MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VIII, No 9, Aug 11, 2009
In This Issue:
1. Featured Article: Celiac Disease is nearly 100 times more common than had been thought
2. In the News: Free our Health Care System of Mandates and Costs Will Plummet
3. International Medicine: Obama and Lessons from the National Health Service
4. Medicare & Medicaid: Tennessee: Tried and Found Wanting
5. Medical Gluttony: Health Insurance without significant co-pays creates gluttony
6. Medical Myths: Americans are going bankrupt because we have no "universal health care"
7. Overheard in the Staff Lounge: There is no health care crisis; Let the crisis continue.
8. Voices of Medicine: Met in Medical School . . . Over a Dead Body
9. The Bookshelf: The Wizard Who Came in from the Cold
10. Hippocrates & His Kin: The thing about government: If it doesn't work, keep doing it
11. Related Organizations: Restoring Accountability in HealthCare, Government and Society
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The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. The third year it was about half, indicating open forums such as these are critically important. The 4th Annual World Health Congress was held April 22-24, 2007, in Washington, D.C. That year many of the world leaders in healthcare concluded that top down reforming of health care, whether by government or insurance carrier, is not and will not work. We have to get the physicians out of the trenches because reform will require physician involvement. The 5th Annual World Health Care Congress was held April 21-23, 2008, in Washington, D.C. Physicians were present on almost all the platforms and panels. However, it was the industry leaders that gave the most innovated mechanisms to bring health care spending under control. The 6th Annual World Health Care Congress was held April 14-16, 2009, in Washington, D.C. The solution to our health care problems is emerging at this ambitious Congress. The 5th Annual World Health Care Congress – Europe 2009, met in Brussels, May 23-15, 2009. The 7th Annual World Health Care Congress will be held April 12-14, 2010 in Washington D.C. For more information, visit www.worldcongress.com. The future is occurring NOW. You should become involved.
To read our reports of the 2008 Congress, please go to the archives at www.medicaltuesday.net/archives.asp and click on June 10, 2008 and July 15, 2008 Newsletters.
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Surprises from Celiac Disease by Alessio Fasano, MD, Professor of Pediatrics, Medicine & Physiology, U of MD, School of Medicine.
Study of a potentially fatal food-triggered disease has uncovered a process that may contribute to many autoimmune disorders.
My vote for the most important scientific revolution of all time would trace back 10,000 years ago to the Middle East, when people first noticed that new plants arise from seeds falling to the ground from other plants—a realization that led to the birth of agriculture. Before that observation, the human race had based its diet on fruits, nuts, tubers and occasional meats. People had to move to where their food happened to be, putting them at the mercy of events and making long-term settlements impossible.
Once humans uncovered the secret of seeds, they quickly learned to domesticate crops, ultimately crossbreeding different grass plants to create such staple grains as wheat, rye and barley, which were nutritious, versatile, storable, and valuable for trade. For the first time, people were able to abandon the nomadic life and build cities. It is no coincidence that the first agricultural areas also became "cradles of civilization."
This advancement, however, came at a dear price: the emergence of an illness now known as celiac disease (CD), which is triggered by ingesting a protein in wheat called gluten or eating similar proteins in rye and barley. Gluten and its relatives had previously been absent from the human diet. But once grains began fueling the growth of stable communities, the proteins undoubtedly began killing people (often children) whose bodies reacted abnormally to them. Eating such proteins repeatedly would have eventually rendered sensitive individuals unable to properly absorb nutrients from food. Victims would also have come to suffer from recurrent abdominal pain and diarrhea and to display the emaciated bodies and swollen bellies of starving people. Impaired nutrition and a spectrum of other complications would have made their lives relatively short and miserable.
If these deaths were noticed at the time, the cause would have been a mystery. Over the past 20 years, however, scientists have pieced together a detailed understanding of CD. They now know that it is an autoimmune disorder, in which the immune system attacks the body's own tissues. And they know that the disease arises not only from exposure to gluten and its ilk but from a combination of factors, including predisposing genes and abnormalities in the structure of the small intestine.
What is more, CD provides an illuminating example of the way such a triad—an environmental trigger, susceptibility genes and a gut abnormality—may play a role in many autoimmune disorders. Research into CD has thus suggested new types of treatment not only for the disease itself but also for various other autoimmune conditions, such as type 1 diabetes, multiple sclerosis and rheumatoid arthritis.
After the advent of agriculture, thousands of years passed before instances of seemingly wellfed but undernourished children were documented. CD acquired a name in the first century A.D., when Aretaeus of Cappadocia, a Greek physician, reported the first scientific description, calling it koiliakos, after the Greek word for "abdomen," koelia. British physician Samuel Gee is credited as the modern father of CD. In a 1887 lecture he described it as "a kind of chronic indigestion which is met with in persons of all ages, yet is especially apt to affect children between one and five years old." He even correctly surmised that "errors in diet may perhaps be a cause." As clever as Gee obviously was, the true nature of the disease escaped even him, as was clear from his dietary prescription: he suggested feeding these children thinly sliced bread, toasted on both sides.
Identification of gluten as the trigger occurred after World War II, when Dutch pediatrician Willem-Karel Dicke noticed that a war-related shortage of bread in the Netherlands led to a significant drop in the death rate among children affected by CD—from greater than 35 percent to essentially zero. He also reported that once wheat was again available after the conflict, the mortality rate soared to previous levels. Following up on Dicke's observation, other scientists looked at the different components of wheat, discovering that the major protein in that grain, gluten, was the culprit.
Turning to the biological effects of gluten, investigators learned that repeated exposure in CD patients causes the villi, fingerlike structures in the small intestine, to become chronically inflamed and damaged, so that they are unable to carry out their normal function of breaking food down and shunting nutrients across the intestinal wall to the bloodstream (for delivery throughout the body). Fortunately, if the disease is diagnosed early enough and patients stay on a gluten-free diet, the architecture of the small intestine almost always returns to normal, or close to it, and gastrointestinal symptoms disappear.
In a susceptible person, gluten causes this inflammation and intestinal damage by eliciting activity by various cells of the immune system. These cells in turn harm healthy tissue in an attempt to destroy what they perceive to be an infectious agent. . .
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10 Steps to Free Our Health Care System by John C. Goodman Thursday, July 30, 2009
To confront America's health care crisis, we do not need more spending, more regulations or more bureaucracy. We do need to liberate every American, including every doctor and every patient, to use their intelligence, creativity and innovative abilities to make the changes needed to create access to low-cost, high-quality health care.
Here are 10 steps to achieve these goals.
1. Free the Doctor. Medicare pays for more than 7,000 specific tasks, and only for those tasks. Blue Cross, employer plans and most other insurers pay the same way. Notably absent from this list are such important items as talking to patients by telephone or e-mail, or teaching patients how to manage their own care or helping them become better consumers in the market for drugs. Further, as third-party payers suppress reimbursement fees, doctors find it increasingly difficult to spend any time on unbillable services. This is unfortunate, since it means that doctors cannot provide the type of low-cost, high-quality services that are normal in other professions. . .
2. Free the Patient. Many patients have difficulty seeing primary care physicians. All too often, they turn to hospital emergency rooms, where there are long waits and the cost of care is high. Part of the reason is that third-party payer (insurance) bureaucracies decide what services patients can obtain from doctors and what doctors will be paid. To correct this problem, patients should be able to purchase services not paid for by traditional health insurance, including telephone and e-mail consultations and patient education services. This can be done by allowing them to manage more of their own health care dollars in a completely flexible Health Savings Account.
3. Free the Employee. It is now illegal in almost every state for employers to purchase the type of insurance which employees most want and need: individually owned insurance that travels with the employee from job to job, as well as in and out of the labor market. We need to move in the opposite direction - making it as easy as possible for employees to obtain portable health insurance.
4. Free the Employer. Liberating employees would have the indirect effect of liberating employers as well. Employers have been put in the position of having to manage their employees' health care costs, even though many businesses lack the experience or expertise. Instead, employers could make a fixed-dollar contribution to each employee's health insurance each pay period. Like 401(k) accounts, the health plans would be owned by employees and travel with them as they move from job to job and in and out of the labor market.
5. Free the Workplace. If a new employee has coverage under her spouse's health plan, she doesn't need duplicate coverage. But the law does not allow her employer to pay higher wages instead. On the other hand, a part-time employee might be willing to accept lower wages in return for the opportunity to enroll in the employer's health plan. The law does not allow that either. The answer: Employers should be free to give employees the option to choose between benefits and wages, where appropriate.
6. Free the Uninsured. Most uninsured people do not have access to employer-provided health insurance, purchased with pretax dollars. If they obtain insurance at all, they must buy it with after-tax dollars, effectively doubling the after-tax price for middle-income families. The answer: People who must purchase their own insurance should receive the same tax relief as employees who obtain insurance through an employer.
7. Free the Kids. The recent expansion of the State Children's Health Insurance Plan (S-CHIP) to cover four million additional children will result in up to half losing private coverage, according to the Congressional Budget Office. However, under S-CHIP, children have access to fewer doctors and medical facilities than children in private plans. . .
8. Free the Parents. Under the current system, a child could be enrolled in S-CHIP, a mother could be enrolled in Medicaid and a father could be enrolled in an employer's plan. However, medical outcomes are likely to be better with a single insurer. The answer: Medicaid and S-CHIP funds should be used to subsidize private health insurance, so that low-and moderate-income families are able to see the same doctors and enter the same facilities as other citizens.
9. Free the Chronically Ill. Under current regulations, insurers are not allowed to adjust premiums to reflect higher expected health care costs. This encourages insurers to seek the healthy and avoid the sick before enrollment. After enrollment, insurers have an incentive to over-provide care to the healthy and under-provide to the sick. These incentives need to be reversed. . .
10. Free the Early Retiree. Most baby boomers will retire early, before eligibility for Medicare. Two-thirds will not get health insurance from their former employer and even those who have been promised employer coverage may see those promises broken, since there is almost no prefunding of benefits. Under current law, an employer can include early retirees in its regular health plan, but cannot contribute to more economical, individually owned plans.
The answer: Employers should be able to contribute pretax dollars to the individually owned insurance of their retirees. Early retirees should be able to pay their share of premiums with pretax dollars. Both the employer and the employee should be able to save (pretax) in preparation for these events.
John C. Goodman is president and Kellye Wright Fellow at the National Center for Policy Analysis.
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Obama And Lessons From The NHS by Philip Reynolds, 08.04.09, LONDON
With support for "ObamaCare" flatlining, the American president has often sought to revive support for his bill by pointing critics to the health of European models like Britain's National Health Service (NHS). But even some Brits aren't buying it.
There are still big problems at the NHS, despite the Labour government's increased spending over the past decade. Between 1997 and 2007, Britain's health care spending rose to 8.4% of gross domestic product, from 6.6%, but according to right-wing think tank Civitas there are still big inefficiencies and $5 billion worth of costs to cut.
"Despite supposed moves to increase autonomy, the buck stops with the government and it's completely distorting the provision of healthcare," says James Gubb, of Civitas, who co-authored a recent report published by the think tank. He says the government-funded, free-at-point-of-entry NHS should cut back on admissions for avoidable conditions, follow-up appointments and preoperative care, which could lead to savings of up to $5 billion and relieve pressure on the system.
Although the NHS is not grossly expensive when compared with other countries' health systems, it falls down on ease of access to specialist care. The Commonwealth Fund found last year that Britain was one of the worst offenders in the developed world when it came to waiting times, with 33% of adults waiting two months or longer for specialist attention for a chronic condition over the past two years. France, Germany and the Netherlands all had better readings, at 20% to 25%, while the United States had 10%.
When asked whether the United States would benefit from having its own NHS, Gubb said: "It's not a particularly smart idea. It's bad enough in England where you have only 40 million people. I don't know how it would work with millions more."
He doesn't think the American system is perfect, though, and says it could learn from the provision of doctors and nurses in local communities in Britain. "There's a big problem of overconsumption [in America]," he says. "Too often people are going straight to specialists when they don't need to."
That said, Obama is finding it hard enough just getting his own party to agree on what health care in the United States should look like without having to worry about the technicalities of Britain's model. Some 40 to 50 fiscally conservative "Blue Dog" Democrats helped stop Obama's ambitions dead in their tracks before the summer recess, meaning that there will be a very long road ahead before worries similar to those over the NHS ever start plaguing the United States.
The NHS does not give timely access to healthcare, it only gives access to a waiting list.
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Under Obamacare, the federal government wants to own and run a public option health care system. But have legislators learned anything from Tennessee's experience with public option health care, asks Fred Lucas, White House correspondent for CNSNews.com?
In 1993, Tennessee received a Medicaid waiver that allowed the state to leave Medicaid but use the same federal funds for its own managed care plan. The plan pulled in nearly 800,000 Medicaid recipients and 300,000 more deemed uninsured or uninsurable.
Conceived primarily as a budget measure with the promise of more care for less money, the program received a costly blow when a federal court in 1996 prohibited the state from reviewing the eligibility of enrollees:
By 1998, enrollment had grown by 100,000, as employers moved employees into the TennCare system.
In 1999, a review by Pricewaterhouse-Coopers found that TennCare paid health care providers 10 percent below what would be considered actuarially sound, most hospitals had between 10 and 14 percent of their care delivered as charity care, indigent care or nonreimbursed care and the state's hospitals were being paid about 40 cents on the dollar for TennCare patients, which eventually rose to 64 cents on the dollar.
Also in 1999, a state audit showed Tennessee was spending $6 million to insure 14,000 dead people, that 16,500 enrollees lived outside the state and that 20 percent were not eligible for the program.
Current governor Phil Bredesen (D) implemented a mend-it-don't-end-it approach by limiting prescriptions to five per person per month and the number of doctor visits and days in the hospital. But by November 2004, he scaled the program down even further with the hope of realizing savings.
Bredesen has called Obamacare the "mother of all unfunded mandates." And he should know, says Lucas.
Already four Blue Dog Democrats from Tennessee, congressmen Bart Gordon, Jim Cooper, Lincoln Davis, and John Tanner, have expressed skepticism about the Obama health plan.
Source: Fred Lucas, "Tried and Found Wanting," Weekly Standard, August 3, 2009.
For more on Health Issues: www.ncpa.org/sub/dpd/index.php?Article_Category=16
Read the original. . . www.ncpa.org/sub/dpd/index.php?Article_ID=18286
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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The low or no deductible insurance plans, including major carriers, Medicare, Medicare HMOs and Medicaid, create an unusual appetite for unnecessary health care expenditures. Still Congress is out purchasing votes in the next elections by promising no co-payments on preventive medicine. Much of what physicians do is preventive medicine from screening tests, vaccinations, mammograms, colon-rectal screening, cervical and uterine cancer screening, many x-rays, electrocardiograms, annual physical examinations, and nearly every blood test imaginable. If all of preventive medicine became free at the point of service, this would create a huge appetite for preventive measures that haven't even been thought of yet. Vitamin coverage next?
This may sound like a broken record in this newsletter, but it needs continued emphasis. The public, patients, Congress and State Legislatures either do not understand it or have another agenda that would not allow such considerations. Although the profit motive in business has come under greater scrutiny recently, James Buchanan, Nobel Prize-winning economist, points out that the laws of economics aren't suspended at the door to City Hall. Government reformers view themselves as morally superior, but that is an illusion. They are just like the private-sector operators, who do things that are in their own interest, not society's, first. Those things include taking advantage of an economic crisis to aggregate power for themselves and their offices. (See Amity Shlaes in Forbes)
Susan, a 27-year-old lady recently remarried, was seen this week. She announced that she now had great insurance and wanted to be pro-active in her health. After examining her and finding her in good health, she began to outline her demands. I was writing on my x-ray pad and laboratory requisition pad as fast as I could, checking the items that I thought reasonable. When she requested checking the levels of all the vitamins in her body, I dropped my pencil and told her to hold on. She couldn't understand why. She had new insurance, she had met her $100 deductible, and now it was her call. She did not like the resistance I started giving her saying that her insurance gave her rights to anything, which in her estimation was required for perfect health.
I'm sure I pruned at least five thousand dollars of health care costs from her requests. I don't think she left the office as a happy camper. She may come to a rational decision and return. Or she might seek out another physician she feels would be more compliant. She may never understand or accept the doctor as her medical counselor. Until there is a significant co-payment on every test and medical procedure, there can be no controls on health care costs. In fact, there is no better or more efficient control than the simple mechanism of an annual deductible that is equal to the average health care costs for her age per year plus a significant deductible on every test and procedure.
Our clinical study revealed that the level of co-payment that causes the patient to accept the doctor's judgment but still does not preclude necessary care is about 30 percent for outpatient medicine. We've found that 20 percent does not blunt the appetite for unnecessary outpatient medicine and 40 percent generally blunts it too much, to the detriment of appropriate care. The numbers are different for inpatient care, for Surgicenter care, and for durable medical equipment.
To keep up with these studies, be sure to subscribe to HealthPlanUSA.net by entering your email address at www.healthplanusa.net/newsletter.asp.
Medical Gluttony thrives in Government and Health Insurance Programs.
It Disappears with Appropriate Deductibles and Co-payments on Every Service.
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Myth 3. Americans are going bankrupt, and American companies are noncompetitive, because we don't have "universal health care."
AAPS: July 2nd, 2009
For years, advocates of "single payer health care" have been warning that middle-class Americans are only "one serious illness away from bankruptcy"—even if they have insurance. Obama has claimed that medical costs cause a bankruptcy in America every 30 seconds. Divided We Fail claims that "millions" go bankrupt every year because of medical costs.
American companies are also going bankrupt and losing out to global competition, allegedly because they are having to bear workers' high health costs.
Both problems would be solved, say proponents of a government takeover, if the U.S. adopted a universal tax-funded medical system, which would purportedly drive down expenditures, while imposing them on taxpayers instead of individuals and employers.
The facts are these:
According to Ning Zhu of the University of California at Davis, author of a study of 2003 bankruptcies in Delaware, only about 5% were caused by medical problems. If this percentage holds, (.05) (822,590) or about 41,000 were caused by medical costs—far from Obama's 30/sec or 1,051,200.
The mean net worth for "medically bankrupt" households was $44,622, while their average out-of-pocket medical costs came to $17,943. Single-payer advocates attribute bankruptcy to medical reasons if the debtor reported uncovered medical bills exceeding $1,000 in 2 years, or lost at least 2 weeks worth of income because of illness or injury. Bankruptcy is caused by debt, and a loss of the income needed to service it.
Many companies are in trouble, especially if they have acceded to union demands for unsustainable "gold-plated" benefits that encourage overconsumption of medical services. But American industry as a whole also faces an increasingly hostile business environment of taxation, regulation, and litigation, as well as high wages compared with the developing world.
Universal tax-funded medical care only compounds the bankruptcy problem. The existing single-payer systems in America—Medicare and Medicaid—are themselves unsustainable and on a course to bankrupt both federal and state treasuries. The price controls they impose on physicians and hospitals lead to cost shifting to private insurers and self-paying patients.
European social welfare systems are even more financially challenged than those in the U.S. Spending growth is about the same in the U.S. and other developed countries.
The entire world is in an economic crisis. "Universal health care" is much more likely to be a contributory cause than a solution.
For additional information, references, and to respond, go to www.aapsonline.org/newsoftheday/00299.
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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Dr. Rosen: There has been a lot of news for the past 15 or maybe 50 years about the health care crisis and the number of uninsured. The uninsured is a nebulous item.
Dr. Paul: How so?
Dr. Rosen: A large number of the uninsured are in the middle class making $50,000 to $75,000 per year. They are making their choices with which you and I may disagree.
Dr. Paul: We should not allow them to make that decision.
Rosen: There are at least 10 million
of those 47
qualify for coverage at this time but for various reasons have not applied for
Dr. Dave: I've noticed that whenever I admit an uninsured to the hospital, the hospital social workers invariably find coverage that the patient was totally unaware of.
Dr. Paul: Isn't that the reason we should have universal coverage, so that they would be covered?
Dave: They still need their Canadian
Medicare or their UK National Health Service card to obtain care. So, is t
to much to
ask that they obtain their Medicaid card in this country?
Dr. Rosen: Then there are millions of college students that don't have health insurance but can get basic coverage at their colleges and universities, which is cheaper than their college fees and tuition.
Dr. Paul: But there must be 10 million to 15 million poor people that don't have insurance.
Dr. Rosen: The United States has the best coverage net of any country in the world.
Dr. Paul: Are you out of your mind? Don't you have sympathy for the poor, the disabled and the aged?
Dr. Rosen: Certainly. All doctors are concerned about those groups and we have them covered.
Dr. Paul: What have you been smoking?
Dr. Rosen: First we have Medicare for everyone over age 65. So our old folks are well covered.
Dr. Edwards: Our Congress thinks they are too well covered and wants to reduce their benefits.
Dr. Yancy: If they pay doctors any less than they do now, we will have a waiting list like the countries with universal coverage.
Dr. Edwards: Some countries with universal coverage have 30 percent of their people on waiting lists. Our 47 million, which is greatly exaggerated, is only 15 percent of our population. That number is really only about 15 million, which is only five percent of our population.
Dr. Dave: That's far better coverage than any country with socialized medicine.
Dr. Rosen: Our country is also concerned about the disabled.
Dr. Paul: How do you propose we cover them?
Dr. Rosen: We have and do cover them. Medicare is also for disabled Americans of any age. Hence, we have a health net so tight that no disabled can fall through the cracks. A Down's baby is covered or a teenager on dialysis is covered by Medicare disability.
Dr. Edwards: I guess our country has done very well.
Dr. Paul: What about all the poor people?
Dr. Rosen: Well, we have Medicaid for the bottom 10 to 12 percent of society that is poor. If you increase that to a larger percentage, you eliminate a significant motivation for work and independence.
Dr. Milton: Don't forget the veterans. All retired and disabled veterans are covered by VA benefits.
Dr. Paul: Dr. Weil in his newsletter also mentions the 47 million uncovered Americans.
Dr. Milton: I saw that also. To give him the benefit of the doubt, he probably has writers that do much of his newsletter. Writers like the staff in Washington see things through jaundiced eyes. If Andrew Weil really wrote that, it would certainly diminish him in my view.
Dr. Dave: What is really unfortunate is that the American Medical Association has come out in favor of government medicine and mentions the 47 million uninsured.
Dr. Yancy: The AMA has always been a socialistic organization. Doctors are very ineffective in cleaning their own house. The administrative bureaucrats run that organization. There have only been a few bright spots when a strong AMA president like Edward Annis can overwhelm the staff and really speak for doctors.
Dr. Edwards: Dr. Annis in the 1960s already understood that health insurance was a misnomer. It really wasn't insurance then and still isn't. It's a political tool that is manipulated by Congress, which has basically destroyed its insurance characteristics.
Dr. Rosen: Well, Paul, there you have. The most complete and tightest health net of any country in the world through which no poor person of any age, no disabled person of any age, no veteran who gave 20 years to our country or was disabled in the process, and no senior citizen can fall through or is denied health coverage.
Dr. Edwards: Isn't it amazing that the world's greatest and most advanced medicine is available to virtually every one in the United States?
Dr. Kaleb: Even the World Health Organization (WHO) ranks the U.S. below Bolivia. When the rationale was finally revealed, it was because without socialized medicine, the WHO bureaucrats couldn't conceive of good health care. Except for a few isolated spots in my country, no one can compete with the United States.
Dr. Rosen: Can you imagine that any in the WHO would even think of having sophisticated Surgery in Bolivia?
Editor's Note: To follow the theme of health care and health plan coverage in the U.S. and elsewhere, be sure to subscribe to HealthPlanUSA.net by entering your email address at www.healthplanusa.net/newsletter.asp.
The Staff Lounge Is Where Unfiltered Opinions Are Heard.
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San Mateo County Medical Association did an issue on What's it like being a Physician married to a physician? There were many issues discussed such as how to raise children when you know too much. Does it work when you're in the same specialty? How do neighbors treat you? How do you handle the free care they expect?
The one that caught my eye was by Pauline Siao, MD: Met in Medical School . . .Over a Dead Body. [Be sure to read the editorial comment at the end.]
My husband and I are both physicians at Palo Alto Medical Foundation. We are both primary care doctors - my specialty being in family practice and his in internal medicine. Contrary to what people may think, it is not as difficult as it would seem and is like any other marriage where there are two working professionals. I actually think it is easier in many ways.
I met my husband in medical school which is an easy place to meet ones mate. t pre-selects for a pool of people who share similar ideals and personality traits—the desire to help mankind with compassion, diligence, determination and perfectionism. Our relationship, romantically enough, developed over a dead body since we were in the same gross anatomy group.
My husband introduced me to golf after medical school, and for the first few years, we played twice a week. I found the five hour rounds on the golf course positively energizing. It was great exercise, and a good opportunity to bond. We were hooked. That is until we had children.
Medical School as Preparation for Parenting
Medical school is a rite of passage where strong bonds are easily formed through late night study sessions, gross anatomy dissections, grueling rotations and a generous amount of scut work. Hardships like these continued on through residency and even now when we still have calls, difficult patients, long hours and endless charting. It seems impossible to draw a line between work and home and often emotions and charting can carry over. As doctors it is difficult not to indulge in some sort of hypochondriasis too. Viral enteritis is monitored for appendicitis, migraines for brain tumors. This unfortunately is amplified with our children where the differential grows exponentially if they should get sick.
Just as there are cons about this type of relationship, there are definitely a share of benefits. It helps to have someone who can empathize with the responsibility and emotional toll inherent in the medical field. As doctors we have been through the various stages in the cycle of life and eventually death with our patients. We never discuss individual cases because of strict privacy laws, but we do commiserate about how demanding medicine can be sometimes. . .
There are lots of parallels between being a doctor and being a wife and parent. They both require a lot of time and hard work. They both do better when one listens and communicates. They both require sacrifices. As doctors we are rewarded with healthy grateful patients. As a wife we are rewarded with a supportive and understanding ally; as parents we are rewarded with hopefully happy and appreciative children. With each you learn to treasure the smallest things in life and to not take life for granted.
EDITORIAL COMMENT: Please note that these married doctors never discussed patients with each other and attribute this to strict privacy laws. This reflects how our profession has been trivialized by the legal profession, primarily through our Congress. Medical students are drilled never to discuss patients with members of the family or friends for this violation of the Hippocratic Oath will sooner or later backfire, causing loss of medical license, disruption of family—personal and professional destruction. Confidentiality is a doctor's MIDDLE name. It is also emphasized in Nursing and Medical Assistant schools.
The U.S. Congress, under the pretext of forcing privacy on physicians, nurses and their staff, has given access to our patients' confidential records to a large number of lay, clerical and administrative bureaucrats, without the patient giving permission or even being informed.
We receive regular notices, with a cover letter, to copy and submit a number of our patients' charts to insurance carriers, Medicare, Medicaid and other government agencies. These notices are signed by a third party that collects this information, advising us not to inform the patient since they have a right to [invade our patient's privacy] because HIPAA authorizes it.
At this juncture in time, each of the five hospital systems in Sacramento has electronic medical records (EMRs). Essentially every physician office can access these EMRs from his office or the hospital. There is no need for the federal government to spend taxpayer's funds to make all EMRs readable by government agencies so they can snoop into our patient's confidential and personal history.
VOM Is Where Doctors' Thinking is Crystallized into Writing.
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(James Murtagh spent 20 years as an Intensive Care Unit physician.)
"Half Blood Prince" by J K Rowling Continues Magical blend of philosophy, civics, and end-of-life ethics
Spoiler alert: Consider seeing the movie and reading the entire Harry Potter series before reading this Op Ed
When we last left Harry Potter, Hogwart's cauldron boiled over. Tranquil old button-down school days were over, and Orwellian evil broke out. Harry and his friends took up against Big Brother to defend free thought.
Be aware: the newest movie "The Half Blood Prince," sharply departs from the book. It had to, as the book was a whopping 652 pages, densely packed, and could not be fully captured on screen. The book and movie are in fact two different universes, the movie offering but a small taste of the full Potter philosophy of good and evil- and the necessity needed to defeat evil. As Winston Churchill might say, to "Never give in. Never, never, never, never give in . . . except to convictions of honor."
The book is both more intense and more covert. Harry battles masters of deception, including double and triple agents. Lives are sacrificed as pawns for ultimate good. Deep philosophy echoes in the deceptive children's story.
John Le Carré and Shakespeare are the real unseen ghosts in cold war Hogwarts. Like Potter, Hamlet featured basically a spy-versus-spy plot, with a deeply undercover prince who discovers through over-hearing and guile. Hamlet and Harry both are "the chosen ones," that rue they were ever born to set a kingdom right.
Harry and Hamlet covertly seek their opponent's weakness. They'd like a direct approach to take arms against a sea of troubles, but know direct action would breed disaster. Claudius and Voldemort both have almost unlimited resources. Both Harry and Hamlet must lie low, and let opponents think they are paralyzed by indecision, then boldly strike. They both fool even the reviewers of their books- even brilliant men through the ages mistake Hamlet as a dreamer, not a doer. Hamlet in fact achieved all his objectives by waiting- all were brought to justice, and Hamlet himself escaped into felicity, though not by his own hand, just as he wished.
Le Carré brilliantly showed spies are best when not told their own mission. If the master deceives his spy, the spy is most effective. Who is the spy really working for? Really good double agents don't even know. Hamlet's divided double-agent consciousness was so complete he sometimes thought himself mad. But, when the wind blew from north to northeast, he knew a hawk from a handsaw. So complete the deception, we all continue to debate today exactly what Hamlet knew, and when did he know it. As J K Rowling writes: "Death is but crossing the world, as friends do the seas; they live in one another still."
Dumbledore, similar to Le Carré, must insert a double agent mole deep into Voldemort's command center. To make the deception complete, he can't even tell Harry his plan. Who is the Half Blood's prince's ultimate master? Does Snape work for good or evil?
Ingeniously, Dumbledore works out a startling plan: he orders Snape to kill Dumbledore! What better way to convince Voldemort! What a set up! Ten times better than the Trojan horse!
Harry has no idea the man he hates most, Snape, is actually Harry's best ally! Snape quickly takes over Hogwarts and becomes Voldermort's trusted agent. From there, Snape can help Harry unseen and unsuspected.
Whoa! Shades of Darth Vader revealing he is Luke's father! Luke kept miraculously escaping from Vader against impossible odds because his father is the man behind the curtain! Harry escapes from duels because Snape is the hidden mole protecting Harry!
Harry Potter meets the bad, the good, and the ugly, encountering philosophies of Hegel, Kant, John Stuart Mills, Nietsche. Dumbledore even drinks the Socratic Hemlock. "The Lightning-Struck Tower" comes right from a pack of tarot cards that might have been dealt to T.S. Elliot in the Wasteland. Insidiously, Rowling weaves in advanced philosophy, human freedom, religion, and end-of-life ethics. Did Dumbledore have the right to sacrifice his own life? Was he dying anyway and asking to go to felicity? Heavy stuff for young viewers. Even better, youngsters are discussing and debating these ideas with their friends, in a whole new domino effect. Rowling's dazzling spoon-full-of-sugar has helped the philosophical medicine go down. Who knows? Many of the youngsters may reach for Shakespeare next.
Rowling's spell over young moviegoers is: "Distrust authority - all authority."
Harry Potter strikes a Churchillian stance and realizes: Something slouches toward Hogwarts waiting to be born. Tune in to the final chapter.
J. Murtagh Jr. MD
Atlanta GA 30329
This book review is found at . . . www.healthcarecom.net/JM_HarryPotterReview.htm.
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VP Joe Biden said Uncle Sam may unleash yet another round of spending.
The thing about government: If it doesn't work, keep doing it.
Sixty-nine-year-old Ruby came in for her annual pulmonary evaluation. Among other complaints, she was putting on weight. Her exam confirmed a 20-pound weight gain since her last evaluation. Ruby stated that the extra pounds were NOT from the food she was eating. "In fact," she said, "I have to eat 5 or 6 times a day because otherwise I wouldn't get enough."
Calories just don't count.
When I was a resident in medicine at Wayne County General Hospital, we had a diabetic patient whose widely fluctuant blood sugars defied all attempts at dietary and insulin management. One day, while on staff rounds, the RN informed us that she had found several cartons of candy bars in this patient's bedside table. When we confronted the patient, she readily admitted that every day she consumed two cartons of candy bars--that's 24 candy bars in 24 hours. She then added, "Doesn't everybody?"
She didn't start counting calories until after two cartons of candy.
To read more HHK, go to www.healthcarecom.net/hhkintro.htm.
To read more HMC, go to www.delmeyer.net/HMC.htm.
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• The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports. This month, read the informative article on the real cost of Obama Care.
• Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog. Just released: Obama vs. Pelosi on Health Care.
• The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government. This month, treat yourself to an article on The Misdirection of Current Corporate Governance Proposals.
• The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business.
• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels. This month, you might focus on Who's Scaring Whom?
• Greg Scandlen, an expert in Health Savings Accounts (HSAs), has embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the initial series of his newsletter, Consumers Power Reports. Become a member of CHCC, The voice of the health care consumer. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn. Greg has joined the Heartland Institute, where current newsletters can be found.
• The Heartland Institute, www.heartland.org, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?. This month, be sure to read another socialized medicine disaster story put into place by Mitt Romney, who must never be elected to a national office: Massachusetts Slashes Funding and Rations Healthcare.
• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling, PhD, 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 by listening to Does the free market ration healthcare?
• The Council for Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse."
• The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter. Be sure to listen to Change we Can Not Believe In.
• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read a review of ATLAS SHRUGGED: A NOVEL OF HUMAN ACTION.
• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section.
• The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission is 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. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site. -- 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, they have lost site of their mission and we will no longer feature them as a freedom loving institution.
• The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. You may also log on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to be an MD today.
• CATO. The Cato Institute (www.cato.org) was founded in 1977, by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio, articles and books at www.cato.org/people/cannon.html.
• The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.
• The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]
• The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, wartime allows the federal government to grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St. Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in wartime, we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to www.stcroixreview.com. This month, be sure to read the editorial about how members of Congress Do Not Read The Bill before voting on it or even afterwards.
• Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read Professor Jean Yarbrough on Jefferson. The last ten years of Imprimis are archived.
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There is no distinctly native American criminal class save Congress. –Mark Twain
Just because you do not take an interest in politics does not mean politics won't take an interest in you. –Pericles (430 B. C.)
The art of government consists of taking as much money as possible from one party of citizens to give to the other. –Voltaire (1764)
The government is like a baby's alimentary canal . . . with a happy appetite at one end and no responsibility at the other. –Ronald Reagan
Some Relevant Postings
From The Economist print edition, Aug 6th 2009
IF GREATNESS was thrust upon Corazon Aquino, and for a while it was, she did her best to parry it. The decisive moment came after eight hours of prayer at St Joseph's Convent of Perpetual Adoration in Quezon City, the former capital of the Philippines. There the self-proclaimed "plain housewife" resolved that she would, after all, accede to the request of 1m petitioners and run for president in the election that the wicked President Ferdinand Marcos had just called. Days of humming, hawing and after-youing were at an end, and the people had a champion. She was the lady in the yellow dress, simple, bespectacled, plain not just in her housewifery but also in her demeanour, a contrast in every way to the stylish Imelda, who was still stuffing the boudoirs of the presidential palace with frocks and furs and shoes, shoes, shoes. The power, however, was with the people, and the people were with Cory.
It was a tumultuous time for the Philippines, a country that has never been easy to take seriously. Its Spanish-American colonial experience, invigorated by Malay, Chinese and indigenous influences, has produced an Asian variant of the rum-and-Coca-Cola culture. In the 1980s this meant visitors could be forgiven for thinking they had arrived on the set of a wacky sitcom, perhaps made for the Central American market, in which the actors, all speaking American with a Latin twang, were masquerading as the nation's public figures. . .
Against such a backdrop, Mrs Aquino—devout, shy and apparently devoid of ambition—was on the face of it an improbable tribune of the Filipinos. But circumstances propelled her. In August 1983 her husband Benigno, better known as Ninoy, a leading opponent of the president, had returned home from three years' exile in the United States. He was at once shot dead. Over 2m people attended his funeral, which turned out to be, in effect, the first of a series of mass demonstrations against the regime, many of them prominently attended by the woman in the yellow dress. These culminated, after Marcos had tried to steal the election and some soldiers had mutinied, in an outpouring of protesters onto Epifanio de los Santos Avenue, known as EDSA, the huge arterial highway that loops round the capital, Manila. Three days later, on February 25th 1986, Marcos was on his way to Hawaii and Mrs Aquino was president.
On This Date in History - August 11
On this date in 1954, Vietnam was partitioned. When King Solomon was asked to judge between two women, each claiming to be the mother of a certain baby, he suggested that the baby be cut in half and half given to each woman. The real mother said, "No, let her have the child," and Solomon knew that it was the real mother who cared enough to give her child up to save her. Partitions of wealth or of land are like the case before King Solomon. Those who agree to such partitions may not be doing so simply out of reasonableness. Today is the anniversary of such a partition. On this day, in 1954, the French withdrawal from what had been French Indochina went into effect and, under the terms of a Geneva agreement, Vietnam was divided into two separate nations. Thereafter, people started voting with their feet. They left the Communist North Vietnam to take refuge in the South. All too soon, there was war—and when it ended, the North ruled all of Vietnam. Partition is rarely the final settlement; it is the intermission. We always seem to have an intermission or two someplace in the world.
After Leonard and Thelma Spinrad
MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE's SiCKO
Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks
funding for a movie exposing the truth about socialized medicine. Clements is
the former publisher of "American Venture" magazine who made news in
2005 for a property rights project against eminent domain called the "Lost
For more information visit www.sickandsickermovie.com or email firstname.lastname@example.org.