July 6th, 2010

From Bob Williams, M.D., Connecticutt

Cam, you called for comments, so here goes! Not a formal proposal, but just thoughts. Edit as desired.

Liberal and Conservative:
It seems to me they reflect on differences in application of the basic concepts of  RULES,  RESULTS, and. ENFORCEMENT. If one outlines the purpose or desired RESULTS, sets the basic RULES of fairness, and assign the implementation and enforcement be done at the most regional and local levels possible, this would be  a CONSERVATIVE approach. Conversely, if one sets down the DESIRED RESULTS, the related set of RULES, and also builds in the necessary ENFORCEMENT provisions and details to be carried out at the highest possible central government level to ensure top down complete control and equality of outcomes, this would be a LIBERAL approach.

It seems more simply described as those preferring LEAST CENTRAL GOVERNMENT CONTROL versus MAXIMUM CENTRAL GOVERNMENT CONTROL. I also don’t see where the word liberal applies to those of us in the general population; the term LIBERAL really only applies to those persons in Congress who are LIBERALLY applying as much central government based control on the country as possible.

In this regard, I believe there is a provision in our federal amendments that specifically addresses the idea that unless something is specifically singled out to be a federal matter, it shall remain a matter to be decided at the state level. Seems like our congress is largely forgetting this issue

Government (really population) SIZE:
There may be something intrinsic qualitatively to the concept of size – historically there develops a breakdown in governance in relation to very large size countries or populations. At some point a subgroup of people appear to come to desire self government, and wish to break off from the rest of the whole country.  Come to think of it, isn’t that pretty much how our country began? Kinda like an individual State wanting to run its own system of checking out doctors and insurance problems, workmans compensation injury problems, etc.

Is there any actual data showing that graduates from say Harvard MBA program are more successful at managing the very largest corporations, or an entire State government, than people lacking higher business degrees? I am strongly persuaded that they Think they are, but, sadly, anecdotal evidence is insufficient for us Caltech trained scientists, and as Dr. Feynman remarked,we tend to remain “schleptical”.

Enough for now  –  enjoyed seeing you at the reunion, and thanks for your book. I bought 2 copies to send to friends (Glen is a doctorate in psychology teaching in Pensacola Junior College and into Lacota Native American traditions, and my daughter Brett who is a special education teacher developing a program to help troubled teenagers (many are Inuits)  in Homer, Alaska.)

By way of explanation, the quote below expresses my view at the treatment of clinical physicians over the last 20 years by the members of Congress in regard to Medicare.  We are now no longer referred to as physicians or doctors; the term now used is “providers”, lumping all service givers together, including aids, nurses, technicians, pharmacists, phlebotomists, even code book experts, called coders! From 1974 through 1994, I collected 92 percent on my bills for care of patients. From 1996 through 2006 I collected 37 percent on my bills, and saved exactly zero for retirement.  My fees remained constant over the whole 30 year time period, and as a spine surgeon my patients were largely the Medicare group. That was the reward I got for trying to work with the establishment.
Every physician I know is concerned about the future quality of medical care for our childrens’ children.

Robert C. Williams, M.D.

“It could probably be shown by facts and figures
that there is no distinctly native American criminal
class except Congress.”    1897  Mark Twain


  1. I really do not believe I have it in me to keep up with managing a site like yours! Magnificent job, I really hope you keep going.

  2. making money says:

    I just assume a lot of the younger workers I work with opt out of the company’s health insurance program. We had a 4 percent company match on our 401k but I suspect 50 to 75 percent of the workers I work with didn’t match it at all. Of course no one matched it when the company dropped their contribution at the bottom of the bear market. The company regularly offers unpaid furloughs for its hourly workers(not the higher paid salary workers) that are usually accepted with enough enthusiasm that forced time off(only for hourly workers) rarely occurs. This also reduces the amount of vacation time those worker are getting. Maybe my experience is just out of ordinary but the young low skilled workers I work with are offering quite a bit of bang for the few bucks they receive.