THURSDAY through SATURDAY, April 28 through 30, 2005

Physicians and their patients are in tough times partly because, in a mis-guided and paternalistic effort to shield their patients from the turmoil, physicians in the 1980's and early 1990's did not keep their patients informed and did not seek their political help.  They also had this quaint idea that politicians and legislators gave a damn about their points of view and input.  We all learned otherwise.  So, in addition to all the warnings I have been sharing since the late 1970's  (see other relevant categories on this web-site),  here are some more that may make a real difference to the most altruistic of your physicians.

1. "Pay for Performance" is one of the latest brainstorms being tested.  If not structured properly, physicians' income, already discounted over 30% from what they legitimately earn,  will be based - not on proper procedures - but on successful outcomes.  So now your physician would be held responsible for your adherence to instructions, for your taking your medications, and for all the other stupid life-style things that you might do...in addition to having chosen the wrong genetic stream at conception.
2. "Cultural Competency Training".  Physicians  may be required to handle not only the medical problems of that patient from Haiti, but also to discuss her problem in her mother tongue and with sensitivity to her beliefs in voodoo.
3. There is planned a further decrease in the already borderline reimbursment for treatment of Medicare patients, stretching several years down the road.
4. Some States are considering taxing physicians 1% of their gross income for the permission to take care of Medicaid patients.  Their care, in which most of us participate, is often the most time-consuming and always the very least reimbursed.

GS

FRIDAY through WEDNESDAY, April 22 through 27, 2005

I think we've solved the computer problems, all the result of adding more internet security to this "defective, unreasonably dangerous" hardware and software enterprise (aka. "product liability").

• Iraq.  Politicians are the same everywhere, but the Iraqi politicians are losing their opportunity for democracy, while some of them are losing their lives, as they continue to bicker.  We hope that they don't have to follow America's entire experience, including that of 1860-1865.
• Interesting article in the WSJ today, entitled "The Stars And -stans", about our presence in central Asia.  A good idea, if we can do it without spooking the Russians.  That would be too high a price to pay.
• Our American apologists for the U.N., in Congress and in the State Department, are still fighting the idea of taking a good dose of Castor Oil, in the person of John Bolton, to purge that body.  What is hardest to take is the actions of Republican "fellow travelers".  What a bunch.  The word "Whus" comes to mind.  This battle should not be lost.
• More about "Freedom from Religion".  Based upon the recent pseudo-furor raised by untra-liberals regarding perfectly rational and obvious comments recently made by Senator Frist,  they have long since replaced George Carlin's famous dirty words of the 1960's with "religion" and "morals".  Now, that to them is progress.
• Another flap, over criticism of judges, suggests that such actions are un-American.  Not only has that been going on for two centuries; but the Judiciary opens itself to fair criticism when it fails to follow the long tradition of avoiding "political questions", a notorious more recent example of which was Roe v Wade.  Act like craven politicians...take your lumps.
• Yet another controversy is over the "nuclear option", aka "democracy".  The filibuster is a useful shield.  But when it is used as a sword, that's what un-democratic.
• Visitors to this section will know my views on stem cell research.  (See also the Category entitled "Abortion" on this web-site).  But the National Academies have just published a useful set of "ethical guidelines" for this area of research...not complete or consistent with moral behavior, but useful nevertheless.  See WSJ, yesterday, Marketplace, pB1.
• An important article on race and racism appeared yesterday in the WSJ entitled "Crippled By Their Culture", by Thomas Sowell (WSJ yesterday, Opinion, pA14).  A clear statement on the subject, in the midst of all the politically correct tripe, is a welcome breath of fresh air.

WEDNESDAY and THURSDAY, April 20 and 21, 2005

We have some catching up to do.

• Pope Benedict XVI.  As suggested in the offering dated April 2-9, the selection of Cardinal Ratzinger points to a period of stabilization in a Church which has had to endure some unsettling tremors in the last few years.  Whether this Pope is  a "traditionalist" or a "conservative", there will be no question regarding where "true North" lies. There are too many "cafeteria Catholics" and secularists out there for whom it may well be said: "We sure don't know where we're going...but we're making good time".  With leaders like this Pope, and like the recently departed one, they will always know where they are going.
• The new Diet Pyramid.  Talk about a camel being a horse designed by committee. This latest offspring of our constantly pregnant Government seems to be the predictable result of a liason between all kinds of lobby groups and a "loose woman".  Anyone interested in a diet approach and life-style that is simple, tested over many generations and clear...check out the Mediterranean Diet and our web site on the subject (www.medidietresources.com).
• As a physician, am I required to prescribe the latest abortion pill, called the "morning after pill"?  Hell, no.  Then why should any pharmacist be required to dispense it if doing so is counter to his or her moral principles?  The liberals and fellow-travelers in our society continue to provoke decent people with these antics.  The approach to this cancer eating away at our national stamina is clearly articulated by David Brooks today in the NYTimes ("Roe's Birth, and Death", Op-Ed, pA23).  "The fact is, the entire country is trapped.  Harry Blackmun and his colleagues suppressed that democratic abortion debate the nation needs to have.  The poisons have been building ever since.  You can complain about the incivility of politics, but you can't stop the escalation of conflict in the middle.  You have to kill it at the root.  Unless Roe v. Wade is overturned, politics will never get better".
• Talk about provocation, gays are now pushing to legitimize sodomy in the military...and some of the Military Brass are going along!  Fellas, check out Iraq.  Don't you have something better to do...after you screwed it up in the first place?
• By contrast, I think that the State of Connecticut did a reasonable thing by making "civil unions" legal while clearly defining "marriage" as the union between a man and a woman.  We should encourage committment, responsibility and monogamy among a group generally noted for the opposite.

MONDAY and TUESDAY, April 18 and 19, 2005

Let's continue with Sunday's effort at common sense approaches to serious national problems.  Our leaders certainly don't seem to be helping here, despite some refreshing insights and efforts from the President.

• Our trade deficits with nations like China and Japan.  It's time to stop playing by their unfair rules...just for the benefit of a few large corporations with very effective lobbyists.  Globalization will not help us, nor the other developed countries, and certainly not the developing countries, until we all eliminate all protectionist efforts and produce a level economic playing field.  That does not mean giving hand-outs to anyone.  It means providing infra-structure and expertise in return for some raw materials and for open markets.
• Security.  We need "cops and robbers", and we certainly need the cops working with each other (among the 30-odd different national security agencies).  We also need a secure cyberspace  - certainly not the case now.  My suspicion is that this is how the producers of hardware and software want it, to enable secondary and tertiary markets of profit to exist...and the consumer be damned.  It may take a Federal crackdown akin to the approach to racketeering, or it may take some class action suits, to correct this.  The present situation is like living in an inner city with all doors and windows unlocked.  Not smart...and with predictable results.  See also my recent comments in this section on the possible coming vigilantism.
• Finally, immorality, amorality, morality and Freedom of (not from) Religion.  Society can only survive and thrive with a inate sense of individual responsibility, an awareness of "The Power Of We" (see the new book by Jonathan M. Tisch, John Wiley and Sons, New Jersey, 2004), and the acknowledgement of the existence of a Supreme Being to whom we are all responsible.  In this category, Americans are leading their leaders...a good sign.

FRIDAY through SUNDAY, April 15 throiugh 17, 2005

If a massive institution like the Catholic Church can seek periodically to re-invent itself, upon the death of its earthly leader, and within the limits of its "constitution", why not the United States.  The last time we did this intentionally was during the Great Depression of the 1930's under FDR (whose story will be told on the History Channel tonight at 9:00 PM).  A cogent argument can be made that this country today faces challenges no less severe than during those dark days.  So, similarly to the "thinking outside the box" that FDR used to "lead us out of the desert" ( then, as now, assisted by despots and foreign dangers), let's do a little of the same regarding national problems facing us today.

• Health Care Costs and Coverage.  Expand Medicare and Medicaid (Federally, not at the whim of individual States) to cover the elderly and the truly needy.  End the stupidity of having removed the consumer-patient from the financial impact of his health care needs and choices...and replace "managed care organizations" with "Health Savings Accounts" which will reward or punish those choices.  Right now, we are all in a "lose-lose" situation.
• Our Energy needs.  As New Yorkers were used to reading on signs all over New York City in the days of Robert Moses, "Dig we must, for a better"...and more secure U.S.  We must become more energy-independent and soon!  And we must reward and punish related public choices regarding energy utilization...like massive SUV's, etc.
• The failure of Public Education.  Inject and maximize choice in the system in every way...and to hell with the obstructionism of the UFT and the NEA.  Students of other countries are beginning to "eat our lunch", literally and figuratively.
• The Budget Deficit and the average American's tax burden.  Eliminate corporate welfare in all its forms; and replace the current tax morass with a "Flat Tax", without deductibles or exemptions.  This would produce both simplicity and a much greater return to the Federal coffers than is now the case.
• "That great sucking sound" of inevitable glogbalization eliminating great sectors of our economy, like the textile industry.  Create a massive re-education and re-training program, like the WPA and the CCC of another era, for workers who find themselves abandoned in these industries.
• No control over our borders.  Establish a workable mechanism of tracking immigrants, (like an ID card, including the driver's license), at least until they become American citizens.  And control that great magnet - jobs - by making employers legally responsible for monitoring their hires.
• I'm on a roll.   More to come...

WEDNESDAY and THURSDAY, April 13 and 14, 2005

• Connecticut may become the first State in the Union to legitimize "civil unions" without a command from the courts.  Civil unions with amendment defining "Marriage"...SI; CIVIL UNIONS WITHOUT AMENDMENT DEFINING "MARRIAGE"...NO.
• What's going on here? Are we getting back to the personal law of the Old West, even before Judge Roy Bean, when Justice came out of a gun barrel? We now have vigilantes on our southern border.  We have 80% of our States now allowing citizens to carry concealed weapons (see "Gun Debate Favors Easier Access, Fewer Rules", The Day, Sunday, April 10, 2005, Nation, pA4).  We might as well take the next, logical step and develop "well-ordered" militias, as provided by our U.S. Constitution.  But do we really want to foster the developing perception that our elected government cannot protect us?  Our fearless leaders are certainly taking us in that direction.

SUNDAY through TUESDAY, April 10 through 12, 2005

The post- Pope John Paul ll Church: everyone has an opinion.  But this time, given the extraordinary attention accorded to this great man and to his work, everyone has a right to have one.  Here are some recent newspaper article titles:  “IS IT TIME TO DOWNSIZE THE PAPACY?”  “POLLS: AMERICAN CATHOLICS WANT REFORM ON CELIBACY, WOMEN PRIESTS.”  “NEW POPE MUST CONFRONT A WANING CHURCH”.  And then there’s the loopy “FLAG-WAVING FOR FAVORED RELIGIONS”.   Our own New London City Manager, Richard Brown, answered this last one quite adequately: “I think the Pope ended up being considered a world leader...I don’t see a church/state issue here.  The Pope, even though he’s head of the Church, was also the head of a sovereign State.”

Democrats: now there’s a chronic disease!   I’m really not much inclined to take on the case. But, as a physician, I just can’t help myself.   See “Why The Democrats Are Losing The Culture Wars”, by Dan Gerstein, WSJ, Monday, April 11, 2004, Opinion, pA22.

John Bolton: just the dose of Castor Oil that the chronically constipated U.N. needs to purge itself.

Here’s another important article by Thomas L. Friedman.  Read it, weep, and then let’s get going: “It’s A Flat World, After All”, The New York Times Magazine, April 3, 2005, p33.

GS

MONDAY through SATURDAY, April 4 through 9, 2005

It is awe-inspiring, and also scary, to witness how much difference, despite the size and diversity of this world’s population, one person can still make...for good or for evil.  After the likes of Hitler and Stalin,  Pope John Paul ll’s example for good nearly put the scales of the 20th century back even.  What a ride.

And now the world goes on.

• The College of Cardinals can now decide to have the Church catch its collective breath, or rather to continue to break new and fertile ground for God.  For the former choice it may elect Cardinal Ratzinger.  For the latter, it may elect a Pope from Africa or from Latin America.  My hope is for the latter.
• The news from the world of business continues to support my conclusion, drawn from education, training and experience: “Business Ethics” is an oxymoron.
• Health care costs continue to be talked about, with no desire in evidence to address root causes.  I was recently amazed to read that GM has for many years paid All of the costs for its employees health plans.   What stupidity!  Folks, please refer to my writings on the subject going back to the late-1970’s (found on this web site).  You have only two rational choices: either continue to demand and get the best and ever-expanding health care...and pay whatever % of the Gross Domestic Product that that requires.  Or agree to a fair and medically sound system of Rationing, to be applied to everyone...without reference to ability to pay.  Of course, there is another, irrational choice:  dis-assemble the best health care system in the world, in terms of quality and availability, through a variety of current and proposed mechanisms that have nothing to do with root causes.  But please, don’t talk to me about the health care hypocracies of Canada, England or Europe.  Except for that, the choice is yours.

FRIDAY through SUNDAY, April 1 through 3, 2005

His Holiness Pope John Paul II is Dead.   It’s one thing to anticipate it.  It’s another to experience it.  The sense of sadness is a little surprising, but not if we realize how much we had come to respect, love and depend upon this Saint in our midst as a sturdy compass in a stormy sea.  In addition,  my wife and I both have personal reflections about this man.

In 1979, just after he was elected Pope and before he had returned in triumph to his native land, my wife and her mother visited Poland, and including Wadowice, the Pope’s home town.  There they were allowed to enter and view the apartment where he had lived for many years.

In 2002, after our first child had contracted Hodgkin’s Disease in a particularly virulent form, we wrote a letter from a mother and father to the Holy Father requesting his personal prayers for Maura. The letter was sent through our Bishop to Washington and then to the Vatican.  A few weeks later we received a reply from the Pope’s personal secretary, confirming that Pope John Paul had received our letter and had granted our wish.  That helped to sustain us during the following very difficult year...and even since Maura’s death two years ago this month.

We miss Maura greatly.  But we know that she...and now also her benefactor...are both in an eternally better place.  God Bless Them Both.

GS