Doctors' pay cuts save little in health costs
By Kevin Pho

"Why should I care if doctors get a pay cut?" my patient recently
asked me.

Therein lies the delicate dilemma physicians face today. While the
common perception is that the medical profession is well-compensated,
there are serious implications in targeting physician pay to control
medical spending.

http://blogs.usatoday.com/oped/2008/08/doctors-pay-cut.html#more

The below story was forwarded to me by a dear friend.

She's a teacher- not a doctor- and she understands clearly the
lessons that doctors in the US must learn - and fast. Before
it' s too late.

"There was a Chemistry professor in a large college that had some
exchange students in the class. One day while the class was in the
lab, the Professor noticed one young man (an exchange student) who
kept rubbing his back and stretching as if his back hurt.

The professor asked the young man what was the matter. The student
told him, he had a bullet lodged in his back. He had been shot while
fighting communists in his native country, who were trying to
overthrow his country's government and install a new communist
government.

In the midst of his story he looked at the professor and asked a
strange question. He asked, 'Do you know how to catch wild pigs?'

The professor thought it was a joke and asked for the punch line.
The young man said this was no joke.

'You catch wild pigs by finding a suitable place in the woods and put
corn on the ground. The pigs find it and begin to come everyday to
eat the free corn.

When they are used to coming every day, you put a fence down one side
of the place where they are used to coming.

When they get used to the  fence, they begin to eat the corn again
and you put up another side of the fence. They get used to that and
start to eat again.

You continue until you have all four sides of the fence up, with a
gate on the last side.

The pigs, which are used to the free corn, start to come through the
gate to eat; you slam the gate on them and catch the whole herd.

Suddenly, the wild pigs have lost their freedom.
They run around and around inside the fence, but they are caught.
Soon they go back to eating the free corn.

They are so used to it, that they have forgotten how to forage in the
woods for themselves, so they accept their captivity.

The young man then told the professor, that is exactly what he sees
happening to America - and to the medical profession in the US.

The government keeps pushing us toward socialism and keeps spreading
the free corn out, in the form of programs such as supplemental
income, tax credit for unearned income, tobacco subsidies, dairy
subsidies, payments not to plant crops, welfare, free medical care
and drugs, etc. while we continually lose our freedoms -
just a little at a time.

One should always remember: There is no such thing as a free lunch!
A politician will never provide a service for you cheaper, than you
can for yourself.

If you see all of this wonderful government 'help', as a problem
confronting the future of democracy in America, you might want to
send this on to yourfriends.

If you think the free ride is essential to your way of life, then you
will probably ignore this warning, about creeping socialized medicine
in the US in the form of expanding Medicare, Medicaid, goverment
programs and quasi-governmental managed care and 3rd party payer
bureaucracies -but God help you when the gate slams shut!

In this 'very important' election year, listen closely to what the
candidates are promising you and just maybe, you will be able to tell
who is about to slam the gate on America.

'A government big enough to give you everything you want, is big
enough to take away everything you have.'

- Thomas Jefferson

"Docs Bailing Out of Medicare, Medicaid"
Plummeting Reimbursement Rates Have Some Doctors Looking for a Way Out

Frustration Mounting for Physicians

According to Dr. Scott Nelson, a family practice physician in
Cleveland, Miss., the reimbursement cuts have hit doctors in his
state very hard.

"There is an unprecedented level of frustration with the government
and Medicare in Mississippi," Nelson explained. "I have not heard of
any doctors in my area opting out of Medicare, because there are not
enough patients with private insurance in the rural Mississippi
Delta... we have no choice but to see them, and we are literally at
the mercy of the government. I foresee some small practices closing
altogether."

Full article:

http://abcnews.go.com/Health/story?id=5326078&page=1

----

Commentary

"While comparatively new to the US, the phenomenom of doctors
rebelling under the heavy-hand of government-run health care is
almost boringly familiar elsewhere around the world. The article
below was written several years ago under slightly different
circumstances, though nothing has changed- and it is no less true
today..."

The Worldwide Epidemic of Doctors Strikes
By Robert Tracinski

Excerpt:

"The outbreak of doctors' strikes in America is spreading…….These
strikes, so unusual in the United States, are an early symptom of the
spread to this country of a worldwide epidemic….

If you haven't heard about any of these cases, you are not alone.
Doctors' strikes outside the United States have apparently become so
frequent that they are no longer regarded as newsworthy.

Yet there is something shocking and dangerous in the idea of a
doctors' strike. In the industrialized world, we are blithely
accustomed to the fact that when an emergency strikes, when we fall
seriously ill, or even when we suffer from minor aches and pains, a
doctor will be there to diagnose the problem and solve it. We take
our doctors -- and the instant availability of their life-saving
knowledge and skills -- for granted.

If there is a worldwide scourge that is prompting these people to
walk off the job, it is crucially important to discover the cause.

A physician investigating the cause of a disease would begin by
looking for a common element, a risk factor that is present in all
cases…."

Diagnosis contained in the full article:

http://www.capmag.com/article.asp?ID=2487

Docs Bailing Out of Medicare, Medicaid
Plummeting Reimbursement Rates Have Some Doctors Looking for a Way
Out

By AUDREY GRAYSON
ABC News Medical Unit

Note from editor:

<<This article remains news- even though, this year, doctors managed
to temporarily avoid the Medicare cuts to reimbursements and income
under discussion below.

The reason?

This did nothing to slow the trend of doctors slowly dumping the
financially failing government programs-  due to a long trend of
plummeting reimbursements and sky-rocketing administrative paper-
work and bureaucratic hassles.>>

Excerpt:

"The Houston Chronicle reported last week that more and more Texas
doctors are opting out of Medicare due to growing cuts in
reimbursement. And the trend is not limited to Texas doctors.

Primary care doctors from around the country have told ABC News that
they too are either opting out of treating Medicare patients, or are
preparing to do so if Congress once again OKs slashing reimbursement
rates.

"Unfortunately, there are physicians that I know of in the Columbus,
Ohio, area that are opting out [of Medicare]," said Dr. Mimi Ghosh,
a family practice physician at the Ohio State University Medical
Center.

"Most physicians I know have taken a pay cut every year for years...
Reimbursements are just getting worse, and more physicians are
retiring early, or going to other careers [like] pharmaceuticals
[or] real estate."

"We find ourselves in a situation where our malpractice premiums
went up July 1 to coincide with the Medicare cuts," noted Dr.
Raymond L. Ebarb, a family physician in West Sayville, N.Y. "I
totally understand the Texas physicians' decision to drop out of
Medicare. I wish the decision were as easy for our practice."

"With the cost of running a medical practice only going up on a
daily basis, and reimbursement taking a dive, how can doctors
running a solo practice keep accepting a payer that only continues
to cut its reimbursement?" said Dr. Gil Holland, a family physician
in Chandler, Ariz.

"This is problem is far reaching because as Medicare cuts its fee
schedule, other insurance payers tend soon to follow suit. Many of
my colleagues in Arizona are dropping Medicare."

What's Up, Doc? Not Reimbursement Rates

According to the American Medical Association (AMA), reimbursements
that have been reduced every year for nearly a decade have slashed
physician payment rates by about 40 percent.

Meanwhile, the cost of practice rises annually. The AMA estimates
that this year practice costs will increase by 20 percent.

And according to a 2007 AMA survey of 8,955 physicians in the United
States, 60 percent of doctors said they plan to limit the number of
new Medicare patients and 40 percent of doctors said they plan to
limit the number of established Medicare patients that they treat if
Medicare payment rates are cut by 10 percent in 2008.

And because the Senate failed to block the latest reduction, this
year's Medicare cut of 10.6 percent has already taken effect -- and
an overwhelming majority of physicians contacted by ABC News say
this will force them to either give up on Medicare patients
altogether or limit the number of new Medicare patients they can
treat."

Full article:

http://abcnews.go.com/Health/story?id=5326078&page=1

The Mystery (from the previous post):

<<Is it not _odd _that the more medical science and technology has
progressed, the more frequently physicians are denounced in the
media as dangerous, greedy exploiters of medically- ignorant and
vulnerable patients?

Is it not _strange_ that, rather than being viewed as the advocates,
champions, guardians and protectors of a patient's health, this role
has been expropriated by "progressive", "idealistic", populist
politicians, legions of Medicare and insurance bureaucrats and
crusading trial attorneys who piously vow to protect patients from
being  "victimized" by money- hungry, greedy,  exploitative doctors
allegedly seeking to fleece and defraud patients, insurance
companies and Medicare by foisting unnecessary medical procedures
and tests on the poor, the sick, the vulnerable and the medically
ignorant?"

What explains this apparent paradox? >>

The Martyrdom of the Doctors and Businessmen

The passage below from an American classic fictional novel gives us
a clue to the paradox described above. It captures a conversation
between Hank Rearden, a fictional captain of industry of great
ambition, productiveness, achievement, moral stature and integrity,
and his friend, Francisco.

Mr. Rearden has dedicated his life to the single-minded pursuit,
discovery and development of a miracle metal which has transformed
society by improving and extending the lives of citizens everywhere
who benefit from the incorporation of this new miracle metal into
all sorts of new products and life-saving and life-enhancing
technologies.

Yet, rather than being celebrated as a hero and rewarded both
materially and spiritually by the public for his great achievement,
society proceeds to condemn him as a dangerous villain, vilify him
for his hard-earned wealth as "loot exploited from innocent victims"
and demand ever-increasing government controls and regulations...to
shackle him like a dangerous criminal to his business which
generously produces the metal their lives depend on, at an ever-
decreasing benefit, and ever-increasing personal expense to himself.

His friend is asking him why he keeps working when others have
stopped under the same self-damaging and self-sacrificial
conditions.

Read the same passage...but imagine that Mr. Rearden is a doctor-
working under the same conditions of government regulation at the
same personal, financial and emotional expense to himself.

The passage below gives doctors an important diagnostic clue as to
who- and what- is actually destroying the medical profession and a
hint - as to what potential changes may be necessary to rid the
medical body politic of legions of feasting parasites in the process
of effecting a meaningful and lasting cure.

Is it really the competitive spirit that is killing him and which
his oppressors are counting on? Or something else?

------------------------------------------------------------
Mr. Rearden: "Don't worry. I'm not going to vanish. Let them all
give up and stop working. I won't. I don't know my limit and don't
care. All I have to know is that I can't be stopped."

Francisco: "Any man can be stopped, Mr. Rearden."

"How?
"It's only a matter of knowing man's motive power."
"What is it?"
"You ought to know, Mr. Rearden. You're one of the last moral men
left to the world."

Rearden chuckled in bitter amusement. "I've been called just about
Everything but that. And you're wrong. You have no idea how wrong."

"Are you sure?"
"I ought to know. Moral? What on earth made you say it?"

Francisco pointed to the mills beyond the window. "This."
For a long moment, Rearden looked at him without moving, then
Asked only, "What do you mean?"

"If you want to see an abstract principle, such as a moral action,
in material form - there it is. Look at it, Mr. Rearden. Every
girder of it, every pipe, wire and valve was put there by a choice
in answer to the question: 'Right or Wrong' ?

You had to choose right and you had to choose the best within your
knowledge- the best for your purpose, which was to make steel-and
then move on and extend the knowledge, and do better, and still
better, with your purpose as your standard of Value.

You had to act on your own judgment, you had to have the capacity to
judge, the courage to stand on the verdict of your mind, and the
purest, the most ruthless consecration to the rule of doing right,
of doing the best, the utmost best possible to you.

Nothing could have made you act against your judgment, and you would
have rejected as wrong as evil -any man who attempted to tell you
that the best way to heat a furnace was to fill it with ice.

Millions of men, an entire Nation, were not able to deter you from
producing Rearden Metal- because you had the knowledge of its
superlative value and the power which such knowledge gives.

But what I wonder about, Mr.Rearden, is why you live by one code of
principles when you deal with nature?
And by another when you deal with men?"

Rearden's eyes were fixed on him so intently that the question came
slowly, as if the effort to pronounce it were a distraction: "What
do you mean?"

"Why don't you hold to the purpose of your life as clearly and
rigidly as you hold to the purpose of your mills?"

"What do you mean?"

"You're guilty of a great sin, Mr. Rearden, much guiltier than they
tell you, but not in the way they preach.

The worst guilt is to accept an undeserved guilt- and that is what
you have been doing all your life.,You have been paying blackmail,
not for your Vices, but for your Virtues.

You have been willing to carry the load of an unearned punishment-
and to let it grow the heavier the greater the virtues you
practiced.

But your Virtues were those which keep men alive.

Your own moral code- the one you lived by, but never stated,
acknowledged or defended- was the code that preserves man's
existence.

If you were punished for it, what was the nature of those who
punished you?

Yours was the code of life. What, then, is theirs? What standard of
value lies at its root?

What is its ultimate purpose? Do you think that what you're facing
is merely a conspiracy to seize your wealth?
You, who know the source of wealth, should know it's much more and
much worse than that.

Did you ask me to name man's motive power?
Man's motive power is his moral code.
Ask yourself where their code is leading you and what it offers you
as your final goal.

A viler evil than to murder a man, is to sell him suicide as an act
of virtue.
A viler evil than to throw a man into a sacrificial furnace, is to
demand that he leap in, of his own will, and that he build the
furnace, besides.

By their own statement, it is they who need you and have nothing to
offer you in return.
By their own statement, you must support them because they cannot
survive without you.

Consider the obscenity of offering their impotence and their need-
their need of you- as a justification for your torture. Are you
willing to accept it?

Do you care to purchase- at the price of your great endurance, at
the price of your agony- the satisfaction of the needs of your own
destroyers?"

"No!"

"Mr. Rearden," said Francisco, his voice solemnly calm, "if you saw
Atlas, the giant who holds the world on his shoulders, if you saw
that he stood, blood running down his chest, his knees buckling, his
arms trembling but still trying to hold the world aloft with the
last of his strength, and the greater his effort the heavier the
world bore down upon his shoulders- what would you tell him to do?"

"I . . . don't know. What . . . could he do? What would you tell
him?"

"To shrug."

www.atlasshrugged.com

Who or What is Killing the Medical Profession?

A colleague commented recently that 'competition among doctors
within the profession is killing the profession". I' d like to disagree and
comment on this further.

What is the Problem Is Not

The problem is _not_ "competition among doctors" that is killing the
medical profession. Competition in a market among the providers of
goods and services is what drives innovation, continually lowers
costs and drives the production and, ultimately, the availability of
quality goods and services.

This is only true, however,  when a market is relatively free and
unregulated. Witness the market for computers, ipods, cell phones,
TV' s  and other electronics, and the remarkable innovation and
availability of  increasingly higher quality, lower cost goods
available to a continually expanding pool of consumers.

What _is_ killing the medical profession is the replacement of
healthy competition in a free market with self- destructive, and
market-destructive, competition in a _highly regulated_ market, as
well as all the layers of the government and bureaucratic
regulations which add ridiculous, unnecessary exorbitant costs and
inefficiencies to the provision of health care services while
simultaneously and _negatively_ impacting on quality and
availability.

Providing health care in such a market is like playing with a deck
of cards stacked against you by monopolistic government and 3rd
party regulators who  _continually_ set prices and drop
reimbursements arbitraily and reflexively _by fiat_in response to
voter demands, political expediency, snowballing government budgets,
pressure group politics, corporate employer needs, etc,  and
completely _unrelated_ to medical market forces such as input costs,
business expenses, employee salaries (including increasing cost of
providing mandated employee health insurance), and the availability
and demand for specific services.

What the Problem Is

The root of the problem leading to the destruction of the medical
profession is NOT  the unchecked ambition  and competitive spirit
with our colleagues. This is the same spirit which  drives many of
us  to continue to learn and grow professionally, mastering ever -
expanding, ever -evolving  bodies of scientific knowledge…learning
and implementing new technologies and procedures, all the while
improving, prolonging and saving the lives of our  patients.

The sense of moral ambitiousness which drives many doctors in their
thirst for continually improving their own knowledge and skills is
not the vice from which such doctors suffer. Rather, it is  a
_profound virtue_ and one that  such doctors who possess it should
take pride in.

In other areas of society, this type of ambition, self-improvement
of knowledge and skills and personal competitiveness would be
rewarded handsomely.

The problem is not with the competitive spirit, ambition and other
virtues that doctors possess.

The problem lies with a society - and an increasingly government-run
and bureaucratic -run and regulated health care system which fails
to justly recognize and reward doctors for that spirit  and that
seeks to _punish_ them_ for_ their _virtue-

or at least expects doctors to be driven and satisfied by the
spiritual rewards for their work,  while eschewing or denying them
the proper material rewards for it which they have rightly earned.

Is it not _odd _that the more medical science and technology has
progressed, the more frequently physicians are denounced in the
media as dangerous, greedy exploiters of medically- ignorant and
vulnerable patients?

Is it not _strange_ that, rather than being viewed as the advocates,
champions, guardians and protectors of a patient's health, this role
has been expropriated by "progressive", "idealistic", populist
politicians, legions of Medicare and insurance bureaucrats and
crusading trial attorneys who piously vow to protect patients from
being  "victimized" by money- hungry, greedy,  exploitative doctors
allegedly seeking to fleece and defraud patients, insurance
companies and Medicare by foisting unnecessary medical procedures
and tests on the poor, the sick, the vulnerable and the medically
ignorant?"

What explains this apparent paradox?

"SICK AND SICKER is a feature-length movie that explores what happens
when the government takes over the medical profession.

SICK AND SICKER will investigate whether government intervention is
the solution to the health care crisis or the cause of it.  Some of
the best interviews take place in Canada where the government system
is near collapse and getting fast, quality treatment means making a
run to the U.S. border.

SICK AND SICKER will deal with ideas long suppressed by the
mainstream media.  This movie will arm you with little-known facts
while giving you an experience that you won't soon forget.  The host
and executive producer, Logan Darrow Clements, is not afraid to use
dramatic, humorous or unconventional methods to shed light on
socialized medicine, whether it's called "a single payer system"
or "universal health care."

But don't worry this "sugar coating" will just make the pill you're
about to take easier to swallow.  The pill will contain hard facts
about socialized medicine from doctors, patients and public policy
experts in the U.S., Canada and elsewhere.  The next time you hear a
politician advocating universal health care you'll be able to ask
them some really nifty questions.

Logan Darrow Clements last set America on fire in 2005 with his "Lost
Liberty Hotel" project.  This rebellion against eminent domain abuse
involved applying the Supreme Court's "Kelo vs. City of New London"
decision to one of the Justices who voted for it.

The Kelo decision allows a government to take your home using eminent
domain if the government believes your property can generate higher
tax revenue with a new owner.  Logan asked the town of Weare, New
Hampshire to take Supreme Court Justice David Souter's house using
eminent domain so Logan could build a hotel in its place.

Logan utilized the same rationale that Souter had voted for when he
approved the Kelo decision.  A hotel will bring in more tax revenue
than what citizen Souter pays.

Within 48 hours of the projects' announcement 700,000 unique visitors
went to Logan's website freestarmedia.com, over 200 reporters from as
far away as Germany reported on the story.

Logan received over 5,000 e-mail of support from people of all
political persuasions, gave 60 radio interviews and made eight
appearances on national television news shows such as Hannity &
Colmes, ABC Nightline and Tucker Carlson….

In August 2005 he began producing a movie about eminent domain
entitled "Eminent Domination".

Filming on this movie is 50% finished but production will be halted
until "SICK AND SICKER" is completed.

VIEW THE TRAILER HERE:

http://www.sickandsickermovie.com

National Grocery Reform
By Richard E. Ralston
November 9, 2007

http://www.afcm.org/nationalgroceryreform.html

One of the great scandals of our age is the fact that America spends
more on food than any other nation. Many political leaders are now
calling for urgent reform to bring spending on food under control.
Even worse, while the result of this uncontrolled spending includes
the fact that many Americans are overweight, some Americans do not
have enough to eat.

Leading liberal candidates now point to what they see as the heart of
the problem: corporate "greed" in the form of grocery stores and
restaurants operating on a for-profit basis. They promise to replace
all private grocery stores with a national system of government
commissaries, which will allegedly operate far more efficiently
without the administrative overhead required to make a profit.

As it will take some time to organize the national network of commissaries,
initially groceries will be available only at offices of the Department of Motor
Vehicles and U.S. Postal Service. These offices apparently have a proven track
record of operational efficiency and excellent customer service, and will be a
model for the development of a government commissary system.

Liberals would achieve further efficiencies, so they claim, by
prohibiting all advertising of food and food products. This wasteful
expense to provide consumers with unnecessary information has proven
to be just a way for food stores and manufacturers to inflate prices
and fatten business profits. Consumers will find shopping to be much
easier if personal preference is eliminated in favor of whatever
foods government makes available.

To achieve savings by eliminating the profits of food manufacturers,
the U.S. Department of Agriculture will assume ownership of all of
these firms, purchase all crops from farmers (until such time as
agriculture can be reorganized into government operations) and
manufacture an appropriate amount of food.

In spite of the efficiencies and cost reductions that government
management will achieve, there is some concern that food might not be
affordable for everyone. And food is surely a "right," as it is
necessary for human survival. Therefore all groceries made available
in government commissaries will be free of charge.

This will be financed by an increase of 15 percent in income taxes, except for
those making over $80,000 a year, whose taxes will be increased by 75 percent.
Because the supply of food is not unlimited, a fixed amount of ration coupons
will be distributed to insure that each consumer can obtain an equal amount of
food.

All private restaurants will be closed because of the need to
equalize availability of food, and limited cafeterias will be
operated in the government commissaries. Liberal political candidates
point to the excellent example of school lunch programs as a model,
and the proven results demonstrated by several generations of well-
nourished, trim and fit students.

So far, conservative leaders are at a loss after hearing these
proposals. Some of the more courageous conservatives are responding
with proposals for Mandatory Food Purchasing. All citizens, including
those who go to bed hungry every night, will be required to purchase
membership in new Food Management Organizations.

Private grocery stores and restaurants would still be permitted but under strict
price controls to insure that all consumers can afford their FMO memberships. To
further control costs, the purchase of certain cuts of meat and imported gourmet
foods could require the FMO's advance approval.

Across the political spectrum, there is a developing consensus that
the only appropriate response to the fact that some consumers cannot
afford groceries is to impose a single, regimented, government-
controlled food system on all citizens.

Advocates point to public education as an example of how forcing all but the
children of the most wealthy citizens into the gray, sterile desert of a poorly
performing public education system is the only way to insure that poor children
receive any education at all.

Rumor has it that the clincher for those proposing socialized grocery
plans was stated recently by one of the presidential candidates:

"The ideal thing about these proposals is that if we can somehow get this to
work for groceries, we can apply it to health care."

Richard E. Ralston is Executive Director of Americans for Free Choice
in Medicine.

Are You  Sick of  Lawsuits ? Part I

In case other readers here haven't already heard of it,
I'd like to bring their attention to very valuable and very useful website.

SickofLawsuits.com documents general and medical malpractice legal abuse in the
US and seeks to educate patients / the public
about how the current, flawed medical malpractice system
and current, general   US  "sue-for -profit" culture and industry
impact _on them personally._

Here is how they frame the problem:

Healthcare Under Attack:

"Personal injury lawyers’ attacks on our health care system have serious
negative consequences on the quality and affordability of the care we receive.

It has contributed to a shortage of certain specialty doctors—especially in
obstetricians and general surgeons—in many areas of the country and helped spur
a rise in health care costs that jeopardizes access to life-saving care and
innovations, even for the middle class.

Though personal injury lawyers would lead you to believe that their lawsuits
against health care providers, hospitals and health care companies are in the
best interest of the consumer because they target “bad actors,” the truth of the
matter is that, for them, it’s about their pursuit of personal wealth.

In the wake of this greed, the rest of the country is left with the
consequences:

- Doctors are afraid to practice medicine.

- Health care costs rise as litigation costs are passed on to patients.

- Access to health care is limited.

- Medical innovation is threatened and patient health is jeopardized.

More detail here:
http://www.sickoflawsuits.com/threats/HealthcareUnderAttack.cfm


SickofLawsuits also advocates for the proper principles of legal reform.

Excerpt from the SickofLawsuits Mission Statement:

Why the Sick of Lawsuits Campaign Was Created:

"Our civil justice system is under attack by personal injury lawyers who game
the legal system for personal profit in the name of “consumer protection.”  The
reality is that consumers are the ones getting fleeced.

These abusive lawsuits harm the economy and job creation, threaten our access to
affordable, quality health care, and delay justice for the truly injured by
clogging our courts. Ultimately, lawsuit abuse hurts all of us."

What We Support:

"We support a system that would compensate those who are injured without costly
and time-consuming litigation while preventing our legal system from being
hijacked by personal injury lawyers and run-away litigation."

Descritpion of principles of proper legal reform here:
http://www.sickoflawsuits.org/mission/index.cfm

My commentary on above:

While many physicians many be aware of this (having lived through the nightmare
of a frivolous lawsuit, I wonder how many of the ideas expressed above are
equally familiar to our family members, friends, acquaintances and patients?

Some may have heard doctors complain in general terms-
and listened sympathetically, then turned back
to the day-to-day issues and events that they _really_ care about...
and which  "really"  effect their day-to-day lives.

Most others probably tuned  it out- on the premise that this issue doesn't
effect them at all thinking :

...."It' s just a  "doctor thing" .....why do I need to care about it ?
...."It 's just a cost of doctors doing business (like buying office supplies,
an Xray machine, paying utilitiy bills, paying staff, etc?? )
...."It goes with the territory.....every job has its unpleasant side...
...."It's unavoidable......stop complaining .....just suck it up"
...."hey that sucks but, What can I, or anyone else, do about it anyway ? "

( This last one will be covered in part 2 of this post. )

Medical blogger is fun...it's interesting, educational, intellectually
stimulating.

It's also very professionally important:

- learning about issues of vitally impacting  the health and well-being of the
profession.....
- discussing the signs, and symptoms of disease throughout the health profession
on a "organ system by organ system " basis....
- searching for the underlying pathogens... the underlying genetic defects or
susceptabilities...the  neoplastic processes metastasizing throughout the
profession
which have resulted in its presently generalized state of debilitiation,
and continues to progressively erodes its vitality and threaten to cause its
ultimate demise from multi-organ failure....

However, if  the myriad of  disease processes are not each, individually
diagnosed
and treated accurately-  with current, state-of-the art care available right
here in the US,
rather than with snake -oil, leeches or any other inefficacious, out-dated,
previously fashionable "cures"-   all of  which have been offered and tried in
the past,
  here or in other countries- and all of which have failed spectacularly in the
past.

From both a professional - and a personal - standpoint,
I think we are all trying to delay or avoid the day when a "code blue" is called
and crusading government bureaucrats in white coats rush in to "resuscitate the
patient", thereby putting it on a bureacratic tax-payer financed,
ever-diminishing, dopamine drip and  life-support ....

When this happens, it will be thoroughly appropriate to notify the next-of-kin -
since a government take-over will certainly lead to a "brain drain" in US
medicine, as the 20th century has shown to occur time and again  in all
socialized medical systems, socialism generally, throughout the
world-wide...with the US being no different in that respect.

Like Terry Schiavo, after a painful period many years of lingering on a
ventilator, the brain-dead patient will eventually be dead.....
and so will some of  the real patients who hope in the future to depend on it to
preserve and prolong their own lives.

To attempt to prevent all this, as fun and interesting as medical blogging is,
nothing will _ever_ change until the proper, rational ideas are taken out of the
self-contained, anti-septic medical blogosphere and into the _real world of
patients)_
- where viable, long-term real world solutions can be discussed openly,
advocated publicly and enacted.

Healthcare Under Attack

Excerpt:

"Personal injury lawyers' attacks on our health care system have
serious negative consequences on the quality and affordability of
the care we receive.

It has contributed to a shortage of certain specialty doctors—
especially in obstetricians and general surgeons—in many areas of
the country and helped spur a rise in health care costs that
jeopardizes access to life-saving care and innovations, even for the
middle class.

Though personal injury lawyers would lead you to believe that their
lawsuits against health care providers, hospitals and health care
companies are in the best interest of the consumer because they
target "bad actors," the truth of the matter is that, for them, it's
about their pursuit of personal wealth."

In the wake of this greed, the rest of the country is left with the
consequences:

Doctors are afraid to practice medicine.

Health care costs rise as litigation costs are passed on to patients.

Access to health care is limited.

Medical innovation is threatened and patient health is jeopardized.

Full Article:

http://www.sickoflawsuits.org/threats/HealthcareUnderAttack.cfm

American Health Care in Critical Condition

The Case for Putting Individuals, Not Employers or Government, in
Control of Health Care

By JOHN STOSSEL and ANDREW SULLIVAN

"Most everyone agrees, America's health-care system is a mess.

Millions of Americans lack health insurance and still our annual
health-care costs exceed $2 trillion — that's about the size of the
entire economy of China. For the country with the world's "best"
medical care, a lot of people seem unhappy.

Many hate the insurance industry.

Employers have seen insurance premiums rise 87 percent over the last
seven years. General Motors now spends more on its employees' health
insurance than on steel. Doctors are fed up, too; the average
physician's office spends 14 percent of its income filling out
paperwork.

No one seems angrier than the patients who have been denied care....

The more people control the money they spend on their own health
care, the more people shop around and the more providers compete to
attract patients by lowering prices while improving quality.

It's putting individuals in control that could turn our health-care
sector into the vibrant, competitive marketplace that we see in
nearly every other area of our economy.

After all, it's our body and our health. Shouldn't we be in control
of how our health-care dollars are spent?

Harvard's Herzlinger said:

"Who should decide whether you live or die?
Do you want the government to decide?
Do you want a health insurer to decide?

Who's gonna make that decision?
Is it gonna be a government?
Is it gonna be an insurer?

Or is it gonna be you and me?"

Putting individuals in control of our health — rather than our
employers or the government — is a better way to cure what ails
America's health system. "

http://abcnews.go.com/2020/Stossel/story?id=3580676

"How Not to Fight Against Socialized Medicine"

Excerpt:

"...Doctors are not the servants of their patients.
No free man is a "servant" of those he deals with.
Doctors are traders, like everyone else in a free society—
and they should bear that title proudly,
considering the crucial importance of the services they offer.

The pursuit of his own productive career is—
and, morally, should be— the primary goal of a doctor's work,
as it is the primary goal of any self-respecting, productive man.

But there is no clash of interests among rational men in a free
society, and there is no clash of interests between doctors and
patients.

In pursuing his own career, a doctor does have to do his best for the
welfare of his patients. This relationship, however, cannot be
reversed: one cannot sacrifice the doctor's interests, desires, and
freedom to whatever the patients (or their politicians) might deem to
be their own "welfare."

Many doctors know this, but are afraid to assert their rights,
because they dare not challenge the morality of altruism, neither in
the public's mind nor in their own.

Others are collectivists at heart, who believe that socialized
medicine is morally right and who feel guilty while opposing it.

Still others are so cynically embittered that they believe that the
whole country consists of fools or parasites eager to get something
for nothing—that morality and justice are futile—
that ideas are impotent—
that the cause of freedom is doomed—
and that the doctors' only chance lies in borrowing the enemy's
arguments and gaining a brief span of borrowed time.

This last is usually regarded as the "practical" attitude
for "conservatives." But nobody is as naive as a cynic, and nothing
is as impractical as the attempt to win by conceding the enemy's
premises.

How many defeats and disasters will collectivism's victims have to
witness before they become convinced of it?

In any issue, it is the most consistent of the adversaries who wins.
One cannot win on the enemy's premises, because he is then the more
consistent, and all of one's efforts serve only to propagate his
principles.

Most people in this country are not moochers who seek the unearned,
not even today. But if all their intellectual leaders and the doctors
themselves tell them that doctors are only their "selfless servants,"
they will feel justified in expecting and demanding unearned services.

When a politician tells them that they are entitled to the unearned,
they are wise enough to suspect his motives; but when the proposed
victim, the doctor, says it too, they feel that socialization is safe.

If you are afraid of people's irrationality, you will not protect
yourself by assuring them that their irrational notions are right.

The advocates of "Medicare" admit that their purpose is not help to
the needy, the sick, or the aged. Their purpose is to spare
people "the embarrassment" of a means test—
that is, to establish the principle and precedent that some people
are entitled to the unrewarded services of others,
not as charity, but as a right.

Can you placate, conciliate, temporize, or compromise with a
principle of that kind?

As doctors, what would you say if someone told you that you must not
try to cure a deadly disease— you must give it some chance—
you must reach a "compromise" with cancer or with coronary thrombosis
or with leprosy?

You would answer that it is a battle of life or death.
The same is true of your political battle.

Would you follow the advice of someone who told you that you must
fight tuberculosis by confining the treatment to its symptoms—
that you must treat the cough, the high temperature,
the loss of weight— but must refuse to consider or to touch its
cause, the germs in the patient's lungs,
in order not to antagonize the germs?

Do not adopt such a course in politics.
The principle— and the consequences— are the same.
It is a battle of life or death."

-from "The Voice of Reason: Essays in Objectivist Thought"
by Ayn Rand

----

Additional essays in above book include:

The Forgotten Man of Socialized Medicine By Ayn Rand and Leonard
Peikoff

Purchase separately here:
http://tinyurl.com/6juau7

----

Medicine: The Death of a Profession
By Leonard Peikoff

Purchase separately here:
http://tinyurl.com/66kokq

A recent post on the online physician discussion board Sermo (www.sermo.com)
asks:

" Is universal healthcare and universal coverage the same thing or
different? Do we bring everyone up to a better level of care by
lowering the base level of care to those presently in the system?"

The post goes on to comment:

" I am for Universal healthcare.
I am not for govt sponsored, run, and administered universal health
insurance.
There is a difference and that is where the debate belongs, and that
is where we need to move the discussion."

----------------------

Dr. Paul Hsieh, blogger and co-founder of (FIRM) Freedom and
Individual Rights in Medicine (www.WeStandFirm.org)answers this way:

" That's an excellent question.
Health care is definitely a need (just as food and clothing), but
that's not the same thing as a "right".

I would love to see everyone have enough to eat, but I would never
want to see any kind of government "universal food" program.

Furthermore, one of the big problems in today's health care debate is
the myth of conflating health *insurance* with health *care*.

The two are related, but not the same. In fact, conflating the two
can be extremely dangerous, because it leads to such bad public
policy.

Many socialized systems guarantee "coverage" but don't provide actual
care. Conversely many people have easy access to care without using
insurance per se (but instead use other financing mechanisms).

The current insurance system has been distorted through years of
government interference in the free market, and in many cases does a
grave disservice to patients and doctors alike.

This subject is covered in:

"'Health care,' more or less"
http://tinyurl.com/58rs5t

"The Difference Between 'Health Care' and 'Health Insurance'"
http://tinyurl.com/5cuqgd

For more information, please also see the article Lin Zinser and I
wrote for "The Objective Standard", which discusses this issue in
more detail:

"Moral Health Care vs. 'Universal Health Care'"
http://tinyurl.com/25zffu

My grandparents just this past week were told by their personal physician of 20 years (a close friend at that) that he was leaving his private practice to be a hospitalist for the same pay at half the hours, simply sacrificing his freedom in setting his own schedule. He did this because because the cost (both in time and effort) of practicing on his own was too great. When asked by my grandparents who he would recommend they seek out as their new doctor, he said he knew of no one taking on new Medicare patients in their town of over 100k.

I see this as leaving us as future physicians at a crossroads... go into private practice and spend a good deal of our time dealing with bureaucracy, but having a level of autonomy in treating our patient's as we see fit, or being an employee of hospital subject to the rules and regulations of administrators separated from actual patient care.

One possible solution to those of us interested in having the freedom and autonomy of private practice is exemplified by a [location deleted] general surgeon I had the pleasure of playing golf with a few months back. He had decided to stop treating Medicare patients which were 40% of his patient base, but accounted for 13% of his total income. By doing this, he was able to close his office one day a week (playing more golf he noted), saving the salary/wages/overhead that running a private practice office entails. In the end, he said he made slightly more money b/c he was able to eliminate the expenses required to treat these patients.

A recent article in the American Medical News reports a planned
massive expansion of the Medicare bureaucracy with the institution of
a new layer of Medicare bounty-hunters charged with slowing the
relentless plunge of the Medicare Trust fund into bankruptcy - by
squeezing health care providers on the Medicare "Rack":

http://www.ama-assn.org/amednews/2008/07/07/gvsa0707.htm

Excerpt:

"Aggressive tactics, vague charges, interrupted patient care, drained
staff resources and administrative headaches. These are some of the
problems doctors say they encountered during their experiences with
Medicare's newest breed of auditor.

The Centers for Medicare & Medicaid Services (CMS)  this spring
wrapped up a three-year pilot program in which "Recovery Audit
Contractors," or RACs, scoured physician and hospital claims in three
states to find overpayments and to recoup those dollars for Medicare.

Thrilled by the project's financial success, lawmakers ordered CMS to
expand the program to all 50 states by 2010. The agency plans to
choose four national contractors to administer the program this
summer. A new round of audits could start right away….

Initially, contractors were paid contingency fees based on how many
Medicare overpayments they dug up. After sharp criticism from the
medical community, in spring 2006 CMS also began to base RAC fees on
underpayments they discovered.

The program has been cost effective for the government...... On
average, Medicare spends about 20 cents to recover each dollar in
overpayments….

So far, the program has focused largely on inpatient hospitals, where
a single incorrect code or duplicate charge can amount to thousands
if not tens of thousands of dollars.

Over the three-year pilot, the RACs collected less than $13 million
from physicians out of the $980 million in total overpayments they
found, with the average overpayment per physician being about $100 to
$200. The contractors found only a small fraction of underpayments,
which physicians said are more difficult for auditors to discover
through claims review....

..For physicians who come under the gaze of the contractors, the
costs to the practice can be far more than the Medicare money at
stake…Whenever the RAC made overpayment determinations, the
physicians were forced to pay the amount in question or risk accrued
interest, garnished Medicare checks or possible loss of Medicare
billing privileges. Because the contractors were paid in part based
on how many overpayments they found, they were soon referred to
as "bounty hunters," a moniker that still persists.

Physicians in California and Florida complained that the contractors
used questionable tactics. They say the RACs made medical necessity
determinations based on written Medicare coverage guidelines without
the input of a single physician.

Contractors reviewed claims that Medicare carriers already had
adjudicated, misinterpreted coding statutes and went on fishing
expeditions by demanding scores of records at a time. For the most
part, CMS officials were powerless to review the RACs'  work unless a
doctor lodged an official appeal.

"There was no one auditing the auditors," Dr. Terpenning said.

She has appealed all of the thousands of dollars in overpayment
charges she received and expects to win all of them with the
exception of about $250 in billing errors that she determined her
office made. CMS reports that, as of March, one-third of such appeals
had resulted in the overpayment determination being overturned. Many
are pending…

Physicians who were reviewed by the RACs said they understand
overpayments occur and audits can benefit the program. But giving
unregulated auditors free rein to squeeze additional dollars out of
practices that already are stretched to the financial limit under
Medicare could force doctors into increasingly larger groups or out
of the program, Dr. Terpenning said….

Dr. Kaufman echoed that sentiment. "This is just one more straw on
the camel's back, and one day it's going to be the final straw."

…By 2010, Medicare is required to roll out the Recovery Audit
Contractor program to all states on a permanent basis. Four yet-to-be-
chosen regional contractors will administer the program and its
expansion.

More on the RACs program on the CMS (Medicare) website:

http://tinyurl.com/5z4qgl

http://tinyurl.com/ywdnmc

Introducing Medpolitics.com

A new web service is now available called "MedPolitics.com"
http://medpolitics.com , a blogging site open to US physicians to
opine on healthcare, public health, politics of medicine, and the
state of our profession.

The time seems perfect considering that healthcare is such a hot
debate topic, and many doctors feel that we should have a stronger
voice in the debate.

We figured we know a thing or two about blogging and healthcare. So
why not build a service where doctors write their political thoughts
and others read them and comment?

We hope that one day politicians, policy makers, news makers, and
others will be checking it out to see what the doctors actually think
on the important medical policy issues.

So we registered the domain, installed a user-friendly publishing
software, and gave it some testing. The site is now ready to go, all
without any significant investments (except for our time) or outside
funding.

In other words, 100% independent political network for doctors.

Some features of the website: WYSIWYG (What You See Is What You Get)
blog editor, drag and drop picture uploading, social networking (make
friends, establish contacts), bookmarking, event announcements, polls
creation,  and much more.

The publishing on Medpolitics is as easy as writing an email: no
knowledge of HTML is necessary.

Again, the site is open for blogging to US physicians only, and
everyone else can follow the debate and comment.  We have a person on
staff to treat everyone who signs up the old fashioned way, "like a
doctor."

That means continuous support, a phone number to call for help or to
explain how to do something, and the utmost attention to all your
requests.  What blogging platform will do that for you?

We are not looking for thousands of members, but just for some of you
that care for the future of our profession and have the desire to
have your opinions heard. So let's see if the experiment will work,
and whether we can get some of the quiet voices out.

Sign up now, and if you have that Blogger account that gets drowned
in a sea of chatter, move it and join other physicians.

A few voices together are definitely louder than individuals
scattered all over.

See you in the debate halls of http://medpolitics.com/ !

Concierge Medicine

Government insurance programs such as Medicare devalue the services
of primary care physicians relative to specialists, as many
physicians such as KevinMD.com have noted here.

http://www.kevinmd.com/blog/2008/06/classic-post-shortage-of-primary-
care.html

As a result, it is entirely natural that some of the more
entrepreneurial primary care doctors are switching into the field
known as "concierge medicine":

http://www.azcentral.com/business/articles/2008/07/23/20080723biz-
elitedocs0724-ON.html

Concierge medicine is an appealing option for some primary-care
doctors who want to break free from the assembly-line method of
patient care that they say they are forced to adopt.

Primary-care doctors say this limited practice is appealing for many
reasons.

They cite the drumbeat of threatened pay cuts from government
programs such as Medicare and the red tape and restrictions of
private insurance companies.

Other factors include the rising cost of malpractice insurance and
the expense of hiring assistants and office managers who must push
paperwork.

The trend underscores the fact that the role of primary-care
practitioner is a less appealing option for young doctors who see
more lucrative career paths in specialized areas of medicine such as
dermatology or plastic surgery.

Both the patients and doctors benefit from this option.

Physicians are able to spend more time with their patients and
practice their craft according to their best medical conscience, for
reasonable reimbursement.

Patients get the benefit of improved quality care for a fair price.
Both parties benefit from the exchange, because in essence it
represents a shift towards a partially free market."

To participate in an online discussion of this article, become a free
member at the new online physician-only  discussion board:

www.medpolitics.com

Reform health care

- Paul Hsieh, M.D.,
Co-founder, Freedom and Individual Rights in Medicine

http://www.WeStandFirm.org

Mandatory insurance does not solve our underlying health care
problem, which is government interference in the free market.

This approach has already been tried in Massachusetts
http://www.nytimes.com/2008/04/05/us/05doctors.html
and has led to long waits, skyrocketing costs and frustrated patients
("Individual health policies leave many in the lurch," Cover story,
News, Thursday).

http://www.usatoday.com/money/industries/insurance/2008-07-16-
healthcoverage_N.htm

Instead of government-imposed "universal health care," America needs
free market health reforms -- reforms such as eliminating mandatory
insurance benefits, repealing laws that forbid purchasing health
insurance across state lines, and allowing individuals to use health
savings accounts for routine expenses and low cost, catastrophic-only
insurance for major expenses.

Such reforms would respect individual rights, allow patients to
choose from the best offerings from all 50 states, lower costs and
make health insurance available to many who currently cannot afford
it.

Medicare's  "Free Market"  Facade
-Dr. Yaron Brook,

http://www.americandaily.com/article/22680

" Some Republicans are bemoaning the passage of a new law they say
undermines allegedly free-market elements of Medicare-- in
particular, Medicare Advantage, a program which gives seniors the
option of receiving their government-financed care through private
health plans.

They claim that such "free market" elements are crucial to
controlling the spiraling costs that are plaguing Medicare.

"The view that programs like Medicare Advantage have anything to do
with free markets is a delusion," said Yaron Brook, executive
director of the Ayn Rand Institute.

"On a free market, each individual is responsible for his own--
and only his own-- health care.

But Medicare Advantage is essentially no different from traditional
Medicare: it forces some Americans to bankroll the health-care needs
of other Americans. The inevitable result is our current health-care
crisis.

"If the government guarantees health care to people, costs have to
skyrocket. When someone else is footing the bill for health-care
costs, consumers demand medical services without having to consider
their real price.

The artificially inflated demand this creates sends expenditures
soaring out of control.

It is irrelevant whether the government finances this spending spree
directly, as it does with traditional Medicare, or indirectly, as
with Medicare Advantage. In the end, the results are the same.

"The only way to fix the problems caused by government interference
in medicine is to eliminate government interference in medicine --
not to have some mishmash of government controls and market elements.

By returning to a truly free system where each individual is
responsible for his own health-care costs, we would unleash the power
of capitalism in the medical industry, leading ultimately to high
quality, affordable medical care for Americans.

Let's start looking at ways to phase out government interference in
medicine."

-Dr. Yaron Brook is president and executive director of the Ayn Rand
Institute.

Leftist Congressmen tried to stage a "town hall" style meeting in
Houston last Friday in order to claim support for socialized medicine.

Fortunately, blogger Gus Van Horn was there, and has composed this
excellent detailed summary on what really happened:

<http://gusvanhorn.blogspot.com/2008/07/hr-676.html>

Feel free to circulate this widely.

The below letter was submitted to members of the Texas State and
Harris County Medical Society on July 17,2008.

Names have been removed in order to convert it to a sample letter or
template for similar medical Action Alerts in the future:

---------------------------------------------------------------------

Action Alert: Oppose Socialized Medicine in Houston Friday July 18!

Dear [<Texas physician or member of the Texas State
or Harris County Medical Society>],

My name is [<>].

I am writing on behalf of the health care reform organization
FIRM (Freedom and Individual Rights in Medicine)
www.WeStandFirm.org
to alert you to a health care policy meeting
promoting [<socialized medicine>]
in the state of [<Texas>]
which has been organized by [<two Texas legislators>]
and is scheduled to take place on [<*today* on Friday, July 18th>].

[<The attached flyer was received from the office of
Democratic Congresswoman Sheila Lee and John Conyers
the meeting is designed to "inform" Houstonians
about the "need" for socialized medicine.>]

The organization FIRM (Freedom and Individual Rights in Medicine),
[<co-founded by Ms. Lin Zinser and Dr. Paul Hsieh>],
helped to stop a major push towards
socialized medicine in Colorado last year.

FIRM was successful in stopping Colorado's attempt at state-
run "universal care" in large part because
they learned about our opponents' plans *early*
and started speaking out *promptly*
which helped them to set the terms of the debate
and to cast the debate in terms of moral fundamentals
- rather than merely in terms of pragmatic economic terms.

Please pass along this information to
[<your membership at the state and county medical society level>]
so that [<Texas physicians opposed to socialized medicine>]
can present a united front
and make their voices heard
[<in opposition to socialized medicine in their state
from the outset.>]

Here is the information on the meeting:

[<"Examination of the Healthcare crisis in America and offering
Universal Healthcare as the solution"
with Congresswoman Sheila Jackson Lee
and  Congressman John Conyers, Jr.

Friday, July 18, 2008 from 1:30 – 3:30pm

The John P. McGovern Theater, The Health Museum
1515 Hermann Drive, Houston, TX>]

[<I've attached the flyer to this e-mail.>]

Please feel free to forward this
to anyone else who might be interested.


If any of you need references
(either for quick self-education or possibly
to print out and distribute to the public),
I can suggest:

[<Add articles or links specifically relevant to issue and state.>]

"Health Care is Not A Right"
by Leonard Peikoff
<http://www.westandfirm.org/Peikoff-01.html>

"Ted Kennedy vs. Universal Healthcare: A Double Irony" by Richard
Parker, MD (ER doctor from Texas)
<http://www.capmag.com/article.asp?ID=5201>

"The Right Vision of Health Care"
by Yaron Brook
<http://www.forbes.com/opinions/2008/01/08/health-republican-plans-
oped-cx_ybr_0108health.html>

"FAQ on Free Market Health Insurance"
by Paul Hsieh, MD
<http://www.westandfirm.org/blog/2008/05/faq-on-free-market-health-
insurance.html>

"Moral Health Care Vs. 'Universal Health Care'"
by Lin Zinser, JD and Hsieh, MD
<http://www.theobjectivestandard.com/issues/2007-winter/moral-vs-
universal-health-care.asp>


If you wish references on how universal health care/ socialized
medicine "works"  in other countries,
I can suggest the following two,
with the caveat that they
are fairly useful for concrete factual information,
but that they don't go all the way
in making the full moral argument for free market medicine:

"The Grass Is Not Always Greener: A Look at National Health Care
Systems Around the World"
Michael Tanner, March 18, 2008,
Cato Institute Policy Analysis no. 613.
<http://www.cato.org/pub_display.php?pub_id=9272>

"Health Care in a Free Society:
Rebutting the Myths of National Health
Insurance"
John Goodman, January 27, 2005, Cato Institute Policy Analysis no.
532.
<http://www.cato.org/pub_display.php?pub_id=3627>


I hope you find this information helpful.
[<I apologize for the short notice, but FIRM only learned about this
upcoming event yesterday.>]

Please feel free to contact [<>] by email for any questions.

Best Regards,

[<>]

Freedom and Individual Rights in Medicine:
http://www.WeStandFIRM.org

Making Money in Medicine Is Moral

After the Massachusetts Public Health Council announced new rules
that will allow CVS and other retailers to open in-store clinics
designed to treat minor ailments, Boston mayor Thomas M. Menino
declared that the decision "jeopardizes patient safety. Limited
service medical clinics run by merchants in for-profit corporations
will seriously compromise quality of care and hygiene. Allowing
retailers to make money off of sick people is wrong."

"These clinics will not be 'making money off of sick people,'" said
Dr. Yaron Brook, executive director of the Ayn Rand Institute, "they
will be making money by helping sick people become well.

"Mr. Menino wishes us to think there is something morally suspect
about retailers requiring payment for providing medical services.
Does he expect them to give away medical services for free? By his
logic, it is unjust that farmers make money off the hungry, gyms make
money off the unfit, and newspapers make money off the uninformed.

"Contrary to Mr. Menino's insinuations, businesses do not profit by
exploiting consumers, but by offering them life-enhancing values--
whether a loaf of bread, a miracle drug, or a cutting-edge surgical
procedure.

The farmers, doctors, and businessmen who create and supply those
values have a moral right to be compensated for their efforts. The
attack on profit in medicine is an attack on profit as such--and on
all the goods and services profit makes possible. We should oppose
Mr. Menino's attack on profit and welcome expanded freedom in
medicine."

For more info:

http://www.aynrand.org/site/News2?
page=NewsArticle&id=16423&news_iv_ctrl=2529

I was just alerted to this thought-provoking essay by Massachusetts
attorney Paula Hall, directed towards American medical students,
entitled "Please don't become primary care physicians!!".  I am
posting it here with her permission.  Please feel free to forward this
onto any interested parties.

Paul Hsieh, MD
Freedom and Individual Rights in Medicine (FIRM): www.WeStandFIRM.org.

====================

http://msthink.blogspot.com/2008/07/open-letter-to-medical-students-please.html

"An Open Letter to Medical Students: Please don't become primary care
physicians!!"

By Paula Hall -- 09 July 2008

All the talk about the health care crisis is about the costs. All the
solutions proposed to the health care crisis are aimed at making it
more affordable.

No one ever talks about access to health care. And with good reason --
because everyone knows, in their heart of hearts, that access to
health care means access to physicians, and the only way to even
attempt to guarantee access to physicians is to enslave them.

What is missing is a proud and open statement by physicians that they,
too, understand that guaranteed access to health care -- government
socialization of health care -- means enslavement of physicians.
Physicians as a group need to stand up and be proud of the decades of
hard work it took for them to become a physician -- and ask everyone
clamoring for universal healthcare if they can conceive any mechanism,
even brute force, that can make someone learn to be a doctor.

Many doctors are leaving the profession, because the bureaucracy is
crushing them, preventing them from spending time practicing, and
because they aren't getting paid enough for what they do. It is a
senseless and useless argument to claim that doctors are being greedy
and should accept whatever low payment we healthcare-needing consumers
are willing to pay. It doesn't matter. There is nothing that can be
done to stop a doctor from leaving the profession. You wouldn't even
want to force a doctor to stay in the profession -- ask yourself if
you would be willing to operated on a surgeon who didn't want to do
the operation and was only there because he was threatened. Could you
possibly trust the advice of a practitioner who hated what he did?
Does anyone truly believe a mind can be forced, that good judgment can
be elicited at gunpoint?

The healthcare access crisis is acutest at the primary care level and
for the elderly on Medicare. Primary care physicians are the
gatekeepers for all the bureaucracies and bear the burden of all the
regulations and requirements. (Do not go on about how HMOs and
insurance companies are greedy private concerns. They are subject to
thousands of laws and regulations telling them what services they may
or may not offer, what things can and cannot be covered. Anyone making
this objection should know that, since they are the ones lobbying for
all the laws.) Primary care physicians receive the lowest
compensation. And primary care physicians are the ones everyone needs,
they are the ones who get to know the patients and refer them on to
specialists.

People clamor for more primary care physicians while at the same time
clamoring for regulations and costs that drive them out of business.
And no one seems to get what is happening, or be willing to admit what
is happening. But it's happening -- we're losing primary care
physicians. And we're losing the doctors who treat the elderly. I'm
middle-aged. By the time I am elderly, there will be few doctors
available to treat me. And I am scared. I am scared that primary care
physicians willing to treat the elderly will be hounded out of the
profession. And I cannot blame them one bit for leaving. I am
completely sympathetic to the medical student who chooses a lucrative
specialty, like plastic surgery or dermatology, over primary care.

I think perhaps the most effective means to get the message to people
that the only way to increase the number of doctors is to free them
is: drastically to decrease the number of doctors on the explicit
grounds that they are not free. So, medical students of today, I beg
of you -- don't go into primary care! Let everyone know that you are
avoiding primary care because it is too regulated and doesn't pay you
enough. If you are a primary care physician, find a way to quit, and
scream from the rooftops the reason why! Doctors and doctors-to-be,
find a way to leave the primary care profession altogether, because if
you try to go on strike while retaining your right to practice, the
bureaucrats will use the antitrust laws to destroy you. Just leave!

And hopefully, when there are no primary care physicians in a few
years, everyone will see what must be done. Only when everyone sets
the doctors free, should they come back to primary care. Hopefully,
this process will be quick -- so that when I am old, I will be able to
find a good doctor.

(Inspired by a column by Senator Tom Coburn (R-OK), appearing on the
Real Clear Politics website at
<http://www.realclearpolitics.com/articles/2008/07/senate_leaders_holding_doctor\
s.html>
-- and which does not go nearly far enough in making the case for
doctors.)

Paula Hall
E-mail: paula.hall@...
Website: http://msthink.blogspot.com

Dr. Madianos makes some excellent points about the Pyrrhic victory in
the recent Medicare tussle.

In fact, all the political wrangling over Medicare is just a small
taste of what's in store for physicians if the US ever adopts any kind
of single-payer system.  Spending decisions will be based on political
expediency, with patient and physicians caught in the crossfire
between political factions.  Medicare suffers from all the typical
flaws of socialized medicine (rising costs, declining payments to
physicians, unhappy patients), because it is in essence "single payer"
for the elderly.

All of these problems come about because of the mistaken presumption
that health care should be a "right" guaranteed by the government.
Health care is *need*, but not a "right", and that is a critical
distinction.  One man's need does not give him an automatic claim on
someone else's labor or property.  If my neighbor is hungry, he
doesn't automatically get to take anything he wants from my pantry.

Whenever the government attempts to guarantee any service (such as
health care), it must necessarily control it.  The end result of this
road will be the immoral and deadly rationing we see in Canada's system.

There is an alternative to government-run medical care -- namely the
free market.  In the other 5/6-ths of the US economy which is still
relatively free, we see falling costs and rising quality, something we
just take for granted (or even complain about whenever we buy a new
computer that's faster and cheaper than last year's model!)

The sectors of medicine which are relatively less regulated (i.e.,
more free market) such as LASIK and cosmetic surgery also show this
typical pattern of falling costs and rising quality.  This can and
should be the norm in *all* sectors of medicine.  The benefits of a
free market to both patients and physicians would be incalculable.
Such a system would be both moral and practical.

For more on moral defense of the free market approach to health care
and health insurance, please see:

"FAQ on Free Market Health Insurance"
<http://www.westandfirm.org/blog/2008/05/faq-on-free-market-health-insurance.htm\
l>

"Health Care Is Not A Right"
<http://www.westandfirm.org/Peikoff-01.html>

--------------------
Paul Hsieh, MD
E-mail: <paulhsiehmd@...>
Freedom and Individual Rights in Medicine: <http://www.WeStandFIRM.org>

From Wikipedia:

"...During the Pyrrhic War in 280 BC at Heaclea and in 279 BC in
Asculum,  the army of King Pyrrhus of Epirus suffered irreplaceable
casualties in defeating the Romans. After the latter battle, Plutarch
relates in a report by Dionysius:

The armies separated; and, it is said, Pyrrhus replied to one that
gave him joy of his victory that one more such victory would utterly
undo him. For he had lost a great part of the forces he brought with
him, and almost all his particular friends and principal commanders;
there were no others there to make recruits, and he found the
confederates in Italy backward.

On the other hand, as from a fountain continually flowing out of the
city, the Roman camp was quickly and plentifully filled up with fresh
men, not at all abating in courage for the loss they sustained, but
even from their very anger gaining new force and resolution to go on
with the war.

In both of Pyrrhus's victories, the Romans lost more men than Pyrrhus
did. However, the Romans had a much larger supply of men from which
to draw soldiers, so their losses did less damage to their war effort
than Pyrrhus's losses did to his.

While most closely associated with a military battle, a Pyrrhic
victory is a victory with devastating cost to the victor."

From an AMA news release:

<< "The AMA celebrates Wednesday's action by the U.S. Senate to pass
the "Medicare Improvements for Patients and Providers Act of 2008"
(H.R. 6331) by a veto-proof majority of 69-30.

  The AMA especially appreciates the_ heroic _efforts of  Sen. Edward
Kennedy,  D-Mass., who made this critical vote his first after his
surgery in early June. Eighteen Republican senators joined Senate
Democrats to make this a truly bipartisan process." >>

My own comments:

Unfortunately, I suspect that the "Medicare Victory" currently being
celebrated by the AMA- currently singing praises to one of the prime
legislative supporters of socialized medicine in the United States,
will prove to be a very costly Pyrrhic victory to doctors.

As the below article points out, "...Besides Hillary Clinton, no
other politician in America has devoted as much of his political
career to the enslavement of physicians..."

"Ted Kennedy vs. Universal Healthcare: A Double Irony?"

full article here:

http://www.capmag.com/article.asp?ID=5201

In light of this fact, I would like to express my dissenting opinion
that pumping tax-payer money to "temporarily shore up" a financially
failing, government-controlled and government-financed medical system
is no more than a cyncial political ploy and temporary band-aid
designed to win over the affection and votes of physicians.

Come November, if physicians, physicians-in-training and other health
care professionals elect to sell their votes and their principles for
short-term economic expediency and political gain to the highest
bidder -and facilitate the political transcendence of a Democratic
party which is whole-heartedly devoted to universal health care
(...aka  socialized medicine... )in taking control of both the
executive and legislative branche s of government,
it is my opinion that every US doctor can bet their student loans,
practice, and professional future that a "permanent fix" will soon be
forthcoming."

Evan Madianos,MD


For more info see:

FIRM Freedom and Individual Rights in Medicine.
www.WeStandFirm.org
E-mail: FIRM@...

Americans for Free Choice in Medicine
www.afcm.com
email: mail@...


-------------- Original message --------------
From: AMA eVoice <evoice@...>

eVoice® Alert

July 10, 2008

Senate votes to stop Medicare physician payment cuts

The AMA celebrates Wednesday's action by the U.S. Senate to pass
the "Medicare Improvements for Patients and Providers Act of 2008"
(H.R. 6331) by a veto-proof majority of 69-30. The AMA especially
appreciates the heroic efforts of Sen. Edward Kennedy, D-Mass., who
made this critical vote his first after his surgery in early June.
Eighteen Republican senators joined Senate Democrats to make this a
truly bipartisan process.

The legislation would replace a 10.6 percent cut in Medicare
physician payments that took effect July 1 with a 0.5 percent update
extension through Dec. 31 and provide a 1.1 percent update for 2009.
The U.S. House of Representatives approved H.R. 6331 two weeks ago by
an overwhelming, veto-proof majority of 355-59.

Now the AMA calls on President George W. Bush to sign H.R. 6331 to
protect access to health care for seniors, the disabled and military
families.

"We urge President Bush to hear and heed the voices of seniors, the
disabled and military families—and sign the bill into law for the
health of America," AMA President-elect J. James Rohack, MD, said.

Consumers for Health Care Choices

http://www.chcchoices.org

"CHCC is a 501(C)4 not-for-profit grass roots organization that
represents the views of the health care consumer to policy makers and
industry leadership.

The membership consists of consumers from all walks of life, and all
professions from across the nation. Members with expertise in health
care issues are encouraged to take an active role in the
organization's efforts --- giving speeches, writing articles, op-eds,
and letters to the editor on behalf of the empowered health care
consumer.

Our Mission

One of the missing ingredients in the Consumer Driven Health Care
movement is the voice of the consumer.

In a health system that puts health care consumers in the driver's
seat, American consumers make millions of daily decisions about what
to buy and what not to buy, what services to use and which not to
use.

These actions will have a greater impact on reforming the nation's
health care system than all of the speeches, op-eds, policy papers,
and media interviews in the world. But up until now the very people
that will have the greatest impact have not been heard from.

Now all of that has changed. Consumers for Health Care Choices is the
voice of the consumer, providing the missing key element in health
care reform---consumer representation. CHCC works to accomplish the
goal of consumer choice in health care through the following efforts:

Federal Government

    CHCC has a Washington presence, and works with Congress, the
Administration, and federal agencies to focus on making consumer
empowerment the unifying theme of national health system reform.

State Government

    CHCC encourages states to adopt consumer driven health care
principles in their own programs, including Medicaid and public
employee benefits.

    We work to convince states to roll-back regulations that impede
the growth of consumer driven health care and competitive markets.

Employers

    CHCC works to persuade employers to entrust health care decisions
to their employees.
    We urge employers to provide free choice of health care coverage
to their employees.
    We educate employers on the advantages of a defined contribution
approach to benefits.

Medical providers

    CHCC encourages hospitals to provide transparent pricing and to
recognize the value of self-pay patients.
    We encourage physicians to move away from third-party contracts
that impede their ability to work in the interests of their patients.

Insurance Industry

    CHCC urges insurance companies to return to true two-party
insurance arrangements and enable consumers to pay directly for
routine services through the use of HSAs and HRAs.

    We encourage insurance companies to honor the relationship between
patients and physicians by empowering patients to make their own cost-
benefit decisions about treatment alternatives.

The future is very bright for health care consumerism. America has
tried virtually every other scheme imaginable to balance the
conflicting demands of access, quality and cost.

None of it has worked very well. It is long past time to use the
power of consumers operating in a free market to obtain the optimum
value of the health care resources available.

If you agree---join now, and finally have a voice.

The Right Vision Of Health Care
- Yaron Brook

FORBES MAGAZINE

With the primary season in full swing, the presidential candidates
are fighting over what to do about the spiraling cost of health care--
especially the cost of health insurance, which is becoming
prohibitively expensive for millions of Americans.

The Democrats, not surprisingly, are proposing a massive increase in
government control, with some even calling for the outright socialism
of a single-payer system. Republicans are attacking this "solution."
But although they claim to oppose the expansion of government
interference in medicine, Republicans don't, in fact, have a good
track record of fighting it.

Indeed, Republicans have been responsible for major expansions of
government health care programs: As governor of Massachusetts, Mitt
Romney oversaw the enactment of the nation's first "universal
coverage" plan, initially estimated at $1.5 billion per year but
already overrunning cost projections. Arnold Schwarzenegger, who
pledged not to raise any new taxes, has just pushed through his
own "universal coverage" measure, projected to cost Californians more
than $14 billion. And President Bush's colossal prescription drug
entitlement--expected to cost taxpayers more than $1.2 trillion over
the next decade--was the largest expansion of government control over
health care in 40 years.

Today, nearly half of all spending on health care in America is
government spending. Why, despite their lip service to free markets,
have Republicans actually helped fuel the growth of socialized
medicine and erode what remains of free-market medicine in this
country?

Consider the basic factor that has driven the expansion of government
medicine in America.

Prior to the government's entrance into the medical field, health
care was regarded as a product to be traded voluntarily on a free
market--no different from food, clothing, or any other important good
or service. Medical providers competed to provide the best quality
services at the lowest possible prices. Virtually all Americans could
afford basic health care, while those few who could not were able to
rely on abundant private charity.

Had this freedom been allowed to endure, Americans' rising
productivity would have allowed them to buy better and better health
care, just as, today, we buy better and more varied food and clothing
than people did a century ago. There would be no crisis of
affordability, as there isn't for food or clothing.

But by the time Medicare and Medicaid were enacted in 1965, this view
of health care as an economic product--for which each individual must
assume responsibility--had given way to a view of health care as
a "right," an unearned "entitlement," to be provided at others'
expense.

This entitlement mentality fueled the rise of our current third-party-
payer system, a blend of government programs, such as Medicare and
Medicaid, together with government-controlled employer-based health
insurance (itself spawned by perverse tax incentives during the wage
and price controls of World War II).

Today, what we have is not a system grounded in American
individualism, but a collectivist system that aims to relieve the
individual of the "burden" of paying for his own health care by
coercively imposing its costs on his neighbors. For every dollar's
worth of hospital care a patient consumes, that patient pays only
about 3 cents out-of-pocket; the rest is paid by third-party
coverage. And for the health care system as a whole, patients pay
only about 14%.

The result of shifting the responsibility for health care costs away
from the individuals who accrue them was an explosion in spending.

In a system in which someone else is footing the bill, consumers,
encouraged to regard health care as a "right," demand medical
services without having to consider their real price. When, through
the 1970s and 1980s, this artificially inflated consumer demand sent
expenditures soaring out of control, the government cracked down by
enacting further coercive measures: price controls on medical
services, cuts to medical benefits, and a crushing burden of
regulations on every aspect of the health care system.

As each new intervention further distorted the health care market,
driving up costs and lowering quality, belligerent voices demanded
still further interventions to preserve the "right" to health care.
And Republican politicians--not daring to challenge the notion of
such a "right"--have, like Romney, Schwarzenegger and Bush, outdone
even the Democrats in expanding government health care.

The solution to this ongoing crisis is to recognize that the very
idea of a "right" to health care is a perversion. There can be no
such thing as a "right" to products or services created by the effort
of others, and this most definitely includes medical products and
services. Rights, as our founding fathers conceived them, are not
claims to economic goods, but freedoms of action.

You are free to see a doctor and pay him for his services--no one may
forcibly prevent you from doing so. But you do not have a "right" to
force the doctor to treat you without charge or to force others to
pay for your treatment. The rights of some cannot require the
coercion and sacrifice of others.

So long as Republicans fail to challenge the concept of a "right" to
health care, their appeals to "market-based" solutions are worse than
empty words. They will continue to abet the Democrats' expansion of
government interference in medicine, right up to the dead end of a
completely socialized system.

By contrast, the rejection of the entitlement mentality in favor of a
proper conception of rights would provide the moral basis for real
and lasting solutions to our health care problems--for breaking the
regulatory chains stifling the medical industry; for lifting the
government incentives that created our dysfunctional, employer-based
insurance system; for inaugurating a gradual phase-out of all
government health care programs, especially Medicare and Medicaid;
and for restoring a true free market in medical care.

Such sweeping reforms would unleash the power of capitalism in the
medical industry. They would provide the freedom for entrepreneurs
motivated by profit to compete with each other to offer the best
quality medical services at the lowest prices, driving innovation and
bringing affordable medical care, once again, into the reach of all
Americans.

Yaron Brook is managing director of BH Equity Research and executive
director of the Ayn Rand Institute.

http://www.forbes.com/opinions/2008/01/08/health-republican-plans-
oped-cx_ybr_0108health.html