Featured Article: The Future of Conservatism
By LARRY P. ARNN, President, Hillsdale College
The future of conservatism is contained in its name. Conservatism regards certain things as abiding. There are laws of nature, and freedom, justice, and civilization depend upon the recognition of those laws. Today they face a challenge that is debilitating to society. Sustained by a transformative president, this challenge claims to have history on its side, and it claims to sit at the moment of final triumph.
In the arithmetic of nature, there must be opportunities to match this danger, and there are. The politics of the left lead to friction along racial and class lines. They raise up a new political class that governs through privileged influence. This political class, for all its pretensions of science and progress, does and will continue to do what unaccountable rulers do: Govern in its own interest. These things have bred and will continue to breed widespread and intractable resentment. Read more . . .
In this resentment there is opportunity, already present and growing. So far the conservative movement has not been able to capitalize on it. This is partly because it does not make its argument, especially in active politics, consistently well or in unity. Such a problem is not easy to fix, because statesmen of the first order are, as Winston Churchill put it, “much rarer than the rarest and purest of diamonds.” This is the age-old problem of politics.
The best we can do is take our guidance where Aristotle said we would find it: in the examples of great statesmen. What, for example, did Churchill do? He lived for long years in the wilderness. He faced the overwhelming opposition of academic and elite opinion, shot through with ideology that made them blind to Hitler and his ilk and devalued the freedoms of their country. He, like us, faced a hostile press, and he was denied access to the major organs of public communication. He was driven, partly by his own party, to the point of bankruptcy and obscurity. As things worsened, his argument rose to a high pitch of reason and eloquence, driven upwards by his own native talent and by terrible events.
Then came the sufficient opportunity: Events proved him right. He had paid a heavy price, and the people saw it and trusted him. First a few, then many, then legions rallied to his cause. He and his people saved their country and, by the time he was done, left it stable and free for more than a generation.
If conservatism is to live, it must repudiate absolutely this system of limitless government, of class and racial privilege and discrimination, of the overturning of human nature, of the vaunting of the ruling class. It must proclaim without ceasing the good of freedom and the danger to it. It must examine itself before it blames the American people, who have a right to govern themselves and who have not been the cause of these troubles. If conservatism speaks with force and persistence in the name of the good that it loves, its day will come.
www.commentarymagazine.com/articles/symposium-future-of-conservatism-2012/
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In the News: The most persecuted religion
By ABRAHAM COOPER, JOHN HUFFMAN AND YITZCHOK ADLERSTEIN, WSJ
At the height of the Nazi Holocaust, the wretched human cargo spilling out of cattle cars onto the platforms of Auschwitz was immediately subject to a brutal “selektion” by the infamous Dr. Josef Mengele, whose flick of a finger to the left meant immediate death in a gas chamber; to the right, slave labor and slow death from starvation or disease.
Fast forward to 2012 Nigeria, where a latter-day incarnation of selektion has been used—this time not against Jews, but against Christians. Read more . . .
Nigeria is the most populous black nation on earth. Among its chief blessings are oil and a large array of religious, tribal and language groups. Yet conflict, violence and terrorism are part of reality there, too.
Recently a new line of inhumanity was crossed. In October, armed attackers, presumed to be members of Boko Haram, an Islamist terrorist group with links to al Qaeda, invaded the Tudun Wada Wuro Patuje area, entering the off-campus housing of the Federal Polytechnic State University.
The attackers called students out of their rooms and asked for their names. Those with Christian names were shot dead or killed with knives. Students with traditionally Muslim names were told to quote Islamic scripture. The selektion completed, at least 26 bodies were left in lines outside the buildings. . .
In earlier times, armies clashed over territory. Objectives were clear, as was the identity of the "enemy," lurking beyond a defined border. Nowadays people in too many parts of the world are taught to identify as the enemy neighbors who are indistinguishable from themselves, save by their beliefs. They have to be "selected" before they can be butchered. Whatever the original cause of a conflict, once religion becomes the driving ideological tool, it is no longer just about oil reserves or farmland.
Today, Islamist extremists' rage has the power to transform small, local conflicts into infernos that can snuff out lives thousands of miles away. Threatened targets of religious hatred today include Hindus, Sunnis, Shiites, Bahais and Jews, but the most widely menaced are Christians. A Pew Forum study last year found that Christians are persecuted—by independent groups or governments—in 131 of the 193 countries in the world. . .
If America fails to exercise leadership, it will further embolden those who invoke God's name to murder and maim families in their houses of prayer and, as in Pakistan earlier this year, young girls who dare dream of an educated future. Theological manipulators of hatred will not be deterred unless and until they face the long arm of international action.
We must, and we can, ensure that the faithful attending a mosque on Friday, a synagogue on Saturday or a church on Sunday can be confident that they'll return home safely. We urge the president to use the next four years to protect not religions, but the religious, wherever they may be.
Rabbi Cooper is associate dean of the Simon Wiesenthal Center. Rev. Huffman is the pastor emeritus of St. Andrew's Presbyterian Church in Newport Beach, Calif. Rabbi Adlerstein is director of interfaith affairs at the Wiesenthal Center.
A version of this article appeared December 22, 2012, on page A15 in the U.S. edition of The Wall Street Journal, with the headline: The Most Persecuted Religion.
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International Medicine: A New Twist on International Medicine: Domestic Medicine
Companies go surgery shopping
By Chad Terhune, Los Angeles Times
Employers are sending workers on all-expenses-paid trips to top-performing hospitals that agree to low, fixed rates for surgery.
Carol and Ed Vogel enjoyed a weeklong all-expenses-paid trip to a Newport Beach resort last month, and they're scheduled to return in a couple of weeks.
The Nevada couple didn't need frequent-flier miles or credit card rewards to get free airfare and hotel stay as well as $1,000 in spending money. It was all because of Carol Vogel's ailing hips and an employer's frustration with the high cost of U.S. healthcare.
Her husband's employer, newspaper publisher Stephens Media, sends employees and their family members needing hip and knee replacements to a handful of hospitals across the country, including one in Orange County, that agreed to a low, fixed rate for surgery and scored well on quality of care.
This year, grocery giant Kroger Co. has flown nearly two dozen workers to Hoag Orthopedic Institute in Irvine and several other hospitals across the U.S. for hip, knee or spinal-fusion surgeries in an effort to save money and improve care. Starting in January, Wal-Mart Stores Inc. will offer employees and dependents heart, spine and transplant surgeries at no cost at six major hospital systems across the nation, with free travel and lodging. Read more . . .
It's all part of a growing movement by employers fed up with wildly different price tags for routine operations. In response, businesses are showering workers with generous incentives — including waiving deductibles or handing out $2,500 bonuses — to steer them to these top-performing providers offering bargain prices.
Bundled deals are common for phone service, cable TV and travel. But an all-in-one price marks a radical departure for the conventional fee-for-service medical industry in which doctors, hospitals, labs and other providers typically bill separately for each part of a procedure. Then they tack on even more if complications and unexpected costs arise.
"You expect to see the hotel, airfare and car bundled together on Expedia," said Susan Ridgely, a senior policy analyst at Rand Corp., a nonprofit think tank in Santa Monica. "We want to stop paying by the widget in healthcare."
By bringing a steady stream of new patients, the arrangement can also be a good deal for the doctors and hospitals involved.
Federal and state officials are catching on as well. Medicare and some Medicaid programs are pushing for more of these all-inclusive prices for the most common procedures, from surgeries to maternity care for low-income mothers, to eliminate some of the huge disparities in U.S. healthcare costs and reward high-quality providers with more patients.
These programs are generally voluntary so patients can still opt for care closer to home, although it may cost them more.
At Kroger, employees may pay 10% out of pocket if they choose one of the company's 19 select hospitals, compared to 25% to 50% out of pocket for other nearby medical centers.
Carol Vogel, a 64-year-old writer in Minden, Nev., said she was skeptical about flying to another state for surgery until the human resources manager explained how much she stood to save.
In Newport Beach "this was 100% paid for," Vogel said. If she stayed closer to home in Nevada, "I would have been out $8,000 or $9,000 easy on my insurance."
She said she's pain-free in her left hip for the first time in years, so she scheduled an implant for her right hip later this month, followed by a free stay at Island Hotel, an oceanfront resort in Newport Beach.
"This is like the honeymoon we never had," she said. "Are you kidding me?"
At Kroger, 21 patients have traveled for surgery this year, and none have experienced complications or been readmitted to the hospital, said Theresa Monti, a company vice president for employee benefits. She said Kroger pays about $30,000 on average for those knee and hip replacement surgeries, 15% less than what it pays at other hospitals.
"It's a new concept, and some people have a hard time getting their arms around the idea of traveling for surgery," Monti said. "We are looking for any opportunity we can to encourage the use of the highest-quality healthcare while holding the line on costs."
BridgeHealth Medical Inc. in Denver is one of a handful of firms that assists employers, insurers and patients with the logistics of surgery shopping. Earlier efforts to persuade employers to send patients to India and other overseas destinations for cheaper care never took off. So BridgeHealth now has negotiated fixed rates with about 45 U.S. hospitals.
Chip Burgett, an executive vice president at BridgeHealth, said employers still come out ahead financially, even after footing thousands of dollars in travel expenses. His firm has negotiated rates on knee and hip replacements as low as $19,000.
Last year, the California Public Employees' Retirement System limited what it would pay for knee and hip replacement surgeries to $30,000 because its hospital bills ranged from $15,000 to $110,000 with no discernible difference in quality. It found 45 hospital systems willing to stay within that amount, and its average price per surgery dropped 30% to $23,113.
"There is a lot of excess margin in healthcare and plenty of room in the pricing of these hospitals," Burgett said. "Hopefully this drives true competition in healthcare and it's not just based on how many helicopters a hospital has."
While employers are leading the way right now, experts say Medicare could have the biggest impact. Federal officials are looking to test these all-in-one prices with hospitals in California and other states.
Some consumer advocates have raised concerns about patients traveling long distances for surgery and taking them away from their regular doctors. Cindy Meyers, benefits manager for Stephens Media in Las Vegas, said it has been difficult in some cases to find local doctors to provide follow-up care for patients who traveled elsewhere.
But she said the overall experience has been positive for her company, which insures about 1,500 people across several states.
"It's a great benefit for us cost-wise, and our employees feel comfort in knowing this doctor specializes in just what they need," Meyers said.
James Caillouette, surgeon in chief at the 70-bed Hoag Orthopedic Institute and an advocate for bundled payments since 2008, said not every patient is a suitable candidate for this arrangement.
First, he requests their medical records and talks to the patient by phone. He rules out patients who may be at higher risk for complications from surgery.
Post-surgery complications matter not just for the patient but also to the doctors and hospital because they pose a risk for additional treatment costs. Some bundled deals include warranties spelling out what complications the medical providers are responsible for. Medical studies show that complications can cost $7,600 per patient.
Hoag Orthopedic Institute's bundled fees for knee and hip replacement range from about $20,000 at an outpatient surgery center to roughly $30,000 or more in the hospital. The surgery location depends largely on the patient's medical condition.
Caillouette said his patients usually spend one or two nights in the hospital and then return to their hotel. A physical therapist visits them there most days, and Caillouette makes house calls to the hotel as well. Most patients fly home after a week in Orange County.
"Now there's one bill, and employers can budget for it," Caillouette said. "This has the potential to be a game changer."
Read the entire article in the LATimes . . . chad.terhune@latimes.com Copyright © 2012, Los Angeles Times
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When American Doctors and Hospital work together they can provide the most cost-effective health care in the world.
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'Not One Successful EHR System In The Whole World'
By
Neil
Versel
InformationWeek
Longtime
advocate of computerizing healthcare C. Peter Waegemann calls
current health IT
policy 'misguided.'
While federal health IT officials were touting the perceived successes of their efforts to increase physician usage of electronic health records (EHRs), one longtime advocate of EHRs was criticizing the whole direction of health IT policy.
"In my opinion, there is not one successful EHR system in the whole world," said C. Peter Waegemann, who founded and ran the Boston-based Medical Records Institute from 1984 to 2009. "User friendlinessusability, and interoperability are not there," he added in an interview with InformationWeek Healthcare.
He defined a successful EHR as one that is fully interoperable. "We have been focusing too much on documentation [for the purpose of reimbursement]," he said. This point has not been lost on the Obama administration, which has warned providers about using EHRs to "game the system." Read more . . .
Still, Waegemann believes the administration has not been aggressive enough with its $27 billion federal Meaningful Use EHR incentive program, based on published rules for Stage 2 and early recommendations for Stage 3. "MU2 and MU3 are just small steps. They rely on old technology," Waegemann said.
He noted that a number of leading EHR systems are written in the MUMPS programming language that originated at Massachusetts General Hospital in the late 1960s. Meaningful Use also relies on outdated standards such as version 2.x of Health Level Seven International's messaging standards rather than the more recent version 3.
According to Waegemann, too many organizations with EHRs still have paper forms and few EHRs are integrated with personal health records (PHRs).
"What we need is an EHR that is only an accessory to 'e-care,'" he said. Waegemann defines e-care as a patient-centric system in which technology serves as an adjunct to make healthcare more efficient. In his opinion, an EHR should include clinical decision support, the capture of clinical information at the point of care so the physician does not have to key in data, and automatic creation of documentation.
Meaningful Use does require physicians and hospitals to give some patients access to their records, but today's patient portals are "passive," according to Waegemann, in that individuals often are not able to enter their own information. It's not a personal health record, with patients truly in control, Waegemann contended.
He also said that the U.S. has wasted hundreds of millions of dollars on what first were called community health information networks (CHINs), then regional health information organizations (RHIOs), and more recently, health information exchanges (HIEs). Instead of regional networks, healthcare should look at point-to-point interoperability through standards.
"We need to have a totally different approach," Waegemann said. "What we need is an app that links anyone in personal care, from physical therapist to chiropractor to pharmacist."
Waegemann's Medical Records Institute put on an annual conference called Toward an Electronic Patient Record (TEPR) for 25 years. In the face of dwindling interest in TEPR, Waegemann reshaped the organization into the mHealth Initiative in early 2009, putting the focus on mobile technology in healthcare. The experiment lasted about three years until he quietly shut that entity down.
Read the entire article and references . . .
Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)
[Is it time to re-engineer your clinical decision support system? See 10 Innovative Clinical Decision Support Programs. ]
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Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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Medical Gluttony: Health Insurance without Copayment Causes Medical Gluttony
For the practicing physician, the difference in appetite for tests, procedures, consultations, operations, MRIs, CTs, PET scans for those fully insured and those with a significant deductible and coinsurance is phenomenal. It is most striking in those with high deductible insurance. With high deductible insurance, which is keyed to the average yearly cost of health care, every single item is evaluated with a cost/health benefit comparison. It is essentially private personal health care with the insurance kicking in only after the average healthcare costs for the average person for the year has been spent. Read more . . .
Patients with this type of plan always tell the doctor or his receptionist the nature of his insurance. He or she understands the yearly annual medical history and physical examination. When it comes to the rest of health care, the differences become obvious. Patient with usual insurance will expect such things as annual blood tests, x-rays, electrocardiograms even if not indicated. They will want colonoscopies starting at age 50 and every five years when the experts state that those without risk can wait to age 55. Without a family history of colon cancer and no polyps found, the GI experts state that the second one should be in the mid to late 60s. In this instance the HMOs have essentially doubled health care costs.
The line of demarcation is so clear that if a patient has been mailed the former recommendation, he or she will demand it and if the physician doesn’t comply report him to his HMO. Straightening this out will take hours of physician time in explaining why. The patient with deductible and copayment responsibility will accept the physician’s recommendations rather than the HMO recommendation. Thus halving his health care costs and staying in the highest regions of quality of care curve.
This pattern replays essentially in all areas of health care costs.
The surprise is with the current government interference in health care as pushed by the HMOs is really HealthCare Gluttony, that HMOs formerly prided themselves on avoiding. This is a rather striking change over the last two decades of non-medical personnel influencing the physician in what they think is appropriate, if for no other reason than a government mandate.
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Medical Gluttony thrives in Government and Health Insurance Programs.
It Disappears with Appropriate Deductibles and Co-payments on Every Service.
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Medical Myths: Health Insurance Improves Health Care
When speaking of Health Insurance vs Health Care, there is no unanimity of consensus. The Tax & Spend Party will always argue that the only way to have good health care is to have health insurance. This argument was made with political success in the mid-twentieth century during the implementation of Kerr-Mills, Medicare, Medicaid, Drug Prescription Plan, and a previous Major Long Term Health plan. It was only on the latter that clear insurable benefits were present and were otherwise unaffordable in the aged. However, this was changed when AARP, the advocate for the aged, felt this did not transfer enough taxpayer’s money from the young to those over 65 that the T & S party reversed the law.
Recently there has been more evidence that excessive health care procedures actually diminishes quality. The sophisticated diagnostic tests such as CT and MRI have found abnormalities that greatly concern doctors and their patients. This has led to increase in other diagnostic procedures and even operations with increasing adverse experiences. Read more . . .
Consider a patient with migraine who may have a CT of the brain as part of the diagnostic procedures. Frequently small aneurysms or malformations are found. What frequently is not told the patient in the surgeons push for immediate operation is that these congenital abnormalities are more than likely present since birth. Hence there is no urgency in proceeding quickly and one has adequate time to look at all the options available which including watchful waiting.
People with health insurance will more likely push for immediate intervention which then lowers the quality of care. Patients with high deductible insurance seem more content in looking at all options before rushing into surgery.
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Medical Myths originate when someone else pays the medical bills.
Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.
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Overheard in the Medical Staff Lounge: Is ObamaCare Decreasing Access to Care?
Dr. Edwards: How is the ObamaPlan working out in Practice? The swelling of the HMO ranks in my practice with the influx of Welfare and MediCal patients is causing some stresses in my staff.
Dr. Milton: It’s not only causing some stresses in my staff, but it is also stressing me. I’m working at least an hour a day longer for no additional revenue.
Dr. Ruth: We were promised that these MediCal Patients would be paid at Medicare rates. That was really subterfuge. The first time we were paid the Medicare rates which are marginable in and of themselves. But the follow up visits were a total misnomer. We were promised a 10 percent increase. But when we realized on our first printout that 10 percent increase on an $18 office visit is only $1.80. So a $19.80 payment for an office call did not improve our income. And sometimes we’re finding we have to work twice as hard for that $19.80 upgrade than we did for the $18 evaluation.
Dr. Milton: We’re also finding that this group of patients is seriously jeopardizing our income. Not only are their office visits longer because of the time required to educate them concerning their diseases and how their personal eating, drinking, smoking habits are causing their health care to deteriorate, but a barrage of “after visit phone” calls to answer other queries.
Dr. Edwards: But don’t you find very little concern about any deterioration in healthcare?
Dr. Milton: Certainly. But no lessening of the demand for expensive and mostly unnecessary?
Dr. Rosen: Don’t you think much of this is a factor that they have perceived themselves as being down trodden and denied what they think the wealthy and those with insurance normally receive?
Dr. Ruth: What has been a surprise to them as well as to us is that when we try to comply with as many of their demands as we can justify, they obtain even less care that the standard patients in their HMO category?
Dr. Rosen: That came as a surprise to us also. We thought we could use our usual HMO referral patterns, but we found that even some of our referral physicians that took MediCal in the past, did not take this new class of Welfare/MediCal patients upgraded to HMO status.
Dr. Ruth: It took us some time to become aware that these new HMO cards had a three digit code that signified their Welfare status and all Consulting physicians and surgeon slowly became aware of this code and declined to see these patients.
Dr. Rosen: What I still don’t understand is that many of these welfare/HMO patients who had a specialist while on Welfare/MediCal, all at once were without that specialist. Thus access to that specialist’s care was cut off.
Dr. Edwards: That doesn’t surprise you that the Medical Illiterates in Washington under the Ruse that ObamaCare will improve access to care had their unintended consequence of loss of access to care.
Dr. Rosen: Which just brings up again the dichotomy that people trust Congress, which now has a single digit approval rating, with something so complicated as their health care?
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The Staff Lounge Is Where Unfiltered Opinions Are Heard.
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Voices of Medicine: EHR: Take Care of the Chart, Don’t Worry about the Patient
Who's got time to listen to patients when the government demands 'meaningful' data entry?
The electronic medical record, or EMR, is a computerized system that allows physicians to record patient information electronically instead of using paper records. Test results can be reviewed through the system, and prescriptions can be emailed straight to the pharmacy. You can order medical tests and medications worth thousands of dollars with just a few mouse clicks. Read more . . .
As stipulated by ObamaCare, Medicare and Medicaid have enthusiastically embraced the concept of a paperless world. Doctors who adopt these programs in a "meaningful" way (more on that later) will be rewarded to the tune of up to $44,000 over five years. For those doctors who say no thanks, reductions in their Medicare payments for service will start in 2015.
At first I thought EMR sounded like a good idea. Then our practice started using one. . .
Tasks that once took seconds to perform on paper now require multistepped points and clicks through a maze of menus. Checking patients into the office is an odyssey involving scanners and the collection of demographic data—their race, their preferred language, and so much more—required by Medicare to prove that we are achieving "meaningful use" of our EMR. What "meaningful use" means no one knows for sure, but our manual on how to achieve it is 150 pages long.
Now the staff scurry about, rictus-like grins plastered to their faces, trying to hide their underlying stress. The patients, each a Job after completing the elaborate new check-in process—and wondering why the government needs to know if they are an Alaska native, among many other things—arrive in my exam room bewildered by their bureaucratic ordeal.
When the clicks don't get me what I want, I naughtily handwrite a prescription. I skip ordering certain tests I might want because it takes too much time—I'll do it next visit. I dreaded the arrival of this season's flu-shot supply—now there were more orders to input!
There was always going to be an adjustment period. As in the aftermath of a tornado, these things take time. I'm sure I'll get faster at using the system, and soon enough the data entry and test-ordering steps will come as second nature.
The end product will be lovely: a meticulously organized digital chart, with gorgeous progress notes. Nuggets of data accessible and ready for the plucking by the numbers crunchers. Medicare says the EMR is going to help me "achieve benchmarks that can lead to improved patient care."
Really? As a colleague remarked, it seems as if this is all about taking care of the chart, as opposed to taking care of the patient. Documentation is important, but the pointing and clicking and cutting and pasting we are so focused on in demonstrating meaningful use of EMR may be getting in the way of meaningful encounters with our patients.
With all the data entry the electronic system requires, my laptop presents a barrier between my patient and me, both physically and metaphorically. It's hard to be both stenographer and empathetic listener at the same time.
Some of the best doctors I've known were famous for the unintelligible scrawl of their hospital chart notes. Yet I doubt that fantastic electronic documentation will translate into fantastic clinical care. The institution of EMR seems to be a case of choosing style over substance, of putting up a few more hoops for doctors to jump through in their quest to simply take care of patients.
So, excuse me if, like a teenager transfixed by her smartphone, my eyes are glued to my screen at your next visit with me. I am truly listening to you. It's just that eye contact has no place in the Land of Meaningful Use.
Dr. Valinoti is an internist in private practice in Bergen County, N.J.
A version of this article appeared October 23, 2012, on page A15 in the U.S. edition of The Wall Street Journal, with the headline: Physician, Steel Thyself for Electronic Records.
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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about
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Book & Play Review: American Conservatory Theater – San Francisco—Sept 29, 2012
The
Normal Heart—Direct
from Broadway!
by Larry
Kramer, Directed
by George
C. Wolfe
Direct from its acclaimed Broadway run, Larry Kramer’s landmark 1985 drama unfolds like a real-life political thriller as a tight-knit group of friends refuse to let doctors, politicians, and the media bury the truth about an epidemic ravaging the gay community. Their differences could tear them apart—or change the world. Kramer’s unapologetic tackling of the early days of the AIDS epidemic, gay marriage, and our national healthcare system casts theatrical light on issues that are as present in today’s national discourse as they were when the play first premiered. An unflinching and unforgettable play, The Normal Heart delivers one of the most powerful evenings you'll ever spend at the theater. –Theater program.
Or it might be considered an unfortunate and ill-informed consideration for gay-marriage which is a non-entity and a non-union. Only a phallus and vagina can be united as one-flesh, the very essence of marriage, something which two phalluses or two vaginas are unable to do. Read more . . .
Angels in America: A Gay Fantasia on National Themes had its SF premier two decades ago shortly after the current artistic director arrived. The Geary Theater had been destroyed by the 1989 Loma Prieta earthquake in San Francisco. A 1993 Pulitzer Prize-winning play in two parts by American playwright Tony Kushner was produced in the Marines Memorial Theater while the Geary was being rebuilt. The two parts of the play are separately presentable and entitled Millennium Approaches and Perestroika, respectively. The play has been made into both a television miniseries and an opera by Peter Eötvös. There were 14 same sex couples and one heterosexual couple in our theater row observing the scene as half of the men on stage lowered their trousers bending over while the other half of the male ensemble opened up their trousers displaying anal sex.
Set in New York City in 1985, the play opens with Louis Ironson, a neurotic gay Jew, learning that his lover, WASP Prior Walter, has AIDS. As the play and Prior's illness progress, Louis becomes unable to cope with the emotional stress and moves out.
Meanwhile, closeted homosexual Mormon and Republican law clerk Joe Pitt is offered a major promotion by his mentor, the McCarthyist lawyer Roy Cohn. Joe doesn't immediately take the job because he feels he has to check with his Valium-addicted, agoraphobic wife, Harper, who is unwilling to move. Roy is himself deeply closeted, and soon discovers that he has AIDS.
As the seven-hour play progresses, Prior is visited by ghosts and an angel who proclaim him to be a prophet; Joe finds himself struggling to reconcile his religion with his sexuality; Louis struggles with his guilt about leaving Prior and begins a relationship with Joe; Harper's mental health deteriorates as she realizes that Joe is gay; Joe's mother, Hannah, moves to New York to attempt to look after Harper and meets Prior after a failed attempt by Prior to confront Hannah's son; Harper begins to separate from Joe whom she has depended upon and finds strength she was unaware of; and Roy finds himself in the hospital, reduced to the companionship of the ghost of Ethel Rosenberg and his nurse, Belize, a former drag queen and Prior's best friend, who meanwhile has to deal with Louis's constant demands for updates on Prior's health.
The subplot involving Cohn is the most political aspect of the play. Portrayed as a self-loathing, power-hungry hypocrite, he prides himself on his political connections and influence, which he has amassed through decades of corruption. In the play, he recollects with pride his role in having Ethel Rosenberg executed for espionage. As he lies alone in the hospital, dying of AIDS, the ghost of Rosenberg sings him a Yiddish lullaby and then brings him the news that the New York State Bar Association has just disbarred him, destroying his final hope of dying as a lawyer. The play ends on a note of optimism. After his friends procure for him a stash of AZT, in 1990, Prior is still alive and is managing to live with AIDS. With his friends, he looks at the statue of an angel in Bethesda Fountain and talks of the legend of the original fountain, and how it will flow again some day.
The play is deliberately performed so that the moments requiring special effects often show their theatricality. Most of the actors play multiple characters. There are heavy Biblical references and references to American society, as well as some fantastical scenes including to Antarctica and Heaven, as well as key events happening in San Francisco and at Bethesda Fountain in Central Park.
With the current efforts of having homosexual anal-intercourse sanction by several protestant churches as being God-pleasing, despite the Good Book condemning it with capital punishment, (Leviticus: any man that lies with another man as he would with a woman, shall be put to death), homosexual priesthood, homosexual man love boy intercourse, a current psychologist stating that pedophile is not a treatable disorder and should not be a crime, that pedophiles are 5% of the population (more than twice the number of homosexuals, making for an astonishing mix of religion, philosophy, culture and politics, this disruption of a civil society warrants further discussions in the public forum without the risk of government or the Gay lobby prosecuting individuals for hate crimes. Most of us have had good homoerotic friends, fellow workers, and colleagues without any intrusion into a civil society. Most of the world’s religions, except for a small group of Protestants, consider the practice anathema. A military officer, in my private practice, who still has connections overseas, informs me that all the Muslim attackers at Benghazi had homosexual anal intercourse with Ambassador Chris Stevens. He was nearly dead before they shot him completely dead. Ambassador Stevens was subjected to a “Hate Crime” of homosexual rape, which the Muslims treat as worse than a heterosexual rape. He also relates that the President and our Secretary of State were watching the whole affair being transmitted live by a Drone above our Embassy in Benghazi to the Oval Office.
And subsequently our Secretary of State at her hearings on Benghazi on the erroneous early accounts of the attacks stated, “We had four dead Americans. Was it because of a protest, or was it because of guys out for a walk one night who decided they’d go kill some Americans? What difference, at this point, does it make?” (WSJ)
If Mrs. Clinton can’t understand the difference between “guys out for a walk one night who decided they’d go kill some Americans” to an attack on our embassy being watched in the Oval Office on a 9-11 anniversary as our Ambassador is being Homosexually Raped to Death, we should certainly make sure that she’s never in the Oval Office in control of America’s Destiny on Terror Flagged 9-11 Days.
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The Book Review Section Is an Insider’s View of What Doctors are Reading about.
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Hippocrates & His Kin: What Party are you?
Singer
Andy Williams, who died on Sept 26 at age 84, in his 2009 memoir
“Moon River and Me”:
When Bobby [Kennedy] began his run for the presidency, I
immediately volunteered to campaign for him and sing at a couple of
fund-raisers. He then asked me if I would be one of the California
delegates to the Democratic convention. “Shirley MacLaine is
going to be one of my delegates, and I’d like you to be one,
too.” I told him I’d love to do it, but a couple of
weeks later a thought suddenly struck me , and I called Bobby and
said, “I hope I haven’t screwed this up, but it’s
just occurred to me: I’m a Republican.” He just laughed.
“That doesn’t really matter. If you’d still like
to do it for me, just go down and register as a Democrat.”
—WSJ, Notable & Quotable, Sept 27, 2012, p 19.
When the Russian’s occupied Afghanistan, women removed their head coverings and girls went to school. Read more . . .
On Tuesday, gunmen in the Swat Valley city of Mingora stopped the school bus she was riding in and shot her in the head. Two other girls were also shot but not seriously hurt. The Pakistani Taliban claimed responsibility for the attack, calling it revenge for the girl's advocacy against the group . . . bent on denying girls the chance to go to school.
Where
is the outrage from our women’s groups in the
USA?
http://www.sacbee.com/2012/10/10/4899566/pakistani-teen-shot-by-taliban.html#storylink=cpy
You know, for all the massive amounts of research that has been done on health policy issues, I have never seen a single study comparing state Medicaid programs on things like administrative costs, patient satisfaction, or any of the other criticisms private insurers get.
—Greg Scandlen, HealthBenefitsReform
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Hippocrates
and His Kin / Hippocrates Modern Colleagues
The Challenges of
Yesteryear, Yesterday, Today & Tomorrow
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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 www.ncpa.org and register to receive one or more of these reports.
Pacific Research Institute, (www.pacificresearch.org) 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.
The Mercatus Center at George Mason University (www.mercatus.org) 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.
To read the rest of this column, please go to www.medicaltuesday.net/org.asp.
The National Association of Health Underwriters, www.NAHU.org. 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.
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 www.galen.org. A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels.
Greg Scandlen, an expert in Health Savings Accounts (HSAs), has embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the initial series of his newsletter, Consumers Power Reports. Become a member of CHCC, The voice of the health care consumer. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn. Greg has joined the Heartland Institute, where current newsletters can be found.
The Heartland Institute, www.heartland.org, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?. This month, be sure to read ?
The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Lawrence W Reed, 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. Be sure to read the current lesson on Economic Education.
The Council for Affordable Health Insurance, www.cahi.org/index.asp, 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."
The Independence Institute, www.i2i.org, 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.
Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm 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.
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 www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section.
The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission was to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. -- However, since they supported the socialistic health plan instituted by Mitt Romney in Massachusetts, which is replaying the Medicare excessive increases in its first two years, and was used by some as a justification for the Obama plan, they have lost sight of their mission and we will no longer feature them as a freedom loving institution and have canceled our contributions.
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 www.mises.org to obtain the foundation's daily reports. You may also log on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to be an MD today.
CATO. The Cato Institute (www.cato.org) 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. Read his bio, articles and books at www.cato.org/people/cannon.html.
The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.
The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, 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, wartime allows the federal government to 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 wartime, 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 www.stcroixreview.com.
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 www.hillsdale.edu 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 ? Choose recent issues. The last ten years of Imprimis are archived.
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 www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information
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 www.patmosemergiclinic.com/ 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. (http://home.earthlink.net/~doctorlrhuntoon/) 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. 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, www.westandfirm.org, 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.
Michael J. Harris, MD - www.northernurology.com - 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."
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 www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.
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, which 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 www.peerreview.org.
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 www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. 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 www.semmelweissociety.net.
The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.
The AAPS California Chapter is an unincorporated association made up of members. The Goal of the AAPS California Chapter is to carry on the activities of the Association of American Physicians and Surgeons (AAPS) on a statewide basis. This is accomplished by having meetings and providing communications that support the medical professional needs and interests of independent physicians in private practice. To join the AAPS California Chapter, all you need to do is join national AAPS and be a physician licensed to practice in the State of California. There is no additional cost or fee to be a member of the AAPS California State Chapter.
Go to California Chapter Web Page . . .
Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"
PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.
Our motto, "omnia pro aegroto" means "all for the patient."
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Words of Wisdom & Great Truths
In my many years I have come to a conclusion that one useless man is a shame, two is a law firm, and three or more is a congress. –John Adams
If you don't read the newspaper you are uninformed, if you do read the newspaper you are misinformed. –Mark Twain
I contend that for a nation to try to tax itself into prosperity is like a man standing in a bucket and trying to lift himself up by the handle. –Winston Churchill
A government which robs Peter to pay Paul can always depend on the support of Paul.—George Bernard Shaw
A liberal is someone who feels a great debt to his fellow man, which debt he proposes to pay off with your money. – G. Gordon Liddy
Democracy must be something more than two wolves and a sheep voting on what to have for dinner.—James Bovard, Civil Libertarian (1994)
Foreign aid might be defined as a transfer of money from poor people in rich countries to rich people in poor countries. – Douglas Case, Classmate of Bill Clinton at Georgetown University
Some Recent Postings
In The Sept Issue: