Author/contributor:  Marilyn M. Singleton, M.D., J.D.  http://www.aapsonline.org/

Black history in American has certainly had its ups and downs. It's troubling when, for political theater, those who should know better fail to emphasize the inspirational stories that highlight the strengths of blacks and the humanity of whites. While it is undeniable that cruelty and suffering are part of this country's history, at some point it is counterproductive to paint blacks as weak victims of the white man's callousness.

There were always free blacks in America (including my family). Indeed, in 1641, Mathias De Sousa, an African indentured servant who came from England with Lord Baltimore, was elected to Maryland's General Assembly. The first census of 1790 counted 19 per cent black Americans, 10 per cent of whom were free.

Black Americans served on both sides during the Revolutionary War. The British promised freedom to slaves belonging to Patriot masters who served. Because of his manpower shortages, George Washington lifted the ban on black enlistment in the Continental Army in January 1776, creating his so-called "mixed multitude," which was 15 per cent black. Economist Walter Williams is so correct that necessity can overcome prejudice.

Nestled in the back of some folks' minds was (is?) the notion that blacks were not as intelligent as whites. They certainly couldn't have had the smarts to be doctors. James Derham (c. 1757-1802?), born a slave in Philadelphia, proved the naysayers wrong. He was the first known black American physician, although not professionally trained in medical school. As was common at the time, physicians were trained in apprenticeships. Young Derham was fortunate that his three early masters were physicians who taught him to read and write.

Derham's third owner taught the young teen how to mix and administer medicines. After this owner, who had been arrested during the war for being a Tory, died in prison, Derham was sold to a British officer, and he served as a doctor to soldiers. After the war, he became the property of a Scottish physician (appropriately named Dr. Love) from New Orleans, who hired him to work as a medical assistant and apothecary.

By 1783, Derham quickly saved enough money to buy his freedom, and he set up his own medical practice in New Orleans. Derham, who spoke English, French, and Spanish, was a popular and highly regarded doctor, who treated both black and white patients. By age 30, Derham earned more than $3,000 annually.

Derham's medical paper on his success in treating diphtheria caught the attention of Benjamin Rush, a physician who signed the Declaration of Independence, served as surgeon general of the Continental Army, and has been called "the father of American medicine." Rush invited Derham to Philadelphia in 1788 and was so impressed that he encouraged him to stay. There, Derham became an expert in throat diseases and in the relationship between weather and disease.

In 1789, Derham returned to New Orleans, where he saved many yellow fever victims. He stopped practicing medicine in 1801, when the new city regulations required a formal medical degree to be considered a doctor. Nothing is known of his whereabouts after 1802.

The first university-trained black American physician was James McCune Smith, born in 1813 to slave parents who were emancipated by New York law. Despite his scholastic achievements at the Free African School of New York, he was denied admission to American medical schools. When he was 19 years old, the Glasgow Emancipation Society helped Smith enroll in Scotland's University of Glasgow. He received his B.A. degree in 1835 and his M.D. degree in 1837. A skilled debater and lecturer, Smith was a founding member of the New York Statistics Society in 1852, and was elected as an early member of the American Geographic Society.

The first American medical degree was conferred on David J. Peck, born circa 1826 into a free black family in Pittsburgh, Pa. In 1846, after studying two years with a private physician, he enrolled in Rush Medical College and graduated in 1847. Peck practiced medicine in Philadelphia for 2 years before moving to Central America to start a homeland for free blacks in Nicaragua.

Thank you, doctors, for paving the way for my grandfather, my father, and me.

http://www.aapsonline.org/

Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and Association of American Physicians and Surgeons (AAPS) member. Despite being told, "they don't take Negroes at Stanford", she graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard's Beth Israel Hospital. She was an instructor, then Assistant Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital in Baltimore, Maryland before returning to California for private practice. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers. Dr. Singleton recently returned from El Salvador where she conducted make-shift medical clinics in two rural villages. Her latest presentation to physicians was at the AAPS annual meeting about challenging the political elite.

Additional op-ed  by Dr. Singleton: ObamaCare and the Twilight Zone: To Serve Man  http://www.aapsonline.org/index.php/site/article/medicine_and_the_twilight_zone_2013_to_serve_man/

AAPS Lawsuit Covered on national TV News with Rand Paul on Andrew Napolitano: http://www.aapsonline.org/index.php/video/2

It's doubtful that the country will be popping bottles of champagne on January 1, 2013?we can't afford it. But we will be throwing confetti printed by the Federal Reserve over a cliff.

As of November 27, 2012, the country's debt was $16.279 trillion?just $115 billion below the $16.394 trillion statutory ceiling. The Treasury predicts that borrowing will reach the current limit near the end of December 2012. Right around the Mayan calendar "end date" of 12-21-12.

Apocalyptic prophecies aside, there are a number of things that are scheduled to expire at the end of 2012. One is the Medicare "Doc Fix," which postponed until Dec 31 the day that the rates at which Medicare pays physicians will decrease by 27 percent. Another is the "Bush tax cuts." On January 1, all income tax, estate, and capital gains tax rates will go up substantially, and millions more people will be subject to the Alternative Minimum Tax.

Then there are new taxes, compliments of the Patient Protection and Affordable Care Act (PPACA or ObamaCare), some of which take effect in 2013. These include the Medicare surtax on so-called millionaires and billionaires, i.e., individuals making more than $200,000 a year ($250,000 if married), and a new 3.8% tax on capital gains and dividends, interest, and other passive income. The now infamous penalty-that-is-really-a-tax kicks in for those who don't buy government-approved health insurance in 2014. Another revenue-raising measure is a cap of $2,500 on previously unlimited Flexible Spending Accounts. This discourages Americans from taking personal responsibility for medical spending instead of relying on third-party payments.

And January 2 could ring in sequestration, that is, automatic budget cuts. The Budget Control Act of 2011 (BCA) authorized the President to increase the debt ceiling by $2.1 trillion in exchange for some $917 billion in cuts, from 2012 to 2021, in "discretionary"?that is, nonentitlement?programs such as defense, education, national parks, the FBI, the EPA, low-income housing assistance, medical research, and many others. Unless Congress and the President agree to modify or repeal the BCA, spending reductions of some $109 billion per year with half coming from defense budget and half from nondefense are triggered. Sequestration for Medicare payments to health care providers and health plans is limited to 2%.

The President does not want cuts to his signature law, the inappropriately named Patient Protection and Affordable Care Act (PPACA). It is, however, a financial disaster. The Congressional Budget Office (CBO) has projected a cost of $1.4 trillion over 10 years, but if we look at history, such projections are meaningless. In 1967, the House Ways and Means Committee said Medicare would only cost $12 billion in 1990. The actual cost was $110 billion. In 2010, total Medicare expenditures were $523 billion. Medicare spending has been forecasted by the CBO to increase to $922 billion in 2020.

Just the IRS and HHS costs to implement the PPACA, $20 billion over 10 years, exceed the House's initial estimate for all Medicare spending. And how can we afford a vast new entitlement when the CBO admits in an Oct 1 report, CRS Report R41390, that "even maintaining current funding levels for existing programs with an established appropriations history may prove a challenge under growing pressure to reduce federal discretionary spending."

In the PPACA, there are about 100 new programs with noble-sounding names or goals: for example, the program to facilitate shared decision making, culture change (to patient-centered care), the Elder Justice Coordinating Council, the Offices of Minority Health, and the Offices on Women's Health. But none have been evaluated for effectiveness before we start pouring money into them. Under the circumstances, I think we should add more funds to the newly minted Centers of Excellence for Depression.

Fortunately, the PPACA's discretionary provisions are subject to the congressional appropriations process, which can potentially defund a program. Additionally, appropriations are needed for administrative costs associated with even exempt programs. Thus, Congress has the power to back off from the PPACA contribution to the cliff, if it has the will to do so.

The cliff, however, is not going away. Cliff diving, anyone?

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http://www.aapsonline.org/