Community For Affordable Health Care

Vol IX, No 3, Oct, 2010


Utilizing the $2 Trillion Information Technology Industry

To Transform the $3 Trillion HealthCare Industry into Affordable HealthCare

Through Innovation by moving from a Vertical to a Horizontal Industry

Thus eliminating $1 Trillion wasted

Insuring every American without spending the Extra $1Trillion Projected

To purchase a copy of the business plan, go to the bookstore at

In This Issue:      

1.             Featured Article: The Forgotten Man of Socialized Medicine

2.             In the News: Discontinuing Failed Drug Research is Expensive

3.             International Healthcare: The Stockholm Network

4.             Government Healthcare: A Growth Agenda for the New Congress

5.             Lean HealthCare: Healthcare is going ‘lean'

6.             Misdirection in Healthcare: What Motivated ObamaCare?

7.             Overheard on Capital Hill: Benign Dictatorship and the Progressive Mind.

8.             Innovations in Healthcare: Health Plan from the National Center for Policy Analysis  

9.             The Health Plan for the USA: How technology reduces health care costs

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: The Forgotten Man of Socialized Medicine

"The Forgotten Man of Socialized Medicine"–and us. by Debi Ghate, ARC, July 20, 2009

During a meeting today, my colleagues and I were discussing the frightening prospect that socialized medicine is right around the corner. Obama-care is not being opposed on any principled grounds – the only real dispute appears to be over the details, such as its projected cost. So if you are counting on somebody, like the Republicans, stepping in to rescue us from this impending disaster, think again.

I emigrated from Canada some time ago and at that point, one of the significant differences between the two countries was their respective approaches to health care. A relatively free market in health insurance and health care rather than a monolithic government-managed system? Terrific! You mean I'm not stuck on a long waiting list in order to see whichever doctors the government allows people in my geographic area to see?  Wonderful!

Should President Obama succeed in implementing "health care reforms," those last remaining advantages of the American health care system will disappear. That would be disastrous for all of us, but it would be especially devastating for the medical profession.

In Ayn Rand's Atlas Shrugged, there's a minor character, a brain surgeon named Dr. Hendricks, who refused to practice under a socialized medicine. This excerpt (reprinted in "For the New Intellectual") explains why Dr. Hendricks decided to shrug:

"I quit when medicine was placed under State control some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I could not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything—except the desires of the doctors. Men considered only the ‘welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, but ‘to serve.' That a man's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards—never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness at which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind—yet what is it they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in the operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man they have throttled. It is not safe, if he is the sort of man who resents it—and still less safe, if he is the sort who doesn't."

Instead of bickering about the price tag of Obama-care, it's time to fight the battle against socialized medicine on moral grounds. It's time for doctors to defend their moral right to practice medicine free from government interference. And it's time for their patients to defend their moral right to purchase health-care on a free market.

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2.         In the News:  Discontinuing Failed Drug Research is Expensive

Novartis AG said Thursday it will halt studies on an experimental lung-cancer drug in favor of developing other cancer treatments, as the Swiss drug maker revamp its portfolio after stopping development of two other candidate medicines earlier this year.

The Basel-based company said it will take a charge of $120 million against fourth-quarter earnings to halt ASA404, after study results indicated the drug had little or no prospect of improving survival rates of patients with non-small cell lung cancer.

They also said the decision to remove the drug from Novartis's pipeline underlines the company's intent to finely manage its research portfolio, which still contains many promising late-stage drugs.

"It's always a tough decision to decide on how to proceed with an experimental drug," said David Kaegi, pharmaceuticals analyst at Bank Sarasin. "But since ASA404 already had weak trial results earlier, the market disappointment is limited. Also, Novartis still has a very strong pipeline."

The decision comes after Novartis said in October it will stop the development of chronic hepatitis C compound albinterferon alfa-2b and also end research of Mycograb, an antifungal agent.

The discontinuation charges of around $590 million for these two compounds were booked in the third quarter.

Like many large drug makers, Novartis faces the pending patent expiration for key drugs. . .

A loss of patent often means that annual sales can drop by more than 30% as cheaper copycat versions of the drug are administered to patients. . .

For this reason, the pharmaceutical industry is expected to keep a tight grip on costs and also continue to consolidate as large pharma firms are expected to look for takeovers to boost their pipelines and seek partnership and licensing deals with smaller biotech companies. . .

Novartis has spent some $7.5 billion in R&D in 2009 and is expected to keep up this elevated spending level—among the highest in the industry—rather than seek bigger acquisitions, analysts say. . .

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How can drug companies keep bringing us new drugs for a $ Billion if they lost nearly three-fourths of a billion dollars on these three drugs which never made it to market?

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3.         International Healthcare: The Stockholm Network

The Stockholm Network is the leading pan-European think tank and market oriented network.

It is a one-stop shop for organisations seeking to work with Europe's brightest policymakers and thinkers. Today, the Stockholm Network brings together more than 120 market-oriented think tanks from across Europe, giving us the capacity to deliver local and locally-tailored global messages across the EU and beyond.
Combined, think tanks in our network publish thousands of op-eds in the high quality European press, produce many hundreds of publications, and hold a wide range of conferences, seminars and meetings. As such, the Stockholm Network and its members influence many millions of Europeans every year.

Weathering the Storm: Central and Eastern European Healthcare in Financial Crisis by Stockholm Network (published 2010)

This CEE Ahead publication assesses the future for Central and Eastern European (CEE) healthcare reform in light of a financial crisis that has exposed the fragility of public budgets. The financial crisis is raining down on the public purses of CEE countries and governments are struggling to provide adequate protection for their citizens. The paper argues that if CEE countries are to weather this storm, there is now a need to consider new ways of providing healthcare:

Ultimately, the paper argues that the CEE region now has an opportunity for healthcare reforms to develop and the financial crisis, however unwelcome, provides an incentive to begin. Whilst the problem will undoubtedly be finding the political will, it should not be overlooked that reform presents the best chance for establishing health systems that are fit to help and cure citizens in the difficult years to come.

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The above three tracks for health care reforms are also relevant to the United States.

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4.         Government Healthcare: A Growth Agenda for the New Congress


For now: Extend the Bush tax cuts, repeal ObamaCare, support free trade. After 2012: Enact a flat tax, stabilize prices, balance the budget, give politicians incentive pay.

Since its cyclical zenith in December 2007, U.S. economic production has been on its worst trajectory since the Great Depression. Massive stimulus spending and unprecedented monetary easing haven't helped, and yet the Obama administration and the Federal Reserve still cling to the book of Keynes. It's an approach ill-suited to solving the growth problem that the United States has today.

The solution can be found in the price theory section of any economics textbook. It's basic supply and demand. Employment is low because the incentives for workers to work are too small, and the incentives not to work too high. Workers' net wages are down, so the supply of labor is limited. Meanwhile, demand for labor is also down since employers consider the costs of employing new workers—wages, health care and more—to be greater today than the benefits.

Firms choose whether to hire based on the total cost of employing workers, including all federal, state and local income taxes; all payroll, sales and property taxes; regulatory costs; record-keeping costs; the costs of maintaining health and safety standards; and the costs of insurance for health care, class action lawsuits, and workers compensation. In addition, gross wages are often inflated by the power of unions and legislative restrictions such as "buy American" provisions and the minimum wage. Gross wages also include all future benefits to workers in the form of retirement plans.

For a worker to be attractive, that worker must be productive enough to cover all those costs plus leave room for some profit and the costs of running an enterprise. Being in business isn't easy, and today not enough workers qualify to be hired.

But workers don't focus on how much it costs a firm to employ them. Workers care about how much they receive and can spend after taxes. For them, the question is how the wages they'd receive for working compare to what they'd receive (from the government) if they didn't work, plus the value of their leisure from not working.

The problem is that the government has driven a massive wedge between the wages paid by firms and the wages received by workers. To make work and employment attractive again, this government wedge has to shrink. This can happen over the next two years, even with a Democratic majority in the Senate and President Obama in the White House, through the following measures:

1) The full extension of the Bush tax cuts. The Republican-controlled House of Representatives can write legislation extending all the tax cuts in perpetuity. Of particular importance for employment is keeping the highest personal income tax rate at 35%, the capital gains tax rate at 15% and the dividend tax rate at 15%, while eliminating the estate tax permanently. If the Senate blocks this legislation or Mr. Obama refuses to sign it, House Republicans should hold firm and let voters decide in 2012. (My guess is that he'll sign it or have his veto overridden.)

2) The full repeal of ObamaCare, which allows individuals to pay only five cents for each dollar of health care. Who do you think pays the other 95 cents? As former Sen. Phil Gramm notes, if he had to pay only five cents for each dollar of groceries he bought, he would eat really well—and so would his dog. No single bill is more antithetical to growth than ObamaCare.

Repeal could take the form of Michele Bachmann's Legislative Repeal Act, and if it is blocked in the Senate or by a veto Republicans should continue bringing it up every six months. Come 2012 the public will have a clear view of what congressional candidates stand for. The end game for U.S. prosperity is the election in 2012.

3) The cancellation of all spending that punishes those who produce and rewards those who don't. This is really the distinction between demand-side economics and supply-side economics. Stimulus spending and quantitative easing don't make it more rewarding to work an extra hour. If the government pays people not to work and taxes people who do work, is it really so difficult to see why employment is so low?

So the government should sell its stakes in public companies acquired via TARP, sell government-run enterprises that lose money (e.g., Amtrak and the Postal Service), end farm subsidies that pay people not to farm, cancel the rest of the stimulus and return all spending programs to their pre-stimulus levels. Congress should also continually examine spending in Afghanistan and Iraq. And it should return the duration of unemployment benefits to the standard 26 weeks, from the current 99 weeks. . .

These changes would spur recovery, but they are just the start. Elected officials should offer longer-term measures that voters can judge in 2012, when 33 senators—including 21 Democrats, two independents who caucus with the Democrats, and 10 Republicans—as well as the entire House and President Obama are up for re-election.

Beyond 2012, the ideal growth agenda would include:

1) A true flat tax, a la Jerry Brown's proposal in 1992. Congress should replace all federal taxes (except sin taxes) with two flat-rate taxes, one on personal income and one on net business sales. The personal income tax would be on all forms of income: wage income, dividends, inheritance (as proposed by Democratic Rep. Jared Polis), and all capital gains. This tax code would remove loopholes and almost all deductions, and the static revenue rate would be around 11.5%.

2) Price stability. . .

3) Passage of a balanced budget amendment, without raising taxes. This would prevent government from being able to balance its budget by unbalancing the budgets of its citizens. And it would force politicians to make difficult decisions about what spending is worthwhile, just like the rest of us.

4) Finally, saving the best for last, the mother of all supply-side reforms is incentive pay for politicians (which the comedian Jackie Mason called "putting the politicians on commission"). Politicians must be held personally responsible for their actions. In business, firms align the incentives of decision makers with the incentives of shareholders to ensure that they take the best course of action. Washington must begin doing the same by creating an incentive structure that pays elected officials according to factors such as stock market performance and economic growth.

Mr. Laffer is the chairman of Laffer Associates and co-author of "Return to Prosperity: How America Can Regain Its Economic Superpower Status" (Threshold, 2010).

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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: Healthcare is going ‘lean'

Business North Exclusives

Adopting Toyota process principles shows promise for improving by Wayne Nelson, 3/25/2009

St. Luke's in Duluth will spend about $1.5 million later this year to modernize its cardiac catheter lab in a strategy to capture larger market share.

Expensive new technology is an old story in the healthcare industry, and widely viewed as a factor in the runaway costs that are forcing many businesses to scale back or drop their group benefits for employees.

But how St. Luke's has developed its project — and is beginning to run its overall operation — represents one of the most promising mechanisms for taming healthcare inflation.

St. Luke's, SMDC Health System and a handful of smaller healthcare providers in Northeastern Minnesota all are adopting the "lean" principles of process efficiency and quality assurance that Toyota developed after World War II to become the world's leading auto maker.

St. Luke's two-bed cardiac catheter lab is plagued with inefficiencies common to industrial and service business processes that are designed around existing facilities rather than for efficient work flow. When St. Luke's added the second bed in its lab, the storage area for cardiac catheter supplies and equipment was relocated to an available room across a hallway, outside the lab's sterile area.

As a result, the lab's nurses and technicians have to keep seldom used sterile supplies on the mobile carts within the lab, making the already cramped space there even less efficient, said registered nurse Michelle Fleming, the hospital's patient care services director. When a physician asks support staff for a special medical item, the physical obstructions become barriers to traffic patterns, she said.

Fleming identified the bottleneck using "value-stream mapping," a lean technique for measuring process efficiency. "There are a number of times when a tech and nurse need to get equipment. We're making way too many trips," she said.

So many, in fact, that St. Luke's believes it will be able to handle current cardiac catheter patient volume with one fewer technician in the new lab. "We're not going to lay off anyone," Fleming quickly added. "Our hope is that with the additional efficiency we'll be able to do more procedures without adding any people."

The healthcare industry is just beginning to adopt Toyota Production System waste reduction and process concepts to increase work capacity, reduce cost, raise worker and patient satisfaction, standardize results and to build a culture for continuous improvement.

While the design of the new cardiac catheter lab is its most striking embrace of "lean," St. Luke's has been at it since Fall 2007, said Jo Ann Hoag, vice president, chief nursing officer and the initiative's self-described "administrative champion."

It began with a 2007 presentation by the customized training team at Lake Superior College to Hoag and other senior St. Luke's managers who embraced the concept and directed 64 executives into formal lean training at the health system's expense.

Two of those executives, Education Director Linda Basara and Michael Boeselager, materials management director, were named "Lean Committee" co-chairs with a mandate to train and implement lean principles that will change how all 2,200 employees at St. Luke's do their jobs by 2013. To date, nine classes of 16 employees across departments have been trained as trainers to spread the lean gospel system wide.

So far, the effort has reorganized the hospital's laboratory and the storage areas that Boeselager manages. Jennifer LaMaurea, the lab's blood bank manager, said lean process changes have helped shrink the bank's inventory of red blood cells on hand by "30 units at $200 per unit. Lean objectifies the process for implementing change," she said.

Boeselager said the initiative is producing a "brush fire" of process improvements.

Hoag said the lean process is creating teams across departments — laboratory, emergency room, nursing units and pharmacy to name a few — to make care more patient-centered.

To measure whether the initiative is making a customer service difference, St. Luke's has commissioned PRC Associates, the Omaha-based healthcare research firm, to conduct satisfaction surveys with discharged patients.

"Where we have taken this on, patients are happy with it," Hoag said. "This is a learning process, we're on a journey." . . .

Meanwhile, Gail Anderson, customized training representative at Itasca Community College, is coordinating lean grant projects . . .

"Each of these projects is customized to the institution," she said. "Lean is very simplistic and easy to learn. Once it becomes part of the (institutional) culture, it becomes sustainable. We help develop the needs assessment and goals, and provide the curriculum to get there."

Anderson is a certified reviewer for Montana-based Lean Healthcare West, which developed the curriculum the Northeastern Minnesota healthcare providers are using to become lean. Founder and President Cindy Jimmerson, a former trauma system developer and emergency healthcare provider, is a pioneer in applying Toyota Production System principles to the healthcare industry. She won a 2001-04 National Science Foundation grant and developed that curriculum for hospitals, clinics, nursing homes, community healthcare programs and health insurance companies.

She said lean is the perfect anecdote for a healthcare system that easily wastes two-thirds of the money it consumes.

"We're spending $3 trillion annually and wasting $2 trillion, enough to insure everyone without spending an additional cent," she said.

"In the United States with all the available technology, science and education, competent healthcare workers are only as good as their ability to deliver.

"We're swimming in money in healthcare, but it's not being used effectively because broken processes are getting in the way," she said.

Lean can fix those processes and gets at embedded waste, she said. "If we want to be a Toyota, we need to do it differently."

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

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6.         Misdirection in Healthcare: What Motivated ObamaCare?

To understand where ObamaCare will eventually lead us, we must understand what motivates this man. Dinesh D'Souze points out that Obama's father stated: "Theoretically, there is nothing that can stop the government from taxing 100 per cent of income so long as the people get benefits commensurate with the income which is taxed." 

Barack Obama: the Last Anti-Colonialist


Barack Obama is perhaps the least known figure ever to enter the White House. A set of very unusual circumstances, including an economic nose-dive just a few weeks before the election, put him there. Only now, almost two years into his presidency, Americans are starting to ask: who is Barack Obama? This was the title of a recent column in the Washington Post by Richard Cohen. The question was not about Obama's policies; everyone knows about those. Rather, it was one of Obama's underlying ideology. What motivates this man?

Europeans are routinely given a pre-packaged portrait of Obama: he is an historic figure, the first African-American president; he is the embodiment of multiracialism and multiculturalism; he is a cosmopolitan, in refreshing contrast to his parochial predecessor; and he looks and speaks the way that many in the world think an American president ought to look and speak. Consequently, Obama's critics are often dismissed in Europe as a bunch of right-wing fanatics, otherwise known as the Tea Party movement.

So goes the usual propaganda. It was pretty much the same propaganda that helped Obama win. But now Americans have had the opportunity to see what Obama is all about and most of them don't like it. Obama's popularity has plummeted. Quite apart from the insatiable right-wing, many moderates and independents who voted for Obama are now suffering buyer's remorse.

Even some of Obama's supporters profess to being mystified by what moves the man. Appearing on a TV show, Newsweek editor Evan Thomas said he found himself curiously repelled by a president with whose ideas he generally agreed. Thomas called Obama "slightly creepy" and "deeply manipulative". He suggested that there was something fake and unreal about Obama's public persona.

Theories about Obama abound. On the Left, he is sometimes portrayed as a champion of the civil rights movement, a kind of latter-day Martin Luther King. On the Right, Obama is often described as a closet Muslim or more often as a kind of socialist. Neither of these quite works. Obama has never sat at a segregated lunch counter. In a sense, he's not even African-American. In the US, this means you are descended from slaves. Obama's father was an educated immigrant from Kenya and his mother was a white woman from Kansas. Obama's formative experience, in Hawaii, Indonesia and Kenya, seems very remote from that of Martin Luther King.

There is no evidence that Obama is a Muslim. His father Barack Obama Sr was raised as a Muslim, the consequence of his grand-father Onyango Obama converting to Islam. His stepfather Lolo Soetoro was also raised in the Islamic faith. But neither man practised Islam, and Obama writes that his father treated Islam with the same contempt he reserved for African witch doctors. Obama studied Islam in Indonesia, where he lived for four years, but he also studied Catholicism and Buddhism and he seems to have emerged with no firm religious convictions at all.

The charge of socialism is closer to the mark. Obama as President has presided over the largest expansion of state power in American history. To an unprecedented degree, he has extended the tentacles of the federal government into banking, mortgage lending, finance, healthcare, insurance, automobiles, and energy. In Britain and the rest of Europe, such aggressive intervention is customary, but in America it is an anomaly. While Europeans debate ways to trim the bloated welfare state, Obama continues to make America's welfare state even more bloated. Consequently, America has become the world's largest debtor, and Obama threatens to stick the bill to the richest Americans, a group that he says is not paying its "fair share". . .

A good way to understand the American president is to ask a simple question: what is Obama's dream? Fortunately, we don't have to speculate about this because Obama himself provides a vital clue. Obama's autobiography is entitled Dreams from My Father. So there it is: according to Obama, his dreams come from his father. It is not Dreams of My Father. Obama isn't writing about his father's dreams. He is writing about the dreams he received from his father.

This isn't just a matter of a book title. Obama's book is chock-full of admissions that Obama derived his aspirations, his values, his very identity from Obama père. Although his father was gone for most of his life, Obama writes that "even in his absence his strong image had given me some bulwark on which to grow up, an image to live up to, or to disappoint". Obama writes: "It was into my father's image, the black man, son of Africa, that I'd packed all the attributes I sought in myself." Others who know Obama confirm this account. Obama's grandmother Sarah Obama told Newsweek: "I look at him and I see all the same things. This son has taken everything from his father. The son is realising everything the father wanted."

So who was Barack Obama Sr and what did he want? As a man, the senior Obama was deeply strange. He was a polygamist who had four wives and eight known children. He looked after none of them, and was accused by one of his sons, Mark, of being a wife-beater and an abusive father. He was also a chronic alcoholic who was known at Harvard as "Double Double" because he liked to order a double Scotch and tell the waiter, as soon as it arrived, "Another double." Since he regularly drove while intoxicated, he was involved in multiple accidents. In one, he killed a man; in another, he injured himself so badly that both his legs had to be amputated and replaced by iron rods. Eventually, he became drunk in a bar in Nairobi and drove into a tree, killing himself.

Not much of a role model for a son. But young Obama didn't know about his father's misdoings, because a romantic image of his father had been cultivated in his mind by his mother, Ann. She revered her husband even though he abandoned her. When Obama complained about his absentee father she chastised her son, informing him that Obama Sr was a great man, a champion of African liberation.

Eventually, Obama discovered the truth about his father from his half-sister Auma. Still, Obama didn't give up on his father. He went to his grave and wept. He pressed his hand into the earth and tried to commune with his father "through Africa's red soil". But Obama couldn't get back his dead father, so instead he decided to take his dream. He concluded that, although flawed as a man, the senior Obama had great ideals. Obama would realise those ideals, and perhaps in this way he could complete the family circle and be worthy of his father's love. Through a kind of sacramental rite at the family tomb, the father's ideology became the son's birthright.

But what was Barack Obama Sr's ideology? First and foremost, he was an anti-colonialist. He came of age in Kenya during that country's struggle for independence from the British. The Obama family suffered the scars of colonialism. In the 1950s, when the Prime Minister, Winston Churchill, cracked down on the Mau Mau guerrillas in Kenya, Obama Sr was arrested for his political activities, and Barack's grandfather Onyango Obama was placed in a detention camp and allegedly tortured. Anti-colonialism arose out of anger and humiliation, and in the case of Obama Sr those sentiments were the product of direct experience. . .

It may seem incredible to suggest that the anti-Western, anti-American ideology of Obama Sr that justifies massive state appropriations of private wealth is the belief system of the American president. But that is what I am saying. For instance, I believe that the premises of Obama Sr's paper can help us understand what President Obama means when he says the rich aren't paying their "fair share". The top 10 per cent of income earners in America pay around 70 per cent of the taxes. By ordinary standards, it would seem that the affluent are more than paying their share. However, if you assume that wealth is not earned through effort or creativity but is rather the product of greed and theft, then there is no limit to what percentage you can legitimately seize. Obama's rhetoric and actions suggest that he feels morally justified in state confiscation of wealth to whatever extent he can get away with it. . .

Many in Britain, I know, are deeply ambivalent about Britain's colonial legacy. But colonialism is now dead and so is anti-colonialism. No one today cares about it — except the man in the White House. He is the last anti-colonial. Obama's problem isn't that he opposes foreign subjugation. It is that he is trapped in his father's time machine. He is trying to apply the ossified, antiquated solutions of a generation ago to the very different problems of the world today. Obama's approach does poor countries no favours, because his remedies would not help them rise out of poverty. At the same time, Obama is trying to end America's leadership in the world, bringing to an end centuries of Western dominance. If he succeeds, the future for both America and Europe is likely to be less prosperous and less secure. . .

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Well-Meaning Regulations Worsen Quality of Care.

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7.         Overheard on Capital Hill: Our Freedom is at Stake

Benign Dictatorship and the Progressive Mind

By Andrew Thomas, American Thinker, August 7, 2010

Recently, I received a rare visit from my brother-in-law. He is a smart guy, having graduated valedictorian of his high school class and currently running a successful business. Unfortunately, his politics run 180 degrees counter to mine, as he grew up in the socialist environment of his Swedish homeland.

As we talked about the weather and other neutral subjects, he stared into my library. Among my compilation of Holy Bibles and Vince Flynn novels, he noticed my Glenn Beck book collection. "Do you believe in that stuff?" he asked, giving me a repulsed look as though they espoused the philosophy of satanic pedophilia. "I do," I replied resolutely, upon which he began a long diatribe on his vehement hatred of George Bush and the fascist dictatorship he created.

President Obama, he declared, although he has his flaws, "means well." I won't go into my rebuttal of that statement, but his final thought on the matter was: "Of course, the perfect form of government is the benign dictatorship."

I have been thinking about that perception for a while now -- not because I believe it's true, but because it may help explain the motivations of the progressive leftists in this country. I am continually attempting to truly understand the conceptual thinking of progressives, as it is so foreign to my analytical personality. Like Star Trek's Mr. Spock, I am driven by phenomenological facts and data. Progressives apparently can function with neither.

Over a year ago, I wrote about my theory that liberals "crave a master" who will instill stern discipline and mete out harsh punishments to a deserving citizenry. This was based on my belief that progressives have a predilection for "moral masochism." While I still maintain the validity of this argument, I am beginning to understand that much of their apparently illogical craving for domination is actually agenda-driven.

To the committed progressive, the leftist priority agenda issues are so pure and righteous that the frustration of not having them immediately implemented is unbearable. For instance, "climate change" legislation is a progressive, neo-religious, life-or-death cause for whose achievement many would gladly give up all of their (and our) democratic freedoms and liberties. 

The U.S. Constitution is a preventer rather than an enabler of the progressive agenda and therefore must be removed as an obstacle. Obama once called it a "charter of negative liberties." And so the dream of a benevolent dictator who will powerfully push aside all opposition and enact just and virtuous laws throughout the land dwells in the psyche of the left. Human beings will always succumb to the corrupt temptations of power, but that doesn't stop progressives from trying. There is no doubt that Obama has successfully amassed power to himself unlike any American president before him in just his first eighteen months. To be fair, George Bush gave him a running start.

The fact that our normal American safeguards have thus far failed to contain this unprecedented expansion of executive power is itself deeply troubling. This failure is due in part to the fact that the executive branch has followed a determined strategy of obfuscating, delaying, withholding information, appearing to yield but then refusing to do so, and dissembling in order to frustrate the efforts of the legislative and judicial branches to restore a healthy constitutional balance.

So spoke Al Gore in a 2006 speech on the Bush administration's abuse of the Constitution. He railed on about Bush's power grabs, including the use of warrantless wiretaps and surveillance, efforts to control the internet, and imprisonment of citizens suspected of terrorism without an arrest warrant or due process.

Following in Bush's footsteps but with a longer gait, Obama has maintained and expanded the wiretapping and surveillance of citizens' communications, recently including warrantless seizure of private e-mails. He has been granted the power to shut down the internet at any time he deems necessary, and he is working diligently to further control all communications through the FCC and his Marxist communications diversity czar, Mark Lloyd. 

Most distressingly, Obama has reserved for himself the right to declare any U.S. citizen a "terrorist" and target him for assassination without a trial or due process. Homeland Security Chief Janet Napolitano has identified veterans, states-rights advocates, people who oppose abortion or illegal immigration, and members of right-wing groups as potential domestic terrorists. To paraphrase Newsweek magazine, "We are all terrorists now."

The pieces of the "benign dictatorship" of Obama have been set into place. The two primary components are the gargantuan monstrosities known as ObamaCare and the Financial Reform Bill. They were intentionally designed to be indecipherable. Read the statements of our most brilliant legislative minds in Congress:

House Speaker Nancy Pelosi (D-CA): "[W]e have to pass the bill so that you can find out what is in it."

Rep. John Conyers (D-MI): "What good is reading the bill if it's a thousand pages?"

Christopher Dodd (D-CT): "No one will know until this [financial reform bill] is actually in place how it works."

An August 5 Wall Street Journal editorial on ObamaCare said this:

Earlier this week, the Congressional Research Service reported that the new bureaucracy the bill created is so complex and indiscriminate that its size is "currently unknowable." Capitol Hill's independent policy arm added that among "the dozens of new governmental organizations or advisory bodies," it is "impossible to know how much influence they will ultimately have."

The bottom line is that it doesn't matter what is written in these convoluted legislative nightmares. They are merely concepts to be molded and interpreted in any way the administration desires. The people who will perform these interpretations are the very scary regulatory czar Cass Sunstein and history's largest assembled collection of '60s radicals appointed as government bureaucrats. They, along with Obama, are now in complete control of our lives.

Congressman Pete Stark (D-CA) may be an elitist and a fool, but I believe he was correct when he recently said, "The federal government, yes, can do most anything in this country." With a total disregard for the U.S. Constitution and no discernible moral compass, Obama's Chicago-style administration looks like it is heading toward dictatorship, though hardly benign, no matter what my brother-in-law and others may believe about Obama's intentions.

Andrew Thomas blogs at

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8.         Innovations in Healthcare: Health Plan from the National Center for Policy Analysis

To confront America's health care crisis, we do not need more spending, more regulations or more bureaucracy. We do need people, however, including every doctor and every patient. All 300 million Americans must be free to use their intelligence, their creativity and their innovative ability to make the changes needed to create access to low-cost, high-quality health care.

I. Free the Doctor

Doctors today are forced to practice medicine under an outmoded, wasteful payment system designed for a different century. They should instead be given access to payment systems available to other professionals.

Problem: Typically, doctors receive no financial reward for talking to patients by telephone, communicating by e-mail, teaching patients how to manage their own care or helping them be better consumers in the market for drugs. In fact, doctors who help patients in these ways will end up with less take-home pay. To make matters worse, as third-party payers suppress reimbursement fees, doctors are increasingly unable to perform any task that is not reimbursed.

Solution: Let Doctors Be Doctors. In Medicare and Medicaid, it should be as easy as possible for providers to get paid in better ways. We should be willing to reward doctors who raise quality and lower costs — including improving patient access to care, improving communication and teaching patients how to be better managers of their own care. What is needed is not pay-for-performance, but performance for pay — with ideas and proposals coming from the supply side of the market (which is more knowledgeable about potential improvements than the demand side).

Any doctor should be able to propose and obtain a different reimbursement arrangement, provided that (1) the total cost to government does not increase, (2) patient quality of care does not decrease and (3) the doctor proposes a method of measuring and assuring that (1) and (2) have been satisfied.

Problem: All too often providers face perverse incentives. When they make changes that raise quality and lower costs, their income goes down, not up!

Example: Geisinger Health System in central Pennsylvania gives heart patients a "warranty" on their surgeries. Patients who have to be readmitted because of complications pay nothing for the second admission. Yet in providing higher quality and lowering patient costs, Geisinger loses money. That's why other hospitals do not follow its example.

Example: Studies show that if every patient went to the Mayo Clinic for health care, we could lower the national health care bill by one-fourth — and quality would improve. If everyone went for care to the Intermountain Hospital System in Salt Lake City, we could lower our health care costs by one-third — while improving quality. Why don't other hospitals copy these exemplars of low-cost, high-quality care? Because they would be severely penalized financially under the current system.

Solution: Let Hospitals Be Hospitals. Facilities that figure out how to lower patient costs, raise quality and offer warranties and other guaranties should be rewarded for doing so — just as they would in any other market. Accordingly, the same three reimbursement rules proposed for doctors above should also apply to hospitals.

Problem: Entrepreneurs are creating new products to meet needs not being met by traditional health insurance. For example, people can pay with their own money for telephone and e-mail consultations. They can purchase blood tests via the Internet and get results in 24 hours. They can get low-cost care with very little waiting at walk-in clinics in shopping malls. Yet all too often these services are hampered by outmoded, unnecessary government regulations. Amazingly, doctors are prohibited from owning and operating walk-in clinics that refer patients to their regular practices!

Solution: Let Entrepreneurs Be Entrepreneurs. We should welcome and encourage new ways of meeting patient needs, rather than stifle these efforts with unnecessary, outmoded laws and regulations. As with providers and facilities, promising innovations should be expedited and approved quickly. For example, walk-in clinics that charge half as much and match the quality of traditional care, with electronic medical records and electronic prescriptions to boot, should be approved outright. . .

II. Free the Patient

Patients also suffer when payments to doctors and hospitals are based on outmoded formulas. Whereas suppliers compete to meet customer needs in almost every other market, this happens all too rarely in health care.

Problem: Many patients have difficulty seeing primary care physicians. All too often they turn to hospital emergency rooms where there may be long waits and where the cost of care is much higher. When they do see doctors, all too often patients get inadequate information. The problem is made worse by the inability to communicate by telephone or e-mail.

Solution: Patient Power. We need to explore new ways to empower patients — especially the chronically ill, allowing them to manage more of their own care and more of their own health care dollars. Also, patients should be able to purchase services that are not paid for by traditional health insurance, including telephone and e-mail consultations and patient education services. Example: Studies show that diabetics, asthmatics and other chronic patients can manage their own care as well as or better than conventional physician care and at lower costs. Yet to do this patients need training, easier access to information and the ability to purchase and use in-house monitors. . .

III. Free the Employees

Our health insurance system evolved at a time when many workers expected to work for the same employer for their entire work lives. Clearly, that assumption is no longer valid.

Problem: When employees switch jobs, they are usually forced to switch insurance plans. This often means a switch of doctors, which means no continuity of care. Also, their new insurance may not have the same benefits as the original. To make matters worse, many employees are trapped in jobs they cannot leave because they cannot afford to lose their health insurance.

Solution: Personal and Portable Health Insurance. We should move to a system in which employees can take their health insurance with them when they travel from job to job. Transition to a new system may take many years. A good place to start is with baby boomers who retire early. . .

IV. Free the Employer

Employers are also trapped in a system designed for a different age.

Problem: In ways that are sometimes subtle and sometimes not so subtle, too many employers are trying to avoid hiring employees (and employee dependents) with high health care costs, much like a game of musical chairs.

Problem: By default, employers have been put in the position of having to manage their employees' health care costs — an activity for which most have no experience or expertise. While some large employers do an adequate job, small employers are incapable of doing it well.

Solution: Personal and Portable Insurance. Portable insurance would be a boon to employers as well as employees. Employers could make a defined contribution to each employee's health insurance; yet the insurance would be owned by the employees and travel with them on their journey through the labor market. In an ideal world, employers should be able to hire employees based solely on their ability to produce, irrespective of expected medical costs.

Example: The United Mine Workers, NFL football players and many other workers have better arrangements. Although employers pay all or most of the health insurance premiums, the health plan is largely independent of any particular employer and coverage is fully portable — traveling with employees whenever they switch jobs. . .

V. Free the Nontraditional Workplace

Most of our labor law, tax law and employee benefits law was enacted years ago and was based on the assumption that employees would be full-time workers, typically with a homemaker telecommuting. Today, one-third of the workforce consists of part-time workers and independent contractors. Many are telecommuting from their own homes. These changes are partly the result of the most important economic and sociological change of the past half-century: the movement of women into the labor market.

Problem: Two-earner couples are common in the labor market. They need employee benefits, including health insurance, but they don't need duplicate benefits. An employee covered by a spouse's health plan should be able to choose higher wages rather than an unnecessary second health plan. Yet today employers cannot give her that option.

Problem: Many part-time employees face the opposite problem. They would willingly take less pay if they could be enrolled in their employer's health plan. Yet employers generally are not allowed to give employees this option either.

Solution: Flexible Employee Benefits. Public policy should be on the side of helping people meet their needs rather than creating bureaucratic obstacles. Employers and employees should be free to adjust their employee benefit policies to meet the needs of a changing workplace.

VI. Free the Insurer

Like doctors, patients, employees and employers, insurance companies are also trapped in a dysfunctional system.

Problem: All too often insurers operate under regulations that encourage them to avoid the sick and attract the healthy. Even worse, they may face incentives to underprovide care to the sick and overprovide to the healthy. These perverse incentives are as bad for the insurers as they are for the patients.

Solution: A Market for the Care of Sick People. We need to encourage insurance markets in which health plans specialize in various conditions — especially chronic illness. Plans should compete to see who can better solve the needs of the people with the most severe health problems. . .

VII. Free the Uninsured

One reason why there are so many uninsured in America is that we encourage people to be uninsured.

Problem: Most uninsured people do not have the opportunity to obtain tax-subsidized employer-provided health insurance. As a result, if they buy insurance on their own they must do so with aftertax dollars. In this way, the tax law discourages private insurance. . .

VIII. Free the Kids

Many in Congress want to push children into a State Children's Health Insurance Plan (S-CHIP), paid for by taxpayers. Both the children and the taxpayers would be better off if kids were enrolled in their parent's private health insurance plans instead.

Problem: Studies show that every time government spends an extra $1 on S-CHIP, private insurance contracts by 60 cents. Either families drop their private insurance in order to take advantage of free government-provided health insurance or employers drop coverage and pay higher cash wages instead — knowing that free health insurance is an option for their employees. Because of a very high crowd-out rate, S-CHIP expansion is very costly to taxpayers and produces small social benefits. To make matters worse, children are leaving private plans where they have access to a broad array of doctors and facilities to enroll in public plans where their access is often no better than the access of the uninsured or Medicaid enrollees.

IX. Free the Parents

Under the current system, a child could be enrolled in S-CHIP, a mother could be enrolled in Medicaid and a father could be enrolled in an employer's plan. Medical outcomes are likely to be better for all three if they are in the same health plan.

Problem: As in the case of S-CHIP, Medicaid has a very high crowd-out rate. Public dollars substitute for private dollars. And access to care inevitably diminishes when people make the transition. . .

X. Free the Grandparents

More than 40 years ago our country decided to segregate seniors into a separate health insurance system called Medicare. In the beginning Medicare copied the standard Blue Cross plan of the day. With the passage of time, however, Medicare lagged behind the improvements in other insurance products.

Problem: The basic Medicare package (Parts A & B) is distinctly inferior to the kind of insurance most other Americans have. (It is even inferior to coverage for poor families under Medicaid.) For example, seniors are exposed to far more out-of-pocket risk and they do not have coverage for preventive care. Shockingly, the basic Medicare package will pay for the amputation of diabetic's leg, but it will not pay for drugs that would have made the amputation unnecessary.

Problem: To fill the gaps in their basic coverage, most seniors obtain MediGap coverage — which means that must pay two premiums to two plans. Even then, seniors usually do not have the coverage for drugs that most nonseniors have. So they must pay a third premium to a third plan (Medicare Part D) to get the same total coverage other people obtain by paying a single premium to a single plan. Paying three premiums to three plans is wasteful. Studies show that if the first two premiums were paid to a single, comprehensive health plan, the third premium seniors are paying would be unnecessary. . .

Read the entire NCPA Health Plan Proposals. . .
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9.         The Health Plan for the USA: How technology reduces health care costs.

Technology reduces health care costs, but it is not implemented by the health care establishment.

In section 5 above on Lean Health Care, Wayne Nelsen cites references that we're spending $3 trillion on healthcare and wasting $2 trillion which is enough to insure everyone without spending an additional cent. 

Unfortunately this does not resonate with members of the US Congress, the White House, the AMA, the medical profession, or the general public. This should not be surprising anymore that these same organizations cannot conceive of any waste in any entitlement, whether Social [In]Security, Medicare, Medicaid, or VA Healthcare. These same people can only think of increases in costs and in benefits—a non-sustainable approach.

This may be the same in many organizations. This was brought home to me when I assumed the Medical Directorship of the Respiratory Therapy Department and Pulmonary Function Laboratory at the now defunct American River Hospital in 1970. We received calls from these same departments at the other five hospitals in Sacramento inquiring what our anticipated fee increases would be for Arterial Blood Gases, Pulmonary Function Tests, and Respiratory Therapy Treatments. There was no awareness of the principles of Lean Medicine with increased efficiencies, which are currently being so well highlighted by the Lean Enterprise Institute. It was always about increase charges so that we keep up with the market. It was never about increased efficiencies to reduce costs and charges.

To illustrate, let's use the efficiency in ABG analysis. The first equipment I ordered was a replacement for the Radiometer Blood Gas apparatus. It not only took a competent Pulmonary Function Technician to operate, it also took at least a half hour of his time. Including the collection and cleanup time, a good PFT technologist could average one analysis an hour or eight per day. The salary of a PFT technologist at that time was $16 an hour or $16 per ABG of labor cost. The capital cost of the equipment was less than $1 per test. Thus the real cost of an ABG was about $17.

With the new automated Instrument Laboratories (IL) analyzer, which cost $16,000, there was considerable savings in labor costs since a technologist could now do eight tests per hour. At the above salary costs, this would be $2 per test or $2 per ABG. The capital cost of the equipment amortized over five years increased to $360 per month.

The number of requested ABG tests went from four per month, or revenue of $100 a month with the old equipment, to four per day, or revenue of $100 per day or $3,000 per month with the new equipment. Even with the new capital cost of $360 a month, doing 120 ABGs a month increased the capital cost to $3 per test. With the labor costs having dropped to $2 per ABG, the total cost per ABG was about $5 per test. Thus the total cost per ABG was considerably less at $5 than the previous $17. The $25 per ABG, which previously covered the $17 cost ($16 labor plus $1 capital cost), would now have to cover the approximately $5 cost per ABG ($2 labor plus $3 capital costs). We proposed that this increase in efficiency be reflected in an initial reduction in ABG charge to patients from $25 to $20 per test, which would still bring in additional revenue of $2400 per month (120 tests a month with the new efficiency vs four tests a month with the labor-intensive equipment). Thus the department's profits would increase to 75% from the previous approximate 30% despite the reduction in charge per ABG.

The critical but misunderstood difference was the total capital cost of the equipment or $16,000. The administration always used this as an excuse to raise charges. The immediate change was to increase the charges from $25 a test to $50 a test. Our calculation on the cost of a standard five-year amortization, which was the standard at that time, was about $360 a month. At 120 ABGs per month, the capital cost per ABG increased from $1 to $3 per test. The administration prevailed in doubling the charges from our proposal of reducing the charge to the patient despite the more than doubling of profit.

Needless to say, the respiratory therapy department remained one of the major hospital profit centers. When we continued our efforts of reducing the charge, we found that administration had already scheduled further increases. When asked why when our profits now exceeded 90%, we were told: We have not yet found the maximum that Blue Cross, Blue Shield, and Medicare will pay since they kept paying the billed charges.

This thinking in the hospitals, the largest cost center of the health care industry, will seriously impact any Medicare and Medicaid costs in the United States. This will ultimately restrict any attempts at true health care reform.

Recent analysis and proposal in Canada to change from a free Medicare system to a 25% co-payment indicated a savings of as much as 50% of Canadian Medicare costs. They predicted the entire overlay of bureaucracy to monitor utilization would disappear since patients would monitor their own utilization with the 25% co-payment. However, a 25% co-payment on hospital costs cannot be implemented because a 25% co-payment on hospital bills would not receive any political or professional or patient support.

We have been working in our research group on a graduated system of age-coordinated deductibles and co-payments. We have devised a HealthPlanUSA, which will be a serious reform of health care costs in the United States. Although we have actuarial analysis that suggested a 40% reduction in health care costs, it is now apparent that this was a reasonable estimate. Others have now suggested (see section five above) that as much as two-thirds of health care costs can be eliminated if unnecessary expenses are eliminated. The graduated deductibles and co-payments will provide better and more efficient utilization than the entire team of reviewers located on every hospital floor and oversight of every private office could possibly achieve. Since most reviewers are RNs, they can easily be re-incorporated into patient care—the profession for which they were trained. This would also solve our nursing shortage problems.

A copy of this plan can be purchased at We invite your review of this innovative Business Health Plan.

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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, has 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 and the countdown to the biggest tax increase in history. 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 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


"Every day I get up and look through the Forbes list of the richest people in America.
If I'm not there, I go to work."

— Robert Orben: Is a magician and comedy writer

"Nurture great thoughts, for you will never go higher than your thoughts."
— Benjamin Disraeli: Was a British prime minister, parliamentarian, and author

"By giving people the power to share, we're making the world more transparent."
— Mark Zuckerberg: Entrepreneur who co-founded Facebook

Some Recent Postings

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This Month in History - October

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Always remember that Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single payer initiative, was born for the benefit of the state and of a contemptuous disregard for people's welfare.