Community For Better Health Care

Vol VIII, No 7, July 14, 2009


In This Issue:

1.                  Featured Article: Rising Health-Care Costs: Who's the Villain?

2.                  In the News: Medical Identity Theft is a Fast-growing Crime

3.                  International Medicine: The Catastrophes of Socialized Government Medicine

4.                  Medicare: Why It's Easy To Steal From Medicare

5.                  Medical Gluttony:  Like any other Entitlement – More is never Enough

6.                  Medical Myths: An Electronic Medical Record could save your life in an emergency

7.                  Overheard in the Medical Staff Lounge: Are Co-payments Cost Effective?

8.                  Voices of Medicine: Critical—What We Can Do About the Health-Care Crisis. . .

9.                  The Bookshelf: Terrorism before 2001 by Russell L Blaylock, MD

10.              Hippocrates & His Kin: Only in Government can Workers add $100K by Retiring.

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 13-15, 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: Rising Health-Care Costs: Who's the Villain? By Charles Van Eaton

Dr. Van Eaton is McCabe/UPS Professor of Economics at Hillsdale College, Hillsdale, Michigan.

Why is the level of health-care spending what it is? Why does the rate of growth in health-care spending tend to rise faster than spending on other things? Can anything be done to control the rate of growth, if not the level, of health-care costs, short of having government take control of what now constitutes almost 14 percent of our entire Gross Domestic Product? What can be done to decrease the number of persons who are without some form of private health-care insurance?

As the political debate about health-care unfolded, it became clear that virtually no one in the federal establishment thought that trying to get answers to these questions made any difference in what the politicians were trying to do to move government even more heavily into the health-care-services production system than it is now.

It does make a difference. There are strong differences of opinion on why the level of U.S. health-care costs are what they are, why these costs have been rising faster than the cost of other goods and services, and what government can do both to reduce the level of costs and to arrest the rate of cost growth.

On one side is the view that if the level of spending on health care is the product of forces over which government can, at best, have little control, there is no reason to give government more control. However, if part of the reason health-care spending tends to rise faster than other streams of spending is the product of policies generated by government programs, and if the goal is to reduce this rate of spending growth, the obvious place to start would be to do away with those government policies which contribute to spending growth.

Why are costs what they are and why do they tend to rise as fast as they do?

"Villain Theories"

On one side of the debate one hears what may be called "villain theories" of healthcare costs. These theories focus on the production side of services and conclude that both the level and rate of growth in costs are the product of greed on the part of insurers, pharmaceutical companies, hospitals, and physicians.[1] Until these parts of the health-care-services production and financing system are brought under control, this argument goes, nothing can be done to reduce health-care spending. . .

Against the villain theory of health-care costs lies the view that the level of healthcare costs is a product of six factors, none of which involves villains of any stripe.

1. The level of health-care costs relative to Gross Domestic Product is higher in the United States than it is in other countries because the American health-care system has been so successful in treating conditions which, in past times, would have been untreatable.[2] Consequently, good medicine increases rather than reduces the proportion of people in our population who have illnesses requiring continued treatment. . . (Put another way, while the dead are no longer a cost burden to the health-care system, survivors are.)

2. The technological superiority of the American health-care-services production system has resulted in an increase in the quantity of health-care services demanded. The technical diagnostic capacity to test for that additional one percent of information, which might provide answers to a medical puzzle, results in a demand for additional testing and additional treatment-at additional cost, of course. . . Consequently there are many who argue that American medical technology is a major reason for the high level of health-care costs.  [Note: While medical technology may be expensive, these advances almost always lead to more cost-effective total care and better quality of life. It is interesting that in no other industry is less technology considered progress.]

3. What is all too often overlooked when the level of American health-care spending is unfavorably compared to spending in other nations is that the United States, in many ways . . . is not like other nations. Therefore comparing the level of health-care spending in the United States relative to spending in other nations is not particularly useful unless all those distinguishing factors are addressed and statistically held constant before cost comparisons are made.

. . . As former Secretary of Health and Human Services Louis W. Sullivan noted, "It cannot be overemphasized that the top ten causes of illness and premature death in our nation are significantly influenced by personal behavior and lifestyle choices.". . .

4. . . . A nation with high income is going to spend more on everything, especially health care, because health care is, to use economists' jargon, highly income elastic. When income levels rise by some given percent, the demand for health care rises proportionately more. . . [George J. Schieber and Jean-Pierre Poullier found that each 10 percent difference in per-capita Gross Domestic Product is associated with a 14 percent difference in per-capita health-care spending.]

What can government do to change these cost factors? Virtually nothing.

The rate of growth in American healthcare costs relative to the cost of other things Americans buy, New York University economist William Baumol argues, is due to the relative difficulty of expanding productivity in services production compared to goods production. In Baumol's view, there are no villains.

Baumol, long considered one of America's foremost scholars in the field of productivity analysis, argues that "There is no advanced country in which complaints about rates of cost increase are not heard." In fact, "in fourteen of eighteen countries in the years 1960 through 1990, health-care prices rose more rapidly than prices in general. The U.S. rate of increase was exceeded by that in seven countries-Australia, Austria, Canada, the Netherlands, New Zealand, Norway, and Switzerland. . .

Those inclined to see the rise in healthcare costs in terms of villains who must be managed by direct government intervention into the health-care-services production system may be failing to grasp the nature of services production relative to goods production. Both data and theory compel serious observers to acknowledge that it is far more difficult to increase productivity in services such as health care, law, welfare programs, mail, police, sanitation, repairs, and the performing arts, compared to manufacturing, because in the latter the continual development of new tools and management techniques makes it possible to expand output with fewer units of labor input.

By contrast, services—particularly health-care services—all have a "hand-craft" attribute in their supply process. Consequently, when productivity rates differ across different sectors of an economy, say, manufacturing compared to health care, the money price of health care will rise relative to the money price of outputs in those sectors where productivity gains are real and substantial. Therefore, Baumol concludes, rising health-care costs are "an inevitable and ineradicable part of a developed economy and the attempt to do anything about it may be as foolhardy as it is impossible.". . .  Consequently, the rise in the dollar price of health-care services is not evidence of a system in despair, but only of a broad difference in relative productivity rates between services and goods.

But, Baumol rightly notes, "This happy conclusion is just a bit too simplistic…. it will not be easy to convince the layperson that, even though the prices of personal services appear to be rising at a phenomenal rate, in fact the costs of these services (in terms of their labor time equivalent) are really declining because of increases in labor productivity generally.". . .

For example, even though the German insurance system is bankrupt despite premiums that come to 13 percent of payroll, after paying the tax, Germans "graze themselves to obesity on medical services because the price of care, as perceived by individuals, is essentially zero."

A new econometric model developed by Gary and Aldona Robbins of Fiscal Associates, Inc., which looks at how America finances health care, provides insight into why our current system for subsidizing health care distorts demand and adds costs that increase the probability that some people will be priced out of the market for affordable health insurance coverage. The Robbinses note the following:

•       Prices matter. People are not price sensitive in the market for health care as they are in the market for other goods and services because some third-party (Medicare or a private insurer) pays most of the cost of health services. . .

•       Health spending has been rising because prices paid by patients have been falling. When we are using someone else's money, we pay less attention to costs and thus spend more.

•       Most Americans are overinsured because of government policies. Through generous tax subsidies to employers, government "pays" up to one-half of the cost of employer-provided health insurance. . .

•       The main cause of rising health-care spending is government. Direct government spending has increased from 24 percent of all health-care spending in 1960 to 42 percent in 1990. . .

•       Because of the third-party character of our health-care finance system, most people have no idea how much they are personally contributing to cover the costs. In 1992 national health spending was equal to $8,821 for every U.S. household, with most of this burden hidden from view.

•       Because of third-party insurance and government subsidies, the most costly services are often the cheapest to patients. On average, patients pay only 4.5 cents out of pocket for every dollar spent on hospitals, but 68 cents out of pocket for every dollar spent on pharmaceuticals. Thus, to patients, hospital therapy appears cheaper than drug therapy while for society as a whole the opposite may be true. . .

One must conclude that, however unintentionally, our current system of third party-driven health-care finance has yielded an unusually perverse outcome: while it contributes to higher levels of health cost for the nation as a whole, it sends a signal to individuals which leads them to believe that health-care costs are cheap. Consequently, the direct effect of rising health-care costs are largely hidden from the majority of individual health-care consumers.

In short, if the word "crisis" has any place at all in the debate, it should not be applied to the health-care-services production system, it should be applied to how we finance the demand for health-care services because this system, which is based on having someone other than the health-care consumer pay the bill, robs individuals of a direct stake in health-care cost control.[18]

What should government be trying to do? It certainly should not be trying to impose a massive Medicare or Medicaid system on the whole country. Neither should it be moving to bring all Americans under the umbrella of employer-provided health insurance. These two systems, to the extent that they have contributed to disguising health-care costs to individuals, have been the single most critical factor in forcing health-care costs upward. Government should move the system away from its heavy reliance on third-party payments toward a system based on individual accountability for health-care spending. Is that the direction government will finally take? We shall see.

Article printed from The Freeman | Ideas On Liberty:

URL to the entire article along with key references:

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2.      In the News: Medical Identity theft is a fast-growing crime, NY Times, June 13, 2009

Medical Problems Could Include Identity Theft, By WALECIA KONRAD, NY Times

Brandon Sharp, a 37-year-old manager at an oil and gas company in Houston, has never had any real health problems and, luckily, he has never stepped foot in an emergency room. So imagine his surprise a few years ago when he learned he owed thousands of dollars worth of emergency-service medical bills.

Mr. Sharp, as it turned out, was a victim of a fast-growing crime known as medical identity theft.

At the time, Mr. Sharp was about to get married and buy his first home. Before applying for a mortgage he requested a copy of his credit report. That is when he found he had several collection notices under his name for emergency room visits throughout the country.

"There was even a $19,000 bill for a Life Flight air ambulance service in some remote location I'd never heard of," said Mr. Sharp, who made this unhappy discovery in 2003. "I had emergency room bills from places like Bowling Green, Kan., where I've never even visited. I'm still cleaning up the mess."

The last time federal data on the crime was collected, for a 2007 report, more than 250,000 Americans a year were victims of medical identity theft. That number has almost certainly increased since then, because of the increased use of electronic medical records systems built without extensive safeguards, said Pam Dixon, executive director of the nonprofit World Privacy Forum and author of a report on medical identity theft. . .

Medical identity theft takes many guises. In Mr. Sharp's case, someone got hold of his name and Social Security number and used them to receive emergency medical services, which many hospitals are obliged to provide whether or not a person has insurance. Mr. Sharp still does not know whether he fell victim to one calamitous perp who ended up in several emergency rooms or a ring of accident-prone conspirators.

In another variant of the crime, someone can use stolen insurance information, like the basic member ID and group policy number found on insurance cards, to impersonate you — and receive everything from a routine physical to major surgery under your coverage. This is surprisingly easy to do, because many doctors and hospitals do not ask for identification beyond insurance information.

Even more common, however, are cases where medical information is stolen by insiders at a medical office. Thieves download vital personal insurance data and related information from the operation's computerized medical records, then sell it on the black market or use it themselves to make fraudulent billing claims.

In a widely reported case in 2006, a clerk at a Cleveland Clinic branch office in Weston, Fla., downloaded the records of more than 1,100 Medicare patients and gave the information to her cousin, who in turn, made $2.8 million in bogus claims. . .

And there are none of the consumer protections for medical identity theft victims that exist for traditional identity theft. Under the Fair Credit Reporting Act you can get a free copy of your credit report each year, put a fraud alert on your account and get erroneous charges deleted from your record. If your credit card is stolen and the thief goes on a spending spree, you're not liable for more than $50 worth of the charges.

With medical identity theft, though, the fraudulent charges can remain unpaid and unresolved for years, permanently damaging your credit rating. Under the federal law known as HIPAA — the Health Insurance Portability and Accountability Act — you are entitled to a copy of your medical records, but you may have to pay a hefty fee for them.

Worse, HIPAA privacy rules can actually work against you. Once your medical information is intermingled with someone else's, you may have trouble accessing your files. Privacy laws dictate that the thief's medical information now contained in your records must be kept confidential, too. . .

And some medical centers and doctors' offices now require patients to show photo ID and attach photos to patient charts.

But privacy advocates worry that these steps do not go nearly far enough, especially in light of President Obama's plans to spend $20 billion to increase the use of electronic medical records nationwide as part of the stimulus package. "Without aggressive safeguards, we could be building an infrastructure for massive medical fraud," said Ms. Dixon.

It would be best if government bureaucracy allowed medical records to evolve naturally and safely.

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3.      International Medicine: The catastrophes of Socialized Government Medicine continue to surface worldwide.

NHS trusts in England did not come up to hygiene standards in Healthcare

The Healthcare Commission today publishes its annual ratings of NHS services. This year it has revealed that 114 of the 391 NHS trusts did not satisfactorily comply with hygiene standards in 2007-08.

They are: To view the list of the unclean hospitals . . .

Why would anyone in Washington DC want us to adopt third world healthcare?

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4.      Medicare: Why It's Easy To Steal From Medicare - WSJ

The White House made a big show last week about "turning the heat up" on Medicare fraud. The dragnet resulted in 53 indictments in Detroit for a $50 million scheme to submit bills for HIV drugs and physical therapy that were never provided, as well as busting up a Miami ring that used fake storefronts to steal some $100 million. As welcome as this is, the larger issue, according to the Wall Street Journal, is what such plots say about President Obama's plans for a new government-run insurance program?

For example:

One of the purported benefits of nationalized health care is that it will be more efficient than private insurers since it would lack the profit motive and have lower administrative expenses, like Medicare. . .

By contrast:

Private insurers try to manage care, and that takes money. Not only does administrative spending go toward screening for waste and fraud -- logical, given the return-on-investment incentives -- they also go toward building networks of (honest) doctors and other providers.

Medicare doesn't pay for this legwork, so it simply counts fraud losses as more spending.

Generally private insurers also attempt to pay for other things that consumers find valuable, such as high quality, while Medicare and Medicaid are forbidden by law from excluding substandard providers, unless they're criminals.

Dead doctors, fake patients, high-school dropouts, fly-by-night businesses and the rest will continue to swindle our sclerotic entitlement system, no matter how far the government turns up the after-the-fact heat. The arrests in Detroit and Miami are another argument against importing to the rest of the health economy the model that enabled these scams, says the Journal.

Source: Editorial, "Why It's Easy to Steal From Medicare," Wall Street Journal, July 2, 2009

For text:

For more on Health Issues:

Government is not the solution to our problems, government is the problem.

- Ronald Reagan

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5.      Medical Gluttony: Like any other Entitlement – More is never Enough

Mr. Allred asked for an excuse from Jury Duty because he was angry at the government of his homeland. This anger made it impossible for him to think logically and he said he would be unable to follow any courtroom deliberations with his mental preoccupation.

The last time he went to visit his family, he counted 99 dead bodies among his friends, acquaintances and townspeople. He stated that these people had cast aspersions on the government and they simply were shot. He learned very quickly not to say anything that could possibly be construed as adverse to the state. This still haunted him and he requested an excuse for medical reason.

Knowing some judges personally, they get upset with what they call Medical or Physician arrogance—the request for an excuse without clarifying the medical reason. They resent a directive "Please excuse" as if coming from Mt Sinai.

Thus to write an excuse, in our estimation, requires a brief review of his last annual exam, the sequence of diagnosis copied into the letter, and an explanation to the Jury Commissioner why that constellation of diagnostic symptoms and findings would interfere with normal court room proceedings, suggesting that they may want to avoid the problem by excusing this patient from jury duty in their court room.

In an elderly medical practice, the requests for being excused from jury duty come rather frequently. The time involved approaches about one-half of an office call. So we started charging for this service, clearly stating that this is not covered by insurance, Medicare or Medicaid.

This may be a rather blunt approach in having patients begin to understand the cost of a physician's time. It has also stopped the creeping increase in time for an unstructured office evaluation. It is always exasperating to give a patient an extra 10 minutes of time and then be expected to give an additional "tens of minutes" for a sundry of other items.

It's always a pleasure to see a business person who knows the appointment time is 20 minutes and, in about 18 minutes, start drawing the discussion to a close because he values the cost of time. It's time for all patients to begin to comprehend this before government controlled office visits occur and everyone becomes unhappy and probably rather angry.

In the U.S. Air Force, when we got behind in seeing patients, the hospital commander just decreased office visits to ten minutes with a warning that if we didn't keep up and get the troops seen, he would reduce the office visit to 7 ½ minutes.

When government bureaucrats run our practice, they will have no problem in cutting the physician's and patient's schedule to whatever they deem important. I've already heard one attorney say, it shouldn't take more than five minutes to look into a pair of ears and listen to the chest. Why does a doctor want to take 20 minutes?

Meanwhile, patients want 30 minutes, 50 minutes, 70 minutes or 90 minutes. We must inform our patients that should the government take over their healthcare, the appointment time will go in the opposite direction. And at that point, it will be too late to reverse the direction.

Medical Gluttony may cause perverse incentives for patients.

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6.      Medical Myths: An electronic medical record could save your life in an emergency

AAPS News, June 29th, 2009

Information technology does not stop bleeding, start IVs, defibrillate the heart, or put in a breathing tube. In an emergency, those are the things that save your life. If you need them, the doctor does not have time to look at your EMR.

In an emergency, the doctor needs to know your blood sugar NOW, not what it was 6 months ago. Ditto for your chest x-ray. If the test needs to be done STAT, the old results are probably irrelevant, and if it doesn't need to be done STAT, there's time to make a phone call and ask for a faxed report.

The most important information in an emergency is what just happened to you, and that will NOT be in your EMR.

If you have a serious allergy or other problem that your doctor needs to know in an emergency, wear a MedicAlert bracelet or something else attached to your body. In a bad emergency, your ID may be lost, the computer may be down, or the power may be off.

The EMR is being promoted for the convenience of bureaucrats and lawyers, and for the profits of vendors. Sometimes it helps doctors; sometimes it's a hindrance. Only the doctor can decide.

The EMR costs a huge amount of money, and the costs never stop. It might save a few dollars in preventing unnecessary tests for people who have bad memories or can't keep track of paper records. *

The whole record could be destroyed by a power surge (especially if it's an electromagnetic pulse or EMP). Or it could become unreadable; tapes, disks, and other media become obsolete and are not necessarily durable. On the other hand, it can be nearly impossible to extirpate errors.

The EMR may prevent some errors, but introduce others, especially ones caused by identity theft, sloppy data entry, poor typing skills, confusing software, dry-labbed information entry by macro, and failure to check data once entered. It could even kill you.

EMR systems are a non-consented experiment, the results of which may be kept secret by the vendors.

If you're desperately ill or critically injured, you need a doctor, not a computer. Your doctor needs to be able to keep his records in a way that works for him, and to choose his own tools, computers included.

[* We've found that good memories that can keep track of tests do not prevent unnecessary tests when they are free of significant co-payments.]

Additional information:

"The Syndrome of Inappropriate Overconfidence in Computing: An Invasion of Medicine by the Information Technology Industry" by Scot M. Silverstein, M.D., J Am Phys Surg, Summer 2009.

"EMR: A Nonconsented Experiment," AAPS News, July 2008.

Please send suggestions for other mythbusters to

Read this and other Myths at

Medical Myths originate when politicians practice medicine.

Medical Myths disappear when Doctors are in charge of the practice medicine.

Medical Myths also disappear when Patients have significant co-payments on every test.

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7.      Overheard in the Medical Staff Lounge: Are Co-payments Cost Effective?

Dr. Rosen: We have shown how to reduce health insurance costs by 30 or more percent.

Dr. Ruth: How so?

Dr. Rosen: We've been conducting a clinical study in my office which isn't double blind but I still think is valid.

Dr. Milton: I think clinical studies and just plain clinical judgment are valid more often than not.

Dr. Ruth: Exactly, what kind of clinical studies are we talking about?

Dr. Rosen: Clinical cost controls projections and measurements.

Dr. Milton: I think I've been doing clinical studies similar to yours, thinking about the last time we discussed this. If this test would have a 30 percent co-payment, would you still want it since it's relatively unrelated to your health or disease?

Dr. Rosen: We've found that the 30 percent co-pay for outpatient work is the point at which unnecessary tests are cut off but important tests are still done, which means that the patient thinks that a cost of 30 percent is beneficial enough to warrant the cost. In other words, all necessary tests are still done and personal healthcare does not suffer.

Dr. Patricia: Why don't you do a real double-blind study so it will be valid?

Dr. Rosen: No one has quite figured out how to do a double-blind, cost-control study. It is impossible to blind the cost of a test or an x-ray or a medication.

Dr. Patricia: Do medications have a co-payment? I thought labs and x-rays don't.

Dr. Rosen: In our study, we have also found that a 30 percent co-payment on medications is also the most cost-effective co-pay with no loss of quality.

Dr. Ruth: Don't you still have to still police generic versus proprietary medications?

Dr. Rosen: In our study, we found that the 30 percent co-payment on medications will in 90 percent of cases cause the patient to voluntarily buy generics rather than proprietary.

Dr. Yancy: It seems to me if proprietary medications are covered by insurance, that everybody will get the proprietary.

Dr. Rosen: But you have to remember with 30 percent co-pay, proprietary drugs will be more than twice the cost of generics.

Dr. Yancy: How can that be?

Dr. Rosen: I know it's difficult to think of having the patient in charge and making choices based on market costs, but patients, rich and poor will both be driven to the generics since co-payments of 30 percent of proprietary may be less than half or a third of the 30 percent co-payment of proprietary medications.

Dr. Yancy: What sleeight of hand are you talking about?

Dr. Rosen: Let's use Lipitor that has a price of about $120 for a month's supply. Another statin is on the $4 list at Costco, Wal-Mart, Sam's Club, and Target, or $10 for a three-month supply. So the co-pay on Lipitor would be $36 per month (30% of $120) or $108 for a three-month supply. A co-payment on Zocor is $3 for a three-months supply (30% of $10).

Dr. Ruth: That really clinches your argument, doesn't it? I don't think I've ever heard it explained so lucidly. I would agree that more than 90 percent of patients would buy generic voluntarily and make that decision at the pharmacy. Amazing, and no government or insurance forcing the issue.

Dr. Milton: And no pharmacists calling back to say the patient wants an alternate cheaper drug. That should save me at least an hour a day.

Dr. Rosen: The main point that still has to continually be made, or the public won't understand, is that this simple maneuver has saved 97 percent of that prescription cost without any government, Medicare or insurance mandate.

Dr. Ruth: That should be a no-brainer, even for a Congressman or Senator. Even for those that have worked very hard for that recognition.

Dr. Yancy: We all know it's much harder to hoodwink the public and get into the Senate than to become a Brigadier General.

Dr. Dave: But not a Brigadier General with Southern courtesies when addressing a Lady as "Ma'am."

Dr. Yancy: Even a Senator who's not a Lady.

Dr. Milton: Rosen, getting back to cost comparisons that patients make, I think you've made the same comparisons with laboratory tests and x-rays, haven't you?

Dr. Rosen: Today, the tests doctors order do not have a co-payment. So the patient's appetite is rather huge. They have no comprehension that the tests they want or their spouse wants or their kids want may cost a hundred dollars, a thousand dollars or even more. But if they had to pay the same outpatient co-pay rate of 30 percent, they have an immediate recognition of costs and an immediate cost-control attitude without any force from Medicare or the insurance plan. In our experience, this would save more than 50 percent of healthcare costs.

Dr. Patricia: Then why doesn't Congress implement this?

Dr. Rosen: Government doesn't have any basis for making business decisions. Government can only make political decisions. What will it take to survive the next election and get re-elected? Nothing else really matters.

Dr. Milton: Since their vote is always with their constituencies in mind, and our citizens are increasingly looking out only for themselves, there can be no improvement in our country, and bankruptcy is the ultimate end. How many generations downstream can the politicians borrow from?

Dr. Rosen: What a juvenile attitude.

Dr. Milton: I think William Golding wrote a book on what happens when juveniles run the kingdom.

Dr. Rosen: Yes, Lord of the Flies was very illuminating about human nature.

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

Dr. Michael Champeau writes about Tom Daschle's book on health care reform in the Spring issue of the CSA Bulletin.

. . . while casting about for a worthy subject, I was intrigued when a friend suggested that I review former senator Tom Daschle's 2008 book on healthcare reform, Critical—What We Can Do About the Health-Care Crisis. . .  The idea presented a serendipitous opportunity to get inside the head, so to speak, of the incoming Secretary of Health and Human Services, the man tapped to lead the Obama administration's attack on the nation's healthcare woes. At the time, it seemed that Daschle's perspective on healthcare reform might be of legitimate interest to the membership.

I therefore read Senator Daschle's book, dutifully taking some eight pages of notes in the process, so as to accurately report my findings. Some of what I read was to be expected, some was [disconcerting], some insightful, and some just plain interesting. Unfortunately, on the very day I finished reading the book, Daschle's own ship ran aground when his failure to pay a portion of his income taxes came to light. Apparently Senator Daschle's enthusiasm for taxing the population didn't extend to his personal situation. Suddenly stranded with a deadline and a dead line of reasoning for my essay, I was struck by the irony of the reformer falling victim to the same human foible he blames for our healthcare woes: greed. . . 

Basically, Daschle's take is that America's healthcare system is fundamentally flawed, and although those in government know this, they are politically incapable of making the required changes. . .

Final Thoughts

. . . the book offers an easy peek inside the head of one of our nation's chief political thinkers on healthcare issues. There is much to like, and much that causes concern. While I could barely restrain my glee with his statement that "the savings we seek will come out of executives' salaries and companies' profits," I was disheartened to learn that the author is completely oblivious to the grossly inadequate payments paid to physicians by the governmental programs. Ironically, these underpayments are a direct cause of the cost shifting he so abhors. His view of the Medicare and Medicaid programs as perfectly acceptable forms of healthcare coverage unfortunately reveals his ignorance of an important aspect of the American healthcare landscape.  Daschle's book is an easy and interesting read and should be available soon in paperback. Now that his career in healthcare reform is over . . . it's never a bad idea to see how these guys in Washington think.

To read CSA President's entire review, please go to

VOM Is Where Doctors' Thinking is Crystallized into Writing.

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9.      Book Review:  Terrorism before 9-11-2001

BIOTERRORISM: How You Can SURVIVE by Russell L Blaylock, MD, Physicians Preference, Inc, ( 1–877-351-0593, 36 pp, $10

Bioterrorism took front and center stage in October 2001 only a month after the terrorist attack on the World Trade Center and the Pentagon. But acts of terror have been present in the United States for more than 15 years, e.g. the intentional Salmonella contamination in Oregon in 1984, and the Shigella contamination in a hospital in Texas in 1996.

The Soviet program, under the aegis of Biopreparate which at its height employed more than fifty thousand scientists and technicians in over forty research and production facilities, was allegedly dismantled by Yeltsin in 1989. The resulting diaspora of tens of thousands of highly trained bioweapons personnel left many wondering: where are these people now and what are they doing?

In 1998, Robin Cook, MD, points out in the "author's notes" of his medical novel, Vector, (Penguin Putnam, Inc, © 1999) that much of what his characters say about bioweapons and bioterrorism is true. He documented the sources of his information, as he frequently does, with key references. He stated that it is not a question of whether a major bioterrorism attack in the United States will occur, but only a question of when. Three years later in October 2001, Anthrax spores were indeed sent by mail just as Robin Cook predicted. With a few dozen envelops, terrorists in this country have demonstrated that almost anyone can be reached. As a result, three people have died and forty-one have been confirmed infected.

The hospitals in the Sacramento area had bioterrorism as a topic for their grand rounds within weeks. Medical societies had terrorist workshops within the first few months.

The Mayo Clinic sent an Health Information Bioterrorism Alert within a month of the Anthrax scare outlining the threat of Anthrax, Botulism, Small Pox, Plague, Tularemia, Viral Hemorrhagic fevers, as well as chemical weapons such as the sarin gas in Tokyo, with mustard gas, chlorine, phosgene and hydrogen cyanide gases. However, it minimize the risks as stating that these weapons are difficult to control once released and the risk to most Americans has been considered low.

Bioterrorism: How you can survive is a privately published and timely work by Russell L Blaylock, MD, a neurosurgeon. It was published just after the biologic terrorism of October 2001 and gives a fresh presentation of facts as well as a hopeful perspective. The public in general does not see the terrorist network as a unified enemy, but rather as small groups of disgruntled, poorly educated impoverished bands of nutcases who can periodically cause nasty things to happen and are no real danger to the powerful West. The fact that terrorist organizations appear so dispersed and disjointed is not a weakness but a strength and makes the counterterrorist's job that much more difficult. Many terrorism experts have stated on television that biological agents are too difficult for the average terrorist to dispense. University medical specialists in infectious disease who were interviewed on television news had no expertise in weaponized biological agents and merely described naturally occurring disease. One even assured the audience that anthrax would not make a good terrorist weapon.

But Blaylock quotes Dr Michael Osterholm, author of Living Terrors, who points out that there are numerous compact aerosol devices available in medical supply and hardware stores that efficiently dispense these biological weapons inexpensively. Even a simple humidifier was very efficient in dispersing test organisms over a wide area. The effectiveness of bioweapon killing power is illuminating by this comparison: In order to kill everyone in a square kilometer, conventional weapons would cost about $2,000, nuclear $800, nerve gas $600, and biological weapons $1. Research has determined that new and used crop dusting airplanes, which can spray both dry and wet materials, can be purchased over the internet with no questions asked. The buyer and seller never meet. As Major General Marshall Stubbs warned in 1986, an enemy with only ten aircraft with dry biological material such as anthrax or plague, could kill or incapacitate 70 million Americans.

Other bioweapons such as smallpox, plague and ten or more others, which we are inexperienced to defend against are chosen by terrorists for that very reason. Vaccines are very specific and will not protect us against the large number of microorganisms that have been weaponized. Blaylock outlines the basic care we should follow in case of exposure bringing us back to America's frontiers of yesteryear. He also recommends use of nutritional supplements and dietary modifications to protect ourselves and our loved ones against bioterrorism, as well as what we should keep in our emergency supply chest. In case of onset of actual disease, he outlines a program of maximizing normal body defenses.

Blaylock points out the pitfalls of much of what is stated by experts and the media. The terrorists not only want to kill us, but also destroy our economy. Just as the destruction of the world trade center killed 3,000 people, it also put over a million people out of work. Blaylock reminds us that terrorism is not an end in itself. Initially it was used to get the media's attention, make demands, and change our foreign policy. Then the terrorists destroyed property and blew up airplanes, ships, marine barracks, and embassies. As the level of violence increased, the demands became fewer. Now they are seeking a world socialist government ruled by terrorist elite, under the guise of Islamic fundamentalism. As their writings and speeches proclaim, the new goal is the total destruction of the West, Christianity, and capitalism. Nothing less will be accepted.

Joseph D Douglass, Jr, PhD, coauthor of America the Vulnerable: The Threat of Chemical and Biological Warfare and CBW: The Poor Man's Atomic Bomb states in his introduction that Blaylock's book is the best on the problem of biological warfare he has read in over 30 years. He surmises that we have just seen the initial warning of terrorist attacks; escalation can come in almost any form.

If the limited attack through the mail system with three fatalities and forty-one infected can overwhelm the capabilities of our CDC to its breaking point according to its chief, what will happen in a real terrorist attack affecting thousands and millions? Blaylock's pamphlet is literally packed with information that every physician and every family should read and study before it's too late. It will depend on the information that's given in this book for us to survive. . .

To order Bioterrorism: How You Can Survive call toll free 1-877-351-0593.
Price per copy (when this was posted) was $10, which included shipping and handling.

To read the entire book review, including the Table of Contents . . .

To read more book reviews . . .

To read book reviews topically . . .  

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10.  Hippocrates & His Kin: Only in Government can workers add $100K by Retiring.

Looking at Sacramento County's rising personnel costs

The lowest paid full-time employee - an entry-level food service worker - made about $29,000 a year.
The median salary for all employees was about $54,000 in base wages.
The median gross salary was about $61,000.
Most overtime for a single employee: $57,434.
Highest base salary: $260, 312.
Highest Gross Salary: $374,058 (for a retiree who cashed out accrued sick leave, holiday and vacation pay).

Where, except in a government out of control, can anyone make an extra $100,000 by retiring rather than working full time?

Maybe at GM (Government Motors).

Government Largess

The U. S. Government hands out $4 Billion in grants each year.

How about reducing taxes by $4 Billion?

America's World Class Pharmaceutical Retail Industry

Look at Wal-Mart, Costco, Sam's Club, and Target that have cut nearly 500 medications to one-tenth (Prilosec was $5 a capsule, the generic Omeprazole is 50 cents) and some to one-hundredth of their previous price (Claritin was $4 a capsule, the generic Loratadine is four cents) by competing in the private arena. The lawmakers in Washington spend years on how to cut drug costs by 10% by force, yet private enterprise can cut them by 90 percent or so without coercion. Doctors competing in the private arena would also reduce their costs and their charges as their expenses decreased. Doctors that limit their practice to cash or credit cards have already decreased their fees by one-third to one-half to reflect the absence of billing, insurance and business office costs.

The answer to cost control in health care is to eliminate government interference.

Doctors Maligned.

Doctors on the whole desire to cure the sick, and - if they are good doctors and this choice were fairly put to them - would rather cure the patient and lose their fee than lose the patient and get their fee.                                                                                                                                        - John Ruskin

Doctors are not the only ones Maligned, many businesses are destroyed by Government Mandates.

California has a mandate for gas stations requiring them to install new gas-dispensing nozzles to capture 98 percent of the vapor emissions instead of the current 95 percent. California has about 10,000 gas stations operating with one-third out of compliance with the California Air Resources Board (CARB). The legislature assured the operators they would be sensitive to loss of jobs and businesses. The CARB would be flexible. However, fines in the first few months approached $1 million - 64 stations have closed; 149 are on the brink of closure. (Carmichael Times May 12, 2009)

Doctors beware: Bureaucrats love their power and they will get even more intoxicated by closing medical practices that don't follow government mandates starting in 2010. Killing physicians professionally is higher up on the bureaucrat's promotion scale that service station owners.

To read more HHK . . .

To read more HMC . . .   

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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 on how Canadian public figures opt out of Canadian Medicare when they personally experience Cancer. They know the government healthcare waiting list is a death knell. . .

                      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. Be sure to read Sally Pipes analysis of Romney's Massachusetts Healtcare Disaster. . .

                      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, prepare for the flu pandemic . . . 

                      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. This month, read their letter to Leaders of Congress concerning healthcare reform . . .

                      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 How Americans Really Feel about Healthcare Reform . . . or gain insight into the Massachusetts' Health Reform Plan: Miracle or Muddle?

                      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. Greg has joined the Heartland Institute, where current newsletters can be found.

                      The Heartland Institute,, Joseph Bast, President, publishes the Health Care News. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care? This month, be sure to read the Overview of Healthcare Policy . . .

                      The Foundation for Economic Education,, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling, PhD, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. Having recently celebrated America's Independence from King George, be sure to read the current article on how America has embraced a system of criminal law that King George himself would have decried as tyrannical and unfit for any Englishman. . .

                      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." Be sure to read what happened to Tennessee when they tried to implement universal healthcare through TennCare . . .

                      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. Read her latest Blog on how Colorado wanted to give Medicaid to All, when most doctors won't see Medicaid Patients because reimbursement is below costs. . .

                      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, enjoy THE EMPEROR'S DERRIÈRE . . .

                      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. This month be sure to read: U.S. medical bankruptcies a myth; personal bankruptcy rate higher in Canada.

                      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. Also beware of what appears to be Mitt Romney running for the presidency in 2012 which would be another healthcare disaster.

                      The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at to obtain the foundation's daily reports. You may also log on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to be an MD today. Treat yourself to an alternate point of view on Bernie Madoff . . .

                      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 Read his current take on health care reform . . .

                      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 the current issue at The last ten years of Imprimis are archived.

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Del Meyer

Del Meyer, MD, Editor & Founder

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Words of Wisdom

Did you know that lobbyists outnumber our Senators 74 to 1?    Boyd's Grab Bag

Professionals least likely to abandon their careers for other lines of work are doctors, lawyers, dentists, pharmacists, architects, engineers and physicists. Research suggests that bill collecting is most likely to be abandoned. One debt detective said, "I couldn't make enough money, so quit when I was inadvertently assigned to go after myself."  L. M. Boyd

If you don't stand for anything, you'll fall for anything.         

Some Relevant Postings

Why Does California Want a Third World Health Care System? By David Gibson, MD

Bird Flu And Illegal Aliens by the late Madeleine Pelner Cosman, PhD, Esq

Politicians Cannot Manage a Health Care System By David Gibson, MD

Emergency Medical Treatment And Labor Act by the late Madeleine Pelner Cosman, PhD, Esq

In Memoriam

Daniel Carroll (Danny La Rue), female impersonator, died on May 31st, aged 81

From The Economist print edition, Jun 11th 2009

HE WAS tall, dark and handsome, with broad shoulders and a crushing handshake. His turned-up nose once annoyed him so much that for a while he slept with a peg on it. He could growl "Ol' Man River" like Harry Belafonte, and once defended the honour of Barbara Windsor, a well-endowed Cockney comedienne, by socking a man on the jaw. On board ship, no storm ever bothered him; he was practical and calm, even when pianos toppled and chinaware smashed all round him.

She was tall and handsome also, but there the resemblance ended. Her hair was blonde, brunette, raven-black, silver minx, as the mood took her. However coiffed, she looked stunning. Fabulous loops of glitter-beading hung from her arms; sun-bursts of diamanté snaked round her hips; fluorescent feather-boas kissed her neck. One day she was Marlene Dietrich in a silver sheath, the next Joan Collins in a deep blue gown, the next Carmen Miranda, in nine-inch platform shoes and with three tons of fruit on her head. She was probably never more herself than when descending the grand staircase at London's Palace Theatre, where she played for two unbroken years, with huge pink plumes bobbing on her head and 20 feet of ostrich feathers slithering behind her.

He was well-mannered and rather shy, schooled in respect by his Irish mother and reinforced in fatalism by his fervent Catholic faith. Hard work was his cardinal virtue; in 50 years of cabaret, theatre and music hall he never missed a show. She was a lady of leisure who, under her inimitable elegance, could be lewd, rude and blue. He called her a tart, which she was. In fact, a whole array of tarts: Nell Gywnne, Lady Hamilton, Cleopatra (to tiny Ronnie Corbett's Caesar). She was Lady Cynthia Grope, political hostess ("Life's better under the Tories, and I should know"), as well as "the girl with a little bit more". Nudge, wink. What she could never be was ugly, clumsy, or just a man in drag.

His beginnings were clear enough: born in Cork, brought up in Soho, undistinguished schooldays, a wartime in the navy. Hers were more misty. She emerged in Juliet at school, with a costume of coloured crepe paper, and then in a navy production of "White Cargo", a pouting beauty wearing nothing but a tan and a sheet she had pinched from the officers' quarters. Once out in public, she caused a sensation. Bob Hope called her the most glamorous woman in the world. Ingrid Bergman said no one could walk down a staircase like her. From 1964 to 1973 her allure alone packed out his night club in Hanover Square with Hollywood stars and the crowned heads of Europe. Women deluged her with requests for advice on how to move, how to stand and what to do with their hands. Every woman longed to look like her (he said), but didn't dare.

In certain ways, their characters coincided. Both knew they were stars, no question. Both adored clothes. As a child, he once laid newspaper down the street to keep his new shoes clean. In the navy, lined up on his ship with 1,199 other seamen in pure white, he affected navy and white because it looked nicer. He could happily have stayed as a window-dresser at J.V. Hutton's General Outfitters (Exeter and London), but the limelight called him, as it did her.

Lace and jockstraps

Looking fabulous was all her money was for. A cool £10,000 was budgeted for her frocks at the Palace, and £30,000 when she played Widow Twankey in "Aladdin". One mirrored train cost £7,000; one wrap involved £8,500-worth of fox-fur. He spent his earnings on houses, a stately home with 76 bedrooms, a Rolls Royce and fine porcelain. Fire, and a fraud into which he innocently stumbled in 1983, destroyed almost all he had saved for. He started again, doggedly doing the rounds of clubs, pier-ends and provincial theatres, the outposts of a disappearing world.

Over half an hour each night in the dressing room, he slowly became her. First, a shave (the face only, leaving a touch of stubble for shading; his legs he left alone). Then the pan make-up, powder on face and eyes, mascara and false lashes. Her foam-rubber bosoms were built into each dress; more pan-stick painted a cleavage. "I can hang my tits up when it's hot!" she once boasted to another envious girl. Last came the wig, made especially for her. . .

He was the person, he always said. She was the illusion. In practice, it didn't seem quite as simple as that.

Read the entire obit at


Rex Features

Rex Features


On This Date in History - July 14

On this date in 1789, the French stormed the Bastille prison in Paris during the French Revolution. Today, Bastille Day is a French national holiday. It started as a great victory for the rights of man but it also produced the infamous Reign of Terror.

On this date in 1913, President Gerald Ford was born. Sometimes a person's place in history is secured by accident as much as of what he does by design. He was a President who came to office in a time of crisis precipitated by an absolutely unprecedented series of events. Gerald Ford was not elected President by the people; he wasn't even elected Vice President. He was the Republican minority leader in the House of Representatives when the then Vice President, Spiro Agnew, pleaded no contest to charges of falsifying tax returns, was fined and resigned his office in October 1973. Two days later, Gerald Ford was nominated by President Nixon to fill Agnew's term. On Dec 6, 1973, he was confirmed as Vice President by both Houses of Congress. Nine months later, Nixon himself resigned after the Watergate impeachment hearings and Gerald Ford found himself President of the United States.

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 which is in progress. 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."
For more information visit or to view the trailer, go to or email