Community For Affordable Health Care

Vol VIII, No 3, October, 2009

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: Sorting Fact From Fiction on Health Care

2.         In the News: Obama Administration’s Health Care Plan

3.         International Healthcare: Is There a ‘Right’ to Health Care?

4.         Government Healthcare: Age 72 is physiologically younger than 65 when Medicare started

5.         Lean HealthCare: Takes many forms not apparent

6.         Misdirection in Healthcare: Crisis of the Uninsured: 2007, by Devon Herrick

7.         Overheard on Capital Hill: Where do Good Treatments really come from?  

8.         Innovations in Healthcare:  Going Horizontal

9.         The Health Plan for the USA: As Proposed by President Obama is unrelated to health

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

HealthPlanUSA is now a separate Newsletter devoted to the rapidly evolving field of health plans being promoted throughout the USA. These are dangerous times. Stay tuned to the current issue, which we bring quarterly and will increase as staffing permits. To read the rest of this newsletter, please sign up at



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 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. The third year it was about half, indicating open forums such as these are critically important. The 4th Annual World Health Congress was held April 22-24, 2007, in Washington, D.C. That year many of the world leaders in healthcare concluded that top down reforming of health care, whether by government or insurance carrier, is not and will not work. We have to get the physicians out of the trenches because reform will require physician involvement. The 5th Annual World Health Care Congress was held April 21-23, 2008, in Washington, D.C. Physicians were present on almost all the platforms and panels. However, it was the industry leaders that gave the most innovated mechanisms to bring health care spending under control. The 6th Annual World Health Care Congress was held April 14-16, 2009, in Washington, D.C. The solution to our health care problems is emerging at this ambitious Congress.  The 5th Annual World Health Care Congress – Europe 2009, met in Brussels, May 23-15, 2009. The 7th Annual World Health Care Congress will be held April 12-14, 2010, in Washington D.C. For more information, visit The future is occurring NOW. 

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1.   Feature Article: Sorting Fact From Fiction on Health Care

By Jerome Groopman, MD and Pamela Hartzband, MD, WSJ, Aug 31, 2009

In recent town-hall meetings, President Barack Obama has called for a national debate on health-care reform based on facts. It is fact that more than 40 million Americans lack coverage and spiraling costs are a burden on individuals, families and our economy. There is broad consensus that these problems must be addressed. But the public is skeptical that their current clinical care is substandard and that no government bureaucrat will come between them and their doctor. Americans have good reason for their doubts—key assertions about gaps in care are flawed and reform proposals to oversee care could sharply shift decisions away from patients and their physicians.

Consider these myths and mantras of the current debate:

           Americans only receive 55% of recommended care. This would be a frightening statistic, if it were true. It is not. Yet it was presented as fact to the Senate Health and Finance Committees, which are writing reform bills, in March 2009 by the Agency for Healthcare Research and Quality (the federal body that sets priorities to improve the nation's health care).

The statistic comes from a flawed study published in 2003 by the Rand Corporation. That study was suppose to be based on telephone interviews with 13,000 Americans in 12 metropolitan areas followed up by a review of each person's medical records and then matched against 439 indicators of quality health practices. But two-thirds of the people contacted declined to participate, making the study biased, by Rand's own admission. To make matters worse, Rand had incomplete medical records on many of those who participated and could not accurately document the care that these patients received. Subscribe . . .

For example, Rand found that only 15% of the patients had received a flu vaccine based on available medical records. But when asked directly, 85% of the patients said that they had been vaccinated. Most importantly, there were no data that indicated whether following the best practices defined by Rand's experts made any difference in the health of the patients.

In March 2007, a team of Harvard researchers published a study in the New England Journal of Medicine that looked at nearly 10,000 patients at community health centers and assessed whether implementing similar quality measures would improve the health of patients with three costly disorders: diabetes, asthma and hypertension. It found that there was no improvement in any of these three maladies.

Dr. Rodney Hayward, a respected health-services professor at the University of Michigan, wrote about this negative result, "It sounds terrible when we hear that 50 percent of recommended care is not received, but much of the care recommended by subspecialty groups is of a modest or unproven value, and mandating adherence to these recommendations is not necessarily in the best interest of patients or society."

           The World Health Organization ranks the U.S. 37th In the world in quality. This is another frightening statistic. It is also not accurate. Yet the head of the National Committee for Quality Assurance, a powerful organization influencing both the government and private insurers in defining quality of care, has stated this as fact.

The World Health Organization ranks the U.S. No. 1 among all countries in "responsiveness." Responsiveness has two components: respect for persons (including dignity, confidentiality and autonomy of individuals and families to make decisions about their own care), and client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider). This is what Americans rightly understand as quality care and worry will be lost in the upheaval of reform. Our country's composite score fell to 37 primarily because we lack universal coverage and care is a financial burden for many citizens.

           We need to implement "best practices." Mr. Obama and his advisers believe in implementing "best practices" that physicians and hospitals should follow. A federal commission would identify these practices.

On June 24, 2009, the president appeared on "Good Morning America" with Diane Sawyer. When Ms. Sawyer asked whether "best practices" would be implemented by "encouragement" or "by law," the president did not answer directly. He said that he was confident doctors "want to engage in best practices" and "patients are going to insist on it." The president also said there should be financial incentives to "allow doctors to do the right thing."

There are domains of medicine where a patient has no control and depends on the physician and the hospital to provide best practices. Strict protocols have been developed to prevent infections during procedures and to reduce the risk of surgical mishaps. There are also emergency situations like a patient arriving in the midst of a heart attack where standardized advanced treatments save many lives.

But once we leave safety measures and emergency therapies where patients have scant say, what is "the right thing"? Data from clinical studies provide averages from populations and may not apply to individual patients. Clinical studies routinely exclude patients with more than one medical condition and often the elderly or people on multiple medications. Conclusions about what works and what doesn't work change much too quickly for policy makers to dictate clinical practice.

An analysis from the Ottawa Health Research Institute published in the Annals of Internal Medicine in 2007 reveals how long it takes for conclusions derived from clinical studies about drugs, devices and procedures to become outdated. Within one year, 15 of 100 recommendations based on the "best evidence" had to be significantly reversed; within two years, 23 were reversed, and at 5 1/2 years, half were contradicted. Americans have witnessed these reversals firsthand as firm "expert" recommendations about the benefits of estrogen replacement therapy for postmenopausal women, low fat diets for obesity, and tight control of blood sugar were overturned.

Even when experts examine the same data, they can come to different conclusions. . . Guidelines developed in the U.S. about whom to treat with cholesterol-lowering drugs are much more aggressive than guidelines in the European Union or the United Kingdom, even though experts here and abroad are extrapolating from the same scientific studies. . .  different experts define "best practice" differently. Many prominent American cardiologists and specialists in preventive medicine believe the U.S. guidelines lead to overtreatment and the Europeans are more sensible. After hearing of this controversy, some patients will still want to take the drug and some will not.

This is how doctors and patients make shared decisions—by considering expert guidelines, weighing why other experts may disagree with the guidelines, and then customizing the therapy to the individual. With respect to "best practices," prudent doctors think, not just follow, and informed patients consider and then choose, not just comply.

           No government bureaucrat will come between you and your doctor. The president has repeatedly stated this in town-hall meetings. But his proposal to provide financial incentives to "allow doctors to do the right thing" could undermine this promise. If doctors and hospitals are rewarded for complying with government mandated treatment measures or penalized if they do not comply, clearly federal bureaucrats are directing health decisions.

Further, at the AMA convention in June 2009, the president proposed linking protection for physicians from malpractice lawsuits if they strictly adhered to government-sponsored treatment guidelines. We need tort reform, but this is misconceived and again clearly inserts the bureaucrat directly into clinical decision making. If doctors are legally protected when they follow government mandates, the converse is that doctors risk lawsuits if they deviate from federal guidelines—even if they believe the government mandate is not in the patient's best interest. With this kind of legislation, physicians might well pressure the patient to comply with treatments even if the therapy clashes with the individual's values and preferences.

The devil is in the regulations. Federal legislation is written with general principles and imperatives. The current House bill H.R. 3200 in title IV, part D has very broad language about identifying and implementing best practices in the delivery of health care. It rightly sets initial priorities around measures to protect patient safety. But the bill does not set limits on what "best practices" federal officials can implement. If it becomes law, bureaucrats could well write regulations mandating treatment measures that violate patient autonomy.

Private insurers are already doing this, and both physicians and patients are chafing at their arbitrary intervention. As Congress works to extend coverage and contain costs, any legislation must clearly codify the promise to preserve for Americans the principle of control over their health-care decisions.

—Dr. Groopman, a staff writer for the New Yorker, and Dr. Hartzband are on the staff of Beth Israel Deaconess Medical Center in Boston and on the faculty of Harvard Medical School.
Printed in The Wall Street Journal, Aug 31, 2009, page A13

Feedback . . . 

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2.   In the News:  Obama Administration’s Health Care Plan

HR 3200, currently under consideration in the House of Representatives, is more than one thousand pages long with most of our Representatives admitting that they have not read it. Although it may be difficult to believe, some of our lawmakers have even admitted that most laws are too long to read in their entirety. The former CEO of the largest insurance agency in Sacramento sent me the following 10-page highlight of the 1000 pages of the Obama Health Plan that he felt would be of vital interest to MedicalTuesday participants. When lawmakers can’t take time to read their own laws, we have to depend on public interest watchdogs to keep us informed.

Reviewed, revised and adapted on July 29, 2009, by Liberty Counsel from the original authored by Peter Fleckenstein and posted on and his blog,

• Sec. 113, Pg. 21-22 of the Health Care (HC) Bill MANDATES a government audit of the books of ALL EMPLOYERS that self-insure in order to “ensure that the law does not provide incentives for small and mid-size employers to self-insure”!

• Sec. 122, Pg. 29, Lines 4-16 - YOUR HEALTH CARE WILL BE RATIONED!

• Sec. 123, Pg. 30 - THERE WILL BE A GOVERNMENT COMMITTEE deciding what treatments and benefits you get.

• Sec. 142, Pg. 42 - The Health Choices Commissioner will choose your benefits for you. You have no choice!

• Sec. 152, Pg. 50-51 - HC will be provided to ALL NON-US citizens.

• Sec. 163, Pg. 58-59 beginning at line 5 - Government will have real-time access to individual’s finances & a National ID health care card will be issued! Subscribe . . . 

• Sec. 163, Pg. 59, Lines 21-24 - Government will have direct access to your bank accounts for electronic funds transfer.

• Sec. 164, Pg. 65 is a payoff subsidized plan for retirees and their families in unions & community organizations (ACORN).

• Sec. 201, Pg. 72, Lines 8-14 - Government is creating an HC Exchange to bring private plans under government control.

• Sec. 203, Pg. 84 - Government mandates ALL benefit packages for private Health Care plans in the exchange.

• Sec. 203, Pg. 85, Line 7 - Specifications of benefit levels for plans means that the government will define your HC plan and has the ability to ration your health care!

• Sec. 205, Pg. 95, Lines 8-18 - The government will use groups (i.e., ACORN & AmeriCorps) to “inform and educate” (sign up) individuals for government plan.

• Sec. 205, Pg. 102, Lines 12-18 - Medicaid-eligible individuals will be automatically enrolled in Medicaid. No freedom to choose.

• Sec. 223, Pg. 124, Lines 24-25 - No company can sue the government for price-fixing. No “administrative of judicial review” against a government monopoly.

• Sec. 225, Pg. 127, Lines 1-16 - Doctors – the government will tell YOU what you can make. “The Secretary shall provide for the annual participation of physicians under the public health insurance option, for which payment may be made for services furnished during the year.”

• Sec. 312, Pg. 145, Lines 15-17 - Employers MUST auto-enroll employees into public option plan.

• Sec. 313, Pg. 149, Lines 16-23 - ANY employer with payroll $400,000 and above who does not provide public option pays 8% tax on all payroll.

• Sec. 313, Pg. 150, Lines 9-13 - Businesses with payroll between $251,000 and $400,000 who do not provide public option pay 2-6% tax on all payroll.

• Sec. 401.59B, Pg. 167, Lines 18-23 - ANY individual who does not have acceptable care, according to government, will be taxed 2.5% of income.

• Sec. 59B, Pg. 170, Line 1 - Any NONRESIDENT alien is exempt from individual taxes. (Americans will pay for their health care.)

• Sec. 431, Pg. 195, Lines 1-3 - Officers and employees of HC Administration (government) will have access to ALL Americans’ financial and personal records.

• Sec. 441, Pg. 203, Lines 14-15 - “The tax imposed under this section shall not be treated as tax.” Yes, it says that.

• Sec. 1121, Pg. 239, Lines 14-24 - The government will limit and reduce physician services for Medicaid. Seniors, low income and poor are the ones affected.

• Sec. 1121, Pg. 241, Lines 6-8 - Doctors, it does not matter what specialty you have; you’ll all be paid the same. “Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service.”

• Sec. 1122, Pg. 253, Lines 10-23 - The government “validates work relative value units” (sets value of doctor’s time), professional judgment, methods etc. (defining the value of humans).

• Sec. 1131, Pg. 265 - Government mandates and controls productivity for private HC industries. “Incorporating Productivity Improvements into Market Basket Updates that Do Not Already Incorporate Such Improvements.”

• Sec. 1141, Pg. 268 - The government regulates rental and purchase of power-driven wheelchairs.

• Sec. 1145, Pg. 272 - Treatment of certain cancer hospitals: Cancer patients and their treatment are open to rationing!

• Sec. 1151, Pg. 280 - The government will penalize hospitals for what government deems preventable readmissions (incentives for hospital to not treat and release).

• Sec. 1151, Pg. 298, Lines 9-11 - Doctors, treat a patient during initial admission that results in a readmission and the government will penalize you for that action.

• Sec. 1156, Pg. 317, Lines 13-20 - “PROHIBITION on physician ownership or Investment.” Government tells doctors what/how much they can own.

• Sec. 1156, Pg. 317-318, Lines 21-25, 1-3 - “PROHIBITION on Expansion of Facility Capacity.” The government will mandate that hospitals cannot expand (“number of operating rooms or beds”).

• Sec. 1156, Pg. 321, Lines 2-13 - Hospitals have opportunity to apply for exception BUT community input required.

• Sec. 1162, Pg. 335-339, Lines 16-25 - The government mandates establishment of outcome-based measures. Rationing.

• Sec. 1162, Pg. 341, Lines 3-9 - The government has authority to disqualify Medicare Advantage Plans (Part B), HMOs, etc. This will force people into a government plan.

 “The Secretary may determine not to identify a Medicare Advantage plan if the Secretary has identified deficiencies in the plan’s compliance with rules for such plans under this part.”

• Sec. 1177, Pg. 354 - Government will RESTRICT enrollment of special needs people! “Extension of Authority of Special Needs Plans to Restrict Enrollment.”

• Sec. 1191, Pg. 379 - Government creates more bureaucracy – “Telehealth Advisory Committee.” HC by phone or the Internet – dial 1 for your health care advice?

• Sec. 1233, Pg. 425, Lines 4-12 - Government mandates Advance (Death) Care Planning consultation. Think Senior Citizens and end of life. END-OF-LIFE COUNSELING. SOME IN THE ADMINISTRATION HAVE ALREADY DISCUSSED RATIONING HEALTH CARE FOR THE ELDERLY.

• Sec. 1233, Pg. 425, Lines 17-19 - Government WILL instruct and consult regarding living wills and durable powers of attorney. Mandatory end-of-life planning!

• Sec. 1233, Pg. 425-426, Lines 22-25, 1-3 - Government provides approved list of end-of-life resources, guiding you in death.

• Sec. 1233, Pg. 427, Lines 15-24 - Government mandates program for orders for life-sustaining treatment (i.e. end of life). The government has a say in how your life ends.

• Sec. 1233, Pg. 429, Lines 1-9 - An “advanced care planning consult” will be used as patient’s health deteriorates.

• Sec. 1233, Pg. 429, Lines 10-12 - “Advanced Care Consultation” may include an ORDER for end-of-life plans - from the government.

• Sec. 1233, Pg. 429, Lines 13-25 - The government will specify which Doctors (professional authority under state law includes Nurse Practitioners or Physician’s Assistants) can write an end-of-life order.

• Sec. 1233, Pg. 430, Lines 11-15 - The government will decide what level of treatment you will have at end of life, according to preset methods (not individually decided).

• Sec. 1302, Pg. 468, Lines 16-21 - “Community-Based Home Medical Services means a nonprofit community-based or state-based organization.”

• Sec. 1302, Pg. 472, Lines 14-17 - PAYMENT TO COMMUNITY-BASED ORGANIZATION: One monthly payment to a community-based organization. Like ACORN?

• Sec. 1308, Pg. 489 - The government will cover Marriage and Family therapy. This will involve government control of your marriage.

• Sec. 1308, Pg. 494-498 - The government will cover Mental Health Services including defining, creating and rationing those services.

• Sec. 1401, Pg. 502 - Center for Comparative Effectiveness Research Established. Big Brother is watching how your treatment works.

• Sec. 1401, Pg. 503, Lines 13-19 - The government will build registries and data networks from YOUR electronic medical records. “The Center may secure directly from any department or agency of the United States information necessary to enable it to carry out this section.”

• Sec. 1401, Pg. 503, Lines 21-25 - The government may secure data directly from any department or agency of the US, including your data.

• Sec. 1401, Pg. 503, Lines 21-25 - The “Center” will collect data both “published and unpublished” (that means public & your private information).

• Sec. 1401, Pg. 506, Lines 19-21 - An “Appointed Clinical Perspective Advisory Panel” will advise The Center and recommend policies that would allow for public access of data.

• Sec. 1401, Pg. 518, Lines 21-25 - The Commission will have input from HC consumer representatives.

• Sec. 1411, Pg. 524, Lines 18-22 - Establishes the “Comparative Effectiveness Research Trust Fund.” More taxes for ALL.

• Sec. 1441, Pg. 621, Lines 20-25 - The government will define “NEW Quality” measures in HC. Since when does government know about quality?

• Sec. 1442, Pg. 622, Lines 2-9 - To pay for the Quality Standards, government will transfer money from “qualified entities” (government Trust Funds) to other government Trust Funds. More Taxes.

• Sec. 1442, Pg. 624, Lines 19-23 - Qualified Entities: “The Secretary shall ensure that the entity is a public, nonprofit or academic institution with technical expertise in the area of health quality measurement.”

• Sec. 1442, Pg. 623, Lines 5-10 - “Quality” measures shall be designed to assess outcomes and functional status of patients.

• Sec. 1442, Pg. 623, Lines 15-17 - “Quality” measures shall be designed to profile you, including race, age, gender, place of residence, etc.

• Sec. 1443, Pg. 628 - The government will give “Multi-Stake Holders” pre-rulemaking input into selection of “quality” measures.

• Sec. 1443, Pg. 630-31, Lines 9-24, 1-9 - Those Multi-Stake Holder groups include unions and groups like ACORN deciding what constitutes quality.

• Sec. 1444, Pg. 632, Lines 14-25 - The government may implement any “Quality measure” of HC services that bureaucrats see fit.

• Sec. 1444, Pg. 632-333, Lines 14-25, 1-9 - The Secretary may issue nonendorsed “Quality Measures” for physician and dialysis services.

• Sec. 1251 (beginning), Pg. 634 to 652 - “Physician Payments Sunshine Provision” – government wants to shine sunlight on Doctors but not government. “Reports on financial relationships between manufacturers and distributors . . . and between physicians and other health care entities.”

• Sec. 1501 (beginning), Pg. 659-670 - Doctors in Residency – government will tell you where your residency will be, thus where you’ll live.

• Sec. 1503 (beginning), Pg. 675-685 - Government will regulate hospitals in EVERY aspect of residency programs, including teaching hospitals.

• Sec. 1601 (beginning), Pg. 685-699 - Increased funding to fight waste, fraud, and abuse. (Like the government with an $18 million website?)

• Sec. 1619, Pg. 700-703 - If your part of HC plan isn’t in the government’s HC Exchange but you qualify for federal aid, you don’t have to pay.

• Sec. 1128G, Pg. 704-708 - If the Secretary determines there is a “significant risk of fraudulent activity,” on HC provider or supplier, the government can do a background check.

• Sec. 1632, Pg. 710, Lines 8-14 - The Secretary has broad powers to deny HC providers and suppliers admittance into HC Exchange. Your doctor could be thrown out of business.

• Sec. 1637, Pg. 718-719 - ANY Doctor who orders durable medical equipment or home medical services is REQUIRED to be enrolled in, or eligible for, Medicare.

• Sec. 1639, Pg. 721 - Government MANDATES that Doctors must have face-to-face with patient to certify patient for home health services.

• Sec. 1639, Pg. 723-24, Lines 23-25, 1-5 - The same government certifications will apply to Medicaid and CHIP (Children’s health plan: Your kids).

• Sec. 1640, Pg. 723, Lines 16-22 - The government reserves right to apply face-to-face certification for patient to ANY other HC service.

• Sec. 1651, Pg. 734, Lines 16-25 - Proposes, for law enforcement sake, that the Secretary of HHS will give Attorney General access to ALL medical data.

• Sec. 1701 (beginning), Pg. 739-756 - The government sets guidelines for subsidizing the uninsured (and you have to pay for them).

• Sec. 1704, Pg. 756-761 - The government will shift burden of payments to Disproportionate Share Hospitals (DSH) to states (your taxes).

• Sec. 1711, Pg. 764 - The government will require preventative services - including vaccinations (no choice).

• Sec. 1713, Pg. 768 - Government-determined Nurse Home Visitation Services (Hello union paybacks).

• Sec. 1713, Pg. 768, Lines 3-5 - Nurse Home Visit Services – Service #1: “Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies.” Compulsory ABORTIONS?

• Sec. 1713, Pg. 768, Lines 11-14 - Nurse Home Visit Services include determinations of economic self-sufficiency, employment advancement and school-readiness.

• Sec. 1714, Pg. 769 - Federal government mandates eligibility for State Family Planning Services. Abortion and government control intertwined.

• Sec. 1733, Pg. 788-798 - Government will set and mandate drug prices, therefore controlling which drugs are brought to market. (Goodbye innovation and private research.)

• Sec. 1744, Pg. 796-799 - Establishes PAYMENTS for graduate medical education. The government will now control your doctor’s education.

• Sec.1751, Pg. 800 - The government will decide which Health Care conditions will be paid. Say “RATION!”

• Sec. 1759, Pg. 809 - Billing Agents, clearinghouses, or other alternate payees are required to register. The government takes over private payment systems too.

• Sec. 1801, Pg. 819-823 - The Government will identify individuals “likely to be ineligible” for subsidies. Will access all personal financial information.

• Sec. 1802, Pg. 823-828 - Government sets up Comparative Effectiveness Research Trust Fund. Another bottomless tax pit.

• Sec. 4375, Pg. 828-832, Lines 12-16 - Government will impose a fee on ALL private health insurance plans, including self-insured, to pay for Trust Fund!

• Sec. 4377, Pg. 835, Lines 11-13 - Fees imposed by government for Trust Fund shall be treated as if they were taxes.

• Sec. 440, Pg. 837-839 - The government will design and implement Home Visitation Program for families with young kids and families that are expecting children.

• Sec. 1904, Pg. 843-844 - This Home Visitation Program includes the government coming into your house and teaching/telling you how to parent!

• Sec. 2002, Pg. 858 - The government will establish a Public Health Fund at a cost of $88,800,000,000 (That’s Billions).

• Sec. 2201, Pg. 864 - The government will MANDATE the establishment of a National Health Service Corps.

            o Sec. 2201 - “Fulfillment of Obligated Service Requirement”

            o Sec. 2201, Pg. 864-875 - The NHS Corps is a program where Doctors perform mandatory HC

               for 2 years for partial loan repayment.

• Sec. 2212, Pg. 875-891 - The government takes over the education of Medical students and Doctors through education and loans.

• Sec. 340L, Pg. 897 - The government will establish a Public Health Workforce Corps to ensure an adequate supply of public health professionals.

• Sec. 340L, Pg. 897 - The Public Health Workforce Corps shall consist of civilian employees of the United States as Secretary deems necessary.

• Sec. 340L, Pg. 897 - The Public Health Workforce Corps shall consist of officers of Regular and Reserve Corps of Service.

• Sec. 340M, Pg. 899 - The Public Health Workforce Corps includes veterinarians. Will animals have heath care too?  

• Sec. 2233, Pg. 909 - The government will develop, build and run Public Health Training Centers.

• Sec. 2241, Pg. 912-913 - Government starts a HC affirmative action program under the guise of diversity scholarships.

• Sec. 2251, Pg. 915 - Government MANDATES cultural and linguistic competency training for HC professionals.

• Sec. 3111, Pg. 931 - The government will establish a Preventative and Wellness Trust fund, with initial cost of $30,800,000,000 (Billions more).

• Sec. 3121, Pg. 934, Lines 21-22 - Government will identify specific goals and objectives for prevention and wellness activities. More control of your life.

• Sec. 3121, Pg. 935, Lines 1-2 - The government will develop “Healthy People & National Public Health Performance Standards.” They will tell us what to eat?

• Sec. 3131, Pg. 942, Lines 22-25 - “Task Force on Community Preventive Services.” More government? Under the Offices of Surgeon General, Public Health Services, Minority Health and Women’s Health.

• Sec. 3141, Pg. 949-979 - BIG GOVERNMENT core public health infrastructure includes workforce capacity, lab systems, health information systems, etc.

• Sec. 2511, Pg. 992 - Government will establish school-based “health” clinics. Your children will be indoctrinated and your grandchildren may be aborted!

• Sec. 399Z-1, Pg. 993 - School-Based Health Clinics will be integrated into the school environment. More government brainwashing in school.

• Sec. 2521, Pg. 1000 - The government will establish a National Medical Device Registry. Will you be tracked?

Feedback . . . 

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3.   International Healthcare: Is There a ‘Right’ to Health Care? Only by Force.

Is There a ‘Right’ to Health Care? By THEODORE DALRYMPLE

If there is a right to health care, someone has the duty to provide it. Inevitably, that “someone” is the government. Concrete benefits in pursuance of abstract rights, however, can be provided by the government only by constant coercion.

People sometimes argue in favor of a universal human right to health care by saying that health care is different from all other human goods or products. It is supposedly an important precondition of life itself. This is wrong: There are several other, much more important preconditions of human existence, such as food, shelter and clothing.

Everyone agrees that hunger is a bad thing (as is overeating), but few suppose there is a right to a healthy, balanced diet, or that if there was, the federal government would be the best at providing and distributing it to each and every American. Subscribe. . . 

Where does the right to health care come from? Did it exist in, say, 250 B.C., or in A.D. 1750? If it did, how was it that our ancestors, who were no less intelligent than we, failed completely to notice it?

If, on the other hand, the right to health care did not exist in those benighted days, how did it come into existence, and how did we come to recognize it once it did?

When the supposed right to health care is widely recognized, as in the United Kingdom, it tends to reduce moral imagination. Whenever I deny the existence of a right to health care to a Briton who asserts it, he replies, “So you think it is all right for people to be left to die in the street?”

When I then ask my interlocutor whether he can think of any reason why people should not be left to die in the street, other than that they have a right to health care, he is generally reduced to silence. He cannot think of one.

Moreover, the right to grant is also the right to deny. And in times of economic stringency, when the first call on public expenditure is the payment of the salaries and pensions of health-care staff, we can rely with absolute confidence on the capacity of government sophists to find good reasons for doing bad things.

The question of health care is not one of rights but of how best in practice to organize it. America is certainly not a perfect model in this regard. But neither is Britain, where a universal right to health care has been recognized longest in the Western world.

Not coincidentally, the U.K. is by far the most unpleasant country in which to be ill in the Western world. Even Greeks living in Britain return home for medical treatment if they are physically able to do so.

The government-run health-care system—which in the U.K. is believed to be the necessary institutional corollary to an inalienable right to health care—has pauperized the entire population. This is not to say that in every last case the treatment is bad: A pauper may be well or badly treated, according to the inclination, temperament and abilities of those providing the treatment. But a pauper must accept what he is given.

Universality is closely allied as an ideal, ideologically, to that of equality. But equality is not desirable in itself. To provide everyone with the same bad quality of care would satisfy the demand for equality. (Not coincidentally, British survival rates for cancer and heart disease are much below those of other European countries, where patients need to make at least some payment for their care.)

In any case, the universality of government health care in pursuance of the abstract right to it in Britain has not ensured equality. After 60 years of universal health care, free at the point of usage and funded by taxation, inequalities between the richest and poorest sections of the population have not been reduced. But Britain does have the dirtiest, most broken-down hospitals in Europe.

There is no right to health care—any more than there is a right to chicken Kiev every second Thursday of the month.

—Theodore Dalrymple is the pen name of Anthony Daniels, a British physician. He is a contributing editor to the City Journal. Printed in The Wall Street Journal, page A13

[This is the logic the World Health Organization uses to say America is No 37th in the world in quality of health care. Communists and Socialists cannot conceive of free countries having higher quality of care than socially controlled countries. But the fact remains that the poorest health care has been in Communist Russia, North Korea, Cuba, UK, and Canada—Communist or Socialized Countries lacking other freedom rights. In all these countries, people can suffer and die waiting for health care because there is no inalienable right to health care any place.]

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Government medicine does not give timely access to healthcare, it only gives access to a 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.   U S Government Healthcare: Nationalized Health Care Threatens America's Future

by Richard Baehr, inFocus, Summer 2009

Spiraling health care costs, both government and private, are the greatest danger to a more prosperous American future. The share of the federal budget devoted to health care (principally though the Medicare and Medicaid programs) is growing rapidly every year, and the entrance of the baby boomers into Medicare will accelerate this trend. Unfunded Medicare and Medicaid liabilities currently run in the tens of trillions of dollars. As with Social Security, there is no real Medicare Trust Fund. The monies raised each year from the Medicare tax are not put into a lockbox for elderly Americans. Rather, they are used to care for Americans today, or to subsidize the current budget. Subscribe . . .

John Goodman, President of the National Center for Policy Analysis, has outlined the dangers:

A recent forecast by the Congressional Budget Office… shows that Medicare and Medicaid alone are going to crowd out everything else the federal government is doing by mid-century… national defense, energy, education, the whole works. We'll only have health care. If, on the other hand, the government continues with everything else it is doing today and raises taxes to pay for Medicare and Medicaid, the Congressional Budget Office estimates that, by mid-century, a middle-income family will have to pay two-thirds of its income in taxes!

Every serious health care economist knows that health care costs are a big problem, yet the current health care reform debate in Washington centers on a far less critical issue —insuring the roughly 15 percent of Americans without health insurance. While conservatives favor a private market solution, the current administration favors a new government insurance option, which will only saddle Americans with more spending, debt, and taxes far into the future.

Comparing Costs

According to the National Coalition on Health Care, the cost of medical care rose at more than twice the rate of general inflation in the United States in 2008, just as in prior years. In 2007, health care consumed 17 percent of U.S. Gross Domestic Product (GDP), or $2.4 trillion. By the year 2017, healthcare costs are projected to be 20 percent of GDP, or $4.3 trillion, according to a study in the journal Health Affairs.

No other country in the world spends nearly as much of their national income as we do on healthcare. Some advanced nations, such as Switzerland, France, and Germany, spend 11 to 12 percent of their total GDP on health care expenditures. The difference is their populations are older than ours (requiring more health care), and their systems insure a higher percentage of their population than we do.

The high cost of American health care stems from one fundamental difference between the U.S. system and those of other countries: most American insurance coverage insulates subscribers or recipients from the cost of the health care at the time they receive it, and does not limit the amount of care provided. This leads to greater demand for services, and increased volume. Other countries, by contrast, have cradle-to-grave insurance systems, which are largely government administered. The systems' providers limit the provision of care to meet annual budget allocations. In other words, the providers ration their health care. They withhold certain types of care, based on cost-benefit analysis, thereby creating lengthy wait lists for non-emergent care. Specifically, they can withhold care if it is deemed too expensive, or unnecessary, such as elective surgeries. Providers in these countries can even limit the use of aggressive treatments for patients with bad prognoses.

By contrast, U.S. physicians routinely practice defensive medicine (more tests and preventive procedures) to indemnify against lawsuits. American doctors are also permitted by insurers to aggressively treat most conditions. The insurance companies, Medicare, and state Medicaid programs have all attempted to impose some modest utilization review controls on procedures and treatments, but they use rate cuts as their primary vehicle for cost reduction. Since healthcare providers are paid for their volume, the savings through the price mechanism are cancelled out through higher volume.

One Size Fits All?

The advocates of universal healthcare are most comfortable with a "one size fits all" approach. Inevitably, this would have to mean a resort to a rationing type approach, masked by the euphemism of "best demonstrated practices." President Barack Obama's 2008 stimulus bill provides $1.1 billion for such initiatives.

As Jerome Groopman and Pamela Hartzband argued in the Wall Street Journal, best demonstrated practices are not always best. "In too many cases, the quality measures have hastily been adopted, only to be proven wrong and even potentially dangerous to patients."

Driving Out Private Firms

A new government program could worsen significantly the already daunting federal budget forecasts. The proposed government insurance leviathan could easily under-price its private market competitors, by underpaying providers relative to private insurers, just as it does for Medicare and Medicaid patients. Over time this process would drive many corporations to drop private health insurance, making room for the government program to replace it.

The highly-respected Lewin Group estimates that a new government insurance option could drive up to 130 million Americans currently insured through the private market to the government insurance at a net cost of $2 trillion in federal spending over ten years. Indeed, U.S. taxpayers would essentially subsidize the collapse of the private health insurance market.

Administrative Waste?

Supporters of universal health insurance like to argue that the real problem is the administrative waste and higher costs of the private U.S. health insurance market. They cite numbers to show, for example, that Medicare and Medicaid spend a much smaller percentage of their budgets on administration than private companies.

These numbers are deceiving. For one, private insurance companies have to pay for marketing. After all, these companies need to sell their product. It is also important to note that Medicare and Medicaid pay providers (hospitals, nursing homes, physicians) significantly less than private insurers for nearly all services, often below the actual cost of care. By contrast, providers charge private insurance patients higher prices to compensate. Remember, also, that the uninsured pay little or nothing for their care, often delivered in expensive emergency room settings. Private insurance patients also subsidize this free care or bad debt burden. On top of that, the federal and state health programs set price caps for all providers, but private insurers have to wrangle over prices with individual providers.

The Uninsured

It may come as a surprise that the problem of America's uninsured may not be as grave as advertised. Many of the estimated 45 million uninsured Americans could obtain insurance if they chose to. Sally Pipes, President of the Pacific Research Institute, has summarized the issue:

"About 18 million of the uninsured make more than $50,000 a year—and almost 10 million have yearly incomes over $75,000. More than 10 million aren't U.S. citizens. And as many as 14 million already are eligible for government programs like Medicare, Medicaid and SCHIP—but haven't signed up."

These numbers suggest that the problem of the uninsured does not require a large new government insurance program. Many of America's uninsured would purchase insurance if it was more affordable, and millions are simply unaware that they qualify for an existing government insurance option. Certainly a federal program can create a safety net for those who fall within the gaps.


The Healthy Americans Act, introduced by Senators Ron Wyden (D-OR) and Bob Bennett (R-UT) and endorsed by others from both parties, presents one potential alternative. The legislation proposes a hybrid of public and private coverage, with a regulated private insurance market. The proposal has a smaller federal price tag, and it relies more on company and individual payments for coverage. However, it guarantees a standardized benefit package (similar to that of members of Congress) that ensures higher levels of utilization and cost.

Regardless of the approach taken with the uninsured, Americans must still address the rapidly escalating cost of both private and government insurance programs. The following six suggestions may provide a point of departure:

1. Allow insurance companies to sell their products nationwide, rather than deal with 50 state bureaucracies. Expanded insurance pools reduce the risk to insurers of high cost patients with chronic diseases, and should result in lower premiums.

2. Reduce the state-regulated mandates for services that must be covered by health insurers. Companies should be allowed to offer a menu of plans, with varying lists of covered services, as well as different deductibles and co-pays. Competition drives down costs in all other areas of the economy, but it is neglected in health care. Without it, costs rise rapidly.

3. Equalize the after-tax treatment of health care benefits for individuals insured through their companies and those who are individually insured. When he ran for president, Senator John McCain (R-AZ) proposed taxing employee health care benefits and offering a tax credit to individuals to purchase insurance. This would provide an incentive to the uninsured to buy insurance, and potentially encourage employees to consider more carefully the costs and benefits of their existing coverage, not to mention their alternatives.

4. Encourage the use of the Health Savings Account (HSA), and other high deductible plans that make health insurance more of a catastrophic benefit, and leave the costs of more routine or day-to-day health care to consumers. While proponents of nationalized health care hate calling patients "consumers," or calling providers and insurers "competitors," HSAs are more affordable than first dollar coverage plans and provide more choices. With consumers more in command of their health care dollars, providers would compete for patients' business on price, service, and convenience. This could set the stage for less costly alternatives to emerge.

5. Provide more significant incentives for greater use of generic drugs and health improving behaviors such as smoking cessation and weight reduction.

6. Address the litigation issue by placing reasonable caps on malpractice awards. In states where such caps exist, physicians pay far lower malpractice premiums, and there are fewer shortages in the high-risk specialty practices, thereby increasing supply and competition. There tend to be greater physician shortages in states that are known to have high malpractice insurance costs resulting both from courts sympathetic to the plaintiffs' bar, and the absence of limits on awards. The problem is most serious in these locations for obstetricians and neurosurgeons.

No Silver Bullet

Reducing national health care spending so that it is closer to the economy's overall growth rate is essential to avoiding fiscal catastrophe. Government health care coverage with rich benefit packages to millions of Americans, many of whom are already insured, may only exacerbate the problem. The government option would provide care to the uninsured, but also to others diverted to this new plan, and significantly increase demand for services, which would drive up costs. The government would then impose price cuts, which would likely drive some physicians and other providers out of the market. Eventually, the government would be forced to ration care to control spending.

This is not the way to improve health care in America. A greater injection of competition, on the other hand, might do more to both improve quality and address the spending levels that are now spiraling out of control.

Richard Baehr is a distinguished fellow at the JPC, and co-founder and political director of The American Thinker, a web-based policy journal. He has worked in the health care industry as a financial and planning consultant for providers for 35 years.

[Age 72 is physiologically younger than 65 when Medicare started.
Medicare can be saved economically by changing onset to age 67, the same as Social Security and advancing it one year every three until Medicare 72 is fully implemented. Medicare and Social Security should then be indexed to life expectancy.]

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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: Takes many forms not apparent

Physicians have many opportunities to provide lean health care. The leanest may not present itself as such but reducing the cost is everyone’s business. With many entitlements to government health care in our Medicare, Medicaid, as well as veterans and spouses of the military, the patient’s immediate tendency is to increase utilization of laboratory, x-ray, and other diagnostic services that are unrelated to quality of health care. This is why the cost of Medicare, Medicaid, and other government benefits increase faster than all projections. Medicare in its third decade had exceeded the original estimated costs by more than 800 percent. Subscribe . . .

This is frequently judged as being the doctor’s fault: It’s the physicians’ orders that drive up the costs. This notion represents a lack of understanding of the doctor-patient relationship. Physicians have a responsibility to remain an advocate for the patient. Hence, it is very hard to also be a policeman. Every personal physician has experienced a patient walking out of his office dissatisfied when the generous laboratory tests were not ordered and not returning but seeing another physician. Sometimes the patient will even threaten the doctor with reporting him to Medicare, Medicaid and other carriers who now regard patients as members. Insurance carriers, including government carriers, are hesitant to reprimand a patient’s excessive appetite and behavior. In reviewing files, we have found many letters of complaint from these patients to their Congressman.

However, attorneys and others who write the laws and regulations are not clinicians but adversaries. The doctor-patient relationship is nearly the opposite of the attorney-client relationship in several aspects. Not only is the doctor the patient’s medical counselor and advocate, he also counsels the patient’s family, may evaluate the work environment and make suggestions concerning types of employment. The attorney is primarily his client’s advocate with a duty to do whatever is necessary to win, even if that destroys the opposition’s well being, which is totally alien to the physician. We try to not only help the patient, but also his family or whoever impacts his/her well being.

People in our Congress and Senate have passed the current health care laws in such detail that many in our Congress and Senate have admitted that they have not the time to read the entire law. This is a great assault on the whole concept of Lean HealthCare. We know that HR 3200 will increase healthcare costs beyond our wildest imaginations, beyond what is affordable.

If the doctor-patient relationship could be fully restored without any third party involvement, lean health care would rule the day and healthcare would be affordable.

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

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6.   Misdirection in Healthcare: Crisis of the Uninsured: 2007, by Devon Herrick

Despite claims that there is a health insurance crisis in the United States, the proportion of Americans with­out health coverage has changed little in the past decade. The increase in the number of uninsured is largely due to immigration and population growth — and to individual choice.

How Big Is the Problem? In 2006, according to Census Bureau data: Subscribe . . . 

·         More than 84 percent (250.4 million) of U.S. residents were privately insured or enrolled in a government health program, such as Medicare, Medicaid and the State Children’s Health Insurance Programs (S-CHIP).

·         Up to 14 million uninsured adults and children qualified for government programs in 2004 but had not enrolled, according to the BlueCross BlueShield Association.

·         Nearly 18 million of the uninsured live in households with annual incomes above $50,000 and could likely afford health insurance.

In theory, therefore, about 32 million people, or 68 percent of the uninsured, could easily obtain coverage but have chosen to forgo insurance. That means that about 94 percent of United States residents either have health coverage or access to it. The remaining 6 percent live in households that earn less than $50,000 annually. This group does not qualify for Medicaid and (arguably) earns too little to easily afford expen­sive family plans costing more than $12,000 per year. However, they could afford the limited benefit plans that are gaining in popularity (see below).

How Serious Is the Problem? According to the Census Bureau, the proportion of people without health insurance was slightly lower in 2006 (15.8 percent) than a decade earlier (16.2 percent in 1997). During the past 10 years the number of people with health coverage rose nearly 25 million, while the number without health coverage only increased about 3.5 million. Both increases are largely due to popula­tion growth. Typically, those who lack insurance are uninsured for only a short period of time. The Con­gressional Budget Office estimated that 21 million to 31 million people had been uninsured for a year or more in 2002 — far short of the 47 million figure cited by pro­ponents of universal health care. Of all the people who are uninsured today, less than half will still be uninsured 12 months from now.

Who Are the Uninsured? It is often assumed that the uninsured are all low-income families. But among households earning less than $25,000, the number of uninsured actually fell by about 24 percent over the past 10 years. [See the figure.] The uninsured include diverse groups, each uninsured for a different reason:

Immigrants. About 12.6 million foreign-born resi­dents lack health coverage —accounting for 27 percent of the uninsured. In 2006, 83.6 percent of naturalized citizens had coverage — close to the rate of native-born residents (87.8 percent). In contrast, 45 percent of for­eign-born noncitizen residents were uninsured. These 10 million uninsured immigrants were more than 20 percent of the total number of uninsured U.S. residents. Income may be a factor — but not the only one. A partial expla­nation for this disparity is that many immigrants come from cultures without a strong history of paying pre­miums for private health insurance. In addition, immi­grants do not qualify for public coverage until they have been legal residents for more than five years.

The Young and Healthy. About 19 million 18-to-34-year olds are uninsured. Most of them are healthy and know they can pay incidental expenses out of pocket. Using hard-earned dollars to pay for health care they don’t expect to need is a low priority for them.

Higher-Income Workers. As the figure shows, the fastest-growing segment of the uninsured population over the past 10 years has been middle- and upper-income families. From 1997 to 2006, the number of uninsured among households earning more than $50,000 annually actually increased by more than seven mil­lion. The ranks of the uninsured in households earn­ing $50,000 to $75,000 increased 49 percent, while the number of uninsured households earning above $75,000 increased 90 percent.

Why the Poor Are Uninsured: The “Free Care” Alternative. Many people do not enroll in government health insurance programs because they know that free health care is available once they get sick. Federal law forbids hospital emergency rooms from turning away critical care patients regardless of insurance coverage or ability to pay. Estimates of spending on free care range from $1,049 to $1,548 for each individual who is uninsured for an entire year. This does not include the more than $300 billion the federal and state governments spend annually on such “free” public health insurance as Medicaid and S-CHIP. Furthermore, there is little incen­tive to enroll in public programs because families can always sign up when the need arises.

Why the Nonpoor Are Uninsured: State Man­dates. Government policies that drive up the cost of pri­vate health insurance may partly explain why millions of people forgo coverage. Many states try to make it easy for a person to obtain insurance after becoming sick by requiring insurance companies to offer immediate cover­age for pre-existing conditions with no waiting period. Thus, when people are healthy they have little incentive to participate and tend to avoid paying for coverage until they need care.

Some states also impose “community rating,” which forces insurers to charge the same premium to all, no matter how sick or healthy they are when they purchase insurance. This mandate drives up the cost of insurance for the healthy. Because their premiums are far higher than their anticipated medical needs, healthy people are often priced out of the market.

How to Reduce the Number of Uninsured: Lim­ited Benefit Plans. Some of the uninsured would purchase insurance if policies were more to their lik­ing. The state of Tennessee recently conducted focus groups with blue-collar workers and discovered that what people want is very different from what health policy experts think they should have. For example, there was very little interest in insurance for catastrophic events. Instead, people wanted insurance benefits that pay for primary care visits or prescription drugs. Limited ben­efit plans designed to meet these patients’ demands are the cornerstone of TennCare, the state program to cover low-income families in Tennessee. And these types of plans are gaining in popularity. Insurers say more than a million people already have limited health plans. Em­ployers also are establishing their own plans, especially for part-time workers.

How to Increase the Number of Uninsured: Man­datory Insurance. If millions of people have access to coverage but choose not to enroll, should they be forced to? The logic is simple: If people won’t buy health insurance voluntarily, pass a law mandating that they buy it anyway. This is a requirement of the Massachu­setts health reform law and many of the other universal coverage proposals. This is also how auto insurance works in 47 states. The problem is: It doesn’t work! Recent research by Greg Scandlen, published by the National Center for Policy Analysis, found that the rate of uninsured motorists is very similar to the proportion of people lacking health insurance.

Conclusion. Despite claims that the United States is experiencing a health insurance crisis, the proportion of people without insurance coverage has changed little in recent years. Even so, much can be done to reduce the number of uninsured. This could include deregulat­ing insurance markets to allow affordable plans that are attractive to the young and healthy. It could also include subsidizing the purchase of private insurance using the free-care money taxpayers are already providing. Fi­nally, the use of limited benefit plans could be expanded to make insurance coverage more affordable to low-in­come families.

Devon Herrick is a senior fellow with the National Center for Policy Analysis.


No. 595 | September 28, 2007

Note: Nothing written here should be construed as necessarily reflecting the views of the National Center for Policy Analysis or as an attempt to aid or hinder the passage of any legislation.

The NCPA is a 501(c)(3) nonprofit public policy organization. We depend entirely on the financial support of individuals, corporations and foundations that believe in private sector solutions to public policy problems. You can contribute to our effort by mailing your donation to our Dallas headquarters or log­ging on to our Web site at and clicking “An Invitation to Support Us.”

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Well-Meaning Regulations Worsen Quality of Care.

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7.   Overheard on Capital Hill: Where do Good Treatments really come from?

Blogger and law professor Glenn Reynolds writing in the Washington Examiner:

The normal critique of socialized medicine is to point out that people have to wait a long time for . . . treatments in places like Britain. And that's certainly a valid critique . . . . Subscribe. . . 

The key point, though, is that these treatments didn't just come out of the blue. They were developed by drug companies and device makers who thought they had a good market for things that would make people feel better.

But under a national healthcare plan, the "market" will consist of whatever the bureaucrats are willing to buy. That means treatment for politically stylish diseases will get some money, but otherwise the main concern will be cost-control. More treatments, to bureaucrats, mean more costs . . . .

It's ironic that the same Democrats who were pushing the medical prospects for stem-cell research during the last election are now pushing a program that will make such progress far less likely.

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What is Congress Really Saying?

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8.   Innovations in Health Care: Going Horizontal

Industries have traditionally been structured vertically. When Henry Ford established the assembly line from handmade automobiles, he increased efficiency and productivity with an automobile the ordinary citizen could afford. At that time he owned the steels mills, the manufacturing plants for motors, transmissions, differentials, the sheet metal bodies as well as the various other suppliers. General Motors did the same with Delco Batteries, Generators and Body by Fisher. Subscribe . . .

The computer industry was also vertical with the large mainframes costing millions. Now we have small desktop personal computers for $500 that have more memory, faster speed and less maintenance than the $5 million mainframes. What would have happened if President Reagan had done what Obama just did and spent $300,000 for each Union Job saved? President Reagan would have saved a lot of jobs at UNIVAC, IBM, Honeywell, Burroughs and others, but would have delayed the computer revolution from going to the vertical from a horizontal structure. We then had companies manufacture chips, hard drives, processors, screens, as well as various storage devices like CDs, DVDs, or flash drives that another and different company can put together in different varieties to meet untold consumer demands. This allowed the mainframes to be partially replaced by a $500 PC with memory and speed greater than the $5 million mainframe. Some large computer companies disappeared in the process. But now with the need for large super computers in research, military and space, new or refocused companies like IBM are again growing, having largely left the PC market to the new competition.

The automobile industry is ready to take off horizontally. It may be delayed because of the expensive bailouts at taxpayer’s expense. The internal combustion engine has been refined almost as much as possible. There is not much more efficiency that can be squeezed out. Congress doesn’t understand that and the auto industry will make lighter, more hazardous small cars to comply. However, most auto companies are already working on the electric car. China sees this innovation as critical and is developing batteries. Already electric cars have a range of about 200 miles between charging. These are now being produced by all Japanese, Indian and American companies. For Sacramento, that provides the ability to drive to San Francisco and the Bay Area and back, to Lake Tahoe and Reno and back, or to Yosemite National Park. This meets the needs of most families’ second car, which means that the two-car family would soon have an internal combustion engine for long trips and an electric car for work and trips within most states. In California, there are now recharge stations. One can travel from Sacramento to Los Angeles in an electric car, which reduces pollution by 50 percent. Many new companies are now entering the market, much like the PC companies did two decades ago. Putting an electric car together with far fewer parts will reduce the cost per car much like the computer costs decreased dramatically when that industry went horizontal.

Healthcare is a very strong vertical industry at this time when the high cost of hospital care is driving the current government threats. But it is the government mandates that have prevented the innovation to horizontal distribution. Some physician laboratories are doing laboratory work and X-rays at one-fifth the cost of hospital labs. Free-standing surgical units are doing operations at one-fifth the cost of hospital operating units. Surgeons have stated that the local hospitals may charge $10,000 for outpatient surgery when the Surgicenter charges $2,000. The majority of operations can now be done in overnight units. Even back operations with micro-techniques can be discharged the same day. Gallbladder surgery, hysterectomy, nephrectomy and prostatectomy can all be performed through a laparoscope. When done in the hospital even on an overnight stay, the cost has not decreased from the former five-day stay. However, the government has prevented physicians from purchasing CT scanners or MRIs because physicians would make money from them. However, experience has shown that physicians make it more efficient and cost effective. If the 80,000 physicians in California could practice outpatient medicine as the market would allow, then the 200 hospitals would specialize in trauma and the critically ill patients such as heart and stroke patients. Healthcare costs would plummet as 80,000 physicians would compete for patients and reduce their charges to attract patients. Physicians who don’t accept insurance and work only for cash have already reduced their costs by eliminating their business, insurance and collection office and have passed this savings on to patients by reducing their charges by an average of 40 percent.

Healthcare reform could be accomplished simply by eliminating all the insurance, hospital and practice mandates and allowing competition to reign. A revolution in healthcare would follow.

Horizontal healthcare is the solution to any healthcare problem in America.

Medicine has been prevented from going horizontal by regulations.

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9.   The Health Plan for the USA: The one Proposed by President Obama is unrelated to health

Subject:  The Truth About the Health Care Bills - Michael Connelly, Ret. Constitutional Attorney 08.24.09

Well, I have done it! I have read the entire text of proposed House Bill 3200: The Affordable Health Care Choices Act of 2009. I studied it with particular emphasis from my area of expertise, constitutional law. I was frankly concerned that parts of the proposed law that were being discussed might be unconstitutional. What I found was far worse than what I had heard or expected. Subscribe. . .  

To begin with, much of what has been said about the law and its implications is in fact true, despite what the Democrats and the media are saying. The law does provide for rationing of health care, particularly where senior citizens and other classes of citizens are involved, free health care for illegal immigrants, free abortion services, and probably forced participation in abortions by members of the medical profession.

The Bill will also eventually force private insurance companies out of business and put everyone into a government run system. All decisions about personal health care will ultimately be made by federal bureaucrats and most of them will not be health care professionals. Hospital admissions, payments to physicians, and allocations of necessary medical devices will be strictly controlled.

However, as scary as all of that it, it just scratches the surface. In fact, I have concluded that this legislation really has no intention of providing affordable health care choices. Instead it is a convenient cover for the most massive transfer of power to the Executive Branch of government that has ever occurred, or even been contemplated. If this law or a similar one is adopted, major portions of the Constitution of the United States will effectively have been destroyed.

The first thing to go will be the masterfully crafted balance of power between the Executive, Legislative, and Judicial branches of the U.S. Government. The Congress will be transferring to the Obama Administration authority in a number of different areas over the lives of the American people and the businesses they own. The irony is that the Congress doesn’t have any authority to legislate in most of those areas to begin with. I defy anyone to read the text of the U.S. Constitution and find any authority granted to the members of Congress to regulate health care.

This legislation also provides for access by the appointees of the Obama administration of all of your personal healthcare information, your personal financial information, and the information of your employer, physician, and hospital. All of this is a direct violation of the specific provisions of the 4th Amendment to the Constitution protecting against unreasonable searches and  seizures. You can also forget about the right to privacy. That will have been legislated into oblivion regardless of what the 3rd and 4th Amendments may provide.

If you decide not to have healthcare insurance or if you have private insurance that is not deemed acceptable to the Health Choices Administrator appointed by Obama there will be a tax imposed on you. It is called a tax instead of a fine because of the intent to avoid application of the due process clause of the 5th Amendment.. However, that doesnt work because since there is nothing in the law that allows you to contest or appeal the imposition of the tax, it is definitely depriving someone of property without the ´due process of law.

So, there are three of those pesky amendments that the far left hate so much out the original ten in the Bill of Rights that are effectively nullified by this law. It doesn’t stop there though. The 9th Amendment that provides: ´The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people; The 10th Amendment states: ´The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are preserved to the States respectively, or to the people. Under the provisions of this piece of Congressional handiwork neither the people nor the states are going to have any rights or powers at all in many areas that once were theirs to control.

I could write many more pages about this legislation, but I think you get the idea. This is not about health care; it is about seizing power and limiting rights.

Article 6 of the Constitution requires the members of both houses of Congress to ‘be bound by oath or affirmation’ to support the Constitution. If I was a member of Congress I would not be able to vote for this legislation or anything like it without feeling I was violating that sacred oath or affirmation. If I voted for it anyway I would hope the American people would hold me accountable.

For those who might doubt the nature of this threat I suggest they consult the source.

Here is a link to the Constitution:

And another to the Bill of Rights:

There you can see exactly what we are about to have taken from us.

Michael Connelly, Retired attorney, Constitutional Law Instructor, Carrollton , Texas

Source: Voicing Our Opinions - - An e-Magazine

There are similar or possibly related Articles in Voicing Our Opinions.

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Stay tuned to this section for the Current Issues Being Studied at HPUSA.

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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 she has items of interest in healthcare.) 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 manifesto  . . .

·                     Americans for Tax Reform,, Grover Norquist, President, keeps us apprised of the Cost of Government Day® Report, Calendar Year 2008. 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.

·                     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 August 13 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, (Sorry about the nepotism, but Kevin has many references to healthcare we could use.) has started a newsletter that 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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Articles that appear in HPUSA may not reflect the opinion of the editorial staff. Sections 1-4, 6, 7, and 9 are entirely attributable quotes in the interest of the health care debate.

Editorial comments are in brackets.

PLEASE NOTE: HealthPlanUSA 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

Feedback . . .

Words of Wisdom

I can’t forecast the action of Russia: It is a riddle wrapped in a mystery inside an enigma. -Winston Churchill 1939

Why Democrats Are Losing on Health Care: They won’t debate the proper role of government. -The Tilting Yard by Thomas Frank, WSJ.

Dependency is a psychiatric diagnosis:

“The bigger the State grows, the weaker the people become - big government creates dependency.” -Julie Meyer

Who Doctors and Nurses work for:

“You work for your customer. I don’t pay you. They do. . . . You do what is needed for the customer.” Kevin Meyer

Some Recent Postings

October in History

The Model T Ford was introduced in 1908.

The first Thanksgiving proclamations occurred in October 1789 and 1863.

Jet air service across the Atlantic began in 1958.

Sputnik orbited the earth in 1957.