My Time in Pensacola with the DFC Society

By

Larry N. Smith, M.D.

            In 2004, when I started writing my book Darwin’s War, about the 416^th Bomb Group’s experiences in World War II, I never imagined where the process would take me. Following its publication, I have been given the honor to speak to many groups over the last year about the book and the important missions that the 416^th BG flew to help win the war. Without reservation, though, the most meaningful and memorable event was my time in Pensacola, Florida, where I had the distinct honor of addressing the decorated members of the Distinguished Flying Cross Society.

            Having always been a devotee of WW II aircraft, I enjoyed the tours of the restoration facilities and the Naval Air Station Museum. Even though I am the progeny of a US Air Force officer, I find all aircraft from the WW II period historically interesting. The sight and sound of a radial engine on a P-47, a Navy Wild Cat or a B-25 Mitchell are all equally exhilarating. I must admit, though, that I have a weakness for A-20 Havocs and A-26 Invaders, because these were the aircraft that the 416^th BG flew for the US Army Air Corps during the war. It was unlikely that I would ever see these aircraft at a Naval Air Museum. Even so, because of having written my book Darwin’s War, I have a much deeper appreciation for the men who have flown aircraft of all types into battle. From the old biplanes to the modern-day weapons of aerial warfare, I have come to realize it is through memorializing the aircraft and the battles that we honor the men — and now women — who have flown them into harm’s way. This appreciation for all aviators was ratified by watching the Blue Angels perform their precision aerial display that chilly morning during the Pensacola reunion.

Prior to attending the reunion, at the request of Michael O’Neil, I had researched my father’s discharge papers and award record and learned that he had been awarded the DFC during WW-II in France, for valor under fire. This message of duty, honor, country, valor and sacrifice was symbolized to me with the posthumous recognition and induction of my father into the DFC Society. It was with great humility and pride that I accepted his membership into your society. I was equally humbled by being award an honorary lifetime membership in the society because of my father’s commitment to our country. As I stated then, I did not have the time to meet all of you personally, but I feel that I am now  part of the team as an honorary member of your elite group. I can only imagine, but never truly appreciate, the battlefield circumstances from World War II through Korea, Vietnam and now the desert wars of Iraq and Afghanistan under which the members of the DFC Society earned their recognition. Nevertheless, I can say, “Thank you.”

It was with this profound humility that I then addressed the membership and discussed the central theme of my book and reviewed the important missions that the 416^th BG flew during their time of service in the European Theater of Operations during WW II. Although only a small part of the overall war, their efforts and sacrifices helped bring the war to its successful conclusion. Without this global victory, life as we know it today would be profoundly different.  I would be negligent if I did not take time to thank those of you who have chosen to buy my book Darwin’s War. It was recently recognized with two finalist awards in the 2009 New Generation Indie Book Awards for History/Historical Non-fiction and Best Cover Design. Again, the two awards are an honor for a first-time author and are recognition and validation for the time spent writing and honoring the veterans of the Ninth Air Force’s 416^th Bomb Group. I must admit, though, that my greatest rewards have come in the form of letters, e-mails and phone calls from the remaining 416^th veterans or their family members, who have ranged from wives to great-grandchildren. Their comments of appreciation for the accurate representations of all the members of the group — from ground crew to pilots — has been recognition enough for a job well done. Any accolade beyond this is icing on the cake, but the awards help me appreciate that I have appropriately honored the men of the 416^th and those who made the ultimate sacrifice.

I am looking forward to the October 2010 Riverside reunion. The dedication ceremony of the Memorial and Flyers Wall is a noble and appropriate recognition for those who have risked it all. Let me close by saying thank you for having made my father and me a member of your society. I hope that I have conveyed to you all the sincere humility and honor with which I look upon this recognition. I hope the society continues to grow as new recipients of the Distinguished Flying Cross are inducted, and I am proud to be part of it.

Reproduced with Permission of the Distinguished Flying Cross Society

Reprinted from Friday August 28, 2009 Washington Times Op-Ed Page 

Private Alternatives:

Tax System can Foster Real Change

Coverage, Cost and Control: Rational Healthcare Reform and Understanding

By

Larry N. Smith, M.D. and Stephen T. Parente, Ph.D.

            As the healthcare reform debate heats up, the true costs and the complexity of the issue are finally coming to the surface. Sticker shock has moderated many proponents of reform, but for many the attitude nevertheless seems to be “damn the tax increases, full speed ahead into some reform.” It is important to keep in mind, though, that the costs of reform will come in more than money. In the push to nationalize healthcare, it will be liberty that is truly the sacrificial lamb, as pointed out at the June 17, 2009 CATO Institute Healthcare Reform Symposia. The reality is that the current healthcare system can expand coverage, lower costs and allow for the patient and the doctor to maintain the constitutional freedoms that we all enjoy, without changing the coverage of the 85 percent of Americans who now have healthcare access.

            Expanding coverage to the 47 million uninsured Americans can be accomplished through simple accounting and tax code changes. These changes would allow doctors to deduct the uncompensated healthcare they provide from their year-end taxable earnings. Physicians are already providing uncompensated coverage all across America, and in Florida, doctors and hospitals provide free care through the We Care Program, specifically for the uninsured. The doctor would deduct the dollar amount of care that is representative for that level and quantity of service, based on the dominant regional payer’s reimbursement for such care. In effect, this change elevates the uninsured patient to a fully insured status, and costs the IRS a small incremental decrease in tax revenue. Plus, the physician and hospitals are rewarded for providing a valuable aggregate social service and these 47 million get comprehensive care. Of course, physicians are mandated by law to provide care through the hospital emergency room already, but generally they do not collect for these services, although they’re still a target of litigation for such services. This simple change in code would mitigate these issues, and it would also help patients who, because of illness, lose their jobs and are in fear of bankruptcy. By allowing the healthcare provider to deduct the ongoing uncompensated costs, the patient’s care is not interrupted and physicians can continue to meet their moral obligations, which the vast majority already do without compensation.  

While the fundamental healthcare model is workable, that does not mean that it does not have room to improve, especially on the cost side of the equation. One issue is the geographic difference in costs for the same risk-adjusted medical condition without better outcomes, as noted in a Dartmouth study. This problem must be addressed and mitigated. With the tax changes noted above, costs can be mitigated since disproportionate share payments to hospitals could be decreased, because the hospitals would receive tax benefits for providing uncompensated care. This change would save the states tax revenue, which can be used elsewhere. Moreover, the hidden cost of the uninsured is eliminated, as there is no need to pass on these costs in the form of higher fees for everyone else. Costs can also be controlled by the government supporting, but not designing, local, regional and national practice guidelines. Once adopted by specialty societies and followed by physicians, these guidelines would insulate the physician from frivolous litigation but also control for regional cost differences. As these care-standards come online, cost comparisons can be undertaken to determine the true balance between quality and cost effectiveness, with the understanding that the cheapest treatment may not always be the best. Third, local healthcare systems need to be allowed to coordinate care into integrated systems free of Federal anti-trust laws, which currently prevent the open exchange of charges and practice data. The patient is the ultimate beneficiary of such changes, since transparency for costs and outcomes can be made available through integrated community networks. Some doctors may stay in private practice, while others may choose to merge into single or multi-specialist groups, but the goal would be for them to be linked electronically with systems designed and integrated by healthcare providers. With these changes, Regina Herzlinger’s and Alain Enthoven’s visions of patient-directed healthcare within a system that is integrated, transparent and conscious of the quality-to-cost balance would be achieved. There may be from one to twenty such competing systems within a community, but quality and price competition will drive the market. Rural physicians and hospitals may receive incentives to participate in several networks, depending upon their areas of proven excellence. In the end, the patient benefits. This is not to say that government assistance would not be needed, but it should be temporary, focused and supportive.

            Much is made of the cost of American healthcare, which represents 17 percent of the GDP. However, no one discusses the fact that medicine only produces healthy workers who are returned to the workforce – a valuable service to the economy but difficult to assign an economic value to. A healthy worker who contributes to the GDP has an innate economic value. Similarly, the economic value that medicine contributes to the GDP by supporting General Electric, Johnson and Johnson, Eli Lilly and those in other healthcare-related industries is not calculated. These two values should be subtracted from this 17 percent of GDP to account for the positive impact that medicine has. As an end-stage consumer and provider of healthcare, medicine‘s contribution to the economy is often overlooked since it produces nothing to sell.

Within these changes, healthcare could be maintained within a market based system among patients, doctors, hospitals and private insurers. If the government is allowed to provide a public healthcare option, then the option will become the dominant single-payer insurance product, as so clearly outlined by David Hyman. Such a move could denigrate the personal choices Americans currently have, while running all other insurance companies out of business. Costs would be controlled by lowering reimbursements to providers by using the Medicare fee schedule – plus 5% to 10% – as an index for payment. One need only study the national healthcare systems around the world to know that a public option could mean long lines, limited access to technology and lower-quality care. Between 1946 and 1952 doctors working with the AMA, American College of Surgeons, and Blue Cross and Blue Shield increased the number of insured from 22 percent to 55 percent. The free market can do it better and should. As noted by our Founding Father Benjamin Franklin, “Those willing to sacrifice liberties for security deserve neither.” Similarly, anyone willing to sacrifice liberties for healthcare will have neither.   

Dr. Larry N. Smith is a fellow of the American College of Surgeons and an adjunct professor at Santa Fe College in Gainesville, Fla. Stephen T. Parente is an associate finance professor at the University of Minnesota, Minneapolis, and director of the university’s Medical Industry Leadership Institute.