Tuesday, March 31, 2009

Midwife legislation

Here is an important memo for the ISMA Government Relations Department. They have learned that the midwife legislation the ISMA defeated in the Senate earlier this session might be resurrected in the House. It is their understanding that language for the licensure of certified professional midwives (CPMs) will be amended into SB 86, a bill dealing with the licensure of genetic counselors.

They are asking that physicians and other healthcare providers contact the members of the House Public Health Committee and ask them to OPPOSE an amendment for the licensure of lay midwives. Here are some talking points to include in your email or phone message:

1. Delivering a baby at home with a certified professional midwife is unsafe.
a. Home delivery does not offer the same protections to the mother and baby as giving birth in a hospital. This is especially true if there are complications with the pregnancy in the home. Many times the only contingency plan for CPMs is to call 911 for help. However crucial minutes are lost during the transportation from the home to the hospital, which can lead to tragic consequences.

2. Licensing certified professional midwives will mislead the public into thinking that CPMs are equal to certified nurse midwives.
a. Nurse midwives must have a baccalaureate degree in addition to graduate work specific to midwifery. Most CPMs are only required to attend a certain number of births and pass a test to be certified. Licensing CPMs actually lowers the standards for all midwives, which could put the public at risk.

3. Liability
a. If there are complications during a home birth conducted by a CPM, where does the liability of the CPM end and the physician begin? Physicians may be liable for the malpractice of a CPM with which they have no relationship as a consequence of treating the mother and child after a complication resulting from a home birth with a CPM.

4. “They are already doing it, so why not make it legal.”
a. The CPMs argue that lay midwives are already delivering babies without a license, so the State should legalize the practice. This is a flawed argument that is dangerous to the health and safety of newborns and their mothers.

Please email or contact the members of the House Public Health committee today to let them know that you oppose the licensure of lay midwives. Ask them to defeat any potential amendments that include this language.

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Monday, March 30, 2009

Fabulous British Speech

Yes, even the British understand that you cannot continue to spend your way out of a depression if you are just adding to the debt.

You cannot tax and place more and more barriers of the productive private sector.

What a fabulous speech that should be broadcast around the globe and replayed over and over in the oval office.

YouTube - Daniel Hannan MEP: The devalued Prime Minister of a devalued Government

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Friday, March 27, 2009

Bumper stickers of the week

You just have to love the simplicity of language and how just a few words can relay a message !




















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Thursday, March 26, 2009

Obama not grasping the situation

Yes Mr. Clements; the 90% taxation the House just past is plain stupid. But when you look at Nancy Pelosi and Barney Frank in association with Obama, why would anyone be surprised.

Jonathan Clements Says the Bonus Tax Creates a Disincentive to Work - WSJ.com

Obama’s entire economic philosophy will continually erode the very fabric of what has made this country great. The ability to utilize personal ingenuity and hard work in order to gain financial reward has always been an addiction that has driven the United States to lead the world in productivity, creativity and personal wealth.

Placing barriers and imposing higher taxes will destroy the incentives that drive individuals to take risks for increasing their personal well-being which in the end stimulates the economy and creates jobs for others.

His interview on 60 minutes really highlights his lack of insight and sincerity about the situation.

As noted in the following article, (Kroft to Obama: Are you punch-drunk? - Craig Gordon and Jonathan Martin - POLITICO.com) the authors point out many instances where Obama was probably inappropriate and too lighthearted as the severity of the topic warrants. But again, why be surprised. He really doesn’t care as long as he can use the crisis for his radical agenda.

“You're sitting here. And you're— you are laughing. You are laughing about some of these problems. Are people going to look at this and say, ‘I mean, he's sitting there just making jokes about money—’ How do you deal with— I mean: explain. . .”

Kroft asked at one point. “Are you punch-drunk?” Kroft said.

“No, no. There's gotta be a little gallows humor to get you through the day,” Obama said, with a laugh.

He signaled that he would like to see changes in a House resolution that would tax the bonuses at 90 percent, saying “we can’t govern out of anger.”

Even his awkward laughter highlighted an issue Obama has faced dating back to the campaign, a sense that he sometimes is too “cool” and detached to fully grasp the public anxiety over mounting job losses and economic worries.

Still, Obama made clear that he’s afraid the nation hasn’t seen the worst of the economic crisis. He said the recession deepened faster than he expected, particularly in terms of job losses.

“If we did nothing, you could still have some big problems. There are certain institutions that are so big that if they fail, they bring a lot of other financial institutions down with them. And if all those financial institutions fail all at the same time, then you could see an even more destructive recession and potentially depression,” Obama said.

“I mean there were a whole bunch of folks who, on paper, if you looked at quarterly reports, were wildly successful, selling derivatives that turned out to be. . .completely worthless,” Obama said, with a chuckle.

“Well, I think that as a general proposition, you don't want to be passing laws that are just targeting a handful of individuals…And as a general proposition, I think you certainly don't want to use the tax code—is to punish people.”

So why does he not understand that what he is doing will ultimately create the worst inflation we have ever seen, destroy the incentive to work and take risks, devalue the dollar to levels we have never seen and possibly bankrupt the nation.

Or maybe he does understand this and sees it as a way to create a more European socialist type of government.

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Wednesday, March 25, 2009

Sweden and Hungary physician shortages

Nationalized healthcare is a disaster in the making. Looking at the severe physician shortage in two European countries, Sweden and Hungary, we can get a glimpse of the problems.


Hungary currently has about 35,000 doctors with 2,200 vacancies. This was based on the 2005 data which was the most recent year for which statistics were available. This data does not reflect big cuts made in the health-care system in the past 2 years which has worsened the problem.


Many physicians who are trained in these countries end up leaving. It is mainly because of money and lifestyle and it is just not practical. A new medical graduate earns less than 380 euros a month. A security guard or shop assistant can usually expect to take home 300 euros and a 22-year-old with a bachelor's degree working as an assistant auditor for a multinational corporation makes more than 600 euros. The economics and motivation to complete 8-12 years past high school and then earn roughly the same as a shop assistant while being responsible for life and death decisions simply isn’t appealing.


The issue of status and income for physicians is an important one that cannot be demeaned and overlooked by governments. With salaries fixed by the government, and a lack of potential for doctors to run their own practices, the incentive to work hard and build a good practice with a good income is simply not there. Salaried positions may have an appeal for some individuals but it is certainly a minority. Too much time and energy go into getting the degree to be restrained by government when other industries are not.


Once the physician shortage occurs, rationing of care is right behind. For governments to control costs; services will be limited.

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Tuesday, March 24, 2009

The Newest Gun Control Legislation

Well as predicted, it didn’t take the democrats long, with Obama as the leader, to propose another odious gun control bill.

HR 45 H.R. 45 - Summary: Blair Holt's Firearm Licensing and Record of Sale Act of 2009 (GovTrack.us) is aimed at restricting guns. It will force people to get a mandatory gun license and requires licensees that move to register a current address within a prescribed period of time or face a penalty. It will creates a tracking database for licensees with the risk of this database being obtained by not so upstanding citizens giving them access to who and what guns you own. It would make it a crime to allow someone under 18 years of age to have access to your firearm and it would give the U.S. Attorney General broad authority over the program (we know how successful they are with other government run programs). These are just a few of the onerous problems within the bill.

Luckily, as of now, there are no co-sponsors to the bill, and there is very little chance it will be adopted; but let one major gun related incident occur and I am certain more liberals will jump on the bandwagon.

Since obesity seems to be an ever-increasing problem, why don’t we ask the government to regulate our utensils and certainly all the snack foods and fast foods? Obesity must be the fault of something other than the individual. We could fine any individual who knowingly sells or gives someone who is 25 pounds overweight any access to the utensil or food.

Too many good men and women have fought to protect our constitutional right to bear arms and I for one will not allow this to change without a fight.

The picture below is by far the best remedy I have seen for controlling the gun control liberals and I am certain we could get donations to buy each one of them their very own


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Monday, March 23, 2009

If We Only Knew

In this op-ed By Victor Davis Hanson, he summarizes very well what most of us knew the Obama administration and policies would look like. Now Obama Tells Us? by Victor Davis Hanson on National Review Online. Conservatives aren’t surprised, but how long will it take for the moderates and the left to open their eyes?

Imagine that last fall, before being elected, Barack Obama had outlined the positions he has embraced since being inaugurated. An honest campaign speech could have gone something like this:

“As we approach Election Day, the American people should not waste the crisis we find ourselves in.

“Consequently, if elected, I promise to get us over the Bush financial meltdown with a stimulus program that will borrow $787 billion — which, of course, will add to the already sizable budget deficit (nearly $500 billion) projected in the Bush administration’s last budget.

“By March of next year, my new $3.6 trillion budget will include a spending bill with over 8,500 budget earmarks to target in-need constituents.

“In addition to the stimulus/borrowing plan, I intend to devote $634 billion to fund a new supplementary national health-care system. But that is not all. Unfortunately, the initial Bush bank bailout of some $700 billion also may well have to be augmented by an additional $750 billion.

“Although my new spending proposals may raise the federal deficit in my first year to $1.75 trillion, I promise the American people that by the end of my first term, I will halve the federal deficit — albeit adding another $3 to $5 trillion to the national debt.

“Those savings can be accomplished by upping the federal income tax to about 40 percent on those rich 5 percent of Americans who currently pay only 60 percent of our aggregate income taxes — as well as lifting Social Security caps on their payroll taxes and cutting out many of their tax deductions.

“With state income taxes, federal income tax, and Social Security and payroll taxes, along with new cutbacks in deductions, some of these rich will pay over 60 percent of their incomes in taxes. That is not an unreasonable rate in comparison with past levels — or the fact that well over 40 percent of Americans do not make enough to pay any federal income taxes.

“I expect that Wall Street may react negatively to these proposals. We may see the Dow fall an additional 2,000 to 3,000 points after I’m elected. It may descend to under 7,000 during my first weeks of office. And this may be the moment when the economy continues to cool and unemployment rises.

“But to deal with this reaction of entrenched interests, I promise a fresh team of hard-nosed American professionals — understanding that it is impossible to ensure that none have past insider connections and occasional tax problems.

“From the former Clinton administration, I will select Rahm Emanuel to run my staff. To oversee revenue, Timothy Geithner will assemble a large team at Treasury. Senator Clinton herself will run State, and I will anchor my cabinet with pros like Tom Daschle, Eric Holder, Bill Richardson, and Hilda Solis.

“On matters of protecting civil liberties, I assure the American people that I have examined the Patriot Act, the FISA accords, and renditions — and I have discovered that they, in fact, do not shred our Constitution. I will, however, shut down Guantanamo Bay — but must keep it open another year and appoint a task force to study the issue.

“Our new direction in energy policy will center on cap-and-trade initiatives that promote wind and solar power. While we won’t rule out oil, gas, coal, and nuclear development, problems with greenhouse-gas emissions and nuclear waste mean that these ossified 20th-century industries — including new offshore-drilling development — must be discouraged and further taxed or regulated to subsidize our green future.

“Abroad, I promise to give America a new image. My first television interview will be with al Arabiya. Due to both new initiatives and my unique background, I can reassure them that no longer will the United States alienate the Muslim world. Our aim is to return to stable and friendly relations with the Middle East characteristic of 20-30 years ago.

“Indeed, on matters in the Middle East, I will bring back my suspended adviser Samantha Power. I look forward to her input, along with that of Charles Freeman, former ambassador to Saudi Arabia and critic of Israel, as head of the National Intelligence Council, to craft new directions in the region.

“We expect to open new dialogues with Basher al-Assad of Syria and Mahmoud Ahmadinejad of Iran without preconditions. And to further the cause of peace in the Middle East, the United States will pledge almost $1 billion to help rebuild the Gaza strip that is governed by Hamas.”

Now all that would have been hope and change that we could have voted on.

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Friday, March 20, 2009

Reality of the Obama Years


Dear President Obama,

Thank you for helping my neighbors with their mortgage payments. You know the ones down the street who, in the good times, refinanced their house several times and went on vacations to wonderful places, bought SUV's, ATV's, RV's, installed a pool, a big screen TV, two Wave Runners and a Harley. I was wondering, since I'm paying my mortgage and now, theirs, could you arrange for me to borrow the Harley now and then?

Daisy Ford
Queen Creek, AZ

P.S. They also need help with their credit cards, when do you want me to start making those payments?

P.P.S. I almost forgot - they didn't file their income tax return this year. Should I go ahead and file for them or will you be appointing them to cabinet posts?
___________________________________________________________________
___________________________________________________________________

A woman in a hot air balloon realizes she is lost. She lowers her altitude and spots a man fishing from a boat below.
She shouts to him, 'Excuse me, can you help me? I promised a friend I would meet him an hour ago, but I don't know where I am.'

The man consults his portable GPS and replies;

'You're in a hot air balloon, approximately 30 feet above a ground elevation of 2346 feet above sea level. You are at 31 degrees, 14.97 minutes north latitude and 100 degrees, 49.09 minutes west longitude.

She rolls her eyes and says, 'You must be a Republican!'

'I am,' replies the man. 'How did you know?'

'Well,' answers the balloonist, 'everything you tell me is technically correct, but I have no idea what to do with your information, and I'm still lost. Frankly, you're not much help to me.'

The man smiles and responds, 'You must be a Democrat.'

'I am,' replies the balloonist. 'How did you know?'

'Well,' says the man, 'You don't know where you are or where you're going. You've risen to where you are, due to a large quantity of hot air. You made a promise that you have no idea how to keep, and now you expect me to solve your problem. You're in exactly the same position you were in before we met, but, somehow, now it's my fault.

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Thursday, March 19, 2009

Healthcare and the Free Market

How should a free market work in Healthcare?

First off, you have to agree that healthcare is a service oriented business where the patient is actually receiving something for the money that gets spent. If you cannot agree on this point, the rest is a mute issue.

In a totally free market, any trade is usually conveyed by freely fluctuating prices and supply and demand. Most medical care could be considered optional as many problems are self-limited. People can choose to treat long term conditions knowing the consequences of their decision. Catastrophic illnesses or accidents are not typically by choice and provisions need to be made for “insurance” for these less common events.

History has shown that medical care in essentially voluntary markets tends to be accessible and affordable for the vast majority of patients. The sustained price inflation we have witnessed over the past 50 years is the result of direct or indirect political intervention.

Competition between providers today is not what is considered free market competition. Providers do not compete for the satisfaction of the actual consumer of care, the patient, but it is the politically created competition from overregulation and 3rd party entities (Insurance companies). Taking the actual consumer out of the equation has created these tremendous costs. For free trade to actually exist the participants in the exchange (the doctor and the patient) must be the legitimate owners of the goods and services exchanged.

Whether the liberals want to admit it or not, medical care is an individual service consisting of the skilled assistance from a healthcare provider directly to a patient for the benefit of recovering from an illness or prevention of an illness.

During the past 50 years when patients were taken out of the mix and no longer had to pay for the service (many companies paid 100% of the insurance), medical care became commodity that most people took for granted. Historically, medical care ranked way below nourishment, sanitation, education, entertainment, and so on but when it was free for so many years and for so many people, it became the expectation that it was deserved and someone else should be paying for it.

Even today, most medical treatments can be deferred for various periods of time, and spontaneous healing often takes place. Lifestyle choices can markedly affect the susceptibility to illness and the ability to heal and certainly can effect the cost of fixing problems.

But if the free market was allowed to work and everyone understood that this is a service oriented business, most routine medical care could be paid for by individuals and families. Insurance would only be needed for catastrophic events and individuals could choose supplemental plans that fit their needs for things other than routine visits.

Yes this change would entail sacrifices. Entertainment, cigarettes, cell phones, cable TV, eating out, etc. may have to be weighed against going to the doctor for a minor illness. But these same choices are made when you look to buy a house, a car, go to your lawyer or accountant or have your automobile repaired. For too many years, financial choices have been made for virtually everything except healthcare.

From personal experience, my patients who have transitioned to MSA’s or HSA’s have increasing become better consumers of healthcare. They understand the costs and they are willing to evaluate the pros and cons of every decision and recommendation. They are also willing to ask for discounts and other options to treat their conditions. The internet has made information readily available and most patients are well informed.

Yes we need changes, but universal healthcare is not the answer. Individual responsibility and putting patients back in charge of the finances of healthcare is the only way to fix the broken system.

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Wednesday, March 18, 2009

The Pro-Abortion President

Many people don’t realize and the media certainly didn’t publish it, but when Obama recently signed the executive order to reverse funding on embryonic stem cell research, he did much more than just reverse the funding. He further advanced his radical views on his pro-abortion stance.

After the signing, Obama congratulated his administration for having the sophistication to ensure that scientific decisions are “based on facts, not ideology.”

But in the last paragraph of this Executive Order, you see that the previous Executive order 13435 is revoked.

THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release March 9, 2009
EXECUTIVE ORDER
- - - - - - -
REMOVING BARRIERS TO RESPONSIBLE SCIENTIFICRESEARCH INVOLVING HUMAN STEM CELLS
By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:


Section 1. Policy. Research involving human embryonic stem cells and human non-embryonic stem cells has the potential to lead to better understanding and treatment of many disabling diseases and conditions. Advances over the past decade in this promising scientific field have been encouraging, leading to broad agreement in the scientific community that the research should be supported by Federal funds.

For the past 8 years, the authority of the Department of Health and Human Services, including the National Institutes of Health (NIH), to fund and conduct human embryonic stem cell research has been limited by Presidential actions. The purpose of this order is to remove these limitations on scientific inquiry, to expand NIH support for the exploration of human stem cell research, and in so doing to enhance the contribution of America's scientists to important new discoveries and new therapies for the benefit of humankind.

Sec. 2. Research. The Secretary of Health and Human Services (Secretary), through the Director of NIH, may support and conduct responsible, scientifically worthy human stem cell research, including human embryonic stem cell research, to the extent permitted by law.

Sec. 3. Guidance. Within 120 days from the date of this order, the Secretary, through the Director of NIH, shall review existing NIH guidance and other widely recognized guidelines on human stem cell research, including provisions establishing appropriate safeguards, and issue new NIH guidance on such research that is consistent with this order. The Secretary, through NIH, shall review and update such guidance periodically, as appropriate.

Sec. 4. General Provisions. (a) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(b) Nothing in this order shall be construed to impair or otherwise affect:
(i) authority granted by law to an executive department, agency, or the head thereof; or
(ii) functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity, by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.
(d) Sec. 5. Revocations. (a) The Presidential statement of August 9, 2001, limiting Federal funding for research involving human embryonic stem cells, shall have no further effect as a statement of governmental policy.
(b) Executive Order 13435 of June 20, 2007, which supplements the August 9, 2001, statement on human embryonic stem cell research, is revoked.

BARACK OBAMA

THE WHITE HOUSE,
March 9, 2009.


Executive order 13435 had to do with support and funding for research that utilized non-embryonic cells and included the groundbreaking research to convert ordinary human cells into ones that resemble embryonic stem cells.

You will remember that in 2007, scientists in Japan and the US discovered they could engineer human skin cells to mimic embryonic stem cell. This could allow the scientific community to probe the benefits of these cells without actually destroying human embryos.

To most people, this development rendered the controversy moot, and vindicated President Bush’s moral and ethical caution. This was an enormous scientific step forward that all observers should support.

HHS/NIH Plan for Implementation of Executive Order 13435

On June 20, 2007, President George W. Bush issued Executive Order 13435. The Executive Order requires that "The Secretary of Health and Human Services shall conduct and support research on the isolation, derivation, production, and testing of stem cells that are capable of producing all or almost all of the cell types of the developing body and may result in improved understanding of or treatments for diseases and other adverse health conditions, but are derived without creating a human embryo for research purposes or destroying, discarding, or subjecting to harm a human embryo or fetus."

The Secretary of the Department of Health and Human Services (HHS) has tasked the National Institutes of Health (NIH) with the responsibility to develop a plan to implement the Executive Order. You can download the implementation plan

So right after Obama told the country he supported alternative, non-destructive stem cell research, he signed the Executive order that revoked the exact scientific research that could have done this.

President Obama has a voting record that repeatedly opposed no-brainer, pro-life legislation (Born Alive Infant Protection Act) that passed the US Congress without a single dissenting vote.

Why is it that he can say one thing and simply do the opposite without any comments from the media. His repeated declaration of working along side republicans and being for alternate types of scientific endeavors in stem cell research is just a lie.

The bioethicist Wesley J. Smith pondered the question on why Obama would do this and on his blog; he wondered why on earth Obama would take the totally unnecessary action in undoing Executive order 13435. Smith’s conclusion: “I can think of only two reasons for this action…First, vindictiveness against all things "Bush" or policies considered by the Left to be "pro life;" and second, a desire to get the public to see unborn human life as a mere corn crop ripe for the harvest. So much for taking the politics out of science.”

Obama’s actions are extremely hypocritical and demonstrate that his language about respect, inclusion, and unity are, in fact, just words.

I guess now that he has been elected, Obama has suddenly been graced with the knowledge of when life begins even though it was “above his pay grade” just a few short months ago!!!

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Tuesday, March 17, 2009

Obama double talk on new taxes

It’s only just begun. The Obama statements that only the wealthy will have their taxes raised were not evidently passed on to his democratic colleagues.

A report from the Washington Post Workers' Health Benefits Eyed for Taxation - washingtonpost.com shows that many politicians, led by Sen. Max Baucus (D-Mont.), think it would be a good idea to begin taxing the employer provided health benefits. These are currently considered pretax dollars but could be an easy target to help pay for the expensive Obama plans.

Baucus made the statement "Everybody's got to share together in the solution. And this might be one component to sharing".

Since when does everyone have to be equal? Some individuals choose riskier lifestyles, make poorer choices and are generally higher risks. Equality will never be achieved and individual responsibility is evidently no where in the democratic plan.

Obama’s budget director Peter Orszag said taxing employer benefits was among several ideas that "most firmly should remain on the table." Obama’s White House economic adviser Jason Furman called for an end to the so-called "employer exclusion" before he joined the administration and other congressional Democrats say the White House has signaled that Obama would accept a tax on employer benefits as long as he didn't have to propose it himself. (What a piece of work this guy is)

I am already tiring of the Obama rhetoric and his “redistribution of wealth”, socialist philosophy. His double talk is nauseating.

You’d better hang on to your wallets; the ride has just begun!!

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Monday, March 16, 2009

Health Care Rationing

Many democrats supporting the radical proposed changes in our healthcare system always state that it won’t result in rationing of care.

But look at Oregon. Rationing Care: Oregon Changes Its Priorities - Brief Analysis #645

Rationing of care is exactly what happens when you transition to a national healthcare program and remove choice from individuals.

I’ve stated before; the government cannot provide everything to everyone.

The Oregon plan has already seen how special interests groups and money can influence what becomes the priority.

Is this really what the people want or expect from our government?

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Friday, March 13, 2009

Golfing Rule Changes Under the Obama Administration

There is a possibility of MAJOR rule changes to the game of golf, this may occur sometime after March 20, 2009.

(Administration of change)

This is only a preview as the complete rulebook is being written now. Here are a couple of basic changes.

Golfers with handicaps:

- below 10 will have their green fees increased by 35%
- between 11 and 18 will see no increase in green fees
- above 18 will play for free and even get a check from the club/course played

The $ amount put in for bets will be as follows:

- for handicaps below 10 an additional $10
- between 11 and 18 no additional amount
- Above 18 you will receive the total amount in the pot and you do not even have to play.

The term "gimme" putt will be changed to "entitlement" and will be used as follows:

- handicaps below 10, no entitlements
- handicaps above 11 to 17, entitlements for putter length putts
- handicaps above 18, if on green, no need to ever putt, just pick it up

These entitlements are intended to bring about fairness in scoring so that the final scores of all players will be about the same.

In addition, a Player will be limited to a max of one birdie and/or six pars, any excess must be given to those fellow players who have not yet scored a birdie or par. Only after all players have received a birdie or par from the player making the birdie or par, can that Player begin to count his score again.

The current USGA handicap system will be used for the above purposes but the term 'net score' will be available only for scoring those players with handicaps 18 and above. This is intended to 'redistribute' the success of winning by making sure that in every competition the above 18 handicap players will post only 'net score' against every other player's gross score.

These new Rules are intended to CHANGE the game of golf. Golf must be about Fairness Only.

It should have nothing to do with Ability!

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Thursday, March 12, 2009

Don't Try to Hide It!

The Obama team with their leader continues to take advantage of the current financial climate. What is so amazing is they don’t even try to hide it. The sad part is that many individuals will continually follow blindly and “drink the cool-aide”.

Their Chief of Staff Rahm Emanuel made a statement to the New York Times about the current situations that "They are opportunities to do big things."

Then Secretary of State Hillary Rodham Clinton told members of the European Parliament, "Never waste a good crisis."

And to top it off, President Obama explained on his Saturday radio and Internet address that there is "great opportunity in the midst of" the "great crisis" befalling America.

This philosophy of using crises to radically change things that would never pass under normal circumstances demonstrates just how radical this administration really is.

No one should be surprised based on his voting record, but it is a shame we vocal minority will be proven right.

Obama is using this crisis to pass the liberal agenda on healthcare, energy and education and redistribution of wealth even though these would never pass in normal times and many would argue that his policies are making the crisis worse.

But that is the real intent. What better way to control the people than to have them live in fear and think the only saving grace is the Government. This is the liberal agenda.

Jonah Goldberg said “Its amorality is outweighed only by the grotesque and astoundingly naked cynicism of it all.”

The media double standard is blazingly obvious as Goldberg further pointed out when he said;

“Recall that not long ago, the first item on the bill of indictment against the Bush administration was that it was "exploiting" 9/11 to enact its agenda. Al Gore shrieked that President Bush "played on our fears" to get his way. In response to nearly every Bush policy proposal, from the Patriot Act to the toppling of Saddam Hussein, critics would caterwaul that Bush was taking advantage of the country's fear of terrorism.

The Bush administration always denied this, and rightly so. If the president admitted that he was using a national calamity for narrow partisan or ideological advantage, it would be outrageous. Indeed, every time Karl Rove or some other administration official said anything that could be even remotely interpreted as using the war or 9/11 for partisan or ideological gain, the editorial pages and Democratic news-release factories churned into overdrive with righteous indignation.

Well, now we have the president, along with his chief aides, admitting -- boasting! -- That they want to exploit a national emergency for their preexisting agenda, and there's no scandal. No one even calls it a gaffe. No, they call it leadership.”

In morally sensitive individuals and companies, exploiting a crisis for your own purposes is an outrage whether it is price gouging during the hurricane, gas hikes during a perceived shortage or raising the price of generators during an electrical failure.

But when Obama and his liberal friends do the same thing; they and the media refer to it as taking advantage of a historic opportunity. This is a sad time for the United States.

We are in for a long 4 years and it will take many more than that to undue the radical changes Obama is making!

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Wednesday, March 11, 2009

Obama advancing his anti-religious agenda

As most have heard, President Barack Obama issued an executive order that authorizes expanded federal funding for research using stem cells produced by destroying human embryos.

His announcement was typical. He looks straight at the American people with his calm and deliberate demeanor and acts as if he moderate while he is advancing his radical policies.

Obama’s order overturned Bush’s policy which balanced an unrealistic promise of stem cell research with morality and ethics.

Obama’s plan not only allows funding for new cell lines by destroying embryos, it actually incentivizes the process.

This has nothing to do with science as the science shows the same results can be achieved using pleuripotent stem cells from other sources.

This is purely politics and Obama paying back his radical left wing members who always tried to paint Bush’s policy as a purely religious and anti-science.

Bush's policy was always one of moderation and certainly not as radical as some on the religious right would have liked. His policy did not ban new embryo-destructive research. It only stopped taxpayer money paying for it. Private industry was free to continue doing this research if they so desired.

But this wasn’t good enough for the left. Obama's policy is in no way moderate. His policy will promote a whole new industry of embryo creation and destruction, including the creation of human embryos by cloning for research in which they are destroyed all while using taxpayer dollars. It forces all taxpayers to participate in this morally inappropriate practice purely for political gain.

Obama’s comments about taking politics out of it are blatantly misleading. He intentionally reversed a very moderate compromise made by Bush only for political gain. He completely ignores the recent scientific breakthroughs that make possible the production of cells that are biologically equivalent to embryonic stem cells without the need to create or kill human embryos and Obama revoked not only the Bush restrictions on embryo destructive research funding, but also the 2007 executive order that encourages the National Institutes of Health to explore non-embryo-destructive sources of stem cells.

The bigger problem with Obama is that he evidently doesn’t realize or doesn’t care that this issue isn’t really about science. The question of whether to destroy human embryos is a moral question. Using research is just a way to overcome the moral implications and questions.

When life begins and how we as a society treat human beings at the beginning of life is a much more difficult discussion and one that Obama clearly doesn’t understand and refuses to acknowledge or admit.

Using taxpayer money to fund this morally controversial issue continues to place the United States on a downward decline in our ethics.

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Tuesday, March 10, 2009

"Right On" Charles

Charles Krauthammer has nailed it again with his recent op-ed.'Intellectually dishonest to the core'

The rhetoric the Obama team continues to dish out is all an attempt to divert the conversation from making the most radical changes this democracy has ever witnessed.

Forget the pork. Forget the waste. Forget the 8,570 earmarks in a bill supported by a president who poses as the scourge of earmarks. Forget the "2 trillion dollars in savings" that "we have already identified," $1.6 trillion of which President Obama's budget director later admits is the "savings" of not continuing the surge in Iraq until 2019 -- 11 years after George Bush ended it, and eight years after even Bush would have had us out of Iraq completely.

Forget all of this. This is run-of-the-mill budget trickery. True, Obama's tricks come festooned with strings of zeros tacked onto the end. But that's a matter of scale, not principle.
All presidents do that. But few undertake the kind of brazen deception at the heart of Obama's radically transformative economic plan, a rhetorical sleight of hand so smoothly offered that few noticed.


The logic of Obama's address to Congress went like this:

"Our economy did not fall into decline overnight," he averred. Indeed, it all began before the housing crisis. What did we do wrong? We are paying for past sins in three principal areas: energy, health care and education -- importing too much oil and not finding new sources of energy (as in the Arctic National Wildlife Refuge and the Outer Continental Shelf?), not reforming health care and tolerating too many bad schools.

The "day of reckoning" has arrived. And because "it is only by understanding how we arrived at this moment that we'll be able to lift ourselves out of this predicament," Obama has come to redeem us with his far-seeing program of universal, heavily nationalized health care; a cap-and-trade tax on energy; and a major federalization of education with universal access to college as the goal.

Amazing. As an explanation of our current economic difficulties, this is total fantasy. As a cure for rapidly growing joblessness, a massive destruction of wealth, a deepening worldwide recession, this is perhaps the greatest non sequitur ever foisted upon the American people.

At the very center of our economic near-depression is a credit bubble, a housing collapse and a systemic failure of the banking industry. One can come up with a host of causes: Fannie Mae and Freddie Mac pushed by Washington (and greed) into improvident loans, corrupted bond-ratings agencies, insufficient regulation of new and exotic debt instruments, the easy money policy of Alan Greenspan's Fed, irresponsible bankers pushing (and then unloading in packaged loan instruments) highly dubious mortgages, greedy house-flippers, deceitful home buyers.

The list is long. But the list of causes of the collapse of the financial system does not include the absence of universal health care, let alone of computerized medical records. Nor the absence of an industry-killing cap-and-trade carbon levy. Nor the lack of college graduates. Indeed, one could perversely make the case that, if anything, the proliferation of overeducated, Gucci-wearing, smart-ass MBAs inventing ever more sophisticated and opaque mathematical models and debt instruments helped get us into this credit catastrophe.

And yet with our financial house on fire, Obama makes clear both in his speech and his budget that the essence of his presidency will be the transformation of health care, education and energy. Four months after winning the election, six weeks after his swearing-in, Obama has yet to unveil a plan to deal with the banking crisis.

What's going on? "You never want a serious crisis to go to waste," said chief of staff Rahm Emanuel. "This crisis provides the opportunity for us to do things that you could not do before."
Things. Now we know what they are. The market's recent precipitous decline is a reaction not just to the absence of any plausible bank rescue plan, but also to the suspicion that Obama sees the continuing financial crisis as usefully creating the psychological conditions -- the sense of crisis bordering on fear-itself panic -- for enacting his "Big Bang" agenda to federalize and/or socialize health care, education and energy, the commanding heights of post-industrial society.


Clever politics, but intellectually dishonest to the core. Health, education and energy -- worthy and weighty as they may be -- are not the cause of our financial collapse. And they are not the cure. The fraudulent claim that they are both cause and cure is the rhetorical device by which an ambitious president intends to enact the most radical agenda of social transformation seen in our lifetime.

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Monday, March 09, 2009

Let the Market Work


Here is a reprint from the Wall Street Journal. Michael Boskin Says Barack Obama Is Moving Us Toward a European-Style Social Welfare State and Long-Run Economic Stagnation - WSJ.com He has some very valid points about Obama's agenda and how is it hurting our economy and destroying individual's savings.

Socialism was a concern and his radical agenda is proving those individuals correct

Obama's Radicalism Is Killing the Dow

A financial crisis is the worst time to change the foundations of American capitalism.

It's hard not to see the continued sell-off on Wall Street and the growing fear on Main Street as a product, at least in part, of the realization that our new president's policies are designed to radically re-engineer the market-based U.S. economy, not just mitigate the recession and financial crisis.

The illusion that Barack Obama will lead from the economic center has quickly come to an end. Instead of combining the best policies of past Democratic presidents -- John Kennedy on taxes, Bill Clinton on welfare reform and a balanced budget, for instance -- President Obama is returning to Jimmy Carter's higher taxes and Mr. Clinton's draconian defense drawdown.

Mr. Obama's $3.6 trillion budget blueprint, by his own admission, redefines the role of government in our economy and society. The budget more than doubles the national debt held by the public, adding more to the debt than all previous presidents -- from George Washington to George W. Bush -- combined. It reduces defense spending to a level not sustained since the dangerous days before World War II, while increasing nondefense spending (relative to GDP) to the highest level in U.S. history. And it would raise taxes to historically high levels (again, relative to GDP). And all of this before addressing the impending explosion in Social Security and Medicare costs.

To be fair, specific parts of the president's budget are admirable and deserve support: increased means-testing in agriculture and medical payments; permanent indexing of the alternative minimum tax and other tax reductions; recognizing the need for further financial rescue and likely losses thereon; and bringing spending into the budget that was previously in supplemental appropriations, such as funding for the wars in Iraq and Afghanistan.

The specific problems, however, far outweigh the positives. First are the quite optimistic forecasts, despite the higher taxes and government micromanagement that will harm the economy. The budget projects a much shallower recession and stronger recovery than private forecasters or the nonpartisan Congressional Budget Office are projecting. It implies a vast amount of additional spending and higher taxes, above and beyond even these record levels. For example, it calls for a down payment on universal health care, with the additional "resources" needed "TBD" (to be determined).

Mr. Obama has bravely said he will deal with the projected deficits in Medicare and Social Security. While reform of these programs is vital, the president has shown little interest in reining in the growth of real spending per beneficiary, and he has rejected increasing the retirement age. Instead, he's proposed additional taxes on earnings above the current payroll tax cap of $106,800 -- a bad policy that would raise marginal tax rates still further and barely dent the long-run deficit.

Increasing the top tax rates on earnings to 39.6% and on capital gains and dividends to 20% will reduce incentives for our most productive citizens and small businesses to work, save and invest -- with effective rates higher still because of restrictions on itemized deductions and raising the Social Security cap. As every economics student learns, high marginal rates distort economic decisions, the damage from which rises with the square of the rates (doubling the rates quadruples the harm). The president claims he is only hitting 2% of the population, but many more will at some point be in these brackets.

As for energy policy, the president's cap-and-trade plan for CO2 would ensnare a vast network of covered sources, opening up countless opportunities for political manipulation, bureaucracy, or worse. It would likely exacerbate volatility in energy prices, as permit prices soar in booms and collapse in busts. The European emissions trading system has been a dismal failure. A direct, transparent carbon tax would be far better.

Moreover, the president's energy proposals radically underestimate the time frame for bringing alternatives plausibly to scale. His own Energy Department estimates we will need a lot more oil and gas in the meantime, necessitating $11 trillion in capital investment to avoid permanently higher prices.

The president proposes a large defense drawdown to pay for exploding nondefense outlays -- similar to those of Presidents Carter and Clinton -- which were widely perceived by both Republicans and Democrats as having gone too far, leaving large holes in our military. We paid a high price for those mistakes and should not repeat them.

The president's proposed limitations on the value of itemized deductions for those in the top tax brackets would clobber itemized charitable contributions, half of which are by those at the top. This change effectively increases the cost to the donor by roughly 20% (to just over 72 cents from 60 cents per dollar donated). Estimates of the responsiveness of giving to after-tax prices range from a bit above to a little below proportionate, so reductions in giving will be large and permanent, even after the recession ends and the financial markets rebound.

A similar effect will exacerbate tax flight from states like California and New York, which rely on steeply progressive income taxes collecting a large fraction of revenue from a small fraction of their residents. This attack on decentralization permeates the budget -- e.g., killing the private fee-for-service Medicare option -- and will curtail the experimentation, innovation and competition that provide a road map to greater effectiveness.

The pervasive government subsidies and mandates -- in health, pharmaceuticals, energy and the like -- will do a poor job of picking winners and losers (ask the Japanese or Europeans) and will be difficult to unwind as recipients lobby for continuation and expansion. Expanding the scale and scope of government largess means that more and more of our best entrepreneurs, managers and workers will spend their time and talent chasing handouts subject to bureaucratic diktats, not the marketplace needs and wants of consumers.

Our competitors have lower corporate tax rates and tax only domestic earnings, yet the budget seeks to restrict deferral of taxes on overseas earnings, arguing it drives jobs overseas. But the academic research (most notably by Mihir Desai, C. Fritz Foley and James Hines Jr.) reveals the opposite: American firms' overseas investments strengthen their domestic operations and employee compensation.

New and expanded refundable tax credits would raise the fraction of taxpayers paying no income taxes to almost 50% from 38%. This is potentially the most pernicious feature of the president's budget, because it would cement a permanent voting majority with no stake in controlling the cost of general government.

From the poorly designed stimulus bill and vague new financial rescue plan, to the enormous expansion of government spending, taxes and debt somehow permanently strengthening economic growth, the assumptions underlying the president's economic program seem bereft of rigorous analysis and a careful reading of history.

Unfortunately, our history suggests new government programs, however noble the intent, more often wind up delivering less, more slowly, at far higher cost than projected, with potentially damaging unintended consequences. The most recent case, of course, was the government's meddling in the housing market to bring home ownership to low-income families, which became a prime cause of the current economic and financial disaster.

On the growth effects of a large expansion of government, the European social welfare states present a window on our potential future: standards of living permanently 30% lower than ours. Rounding off perceived rough edges of our economic system may well be called for, but a major, perhaps irreversible, step toward a European-style social welfare state with its concomitant long-run economic stagnation is not.

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Friday, March 06, 2009

Property tax evaluations

As a service to the loyal readers, I thought I would help clarify the property tax evaluation process.

This is especially important in this housing market crisis.

This is your house as seen by:

YOURSELF
YOUR BUYER

YOUR LENDER



YOUR APPRAISER





YOUR COUNTY TAX ASSESSOR......






I believe this is pretty self-explanatory!!


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Thursday, March 05, 2009

More From Dr. Orient

Below is another reprinted article by Dr. Orient giving a viewpoint of this horrible mindset we are currently trying to implement.

Stay Healthy: Government Healthcare May Be Coming

If they had been designing a health system from scratch, the change agents assuming power in January would have done things differently. Barack Obama and Ted Kennedy would have given us a Single Payer for medical care, as in Canada and Britain (and Cuba and North Korea) and (according to national healthcare promoters) "the rest of the industrialized world."

Senate Finance Committee Chairman Max Baucus (D-Mont.), on the other hand, doesn't feel he needs to go so far back in time, but he'd make similar changes nonetheless. In his Call to Action: Health Reform 2009, he speaks of failed efforts to enact "national health insurance" or "socialized medicine," starting around the turn of the last century, in 1900. It's finally time to just get it done, they say.

The motive behind their efforts, they also say, has to do with about 46 million uninsured Americans. But the politicians' plans are not just about insurance, which is only a method of payment for medical services. The real agenda is to use "coverage for all" as a lever to make fundamental changes in the way patients are treated — and in the economy and society as a whole. This is evident to anyone who listens carefully. Obama, Kennedy, and Baucus are talking about universal health reform, or what Baucus calls "serious and comprehensive reform of the health system in crisis."

This is also evident if one analyzes the "insurance" model they have in mind to follow — Massachusetts' healthcare plan, which boasts of achieving universal coverage, or almost, by forcing most people to buy insurance or face a tax penalty, or, if eligible, to enroll in a government-subsidized plan. "Progressives" like the plan for several reasons. In particular, young and healthy patients would be forced to pay more to subsidize older, sicker patients. (It plays off the Obama "wealth redistribution" idea.) Instead of pricing premiums according to risk, insurers would have to accept all comers, and charge them all the same. This changes the nature of the product from insurance, which is about the accurate pricing of risk, and turns it into a collectivized prepayment system. Welfare, in other words. Premiums become a type of privatized taxation — a neat way of sidestepping protests about tax increases.

What We're Promised

Obama has promised to allow people to keep the insurance plans they have if they like them. Their plans, however, might no longer exist because they might not measure up (likely won't measure up). The plans won't pass muster if they allow a person to benefit from good health and a prudent lifestyle, and not "contribute" enough to the collective pool. But if your plan can no longer be offered, don't worry; a proposed insurance exchange, like the Massachusetts Connector, would match people up with a "high-quality, affordable, comprehensive, nondiscriminatory Health Plan." Insurers may go along with the scheme in exchange for a guaranteed market: 46 million new customers overnight! And individuals would have to buy a product they might otherwise reject as being unnecessary or too expensive. Obama promised to delay forcing the plan on Americans until insurance becomes "affordable" — by the government's definition, not necessarily the customer's — but he may well accept the demands for mandates.

Obama and friends also promise that they will ensure that providers deliver quality care — better care than we have now. The reformers claim that at the present time the United States spends much more than other countries but still has worse health outcomes. They claim to know this because rankings made by the World Health Organization place U.S. medical care below most other developed countries — far below most socialist countries. In the WHO ranking, France has the best medical care, Italy came in 2nd, the United Kingdom was in the 18th spot, Saudi Arabia 26th, and Canada 30th. The United States came in 37th, just above Cuba (in 39th place). The politicians don't state (or don't know) that the WHO rankings are designed to place a much higher value on "equitable" access and less value on satisfying consumers' desires. In fact, if everyone in a country received poorer medical care than people in the United States, but care was "universal," it could rank higher than the United States. (See "Bad Economics & Medicine" in our January 5, 2009 issue for a more detailed explanation of the WHO rankings.)

And finally, we're also promised savings through nationwide investment in an electronic office management system for doctors' offices. A critical feature of reformed healthcare will be interoperable electronic health records. This "modernization" of the system is supposed to save tens of billions of dollars, at some point, after a hefty initial investment. But its main purpose is to monitor and enforce standards for quality, "medical necessity," reduction of "disparities," and proper billing and coding.

Wrong Diagnosis and Prognosis

The new blueprint will fail for the same reason that the system is already failing: it is really the same old blueprint that violates the basic laws of economics. When the apparent price of something, including medical care, goes down, as because of subsidies, demand goes up. If one is not charged for medical care based on one's level of health and one's number and length of visits to a doctor, one will be more inclined to visit the doctor more often. Collective prepayment drives demand even more, as people who are forced to pay for excessive insurance try to get their money's worth. This causes increased waits for medical appointments and spotlights the biggest problem. As in Canada, there are not enough physicians or facilities to meet the burgeoning demand for "free" services. To get into the "system," you need a primary care physician. In Massachusetts, the first available appointment may be a year away, if you can find a doctor in your area who is accepting new patients.

Exacerbating the shortage of doctors is the fact that when the price of something goes down, there is no incentive to increase the supply (lower payments mean fewer people become doctors). If the price doesn't cover costs and allow some profit, supply dries up completely. Under such a scenario, lines form at gas pumps; grocery shelves empty overnight; and doctors become scarce.

Doctors' Medicare fees have been restricted since the 1980s — and most managed-care arrangements are linked to Medicare. There still are some nice cars in the doctors' parking lot. Some specialist fees are still very high. Many physicians made out very well in earlier years. But contrary to the rhetoric from Rep. Pete Stark (D-Calif.) and other politicians, many physicians are already struggling to make ends meet. Especially in primary care. This is already reducing the number of people entering the medical field, and the planned new restrictions on medical care will make the situation worse. In the past decade, the number of U.S. medical graduates entering family medicine and internal medicine has fallen by half. And it's not just the money. Time pressures and increased demands for administrative work contribute to burnout: "I felt like I was becoming a guideline-following automaton and a documentation drone," said general internist Christine Sinsky, quoted in a November 27, 2008 article in the New England Journal of Medicine.

Incentives work, but letting patient demand set prices is not in the reformers' toolbox. They just want to redistribute the pain. As Baucus admits, his plan would revise Medicare's payment formula so as to redistribute resources from "high-growth, potentially overpaid aspects of health care to underutilized, potentially more valuable services, such as primary care and prevention." This means that "some specialists might take bit of a nick." It's part of a pattern: more healthcare, less sickness care.

And increased demand for "free" services means increased spending — unless rationing is instituted. Some cost data are available. In Massachusetts, the cost of "universal" care was immensely more than anticipated and annual state spending could top $1 billion by the end of this year, but then Massachusetts knew it was not addressing the cost issue. To try to avoid rationing care, one answer has been put forth: the group appointment, like those offered by Harvard Vantage Medical Associates (HVMA). Patients can get in to see a doctor much sooner if they are willing to share their appointment time with about eight other patients. They all sit in the same room for about 90 minutes while a doctor goes from patient to patient examining them. About 80 percent of patients say they are satisfied with the arrangement; some seem to value being in the same room with the doctor for 90 minutes, even if he is not attending to their individual needs during most of that time. The doctors like it too; they get paid for nine individual visits, instead of the four to six they would otherwise be able to wedge into 90 minutes.

A video of a group appointment, posted on the Boston Globe website, is a vision of the new system. Dozens of comments about the video and its accompanying article show the deep divide between those who favor the radical "change" and those who are appalled by it. As one person commented to the Boston Globe, "I think that as a nation we need to move away from rampant individualism toward a system that embraces shared responsibility in a community. You are more likely to follow those pesky lifestyle recommendations if you feel like you'll not only be letting down yourself and your doctor, but also your community."

"It's a third-world standard of care," wrote another disparagingly.

The group appointment is about the health of society, the collective. The patients in the Globe video all look pretty healthy. Examination of fully clothed people sitting up on folding chairs in a noisy room is not likely to reveal any signs of illness that are not flagrant. The main activity is not the doctor listening to hearts and lungs, but patients listening to the doctor's canned speech about smoking, diet, exercise, and taking all the prescribed drugs. This is not sickness care, which the reformers deplore and that doctors go to medical school to learn how to do. It is not about understanding the individual patient and his illness. It is not about making a complex diagnosis. It is not about personalizing and optimizing therapy in accordance with the patient's needs and priorities. The group visit is for standardized patients with a standardized diagnosis. It's about "education," peer group pressure, and compliance with a cookie-cutter protocol handed down by an expert committee.

It's what reformers mean when they aim to change our priorities to wellness and prevention. The sick are a burden; providing them too much attention could come to be seen as antisocial. "Universal care" might move the United States up in the WHO ranking system, which places a very high value on "equity," and a much lower one on individual patient satisfaction. It would stimulate certain areas of the economy: the provision of information technology to monitor wellness, the expansion of wellness clinics, and perhaps the birth of a whole new industry like the already existing one in Canada to manage ever-growing waiting lists for sickness care. But it wouldn't mean taking better care of people with health ailments.

Enduring Myths

In its entirety, the new plan not only flaunts basic economic principles, it defies observable evidence. Each major premise behind the plan's design is based on fallacious statistics or idealistic desires that show little likelihood of being obtainable.
Prevention:: The reformers imply that the sickness-care system will simply wither away when we are all healthy. Baucus enthusiastically quotes Robert Beaglehole, the World Health Organization's director of chronic diseases and health promotion, in claiming that an estimated 80 percent of heart disease, stroke, and type II diabetes, and 40 percent of cancers, could be prevented if Americans stopped smoking, adopted healthy diets, and became more physically active.

However, there has never been a real-life program anywhere that induced a population of previously smoking, sedentary, fat patients to reform and demonstrated such an enormous drop in disease. Leaving aside public-health engineering projects such as sanitation systems, preventive health measures, though valuable, usually do not save more than they cost. The British were long ago promised that once socialized medicine had met all the pent-up demands, and all the prevention programs were in place, costs would go down, and there would be much less sickness. More than 60 years later, people still get sick in the UK and wait years for treatment. The National Health Service never has enough money. And no one learns from the experience.

The uninsured: Then there's the promise that costs will go down if we can just insure everybody and thereby keep people out of expensive emergency rooms. In Massachusetts this hasn't worked because to get in to see the correct doctor to cure their ailments, patients first need to see a primary doctor, and they can't get an appointment. So newly insured patients still go to the emergency room for every medical need, including regular prescriptions.

The constantly repeated assertions about ER abuse, in any event, turned out to be wrong when subjected to scrutiny. An analysis published in the October 22/29, 2008 issue of JAMA (The Journal of the American Medical Association), which looked at 127 studies, showed that six commonly held beliefs about the uninsured and emergency room use were either unsupported by evidence, or equally true of both insured and uninsured patients. The uninsured were actually under-represented among patients using the ER for primary care — probably because they were concerned about the cost. And the claim that huge cost savings could be achieved merely by keeping more primary clinics open during off-hours — reducing ER visits — isn't true either. ERs do charge more - but the actual marginal cost per patient is likely to be no higher than that of keeping a primary-care clinic open after hours.

The uninsured have become scapegoats. Costs are so high, the argument goes, because "we all" are paying to take care of the selfish freeloaders who don't buy insurance. We pay through taxes (such as for Medicaid) and higher insurance premiums (because providers shift unpaid costs). That's true to an extent. Large amounts of cost-shifting happen when people abandon private insurance for Medicaid (public insurance). But those people who are truly uninsured (no private or public insurance) often do pay taxes (except for a substantial proportion of illegal aliens and those people deemed by the government to be "poor" — who usually shift to public insurance) but arguably not their fair share.

About 40 percent of people in the United States either pay no federal tax at all or they actually get money from the government as an Earned Income Tax Credit. Some of them use medical care (less care than insured people use), and some of them don't pay their bills. There is some cost shifting from people who don't pay for insurance to people who do, just as honest shoppers pay for shoplifters, but not much. The amount: 2.7 percent in 2004, according to the Kaiser Commission on Medicaid and the Uninsured. Of the uninsured with incomes at least twice the poverty level, 8 percent received some pro bono care during a year, and 50 percent received care for which they were charged. Of the latter, 80 percent paid in full, and another 10 percent were paying in installments, according to William Snyder in a November 21, 2008 article in the Wall Street Journal. The real problem with these folks, as reformers might view it, is not that they don't pay for what they use (they usually do), but that they don't help to pay for what other people use — except through taxes and the higher prices they are often charged.

Unmentioned by the reformers is the fact that government causes far more cost shifting than do the uninsured because of underpayment to doctors and hospitals by the price-controlled government systems, Medicare and Medicaid. Medicare and Medicaid often only pay cents on the dollar toward the actual cost of care given to patients, forcing many doctors to make this money back by charging more to patients who have private insurance — and to the uninsured who pay their own bills. This fact raises the obvious question of what health institutions would do if there were no private sector to shift costs to.

The Obama/Kennedy/Baucus solution to the "uninsured problem" appears to be this: for the uninsured who can't pay big bills, require them to sign up for Medicaid — or for a subsidized "private" prepayment mechanism — so we all pay for them constantly, and not just when they become sick. For the uninsured who can pay, force them to prepay — for care they might or might not use — through insurance premiums.

Information technology: The reformers' favorite panacea is health information technology. Obama promises to "make sure that every doctor's office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year."

The savings, however, are all hypothetical, long-term savings, and they are mostly destined for the insurance companies and government entities that are paying the bills. Converting a medical office to electronic records is extremely costly and disruptive. The cost in terms of diminished productivity continues for years, and is possibly permanent. Anything that slows patient flow is, of course, an advantage to payers (fewer patients, fewer payments). Arguably, electronic medical records introduce more new errors than they prevent — and errors may be impossible to expunge.

It may seem counterintuitive to say that improved technology will cause more medical errors, but it's true because computer program designs, the programming, or the inputting of data can all cause errors. The December 11 Sentinel Event Alert released by the Joint Commission on Healthcare (operating experience and lessons-learned information from the U.S. Joint Committee on Accreditation of Healthcare Organizations) includes statements such as: "Technology-related adverse events in health care can involve, but are not limited to, computerized provider order entry (CPOE), automated dispensing cabinets (ADCs), electronic medical records (EMRs), clinical decision support (CDS), bar coding or RFID (radio frequency identification), virus threats to information security, CT (computed axial tomography) scanning technology, and the loss of patient data." Patient privacy, of course, is inevitably sacrificed. The real effect of electronic records is to enable intrusive monitoring of every aspect of the patient-physician interaction.

We have much more experience with computer disasters than successes in medicine. Rollout of the £12 billion flagship centralized Cerner IT system of the British National Health Service was halted because it was "hugely expensive," "desperately behind schedule," and a "shambles from the start." Suppliers were "deserting in droves." Frontline professionals were "voting with their feet." Before investing billions, why not learn from experience — preferably other people's experience.

Medical errors: Medicine would be both cheaper and better, of course, if doctors always did the right thing for their patients, both in the way of treating them and in giving illness-prevention advice. Toward this end, the reformers plan to save money by making doctors follow strict guidelines for care. But "proven" disease-management systems exist only if we accept authoritative opinion in lieu of actual evidence.

In a system that permits research and innovation, opinion changes about every five years concerning best practices to care for patients. By following government guidelines, we can be sure that patients will be given outdated care regimens. Even a simple government direction, such as making sure a certain test is done, and recording the results, can prove problematic. If we measure certain processes, like obtaining recommended tests, we may show an increase in the number of patients getting those, but even such a seemingly innocuous mandate would change the allocation of resources and affect some medical function that is not being tested. On the items that we don't measure, such as the activities from which effort is shifted to meet the new goals, we won't know the effect, because we won't measure it. Perversely, unimportant things are generally much easier to measure than important things.

What Should Be Done?

Reformers claim that whatever the cost of implementing the new plan, it can't be higher than the cost of not doing anything. Baucus warns that "we" will soon be spending $4 trillion on healthcare if we don't do something. The answer to those who say we can't afford to do it? We can't afford not to!

Progressives always have a plan and, when they are told their plan won't work, demand that opponents have a plan that's better and more inclusive than the progressive plan. So this is the plan: as Hippocrates would say, "First, do no harm." Not jumping off a cliff is always a good first step, whether that cliff be real or metaphoric, as in government control of medical care. Recognize that health reformers like Obama, Kennedy, and Baucus are not just making empty promises. They can indeed deliver universal "health coverage." But it will be at the expense of sickness care. We've all heard of the military's excuse that they had to destroy the village in order to save it. The Obama/Kennedy/Baucus ploy is to pretend to save the system in order to wreck it, to put additional money and power into the hands of politicians. (Those politicians who are for the new plan, but who don't see it for the ploy it is, really need to brush up on their research skills or get into another line of work.)

Second, realize that America needs to undo much of what the government has already done - to go back to the free market. A free-market solution is never one, universal solution. It is the sum of millions of individual decisions. Allowed freedom, individual decision makers would unleash creative destruction on much of the current system. To allow a solution that is likely to exceed all expectations, and to reduce costs dramatically, it is only necessary to remove the barriers. Some suggestions, for starters:

Stop all tax discrimination against individually owned sickness insurance. The present system gives tax breaks to companies that provide insurance to employees, but workers who pay for their own insurance get no such deduction. This causes insurance companies to be unresponsive to providing inexpensive insurance for individuals, and it means insurance is tied to a job instead of being portable between jobs.

• Allow individuals to purchase sickness insurance across state borders, to avoid costly mandates by states. State governments create lists of services that insurance companies must cover, including non-illness-related things such as in vitro fertilization. The Washington Times wrote: "A health policy for a single Pennsylvanian costs roughly $1,500 annually. Cross the Delaware into New Jersey ... and a similar health plan costs about $4,000, thanks to state regulations."

• Expand health savings accounts by removing regulatory barriers so that Americans can pay for medical bills with before-tax money.

• End Medicare price controls. Allow patients and physicians to contract for mutually agreeable fees. Medicare can compute its reimbursement by any mechanism it chooses, but that should not determine the fee. This would also have the effect of drastically reducing physician overhead by removing the costs required primarily to justify Medicare's price-controlled, coded fee.

• Repeal the McCarran-Ferguson exemption that permits insurance companies to engage in behavior prohibited to other industries by antitrust law. (Insurance companies can form giant conglomerates that fix prices and make it impossible for competitors to enter the marketplace.)

Much more could be added. But the one-sentence answer is to put patients back in control of their medical dollars and their medical decisions. In a free-market system, prices would be much lower, and patients would have much broader choices. If they had more money in their own pockets - having given less to their insurer - more people would opt for less expensive, less toxic, possibly more effective treatments that insurers have historically refused to cover. Self-insurance for all but the most catastrophic expenses would be very common. There will always be a role for charity and social safety-net programs, but the neediest will be better served by programs targeted to their needs rather than demolishing the ship and giving everyone no choice but to cling to the wreckage.

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Wednesday, March 04, 2009

Another Perspective on HealthCare

As we begin listening to the main stream about Obama's health plan and his changes, here is a well written and well thought out article written by Jane M. Orient, M.D

The article can be found here: Foundation for Economic Education » Healing America: The Free Market Instead of Government Health Care »

Healing America: The Free Market Instead of Government Health Care

The following is abridged from a speech delivered at “Evenings at FEE” in July 2006.

Our society has been bedazzled by a host of seductive and erroneous ideas about American medical care: we can change human nature, and this time we can do it right; we can find the fountain of youth; we can eat from the Tree of Life; and we can surely fly into the Sun with our paraffin wings.

Unfortunately medicine is very well adapted to fuel all of these dangerous illusions. It is a two-trillion-dollar pot of gold, one seventh of the American economy. It is certainly a great magnet and motivation for all types of people. It attracts people because of fear and greed, and it attracts people because of their better instincts. It is also the third-rail of politics. Once people are given some sort of entitlement to medicine, it can never be taken away. Let us not blame the free market for that; there has been no free market in medicine for at least 60 years, thanks to the public-private partnership, the federal tax code, and all types of government intrusions and incentives.

Medicine is a great place for practicing Sutton’s Law. When asked why he robbed banks, the famous bank robber Willie Sutton replied, “Well, because that’s where the money is.” But the money is not in taking care of sick people. The money is in what we now call health care. Money comes from things like data mining—from selling information to pharmaceutical companies so that they can monitor doctors to make sure they are prescribing enough drugs.

The real money, of course, is in so-called insurance. Insurance is supposed to be a voluntary means of sharing risks and paying a premium based upon an estimate of an individual’s risk. For example, when you buy life insurance, it does not actually protect your life. In fact, it may become a danger to your life, depending on who the beneficiary is. Who are the beneficiaries of your health insurance? To a large extent, hospitals.

So health insurance is not really insurance but a health plan, a way of prepaying for medical care. Customers pay the premiums; insurance companies collect all those premiums and make huge money through investing the float. They also make a great deal of money from doing the administrative paperwork, often just by processing the claims to give the patient back his $2.50 worth of reimbursement. The more money flows through their hands, the more of it sticks to their fingers. This is why insurance companies are so upset about the idea of individual health savings accounts: they want all that money in their accounts, not in yours.

Nevertheless, health-insurance companies can be credited with the greatest marketing success in history. They have managed to transform something that people generally begrudge—insurance—into the “Holy Grail” that everybody thinks he must have. Somehow they were able to convince all of us that having health insurance automatically guarantees access to care when we are sick or injured.

But the very people who are marketing the idea of “universal coverage” want us “covered” so they can control medical care. This way they do not have to spend all that money on sick people who are too big a liability and do not fit into their central plan. Sick people are kind of a “disaster”: they cannot go to work, treatment takes up all their money, and they cannot really pay for their care. Clearly insurers do not make money from paying sick people’s bills; they make money from collecting the premiums in advance from healthy ones.

In other words, medicine cannot be a big source of profit if people only use it when they have a problem. The solution? Find a steady source of income from people who are not sick, but healthy, promise to take care of their health, and turn what used to be called medicine into “health care.”

Coercion versus Choice

Proponents of universal health care keep a big “secret” that I want to share with you: your health care is up to you. It is your individual responsibility, and you probably learned everything you need to know about it from your grandmother. You should eat your vegetables and get your exercise, you should not smoke or drink to excess, you should not run around. In reality your health is determined by your genetic endowment, by your behavior, by the choices you make, and, to a large extent, just by pure luck.

Yet we are constantly being told that we ought to have a better health-care system. After all aren’t we the only industrialized country without universal health care? We Americans need to be made healthier. We need more and more guaranteed preventative services like mental-health screening and treatment for high cholesterol and hypertension.

At the same time the standards that make one eligible for all those treatments are getting lower and lower, as more and more new, expensive drugs become available. A lot of these protocols may possibly decrease one’s risk of certain types of mortality by half a percent. But the cost is very high in both money and potential side effects, which are not very well researched, cannot possibly be known, and may determine long-term outcomes.

Nevertheless, the insurance companies want to make sure that you will buy all of these products, allegedly to improve your health. It makes you very dependent: the more expensive drugs and services you have to buy, the more important it becomes for you to have health insurance. In other words, all of these products and services react in a synergistic way: they are very expensive, and you need more and more of them, so you need more and more health coverage. If you do not have health insurance, you are in bigger and bigger trouble because you cannot afford to buy all of these health solutions.

That is the reason why the universal health-care movement, which is really the universal get-you-covered-by-insurance movement, continues to gain momentum. Those on the left insist that health care is a shared social responsibility and demand legislation which will guarantee life-long, affordable health-care coverage for all Americans.

Many people have chosen not to buy coverage, either because it is expensive and they don’t think they need it—or because they think it is a rip-off and plan to pay their own bills when they get sick. Today the tide has turned against them. They are branded as free riders who don’t pay their bills, and thus must be forced to buy health insurance. Sadly, Massachusetts has just passed a bill mandating everybody to buy health coverage.

Socialism Through the Back Door

Besides being a scam as far as health is concerned, universal health care is a great way of implementing one of socialism’s main objectives through the back door: equalization of incomes through redistribution of wealth. Let us not forget that Lenin called medicine the “keystone in the arch of socialism.” In Canada, for example, socialized medicine is a reality of everyday life. Everybody has to have insurance. It is universal, it is mandatory, and it is affordable. People with low incomes may pay as little as $300 a year through their taxes whether they like it or not.

Those in the upper-income category may pay as much as $22,000 for the same low-quality insurance policy. Canada’s upside-down-and-backward universal health care makes sure that anybody can go to the doctor because of a sniffle ithout paying the bill. On the other hand those who are really sick are “guaranteed” to be circling around the emergency room or piled up on gurneys in the corridor, and they are forced to pay for such care on the basis of income. It is the ultimate sliding scale.

Can you think of any other product that you have to pay for according to your income? When you buy a car, does the dealer look at your tax return and say, “Well, this car is going to be ten times as much for you as it is for me”? It’s a great way to redistribute the wealth.

Vernon L. Smith, a Nobel laureate who has spoken here at FEE, explains the way we buy health care in a recent Wall Street Journal article: A is the customer, B is the service provider. B tells A what service he should buy. Then a third party pays for it from a common pool of funds. This problem has no economic solution. We have simply disconnected supply from demand by taking the price to be paid directly by the customer out of the equation. Thus we have absolutely no control over the cost of this system. No wonder the cost keeps going up and up and up. Medicare is a perfect example.

Every time the government passes a law to make health insurance more affordable, the expenditures rise and so do the premiums. As a result, the number of uninsured people goes up as well. The only way we can get people to buy such an overpriced product is to use force. Having disconnected the free-market mechanism, the government now must control the supply side by rationing health-related products and services. Of course the word rationing is never used; instead, medical services are rationalized.

Under this “non-rationing” rationalized system, we are going to make sure that we get the right care to the right person in the right setting at the right time. The government promises to eliminate disparities so no one gets better treatment than another.

Quality or Equality?

The medical central planners are determined to make us all equal, insisting that it is not right that a rich person can get better treatment than a homeless one. In practice this means cutting off the outliers from both ends of the bell-shaped curve. On one end, you should not be at liberty to spend your hard-earned wealth to improve the quality of your own medical care. On the other end, if you are poor and become a liability—if you live too long or are disabled and the system has to take care of you—well, don’t get your hopes up. In other words, cut off the rich so they don’t have more than anybody else, and cut off the poor.

This can in no way improve the quality of medical care unless quality is redefined to mean compliance with the rules. Compliance with what the government allows you to have, which, of course, will be influenced by a political process. We already practice this in Medicare. A doctor is not allowed to give charity to a Medicare patient. One could even go to jail for it. In spite of all this the word compassion is constantly used in an attempt to sell universal medical care, under which compassion is simply not going to be allowed. What total and utter hypocrisy!

But people are in denial. They are bedazzled by all kinds of illusions and false promises that keep their eyes off what the man behind the curtain is doing. Americans believe that we can all have good health and we can all be taken care of by the compassionate state.

There is a sense of urgency in all these political plans to bring about universal health care. We’ve already begun to see the effects in the older age groups. Through Social Security taxes a large younger generation, the baby-boomers, supported very generously the less-numerous older generation. The government has taken the excess, spent it, and stuffed the Medicare trust fund with IOUs.

Do you know what is in that famous “lock box”? It is full of IOUs, which the younger generation is going to pay off one of these days to support the aging babyboomers. In fact, people of my age (I am at the leading edge of the baby-boomers) are the real troublemakers here because they will cause the day of reckoning.

Ignoring Ethics

Medical ethics is being turned upside down and backwards. When you go to the hospital, even for some minor outpatient procedure, you will be asked to sign an advance directive or possibly grant permission not to resuscitate you in case of some disaster. For example, I once admitted to the hospital an older patient of mine with a minor problem. I expected her to do well and reassured her that she would go home in a couple of days. I had completed my examination when somebody asked her to sign a paper giving us permission not to restart her heart if it stops. Why was my patient being terrorized? I had just finished trying to reassure her.

When I was an intern at Parkland Memorial Hospital in Dallas, I expected people who were admitted with a little bit of heart failure or a mild stroke to get better fairly soon. These days, such patients may suddenly go downhill and die. I think they are administered large dosages of sedatives or painkillers they do not really need. They cannot take a deep breath, they cannot cough, they cannot get out of bed, they get blood clots, and finally they just die.

We got ourselves into our current dilemma by trying to repeal the laws of economics, and now we are trying to cope with it by repealing the laws of ethics. We must not ignore the fact that all of this rhetoric about the “universal right to health care” has very serious implications. Being covered by health insurance by no means guarantees you medical care. On the contrary, the more medicine is socialized, the less medical care you can count on receiving. If you have the right to all the health care that society determines you are entitled to but cannot afford to provide, that means that you have no right to live.

Medical care is no longer a free-market enterprise. It is used to cover up for making political promises that we should have known a long time ago cannot be kept. Until we are willing to face the truth of what we have done, the consequences are going to be disastrous.

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