Community For Better Health Care

Vol IX, No 5, June 8, 2010


In This Issue:

1.                  Featured Article: Alzheimer's: Forestalling the Darkness with New Approaches

2.                  In the News: The Rise of the Part-Time Smoker

3.                  International Medicine: Waiting for New Medicines in Canada

4.                  Medicare: "Risk-based pricing" vs. "Guaranteed issue"

5.                  Medical Gluttony: Starts with the political climate in each state

6.                  Medical Myths: U.S. should join the march to coercive, state-funded medicine

7.                  Overheard in the Medical Staff Lounge: Whistle Blowers

8.                  Voices of Medicine: We have mandatory free "health care for the universe."

9.                  The Bookshelf: The Innovator's Dilemma by Clayton Christensen, MBA, DBA

10.              Hippocrates & His Kin: Failure to brush teeth twice a day increases risk of heart disease

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 7th Annual World Health Care Congress was held April 12-14, 2010 in Washington D.C. For more information, visit The future is occurring NOW. 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: Alzheimer's: Forestalling the Darkness with New Approaches

Interventions before symptoms appear could be key to slowing or stopping the leading cause of dementia. By Gary Stix, From the June 2010, Scientific American Magazine

Key Concepts

·                     The incidence of Alzheimer's disease continues to rise as the population ages, but effective treatments are lacking.

·                     Some new drugs may have failed because they were tried too late.

·                     New techniques to track the disease before symptoms arise may allow testing of drugs at a stage when they may be more effective.

In his magical-realist masterpiece One Hundred Years of Solitude, Colombian author Gabriel García Márquez takes the reader to the mythical jungle village of Macondo, where, in one oft-recounted scene, residents suffer from a disease that causes them to lose all memory. The malady erases "the name and notion of things and finally the identity of people." The symptoms persist until a traveling gypsy turns up with a drink "of a gentle color" that returns them to health.

In a 21st-century parallel to the townspeople of Macondo, a few hundred residents from Medellín, Colombia, and nearby coffee-growing areas may get a chance to assist in the search for something akin to a real-life version of the gypsy's concoction. Medellín and its environs are home to the world's largest contingent of individuals with a hereditary form of Alzheimer's disease. Members of 25 extended families, with 5,000 members, develop early-onset Alzheimer's, usually before the age of 50, if they harbor an aberrant version of a particular gene. . .

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2.      In the News: The Rise of the Part-Time Smoker

The New Smoker, Who Lights Up Only Intermittently, Needs New Strategies to Learn to Quit

By MELINDA BECK, WSJ, January 12, 2010,

It's tough to be a hard-core chain-smoker these days.

Half of the U.S. population lives in areas where smoking is banned in workplaces, bars and restaurants.

More than 70% of Americans don't allow smoking in their homes, including about half of current smokers.

Taxes have pushed the cost of smoking ever higher ($10 per pack in New York City) and the social costs - in disgusted looks and lectures from friends and family members - have escalated too.

Such inconveniences are forcing a sea change in smoking habits and upending traditional approaches to smoking cessation. For one thing, there's a growing group of intermittent and secret smokers who seem to smoke as much for psychological and emotional reasons as nicotine addiction. In addition to breaking the physical addiction, smokers who want to quit today need to understand why, when and where they smoke, and challenge some of the thinking that goes along with it, cessation experts say.

" 'Sneaking one in' has become a smoker's pastime and avocation," says Timothy Stephens, a 40-year-old Manhattan lawyer who started smoking cigarettes in high school when he played a Jet in "West Side Story." Nowadays, with a wife and baby, he doesn't smoke at home. He takes five-minute smoking breaks outside his office building ("four minutes if it's cold") and he drives to work from the suburbs instead of using public transit so he can get more smoking in.

Even though the percentage of American adults who smoke has stalled at about 20% in recent years, smokers are smoking fewer cigarettes than they used to (an average of 13 per day, down from 21 in 1980). And a growing proportion of smokers - roughly 25% - don't smoke every day. One government study found that half of American smokers either don't smoke daily or smoke fewer than six cigarettes a day.

Researchers used to think light and intermittent smoking was a transitional phase for smokers on their way to quitting or ramping up to a more serious habit. But a few recent studies suggest that it's a new, stable pattern, particularly among young, college-educated smokers. An analysis of smoking patterns during the 1990s, published in the journal Nicotine & Tobacco Research last year, found that 18-to-29-year-olds were twice as likely as those aged 50 to 64 to be nondaily smokers. Many experts expect that pattern to continue. "Young people who have grown up with a smoke-free home, school and workplace environment may stabilize at a much lower dependence level than those without such restrictions," the researchers wrote. . .

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3.      International Medicine: Access Delayed, Access Denied:

Waiting for New Medicines in Canada 2010

Authors: Brett J. Skinner, Mark Rovere Frasier Institute, March 17, 2010 

Executive summary

This is the Fraser Institute's fourth annual report on the amount of time patients must wait for access to new medicines in Canada. The 2010 edition of this study uses the most recent data available, covering the years 2004, 2005, 2006, 2007, and 2008. This edition replicates and adapts the method previously used by Skinner et al. (2007) and Skinner and Rovere (2008a; 2009) to estimate the total amount of time patients must wait for access to new patented prescription medicines in Canada. Like the 2009 report, this edition focuses narrowly on the wait for access to new drugs classified by Health Canada as new drug submissions (NDS) and excludes supplemental new drug submissions (SNDS).

The purpose of this report is (1) to draw attention to the impact that Canadian public policies and institutions have on lengthening the time it takes before patients have access to newly invented, patented prescription drugs; and (2) to offer alternative policy options that could improve access to new drugs in Canada.

Access delayed

After a new drug is developed and ready for use by patients, various government policies extend the time that patients must wait for access to it. An estimate of the total additional time that Canadians must wait for access to new medicines because of government policies and institutional performance can be calculated by adding: the national delay the time spent waiting for Health Canada to certify the safety and effectiveness of new drugs and approve them for use in Canada; and, the provincial delay the time spent waiting for provincial drug insurance programs to approve the public reimbursement of new drugs.  Figure 1 shows the consolidated average wait time for access to new medicines in Canada, broken down by each of the two segments described above.  This wait time is measured in days and is presented as a weighted average for pharmaceutical and biological drugs, including all new drugs classified by Health Canada as new drug submissions (NDS) and excluding supplemental new drug submissions (SNDS).

Access denied

Despite improvements in the speed at which decisions are made about national and provincial drug approvals, most of the drugs that are approved by Health Canada as safe and effective are not declared eligible for reimbursement under provincial drug plans. Averaged across all provincial public drug programs, as of December 31, 2009, only 23.0% of all drugs that Health Canada approved as safe and effective in 2004 had actually been approved for reimbursement (fully or partially) by the provinces; compared to 16.2% of new drugs certified in 2005, 28.0% of new drugs certified in 2006, 19.1% of new drugs certified in 2007, and 20.3% of new drugs certified in 2008.

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

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

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4.      Medicare: "Risk-based pricing" vs. "Guaranteed issue"

ObamaCare Could Punish You For Being Healthy by David Whelan, Forbes, 06.12.09

Will smokers and marathon runners pay the same?

In the 1970s HMOs started the rather innovative concept of pricing health insurance on the basis of an individual's health. This "risk-based pricing" means that if you treat your body like a temple you pay less for health care than your counterpart who overeats and smokes a pack a day. Even as HMOs came to be reviled, this practice continues in 45 states . . .

In California, a risk-rating state, you can get basic coverage for under $100 a month if you are male and in your 20s with no red flags in your chart. A quick search on eHealth's ( EHTH - news - people ) Web site found numerous plans for non-smoking males born in 1981. One high deductible PPO plan is offered for $49 a month from Health Net ( HNT - news - people ).

Now do the same experiment in New York, which has "guaranteed issue," much like ObamaCare will have. The same 28-year-old male will have to pay $150 for a hospital-only indemnity Blues plan. And HMO policies with high deductibles start in the $300 to $400 a month range. That's because plans in New York are priced with the assumption that you must be sick or you wouldn't need health insurance.

Risk-based health insurance pricing is not all sunshine and rainbows. Breast cancer survivors, juvenile diabetes patients and accident victims have trouble even getting a quote in risk-rating states like California and Illinois. An estimated 10% of individual applicants are turned down. The insurer of last resort—the state-run high-risk pools that exist in about 30 states—are known for their long wait lists and expensive premiums. (For example, the California high-risk pool offers a Blue Shield plan for a 60-year-old that's $1,611 a month.)

Supporters of guaranteed issue argue that it will improve the market for people with pre-existing conditions and, when combined with a mandate that everyone must buy insurance, eliminate the problem of the insurance pool only attracting sick patients. This argument makes sense, yet the structure would still create a system where compliant, responsible patients are subsidizing those who don't take care of themselves. The perverse incentive would still exist.

The insurance industry, in failing to make sure that "innocent" patients with pre-existing conditions can get affordable individual health insurance on the open market, has in a way brought reform upon itself. That may be why the HMO lobby, America's Health Insurance Plans, grudgingly conceded, right after Obama won the election, that it would accept legislation that included "guaranteed issue."

But, says Wharton's Harrington, if you remove incentives to stay healthy, health reform could miss the mark. As health diminishes, costs will rise, and scarce resources will be run through more quickly. Reformers, for all their trouble, could get a decrease in health and a decrease in health care, while trying to accomplish the opposite.

Read the entire somewhat dated but relevant article in Forbes . . .
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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: Starts with the political climate in each state

There is no limit on Politicians spending Taxpayers dollars.


Governor of California is jogging with his dog along a nature trail. A coyote jumps out and attacks dog.

1. Governor starts to intervene, reflects upon the movie "Bambi" and then realizes he should stop; the coyote is only doing what is natural.

2. He calls animal control. Animal control captures coyote and spends $200 testing it for diseases and $500 upon relocating it.

3. He calls veterinarian. Vet collects dead dog and spends $200 testing it for diseases.

4. Governor goes to hospital and spends $3,500 getting checked for diseases from the coyote and on getting bite wound bandaged.

5. Running trail gets shut down for six months while wildlife services conduct a $100,000 survey to make sure the area is clear of dangerous animals.

6. Governor spends $50,000 of state funds implementing a "coyote awareness" program for residents of the area.

7. State legislature spends $2 million investigating how to better handle rabies and how to possibly eradicate the disease.

8. Governor's security agent is fired for not stopping the attack and for letting the Governor intervene.

9. Cost: $75,000 to train new security agent.

10. PETA protests the coyote relocation and files suit against the state.

New York:

Governor of New York is jogging with his dog along a nature trail. A coyote jumps out and attacks dog.

See answers 1-10 above


Governor of Texas is jogging with his dog along a nature trail. A coyote jumps out and attacks dog.

1. Governor shoots coyote and keeps jogging. Governor has spent a dollar on a .45 ACP hollow-point cartridge. Buzzards eat dead coyote.


Governor of Nevada is jogging with his dog along a nature trail. A coyote jumps out and attacks dog.

1. Governor shoots coyote and keeps jogging. Governor has spent a dollar on a .45 ACP hollow-point cartridge. Buzzards eat dead coyote.

What is the Moral of this Story?

Which state is the safest? Which state is the most unsafe?

Which state has the leanest cost of government? The most bloated government?

Which 7 states have no income taxes? Alaska, Florida, Nevada, South Dakota, Texas, Washington, and Wyoming.

Which 9 states don't double tax Federal Income Taxes? (No Taxes on Taxes - all taxes are deducted from income before other taxes are applied) Alabama, Iowa, Louisiana, Missouri, Montana, North Dakota, Oklahoma, Oregon and Utah 

Which 27 states allow for full deductions for social security benefits? Alabama, Arizona, Arkansas, California, Delaware, Georgia, Hawaii, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Virginia and Wisconsin

Which states tax SS benefits that are the result of other taxes previously paid and thus are double taxed? (Hey! this is simple arithmetic.)

Which states are growing?

Which states are losing population so taxes are raised on those that stay?

Need any help with the answers?

Ever wonder why some states are going broke?

Should we shoot all the lawmakers? (After Shakespeare)

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Gluttony thrives in Government.

It Disappears with Appropriate Responsibilities.

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6.      Medical Myths: It is past time for the U.S. to join the march to coercive, state-funded medicine.

Myth 23. Private insurance and self-payment are relics of an oppressive past, confined to the United States and backwater, poorly developed nations.

We constantly hear that the United States is the only nation in the "developed," or "industrialized" world (we no longer say "civilized" world or "free" world) that doesn't have taxpayer-funded medical care for all.

It is therefore past time for the U.S. to relinquish the traditional idea that "the voluntary way is the American way" and join the "progressive" march to coercive, state-funded and state-directed medicine—as instituted by Chancellor Otto von Bismarck in Germany in 1884. These days, the state-owned variant, adopted by Britain in 1948 based on a model developed by Lenin in 1911, is considered "politically unfeasible" in America.

We need to give up our own perception of having the best medical care the world has ever known (in the eyes of individual American citizens and foreign visitors) and aspire to move from the 37th position closer to the 1st position held by France in 2000 (in the eyes of the World Health Organization, which prefers equal misery to unequal blessings)—or so say advocates of "reform."

Meanwhile, countries outside the U.S. are moving away from failing single-payer systems. "Health insurers worldwide added over 100 million covered lives in 2008 in one of the strongest markets since health insurance was invented in 1880s, according to official government statistics" (HealthPlanWire 8/24/09). The number is projected to exceed 1 billion by 2012.

Single-payer systems are declining because they are based in countries with static or declining populations—many of which are also adopting market-based reforms. Private insurance is growing rapidly in countries with the fastest growing populations. Building a health financing system for the first time, countries on five continents are choosing the private way. Examples include China, South Africa, Mexico, India, Australia, and most of Eastern Europe. But in at least 25 of the 125 nations with national health systems, private insurance is growing faster than the government-run system (ibid.).

Democrat-proposed reform plans would restrict out-of-pocket payment for "covered" services—while U.S. patients already have the lowest out-of-pocket costs (OOP) as a percentage of total national health spending of any developed country except France, Luxembourg, the Czech Republic, and Ireland. They are even lower than in Canada. OOP spending in the U.S. represented about 60% of real per-capita spending on medical care in the U.S. in 1960, and dropped to 10% by 2002. This surely has a lot to do with escalating costs. But Democrat reformers would eschew financial incentives to patients in favor of "health information tools" enabling payment denials right in the doctor's office (Scott Gottlieb, Wall St J 8/15-16/09).

A few facts about private insurance and self payment in nations with national health systems (Gregory Dattilo and Dave Racer, Your Health Matters, Alethos Press; 2006):

Health Canada pays about $1 billion for services purchased in the U.S. because of a shortage of facilities in the country. It is not known how much Canadians spend abroad beyond this amount.

In the UK, 13% of its residents own private insurance, enabling them to bypass waiting lists.

The Japanese face a coinsurance cost of up to 30%, and pay an average of 44% of employer-based premiums. Childbirth, check-ups, vaccines, and prosthetics are not covered. The maximum OOP for a Japanese worker, if copied in the U.S., would expose the average worker to a potential health cost exceeding 50% of his disposable income. Japan relies largely on market forces to restrain expenditures.

About 85% of French citizens buy private supplemental insurance. Because of escalating costs, the government increased co-payments to as much as 30% to 40%.

Germany is the only [European] country where high-income people, self-employed, and civil servants may opt out of the compulsory social security system and join private health insurance. (See comments by German physicians, with English subtitles, and Myth 20.)

Per capita spending rates are increasing as fast in most national health systems as in the U.S. Increases between 1990 and 2003 were: U.S., 28%; Germany, 30.5%; France, 17.4%; Canada, 10%; Japan, 33%; and England, 28%.

The French system, held up as the example now that Canada and Britain have lost appeal, is also in trouble. "Citizens must pay more and doctors must alter their behaviour" said a government-commissioned report (BBC News 1/23/04). In 2009, the total cost of the system, from employee and employer combined, is more than half the worker's wages (Investors Business Daily 8/26/09).

"In France, the supply of doctors is so limited that during an August 2003 heat wave when many doctors were on vacation and hospitals were stretched beyond capacity—15,000 elderly citizens died," wrote David Gratzer (ibid.).

While upcoming nations are choosing the private, voluntary path, American "reformers" are pushing for a regression to 19th century, consistently failed systems of centrally planned coercion.

Additional information:

          "Financing Free-Market Medicine, presented by Ralph Weber, C.L.U., at AAPS annual meeting 2008.

          "Socialized Medicine," by Dan Smoot, originally published in The Freeman, April 1960.

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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: Whistle Blowers

Dr. Rosen: We are hearing a lot about "Whistle Blowers" being subjected to abusive "PEER REVIEW" and losing their medical staff privileges. Is that happening in our community?

Dr. Yancy: Certainly. All the time. Confidentially, I had an episode where I blew the whistle on an incompetent surgeon and immediately became the butt of abusive Peer Review in my former hospital. I got out of there and moved to Sacramento before it went anywhere and had my privileges secured here in two hospitals, doing good surgery, before they ever found out about it.

Dr. Dave: Legitimate Peer Review became abusive when doctors, not held in favor by those in charge in hospitals, had a large number of charts put into "Chart Review" stacks for the Department Committees to review. Minor variations in care precipitated referral of these charts through the Peer Review Committee. These were run by doctors in positions of power in hospitals.

Dr. Milton: That's what was happening until recent years.

Dr. Rosen: And it was usually precipitated by good physicians and surgeons who took issue on very poor, if not dangerous care. But what was obviously below standard of care was gradually extended to minor variations in care, which actually was acceptable care.

Dr. Yancy: I was formerly a "Whistle Blower" but since I came to Sacramento, I have refrained. Blowing the whistle is much too dangerous.

Dr. Rosen: So you're saying a good physician, by helping clean out our own ranks, allowed physicians in power, who actually may not have been our best doctors, get rid of good physicians?

Dr. Yancy: Exactly. I saw a lot of poor surgery with bad outcomes in my previous hospital and I though I was doing the Peer Review Committee a favor by pointing this out and then they pounced on me. I hadn't realized that those dangerous surgeons were hospital insiders and financially important to the hospital.

Dr. Rosen: Isn't that rather like the Cardiologist and Cardiac Surgeons at the Redding Medical Center who did Coronary Artery Bypass Grafts on patients that didn't need them?

Dr. Ruth: I understand that Peer Review didn't work there because everyone knew if they interfered with this major source of hospital revenue, they wouldn't survive.

Dr. Rosen: I think that is what the "Whistle Blowers Group" is trying to highlight. Most of Peer Review these days has nothing to do with the quality of medical care. It has provided a mechanism for hospitals and the Medical Executive Committee to eliminate the competition that is perfectly legal.

Dr. Edwards: And therein, lies the crux. It is legal and thus outside the court system and lethal.

Dr. Milton: And that's a Paradox. Anyone that is seen as unfavorable to the hospital or the major groups in power can be eliminated by a chart review, a summary suspension, a Kangaroo trial and elimination from the staff.

Dr. Edwards: But it's not as simple as losing a job. This goes to the National Data Bank, which is available to all hospitals, and anyone found in the Data Bank will never get another job as a physician or surgeon.

Dr. Ruth: Isn't that why the National Data Bank is called the National Tomb for Doctors? You will never get the opportunity to practice again. Your children, spouse and family may leave, and your home and assets will be sold to pay the attorney fees and medical board fines.

Dr. Joseph: I retired from surgery just in time to avoid all this. When we saw a surgeon who we thought made a serious mistake, we talked seriously to him and he usually saw his error, apologized and offered some recompense by reporting some research on the problem discussed at another meeting. Surgical care was improved and no one got hurt, least of all patients.

Dr. Paul: I think you are all barking up a dead tree. In Pediatrics we use Peer Review but it's always pleasant and people apologize, shake hands and get back to work. It's more like a family at odds where pediatricians make up. I can't think of one of us that was ever thrown off the staff.

Dr. Yancy: How many pediatric groups do you have competing with each other?

Dr. Paul: We all share call and thus watch over each other's practice. That keeps all of us on our toes. And it also keeps us talking to each other.

Dr. Milton: I wish all Internists could get along that well. We're not all that busy and a few less would be beneficial.

Dr. Michelle: So you are thinking about being a "Whistle Blower" and get the numbers down?

Dr. Milton: I would never be involved with whistle blowing in this climate. I'd get eliminated in no time. I'll leave "Whistle Blowing" to the large societies that are doing a good job of it.

For more on Peer Review . . .

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The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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8.      Voices of Medicine: A Review of Articles by Physicians

Guest column, Dr. Alieta Eck |

As Illegals Take, Are Americans Free? By Alieta Eck, MD

Abolish Legal Plunder-End the Empire-Restore Free Enterprise

We do not have "universal health care. We have mandatory free "health care for the universe." A middle-aged woman came to our local emergency room, suitcase in tow, complaining of a severe headache and diminished vision. A CT scan of the head showed a brain tumor. The neurosurgeon on call was summoned and within days the patient had surgery to preserve her vision.  An inspiring story giving tribute to the wonderful ingenuity, generosity, and high standards in our country? There's more.

This woman knew about her brain tumor and had already had an unsuccessful attempt at surgery in her home country.  She booked a flight as a tourist, and her extended family took her directly from the airport to the emergency room. None of them had the slightest intention of paying any part of her bill. American patients, insurance subscribers, and taxpayers will subsidize the hospital, albeit inadequately.  The neurosurgeon will not get paid, but will still be fully liable for any adverse outcome in our medical malpractice environment.

For foreigners, it appears that dishonesty pays. But those who are completely honest have a harder time. The headmaster of a Christian grammar school in Liberia had an abdominal tumor the size of a football. No one in Liberia felt capable of handling such surgery so our church arranged for him to come to that same hospital in New Jersey. Since US government officials knew this man needed medical attention, he was asked to supply letters from the church guaranteeing payment for his surgery. Only then, would the US embassy give him a visa. The church, here, will fulfill its promise and pay a fair price as this is the honorable thing to do. The surgeon will be paid unless he voluntarily chooses to perform the procedure for free, and everyone is uplifted.

There will be those who say they would do anything to get medical care for a loved one. Does this mean they would steal for it? And does their need make stealing right?

Charity is a noble thing, but it cannot be mandated. Our government's requiring physicians and hospitals to provide free services to whomever walks into the ER does not represent true charity, but a taking of the services from those with valuable skills. The more that is taken, the less charity can be freely given, and all patients suffer as services become less available. Many hospitals now lack neurosurgery coverage for any patient, insured or not. . .

An added attraction is automatic American citizenship for the child. Births to illegal alien mothers constitute nearly 40% of all births paid for by Medi-Cal. Dozens of hospitals along the border in California, Arizona, New Mexico, and Texas have been forced to close or go bankrupt because of the unfunded federal mandate to provide free care to illegals.

The Arizona state government has passed a law making it a state offense to cross the border illegally.  It is already a federal offense.  How else should Arizona respond when the federal government does not take seriously its constitutional obligation to protect the US borders? Our forefathers came to this country with only the shirts on their backs, expecting nothing but an opportunity to work in freedom. They did not demand free services but worked alongside hardworking Americans to build their own American dream. That was always the promise of America and we need to be vigilant lest we lose it.

Dr. Alieta Eck, MD graduated from the Rutgers College of Pharmacy in NJ and the St. Louis School of Medicine in St. Louis, MO. She studied Internal Medicine at Robert Wood Johnson University Hospital in New Brunswick, NJ and has been in private practice with her husband, Dr. John Eck, MD in Piscataway, NJ since 1988. She has been involved in health care reform since residency and is convinced that the government is a poor provider of medical care. She testified before the Joint Economic Committee of the US Congress in 2004 about better ways to deliver health care in the United States. In 2003, she and her husband founded the Zarephath Health Center, a free clinic for the poor and uninsured that currently cares for 300-400 patients per month utilizing the donated services of volunteer physicians and nurses. Dr. Eck is a long time member of the Christian Medical Dental Association and in 2009 joined the board of the Association of American Physicians and Surgeons. In addition, she serves on the advisory board of Christian Care Medi-Share, a faith based medical cost sharing Ministry. She is a member of Zarephath Christian Church and she and her husband have five children, one in medical school in NJ.

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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: The Revolutionary Book That Will Change the Way You Do Business

THE INNOVATOR’S DILEMMA, The Revolutionary Book That Will Change the Way You Do Business, by Clayton M. Christensen, DBA, HarperBusiness, New York, © 2000, ISBN-10: 0-06-052199-6; ISBN-13: 978-0-06-052199-8, 286 pp, $17.99. Hardcover edition was published in 1997 by Harvard Business School Press.

“This book ought to chill any executive who feels bulletproof - and inspired entrepreneurs aiming their guns.” -Forbes

Clayton M. Christensen is the architect of and the world’s foremost authority on disruptive innovation, a framework which describes the process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves ‘up market’, eventually displacing established competitors.  Consistently acknowledged in rankings and surveys as one of the world’s leading thinkers on innovation, Christensen is widely sought after as a speaker, advisor and board member. His research has been applied to national economies, start-up and Fortune 50 companies, as well as to early and late stage investing

His seminal book The Innovator’s Dilemma (1997), which first outlined his disruptive innovation frameworks, received the Global Business Book Award for the Best Business Book of the Year in 1997, was a New York Times bestseller, has been translated into over 10 languages, and is sold in over 25 countries. He is also a four-time recipient of the McKinsey Award for the Harvard Business Review’s best article. See entire bio . . .

I first heard Dr. Christensen speak at the sixth World Health Care Congress in Washington DC in 2008. Amongst a faculty of hundreds speaking to thousands of the business and professional health care leaders of the world, he was the towering speaker that singularly put hope and confidence in the future of health care. He was totally out of sync with the other speakers who talked about patches to the current system. He showed those participants that there would be serious disruption in health care before any new direction would be realized. Using free enterprise and market efficiency to reduce costs is not well understood or taught in today’s educational environment.

This book, as Christensen states in his introduction, is about the failure of companies to stay atop their industries when they confront certain types of marked and technological change. It’s not simply about the failure of any company, but of good companies - the kinds that many managers have admired and tried to emulate; the companies known for their abilities to innovate and execute. Companies stumble for many reasons, of course, among them bureaucracy, arrogance, tired executive blood, poor planning, short-term investment horizons, inadequate skills and resources, and just plain bad luck. But this book, he continues, it not about companies with such weaknesses. It is about well-managed companies that have their competitive antennae up, listen astutely to their customers, invest aggressively in new technologies, and yet still lose market dominance.

Such seemingly unaccountable failure happens in industries that move quickly and in those that move slowly; in those built on electronics technology and those built on chemical and mechanical technology; in manufacturing and in service industries. Dr. Christensen in illustrating the Innovator’s Dilemma takes on a tour of several industries.

Sears Roebuck, for example, was regarded for decades as one of the most astutely managed retailers in the world. It pioneered several innovations critical to the success of today’s most admired retailers: for example, supply chain management, store brands, catalogue retailing, and credit card sales. Yet no one speaks about Sears that way today. Somehow, it completely missed the advent of discount retailing and home centers. In the midst of today’s catalogue retailing boom, Sears has been driven from that business. Indeed, the very viability of its retailing operations has been questioned.

Consider the computer industry. IBM dominated the mainframe market but missed by years the emergence of minicomputers, which were technologically much simpler than mainframes. In fact, no other major manufacturer of mainframe computers became a significant player in the minicomputer business. Digital Equipment Corporation created the minicomputer market and was joined by a set of other aggressively managed companies. But each of these companies in turn missed the desktop personal computer market. It was left to Apple Computer, together with Commodore, Tandy, and IBM’s stand-alone PC division, to create the personal computing market. But Apple and IBM lagged five years behind the leaders in bringing portable computers to market. In 1980s, Digital Equipment was the most prominently featured company.

In Digital’s case, as in Sears, the very decisions that led to its decline were made at the time it was so widely regarded as being an astutely managed firm. It was praised as a paragon of managerial excellence at the very time it was ignoring the arrival of the desktop computers that besieged it a few years later.

The list of leading companies that failed when confronted with disruptive changes in technology and market structure is a long one. At first glance, there seems to be no pattern in the changes that overtook them. In some cases, the new technologies swept through quickly; in others, the transition took decades. In some, the new technologies were complex and expensive to develop. In others, the deadly technologies were simple extensions of what the leading companies already did better than anyone else. One theme common to all of these failures, however, is that the decisions that led to failure were made when the leaders in question were widely regarded as being among the best companies in the world.

How to resolve this paradox? Christensen excluded poor management and hard luck because good fortune ran out. These failed firms were as well run as one could expect from firms managed by mortals. From the research reported in this book, he proposed that there is something about the way decisions get made in successful organizations that sows the seeds of eventual failure.

Good management was the most powerful reason these firms failed to stay atop their industries. Precisely because these firms listened to their customers and invested aggressively in new technologies that would provide their customers more and better products of the sort they wanted, and because they carefully studied market trends and systematically allocated investment capital to innovations that promised the best returns, they lost their position of leadership.

At a deeper level is that many of what are now widely accepted principles of good management are, in fact, only situationally appropriate. There are times at which it is right not to listen to customers, right to invest in developing lower-performance products that promise lower margins, and right to aggressively pursue small, rather than substantial, markets.

The Innovator’s Dilemma helps executives understand how logical and competent decisions of management critical to the success of their companies in the near term can undermine them in the long term if they don’t focus adequate resources on the disruptive technologies that are surfacing below that could lead to their down fall.

Christensen spends the first two chapters recounting in some detail the history of the disk drive industry, where the saga of “good-companies-hitting-hard-times” has been played out over and over again. This industry is an ideal field for studying failure because rich data about it exists and because, in the words of Harvard Business School Dean Kim B. Clark, it is “fast history.” In just a few years, market segments, companies and technologies have emerged, matured and declined. Only twice in the six times that new architectural technologies have emerged in this field has the industry’s dominant firm maintained its lead in the subsequent generation.

“Those that study genetics avoid studying humans,” as Christensen analogizes his research to genetics. “Because new generations come along only every thirty years or so, it takes a long time to understand the cause and effect of any changes. Instead, they study fruit flies, because they are conceived, born, mature, and die all within a single day.” If you want to understand why something happens in business, study the disk drive industry. Those companies are the closest things to fruit flies that the business world will ever see. 

Nowhere in the history of business has there been an industry like disk drives, where changes in technology, market structure, global scope and vertical integration have been so pervasive, rapid, and unrelenting. While this pace and complexity might be a nightmare for managers, it is a fertile ground for research. Few industries offer researchers the same opportunities for developing theories about how different types of change cause certain types of firms to succeed or fail or for testing those theories as the industry repeats its cycles of change.

When the best firms succeeded, they did so because they listened responsively to their customers and invested aggressively in the technology, products and manufacturing capabilities that satisfied their customers’ next-generation needs. But, paradoxically, when the best firms subsequently failed, it was for the same reasons. Blindly following the maxim that good managers should keep close to their customers can sometimes be a fatal mistake. This provided the framework for Christensen to understand when “keeping close to your customers” is good advice—and when it is not. At this point Christensen gives the basics of the disk drive industry in two chapters, which is a tour de force.


Disk drives write and read information that computers use. They comprise read-write heads mounted at the end of an arm that swings over the surface of a rotating disk in much the same way that a phonograph needle and arm reach over a record; aluminum or glass disks coated with magnetic material; at least two electric motors, a spin motor that drives the rotation of the disks and an actuator motor that moves the head to the desired position over the disk; and a variety of electric circuits that control the drive’s operation and its interface with the computer.

The read-write head is a tiny electromagnet whose polarity changes whenever the direction of the electrical current running through it changes. Because opposite magnetic poles attract, when he polarity of the head becomes positive, the polarity of the area on the disk beneath the head switches to negative, and Vice Versa. By rapidly changing the direction of current flowing through the head’s electromagnet as the disk spins beneath the head, a sequence of positively and negatively oriented magnetic domains are created in concentric tracks on the disk’s surface. Disk drives can use the positive and negative domains on the disk as a binary numeric system - 1 and 0 - to “write” information onto disks. Drives read information from disks in essentially the opposite process: Changes in the magnetic flux fields on the disk surface induce changes in the micro current flowing through the head.

Researches at IBM’s San Jose research laboratories developed the first disk drive between 1952 and 1956. It was named RAMAC (for Random Access Method for Accounting and Control) and was the size of a large refrigerator, incorporating fifty 24-inch disks and storing 5 megabytes (MB) of information. Most of the fundamental architectural concepts and component technologies that defined today’s dominant disk drive component were also developed at IBM. These include the removable packs of rigid disks (introduced in 1961), the floppy disk drive (1971) and the Winchester architecture (1973).

As IBM produced drives to meet its own needs, an independent disk drive industry emerged serving two distinct markets. A few firms developed the plug-compatible market (PCM) in the 1960s, selling souped-up copies of IBM drives directly to IBM customers at discount prices. Although most of IBM’s competitors in computers (for example Burroughs and Univac) were integrated vertically into the manufacture of their own disk drives, the emergence in the 1970s of smaller, nonintegrated computer makers spawned an original equipment market (OEM) for disk drives as well. By 1976 about $1 billion worth of disk drives were produced, of which captive production accounted for 50 percent and PCM and OEM for about 25 percent each. The value of drives produced rose to about $18 billion by 1995. By the mid-1980s the PCM market had become insignificant, while OEM output grew to represent about three-fourths of world production. Of the seventeen firms populating the industry in 1976, all of which were relatively large, diversified corporations, all except IBM’s disk drive operation, had failed or had been acquired by 1995. During this period an additional 129 firms entered the industry, and 109 of those also failed. Aside from IBM, Fujitsu, Hitachi, and NEC, all of the producers remaining by 1996 had entered the industry as start-ups after 1976.

The number of megabits (MB) of information that the industry’s engineers have been able to pack into a square inch of disk surface had increased by 35 percent per year, on average, from 50 KB in 1967 to 1.7 MB in 1973, 12 MB in 1981, and 1100 MB by 1995. The physical size of the drives was reduced at a similar pace: The smallest available 20 MB drive shrank from 800 cubic inches in 1978 to 1.4 by 1993, a 35 percent annual rate of reduction. The number of terabytes (one thousand gigabytes) of disk storage capacity shipped in the industry’s history, with each doubling of cumulative terabyte shipped, decreased the cost per megabyte of memory to 53 percent of its former level. This is a much steeper rate of price decline than the 70 percent slope observed in the markets for most other microelectronics products.

The story of the 14-inch Winchester architecture change to the small 8-inch entrants sold their disruptive drives into new applications—minicomputers. Then the 8-inch drive penetrated the mainframe market and within a three-to-four-year period, the 8-inch drives began to invade the market above them. Of the established 14-inch drive makers, the few that entered the 8-inch market did so two years belatedly. Two-thirds never entered the 8-inch market and were driven from the industry. This story was repeated in the 5.25-inch disk drive, again repeated in the 3.5-inch drive, then the 2.5-inch drive and finally in the 1.8-inch drive. All were disruptive forces from below the current market. All entered new and distinctive markets.

Less we think this can only happen in the “fruit fly” of modern industry, Christensen goes on exploring the mechanical excavator industry and finds that the same factors that precipitated the failure of the leading disk drive makers also proved to be the undoing of the leading makers of mechanical excavators, in an industry that moves with a very different pace and technological intensity.

He then concludes Part One of the volume completing the disruptive framework and uses it to show why integrated steel companies worldwide have proven so incapable of blunting the attacks of the minimill steel makers. Another fascinating journey that’s worth taking.

The names associated with all these studies are an excellent history of our times, going from Honda to DaimlerChrysler, from the Sears Card to VISA and MasterCard, and dozens more.

The book begins by posing a puzzle: Why was it that firms esteemed as aggressive, innovative, customer-sensitive organizations could ignore or attend belatedly to technological innovations with enormous strategic importance? Purchasing, reading and referencing this book is important for us in the healthcare industry, an area that Christensen tackles so well in his next book, The Innovator's Prescription.

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10.  Hippocrates & His Kin: Doctor Tom Coburn for President of the USA

Stephen Moore writing in the Wall Street Journal's Political Diary e-newsletter: It's on almost no one's radar screen, but Oklahoma is hosting a Senate race this year—a race, but not a contest. In a year when many incumbents are supposedly in deep trouble, Republican Tom Coburn faces not a single challenger from either party. "He's easily the most popular politician in Oklahoma," says Stuart Jolly, director of the Oklahoma chapter of Americans for Prosperity. "No one will run against him, because no one can come anywhere close to him."

One obvious reason is Mr. Coburn's unrelenting battle against the same status quo (e.g., earmarks) that voters this year have decided they are sick of. It began when he first arrived in the Senate and Democrats immediately slapped him with an ethics complaint for continuing to practice medicine, which Dr. Coburn said he would do partly to avoid becoming too attached to his Senate salary and perks.

This week, Dr. Coburn, from the town of Muskogee, made a startling revelation that should silence his critics. He lost $11,000 in his practice last year because, while he has kept seeing patients, he doesn't charge them. "I want to keep practicing medicine even if I don't make money at it. I'm prouder of being a doctor than a Senator," he recently told me in all seriousness.

Mr. Coburn is already being mentioned as a possible presidential candidate in 2012, and his stock will certainly rise after what looks like a runaway re-election victory in 2010, especially because he's been freed up to put his time into raising money for other candidates. "He's one of the godfathers of the tea party movement," says Matt Kibbe, director of Freedom Works. That gives Mr. Coburn a growing national base that few other Republicans have shown any knack for tapping into.

Looks like a platform all Americans could tap into.

Failure to brush your teeth twice a day increases risk of heart disease By Katherine Harmon, SCIAM
Neglecting to brush twice a day could lead to a 70 percent increased risk of cardiovascular disease, according to a new large population-based study. . .

This should help our indoor environment.

Fathers No Longer Just Backup Parents, By Emily Anthes, Scientific American Mind
Move over, "mommy brain." Men go through their own biological changes after a baby is born. But dads are programmed to challenge their kids, not coddle them. . . . Fathers influence children in unique ways. In particular, they play an outsized role in stretching their emotional and cognitive capabilities - enriching their verbal skills, for example, and encouraging them to take risks. Read more . . .

Are fathers re-entering the family?

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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 The Hobbesian Jungle, Part I.

                      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. Recently released: Let's Face It: Nobody Will Ever Fully Understand This Bill.

                      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, congratulations: The Honorable Maurice McTigue, QSO, Vice President at the Mercatus Center at George Mason University, has been named to Virginia Governor Bob McDonnell's Commission on Government Reform and Restructuring.

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

                      The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels. This month, you might focus on Soaring ObamaCare Costs Break the Bank.

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

                      The Heartland Institute,, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?. This month, be sure to read: Of the four million people the Congressional Budget Office expects to pay the IRS-levied fine rather than purchase health insurance, the vast majority of penalties are expected to be paid from households with incomes more than 400 percent above the federal poverty level. The penalties at that point should average around $1,000 a year – well below the expected cost of coverage. I continue to believe that, given the simple math involved, these estimates are far lower than the actual number of people who will pay the fine and skip the coverage until they need it. As much as 15 percent of American drivers lack auto insurance, and I expect nearly that percentage to avoid purchasing health insurance

                      The Foundation for Economic Education,, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Lawrence W Reed, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. Be sure to read the current lesson on Economic Education: Freedom Seminars of Portland, Ore.

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

                      The Independence Institute,, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter. This month read: President Jon Caldara Statement: On Sunday, March 21st, the US House of Representatives passed what we call "Obama-care." This is one of the darkest moments in American history. The federal government has taken a large step towards control of our healthcare, and with it control of our very bodies. The federal government is taking away our decisions over health insurance and, unprecedented in history, forcing citizens to purchase private products, ultimately under penalty of incarceration.

                      Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read The return of Keynesianism: If an individual, family or business has long lived for the day and disregarded the morrow, spending more than it earns, buying what it doesn't need and can't afford, making foolish and reckless "investments" (which are actually consumption) and borrowing more than it can repay, then it must eventually face a reckoning. When that day arrives, what must it do? Few people would prescribe more of the same: that'd be like taking an alcoholic on a pub crawl. Most would agree that a profligate family or business must ultimately mend its ways. Whether it likes it or not, it must live within its means.

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

                      The Heritage Foundation,, founded in 1973, is a research and educational institute whose mission was 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. -- 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, and was used by some as a justification for the Obama plan, they have lost sight of their mission and we will no longer feature them as a freedom loving institution and have canceled our contributions and 5,000 physicians have done the same. We would also caution that should Mitt Romney ever run for National office again, he would be dangerous in the cause of freedom in health care. We would also advise Steve Forbes to disassociate himself from this institution.

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

                      CATO. The Cato Institute ( 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

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

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Please note that sections 1-4, 6, 8 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.

Spammator Note: MedicalTuesday uses many standard medical terms considered forbidden by many spammators. We are not always able to avoid appropriate medical terminology in the abbreviated edition sent by e-newsletter. (The Web Edition is always complete.) As readers use new spammators with an increasing rejection rate, we are not always able to navigate around these palace guards. If you miss some editions of MedicalTuesday, you may want to check your spammator settings and make appropriate adjustments. To assure uninterrupted delivery, subscribe directly from the website rather than personal communication: Also subscribe to our companion newsletter concerning current and future health care plans:

Del Meyer

Del Meyer, MD, Editor & Founder

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

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Words of Wisdom

Don't wish for what you want. Don't wait for what you want. Command What You Want . . . -Earle Nightingale

"Remember, you only have to succeed the last time." -Brian Tracy: Author, speaker, and consultant.

Learn to make long-lasting personal changes by doing nothing more than kicking back and listening. You'll LOVE the results!  -Vic Conant

"Priorities lead to prosperity."  -Michelle Singletary: Nationally syndicated columnist for The Washington Post

Some Recent Postings

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

The Prisoner's Dilemma of Health Insurance by Gerry Smedinghoff

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

In Memoriam

Art Linkletter-American Hobo : "A Great way to see this great country!"


America lost a laughing legend this week when Art Linkletter, the iconic face of American comedy TV in the 1950s and 1960s, died at the age of 97. He was one of the last of the remaining big names from TV's star-studded early years. I was fortunate enough to visit Art on several occasions at his home up in the mountains above Beverly Hills.

Linkletter was a Canadian immigrant who lived a story-book, rags-to-riches American life. An orphan adopted by "a one-legged preacher," Linkletter left home at 17, bummed around America as a hobo on the trains—"a great way to see this great country," he said—and at age 19 was a stock runner on Wall Street when the market crashed in October 1929. "I was out of a job the next day; people were crying and jumping out of windows," he recalled.

Never at a loss for a funny line, Linkletter became one of the most famous radio voices in the 1930s, then made the rare successful transition to television. He hosted a series of daily TV shows that were all hits, the most enduring of which was the wildly popular "Kids Say the Darndest Things."

Linkletter could go on for hours telling hilarious stories from that show. One of his favorites was of the 7-year-old boy whose dog died. He told the teary-eyed lad, "Don't be sad because your dog is up in heaven with God." The boy responded, "Mr. Linkletter, what would God want with a dead dog?"

A staunch political conservative, he told me he'd tried to talk his friend Ronald Reagan out of running for the White House because "an actor will never be president . . . Thank God he ignored my advice, because Ronnie really turned this country around. "

In the last years of his life Linkletter crusaded for Social Security privatization and repeal of the estate tax. Social Security was "the worst investment that any of us will ever make in our lifetimes," he said, adding, "The trust fund is a fraud. How do these members of Congress stay out of jail?" He thought the death tax was "the cruelest of taxes, because why should the government help itself to half of a man's lifetime earnings?" I had no answer. . .

Mr. Moore is senior economics writer for The Wall Street Journal.

Printed in The Wall Street Journal, May 29, 2010, page A11

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Art Linkletter, TV Host, Dies at 97

Published: May 26, 2010, NY Times

Art Linkletter, the genial host who parlayed his talent for the ad-libbed interview into two of television's longest-running shows, "People Are Funny" and "House Party," in the 1950s and 1960s, died on Wednesday at his home in the Bel Air section of Los Angeles. He was 97. . .

Gordon Arthur Kelly was born on July 17, 1912, in Moose Jaw, Saskatchewan. Before he was a month old he was abandoned by his parents and adopted by Fulton John and Mary Metzler Linkletter, a middle-age couple whose two children had died. It was not until he was 12, while rummaging through his father's desk, that he discovered he was adopted. . .

"I know enough about a lot of things to be interesting, but I'm not interested enough in any one thing to be boring," Mr. Linkletter told The New York Post in 1965 . . .

After graduating from high school at 16, Mr. Linkletter decided to see the world. With $10 in his pocket, he rode freight trains and hitchhiked around the country, working here and there as a meatpacker, a harvester and a busboy in a roadhouse. "Among other things, I learned to chisel rides on freight trains, outwit the road bulls, cook stew with the bindlestiffs and never to argue with a gun," he later recalled.

Read the entire obituary in the NY Times. . .
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On This Date in History - June 9

On this date in 1791, John Howard Payne, who wrote "Home Sweet Home," was born in New York. Although he was the author of dozens of plays and an actor of some repute, it shows that one success outlives a parade of lesser efforts. Be it ever so humble, there's no place like the top, and John Howard Payne made it once and is remembered for it.

On this date in 1891, another songwriter, Cole Porter, was born in Peru, Indiana. Instead of just one, he had many successes. He was one of our best-known popular songwriters and his Broadway hits were innumerable, his lyrics sophisticated, his music catchy and clever. His selection of themes included: "Anything Goes," "Just One of Those Things," "My Heart Belongs to Daddy," "Don't Fence Me In," "Wake Up and Dream," "You're the Top" and "Let's Do It," to name just a few.

After Leonard and Thelma Spinrad

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.