Secretary of State Hilary Clinton recently visited South Korea and India.  During these visits, she was quoted as saying that if necessary the United States would expand its nuclear umbrella.

I realize this is only one small comment from the myriad of interactions and speeches she made, but it is perhaps the most significant.

This indicates that the current administration, meaning the United States, will not or cannot deter Iran or North Korea from complete nuclear armament.  Since we have not the political or military will to deter Iran from its quest for nuclear weapons, we will extend our nuclear umbrella in order to prevent other nations from developing their own nuclear warheads as protection.

Currently, we offer protection to Japan, South Korea, Taiwan, and the Philippines.  We offer protection to Western Europe and they have relied upon the U.S. for its military protection while they in turn channeled financial resources toward their social-welfare states. We also afford protection to the moderate Arab states who most definitely do not wish for Iran to be a nuclear armed nation.

Worse yet, President Obama informed Russian President Medvedev that the U.S. would decrease its nuclear warheads even before the due date of re-ratification of the STARK treaty.  Our nuclear warheads need to be maintained and the computer systems updated but this discussion has been stalled in Congress and now we are offering to further reduce our aging stockpile.  Russia has maintained their weapon systems.

So we offer concessions to Russia, unilaterally, and we concede nuclear proliferation to Iran and North Korea.  We further complicate nuclear non-proliferation by delaying or foregoing a defensive missile defense shield in Poland (the strategic Polish-Czech ground-based defense) and diminishing our own security.

Let us hope that the pro-life, pro-gun democrats that were cultivated by the Democrat machine (in order to gain house and senate seats) join with their republican colleagues and put American interests back onto center stage.

Have you “heard” about a program called “Back on My Feet”?  It started a couple of years ago when a young recent college graduate named Anne Mahlum literally ran into a Philadelphia homeless shelter looking for a running partner.

Anne may not have intended her idea to blossom into a program now being studied by sociologists nationwide, but that is the result of her simple desire to help others.

She jogged into Sunday Breakfast Rescue Mission in Philadelphia and asked if anyone wanted to run with her.  Some joined her for the novelty or for the exercise.  It wasn’t exactly the safest part of town either.

She came back daily and what resulted was goal setting by some of the homeless.  This lead to running a with a team and finishing a 3-mile run to a half or full marathon.

Working as a team establishing and accomplishing goals led to to acquiring trust in oneself and others such that other goals now seemed attainable.  Running became a vehicle for the homeless to gain self-sufficiency in one arena.

This self-sufficiency in running beget confidence that would be utilized elsewhere in their lives.  Some of the homeless have gone onto to college or full time employment and now the “program” is being evaluated and studied  and replicated.

What a difference this one young lady with only a pair of running shoes has made and with so little material resources.  She told the inhabitants of the strength they had within them and encouraged them to tap into it.

Perhaps, we can each find the inner courage to assist another in a manner yet undescribed.  It was never the role of government to do what we were instructed to do (in the biblical sense) as humans.

I, too, am challenging myself to find ways to tap into my humanity.

Sunday night, the 19th of July, I landed on the C-Span channel.  It was one of those media or press dinner forums with a speaker and one immediately changes the channel.  But for some reason I remained, perhaps because the speaker was french and I love languages.

The speaker was Guy Sorman, a French economist.  Perhaps the reason I remained fixed on this station was the first line I heard him say.  I will paraphrase: government spending as stimulus rarely works.  I thought “Wow”, this guy isn’t even on Fox News or at the Heritage Foundation and he is saying what many of us have been arguing since January.

He described that going back through history, government spending to end econmomic downturns has never worked.  I have quoted economists who have said exactly that, especially in reference to the great depression and the policies of FDR.

Professor Sorman indicated that John Maynard Keynes, of Keynesian economics is often taken out of context.  We have all heard by now that Keynesian economics justifies spending by a government body during a recession or depression to prime the pump and reinvigorate the private sector.  Deficit spending therefore is justified. We heard this both during the Bush administration and more loudly with the Obama administration.

What is deleted from the Keynesian philosophy however, is that governments are supposed to set aside revenue during the good times, so that they can spend during the rough times.

In other words, governments should be spending reserves, not going into deficits.  We have seen this both on a local, state and federal level.  The primary difference is that on a federal level, the government can print money.

Given the true intent of Keynes, our government should not be racking up the federal deficit and incurring massive federal debt.  With only 10% of the stimulus package spent and the economy showing some “green shoots” of recovery, maybe Congress should vote to reverse the remainder.

It appears that the economy is recovering despite the stimulus, not because of it.  I also think that unemployment will reach over 10% regardless of the stimulus money.  A recovery may have been faster without all the uncertainity introduced by the administration and Congress.

Stimulus anyone?

After a week of speaking on health care, I have to elucidate a question which continually arises, but upon which I don’t address.

Is the cost of health care in the U.S. so high because of malpractice and therefore wouldn’t costs decrease if we had tort reform.

For all industries in the U.S., costs are increased because of litigation or fear of litigation.  At the same token, our legal system has kept some really bad actors more honest and compensated some who were gravely injured.  We need a healthy legal system, not a lottery within the courts.

Rising costs of malpractice insurance do add to the cost of health care primarily for physicians and hospitals.  But this cost is not a primary factor in escalating prices. More than the actual premiums paid, which is readily accountable, is the intangible cost of practicing defensive medicine.

What exactly is defensive medicine???

This is the practice wherein a provider may order tests, blood work, imaging studies, invasive procedures or more office visits to solidify a diagnosis or increase the likelihood of a desirable outcome.  In general, the less education a provider has, the more tests may be ordered (except if you are House M.D.).  It may additionally pit providers against one another.

At the AMA meeting, I recently encountered 2 family doctors discussing the validity of a CAT scan in the diagnosis of appendicitis.  When I was a nurse we never did a CAT scan, and yes some individuals did get an appendectomy and later find that they did not have appendicitis.  The doctors comment however, was that the surgeon “only wants to operate” so surgeons don’t care about getting CAT scans to cement the correct diagnosis.

I interjected a conservation I had had last year on campaign trail.  A well-to-d0 businessman was upset that he had to pay $1000 for a CAT scan when his daughter had appendicitis.  The ER doctor said she had it, the surgeon and nurses were fairly certain by her symptoms, physical signs and elevated white blood count indicating infection, but the surgeon ordered a CAT scan.

The scan, of course, confirmed the diagnosis of appendicitis.  His teenage daughter underwent a successful appendectomy and recovered without incident.  But to this father, the CAT scan was “unnecessary care” and done only to boost the revenue stream of the surgeon who ordered it or the hospital who employed him. God forbid, if the doctor was a partial owner of the scanner or imaging facility!!

You see, family doctors consider it standard of care to order a CAT scan and confirm the “clinical” diagnosis.  They would have testified as such in a court of law against a surgeon if a CAT scan was not ordered.  So even if the ER doctor and surgeon were 99% sure that the correct diagnosis was appendicitis, they would be outside the “standard of care” if they didn’t order a CAT scan.

They would face strict scrutiny if an appendectomy were performed and the diagnosis were found to be something else.  And then the surgeon may have performed an “unnecessary” operation, done primarily as a source of income because “they get paid to do things.”  So you can see where I am going with this.

It is why algorithms for treatment are not exact and won’t reduce cost of care or offer true quality.  It is also why the relationship between provider and patient is so important.  If there were a high level of trust, the physician could counsel the patient or family appropriately, and maybe avoid an additional test.  And it is precisely why a third party payer distorts the relationship between the doctor and patient.

It is not as though doctors are constantly thinking that they may get sued or reported, but it does add layers upon layers to the interaction and complicate an encounter. Certainly this adds to the cost.  Mostly, doctors want to do the right thing by their patient.  All providers do.

And sometimes to try to help their patient and avoid accusations of improper care or missed diagnoses, they order tests which may be negative and of low yield.  Thus is a fine balance that is the art of medicine.

So what do we do about it?  Caps on awards or damages for pain and suffering?  Exempt providers?  I suggest that we adopt medical courts as a solution.  Certificate of merits that determine if true negligence has occurred and if there is a correlation would be beneficial and reduce costs of defending a suit.  Adopt the British system where the loser pays for the costs if a lawsuit is brought forward which proves to be frivolous.

A medical court system would have been very helpful in the Dupont litigation for silicone breast implants in which the science was ignored.  The recent asbestosis and silicosis lawsuits would have taken a different flavor and those individual truly injured may have had a larger settlement.

Although President Obama acknowledged the impact, he offered no solutions.  He instead provided a “confirmatory diagnosis” for a disease we already knew we had!

Many of you, including those who aren’t “rich,” have heard this slogan.  Some of you may agree with it and think those who have more, should pay more.  Others may disagree knowing that when the government taxes the “rich” that we all end up being taxed.

I am not adverse to paying the taxes I or we (my husband and I) pay to offer our government the ability to finance those things that we all agree are necessary for society to function well.  Our constitution even outlines those things, but in a very limited fashion so as to avoid concentrating power in the hands of a few within a centralized government.

I have known for years that the vast majority of taxes and federal revenue is procured from a very few of the wealthiest Americans.  I have also known the congressional budget office statistics indicate that if the government taxes greater than 46%, the revenue actually declines rather than increases.  But this is a startling fact I recently learned.

In the current financial crises in California, the voters recently refused to allow Sacramento to increase taxes to close the budget deficit. The government had already increased taxes on the wealthiest Californians, and there are too few of them to have ushered in this refusal of further taxation.

Now, why would the mainstream voter have a problem with further increasing taxes on the rich, and why would the Democrat speaker of the California State Assembly commission a task force that will recommend the state adopt a flat personal income tax and cut or repeal corporate and sales taxes?

Speaker Karen Bass has become concerned about the state’s heavy reliance on about 144,000 wealthy people to pay half of all the income taxes in a state with 38 million people.  That is correct!  Half of the massive budget of  California is dependent on 144,000 individuals.

And those people are leaving at about 10 a day.  They take with them the taxes they used to pay and often family members who also pay income taxes, property taxes or sales taxes.  Even more importantly, they take away small businesses that create jobs or sustain jobs for numerous others, who in turn pay taxes.

If there are less jobs created, there is less need of government services if the population migrates elsewhere.  You don’t need as large a police or fire force.  You don’t need as many teachers or schools.

The salary, pension and health insurance of people listed above, and countless others all depend upon the benevolence of 144,000 wealthy people.  And these wealthy people are crying UNCLE!  They are leaving and taking their money and jobs with them.

The problem we have is not that governments need to cut taxes.  They just need to cut spending!  One should not expect to have a job from which you cannot be fired, health care is better than someone in the private sector, and  pensions permitting you to retire at age 55 and that is comparable to your working salary.

This scenario is a global warming catastrophe waiting to happen and is already happening in Europe and in some cities and counties within the United States. This is not a function of an economic downturn, but of a chronically ill patient refusing to adopt a healthy lifestyle.

This doctor is prescribing a diet!