Community For Affordable Health Care

Vol VII, No 1, April, 2008


Utilizing the $1.5 Trillion Information Technology Industry

To Transform the $2 Trillion HealthCare Industry into Affordable HealthCare


In This Issue:            

1.         Featured Article: The Case Against Health Care Reform

2.         In the News: Non-Profit Hospitals Strike It Rich

3.         International Medicine: In Socialized Medicine, Even Patients Starve

4.         Medicare: Is Medicare For All the Real Answer?

5.         Lean HealthCare: Five Basic Principles We Can Use in Health Care

6.         Medical Myths: The Single-Payer Remedy Myth

7.         Overheard on Capital Hill: Ted Kennedy and John Tunney Sought KGB Advice

8.         What's New in U.S. Health Care: Health Care and Welfare to Illegal Aliens

9.         Health Plan USA: Good Reason for Optimism

10.        Restoring Accountability in Medical Practice by Nonparticipation in Insurance and Government Programs

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1.         Feature Article: The Case Against Health Care Reform By David J. Gibson, M.D.

At some point, the candidates running for national office need to pay heed to the lessons we have learned here in California. To ignore them will be a grave mistake.

In January, the Senate Health Committee drove the final nail in the Schwarzenegger / Nuñez plan to arrange medical insurance for nearly all Californians.  The plan would have required people to hold private insurance and subsidized the premiums for those who could not afford them.

This failure to produce health care reform here in California occurred within the context of a crumbling system for financing health care.  A growing number of Americans have no health insurance, costs of providing care have been rising far faster than the overall rate of inflation for the past decade, costs to workers of employer-provided insurance are growing at unsustainable rates while benefits are limited and the costs of coping with catastrophic illness are placing a growing risk of insolvency on families and all levels of government.

Despite this disappointing outcome, there are a number of sound reasons for the Senate’s having rejected the reform proposal passed by the Assembly.  Perhaps, some important lessons we have learned can be and applied as the debate about health care moves to the national level.  "Universal" health care is a major Democratic issue in the presidential nominating campaign.

So, what are some of the lessons that can be learned from the California experience that have applicability on the national debate?  The following five realities evolved during our debate.

The cost for a massive new government health care obligation is both unknown and problematic

It became evident during the California debate that state funds would not able to match the future growth in program costs.  This has been a painful lesion has been buttressed by our experience with the Medicare entitlement program.

According to the recently released report by the Medicare Trustees, the program’s unfunded liability has grown to $74 trillion -- five times that of Social Security.  According to the Congressional Budget Office, health care spending within Medicare is on a course that will crowd out all other government programs.  This represents a catastrophic miscalculation of future cost and represents a sobering restraint upon the exuberance to develop a new health care entitlement for the general population.

Furthermore, Medicare is progressively failing to financially protect its existing beneficiaries.  Retiree out-of-pocket expenditures to cover premiums, deductibles and co-pays for parts B and D of Medicare will consume 29 percent of the average Social Security benefit check this year.a,b

A poorly designed reform generally does more harm than good.

The health care legislation that the Assembly approved during the waning hours of the special session at the behest of Speaker Fabian Núñez closely resembled the far-reaching energy "deregulation" scheme of 1996 that turned out to be a disaster.  The Assembly Bill was worked out in private negotiations, and then dropped into the hopper late near the close. The Assembly Appropriations Committee conducted a pro forma hearing and gave party-line approval, even though few on the committee or those in the Assembly knew the contents of the Bill.

There was no financing component for the $14.4 billion expansion of health care coverage called for in the Assembly Bill.  It was highly likely that requiring employers to pay 1 percent to 6.5 percent of their payroll to fund this initiative violates long-standing federal law, as courts have held in other states.

Furthermore, the $14.4 billion price tag estimated by the Schwarzenegger administration was not credible.  Massachusetts under its recently enacted mandated universal health-care plan is now experiencing fare greater cost for the program than predicted.  The program has generated costs 20% over what the state had budgeted. The tab will likely run $619 million for the current fiscal year, $150 million over budget.  The cost could increase $350 million next year.  During implementation, Massachusetts has learned that it costs twice as much to insure people than paying for the sick ones who show up in hospitals.

The “universal” promise of the Massachusetts initiative is also now in question.   Massachusetts has now exempted almost 20% of uninsured adults who don't qualify for subsidies from mandated coverage because it is too expensive.

The board that oversees the plan has just approved cuts of 3% to 5% in reimbursements for to health-care providers caring for those in the subsidized plan. The article suggests the cuts will bring reimbursement in line with Medicaid.  So, one might reasonably ask, why all the hoopla about reform?  Just expand Medicaid.  Unfortunately, as reality dawns, we would discover that this approach would provide the uninsured with coverage but no providers to care for them.c

Dan Walters, the political writer for the Sacramento Bee observed in his column on December 18, 2007, that it is inexplicable “that the governor and the speaker would push an incomplete, unclear and legally questionable health plan, especially when they face a budget deficit of over $14 billion.

He goes on to observe that “this a lousy way to make public policy that could affect the lives of millions of Californians – just like the ill-conceived, sloppily written energy scheme 11 years ago. If (health reform) is worth doing, it's worth doing right, not as a cheesy stunt a few days before Christmas…Should this hastily designed reform package (have) become law and thereafter survive challenges in federal court, it would have made the energy crisis and the Enron story seem like a minor irritant compared to the damage this program (would have done) to California’s fragile economy.”

Despite all of the political posturing and misleading polls, we learned that the electorate was not yet ready for reform

On its face, revamping our health care system should be a political winner. Voters see two fundamental problems with health care. First, it costs too much: 74 percent in a recent Democracy Corps poll say they are dissatisfied with the cost of health care, a number matched in a Kaiser Family Foundation poll from 2006 (80 percent). Second, 70 percent of voters believe the number of uninsured people is a very serious problem, according to a recent New York Times poll.

A strong majority believes health care is a top domestic priority -- 55 percent, according to the Times poll -- and 64 percent believe the federal government should guarantee health care for all Americans.

All of this appears to create an environment for sweeping reform which politicians both here in California and in Washington have consistently misread.  They base their interpretation on the fact that 90 percent of Americans say the health care system as a whole needs change - 54 percent say "fundamental change" is necessary, and 36 percent say the system should be "completely (rebuilt)." Just 8 percent believe the system needs "minor changes."

But the picture changes dramatically when questions shift from the systemic to the personal. Despite concern about the broader health system, Americans are generally satisfied with the care they currently receive. In the Times poll, 77 percent of Americans are satisfied with the quality of their care; 82 percent say the same in the Democracy Corps poll, compared with 89 percent in the Kaiser poll. Indeed, the Kaiser poll finds high satisfaction across a broad range of health care dimensions: communication with the doctor (87 percent), availability of emergency care (83 percent), availability of appointments (82 percent), specialists (79 percent), getting the latest treatments (78 percent) and getting treatment without waiting (73 percent).

Why this seeming contradiction? This much is known.  Just as was the case in 1993, reforms that threaten -- or which can be made to appear to threaten -- the plans that insured Americans (who generally vote and pay the taxes for government programs as opposed to the uninsured who do not) currently have will face a backlash.

Polling shows how quickly opinion can turn. The 64 percent majority in the Times poll that believes the government should guarantee health insurance for all shrinks to 48 percent when asked their support if a universal program were to raise their own health insurance cost. The 60 percent in the same poll who say that they would be willing to pay higher taxes to insure everybody shrinks to 49 percent when a $500 price tag is attached to it.  . . .


There were many additional and important lesions we learned during the health policy debate.  Reforming the way we pay for health care is infinitely easier than to address actually reforming the health care delivery system.  Implying that an expensive new health care entitlement program can be financed by increasing taxes only on the wealthy does not compute.  The government, from the national to the local level, is now bankrupt and will be unable to meet the existing commitments made to provide health and retirement benefits.  The private sector is evolving new and more efficient systems for health care financing that would only be impeded by a massive new entitlement structured to support the imploding group health model.

Time and space does not permit a full discussion concerning the above lessons.  At some point, the candidates running for national office need to pay heed to the lessons we have learned.  To ignore them will be a grave mistake.

aA baby born this year can expect the same costs to absorb nearly 70 percent of future Social Security benefits at age 65.

bSince Social Security benefits will have to be cut 25 percent by 2041 unless taxes are increased, today's newborns are facing a future in which the cost of health care will have gobbled up the entire Social Security program.

cThe recent withdrawal by Sutter Roseville from the MediCal program is an example.


To read the entire OpEd, go to

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2.         In the News:  Nonprofit Hospitals Strike It Rich

Nonprofit Hospitals, Once For the Poor, Strike It Rich—With Tax Breaks, They Outperform For-Profit Rivals By JOHN CARREYROU and BARBARA MARTINEZ, WSJ, April 4, 2008 

Nonprofit hospitals, originally set up to serve the poor, have transformed themselves into profit machines. And as the money rolls in, the large tax breaks they receive are drawing fire.

Riding gains from investment portfolios and enjoying the pricing power that came from a decade of mergers, many nonprofit hospitals have seen earnings soar in recent years. The combined net income of the 50 largest nonprofit hospitals jumped nearly eight-fold to $4.27 billion between 2001 and 2006, according to a Wall Street Journal analysis of data from the American Hospital Directory. AHD, an information-service company, compiles data that hospitals report to the federal government.

The Cleveland Clinic swung from a loss to net income of $229 million during that period. No fewer than 25 nonprofit hospitals or hospital systems now earn more than $250 million a year. One nonprofit hospital system, Ascension Health, has a treasure chest of $7.4 billion -- more than many large, publicly traded companies.

Nonprofits, which account for a majority of U.S. hospitals, are faring even better than their for-profit counterparts: 77% of the 2,033 U.S. nonprofit hospitals are in the black, while just 61% of for-profit hospitals are profitable, according to the AHD data.

At some nonprofits, the good times are reflected in new facilities and rich executive pay. Flush with cash, Northwestern Memorial Hospital in Chicago has rebuilt its entire campus since 1999 at a cost of more than $1 billion. In October, it opened a new women's hospital that features marble in the lobby, birthing rooms with flat-screen televisions, 1,000 works of art and a roof topped with 10,000 square feet of gardens. In 2006, Northwestern Memorial's former chief executive officer, Gary Mecklenburg, received a $16.4 million payout.

But Northwestern Memorial has been frugal in its spending on charity care, the free treatment for poor patients that nonprofit hospitals are expected to provide in return for the federal and state tax breaks they receive. In 2006, Northwestern Memorial spent $20.8 million on charity care -- less than 2% of its revenues and a fraction of what it received in tax breaks. By comparison, the hospitals run by Cook County, where Northwestern Memorial is located, spent 14% of revenues on charity care. . .

To be sure, some nonprofit hospitals, particularly ones in inner cities that handle large numbers of uninsured patients, remain under financial strain and are struggling to keep their doors open.

But the growing gap between many nonprofit hospitals' wealth and what they give back to their communities is raising questions about the billions of dollars in tax exemptions they receive. . .

Nonprofit hospitals account for about 60% of the more than 3,400 hospitals in the U.S. The rest are either for-profit or government-owned.

In a report issued in December 2006, the Congressional Budget Office estimated nonprofit hospitals receive $12.6 billion in annual tax exemptions, on top of the $32 billion in federal, state and local subsidies the hospital industry as a whole receives each year.

Community Benefit

In return for not paying taxes, nonprofit hospitals are supposed to provide a "community benefit," a loosely defined requirement whose most important component is charity care. But many hospitals include other expenses in their community-benefit accounting to the Internal Revenue Service, including unpaid patient bills. Often, hospitals also include the difference between the list prices of treatment they provide and what they are paid by Medicaid and Medicare, the government programs for the poor, disabled and elderly. Excluding those other expenses, many hospitals spend less on charity care than they get in tax breaks, studies by various counties and states show.

One nonprofit hospital system, St. Louis-based BJC HealthCare, counts the salaries of its employees as a community benefit. BJC, which runs 14 hospitals in Missouri and Illinois, says on its Web site that it provided more than $1.8 billion in benefits to various communities in 2004. Its payroll, including its CEO's $1.8 million compensation, accounted for $937 million of that figure, while charity care represented $35 million, according to BJC.

"The impact that any organization that's job-producing and buying goods has on a community is of benefit to that community," says BJC HealthCare spokeswoman June Fowler. However, she says BJC won't count its payroll as a community benefit in the future because of new standards adopted by the IRS.

The new standards, due to take full effect in 2009, will require nonprofit hospitals to break out specifics of their community-benefit contributions. But they won't require the hospitals to provide any minimum amount of charity care.

The size of nonprofit hospitals' tax exemptions is coming under scrutiny in part because their incomes have risen so sharply in recent years, and because they represent such a big chunk of America's health-care spending. Thirty-one cents of every dollar spent on medical care is spent on hospitals.

One reason for hospitals' soaring profits is a gradual increase in Medicare reimbursements after federal budget cutbacks during the 1990s. By merging and gaining scale, many hospitals also gained leverage in price negotiations with health insurers.

However, much of the industry's profit growth comes from strategies it honed to increase profits. Among them: demanding upfront payments from patients; hiking list prices for procedures and services to several times their actual cost; selling patients' debts to collection companies; focusing on expensive procedures; and issuing tax-exempt bonds and investing the proceeds in higher-yielding securities.

Untaxed investment gains have greatly increased some hospitals' cash piles. Ascension Health, a Catholic nonprofit system that runs 65 hospitals, mostly in the Midwest and Northeast, reported net income of $1.2 billion in its fiscal year ended June 30, 2007, and cash and investments of $7.4 billion. That's more cash than Walt Disney Co. has.

Ascension says it needs to maintain a sufficient amount of cash to pay for charity care, to keep the interest rates it pays on its debt low, to provide retirement benefits to its 106,000 employees, and to make capital and technology investments at its hospitals.

At the University of Pittsburgh Medical Center, which runs 20 facilities, cash and investments totaled $3.35 billion at the end of last year. UPMC says the money goes toward producing "world-class health care, education and research," citing the $1 billion it spent over five years to create electronic medical records for patients and an additional $500 million to build a children's hospital and a network of cancer centers.

But some of UPMC's expenses are only tenuously related to medicine. In its 2006 fiscal year, UPMC also spent $10 million on advertising, including $1 million on ads in the New York Times. Wendy Zellner, a spokeswoman for the hospital, says the ads enable UPMC "to better compete with other leading hospitals."

UPMC paid its CEO, Jeffrey Romoff, $3.3 million in fiscal 2006. Mr. Romoff also received $36,995 from the hospital to cover a car allowance, spousal travel and legal and financial counseling. Ms. Zellner says what UPMC pays Mr. Romoff is in line with "nonprofit and for-profit organizations of comparable scope and complexity."

Some nonprofit hospital executives enjoy other perks. Royal Oak, Mich.-based Beaumont Hospitals says it paid $10,795 for the country-club membership of the president of its foundation last year. A spokeswoman for Beaumont says it pays for the membership to provide the executive "a venue with access to potential donors."

The Cleveland Clinic continued to pay its former CEO, Floyd Loop, more than $1 million a year for two years after he retired in April 2005. The Cleveland Clinic says part of that was deferred compensation and vacation pay and the rest was for consulting services.

The University of California San Francisco Medical Center provided its CEO and chief operating officer low-interest mortgage loans of more than $1 million each, according to the University of California's executive compensation reports. A UCSF spokeswoman says such loans help recruit and retain executives, given the area's high cost of housing.

Catholic Healthcare West, a hospital system based in San Francisco, forgave a $782,541 housing loan it made to its CEO, Lloyd Dean. Counting the forgiven loan, Mr. Dean's total accrued compensation in 2005 was $5.8 million. Catholic Healthcare West says his compensation reflects his skill in turning the hospital system around financially.

One nonprofit hospital executive who has benefited from the industry's good fortunes is Mr. Mecklenburg, the former CEO of Chicago's Northwestern Memorial. The hospital says it paid him $5.45 million in salary, bonus and deferred compensation in its fiscal year ended Aug. 31, 2006, and an additional $10.95 million when he retired the next day. The hospital also awarded five other executives a combined $13.3 million in total compensation in fiscal 2006, according to its filings to the IRS.

Mr. Mecklenburg, now a partner at Chicago private-equity firm Waud Capital Partners LLC, declined to comment, referring questions to the hospital and to the former chairman of its compensation committee, James Denny.

Stellar Results

Northwestern Memorial says a big part of Mr. Mecklenburg's $16.4 million payout represents retirement benefits and deferred compensation accrued over his 21-year tenure. Mr. Denny, who chaired the hospital's compensation committee from 1995 to January 2008, says Mr. Mecklenburg delivered stellar results, nearly quintupling the hospital's patient revenues. "Our view of it is: This is the best deal we've ever made," he says.

Critics argue that Mr. Mecklenburg's compensation is excessive for a charity organization that gets tens of millions of dollars a year in tax breaks. Northwestern Memorial sits on property on the Gold Coast, Chicago's most affluent neighborhood, abutting Lake Michigan. The Center for Tax and Budget Accountability, a Chicago nonprofit organization, estimates the value of the hospital's annual property-tax exemption at $37.5 million. Northwestern Memorial is also exempt from $12.5 million in sales tax for a total of $50 million in annual tax exemptions, not counting the taxes it doesn't pay on its investment gains, the center estimates.

"The hospital's tax benefit is more than two times greater than the charity care provided," says Heather O'Donnell, the center's health-care policy director. . .

Room Service

Around Chicago, Northwestern Memorial is known as a hospital that attracts the well-heeled. It's a short walk from the Magnificent Mile, the famous thoroughfare lined with expensive shops and restaurants. At Northwestern Memorial's new Prentice Women's Hospital, expectant mothers can watch TV or browse the Internet on 42-inch flat-screen televisions, order room service 24 hours a day and page nurses and doctors via a wireless system. Some birthing rooms have views of Lake Michigan. Only 6% of Northwestern Memorial's patient revenues come from Medicaid.

By comparison, Sacred Heart Hospital, a small for-profit hospital in a poor neighborhood on the west side of the city, gets 62% of its revenues from Medicaid and pays several million dollars a year in taxes, according to its president, Edward Novak. Parts of Sacred Heart date back to 1928, when the hospital was founded. Another wing was built in 1950. Mr. Novak says he would like to replace the aging hospital with a new facility, but is struggling to figure out how to pay for it. He says his compensation is less than $220,000 a year.

At John H. Stroger Jr. Hospital -- formerly known as Cook County Hospital -- 56% of patients don't have any insurance when they are admitted, says John Cookinham, the hospital's chief financial officer. At Northwestern Memorial, the percentage of uninsured patients is less than 5%. Stroger's chief operating officer earned $204,485 in 2007, according to Cook County budget records.

In recent years, some nonprofit hospitals have decided to stop using the courts to collect from patients who owe them money. But Northwestern Memorial pursues patients such as Iris Ayala who haven't paid their bills. While running an errand for her employer, the 50-year-old Ms. Ayala fainted and collapsed in the street one day in 2006. A friend rushed her to Northwestern Memorial's emergency room.

Ms. Ayala says her insurer paid for the bulk of her 24-hour hospital stay, but she was responsible for a $1,035.39 co-pay. Working only part-time because of health issues and with a daughter in college, she says she couldn't afford her portion of the bill.

After representatives for Northwestern Memorial repeatedly called her to ask for payment, Ms. Ayala says she promised she would settle the bill once she got her annual tax refund. But Northwestern Memorial sued her in Cook County Circuit Court in July 2007. To make the lawsuit go away, Ms. Ayala says she borrowed the money and paid the hospital. "They didn't want to hear my sob story," she says.

Northwestern Memorial declined to discuss Ms. Ayala's case, citing patient privacy laws. . . .

"Nonprofit is a misnomer -- it's nontaxable," says Sacred Heart Hospital's Mr. Novak. "When you're making hundreds of millions of dollars a year, how can you call yourself a not-for-profit?"

To read the entire article, go to

Write to John Carreyrou at and Barbara Martinez at

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3.         International Medicine: In Socialized Medicine, Even Patients Starve

NHS updates: Patients starve; not allowed to pay for extra care February 27th, 2008

Recent news from the UK:

1. Statistics obtained by Conservatives show that the number of patients released from British National Health Service (NHS) hospitals with malnutrition has doubled in the decade since Labour came to power, increasing from 74,431 in 1997 to 139,127. While most of the patients had nutritional deficiencies on admission, the nutritional condition of at least 8,500 actually worsened during their hospital stay. Last year, health minister Ivan Lewis admitted that patients were being starved on the wards, with some elderly patients given little more than a scoop of mashed potatoes for lunch. Often, elderly patients are given non-pureed food that they cannot chew or swallow. Food trays may be placed out of reach and simply taken away when patients are too weak to get to them (Telegraph 1/1/08).

2. To meet government targets, which require emergency department patients to be treated within 4 hours, thousands of patients are kept in ambulances outside the department for hours. Last year, more than 43,000 patients waited for more than an hour before being allowed into the emergency room.

Ambulances that are being used as “mobile waiting rooms” are unavailable to take fresh calls. 

The Labour government brought in the 4-hour standard in an effort to end the scandal of patients waiting in casualty for days (Daily Mail 2/20/08).

3. British patients are being denied certain operations because of lack of worthiness, based on smoking, obesity, heavy drinking, or age. Officials are urging patients to turn to “self care” instead of physician visits.

“The threat to cut benefits to the old and the unhealthy in Britain is a clear confirmation that health care can never be free…. The threat also shows that health care can’t be truly universal, at least not for the long term, because it becomes too costly to maintain as such” (“Health Freezes Over,” Investor’s Business Daily 1/29/08).

4. One way to relieve strains on the system is to allow patients to pay privately for portions of their care—while still receiving “basic” care from the NHS. For example, patient Debbie Hirst, who has metastatic breast cancer, was attempting to raise $120,000 to pay for Avastin, a drug widely used in the U.S. and Europe but not available to NHS patients, at least not until the cancer is so widespread that treatment may be hopeless.

Such arrangements have tacitly been allowed before, but in this case the doctor delivered the news that he was getting his wrists slapped by the higher-ups. If the patient paid for Avastin, she’d have to pay for all of her treatment—far more than she could afford.

Patients “hopscotch” all the time, say paying for a timely private consultation or MRI, then getting their surgery from the NHS.

But “[t]hat way lies the end of the founding principles of the NHS,” said health secretary Alan Johnson to Parliament.

The rules for private copayments are contradictory and confusing. The idea of the NHS may be to assure that rich and poor get equal treatment, but the system is riddled with inequities. Drug availability, waiting lists, and per capita spending for cancer care vary wildly from region to region.

As Mrs. Hirst explained: I’m a person who left school at 15 and I’ve worked all my life and I’ve paid into the system, and I’m not going to live long enough to get my old-age pension from this government” (Sarah Lyall, New York Times 2/21/08).

Could that be the main point?

Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

To read the Jacques Chaoulli, M.D. report, go to

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4.         Medicare: Is Medicare for all the real answer? Read & Weep by Dr. Goodman

On Good Friday (when most people were off, including most reporters) the Administration announced that the following Tuesday during Spring Break (when Congress was in recess and everyone’s attention was focused elsewhere) the Social Security/Medicare Trustees annual report would be released.   

Apparently someone isn’t anxious for you to pay close attention to this year’s report. The table below may explain why. The federal government has promised more that $100 trillion in benefits over and above expected taxes and premium payments! 

Program                                 75-Year           Infinite Horizon   
Social Security                        $6.6 trillion      $15.8 trillion   
Medicare Part A                     $12.7 trillion    $34.7 trillion   
Medicare Part B                     $15.7 trillion    $34.0 trillion   
Medicare Part D                     $7.9 trillion      $17.2 trillion   
Total Medicare                       $36.3 trillion     $85.9 trillion   
Total Medicare and SS            $42.9 trillion     $101.7 trillion   
*These calculations ignore the existence of the trust fund, estimated at a little more than $2 trillion.   
Source: Social Security/Medicare Trustees Reports 2008   
Read and weep.    
To view the comments for this blog entry: 
John Goodman, President    
National Center for Policy Analysis   
12770 Coit Rd., Suite 800   
Dallas, Texas 75251    

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

- Ronald Reagan

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5.            Lean Health Care: Five Basic Principles We Can Use in Health Care

Womack and Jones note in Lean Thinking:


"The critical starting point for lean thinking is value. Value can only be defined by the ultimate customer. And it's only meaningful when expressed in terms of a specific product (a good or a service, and often both at once), which meets the customer's needs at a specific price at a specific time."

Above all, lean practitioners must be relentlessly focused on the customer when specifying and creating value. . . "Why is it so hard to start at the right place, to correctly define value?”

Partly because most producers want to make what they are already making and partly because many customers only know how to ask for some variant of what they are already getting. They simply start in the wrong place and end up at the wrong destination. Then, when providers or customers do decide to rethink value, they often fall back on simply formulas‹lower cost, increased product variety through customization, instant delivery rather than jointly analyzing value and challenging old definitions to see what¹s really needed."


The value stream is the set of all the specific actions required to bring a specific product through the critical management tasks of any business: the problem-solving task running from concept through detailed design and engineering to production launch, the information management task running from order-taking through detailed scheduling to delivery, and the physical transformation task proceeding from raw materials to a finished product in the hands of the customer. Identifying the entire value stream for each product is the next step in lean thinking, a step which firms have rarely attempted but which almost always exposes enormous, indeed staggering, amounts of waste.

In order to get started mapping your own value streams, LEI recommends that you read and use the Learning to See workbook. Additionally, the library section for this tool contains a wealth of further material about this critical principle.


Only after specifying value and mapping the stream can lean thinkers implement the third principle of making the remaining, value-creating steps flow. Such a shift often requires a fundamental shift in thinking for everyone involved, as functions and departments that once served as the categories for organizing work must give way to specific products; and a "batch and queue" production mentality must get used to small lots produced in continuous flow. Interesting, "flow" production was an even more valuable innovation of Henry Ford¹s than his better-known "mass" production model.

Lean managers eager to implement flow in their organizations can learn more about the topic in the books Creating Continuous Flow and Making Materials Flow, and they can use these workbooks as an excellent starting point when implementing this principle.


As a result of the first three principles, lean enterprises can now make a revolutionary shift: instead of scheduling production to operate by a sales forecast, they can now simply make what the customer tells them to make. As Womack and Jones state, "You can let the customer pull the product from you as needed rather than pushing products, often unwanted, onto the customer." In other words, no one upstream function or department should produce a good or service until the customer downstream asks for it.

Of course following this principle is a bit more complicated than that. A good place to start with implementation is the LEI workbook Creating Level Pull, which also has an excellent Library section with many resources to help with this principle.


After having implemented the prior lean principles, it "dawns on those involved that there is no end to the process of reducing effort, time, space, cost, and mistakes while offering a product which is ever more nearly what the customer actually wants," write Womack and Jones. "Suddenly perfection, the fifth and final principle, doesn¹t seem like a crazy idea.

To read the entire article, got to

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6.            Medical Myths: The Single-Payer Remedy Myth

International Health Systems: The Single-Payer Remedy Is Worse Than the Disease, The Galen Institute, January 22, 2008

No one denies that America's health sector faces problems. Costs continue to rise, and 45 million people lack insurance. Even worse, many politicians think they've discovered the cure in a single-payer system.

But that remedy would be worse than the disease. The government-dominated health systems of Europe and Canada are struggling with serious cost pressures, inefficient bureaucracies, and unmet demands for more advanced medical care.

For the privilege of their supposedly "free" care, other countries pay much higher taxes. In 2005, taxes consumed 41% of GDP in Canada, 42% in Britain, and 51% in France, compared to 32% in the U.S.

Single-payer systems invariably involve rationing. What good is free care if the government denies access to it?

About one million people in the U.K. are on waiting lists for hospital care, including surgeries. And 200,000 more are waiting just to get on the waiting list.

Cancer patients in Britain have resorted to waging public relations campaigns because their government won't pay for new medications for breast and kidney cancer.

In Canada, the situation is no better. Long waiting lines lead to restricted access to care.  There were 45 inpatient surgical procedures per 1,000 Canadians in 2003, compared to 88 in the United States. Canadians received only one-third as many MRI exams and half as many CT scans.

Meanwhile, patients in Sweden have been sent to veterinarians for diagnostic tests so the government could reduce waiting lists.

Proponents of a single-payer system argue that the United States would be different -- that we could get all the money we need to finance universal health insurance by eliminating profit in the private health sector.

But that's like trying to cure a disease with arsenic. Socializing our health care system would mean that one-sixth of our economy would operate under different economic rules, with the government setting prices, allocating resources, and deciding what medical care would be available to whom and when.

There is a better way.

We should embrace competition, not stifle it. We should reward innovators, risk-takers, and entrepreneurs for providing faster, better, more affordable health care. And we should recognize that progress depends upon innovation and profit.

The U.S. market already is pointing the way by responding to consumer demands for more convenient, more affordable health services. Health plans are offering programs to help patients better manage chronic diseases like diabetes, lowering costs and improving health.

Small clinics are springing up in retail stores around the country, providing customers with easy access to nurses who treat common ailments like ear infections and poison ivy. These clinics cost less than a visit to the doctor or emergency room.

Competition is leading to more affordable prescription drugs. Wal-Mart started a price war by announcing it would sell a long list of generics for only $4 for a month’s supply. Target and other pharmacies followed suit. Today, more than half of the prescriptions Wal-Mart fills are $4 generics.

And the new Medicare drug benefit shows how competition can lower costs and provide better benefits.

When the Part D program started in 2003, Congress estimated the drug benefit would cost beneficiaries an average of $37 a month. But because private drug plans compete to deliver the Medicare benefit, prices have been far lower than predicted. The average monthly cost of the standard benefit is just $22.

Coming in below cost is unprecedented for a government program – and it shows the government can lower prices by encouraging competition. It's virtually the opposite of a single-payer system, in which governments shut out the private sector.

Rather than regressing to the failing systems of Europe -- with waiting lines and rationing -- we must develop our own unique solution. Ultimately, that means embracing the truly American qualities of innovation and competition.

Grace-Marie Turner is president of the Galen Institute in Alexandria, VA.,8/action,show_content/id,13/blog_id,997/category_id,10/type,33/

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7.            Overheard on Capital Hill: Ted Kennedy and John Tunney Sought KGB Advice!?

David Freddoso writes:  The Left’s failure to convince the public in 2002 that the Iraq War was a bad idea stemmed in large part from the Left’s historical lack of credibility on foreign policy. That, in turn, goes back to its reflexive opposition to almost all anti-Soviet American military activity-hot or cold-from the Nixon era until the fall of the Soviet Union.

During the Reagan administration, a significant number of Democrats mechanically opposed the very policies that undid the USSR-an aggressive and hostile foreign power which posed a greater long-term danger even than today’s Islamic terrorists. The reaction of liberals and Democratic lawmakers to Reagan’s famous “Evil Empire” speech of March 8,198354 and his call for a space-based strategic defense initiative provides a small glimpse of how many Democrats did not see the Soviets as an enemy the way Reagan did. They did not even view “victory” as an attainable goal, preferring instead coexistence with a power that had no intention of coexisting with the United States of America.

They ridiculed Reagan on the House floor: Democratic congressman Ed Markey of Massachusetts mocked: “The force of evil is the Soviet Union and they are Darth Vader. We are Luke Skywalker and we are the force of good.”

New York congressman Tom Downey, also a Democrat, said, “Mr. Speaker, the only thing the President didn’t tell us last night was that the evil empire was about to launch the Death Star against the United States.”

Even House Speaker Tip O’Neill, supposedly friendly with Reagan, got into the act. At the Democratic convention a little more than a year later, O’Neill riffed off of this. “The evil,” he explained, “is in the White House at the present time, and that evil is a man who has no care and no concern for the working class of America and the future generations of America, and who likes to ride a horse. He’s cold. He’s mean. He’s got ice water for blood.” O’Neill exploded with rage upon learning that American forces had wrested Grenada from the Soviet backed junta: “He is wrong in his policy. He’s caused us continuous harm,” adding, “It’s sinful that this man is President of the United States.”

Such mockery and disdain was the tip of the iceberg. Decoded files from the Soviet Union show that at least two Democratic Senators—Ted Kennedy and John Tunney—were so fearful of Reagan’s foreign policy vision that they sought KGB advice in 1983 on how to argue against the president’s anti-Soviet policies. There have since been books and articles written on this subject, but there has been no explanation or accountability for what we now know happened. To read more, please go to 

Before that, in 1975, two years after all American combat troops had left Vietnam, Democrats in Congress had cut off funding for the indigenous war efforts in Saigon, leading to Communist victory and massacres throughout Indochina.

These words, actions, and causes of the Left—ranging from U.S. Senators and a House Speaker to left-wing protestors—hardly convey a “near unanimity” on the Cold War.

. . . Despite a professed admiration for what Reagan accomplished, Obama relates in Audacity of Hope his continued opposition to each discrete step that Reagan took to end Soviet domination. He decries our resistance to Soviet influence in Latin America using the old 1980s terms of art: “funding death squads,” “the invasion of tiny, hapless Grenada.” He is especially disdainful of the so called “ Star Wars” program, which was crucial to bankrupting the Soviets then and which has today evolved into a working missile defense system that passes test after test. He has even recorded a YouTube campaign video promising to “cut investments in unproven missile-defense systems,” and he has voted to cut $50 million from missile defense.

This is why no one listened to the Left’s warnings about Iraq in 2002. It explains, in turn, why elected Democrats went out of their way to distance themselves from the peace movement. Fully twenty-nine Democratic senators and eighty-one Democratic congressmen voted in favor of war in October 2002, including Hillary Clinton and John Kerry. What choice did they have? There was an election approaching, and as far as congressional Democrats are concerned, their historical reputation on national security did not afford them the option of standing on principle against war. Not only did Clinton and Kerry vote for war, but each one publicly supported the precise course of diplomatic and military action that President Bush took over the next six months-ill-conceived or no.

That is the “old politics” of foreign policy. Barack Obama is right in the thick of it.

[Despite the national and international ridicule of President Reagan, he is now revered as probably the third greatest president after Washington and Lincoln. When flying to Washington, DC, we frequently enter through Reagan International Airport. The current hostilities of the liberal left to President Bush are not dissimilar. Should Bush bring peace and democracy to the uncivilized Middle East, he may become the recipient for the Nobel Peace Prize.]

David Freddosso covers Capitol Hill for National Review Online. He is a graduate of Notre Dame and the Columbia School of Journalism and lives in Washington, DC.

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8.            What's New in U.S. Health Care: Health Care and Welfare to Illegal Aliens

Illegal Aliens Cause Massive Cuts For US Seniors
      1. $11 billion to $22 billion is spent on welfare to illegal aliens each year.
      2. $2.2 billion dollars a year is spent on food assistance programs such as food stamps, WIC, and free school lunches for illegal aliens.\iscalexec.html
     3. $2.5 billion dollars a year is spent on Medicaid for illegal aliens.
      4. $12 billion dollars a year is spent on primary and secondary school education for children here illegally and they cannot speak a word of English!

      5. $17 billion dollars a year is spent for education for the American-born children of illegal aliens, known as anchor babies.
      6. $3 Million Dollars a DAY is spent to incarcerate illegal aliens
      7. 30% percent of all Federal Prison inmates are illegal aliens.
      8. $90 billion Dollars a year is spent on illegal aliens for Welfare and Social Services by the American taxpayers.
      9. $200 billion dollars a year in suppressed American wages are caused by the illegal aliens.  http://transcripts! 
      10. The illegal aliens in the United States have a crime rate that's two-and-a-half times that of white non-illegal aliens. In particular, their children are going to make a huge additional crime problem in the US.
      11. During the year of 2005 there were 4 to 10 MILLION illegal aliens that crossed our southern border also, as many as 19,500 illegal aliens from terrorist countries. Millions of pounds of drugs, cocaine, meth, heroin and marijuana, crossed into the U. S from the southern border.
      Homeland Security Report.
      12. The National Policy Institute, 'estimated that the total cost of mass deportation would be between $206 and $230 billion or an average cost of between $41 and $46 billion annually! over a five-year period.'
      13. In 2006 illegal aliens sent home $45 BILLION in remittances back to their countries of origin.

      14. 'The Dark Side of Illegal Immigration: Nearly One Million Sex Crimes Committed by Illegal Immigrants In The United States '.
      Total cost is a whopping... $338.3 BILLION A YEAR!!!

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9.            Health Plan USA: A Good Reason for Future Optimism

There Are Good Reasons To Be Optimistic About The Future Of Liberty By Martin Masse

Some of my friends are on occasion surprised by my optimism about the dissemination of libertarian ideas. Don't we read and hear tons of statist nonsense, coming both from the left and the right, every day in the media? Yes, we do, and the multiplication of the means of communication is such that the quantity of nonsense expressed has probably increased exponentially in recent years. But we have to see the other side of the coin, too: the quantity of pertinent information has also exploded, and it is more easily accessible than ever before in the history of the world.

Remember that barely twenty years ago, most people read no more than one daily newspaper, possibly supplemented by one current affairs magazine, and stayed informed by listening to one of only a handful of television and radio stations available. The debates carried out in the opinion pages of the large dailies rarely offered anything other than the tired platitudes of the main political factions. Trying to get a point of view different from what was perceived as legitimate into one of these venues was practically impossible.

A few hard to find magazines did offer more marginal perspectives, but that's just it: these were isolated debates taking place in a vacuum, debates that rarely reached a wider audience. Finding a relatively rare book was not easy either, unless you had access to a university library, and even then. Older readers will recall the difficulty of finding a book on a specific subject by searching through drawers filled with little typed-up index cards.

During my university studies, I have no recollection whatsoever of any professor ever mentioning the Austrian School or libertarianism in a political science or economics course. It was in reading an article in the Financial Times of London in the early 90s that I first heard about Ludwig von Mises. It piqued my curiosity. Fortunately, the McGill University Library had a copy of Human Action. In the very first pages, I discovered the individualist and subjectivist methodological perspective on social phenomena that I had confusedly been trying to develop on my own for a few years, without realizing that others had done so long before me (see "Durkheim's Collective Conscience"). Other material on the subject (books or magazines) being hard to locate and obtain, it took me another few more years before I could really familiarize myself with all aspects of this school of thought.

When I met other Quebec libertarians for the first time, about thirteen years ago, there were literally just a handful of us in the whole province who knew about these ideas. There was no quick way to find out if others were on the same wavelength. In such a context, trying to introduce an unknown philosophy or to launch a new political movement was an arduous, long-term enterprise.

It's true that extreme left-wing ideas spread like wildfire in Quebec and elsewhere in the West in the 1970s. But this was enabled in large part by the institutional support of universities and trade unions. Tens of thousands of social science students indoctrinated by Marxist professors and preparing to be hired into the civil service made fertile ground for such ideas. The unions, reinforced in number by the rapid growth of state employment and in power by the granting of ever more numerous legal privileges, naturally promoted a doctrine that favoured their interests.

It is no coincidence, of course, that these are two essentially statist entities that would not exist in the same form in a free society. If we had a minimal State, practically every student would be planning to look for useful employment in the private sector instead of dreaming of a public sector sinecure.

Similarly, in private universities where they would be required to pay the full cost of their education, far fewer students would waste their time learning the secrets of Marxism, Keynesianism, structuralism, deconstructionism, and the lesbian feminist perspective on Guatemalan peasant folk tales. Private, dynamic colleges and universities, competing among themselves, would organize themselves to offer pertinent training. They certainly would not have hired so many ignorant ideologues for professors.

The Surge of the Far Left

 In a minimal State, there would also obviously be far fewer unionized civil servants. In the private sector, voluntary employee associations (i.e., unions that individual members would be free to join or not, as opposed to the current union mafia that legally imposes its diktats to all) would essentially work to protect the interests of their members, and not to serve as a political machine, spreading propaganda for the apparatchiks that run these organizations today.

Unless you have hundreds of millions to invest in a newspaper chain, it's impossible to have this kind of impact by means of private institutions. Conrad Black was able to alter the tenor of the debate in English Canada by buying the Southam chain of dailies, by founding the National Post and by imposing an editorial line in accordance with his views (more classical liberal on economics, but neoconservative on foreign policy questions) to his new newspapers.

The Internet Effect

The arrival of the Internet, however, has changed everything. Today, all the world's newspapers and magazines are available with a few clicks of a mouse. With the digitization of libraries that is now taking place, the totality of human knowledge will soon be available on the Web. With just a little searching, someone can easily uncover every imaginable viewpoint. One can become familiar with a philosophy in a single weekend.

The "barriers to entry" have therefore been lowered spectacularly for those who want to disseminate their points of view. There is no longer any need for lots of start-up capital, hard-to-establish contacts or costly distribution networks. Spreading new ideas is now relatively easy for intellectual entrepreneurs who care to make the effort and who are able to work with others to create a quality product.

The Québécois Libre has, in ten years, gone from a small site hosted by a few friends to one of the largest independent sites in Quebec and in the French-speaking world. It receives around 100 000 visitors every month from all over the world, has contributors from three continents writing in two languages, and its update message is sent to over 1200 subscribers. Its sister site, Le Blogue du Québécois Libre, also brings thousands of visitors a month interested in discussions about Quebec current affairs. Both sites have a very high Google page ranking (thanks to the large number of links from other sites), which ensures that they are extraordinarily visible on the Web. It is practically impossible to research economic, political or social issues in French on the Web without regularly coming across QL articles.

People who would no doubt never have discovered libertarianism without the Web can now drink from this source and many others too. Some who were in effect libertarians without knowing it realize it by reading us. We regularly receive messages that say something along the lines of: "I'm so happy to have found your site and discovered the libertarian philosophy. I've thought this way for a long time, but I thought I was the only one who did." The very existence of an alternative point of view being expressed and easily accessed completely changes the situation by allowing individuals who have until now been isolated to come into contact with each other, with no geographical limits.

The Marketplace of Ideas

Now that we can compete more directly with collectivist and statist doctrines, bypassing the mainstream media that still speaks about us only rarely (though that too is changing, journalists being less and less able to ignore a school of thought that seems more and more influential), there is every reason to believe that our ideas are going to continue to spread.

First and foremost, this is because when libertarian ideas find themselves on equal footing with others in the marketplace of ideas, they have an excellent chance of winning. Libertarian explanations conform to reason and reality, while statist ones are founded on myths. Those on the economically illiterate left, for example, have no logical explanations for economic phenomena. They do not understand how economic growth happens; they pay no attention to notions like productivity, price signals, or time preference; and they are too obsessed with denouncing the horror of profit to see what role it plays for example in allocating resources.

Every version of centralized planning and statist interventionism has failed. In our society, the private sector usually displays dynamism and efficiency, while every publicly controlled sector from health to education is in constant crisis. It is becoming increasingly harder to deny that the free market is the one and only system that favours prosperity. Intelligent people who are exposed to libertarian ideas are going to realize this more and more.

We are at the dawn of an era of economic dynamism that is without precedent in human history, with the continued expansion of capitalist globalization and with the integration of China and India into this great global market. A generation ago, Asia was still cursed with famines. Today, hundreds of millions of Asians are living comfortably thanks to the opening of markets and to the gradual retreat of state planning. Only Africa, whose economies are still largely bypassed by global economic networks and dominated by illiberal tyrants, has yet to understand the recipe for development.

Because they are founded on myths, collectivist ideas also require unanimity or consensus. The whole collectivist logic depends on "raising the consciousness" of the masses, on a collective mobilization aimed at attaining abstract and unattainable goals. This mobilization is very costly in human terms and is hard to maintain for long, and the sought-after utopia is anyway impossible to attain. When these movements succeed in part in attaining their political objectives, there are always perverse consequences to their statist interventions. The structures created never attain their desired goals, and are always in crisis and about to fail. We either need to bail them out with public funds or impose new coercive measures, or they risk collapsing, as they did in the USSR and the communist bloc. That's why statist militants are constantly finding new reasons to be depressed, as we can see by reading their blogs and magazines.

In contrast, to score points, libertarians simply have to explain the logic of human action in a context of liberty and voluntary cooperation, and show to what extent the civilization in which we live is based on these notions and depends on them for its continued survival and success. There is no need to call for collective action and mobilization. An ordinary citizen who believes in the libertarian ideal can do many useful things at home by himself: stop being manipulated by the statist propaganda of politicians and pressure groups; remain unaffected the next time a false crisis requiring the State's urgent intervention captures newspaper headlines; disengage from all movements that are based on collectivist myths; refuse to participate in any action aimed at increasing the coercive power of the State; get by as much as possible without calling on the State; and always choose a private alternative when there is one.

Every time someone, in his or her daily life, takes responsibility in this way, staying away from collectivist movements and, as far as is possible, keeping out of reach of the statist octopus, our movement advances. Every time one more individual exercises his or her individual sovereignty, the State and collectivist movements retreat. All of these little actions have the effect of an acid dissolving the pseudo-consensus and the false unanimity upon which our adversaries rely to advance tyranny. Collectivist utopia (generally bloody when it is pushed to the extreme) cannot be maintained without the enthusiastic support of a significant proportion of the population. By simply refusing them this support, we are placing sticks in their spokes. And thanks to the Internet, there are more and more of us doing it consciously and deliberately.

Objective Conditions

The apparatchiks seek every possible avenue to control our work, our education, our health, our culture, our food, and practically every other aspect of our lives. It is clear that we won't be living in a society that is truly free from their diktats any time in the near future. States did not stop growing during the 20th century, and it is only very recently that their growth has at least slowed. But there is every reason to be optimistic about the 21st century. To borrow a bit of Marxist jargon, the "objective conditions" are there for us to witness a revival and a radicalization of the grand classical liberal tradition that allowed for the emergence of civilization.

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10.        Restoring Accountability in Medical Practice by Nonparticipation in Government Programs and Understanding the Devastating Force of Government

·         Medicine and Liberty – Network of Liberty Oriented Doctors,
Medicine & Liberty (MedLib) is an independent physician network founded in 2007, dedicated to the study and advocacy of liberty, ethics & market in medical services.

·         We support professional autonomy for doctors and liberty of choice for patients

·         We uphold the Hippocratic covenant that forbids action harmful to the patient

·         We defend responsible medical practice and access to therapeutic innovation free from bureaucratic obstruction

·         We work towards a deeper understanding of the role and importance of liberty & market in medical services

MedLib is part of a wide movement of ideas that defends

·         The self-ownership principle & the property rights of individuals on the products of their physical and intellectual work

·         Free markets, free enterprise and strict limits to the role of the State

·         Grover Norquist, President of Americans for Tax Reform, keeps us apprised of the Cost of Government Day® Report, Calendar Year 2006 Fourteenth Edition, Cost of Government Day (COGD) is the date of the calendar year on which the average American worker has earned enough gross income to pay off his or her share of spending and regulatory burdens imposed by government on the federal, state and local levels. Cost of Government Day for 2006 is July 12th, a one day increase above last year’s revised date of July 11th. With July 12th as the COGD, working people must toil on average 192.5 days out of the year just to meet all the costs imposed by government. In other words, the cost of government consumes 52.7 percent of national income. If we were to put health care into the public trough, the additional 18 percent would allow the government to control 70 percent or nearly three-fourths of our productivity and destroy our health care in the process. We would have almost no discretionary income.

·         John Berthaud, President of the National Taxpayer’s Union,, died unexpectedly on September 27, 2007, peacefully in his home. He had been keeping us apprised of all the taxation challenges our elected officials are trying to foist on us throughout the United States. I understand the staff is rising to the challenge to continue his mission in life. To find the organization in your state that’s trying to keep sanity in our taxation system, click on your state at To find important tax news, just click on the URL above. 

·         FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder,, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance.

·         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. 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."

·         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." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. Private Neurology also guarantees that medical records 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

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Stay Tuned to the MedicalTuesday and the HealthPlanUSA Networks and have your friends do the same.

Articles that appear in MedicalTuesday and HPUSA may not reflect the opinion of the editorial staff. Sections 1-7 are attributable quotes in the interest of the health care debate.

Editorial comments are in brackets.

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.

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Del Meyer

Del Meyer, MD, CEO & Founder

HealthPlanUSA, LLC

6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608

Words of Wisdom

“The size of the future you actually experience will largely be determined by one factor: the people you choose to connect with. When you invite people who are truly committed to growth into every aspect of your life, your own potential for growth becomes truly unlimited.”Dan Sullivan: Speaker and coach to entrepreneurs.

A clear, simple, and penetrating theory of the business, rather than intuition, characterizes the truly successful entrepreneur. -Peter F. Drucker

"It is not what we get. But who we become, what we contribute ... that gives meaning to our lives."
-Anthony Robbins: Authority on leadership psychology

One of the things that distinguishes man from the other animals is that he wants to know things, wants to find out what reality is like, simply for the sake of knowing. When that desire is completely quenched in anyone, I think he has become something less than human. -C. S. Lewis

Some Recent or Relevant Postings   

This Month in History – April 1

April 1 is a difficult day to be taken seriously. It is the day in 1789 that the House of Representatives finally achieved a quorum and went to work. If we had only known then what we were getting in to.

April 1 is the day in 1863 that the United States had its first wartime conscription law.

After Leonard and Thelma Spinrad

Abraham Lincoln was a hugely gifted writer and speaker — a truly great communicator. And he was almost entirely self-taught. He had less than one year of formal education in his whole life, yet from early childhood he was an extremely diligent reader and writer. Virtually everything he wrote or said had a unique stamp of greatness — a combination of humility and authority like no one else in history.

After Nightingale-Conant