Community For Better Health Care

Vol V, No 11, Sept 12, 2006


In This Issue:

1.                  Featured Article: Where Is Tulane Medical School Now?

2.                  In the News: Some Convenient Truths, Comment by Gregg Easterbrook, The Atlantic Monthly

3.                  International Medicine: Will the National Health Service Become Kaiser Permanente UK?

4.                  Medicare: Saving Health Insurance from the Minimum Wage

5.                  Medical Gluttony: Feed the World - Pour Money on the Problem (A Debate)

6.                  Medical Myths: Single Payer, Like Medicare, Is More Dependable than Other Insurance

7.                  Overheard in the Medical Staff Lounge: The Danger of Doctors Talking Politics!

8.                  Voices of Medicine: Care by the Hour, By ROBIN COOK, MD, The New York Times

9.                  From the Physician Patient Bookshelf: THE AMERICAN WAY OF HEALTH

10.              Hippocrates & His Kin: What Is a Morbid Disease?

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. This year it was 50 percent, indicating open forums such as these are critically important. The 4th Annual World Health Congress has been scheduled for April 22-24, 2007, also in Washington, D.C. The World Health Care Congress - Asia will be held in Singapore on May 21-23, 2007. The World Health Care Congress - Middle East will be held in Dubai, United Arab Emirates, on November 12-14, 2007. World Health Care Congress - Europe 2007 will meet in Barcelona on March 26-28, 2007. For more information, visit

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1.      Featured Article: Tulane Was Saved by Terminating 166 Faculty Positions, Including 61 with Tenure, But Can It Survive the AAUP Bureaucracy? Where Is Tulane Medical School Now?

The Storm After the Storm Jennifer Reingold, Senior Writer, Fast Company, April 2006

Tulane University President Scott Cowen was at the tail end of a respected career when Katrina hit. The hurricane almost destroyed his institution--and gave him the chance to reinvent it. . .

It's a cloudy, foggy day in New Orleans, but at least it's not raining. That wouldn't bode so well for freshman move-in day at Tulane University. After all, the last time these students arrived, on August 27, 2005, they were here only a few hours before Scott Cowen, Tulane's president, told them to get the hell out of town. The rain that Hurricane Katrina brought--and the terrible wind, and the broken levees, and the chaos, and the devastation--not only shuttered Tulane for a semester but also spawned the largest diaspora from a natural disaster ever to befall an American city. . .

Most crises that affect an organization affect only one part. A computer virus might cripple a company's intranet but not its phone lines. A train derailment might delay one component of a product, but there should be alternative sources. Katrina was an assault on all fronts at once. Tulane had no functioning IT infrastructure, no way to communicate with its 12,500 students and 6,000 employees, no news on federal funding, no way even to assess the damage. Some of the staff had no homes, clothes, or news of relatives. But Cowen and his team plunged in, fueled by little more than adrenaline. "Why wait for the government?" he says. "If we did, we'd be out of business.".  .  . (Emphasis ours.) 

Cowen put in place a triage system centered on a daily 9 a.m. meeting. "Scott would say, 'We have 1 million things on our plate, but what are the top-five things that need to get done today?' " says Luann Dozier, VP for development, who lost her home. "You go and come back with the recommendations and move on. So you could see progress every day." The first order of business was to retrieve the school's IT files from the 14th floor of a downtown New Orleans building with massive flooding, no working elevators, and chaotic surroundings. A posse of Tulane employees, escorted in SUVs by police officers, spent hours lugging the disks down the darkened stairways. They needed the records to find students as well as to figure out how to pay staffers and faculty, many of whom had been displaced and presumably needed the money right away. "If we didn't make payroll, everyone would have thought we were gone," says Cowen.

Yet some 15% of the employees were not on direct deposit, and there was still no central Web site for students seeking information about whether and when the school would reopen. Cowen reached out to alumnus David Filo, cofounder of Yahoo, for help. Filo donated some manpower and Web-hosting resources, and soon a makeshift Web site came to life, along with a relentlessly cheery blog from Cowen. Privately, however, he had doubts. Why would freshmen, about to be dispersed to hundreds of different colleges, feel loyalty to a school they'd attended for just a few hours? Who would want to come back to a campus with absent professors, few services, limited pizza joints, and, possibly, no Mardi Gras? To make it easier to come back (actually, harder to leave), national university organizations asked other schools to accept students affected by Katrina, but only for one semester. The school also took out a $150 million loan to hire a disaster-relief firm to fix the damaged campus. . .

"As I was going to say before Katrina interrupted me…, " begins Cowen, looking resplendent in his president's robes. "We are absolutely delighted that you are here with us finally… No major research university, or for that matter, any organization, has ever been confronted with the challenges we've faced. Yet we have recovered, we have survived, and we have charted a path to the future."

With equal parts grit, creativity, and optimism, Cowen has resuscitated Tulane--formerly the largest private employer in New Orleans and, since Katrina, the largest altogether--even as the rest of the city remains mired in the literal and figurative muck. But Cowen has also decided to do something more than merely rebuild his institution as it once was. Using the powers granted him as a result of the school's financial emergency, he has enacted a bold, controversial, and wrenching "renewal plan," with which he hopes to remake Tulane from a very competitive school into a truly elite one. "I wouldn't wish this on anybody," he says. "But out of every [disaster] comes an opportunity. We might as well take the opportunity to reinvent ourselves." . . .

The dozens of meetings--which went on throughout October and into November--were long and painful, but seven years of experience and a lot of the analysis Cowen had already done in prior years led the group to some obvious cost savings. It quickly became clear that the medical school, which had moved to Baylor University for the year, was in the most trouble, primarily because of the lack of patients. The group ended its emphasis on clinical work and reduced the school's faculty and staff by a full 30%. "That was really difficult," says Dr. Paul Whelton, SVP for health sciences and dean of the medical school, "to tell people who had been loyal to this university for 20 years that unfortunately you are not critical to the mission." . . .

Given the scope of the crisis, Cowen's plan met with little initial resistance. It didn't hurt that he required Tulane's board to approve or reject the plan as a whole; it passed unanimously. But now, perhaps because Tulane is perceived to be on the mend, the critical rumblings are getting louder. In January, the American Association of University Professors wrote Cowen asking for a full accounting of exactly how he eliminated 166 full-time faculty positions (including 61 with tenure)--believed to be the largest number of mass terminations ever at an American university. Groups have sprung up to fight the changes with petitions and protests. And chalked in front of the engineering building was a lament: "We survived Katrina, but not the administration." . . . 

Cowen denies having any sort of master plan to alter the course of the university, but he was prepared to move aggressively in part because he had launched a financial analysis of every Tulane department in 2001, giving him data to rely upon once the hurricane hit. While no one would ever wish the horror of a Katrina on anyone, it gave Cowen the clout to move faster than any university administrator in memory. Other university presidents respect that decisiveness. "The first thing that popped into my mind was the quote from Plunkett, the Tammany Hall guy," says Madeleine Wing Adler, president of West Chester University of Pennsylvania. " 'I seen my opportunities and I took 'em.' "

Jennifer Reingold ( is a Fast Company senior writer.

To read the entire article, please go to           

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2.      In the News: Some Convenient Truths, Comment by Gregg Easterbrook, The Atlantic Monthly

Comment: Runaway global warming looks all but unstoppable. Maybe that's because we haven't really tried to stop it

If there is now a scientific consensus that global warming must be taken seriously, there is also a related political consensus: that the issue is Gloom City. In An Inconvenient Truth, Al Gore warns of sea levels rising to engulf New York and San Francisco and implies that only wrenching lifestyle sacrifice can save us. The opposing view is just as glum. Even mild restrictions on greenhouse gases could "cripple our economy," Republican Senator Kit Bond of Missouri said in 2003. Other conservatives suggest that greenhouse-gas rules for Americans would be pointless anyway, owing to increased fossil-fuel use in China and India. When commentators hash this issue out, it's often a contest to see which side can sound more pessimistic.

Here's a different way of thinking about the greenhouse effect: that action to prevent runaway global warming may prove cheap, practical, effective, and totally consistent with economic growth. Which makes a body wonder: Why is such environmental optimism absent from American political debate?

Greenhouse gases are an air-pollution problem - and all previous air-pollution problems have been reduced faster and more cheaply than predicted, without economic harm. Some of these problems once seemed scary and intractable, just as greenhouse gases seem today. About forty years ago urban smog was increasing so fast that President Lyndon Johnson warned, "Either we stop poisoning our air or we become a nation [in] gas masks groping our way through dying cities." During Ronald Reagan's presidency, emissions of chlorofluoro­carbons, or CFCs, threatened to deplete the stratospheric ozone layer. As recently as George H. W. Bush's administration, acid rain was said to threaten a "new silent spring" of dead Appalachian forests.

But in each case, strong regulations were enacted, and what happened? Since 1970, smog-forming air pollution has declined by a third to a half. Emissions of CFCs have been nearly eliminated, and studies suggest that ozone-layer replenishment is beginning. Acid rain, meanwhile, has declined by a third since 1990, while Appalachian forest health has improved sharply.

Most progress against air pollution has been cheaper than expected. Smog controls on automobiles, for example, were predicted to cost thousands of dollars for each vehicle. Today's new cars emit less than 2 percent as much smog-forming pollution as the cars of 1970, and the cars are still as affordable today as they were then. Acid-rain control has cost about 10 percent of what was predicted in 1990, when Congress enacted new rules. At that time, opponents said the regulations would cause a "clean-air recession"; instead, the economy boomed. . . .

One reason the global-warming problem seems so daunting is that the success of previous antipollution efforts remains something of a secret. Polls show that Americans think the air is getting dirtier, not cleaner, perhaps because media coverage of the environment rarely if ever mentions improvements. For instance, did you know that smog and acid rain have continued to diminish throughout George W. Bush's presidency?  . . .

Does it matter that so many in politics seem so pessimistic about the prospect of addressing global warming? Absolutely. Making the problem appear unsolvable encourages a sort of listless fatalism, blunting the drive to take first steps toward a solution. Historically, first steps against air pollution have often led to pleasant surprises. When Congress, in 1970, mandated major reductions in smog caused by automobiles, even many supporters of the rule feared it would be hugely expensive. But the catalytic converter was not practical then; soon it was perfected, and suddenly, major reductions in smog became affordable. Even a small step by the United States against greenhouse gases could lead to a similar breakthrough.

And to those who worry that any greenhouse-gas reductions in the United States will be swamped by new emissions from China and India, here's a final reason to be optimistic: technology can move across borders with considerable speed. Today it's not clear that American inventors or entrepreneurs can make money by reducing greenhouse gases, so relatively few are trying. But suppose the United States regulated greenhouse gases, using its own domestic program, not the cumbersome Kyoto Protocol; then America's formidable entrepreneurial and engineering communities would fully engage the problem. Innovations pioneered here could spread throughout the world, and suddenly rapid global warming would not seem inevitable. . . .

Americans love challenges, and preventing artificial climate change is just the sort of technological and economic challenge at which this nation excels. It only remains for the right politician to recast the challenge in practical, optimistic tones. Gore seldom has, and Bush seems to have no interest in trying. But cheap and fast improvement is not a pipe dream; it is the pattern of previous efforts against air pollution. The only reason runaway global warming seems unstoppable is that we have not yet tried to stop it.

Gregg Easterbrook is a contributing editor of The Atlantic, a visiting fellow at the Brookings Institution, and the author of The Progress Paradox.

The URL for this page is

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3.      International Medicine: Will the National Health Service Become Kaiser Permanente UK?

Curing European Health Care, By HELEN DISNEY, The Wall Street Journal - Europe, August 9, 2006

Reform of health services in Europe is as controversial a topic as you can find, stoked by headlines like "American firm hired to do all National Health Service shopping" in one British newspaper. As the private sector is called on to play a new health-care role, though, should Europeans really be alarmed?

The news that a U.S. company has been given a major procurement contract for Britain's NHS comes on the back of another recent controversy. In June the U.K. Department of Health prematurely published future reform proposals, causing consternation among health professionals and unions. Under the reforms, primary care trusts -- which commission hospital and family doctor services in Britain -- will be allowed to contract out key parts of their work. Consortiums with expertise in the insurance industry and health-care procurement will be among the frontrunners in bidding, and may include the U.S. health-care giants United Health and Kaiser Permanente.

Critics claim these developments are the beginning of the end of the welfare state -- a drive toward the "Americanization" of health care -- and the antithesis of equity, solidarity and everything else good that European systems are meant to represent. They also note, legitimately, that reforms should be about driving up the quality of service, not just cutting costs.

The strength of European feelings against liberalization was made quite clear in February, when the EU Parliament amended the services directive. In the process, lawmakers threw out the directive's public health and social services element, which would have created a more competitive internal market in health care.

Though introducing market mechanisms may seem radical now, it likely won't in a decade's time. A combination of demographic changes, increased consumer demand, rising medical costs and the resulting bankrupt welfare systems makes further market-oriented reform of European health systems highly likely. In fact, as in the U.K., a groundswell of change is already under way on the Continent.

Many countries are introducing what would have been seen as heretical moves a few years ago. Some, like "left wing" Sweden and formerly communist Slovakia, seem like unlikely places for free-market reforms.

For the most part, the reforms have turned out to be good for both health-service users and staff. Why? First, they make systems more responsive to individual needs. Second, they introduce more investment in the system. Third, and perhaps most important, they lead to more sustainable health systems for the long term without sacrificing access for all.

Slovakia, for example, emerged from the yoke of communism with a state-run, state-funded system that was highly bureaucratic, mismanaged and often corrupt. Recently, though, it has been at the forefront of pushing for a more consumer-driven system. . .

To the north, in Sweden, nurses were at the forefront of health-care reforms in the Stockholm region, largely because the changes allowed them to take charge of their own shift patterns and thus coordinate work with child care.

Yet this development would never have come about without the so-called Stockholm health-care revolution -- structural reform that opened up the supply of health care to more private players. With free-market forces at play, nurses turned out to be in high demand. Besides winning more flexible scheduling, their pay increases shot up, outstripping those in the rest of Sweden's health-care sector by 50%. Almost all union organizations in the Swedish health-care sector now support reforms -- a vital element in effecting long-term change.

Similarly, in Britain the governing Labour Party is opening up swaths of the health-care sector to market-based reforms. These include contracting with private-sector vendors to provide set numbers of standard elective surgeries, such as hip operations. This keeps prices down and allows patients to be treated more quickly.

Last but not least, the U.K. government has been championing a set of policies collectively known as "Patient Choice," which allows patients to choose their own hospitals and, with help from a new electronic booking system, gives them more control over when and where they are seen by a doctor. . .

Despite the scare mongering, many of these efforts have little to do with copying the U.S. system. Instead, they forge long-term, European solutions that will not only save taxpayers money put provide better, more personalized service to all citizens -- keeping the Continent's commitment to social solidarity very much intact.

Ms. Disney is director of the Stockholm Network, a pan-European think tank.

Read the entire article at (subscription required).

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

Kaiser Permanente, the world's leading totally integrated health-care system, is known for giving immediate, same-day access to a physician or nurse practitioner and improving quality.

What a logical and sensible way to eliminate waiting lists that extend over years.

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4.      Medicare: Saving Health Insurance from the Minimum Wage by John C. Goodman and Richard B. McKenzie

Political support is growing in Congress for another increase in the federal minimum wage. A bill now under consideration would raise the minimum hourly wage from $5.15 to $7.25 over the next two years. According to the Economic Policy Institute, an estimated 6.6 million workers currently earn less than $7.25, and a total of 14.9 million workers would be affected by 2008.

What are the likely consequences? Economists have traditionally warned that a higher minimum wage causes more people to be unemployed. [See, for instance, David R. Henderson, "The Negative Effects of the Minimum Wage," NCPA Brief Analysis No. 550.] But a number of studies point to an even more serious consequence: fewer fringe benefits, including health insurance.

An unintended consequence of a minimum wage increase would likely be a rise in the number of Americans without health insurance. Congress can avoid adding to the ranks of the uninsured  -  in fact, it can make progress toward reducing their number  -  by giving employers and employees the option of using the amount of the minimum wage increase for health insurance in lieu of wages.

Wages versus Other Benefits. Workers tend to get paid a wage equal to the value of what they produce. So employees who produce $5.15 worth of goods and services per hour will tend to be paid $5.15. But what happens if the law makes employment illegal unless the wage is at least $7.25 per hour? No employer is going to pay $7.25 for $5.15 worth of productivity. So employers and employees will seek ways around the law  -  by reducing nonwage compensation:

  • About one in every three employees near the minimum wage has access to such benefits as vacation time, health insurance, holiday pay, employee discounts, uniforms and credit toward college tuition.
  • Overall, fringe benefits account for up to 30 percent of total employee compensation.
  • Fringe benefits are not subject to payroll and income taxes; thus, after taxes, $1 of fringe benefits can equal $1.25 or more of wages.

Employers can also reduce labor costs by spending less on working conditions or employee training. Employers may also impose more rigorous work requirements, insisting that employees work faster or work harder.

The net effect of these adjustments is to largely neutralize the cost impact of the minimum wage hike. For example, when the minimum wage increases by $1, the cost of labor may, on balance, rise by only 5 cents. Workers who retain their jobs are unlikely to be any better off than before. They get more money, but they also get fewer benefits and have to work harder for their pay.

  • A 1982 study by Ohio State University labor economist Masanori Hashimoto found that under the 1967 minimum wage hike, employees gained 32 cents per hour in money income but lost 41 cents per hour in on-the-job training, for a net loss of 9 cents per hour in total compensation.
  • Economists Linda Leighton and Jacob Mincer concluded in a 1981 study for the American Enterprise Institute that minimum wage increases reduce on-the-job training and, as a result, dampen growth in the real long-run income of covered workers.

Of course, if employers can't reduce fringe benefits (say, because there are none) or are unable to make other adjustments (such as increased work demands), employees are in danger of losing their jobs.

Wages versus Health Insurance. One of the most important employer benefits that substitutes for money wages is employer-provided health insurance. But health insurance premiums are rising and some employers no longer offer this benefit. Low-wage workers are particularly affected:

  • A recent study analyzing the impact of various federal minimum wage increases over a decade found that a 20 percent increase in the minimum wage reduces employer-sponsored health insurance coverage by 4 percent.
  • In most cases the trade-off is dollar for dollar - thus, a $1 per hour increase in the minimum wage could result in a $1 per hour decrease in employer-provided health insurance, according to a recent study for the Board of Governors of the Federal Reserve System by economist Louise Sheimer.
  • Nationwide, about 27 percent of people below the poverty line lack health insurance, according to the U.S. Census Bureau, and the percentage is much higher in some states. [See the figure.]

A minimum wage increase will induce even more employers to drop or reduce health insurance benefits, resulting in a further increase in the number of uninsured.

Solution: Creating an Option for Employers. If there is an increase in the minimum wage, employers should be able to count their spending on health insurance for their employees - dollar for dollar - against the minimum wage increase. Specifically, all employers should be allowed to count up to $2.10 per hour per worker in health benefits toward meeting the minimum wage level. As a result, employers would not have to reduce health insurance benefits to meet the wage mandate.

This option would allow an employer to substitute a nontaxable benefit for taxable wages. For a person working 2,000 hours per year, a $2.10 increase in nonwage benefits would amount to $4,200, enough to purchase an individual health insurance policy in most places. A couple, both working at the minimum wage, would have $8,400, enough to purchase a family policy in most places.

Solution: Individually-Owned Insurance. In many states, individual and family insurance is less expensive than group insurance (usually because there are fewer cost-increasing regulations). However, employers currently cannot buy individually-owned insurance for their employees. If they were allowed to, employers could pay some or all of the premiums for insurance employees could take with them as they move from job to job.

Insuring the Uninsured. Market forces will largely neutralize the impact of a minimum wage increase, and the minimum-wage employee is unlikely to be much better off than before the increase. However, if the health insurance option is part of the legislation, it offers an opportunity to reduce rather than increase the number of Americans without health insurance.

To read the entire article, go to

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

- Ronald Reagan

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5.      Medical Gluttony: Feed the World - Pour Money on the Problem (A Debate)

Billy Shore: Founder and executive director of Share Our Strength, a leading antihunger organization

William Easterly: New York University professor, author of The White Man's Burden (Penguin Press)

Resolved: We can feed the world.

Shore: Americans can't feed the world, but we can do much more to help the world feed itself. Some of the most effective antihunger and antipoverty programs in developing nations are small-scale projects run by local or regional social entrepreneurs innovating in ways governments can't. We saw this in Ethiopia with an organization called Action for Development, which was introducing new crops, innovative farming methods, and water projects into the community. Such local programs may be less glamorous than global antipoverty programs, but in the long run, they're more effective. But we'd be in a better position to advance such efforts if we closed the economic gap that exists in our own country, one that leaves too many families with children seeking emergency food assistance. Hunger in the United States is one issue that is eminently solvable.

Easterly: Whenever I hear that a tragic problem is "eminently solvable," I feel the urge to reach for my intellectual shotgun. If hunger in the U.S. is so solvable, why didn't decades of antipoverty campaigns already solve it? And what does this have to do with Ethiopians? I am sympathetic to your program to address the much more serious hunger problem in Ethiopia--it sounds like just the right kind of thing to do. Let the people who know the problem best--the poor people themselves--solve their own problems. However, I hope you are resisting the official-aid-agency syndrome:

Do lots of symbolic things that play well to the rich-country public but don't let yourself be held accountable for whether the intended beneficiaries are better off or not.

Shore: When I hear a catchall phrase like "decades of antipoverty campaigns," I reach for my protective vest. But fortunately, we're not debating antipoverty programs. The antihunger programs in the U.S., which I suspect you are lumping into that broader category, have actually done an amazing job of reducing hunger, which is why school lunch, school breakfast, food stamps, and the Women, Infants and Children supplemental feeding program (WIC) are among the few to enjoy so much bipartisan support. In the U.S., we are able to measure progress, hold ourselves accountable, and invite our stakeholders to judge us upon those results. I'm not sure how one would best do that globally. Are you?

Easterly: You have put your finger on the problem with foreign aid: Official aid agencies have virtually no feedback from, or accountability to, the voiceless poor of the world. I hope nongovernment organizations like yours can do better--such as subjecting yourselves to independent evaluation of the impact of a random sample of your projects by third parties. In short, if you want to know if you've helped the poor, try asking them.

Shore: You've put your finger on what seems like a dilemma. There are a lot of things NGOs can do that the government cannot: They can innovate, take risks, and be closer to the people they serve. But even the best NGO efforts probably won't reach all of those in need without broader public and government support. And that's when things get muddy. I have been encouraged by the eagerness of antihunger leaders in developing countries to access help. On my last trip to Ethiopia, a young man whose agricultural project we visited followed us back to our small plane. He said, "If you know anyone who could give us just two weeks of training in marketing and communications, it would be a great boost." Creating chances for people to share their strengths this way seems like a huge opportunity. . .

To read the rest of the debate, please go to

Feed the world, but not by throwing money at the problem.

On that, Share Our Strength's Billy Shore and William Easterly of New York University agree.

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6.      Medical Myths: Single Payer, Like Medicare, Is More Dependable than Other Insurance.

Payment Delay Looming: Physicians should be aware Medicare will not pay any claims for the last nine days of the federal fiscal year (September 22-30, 2006). This one-time payment hold - mandated by the Deficit Reduction Act of 2006 - will defer $1.3 billion in FY 2006 claims to the FY 2007 budget.

Held claims will be paid on October 2. No interest or late-payment penalty will be paid to physicians or other health care providers whose payments are delayed by this one-time hold. Physicians with large numbers of Medicare patients should prepare now for this cash flow interruption.

[When we have single-payer medicine, the government, which is not adverse to delaying one-third of a physician's monthly income, an involuntary short term loan without interest, will have no trouble delaying a month's income and then one week out of each month, and then "Only God Knows." When the State of California delayed all June MediCal payments for similar fiscal problems, we did see an absence of income for June, but we never saw an increase in July or August. When will physicians begin to comprehend the intense animosity the government bureaucracy has for physicians?]

Come on Docs, Let's Get to the Federal Trough - There Aren’t Enough Husks For Everyone.

Tell Your Member of Congress to Stop the Payment Cut and Give Physicians a 2.8% Increase.
Physicians, CMA needs you to turn up the heat on your members of Congress and motivate them to fix the Medicare payment problems before Congress adjourns in September. As you know, CMA has for years been fighting for a long-term fix to Medicare's flawed sustainable growth rate (SGR) formula.

If Congress fails to act before the end of the year, physician rates will be cut 5 percent on January 1 of next year, and rates will be cut by a total of 35 percent during the next six years. The cuts are an unintended consequence of a formula, established under laws passed in 1989 and 1997, that was supposed to establish a "sustainable growth rate" for spending on doctors' services. The formula allows Medicare spending on physician services to grow at the rate of the gross domestic product (GDP), but it actually penalizes physicians because the cost of physician services rises more rapidly than the GDP.

Reimbursement for all other Medicare providers is calculated using the Medicare Economic Index (MEI), which is a market index of actual medical practice costs. Health plans, hospitals, and nursing homes are all seeing payment increases, while physician payments are being slashed. 

2007 Medicare Provider Payment Updates: Health Plans: + 7 percent; Hospitals: + 3.6 percent; Nursing Homes: + 3.5 percent; Physicians: - 5 percent

To read the entire CMA article, please go to

[Looks like the government's actuaries are smarter than our actuaries and reducing physician payments while increasing all others are the real intended consequences of the laws. When will we learn to oppose all government shenanigans? And why are we the pigs at the trough asking for government largess? Why don't we let patients handle their problem? As doctors quit seeing Medicare patients, the Medicare patients have far greater clout with Congress than we will ever have. We have none - or rather a negative effect. Medicare patients have 37 million votes; we have less than one million. It's really a no-brainer.]

Should All Doctors Start Working For The Government?

The Cato Institute's Chris Edwards tracks government compensation, and he finds that in 1950 the average federal bureaucrat received $1.19 for every dollar that a private employee earned. By 1990 that ratio had risen to $1.51 and is now $2. In 2005 federal wages rose 5.8% compared to 3.3% in the private sector.

[Let's see. Did we say physicians working for the government's Medicare division were getting a 35 percent cut over the next six years? But are employed Federal physicians sharing in this rape of the public till? A fulltime physician told me last week he makes a salary of $60 an hour or $120,000 for a 2,000-hour work year. He thinks his administrative boss, who doesn't know in which organ system a seizure fits (is it neurological or musculoskeletal?), makes more than $180,000 a year and wishes he could put the disease in the category he chooses. No, Hippocrates, the government hates employed and Medicare contract physicians equally.

Single Payer, Like Medicare in the US and Canada, Is the Least Dependable Form of Insurance.

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7.      Overheard in the Medical Staff Lounge: The Danger of Doctors Talking Politics!

How About Dropping Some Devices on Pakistan?

Dr Sam: The UK and the USA shouldn't just take this intended destruction of ten jumbo jets flying to the USA with a Holocaust in the Sky by suicide bombers without a firm response. Remember the last time a nation sent suicide bombers against us, President Truman sent the Potsdam Declaration on July 26, 1945:  "Surrender or suffer prompt and utter destruction." On July 29 Japan rejected it. On August 6, 1945, we dropped a device called "Little Boy" on Hiroshima. Japan failed to respond. On August 9, 1945, we dropped a second device call "Fat Boy" on Nagasaki. On August 15, 1945, Japan surrenders. It put an end to suicide missions for more than 50 years. We need to have the courage to do so again. It's not even safe for me to go to the World Health Care Congress - Europe in 2007.

Dr Michelle: I can't believe you said that, Sam. Look at all the innocent women and children you would kill. And it won't stop the terrorist.

Dr Sam: There were a lot of women and children killed in Hiroshima and Nagasaki but if we hadn't dropped those devices, the Japanese would have ended up killing our women and children. Don't you think?

Dr Kaleb: Actually there are a couple of areas in Pakistan that would be very effective in stopping the terrorists and probably vaporizing Osama in the process. It would do much to stop this terrorist activity in its tracks.

Dr Michelle: None of this would have happened if we hadn't gone in and stirred up the pot in the Middle East. We should get out of there immediately. Let them fight it out.

Dr Sam: How can you be so naïve, Michelle? Did you have any idea that such a major part of the globe is so uncivilized?

Dr Rosen: The mission to establish a beachhead of democracy in that uncivilized society was a noble idea. But the constitution with law and order should have come first. Democracy and elections should have come years later. It would take at least a generation to change the thinking that prevails in that part of the world. Arab textbooks have first graders recite when the teacher asks: Who are the Jews? CHILDREN: THEY ARE OUR ENEMY. What do we do with our enemies? CHILDREN: WE KILL THEM. To have this drilled into the heads of the children from preschool through secondary school cannot be changed in a few years. We would have to occupy the country for at least 12-14 years, one entire school cycle, to assure that the next generation does not grow up to hate and murder for no reason whatsoever except ethnicity.

Dr Sam: Can't we learn from the Second World War? After Japan surrendered on August 14, 1945, Allied forces landed in Japan on August 28, 1945 and General Douglas MacArthur arrived on August 30 and immediately set a number of laws. The Allied Forces, totalling more than 350,000 US personnel by year's end, were stationed throughout Japan enforcing all the unilateral laws until the San Francisco Peace Treaty was signed and went into effect on April 28, 1952, when Japan became an independent state. Seven years of occupation in an otherwise civilized society to allow the long road to recovery. We should plan twice that long in the Mid East with a relatively primitive society. Our leaders should summarily reject any pressure to allow such a huge human society to revert to a more primitive culture.

Dr Michelle: I think I'll go back to my office and see some patients before I lose my lunch.

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

Care by the Hour, By ROBIN COOK, The New York Times, August 30, 2006

A PRIMARY care doctor I've known since we were residents 30 years ago recently described for me his typical day as foisted on him by current economic realities. He rises at 4 a.m. to make a dent in his avalanche of paperwork before dashing off to make rounds at the hospital and arrive at his office before 8. For the next 10 to 11 hours, he races through a series of patients so long, he cannot talk to any one of them as much as he believes he should, and he constantly worries he'll miss something. Worst of all, he admitted, he no longer enjoys practicing medicine.


Ten-plus years ago primary care was lauded as the potential rescuer of a health care system in chaos. Primary care doctors, it was hoped, would fix what had become an expensive, fragmented specialty system geared toward treating emergencies and episodes of acute illness. Thanks to new technologies and treatments, medicine had become a team effort, but the teams needed captains who would keep patients' overall health in mind, and that role was to be filled by the primary care doctors: internists, family physicians, general practitioners and pediatricians. We would all know our doctors, and they would know us.


But unfortunately, primary care has not flourished, and the ranks of primary care doctors are thinning. As reported in a series of articles in The Annals of Internal Medicine in 2003, medical students are shunning residencies in primary care, and primary care doctors are migrating to other careers or retiring early. Many who have remained in primary care are, like my friend, dispirited, disgruntled and disillusioned.


What is the solution? We must make primary care a more manageable business by changing the way we pay for it. Primary care doctors should be paid by the hour.


As it is now, insurance companies - following Medicare's lead - pay primary care doctors according to the number of patients they see. Each patient visit is generally reimbursed at a flat rate of slightly more than $50. The payment is the same whether the patient is a healthy, young person with a runny nose or an elderly person whose multiple chronic illnesses require many tests, referrals to specialists and detailed explanations to both the patient and his or her family. . .


A typical primary care doctor spends slightly more than half of his or her day seeing patients; the other half is spent conferring with specialists, lab technicians and patients' families, or trying to persuade health insurance companies to cover some needed treatment. This other half of his work day must be considered pro bono. Factor in rising overhead costs (office space, employees and malpractice premiums), and the situation easily becomes untenable.


No wonder hundreds of primary care doctors have switched to concierge-style practices, in which patients are charged subscription fees in return for more personal service in markedly smaller practices. But this trend only adds to the problem of accessibility by reducing the pool of regular primary care doctors.


Ideally, the hourly rate would not be the same for all primary care physicians, but would be assessed on a sliding scale, predicated on a doctor's level of education. Internists and pediatricians - the primary care doctors who have had the most training - would receive a higher rate than general practitioners and family physicians would. . . .


But this expense can be balanced out by cutting the health care pie differently - as some large, multi-specialty medical groups already do. Recognizing that Medicare and health insurance companies pay disproportionately higher amounts for specialty procedures (angioplasties, for example, or colonoscopies or even freckle removal) than for consultations by primary care doctors, many practices redistribute their total income according to each doctor's contribution. Consequently, primary care doctors receive more than the amount the group is reimbursed for their services. . . .


In the long run, paying by the hour could save money. It would provide doctors the time they need to investigate symptoms themselves rather than reflexively refer patients to specialists. After all, every headache doesn't need to be evaluated by a neurologist; nor does every painful shoulder require an M.R.I.


It would also increase the pool of primary care doctors, so that more health problems could be handled in doctor's offices rather than in emergency rooms, where the cost of care is more expensive. And finally, better long-term doctor-patient relationships might reduce the number of malpractice lawsuits. Paying for primary care by the hour would be better for both doctors and patients, and it would return a measure of rationality to our health care system.


Robin Cook is a medical doctor and the author, most recently, of the novel "Crisis.''

[We always welcome the wisdom of physician authors and especially Robin Cook who has entertained us with his Medical Thrillers. Actually much of what Dr Cook describes has been tried. There was a massive revision of the Relative Value Scale to make it reflect the time that physicians spent with a difficult diagnostic problem. The short and intermediate office calls were subdivided into five levels. Unfortunately, the government did not trust doctors to use the correct level of service and proceeded to review a massive number of charts. In their estimation, what doctors recorded didn't measure up to what Medicare thought the level of complexity should be. They even sent doctors to jail for fraud when the doctors thought they were providing the complexity of service billed. If doctors charged by the hour, the government would have similar problems in trusting doctor’s charges for a twenty minute charge in one patient and a 40 minute charge in another. Furthermore, patients can use up an hour of time and think they've been there only 15 minutes. Until the co-payment is a percentage of the fee, there will be no patient incentive to monitor his or her own healthcare costs. So the answer is not an hourly rate, but patient-driven health care where the patient monitors each and every item of cost - including his/her own time with the physician.]

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9.      Book Review: THE AMERICAN WAY OF HEALTH - How Medicine is Changing and What it Means to You by Janice Castro, Back Bay Books, (Little, Brown, & Company), Boston, 1994, x & 282 pages, including glossary, notes, & index, $9.95, Paperback. Reviewed by Del Meyer, MD

Janice Castro, senior health-care correspondent at TIME who interviews professionals, patients, and others, opens with "Ask most people what they think about the state of American medicine, and they will tell you about their own doctors, or about something that happened to them during an illness. Chances are, if they see a need for health-care change, it will be very specific, based on personal experience. On the other hand, listen to American leaders discussing health-care reform. They speak of providers. Access. Alliances. Competition. Mandates... The concepts seem impossibly complicated and remote from the experience of one sick person needing help."

She continues, "This book will help the general reader understand how the American health system works, why it costs so much... Medicine is too important, too personal, to be left to economists and politicians... After all, the health-care debate is really about life and death. It is about those times when people need help and about whether it will be there, about one sick patient at a time and the doctor or nurse who provides care... It is fundamentally a moral problem. Viewed in that light, the challenge... begins to come more clearly into focus. It is not really that complicated. We know what we need to do. We need to take care of old people... Children should see doctors and dentists. A pregnant woman should be able to check in with a doctor as the baby grows. People should not be dying in the street... Families shouldn't lose their home over the cost of coping with medical disasters. Breadwinners should not quit good jobs in order to qualify for poor people's insurance... People should take responsibility for their own health and for their family's. Children should not be having children..."

And, "If we are going to ensure that every American has access to decent health care, while also controlling the burgeoning costs, all of us must curb our medical greed. All of us must stop pretending that someone else is paying the bills. 'What do you think most people would say if one of their parents called up and said they needed a hundred and twenty-five thousand dollars for an operation?' asks one economist. 'Do you think that son or daughter would think twice and wonder whether that operation was really necessary? Of course they would. But none of us think we pay for medical care. And of course we all do.' All of us must pay our share..."

Castro then takes us on a tour de force of health-care about our country. She starts at Kaiser Walnut Creek's two delivery rooms where 4,000 infants, mostly delivered by midwives, take their first breath each year. She interviews a midwife who feels that midwives can deliver most women in tents, a practice which is prevented by organized medicine. She then takes us inside the delivery room where the midwife has a complication with a stuck shoulder. Within seconds, an obstetrician and pediatrician come through the delivery room doors and deliver a healthy infant two minutes later. Castro feels it was fortunate this baby was not born in a tent and that the pediatric ICU is only twenty steps from the delivery room. . .

To read the entire review, please go to

To browse the Doctor/Patient Bookshelf, please go

To review in topical fashion, please go to

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10.  Hippocrates & His Kin: What Is a Morbid Disease? (after Hart)

Teacher: There's a morbid disease that can grow until it consumes the body that gave it life! Who in the class can tell me what it is? Yes, Johnny?

Johnny: The Government

The Slovak parliament adopted new health laws at the end of 2004, including the introduction of user charges. . .  Reformers also instigated a major public consultation . . . in order to determine what should be covered by mandatory health insurance. . . Health insurers and providers were given for-profit status to spur competition, rather than leaving patients to rely on a single state provider. These changes have already led to a sharp reduction in the annual health-system deficit by cutting costs . . . In all likelihood, they will go on to allow patients more and better choices, as the new providers begin to compete on quality and thereby drive up standards.

What a crazy world. The misguided in our country want to install government single payer health care to improve quality and decrease cost. Meanwhile, Europe is looking at less reliance on “single state provider” and look to privatize to “improve quality and decrease costs.

In our recent review of the last issue of Sonoma County Physician, there were excellent articles on sexual dysfunction, sexual discrepancies, and the health hazards of closets. The photography and multicolored cover are of the high caliber we've come to expect from Steve Osborn, the managing editor. To end on a more personal note, the humor in several of those articles caused me to reflect on my late uncle who was widowed in his mid 60s. He became serious about a woman he met at a senior citizens' gathering whom he eventually married. Because she smoked an occasional cigarette after meals, which he detested, he asked her if she ever smoked after sex? "Well, Otto," she answered, "I'm not sure. I don't think I've ever looked."

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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 be sure to read Reveal Health Care Costs at

                      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 subscribe at or access their health page at Be sure to review the book: What States Can Do to Reform Health Care - A Free-Market Primer at

                      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. You may want to follow their five-year project: Crisis, Preparedness, and Response in the Wake of Katrina. "The purpose of our inquiry is to examine the role in the rebuilding process played by three groups: For-profit businesses: small, local businesses as well as larger, national and multi-national businesses; Non-profit organizations: local, regional, national, and international relief organizations, charities, and faith-based groups; and Governments: local, state, and federal, including emergency relief and recovery agencies. Our goal is to determine where-and why-each sector has its greatest successes. Further, we seek to examine how each of these sectors interact, where they build synergies, and where they work at cross purposes."

                      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. If you're in the market to purchase or change health insurance, be sure to review the exceptionally large data base at 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 at To see my recent columns, enter my name in the search box.

                      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 Be sure to read Grace-Marie's report this months "Ownership of Insurance" at With many employers priced out of the health insurance market and with an increasingly mobile workforce, it is vital that policy changes be made to give people more options. Our prescription: Tax credits and deductions to allow individuals and families to buy their own health insurance that they can take with them from job to job, and giving them new options to purchase policies that are not burdened by mandates and regulations that drive the price of premiums sky high.  

                      Greg Scandlen, an expert in Health Savings Accounts (HSAs) has embarked on a new mission: Consumers for Health Care Choices (CHCC). To read the initial series of his newsletter, Consumers Power Reports, go to To join, go to Be sure to read the real facts on medical bankruptcy which is only 6 percent of unsecured debt, not a primary cause, at or read the original reference at,pubID.24680/pub_detail.asp.

                      The Heartland Institute,, publishes the Health Care News. Read the late Conrad F Meier on What is Free-Market Health Care? At You may sign up for their health care email newsletter at To read a report on a bill pending in Congress which would create a framework for a national interoperable network for storage and transmission of individual health care records, please go to

                      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. Does freedom extend to smokers? To read a news report on Alexander Schoppmann’s Airline for Smokers to Begin Germany-Japan Service, please go to He couldn't do this in the U.S.

                      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." Be sure to read "Despite exploding costs, most Americans got sizable life-extending bang for their medical bucks over recent decades, says one of the most sweeping studies ever of health care value" at

                      The Health Policy Fact Checkers is a great resource to check the facts for accuracy in reporting and can be accessed from the preceding CAHI site or directly at This week read the Fact File: Cost of Health Insurance at

                      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 at Read her latest newsletter at, which includes a section on PC Medicine and Euthanasia. Be sure to read How U.N.-backed gun confiscation programs in Kenya and Uganda have led to murder, torture, and arson, and have turned tens of thousands of pastoral  tribespeople into starving refugees at

                      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, read THE RATIONAL ARGUMENTATOR: PROFIT IS MORAL by Gennady Stolyarov II. All too often today, we hear condemnations of the profit motive as destructive and uncaring. But is it really? Or is the profit motive one of the noblest forces that can impel a man to act? If human flourishing is moral than so is the pursuit of profit. To read the entire article, go to

                      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. You may want to go directly to their health research section at This month, note the new Hospital Report Card at

                      The Heritage Foundation,, founded in 1973, is a research and educational institute whose mission is 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. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available. This month, review the Values-Driven Health Care at

                      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. This month read the real reason behind the Minimum Wage at You may also log on to Lew's premier free-market site at to read some of his lectures to medical groups. To learn how state medicine subsidizes illness, see; or to find out why anyone would want to be an MD today, see To read his current column on police should serve, not help politicians, go to

                      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. Read his bio at To read an analysis of California’s Single payer initiative on how it's bad for Californians and a terrible precedent for the nation, please go to

                      The Ethan Allen Institute,, 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. To peruse the Center for Education Reform, go to

                      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.]

                      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. Read President Arnn's comments at Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, Bernard Lewis on "Freedom and Justice in Islam" at The last ten years of Imprimis are archived at

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Today we say thank you and bid farewell to our MedicalTuesday Secretary, Jessica Falkenstein, for her work the past two years in responding to all of your emails, address changes, enrollment and removal requests. She has also formatted the newsletter, inserted all the links and posted it to Constant Contact for automatic send on the second and fourth Tuesdays of each month. She maintained the website visit log (which now has reached 30,000 a month). (Our other electronic journals, and have an additional 20,000 visits per month). We wish Jessica well as she heads off to the University of California at Irvine. We welcome Kevin Wilson who has been working with her for the past three weeks and will take over these tasks beginning next week. Kevin, a senior at the Sacramento Seventh Day Adventist Academy, will be reviewing all the MedicalTuesday email and can be reached at 

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Del Meyer

Del Meyer, MD, Editor & Founder

6620 Coyle Ave, Ste 122, Carmichael, CA 95608

Words of Wisdom

"Whatever may be conceded to the influence of refined education on minds of peculiar structure, reason and experience both forbid us to expect that National morality can prevail in exclusion of religious principle." -George Washington

"The only difference between a tax man and a taxidermist is that the taxidermist leaves the skin." -Mark Twain

Some Recent Postings

Physician Profile: Michael Goodman, MD at

July HPUSA Issue:

April HPUSA Issue:

January HPUSA Issue:

In Memoriam

General Alfredo Stroessner Matiauda, dictator of Paraguay, died on August 16th, aged 93

NOT only Africa has a heart of darkness. South America has one too, squeezed in the tight embrace of Argentina, Bolivia and Brazil. Two great rivers, the Paraguay and the Parana, flow through Paraguay and past it, but travellers have little reason to come to this empty, landlocked place. The dry western chaco has no gold or oil, though wars were fought on the supposition it did; the east is more fertile, but still poor. The people are mostly Indian farmers, the army dangerously unpredictable. It is good ground for dictators.

For 35 years, from 1954 to 1989, Alfredo Stroessner ruled there. Under him, although he brought electrification, asphalt roads and friendship with America, the place became yet more isolated and benighted. The economy was based on contraband: whisky, cigarettes, passports, coffee, cocaine, luxury cars, rare bird skins, anything, until the unofficial value of Paraguay's exports was said to be three times the official figure. The style of government was a spoils system, underpinned by terror of a vicious network of spies and secret police. Foreign policy was a buddies' brigade with other dictators - Videla of Argentina, Pinochet of Chile - to co-ordinate counter-terrorism and assassinations. And the most famous tourist was Josef Mengele, the fugitive doctor of Auschwitz, riding into a village in the Paraguayan wilderness to be welcomed and protected. . .

As healthcare is in a power struggle with the government against our sick, suffering and dying patients with no concept of family bereavement, with costs their only consideration and euthanasia beoming an acceptable approach to end lives not worth living or spending money on, we may be able to learn from how the ruthless have maintain their power structures. To read the rest of the obituary, go to

On This Date in History - September 12

On This Date in 1866, the premiere of a show called The Black Crook in New York City ushered in a new era of entertainment. The Black Crook was the first American Presentation to feature beautiful American Girls. It was the forerunner of the time when people would go to the musical theatre to hear the show and others would go to see the showgirls. There has been a tendency ever since to, so to speak, bring on the dancing girls as attractive window dressing to help sell a concept or an idea.

On This Date in 1953, Nikita Khrushchev became the first Secretary of the Communist Party of the USSR, a position which automatically brought him front and center. Khrushchev loved to talk, and in one of his public appearances, he brought a new technique to the public forum when he pounded his shoe on the table in the course of a discussion at the United Nations.

Speaker's Lifetime Library, © 1979, Leonard and Thelma Spinard