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What? No Obama birth certificate threads?


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Health care reform would be nice. But we can't afford it right now. I guess this will come as a revelation to some people. America is hopelessly in debt. Obama and the Democrats have spent trillions in a few months. And no one to this point has a clue as to how this reform is going to be paid for. There are even rumblings that Obama is going to break his "read my lips, no new taxes on the middle class" pledge. Maybe that's why some people are mad.

When you can't afford something, you should abstain for now. This is basic living.

Someone should tell Obama the old joke about the Eisenhower doll: You wind it up and it doesn't do anything for eight years. Obama should just try doing nothing for a while. I know it's hard, but let some common sense come into play. This would even shut up Republicans.

When the Labour Government introduced the National Health System in 1947 they were heavily in debt (the cost of the Second World War). When they promised to do this in the 1945 general election they were described as Nazis (Churchill) and communists (they admitted to being socialists). However, the Conservative governments that followed, did not dare remove it because it was the most popular thing ever done by a British government. A recent survey showed that the NHS is the most popular aspect of British society. If Obama does bring in "socialised medicine", it will never be removed. That is why the far-right in America is spending so much money and energy on attacking the idea.

John-

How many people work for GB's national health care program?

I read that it was 1,400,000.

Is that true?

Also, does it ration care based on age, health, etc.?

Thanks.

Chris

Hi Chris, I don't know the exact number, I will try and find out, but its nothing like 1,400,000, There is, up to date, no rationing based on your catogories, everybody is entitled, by right, to the best health care that can be afforded. its far from perfect, standards of care can be a bit patchy between diferent health authorities, but the Brits love their "Socialised" health care, and as John says, no Government would dare try and remove it, there would be riots on the streets.

It is about 1.4 million. The corresponding number for the United States is 15 million. The population of the UK is about 61 million and the population of the USA is about 300 million...

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Thanks for all of the info, guys.

I will try to read it tonight.

Christopher, you should take particular note that the UK spends less per head on healthcare but has a higher life expectancy than the US. The World Health Organisation ranks Britain's healthcare as 18th in the world, while the US is in 37th place.

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What choices do you, as a health care consumer, have under the NHS system?

What do you do if you don't like your doctor or if he or she is incompetent?

What kind of parameters does NHS give you to work within in making health care decisions?

Are your choices limited if you are old and/or infirm?

How are health care professionals and other providers compensated?

Who sets their compensation and who pays it?

Does GB have limits on the amounts that a patient can recover for malpractice?

These are questions about your system, not challenges to it.

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What choices do you, as a health care consumer, have under the NHS system?

What do you do if you don't like your doctor or if he or she is incompetent?

What kind of parameters does NHS give you to work within in making health care decisions?

Are your choices limited if you are old and/or infirm?

How are health care professionals and other providers compensated?

Who sets their compensation and who pays it?

Does GB have limits on the amounts that a patient can recover for malpractice?

These are questions about your system, not challenges to it.

I haven't lived in the UK for 35 years, so I can't answer your questions about the NHS. However, we also have "socialized medicine" here in Spain and these answers relate to our system:

1.The question of choice is a strange one. No one FORCES me to go to the social security doctor. If I wish, I'm free to go as a private patient, and some companies offer private health care plans to their employees. Anyone who can afford it COULD take out private health insurance and many do. The huge advantage of the system is that everyone is guaranteed good quality healthcare, regardless of his or her economic situation. No one is obliged to sell his or her home in order to pay medical bills.

2. If we don't like our doctor, we have the right to change to another.

3. I don't understand the question. Could you explain what you mean?

4. No.

5. They're paid by the government out of general taxation and from the social security payroll tax.

6. Spanish judges do no generally award huge damages for malpractice, but that's not as a result of legislation. It's just the norm for Europe.

Edited by Mike Tribe
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Speaking of birth certificates and health care.

Meet Dr. Pedro Jose Greer, Jr., whose parents are Cuban, but who is an American citizen because he was born in Miami while his mother was visiting. He returned to Cuba, then came back to Miami with his parents as refugees, was educated in Florida and became a doctor in the early 1980s.

Rather than cater to the rich, or even his fellow Cuban refugees, he set up a clinic and cared for the homeless. He wrote the book "Waking Up In America."

As with Che Guevara Lynch, Greer's grand father was an Irish-American from Georgia who went to Cuba as a soldier with Teddy Roosevelt and General Wood, fell in love and stayed there.

Greer was honored at the White House today with a Presidential Medal of Freedom.

Little Havana's "Dr. Joe."

By Paula Andalo

http://www.paho.org/English/dd/pin/Number21_article03.htm

What do Cubans and the Irish have in common? "Our cultures are just alike. We both come from little islands; we're both Catholic. We were the first communities in this country to define ourselves as exiles. We're passionate, we like to tell stories, we love politics, and we both drink whiskey and rum. For both Cubans and the Irish, funerals are parties that last all night," says Pedro José Greer, the Cuban-Irish-American doctor who turned his back on Miami's fashionable Ocean Drive to hunt for "souls" living in the mudflats under highway I-395.

Doing justice to all he's done would require a book—and, indeed, Greer has written an autobiography. But to sum it up, "Dr. Joe," as he's affectionately known, has made two major contributions to his Miami community. The Camillus Health Concern, which he founded in 1984, provides health services to more than 10,000 homeless men, women and children each year. His San Juan Bosco Clinic, in Little Havana, sees some 6,000 patients per year, most of them poor, undocumented immigrants looking for a little health care and human warmth.

Greer has won a string of top honors, including three presidential awards, two papal awards and the coveted MacArthur "genius" fellowship, which carries a hefty no-stringsattached monetary award for individuals who "show exceptional merit and promise for continued and enhanced creative work."

A physician trained in hepatology, Greer today serves as assistant dean for homeless education at the University of Miami School of Medicine (where he received his medical degree in the 1980s) and is chief of gastroenterology at Mercy Hospital. He is also a partner in private clinical practice with his father, who he says instilled in him an acute social conscience.

Greer strives to pass on his father's inspiration. His persistent activism has made him a leader in the fight for better health for all, and especially for Miami-Dade's homeless. Reaching out to broad sectors of Miami society, Greer has created a network of people and organizations that provide food and shelter, health care, work opportunities, counseling and, above all, a little respect to those in need.

"He has made a commitment to making this world a better place and lives each day making sure that he follows through," says Gloria Estefan, the Latina superstar and Greer's close friend, on the jacket of his 1999 autobiography, Waking Up in America, written with The Miami Herald's Liz Balmaseda.

Greer was born in Florida, by accident. His mother, a native of Cuba, traveled to the United States in 1956 for a family birthday party. She was only six months pregnant, but little Joe decided to come out.

Two weeks after the birth, mother and son returned to Cuba. Four years later, in 1960, Joe's U.S. citizenship helped his family leave Cuba following Castro's triumph. The Greers are among those expatriate Cubans who've long since burned their boats.

Greer's great-grandfather, of Irish origin, had emigrated from the U.S. state of Georgia to Cuba in 1896 as a soldier in the Spanish-American War. He fell in love with a girl from the Canary Islands living in Pinar del Río and decided she was sufficient reason to put down roots. His son, "Papa Greer," was the first in the family to finish high school and went on to study medicine in the United States in the 1940s.

This multinational lineage helped shape Pedro's persona, along with formative experiences such as the year he spent in the Bahamas, at age 9. His father was assigned to be the doctor on the island.

"We'd go out with my father in little boats to treat children in remote areas," Greer recalls, smiling. "When Papi would walk into a waiting room with his white coat and his doctor's bag, the children would climb out the windows, and we'd have to run after them so he could give them checkups and vaccines. That's what makes a doctor."

A major milestone in Greer's early life was the loss of his sister Chichi, who died in a car crash when she was about to turn 18.

"It was my first lesson as a doctor. I became aware of what it means to lose someone forever. We're never prepared for death, and that's why the most difficult thing in medicine is talking with the family."

The moment that sealed Greer's future, however, came in 1984, on the day he began his internship at Miami's Jackson Memorial Hospital. Greer came across his first patient with no name or address. It was a homeless man whom firefighters had picked up off the street, and who was suffering from severe tuberculosis. The man's only identification was the number "9" on his hospital bed. The young physician became obsessed with learning his name, discovering his history and finding a family member who might provide him company in his last days. But it was all in vain.

That human being—alone, unable to speak, surrounded by the latest technology in a country where hardly anyone dies of tuberculosis—became an obsession for Greer.

"I tried to communicate with him, but he didn't respond. He died a few days later, all alone. At that moment, I became aware of a Miami I had never known. I finally understood that every patient has a story, a soul and that their clinical history is just a façade that conceals dreams, hopes, successes and failures. And I wanted to find those stories, hidden under the bridges."

Bad policies

The same year "Dr. Joe" met the nameless patient he laid the cornerstone of his clinic, the Camillus Health Concern, dedicated to providing medical treatment to people without health insurance.

"Back then, street people used to complain that nearly all the shelters were religious and dished out what they called 'soup and salvation,'" Greer recalls. "They had to go to mass before they could get dinner. What they wanted was soup, not to be evangelized."

Life in the shelters was highly regimented; residents were expected to go to bed at 6 in the evening and rise at 5 in the morning.

Greer consults with María Elena Torres, one of his clinic's nurse practitioners. "Dr. Joe's" relaxed personal style permeates the atmosphere at the Miami clinic. "No one likes to be homeless, but when you have nothing, the only thing you have is your freedom," says Greer. Camillus was new and different, and it caught on, growing steadily over two decades into a health care center with 10,000 patients annually and 100 physicians on its rotation roster. The clinic's goal is 100 percent humanitarian: to provide help—if only temporarily—to those who need it most.

How have things changed in those two decades?

"I've seen the hearts and minds of medical professionals change," says Greer, "but the situation on the streets has gotten worse. There are more poor people, more homeless and more people without health insurance. I always say, what I do for a living is manage the consequences of bad policies."

He goes on: "The ones who pay the price of those bad policies—lack of education, lack of prevention—are the patient, the family and the doctor. It's a vicious circle. If you cut the education budget, kids end up on the streets, they get involved in alcohol and drugs, they get sick and end up in the clinic. It's a whole chain of social problems."

Greers recalls that when he started this work, only 5 percent of people living on the streets were women and children. Now they make up nearly 40 percent.

"These are families where the father is in jail or is an addict. They're people with no education and no protection," he says. Contrary to common belief, he adds, not all of them are illegal immigrants.

"Culturally, immigrant families tend to congregate in communities and protect each other. It's not common for them to end up indigent," Greer says.

Still, he believes that indigence is a constant threat for the growing numbers of illegal immigrants and that fear of it plays a very negative role.

"Many women put up with verbal and physical abuse, or they fail to get treatment for medical conditions, because of their fear of deportation. We trap them in a corner when we should be giving medals to those who manage to come to this country and try to start a new life."

"One year we gave out Christmas presents, and we asked street children what they wanted from Santa Claus," he recalls. "They said socks and underwear—that's what it comes down to when you're living on the streets."

For Greer, diagnosing patients and prescribing treatment is the easy part of doctoring. What's hard for most doctors, he believes, is to feel warmth and compassion and to see that a patient's body isn't divided into parts according to medical specialties. If it were, Greer would be focusing on livers—not a very good place to hunt for people's souls.

"I have never had a liver or a colon walk into my office alone. They always came attached to a person," Greer said in his autobiography. "That person had a family, friends, a history, dreams. As physicians . . . we treat people, not organs or diseases."

In Little Havana

The San Juan Bosco Clinic was built in 1991, behind a church on a lot that in the 1960s housed an auto dealership that catered to Cuban immigrants. The area is the heart of Little Havana, the point of reference for Miami's Cuban-American community.

The clinic has a medium-size waiting room and an office staff made up mostly of puras (Cuban for "mothers"), who never seem to stop talking. Greer fits into the scene perfectly. Garrulous and fond of doctor jokes—most of which parody himself—Greer chats comfortably with waiting patients, with the priest from the church next door, with the nurse who just returned from a working trip to India, and with Mari, his assistant and right hand.

Greer jokes with patients outside his "people's clinic," the Camilllas Health Concern. His Reach Out, Miami program recruits doctors willing to donate time to patients who cannot pay for treatment.

In his spotless white lab coat and with his trusty stethoscope around his neck (he is a doctor, after all), Greer stands out like the former football player he is against a backdrop of posters promoting diabetes prevention and mammograms. His relaxed style permeates the clinic's atmosphere, producing the opposite of the tense calm that pervades large hospitals' waiting rooms.

"A patient who feels comfortable is a patient you can talk to," says Greer. These days, there are 150 doctors and 37 volunteers who follow that same precept as they treat patients in Greer's "people's clinic."

As part of his campaign to raise awareness of the kind of care patients need and deserve, Greer launched an initiative called "Reach Out, Miami," which recruits doctors willing to donate time in their own private offices to treat patients who cannot pay.

"The key is not just human caring but also accessibility," Greer explains as he greets a patient. He recalls trying to get this point across to policymakers in Washington, D.C, while serving as an advisor to the Bush, Sr., and Clinton administrations.

Did he ever consider going into politics himself?

"I came of age during the era of Vietnam and civil rights. Those were very controversial times. Yes, I considered it when I was young, but when Nixon resigned, I decided no. And it was the right decision. Through medicine, I was able to channel that need I always felt to do social work."

Greer sees himself as living in a "piece of Cuba" inside the United States, but says he retains much of the cultures of both islands that were home to his ancestors. Breaking into one of his enormous, resplendent smiles, he says that one of his fondest dreams is that his wife (who's 100 percent Irish) will someday make him a Cuban sandwich without his having to explain what goes in it.

Greer's ethnic roots may explain his strong attachment to family life and why he spends what little free time he has with his wife and two children (whenever they're home from college) and his sailboat. During those brief Sunday voyages on Biscayne Bay, he surveys the Miami skyline and always comes back to the same thought: "This is my community, this is where I live, where my family is. If I can't make the place I live better through what I do, what am I here for?"

Paula Andaló is a journalist working in the Area of Public Information of the Pan American Health Organization in Washington, D.C.

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What choices do you, as a health care consumer, have under the NHS system?

What do you do if you don't like your doctor or if he or she is incompetent?

What kind of parameters does NHS give you to work within in making health care decisions?

Are your choices limited if you are old and/or infirm?

How are health care professionals and other providers compensated?

Who sets their compensation and who pays it?

Does GB have limits on the amounts that a patient can recover for malpractice?

These are questions about your system, not challenges to it.

1. What choices do you, as a health care consumer, have under the NHS system?

1. You can register with any NHS GP in your area. I am registered with my local Health Centre and have a choice of 10 GPs. However, my wife and I nearly always saw the same one. She was great during Judith's illness. In fact, she became a family friend, visiting her in hospital and phoning up about how she was doing. She also called me after Judith's death to check on my health.

2. What do you do if you don't like your doctor or if he or she is incompetent?

2. As I said above, you are free to go with whatever GP you want.

3. What kind of parameters does NHS give you to work within in making health care decisions?

3. I am not sure what you mean by this? It is definitely true that you get more from the system if you are pro-active. This is especially the case when the patient enters a hospital. As in most areas of life, it helps if you are well educated and articulate.

4. Are your choices limited if you are old and/or infirm?

4. See answer for 3. This is more of a problem if the old/infirm do not have someone to speak up for them. My mother, who is 95, lives in a residential home that is as good as a hotel, for no cost at all to the family. The standard is far better than my friends who pay for private care for their parents. The reason for this is that my mother has always lived in social housing and therefore the state take full responsibility for her. It is one of the advantages of being working-class.

5. How are health care professionals and other providers compensated?

5. Senior doctors and GPs are paid too much but young doctors and nurses are worked too hard for not enough money.

6. Who sets their compensation and who pays it?

6. A combination of the government and the NHS trusts.

7. Does GB have limits on the amounts that a patient can recover for malpractice?

7. Not as far as I am aware. About 15 years ago a friend of mine won £11.5m when mistakes were made during the birth of his twins.

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And now, after that brief feel good momentary pause to praise Dr. Joe,

back to the mud fight.

Check this out, HNN picks up an article that Macaroni Max posted for Jeff Flanders.

Maybe they'll pick up one of my articles from JFKCountercoupblogspot?

Na. They only like conspiracies they can make fun of.

But Jeff Flanders almost ends it on the right note - free the files, but then he blows it by suggesting that the JFK records have been released. Macaroni Max should have set him straight. - BK

http://hnn.us/roundup/entries/113243.html

http://www.washingtondecoded.com/site/2009...noid-style.html

Jefferson Flanders: Birthers, Truthers, and Buffs: The Paranoid Style

SOURCE: Washington Decoded (website run by Max Holland) (8-11-09)

[Jefferson Flanders, an independent journalist, has taught at the Arthur L. Carter Journalism Institute at New York University. He blogs at Neither Red Nor Blue. ]

No he blogs with Max, who wishes he could throw all everybody into one soup. - BK

The tone and tactics of the Birther movement—those who dispute Barack Obama’s American citizenship and consequently, his legitimacy as America’s 44th president—are eerily familiar. Birthers embody that mixture of “heated exaggeration, suspiciousness, and conspiratorial fantasy” that historian Richard Hofstadter indelibly called the “Paranoid Style in American Politics.”[1]

But before the liberal-left chortles too loudly about the GOP being in thrall to this ragtag group of right-wingers, it would do well to remember its own problems with conspiracy theorists. Truthers and Buffs are the liberal-left’s own variations on Birthers. Truthers, of course, claim that Bush administration neo-conservatives engineered the 9/11 attacks in 2001, while Buffs have long asserted US government complicity in the 1963 assassination of President Kennedy.[2] As Hofstadter rightly noted in this 1963 essay, “[M]ovements of suspicious discontent” are common to both ends of the political spectrum.[3]

Birthers began the Obama citizenship controversy in 2008 with a series of lawsuits challenging the Illinois senator’s eligibility to run for president, arguing that Obama had not proved he was a natural-born citizen as required by Article II, Section 1 of the Constitution. Both FactCheck.org and the Chicago Tribune quickly debunked the claim that Obama had been born in Kenya after reviewing Obama’s Hawaii certificate of live birth; subsequently, the court challenges were dismissed by properly skeptical judges.[4]

Yet the Birthers refused to admit defeat. Indeed, like Truthers and Buffs before them, and in keeping with Hofstadter’s description of the Paranoid Style’s methodology, the curt dismissal of their claim mainly served to generate new theories. Now they argued that Obama’s release of the short-form certification of live birth was a ruse and a way of hiding his foreign origin. The long-form “vault birth certificate,” a document which includes the attending doctor’s name and hospital, and from which health officials prepare the shorter form, supposedly contained the real truth.

When Rush Limbaugh and CNN’s Lou Dobbs offered a national platform for these percolating allegations, the controversy achieved critical mass and became part of the daily news agenda. Left-leaning websites like Daily Kos and the Huffington Post mocked conservative Republicans who were slow to disavow Birthers because they feared alienating core supporters. Other liberal commentators chimed in by observing that Republicans’ receptivity to Birthers’ claims was proof that racist and nativist fears had captured the GOP. Seeking to accentuate the Republicans’ discomfort, Congressional Democrats gleefully proposed a resolution proclaiming Hawaii as President Obama’s birthplace, and it passed unanimously on July 27. A Daily Kos/Research 2000 poll released a few days later showed that only 42 percent of Republicans believed Obama had been born in the United States.[5]

Curiously, all this occurred even while many high-profile conservative pundits, like Michelle Malkin, Ann Coulter, Michael Medved, and Bill O’Reilly, who usually set the table for the right-wing, were branding Birther claims as ludicrous, and an unwelcome distraction from the debate over Obama’s health care initiative.[6] Some conservatives even wondered whether the Democrats were stoking the controversy. James Kirchick of the New York Daily News argued that the impetus for coverage of the Birthers came from liberals “. . . bent on portraying their conservative opponents as extremists—and changing the subject to help a president under increasing scrutiny for the substance of his policies . . . ”[7]

Certainly, the extent of mainstream media coverage of the Birther movement in July was surprising, considering how little credibility its leading proponents have. Lawyer and dentist Orly Taitz, author Jerome Corsi, lawyer Philip J. Berg, and perennial candidate Alan Keyes are notorious for advancing Paranoid Style-conspiracy theories. Berg, a former deputy attorney general of Pennsylvania, had filed an Obama eligibility lawsuit (dismissed) and a RICO lawsuit (dismissed) against President George W. Bush alleging his complicity in the 9/11 attacks. Corsi has embraced the 9/11 and the JFK assassination conspiracy theories and was co-author of the anti-John Kerry book Unfit for Command, one of the opening salvos in what became known as the Swiftboating of the Massachusetts senator. In April, Keyes publicly warned that the Obama administration would stage terror attacks in order to declare martial law and establish a police state.[8]

Indeed, while de-legitimizing Obama greatly appeals to the far right, several prominent Birthers have only a tenuous connection with the Republican Party: Corsi is a member of the Constitution Party; Keyes ran for President on the America’s Independent Party ticket; and Berg, a Democrat, supported Hillary Clinton’s presidential candidacy in 2008.[9]

Elements of the Paranoid Style

From the start, Birthers’ modus operandi has matched the classic Paranoid Style. Those elements include:

• The belief that powerful hidden forces conspire to shape events and/or seize power.

For Birthers, those hidden forces include the Obama White House, the governor of Hawaii, other Hawaii state officials and the news media. For the 9/11 Truthers, the grand conspiracy involved the White House, FAA, NORAD, the CIA, FBI, National Institute of Standards and Technology (NIST), the Mossad, the mainstream media, and a host of other enablers. But if Truthers’ scenario seems hopelessly complicated, it still takes a backseat to JFK assassination theories. They are fiendishly complex and implicate so many players (Cubans working for the CIA, Mafia hitmen, Texas right-wing oil men, the Federal Reserve, the KGB, Fidel Castro, Lyndon Johnson, J. Edgar Hoover, Richard Nixon, George H.W. Bush, etc.) that it’s hard to keep track exactly who was supposed to have done what.

While conspiracies do exist, they generally involve small groups of dedicated people focused on a single, or discrete, action or outcome, viz., the conspiracy to cover-up the Watergate break-in. They can be kept secret although usually not for too long. What distinguishes real conspiracies from the Paranoid Style-conspiracy theories is simplicity. Real conspiracies conform to the principle of parsimony described in Occam’s razor: the idea that “one should not increase, beyond what is necessary, the number of entities required to explain anything.” A fundamental flaw in Paranoid Style-thinking is that it presupposes that large numbers of people will go along with illegal or immoral covert activities and remain silent.

• The rejection of evidence that doesn’t match their preferred conspiracy theory and invention of evidence that does.

Since they believe they possess the hidden truth, conspiracy theorists will ignore, or will seek to discredit, whatever information surfaces to contradict their thesis. That Honolulu’s two major newspapers carried birth notices for Barack Obama in August 1961; that state records show Obama was born on Oahu on August 4, 1961; and that the name of the attending obstetrician (Dr. Rodney T. West) has been reported doesn’t faze Birthers—they argue these are fabrications meant to create a false record.[10]

Similarly, 9/11 Truthers have spent years attacking scientific studies that show how jetliners crashing into the World Trade Center towers could caused their collapse. Instead, they cling fiercely to the idea that controlled demolition, not the actions of Al Qaeda terrorists, brought down the buildings as part of a “false flag” operation.[11] Meanwhile, the endless creativity of JFK Buffs is a testament to human imagination. For decades Abraham Zapruder’s home movie of the assassination was thought to hold the key, and scoured for clues. Now, however, there is an entire “alterationist” school of thought that argues the film was doctored as part of the government’s cover-up.[12]

• A focus on uncovering inconsistencies or errors in the official account, or discovering “incriminating” details that “prove” the conspiracy.

Conspiracy theorists often seize on the most arcane minutiae (the proverbial “smoking gun”) in support of their preferred explanation. Thus, Birthers quickly focused on details from Obama’s 1961 certification of live birth, hoping to brand it as a forgery. Why did it identify his father as an African, not as a Negro, unlike other certifications from the period? Why didn’t it resemble other certificates from 1961? In response, Hawaiian health officials explained that Obama’s father had chosen the African description for his race, and the Obama’s certification paperwork was consistent with other 1961 documents.[13] But that didn’t matter.

Truthers, meanwhile, have focused on videos of the World Trade Center attack and subsequent collapse of the buildings, claiming to find visual evidence of missiles or high energy weapons or puffs of smoke from demolition charges. Some even assert the planes weren’t real, but projected holograms.[14] And then there are those supposed shots from the grassy knoll . . . bullets that did not hit anyone fired by no one that anyone saw.

• An often-sophisticated use of the media to spread the word. The Internet has allowed the real-time viral connection of like-minded conspiracy buffs.

Birthers initially turned to radical Right websites like WorldNetDaily (WND) and Prison Planet.com (which is run by serial conspiracy-monger Alex Jones), and to sympathetic right-wing talk show hosts like Rush Limbaugh, Michael Savage, Lars Larson, Bob Grant, and G. Gordon Liddy (now there’s someone who knows about conspiracies!).[15] They moved up the media food chain to cable news with Lou Dobbs and CNN, prompting MSNBC and Fox News to cover the Birthers. The networks and elite newspapers followed, making the Obama citizenship “debate” a national, if not global, story.

The 9/11 Truthers have employed books, websites, seminars, and a popular YouTube video, Loose Change, to hawk its vision of an “inside job.” Still, the model for injecting conspiracy theories into the mainstream started with the JFK Buffs.[16] Beginning with Mark Lane’s carnival barker-like lectures in 1964, thousands of books, articles, newsletters, conferences, films, and seminars have kept the conspiracy flame burning. Nothing, perhaps, has been so powerful, however, as Oliver Stone’s muddled 1991 film JFK. It proved to be a breakthrough, in that it encouraged a whole new generation which had not experienced the event to doubt the conclusions of the Warren Commission that Lee Harvey Oswald was Kennedy’s lone assassin.[17]

• The enlistment of mainstream political and cultural figures to lend credibility.

Birthers gained momentum, and air time, when they attracted the attention of CNN’s Lou Dobbs, and, to a lesser extent, Sean Hannity of Fox News. Some conservative Republican politicians apparently let their dislike of Obama and his policies overcome their better judgment: Senator Richard Shelby of Alabama and Representative Roy Blunt of Missouri reportedly questioned Obama’s citizenship, although both later claimed they had been misquoted. Congressman Bill Posey (R-Florida) introduced a bill that would require future presidential candidates to produce original birth certificates, and quickly attracted 11 Republican co-sponsors. It was denounced, accurately, as pandering to Birthers.[18]

Truthers have had well-known enablers as well. A few prominent politicians, including former governors Howard Dean (D-Vermont) and Jesse Ventura (I-Minnesota), and former Representative Cynthia McKinney (D-Georgia) have repeated Truther memes, along with such celebrity know-nothings as Charlie Sheen, Rosie O’Donnell, Sean Penn, Willie Nelson, and Mark Cuban. An assortment of left-wing academics, including Princeton professor emeritus Richard A. Falk, and even some former Republican government appointees (Paul Craig Roberts, Assistant Secretary of the Treasury under President Reagan, and Morgan Reynolds, a former Labor Department economist in the George H.W. Bush administration) have also piped in.[19]

How and why do prominent public figures allow themselves to be quoted in support of conspiracy theories? In some cases they aren’t particularly well-informed, or aren’t properly skeptical, or they allow ideology to overwhelm common logic. With politicians, it’s also fair to say they would rather humor constituents than alienate, or level with them. Some may think they are simply being provocative. Some, sadly, appear to be delusional—Morgan Reynolds, for example, has insisted that jetliners were not involved in any of the 9/11 attacks.[20] In any case, they give cover to the promoters of these noxious theories, allowing them to be injected into American political discourse. Acceptance of conspiracy theories makes healthy political debate difficult, if not impossible. It creates an atmosphere of enmity and suspicion. It encourages the growth of extremism, since—to take the 9/11 “inside job” theory as an example—a government that would murder its own people can hardly be trusted on anything, could it?

What Lies Ahead

Will Birthers’ conspiracy theories have any shelf life? It’s likely that the “Obama as alien usurper” meme will retain its power for many on the extreme Right, and an Obama re-election campaign in 2012 will surely cause the eligibility controversy to re-surface. White House spokesman Robert Gibbs is correct when he observes that nothing will convince Birthers of Obama’s legitimacy.[21] “It is useless to attempt to reason a man out of a thing he was never reasoned into,” as Jonathan Swift once observed.

Then, too, many vocal proponents will be looking to profit from the cottage industry of books, videos, seminars, and public appearances that are endemic to any good conspiracy theory. Still, Birthers can be marginalized and their fraudulent claims discredited even in the eyes of conservative Republicans doubtful about Obama. Transparency and repeated debunking are the keys.

President Obama should follow the lead of his predecessors, George W. Bush and Bill Clinton, and release more of his personal records.[22] Access to the US government’s files on the assassination was vital to disproving some JFK assassination theories, and the 9/11 Commission report and NIST studies on the World Trade Center attacks have sucked much, though not all, of the air out of the 9/11 Truth Movement.

When it comes to the Paranoid Style, sunshine is the best disinfectant.

[1] Richard Hofstadter, “The Paranoid Style in American Politics,” Harper’s Magazine, November 1964. The “Birthers” nickname is a play on the popular tag for another group of conspiracy theorists, the 9/11 “Truth Movement,” who have become known as the “Truthers.” Calvin Trillin popularized the term “assassination buffs” in a 10 June 1967 New Yorker article, “The Buffs.”

[2] Jonah Goldberg, “Birthers of a Nation & The Paranoid Style of American Liberalism,” National Review Online, 5 August 2009.

[3] Hofstadter, “The Paranoid Style,” November 1964. Hofstadter argued that groups shut out of political process (often because of their extremism) resort to the Paranoid Style: “Having no access to political bargaining or the making of decisions, they find their original conception that the world of power is sinister and malicious fully confirmed.”

[4] “Born in the USA: The Truth About Obama’s Birth Certificate,” FactCheck.org, 1 November 2008; James Janega, “Obama Birth Certificate Rumor Debunked,” Chicago Tribune, 30 October 2008.

[5] “Daily Kos/Research 2000 Poll, 27-30 July 2009,” DailyKos.

[6] Alex Koppleman, “The Right Bails on the Birthers,” Salon, 28 July 2009.

[7] James Kirchick, “Liberals’ Birther Obsession: It’s the Left-Wing, Not the GOP, That’s Pumping Up the Story,” Daily News, 5 August 2009.

[8] Paul Joseph Watson, “Alan Keyes: Government Will Stage Terror, Declare Martial Law,” PrisonPlanet, 21 April 2009.

[9] On Corsi, see Kenneth P. Vogel, “Wild Theories of ‘Obama Nation’ Author,” Politico, 13 August 2008. On Keyes, see America’s Independent Party website. On Berg, see Jennifer Haberkorn, “Lawsuit Questions Obama’s Eligibility for Office,” Washington Times, 28 August 2008.

[10] For the identification of Dr.West, see Paula Veoll, “Teacher from Kenmore Recalls Obama Was a Focused Student,” The Buffalo News, 20 January 2009.

[11] On the 9/11 Truth Movement and conspiracy theories, see Jefferson Flanders, “Confronting Reality: Occam’s Razor and the 9/11 ‘Truth Movement’,” jeffersonflanders.com, September 2008.

[12] Assassination buffs Jack White and James Fetzer are two of the leading proponents of the “alterationist” faction, which is a fairly recent phenomenon and considered disreputable even within the larger “research community.” Not uncoincidentally, White and Fetzer also attached themselves to the “911 Scholars for Truth” organization, one of the earliest conspiratorial groups formed in the wake of September 11.

[13] “Born in the USA: The Truth About Obama’s Birth Certificate,” 1 November 2008. FactCheck.org’s investigation debunked the forgery claims:

“We received responses to some of our questions from the Hawaii Department of Health. They couldn’t tell us anything about their security paper, but they did answer another frequently-raised question: why is Obama’s father’s race listed as ‘African’? Kurt Tsue at the DOH told us that father’s race and mother’s race are supplied by the parents, and that ‘we accept what the parents self identify themselves to be.’ We consider it reasonable to believe that Barack Obama, Sr., would have thought of and reported himself as ‘African.’ It’s certainly not the slam dunk some readers have made it out to be.

When we asked about the security borders, which look different from some other examples of Hawaii certifications of live birth, Kurt said, ‘The borders are generated each time a certified copy is printed. A citation located on the bottom left hand corner of the certificate indicates which date the form was revised.’ He also confirmed that the information in the short form birth certificate is sufficient to prove citizenship for ‘ all reasonable purposes.’”

See also Dan Nakaso, “Hawaii Officials Confirm Obama’s Original Birth Certificate Still Exists,” Honolulu Advertiser, 28 July 2009.

[14] Jim Dwyer, “2 US Reports Seek to Counter Conspiracy Theories About 9/11,” New York Times, 2 September 2006; Brendan O’Neill, “Meet the No Planers,” New Statesman, 11 September 2006.

[15] On WND’s role in promoting the Obama citizenship controversy, see Terry Krepel, “Joseph Farah’s Birther Factory,” Huffington Post, 7 August 2009, and Brian Seltzer, “On Television and Radio, Talk of Obama’s Citizenship,” nytimes.com, 24 July 2009.

[16] See, for example, Alan Feuer, “500 Conspiracy Buffs Meet to Seek the Truth of 9/11,” New York Times, 5 June 2006.

[17] For a discussion of the JFK conspiracy theory network, see Gavin Esler, “JFK: The Simple Truth,” BBC News, 22 November 2003.

[18] Gabriel Winant, “The Birthers in Congress,” Salon, 28 July 2009.

[19] On Dean, see Timothy Noah, “Whopper: Howard Dean,” Slate, 13 December 2003. See also “Celebrity 9/11 Conspiracy Club Still Growing,” Washington Times, 6 March 2008.

[20] Morgan Reynolds, “Revisiting the WTC Building Collapses, Part I,” 9-11 Research.com, 12 July 2005.

[21] Helene Cooper, “Gibbs Slams the Birthers: Obama’s a Citizen,” nytimes.com, 27 July 2007.

22] Bill Clinton and George W. Bush had much more extensive vetting of their personal histories during their political careers. They released more personal information during their campaigns (medical history, military records, college grades, etc.) than has Obama. As Andrew C. McCarthy pointed out July 30 in the National Review Online (“Suborned in the USA”), Obama has resisted releasing basic information about his past. McCarthy concludes: “What’s wrong with saying, to a president who promised unprecedented ‘transparency’: Give us all the raw data and we’ll figure it out for ourselves?” The Atlantic’s Andrew Sullivan and Salon’s Camille Paglia have urged Obama to release his long-form birth certificate.

© 2009 by Jefferson Flanders

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Guest Tom Scully

Thank you, Mike and John, for your polite, patient answers to Chrstopher's questions, which shoulg have an eye opening effect, because Christopher is an educated man.

I predict your answers will have little or no effect on Christopher's opinion, because he seems to have strong faith in the American "free markets" system, which history actually demostrates is a rigged, predatory game, at least against those who don't get in on a generous share of the spoils. IMO, our "system" is broken, and for a long time.

The top ten percent own 70 percemt of all US assets, but Christopher's questions seem so similar to the topics injected into the publc's fear stream since Clinton's 1993 attempt to "reform" US healthcare. Yhose topics of concerned are created and distributed by those making fortunes off of the system as they've made it, aided by the political party who they've contributed the most money to.

The core concerns are about "losing the ability to see your favorite doctor", aboiut the "tort lawyers driving up medical malpractive premiums with phoney lawsuits, and splitting the profits with democrats in congress,", as you can see reflected in Chistopher's questions.

Yhis post ends with two stories, 75 years apart, of two former heads of major US stock exchanges, both men corrupt to the core and finally sent to prison after stealing huge amounts of money. One was John Train's next door nerighbor in 1930, Richard Whitney, and the other is Bernie Madoff.

My other examplse are pharma giant Pfizer stealing $14 billion a year, selling it's own branded and heavily advertised, very expensive version of a now cheap, staple drug,

only superior to the cheaper generic in that it does not lose effectiveness when the user also drinks large quantities of grapefruit juice. The US pharma industry sells unneeded, overly expensive drugs through shear bribery....like Whitney and Madoff , it is corrupt to the core!

I also document that the Federal gov's Medicare expenses for the elderly are robbed and raided of billions by private insurers who mugged the governmen,t 40 years ago, into allowing them, and only them, to examine and pay out on all submitted claims for the costs of care of those covered under the program.

The man who thought he could be president, Bill Frist, who as senate majority leader, blocked all efforts to insert an illness exception into a tough, 2005, anti-consumer bankruptcy bull, is himself a medical doctor from a family enriched with, by now, at least $2 billion from profits of it's hospitals and insurance business, Reas about this company called HCA, Senator Frist's greedy and deceptive stock sales, and about his family and the Tennessee lawfirm that made many millions, churning HCA and it's stock, taking the company public, and then back to private control again, making huge amounts for a select few at each manipulation.

Welcome to the US system, perpetuated by the brainwashed and the elite few who pay to feed them the very misinformation that ends up oppressing them. But, in the US, we're told by these corrupt elite, we are "different", we cannot have a successful single payer system of medical care as all other inductrialized states enjoy. Could it be because our "sytem" is the most corrupted, due to the crisis level concentration of wealth experienced here, which seems to go almost unnoticed, except by the rest of the world?

http://en.wikipedia.org/wiki/Bill_Frist

William Harrison "Bill" Frist, Sr., M.D. (born February 22, 1952) is an American physician, businessman, and politician.

http://en.wikipedia.org/wiki/Bill_Frist_me...nts_controversy

Bill Frist medical school experiments controversy

http://www.usatoday.com/tech/techinvestor/...lionaires_x.htm

New names among the richest on Forbes' billionaires list

Updated 3/11/2005 5:40 AM

....Tennessee had three entries on the list: Martha Ingram and family of Ingram Industries at No. 228 with $2.6 billion; Frederick Smith of FedEx at No. 306 with $2.1 billion; and Thomas Frist Jr. and family of HCA Inc. at No. 584 with $1.1 billion.....

http://www.theledger.com/article/20050309/...ictory-for-Bush

Bankruptcy Bill Set for Passage; Victory for Bush

By STEPHEN LABATON

New York Times

Published: Wednesday, March 9, 2005

But critics said the measure was a thinly disguised gift to banks and credit card companies, which, they contend, are largely responsible for the high rate of bankruptcies because they heavily promote credit cards and loans that often come with large and largely unseen fees for late payments. They said that the measure would impose new obstacles on many middle-income families seeking desperately needed protection from creditors, and that it would take far longer for those families to start over after suffering serious illnesses, unemployment and other calamities.

The votes on Tuesday were the second legislative victory in recent weeks both for Mr. Bush and the Senate majority leader, Bill Frist, himself a possible presidential contender in 2008. Mr. Frist nimbly moved both the bankruptcy bill and another bill last month making it more difficult to bring class-action lawsuits through the Senate.

In both cases, he unified the Republicans to beat back every effort by the Democrats to water down or delay the measures. In both cases, he also reached a deal with House leaders in which the Senate blocked any significant changes to the measure in exchange for a commitment from the House that it would adopt unaltered what the Senate approved.

The White House applauded the votes on Tuesday....

http://www.cbsnews.com/stories/2005/03/11/...ain679480.shtml

WASHINGTON, March 11, 2005

Senate OKs Bankruptcy Bill 74-25

Bush Urges House To Follow Suit On Measure Making Ch. 11 Harder

Font size Print E-mail Share By Joel Roberts

"This legislation restores personal responsibility and fairness to an abused system," said Senate Majority Leader Bill Frist, R-Tenn.

The bill's supporters argued that bankruptcy frequently is the last refuge of gamblers, impulsive shoppers, divorced or separated fathers avoiding child support, and multimillionaires, often celebrities, who buy mansions in states with liberal homestead exemptions to shelter assets from creditors.

Opponents, too, have a litany of stories. Sen. Edward M. Kennedy, D-Mass., speaks of Zoraya Marrero, a single mother with three children from Woodbridge, Va., the eldest of whom has spina bifida. Having had to return $60,000 in state disability benefits and medical coverage for the child, and paying medical expenses, Marrero recently filed for bankruptcy.

Most applicants "did not seek bankruptcy relief willingly," Kennedy says. "Millions of ... Americans in similar situations have filed for bankruptcy only after exhausting all other options."

A recent Harvard University study found that costly illnesses led to about half of all personal bankruptcies and that most people who file for bankruptcy protection because of medical problems have health insurance.

Democratic opponents argued that the changes would keep people who are overwhelmed by medical costs or loss of a job hopelessly in debt for the rest of their lives....

....Over the past two weeks, Republicans knocked down Democratic attempts to ease the impact of the legislation on people facing huge debts they cannot pay, including single parents, the unemployed and the ill....

http://uk.biz.yahoo.com/060810/323/gj6je.html

Thursday August 10, 05:13 PM

Shareholders to vote on HCA deal

.... The next day, the offer was upped to $50.50 per share, which the special committee also rejected, but said it would consider a proposal at $52 per share, it said.

Later that day, Merrill Lynch representatives contacted the special committee and said the potential buyers would submit their 'best and final' offer of $50.75 per share. The special committee said it would only pursue a proposal at $51 per share, which buyers finally agreed to, it said.

The SEC filing also contained details of the expected buyout of shares.

It said that Thomas Frist Jr., who co-founded the hospital chain in 1968 with his physician-father, would put nearly 16 million shares of HCA stock back into the company.

Frist owns about 4 percent of HCA shares, but after the pending buyout he would own about 15 percent of the company.

Thomas Frist Jr. is the brother of Senate Majority Leader Bill Frist, who is under federal investigation for selling HCA shares last year around the time insiders were selling and when the stock price hit a 52-week high.

At least six members of HCA's senior management would invest a total of at least $46.5 million in cash or roll over a portion of their stock options into the deal, according to the SEC filing.

Of these executives, Chairman and Chief Executive Jack Bovender Jr., would put up the most -- about $20 million -- giving him 0.47 percent ownership of HCA after the buyout.

Richard M. Bracken, HCA's president and chief operating officer, would invest at least $10 million, for a 0.23 percent stake.....

http://phx.corporate-ir.net/phoenix.zhtml?...ol-fundsnapshot

HCA owns and operates approximately 179 hospitals and approximately 104 freestanding surgery centers in 21 states, England and Switzerland. We are dedicated to providing healthcare services that meet each community's local healthcare needs. We seek to integrate various services to deliver patient care with maximum quality and efficiency. Our approach includes focusing on quality; streamlining operations; sharing technology, equipment and personnel where appropriate; and using economies of scale when contracting for medical supplies and administrative services.

11/16/06

HCA Shareholders Approve Merger With Private Equity Consortium632

Income From Total Operations (mil) (FYE) 1,424.00

http://www.tennessean.com/apps/pbcs.dll/ar...0334/1003/RSS03

Monday, 01/08/07

Firms cash in on merger mania

Midstate bankers, lawyers, accountants collect hefty fees

By GETAHN WARD

Staff Writer

....The biggest was the purchase of hospital chain HCA by three private equity firms and the Frist family for $33 billion, the second largest leveraged buyout in history.

Beneficiaries included the law firm Bass, Berry & Sims of Nashville, which offered HCA legal advice and had a share in an estimated $62 million of legal and consulting fees."We did several billion dollar-plus deals (nationwide). That's very unusual," said Jim Cheek, a senior partner in Bass, Berry & Sims. "The amount of private equity money and the ability to leverage that money with significant debt-financing have been unparalleled."

In such transactions, lawyers and other professionals play various roles. Lawyers help with negotiating terms, reviewing contracts, advising directors and preparing regulatory filings.

Investment bankers help in structuring the transactions, including determining the appropriate price and arranging funding sources.

Accountants help to verify that financial information provided by a seller to a buyer is accurate, offer tax advice on structuring the transaction, and might help a party with negotiations.

In Nashville, fees lawyers can earn for work on such transactions range from $135-$140 an hour for younger attorneys up to $400-$500 an hour for senior partners. New lawyers in larger cities such as New York, Chicago and Atlanta can earn $200 an hour and senior partners $600 to $650 an hour, said George Bishop, a partner in corporate mergers and acquisitions with the law firm Waller Lansden Dortch & Davis.

A big deal doesn't always mean more work, he said, adding that parties might not have the time to review every contract and that much information might already be available.

Nationwide, cash-flush private equity firms — with an ability to put down so little of their own money and borrow more than ever before — are a major force behind the mergers and acquisitions boom that kicked off in 2003.

But a Bloomberg analysis of last year's 246 Tennessee deals shows that only 29 involved such equity firms,with a total acquisition value of more than $36 billion. Most deals were acqui sitions of companies by another player in their industries, including foreign companies involved in 37 deals worth more than $3 billion.

Health-care and pharmaceutical companies accounted for 47 deals worth $83 billion, making Nashville's signature industry the most active sector in terms of total dollar volume.....

http://en.wikipedia.org/wiki/Atorvastatin

Atorvastatin (INN) (pronounced /əˌtɔrvəˈstætən/) (Lipitor, Pfizer), is a member of the drug class known as statins, used for lowering blood cholesterol. It also stabilizes plaque and prevents strokes through anti-inflammatory and other mechanisms....

....Atorvastatin was first synthesized in 1985 by Bruce Roth while working at Parke-Davis Warner-Lambert Company (now Pfizer). With 2008 sales of US$12.4 billion, Lipitor is likely the top-selling drug in the world.[1] US patent protection is scheduled to expire in June 2011.[2] However, Pfizer made an agreement with Ranbaxy Laboratories to delay the generic launch in the US until November 2011.[3]

Market

Lipitor market analysis

In 2006, Pfizer’s Lipitor (atorvastatin) generated global revenues of $13.6bn, making it the best selling drug in pharmaceutical history. The blockbuster medicine has single-handedly driven the overall revenue margins of the cardiovascular segment, as this area continues to dominate the pharmaceutical market....

....Pfizer fight against simvastatin alternative

After doctors and patients began switching by the millions to a cheaper alternative within the same class of drugs called simvastatin, Pfizer launched a campaign including advertisements, lobbying efforts, and a paid speaking tour by Dr. Louis W. Sullivan, a former secretary of the federal Department of Health and Human Services, to discourage the trend.[4] The main clinical advantage of Lipitor over simvastatin is that it is not metabolised by certain liver enzymes, and thus its blood concentration is not increased when combined with grapefruit juice which inhibits these enzymes. Simvastatin patients should avoid drinking large amounts of grapefruit juice for this reason. An independent analysis showed that, at commonly prescribed doses, atorvastatin and simvastatin have no statistically significant differences in reducing cardiovascular morbidity and mortality.[34]

[edit] Advertisements withdrawn

On February 25, 2008, Pfizer announced that it will voluntarily withdraw all advertisements for Lipitor featuring Dr. Robert Jarvik and will commit to ensuring greater clarity in the roles and responsibilities of its spokespeople in its consumer advertising and promotion. [35] Dr. Jarvik is not a licensed physician and his use in advertisements was considered misleading. In addition, although he was shown rowing (and therefore implying that his heart was healthy) he in fact does not row and the advertisement employed a body double. Pfizer withdrew the advertisement as a result of bad press.[citation needed]

http://www.straight.com/node/160083

September 4, 2008

The pill pushers

By Alex Roslin

....Pushing pills involves fantastic amounts of money. In a study in January in the journal Public Library of Science Medicine, two Canadian academics, Joel Lexchin and Marc-André Gagnon, calculated that pharmaceutical companies spent $57.5 billion on marketing in the U.S. in 2004. That was nearly double the $32 billion spent on researching and developing drugs.

The marketing budget included $20.4 billion for an army of 100,000 detailers—one for every eight doctors. This sales force has almost tripled, from 38,000 in 1995.

Another $2 billion was spent on 371,000 pharma-sponsored lunch and dinner meetings, conferences, and other events for U.S. doctors.

According to a 2006 study by Cassels’s Drug Policy Futures, Canada is similar. The number of detailers here jumped from 3,990 to 5,190 between 1998 and 2002, working out to one rep for each 11.4 doctors.

But the numbers don’t tell the whole story. In fact, a very large portion of all that lucre goes to the secret weapon of the detailer: food. “Food is a pretty powerful catalyst for sales,” Ahari said from Berkeley, California, where he now works as a consultant to PharmedOut.org, a group of doctors working to counter pharmaceutical marketing. “I sometimes saw myself as a glorified caterer.”

While at Lilly, Ahari cozied up to doctors with invitations to dinner at Manhattan’s hottest eateries. “....

http://www.washingtonpost.com/wp-dyn/conte...2800896_pf.html

Drugmakers, Doctors Get Cozier

Gifts Continue, Contacts Increase Despite Guidelines

By Christopher Lee

Washington Post Staff Writer

Sunday, April 29, 2007; A03

Despite efforts to curb drug companies' avid courting of doctors, the industry is working harder than ever to influence what medicines they prescribe, sending out sales representatives with greater frequency and plying physicians with gifts, meals and consulting fees, according to several new papers.

One study published in the New England Journal of Medicine last week found that 94 percent of doctors have some type of relationship with the drug industry -- most commonly accepting free food or drug samples, which about 80 percent of physicians did. More than one-third of the 1,662 physicians who responded to a survey conducted from November 2003 to June 2004 reported being reimbursed by the drug industry for costs of going to professional meetings or continuing medical education, and 28 percent said they had been paid for consulting, giving lectures or signing up patients for clinical trials.

Two other papers examined in detail the strategies that pharmaceutical representatives, or "detailers," use and how effective the industry is at influencing doctors.

"We now know that virtually every doctor in the United States has some form of relationship with the pharmaceutical industry," said Eric G. Campbell, lead researcher of the New England Journal of Medicine study and an assistant professor of medicine at Harvard Medical School. "They are common. A quarter receive honoraria or some form of payment for their services, and that was much higher than we expected." ....

..The ties between doctors and drug companies are deepening despite voluntary guidelines to curb excesses, adopted in 2002 by the American Medical Association, the American College of Physicians, the Accreditation Council for Continuing Medical Education and the Pharmaceutical Research and Manufacturers of America. The inspector general of the Department of Health and Human Services issued similar guidance in 2003.

Under the industry code, gifts must be worth less than $100 and should primarily benefit patients -- items such as stethoscopes or medical dictionaries. Meals should be "modest" in cost, and a physician's spouse should not be included. Gifts of cash or tickets to sporting events are inappropriate. Consulting arrangements must be for real services, and doctors should not be paid for listening to marketing pitches.....

....A former industry insider, however, painted a different picture in an article last week in PLoS Medicine, a journal published by the Public Library of Science. Shahram Ahari, a former drug company representative, and physician Adriane Fugh-Berman wrote that the estimated 100,000 representatives who visit doctors' offices look for details such as family photos or hobbies that they can use to forge a relationship. They use food, gifts and money to make often-overworked doctors feel more appreciated -- and more loyal to the company's drugs. If a physician will not meet with them, the representatives often woo the office staff with flattery and meals.

"Pharmaceutical gifting . . . involves carefully calibrated generosity," Ahari and Fugh-Berman wrote. "Many prescribers receive pens, notepads, and coffee mugs, all items kept close at hand, ensuring that a targeted drug's name stays uppermost in a physician's subconscious mind. High prescribers receive higher-end presents, for example, silk ties or golf bags."

Drug companies also purchase prescription records from pharmacies and, with the help of an American Medical Association database, identify individual physicians' prescribing patterns and rank doctors based on how many prescriptions they write, the authors wrote.

The tactics work. Another study in PLoS Medicine last week found that visits by detailers prompted nearly half of 97 physicians to increase prescriptions of gabapentin, a drug approved to treat seizures. In many cases, the drug representatives were pushing non-approved, or "off-label," uses of the drug, the study found....

http://www.sfgate.com/cgi-bin/article.cgi?.../12/MN63168.DTL

Medicare bilked for billions in bogus claims

Private watchdogs rife with conflicts make system an easy target for fraud

- Reynolds Holding, Chronicle Staff Writer

Sunday, January 12, 2003

The system of private contractors policing the $250 billion-a-year Medicare program is riddled with conflicts of interest, financial disincentives and regulatory breakdowns so severe that fraud and abuse bleed tens of billions of dollars from the program every year.

Several of the most egregious frauds have involved the watchdogs themselves -- private insurance companies the government hires to examine and pay Medicare claims -- court records show.

But even reputable companies lack incentive to search for fraud. They serve at the behest of medical trade groups and, in some cases, are business partners with doctors and hospitals. They skimp on oversight, checking for the proper completion of claims forms but rarely for deceit.....

....CONFLICTS OF INTEREST

Medicare's persistent breakdowns derive in part from its size. The program, created in 1965 to guarantee health care coverage for Americans over 65 or with certain disabilities, covered more than 40 million Americans last year and paid about a billion claims.

But critics say the system's fraud problems stem from a compromise Congress struck with the health care establishment 38 years ago. Fearing socialized medicine, doctors and hospital owners agreed to participate in the program only after being allowed to select the insurance companies that process the claims and serve as the program's watchdogs.

Today, 49 private insurance companies work for the Centers for Medicare and Medicaid Services, the federal agency that runs Medicare.

The insurance companies receive bills from doctors and hospitals that treat Medicare patients, examine the bills for mistakes and then pay them with checks drawn on two federal trust funds. The trust funds are financed through payroll taxes, patient premiums and general tax revenues.

The government reimburses the companies for their costs of processing claims, and grants them a fixed budget for administrative tasks such as controlling fraud and abuse.

Typically, the U.S. government awards contracts through competitive bidding.

But the compromise with Congress allowed the American Hospital Association, an advocacy group for hospitals, to decide which insurance companies should handle hospitals' Medicare bills.

Virtually all the companies turned out to be members of the National Association of Blue Shield Plans, now the Blue Cross Blue Shield Association, a frequent political ally of the American Hospital Association and the American Medical Association.

"'No sooner had the ink dried on that compromise than we began . . . to have horror stories," says Richard Kusserow, inspector general in the Department of Health and Human Services from 1982-1991. For every abuse the government tried to stop, says Kusserow, three would appear in its place.

Bilking Medicare became so lucrative that professional criminals got involved. In 1993, Gabriel Hernandez, a former "logistics coordinator" for the Medellin, Colombia, cocaine cartel, opened a chain of Florida health clinics that billed Medicare and state Medicaid programs for fictitious patients with phony ailments. Over two years, he received checks for more than $1.7 million.

"Everything was easy compared with being in the trafficking business," he says. "All I was doing was picking up checks every week. And I got caught, but I didn't get killed."

Hernandez was convicted in April 1997 of racketeering and spent five years in prison.

Three years ago, the General Accounting Office (GAO) cited "fundamental" conflicts of interest as a factor in the watchdogs' poor performance.

Hospitals and doctors not only help select their overseers, they go into business with them. Many of these companies also run health maintenance organizations. The HMOs funnel business to hospitals and doctors that the insurers may regulate.

Some of the companies even own hospitals. For example, one subsidiary of Cigna Corp. reviews and pays Medicare claims for doctors. Another subsidiary owns Lovelace Health Systems, a hospital and physician group in Albuquerque, N. M. Last month,. Lovelace agreed to pay $24.5 million to settle a whistle- blower suit charging that the company had submitted tens of millions of dollars in false claims to Medicare over 10 years. Cigna did not review the Lovelace claims.

And when a private insurer and Medicare cover the same patient, the insurer is primarily responsible for paying the patient's claims, with Medicare picking up anything left over. But some insurers exploit their Medicare roles by making Medicare the primary payer, a violation that has cost the national Blue Cross Blue Shield Association, Transamerica, Travelers and other insurers more than $100 million in legal settlements.

"Government contractors policing themselves," says Kusserow, "is not a very healthy situation to have."

CORPORATE ABUSE OF SYSTEM.....(read on...

http://www.npr.org/templates/story/story.p...toryId=16045685

Feds Fight Rampant Medicare Fraud in South Florida

by Greg Allen

Listen Now [5 min 13 sec] add to playlist

All Things Considered, November 6, 2007 · It doesn't sound sexy, but amid the bikinis, beaches and palm trees of South Florida, one of the most popular and lucrative crimes now is Medicare fraud, and a team of federal investigators and prosecutors are tasked with putting a stop to it.

The dollar totals are staggering: Law enforcement officials say they've uncovered more than a half-billion dollars in fraudulent claims this year in South Florida alone.

If you want to know how bad Medicare fraud is in Miami, a good place to start is with a study released by federal inspectors. They visited, at random, nearly 1,600 businesses in Miami that bill Medicare for services allegedly delivered to beneficiaries.

The U.S. attorney in Miami, Alexander Acosta, says the inspectors found that nearly one-third of the businesses — 481 — didn't exist.

"Those 481 businesses — so-called businesses that didn't exist — had billed $237 million in fraud over the past year," Acosta says.

That study helped focus national attention on the problem of Medicare fraud in Miami — especially among shell companies that purport to sell what's known as "durable medical equipment" — wheelchairs, walkers, respirators and the like.....

http://money.cnn.com/2008/12/16/news/madof...rtune/index.htm

70 years before Madoff, there was Whitney

Former New York Stock Exchange president Richard Whitney boasted a sterling reputation during the Depression, then became a symbol of Wall Street's betrayal of investors.

By James Bandler and Doris Burke

Last Updated: December 16, 2008: 3:50 PM ET....

http://dealbook.blogs.nytimes.com/2009/08/...f-ponzi-scheme/

It Was All Fake’: Madoff Aide Details Scheme

August 12, 2009, 3:58 am

....On Tuesday, Mr. DiPascali stood in a federal courtroom in Lower Manhattan and admitted that, for at least the last 20 years, he had helped Mr. Madoff carry out one of the biggest frauds in Wall Street history, The New York Times’s Jack Healy and Diana B. Henriques reported.

Indeed, he detailed for the first time how he and unidentified others helped Mr. Madoff perpetuate the crime — using historical stock data from the Internet to create fake trade blotters, sending out fraudulent account statements to clients and arranging wire transfers between Mr. Madoff’s London and New York offices to create the impression that the firm was earning commissions from stock trades.

“I knew it was criminal, and I did it anyway,” Mr. DiPascali told Judge Richard J. Sullivan, of Federal District Court, just before pleading guilty to 10 felony counts, including conspiracy and tax evasion.

But Judge Sullivan refused to release Mr. DiPascali on bail after his plea, despite a request by prosecutors that he remain free to better assist their complex, wide-ranging investigations, a jolt to both the government attorneys and the defense lawyers....

http://www.insurancenewsnet.com/article.as...nnID=1020495260

Accountants'' Liability in the Madoff Scheme: A CPA Journal Symposium

....Tax recovery is an important element to this scheme. Dan L. Goldwasser, shareholder and member of the accounting law practice group at Vedder Prince, said that the area of damage control in the Madoff situation really boils down to two or three things that you can do. The most important thing you can do is to protect your insurance coverage. FULL TEXT

Edited by Tom Scully
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Thank you, Mike and John, for your polite, patient answers to Chrstopher's questions, which shoulg have an eye opening effect, because Christopher is an educated man.

I predict your answers will have little or no effect on Christopher's opinion, because he seems to have strong faith in the American "free markets" system, which history actually demostrates is a rigged, predatory game, at least against those who don't get in on a generous share of the spoils. IMO, our "system" is broken, and for a long time.

The top ten percent own 70 percemt of all US assets, but Christopher's questions seem so similar to the topics injected into the publc's fear stream since Clinton's 1993 attempt to "reform" US healthcare. Yhose topics of concerned are created and distributed by those making fortunes off of the system as they've made it, aided by the political party who they've contributed the most money to.

The core concerns are about "losing the ability to see your favorite doctor", aboiut the "tort lawyers driving up medical malpractive premiums with phoney lawsuits, and splitting the profits with democrats in congress,", as you can see reflected in Chistopher's questions.

Yhis post ends with two stories, 75 years apart, of two former heads of major US stock exchanges, both men corrupt to the core and finally sent to prison after stealing huge amounts of money. One was John Train's next door nerighbor in 1930, Richard Whitney, and the other is Bernie Madoff.

My other examplse are pharma giant Pfizer stealing $14 billion a year, selling it's own branded and heavily advertised, very expensive version of a now cheap, staple drug,

only superior to the cheaper generic in that it does not lose effectiveness when the user also drinks large quantities of grapefruit juice. The US pharma industry sells unneeded, overly expensive drugs through shear bribery....like Whitney and Madoff , it is corrupt to the core!

I also document that the Federal gov's Medicare expenses for the elderly are robbed and raided of billions by private insurers who mugged the governmen,t 40 years ago, into allowing them, and only them, to examine and pay out on all submitted claims for the costs of care of those covered under the program.

The man who thought he could be president, Bill Frist, who as senate majority leader, blocked all efforts to insert an illness exception into a tough, 2005, anti-consumer bankruptcy bull, is himself a medical doctor from a family enriched with, by now, at least $2 billion from profits of it's hospitals and insurance business, Reas about this company called HCA, Senator Frist's greedy and deceptive stock sales, and about his family and the Tennessee lawfirm that made many millions, churning HCA and it's stock, taking the company public, and then back to private control again, making huge amounts for a select few at each manipulation.

Welcome to the US system, perpetuated by the brainwashed and the elite few who pay to feed them the very misinformation that ends up oppressing them. But, in the US, we're told by these corrupt elite, we are "different", we cannot have a successful single payer system of medical care as all other inductrialized states enjoy. Could it be because our "sytem" is the most corrupted, due to the crisis level concentration of wealth experienced here, which seems to go almost unnoticed, except by the rest of the world?

http://en.wikipedia.org/wiki/Bill_Frist

William Harrison "Bill" Frist, Sr., M.D. (born February 22, 1952) is an American physician, businessman, and politician.

http://en.wikipedia.org/wiki/Bill_Frist_me...nts_controversy

Bill Frist medical school experiments controversy

http://www.usatoday.com/tech/techinvestor/...lionaires_x.htm

New names among the richest on Forbes' billionaires list

Updated 3/11/2005 5:40 AM

....Tennessee had three entries on the list: Martha Ingram and family of Ingram Industries at No. 228 with $2.6 billion; Frederick Smith of FedEx at No. 306 with $2.1 billion; and Thomas Frist Jr. and family of HCA Inc. at No. 584 with $1.1 billion.....

http://www.theledger.com/article/20050309/...ictory-for-Bush

Bankruptcy Bill Set for Passage; Victory for Bush

By STEPHEN LABATON

New York Times

Published: Wednesday, March 9, 2005

But critics said the measure was a thinly disguised gift to banks and credit card companies, which, they contend, are largely responsible for the high rate of bankruptcies because they heavily promote credit cards and loans that often come with large and largely unseen fees for late payments. They said that the measure would impose new obstacles on many middle-income families seeking desperately needed protection from creditors, and that it would take far longer for those families to start over after suffering serious illnesses, unemployment and other calamities.

The votes on Tuesday were the second legislative victory in recent weeks both for Mr. Bush and the Senate majority leader, Bill Frist, himself a possible presidential contender in 2008. Mr. Frist nimbly moved both the bankruptcy bill and another bill last month making it more difficult to bring class-action lawsuits through the Senate.

In both cases, he unified the Republicans to beat back every effort by the Democrats to water down or delay the measures. In both cases, he also reached a deal with House leaders in which the Senate blocked any significant changes to the measure in exchange for a commitment from the House that it would adopt unaltered what the Senate approved.

The White House applauded the votes on Tuesday....

http://www.cbsnews.com/stories/2005/03/11/...ain679480.shtml

WASHINGTON, March 11, 2005

Senate OKs Bankruptcy Bill 74-25

Bush Urges House To Follow Suit On Measure Making Ch. 11 Harder

Font size Print E-mail Share By Joel Roberts

"This legislation restores personal responsibility and fairness to an abused system," said Senate Majority Leader Bill Frist, R-Tenn.

The bill's supporters argued that bankruptcy frequently is the last refuge of gamblers, impulsive shoppers, divorced or separated fathers avoiding child support, and multimillionaires, often celebrities, who buy mansions in states with liberal homestead exemptions to shelter assets from creditors.

Opponents, too, have a litany of stories. Sen. Edward M. Kennedy, D-Mass., speaks of Zoraya Marrero, a single mother with three children from Woodbridge, Va., the eldest of whom has spina bifida. Having had to return $60,000 in state disability benefits and medical coverage for the child, and paying medical expenses, Marrero recently filed for bankruptcy.

Most applicants "did not seek bankruptcy relief willingly," Kennedy says. "Millions of ... Americans in similar situations have filed for bankruptcy only after exhausting all other options."

A recent Harvard University study found that costly illnesses led to about half of all personal bankruptcies and that most people who file for bankruptcy protection because of medical problems have health insurance.

Democratic opponents argued that the changes would keep people who are overwhelmed by medical costs or loss of a job hopelessly in debt for the rest of their lives....

....Over the past two weeks, Republicans knocked down Democratic attempts to ease the impact of the legislation on people facing huge debts they cannot pay, including single parents, the unemployed and the ill....

http://uk.biz.yahoo.com/060810/323/gj6je.html

Thursday August 10, 05:13 PM

Shareholders to vote on HCA deal

.... The next day, the offer was upped to $50.50 per share, which the special committee also rejected, but said it would consider a proposal at $52 per share, it said.

Later that day, Merrill Lynch representatives contacted the special committee and said the potential buyers would submit their 'best and final' offer of $50.75 per share. The special committee said it would only pursue a proposal at $51 per share, which buyers finally agreed to, it said.

The SEC filing also contained details of the expected buyout of shares.

It said that Thomas Frist Jr., who co-founded the hospital chain in 1968 with his physician-father, would put nearly 16 million shares of HCA stock back into the company.

Frist owns about 4 percent of HCA shares, but after the pending buyout he would own about 15 percent of the company.

Thomas Frist Jr. is the brother of Senate Majority Leader Bill Frist, who is under federal investigation for selling HCA shares last year around the time insiders were selling and when the stock price hit a 52-week high.

At least six members of HCA's senior management would invest a total of at least $46.5 million in cash or roll over a portion of their stock options into the deal, according to the SEC filing.

Of these executives, Chairman and Chief Executive Jack Bovender Jr., would put up the most -- about $20 million -- giving him 0.47 percent ownership of HCA after the buyout.

Richard M. Bracken, HCA's president and chief operating officer, would invest at least $10 million, for a 0.23 percent stake.....

http://phx.corporate-ir.net/phoenix.zhtml?...ol-fundsnapshot

HCA owns and operates approximately 179 hospitals and approximately 104 freestanding surgery centers in 21 states, England and Switzerland. We are dedicated to providing healthcare services that meet each community's local healthcare needs. We seek to integrate various services to deliver patient care with maximum quality and efficiency. Our approach includes focusing on quality; streamlining operations; sharing technology, equipment and personnel where appropriate; and using economies of scale when contracting for medical supplies and administrative services.

11/16/06

HCA Shareholders Approve Merger With Private Equity Consortium632

Income From Total Operations (mil) (FYE) 1,424.00

http://www.tennessean.com/apps/pbcs.dll/ar...0334/1003/RSS03

Monday, 01/08/07

Firms cash in on merger mania

Midstate bankers, lawyers, accountants collect hefty fees

By GETAHN WARD

Staff Writer

....The biggest was the purchase of hospital chain HCA by three private equity firms and the Frist family for $33 billion, the second largest leveraged buyout in history.

Beneficiaries included the law firm Bass, Berry & Sims of Nashville, which offered HCA legal advice and had a share in an estimated $62 million of legal and consulting fees."We did several billion dollar-plus deals (nationwide). That's very unusual," said Jim Cheek, a senior partner in Bass, Berry & Sims. "The amount of private equity money and the ability to leverage that money with significant debt-financing have been unparalleled."

In such transactions, lawyers and other professionals play various roles. Lawyers help with negotiating terms, reviewing contracts, advising directors and preparing regulatory filings.

Investment bankers help in structuring the transactions, including determining the appropriate price and arranging funding sources.

Accountants help to verify that financial information provided by a seller to a buyer is accurate, offer tax advice on structuring the transaction, and might help a party with negotiations.

In Nashville, fees lawyers can earn for work on such transactions range from $135-$140 an hour for younger attorneys up to $400-$500 an hour for senior partners. New lawyers in larger cities such as New York, Chicago and Atlanta can earn $200 an hour and senior partners $600 to $650 an hour, said George Bishop, a partner in corporate mergers and acquisitions with the law firm Waller Lansden Dortch & Davis.

A big deal doesn't always mean more work, he said, adding that parties might not have the time to review every contract and that much information might already be available.

Nationwide, cash-flush private equity firms — with an ability to put down so little of their own money and borrow more than ever before — are a major force behind the mergers and acquisitions boom that kicked off in 2003.

But a Bloomberg analysis of last year's 246 Tennessee deals shows that only 29 involved such equity firms,with a total acquisition value of more than $36 billion. Most deals were acqui sitions of companies by another player in their industries, including foreign companies involved in 37 deals worth more than $3 billion.

Health-care and pharmaceutical companies accounted for 47 deals worth $83 billion, making Nashville's signature industry the most active sector in terms of total dollar volume.....

http://en.wikipedia.org/wiki/Atorvastatin

Atorvastatin (INN) (pronounced /əˌtɔrvəˈstætən/) (Lipitor, Pfizer), is a member of the drug class known as statins, used for lowering blood cholesterol. It also stabilizes plaque and prevents strokes through anti-inflammatory and other mechanisms....

....Atorvastatin was first synthesized in 1985 by Bruce Roth while working at Parke-Davis Warner-Lambert Company (now Pfizer). With 2008 sales of US$12.4 billion, Lipitor is likely the top-selling drug in the world.[1] US patent protection is scheduled to expire in June 2011.[2] However, Pfizer made an agreement with Ranbaxy Laboratories to delay the generic launch in the US until November 2011.[3]

Market

Lipitor market analysis

In 2006, Pfizer’s Lipitor (atorvastatin) generated global revenues of $13.6bn, making it the best selling drug in pharmaceutical history. The blockbuster medicine has single-handedly driven the overall revenue margins of the cardiovascular segment, as this area continues to dominate the pharmaceutical market....

....Pfizer fight against simvastatin alternative

After doctors and patients began switching by the millions to a cheaper alternative within the same class of drugs called simvastatin, Pfizer launched a campaign including advertisements, lobbying efforts, and a paid speaking tour by Dr. Louis W. Sullivan, a former secretary of the federal Department of Health and Human Services, to discourage the trend.[4] The main clinical advantage of Lipitor over simvastatin is that it is not metabolised by certain liver enzymes, and thus its blood concentration is not increased when combined with grapefruit juice which inhibits these enzymes. Simvastatin patients should avoid drinking large amounts of grapefruit juice for this reason. An independent analysis showed that, at commonly prescribed doses, atorvastatin and simvastatin have no statistically significant differences in reducing cardiovascular morbidity and mortality.[34]

[edit] Advertisements withdrawn

On February 25, 2008, Pfizer announced that it will voluntarily withdraw all advertisements for Lipitor featuring Dr. Robert Jarvik and will commit to ensuring greater clarity in the roles and responsibilities of its spokespeople in its consumer advertising and promotion. [35] Dr. Jarvik is not a licensed physician and his use in advertisements was considered misleading. In addition, although he was shown rowing (and therefore implying that his heart was healthy) he in fact does not row and the advertisement employed a body double. Pfizer withdrew the advertisement as a result of bad press.[citation needed]

http://www.straight.com/node/160083

September 4, 2008

The pill pushers

By Alex Roslin

....Pushing pills involves fantastic amounts of money. In a study in January in the journal Public Library of Science Medicine, two Canadian academics, Joel Lexchin and Marc-André Gagnon, calculated that pharmaceutical companies spent $57.5 billion on marketing in the U.S. in 2004. That was nearly double the $32 billion spent on researching and developing drugs.

The marketing budget included $20.4 billion for an army of 100,000 detailers—one for every eight doctors. This sales force has almost tripled, from 38,000 in 1995.

Another $2 billion was spent on 371,000 pharma-sponsored lunch and dinner meetings, conferences, and other events for U.S. doctors.

According to a 2006 study by Cassels’s Drug Policy Futures, Canada is similar. The number of detailers here jumped from 3,990 to 5,190 between 1998 and 2002, working out to one rep for each 11.4 doctors.

But the numbers don’t tell the whole story. In fact, a very large portion of all that lucre goes to the secret weapon of the detailer: food. “Food is a pretty powerful catalyst for sales,” Ahari said from Berkeley, California, where he now works as a consultant to PharmedOut.org, a group of doctors working to counter pharmaceutical marketing. “I sometimes saw myself as a glorified caterer.”

While at Lilly, Ahari cozied up to doctors with invitations to dinner at Manhattan’s hottest eateries. “....

http://www.washingtonpost.com/wp-dyn/conte...2800896_pf.html

Drugmakers, Doctors Get Cozier

Gifts Continue, Contacts Increase Despite Guidelines

By Christopher Lee

Washington Post Staff Writer

Sunday, April 29, 2007; A03

Despite efforts to curb drug companies' avid courting of doctors, the industry is working harder than ever to influence what medicines they prescribe, sending out sales representatives with greater frequency and plying physicians with gifts, meals and consulting fees, according to several new papers.

One study published in the New England Journal of Medicine last week found that 94 percent of doctors have some type of relationship with the drug industry -- most commonly accepting free food or drug samples, which about 80 percent of physicians did. More than one-third of the 1,662 physicians who responded to a survey conducted from November 2003 to June 2004 reported being reimbursed by the drug industry for costs of going to professional meetings or continuing medical education, and 28 percent said they had been paid for consulting, giving lectures or signing up patients for clinical trials.

Two other papers examined in detail the strategies that pharmaceutical representatives, or "detailers," use and how effective the industry is at influencing doctors.

"We now know that virtually every doctor in the United States has some form of relationship with the pharmaceutical industry," said Eric G. Campbell, lead researcher of the New England Journal of Medicine study and an assistant professor of medicine at Harvard Medical School. "They are common. A quarter receive honoraria or some form of payment for their services, and that was much higher than we expected." ....

..The ties between doctors and drug companies are deepening despite voluntary guidelines to curb excesses, adopted in 2002 by the American Medical Association, the American College of Physicians, the Accreditation Council for Continuing Medical Education and the Pharmaceutical Research and Manufacturers of America. The inspector general of the Department of Health and Human Services issued similar guidance in 2003.

Under the industry code, gifts must be worth less than $100 and should primarily benefit patients -- items such as stethoscopes or medical dictionaries. Meals should be "modest" in cost, and a physician's spouse should not be included. Gifts of cash or tickets to sporting events are inappropriate. Consulting arrangements must be for real services, and doctors should not be paid for listening to marketing pitches.....

....A former industry insider, however, painted a different picture in an article last week in PLoS Medicine, a journal published by the Public Library of Science. Shahram Ahari, a former drug company representative, and physician Adriane Fugh-Berman wrote that the estimated 100,000 representatives who visit doctors' offices look for details such as family photos or hobbies that they can use to forge a relationship. They use food, gifts and money to make often-overworked doctors feel more appreciated -- and more loyal to the company's drugs. If a physician will not meet with them, the representatives often woo the office staff with flattery and meals.

"Pharmaceutical gifting . . . involves carefully calibrated generosity," Ahari and Fugh-Berman wrote. "Many prescribers receive pens, notepads, and coffee mugs, all items kept close at hand, ensuring that a targeted drug's name stays uppermost in a physician's subconscious mind. High prescribers receive higher-end presents, for example, silk ties or golf bags."

Drug companies also purchase prescription records from pharmacies and, with the help of an American Medical Association database, identify individual physicians' prescribing patterns and rank doctors based on how many prescriptions they write, the authors wrote.

The tactics work. Another study in PLoS Medicine last week found that visits by detailers prompted nearly half of 97 physicians to increase prescriptions of gabapentin, a drug approved to treat seizures. In many cases, the drug representatives were pushing non-approved, or "off-label," uses of the drug, the study found....

http://www.sfgate.com/cgi-bin/article.cgi?.../12/MN63168.DTL

Medicare bilked for billions in bogus claims

Private watchdogs rife with conflicts make system an easy target for fraud

- Reynolds Holding, Chronicle Staff Writer

Sunday, January 12, 2003

The system of private contractors policing the $250 billion-a-year Medicare program is riddled with conflicts of interest, financial disincentives and regulatory breakdowns so severe that fraud and abuse bleed tens of billions of dollars from the program every year.

Several of the most egregious frauds have involved the watchdogs themselves -- private insurance companies the government hires to examine and pay Medicare claims -- court records show.

But even reputable companies lack incentive to search for fraud. They serve at the behest of medical trade groups and, in some cases, are business partners with doctors and hospitals. They skimp on oversight, checking for the proper completion of claims forms but rarely for deceit.....

....CONFLICTS OF INTEREST

Medicare's persistent breakdowns derive in part from its size. The program, created in 1965 to guarantee health care coverage for Americans over 65 or with certain disabilities, covered more than 40 million Americans last year and paid about a billion claims.

But critics say the system's fraud problems stem from a compromise Congress struck with the health care establishment 38 years ago. Fearing socialized medicine, doctors and hospital owners agreed to participate in the program only after being allowed to select the insurance companies that process the claims and serve as the program's watchdogs.

Today, 49 private insurance companies work for the Centers for Medicare and Medicaid Services, the federal agency that runs Medicare.

The insurance companies receive bills from doctors and hospitals that treat Medicare patients, examine the bills for mistakes and then pay them with checks drawn on two federal trust funds. The trust funds are financed through payroll taxes, patient premiums and general tax revenues.

The government reimburses the companies for their costs of processing claims, and grants them a fixed budget for administrative tasks such as controlling fraud and abuse.

Typically, the U.S. government awards contracts through competitive bidding.

But the compromise with Congress allowed the American Hospital Association, an advocacy group for hospitals, to decide which insurance companies should handle hospitals' Medicare bills.

Virtually all the companies turned out to be members of the National Association of Blue Shield Plans, now the Blue Cross Blue Shield Association, a frequent political ally of the American Hospital Association and the American Medical Association.

"'No sooner had the ink dried on that compromise than we began . . . to have horror stories," says Richard Kusserow, inspector general in the Department of Health and Human Services from 1982-1991. For every abuse the government tried to stop, says Kusserow, three would appear in its place.

Bilking Medicare became so lucrative that professional criminals got involved. In 1993, Gabriel Hernandez, a former "logistics coordinator" for the Medellin, Colombia, cocaine cartel, opened a chain of Florida health clinics that billed Medicare and state Medicaid programs for fictitious patients with phony ailments. Over two years, he received checks for more than $1.7 million.

"Everything was easy compared with being in the trafficking business," he says. "All I was doing was picking up checks every week. And I got caught, but I didn't get killed."

Hernandez was convicted in April 1997 of racketeering and spent five years in prison.

Three years ago, the General Accounting Office (GAO) cited "fundamental" conflicts of interest as a factor in the watchdogs' poor performance.

Hospitals and doctors not only help select their overseers, they go into business with them. Many of these companies also run health maintenance organizations. The HMOs funnel business to hospitals and doctors that the insurers may regulate.

Some of the companies even own hospitals. For example, one subsidiary of Cigna Corp. reviews and pays Medicare claims for doctors. Another subsidiary owns Lovelace Health Systems, a hospital and physician group in Albuquerque, N. M. Last month,. Lovelace agreed to pay $24.5 million to settle a whistle- blower suit charging that the company had submitted tens of millions of dollars in false claims to Medicare over 10 years. Cigna did not review the Lovelace claims.

And when a private insurer and Medicare cover the same patient, the insurer is primarily responsible for paying the patient's claims, with Medicare picking up anything left over. But some insurers exploit their Medicare roles by making Medicare the primary payer, a violation that has cost the national Blue Cross Blue Shield Association, Transamerica, Travelers and other insurers more than $100 million in legal settlements.

"Government contractors policing themselves," says Kusserow, "is not a very healthy situation to have."

CORPORATE ABUSE OF SYSTEM.....(read on...

http://www.npr.org/templates/story/story.p...toryId=16045685

Feds Fight Rampant Medicare Fraud in South Florida

by Greg Allen

Listen Now [5 min 13 sec] add to playlist

All Things Considered, November 6, 2007 · It doesn't sound sexy, but amid the bikinis, beaches and palm trees of South Florida, one of the most popular and lucrative crimes now is Medicare fraud, and a team of federal investigators and prosecutors are tasked with putting a stop to it.

The dollar totals are staggering: Law enforcement officials say they've uncovered more than a half-billion dollars in fraudulent claims this year in South Florida alone.

If you want to know how bad Medicare fraud is in Miami, a good place to start is with a study released by federal inspectors. They visited, at random, nearly 1,600 businesses in Miami that bill Medicare for services allegedly delivered to beneficiaries.

The U.S. attorney in Miami, Alexander Acosta, says the inspectors found that nearly one-third of the businesses — 481 — didn't exist.

"Those 481 businesses — so-called businesses that didn't exist — had billed $237 million in fraud over the past year," Acosta says.

That study helped focus national attention on the problem of Medicare fraud in Miami — especially among shell companies that purport to sell what's known as "durable medical equipment" — wheelchairs, walkers, respirators and the like.....

http://money.cnn.com/2008/12/16/news/madof...rtune/index.htm

70 years before Madoff, there was Whitney

Former New York Stock Exchange president Richard Whitney boasted a sterling reputation during the Depression, then became a symbol of Wall Street's betrayal of investors.

By James Bandler and Doris Burke

Last Updated: December 16, 2008: 3:50 PM ET....

http://dealbook.blogs.nytimes.com/2009/08/...f-ponzi-scheme/

It Was All Fake’: Madoff Aide Details Scheme

August 12, 2009, 3:58 am

....On Tuesday, Mr. DiPascali stood in a federal courtroom in Lower Manhattan and admitted that, for at least the last 20 years, he had helped Mr. Madoff carry out one of the biggest frauds in Wall Street history, The New York Times’s Jack Healy and Diana B. Henriques reported.

Indeed, he detailed for the first time how he and unidentified others helped Mr. Madoff perpetuate the crime — using historical stock data from the Internet to create fake trade blotters, sending out fraudulent account statements to clients and arranging wire transfers between Mr. Madoff’s London and New York offices to create the impression that the firm was earning commissions from stock trades.

“I knew it was criminal, and I did it anyway,” Mr. DiPascali told Judge Richard J. Sullivan, of Federal District Court, just before pleading guilty to 10 felony counts, including conspiracy and tax evasion.

But Judge Sullivan refused to release Mr. DiPascali on bail after his plea, despite a request by prosecutors that he remain free to better assist their complex, wide-ranging investigations, a jolt to both the government attorneys and the defense lawyers....

http://www.insurancenewsnet.com/article.as...nnID=1020495260

Accountants'' Liability in the Madoff Scheme: A CPA Journal Symposium

....Tax recovery is an important element to this scheme. Dan L. Goldwasser, shareholder and member of the accounting law practice group at Vedder Prince, said that the area of damage control in the Madoff situation really boils down to two or three things that you can do. The most important thing you can do is to protect your insurance coverage. FULL TEXT

Nice try, Tom.

I don't know how much education you have, but you obviously missed class the day they taught civil discourse in school.

Most of the other forum members, at least the ones with whom I engage in discussion, are respectful and civil, even if we have polar opporsite worldviews.

If I had wanted personalized attacks, sarcasm and shallow drivel which doesn't address substantive issues that I have respectfully raised with other forum members, I would have addressed my questions to you.

Saul Alinsky would be proud.

I will not communicate with you further.

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Guest Stephen Turner

Chris, just a little personal story.

I recently became a Grandfather for the first time, the Baby(Rose May) had to be delivered by C section, as she had become turned in the womb, during the operation baby became very aggitated, and inhaled some amniotic fluid, she was on special care for nearly a week, with round the clock Nursing and medical care, and Mum was fairly poorly too, the "upfront" cost of all this to the Family was Nil. I have no idea how much it would have cost in America, but I shudder to think. Saying this the system is far from perfect, but I know which I'd rather have. Regards, Steve.

Edited by Stephen Turner
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Chris, just a little personal story.

I recently became a Grandfather for the first time, the Baby(Rose May) had to be delivered by C section, as she had become turned in the womb, during the operation baby became very aggitated, and inhaled some amniotic fluid, she was on special care for nearly a week, with round the clock Nursing and medical care, and Mum was fairly poorly too, the "upfront" cost of all this to the Family was Nil. I have no idea how much it would have cost in America, but I shudder to think. Saying this the system is far from perfect, but I know which I'd rather have. Regards, Steve.

Thanks, Steve, and congrats on the new family addition.

I have no doubt that the cost over here would be outlandish.

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Guest Tom Scully

Christopher,

RE: Your post #74.....

I took offense from your questions. I apologize for letting it show. Did you notice that those who responded to your questions did not seem to fully comprehend what you

were asking?

I took offense because your questions, IMO, were not even your questions. You only repeated what I consider to be the product of an "Op" that is part and parcel to a much bigger problem. It is a problem, IMO, that is destroying our country and setting us apart from the rest of the ODCs, much to our detriment.

If even a well educated person, such as yourself, can be influenced to believe that lawsuits against medical care providers are worrisome enouigh, for example, to frame the question you asked, what hope is there for the rest of us avoiding the intended effort to confuse and thus sidetrack any remedy to this growing financial and political crisis ?

By aksing the questions you asked, I deduce that you do not even see it happening....I regret that I could not come up with some other way to react to what I see as your provocative act of posting those questions, because you've used my tone to justirfy dismissal of consideration of the support for my argument....and the sabotage of our future goes on and on, anyway.

http://www.cbo.gov/showdoc.cfm?index=4098&sequence=0

Congressional Budget Office

Cost Estimate March 10, 2003

H.R. 5

Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2003

As ordered reported by the House Committee on Energy and Commerce on March 6, 2003

...Impact on Health Insurance Premiums

The percentage effect of H.R. 5 on overall health insurance premiums would be far smaller than the percentage impact on medical malpractice insurance premiums. Malpractice costs account for a very small fraction of total health care spending; even a very large reduction in malpractice costs would have a relatively small effect on total health plan premiums.....

http://www.factcheck.org/article133.html

President Uses Dubious Statistics on Costs of Malpractice Lawsuits

January 29, 2004

Two Congressional agencies dispute findings that caps on damage awards produce big savings in medical costs.

Summary

The President holds out the prospect of major cost savings if Congress will pass a law limiting what injured patients can collect in lawsuits. He wants a cap of $250,000 on any damages for “pain and suffering” and other non-economic damages. His administration projects savings to the entire economy of between $60 billion and $108 billion per year in health-care costs, including $28 billion or more to federal taxpayers.

But both the General Accounting Office and the Congressional Budget Office criticize the 1996 study the Bush administration uses as their main support. These nonpartisan agencies suggest savings – if any – would be relatively small.

Analysis

In a speech in Little Rock, Arkansas on Jan. 26 the President said, “One of the major cost drivers in the delivery of health care are these junk and frivolous lawsuits.” He said rising malpractice insurance premiums and needless medical procedures ordered up out of fear of lawsuits cost federal taxpayers “at least” $28 billion a year in added costs to government medical programs. Bush’s Department of Health and Human Services claims total savings – public and private – of as much as $108 billion a year. ....

http://www.boston.com/business/globe/artic...lawsuit_awards/

Rising doctors' premiums not due to lawsuit awards

Study suggests insurers raise rates to make up for investment declines

By Liz Kowalczyk, Globe Staff | June 1, 2005

Re-igniting the medical malpractice overhaul debate, a new study by Dartmouth College researchers suggests that huge jury awards and financial settlements for injured patients have not caused the explosive increase in doctors' insurance premiums.

The researchers said a more likely explanation for the escalation is that malpractice insurance companies have raised doctors' premiums to compensate for falling investment returns.

The Dartmouth economists studied actual payments made to patients between 1991 and 2003, the results of which were published yesterday in the journal Health Affairs. Some previous studies have examined jury awards, which often are reduced after trial to comply with doctors' insurance coverage maximums or because the plaintiff settles for less money to avoid an appeal. Researchers found that payments grew an average of 4 percent annually during the years covered by the study, or 52 percent overall since 1991, but only 1.6 percent a year since 2000. The increases are roughly equivalent to the overall rise in healthcare costs, said Amitabh Chandra, lead author and an assistant professor of economics at the New Hampshire college.....

http://www.commonwealinstitute.org/reports...t/Section1.html

.....The Funding Behind the Right-Wing Movement Organizations

Right-wing organizations in this network all receive major general operating support, project grants and coordinated strategic guidance from a core group of interlocking, ultra-conservative foundations that has been working for nearly thirty years to alter public attitudes and move the national agenda to the right. This core group of right-wing foundations includes the Scaife, Castle Rock (endowed by the Adolph Coors Foundation in 1993), Bradley, Olin and Koch foundations. (See Appendix 4)

"Five foundations stand out from the rest: the Lynde and Harry Bradley Foundation, the Koch Family foundations, the John M. Olin Foundation, the Scaife Family foundations and the Adolph Coors Foundation. Each has helped fund a range of far-right programs, including some of the most politically charged work of the last several years."

- "Buying a Movement," People for the American Way Foundation[6]

These foundations are associated with the extreme right of the political spectrum. The Bradley Foundation's money comes from Harry[*] Bradley, a member of the John Birch Society.[7] The Coors Foundation previously financed the John Birch Society.[8] The Koch Foundations were founded by Charles and David Koch, sons of Fred Koch, founder of the John Birch Society. David Koch, the 1980 Libertarian Party Vice Presidential candidate, funds many libertarian organizations, and is co-founder of the libertarian Cato Institute.[9] William Simon of the Olin Foundation was a member of the secretive Christian-Right Council for National Policy, and chairman of an organization set up by the Rev. Sun Myung Moon's Unification Church.[10] Richard Mellon Scaife and his foundations were the primary funders of the anti-Clinton efforts of the 1990s, which included funding the vitriolic magazine, American Spectator.[11] As for today's John Birch Society, it is currently engaged in a "Get US Out!" (of the UN) campaign, a philosophy reflected across the right-wing movement.[12]

There are now over 500 organizations, of which Heritage Foundation is the most influential, all receiving funding from this core group. A 1999 study, $1 Billion for Ideas: Conservative Think Tanks in the 1990s,[13] shows how well-funded these organizations are. The study found that the top 20 of these organizations spent over $1 billion on their ideological campaign in the 1990s, not only on tort reform, but on a number of other issues they are advancing....

http://www.policycounsel.org/18856/35101.h...session*id*val*

Grover Norquist - president, Americans for Tax Reform; president, Americans Against a National Sales Tax/VAT; national leader of the "No New Taxes" pledge for political candidates; economist and chief speechwriter, U.S. Chamber of Commerce 1983-84; economic advisor to Jonas Savimbi, UNITA; B.A. Harvard College 1974-78; Harvard Business School 1979-1981, M.B.A.

.....It has been estimated that 75 percent of the American left is government-funded, federal, state and local. When you look at who goes to their meetings, when you look at who goes to their conventions, you're talking about government workers, you're talking about labor union leadership, you're talking about coercive union dues, you're talking about the tort lawyers, the trial lawyers, who now match the labor unions in many states as the major funding source for the Democratic party.

When you have tort reform, step-by-step, a little tort reform here and a little there, in each of the fifty states, every time you do that you puncture a hole in the fundraising efforts of the Democratic Party. Every time you have a new start-up company that's non-union--and jobs are created in new companies--you reduce the flow of cash to the Democratic party.

Now, while I'm projecting a future that's cheerful and where we're doing well, let me make it very clear that we are going to have betrayals, we are going to have setbacks, we are going to have compromises. We have a weak Senate, we don't have every member of the House hard-core. But even with all of those problems, I suggest that we are methodically moving forward and crushing the left.

Even if we get sold out and get the miserable Legal Services Corporation cut 40 percent instead of eliminated, as it should be, this is what it means. It is the equivalent loss to the left as if the Democrats had come and stood in front of the Heritage Building, burned it down, shot everybody inside, walked down the street, done the same thing to the Cato Institute, then gone down to American Enterprise Institute and burned that as well, and done all that three times. That's the loss of resources which results from simply cutting Legal Services Corporation, which funds left-wing lawyers, by 40 percent.

No, we didn't get everything we wanted. I'm very unhappy we didn't kill Legal Services the first day. But if I were on the left watching those resources, in effect, go up in smoke, I would be more distraught.

I suggest that there are four fronts that the Republicans are moving forward on, in going after the left. And these are the same four fronts that also destroyed the Soviet Union......

This address was delivered to the Board of Governors of the Council for National Policy in September, 1995 in Nashville, Tennessee.....

Edited by Tom Scully
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The British media is now reporting the ridiculous attacks on the British NHS by the Republicans. There was an interesting debate on BBC Radio yesterday. They had one of the men who produced one of these anti-NHS television commercials. They used a expert in the subject to show that these so-called facts were lies. The American replied that the facts did not matter. He was trying to explain with the commercial that the British have a system based on fairness whereas America had one based on freedom. He was unable to explain what sort of freedom this was for those who cannot afford health-care. :tomatoes

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The American replied that the facts did not matter.

Bit of a thread derail, but I have to relate this. Some people on the Defence newsgroups were talking about how journalists get so many details wrong - calling an Army helicopter an Air Force helicopter (our air force does not have any helos), calling a large Air Force transport aircraft an Army aircraft. One of the people on the board said their daughter was doing media at uni, and had spoken to her lecturer about some reports which were used in class. The lecturer had made up the news articles, but had got names wrong, titles wrong, descriptions wrong, etc. The lecturer told her that "... minor facts are unimportant, people don't care about them, and it's more important to make sure the story reads well".

:tomatoes

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