Saturday, February 27, 2010

AlterNet: Ayn Rand, Hugely Popular Author and Inspiration to Right-Wing Leaders, Was a Big Admirer of Serial Killer

AlterNet: Ayn Rand, Hugely Popular Author and Inspiration to Right-Wing Leaders, Was a Big Admirer of Serial Killer

If you knew Ayn Rand was a bit whacked, you had no idea...

So what, and who, was Ayn Rand for and against? The best way to get to the bottom of it is to take a look at how she developed the superhero of her novel, Atlas Shrugged, John Galt. Back in the late 1920s, as Ayn Rand was working out her philosophy, she became enthralled by a real-life American serial killer, William Edward Hickman, whose gruesome, sadistic dismemberment of 12-year-old girl named Marion Parker in 1927 shocked the nation. Rand filled her early notebooks with worshipful praise of Hickman.

According to biographer Jennifer Burns, author of Goddess of the Market, Rand was so smitten by Hickman that she modeled her first literary creation -- Danny Renahan, the protagonist of her unfinished first novel, The Little Street -- on him.What did Rand admire so much about Hickman?

His sociopathic qualities: "Other people do not exist for him, and he does not see why they should," she wrote, gushing that Hickman had "no regard whatsoever for all that society holds sacred, and with a consciousness all his own. He has the true, innate psychology of a Superman. He can never realize and feel 'other people.'"This echoes almost word for word Rand's later description of her character Howard Roark, the hero of her novel The Fountainhead: "He was born without the ability to consider others."

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Friday, February 26, 2010

Individual Irresponsibility in the President’s Healthcare Reform Plan

Individual Irresponsibility in the President’s Healthcare Reform Plan

A response to the above titled post from "Health Leaders"

"The result is that nearly everyone will be "covered" whether they're insured or not. They'll be treated, and someone else will pay the cost. That's the way it is now, and that's the way it will continue to be if these bills pass—just under a different mechanism."

And with considerably fewer uninsured to require that cost shifting. That's the whole point, isn't it? Less uninsured.

Look, a certain percentage of the population will always try to game the system, by paying the penalty rather than buying insurance. But even those people will stop that behavior as soon as someone in their family has an illness requiring more than a couple visits to the doctor. So, yes there are gamers, but most people want to do the right thing, I still believe.

"Premiums from commercial insurers will be sky-high, if commercial plans even continue to exist long-term."

That's not what the CBO says.

"What better way to get the deeply unpopular public option back in the mix in a few years?"

Except it isn't unpopular, except with the Fox News crowd, who still think it is some sort of Sino-Soviet hybrid system.

And, just for the record, the 10 largest physicians organizations support reform with the option.

Posted using ShareThis

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Individual Irresponsibility in the President’s Healthcare Reform Plan

Individual Irresponsibility in the President’s Healthcare Reform Plan

Posted using ShareThis

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Sunday, February 21, 2010

Why doctors’ pay keeps on rising - Herald Scotland | News | Politics

Why doctors’ pay keeps on rising - Herald Scotland News Politics

"GPs, who earned an average of £80,959 in 2007, benefit from “aspiration” and “performance” payments under the Quality and Outcomes Framework (QOF)."

This is an article about bonus payments to GP's in the NHS for a variety of things, including taking care of oncology patients, MRSA screening, practicing in underserved areas in the UK, among others. The grumbling is that they are getting paid pretty well, since a new contract from 2004, and they are out sourcing night call to other services.

They were doing this in London back in 1984 when I was there for some medical school electives, and they were grumbling about it then, too. My feeling is that, especially with the upcoming generations, that life style is important and it is important to bring in people to the profession who are bright and enthusiastic. A miserable life style makes that less likely.

For the record, the £80,959 average salary in US Dollars equals $125K at the current exchange rate, comfortably in the top quintile of earners. But it comes without hundreds of thousands of dollars in expense/debt to get through college and medical school.

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Saturday, February 20, 2010

Tea Partiers as Christians - Big Fail

Non-negotiable Core Beliefs from's Dale Robertson
(Founder/President) and my comments in italics.

Illegal Aliens are illegal.
Pro-Domestic Employment is indispensable.
Stronger Military is essential.
Gun ownership is sacred.
Government must be downsized.
National Budget must be balanced.
Deficit Spending will end.
Bail-out and Stimulus Plans are illegal.
Reduce Personal Income Taxes a must.
Reduce Business Income Taxes is mandatory.
Intrusive Government Stopped.
English only is required.
Traditional Family Values are encouraged.
Common Sense Constitutional Conservative
Self-Governance is our mode of operation.

....and Yes, we are a Christian Nation!

So, let's start with the hilarious first, "Yes, we are a Christian Nation!" Well, not hilarious, just sad. Look through all of those and tell me which items would get Jesus all fired up? Nothing about universal access to health care ("when I was sick"), nothing about the unprecedented dependence on Food Stamps, not only to buy food ("when I was hungry"), but for subsistence needs ("when I was naked"), nor anything about our embarrassingly high incarceration rates for Americans ("when I was a prisoner").

But these "Christians" did include those damn illegal aliens!! The Bible is terribly draconian on aliens:
Exodus 22: Do no wrong to a man from a strange country, and do not be hard on him; for you yourselves were living in a strange country, in the land of Egypt
And Leviticus is even worse: The alien living with you must be treated as one of your native-born. Love him as yourself, for you were aliens in Egypt. I am the LORD your God.
Anyway, may as well go through the rest of his list, briefly.
Pro-domestic employment. OK, we can agree on this one. However, I expect their view is very anti-union, which the Pope, at least (he's Christian, right?) opposes.

Thus, the encyclical rises strongly to the defense of labor unions, which are still vehemently opposed by large numbers of politically conservative Catholics. The pope notes that unions "have always been encouraged and supported by the Church.

Stronger Military. How about smarter military? How abut defunding "Star Wars," and preparing for the wars we are fighting and will fight in the future: "wars" against terrorist organizations. Oh, wait, that's law enforcement and intelligence. Then how about focusing the Pentagon on human resources instead of lining the pockets of Haliburton, Blackwater, Northrup and the rest of the Military industrial complex. Eisenhower was so prescient and wise:

Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. The cost of one modern heavy bomber is this: a modern brick school in more than 30 cities. It is two electric power plants, each serving a town of 60,000 population. It is two fine, fully equipped hospitals. It is some fifty miles of concrete pavement. We pay for a single fighter plane with a half million bushels of wheat. We pay for a single destroyer with new homes that could have housed more than 8,000 people. This is, I repeat, the best way of life to be found on the road the world has been taking. This is not a way of life at all, in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron. ... Is there no other way the world may live?
Gun Ownership is sacred. Fine, this is way low on my list of issues to get exorcised about but gun rights are not unlimited. Again, I don't see this as being near the top of Jesus' list for important aspects of national governance. Also, why is it that the most heinous crimes always seem to be done with legally purchased guns?
Government must be downsized, National Budget must be balanced, Deficit Spending will end. Reduce Personal Income Taxes a must. Reduce Business Income Taxes is mandatory.
Typical right wing BS. Run up the most massive deficits in the history of the country, first under Reagan and again under Bush, then bitch about it as Democrats try to clean up the mess (Clinton for Reagan, and Obama for Bush). I'll let you all in on a little secret: Tax cuts never have, never will pay for themselves. "Supply side" economics, wherein lightening the tax burden on the wealthy so that they will supply more products and thus stimulate demand is as S-T-U-P-I-D as it sounds. Besides, investment income is taxed at such low rates already, the wealthiest in America have far lower tax rates than the rest of us! Patriots like Teddy Roosevelt would be out there railing against this injustice.
Bail-out and Stimulus Plans are illegal. Very stupid, poorly thought out, way too generous to Wall Street with not nearly enough regulatory "burden" injected in return for the favors. Did anybody else notice that the same stupid Ayn Rand- Milton Friedman stupidity that led to the S&L Bailout under Reagan-Bush I led Phil Gramm to believe they could do even more damage to the tenuous regulatory environment in place in the 90's and everything would turn out just swell - for the "Fortunate 400", and the pretty fortunate 40,000.
Intrusive Government Stopped. This is just so funny because of where I expect they see the government is being too intrusive and where I think it is too intrusive. I am one of those silly Bill of Rights types, and so I reject pretty much every intrusion into the lives of Americans that the chickens in the Bush administration thought were so vital to national security. And yet, I have been paying attention enough to realize that intrusions into the affairs of Corporate America in general, and Wall Street gambling, in particular, are vital to the stability and prosperity of the country.
English only is required. I guess this goes up above with how we treat each other and the strangers among us. I think Jesus, who spoke Aramaic, while living under Roman rule, might have a touch of sympathy for the non-English speaking.
Traditional Family Values are encouraged. This is a little tricky, in that Jesus and Christian tradition is so clearly liberal in matters of economics, social justice, immigration, etc., and yet Jesus was pretty darn tough on sexual issues. So, I'll make an offer to the Tea Partiers: You make Jesus' rule against divorce into law, help us with the big social justice issues like universal health care, reforming prisons, strengthening workers rights, and more, and then we'll go after gay marriage. Deal?
Common Sense Constitutional Conservative Self-Governance is our mode of operation. I really don't know what the heck this means, but I did find it amusing that there is another organization called "We the People" (From the Constitution - get it?) that is an ANTI-government, Tea Party type organization.
But I do think this last bit is critical: I think progressives view government as "us" (as in "We the People") and conservatives view government - when they are not in power - as them. Even when my party was not in power, I still believed government was us, but that we had failed our country by allowing the Siths to win so many elections.
So, in summary, these people who constantly complain that we are not acting as a Christian Nation, seem to completely miss the point of Christianity, the social justice mission, the generosity of heart, the embracing of the weak, the poor, the hungry the sick, the loving of those NOT like us :
If you love those who love you, what credit is that to you? Even 'sinners' love those who love them. And if you do good to those who are good to you, what credit is that to you? Even 'sinners' do that. (Luke 6)
Update just to add this from
"...How terrible it will be for those who make unfair laws, and those who write laws that make life hard for people. They are not fair to the poor, and they rob my people of their rights. They allow people to steal from widows and to take from orphans what really belongs to them. (Is 10:1-2 NCV)"

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Thursday, February 18, 2010

Go forward on health reform - Washington Greene PA Letter to Editor -

Go forward on health reform - Washington Greene PA Letter to Editor -

I didn't realize this had been published until just now. Here is my letter for the DFA LTE Campaign:

I am a practicing physician who routinely sees the suffering and deaths caused by a health care system that leaves tens of millions of people on the outside, unable to access health care except when so desperately ill, they find their way to an emergency room, and often end up in my ICU, far sicker than they would have been with access to a doctor earlier in their illness - and at this point a drastically more expensive illness as well. Every doctor you know can tell you similar stories.

That is why it is no accident that the 10 largest physicians organizations support health reform including the House Bill that passed last year, which includes a public option and an individual mandate, so that private insurers will have a competitor and benchmark, and so that everyone will be "in," with an option to buy insurance from a true, not-for-profit insurer if they can't get it anywhere else.

It is no accident that the American Cancer Society has made reform its top advocacy priority, because they see the needless anguish of cancer patients trying to get the care that they need, fighting with insurers, struggling to pay the bills, begging not to be thrown off insurance plans.

So when you hear the naysayers complaining about this or that aspect of the bills, remember that your friends, your families, and our patients continue to struggle with getting good care and paying for it.

Forty-five thousand of us die every year due to lack of access to health care. And that number is only a fraction of those suffering due to untreated or under-treated illness and chronic conditions.

We need to move forward, not step back for all of our sakes.

The comments from the right wingers are, sadly, all too predictable, but hey, it had been read 422 times when I checked a bit ago.

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Tuesday, February 16, 2010

Exodus 22:21 "Do not mistreat an alien or oppress him, for you were aliens in Egypt.

Exodus 22:21 "Do not mistreat an alien or oppress him, for you were aliens in Egypt.

Bible in Basic English

Do no wrong to a man from a strange country, and do not be hard on him; for you yourselves were living in a strange country, in the land of Egypt.

And Leviticus 19:34

'The stranger who resides with you shall be to you as the native among you, and you shall love him as yourself, for you were aliens in the land of Egypt; I am the LORD your God.

Just throwing this in for all of those who get the vapors when the subject of providing health care for illegal aliens comes up.

First, we should do it because it is the right thing to do, but on a more pragmatic level, just as with all of the other uninsured in the country, it costs a lot less to take care of them in an ongoing, preventive manner rather than during crises in our EDs and ICUs.

I'm going to post a few more here for my own future reference...

Matthew 5:43-48, Love for Enemies

"You have heard that it was said, 'Love your neighbor and hate your enemy.' But I tell you: Love your enemies and pray for those who persecute you, that you may be sons of your Father in heaven. He causes his sun to rise on the evil and the good, and sends rain on the righteous and the unrighteous. If you love those who love you, what reward will you get? Are not even the tax collectors doing that? And if you greet only your brothers, what are you doing more than others? Do not even pagans do that? Be perfect, therefore, as your heavenly Father is perfect.

And the version from Luke 6:27-36

"But I tell you who hear me: Love your enemies, do good to those who hate you, bless those who curse you, pray for those who mistreat you. If someone strikes you on one cheek, turn to him the other also. If someone takes your cloak, do not stop him from taking your tunic. Give to everyone who asks you, and if anyone takes what belongs to you, do not demand it back. Do to others as you would have them do to you.
"If you love those who love you, what credit is that to you? Even 'sinners' love those who love them. And if you do good to those who are good to you, what credit is that to you? Even 'sinners' do that. And if you lend to those from whom you expect repayment, what credit is that to you? Even 'sinners' lend to 'sinners,' expecting to be repaid in full. But love your enemies, do good to them, and lend to them without expecting to get anything back. Then your reward will be great, and you will be sons of the Most High, because he is kind to the ungrateful and wicked. Be merciful, just as your Father is merciful.

And here is a very nice summary for the Biblical case for social justice from the United Church of Christ website, with this nice bit:

God, however, requires both charity and justice, and justice can often be achieved only through the mechanism of government. The view that nations, as well as individuals, will be judged by the way they treat the weakest and most vulnerable among them is deeply embedded in the witness of prophets such as Isaiah, who said:
How terrible it will be for those who make unfair laws, and those who write laws that make life hard for people. They are not fair to the poor, and they rob my people of their rights. They allow people to steal from widows and to take from orphans what really belongs to them. (Isaiah 10:1-2)

Jesus criticized and disobeyed laws when they got in the way of helping people. He healed people on the sabbath, for example, even though all work was prohibited on the sabbath. Religion and government were intermixed, so Jesus was challenging the law of the land. The threat Jesus posed to both religious and political authorities led to his crucifixion.

Government is not the only or always the best instrument to deal with injustice. But it is one of the institutions created by God part of God's providence for the welfare of people. Because we live in a democracy, a nation with a government of the people," we have a special privilege and responsibility to use the power of our citizenship to promote public justice and reduce hunger.

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Saturday, February 13, 2010

Georgetown/On Faith: Pope Benedict on Economic Justice - Thomas J. Reese

Eavesdropping on a Facebook conversation my wife was having with some conservatives, and they sent her a well produced, but intellectually 5th grade level, video on a certain view of "liberty," mainly a diatribe against social responsibility and community. You know, John Galt crap.

Anyway, I knew many hardcore Catholics were on this list so I Googled around a bit to find this bit from Pope benedict's Encyclical of last year...

Georgetown/On Faith: Pope Benedict on Economic Justice - Thomas J. Reese

The pope disagrees with those who believe that the economy should be free of government regulation. "The conviction that the economy must be autonomous, that it must be shielded from 'influences' of a moral character, has led man to abuse the economic process in a thoroughly destructive way," he writes. "In the long term, these convictions have led to economic, social and political systems that trample upon personal and social freedom, and are therefore unable to deliver the justice that they promise."

Benedict even supports "a political, juridical and economic order which can increase and give direction to international cooperation for the development of all peoples in solidarity. To manage the global economy; to revive economies hit by the crisis; to avoid any deterioration of the present crisis and the greater imbalances that would result; to bring about integral and timely disarmament, food security and peace; to guarantee the protection of the environment and to regulate migration: for all this, there is urgent need of a true world political authority, as my predecessor Blessed John XXIII indicated some years ago."

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Wednesday, February 10, 2010

Ezra Klein - The six Republican ideas already in the health-care reform bill

Ezra Klein - The six Republican ideas already in the health-care reform bill

Yes, they are already in there.

As Ezra sums up in his last paragraph:

On Sunday, John Boehner and Mitch McConnell responded to Barack Obama's summit invitation by demanding Obama scrap the health-care reform bill entirely. This is the context for that demand. What they want isn't a bill that incorporates their ideas. They've already got that. What they want is no bill at all. And that's a hard position for the White House to compromise with.

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Tuesday, February 9, 2010

Organized Medicine on HCR Updated Again

Update: the ASA, No. 7 below did not support the HCR Bill, just a Public Option. See the full correction here. My apologies.

Not an earth shattering update, but a membership update on one of the organizations courtesy Alice C. of Doctors for America

Below are the largest physicians organization, in order, with estimated membership numbers based on their own websites (or other sources when the Web Site didn't have them). Previously we had the AOA, American Osteopathic Association, as number 5 because their web site had previously said they "represent" 67,000 Osteopaths. Alice sent me actual numbers indicating they have about 40,000 members, still keeping them in the top ten, just not as high up.

All are YES on reform with Public Option and supporting the House Bill, with some points of contention, but generally have endorsed it.

1. AMA 240,000
2. ACP 126,ooo (Internists and many medical subspecialists)
3. AAFP 94,000 (Family Practice)
4. ACS 76,000 (surgeons)
5. AAP 60,000 (pediatricians)
6. ACOG 52,000 (ob-gyn)
7. ASA 43,000 (Anesthesiology!)

8. AOA 40,000 (osteopaths)
9. APA 38,000 (psychiatry)
10. ACC 37,000 (cardiology)

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Friday, February 5, 2010

The Cost of Living : Cardiologists' Lament

The Cost of Living : CJR:

The Herald’s story, by John Dorschner, said the doctors were complaining that Medicare had reduced “reimbursement for cardiac services on average by 40 percent,” and that another 21-percent cut was coming March 1. The doctors’ letter warned that they “will be either forced out of business or forced to drastically increase the number of patients seen, most likely with physician assistants or nurse practitioners.” Oh, oh. The specter of rationing and inferior care—and from nurse practitioners no less!

Dorschner’s story described a new Medicare rule, which took effect January 1, that cut projected total revenues for cardiologists by 13 percent on average over four years while increasing the revenue of internists, family doctors, and general practitioners.

Think of it as income redistribution designed to make primary care more attractive to med students and increase the supply of those kind of docs. (At a minimum, the health-reform debate has illuminated payment disparities between the primary-care doctors and the high-priced specialists who have always commanded big bucks.)

Heart doctors across the country—not only in Miami—cried foul, and Jack Lewin, who heads their trade group, the American College of Cardiology, vowed “to do everything we can in the legislative, legal and regulatory arenas to stop these cuts.” Lewin could have added the media to that list of arenas, because the ACC pulled out all stops to sound the alarm with the nation’s press and public through its Campaign for Patient Access.

The Herald’s story was the best of a bunch of news articles that for the most part passed along the cardiologists’ complaints, threats, and warnings without any hint that there was another side to the story. Between the slanted newspaper articles and audio news releases from the ACC, millions of Americans learned that the incomes of heart doctors, which can be upwards of $400,000, could take a hit. As an example of the kinds of cuts Medicare envisioned under the new rule, the administrator of one Florida heart practice explained that the reimbursement for a nuclear stress test could drop from $850 to $600. Presumably he said it with a straight face.

We will need to have this very important discussion at some point, so I'm glad to see someone looking critically at the need for substantive analysis of complaints about reimbursement.

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The Debate Over Selling Insurance Across State Lines

Kaiser Health News Today's Headlines:

An article giving a brief overview of the issue. My favorite line, from John Shadegg is here:

"Why are Republicans critical of how Democrats handle the issue?

They say its redundant for states to have to pass laws to allow their residents to buy coverage from other states. And they don't like the idea of having the federal government set minimum standards. 'In reality, (their) bill nationalizes federal insurance regulation and gives the average American family no relief from expensive mandates that drive up the cost of health insurance,' said Rep. John Shadegg, R-Ariz. said."

Expensive mandates like, covering stuff.

But, according to CBO estimates quoted at the end, even the states with the laxest regulations would only generate a 5% reduction in premium costs.

Until, of course, the industry picks a state, buys the insurance regulating apparatus and the state's legislature, and develop the classic "never pay policy."

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Monday, February 1, 2010

SGR History

Just looking up a little SGR history.

It was part of the 1997 Balanced Budget Act passed under Congress controlled by Republicans and Clinton signed. It was designed to save $115 billion over ten years to avoid making any other painful, politically unpopular changes to Medicare.

In 1998, all the interested parties were pushing back:

"Everybody who got a tuck and a trim in 1997 wants more money," said Ari Fleischer, spokesman for the House Ways and Means Committee, which oversees the nation's health care program for the elderly and disabled. "If everybody . . . gets more money, Medicare will go broke even faster.

And here we are, gearing up again...

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Escaping To England To Find Treatment She Can Afford

From Kaiser Health News Today:

Sometimes my husband Roger gripes about what he calls the British “nanny state.” So much is done for the English, he maintains, they can’t think for themselves anymore. Showers, for instance, are statutorily equipped with automatic shut-off valves on the thermostats. In case the water gets too hot. I remind him that the opposite of the nanny state is me in the U.S. with breast cancer and no steady job and insurance.

I had some wonderful doctors in New York, caring and helpful. But I also had to fight with my hospital there to get the tests I needed, and several of the specialists were so difficult to deal with I chose medical protocols to avoid them—no matter what the best option for treatment was. What I really notice about the health care providers in England is that they seem to have more than half a second for me – and they actually listen.

A nice piece about the nightmare that medicine is not in England. She left the US to go to England because she couldn't afford the US health care system, and found out there were other bonuses to a differenet model of financing health care.

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