About Robert Sewell, MD

Dr. Robert Sewell is an Advanced Laparoscopic and Minimally Invasive Surgeon specializing in bariatric and anti-reflux surgery. He is a Fellow of the American College of Surgeons and is the President of the American Society of General Surgeons. Dr. Sewell is also the Delegate to the AMA from the ASGS and is a staunch conservative political activist.

Forestalling the Demise of Freedom

I am attaching an e-mail letter I received recently without specific permission, but, you will see at the end there is a request to forward it to everyone, thus the inclusion in this blog. I actually thought about trying to rewrite this in my own words, but I’m not sure there is any way I could deliver this message any more clearly than this author has.

Obama’s Second Term Transformation Plans

The 2012 election has often been described as the most pivotal since 1860. This statement is not hyperbole. If Barack Obama is re-elected the United States will never be the same, nor will it be able to re-capture its once lofty status as the most dominant nation in the history of mankind.

The overwhelming majority of Americans do not understand that Obama’s first term was dedicated to putting in place executive power to enable him and the administration to fulfill the campaign promise of “transforming America ” in his second term regardless of which political party controls Congress. That is why his re-election team is virtually ignoring the plight of incumbent or prospective Democratic Party office holders.

The most significant accomplishment of Obama’s first term is to make Congress irrelevant. Under the myopic and blindly loyal leadership of Harry Reid and Nancy Pelosi, the Democrats have succeeded in creating an imperial and, in a second term, a potential dictatorial presidency.

During the first two years of the Obama administration when the Democrats overwhelmingly controlled both Houses of Congress and the media was in an Obama worshipping stupor, a myriad of laws were passed and actions taken which transferred virtually unlimited power to the executive branch.

The birth of multi-thousand page laws was not an aberration. This tactic was adopted so the bureaucracy controlled by Obama appointees would have sole discretion in interpreting vaguely written laws and enforcing thousands of pages of regulations they, and not Congress, would subsequently write.

For example, in the 2,700 pages of ObamaCare there are more than 2,500 references to the Secretary of Health and Human Services. There are more than 700 instances when he or she is instructed that they “shall” do something, and more than 200 times when they “may” take at their sole discretion some form of regulatory action. On 139 occasions, the law mentions that the “Secretary determines.” In essence one person, appointed by and reporting to the president, will be in charge of the health care of 310 million Americans once ObamaCare is fully operational in 2014.

The same is true in the 2,319 pages of the Dodd-Frank Financial Reform Act. which confers nearly unlimited power on various agencies to control by fiat the nation’s financial, banking and investment sectors. The bill also creates new agencies, such as the Consumer Financial Protection Bureau, not subject to any oversight by Congress. This overall process was repeated numerous times with other legislation all with the intent of granting unfettered power to the executive branch controlled by Barack Obama and his radical associates.

Additionally, the Obama administration has, through its unilaterally determined rule making and regulatory powers, created laws out of whole cloth. The Environmental Protection Agency on a near daily basis issues new regulations clearly out of their purview in order to modify and change environmental laws previously passed, and to impose a radical green agenda never approved by Congress. The same is true of the Energy and Interior Departments among many others.

None of these extra-constitutional actions have been challenged by Congress. The left in America knows this usurpation of power is nearly impossible to reverse unless stopped in its early stages.

It is clearly the mindset of this administration and its appointees that Congress is merely a nuisance, and can be ignored after they were able to take full advantage of the useful idiots in the Democrat controlled House and Senate in 2009-2010, and the Democrat Senate in the current Congress.

Additionally, Barack Obama knows after his re-election a Republican controlled House and Senate will not be able to enact any legislation to roll back the power previously granted to the Executive Branch, or usurped by them. His veto will not be overridden as there will always be at least 145 Democratic members of the House or 34 in the Senate in agreement with or intimidated by an administration more than willing to use Chicago style political tactics.

The stalemate between the Executive and Legislative Branches will inure to the benefit of Barack Obama and his fellow leftists.

The most significant power Congress has is the control of the purse-strings as all spending must be approved by them. However, once re-elected, Barack Obama, as confirmed by his willingness to do or say anything and his unscrupulous re-election tactics, would not only threaten government shutdowns but would deliberately withhold payments to those dependent on government support as a means of intimidating and forcing a Republican controlled Congress to surrender to his demands, thus neutering their ability to control the administration through spending constraints.

Further, this administration has shown contempt for the courts by ignoring various court orders, e.g. the Gulf of Mexico oil drilling moratorium, as well as stonewalling subpoenas and requests issued by Congress. The Eric Holder Justice Department has become the epitome of corruption as part of the most dishonest and deceitful administration in American history. In a second term the arrogance of Barack Obama and his minions will become more blatant as he will not have to be concerned with re-election.

Who will be there to enforce the rule of law, a Supreme Court ruling or the Constitution? No one. Barack Obama and his fellow-travelers will be unchallenged as they run roughshod over the American people.

Many Republicans and conservatives dissatisfied with the prospect of Mitt Romney as the nominee for president are instead focused on re-taking the House and Senate. That goal, while worthy and necessary, is meaningless unless Barack Obama is defeated. The nation is not dealing with a person of character and integrity but someone of single-minded purpose and overwhelming narcissism. Judging by his actions, words and deeds during his first term, he does not intend to work with Congress either Republican or Democrat in his second term but rather to force his radical agenda on the American people through the power he has usurped or been granted.

The governmental structure of the United States was set up by the founders in the hope that over the years only those people of high moral character and integrity would assume the reins of power. However, knowing that was not always possible, they dispersed power over three distinct and independent branches as a check on each other.

What they could not imagine is the surrender and abdication of its constitutional duty by the preeminent governmental branch, the Congress, to a chief executive devoid of any character or integrity coupled with a judiciary essentially powerless to enforce the law when the chief executive ignores them . Americans must come to grips with this moment in time and their historical role in denying Barack Obama and his minions their ultimate goal. All resources must be directed at that end-game and not merely controlling Congress and the various committee chairmanships.

Steve McCann, May 12, 2012

Please forward this to all you can, maybe together we can save America for ourselves and those who will follow after us


I would only add, if we (the American public) accidentally overheard this President telling Russian President Putin that he would have a lot more flexibility after the election, how many other “deals” has Obama made with those who would seek to destroy our freedoms and the American way of life? Now is a time for choosing. “We The People” of this great nation must stand against the tyranny that Abraham Lincoln warned us about 150 years ago. He said  “America will never be destroyed from the outside. If we falter and lose our freedoms, it will be because we destroyed ourselves.”


As an American…

I received a letter recently from a young, black, conservative physician named Dr. Robin Armstrong. He was recently elected to the Republican National Committee from Texas and is obviously a supporter of the Romney/Ryan ticket. However, the specific points he made in his letter were more than just the usual partisan politics; they were a plea to all Americans to come to our collective senses and change the direction of our nation. Dr. Armstrong said,

“As a proud American, I am offended that Barack Obama has attacked our institutions that have made our nation great!

As a Texan, I am angry that Barack Obama has abused his executive authority to attack our voter ID laws, and to attack the oil and gas industry with radical environmental restrictions and regulations!

As a Christian, I am disappointed this president has abused his office to impose his will and his values on religious institutions despite the clear violation of the First Amendment!

As a Conservative, I am offended this president considers me his enemy and a greater danger to our nation than radical Islamists!

As an African American, I am saddened this president’s policies have expanded the welfare state, skyrocketed the black unemployment rate to 14.4%, and further isolated our community!

As a Physician, I am frightened by Barack Obama’s unconstitutional assault on the healthcare industry, which will lead to bankruptcies in both government budgets and healthcare quality!

As a Taxpayer, I am angry this president wants to raise my taxes even further because he thinks I do not pay my fair share!

President Obama has stated he wants to fundamentally change our nation.  He is well on his way and he must be stopped!”

There is really nothing to add to Dr. Armstrong’s arguments except to say, as each of us is awakened to the fact that our freedoms and our very way of life are being stolen from us, and our posterity, it is our duty and our moral obligation to do whatever we can to arouse those around us before our current American Nightmare becomes the new and permanent American Reality.

Make no mistake, Barack Obama is a Marxist, socialist and should he win re-election, even if he loses Democrat control of the Senate, he will continue to seize more and more power through executive orders.

We were warned about the process we are now witnessing by none other than Abraham Lincoln when he said, “America will never be destroyed from the outside. If we falter and lose our freedoms, it will be because we destroyed ourselves.”


An Open Letter on the Destruction of American Healthcare

By Kris Held, MD

My Dear American Sisters,

As a sister, daughter, mother, physician and patient, my maternal core drives me to reach out to you. We must act now. One in 6 of us will be diagnosed with breast cancer within our lifetimes; 230,000 of us will be diagnosed and 40,000 of us will die from breast cancer this year alone in the U.S. Our government has already begun deciding who gets mammograms and who doesn’t, who gets treatment and who doesn’t, and what that treatment will be if you are deemed eligible.

You see, I have read the healthcare law, and it creates government task forces of non-experts and non-doctors that make medical decisions where they are willing to sacrifice thousands of women’s lives to save money to spend on other things the government deems more important than our lives.
Already they have gone against the recommendations of the very medical and scientific groups that have afforded us Americans the earliest diagnosis and best survival rates in the world.

Traditionally, American medicine is based on the Hippocratic philosophy where we, as doctors, take an oath and strive to do the utmost for each individual patient as part of a private patient-physician relationship. Experts in each specific field of medicine do research and publish peer reviewed science based data for us to guide our treatment accordingly for each unique patient.

President Obama’s healthcare law totally shatters this and instead implements a philosophy of medicine according to Plato, where government and its subject society are more important than the individual patient. They believe it is the individual’s duty to sacrifice medical care and treatment if it is more cost effective for society as a whole.

This started with The American Reinvestment and Recovery Act in 2009, known as Obama’s stimulus bill, which created The Federal Coordinating Council on Comparative Effectiveness Research- “The Council”. The Council is a group of 15 government bureaucrats appointed by President Obama and chaired by the Secretary of Health and Human Services, who is also appointed by Obama and is also not a doctor. This Council already exists. One member is Rahm Emanuel’s brother, Ezekial, an Obama crony, who favors socialized medicine and created a new rationing system called the Complete Lives System that prioritizes care to those between ages 15 and 40. This Council uses its own discretion and data it takes from Health Information Technology, also funded by the stimulus law with money taken from Medicare, to make major life and death decisions for us. The government has empowered itself to delve into our private medical records, extract personal data, do comparative effectiveness research on us, and dictate our care-all without our consent. Doctors that do not comply will be penalized and punished. Doctors that do comply will be rewarded. This is unacceptable and unethical.

Already, a government task force born of the healthcare law defied the accepted, state-of-the-art medical standards that have afforded American women the highest survival rates and earliest diagnosis in the world. Instead, the U.S. government task force of appointees, which had no breast cancer specialists on it, made recommendations that will delay diagnosis and cost lives. They decide who lives and who dies. They believe it is our duty to die if it is in their best interest.

The government has the audacity to over-rule the best practices of medicine in the world and say no mammograms under age 50 or over age 70, and only every other year in between. The youngest women, who have young children at home, will be diagnosed in late stages subjecting themselves to more severe treatment and lower survival rates. This especially hurts our African-American young women who are diagnosed later and have lower survival rates already. The older women aren’t even offered mammograms, apparently because they won’t be offered treatment. They will be diagnosed late when struck by late metastatic disease and face poor chances of survival. We will see our mothers, sisters and daughters diagnosed late and die unnecessarily of painful devastating late stage disease, which is more costly and more difficult to treat.
You see, I have read the law, I am a physician, a daughter, a mother of 4 daughters, and I have personally battled breast cancer.

I was always so trusting of my government, just as my patients trust me and I trust my doctor. I was fooled into thinking I could delay my mammogram based on government task force recommendations, but a wise young medical student, who was in the midst of her “women’s health module”, said this was wrong. She insisted I not wait but have the annual mammogram ASAP- the very test that revealed my cancer in early stages and led to my expert personalized treatment which got me back to work taking care of my own patients and my family with excellent chances of survival… a cure. I bet this bright young doctor never dreamed the first life she would save would be her mother’s.

We, the women of the United States, have the highest survival rate of breast cancer in the world, and now our government has decided to change that. We must stop them.
Please, make repeal of this unacceptable, un-American healthcare law the litmus test for who you will vote for this November. The government must not be allowed to practice medicine. This is the most critical vote in the history of our country. Do you have the right to the patient-centered individualized care of Hippocrates, or do you have the duty to die when you become a burden to society in the fashion of Plato and the authors and players of this healthcare law? Vote for only those candidates who vow to repeal the healthcare law and return control over our most intimate decisions, our very lives, to us and our doctors through true patient-centered, market-driven healthcare reform.
The choice is ours…for the time being…

Kristin S. Held, MD

Dr. Held is a practicing Ophthalmologist in San Antonio, Texas. She is a co-founder of American Doctors for Truth. http://americandoctors4truth.org/

Is It Really About Healthcare?

If you’ll recall, two years ago this past spring we were all watching the activities of our Congress with a great deal of anxiety. The healthcare reform process exposed the truly seedy side of the political gaming that goes on in Washington everyday, to one degree or another. But in this instance the eyes of the American public were a bit more focused than usual, and no matter which side you favored, the backroom deals and strong arm tactics had to make you more than a little uncomfortable with the way power was being wielded. What we saw was anything but representative of the will of the people.

In the end, both the House and Senate passed the President’s healthcare reform strictly along party lines, with votes being cast by elected representatives who freely admitted they had not even read the bill. So now, in the wake of all that, the question we should be asking ourselves is why? Why is controlling or overseeing individual’s personal healthcare such a big deal to this current administration and their minions in the Congress? The answer is actually very simple and it has absolutely nothing to do with ensuring the public health or the citizens’ wellbeing; its all about Power and Money.

For elitists who aspire to power, often based on their perceived superior intellect, the easiest way to achieve it is to first convince the masses that they require the government’s help to meet a specific need. The success of this philosophy relies heavily on a combination of fear and protection; something right up this Chicago gang’s alley. We’ve all heard the statement, “never let a crisis go to waste” and the reason is that public fear is a natural product of any crisis. But, if fear doesn’t actually exist, then you can create it using anecdotes and hyperbole. Once fear is well established the power-seekers can step in and offer protection and security in the form of a magnanimous government solution.

So, why start with healthcare? Simple, it is far easier to create a sense of fear over an emotionally charged issue like breast cancer or the sudden severe injury of a child than it is for any of the “necessities of life” like housing, food, clothing or virtually anything else we use or depend on everyday. It’s natural to be concerned and even a bit anxious over the potential impact of an unexpected illness or injury and all it takes to turn that anxiety into a full-blown crisis-level fear, which demands a government solution, is the injection of the final element – money, or the potential loss of it.

Clearly, government control of healthcare has been a goal of “progressives” in this country for more than a hundred years. When the liberal factions of the Democrat party gained control of both houses of Congress and the Presidency in 2008 their long awaited opportunity finally presented itself. They were quick to point to private insurance companies as being guilty of raising premiums and reducing coverage at the expense of the consumer, and on that score they were correct. “Reform” became their rallying cry without specific mention as to what exactly needed reform. Change for the sake of change alone was considered by many to be reason enough to overturn what has been the best healthcare system in the world. After all, “this is a Crisis!”

While the subsequent developments have been very upsetting to those of us in medicine who have dedicated our lives to providing that care, it should be truly frightening to every American based on where it will most certainly lead. Using the time-tested approach of “fear and protection” our increasingly dependent society appears to be ripe for the progressive destruction of all personal freedoms and individual liberties by our leaders drunk on Power and Money. Their newest target – entrepreneurs and small business owners who in the words of President Obama, “If you’ve got a business, you didn’t build that. Somebody else made that happen.” Obviously, healthcare reform was simply the first step toward “fundamentally changing America.”

Thomas Jefferson has been widely quoted in recent years on a number of issues, but in one of his somewhat less famous writings he said to Edward Carrington in Paris, May 27, 1788, “The natural progress of things is for liberty to yield, and government to gain ground.”   I pray to God it isn’t so.


The opinions expressed are my own and do not necessarily reflect those of any organization or group. please feel free to review other posts on www.spiritofhealthcare.com and check out my clinical site at www.robertsewellmd.com

Stop Calling It Obamacare

By Adrain Murray

When Mitt Romney went before the convention of the NAACP and said that as president he would repeal “Obamacare”, he was roundly and predictably booed.  In doing so, he stepped into a carefully laid trap.

Why is the Patient Protection and Affordable Care Act routinely referred to as “Obamacare”?  Surely no one seriously believes President Obama wrote the 2,700 page bill or, for that matter, even knows what is in it.  Yet the act is commonly labeled President Obama’s signature piece of legislation, the crowning achievement of his first term.

Even Nancy Pelosi would not take credit for authoring the bill, famously declaring we had to pass it in order to find out what’s in it.  So if the president didn’t write the Affordable Care Act and the Speaker of the House didn’t know what was in it, why is it called Obamacare?

One could make the argument that it’s just laziness on the part of the media, which revels in finding the lowest common denominator to explain complex issues.  One could argue that it is political posturing by Republicans who want to saddle the president with responsibility for what is undeniably an unpopular law.  One could argue it is the president himself, trying to take legislative credit for something he had nothing to do with, popular or not.  In fact Obama, a supporter of a single payer system, actively campaigned against many of the provisions that have ended up as cornerstones of the ACA law.

One could make a lot of arguments, but calling the Affordable Care Act “Obamacare” is a huge tactical error.  Why?  Because naming the law after Obama personalizes it and, as Romney learned from the NAACP audience, opposing Obamacare equals opposing Obama and the only reason anyone opposes Obama is, of course, because he is black.  To those inclined to think as such, opposing the complete government takeover of the healthcare system and changing the status of Americans from private citizens to property of the state is, quite simply, racist.  It also distracts from the true question that should be asked:

Who, precisely, wrote the Patient Protection and Affordable Care Act and why?

Our first clue comes from testimony given by Peter Orszag, then-Director of the Office of Management and Budget, before Congress in August of 2009.  “Ultimately,” he said, “without structure in place to help contain health care costs over the long term as the health market evolves, nothing else we do in fiscal policy will matter much, because eventually health care cost will overwhelm the federal budget.”

If Orszag had been addressing the board of directors of Wellpoint, the nation’s second largest managed health care company, such a statement might seem perfectly proper.  But, even accepting the wildly suspicious claim that 30 million Americans were uninsured, that’s still just 10% of the population.  If 90% of Americans in 2009 were covered by private insurance, why would health care costs overwhelm the federal budget?  It is more likely that rising health care costs would soon overwhelm the nation’s health insurance providers.

According to Kaiser Permanente, total health insurance costs in 1980 were $286 billion.  By 2010, they had increased nearly tenfold to $2.3 trillion.  As the population ages, that number is expected to soar.  According to federal estimates, health care costs will double in the next decade and are likely to double again by 2030, when 70 million Americans – fully 20% of the population – will be over the age of 65.  Could such dire estimates have provided the health insurance industry with a powerful $10 trillion incentive to move this looming liability off their balance sheets and onto the backs of the American taxpayer?

In May 2010, after final passage of the current health care law, Senator Max Baucus, from whose Finance Committee the legislation emerged, stood before the Senate and members of the press to publicly thank the person he credited with making it all happen:

“I wish to single out one person, and that one person is sitting next to me. Her name is Liz Fowler. Liz Fowler is my chief health counsel. Liz Fowler has put my health care team together. Liz Fowler worked for me many years ago, left for the private sector, and then came back when she realized she could be there at the creation of health care reform because she wanted that to be, in a certain sense, her professional lifetime goal. She put together the White Paper last November–2008–the 87-page document which became the basis, the foundation, the blueprint from which almost all health care measures in all bills on both sides of the aisle came.”

So who is Liz Fowler?  Prior to joining Baucus’ staff as the senior advisor on health care, she was Vice President of Public Policy and External Affairs for none other than the aforementioned number two insurance company, Wellpoint.  Not to put too fine a point to it, but the chief lobbyist for AHIP (America’s Health Insurance Plans), a national trade organization of over 1,300 insurers, infiltrated the Senate Finance Committee and wrote a law to benefit not the American people, but the entire insurance industry.  As it turns out, the Patient Protection and Affordable Care Act is not intended to make health insurance more affordable for the American people.  It is designed to make the American people more affordable for the health insurance industry.

As it further turns out, Baucus’ staff was infested with Wellpoint hirelings.  Prior to Fowler arriving on scene, the chief advisor on Senator Baucus’ team was Michelle Easton.  Upon passing the baton to Ms. Fowler, Easton went to work as a lobbyist for Wellpoint at Tarplin, Downs and Young, a DC-based lobbying firm founded in 2006 “specializing in strategic consulting and policy development with a particular focus on health care”.

Keep turning the wheel, though, and we come to Stephen Northrup.  Northrup was the chief health advisor to Wyoming Senator Mike Enzi when Enzi pushed similar health care legislation in 2006.  Prior to joining Enzi’s staff, Northrup was the executive director of the Long Term Pharmacy Alliance, an organization that played a lead role in drafting the mother of all giveaways to Big Pharma, Medicare Part D.  Not surprisingly, the revolving door and interchangeable roles of advisors/staff/lobbyists eventually lead Northrup in 2007 to Wellpoint, where he served as Vice President of Federal Affairs.

The insurance lobby, tired of decades of failed attempts to influence Congress to create a national health care plan which would immunize them from the looming trillions of dollars in liabilities they faced as the boomer generation aged, simply decided they would infiltrate Congress instead and write the legislation themselves.  Time, after all, was running out.

But simply enacting the legislation was not enough.  Big Insurance also demanded a seat at the table when it came time to actually drafting the regulations and implementing the law, since incompetent government bureaucrats could not be trusted to enact regulations and procedures that would fully indemnify the insurance lobby to its complete satisfaction.  Which brings us to the return of Liz Fowler, the author of the Affordable Care Act who is now the Deputy Director of Consumer Information and Oversight at the U.S. Department of Human Services, sort of an industry cop on watch to be sure government employees do what they are told.

Despite Big Insurance’s success in pulling off one of the most intricate swindles in the history of mankind by transferring tens of trillions of dollars of liabilities from their balance sheets to that of the Treasury Department, all to be paid for by massive tax increases on the American people (or fees, if you’re still arguing about the Commerce Clause in the increasingly irrelevant Constitution), the whole transaction would certainly deserve a special place in the pantheon  of lawlessness were it not for the decidedly unhappy outcome it will have for the true victims of this crime – the American citizens, who are now merely the property of an insurance industry that has a vested interest in keeping them healthy while they are still useful.  Those 22 year-olds who are today gleeful that they can stay on Mommy and Daddy’s insurance for a few more years won’t be quite as cheerful in 2030 when they are called before a panel Liz Fowler will undoubtedly have had a role in creating to explain why their cholesterol level has increased or are informed that certain substances detected in their last blood test indicated they are surpassing the monthly limit on pepperoni pizzas.  After being sent home with a hefty fine and orders to adhere to a strict diet of carrot sticks and mineral water, along with the latest behavioral modification drug developed by the recent merger of Pfizer and Merck, they may well wish they had been paying attention back in 2012, when there was still a chance to put a stop to it all.

In the meanwhile, it would be nice if certain political figures would put a stop to feigning political courage by mockingly referring to this legislation as Obamacare.  Obama didn’t write it or read it and there is nothing caring about it.  Call it what it is:

The Health Insurance Industry Protection Act.

You could also call it the end of freedom.


This post was authored by Adrian Murray is a business man in Fort Worth, Texas (President and CEO of Painless Performance Products) and an ardent Conservative thought leader in the North Texas community. It is with his expressed permission that this incredible piece is offered here. Thank You Adrian for your patriotism.

A Second Declaration Of Independence – “If Not Now, When?”

Two hundred and thirty-six years ago a small group of brave souls stood up to what was at the time the most powerful nation on earth, declaring their independence from the tyranny of the British Crown. The Sugar Act of 1764, the Stamp Act of 1765, and the Declaratory Act of 1766 (Collectively known as the Townsend Acts) along with the Quartering Act of 1765 and the Tea Act of 1773 all lead to the uprising of the colonies and the American Revolution. Today we are faced with a tyranny of a different sort, which is similarly unacceptable. The Patient Protection and Affordable Care Act of 2010 (Obamacare) has now been upheld by the Supreme Court on a rather thinly veiled technicality. Its not a tax, but its constitutional because it really is a tax. No matter what you call it, this law represents historically the most significant overreach by our own government, and all freedom loving Americans should vigorously oppose it.

As a physician I am privileged to represent the American Society of General Surgeons both as a Delegate to the American Medical Association and as a representative to the Coalition of State Medical and National Specialty Societies; a rather loose consortium of conservative organizations within the AMA, where we’re in the minority to be sure. Following the annual meeting of the AMA House of Delegates in Chicago in June, 2011, we were frustrated by the fact that the House reaffirmed existing AMA policy, supporting a government requirement that every American purchase health insurance, the so-called individual mandate. In the wake of that defeat our Coalition came away without a clear understanding of what our next move should be. Various e-mail threads since then have failed to define a coherent physician-lead strategy. One such series of communications was titled “What is the Battle Plan?” While some would prefer the term Game Plan, either way its clear that we’re talking about a critical contest.

It seems obvious that before any competition one must first determine what is the object of the battle, or game. The problems that exist within the healthcare system are myriad, but central to every argument is one question. Is healthcare a basic human right and therefore the responsibility of government to provide for its citizens, or is it a benefit that has been developed by a civilized society and should be available to those who exercise individual responsibility to obtain it? Not surprisingly this question is quite polarizing, both for healthcare professionals (notice I didn’t use the demeaning term “providers”) and for the public as a whole. This is obviously a complicated issue for which there is no simple answer.

It is ridiculous to imply that American healthcare is bad, as some have claimed. It is the best in the world, but its also the most expensive, and no matter what anyone says, this fact is the sole reason behind the impassioned pleas for reform. Part of the reason our system is so expensive is because there are so many hands in the cookie jar. For years special interest groups have invested heavily in obtaining power within the ranks of government and they were actually the authors of the more than 2,000 page healthcare reform act.

The AMA is often considered to be the doctors’ special interest group, but It is important to recognize that the AMA, and all doctors for that matter, were only peripherally involved in the process of producing Obamacare. AMA leaders were wooed by the White House, but not as potential authors of the new law. Instead they were relegated to the role of commentators. Then during the actual public debate, they inexplicably seemed content just to be at the table, failing to recognize that our profession was indeed the main course. AMA leadership openly supported some elements of the bill, but the public never heard about the parts they objected to. AMA leaders told their dwindling membership (now less than 17% of America’s physicians) that problem areas, like the Independent Payment Advisory Board (IPAB) and the flawed Medicare payment system known as the Sustainable Growth Rate formula (SGR), would be “fixed” when the House and Senate versions came to conference committee. But, as we all found out, aggressive back-room politicians who recognized their opportunity (“If not now, when?”), worked in concert with the giddy media to push the Senate bill through unaltered. In no small way, AMA statements that sounded like doctors supported the bill helped put it on the President’s desk. The total lack of transparency and last minute parliamentary maneuvering made this perhaps the most shameful act of legislative cowardice in American history.

Whether you agree with the concept of universal health insurance or not, (again note I didn’t say universal healthcare because they are clearly not one and the same) the question remains whether it is the role of the government to command it. Patronizing lawmakers have told America’s physicians and our patients that this Congress and this President know what is best for us, and that we’ll like this new system once we get used to the idea. That reminds me of a statement made during a campaign by a gubernatorial candidate in Texas a few years back. He offered this advice to any woman being raped. “As long as it’s inevitable, you might as well lay back and enjoy it.” Well, obviously he lost the election, and based on the results of the 2010 midterm elections, a clear majority of Americans have not yet learned to “enjoy it”, preferring instead to fight back. Many of my fellow physicians have joined in that fight through organizations like the Association of American Physicians and Surgeons and Docs4PatientCare. So to the rest of my colleagues, and to the patients we serve, I would offer the following as a guide for our collective efforts.

  1. What is the objective of this fight? Repeal the ENTIRE law that we unaffectionately call Obamacare, and start over to create a patient centered system that encourages personal responsibility and rewards individuals for good health practices rather than punishing those who refuse to submit to some government mandate.
  2. What is the Battle Plan? Practicing physicians must get to work, joining other similarly minded groups and individuals to save our beloved profession. This battle starts with winning the hearts and minds of our fellow physicians. Our message must be that the future of healthcare relies on the individual physician’s moral compass and professional ethics and responsibility, not arbitrary controls mandated by any third party, be they the Federal government or private insurance companies. If we provide clear leadership for those who have lost faith in their representative organizations we will be able to effectively call up the vast militia of practicing physicians to join the fight. They will in turn be able to marshal the support of their patients who intuitively trust their doctors and want us to lead the way.
  3. What is our first engagement? Our main obstacle to achieving the basic objective of repealing Obamacare is the current uncompromising administration in Washington. Therefore, our primary mission must be to change the current regime. Unlike the Patriots in Philadelphia in the summer of 1776, we can accomplish this change at the polls, but it will not be easy. Between now and November 6, 2012 we must work tirelessly to turn the political tables on those who believe they know what is best for us and all our fellow citizens. There is a true urgency to get to work immediately as the elections are just four months away. Our battle cry in this effort should include that now famous phrase “if not now, when?”

Our God given freedoms and individual rights are like a handful of sand. We don’t lose them all at once; rather they slip through our fingers one grain at a time. The election this coming November has become our final opportunity for “We The People” to declare our independence from a government which openly seeks to control our personal health and individual wellbeing. If we fail in this effort to change the course of this nation now, how can we hope to retain any of our precious few remaining freedoms for ourselves or our posterity.

The best way to predict your future is to create it.” Abraham Lincoln.


The opinions expressed are my own and do not necessarily reflect those of any organization or group. please feel free to review other posts on www.spiritofhealthcare.com and check out my clinical site at www.robertsewellmd.com


Oh! Say does that Star-Spangled Banner yet wave?

Over the last few days I’ve written a couple of impassioned healthcare related pieces and have received some very positive feedback, which I appreciate very much. But, sitting here at the computer today it suddenly hit me; I’m sick and tired of being on the losing side of all that is going on in America, and I don’t just mean healthcare. Like everyone else, I want to be on the winning side. After thinking about it for a bit, it’s clear that there are only two options available, assuming you want to be a winner. Either you join the side that appears to be winning already, or do whatever it takes to make your side the winner.

When it comes to politics I have been solidly right of center my entire life, but it seems the left has been winning most of the battles for the last several decades. And like I said, I’m tired of losing. The option of joining the left would mean I’d need to embrace the concept of big brother having oversight and control over virtually all aspects of people’s lives. I guess I could live with that idea for everybody else, but not for me, or my family. I’d also need to be willing to tell people who trust me whatever they want to hear, even if I know it isn’t true. Perhaps that would also be okay as long as no one was harmed in the process. Obviously I’d have to sacrifice my integrity. I’d also need to learn how to look the other way whenever a colleague or a friend fails to do their job then blames their failure on someone else. Even if one of my teammates committed a crime I would have to be willing to just stay silent. That might be okay as long as the victim wasn’t someone I know. Actually, I suppose I’d need to learn how to rationalize that kind of behavior by making every situation seem like someone else is at fault. All of this would be acceptable I guess, as long as no one found out, right? If I could do these things I’m sure I could fit right in with the winning team of enlightened liberals.

My other choice would be to do the things my dad taught me as a boy. I would have to accept responsibility for what I’ve done and what I haven’t done thus far, and how I may have contributed to our current state of affairs. I would have to recognize that like many others I haven’t always stood up for what I knew was right. I’ve sometimes been slow to speak out with conviction against things that I knew were wrong, like lying and cheating. I would need to recognize the hard-work of others and do whatever I could to ensure that everyone gets an opportunity to succeed or fail, based on their own work ethic and effort. I certainly could do more to offer charity to those individuals around me who are truly in need, given the abundant blessings I’ve received. I could also do more to teach my children the values that my dad taught me to help ensure they aren’t lost forever. Perhaps most importantly, I would need to be more active in fighting against the general ignorance of history among those who have been easily drawn into the clutches of the side that currently appears to be winning.

The easy choice is obvious, just join those who are celebrating victory after victory today. They will gladly embrace anyone who thinks and acts the way they do. But the question that lingers before deciding is, are they going to be the winning side in the end? After all, that’s what really matters once all is said and done.

So before declaring which side to choose it is critical to define what we mean when we say someone is a winner. It isn’t how much money you accumulate, what you do for a living, where you live or even how many people depend on you everyday. For me the answer is much simpler. Being a winner means being able to say without hesitation that you did the right thing, not just when it was easy, but especially when things seem to be going hard against you. This is a difficult measuring stick because it requires courage, stamina, conviction and most of all a passionate heart.

Today, our nation, the greatest, most honorable, most prosperous and most free in the history of mankind, stands on the brink of a disastrous fall. We all know that the direction we are headed is wrong, politically, economically and morally, and will lead to the certain collapse of the cherished way of life our ancestors fought and died to achieve. The challenge we face is obvious but the question remains, will “We the People of the United States of America” recommit ourselves to saving our nation from those who would destroy it? Are we willing to individually take up the task of securing for our children, our grand children and their posterity, the promises offered by our “Land of the Free”? I believe it is still possible to win, but only if we are each willing to once again prove to ourselves and each other that America is indeed the “Home of the Brave.”

If you agree to take up this challenge of winning back our nation, please join me in praying for God to renew his blessing on this country. We need it now more than ever.

TO ARMS! TO ARMS! British Healthcare Is Coming!

In the Spirit of the 4th of July holiday, the following is an updated version of an article published in “General Surgery News” – August 2009.

April 18, 1775 was a fateful date in American history. That night, Paul Revere, a Boston silversmith, rode his horse through the countryside and called his fellow colonists “To Arms!” British troops were arriving by sea to suppress any effort by the colonists to gain their freedom from the tyranny of the crown. Once alerted, the Minutemen responded at Lexington and Concord, and the rest is, as they say, history. The event was immortalized by Longfellow nearly a century later. But to be sure, not everyone in the colonies was in favor of revolution. There were those who were loyal to the crown called Tories or Loyalists, and those who vigorously opposed the repression of King George, commonly referred to as Whigs or Patriots. Thank God the Patriots’ efforts didn’t stop with the first “Tea Party.”

Today, we face another British invasion of sorts, and once again we must be called “To Arms!” This time the threat is to our personal healthcare freedoms, and is being imposed by our own government as it now has the power to regulate patients’ rights to choose what is best for them, as well as physicians’ rights to practice as independent advocates for our patients. Make no mistake, Obamacare has a distinctly British look and feel to it. In Great Britain everyone has access to “free” care through the National Health Service. While this sounds good, in reality diagnostic tests and treatments are frequently delayed for months or even years, and some treatments are denied as not cost effective.

Our Congress and the President have effectively seized the practice of medicine by controlling both reimbursement and access under the direction of a Healthcare Czar, otherwise known as Secretary of Health and Human Services, Kathleen Sebelius. Although government take-over of medicine has been occurring incrementally for decades, this current effort was designed to absorb the final segment, known as private practice.

Perhaps of even greater concern to all Americans is the precedent that has been set. This law was rammed through Congress based on the claim of an “economic crisis” requiring “emergency surgery.” This approach is now the model for achieving any additional “reforms” supposedly designed to “help us.” Thomas Jefferson once said “Be most on guard for your personal freedom when the government’s purposes are beneficent.” Interestingly, the members of Congress who proposed this new and improved healthcare plan voted down an amendment that would have forced them, their families and all government employees to participate in it.

Every American deserves a healthcare system that maintains our fundamental freedoms, including the right to choose and maintain their own physician. Obamacare severely curtails or eliminates these freedoms. Furthermore, it does nothing to improve the insolvent Medicare system. It actually makes it worse by cutting $500 Billion from the Medicare budget over the next ten years. It also failed to address the medical liability crisis that exists in most parts of this country, and does nothing to address the fatally flawed physician payment formula. The net effect of Obamacare promises to exacerbate the growing shortage of physicians in critically important specialties like General Surgery. New physicians won’t choose this or other equally demanding fields of medicine, and those who are in practice won’t remain because it simply isn’t worth it.

Many patients have asked, “Why don’t you doctors do something?” Well, many of us are trying but our influence is limited, partly because physicians are not well organized. On the issue of healthcare reform there are basically two camps, much like the colonist who were either Loyalists or Patriots. The AMA is often described as the voice of doctors, but it has fewer than 17 percent of America’s physicians as members. This is in no small part due to the fact the AMA leadership chose a “Loyalist” approach to government reforms, while the overwhelming majority of practicing physicians favor a “Patriot” strategy of active resistance. Organizations like the Association of American Physicians and Surgeons and Docs4PatientCare are among those attempting to carry this banner and are thus deserving of our support.

President Obama warned that writings such as this are the scare tactics of those who want to preserve the status quo. With all due respect, America’s physicians don’t need scare tactics. The public is already frightened and so are their doctors. A government take-over of our profession has everyone worried, as it should. Personally, as a physician who has been in practice for more than thirty years, I see this simply as an unacceptable intrusion by the federal government. However, it appears the only thing that can save American medicine is a general outcry from the public militia, our patients; thus the reason for this “Call to Arms.” All freedom loving Americans must make their voices heard at the polls in November.

Although this is a political process, it is actually very similar to the treatment of a patient with a life-threatening illness or injury. DIAGNOSIS: Obamacare threatens the very existence of what has been the best healthcare in the world. TREATMENT: Vote for  candidates who will repeal this law. In addition we must also remove Mr. Obama from the Presidency to avoid his certain veto of the true will of the people. FOLLOW-UP: Watch closely what happens and call or write your representatives to ensure they don’t forget what you’ve sent them to Washington to do.

Liberty, like life, is a precious commodity and once lost cannot be replaced. We simply cannot give up the fight to retain the freedoms others have fought and died to secure. So, before you say “my voice and my vote don’t really matter,” consider what would have happened had the Minutemen remained safely in their beds, allowing the Red Coats to cross Concord Bridge unopposed.

Robert Sewell, M.D., F.A.C.S.


The opinions expressed herein are my own, and do not necessary reflect those of any group or organization. Visit my web site at http://www.robertsewellmd.com

A Healthcare Road Less Traveled

Robert W. Sewell, M.D., F.A.C.S.

Despite the fact that the Supreme Court has ruled the Patient Protection and Affordable Care Act of 2010 to be Constitutional, we continue to find ourselves at a fork in the road. The Republican members of Congress have pledged to repeal the law and start over with a patient centered healthcare reform act. While this sounds promising, the question remains, which way will we go this time? Will we continue to be lured down the path taken by most European countries and our neighbor Canada, where a central government-run system provides cradle to grave care, or will we choose to empower the individual with freedom of choice? It has been this road less traveled which has been and will continue to be the key to American exceptionalism.

Next week we celebrate the two hundred and thirty-sixth anniversary of our founding fathers telling the world that they refused to accept the tyranny of the British crown. They had witnessed the impact of higher taxation, restrictions on opportunity and forced subservience, and when they had endured enough they rebelled. They rightfully concluded that they were better off pursuing a course based on individual freedom and they set this country down the freedom road that has lead to unparalleled prosperity. It hasn’t been easy and there have been many bumps along the way, but there is no doubt it was the right choice then, and it is still the right choice today. The choice is between liberty and servitude, personal freedom and government mandates. So why is it that so many argue vehemently for a government run system? It all revolves around the concept of responsibility.

Since the beginning of civilization the “common man” has been typically subjected to the rule of kings, czars, emperors, dictators and various other demigods, sometimes willingly but often under threat of force. Frequently, aristocratic rulers declared themselves to be appointed by, or in some instances actually descendants of God, as a means of legitimizing their control over the sea of commoners. The masses accepted this form of centralized, top-down government in part because someone else assumed responsibility for many of the tough choices in life. Only when a ruler grossly exceeded the unwritten laws of human decency would the people rise up in protest. But, historically another ruler would invariably step forward to fill the void. It seems people must be reminded over and over again that “Power corrupts and absolute power corrupts absolutely.” (Lord Acton)

The alternative offered by the Great American Experiment has been individuals possessing the ability to exercise their own free will and accept responsibility for their own successes and failures. In a totally free society there isn’t a “higher power”  waiting to bail-out the person who either makes poor choices or is simply unlucky. It is understood that there will always be winners and losers in a true “survival of the fittest” system. But man is no longer trying to simply survive on the plains of Africa. Our collective conscience compels us to adjust our social framework to one that provides a safety-net for those who are either born into poverty or have fallen on hard-times through no fault of their own. Herein lies the greatest challenge to any group of free individuals. On the one extreme, with total freedom you have “losers” who suffer while “winners” enjoy the opulence and privilege of the “elite”.  On the other extreme you have a society where there are no winners or losers because the incentives that encourage personal achievement are destroyed by a collective philosophy. It is the state that ultimately decides how much individual success is allowed, “just to make it fair.” This is the basic premise behind socialism and communism.

Nowhere in modern civilization is this argument more prominent than in our evolving system of healthcare. Obviously, no one wants to see a child or an elderly person, or anyone for that matter, go without needed medical attention, but in our efforts to ensure against the socially unacceptable, we risk over-reaching, as we gradually come to accept the idea that no one should have to be responsible for themselves. Gradually, we have either turned over responsibility for our individual healthcare to a corporate insurance entity that offers some version of A-Z healthcare or accepted the idea that a government controlled system is the best model. In doing so we have lost control of the most important personal service any of us ever receives. We have in essence relinquished our personal responsibility in exchange for a sense of security, which rests in the hands of either corporate moguls or government bureaucrats. Benjamin Franklin summarized this dilemma when he wrote “They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety.

Certainly there are those for whom choices are limited and some form of government sponsored healthcare may provide the only option. Even for the majority who have the means and desire to choose for themselves, the options have become limited by those who benefit either financially or politically from maintaining control. The current mantra of both the insurance industry and the government is that healthcare is too expensive and therefore must be taken over by wiser and more responsible people, (i.e.) them, because they know what is best for us and have the resources to deal with the inequities of the system. It is to that assertion we must collectively say no thank you. After all, where do the resources come from, which they use to manipulate the system?

For the majority of Americans the best solution would be a free and open market where the cost and availability are determined not by an arbitrary government panel or an insurance contract, but by the basic laws of supply and demand. This can be accomplished by expanding on the idea of individual empowerment. Health Savings Accounts (HSAs) that are independent from employer based insurance is an idea whose time has come. People will become true consumers of healthcare only when they are making decisions about how to spend their own resources. Obviously, this only works if it is coupled with catastrophic insurance for major costs that are beyond the average individual’s capability, but isn’t that what insurance is for? There must also be competition in the marketplace. Anyone should be allowed to buy insurance from any entity, not just those who operate within the boundaries of the state where they currently reside. Both the catastrophic insurance and HSA should be totally portable and remain with the individual and his or her estate.

Our current system of healthcare financing does not empower the individual, in large part because of our current tax law. The vast majority of health insurance policies in this country are employer based. The employer provides health insurance as a benefit to employees and their dependents, and then writes off the premium as a business expense. Individuals who purchase their own health insurance are penalized twice. They are unable to benefit from “bulk rate” discounts that larger employers enjoy, and they cannot write off the cost of their insurance on their personal tax returns. This is blatantly unfair, and correcting this inequity should be a major part of any new healthcare reform act, and it should be part of the foundation of the promised Federal tax reform next year.

Currently, the American healthcare system is anything but a free market, and as a result prices are high, quality is in decline and availability is threatened for all. The solution will not be easy because it will require a return to the fundamental principle so eloquently stated by Eleanor Roosevelt when she said, “With Freedom Comes Responsibility.”  Now is the time, in the wake of this historic decision by the highest court in the land, for all free men and women of this nation to renew our commitment to being worthy of our heritage. We must raise our collective voices and demand our individual freedoms be restored, lest we will all eventually become wards of the state; the very thing our forefathers rebelled against.


The opinions expressed herein are my own and do not necessarily reflect or represent the policies or opinions of any medical organization or group.

Check out my web site at www.robertsewellmd.com

Can Golf Save America?

We live in an age where professional sports seem to dominate much of our social landscape. Currently the Major League Baseball season is well underway and the NBA and NHL playoffs are nearing their climax. NFL teams are conducting off-season Organized Team Activities (OTAs) and it won’t be long before those guys report to training camp. There are numerous contrasts between these sports and the guys who play them and another sport, golf. Here are just a few obvious differences.

  1. All team sports require everyone to work together to achieve a common goal, while golf is essentially an individual sport; the Ryder Cup and President’s Cup being the only notable exceptions.
  2. Team sports involve competition between teams on a precisely defined field, rink or court, while golf competitions have individual players competing against a course that offers infinite variations.
  3. Virtually all team sports include some degree of physical contact between the competitors (not as much in baseball as the others), while the only contact between competitors in golf is a handshake or the occasional pat on the back.
  4. The tone of conversation between team sport competitors is typically described as “trash talk” with the goal being intimidation or distraction, while such confrontational communications are considered inappropriate between professional golfers.
  5. The spectators at team sporting events attempt to impact the outcome of the game by cheering, booing or heckling the players during the course of play, while golfers enjoy respectful silence during their actual play and good shots are universally applauded, no matter who makes them.

Perhaps the most striking difference between our beloved team sports and the game of golf rests in how they are administered. In football there are 22 players on the field at any given time, and 7 officials, not including the guy in the replay booth. In basketball there are 10 players and three officials. In hockey there are 12 players and 4 officials. In baseball there is a maximum of 13 players on the field at any given time, with 4 umpires, unless its the playoffs when there are 6 umpires. In each instance there is one official for about every three players. Their job is to control the play by enforcing the rules, often based on what one can only hope are independent and unbiased judgements. Needless to say the officials are often targeted by angry players and fans of losing teams as the reason for their lack of success. But, without these officials the games simply could not be played. Can you imagine Kobe Bryant or LeBron James ever calling a foul on themselves during a crucial playoff game. Is it likely that any tight end would ever agree that he was holding the opposing defensive end. Hockey without officials and the “sin bin” would be nothing more than a brawl on ice. Oh wait! Bad example. Hockey already is a brawl on ice. Perhaps that’s why some people love it the most.

Golf, on the other hand, is described as a gentleman’s game. It isn’t that there aren’t any rules, quite the contrary. The rules of golf are as numerous and as penal as those of any other sport, and every tournament employs numerous officials who oversee the conduct of the competition. But golf officials are, by and large, simply available to the players to assist them in interpreting the rules. With very few exceptions the officials stay behind the scenes while the players police themselves. It is far more common for a player to willingly call a penalty on himself than it is to have an official step forward with an unsolicited adverse ruling. The rules of golf actually call for competitors to assist each other in making rulings during the course of play, and this universally takes place in a cordial and often collegial manner.

Participating in a team sport is often encouraged for children as a means of teaching them life lessons, such as working together and recognizing, understanding and playing within a set of rules. All children naturally tend to rebel against the rules, so the responsible parent, just like the official in a team sport, must step in with some form of discipline when the rules are violated. Over time the goal of parenting is to encourage each child to assume responsibility for their own actions, with the reward being the freedom to make their own independent decisions as adults.

Sadly, many of today’s team sport professionals appear to have never learned these basic lessons. They seem to have little respect for the officials, their opponents or the fans. Their behavior can only be described as that of a undisciplined teenagers or the growing group of “occupy” participants. When these truly incredible athletes prance around beating their chests, whine about every foul called against them or in some instances act like common backstreet thugs, they are distracting from both their talent and their game.

I find it very interesting how many professional athletes eventually gravitate toward golf as their preferred leisure activity. Perhaps it’s because they see golf as an opportunity to compete as an individual. They are not reliant on a teammate to pass them the ball or drive them in from second base. But I think it also has something to do with a desire to escape the constant oversight of third party officials, much the way the teenager wants their freedom and independence from their parents’ oppressive control.

If you have been watching professional golf on television lately you no doubt have seen the promotions for “The First Tee”, a program of the World Golf Foundation, which is supported by the PGA, the LPGA, the USGA, numerous corporations and other organizations. Their mission is “To impact the lives of young people by providing educational opportunities that build character, instill life-enhancing values and promote healthy choices through the game of golf.” Their stated goal is to get 10 million more kids introduced to the game of golf and all that goes with it. Watching “The First Tee” ads during the recent telecast of the Masters golf tournament reminded me of an old saying taught to me by my father when I was growing up. He said, “If you want to know the true character of a man, get him on the golf course.”

The nine core values that “The First Tee” teaches through golf include: Honesty, Integrity, Perseverance, Sportsmanship, Judgement, Responsibility, Courtesy, Confidence and Respect. These are indeed the characteristics that every adult should embrace, and ones that all our children should be taught. It’s a shame that many of our highly visible athletes who, like it or not, serve as “role models” for America’s youth often demonstrate quite the opposite through their own behavior. But, hopefully through the efforts of programs like “The First Tee” and the clear example of earned personal freedom based on the assumption of individual responsibility embodied in the game of golf, the next generation of Americans can escape the growing trend toward childlike dependence.