Professional Documents
Culture Documents
M AY 2 0 1 5
Medicare at 50
CNIs Brain Academy
Dr. Housecall retires
Sombrero
Pima County Medical
Society Officers
President
Melissa Levine, MD
President-Elect
Steve Cohen, MD
Vice-President
Guruprasad Raju, MD
Secretary-Treasurer
Michael Dean, MD
Past-President
Timothy Marshall, MD
R. Screven Farmer, MD
Board of Mediation
Timothy Fagan, MD
Thomas Griffin, MD
Evan Kligman, MD
George Makol, MD
Mark Mecikalski, MD
Delegates to AMA
William J. Mangold, MD
Thomas H. Hicks, MD
Gary Figge, MD (alternate)
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Pima County Medical Society
5199 E. Farness Dr., Tucson, AZ 85712
Phone: (520) 795-7985
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Thomas Rothe, MD
immediate past-president
Michael F. Hamant, MD
secretary
Richard Dale, MD
Charles Krone, MD
Jane Orient, MD
Editor
Stuart Faxon
E-mail: tjjackal@comcast.net
Please do not submit PDFs as editorial copy.
Arizona Medical
Association Officers
Members at Large
Executive Director
Bill Fearneyhough
Phone: 795-7985
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Vol. 48 No. 5
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Madeline Friedman
ABR, CRS, GRI
Vice President
296-1956 888-296-1956
Inside
5 Dr. Melissa Levine: Medicare is only 50, so it
isnt qualified for Medicare yet.
On the Cover
update.
Clarification
George Ridge, formerly of the UofA Journalism Department, is
the man providing human perspective in this Dr. Hal Tretbar
photo from the Grand Canyons South Kaibab Trail circa 1980.
Travelin Tretbar was using Kodachrome Pro film that
captured the subtle colors well. See this months Behind the
Lens for more fabulous rediscovered images from Arizonas
northland.
Reminder
The May Sombrero ends our monthly publishing schedule until
October. Members and subscribers will receive bi-monthly
magazines for June-July and August-September.
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4
associated it with Bolshevism and communism and general antiAmericanismsimilar to the opponents of Medicare in the 60s
and the Affordable Care Act today.
In the 1920s healthcare costs began to rise. Middle-class people
were using hospitals, and actual medical costs became more of
an issue than lost wages. Some states made rumblings about
compulsory health insurance, but didnt get very far. Nineteen
twenty-six saw establishment of the Committee on the Cost
of Medical Care (CCMC), funded by eight philanthropic
organizations including the Rockefeller Foundation. They met
over a six-year period and produced 26 research volumes and
15 reports. The CCMC was a conglomerate of 50 that included
economists, physicians, public health specialists, and specialinterest groups. Essentially they determined that more medical
care was needed for everyone. For the most part they
recommended voluntary health insurance as a means to that
end. The AMA was no longer on board, and the editor of JAMA
called it an incitement to revolution.
Now, happy birthday, Dad! President Franklin Roosevelt
considered including national health insurance in the Social
Security Bill of 1935 but feared, quite reasonably, that it would
threaten the passage of Social Security Legislation. He did
establish the Tactical Committee on Medical Care in 1937, and
out of that came the Wagner bill, the National Health Act of 1939.
The Wagner bill gave general support for a national health
program funded by federal grants and administered by states and
localities. Does this sound a bit like Medicaid to anyone else?
Then the 1938 elections brought a wave of conservatism and Sen.
Wagner went nowhere until 1943.
Wagner-Murray-Dingell transformed Wagner from federal grants
to compulsory national health insurance funded by a payroll tax.
The bill generated a lot of debate, but obviously never passed. It
was re-introduced in every session of Congress for 14 years. On
Jan. 11, 1944, President Roosevelt called for an Economic Bill of
Rights that included, The right to adequate medical care and the
opportunity to achieve and enjoy good health.
President Harry S Truman (served 1945-1953) continued the
theme and then some. In a speech to Congress on Nov. 19, 1945
he called on legislators to implement a comprehensive insurance
for all people through Social Security, not just the needy.
Although he emphasized that it was not socialized medicine,
still a kill-phrase today, many conservatives saw it as just that.
Sen. Robert Taft (R-Ohio) declared that compulsory health
insurance and the Full Unemployment Act came right out of the
Soviet constitution.
Republicans took control of Congress in 1946 elections and
national health insurance faced hospice once again. Stay tuned
for Part II. I cant wait to see how this turns out!
SOURCES
Physicans for a National Health Program
CMS Oral History Project
AAFP News April 15, 2015
National Academy of Social Insurance
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Now youre
Thinkin Smart
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To the Editor:
ROC #278632
Excellence In:
Milestones
The future, I believe, is bright and on track for the board, and I
intend to do all I can to continue in that direction and goal of
making sure the public has access to the best healthcare
available, and that Arizona is a place the best physicians and
physician assistants would want to practice.
There can be no more than five members from any one county,
Dr. Figge said, and my appointment brings Pima County to the
maximum of five along with doctors Farmer, Gillard, and Berg, as
well as public member Jodi Bain, an attorney in Tucson. So
TINNITU
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five- year terms, with the twist that anyone
appointed to complete somebody elses fiveTINNITUS
year term can serve out that term and not
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terms, as happened with me. Thus, my
current appointed term is until 2019, as I
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Dr. Tyler J. Kents plaque speaks for itself, but he had a good
excuse for not being there April 14, as he was in Hawaii getting
married. Dr. Kent is a general and vascular surgeon, graduate
medical instructor, and director of outpatient clinics at St.
Elizabeths Health Center, Tucson. (Stuart Faxon photo).
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In Memoriam
By Stuart Faxon
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Rediscovery
By Hal Tretbar, M.D.
Arizonas world-famous
geography and topography
always offer discovery and
rediscovery for travelers, hikers,
tourists, and photographers.
We even have our own statepublished magazine for them
all: Arizona Highways.
Recently I received a package
from Ray Graap, M.D., the
longtime Tucson endocrinologist.
In it were three calendars from
1990, 91, and 92, published by
the Tucson branch of Physicians
for Social Responsibility. Ray
had enticed me to submit images for possible use.
Recently while cleaning out some shelves, Ray wrote, a longoverdue task which is usually put off by those of us further along
In 1969 I won first prize in a contest for the best image of Sedonas Bell Rock. A land developer sponsored it, so Im to blame for the
sprawl that is now across this once-pristine area. I also won the second month of the contest. That gave Dorothy and me a weekend in
Las Vegas!
SOMBRERO May 2015
11
Red Rock Crossing, southwest of Sedona on Oak Creek, is one of Arizonas prettiest places and most famous images. Late afternoon
light brings out the color of Cathedral Rock. This reflecting pool was washed out long ago.
Steven J.
Blatchford,
MD
A. J. Emami,
MD, FACS
James D.
Gordon,
MD
(520) 792-2170
Adam D. Ray,
MD
Green Valley
Sierra Vista
Marana
David T.
Miyama
MD
Ribbon Falls is on the North Kaibab Trail. It drops from an overhang and this view from behind shows the mossy ground below. I sat
there alone, enjoying the warm shower splashing on the soft moss.
Our first trip to Havasupai was in 1967 when it was still under jurisdiction of the National Park Service. This image of Havasu Falls
was taken on one of many subsequent visits. The deep travertine pools have been washed out by flash floods. Can you see the people in
the pool on the right?
SOMBRERO May 2015
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Neurology
By such methods we may even produce the next physiciangenerations neurologists, which is the aim of Carondelet
Neurological Institutes Brain Academy, an annual two-day
event for Southern Arizonas best and best-motivated high
school students.
Western Neurosurgerys 12 physicians staff CNI, based at
Carondelet St. Josephs Hospital and serving Southern Arizona
24-7 with neurology and neurosurgery. Many of Westerns
physicians are fellowship-trained in aspects of neurosurgery such
as Parkinsons, scoliosis, and vascular diseases of the brain.
As they brainstormed about what became
Brain Academy, several physicians at Western
agreed that it was very important to get
young people involved in the neurosciences,
said CNI Chairman Robert P. Goldfarb, M.D.,
F.A.C.S. Many high school students never have
an opportunity to have a one-to-one talk with
doctors, have lectures, and exposure to faculty.
This is a chance for them to see what the brain
surgeons and neurological specialists do.
In 2011 they started collecting the most
capable and interested students, CNI
Administrative Director Leah Shea said. We
targeted Tucson Unified School District science
and math students who showed special
aptitude. In the four years since, we now cover
TUSD, Sunnyside, Marana, Vail, Sahaurita,
Flowing Wells, Catalina Foothills, Salpointe, the
charter schools and the Christian academies.
This year we had 40 applications for 20 spots.
Qualified students must be a junior in high
school with at least a 3.0 GPA, write an essay
answering why they are interested, and have a
teacher recommendation, Shea said. The
selection committee reviews al the applicants
for the cream of the crop. We keep all district
sources considered, including transcripts and
course work. This year we have an
international student, from China.
In their essays students most often describe a
family members experience with Alzheimers,
movement disorders, Parkinsons, or stroke. It
could be a parent, grandparent, or other family
member. We want them to tell us what
interests them about science and medicine, or
their high school introduction to anatomy.
This years program takes place April 24-25,
when the May magazine youre reading was in
process of proofing and printing, so we cant
tell outcomes in this issue. But the students
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16
Makols Call
killed during the war. Leon Askin was also in a pre-war French
internment camp and his parents were killed at Treblinka. Caine,
who was also Jewish (his birth name was Cohen), was American,
and Jewish actors Harold Gould and Harold J. Stone played
German generals. Jon Cedar played a camp guard.
As a teenager, Werner Klemperer (Klink), son of famed symphonic
conductor Otto Klemperer, fled Hitlers Germany with his family
in 1933. During the shows production, he insisted that Hogan
always win over his Nazi captors, or else he would not take the
part of Klink. He defended his playing a Luftwaffe officer by
claiming, I am an actor. If I can play Richard III, I can play a Nazi.
Banner attempted to sum up the paradox of his role by saying,
Who can play Nazis better than us Jews? Klemperer, Banner,
Caine, Gould, and Askin played stereotypical World War II
Germans, and all had served in the U.S. Armed Forces during
World War II.
Wait, you might say, how can a totally unrealistic program about
a beneficent prison camp with an incompetent colonel in charge
possibly be of interest to a modern physician? It is because of my
friendship with a patient, a real Hogans hero, that went on for
more than 15 years before he told me of his war experience.
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Lets call him Mr. M, a native Austrian living there in 1935, and
being Jewish, he was obliged to flee the country and come to
America to avoid persecution. He happened to move to my
hometown of Springfield, Mass., where he opened a foreign
sports car dealership on Boston Road, near my house.
Although I was only about six years old, I can remember driving
by with my parents and seeing the fantastic rides like the
Austin Healeys, Jaguars, MGBs, and Alpha Romeo convertibles
parked out front. My eyes bugged out, but I never got to see the
owner, as my dad in those days only bought Cadillacs.
Fast-forward 25 years or so, and this gentleman moves to Tucson
to retire, is followed for his asthma by my senior associate, and
then becomes my patient when the older doctor retires.
Although this man is 30 years older than I, I discover hes from my
hometown, is a former race-car driver, and like most of our
seniors has a treasure trove of knowledge to impart. We become
fast friends and go out to lunch virtually every other month for
many years. In all honesty I think he learned more about me over
those years than I did about him, up until just about the last time
we went out to lunch.
It was then, after all that time knowing him, that he told me the
story about coming to America to escape the forming Nazi
regime, volunteering for the U.S. Army, and being sent back over
to fight for the freedom for his countrymen.
He did not just join the Army and get stationed at some outpost
behind the front lines, but landed on Omaha Beach on D-Day.
This beachhead was center of the Allies Normandy invasion, and
as Im sort of a history buff, I thought I knew a lot about this.
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Allergies
Nasal/sinusitis problems
Hearing & balance disorders
Hearing aids & tinnitus
Endocrine & salivary gland disease
Snoring and sleep apnea
Cosmetic/Aesthetic surgery
Jonathan Lara, DO
Thomas S. Kang, MD
not functioning properly; the seat was hot, and it is not even
summer yet!
The Hogans Heroes connection is that like Mr. M, Werner
Klemperer and his family fled Germany in 1935 for much the
same reasons. Klemperer too volunteered for service, joined the
Army, and was first stationed in Hawaii. Klemperer was also a
singer and violinist, an accomplished a musician like his father.
You may remember Col. Klinks awful violin playing, one of the
shows regular themes. Its work for a good violinist to play badly!
Now Mr. M, like many of the Greatest Generation, has passed on.
I cannot find anyone 30 years older than I am to go to lunch with;
in fact, I cannot find anybody 30 years older, period. My mother is
92, and even she is not 30 years older than I!
Maybe its best if I just start watching all the reruns of I Love Lucy.
Laughter is truly the best medicine.
Sombrero columnist George J. Makol, M.D., a PCMS member
since 1980, practices at Alvernon Allergy and Asthma, 2902 E.
Grant Rd.
19
Rerement
His colleagues must have felt the same way. He was named
PCMS Physician of the Year in 2003. In 2005 he received the
Rose Marie Malone Award for Service to Organized Medicine.
Last year Pima County Medical Foundation gave him its
Foundation Award for Exemplary Lifetime Achievement in
Furtherance of Medical Education.
Dr. Garcia appreciates the acknowledgment he has received from
his peers, but says the everyday interaction with his patients is
what he will miss most in retirement. I have had some patients
for almost 50 years, he said. I am not sure new patients want
to start with a doctor my age!
n
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21
CME
May
May 15-17: The Second Annual Southwest Laryngology
Conference: Focus on Dysphagia and Laryngeal HyperResponsiveness is at Mayo Clinic Talor Auditorium on the Mayo
Clinic Scottsdale campus, 13400 E. Shea Blvd., Scottsdale.
June
June 5: The Association of American Physicians and Surgeons
presents the 22nd Thrive, Not Just Survive Workshop at the
Embassy Suites, 201 Harrison Oaks Blvd., Cary, N.C. in the Raleigh
area. Workshop is 1-6 p.m., immediately followed by Politics and
Your Practice focusing on updates on physician-led initiatives in
Washington, D.C. And nationwide to protect patient-centered
medicine.
For $124-per-night room reservations, call 919.677.1840 and
mention AAPS or use the link at aapsonline.org/raleigh
Accreditation maximum 4.75 Category 1 credits by New Mexico
Medical Society through joint providership of Rehoboth McKinley
Christian Health Care Services and AAPS. Online signup and more
information is at www.aapsonline.org/raleigh
Members Classifieds
MEDICAL PRACTICE FOR SALE: Hector L. Garcia MD and Hector F Garcia
are selling their Internal Medicine practices located in Tucson and Douglas.
The offices are located at 1601 N. Tucson Boulevard, Suite 1A, Tucson, and
1116 G. Avenue, Suite 7, Douglas. Interested parties may call 298-7251
for details.
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