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DJP Update 9-7-2010 Press conferences re PPACA, Malpractice, Medicaid, & ER use

DJP Update 9-7-2010 Press conferences re PPACA, Malpractice, Medicaid, & ER use

Today Health Affairs had a press conference regarding two articles in Health Affairs.  I did not participate in that conference.  However, my comments about two of the papers presented were requested for an article in MedPageToday.  The MedPage Article by Peggy Peck is below with a Weblink.

In addition, I participated in a press conference held in Washington, DC.  Other members of the panel who spoke and then answered questions from the press are listed below in this excerpt from the press release:

The American Action Forum will host a press conference on Tuesday, September 7 at 1:00PM (EDT) to discuss costly care delivery problems that went unaddressed and have worsened as a result of the healthcare reform law.

  

WHAT: The American Action Forum will host a press conference to discuss “Medical Liability, Medicaid, and Emergency Room Use: What Does Health Reform Mean?”

 WHO:

§  Douglas Holtz-Eakin, President of the American Action Forum

§  Dr. Donald Palmisano, Clinical Professor of Surgery and former AMA President 

§  Grace-Marie Turner, President of the Galen Institute 

§  Jim Copland, Direct of the Manhattan Institute’s Center for Legal Policy

§  Edmund Haislmaier, Senior Research Fellow at the Heritage Foundation

———-

 A podcast of this press conference will be available soon at the American Action Forum Website.  I will send the link when it is available.  Some great comments about statistics and what is put in numerator and denominator when calculating percentages.  Very interesting.  If you put all health care costs for entire system in denominator and only put a subset of individuals in the numerator, you get a lower percentage.  Basic statistics!

MedPageNow article follows:
http://www.medpagetoday.com/PracticeManagement/Medicolegal/22051

Malpractice Adds Less than 3% to Healthcare Tab

By Peggy Peck, Executive Editor, MedPage Today
Published: September 07, 2010

 

Costs associated with medical malpractice added about $55.6 billion to the nation’s total healthcare costs in 2008 — roughly 2.4% of a more than $2.3-trillion tab — and most of that money went to pay for tests, procedures, and treatments associated with defensive medicine, according to an analysis by Harvard researchers.

The estimate by a research team that included Atul A. Gawande, MD, of Harvard Medical School, is considerably less than “some imaginative estimates put forth in the health reform debate, and it represents a small fraction of total healthcare spending. Yet in absolute dollars, the amount is not trivial,” they wrote.

The analysis was published online today and in the September issue of Health Affairs as part of a package of articles aimed at exploring “Physicians’ Misperception of Malpractice Lawsuits,” according to a press release issued by the journal.

A second paper by J. William Thomas, PhD, of the Cutler Institute for Health and Social Policy at the University of Southern Maine, in Portland, and colleagues, analyzed the costs of defensive medicine across 35 medical specialties and concluded that “defensive medicine practices exist and are widespread, but their impact on medical costs is small.”

So small, they wrote, that tort reform changes that would reduce medical malpractice premiums by 10% would only reduce the nation’s total medical costs by 0.120% to 0.134%.

Taken together, the papers suggest that promoting tort reform as a means to control healthcare costs is a straw man, and their conclusions run contrary to the figures cited by supporters of tort reform.

For example, Rep. Darrell Issa (R-Calif.), in an opinion column posted on Politico in the height of this year’s healthcare reform debate, wrote, “Defensive medicine — when doctors order unnecessary and usually expensive tests and procedures in order to avoid lawsuits — is a major contributor to skyrocketing healthcare costs. As much as $210 billion is spent on defensive medicine annually — equal to $700 for every U.S. man, woman and child. This helps drive up insurance premiums that are already too high for many Americans.”

And Donald J. Palmisano, MD, JD, of Metairie, La., told MedPage Today $55 billion a year is real money. In an e-mail, Palmisano, who is a former president of the American Medical Association and a well-known campaigner for tort reform, pointed out that $55 billion adds up to “over half a trillion dollars in 10 years!”

Yet even as they characterized such estimates as “imaginative,” the Harvard researchers were not unsympathetic.

Michelle M. Mello, JD, PhD, of the Harvard School of Public Health; Amitabh Chandra, PhD, of the John F. Kennedy School of Government at Harvard; Gawande; and David Studdert, LLB, ScD, of the University of Melbourne School of Law in Melbourne, Australia, pointed out that some malpractice costs “stem from meritless malpractice litigation,” which, they concede, is “particularly objectionable to healthcare providers.”

Meritless malpractice suits are so objectionable, Mello and colleagues wrote, that “the psychological and political value of addressing this grievance could be considerable.”

Mello and colleagues broke down the costs of malpractice this way:

  • Indemnity payments: $5.72 billion, of which $3.15 billion represents payment for economic damages, $2.4 billion for noneconomic damages, and $0.17 billion for punitive damages.
  • Administrative expenses: $4.13 billion, which includes $1.09 billion in fees to defense attorneys and $3.04 billion in overhead expenses. (Estimated fees to plaintiffs’ attorneys were $2 billion, but that amount is included in indemnity payments.)
  • Defensive medicine costs: $45.59 billion, of which $38.79 billion was estimated as the costs of hospital services and $6.80 billion as physician services.

 

Another $0.20 billion was added to the estimate to cover other costs, including lost physician work time — the authors estimated that physicians lose 2.7 to five working days for each malpractice suit — and the cost of “reputational and or emotional harm” to the defendant physician.

Although they didn’t find much benefit in tort reforms that put caps on noneconomic damages, Mello et al. did conclude that collateral source offsets appear to work, and, in this case, the new healthcare reform law, known as the Affordable Care Act (ACA), may be helpful to tort reform advocates.

The ACA will eventually require all individuals to obtain health insurance, and in states that have already adopted collateral source offsets — which prohibit malpractice awards from covering expenses already covered by health insurance — “greater prevalence of insurance will mean more frequent offsets, lower total indemnity payments, and less ‘double payment’ of medical expenses,” they wrote.

Thomas and colleagues, meanwhile, concluded that even if tort reform wouldn’t save much money, it doesn’t mean that Congress should back away from tort reform that would place a cap on damages and attorneys’ fees because “even this small cost [of defensive medicine] should be eliminated from the system.”

Palmisano echoed that sentiment and pointed out that Thomas et al. did not consider the implications of “negative” defensive medicine, a term that refers to the practice of physicians either leaving medicine altogether or closing practices in areas considered litigious.

“The implications for patients who can’t find a doctor in the hour of need should not be forgotten as doctors leave areas that do not have meaningful medical liability reform,” Palmisano said.

———– END OF MEDPAGENOW ARTICLE. ———–

Some of the recent tweets at www.twitter.com/DJPNEWS

  1. Paul #Gigot & Journal Editorial Report show yesterday: critical analysis taxes, depressed economy & nailed #spin of politics #WSJ1:04 PM Sep 5th via Echofon
  2. Holiday #safety tips: take extra care driving in shopping centers, some don’t follow road; caution with home repairs esp ladders!12:24 PM Sep 5th via Echofon
  3. NBC’s #Gregory #MeetThePress superb show today; many views; factual responses by #Graham (SC) #Lowey & #Cook; some others = elec #spin12:05 PM Sep 5th via Echofon
  4. Leadership! RT @TheSaints Drew Brees key ingredient..New Orleans Saints’ recipe for success – NOLA.com http://is.gd/eW4iX #Saints7:28 AM Sep 5th via Echofon

———-
Lagniappe:  Heading out to Oregon later this week to deliver 3 speeches there.  The joy of travel!
Stay well!  And get more folks to join DJP Update and www.twitter.com/DJPNEWS  We have a short time to get the message out before the upcoming Congressional session and the NOVEMBER Elections!  The more we communicate, the greater is the chance we can get meaningful health system reform including medical liability reform.  The current system is collapsing because of wrong policies out of Washington, DC.  Better to fix the problem then have a complete collapse.  Communicate & Act!  Remember “Facts don’t cease to exist because they are ignored”.  PPACA is a disaster. Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at:  http://www.intrepidresources.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432 Metairie, Louisiana USA 70006
504-455-5895 office 504-455-9392 fax
DJP@intrepidresources.com
www.intrepidresources.com
www.onleadership.us

This DJP Update goes to 2290 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends. You can share it with your members and it has the potential to reach 800,000 physicians. To join the list, send me an  email stating “Join DJP Update” To get off the list, state ” Remove DJP Update” in subject line.

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DJP Update 9-2-2010 Health System meltdown in progress: PPACA making it worse; Lagniappe: Hug a loved one, especially on birthdays!

“Facts don’t cease to exist because they are ignored.”  Great quote by Aldous Huxley and applicable today with PPACA, the 2400 page plus healthcare law of disasters that will not enhance quality, will not decrease cost spent on medical care, and will not increase access to medical care.  And just wait until you see all of the regulations that will be the evil twin of this law!  The meltdown will get worse.  We must act before it is too late.  Get involved!  Time is of the essence.  Grousing around the coffee pot won’t fix the problem.
Some facts:  

1- Medicaid is a failed system.  Putting millions of additional patients on Medicaid will not fix the failure.  Instead it is a cruel hoax on Americans to claim that having a Medicaid card is access to medical care.
2- Medicaid is a price-fixed payment scheme that pays less than the cost of delivering the care to patients.  History teaches that such price-fixing leads to decrease of service or loss of the product.  The patient suffers.  The doctors flee the system.  But the central planners says they know better.  Here are some breaking news facts to add to the abundance from the history books worldwide.  Folks can spin PPACA any way they want but the facts remain.  Gravity exists.  Failed experiments will fail again if nothing is changed in the experiment.  

Read these tweets I did today about what is happening in Louisiana.  The Louisiana State Medical Society (LSMS) has the survey of Louisiana doctors who are not taking Medicaid patients at:  http://tinyurl.com/2g235dd  Over 1/2 not taking new Medicaid patients.  95% find it difficult to find consultants to refer patients to.

By the way, LSMS is now tweeting with the ID LaMedSoc    (Someone else had LSMS) Here is my tweet with the info:   The Louisiana State Medical Society is now on Twitter as @LaMedSoc Go to twitter.com/LaMedSocto join as a followerabout 6 hours ago via web

——-

More tweets from www.twitter.com/DJPNEWS

  1. Latest tweet Medicaid cuts is another example of failed Fed gov programs even when admin by state. #PPACA continues failureabout 6 hours ago via web
  2. Read about 2 years Medicaid cuts about to be implemented in Louisiana at LSMS Website plus survey http://tinyurl.com/2g235ddabout 6 hours ago via web

——-

Medicaid ins doesn’t = find doc: pay so low. LSMS: >1/2 docs no new #Medicaid & 25% consid..; 95% docs difficulty referrals #hcrabout 10 hours ago via Echofon

——–
And check out this press release from Louisiana Department of Health & Hospitals Secretary (more facts that won’t cease to exist by being ignored) http://www.dhh.la.gov/news.asp?Detail=1633

EXCERPT: (but read entire press release at link)


Wednesday, May 26, 2010
Contact: Lisa Faust; (225)342-7913 or (225)252.3579 (cell)

 

DHH Secretary Releases State Data on Costs of Federal Health Reform in Response to National Report Issued Today

 

Kaiser Family Foundation Study a Good Start, but is Limited in Scope and Does Not Account for Real Policy Costs States Must Consider

BATON ROUGE—Federal health care reform could cost Louisiana taxpayers in excess of $6 billion over 10 years once implemented, Louisiana Department of Health and Hospitals Secretary Alan Levine announced today in response to a report by Kaiser’s Commission on Medicaid and the Uninsured.

…. Finally, DHH disputes any conclusion that the impact of reform on states is “relatively small.”  To be sure, the impact is significant, particularly given the difficulty faced in the current budget climate.  

“It is not appropriate to ignore the real policy implications faced by the states,” said Sec. Levine. “To simply enroll more people in a fundamentally broken system where doctors cannot even take care of the people we have today, where hospitals are openly struggling to maintain services at the rates they are currently paid, and where Legislatures are faced with having to make choices between funding the ever-growing costs of Medicaid and other priorities like education, roads and public safety,  we simply don’t know how anyone can say with a straight face that the cost impact is ‘relatively small.’ It is relatively large, and our governor and Legislature have the right to understand what the potential implications are.”

——–

LAGNIAPPE  My important thought for today:  Hug a loved one, especially on a birthday!  Life can be fleeting.  Let loved ones know you love them & thank them for all they do.  Robin’s birthday is tomorrow, Sept 3.  She deserves lots of hugs for all she does for me (& putting up with me!).  And yes, call a friend and ask how he or she is doing.  You will feel better and the friend will too.  We are entering tough times and friends and loved ones are especially important in times of stress.  Count on it.

Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at:  http://www.intrepidresources.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432 Metairie, Louisiana USA 70006
504-455-5895 office 504-455-9392 fax
DJP@intrepidresources.com
www.intrepidresources.com
www.onleadership.us

This DJP Update goes to 2281 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends. You can share it with your members and it has the potential to reach 800,000 physicians. To join the list, send me an  email stating “Join DJP Update” To get off the list, state ” Remove DJP Update” in subject line.

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DJP Update 8-21-2010: DJP presenting Tulane Surgical Grand Rounds; AMA tweets about article critical of Florida Medical Association & DJP tweet response plus other tweets; Lagniappe: don’t miss articles

DJP Comment:  In you are in the area or within driving distance, attend Grand Rounds this Wednesday!
Will get into leadership in health system reform and the need to be involved before Medicine is destroyed.
Dr. Doug Slakey, Chair of Surgery Dept at Tulane, asked me to do Grand Rounds.  Details below.
Tulane Surgery Grand Rounds

“Control Your Destiny:
Surgical Leadership”
Presented By
Donald J. Palmisano, MD, JD, FACS
Clinical Professor of Surgery
Tulane Department of Surgery
Clinical Professor of Medical Jurisprudence
& Adjunct Professor
Department of Health Systems Management
Tulane School of Public Health and Tropical Medicine
Wednesday
August 25, 2010
8:00AM – 9:00AM
Room 6065
1430 Tulane Avenue
New Orleans, LA
——-
AMA TWEET:
RT @ FloridaTimesUnion: Guest column: Florida Medical Association is off base fighting reform. http://bit.ly/a1Rdoj5:15 PM Aug 20th via TweetDeck
The two individuals who wrote the guest editorial make comments such as:
——-
“But recently, the AMA became more progressive. It mounted a three-year campaign for universal coverage. It supported government’s efforts to reward the meaningful use of modern computerized tools and the best medical science in clinical practice.
They are incredibly important to us, but over the last half century, American physicians have been handsomely, even often excessively, rewarded.
But now, the system that has been hugely wasteful must find ways to reduce costs while improving quality, and make sure that care is accessible to everyone. These imperatives are emerging just as data and information tools are becoming more available. Health care will become more like a market than before.
Medical practice is changing profoundly, mostly for the better. Doctors will still be highly valued, but many may earn less.
The FMA’s challenge to the AMA was the old guard denouncing the new. But the new way is what mainstream patients, doctors and the people who pay the bills for care desperately need.
It is coming, and the FMA should get on board or out of the way.”
——-
DJP Comment:  Looking forward to AMA tweeting articles written by individuals who point out the flaws in PPACA and why AMA made a mistake supporting the law.
DJP RESPONSE to AMA tweet:
After the column with the view of two individuals writing the column one can find in the response section a “John Galt” response .  The point of my tweet later is that John Galt would never approve of the PPACCA law passed in Congress masquerading as health system reform.  And the “John Galt” who responded obviously disagrees with the column. 
——
“John Galt” column attacking FMA not the view of #JohnGalt of#AtlasShrugged Via @AmerMedicalAssn & @FloridaTimesUnion:http://bit.ly/a1Rdojabout 9 hours ago via Echofon
——-
More recent DJPNEWS tweets:
  1. Be sure to read Wired article. Internet versus Web explained RT @alleyinsider Is The Web Dead? by @fredwilsonhttp://read.bi/bosGcu7:18 AM Aug 18th via Echofon
  2. In #NYC & good meeting with my book publisher today, Skyhorse Publishing. Speech in morning.9:55 PM Aug 11th via web
  3. Interesting. See #NYTimes re Rep Paul #Ryan “Waiting in the Wings…dealmaker” http://tinyurl.com/338cord #hcr9:52 PM Aug 11th via web
  4. R.I.P. former US Rep Dan Rostenkowski at 82. My 1st Cong testimony health system reform: SubComm Health/Ways & Means he chaired in 197610:40 AM Aug 11th via web
  5. www.onleadership.us now has excerpts from “On #Leadership…” book chapters plus interview Gov Bobby #Jindal & his Foreword8:19 PM Aug 10th via web
  6. Summary voters reacting to #hcr & Ct challenges RT @MerrillMatthews Here’s my new piece in Forbes. http://tinyurl.com/2flnwdg8:17 PM Aug 8th via Echofon
  7. Cogent analysis of #hcr & spin RT @MerrillMatthews Here’s my new piece in The Weekly Standard. http://tinyurl.com/29tvkbk8:15 PM Aug 8th via Echofon
  8. RIP: Dave Dixon, a man of big ideas RT @TheSaints Dixon, who was catalyst for Saints & Superdome, dies at 87 http://is.gd/e98u27:20 PM Aug 8th via Echofon
——-
LAGNIAPPE:  
Here is a brand new tweet that gives the full text of one of Winston Churchill’s most famous speeches and a few more articles you may enjoy:

DJPNEWS 

#WinstonChurchill speech “Never in the field of human conflict was so much owed by so many to so few” http://tinyurl.com/2877xjr

DJPNEWS 

Grace-Marie Turner of #Galen in #IBD “Fast Track to Government Health Care” http://tinyurl.com/2b4m5py

Donald PalmisanoDJPNEWS 

He’s unique! #ScottAdams #Dilbert cartoon “How I (Almost) Saved the Earth” in WSJ Weekend Journal http://tinyurl.com/25994ctless than 5 seconds ago via web——–
Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at:  http://www.intrepidresources.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax

This DJP Update goes to 2281 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an  email stating “Join DJP Update”
To get off the list, state ” Remove DJP Update” in subject line.
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DJP Update 7-18-2010 Potpourri of tweets from DJPNEWS since July 12; comment re my philosophy of tweets; Lagniappe

DJP Update 7-18-2010 Potpourri of tweets from DJPNEWS since July 12; comment re my philosophy of tweets; Lagniappe

DJP Comment: Everyone’s life is busy. And for some, following tweets is another demand on time. But the tweet universe is easy to navigate and one can just receive tweets. You can follow anyone you want.

Remember the old advice, by their words and actions you shall know them. Well, I believe you can learn a lot about the person tweeting by just following his or her tweets. Frequently you learn a lot about people you have known for years but who frequently are quiet in groups and rarely express their opinions. It is as though the tweet world for some of these folks opens up their inner thoughts for the world to view. Nothing wrong with that but I find it interesting.

You also will learn the views of the Democrats and the Republicans and their talking points on an issue long before it is stated on radio or TV. You may find you have to spend less time with the “news” programs because you already have the info many hours earlier. Follow those you agree with and those you disagree with. Sometimes you actually learn something!

And thanks to all of you who send me alerts!

———

Tweets and some “Retweets” of others since July 12 by DJP located at www.Twitter.com/DJPNEWS

You can view on Web or have them delivered directly to your PDA BlackBerry, IPhone, Android, etc. with one of the many apps.

——-

Gov control. USA’s future? “Cash crisis in NHS leaves patients..on operating tables” http://tinyurl.com/2usxma6 #hcr#Doctors

3 hours ago

Fineman in #Newsweek re “Obama’s Indie Crash” http://tinyurl.com/25yr7j5 #hcr #election #vote #politics#POTUS #Dem #GOP

about 8 hours ago via Echofon

In book 1984 & MinistryOfTruth & Newspeak? #Pear#NYTimes Admin..defends insur mandate as tax http://tinyurl.com/29ao4a7 #hcr

about 10 hours ago via web

RT @alleyinsider Ex-Googlers launch “newspaper of the future” …designed to drive last nail in coffin of newspapers http://read.bi/b3rAED

about 10 hours ago via web

Yes! Leaders lead! #TimesPicayune ” #Jindal Thrives in Crisis”http://tinyurl.com/2w96qpu #BP #oilspill #JindalNews#BobbyJindal

about 11 hours ago via web

Time will tell RT @flitedocnm …Kagan’s undergrad thesis on socialism: .. excellent writing…all good indicatorshttp://bit.ly/9LQCrA

about 12 hours ago via Echofon

Actions have consequences. Bad law=bad results RT @texmedMedicare rules, cuts push doctors out http://bit.ly/ayWyAk#hcr

about 12 hours ago via Echofon

A president, a master giving speeches, shares wisdom on transparency http://tinyurl.com/kky7h #gov #hcr #1Amend#news #docs

8:20 AM Jul 17th via web

Words of wisdom RT @Peggynoonannyc ..column: “Youth Has Outlived Its Usefulness” http://bit.ly/aFRLSJ

6:32 AM Jul 17th via Echofon

Creative #marketing RT @alleyinsider 7 Social Media Marketing Lessons You Should Learn From The Old Spice Man http://read.bi/9AofIH

6:09 AM Jul 17th via Echofon

That’s fair! RT @washingtonpost RT @postmetro Jobs#iPhone4 ..antenna.. not serious prob..offers..case or full refund: http://wapo.st/cMfmX7

1:38 PM Jul 16th via Echofon

Good news! Don’t give up! RT @washingtonpost The BP well? Still sealed. Whew. Pressure tests continue: http://wapo.st/aeod0n

1:30 PM Jul 16th via Echofon

More articles tax break? plaintiff lawyers RT @sonodoc99@DJPNEWS Yes … there would be fallout. http://tinyurl.com/32mld23

7:27 PM Jul 15th via Echofon

Outrage if true! Tax cuts plaintiff lawyers?http://tinyurl.com/28a3amb #DJPUPDATE http://tinyurl.com/37w7jux #gov #law #tax

6:01 PM Jul 15th via Echofon

Hearing & overview @wsjopinion #Henninger – Berwick Recess Appointment Is Bigger Than Kagan http://tinyurl.com/258roo8 #hcr

6:35 AM Jul 15th via Echofon

Read my friend Dr Bob Thomas of Loyola discuss tar balls from BP oil disaster http://tinyurl.com/27j5j4a #BP #oilspill

2:39 PM Jul 14th via Echofon

Don’t miss #CNN #AndersonCooper video – upset with block media by Admin re #oilspill #BP via @Heritagehttp://tinyurl.com/2a6nnw2

3:44 PM Jul 12th via Echofon

Gov v #FreeEnterprise RT @M_P_T Opinion: Donald Berwick’s Five-Year Plan v. the iPhone http://bit.ly/bQ5q2n Agree?#tcot #hcr

10:57 AM Jul 12th via Echofon

!! RT @Heritage oil drilling ban..killing..Gulf economy. But that doesn’t matter to ..Obama admin. #tcot http://herit.ag/OGK#BP #oilspill

9:39 AM Jul 12th via Echofon

——–

LAGNIAPPE: I was in Atlanta on Wednesday to give a speech to a client of Intrepid Resources. That night Robin and I had the privilege to have dinner with a retired Special Forces Colonel who served in Vietnam as an advisor to the Montagnard troops. Always a privilege to spend time with those who have served our Country with honor and put their lives at risk for our liberty. More on this person in a future update as he is now a published writer of mystery books plus one true crime adventure. I now have 3 of his books to read. Will give you his name when I give you a book review soon.

We also got to spend a few ours with our grandsons while in Atlanta and went to a movie with them and took a walk back to the hotel. Great joy!

Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at: http://www.intrepidresources.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@intrepidresources.com
www.intrepidresources.com
www.onleadership.us

This DJP Update goes to 2263 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

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DJP Update 7-17-2010 A President, a master giving speeches, shares wisdom on transparency

DJP Update 7-17-2010 A President, a master giving speeches, shares wisdom on transparency

DJP Comment: More reflections on messages from the past. An important message about transparency that applies not only to government but all organizations, especially in times of crisis. Balancing and judgment require wisdom. Frequently wisdom is gained by learning from errors. Experience and failures give all of us the opportunity to reflect, correct, and move to success. Implementing lessons learned is evidence of wisdom.

The President and the Press: Address before the American Newspaper Publishers Association

President John F. Kennedy

Waldorf-Astoria Hotel

New York City, April 27, 1961

http://www.jfklibrary.org/Historical+Resources/Archives/Reference+Desk/Speeches/JFK/003POF03NewspaperPublishers04271961.htm

Complete TEXT of speech and also AUDIO of this speech available at this link. Be sure at least take the time to listen to the start of his speech to learn how to warm up the audience for a powerful message.

EXCERPT

It is the unprecedented nature of this challenge that also gives rise to your second obligation–an obligation which I share. And that is our obligation to inform and alert the American people–to make certain that they possess all the facts that they need, and understand them as well–the perils, the prospects, the purposes of our program and the choices that we face.

No President should fear public scrutiny of his program. For from that scrutiny comes understanding; and from that understanding comes support or opposition. And both are necessary. I am not asking your newspapers to support the Administration, but I am asking your help in the tremendous task of informing and alerting the American people. For I have complete confidence in the response and dedication of our citizens whenever they are fully informed.

I not only could not stifle controversy among your readers–I welcome it. This Administration intends to be candid about its errors; for as a wise man once said: “An error does not become a mistake until you refuse to correct it.” We intend to accept full responsibility for our errors; and we expect you to point them out when we miss them.

Without debate, without criticism, no Administration and no country can succeed–and no republic can survive. That is why the Athenian lawmaker Solon decreed it a crime for any citizen to shrink from controversy. And that is why our press was protected by the First Amendment– the only business in America specifically protected by the Constitution- -not primarily to amuse and entertain, not to emphasize the trivial and the sentimental, not to simply “give the public what it wants”–but to inform, to arouse, to reflect, to state our dangers and our opportunities, to indicate our crises and our choices, to lead, mold, educate and sometimes even anger public opinion.

This means greater coverage and analysis of international news–for it is no longer far away and foreign but close at hand and local. It means greater attention to improved understanding of the news as well as improved transmission. And it means, finally, that government at all levels, must meet its obligation to provide you with the fullest possible information outside the narrowest limits of national security–and we intend to do it.

——–

END OF EXCERPT

Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at: http://www.intrepidresources.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@intrepidresources.com
www.intrepidresources.com
www.onleadership.us

This DJP Update goes to 2263 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

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DJP Update 7-15-2010 Special tax break for trial lawyers? If true, this is outrageous!

DJP Update 7-15-2010 Special tax break for trial lawyers? If true, this is outrageous!

Outrageous if the details of the article of July 15, 2010 in Washington Examiner are true. See article below. Thanks to Dr. John Gill for alerting me about this article.

Plaintiff attorneys are not suppose to become owners of lawsuits. in my opinion, by advancing the funds and getting tax advantages, the attorney shows ownership via contingency fee and special provisions that protect the attorney at the expense of the client. I discussed plaintiff attorneys getting ownership of lawsuits and the implications for countersuits in my Loyola Law Review, A Quest for Justice… article in Vol. 27, Number 2, 1981, pages 325-367. Write me if you want a copy.

Meanwhile, the broken liability system will get worse if this tax cut becomes reality. The Nation will be going in the wrong direction. This decreases accountability for attorneys!

No special tax cuts for wealthy trial lawyers

http://www.washingtonexaminer.com/opinion/No-special-tax-cuts-for-wealthy-trial-lawyers-1000453-98448669.html

Facing criticism over massive deficits, President Obama is in no mood to give anyone a tax cut. He’s eager to let President George W. Bush’s tax cuts expire, and he’s blown off his promise not to raise taxes on families making less than $250,000 a year with his tax-hiking health plan and cap-and-trade scheme.

Wealthy trial lawyers, however, may be a different story: Obama is on the verge of giving them a special interest tax break worth $1.6 billion. Legal Newsline reported yesterday that John Bowman, top lobbyist for the American Association for Justice, told a private briefing that Obama’s Internal Revenue Service will soon unilaterally cut their taxes without congressional approval.

The tax break would allow plaintiffs’ attorneys to deduct litigation costs in the same year that they bring contingency lawsuits. Currently, such costs are considered loans to clients, deductible only if and when a case is lost. The loan arrangement exists because most states consider it unethical or even illegal for lawyers to fund their clients’ lawsuits directly.

Last year, the group’s then-chief lobbyist (and now CEO) Linda Lipsen said Democrats in Congress might push the provision through by sneaking it into unrelated legislation. This already-underhanded strategy appears to have failed, and so a supportive Obama administration may simply bypass Congress. It is unconscionable that “spread-the-wealth” Obama should force taxpaying plumbers, waiters and bus drivers across America to shoulder up to 40 percent of the cost of wealthy trial lawyers’ litigation with this tax break. Worse, the tax break provides an effective reduction in lawsuit expenses, freeing up lawyers to file more suits that have less probability of success.

Obama has already given trial lawyers an executive order preventing federal regulations that pre-empt state lawsuits, as well as favorable new laws to increase their business. The current financial reform bill, for example, allows state attorneys general to deputize treasure-seeking trial lawyers to sue under its titles and keep the spoils. But this tax change could be the most odious favor yet to this overwhelmingly Democratic donor group — an insult at a time when small businesses struggle under soon-to-increase tax burdens and prepare to make cutbacks because of the added costs of Obamacare.

The White House declined comment on this issue, referring us instead to the Treasury Department, which also declined comment. But the White House must answer for its actions. Does AAJ, whose top lobbyists have visited the White House at least 13 times since Obama’s inauguration, own this “lobbyist-free” administration?

——————————-

Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at: http://www.intrepidresources.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@intrepidresources.com
www.intrepidresources.com
www.onleadership.us

This DJP Update goes to 2263 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

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DJP Update 7-11-2010 General Douglas MacArthur Farewell Speech to Congress

DJP Update 7-11-2010 General Douglas MacArthur Farewell Speech to Congress

Sometimes when crisis is upon us and each day brings more turmoil in our world I find it helpful to review the words of those who have gone before us in this great Land of Liberty called America. Their words, in time of crisis, sometimes have a lesson for the tribulations of today.

On this day I reflect on a speech I heard as it was being delivered. I was on a playground at a boarding school, St. Paul’s College, in Covington, La., sitting on the grass near a small stream trying to get a radio station to tune in on a small crystal radio, one of my earliest gadgets. Suddenly I got a station and heard General Douglas MacArthur as he gave his farewell speech to Congress after being fired by President Truman. At the time I did not know all of the details that led up to this speech but I sensed that this was serendipity at its best. I was mesmerized by the speech and reflect on the words from time to time.

So, here is the text and a link to a video of the speech. The video is not high definition but the impact, to me, is powerful. See if you find any lessons for today. Reflect, regardless if you are Democrat, Republican, or Independent.

General Douglas MacArthur Farewell Speech to Congress

April 19, 1951

Mr. President, Mr. Speaker and distinguished members of the Congress:

I stand on this rostrum with a sense of deep humility and great pride – humility in the wake of those great architects of our history who have stood here before me, pride in the reflection that this home of legislative debate represents human liberty in the purest form yet devised. Here are centered the hopes and aspirations and faith of the entire human race.

I do not stand here as advocate for any partisan cause, for the issues are fundamental and reach quite beyond the realm of partisan considerations. They must be resolved on the highest plane of national interest if our course is to prove sound and our future protected.

I trust, therefore, that you will do me the justice of receiving that which I have to say as solely expressing the considered viewpoint of a fellow American.

I address you with neither rancor nor bitterness in the fading twilight of life, with but one purpose in mind: to serve my country.

The issues are global, and so interlocked that to consider the problems of one sector oblivious to those of another is to court disaster for the whole. While Asia is commonly referred to as the gateway to Europe, it is no less true that Europe is the gateway to Asia, and the broad influence of the one cannot fail to have its impact upon the other.

There are those who claim our strength is inadequate to protect on both fronts, that we cannot divide our effort. I can think of no greater expression of defeatism.

If a potential enemy can divide his strength on two fronts, it is for us to counter his efforts. The Communist threat is a global one. Its successful advance in one sector threatens the destruction of every other sector. You cannot appease or otherwise surrender to communism in Asia without simultaneously undermining our efforts to halt its advance in Europe.

Beyond pointing out these general truisms, I shall confine my discussion to the general areas of Asia…

While I was not consulted prior to the President’s decision to intervene in support of the Republic of Korea, that decision, from a military standpoint, proved a sound one. As I say, it proved a sound one, as we hurled back the invader and decimated his forces. Our victory was complete, and our objectives within reach, when Red China intervened with numerically superior ground forces.

This created a new war and an entirely new situation, a situation not contemplated when our forces were committed against the North Korean invaders; a situation which called for new decisions in the diplomatic sphere to permit the realistic adjustment of military strategy. Such decisions have not been forthcoming.

While no man in his right mind would advocate sending our ground forces into continental China, and such was never given a thought, the new situation did urgently demand a drastic revision of strategic planning if our political aim was to defeat this new enemy as we had defeated the old.

Apart from the military need, as I saw it, to neutralize the sanctuary protection given the enemy north of the Yalu, I felt that military necessity in the conduct of the war made necessary —

1. The intensification of our economic blockade against China.

2. The imposition of a naval blockade against the China coast.

3. Removal of restrictions on air reconnaissance of China’s coastal area and of Manchuria.

4. Removal of restrictions on the forces of the republic of China on Formosa, with logistical support to contribute to their effective operations against the Chinese mainland.

For entertaining these views, all professionally designed to support our forces committed to Korea and to bring hostilities to an end with the least possible delay and at a saving of countless American and Allied lives, I have been severely criticized in lay circles, principally abroad, despite my understanding that from a military standpoint the above views have been fully shared in the past by practically every military leader concerned with the Korean campaign, including our own Joint Chiefs of Staff.

I called for reinforcements, but was informed that reinforcements were not available. I made clear that if not permitted to destroy the enemy built-up bases north of the Yalu, if not permitted to utilize the friendly Chinese force of some six hundred thousand men on Formosa, if not permitted to blockade the China coast to prevent the Chinese Reds from getting succor from without, and if there were to be no hope of major reinforcements, the position of the command from the military standpoint forbade victory.

We could hold in Korea by constant maneuver and at an approximate area where our supply-line advantages were in balance with the supply-line disadvantages of the enemy, but we could hope at best for only an indecisive campaign with its terrible and constant attrition upon our forces if the enemy utilized his full military potential.

I have constantly called for the new political decisions essential to a solution.

Efforts have been made to distort my position. It has been said in effect that I was a warmonger. Nothing could be further from the truth.

I know war as few other men now living know it, and nothing to me is more revolting. I have long advocated its complete abolition, as its very destructiveness on both friend and foe has rendered it useless as a means of settling international disputes.

Indeed, on the second day of September, 1945, just following the surrender of the Japanese nation on the battleship Missouri, I formally cautioned as follows:

“Men since the beginning of time have sought peace. Various methods through the ages have been attempted to devise an international process to prevent or settle disputes between nations. From the very start workable methods were found in so far as individual citizens were concerned, but the mechanics of an instrumentality of larger international scope have never been successful.

“Military alliances, balances of power, leagues of nations, all in turn failed, leaving the only path to be by way of the crucible of war. The utter destructiveness of war now blocks out this alternative. We have had our last chance. If we will not devise some greater and more equitable system, our Armageddon will be at our door. The problem basically is theological and involves a spiritual recrudescence, an improvement of human character that will synchronize with our almost matchless advances in science, art, literature, and all material and cultural developments of the past two thousand years. It must be of the spirit if we are to save the flesh.”

But once war is forced upon us, there is no other alternative than to apply every available means to bring it to a swift end. War’s very object is victory, not prolonged indecision.

In war there is no substitute for victory.

There are some who for varying reasons would appease Red China. They are blind to history’s clear lesson, for history teaches with unmistakable emphasis that appeasement but begets new and bloodier war. It points to no single instance where this end has justified that means, where appeasement had led to more than a sham peace.

Like blackmail, it lays the basis for new and successively greater demands until, as in blackmail, violence becomes the only alternative. Why, my soldiers asked of me, surrender military advantages to an enemy in the field? I could not answer.

Some may say to avoid spread of the conflict into an all-out war with China. Others, to avoid Soviet intervention. Neither explanation seems valid, for China is already engaging with the maximum power it can commit, and the Soviet will not necessarily mesh its actions with our moves. Like a cobra, any new enemy will more likely strike whenever it feels that the relativity in military or other potential is in its favor on a worldwide basis.

The tragedy of Korea is further heightened by the fact that its military action is confined to its territorial limits. It condemns that nation, which it is our purpose to save, to suffer the devastating impact of full naval and air bombardment while the enemy’s sanctuaries are fully protected from such attack and devastation.

Of the nations of the world, Korea alone, up to now, is the sole one which has risked its all against communism. The magnificence of the courage and fortitude of the Korean people defies description. They have chosen to risk death rather than slavery. Their last words to me were: “Don’t scuttle the Pacific.”

I have just left your fighting sons in Korea. They have met all tests there, and I can report to you without reservation that they are splendid in every way.

It was my constant effort to preserve them and end this savage conflict honorably and with the least loss of time and a minimum sacrifice of life. Its growing bloodshed has caused me the deepest anguish and anxiety. Those gallant men will remain often in my thoughts and in my prayers always.

I am closing my fifty-two years of military service. When I joined the army, even before the turn of the century, it was the fulfillment of all my boyish hopes and dreams.

The world has turned over many times since I took the oath on the plain at West Point, and the hopes and dreams have long since vanished, but I still remember the refrain of one of the most popular barracks ballads of that day which proclaimed most proudly that old soldiers never die; they just fade away.

And like the old soldier of that ballad, I now close my military career and just fade away, an old soldier who tried to do his duty as God gave him the light to see that duty. Good-bye.

———–

Weblink to video of speech: http://www.americanrhetoric.com/speeches/douglasmacarthurfarewelladdress.htm

General MacArthur died at age 84 on April 5, 1964 and is buried at the MacArthur Memorial in Norfolk, Virginia.

—————–

TWEETS recently posted at www.twitter.com/DJPNEWS

Be sure to read the one about the NHS.

Read for sure! RT @sonodoc99@kevinmd @DJPNEWS Copying the NHS is the last thing the US should do. http://tinyurl.com/34hv86t #hcr

about 5 hours ago via Echofon

Wonder why putting uninsured on Medicaid is a mistake in new #hcr law? Better fixes existed! RT @texmed http://fb.me/EERwhnu5

about 10 hours ago via Echofon

Impt! RT @texmed Dallas News graphic compares Medicaid pay.. for common procedures to Medicare, private plans http://ow.ly/29Q9X

about 10 hours ago via Echofon

RT @CariAndRob “For Republicans, the Road Map..congressman Paul #Ryan.. is the most impt proposal in… http://fb.me/Bmq9B2lr #hcr

about 10 hours ago via Twitter for iPhone

Oil spews full blast as expected while attempting to place new cap; sad if fails http://tinyurl.com/2axukt7 #AP #BP #oilspill

about 17 hours ago via Echofon

No need to wonder why taxes high England – generous benefits cost money; expen housing tale http://tinyurl.com/24rk85q #tax

about 17 hours ago via Echofon

Celebrate genes, lifestyle, & modern #Medicine RT @nytimeshealth Turn 70. Act Your Grandchild’s Age. http://nyti.ms/bmY4Wd

about 18 hours ago via Echofon

Critical mass forming to stop the deficit spending, earmarks, etc in #Congress. See @thecontract www.thecontract.org #liberty

4:39 PM Jul 10th via Echofon

Mess! RT @sonodoc99 @DJPNEWS @kevinmd THIS was part of “Healthcare Reform” http://tinyurl.com/25hdkle Where’s that RESET button? #hcr

4:19 PM Jul 10th via Echofon

Interested in list of the “100 Most Powerful Celebrities”? Here is 2010 #Forbes http://tinyurl.com/2aun83w #celebrities

8:11 PM Jul 9th via web

Fascinating! Future #NobelPrize ? “The Light Fantastic” & the brain; #Depression Rx? #Forbes http://tinyurl.com/2vx7sh7

7:54 PM Jul 9th via Echofon

Senators (Drs) #Coburn & #Barrasso report “Bad Medicine” re new federal health law http://tinyurl.com/2c5to2z #hcr#Doctors

4:54 PM Jul 9th via Echofon

—————

Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at: http://www.intrepidresources.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@intrepidresources.com
www.intrepidresources.com
www.onleadership.us

This DJP Update goes to 2263 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

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DJP Update 7-9-2010 late edition – 2nd Update of today; this for breaking news: Death of Dr. Daniel Cloud, former AMA President; Special message from AMA Board Chair re Dr. Berwick

DJP Update 7-9-2010 late edition – 2nd Update of today; this for breaking news: Death of Dr. Daniel Cloud, former AMA President; Special message from AMA Board Chair re Dr. Berwick

DJP Comment: I just got this information, minutes after sending DJP Update 7-9-2010 a few minutes ago.

First, the wonderful Dr. Dan Cloud has died. He was AMA President 1981-82 and was an excellent caring doctor who was kind to all. I knew of him by reputation but then I met him one day in coffee shop of Hilton in Chicago after AMA meeting ended. I told him hello and he invited me to sit with him. He was a great storyteller and always helpful to me. He also wrote a terrific suspense thriller, “The Aesculapian” that dealt with the AMA. Amazon has some copies at http://www.amazon.com/Aesculapian-Dan-Cloud/dp/0913720984

It should have been a best-seller. I encourage you to read it. He will be missed. Robin and I send our sincerest condolences to his family.

Second: I am passing on to you the information I just received from AMA Board Chair about Dr. Berwick and AMA’s support. No further comment by me except to say I don’t recall the 3 person candidate committee during my 9 years on the board. Maybe I need the memory medicine being developed in the NIH tweet I sent a few minutes ago. Regardless of what your view is about the person nominated, it is NOT a good procedure for 3 people to make such decisions as the decisions reflect on the entire AMA. The Board of Trustees has that responsibility for decisions that put AMA on record for such important considerations. Just my opinion!

NOW THE AMA MESSAGE and all of the article quotes are sent by AMA:

A Message from Dr Ardis Hoven, Chair, AMA Board of Trustees on the Berwick Appointment

We want to take this opportunity to address questions and criticism of the decision by the AMA leadership to support the nomination of Dr. Donald Berwick as CMS Administrator.

History

The AMA’s support for Dr. Berwick as CMS Administrator is based on our work with him in his role as the CEO of the Institute for Healthcare Improvement, an award winning partnership with physicians and hospitals to improve quality and patient safety. We announced our support for Dr. Berwick in a press release on April 19, 2010 and it was reported by AM News as well as other media outlets.

CMS has been directed by an Acting Administrator since 2006.

AMA Process For Supporting Candidates for Federal Appointments

For at least two decades, decisions regarding AMA support candidates for federal appointments have been made by the Candidate Selection Committee comprised of the AMA Chair, Chair-elect and AMA President. The full AMA Board does not vote on these matters.

Controversial Statements Made by Dr. Berwick

AMA support for Dr. Berwick is based on our direct involvement with him on quality improvement and patient safety initiatives. Over the years, Dr Berwick has made a number of controversial statements regarding the British health care system, single payer and other issues. The AMA remains a strong opponent of a single payer approach and we do not agree with some other views expressed by Dr. Berwick. That said, we believe Dr Berwick has the leadership track record and expertise to direct CMS activities. A broader perspective on Dr Berwick is provided in the article below developed by the Kaiser Health News.

Whatever Dr Berwick’s personal views may be on policy issues, he cannot operate outside the authority prescribed by Congress.

Recess Appointment

The decision to utilize the authority for a recess appointment is a reflection of the Washington political environment. We do not have control or standing of process issues determined by government leaders. Like others, we believe the committee hearing process and full Senate debate is the preferred course of action. We are also cognizant that Senate rules allow a unified minority to block action by lining up 41 votes to oppose a cloture motion.

The recess appointment authority has been used extensively by President of both parties. President George W. Bush used recess appointment authority 171 times and President Clinton employed this option for 139 appointments.

Medicine’s Agenda

Dr Berwick is legally authorized to serve as CMS Administrator through December, 2011. There is a long list of important regulatory and implementation decisions that need to be made by the CMS Administrator as a result of the health system reform law enacted in March. We believe physicians and patients will be best served by focusing on securing the desired outcome on pending policy matters such as repealing the flawed Medicare payment formula and implementation of the new health reform statute rather than dwelling on a matter that has been decided through established legal authority.

From the Kaiser Health News

Dr. Donald Berwick – A Resource Guide

Jul 08, 2010

President Barack Obama appointed Dr. Donald Berwick head of the Centers for Medicare and Medicaid Services Wednesday. Berwick, known as a passionate advocate for improving the health care system, was nominated earlier this year but his nomination turned out to be controversial. Some Republicans accuse him of favoring health care rationing — a charge Democrats dismiss as nonsense. To shed light on Dr. Berwick, and the controversy surrounding him, KHN’s Allison Fero assembled this resource guide.

Background | In His Own Words | Summaries of News Coverage

Who Is Donald Berwick?

Berwick is currently President and CEO of the Institute for Healthcare Improvement.

An edited excerpt of his biography, from the IHI website:

Donald M. Berwick, MD, MPP, FRCP, is also Clinical Professor of Pediatrics and Health Care Policy at the Harvard Medical School, and Professor in the Department of Health Policy and Management at the Harvard School of Public Health. Dr. Berwick has served as vice chair of the US Preventive Services Task Force, the first “Independent Member” of the Board of Trustees of the American Hospital Association, and chair of the National Advisory Council of the Agency for Healthcare Research and Quality.

He is a recipient of numerous awards, including … the 2002 American Hospital Association’s Award of Honor … the 2007 William B. Graham Prize for Health Services Research, and the 2007 Heinz Award for Public Policy from the Heinz Family Foundation. In 2005, he was appointed “Honorary Knight Commander of the British Empire” by the Queen of England in honor of his work with the British National Health Service. Dr. Berwick is author of numerous articles and the books Curing Health Care and Escape Fire.

Media Profiles

Who Runs Gov : “Berwick is famous in the health-care system for advocating its destruction. An academic who has spent his career looking for ways to deliver care more efficiently and effectively, Berwick has been called a “revolutionary.” He believes the structure of the health-care system encourages good people to make harmful medical errors and waste millions of dollars. If he could, he’d blow the whole thing up and start over.”

CBS Evening News : “Two years ago, he launched the 100,000 Lives Campaign. That’s the number of lives he hoped to save by getting hospitals to have standard operating procedures for the way they care for patients.

Enlarge Video

This includes hooking up a ventilator properly to eliminate the risk of pneumonia and ensuring that a patient’s medication is monitored from the ICU to the hospital room to home.”

Berwick says even something as simple as uniform hand-washing requirements would cut hospital infections in half” (Feb. 2007).

The Boston Globe : “Berwick gets irritated when health care leaders complain about a lack of resources. There’s too much money in the system already, he says. His critique takes aim at the medical profession’s exalted view of itself. He’s convinced that the fundamentals of the current system — the same fundamentals Boston used to build its reputation as the world’s medical leader — are so screwed up that it is no longer possible for the medical profession to provide reliable, high-quality care, no matter how many innovations its renowned doctors roll out, no matter how many awards they rack up.” (Jan. 4, 2004).

NPR : “Berwick has built the Institute for Healthcare Improvement into a considerable force for change. … Berwick’s institute has been working on reforms with thousands of doctors offices and hospitals around the country and the world” (July 16, 2002).

In His Own Words

Excerpts of Berwick’s speeches or writings, with links to the entire article or video.

Kaiser Health News, Checking In With Dr. Donald Berwick

Enlarge Video

“Hospitals and health care systems are making phenomenal strides in quality and my optimism is very high. But the structures are still broken. We have fragmented payment systems and fragmented institutional boundaries. The enemy is fragmentation. We just don’t seem to form into the coalitions, the communities we need to make progress. Until we fix structures and finance it is going to be very hard to make fast progress” (Nov. 12, 2009)

New York Times Editorial, 10 Steps to Better Health Care

“There is a lot of troubling rhetoric being thrown around in the health care debate. But we don’t need to be trapped between charges that reforms will ration care and doing nothing about costs and coverage. We must instead look at the communities that are already redesigning American health care for the better, and pursue ways for the nation to follow their lead” (Berwick was one of four authors, Aug. 12, 2009).

Institute for Healthcare Improvement Video, Defining Quality: Aiming for a Better Health Care System

“If you’re buying a car, there are dimensions of quality: safety, fuel efficiency, comfort, fun in driving, durability and so on. We’re used to that. But what are the dimensions of ‘goodness’ in health care?” (Oct. 2008).

Speech To Britain’s National Health Service KHN Transcript of Speech Excerpts

“Here, in the NHS, you have historically put primary care – general practice – where it belongs: at the forefront. The NHS is a bridge, it’s a towering bridge, between the rhetoric of justice, and the fact of justice. No one in their right mind could expect that to be easy. … You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker, and that any health care funding plan that is just, equitable, civilized, and humane must – must – redistribute wealth from the richer among us to the poorer and less fortunate. Excellent healthcare is by definition redistribution. Britain, you chose well. … Is the NHS perfect? Far from it, far from it. I know that as well as anyone in this room. From the front line to Whitehall, I have had the privilege to observe its performance and even to help to measure its performance. … [but] the NHS has more evidence-based care, lower mortality rates for some major disease groups (especially cardiovascular diseases), you have lower waiting times for hospital, outpatient, and cancer care now, more staff and technologies are available, you have in many places better community-based mental health care, and you are starting to see falling rates of hospital infection” (July 1, 2008). NHS video of speech excerpts.

The Journal of the American Medical Association, The Science of Improvement

“Academic medicine has a major opportunity to support the redesign of health care systems; it ought to bear part of the burden for accelerating the pace, confidence, and pervasiveness of that change. Health care researchers who believe that their main role is to ride the brakes on change—to weigh evidence with impoverished tools, ill-fit for use—are not being as helpful as they need to be. ‘Where is the randomized trial?’ is, for many purposes, the right question, but for many others it is the wrong question, a myopic one. A better one is broader: ‘What is everyone learning?’ Asking the question that way will help clinicians and researchers see further in navigating toward improvement.” (Mar. 12, 2008).

Boston Globe Editorial, Dirty Words In Healthcare

“Managed healthcare was a great idea when it first emerged, before the term got hijacked by insurance companies that claimed to manage care but in many cases only managed money. … The innovations that managed care and capitation made possible were good for almost everyone. … Thousands of people avoided needless hospital visits; they got more appropriate, less expensive, better coordinated care in office settings” (Feb. 27, 2008).

British Medical Journal (via the U.S. National Institutes of Health), Steadying The NHS

“We believe, and refuse to be dissuaded, that the National Health Service, with its moral intent, commitment to equity, and store of knowledge, has the inherent capability to become the greatest healthcare system of any nation. Yet, lately, it seems like a boxer on the ropes, not the champion it should be…. The NHS is not just a national treasure; it is a global treasure. As unabashed fans, we urge a dialogue on possible forms of stabilisation to better provide the NHS with the time, space, and constancy of purpose to realise its enormous promise” (July 10, 2006).

Newsweek Editorial, Keys to Safer Hospitals

“Here’s the problem. Instead of helping me, health care might kill me. In 1999, the Institute of Medicine shocked the nation with an authoritative report on hospital errors. The report concluded that up to 98,000 Americans each year die in hospitals, not from the diseases that brought them there but from injuries caused by their medical care. … We have identified six basic measures that could save as many as 100,000 lives a year if even 2,000 hospitals adopted them. It’s surprising to learn that these standards aren’t already the norm–but the norms may finally be changing” (Dec. 12, 2005).

Health Affairs, ‘A Deficiency Of Will And Ambition’: A Conversation With Donald Berwick

“I have said before, and I’ll stand behind it, that the waste level in American medicine approaches 50 percent. It’s certainly in double digits, and this has to be absolutely pasted onto the quality agenda. There is no difference between quality and efficiency …. a lot of people make a lot of money on inefficiency—on production of things that have no value. So the minute you try to become truly efficient, you’re going to run into stakeholders who are going to tell you that you’re harming care, and the knee-jerk reactions of doctors and others will be to reinforce that idea” (Jan. 12, 2005).

The New England Journal of Medicine, Errors Today and Errors Tomorrow

“First, in local settings, our workforce largely remains blind to the enemy — patient injury. … The invisibility of injuries to patients makes them seem trivial or infrequent. Until we find ways to make errors and injuries routinely visible in local health care settings, the national will to improve safety will be hard to translate into local intent. Second, even when hospitals find ways to notice the injuries to their patients, their theories of cause often remain scientifically Neanderthal. They cling to unsound but deeply entrenched beliefs” (June 2003).

Health Affairs, A User’s Manual For The Institute of Medicine’s “Quality Chasm” Report

“The report therefore suggests to any careful reader that whether we wish to tackle the problem of quality as payers, regulators, executives, managers, or clinicians, we will improve health care as it needs to be improved, either all together or not at all” (May/June 2002).

Escape Fire: Lessons for the Future of Health Care

“This has been a tough year for my family, and especially for my wife, Ann, who last spring began developing symptoms of a rare and serious autoimmune spinal cord problem. … this has been the formative experience for me overall in the past year … The people work well, by and large, but the system often does not. Every hour of our care reminded me, and alerted Ann, about the enormous, costly, and painful gaps between what we got in our days of need, and what we needed. The experience did not actually surprise me, but it did shock me. Put in other terms, as a friend of mine said: Before this, I was concerned; now, I am radicalized” (First from a speech at the IHI National Forum, Dec. 9,1999; later part of a Commonwealth Fund book with same title). Watch the related video.

* * * * * * * * * *

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————–

End of this DJP Update late edition.

Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at: http://www.intrepidresources.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@intrepidresources.com
www.intrepidresources.com
www.onleadership.us

This DJP Update goes to 2263 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

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DJP Update 7-9-2010 Tweets re opinions on taxes, new health system reform law, comments about recess appt Dr. Berwick, trial lawyers & departure La. DHH head

DJP Update 7-9-2010 Tweets re opinions on taxes, new health system reform law, comments about recess appt Dr. Berwick, trial lawyers & departure La. DHH head

Have a great weekend! Here are a few tweets from the past two days. Great research on memory from NIH in one tweet! Hope for all of us who have been around a while.

Too bad AMA fails to mention private contracting and balance-billing in the interviews and letters to blogs etc.

When will AMA get aggressive about this mandate from House of Delegates! It is not enough to say the SGR is a disaster. Give a solution! The House of Delegates has one. It is called liberty and freedom of contract!

The doctors are looking for someone to lead them out of this government mess so they can care for their patients. And don’t forget, a substitute price-fixing formula without balance-billing option without penalty is NOT A SOLUTION.

Keep doing the same approach to Washington, DC and one can expect the same results. If this keeps up, another organization will emerge as the representative of doctors. Sad but true.

And now the tweets from www.twitter.com/DJPNEWS

——–

Taxes affect actions! RT @Heritage LeBron James is one wise “king.” Looks like he prefers lower taxes. #tcot #teaparty http://herit.ag/O64

17 minutes ago via Echofon

Via #LHA La. DHH Sec Alan Levine resigns; replace = Bruce Greenstein, Sr Dir worldwide health Microsoft Corp #hcr #Doctors

23 minutes ago via Echofon

Heat debate incl #AMA but no mention bal bill! RT @texmed AARP..recog.. the access..care crisis..the Medicare Meltdown http://fb.me/CA6CZl76

about 1 hour ago via Echofon

More debate; more surprises coming! RT @M_P_T Opinion: ObamaCare has another “surprise” http://bit.ly/9oFQ0w Agree? #tcot #hcr

about 1 hour ago via Echofon

NEJM & #SGR #hcr #Doctors RT @sonodoc99 @DJPNEWS SGR – Indispensable Abomination http://tinyurl.com/234emql

about 5 hours ago via Echofon

Thanks to @sonodoc99 for alert about Stossel article!

about 16 hours ago via web

John #Stossel article “Parasitic Tort Lawyers” http://tinyurl.com/24ycp88 #lawyers

about 16 hours ago via web

Fascinating! Potential for humans! RT @NIHforHealth News: Mental Decline Thwarted in Aging Rats http://bit.ly/dhXHv7

about 19 hours ago via Echofon

Ruth #Marcus in #WashingtonPost “Obama’s cynical recess appointment of Donald Berwick” http://tinyurl.com/28exhe5#hcr #Berwick

about 23 hours ago via web

RT @WSJopinion The Berwick Evasion: Obama dodges..Senate debate on his ideal Medicare chief http://on.wsj.com/cZuP4s #hcr #Berwick:

7:08 PM Jul 7th via Echofon

I repeat: recess appt these facts mistake RT @KeithHennessey..Pres.. recess appoint..of Dr. Donald #Berwick: http://bit.ly/9Y5yA8 #hcr

3:26 PM Jul 7th via Echofon

———

Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at: http://www.intrepidresources.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@intrepidresources.com
www.intrepidresources.com
www.onleadership.us

This DJP Update goes to 2263 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

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DJP Update 7-6-2010 Recent tweets – lots going on in DC and in Gulf with oil spill; LAGNIAPPE: some special meals

DJP Update 7-6-2010 Recent tweets – lots going on in DC and in Gulf with oil spill; LAGNIAPPE: some special meals

DJP Comments: Robin and I had delightful time this past week visiting with friends from Australia who were in New Orleans as past of a multi-city visit to USA.

Lots of photos and video done!

Very sad to see tar balls now in Lake Pontchartrain!

Below are the recent tweets found at: www.Twitter.com/DJPNEWS

And yes! Tabasco, our wonderful dog, is now 15 years old as of July 4! Be sure to see her photo in the tweet link.

I believe it is a mistake to do a recess appointment of Dr. Berwick. He is a smart man and should be able to present his views on Medicare/Medicaid and handle questions regardless of whether you agree with him or not. America longs for transparency. A recess appointment will only increase the partisan bickering. White House statement about this action is in link in first tweet below. A recess appointment only increases the division over a health system reform law that the majority of Americans oppose and believe was jammed through Congress. Actions have consequences and perhaps in November we will see the consequences of such actions. I worry about the financial stability of America. I worry about the patients who will not be able to find doctors in the hour of need.

There is lots to worry about. Time to stop partisan fighting and show leadership!

And one more item that will be tweeted shortly. Read Dr. Leah McCormack, president of Medical Society of the State of New York, declaring “independence from Medicare and Managed Care” at:

http://readme.readmedia.com/The-Fourth-of-July-Is-My-Professional-Independence-Day/1562194

Read the entire letter. Here is an excerpt:

—–

WESTBURY, NY (07/01/2010)(readMedia)– I have made a personal decision as of July 4th to terminate all of my contracts with Medicare and managed care companies as soon as the contracts allow. I think of this as my own personal independence day.

This has been a long time coming, but I can no longer bear the shackles of government and insurance company rules, the burdens of their regulations and the fear of their retributions for the paltry reward of their monetary compensation for my services. …..

———

If only Congress would listen!!

And now the tweets: www.Twitter.com/DJPNEWS

Recess=mistake! RT @marklhayesRT @MajoratWH: ..WH blog..recess appoint of Berwick to head Medicare/Medicaid Services. http://bit.ly/91g6sy

about 1 hour ago via Echofon

Yes! RT @JindalNews Gov. Jindal to Feds: No Is Not A Plan, Lead Or Get Out Of The Way http://twurl.nl/6yd0jq #BP#oilspill

about 1 hour ago via Echofon

Thanks! RT @Heritage Remember the Gulf. We aren’t forgetting…keeping the Administration accountable. http://herit.ag/XM3 #BP #oilspill

about 11 hours ago via Echofon

Facts don’t cease to exist when ignored RT @M_P_T Emergency Room Visits Increase in Mass.: http://bit.ly/bQt7EA #tcot #hcr

about 13 hours ago via Echofon

Time for principle, fiscal responsibility, & term-limits in DC. RT @ThomasSowell Column: Santa and Frank http://bit.ly/aTirzG

about 14 hours ago via Echofon

Powerful! Remember! “I fought for you” video. Thanks, Mark @Constantian http://tinyurl.com/2595hou #DDay #Liberty#Military

about 21 hours ago via web

Rats! Tar balls in Lake Pontchartrain, the lake between New Orleans & Slidell .. http://tinyurl.com/2cpjpw9 #BP #oilspill

about 22 hours ago via Echofon

RT @RasmussenPoll 60% favor repeal of health care law… just 41% think…likely to happen… http://tinyurl.com/RR1725#hcr

8:21 AM Jul 5th via Echofon

Thanks Art. More problems new #hcr RT @sonodoc99@DJPNEWS ObamaCare Takes a Bite Out of White Castle http://tinyurl.com/27q7gek

8:18 AM Jul 5th via Echofon

Update practice of Medicine RT @sonodoc99 @DJPNEWS July 4 Colleagues http://tinyurl.com/2avhv98 words prez #MSSNY#hcr

8:13 AM Jul 5th via Echofon

Rodrigue #BlueDog #SaveTheGulf Artist Rodrigue of La & his Blue Dog join quest. #BP #OilSpill #dog http://twitpic.com/22idsd

4:55 PM Jul 4th via Twitpic

Happy Birthday, Tabasco! Now 15 y.o. & 14 1/2 years ago found on highway near death. Wonder #dog! http://twitpic.com/22iabl

4:43 PM Jul 4th via Twitpic

Yes! RT @WWIImuseum As we celebrate Independence Day & our freedom, let’s remember the men & women who preserved it! www.10forThem.org

7:29 AM Jul 4th via Echofon

Wrong! Allow balance-billing! RT @amednews RT @KentBottles http://ow.ly/26EgM why is a Medicare doc payment fix so elusive? #SGR

8:50 AM Jul 3rd via Echofon

Happy Birthday, America! Enjoy #liberty this 4th of July &#RedSkelton discuss #PledgeOfAllegiance http://tinyurl.com/cnqdsj

8:23 AM Jul 3rd via web

——-

LAGNIAPPE: A few words about recent special meals

CHICAGO

West Egg Cafe

Spectacular breakfast until 3 p.m.

Walking distance from Hyatt on Wacker where AMA June 2010 Annual Meeting held

620 North Fairbanks Court

Chicago, IL 60611-3011

(312) 280-8366

——–

New Orleans

Ralph’s On The Park

Across from City Park

900 City Park Avenue

New Orleans, La. 70119

Best Turtle Soup I have tasted and I taste turtle soup at every restaurant I visit when it is available.

——–

Tony Angello’s Restaurant

Don’t order from menu, tell Dale to feed you. Recent meal in “Wine Room” terrific.

See details at: http://www.intrepidresources.com/html/restaurants.shtml

Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at: http://www.intrepidresources.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@intrepidresources.com
www.intrepidresources.com
www.onleadership.us

This DJP Update goes to 2262 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

Read More