Community For Affordable Health Care

Vol V, No 1, April, 2006


Utilizing the $1.4 Trillion Information Technology Industry

To Transform the $1.7 Trillion HealthCare Industry into Affordable HealthCare


In This Issue:            

1.         Featured Article: Poison Pill – The Atlantic Monthly

2.         In the News: You Can Be Too Careful - Reason

3.         International Medicine: In the NHS, the Maximum Waiting Period Of Six Months Becomes the “Minimum Waiting Period” To Save Money – London Telegraph

4.         Governmental Health Plans: A View As To What’s In Store for America

5.         Lean HealthCare: How the NHS Achieves Lean Health Care – Close Hospitals

6.         Medical Myths: HealthCare is Free in France and Germany

7.         Overheard on Capital Hill: Goodbye to Goldwater - Reason

8.         What's in Store for US Health Care:  Well-Meaning, Intelligent Experts Who Are Medical Illiterates Discussing Health Care

9.         Health Plan USA: A Work in Progress

10.        Doctors Restoring Accountability in Medical Practice by Non Participation in Insurance and Government Programs

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1.         Feature Article: First Principles: Poison Pill, by Clive Crook
Big, politically ugly changes to
America's health-care system are unavoidable—consumer-driven health care may be the least-bad option – The Atlantic Monthly

In every rich country, it seems, people expect too much of their health-care systems. That is why, in their different ways, they are disappointed—and why they always will be. Citizens everywhere desire unrestricted access to state-of-the-art technologies. Increasingly, they insist on choice and control, too. Yet they are unwilling to pay what those things cost. People demand as a right the best health care money can buy, delivered in the way that best suits them, expense be damned. All that, and the price must be affordable.


Nowhere can this self-contradictory demand be satisfied. Everywhere, therefore, health care presents itself to governments as their most difficult nonsecurity challenge. In the United States, the costs are already staggering, and unless something changes, they will only get worse. Such is the sensitivity, though, that only the bravest or most reckless policy makers stride up to the issue with a genuine intention to act. Health care is a political death trap.

Consider this: the government increases its spending on Medicare by tens of billions of dollars a year (as the administration did with its recent prescription-drug reform) and the beneficiaries are up in arms about it. Yes, the execution of the scheme was botched. Still, where else could generosity on such a scale actually arouse hostility, to say nothing of its apparent failure to buy votes? When Americans are asked what they think about health care, most say they like the quality of service (the government must do nothing to compromise those high standards); they also complain that health care is far too costly (the government must act).

Wherever you look, you find no plainly superior system. Countless variants—from the mainly government-run, single-provider, single-payer model at one extreme to America's semi-private, multi-provider, multi-payer approach at the other—have been tried. None is widely popular. Canada, did somebody say? You must be joking. Rationing and gaps in coverage, necessary instruments of cost control in that system, are at the limit of what people will accept: they were an issue in the recent election, and helped get the previous government thrown out. Britain's National Health Service, once the country's pride, is today renowned for dirty hospitals that make you sicker than you were to begin with. (Private health insurance, with its higher costs and standards, is popular there; a two-tier system, one for haves and another for have-nots, quite at odds with the founding principles of the NHS, is firmly in place.)

Of course, the world's national health systems have more in common than you might think. Almost all of them are hybrids, mixing public and private. In statist Canada, some 30 percent of health spending is privately financed. In supposedly free-market America, well over 40 percent is taxpayer financed, and the privately financed part is intensely regulated—hardly a case of "leaving it to market forces." But the fact remains: many blueprints have been tried; all have drawbacks, and all leave users complaining about standards or costs, or both.

Here is a basic principle: if costs are to be better controlled, some medical services must be either forgone or denied. The key question: Who decides? Top-down rationing—as in Britain's health service—is one approach. Consumer-driven health care—where patients decide for themselves what they can afford—is another.

In the United States, where almost all privately financed health care is provided by employers through tax-sheltered insurance plans, neither of these curbing mechanisms is in place. There is no government monopoly, and, with employers paying for their insurance, most patients need not concern themselves much with the cost of their treatments. The result is that this country spends more per person on health care than any other—15 percent of the national income, compared with a rich-country average of 9 percent.

This enormous extra cost doubtless saves or significantly improves many lives. It supports a remarkable pace of innovation. And nothing is wrong in principle with a country spending proportionally more of its income on health care as it gets richer. But the system includes plenty of waste. It delivers services that cost more to provide than they would be worth to the patient if the patient were paying. And millions of Americans with low-paying jobs have no insurance: their employer does not provide it, they cannot afford to buy their own, and they are not poor enough to qualify for Medicaid. So America's health outcomes, in the aggregate, are only fair by international standards, and are not nearly as good as they should be, given what the country spends.

The administration and the economists it listens to want to control costs by mobilizing consumers. If the tax advantage for employer-provided insurance were removed or offset, and if more people bought their own policies, Americans would lean more toward plans with low premiums and plenty of cost-sharing (high deductibles and high co-payments). In this way, health insurance would be more like real insurance—a protection against serious financial risk—and less akin to a utility payment plan. Patient-consumers would have the incentive they lack at present to force costs down. The administration has proposed some reforms with this notion in mind.

This kind of approach draws two objections—one largely false (though widely advanced), the other valid. The false objection is that patients are too ignorant to be intelligent consumers of medical services. It is all too complicated, this argument goes. Necessary health expenditures would be cut as well as unnecessary ones. Some even question whether there is any such thing as an unnecessary health expenditure. It is not as though people go to the doctor for fun, they point out; people do it only when they have to. If you restrict access by directly confronting people with the costs, their health will suffer.

Well, such evidence as there is says that when patients have to pay a direct share of health-care costs, they do buy fewer medical services—but also that the effect of this on health outcomes is small. This was the principal finding of the RAND Health Insurance Experiment of the 1970s and early 1980s, still the largest health-policy study ever conducted in the United States. (Its findings are often quoted, but not always accurately.) One of the researchers, in a summary of the results on the RAND Web site, put it like this: "The additional care with free care may have had little marginal value besides relief of temporary anxiety and symptoms. In fact, free care led to more self-reported diseases and worry, especially among the initially well and rich ... There seems to be little [health] cost to increasing cost sharing within the range studied by the experiment and enormous potential savings."

Patients, given a reason, buy wisely. Is that so surprising? The truth is, buyers are at an informational disadvantage to sellers almost every time a deal—any deal—is struck. But they understand this, do their homework (if the transaction justifies the effort), and find ways of mitigating the problem, whether they are buying a car, a home, a college education, or an operation to remove a mole. Health-care professionals have a vested interest (15 percent of the gross domestic product) in insisting that health is special. In this respect it is not, or at any rate not as different as the argument implies. In all likelihood, making America's health-care market work better—more like other markets, in other words—would succeed in restraining costs, maybe quite significantly, without making health outcomes much worse. And people value the ability to make choices for themselves as a good thing in its own right . . . 

The whole thing is political poison, of course, but as costs keep rising, something will eventually have to give. The present system is on course to be unaffordable and to let too many people down, and the closer you get to the single-payer socialized alternative, the less appealing it looks. Consumer-driven health care, supplemented with generous subsidies for those with low incomes, is at least worth a try.

To read the article, (subscription required) go to

Any Entitlement Is Permanent Because It Is A Poison Pill That Congress Won’t Swallow

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2.         In the News:  You Can Be Too Careful by Brian Doherty

How the government’s new corporate accounting rules impede efficiency and stifle innovation – Reason

Adelphia founder John Rigas got 15 years (a life sentence for the 80-year-old executive), and former WorldCom CEO Bernard Ebbers got 25—two victories in the government’s post-Enron wave of corporate fraud prosecutions. Meanwhile, the Enron case itself has crawled along, with few significant victories and a handful of defeats for federal prosecutors. The trials of former Enron chairman Kenneth Lay, president Jeffrey Skilling, and chief accounting officer Richard Causey are set to begin in January.

New laws were not necessary to prosecute those executives. Still, Congress responded to the scandals that destroyed or hobbled their companies by passing the Sarbanes-Oxley Act. Signed into law by President George W. Bush on July 30, 2002, Sarbanes-Oxley was supposed to crack down on accounting irregularities, punish those responsible for hiding them from the public, and curtail potential conflicts of interest in corporations’ relationships with their auditors. HealthSouth CEO Richard Scrushy was the law’s first big collar. He recently walked away from his trial a free, if disgraced, corporate bigwig, after 21 days of jury deliberation. Many credit Scrushy’s refusal to testify in his own trial as a plus for him—he left the jury to judge the probity of a bunch of other HealthSouth execs, self-confessed fraudsters who had previously pled guilty and testified against Scrushy. 

Sarbanes-Oxley, a.k.a. SarbOx, is a complicated law that has the business world abuzz with annoyance and anxiety. Among other things, it requires that CEOs and chief financial officers certify, under penalty of 20 years in prison and $5 million in fines, that their internal financial controls are in order and that they lead to accurate reports. It says executives must provide “reasonable assurance” that everything is kosher, a provision that is likely to invite litigation as well as prosecution. The law created the Public Company Accounting Oversight Board, adding yet another level of oversight to a profession already monitored by the Securities and Exchange Commission, the Fair Accounting Standards Board, and the Justice Department. The board is ostensibly private, but has the power to force accounting firms to pay both fees for its operations, and fines for disobeying its edicts. SarbOx also requires that auditors (though not necessarily auditing firms) switch out every five years, and it prohibits auditors from jumping ship to executive positions at companies they have just audited.

Critics in academia and business journalism—and many from the corporate world itself, most of whom are reluctant to talk on the record and thereby show “bad faith” regarding the law—have many complaints about SarbOx, from its picayune requirements to its overall cost. While all such guesstimates should be taken with a grain of salt, one financial consulting firm, the Johnsson Group, has put the 2004 costs of SarbOx compliance at $15 billion. The critics also argue that the law’s benefits are apt to be small. . . .

SarbOx probably won’t cripple the American economy, any more than the Clean Air Act or the Americans with Disabilities Act did. But it’s bound to create bad incentives and unintended consequences. Far from increasing the efficiency of capital markets, it will discourage some businesses from going public, since most of its provisions do not apply to privately held companies; will encourage some now-public companies to go private; and will keep some foreign companies out of the U.S. stock market.

According to a survey of companies with under $1 billion in annual revenue done by national law firm Foley and Lardner, SarbOx has more than tripled the average annual regulatory costs of being a public company in the U.S., from around $1 million pre-SarbOx to $3.4 million in 2004. The law also may tend to chill mergers, since purchasing companies will now be legally responsible for the financial records and statements of their targets, documents they had no role in creating.

The costs of SarbOx compliance, while not driving anyone out of business, will siphon revenues toward legal and accounting work. That drain may, in the words of Forbes’ Rich Karlgaard, “succeed in stopping the next Enron, but…crib-kill the next Cisco, Microsoft and Starbucks” by leaving them less capital with which to expand.

To get a better sense of how Sarbanes-Oxley is affecting American businesses, Reason Senior Editor Brian Doherty asked four people familiar with the law’s consequences to explain what the new rules mean in practice. . . .

As a Sarbanes-Oxley compliance consultant, Stephen Stanton is a man whose self-interest should encourage him to praise the law. But he sees little good coming from it, aside from added income for consultants and auditors.

Charles Wilson is chairman of the board of Trio-Tech International, a California-based semiconductor testing company with about 500 employees and a market capitalization of $12 million. Wilson, whose company went public in 1981, says Sarbanes-Oxley makes him wish he could reverse that decision.

To read the other responses and the entire original article, please go

Congress Has Placed Another Roadblock To An Innovative Market Based Health Plan.

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3.         International Medicine: In The NHS The Maximum Waiting Period Of Six Months Becomes The “Minimum Waiting Period” To Save Money.

It's the doctors' fault the NHS is in financial trouble, says Hewitt
By Melissa Kite and Beezy Marsh (Filed: 12/03/2006)

Patricia Hewitt blamed doctors for holding up National Health Service improvement yesterday as she announced that hospitals are to be rated on their financial performance.

The Health Secretary said part of the problem facing the health service was "clinical resistance" to change.

Tomorrow a Government watchdog the Healthcare Commission will announce a two-tier rating system that will see hospitals given separate scores for clinical care and management of resources.

The Sunday Telegraph can also reveal that NHS staff may have their pay rises delayed by the Government to help to ease the financial crisis in the NHS. Sources said the Treasury and Department of Health were considering a "staged" pay award, which would allow them to put off payment until later in the year.

An announcement on the pay deal for 2006-7 was postponed last week following the departure of the NHS chief executive Sir Nigel Crisp after it emerged that debt is likely to top £800 million this year.

More evidence of the worsening situation came yesterday when Eastbourne Downs primary care trust ordered the town's hospital not to operate on any patient who had not been waiting six months, the maximum allowed, making it the latest to introduce in effect a "minimum waiting time" to save money.  

Ms Hewitt said the best hospitals were those where "you have got the clinicians and the managers working well together". She said: "Behind every good clinical team is a good manager. Patient care goes hand in hand with good finance." . . .

Ms Hewitt appeared to acknowledge there was a problem with pay. She said: "It's been clear for a while that 'Agenda For Change' and the new GP contracts are all costing us rather more than we anticipated." . . .

The Chancellor, Gordon Brown, has already told the Pay Review Body - the independent body that makes recommendations on NHS pay - that he wants awards to be capped at two per cent this year, just above inflation.

The British Medical Association is seeking a minimum pay rise of 4.5 per cent for doctors this year.

To read the entire article, please go to

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4.         Governmental Health Plans: A View As To What’s In Store For America

Botched operation
By Ross Clark, Melissa Kite and Beezy Marsh, (Filed: 12/03/2006)

Patricia Hewitt was confined to barracks as news of the parlous state of NHS finances swept Westminster. The Health Secretary had been ordered to wait for a vote on the Childcare Bill and so found herself crammed with a team of advisers into her spartan Commons office lined with health service "best practice" guides.

A meticulously composed minister, Ms Hewitt was making the most of an unenviable task: how to explain to journalists why health service deficits were running at a record £800 million and why Sir Nigel Crisp, the chief executive, had just taken "early retirement".

Three-hundred miles away in Penzance, 14 ambulances queued to unload their occupants at the A&E department at the West Cornwall Hospital - unwelcome news for local health chiefs as they prepared to announce 300 job cuts and the closure of wards and operating theatres. The queue, according to the Royal Cornwall Hospitals NHS Trust, was caused by an "unpredictable peak of activity" - health quango-speak for a spate of road accidents - but it must have seemed a portent of doom.

The trust's other main hospital, the Royal Cornwall Hospital in Truro, had just written to 200 patients to warn that their operations were to be postponed as part of an attempt to solve a cash shortage of £8.1 million this financial year.

For Cornwall's sick and infirm, more delays and cancellations in treatment inevitably lie ahead and it is the same story across the country, where dozens of small hospitals have either been closed or earmarked for closure, wards have been mothballed and training slashed.

Had this been happening against a background of Government cuts it might be easier to understand. Yet, money has been lavished on the NHS in recent years. Since Gordon Brown announced in his 2002 Budget that he was putting a penny on National Insurance to fund health spending, the NHS budget has risen from £65 billion to £87 billion, an increase in real terms of 7.5 per cent a year. British health spending - NHS and private health - has grown rapidly from 7 per cent of GDP in 1997/98, and is on course to reach the 9.8 per cent of GDP spent by the French by 2008.

So where has all the extra money gone? Much of it, according to the King's Fund, the independent think-tank, has gone into the pockets of doctors and nurses. In 2004/05, the fund claims, an extra £5.086 billion was spent on hospital and community health services (ie most NHS expenditure excluding GPs' surgeries), a 12.4 per cent rise on the year before. Yet, of this hefty increase, a mere 2.4 per cent found its way into new beds and extra operations. A massive 27 per cent went on pay rises and 29 per cent was spent on "rebasing" the pensions of NHS staff, effectively shifting the liability from the Treasury to the NHS.

According to Laura Mason, of the Royal Cornwall Hospitals' Trust, new consultants' contracts have added £1 million to the wage bill this year, and Agenda for Change, which established national pay scales for nursing and other staff, has added a further £2.5 million. The trust's funding from Whitehall, however, has failed to take account of the fact that hospitals must now pay nurses the same rate in Truro as in the Home Counties. Rather, money is doled out to hospitals on the basis of the market-forces factor, which assumes that staff are cheaper in certain areas. "We lose out because while Cornwall has some of the lowest wages in the country, we have to pay a national rate," says Miss Mason. . .

Ms Hewitt went on to blame "clinical resistance" to change among some doctors, echoing Tony Blair's remark in a speech in 1999 that he had "scars on my back" from attempting to reform health.

She cited the case of John Petri, an Italian orthopaedic surgeon who has spent most of his career in France. Mr Petri came to work at the James Paget hospital in Great Yarmouth, and was astonished to find that although there were more doctors employed at the hospital than at an equivalent hospital across the Channel, fewer operations were being performed and there was a long waiting list. He adopted a French-style "production-line" system.

While he operated in one theatre, another patient was prepared in a second. He moved on to the second patient, leaving a junior to finish the first. By the time the second operation was nearing completion, a third patient was waiting for him in the original theatre. The system enabled him to perform up to five hip and knee replacements in a shift, compared with one or two carried out by surgeons who use one theatre. Yet it faltered, said Ms Hewitt, because "other surgeons in that hospital were not particularly keen to adopt the same practice".

Ms Hewitt's complaint certainly won't wash with surgeons down at the Royal Cornwall Hospital. There, operations have been cancelled not because of lax clinical practices but because surgeons have been "too efficient". In the financial year to December, the trust performed 37,000 operations - 4,600 more than had been planned. The surgeons would have happily carried on cutting, but the local primary care trusts (PCTs), which purchase operations, could not afford any more and 200 operations have been put off until the new financial year.

Indeed, the very introduction of PCTs, has played a part in the financial debacle. Inspired by World Health Organisation dogma that health care is best administered through public bodies that cover about 100,000 people, PCTs were supposed to provide a missing element of localism into the bloated monolith that is the NHS. Instead, they have managed to upset more local people than a Whitehall planner could ever dream of doing.

West Suffolk PCT, for example, has proposed the closure of two hospitals in Sudbury, one of which has a well-used outpatients' department. Patients would have to take a 75-minute bus ride to Bury St Edmunds. According to the PCT, the closures are part of a scheme to introduce a new concept called "Intensive Care Management", whereby fleets of nurses would set out on the road to treat patients at home instead. But, given that West Suffolk PCT, like many others, is nursing a large deficit, it is hard to escape the conclusion that the motive is financial . . .

One thing is sure: the Public Finance Initiative (PFI) deals which have been used to construct many new hospitals are not going to save money. The Norfolk and Norwich Hospital, for example, is locked into a management contract with a private consortium for 60 years. While contracting out the running of buildings and catering services is common in the private health sector, only the NHS has managed to tie itself up for so long. . . .

When, in 2008, spending matches that of the French health service, you can be sure that Ms Hewitt, if she is still in office, will herald it as a great success. Nurses and doctors will be happily spending their extra wages. Whether we will really be healthier for it all, or whether the rapid increase in NHS spending is based on a false premise that more money equals better health, is another matter.

To read the entire article, please go to


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5.         Lean HealthCare: How The NHS Achieves Lean Health Care – Close Hospitals

Christopher Booker's notebook (Filed: 12/03/2006)

Hospitals must go, to pay for the managers to close them

Two weeks ago today, when I went for a cataract operation at a small community hospital in Westbury, Wiltshire, I little realised I was walking into the centre of a major national scandal. Originally referred to a large general hospital, I had been told the operation might not be possible for a year. On questioning this, I was told that if I went to the special eye unit at Westbury, I could be fitted in just two weeks later.

Arriving at the hospital's clean modern buildings on a Sunday afternoon, I was so struck by the friendly atmosphere and the speed and efficiency with which the operation was completed that I observed that Westbury seemed an absolute model of everything the NHS should be. I was then told that, thanks to a shock decision by West Wiltshire Primary Care Trust (PCT), the hospital was being closed down - starting the following week with the removal of its 12 elderly in-patients. The rest of its wide range of services would soon follow.

What made this decision incomprehensible, as Westbury's MP Dr Andrew Murrison pointed out when he raised it in Parliament, was that it flies right in the face of Patricia Hewitt's recent White Paper on community care. Not only had Mrs Hewitt stated that "community hospitals should be retained if needed and wanted by the communities they serve", she urged "Primary Care Trusts to rethink their closure plans, particularly when they were being put forward as a cost-saving measure. Community facilities should not be lost in response to short-term budgetary pressures".

But Westbury is far from alone. Such is the spate of closures and cutbacks taking place all over the country, in a bid to reduce the NHS's current £800 million deficit, that some 90 of our 350 community hospitals are threatened, according to Chant (Community Hospitals Acting Nationally Together), a body formed to fight the closures. In Shropshire alone, protest marches in Bridgnorth and Ludlow each attracted 4,000 people, while another 2,000 turned out to protest at the proposed closure of Whitchurch.

What makes this truly scandalous are the reasons for the closures. Since 1999 the Government has almost doubled its NHS spending, from £40 billion to £76 billion. But 80 per cent of this additional money has gone, not on expanding health care, but on a massive inflation in salaries (with many GPs now said to be earning £125,000 a year); on the increased cost of drugs and compensation claims; and on the soaring cost of interest on PFI building schemes.

One of the biggest increases has been the 66 per cent rise in the number of health service "managers", in what is now said to be the third-largest state-run organisation in the world, after the Chinese army and the Indian railways. Yet it is these bureaucrats who are deciding to close down nearly a quarter of our community hospitals, to meet a deficit which has resulted not least from their own recruitment: precisely the "short-term budgetary pressures" which Mrs Hewitt insists must not be made an excuse for closing community hospitals.

[In] Westbury where, last Sunday, in what was described as a "dawn raid", the remaining in-patients, elderly and confused, were summarily removed from their beds, without breakfast, to be sent to other hospitals. Only one remained - Mena Rising, terminally ill with cancer and too weak to be moved. She died on Thursday.

Such inhumanity should prompt Mrs Hewitt to intervene now, to halt a disaster which makes such a mockery of her fine but, it seems, empty words.

To read the original article, go to

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6.         Medical Myths: HealthCare is Free in France and Germany

More doctors, but care isn't free for the French and Germans (Filed: 12/03/2006)


Public health is financed from taxes and compulsory social-health insurance contributions from employers and employees. Tax is "ring-fenced" from pay packets and paid into the national health service budget.

Compulsory sickness insurance funds cover 99 per cent of the population. People are affiliated to a health-insurance scheme on the basis of their professional status and place of residence. The insurers are non-government, non-profit agencies and employers pay a premium for them.

Seventy per cent of a person's health-care costs are covered by social security. To cover the remaining 30 per cent, they pay their "mutuelle", an annual premium equivalent to £1,500 per year that guarantees them a single room in hospital. Employers bear a heavy part of the cost.

Patient contributions are taken for visits to the GP, which costs about £13 up front but with 70 per cent of the cost refunded. Prescriptions are also paid for but up to 65 per cent of the cost is refunded by the state.

Dental care is not covered by the public health scheme.

France spends about 10 per cent of its GDP on health, compared with about 8 per cent of GDP in the UK. France has about 3.4 practising physicians per 1,000 population, compared with 2.2 per 1,000 here. To read the entire article, please go to


There are about 450 so-called sickness funds, or public-health insurance companies, which the employee and employer must pay into to fund Germany's public health care system.

Contributions are shared equally between the insured and their employers. The average contribution rate is 13.5 per cent, so the employee will contribute 6.75 per cent out of their pre-tax income and the employer will pay the same amount in addition to wages.

Everyone has the right to choose which fund they want to join. . .

Germany spends 11.1 per cent of its GDP on health and has 3.4 physicians per 1,000 population.

To read the entire article, please go to

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7.         Overheard on Capital Hill: Goodbye to Goldwater

Rick Santorum’s Republican crusade for big government. By Jonathan Rauch for Reason – Free Minds and Free Markets

It Takes a Family: Conservatism and the Common Good, by Rick Santorum, Wilmington, Del.: Intercollegiate Studies Institute, 464 pages, $25

In 1960 a Republican senator from Arizona named Barry Goldwater published a little book called The Conscience of a Conservative. The first printing of 10,000 copies led to a second of the same size, then a third of 50,000, until ultimately the book sold more than 3 million copies. Goldwater’s presidential candidacy crashed in 1964, but his ideas did not: For decades, his hostility to big government ruled the American right. Until, approximately, now.

Rick Santorum, a second-term Republican senator from Pennsylvania, has written a new book called It Takes a Family: Conservatism and the Common Good. The book is worth taking seriously for several reasons, not least of which is that it is a serious book. The writing and thinking are consistently competent, often better than that. The lapses into right-wing talk-radioese (“liberals practically despise the common man”) are rare. Santorum wrestles intelligently, often impressively, with the biggest of big ideas: freedom, virtue, civil society, the Founders’ intentions. Although he is a Catholic who is often characterized as a religious conservative, he has written a book whose ambitions are secular. As its subtitle promises, it is about conservatism, not Christianity.

Above all, it is worth noticing because, like Goldwater’s Conscience, it lays down a marker. As Goldwater repudiated Dwight Eisenhower and Richard Nixon, so Santorum repudiates Goldwater and Ronald Reagan. It’s now official: Philosophically, the conservative movement has split. Post-Santorum, tax cutting and court bashing cannot hold the Republican coalition together much longer.

As a policy book, It Takes a Family is temperate. It offers a healthy reminder that society needs not just good government but strong civil and social institutions, and that the traditional family serves essential social functions. Government policies, therefore, should respect and support family and civil society instead of undermining or supplanting them. Parents should make quality time at home a high priority. Popular culture should comport itself with some sense of responsibility and taste  . .

Goldwater and Reagan, and Madison and Jefferson, were saying that if you restrain government, you will strengthen society and foster virtue. Santorum is saying something more like the reverse: If you shore up the family, you will strengthen the social fabric and ultimately reduce dependence on government . . .

To read the entire article, please go to

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8.         What's in Store for US Health Care:  Well Meaning Intelligent Experts Who Are Medical Illiterates Discussing Health Care

What can be done to aid the recovery of the [NHS] system? (Filed: 12/03/2006)

John Appleby
The chief economist for the think-tank, the King's Fund, a charity that works to improve health care through research and policy analysis

"The NHS needs to look at how long patients actually mind waiting for their operations. It has achieved a target of maximum waits of six months, but now has a new target of 18 weeks' waiting by 2008. That could be very difficult to achieve.

"With the current financial situation, we may have to see patients waiting up to the maximum six-month limit in order to save money for the NHS. The Department of Health is going to have to start thinking about relaxing some of the targets it has set the NHS."

Josie Irwin
The head of employment relations at the Royal
College of Nursing

"The Government needs to look at what has happened to the NHS and put the pieces of the jigsaw together to solve the current financial problems.

"The NHS has been stretched to the limit by a range of Government initiatives without the capacity to fulfil them. It's an issue of not getting to grips with finance before launching new schemes.

"There is a hugely expensive new computer system, which has been fraught with difficulties, spiralling drug costs and private finance initiatives to build new hospitals, which have locked the NHS into debts for years to come.

"Restructuring the NHS needs to be thought out carefully so that we don't face another round of upheaval in another year or two. How much is it costing the taxpayer to recruit all these new boards and chairmen?"

Dr Jonathan Fielden
The deputy chairman of the British Medical Association consultants' committee

"There has to be an appreciation that there is a limited amount of money in the NHS, so it can't all be delivered 'now'.

"When politicians impose a significant number of targets to be delivered in unreasonable time scales, things start to fall down. We are already stumbling into a situation where the only way to sort out the NHS is the blunt tool of finance.

"There are no easy answers on how to 'fix' the NHS. That means the time is right now for a proper public debate, led by the profession, about what we actually want from the NHS for the next 15 to 20 years."

To read what others are saying and the rest of the article, please go to

The entire NHS debate seems to be about finance, bean counting, even from the physicians and the BMA. Isn’t anyone even thinking about the suffering and dying patients and their needs? Why do we allow government to hurt our patients and destroy healthcare?

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9.         Health Plan USA: A Work in Progress

Our feature article this quarter, by Clive Crook in The Atlantic Monthly, gives an excellent overview of health care in this country and the world. Things are really in a shambles, essentially throughout the world. Many hold up the National Health Service or the Canadian Medicare as a goal for the United States. This should essentially eliminate that discussion, if based on reality.

Also, our correspondent in London has favored us with a series of articles from the London Telegraph, which she simply labeled with a yellow post it, “The NHS is going to [Hades] in a hand basket.” The horror stories from the UK are difficult to believe. What is even more tragic, many of our friends in England, after 50 years of the NHS, are unable to think outside of the “hand basket,” as if there is no alternative to having their medicine subservient to the public budget. To having necessary care and surgery cancelled and newly built hospitals closed, because of no national funds even when the local government is willing to keep them open, is a tragedy few seem to want to come to grips with.

The father of government social insurance, German Chancellor Otto von Bismarck, observed how Napoleon III used state pensions to buy support for his regime when he was Ambassador to Paris in 1861. "I have lived in France long enough to know that the faithfulness of most of the French to their government . . . is largely connected with the fact that most of the French receive a state pension." According to Brink Lindsey’s article in the journal Reason, the appeal of social insurance for Bismarck was that it bred dependence on, and consequently allegiance to, the state. Social insurance, whether social security, Medicare, or single-payer medicine, was thus born of a contemptuous disregard for liberal principles: What mattered was not the well-being of the patient or workers, but the well-being of the state.

When social insurance began to include our health care, we essentially became slaves to the state. Slavery was a difficult problem in our country in the past, but we finally prevailed. Will we prevail in freeing humankind from the medical slavery imposed by the state?

That is our purpose in life. We welcome you to the mission of freedom in medicine.

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10.       Doctors Restoring Accountability in Medical Practice by Non Participation in Insurance and Government Programs

  • John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to Stay tuned for their next innovative move in designing the healthcare system for the entire country of Antigua and Barbuda.
  • Michael J. Harris, MD - - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, no Medicaid, no HIPAA, just patient care. Dr Harris is also nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis" at

·         PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work.  Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE.   Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law. Ever have a blinding migraine and couldn't even drive to see a doctor? Dr Huntoon even makes house calls. Canadian patients are welcomed. Such a deal.

  • PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist states: "Our point-of-care payment clinic makes acute and chronic primary medical care affordable to the uninsured of our community by refusing to accept any insurance (along with the hassles and crushing overhead that inevitably come with it).  Read the rest of the story at
  • Dr Vern Cherewatenko has success in restoring private-based medical practice that has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the “Cash-Based Revolution.” The patient pays in full before leaving. Because doctor charges are anywhere from 25 – 50 percent inflated due to administrative costs caused by the health insurance industry, you’ll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to
  • Dr. Nimish Gosrani has set up a blend between concierge medicine and a cash-only practice. “Patients can pay $600 a year, plus $10 per visit, to see him as many times in a year as they want. He offers a financing plan through a financing company for those unable to plop down $600 all at once.” Patients may also see him on a simple fee-for-service basis, with fees ranging from $70 for a simple office visit to $300 for a comprehensive physical. Dr. Gosrani reports that he saves two hours per day that he used to spend dealing with insurance company paperwork. To read more, go to
  • Dr. Elizabeth Vaughan is another Greensboro physician who has developed some fame for not accepting any insurance payments, including Medicare and Medicaid. She simply charges by the hour like other professionals do. Dr. Vaughan's web site is at, where you can see her march in a miniskirt (which doctors should not be wearing) for Breast Health without a Bra. Careful or you may change your habits if you read her entire page.

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Please Note: Articles that appear in MedicalTuesday and HPUSA may not reflect the opinion of the editorial staff.

ALSO NOTE: MedicalTuesday receives no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the research and writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country.


Del Meyer

Del Meyer, MD, CEO & Founder

HealthPlanUSA, LLC

6620 Coyle Ave, Ste 122, Carmichael, CA 95608

Words of Wisdom

Charles de Gaulle (1890-1970):  I have come to the conclusion that politics are too serious a matter to be left to the politicians.

Plato (427 – 347 BC):  One of the penalties for refusing to participate in politics is that you end up being governed by your inferiors.

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This Month in History

April begins with the day that all Jokesters love, April Fools Day – the day when practical jokesters go to town. Aquariums receive a lot of phone calls for Mr Fish, salt and sugar gets switched, quarters are glued to the sidewalk, and improbable tales are told with a straight face.

It was no joke that on this day in 1789, the United States House of Representatives was finally able to assemble a quorum and get down to business.

And it was not a laughing matter, that on this date in 1863, the First Wartime Conscription Law went into effect in our nation, which was built by volunteer enlistees.