OUTDATED  RULES FOR HAPPINESS

Not obeying my rules of life.

As I age, I see that the rules that apply to me don't apply to my family anymore.  The rules saved a lot of talking from my parents.  I'm not explaining how the world works. I don't want to ruin your Independence.  Some of the rules are easy and some of them are hard.

“Maybe” is not a word anymore. When my family asked me to come to their house at a certain time and a certain day, They don't understand a “maybe”. They just want a “yes or no”. They can't realize that it depends on my circumstances. At least I don't tell them "I don't know if I can”. That would replace my  “maybe”.   

 Work with what you have.  When something is broken, you don't throw it away. You repair it with the tools at hand.

When someone says hello, you say hello right back to them.This opens a conversation that you might have with the person that created you first. It might be to your advantage.   Small talk is precious talk.

When you don't like the company, say “Sorry, I got to go” This is a good escape mechanism to move on to other places my friends away.

If you're going to con me, don't let me know ahead of time.

Suspicious behavior is always recognized by parents

Never stand in front of a TV with a football game on. There's always somebody who wants to see the touchdown coming in the next minute.

Never leave the bathroom without thinking of the word Flush. Someone is just outside the door waiting to enter. If it's a girl, add to words  toilet seat down.  Especially if she's your girlfriend.

If you had a big burp, put your hand by your mouth and say excuse me.  You never know what might protect from your mouth and where is lands..

It's okay to scream at the Lions football game, but not at my dinner table.  This behavior puts you  on the opposing team.

It's okay to take your shirt off at the beach, but never your trunks.

The viewers may be  surprisingly disappointed.

It's okay t.o hug your mom, but not your waitress.  

 She may have her beloved boyfriend waiting in the car.

Don't get ticked off if someone doesn't answer you.

It may be that they don't want to hear you.

A funny looking apple may really be a peach.

Everyone with long hair is not necessarily a girl.

Don't make me go over time explaining the rules of life.

You will hear the rule over and over again.  I am not one to give up nor shut up.

Things can look more beautiful if you look closer at them.

A polite way of saying:“Open your eyes and look at people.”

Hold on to your pants.

Quit playing with the tiny pop spot on your pants.

Only take them off if your doctor or girlfriend says.

A person laughing does not necessarily like you.

 Sometimes people laugh  to hurt you.

When asked to do something unpleasant or wrong,

 say "I'll think about it.”

This gives the person  time to forget the bad idea.

“I'll be a little late” can be misunderstood.  

Perhaps it means “I am not coming.” 

Don't use a lot of words when one word is enough.

Get to the point and answer “yes or no”.

Everything not useful does not have to be tossed away.

That Detroit Tiger cap might someday be precious

Open your junk box carefully, something may just jump out.

Perhaps a dried land crab, or some wiggly creature.

Knock  before you open a  bathroom door.

Your sister will realize that you finally have grown up.

If someone wants to be alone, agree with them.

Sorry, I have to go now.   See you later.

Saying ’ I'll do it  means “you must do it”

No “ands ,ifs,or buts.

If you want something, ask you if you can try it.

Waiting for your turn can prove exciting.

Some people don't know who they are or where they are.

Most pretend they know everything and keep talking forever.

Pick very carefully if you can only choose one.

It might be your soulmate until death do you part.

Leaving something out it's not lying.

Any politician will verify that statement.

Answer a troubling question by asking a question.

Switching topics keeps your conversation going.

Add to word just to diffuse importance. Is he your lover?

No, just a friend from work.  

Are your parents divorced?

 No, they're just separated taking a break from each other. 

Why are you crying?

 To get your attention.

 Why are you screaming?

 to get my share of everything

 Why are you putting that in your mouth?

 If it fits in my mouth it has to be food.

Someone's upset.  No time to bring up my problems.

Must stick to the topic at hand.  No distractions.

Want to change the subject? Take a quick detour in your talking.

How would you like to go to the buffet table?

A problem solved can create another problem.

Friendship often leads to marriage.

When things get tough, time to make a joke.

When I laugh I can't cry.

Safe to dance in the dark when you are home alone.

Practice makes perfect.

Quit following me wherever I go.

Unless you're just playing games.

When I'm being teased, take my side.

Then we can stay friends.

Quit saying mean things like “my cat likes me better”.

I don't even own a cat.

Sometimes I get to choose what we will do and sometimes you get to decide.

See, everything is give and take.

 When I ask you to go out with me, say yes sometimes.

You can say no to yourself.

Quit hogging the computer or the TV.

Sharing is important.

 just ask me why I'm upset.

Then you will start listening to me.

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DO YOU NEED A FLU SHOT THIS YEAR

DO YOU NEED A FLU SHOT THIS YEAR


With our flu season upon us (running from November to April), drugstores and now even grocery stores, are  doing some creative things to promote flu shots.  With over 166 million doses made this year, compared to 157 last year, it has become difficult to sell flu vaccinations. Since retailers last year gave only 20% of all flu shots, they are heavily promoting it this year. Drugstore chains use this to introduce the diabetic screening and in-store clinics.

Last year only one third of adults and one half of children got flu shots.  A big difference from two years ago when people were standing in line demanding shots. This year’s  flu shot doesn’t  offer any new protection against other viruses, and it is harder to convince people to get another shot.  You are told: “last year’s shots have worn off, and  new shots are needed”.

There are offers of coupon booklets, grocery discounts, signs down every aisle and at checkout, all saying “this  friendly drugstore will give you a flu shot”.  Grocery chains are offering 10% off coupons for future shopping, giving free grocery items as apples, coupon books on frozen vegetables bottled water and vitamins,  and  even hands sanitizers.

Drugstore television ads are aimed to the elderly, who are most vulnerable. Flu shots are offered at $25-$30, and half of this is drugstore profit.

25% of 2009’ flu vaccine that was produced were thrown into the trash and incinerated-- over 40 million doses at a cost of $260 million. That was four times as much left over than any other season. Another 30% later expired and were also unusable. In summary,  43% of our vaccine supply was wasted. The government defended our huge drug house purchase as necessary, fearing the flu epidemic could be global. As it turned out, it ended up killing fewer people than our seasonal flu. 

The message is being sent to that even healthy people can become severely ill from the flu. There is a great added push to promote this message of prevention. The government does not want to be stuck with another  huge vaccination expense it’s as two years ago, yet they have ordered the same amount of vaccines.

The CDS anticipates the same three strains again will be needed. The current flu vaccine protects against all three strains, (A/H3N2 strain, B strain, and the 2009 H1N1 pandemic strain. Human influenza, A  and B, are present every winter in the United States. This matchup in this years  vaccine  may not be the actual circulating strains needed. There is concern that young people may be susceptible to H1N1–like viruses that continue to circulate.

Do you REALLY need a flu shot this year?  READ MORE

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HOSPITALS FINANCIALLY CRUNCHED

Hospital reimbursements will be reduced to Medicare levels, bad debts will rise, hospitals will bundle payments, employ more general practitioners, and many close their doors or be acquired by bigger hospitals. To survive the hospital will require 95% occupancy. Unions will organize hospital healthcare workers, and hospitals will find it difficult to get money from banks.

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HOSPITALS FINANCIALLY CRUNCHED
 
Hospital reimbursements will be reduced to Medicare levels, bad debts will rise, hospitals will bundle payments, employ more general practitioners, and many close their doors or be acquired by bigger hospitals. To survive the hospital will require 95% occupancy. Unions will organize hospital healthcare workers, and hospitals will find it difficult to get money from banks.

Because of Medicaid and Medicare disproportionate share of hospital costs, reimbursements will be reduced.  They will be reimbursed at near Medicare rates over the next 3 to 5 years.

 Commercial health plans will lower their premiums to match government and co-op health care options and hence, payments to providers will be reduced. Health plans and the number of hospitals will decrease by more than 20%. They will need to also reduce operating expenses by a 20%.  They will be giving doctors incentives to encourage clinical effectiveness and cost.

Bad hospital debts will rise.  Even with Obama’s subsidies, laid off employees still will not be able to afford COBRA health benefits.  There will be fewer Medicare advantage providers as senior premiums rise and benefits are reduced.

Can your hospital maintain a positive operating margin if they're getting paid for their commercial insurance payments the same as the Medicare reimbursement payments?   With another 30 million uninsured getting health insurance at Medicare levels, hospitals will have to lower their costs to make up the difference with this increased volume.

Doctors will also feel the impact of recession.   General practitioners and specialists revenues have dropped dramatically.  This reform will be especially hard on specialists and sub-specialists.

Hospitals will pay specialists from their bundled Medicare payment.  Hospitals will hire more general practitioners and specialists to create some platform for better care coordination. When they look for employment by hospitals and large medical groups, doctors will look for safety in numbers, ease of practice, and more balanced lifestyles.

Hospitals and doctors will look to integrate into the Mayo clinic model that federal and healthcare plan guidelines will dictate. The payments will reward clinical and financial integration. Studies on bundled payments are now being done on cardiac and orthopedic procedures and will likely expand to other procedures.

THE MAYO STORY

Last year President Obama praised the Mayo Clinic as a great example of how a healthcare provider can get better outcomes at lower costs.  This month, Mayo Hospital made a decision to no longer accept Medicare and denies Medicare patients in one of its Arizona primary care clinics.   The hospital plans on dropping Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve over 500,000 seniors.

The reason is that Mayo hospital lost $840 million last year treating Medicare patients, because of Medicare’ low reimbursement rates. It's lost $120 million at its four Arizona clinics last year, and could no longer shift the costs by charging private patients even more for Mayo’s medical services.

Is this an indicator of where other hospitals and doctors are heading?

Physicians get paid 30% less for Medicare than they do from private insurers.  Many doctors are dropping out of the Medicare program.   In New York and Washington, patients are struggling to find a doctor who will accept Medicare in specialties like neurology, oncology, and gynecology, By Obama-care pushing for another $500 billion cut in Medicare, this trend will certainly not reverse. Twenty percent of hospitals today are becoming unprofitable because of the hospitals accepting cuts in Medicare payments.

Mayo's doctors are salaried and work in teams, known as ACO'S (accountable care organizations).  The hospital prefers to receive a bundled payment for an episode of illness, rather than Medicare's practice of reimbursing for individual procedures. The hospital can't make up its true costs on increased volume.

The ACO model, which the White House is advocating, converts health care providers into managed care providers, as failed in the 1990s. They say that this new managed care will work better this time, because the providers are reducing costs now because of the governments pressure instead of insurance company pressures.

This Mayo model still hides the cost of care from individuals, and there is no incentive to reduce utilization. Mayo hospital can save on cost easier, because they have a more affluent population than have most hospitals.

COMMENTARY

Medicare payments are preventing even Mayo clinics from being successful. It looks like all of healthcare must operate like Medicare, if this reform is to be successful.  A few hospitals will have opportunities but many will have catastrophes. A number of hospitals will close during the next five years. There will be consolidations by hospitals to combine resources.

Those hospitals that cannot survive will be acquired, closed, or converted to hospice or nursing homes. To survive the hospital will have to generate enough patient volume, 95% occupancy, and reduce their overhead.

 Unions will continue to aggressively unionize hospital health care workers. Hospitals will then be pushed into mandated staffing ratios of nurses and allied professionals. Unions and federal government will pressure for more advanced nursing training, programs and increased recruitment.

It'll be harder for hospitals to get money from banks.  Hospitals must  focus on essential projects, critical information technology, buy equipment that generates revenue and services, and cut down their care processes. They will need to develop pay for performance programs,

Hospitals will have to invest in an appropriate IT resources.   To ensure high quality, efficient standard of care service they will need to buy for their doctors’ offices and their hospitals, clinical information systems, as CBOE, and EMR.

Quality reports will be required if hospitals wish to get full payment for their services.  Those hospitals that have bundled payments, P4P (pay for payment), and value-based purchasing will be winners.

Readmission, hospital acquired infections, and other negative things, will result in denied payments.  The public will be posted transparently about the hospital's quality and patient safety data.

Patients will be given more choices of fewer hospitals, and will make their choices on value, network accessibility of doctors, and perceptions of quality.   Hospitals will be forced to market their brand identity and demonstrate some quantifiable indicators of their value.







Sources WSJ 1.08.10,
Governance Institute, briefing January 2010, (Valentine and Masters, Camden group)

INSURANCE BATTLES HEALTH REFORMS

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PLAN LOSES SUPPORT OF INSURANCE COMPANIES

Drug industry lobbyists agreed to contribute a total of $80 billion, but no more, over 10 years in reductions of their government payments. It was agreed to limit the industry's costs by excluding government price negotiations on drug prices. . The drug lobbyists also made sure a proposed Medicare commission could not force negotiations either.

Congress is going to prevent insurance companies from denying people coverage or charging different rates under pre-existing conditions. How do we handle people who are uninsurable?

States have experimented with high-risk pools and health status insurance. It gives people an incentive to postpone buying insurance till they need expensive care. You can only guarantee this kind of insurance if the government requires everyone to have mandatory insurance coverage.

Subsidies will be needed to help lower income people get the coverage they would be forced to buy. Many of us would be forced to buy expensive policies without any help from the government. Workers, who are offered coverage by their employers, will require the employer to offer it. You will not be eligible for any subsidies and would have to accept what they're given. (You know it would be a minimum package of benefits designed by Washington.)

The insurance industry forecasts that thousands of dollars that will be added to their cost of a typical insurance policy, when insurance companies would be banned from denying coverage on account of poor health. Many people will wait to sign up until they get sick, thus driving up insurance costs. (Karen Ignani, president of America's Health Insurance Plans)

PricewaterhouseCoopers, projected that this legislation will add $1700 a year to the cost of family insurance coverage in 2013. Payments for a single person would go up more than $600. A family plan would cost over $4000 and an individual plan would cost $1500.

Proposed government taxes on high-cost insurance, new taxes on insurers, and Medicare cuts, will have to be passed on to privately insured policyholders. Employers and individuals will be forced to switch to lower-cost plans to avoid taxation.

The Senate Finance bill in its current form replaces a public option with nonprofit “health care cooperatives. Instead of an employer mandate, the finance bill has a “free-rider” provision. That will make companies with over 50 employees who don’t offer insurance contribute to any public subsidies their workers qualify for. This Senate Finance plan includes tax credits to help small businesses afford insurance.

The small print of the released bill, limits compensation of key officers to $500,000. This has caused a change in the position of the insurance companies.

COMMENTARY

Obama has wagered huge political capital on the fight to pass health reform, and to offer affordable care to 46 million people in the United States who have no insurance. The Senate plan already has reduced the number of people covered to 26 million. A far cry from the Obama goal of 46 million.

Should the reform bill pass and include the president's campaign promises, Obama may still hang on to his political credibility and take credit for this historic domestic reform.

But, should the effort unexpectedly fail, despite Democratic majorities in both chambers of Congress, Obama could find his political leverage and capacity to enact other elements of his sweeping agenda severely hampered.

The Senate will try to blend the finance bill with the House’s more liberal version. The two chambers disagree on how to pay for this legislation.

The Senate prefers a tax on high-value insurance policies as its main revenue measure, and slapping a surcharge on millionaires. The House liberals want to penalize companies that don't provide coverage to their employees.

The original $1.2 trillion plan for expanding coverage has been squeezed into a $900 billion dollar box, by making subsidies less generous for co-payments, and increasing the deductibles for people buy insurance through the new exchanges.

These cuts in the cost of the plan were made available by the following:

$240 billion was cut from the bill by placing a separate piece of legislation which would require doctors who see Medicare patients to take a big cut this January. By taxing the wealthy, with incomes over $500,000, they expect to raise another $460 billion over the next decade.

The insurance industry has a great incentive to reduce the costs of these plans. It will allow them to reduce benefits, rather than raising their prices.
A major question is whether people will be able to afford the policies they would be required to buy under the finance committee's bill?

PLAN OF PRESIDENT

The president wants to fulfill one of his key campaign promises--providing health care to 47 million Americans (15% of our population). He hopes to cut health-care expenditures by 50%.

Once the major proposals are narrowed down into a single bill, you can expect President Obama to hit the campaign trail again and come back to the center of the public stage. As negotiator to drive the legislative process, he will use the persuasion tactics of Roosevelt and Lyndon Johnson.

There are very deep problems with the health care system, but the should not be made worse than the problem we are trying to solve. “Haste makes waste”.

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THE CAPP ABORTION AMENDMENT

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ABORTION, THE CAPP AMENDMENT

Representative Capp has proposed a an amendment radically different from the status quo. Today the federal government does not pay into health care plans that cover elective abortions. No government health plans cover elective abortions. This includes Medicaid, federal employees health benefits program, the State children's health insurance program and other programs.

Opponents of abortion, like the National Right to Life Committee, say the legislation would use tax dollars to subsidize insurance that would cover abortion.

Under a bill, approved by the House Energy and Commerce Committee, health plans, including the new government insurance plan, can choose to cover abortion. But they generally could not use federal money to pay for the procedure. Instead, would have to use money from the premiums paid by beneficiaries, through government subsidies.

Health care legislation counseling might encourage elderly people to end their lives sooner then they wish. As seniors grow increasingly ill or incapacitated, what extensive steps should we take to keep them alive?

Should seniors draw up advance directives, powers of attorney do not resuscitate orders, or other documents to express their wishes? Who should be authorized to make crucial decisions for them?

To reduce health care, government paid consultations would certainly encourage people to accept approaching death rather than have them receive costly medical procedures that could extend their lives. Such panels would promote euthanasia.

All five Senate committees, had voted down an explicit measure to prevent federal dollars from being used for elective abortions.

Nothing in federal law prohibits individual states from using their own tax dollars to pay for elective abortions, or pay into plans that do cover elective abortions. Currently 17 states pay for elective abortions.

Each year there was a provision added to all the spending bills that prohibits states from using the matching funds they get from the federal government for Medicaid to pay for abortions. That provision is called the Hyde amendment this means no dollar, that your state, associated with Medicaid may paid for elective abortions.

Federal law currently protects American taxpayers from paying for abortions as part of health benefits given to federal employees.

The Capps amendment if it becomes law, would make abortion coverage a part of the public option. Tax dollars would be funneled to private health plans that cover abortions and ensure every area of the country who have at least one health insurance plan to cover elective abortions. The federal government for the first time in 30 years would be in the business of funding abortions.

The amendment is supposed to make sure that federal dollars do not go directly for elective abortions. This is being bypassed because federal dollars would still subsidize insurance plans that pay for abortions.

The plan is being sold on the false premise that the status quo would be maintained. Americans would not go along with it otherwise.

EUTHANASIA: The House bill provides Medicare coverage for optional consultations with doctors who advise patients on life-sustaining treatment and “end-of-life services,” including hospice care.

The legislation instructs Medicare officials to propose ways to measure the quality of end-of-life care. Doctors would have financial incentives to report data on such care to the government. Currently, this has been removed from the Senate version.

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THE GREAT HEALTH DEBATE NEEDS COOLING

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THE GREAT HEALTH DEBATE

The White House has the best communications professionals and modern campaign consultants ever assembled. However they didn’t watch the details of Congressional health care policy-making.

The initial financial stimulus was only two pages long. The details came out as the plan progressed. Unfortunately, the reverse is true with this healthcare program. With all the details on the table, it will be very hard to please anyone.

TOWN HALL MEETINGS

Town hall meetings are set up by politicians to orchestrate their events as much as protesters do to disrupt them. It may not be right, but that is democracy.

Everyone has a right to go to a town hall meeting and express their views on issues that affects them. All of us should have the same right to talk, argue, or even shout about issues. It's too bad we are doing it in an unruly way.

THE GREAT DEBATE

There is a vicious debate over how to change health care in America. The debate is hurting Obama’s high approval rating as this debate drags on. The intensity is seeing in congressional town hall meetings throughout the country. This debate is quickly consuming the country. There are various interpretations of the proposed legislative plan, and there is certainly is much to debate: the cost to taxpayers, how private insurance companies will be affected, the cost to businesses, how seniors will be effecting etc.

A lot of the debate is not helping anyone on both sides of the arguments. There is some hysteria among opponents and some exaggerations among proponents. In America, people always question what the government proposes, rather than swallowing it blindly. That is democracy in action. All this shouting and viscious confrontations are not pretty, and better manners should exist. However silence would be much worse.

CONCERNS MAGNIFIED

Pres. Obama has yet to convince skeptics that reform will lower healthcare spending. There is also concern that people will not be able to keep their same health coverage. People worry about the government dictating the levels of minimum coverage, cost containment, end of life dictates, reduced Medicare coverage, and the government’s intent to create its own public plan that might remove people from private insurance coverage.

There is a fear that government will decide what level of treatment you may get at the end of life. Advanced care planning consultations are planned where doctors would talk to their elderly people about end-of-life care, living wills, and wishes for terminating care in some circumstances--this is not resonating well with seniors. There are numerous interpretations, some are extreme, and everyone is trying to educate everyone else.

CAN’T SIMPLIFY THE ISSUES

The real issues of health care coverage cannot be overly simplified and generalized. Yet both sides rely on bitter slogans and exaggeration to create shock value. It is not been a good debate, not even a serious one. Complex health care answers cannot be conveyed in a nine second commercial.

The healthcare issue is bigger than anyone ever thought. It has resulted in falling congressional personal polls and angry town hall meetings. This great recession has changed the mood of our nation. All of Congress seems to be shell- shocked. They had not really known how people feel about their health care.

IS THE PASSION AUTHENTIC?

The public is passionate and is scared. Both sides claim the passion isn't authentic, was set up by insurance companies, lobbyists, and especially the Republican national committee. Accusations are made that people are carrying swastikas, are two well dressed in jackets and ties, and must represent an organized planned protest engineered to hurt the president.

The Republicans, on the other hand, criticize the White House about creating a new White Hous e-mail address to encourage citizens to report any “fishy’ information they may see on an e-mail or anything on the web that looks suspicious and then send it to flag@Whitehouse.gov. This is an attempt to “fight intentionally misleading information” says the white house.

The Republicans accuse the White House of compiling an enemy list with this website, creating a dissident database. If this were so, why would the White House make it so public?

COMMENTARY

With a government health care plan so complex, confusing, and undercooked, can anyone really say what it will or will not allow, what it will or will not pay for? What is being sold, is not accepted by the public. No matter how good the communications may be now, bad policy must be changed.

It seems concerned citizens are being mocked, called stupid, extremists, right-wing, and can not see light, but in reality they are merely concerned citizens that deserve respect.

Americans question our government whose members take our tax money while taking bribes, shout for morality, and then get caught with their pants down, or lecture business people about private planes, and then turn around and order a bunch of them for themselves.

This health care plan should be argued on its merits. The bill submitted is over 1000 pages long, and many different bills are being submitted with the same length. What the final bill will be, is unknown.

Congress needs to act responsibly, deliberate, and with wisdom. Every day the town meetings seem to be a little angrier, and people are more afraid. With President Obama himself having three town meetings this week, the rhetoric may change.

Since, we have a peace initiative in the Middle East, why not have a peace initiative on health care reform? Perhaps the timing is wrong, and it should take a little longer for Americans, to have the health care details clairified.

As we face uncharted territory, with all the details of the plan on the table, it certainly will be hard to please anyone.

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KIDNEY DONOR BLACK MARKET

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KIDNEY DONOR BLACK MARKET TRADE

More than 80,000 Americans now wait for a kidney, thirteen die daily--the rest are on dialysis. The number of donors decreases each year.

A Brooklyn broker, Rosenbaum, conspired the sale of a human kidney for a transplant. The cost to the recipient was $160,000 and the donor got only $10,000. Rosenbaum brokered such sales many times over the past 10 years.

In the 1970s, pharmaceutical companies developed drugs that could prevent organ rejection. Kidney transplants became common about 13 years ago when the anti- rejection drug ,cyclosporine, became available. With a lack of medical regulation, the organ black-market developed.

The dramatic success rates of operations also fueled kidney transplant growth. Lack of regulations and loose medical ethics followed . Desperate people depend on dialysis machines and the demand for kidneys has not kept up with the demand. The poor sell their kidneys to pay for a daughter’s dowry, to build a small house, or feed their families.

THE PROBLEM

Every year, more than 1 million people worldwide develop end-stage kidney failure. Because of the long waiting list, patients who have enough money resort to other options. It may be unethical and immoral, but it exists.

Since one kidney is sufficient for a good quality of life, people are willing to trade the other one for cash. When there is a shortage of deceased kidney donors, and donations are restricted, and one desperately needs an organ, people are willing to buy organs.

Thanks to the Internet, anyone on the globe can sell one of his or her kidneys without any difficulties. Potential recipients might get lucky and find a transplant that matches. There are literally hundreds of offers to sell a kidney, like shopping on eBay. Donors are desperate, but the poor and vulnerable people suffer.

THE KIDNEY ORGAN TRADE

There are many trafficking networks in India, Turkey, Ukraine, China, and Israel. If you have approximately $70,000 you can travel abroad and get yourself a kidney in these countries.

Out of desperation young people in parts of Eastern Europe sell one of their kidneys for sums up $3000, while the recipients pay between 100,000 and US$200,000 for each transplant. The donor's health generally worsens due to absence of any medical follow-up, their hard physical work, and their unhealthy lifestyle, complicated by inadequate nutrition and high alcohol consumption. In time, most of these illegal donors may themselves need dialysis treatments.

WHO ARE THE DONORS?

90% of organs from China come from deceased prisoners. They sign agreements before execution. A leprosy colony near Madras, India, freely donated kidneys for money offered by agents. Prominent doctors removed the kidneys of nearly 1000 people in a leading city hospital. The donors were offered jobs: they were told blood was being removed, rather than kidneys. The kidneys went to patients from the Middle and Far East.

SOLUTIONS

The strategy to crack down on trafficking in organs and body parts is doomed, since it ignores the fact that efforts to stamp out the underground markets either drive corruption further underground, or causes it to erupt elsewhere. The critical shortage of organs for transplants can only disappear by giving legitimate incentives (like money) to people who might be willing to donate their organs.

IRAN MAY HAVE THE ANSWER

Iran has no waiting list for kidney transplants, since the practice of selling one's kidney for profit is legal and regulated. The government supports such programs. Organizations match donors to recipients, setting up tests to ensure compatibility. The donor gets approximately $6000 for kidney donation. There is a strict regulation of the allocation of organs only to local citizens (no foreigners allowed), restricting international trade.

LEGISLATIVE LOOPHOLES

Most countries still have legislative loopholes since criminal responsibility in organ trade is rarely established in international criminal codes. Congress will probably raise the penalties for underground organ sales, as in Mr. Rosenbuam’s case. Al Gore tried to push a voucher system or a tax credit to a donor's estate to improve voluntary donation. Democratic Senators aren't talking about governmental entities offering donor benefits but they are raising penalties for brokering. The proposed bill allows states to offer health and life insurance to living donors, or funeral benefits to families of posthumous donors. Donors could be offered a tax credit, or perhaps a very generous contribution to a charity of their choice (not to themselves). Organs would be distributed according to formulas already in place, and not be available just to the wealthy. The rewards would go to approved charities or state governments, but not to individuals. Congress might allow donors to accept third-party benefits for saving the life of a stranger. Otherwise, desperate patients and donors will continue to be reluctant co-conspirators in crime, as they seek organs.

COMMENTARY

The illegal organ trade is booming across the globe. It will only disappear when the critical shortage of organs for transplants disappears. If legal incentives, (like dollars), could be given to people who might be willing to donate, the shortage might disappear.

Most countries require living donors to be either family members, or organs removed from cadavers, usually accident victims. It is illegal and unethical to remove kidneys from live donor especially for money. Donating a kidney isn't particularly risky, and does not impair one's health. They are easily available. With any illegal kidney black market that caters to buyers around the world, many countries have benefited from the kidney trade.

Must a person who sells one of his kidneys, be treated as a felon? This has encouraged the black market with middlemen who can benefit, like Mr. Rosenbaum, from Brooklyn. We could lower the cost of medical dialysis treatment by finding a solution to kidney donations. But does the government really want a solution? You might live too long.

What do you think? Your comments are always appreciated. Visit www.drneedles.com for more commentaries on controversial medical subjects.

SOURCES Cherry MJ. Kidney for sale by owner: human organs, transplantation, and the market. Washington: Georgetown University Press; 2005./ Doctors banned from brokering transplants. China Post. 2006 Aug 17. /The Guardian. 2005 Feb 10. /McLaughlin A, What is a kidney worth? Christian Science Monitor. 2004 Jun 9 /Hogg C. Why not allow organ trading? BBC News. 2002 Aug 30