Community For Better Health Care

Vol VIII, No 15, Dec 8, 2009


In This Issue:

1.                  Featured Article: The neuropathology of the brains of ex-N.F.L. players

2.                  In the News: Whither the Conscience Clause?

3.                  International Medicine: Delay in Cancer Diagnosis is Tragic in the UK!

4.                  Medicare: Spending on nearly all Federal Benefit Programs grows relentlessly.

5.                  Medical Gluttony: Mr. Obama's Health Care Reform - Mega Gluttony

6.                  Medical Myths: Why spend ourselves out of business just to re-invent the wheel?

7.                  Overheard in the Medical Staff Lounge: The Courtesies in Consultations

8.                  Voices of Medicine: The privilege to care for others outweighs any other . . .

9.                  The Bookshelf: Global Warming

10.              Hippocrates & His Kin: There are no political solutions

11.              Related Organizations: Restoring Accountability in HealthCare, Government and Society

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

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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 The future is occurring NOW.  You should become involved.

To read our reports of the 2008 Congress, please go to the archives at and click on June 10, 2008 and July 15, 2008 Newsletters.

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1.      Featured Article:  The neuropathology of the brains of ex-N.F.L. players

Offensive Play: How different are dogfighting and football?
by Malcolm Gladwell, New Yorker,
October 19, 2009

An offensive lineman can't do his job without "using his head," one veteran says, but neuropathologists examining the brains of ex-N.F.L. players have found trauma-related degeneration.

One evening in August, Kyle Turley was at a bar in Nashville with his wife and some friends. It was one of the countless little places in the city that play live music. He'd ordered a beer, but was just sipping it, because he was driving home. He had eaten an hour and a half earlier. Suddenly, he felt a sensation of heat. He was light-headed, and began to sweat. He had been having episodes like that with increasing frequency during the past year—headaches, nausea. One month, he had vertigo every day, bouts in which he felt as if he were stuck to a wall. But this was worse. He asked his wife if he could sit on her stool for a moment. The warmup band was still playing, and he remembers saying, "I'm just going to take a nap right here until the next band comes on." Then he was lying on the floor, and someone was standing over him. "The guy was freaking out," Turley recalled. "He was saying, 'Damn, man, I couldn't find a pulse,' and my wife said, 'No, no. You were breathing.' I'm, like, 'What? What?' "

They picked him up. "We went out in the parking lot, and I just lost it," Turley went on. "I started puking everywhere. I couldn't stop. I got in the car, still puking. My wife, she was really scared, because I had never passed out like that before, and I started becoming really paranoid. I went into a panic. We get to the emergency room. I started to lose control. My limbs were shaking, and I couldn't speak. I was conscious, but I couldn't speak the words I wanted to say."

Turley is six feet five. He is thirty-four years old, with a square jaw and blue eyes. For nine years, before he retired, in 2007, he was an offensive lineman in the National Football League. He knew all the stories about former football players. Mike Webster, the longtime Pittsburgh Steeler and one of the greatest players in N.F.L. history, ended his life a recluse, sleeping on the floor of the Pittsburgh Amtrak station. Another former Pittsburgh Steeler, Terry Long, drifted into chaos and killed himself four years ago by drinking antifreeze. Andre Waters, a former defensive back for the Philadelphia Eagles, sank into depression and pleaded with his girlfriend—"I need help, somebody help me"—before shooting himself in the head. There were men with aching knees and backs and hands, from all those years of playing football. But their real problem was with their heads, the one part of their body that got hit over and over again.

"Lately, I've tried to break it down," Turley said. "I remember, every season, multiple occasions where I'd hit someone so hard that my eyes went cross-eyed, and they wouldn't come uncrossed for a full series of plays. You are just out there, trying to hit the guy in the middle, because there are three of them. You don't remember much. There are the cases where you hit a guy and you'd get into a collision where everything goes off. You're dazed. And there are the others where you are involved in a big, long drive. You start on your own five-yard line, and drive all the way down the field—fifteen, eighteen plays in a row sometimes. Every play: collision, collision, collision. By the time you get to the other end of the field, you're seeing spots. You feel like you are going to black out. Literally, these white explosions—boom, boom, boom—lights getting dimmer and brighter, dimmer and brighter.

"Then, there was the time when I got knocked unconscious. That was in St. Louis, in 2003. My wife said that I was out a minute or two on the field. But I was gone for about four hours after that. It was the last play of the third quarter. We were playing the Packers. I got hit in the back of the head. I saw it on film a little while afterward. I was running downfield, made a block on a guy. We fell to the ground. A guy was chasing the play, a little guy, a defensive back, and he jumped over me as I was coming up, and he kneed me right in the back of the head. Boom!

"They sat me down on the bench. I remember Marshall Faulk coming up and joking with me, because he knew that I was messed up. That's what happens in the N.F.L: 'Oooh. You got effed up. Oooh.' The trainer came up to me and said, 'Kyle, let's take you to the locker room.' I remember looking up at a clock, and there was only a minute and a half left in the game—and I had no idea that much time had elapsed. I showered and took all my gear off. I was sitting at my locker. I don't remember anything. When I came back, after being hospitalized, the guys were joking with me because Georgia Frontiere"—then the team's owner—"came in the locker room, and they said I was butt-ass naked and I gave her a big hug. They were dying laughing, and I was, like, 'Are you serious? I did that?' . . .

In August of 2007, one of the highest-paid players in professional football, the quarterback Michael Vick, pleaded guilty to involvement in a dogfighting ring. The police raided one of his properties, a farm outside Richmond, Virginia, and found the bodies of dead dogs buried on the premises, along with evidence that some of the animals there had been tortured and electrocuted. Vick was suspended from football. He was sentenced to twenty-three months in prison. The dogs on his farm were seized by the court, and the most damaged were sent to an animal sanctuary in Utah for rehabilitation. When Vick applied for reinstatement to the National Football League, this summer, he was asked to undergo psychiatric testing. He then met with the commissioner of the league, Roger Goodell, for four and a half hours, so that Goodell could be sure that he was genuinely remorseful. . .

Goodell's job entails dealing with players who have used drugs, driven drunk and killed people, fired handguns in night clubs, and consorted with thugs and accused murderers. But he clearly felt what many Americans felt as well—that dogfighting was a moral offense of a different order.

Here is a description of a dogfight given by the sociologists Rhonda Evans and Craig Forsyth in "The Social Milieu of Dogmen and Dogfights," an article they published some years ago in the journal Deviant Behavior. The fight took place in Louisiana between a local dog, Black, owned by a man named L.G., and Snow, whose owner, Rick, had come from Arizona:

To read the graphic details of this dog fight . . .

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2.      In the News: Whither the Conscience Clause?

Pulling the Plug on the Conscience Clause by Wesley J. Smith FIRST THINGS, December 2009 

Over the past fifty years, the purposes and practices of medicine have changed radically. Where medical ethics was once life-affirming, today's treatments and medical procedures increasingly involve the legal taking of human life. The litany is familiar: More than one million pregnancies are extinguished each year in the United States, thousands late-term. Physician-assisted suicide is legal in Oregon, Washington, and, as this is written, Montana via a court ruling (currently on appeal to the state supreme court). One day, doctors may be authorized to kill patients with active euthanasia, as they do already in the Netherlands, Belgium, and Luxembourg. 

The trend toward accepting the termination of some human lives as a normal part of medicine is accelerating. For example, ten or twenty years from now, the physician's tools may include embryonic stem cells or products obtained from cloned embryos and fetuses gestated for that purpose, making physicians who provide such treatments complicit in the life destruction required to obtain the modalities. Medical and bioethics journals energetically advocate a redefinition of death to include a diagnosis of persistent vegetative state so that these living patients—redefined as dead—may be used for organ harvesting and medical ­experimentation. More radical bioethicists and mental-health professionals even suggest that patients suffering from BIID (body-integrity identity disorder), a terrible compulsion to become an amputee, should be treated by having healthy limbs removed, just as transsexuals today receive surgical sexual reassignment.

The ongoing transformation in the methods and ethics of medicine raises profound moral questions for doctors, nurses, pharmacists, and others who believe in the traditional virtues of Hippocratic medicine that proscribe abortion and assisted suicide and compel physicians to "do no harm." To date, this hasn't been much of a problem, as society generally accommodates medical conscientious objection. The assisted-suicide laws of Oregon and Washington, for example, permit doctors to refuse to participate in hastening patient deaths. Similarly, no doctor in the United States is forced to perform abortions. Indeed, when New York mayor Michael Bloomberg sought to increase accessibility to abortion by requiring that all residents in obstetrics and gynecology in New York's public hospitals receive training in pregnancy termination, the law specifically allowed doctors with religious or moral objections to opt out through a conscience clause.

This comity permits all who possess the requisite talent and intelligence to pursue medical careers without compromising their fundamental moral beliefs. But that may be about to change. Tolerance toward dissenters of what might be called the "new medicine" is quickly eroding. Courts, policymakers, media ­leaders—even the elites of organized medicine—­increasingly assert that patient rights and respect for patients' choices should trump the consciences of medical professionals. Indeed, the time may soon arrive when doctors, nurses, and pharmacists will be compelled to take, or be complicit in the taking of, human life, regardless of their strong religious or moral objections thereto.

A recent article published by bioethicist Jacob Appel provides a glimpse of the emerging rationale behind the coming coercion. As the Montana Supreme Court pondered whether to affirm a trial judge's ruling creating a state constitutional right to assisted suicide, Appel opined that justices should not only validate the "right to die" but also, in effect, establish a physician's duty to kill, predicated on the medical monopoly possessed by licensed practitioners. "Much as the government has been willing to impose duties on radio stations (e.g., indecency codes, equal-time rules) that would be impermissible if applied to newspapers," Appel wrote, "Montana might reasonably consider requiring physicians, in return for the privilege of a medical license, to prescribe medication to the dying without regard to the patient's intent." Should the court not thus guarantee access to assisted suicide, it would be merely creating "a theoretical right to die that cannot be meaningfully exercised."

Indeed, forcing medical professionals to participate in the taking of human life is already advancing into the justifiable stage. In Washington, a pharmacy chain refused to carry an abortifacient contraceptive that violated the religious views of its owners. A trial judge ruled that the owners were protected in making this decision by the First Amendment. But in Stormans Inc. v. Salecky, the Ninth Circuit Court of Appeals reversed the decision, ruling that a state regulation that all legal prescriptions be filled was enforceable against the company because it was a law of general applicability and did not target religion.

In a decision that should chill the blood of everyone who believes in religious freedom, the court stated: "That the new rules prohibit all improper reasons for refusal to dispense medication . . . suggests that the purpose of the new rules was not to eliminate religious objections to delivery of lawful medicines but to eliminate all objections that do not ensure patient health, safety, and access to medication. Thus, the rules do not target practices because of their religious motivation." And since pharmacists are not among the medical professionals allowed by Washington's law to refuse participation in assisted suicide, Stormans would also seem to compel dispensing lethal prescriptions for legally qualified patients even though the drugs are expressly intended to kill.

It isn't just the courts. Many of the most notable professional medical organizations are also hostile to protecting medical conscience rights. In 2007, for example, the American College of Obstetricians and Gynecologists (ACOG) published an ethics-committee opinion denying its members the right of conscience against abortion:

Although respect for conscience is important, conscientious refusals should be limited if they constitute an imposition of religious and moral beliefs on patients. . . . Physicians and other healthcare providers have the duty to refer patients in a timely manner to other providers if they do not feel they can in conscience provide the standard reproductive services that patients request. . . . Providers with moral or religious objections should either practice in proximity to individuals who share their views or ensure that referral processes are in place. In an emergency in which referral is not possible or might negatively impact a patient's physical or mental health, providers have an obligation to provide medically indicated requested care.

If this view is ever mandated legally, every obstetrician and gynecologist in America will be required either to perform abortions or to be complicit in them by finding a willing doctor for the patient. And don't think that can't happen. A law enacted last year in Victoria, Australia (the Abortion Law Reform Act of 2008) imposes that very legal duty on every doctor. The law states:

If a woman requests a registered health practitioner to advise on a proposed abortion, or to perform, direct, authorize, or supervise an abortion for that woman, and the practitioner has a conscientious objection to abortion, the practitioner must—(a) inform the woman that the practitioner has a conscientious objection to abortion; and (b) refer the woman to another registered health practitioner in the same regulated health profession who the practitioner knows does not have a conscientious objection to abortion.

Recent California legislation for what could be called euthanasia by the back door attempted to incorporate the same approach. As originally written, AB 2747 would have granted terminally ill patients—defined in the bill as persons having one year or less to live—the right to demand "palliative sedation" from their doctors. The bill was subversive on two fronts. First, it redefined a proper and ethical palliative technique, in which a patient who is near death, and whose suffering cannot otherwise be alleviated, is put into an artificial coma until natural death from the disease occurs. But as originally written, the bill redefined, as a method of killing, "the use of sedative medications to relieve extreme suffering by making the patient unaware and unconscious, while artificial food and hydration are withheld, during the progression of the disease, leading to the death of the patient." In other words, the bill sought to legalize active euthanasia via sedation and dehydration.

Second, it would have granted patients with a year or less to live the right to be sedated and dehydrated on demand. And it wouldn't matter whether the physician didn't believe that the patient's symptoms warranted sedation or whether he or she objected morally to killing the patient: Physicians asked by qualified patients to be terminally sedated would have had the duty to comply or refer. (The bill ultimately passed without these objectionable provisions and without the improper definition of palliative sedation.)

Here's another example of intolerance of medical conscience: In the waning days of the Bush Administration, the Department of Health and Human Services issued a rule preventing employment discrimination against medical professionals who refuse to perform a medical service because it violates their religious or moral beliefs. Based on the decibel level of the opposition, one would have thought that Roe v. Wade had been overturned. "That meddlesome regulation encouraging healthcare workers to obstruct needed treatment considered offensive," Barbara Coombs Lee, the head of Compassion and Choices, railed on her blog, "allows ideologues in health care to place their own dogmatic beliefs above all." Protecting the consciences of dissenting medical professions is "dangerous," she wrote, because "it's like a big doggy treat for healthcare bulldogs who would love to sink their teeth into other people's healthcare decisions."

It wasn't just overt true believers like Lee. Even before the final rule was published in the Federal Register, Hillary Clinton and Patty Murray introduced a bill to prevent the rule from going into effect. Immediately following its promulgation, Connecticut—joined by California, Illinois, Massachusetts, New Jersey, Oregon, and Rhode Island, and supported by the ACLU—filed suit to enjoin the regulation from being enforced. One of the Obama administration's first public acts was to file in the Federal Register a notice of its intent to rescind the Bush conscience regulation.

Newspaper editorial pages throughout the nation exploded, opening another front against the rule. The New York Times called it an "awful regulation" and a "parting gift to the far right." The St. Louis Post-­Dispatch went so far as to state: "Doctors, nurses, and pharmacists choose professions that put patients' rights first. If they foresee that priority becoming problematic for them, they should choose another profession." In other words, physicians and other medical professionals who want to adhere to the traditional Hippocratic ethic should be persona non grata in medicine—an astonishing assertion.

·                     Society is approaching a crucial crossroads. It seems clear that the drive to include death-inducing techniques as legal and legitimate methods of medical care will only accelerate in the coming years. If doctors and other medical professionals are forced to participate in these new approaches or get out of health care, it will mark the end of the principles contained in the Hippocratic Oath as viable ethical protections for both patients and medical professionals. . .

It is a sad day when medical professionals and facilities have to be protected legally from coerced participation in life-terminating medical procedures. But there is no denying the direction in which the scientific and moral currents are flowing. With ethical views in society and medicine growing increasingly polyglot, with the sanctity of human life increasingly under a cloud in the medical context, and given the establishment's marked hostility toward medical professionals who adhere to the traditional Hippocratic maxims, conscience clauses may be the only shelter protecting traditional morality in medicine.

Wesley J. Smith, award-winning author and Senior Fellow in Bioethics and Human Rights at the Discovery Institute, is a consultant for the International Task Force on Euthanasia and Assisted Suicide and for the Center for Bioethics and Culture. His blog, Secondhand Smoke, is available on,
First Things Online

Read the entire OpEd . . .

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3.      International Medicine: Delay in Cancer Diagnosis is Tragic in the UK!

Late cancer diagnosis kills 10,000 a year according to government tsar
Denis Campbell 
The Guardian, UK, November 29, 2009

Up to 10,000 people die needlessly of cancer every year because their condition is diagnosed too late, according to research by the government's director of cancer services. The figure is twice the previous estimate for preventable deaths.

Earlier detection of symptoms could save between 5,000 and 10,000 lives in England a year, Prof Mike Richards will reveal this week. The higher figure is nearly twice his previous calculation, which put the figure at about 5,000.

Richards has revised up his estimate after studying the three deadliest forms of the disease ‑ lung, bowel and breast cancer ‑ which together kill almost 63,000 people a year.

"These delays in patients presenting with symptoms and cancer being diagnosed at a late stage inevitably cost lives. The situation is unacceptable," Richards told the Guardian. . .

Britain is poor by international standards at diagnosing cancer. Richards's findings will add urgency to the NHS's efforts to improve early diagnosis. . .

Experts say early diagnosis can be the difference between a patient living for a short or long time or deciding whether they need surgery, such as a mastectomy, or not because quick access to surgery, drugs or radiotherapy greatly improves chances of survival.

In an article in the forthcoming British Journal of Cancer, which is published by Cancer Research UK, Richards will say: "Efforts now need to be directed at promoting early diagnosis for the very large number (over 90%) of cancer patients who are diagnosed as a result of their symptoms, rather than by screening.

"The National Awareness and Early Diagnosis Initiative [NAEDI] has been established to co-ordinate and drive efforts in this area. The size of the prize is large – potentially 5,000 to 10,000 deaths that occur within five years of diagnosis could be avoided every year."

Richards reached his conclusions after analysing one-year survival rates for the three cancers in England and comparing them with those in other European countries in the late 1990s. Previously he had looked at the number of patients who were still alive five years after diagnosis.

One-year survival is now thought to be a much better indicator of whether diagnosis was early or late.

The study focused on Britain's three biggest cancer killers: lung, which killed 34,589 people in 2007; colon (16,087); and breast (12,082). They account for 40% of the 155,484 cancer deaths in the UK in 2007 and, Richards found, about half of all the deaths that could have been avoided if diagnosis was as good as the best- performing European countries.

Richards found that "late diagnosis was almost certainly a major contributor to poor survival in England for all three cancers", but also identified low rates of surgical intervention being received by cancer patients as another key reason for poor survival rates. . .

"It's wrong to blame GPs for all these deaths, as there are many factors involved, including patients not recognising symptoms of cancer and not talking to their GP about them, especially middle-aged men. But I'm sure that we could all at times be more alert to symptoms and investigate and refer patients quicker," he added.

Sara Hiom, director of health information at Cancer Research UK, said GPs faced a difficult task in spotting cancer: "Despite cancer being a common disease, the average GP will only see one case of each of the four biggest cancers each year.

"Many of the symptoms that could be cancer turn out to be something less serious, but it's best to get things like unusual lumps, changes to moles, unusual bleeding or changes to bowel motions checked by a GP."

Early diagnosis usually means that treatment is more effective and milder for the patient, added Hiom.

Katherine Murphy, director of the Patients' Association, said: "Some patients are diagnosed with cancer when they have presented with the same symptoms six months earlier.

"Patients will sometimes tell us that they had been going to see their GP for six to nine months with, say, a pain in their stomach and were told to go to the pharmacy and buy an over the counter medicine [and later are found to have cancer]."

Read the entire report . . .

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

It's the same story the world over for Socialized Medicine.

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: Spending on nearly all Federal Benefit Programs grows relentlessly.

Health Costs and History WSJ, REVIEW & OUTLOOK, OCTOBER 20, 2009

Government programs always exceed their spending estimates.

Washington has just run a $1.4 trillion budget deficit for fiscal 2009, even as we are told a new health-care entitlement will reduce red ink by $81 billion over 10 years. To believe that fantastic claim, you have to ignore everything we know about Washington and the history of government health-care programs. For the record, we decided to take a look at how previous federal forecasts matched what later happened. It isn't pretty.

Let's start with the claim that a more pervasive federal role will restrain costs and thus make health care more affordable. We know that over the past four decades precisely the opposite has occurred. Prior to the creation of Medicare and Medicaid in 1965, health-care inflation ran slightly faster than overall inflation. In the years since, medical inflation has climbed 2.3 times faster than cost increases elsewhere in the economy. Much of this reflects advances in technology and expensive treatments, but the contrast does contradict the claim of government as a benign cost saver.


Next let's examine the record of Congressional forecasters in predicting costs. Start with Medicaid, the joint state-federal program for the poor. The House Ways and Means Committee estimated that its first-year costs would be $238 million. Instead it hit more than $1 billion, and costs have kept climbing. 

Thanks in part to expansions promoted by California's Henry Waxman, a principal author of the current House bill, Medicaid now costs 37 times more than it did when it was launched—after adjusting for inflation. Its current cost is $251 billion, up 24.7% or $50 billion in fiscal 2009 alone, and that's before the health-care bill covers millions of new beneficiaries.

Medicare has a similar record. In 1965, Congressional budgeters said that it would cost $12 billion in 1990. Its actual cost that year was $90 billion. Whoops. The hospitalization program alone was supposed to cost $9 billion but wound up costing $67 billion. These aren't small forecasting errors. The rate of increase in Medicare spending has outpaced overall inflation in nearly every year (up 9.8% in 2009), so a program that began at $4 billion now costs $428 billion . . .

The lesson here is that spending on nearly all federal benefit programs grows relentlessly once they are established. This history won't stop Democrats bent on ramming their entitlement into law. But every Member who votes for it is guaranteeing larger deficits and higher taxes far into the future. Count on it.

Read the entire WSJ Editorial . . .

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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: Mr. Obama's Health Care Reform - Mega Gluttony

Peggy Noonan writes in her column last week: Mr. Obama is in a hard place. Health care hangs over him, and if he is lucky he will lose a close vote in the Senate. The common wisdom that he can't afford to lose is exactly wrong - he can't afford to win with such a poor piece of legislation. He needs to get the issue behind him, vow to fight another day and move on.

The radical wisdom in this country that the $1.7 trillion we spend on health care is gluttonous is an unbelievable understatement should Obama have his way and add $trillions more. That type of national medical gluttony will be lethal for not only health care, but for individual freedom and for our country. It cannot survive this huge increase in debt.

Obama didn't get any of the three goals he sought in his recent Asian tour. The Chinese stiffed him as he bowed so low he could almost lick "Emperor Akihito's shoes."

Maybe the Emperor's smile indicated that he knows that they own so much of the United States Debt that they could just call all the notes in and own our entire country without ever firing a shot or launching a missile. Will we be able to be as proud of our country when we are the Chinese States of America and our Capital is Beijing?

With Mr. Obama's approval ratings now lower in his first year than Mr. Bush's in his fifth year, we should have enough time to get a health program organized before he becomes a mature leader. However, radical lies don't die easily when they are repeated so often.

We've heard some respectable physicians, including Dr. Andrew Weil, mention such lies as 47 million Americans are uninsured. That these misconceptions are so often spoken by even physicians who should know better, they must be challenged on a daily or more frequent basis.

That 47 million wasn't even true in 1965. Since then, we have Medicaid to cover all poor people in this country. Since then, we have Medicare that covers everyone over 65 and so we don't have any seniors uncovered. Medicare disability covers all disabled of any age and thus we have no disabled Americans without health care. Since then, we have veteran's benefits that cover all retired and disable veterans of all wars. Thus, we have no veterans who lack coverage. With such a triple net, there is no one that is poor, disabled or retired, and no disabled vet or senior citizen that is uncovered. The people uncovered today are a totally different population from those uncovered in 1965. The uncovered today make over $50,000, many over $75,000, and now there are a significant number making $100,000, that chooses not to have coverage. How can we say that someone making $4,000 a month is too poor to purchase a basic $400-a-month hospital surgical plan? Sure the many stories abound. Last week, there was a story of a physician's son who lacked coverage. We should not even be interested in covering people who make $4000 to $6000 a month and choose not to purchase a basic high-end policy.

It has become apparent that many people on Medicaid, when asked if they were covered by insurance, said they don't have insurance since they do not perceive Medicaid as health insurance. When we try to refer a Medicaid patient for surgery, the patient immediately asks if we know a surgeon that will accept Medicaid. They know it's hard to get into a doctors office. And Mr. Obama wants to shove another 25 million Americans into Medicaid and call it coverage?

Many physicians no longer accept Medicare because of meager reimbursements. And Mr. Obama wants to rape the Medicare till of some $460 million for his other programs. Is he totally out of touch with reality? Everyone thinks he's smoking cigarettes, but I wonder what he is really smoking?

It is important that all responsible Americans, whenever they hear the 47 million number, reply with the above facts and then forgive those for their anti-American attitudes and respect for freedom.

On listening to the Audio Book "House of Cards," the story of the Bear Stearns collapse, it was interesting to hear the multi-millionaires and billionaires, who in their better days sat around the country clubs talking about their parents coming from Eastern Europe so poor that they did not have any coins in their pocket and had to sweep floors or sell papers before they could purchase their first meal. They had very little sympathy for those who were so lazy and felt they were above this type of work. I have many patients from Eastern Europe who are very appreciative of living in humble surroundings with a TV and car, things their parents never had. Have we forgotten the opportunity of living in this country, where any poor person can become wealthy by keeping his nose to the grindstone?

Let's start by teaching our children, our family and friends not to accept a free lunch. Look what happened to Hillsdale when their students accepted government funds. It cost their Alumni $Hundreds of million. Government largess will bankrupt you.

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Medical Gluttony thrives in Government and Health Insurance Programs.

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

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6.      Medical Myths: Why spend ourselves out of business just to re-invent the wheel?

Myth 11. There are 46 million or more Americans without "health care." July 24th, 2009

No one, to our knowledge, has actually come up with an estimate of the number of residents in America, legal or illegal, who are denied life-saving medical care—if indeed there are any. Even accusations of violating EMTALA—the Emergency Medical Treatment and Active Labor Act, which requires screening and stabilization of any patient presenting to an emergency room—are apparently rare.

The 46 million are the "uninsured." They lack "coverage," not care.

The Institute of Medicine and the Kaiser Commission on Medicaid and the Uninsured have published widely cited 2002 reports concluding that uninsured people have worse health than insured people. The IOM guesstimates that 18,000 people a year die for lack of insurance—an impressive sound bite that "has no factual basis," writes Greg Scandlen.

In the actual report, the number 18,000 occurs only once, in Appendix D, with a description of the convoluted method for calculating it—extrapolating from one questionable estimate from one study.

Scandlen observes that neither IOM nor Kaiser did any original research, but simply compiled previous studies. These identify a correlation between lack of insurance and poor health, but cannot determine whether one is caused by the other, or both are caused by some other factor.

In the U.S. 37% of people with below-average income reported that they were in fair or poor health, while only 9% of people with above-average income said the same. A similar disparity is seen in the UK, New Zealand, Canada, and Australia, despite their "universal coverage."

People in lower income groups are more likely to be uninsured, but only 18 of the 164 separate studies made any effort to control for income. The Medicaid population, being low income and well-insured, could serve as a control group. In 61% of the 31 studies that identify three populations (privately insured, uninsured, and Medicaid), Medicaid recipients appeared to do as badly or worse than the uninsured in receiving medical services or maintaining good health. In many cases, they have worse outcomes than the uninsured. This is consistent with other information suggesting that income is a much better predictor of health than is insurance status (ibid.).

Smoking and education level were other confounding variables that the IOM failed to consider (David Hogberg, American Spectator 9/22/09).

While the increasing number of uninsured is presented as a crisis, the proportion of Americans without health coverage has changed little in the past decade. The increase in number is owing to immigration and population growth, writes Devon Herrick.

In 2006, 15.5% of Americans were uninsured, compared with 16.2% in 1997.

Of the claimed 46 million uninsured, 12.6 million (27%) are immigrants, either legal or illegal. Up to 14 million (30%) are eligible for government insurance, but haven't bothered to enroll. They can sign up the instant they need medical attention.

The percentage of low-income people (<$25,000/yr) without insurance actually decreased 24% over the past 10 years. The highest rate of increase in uninsured status, 90%, was in families with incomes over $75,000, who presumably could have bought insurance if they considered it worth the price.

Insurance "coverage" is not the same thing as medical care. It is not necessarily the best way to pay for medical care—although it probably is the most expensive. And there is no actual evidence, only inference from uncontrolled observational studies, that increasing the level of insurance coverage improves health outcomes. If expanding coverage means restricting care, the opposite could occur.

Additional information:

"The Uninsured: Reframing the Issue," AAPS News, November 2004.

"The Coverage Trap," AAPS News, May 2004.

"Down with 'Health Plans'!" AAPS News, January 2004.

"'Covering' the Uninsured: the Wrong Goal," AAPS News, April 2003.

"'Giving' and Taking," AAPS News, January 1992.

This entry was posted on Friday, July 24th, 2009 at 12:02 am and is filed under health care reform, mythbusters, uninsured. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

Responses to "Myth 11"

Willard Lyons says:

July 24, 2009 at 9:14 am

The system is NOT BROKEN! If one of the problems is catastrophic illness or trauma, address that problem and arrange to provide accordingly. If there are other issues that need modification, address them in a methodical manner.
Don't throw the baby out with the bath water!
Most people are not unhappy with their health care, especially seniors.
Why spend ourselves out of business just to re-invent the wheel?

John T Neilson, MD, FACP says: July 24, 2009 at 10:48 am

Tell a lie often enough and it becomes the truth. The essence of politics, especially the current administration.

Lyska Emerson, MD says: July 24, 2009 at 5:12 pm

I sent this link to my congressman. We must look at the objective data lest we make critical decisions based upon propaganda. I suggest others pass this along to their congressmen.

Feedback . . .

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: The Courtesies in Consultations

Dr. Rosen: When we see a patient in consultation, the chances are greater than not that we'll see a lot of inappropriate care.

Dr. Edwards: This is one way that consultants elevate the level of care with their consultative opinions.

Dr. Paul: I see this so frequently that I report it to the Medicine Committee.

Dr. Rosen: And what is the immediate result?

Dr. Paul: You get rid of bad doctors.

Dr. Rosen:  Shouldn't the consult provide greater expertise and improve patient care?

Dr. Paul: But so many of the patients I see in consultation have been so badly mismanaged that those doctors should lose their license.

Dr. Edwards: Would you say half?

Dr. Paul: I think close to that.

Dr. Edwards: So you're saying that half of the doctors you work with are marginal and give poor care?

Dr. Paul: Maybe I overstated the situation. But a large number of doctors are incompetent.

Dr. Milton: Would you feel that maybe a third of doctors are incompetent?

Dr. Paul: That might be a little closer.

Dr. Milton: So you think that perhaps a third of doctors should lose their license to practice?

Dr. Paul: That would certainly improve the level of care in this country.

Dr. Milton: You think that the level of care in this country is below that of other countries?

Dr. Paul: I didn't say that. But in most countries the doctors are so closely regulated that no one deviates too far from the norm.

Dr. Edwards: So you think we need more regulation in this country?

Dr. Paul: That would improve the level of care, don't you think?

Dr. Edwards: So you think to get rid of 300,000 of the 900,000 doctors in this country would improve care?

Dr. Paul: Certainly. Don't you agree?

Dr. Edwards: Not really. I think that would actually lower the level of care.

Dr. Paul: How so?

Dr. Edwards: First, there would be far fewer consultations and the poor care would go unnoticed. Secondly, we may not have enough doctors left to provide appropriate care. And thirdly, doctors would not take any risk to save lives. There would be no heroic physicians anymore. It would be safer to just let the patient die.

Dr. Paul: But in the chart review by the Peer Review committee, just letting a patient die would come to the committee's attention and they might rule it was an unnecessary death.

Dr. Milton: But an unnecessary passive death is easier to justify than an active death during high activity.

Dr. Rosen: Managing dying has become somewhat of an art in recent years.

Dr. Ruth: How could that possibly be the art of medicine?

Dr. Rosen: I saw a patient brought into the ER in full code. This treating doctor arrived while the code was in progress. He calmly examined the patient, albeit briefly, reviewed the chart quickly and determined that not only was the patient having a myocardial infarction, but he also had pneumonia, although it was probably an aspiration.

Dr. Ruth: In other words, death was inevitable. Why didn't he just let him die?

Dr. Rosen: This physician was streetwise in the workings of the hospital medicine committee and knew in retrospect things look markedly different than during the heat of the resuscitation activity. He had experienced a patient with unexpected pneumonia that had not received antibiotics and he was criticized for not treating it even though with the rapid turn of events it would not have helped.

Dr. Ruth: So what did he do to turn the tables?

Dr. Rosen: He gave the patient the cardiac medications IV, gave him antibiotics IV, gave him steroids IV, and even though his circulation was so poor that none of it may have reached his heart, the chart a few weeks later during review will show that all problems were adequately treated.

Dr. Ruth: Doesn't the Peer Review committee take such things into account?

Dr. Milton: There other dynamics working.

Dr. Ruth: Such as?

Dr. Milton: What if the reviewer doesn't like the doctor being reviewed and sees this as an opportunity to get rid of this bit of competition. He might be rather aggressive in his criticism so that the other committee members would not want the tables turned on them and so they stay quiet.

Dr. Ruth: Do you think this is a significant problem?

Dr. Rosen: This is so significant that there has been a case brought before the United States Supreme Court recently to rule on Abusive Peer Review. The stats are rather impressive.

Dr. Milton: The cost to society of eliminating one doctor, where society has invested a quarter million dollars on his education, is far greater than losing a tradesman who learned his skills "On The Job," built an inadequate house, lost his carpenter's permit but can more easily find another trade.

Sham Peer Review: A National Epidemic

Model Resolutions for Sham Peer Review

Feedback . . .

The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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

Orange County Medical Association: Finding the Right Place, By OCMA Staff

Dr. Patch Adams stated that physicians should never suffer burn-out if we focus on the giving of ourselves to assist others to restored health and a sense of well-being. Yet I struggle.

The privilege to care for others outweighs any other consideration in the healing arts.

In May, the idealistic clown Patch Adams, MD, spoke at the Pri-Med conference in Anaheim. In his speech on "The Joy of Caring," he mesmerized the audience with a compelling message: The privilege to care for others outweighs any other consideration in the healing arts.

There stood Dr. Adams--clown, political activist, humanitarian and advocate for peace--with the same academic credentials as me, but on a very different course in life. He eschews the trappings of "American success," claiming he owned no possessions, carried no insurance (health, life or liability) and proudly avoided technology. He denies any specific religious belief, but gathers around him people dedicated to caring for the poor in more than 66 countries afflicted by war, famine and natural disaster. Speaking without notes or a PowerPoint presentation, he enthralled the physicians for an hour that seemed only a few minutes long. For the first time in my 35 years of attending scientific medical meetings, a presenter received a standing ovation.

Dr. Adams stated that physicians should never suffer burn-out if we focus on the giving of ourselves to assist others to restored health and a sense of well-being. Yet, I struggle. I believe I am not alone in facing the difficult choice of a path between total altruism and self-indulgence. In my generation, the epitome of selflessness is Mother Teresa of Calcutta. And my award for self-centeredness goes to Paris Hilton. We must all ask ourselves: Where in that wide swing of the pendulum do I fall?

Here's another example of a struggle I face as I try to determine where I fit. Let's look at a recent story from Toronto, which dispels the myth of the great Canadian health plan. John, a man in his mid-60s, presents to his physician with neurological changes consistent with a cerebral neoplasm. His doctor referred him for a diagnostic MRI, which was estimated to take a minimum of four months. Through a different referral, John travels to Buffalo, N.Y.-a one-hour drive-and obtains an MRI brain scan confirming the malignant tumor. John returns back to his Canadian physician for a referral for surgery. Again, the neurosurgical consultation is estimated to take four months to occur. So John goes back to Buffalo the next week and undergoes surgery to biopsy and de-bulk the tumor. He returns to his Canadian physician with his biopsy and a request for radiation therapy. Guess what? Again there's a four-month wait list. He returns to Buffalo for the needed radiation treatment.

This story depicts the type of healthcare delays that Ted Kennedy's favorite approach will result in for Americans. Sen. Kennedy suffered the same disease as John, but not the same delay in care. Within hours of a seizure, Sen. Kennedy obtained a diagnosis and a well-organized treatment plan. In the United States, even if you aren't Sen. Kennedy-and even if you are an uninsured migrant worker-if you show up in an emergency room with a seizure, you'd receive better treatment than John did as an average Canadian citizen. I personally know that Canadian physicians are compassionate, but they are hampered by bureaucracy imposed by a national healthcare system that is, ironically, meant to address the inequalities in care between the rich and the poor. I could not practice in an environment where delays in diagnosis and treatment became accepted as a way of life.

Referring to the words of Viktor Frankel, the Austrian psychotherapist who survived the Auschwitz death camp, Dr. Adams said that in even the worst conditions of existence we can all choose our own ways. I struggle. Can we choose our own way if a system prevents choice? A single-payer, no-choice system, dictated by bureaucracy, scares me because of its lack of compassion. . .

Feedback . . .

VOM Is Where Doctors' Thinking is Crystallized into Writing.

* * * * *

9.      Book Review: Global Warming

State of Fear - by Michael Crichton, MD, HarperCollins , New York , © 2004, 672 pp, $25.95, Avon PB $7.99, ISBN-13-978-0-06-101573-1, Harper Audio, 16 CDs, 18 ½ hours, Performed by George Wilson, $49.95.

There is something fascinating about science. One gets such wholesale returns of conjecture out of such a trifling investment of fact.  -Mark Twain

Within any important issue, there are always aspects no one wishes to discuss.   -George Orwell

 "In late 2003, at the Sustainable Earth Summit conference in Johannesburg, the Pacific island nation of Vanutu announced that it was preparing a lawsuit against the Environmental Protection Agency of the United States over global warming. Vanutu stood only a few feet above sea level, and the island's eight thousand inhabitants were in danger of having to evacuate their country because of rising sea levels caused by global warming. The United States, the largest economy in the world, was also the largest emitter of carbon dioxide and therefore the largest contributor to global warming."

In Paris, a young physicist performs an oceanographic experiment for a beautiful visitor - then dies mysteriously after a romantic tryst with her.

In London's warehouse district below the Tower Bridge, an American picks up a shipment but does not fail to note two posters on a wall. One says "Save the Earth" and beneath it, "It's the Only Home We Have." The other says "Save the Earth" and beneath that, "There's Nowhere Else to Go." After a struggle to load the 700-pound box, he becomes suspicious, sensing that he is being watched. No sooner does he become wary than a woman accosts him and attempts to strangle him. He takes off down the street. The woman tells a warehouse attendant, "Go back to work. You did a good job. I never saw you. You never saw me. Now go." The hapless American, however, succumbs to a mysterious paralysis and dies suddenly in the street as the woman drives the Van away with the "merchandise."

In the jungles of Malaysia, a mysterious buyer purchases, for an unspecified purpose, deadly hypersonic cavitation technology, built to his specification that is capable of toppling mountains with sound. After business has been concluded, his contact drives him to the airport. Unfortunately he leaves his cell phone behind.

In Vancouver, a businessman leases a small research submarine for use in the waters off New Guinea.

At the International Data Environmental Consortium (The IDEC): In a small brick building adjacent to a University in Tokyo, which bears the University's Coat of Arms – leading the casual observer to assume an association, but which is totally independent, a network of servers equipped with multilevel quad-check honeynets is at work. The nets are established in both business and academic domains, which enable them to track backward from servers to user with an 87 percent success rate.

"The National Environmental Resource Fund, an American activist group, announced that it would join forces with Vanutu in the lawsuit, which was expected to be filed in the summer of 2004. It was rumored that wealthy philanthropist Gorge Morton, who frequently backed environmental causes, would personally finance the suit, expected to cost more than $8 million. Since the suit would ultimately be heard by the sympathetic Ninth Circuit in San Francisco, the litigation was awaited with some anticipation."

In Los Angeles, George Morton begins checking some of the data on global warming and finds conflicting scientific information. He finishes a bottle of Vodka in his private jet on his way to San Francisco to accept the National Environmental Resource Fund [NERF] award and gains the courage during his acceptance speech to urge more time for study. He is physically pushed off the stage. Having downed a few more Vodkas during the course of his meal, he leaves the building, weaves past his waiting limousine, and slips behind the wheel of his recently purchased Ferrari. Despite the urgings of his lawyer not to drive, George speeds away. Shortly after crossing the Golden Gate Bridge, the car crashes, leaving a mangled mound of steel, but the body of George Morton has disappeared.

In Antarctica, where the ice is getting thicker every year, an intelligence agent and members of his team race across glaciers in an attempt to put all the puzzling pieces together and prevent what will doubtless be a global catastrophe producing the largest iceberg in history. However, his partners who have been following his lead vehicle slide into a deep crevasse.

"But the law suit is never filed." Why was the Vanutu suit, which was to have been funded by George Morton, dropped?

Thus begins "State of Fear" an exciting and provocative techno-thriller. Author Michael Crichton who has given us a number of medical thrillers and the television series ER unravels the reasons while revealing some impressive research on the scientific pros and cons of global warming.

The novel is not politically correct and thus the reviews from the media were predictable. Or as David Kipen at the SF Chronicle states, "Unless I'm mistaken, State of Fear is the first thriller in history whose goals are to convince you that there's really nothing to be afraid of, and then to scare you to death about it." . . .

The 16 CD audio version performed by George Wilson is very well done. For physicians who drive between hospitals and their office, it's an easy way to brush up on how political science works. In fact, it packs a more powerful punch than silent reading.

But be sure you do not have a tight schedule. Several times during the past month after parking, I was unable to cease listening, open the door to my car, and meet my time constraints. One evening on my way home, I phoned my wife, "Would you mind if I drive to San Francisco and back? I just can't turn off George Wilson and Michael Crichton."

To read the entire book review . . . 

To read more book reviews . . .  

To read book reviews topically . . .  

Feedback . . .

* * * * *

10.  Hippocrates & His Kin: There are no political solutions - especially in healthcare.

Political Problems

There are no political solutions; there are only rearrangements of problems. - after David Mamet in November

Won't that keep politicos busy for at least a lifetime?

The Radical Message hasn't changed since 1965 even though the uninsured are a totally different class of people.

Since 1965, we've added Medicare so everyone over 65 is covered. We've added Medicaid so all poor people are covered with insurance. We've added Social Security Disability so all Disabled Americans of any age are covered. We've added coverage for all retired and disable veterans. No one can fall through this tripled layer health net.

All poor people are covered. The percentage of low-income people, those making less that $25,000 without insurance continues to decrease. The highest rate of increase in uninsured status, 90%, was in families with incomes over $75,000.

The radicals are now misleading Americans when the uninsured has shifted from the poor and aged to well off Americans. They're not interested in healthcare coverage for people in need; they are only interested in controlling people that willfully avoid insurance that they can afford.

Where are those 47 million?

There is no data on who the 47 million people without insurance are that PEW allegedly found. When they asked people on Medicaid if they had insurance, they replied NO. They don't consider themselves as having insurance. Probably because they have such difficulty finding a doctor or hospital that welcomes them.

And Obama wants to put another 25 million people into Medicaid?

Medicare Coverage

Medicare reimbursement continues to plunge so Medicare recipients are also having trouble finding a doctor. And Obama wants to remove $40 million from Medicare funding?

That should produce a real crisis in American Medicine.

The next Congress will be different.

Should the Obama-Pelosi bill pass, that should change the party affiliation of the next Congress. But that won't change much because the other party hasn't been able to get their act together for some time.

It looks like it's crucial for medicine to get out of politics to avoid Medical Armageddon.

Hacking into climatologists computers spoils the foil.

Hacking into computers of the global warming scientists revealed up to 13-year-old drafts portraying climate skeptics on an ice floe. There were also email exchanges of using a statistical "trick" in a chart to show a recent sharp warming trend. "This is not a smoking gun, this is a mushroom cloud," said Patrick J. Michaels, a climatologist who has long faulted evidence pointing to human-driven warming and is criticized in the hacked documents. "The fact is that we can't account for the lack of warming at the moment and it is a travesty that we can't," Kevin Trenberth, a climatologist at the National Center for Atmospheric Research, said.

It is unfortunate that so many scientists have political agendas now rather than scientific agendas.

Presidential Faults

I found not only that I didn't trust the current government, but that an impartial review revealed that the faults of this president - whom I a good liberal, considered a monster - were little different from those of a president whom I revered. Bush got us into Iraq, JFK into Vietnam. Bush stole the election in Florida, Kennedy stole his in Chicago. Bush ousted a CIA agent; Kennedy left hundreds of them to die in the surf at the Bay of Pigs. Bush lied about this military service; Kennedy accepted a Pulitzer Prize for a book written by Ted Sorenson. Bush was in bed with the Saudis, Kennedy with the Mafia. Oh. -David Mamet.

Oh! Isn't any president trustworthy anymore?

The only country that's not divided is totalitarian. -David Mamet

"Why I Am No Longer a 'Brain-Dead Liberal': An Election-Season Essay," by David Mamet published in The Village Voice in March 2008. November, he wrote in the essay, is, in fact, a play about politics.

Father to son as they look to the financial tower with a $13 trillion national debt clock at the top - My son, we're imprisoned for life without the possibility of parole. -Stahler, Columbus Dispatch

And some folks think that's more humane than capital punishment?

Feedback . . .

To read more HHK . . .

To read more HMC . . .

* * * * *

11.  Organizations Restoring Accountability in HealthCare, Government and Society:

                      The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at and register to receive one or more of these reports. This month, read the informative article: Being uninsured is like being unemployed -- it happens to lots of people for brief periods, says John C. Goodman, President, CEO and the Kellye Wright fellow with the National Center for Policy Analysis...

                      Pacific Research Institute, ( Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog. Just released: How Federal Health "Reform" Will Devastate California's Budget
Capital Ideas By: John R. Graham 12.2.2009

                      The Mercatus Center at George Mason University ( is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government. This month, treat yourself to an article Not What They Had in Mind: A History of Policies that Produced the Financial Crisis of 2008.

                      The National Association of Health Underwriters, The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business.

                      The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels. This month, you might focus on The 2,074-page health reform bill that Senate Majority Leader Harry Reid unveiled Wednesday is a maze of complexity and duplicity and deceit. It would spend $848 billion over 10 years to provide new subsidies for health coverage, increase taxes by $486 billion, and allegedly cut spending by $491 billion. All the while, it pretends to use this massive government expansion to cut the deficit.

                      Greg Scandlen, an expert in Health Savings Accounts (HSAs), has embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the initial series of his newsletter, Consumers Power Reports. Become a member of CHCC, The voice of the health care consumer. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn. Greg has joined the Heartland Institute, where current newsletters can be found.

                      The Heartland Institute,, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?. This month, be sure to read: In a new Policy Study for The Heartland Institute, Peter Ferrara demystifies the several health care overhaul bills pending in the U.S. House and Senate, explaining how the measures would result in less health care for consumers and higher taxes for all ... and offering a patient-empowering alternative plan.

                      The Foundation for Economic Education,, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Lawrence W Reed, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. Be sure to read the current lesson on Economic Education: The House That Uncle Sam Built By Steven Horwitz & Peter Boettke The Great Recession (or the Great Hangover) that began in 2008 did not have to happen. Its causes and consequences are not mysterious. Indeed, this particular and very painful episode affirms what the best nonpartisan economists have tried to tell our politicians and policy-makers for decades, namely, that the more they try to inflate and direct the economy, the more damage the rest of us will suffer sooner or later.

                      The Council for Affordable Health Insurance,, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse."

                      The Independence Institute,, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter. You may want to obtain the book: Aiming for Liberty: The Past, Present, And Future of Freedom and Self-Defense.

                      Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read Illiberal Belief # 28: Governments Can Create Jobs. In pushing for and signing a near-trillion-dollar stimulus bill in February, Obama explicitly accepted the notion that governments can create jobs. But every dollar spent on stimulating the economy is a dollar taken away from taxpayers. By BRADLEY DOUCET

                      The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at for an overview of the extensive research articles that are available. You may want to go directly to their health research section.

                      The Heritage Foundation,, founded in 1973, is a research and educational institute whose mission 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 but as a socialistic institution and have canceled our contributions.

                      The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at to obtain the foundation's daily reports. Be sure to read Why Some People Are Poorer by Henry Hazlitt: Throughout history, until about the middle of the 18th century, mass poverty was nearly everywhere the normal condition of man. Then capital accumulation and a series of major inventions ushered in the Industrial Revolution. In spite of occasional setbacks, economic progress became accelerative. Today, in the United States, in Canada, in nearly all of Europe, in Australia, New Zealand, and Japan, mass poverty has been practically eliminated. It has either been conquered or is in process of being conquered by a progressive capitalism. Mass poverty is still found in most of Latin America, most of Asia, and most of Africa. You may also log on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to be an MD today.

                      CATO. The Cato Institute ( was founded in 1977, by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio, articles and books at This month, read the Latest Watergate Fiasco: Climate Scientists Subverted Peer Review [Also] The more we learn about the purloined e-mails from the University of East Anglia's Climate Research Unit, the more it resembles Watergate

                      The Ethan Allen Institute,, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.

                      The Free State Project, with a goal of Liberty in Our Lifetime,, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]

                      The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, wartime allows the federal government to grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St. Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in wartime, we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to

                      Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read Professor Victor Davis Hanson speaking:  I want to talk about the Western way of war and about the particular challenges that face the West today. But the first point I want to make is that war is a human enterprise that will always be with us. Unless we submit to genetic engineering, or unless video games have somehow reprogrammed our brains, or unless we are fundamentally changed by eating different nutrients - these are possibilities brought up by so-called peace and conflict resolution theorists - human nature will not change. And if human nature will not change - and I submit to you that human nature is a constant - then war will always be with us. The last ten years of Imprimis are archived.

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Del Meyer

Del Meyer, MD, Editor & Founder

6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608

Words of Wisdom

Politicians believe they can intervene and fix the health care sector of the economy as if it were an engine in need of a tune-up. - Gerry Smedinghoff

"Ask yourself the easy questions and you'll have a hard life, ask yourself the hard questions and you'll have an easier life!" - Peter Thomson: U.K. strategist on business and personal growth

The majority of individuals view their surroundings with a minimal amount of observational effort. They are unaware of the rich tapestry of details that surrounds them, such as the subtle movement of a person's hand or foot that might betray his thoughts or intentions." - Joe Navarro: Former FBI agent and expert on nonverbal language

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In Memoriam

Earl Cooley, smokejumper, died on November 9th, aged 98

From The Economist print edition Nov 26th 2009

SEEN from the height of a passenger jet, the mountains of Idaho and western Montana look like the grey, wrinkled hide of a dinosaur. Closer up, from a twin-engine aircraft, those wrinkles become thousands of conifers marching over the steep and broken ground. Closer still—"My God! My chute's not opening! Something's wrong!"—that's a spruce you're plunging into, your tardy parachute lines tangling round your neck and your flailing legs kicking off branches a hundred feet above the ground. Luckily, you're alive. Luckier still, you have a rope in your trouser pocket that lets you rappel down from the tree. And you haven't even got to the fire yet.

Such was Earl Cooley's introduction, on July 12th 1940 when he was 28, to the completely new science of smokejumping. After years spent trying to douse the forest fires of America's West from aircraft—labouring skywards with water stowed in five-gallon cans and beer barrels—this was the first attempt to parachute firefighters to blazes too remote to reach by road. In the 22 years Mr Cooley was to spend doing it, it was also his closest call. He reflected later that if the spruce had not saved him, the smokejumping programme itself would not have survived—let alone become the success it is today, with 1,432 jumps made for the Forest Service last year. Back then, too many people thought it crazy. . .

Hunting the fire

The jumpers were firefighters first and foremost: young men impatient to get to a fire. Like hunters, they aimed to "catch" it before it went "over the hill", or before it blew up from a spot fire to a raging "project fire" over 50 acres or more. . .

His expertise often gave him the job of spotter in a plane. He had to read wind speed, direction and drift; assess, from the speed of the lumbering Ford Trimotor aircraft and his watch, the size of the fire; find, and mark with streamers, a suitable place to drop that was free of "snags" (dead trees), felled logs, stumps or boulders; check every inch of kit and harness, every buckle and strap and pin, and then tap each man on the left leg to make him jump. Mr Cooley was not just a trainer of men (including quivering Mennonites and Quakers, conscientious objectors, who were sent to become smokejumpers during the second world war). He also felt responsible for seeing that they returned. . .

Read the entire obit . . .

On This Date in History - December 8

On this date in 65 B.C., Horace, the great Latin Poet, was born. He is the one person who has long since become an institution to countless generations that have had occasion to study his work. One line that has stood the test of time is, "It is when I am struggling to be brief that I become unintelligible."

On this date in 1886, a group of labor unions meeting in Columbus, Ohio, organized the American Federation of Labor (AFL)

After Leonard and Thelma Spinrad


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 Liberty Hotel."
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