Community For Better Health Care

Vol IX, No 10, Aug 24, 2010


In This Issue:

1.                  Featured Article: Hereditary Acquisitions

2.                  In the News: German Hospitals Can Ill Afford End to Draft

3.                  International Medicine: A case study in the "fatal conceit" of central planning

4.                  Medicare: How painful will reform have to be?

5.                  Medical Gluttony: Excessive health care spending is frequently caused by family members.

6.                  Medical Myths: Illegal Aliens not covered? Wanna Bet?

7.                  Overheard in the Medical Staff Lounge: Electronic Medical Records

8.                  Voices of Medicine: Physician Invictus

9.                  The Bookshelf: Physicians almost persuaded again that Socialized Medicine is inevitable

10.              Hippocrates & His Kin: More people without life insurance than without health insurance

11.              Related Organizations: Restoring Accountability in Medical Practice and Society

Words of Wisdom, Recent Postings, In Memoriam . . .

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 A new movie has Canadian doctors, patients, journalists and others warning Americans about the final destination of ObamaCare. The producer, Logan Darrow Clements hopes people will understand that ObamaCare isn't about reforming health insurance but a complete government take-over of the medical system.  Clements is hoping doctors across American can help him screen the movie through a revolutionary new distribution system whereby doctors can become instant distributors. Read more . . . For a flat fee of $500 they can buy a screening license and show the movie in their community keeping all ticket revenues. The process is simple. A doctor downloads a high resolution version the movie overnight onto their laptop computer.  They can then take their laptop anywhere and connect it to a projector or purchase one at a local office supply store. Whenever possible the producer plans to be available for question and answer sessions after screening by phone or webcam.  A personal version of the movie can be instantly downloaded right now for only $4.95 at  Mr. Clements can be reached in Los Angeles through his production company Freestar Movie, LLC at 310-795-2509.

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1.      Featured Article: Hereditary Acquisitions

Hereditary Acquisitions; August 2010; Scientific American Magazine; by JR Minkel

One of the primary goals of genetics over the past decade has been to understand human health and disease in terms of differences in DNA from person to person. But even a relatively straightforward trait such as height has resisted attempts to reduce it to a particular combination of genes. In light of this shortcoming, some investigators see room for an increased focus on an alternative explanation for heritable traits: epigenetics, the molecular processes that control a gene's potential to act. Evidence now suggests that epigenetics can lead to inherited forms of obesity and cancer.

The best-studied form of epigenetic regulation is methylation, the addition of clusters of atoms made of carbon and hydrogen (methyl groups) to DNA. Depending on where they are placed, methyl groups direct the cell to ignore any genes present in a stretch of DNA. During embryonic development, undifferentiated stem cells accumulate methyl groups and other epigenetic marks that funnel them into one of the three germ layers, each of which gives rise to a different set of adult tissues. In 2008 the National Institutes of Health launched the $190-million Roadmap Epigenomics Project with the goal of cataloguing the epigenetic marks in the major human cell types and tissues. The first results could come out later this year and confirm that different laboratories can get the same results from the same cells, says Arthur L. Beaudet of the Baylor College of Medicine, the project's data hub. "One couldn't automatically assume it would be so nice," he says.

Up to this point, the best way to study epigenetic effects has been a strain of mice known as agouti via­ble yellow. In these mice, a retrotransposona bit of mobile DNAhas inserted itself in a gene that controls fur color. Mice bearing the identical gene can be yellow or brown depending on the number of methyl groups along the retrotrans­poson. Such methylation marks would normally be erased in the re­productive cells of an animal. But in 1999 a group led by geneticists at the University of Sydney in Aus­tralia discovered that methylation of the fur color genes persists in the female germ line, allowing it to be passed down to off­spring like a change in the DNA.

Agouti viable yellow mice might have something to say about the human obesity epidemic. The animals have a tendency to overeat and become obese. In 2008 Rob­ert A. Waterland, also at Baylor, discov­ered that this trait gets passed down and amplified from one generation of agouti to the next, so that "fatter mothers have fat­ter offspring," he says. He is investigating whether the effect can be explained in terms of methylation patterns in the hypo­thalamus, the part of the brain that regu­lates appetite.

Retrotransposons could lead to other epigenetic effects. In the early 2000s geneticist David Martin of Children's Hospital Oakland Re­search Institute in California rea­soned that the silencing mechanism that keeps retrotransposons inac­tive might randomly shut down genes that are supposed to be left on. If the silencing occurred in a gene responsible for suppressing tu­mor formation, the result would ap­pear the same as genetic mutations that predispose people to cancer.

To read more about this innovative research in Scientific American . . . (Subscription required)
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2.      In the News: German Hospitals Can Ill Afford End to Draft – WSJ – 7-19-10

Public-Service Providers rely on Conscientious Objectors' work say conscription would hurt programs.


A proposal in Germany to abolish compulsory military service is drawing major opposition from unlikely quarters—the thousands of hospitals and other public-service providers where most young German men end up fulfilling their draft duties.

Germany is one of the last European countries with a draft, which many of its neighbors have abandoned since the end of the Cold War. But amid pressure to cut defense spending and modernize German's armed forces, Defense Minister Karl Theodor zu Guttenberg has amplified a longstanding debate about military conscription by calling for it to be scrapped. . .

Increasingly, though, conscription's main impact has little to do with military training at all> As attitudes toward mandatory service have changed over the decades, the draft's biggest beneficiaries have become Germany's hospitals, nursing homes and other social programs, where for the past 20 years more than half of draftees have opted to carry out alternative, nonmilitary service.

Abolishing the draft would leave a large hole in Germany's public services. More than 150,000 men out of 226,000 deemed fit to serve in 2009 filed as conscious objectors, slating them for civilian-servant jobs. . . .

Losing the steady flow of civilian servants would be the latest blow to Germany's health-care system, beleaguered by the spiraling cost of caring for an aging population. Earlier this month, Chancellor Angela Merkel's government announced further increases in premiums and cuts in medical spending to help plug an €11 billion ($14 billion) deficit in the country's public health-insurance system next year. . .

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3.      International Medicine: eHealth Ontario: A case study in the "fatal conceit" of central planning, by Brett J. Skinner

Ontario's health minister recently resigned due to a public spending scandal revealed by the provincial Auditor General. The incident raises serious political concerns about the corruption of government procurement processes. It also provides an opportunity for Canadians to discuss one of the many economic pitfalls associated with government-run health care: the futility of central planning.

The details of the scandal are found in the Auditor's report (Auditor General of Ontario, 2009), which charges that since 2003 more than a billion dollars in public spending has been wasted on eHealth Ontario and its predecessor, Smart Systems for Health Agency. Both agencies of the Ministry of Health were responsible for developing centralized electronic medical records for the province's Medicare system, but have failed to produce anything useful for the money spent.

Yet, on a more fundamental level, the failure of eHealth Ontario is beside the point. Even if eHealth had successfully delivered a working health information system, the basic economic premise of the project was wrong from the beginning.

Spontaneous market order in health care

The establishment of a government-controlled health information system was justified on the grounds that it would save the province money by giving authorities the information they need to improve the  efficiency of the health care system. The eHealth project was based implicitly on the belief that, with enough information, government bureaucrats could manage the allocation of medical care better than market forces, and that this would reduce public health expenditures.

But Nobel Prize-winning economist Frederic Hayek would have characterized the implied rationale for the creation of eHealth as the "fatal conceit" of central planning. Hayek (1945) showed that central planners cannot possibly satisfy all of the individual needs and preferences of consumers (or patients) as efficiently as the market. The allocation of resources in a market is spontaneously ordered by countless individual choices. These choices are determined by needs and preferences that are unique to individuals and informed by various bits of information.  It is absurd (and, in Hayek's view, somewhat arrogant) to believe that a single person, or even a group of experts, could set prices or determine the supply of goods and services and their allocation to individuals better than the spontaneous ordering of the market. Even if theoretically possible, the practical cost and technical barriers to obtaining the information necessary to allow central planners to be as efficient as the market would vastly outweigh the benefits.

Yet, with eHealth, Ontario was spending vast sums of taxpayers' money on an information system designed, essentially, to make central planning more efficient. This is a wasteful, unnecessary, and ultimately futile exercise because the market does a better job of allocating resources, without a centralized information system and the enormous additional cost to taxpayers.

Of course, information technology has the potential to make the delivery of health care goods and services more efficient. But as with other sectors of the economy, market-driven adoption of technology is a more efficient approach to allocation than centralized government planning. In a market, the value of information technology would be apparent from its reputation for reducing costs and improving quality, and its allocation within the health care system would be determined by cost-benefit choices about its value among medical providers.

If Ontario wants to make its health care system more efficient, all that is needed is the dispersion of information in the form of market-based price signals, and market-based competition for the delivery of medical goods and services.

For example, Ontario could simply expose consumers to prices for their personal use of publicly insured health care. If governments reimbursed patients directly for only 75% of the cost of the health care they consumed, then there simply wouldn't be any need for centrally planned allocation. The 25% out-of-pocket co-payment would act as a price signal that would give consumers (following the expert advice of their physicians) the information needed to make appropriate use and substitution choices on their own. Structuring copayments as a percentage of the cost of consuming medical goods and services effectively creates a price that is proportional and directly relative to the total cost. For non-emergency treatment decisions, even a small price gives patients the economic incentive to weigh the value of medical treatment against alternative uses of their money, and consider the relative value of various types of treatments. . .

[This is an excellent rationale of why Medicare became insolvent in the United States.]

Download the rest of this article from the Frasier Institute . . .
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Health care may be awakening to market forces one country at a time.

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

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

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4.      Medicare: How painful will reform have to be?

The most important domestic policy problem this country faces is health care. The most important component of that problem is Medicare. Forecasts by every federal agency that produces such simulations - the Congressional Budget Office (CBO), the Social Security/Medicare Trustees, the General Accounting Office (GAO) - show that we are on a dangerous and unsustainable path. Indeed, the question is not: Will reform take place? The question is: How painful will reform have to be?

 by John C. Goodman, Ph.D, President, NCPA

 Executive Summary

Health care is the most serious domestic policy problem we have, and Medicare is the most important component of that problem. Every federal agency that has examined the issue has affirmed that we are on a dangerous, unsustainable spending path:

·         According to the Medicare Trustees, by 2012 the deficits in Social Security and Medicare will require one out of every 10 income tax dol­lars.

·         They will claim one in every four general revenue dollars by 2020 and almost one in two by 2030.

·         Of the two programs, Medicare is by far the most burdensome — with an unfunded liability five times that of Social Security.

Nor is this forecast the worst that can happen:

·         The Congressional Budget Office notes that health care costs overall have been rising for many years at twice the rate of growth of our in­comes.

·         On the current path, health care spending (mainly Medicare and Medicaid) will crowd out every other activity of the federal govern­ment by midcentury.

There are three underlying reasons for this dilemma:

·         Since Medicare beneficiaries are participating in a use-it-or-lose-it system, patients can realize benefits only by consuming more care; they receive no personal benefit from consuming care prudently and they bear no personal cost if they are wasteful.

·         Since Medicare providers are trapped in a system in which they are paid predetermined fees for prescribed tasks, they have no financial incentives to improve outcomes, and physicians often receive less take-home pay if they provide low-cost, high-quality care.

Since Medicare is funded on a pay-as-you-go basis, many of today's taxpayers are not saving and investing to fund their own post-retire­ment care; thus, today's young workers will receive benefits only if future workers are willing to pay exorbitantly high tax rates. . .

To address these three defects in the current system, we propose three fundamental Medicare reforms . . .

With assistance from Andrew J. Rettenmaier, an NCPA senior fellow, we have been able to simulate the long-term impact of some of these reforms. The bot­tom line: Under reasonable assumptions, we can reach the mid-21st century with seniors paying no more (as a share of the cost of the program) than the premiums they pay today and with a taxpayer burden (relative to national income) no greater than the burden today. Along the way, the structure of Medicare financing will be totally transformed:

·         Whereas today, 86 percent of all Medicare spending is funded through taxes, by 2080, taxes will be need­ed for only one out of every four dollars of spending.

Whereas there is no prefunding of Medicare today, 60 percent of all Medicare spending will eventually be funded through savings generated by beneficiaries during their working years. 

In terms of the impact of Medicare on the economy as a whole:

·         With no reform, the size of the Medicare program will more than triple (relative to national income) over the next 75 years.

·         With reform, Medicare will take no more of national income than it does today.

Read the entire policy report 315 . . .
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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: Excessive health care spending is frequently caused by family members.

We received a call from the wife of a long time patient. She stated that her husband had injured his elbow and she was sending him. She wanted to alert us ahead of time so that we could obtain an MRI and Orthopedic Consult with all dispatch. It always is somewhat amusing how a lay person can chart the entire diagnostic program and demand it being accomplished without so much as input from the physician who is the only one that can authorize the risk and expense.

When he came in, he had a fluid filled bursa over his left elbow for about two weeks. He had already been to the hospital emergency room ten days earlier where it was drained and he was given a Rocephin (Ceftriaxone) injection and placed on Cephalexin for ten days. Since there was no trauma, the ER physician did not do an x-ray. It was improving but the fluid returned after about a week when his wife got very excited and demanding of consults and MRIs.

Since it was painless, it did not interfere with his activities or work, he decline further drainage and agreed no x-ray was indicated and certainly no MRI. Neither would he consider seeing an orthopedist for this. Since there were some residuals of the cellulitis, the Cephalexin was continued for another week.

Then the question came up about his anxious wife. Since, neither he nor I wanted to face a very irate wife, we agreed that an x-ray may be of some therapeutic benefit, if not to him, certainly to his wife. Since he had returned to smoking cigarettes at two packs per day, this was also an excellent way of obtaining a Chest X-ray, which he otherwise would not be inclined to do. As an entrepreneur he was much too busy. Neither could he ever imagine being sick with cancer - even though he had lost his first wife two years earlier to a five-year ovarian cancer struggle.

When seen a week later, the cellulitis was resolved, the fluid filled bursa was smaller, the elbow had a normal bony architecture, and the chest x-ray was clear of any suggestion of cancer.

Was this excessive testing? With all the information in the media about CT of the chest is the best screening test. However, this did allay the wife's concern before the more expensive CT was demanded again.

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Medical Gluttony thrives in Government and Health Insurance Programs.

Gluttony Disappears with Percentage Co-payments and Appropriate Deductibles on Every Service.

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6.      Medical Myths: Illegal Aliens not covered? Wanna Bet?

Myth 28. Healthcare reform bills will not cover illegal aliens.

The growing number of "48 million uninsured" includes perhaps 15 million illegal aliens (Phoenix Business Journal 7/22/09).

Obama's statement that " the reforms I'm proposing would not apply to those who are here illegally" elicited the notorious "You lie" outburst from Rep. Joe Wilson (R-SC).

Currently proposed legislation does not explicitly extend coverage to illegal aliens, only to legal non-citizen residents. Of course, illegals could be made legal through other legislation. Some say that amnesty is on the legislative agenda immediately after "healthcare reform" and energy taxes ("cap and trade"), writes James R. Edwards, Jr. (Center for Immigration studies 10/2/09).

All four bills that had passed committees as of September would allow illegal aliens to take part in Health Insurance Exchanges (Charles Krauthammer, Ariz Daily Star 9/19/09) . . .

If all uninsured illegal aliens with incomes below 400% of poverty accessed the credits, it would cost federal taxpayers $30.5 billion annually. The current cost to all levels of government for treating uninsured illegals is estimated to be $4.3 billion, primarily at emergency rooms and free clinics ( 9/8/09). . .

Medicaid also does not require identity verification for those claiming U.S. birth. Illegals would also likely benefit from proposed expansion of eligibility to 133% of poverty (ibid.).

Illegals might not sign up for benefits, especially if it required filing a tax form. It is not clear that the private sector, especially hospitals, would see any relief from the enormous unfunded mandate ( to treat indigent illegals not covered by government programs.

Additional information:

§                     Congressional Research Service. Treatment of Noncitizens in H.R. 3200, Aug 25, 2009.

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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:  Electronic Medical Records

Dr. Edwards: We had an excellent presentation at the Independent Practice Association (IPA) last week. It really explained the difference between an Actually Integrated system such as Kaiser Permanente (KP) and the Virtually Integrated system like our IPA.

Dr. Milton: Wasn't that impressively and professionally done?

Dr. Thomas: It was also enlightening how it was understood that ObamaCare was simply the first step in moving toward universal coverage.

Dr. Rosen: Yes, wasn't it smooth how they never mentioned Socialized Medicine?

Dr. Milton: In the Liberal Left instructions on how to win the war by taking over and implementing universal health care, it mentions never using such words as Socialized Medicine, which still has a negative connotation in the public eye.

Dr. Rosen: That just points out that it really is not an "above the board" dialogue but an underhanded subterfuge - a war, if you will, to hoodwink the public.

Dr. Milton: It should be obvious to any clear-thinking, freedom-loving American that this is the system our grandfathers left in Europe.

Dr. Edwards: Why would anyone want to go back to an oppressive government, especially in matters relating to our personal health?

Dr. Paul: Big business is just as oppressive as any government.

Dr. Rosen: Big business is poorly understood. They are apolitical. They can be radical left, radical right, or any place in between that serves their business purpose. In general, big business likes big government that they feel they can manipulate to their advantage. But they can never knock on your door at night and arrest you. Only Big Government can do that.

Dr. Edwards: And that is what government throughout all the ages has done. And the United States was the first attempt to change that forever. As our forefathers have stated, we have given you a Republic, if you can keep it. It seems to take a lot of effort to keep it. Big government is like a slowly growing incurable cancer. If we don't cut it out while its operable, it will eventually take over out entire system. 

Dr. Milton: Getting back to your IPA meeting, don't you think the EMR is the vice that will force all of us into submission? It's really surveillance, isn't it? It's like having a camera on you at all times. If you vary even slightly from government protocol, they will warn you the first time, haul you in front of a bureaucratic board the second time, and prosecute you the third time - that may mean jail time.

Dr. Paul: Come on, you guys; you're all getting paranoid. The government is just trying to help us.

Dr. Rosen: Isn't that what medical school, internship, residencies, fellowships, grand rounds and specialty meetings do to keep us current on the latest? The government is the last one that can even measure quality.

Dr. Edwards: Isn't that the truth. Have you ever had a visit from a stranger and he says, "We're from the government and we're here to help you." Did you smile and offer him a beer? Or did you feel queasy, uneasy and sweaty?

Dr. Paul: Well, I wouldn't offer him beer, but I'd poor a cup of coffee or a coke and cooperate fully.

Dr. Edwards: And if he told you how to handle your case the next time, what would you do?

Dr. Paul: I'd handle the patient just as he wanted me to.

Dr. Edwards: And if you thought that was not in the best interest of the patient, would you still do it?

Dr. Paul: Certainly. He's the boss.

Dr. Edwards: So you immediately acquiesce to the government boss to the detriment of your patient?

Dr. Paul: Hey, I want to survive. The patient can die. That's no sign that I want to die professionally.

Dr. Edwards: I think we have just confirmed how bad government medicine, AKA as ObamaCare, really is. It's professional servitude, like the world has never witnessed in health care before, even in a totalitarian state before the Nazi era. ObamaCare may actually equal NaziCare.

Dr. Rosen: It's hard to realize after six generations of Rosen's in America, first coming during the time of Bismarck, that America may revert to a time more than two centuries earlier in Europe. Goodness, how civilization can regress.

Ref: How long does it take to read a 243 page EMR?
Ref: Information Technology . . .
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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

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

Physician Invictus – From Heroin Addict to Addiction Physician By Don Kurth, AAD

April 5, 1969. The red and white ambulance races through the early morning hours of the dark North Jersey night.  Sirens are screaming and red lights are flashing, casting revolving shadows against the trees and houses as the medics race through the darkened suburban neighborhoods. The rain has just stopped falling and a hazy mist rises from the black pavement.  In the back of the ambulance lies a young man, barely out of his teens. His lips are blue and his skin is pale gray, but the paramedics continue to pump on his chest and force oxygen in to his lungs with the plastic face mask and ambu-bag. Bloody vomit drips out of the mask and down his cheek. There are no signs of life, no respirations, no pulse. His dark blood is filled with drugs and alcohol and his lungs are filled with vomit and beer. Behind the ambulance the young man's parents are following, trying to keep up with the racing van. Neither speaks. They are remembering all the hopes and dreams they had had for their firstborn, their only son. His mom thinks about when she dropped him off for his first day of kindergarten, when he cried and called for his mother not to leave him. His dad remembers the first time his boy caught a trout by himself and how proud he was of his son and the photos they took of the speckled fish before they slipped him back into the creek. They both remember their dreams of college and a profession for their son, and maybe grandchildren of their own someday. And another round of siren screams fills the night air as they race to follow the ambulance through the night.

Finally they arrive at the hospital and their son is whisked into the treatment area, the paramedics still trying to pump life back into his dying body. The parents park to the side and are directed to the reception clerk to fill out the forms and paperwork Then they are asked to take a seat and wait As they sit, silent in the empty waiting area, neither speaks; neither lifts their eyes to look at the other; each is lost in private thoughts. Quietly both pray to their own God, isolated in their grief over the loss of their son, wondering if they should have done something differently, wishing they could do something more now.

Finally, the young ER doctor walks through the swinging double doors from the treatment area, looks around the waiting room, and walks toward the grieving pair.

"I am so sorry," he says slowly, deliberately. "I don't think he is going to make it. He was dead by the time he arrived. There just wasn't anything more we could do. He didn't have oxygen to his brain. I am sorry."

The doctor feels the grip of both sets of eyes on his own. He feels the sorrow of their loss in his own heart. Then, after a quick moment, he turns on his heel and hurries back through the double doors into the treatment area of the emergency room. An agonizing twenty more minutes pass before he returns with a different look on his face.

"I think he is going to make it!" he exclaims. "We've got a pulse and he is starting to breathe on his own. I think he might be OK!"

That young man was me, and I did not die of that overdose in 1969. But I was not done yet, either. I still had more overdoses to survive and jails to visit. And I still had to stumble my way into drug rehab and have a chance to turn my life around.  On August 12, 1969—three days before Woodstock—I slammed my last speedball just before the police surrounded my parent's home and a new phase of my life began.

Later that year I entered drug treatment at Daytop Village in New York and started to get my life back on track I had already flunked out of college twice by the time I overdosed in 1969. In fact, I had actually achieved a perfect GPA at my first college—0.00. I had split for California to visit the Haight and neglected to inform my registrar that I might not be returning to complete my final exams. Apparently, my professors were not listening as intently as I was to the "Turn on, tune in, and drop out," call of Dr. Timothy Leary. They failed to recognize the value of my desire to join in the "Summer of Love" and manifested their misunderstanding by awarding me F's in every single class.

But by the summer of 1972, I had completed drug rehab and begged my way back into college. Without drugs in my bloodstream, my grades improved dramatically and by 1975 1 had snagged an academic scholarship to Columbia University in New York City. I worked as a gardener to pay for my living expenses and scrimped every penny I could. I couldn't afford a car, so I bought a used Suzuki motorcycle to get around. I managed to save $200 over my next month's rent, so I bought a chain saw and a hundred feet of rope and became a tree cutter. After each hurricane or blizzard, I would tie the chain saw and rope to the back of my motorcycle and ride around looking for fallen trees to cut. There was always somebody who needed my help, and eventually I found a partner and bought a pickup truck to expand the business. It was hard work, but I enjoyed what I did and made enough money to get through school. I eventually graduated, Phi Beta Kappa and cum laude, and went on to medical school at Columbia.  I had to work hard to get good grades. I had a lot of remedial work to do just to catch up with the other students. And I had to make the sacrifices that we all have had to make to dedicate our lives to medicine and patient care.

I trained at Hopkins and UCLA and found myself seduced by the California sunshine. I opened an urgent care practice in Rancho Cucamonga, California. But I have always had a soft spot in my heart for those who suffer from addictive disease, and eventually I found myself on the faculty of Loma Linda University, where I have run the addiction treatment program since the mid-nineties.  I got involved with the Rancho Cucamonga Chamber of Commerce, really just to get to know people in my community and to build up my own practice. . .

The more I got involved, though, the more I began to realize the importance of being involved on a political level. It became more and more clear to me that many of the challenges we face, not just in addiction medicine but throughout medicine, are challenges that can only be met on a public policy level.

Scope of practice, corporate bar, and MICRA are all issues that must be defended on a public policy level. But our political responsibility as physicians goes far beyond that. Who but physicians can better fight the battle to ensure greater access to care for our patients? Who but physicians can articulate the importance of our physician-patient relationship remaining unfettered by burdensome government interference and regulations? If we cannot or will not advocate for ourselves, who do we expect to speak for us? The questions we must ask ourselves are these: If not us, then who? If not now, then when? As in the poem "Invictus," by William Ernest Henley, we must be the masters of our fates; we must be the captains of our souls.

I suppose my career path has been one of unlikely twists and turns. But believe me, I did not plan it this way. Following my chamber involvement I was elected to the local water district board. After eight years of elected office, I moved on to the city council in Rancho Cucamonga (population 180,000} and was then elected mayor in 2006. Concurrently though, as my skills have sharpened in this world of public policy, I have done my best to pull my physician colleagues along with me, and together we have achieved some degree of success. I helped create our Addiction Treatment Legislative Days, first in California and then in Washington, D.C. Working together, we greatly improved access to care and our Addiction Treatment Parity Bill was signed into law by then-President George Bush on October 5, 2008. Greater access to medical care for those suffering from addiction is now the law of the land in the United States of America. I was honored by my colleagues to be elected president of the California Society of Addiction Medicine and now serve as president-elect of the American Society of Addiction Medicine. . .

Donald J. Kurth, MD, MBA, MPA, FASAM, is an associate professor at Loma Linda University and president-elect of the American Society of Addiction Medicine. He is also mayor of the City of Rancho Cucamonga, California, and a candidate for the 63rd Assembly District in southern California. His website is at

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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: Are Physicians almost persuaded again that Socialized Medicine is Inevitable?

Almost Persuaded, American Physicians and Compulsory Health Insurance, 1912-1920
by Ronald L. Numbers. The Johns Hopkins University press, Baltimore & London. 1978.

Numbers points out in his preface: "In 1911 the British parliament passed a National Insurance Act making health insurance mandatory for most employees between the ages of 16 and 70. The following year the American Association of Labor Legislation created a Committee on Social Insurance to prepare a model health-insurance bill for the United States, and by 1916 several state legislatures were actively considering bills that would have covered virtually all manual laborers earning $100 or less a month. No such law ever passed, but between 1916 and 1920 compulsory health insurance was a real possibility in a number of industrial states."

In this study of America's first debate over compulsory health insurance, Numbers focuses on the changing attitudes of the medical profession. The initial response of physicians to compulsory health insurance was surprisingly positive. From the AMA to various state and sectarian medical societies, the feel prevailed that this method of paying medical bills was both inevitable and desirable. By 1917, however, medical opinion was beginning to shift, and, before long, scarcely a physician could be found willing to endorse such a "socialistic" proposal.

In an era prior to opinion polls, Numbers relies on medical society minutes, unpublished correspondence, and the numerous national, state, and local publications to present what he feels is a reasonably accurate reading of the prevailing view of the medical profession. As the public debate continues, it behooves as many of us as possible to become conversant with how health care evolved to our present dilemma.

Review by Del Meyer, MD

This book review is found at . . . read more book reviews . . .
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The Book Review Section Is an Insider's View of What Doctors are Reading and Writing about.

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10.  Hippocrates & His Kin: More people without life insurance than without health insurance

There are 35 million U.S. households that neither own their own life-insurance policies nor are covered under employer-sponsored plans, up from the 24 million, or 22% of households, without coverage in 2004, according to the study this year by Limra, of Windsor, Conn.

Limra is an industry-funded research organization that has conducted periodic surveys of ownership trends since 1960. The percentage without life insurance is a sign of the financial pressures on middle-income families as the economy struggles. The rise reflects tight household budgets, loss of employer-provided coverage as a result of layoffs, and cutbacks by some employers in their benefits packages, Limra said. Half of the respondents in the latest survey said they needed more life insurance, but many haven't bought it because their financial priorities include paying off debt.

Among households with children under 18, four in 10 respondents said they would immediately have trouble meeting living expenses if a primary wage earner died, and another three in 10 would have trouble keeping up with expenses after several months.

"Clearly, more American families are living on the edge, surviving paycheck to paycheck, and, as our new study suggests, too many are without the safety net that life insurance provides," said Robert Kerzner, president of Limra. . .

Life-insurance coverage provided through benefits packages at work has played a significant role in protecting families in recent decades, but it may be lost if the wage earner loses his job or reduces work hours. Employers scaling back or eliminating coverage is another factor in the declining percentage of households with insurance, Limra noted. The number of households relying solely on life insurance provided through an employer shrank to one in four, from about one in three in 2004, when the previous survey was conducted.  --By LESLIE SCISM

I'm sure President Obama will have the insurance industry in his sights shortly and force us to buy coverage.

The US ranked 87th in Economic Stability as it's viewed as a wasteful spender by the world. Its Index of Financial Marked Developoment fell from ninth to 31st.

The U.S. fell from second, a year after losing the No. 1 position for the first time since the Geneva-based organization began its current index in 2004. A budget shortfall of more than $1 trillion and public distrust of politicians were among the weaknesses in the world's largest economy.

I'm sure Obama can get us into the last or 139th place before he's impeached?

Vietnamese Americans show the path out of welfare

One broiling Saturday 15 years ago, 345 Vietnamese American kids attended a celebration at Florin High School, where they each were awarded cool backpacks for getting straight A's.

Students from first grade through college shared their secrets for getting 4.0 GPAs, and underscored Southeast Asian immigrants' drive to climb out of poverty.

In 1990, half the Sacramento region's Southeast Asians were poor. Today, 52 percent own homes, according to a Bee analysis of census data. They enjoy a median household income of $50,000 annually, up from $17,350 in 1990 – about $28,500, adjusted for inflation. The regional average is $61,000.

Many fled Vietnam or Laos by boat after the Communist victory in 1975, arriving here with post-traumatic stress disorder and little else. Vietnamese, Hmong, Lao, Iu Mien and Cambodian refugees had lost their land, their freedom, and often their closest relatives.

Most started at the bottom – without English or job skills – but through teamwork and the will to succeed have gone from roach-infested apartments in gang-controlled neighborhoods to suburban homes.

Their children – including those at Florin High that hot August morning – have gone to America's top universities and become doctors, lawyers, engineers and teachers.

Read more:

American parents should take note since recent statistics indicate that half of America's children have no aspirations beyond high school. Many join the physical labor pool where one injury can take them back to the welfare slums.

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

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11.  Professionals Restoring Accountability in Medical Practice, Government and Society:

                      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. For their article, "Are you really insured?," go to

                      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. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. 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."

                      Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25–50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to 

                      Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.

                      Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at She will be remembered for her important work, Who Owns Your Body, which is reviewed at Please go to to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at

                      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

                      ReflectiveMedical Information Systems (RMIS), delivering information that empowers patients, is a new venture by Dr. Gibson, one of our regular contributors, and his research group which will go far in making health care costs transparent. This site provides access to information related to medical costs as an informational and educational service to users of the website. This site contains general information regarding the historical, estimates, actual and Medicare range of amounts paid to providers and billed by providers to treat the procedures listed. These amounts were calculated based on actual claims paid. These amounts are not estimates of costs that may be incurred in the future. Although national or regional representations and estimates may be displayed, data from certain areas may not be included. You may want to follow this development at During your visit you may wish to enroll your own data to attract patients to your practice. This is truly innovative and has been needed for a long time. Congratulations to Dr. Gibson and staff for being at the cutting edge of healthcare reform with transparency. 

                      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, who 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

                      Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to

                      Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives. He now has a new column with Richard Dolinar, MD, worth reading at

                      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. This month, be sure to read the new rules . 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.

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Please note that sections 1-4, 6, 8-9 are entirely attributable quotes and editorial comments are in brackets. Permission to reprint portions has been requested and may be pending with the understanding that the reader is referred back to the author's original site. We respect copyright as exemplified by George Helprin who is the author, most recently, of "Digital Barbarism," just published by HarperCollins. We hope our highlighting articles leads to greater exposure of their work and brings more viewers to their page. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.

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Words of Wisdom

Life is what happens while you are making other plans. -John Lennon

"Suppose one of you wants to build a tower. Will he not first sit down and estimate the cost to see if he has enough money to complete it?" - Jesus of Nazareth, Luke 15:28

Sounds like good advice also for government towers, such as health care.

If the government will get out of the way, there's no limit to what the American people can achieve. - Ronald Reagan.

Sounds like the road to freedom should be obvious.

Some Relevant Postings

FALSE HOPES - Why America's Quest for Perfect Health Is a Recipe for Failure by Daniel Callahan . . .

Health Care: A Two-Decade Blunder Tevi Troy . . .

Sorting Fact From Fiction on Health Care Jerome Groopman, MD and Pamela Hartzband, MD

In Memoriam

Alex "Hurricane" Higgins, transformer of snooker, died on July 24th, aged 61

The Economist, Aug 5th 2010

THE game of snooker is a curious one. Professional players wear black waistcoats and bow ties, as if they have been waylaid on their way to a funeral. The referees, similarly attired, also wear white gloves with which to replace the balls upon the table. The green baize cloth, much like the smooth lawn of a bowling green, enforces quiet, concentration, care. Only the odd nervous cough, soon suppressed, breaks the glacial atmosphere.

But snooker grew up in Britain's working men's clubs as something rough, rude and rambunctious. Beer fuelled it, cash betting underpinned it, and scores were settled with fists in the street outside. Speed was a virtue; safety, beyond a certain point, just sissy. The good player took on all comers and dispatched them, mercilessly, one by one.

Most professionals learned to establish a prudent distance from that world. Alex Higgins never did. The man who reached the heights of snooker in the 1970s, and turned it into a global phenomenon in the 1980s, was always the edgy, jigging teenager who haunted the Jampot Billiard Hall off the Donegall Road in Belfast's Shankill. There he would keep the score for pocket money and, little by little, start to play himself, a scrawny creature with fast, feline grace who would prowl around the table and seem to know at once how to build a break or make a clearance, always three balls ahead of himself. He'd play for anything: Mars Bars, fizzy drinks, a packet of Player's, a smooth pint of Guinness down the throat. He was a Protestant boy who would even take on a Taig if there was money in it. He would take on anyone, because he knew within a short time that he could beat them all.

This was the world he brought with him like a gale into the sacred halls of the sport, such as the Selly Park British Legion Hall in Birmingham, where in 1972 he won his first world championship at 22, then the youngest winner ever. At the time he was homeless, moving from squat to squat through condemned streets in Blackburn. He appeared for the final, fingers stained with nicotine, in white trousers and a tank top. The World Professional Billiards and Snooker Association ruled these "clothes unbecoming to a professional" and, after his victory, fined him. . .

Read the entire obituary . . .

On This Date in History – August 24

On this date in 79 A.D., a volcano named Vesuvius began a tremendous eruption; before it was over, two Roman cities, Herculaneum and Pompeii, were wiped out. The ruins of Pompeii remain to this day as a reminder of how suddenly and how thoroughly a living city can cease to exist. Today, cities must change or they run the risk of falling apart and deteriorating.

On this date in 1814, by odd coincidence, the British burned Washington during the war of 1812. The British were infinitely more selective. They didn't burn the whole city; they concentrated on the White House and other government buildings. They went on to try to capture Baltimore, where they were repulsed by the Battle of Fort McHenry and Francis Scott Key was inspired to write "The Star Spangled Banner." Washington was, of course, rebuilt, and the British and the Americans, after a suitable lapse of time, became the best of friends. The only real thing separating the British and the Americans is their mutual illusion that they speak the same language.

After Leonard and Thelma Spinrad

The 7th Annual World Health Care Congress

Advancing solutions for business and health care CEOs to implement new models for health care affordability, coverage and quality.

The 7th Annual World Health Care Congress was held April 12-14, 2010
Washington, DC
Toll Free: 800-767-9499

In partnership with, the 7th Annual World Health Care Congress is the most prestigious meeting of chief and senior executives from all sectors of health care. The 2010 conference convened 2,000 CEOs, senior executives and government officials from the nation's largest employers, hospitals, health systems, health plans, pharmaceutical and biotech companies, and leading government agencies. Please watch this section for further reports in the future as well as