Community For Affordable Health Care

Vol IX, No 2, July, 2010


Utilizing the $1.8 Trillion Information Technology Industry

To Transform the $2.4 Trillion HealthCare Industry into Affordable HealthCare

Through innovation by moving from a vertical to a horizontal industry

In This Issue:            

1.         Featured Article: Bad Medicine

2.         In the News: Federal Largess Allows Crime to Flourish

3.         International Healthcare: Greece Told to Privatize HealthCare before Bailouts

4.         Government Healthcare: Around the World

5.         Lean HealthCare: Going Horizontal

6.         Misdirection in Healthcare: Why Doctors Don't Want Free-Market Medicine

7.         Overheard on Capital Hill: Jefferson's tender lament didn't make it into the Declaration

8.         Innovations in Healthcare: Health Care's 'Radical Improver'

9.         The Health Plan for the USA: An Increasing Challenge: A Stranger in our Midst

10.        Restoring Accountability in Medical Practice by Moving from a Vertical to a Horizontal Industry:

The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 8th Annual World Health Care Congress will be held April 4-6, 2011 at the Gaylord Convention Center, Washington DC. For more information, visit The future is occurring NOW.

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1.         Feature Article: BAD MEDICINE – ObamaCare Begins by Joseph Bottum, Editor, First Things, May 2010

Bad Medicine

The Public Square - A Continuing Survey of Religion, Culture, and Public Life

Joseph Bottum, Editor

A kind of exhaustion always settles in, murky and miasmatic, after battle. The nation's conservatives foresaw the apocalypse if the Democrats' plan for health-care reform passed, and on Sunday—yesterday, as I write—it did pass. The world didn't end. The people didn't rise up in rage. Furious lightning didn't descend from the heavens to smash the apostate Capitol into rubble.

Of course, watching the ring of applause and self-congratulation around the podium in the House of Representatives, one could see that the nation's Democrats were also thinking of the apocalypse—albeit, in happier terms. But, on Monday morning, the Rapture didn't come, either, and the stony places of the earth didn't blossom with sudden flowers. Despite the left's predictions, the rise of the oceans didn't slow, and the planet didn't heal, and the lame didn't walk, and the blind didn't see.

Instead of falling—or rising, if the left proves correct—on the great wave of Armageddon, we must wait, in this trough of exhaustion, to learn what happens next. Our apocalypse is a slow one; it smothers us in whimpers. And here on Monday morning, all that remains is a sense of the impending. Something is slowly coming, something is slouching toward us.

I don't know exactly what that something is. Neither do you. Neither does the president or the Congress or the Senate, or anyone else who forced this change upon us. Change they wanted, and change they got—but change to what? The actual text of the bill makes little sense, as nearly everyone admits, but, then, as House Speaker Nancy Pelosi explained, the point wasn't really to get an intelligible bill. The point was to get any bill. To get the nationalization of health care rolling. To start the socialization process. To turn the corner. The point was to change the American system—in the belief that, once changed, the system can never change back.

Perhaps the courts will stop this. Certainly much of the bill will end up in lawsuits. The requirement that people buy insurance—and wasn't that the strangest thing in the bill? I know, Judy! We can punish those hated insurance companies by forcing everyone to use them!—has an unconstitutional feel to it, and it is, in any case, directly outlawed by such states as Virginia and Idaho. To court we must go, and in court we'll find out . . . whatever it is that we'll find out. I don't know what the courts will end up saying. Neither do you, and neither does anyone else.

Meanwhile, the November congressional elections are coming, and the health-care bill is already the major issue on which conservative candidates are running. That the Republicans will gain some midterm seats is predicted by all political pollsters. That they will win enormously, picking up the ten seats they need to control the Senate and the forty they need to control the House, is predicted by some. That they will find the twenty-five votes in the Senate and the 112 in the House they need to override a presidential veto is predicted by no one—although such gains are necessary for undoing this bill, through normal political channels, before the 2012 presidential election.

Politicizing Politics

But, then, normal political channels are exactly what seem to have disappeared in the process by which the health-care bill came into being. "All this talk about rules. We make them up as we go along," said Congressman Alcee Hastings during the health-care debates, and right he was.

Commentator after commentator has insisted that America has grown highly politicized over the last decade. Maybe even over the last half century, since calmness hasn't really existed in the public square since Eisenhower was president. And even then, the bitterness of Adlai Stevenson's defeated supporters was palpable, and the civil-rights battles were beginning to rage, and the hipster and the organization man were emerging, and the playboy was being born, and the communists threatened the nation, and the Cold War fed the apocalyptic imagination . . .

I've always been dubious about claims of a great calm consensus, a golden age, that once existed in any stretch of American time. Politics is political, by its very nature. It's where people of ambition meet and push on one another their ambitions—a process that cannot ever be calm.

The American Founders understood this, and they set up a system where the ambitious could stage their fights, without doing too much collateral damage to the rest of us. And any investigation into history will reveal that the nation has been politicized, in the sense of having a highly charged political atmosphere, from its founding.

Still, the commentators who feel the nation is caught up in a new kind of politicizing—a new type of rage and a new style of activism—are not wrong, exactly. One clear change in recent years is the emergence of a factionalism that we've never quite known before in American history.

The Founders understood the dangers of faction, of course. Alexander Hamilton famously issued a warning against it in the ninth of the Federalist Papers, and James Madison worked on the answer in the tenth, where he defined faction as "a number of citizens, whether amounting to a minority or majority of the whole, who are united and actuated by some common impulse of passion, or of interest, adverse to the rights of other citizens, or to the permanent and aggregate interests of the community."

The solution, Madison thought, is representative democracy. Direct democracy, all the people voting on all the issues, is too likely to be swayed by the passions of the moment and the interests of small crowds: "A pure democracy can admit no cure for the mischiefs of faction. A common passion or interest will be felt by a majority, and there is nothing to check the inducements to sacrifice the weaker party. Hence it is, that democracies have ever been found incompatible with personal security or the rights of property; and have, in general, been as short in their lives as they have been violent in their deaths."

Madison won that argument; representative democracy he wanted, and representative democracy he got. The dangers of factionalism didn't thereby go away, however. A representative system, the interposition of elected officials and procedural rules between the people and the law, only dams up factional dangers—to the enormous frustration of those who gain what they believe to be popular mandates and then discover that they cannot simply do whatever they want. (Remember the angry columns this year by several liberal commentators, which said that the Senate's filibuster rules are an unconstitutional outrage, when the election of Massachusetts senator Scott Brown cost the Democrats their sixtieth Senate vote and looked as though it might derail the health-care bill?) And when a great surge washes over the dam, factionalism is translated from a danger of the populace to a danger of the representatives.

Whatever its rightness or wrongness, the national anger at George Bush over the ongoing wars pushed up to the top of the dam in 2006 and brought the Democrats control of both the Senate and the House. And there it might have stayed, or even receded, had the financial crisis of 2008 not come along. Add that flood on top of the earlier ones, and there was swept into office a supermajority of highly charged, highly motivated, and highly factionalized individuals.

Am I alone in thinking that things like the health-care bill are not what voters thought they were getting? In the passion of the moment, they wanted Bush's supporters chased out. And the voters got what they wanted—along with something they didn't want: the election of a class of officials comparable to the Republican radicals of 1866 and the Democratic extremists of the 1974 post-Watergate tide. The flood carried faction into the Congress.

Consider our current situation with this fact in mind: Not a single Republican, in either house, voted for the Senate's version of the bill, which is now the law of the land. Logically speaking, there is a faint possibility that this is because the current crop of Republicans are themselves too factionalized to join in a great national project (one of the curious effects of a flood election is that moderates on the losing side are among the most likely to be defeated, since the hardliners had already managed to face down ideological opposition in previous elections).

But the polls, which show a majority of the public opposed to the bill—59 percent, according to a CNN poll published this morning—suggest the opposite: The Democrats who forced through this incoherent bill are acting as a faction. The dangers that Hamilton and Madison struggled to control in the populace are beyond control when they wash into the Capitol.

"Are we now in a world where there is absolutely no recourse to the tyranny of the majority?" asks the serious economics blogger for the Atlantic, Megan McArdle. The opponents of the health-care bill did what the old system suggested they do: They went out and convinced the public that now was not the time for such a major change in a country that is already financially strapped. In January 1993, when the Clinton health-care task force was created, nearly 60 percent of the American people supported reform. In July 1994, when the effort was declared dead, almost 60 percent of the people opposed it. Responsiveness to public feeling—remember Clinton's "permanent campaign"?—meant the defeat of the bill.

By some polls, less than 20 percent of Americans opposed the Democrats' health-care proposals in January 2009. Over 50 percent did by January 2010—but unlike the process in 1994, popular feeling made no difference this time around. "If you don't find that terrifying," McArdle notes, "let me suggest that you are a Democrat who has not yet contemplated what Republicans might do under similar circumstances. Farewell, Social Security! Au revoir, Medicare! The reason entitlements are hard to repeal is that the Republicans care about getting re-elected. If they didn't—if they were willing to undertake this sort of suicide mission—then the legislative lock-in you're counting on wouldn't exist."

The Republicans will surely be back in power at some point. Maybe after the 2010 congressional and 2012 presidential elections, although I'm somewhat convinced that a major Republican victory this November is Obama's best chance for reelection in 2012, for it would give him something to run against, and a kind of pure running againstness—Hope! (in what?) Change! (to what?) Not Bush!—has always been his best form of action.

Regardless, when the day comes that Republicans rule again, why shouldn't they do what the Democrats have now done? How can they not do what the Democrats have now done, ignoring the voters who put them in office and pushing through a radical agenda?

The conservatives aren't stupid. They'll surely see that if only the liberals get to use these changes in the American political system, then politics has become a ratchet that bites in only one direction: Push back in the other direction, and all you get is running room to tighten the nut some more. No conservative leader could allow that to happen. If these are the new rules of the game, then the Republicans have to play along. And when politicians cease to care what their constituents believe, we no longer have a representative democracy. We have, instead, a democratically elected tyranny—changing sides from time to time, but still disconnected from the people. Is it too much to think, with Madison, that such things are likely to be "as short in their lives as they have been violent in their deaths"?  . . .

Electing Tyranny?

The process by which this health-care bill came about has baleful effects throughout the American political scene. The banishment of the pro-life movement to one party will produce only ugly results, and although abortion is not, in itself, a religious issue, it parallels a faith divide in this country—a divide no one in their right mind should want echoed in the definitions of our political parties.

Meanwhile, the American populace, which strongly believes we cannot afford this, is angry at being ignored. The civility of the Capitol, such as it was, is further reduced. And representative democracy has taken a beating, perhaps even pushed down toward a system in which we are free only to elect the tyrants who will rule us until the next election. This bill was badly thought-through economics, badly constructed legislation, and badly conceived ideology. All in all, just plain bad medicine. But the worst of it may lie in the process by which it came about. Is this the manner in which we wish to be ruled?  . . .

Machiavelli may have been right to claim that we judge more from appearance than from reality, but the difference between the two sometimes may be deeper than we think. On October 5, 2009, President Obama held a photo-op speech on the White House lawn. Standing with him were 150 physicians who supported the president's plan for health-care reform. The doctors invited to the event had been told to bring along white lab coats (just in case they should need to examine a patient or two along the way, of course). Inevitably, a few docs forgot to bring their coats, and at the event, as cameras whirred, Obama staffers could be seen handing White House–issue white coats to les médecins sans manteaux.

As Obama addressed the uniformed group, he asserted that "Nobody has more credibility with the American people on this issue than you do." There are two ways to interpret this flattering line: Either it was genuine, and Obama will follow the lead of the doctors' credible voices, or it is disingenuous and patronizing.

Unfortunately, neither possibility works in Obama's favor. A poll conducted in 2009 by Investor's Business Daily and TechnoMetrica Market Intelligence suggested that physicians are not nearly as uniform in their approval as Obama would like us to think. The poll found that more than two-thirds of doctors opposed Obama's health-care plan, and 45 percent would consider leaving medicine altogether or taking early retirement if the proposed plan were to become a reality. . .

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2.         In the News:  Federal Largess Allows Crime to Flourish

Strapped Police Run on Fumes, and Federal Pot-Fighting Cash

By Justin Scheck, WSJ, June 25, 2010

IGO, Calif.—Shasta County Sheriff Tom Bosenko, his budget under pressure in a weak economy, has laid off staff, reduced patrols and even released jail inmates. But there's one mission on which he's spending more than in recent years: pot busts.

The reason is simple: If he steps up his pursuit of marijuana growers, his department is eligible for roughly half a million dollars a year in federal anti-drug funding, helping save some jobs. The majority of the funding would have to be used to fight pot. Marijuana may not be the county's most pressing crime problem, the sheriff says, but "it's where the money is."

Washington has long allocated funds to help localities fight crime, influencing their priorities in the process. Today's local budget squeezes are enhancing this effect, and the result is particularly striking in California, where many residents take a benign view of pot but federal dollars help keep law-enforcement focused on it.

To make sure his office gets the federal funds, Sheriff Bosenko since last year has spent about $340,000 of his department's shrinking resources, more than in past years, on a team that tramps through the woods looking for pot farms. Though the squad is mostly U.S.-funded, the federal grants don't cover some of its needs, such as a team chief and certain equipment. So, Mr. Bosenko has to pay for those out of his regular budget.

He doesn't doubt the value of pursuing pot farming, which he says is often the work of sophisticated Mexican gangs and leads to other crimes like assault. But other infractions, like drunken driving and robbery, may have a bigger direct impact on local residents than pot growing, he says.

The pot money is "$340,000 I could use somewhere else in my organization," he says. "That could fund three officers' salaries and benefits, and we could have them out on our streets doing patrol." . . .

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3.         International Healthcare: Greece Told to Privatize HealthCare before Bailouts

ObamaCare, Tried in Greece, Leads to Bankruptcy, Rioting & Bloodshed, AAPS, June 7th, 2010

By Alieta Eck, MD

Some people learn from others' mistakes, and some have to "learn the hard way."  Will America follow the lead of countries who have actually tried their own version of ObamaCare, or could we still learn from their mistakes?  In a remarkable statement, the International Monetary Fund has recommended that, before any bailouts are considered, the Greek government must privatize transportation, energy and health care to rein in costs.  The IMF recognizes that increased government involvement in health care does not save money.  It also does not lead to better health care.

In 1983, when the socialists were in power, Greece established "health care for all."  Today government spending is unsustainable and Greece is awash in red ink.  Talks of budget cuts and program cutbacks are causing rioting and bloodshed.

The Greek system is employer- based but the Greek Ministry of Social Health and Cohesion has enacted strict regulations so that innovation cannot exist.  Employers must choose from government-approved insurers, with rates and benefits packages clearly delineated.  This sounds much like ObamaCare– private but heavily regulated insurance.

According to Michael Tanner of the Cato Institute, "the Greek health care system is funded through payroll taxes, general tax revenue and bribery." Tanner, Michael D. (2008) "The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World" Cato Policy Analysis no. 613.

Read the entire history of Greek Socialized Medicine and the IMF demands that Healthcare be privatize to save funds before bailout is granted . . .

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Government Medicine Only Gives Access to a Costly Waiting List.

In America, everyone has access to HealthCare at all times. No one can be refused by any hospital.

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4.         Government Healthcare: Around the World

The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World

by Michael D. Tanner

Critics of the U.S. health care system frequently point to other countries as models for reform. They point out that many countries spend far less on health care than the United States yet seem to enjoy better health outcomes. The United States should follow the lead of those countries, the critics say, and adopt a government- run, national health care system.

However, a closer look shows that nearly all health care systems worldwide are wrestling with problems of rising costs and lack of access to care. There is no single international model for national health care, of course. Countries vary dramatically in the degree of central control, regulation, and cost sharing they impose, and in the role of private insurance. Still, overall trends from national health care systems around the world suggest the following:

Although no country with a national health care system is contemplating abandoning universal coverage, the broad and growing trend is to move away from centralized government control and to introduce more market-oriented features.

The answer then to America's health care problems lies not in heading down the road to national health care but in learning from the experiences of other countries, which demonstrate the failure of centralized command and control and the benefits of increasing consumer incentives and choice.

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

- Ronald Reagan

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5.         Lean HealthCare: Going Horizontal Rather than Vertical by James P. Womack

One of my favorite value-stream walks is with the senior managers of several organizations who share and jointly manage a value-creating process that stretches all the way from raw materials to the end customer. I've been taking walks of this sort for more than 20 years and I usually see the same thing: Smart, hard working managers, each trying to optimize their portion of the value stream and wondering why there is so much inventory, interruption, and waste along the stream and why it is so hard to truly satisfy the customer waiting at the end.

This is what I usually see because we live in a world where everything is oriented vertically - departments, functions, enterprises, and, very important, individuals - despite the fact that the flow of value to the customer is horizontal across all the departments, functions, and enterprises. And - here's the really odd part -- every manager and employee touching the value stream knows intuitively, just below the surface, that value flows horizontally and that customers have no interest at all in the vertical constraints interrupting the flow.

So what's the problem? Why is it so hard for us to act horizontally rather than just work around (or simply ignore) the enormous problems of being vertical?

I hate to say, but the problem begins with you and me. We are all points along the stream, standing tall in our own estimation, and our first objective is to optimize ourselves, our own point! Given this, it's not surprising that we first seek to optimize our department (where our boss, our personnel evaluation, and our career path reside) and then our function and then, maybe, our enterprise, with no energy left over for optimizing the whole stream.

But let's not be too hard on ourselves. Our personal objectives, compensation, and career trajectories strongly direct us to look up, for fear of falling down, rather to look from side to side in hopes of doing better. We aren't so much bad people - at least I'm not! - but good people working in a bad management process. However, unless we can devise a new framework for thinking together about the horizontal flow of value in a way that makes everyone better off, we will all continue to act as we always have. The predictable result is frustrating work lives and an exasperating experience for customers.

How can we do better? The first step is simple. Take a walk together along the stream to see, and to reach agreement on, what is really happening and the problems the current state causes managers, employees, and customers. Then draw a map that everyone touching the stream can see and post this as the baseline. This step always produces amazement and then relief that all of the dysfunctions and conflicts are finally out in the open.

Next, assign someone to lead a team involving every function and firm touching the value stream to envision a value-creating process that better solves customer problems while saving time and money. Then ask why this can't be created and seek the root cause. Part of the problem may be technical and some outside help may be needed when skills are lacking. But in my experience the critical problems are more likely to be organizational across multiple functions and enterprises. For example, money may need to be spent at one point (for facilities, equipment, training, new packaging of goods, etc.) and behaviors may need to change at this or other points to create a better result for the whole stream.

But why would the managers of the factory or the warehouse or the retailer do this when all of the benefit goes to one or a few points elsewhere along the stream? And why would employees cooperate in rethinking work when they may individually have more work or no work at all? The answer, of course, is that they won't and everyone involved will spend their time instead on explanations of why the failure to improve performance is everyone else's fault. A classic prisoner's dilemma in which everyone gets to stay in their vertical jail!

So the job of the value-stream leader - who it should be noted has no authority over most and perhaps all of the departments and firms involved - is to take responsibility for the performance of the whole value stream and discover ways to make everyone along the stream whole as the stream is improved. In the end the senior leaders of all the departments, functions, and firms will need to agree with the plan, arrange compensation mechanisms for those who would otherwise be losers, and make sure that everyone touching the stream has incentives aligned with the goal of optimizing the stream. But the first step is to raise consciousness, create the vision, highlight the problems to be overcome, identify the costs of improvement along with the benefits of success, and describe the ways to offset costs with benefits to achieve a positive sum solution. Without this first step, starting with a simple walk together, we will all continue along our vertical path, where value stream performance is a stagnant, horizontal line.

Best regards,

James P. Womack
Founder and Chairman
Lean Enterprise Institute, Inc.

P.S. LEI has just released a path-breaking workbook with practical advice on how to do what I have just described. Robert Martichenko and Kevin von Grabe have distilled their many years of experience developing logistics systems, initially in collaboration with Toyota, into a brief workbook on optimizing "fulfillment streams" (their helpful term for the entire flow of value from raw materials to customer.) Building a Lean Fulfillment Stream introduces the critically lacking management tools of the Fulfillment-Stream Council and the Fulfillment-Stream Leader. It utilizes a case study, based on their extensive experience deploying lean logistics far beyond Toyota and the auto industry, that shows you how to apply these and other important concepts such as the Total Cost of Fulfillment. I hope you will go to for further details on this workbook, including chapter downloads and a Q&A with the authors.

Feel free to forward this message to suppliers, customers, or colleagues who are implementing lean -- or should be. (You may also quote portions of this e-letter. But please remember that it is protected under U.S. and international copyright laws. That means you can't use it commercially, post, or republish it without written permission in advance from the Lean Enterprise Institute. For permission, write to ) Permission was granted.

© Copyright 2010 Lean Enterprise Institute, Inc. All rights reserved.

If this e-letter was forwarded to you, visit to subscribe. Just click the "Become a Member" link on the right to get a free subscription and access LEI's valuable content about implementing lean principles in production, service, administration, and healthcare value streams.

-Lean Enterprise Institute, One Cambridge Center, Cambridge, MA 02142, (617) 871-2900.

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The Future of Health Care Has to Be Lean, Efficient and Personal.

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6.         Misdirection in Healthcare: Current doctors have paid huge costs to be where they are.

Why Doctors Don't Want Free-Market Medicine By Theodore Levy

The Freeman | Ideas On Liberty • July/August 2010 • Vol. 60/Issue 6

You may have heard that the AMA and "America's physicians" favor universal health care. That's true of the AMA, but that organization represents fewer than 20 percent of the nation's doctors. And it's true of many academic university physicians, but anecdotally it is obviously untrue of most doctors in private practice. Many of those docs desire to "get government out of medicine."

But those physicians have a problem, of a sort that "getting government out of medicine" doesn't solve.
I'll describe the problem in a moment; but first, an economic interlude:

When special interests get special grants of power from government, they benefit, of course. But the benefits—what economists call rents—are not static. Over time they tend to dissipate, because the prices of the factors of production required to obtain them are bid up. A new market equilibrium is formed. Some examples:

·                     The chattel-slave system present during the first century of this country's existence gave the lie to the noble words of the Declaration of Independence that all men are created equal. I have much sympathy for abolitionist William Lloyd Garrison's famous epithet that, because it sanctioned slavery, the Constitution was a "covenant with death and an agreement with hell." But slavery persisted. Economic historians have asked why. Nobel laureate economist Stanley Engerman, in his work Time on the Cross, coauthored with Robert Fogel, investigated the tricky economics of slavery. . . 

·                     Few people think today that Social Security is a good deal. Young people doubt it will be around when they retire. Middle-aged people and those recently on Social Security know they could have done better had they been allowed to invest the money themselves in a diversified low-risk portfolio. Granted, those who turned 65 in the early years after FDR began the program benefitted, as they received benefits without incurring costs. But those days are long gone. Now people on Social Security may only break even, and surely in the future they will suffer a financial loss. Nonetheless, current recipients don't want the system to end, because they'd lose even the little money they're counting on.

·                     In New York City and other large metropolitan areas, before you can legally drive a taxi, you have to purchase a medallion (license) from the government. The nominal price of a medallion is not high, but to restrict the supply of cabs the municipality sharply limits the number sold. So (as with ticket scalping) in the resale market the price is much higher than the face value, sometimes several hundred thousand dollars or more. The system benefitted the taxi companies operating at the time licensing was enacted—unsurprisingly, these were the very companies that lobbied for them—because restricting medallions restricted taxi supply and increased the amount the companies could charge their customers. But it didn't help make a larger profit for the taxi owners who came along later, because the larger fees they were able to earn from a lower supply of cabs were offset by the exorbitant cost of the now-expensive medallions. And yet, although making only market incomes, the current taxi owners have every incentive to maintain the medallion system because eliminating it now would cause them an even greater loss when the market price of medallions fell to zero.

What does any of this have to do with medical care? Medical licenses are like taxi medallions. The AMA assiduously sought the licensing of medical professionals from its very beginning in 1847. At that time, ironically, schooled physicians had little more to offer patients than charlatans did and often caused more harm than good through what was known as "heroic therapy," treatments like leeching and the use of arsenical purgatives. Finally, about a hundred years ago, medical services were cartelized. After the release of the Flexner Report (1910), the number of medical graduates declined by approximately half over the next decade, a decrease falling disproportionately on minority and female physicians.

How Much Training?

The question is not whether it's a good thing to have better-trained doctors; the question is whether overtraining is possible, and how to know without market competition whether we've reached that point. A recent physician survey asked if doctors thought every M.D. needed all the training he received to be able to provide high-quality care. Many respondents answered no.

Perhaps doctors as good as those currently practicing could be trained in six or seven years—rather than the 12 or more today. Perhaps a combination of less human training but better computer diagnostics would be of value. Perhaps an apprenticeship model would work better than the current didactic educational model. Without a competitive market, there's no way to tell.

No doubt most physicians are sincere when they say they can't imagine a system with less training that would protect the patient from charlatans. But it's also true most citizens under Soviet rule couldn't imagine how shoes would reach market without central command, and no doubt at least some plantation owners were sincere in their concern that if slavery ended, the slaves would not know what to do or where to go.

Most everyone has met a bad doctor. And yet he, too, spent four years in medical school and passed the boards as presently constituted. If quality were the only consideration, isn't that evidence that four years plus residency is not enough? Should medical school be eight years long? The point, of course, is that extra training before practice has a cost as well as a benefit.

Just as the economic rent (the excess earnings over the amount necessary to keep the factor of production in its current use) from taxi medallions was dissipated over time as the cost of obtaining the medallions increased, so too the economic rent of a medical license over time does not go to doctors but rather to those who can charge doctors more to meet the license and practice requirements. In the decades after Medicare spending increased the income of physicians, the price of medical school skyrocketed. So while licensed doctors made more money, becoming a doctor with a license cost more money. Doctors all complain about the high cost of malpractice insurance, but few realize that one reason such insurance commands a high price is that doctors can pay it.

Trouble Breaking Even

Current doctors have all paid huge costs to be where they are today. Yet many of them describe trouble breaking even financially, even though the average doctor makes a great income compared to the average American. Like those currently collecting Social Security, they would be hurt by a change in the system that lowered their incomes.

So most doctors do not really want "less government" in health care. They want the type of government control and regulation that restricts supply and limits innovation to that which directly benefits the medical cartel. They don't want nurses doing things—even simple things—without physician supervision for the same reason dentists don't want dental hygienists to do even simple basic cleanings without dental supervision. They prefer to view ancillary personnel as subordinates rather than competitors. Like most other licensed professionals, they complain only about the regulations that harm them to the benefit of others, not those that benefit them at the expense of others.

Society was better off ending slavery and would be better off ending the Ponzi scheme of Social Security and the legal cap on taxi medallions. But there are always special interests who will be hurt by socially beneficial reforms. No one likes to see himself as a special interest. But physicians as a group would likely be financially harmed by a true free market in health care, one that ended not only the burdensome regulation doctors all complain about but also the restrictions placed on who is legally allowed to offer services labeled as "health care," restrictions that redound to physicians' benefit.

Fortunately for the physicians, almost no one is calling for a free market in health care. Doctors want regulations that free them to practice as they wish, while still having the government assure that everyone can get health insurance and thus pay doctors for practicing as they wish. Patients want as much care as they need and desire, paid for by others. Insurance companies want to maintain their cozy relationships with state regulators, built up over years, and not have to compete nationally, and are therefore opposed to calls to end the prohibition of interstate sales of health insurance. Everyone calls for help from the State, which, as Bastiat pointed out, is the fiction by which everyone tries to live at the expense of everyone else.

Article printed from The Freeman | Ideas On Liberty:

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Well-Meaning Regulations Worsen Quality of Care.

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7.         Overheard on Capital Hill: July 4, 1776

A Cold Man's Warm Words
Jefferson's tender lament didn't make it into the Declaration.

Declarations by Peggy Noonan, WSJ, July 4, 2010

The tenderest words in American political history were cut from the document they were to have graced.

It was July 1, 2 ,3 and 4, 1776, in the State House in Philadelphia. America was being born. The Continental Congress was reviewing and editing the language of the proposed Declaration of Independence and Thomas Jefferson, its primary author, was suffering the death of a thousand cuts.

The tensions over slavery had been wrenching, terrible, and were resolved by brute calculation: to damn or outlaw it now would break fragile consensus, halt all momentum, and stop the creation of the United States. References to the slave trade were omitted, but the founders were not stupid men, and surely they knew their young nation would have its date with destiny; surely they heard in their silence the guns of Fort Sumter.

Still, in the end, the Congress would not produce only an act of the most enormous human and political significance, the creation of America, it would provide history with one of the few instances in which a work of true literary genius was produced, in essence, by committee. (The writing of the King James Bible is another.)

The beginning of the Declaration had a calm stateliness that signaled, subtly, that something huge is happening:

"When in the Course of human events it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to separate."

This gave a tone of moral modesty to an act, revolution, that is not a modest one. And it was an interesting modesty, expressing respect for the opinion of the world while assuming the whole world was watching. In time it would be. But that phrase, "a decent respect to the opinions of mankind" is still a marker, a reminder: We began with respect. America always gets in trouble when we forget that.

The second paragraph will, literally, live forever in the history of man. It still catches the throat:

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness.—That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed."

What followed was a list of grievances that made the case for separation from the mother country, and this part was fiery. Jefferson was a cold man who wrote with great feeling. He trained his eyes on the depredations of King George III: "He has plundered our seas, ravaged our coasts, burnt our towns. . . . He is at this time transporting large Armies of foreign Mercenaries to compete the work of death, desolation and tyranny . . ."

Members of the Congress read and reread, and the cutting commenced. Sometimes they cooled Jefferson down. He wrote that the king "suffered the administration of justice totally to cease in some of these states." They made it simpler: "He has obstructed the Administration of Justice."

"For Thomas Jefferson it became a painful ordeal, as change after change was called for and approximately a quarter of what he had written was cut entirely." I quote from the historian David McCullough's "John Adams," as I did last year at this time, because everything's there. . . .

Poignantly, with a plaintive sound, Jefferson addresses and gives voice to the human pain of parting: "We might have been a free and great people together." *

What loss there is in those words, what humanity, and what realism, too. . .

America and Britain did become great and free peoples together, and apart, bound by a special relationship our political leaders don't often speak of and should never let fade. You can't have enough old friends. There was the strange war of 1812, declared by America and waged here by England, which reinvaded, and burned our White House and Capitol. That was rude of them. But they got their heads handed to them in New Orleans and left, never to return as an army.

Even 1812 gave us something beautiful and tender. There was a bombardment at Fort McHenry. A young lawyer and writer was watching, Francis Scott Key. He knew his country was imperiled. He watched the long night in hopes the fort had not fallen. And he saw it—the rocket's red glare, the bombs bursting in air, gave proof through the night that our flag was still there.

And so to all writers (would-be, occasional and professional) and all editors too, down through our history: Happy 234th Independence Day. And to our British cousins: Nice growing old with you.

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*It hurt Thomas Jefferson to see these words removed from his great document. And we know something about how he viewed his life, his own essence and meaning, from the words he directed that would, a half-century after 1776, be cut onto his tombstone. The first word after his name is "Author."

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8.         Innovations in Healthcare: Health Care's 'Radical Improver'

How medicine's digital revolution can empower doctors and patients, with or without ObamaCare.

By JOSEPH RAGO | WSJ | December 12, 2009  

Watertown, Mass.

'It's a little bit like talking to a young prince," says Jonathan Bush, chairman and CEO of Athenahealth, a major player in information technology services for physicians, of his recent visits to Capitol Hill. "'So—tell me about this market thing that your people use,'" he says, mimicking the political royalty with a grin and extending his forearm. "'Wait: I must catch my falcon!'"

Athenahealth's headquarters, on the banks of the Charles River outside Boston, is a world away from D.C., and it's clear, as he continues his metaphor, that Mr. Bush enjoys the distance: "And these princes, they mean well and they're lovely," he says, "but they're living in this alternate universe where there's no such thing as a market in health care and they don't understand why one might be remotely useful."

He pauses. "That's weird to me."  

Mr. Bush is an outlier in the generally buttoned-down world of the health industry. He's exuberant, hyperactive, speaking in frenetic running monologues; it's not hard to see why the political class might be taken aback: "I still have to keep going to Washington and sucking up," he says, switching metaphors. "Because the problem is when you have a baby with an Uzi, right, they might accidentally mow you down. But here's the thing . . . they're brilliant people. It's just that the idea of a market in health care never occurred to them."

As Mr. Bush sees it, the profound problem with U.S. health care is that there's "no landscape of choices, or choosers." Due to the complexity of America's third-party laundromat for health dollars—your doctor's clerical staff bills your treatment to an insurance company picked by your employer, and it pays him with your money via premiums or foregone wages—"few doctors in America know the actual value of the services they render."

Athena's core business helps them manage their practices and get paid, but the larger purpose of the company, which he and board member Todd Park co-founded in 1997, is to try to shore up health care's resemblance to a normal market. It has grown into one of the country's most innovative health IT firms.

Athena began as a San Diego birthing clinic and floundered because it couldn't cope with back-office volatility. All transactions were conducted on paper. No one understood how to navigate the dense and bewildering coding rules for dozens of different insurers or the fee schedules for government payers like Medicaid. Claims were denied with no explanation or vaporized in purgatory. The clinic went bankrupt in 18 months.

With Mr. Park (who has joined the Obama administration), Athena designed a program to digitize records and automate billing. It now colonizes the wilderness of paperwork and habitual financial chaos that defines running a doctors office, and it is also moving into clinical record-keeping for individual patients. Some 15,000 physicians in 43 states use Athena as a virtual office, a number that is growing at an annual 30% clip.

It is a massive logistical undertaking. Athena's main facility is housed in a decommissioned World War II arsenal on the Charles, where 30,000 pounds of paper is processed every month, most of the tonnage being paper checks. Incredibly, doctors also receive on average 1,185 faxes each month—mostly lab results—and those are handled too.

State Medicaid programs, by the way, are easily the worst payers, according to Athena's annual ranking. In New York, for instance, claims must be tendered on a dead-tree form instead of electronically and in blue ink—black is grounds for rejection—and then go on to spend a full 161 days, or almost a half year, in accounts receivable.

While streamlining this disorder frees up time for the company's clients to treat patients, it also throws off vast data, which are fed in central servers, aggregated and analyzed. This "athenanet" system is among the few health-tech offerings based on "cloud computing"—in the sense that the applications are accessed on the Web, instead of a computer's hard drive, allowing constant updates and refinements. If a regulation changes or an insurer adjusts a payment policy, it is reflected on athenanet almost in real time; on the clinical side, the program can adapt at the same rapid pace as medicine itself.

Mr. Bush thinks the main benefit is the "collective intelligence" that he is starting to weave together from the 87% of American physicians who practice solo or in groups of five doctors or fewer. "We found one of the last few remaining crowds in health care, which are these independent practices. Now you can argue that this decentralization is not the best thing in the world," but what's most important, he argues, is that "they're still allowed to go and make their own decisions."

In effect, as the network gets bigger, it gets smarter, while opening the space for innovations to feed off one another and spread. There really can be "radical improvement" in health care, Mr. Bush says, but only if there are "radical improvers" able to set themselves apart and lead the forward advance. "No one ever says, 'Here's to the average,'" he declares pointedly.

The Athena model is superior to most electronic medical record systems, or EMRs, which are generally based on static software that are inflexible, can't link to other systems, and are sold by large corporate vendors like General Electric. One reason the digital revolution has so far passed over the health sector is sheer bad product. The adoption of EMR in health systems across the country has been dogged by cumbersome interfaces, error propagation and other drawbacks. In 2003, for instance, Cedars-Sinai in Los Angeles dumped a $34 million proprietary system after doctors staged a revolt.

Athena also stands in marked contrast to most of the wider health-care market, which Mr. Bush argues is homogenized and rigid, and getting more so. The problem is "easily fixed by releasing some power into the arms of consumers and cutting employers and certainly the government out of it," he says, turning to ObamaCare. "Certainly I'm not commenting on the amount of wealth redistribution that we should do as a society. Fundamentally I believe we need some, and whether the amount we're doing today is enough or too much or not enough, that's not my thing. If we feel like rich people should pay more for not-rich people's health insurance, that's fine.

"But just give them the money," he cries. "It's totally inefficient wealth redistribution because they can't get creative with it. They're not allowed by law to get creative with it."

What Mr. Bush means is that the government imposes standardized rules and mandates with no concern for how much they will cost or who will bear the burden. Given the choice, consumers might decide on cheaper policies that cover some services but not others, or decide to run more risk.

Yet for all the talk about expanding coverage, Mr. Bush says the real problem is that "You can't buy what you want." Another way of putting it is that "America will have one car. Everyone will have access to transportation, which means that everyone will have a black Escalade, with spinners. That's it. There's no Hyundais, no bicycles, no nothing."

And it's scandalously unfair. "These poor people who clip the things off the backs of cans to make the tomatoes cheaper are subsidizing the hypochondriac who gets his shoulder done with an arthroscope because it clicks when he serves at tennis."

Under ObamaCare, Mr. Bush says, "everyone is going to get health care according to the wise-men benefit panel, who will tell you exactly what it is, and then they'll run out of money, so every year the wise panel will just squish the benefit a little. People will start to say, well, that's not going to work for me." For this reason he doesn't think central health planning will have any longevity, and eventually people "will start leaking out into the [private] market once we run out of Obama energy."

His company, he thinks, will play an important role in such a world, where individuals would have more responsibility for weighing trade-offs—which, he believes, is the only lasting way to enforce discipline in health spending: "Today it's so complicated that the average consumer—and this is what the academics say—you can't put the average consumer in charge, it's too complicated. Yeah it's too complicated! So let's make it not complicated," he says. Athenanet generates "clean information," the basic price signals about health care that "a regular old consumer could look at and say, 'That's worth it' or 'I'd rather do this one on the other side of Route 128 that does it cheaper.'"

Mr. Bush is less sanguine about the White House cost-control approach of better living through technocracy and "Benthemite micromanagement." As an illustration he singles out the idea of dispensing bonus payments to hospitals that find ways to reduce Medicare spending. If the bonus is higher than what the hospital would have been paid under the status quo, then Medicare is worse off—but if the bonus is less than what the hospital would have earned otherwise, in what sense is it an incentive to change? In other words, "I'm going to give you a dollar bill for every 10-dollar bill you give me?" Mr. Bush asks incredulously.

The irony is that Athena will likely benefit from the Project Mayhem that is about to begin. "It's probably terrible that all this new bureaucracy is being created," Mr. Bush says. "But there's going to be 50 new Medicaid-type plans in these insurance exchanges, run by the same insurance commissioners, these same sort of glazed-over-looking state secretaries of health. You know, just not really the brightest bulbs in the chandeliers of the world. Medicaid, the worst payer in the country by a factor of four! Mother of pearl! So I feel a little bit like a robber baron. I am going to make oil money dealing with them."

The double irony is that Athena—while Mr. Bush might not put it in such an impolitic way, but then again, maybe he would—is also showing that the status quo for all its flaws is capable of organic change and real progress without the blunt-force trauma Congress is likely to inflict. Or in spite of it.

Take the nearly $47 billion in stimulus cash the White House has budgeted to prime the pump for health IT adoption. Mr. Bush says he's glad his industry is getting more attention from the bully pulpit, but that "It is kind of too bad that all these software companies that we're really close to putting out of business, these terrible legacy companies, with code that was written in the '70s, are going to get life support. That's why I call it the Sunny von Bülow bill. What it is, basically, is a federally sponsored sale on old-fashioned software."

"It's designed like a box-buying campaign," he continues. "You get this fixed chunk of money for a few years, you get to pay off your EMR, like its a thing. People in Washington think in terms of things that we'll buy and then they'll be there. Buildings. Roads. Tanks. What Lockheed Martin makes. Things.

"And this isn't that. This is a market: its a set of agreements, it's a language. What's needed is a way of exchanging value and making choices, that's ethical—and, you know, nobody, nobody, not nobody, has said a word about that.

Mr. Rago is a senior editorial page writer at the Journal.

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9.         The Health Plan for the USA: An Increasing Challenge: American Thinker

A Stranger in our Midst

By Robert Weissberg, Prof of Political Science

As the Obama administration enters its second year, I –and undoubtedly millions of others –have struggled to develop a shorthand term that captures our emotional unease. Defining this discomfort is tricky. I reject nearly the entire Obama agenda, but the term "being opposed" lacks an emotional punch. Nor do terms like "worried" or "anxious" apply. I was more worried about America's future during the Johnson or Carter years, so it's not that dictionary, either. Nor, for that matter, is this about backroom odious deal-making and pork, which are endemic in American politics.

After auditioning countless political terms, I finally realized that the Obama administration and its congressional collaborators almost resemble a foreign occupying force, a coterie of politically and culturally non-indigenous leaders whose rule contravenes local values rooted in our national tradition. It is as if the United States has been occupied by a foreign power, and this transcends policy objections. It is not about Obama's birthplace. It is not about race, either; millions of white Americans have had black mayors and black governors, and this unease about out-of-synch values never surfaced.

The term I settled on is "alien rule" –based on outsider values, regardless of policy benefits –that generates agitation. This is what bloody anti-colonial strife was all about. No doubt, millions of Indians and Africans probably grasped that expelling the British guaranteed economic ruin and even worse governance, but at least the mess would be their mess. Just travel to Afghanistan and witness American military commanders' efforts to enlist tribal elders with promises of roads, clean water, dental clinics, and all else that America can freely provide. Many of these elders probably privately prefer abject poverty to foreign occupation since it would be their poverty, run by their people, according to their sensibilities.

This disquiet was a slow realization. Awareness began with Obama's odd pre-presidency associations, decades of being oblivious to Rev. Wright's anti-American ranting, his enduring friendship with the terrorist guy-in-the-neighborhood Bill Ayers, and the Saul Alinsky-flavored anti-capitalist community activism. Further add a hazy personal background -- an Indonesian childhood, shifting official names, and a paperless-trail climb through elite educational institutions.

None of this disqualified Obama from the presidency; rather, this background just doesn't fit with the conventional political résumé. It is just the "outsider?" quality that alarms. For all the yammering about George W. Bush's privileged background, his made-in-the-USA persona was absolutely indisputable. John McCain might be embarrassed about his Naval Academy class rank and iffy combat performance, but there was never any doubt of his authenticity. Countless conservatives despised Bill Clinton, but nobody ever, ever doubted his good-old-boy American bonafides.

The suspicion that Obama is an outsider, a figure who really doesn't "get" America, grew clearer from his initial appointments. What "native" would appoint Kevin Jennings, a militant gay activist, to oversee school safety? Or permit a Marxist rabble-rouser to be a "green jobs czar"? How about an Attorney General who began by accusing Americans of cowardice when it comes to discussing race? And who can forget Obama's weird defense of his pal Louis Henry Gates from "racist" Cambridge, Massachusetts cops? If the American Revolution had never occurred and the Queen had appointed Obama Royal Governor (after his distinguished service in Kenya), a trusted locally attuned aide would have first whispered in his ear, "Mr. Governor General, here in America, we do not automatically assume that the police were at fault," and the day would have been saved.

And then there's the "we are sorry, we'll never be arrogant again" rhetoric seemingly designed for a future President of the World election campaign. What made Obama's Cairo utterances so distressing was how they grated on American cultural sensibilities. And he just doesn't notice, perhaps akin to never hearing Rev. Wright anti-American diatribes. An American president does not pander to third-world audiences by lying about the Muslim contribution to America. Imagine Ronald Reagan, or any past American president, trying to win friends by apologizing. This appeal contravenes our national character and far exceeds a momentary embarrassment about garbled syntax or poor delivery. Then there's Obama's bizarre, totally unnecessary deep bowing to foreign potentates. Americans look foreign leaders squarely in the eye and firmly shake hands; we don't bow.

But far worse is Obama's tone-deafness about American government. How can any ordinary American, even a traditional liberal, believe that jamming through unpopular, debt-expanding legislation that consumes one-sixth of our GDP, sometimes with sly side-payments and with a thin majority, will eventually be judged legitimate? This is third-world, maximum-leader-style politics. That the legislation was barely understood even by its defenders and vehemently championed by a representative of that typical American city, San Francisco, only exacerbates the strangeness. And now President Obama sides with illegal aliens over the State of Arizona, which seeks to enforce the federal immigration law to protect American citizens from marauding drug gangs and other miscreants streaming in across the Mexican border.

Reciprocal public disengagement from President Obama is strongly suggested by recent poll data on public trust in government. According to a recent Pew report, only 22% of those asked trust the government always or most of the time, among the lowest figures in half a century. And while pro-government support has been slipping for decades, the Obama presidency has sharply exacerbated this drop. To be sure, many factors (in particular the economic downturn) contribute to this decline, but remember that Obama was recently elected by an often wildly enthusiastic popular majority. The collapse of trust undoubtedly transcends policy quibbles or a sluggish economy -- it is far more consistent with a deeper alienation. 

Perhaps the clearest evidence for this "foreigner in our midst" mentality is the name given our resistance -- tea parties, an image that instantly invokes the American struggle against George III, a clueless foreign ruler from central casting. This history-laden label was hardly predetermined, but it instantly stuck (as did the election of Sen. Scott Brown as "the shot heard around the world" and tea partiers dressing up in colonial-era costumes). Perhaps subconsciously, Obama does remind Americans of when the U.S. was really occupied by a foreign power. A Declaration of Independence passage may still resonate: "HE [George III] has erected a Multitude of new Offices [Czars], and sent hither Swarms of Officers [recently hired IRS agents] to harass our People, and eat out the Substance." What's next?

Robert Weissberg is Professor of Political Science-Emeritus, University of Illinois-Urbana.

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

·                     Medicine and Liberty - Network of Liberty Oriented Doctors,, Alphonse Crespo, MD, Executive Director and Founder
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

·                     Entrepreneur-Country. Julie Meyer, CEO of Ariadne Capital, (Sorry about the nepotism, but her message is important) recently launched Entrepreneur Country. Read their manifesto for information:  3. The bigger the State grows, the weaker the people become - big government creates dependency . . .  5. No real, sustainable wealth creation through entrepreneurship ever owed its success to government . . .  11. The triple play of the internet, entrepreneurship, and individual capitalism is an unstoppable force around the world, and that Individual Capitalism is the force that will shape the 21st Century . . .  Read the entire  manifest . . .

·                     Americans for Tax Reform,, Grover Norquist, President, keeps us apprised of the Cost of Government Day® Report, Calendar Year 2010. 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 2008 was July 16th, a four-day increase above last year's revised date of July 10th. With July 16th as the COGD, working people must toil on average 197 days out of the year just to meet all the costs imposed by government. In other words, the cost of government consumes 53.9 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. ATR also keeps us informed of the campaign promises. You may have noticed that President Obama has broken his central campaign promise – a "firm pledge" that Americans making less than $250,000 would not see "any form of tax increase." He first broke this pledge sixteen days into his presidency when he signed a 156 percent increase in the federal excise tax on tobacco. And Obamacare contains 21 tax increases – several of which violate his "firm pledge". Get your Obama care at . . . . To protect you from these tax hikes, Americans for Tax Reform presents the "Obama Tax Hike Exemption Card". The card fits neatly in your wallet and contains a list of the tax hikes signed into law by President Obama that violate his tax pledge, as well as a few other taxes that have been threatened: a European-style Value-Added Tax, Cap and Trade taxes, and even a federal soda tax. How to use the card: Step 1: Present the card to merchants, employers, and tax authorities.  Step 2: If challenged, pleasantly ask: "Are you calling President Obama a liar?" Click here to find out of your member of Congress voted for these taxes. "I can make a firm pledge. Under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes." "If your family earns less than $250,000 a year, you will not see your taxes increased a single dime. I repeat: not one single dime."
--Candidate Barack Obama, Sept. 12, 2008

·                     National Taxpayer's Union,, Duane Parde, President, keeps us apprised of all the taxation challenges our elected officials are trying to foist on us throughout the United States. To find the organization in your state that's trying to keep sanity in our taxation system, click on your state at On August 19 you can start working for yourself. It takes nearly 8 months of hard work for every American to pay for the cost of government. Read more  . . .

·                     Evolving Excellence—Lean Enterprise Leadership. Kevin Meyer, CEO of Superfactory, has a newsletter which impacts health care in many aspects. Join his evolving excellence blog . . . Excellence is every physician's middle name and thus a natural affiliation for all of us. This month, read his The Customer is the Boss at FAVI "I came in the day after I became CEO, and gathered the people. I told them tomorrow when you come to work, you do not work for me or for a boss. You work for your customer. I don't pay you. They do. . . . You do what is needed for the customer." And with that single stroke, he eliminated the central control: personnel, product development, purchasing…all gone. Looks like something we should import into our hospitals. I believe every RN, given the opportunity, could manage her ward of patients or customers in similar lean and efficient fashion.

·                     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.

·                    Ayn Rand, a Philosophy for Living on Earth,, is a veritable storehouse of common sense economics to help us live on earth. To review the current series of Op-Ed articles, some of which you and I may disagree on, go to 

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Words of Wisdom

Success is not final, failure is not fatal: it's the courage to continue that counts. -Winston Churchill

The best thing about the future is that it comes only one day at a time. -Abraham Lincoln

A people that values its privileges above its principles soon loses both. -Dwight Eisenhower

Liberty without learning is always in peril; learning without liberty is always in vain. -John Kennedy   

Failure is but the opportunity to begin again more intelligently. -Henry Ford

Investment in knowledge pays the best interest. -Benjamin Franklin

Recession is when a neighbor loses his job. Depression is when you lose yours. -Ronald Reagan

Some Recent Postings

April 2010 HPUSA Newsletter . . .

This Month in History

This Month in History – July was Freedom Month and Now is Enslavement Month

July 1 marks the beginning of the month in which so many nations, including our own, gained their freedom.

Canada became a self-governing dominion of Great Britain on this day in 1867.

France celebrates the anniversary of its first revolution on July 14.

Such other nations as Algeria, Argentina, Columbia, Belgium, Peru, Liberia and Venezuela gained self- government and freedom during this month.

Our theme this month is freedom—freedom from several points of view: first, how do we keep it and second, what do we do with it. Third, we have to decide how strongly we are committed to it.

Today, we have a memorable reminder of the sad fact that freedom means different things to different people. Today is the anniversary of the beginning of the Battle of Gettysburg in 1863, a battle memorable both for the bravery and dedication of those who fought it and for its role as a turning point in the Civil War. The Battle of Gettysburg, as Abraham Lincoln said a few months later, must be remembered so that from its honored dead "we take increased devotion to that cause for which they gave the last full measure of Devotion." In the largest sense, that cause was, again as Lincoln said, "that government of the people, by the people, for the people shall not perish from the earth."

Medicare went into effect in the United States on this date in 1966. Many well-to-do seniors paid for their private health insurance for some years and finally succumbed to become enslaved to the government for their most personal privacy. In 1970, my father finally gave up paying his Blue Cross/Blue Shield and White Cross policies premiums and sadly just had Medicare. He felt sad for the country that his parents came seeking freedom from the Father of government social insurance, German Chancellor Otto von Bismarck in 1866. As with any entitlement, there is never an objective appraisal of what alternatives would have kept our nation from enslaving themselves, our children and our grandchildren. Charles Ponzi, Bernard Ebbers, Enron, Lou Pearlman, Ivan Boesky, Michael Millikin, Dr. Bill McGuire, Bernard Madoff, ($65 billion), PG & E, and others were mere pikers compared to the grandiose Ponzi schemes that Roosevelt, and Johnson pulled off in 1933 and 1966. It took Reagan and 30 years to reverse the process of living on our children's and grandchildren's future. Will it take another 30 years to survive the current administration's Ponzi Scheme of $ trillions that will outdo Roosevelt & Johnson combined and also enslave us? Or will we fade into the history of human misery being subject to the devastations of government by Kings, Emperors, Dictators, Czars, and other Ruthless Rulers. We could fade into slavery by not even firing a shot or giving serious resistance. What a tragedy from becoming so comfortable with our freedom that we failed to understand the daily risks. Will we then become so comfortable with enslavement like the people of Russia when Communism was overthrown? Some actually wished for the return of the dictator to be told when and where to buy their daily bread, even if it was only once a week. Starvation was more comfortable and secure to them than freedom. 

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