Volume 65, No. 12 December 2009
THE POWER OF THE MINORITY
Radical "healthcare reform" is not being rammed through
Congress by demand of the majority of Americans. On the contrary,
a Pew survey shows that a strong plurality (47%) actually opposes
the legislation, while only 38% support it.
Does it matter? How does radical change happen?
In the wake of the Fort Hood massacre of American troops by
a Muslim officer, the experts and talking heads again assure us
that the vast majority of Muslims just want to live in peace. But
as Paul E. Marek wrote in 2006, "It is the fanatics who march."
His conclusion was not restricted to Islam: "The hard,
quantifiable fact is that the peaceful majority, the 'silent
majority,' is cowed and extraneous."
Marek, whose grandparents fled Czechoslovakia just before
the Nazi takeover, recalled a conversation he had with a man
whose family once owned large estates and factories in Germany.
"Very few people were true Nazis, but many enjoyed the return of
German pride, and many more were too busy to care. I...just
thought the Nazis were a bunch of fools. So, the majority just
sat back and let it all happen. Then, before we knew it, they
owned us, and we had lost control.... My family lost everything.
I ended up in a concentration camp, and the Allies destroyed my
History features repeated episodes of mass slaughter,
despite the peaceful majorities in China, Japan, Rwanda, and
elsewhere who did not speak up, and awoke one day to find their
world had ended. Whether cowed by terror, swept up by a herd
mentality, or simply acting on the basest human impulses, the
majority generally collaborates with the fanatics, once they are
entrenched in power, or even participates zealously in once-
Marek's article is now widely distributed by internet and
often attributed to psychiatrist Emanuel Tanay, a Holocaust
survivor from Poland, who sent it to a few friends.
Radical Power Grab
Dictators don't always come to power through a violent coup
d'etat, and often derive legitimacy through a ballot box or
parliamentary vote albeit a loaded one. The machinery of
oppression can be assembled gradually, behind a facade of
democracy. The most important warning sign is the penalties.
A feature of the Clinton plan that was considered so
outrageous as to be unbelievable in 1993 was the criminalization
of medicine. I lugged around a highlighted copy to speeches, and
reporters videotaped the provisions. These were later enacted, by
a Republican Congress, in the Health Insurance Portability and
Accountability Act (HIPAA).
The draconian civil monetary penalties of $10,000 per
miscoded item, and even prison time and hundreds of millions of
dollars devoted to investigations have not eliminated "waste,
fraud, and abuse." This is still the mother lode of new money to
finance the new system. Penalties are increased to $50,000 per
"false statement." And crimes of omission are added as for
failing to submit information. Most alarming are prison terms of
up to 5 years length based on income for not having government-
approved health insurance.
Shomari Stone of KOMO 4 News in Seattle pressed Speaker
Pelosi on whether she felt it was fair to imprison someone for
being uninsured. She side-stepped the direct question about jail
four times, and asked whether it was fair for a person to refuse
insurance and say that "if I get sick, I'll go to the ER and send
the bill to you." In other words, it is fair to punish someone
for not buying a very expensive product laden with mandates
because he might use an emergency service and might
not pay for it. (See http://blog.heritage.org or
Who Are the Extremists?
Winners control the semantics and the microphones, write the
scripts, and wear suits to sit around tables. The
dissidents members of the once-silent majority stand in the
streets and are called "extremists," or even "terrorists." The
most vulgar and demeaning terms are for those who dare to refer
to historical examples of totalitarianism.
With only 5 days' notice, some 25,000 Americans came to
Capitol Hill at their own expense for a "house call," at the
invitation of Rep. Michele Bachmann (R-MN). The Democratic
National Committee (DNC) issued a statement about their "extreme
right-wing, rigid ideological agenda." Their "pathologic" views
include opposition to mandates, tax increases, bureaucratic
intrusions, funding of abortions and illegal aliens, and
increased government dependency and support of freedom.
Just under 50% of House members sided with the people, so
the House bill squeaked by, 220-215. MoveOn.org pledged $3.5
million to fund primary challenges to any Democrats who side with
Republicans to "doom health care reform." It also urges Senate
Democrats to strip any Democrats of their committee chairmanships
if they support a filibuster of the bill.
Tight security protected the AMA House of Delegates from
interlopers at its interim meeting in Houston, as physicians held
a "shout-out" nearby (www.takebackmedicine.com). Democrats cite the position of the AMA as proof that their
version of reform is supported by physicians. The House defeated
by about 270 to 150 a motion to rescind the Board of Trustees
endorsement (now called "support") and adopted a "say-nothing,
do-nothing, excuse-me-for-living" resolution instead, writes
Mississippi delegate Kenn Beeman, M.D.
If the takeover of American medicine, the culmination of a
50-year effort, is to be stopped, it will require a dedicated
pro-freedom minority to stand up for the disenfranchised majority
of our patients. If not AAPS, then who?
Medicine Leads the Way to Socialism
In 1962, Robert Welch gave a talk before the Los Angeles
County Medical Association (LACMA), reciting the chronology of
the effort to force coercive government control of medicine on
Americans. If physicians did not prevent it, the sovietization of
American medicine would not only destroy the finest illness care
in history, but would complete the total collectivization of
America. Here are a few snippets from the 33 1/3 rpm recording of
One of the great struggles in human history is between
individualism and collectivism. "[T]he actual and practical
result of the drive towards collectivism...is...always tyranny."
"Bismarck's compulsory health insurance not only implemented
a whole new concept of the function of government, but...made
inevitable a mushrooming of both the power and the extensiveness
of this bureaucracy...."
Even if all other facets of the economy are mostly
collectivized, except medicine, total control is not achieved,
because a few diehard individualists are left. But once medicine
becomes a "right," the keystone of socialism is set.
Patients and doctors must remove our tacit support of
socialism while there is still time. We must not
cooperate, we must not participate, we must not be
excerpted from a 16-page essay by
Curtis Caine, M.D., Jackson, MS, Mar 24, 1994
[Download talk from http://www.jbs.org/action/downloads/ member-downloads/33-medicineleadstheway/download. Transcript available from
AAPS on request.]
The AMA is "more a monopoly in crisis than a professional
association," writes John R. Graham (NRO 11/6/09). The
bulk of its revenue as much as $118 million of $282 million comes
from CPT (current procedural terminology) codes. When developed
in 1966, CPT codes were only one of many competing systems,
points out Linda Gorman. In 1983, the government agreed to not to
use any other coding system. It is so important that companies
issue a press release when a code is awarded to a new device, and
the award can move the price of the company's stock.
Dues revenue, trending downward since 2004, was $45 million
in 2008, less than 16% of the total and only 2.25 times the $20
million received from the Robert Wood Johnson Foundation to
manage a nationwide effort to ban smoking.
AMA advocacy reflects ideology as well as funding. CEO
Michael Maves personally contributed $1,000 to candidate Obama in
March 2008, when his nomination was in doubt.
"In 2008," Gorman writes, "the AMA's devotion to pushing for
more government control of patient lives took the form of
spending $15.6 million for its 'Voice of the Uninsured' media
campaign...[that] promotes...laws requiring individuals to buy
health insurance or 'face tax implications.'"
Analyzing the AMA's annual report, Kurt Miceli, M.D.,
observes an unfunded liability of $56.6 million for postretire-
ment health care benefits. The AMA, like other large businesses,
may hope that the government will assume this obligation. Miceli
also notes that it costs about $1,600 per attending physician
member to run the AMA. Governance the board of trustees and
officer services and the house of delegates and professional
relations units costs $12 million.
Who's Who of Czars
Expediting the concentration of power in the executive
branch is Obama's appointment of more than 30 "czars," many with
no congressional input. One list is at http://www.rense.com/general88/czars.htm. Resumes are short on technical
expertise, long on activism: anti-business, anti-gun, anti-free
speech, pro-radical environmentalism, pro-UN, pro-healthcare
Top Claims Denier Is Medicare
According to the AMA 2008 National Health Insurance Report
Card, between March 2007 and March 2008 Medicare denied 475,566
claims (6.85%). A denial is defined as: allowed amount = billed
charge, and payment is $0. This denial rate exceeds that of all
top seven commercial health insurers, and is double their
average, notes Beverly Gossage of HSA Benefits Consulting. UHC
had the lowest rate, 2.68%.
Cost Shifting and Social Cost
Pelosi evidently thinks it is a crime to risk shifting costs
to others by refusing insurance. To fix this "free riding" a
"trivial" (2%) problem, writes John Goodman, would require
policing the insurance of 100% of Americans (illegal immigrants
are exempt from the mandate). The real uncompensated care prob-
lem from underpayment by Medicare and Medicaid is 500% greater.
Under reform, the cost shift would increase to $191 billion in
2020-2029, according to the Lewin Group.
The government is powerless to reduce the true social cost
of delivering care. It can only shift it around, as by imposing
more of it on physicians and hospitals which results in greater
demand and less supply. This then imposes the social costs of
delayed or denied care on patients.
Subsidized insurance shifts costs from less productive to
more productive workers. Current reform plans would make
subsidies available to a population greater than that of Russia
(140 million) or most other nations. Dave Racer notes that the
official federal poverty level (FPL) for a family of four is
$21,910. About 32% of the U.S. population is at <200% FPL; 49%,
<300% FPL; 63%, <400% FPL; and 73%, <500% FPL.
Plans either add billions in costs or shift payment from
medical professionals to "community" and "diversity" programs
with vague standards of accountability, and to training workers
to inform Medicare beneficiaries with limited English proficiency
of their "right" to have an interpreter at all times at no cost
(Betsy McCaughey, Wall St J 11/7/09).
Feb 5, 2010. Thrive Not Just Survive workshop, Houston,
Feb 6, 2010. Board of Directors meeting, Houston, TX
Sep 15-18, 2010. 67th annual meeting, Salt Lake City,
New "Ethical" Obligations
The reformed health care delivery system may be globalized,
according to the vision of Robert H. Brook, M.D., Sc.D., of RAND
and UCLA (JAMA 2009;302:1465-1466). This could shift
jobs, as for providing elective surgery, outside the U.S. There
would be a radical disruption in outcome measures: "Will
professional associations commit to being responsible for both
cost and quality on a population basis and will board
certification depend on performance in both dimensions?"
Beyond that, he would ask how changes in health policy
affect the planet: "The planet earth is no longer a stable
environment, and its future...depends on how well it is treated."
For example, would making a health care a 24-hour business
protect the planet? What about the carbon footprint of new
technologies? Should new facilities be located in "energy
friendly" places? And how will increasing life expectancy affect
the ability to reduce carbon dioxide emissions?
Hippocrates is apparently dead and forgotten.
A New Ponzi Scheme
Even as Bernard Madoff is imprisoned for a $50 billion scam,
Congress is on the verge of enacting a scheme that is 180 times
larger. If the new health care entitlement were subject to the
same 75-year actuarial standards as Social Security or Medicare,
its unfunded liabilities would exceed $9.2 trillion on top of the
cumulative $51 trillion unfunded liability of those two programs.
According to analysis by minority staff of the House Ways and
Means Committee, the deficit from the House bill would reach $760
billion by 2024, and $1.6 trillion by the end of the 2020s. These
figures assume that current estimates, unlike those of the past,
are accurate rather than wildly optimistic (Michael Cannon, Cato
Policy Analysis 9/9/09).
Armageddon in Enforcement
"There will be a sea change in enforcement," warns former
HHS Inspector General Richard Kusserow. "We all know that
Armageddon is coming in health care. The government's hope is
that each RAC [Recovery Audit Contractor] recovers $1 billion a
year" (Med Practice Compliance Alert 10/5/09). RACs will
soon be able to conduct complex review for coding errors in 50
There is audit insurance, but it is geared toward covering
the overhead costs of the appeals process, which can quickly
outstrip the amount of overpayment. If your claim is perfect, you
need to appeal; refunding the "overpayment" will invite the RAC
and the carrier to come after you again and again, warns attorney
Ann Marie Gaitan. If you bring in an attorney from the beginning,
legal fees could exceed $250,000 (ibid.).
Three of four RACs will be focusing on physicians. Even
during the demonstration project, $20 million of the amount
recouped came from physicians' pockets (ibid.).
The House reform bill contains "breathtaking new authority"
for fraud investigations. Note that failure to refund a known
overpayment becomes a "reverse false claim." In an effort to
prevent fraud up-front, the bill calls for all Medicare payments
to be made by electronic funds transfer (EFT). These are easier
to track and "provide authorities with another tool to recover
any potential losses" (BNA's HCFR 11/4/09).
The "public option" will also operate under the Medicare
fraud-and-abuse regime (ibid.).
The Precedent for Forced Insurance
Forcing people to buy any private product or service is
immoral, writes Donald Levit. However, we do have a system in
which people are forced to buy insurance Medicare.
In the view of the Federal Accounting Standards Advisory B-
oard (FASAB), "social insurance programs comprise two separate
nonexchange transactions the compulsory payment of taxes, and the
government's payment of benefits." This means, Levit explains,
that "taxes are compulsory, but benefits are discretionary, and
they are two separate transactions." (See www.fasab.gov/pdffiles/socialins_exposurefinal.pdf, p 31.)
The "Alternate View" holds that "benefits beyond the due and
payable amounts are not present obligations of the Government and
should not be recorded as current expenses or current
liabilities." Moreover, "given the ability of the Federal
Government to change the laws relating to social insurance
programs and the unsustainability of current benefit payments
with current financing, about which beneficiaries are on notice,
amounts are uncertain and not reliably estimable" [emphasis
added] (ibid.). Does this spell Social Security/Medicare default?
Three Felonies a Day
In the above title of his new book, civil liberties attorney
Harvey Silverglate estimates the number of crimes the average
American commits because of vague laws. Since the New Deal,
Congress has delegated increasing authority to write regulations
and also demonstrates "a growing dysfunction in crafting
legislation that can in fact be understood." Today, "prosecutors
identify defendants to go after instead of finding a law that was
broken and figuring out who did it," writes L. Gordon Crovitz
(Wall St J 9/28/09). "The concept of intent has
Tip of the Month: When a visitor is in a bad
neighborhood late at night, and senses danger, he gets out as
soon as he can. A bad hospital on the verge of initiating a sham
peer review against you may be more dangerous. If you sense
danger at a hospital, ask to see your personnel file. If it is
much bigger than you expect, and contains lies about you, then
consider getting out (resigning your privileges) as soon as you
can. But beware: if an actual investigation has already been
initiated against you, even in secret, a resignation will trigger
an adverse entry against you in the National Practitioner Data
Bank. That's why it is important to get out early, or not go to a
bad hospital in the first place.
Stimulus Bill Hikes HIPAA Penalties
The American Recovery and Reinvestment Act (ARRA) increased
the maximum individual penalty for civil violations of the
privacy and security provisions of HIPAA from $100 to $25,000,
and the penalty cap from $25,000 to $1.5 million for total
violations of the same provision. ARRA also removes the provision
that bars civil penalties if the covered entity could demonstrate
that it did not know it had violated the rules. To escape fines
for an unknown violation, the entity now has to correct it within
30 days of discovery (HITS 11/2/09).
"Never have so few trampled on so many free souls, and
apparently, so far at least, without consequences."
Ron Ewart, Canada Free Press 11/8/09
on the House "nationalizing American Health Care bill"
Making a Deal. When Congress resorts to secret meetings
to conduct the public's business, you know bad things are on the
way. Obama, Reid, Baucus, Dodd, and Rahm Emanuel have been
meeting in secret to resurrect the "public option." Although they
are supposed to be merging two Senate bills, they will probably
draft something even more socialistic. Moderate Democrats are
being told that the "public option" is voluntary, and states can
opt out. However, once all private options are destroyed, only
the "public option" will be left.
Meanwhile, the Obama takeover of the banking industry
continues, as the "pay czar" dictates what banks can pay their
top management. Evans Bancorp CEO David Nasca said, "I don't
believe government should dictate pay practices." Yet government
has been doing it to physicians since 1965.
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY
Keep Them Busy. I got strafed by AMA President Rohack,
along with another ankle biter, for suggesting that the AMA might
be representing something other than physicians (www. john-goodman-blog.com
10/21/09). It makes me a reactionary bourgeoisie or something. If
they have to keep busy writing boilerplate replies about the
AMA's "democratic assembly," maybe they'll take a break from
joining hands with the government to wreck all of our lives.
Linda Gorman, Ph.D., Independence Institute, Golden,
Traitors. As Greg Scandlen noted, the Washington-based
trade and professional associations, and even Wal-Mart, have cast
their lot exclusively with the most far-left elements in America:
the Service Employees International Union (SEIU), Families USA,
and the Obama Administration. They remind me of the supporters of
the Vichy puppet government in France, who decided to "go along
to get along" with the occupation.
Frank Timmins, Dallas, TX
Paying the Price. Through its lobbyist Billy Tauzin,
PhRMA made a deal to pay $150 million for ObamaCare promotion.
The Democrats reneged and now want $500 billion instead of $80
billion in price concessions; PhRMA still pays the $150M.
L. Robert McMurray, M.D., Lansing, MI
Universal Stealing. Stuck in a Boston hotel without
access to Fox News, I listened to OpEd. Lambasting HSAs,
the host said it is completely unreasonable to expect people to
pay their own bills the average family income being $50,000/y so
we have to rely on other guys to pay our bills. Of course,
everybody living at the expense of everybody else does not work.
Alieta Eck, M.D., Somerset, NJ
You Will Pay. High medical costs are the
result of 70 years of third-party interference to the extent that
government and employers are now the "consumers." Based on
government figures, everything over a deductible of twice the
average family medical spending could be covered by a premium of
only $210/mon. Since only 12% of families would exceed that
amount, 88% would be closely monitoring costs and quality. Prices
would come down with competition.
The question is how will we pay: with inexpensive
insurance for disasters, or with escalating taxes and rationing?
Sherwood Kaip, M.D., El Paso, TX
Yes, You Can. Most people can pay their doctor
bills just as they pay their TV cable bills at least if they pay
the real bill (the "approved charges," or what the
insurance company pays), and not the fake bill. What do they
spend on car payments, or medical insurance? Medicare
supplemental may cost $5,000/y, and Part B $1,000 $2,000. People
now recognize that [much] medical insurance is a scam facilitated
No bureaucracy could achieve cost savings better than
doctors. We need to stop government control and red tape and to
end insurance payments directly to doctors. This
wouldn't solve the problem of vulgar, greedy hospital charges but
would be a giant step to stop socialism.
Remember the history. Germany introduced Social Security and
compulsory medical insurance in 1883. In 1933, after Hitler
became chancellor, 45% of doctors and most university professors
joined the Nazi party. Hitler exterminated or sterilized large
numbers of nonproductive Germans, with the assistance of doctors,
before starting on the Jews.
Richard B. Swint, M.D., Paris, TX
War Against the Strong. Just like in Roman times,
contemporary politicians representing the ruling oligarchy have
found it is easy to gain popular support by dispensing bread
("free healthcare") and circuses (spectacular persecution of
successful doctors, scientists, and businessmen). Ironically,
Rome was conquered by "barbaric" Germanic tribes that were both
weaker and stronger than Senatus Populusque Romanus.
People may cope with their own inferiority complex by
focusing hatred on those perceived to be better.
Walter Borg, M.D.
"Choice." To say that any government plan
gives more choices ignores the vast destruction of
options that has already occurred; one's choice is limited to
what is left. Under current proposals, physicians'
choices would be to obey the protocols, risk sanctions, or leave
the profession. We must decline to participate; we must withhold
the sanction of the victim.
Maria Martins, M.D., Los Banos, CA