48 Hours Until Medicare Expansion Vote

*** WIRE: MORE MEDICARE VOTE AS EARLY AS FRIDAY ***

*Gingrich Pushes Welfare State*

Gingrich Pitches More Medicare:
http://www.forbes.com/home_europe/newswire/2003/11/19/rtr1153585.html
Newt Gingrich's Health Care Reform Web Site:
http://www.healthtransformation.net/
[PULSE POINT: Bringing Gingrich -- who acheived and squandered an historic
GOP congressional takeover in 1994 -- in to promote more Medicare is a sign
of desperation. He steadfastly refused to include MSAs in the 1994 Contract
with America, instead pushing term limits, and it's not surprising he's
pushing more Medicare]

Bill Grants $ 25 Billion in Rural Subsidies:
http://www.usatoday.com/news/washington/2003-11-19-medicare_x.htm

GOP Congressman: I'm Voting Against More Medicare:
http://www.foxnews.com/story/0,2933,103471,00.html
GOP Congressman Blasts More Medicare:
http://www.lewrockwell.com/paul/paul133.html

Newspaper to Bush: Stop More Medicare:
http://news-register.net/edit/story/1117202003_edt2.asp

Those who oppose more Medicare:

€    Rush Limbaugh
€    Heritage Foundation
€    National Center for Policy Analysis
€    Most seniors polled
€    USA Today and most newspaper editorial boards
€    Human Events

Are We All Socialists Now?
Buy Your Own Drugs, Grandma:
http://www.humaneventsonline.com/article.php?id=1019

Bill Kills Retiree Benefits:
http://www.heritage.org/Research/HealthCare/wm344.cfm

"We should be bending our wills and efforts to eliminating Medicare,
not expanding it."

      -- Virginia AFCM member in letter to United States Senator

"This could be a big nail in the coffin of any incentive to develop new
wonder drugs."
      -- Seattle AFCM member to talk radio show host by e-mail

"I recently turned 65 and I don't want this expansion. I don't like Medicare
and neither do my doctors. My doctors are more important to me than any
government insurance plan."
        -- AFCM Member in Nevada to each legislator on conference committee

Congress:
http://capwiz.com/yo-demo/

White House:
Tel: (202) 456-1414
Fax (202) 456-2461


**********

PULSE

**********
E-News from Americans for Free Choice in Medicine (AFCM)


http://www.afcm.org
1525 Superior Avenue, Suite 101
Newport Beach, CA 92663
E-Mail: mail@...
Promoting Individual Rights in Medicine Since 1993

      Support individual rights in medicine:
      http://www.afcm.org/membership.html
      Support AFCM Today:
      https://www.paypal.com/xclick/business=donations%40afcm.org

NEWS RELEASE
For Immediate Release

AFCM: PILL BILL IS ROTTEN

NEWPORT BEACH, CALIFORNIA -- Americans concerned about the cost of their
drugs and their own health need to reject the current Medicare reform plan,
according to Americans for Free Choice in Medicine.

    "What the government really needs to expand is not government, but
freedom," states Richard E. Ralston, AFCM's executive director, in an op-ed
released today. "There is one minor feature of the bill that would help
seniors pay for their prescriptions: tax-free Health Savings Accounts. But
this single feature is not nearly enough to make the legislation palatable."

Full article:

www.afcm.org

Americans for Free Choice in Medicine (AFCM)
Promoting Individual Rights in Medicine Since 1993

1525 Superior Avenue, Suite 101
Newport Beach, CA 92663
E-Mail: mail@...

        Support individual rights in medicine:
        http://www.afcm.org/membership.html

        Support AFCM Today:
        https://www.paypal.com/xclick/business=donations%40afcm.org

Health Care Reform: Health Savings Accounts

Some conservative members of Congress are demanding that
market-oriented health care reforms be included in the Medicare
bill being negotiated in Congress. If they succeed, it could
improve health care for all Americans, says analyst Stephen
Moore.

The problem with health care today is that markets are hardly
permitted to operate at all. The government's dominating role has
caused hyper-inflation in costs.


   0   In the last three years, according to the Labor Department,
       employer-covered health costs have risen by 14 percent, 12.5
       percent and 13.9 percent.


   0   In just five years, health costs have doubled for families to
       an average annual cost of $9,068 for a family of four.

   0   Meanwhile, overall inflation has not grown at all, and costs
       and prices have been declining in most consumer-driven industries.

Health care is unaffordable to a growing number of families. Soaring
health-care costs are also a major reason why so many states are broke
today (Medicaid expenses) and why the federal government is running
huge deficits (Medicare).

The most important reform conservatives want is universally available
Health Savings Accounts (HSAs). HSAs are like tax-free IRAs where the
money is stored in the account to pay for health expenses. If the
family incurs a medical cost, it pays out of the account. If the
family does not incur expenses of $3,000 or more a year, it can roll
over unspent money into a regular individual retirement account (IRA).

HSAs already exist on a limited basis and are cutting health-care costs
dramatically.

For example, one study by the Reason Foundation recently
found that Medical Savings Accounts (a type of HSA) combined with a
catastrophic coverage plan could save the typical family about $2,000
a year -- more than 20 percent -- on health costs compared to
conventional insurance, while providing more comprehensive coverage.

Source: Stephen Moore (Club for Growth), "Hidden Snares in Health Care,"
Washington Times, November 13, 2003.

For text
http://www.washingtontimes.com/commentary/20031112-093419-5573r.htm

For more on Consumer Driven Health Care
http://www.ncpa.org/iss/hea/

Free-Lunch Medicine
by Thomas Sowell (November 13, 2003)

Summary: "Government price controls on medicines and medical care simply mean
that these costs do not all get covered. This works in the short run -- and the
short run is what politicians are interested in, because elections are held in
the short run. But the rest of us had better think ahead, if we value our
health."

Article website address: <http://www.capmag.com/article.asp?ID=3312>

Unless Congress acts immediately, Medicare will cut physician payments by 4.5%
on January
1, 2004.  This comes on top of a 5.4% cut made in 2002.

"America's seniors can't afford another cut."

<< ***** This is *NOT* the moral issue involved. The PROPER  moral issue is that
the government has no right to violate the rights of America's doctors  by
extorting services from them at whatever prices it dictates as  the sole payer
of health care services for seniors.

A right to one's own life means a right to decide at what prices and on what
terms one chooses to work and offer services volutarily to others, trading by
mutual consent to mutual benefit, NOT benefitting one party at the expense of
the other due to government coercion. ***** >>

Already, some 24% of family physicians
surveyed nationwide indicated they are no
longer able to accept new Medicare patients.

The Medicare Prescription Drug Bill now being
considered by Congress would STOP THE CUTS
and require POSITIVE PAYMENT UPDATES for
physicians in each of the next two years.

CALL CONGRESS TODAY!  Calling is QUICK, EASY, and
FREE using the AMA�s automated Grassroots
Hotline.

Congress Must Act Immediately To Block
4.5% Physician Payment Cut In 2004

AMA Grassroots Hotline:  (800) 833-6354

Ask your Senators and Representative to
VOTE FOR THE MEDICARE PRESCRIPTION DRUG BILL!

<< *** AT THE SAME TIME, DON'T DELUDE YOURSELF INTO THINKING THAT
PETITIONIING/FUNDING YOUR "CONGRESSIONAL FOLLOWERS" WITHOUT CHANGING THE MINDS
OF THEIR CONSTITUENTS/ YOUR PATIENTS  WILL BE ANY MORE SUCCESSFUL ON THIS ISSUE
THAN IN SEEKING MEDICAL MALPRACTICE REFORM HAS BEEN >>

For more information on this issue, or to send an
e-mail to your member of Congress, please visit
the AMA's Grassroots website at:
http://www.ama-assn.org/grassroots

http://online.wsj.com/article/0,,SB106858499189259400,00.html

Universal Care Has a Big Price: Patients Wait

Canada, Where Long Delays Have Stirred an Outcry, Tries a New Triage Tactic

By ELENA CHERNEY
Staff Reporter of THE WALL STREET JOURNAL

TORONTO -- Nurse Donna Riley hurried through the drab halls of St. Michael's
Hospital to deliver the bad news.

Eduard Krause, a 71-year-old retired mechanic, had been waiting more than six
weeks for heart-bypass surgery. After fasting for 18 hours, he was lying on a
gurney, ready to be rolled into the operating room. Now he would have to wait a
bit longer: An emergency patient had been rushed into surgery, bumping him from
the day's schedule.

"The lady who is having her operation is 34 years old," explained Ms. Riley.
"They found a big tumor on her heart." Mr. Krause replied: "I can understand all
that. But if I go home, I'm afraid I might not come back."

In Canada's public-health system, which promises free, equal-access care to all
citizens, medical resources are explicitly rationed. For the country as a whole,
that works -- Canada spends far less on health care, yet the health outcomes of
its citizens are generally as good as those in the U.S.

But the trade-offs are steep: Canadian hospitals are slower to adopt the latest
technology, meaning patients have more limited access to cutting-edge medical
equipment. There are fewer specialists for patients to see.

The riskiest trade-off of all is troublingly long waits. Once patients see a
family doctor and get a referral for specialist care, it can take weeks or even
months to get an appointment. In some parts of the country, patients waiting for
admission to a hospital sometimes find themselves waiting for hours and even
days on gurneys in the corridor, and receiving treatment there.

Waiting is the giant flaw in many national health-care plans. A study this year
by the Organization for Economic Cooperation and Development found waiting times
for elective surgery are a "significant health-policy concern" in about half of
the group's 30 members, including the United Kingdom, Australia, Sweden, Canada,
Italy, Denmark and Spain. Waiting times weren't a problem in the U.S., the group
said.

In Canada, the long waits stirred a public outcry and a government inquiry when
a 63-year-old heart patient at St. Michael's died in 1989 after his surgery had
been canceled 11 times. While the inquiry concluded the death wasn't caused by
the delays, it highlighted the long waiting lists and called for better
management of patients in the line.

To tackle this crucial problem, Canada is turning to Donna Riley and others like
her. The 51-year-old nurse is one of Ontario's "cardiac-care coordinators." Her
job: to make sure waiting doesn't kill patients.

Hospitals across Canada struggling with their own waiting-list woes are now
trying to follow Ontario's model. The experience in Ontario, the largest of
Canada's 10 provinces, spotlights one of the essential problems with health-care
rationing and a possible solution.

In Canada, one way hospitals restrain costs is by trying to always run at
capacity. It's more efficient to run a hospital that way, just as it's more
efficient to fly an airplane with every seat full. But running at capacity means
lines always form. Waits for certain nonemergency surgeries in Canada can be up
to two years. In parts of the country, there are long lines for such things as
magnetic resonance imaging or children's mental-health services.

Health-care spending accounts for 10% of Canada's gross domestic product, while
in the U.S., it consumes about 14%. Canadian patients can choose their own
doctors, and they never see a bill for their care. Canadian physicians, who are
paid by the government, generally earn much less than their U.S. counterparts.

Despite Canada's lower health-care spending, patient outcomes in a number of
areas, including cancer and heart disease, are similar. Overall, life expectancy
in Canada is 79.4 years, compared with 76.8 years in the U.S., the OECD says.

Many factors affect longevity, of course. Nearly one-third of Americans are
obese, for instance, compared with 15% of Canadians. And since millions of
Americans are uninsured, many may not get access to the care they need..

<<ignoring the fact that "insurance"-  whether or not health care services "are
paid for" and if so, "by whom" -  is a completely separate issue from "access"
and whether the services are utilized/ consumed in this country......>>

Some U.S. experts who have studied the Canadian system say that waiting lists
are a sign that the health-care system isn't wasting money on unnecessary
procedures, equipment or personnel.

"If you don't wait in a medical system, there's a problem," says Ted Marmor, a
health-policy "expert" at Yale University. The question, Prof. Marmor says, "is
whether people are waiting inappropriately."

<<This ignores the fact that in a truly fee market, "waiting lines" - the
hallmark of excess consumer demand-  represent an opportunity for additional
producers to enter a market or pre-existing ones to expand their services at
their own cost in order to increase profits by satisfying consumer needs and
wants.

On the other hand, in a completely or largely government-financed system, 
"waiting lines"  are the byproduct of rationing- an attempt to hold down costs
by limiting the supply of services or providers to offset the unlimited demand
for the "free" services paid for by government taxation.>>

In Ontario, the cardiac-care network works to strike this balance. The network
consists of 17 hospitals, and 50 surgeons who share heart-patient cases. There
are government guidelines to follow: At St. Michael's, six scheduled surgeries
are allowed each day.

Ms. Riley's challenge is to juggle the elective and the urgent cases so that all
six operating-room slots are filled every day -- and no one is left waiting
longer than the recommended length of time.

To do that, she fields calls about urgent cases from community hospitals that
don't do heart surgery and need to transfer patients. Using test results
received by e-mail or fax, she fast-tracks urgent cases to the attention of St.
Michael's on-call surgeon, who decides who will be treated that day.

On evenings and weekends, Ms. Riley's bridge games and outings to her nephew's
sporting events are often interrupted by pages from patients waiting for surgery
whose pain is suddenly worse.

"Donna's the traffic cop in the middle of a busy intersection," says Dr. William
Sibbald, a Toronto expert in critical care and one of the authors of the
government report that led to the creation of the cardiac-care network.

<< In other words, what should be "elective" surgery becomes "emergency" surgery
if the bureaucratic "traffic cop" catches things in time and bumps you to the
top of the list, or what's popularly known as "death", if they don't....>>

Before the network was created there wasn't much coordination between Ontario's
hospitals and doctors. Surgeons managed their own list of patients, and waiting
times varied greatly from hospital to hospital.

With Ms. Riley and her fellow coordinators working to distribute the patient
load, the mortality rate for those on the network's waiting list has been
reduced to about 0.39%, from as high as 0.74% in the mid-1990s.

Waiting times, which have been on a downward trend in recent years, increased
slightly in the first part of 2003, partly because the severe acute respiratory
syndrome outbreak earlier this year forced the cancellation of hundreds of lab
tests and elective surgeries.

The SARS episode showed Canada's system lacks "surge capacity," according to a
report by David Naylor, the dean of the University of Toronto's medical school.
With hospitals already full, handling a large number of patients who required
isolation overwhelmed the system. At least some of the early infections spread
because patients shared emergency-room observation areas separated only by a
curtain.

<< Any implications for US medical capacity to effectively combat actual
bioterrorism? >>

To ensure standardized waiting times for heart patients in Ontario, surgeons
assign every patient a score of between one and seven, depending on the severity
of their symptoms. The scoring system was devised by heart surgeons and
cardiologists. Patients are then separated into four categories: emergency,
urgent, semiurgent and elective.

For example, a patient who is rated a 2 should wait no more than 48 hours,
according to network guidelines, while a person rated a 3.5 could wait as long
as 14 days.

A score of between 5 and 7 indicates an elective patient for whom a wait of as
long as 120 days is considered safe.

Hospitals' waiting times, and the percentage of patients treated within the
recommended time frames, are posted on the network's Web site.

"Urgent people get treatment in a timely fashion," says Dr. Lee Errett, chief of
cardiac surgery at St. Michael's. Today, most urgent and semiurgent heart
patients are treated within two weeks. Non-urgent patients wait an average of 49
days for surgery.

Ms. Riley decided at age 12 that nursing was her calling, after she helped care
for a uncle dying of cancer at her family's farm on Prince Edward Island. After
working as a cardiac nurse, she rose to the position of head nurse on the
surgical ward. By the late 1980s, the Ontario government tightened spending,
forcing hospitals to cut beds. Heart patients found themselves waiting up to a
year for surgery. "There was no mechanism in place" to triage patients or share
them between surgeons or hospitals, says Ms. Riley. "This always bothered me."

These days, Ms. Riley is usually calling the hospital on her cellphone by the
time she backs her Honda out of her driveway in the morning. Her first call is
often to the intensive-care unit. She needs to know how many patients are well
enough to be moved to regular hospital beds. "The ICU is the bottleneck," she
says.

Intensive-care beds are the most expensive and scarce in the city. At St.
Michael's, 13 ICU beds are reserved for cardiac-surgery patients. When St.
Michael's gets hit with several cardiac emergencies, Ms. Riley, in her white
gown and well-worn Birkenstock sandals, heads to other floors in search of the
beds she needs. "Donna won't sleep well if we cancel a cardiac surgery," says
St. Michael's cardiac program director Ella Ferris.

During the day, she reviews her three-ring binder of elective cases, penciling
in notes about patients who call to complain about increased pain or scheduling
concerns, such as a wedding, vacation or work commitment.

On the spring day Mr. Krause was scheduled to have his long-awaited bypass, Ms.
Riley got a call about another patient -- a woman with a benign tumor on her
heart that could cause a stroke. To fit her in, Ms. Riley needed to cancel
another patient. The only one she could cancel was Mr. Krause, because he was
rated the least urgent of the six scheduled surgeries for that day.

While Mr. Krause had been waiting six weeks for his date in the operating room,
he had also waited several additional weeks before that for an angiogram and a
stress test. "They are always booked," he said. Informed of the last-minute
delay, Mr. Krause told Ms. Riley his chest pains had grown worse lately -- to
the point where he had almost called an ambulance the night before. "The pain is
constant," he said.

Mr. Krause was also worrying about his ailing wife and mother-in-law at home.
His wife had broken her leg and was on crutches. His 91-year-old mother-in-law,
who has Alzheimer's disease, lives with the couple. Mr. Krause had recruited his
brother and sister-in-law to help out while he was in the hospital. A delay
would force the whole family to make another set of arrangements.

In pushing for Mr. Krause's admission and surgery, Ms. Riley considered his
family situation in addition to his pain. He got the operation the next day.

"She's kind of the patient advocate," says her boss Dr. Errett. "She's always
the voice of the underdog." Yet he says the two don't always agree on who should
be treated first. "I override her sometimes," he says.

Concern for patients sometimes leads Ms. Riley to an odd role reversal: She
finds herself hounding patients who are hesitant to schedule surgery. One
patient, who operated a swimming-pool business, refused to be scheduled for his
bypass "because of pool season. He was taking a risk by waiting," says Ms.
Riley. She called him every few days to check on him. He had his surgery after
pool season and did fine.

The hospitals in the cardiac-care network keep a database of patient outcomes to
help pinpoint those at highest risk from waiting. A recent analysis of the data
showed a disproportionate number of deaths were occurring in patients with a
condition called aortic stenosis. Because of the finding, patients with the
condition are now seen more quickly.

The system still leaves surgeons grappling with questions about how to ration
finite resources. On one of the busiest days in recent months, an emergency
patient was transferred to St. Michael's with a ruptured valve condition.

The survival rate for the procedure, according to the network's data, is just
10% to 20%. Indeed, the man died a few days after his six-hour surgery.

The procedure is frustrating, says Dr. Errett, because it claims many resources
and so seldom succeeds. "I've met with our group and said, 'Maybe we shouldn't
do them at all,' " he says. In the end, the doctors decided to continue doing
the procedures.

Some patients, such as Mr. Krause, say that waiting isn't too bad a price to pay
for their "free" medical treatment. Now recovered from his May surgery, he takes
a mile-long walk before breakfast most mornings. "The care, I think, was pretty
excellent," he says.
--------------------------------------------------------------------------------
Comparing Health Care
Canada

Who Pays: The government provides coverage for all medically necessary
treatments -- 70% of the nation's health-care expenditures. Private insurance is
available for prescription drugs, dental, vision, psychotherapy, fertility
treatments and private hospital rooms.

Hospitals: Government-funded.

Doctors: Bill the government according to rates set by the provinces.

Prescription drugs: Hospitals pay for drugs they dispense. For other drugs,
Canadians pay out of pocket or through private insurance. Some provinces offer
public drug-insurance plans. The government regulates prices of brand-name
drugs, so prices are much lower than in the U.S.

Advantages: Everyone is guaranteed access to care. Patients can seek services of
any specialist.

Disadvantages: Top specialists and many family doctors have long waiting lists.

United States

Who Pays: Individuals are generally responsible for costs, either out of pocket
or through insurance. Many have employer-paid or subsidized programs. The very
poor are covered by the government's Medicaid program, and seniors and the
disabled are covered largely by the government's Medicare program.

Hospitals: Generally compensated by a mix of insurance and patient payments,
charitable contributions, government funds and investment income. Some uninsured
patients are billed by hospitals.

Doctors: Set their own (irrelevant) fees. Many accept public and private patient
insurance and receive amounts (pre-) set by insurers (sometimes).

Prescription drugs: Drugs dispensed by hospitals are usually included in the
cost of treatment. For other drugs, insured patients generally make a
co-payment, with insurers covering the rest. Uninsured patients can face
extremely high drug costs. Medicare pays for drugs only during hospital stays.

Advantages: Patients with good coverage get access to one of the world's best
medical systems, often at a relatively low cost.

Disadvantages: For the growing number of uninsured, health care can prove
enormously costly and difficult to obtain.

elena.cherney@...

The Worldwide Epidemics of Doctor's Strikes
by Robert W. Tracinski

Excerpt:

"...In the doctors' strikes across the world, there is one factor that is
omnipresent: government controls. All of the overseas doctors are striking
against socialized medical systems in which doctors' fees and work procedures
are set, in minute detail, by the government. When the government is short on
money or wants more services, its first step is always to squeeze the doctors --
restricting their fees, regulating their services or just plain refusing to pay
them. The doctors are left with only one recourse: to go on strike.

.... The principle behind socialized medicine is stated by a Croatian government
official who condemned the doctors' strike in his country: "To strike is
everyone's constitutional right, but the people's right to health and a regular
health service is even greater." Under socialized medicine, the doctors are
always presumed to have no rights, while all comers are presumed to have a
"right" to the doctors' unrewarded services. This transformation of doctors into
servants of the state -- whose only bargaining tool is the mass withholding of
their services -- is the cause of the rash of doctors' strikes.

...... The immediate complaint in America stems from this same hostility to the
rights of doctors -- in this case, our government's refusal to protect them from
arbitrary medical malpractice awards that amount to legalized looting. And now,
both Congress and the Bush administration want to expand Medicare, which has
been the leading edge of socialized medicine in America, imposing the kind of
controls on doctors' fees and regulation of their practices that is endemic in
the rest of the world."

Full article:

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

Lies My Mother Never Told Me About Single-Payer Health Care
by Conrad F. Meier

" The nature of a lie is such that if you repeat it often enough it
takes on a life of its own, always at the expense of truth.

While some lies-- "your hair looks great"-- are harmless enough, and
lies like "I never had sex with that woman" are laughable, others can
be harmful to life, liberty, and the pursuit of health. So it is with
lies spoken in defense of single-payer health care.

......A single-payer system is one big Medicare plan, without the
discipline and accountability achieved by competition and consumer
choice. Sorry, but that's socialism."

http://capmag.com/article.asp?ID=2887

Is a "Right to Prescription Drugs" Good Medicine?
by David Holcberg

Excerpt:

"Most members of both parties assume that senior citizens have a "right to
health care," which includes a "right to prescription drugs."......

But if seniors had a right to receive medical care, then others would be legally
bound to provide it for them -- non-seniors would be forced by law to support
seniors' medical needs.

In a free society no man should have a legal claim to the life and property of
another. In justice, no man should have a right to demand that another surrender
his effort, his money or his property -- not even to pay for seniors' medical
bills. This type of demand amounts to a crime, whether the criminal is a man, a
gang, or the US government.

Any use of force against a human being is morally wrong and is a violation of
his individual rights and of his freedom.

Government exists to protect our individual rights, not to violate them. There
are no "noble" causes that would justify a reversal of government's role from
enforcer to destroyer of rights. This reversal has always proven to have
terrible consequences."

http://capmag.com/article.asp?ID=645

Waiting Your Turn for Health Care

"Rationing of health care under a public system means that Canadians are waiting
longer than ever for medical treatment.
Canadian patients wait almost 18 weeks for essential
health care, according to a new study."

http://www.ncpa.org/iss/hea/2003/pd110503e.html

Will Canada's "Universal" Health Care System Come to America?
by Michael J. Hurd

Excerpt:

".....The hard truth is that socialized medicine is destroying health
care in Canada.

Most Americans do not understand that we are headed down a similar
path in this country. The same mistaken economic and philosophical
ideas that created socialized medicine in Canada are creating semi-
socialized medicine in the United States today.

The increase in managed care, bureaucracy, waiting lists, and expense
of health care is the fault of our government. In its zeal
to "compassionately" meet all of our health care needs and demands,
our government is loving us to death. "

http://capmag.com/article.asp?id=229

Pay-as-You-Go M.D.: The Doctor Is In, But Insurance Is Out
Maverick Physicians Skip Red Tape and Cut Charges

By RHONDA L. RUNDLE
Staff Reporter of THE WALL STREET JOURNAL

GREENEVILLE, Tenn. -- After Aaron Smith's weight plunged and he began
feeling thirsty all the time, several doctors balked at seeing him
because he doesn't have health insurance. On the verge of heading to the
emergency room, his mother saw a newspaper ad: "No health insurance? Try
Patmos EmergiClinic."

The ad put the Smiths in contact with a small but growing corner of the
medical world where insurance is viewed as the problem with, not the
answer to, rising health-care costs. Frustrated by red tape, some
maverick doctors have cut out the middlemen, allowing them to offer
less-expensive service and a return to the days when nothing came
between patients and their family doctor.

A few days later, Mr. Smith, who was down to 133 pounds from 170, had a
physical examination and a battery of blood, thyroid and other tests at
the Patmos clinic, which is near the supermarket where he works. It
turned out that Mr. Smith, 28 years old, was diabetic and his blood
sugar was dangerously high. He left the clinic that day with a
prescription and an appointment for a checkup a week later. The tab for
the visit, including the tests, was $150, which his mother, Charlotte,
cheerfully paid on her way out.

Robert S. Berry, the founder and only doctor at the clinic here, offers
what he calls "low-priced treatment" in exchange for "payment at the
time of service," or P-a-t-m-o-s. The 45-year-old physician doesn't
accept any third-party payment -- not even from Medicare, the federal
program that covers a large chunk of the nation's medical bills. He says
insurers "brutally intrude in the doctor-patient relationship and put
doctors and patients at odds with one another."

By accepting only cash, checks and credit cards, he keeps his
administrative costs to a minimum and passes the savings on to his
patients. He posts prices on his Web site and on a huge
turquoise-and-orange sign in front of the clinic. A typical office visit
costs $35, a set of blood tests is $20 and a pregnancy test is $10.
Other doctors in town typically charge $55 or more for an office visit
and send patients to an outside lab where blood work can start at $100.
Dr. Berry also carries a few common drugs: Antibiotic eye drops cost $5
and amoxicillin is $7.

Dr. Berry jokes that visits to his office cost something "between an oil
change and a brake job."

Similar cash-on-the-barrelhead clinics are sprouting across the country.
Dr. Berry and others like him say they are demonstrating a way to lower
costs and relieve pressure on emergency rooms that are crowded with
people without insurance. Besides, more patients are digging deep into
their pockets even if they have insurance, as premiums and co-payments
rise.

Pay-as-you-go medicine is "a phenomenon that certainly isn't in the
mainstream yet, but it seems to be becoming more visible and perhaps
more common," says William Jessee, president and chief executive officer
of Medical Group Management Association, a physician organization in
Englewood, Colo. The arrangement doesn't work for major medical
problems, which everyone agrees still require some form of health
insurance.

Todd Coulter, a 39-year-old internist in Ocean Springs, Miss., stopped
taking insurance in August 2002. "I was tired of being dishonored and
disrespected" by insurance companies that delayed payment or denied
claims altogether, he says. Then one day, "I looked up and realized that
cash-paying patients were subsidizing rich people with insurance"
because insurance payments were discounted and harder to collect, he
says.

Dr. Coulter sees fewer patients these days. By cutting his office staff
to two part-timers from seven -- including four who were full time -- he
says he was able to reduce his charge for an office visit to $40 from
$60. His practice income after expenses has shrunk to about $115,000 a
year from $175,000, but, he says, "I don't spend all day begging Blue
Cross & Blue Shield for money." Dr. Coulter also says he thinks he is
improving medical care for people with chronic conditions such as
diabetes and hypertension because they can afford to see him once a
month.

In Greeneville, a woodsy town of 16,000, Dr. Berry has some fans. Ella
Price, the owner of the Backstage Coffee House & Cafe, applauds him for
helping people such as herself who can't afford the $500-plus-a-month
cost of medical insurance. "Around here, that's a house payment," she
says.

Dr. Berry says he started thinking about setting up a clinic when he was
working as an emergency-room doctor at Greeneville's Takoma Adventist
Hospital because treatment was "ridiculously expensive" for people
without insurance. Many patients weren't sick enough to be admitted to
the hospital, but they came to the ER because they didn't have a doctor.
At the ER, these patients received treatment but not comprehensive care.

Dr. Berry's musings about self-employment turned serious when Takoma
Adventist fired him in December 2000 after about 3� years there. Carlyle
L.E. Walton, the hospital's president, says he dismissed Dr. Berry
because he's a difficult person who rocked the boat and alienated some
patients by lecturing them about smoking and obesity, among other
things. "Clinically, he is above reproach -- I would go to him in a
heartbeat -- but he is highly condescending and confrontational," Mr.
Walton says. There were also conflicts over work schedules and
compensation, Dr. Berry says.

Besides describing Dr. Berry's payment philosophy, the clinic's peculiar
name makes a personal statement. Patmos is a Greek island where the
Romans sent political prisoners. The clinic, explains Dr. Berry, serves
people who are "politically exiled within our health-care system."

Dr. Berry launched his clinic on Jan. 10, 2001, with two doctors
including himself, an office manager, and the equivalent of a full-time
nurse and a paramedic. A 1989 graduate of the University of North
Carolina Medical School in Chapel Hill, Dr. Berry is board certified in
both internal medicine and emergency medicine. With strong credentials
and low prices, he figured that he could build a clinic and "they will
come."

But as the weeks and months passed, Dr. Berry had to lower his
expectations. Patients didn't beat a path to his door even after he
distributed fliers to convenience stores, restaurants, beauty salons and
barbershops. Word-of-mouth advertising seems to be boosting business
now. And people who have lost their insurance, along with their jobs,
are finding their way to the clinic.

Dr. Berry expects to earn about $120,000 this year after expenses,
perhaps half of what he might earn as an emergency-room doctor in
Knoxville, 65 miles away. Working with two alternating part-time office
assistants, Dr. Berry gets a lot of walk-in business. His clinic
occupies the street-level floor of a small brick building nestled
between a Ford dealership and a U.S. Army recruiting office on a busy
road. Dr, Berry says his overhead is about $6,000 a month and that he
thinks it would triple if he were to start accepting insurance. He says
he would need to hire an office manager to review long and complex
insurance contracts and two billing clerks. Reimbursements from some
insurers are so low, he says, that he would also need to hire a nurse to
give shots and otherwise help him speed up patient flow.

The clinic's patients are mostly farmers, mechanics and other low-income
working people in the surrounding rural area. Many are Hispanic. Most
don't have health insurance. "These are good folk who pay their bills.
I'm not giving anything away," Dr. Berry says.

One recent morning, Donald Reid came in for a routine checkup for his
high blood pressure. After his exam, he bought a three-month supply of
the hypertension drug enalapril from the clinic for $60, a 30% discount
from the retail pharmacy price. Mr. Reid, a 52-year-old management
consultant, and other members of his Mennonite church shun insurance for
religious reasons. Some of them have turned to Dr. Berry when other
doctors refused to see them for that reason. "Dr. Berry has been a
blessing to us," says Mr. Reid.

Patmos isn't for everyone. One recent morning, a pregnant mother and her
small daughter arrived at the clinic and were quickly sent away by Dr.
Berry's assistant, Jennifer Bowerman. "I'm sorry, we don't accept
TennCare," she told the woman, who marched out in disgust. TennCare is a
$7.1 billion state and federal health-care program for the poor.

Another patient, Deborah Spencer, signed in at the counter. After a few
minutes, Dr. Berry emerged from the back and ushered her into one of his
three exam rooms. She complained of a pesky cough and runny nose. A few
minutes later, she left satisfied, clutching a new prescription.

Ms. Spencer says it's difficult to get a timely appointment to see a
doctor who accepts her medical insurance and when she does, it's a long
wait at the office. Compounding the frustration, her Blue Cross & Blue
Shield coverage requires her to pay $20 at each visit. By contrast, the
charge at Patmos is usually $35. "For an extra $15, it's worth coming
down the street," says the 32-year-old sales representative.

Write to Rhonda L. Rundle at rhonda.rundle@...

Updated November 6, 2003

Hands Off My Industry

By SIDNEY TAUREL

Medicine has been transformed by pharmaceutical innovation. We've seen the
widespread use of antibiotics, the discovery of agents for cancer, major
advances in cardiovascular medicine. We've seen the development of new
treatments for depression and the advent of drugs that make organ transplants
possible and chemotherapy bearable. Today, we are experiencing the breakthroughs
of biotechnology and the consequent surge of new therapeutic proteins.

Many organizations and dedicated people have participated in this medical
advancement. Importantly, it is the working partnership between government
agencies, like the National Institutes of Health, academic institutions, and the
pharmaceutical industry that has fueled this progress, bringing to people of all
societies the medicines for a healthier and longer life.

If you appreciate the medical breakthroughs of the past 50 years, you should be
concerned about the public policy debate in Washington. Today, there are bills
before Congress that have the potential to decimate pharmaceutical innovation.
One provision, the legalization of prescription drug importation, would have the
effect of importing damaging price controls from other countries. Other
provisions would significantly weaken patent protection for pharmaceuticals.

I believe support for such legislation is due in large part to our critics'
ability to trivialize the role of the pharmaceutical industry in medical
innovation. Specifically, they perpetuate the belief that government and
academic institutions are solely responsible for the discovery and development
of new medicines. Their argument can be refuted by data from government sources.
In 2001, Congress asked the NIH for a report of its involvement in all drugs
with sales of more than $500 million a year. The NIH reported that 47
prescription drugs met the criteria. Of those, the NIH contributed to the
discovery or development of four -- primarily through its program of grants to
universities and research institutions. Looking at a broader range of
pharmaceuticals, scholars at Tufts examined all 284 new medicines approved in
the U.S. in the '90s. They found that 93% originated from the pharmaceutical
industry, with 7% split between government and academic or nonprofit sources.

At a deeper level, this comparison is based on the faulty premise that public-
and private-sector scientists are competitors in the search for new therapies.
In fact, both pursue quite separate objectives, which nonetheless complement one
another. Generally, academic research, like that of the NIH, is not focused on
anything so specific and resource-intensive as drug discovery. Rather, academic
scientists are free to range over the vast puzzle of health and illness, helping
to expand our understanding of both physiology and pathophysiology. In a vast
majority of cases, these scientists may not produce new drugs or ingredients but
rather observations of biology. These generate ideas and hypotheses about the
biochemistry of a disease state, which may offer a new target for drug
discovery.

This represents the very early part of the "R" in pharmaceutical R&D. The
remainder of the continuum, the long and costly process of research and
development, is left to the pharmaceutical industry. These stages of the R&D
process take many years and require staggering investments, more than $800
million per drug. They begin with hypothesizing about the biochemistry of a
disease state, developing and optimizing drug candidates, conducting
pre-clinical work, and then transitioning to years of clinical studies. The odds
of success are daunting; an extraordinarily small number of drug candidates
ultimately recoup their cost of development. These efforts are what it takes to
turn that question mark from the academic into the exclamation point in the
physician's hands. This, in the full sense, is where drugs come from.

The critics who claim the industry does not innovate also attempt to advance the
notion that new drugs created by the industry aren't really new. FDA data reveal
a different story. From 1998 to 2003, the FDA has approved 136 new molecular
entities. Sixty of these molecules, or 45%, were given priority review. The
agency does this only when it believes both the medical urgency and potential
therapeutic value are significant enough to warrant a fast-track review. In just
the last 10 years, the industry has generated a steady flow of new classes of
drugs, many representing first-ever therapies for serious medical needs, while
others amount to much-improved options. For instance:

• Diabetes care: New agents for managing blood-sugar levels, notably, the TZD
class and several new types of biotech insulin.

• Cardiovascular: New classes of drugs for hypertension and lowering
cholesterol and the development of several anti-platelet and anti-clotting
agents for treating heart attacks.

• Central nervous system: The advent of atypical antipsychotics, which have
been revolutionary in the treatment of schizophrenia and bipolar disorder.

• Infectious diseases: Four new classes of drugs for HIV/AIDS developed to
target the three different stages of the virus.

• Oncology: New treatments for colorectal and pancreatic cancers as well as
targeted cancer agents for chronic myeloid leukemia and breast cancer.


Looking to the future, one can see the tremendous potential for the flow of
pharmaceutical innovation to expand and accelerate. In terms of the science, we
are now in the early stages of a revolution in biomedicine, an explosion of new
knowledge that will translate into a whole host of new and better medicines.
Yet, the business of finding these new medicines is risky and costly. No one is
guaranteed to achieve the financial returns that encourage investment in
pharmaceutical R&D. However, two important principles guarantee that such a
return is possible: a market-based system of pricing, and intellectual property
protection. The legislation before Congress has enormous consequences for these
distinct features of our economic system.

The question our policy makers need to ponder is: What happens to pharmaceutical
R&D if these two principles are compromised to any significant degree? I
sincerely believe that, by compromising these principles, we could see the
collapse of true innovation in biomedicine, therefore vanquishing the hopes of
making advances against devastating illnesses like Alzheimer's, cancer, heart
disease, and diabetes.

It is up to Congress to decide. Their choice will shape the future of medicine.

Mr. Taurel is the president, chairman, and chief executive officer of Eli Lilly
.

Updated November 3, 2003

http://online.wsj.com/article/0,,SB106782096631988000-search,00.html?collection=\
wsjie%2F30day&vql_string=eli+lilly%3Cin%3E%28article%2Dbody%29

Prescription Drug Price-Controls Violate the Rights of Drug Companies

by Onkar Ghate
July 24, 2002

Excerpt:

"Do not be so short-sighted as to think that violating the drug companies'
property rights will benefit you. For what is to become of you thirty years from
now, when you are stricken with cancer but cannot buy the next Lipitor that
would have been invented by the research that would have existed if only drug
companies had been free to earn the profits necessary to fuel their vast
research programs?

It is no accident that despite the massive spending by other countries on health
care, America produces most of the world's new drugs: America most respects
intellectual property rights."

http://capmag.com/article.asp?ID=2021

A Plea to Grandparents: Just Say No To Prescription Drug Subsidies
by Scott Holleran

October 28, 2003

"Choice is the cure for America's rising drug costs. Being responsible for one's
own health care is still a choice.

Increased free choice of doctors and hospitals, not increased government
intervention, is the proper tool for bringing down health care expenditures. "

http://www.capmag.com/article.asp?ID=3235

From Sunday's NY Times:

"Do Some Pay Too Little for Health Care?"

This article illustrates how medical spending is influenced by the highly
subsidized prices generated by our current employer-based system of health care
payment that actually has none of the essential features of actual "insurance"
that you see in other true insurance markets.

"Consider what would happen if employers paid  for their workers' car insurance
and if that insurance covered routine maintenance. No doubt, the price of
repairs and the cost of auto insurance would skyrocket.

.....Americans see doctors more often, have more procedures and take more
medicine than they need because most, if not all, of the cost is covered by
insurance.

'When consumers don't have to pay any regard to price, they
overconsume........you get more value for what you buy when you have a stake in
it.'"

http://www.nytimes.com/2003/10/26/weekinreview/26ROSE.html?ex=1068204552&ei=1&en\
=ec1003dc6e396e84

From Sunday's NY Times:

"Generous Medicare Payments Spur Specialty Hospital Boom"  illustrates how
bureaucratic regulations, arbitrary pricing schemes and pressure-group politics
subvert a  normal free market system's pricing mechanisms which optimally
auto-regulate supply and demand of goods and services, nstead working  together
to create regional oversupplies and shortages of different medical services.

It describes a boom of 4 state- of-the-art dedicated cardiac care specialty
hospitals  in the same region where "hospitals are laying off employees or
scaling back programs that are less generously reimbursed."

The article contains a few nonsensical economic non-sequiturs and vagaries....

"...The construction of so many new heart hospitals could create "excess demand"
(should be "supply") for treatment rather than produce better cardiac care"

and

"....Given these market conditions, provider competition could, alternatively,
result in higher use rates and "costs." (of what and to whom? are we talking
about overhead?  prices?  overall health care expenditures?)

The writer's  conclusion seems to be *not* that bureaucrats can't possibly set
prices to meet needs as efficiently as the free market, but that the "particular
prices they set" are either "dated" or, by co-incidence, reflective of pressure
group politics.....

" With cuts in spending on cancer or heart disease politically unpalatable, they
tend, under lobbying pressure, to expand coverage or increase payments."

http://www.nytimes.com/2003/10/26/business/26HOSP.html?ex=1068204433&ei=1&en=a5b
e4a79066fe351

Fall 2003 Money magazine is entirely devoted to health care issues.

In addition to consumer information for the intelligent, inquisitive,
value-oriented patient on how to assess personal health care needs and ask
informed
questions regarding procedures and  drugs, it also includes a great deal of very
accurate and readable economic analysis of the causes of various problems in the
US medical system, shorn of political rhetoric.

It includes an anecdotal look at medical care in Britain's National Health
Service, articles analyzing patterns and causes of  rising US health care
spending (including perverse incentive built into Medicare and 3rd party payment
systems), the economics and politics of Medicare reform and prescription drug
costs, the financial challenges of medical training and starting and operating a
practice, etc.

I highly recommend it for personal reading and prominet display in physician
waiting rooms.

"What Can One Do?"
by Ayn Rand

This question is frequently asked by people who are concerned about
the state of < today's health care system > and want to correct it.

More often than not, it is asked in a form that indicates the cause
of their helplessness: "What can one person do?"

I was in the process of preparing this article when I received a
letter from a reader who presents the problem (and the error) still
more eloquently: "How can an individual propagate < the correct ideas
> on a scale large enough to effect the immense changes which must be
made in order to create the kind of ideal social system
< or health care system > which you picture?"

If this is the way the question is posed, the answer is: he can't.

No one can change a country single-handed. So the first question to
ask is: why do people approach the problem this way?

Suppose you were a doctor in the midst of an epidemic. You would not
ask: "How can one doctor treat millions of patients and restore the
whole country to perfect health?"

You would know, whether you were alone or part of an organized
medical campaign, that you have to treat as many people as you can
reach, according to the best of your ability, and that nothing else
is possible.

People approach intellectual issues in a manner they would not use to
deal with physical problems.

They would not seek to stop an epidemic overnight, or to build a
skyscraper single-handed. Nor would they refrain from renovating
their own crumbling house, on the grounds that they are unable to
rebuild the entire city.

But in the realm of ideas, they still tend to regard knowledge as
irrelevant, and they expect to perform instantaneous miracles,
somehow or they paralyze themselves into inaction by projecting an
impossible goal.

If you are seriously interested in fighting for a better < health
care system >, begin by identifying the nature of the problems.

The battle is primarily intellectual (philosophical), not political.
Politics is the *last consequence*, the practical implementation, of
the fundamental philosophical ideas that dominate a given nation's
culture.

You cannot fight or change the consequences without fighting and
changing the cause; nor can you attempt any practical implementation
without knowing what you want to implement.

In an intellectual battle, you do not need to convert everyone.
History is made by minorities or, more precisely, history is made by
intellectual movements, which are created by minorities.

Who belongs to these minorities? Anyone who is able and willing
actively to concern himself with intellectual issues. Here, it is not
quantity, but quality that counts (the quality and consistency of the
ideas one is advocating).

An intellectual movement does not start with organized action. Whom
would one organize?

A philosophical battle is a battle for men's minds, not an attempt to
enlist blind followers. Ideas can be propagated only by the men and
women who understand them.

An organized movement has to be preceded by an educational campaign,
which requires trained- self-trained - teachers (self-trained in the
sense that a philosopher can offer you the material of knowledge, but
it is your own mind that has to absorb it).

Such training is the first requirement for being a doctor during an
ideological epidemic and the precondition of any attempt to "change
the world."

"The immense changes which must be made to < rationally reform the
American health care system > cannot be made singly, piecemeal
or "retail," so to speak; an army of crusaders would not be enough to
do it.


But the factor that underlies and determines every aspect of human
life is philosophy; teach men the right ideas and their own minds
will do the rest. Philosophy is the wholesaler in human affairs.

Man cannot exist without some form of philosophy, i.e., some
comprehensive view of life. Most men are not intellectual innovators,
but they are receptive to ideas, are able to judge them critically
and to choose the right course, when and if it is offered.

There are also a great many men who are indifferent to ideas and to
anything beyond the concrete-bound range of the immediate moment;
such men accept subconsciously whatever is offered by the culture of
their time, and swing blindly with any chance current.

They are merely social ballast, be they day laborers or company
presidents, and by their own choice, irrelevant to the fate of the
world.

Today, most people are acutely aware of our cultural-ideological
vacuum <and the legal and economic chaos of our health care system>;
they are anxious, confused, and groping for answers. Are you able to
enlighten them?

Can you answer their questions? Can you offer them a consistent case?
Do you know how to correct their errors? Are you immune from the
fallout of the constant barrage aimed at the destruction of reason
<and freedom in our health care system>? Can you provide others with
antimissile missiles?

* A political battle is merely a skirmish fought with muskets; a
philosophical battle is a nuclear war.*

If you want to influence a country's intellectual trend <or bring
rational reform to the health care system>, the first step is to
bring order to your own ideas and integrate them into a consistent
case, to the best of your knowledge and ability.

This does not mean memorizing and reciting slogans and principles;
knowledge necessarily includes the ability to apply abstract
principles to concrete problems, to recognize the principles in
specific issues, to demonstrate them, and to advocate a consistent
course of action.

This does not require omniscience or omnipotence; it is the
subconscious expectation of automatic omniscience in oneself and in
others that defeats many would-be crusaders (and serves as an excuse
for doing nothing).

What is required is honesty- intellectual honesty-   which consists
in knowing what one does know, constantly expanding one's knowledge,
and never evading or failing to correct a contradiction. This means:
the development of an active mind as a permanent attribute.

When or if your convictions are in your conscious, orderly control,
you will be able to communicate them to others.

If you like condensations (provided you bear in mind their full
meaning), I will say: when you ask "What can one do?" the answer
is "SPEAK" (provided you know what you are saying).

A few suggestions: do not wait for a national audience. Speak on any
scale open to you, large or small, to your friends, your associates,
<your patients>, your professional organizations, or any legitimate
public forum.

You can never tell when your words will reach the right mind at the
right time. You will see no immediate results, but it is of such
activities that public opinion is made.

Do not pass up a chance to express your views on important issues.
Write letters to the editors of newspapers and magazines, to TV and
radio commentators and, above all, to your Congressmen (who depend on
their constituents).

If your letters are brief and rational (rather than incoherently
emotional) they will have more influence than you suspect.

The opportunities to speak are all around you. I suggest that you
make the following experiment: take an ideological "inventory" of one
week, i.e., note how many times people utter the wrong political,
social and moral notions as if these were self-evident truths, with
your silent sanction.

Then make it a habit to object to such remarks. No, not to make
lengthy speeches, which are seldom appropriate, but merely to say: "I
don't agree." (And be prepared to explain why, if the speaker wants
to know.) This is one of the best ways to stop the spread of vicious
bromides.

(If the speaker is innocent, it will help him; if he is not, it will
undercut his confidence the next time.) Most particularly, do not
keep silent when your own ideas and values are being attacked.

Above all, do not join the wrong ideological groups or movements, in
order to "do something". To join such groups means to reverse the
philosophical hierarchy and to sell out fundamental principles for
the sake of some superficial political action which is bound to fail.
It means that you help the defeat of your ideas and the victory of
your enemies.

The only groups one may properly join today are ad hoc committees,
i.e., groups organized to achieve a single, specific, clearly defined
goal, on which men of differing views can agree.

In such cases, no one may attempt to ascribe his views to the entire
membership, or to use the group to serve some hidden ideological
purpose (and this has to be watched very, very vigilantly).

I am omitting the most important contribution to an intellectual
movement: writing. Books, essays, articles are a movement's permanent
fuel, but it is worse than futile to attempt to become a writer
solely for the sake of a "cause." Writing, like any other work, is a
profession and must be approached as such.

It is a mistake to think that an intellectual movement requires some
special duty or self-sacrificial effort on your part. It requires
something much more difficult: a profound conviction that ideas are
important to you and to your own life. If you integrate that
conviction to every aspect of your life, you will find many
opportunities to enlighten others.

It is too late for a movement of people who hold the conventional
mixture of contradictory philosophical notions. It is too early for a
movement of people dedicated to a philosophy of reason.

But it is never too late or too early to propagate the right ideas-
except under a dictatorship.

If a dictatorship <or government run socialized medicine> ever comes
to this country, it will be by the default of those who keep silent.
We are still free enough to speak. Do we have time? No one can tell.
But time is on our side because we have an indestructible weapon and
an invincible ally (if we learn how to use them): reason and reality.

"What Can One Do?" by Ayn Rand
< with personal editorial modifications in
bracket >

This appeared in original form in the Ayn Rand Letter, January 1972
Published in " Philosophy: Who Needs It? "

For sale at :
http://www.aynrandbookstore.com/

<NB: We also have other powerful tools at our disposal the awesome
power of the internet in disseminating ideas, and the most important
tool of all: the trust of those patients for whom we personally
provide life- giving and life-preserving medical care- and who trust
their own doctor to make decisions that are in their best interest,
while rightfully distrusting politicians, lawyers and today' s
politically biased media.>

An Ominous Quantum  Leap Toward Socialized Medicine

1��� Healthcare Hypocrites
2���.Americans for Free Choice in Medicine Blasts Bush on
Medicare
3���.Americans for Free Choice in Medicine on Medicare Reform
4���.Kill Bill --   to Expand Medicare
5���.Crossing the Line Over Health Care As a Right
6���.Health Care Is Not A Right
7���.Americans for Free Choice in Medicine- Who We Are
8���.What You Can Do

*******************************************************************
1���. Healthcare Hypocrites
October 15, 2003

by Michael P. Tremoglie

"Once again, the subject of healthcare reform gains prominence on
the national scene. The specter of single - payer, socialized healthcare
is being proffered by the Democratic Party's presidential
candidates.

It would be a grievous error to believe that the current proponents
of a single payer healthcare system are concerned with anything other
than ideology."

http://mensnewsdaily.com/archive/t/tremoglie/03/tremoglie101503.htm
**************************************************************
2��Americans for Free Choice in Medicine  Blasts Bush on
Medicare

"Bush's Medicare law is neither compassionate nor conservative -- it
is pure Big Government and it will bring harm to millions of
Americans."

"Not everyone is thrilled with President Bush's new Medicare drug
regulations -- and at least one organization is directly challenging
the President's motives.

Americans for Free Choice in Medicine (AFCM) denounced the largest
expansion of government intervention in medicine since Medicare was
passed 38 years ago as a huge step toward socialized medicine."

http://www.afcm.org/pr-bushonmedicare.html
**********************************************************************
************
3�.Americans for Free Choice in Medicine on Medicare Reform

"On the brink of the biggest expansion of Medicare in its 38-year
history, Americans for Free Choice in Medicine (AFCM), a non-profit
patient education organization, warned that older patients will
suffer under the proposed changes.

"The ideas in the proposed Medicare reform bills are based on
government control," explained Richard E. Ralston, AFCM's executive
director. "It's an attempt by the government to control health care
costs by restricting medical treatment for the oldest Americans under
the guise of prescription drug coverage.

Patients have the right to choose and purchase the drugs they need in
consultation with their doctors."

http://www.afcm.org/pr-medicarereform.html
**********************************************************************
**********************
4��� Kill Bill --   to Expand Medicare
by Scott Holleran

"From time to time, Congress passes, and the President signs, a bill
that forever changes every American's life.

The Medicare prescription drug coverage bill -- which President Bush
has vowed to sign -- is such an event; if passed, this expansion of
Medicare, like the Medicare Act of 1965, will make history.

With the nation at war following a devastating attack, the economy
struggling, and every realistic economic analyst forecasting
financial trouble for the 38-year-old government program, expanding
Medicare is among the most ill conceived notions in American
politics�..."

http://www.afcm.org/killbill.html
**************************************************************
5���.. Crossing the Line Over Health Care As a Right
by Scott Holleran

Summary: L.A.'s striking grocery employees have declared, by a 97
percent vote, that they are born with a right to health care --
practiced by the doctor and funded by the business that hired them.

http://www.capmag.com/article.asp?ID=3177
**************************************************************
6����Health Care Is Not A Right
by Leonard Peikoff, Ph.D

"Most people who oppose socialized medicine do so on the grounds
that it is moral and well-intentioned, but impractical; i.e., it is a
noble idea � which just somehow does not work.

I do not agree that socialized medicine is moral and well-
intentioned, but impractical. Of course, it is impractical � it
does not work � but I hold that it is impractical because it is
immoral.

This is not a case of noble in theory but a failure in practice; it
is a case of vicious in theory and therefore a disaster in
practice."

http://www.afcm.org/hcinar.html
**************************************************************
7���.Americans for Free Choice in Medicine (AFCM) is a national
non-profit, non-partisan educational organization. AFCM promotes the philosophy
of individual rights, personal responsibility and free market economics in the
health care industry.

     AFCM advocates a full, free market health care system by
promoting medical savings accounts (MSAs), tax equity for the
individual, and AFCM teaches the history of HMOs, which were
instituted by a long, incremental process of government intervention.

     AFCM sponsors educational programs, lectures and town hall
meetings for the public. Membership grades begin at $25 per year and
may be tax deductible.

     Members include patients, Medicare recipients, physicians, nurses
and health care professionals, insurance industry professionals,
including agents, pharmacists and pharmaceutical industry
professionals, financial services professionals, businessmen,
employee benefits professionals and hospital staff.

WWW.AFCM.ORG
**********************************************************************
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8��What You Can Do

Contact the following key legislators by calling or using CapWiz:

http://capwiz.com/yo-demo/

Rep. Billy Tauzin (R-La.)
Tel: (202)-225-4031
Rep. Bill Thomas (R-Calif.)
Tel: (202) 225-2915
Rep. Tom DeLay (R-Texas)
<http://tomdelay.house.gov/>
Rep. Nancy Johnson (R-Conn.)
Tel: (202) 225-4476
Rep. Mike Bilirakis (R-Fla.)
Tel: (202) 225-5755
Rep. John Dingell (D-Mich.)
Tel: (202) 225-4071
Rep. Charles Rangel (D-N.Y.)
<http://www.house.gov/rangel/>
Senate Majority Leader Bill Frist (R-Tenn.)
Tel: (202) 224-3344
Minority Leader Tom Daschle (D-S.D.)
Tel: (202) 224-2321
Finance Committee Chair Charles Grassley (R-Iowa)
Tel: (202) 224-3744
Finance Committee ranking member Max Baucus (D-Mont.):
Tel: (202) 224-2651
Judiciary Committee Chair Orrin Hatch (R-Utah)
Tel: (202) 224-5251
Budget Committee Chair Don Nickles (R-Okla.)
Tel: (202) 224-5754
Sen. Jon Kyl (R-Ariz.)
Tel: (202) 224-4521
Sen. Jay Rockefeller (D-W.Va.)
Tel: (202) 224-6472
John Breaux (D-La.)
Tel: (202) 224-4623

The Moral and the Practical
by Robert W. Tracinski

Free Markets Are Practical for the Same Reasons That Make Them Moral:
Respect for the Mind and Values of the Individual

The worldwide discrediting of socialism has left our intellectual leaders in an
odd dilemma. The system that they hailed for decades as a moral and
philosophical ideal has been shown to be disastrous in practice, leading to
stagnation at best and starvation at worst.

Meanwhile, (free markets) have led to the creation of unprecedented wealth,
advanced technology, and widespread prosperity. Yet the free market system,
capitalism, is denounced by these same intellectuals as a system of greed,
materialism, and ruthless "dog-eat-dog" competition.

<< Likewise, socialized medicine  is  touted  as  "moral"  even today by those
who assert that individuals are born with a "right" to health care services.

Yet, it  has been shown to lead to unlimited public demands for and resulting
bureaucratic rationing of  health care services, rising taxes,  waiting lists
and lines for necessary medical care,  bureaucratic  micromanagement of medical
decision-making,  limitations of available technology  and  the flight of
medical providers to relatively freer countries or professions.

By contrast, and in comparison to the Canadian and UK systems, such preservation
of quality, technological innovation and  relative abundance of high- tech goods
and services in the  US system is the result of the ever- diminishing  remnants 
of freedom/  incomplete regulation under a system that is relatively less
bureaucratically regulated, though rapidly catching up, thanks to  the US form
of  socialized medicine ie., Medicare/Medicaid  and  government- spawned
"Mangled Care". >>

So it would seem that the system that enforces "virtue"  leads to poverty ( and
deteriorating medical systems) while the system that encourages vice leads to
prosperity ( and technological innovation, superiority and abundance)

But there is another answer to this dilemma; there is a solution to this
apparent contradiction between the moral and the practical. That solution is to
re-examine the premise that the free market system is immoral.

<< ...which is not to defend that highly immoral outgrowth of government
regulations-  managed care- that bureaucratically micromanages every medical
decision and violates the rights of patients and providers to pursue their lives
and own interests and is frequently and ridiculously cited as an example of a
"free market run amok"......>>

If we do this, we can see that every characteristic that makes capitalism
practical is also a principle that makes capitalism moral.

Capitalism is practical, many economists have argued, because it allows
individuals to act on their own thinking rather than being forced to obey the
decrees of bureaucrats. Under a free market system, every problem of economic
production is tackled by thousands, even millions, of minds.

  The people whose thinking is successful will thrive. They succeed because they
find opportunities that others don't see, because they develop new products that
no one else has thought of, or because they discover more efficient production
methods that have never been tried before.

In a free market, where everyone is free to start a business, raise capital, and
place his product on the market, each individual thinker has the opportunity to
put his ideas into practice, and to succeed or fail based on the merits of his
idea. Those who succeed bring us new and improved products at an ever lower
cost, creating economic progress and prosperity.

In the regulatory state << or under government regulated medicine>>  by
contrast, the edicts of politicians and bureaucrats override the thinking of
individuals. The result is that political expediency, rather than the truth or
falsity of an idea, determines who gets to put his ideas into practice.....

Stated in more fundamental terms, it is the rational thinking of individuals
that causes the production of wealth. But government regulation acts to stymie
individual thought, subordinating the knowledge and creativity of millions of
individuals to the edicts of public officials.

Thus, the practical value of capitalism flows from the need to protect the
creativity and freedom of thought of the individual. But isn't this also a
profound moral principle?

Most of today's intellectuals still recognize that we need to protect the
thinking of the artist or the scientist—but the same principle applies equally
to the worker, the executive, and the industrialist.

<< and  especially to  the doctor- whose ability to think, make  life-saving and
life-preserving medical decisions and take actions based on his or her own best
medical judgment requires  protection  from bureaucratic interference in order
that it be of value to a patient.>>

Only a truly free market system fully recognizes the moral right of the
individual to think and to act on his thinking-  not just in his personal life
or intellectual life, but also in his economic life.

Economic production << including the production of health care services >> is
not just a matter of thinking; it is also a matter of motivation  << as doctors
leaving the state of PA in the face of declining financial incentives and
sky-rocketing malpractice costs  recognize >>.

Thus, according to economists, the "practicality" of a free market also stems
from the fact that it allows individuals to set their own plans and pursue their
own goals.....

  In a state-run economy << or medical system >> by contrast, the central
planning of government officials wipes out the plans of individuals. Since they
don't own the business, can't control the course of their own careers, and don't
stand to gain or lose from their actions, the workers' predominant attitude is
apathy.

And why should they care? If they succeed in increasing production, the extra
wealth will be used to support those who haven't succeeded. "From each according
to his ability, to each according to his need" is the motto of the welfare
state.

But in such a system, who would want to be the man of ability << in general, let
alone a doctor....>>, conscripted into a life of unrewarded drudgery so that
others can consume the product of his labor?

It is no surprise that every society that has approached this socialist ideal
has found few volunteers to be the men of ability who keep the economy running.

Stated in more fundamental terms, capitalism is practical because it relies on
the inexhaustible motive-power of self-interest. Under capitalism, people are
driven by loyalty to their own goals and by the ambition to improve their lives.
They are driven by the idea that one's own life is an irreplaceable value not to
be sacrificed or wasted.

But this is also a crucial moral principle: the principle that each man is an
end in himself, not a mere cog in the collective machine to be exploited for the
ends of others.

Most of today's intellectuals reflexively condemn self-interest; yet this is the
same quality enshrined by our nation's founders when they proclaimed the
individual's right to "the pursuit of happiness."

It is only capitalism that recognizes this right. The fundamental
characteristics that make capitalism practical- its respect for the freedom of
the mind and for the sanctity of the individual are also profound moral ideals.

This is the answer to the dilemma of the moral vs. the practical. The answer is
that capitalism is a system of * virtue *  the virtues of rational thought, 
productive work, and pride in the value of one's own person.

The reward for these virtues and for the political system that protects and
encourages them is an ever-increasing wealth and prosperity."

Full article:

http://www.capitalismcenter.org/Philosophy/Essays/The_Moral_and_the_Practical.ht\
m

Why Are Health Costs Rising?
by Devon Herrick

Excerpt:

"Prices for medical services have been rising faster than prices of other goods
and services for as long as anyone can remember. But not all health care prices
are rising.

Although health care inflation is robust for those services paid by third-party
insurance, prices are rising only moderately for services patients buy directly.

For example, the real (inflation-adjusted) price of cosmetic surgery fell over
the past decade despite a huge increase in demand and considerable innovation.

Lesson: Health Care Costs Rise When Others Pay.

  A primary reason why health care costs are soaring is that most of the time
when we enter the medical marketplace as patients, we are spending someone
else's money.

Economic studies and common sense confirm that we are less likely to be prudent,
careful shoppers if someone else is paying the bill.

When we are paying our own medical bills, we are conservative consumers. The
increase in spending has occurred because someone else is paying the bill.

Thus we have an incentive to consume hospital services until they are worth to
us, on the average, only three cents on the dollar. We have an incentive to
consume  physician's services until they are worth only 15 cents on the dollar.
And for the health care system as a whole, our incentive is to utilize
everything modern medicine offers until the value to us is only 18 cents out of
the last dollar spent.

Medical Inflation.

  Prior to the advent of Medicare and Medicaid in 1965, health care spending
neverexceeded 6 percent of gross domestic product. Today it is 14 percent. These
two government programs unleashed a torrent of new spending and led to rising
health care prices."

Full article:

www.ncpa.org
NCPA Brief Analysis No. 437

The National Center of Policy Analysis (NCPA) is a nonprofit, nonpartisan public
policy research organization, established in 1983. The NCPA's goal is to develop
and promote private alternatives to government regulation and control, solving
problems by relying on the strength of the competitive, entrepreneurial private
sector

Viewing the Future of American Medicine through a Canadian  Crystal
Ball

Quebec plans to turn MDs into contract employees

By RH�AL S�GUIN

Friday, July 26, 2002 � Print Edition, Page A1

QUEBEC CITY -- The Quebec government is planning to become the first
to change the status of its doctors from independent, self-employed
professionals to contractual employees.

The proposal has shocked the medical community, which was already
shaken by a special law that was passed last night. The legislation,
tabled yesterday in the Quebec National Assembly, will require
doctors to work in emergency rooms to ease a staffing crisis that has
become critical recently.

Under legislation to be tabled next fall, all doctors, including
those working in private clinics, would be required to sign contracts
with hospitals or regional health boards that will define their
priorities and the obligations they have to fulfill to practise
medicine in the province. The government will describe these
obligations when the legislation is introduced.

The objective is not only to ensure that all qualified doctors
perform emergency ward duties and other essential hospital services,
but that the government can put physicians in regions with shortages.

The government is considering using the legislation to limit the
number of doctors licensed to practice in some areas in order to
force new doctors to fill vacancies elsewhere.

Minister of Health and Social Services Francois Legault said the days
when doctors were allowed to offer their services to hospitals
voluntarily are over.

"This is a major change, one that has become necessary," Mr. Legault
said yesterday. "We have regions that have a shortage of specialized
health services. We even have regions that have no emergency-room
services. This has to change. . . . People's needs come first."

The government said it was responding to a shortage of doctors and
other medical staff that has existed for years.

The problem has been the result of cutbacks in government spending
introduced in the mid-1990s that encouraged doctors and nurses to
retire early.

Hospitals since then have closed beds and cut services. This summer,
some emergency wards have been closed at night and on weekends
because of the shortage of doctors and nurses. This year alone,
nearly a dozen of the province's 94 emergency rooms have been forced
to close at one time or another, resulting in the death of at least
one patient and a public outcry. Overworked emergency room doctors
refused to cancel vacations, and others did not respond to a
government request that doctors work in the emergency rooms until a
solution could be found.

Negotiations with doctors over the past four weeks ended in an
impasse.

The legislation that passed in yesterday evening's special session of
the National Assembly would impose fines of up to $5,000 a day on
doctors who refuse to work in emergency wards when called upon.
Unions could be fined as much as $125,000 a day.

The government had planned to exclude specialists from yesterday's
legislation, but then decided to include all of the province's 17,000
doctors.

The new law adopted last night will be a springboard to radical
changes in the way doctors work and their freedom to choose where
they work.

Money has always stood in the way of finding an acceptable deal with
doctors to solve the staffing shortages. Financial incentives have
been used to post doctors in underserviced rural areas temporarily,
but now the government says the public supports its plan to impose a
solution.

The fight is turning into a major political confrontation.

The Liberal Opposition withdrew its support of the bill yesterday,
calling it a poison bandage and a demolition derby against the health-
care system. Liberal Leader Jean Charest said the Parti Qu�b�cois
government has mismanaged health services through poor planning and
negligence and should have acted years ago. He said the government's
plan will drive doctors to leave the province.

"This government has demonstrated to us that they have by negligence,
by omission, they have not responded, that they have created this
crisis and now they have to commit today to delivering, in the
session that will be called in October, very specific measures to
deal with emergency rooms. And they can't deliver on that; I will not
give them a vote to support this odious legislation," Mr. Charest
said.

The Liberals have said negotiations should have begun two years ago
when doctors first proposed ways to alleviate the shortages in
emergency wards.

The Action D�mocratique du Qu�bec party supported yesterday's special
legislation but not the changes to doctors' status that will be
introduced next fall. Party Leader Mario Dumont accused the
government of undermining the free entrepreneurial spirit of the
medical community.

"I don't believe in the idea of Soviet-style planning, where the
government will plan everything for all the hospital needs, all of
the people's needs. . . . Let's give the budgets to the regions," Mr.
Dumont said.


http://www.globeandmail.com

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

Is this a satire? No, This article actually appeared on Friday, July
26,  2002  in the Globe and Mail, one of Canada's largest daily
newspapers.

What does this mean for the future of Canadian doctors in Quebec, and
even all of Canada?

Does this have any implication for the possible fate of American
doctors and  medicine, or is this merely an isolated phenomenon
unique to Canada, with no wider implications for American medicine.

Is even raising the issue of a possible linkage to be dismissed as an
irrelevant scare tactic, since the problems in the US health care
industry deriving from managed care are completely unrelated to those
arising in Canada's formal system of socialized medicine?

As this article demonstrates, in Quebec now, the possession of a
medical degree obligates the state not to protect the individual
rights and freedom of a doctor to voluntarily choose where he lives
and works and under what terms , as any other ordinary Canadian
citizen, but to violate them, and sacrifice them to the needs of all
other Canadian citizens, who possess these rights by virtue of being
a non- doctor.

Canadian doctors are now formally declared to be "second �class
citizens"  upon whom the State can impose involuntary servitude  and
criminal and financial penalties should they object  to the State's
demands.

"The days when doctors were allowed to offer heir services to
hospitals voluntarily are over�.People's needs come first.", declares
the Minister of Health and Social Services.

  No  sequence of facts and no bold  declaration of this sort  more
clearly demonstrate  that, at  the end of the road of  monopolistic
government financing of medicine, lie the economic fleecing of health
care institution and providers; the violation and  revocation of the
rights of medical practitioners and  their resentful transformation
into rightless servants of the State;  their flight form the health
care field ; the  resulting deterioration of quality and availability
of health care services to the entire population.

But, you say, "Of course, this is the result of socialized medicine-
but that problem was defeated in 1994 with Clinton's health care
plan, The  problems in the US are only related to "managed care" and
runaway "free-market"  forces."

  Are they? Can you name another example of a "free market"  where the
government pays half the bills of the general population, one or two
local bureaucracies controlling 50-80% of the market pay the other
half and dictate to consumers and producers alike, what goods and
services they will have, where, by whom, and under what terms, and
are immune to the same  government anti-trust laws used to contraol
the service providers?  Are they truly unrelated?

Are governement  funding cutbacks in the US  not  having similar
effects on hospital closures  and service contractions, the loss of
health care workers though early retirement and career change? As a
health care provider or consumer, are you any happier under the
system of managed care? If only the medical malpractice problems
which bleed  US health care providers and institutions  � which the
Canadian system  didn't even have to contend with-  could be fixed
life would be all better. Would it?

As the history of health care in the past 30 years in Canada and the
US demonstrate, governemtn intrusion and regulation of the medical
field is not a one-time deal. Bad regulations with unintended
economic consequences are not revoked, but rather, multiply and
metastasize  to all areas of the field, wreaking economic
destrucition in their wake. More concisely, controls breed more
controls.

As this article clearly demonstrates, when the goventment pays the
bills, the government sets the terms of employment, conditions of
work, and criminal penalties for violating its arbitray decrees.
Physician shortages , hospital and emergency room closures, regional
variations and limitations on availability of medical services in
Canada are the direct end result of government regulation, as the
governemtn attempts, in futility, to re-write the economic rules of
reality and provide unlimited services at limited cost.

Pushed to the breaking point by snowballing regulations, expanding
hours, time demands and serivces, decling reimbursements, and their
political helplessness as governtment agencies invent a   media �
hyped epidemic of   "quality concern issues"  to justify yet more
expanding regulation, the  health care worker is under attack from
all sides.

His  everyday activites face oversight by those with less medical
knowledge, experience and  and competence. Citing isolated anecdotes
of incompetence and unethical professional behavior, which warrant
punishment under existing laws, governement agencies step in to
regulate and revoke the  rights and freedom of  the large majority
of  innocent , though helpless, individual doctors, who are
threatened with arbitrary criminalization of their  behavior. The
rights and freedom of US doctors are thus being sacrificed on the
alter of "the good of society" . And that `s  even leaving aside the
extortionary  medical malpractice "sue-for-profit"  industry.


What effect did this same treatment of medical professionals  have in
Canada? Did this transformation take place overnight?  What lessons
can we draw from the failure of the Canadian medical system and the
failure of its doctors to prevent  the rise and complete government
take-over of  medicine? Will early retirement or changing careers out
of resignation save you long-term, when you look to the US health
care system in 30 years to sustain your life and the life of your
family -  not as a doctor-  but as  a patient?

  Is attempting to buy political pull  to slow the pace of erosion of
your rights as a doctor a viable long-term solution, when a
politician is ultimately elected by the number of votes he receives-
not the number of dollars he collects- and, as a small minority, you
cannot possibly protect your own interests and rights as a citizen,
if they are not  "inalienable  rights" at all, but merely political
privileges dispensed, or not, at the discretion of a popularly
elected official?

What intellectual ammunition is needed, and what are the proper and
the improper ways to defend your rights as a health care provider for
your own benefit, and for the benefit  of the prosperity and
integrity of the US health care system, and the health of your
family, friends, and patients?

Let the lessons of the past and present, and your mind's respect for
rational principles be your guide.

"Right"-to-Health-Care Junkies
by Wayne Dunn
(April 28, 2003)

Excerpt:

A "right" to health care is the new opiate of the masses. And politicians are
among the biggest pushers. To preserve both health care and rights, Americans
must quit health care "rights" cold turkey.

Full article:

http://capmag.com/article.asp?ID=2584

It's My Life! A Doctor Has a Right to His Own Life
by Jonathan Rosman, M.D.

(December 30, 2002)

Excerpt:

"Doctors must challenge the invalid notion of a "right" of health care. A
doctor, like individuals in other jobs, has a right to work for himself, and to
charge such fees as he deems his expertise to be worth; every patient has a
right to accept or reject a doctor's services and to shop around for the best
deals he can get."

Full article:

http://capmag.com/article.asp?ID=2278

In December 2002, the PA doctors' malpractice crisis in prompted C. Michael
Weaver, Secretary of the Commonwealth of PA, to write a threatening etter to
Pennsylvania doctors excepted below:

"As you are aware, there have been many recent reports suggesting that some
physicians are planning to cease practice on the first of the year in reaction
to rising malpractice insurance costs and shrinking reimbursement rates....

While I know that an overwhelming majority of physicians intend to “honor
their commitment”  to their patients, as Secretary of the Commonwealth, I feel
a strong sense of “duty and obligation” to caution those of you who are
considering “withdrawing  services”....

*In accordance with the regulations issued by your licensing board*, abandonment
occurs when you “withdraw (your) services” from your patients without
providing “sufficient” notice to the patients in order for them to obtain
substitute care.

Abandonment occurs when a physician “leaves a group practice, hospital,
clinic, or other health care facility”  without the physician giving
“reasonable”  notice and under  circumstances which seriously impair the
delivery of medical care to patients....

A stoppage of practice may be detrimental not only to you patients, but also to
“ your practice, your standing amongst your colleagues, as well as your
license”, should your conduct be found to “constitute abandonment”.

To the vast majority of doctors providing quality care to their patients, I
thank you. We appreciate your dedication and continued allegiance to the
Hippocratic Oath....

Sincerely,

C. Michael Weaver
Secretary of the PA Commonwealth

**************************************************************

Whose Life Is It Anyway?

As Mr. Weaver clearly indicates above - at least from the state’s perspective
-  as a physician, you apparently have a moral and legal obligation to continue
to offer your professional services to patients, even at the expense of
sacrificing your own personal, financial and professional welfare.

While acknowledging the immediate problem of ever-diminishing personal reward
and the ever- increasing risk of potential economic ruin doctors face from
continually rising malpractice insurance costs and shrinking reimbursement
rates, any doctor considering   “withdrawing” his or her own professional
services is considered by the state to be “harming patients” by depriving
them of their “fundamental right” to his professional services, and thus,
health care.

For the benefit of those physicians who, facing personal economic suicide are
contemplating a personal decision not to offer their professional services under
the current corrupt, irrational, government-orchestrated medical-legal justice
and financing systems, Mr. Weaver invokes the physician’s   “moral duty”
under the Hippocratic Oath   to “serve others”- even at the expense of his
own personal and professional ruin.

Should Mr. Weaver’s moral injunction to “sacrifice oneself in service of
others” go unheeded, he reminds you of the state’s legal obligation and
ability to ensure the satisfaction of the health care needs of all non-physician
citizens by violating the individual rights of those citizens who are
physicians.

Unlike all other citizens, the physician no longer has the right and obligation
to support his own life by voluntarily, competently and skillfully practicing
his trade to the best of his knowledge and ability, satisfying the medical needs
of his patients within the accepted medical standards of the scientific
community.

Rather, the physician lives and practices in the state by bureaucratic
permission and obedience to arbitrary regulations.

Unlike any other citizen, the “need” of his patients for  his professional
services erases the physician’s  individual rights to his life and his work- 
and to decide when , where , how, and under what terms he wants to provide those
services. The needs of patients are now to be the moral justification for the
state to request-   and if unsuccessful- impose involuntary servitude on
physicians.

By what method does Mr. Weaver seek to do this?

Firstly, by hijacking, distorting and subverting a physician’s professional
code of ethics- attempting to hold him morally hostage to a morally corrupt form
of the Hippocratic Oath that enjoins physicians not to “apply their knowledge,
skills and professional   services to alleviate pain, suffering and illness” ,
but rather to “serve others at their own expense”.

Secondly, anticipating that this type of moral extortion and
“public-spirited” call for self-sacrifice may only partially achieve his
goal, Mr. Weaver reminds us of the bureaucratic power of the state to enforce
his demands.

He threatens to use the state’s licensing power *not*  to protect the rights
of its citizens by preventing medical fraud and abuse by unqualified,
incompetent medical practitioners, but rather to extort demands from the very
citizens who provide those services - threatening to revoke the state’s
“permission” for a physician to offer the professional   services by which
he seeks to  support his own his life, if he fails to accept the terms the state
chooses to dictate.

The  physician, we are told, is  to be considered in violation of the law and, 
thus, subject to legal recrimination for “abandonment” for refusing to offer
his own personal services- to which all other citizens  are apparently legally
entitled-   under conditions, which he deems destructive to his own personal and
professional life, the future and vitality of the health care system, and the
future lives and health of his patients.

Does the Hippocratic Oath, or the ability to provide a vital service or skill,
require one to forfeit one’s rights as an individual and as an American
citizen or to work at one’s own self-sacrifice and the destruction of one’s
profession?

By virtue of living in a free country, every individual has the right and moral
duty to support   his own life and pursue his own happiness by choosing a career
and place of employment, exchanging goods and services of value to others on
mutually agreeable and mutually beneficial terms.

Any  free individual also has the right to change his place of employment and
career of his own free will, when he no longer voluntarily chooses to accept the
terms of employment at a particular job, in a particular location, or in a
particular career, or ceases to derive personal, financial or professional
satisfaction from them.

Should a free individual choose to change jobs, careers, or to no longer offer
some or all of  those services of his own free will, is he asserting his own
inalienable,  individual rights, or depriving other individuals of their right
to his services?

Does the  “need” of some individuals give any individual claiming  to
represent “the good of society”  the right to violate  the rights of other
individuals, imposing involuntary servitude on them to satisfy the needs of
their fellow man?

As writer Alex Epstein has pointed out, “America was founded on the principle
of individualism:  the idea that each individual is a sovereign being with the
moral right to his own life and to the achievement of his own goals. This is the
basis of the political idea, enshrined in our Declaration of Independence, that
the individual possesses inalienable rights to life, liberty and pursuit of
happiness. American individualism and freedom are incompatible with the notion
that people   (including doctors) are servants who owe their lives- or any
portion of them- to the state.”

Apparently, Mr. Weaver disagrees. In Mr. Weaver’s mind, individual rights
don’t matter-peoples “needs” come first.

The state has the duty to sacrifice the individual rights of any individual or
group for whatever people like Mr. Weaver, as spokesman for the public, deems to
be the “public good”.

Tragically,  “humanitarians” like Mr. Weaver never seem to notice that one
cannot satisfy the public need by violating the individual rights of the
provider of any good or service.

As the history of socialism and socialized medicine attests, by dictating and
regulating the terms of employment, the government inevitably destroys the
availability and quality of that service.

The statist assertion that individuals have a “fundamental right” to health
care services- at the personal sacrifice of the time, money, and voluntary
consent of the individual health care practitioner – provides the ultimate
moral justification for government- mandated socialized medicine.

We need only look at a one of the recent  “social achievements” of the
celebrated Canadian health care system to see a more fully explicit statement of
Mr. Weaver’s philosophic idea of  “health care as a right ”and the
practical  result of its implementation in the form of socialized medicine. Can
this same principle lead to any other end result, if allowed to progress to its
logical conclusion in the US?

Evan Madianos, MD

Reform the Pennsylvania Medical System By Upholding the Rights of Medical
Providers

by Evan Madianos, MD

(January 24, 2003)

Summary: By implying that a physician considering voluntarily leaving the state
or "withdrawing his services" would be subjected to prosecution for abandonment
of patients or subject to revocation of medical licensing, the state tells
physicians that in Pennsylvania, a physician has no right to his own life, his
own work and his own services, but that others do.

Full article:

http://capmag.com/article.asp?ID=2349

The Worldwide Epidemic of Doctors Strikes

By Robert Tracinski
2/19/03

Excerpt:

"Under socialized medicine, the doctors are always presumed to have no rights,
while all comers are presumed to have a "right" to the doctors unrewarded
services.

This transformation of doctors into servants of the state - whose only
bargaining tool is the mass withholding of their services - is the cause of the
rash of doctors strikes....

The immediate complaint in America stems from this same hostility to the rights
of doctors - in this case, our government's refusal to protect them from
arbitrary medical malpractice awards that amount to legalized looting.

And now, both Congress and the Bush administration want to expand Medicare,
which has been the leading edge of socialized medicine in America, imposing the
kind of controls on doctors fees and regulation of their practices that is
endemic in the rest of the world.

         We have to learn the lesson of the worldwide epidemic of doctors
strikes. If we make war on the rights of our doctors, we have no right to rely
on them to keep working."

Full article:

http://capmag.com/category.asp?action=cat&catID=6

Health Care Is Not A Right
by Leonard Peikoff, Ph.D

Excerpt:

"....All legitimate rights have one thing in common: they are rights
to action, not to rewards from other people. American rights impose
no obligations on other people, merely the negative obligation to
leave you alone. The system guarantees you the chance to work for
what you want � not to be given it without effort by somebody else.

The right to life, e.g., does not mean that your neighbors have to
feed and clothe you; it means you have the right to earn your food
and clothes yourself, if necessary by a hard struggle, and that no
one can forcibly stop your struggle for these things or steal them
from you if and when you have achieved them.

In other words: you have the right to act, and to keep the results of
your actions, the products you make, to keep them or to trade them
with others, if you wish. But you have no right to the actions or
products of others, except on terms to which they voluntarily
agree....

Otherwise, there would be no liberty in the country: if your mere
desire for something, anything, imposes a duty on other people to
satisfy you, then they have no choice in their lives, no say in what
they do, they have no liberty, they cannot pursue their happiness.

Your "right" to happiness at their expense means that they become
rightless serfs, i.e., your slaves. Your right to anything at others'
expense means that they become rightless.

That is why the U.S. system defines rights as it does, strictly as
the rights to action. This was the approach that made the U.S. the
first truly free country in all world history � and, soon afterwards,
as a result, the greatest country in history, the richest and the
most powerful.

It became the most powerful because its view of rights made it the
most moral. It was the country of individualism and personal
independence....

As with any good or service that is provided by some specific group
of men, if you try to make its possession by all a right, you thereby
enslave the providers of the service, wreck the service, and end up
depriving the very consumers you are supposed to be helping.

To call "medical care" a right will merely enslave the doctors and
thus destroy the quality of medical care in this country, as
socialized medicine has done around the world, wherever it has been
tried..."

Full article:

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

How Not to Fight Against Socialized Medicine
by Ayn Rand

In the spring of 1962, some two hundred New Jersey doctors, led by
Dr. J. Bruce Henriksen, signed a resolution of protest against the
Kennedy Administration's King-Anderson bill, which was the precursor
of President Johnson's goevernment-sponsored Medicare program. The
doctors stated that they would treat the indigent aged without
charge, but would not treat anyone whose medical care was financed
under the Kennedy plan. The King-Anderson bill was soon afterwards
defeated in Congress.

The following is a condensed version of a talk delivered on February
6, 1963 at a meeting of the Ocean County Medical Society of New
Jersey, to which Dr. Henriksen and his group belonged. These remarks
were published in The Objectivist Newsletter, March 1963.

I am happy to have this opportunity to express my admiration for Dr.
Henriksen and the group of doctors who signed his resolution.

Dr. Henriksen and his group took a heroic stand. The storm of vicious
denunciations unleashed against them at the time showed that they had
delivered a dangerous blow to the welfare-statists. More than any
other single factor, it was Dr. Henriksen's group that demonstrated
to the public the real nature of the issue, prevented the passage of
the King-Anderson bill and saved this country from socialized
medicine�so far.

Their action was an eloquent example of the fact that only a  strong,
uncompromising stand�a stand of moral self-confidence, on clear-cut,
consistent principles�can win.

But there are grave danger signs that the medical profession as a
whole�like every other group today�will ignore that example and
pursue the usual modern policy of caution and compromise. Such a
policy is worse than futile: it assists and promotes the victory of
one's own enemies. The battle is not over. The King-Anderson bill
will be brought up again, and if the doctors are defeated, they will
be defeated by their own hand, or rather: by their own mind.

I want, therefore, to make certain suggestions to the medical
profession�on the subject of how not to fight against socialized
medicine.

The majority of people in this country�and in the world�do not want
to adopt socialism; yet it is growing. It is growing because its
victims concede its basic moral premises. Without challenging these
premises, one cannot win.

The strategy of the Kennedy administration, and of all welfare-
statists, consists of attempts to make people accept certain
intellectual "package deals," without letting them identify and
differentiate the various elements�and equivocations�involved. The
deadliest of such "package deals" is the attempt to make people
accept the collectivist-altruist principle of self-immolation under
the guise of mere kindness, generosity, or charity. It is done by
hammering into people's minds the idea that need supersedes all
rights�that the need of some men is a first mortgage on the lives of
others�and that everything should be sacrificed to the undefined,
undefinable grab bag known as "the public interest."

Doctors have no chance to win if they concede that idea and help
their enemies to propagate it.

Yet the ideological policy of most spokesmen for the medical
profession�such as the A.M.A.�is as permeated by the collectivist-
altruist spirit as the pronouncements of the welfare-statists. The
doctors' spokesmen declare, in net effect, that selfless service to
their patients is the doctors' only goal, that concern for the needy
is their only motive, and that "the public interest" is the only
justification of their battle.

The sole difference is this: the voices of the welfare-statists are
brazenly, self-righteously overbearing�while the voices of the
doctors' spokesmen are guiltily, evasively apologetic.

Whom can one expect the people to believe and to follow?

People can always sense guilt, insincerity, hypocrisy. The lack of a
morally righteous tone, the absence of moral certainty, have a
disastrous effect on an audience�an effect which is not improved by
the triviality of the arguments over political minutiae. And the
terrible thing is that the doctors' spokesmen give an impression of
guilty evasiveness while the right is on their side. They do it by
being afraid to assert their rights.

They are afraid of it because they do not believe that they possess
any rights�because they have conceded the enemy's premises�because
they have no moral base, no intellectual guide lines, no ideology, no
defense.

Consider, for instance, the outcome of the Canadian doctors' struggle
in Saskatchewan. The doctors had gone on strike [in 1962] against the
full-scale socialized medicine instituted by the provincial
government. They won the battle�and lost the war; in exchange for a
few superficial concessions, they surrendered the principle for which
they had been fighting: to permit no socialized medicine in the
Western hemisphere.

They surrendered even though the overwhelming sympathy and support of
the Canadian people were on their side (except for the intellectuals
and the labor unions). They were defeated not by the power of the
socialists, but by the gaping holes in their own ideological armor.

They had been fighting, properly, in the name of individual rights,
against the enslavement of medicine by totalitarian-statist controls.
Then, under the pressure of the usual intellectual lynching, under
the hysterical, collectivist charges of "antisocial selfishness and
greed," they made a shocking change in their stand. Declaring, in
effect, that their rebellion was not directed against socialized
medicine as such, but against the high-handed, arbitrary manner in
which the government had put it over, their spokesmen began to argue
that the government plan did not represent "the will of the people."
The ideological kiss of death was a statement by Dr. Dalgleish, the
strikers' leader, who declared that if a plebiscite were taken and
the people voted for it, the doctors would accept socialized medicine.

Could they deserve to win after that? They could not and did not.

Consider the full meaning of Dr. Dalgleish's statement. It meant the
total repudiation of individual rights and the acceptance of
unlimited majority rule, of the collectivist doctrine that the
people's vote may dispose of an individual in any way it <vor_287>
pleases. Instead of a battle for the integrity of a doctor's
professional judgment and practice, it became a battle over who
should violate his integrity. Instead of a battle against the
enslavement of medicine, it became a battle over who should enslave
it. Instead of a battle for freedom, it became a battle over a choice
of masters. Instead of a moral crusade, it became a petty quarrel
over political technicalities.

This led to the ludicrous spectacle of the alleged individualists
arguing for democratic mob rule, and the socialists righteously
upholding the parliamentary form of government.

Those who doubt the power of ideas should note the fact that the
doctors' surrender took place five days after Dr. Dalgleish's
statement.

The text of the agreement reached between the doctors and the
government contained the following horrifying sentence: "The doctors
fear that if the government becomes their only source of income they
are in danger of becoming servants of the state and not servants of
their patients." [Emphasis added.]

A more abject statement of self-abnegation could not be hoped for or
extorted by the most extreme collectivist.

No self-respecting labor union would declare that its members
are "servants" of their employers. It took so-called "conservatives''
to declare that professional men�and of so responsible, so demanding,
so unusually skilled a profession as medicine�are the "servants" of
their patients or of anyone who pays them.

The concept of "service" has been turned into a collectivist "package
deal" by means of a crude equivocation and a cruder evasion. In the
language of economics, the word "service" means work offered for
trade on a free market, to be paid for by those who choose to buy it.
In a free society, men deal with one another by voluntary, uncoerced
exchange, by mutual consent to mutual profit, each man pursuing his
own rational self-interest, none sacrificing himself or others; and
all values�whether goods or services�are traded, not given away.

This is the opposite of what the word "service" means in the language
of altruist ethics: to an altruist, "service" means unrewarded, self-
sacrificial, unilateral giving, while receiving nothing in return. It
is this sort of selfless "service" to "society" that collectivists
demand of all men.

One of the grotesque phenomena of the twentieth century is the fact
that the "package deal" of "service" is most vociferously propagated
by the "conservatives." Intellectually bankrupt,  possessing no
political philosophy, no direction, no goal, but clinging desperately
to the ethics of altruism, such "conservatives" rest their case on a
cheap equivocation: they proclaim that "service" to others (to one's
customers or clients or patients or "consumers" in general) is the
motive power and the moral justification of a free society�and evade
the question of whether such "services" are or are not to be paid for.

But if "service" to the "consumers" is our primary goal, why should
these masters pay us or grant us any rights ? Why shouldn't they
dictate the terms and conditions of our work?

If socialized medicine comes to the United States, it is
such "conservatives" that the doctors would have to thank for it, as
well as their own spokesmen who recklessly play with an intellectual
poison of that kind.

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

-available at The Ayn Rand Bookstore
http://www.aynrandbookstore.com