Community For Better Health Care

Vol VI, No 24, Mar 25, 2008


In This Issue:

1.                  Featured Article: Can Government be Charitable to some without being Uncharitable to others?

2.                  In the News: It is extremely difficult to bring efficiency to a charity.

3.                  International Medicine: Ontario hospitals refuse to be identified in report.

4.                  Medicare: Does Medicare Change the Benefit-Risk Equation?

5.                  Medical Gluttony: Medicare Regulations Cause Gluttony

6.                  Medical Myths: Health Care Spending In Africa Improves Health

7.                  Overheard in the Medical Staff Lounge: Senator Barrack Hussein Obama's Speech

8.                  Voices of Medicine: - Medical Staff Self-Governance - Strong Physicians, Better Hospitals

9.                  From the Physician Patient Bookshelf: DIETS DON'T WORK  by Bob Schwartz, PhD

10.              Hippocrates & His Kin: Politicians - Who Are the Ethical Politicians?

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

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Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the truth about socialized medicine. Clements is the former publisher of "American Venture" magazine who made news in 2005 for a property rights project against eminent domain called the "Lost Liberty Hotel."
For more information visit or email

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1.      Featured Article: Can Government be Charitable to some without Being Uncharitable to others?

Not Yours to Give by Davy Crockett

In this tale an unidentified narrator relates Davy Crockett's experience when he was a member of Congress (1827–31, 1832–1835). The story is slightly condensed from The Life of Colonel David Crockett compiled by Edward S. Ellis (Philadelphia: Porter & Coates, 1884).

First published as "A Sockdolager" in The Freeman, August 1961, "Not Yours to Give" has been a FEE favorite for more than 40 years, second in popularity only to "I, Pencil.". . .

One day in the House of Representatives, a bill was taken up appropriating money for the benefit of a widow of a distinguished naval officer. Several beautiful speeches had been made in its support. The Speaker was just about to put the question when Crockett arose:

"Mr. Speaker - I have as much respect for the memory of the deceased, and as much sympathy for the sufferings of the living, if suffering there be, as any man in this House, but we must not permit our respect for the dead or our sympathy for a part of the living to lead us into an act of injustice to the balance of the living. I will not go into an argument to prove that Congress has no power to appropriate this money as an act of charity. Every member upon this floor knows it. We have the right, as individuals, to give away as much of our own money as we please in charity; but as members of Congress we have no right so to appropriate a dollar of the public money. Some eloquent appeals have been made to us upon the ground that it is a debt due the deceased. Mr. Speaker, the deceased lived long after the close of the war; he was in office to the day of his death, and I have never heard that the government was in arrears to him.

"Every man in this House knows it is not a debt. We cannot, without the grossest corruption, appropriate this money as the payment of a debt. We have not the semblance of authority to appropriate it as a charity. Mr. Speaker, I have said we have the right to give as much money of our own as we please. I am the poorest man on this floor. I cannot vote for this bill, but I will give one week's pay to the object, and if every member of Congress will do the same, it will amount to more than the bill asks." To read what the vote was, please go to

He took his seat. Nobody replied. The bill was put upon its passage, and, instead of passing unanimously, as was generally supposed, and as, no doubt, it would, but for that speech, it received but few votes, and, of course, was lost.

Later, when asked by a friend why he had opposed the appropriation, Crockett gave this explanation:

"Several years ago I was one evening standing on the steps of the Capitol with some other members of Congress, when our attention was attracted by a great light over in Georgetown. It was evidently a large fire. We jumped into a hack and drove over as fast as we could. In spite of all that could be done, many houses were burned and many families made houseless, and, besides, some of them had lost all but the clothes they had on. The weather was very cold, and when I saw so many women and children suffering, I felt that something ought to be done for them. The next morning a bill was introduced appropriating $20,000 for their relief. We put aside all other business and rushed it through as soon as it could be done.

"The next summer, when it began to be time to think about the election, I concluded I would take a scout around among the boys of my district. I had no opposition there, but, as the election was some time off, I did not know what might turn up. When riding one day in a part of my district in which I was more of a stranger than any other, I saw a man in a field plowing and coming toward the road. I gauged my gait so that we should meet as he came up to the fence. As he came up, I spoke to the man. He replied politely, but, as I thought, rather coldly.

"I began: ‘Well, friend, I am one of those unfortunate beings called candidates, and - '

"‘Yes I know you; you are Colonel Crockett. I have seen you once before, and voted for you the last time you were elected. I suppose you are out electioneering now, but you had better not waste your time or mine. I shall not vote for you again.'

"This was a sockdolager . . . I begged him to tell me what was the matter.

"‘Well, Colonel, it is hardly worth-while to waste time or words upon it. I do not see how it can be mended, but you gave a vote last winter which shows that either you have not capacity to understand the Constitution, or that you are wanting in the honesty and firmness to be guided by it. In either case you are not the man to represent me. But I beg your pardon for expressing it in that way. I did not intend to avail myself of the privilege of the constituent to speak plainly to a candidate for the purpose of insulting or wounding you. I intend by it only to say that your understanding of the Constitution is very different from mine; and I will say to you what, but for my rudeness, I should not have said, that I believe you to be honest. . . . But an understanding of the Constitution different from mine I cannot overlook, because the Constitution, to be worth anything, must be held sacred, and rigidly observed in all its provisions. The man who wields power and misinterprets it is the more dangerous the more honest he is.'

"‘I admit the truth of all you say, but there must be some mistake about it, for I do not remember that I gave any vote last winter upon any constitutional question.'

"‘No, Colonel, there's no mistake. Though I live here in the backwoods and seldom go from home, I take the papers from Washington and read very carefully all the proceedings of Congress. My papers say that last winter you voted for a bill to appropriate $20,000 to some sufferers by a fire in Georgetown. Is that true?'

"‘Well, my friend; I may as well own up. You have got me there. But certainly nobody will complain that a great and rich country like ours should give the insignificant sum of $20,000 to relieve its suffering women and children, particularly with a full and overflowing Treasury, and I am sure, if you had been there, you would have done just as I did.'

"‘It is not the amount, Colonel, that I complain of; it is the principle. In the first place, the government ought to have in the Treasury no more than enough for its legitimate purposes. But that has nothing to do with the question. The power of collecting and disbursing money at pleasure is the most dangerous power that can be entrusted to man, particularly under our system of collecting revenue by a tariff, which reaches every man in the country, no matter how poor he may be, and the poorer he is the more he pays in proportion to his means. What is worse, it presses upon him without his knowledge where the weight centers, for there is not a man in the United States who can ever guess how much he pays to the government. So you see, that while you are contributing to relieve one, you are drawing it from thousands who are even worse off than he. If you had the right to give anything, the amount was simply a matter of discretion with you, and you had as much right to give $20,000,000 as $20,000. If you have the right to give to one, you have the right to give to all; and, as the Constitution neither defines charity nor stipulates the amount, you are at liberty to give to any and everything which you may believe, or profess to believe, is a charity, and to any amount you may think proper. You will very easily perceive what a wide door this would open for fraud and corruption and favoritism, on the one hand, and for robbing the people on the other. No, Colonel, Congress has no right to give charity. Individual members may give as much of their own money as they please, but they have no right to touch a dollar of the public money for that purpose. If twice as many houses had been burned in this county as in Georgetown, neither you nor any other member of Congress would have thought of appropriating a dollar for our relief. There are about two hundred and forty members of Congress. If they had shown their sympathy for the sufferers by contributing each one week's pay, it would have made over $13,000. There are plenty of wealthy men in and around Washington who could have given $20,000 without depriving themselves of even a luxury of life. The congressmen chose to keep their own money, which, if reports be true, some of them spend not very creditably; and the people about Washington, no doubt, applauded you for relieving them from the necessity of giving what was not yours to give. The people have delegated to Congress, by the Constitution, the power to do certain things. To do these, it is authorized to collect and pay moneys, and for nothing else. Everything beyond this is usurpation, and a violation of the Constitution.

"‘So you see, Colonel, you have violated the Constitution in what I consider a vital point. It is a precedent fraught with danger to the country, for when Congress once begins to stretch its power beyond the limits of the Constitution, there is no limit to it, and no security for the people. I have no doubt you acted honestly, but that does not make it any better, except as far as you are personally concerned, and you see that I cannot vote for you.'

"I tell you I felt streaked. I saw if I should have opposition, and this man should go to talking, he would set others to talking, and in that district I was a gone fawn-skin. I could not answer him, and the fact is, I was so fully convinced that he was right, I did not want to. But I must satisfy him, and I said to him:

"‘Well, my friend, you hit the nail upon the head when you said I had not sense enough to understand the Constitution. I intended to be guided by it, and thought I had studied it fully. I have heard many speeches in Congress about the powers of Congress, but what you have said here at your plow has got more hard, sound sense in it than all the fine speeches I ever heard. If I had ever taken the view of it that you have, I would have put my head into the fire before I would have given that vote; and if you will forgive me and vote for me again, if I ever vote for another unconstitutional law I wish I may be shot.' . . .

"It was one of the luckiest hits of my life that I met him. He mingled but little with the public, but was widely known for his remarkable intelligence and incorruptible integrity, and for a heart brimfull and running over with kindness and benevolence, which showed themselves not only in words but in acts. He was the oracle of the whole country around him, and his fame had extended far beyond the circle of his immediate acquaintance. Though I had never met him before, I had heard much of him, and but for this meeting it is very likely I should have had opposition, and had been beaten. One thing is very certain, no man could now stand up in that district under such a vote. . .

To read the entire article and how this election went, go to

Foundation for Economic Education
30 South Broadway
New York, 10533
1-800-960-4FEE • 1-914-591-7230
©2007 Foundation for Economic Education. All Rights Reserved. 

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2.      In the News: It is extremely difficult to bring efficiency to a charity.

Muhammad Yunus Subprime Lender By EMILY PARKER, WSJ, March 1, 2008 Queens, N.Y.

In a Jackson Heights shop for colorful saris and glittering bracelets, several women have gathered to meet with their banker. They laugh and chat in Bengali. Sultana, a 39-year-old woman wearing a headscarf, hands him $128 in cash. She is making her first repayment of the $3,000, six-month loan she'll use to help with her husband's candy store.

Welcome to Grameen America, Muhammad Yunus's brand-new microfinance venture. Mr. Yunus, along with his Bangladesh-originated Grameen Bank, won the 2006 Nobel Peace Prize for battling poverty by lending out small sums of money to the poor. The loans are mainly for income-generating activities -- from making baskets to raising chickens. Since its establishment in 1983, Grameen has given out billions of dollars in loans, helping to pull families out of poverty and inspiring similar operations all over the world. To read more, please go to

Mr. Yunus has now brought Grameen to this borough of New York City. Since taking off in January, Grameen America has lent out a total of $145,000, with interest rates at around 15% on the declining loan balance. The money will be used for everything from taxi registrations to sewing machines. I meet Josefina from the Dominican Republic, who has borrowed money to buy women's accessories to sell.

Grameen works a little differently from your average American financial institution. The Grameen banker comes to the borrowers, either in their homes or businesses. Women borrowers take priority. There is no need for collateral, credit-history checks, legalities or complicated paperwork. Just credit, plain and simple. . .

Mr. Yunus, who cheerfully refers to his business as "sub sub sub subprime," seems unfazed by the U.S. subprime mortgage collapse and the various tightenings of credit that followed in its wake. "If subprime cases are risky, Grameen cases are extremely risky," he says. "Because not only are we poorest, [borrowers] don't have collateral, they don't have guarantees, they don't have lawyers, nothing. How risky can you get? Still, our money comes back." Grameen has claimed that over 98% of their debts are repaid.

I mention that Mr. Yunus's way of doing business seems like an "old-fashioned" notion of credit, which a few centuries back was apparently closer to the Latin credere (to believe or trust). To have "credit" in a community, for example, meant that you could be trusted to pay back your debts.

"I use to say this in my speeches, in the early days," he responds. "I said: look at the world, how funny it is. They took the word credit which means trust, and built a whole edifice of credit institutions, refined, very sophisticated, entirely based on distrust." At Grameen, he says, "we went back to the original meaning of credit."

Mr. Yunus would argue that in making credit more easily accessible, he is helping guarantee a fundamental human right. "There are certain items that are listed as human rights: right to food, right to shelter, right to work, right to health . . . but who are going to implement those human rights?"

Some might say that government is responsible. But "that doesn't mean that government has to bring a platter full of food every morning to feed you, that's not what the government could do. Government could not bring health care to every single citizen or work opportunity for every single citizen."

Out of all the rights that he listed, Mr. Yunus says he would put credit as No. 1. "If you agree that each case of receiving microcredit is a creation of self-employment, then my argument is self-employment creates income," he explains. "Income is the thing which brings food. Income is the thing which creates the possibility of shelter, home. And income is the best medicine."

The collapse of the American subprime market has not shaken Mr. Yunus's confidence in credit. Rather, he blames the problem on sloppy business techniques. "They have the collateral, they have the lawyers, they have the entire legal system behind them . . . But they still could not protect themselves. What does it say?" he asks. One, "it says you didn't know how to do business . . . No. 2 . . . you got extra greedy. You overstepped your territory." . . .

Why is Grameen's debt-repayment rate so high? "Self-interest," is one reason. "For the first time, she has been given this opportunity to make money, make an income. Now she has a choice: she can pay back the loan so that she can continue with this door open and she can move on step by step. Or she says, enough is enough, I'm not going to pay back, I'm going to enjoy the money I got. What happens? The door gets closed."

Grameen, crazy as it may sound, "assumes that every borrower is honest." But it does have ways to help ensure repayment. Each borrower joins a group of people from similar social and economic conditions, and the group approves the loan request of each member. In this way, the group assumes "moral responsibility" for the loan.

Mr. Yunus's use of the female pronoun is not accidental. He says Grameen Bank's borrowers are 97% women, the result of a very deliberate policy. It all started when Mr. Yunus complained that Bangladesh's banks weren't lending to women at all. "I was trying to show in how many different ways conventional banking went wrong. So when I began I wanted to make sure that I do not face the same complaint against me. So I wanted to have 50% of my borrowers as women." . . .

After Grameen got to their desired level, 50% women borrowers, "we started noticing that money going to the family through women brought so much more benefit to the family than the same amount of money going to the family through men . . . So at one point we said, forget about 50-50. Let's focus on women because it changes the family faster." . . .

Mr. Yunus's determination paid off. Grameen, in quiet ways, is helping to empower women. "Every single of those seven-and-a-half million borrowers," he says, has a "personal bank account, and they are accumulating quite a significant amount for themselves." This "immediately establishes ownership because she is the only one who can withdraw money. This is her protected territory." . . .

In his new book, "Creating a World Without Poverty," Mr. Yunus does just that. He defines social business as "cause-driven" rather than profit-driven. And yet, it is not a charity: Its owners are entitled to recoup their investments, and the social business must recover its full costs, or more, even as it concentrates on creating products or services that provide a social good. It does this by charging a fee for its products and services. (One example: a business that manufactures and sells low-priced, nutritious food products to underfed children. Grameen America is also a social business.)

Mr. Yunus freely acknowledges that the free market has done a great deal for the poor. "I didn't say that what is there is wrong. I said the structure was not complete. One piece was missing. We couldn't express within the business world all the things we want to do for others."

He argues that in today's world, people whose main ambition is to help those in need tend to be pushed into philanthropy, which isn't always the most efficient way to bring about change. In philanthropy, he says, the "dollar has only one life, you can use it once . . . social business dollar has endless life, it recycles. And you build institutions." He continues, "when it's an institution you bring creativity into it. You bring innovations into it. You bring continuity into it."

Mr. Yunus argues that it's extremely difficult to bring efficiency to charity. But "the moment you bring in a business model, immediately you become concerned about the cost, about the revenue, the sustainability, the surplus generation, how to bring more efficiency, how to bring new technology, how to redesign, each year you review the whole thing . . . charity doesn't have that package.". . .

Mr. Yunus likes to tell a story of going into a village and meeting one of his borrowers, whose daughter has risen to become a doctor. "You look at the mother, that illiterate woman who borrowed money to raise chickens, to buy a cow to send the daughter to school, and now she's a doctor. And I get the question in my mind: the mother could have been a doctor too," he says.

"The whole thing is about making those opportunities available, so that they can change their lives."

To read the entire article, go to

Ms. Parker is an assistant editorial features editor at The Wall Street Journal.

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3.      International Medicine: Ontario hospitals refuse to be identified in report comparing patient care

TORONTO, ON - Most Ontarians have no way of knowing if their local hospital is one of the best performing in Ontario, or one of the worst.

A new study released today by independent research organization The Fraser Institute compares the performance of Ontario's 136 acute care hospitals. But only 29 of the hospitals agreed to be identified. To read more, please go to

Stratford General Hospital is the highest ranked of the hospitals that agreed to be identified, finishing 19th. Stratford has ranked among the top 10 hospitals going back to 2002.

Anonymous Hospital #10 is the highest ranked hospital in Ontario and has been a consistent top performer, ranked first or second since 2002. But its top administrators refused to let the Fraser Institute divulge its name. The eight lowest-ranked hospitals also refused to be identified. These hospitals have consistently been among Ontario's poorest performing hospitals.

"The hospitals that agreed to be identified in this report should be commended. These hospitals are obviously committed to their patients and the public by being accountable and transparent regarding their performance," said Nadeem Esmail, Director of Health System Performance Studies at The Fraser Institute and co-author of the Hospital Report Card: Ontario 2008.

In the Institute's 2006 Hospital Report Card, 43 hospitals agreed to be identified.

"It's unfortunate that even fewer of Ontario's hospitals appear willing to embrace the values of accountability and transparency, something I'm sure most people in Ontario will find unacceptable."

To read the entire Hospital Report Card: Ontario 2008 by Nadeem Esmail  Maureen Hazel  go to

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: Does Medicare Change the Benefit-Risk Equation?

Hospital and Surgical Errors or are they Just Poor Outcomes?

Sacramento had a recent case of post-op, drug-resistant hip infection at one of the local hospitals. There was a lot of unhappiness and resentment against the surgeon and the hospital. The investigation indicated that all the sterile protocols were completed as outlined. Mistakes, errors and sometimes poor outcomes just happen. But does anyone go back to the decision-making process? Was this hip replacement really needed? If it wasn't free with taxpayers' moneys such as Medicare, would the patient have had it done? To read more, please go to

Most patients expect perfect outcomes despite a list of possible bad results that they read, sign, and don't believe will ever happen to them. What would put this in perspective? A percentage co-payment. If a patient had to pay even 10 percent of the hospital bill of, say $20,000, everything would be in perspective. "Is the pain and suffering I'm experiencing worth the $2,000 I'll be paying for this operation?" When I phrase it this way to patients asking the question, I'm always surprised at the number that state the pain and suffering is not really that severe and really doesn't interfere with activities significantly enough to warrant the expense. "I'll wait a few years." At that time, the risks and cost vs benefit ratio may be entirely different and the operation can proceed with an entirely new perspective. An adverse outcome will become acceptable considering the pain and suffering at that time.

With government medicine, there is no benefit-risk ratio that reaches the level of consciousness. Everyone expects a perfect outcome. It they are advised to have a surgical procedure, they assume that is the only option. It is all benefit and the risks are a fairy tale. The risks are written down, in their estimation, because some government agency tells doctors and hospitals it must be done. "It doesn't apply to me." Only when they have a stake in the procedure, not a fixed dollar co-payment, but a percentage co-payment which forces them to have a stake in the action from start to finish, will appropriate benefit-risks be understood. It will never happen in universal health care. That's why health care costs escalated with Medicare, Medicaid, Government sponsored HMOs, and will skyrocket with Universal health insurance which will then ration care.

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

- Ronald Reagan

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5.      Medical Gluttony: Medicare Regulations Cause Gluttony

This week, we saw a patient who was convalescing somewhat slower than he liked after being hospitalized with pneumonia. This was attributed to his advanced age of 98. The nurse at the "board and care" facility stated it was difficult supervising his self-care and he needed to be transferred to a higher level of care. According to Medicare Regulations, he had to be admitted to the hospital for three days and then sent to an available nursing facility. For the admission diagnosis, they used the previous diagnosis of bilateral pneumonia. This got everyone's attention and intravenous infusions were quickly started. By the time the hospitalist got the records put together, it was the third day and he was placed in a facility with a higher level of nursing care. To read more, please go to

The nurse seemed somewhat embarrassed when asked about the need for these events and shrugged it off as Medicare regulations over which neither she nor the hospital had any control.

On reflection, the mechanism became more apparent and more illustrative. The diagnosis was needed to facilitate a major amount of nursing care. Patients with antibiotic infusions can command thousands of dollars more in charges over regular patients. They also require more consultations, immediate x-rays and follow-up x-rays. This higher level of care eliminates the personal physician from caring for this patient any longer since the nursing facilities have their own physicians. These physicians are more pliable to the home nursing program of the hospitals and are more easily motivated to readmit and utilize other hospital services. They can send patients to hospital emergency rooms knowing that a large number of unnecessary testing will be accomplished to increase revenue of the hospital.

Mandates always increase health care costs. What is not generally appreciated is that all mandates can be gamed for increased revenue at taxpayers' expense and taxpayers will never be aware of the gaming operation. We have to continue working towards eliminating all government mandates and restore health care to the patients as advised by their doctors. Then with a percentage co-payment, healthcare will again be in a Medical MarketPlace competitive environment, which will reduce health care costs astronomically.

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6.      Medical Myths:  Health Care Spending In Africa Improves Health

Health Alert: Saving Africans from Limousine Liberals and People Who, Although Not as Rich as Barbra Streisand, Think Just Like She Does; Part II.

My definition of a Hollywood liberal is someone who believes you can solve all the world's problems without knowing anything about economics.  (After all, who needs graphs and mathematical symbols, when all you really need is love?)  Unfortunately, there are way too many people in health policy who think exactly the same way.  They not only resist the economic way of thinking, they are actually resentful if anyone injects it into the discussion. To read more, please go to 

Consider health care spending in Africa and suppose we had only $1,500 to spend.  How should we spend it?  Health economist estimate $1,500 would:

•          Treat 1 HIV positive person for one year.

•          Prevent 75 people from contracting polio, diphtheria, pertussis, and tetanus.

•          Treat 150 people with tuberculosis for one year.

•          Prevent 500 people from contracting tuberculosis each year.

•          Treat 1,500 people with intestinal worms for one year.

•          Treat 1,500 people with malaria for one year.

How can we choose among these alternatives? A common technique employed by health researchers is to measure the payoff from health care spending in terms of "years of life saved," which is the number of extra years of life the health intervention produces.   

Sometimes the measurement is expressed as "quality adjusted life years" or "disability adjusted life years" (DALY) in recognition of the fact that the goal is not simply to keep people alive, but to keep them alive and functioning as healthy human beings.   

If we want to maximize health and well-being in Africa, we certainly would not start out focusing on AIDS treatment.  Consider the anti-retroviral (ARV) drug treatment for AIDS - currently so popular among rock stars and politicians.  According to the World Health Organization (WHO):

•          The cost of ARV drug treatment for AIDS is $1,500 per DALY.

•          Yet if this same amount of money were reallocated to immunizations we could save 214 years of life instead of one year for an AIDS patient.

Two and one-half times as many Africans die from other preventable diseases as die from AIDS, including measles, respiratory infections, malaria, tuberculoses, diarrhea and others.  Yet AIDS treatment competes against these other health care needs.  And in drawing health resources away from areas where they are more productive, AIDS treatment programs can cost more lives than they save. 

If you're disappointed on the health front, this is only the tip of the iceberg.  In last week's Alert,, I noted that over the past five decades, the developed countries of the world have given less-developed countries $2.3 trillion in foreign aid.  

What difference has all this spending made?  International Monetary Fund chief economist Raghuram G. Rajan and Arvind Subramian have done comprehensive testing of a broad array of theories and found that there are no significant effects (either positive or negative) of foreign aid on economic growth.  Specifically:    

•          It apparently does not matter what aid is used for (health, social sector, technical assistance, etc.).

•          It apparently does not matter who gives the aid (multilateral donors, bilateral donors, good donors, bad donors, etc.).

•          It apparently does not matter to which countries the aid is given (those with good policies and institutions, those with bad ones, etc.).

•          It apparently does not matter when the hoped for impact is supposed to take place (short term, long term, etc.).

So given this incredibly sad and depressing record of massive failure on the part of government bureaucrats, what's the next step for Hollywood? 

Give the bureaucrats complete control over the US health care system, of course.  How could you possibly doubt?

To view the comments for this blog entry:


John Goodman, President

National Center for Policy Analysis  

12770 Coit Rd., Suite 800, Dallas, Texas 75251 

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7.      Overheard in the Medical Staff Lounge: Senator Barrack Hussein Obama's Speech

Dr. Wilson: Did you hear Senator Obama's wonderful speech?

Dr. Sharon: I did and didn't think it so wonderful. Never once did he distance himself from the supposed minister of "God is Love" who spewed forth hate Sunday after Sunday.

Dr. Wilson: But he raised our level of consciousness about the racial issue, don't you think?

Dr. Sharon: I think it may have made it worse. There seems to be an increase in the racial divide as you now look at the polls.

Dr. Sam: Looking at the polls, did you note that if the general elections were held today that McCain pulled ahead of Obama for the first time? To read more, please go to

Dr. Rosen: And Obama's share of the Democratic vote dropped to 65 percent and McCain's percentage of the Republican vote increased to 80 percent. That speech may be the best thing that has happened to McCain.

Dr. Sam: It really bothers me that Obama could listen to those sermons of Hate for twenty years and still support his pastor.

Dr. Dave: And to make things even more interesting on that side of the isle, Mrs. Clinton was forced to reveal her White House records.

Dr. Edwards: But did you also note that she released only 11,000 pages of the two million pages requested? What is she hiding?

Dr. Ruth: Peter Nicholas of the Los Angeles Times reported today that the material she offered to show indicating she had been an active first lady offered little support to her assertion that her White House experience left her best prepared to become president.

Dr. Patricia: Well, I voted for her and I'm wondering why I don't feel good about doing that?

Dr. Ruth: Maybe Peggy Noonan's comment that Obama gave the thinking man's speech gives the answer.

Peggy Noonan wrote:

The speech assumed the audience was intelligent. This was a compliment, and I suspect was received as a gift. It also assumed many in the audience were educated. I was grateful for this, as the educated are not much addressed in American politics.

Here I point out an aspect of the speech that may have a beneficial impact on current rhetoric. It is assumed now that a candidate must say a silly, boring line -- "And families in Michigan matter!" or "What I stand for is affordable quality health care!" -- and the audience will clap. The line and the applause make, together, the eight-second soundbite that will be used tonight on the news, and seen by the people. This has been standard politico-journalistic procedure for 20 years.

Mr. Obama subverted this in his speech. He didn't have applause lines. He didn't give you eight seconds of a line followed by clapping. He spoke in full and longish paragraphs that didn't summon applause. This left TV producers having to use longer-than-usual soundbites in order to capture his meaning. And so the cuts of the speech you heard on the news were more substantial and interesting than usual, which made the coverage of the speech better. People who didn't hear it but only saw parts on the news got a real sense of what he'd said.

If Hillary or John McCain said something interesting, they'd get more than an eight-second cut too. But it works only if you don't write an applause-line speech. It works only if you write a thinking speech.

To read the rest of Peggy Noonan's Analysis, please go to (subscription may be required). 

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

Southern California Physician

Part 1 - Medical Staff Self-Governance - Strong Physicians, Better Hospitals By John Hill, MD 

An introduction to the three-part series by John Hill, MD, the physician who was at the center of a major medical staff-hospital administration conflict.

With pleasure, I provide this introduction as a preface to a series of articles devoted to medical staff issues and rights. As one who has been in the vortex of a medical staff-administration maelstrom, I cannot emphasize enough the importance of knowing your rights as medical staff members and leaders. Equally important is constant vigilance in guarding and protecting these rights.

In 2002, the medical staff of Community Memorial Hospital in Ventura got a jarring reality check when we found that the traditional role of our medical staff had been subverted by an aggressive and controlling administrator and a complicit hospital board of directors. The opening salvo in our crisis was fired when the administrator, for all practical purposes, cashiered the entire hospital radiology department and replaced it with unknown locum tenens physicians who were unable to provide the quality services our patients had previously enjoyed. To read more, please go to

When we approached our medical staff leaders about this serious medical quality issue, we received another rude awakening. It was immediately apparent that the administrator had been successful in co-opting a significant component of the medical executive committee's leadership - and that those leaders would not be of help in resolving this or subsequent problems. We then started to explore our options, first by looking at our medical staff bylaws. We were again jolted when it became obvious that our bylaws had been neglected and corrupted. They were so inconsistent that we couldn't even impeach our medical staff officers without their prior approval.

The medical staff, unfortunately, bore some responsibility for the genesis of this meltdown. When this situation was developing, it was a particularly difficult time for practicing physicians. We were being bombarded by managed care, capitation and medical group bankruptcies, as well as the alphabet soup of unfunded government mandates, such as EMTALA and HIPAA. As a result, apathy regarding hospital involvement had set in and medical staff participation played second fiddle to the economic survival of our practices. The resulting vacuum provided fertile ground for the administration's takeover of control from the medical staff. . . .

To read the rest of Dr. Hills' message, go to

To read other Voices of Medicine columns, go to

To read other VOM columns that appeared in MedicalTuesday, go to the archives and click on the VOM in any issue.

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9.      Book Review: DIETS DON'T WORK  by Bob Schwartz, PhD,

Breakthru Publishing, Houston, Texas, Third Revised Edition, 149 pp, $12.95 © 1996, by Bob Schwartz, PhD, ISBN: 0-942540-16-6.

Diets and Exercise

For twenty years, Dr. Schwartz owned a chain of health clubs across the United States. A large percentage of the people who came to his clubs wanted to lose weight, and at the time, the answer seemed simple - just exercise and stick to a diet plan and the pounds will roll off. As he studied his clientele, he saw that many who went on diets and started an exercise program in his clubs did not lose all the weight they intended. Almost all of the ones who did lose, gained it right back - plus some.

Schwartz says that he personally never had a weight problem, until he decided to experiment with his own weight and diets to understand his clientele. Thereafter, the weight problem developed. To read more, please go to

He tried one of the popular diets of the day. Losing weight was easy initially. With his first diet, he felt as though his body told him it didn't like what was happening. But after one week, he had lost eleven pounds. When he went off the diet, he regained the weight he had lost. So he had an excuse to try another of the 26,000 diets floating around.

Diets Don't Work

But with every successive diet, it took longer to get the weight off. After every diet, the weight came back quicker and quicker. Thus, he surmised that people couldn't wait to get off of their diets and resume normal eating. Consequently, they regained their weight. Schwartz tells how between the ages of thirty and forty, he personally lost over 2,000 pounds using successive diets. But he also regained 2,001 pounds. Keeping it off wasn't easy. So he concluded that Diets Don't Work.

He found that statistics bore this out. Out of every 200 people who go on any diet, only ten lose all the weight they set out to lose. And of those ten dieters, only one keeps it off for any reasonable length of time - a failure rate of 99.5 percent.

One morning when he couldn't find a pair of pants he could button, he became desperate. He noticed that joggers were thin. That must be the answer. "If you jog, you get thin." He considered buying a jogging outfit and jogging shoes and start jogging east, like Forrest Gump. Surely, by the time he reached New York he would be thin. Maybe he would already be thin by the time he jogged through Kansas. He would then catch the next plane home. But as he considered this option, he decided, "Jogging wasn't the answer."

Schwartz studied every kind of diet and weight-loss plan imaginable - including behavior modification, drinking light beer and diet sodas, and eating diet foods. He talked with people who had gone to extreme measures, including popping diet pills, taking shots and drinking liquid protein. [One diet recommended shots of pregnant women's urine. The AMA advised him not to sponsor that one.] They had meditated, been hypnotized, fussed over, pleaded with, prayed for and starved. Some even had their teeth wired together and staples put into their ears and stomachs. Nothing had worked.

No one had the answer to the problem of how to permanently lose weight. Doctors didn't have it. Diet experts didn't have it. Psychologists didn't have it. Members of the clergy didn't have it. Politicians didn't have it.

There are lots of psychologists, doctors, diet experts, and diet business owners and employees - the Diet Industry - who are wondering what they'd do with their time if someone let out the secret that diets don't work. . .

To read the rest of this review, go to'tWork.htm.

For the health book reviews, go to

To browse the Physician/Patient Bookshelf, go to

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10.  Hippocrates & His Kin: Politicians - Who Are the Ethical Politicians?

This being an election year, we should be aware of the ethical lapses of our elected rulers. Judicial Watch, the public interest group that investigates and prosecutes government corruption, released its 2007 list of Washington's "Ten Most Wanted Corrupt Politicians."  The list, in alphabetical order, includes: . . .  To read who these scoundrels are and what their scandals were, go to

Any Surprises?

Barack Obama

"My friends, we live in the greatest nation in the history of the world. I hope you'll join with me as we try to change it."

Did that come out right?

Eating Candy
I observed a ward clerk at the nursing station reading "Weight Watchers" as she devoured a "Babe Ruth." I guess that keeps the scales balanced and the economy moving. It also contributes to the epidemic in America - 60% of the population is overweight and 30% is obese. We consumed 15% more calories in 1994 than we did in 1970 and today we dine out twice as often. High school students are becoming obese and it's invading the junior high school and grade schools.

If obesity was an infectious disease, we would call it a national epidemic and a crisis.

To read more, please go to

MediCal Backlog Rises

A headline in this week's newspaper indicates that there is an increasing backlog in MediCal, the government-sponsored Medicaid program for poor people who can't afford health insurance. The United States has had a superior safety net for health care than any socialized health care country. We have no significant waiting beyond a few days. Our pharmacy formulary exceeds what's available to the well-to-do in the European Government-controlled health care systems, such as the NHS where the waiting lists are routinely many weeks, months and sometimes years. But that may be changing. California Medicaid now can take a few weeks to get approval. This will be compounded when the MediCal reimbursement is reduced another 10 percent on July 1, 2008, from the now average reimbursement of about 25 percent of the usual and customary charges. In addition, payments will be delayed an extra thirty days.

Looks like Americans are already experiencing the reduced quality of Socialized Medicine.

Why are more doctors getting out of the MediCal program?

As the MediCal reimbursement is decreasing to about half of the average doctor's overhead costs, more are eliminating MediCal from their practices. A few have an exclusive MediCal practice. How do they do it? Doctors traditionally have given patients all the time they needed to complete the evaluation of the medical complaint precipitating the office call. As the government-sponsored HMOs have taken over, doctors are asked to see three patients an hour if they previously saw two or four patients an hour if they previously saw three. One HMO requests five patients an hour. As one wag put it, I now have two doors in my examination room. I greet the patient at one door; my writing desk has become an elevated counter to write prescriptions. I try to keep the momentum going as I lead them out of the other door before my nurse brings the next patient through the first door and I rush to the next examination room.

MediCal practices see patients on a five- to seven-minute basis to increase the volume to maintain a cash flow. There is one physician who schedules private patients every fifteen minutes and MediCal patients ever 7 ½ minutes.

If half of the doctors quit seeing MediCal patients, that should increase the waiting lists to what the British and Europeans have been experiencing for the past 60 years. Do politicians really see this as Nirvana rather than lowering quality?
But then Politicians wouldn't recognize Quality if the "Cue" struck them in the face.

To read more Medical Vignettes, please go to

To read the Hippocrates Archives, please go

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


•                      John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to To reach people where they hurt, go to


•                      PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to For his Congressional testimony, start by clicking on To read more on Dr Berry, please click on the various topics at his website.

•                      PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that Payment Is Expected At The Time Of Service. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.

•                      Michael J. Harris, MD - - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."

•                      To read the rest of this section, please go to

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

·                     Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.
"Questions are easy, when you know the answers." Mark Twain
"The answers are easy, when you know the questions to ask." Art Coday, M.D.

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

•                      David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at To read his "Lessons from the Past," go to For additional articles, such as the cost of Single Payer, go to; for Health Care Inflation, go to Be sure to read our featured article by him in MedicalTuesday at

•                      Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at

•                      Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see To see Attorney Sharon Kime's response, as well as the California Medical Board response, see Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.

To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to

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

•                      Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at 

•                      The Association of American Physicians & Surgeons (, The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians.  Be sure to scroll down on the left to departments and click on News of the Day in Perspective: Registry for egg donors proposed after young woman dies of colon cancer, or go directly to it at Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read AAPS SUES TEXAS MEDICAL BOARD. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief ( There are a number of important articles that can be accessed from the Table of Contents page of the current issue. Don't miss the excellent articles on Tales from the HealthCare Crypt, The 180-Degree Approach to Medical Benefits Reform, or Free Market Reform in Health Care. There is an excellent and extensive book review section, which covers six great books this month.


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Del Meyer       

Del Meyer, MD, Editor & Founder

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Words of Wisdom and Caution

"Think like a man of action, act like a man of thought."  - Henri Bergson, a French philosopher

One of the things that distinguishes man from the other animals is that he wants to know things, wants to find out what reality is like, simply for the sake of knowing. When that desire is completely quenched in anyone, I think he has become something less than human. - C. S. Lewis

What this country needs are more unemployed politicians. - Edward Langley, Artist 1928-1995

Some Recent Postings

DIETS DON'T WORK by Bob Schwartz, PhD.'tWork.htm

In Memoriam

Lazare Ponticelli, the last French foot-soldier of the first world war, died on March 12th, aged 110

THE business of memory is a solid and solemn thing. Plaques are unveiled on the wall; stone memorials are built in the square; the domed mausoleum rises brick by brick over the city. But the business of memory is also as elusive as water or mist. The yellowing photographs slide to the back of the drawer; the voices fade; and the last rememberers of the dead die in their turn, leaving only what Thomas Hardy called "oblivion's swallowing sea".

The approach of the death of Lazare Ponticelli therefore caused something of a panic in France. This derdesders, "the last of the last", was for a while the only man in the country who remembered the first world war because he had fought in it. The suburb of Kremlin-Bicetre, where he lived, had like most other communities in France a memorial to the war dead. But, more important, it had Mr Ponticelli, who up to his 111th year appeared every November 11th in his flat cap and brown coat, lean and bright-eyed, gamely managing the few steps required to lay his small bunch of carnations there. The most astonished and serious observers were always children, to whom - if they wanted - he would tell his stories. To read more, please scroll down at

Successive presidents of France strove to honour Mr Ponticelli. It was a way of detaining all the other shadows he represented: the 8.4m workmen, peasants and common folk who, in pointed steel helmets and flapping greatcoats, had gloriously defended the fatherland as poilus, or foot-soldiers, between 1914 and 1918. Jacques Chirac suggested a state funeral for him and perhaps interment in the Pantheon, alongside Rousseau and Voltaire. Nicolas Sarkozy proposed a mass at Les Invalides. Mr Ponticelli wanted none of that: no procession, no racket, pas de tapage important. He was grateful for his belated Lιgion d'Honneur, which he kept with his other medals in a shoe-box. But he was keenly aware that he drew such attention only because he was the last.

What had become of the others? The stretcher-bearers in the Argonne, for example, who had told him they didn't dare leave the trench for fear of German fire. The man he had heard from no-man's land, caught in the barbed wire and with his leg severed, screaming to be rescued, until Mr Ponticelli ran out to him with wire-cutters and dragged him back to the lines. The German soldier he tripped over in the dark, already wounded and expecting to be killed, who mutely held up his fingers to show him that he had two children. The comrades who helped him, because he could not read or write, to keep in touch by letter with the milkmaid he had met before the war. Or the four colleagues who held him down when, after the battle of Pal Piccolo, the army surgeon gouged out of his cheek a piece of shrapnel already lodged in gangrene.

With each new round of shelling, he said, they all expected the worst. They would reassure each other by saying, "If I die, you'll remember me, won't you?" Mr Ponticelli felt he had a duty to try, but struggled. These were mes camarades, les gars, un type: faces, not names. And as he faded, even those faces lost their last hold on the living. . .

On March 17th he had his wish, or most of it: a state funeral for all the poilus at Les Invalides, and then a simple family burial. The government badly wanted this last foot-soldier to be memorialised; but he preferred to be uncelebrated and ordinary, even in some sense forgotten, and thus the more symbolic of all the rest.

To read the entire obit, go to

On This Date in History - March 25

On this date in 1871, Gutzon Borglum, who sculptured Mount Rushmore National Memorial, was born in Bear Lake, Idaho. One of the ironies of history is that great artists who preserved history are themselves often forgotten. Gutzon Borglum, one of the greatest and certainly the most monumental of American Sculptors, carved the huge faces of Washington, Lincoln, Jefferson and Theodore Roosevelt from a natural rock mountain in South Dakota. As we ponder the glories of America let us not forget the people who made those glories real.

After Leonard and Thelma Spinrad