Community For Better Health Care

Vol XI, No 12, Mar 2013

In This Issue:

  1. Featured Article: It’s a good day for BABIES

  2. In the News: ObamaCare Tax Increases: Onward and Forever Upward

  3. International Medicine: Canadian Health Care

  4. Medicare: Another loss of access caused by Obamacare: When will it end?

  5. Medical Gluttony: Second opinions from a second emergency room are costly.

  6. Medical Myths: Whistle Blowers Keep Doctors in Line?

  7. Overheard in the Medical Staff Lounge: Don’t Bill Medicaid Patients. You lose in two ways.

  8. Voices of Medicine: Authentic Medic - Douglas Farrago MD, Editor, Creator & Founder

  9. The Bookshelf: Love in the time of Algorithms

  10. Hippocrates & His Kin: GOP senator backs same-sex marriage

  11. Restoring Accountability in Medicine, Government and Society

  12. Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

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The Annual World Health Care Congress

In April, the most forward-thinking health insurance, employer, hospital and health system executives and top health care thought leaders will come together to discuss transformative trends such as consolidation, transparency , quality metrics, engagement and procedural costs, payment model innovations.

Mention promo Code QPH357 and Save $300 off of the registration fee. Please take a moment to download the printable agenda (PDF)

As the national leadership forum to transform health care costs and quality, the 11th Annual World Health Care Congress drills down to find solutions to the challenges and issues facing health care executives in an unprecedented, peer-driven forum of open discussion and debate. 

SEVEN dedicated, educational Summits provide focused presentations, along with interactive discussion on emerging trends and solutions. Join many organizations already sending their executive teams to cover all seven summits that include:

These Summits take place April 7-9, 2014, at the 11th Annual World Health Care Congress (WHCC) in National Harbor, Maryland – the only health care meeting that simultaneously convenes all stakeholders to share global strategies and offers targeted summits focused on each health care sector. Please take a moment to download the printable agenda (PDF)

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  1. Featured Article: It’s a good day for BABIES

Or so says Rep Bette Grande, who introduced the bills.

North Dakota has all but enacted what would be two of the most restrictive abortion laws in the country. .

Even those in North Dakota who normally balk at government spending don't seem concerned about spending money on a fight over the U.S. Supreme Court's 1973 Roe v. Wade decision that legalized abortion.

"We have a lot of important things to spend money on," said Sen. Dwight Cook, a Republican from Mandan who chairs the Senate Finance and Taxation Committee and calls himself a fiscal conservative. "But I didn't give any consideration to the cost (of abortion litigation)."

Lawmakers on Friday sent Gov. Jack Dalrymple two anti-abortion bills, one banning the procedure as early as six weeks into a pregnancy and another prohibiting women from having the procedure based on the fetus' gender or because it has a genetic defect, such as Down syndrome. Abortion-rights activists have vowed to fight the measures in court. The battle is likely to be closely-watched by abortion foes and supporters of legal abortion across the U.S. Read more . . .

Dalrymple hasn't offered any hints as to where he stands on the abortion bills. . . "I think plenty of people in the party would love to push this to the Supreme Court and they would love to be the state that overturns Roe v. Wade," said Mark Jendrysik, a University of North Dakota political science professor who expects Dalrymple to sign the abortion measures into law. . .

Cook, who has served in the Legislature for 17 years, said he expects Dalrymple to sign the legislation.

"He's as pro-life as I am, and to what degree he looks at cost, I don't know," Cook said. "If I had to bet, I'd bet he signs them."

North Dakota is one of several states with Republican-controlled Legislatures and GOP governors that is looking at abortion restrictions. Arkansas passed a 12-week ban earlier this month that prohibits most abortions when a fetal heartbeat can be detected using an abdominal ultrasound. . .

A fetal heartbeat can generally be detected earlier in a pregnancy using a vaginal ultrasound, but Arkansas lawmakers balked at requiring women seeking abortions to have the more invasive imaging technique. North Dakota's measure doesn't specify how a fetal heartbeat would be detected.

North Dakota is uniquely positioned to undertake an expensive legal fight. Fueled by the unprecedented oil bonanza in the western part of the state, North Dakota now leads the nation in population growth, boasts a nearly $2 billion budget surplus and has the lowest unemployment rate in the nation. . .

Read more:

Murder is the unlawful killing, with malice aforethought, of another person, and generally this state of mind distinguishes murder from other forms of unlawful homicide (such as manslaughter). As the loss of a human being inflicts enormous grief upon the individuals close to the victim, and the commission of a murder is highly detrimental to the good order within society, most societies both present and in antiquity have considered it a most serious crime worthy of the harshest of punishment. In most countries, a person convicted of murder is typically given a long prison sentence, possibly a life sentence where permitted, and in some countries, the death penalty may be imposed for such an act – though this practice is becoming less common.[1] In most countries, there is no statute of limitations for murder (no time limit for prosecuting someone for murder). A person who commits murder is called a murderer.[2]

States have adopted several different schemes for classifying murders by degree. The most common separates murder into two degrees, and treats voluntary and involuntary manslaughter as separate crimes that do not constitute murder.

Under the common law, an assault on a pregnant woman resulting in a stillbirth was not considered murder; the child had to have breathed at least once to be a human being.[citation needed] Remedies were limited to criminal penalties for the assault on the mother and tort action for loss of the anticipated economic services of the lost child and/or for emotional pain and suffering. With the widespread adoption of laws against abortion, the assailant could be charged with that offense, but the penalty was often only a fine and a few days in jail.

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  1. In the News: ObamaCare Tax Increases: Onward and Forever Upward

Tax Prof Blog: ObamaCare Tax Increases Are Double Original Estimate

The Joint Committee on Taxation recently released a 96 page report on the tax provisions associated with Affordable Care Act. The report describes the 21 tax increases included in Obamacare, totaling $1.058 trillion – a steep increase from initial assessment, according to the Tax Prof Blog. The summer 2012 estimate is nearly twice the $569 billion estimate produced at the time of the passage of the law in March 2010. Read more . . . .


2010 Estimate, 2010-2019, $billion



2013-2022, $billion

0.9% payroll tax on wages and self-employment income and 3.8% t tax on dividends, capital gains, and other investment income for taxpayers earning over $200,000 (singles) / $250,000 (married)



Cadillac tax” on high-cost plans *



Employer mandate *



Annual tax on health insurance providers *



Individual mandate *



Annual tax on drug manufacturers/importers *



2.3% excise tax on medical device manufacturers/importers* 



Limit FSAs in cafeteria plans *



Raise 7.5% AGI floor on medical expense deduction to 10% *



Deny eligibility of “black liquor” for cellulosic biofuel producer credit 



Codify economic substance doctrine



Increase penalty for nonqualified HSA distributions *



Impose limitations on the use of HSAs, FSAs, HRAs, and Archer MSAs to purchase over-the-counter medicines *



Impose fee on insured and self-insured health plans; patient-centered outcomes research trust fund *



Eliminate deduction for expenses allocable to Medicare Part D subsidy



Impose 10% tax on tanning services *



Limit deduction for compensation to officers, employees, directors, and service providers of certain health insurance providers



Modify section 833 treatment of certain health organizations



Other Revenue Effects



Additional requirements for section 501(c)(3) hospitals



Employer W-2 reporting of value of health benefits



Total Gross Tax Increase:



* Provision targets households earning less than $250,000.

** Includes CBO’s $216.0 billion estimate for “Associated Effects of Coverage Provisions on Tax Revenues” and $6.0 billion within CBO’s “Other Revenue Provisions” category that is not otherwise accounted for in the CBO or JCT estimates.

Source: Joint Committee on Taxation Estimates, prepared by Ways and Means Committee Staff

Donna Andrews March 13, 2013 at 9:28 AM

And who, exactly, did NOT see this coming?


  1. Bud Mathis March 13, 2013 at 9:58 AM

  2. Who???? Me for one. I thought it would be much more than double

  3. Paul March 13, 2013 at 12:33 PM

  4. It will Bud, just wait a little longer.

  5. Donna Andrews March 13, 2013 at 11:11 AM

  6. Anyone who ever thought that Obamacare was about health care is an idiot. This was never about your healthcare....NEVER. From its very conception, this was about nothing more than control and money. Obama and Company couldn't care less about your health. They just want to control how you live. I challenge anyone to name for me one thing, just ONE thing, that the government cannot force you to do in the name of "healthcare". Just one little thing! It's time for Atlas to shrug.

Onward and Forever Upward!

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  1. International Medicine: Canadian Health Care

The Ugly Truth About Canadian Health Care
David Gratzer

Socialized medicine has meant rationed care and lack of innovation. Small wonder Canadians are looking to the market.

Mountain-bike enthusiast Suzanne Aucoin had to fight more than her Stage IV colon cancer. Her doctor suggested Erbitux—a proven cancer drug that targets cancer cells exclusively, unlike conventional chemotherapies that more crudely kill all fast-growing cells in the body—and Aucoin went to a clinic to begin treatment. But if Erbitux offered hope, Aucoin’s insurance didn’t: she received one inscrutable form letter after another, rejecting her claim for reimbursement. Yet another example of the callous hand of managed care, depriving someone of needed medical help, right? Guess again. Erbitux is standard treatment, covered by insurance companies—in the United States. Aucoin lives in Ontario, Canada.

When Aucoin appealed to an official ombudsman, the Ontario government claimed that her treatment was unproven and that she had gone to an unaccredited clinic. But the FDA in the U.S. had approved Erbitux, and her clinic was a cancer center affiliated with a prominent Catholic hospital in Buffalo. This January, the ombudsman ruled in Aucoin’s favor, awarding her the cost of treatment. She represents a dramatic new trend in Canadian health-care advocacy: finding the treatment you need in another country, and then fighting Canadian bureaucrats (and often suing) to get them to pick up the tab.

But if Canadians are looking to the United States for the care they need, Americans, ironically, are increasingly looking north for a viable health-care model. There’s no question that American health care, a mixture of private insurance and public programs, is a mess. Over the last five years, health-insurance premiums have more than doubled, leaving firms like General Motors on the brink of bankruptcy. Expensive health care has also hit workers in the pocketbook: it’s one of the reasons that median family income fell between 2000 and 2005 (despite a rise in overall labor costs). Health spending has surged past 16 percent of GDP. The number of uninsured Americans has risen, and even the insured seem dissatisfied. So it’s not surprising that some Americans think that solving the nation’s health-care woes may require adopting a Canadian-style single-payer system, in which the government finances and provides the care. Canadians, the seductive single-payer tune goes, not only spend less on health care; their health outcomes are better, too—life expectancy is longer, infant mortality lower. . .

I was once a believer in socialized medicine. I don’t want to overstate my case: growing up in Canada, I didn’t spend much time contemplating the nuances of health economics. I wanted to get into medical school—my mind brimmed with statistics on MCAT scores and admissions rates, not health spending. But as a Canadian, I had soaked up three things from my environment: a love of ice hockey; an ability to convert Celsius into Fahrenheit in my head; and the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people. When HillaryCare shook Washington, I remember thinking that the Clintonistas were right.

My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks. Read more . . .

I decided to write about what I saw. By day, I attended classes and visited patients; at night, I worked on a book. Unfortunately, statistics on Canadian health care’s weaknesses were hard to come by, and even finding people willing to criticize the system was difficult, such was the emotional support that it then enjoyed. One family friend, diagnosed with cancer, was told to wait for potentially lifesaving chemotherapy. I called to see if I could write about his plight. Worried about repercussions, he asked me to change his name. A bit later, he asked if I could change his sex in the story, and maybe his town. Finally, he asked if I could change the illness, too.

My book’s thesis was simple: to contain rising costs, government-run health-care systems invariably restrict the health-care supply. Thus, at a time when Canada’s population was aging and needed more care, not less, cost-crunching bureaucrats had reduced the size of medical school classes, shuttered hospitals, and capped physician fees, resulting in hundreds of thousands of patients waiting for needed treatment—patients who suffered and, in some cases, died from the delays. The only solution, I concluded, was to move away from government command-and-control structures and toward a more market-oriented system. To capture Canadian health care’s growing crisis, I called my book Code Blue, the term used when a patient’s heart stops and hospital staff must leap into action to save him. Though I had a hard time finding a Canadian publisher, the book eventually came out in 1999 from a small imprint; it struck a nerve, going through five printings.

Nor were the problems I identified unique to Canada—they characterized all government-run health-care systems. Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled—48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. A while back, I toured a public hospital in Washington, D.C., with Tim Evans, a senior fellow at the Centre for the New Europe. The hospital was dark and dingy, but Evans observed that it was cleaner than anything in his native England. 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. Across Europe, state-of-the-art drugs aren’t available. And so on.

Read the entire report . . .

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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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  1. Medicare: Medicaid: Another loss of access caused by Obamacare: When will it end?

The significant promotion of Obama’s Health Plan initiative was to provide greater access to health care for the poor and poorly covered Americans. California was at the forefront of placing their Medicaid recipients into HMOs. These patients were thrilled with having a health insurance card like most middle class American. They did not notice the GMS at the end of their ID numbers which they interpreted as still being part of the government Medical service. We didn’t either when we were asked to have 500 of these added to our panel. We have always had an average of 20 percent of our practice from Medicaid rolls as our fair contribution to the down and trodden since the reimbursement never equaled our cost of caring for them. Read more . . .

We were asked by our IPA (independent practice association) to accept 500 of these Medicaid/Welfare --recipients into the HMO portion of our practice, which was approximately half of our practice. We were promised improve reimbursement to the Medicare fee system for the first visit and a 10% improvement for the follow up visits. We had assumed that several of these would enter our practice on a weekly basis. It should not have been a problem with our single employee practice in the final years before retirement. She was my receptionist, publicists, patient scheduler, buyer/purchaser of all office supplies, inventory control officer, accounts manager, and my sole office manager for a very controlled practice. There were the usual phone calls from a half dozen patients to schedule appoints, reps to be scheduled for five minutes of my time, daily charts to be processed, and filed. She was busy.

The very first day after these 500 welfare patients were added to our obligations, we had 65 messages on the phone the next morning instead of the usual three or four. These messages came in at all hours of the day and night. It took her two hours to record all the messages and another three hours to process all the messages. This rate continued on a daily basis. It was then that we realized that these patients did not have jobs. But they all had cell phones and could call from any place they were, day or night. We found that most of these had not been to a physician for three to 15 years. So there were no significant records to be transferred most of the basic informational data which greatly reduces the initial consultation in the usual new patient. It takes about twice as much time to obtain a complete medical history from the medically unsophisticated. Just to record the dates of a patient’s operations takes seconds to record from a prior record or from the medically informed as it does from a medical illiterate who begins to answer such a question with let’s see, we were living in Oklahoma at the time, my eldest was just starting the first grade, and . . . . . the year of her cholecystectomy took five minutes instead of five seconds. So the first initial office consultation, examination, ordering lab testing, x-ray requests and prescription writing grew from 45 minutes to 75 minutes. But we got paid Medicare rates of $85. But when these patients returned for their office visits to review their status, response to drugs, go over their lab and x-ray data, make plans for their future care, the office call increased from 15 minutes to 25 minutes. But remember we would get a 10% boost in payment. It took a few months before the data came in and we noticed that the HMO vs Medicaid reimbursement for office visits had increased from $18 to $19.80 under the HMO coverage.

We also found out that our referral arrangements were no longer valid. Some of them noted the GMS at the end of their ID number and tracked them immediately and found the reimbursement was not significantly different than Medicaid and refused to see them. So these patients had far less access to care in their new arrangements than they had with Medicaid. The HMO had to find consultants for these patients in more remote areas. We felt uncomfortable to refer patients to consultants we didn’t know. This increases our liability also. When the HMO said that they could not find any consultants in one specialty that we needed for our patient in the Sacramento area, and gave us the name of a physician in San Francisco, about a hundred miles west of here, we were convinced that Obama’s promised of improved access in his plan was a blatant lie, we sorrowfully knew we had to make plans for withdrawal from this component of humanity.

These patients also gave us greater cause for concern. I always greeted these patients in the waiting room, welcomed them to my practice with a nice warm and friendly hand shake. One patient complained that I held her hand too long. Another asked me at the end of her exam, what could she do about her obesity, I pointed to her abdomen and gave my usual spiel (which is identical to the one Weight Watchers uses) that to maintain her weight of 180 pounds, she was eating 1800 calories. If she would reduce that by 500 calories a day, then in a 7 day week, she would lose 3500 calories which equals one pound. She complained to her HMO that I had called her a fatty, which then directs it to the State Department of Health Services, and hours can be spent on clearing this complaint that never happened. The state feels they need to pacify their “members” and makes such recommendations as “we have advise your doctor to take a course in sensitivity training” or take a course on “HIPAA Compliance.” Such little items on an evaluation form can cause great jeopardy to one’s license and we knew we had to make changes.

We also have completed 40-years of hospital and critical care pulmonary medicine practice having had as many as ten patients on life support in several hospitals at the same time. About five years ago, we moved our office into suburban Sacramento in Carmichael and continued with an ambulatory practice. This was reasonable since the hospitals had all established hospitalists to take care of inpatients. This has been common practice for decades for most physicians. However, our IPA and HMO were so desperate to become an Accountable Care Organization under Obamacare, that they used force to place patients. We were threatened to accept a patient on a gurney. We tried to reason with the HMO that such patients do not belong in an ambulatory care setting, but in a practice that saw hospital patients on a regular basis.

And so after six months, when my one person office staff gave me notice, I had to give my IPA notice that we had to withdraw from the remainder of the 500 welfare patients and extended to the President our apologies that his plan was not working. Their access to care was far worse despite our valiant attempts to improve it, they took more than twice as much professional time to deliver less than a quality of care that they did not understand and generally did not appreciate, that their hostility to my services were hazardous to my professional health, and the reimbursement for our professional care was less than their cost to me.

We should have followed the practice of Sandy Marcus, MD, President of the Physician’s Union, who accepted welfare as 10 percent of his practice, but never added the cost of billing and general harassment from Medicaid which he felt would exceed the 10% contribution to welfare by seeing these patient free.

So we decided it was good policy to see our long term welfare patients, which are 20% of our practice, avoid the cost of billing and make it a true charity. As long as physicians accept any welfare payments, no one recognizes our work. By eliminating accepting payment, the public recognizes this as charity, gains respect and profession status, with no loss in income.

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

- Ronald Reagan

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  1. Medical Gluttony: Second opinions from a second emergency room are costly.

Josie came to the office recently under duress. She hadn’t been seen for more than 18 months. She was trying to get not only refills, but new medications by phone without evaluation for their need. This not only is a violation of the medical practice act by obtaining refills without a current exam which has generally been interpreted as one year for the same type of illness, but also malpractice by requesting a new medications without an appropriate medical history and examination. For instance, if a new medication is given and the patients explanation for the need is not medically correct and the patient has an adverse event, in a malpractice case, the doctor will always be held responsible to which the patient would agree in the court room situation, even if she had agreed in the phone consultation without an exam. Read more . . .

On interviewing Josie, she had been to the Emergency room of one hospital the previous month and didn’t like their evaluation and obtained a second Emergency room evaluation at another hospital a few days later. When seen, she was unhappy with the second evaluation also. Now I was supposed to be the final arbitrator. I could tell from her stern look, it was not just being forced in for an exam, it was more like a “Do or Die” look. So I gave her the time of two appointments, knowing pushing the entire day’s schedule back 20 minutes would be the least risky approach.

I had some excellent charts on the anatomy of the ears, sinuses and nasal passages and how nasal allergies, congested ears of a serous otitis situation, diminished hearing from the fluid behind the ear drum, slight vertigo from this congestion involvement of the balance semicircular canals in the middle ear, can make this very difficult to treat without a multipronged approach. I suggested she moisturize her nasal and sinus passages with saline, use antihistamine and steroid nasal spray, nocturnal antihistamines plus antimicrobial cleaning would be necessary. Since the primary problem occurred at night, there must be something in her bedroom to which she was allergic. She was sleeping on a feather pillow and her pet was sleeping on her bed and these two issues also needed to be address.

I could tell that this didn’t sit well with her, and that I would be her next complaint of a doctor now knowing how to diagnose and treat. So I completed a rather thorough exam, refill all her other medications for another three months, asked her if she had any questions. She said it wouldn’t do any good, anyway. I then told her that it appeared that all her medical needs had been address, and she should call her HMO that after noon or in the morning at the latest, and get herself reassigned to another physician.

Observations: My IPA (independent practice association) which contracts with various HMOs stated in a recent meeting. The average statement from most emergency rooms was in the $thousands, they were usually able to settle for $600 or slightly more. To go from one ER to another is a cost that welfare patients as well as regular HMO patients do not understand. Hence, there is no limit to their gluttony. Oversights from the HMOs have not made a serious dent in this cost. Our clinical data from years of observations has found that a 20% co-payment for emergency care, at the time of registration, would reduce over half of the unneeded ER costs which would not diminish the quality of care. In other words, collecting $120 at the ER registration desks makes the patient instantly re-evaluate whether she really has an emergency. In our surveys, approximately three-fourths, would cancel their registration and go home. They will see their own physician the next day, or use basic treatment in their medical cabinet and feel better the next day.

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Medical Gluttony thrives in Government and Health Insurance Programs.

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

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  1. Medical Myths: Whistle Blowers Keep Doctors in Line?

WASHINGTON, DC . . . the whistleblowers and persons of conscience will hold the fifth annual gathering on Capitol Hill, focused on signature issues of Judicial Accountability, Medical Integrity and expanding education and awareness of whistleblower issues, particularly in light of consideration of the preventable **disasters that have beset the United States. Advocates from around the country to meet in the Nation's Capitol and encourage their lawmakers to pass the protection for whistleblowers.

As the Nation's budget crisis continues to grow, lawmakers must be encouraged to look towards the activities of corporate and federal whistleblowers in assuring proper spending.

Registration and details at

Dear Scoop Readers and Writers,

Scoop has been crucial to the public interest, and in exposing matters of critical interest to the nation. Now, all of us are having a National Meeting to press our agenda to Congress. OEN has consistently pursued the public interest and whistleblower rights. We have a once in a lifetime opportunity to make our voices heard, and to meet and make the public aware of the crisis in rights

We Need Every Single OEN reader and writer to attend. Please send this invitation everywhere. We need all interested citizens. Please examine:

The IAW is non-political, and non-aligned. The IAW seeks to provide a forum for citizens of conscience to meet, network, and seek new relationships and mentoring in the struggle to bring integrity to healthcare.

Now is the time for all public minded and enlightened citizens to band together. The International Association of Whistleblower Caucus will be held in Washington, DC: Read more . . .

Included in the IAW Caucus are many signature panels and events:
    A ceremony to Honor Absent Heroes; a "empty chair" panel will represent four outstanding whistleblowers that cannot attend the meeting because they are in prison or are deceased:
    Martin Salazar, former Dept. of Energy employee
    Bradley Birkenfeld, former UBS banker
Mordechai Vanunu, former Israeli nuclear technician
   Karen Silkwood, Kerr-McGee technician (deceased)

Other absent heroes will also be honored in a roll call of those lost while serving the nation's interests.

   Atlanta Whistleblowers will discuss the alarming problems in Georgia including the eruptions of scandals in schools, hospitals and courts. Dr. Helen Salisbury and her colleagues will ask: "Can the Patient Quality Care Project Bring Integrity back to Medicine?"

  Medical Whistleblowers will report on need for improvements at the nation's for-profit hospital chains.

       A special session will be provided by OpEdNew's own Rob Kall and Joan Brunwasser and Tapping the Power of Media "How can we use the power of story, and new internet media, to promote social justice?

More events can be seen on the IAW website. Whistleblowers from all walks of life are welcomed. Membership is being enlarged. The IAW will also host social events and booksignings. Every single person attending will have the opportunity to have their story recorded for U-tube.  This event is "of, by and for the whistleblower."

"Starting today, every agency and department should know that this administration stands on the side not of those who seek to withhold information, but those who seek to make it known."

We encourage all 264 organizations and corporations that signed the Whistleblower letter to join us! We are already bonded by a shared principle that "whistleblower protection is a foundation for any change in which the public can believe. It does not matter whether the issue is economic recovery, prescription drug safety, environmental protection, infrastructure spending, national health insurance, or foreign policy."

Medical Truth: Whistleblowers will restore integrity in medicine by bringing hospitals in line.

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Medical Myths originate when someone else pays the medical bills which eliminates Market forces.

Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service. This returns utilization and pricing to their lowest level as determined by market forces, essentially halving costs and utilization.

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  1. Overheard in the Medical Staff Lounge: Don’t Bill Medicaid Patients. You lose in two ways.

Dr. Rosen: What’s new in Obamacare this week with the welfare patients being placed in HMOs?

Dr. Dave: The oppression is beginning early. We had eliminated referrals from what appeared like HMOs except for the little Medical mark after the HMO name.

Dr. Rosen: We had an outside business consultant review our finances. My attorney had advised me to close my practice since it was no longer profitable. I would like to practice another ten years or so.

Dr. Ruth: Did you find any useful information? Read more . . .

Dr. Rosen: We found out our HMO was paying us about 70 percent of our fee. We found that Medicare was paying us about 60%. Most private insurers were paying us between 50% and 70% of our usual and customary fee.

Dr. Dave: What’s surprising to me is that Medicare is still paying you more than 50%. The last time we looked at our surgery reimbursements, Medicare was at less than 50%.

Dr. Patricia: We’re getting about the same from Medicare. It’s always over 50% and it fluctuates to over 60% at times.

Dr. Sam: That’s why I don’t participate in any government plan whether it’s Medicare or Medicaid. The arrogance of their paying bills at whatever level they wish. Aren’t we the only profession that tolerates such discrimination?

Dr. Rosen: Sam, putting the discussion in that frame of reference, reminds me that the biggest surprise was the Medicaid program. We didn’t average even 10% of our fee.

Dr. Sam: Looks like you’re finally waking up to government medicine.

Dr. Rosen: It even gets worse. Of the seven Medicaid patients we saw the last quarter, our total income was $25.

Dr. Ruth: That’s not even the cost of billing!

Dr. Rosen: That’s precisely the point I was leading up to. We then decided not to bill the state for their welfare patients. We will see them totally as charity.

Dr. Patricia: That’s the only way that the patients will see it as charity. As long as you bill, they’ll think that you’re making money. They can’t conceive that you’re losing money. In fact they think that your $25 for seven patients is income. That doesn’t covering one hour of staff time to provide their services.

Dr. Rosen: When Dr. Sanford, who was the president of the Union of American Physicians and Dentist, spoke to our group in the 1970s, Medicaid patients receive two small stickers about a quarter inch by a half inch per month, he said he would never stoop to such an insulting menial task as the paste these to an insurance form and told all his Medicaid patients that he would see them free as often as they needed him.

Dr. Milton: I also remember him saying that they were more appreciative of his services when it was real charity.

Dr. Ruth: It’s basically charity either way. But as long as you’re losing the cost of billing, and each patient costs you the price of billing with essentially no income from them, the patient is a liability.

Dr. Milton: The patients don’t see it that way.

Dr. Ruth: The State doesn’t see it that way either. They see a $100 fee and pay the doctor $10. This obviously means that doctors are charging their patients ten times what they’re worth and that’s why doctors are rich.

Dr. Rosen: So I think we’ve come to the consensus that it’s probably not financially advisable to even bill the State for Medicaid patients. And it’s even a bad public relations endeavor. Maybe that’s also why we see such hostility from state employees.

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The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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  1. Voices of Medicine: Authentic Medicine - Douglas Farrago MD, Editor, Creator & Founder


The mission of Authentic Medicine is to rediscover how much the art of medicine means and allow us to reconnect to our roots once again. It is about fighting back against those things that are taking us away from the direct care of patients while still pointing out the lunacy and hypocrisy of this job. Be part of the movement that will take back the healthcare system from the idiots who are ruining it.

Douglas Farrago MD is a full-time practicing family doc in Auburn, Maine.  He is board certified in the specialty of Family Practice.  He is also the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver, and its knock-offs, are worn by many major league baseball catchers.

From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years.  He was featured in the Washington Post, US News and World Report, the AP, and the NY Times.

Authentic Medicine was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. Only when physicians regain control and connect back to the roots of this profession will we ever have AUTHENTIC MEDICINE again. Read more . . .

about this site

Authentic Medicine is about connecting us back to the roots of medicine.  This online “magazine” will constantly be updated with informative and challenging opinions and ideas.   The goal is to fight back against those things that are taking us away from the direct care of patients while still pointing out the lunacy and hypocrisy of this job.  It is the evolution of what I was really trying to accomplish by the end with the Placebo Journal.

Physicians and patients need to join together to form the “Authentic Medicine Movement”.  This is not about being Republican or Democrat. It is about opening up a dialogue and keeping that conversation going. You may hate some of the things I say.  I may hate some of your comments.  It doesn’t matter.  

The wrong people (politicians, businessmen, and administrators) are running and ruining this healthcare system.   We need to speak up and be part of the NEVER ENDING DEBATE.

Issues that I am concerned about:

I would be honored if you can check out the site and tell me what you like or dislike so far.  Come back regularly as new items are added daily (at least).

Email Dr. Farrago –

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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about

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  1. Book Review: Love in the time of Algorithms

Online dating is awash with deviance. There are perverts, scammers and misanthropic entrepreneurs all hellbent on profiting from loneliness. But then there are women like Laura Brashier, a 37-year-old hairdresser from California and a survivor of cervical cancer. Her treatment left Ms Brashier unable to have sex. Read more . . . Rather than endure the anxiety of conventional dating she decided to set up a dating site for people like her. 2Date4Love describes itself as the site for “people who cannot engage in sexual intercourse to meet and experience love, companionship and intimacy at its deepest level. Since its creation in 2011, it has enrolled thousands of members who might otherwise have struggled to find romance.

WSJ Jan 29, 2013, A13 Bookshelf.

This book review is found at .

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The Book Review Section Is an Insider’s View of What Doctors are Reading about.

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  1. Hippocrates & His Kin: GOP senator backs same-sex marriage

U. S. Senator Rob Portman, is the first GOP senator to back same-sex marriage, after announcing that he has a gay son and could no longer justify his opposition to same-sex marriage. That statement, in and of itself, would normally remove him from any objectivity in the debate. He was a sponsor of the 1996 Defense of Marriage Act, which was reviewed by the Supreme Court. That case, he said, was a factor in his decision to speak out. Read more . . .

Or is this a factor in delaying his “coming out of the closet” announcement?

Britain investigates price fixing for the Shock Absorber Bra

The Shock Absorber Bra was once advertised by tennis player Anna Kournikova under the slogan: “Only the balls should bounce.” It is now being investigated for price fixing.

Was it really that the “price that was fixed” or that the “mammae were not fixed?”

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow

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  1. Restoring Accountability in Medical Practice, HealthCare, Government and Society:

Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"

Our motto, "omnia pro aegroto" means "all for the patient."

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  1. Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

Words of Wisdom

Party loyalty lowers the greatest of men to the petty level of the masses. –Les Caracteres.

The greater our knowledge increases the more our ignorance unfolds. –John Fitzgerald Kennedy (1917-63), U.S. Statesman. Speech, Rice University, 12 Sept 1962.

In my early years I read very hard. It is a sad reflection, but a true one, that I knew almost as much at eighteen as I do now. –Samuel Johnson, Life of Johnson (J. Boswell), Vol I

Some Recent Postings

In The February Issue:

  1. Featured Article: P r a c t i c e F u s i o n , # 1 Wi t h 25 M E l e c t r o n i c M e d i c a l R e c o r d s , D e b u t s I Pad App

  2. In the News: The Real Star War

  3. International Medicine: Single-Payer National Health Insurance around the World

  4. Medicare: In Healthcare reform, there is a perverse incentive to be uninsured

  5. Medical Gluttony: Frequently not recognized by patient, family, hospital, or physician

  6. Fiscal Myths: The Tax, Spend, and Regulate (TSR) Party can’t manage city finances either.

  7. Overheard in the Medical Staff Lounge: Has Obamacare Arrived early?

  8. Voices of Medicine: An Israelis Psychiatrist says Obama has a Mental Disorder

  9. The Bookshelf: The American Conservatory Theatre: Dead Metaphor

  10. Hippocrates & His Kin: Now we know why the Editor of Medical Tuesday was targeted.

  11. Restoring Accountability in Medicine, Government and Society

  12. Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

In Memoriam

Beate Sirota Gordon, interpreter of Japan to Americans, died on December 30th, aged 89

The ECONOMIST | Jan 12th 2013 | From the print edition

DRAFTING a constitution isn’t something one does every day. It took Washington, Franklin and Co several months to achieve, that steamy summer in Philadelphia in 1787. When Beate Sirota was roped in to do it, in chilly, ruined Tokyo in the spring of 1946, she was amazed. She was no lawyer. She was 22, and only just an American citizen. Her idea of fun was going out every night. She had tagged on to General MacArthur’s occupation army mostly to find her parents, whom she had left in Japan before the war. Her job, which she did very well, was to translate Japanese. But suddenly there she was, called in with two dozen men, to write—in deepest secrecy—the basic law for post-war Japan. In a week. “Beate, you’re a woman,” said her colleagues. “Why don’t you do the bit about women’s rights?” “Wonderful, I’d love to!” she cried—and then realised she had no idea how.

She saw all too clearly, though, how women were treated in Japan. From the age of five to 15 she had lived there while her father Leo Sirota, a concert pianist from Ukraine, taught at the Imperial Academy. The land seemed enchanted to her, all exquisite gardens and cherry blossom and black-eyed, straight-haired children with whom, unusually for a Westerner, she was allowed to play. Over puppet shows and shuttlecock games she picked up the language, she claimed, in just three-and-a-half months. And she learned other things. Japanese women, for example, never came to her mother’s parties. Only the men came. Japanese women would serve their husband’s friends dinner, then eat alone in the kitchen. In the street they always walked three or four paces behind the men. They were usually married to men they did not know, could inherit nothing, and could even be bought and sold, like chattels. Read more . . .

Fired with her task, she raced in a requisitioned Jeep round Tokyo, borrowing other countries’ constitutions from war-battered libraries. Rattling through them, she produced what became Article 24:

Marriage shall be based only on the mutual consent of both sexes and it shall be maintained through mutual co-operation with the equal rights of husband and wife as a basis. With regard to choice of spouse, property rights, inheritance, choice of domicile, divorce and other matters pertaining to marriage and the family, laws shall be enacted from the standpoint of individual dignity and the essential equality of the sexes.

There was plenty more, as she warmed to her mission: women’s right to paid work, to custody of children, to equal education. Much of it was stripped out, because it made the men’s eyes water on the American side as much as the Japanese. A kindly colonel pointed out that she had put in far more rights than were in America’s constitution. She fired back that that wasn’t hard. He told her that matters like divorce did not belong there. She informed him, from long experience of trying to sort out her parents’ papers with Japanese bureaucrats, that if rights were not already mentioned in a constitution they would never be written into the civil code. Then, to her huge vexation, she burst into tears.

The Japanese negotiators hated Article 24. But because they liked her, and because they were told that “Miss Sirota’s heart is set on this” (with no word of the fact that this mere girl had also written it), they acquiesced. And so, to her astonished satisfaction, history was made. Whenever she visited Japan in later years women would cluster round to take her photograph, press her hand and thank her for her gift to them . . .

Immersed in all this, and aware that her post-war work had been secret, she never mentioned her constitution-drafting until 1995, when she wrote a memoir. After that, she was full of it. Yet, when all was said and done, she did not think Article 24 was the most important clause in Japan’s post-war constitution. That honour, she said, belonged to Article 9, under which Japan renounced war and embraced peace. And hers was second.

Read the entire obituary in The Economist . . .

On This Month in History - March

Anniversaries are a convenient way to illustrate how times have changed. In 1840, for example, President James Van Buren established a ten-hour work day for government employees, as a means of bettering their working conditions. Now more people than ever work a ten hour day – venture capitalist, physicians, CEOs of industry, and many others. The only exception may now be government employees. (Email me your exceptions at

Secretary of State William H. Seward completed the negotiations for the U.S. purchase of the Alaskan territory from Russia at a price of $7.million. Critics called the deal Seward’s Folly. May we commit similar follies in our own time.

After Leonard and Thelma Spinrad

Thank you for joining the MedicalTuesday.Network and Have Your Friends Do the Same. If you receive this as an invitation, please go to, enter you email address and join the 10,000 members who receive this newsletter. If you are one of the 80,000 guests that surf our web sites, we thank you and invite you to join the email network on a regular basis by subscribing at the website above. To subscribe to our companion publication concerning health plans and our pending national challenges, please go to and enter your email address. Then go to the archives to scan the last several important HPUSA newsletters and current issues in healthcare.

Please note that sections 1-4, 6, 8-9 are entirely attributable quotes and editorial comments are in brackets. Permission to reprint portions has been requested and may be pending with the understanding that the reader is referred back to the author's original site. We respect copyright as exemplified by George Helprin who is the author, most recently, of “Digital Barbarism,” just published by HarperCollins. We hope our highlighting articles leads to greater exposure of their work and brings more viewers to their page. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.

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

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Del Meyer, MD, Editor & Founder

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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, any single payer initiative, Social Security was born for the benefit of the state and of a contemptuous disregard for people’s welfare.

We must also remember that ObamaCare has nothing to do with appropriate healthcare; it was similarly projected to gain loyalty by making American citizens dependent on the government and eliminating their choice and chance in improving their welfare or quality of healthcare. Socialists know that once people are enslaved, freedom seems too risky to pursue.