24 September 2009

The Hindenburg in Spray Paint

Tuesday’s Times-West Virginian had a raging above-the-fold story on the community’s outraged and righteous reaction to some racial graffiti spray painted on a street and parked cars. The guy who wrote the story is a very handy wordsmith who called the event “a clarion call to City Hall for action.” And even though city workers went out and cleaned up the vandalism, the reporter went on, “the ugly words’ lingering echo remains.” (The guy writes well.)

A number of community leaders, all of whom I respect, were quoted concerning the seriousness of the event and the need to take action. One individual strongly recommended “sensitivity training,” although I’m not sure who is supposed to get it, how we procure their attendance or how the message is supposed to get through to them.

Every city official who could scratch their way to a camera or a reporter’s notebook expressed his or her shock and dismay, treating the whole thing like the Hindenburg disaster, "Oh, the humanity!"

And in the meantime, some kids or young ne’er-do-well morons are sitting around drinking, smoking and laughing themselves silly over the attention their spray painting has gotten.

People: These are WORDS. When will we as a society move on? What will the milestones be?

Well, how about when we respond to graffiti by cleaning it up, painting it over and treating it as any other property crime. And when the miscreants have been to court, hey, as part of their sentence, now we have the cleaning crew ready to go for the next clean-up job that needs to be done.

Another milestone will be when we stop yakking about unity, unity, unity and start acting like we believe in it. Unity for America means a common language (that would be English), a common flag, a common nationality (American, not Irish-American, Italian-American, African-American, Asian-American, Martian-American, or any other hyphenated American) and a common purpose - Do what helps our families and neighbors.

A milestone will be when the Klan joins the Flat Earth Society in our level of respect. Another will be when criminal things done against people maliciously which cause harm will be treated as “hate crimes” because they are criminal things done against PEOPLE maliciously which cause harm. If someone has an irrational hatred based on an irrational classification, we can’t lobotomize them. But if they DO something criminal, we’ve had a legal system for the last 1000 years to deal with them.

A milestone will be when we don’t whine about what doesn’t harm us and don’t hunt for ways to be victims. If school administrators call for a prayer at some school breakfast, after breakfast someone will whisper in their ear, hey, dummy, don’t do that, rather than drag them to federal court and attempt to jail them. A milestone will be when we realize that we CAN have prayer in school. You want to pray, pray. Don’t make anybody else pray with you, but this is America, you’re free to follow God. We’d expect City Council to focus on 150 miles of leaky water lines that need replaced, and not get in a lather about things they can’t fix. A milestone will be when we cut through the crap and teach children that results count, and that we and they will not have a just society without it being a productive society and that requires responsible and productive people.

And a milestone will be that we think and reason. Words, how will be look at words?

Let me personalize this. I asked a couple of friends to insult me today, to really let it all out. With their suggestions, I synthesize that someone now writes about me, “Roger is a fat, ignorant, pompous moron, and how he ever expects to read all the books he buys is a fantasy!”

Well, that’s colorful. (Oh, I left out the REALLY colorful stuff as being unfit for general public consumption.) These are WORDS. If those words are true, they may be unpleasant, but facts are stubborn. If they are false, they are still WORDS, and if they do not cause tangible harm, they are nothing – wounded feelings don’t count. And if they are arguable, that’s the First Amendment at work. Some (newspapers, for example) have much bigger hammers with which to use words, and in our nation that’s controlled only loosely by libel laws in order to encourage free speech. So, let’s think: Is the insult to me true?

Fat - Got it in one. Facts are stubborn.

Ignorant - That’s mostly untrue, although there are some areas (e.g., popular culture, conventional etiquette) where my ignorance is breathtakingly broad. If you disagree with me (and many, many do), it’s usually because I just look at things differently. And if you’re thoughtful, I love talking about our differences.

Pompous - Not in the sense of driving a Mercedes or wearing a Brooks Brothers suit, but I speak up at inappropriate times, so this one isn’t unfair, so I guess I have to cop to this one, too.

Moron - That’ s meant in the pure epithet sense, so it’s a “sticks & stones” thing. Do I like it? No. “Sticks & stones,” it’s nothing in the real world. Being insulted isn’t pleasant, is it. But it’s still WORDS.

Books - Them's fightin' words - I'm gonna read them all if I die trying, which I probably will.

The WORD used by vandals - nigger - is an epithet. It is a word. The person/concept/thing/object it describes does not exist. It is an insult. Do we really want to honor the guys who toss that around, who deface public spaces and who cheapen public discourse by taking their idiocy seriously? Is a knucklehead with a can of spray paint stronger than our power of self-control?

Pippa passes.

R

21 September 2009

Welcome to our buffet: Tonight we have Ignorant or Prurient, Take Your Pick

The stories are West Virginia, but their analogs are everywhere.

A week ago in Taylor County (just to the south of us), there was an MVA (motor vehicle accident), a head-on, on Route 50. A car containing 4 high school students caught fire and burned, and while those passengers were all flown to a trauma center, they all died. Grafton High School and all of Grafton are having genuine difficulties coming to grips with this, especially since it is a small town in a small county (<20,000). Everyone who responded to this emergency - the Sheriff himself and numerous deputies, the prosecuting attorney himself, the emergency squad people, both fire departments, and the state police - knew these people or their parents or friends. The EMS grapevine has described the scene as well-managed and efficiently run, and the victims received optimal care under the circumstances.

So far, I have not heard one damn word about the people who worked this accident, nor about the effect of such a thing on them. Not a damn word. They are not whiners, they certainly aren't cowards, they are the people who do moderate to very dangerous things daily for their fellow man. A "y'all are doing a good job," "we're glad you're there," "how's it going?" or the like is appreciated far more than you can imagine. A note, a pan of lasagna sent to the stations at Christmas or the like is stunningly rare.

I can somewhat accurately describe those peoples' experiences that night, but trust me when I say that you do not want to read the details. The work had to be done, somebody had to do it, and we as a society should be very glad that those people were there.

Also about a week ago, a Charleston Police officer was shot and killed in the middle of the night while on duty. This was a subject of discussion and great sadness in the state over the past week (indeed, a good bit in our church). I hope that I don't need to explain our debts to police officers.

Today, I went on the website of "West Virginia's Newspaper," The Charleston Gazette. There is a link to a sound file of the radio traffic from the shooting. Silly me, I thought snuff movies belonged in underground porno. This is the worst prurience I can imagine, and the drooling idiots who are sucked into listening to this with some sort of lame justification that they are learning something are pathetic. Radio communications under great stress (any such communications for that matter) are harsh and emotional, and it is nothing but a cheap thrill, an adrenaline masturbation to listen to that. Shame on the Gazette.

Pippa passes.

R

16 September 2009

Lying Your Ass Off; Tales of a Lonely Power Chair

Effective Political Fundraising Methodology 101: Lying Your Ass Off

I’m on all sorts of email lists for different organizations of different orientations. Today, I received an “urgent” email from the Minuteman PAC. It provided, in part:

“Since last week when Joe Wilson stood in truth and declared Obama a liar on health care benefits to illegal aliens, the liberal left has raised well over $1,000,000 for his Democrat opponent. $1,000,000 in one week for a seat in Congress!!!”

* * *

“So, let's sum this all up. Because Congressman Joe Wilson has the guts to stand up and call a lie a lie, he has been forced to endure:
--- an energized and well-funded Democrat opponent
--- the hacking and crashing of his website by leftwing nuts
--- the continual lecturing and barrage of mainstream media attacks
--- the first formal rebuke of a Congressman...ever
--- and being called a racist by a former president [Carter.]”

The email was signed by Brett Farley, Executive Director, Minuteman PAC, whatever that is.

One kind of lie is the omission which leads intentionally to a false impression. “. . . the liberal left has raised well over $1,000,000 for his Democrat opponent. $1,000,000 in one week for a seat in Congress!!!” Congressional campaigns are now cracking the million dollar barrier routinely. That’s a shame, it’s a scandal and it’s a fact. And according to politico.com today, both Joe Wilson and his opponent, “former Marine Rob Miller” BOTH have cracked $1 Million since last Wednesday in new money. [Oh, to the extent that “former Marine” denotes history, it’s a thing of honor. To the extent that Miller's campaign sticks it on everything, it’s pandering. Rep. Wilson also has a distinguished military history.]

Being called a racist? Come on, Brett, are you kidding? Surely the “Minuteman PAC” has the guts to endure some name-calling. If not, here's another name: Whiners.

And the best of all: “the first formal rebuke of a Congressman...ever” How shall we respond? Well, maybe . . . You lie!

Congress rebukes and censures at will. Often, the recipients ignore them, which apparently is the posture of Rep. Wilson. (Actually, I don’t blame him for that. He apologized, said it was stupid, and it’s a waste of time to keep it up. The horse is dead.) On 9 July 2009, the U.S. House of Representatives voted 429-2 to rebuke President Obama over his signing statement on 24 June which said that he could ignore provisions of the law he was signing on how a $106 billion loan guarantee to the International Monetary Fund could be used. I haven't heard any "oh how awful's" this week about that. The House and Senate rebuked Theodore Roosevelt in 1908 when they were annoyed by his annual message. Nope, no call to apologize to TR's heairs.

Well, maybe Brett only meant rebukes, not the far more serious censures. After all, shouldn’t Rep. Wilson be concerned about getting a lesser “punishment” to ignore? This is film noire. Representatives censured include William Stanbery (1832, insulting the speaker), Benjamin Gwinn Harris (D-MD) and Alexander Long (D-OH) (1864, saying nice things about the Confederacy), William D. Bynum (R-IN) (1890, bad language), Thomas L. Blanton (D-TX) (putting naughty things into the Congressional Record), Laurence M. Keitt (D-SC) (1856, pulling a gun on other Representatives to keep them from helping Senator Charles Sumner as Rep. Preston Brooks was beating hell out of him on the floor of the Senat with a cane), John Winthrop Chanler (D-NY) (1866, insulting Congress)(maybe he said, “You lie!”), Barney Frank (D-MA)(1990, fixing parking tickets for his bunkie), Gerry Studds (D-MA) and Dan Crane (R-IL) (1983, sexual behavior with congressional pages), John W. Hunter (D-NY) (1867, bad language),
Fernando Wood (D-NY) (1868, bad language), Edward D. Holbrook (D-ID Ter.) (1869, bad language), plus a minor host of others.

So what might we conclude about the clear implication that Rep. Joe Wilson is being uniquely picked on? Well . . . That it’s a lie.

Speaking of rebukes, here’s a funny one: President Obama has “rebuked” Congressional Democrats for calling for the more serious “censure” of Rep. Wilson, calling what they were doing “a circus.” (He’s right, by the way.)

And here’s perhaps the funniest thing about the whole matter. Look at Joe Wilson’s record. This is an intelligent guy, a moral guy and a nice guy. He acted sincerely and with abominable lack of control at an extremely bad time. He apologized for that. As a result, he has the opportunity to be a spokesman for civil discourse. Picture a public service announcement - “Hey, I was impolite. If you act like a jerk, your message doesn’t get across. Let’s all talk rationally and work together.” But if political minelayers and yip-yap doggies of dogma can turn this into millions of ad-bucks, it will only encourage freakish public behavior and communication.

Simply a wonderful lesson here. Children of America, are you watching?


Tales of a Power Chair

One of my very longest-term clients stopped in last week for some deed work. He was my landlord when I graduated from law school, and is a hell of a man. At the age of 95, he still mows his own grass, drives to Florida, and takes women out to dinner. He was telling me that someone bought him one of those “power chairs” that’s advertised on TV to make his life easier. “Ain’t no way,” he said. “I start using that damn thing, I’ll die. That dark angel’s gonna have to catch up to me, boy, I’m not gonna sit and wait for him, by God.”

I cannot improve that attitude with any comment.

Pippa passes.

R

11 September 2009

My President Can Beat Up Your President: Choosing A Rational Path to a Health Care

President Obama’s speech last Wednesday night was convoluted, hit-and-miss and largely irrelevant blather. Oh, it was well-written and lofty and all of that. The speech appealed to my pride as an American, but then it doesn’t take much to do that. We should be proud that we are Americans.

As a political “necessity,” the President seeks compromise in a world (1) where a substantial number part of his political foes will brook absolutely zero compromise, (2) where a substantial number of his own political groupies are drooling to “help” by sticking the knife in the “other side” wherever they can (and in their wildest dreams ending up with a single-payer system, and (3) where the only compromise in play is some patchwork on a system that is in crisis. Such is not the recipe even for no-bake brownies.

Let us consider the current players, Congress and all of the loudest people participating in the health care & insurance debate. Their primary concerns are not illness, accident or suffering. Oh, they are mostly normal humans who don’t like the abstract idea of cancer eating up young people and so forth, but these are generalities, not gut-check images of dying people. Representatives, Senators, Congressional staff people, the Executive Office of the President, the entire pig-snail bureaucracy, Gucci-suit insurance executives, Armani-suit health care executives, disability examiners, the kinds of doctors who review files rather than see patients, wing-tip & Manolo Blanik trial lawyers on both sides of malpractice cases, HR directors, health care union reps, prominent writers, K Street lobbyists, political pundits, think tank policy wonks, and the usual suspects in the peanut gallery follow the money. And they really have three things in common:

1 - They have good medical insurance so the debate isn’t personal to most of them.

2 - They will continue to prosper personally so long as they focus on money first.

3 - They will moan like they’ve been gut-shot if you say they are all about money and claim that they out-nice Mother Theresa.

Thus, they follow what Hagar the Horrible calls “The Viking Motto”: I got mine.

My own anecdotal observation is this: The amount people care goes up with the amount of blood and feces they get on their hands. I don’t know of any scientific study like that, but the kindest and most caring and most human people about health care are those in the trenches. Perhaps it is the lowly “orderlies” and “Certified Nursing Assistants” who have the greatest caring - and most dignity - of all. But the docs and nurses and x-ray techs and med techs and paramedics and so forth are right there, too.

Following the money is DEstructive. That’s easier. It takes less thought, although the players have to have fewer morals and stronger stomachs. One of the very best follow-the-money strategies is the simplest: If you don’t have good enough facts or shocking enough facts, make stuff up. People will believe it. Thousands of people die of cancer when insurance companies cancel policies after they get sick because the insured didn’t tell the company about their acne. That’s a pretty good story. The champion story of recent months is the one about the bureaucratic Committee to Kill Granny. That was inspired. In 1729, Jonathan Swift wrote A Modest Proposal, where he proposed that the Irish solve their hunger problem by selling and eating their children. That was condemned as cruel satire. The funniest thing is, the 18th Century people knew it was satire and the 21st Century people swallowed the Committee to Kill Granny hook, line & sinker. Who says we’re making intellectual progress?


So let’s take the Vince Lombardi approach. In two years, Lombardi took the Green Bay Packers from the bottom of the NFL to the championship. One of his mantras was “The basics.” What are the basics of health care? They are not instantly to declare that all employers will buy health care or that we’ll switch on Tuesday to a single payer. The basics of health care REQUIRE that we as a nation answer 3 questions. These questions are hard to answer, but the questions are simple and clear:

1 - Who will get health care?
2 - What care will they get?
3 - Who will pay for the care?

Of course I have opinions, and I’m not pretending to hide them. But this is not advocating “my plan,” because I really don’t have one. Let’s identify the questions and consider the process we MUST go through to answer them. If you disagree with what I might think is a good solution, that’s fine with me - but you still have to confront the problems and answer the questions. If you don’t answer the questions, you’re not talking about health care, you’re talking about moving money around and ignoring sick people.

Under the President’s plan “announced” Wednesday, we get the idea that everybody (with unspecified exceptions) with get unspecified health care paid for either by themselves or their employers or unspecified others, possibly financed in an unspecified way by unspecified savings from unspecified waste and fraud.

OK, that sounds harsh. But under many health insurer’s plans, healthy people hopefully won’t get sick and if they do, they’ll try to find a way to deny or limit coverage, and if they can’t do that, they’ll approve treatments which were modern 15 years ago and limit payments for what they do approve to what was reasonable 20 years ago and stick the patient with the rest.

Under the overall prevailing American system, the most advanced medical care in the world is theoretically available. Some people get all of it, some people get some of it and some people get very little of it. Generally, those who get the least are those who work at relatively low paying jobs.

Under the most liberal plan, the single payer, we will provide everybody with everything paid by taxes and pay doctors what we damn well please, but rich folks will pay the best doctors privately because they’ll establish a private-pay, superior care network. Other folks will get the care they get when the system gets around to giving it to them.

Let’s look at some issues that will come up as the questions are considered and answered.

WHO WILL GET CARE?

Currently, the rich get good care, and so do people with excellent health insurance. Those in government-as-employer-funded insurance plans (such as members of Congress) have the best insurance of all, which will pay for just about anything forever. Other insurance plans go from good to nearly useless, depending on the plan and that depends mostly on what premiums are paid. Insurance companies are not stupid. They have to take in more than they pay out. If they don’t, they go to a place called “Out Of Business.”

The poor get an acceptable level of health care in many instances. No, I will not retract that. The poor who qualify for Medicaid have health insurance which is better than the insurance of most working people. You may think that’s good, you may think that’s bad, but whatever you think it is, it’s a fact. The “working poor” and “lower middle class” more often get the shaft. With too much income for Medicaid and too little to pay the employee part of health insurance premiums plus deductibles and co-pays, these people are the most at-risk for having medical needs and no way to pay for them. Again - be it good, bad, or just their tough luck, this is a fact in America today. Oh, hospitals tout their level of “charity care,” which is the dollar value of care which they give to people who they know can never pay. That is a good thing, but let’s not get teary eyed here. There is no person called “Hospital” who has to eat macaroni tonight because s/he gave too much charity care this month. The executive staff still gets paid. The power stays on. “Charity care” is another term for “shift the cost.” Somebody pays the cost to treat charity patients. Those costs are just moved to whoever pays for the other patients.

Before we look at what care will be given, let’s consider two special categories of potential patients. First, there are the illegal aliens/illegal immigrants. This is a hot button topic. Representative Joe Wilson improvidently but sincerely blew his top during the President’s speech. That was dumb, but I doubt if it was planned or cynical. Nevertheless, it is CERTAIN that the following event will occur: A car will pull up to an Emergency Room door. A woman will get out, rush in and tell the people inside, “My husband is having a heart attack.” The husband is an illegal immigrant. This is no longer a theoretical debate, and we are cowards if we hide from the issue. We as a society have to decide: Does the guy having the heart attack come in the hospital for treatment that may cost tens of thousands of dollars that others (like taxpayers) will pay, or is he turned away. There is no compromise here. He’s in or he’s out. He’s an illegal immigrant. Society, decide.

The second people to think about are the “they did it to themselves” crowd. This person has lung cancer. S/he was a smoker for 30 years. “They did it to themselves.” Will that affect their access to care? AIDS. (Give me a break - of course there are people who got AIDS purely by non-preventable causes. They are a minority, however. Most AIDS patients could have avoided the disease by using sanitary or sterile precautions.) Are they fully in the system? Fat people. They/we have more heart attacks and strokes. Is it fair that others pay for their/our sinful indulgences?

Again, whatever your answers might be, the questions have to be answered.

WHAT CARE WILL THEY GET?

America has the most advanced medical care on Earth available to its citizens. That doesn’t mean that all the citizens get that care, but it is available. In 21st Century Health Care America, what care actually will be given?

Preventive care - We know so much about the value of preventive care, but citizens do not take care of their own health and third-party payers either don’t pay or poorly pay for prevention. Dental and vision care are particularly poorly covered, but each can prevent serious (and expensive to treat) medical conditions later. Adults need PSA/prostate exams or mammograms, and every older adult needs colonoscopies. Without good insurance, you don’t get those, and if you contract the diseases they are designed to detect, you will more likely die, but only after you have much more expensive treatment than you would have had if the condition had been caught earlier. Payment for diabetic medications and testing supplies can help avoid amputations or kidney dialysis. Ignore the fact that those are awful things for a patient to experience. Even if we are just following the money, it seems stupid to let those things happen.

Garden variety acute care - We do pretty well there. Appendectomies, hospitalization for pneumonia, getting stitches, lab work and x-rays seem to happen reasonably dependably. When we talk about what care is given, we will have to listen to the doctors mostly. True, there are as many insufferable egomaniac doctors as insufferable egomaniac lawyers as insufferable egomaniac politicians, but the docs are the only ones who know the details of medical care.

Expensive care - As the care becomes more expensive, we look at its cost and necessity more closely. Does this patient really need a cardiac bypass operation, or will placement of a stent do? Does this patient need a month in a rehabilitation center? And what are reasonable costs. (See below, “Who will pay,” about cost containment.)

Experimental and “Hail Mary” care - I want to live forever. Because of my faith, I fully expect to live forever in the broadest sense, but I want to live here on this Earth in a young and healthy body forever. Impossible, you say? Not so fast there, I’m working on it. Most people have the same goal, at least in secret. There are some dread diseases that are almost sure to kill a patient in a relatively short time.

Let’s assume a patient age 60 has cancer of the funny bone. The survival rate for that mythical cancer over one year is 5%. A bone marrow transplant is the treatment, costs around $200,000 and assume that it increases the one year survival rate to 10%. Does the patient want the treatment? Yes. The patient is broke and has no insurance. Do we pay for that treatment from public funds. Hey, says the patient, it’s a bargain, it doubles my chances of living. Hey, says the heartless people who have to balance the books, it’s 200,000 bucks we can spend where it will do more good, you’re 60, and doubling the chance to 10% still is a bad deal. The answer? I don’t know. But we have to decide. When the situation arises, we will not have time for philosophical debate or a 10 day court hearing or extended prayerful reflection. We have to make a decision. The patient is treated. The patient is not treated. Period.

End of life care and other “hopeless” care - Life is precious and we have an obligation to keep a patient alive, period. Everyone has the right to a dignified death at a time of their choosing, and if they are unable to choose, we need to figure out what they would want. Or something else. Or I don’t want to make the decision, doc, you decide, I’m going outside for a smoke. Here is another hot button issue. It is virtually impossible to divorce this one from the appearance of morality and money. Proponents of different views will even embrace those concepts. The anencephalic baby. Anencephalic means no brain. None. No place for conscious thought to form. A soul? Don’t ask me, I’m not that smart. Science says there is no reason to use medical resources on this baby. I cannot tell you the “right” answer. These babies will be born. We as a society have to decide the answer. Granny will die. How long will the standards of treatment support her life? If she is in an irreversible coma, will we put on a respirator and keep her going at $2,000 a day for a month? (How dare you ask the question! No, perhaps how dare I answer it in a way you consider wrong, but we must ask the question and discuss it. If we don’t, we prove ourselves to be cowardly and stupid. I don’t care how strongly you hold your beliefs. But if you are unwilling to talk, you are an idiot.)

Last year, I sat in an ICU as a dear friend died after supportive medication was stopped. This was his choice. The ICU had other patients in crisis, so it was my buddy, me and another buddy. We read the Bible to him, prayed with him and for him, and it took him 11 hours to die. He could have lived a few more weeks or months in pain and almost complete dependence on caregivers. I do not know as a fact what the right thing to do was. I think he did the right thing. I may be wrong. Will we, can we as a society make this decision in the name of efficiency and cost-effectiveness? Decide.

WHO WILL PAY?

In the largest sense, this is a trick question. Ultimately - the people will pay. Always. There is no Ms. Insurance Company who will be peeved that she is overdrawn because Joe Lunchbucket needed an operation. Her managers may be upset. Her stockholders who depend on dividends may gripe. But notice, those are real people. There is no Captain Government to ride to the rescue and pay gladly for the incomprehensible art on the Hospital walls. But there are taxpayers whose pockets (and sweat) created that value. Real people. So the question is not whether it is insurance, government or individuals who pay. It is simpler. What people pay?
On its face, the simplest and fairest system is that the sick people themselves pay for their own care. If a person of means is impoverished by health care, well, s/he’s the one with the medical needs, it’s not our fault. Here we go, “How heartless!” No, if we don’t ask hard questions, if we are so afraid that we won’t confront them, we are cowardly and stupid.

Any other method of payment shifts the burden to someone else. If the “someone else” is the government (funded by taxes, i.e., the public), employers (funded by customers, i.e., the public), insurance companies (funded by premiums, i.e., the public) or a mix of those, this is simply a risk-spreading device. In other words, it’s insurance whether an insurance company is involved or not. What people pay the premiums?

And here’s where the “single payer” concept breaks down. It would not be a “single payer.” It would be a “200 million people who pay their taxes payer” system with one checkbook. The public foots the bill every time. The wealthier part of the public foots more of the bill every time. So the “who pays” is a matter of degree. How hard will we stick it to how many? And where will we catch them? From their paychecks? Their dividends? Their taxes? Their monthly bills and payments for goods and services? Will we target some and excuse others? If Ohio requires employers to pay full health insurance for workers and West Virginia doesn’t, does West Virginia get the Honda plants? There are lots of issues and lots of dogs in the fight, but make no mistake: People will be paying the bill.

Waste & Fraud?

Walk into a hospital. How many people are wearing scrubs? How many people (men & women both) are wearing suits? Now you know about the waste. Watch what drug sales people drive, google “health care fraud,” check the relationships between doctors, hospitals, owners of MRI’s, critically look at the minutes of hospital boards for what is hinted at but not there, and audit a sample of Medicare billing for whether the services were really provided. Now you know about the fraud.

Tort Reform


I love hysteria. I still remember Schwartzenegger in the Conan movie talking about the joy of hearing the lamentation of the survivors of his slain enemies. Aren’t lawsuits great? OK, some honesty here. Some lawsuits are bizarre, and should not be brought, although not nearly as many as the insurance companies pretend. This is not because malpractice lawyers are all nice and responsible, it is because they want to pay for their Mercedes & Lamborghnis and the other cars they don’t park in front of the Courthouse when they go try a case. A bad case will get thrown out and because these cases are done on a “contingency fee,” (the lawyer gets a piece of the action; no action, no fee), so they’ll not knowingly bring a bad suit. Some plaintiffs’ lawyers, however, are stupid and bring bad suits anyway. There is and always has been a way to throw these suits out, but only after some expense has gone into the defense of them.

Some doctors are good doctors who rarely made mistakes, but once in a while do so. A few doctors are quacks and hacks who blunder their way through bodies happily helping the Grim Reaper. “Tort reform” does not discriminate among these people. Actually, let’s go further with the honestly. This is not tort “reform.” Every change is called “reform.” If someone suggests that we put surviving spouses out in the bitter cold when their mate dies, someone would call it “parental reform.” “Tort reform” is really “targeted lawsuit limitation.” For particular defendants, doctors, we decide that the needs of society are more important than the needs of the individual, and so the person who believes that s/he has been injured by medical negligence (whether s/he is right or wrong) will have a more difficult time proving it and will recover less than what a jury would say were a correct verdict if the harm were inflicted by another sort of defendant. (On the other hand, doctors and insurance companies have lots of money, so malpractice verdicts may be larger than other verdicts.) You can say that lawsuit limitation is a bad idea, you can say that’s a great idea, I don’t care. That’s the purpose of it, and is a policy choice. Let’s just be honest. In the meantime, the liability insurance companies terrorize doctors with tall tales and rape them with jaw-dropping premiums (which get passed on to guess-who, the people who pay for health care).

The whole fear of malpractice suits does add very large costs to the health care system through “defensive medicine.” A doctor can be morally certain that a patient has some minor problem. Then the doctor thinks, well, there’s a 1 in 10,000 chance s/he has some particular major condition which would show on an MRI. Just my luck, the doc thinks, this patient has that, I’ll get sued, and so forth. So the doctor orders an MRI that someone else will pay for, and it’s $750 to $1,000 spent for no rational reason. With the fear that’s out there, justified or not, we can hardly blame those doctors.


And so, here’s the choice. Continue the circus. “You lie!” “There are significant details to be ironed out.” “The time for games is over.” “Socialism.” “Mandate.” Blah, blah, blah. Or employ rational minds. Answer the three questions.


Note: A bright spot: West Virginia’s Governor, Joe Manchin, is encouraging business to offer health insurance to attract and retain good and loyal employees. He’s not telling them how to do it. He’s not asking the Legislature to pass laws or making executive decrees forcing them to do it. He’s communicating logically, using reason, and trusting the honor and intelligence of business people to do the right thing in an efficient way that works for them and that improves life for everyone.


Pippa passes.

R

06 September 2009

Small Stuff and Discomfort

I’ve some short observations tonight.

New Eyes

I am pleased that several new readers of these humble scriblings have contacted me in the past month. I make no pretense that I have superior ideas or insight. Wait, wait, wait, that’s bullshit. Of course I do. But where I (hope that I) differ is that I know that I may be wrong. Adopting convictions instantly without thought or the intake of facts is stupid, and unwillingness to reevaluate and engage in reasoned, fact-based discussion/debate is equally stupid. Anyway, all are welcome and all are encouraged to comment and direct us to their own offerings in the Marketplace of Reason. [This was formerly termed the "Marketplace of Ideas," but that admitted ideas such as "The Secret" (sit on your ass and think what you want and you get it), debt stimulation (get out of debt by incurring more debt), and the suspension of Cause & Effect, so I've capriciously changed the name of the souk. Reason raises the bar.]


Healthy Children

I sit here in the domesticity of Casa LaJ, and at the other end of the room the flicker of the TV competes with the laptop for my eye. [My aside: This is a hardwired brain thing. Early man needed to be on the ball to keep from being eaten, so we are wired to respond to motion.] And a few moments ago, there was some sort of ad or blurb for some children’s show or CD involving “Thomas the Tank Engine,”, essentially a talking train in a little society of talking trains. That takes me back to when Tim was very little and we would watch such things and read such books. It’s easy now for “kids” of his age to pooh-pooh those things. He came in about 1 AM this morning and we talked a while about his hard night shift at Rescue 20 last night, one of those places that services the harsh world. But Thomas and his friends, and Winnie the Pooh, and Dr. Suess and the Lorax and the Cat in the Hat and the stuffed animals, they are all real, too. They are a part of the emotional and moral world of learning for little ones and the awakening to wonder of them and the reawakening to wonder of jaded adults.

I am reminded of a lesson I learned unexpectedly in college. I was spending a couple of weeks at the State Capitol on an internship led by my good friend and mentor, Dr. Jim Whisker. (Google him - Conservative voice, writer on early firearms) One of the people he had sit with us, a group of 20 high energy college students who, by then, were running on the reserves which the 20-somethings seem to have, was Jack Whiting, the director of the Kanawha County Regional Development Authority. Jack brought with him a stuffed tiger and passed it around. Well, we were college students, not little kids, so the darn thing went around quickly and at arms’ length - almost. Until (well past me), someone cuddled it a bit and lost themselves for a second, and then it seemed to be OK to act like humans. What a lesson - you can be a human and sentimental and it doesn’t lessen you as a strong person.


Cat

I spent the afternoon at No. 3. When I have things to do on a computer that don’t require a large screen or lots of books or documents, I may move to the armchair with the laptop. This afternoon as I was there, the stubbornly unnamed neighborhood cat who is attempting to inveigle himself into the office dropped into my room. (He pops in when Pooka the Dalmation takes an outside break.) Cat cynically jumped onto my chest. Two hours later, I woke up and resumed activity. But don’t get the idea from this that I am moved by my many animal friends.


The Clampetts Make a Phone Call

Until Friday, I had never made an international phone call. I am extraordinarily untraveled and of unimaginative geographic focus. (Also, as the Shelf Community denizens know, my modern popular cultural orientation is totally out of whack.) Friday, that All Changed, and I Joined The Pepsi Generation. On My Very Own, I Made An International Phone Call. (To Tunisia.)

It’s interesting how blas√© on the one hand and cocky on the other we become about the things we do. Oh, my yes, what a hillbilly bumpkin, pshaw, never called Africa? Good heavens, you’re impressed just by meeting The Governor? You must be kidding! A little blood? That bothers you? How odd! Goodness, I meant this to be light, but I’ve led myself into one of my pedantic hobby horses, when people believe that something about them makes them better than others. Smarter? Often that’s true. More skilled at particular things? No problem. But better?


The Discomfort Part

This evening, the notion of writing in the short blurb bothers me, and I’ve no idea why.


Pippa passes.

R