Volume 65, No. 12 December 2009


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 factories."

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- unthinkable atrocities.

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 www.youtube.com.")

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 his talk:

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 particeps criminis.

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 rationing.


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).


AAPS Calendar

Feb 5, 2010. Thrive Not Just Survive workshop, Houston, TX

Feb 6, 2010. Board of Directors meeting, Houston, TX

Sep 15-18, 2010. 67th annual meeting, Salt Lake City, UT.

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 states.

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 disappeared."


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, CO


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 by politicians.

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