voice of a whole nation, however diverse or secular. The feelings of low-church evangelicals who oppose women bishops have to some degree been assuaged by a promise that one of their number will be appointed to high office; among high-church opponents, quite a few have taken up an offer to join the Roman Catholic church. So hard-line opposition to ladies in purple has gradually faded. . .

Nobody can deny that Justin Welby, who is leader both of England's established church and worldwide Anglicanism, has tried his best keep the family intact. As he told the Synod, he has visited 36 fellow "primates" of Anglican provinces in the past 18 months, covering virtually the entirety of an institution that functions in every corner of the world, especially places where the British flag once flew. And although he was well received almost everywhere, he had to acknowledge that:

There are enormous problems. We have deep divisions in many areas, not only sexuality...Our divisions may be too much to manage. In many parts of the Communion...there is a belief that opponents are either faithless to the tradition, or by contrast that they are cruel, judgemental, inhuman. I have to say that we are in a state so delicate that without prayer and repentance, it is hard to see how we can avoid some serious fractures.

In even plainer language, the division between (roughly speaking) northern and especially North American liberals, and traditionalists whose biggest stronghold is Africa, has become or is about to become unmanageable. As the archbishop implied, the split is mainly but not purely over same-sex relations. At one end of the spectrum, the Episcopal Church of the United States has consecrated an openly lesbian bishop; at the other end, African bishops have supported harsh anti-gay laws. By comparison with same-sex relations, the issue of female clergy and bishops is not especially divisive, though Nigeria stands out as a large Anglican province where women are not ordained to any clerical rank. But developing-world conservatives are also dismayed when their northern colleagues make liberal theological noises—by suggesting, for example, that Jesus Christ might not offer the only path to salvation.   

In his latest speech, Archbishop Welby acknowledged for the first time that the Lambeth conference—a once-in-a-decade gathering of Anglican bishops—might never happen again. Nor, he made clear, was it even certain whether the basis existed for convening another "primates' meeting"—a global gathering of slightly lesser status which would normally take place every couple of years. In any case, he was no longer prepared to take sole responsibility for deciding such matters; instead there should be a "collegial model of leadership" with Anglican leaders from around the world deciding which meetings were worthwhile.

Despite all this, the archbishop gallantly insisted, reports of the global club's death were exaggerated. "The Anglican Communion exists and is flourishing in roughly 165 countries." That may be sort-of true as far as it goes, but it is rather like the Queen saying that the Commonwealth exists. Of course it does, in the sense that nobody has abolished it, and not many people have left it. But post-imperial arrangements can lose salience very gradually, to the point where the boundary between existence and non-existence becomes almost imperceptible.

Read the entire article in The Economist . . . 

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2.      In the News: The financial pain of Electronic Health Record transition

Subsidies aren’t enough to ease the financial pain of EHR transition for some docs. We’d all like to think that regulating electronic health records (EHR) is a good thing for everyone involved, patients and doctors, but it turns out that it’s not that simple. Read more . . .

Dr. Oliver Korshin is an ophthalmologist in Anchorage, Alaska, and after three decades in his small office, he’s seen patients move into Medicare coverage – he’s doing the same himself.

For Korshin and his practice, having patient’s medical records transitioned into an online database just isn’t practical because it will cost too much to install and maintain, according to him, and he’s pretty close to retirement anyway.

Unfortunately for him, the federal government will penalize Korshin for not using EHR starting next year by withholding 1 percent of his payments, and he’ll lose an additional 1.5 percent for failing to enroll in a federal program that requires doctors to digitally keep track of (and report) quality data about how their patients fare under their care.

That’s not all:

And then there’s the new coding system, also set to take effect in the fall of 2015 — an overhaul of the standard method of classifying diseases and conditions. Medicare and other insurers require the proper use of these codes if doctors want to get paid for the treatments and procedures they perform. A cost study sponsored by the American Medical Association earlier this year estimated that depending on “variable factors such as specialty, vendor and software,” implementing the new coding system alone could cost a small medical practice between $56,639 and $226,105. . .

This story is part of a reporting partnership that includes NPR, Alaska Public Media and Kaiser Health News

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3.      International Medicine: The angel of good death opens up his surgery

Atul Gawande: The angel of good death opens up his surgery

The American surgeon and bestselling author begins his Reith lectures this week on why doctors sometimes do harm. And the nation is dying to hear them

The Sunday Times: 23 November 2014

As a senior surgeon who has become a bestselling author by writing about his day job, Atul Gawande has unusual advice for the medical profession: he thinks practitioners should talk to their patients more about death. The 49-year-old son of Indian immigrants to America, who studied philosophy, politics and economics at Oxford and influenced President Barack Obama’s healthcare reforms, is about to be hailed with a very British honour: he will deliver the BBC’s 2014 Reith lectures, entitled The Future of Medicine and to be broadcast on the next four Tuesdays. Read more . . .

It is not just the wonders of modern medical science that have fascinated Gawande for most of his professional and literary life, but the blunders that occur, the amount of money wasted and the way more effort goes into extending life expectancy than into the quality of life towards the end.

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.

Gawande, a practicing surgeon, addresses his profession’s ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.

Full of eye-opening research and riveting storytelling, his most recent book, Being Mortal asserts that medicine can comfort and enhance our experience even to the end, providing not only a good life but also a good end.

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4.      Medicare: SSDI Reform: Promoting Gainful Employment while Preserving Economic Security

by Jagadeesh Gokhale | CATO

Determining whether medical impairments imply inability to work is becoming more difficult in a growing number of cases, with the result that many applicants with residual work capacities are admitted to Social Security Disability Insurance (SSDI), a program facing imminent insolvency. In this paper, Cato scholar Jagadeesh Gokhale encourages a change in the structure of SSDI’s benefit payments to those admitted to the program. Shifting benefits at the margin toward paying beneficiaries to work rather than to remain out of the work force would encourage beneficiaries with residual capacities to return to work. Read more . . .

Many beneficiaries express a desire to return to work but fear of losing benefits and health coverage under SSDI’s current benefit rules impedes such a decision. Accordingly, this paper advocates a change in the structure of SSDI’s benefit payments to those admitted to the program. Shifting benefits at the margin toward paying beneficiaries to work rather than to remain out of the work force would encourage beneficiaries with residual work capacities to return to work. That shift would serve as a backstop to reduce the economic loss from wrongful allowances of applicants into SSDI. Such a switch in benefit design can be accomplished without compromising benefit eligibility for those who cannot work. The paper explains how to implement such a change to SSDI’s benefit structure and the advantages that would accrue from it. Apart from creating better incentives to work, the proposed reform complements other reforms Congress might adopt. . .

Read the entire policy analysis at

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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: Education Gluttony

Student Debt Linked to Worse Health and Less Wealth

Those with over $50,000 in debt have lower well-being than debt-free peers

by Andrew Dugan and Stephanie Kafka

As college costs rise and enrollment increases, the amount of outstanding undergraduate student debt in the U.S. continues to climb. The amount of student debt now stands at over $1 trillion for both undergraduate and graduate loans and exceeds Americans' overall credit card debt, according to the Federal Reserve. In particular, estimates put the average amount of undergraduate student loan debt for the class of 2014 at just over $33,000, a substantial increase from $18,600 in 2004. . . Read more . . .

As the amount of money students are borrowing continues to grow, the importance of student debt as a U.S. political issue has increased. Politicians and higher education leaders express concern that highly indebted graduates are unable to forge an economic identity after graduation, putting off major purchases and suffering from low savings. . .

The findings from the Gallup-Purdue Index raise another important concern about student debt: its link to lower well-being. . .

Link Between Student Debt and Lower Well-Being Holds Across Graduation Classes

Relatively recent college graduates -- those who earned their degree from 2000 to 2014 -- who have more than $50,000 in student debt are significantly less likely to be thriving financially and physically than their counterparts without loans. They are also less likely to have a strong sense of purpose and to be thriving in their community well-being. Notably, for 2000-2014 graduates, the most indebted degree holders are less likely to be thriving in social well-being. . .

But older graduates who took out large student loans also differ from their fellow graduates in their current well-being. Though their student debt is likely paid off, those who graduated in the 1990s and borrowed more than $50,000 have lower financial, physical, and purpose well-being compared with those who never took out loans.

In financial well-being, older graduates that had large student loans trail behind their debt-free peers by 13 points in terms of thriving rates, nearly as large as the gap among the two of graduate types for the 2000-2014 cohort. . . .

Read the entire report at

Phil Izzo, “Congratulations to the Class of 2014, the Most Indebted Ever,” The WSJ, May 16, 2014

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Gluttony thrives in Government, Health Insurance, and College Loan Programs.

Get your initial two years of college at the inexpensive community colleges

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6.      Medical Myths: Education Myths: Why is “Logan” depressed?

Logan graduated from “Bowdoin College” convinced that he is a “citizen of the world.” He convinced his alma mater to divest from carbon-based energy stocks. He can speak fluently about “the common good.” Although he is a “citizen of the world” in his mind, he was never required to learn a foreign language. He considers himself an expert on carbon-based energy, but his education has never touched on chemistry or thermodynamics. Logan has achieved a high level of confidence in his abilities and is pretty smart as measured by IQ tests, but he knows far less than he thinks he does. Read more . . .

He has scant knowledge of America’s past, our economic and political systems, and our common bonds as a nation. Peter Wood, President, NAS, hopes that this new Graduate will wake up one of these days, realized that he has been cheated out of a real education. To repair the damage, Logan will need to jettison most of the ideological baggage his college gave him, restart educating himself with strenuous reading, and find the humility to start at the bottom.

Peter Wood thinks he may choose one of several options. He may imagine himself stuck where he is because the “Koch brothers” put him there, and the banks have exploited him, and global capitalism is oppressing everyone. Occupy Wall Street is in his soul. The “People’s Climate March” is treading round and round in his mind.

Or, bored with the whole thing, he has settled into apathy. He has no good way out of his parents’ basement because his education from kindergarten through college has taught him dependency, resentment, and self-indulgence.

College essentials were long thought to be that it teaches the pursuit of truth, promotes active citizenship, and fosters a love for best of our civilization. But it has degenerated into scare words in our contemporary university. Whose truth? Citizen of what? Which civilization?

The National Assn of Scholars, which is open to all citizens, recognizes that colleges and universities exist in our society by virtue of the hard-one political and intellecdtual freedoms bequeathed to us by earlier generations and that we all bear a responsibility—call it citizenship—to carry those freedoms forward for generations to come. The high achievements in science, art, law, medicine, and many other fields are rooted in Western civilization.


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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: Medicaid patients with HMOs think they are insured.

Dr. Rosen:      Now that Obamacare has been implemented, how is that affecting our practice?

Dr. Dave:        It has increased our complement of Welfare Patients under the illusions that they are now                 in an HMO. Read more . . .

Dr. Sam:         But they aren’t like an HMO patient. The new clothes has not made a difference in how                               he acts.

Dr. Edwards:  Just giving someone new clothes does not change the person.

Dr. Milton:      New clothes do not change the man unless it changes his perception of who he is. And                                 that doesn’t usually happen. My psychiatry colleagues say that they have difficulty in                                  doing that even with two or three years of talk treatment.

Dr. Ruth:        We receive a number of requests daily from welfare patients who try to avoid                                               stating their previous welfare or Medicaid status. They feel they are now first class                           citizens with an HMO. But my front office is very skillful in picking up from their                            language that they are medical recipients in sheep’s clothing.

Dr. Edwards:  Isn’t it tragic how these Medicaid and welfare patients think that now they have                                            HMO coverage, that they have usual insurance. Some have even told my staff that they                                have called more than a dozen physician’s offices and none were willing to accept them.

Dr. Patricia:   We are also receiving a number of calls daily from patients who think they have health                                care coverage under the new Obamacare. These have to be dealt with very carefully.                                    Once they get into your practice, it’s very hard to get them to move on. They act very                                   litigious. And litigious threats can become lawsuits which will tie you up for months and                              possibly for years and bankrupt you.

Dr. Milton:      Physicians at the Association of American Physicians and Surgeons have shown for more                than a decade that having insurance may not provide you with health care.

Dr. Rosen:      Let’s not forget the famous case in Canada where Dr Jacques Chaoulli went before the                                 the Canadian Supreme Court and Won: Final verdict: Canadians don’t have access to                                   healthcare, they only have access to a waiting list. Isn’t that what Americans are learning                              from Obamacare. They don’t really have access to health care. They now just have an                                  HMO card.

Dr. Milton:      The person that implemented RomneyCare in Massachusetts stated that people are                            basically stupid about health care. He then got a promotion to help develop Obama Care.                             He thought most Americans are equally stupid about their healthcare. 

Dr. Rosen:      But it doesn’t stop there. The Congress has a confidence rating approaching 10%. The                                  president has a confidence rating that’s now below 40%. Why would any thinking                            progressive or regressive or conservative American put any stock in any health plan                         developed by these medical illiterates?

Dr. Milton:      And we have to be very careful not to fall for another catastrophic political conundrum. I                            think that many Americans are not sufficiently aware of Governor Romney and Governor               Christie being RINOs, Republican In Name Only. If such a person would be nominated                                for president, that would spell the death knoll to the Republican Party. And then Goodbye                to the American Dream of Freedom that is scarcely two centuries old. Hillary has said                                Americans have too much Freedom. It’s hard to socialize and restrict freedom without                           being a tyrant which she would be good at—probably as good as    our current White                                 House occupant.

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The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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8.      Voices of Medicine: A Review Regional Medical Journals: MARIN MEDICINE | Fall 2014  

EDITORIAL: Medicine & Politics

Jeffrey Stevenson, MD

This issue of Marin Medicine focuses on medicine and politics, a theme with many facets. First and foremost is Proposition 46, which would raise the statutory cap on pain-and-suffering awards, thereby increasing malpractice insurance rates. The proposition could cause patients to lose their doctors and restrict access to care across the state. . .

Trial attorneys have generated Prop. 46 as a revenue source from physicians, and it stands to add malpractice costs at a time when physicians are struggling to make adjustments for reduced reimbursements and increased workloads. In the interest of financial survival, many physicians have allied themselves with large groups or medical foundations. The greater challenge is whether doctors can work together politically. We need to stand firm for access to quality care. Both the California Medical Association and the Marin Medical Society provide state and national leverage for physicians. . .

One place where physicians need more leverage is with health care insurance companies, who commonly don’t give doctors a seat at the boardroom table. Physician medical directors at these companies provide advice, but the companies aren’t obligated to follow it. A voting physician “on the board” could probably impact policy at a higher level. . .  Read more . . .

Interested parties are developing a time-of-service treatment authorization portal to expedite this process and allow guidelines to be queried and applied to an individual situation in real time. Key to this revised process is the provider’s ability to upload or enter key information to designated algorithms, along with comments, reports and documentation. Part of the concept evolution is for nurses and on-call specialists to handle more detailed reviews in real time. This ability would allow them to focus on the subset of requests that are complex and warrant the extra review.

Meanwhile, fiber-optic infrastructure and emerging hardware promise to bring faster speed and better access. Emerging fiber-based products can download a fully loaded CD in 8 seconds vs. the 90 seconds required with current business broadband. Applying these fiber technologies within local networks as well as distant file transfers can not only speed things up, but also bring real-time streaming without sacrificing fidelity. Fiber-optic provides a more secure network. On the Internet, anything can be hacked, for a price.

I recently tried out a Google Glass real-time transcription product. It had many positive features but was limited in visual resolution in favor of optimizing audio for the transcriptionist. The limited resolution prevented me from getting a video “screen shot” of a page of information, such as a handwritten chart note with diagrams or a picture to the transcriptionist. These details are being sorted out by the developer.

The interconnectivity of different electronic health record systems, whether city-to-city or state-to-state, continues to evolve. Interconnection requires careful segregation of psychological and psychiatric reports, as well as particular infections, alcohol and drug conditions from the past. There are some records that are just too precious to transmit, despite HIPAA promises of security.

Finally, opioids and other pain medications are receiving considerable attention and are under careful review. Locally, we are bringing together community resources, both private and public, to better understand the situation and what we have to learn. Fortunately, some of the world leaders in pain management are available in our community. The risks of opioids have to be balanced with the important need for pain control and the unique situations that apply with particular patients. They need pain-control resources that will give them adequate support.

In closing, I would like to thank my colleagues for the opportunity to serve you this year as president of MMS. ::

Dr. Stevenson, a Novato general practitioner, is president of the Marin Medical Society.

MARIN MEDICINE|Fall 2014  |  Marin Medical Society

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

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9.      Book Review: Stanley Fish’s Postmodern Take on Academic Freedom

Versions of Academic Freedom

Reviewed by Peter Wood | Oct 27, 2014

This article originally appeared on Minding the Campus on October 24, 2014.

Whatever their ostensible subjects, Stanley Fish’s books tend to be about Stanley Fish. His new one, Versions of Academic Freedom, extends the conceit.

Which is not to say that the book is only a “Version of Stanley Fish.” It is also a succinct, well-informed, and often elegant essay.  Fish’s great talent is compression.  In this case he reduces the overgrown jungle of debate about academic freedom in America’s colleges and universities to a lucid list of five alternative positions: Read more . . .

1. The “It’s just a job” school

2. The “For the common good” school

3. The “Academic exceptionalism or uncommon beings” school

4. The “Academic freedom as critique” school

5. The “Academic freedom as revolution” school

These are “ideal types” in Max Weber’s phrase.  Fish no sooner names them than he admits that in the real world the lines blur and people are inconsistent.  Nonetheless, the five-fold typology provides both a map of the larger territory and a path to specific destinations.

It could use up the better part of a review just to explain the five alternatives, so at the risk of further compressing Fish’s compressions, I will leave it at this.  “It’s just a job” treats academic scholars as professional workers who, because they are hired to advance knowledge, need a certain amount of workplace latitude to do their jobs. This is the form of “academic freedom” that Fish says he upholds.  His position on this is consistent with his 2008 book, Save the World on Your Own Time, which I reviewed on my own time as “Night Makes Right.”

“For the Common Good” refers to arguments that granting academic freedom to professors within their disciplines contributes to self-government by militating against facile enthusiasms that can lead to the tyranny of public opinion.  “Academic exceptionalism” extols academic freedom by treating professors as people set apart from everyone else by their unusual talents and therefore deserving of privileges that are denied to ordinary people.  “Academic freedom as critique” projects the freedom of the professors beyond their disciplines to the rest of the social order.  “Academic freedom” in this view is almost synonymous with dissent.  “Academic freedom as revolution” holds that the whole purpose of education is to advance radical reform of society.

Fish’s typology is impressive, but the moment he applies it, it breaks down.  That moment comes straightaway with the case of U.C. Santa Barbara sociology professor William Robinson who got into hot water by sending an email to his students “comparing Israelis to Nazis and asserting that Martin Luther King would have stood with the Palestinians had he been alive.”  Fish proceeds by showing that the proponents of each rationale for academic freedom other than his own (“It’s just a job”) would have (or actually did) side with Robinson.  Fish’s position, by contrast, is that Robinson erred because his explicit goal was to advance a political cause rather than to stimulate “vigorous discussion” of an academic issue.  For Fish, the key question is motive.  He quotes Robinson speaking to the Seventh Annual International Al-Awda Convention in 2009 explaining that he acted out of “growing horror” at the “siege of Gaza,” and he intended, plainly, to advance his own judgments to his students.  In Fish’s view, this crosses the line.  If the conclusion is “ordained” before the inquiry begins, the inquiry is “not academic” and does not enjoy the protection of academic freedom.

In this case, Fish has set himself up rather nicely.  Every other “version” of academic freedom called to the witness stand has given the anti-Semite professor an alibi.  Only Fish can provide unambiguous and principled grounds to say why Robinson abused his privileges as a professor.

But surely something is missing from Fish’s account.  Might it be this?  Academic freedom concerns the pursuit of the truth. There are numerous situations in which the truth is not well-established, or established views are open to reasonable objections, or there are well-argued but mutually incompatible views.  A deep reason why we want academic freedom is to create a context in which reason and evidence on all sides of a contentious issue can be brought forward for thoughtful consideration and debate.  Without such debate, knowledge settles into stultifying orthodoxy.  Because “settled opinion” or orthodoxy is the natural state of opinion on most things, we have to take care to create some special conditions where people are encouraged to look further, question assumptions, and seek evidence that might not otherwise come into focus.  Academic freedom is what we call that special condition.  It is undermined when someone purloins its name not to seek the truth but to propound an opinion or enforce an orthodoxy. . .

Read the entire book review at

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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: Red States vs. Blue States

Red States and Blue States

During the second war era, the Democrats were looking like Red Commies and the Republicans like True Bloods. Time magazine didn’t like their fellow democrats labeled as Red sympathizers, so they started calling the Democrats the Blue party and the Republicans the Red Party. This then evolved into the Blue states and the Red states. But one’s true colors can’t hide forever. San Francisco’s former mayor and the California Assembly long time speaker, California’s most powerful politician, who could only lose by being “termed” out, states in his SF Chronicle column that both Democrats running for his old assembly seat are communists. And he explains the difference. Read more . . .

One is a communist only in certain situations.

Willie Brown on SF Politics

The most heated race in San Francisco is the one for WB old assembly seat between David Chin and David Campo. According to WB, both are supervisors, both are Democrats, both are Harvard Graduates, and both vote the same way. The only distinction that he sees between the two is that Campos is a straight up communist while Chin is a situational communist.

Are Democrats really calling themselves Communist?

HMO Stress Workshop for Office Managers

My office manager went to a recent HMO Stress Workshop. They were given a toolkit for dealing with difficult patients. They were advised to have four items in this tool kit:

1.                Bottle of Water (for breaking stress symptoms)

2.                Pen (for emotional boundary reminder)

3.                Rubber band (to give yourself a painful stimulus for mindfulness)

4.                Colored object (for “self” reminder)

I wouldn’t have believed such a sophisticated system of relieving stress if she had not brought back a copy of the slide.

I understand that HMOs are on their way out. I guess this was a final descent out the back door.

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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

                      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."

* * * * *

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

Words of Wisdom – Aphorisms of Sir William Osler

The modest country doctor may furnish you the vital link in your chain, and the simple rural practitioner is often a very wise man.

I would speak of the general practitioner’s failure to realize first the need of a lifelong progressive personal training. And secondly, the danger lest in the stress of practice he sacrifice that most precious of all possessions, his mental independence.

The incessant concentration of thought upon one subject however interesting, tetherers a man’s mind in a narrow field.

In no profession does culture count for so much as in medicine, and no man needs it more than a general practitioner.

Some Recent Postings

In The October Issue:

1.                  Featured Article: A Campus Crusade Against the Constitution

2.                  In the News: Obama’s ‘Horrible Bosses 3’ Audition

3.                  International Medicine: NHS litigation claims double under coalition

4.                  Medicare: Palliative and End-of-Life Care

5.                  Medical Gluttony: Government medicine cannot avoid gluttony.

6.                  Medical Myths: Government Medicine will give immediate access for everyone.

7.                  Overheard in the Medical Staff Lounge: How can we reduce reversed race riots?

8.                  Voices of Medicine: Colorado Med Society: Prescription drug abuse

9.                  The Bookshelf: Moral Tribes: Emotion, Reason and the Gap Between Us and Them, Joshua Greene

10.              Hippocrates & His Kin: The In Vivo organ grinder

11.              Restoring Accountability in Medicine, Government and Society

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

In Memoriam

Mike Nichols was a learned man who loved his work and was in love with the world.

He died last week at 83, I’m grateful this Thanksgiving just to have known him, and been his friend. 

Declarations | By Peggy Noonan | The Wall Street Journal | BiographyPeggy Noonan

I wrote of this two summers ago: Updated Nov. 28, 2014

There was a 7-year-old boy who came over from Germany on the SS Bremen, traveling with his younger brother. They were fleeing the Nazis. The Bremen anchored on Manhattan’s west side on May 4, 1939, and the children were joined by their father, who was already in New York. They stood on deck watching all the bustle of disembarking when the boy saw something: “Across the street from where we were, and visible from the boat, was a delicatessen which had its name in neon with Hebrew letters,” he later remembered.

He was startled, then fearful. A sign in Hebrew letters—that would be impossible back home. He asked: “Is that allowed?”

“It is here,” said his father.

The little boy was Mike Nichols, the great film and stage director, who went on to do brilliant things with all that America allowed.

He died last week at 83, at the top of his game and still in the thick of it. I’m grateful this Thanksgiving just to have known him, and been his friend.

He was a great man.

We all know his work but it must be said he had such range. Everyone noted the past week that he did it all—directing on Broadway, in film, brilliant comedy act with Elaine May, comedy albums. And he had another kind of range. He had perfect pitch for the tale of a lost, affluent college graduate in the heart of Los Angeles in the 1960s, perfect pitch for a striving Staten Island working girl who wanted to make it in America in the ’80s, perfect pitch for the Midwestern working people whose story was told in “Silkwood.” He understood people! He saw their sameness, their hungers and hopes. He bothered to understand the country he first glimpsed from the Bremen.

He once told me he didn’t direct movies, he cast them. In a way it was a line and a typically modest one—it wasn’t him, it was them—but it also wasn’t. He was saying he picks actors who have the quality and depth to do what he wants, and he trusts them to come through. That is a great thing, when an artist trusts his paint.

There was something in the home that he shared with his wife, his beloved Diane Sawyer , that I always looked for when I visited. He kept a big, faded pillow on the living-room couch. It bore the words “Nothing Is Written.” When I first saw it I pointed. “You know what that’s from?” he asked. Yes, I said, “ Lawrence of Arabia, ” Robert Bolt ’s screenplay. He clapped his hands with delight. To know it was to honor what it meant—that no outcome is dictated, no impediment is insuperable; you can wrest life from its ruts, its false limits.

I can’t think of a better attitude for an artist, or any other professional for that matter.

His closest friends this week marveled at the depth of the impression he made on all whose lives he touched. “He’d make you feel you were better than you believed—smarter, funnier, more alive,” one said.

It was his way not only as an artist but as a human being to turn things on their head. A friend of his son, Max, wrote to remind him of a birthday party they’d attended years before, when she was a little girl. They had gone to see “20,000 Leagues Under the Sea.” In the middle of it she ran out into the lobby, terrified. Naturally a parent would be expected to follow and comfort her by explaining it wasn’t real, there was nothing to be afraid of. But it was Mike who followed her out, and he asked, “Is being scared always such a bad thing?” A soothing philosophical discussion commenced. . .

A thing that distinguished Mike professionally is that he thought he had to know things. He came up in a generation that thought to know the theater you have to know the theater. They read. He read, all his life. He knew the canon—his Chekhov, Ibsen and Molière, his Shakespeare, Tennessee Williams and Tom Stoppard.

He learned his stuff in part for the sheer pleasure of learning, but in part because you have to know what has been said and thought and given to the world, you have to know what’s a cliché to be lost and what’s an ever-present truth to be resurrected or enlarged upon. Mrs. Robinson was, in fact, Phaedra. He knew, said a friend, that “every great story is a tremor from those dynamics that stretch back way over time.”

To make great art you have to know great art. And so his learned, highly cultivated mind. He dropped out of the University of Chicago and sought to teach himself through great books and smart people.

Great writers and directors have to start as great readers or it won’t work, nothing needed from the past will be brought into the future, and art will become thinner, less deep, less meaningful and so, amazingly, less fun, less moving and true.

The makers of American culture should return to this old style, which isn’t really old and yet is being lost.

Mike Nichols cared deeply—this was apparent in his later years—about keeping the American culture a thing of stature and height and radiance. It was the subject of our last long conversation, late this summer.

When he directed “Death of a Salesman” on Broadway two years ago he was, in fact, rescuing a classic and making it new again for those who had never seen or even known of this great play. He did a lot of rescue work. He wasn’t stuffy or old fashioned—that’s the last thing he was!—he loved the new, the breakthrough, the brave moment that he’d never seen before. But he wanted very much for us to retain and maintain the excellence of American theater and film.

An anecdote, about a friend who really got him:

The morning after Mike’s death, a friend of the family called those who had been in touch to invite them to a small gathering in New York the next afternoon. Among them was the actress Emma Thompson, who knew of his death and was bereft. Now, told of the gathering, she was crestfallen. She was in London, there was a big event months in the making the very next day, it wasn’t possible. Of course, she was told, we understand. Mike would understand.

The next day the gathering began, and first through the door was Emma Thompson. “Where else would anyone who knew him be?” she said.

Lucky us, that the Bremen came here.

On This Month in History - November

November traditionally is “Religion in American Life Month.” It is the month of Thanksgiving, the month when we start selling Christmas Seals, the month when a worldwide Bible reading observance gets under way. But for a month of spiritual remembrance, it has some rather surprising anniversaries.

On the very day when the month begins, we have the anniversary of the attempt by a group of Puerto Rican nationalists to assassinate President Truman in 1950, the beginning of the Algerian revolution against the French, and the anniversary of our nation’s test explosion of an H-bomb.

The message of Religion in American Life Month is that a faith worth keeping is worth fighting for.

On this date, Nov 1, 1870, the United States Weather Bureau made its first observations. It wasn’t called the weather bureau then, because it was a service of the Signal Corps of the U. S. Army. On this day reports were telegraphed from 24 places around the U.S. and the national weather service was born. History does not record how accurate these early forecasts were. They are best remembered when they are spectacularly wrong.

On this date, Nov 1, 1952, the United States conducted a test explosion of a hydrogen bomb at Eniwetok Island in the Pacific that began a new era of military power for the U.S.  It was so awesome that it probably strengthened the resolved of sensible people everywhere never to come to the point of having to employ such a weapon.

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.