Rough Men

We sleep soundly in our beds at night because rough men stand ready to do violence on our behalf. Churchill

This is on the wall of the Memorial at Coville, France. A few yards from Omaha Beach. Yet another reminded of what one group of people were willing to do for another. Rest in Peace and never be forgotten.

As a surgeon with gray hair, I can say without reservation, as Medicare implodes in 20 years (not next year or the year after) there are really only five steps that can be taken to halt the decline of American health care as we know it.
1. Evidence based, compassionate rationing. Should a bed bound 85 year old patient be given a pacemaker just because we can?
2. Tort reform. I always base things I do and order on the circumstance of trying to explain on the witness stand why I did or didn't do somehting to a jury not of my peers. So far, it's worked. I have not been sued.
3. Get rid of all this paperwork. One chart I just peer-reviewed for a complicated 2 week stay in the hospital was 500 pages long. Standardize all of this so a hospital in Brooklyn is the same as one in Walla Walla.
4. Focus the research so that the next expensive test or therapy is affordable and practical.
5. Incentivize the practice of medicine so it once again becomes a noble profession and it's doctor-patient not doctor-client...

Bombing

Some very favorable reviews for the novel. Thank you for all the kind words. The next one, The Business of Killing, is in the works and should be ready by the fall. Philip Roth said, The idea is to turn flesh and blood into literary charcters and literary characters into flesh and blood. Nobody told me it would be this much fun, though. Wes

Have a healthy day

I just thought you should know:

An Indianapolis doctor's letter to Sen. Bayh about the Bill (Note: Dr. Stephen E. Frazer, MD practices as an anesthesiologist in Indianapolis, IN ) Here is a letter I sent to Senator Bayh.. Feel free to copy it and send it around to all other representatives. -- Stephen Fraser Senator Bayh, As a practicing physician I have major concerns with the health care bill before Congress. I actually have read the bill and am shocked by the brazenness of the government's proposed involvement in the patient-physician relationship. The very idea that the government will dictate and ration patient care is dangerous and certainly not helpful in designing a health care system that works for all. Every physician I work with agrees that we need to fix our health care system, but the proposed bills currently making their way through congress will be a disaster if passed. I ask you respectfully and as a patriotic American to look at the following troubling lines that I have read in the bill. You cannot possibly believe that these proposals are in the best interests of the country and our fellow citizens. Page 22 of the HC Bill: Mandates that the Govt will audit books of all employers that self-insure!!Page 30 Sec 123 of HC bill: THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you get.Page 29 lines 4-16 in the HC bill: YOUR HEALTH CARE IS RATIONED!!! Page 42 of HC Bill: The Health Choices Commissioner will choose your HC benefits for you. You have no choice!Page 50 Section 152 in HC bill: HC will be provided to ALL non-US citizens, illegal or otherwise. Page 58 HC Bill: Govt will have real-time access to individuals' finances & a 'National ID Health card' will be issued! (Papers please!) Page 59 HC Bill lines 21-24: Govt will have direct access to your bank accounts for elective funds transfer. (Time for more cash and carry) Page 65 Sec 164: Is a payoff subsidized plan for retirees and their families in unions & community organizations: (ACORN).Page 84 Sec 203 HC bill: Govt mandates ALL benefit packages for private HC plans in the 'Exchange.' Page 85 Line 7 HC Bill: Specifications of Benefit Levels for Plans -- The Govt will ration your health care! Page 91 Lines 4-7 HC Bill: Govt mandates linguistic appropriate services. (Translation: illegal aliens.) Page 95 HC Bill Lines 8-18: The Govt will use groups (i.e. ACORN & Americorps to sign up individuals for Govt HC plan.Page 85 Line 7 HC Bill: Specifications of Benefit Levels for Plans. (AARP members - your health care WILL be rationed!) Page 102 Lines 12-18 HC Bill: Medicaid eligible individuals will be automatically enrolled in Medicaid. (No choice.)Page 12 4 lines 24-25 HC: No company can sue GOVT on price fixing. No "judicial review" against Govt monopoly.Page 127 Lines 1-16 HC Bill: Doctors/ American Medical Association - The Govt will tell YOU what salary you can make.Page 145 Line 15-17: An Employer MUST auto-enroll employees into public option plan. (NO choice!)Page 126 Lines 22-25: Employers MUST pay for HC for part-time employees ANDtheir families. (Employees shouldn't get excited about this as employers will be forced to reduce its work force, benefits, and wages/salaries to cover such a huge expense.)Page 149 Lines 16-24: ANY Employer with payroll 401k & above who does not provide public option will pay 8% tax on all payroll! (See the last comment in parenthesis.) Page 150 Lines 9-13: A business with payroll between $251K & $401K who doesn't provide public option will pay 2-6% tax on all payroll. Page 167 Lines 18-23: ANY individual who doesn't have acceptable HC according to Govt will be taxed 2.5% of income.Page 170 Lines 1-3 HC Bill: Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay.) (Like always)Page 195 HC Bill: Officers & employees of the GOVT HC Admin.. will have access to ALL Americans' finances and personal records. (I guess so they can 'deduct' their fees) Page 203 Line 14-15 HC: "The tax imposed under this section shall not be treated as tax." (Yes, it really says that!) ( a 'fee' instead) Page 239 Line 14-24 HC Bill: Govt will reduce physician services for Medicaid Seniors. (Low-income and the poor are affected.) Page 241 Line 6-8 HC Bill: Doctors: It doesn't matter what specialty you have trained yourself in -- you will all be paid the same! (Just TRY to tell me that's not Socialism!)Page 253 Line 10-18: The Govt sets the value of a doctor's time, profession, judgment, etc. (Literally-- the value of humans.)Page 265 Sec 1131: The Govt mandates and controls productivity for "private" HC industries. Page 268 Sec 1141: The federal Govt regulates the rental and purchase of power driven wheelchairs. Page 272 SEC. 1145: TREATMENT OF CERTAIN CANCER HOSPITALS - Cancer patients - welcome to rationing! Page 280 Sec 1151: The Govt will penalize hospitals for whatever the Govt deems preventable (i.e...re-admissions).Page 298 Lines 9-11: Doctors: If you treat a patient during initial admission that results in a re-admission -- the Govt will penalize you. Page 317 L 13-20: PROHIBITION on ownership/investment. (The Govt tells doctors what and how much they can own!) Page 317-318 lines 21-25, 1-3: PROHIBITION on expansion. (The Govt is mandating that hospitals cannot expand.) Page 321 2-13: Hospitals have the opportunity to apply for exception BUT community input is required. (Can you say ACORN?) Page 335 L 16-25 Pg 336-339: The Govt mandates establishment of=2 outcome-based measures. (HC the way they want -- rationing.) Page 341 Lines 3-9: The Govt has authority to disqualify Medicare Advance Plans, HMOs, etc. (Forcing people into the Govt plan) Page 354 Sec 1177: The Govt will RESTRICT enrollment of 'special needs people!' Unbelievable! Page 379 Sec 1191: The Govt creates more bureaucracy via a "Tele-Health Advisory Committee." (Can you say HC by phone?) Page 425 Lines 4-12: The Govt mandates "Advance-Care Planning Consult." (Think senior citizens end-of-life patients.) Page 425 Lines 17-19: The Govt will instruct and consult regarding living wills, durable powers of attorney, etc. (And it's mandatory!) Page 425 Lines 22-25, 426 Lines 1-3: The Govt provides an "approved" list of end-of-life resources; guiding you in death. (Also called 'assisted suicide.')(Sounds like Soylent Green to me.) Page 427 Lines 15-24: The Govt mandates a program for orders on "end-of-life." (The Govt has a say in how your life ends!) Page 429 Lines 1-9: An "advanced-care planning consultant" will be used frequently as a patient's health deteriorates. Page 429 Lines 10-12: An "advanced care consultation" may include an ORDER for end-of-life plans.. (AN ORDER TO DIE FROM THE GOVERNMENT?!?) Page 429 Lines 13-25: The GOVT will specify which doctors can write an end-of-life order.. (I wouldn't want to stand before God after getting paid for THAT job!) Page 430 Lines 11-15: The Govt will decide what level of treatment you will have at end-of-life! (Again -- no choice!) Page 469: Community-Based Home Medical Services = Non-Profit Organizations. (Hello? ACORN Medical Services here!?!) Page 489 Sec 1308: The Govt will cover marriage and family therapy. (Which means Govt will insert itself into your marriage even.) Page 494-498: Govt will cover Mental Health Services including defining, creating, and rationing those services. Senator, I guarantee that I personally will do everything possible to inform patients and my fellow physicians about the dangers of the proposed bills you and your colleagues are debating. Furthermore, if you vote for a bill that enforces socialized medicine on the country and destroys the doctor-patient relationship, I will do everything in my power to make sure you lose your job in the next election. Respectfully, Stephen E. Fraser, MD

Change We Can Believe In

Many people maintain the assumption that Americans are complacent and stupid. Seeing the crazy things that happen in this country on a daily basis, it is hard to argue with that sometimes. But Americans know when they are being threatened and know when they are being lied to. They abhor hypocracy (usually) unless they are in love with the hypocrite. Once committed to an idea or an ideal they are frequently unmoved by fact or reality. But all notions, ideals and belief systems have tipping points. All of them. Actions have consequences but so do inactions. It is time we put honor and dignity back in our lives, hold each other accountable and educate ourselves to the sometimes bitter truths of common sense and a plain talk. Cheers

The Bombing Of Dresden

Today, tomorrow and Monday mark the 65th anniversary of the bombing of Dresden. On those days RAF BomberCommand and Divisions of the USAAF VIII Bomber Command bombed Dresden unleashing a firestorm that consumed 15 square miles of the center of the city and killed between 18 and 25 thousand people. Even more controversial than the nuclear bombings of Hiroshima and Nagasaki, this remains one of the most inexplicable acts by the Allies during World War II. Some have argued it was a legitimate strategic target, an industrial and communications center that the Russians wanted destroyed to assist their offensive into Germany. Many have doubted thay assertion.

What is important here, I believe, is the myopia imposed by hindsight and revisionism. One must always put the act within the context of the thinking of the commanders "on the ground" at the time such decisions were made. To judge now, even based on the historical record, deprives the advocate and the critic of the contextual thinking. In other words, we will never know what was truly going on "inside their heads" 65 years ago. One can only guess. Any answer could be the right one.