Finally, the US government will have 150 million swine flu doses available in December, 8 months after H1N1/swine flu arrived in the USA. On November 20^th the Center for Disease Control (CDC) admitted that H1N1 - “may have peaked in most areas of the United States.”

Trying to make an argument for vaccination anyway is the so called second wave theory where the virus returns later, mutated and more dangerous than ever. However, the Southern Hemisphere of the globe, already having experienced swine flu this summer (their winter), is experiencing no such second wave. In fact, the CDC web site shows H1N1 to be almost nonexistent in the Southern Hemisphere at this time. On review of the CDC’s  Map of International Activity Estimates,  H1N1 is singularly confined to the Northern Hemisphere. Most influenza epidemics phase out after 5 to 6 months. The US epidemic will be 8 months old when the US government distributes 150 million doses of swine flu vaccine that it bought for billions of dollars. This is analogous to throwing water on a burned down house.

Having immunized 150 million people during a non existent epidemic the government will study the effectiveness of their efforts and eureka, a resounding success. Such is a pasquinade.

The Constitution of the United States resolved that all powers not enumerated to the federal government belong to the states. Therefore, there is no Constitutional power allotted to the President, the Health and Human Services secretary (or simply “the Secretary” as she is referred to in all these massive health care bills) or any other federal bureaucrat to interfere in health care at all. So, with regard to vaccines and their purchase, delivery and distribution how can they justify such entanglement? Simple, by ginning up a crisis.

Several interesting pieces of legislation were put into effect after the September11th attacks (a real crisis) which affect us now in precarious ways.

The Project Bioshield Act of 2004 was introduced into law to allow the Food and Drug Administration (FDA) to approve drugs for use in emergency situations that may or may not have passed muster under normal circumstances. It contains the Emergency Use Authorization (EUA) program. Clearly, the intention of the civilian use of this program was to help protect us against limitations on novel treatments against biologic or radiation based attacks. A EUA can be triggered by a Declaration of Emergency by “the Secretary”.

Our current Health and Human Services (HHS) Secretary, Kathleen Sebelius, has declared such an emergency twice in regard to H1N1. Once in June and then in September as the declaration only lasts 90 days.

According to the Public Health Services Act  (a legislation from 1946 that continues to be amended) she is only empowered to do so with regard to an infectious agent if it poses a risk to national security. Therefore, H1N1 is a threat to national security. H1N1, the virus that may have killed 4,000 Americans is more of a threat than the seasonal influenza virus known to kill 36,000 Americans every year despite government and private sector vaccination programs. 

 Is the mishandling of the H1N1 vaccination program a national security failure on the part of this administration? Well, yes if you believe what Mrs. Sebelius believes. Apparently she is given great discretionary power as to what constitutes a national security threat and therein lays a potential threat to you.

 Through legislation named the Public Readiness and Preparedness (PREP) Act of 2006 the HHS secretary may issue a declaration that absolves anyone involved in the administration of EUA program treatments, including but not limited to untested vaccines like H1N1, complete immunity from law suits involving damages including death. She only needs the threat of a pandemic to trigger this  but since she must invoke the EUA she still has to declare the national security threat first. This protection is extended to manufactures, distributers and the people who disburse the treatments i.e. your doctor, provider or pharmacist. Were you to be maimed or killed by any of these treatments you could apply for compensation from the Covered Countermeasures Process Fund. This is a fund which has never been appropriated any money from Congress.

States themselves like flexing their muscles in times of crisis. In 2002 the CDC, concerned that the constitution may someday make a comeback, was involved in funding and drafting a model of legislation that it desired state legislatures to adopt. Taking advantage of the mood of the country after September 11^th, the Model State Emergency Powers Act (MSEHPA) was designed to broaden state powers in times of bioterrorism or other infections it deems worthy (read H1N1). It contains such abuses of police power that even the American Civil Liberties Union opposed it. When the hard left is worried you should be very worried.

The MSEHPA is currently the guideline for legislation in 44 states and the District of Columbia. Although implementation of the guidelines varies from state to state here is a sampling of what it purports: Allows police and militia to take control of roads in and out of cities. Seize homes, food, fuel, firearms and cars. Arrest, imprison without bail, forcibly examine, vaccinate and treat without consent. People enforcing these laws are indemnified by the government of that state. Hard to believe they would do this for H1N1. Well, but maybe during a national security crisis.

Some of what all of this legislation advances would seem reasonable in the event of a nuclear attack or nationwide bioterrorism attack. In such an instance widespread anarchy would ensue and special measures to control the panic and contain the spread of possibly deadly contamination would be necessary. However, in the hands of the extreme left this type of power can be egregiously abused. Using H1N1 as a national security threat may have exposed the flank of those now in power as to their genuine intentions.

The Congressional Budget Office (CBO) Director, Douglas Elmendorf, sent Chairman of the House Ways and Means Committee, tax cheat Charles Rangel, a letter on October 29, 2009. That letter included a preliminary analysis on the cost of H.R. 3962 the Affordable Health Care for America Act. The analysis concluded that-halleluiah- it will reduce the federal deficit by $104 billion. Like any good fairytale, this requires a suspension of disbelief.

Let’s just examine a few statements imparted to the Honorable Chairman.

 The CBO assessment states that the proposed government run public health insurance plan assumes that it would have lower administrative costs than the private plans and “would typically have premiums that are somewhat higher than the average premiums in the private plans in the exchanges.” Who in their right mind believes that the government has a lower administrative cost for anything done in the private sector? Higher premiums for people who won’t be paying anything mean higher taxes for everyone else.

Additionally, the report states that savings will ultimately arise from the fact that the public plan will “… engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees.” Therefore, they expect to not control the amount of health care the sickest people utilize and this will bring down costs. This is the reason

that Medicare and Medicaid crippled the budget in the first place. Truly, this is the contemplation of morons.

Part of H.R. 3962’s savings will come through reducing payments to Medicare, Medicaid and related programs by $426 billion over the ten year budget estimation. This will be accomplished in part by “permanent reductions” (read price fixing) in payments to Medicare services sans those to physicians. What this means is that the government will basically destroy businesses and jobs which supply durable medical goods and services such as diabetic supplies, nebulizers, certain medications and home health services to mention a few. Well, it wouldn’t meet the requirements of a government program if it didn’t decimate something. Is anyone still holding on to their AARP card?

Doctors aren’t so smart. The American Medical Association (AMA) is fully supportive of H.R. 3962. This probably stems from the fact that they get a teacher’s pet exclusion from what I mention in the previous paragraph. The CBO states that the 21% reductions in Medicare payments slated to take place are still in the bill. Moreover, any increases in further payments will be below the level of inflation so you will never crawl out of the hole. And, “Those payment rates and rules may differ from the current law assumptions underlying the CBO’s baseline projections.” Has anyone at the AMA ever heard of “bait and switch”?

Spurious accounting is revealed in H.R.3962 thanks to the non-partisan CBO. There is a $72 billion slight of hand taking place in this legislation. The Community Living Assistance Services and Supports (CLASS) program, a long term care insurance scheme,

is credited with reducing the deficit by that amount. Presented as a voluntary insurance (until it is mandated), its premiums are counted in the black. However, the CBO estimates that by the time most people grow old enough to utilize it, around 2029; it will start to add to the national deficit. This, of course does not show on the books because the CBO analysis only evaluates 2009-2020. Presto,Change-o another unsustainable government program adding to the $89 trillion unfunded liability in health care.

Just as in H.R 3200, the CBO does not count the “discretionary costs” of H.R.3962.

This means it does not account for one dime of expanding the bureaucracy to accommodate this monstrosity. Neither does it count the costs of the multitudes of grants for programs yet to be created and legislated in the bill. I am certain that it will wash away the paltry $104 billion in deficit reduction like a tsunami.

In its last few pages the CBO issue a “caveat” to the Chairman. It warns- “For a number of reasons, the preliminary analysis that is provided in this letter does not constitute a final and comprehensive estimate for HR 3962”

Today, Senator Judd Gregg (R-NH), ranking member of the Senate Budget Committee, stated that when H.R.3962 is fully funded it will cost “more than $3 trillion dollars over ten years.”

I thought fairy tales were supposed to end well.

"The nine most terrifying words in the English language are: 'I'm from the government and I'm here to help.'"

                                       -Ronald Reagan

Just as health reform is not really about health, the left’s official 8 year war on obesity is not about improving anyone’s well being. It is about the amount of control which can be leveraged against the liberty of the individual-the avowed goal of all statists.

In 2001, the Office of the Surgeon General, then headed by Dr. David Thatcher, fired the first shot in the obesity war with its report- “The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity.” Among the report’s five core principles we find the rub of the concern. The fourth principle-disingenuously chronicled as it is the overriding intention of the matter-espouses to “Encourage environmental changes that help prevent overweight and obesity.”  That would be your environment.

President Obama, in a conference call to his minions at Organizing for America is quoted as saying “If we went back to the obesity rates that existed back in the 1980’s, the Medicare system over several years could save as much as a trillion dollars.” The Centers for Disease Control exposed the sophism of this statement showing that if this were to occur (can he not make it so?) the savings to the government program would be more like 12-15 billion dollars a year. Therefore, it would require 67-83 years to accomplish the President’s predicted savings. 

Further attestation to his penchant for blundering is his recent appointment of an obese individual to the Office of the Surgeon General.

The National Academy of Sciences (NAS), now headed by Dr. Ralph Cicerone, recognized for his award winning research on climate change, is the home of its companion in the National Academy the Institute of Medicine (IOM). Through its charter and the authority given to it in the 1972 Federal Advisory Committee Act, the NAS and IOM are positioned to give influential advice on matters of health to the President.

When environments-like the one in your bank account- need changing, liberals will always showcase, with great hyperbole, the victims of the circumstance they wish to rectify. So say they, the obesity crisis places our national environment in a debacle we must be extricated from with great haste. Who can be martyred to quicken our resolve. Ah, yes, the children.

In September, the IOM released a report-“Local Government Actions to Prevent Childhood Obesity.” This report is meant as a guideline for local and state governments to interfere into every child and parent’s life. Since 16% of children are obese we must change the “environment” for the other 84%. This theory is hauntingly familiar. Moreover, we must correct, in the name of social justice, the racial and ethnic disparities that exist among these obese tots.

 In the journal Pediatrics ( 2009;123: e l 53-8), it notes that the exact same percentage of White and African-American children are overweight and obese with only a 1% increase in severe obesity in the African-American group. Given the population disparities between the two, the burden of obesity clearly rests with the White children. Hispanic children were more obese and severely obese by 4% and 2-3% respectively. This disparity may be amenable to real immigration reform.

I don’t like to see children suffer from obesity and it does not matter whose child it is. However, the word that is missing in the IOM report and all similar such literature is parent. Liberal governments supplant the rights of parents wherever they exist.

No one with the capacity for good judgment would deny that there is a problem of obesity in this country. It does not require the force of government and increases in taxes and loss of personal freedom to solve it. What’s a PTA?

So how will this work in the real world? We can look to the Arkansas Act 1220 of 2003.

The Arkansas Act 1220 was a piece of state legislation designed to fight childhood obesity. The Act included an unfunded mandate for schools to corral all the children, weigh them and calculate their Body Mass Index (BMI), a measure of obesity. The BMI was then reported to the children’s parents. Some parents raised objections on the basis of their child’s personal rights and fears that their child may suffer embarrassment or intimidation. Undaunted by the suggestion of the infringement on personal liberty and the demoralization of small children, the liberals courageously advanced. They changed to nutritious lunches, increased “vigorous” physical activity, mandated appropriate education on nutrition, convened an advisory board replete with diversity and then reported the little kinder’s BMI’s to their folks.

After three years of data, childhood obesity diminished .3%! Although it was a case of Twinkies away from abject failure, it was deemed an unequivocal success as it- “at least contributed to halting the progression” of childhood obesity. This is the same logic our current President uses as he saves American jobs, now with net losses measured in the millions. Perhaps more needs to be done to combat the out of control situation.

From the IOM brief on its report:

Local governments are experienced in promoting children’s health, as they historically have implemented

policies intended to ensure, among other things, that children are immunized or they wear helmets when riding a bike. In the same way, local governments—with jurisdiction over many aspects of land use, food marketing, community planning, transportation, health and nutrition programs, and other community

issues—are ideally positioned to promote behaviors that will help children and adolescents reach and maintain healthy weights. Promoting children’s healthy eating and activity will require the involvement of an array of government officials, including mayors and commissioners or other leaders of counties, cities, or townships. Many departments, including those responsible for public health, public works, transportation, parks and recreation, public safety, planning, economic development and housing will also need to be involved.

Good grief, it takes a village.

What will this all bring about? Taxes, increases in bureaucracy, out of control spending and all the other accoutrements of liberal social engineering.

Childhood obesity is a problem to be solved. Let’s use empathy and compassion. And if we are going to use tax dollars, let’s use them to help parents get educated. We don’t need an overhaul of our society to accomplish that.

Like most of my generation, I first felt the oppression of tyranny at the dinner table where my mother would imprison me until I consumed every last morsel of a disagreeable meal.

Usually, it was a food I would eventually find more appetizing with a less jejune palate. My distaste for tyranny was more precocious and permanent.

In the America’s Affordable Health Choices Act of 2009 (HR 3200), the classic blueprint for the liberal reformation of health care in America, on page 934 we find: “Subtitle B-National Prevention and Wellness Strategy.” This portion of the bill empowers the Secretary of Health and Human Services to create “.a national strategy that is designed to improve the nation’s health through evidenced based clinical and community prevention and wellness activities.” After dispensing with the Constitution and State’s rights where will this take us?

This June, President Obama’s selection for Director of the Center for Disease Control (CDC), Thomas Frieden, MD, took office. This position does not require Senate conformation, a subject which deserves reconsideration. Dr. Friedan is more famously known as New York City’s former health commissioner where his arrogance was on full display in New York and on the national stage. As you will recall, he was instrumental in achieving the abolition of trans-fat (the thing that makes food taste good) from all foods in a city where people fancy themselves at least intelligent enough to know what to eat. Additionally, too stupid to know what to drink, New Yorkers were targeted by Dr. Frieden to pay a punitive tax on soft drink consumption designed to change their behavior, combat obesity and enhance the city’s revenue. As CDC Director, Friedan will be intimately involved in framing our national wellness strategy.

A similar soda tax was considered in drawing up the health care reform bills in Congress. However, realizing how contemptuous it was, they struck the idea. Speaking on the Congressional retreat, Kenneth Thorpe, former health policy official under President Clinton said “They’re at such a fragile place, introducing anything new and big like that into the mold is not likely to happen.” Dr. Frieden, dedicated  fighter of obesity and righteous custodian of our collective health, is not so easily daunted.

This summer, Dr. Frieden and the CDC hosted the “Weight of the Nation Conference” on obesity in Washington D.C. Spokes persons included grand paragons of self-restraint and caloric discipline such as former President Bill Clinton. At the conference Dr Frieden revealed his belief that-“Political commitment is the leading predictor of effective action.” He admits that companies, through litigation and coercion, will need to be made to comply with standards that he and the government will set, as to what is fit for you to eat and drink. He does not believe you have any individual rights. In fact, he is quoted here-“The only way on a societal basis to reduce the prevalence of obesity is through community action, not through individual clinical interventions.”

This will be accomplished through confiscatory taxes on people that consume certain foods and with taxes levied on the manufacturers of these products. Therefore, like every other liberal government program it will cost jobs, increase taxes and diminish liberty.

Where would a liberal government policy be without a hypocrite?

Dr. Frieden penned an article in the April 30, 2009 issue of The New England Journal of Medicine with fellow obesity scold Kelly Brownwell, PhD. -“Ounces of Prevention-The Public Policy Case for Taxes on Sugared Beverages”  Dr. Brownwell is the Director of the Rudd Center for Food Policy and Obesity. At first glance you might think that Dr. Brownwell has adopted obesity as an avocation and would be an unlikely braggart of the advantages of physical fitness. A Google image will suffice.

From the Rudd Center’s website: “The Rudd Center expects many obesity related issues will be resolved through regulation, legislation and litigation, and we are pleased to remain on the cutting edge of these legal initiatives and developments.” Moreover, on policy: “Rather than focusing on changing people’s behavior one person at a time, effective public policy makes positive changes in the environments in which we live.”

These people are frighteningly out of the reach of the power of the electorate to remove them. They understand, as did the Congress, that given the chance the American people would reject this type of autocracy. Therefore, they have to have unaccountable accomplices in the government like Dr. Frieden to help them forward their agenda. It needs to be reiterated that the CDC Director position is an appointed one. What can be accomplished is to hold those who would place power in the hands of such ideologues accountable.

2010 is closer than you think and its consequence may reverberate for generations.

In January 2009 the ACORN 8, eight members previously serving on ACORN’s board, submitted a paper filing charges against other board members. The charged included ACORN co-founder and Chief Organizer Wade Rathke. They were complainants for their summary dismissal from the board for trying to investigate the embezzlement of almost one million dollars. The million dollars was embezzled by Wade’s brother Dale Rathke and a cover up ensued involving several high level ACORN board members. Charges included mail fraud, tax fraud, conspiracy and racketeering.

On July 23, 2009 the 111^th Congress Committee on Oversight and Government Reform issued its staff report- “Is ACORN Intentionally Structured As a Criminal Enterprise?”

The conclusion of the 88 page report was a tepid call for more scrutiny. The Congress as a body took bolder steps when it overwhelmingly voted to defund ACORN last week.

The prescience of these recent events to the inconspicuous annexation of our health care system by people of this ilk can not be overstated.

ACORN will remain viable without government funding through its relationships with big labor organizations which use its organizing machinery. The State Employees International Union (SEIU), still the largest union of health care workers, is such an entity. These two groups are intimately entwined and together promote ACORN’s Health Care for America Now project (HCAN). This project is responsible for advocating the Democrat health care reform that we see the Tea Party patriots pushing back.

Within the SEIU there is already a plan to get America’s doctors to comply with socialism. The Committee of Interns and Residents (CIR) and the Doctor’s Council are two arms of the union which espouse the glories of socialism and the single payer system. In the June, 2009 CIR quarterly newsletter one young physician/Bolshevik in training highlights the “Three Pillars” to CIR’s success- “Collective bargaining, Organizing and Patient Advocacy Through Political Action.”   If you really want to advocate for patients learn to do your job first.

The Doctor’s Council website asks us to help protect patients by being active in ACORN’s own HCAN. They also request that you become active by joining their “Active Response Team.” Here, when needed, you will be called to drop what you are doing and head to the nearest protest against your own health care system and profession.

Bus ride and purple shirt provided.

SEIU thug behavior is well documented and no quarter is given to members of other health care unions even if they have the same message.

The California Nurses Association (CNA) is emerging as a very powerful union and extends well beyond the borders of the Golden State. Currently, they have union representation in several states and the District of Columbia. New York Times reporter Stephen Greenhouse called the CNA-“...an unusually militant union that is seeking to expand nationwide.” You would assume then that the SEIU and the CNA would get along famously. Not so.

In March 2009, the CNA sent rabble rousers to nine Catholic Health Partners hospitals in Ohio to steer workers away from a proposed SEIU contact that was already in negotiations. Shamelessly, the CNA workers maneuvered their way into patient care areas to confront the hospital staff. Not sure of the impact the trespass caused, the SEIU postponed the worker’s vote. Rose Ann DeMoro executive director for CNA (and never a nurse, but longtime Teamsters hack) called the huge violation of the hospital’s and patient’s privacy “a significant victory for employee rights.”

Such an affront was not to go unanswered. The next month, Ms. DeMoro was to be a keynote speaker at a labor conference in Michigan. The SEIU, all dressed in purple, bussed in 800 union thugs who beat their way through the doors of the conference hall and charged the podium. Many people were kicked and beaten with one woman suffering a significant head injury as reported by a witness.  In a simultaneous effort SEIU members stalked and harassed CNA board members, mostly women, at their homes and places of work. Earlier this year, Ms DeMoro stated that the SEIU tactics made the Teamsters “look like choirboys.” She would know.

Fast forward to March 2009. It seems that the two unions, now apparently relieved of their mutual mistrust, are willing to just get along. Like other rackets before them they have learned that turf wars can be nasty and unbeneficial to both sides. In seeking to expand they will advance together. The SEIU will get the hospital workers and the CNA will get the nurses. This reminds me of the last few episodes of The Sopranos.

The physicians who are already in the SEIU are complicit with the actions this union takes. This includes the relationship to ACORN, the CNA and their minions. These groups are about their own power and are fully detached from advocating for anything less than their own self aggrandizement and political influence. These doctors should be pariahs in our profession.

The behavior of the average American citizen in this health care debate, people who before wouldn’t complain of an over cooked steak, is exemplary. When physicians begin to side with the hoodlums in the delinquent groups I have mentioned and not serve as examples of respectful people in a civil society we will lose a great public trust that we may never be able to recover.

S.773

A disturbing trend in government today is the unrelenting avarice of the current administration to place more and more power in the grip of the executive. The creation of dozens of governmental agency “czars”  in the control of the White House at this time and unanswerable to the electorate is unprecedented. Some would argue the Constitutional soundness of such appointments.

 Unseemliness is a mere bother to the administration that would bring the United States Census Bureau into the West Wing and cast dispersions on the intentions it portends for future free elections in this country.

Senator Jay Rockefeller (D-WV) has sponsored and introduced to the Senate S.773- The Cybersecurity Act of 2009. The bill’s drift is to protect America’s security by creating the means to thwart any hostility towards our cyber space from enemies foreign and domestic. It reveals what lies within in the last line of its preamble- “…maintain effective cyber security defenses against disruption and for other purposes.” Other purposes, indeed.

Sensing the crisis in cyber security, while insensible to the one that exists on the borders, S.773 and Senator Rockefeller are here to help. This bill places prodigious power in the hands of this and any future U.S President by giving that person control over the cyber communication system in this country.

It allows the President to create a “Cyber Advisory Panel” which would be fully answerable to him or her. It will be in charge of all standards in cyber security and its implementation. Furthermore, the President is not fully accountable to any State or Federal entity in all of this. As the bill states- “The President- (2) may seek and give consideration to recommendations from the Congress, industry, the cybersecurity community, the defense community, State and local governments and other appropriate organizations.” Consideration! Is this a “checks and balances” approach to government? Are not States protected by the 10^th Amendment?

S.773 goes on to new Orwellian heights. It creates Regional Cybersecurity Centers which will be the standard bearers of your cyber well being. What will their role be? “The purpose of the Centers is to enhance the cybersecurity of small and medium sized businesses in the United States..” and “Each center shall be affiliated with a United States based non-profit institution or organization, or consortium thereof, that applies for and is awarded financial assistance under this section.” Why would we need to relinquish our private self reliance on our security to non-profit organizations directed by the government? What selection process would be in place for this? What chapter of ACORN do want to be in charge of your privacy and protection?

Where else will mercurial political power flow should this bill pass? 

Most of us do not even know about the National Institute of Science and Technology (NIST). The Director position at NIST is currently vacant and awaits a Presidential appointment. It will be NIST that arranges for what is in place in the computers of the government and in private sector businesses deemed “critical” to our infrastructure. Just for the record, the NIST Director also chairs and appoints members to an advisory committee- the Technical Guidelines Development Committee- of the Elections Assistance Commission. They oversee the standards for the voting machines and computers we use in elections.

In this bill the power of assigning the designation of critical infrastructure is given to the President of the United States. Perhaps your business will pass muster.

Like all power grabs by tyrannical governments this one seeks, as it must, to abolish the private sector competition. They will license and vet the workforce that will protect you. It will be unlawful, if you are deemed critical to the infrastructure, to contract outside of a government designee for your cyber protection.

What’s in it for the kids? As Marx stated- “From each according to his ability to each according to his needs.” S.773 offers this for the little ones- “The Program- shall provide a procedure for identifying promising K-12 students for participation in summer work and internship programs that would lead to certification of Federal information technology workforce standards and possible future employment.” We all want our first graders to go to Federal work programs don’t we? Ponder what selection procedure will be developed.

College aged young adults well versed in computer technology will be reported by their respective schools to the Federal government under this legislation. Any school which participates in government funding equal to or greater than one million dollars will be required to report students educated enough to have the ability to launch a cyber attack.

When will the availability of certain books require a security clearance?

Lastly, “The President- may declare a cyber emergency and order the limitation or shutdown of Internet traffic to and from any compromised Federal Government or United States critical infrastructure information system or network.” Like on Election Day.

The quote from S.733 in the last paragraph contains the dish that is feeding the frenzied news outlets. It is the realization of the dissemblance in this government from the one our country was founded on that will peel away the veil of the deeper deceptions.

“We are God’s partners in matters of life and death.”

                                     __ Barack Obama, August 19, 2009

There is a crosscurrent in our society at present which seeks to ebb tide the individual rights of our citizens. This is best epitomized in the government’s efforts to have our senior citizens commit to end of life care plans under the guise of compassion.

Dr. Robert Pearlman, a Fellow of the Program for Ethics and the Professions at Harvard University, does not disappoint my circumspection of his pedigree. Currently, he serves in the Veterans Administration as a senior ethicist. In 1997 he co-authored a pamphlet called Your Life, Your Choices with fellow ethicist Helene Starks, PhD among others. This was to be the blueprint for end of life counseling for the entire Veterans Administration Health System until it was rescinded by President George W. Bush. The Obama administration is pressing for its reinstatement.

Dr. Pearlman and Dr. Starks most likely constructed their pamphlet through the prism of a study they did together and published in the October 1, 1997 edition of the Annals of Internal Medicine entitled: “Validation of Life Preferences for Life Sustaining Treatment: Implications for Advanced Care Planning.” This study was designed to prove that end of life choices made in advance concurred with the choices patient made when they actually became ill. This project was grossly flawed. The study was completed in Seattle, Washington and the authors admit that whites and college educated participants were over-represented. Almost half of the participants were lost at 3 months in the 18 month study, 83 of them due to death. Therefore, many of the sicker patients were unavailable.

When respondent’s choices did not concur with their earlier decisions they were re-interviewed and pressured to change their minds. Two-thirds of them succumbed to the pressure and reverted to their original stance. This was the data used in the final results.

When reading “Your Life, Your Choices” the negativity toward the attitude of choosing medical treatment and life over death is palpable. The language used to describe medical treatments is intimidating and onerous. I tried to imagine what the Advanced Care Directives of a monstrous government-run health system would look like and I think I just read the preamble.

In the same year that Dr. Pearlman was cobbling together his pamphlet (which is colloquially referred to as the “VA Death Book”) another physician, Dr. Timothy Quill was having his case for physician assisted suicide heard before the Supreme Court of the United States. Known as Vacco, Attorney General of New York v. Quill; it is a landmark decision regarding issues of the right to die movement. Dr Quill and three terminally ill patients were suing the state of New York for an alleged violation of their rights under the Fourteenth Amendment of the Constitution by banning physician assisted suicide. The ruling was 9-0 against Dr. Quill. Sources say Dr. Pearlman testified in favor of physician assisted suicide in that case. This would place him in libertine company.

There is a frightening subculture in this country that advocates death over life. It is best represented by the group Compassion and Care, formerly known as the Hemlock Society. Politically active, they proudly post their hurrahs for helping Washington state become the second state to pass physician assisted suicide legislation. They unsurprisingly support HR 3200. Where will this all lead? Let’s go back to the roots of their belief system.

Derek Humphry, one of the Hemlock Society founders, wrote the following in his book, Final Exit: “What can those of us who sympathize with a justified suicide by a handicapped person do to help? When we have statutes on the books permitting lawful physician aid in dying for the terminally ill, I believe that along with this reform there will come a more tolerant attitude to the other exceptional cases.” It would appear Mr. Humphry also believes in suicide for elderly people who are not ill. From the same book, Chapter Twenty: Going Together-“Some couples choose to die together regardless of whether both are in poor health or only one…That the couple would wish to die together is a tribute to the strength of a loving relationship.”

First, they have to get the doctors to be sympathetic to this undertaking. That is what they are relying on, doctors like Quill and Pearlman. Then they will only need men and women who think they are God’s partners.

The Western Political Science Association, a California based research group of 1000 political scientists, recently held their annual meeting in March, 2009. There Dr. Edward Fox presented his paper, “Medicaid and the Indian Health Programs: Financing Indian Health Programs in the US.” Dr. Fox is thoroughly acquainted with the IHS and has served as Executive Director for the Northwest Portland Indian Health Board. Much is gleaned from his insight.

The health care of Native Americans is almost completely publicly funded. It is expected that the amount of funding this program would need were it to match the care delivered in the private sector would be approximately 10 billion dollars. With the 3.6 billion funded to the IHS and the additional estimated 4 billion from those eligible for Medicaid and Medicare (which serve as priority payer before the IHS funds are tapped) it is underfunded by billions of dollars. This is your government in action. Underestimate the demand and be incompetent in providing the supply. Can you spell Massachusetts?

The IHS serves 1,485,431 Native Americans which is about 57% of the total Native American population. Per Dr. Fox’s paper, some tribes are not too happy that they have to qualify for Medicaid: “One important point that has to be presented in this paper is while that the tribes see the partnership between IHS and CMS as beneficial, most take the position that they should not have to rely on a means-tested program such as Medicaid to meet their member’s health needs. Tribes argue that the treaties signed by the Federal government establish a legal and moral obligation to provide health care services.” Thus is the inherent value of a Federal government promise exposed.

Speaking to the point of inferior funding, Fox States-“Unfortunately, IHS is chronically underfunded and thus has suffered budget shortfalls, additionally years of inflation and mandatory costs have further eroded financial resources, resulting in year after year of severe rationing.” The embellishment is mine. It portends the hopes of the left for real change.

So what has been wrought by a health care program -a public option- run entirely by the Federal bureaucracy?

Native Americans:

-Have life expectancy that is 4.6 years lower than the US all races population.

-Die at higher rates from Tuberculosis (700%), Diabetes (190%), Suicide (70%)

-Have higher infant mortality,

 -More likely to die from pneumonia or influenza

What is scary is that the Native American population, over all, is younger than the all races American population

Living under the health care “nanny state” has done little for Native Americans.

The most disturbing line in Dr. Fox’s report is a statement from a 2005 IHS report which states: “The IHS is the principal federal health care provider and health advocate for Indian people and its goal is to raise their health status to the highest possible level.”

Good grief.

Data for this article was collected from the Indian Health Service (HIS) web site “Facts Sheet” and a paper presented at the Western Political Science Association annual meeting March 19, 2009 entitled; “Medicaid and the Indian Health Programs: Financing Indian Health Programs in the US”, by Edward Fox, PhD (et. al) -2009

Erdman Palmore, 78, professor emeritus at the Duke Center for the Study of Ageing at Duke University Medical Center, is a very affirmative proponent of the conviction that getting older does not have to be a vexation. Having a very positive attitude and perspective is essential and as he sees it - “Once you’re over the hill you pick up speed.” Liberals in government would like to assist the professor by increasing the slope.

Earlier this week, a story in the Boston Globe stated that to facilitate the administration of the newly vetted novel swine flu (H1N1/09) vaccine Massachusetts health authorities would “deputize dentists, paramedics and pharmacists” to give the shots. Deeper into the article the populations targeted for immunization were revealed and curiously it stated – “Older adults will not be a major focus of swine flu campaigns.” The swine flu, present a mere 4 months in America, had only affected 1% of the elderly in that state. Therefore, having satisfied the health experts, the pronouncement was made to exclude them until all other individuals under the age of 65 had received the potential protection.

On July 29, 2009, at the Centers for Disease Control (CDC), an urgent meeting of the CDC’s Advisory Committee on Immunization Practices was held to cobble together guidelines for the swine flu vaccination. The 15 board members, with their 4 months of data, decided how best to proceed in protecting the American people. Well, some of them anyway.

Data collected on novel H1N1/09 in America to date have shown that younger populations of patients are affected disproportionately versus the Medicare eligible populace in raw numbers. However, the hospitalization rate by age group shows that the above 65 year old patients were hospitalized more frequently than the 25-49 and 50-64 year old ones. One hundred per cent of those 65 and older who were hospitalized had a pre-existing co-morbid medical condition. Furthermore, with regard to the elderly the CDC report states- “Summary of Key Epidemiologic findings- Fewest cases but highest case-fatality ratio in older adults.” Well.

The CDC admits that the mobility of younger patients contributes to the swine flu in that population. It is now summer and there is concern that this novel virus may return in the winter and little is known about whether or not it will be more or less virulent than it is now. Older Americans have a greater chance of being introduced to it in colder climes as they and younger people spend more time indoors. The elderly will be exposed in the doctor’s office, volunteering at hospitals and some probably will be deputized by the state of Massachusetts to render treatment to others that they will be denied solely on the basis of their age.

How does the government plan to enforce the CDC discriminatory guidelines? Simple. They bought and control all of the vaccine that will be available. Frightening.

In the CDC guidelines there is no allowance—none--for a 65 or older American citizen to qualify for a “first in line” immunization against the swine flu. Not heart disease, not chronic lung conditions or even cancer will get an older American a possibly protective treatment until everyone else gets theirs first. It is eerie how discrimination is accepted across all racial, religious and gender lines when it involves our senior citizens.

The CDC says that, to their advantage, the elderly may have been around long enough to have been exposed to other H1N1 viruses and therefore may have some protection against it. Studies show that antibodies were present in 30% of older people as opposed to 10% in younger groups. Looking at it with circumspection that means 70% of seniors have no more immunity than anyone else naïve to the virus.  But the H1N1/09 is novel. It is composed of genes from Avian, pig and human origin and is unlike previous H1N1 viruses in some ways. Additionally, any geriatrician worth his or her salt would educate you with the fact that people’s immune responses are diminished and hypo responsive with advancing age.

The current health reform bill before Congress is a threat to all Americans. It will wrest control from the individual and in so doing infringe on his or her liberty. God help our seniors if they are successful. The current attitude of those now making health care decisions at the national and state level evidence a subtle shift in the respect for the humanity of our senior citizens who are our fathers, mothers, brothers and sisters and our countrymen. Many of them fought for our freedom and our liberty. Let’s fight for theirs.

My Dad, 76, is battling cancer. He told me-“Life is a treasure in fragile containers.”

We are at risk of losing our civil society if we think otherwise.

“If the physician presumes to take into consideration in his work whether a life has value or not, the consequences are boundless and the physician becomes the most dangerous man in the state.”

                                        -Christopher Hufeland

                                          Eighteenth century physician

Today in America we citizens are faced with a government absorbed with foisting a statist directed health care system upon us. Firm in its resolve to transform the country into a socialist utopia with nationalized health care (unfazed by the stubborn historical facts which point to the disastrous consequences of such a hypothesis) they sally forth with trying to get America’s Affordable Health Choices Act of 2009 (HR 3200) to the House floor for a vote in the fall. During this summer’s Congressional recess we must work to stop them.

By pounding away endlessly on cable TV and radio, liberals are using their slippery talking points on health care reform to conjure visions of a destitute nation yearning to dismantle a failing health system. You can fool some of the people some of the time. But, what about the doctors? How do they get them on board with the idea of government determining how care is delivered, who gets care and, more importantly who doesn’t. Moreover, if liberal health reform succeeds what is to be done with the recalcitrant defenders of The Hippocratic Oath? How do they get our minds right?

In 2003, uber-liberal billionaire George Soros and his Open Society Institute founded the Institute on Medicine as a Profession (IMAP). Headed by Dr. Daniel Rothman, IMAP is dedicated to what will constitute professionalism should liberal health care succeed. Professionalism under the IMAP definition is really tantamount to compliance with liberalism.   If the involvement of George Soros isn’t enough to convince you of the socialist leanings of this organization—from their website:

“Professionalism alone should not be responsible for governing medical practice; there is clear need for formal regulation, whether through state or federal legislative and administrative bodies. Nevertheless, external intervention confronts significant barriers. Law and regulation are blunt tools for governing the many intricacies of the doctor-patient relationship.”

The IMAP library link is a treasure trove of liberal propaganda containing articles related to physician assisted suicide, social justice and medical professionalism as “force for change.”

You may ask yourself-“So what? It’s just another liberal advocacy group. What influence can they have?” George Soros notwithstanding, their influence ascends all the way to The White House. In a joint effort with the Institute for Health Policy at the Massachusetts General Hospital (IHPM), IMAP issued a report on physician’s attitudes toward their definition of professionalism. Who is the founding director of IHPM and co-author of Dr. Rothman’s article on conflicts of interest in the pharmaceutical industry? The ubiquitous, Institute of Medicine liberal and White House Director of Health IT- Dr. David Blumenthal. Therefore, the IMAP has, at least, the ear of the powerful.

HR 3200 is plump with legislative language which would alter the way care is delivered.

Illustrative foreshadowing of the natural history of the attitudes that are espoused by IMAP is contained in section 1233 of the bill which calls for Advanced Care Planning of elderly Americans. This section of the bill will require by law that every 5 years an American senior citizen be coerced to discuss with a “practitioner” the terms of the end of life care they will receive. They must spell it out for the government whether they want to live or not. I can not think of a more egregious violation of personal liberty. Joining me in this is the Chairman of the New York State Senate Aging Committee, State Senator Ruben Diaz. In a letter to Congressman Henry Waxman (D) California and Chairman of the House Energy and Commerce Committee he wrote-“Section 1233 of HR 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives. Each life must be cherished and regarded with reverence.” Every good socialist movement needs a good scapegoat.  Along with obese people, the elderly are currently under heavy assault by the left.

In a chapter of a scholarly collection of reviews on the Holocaust entitled “The Holocaust and History”, author Hugh Gregory Gallagher prefaces his contribution with a personal statement:

“I am a historian, author of “By Trust Betrayed: Patients, Physicians and the Licenses to Kill in the Third Reich”; I am also a severely disabled person, a polio quadriplegic. As such, I am interested in the evolution of the social attitudes toward and assumptions about disabled people. It is my conviction that the underlying assumptions that made possible the killing by physicians of upwards of 200,000 disabled German citizens in the 1930’s and 1940’s are still widely held, not just in Germany but throughout the Western industrialized world. The purpose of the following material, as of my book, is to make the reader aware of these assumptions and of the evil that can arise from their careless application.”

We will be remiss in our duty to our patients, our countrymen and our posterity if we fail to assume that it is possible that such malignity can wellspring from this movement to government control over health care.

Irrespective to the damage the American’s Affordable Health Choices Act of 2009 (HR 3200) will do to the national debt (a 239 billion dollar budget deficit over the next decade), what it will do to the profession of medicine is repellent.

The hidden implement for defrocking American doctors as the principle stewards of patient care lies concealed in this 1018 page bill. On page 461 HR 3200 states “-(4) Participation of Nurse Practitioners and Physicians Assistants - (A) Nothing in this section shall be construed as preventing a nurse practitioner (consistent with state law) from leading a patient centered medical home.” The patient centered medical home remains the preferred care model adopted by this new legislation: the doctor’s office.

People will argue that state laws, at least for now, usually require physician oversight of nurse practitioners. However, in my state, North Carolina, there is no limit to the number of nurse practitioners a physician may supervise and physician review requirements of the nurse practitioner’s activities must only be performed once every 6 months. This allows nurse practitioners to practice medicine with very little restriction and now with HR 3200 gives them their own office.  Moreover, this bill changes the very definition of a physician.

Cloaked in the middle of page 445- “(C) PHYSICIAN- the term ’physician’ includes, except as the Secretary may otherwise provide, any individual who furnishes services for which payment may be made as physicians services.”

Thirty four pages later this bill repeals the section of the Social Security Act which defines a physician in this way- “The term physician when used in connection with the performance of any function or action means (a) a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he performs such function or action.”   Incredulously, the American Medical Association and other physician organizations are on board with this legislation.  Why go through all this legal redefinition?  Where there is language in a bill that redefines anything look for a lobbyist and a willing accomplice in the government.

A coalition of the American Association of Nurse Practitioners attended a congressional briefing on May 9, 2009. From the AANP website regarding the briefing:

“The briefing emphasized the potential role of the nurse practitioner as a licensed independent primary care provider in health care reform.”

“It is recommended that the Institute of Medicine (IOM) definition of primary care (‘the provision of integrated accessible health care services by clinicians who are accountable for addressing a large majority of health care needs, developing a sustained partnership with patients and practicing in the context of family and community”) be utilized in the development of health care reform agendas and that nurse practitioners be recognized as primary care providers within that framework.”

In researching the origins of this push to socialize medicine, under every turned rock lurks the Institute of Medicine. This organization enjoys excessive power within our government. Among the affiliated cast of characters: David Blumenthal, Obama Health Technology Information Czar, and Ezekiel Emanuel, Obama White House Health Care Policy Advisor (both doctors of self loathing) who appear hell bent on turning a wonderful health system into a giant Minute Clinic--and for what…money?

A full time nurse practitioner earns approximately $86,000 a year.  Will this offset the health care problem? No, but nurse practitioners will likely submit to government standards as a way of compensating the government for elevating their status. Politicians view stubborn doctors (who take the Hippocratic Oath too seriously) as obstructive to their plan.

We doctors are on our heels in this fight. Outflanked by liberals in the government and in our own professional organizations it is time to regroup, educate ourselves about this issue and recognize we have let the enemy in through the front door via the patient centered medical home.  As I have said, the patient centered medical home is the Trojan horse which will destroy our profession. We have been betrayed.

Let’s get busy.

President Obama’s recent reversal on mandates for Americans to purchase health care insurance draws a clear distinction from candidate Obama who campaigned against it in the Democratic primaries. In a debate November 2007 he said,“Senator Clinton is arguing that the only way to get every American covered is if you force every American to buy health care. And unfortunately she hasn’t told anybody how she would enforce this mandate.” With the introduction of H.R. 3200, the America’s Affordable Health Choices Act of 2009 (AAHC), he has clearly had an epiphany. One wonders what method of enforcement he has at the ready to apply.

Today on his weekly Saturday address, Obama said he would not sign a health reform bill that would add to the national budget deficit. He obviously practices duplicity as the Congressional Budget Office (CBO) has projected more than a trillion dollars worth of deficit balanced by unrealized savings procured from his plan and cost cuts (mostly to Medicare) which will still lead to a calculated 239 billion dollars of deficit over the next decade. I do not believe that anyone is actively shielding the President from this information. Per their report on the AAHC, the CBO admits this estimation lacks any consideration--not one dollar--for administration costs created by the new bureaucracy of H.R. 3200.

Consider this: if the approximate 1700 people on staff under White House auspices make $50,000 (some less, some much more) this adds up to $85 million dollars before one computer is purchased. It should cause taxpaying Americans to shudder when considering the tens of thousands of bureaucrats and government employees necessary to support this reform.  To not include some projection of administrative cost in this report is negligent.

Should this legislation get to the President’s desk in its current form will he sign it anyway? Probably. What example do we look to see where H.R. 3200 will take us? With his acquiescence to insurance mandates and a public option for health care, President Obama’s vision appears a virtual carbon copy of the Massachusetts health system.

For the last three years the Commonwealth of Massachusetts has enforced a mandate requiring all people to purchase health insurance. Prior to this, Massachusetts had a low percentage of uninsured citizens at 10.4%, currently standing at 2.6%; meaning they overhauled their health care system for a net 7.4% of its populace. The CBO estimates, even with the Obama reforms, 17 million people will remain uninsured in the US. There are approximately 6.5 million people in Massachusetts by contrast.

Unaware of basic economic tenants, Massachusetts increased demand for medical services without an equal increase in the supply of doctors--leading to reduced access for all--with waiting times increasing to approximately eight weeks to see a primary care doctor and longer still to see a specialist. 

Did it save costs? Not exactly, as costs have increased 10% each year to cover the newly insured 169,000 people the program serves, exceeding the program’s projected budget by tens of millions of dollars and contributing to the state’s $6 billion dollar budget deficit projected for fiscal year 2009-2010.

Yet Jon Kingsdale, Executive Director of the Commonwealth Health Insurance Connector Authority (which oversees the subsidized portion of the plan) calls it “an unqualified success.” In the July 2009 edition of Medical Economics he stated, “Cost is clearly the next frontier but in terms of the primary goal of getting everybody covered it’s been an unqualified success.” This is consistent with the logic which existed in the housing industry prior to it reaching its natural conclusion.

If he remains consistent in mirroring the Massachusetts plan President Obama will be guilty of another fabrication-allowing you to keep your own doctor. The Massachusetts Medical Society is litigating against a system that categorizes doctors by “tiering” them based on evaluation guidelines set up by the Group Insurance Commission which oversees health insurance for about 300,000 state and local public employees. Physicians are rated or tiered based on billing claims data. Physicians deemed more costly are assigned lower tier rating and their patients are penalized with higher co-pays. Obviously if a doctor cares for a sicker population of patients they will naturally incur a greater cost to the system. Many of these sicker patients, usually poorer, will likely need to choose another doctor and not necessarily a better one. 

Dr. Sally Ginsburg, a Massachusetts pediatrician, is frustrated by this system. She states, “They have used claims data, not clinical data, as the basis of this approach [tiering]. There is no way [that] the average Joe/Joan out there is looking at this information and thinking that I am as good as my fellow MD with a Tier 1 rating. Is this slander? Yes, I think it is, particularly if the methodology used is biased and the data employed are flawed.” Doctors who succumb to this will do the government’s bidding by denying and rationing care to claim a Tier 1 rating.

On pages 16 and 17 of the onerous 1018 page H.R. 3200 is the true testimony to the President’s poverty of principle when it comes to being forthright with the American people on his designs for health care. Here is where mouthing platitudes rubs against reality. Mr. Obama states that you will be able to keep your current health insurance if you so desire. What he does not tell you, and what is clear in this section of the bill, is that after year one of this bill’s passage there will be no choice for independent private insurance. All insurance will need to pass muster with the government to enter a health insurance exchange like in Massachusetts or it will not be available at all. 

When will the Janus mask of this administration be pulled away to reveal its true features? I pray now.

Dr. David C. Goodman, a member of the Dartmouth Atlas of Health Care which recently scolded doctors for being liable for America’s health care crisis, gave invited testimony in March 2009 to the United States Senate Committee on Finance, the committee that will be largely responsible for what passes on health care reform.  Director of the Dartmouth Center for Health Policy Research, Dr. Goodman presented his affidavit “Linking Workforce Policy to Health Care Reform” to the committee chaired by health care reform zealot Senator Max Baucus of Montana among others. Dr. Goodman gives us his prescription for how to solve what he calls the “indiscriminant growth in physician numbers” in areas with already arbitrarily adequate physician supply. Lamenting that physician per capita numbers vary from region to region in the U.S. he states-“This variation in physician supply is not explained by differences in patient illness levels or in population health but by where doctors prefer to practice and live.” If you read the full testimony you will realize that this is meant to be pejorative. Who is to blame for this? Well, doctors, of course, but not just any doctors. He lays this at the feet of the doctors involved with physician graduate medical education (GME). Something must be done.

The Council on Graduate Medical Education (CGME) was originally charged by Congress to oversee the training of doctors and to insure that the physician workforce would meet the country’s needs. It does not have conniption fits about where doctors choose to live and contribute to their communities. Originally funded for years at a time it is now is subject to annual review for appropriations through its relation to the budget of the Department of Health and Human Services. Max Baucus could call for a budget hearing on the CGME on a whim. Dr. Goodman stating that the CGME’s charter “..has impaired its effectiveness.” – calls for change. CGME’s higher ups are almost exclusively physicians which does not settle well with Dr. Goodman who hails for a “permanent health work force commission.” He goes on-“The membership of the commission should extend beyond physicians and include experts in public health, patient centered care, as well as nurses, consumers, health care systems and payers.” and “Effective policy requires a dedicated staff that is independent of professional societies (read doctors) and trade associations.” Therefore, we can assume that Dr. Goodman, who lives in New Hampshire because he is needed there and would prefer to live elsewhere, is trying to convince a very powerful group of Senators that doctors shouldn’t be allowed to live where they want and are incapable of safe guarding the public and their own profession. You can imagine for yourself which groups of people he would prefer to have a permanent seat at the workforce policy table. He bemoans the fact that we are not more like “…Canada, the United Kingdom and Australia” when it comes to workforce planning. Lastly, he wants this commission to have power. “Congress should provide the commission with an increasing degree of regulatory responsibility that insulates reform from the self-interests of training programs and clinicians.”  How would they put such powers to work? There are examples.

In 1985 in British Columbia, Canada, Bill 41 was passed into law as the Medical Service Amendment Act.  Having been defeated earlier in other forms of legislation it was rapidly pushed through before the medical profession was able to mount another effort to defeat it. Sound familiar? Originally developed by an advisory committee of the Ministry of Health, not unlike the type that Dr. Goodman advocates now, its purpose was to solve the perceived maldistribution of physicians in the province. It tied a new applicant physician’s ability to get an assigned billing number, necessary to be able to bill the single payer government system, to geographic locations. Simply put, if the government needed a doctor in a rural area and if you wanted to practice in British Columbia you went where you were told. Of course this was fraught with corruption and you could get around it by buying an outgoing physician’s practice who sat on one of the boards in the area you wanted to practice in. In place for years, Bill 41 was defeated in large part due to law suits brought on by the Professional Association of Residents and Interns of British Columbia (PAR-BC), a group greatly affected by it as they all had to apply for billing numbers once out of training. There is no way to measure how much liberty was lost during its grasp on these physicians. 

Undeterred by defeat and impervious to what is just the Ministry of Health now ties reimbursement to geographic location. All General Practitioners with a new billing number get 50% of the customary reimbursement for 5 years. Specialist can get 50%,75% or100% depending on the “need” in the area they choose to live in. They are subsidized by the government if they agree to go to “designated areas” with what are basically stipends. This was all done with the blessing of the traitors at the British Columbia Medical Association. PAR-BC challenged this legislation and lost.

Young men and women in this country considering medicine as a career need to be aware of their governments’ intentions on limiting their liberty in this and many other issues before us. Your labor and hard work are your property. Marx believed in the eventual abolition of private property. He would see the efforts of Dr. Goodman as a good start.

Nauseated by the repeated citations of the Dartmouth study which shows physicians to be the genesis of all our health care woes I decided to do a novel thing-read it. Politicians, including the President, admittedly negligent in not reading the massive spending bills they have passed are not likely to have vetted this research before blathering away on how, in the words of Washington Post columnist Steven Pearlstein,   “It’s the doctors stupid.”

One of our liberal friends, Dr. Elliot Fisher of the non-partisan (satire) Institute of Medicine, is co-author of a perspective piece on the study published in the New England Journal of Medicine on February 26, 2009. He and his co-authors draw broad and unscientific observations about physician responsibility for regional differences in per capita Medicare beneficiary costs when it is more likely that patient population and cultural differences are more likely to account for much of the differences. These are my own observational opinions of course but they are just as well founded as Dr. Fisher’s and are tempered by the fact that I have actually lived in several of the areas cited and there is no extenuation for making cohorts of patients in such diverse areas of the country.

At the extremes of per capita costs are Miami, Florida and Salem, Oregon. The former represents the most expensive and the latter the least. For health policy wonks like Dr. Fisher it is amazing that such diversity is lost on him. Not withstanding that Oregon rations care, has assisted suicide and gives quality of life scores to patients determining who gets care and who doesn’t, Miami does not remotely resemble Salem. Considering Miami, mostly comprised of very elderly retired people, people of diverse cultural backgrounds and transients from other areas of the country, why would one even begin to believe that a doctor would practice in a similar manner there and in Salem? People in each area have completely different expectations of their health care system with Salem having probably the lowest being used to rationing or being given the option of being dispensed with.  Anyone who would make the statement, as Fisher et al did that-- “..there is no evidence that health is decaying more rapidly in Miami than in Salem.”—has never, ever lived in Miami. Unless Americans from all over the over crowded, over taxed Northeastern United States are flocking to Salem, Oregon this statement is pabulum.

The article also cites that physicians in high cost areas were also more likely to order tests and refer to specialist. Having worked as a doctor in Florida, this can partially be explained by the incredible litigious environment in that state in contrast to Oregon where, well, you get what you get.

Becoming familiar with Dr. Fisher, the Institute of Medicine, the Harvard School of Health Policy and all of the other liberal institutions adulterating the real solutions to health care reform with their bias is essential. I would encourage everyone concerned, mostly my physician colleagues, to take note of this study as in the coming weeks and months it will be referenced to until it makes you, like me, crave for an air bag.

President Obama, intent on thrusting us headlong into financial bondage for decades to come with his health care reform initiatives, yammers on at every opportunity how this must all be done quickly lest the opportunity for real change evaporate like a Medicare trust fund. He is an impetuous fellow and likely has never heard the idiom imparted to most American children very early in life: Haste makes waste.

In Britain they have been experimenting with socialized medicine since 1948 and being more circumspect than our current President and Democrat run Congress have of late made some very interesting reforms of their own. The British National Health System (NHS) is the public health system in charge of 92% of healthcare delivery in England.  By the mid 1990's need for reform was recognized. Starting with the Community Care (Direct Payments) Act of 1996 people were eligible to receive direct payment of money from the government to apply to their health care. The money was only to be used for needed health care services and was given in proportion to the assessed needs of the individual patient. The patient is responsible for making their health care choices and there are social services available to assist them in how to manage their budget. Emergency services lie outside this budget and are available with the patient’s other benefits within the NHS. Although this would be great if this were available to everyone in the UK it is now only available to people requiring social services such as the disabled. It is intended to enhance their lives by empowering them with their own health care decisions. Ah, good intentions.

Apparently there can be a limit to the British governments’ largess in letting disabled persons have self determination. Two disabled pensioners Steven Harrison and Valerie Graham are currently in court to retain their privileges of Direct Payments rather than re-enter the NHS general agency care through Primary Care Trusts (PCT). PCT’s are local socialized medicine politburos that most UK citizens are subjected to where decisions for your care are made by guidelines developed by the National Institute for Health and Clinical Excellence (NICE). If all goes well for socialism the Health Care Institute of Comparative Effectiveness Research will be its  parallel in the USA.  

Mr. Harrison, 41, a former soldier, is a quadriplegic who requires significant care with his activities of daily living. He currently is able to choose his doctor and his health care attendants by employing them through monies he gets from Direct Payments. Likewise, Mrs. Graham, in her sixties and severely disabled since birth with a degenerative muscular disorder, wishes to retain the autonomy and dignity she derives from the program. The travesty in  all this stems from a change in the law that states that people can not receive funding from the NHS and social serves funded by Direct Payment programs. They must choose one or the other. In Mrs. Graham’s case it was determined that after her need for a tracheotomy her care needs were such that they fell within the purview of the NHS and she would need to drop her care provided by the Direct Payment program. Mrs. Graham has apprehensions that if she is denied Direct Payments and instead has to rely on the inferior NHS services that it would destroy her and her husband’s lives. Mr. Harrison similarly was assessed to have a health need which negated his eligibility. The cost of NHS agency care for the disabled is sometimes as much as 3 times that of care proved through Direct Payments. There is no evidence that both patients needs could not be met by self determining who would provide that care.  Mr. Harrison and Mrs. Graham presently have a discrimination suit being heard in the High Court.

George Baker, a disabled citizen and Direct Payments advocate, has written a book: “The Complete Insider’s Guide to British Health and Social Care : How to Secure the Perfect Care Package”. Seeing the possible duplication of his fate in the case of Mr. Harrison and Mrs. Graham, Mr. Parker  commented-“ I’ll tell you something now, it is beyond me how most of the decisions in the NHS and health and social sector are made and sometimes it even makes me think: You know what? Screw the NHS! It’s inefficient, ineffective and insanely expensive….let’s just have nationwide private health care instead…at least then the private businesses might compete with each other and give us more value for {our} money.” Nothing teaches like experience. 

When government is so fully ingrained in the life of its citizens the natural consequence of its paternalism is failure. In 2001 the future President of the United States, Barak Obama, said of the Constitution “..generally the Constitution is a charter of negative liberties. Says what the federal government can’t do to you, but doesn’t say what the federal government or state government must do on your behalf.”  I wish that our President did not find himself so compelled to intercede on our behalf. Worse yet, he is in a hurry.

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