AAPS News November 2016 – It’s the Culture

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Volume 72, no. 11 November 2016

A nation’s culture is defined as a unique set of beliefs formed and transmitted through behavior from generation to generation: “historically validated right behavior,” writes John Harmon McElroy (America’s Culture: Its Origins & Enemies, 2016).

American culture developed in an exceptional way. Unlike Spain, Portugal, and France, England imposed no test of religion or nationality to settle its colonies in the New World. Americans were self-selected for ambition to get ahead by their own efforts.

That all men were equal under the law, and meant to be self-governing, rather than being ruled by an aristocracy, was a foundational belief, as was the belief in individual rights that came from “Nature, and Nature’s God.” While not necessarily pious, most Americans shared Benjamin Franklin’s “Creed”: that there is “one God, Creator of the Universe. That he governs it by his Providence…. That the most acceptable Service we render him is doing good to his other Children….” (ibid.).

McElroy writes that it takes at least four generations to create a lasting culture. But it can be destroyed much more quickly.

The Transformation of Austria

A woman who grew up in Vienna told me that when German soldiers marched in, they put flowers in the barrel of their rifles.

Many Austrians welcomed the Anschluss. There was hunger and unemployment after the disaster of World War I. Businesses were declaring bankruptcy daily. (“It’s the economy, Stupid”?)

Kitty Werthmann, who lived through the Hitler years, writes that there were soon plenty of jobs in public works projects. There were “equal rights” for women—mothers had to work, often at jobs generally done by men. Those who did not could not get ration cards, without which they could not get food. Children over the age of 4 weeks were totally cared for in government centers by people trained in child psychology.

In Catholic Austria, crucifixes were immediately removed from schools, and prayer was banned. Instead, children sang “Deutschland Deutschland über Alles.” [The melody by Franz Joseph Haydn, originally the setting for “Austria” (“Gott erhalte Franz den Kaiser”) is now used for John Newton’s hymn “Glorious Things of Thee Are Spoken.”] Morals became very loose, and unwed mothers were glorified for having babies for Hitler.

Medical care, once excellent, was socialized—and became scarce. College tuition was subsidized. Businesses closed because of expensive “safety” regulations—replacing square tables with round ones, adding more bathrooms. Mentally retarded but productive workers were taken to “schools,” where they soon died of “natural causes.” Guns had to be registered, to help catch criminals—then “voluntarily” turned in, to protect toddlers. Rights were eroded gradually. It took 5 years to establish a full dictatorship—and by then our only weapons were broomsticks, Werthmann writes (http://tinyurl.com/nqa6v2v).

The Cultural Revolution in China

Mao Zedong’s Communist China, along with sending millions to “reeducation” camps, deployed the Red Guards to attack the “Four Olds” of Chinese society (old customs, old culture, old habits, and old ideas). They ransacked museums, destroyed books and art, and beat “bad people” to death. Nien Cheng describes life in the Cultural Revolution in her 1986 book Life and Death in Shanghai (reviewed at http://tinyurl.com/zgff3wo). Despite the enormous losses (the number of casualties is a state secret), American medical elites applauded Mao’s noble premises (“to serve the people”), methods (“team effort” and “prevention first”), and purported improvements in population health (ibid.).

American Counter-Culture (“Political Correctness”)

Ominous parallels—to borrow the title of Leonard Peikoff’s 1983 book—are seen in the U.S. today. Agitators paid by radical organizations incite violence at Trump political rallies, and arson and looting in inner cities after a police shooting. Dissenters to the established “Science” (as on “climate change”) are marginalized or even threatened with prosecution. Items of religious significance, including the Ten Commandments, are removed from schools and public spaces. Democrat Presidential candidate Hillary Clinton has said that churches will just have to change their beliefs if they conflict with government policy on “social” issues such as abortion and same-sex weddings.

Massive waves of immigrants, in addition to the illegal ones, are being brought in as “refugees,” government-selected for anti-Christian, anti-American culture. The very name of the government-preferred religion for migrants means submission, and it teaches that all are not created equal. Women are inferior, and non-Muslims have no rights, not even to life. Such waves would be difficult to assimilate, but a worse problem is the alienation of American-born youth from their own culture. The mostly nonviolent cultural transformation is far advanced (AAPS News 12/11).

Atheist Robert Tracinski, an admirer of Ayn Rand, has become a “reluctant culture warrior” (The Federalist 12/23/14, http://tinyurl.com/mgqj22f). This time it’s “first they came for the Christians.” In 2014 we were served notice that “we will not be allowed to think differently…. The new orthodoxy is total.”

The new, mandated ideology rejects the value of the individual,” writes John Dale Dunn, M.D., J.D. “It advocates the new high holy church of statist socialist secularism.”

Sunshine on the Ruling Class

With so many institutions already owned by the Left, the resistance is finding its voice in alternative media.

Wikileaks, in the release of the Podesta emails, is exposing the existence of an American Nomenklatura (literally, list of names), with deep incestuous links between the media, the Democrat Party leadership, and even the Dept. of Justice, writes Roger L. Simon, co-founder of PJ Media (http://tinyurl.com/hgekuo2).

Tens of thousands of emails related to the Clinton campaign have been released. One spreadsheet of the most important releases organized by topic is here: http://tinyurl.com/heo7xja.

Wikileaks editor-in-chief Julian Assange, once a darling of the Left, has been holed up in the Ecuadoran embassy in London for years to avoid extradition. The Guardian has compiled articles about him dating back to 2010 (http://tinyurl.com/zcgje2a). When the embassy cut his internet access because he was accused of “interfering with the U.S. election,” rumors of his death circulated, but “contingency plans were activated,” and releases continued (on Twitter, search #PodestaEmails). Hillary Clinton “does not recall” having said “Can’t we just drone this guy?”, but if she did say it, it would have been meant as a joke, she claims.

Coverage by the mainstream media has been sparse. While some emails are claimed to have been “doctored,” the Clinton campaign has not released any originals (http://tinyurl.com/jntqf65).

It is possible to verify the authenticity of many though not all because of the digital signature automatically applied by most email systems. One method is said to be with the Thunderbird email app with the DKIM Verifier add-on. Tyler Durden is offering a bounty to anyone who can prove him wrong about this(http://tinyurl.com/hrs6uvg).

The Daily Caller News Foundation claims to have verified the authenticity of one-fourth of 23,000 emails from John Podesta released by Wikileaks, and provides a list of messages undeniably proved to be authentic. Real messages can fail to verify for many reasons, most commonly that the server changed its keys since the message was sent (http://tinyurl.com/hyg9rg5).

Hidden beneath the sheer volume is evidence of pervasive corruption and attempts to keep the real Clinton agenda secret, writes Robert Eno (http://tinyurl.com/zrdwuap).

Before Wikileaks started its daily data releases, a hacker calling himself Guccifer 2.0 released a huge archive of files allegedly found on the Democratic National Committee server with information on the Clinton Foundation and “pay for play” for U.S. State Dept. favors (http://tinyurl.com/httcdal). The best-selling book Clinton Cash by Peter Schweizer and freely available documentary film (http://tinyurl.com/hlbuewm) also document the massive corruption in this charitable front organization. Podesta, however, claims there is “zero evidence.”

The Veritas Project of James O’Keefe has released a series of undercover videos concerning attempts to rig the election through incitement of violence and mass voter fraud (search http://www.YouTube.com on “Veritas.”)

The age of lust is giving birth, and both the parents ask/
the nurse to tell them fairy tales on both sides of the glass./
And now the infant with his cord is hauled in like a kite,/
and one eye filled with blueprints, one eye filled with night.

Leonard Cohen, Stories of the Street, 1967
(“Leonard Cohen against the Sexual Anarchists,”
http://tinyurl.com/hx7e65a)

Guccifer 2.0: Don’t Blame the Hackers

“Speaking” through a surrogate at a London cybersecurity conference, Guccifer 2.0 made many points applicable to electronic medical records. He acknowledged that hackers are causing lots of trouble for businessmen and politicians. But what is the real threat? (http://tinyurl.com/zozg9y5)

“Large IT companies pose a real cyber threat…. But their responsibility for the future of our world is growing [daily]….

“First. On their way to…big money they are collecting users’ personal data, which is the same as spying on people…. Companies store these data making it vulnerable for leaks.

“Second. They create conditions that make people store their info in cloud services. It seems convenient but it’s extremely vulnerable because it’s thousand times easier to steal the data from the cloud than from a personal cell phone for instance.

“[Third]… is software vulnerability. Tech companies hurry to finish the work and earn money. So they break development cycle very often omitting the stage of testing. As a result, clients have raw products installed…with a great number of bugs and holes.

“Fourth…. [A]ll large companies look forward to receiving governmental contracts. They develop governmental websites, communication systems, electronic voting systems, and so on and have their products installed to critical infrastructure objects….”

He concludes that IT companies pose a threat to critical infrastructure and national security, through total computerization and inadequate software. “That’s why it’s better to use paper sometimes. We should start now to prevent electronic apocalypse and rise of the machines in the future…. As the financial corporations are ruling the world now so the IT companies will rule it in the near future.”

AMA Declares Victory on MACRA Rule

AMA president Andrew Gurman, M.D., stated that AMA’s initial review of the Final Rule (http://tinyurl.com/zap9xaj) on the Medicare Access and CHIP Reauthorization Act (MACRA) showed that CMS Acting Administrator Andy Slavitt was true to his promise to listen to physicians. “I would like to thank him for being a sincere partner during the process,” writes Gurman (http://tinyurl.com/jm562ar). Gurman urges physicians to get ready for this “monumental change to the practice of medicine.”

AMA takes credit for a more flexible transition period and for increasing the reporting threshold from less than $10,000 and fewer than 100 Medicare patients in a year to less than $30,000 or fewer than 100 Medicare patients. [That is less than $600 in Medicare receipts or fewer than two patients per week.] Gurman wants us all to be “set up to succeed under this new program”—although it is by its nature a zero-sum game.

AAPS Calendar

Jan 27, 2017. Thrive Not Just Survive XXV, Orlando, FL.
Jan 28, 2017. Board of Directors & FL chapter, Orlando, FL.
Oct 5-7, 2017. 74th annual meeting, Tucson, AZ

“End of Life Option”—Adventist Opts Out

After considering a patients’ petition (AAPS News, June 2016), “Adventist Health has chosen not to participate under the ‘death with dignity’ legislation [End of Life Option Act] in California, or in any of the other states in which the health system has operations. This means that “no Adventist Health employees, independent contractors, or other persons or entities may participate in activities under any death with dignity law while on the premises of an Adventist Health facility, or while acting within the scope of any employment or contractual relationship with Adventist Health. If a patient requests assistance under a death with dignity law, a referral may be provided (http://tinyurl.com/hco9hft).

The Cheapest Option

One week after the California law passed, a woman with a terminal form of scleroderma received a letter from her insurer informing her that it would deny payment for a chemotherapy drug it had initially indicated it would approve. But the company told her that the drugs to kill herself would only cost her $1.20.

“As soon as this law was passed—and you see it everywhere when these laws are passed—patients fighting for a longer life end up getting denied treatment,” the patient said. And while her support group meetings for terminally ill patients were formerly positive and encouraging, after the right-to-die movement began garnering national attention, there was a change in tone, with the specter of suicide hanging above them like a dark cloud.

A similar law is pending before the District of Columbia Council (http://tinyurl.com/z4qley7).

A “Catholic Spring”?

In a communication to John Podesta released by Wikileaks, Sandy Newman, president of Voices for Progress, writes: “There needs to be a Catholic Spring, in which Catholics themselves demand the end of a middle ages dictatorship and the beginning of a little democracy and respect for gender equality in the Catholic church.” Podesta responds that “we created Catholics in Alliance for the Common Good to organize for a moment like this…. Like most Spring movements, I think this one will have to be bottom up.” In another email, former Clinton staffer Neera Tanden writes about how contraceptive coverage is a “wedge issue,” a “political cudgel.” Hillary Clinton replied: “Can you believe we are still fighting this battle?” Catholics should have “given up” by now. Precedents include the Arab Spring, and the two state-sanctioned “Catholic” and “Protestant” churches in China.

Tip of the Month: A solo physician, previously denied payment via delays and subterfuge and subjected to meaningless audits by an insurer, has received a demand for all prior payment records of patients, some seen for decades. Doctors need to realize that if you sign a contract and take the insurer’s money you are probably authorizing it to harass you indefinitely. It may demand a refund for something paid years earlier. Insurers generally do not have the authority to conduct audits on out-of-network physicians or demand money back that was paid to patients. Doctors may want to look at their contracts, or have an attorney look at them, to see when the next opportunity to drop the insurer will occur.

AAPS Sues California on “Surprise Billing” Law

California recently passed, with only one dissenting vote, a bill that will likely be imitated in other states, AB72. It caps out-of-network physicians’ fees for services provided to patients enrolled in a health plan. It effectively lets private insurance companies set prices for their competitors. By law, plans won’t be able to drop allowable fees below 125% of Medicare, but it is unlikely that doctors will be able to charge any more than that.

“In order to stop the rare (<<1%) event when the patient receives a surprise bill in an emergent situation, the government destroys patients’ options in the >99% of cases when there is no surprise bill from a chosen out-of-network physician,” writes Gerard Gianoli, M.D. “AB72 gives insurers the leverage to force doctors to go in network or out of business.”
“In typical government fashion, instead of demanding price transparency, California has preserved a system where charges are still hidden from patients for months,” he added.
AAPS filed suit in federal district court in the Eastern District of California, AAPS vs. Brown, No. 2:16-cv-02441 (http://tinyurl.com/hblgnv4), arguing that AB72 violates both federal and California state constitutions. It delegates authority to private entities to set rates for physicians with whom they have no contract. It deprives physicians of just compensation for their work and of full due-process rights in court. Their only recourse is costly arbitration, where insurers almost always prevail. The bill will have a disparate impact on minority communities as physicians can no longer afford to provide charity services.

Aside from AAPS, the only groups to oppose the law were the American Society of Plastic Surgeons, the American College of Surgeons, and the Calif. chapter of the American College of Cardiology. The California Medical Association (CMA) chastised members who spoke out against the bill—and who sent email to AAPS, other CMA members, specialty societies, and legislators, using “officers” titles from a CMA forum, without CMA authorization. “We cannot have these CMA internal bodies publicly contradicting official policies of CMA,” thus damaging its credibility.

 

AAPS Objects to CDC Power Grab

AAPS filed comments on the Centers for Disease Control and Prevention (CDC) proposed rulemaking on quarantine and communicable diseases, Docket No. CDC-2016-0068, RIN 0920-AA63, objecting to the following provisions:

  • 72-hour or more apprehension. The vaguely worded rule appears to grant a new power to detain and isolate individuals for 72 hours or even longer without the authority of a court order.
  • Draconian penalties. The penalty for violating a quarantine is increased to $100,000 for a harmless violation to $500,000 for a violation that causes death, 100 times to 500 times the current statutory penalty of $1,000 or a year in jail or both.
  • Vast expansion of electronic monitoring. Temporary public health supervision of an individual may include electronic mail, SMS texts, video conference or webcam technologies, integrated voice-response systems, entry of information into a web-based forum, wearable tracking technologies, and other mechanisms.
  • Coercive treatment. While styled as an “agreement,” there is an implication that treatments including vaccinations could be imposed without the genuine consent of the patient.

 

Correspondence

China’s Big Data Will Rate Everyone. Communist China is developing a government-run database that will assign every citizen a single score that measures “trustworthiness,” i.e. loyalty to the Communist Party agenda. The principle is that “if trust is broken in one place, restrictions are imposed everywhere.” The ambition is to collect every scrap of information available online. The plan is to build a culture of “sincerity” and a “harmonious socialist society” (http://tinyurl.com/jhd679k).

In the U.S., we already have a rating system for physicians, whereby government assigns a “composite score” under the Merit-based Incentive Payment System (MIPS). In essence, it is a compliance score. One of Hillary Clinton’s allies, Ezekiel Emanuel, is coauthor of a scheme for assigning citizens a number that will determine the likelihood that each will receive medical care: the Complete Lives System (Lancet 1/31/09). This is very similar to the scheme being pursued by Chinese Communists.
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY

MACRA Reprieve. The first year every one of the 696,000 Medicare participants will get a small reward if they just report 3 of 100 quality measures. No financial loss the first year—then the squeeze. It reminds one of the rancher putting the hay in the field and getting the cows around it so he can build a fence around them. When the hay is gone, they go to slaughter.
Ray Page, D.O., Ph.D. Fort Worth, TX

MACRA Response. I have been assigned to read pages 800 to 900 of the Final Rule. The committee that is writing the Rule seems to believe that the doctors will do whatever they dream up. As if the doctors are pawns that can be moved this way and that way. As if doctors are motivated only by dollars. As if we still are like premed students who want the highest score. As Theodore Dalrymple said, people including doctors might be motivated by more than just money. We might be motivated to do what we think is best for the patient. We might be motivated to maintain patient privacy. We might actually decide that we are not going to put our patient’s records up on the internet. We might actually decide that we are not going to allow any more government or insurance company interference in the practice of medicine.
Albert Fisher, M.D., Oshkosh, WI

A MACRA Lottery? The $30 K/100 patient number is a farce. Shall physicians hold a lottery for a place in the practice? If somebody dies, someone gets in. Insanity reigns.
Kristin Held, M.D., San Antonio, TX

Pharmacy Scoring. Rite-Aid, Wal-Mart, and many others require pharmacists to use EQUIPP software so pharmacy benefits managers can generate secret predictive scores about medication compliance. If you pay cash, you’ll be tagged as an outlier, but they’ll have less data linked to you. Pharmacists are required to hammer patients so to increase their own scores to meet goals and perhaps even keep their job. If you are a diabetic, EQUIPP requires pharmacists to tell you to ask your doctor about statins.

The incest between United Healthcare and HHS/CMS began when Lois Quam took leave from United to become White House senior advisor to Hillary when HillaryCare was created. There is more incest with current United executives as “fellows” at the Center for American Progress, which was created by John Podesta, former chief of staff to Bill Clinton and now Hillary’s campaign manager. United subsidiary Optum continues to buy more practices and manage more doctors (http://ducknetweb.blogspot.com).
Barbara Duck, Orange County, CA

WSMA Opposes MOC. The Washington State Medical Association just passed a resolution calling for the immediate end to any mandatory secured recertifying examination by the American Board of Medical Specialties (ABMS) or other organization. The usual opposition said that if we drop MOC by ABMS, the public will lose trust in our abilities, and the government would force worse programs on us. I argued that we now have a new competitor, ARNPs (advanced practice nurse practitioners), who have no board certification, and no MOC, but who can now work as hospitalists, independent gynecology providers, and psychiatrists, and even do radiology at the VA. Why should we submit to ABMS abuse when ARNPs don’t?
Kenneth Lee, M.D., Olympia, WA

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