Friday, September 24, 2010


Exhibiting proper manners is usually a very good thing. Demonstrating professional behavior and decorum is, also, admirable. Attempting to avoid embarrassing your adversaries and maintaining civility in the public forum should usually be pursued. BUT, there are exceptions to these rules of behavior. If one is walking down a street at night and a thug jumps out of the dark and falls upon you, all bets are off and you must fight for your very life. That is exactly the position in which the BC School System finds itself on the issue of funding.

The facts are simple. For many years there was an agreement between BC Government and the BC School System as to the division of the Fee In Lieu of Tax funds. Now, Supervisor Dan Davis has decided he wants, and fully intends to take, a larger share of these funds to finance his agenda items. There is a myriad of smaller periphery issues connected to the main issue but this is the crux of the disagreement.

Monday, September 13, 2010


Hello Everyone,

Well, the initial firestorm about the Healthcare Bill has been extinguished. Now, the ashes must be cleared and a road forward constructed. In this debate, there was little, if any, substantive contributions from REAL practicing physicians as to the merits of this grand plan and how it would effect the day-to-day doctor/patient relationship that has been the bedrock of medical practice from ancient times (Hippocrates). These ten predictions are from me to help you understand where we will be once Mr. Obama leaves office in January 2017 (an eleventh prediction!!). These predictions are based on solid data and a 25 year practice experience.

1. Up to 200,000 physicians will quit or retire. The average age of the practicing physician in America is 49. Each one of these doctors will take four jobs with him. The New England Journal of Medicine (liberal as it comes in medicine) actually predicted 250,000 doctors leaving practice. Well, you do the numbers. I will be one of them.
2. The Federal government will continue to decrease reimbursement to physicians in the Medicare and Medicaid programs to unsustainable levels. Doctors will be forced to join the new National Physician Manpower Corps or face economic disaster. This will happen in primary care first and specialist physicians will follow.
3. Many states will be driven to the brink of bankruptcy as more and more individuals will now qualify for Medicaid. In South Carolina alone, the estimate is 480,000 more people on Medicaid. The state will be forced to make drastic cuts in education, transportation and other programs to support this. Taxes will soar here and elsewhere to support these programs. California is looking at 3.2 Million more residents on MEDI-CAL! Who would want to live there?
4. Hospitals across the USA will close because of unsustainable cuts in funding and increased lawsuits. The border states of Texas, New Mexico, Arizona, and California will be especially hard hit as more undocumented people from Latin America come to the USA for health benefits. More jobs lost.
5. Pharmaceutical companies will have massive layoffs. They have already started as they are forced to pay higher taxes and receive less for their products through government programs, especially Medicare. Drug R&D will essentially be non-existent in the USA due to lack of revenue and liability.
6. Healthcare rationing will be implemented in small steps. The first programs to be restricted will be dialysis, organ transplants, oncology care, and neonatal services. (KIDS DO NOT VOTE) Vaccines will be in chronic short supply, if available at all, as the reimbursement will not cover costs. Ultimately, the FEDS will take over almost all vaccination programs.
7. The additional taxes to support the massive expansion in Medicaid, pharmacy coverage in Medicare, and coverage of illegal persons in the USA will accelerate unemployment. A permanent unemployment rate of 12-14% here will be a reality.
8. Abortions and other progressive initiatives will be covered by the new plans.
9. The government currently covers 55% of all lives in the USA by Medicare, Medicaid, and the military programs. Once that number exceeds 85%, a single payer system will take it all just like England and France. Think of what that will really mean for you and your family who have been perhaps accustomed to on-demand medical care with excellence.
10. Finally, as 10,000 baby boomers go on Medicare daily starting in January 2011, the Federal deficit will explode and likely top $22 TRILLION by January 2017. And do not forget Social Security, pension bailouts, and the California bailout will be looming. OUCH!

I do not know one doctor who would turn a patient away. This is not part of our "culture". However, the current administration has a general distain for physicians and their generally conservative values. Despite what many in the progressive movement think, physicians are small businessmen who provide jobs, pay taxes, provide uncompensated care, and support their communities at many levels. The NEW doctor who is left will likely have all of the compassion of their predecessors, but in the final analysis, will expect the same entitlements generally provided to most Federal employees, i.e. time and a half over 40 hours, paid health, dental and disability insurance, six weeks paid vacation plus CME and, of course, retirement with COLA!! (cost of living adjustment) I am glad that I was able to practice medicine at a time when the doctor/patient relationship really had value. This will not be the case in a single-payor Federal system as the system design does not allow that type of special relationship. Please share with me your thoughts but please base any criticism on sound facts not emotion.

Bless you all,

Dr. Salvatore Moscatello
Elms Digestive/Endoscopy Center


Supervisor Davis planned and chaired a "Citizens' Meeting" on Daniel Island last Thursday night. According to Mr. Davis, in his opening remarks, he formulated this plan before the primary but waited until after the fact to put the plan into action, as he didn't want the plan to appear self serving. He stated that he realized a great number of voters are interested in the workings of County government and have many concerns and questions. He went on to say he understood that many of these folks couldn't make it to the Council meetings and he wanted to create a forum where people in each District could participate in the process. He noted that he planned to have one of these "open" meeting each month until he had included every Council District. The next meeting has been announced and is to be held in District 7.

Up to this point, everything was wine and roses. Then Mr. Davis inadvertently opened the flood gates by asking, "Does anyone have any concerns or questions?"

"What effort is being made by the County to work more closely with the School District concerning economic development and its impact on the School District?"

"What effort is being made to assure that the School District gets its fair share of the FILOT funds from the Mount Holly Park?"

"Why was the existing ordinance allotting the FILOT over-ridden?"

"Why is the County pursuing a "no bid" process for the purchase of heavy equipment?"

"Why is the County so reluctant to provide information to concerned individuals and groups concerning these issues?"

"Why does the County expect the School District to blindly enter into an agreement with the County on the Jedberg project without having the Mount Holly dispute settled?"

"Why are there no plans to install a bike/walking path from St. Thomas Island to Daniel Island so the school children can safely walk to school?"

GE&P could go blow by blow with the attempted answers to these questions but that would be redundant for regular attendees of the Council meetings. We will just hit the high points.

Mr. Davis assured everyone that the County has always worked very closely with the School District concerning the impact economic development has on the School District. But, when Mr. Davis called upon the District to confirm this fact, he didn't receive an affirmative answer.

Mr. Davis connected the School District's effort to secure the FILOT funds to the story of the Little Red Hen. He indicated that the School District hadn't really done anything to secure the funds so had no right to expect to receive them.

Two people in the audience pointed out that the Roads and Bridges spokesman was disingenuous when he said the County followed an open bid process for heavy equipment because of the specifications required for bidding. One equipment supplier stated the specifications published on several contracts excluded all bidders save one supplier.

One attendee was told that all requests for information from the County were answered in a timely manner. When this person pointed out that his request was made in May of 2010 and still remained unanswered, an administration spokesperson said the County had to research the request back 20 years because the County didn't want to give out incomplete or inaccurate information. When asked if he had been sent a letter to this effect by the County, the spokesperson said he had not.

The meeting was scheduled and advertised to last from 6-8 PM. At 7:05 PM, Mr. Davis announced that he thought all issues had been addressed so he would call the meeting to a close. He did so and beat a hasty retreat to the parking lot, leaving most of the attendees gathered in small groups to continue the dialog. Most of the crowd didn't disperse until the 8 o'clock hour.

A thoughtful person would have assessed this meeting as a rousing success. Everyone was polite and respectful. Issues were addressed. No one was refused the opportunity to speak. Judging from the questions and comments, it was obvious the attendees were well informed and had done their homework on the issues. It appeared the only ones displeased with the outcome were members of the County administration.

GE&P has never claimed to be clairvoyant BUT we have a prediction. "The citizens of Berkeley have seen the first and the last of the new 'Citizens' Meetings'."