Volume 66, No. 1 January 2010

HIDE THE DECLINE

ClimateGate hit as 1,200 stretch limousines were converging on Copenhagen, some from hundreds of miles away, to accommodate world dignitaries arriving by private jet. Their mission: to save the Planet through a global carbon budget, with global wealth redistribution to achieve social justice and "climate equity." Their justification: complex computer models predicting Apocalytic global warming.

Their game plan resembles the one for radical "healthcare reform" written by Robert Creamer while serving time in prison for bank fraud: generate a crisis fueled by emotion. "This will require an ongoing highly integrated earned-media messaging program" that converts opinion into stipulated fact (Joel Pollak, www.biggovernment.com 12/7/09).

The slogan for what may be the greatest scientific fraud in history "hide the decline" comes from a recently exposed email from Phil Jones, former CRU (Climate Research Unit) chief. The method: "Mike's (Michael Mann's) Nature Trick."

That decline is unrelated to temperatures since 1998. The trick was to graft recent instrumental data onto a set of proxy data from 1000 A.D. to 1980 A.D. that wipes out both the Medieval Warm Period and the Little Ice Age. Proxy data after 1980 was scrapped, explains Marc Sheppard, because it showed a continuing decline, casting doubt on the whole series which was needed to send inconvenient climate history down the memory hole (American Thinker 12/6/09).

The "hockey stick" pattern of unprecedented recent rapid warming is an artifact that can be generated by cherry-picked data from Siberian pine YAD061, the "most influential tree in the world," or by Mike's computer model, which generates such a pattern when fed random data (Telegraph 12/5/09).

Trillions of dollars are to be spent on this basis.

Copenhagen and Washington

On the global and national level, proposed crisis-driven radical changes, which centralize and greatly expand governmental power, would have the effect of establishing a new mandarin class. Computer technology, with the potential to be as liberating as the alphabet and the printing press, could be used as a tool of intrusive monitoring and oppressive control of masses dependent on government for energy and medical care. Computers can complicate, mystify, and obstruct, as well as simplify, elucidate, or expedite.

Similar tactics are being used on climate, energy, health, and other issues: (1) Appoint Peers and sanctify their work in the mainstream media and elite publications such as Science, Nature, JAMA, and the New England Journal of Medicine. (2) Marginalize, discredit, gag, or even demonize dissenters. (3) Hide the computer code and inconvenient facts.

In Copenhagen, Lord Christopher Monckton, former adviser to Margaret Thatcher, plans to present his case against the UN IPCC's climate models to Russians, but not to Western Europeans. The Russian parliament still makes laws; 90% of the laws governing the European Union are made by unelected, non-removable commissars in Brussels.

By transferring its power to the executive branch as to the Environmental Protection Agency (EPA) for energy rationing Congress is moving the U.S. toward an EU model of government. Proposed health reform would create at least 111 new bureaucracies and delegate hundreds of decisions to the Secretary of Health and Human Services. Even if it fails, there's a backup: the MedPAC Reform of 2009, which would transfer Medicare guideline and rule-setting processes from Congress to the White House and executive agencies, writes SusanAnne Hiller (www.biggovernment.com 12/8/09).

Hiding the Bust

Sen. Reid has proposed expanding Medicare to 55-64 year- olds, despite the program's unfunded liabilities. Single-payer advocates brush off Medicare's insolvency possibly thinking that it is just crying wolf. Social Security, after all, has been bankrupt twice, and it just took a little tweaking and tax increase to fix it. That was before the demographic tsunami.

According to the Congressional Budget office (CBO), 2009 Social Security outgo is expected to be $670 billion. Revenues from FICA are projected to be $653 billion. Total income of $801 billion, Gary North points out, includes $21 billion from taxes on benefits, $14 billion from federal employee share, and $120 billion from interest on the off-budget IOUs in the "trust fund." By 2010, Social Security will be a net drain on the Treasury, and Medicare is even more "seriously challenging."

Debt service for the on-budget national debt was $202 billion this year, at rock-bottom interest rates, and could exceed $700 billion/year by 2019 (see AAPS Mythbuster 27).

While alarmists fret about hypothetical global warming to re-emerge in a few years, the real disaster that is truly "in the pipeline" is the hyperinflation to which Federal Reserve policy has committed us, writes John Williams. Though the Treasury has delayed releasing the 2009 GAAP-based financial statements until February, by which time health reform is supposed to have been passed, he estimates a GAAP-based annual deficit of $9 trillion. Foreigners hold more than $10 trillion of liquid, dollar- denominated assets that could be dumped into the market at will (see www.shadowstats.com).

Cold Reality

Some business accounting software, Williams writes, can handle any number of digits. No software, however, can generate electricity, fuel trucks, feed people, make drugs, or perform surgery. Exchanging paper or digital entries for real goods and services will work only until it doesn't.


Other Declines

World trade: The collapse of 15% YoY is less than in the Great Depression, but much steeper (www.zerohedge.com).

Stock values: Over the past 10 years, the Dow Jones Industrial Average has dropped 5-fold in terms of pounds of copper, platinum, silver, or gold per Dow unit. Dow-oil has dropped 7-fold, and Dow-wheat 3-fold (Access to Energy 11/09).

Confidence in the dollar: The difference in yields between Treasury bonds and Treasury Inflation Protected Securities (TIPS spreads) has exploded. The 10-year TIPS spread has increased from 4 basis points in November 2008 to 222 basis points, indicating that inflation fears are 55-fold higher (Martin Weiss, Safe Money Report, December 2009).

Support for ObamaCare. After the Reid compromise, support for ObamaCare dropped below 39%, with more than 51% opposed. At this point in the Clinton presidency, 47% backed HillaryCare, and 32% opposed it (Wall St J 12/11/09).

Tax revenues. The decline in state tax revenues is the steepest in 46 years: compared to 2008, the decline was 10.7% in nominal terms, or 11.3% when adjusted for inflation (NYT- ).

Education. Productivity of public schools has plummeted 71% in 40 years, as measured by test scores in relation to public per-pupil spending (Craig Cantoni).

 

Will Doctors Quit?

In September, Investors Business Daily reported that 45% of physicians responding to a mail-in poll would consider "leaving their practice or taking an early retirement" if the Democrats' proposal passed (IBD 9/15/09). Are they cryng wolf? A White House spokesman said, "Congress has implemented even larger savings in Medicare in the past, and no access problems materialized" (Wash Post 12/12/09).

Mayo Clinic lost $840 million treating Medicare patients last year, stated Jeffrey Korsmo. The Reid proposal for 55-64 year-olds to "buy into" Medicare and its price controls would "push the best...hospitals and physicians closer to the brink of financial ruin" (WSJ 12/10/09). The Mayo Family Medicine Clinic in Glendale, AZ, has notified patients that it will no longer be a Medicare provider as of Jan 1. Total annual costs for patients who continue there will be around $1,500; they will not be able to transfer to another Mayo facility.

Patients are opting out also. More than 750,000 Americans went offshore in 2008 for elective surgery, a number expected to grow to 6 million by 2010 (Reuters 7/30/08).

 

Mississippi State Medical Assn Quits AMA

In October, "an energized, invigorated MSMA House of Delegates engaged in discourse addressing...autonomy, self- determination, and the right, if not the occasional obligation, to express dissent," writes Kenn Beeman, M.D., of Tupelo. MSMA has de-unified, and non-AMA members may join.

Dr. Beeman attributes the action to the "imperial presumption and imperious action of a virtually unaccountable AMA leadership and its collaboration with majority party leadership in the Congress and White House." The AMA Board of Trustees rushed to exercise its "executive privilege" to endorse H.R. 3962 just two days before the interim meeting of the House of Delegates convened, thus preempting its membership. To the AMA, Dr. Beeman, "conciliation" means "acquiescence" or "capitulation" by the rank and file.

 

500,000 Doctors Oppose "Reform," McCain Says

Sen. John McCain entered into the Congressional Record, Senate S12857, a statement that more than 40 state, county, and national medical societies, including AAPS, representing more than half a million physicians, have stated their public opposition to H.R. 3590, the Patient Protection and Affordable Care Act. Also signing were three former AMA presidents, Donald Palmisano, Daniel Johnson Jr., and William Plested III.

 

Hiding the Quality Decline

The Mammogram Recommendation Guidelines by the U.S. Preventive Task Force perhaps show best how our society has been hiding the decline in quality in the name of alleged cost savings, writes Scot Silverstein, M.D. The method of meta- analysis assumes that studies were unbiased. Yet there are numerous cases of manipulation of clinical research and suppression of inconvenient results.

As with global warming, when I see "computer modeling" in medicine, I recall that Richard Feynmann called it a "disease," and that Michael Crichton called the arrogance of the model makers breath-taking. The output of such black boxes is seriously affected by slight changes in the variables and the weights and algorithms employed inside the box. Applying them to complex systems in medicine is at best informed speculation. (See hcrenewal.blogspot.com.)

 

The NICE Model

The British National Institute of Clinical Excellence (NICE) was designed in 1998 to "ensure that every treatment... used is the proven best. It will root out under-performing doctors and useless treatments, spreading best practices everywhere." In practice, it is a rationing board (WSJ 7/8/09).

NICE is the world leader in comparative effectiveness research, on which the U.S. has made a "down payment" of $1 billion (Ann Intern Med 2009;151:203-211). NICE synthesizes evidence and builds models that assign hard values to the quality and cost of an additional month of life. Assumptions include the possibility of separating time and health, and are influenced by many social, economic, and political factors. There was a huge backlash when NICE refused to approve any drugs for advanced renal cell carcinoma. When it modified its guidelines for these patients, there was concern that it would make it harder to draw the line in the future (Nature 2009;461: 315-316, 336-339). A global budget for Medicare would probably be enforced by a NICE method (WSJ 11/16/09).

 

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

Sep 28-Oct 1, 2011. 68th annual meeting, Atlanta, GA


Winners, Losers, and Frauds

While users of fuel ("polluters") and providers of medical services can expect to be squeezed with taxes and price controls, or prosecuted for ever growing numbers of regulatory crimes, there are fortunes to be made.

The UK's richest resident, Lakshmi Mittal, CEO of the steel giant ArcelorMittal, could make nearly 1 billion between now and 2012 from participation in the EU's carbon trading scheme (www.dailypaul.com 12/10/09). Al Gore could become the world's first carbon billionaire, profiteering from government policies he supports that will direct billions to "green" enterprises he has invested in. Like Sen. Mary Landrieu (D-LA), who got $300 million for her state in return for voting for cloture on the Senate health reform proposal (Wash Post 11/22/09), Gore is proud of himself (Telegraph 11/3/09).

According to the European law enforcement agency Europol, carbon trading fraudsters may account for up to 90% of all market activity in some European countries, endangering the credibility of the entire scheme (Telegraph 12/10/09).

The Mafia and violent criminals are turning to Medicare fraud, as scammers can net up to $25,000 a day. A cocaine dealer could take weeks to net that amount, and faces much higher risks (Kelli Kennedy, AP 10/6/09).

 

84% of CMS Management Controls Deficient

Based on a random sample of 2008 contract actions by the Centers for Medicare and Medicaid Services, the Government Accountability Office (GAO) found that at least 84.3% had involved failure to implement at least one key control. In more than 37%, at least three lapses were found. Of nine 2007 GAO recommendations to improve internal controls over contracting and payments to contractors, only two were substantially addressed. One key defect is lack of quality control over data entry procedures. Faulty CMS contracting puts billions of taxpayer dollars at risk (GAO-10-60).

 

CMS Reports 7.8% Error Rate in FFS Payments

The error rate in making fee-for-service payments doubled since 2008, said White House budget chief Peter Orszag, largely because of changed counting methods. Items such as an illegible signature on the claim, or insufficient documentation, are now likely to be called errors. The administration is planning to impose penalties for failure to return payments made in error (Modern Healthcare 11/17/09).

 

Consultation Codes Deleted

In the 2010 CMS Physician Fee Schedule, outpatient or inpatient consultations, codes 99241-99245 and 99251-99255, will no longer be paid. Physicians who have billed for consults need to learn the finer points of evaluation and management (E/M) visit codes for Medicare patients (MPCA 11/16/09).

 

More Rules, Stiffer Penalties

HIPAA. For violations going back to Feb 18, 2009, even an "innocent" violation could cost you up to $1.5 million. Comments are open on the interim rule implementing the HITECH Act until Dec 29. Read the rule and submit comments at http://tinyurl.com/HIPAA- Penalty.

Unclaimed funds. States are beginning to target physicians under escheat laws that require businesses to turn over unclaimed credits, paychecks, or other property to the state after a certain dormancy period. Some states require an annual report even if you don't have property to hand over, with interest, penalties, and fines for failure to report. Keep complete records of attempts to return unclaimed funds, and get written confirmation from any person who receives them. Information is available from the National Association of Unclaimed Property Administrators (MPCA 11/30/09).

Cybercrime. In a national survey of small and medium businesses, 44% report having been the victim of hackers, viruses, or spyware. Medical practices are attractive targets, and have greater legal liability, from both state breach notification laws and HIPAA. "Smaller [providers] are hopelessly exposed," warns Cliff Baker of Health Information Trust Alliance. A small hospital had to close its cardiovascular unit and divert patients when attacked by a computer worm. Note that one infected provider can spread the problem to any others who access information (MPCA 11/30/09).

Required fraud and abuse course. CMS now requires all participating and nonparticipating physicians, licensed medical personnel, and billing staff to complete an 85-minute module annually. Go to http://www.cms.gov/MLNGenInfo/, scroll down "Related Links Inside CMS," click on "WBT Modules" and then on "Medicare Fraud and Abuse April 2007."

 

Doctor Pays $400,000 to Settle Tricare Case

The only gastroenterologist at Fort Huachuca, AZ, settled allegations of less than $100,000 in overpayments. Fines could have amounted to tens of millions of dollars. In a 2007 Tricare audit, the physician was not informed of any billing errors.

"This case is a warning...that even the best and most ethical physicians face potential financial ruin for unintentional and unknown errors," said Dan Cavett, attorney to Dr. Jaya Maddur. The system involves "complex and confusing codes that could fill a phone book" (Ariz Daily Star 11/23/09).

 

Swine-flu Bribe Fever

World Health Organization (WHO) scientists are accused of accepting secret bribes from vaccine manufacturers to influence the H1N1 pandemic declaration. Many countries are required to purchase vaccine in the event of a pandemic. Many WHO advisers have financial ties with pharmaceutical companies, which are not publicly disclosed (WND 12/7/09).

 

Challenging Bad Science

The Competitive Enterprise Institute (CEI) is filing suit to block the EPA finding that greenhouse gas emissions endanger public health and must therefore be regulated under the Clean Air Act. CEI states that EPA has ignored major scientific issues, including those raised in the Climategate fraud scandal.

AAPS general counsel Andrew Schlafly notes that the Mar 9, 2009, White House memorandum ordering "scientific integrity" in the federal government "gives a solid basis to file a complaint every time the bureaucrats or their grantees lie, cheat, or steal in connection with the use or abuse of research for the purpose of developing...policy."


Correspondence

Junk Science Has Consequences. It has been revealed that certain prominent climate scientists sought to hide data that did not fit their theory of man-made catastrophic global warming. Still, the junk science is being used by the Obama Administration to bypass Congress and impose ruinous restrictions on Americans. The Environmental Protection Agency's (EPA) "health threat" announcement came just before Obama is scheduled to address the Copenhagen conference on climate change. Junk science is the key ingredient in what could be an economic bomb of epic proportions. What better way to destroy America than to harm an already struggling economy? Believe it or not, some people are working to save the planet by reducing the number of cow burps.
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY

 

Junk Economics. When General Motors was bleeding cash and wanted to offload its health benefits commitments, it floated the bogus number that it paid more to provide health care than to make cars. It fit the media template perfectly, and all sorts of outlets ran with it. Several problems: (1) They conveniently left out the profits of GMAC, then the most profitable part of the company. (2) You could make a similar statement about other things such as "we spend more on taxes than on steel." (3) Unions bargained for ridiculous benefits; heavily unionized companies spend much more on health benefits than others do.
Linda Gorman, Ph.D., Independence Institute, Golden, CO

 

Coming to America? Samizdat was the clandestine copying and distribution of government-suppressed literature in Soviet- bloc countries. Copies were made a few at a time, and those who received copies were expected to make more, as by handwriting or typing. People caught possessing or copying such materials were harshly punished.
William K. Summers, M.D., Albuquerque, NM

 

The New M.D. Successful implementation of a universal electronic health record will require a new breed of doctor for the brave new world of medicine. The current generation of physicians are not suited for the new Age of Enlightenment. They neither need nor want something that disrupts their thought processes, fill charts with clots of irrelevant verbiage, and impedes their normal work flow. The new model M.D.s, however, will need an EHR to guide their decisions and monitor their practice; they will be trained as functionaries to serve the system. Independent thinkers who remain will be purged. We are seeing the vanguard of the new M.D.s, many of whom express anxiety about functioning without an EHR.
R. Wayne Porter, M.D., Terrell, TX

 

Still Using Paper. Admittedly, I don't have the ability to quickly determine what percentage of my patients are being prescribed Zoloft, or how many patients missed their appointments this week. But these are administrative tasks, and they are questions that I rarely want answers for. I'm still quite happy using blank sheets of white paper for my patient notes. It's cheap, easy, and works when the power fails.
Stuart Gitlow, M.D., M.P.H., M.B.A., New York, NY

 

Hospital EHR Systems. I spent 45 minutes trying unsuccessfully to enter orders. The system asked irrelevant questions, such as who was my maid of honor! The "computer expert" finally arrived, and he couldn't figure it out either. At another hospital, I asked for a lower extremity angiogram, but somebody entered the order inappropriately for a vertebral angiogram! Fortunately, an alert radiologist saved the patient from the wrong test. These computers are expensive, time- consuming, and dangerous. They should be discarded promptly.
Kenneth Christman, M.D., Dayton, OH

 

Obstacles to Care. To act, you have to know a new system, with cryptic headings and little icons. What if firemen couldn't run to a fire without facing a bank of computers, keying in when the alarm sounded, what they were doing at the time, what kind of fire it is supposed to be, etc., while the fire rages on! Doctors are like Gulliver, tied down with thousands of tiny ropes by Lilliputians. It's a national epidemic of obsessive-compulsive disorder. Congress ought to have to use Cerner!
Tamzin A. Rosenwasser, M.D., Lafayette, IN

 

It's War. We are being distracted by minute details in the healthcare reform bills, and that is part of the artillery being used against us. We are in the midst of an intense culture war that our Constitution was formulated to prevent. The reform effort is a sweeping attempt for one culture to dominate morally, politically, and economically.
Janice Michaud, Manhattan Beach, CA

 

The Real Agenda. The congressional battles are not about healthcare reform or "saving the planet" with cap and trade. Instead it is really about changing the American culture from one of basic independence to one of dependence, with the politically elite in charge in a kingly way. "Healthcare" is a tool to trick the Great Unwashed into neutering themselves.
Frank Timmins, Dallas, TX

 

P4P = Penalize for Practice. We should perhaps call the Secretary "Her Royal Majesty." One of her vast new powers is to decide on "differential payments" for cost and quality.
David McKalip, M.D., St. Petersburg, FL