Community For Better Health Care

Vol VII, No 13, Oct 14, 2008


In This Issue:

1.                  Featured Article: Education for Profit

2.                  In the News: The Candidates, The Uninsured, Their Medical Plans and Taxes

3.                  International Medicine: International Health Systems Comparison

4.                  Medicare: The Geographic Practice Cost Index (GPCI) Inequity - Time To Fix It

5.                  Medical Gluttony: Can't We Repeat All Those Hospital Tests?

6.                  Medical Myths: If You Are Cost Conscious, You Will Save Health Care Dollars

7.                  Overheard in the Medical Staff Lounge: The $700 Billion Theft

8.                  Voices of Medicine: Election 2008 is the Most Critical We Have Seen

9.                  From the Physician Patient Bookshelf: Here's Looking at You, Kid

10.              Hippocrates & His Kin: A $700 Billion Bank Heist

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

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The Annual World Health Care Congress, 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 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. The third year it was 50 percent, indicating open forums such as these are critically important. The 4th Annual World Health Congress was held April 22-24, 2007 in Washington, D.C. That year many of the world leaders in healthcare concluded that top down reforming of health care, whether by government or insurance carrier, is not and will not work. We have to get the physicians out of the trenches because reform will require physician involvement. The 5th Annual World Health Care Congress was held April 21-23, 2008 in Washington, D.C. Physicians were present on almost all the platforms and panels. This year it was the industry leaders that gave the most innovated mechanisms to bring health care spending under control. The solution to our health care problems is emerging at this ambitious congress. Plan to participate: The 6th Annual World Health Care Congress will be held April 14-16, 2009 in Washington, D.C. The 5th Annual World Health Care Congress – Europe 2009 will meet in Brussels, May 23-15, 2009. For more information, visit The future is occurring NOW. 

To read our reports of the last Congress, please go to the archives at and click on June 10, 2008 and July 15, 2008 Newsletters.

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1.      Featured Article: Education for Profit

Why is everyone flaming the University of Phoenix? Katherine Mangu-Ward | Reason, July 2008 Print Edition

By many measures, the University of Phoenix is the most successful institution for higher education in American history. With more than 325,000 students currently enrolled - 22 times the number at the University of Chicago - Phoenix is vast, and contains multitudes. On campuses scattered across 39 states, and online as well, it offers everything from associate's degrees in sports management to Spanish-language MBAs. And unlike most universities, Phoenix makes a hefty profit. Its parent company, the Apollo Group, produced margins of 11.7 percent last year on revenue of $2.9 billion. What began in 1976 as a small night school where firemen and policemen between shifts completed unfinished bachelor's degrees is now an educational and commercial powerhouse listed on NASDAQ, with a market capitalization of $7.4 billion. To read more, please go to

But in recent years, the University of Phoenix has become the poster child for everything the mainstream academic establishment thinks is wrong about for-profit higher education. The school's aggressive recruiting practices and high dropout rates have drawn fire from The Chronicle of Higher Education, where a college admissions specialist in 2004 called Phoenix's approach "an affront to the principles that have been developing in college admissions over the last three decades." The head of the major accreditation body for business schools, the Association to Advance Collegiate Schools of Business, last year accused Phoenix of using "a lot of come-and-go faculty." The U.S. Department of Education has punished the school for insufficient hours spent in the classroom and illegal recruiting practices, exacting two settlements during the last decade totaling $15.8 million. "Their business degree," Henry M. Levin, a professor at Columbia University's Teachers College, told The New York Times last year, "is an MBA Lite." . . .

But much of what academic traditionalists see as problems, Phoenix advertises proudly as solutions. The university aims to meet underserved demand for post-secondary education, tailor-made to fit the individual circumstances of harried adults. Like other for-profit schools such as DeVry and ITT, Phoenix offers the educational equivalent of a subprime mortgage: not the best product the industry has to offer, but a potentially valuable option for people who might not otherwise get into a desired market.

As with subprimes, a nonnegligible portion of consumers won't be able to stay afloat, exiting school moderately poorer and perhaps not much wiser. But the students who do graduate - like the millions who use subprime deals to gain a firmer foothold in the housing market - have a much different story to tell. Their tales are not about sunshine on the quad, Saturday night football games, or ivy-covered walls. They're about a kind of practical, bare-bones education that you never see in coming-of-age films but that is usually superior to no education at all. . .

From ‘Plague Spot' to Juggernaut
For-profit higher education is nothing new in America. Up through the 19th century, most doctors, lawyers, and accountants picked up their basic skills at schools that were out to make a buck. The army of typists and stenographers that midwifed the information age at the turn of the last century came pouring out of commercial institutions all over the country. One hundred years ago, most medical schools were still small trade operations run by practicing local or retired doctors as a way to supplement their income.

But in 1910, amid newspaper horror stories about quack doctors ("The Doctor Who Killed His Patients With Germs") and fears that the U.S. was falling behind the rest of the world ("Germany to Stop Quackery"), the Carnegie Foundation sent the prominent educator Abraham Flexner to survey the state of medical education in North America. The influential Flexner Report, which singled out Chicago's 14 mostly for-profit medical schools as "the plague spot of the nation," called for standardizing curriculum and dramatically reducing the overall number of diplomas issued. As a result, the 160 institutions that educated more than 28,000 med students in 1904 became 85 schools educating half that many in 1920. (Among the effects: a decrease in medical competition and an increase in doctors' fees.)

The Progressive Era also saw the creation of the modern research university. Schools such as Princeton, with its Institute for Advanced Study (founded by Flexner himself), hit on the magic formula of combining under one roof undergraduate education, graduate and professional training, and academic research. Universities expanded and began to swallow smaller medical schools. By 1935 there were only 66 medical schools left in the country, 57 of which were affiliated with universities, according to a study by the University of Virginia radiologist Mark Hiatt and the D.C.-based consultant Christopher Stockton.

After World War II, the baby boom and the GI Bill helped usher in the "golden age of higher education," a three-decade stretch in which America went from a country where two-thirds of adults hadn't even managed to complete high school to one in which more than 17 percent earned a college degree. Not coincidentally, this era was also the golden age of public funding for universities. Federal and state research grants and student aid became major sources of revenue for public schools and nonprofits. In 1972 Congress allowed for-profit colleges to sidle up to the government trough as well. Now students were allowed to carry what would eventually be called Pell grants with them from school to school; as with vouchers, the money adhered to the student, not the institution.

John Sperling was a middle-aged professor of humanities at San Jose State University in the mid-1970s when he decided to take advantage of what he saw as a gap in the market by risking his life savings, a whopping $26,000, to start a private school. According to Phoenix's official history, Sperling hatched the idea after realizing that "working adult students were invisible on the traditional campus and were treated as second-class citizens."

Initially, there was little more than a facility in San Jose called the Institute for Professional Development, dedicated exclusively to adult education - that is, education for students past their early 20s. At the time, Sperling found, it was taking adult students in the U.S. about eight years to finish a typical four-year degree, in part because nearly all university business happened during work hours. Even if classes were offered at night, the rest of the campus was typically closed, forcing full-time workers to take time off just to register for class, meet with a professor, or buy a book. By offering extended hours and a host of other individualized tweaks, Sperling made it possible for older students with jobs to satisfy all the requirements for a college degree in about four years.

Sperling's fledgling school left San Jose in 1976 and struck out for Arizona after being denied accreditation (not for the last time), in this case by the Western Association of Schools and Colleges. (Nonprofit regional accreditation bodies certify most schools in the U.S. based on site visits and other measures of quality, though schools do not need any accreditation to operate.) The Institute for Professional Development was reassembled as the University of Phoenix, winning accreditation from North Central Association of Colleges and Schools the following year.

The school grew quickly, graduating its first full class in 1981 and gaining accreditation for a nursing school in 1987. In 1989 it inaugurated an online campus. A few years later it launched an online library, one of the first of its kind, offering course materials and reference books that might otherwise require students to dig through the stacks of an academic library - a time-consuming luxury many Phoenix students can't afford. . . .

To read the entire lengthy report, go to

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2.      In the News: The Candidates, The Uninsured, Their Medical Plans and Taxes

McCain, Health Insurance and Taxes, by Grace-Marie Turner, Galen Institute, October 6, 2008

Sen. John McCain would replace the current tax break that locks health insurance to the workplace with a new refundable tax credit of $5,000 for families and $2,500 for individuals to help them buy health insurance.  This credit would give families more control over their health benefits, would provide new help for the uninsured, and would modernize health insurance so it is portable and people don't have to lose their coverage when they lose or change jobs.

Lately, this tax credit has come under fire from Sen. Barack Obama's campaign and the media.

The McCain plan has been criticized for taxing workers' health benefits.  This is inaccurate.

To read more, please go to

·     Sen. McCain replaces an outmoded tax break with a new direct, refundable credit.  And the new $5,000 credit would be worth more to the great majority of Americans than the currently invisible and regressive tax break, which he estimates is worth $4,200 today a year for a family in a 35-percent tax bracket. For those in lower tax brackets (or non-taxpayers), the $5,000 would go even farther.  So rather than a tax increase, the McCain tax credit would in fact lead to a tax cut for the great majority of workers. 

·     In fact, health coverage is part of the employee's overall compensation package, but the value of these non-tax wages is generally invisible to workers, many of whom think the insurance is a gift from their employers.  Under the McCain plan, that part of workers' income they receive in the form of health benefits would be visible, as would the new direct tax benefit. . . .

Sen. McCain's health plan also has been criticized for threatening the stability of employment-based health insurance.  

Critics say it would undermine the employment-based system because the employer would lose his tax deduction.  But this is inaccurate.  Whether the employer offers compensation in the form of health benefits or direct compensation, employers still would receive a tax deduction for the amount they spend on health coverage. In addition, the payroll taxes they pay would continue to be protected from corporate income taxes under the McCain plan. These provisions make providing health insurance neutral for employers in terms of financial incentives.

Sen. McCain has been criticized for not helping the uninsured.

The uninsured would get meaningful help in purchasing health insurance because they, too, would be eligible for the tax credit.  The average price of health coverage that people buy on their own is less than half the cost of a job-based policy, so the credit could provide significant help in enabling them to buy coverage for their families. 

A survey by Forrester Research found that families purchasing health insurance in the individual market pay between $3,300 and $4,550 a year for health insurance. Many of these are high-deductible plans, but for most of these families, the $5,000 credit would pay for the full cost of the policy and even provide extra money to fund the deductible.

And because the credit is refundable, people would receive the full amount, even if they owe less than that in taxes.

Read more,8/action,show_content/id,68/category_id,0/blog_id,1095/type,33/.

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3.      International Medicine: International Health Systems Comparison

The Single-Payer Remedy Is Worse Than the Disease, Grace-Marie Turner, The Galen, Jan 22, 2008

No one denies that America's health sector faces problems. Costs continue to rise, and 45 million people lack insurance. Even worse, many politicians think they've discovered the cure in a single-payer system.

But that remedy would be worse than the disease. The government-dominated health systems of Europe and Canada are struggling with serious cost pressures, inefficient bureaucracies, and unmet demands for more advanced medical care.

For the privilege of their supposedly "free" care, other countries pay much higher taxes. In 2005, taxes consumed 41% of GDP in Canada, 42% in Britain, and 51% in France, compared to 32% in the U.S.

Single-payer systems invariably involve rationing. What good is free care if the government denies access to it?

About one million people in the U.K. are on waiting lists for hospital care, including surgeries. And 200,000 more are waiting just to get on the waiting list. To read more, please go to

Cancer patients in Britain have resorted to waging public relations campaigns because their government won't pay for new medications for breast and kidney cancer.

In Canada, the situation is no better. Long waiting lines lead to restricted access to care.  There were 45 inpatient surgical procedures per 1,000 Canadians in 2003, compared to 88 in the United States. Canadians received only one-third as many MRI exams and half as many CT scans.  

Meanwhile, patients in Sweden have been sent to veterinarians for diagnostic tests so the government could reduce waiting lists.  

Proponents of a single-payer system argue that the United States would be different -- that we could get all the money we need to finance universal health insurance by eliminating profit in the private health sector.

But that's like trying to cure a disease with arsenic. Socializing our health care system would mean that one-sixth of our economy would operate under different economic rules, with the government setting prices, allocating resources, and deciding what medical care would be available to whom and when.

There is a better way.   

We should embrace competition, not stifle it. We should reward innovators, risk-takers, and entrepreneurs for providing faster, better, more affordable health care. And we should recognize that progress depends upon innovation and profit.

The U.S. market already is pointing the way by responding to consumer demands for more convenient, more affordable health services. Health plans are offering programs to help patients better manage chronic diseases like diabetes, lowering costs and improving health.

Small clinics are springing up in retail stores around the country, providing customers with easy access to nurses who treat common ailments like ear infections and poison ivy. These clinics cost less than a visit to the doctor or emergency room.  

Competition is leading to more affordable prescription drugs. Wal-Mart started a price war by announcing it would sell a long list of generics for only $4 for a month's supply. Target and other pharmacies followed suit. Today, more than half of the prescriptions Wal-Mart fills are $4 generics. . .

Rather than regressing to the failing systems of Europe -- with waiting lines and rationing -- we must develop our own unique solution. Ultimately, that means embracing the truly American qualities of innovation and competition.

Grace-Marie Turner is president of the Galen Institute in Alexandria, Va.

Read more,8/action,show_content/id,13/blog_id,997/category_id,10/type,33/

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

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

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4.      Medicare: The Geographic Practice Cost Index (GPCI) Inequity - Time To Fix It

Where Did The Geographic Practice Cost Index Come From?

The woeful state of physician reimbursement deserves careful study. Just how did we get here

and how can we fix it? It all started with the development of the relative value scale (RVS). At the time in the mid-1950s, it seemed logical and efficient to apportion a doctor's daily tasks by difficulty and time consumption so that the physician could more reasonably and correctly bill for his or her work. In addition, a personalized multiplication factor added to the RVS could reflect overhead costs and that factor could change as overhead costs changed. Further, others could use the RVS and modify their work product with their own personal multiplication factor. The final result would be a universal formula - a usual, customary and reasonable rate to charge - and all would be happy. To read more, please go to

With this incentive, the California Medical Association (CMA) went to work. In 1956, CMA launched a project titled "California Relative Value Studies." First, every possible procedure and diagnosis was listed as a code number - the Current Procedural Terminology, or CPT code, as it was later named by the American Medical Association. Then a relative value unit (RVU) reflected the physician's time, resources, and work intensity necessary to accomplish each CPT code. Next, an individual physician assigned a "conversion" factor to the formula based on individual office overhead expenses and local area of practice.  When a physician multiplied the conversion factor by the RVU, the "uniform" fee was revealed.  At the time, just about every physician's office had an RVU rate schedule. The booklet was an essential first purchase for any doctor starting a medical practice.  In 1969, CMA published its "California Relative Value Studies." It was revised and published again in 1974.  CMA finally published the "California Standard Nomenclature" in 1979. The final CMA publication is still referred to as the "RVS book."

The recommended use of conversion factors to reflect differences meant that physician fees varied greatly. Eventually, insurers became reluctant to pay at different rates. A cry of injustice was heard throughout the land. The media warned that doctors were operating outside the law and demanded that the RVS be eliminated.

In 1979, the Federal Trade Commission charged that the RVS system placed private-practice physicians in violation of federal provisions against price fixing.  Payers were exempt from the ruling. Why were payers allowed to act like businesses when solo and smallgroup physicians were not?

The result was that physicians secretly hid their RVS books deep in office file drawers and developed individual billing schedules that looked remarkably like the RVS.

Young physicians just starting their medical practices bought gray market RVS books and kept them under lock and key.

However, when it came time for the government to pay for Medicare and Medicaid, standardized billing was suddenly recognized as an essential component. The shoe was on the other foot. The government established national standard rates and fees based on a defined and limited total pool of money, which they defined as a "resource." In 1989, the Health Care Financing Administration developed a Resource-based Relative Value Scale (RBRVS) to redistribute a fixed budget of Medicare funds to physicians. Healthcare rationing, disguised as cost containment, rapidly won legislative approval.  In 1970, projected Medicare spending for 1990 was $16.3 billion. In 1990, the actual cost of Medicare was $109 billion. A few extra billion here and there, and pretty soon the healthcare delivery system added up to major government debt. The RBRVS did not do what the RBRVS was supposed to do.

Then, because no good deed goes unpunished, the government came up with an even more confusing dynamic for payment.

From the 1991 proposed rule in the Federal Register:

Payment = [{RVUws x GPCIwa} + {RVUpes x GPCIpea} + {RVUms x GPCIma}] x CF

·         RVUws = Physician work relative value units for the service.

·         GPCIwa = Geographic practice cost index value reflecting one fourth of the geographic variation in physician work applicable in the fee schedule area.

·         RVUpes = Practice expense relative value units for the service.

·         GPCIpea = Geographic practice cost index value for the practice expense applicable in the fee schedule area.

·         RVUms = Malpractice relative value units for the service.

·         GPCIma = Geographic practice cost index value for malpractice expense applicable in the fee schedule area.

·         CF = Uniform national conversion factor.

All of the above only served as more subterfuge. The resource for Medicare funding was based on Americans having an average life expectancy of 65 years in 1964.  By 2000, that life expectancy was 78 years and today it is 80 years. The fastest growing segment of our society is older people. The resource is grossly inadequate. In an era of expanding technologies, the amount of funding available for physician fees from a fixed-dollar resource mathematically decreased. The logical next step was to increase the resource base, but neither side of the political aisle appears to be interested in confronting this painfully obvious solution. . .

Perhaps our government officials should get their act together and properly fund programs so that those who actually deliver healthcare are adequately reimbursed. Ω

Ralph Di Libero, MD, Southern California Physician

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

- Ronald Reagan

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5.      Medical Gluttony: Can't We Repeat All Those Hospital Tests?

Martha, a 63-year-old lady, was admitted to the hospital for observation of her abdominal pain. This resolved over several days and she was discharged to see her personal physician immediately. She came in the following morning. My medical assistant had already obtained the hospital records, which included a 13-page section of laboratory work. Many tests had been done daily and were essentially within normal limits. Even her cholesterol, lipids and diabetic glycohemoglobin were all normal. Since it was time for her annual exam, I went through my chart and brought items of her history up-to-date. When I was writing her prescription renewals, she asked for her annual tests. I explained to her that all the tests that we normally do to check her elevated lipids and diabetes had been done several times over the past few weeks. There was no further testing indicated. To read more, please go to

She said, "But we always do them at this time of year. How do we know that the hospital tests are valid?"

I tried to explain that they were indeed valid and we should accept them as such. The additional tests could not be justified as appropriate health care costs.

She retorted that costs should never be any criteria when her health care was in question.

This was a real switch. Many hospitals refuse to accept outside laboratory tests as valid for pre-surgical screening because they believe no one has the quality control of hospitals. And here is a lady that thinks the hospital tests are of poorer quality.

The cost of health care never crossed this lady's conscious brain. There's no chance of it making any impact until patients pay a percentage of every health care expenditure.

To read more, please go to:

Designing the Patient-Centered Health Plan for America

A National Health Care Plan

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6.      Medical Myths: If You Are Cost Conscious, You Will Save Health Care Dollars

A patient had chest pain and had his wife take him to the hospital ER. He was found to have coronary insufficiency. He was criticized for not calling 911 and taking an ambulance in trying to save health care costs. He had no difficulty riding in the car to the hospital.

He did have a coronary and was transported by ambulance to another hospital for a cardiac catheterization. He said the ride was so rough, he wished he'd hired a $50 limousine and a nurse and gone down on his own. He was especially sorry after he got the ambulance bill for the 17-mile ride: $1500. To read more, please go to

The choices in health care are difficult for everyone. We need to be less critical of people trying to do their best in their own estimation of cost-effective health care. Criticizing our patients for making what the establishment sees as inappropriate choices only makes the public more critical of us. Isn't it time we all became more tolerant of each other?

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7.      Overheard in the Medical Staff Lounge: The $700 Billion Bailout

Dr. Dave: What do you think of the $700 billion bailout plan?

Dr. Ruth: Looks like we needed it to keep us out of a depression.

Dr. Dave: You really think that taking $2300 from every American will help them.

Dr. Ruth: Did we have an alternative?

Dr. Edwards: Yes, we could have let the large insurance carriers and brokerage houses go under. Just like any other business that makes poor choices. It wasn't my fault that they made poor choices.

Dr. Ruth: Wouldn't that have messed up my retirement plans?

Dr. Edwards: When the bubble burst in the late 1990s, I lost two-thirds of my retirement plans and no one bailed me out. To read more, please go to

Dr. Milton: Once the government bails out one industry, where does it stop?

Dr. Rosen: Which presidential candidate would have done it your way?

Dr. Milton: I don't think either one would have. The debates don't clarify anything. Both candidates made vast over statements. One candidate, who was against nuclear power and offshore drilling, stated that he has always been for those things.

Dr. Edwards: Well, he's a lawyer; he's very skillful at bending the truth to serve his needs. Lawyers don't call that lying. They consider that anything goes when trying to win the case.

Dr. Michelle: Even lying?

Dr. Edwards: They don't perceive that as lying. They perceive that as winning an election or a court case. How else can you win?

Dr. Rosen: I think most people see through that. They aren't going to change their vote on the basis of any debate. Debating skills have no relationship to governing skills.

Dr. Edwards: But will the public see it that way?

Dr. Rosen: I think when Americans get into the voting booth and it's only them and their conscience, they will vote for the best man to be president; not the best debater or the best liar.

Dr. Milton: I certainly hope so. I won't rest until after the elections. So much depends on this one.

Dr. Edwards: Remember when Osama said that he would some day rule America and he would be able to do that through the political process?

Dr. Rosen: Are you trying to say, that Obama is Osama's agent?

Dr. Edwards: Well Obama has lived in Pakistan and has numerous friends in that part of the world. He was middle class until recently. He went to ordinary schools. Then he went to Ivy League schools and now has a $1.4 million house. Where did all this funding come from?

Dr. Rosen: You really think that Osama and his supporters are funding Obama?

Dr. Edwards: Who knows? We may never know for sure until he's inside the White House. And then it will be too late. Our country will come crashing down after a short stint of 225 years of freedom. It will be millennia before anyone tries this experiment in freedom again.

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8.      Voices of Medicine: Election 2008 is the Most Critical We Have Seen, by Tom LaGrelius, MD

[MedicalTuesday is nonpartisan but this physician's viewpoint on important issues is critical for our patients' and our country's future.]


There is no doubt the presidential election of 2008 is critical, perhaps the most critical we have seen. In this financial crisis we need strong, experienced leadership. In this time of terrorist threat and conflict we need even stronger, more experienced leadership. John McCain is prepared, experienced and qualified to lead this nation in these dangerous times. Barack Obama, despite his current six-point lead in the polls, is not.

McCain is a war hero who spent years in an enemy prison camp being tortured, yet refused an offer of early release unless his fellow prisoners were also sent home. He can be trusted to look out for his fellow Americans first and foremost. Barack Obama has never served in this or any other country's military and has really never been tested in any way.

John McCain has leadership and command experience. After his heroic Naval Air actions in Viet Nam, he later commanded the Navy's largest aviation squadron training its pilots and bringing it from a level of poor performance to excellent during his command.(1)  He has been a leader in the House and Senate for decades, opposing waste, corruption, all earmarks and many of the current administration's weak policies including mistreatment of prisoners at any level.  He is incorruptible and if elected will be the real agent of change and bipartisanship in Washington DC, that Obama, being such a polarizing candidate, can never be. 

Barack Obama has commanded nothing but his own campaign and served only as an Illinois legislator and part of one term beginning in 2005 as a freshman US Senator. He offered little innovative legislation and voted "present" rather than "yes" or ‘no", over 130 times which obscured his true opinions, while inserting earmark after earmark in legislation he did not author. He speaks of reform, change and hope, but has no track record to point to. To read more, please go to

John McCain is a centrist patriot who reaches across the isle in both directions. He has worked effectively with his own party, with liberal Democrats like Kennedy and centrist Democrats like Lieberman. He is now actively supported by Senator Lieberman who was the former Democratic candidate for Vice President on the Gore/Lieberman ticket in 2000. 

Barack Obama had the most leftist voting record in the Senate in 2007.(2)   As McCain noted in their first debate, reaching across the isle to Obama is a hard, long reach to the far left. Obama stands way farther to the left than the vast majority of Americans who plan to vote for him, let alone the ones who don't.

Members of John McCain's family have been patriotic American loyalists, military leaders and Navy Admirals like his father dating back to the 19th century. Barack Obama's father was a brilliant Harvard trained economist whom the younger Obama lionized in his 1995 book "Dreams from My Father", but who returned to his native Kenya and literally tried to communize it. Barack Obama Sr. wrote scholarly papers encouraging Marxist changes in the Kenyon government.(3) (4) 

In the case of John McCain the apple did not fall far from the tree, and the same may be true of Obama Jr., whose high tax plans and redistributive legislative proposals often sound much like the ones his father proposed in Kenya. Before achieving his goals, Obama Sr. was ultimately recognized for his ultra far left political position, ousted from the Kenyon government and fell into obscurity, a fact not lost on the younger Obama who keeps his long term political associations and deepest opinions well under wraps until and unless others unwrap them. Only by his actions as president are we likely to learn of them directly. 

John McCain's chosen mentors were military heroes and American patriots at every step on the road. Barack Obama's chosen mentors included Viet Nam era terrorists like Ayers and radical black activists, like his minister and "inspiration" for twenty years, the now denounced and discredited Reverend Jeremiah Wright whose anti-American rantings have shocked all who have seen them.(5) 

Another Obama mentor was Communist Party member, former Chicago community organizer and later Hawaiian ILWU union organizer Frank Marshall Davis mentioned warmly as "Frank" in Obama's book, but now acknowledged by Obama to be his friend and mentor during Obama's formative years in Hawaii.(6) Time Magazine recently noted this connection and influence and stated speaking of Davis "Still, it's clear that Obama did seek advice from the old man and that what he got was undiluted. "You're not going to college to get educated. You're going there to get trained," Davis once warned Obama. "They'll train you so good, you'll start believing what they tell you about equal opportunity and the American way and all that s___."(7) 

So, to me, there is little choice in this election. We must elect John McCain. To those Obama supporters who may have a flicker of lingering doubt about their choice I invite them to take the time to investigate the history and records of Obama and McCain. Perhaps enough of them will change their minds in time, I sincerely hope.  

Thomas W. LaGrelius, MD, FAAFP
Speaking only for myself. 

Footnote links to sources


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9.      Book Review: Here's Looking at You, Kid From The Economist print edition Sep 18th 2008 

The Case Against Barack Obama: The Unlikely Rise and Unexamined Agenda of the Media's Favorite Candidate
By David Freddoso

Regnery; 290 pages; $27.95 and £16.99

Buy it at


IF YOU find yourself believing that "we are the ones we've been waiting for", or that "this is the moment when the rise of the oceans began to slow" or even, tout court, that "yes we can", the chances are that you are suffering from a severe case of Obamamania.

Tens of millions of Americans and an even larger number of Europeans have fallen victim to the syndrome, which involves a belief that a young black senator from Chicago can cure the world's ills, in part because of his race, in part because of his obvious intelligence and rhetorical skill; but in no part because of any record of achievement in the past. Fortunately, an inexpensive remedy is at hand.

It comes in the form of a new book by David Freddoso, "The Case Against Barack Obama". Unlike the authors of some of the cruder attacks on Mr Obama, Mr Freddoso works for a well-respected organisation, the online version of the National Review. Although it is a conservative publication and the author makes no secret of where his political sympathies lie, this is a well-researched, extensively footnoted work. It aims not so much to attack Mr Obama as to puncture the belief that he is in some way an extraordinary, mould-breaking politician. To read more, please go to


The Obama that emerges from its pages is not, Mr Freddoso says, "a bad person. It's just that he's like all the rest of them. Not a reformer. Not a Messiah. Just like all the rest of them in Washington." And the author makes a fairly compelling case that this is so. The best part of the book concentrates on Mr Obama's record in Chicago, his home town and the place from which he was elected to the Illinois state Senate in 1996, before moving to the United States Senate in 2004. The book lays out in detail how this period began in a way that should shock some of Mr Obama's supporters: he won the Democratic nomination for his Illinois seat by getting a team of lawyers to throw all the other candidates off the ballot on various technicalities. One of those he threw off was a veteran black politician, a woman who helped him get started in politics in the first place.

If Mr Obama really were the miracle-working, aisle-jumping, consensus-seeking new breed of politician his spin-doctors make him out to be, you would expect to see the evidence in these eight years. But there isn't very much. Instead, as Mr Freddoso rather depressingly finds, Mr Obama spent the whole period without any visible sign of rocking the Democratic boat.

He was a staunch backer of Richard Daley, who as mayor failed to stem the corruption that has made Chicago one of America's most notorious cities. Nor did he lift a finger against John Stroger and his son Todd, who succeeded his father as president of Cook County's Board of Commissioners shortly before Stroger senior died last January. Cook County, where Chicago is located, has been extensively criticised for corrupt practices by a federally appointed judge, Julia Nowicki.

The full extent of Mr Obama's close links with two toxic Chicago associates, a radical black preacher, Jeremiah Wright, and a crooked property developer, Antoin Rezko, is also laid out in detail. The Chicago section is probably the best part of the book, though the story continues: once he got to Washington, DC, Mr Obama's record of voting with his party became one of the most solid in the capital. Mr Freddoso notes that he did little or nothing to help with some of the great bipartisan efforts of recent years, notably on immigration reform or in a complex battle over judicial nominations.

Sometimes, however, Mr Freddoso lets his own partisan nature run away with him. It strikes the reader as odd to make an issue out of the Obamas' comfortable income, when everyone knows that John McCain and Hillary Clinton both have family fortunes in excess of $100m. On the whole, though, Mr Freddoso raises legitimate points. And he ends with a question Obamamaniacs should ask themselves more often: "Do you hope that Barack Obama will change politics if he becomes president? On what grounds?"

The Case Against Barack Obama: The Unlikely Rise and Unexamined Agenda of the Media's Favorite Candidate. By David Freddoso.  Regnery; 290 pages; $27.95 and £16.99 

To read more book reviews, go to

To read book reviews topically, go to

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10.  Hippocrates & His Kin: A $700 Billion Bank Heist

The $700 Billion Bailout: A $2300 Theft from Every American Taxpayer

The a major difference between free enterprise and government programs is that when a free enterprise venture fails, it passes out of the picture and new businesses sprout up with the same risk; when a government program fails, congress just taxes it citizens more and more and pump more taxpayer funds into the failed program which never goes out of existence. It continues to cost taxpayers money ad infinitum, even future generations.

When the silicon bubble of the 1990s dissolve in the late 1990s, most doctors I know lost about one-third to two-thirds of their retirement fund. The doctors just dug in their heels, realizing it was their decision where to invest their pension plans, and decided not to retire at the now relatively young age of 72 and continue to work until age 80 or so. Actually age 80 today is equivalent to age 65 when Social Security was implement and is where Social Security Retirement would begin if Social Security had been index for life expectancy.

Why would Congress even consider a bail out when the investment banks are failing because of their own reckless programs rather than let them fail? Is that the American or Free Enterprise way of thinning the forest to allow the trees to grow? Why do we allow Congress to steal $2300 from every man, woman and baby at gun point? Yes, we have gotten more sophisticated, since the days of the Wild West, with gun control. But at least in the old Wild West you could only be robbed of the money you had. Congress can take the $2300 you don't have, the $2300 your children don't have, confiscate your property and can collect what's left from your children which may be yet unborn. That's worse than gun point.

Can we defeat every incumbent that voted for this in our elections next month? What a cleansing that would be. What a statement in support of our forefathers who came to this country for freedom to choose, without government intrusion, whether one wins or fails?

My grandparents fled German Chancellor Otto von Bismarck's government medicine in Germany in the 19th century. Why are we importing Socialized Medicine to America in the 21st century?

To read more, please go to

Warren Buffet receives a call: "I'm from Bear Stearns, should I go on?"

Mr. Buffet recalls thinking: "It's like a woman taking off half her clothes and asking, ‘Should I continue?' Even if you're a 90-year-old eunuch, you let 'em finish."

The deal was never consummated.

Warren Buffett observed when the investment houses toppled: "One really doesn't know until the tide goes out, who's been swimming naked.

The next deal from Morgan Stanley was consummated.

To read more HHK, go to

To read more HMC, go to

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


•                      The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at and register to receive one or more of these reports. This month, enjoy reading Medical Licensing: An Obstacle To Affordable Care.

•                      Pacific Research Institute, ( Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog. This month, be sure to read:  Our Healthcare System Is Hemorrhaging. 

•                      The Mercatus Center at George Mason University ( is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government. This month, consider reading Why Current Publication Practices [In Biomedical Research] May Distort Science.

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

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

•                      The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at This month, click on the timely Debate: Health Care ‘Right' or ‘Responsibility'.

•                      Greg Scandlen, an expert in Health Savings Accounts (HSAs) has embarked on a new mission: Consumers for Health Care Choices (CHCC). Scroll down to read the initial series of his newsletter, Consumers Power Reports. There are two levels of membership to receive this newsletter by email and other benefits. Be sure to read The Brookings Institution's Henry Aaron is calling on Barack Obama and Congressional Democrats to drop their ambitions for "universal health care."

•                      The Heartland Institute,, publishes the Health Care News. Read the late Conrad F Meier on What is Free-Market Health Care?. You may sign up for their health care email newsletter. Read Expert Comment: Medicare and Social Security Face Failure.

•                      The Foundation for Economic Education,, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling, PhD, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. With the current financial mess, you might turn to an old classic: The Government as Robin Hood.

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

•                      The Independence Institute,, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter. This month, read Obama and Taiwan.

•                      Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, consider reading Who's Afraid Of The Big Bad Dragon? Part Two: China And Democracy.

•                      The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at for an overview of the extensive research articles that are available. Read the News Release: Surgical wait times down but Canadians still waiting more than 17 weeks for treatment.  

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

•                      CATO. The Cato Institute ( was founded in 1977 by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. This month, be sure to read Does Barack Obama Support Socialized Medicine?. 

•                      The Free State Project, with a goal of Liberty in Our Lifetime,, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]

•                      The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, war time allows the federal government grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in war time we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to

•                      Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read Sarah Palin. The last 35 years of Imprimis are archived.

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Del Meyer

Del Meyer, MD, Editor & Founder

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 Words of Wisdom

Gaffe: The classic definition is when a politician accidentally tells the truth. WSJ, 9-25-08.

There are infinite possibilities in little beginnings. -R Schuller

Feedback from the results of a decision compare against the expectations when it was being made makes even moderately endowed executives into competent decision makers. -Peter F. Drucker-Daily Drucker

Some Recent Postings

AMERICA ALONE, The End of the World as we Know It, by Mark Steyn,

HEALTH CARE CO-OPS IN UGANDA - Effectively Launching Micro Health Groups in African Villages, by George C. Halvorson

A CALL TO ACTION - Taking Back Healthcare for Future Generations by Hank McKinnell

PUTTING OUR HOUSE IN ORDER - A Guide to Social Security & Health Care Reform by George P. Shultz and John B Shoven

In Memoriam

Martin Tytell, a man who loved typewriters, died on September 11th, aged 94

ANYONE who had dealings with manual typewriters - the past tense, sadly, is necessary - knew that they were not mere machines. Eased heavily from the box, they would sit on the desk with an air of expectancy, like a concert grand once the lid is raised. On older models the keys, metal-rimmed with white inlay, invited the user to play forceful concertos on them, while the silvery type-bars rose and fell chittering and whispering from their beds. Such sounds once filled the offices of the world, and Martin Tytell's life.

Everything about a manual was sensual and tactile, from the careful placing of paper round the platen (which might be plump and soft or hard and dry, and was, Mr Tytell said, a typewriter's heart) to the clicking whirr of the winding knob, the slight high conferred by a new, wet, Mylar ribbon and the feeding of it, with inkier and inkier fingers, through the twin black guides by the spool. Typewriters asked for effort and energy. They repaid it, on a good day, with the triumphant repeated ping! of the carriage return and the blithe sweep of the lever that inched the paper upwards. To read more, scroll down at

Typewriters knew things. Long before the word-processor actually stored information, many writers felt that their Remingtons, or Smith-Coronas, or Adlers contained the sum of their knowledge of eastern Europe, or the plot of their novel. A typewriter was a friend and collaborator whose sickness was catastrophe. To Mr Tytell, their last and most famous doctor and psychiatrist, typewriters also confessed their own histories. A notice on his door offered "Psychoanalysis for your typewriter, whether it's frustrated, inhibited, schizoid, or what have you," and he was as good as his word. He could draw from them, after a brief while of blue-eyed peering with screwdriver in hand, when they had left the factory, how they had been treated and with exactly what pressure their owner had hit the keys. He talked to them; and as, in his white coat, he visited the patients that lay in various states of dismemberment on the benches of his chock-full upstairs shop on Fulton Street, in Lower Manhattan, he was sure they chattered back.

A drawer of umlauts

His love affair had begun as a schoolboy, with an Underwood Five. It lay uncovered on a teacher's desk, curved and sleek, the typebars modestly contained but the chrome lever gleaming. He took it gently apart, as far as he could fillet 3,200 pieces with his pocket tool, and each time attempted to get further. A repair man gave him lessons, until he was in demand all across New York. When he met his wife Pearl later, it was over typewriters. She wanted a Royal for her office; he persuaded her into a Remington, and then marriage. Pearl made another doctorly and expert presence in the shop, hovering behind the overflowing shelves where the convalescents slept in plastic shrouds.

Mr Tytell could customise typewriters in all kinds of ways. He re-engineered them for the war-disabled and for railway stations, taking ten cents in the slot. With a nifty solder-gun and his small engraving lathe he could make an American typewriter speak 145 different tongues, from Russian to Homeric Greek. An idle gear, picked up for 45 cents on Canal Street, allowed him to make reverse carriages for right-to-left Arabic and Hebrew. He managed hieroglyphs, musical notation and the first cursive font, for Mamie Eisenhower, who had tired of writing out White House invitations.

When his shop closed in 2001, after 65 years of business, it held a stock of 2m pieces of type. Tilde "n"s alone took up a whole shelf. The writer Ian Frazier, visiting once to have his Olympia cured of a flagging "e", was taken into a dark nest of metal cabinets by torchlight. There he was proudly shown a drawer of umlauts.

Mr Tytell felt that he owed to typewriters not only his love and his earnings, but his life. In the second world war his knowledge of them had saved him from deploying with the marines. Instead he spent his war turning Siamese keyboards into 17 other Asian languages, or customising typewriters for future battlegrounds. His work sometimes incidentally informed him of military planning; but he kept quiet, and was rewarded in 1945 with a medal done up on a black, familiar ribbon.

Each typewriter was, to him, an individual. Its soul, he reminded Mr Frazier, did not come through a cable in the wall, but lay within. It also had distinguishing marks - that dimple on the platen, that sluggishness in the typebars, that particular wear on the "G", or the "t" - that would be left, like a fingerprint, on paper. Much of Mr Tytell's work over the years was to examine typewritten documents for the FBI and the police. Once shown a letter, he could find the culprit machine.

It was therefore ironic that his most famous achievement was to build a typewriter at the request of the defence lawyers for Alger Hiss, who was accused in 1948 of spying for the Soviet Union. His lawyers wanted to prove that typewriters could be made exactly alike, in order to frame someone. Mr Tytell spent two years on the job, replicating, down to the merest spot and flaw, the Hiss Woodstock N230099. In effect, he made a perfect clone of it. But it was no help to Hiss's appeal; for Mr Tytell still could not account for his typewriter's politics, or its dreams.


On This Date in History - October 14

On this date in 1890, Dwight D. Eisenhower, 34th President of the United States and one of our greatest military commanders was born. Although he was not regarded as one of his generation's outstanding public speakers, he used a very eloquent phrase in his speech at the Bicentennial Celebration of Columbia University in 1954. Having been through all that nonsense of the divine right of kings, he referred to "the revolutionary doctrine of the divine rights of the common man." He put the emphasis where it rightfully belongs.

On this date in 1644, William Penn was born in London. He, of course, founded Pennsylvania and established what he called the City of Brotherly Love, Philadelphia. He made peace with the Indians and established a tradition of brotherhood and decency, a valued American heritage.

On this date in 1066, the Battle of Hastings was fought. This was the battle in which William the Conqueror defeated the English and brought about the Norman Conquest. The Battle of Hastings is regarded as one of the most historic turning points in the development of England.

After Leonard and Thelma Spinrad


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