Community For Better Health Care

Vol X, No 20, Jan 31, 2012


In This Issue:

1.                  Featured Article: Understanding Lung Function

2.                  In the News: Have you thought about Outsourcing your New Year’s Resolutions?

3.                  International Medicine: Schumpeter: Saving Britain's health service

4.                  Medicare: Clowns to the left of me, jokers to the right

5.                  Medical Gluttony: A Letter from the HMO concerning an 85-year-old patient with a stroke

6.                  Medical Myths: The High Cost of Technology

7.                  Overheard in the Medical Staff Lounge: There will be no effective opposition to Obama

8.                  Voices of Medicine: From the North Coast Physician

9.                  The Bookshelf: The Unbreakable Bond Between a Marine and His Military Working Dog

10.              Hippocrates & His Kin: The Low Cost of Technology

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

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

* * * * *

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.

* * * * *

1.      Featured Article: Understanding Lung Function

Ahem! These Cells Help Clear Your Lungs by Ann Chin | Scientific American | January 25, 2012

Courtesy of Chris Kintner, Matthew Joens and James Fitzpatrick/Salk Institute for Biological Studies

Scientists recently identified the gene that instructs certain cells to develop hairlike structures called multiple cilia, which move mucus out of the lungs to prevent infection. Christopher Kintner and his team at the Salk Institute for Biological Studies made this discovery working with Xenopus laevis (African clawed frog) embryos. The scanning electric microscope image, below, magnified at 7,000 times actual size, shows the gray surface of embryonic cells, which sprout hundreds of pink cilia that beat in one direction to push fluids along. These multiciliated cells form on the outside of the frog embryos, making the cells easy to study. Read more . . .

Ahem! These Cells Help Clear Your Lungs

Kintner says this research is a step toward a better understanding of how cilia form and function. His finding, which appears in the January 8 online issue of Nature Cell Biology, may be an important tool for creating multiciliate cells from embryonic stem cells. "In the lung, multiciliate cells are [of] major importance to cell population, and knowing how to generate these cells is the basis for producing the methods and therapies for tissue regeneration," Kintner says. (Scientific American is part of Nature Publishing Group.)

—Ann Chin

Read the article at Scientific American – subscription required . . .
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

* * * * *

2.      In the News: Have you thought about Outsourcing your New Year’s Resolutions?

To Stick to New Year's Resolutions, Try Outsourcing Them

Elizabeth Bernstein

If you'd like to make your New Year's resolutions stick, try this: Have someone else—a significant other, your best friend, maybe even your mom—make them for you. Read more . . .

Sure, resolutions are supposed to be personal. People can't change unless they're ready to change. And having someone you love tell you how you could become a better person could be terrifying.

But Mark Twain pretty much got it right when he said we make our annual good resolutions on New Year's Day and "begin paving hell with them as usual" the following week.

Most of us could use help achieving our goals. Who better to tell us how to improve ourselves than someone who knows us well—perhaps better than we know ourselves—and even may be all too happy to offer up some tough love? And if we promise to check in regularly with this person to discuss our progress, we'll probably do a much better job of keeping our resolutions.

"We all have blind spots, but the people we are intimate with can see through them," says David Palmiter, a couples therapist and professor of psychology at Marywood University, in Scranton, Pa. A loved one can encourage us to meet our goals and hold us accountable when we slip, he says.

Elizabeth and Michael Singer made each other's New Year's resolutions last December while driving home to New York after spending Christmas in Washington, D.C. Ms. Singer, a 55-year-old psychoanalyst, broached the subject. Her husband, 54, had retired from his antique jewelry business several years earlier and was feeling restless. He was also spending a lot of time at home. She suggested a goal for him for the coming year: "Start a new company. Get out of my hair."

The couple, who have been married 19 years and live in Forest Hills, N.Y., brainstormed about what type of business Mr. Singer could create. Then, Ms. Singer came up with two more resolutions for her husband: Choose movies that the entire family would want to watch together. And eat more healthfully.

"Next year, the sandwich named for you at the corner deli will be tofu and sprouts, not pastrami with roasted peppers and Russian dressing," she told him.

Then she did something really brave. She asked her husband to come up with resolutions for her. At first, he insisted that she was perfect. ("I didn't want to hurt her feelings," he says.) Eventually he gave her three goals: Be more adventurous and bold. Stop criticizing yourself so much. Cook dinner twice a month.

The Singers took their resolutions seriously. In February, Mr. Singer launched a tutoring company. He has started eating salads and sushi. Meanwhile, Ms. Singer has taken a writing workshop and created a group therapy program for actors. And she has been trying to silence her inner drillmaster . . .

Read the entire report in the WSJ – Dec 27. 2011 – Subscription required . . .
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

* * * * *

3.      International Medicine: Schumpeter:  Saving Britain's health service

The NHS needs to learn from innovations in the rest of the world

The Economist | from the print edition | Jun 16th

NO SPECTACLE is “so ridiculous as the British public in one of its periodical fits of morality”, harrumphed Thomas Macaulay, a Victorian historian. Today there is no spectacle so ridiculous as the British public in one of its periodic fits of panic about the National Health Service (NHS). Every decade or so the government tries to reform the NHS—and every decade or so the NHS masses its forces to work the public into a frenzy. Read more . . .

Doctors threaten to strike against “privatisation”. Bishops bleat that anxiety stalks the land. The BBC waves blood-stained sheets. And the government eventually backs down. Thus it was with Margaret Thatcher and (more mutedly) with Tony Blair. And thus it is with David Cameron, who came to office promising to reinvent the welfare state but now promises that the NHS of the future “will be much like what we have today”.

This is a mind-boggling statement. The internet and the mobile phone are revolutionising social life. New drugs and surgical techniques are revolutionising treatment and prolonging life. Entrepreneurs and innovators are demonstrating that you can use new technology and clever business models to deliver better health care for less money. As Britain ages and its medical bills soar, the NHS must experiment or die.

The NHS was built on the idea that patients are passive recipients of medical wisdom, most of it delivered face-to-face. This is beginning to change: doctors now advise patients to take exercise and eat their vegetables. But it has a long way to go. The private sector has revolutionised productivity by getting customers to do more things for themselves. Rather than waiting for a butcher or baker to serve us, many people now choose their own groceries and scan them themselves at the checkout. This model is now reaching health, too .  .  .

Much of the pressure for a more collaborative approach to health care is coming from the bottom up—from patients themselves and from what David Cameron calls the “big society”. Voluntary organisations such as Alcoholics Anonymous have a better record than the NHS at teaching people to look after themselves. People who suffer from rare or debilitating diseases form online groups such as PatientsLikeMe and WeAreUs to swap advice and support each other. There is a growing community of “quantified selfers” who monitor their own bodily functions and hold meetings to discuss their results. This combination of monitoring and self-help holds the key to cost control as well as improved health: about 75% of NHS spending is devoted to 17.5m people who suffer from long-term problems.

The NHS was also built on the assumption that general hospitals are the flagships of the system. (Mr Cameron promises to defend them.) But across the developing world entrepreneurs are demonstrating that “focused factories”, to use the jargon, can use economies of scale and intense specialisation to improve productivity. The Narayana Hrudayalaya Hospital in Bangalore has reduced the cost of heart surgery to $2,000 (60% cheaper than most Indian hospitals). Its 42 surgeons perform an impressive 3,000 operations a year. They become virtuosos in their sub-specialisms. LifeSpring Hospitals, an Indian chain, has used standardised procedures, borrowed from manufacturing, to reduce the cost of delivering a baby to $40, a fifth of the cost at comparable local hospitals. Every year the Aravind Eye Hospital performs 70% of the number of eye operations performed by the entire NHS for just 1% of the cost. . .

Wanted: a medical Martin Luther

The struggle for NHS reform has not been completely lost. On June 8th Reform, a think-tank, staged a conference on “disruptive innovation” in health care. NHS veterans repeated the old saw that the NHS is the closest thing Britain has to a national religion. But they also listened excitedly as Indians and Mexicans told stories of innovations back home. And they produced numerous examples of innovations of their own. NHS Direct, a hotline, dishes out medical advice by phone and the internet to 8m people. Boots and Specsavers, two high-street stores, apply something like the franchise model to the distribution of spectacles. Pointing out flaws in a nation’s religion will seldom win you friends. But sometimes it takes a Reformation to save a church. | from the print edition | Business
Read more . . .
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

The NHS does not give timely access to healthcare; it only gives access to a waiting list.

* * * * *

4.      Medicare: Clowns to the left of me, jokers to the right

How Doctors are Trapped By John Goodman

Health Alerts | January 16, 2012

Every lawyer, every accountant, every architect, every engineer — indeed, every professional in every other field — is able to do something doctors cannot do. They can repackage and reprice their services. If demand changes or if they discover a way of meeting their clients’ needs more efficiently, they are free to offer a different bundle of services for a different price. Doctors, by contrast, are trapped. Read more . . .

To see how trapped, let’s look at another profession: the practice of law. Suppose you are accused of a crime and suppose your lawyer is paid the way doctors are paid. That is, suppose some third-party payer bureaucracy pays your lawyer a different fee for each separate task she performs in your defense. Just to make up some numbers that reflect the full degree of arbitrariness we find in medicine, let’s suppose your lawyer is paid $50 per hour for jury selection and $500 per hour for making your final case to the jury.

What would happen? At the end of your trial, your lawyer’s summation would be stirring, compelling, logical and persuasive. In fact, it might well get you off scot free if only it were delivered to the right jury. But you don’t have the right jury. Because of the fee schedule, your lawyer skimped on jury selection way back at the beginning of your trial.

This is why you don’t want to pay a lawyer, or any other professional, by task. You want your lawyer to be able to reallocate her time — in this case, from the summation speech to the voir dire proceeding. If each hour of her time is compensated at the same rate, she will feel free to allocate the last hour spent on your case to its highest valued use rather than to the activity that is paid the highest fee.

Clowns to left of me, jokers to the right
Here I am, stuck in the middle with you

In a previous Health Alert, I noted that Medicare has a list of some 7,500 separate tasks it pays physicians to perform. For each task there is a price that varies according to location and other factors. Of the 800,000 practicing physicians in this country, not all are in Medicare and no doctor is going to perform every task on Medicare’s list.

Yet Medicare is potentially setting about 6 billion prices across the country at any one time.

Is there any chance that Medicare can get all those prices right? Not likely.

What happens when Medicare gets them wrong? One result: doctors will face perverse incentives to provide care that is costlier and less appropriate than the care they should be providing. Another result: the skill set of our nation’s doctors will become misallocated, as medical students and practicing doctors respond to the fact that Medicare is overpaying for some skills and underpaying for others.

The problem in medicine is not merely that all the prices are wrong. A lot of very important things doctors can do for patients are not even on the list of tasks that Medicare pays for. Some readers will remember our Health Alert on Dr. Jeffrey Brennan in Camden, New Jersey. He is saving millions of dollars for Medicare and Medicaid by essentially performing social work services to reduce spending on the most costly patients. Because “social work” is not on Medicare’s list of 7,500 tasks, Brennan gets nothing in return for all the money he is saving the taxpayers.

We have also seen that there are other omissions — including telephone and e-mail consultations and teaching patients how to manage their own care.

In addition, Medicare has strict rules about how tasks can be combined. For example, “special needs” patients typically have five or more comorbidities — a fancy way of saying that a lot of things are going wrong at once. These patients are costing Medicare about $60,000 a year and they consume a large share of Medicare’s entire budget. Ideally, when one of these patients sees a doctor, the doctor will deal with all five problems sequentially. That would economize on the patient’s time and ensure that the treatment regime for each malady is integrated and consistent with all the others.

Under Medicare’s payment system, however, a specialist can only bill Medicare the full fee for treating one of the five conditions during a single visit. If she treats the other four, she can only bill half price for those services. It’s even worse for primary care physicians. They cannot bill anything for treating the additional four conditions.

Since doctors don’t like to work for free or see their income cut in half, most have a one-visit-one-morbidity-treatment policy. Patients with five morbidities are asked to schedule additional visits for the remaining four problems with the same doctor or with other doctors. The type of medicine that would be best for the patient and that would probably save the taxpayers money in the long run is the type of medicine that is penalized under Medicare’s payment system. . .

Take Dr. Richard Young, a Fort Worth family . . . calls the payment rules “ridiculously complicated.”

That’s an understatement.

The sick are fleeing trapped doctors by either purchasing high deductible health insurance or by utilizing the International Medical Centers with charges of one-third to one-tenth the cost of standard health insurance coverage in the United States.

Read Dr. Goodman’s entire OpEd at the NCPA . . .
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

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

- Ronald Reagan

 * * * * *

5.      Medical Gluttony: A Letter from the HMO concerning an 85-year-old patient with a stroke.

[Dear Provider:]

As part of our effort to accurately capture the health status of our Medicare Advantage members, CenseoHealth recently performed an assessment on [your patient.]

This assessment relies on information from our claim files, medical history provided by the patient, and a brief physical examination performed at the time of the assessment. We are providing the information gathered during the assessment to supplement the information already contained in your chart. We realize that some of the information will be duplicative. Read more. . .   We also realize the patients’ memories can be incomplete, especially in the recall of counseling and immunization.

[Your patient] has been asked to contact you to discuss whether these recommendations are appropriate for her particular situation. Should you have any questions about the information contained in this letter, please contact your Practice Support advisor.



Chief Medical Officer.

Page 2

The following patient recommendations were triggered during the CenseoHealth assessment (these may already be documented in patient’s chart):

  1. Discussion on aspirin therapy
  2. Further evaluation/treatment for hypertension
  3. Discussion on possible risks of medications
  4. Colonoscopy
  5. Annual dental evaluation
  6. Discussion on following treatment plan
  7. Pneumococcal vaccine
  8. Annual influenza vaccine
  9. Further evaluation/treatment for osteoporosis
  10. Discussion of high risk medications
  11. Discussion on your chronic illness and side effects of treatment

We did a trial run on this patient. To cover the eleven points above, took the equivalent of two office calls. The patient did not feel the 11 points covered any new information that we had not covered before. She did not accept any of the HMO recommendations. In fact, she had a good laugh over them. The American College of Gastroenterology in the 2008 Colon Rectal Cancer Screening Guidelines does not recommend colonoscopy in an 85-year-old patient with a negative prior colonoscopy in her eighth decade of life. The GI colleagues on our medical staff could not support a Colonoscopy in this patient. Clinically in her medical state a colonoscopy could not be recommended and could be hazardous if not life threatening.

This intrusion into our practice cannot be justified as cost effective, or medically desirable. It should furthermore be noted that this major increase in health care costs cannot be justified as improving Quality of Care. In fact, it was the consensus of these GI specialists that we discussed this with, that this would decrease the quality of care and could be hazardous to our patient’s welfare, health and perhaps her life. It was furthermore the consensus that this Health Maintenance Organization was not in any way “Maintaining Health” and thus was an “Organization” misnomer.

It appears that our HMO actually sent a physician to see this patient. In our experience it takes at least five times as long to make a home visit as an office call provided the patient does not live more than 15 minutes from our office. Plus two extra office calls to evaluated this intrusion into our practice. Thus a discounted office call of $100 grew to $500 for this intrusion. Their physician surely was paid.  My two extra office calls were not paid just like all the extra work that the HMO piles onto a physician is not paid. It doesn’t take long for the private physician in practice to understand why our health care costs are so high. Wouldn’t it be great if Health Maintenance Organizations understood costs? They don’t see the cost of all the extra work they require from physicians. Since they don’t pay for this extra work, they think it is free. Why do HMO physicians except this unnecessary burden? No wonder HMOs will go out of existence in the next 10-20 years. Why don’t physicians speed up this process?

It appears that this HMO is vying to become an Obama ACO (An Obama Accountable Care Organization) which will be rejected by the public in the same manner that HMOs are being rejected.
[HMOs dropped from 31 percent of the healthcare market in 1996 to 17 percent in 2011]

Maybe they’re drinking too much of the Obama Kool-Aid.

"Drinking the Kool-Aid" is a metaphor commonly used in the United States and Canada that refers to a person or group's unquestioning belief in an ideology.  .  . 

Feedback  on this article will be appreciated. . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Medical Gluttony thrives in Government and Health Insurance Programs.

It has not been controlled by HMOs. It will not be controlled by the Obama ACOs.

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

* * * * *

6.      Medical Myths: The High Cost of Technology

In a presentation to investors Wednesday, Roche forecast that sales of DNA-sequencing machines will nearly double to $2.1 billion by 2015, driven in part by more routine use in everyday practice. . .

DNA-sequencing machines today are largely used by researchers to scan large numbers of patients with a certain disease to look for common genetic characteristics that may be causing the disorder. The researchers can also run smaller sequencing jobs involving, for example, tumor tissue to look for disease-causing mutations that are potential drug targets. . . Read more . . .

One stumbling block to widespread use of DNA sequencing is the reluctance of some insurers to cover the cost, said David Goldstein, director of the Center for Human Genome Variation at Duke University. But that will change, he said, as the cost comes down and insurers realize genome sequencing can save money. He cited the case of children with rare genetic diseases who sometimes go for long periods without getting the right diagnosis. For such patients, he said, DNA sequencing is increasingly common.

Just three years ago, it cost more than $200,000 to sequence an entire human genome, according to the National Institutes of Health's National Human Genome Research Institute, known as NHGRI, in the U.S. Now the cost is down to about $3,000, with a recent claim by Life Technologies Inc. that it will do the job for $1,000 by the end of the year. *

That big cost reduction has prompted some predictions that millions of patients will soon have their genomes sequenced so the data can be used to guide disease prevention and treatment. But hardly anyone expects medicine to be broadly affected overnight.

"We are convinced this is going to markedly change the way we are looking after our patients," said Gianrico Farrugia, head of the recently established Center for Individualized Medicine at the Mayo Clinic in Rochester, Minn. "But it's not a question of getting the [sequencing] data. It's a question of having mechanisms to interpret the data to make it most useful to people."

Eric Green, head of the NHGRI, said that one of the biggest challenges with genomics is how to analyze the data and put it to productive use. Both sequencing costs and efforts to interpret the data are "all heading in the right direction," he said. "But it will take years" for genomics to become part of routine care. "It's not going to take five or 10. It will take more than that.". . .

Technology always reduces costs.

Read the entire article at the WSJ – subscription required . . .
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Medical Myths Originate When Someone Else Pays The Medical Bills.

Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service.

This would be a very effective control on DNA-Sequencing requests increasing in the near future.

* * * * *

7.      Overheard in the Medical Staff Lounge: There will be no effective opposition to Obama

Dr. Edwards:  It looks like the Musical Chairs Campaign is winding down to two candidates who not everybody likes and are not presidential. Both the Daniel Henninger and the Karl Rove columns in the WSJ this week talk about the sad predicament the Republicans are in and what their awakening will be on Nov 6, 2012.

Dr. Sam.          Too bad more of the A-Team didn’t stay in the running.

Dr. Dave:        Maybe they were the smart ones. They knew it would be very unpopular to try to undo Obama’s massive spending program. They didn’t want to be sacrificial lambs. Read more . . .

Dr. Edwards:  Obama is one of the most unpopular presidents at mid cycle that we’ve had. But we’ve had unpopular candidates win elections. Look at Harry Truman. No one gave him a chance. Even the New York Gray Lady put out her “Dewey Won” NY Times before the election was called. Right now Bush is still so unpopular that many people would vote for a candidate from the Chicago Mob rather than vote for what they perceive as Bush Republicans.

Dr. Rosen:      I’m not so sure that Mitt Romney or Newt Gingrich could win the Doctor vote at this time. This past week I was at a Medical Conference and was amazed at the number of pediatricians' cars that had Obama 2008 stickers on them. That they are still on their cars with his ratings plummeting in the polls suggests they are not ashamed to be associated with what some of us feel is the greatest threat to private practice.

Dr. Edwards:  What’s even worse, many don’t see Obama as a threat to our future welfare as a freedom-loving country.

Dr. Rosen:      I’m not sure there is enough time between now and November to have an objective discussion on any of the major issues of the day. There are so many people in a fit of anger or despair that any candidate running against Obama will be a lamb led to the slaughter. Looks like I might vote a full ballot but leave the Presidential vote blank.

Dr. Edwards:  Maybe that would be more effective than voting for a losing candidate. The message may be clearer.

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

* * * * *

8.      Voices of Medicine: A Review of Regional Medical Journals: North Coast Physician

North Coast Physician is published monthly by the Humboldt-Del Norte County Medical Society

In My Opinion Occupy Humana by Stephen Kamelgarn, MD, The GURU

2011 may be known as the year where the public finally stood up and screamed, ala Network (1976): “I’m mad as Hell, and I’m not gonna take it anymore!” Read more . . .

First, we witnessed the awakenings of the masses in Egypt, Tunisia, Libya, Syria and Yemen. This “Arab Spring” was then followed by our own homegrown protests, of what is now known as “The Occupy” movement. It started as Occupy Wall Street in Zuccoti Park, protesting Wall Street’s destruction of the world’s economy and the criminal malfeasance of “the 1%,” and has spread to virtually every major city in the US and many other cities throughout the world. As the movement has moved and grown, it has morphed into a variety of forms, and is taking on a local flavor in the individual cities. Occupy Denver, for example, is also protesting treatment of immigrants. Even up in our little corner of paradise we have Occupy Eureka and Occupy Arcata. Not much I admit, but a presence in front of the courthouse or Arcata city hall, nonethe­less.

While the mainstream press has downplayed or dismissed the protests as “a student lark,” or “they have no message,” the protests are having an effect. In October alone, more than 600,000 Americans moved their bank accounts into Credit Unions. This is more account transfers than occurred in all of 2010! (US News & World Report Nov. 2, 2011­ticles/2011/11/02/americans-closing-bank-accounts-moving-money-to-credit-unions.) The nature of the national conversation has changed, and The Occupy’s motto of, “We are the 99%,” is beginning to resonate all through society. Yes, the Occupy Movement is definitely having an effect.

I think it’s time that we, as physicians, jump on this bandwagon. It’s time for us to give a huge resounding NO to the insurance industry. For years, I’ve been screaming about what the insurance gorgon has done to ours and our patients’ lives. Obamacare has done nothing, and I fully suspect that by the magic 2014 date, when most of the reforms are supposed to kick in, what little remain of the minuscule reforms that were actually enacted, way back in 2010, will have been gutted by the Supreme Court and/or the pampered mandarins in Congress.

On Dec. 6, 2011, Michael Moore (of Sicko and Fahrenheit 9/11 fame) posted an article on Truthout that had a recipe for the Occupy movement to survive the coming winter. He listed five activities we can do to keep the movement alive. Here’s Number 5:

5. Occupy the Insurance Man. It's time to not only stand up for the 50 million without health insurance but to also issue a single, simple demand: The elimination of for-profit, privately-controlled health insurance companies. It is nothing short of barbaric to allow businesses to make a profit off people when they get sick. We don't allow anyone to make a profit when we need the fire department or the police. Until recently we would never allow a company to make a profit by operating in a public school. The same should be true for when you need to see a doctor or stay in the hospital. So I say it's long overdue for us to go and Occupy Humana, United Health, Cigna and even the supposed "nonprofit" Blue Crosses. An ac­tion on their lawns, in their lobbies, or at the for-profit hospitals -- this is what is needed. Dec. 6, 2011

Who, better than we physicians, knows how malignant these bastards are. They siphon off 30% of their clients’ pre­miums to pay for bloated executive salaries and perks, and to pay off investors and stockholders. And how does this all get paid for: by exorbitant premiums, high co-pays and deductibles on the income end, and restrictive formularies, denials, discounted reimbursements, obfuscation, delays and exemptions on the outlay side of the equa­tion. These “responses to the market” netted them $12.2 billion in profits in 2009. . .

Back in 2009 (“Let’s kill all the In­surance Execs,” The Bulletin April 2009), I wrote that I felt the insurance industry was operating illegally by practicing medi­cine without a license, or was committing malpractice by not performing good faith exams. I publicly called for the California State Attorney General’s office to investigate and criminally prosecute the most egregious offenders. Toward that end I sent both the State Insurance Commissioner and the At­torney General dozens of charts and letters of protest documenting insurance abuses.

Both offices refused to give me the time of day. I spoke to the CMA who promised to follow-up, but I haven’t heard a thing. I’ve thought of all kinds of things I’d like to do.

I’ve actually entertained the notion of hiring several Eastern European Computer Geeks to hack the computer systems of the insurance companies in such a manner that they approve 100% of the charges that come through, no questions asked. And they won’t even know they’ve been hacked! Only when they come up sinking below their bottom line, will the grossly overpaid CEOs and CFOs realize they lost their gravy train. While this always remains an attractive notion, something is sure to go wrong, and I have absolutely NO desire to spend my retirement years in some Federal Prison. . .

What we can do is unify, and CANCEL all of our insurance contracts. We then bill the insurance companies as “out of network providers,” and let them know, in no uncer­tain terms, that we won’t accept their measly discounted rates, restrictive formularies and onerous approval rules.

We North Coast physicians may be in the best position to do this: we’re a small, self-contained community, that is far from other centers. There’s no way they can force their subscribers to brave the winter passes to Redding for a well-child check, or maneuver through a rockslide closed 101 to Santa Rosa for a pre-natal visit. In other words, we’re the only game in town. If the insurance compa­nies cannot put together a panel of “network” physicians, they’re going to have to deal with us on our terms. If we, as a community, hang together and negotiate as a unit to advocate for both us and our patients, we just might get somewhere. We must demand that these bloated parasites give back to the people who pay their salaries, and provide a decent level of service and reimbursement. And if it gets us sued by the state for anti-trust violations I say, in the words of our former Commander and Thief: “Bring ‘em on.!”

Read the entire OpEd at the Humboldt-Del Norte County Medical Society

We at MedicalTuesday publish this intemperate OpEd to reflect some of the anger filtering through our society and why that will influence our elections in November. This huge non-directed anger, whether the war, or Bush, or insurance, or Wall Street, or just about anyone that gets in the way, including criminal suggestions, will prevent any effective opposition to our sitting president. Since the Republicans will not have a viable candidate, and any candidate that will run will be “a sacrificial lamb led to the slaughter,” we would suggest all conservatives, libertarians, constitutionalists and basic Americans to be sure to vote, but leave the box for the president and vice president blank. It the president got only 40 percent of the vote from the people that still give him a positive rating, that will be more effective than any one from the “third team of candidates” trying to get votes which no one will be able to interpret.

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

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

* * * * *

9.      Book Review: Meet the Author Event at the Marines Memorial in SF

Sergeant Rex: The Unbreakable Bond Between a Marine and His Military Working Dog

Sergeant Mike Dowling and his military working dog Rex were part of the first Marine Corps military K9 teams sent to the front lines of combat since Vietnam. It was Rex’s job to sniff out weapons caches, suicide bombers, and IEDs, the devastating explosives that wreaked havoc on troops and civilians alike. It was Mike’s job to lead Rex into the heart of danger time and time again, always trusting Rex to bring them both back alive. Loyalty is one of the hallmarks of any good Marine, and nowhere is that quality more evident than in this astonishing account of Mike Dowling and Rex’s wartime experiences. A moving story of how a man and a dog developed complete trust in each other in the face of terrible adversity, Sergeant Rex is an unforgettable tale of sacrifice, courage, and love. Read more . . .

Our special event will be a follow-on presentation by "Canine Companions for Independence" and how dogs are trained to be companions to our wounded Veterans. CCI is the largest and oldest service dog organization in the world and has been assisting people with disabilities for close to 38 years.  In the past 4 years CCI created a special initiative to assist veterans returning from the Middle East Conflicts.  The trainers will even bring a trained dog and show the many amazing commands they perform to support the veteran with a disability. See their website at:

The program will start at 6 pm on Monday, 6 February at the Marines' Memorial Club in downtown San Francisco.  Register now by going to this website:<

All active duty, retired, or previous members of the military services are eligible to become members.

To read a review, go to . . .
To read more book reviews . . .
To read book reviews topically . . .

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

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

* * * * *

10.  Hippocrates & His Kin: The Low Cost of Technology

Will Gene-Sequencing become part of a Doctor’s Office visit? WSJ

Just three years ago, it cost more than $200,000 to sequence an entire human genome, according to the National Institutes of Health’s National Human Genome Research Institute in the U.SA. Now the cost is down to about $3,000 with a recent claim by Life Technologies Inc. that it will do the job for $1,000 by the end of the year. Read more . . .

With technology reducing costs by 99% in just three years, how can we get HMOs out of the way of progress?

It'd be nice if President Obama had a record to defend. But he doesn't, and I've gotten over it.
—Karl Rove

Do Alcoholics really have it better than patients in the UK?

Voluntary organizations such as Alcoholics Anonymous have a better record than the NHS at teaching people to look after themselves. [See the International section (3) above]

Soros: Romney Is Like Obama, Don't Worry

Billionaire financier George Soros likes Mitt Romney, and is telling European liberals not to worry. He says of Obama and Romney "there isn’t all that much difference" between them.

Like we’ve been saying.

To read more HHK . . .
To read more HMC . . .

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

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

* * * * *

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

                      John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to and check out their history, mission statement, newsletter, and a host of other information.  They have a new address and their program is expanding.

                      Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .

                      PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .

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

                      FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder,, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser’s view on today’s health care problem:  In today’s proposals for sweeping changes in the field of medicine, the term “socialized medicine” is never used. Instead we hear demands for “universal,” “mandatory,” “singlepayer,” and/or “comprehensive” systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this “nationalized financing” or “nationalized health insurance.” In a more honest day, it was called socialized medicine.

                      To read the rest of this section, please go to

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

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

                      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.

                      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

                      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, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives. He now has a new column with Richard Dolinar, MD, worth reading 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 read News of the Day in Perspective:  Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.

The AAPS California Chapter is an unincorporated association made up of members. The Goal of the AAPS California Chapter is to carry on the activities of the Association of American Physicians and Surgeons (AAPS) on a statewide basis. This is accomplished by having meetings and providing communications that support the medical professional needs and interests of independent physicians in private practice. To join the AAPS California Chapter, all you need to do is join national AAPS and be a physician licensed to practice in the State of California. There is no additional cost or fee to be a member of the AAPS California State Chapter.
Go to California Chapter Web Page . . .

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

 PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.

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

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

Words of Wisdom

"Losers live in the past. Winners learn from the past and enjoy working in the present toward the future." — Denis Waitley: is an American motivational speaker and writer.

"Inaction breeds doubt and fear. Action breeds confidence and courage. If you want to conquer
fear, do not sit home and think about it. Go out and get busy." — Dale Carnegie:
was an American writer and lecturer.

"Failures do what is tension relieving, while winners do what is goal achieving" — Dennis Waitley: is an American motivational speaker and writer.

Some Recent Postings

In The January 17th Issue:

1.                  Featured Article: To Increase Jobs, Increase Economic Freedom

2.                  In the News: Studies Could Ease Fears of Medicines for ADHD

3.                  International Medicine: The cost of Canadian Medicare

4.                  Medicare:  Can Medicare pay for Sex?

5.                  Medical Gluttony: Emergency room visits after a full consultation

6.                  Medical Myths: Health Insurance monitoring the practice of medicine saves costs.

7.                  Overheard in the Medical Staff Lounge: The Presidential Campaign: Musical Chairs

8.                  Voices of Medicine: Hospital Medicine: The Good, the Bad and the Ugly

9.                  The Bookshelf: Inside the AARP

10.              Hippocrates & His Kin: Political IRAs

11.              Related Organizations: Restoring Accountability in HealthCare, Government and Society

In Memoriam

Gustav Leonhardt, harpsichordist and father of the early-music movement, died on January 16th, aged 83

The Economist | from the print edition | Jan 28th 2012

A CONCERT by Gustav Leonhardt was not like any other. He approached his harpsichord with the air of a mortician, slightly flexing his long, delicate hands. As he played he sat bolt upright, gaunt and aquiline, unsmiling in his crisp, perfect suit, with his elbows held close to his sides. No unnecessary gesture, no hint of emotion: senza baldanza, as a composer might have marked it. He did not have the look of a man on a mission. But he was.

Mr Leonhardt’s life-work was to persuade the world how beautiful the harpsichord was, and how the harpsichord repertoire should be played. When he first fell in love with it, in the shape of the fairly bad instrument his parents bought for their house at Graveland in the Netherlands, he recognised it as the king of keyboards. Organs were noble characters, and he played church organ for years. Virginals were pleasing; he wrote a book on Flemish examples. But fortepianos were awful, the sound muffling all over the place when the hammer hit the keys, which put him off playing his beloved Mozart; and modern grands were unspeakable. None had that direct pluck of plectrum on string for which he loved the harpsichord—though that mechanism was also fearsomely exacting, even “diabolical”, and that was why he did not smile as he played.

It would also have been vulgar. Mr Leonhardt was ever on the watch for that, whether in the form of electric lighting, or showy articulation, or hotel breakfast buffets, or Beethoven’s Ninth. (“That ‘Ode to Joy’, talk about vulgarity! And the text! Completely puerile!”) His own manners were exquisitely courteous; he seemed to have stepped from the past, and even a shockingly fast drive in his Alfa Romeo might end with Mr Leonhardt, lost, finding his way home not by sat-nav but the stars. . .

 Read the entire obituary in The Economist – subscription required . . .

On This Date in History – January 31

On this date in 1709, Alexander Selkirk, “Robinson Crusoe,” was rescued after four years on an island in the Pacific. Truth, they say, is stranger than fiction. The true story of this British sailor that nobody really remembers provided the basis for a piece of fiction that everybody knows. His real-life adventure inspired the story of Robinson Crusoe. Somehow, we seem to prefer to deal with facts in fictional, story-telling terms. That may be why commentaries about current conditions—social, cultural, or political—all seem more effective when they “tell a story.”

On this date in 1919, Jackie Robinson was born. Occasionally it falls to the lot of one person to become the living embodiment of an idea and become the symbol in which many people believe. That person usually has to do most of the hard work. That’s the way it was with this great athlete. Jackie Robinson integrated major league baseball and opened doors in all organized sport to Blacks who had previously been barred.

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.

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

Del Meyer      

Del Meyer, MD, Editor & Founder

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

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 9th Annual World Health Care Congress will be held April 16-18, 2012 at the Gaylord Convention Center, Washington DC. For more information, visit The future is occurring NOW.