Volume 73, no. 6 June 2017
“Resist!” signs are proliferating across the land. The “resist what?” is unstated. They do not appear at the same protests as the signs reading “9/11 beginning of the end of democracy: Shariah is the future” and “Islam will dominate.” But both sets of protesters want to bring down the pillars of Western civilization, and force all to submit to their preferred brand of totalitarianism—to which resistance is supposed to be futile. They are resisting the Resistance: the actions favored by Americans who elected Trump.
“For Poland to Be Poland, 2 + 2 Must Always Equal 4”
The Polish Solidarity Party adopted this slogan in 1989 in its fight to defeat Communism. “For 44 years of communist rule, the Poles had been lied to, in effect told that 2+2=5,” wrote Newt Gingrich in 2009 (http://tinyurl.com/yafm2uks). They knew that to challenge the authority of the communists…they had to be grounded in truth and reality.” Denial of reality is at the root of America’s problems as well, Gingrich stated.
In his novel 1984, George Orwell used the slogan “2 plus 2 equals 5” as a demonstration of the false dogma and absurdity expounded in a totalitarian state (see AAPS News, July 2014). The hero, Winston Smith, says that “freedom is the freedom to say that two plus two equals four.” The Communist slogan “Two plus two equals five” suggested that the goals of the first five-year plan could be achieved in four years if people worked harder.
Solidarity was the first free trade union in the Soviet bloc. It led the “10-year revolution” that ultimately led to the collapse of the Soviet empire. It became not only a labor union but an underground social network and “a movement for the moral rebirth of the people.” Its official program of October 1981 stated: “History has taught us that there is no bread without freedom…what we had in mind was not only bread, butter and sausage, but also justice, democracy, [and] truth….” (http://tinyurl.com/zub266q).
The election of Karol Józef Wojtyła as Pope John Paul II was crucial. He believed that Catholicism and the individual conscience stood diametrically opposed to Communism’s suppression of religious, economic, and political freedoms, which established the state as an alternative to a higher being.
The Orange Alternative was the third front in the battle to free Poland. This artistic movement offered a low-risk opposition method, such as painting humorous dwarves and circulating slogans like “Help the militia; beat yourself up.”
Despite brutal suppression, Solidarity stood firm, and won a wedge of freedom, the ability to distribute an uncensored publication as long as it was stamped “for intra-trade-union use only.”
In 1990, Solidarity’s Lech Walesa became Poland’s first democratically elected president (http://tinyurl.com/y8fulpyr).
Today, solidarity and moral conviction are found on the Left and in Islam, which make common cause with each other against the common enemy, setting aside their own internal divisions.
The Islamic invasion of Europe has been stopped before:
at the Battle of Tours by the Franks under Charles Martel in 732; in the naval Battle of Lepanto by the Holy League organized by Pope Pius V in 1571; and at the gates of Vienna with the aid of Polish King John III Sobieski in 1683. But now millions of Muslim “refugees” are invited in, and Europe is told to “get used to” suicide bomb attacks like in Manchester, or widespread rape to which police turn a blind eye (http://tinyurl.com/yb5hp9az). And Christianity is splintered and neutered by multiculturalism.
As to moral authority in the medical profession, MedScape features a discussion on “Is It Time to Retire the Hippocratic Oath?” (http://tinyurl.com/y8lxcrj8). In the oaths students write for themselves at Harvard Medical School and others, “new [leftist] ideals,” e.g. “societal responsibility” and “accountability to collaborative patient-care models” are encouraged.
The Attack on Truth and Reality
In the fiscal realm, the numbers do not add up. The Congressional Budget Office (CBO) claims that under the Affordable Care Act (ACA, or ObamaCare), the insurance market is pretty stable in most places, but might be destabilized by the American Health Care Act (AHCA) (http://tinyurl.com/ycaznfyg).
The media seems to assume that Medicare and Medicaid are fine, but Republicans might damage them. The CBO report released in April, The 2017 Long-Term Budget Outlook, is an alarming view of the coming wreck (http://tinyurl.com/y7odhlzr). The problem is intractable if welfare-state entitlements are untouched.
The “religion of peace” continues to call for perpetual war. Just days after Manchester, an Islamic group launched a Ramadan fund-raiser in the UK to build an “Anti-Islamophobia Nerve Centre” and promote the Islamic system of government. Its website features a large headshot of Trump and some British politicians, and the slogan “The best jihad is the word of justice in front of the oppressive ruler” (http://tinyurl.com/y7cqvkzd).
But a more serious danger to freedom than the forced replacement of Western values with alien ways is the loss of our soul in our own cultural suicide. Where is the resistance to a culture of lies? For example, (XY – testosterone + estrogen + plastic surgery ¹ XX). Yet physicians may be pressured, under threat of discrimination lawsuits, to violate their conscience and treat patients on the basis of what they believe to be a lie.
Reality always wins. But in the meantime, will Americans act in solidarity to prevent the loss of their integrity and freedom?
Reality Check on ACA
As duly reported in the press and by the AMA, the CBO calculated that under AHCA 23 million Americans will “lose” health insurance; however, most of them do not have any coverage to lose. CBO assumes they would have gotten it had ACA continued, despite its wildly erroneous past estimates of enrollments (http://tinyurl.com/m8h99vv). Many will not lose coverage but will opt out, possibly buying catastrophic coverage that CBO does not consider to be insurance (WSJ 5/26/17).
Training for Indoctrination
In an OSCE (objective structured clinical examination), a medical student practices how to change a reluctant parent’s mind about vaccinations, and gets feedback from the “standardized patient,” a trained actor. Brit Trogan, a medical student at New York University, writes about “evidence-based metaphors,” a form of “evidence-based communication” to help explain complicated scientific concepts to patients in the few moments permitted for a visit. His “patient” thought the “fingerprint of a germ” analogy worked well. Instead of just transferring information, doctors might focus on ways to “nudge” patients into more healthful behavior. “What if patients…heard only tried and tested messages from the medical community?” (JAMA 4/11/17). Note that the communication is one way, and the message is assumed to be true.
- The new Oregon Secretary of State, Dennis Richardson, the only Republican in a state-wide office, discovered that the Oregon Health Authority has been spending as much as $37 million/month for 3 years for capitation payments for ineligible persons (http://tinyurl.com/y7rqg5zs).
- In a preliminary look at Arizona’s Medicaid system, Charles Kroll, who was engaged by the Arizona State Chapter of AAPS, found that over 5 years nearly $400 million that is supposed to provide medical care to the poor is funding state agencies, and contractors cleared $228 million in pre-tax profits in one year. Acknowledged administrative expenses over 5 years were about $1 billion by the state agency plus $1 billion at the contractor level. The Arizona program is 100% managed care. (See http://tinyurl.com/y768nzlc and http://tinyurl.com/y9oecq82).
Conservatives Forced out of Colleges
In a single week, at least seven high-profile conservatives, including Anthony Esolen and Paul McHugh, were pushed out of their academic positions. This “putsch” has corrupted research, knowingly spread profligate falsehoods, and defrauded millions of graduates who went into debt for “education” that left them dysfunctional and brainwashed (http://tinyurl.com/ycepnnvv).
“Diversity means not that there should be a diversity of thriving cultures across the world, but that this civilization and what is left of American culture should pass away…. To say that it does not matter how the next generation is brought into the world is to say that the future need have no connection with the past, and that is to say that there shall be no culture at all.”
Anthony Esolen, “Ut Plures Sint,” Chronicles, March 2017
ACTION OF THE MONTH
Where does the money go in Medicaid, while patients can’t get appointments? Is it a cash cow for the managed-care cartel and state government? Ask your state ass’n to demand an audit.
More Veterans to Get HBOT for TBI/PTSD
Hyperbaric oxygen therapy (HBOT) for traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD)—“invisible wounds” from blast exposure—will be funded for veterans in Indiana, Texas, and Oklahoma thanks to state legislation. And the U.S. Marine Corps will permit active-duty Marines to participate in a study at Louisiana State University. HBOT for brain injury is standard treatment in Israel. Many of the 600,000 veterans with TBI also have drug dependency problems, and HBOT has been shown to facilitate recovery. About 2,300 veterans have had HBOT in private facilities (http://tinyurl.com/ybwoxp2y).
Outcomes of Socialized Medicine
- UK: “The past four decades of the NHS [National Health Service] have been a striking exercise in political incompetence and failure” (Lancet 10/12/16, http://tinyurl.com/yceuvlns).
- Venezuela: maternal mortality rose by about 9% between 2014 and 2015, then jumped by nearly 66% by the end of 2016. Infant mortality rose by about 30% between 2015 and 2016 (Lancet 5/27/17). Hundreds of political prisoners are being held with sham trials or no trial (Nature 5/11/17).
- Canada: Historically long wait times cost Canadians $1.7 billion in lost wages—or $1,759 per patient last year. If weekend time is valued, the cost of waiting jumps to $5.2 billion, according to a Fraser Institute study (http://tinyurl.com/yb2p8fw2).
Patient Outcomes Worse with Older Physicians?
In a widely publicized article, Harvard-affiliated authors Tsugawa et al. write that Medicare fee-for-service patients treated by hospitalists in U.S. acute-care hospitals had statistically and clinically significantly lower mortality when their physician was < 40 compared with ≥ 60 years old, based on complex statistical manipulations. The adjusted 30-day mortality rates were 10.8% vs. 12.1%, respectively. The authors speculate that physicians further removed from training might “more often rely on clinical evidence that is not up to date,” and refer to debates about Maintenance of Certification (http://tinyurl.com/kgwxe58).
The article assumes that the billing hospitalist was the one responsible for the outcome, comments Brant Mittler, M.D., J.D. He notes that the same authors have now published a trio of recent articles claiming that older, male, U.S.-trained physicians are more dangerous. Other journals are publishing “viewpoint” pieces questioning the competence of “older” physicians—the ones more likely to resist capitated or bundled-payment arrangements.
“There are intense political agendas at work here,” he writes.
Oct 5-7. 74th annual meeting, Tucson, AZ.
Oct. 3-6, 2018. 75th annual meeting, Indianapolis, IN.
Retreat on Female Genital Mutilation Ban
After the Minnesota House of Representatives passed a bill, nearly unanimously, that would ban female genital mutilation (FGM), lawmakers are having second thoughts. Apparently there has been pushback from the refugee resettlement industry, primarily Catholic Charities and Lutheran Social Services, which receive millions of dollars in federal funding.
Minneapolis mayor Betsy Hodges met with Somali leaders wearing a hijab. Democrat governor Mark Dayton has told Minnesotans to find another state if they are uncomfortable living with the growing number of Somali refugees.
Liberal legislators say that the law’s penalties are overly harsh—loss of child custody and 5 to 20 years imprisonment for parents, depending on the extent of the injuries. The federal law, which is rarely enforced, calls for up to 10 years imprisonment for doctors. Critics prefer education about why the practice is wrong.
Former congresswoman Michele Bachmann urges the bill’s authors to ignore the “Islamic religious police” and help the Muslim community to understand that it is “their duty to conform to U.S. law, values and norms” (http://tinyurl.com/mnytdof).
Doctor Invokes Religious Freedom for FGM
Two Detroit physicians accused of performing FGM state that the procedure was only a “minor nick” that did not harm the girls, although they screamed in pain and reported being barely able to walk afterward. But even if it did qualify as FGM, defense attorney Mary Chartier stated it would be protected by the First Amendment right of physicians to practice their religion (http://tinyurl.com/ydef2496). However, Erwin Chemerinsky, dean of the law school at the University of California at Irvine, stated: “You don’t have the right to impose harm on others in practicing your religion” (http://tinyurl.com/n58ggqy).
Jail for Using Wrong Pronoun?
Canada bill C-16, an act to amend the Canadian Human Rights Act and the Criminal Code, adds “gender expression” and “gender identity” to the hate crimes section of the law. Opponents of the bill say that Canadians who disavow gender theory could be charged with hate crimes, fined, jailed, and compelled to undergo anti-bias training. Proponents downplay effects of the law, but breaching a tribunal order can result in jail through a civil contempt-of-court process. The Ontario Human Rights Commission ordered University of Toronto psychology professor Jordan Peterson to cease and desist from public utterances, such as refusals to use genderless pronouns (http://tinyurl.com/k4ovax6).
Tip of the Month: Be aware that despite previous communications from CMS stating that opted-out physicians no longer have to make new private contracts with their patients every two years, the CMS manual of August 2016 reads: “When a 2-year opt-out period ends, the physician/practitioner must enter into new private contracts with each beneficiary for the new 2-year period. The new private contracts must state the expected or known effective date and the expected or known expiration date of the current 2-year opt-out period” (http://tinyurl.com/nt3xhb7, p 30). AAPS is seeking clarification of this contradiction.
Pennsylvania May Redefine “Sex”
Pennsylvania has repeatedly thwarted attempts by LGBT activists to add sexual orientation and gender identity (SOGI) language to its antidiscrimination laws. In a quietly released statement issued late on a Friday afternoon, the Pennsylvania Human Relations Commission announced a proposal to effectively redefine the word “sex” to include SOGI in its “guidance” on the matter. But this new “guidance” would mean the law would be enforced as if it had changed. Democrat Tom Wolf, named the most liberal governor in the U.S., demoted the chairman of the Commission and appointed a new one to implement this end-run around the legislature (http://tinyurl.com/mgw6u2j).
Right to Therapy
A statement issued by the American College of Pediatricians (ACPeds) and signed by AAPS and others opposes laws banning psychotherapy for minors who request it for unwanted sexual attractions or gender dysphoria. In states with such a ban, therapists are required to engage “solely in speech that affirms the child as lesbian, gay, bisexual or transgender.” As a result, “a number of youth will be legislated into a false sexual identity, and many others will…begin the high risk sex change process as young as age 11 that renders them permanently sterile.” The letter cites references showing that 80-95% of transgender children come to accept their biological sex by late adolescence with watchful waiting or therapy.
UnitedHealth Group’s One-Way Coding Audits
To obtain inflated risk-adjustment payments from the Medicare Advantage (MA) program, UnitedHealth Group (UHG) used “untruthful” information, alleges the Dept. of Justice in a False Claims Act complaint (U.S. ex rel. Swoben v. Secure Horizons, C.D. Cal., No. 09-cv-5013, complaint 5/1/17, posted at http://src.bna.com/orc). This action follow another DOJ intervention in a FCA case against UHG filed by whistleblower Benjamin Poehling. DOJ and Swoben allege that UHG conducted audits of its diagnosis code data to add codes that would increase its risk payments, but wouldn’t remove incorrect codes that reduced its payments (BNA’s HCFR 5/10/17).
The DOJ “conservatively estimated” that in the course of the 10-year scheme UHG “knowingly and improperly avoided repaying Medicare” more than $1 billion. It allegedly ignored repeated warnings from its own auditors. In 2009, federal auditors determined that half the diagnoses at one of its plans were invalid.
UHG, the largest MA operator, received $56 billion from Medicare in 2016. MA now covers nearly 1 in 3 Medicare beneficiaries. All but two of 37 MA plans examined in 2007 were overpaid, often by thousands of dollars per enrollee, reports Kaiser Health News (http://tinyurl.com/mmj7nv3).
“Providers” Need Proactive Compliance
“Providers” need to return Medicare overpayments within 60 days of discovery or face FCA liability. A sharp increase in Medicare revenue could be considered “credible information” that overpayments were received, and could start the 60-day clock (BNA’s Health Care Fraud Report 4/12/17).
“Coverage” = Wealth Transfer Scheme. In the current environment where socialists whine that people will lose coverage in the now unlikely event that ObamaCare is ever repealed, we must remember that coverage does not mean timely access to care or that a private insurer will pay anything at all. The Explanation of Benefits may say a service is covered, but the entire bill will be paid by the patient. Insurers will try to persuade people that coverage is needed for everything, but in reality 90% of people will never reach a deductible of $5,000 and are simply giving their money to the insurer for the false security label of being covered.
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY
AOA Uncouples Membership and OCC/MOC. Likely as a reaction to a lawsuit filed by four AOA members (three of whom are also AAPS members), the American Osteopathic Association has for the first time separated the $90 maintenance of certification fee from membership dues of $683. Previously, osteopathic physicians were forced to pay almost $800 per year to maintain AOA membership or have their board certification canceled. The lawsuit argues that forcing membership under penalty of removal of board certification is a restraint of trade. Finally, DOs have the opportunity to decline to support the AOA’s political agenda and yet remain certified. In my opinion, “certification” should only mark the successful completion residency training and be lifelong as originally intended, maintained by years of practice and CME.
Craig M. Wax, D.O., Mullica Hill, NJ
AOA Removes Non-members from Directory. After 25 years of paying annual dues, I did not pay up in 2016, and my name has been removed from the doctorsthatdo.org website. My patient “new” population has decreased since then because people don’t know I am out there. AOA encourages people to see only “their” doctors. It’s just one more way the AOA harms doctors who do not support their evil agendas such as pay-to-practice medicine. [You can find Dr. Reghetti on apps.ama-assn.org/doctorfinder, but you must specifically request nonmembers. —Ed.]
Gina Reghetti, D.O., Warren, OH
Remember the Alamo. I see certain parallels with the defense of private medicine. We are few in number and surrounded by overwhelming force. There are, however, no open demands for surrender. We’re just a minor burr under the saddle, no real threat to the $3 trillion/yr medical machine. But the war is not lost until the final cry of “Remember Hippocrates!” dies out. Fight on!
Robert Sewell, M.D., Southlake, TX
Freedom’s Last Stand. We’ve been trading freedom for security —even in the U.S., which has been called the last stand for freedom on earth. Some think freedom is over-rated, and relinquish freedom to choose for ourselves—in return for “protection” from the cost of blood-pressure medicines. Would you be better off if I gave you $40 worth of medicine, or if I paid your electric bill? We don’t know. We can’t even define “health.” Yet we throw public dollars at therapies that provide only minuscule benefits to an imaginary construct called the “Population.” Depending on government has led to an over-regulated system too expensive for most, bureaucratically stifling for all, and bleeding inefficiency. More dependence continues the spiral toward totalitarianism. The greatest mistake might be to believe that problems create by government meddling can be fixed by more government meddling.
Rocky Bilhartz, M.D., bilhartzmd.com/?p=3884
Motive: Obstruction. The Republicans had 7 years to reach consensus on a bill to repeal and replace ObamaCare. They are still stalling. I think they are trying to torpedo President Trump’s agenda to drain the swamp. The Republican establishment is thriving in the swamp it helped create.
Stanley Feld, M.D., Dallas, TX, http://tinyurl.com/yd2nb6lj
Dialogue for ObamaCare Fans. Pt: What makes you think your clinic can stay open if you don’t take insurance? Dr: Your $7,000 deductible. Pt: How do you turn a $100 doctor visit into a $20 copay? Insurer: By buying an $1,800/mon insurance plan. Pt: My HMO has only 6 doctors in the D/FW area who are taking new patients. But thank goodness I’m covered. Dr: Blink, blink. Q: What’s the difference between a copay and a deductible? A: Probably thousands of dollars. HR Rep: So you discount $50/mon for each biometric screening? Health Ins Co: Yes. Then we raise the premiums based on the data. Q: What do you call a bunch of doctors who refuse to take any form of health insurance? A: A very good start. [compiled from Twitter @Hconomics]
Kevin Wacasey, M.D., healthcareonomics.com
Legacy. Recent riots in South Africa, as a protest against foreigners turned violent, are a legacy of the South African constitution, which Justice Ginsburg considers superior to ours. It promises a right to healthcare, education, etc., paid for by an unspecified somebody else. These protestors are brothers-in-spirit of American “activists” engaged in war against free speech—the legacy of Obama. Most claim to be victims, deprived of their rights. Of course they are victims—of Marxism, tribalism, anti-freedom/anti-life philosophies that prevent the creation of wealth.
Jim Douthit, Tucson, AZ