Community For Better Health Care

Vol VIII, No 20, Jan 26, 2010


In This Issue:

1.                  Featured Article: Haiti's Biggest Threat

2.                  In the News: Another Failed Presidency

3.                  International Medicine: The NHS is in deep trouble, mired in scandal and incompetence

4.                  Medicare: Mayo Clinic in Arizona stops accepting Medicare

5.                  Medical Gluttony: Laboratory Gluttony

6.                  Medical Myths: The "status quo" versus the "reform"

7.                  Overheard in the Medical Staff Lounge: Does the Massachusetts Election give us Hope?

8.                  Voices of Medicine: A Transatlantic Malaise

9.                  The Bookshelf: A short course in history as our nation's course changes

10.              Hippocrates & His Kin: Health Insurance Portability and Accountability Act

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

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

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Always remember that Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single payer initiative, was born for the benefit of the state and of a contemptuous disregard for people's welfare.

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1.      Featured Article: Mental Health Rather than Infectious Disease may be Haiti's Biggest Threat       

Despite much concern about diseases spreading through Haiti's earthquake-shattered areas, one epidemiologist explains that mental health issues will be more widespread. By Katherine Harmon,
Scientific American, Jan 15, 2010.

As the aftershocks of the January 12 magnitude 7.0 earthquake outside of Port-au-Prince, Haiti, taper off and the dust settles, new needs are coming to light. The health of many of the three million residents said to have been shaken by the quake will be determined in the coming weeks as aid workers and others rush to treat the wounded, provide food and water, and try to prevent disease outbreaks.

Concern already has run high about the spread of cholera and typhus in a country whose everyday "water supply and basic sanitation services are still very deficient," according to the Pan American Health Organization. Many diseases, including malaria, HIV and typhoid, were already widespread issues in Haiti before the earthquake struck, and the intensely weakened health care system (established hospitals and clinics having collapsed or been damaged) and other infrastructure is expected to exacerbate these problems. . . .

But not all of the human harm from this disaster will be of the physical variety. For example, many experts have noted that the multitude of dead bodies—some 50,000 possibly having died in the disaster already, the Red Cross estimates—don't pose an infectious disease risk so much as a psychological threat to the survivors.

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2.      In the News: Another Failed Presidency By Geoffrey P. Hunt, American Thinker, Jan 17, 2010

Barack Obama is on track to have the most spectacularly failed presidency since Woodrow Wilson.

In the modern era, we've seen several failed presidencies--led by Jimmy Carter and LBJ. Failed presidents have one strong common trait-- they are repudiated, in the vernacular, spat out. Of course, LBJ wisely took the exit ramp early, avoiding a shove into oncoming traffic by his own party. Richard Nixon indeed resigned in disgrace, yet his reputation as a statesman has been partially restored by his triumphant overture to China. . .

But, Barack Obama is failing. Failing big. Failing fast. And failing everywhere: foreign policy, domestic initiatives, and most importantly, in forging connections with the American people. The incomparable Dorothy Rabinowitz in the Wall Street Journal  put her finger on it: He is failing because he has no understanding of the American people, and may indeed loathe them. Fred Barnes of the Weekly Standard says he is failing because he has lost control of his message, and is overexposed. Clarice Feldman of American Thinker produced a dispositive commentary showing that Obama is failing because fundamentally he is neither smart nor articulate; his intellectual dishonesty is conspicuous by its audacity and lack of shame.

But, there is something more seriously wrong: How could a new president riding in on a wave of unprecedented promise and goodwill have forfeited his tenure and become a lame duck in six months? His poll ratings are in free fall. In generic balloting, the Republicans have now seized a five point advantage. This truly is unbelievable. What's going on?

No narrative. Obama doesn't have a narrative. No, not a narrative about himself. He has a self-narrative, much of it fabricated, cleverly disguised or written by someone else. But this self-narrative is isolated and doesn't connect with us. . . We admire those presidents whose narratives not only touch our own, but who seem stronger, wiser, and smarter than we are. Presidents we admire are aspirational peers, even those whose politics don't align exactly with our own: Teddy Roosevelt, FDR, Harry Truman, Ike, Reagan.

But not this president. It's not so much that he's a phony, knows nothing about economics, is historically illiterate, and woefully small minded for the size of the task-- all contributory of course.  It's that he's not one of us. And whatever he is, his profile is fuzzy and devoid of content, like a cardboard cutout made from delaminated corrugated paper. Moreover, he doesn't command our respect and is unable to appeal to our own common sense. His notions of right and wrong are repugnant and how things work just don't add up. They are not existential. His descriptions of the world we live in don't make sense and don't correspond with our experience.

In the meantime, while we've been struggling to take a measurement of this man, he's dissed just about every one of us--financiers, energy producers, banks, insurance executives, police officers, doctors, nurses, hospital administrators, post office workers, and anybody else who has a non-green job. . .

Mercifully, the Founders at the Constitutional Convention in 1787 devised a useful remedy for such a desperate state--staggered terms for both houses of the legislature and the executive. An equally abominable Congress can get voted out next year. With a new Congress, there's always hope of legislative gridlock until we vote for president again two short years after that.

Yes, small presidents do fail, Barack Obama among them. The coyotes howl but the wagon train keeps rolling along.

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3.      International Medicine: The UK National Health Service is in deep trouble

Michael Moore has mad view of the NHS by Minette Marrin,

"You'd never guess from his film that the NHS is in deep trouble, mired in scandal and incompetence"

The fourth estate has always had a bad name, but it seems to be getting worse. Journalism should be an honest and useful trade, and often still is. But now that journalism has more power than ever before, it seems to have become ever more disreputable. In recent years it has been brought lower and lower by kiss-and-tell betrayals, by "reality" TV, by shockumentaries and by liars, fantasists, hucksters and geeks of every kind, crowing and denouncing and emoting in a hideous new version of Bunyan's Vanity Fair.

Outstanding among these is Michael Moore, the American documentary maker. He specialises in searing indictments, such as Fahrenheit 9/11 and Bowling for Columbine, and has, without a doubt, a genius for it. Although his films are crude, manipulative and one-sided, he is idolised by millions of Americans and Europeans, widely seen as some sort of redneck Mr Valiant-for-truth.

Nothing could be further from the truth. His latest documentary, Sicko . . . is a dishonest film. That is not only my opinion. It is the opinion of Professor Lord Robert Winston, the consultant and advocate of the NHS. When asked on BBC Radio 4 whether he recognised the NHS as portrayed in this film, Winston replied: "No, I didn't. Most of it was filmed at my hospital [the Hammersmith in west London], which is a very good hospital but doesn't represent what the NHS is like."

I didn't recognise it either, from years of visiting NHS hospitals. Moore painted a rose-tinted vision of spotless wards, impeccable treatment, happy patients who laugh away any suggestion of waiting in casualty, and a glamorous young GP who combines his devotion to his patients with a salary of £100,000, a house worth £1m and two cars. All this, and for free.

This, along with an even rosier portrait of the French welfare system, is what Moore says the state can and should provide. You would never guess from Sicko that the NHS is in deep trouble, mired in scandal and incompetence, despite the injection of billions of pounds of taxpayers' money. . .

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The NHS does not give timely access to quality healthcare; it only gives access to incompetence.

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4.      Medicare: Mayo Clinic in Arizona stops accepting Medicare


President Obama is a great admirer of the Mayo Clinic.  Time and again he has extolled it as an outstanding model of health care excellence and efficiency.  So perhaps the president will give some thought to the Mayo Clinic's recent decision to stop accepting Medicare payments at its primary care facility in Glendale, Arizona, says columnist Jeff Jacoby.


More than 3,000 patients will have to start paying cash if they wish to continue being seen by doctors at the clinic; those unable or unwilling to do so must look for new physicians.

For now, Mayo is limiting the change in policy to its Glendale facility, but it may be just a matter of time before it drops Medicare at its other facilities in Arizona, Florida and Minnesota as well.

Why would an institution renowned for providing health care of "the best quality and the lowest cost" choose to sever its ties with the government's flagship single-payer insurance program?  Because the relationship is one it can't afford, explains Jacoby:

Last year, the Mayo Clinic lost $840 million on its Medicare patients.

At the Glendale clinic specifically, a spokesman told Bloomberg, Medicare reimbursements covered only 50 percent of the cost of treating elderly primary-care patients.

Not even the leanest, most efficient medical organization can keep doing business with a program that compels it to eat half its costs.

The Centers for Medicare and Medicaid Services, a branch of the U.S. Department of Health and Human Services, estimated last month that the Senate bill would squeeze $493 billion out of Medicare over the next 10 years.  As a result, it cautioned, "providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and… might end their participation in the program."

Nearly six months ago, the Mayo Clinic tried to sound an alarm, says Jacoby.  Instead of making American health care better and more affordable, it warned, the legislation working its way through Congress will do the opposite and the real losers will be the citizens of the United States.

Source: Jeff Jacoby, "Medicare and the Mayo Clinic," Jewish World Review, January 3, 2010.

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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: Laboratory Gluttony

Recently after I saw a patient with a single disease, I was checking off on the laboratory requisition a CBC, UA, chemistry and lipid panel, which I thought was basically needed and consistent with best practices for new patients. The patient asked me if she could have every test on the requisition. She further stated that she wanted to be pro-active and make sure she was in the best of health. She stated that she had insurance and it wouldn't cost her anything.

I pointed out to her that I had to have medical justification for every test. I explained that these tests I ordered are similar to what my personal physician orders on me every year and the bill I receive from the laboratory is $376. I further illustrated that there are more than one hundred tests on this requisition, plus a dozen multi-test panels, plus more than 30 tests listed on the bottom of the requisition.

Yes, but I have insurance and I deserve to have all the tests I think I need, she continued.

I'm sorry, I responded. But isn't that the reason you have doctors - to make a medical determination on what you need?

But doctors are so stingy with tests and they miss a lot of things. So I have a legal right to these other tests, she replied.

But if we obtained the other one hundred plus tests, that would be tens of thousands of dollars. We ordered common tests on you that cost the insurance company $376. All these other tests include endocrine, hormone, and vitamin level tests which may cost 10 to 20 times what a simple blood count costs. And they would not improve your health.

I'm not asking that they be done every year, she explained. I just think maybe once every ten years everything possible should be done. Why do I pay for insurance?

You have insurance to pay ordinary costs needed for your health care. All these additional extra-ordinary costs are expensive. For the insurance to pay ten or a hundred times the usual cost would mean that your insurance premiums would have to increase ten or a hundred times the present level.

But my employer pays for my health insurance, she assured.

Your employer won't pay for them long if the premium goes up so astronomically.

We'll just have President Obama pass a law to force employers to pay for all health insurance. That'll solve the problem won't it, she asked?

No it won't. Employers will go out of business and we'll regress to an agrarian and barter economy. Then we'll respond to market forces where everyone is reasonable because it's expensive not to be.

But that will force employers to pay since they have a lot of money and a lot of profit, she continued.

Employers can't pay beyond their income. They can't print money like the government and continue to be irresponsible. Let's just look at how market forces would affect your request for laboratory tests. First we have to put your insurance plan on the market by making you responsible for at least a small portion of the cost of laboratory care. Shall we start with 20 percent? In my case that would mean that I would be paying $76 of my laboratory bill which is the same that I ordered on you. So if I ordered twice as many tests on you and it costs $750, your copay would be $150. Would you then want twice as many tests?

No I wouldn't want to be responsible for that kind of a co-payment, she admitted; but I would want the tests.

The insurance company has no more money than the premiums we pay. So the more you want, the higher your premiums will be. If your employer pays the premium, he would just have to deduct twice as much from you salary for you health care. You can't give him the authority to print money like Uncle Sam.  .  .

Having doubled her appointment time, I could see that I would be unable to educate her even if I tripled her appointment time and so I moved on to the next patient.

But it does show that we can place health care in a market environment, which would reduce costs by making the patient a participant in the health care decision-making process. The mechanism to bring the patient into this decision-making process is for the patient to have a percentage co-payment responsibility. This would force the patient to be interested in the cost of every test or procedure ordered and to understand why it should be done or if it should be "axed" on the spot. This would be an instant way to cut health care costs dramatically without any government or insurance oversight. Freedom in the consultation room would be restored. Medical costs would plummet. Quality of health care would rise. This would be a triple winner.

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Medical Gluttony thrives in Government and Health Insurance Programs.

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

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6.      Medical Myths: The "status quo" versus the "reform"

AAPS Myth 14: We must choose between the "status quo" and the Democrats' "reform" plan

July 31st, 2009

The strategy during the August recess was outlined by Paul Begala, a Democrat strategist close to the White House: "Supporters of reform have to put the status quo on trial" ( 7/26/09).

"If somebody told you that there is a plan out there that is guaranteed to double your health care costs over the next 10 years, that's guaranteed to result in more Americans losing their health care, and that is by far the biggest contributor to the federal deficit, I think most people would be opposed to that," Obama said. "Well, that's the status quo," he claims (ibid.).

Members of Physicians for a National Health Program (PNHP) identify the 70-some health plans with which they have voluntarily contracted as the status quo, or even as the "free market," and complain bitterly about the poor remuneration and costly administrative hassles.

AAPS does not support the status quo, but over years and decades has advocated fundamental reforms that—unlike the Democrat plans—

Instead, AAPS supports reforms that:

Reform can begin immediately at the individual level, as physicians quit participating in third-party arrangements, and patients fire health plans that insist on intruding into the patient/physician relationship.

Specific desirable legislative changes include the following: Read the changes the AAPS supports . . .

A coalition of state and specialty medical societies has drafted a letter to Congress espousing a patient-centered system rather than a government-controlled system—the right kind of change from the status quo.

Additional information:

This entry . . . is filed under health care reform, mythbusters. 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.

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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: Does The Massachusetts Election give us Hope?

Dr. Rosen: This has been an eventful week. The Socialists health care plan may not be a fait accompli after all.

Dr. Dave: With Scott Brown's victory last night, the socialists, misnamed as liberals, will be on the run.

Dr. Yancy: Harry Reid will certainly be another victim at the regular elections next year. Nevada is against the health care monstrosity.

Dr. Sam: I think there are about a dozen socialist's Senate seats that are up and with the mood of the country returning to its Constitutional Roots, several of them will be won by Freedom-loving candidates.

Dr. Paul: Don't be so sure we'll lose. The people want free health care. The whole world has free health care. It's a march that will go on to victory.

Dr. Ruth: I don't think there is any such thing as free health care. If it were true, we'd all be working for slave wages.

Dr. Paul: My friends in England brag about their system being so free and universal. That's the humane thing to do.

Dr. Sam: You must live on a different planet than I do, Paul. From what I read and what my friends tell me, they wait for months to get life-saving surgery.

Dr. Paul: And my friends in the UK make £130,000. That's not bad for a 40-hour work week and no night work or stress.

Dr. Yancy: That's about £2500 a week.

Dr. Ruth: Let's see. A pound is about $1.40. So that would be $3500 a week. I think my family and I could live on that.

Dr. Yancy: And give up the freedom of managing your own practice and decisions?

Dr. Ruth: After twenty years of practice, with my children getting ready for college, I'm getting ready to give up freedom for security.

Dr. Yancy: You're also giving up quality care. You have to follow government-approved protocols that you know are not the best for your patients. Wouldn't that bother you?

Dr. Ruth: Yes, it would. But it's not humanly possible to hold out for the best forever when everything is devolving into the lowest common denominator.

Dr. Rosen: What if our great grandparents had given up the ship in the 1770s and 1780s and we were living under kings and despots without a voice? Do you want our grandchildren to revert to such a life that was present for millennia before the great American Experiment in Freedom?

Dr. Dave: Rosen, you always give us hope. The election sure gave me hope. I think this should give us the stamina to see things through and to turn our country and our health care around to greater freedom for our physicians and our patients and continue the highest quality of care in the world.

Dr. Rosen: See, we can do it if we all set our minds towards the same goals our forbearers had. We don't have to clear the land like they did. But to clear the socialistic mind sets of so many of our colleagues and citizens may be a greater challenge than making forests tillable.

Dr. Dave: Well, maybe I'll accept the challenge after all. The stakes are rather high, don't you think.

Dr. Rosen: Another caveat. The CATO newsletter received today notes that in 2006, Massachusetts enacted a sweeping health insurance law that mirrors the legislation currently before Congress. And Scott Brown voted for it. So we can never be entirely sure of anybody's credentials any more. Is he a RINO like Mitch Romney?

Dr. Dave: Maybe he voted for it for political reasons since Romney was Governor. I would trust Brown more than Romney.

Dr. Rosen: It's difficult today to separate the RINOs and the DINOs. One has to pay close attention and sometimes infer from verbal cues. But Romney should never be allowed to represent us in Washington. He's dangerous and a socialist. If he were in power, he could be doing the same thing that Obama is doing. A RINO doing government control is worse that a DINO enslaving us.

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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 

From Sonoma Medicine, the Official Journal of the Sonoma County Medical Association, Winter 2010

A Transatlantic Malaise by John Toton, MD

Physicians receive an overwhelming number of medical journals and medical newspapers on topics of current interest, usually supported by advertising. We scan and sometimes read this flood of information, but occasionally an article or reference stands out, and we follow up on it. Such was the case with an article about Physician Disempowerment: A Transatlantic Malaise, a "treatise" on the reality of European medicine from the physician's perspective.

I downloaded the treatise from, the website for the Center for Medicine in the Public Interest, an organization that lobbies for a traditional American approach to medicine. The treatise consists of the full texts of 12 presentations made at a 2008 conference on physician disempowerment sponsored by CMPI. Half the presenters were physicians, PhDs and other experts from the United States, and the other half were from countries with nationalized health care systems.

Editor Mark Crane introduces the presentations by affirming the "American malaise." According to Crane, the United States is losing doctors because of excess paperwork, retirement, and practices that are overextended and overworked. He predicts a shortage of 35,000 to 40,000 primary care physicians by 2025.

"Person in the street" interviews conducted by CMPI in New York City highlight how little the public knows about Canadian and European systems. When asked whether they would want universal health care, the answer was invariably yes; but when asked how much extra income tax they would pay, a typical response was, "No, no, no. We want it to be free, like in Europe."

The keynote speaker, Dr. Francois Sarkozy (brother of French President Nicolas Sarkozy), addresses what kind of care one gets in France "for free." He describes the flight of French physicians away from private practice to salaried positions. He finds a paradox that there are now more physicians per population than ever before, and that many are seeking "the balanced life" while practicing only 50% to 75% of the time. Physicians are unionized, and their medical fees are agreed upon between the government and the union. Having given up their independence, says Sarkozy, physicians reluctantly accept the regimentation and loss of collaboration, along with the loss of accountability and quality assessment. 

Sarkozy identifies a "physician malaise," arguing that all is not well. Physicians need to recover their respected status and recognition in the community; they need to relearn the principles of independent practice, to delegate, to seek efficiency, to collaborate—in short, to redevelop what they've given up, what American medical practice up to now fights to maintain.

Dr. Tim Evans, from Great Britain, describes waiting lists that have become "intolerable." The country has a population of 60 million and a health care budget exceeding $175 billion per year, yet Great Britain at any given time has more than 1 million people on an active waiting list for care and an additional 200,000 trying to get onto that list. Seven million people also have private medical insurance, and another six million will pay cash to get their desired or needed care. This situation, says Evans, is a far cry from a 1948 government promise that "The National Health Service will provide you with all medical, dental, and nursing care. Everyone, rich or poor, will be able to use it." Physicians in the NHS now tell patients, in effect, "If this is an NHS dialogue, you can have 10 minutes. If you want to pay privately, then we might have a slightly longer, slightly more fruitful conversation."

Evans claims that most British physicians now realize that there are only two ways to organize health care. One is on an entrepreneurial basis, where you serve customers and create value. The other is to organize care politically and put the politicians in charge, making physicians "a salaried lackey of the state." 

Jacob Arfwedson, director of the Paris office of CMPI, describes the issues in Sweden, a country with a longtime government model of health care. Sweden recently began offering "choice of care" options with performance-based pay for medical physician entrepreneurs. The Karolinska Hospital in Stockholm, known worldwide as a model of state care, now runs training sessions in private care. The state is naturally opposed to these developments, but as market-based care models demonstrate improved services, they are becoming firmly entrenched, according to Arfwedson . . .

Other presenters rehash our American complaints and observe that American baby boomers want universal care at no cost to themselves. While American physicians are acutely aware of our own problems, we are grossly unaware of the European and Canadian systems. Our fellow physicians in these countries have the experience to advise us of what is ahead.

The presenters in Physician Disempowerment speak to a wide range of government mandated and supervised health care options, all of which appear to weigh heavily on the backs of physician providers. Although CMPI is clearly an advocacy organization with a conservative viewpoint, its treatise does offer an informative window into an experience we may all be facing in the near future.

Dr. Toton, a Healdsburg orthopedic surgeon, serves on the SCMA Editorial Board.

Back to Sonoma Medicine Winter 2010 Table of Contents

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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: A short course in history as our nation's course changes from its historical roots

A Time For Freedom, by Lynne Cheney, Simon & Schuster, New York, © 2005, ISBN: 13-978-1-4169-0925-5, 282 pp, $15.95 US, $21.95 CAN.

"No one can fully appreciate the great fortune we have to be Americans without knowing the events that brought us to where we are today." –Lynne Cheney

Lynne Cheney, a teacher, states in her introduction that our freedom and strength are products of the past, and although the choices made by the brave men and women who preceded us do not offer sure guidance to the future, they offer the best guidance that we have.

Unfortunately, fewer and fewer of us are leaving school knowing the basic facts of our history. One study found that two thirds of seventeen-year-olds could not identify the half-century in which the Civil War occurred. A survey of seniors at elite colleges and universities showed that only one out of five was familiar with the words of the Gettysburg Address. A significant number of seniors thought that Ulysses S. Grant was a general in the Revolutionary War.

Facts alone are not enough for understanding history of course, but without the facts understanding is impossible. A full appreciation of the achievement represented by the Nineteenth Amendment, ratified in 1920, requires knowing that women first organized to work for the right to vote in 1848, more than seventy years before. Comprehending why the Civil War occurred in the 1860s requires knowing that our nation expanded dramatically in the 1840s. It was a question of whether new states would be free or slave that finally made it impossible to paper over the great moral contradiction that slavery represented in a nation dedicated to freedom.

Cheney feels that some dates should be locked in our memory—1492, 1607, 1620, 1776, and 1787 for starters. But it is equally important to be familiar enough with the order of events so that one has a sense of the progress of our national story. We should all understand that when the delegates to the Continental Congress declared that "all men are created equal," they provided more than a rationale for independence; they gave inspiration to generations of men and women whose struggles would make that ideal a reality for more and ever more Americans.

This book is a time line of the events in our nation's history. She chose to highlight our political history rather than many other areas of importance. She feels the history of the entire world ought to be a subject of interest for students. But in A Time for Freedom, she chose to start with America. This is our home—how lucky we are that it is.

We shall highlight a few dozen of the hundreds of dates she has listed hoping that will inspire you to obtain a copy of her book and search further.



Under the sponsorship of King Ferdinand and Queen Isabella of Spain, Christopher Columbus and his crew sail three ships, the Niña, the Pinta, and the Santa Maria, more than three thousand nautical miles across the Atlantic. Hoping to find the Indies, Columbus lands instead on an island in the Bahamas that he names San Salvador, or "Holy Savior." Columbus made four voyages to the New World, which he persisted in believing was the Indies. He died ignorant of his real accomplishment.

"An age will come after many years when the ocean will loose the chains of things, and a huge land lie revealed." –A Prophecy in Seneca's Medea, a play Columbus knew well
"The prophecy was fulfilled by my father the admiral, in the year 1492." –Ferdinand Columbus, writing alongside the prophecy in his father's copy of Seneca . . .

"Is life so dear, or peace so sweet, as to be purchased at the price of chains and slavery? Forbid it, Almighty God! I know not what course others may take; but as for me, give me liberty or give me death!" –Patrick Henry

British troops moving to seize a store of arms in Concord, Massachusetts, encountered militiamen at Lexington, and shooting breaks out, leaving eight colonists dead. A skirmish at North Bridge forces the British to retreat; by the time they make it back to Boston, 273 redcoats are killed, wounded or missing.

"Stand your ground. Don't fire unless fired upon, but if they mean to have war, let it begin here." –Militia Captain John Parker

One the night of April 18, 1775, both Paul Revere and William Dawes rode to sound the alarm that the redcoats were coming. They reached Lexington but then ran into a British patrol. Dawes turned back, and Revere was arrested, but Dr. Samuel Prescott, who had joined Revere and Dawes, made it to Concord and alerted the militia there. . .

In what will become known as the Battle of Bunker Hill, the British attack American Militiamen dug in on Breed's Hill and drive them off, but only after suffering more than one thousand casualties.

"I wish [we] could sell them another hill at the same price." –American General Nathanael Greene


Thomas Paine's essay Common Sense lays out the case for revolution.

"The period of debate is closed. Arms, as the last resource, decide the contest . . . The blood of the slain, the weeping voice of nature cries, 'Tis Time to Part." –Thomas Paine

July 4, 1776

The Continental Congress formally approves the Declaration of Independence.

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness." –The Declaration of Independence


Congress adopts the Stars and Stripes.

"Resolved, that the flag of the thirteen United States be thirteen stripes, alternate red and white; that the Union be thirteen stars, white in a blue field, representing a new constellation." –Continental Congress


The Articles of Confederation are ratified and become the governing framework for the thirteen states.

With the help of a French fleet and troops, American forces under the command of General Washington defeat General Charles Cornwallis and his forces at Yorktown, effectively ending the war.

"Oh God! It is all over." –British Prime Minister Lord North, according to legend


The Treaty of Paris formally ends the Revolutionary War.

"The citizens of America . . . are, from this period, to be considered as the actors on a most conspicuous theater, which seems to be peculiarly designated by Providence for the display of human greatness and felicity." –George Washington, Circular to the States


Delegates meeting in Philadelphia create a new and stronger framework for government, the Constitution of the United States.

"We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America." –Preamble to the Constitution


George Washington is sworn in as the first president of the United States.

"I walk on untrodden ground." –President George Washington . . .

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10.  Hippocrates & His Kin: HIPAA Compliance after the Stimulus Package

Brochures are fast arriving to "help" physicians comply with the new stimulus package. One states that the new stimulus package has dramatically increased HIPAA compliance requirements. DO NOT MISS THIS SEMINAR! Bring all your business associates because HIPAA now applies to all business associates too! Who Should Attend? The brochure lists 30 health care titles that must attend. What will you learn during the six-hour course? Pay your $219; 2-4, $209 each; 5 or more, $199 each and see. After a thousand attorneys wrote the new health care bill and stimulus package, it would take a faculty of attorneys to explain the ramifications. Yes, the course director and the faculty are all attorneys to explain what they foisted upon us.

The litigation that will follow should put an extra $100K into each trial attorney's pocket.

Coding Guidelines to increase you Re-imbursement

Another brochure arrived on the Massachusetts Senatorial Election Day to fill Senator Kennedy's term. It was to improve the amount of money you can get out of your insurance company for every patient you see. This course is taught by non-physicians telling physicians how to charge for their services to get the most money from the insurance industry. I also noted the cost to doctors was the same as above.

If everyone were able to rake an extra 20 percent from insurance, wouldn't health care costs soar?

I thought our goal was to decrease health care costs.

Health Insurance Portability and Accountability Act

I understand there is another course for attorneys, government officials, and insurance companies to understand how you can now through HIPAA obtain patient records en mass without notifying the patient and preventing the doctor or hospital from informing the patients that their records went out without their permission. Government agencies and insurance companies now have free right of access. Doctors and patients thought this had reference to their health insurance being portable to their new job. They never fully understood that it referred to the medical record being Portable without Accountability.

The benefit of having attorneys write health care laws is that only attorneys benefit.

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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

                      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. Here are some important innovative presentations for you to read and digest:
LH - Manuscript - The Critical Role Patients Will Play in the New Financing System for Health Care.pdf
LH - Manuscript - The Critical Role Pharmacists Will Play in the New Financing System for Health Care.pdf
LH - Manuscript - The Critical Role Doctors Will Play in the New Financing System for Health Care.pdf
LH - Manuscript - The Critical Role Doctors Will Play in the New Financing System for Health Care.pdf
LH2 - Manuscript - International Hospital Participation in the U.pdf

                      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

                      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. For starters, read An Open Letter to America's Physicians Be sure to read News of the Day in Perspective: Chicago Tribune exposes AMA – "Medical billing code monopoly explains AMA support for health plan." 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 ClimateGate hit as 1,200 stretch limousines were converging on Copenhagen. 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.

ALSO NOTE: MedicalTuesday receives no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the research and writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country.

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Del Meyer      

Del Meyer, MD, Editor & Founder

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Words of Wisdom

"The trouble with Socialism is, sooner or later you run out of other people's money." -Margaret Thatcher

 "When you subsidize poverty and failure, you get more of both." -James Dale Davidson, National Taxpayers Union

"The more corrupt the state, the more it legislates." -Tacitus 

"A Liberal is a person who will give away everything he doesn't own." -Unknown  

Liberals should be renamed: Socialists

Some Recent Postings

Politicians Cannot Manage a Health Care System . . . by David Gibson, MD . . . Read the ten-page summary of the 2,000 page worst health care tax increase legislation before Congress in its two century history . . Stay Current with the HealthPlan Debate . . .

In Memoriam

Tsutomu Yamaguchi, a double nuclear survivor, died on January 6th, aged 93

From The Economist print edition, Jan 14th 2010

WHEN he had stopped crying, Tsutomu Yamaguchi would tell you why he called his book of poems "The Human Raft". It had to do with the day he forgot to take his personal name-stamp to work, and had to get off the bus. Much was on his mind that morning. He had to pack his bags to leave Hiroshima after a three-month assignment as an engineer in the Mitsubishi shipyard; there were goodbyes to say at the office, then a 200-mile train journey back to Nagasaki to his wife Hisako and Katsutoshi, his baby son. He was slightly stressed when he got to his stop, still with half-an-hour's walk ahead of him on a track that led through featureless potato fields. But it was a beautiful August day; the sky was clear, his spirits high. And then—readers will feel a tremor, but he felt none—he noticed an aircraft circling, and two parachutes dropping down.

The next thing he knew was a blaze of white magnesium light, and a huge ball of fire. He dived to the ground. The fireball, roaring upwards, sucked him up again and threw him, blinded, face-down into the mud of the potato field. He was two miles from the epicentre of the blast, in a rain of flaming scraps of paper and clothes. His upper body and half his face were badly burned, his hair gone and his eardrums ruptured. In this state, he made his way back to the devastated city to try to do what he had meant to do that day: catch the train. The river bridges were down. But one river was full of carbonised naked bodies of men, women, children, floating face-down "like blocks of wood", and on these—part treading, part paddling—he got to the other side. His human raft.

At this point in his story he would weep uncontrollably. It was by no means the end of it. When he reached Nagasaki, barely pausing to get his burns dressed, he reported for work. His boss was sceptical: how could a single bomb have destroyed Hiroshima? Then the same white magnesium light blazed in the window, and Mr Yamaguchi was tossed to the ground again. A reinforced-steel stairwell saved him. His bandages were blown off, and he spent the next weeks curled round his raw wounds in a shelter, close to death. His house was destroyed, his wife and son saved for no reason he could see. But when schoolchildren later asked him, in awed respect, "What was the most terrible thing?", his answer was not the dangling tongues and eyeballs, not the skin that hung off the bodies of the living "like giant gloves"—but the bridge of bodies on which he had crossed the river. . .

Read the entire story . . .

On This Date in History - January 26

This date in 1778 is known as Australia Day, commemorating the settlement of British convicts, of whom there were too many to keep in England, who were diverted from America because of the Revolutionary War.  It is a comment on both the hardiness and the resilience of disadvantaged people that from these convict settlers Australia developed into one of the great civilized lands in the South Pacific. When tested, the goodness of people emerged—and more good people were attracted. Thus Australia Day gives us today a timely reminder that faith in people can be well rewarded.

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 will be held April 12-14, 2010
Washington, DC
Toll Free: 800-767-9499

In partnership with, the 6th Annual World Health Care Congress was the most prestigious meeting of chief and senior executives from all sectors of health care. The 2010 conference will convene 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.