ACA Obamacare debate will be over when the people say it’s over

The #Obamacare debate will be over when it is repealed in full and competition and efficiency of the freemarket individual healthfreedom rules supreme.

http://m.weeklystandard.com/blogs/debate-will-be-over-when-american-people-say-it-s-over_787058.html

Letter to the AACOM Society of Osteopathic Medical Educators (SOME)

Long response to the following question posed after completion of a national conference:

What educational projects can SOME sponsor that will be of benefit to your campus, and the profession?

One of the most perplexing issues that continues to face the profession remains full faced and largely un-addressed in the literature and in research today largely because there has not been a concerted effort to define the Distinctiveness of Osteopathic Medicine on its own terms. What has been promulgated through all our education programs is that DO ≠ MD + OMM.

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Physician Comments on ABIM “2020″ Blog

from Dr. Howard Mandel:

I find these comments on this thread quite interesting—-Marilyn as a regulator and as a lawyer, are you advising that all lawyers retake the Bar exam every year or two? If not are you advising that the federal government mandate that lawyers take a national certification or recertification exam? How about architects, engineers, nurses and other professionals? Every time testing goes on there is a pro and a con, a cost and a benefit——where does the money come from to pay for this? If there were proven benefit, we all could have a different discussion, but there is no scientifically proven benefit—-only cost. Lawyers are trained to argue based on law and interpretation of the law; doctors argue based on scientific fact. Doctors opine based on scientific fact, pros and cons, risks and benefits. MOC has never been proven to be beneficial but it does have real costs. Some of those costs are non economic and are harmful to the medical profession. There are decreased attendance to educational meetings that are more relevant to those individuals practice, there is decreased comradery and decreased time for physicians to read/study articles that apply to their specific patient populations. America has a very diverse population—-one size does not fit all. Do you think that all women should only buy a size “4″ pair of jeans? All men drive the same kind of car? Nobody should be uncivil. The tone that we all pick up from the thread is obviously one of anger and frustration. As a lawyer and defender of peoples rights, I can not figure out why you would defend MOC. It is a one size fits all program that has never been proven to improve the quality of care. It takes away individual freedom of physicians who have sought varied approved ways to keep current and it is weakening the profession of medicine by destroying other long proven quality CME programs and meetings.

Mandates vs. Real Medicine

Bob Maurer, D.O. writes:

Yesterday, in Atlantic City, I moderated a seven hour program on the Business of Medicine. One two-hour presentation consisted of some of the most onerous and burdensome mandates that physicians have to face today: HIPAA, ICD-10, and
Medicare CPT codes.

There is nothing in these mandates that has anything to do with patient care.

This past Friday, I went to an old time osteopathic physician for an ENT visit. He did not use a computer, a code book, or a pen. What he did use were his ten fingers, along with his eyes, his ears and his brain. He had a pleasant smile and a good amount of compassion.

A good doctor should be a doctor who is attentive to his patients, not a doctor who is forced to spend most of his time complying with government mandates and regulations.

To paraphrase a statement once attributed to Patrick Henry:

“NOW IS THE TIME FOR ALL GOOD DOCTORS TO COME TO THE AID OF THEIR PROFESSION”

Reevaluating politically and bureaucratically based medical licensing

Guest post by Paul Kempen, MD, PhD
The natural history of any bureaucratic entity must include the generation of rules, procedures, restrictions, forms, fees, investigations, penalties, and educational material which shows how vital the respective entity is for the nation, civilization, etc. These productions are the lifeblood of the entity, since its first duty and task is to survive and expand its power. And its resistance to attrition and extinction can be as intense and extended as that of a biological organism fighting to survive. A very telling example is the Board of Tea Tasters: it took 20 years of bipartisan efforts spanning four administrations to finally close it down, after 99 years of existence and millions of tea brews, collections of samples, reports, stats, and permissions/restrictions of tea importation.
However, what we must observe with regard to our Medical Boards and Institutions is that our own profession has begot them. One hundred years ago, the Hippocratic “hypocracy” (leadership of hypocrites) of our allopathic forerunners decided to get the competition of homeopaths, naturopaths, and others out of business by resorting to the police powers of the governments. Medical Licensing was born, not as a private credentialing and certification agency, but as a general patent grant of exclusive economic rights, contrary to the US Constitution and to the British pro-market revolution initiated by the 1624 Statute of Monopolies, but very much in keeping with the burgeoning crony capitalism that swept the 20th century, introducing socialism through the back door of the progressivist movement and the figment of government-business cooperation, the American version of fascism.
The sea change that followed in medical ethics was not immediately apparent, as the medical hypocrisy alleged its continued commitment to the patient-centered Hippocratic values, even as behind the scenes it allowed vast inroads of the coercive-collectivistic values of a Platonic type of medical ethic. As you might recall, 24 centuries ago, in The Republic, Plato advanced the concept that the physician’s allegiance is to himself and the other holders of power, not to the patient: “The business of the physician, in the strict sense, is not to make a profit but to exercise his power over the patient’s body.” And Plato clearly explained, “This then is the kind of medical and judicial provision for which you will legislate in your state. It will provide treatment for those of your citizens whose physical and psychological constitution is good; as for the others, it will leave the unhealthy to die, and those whose psychological constitution is incurably corrupt it will put to death.”
It is of course high time for us to re-evaluate the sordid achievements of the politically and bureaucratically based Medical Licensing that we live and practice under today. Far from being crazy, its standards and procedures only reflect the natural course and propensities of this century old arrangement.
To put it more allegorically, no pact with the devil can portend the eternal life and perpetual happiness that the deceiver promised in order to get the agreement signed.

ABIM responds to a physician’s letter

(name of physician and ABIM administrator omitted)

Dear Dr.  ?????,

Thank you for your inquiry about the governance of the American Board of Internal Medicine (ABIM).  As you may know, ABIM is not a membership society, but a physician-led, non-profit, independent evaluation organization. ABIM diplomates do not pay “membership dues”; the fees paid to ABIM are for participation in our Certification and Maintenance of Certification programs.

However, like most standard-setting organizations, ABIM has its roots in membership organizations.  ABIM was created in 1936 by a joint action of the American College of Physicians and the American Medical Association. The founders intentionally incorporated an independent organization to shield themselves from the pressure of dues-paying members and instead established a governance structure that relies on experts in the field to set standards for the profession in the best interest of the public. In fact “of the profession, for the public” continues to be the touchstone for ABIM governance decision-making. Sometimes tension develops between the standard setters and the members of their antecedent membership organizations. However, a well-functioning certifying board needs to be insulated without being insular, listening carefully to those who seek to meet our standard yet remaining independent and evidence-based in the standards and processes we set.

All of ABIM’s standards, policies, programs and products are developed by internists. ABIM’s governance is composed of distinguished physician experts with records of achievement in diverse health care settings, whom ABIM seeks out through open calls for nominations and outreach via a variety of channels, including professional societies.

The purpose of board certification is to offer a credential that distinguishes in a publicly recognizable way those physicians who have met a standard set by their peers from those who do not or choose not to. ABIM’s accountability is both to the public and to the profession of medicine. All diplomates are encouraged to provide us with feedback to help enhance our policies, products and programs. We regularly solicit diplomate feedback through surveys and focus groups, and many enhancements implemented or in development have been a direct result of diplomate feedback. To further enhance the relevance of our assessments, we have recently convened the Assessment 2020 Task Force, which includes a broad array of experts from both inside and outside the profession of medicine. This task force is directly seeking input from our diplomates and other members of the public about what skills a physician needs now and will need in the future. We encourage internist feedback via the Assessment 2020 website and the Assessment 2020 blog.  

I hope this information helps. If you need further assistance, you may reply to this e-mail or call us at 1-(800)-441-ABIM (2246) Monday through Friday, 8:30 a.m. to 8:00 p.m., and Saturday, 9:00 a.m. to 12:00 p.m. EST.

Respectfully,

??????

Governance Administrator

When Will ABIM Debate?

Paul Kempen, MD, PhD comments on Medical Economics article, “MOC changes aim to lessen burden on physicians, but debate continues” :

I continue to be astounded that the ABIM refuses to openly debate the topic in an open forum. The Benjamin Rush Society invited the ABIM and ABMS to debate MOC in their home town of Philadelphia last April-they failed to come (http://www.youtube.com/watch?v=AetMD0OYVkY). The ABIM does NOT want to debate the issues openly in a neutral forum because the whole extortion process is unwanted by physicians in General, and it provides no index of quality. The ABIM and ABMS are trying to introduce these changes under the radar through the gradual program of lobby congress and hide from Open discussion. MOC is simply a money making extortion program self-serving to the certification industry. The ABIM itself concluded as early as 1986 and themselves published in 2000 the fact that voluntary MOC would not be possible (ANN INT MED 2000; 133:202-08 . THAT is why they imposed it with artificially restricting the certification to 10 then 8 and now to Continuous subscriptions to MOC to maintain a certificate that they themselves deem to be “VOLUNTARY”.

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