My friend and neighbor died last week.  In his early eighties, wiry, opinionated, well-read, he never tolerated schooling. He built an excavating business with a perfected aesthetic for contouring soil and also built a few homes in town including mine.  When he saw the architect’s lower pitched roof framed on the garage, he had it torn off because: “It just wasn’t right. It looks like a tiny bowler hat on ...

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Making a diagnosis is one of my most common challenges. Families and patients are understandably more interested in the therapy to alleviate illness and suffering than exact diagnosis. We are swept along with this laudable therapeutic objective in the current of prompt empiric therapy bringing relief and hopefully confirming an empiric diagnosis and buying time before more definitive testing. I object to this approach even as I engage in it. Necessary ...

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When the political process is not working, one option is to examine the shared values of most Americans. Values are learned, clarified and even negotiated. They are the algebraic axioms from which the formulas of public policy are derived. Examples include: Society should care for the sick, written into the EMTALA law that prohibits turning patients away from emergency rooms. Free enterprise is the engine of material prosperity. The government must correct the dangers ...

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I can envision a comprehensive design for health care in the United States that will expand access and control costs while conforming to our shared national values of personal responsibility, care for thy neighbor and free enterprise. After dozens of attempts to repeal, defund, delay or restrict Obamacare, the Republicans now have the opportunity to do all of the above. The problem is that it is not clear what should be ...

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