Community For Better Health Care

Vol X, No 22, Feb 28, 2012


In This Issue:

1.                  Featured Article: Rick Santorum and Secular Natural Law

2.                  In the News: A Church president responds to Obama’s restriction of religious liberty.

3.                  International Medicine: The Fight to stop the reform of the National Health Service

4.                  Medicare: Health Care's Coming Price Revolution

5.                  Medical Gluttony: Have a Clinic in several cities

6.                  Medical Myths: Politicians will fix the health care system.

7.                  Overheard in the Medical Staff Lounge: Musical Chairs Continue For Mitt and Newt

8.                  Voices of Medicine: Why Doctors Die Differently

9.                  The Bookshelf: The Story of a Family Who Would Never Give An Inch

10.              Hippocrates & His Kin: The Cost of Dying

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

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

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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.

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1.      Featured Article: Rick Santorum and Secular Natural Law by Peter J. Leithart

First Things, Feb 24, 2012

Rick Santorum recently criticized Obama’s worldview as a “phony theology not based on the Bible.” A few days ago, the Drudge Report resurrected a 2008 speech in which Santorum warned that Satan has it in for the U.S. Santorum’s blatantly religious comments have already made him an object of ridicule and will doubtless cost him support. My cynicism meter goes as wild as anyone’s when politicians talk like this. Still, I find it invigorating. Read more . . .

Politicians are usually careful to couch their public remarks in a more generic idiom. Romney never criticizes Obama for failing to follow the instructions of 4 Nephi or for not living up to the example of Ether 7:11. Christian though he is, Ron Paul mentions von Mises more than Matthew. It’s an understandable stance. Politicians want votes, and talk in a way that makes sense to as many people as possible. Besides, we are in a delicate moment in American history. We need some common norms to be a functional society, yet no secular consensus has replaced the decayed Protestant consensus of earlier centuries.

For many conservatives, natural law provides the secular grammar we need for debating moral issues in a pluralistic society. John Finnis, a leading “new natural law” theorist, contests the notion that every argument against homosexual conduct is “a manifestation of purely religious, theological, and sectarian belief.” Natural law arguments against homosexuality are instead “reflective, critical, publicly intelligible and rational.” Finnis acknowledges debts to theologians, especially Germain Grisez, but claims that “the relevant philosophical arguments and considerations can be distinguished and detached [from theology] by careful analysis.”

I don’t think so. Natural law theory remains too entangled with the particularities of theology to do everything natural lawyers want it to do. That is the thrust of Nicholas Bamforth and David A.J. Richards’ Patriarchal Religion, Sexuality, and Gender (2007). Bamforth and Richards argue that “the new natural lawyers’ arguments about sexuality, gender, and the law are religious.” Natural law theorists “meld” secular and religious motivations and norms and are “unlikely . . . to be able to draw a clean distinction between that which is knowable through revelation and that which is graspable by reason alone.”

For instance, Bamforth and Richards trace Finnis’s argument that marriage is a “basic good” back to Grisez. In defending his characterization of marriage as a basic good, Grisez cites the “development in Catholic teaching about marriage” and particularly John Paul II’s magisterial teaching that marriage is “a unique kind of communion and form of cooperation.” Using biblical language, Grisez describes marital sex as “one flesh unity” and marriage as “a covenant” that is “involved in the covenant with God.” Marriage is “not purely secular.” Grisez’s very notion of human good is theologically charged: “Every human good realized on earth will last forever” in some form, enduring after “God creates the new heavens and the new earth and Jesus hands over his kingdom to his Father.”

Finnis directly borrows Grisez’s biblical notion of marriage as a “one-flesh communion” when he says that the biological union of a man and woman “is part of, not merely an instrument of, their personal reality.” Robert George and Gerard Bradley also say that the good of marital sex is “the basic good of marriage itself, considered as a two-in-one-flesh communion of persons.” George knows that natural law arguments will not convince everyone. Anyone who assumes the “modern conception of human nature and human good would be dubious” about restrictions on extra-marital sex. Natural law, though, is “an alternative conception of human nature.” In practice, this “alternative” is inseparable from biblical claims about the Creator and his creation.

On the plus side, the fact that natural lawyers don’t actually put revelation and the gospel to the side is much to their credit. In practice, they resist the pressure to erect a wall between their faith and their public philosophy. On the down side, this “melding” of secular and religious arguments undermines their claim that natural law provides a theologically neutral grammar for a pluralistic society.

Natural law theory has many uses. Using its categories, we explore the contours of creation to uncover the pathways the Creator has laid out for us. Natural law reasoning can demonstrate the “fit” between creation and revelation. The fact that women, not men, bear babies is ethically significant, as is the fact that human beings talk but animals don’t. Natural law is rhetorically useful for advancing arguments and purposes that would be rejected out of hand if stated in overtly religious terms.

Bamforth and Richards don’t accuse natural lawyers of bad faith. They simply conclude that natural lawyers are more dependent on religion than they realize. Critics like Bamforth and Richards sniff out the aroma of theology that clings to natural law arguments, and they are right that Christians should be transparent about the theological sources of our political convictions.

The fundamental Christian political claim is “Jesus is Lord,” a truth that lies beyond natural reason. Christians can’t finally talk about politics without talking about Jesus, and, yes, Satan and the Bible too. We can’t talk politics without sounding like Rick Santorum, and we shouldn’t try to.

Peter J. Leithart is pastor of Trinity Reformed Church in Moscow, Idaho, and Senior Fellow of Theology and Literature at New St. Andrews College. His most recent book is Athanasius (Baker Academic).
Resource . . .

Resources:  Nicholas Bamforth and David A. J. Richards, Patriarchal Religion, Sexuality, and Gender: A Critique of New Natural Law

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2.      In the News: Lutheran Church President Responds to Pres. Obama’s “Compromise” on HHS Regulations

Cyberbrethren: A Lutheran Blog, February 14th, 2012

In response to President Obama’s announcement Friday concerning an “accommodation” to a previous mandate that health plans must cover all forms of birth control (even those that can kill the unborn), The Lutheran Church—Missouri Synod (LCMS) remains deeply concerned. We strongly object to the use of drugs and procedures that are used to take the lives of unborn children, who are persons in the sight of God from the time of conception. Drugs such as “Plan B” and “Ella,” which are still included in the mandate, can work post-conception to cause the death of the developing child, so don’t be fooled by statements to the contrary. Read more . . .

We see President Obama’s action Friday as significant, in that it appears to have been prompted by the many voices united in concern over an infringement of our religious liberties. But the “accommodation” did not expand the exemption for religious employers, nor did it restrict the mandate in any way. It simply described a temporary enforcement delay and a possible future change—a change that, unfortunately, would not adequately protect religious freedom or unborn lives.

We remain opposed to this mandate because it runs counter to the biblical truth of the sanctity of human life. We are committed to working to ensure that we remain free to practice the teachings of our faith, that our religious rights are not violated, and that our rights of conscience are retained. Freedom of religion extends beyond the practice of our faith in houses of worship. We must be free to put our faith into action in the public square, and, in response to Christ’s call, demonstrate His mercy through our love and compassion for all people according to the clear mandate of Holy Scripture.

The government has overstepped its bounds. This controversy is not merely about “birth control” and the Catholic Church’s views about it. It’s about mandating that we provide medications which kill life in the womb. And moreover, and perhaps even more ominous, it is about an overzealous government forcing coercive provisions that violate the consciences and rights of its citizens. We can no longer expect a favored position for Christianity in this country. But we can, as citizens of this great nation, fight for constitutional sanity against secularizing forces. As we have vividly experienced in discriminatory state legislation with respect to homosexual adoption, we, and our institutions (and those of other religious citizens of good will), are being robbed of the right to the free exercise of religion absent government intrusion or threat. The next assault will come upon church-related retirement facilities. How much longer will it be legal in this country to believe and act according to the dictates of biblical and creedal Christianity?

Jesus bids us, “Render to Caesar the things that are Caesar’s, and to God the things that are God’s” (Mark 12:17). We will pray for and support our government where we can, but our consciences and lives belong to God.

In His peace,

The Rev Dr Matthew C. Harrison
President, The Lutheran Church—Missouri Synod

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3.      International Medicine: The Fight to stop the reform of the National Health Service

Labour will turn up the pressure on the Liberal Democrat leader Nick Clegg on Thursday by declaring him "one of the few people" who can stop the government's NHS reforms

The opposition will also attempt to divide the coalition partners in the Lords by making a public offer that Labour and Lib Dems could together table and vote for an amendment to drop the whole third part of the bill – the most incendiary section which would introduce competition into the health service. . .  Read more . . .

In another sign of Lib Dem strife over the bill, a high-profile senior doctor resigned from the party on Wednesday and warned that its continued backing for the shakeup is risking "slow motion disaster for the NHS and for the party". . .

Burnham's letter refers directly to a letter jointly written by Clegg and Williams this week in which they promised Lib Dem MPs and peers five new amendments to "rule out beyond any doubt any threat of a US-style market in the NHS". That move to head off a backlash at the Lib Dem spring conference next weekend was undermined by the prime minister's spokesman saying that the changes would be "not significant". . .

Read the entire article in The Guardian
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Privatization of Government Healthcare meets opposition from Bureaucrats Everywhere

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4.      Medicare: Health Care's Coming Price Revolution

            The private sector is moving to give people the information they need to get treatments that are worth the money. But ObamaCare blocks the way.

OPINION | WSJ | By JOSEPH RAGO | February 23, 2012

The old-line Marxists used to talk about "heightening the contradictions" of capitalism to make things worse and hasten the revolution. One of the great ironies of the Affordable Care Act is that it may be doing just that.

Two years on, the major achievement of President Obama's new entitlement and its regulatory apparatus has been to heighten the contradictions and dysfunctions of the health-care status quo even as it creates multiple new problems. The good—and less noticed—news is that the growing disruption is driving the industry toward the solution that prevails in the rest of the economy: the price mechanism. In the context of American health care, this might be a watershed. Read more . . .

To appreciate what's wrong with the current system, imagine four patients identical in every way except for their insurance coverage. They report to the same doctor for a routine procedure, say, a colonoscopy.

The first patient is on Medicare, which controls prices. The program's fee formula sets prices unilaterally for about 7,000 physician services and pays lump sums for 600 general hospital diagnoses, regardless of the quality of care. Medicare pays twice as much on average for a colonoscopy if it is performed in a hospital outpatient setting rather than in a doctor's office.

Patients two and three are covered by private insurers, but those insurers are likely to reimburse the doctor at different rates—whatever they've negotiated to include him in their networks. The rate will be higher than competitive to make up for Medicare's below-cost fees—the gap between public and private rates is now about 40 percentage points. The rate is also likely to be a proprietary trade secret, or else literally unknowable: The doctor can only generate price information when he codes his services and bills the insurer.

The fourth patient is uninsured. If she seeks treatment, she'll be billed directly from a "chargemaster," a hospital's list of marked-up sticker prices that no one with coverage will ever pay.

So one doctor, four patients, four different prices, multiplied times one-sixth of the economy. Price discrimination, or varied pricing, is common in service industries with high fixed and low marginal costs: airlines, colleges, hotels, telecom. But nowhere else but health care are prices so arbitrary, so disconnected from value. The consensus, on the right and left, is that this fee-for-service jumble is incoherent.

What liberals usually mean when they complain, however, is that they'll cook up speculative and supposedly better payment forms—to pay for "bundles" of care; or to pay more for treatments the government decides are valuable, and less for those the government decides are wasteful; or to encourage physicians to practice this way instead of that way. This is the price-is-"right" fallacy and it always fails: No matter how expertly designed, price controls always distort the allocation of resources. The health-care dollar is spent behind a veil of ignorance, instead of revealing value.

A more encouraging turn is the gradual emergence of a workable market-driven alternative to all this in the private sector, which is happening for a simple reason: There's no money left. . .

For decades businesses merely absorbed health-cost increases and effectively took them out of employee compensation. But the erosion of real wage increases that this caused is now too large to ignore. RAND recently estimated that health care consumed 79% of the dollars that otherwise would have gone into paychecks for the average U.S. family during the 2000s. Meanwhile, after the enactment of ObamaCare, premiums in employer-sponsored health plans climbed by 9% in 2011, and they're due to rise another 9.4% by 2014, according to Medicare's actuaries. They further estimate that the increase would be 4.4 percentage points lower without ObamaCare's mandates and rules.

But now insurers are starting to give workers and businesses the information and tools they need to lower costs. This is, in fact, a remarkable period of industry innovation and creative thinking. All the major insurers—UnitedHealth, Aetna, Cigna, WellPoint—are now mining their billing data and attempting to accurately measure costs and compare them with outcomes. "Moneyball" is coming to health care for the first time. . .

The other important trend in terms of aligning costs and incentives is the growing interest by employers in defined-contribution insurance. Here companies would give their employees a fixed-dollar payment and allow them to choose from a menu of coverage options and make the trade-offs themselves, rather than having their bosses do it for them. Workers would pay the marginal costs of higher-priced plans, much like what Rep. Paul Ryan has proposed for Medicare.

A recurring theme on insurer earnings calls to analysts in 2011 was that this shift—much like the migration to 401(k)s from pensions—may happen within the next decade. As Aetna CEO Mark Bertolini put it in October, "We have heard a lot of talk. We have actually engaged employers in very detailed discussions about what it would take to do it. But we have not seen anybody really interested in pulling the trigger yet." Aetna recently bought Medicity and WellPoint bought Bloom Health, two start-ups that are experimenting with this model.

The impulse here is to restore the price signals that will drive U.S. health care to deliver care that is worth the money. But these gains—in transparency and efficient pricing, for instance—will need to be consolidated and expanded to constitute a true revolution. The Affordable Care Act stands in the way.

ObamaCare's core philosophies are standardization and centralization, which in practice will mean higher costs for everyone caused by suffocating price competition. The share of insurance industry revenue that comes from government now stands at 42%, up from 36% just three years ago, and that's before the new entitlement kicks in. And a wave of ObamaCare-promoted provider consolidation is creating hospital monopolies that can demand higher-than-competitive prices. . .

So a revolution won't come automatically. Still, the market is naturally creating an ObamaCare alternative, and the moment for structural reform may be riper than Washington rhetoric suggests. "Health-care reform" is inevitable. The only question is whether it will run in the direction of prices and choice or more government control.

Mr. Rago is a member of the Journal's editorial board.

A version of this article appeared Feb. 23, 2012, on page A15 in some U.S. editions of The Wall Street Journal, with the headline: Health Care's Coming Price Revolution.

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

- Ronald Reagan

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5.      Medical Gluttony: Have a Clinic in several cities

Mrs. Zim, a 52 YO-WMF had Medicaid coverage. She wasn’t destitute but lived with family in Napa, CA and also in Oroville CA where she owned some property. When she visited, she usually went to a clinic and asked for whatever she felt she needed. Her total Social Security disability was based on her spine. Examination of her back, however, revealed normal full Range of Motion (ROM) with flexion of 90 degrees, extension of 30 degrees, lateral bending of 45 degrees and rotation of 90 degrees without any back pain, tenderness of the spine or spasms of the para-spinal muscles. Read more . . .  

She had x-rays of her spine, her sore knee, and ultrasounds of her liver. In fact she had two ultrasounds of her liver, one in Napa and one in Oroville, because she read the reports as being abnormal. However, the official report was benign cyst. She said she had liver cancer and the reports were not trustworthy.

Medicaid allows all recipients access to health care where ever they desire. None of the prior tests are available at the new location. Thus, there is no limitation of duplicative services or unnecessary medical costs.There isn’t the medical oversight that only a personal physician gatekeeper can give.

Medicaid patients basically have a blank check or a MasterCard paid by the US Treasury. Even though it is discounted payment, sooner or later the Bank Account is depleted or the Credit Limit is reached.
 Why doesn’t the US Congress understand that overdrafts can’t go on forever?

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Medical Gluttony thrives in Government and Health Insurance Programs.

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

For Medicaid it disappears with a personal physician gatekeeper.

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6.      Medical Myths: Politicians will fix the health care system.


John Godfrey Saxe's (1816-1887) version of the famous Indian legend.

It was six men of Indostan
To learning much inclined,
Who went to see the Elephant
(Though all of them were blind),
That each by observation
Might satisfy his mind.                        Read more . . . .

The First approach'd the Elephant,
And happening to fall
Against his broad and sturdy side,
At once began to bawl:
"God bless me! but the Elephant
Is very like a wall!"

The Second, feeling of the tusk,
Cried, -"Ho! what have we here
So very round and smooth and sharp?
To me 'tis mighty clear
This wonder of an Elephant
Is very like a spear!"

The Third approached the animal,
And happening to take
The squirming trunk within his hands,
Thus boldly up and spake:
"I see," quoth he, "the Elephant
Is very like a snake!"

The Fourth reached out his eager hand,
And felt about the knee.
"What most this wondrous beast is like
Is mighty plain," quoth he,
"'Tis clear enough the Elephant 
Is very like a tree!"

The Fifth, who chanced to touch the ear,
Said: "E'en the blindest man
Can tell what this resembles most;
Deny the fact who can,
This marvel of an Elephant
Is very like a fan!"

The Sixth no sooner had begun
About the beast to grope,
Then, seizing on the swinging tail
That fell within his scope,
"I see," quoth he, "the Elephant
Is very like a rope!"

And so these men of Indostan
Disputed loud and long,
Each in his own opinion
Exceeding stiff and strong,
Though each was partly in the right,
And all were in the wrong!


So oft in political wars, 
The disputants, I ween, 
Rail on in utter ignorance 
Of what each other mean, 
And prate about an Elephant 
Not one of them has seen!

You suppose that Newt and Mitt should be in the Donkey Party?

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Medical Myths Originate When Someone with no Medical Experience

Designs the medical plan which none of them understand.

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7.      Overheard in the Medical Staff Lounge: Musical Chairs Continue For Mitt and Newt

Dr. Rosen:      Things are changing in the political landscape. Rick Santorum still has a musical chair. Much to everyone’s surprise, Mitt and Newt are still going around the circle trying to find a free chair.

Dr. Edwards:  I think that is good news. But what if Mitt Romney or Newt Gingrich captures the White House? Read more . . .

Dr. Sam:         That would be tragic, indeed. And I’m not sure most Americans see the implications.

Dr. Dave:        I’m not even sure most physicians realize the implications.

Dr. Paul:         As a Pediatrician, I’m still in Obama’s court. He will continue to get me paid.

Dr. Edwards:  That’s because you are totally in the clutches of the government. Most of your patients are under some Government program which allows them to get other government  handouts such as free lunches, and now, dinners in grade school.

Dr. Yancy:      We surgeons are already under the clutches of government medicine. It will only get worse unless we have a change in the White House.

Dr. Milton:      But what’s best for HealthCare in General and Medicine in particular?

Dr. Ruth:        Yes, what is best for our society?

Dr. Sam:         There are two candidates we know we cannot trust. Mitt Romney advanced an Obama-like plan for Massachusetts which he’s never retracted. In fact, he had an editorial in the WSJ still supporting his ignominious health plan in Massachusetts.

Dr. Dave:        He still doesn’t see the problem he caused in Massachusetts.

Dr. Milton:      And he has the attitude of “Tell me the problem and I’ll fix it.” He saw the problem in Massachusetts, which his doctor friends explained as an Emergency Room problem to him. “He fixed it” but it made health care less affordable and is causing real fiscal problems. He reminds me of the six blind men and the elephant. Each went up to the elephant and one who caught the tail said, “The elephant is much like a rope.” A second one put his hand around the leg and said, “The elephant is much like a tree.” Another felt the flanks and said, “The elephant is much like a wall.”

Dr. Dave:        Very good, Milton, precisely why Mitt Romney would be dangerous in the White House. He can’t comprehend the entire picture. I hope no Doctor considers voting for him.

Dr. Milton:      As for Newt Gingrich, no one, maybe not even Newt, knows where he stands. I’ll never forget when he shared the stage with Nancy Pelosi. I’m sure he regrets it now, but we need a candidate who knows where he stands at all times. How else will the voters know where he stands? We don’t need a Chameleon in the White House.

Dr. Sam:         You got that right, Milton. Does that leave only Rick Santorum? Is he electable?

Dr. Ruth:        We won’t know that until after the elections. But is he the best candidate for America?

Dr. Edwards:  Yes, Ruth, I think he’s the only candidate for America at this time. He’s had a lot of flak for his basic high moral stance. And I know many doctors disagree with some of his positions on life issues, but isn’t that what we need at this time in our history? Don’t you think America is ready for some reversal of misfortune? Some restoration of our heritage?

Dr. Sam:         There’s a more ominous outlook if we allow the Chicago Mobster Machine to continue to control the White House. Like Adolf Hitler who was the idol of German youth, Barrack Hussein Obama is the idol of the university youth.

Dr. Dave:        Not only the University Youth. But also the University faculty.

Dr. Sam:         I really think, with another term, Obama could become a dictator. And what no one understands is that he could pull this off without ever firing a shot. He’s making a class society of the Poor vs the Rich which is where President Reagan found America in the 1980s. Remember the graduated income tax was at 91 percent before he brought the top level down to 35 percent. It took 40years to reverse Franklin Roosevelt and now it’s being reinstituted.

Dr. Edwards:  Obama’s oratory totally obfuscates the issues. He can almost sound Reaganesque to lower America’s watch and alertness as he takes over.

Dr. Sam:         Remember after the war, free Germany could not understand why in a weak moment they didn’t comprehend the dangers of Adolf Hitler?

Dr. Dave:        What’s even more amazing, after the Communists devastated East Germany, it took a while for the population to understand Freedom. Remember some even wanted to rebuild the “wall.”

Dr. Sam:         Didn’t the same thing happen in the Soviet Union? After Reagan and Margaret Thatcher won the cold war, many in Russia wanted to return to dictatorship even though under that system, grocery shelves were nearly bare.

Dr. Milton:      Don’t you remember the Russian Czars? Obama has installed a number of Czars which were appointed, not elected. Not even approved by the US Senate, a normal procedure during our first two centuries.

Dr. Edwards:  And the Obama Health Plan fits right in with his scheme. If he’s re-elected, the entire Government Health plan will be in effect by 2014. It will then be too late for any revision or reversal. He will have two additional years with his Czars to establish total control of our nation. There won’t have to be any additional elections. And I was so looking forward to having a woman president in 2016 on the one hundredth anniversary of women’s suffrage.

Dr. Patricia:    Sarah, where are you when we need you?

Dr. Nichols:    With Sarah, there would never be a question on where she stands.

Dr. Michelle:   You guys are frightening me. Here I was thinking Obama’s mandates were good. They were improving quality of health care. They were weeding out the worst Doctors.

Dr. Sam:         Remember Michelle, every mandate reduces the physician’s control over the health care of his personal patients. Maybe you think there are some rotten eggs in our profession. But let me tell you, there are far more rotten eggs in the political basket, whether you talking about the Senate or the House or any political candidate.

Dr. Dave:        Making physicians the culprit is just one cog in the Obama wheel or the AMA which supported him in the last election and is poised to support him this year.

Dr. Sam:         The executive of our own society observed that with every election more physicians always voted liberal.  He felt it will only be a matter of time before all doctors will fall in line with Single Payer. He always refrained from using such tainted words as Socialized Medicine. Sometimes it seemed as if the doctors didn’t understand the difference.

Dr. Dave:        Or the similarities!

Dr. Milton:      Or the identities!

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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

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

Why Doctors Die Differently

Careers in medicine have taught them the limits of treatment and the need to plan for the end


What's unusual about doctors is not how much treatment they get compared with most Americans,
 but how little.

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. It was diagnosed as pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient's five-year-survival odds—from 5% to 15%—albeit with a poor quality of life. Read more . . .

Charlie, 68 years old, was uninterested. He went home the next day, closed his practice and never set foot in a hospital again. He focused on spending time with his family. Several months later, he died at home. He got no chemotherapy, radiation or surgical treatment. Medicare didn't spend much on him.

It's not something that we like to talk about, but doctors die, too. What's unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.

Doctors don't want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don't want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).

In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public. (As one might expect, older doctors are more likely than younger doctors to have made "arrangements," as shown in a study by Paula Lester and others.)

Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life. . .

. . . Several years ago, at age 60, my older cousin Torch (born at home by the light of a flashlight, or torch) had a seizure. It turned out to be the result of lung cancer that had gone to his brain. We learned that with aggressive treatment, including three to five hospital visits a week for chemotherapy, he would live perhaps four months.

Torch was no doctor, but he knew that he wanted a life of quality, not just quantity. Ultimately, he decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months having fun together like we hadn't had in decades. We went to Disneyland, his first time, and we hung out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He had no serious pain, and he remained high-spirited.

One day, he didn't wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

As for me, my doctor has my choices on record. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like so many of my fellow doctors.

—Dr. Murray is retired clinical assistant professor of family medicine at the University of Southern California. Adapted from an article originally published on Zocalo Public Square.

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

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9.      Book Review:  Themes of independence, individualism, and self-sufficiency.

Sometimes a Great Notion:

The Story of a Family Who Would Never Give an Inch

by Edward W. Younkins



Ken Kesey’s novel, Sometimes a Great Notion (1964), is a complex and integrated historical background and relationship study of the Stamper family, a prideful logging clan living in Wakonda, Oregon. This big story involves a man, his family, a town, the country, a period of time, and the effects of time. All of the elements of the novel including its characters, events, settings, symbols, and so on, are integrated and oriented toward the themes of independence, individualism, and self-sufficiency. The novel teaches that a person should have the right to try to be as big as he believes it is in him to be. Sometimes a Great Notion was made into a 1971 film directed by and starring Paul Newman. In Britain this film about generations of loggers was called Never Give an Inch. Read more . . .

At the beginning of the 20th century, Jonas Stamper had traveled from Kansas to Oregon to pursue his American dream of becoming a successful pioneer in the promising new Western frontier. Jonas begins to construct a large frame house on a bank of the Wakonda Auga River. Overcome by the potential of the Oregon climate and wilderness to overpower and destroy men, the intimidated Jonas leaves his family and goes back to Kansas.

Jonas’s son, Henry, takes command, finishes the house, and commences a continual battle to keep it from being washed away by the mighty river. Stamper House stands on a dangerous peninsula on a river bend. All of the other homes in the vicinity are eventually destroyed by the waters. Henry refuses any help from others in the community and declines to join the Wakonda Co-op or any other community association. By 1961, the independent, stubborn, and fierce Henry is widely recognized as the patriarch of the long-resented Stamper clan. His motto is “Never Give an Inch.” In the novel, the house built on the river will come to represent family tradition, the river will symbolize the eroding effects of time, and Henry will epitomize the family’s link with its pioneering past. Henry is a man of habit whose philosophy is “to keep on going.”

Hank is Henry’s oldest son. A man of integrity, he is loyal, honest, and courageous, and possesses a strong will and personality. The toughest man in the region, Hank was an all-state football player and a veteran of the Korean War as a Marine. Like his father, Hank is tough, obstinate, self-reliant, and independent. He is the only character in the novel who is able to swim across the river, his most powerful and relentless adversary. The aggressive and vital Hank becomes the leader of the family and has numerous clashes with members of the community and his own family. Throughout the novel he is portrayed as a heroic small businessman who is able to deal with and withstand a variety of pressures.

Hank’s mother dies when he is only ten years old and Henry goes off to New York City to find another wife. Henry returns with a youthful new wife, Myra. The beautiful, 21-year-old, Stanford-educated Myra prefers an urban environment and becomes unhappy in a household of loggers. She and Henry have a son, Leland, who is sensitive, intellectual, and has low self-esteem. Henry pays little attention to Leland as he is apparently satisfied with one son in his image. When Leland was born Hank was already twelve years old.  .  .

The major action of the story occurs during a period of several weeks in 1961. At that time Hank and his cousin and best friend, Joe Ben, are running the Stamper family’s logging business. Henry does what he can but has recently been injured and wears a cast on one side of his body. Having captured the market, the big lumber corporations have been putting pressure on the smaller companies and the union. The Stamper family owns and operates a company that does not have a union‒Hank only hires family members. Henry’s goal is to keep the family logging business alive.

The small town is dying due to the introduction of the gas-powered chainsaw, which has reduced greatly the need for manual labor. As a result, the union loggers go on strike demanding the same pay for shorter hours in response to the decreasing need for manual labor. The union is striking against Wakonda Pacific Lumber Company, a regional mill. The union leaders and members want the Stampers to close down their family-owned, non-union shop believing that it was the Stamper’s duty to support the strike as a sign of solidarity for this small town. The union’s message is one of brotherhood and interdependence.

The Stampers decide to continue to work and to cut and to supply trees to the regional mill in opposition to the striking unionized workers. They supply all of the lumber that the union laborers normally would have supplied from their union shops if the strike had not occurred. Accepting the contract to supply the big lumber company with logs is the opportunity for the Stamper family to gain great wealth. Signing this contract with Wakonda Pacific is the break they had been waiting for. The Stampers also understand that backing the union would damage their own non-unionized family business. To Hank and the other Stampers, the union represents mediocrity and conformity. These small businessmen are thus eager to confront the union.

The union has the backing of the whole town except for the Stampers. This does not sit well with the union workers who feel betrayed. The Stamper family’s decision to keep working prevents the strike from ending because there is no good reason for Wakonda Pacific to negotiate and to resolve the dispute when the Stampers are doing all of the work that the unionized workers would have done. This large corporation can only meet its own contracts by dealing with men like Hank Stamper, a man of his word. ..

The Stampers will not succumb to the demands of the union workers to cease working so that they can gain the benefit of higher wages. One of the townspeople, who is Hank’s friend and union member, pleads with Hank to stop working during the strike. He says that if the Stampers don’t stop then he will commit suicide pretending it was an accident thereby gaining insurance proceeds for his family. Hank refuses while exhibiting no emotions. His friend later follows through with his suicide. Hank is determined by principle to fulfill his commitment to deliver the logs. . .

At this point in the story Hank appears to be ready to give in to the union demands. This has negative effects on the community, and the townspeople are saddened. His giving up would disillusion the residents of the community and would destroy their assurance in confronting life’s challenges. The novel thus illustrates how an heroic free individual with strength and integrity, like Hank, has a positive effect on the community. The community benefits from Hank’s free expression of his self-interest. . .

Sometimes a Great Notion illustrates the value of a family sticking together. Hank, the product of a frontier culture, has a strong will and work ethic and leads his family in fighting for what they believe. He is a man of integrity who has a strong sense of kinship. In association with his family, Hank is able to withstand a variety of pressures including the forces of nature, (i.e., the river and the forest), social pressures exerted by the townspeople, the conformist pressures brought by the union, and the need to fulfill their logging contract. Hank represents the joy of an unyielding will in his quest to deliver the logs to the Wakona Pacific Lumber Company. . .

This fine tale of independence, individualism, and family has been made into a 1971 film. The roles and actors include: Hank Stamper (Paul Newman), Henry Stamper (Henry Fonda), Viv Stamper (Lee Remick), Leland Stamper (Michael Sarazin), Joe Ben Stamper (Richard Jaeckel), Floyd Everwrite (Joe Maross), and Jonathan Draeger (Roy Poole).

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10.  Hippocrates & His Kin: The Cost of Dying

Notable & Quotable (WSJ 2-15-12)

What do you call it when someone steals some else’s money secretly?  Theft.

What do you call it when one takes someone else’s money openly by force?  Robbery.

What do you call it when a politician takes someone else’s money in taxes and gives it to someone who is more likely to vote for him?  Social Justice.

Economist Thomas Sowell writing in his syndicated column, Dec. 27.

Cost of end of life cancer care? (See section 8 above) Read more . . .

A patient with Cancer of the Lung who had everything done that his medical oncologist and radiation oncologist had recommend brought in his chemotherapy and x-ray statement he received from his insurance company. It was more than $200,000. He was given a year to live. That’s 10,000 times the $20 cost of the patient in section 8 above.

The only way to lower the cost of health care is patient responsibility. That is only achieved with a patient copayment. Our research indicates that a10 percent copay on hospital bills such as above would eliminate 60 to 75 percent of the cost of dying. And it would improve the quality of that last year of life.

What a logical way to control health care costs.

Sacramento approves car park for an arena that is only in the planning stages.

The Sacramento Kings have been courted by Anaheim and Seattle to move because the 20-year-old Sacramento Arco Arena is dated. But it still has a regulation size basketball court and the arena is large enough to seat all the fans that desire to come to a game and leave unhappy.

What if the Kings play another year at Arco Arena 20 miles out of town?

Will a new arena improve the number of wins?

Won’t Parking 20 miles from the Arena be rather inconvenient?

I understand the shuttle services are behind this. I wonder if they are already purchasing Vans to transport 20,000 people before and after the games. Or Buses? Maybe they will fund a new light rail?
Or maybe the attendance will drop to 10,000. Or maybe the sports business should pay the costs of their facilities rather than taxpayers? Why are taxpayers on the hook for almost anything?

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

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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. For their article, "Are you really insured?," go to

                      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. This month, be sure to read ? . 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

The road to hell is paved with good intentions, and then after heavy use it gets resurfaced with cynicism.

Conservatives like me were liberals mugged by liberalism.

A true patriot weeps more often than he brags.             

                –Aphorisms from First Things

Some Recent Postings

From The February 14th Issue:

1.      Featured Article: Why the World Needs America

2.      In the News: Professor Muhammad Yunus, winner of the 2006 Nobel peace prize

3.      International Medicine: How I woke up to the untruths of Barack Obama

4.      Medicare: A rare injection of politics into the prayer breakfast - health care overhaul

5.      Medical Gluttony: Only one diagnosis can be treated during one doctor’s visit

6.      Medical Myths: Insurance companies have to provide advice nurses to control doctor costs.

7.      Overheard in the Medical Staff Lounge: Can Santorum Restore America?

8.      Voices of Medicine: Medical Research

9.      Movie Review: The Iron Lady

10.  Hippocrates & His Kin: Some patients enjoy the freedom of ordering their own tests.

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

In Memoriam

 Wall Street Journal Columnist Jeffrey Zaslow Dies at 53

FEBRUARY 11, 2012


Jeffrey Zaslow, a longtime Wall Street Journal writer and best-selling author with a rare gift for writing about love, loss, and other life passages with humor and empathy, died at age 53 on Friday of injuries suffered in a car crash in northern Michigan.

He died after losing control of his car while driving on a snowy road and colliding with a truck, according to his wife and the Antrim County Sheriff's Office. The condition of the truck driver wasn't available.

In addition to writing hundreds of memorable Journal articles and columns, Mr. Zaslow did a long stint as an advice columnist at the Chicago Sun-Times, succeeding Ann Landers—a job he won after he entered a competition for the position as an angle for a Journal front-page feature.

At the Journal his subjects ranged from the anguish of losing a car in the Disney World parking lot, to the power of fathers' lunchbox letters to their daughters, to the distinctive pain of watching a beloved childhood stadium go under the wrecking ball.

More recently, he became one of America's best-selling nonfiction writers, known internationally for such books as "The Girls from Ames," the story of a 40-year friendship among 10 women, and "The Last Lecture," about Randy Pausch, a Carnegie Mellon University computer-science professor who in 2007 was diagnosed with pancreatic cancer and given only a few months to live.

After Mr. Pausch gave an inspirational multimedia presentation about his life's lessons, Mr. Zaslow—a 1980 Carnegie Mellon graduate—wrote a Journal column about the lecture and posted it on the Journal's website with a video that became an online sensation. The resulting book spent more than a year on best-seller lists and was translated into dozens of languages.

He was twice named best columnist by the National Society of Newspaper Columnists and in 2000 he received its Will Rogers Humanitarian Award.

In a statement Friday to the staff of the Journal, editor Robert Thomson said: "Jeff's writing, for the Journal and in his books, has been a source of inspiration for many people around the world and his journalistic life has been a source of inspiration for all journalists." . . .

His latest, "The Magic Room: A Story About the Love We Wish for our Daughters," is set in a Fowler, Mich., bridal store where he looked at American weddings. "I found a place with an awful lot of emotion. And I have been writing books with emotion for all these years so I was just grateful to find this place," he told an interviewer.

A native of the Philadelphia suburb of Broomall, Mr. Zaslow majored in creative writing in college. . .  

Read the entire REMEMBRANCE on the WSJ . . .

On This Date in History – February 28

On this date in 1933

German President Von Hindenburg abolishes free expression of opinion.

On this date in 1933

Hitler disallows German Communist Party (KPD)

On this date in 1847 U.S. defeats Mexico in the battle of Sacramento

On this date in 1784

John Wesley charters the Methodist                                                                    


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The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 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.

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.