Thursday, January 26, 2012

Senators question contraception mandate constitutionality

Excerpted from United States Senate News Release, "Hatch, Johanns Push Back on Administration Decision On Birth Control Insurance Rule," January 20, 2012.

WASHINGTON – U.S. Senators Orrin Hatch (R-Utah) and Mike Johanns (R-Neb.) today pushed back on a decision made by the Obama Administration to mandate preventive services, including birth control and emergency contraception, for health insurance plans. In July 2011, the Institute of Medicine recommended several mandatory health services, as called for by the new health care law. This included a recommendation requiring all health care plans to provide controversial services, including contraceptives. Subsequently, Johanns and Hatch authored a letter, signed by 26 of their colleagues, to HHS Secretary Kathleen Sebelius outlining constitutional concerns regarding conscience protections.

“Today’s decision by the Obama Administration shows once again that in their mind, politics will always trump the Constitution,” Hatch said. “The problem is not that religious institutions do not have enough time to comply, it’s that they’re forced to comply at all. Unfortunately, this Administration has shown a complete lack of regard for our central constitutional commitment to religious liberty.”

“Forcing religious institutions to violate a cornerstone of their faith by providing contraceptives in their health care plans completely defies the Constitution,” said Johanns. “The President promised to uphold life and conscience protections in the health care law, but rather than live up to his word, he has regrettably chosen to punt on implementation of the controversial mandate until after the elections. I will do everything I can in the next year to ensure that the conscience rights of these churches, charities, hospitals and other religious organizations are protected.”

CMA President David Stevens, MD, MA (Ethics): "The original decision by the Obama administration to mandate contraception coverage without a meaningful conscience exemption was outrageous--a blatant violation of the First Amendment and long-standing American principles of religious freedom. This recent decision to wait a year before forcing the mandate down the throats of organizations that oppose the coercion on conscience grounds is a cynical and meaningless political ploy. If subsidizing potentially life-ending contraceptives such as Ella and the morning-after pill is morally wrong in our eyes now, it will be morally wrong a year from now. The only thing that will change in a year is the likelihood of a court challenge to this conscience- and religious freedom-trampling requirement. "

CMDA Ethics Statement: The Beginning of Human Life: Fertilization (Addendum)
CMA Testimony on Contraceptives Mandate, Conscience and HealthCare Access

CMA engages Obama health officials on conscience rights

Excerpted from "The Global Health Initiative: Maximizing Impact on Global Health," December 2011, by Lois Quam, executive director of the Global Health Initiative.

The Global Health Initiative (GHI), the Obama administration’s strategy to maximize the impact of U.S. investments in global health, aims to protect Americans, save millions of lives around the world and create strong nations. Our health agenda is taking on the hardest and most intractable challenges, including maternal and child mortality, HIV/AIDS and malaria.

This unified effort is driven by the combined leadership of key U.S. agencies and builds on current programs, such as the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI), to deliver a focused, cost-effective and results-oriented program for enhancing global health. To achieve its goals, GHI also reaches beyond the health sector to areas that intersect with health, such as safe water, sanitation, health financing and education for girls.

GHI is rooted in seven core principles:
  1. Focusing on woman, girls and gender equality.
  2. Encouraging country ownership and investing in country-led plans.
  3. Building sustainability through health systems strengthening.
  4. Strengthening key multilateral organizations, global health partnerships and private-sector engagement, and leveraging resources of key stakeholders.
  5. Increasing impact through strategic coordination and integration.
  6. Improving metrics, monitoring and evaluation.
  7. Promoting research and innovation.

Through GHI, the United States also seeks to achieve major improvements in health outcomes by reforming the way it supports countries in delivering health services. Strategies include working to increase the number and types of local partners, such as nonprofit organizations, private businesses, civil society, faith-based organizations and partner governments, and strengthening the capacity of partner countries to lead, manage and oversee health programs.

CMA VP for Govt. Relations Jonathan Imbody: "I recently sought to persuade the author of this article, GHI Executive Director Lois Quam, and other high-ranking Obama administration officials to respect conscience rights in order to gain the crucial partnership of faith-based health organizations overseas and in the U.S.

"In a meeting this month at the U.S. Department of State with Ms. Quam and officials from the CDC, USAID, HHS and the Office of the Global AIDS Coordinator, I urged administration officials not to discriminate against faith-based organizations on the basis of their conscientiously held moral convictions, especially considering that such organizations often can best accomplish the vast majority of the health care goals aimed at by domestic and international grant programs.

"A World Health Organization report reveals that between 30 percent and 70 percent of the health infrastructure in Africa is currently owned by faith-based organizations.[1] The Gallup World Poll asked sub-Saharan Africans in 19 countries about their confidence in eight social and political institutions. Overall across the continent, they were most likely to say they were confident in the religious organizations (76 percent) in their countries.[2]

"I explained to the U.S. officials at our State Department meeting that the same faith that compels faith-based individuals and organizations to care for the poor also compels them to minister according to faith-based moral and ethical standards. For the government to ignore those convictions or worse, to purposely exclude faith-based groups on the basis of those convictions, is to throw away the critical assistance of a huge sector of the health care community, especially in poor and medically underserved countries and regions. Why reject the partnership of a faith-based group, I asked, simply on the basis of one area of disagreement when that group is willing and ideally equipped and positioned in a community to achieve 90 percent of the health goals of a federal program?
"I cited the recent discrimination by HHS against a Catholic group by taking away a federal grant to provide care for victims of human trafficking, after the group declined to participate in abortions as stipulated by revised grant requirements. I urged federal officials at our State Department meeting to put systems in place to review grant requirements to insure that they do not unnecessarily or illegally discriminate against faith-based organizations."

Please pray for CMA's ministry in Washington, that we might represent Christ well as His ambassadors.

CMDA Ethics Statement - Right of Conscience
Global Health Relief

U.S. agency acts on CMA idea to fight human trafficking

Excerpted from "Blue Campaign Announces New Human Trafficking Trainings," January 11, 2012 blog entry posted by Alice Hill, Senior Counselor to U.S. Department of Homeland Security Secretary Janet Napolitano.

Today, I’m proud to announce several new human trafficking awareness and training materials for the general public, federal workforce, first responders and airline employees. These new materials aim to help increase awareness and provide education on the indicators of human trafficking and the importance of reporting it to officials. We can’t end the horrendous crime of human trafficking on our own--we need individuals and communities to spot the signs of human trafficking and report it to authorities.

The new trainings were unveiled earlier today at a meeting with DHS officials, other federal agencies along with representatives from non-governmental organizations (NGO), the private sector and the international community at a human trafficking event. Subject matter experts from across the government also engaged in a dialogue with stakeholders on methods and services to support victims, ways to engage local communities, and new initiatives taking place in the NGO, private sector and international communities. The session gave participants the opportunity to provide ideas to federal experts leading an array of anti-human trafficking programs and services. I’m very excited for the ideas that were expressed, and am hopeful that they will lead to new ways to prevent the terrible crime of human trafficking.

To learn more and take our general awareness training, please visit

CMA VP for Govt. Relations Jonathan Imbody: "Following up on an idea advanced by the Christian Medical Association in previous meetings with U.S. Dept. of Homeland Security officials, agency officials at this meeting I attended announced a new program to engage health care professionals to help recognize and report victims of human trafficking.

"Sec. Janet Napolitano's Sr. Counselor Alice Hill announced, '[DHS Chief Medical Officer] Dr. Alexander Garza will present a medical project developed based on comments from you. It's a powerful example of your idea that came out of our meetings." After raising the idea of engaging medical professionals, CMA had provided Dr. Garza with examples of training materials developed by CMA member Dr. Jeff Barrows, an OB/Gyn physician who now runs Gracehaven, a shelter in Ohio for female teen victims of human trafficking.

"Dr. Garza unveiled a video and explained the outreach to the health care community being developed, observing that that 'conversations with stakeholders including you helped us realize that more needed to be done to [reach the medical community].' Human trafficking awareness materials now available on the DHS website include a wallet-sized card for health care professionals.

"In August, I had presented an idea to Secretary Napolitano of engaging leaders of medical specialty groups at a White House summit on human trafficking. Sec. Napolitano promised to bring up the idea that day in a White House cabinet meeting with U.S. Dept. of Health and Human Services (HHS) Secretary Kathleen Sebelius. (See Meeting with DHS Sec. Napolitano on human trafficking.)

"HHS officials, however, recently discriminated against faith-based groups engaged in fighting human trafficking by taking away from a faith-based group a federal grant to aid trafficked victims on the basis that the group declined to participate in abortions. A Catholic group had by all accounts successfully served victims for five years under a federal grant program. Despite past proven performance and much higher objective scores by a grant review panel, the Catholic organization lost the competition for a new federal grant because of a new stipulation--inserted by administration political appointees and likely including the approval of Secretary Sebelius--that gave preference to applicants willing to refer victims for abortions. (See Abortion Ideology Trumps Aid for Victims of Human Trafficking.) Increasingly here in Washington it appears that few issues remain that partisan politics don't pollute."

Christian Doctor's Digest on Human Trafficking - January 2012
CMDA Ethics Statement: Abuse of Human Life
Human Trafficking Continuing Education

Thursday, January 19, 2012

The heartbreak of grief

Excerpt from "How Grief Can Break Your Heart," Time, by Alice Park. January 10, 2012--Grief is a powerful emotion, and the latest research shows just how damaging it can be, especially for the heart. The sobering results, appearing in the journal Circulation, are the first to compare how grief affects an individual’s heart-disease risk within a period of time. Previous studies have documented that people losing loved ones tend to have more heart problems than those who aren’t bereaved. In the current analysis, lead author Elizabeth Mostofsky and her colleagues took a unique approach by calculating an individual’s “average loss” of loved ones over a year, by asking how many people study participants had lost in the past year and comparing that figure to the number of loved ones that same person lost during the study period in question, which included the most recent day and week preceding a heart attack.

“We compared these patients’ losses in the recent past of the last day or week before their heart attack to the loss we would have expected to see based on their loss [pattern] over the past six months,” says Mostofsky. “People who have a heart attack are more likely to have lost a person in the recent past than would have been expected based on the number they lost over the past six months to a year.”

That’s not really surprising, but the extent of grief’s effect on the heart was more eye opening. Losing someone raises the risk of having a heart attack the next day by 21-fold, and the risk of a heart attack in the following week by six times. The apparently broken hearts showed signs of mending after about a month, when risk of heart attacks started to decline.
The findings only heighten the need to better understand the myriad ways that grief can affect the body and mind, from changing blood pressure to altering blood-vessel chemistry so clots are more likely to both form and rupture, leading to a heart attack. The emotional distress from a loss can also cause the bereaved to change their lifestyle and either stop taking medications that help their heart or give up on behaviors such as exercising and eating a healthy diet that can keep them healthy as well.

Eugene Smith, MDCMDA Cardiologist and CMDA Member Eugene Smith, MD: "The loss of someone close can rend our emotions, steal our pleasure and empty our spirit. The effects ripple through the entirety of our being and are felt by our bodies. Crying, anorexia, sleeplessness and anhedonia are a few of these manifestations. The study by Mostofsky underscores the severity of this bodily effect by demonstrating a marked increase in myocardial infarction at the onset of bereavement.

"Such information highlights some important truths. First is our interconnectedness. We are social creatures. It is not good for man to be alone. God exists in a community (Father, Son and Spirit) and intends for His creation to live in community. When that community loses a member, the loss impacts the entire group. Our presence (or our absence) affects those around us.

"Second is the interaction of body and spirit. Christians recognize that man is more than material, but perhaps we give considerably less thought to the interaction between the material and non-material: they are not dissociated. What we do with our bodies influences our emotion and our spiritual health; alternatively, our emotions and our spirit influence bodily health. A growing body of medical literature shows that grief, anger, anxiety, depression, isolation, social stressors, marital dissatisfaction and even an unforgiving spirit change our physiology and worsen clinical outcomes. To fully address our patient’s physical health, we must consider the psychological, social and spiritual issues confronting them.

"At a time when medicine seems dominated by technologic solutions and squeezed by economic concerns, the Christian physician must remember that the true source of healing is the power of Christ. Our patients need not only our pills and procedures, but also our presence and our commitment to minister to the whole person."

A breakdown of society?

Excerpt from "Many options on TV rules," SCOTUSblog, by Lyle Denniston. January 20, 2012--With one Justice testing the ultimate constitutionality of government controls on broadcast TV, another trolling for an exceedingly narrow approach, two others suggesting that technology may be overtaking the constitutional dispute, one signing himself up for rigorous morality policing and one whose vote may really be crucial staying entirely silent, the Supreme Court on Tuesday wandered widely in its new exploration of the state of profanity and nudity on television and radio. The lively argument in the latest round of that controversy even had a lawyer pointing out portrayals of nudity in the courtroom decorations above the Justices’ heads.

At the end of the hour of argument in Federal Communications Commission v. Fox Television Stations, et al. (docket 10-1293), nothing seemed predictable and, thus, Justice Clarence Thomas’s customary silence may have been the most eloquent expression. The last time the Court heard this case, in an earlier version, Justice Thomas had written a separate opinion essentially dismissing as out of date the constitutional norm of giving broadcasting fewer First Amendment rights than other media enjoy. With only eight Justices taking part this time (Justice Sonia Sotomayor is recused), it may not be possible for a majority to come together without Thomas on its side and, this time, the ultimate constitutional question he raised before is directly at issue.

Quite early in Tuesday’s argument, it was Justice Anthony M. Kennedy who brought up that question. With U.S. Solicitor General Donald B. Verrilli, Jr., at the lectern defending the FCC’s current policy against fleeting use of four-letter words and scripted nudity on TV, Justice Kennedy asked him to spell out “the public value in having different segments of the media governed by different standards” under the First Amendment. The Justice said that, surfing channels, it is not clear what is broadcast TV and what is not, and yet the government was saying “there was still a need for a standard for broadcast television” alone. To finish reading this story please click here.

Gene Rudd, MDCMDA Senior Vice President Gene Rudd, MD: "Important social principles are at stake in this case. Fox Broadcasting’s dispute with the Federal Communication Commission (FCC) stems from a fine leveled against Fox for allowing profanity to air during an awards show. (Fox could have used delay technology to prevent this.) Fox claimed the FCC was being inconsistent in its enforcement of profanity and nudity rules.

"On the surface this may seem like an odd case to attract the attention of CMDA. However, the case became more than a question of consistent enforcement of decency rules. During hearings in lower courts, the constitutional question surfaced. Are First Amendment rights breeched when government limits profane speech or explicit visuals? Knowing the harm that such exposure has on the mental health development of minors (not to mention the negative influence it can also have on adults), CMDA voiced its concerns. Along with others, we supported the government’s right to establish and enforce decency rules. Our brief filed with the Supreme Court outlined the deleterious psychological impact exposure to certain content can have on minors.

"While reliable conclusions cannot be drawn from the comments and questions from the Justices, it seemed clear that our concerns were shared by some of them. The ruling is weeks away. The decision might be limited to broadcast TV, but a decision to affirm decency rules would be a positive step in a culture plagued by social decay."

Supreme Court Brief: FCC vs. Fox and ABC
Freedom2Care: Protect our children: Censorship is not a bad word

Retardation makes her unworthy of transplant

Excerpt from "Mom claims in viral blog that disabled child denied transplant," CNN, by Madison Park. January 18, 2012--Can a patient be rejected for a kidney transplant based on a developmental disability? A New Jersey mother alleges in her blog that this happened to her 3-year-old daughter, and it has sparked Internet uproar.Whether a person with a mental disability qualifies for an organ transplant is a decision made on a case-by-case basis, based on that patient's health, experts say. On Thursday, Chrissy Rivera wrote in the blog about her latest doctor's visit concerning her daughter, Amelia. Rivera writes in the blog that Amelia was ruled out from receiving a kidney transplant because of her developmental disability. It's not possible to confirm Rivera's story with the hospital because of privacy protection laws. CNN contacted Children's Hospital of Philadelphia, but the hospital said it had no comment other than a statement posted on Facebook.

There are no national guidelines over transplants involving mentally disabled patients. The United Network for Organ Sharing, the private, nonprofit organization that manages the nation's organ transplant system, does not have rules about what to do in cases of patients with mental disabilities. Doctors can refuse to consider a patient for an organ transplant if there is another illness or complications such as a severe infection or cancer that is likely to limit the life span. Mental disabilities should not factor into the decision making for transplants, so long as the patient has strong support from family and caregivers who would ensure that the required medications and care is given, said Dr. Raul de Velasco, the clinical ethics program director at the University of Miami.

"The mental disability should not be the reason why you should not receive a kidney," said de Velasco. The decision should come down to "a medical problem, not the value of the life of a mentally disabled person."On the flip side, patients who have mental disabilities or neurological delays can qualify to be live organ donors after undergoing screening processes and consent from the family.

David Stevens, MD, MA (Ethics)CMDA CEO David Stevens, MD, MA (Ethics): ""It is ironic that the Americans with Disabilities Act prohibits discrimination on the basis of disability in employment, public accommodations, commercial facilities, transportation and telecommunications, but a child can be denied a lifesaving kidney transplant with impunity. A business can be fined $100,000 because a door is too narrow for a wheelchair, but a transplant specialist can decide a child is not smart enough to receive the hospital’s services.

"Wolf-Hirschhorn Syndrome is a rare genetic disorder occurring in one in every 50,000 births. Three-year-old Amelia has already beaten the 35 percent odds of dying in her first two years of life from developmental retardation, hypotonia, seizures and other defects, but her kidney malformation will soon push those odds to 100 percent. Without a transplant, she will die in six months.
"If the parent's report is correct, it is difficult to defend the decision of the Children's Hospital of Philadelphia's (CHOP) transplant team. A study in 2006 showed the success rate of kidney transplants in intellectually disabled children was 100 percent at one year and 90 percent at three years, equaling the rates in the general population.

"The family has agreed to get a donor from among their extended family, but this raises an ethical issue. It is impossible for a child with a tissue match to give informed consent to undergo the risk because of their age. All the same, Amelia should not be kept off the transplant list because of her intellectual disability. Unless there is something specific about her medical condition that we don't know that makes it impossible to do the transplant, CHOP doesn't have a leg to stand on despite their Facebook protestations that they don't discriminate.

"Sadly, an ethic based on 'quality of life' only, is no ethic at all; yet that concept is increasingly creeping into life-and-death decisions in the halls of medicine. A person's worth is not based on their capabilities but the undeniable truth that all are each made in God's image. We all need to advocate for that ethic, or someday as we age and our capabilities decline, someone will decide a quality of life worth living."

Stem cell research often not disclosed

Excerpt from "Stem cell research on donor eggs often not disclosed," Reuters by Frederik Joelving. December 29, 2011--Many U.S. fertility clinics don't tell egg donors that embryos made from their eggs may end up being used in stem cell research, according to a new government survey. That's despite widespread opposition to such research, which is considered morally offensive by a third of Americans, researchers write in the journal Fertility and Sterility.

They found that among 100 fertility clinics, two said they didn't have a consent form for women donating eggs. Of the 66 clinics that sent in a consent form and said they used excess embryos for research, just 20 told women about that. And only three of 38 clinics that used some embryos for stem cell research in particular disclosed that to donors. "The survey shows that only a minority of IVF (in vitro fertilization) clinics mention to egg donors who are donating for the sake of treatment (as opposed to research) that resultant embryos might ultimately be used in research," said study co-author Gerald Owen Schaefer of the National Institutes of Health in Bethesda, Maryland. "An even smaller minority mention stem cell research explicitly."

"We recommend that all IVF clinics that provide some embryos for research inform egg donors about the possibility of such research (including stem cell research, which is particularly controversial)," Schaefer told Reuters Health by email. That agrees with several organizations such as the National Academy of Sciences and the International Society for Stem Cell Research. Bioethicists not involved in the new study questioned whether disclosing that surplus embryos might be used for research would have an effect on women's decision to donate.

"Getting an egg out of a woman is not like going to the chicken coop and getting an egg," he said. "It is not a completely risk-free endeavor." Yet, there is no federal regulation of IVF clinics in the U.S., according to Raymond De Vries, a social scientist and a professor of bioethics at the University of Michigan Medical School in Ann Arbor. "It's cowboy land out there," he said.

Jeffery Keenan, MD ImageMedical Director of the National Embryo Donation Center Jeffery Keenan, MD (NEDC): "Unfortunately, this story does not come as a surprise to those of us who practice reproductive endocrinology and infertility. Experience tells us that the informed consent process for ARTs (Assisted Reproductive Technologies) is very poor in many centers. Furthermore, the emphasis with the egg donor is almost always on the monetary rather than the altruistic aspect of this process. So, an attitude of 'she was paid for her eggs, that’s all that matters,' is perhaps not so surprising.

"However, infertility doctors also know just how important these embryos are to the couples, and how often they agonize over what to do with remaining embryos following successful treatments. The fact that an egg donor is not herself pregnant with the donated eggs should not constitute reason to dismiss the importance of the new being that they helped to create.

"In these times when so much attention is focused on being sensitive to cultural, racial and sexual differences, shouldn’t we also be just as sensitive to moral and ethical differences? Sadly, this is not the case in our post-modern society. Still, it is encouraging to note that this article was at least published. Now it’s up to us to 'change the culture' in assisted reproduction.

"For the last nine years, the National Embryo Donation Center, working with CMDA, has promoted its mission to facilitate the process of embryo donation and adoption, educate the lay and medical communities so as to increase the practice of these options, and to work to increase respect for the life and dignity of the human embryo. We have been blessed with more than 300 births/ongoing pregnancies, but there is still much work to be done. We are grateful to CMDA for raising a clarion call on this and so many other current controversies which we physicians face on a daily basis!"

Adult vs. Embryonic Stem Cell Research
Stem Cell Research Facts

Thursday, January 5, 2012

Vegetative state versus conscious

Vegetative state versus consciousArticle 1 image

Excerpt from "'Vegetative' patients may be fully conscious: Lancet study," LifeSiteNews. November 15, 2011--A study published in one of the most respected medical journals in the world in November 2011 has found that many "vegetative" patients are in fact fully conscious and aware.

Experts at the University of Western Ontario conducted the experiment by applying an electroencephalogram (EEG) machine, a common mechanism for measuring brain waves, to a large group of unresponsive patients suffering from brain injuries. The New York Times reported that, when researchers asked "vegetative" patients to imagine squeezing their hand into a fist or wiggling their toes on cue, they found the brain waves of about 20 percent of such patients responding in precisely the same way as healthy patients.

While one of the researchers of the Lancet study concluded that the experiment was "a strong sign of our inability to correctly diagnose people in the vegetative state," some disability advocates say the diagnosis should be abandoned altogether, arguing that it is a tool routinely used to discriminate against the cognitively disabled. Bioethics commentator Wesley Smith expressed concern that the new testing would likely do little to stop the routine dehydration of minimally conscious patients.

While the test should certainly "become part of the practice of medicine" if it is accurate, Smith said, "we really need to change our values so that all of us are embraced and accepted as moral equals regardless of our cognitive states."

Jeff Fenyves, MD ImageGastroenterologist and CMDA Member Jeff Fenyves, MD:"Two Christmases past, my baby sister of 42 years made the brave decision to not allow her placement on a ventilator after a very painful, decades-long battle with aggressive Syringomyelia. She was tired of hurting, and could no longer use her limbs at all. She made a conscious decision that I will defend to my death.

"Then this Lancet study provides confirmation that AT LEAST 20 PERCENT of our coma decisions are wrong, combined with the illustrative case recently of Sam Schmid, the Arizona student in a coma since he was involved in a five-car accident on Oct. 19. Do you recall the headlines of his miraculous awakening on Dec. 22, just as plans were being contemplated for his removal from life support and organ donation?

"These two cases, my sister and Mr. Schmid, contain a stark contrast we should not dismiss. She made a conscious decision, while we almost made a decision to put a 21-year-old man to death because we ASSUME he is NOT conscious and thinking, an assumption made with very primitive tools at best. Remember, we no longer put any criminal in the United States to death if there is a REASONABLE doubt. Don’t our loved ones in coma deserve at least as much consideration as a death row case?"


CMDA Ethics Statement - Vegetative State

CMDA Ethics Statement - Withholding Nutrition

A modern day Greek tragedy

A modern day Greek tragedyArticle 2 image
"Fiscal crisis takes toll on health of Greeks," The New York Times. December 26, 2011--The free clinic in Perama, Greece, opened about a year ago to serve illegal immigrants. But these days, it is mostly caring for Greeks like Vassiliki Ragamb, who was sitting in the waiting room hoping to get insulin for her young diabetic son. Four days earlier, she had run out of insulin and, without insurance and unable to pay for more, she had gone from drugstore to drugstore, pleading for at least enough for a few days. It took her three hours to find a pharmacist who was willing to help.

Greece used to have an extensive public health care system that pretty much ensured that everybody was covered for everything. But in the last two years, the nation's creditors have pushed hard for dramatic cost savings to cut back the deficit. These measures are taking a brutal toll on the system and on the country's growing numbers of poor and unemployed who cannot afford the new fees and co-payments instituted at public hospitals as part of the far-reaching austerity drive.

Many experts say that Greece's public health system was bloated and corrupt and in dire need of reform. But they say also that the cuts have been so deep and have come so fast, that they have hit like a tsunami. In just two years, the government has cut spending on health care to $17 billion from $19.5 billion — a 13 percent decrease. And under its agreement with its creditors, Greece must find even more health care savings next year — as much as $915 million, government officials said. At the same time, public health facilities have seen a 25 to 30 percent increase in patients because so many Greeks can no longer afford to visit private clinics.

In a recent letter to the medical journal The Lancet, a team of English researchers warned that a "Greek tragedy" could be in the making, pointing to rising suicide and HIV rates and deterioration of services at hospitals under financial pressure. "In an effort to finance debts," the researchers said, "ordinary people are paying the ultimate price: losing access to care and preventive services, facing higher risks of HIV and sexually transmitted diseases, and in the worst case losing their lives."

David Stevens, MD, MA (Ethics)CMDA CEO David Stevens, MD, MA (Ethics): "Last summer, I visited the largest Christian hospital in Greece and was impressed with their quality of care and compassion. However, when I sat down with the hospital's physician/CEO, the focus of our conversation was on their dire financial straits. More than 80 percent of the hospital's income was from the government healthcare system and the hospital hadn't been paid anything in 18 months.

"I'm not an economist, but as I talked to many new Greek friends they stated their country's system of government entitlements and mismanagement had led to their downfall. Politicians promised what they could not pay for and then borrowed huge sums to make it happen so they could stay in power. The huge unionized bureaucracy they created was inefficient and corrupt. It was impossible to award merit or discharge the incompetent. Costs skyrocketed until they were unsustainable and the system finally went into a downward spiral. They haven't reached bottom yet.

"The U.S. isn't Greece, but we now face some of the same problems. Medicare and Social Security costs are skyrocketing and could bankrupt our government. Politicians fear touching these "third rails" that could eliminate them at the ballot box. Instead of dealing with the root causes of healthcare hyperinflation, we increased costs by more than $1.2 trillion dollars under the rubric of "affordable healthcare."

"CMDA's insurance premium invoice was 30 percent higher this year – again, we increased the employees' contributions – again

...we are trying to absorb the increase – again it will be difficult to give raises to cover even cost of living increases this year – again.

"By changing our healthcare policy, we are now forced to become part of the healthcare exchange system, but isn't the system the government created already facing bankruptcy?

"If we aren't already in a downward spiral, why am I so dizzy?

"I know one thing, the longer we wait to address this problem, the stronger the suction in the whirlpool grows. Finally, we will reach the spot where we won't be able to swim out no matter how hard we try. Just like a Greek tragedy."