Author: cmh

Small thoughts – The 16 concerned scientists – who they are

Small thoughts – The 16 concerned scientists – who they are:

The WSJ apparently had an op-ed telling us “no worries” regarding climate change. And if there is anyone I trust to try to shine up horse manure on any subject to a gleaming sheen, it is the WSJ. The link above takes us to a review of who these concerned citizens are, but here is the gist of it:

If it’s an argument from authority these gentlemen want, it’s telling that “[d]espite seven months of intense effort to recruit physicists to sign a politically motivated petition disputing anthropogenic climate change, a mere, 0.45% of the American Physical Society‘s 47,000 members signed on.”

So 99 doctors tell you to quit smoking and get more exercise, but you listen to the one selling supplements instead.

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Address to the members of different Churches and Christian Communions, 14 September 1984

Address to the members of different Churches and Christian Communions, 14 September 1984:

“For instance, the needs of the poor must take priority over the desires of the rich; the rights of workers over the maximization of profits; the preservation of the environment over uncontrolled industrial expansion; production to meet social needs over production for military purposes.”

John Paul II, at an address given in Canada in 1984.

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‘How Many of You Expect to Die?’ – NYTimes.com

‘How Many of You Expect to Die?’ – NYTimes.com:

The third option, death following extended frailty and dementia, is everyone’s worst nightmare, an interminable and humiliating series of losses for the patient, and an exhausting and potentially bankrupting ordeal for the family. Approximately 40 percent of Americans, generally past age 85, follow this course, said Dr. Lynn, and the percentage will grow with improvements in prevention and treatment of cancer, heart disease and pulmonary disease.

These are the elderly who for years on end must depend on the care of loved ones, usually adult daughters, or the kindness of strangers, the aides who care for them at home or in nursing facilities. This was my mother’s fate, and she articulated it with mordant humor: The reward for living past age 85 and avoiding all the killer diseases, she said, is that you get to rot to death instead.

Those suffering from physical frailty, as she was, lose the ability to walk, to dress themselves or to move from bed to wheelchair without a Hoyer lift and the strong backs of aides earning so little that many qualify for food stamps. These patients, often referred to as the old-old, require diapers, spoon-feeding and frequent repositioning in bed to avoid bedsores. Those with dementia, most often Alzheimer’s disease, lose short-term memory, fail to recognize loved ones, get lost without constant supervision and eventually forget how to speak and swallow.

What all of these patients need, Dr. Lynn said, is custodial care, which can easily cost $100,000 a year and is not reimbursed by Medicare. The program was created in 1965 when hardly anyone lived this long.

“We’re doing this so badly because we’ve never been here before,” Dr. Lynn said. “But the care system we’ve got didn’t come down from the mountain. We made it up, and we can make it up better.”

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The Washington Monthly – Ten Miles Square – The Quiet Triumph of Obama Care

The Washington Monthly – Ten Miles Square – The Quiet Triumph of Obama Care:

We understand why President Obama trumpeted the killing of Osama bin Laden while barely mentioning health reform, his most significant domestic accomplishment in his State of the Union address last week. Ten years after 9/11, the killing of Bin Laden was an indisputable triumph for President Obama, welcomed by almost every American. In contrast, the Patient Protection and Affordable Care Act (ACA), enacted with only Democratic votes by the scarcest of margins in 2010, remains a complex, highly controversial piece of legislation with outcomes and costs that remain to be seen in the years ahead.

Yet surprising even to many advocates of health care reform, evidence is emerging that the ACA is already improving life for millions of average Americans. It is promoting long-overdue fundamental changes in our dysfunctional medical system. Moreover, because those reforms are starting to directly address heightened economic insecurities of average families – the personal financial conditions that will largely determine this year’s election outcomes – President Obama would be wise to more forcefully and more specifically explain how his health care bill is already helping millions of vulnerable families and the country as a whole. Sure, financially-pressured families will celebrate the derring-do of Seal Team Six. They should directly appreciate the immediate impact of improved insurance coverage and reduced medical costs.

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The Facts On Massachusetts Health Reform – Health Affairs Blog

The Facts On Massachusetts Health Reform – Health Affairs Blog:

Last Thursday’s Republican Presidential Debate in Florida included a lively, but not always accurate, exchange on health reform in Massachusetts. In particular, Senator Santorum reported that one in four Massachusetts residents were going without needed care because of high costs; he also implied that the share of residents choosing to pay the fine for failing to comply with the individual mandate, and the share of residents who were free riders on the system, were serious problems in the state. None of that is true.

My colleagues and I have been tracking health reform in Massachusetts since 2006, with a summary of our most recent findings published in Health Affairs last week. As we report, Massachusetts continues to show strong gains in insurance coverage, access to care, and self-reported health status under reform, all important goals of the state’s 2006 legislation. Currently residents of the Bay State enjoy the highest level of insurance coverage in the nation, with most of that coverage provided through their jobs, as it was before health reform. As Governor Romney noted, a majority of Massachusetts residents continue to support the state’s reform efforts.

Contrary to Senator Santorum’s claims, very few residents of the state are “free riders” on the health care system in Massachusetts, moving in and out of coverage as they need care

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General Surgery News – Spam in a Can

General Surgery News – Spam in a Can:

For those of you who have been spending your days operating and taking care of patients instead of keeping up with the latest machinations from central planning to separate you from the fruits of your labor and control of your practice, ACOs are bundles of providers who will receive a global payment for a specific patient encounter, like a cholecystectomy. Who will bill, receive and divide the money is uncertain, except that it won’t be you, the surgeon. The only thing certain is that like diagnosis-related groups, the sustainable growth rate, and relative value units, this latest iteration in health care spending discipline will be gamed and ultimately relegated to the alphabet graveyard of designer cost-containment programs invented by health policy wonks who have an aversion to traditional medicine based on the private doctor–patient relationship. I’ll say this much for them: They are undeterred by their unbroken string of failures. Maybe they’re Cubs fans.

An interesting read, if you want to really appreciate the “old school” approach of a lot of our colleagues (this was sent to me by one). My thoughts:

Some interesting phrasing choices in this piece.
“outside secular influence”
“the surgical workforce has been transformed by macroeconomic factors from the ownership class to the labor class.”
“Ownership and labor never agree on anything”
“Strip away the thin veneer of status, and the chief of surgery at Johns Hopkins and the junior surgeon at Kaiser both serve at the pleasure of a boss, punch a clock and take fire training and corporate compliance classes.”
“you had the common values, aspirations and headaches typical of small-business owners.”
“cookbook medicine” (Really? Who still thinks this way?)
Anyway, it all made me think of the Master-Slave morality dichotomy. Since Jesus was the epitome of the ‘slave’ side of this, I’m comfortable with my position, as is, I expect, is Dr. Russell.
And it also made me think of this great quote:

“A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it”

Max Planck

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Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries – The Commonwealth Fund

Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries – The Commonwealth Fund:

Key Findings

Public payer fees for an office visit ranged from $34 in Australia to $66 in the United Kingdom; private payer fees ranged from $34 in France to $133 in the United States.
U.S. primary care physicians were paid an average of 27 percent more by public payers for an office visit, and 70 percent more by private payers for an office visit, compared with the average amount paid in other countries.
Public program fees for hip replacements ranged from $652 in Canada to $1,634 in the U.S. In the U.S., private health insurance fees for hip replacements were nearly $4,000—twice as high as the private rates in the five other countries.
U.S. payers paid much higher fees to orthopedic physicians for hip replacements: public payers paid 70 percent more, while private payers paid 120 percent more.
U.S. primary care physicians earned an average $186,582, compared with a range of $92,844 (Australia) to $159,532 (U.K). U.S. orthopedic surgeons earned an average $442,450, compared with a range of $154,380 (France) to $324,138 (U.K.).

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Editor of journal critical of welfare still has DPW job – Philly.com

Editor of journal critical of welfare still has DPW job – Philly.com:

INQUIRER HARRISBURG BUREAU HARRISBURG – A controversial adviser to Welfare Secretary Gary Alexander is still working for the state and will do so for an indefinite period, despite last week’s announcement that he had resigned.

Last week, officials said Robert W. Patterson, a special assistant to Alexander, had quit his $104,470 position as The Inquirer was preparing to publish a story about his outside role as editor of a conservative, faith-based journal.

In announcing Patterson’s exit, the Corbett administration distanced itself from views expressed in the journal, which has criticized key welfare programs administered by the Department of Public Welfare and offered opinions that women should be stay-at-home mothers and opposing birth control – as well as musings on how condom use could rob women of reported mood-enhancing benefits of chemicals in semen.

If you haven’t read Thomas Frank’s “The Wrecking Crew,” this could be straight out of it. Hire someone who detests a government agency and especially its constituency, and put them in positions of power within that organization to make it weak and ineffectual, then decry it for being weak and ineffectual.

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Gingrich and Reagan – National Review Online

Gingrich and Reagan – National Review Online:

Off topic, but too fun to skip…

The best examples come from a famous floor statement Gingrich made on March 21, 1986. This was right in the middle of the fight over funding for the Nicaraguan contras; the money had been cut off by Congress in 1985, though Reagan got $100 million for this cause in 1986. Here is Gingrich: “Measured against the scale and momentum of the Soviet empire’s challenge, the Reagan administration has failed, is failing, and without a dramatic change in strategy will continue to fail. . . . President Reagan is clearly failing.” Why? This was due partly to “his administration’s weak policies, which are inadequate and will ultimately fail”; partly to CIA, State, and Defense, which “have no strategies to defeat the empire.” But of course “the burden of this failure frankly must be placed first on President Reagan.” Our efforts against the Communists in the Third World were “pathetically incompetent,” so those anti-Communist members of Congress who questioned the $100 million Reagan sought for the Nicaraguan “contra” rebels “are fundamentally right.” Such was Gingrich’s faith in President Reagan that in 1985, he called Reagan’s meeting with Soviet leader Mikhail Gorbachev “the most dangerous summit for the West since Adolf Hitler met with Neville Chamberlain in 1938 in Munich.”

Gingrich scorned Reagan’s speeches, which moved a party and then a nation, because “the president of the United States cannot discipline himself to use the correct language.” In Afghanistan, Reagan’s policy was marked by “impotence [and] incompetence.” Thus Gingrich concluded as he surveyed five years of Reagan in power that “we have been losing the struggle with the Soviet empire.” Reagan did not know what he was doing, and “it is precisely at the vision and strategy levels that the Soviet empire today is superior to the free world.”

There are two things to be said about these remarks. The first is that as a visionary, Gingrich does not have a very impressive record. The Soviet Union was beginning to collapse, just as Reagan had believed it must. The expansion of its empire had been thwarted. The policies Gingrich thought so weak and indeed “pathetic” worked, and Ronald Reagan turned out to be a far better student of history and politics than Gingrich.

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Front Group King Rick Berman Gets Blasted by his Son, David Berman | Center for Media and Democracy

Front Group King Rick Berman Gets Blasted by his Son, David Berman | Center for Media and Democracy:

Rick Berman’s son, David Berman, is a 42-year-old singer-songwriter who, since 1989, has been the front singer for a popular New York City indie rock band called the “Silver Jews.” Over the years, the Jews have developed a loyal following, but on January 22, 2009 David Berman stunned his fans by posting a note to an online message board announcing that after all these years he was leaving the Silver Jews. The reason? His father, Rick Berman.

In scathing language, David disclosed to his fans who his father is, and how leaving the band related to his father’s work. David wrote,

…follow the link. Amazing stuff!

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