Archive for November, 2011

Top 10 reasons why men prefer guns over women

Saturday, November 19th, 2011

#10. You can trade an old 44 for a new 22 AND nobody gets hurt.

#9. You can keep one gun at home and have another for when you’re on the road AND nobody gets hurt.

#8. If you admire a friend’s gun and tell him so, he will probably let you try it out a few times.

#7. Your primary gun doesn’t mind if you keep another gun for a backup.

#6. Your gun will stay with you even if you run out of ammo.

#5. A gun doesn’t take up a lot of closet space.

#4. Guns function normally every day of the month.

#3. A gun doesn’t ask, “Do these new grips make me look fat?”

#2. A gun doesn’t mind if you go to sleep after you use it.

And the number one reason a gun is favored over a woman is…


Congress is a criminal enterprise.

Friday, November 18th, 2011

Mark Twain once said, ” There is no true criminal class in America with the possible exception of Congress.” It’s time to withdraw the qualifier. It is now apparent that, with a few rare exceptions, Congress is a criminal enterprise and the Obama Administration is, as well. Here is the story of part of it.
“To entrench Fannie’s privileged position, Morgenson and Rosner write, Johnson and Raines channeled some of the profits to members of Congress — contributing to campaigns and handing out patronage positions to relatives and former staff members. Fannie paid academics to do research showing the benefits of its activities and playing down the risks, and shrewdly organized bankers, real estate brokers and housing advocacy groups to lobby on its behalf. Essentially, taxpayers were unknowingly handing Fannie billions of dollars a year to finance a campaign of self-promotion and self-­protection. Morgenson and Rosner offer telling details, as when they describe how Lawrence Summers, then a deputy Treasury secretary, buried a department report recommending that Fannie and Freddie be privatized. A few years later, according to Morgenson and Rosner, Fannie hired Kenneth Starr, the former solicitor general and Whitewater investigator, who intimidated a member of Congress who had the temerity to ask how much the company was paying its top executives.”The latter item is just to show that the corruption was bi-partisan. The quoted text above was written by Robert Reich, the left wing former Clinton Labor Secretary.

Johnson was the man chosen by Obama to vet his possible VP choices. When his history came to the public’s attention, he quickly withdrew. He had no financial background at the time he became the chief of Fannie Mae. He was a pure political animal.

The most telling recent blow is the bankruptcy of MF Global, a commodity trading firm run by Job Corzine, former governor of New Jersey. It appears that he stole $600 million of investor’s money. Another commodity trader has now closed her fund and returned her customer’s money. Here’s why: “The reason for my decision to pull the plug was excruciatingly simple: I could no longer tell my clients that their monies and positions were safe in the futures and options markets – because they are not. And this goes not just for my clients, but for every futures and options account in the United States. The entire system has been utterly destroyed by the MF Global collapse. Given this sad reality, I could not in good conscience take one more step as a commodity broker, soliciting trades that I knew were unsafe or holding funds that I knew to be in jeopardy.

I do not agree with some of her theories, she appears to be a “birther,” for example, but that doesn’t matter. If Obama is a legal citizen, his corruption is just as bad.

“A firm, led by a crony of the Obama regime, stole all of the non-margined cash held by customers of his firm. Let’s not sugar-coat this or make this crime seem “complex” and “abstract” by drowning ourselves in six-dollar words and uber-technical jargon. Jon Corzine STOLE the customer cash at MF Global. Knowing Jon Corzine, and knowing the abject lawlessness and contempt for humanity of the Marxist Obama regime and its cronies, this is not really a surprise. What was a surprise was the reaction of the exchanges and regulators. Their reaction has been to take a bad situation and make it orders of magnitude worse. Specifically, they froze customers out of their accounts WHILE THE MARKETS CONTINUED TO TRADE, refusing to even allow them to liquidate. This is unfathomable. The risk exposure precedent that has been set is completely intolerable and has destroyed the entire industry paradigm. No informed person can continue to engage these markets, and no moral person can continue to broker or facilitate customer engagement in what is now a massive game of Russian Roulette.”

The bankruptcy petition may have been responsible for freezing the accounts but criminal law should deal with this. Corzine should spend years in prison. Here is a depressing comment: “If Obama doesn’t win next year, watch for a January 19, 2013 pardon.”

Another Powerline deleted comment.

Monday, November 14th, 2011

Apparently, the webmaster at Powerline does not approve of some of my comments and deletes them. The latest example;

“ (signed in using Hotmail)
I think this series would have a lot more impact if you just called it annals of british medicine…I don’t recall a single instance where you referenced any other government medicine (horror) story. surely there are stories out of spain, france, canada, italy, belgium, etc etc.
it is also disappointing (but not surprising just thought you were above that sort of stuff) that you equate the NHS with Obamacare…they are not the same…government medicine (nhs) versus government insurance (obamacare).the NHS is the equivalent of a federal dept where all employees, doctors, nurses, etc are actual employees of the government and the government owns the hospitals, clinics, etc. That is not the same as obamacare where it amounts to government insurance unless you actually believe that all the doctors and healthcare workers will be employees of the government.”

My comment in reply to this was two words; Natasha Richardson.

Natasha Richardson the actress and wife of actor Liam Neeson was skiing at a Canadian ski resort in Quebec when she had a seemingly trivial head injury. Over the next few hours she developed signs of an intracranial bleed. No CAT scan or MRI was available and, in spite of frantic efforts to transport her, she died of an intracranial hemorrhage( an acute epidural hemorrhage). Grace Kelly had a similar history but, of course, that was in 1982 when CAT cans were very new. In both cases, the high tech device was not available.

Does anyone think that a US ski resort would lack immediate access to a CAT scan ? If Natasha Richardson had been skiing at a US resort, she would be alive today. Epidural hematomas are eminently treatable, even without a CAT scan. The lucid interval is almost diagnostic of the lesion. Decompression of the hematoma is curative.

Australian health care

Saturday, November 12th, 2011

I posted a comment in response to a question on the blog but WordPress ate it so I will try to Post some thoughts about the Australian system. In the 1970s, Australia may have had the best system in the world but politics, as usual, screwed it up. When I was first starting out in the 1970s, we were out for dinner with a couple of Australian surgeons. They explained the system as it existed at the time. The hospitals were almost all owned by the states which funded them. There was a private health care system, called “Medicare” in which individuals who wanted private care paid a monthly premium though the Post Office. All hospital care was in the state owned public hospitals. The hospital based specialists cared for everyone regardless of insurance status in the same setting.

In the early days of the National Health Service in England, a similar situation existed with private patients in NHS hospitals. Then, in the early 1970s, under the Labour government, the unions of NHS employees refused to care for private patients. The result was that Harley Street specialists and their patients left for Belgium. A few years later, there was a small scandal in which the Labour Health Minister had her hysterectomy performed in Belgium by a private specialist. Such hypocrisy is an old story.

In Australia, the Labor Party campaigned in the 1984 election telling voters that, if they were elected, health care would be free. They would abolish the Medicare premium. As it happened, they had made no provision to pay doctors. It’s not clear if this was the result of ignorance on their part or if it was a calculated risk in an election they did not expect to win.

I visited Australia a few years later and saw the remains of the mess. Big states, like New South Wales, had no private hospitals and hospital based specialists, like surgeons, had no source of income. Patients dropped their Medicare premium and the doctors were screwed. With time, there has been a reorganization and official descriptions gloss over the story. If you read this description, for example, there is no description of the chaos that I found in 1988. There were daily newspaper stories, at the time, of patients going without treatment.

I was visiting friends, two GPs in Toowoomba, in Queensland. From them, I learned considerable background. Queensland, the most conservative Australian state, had both private and public hospitals. The public hospitals were not on the same level of sophistication and equipment as the private ones. The doctors in Queensland told their patients that, if they wanted private care, they had better pay their Medicare premiums. My friends owned their own office building and surgery center (called day-surgery). The public hospital also had a day surgery across the street from the private one. A year after my visit, the public hospital approached the two GPs and asked them if they would take over management of the publicly own day surgery as well as their own.

I think most of the major mistakes of the Labor government have been corrected with time. I don’t think the system is as good as it was 30 years ago.

Is socialized medicine bad ?

Thursday, November 10th, 2011

There was a post on Powerlineyesterday, which attracted a lot of comments, including one of mine that never appeared. Maybe it was too long but I was trying to respond to a question.

This is a better place to respond so I will try here. The questioners seemed to be single payer advocates.

“Brody Halverson · Top Commenter · College for Financial Planning
Where is Michael’s response? I’m eager to learn of your findings after years of studying this.”

I had earlier posted a comment that I had studied medical errors and medical quality for years. The issue was whether the NHS has better outcomes than the US record.

I have had some experience with the NHS going back 15 years. In 1995, I went to northern England as part of a group from Dartmouth to advise primary care doctors on how to cope with the new “Fund Holding” system introduced by the Conservative government. Fund Holding was a way of dealing with a chronic NHS problem. In the NHS, hospitals and hospital-based physicians have almost no contact with the general practitioners. The GPs find it nearly impossible to find out what happens to their patients while hospitalized. Fund holding allowed the GPs to send their patients to hospitals that are not the local district hospital. The payment for treatment followed the patients. The result was a considerable improvement in the relationship between hospital based-specialists and GPs. A lot more information was shared, similar to what happens in the US system.

A personal friend of mine, a surgeon and teacher of anatomy at a London medical school, has told me that he cannot get Muslim female students and nurses and junior doctors, to scrub their forearms before going into surgery. Hospital infections in NHS hospital are high and rising. NHS hospitals are described as “dirty” and there are problems with obvious issues as changing bed linen. This is pretty bad.

Then there is the notorious order from the health ministry to reduce ER waiting times or face fines. The response of NHS hospitals was quite a bit different from those of US hospitals, even public hospitals. In the NHS, the “target waiting time is four hours. Even at that some hospitals have refused to allow ambulances to bring patients to ERs if the wait will exceed the rules. Instead, the ambulance have been forced to wait in the parking lot until the wait time is reduced.

For one thing, patients in the UK have spent 30 million pounds when ambulances were not available or wouldn’t come. THere are stories of patients dying in ambulances during the wait.

Some commenters have described Medicare as “socialized medicine.” This gets into definitions. Fee-for-service medicine is what is at issue here. There are some patients who prefer HMOs, like Kaiser. That is not a problem because they have a choice. The French have the best medical care system in Europe because they have kept most of it fee-for-service. The patient has a choice. Some of them go to community clinics, similar to our HMOs because choice of physician is not important to them.

However, the fact that the French system is largely fee-for-service makes the single payer segment responsive. Those doctors know that their patient volume may drop precipitously if the patients lose confidence in the system.

Canada has had a modified fee-for-service system for years but it has been starved of funding to the point that patients have begun to seek non-government care. The same thing is happening to Medicare here. The changes are still small and not that many people are affected yet. Most of the problem has to do with the elderly. There are severe restrictions on care of the frail elderly, how frequently the doctor can see them, for example. A government official complained recently that surgery on the elderly is useless because ‘most of these people die anyway.’ In fact, that is a distortion of the data. Only those patients who died were included in the study. I have done major surgery on 90 year old people. The key was that they knew the facts and wanted the surgery.

In Canada people are seeking private care. Technically, it is illegal however a recent decision of the Canadian Supreme Court ruled that a government health care system does not mean that care is available. We are seeing an increasing level of private care used by Medicare patients in this country. Expect this trend to increase if Medicare is subjected to increasing cuts, as in the Obamacare plans.

My recommendations for reform follow the pattern of the French system and I have tried to provide some detail on my reasons.

Why socialized medicine is a bad idea.

Tuesday, November 1st, 2011

For many years the term “Socialized Medicine” has been a watchword for reactionary and out of date doctors who think we still live in an era of self-reliance. Everybody knows that health care should be a communitarian responsibility because no one can afford their own healthcare. I can’t afford a car crash, either, but I have car insurance for that.

Now, we have evidence that we can’t afford, as individuals, community health care either. The federal government now has a powerful agency named “United States Preventive Services Task Force (USPSTF), which by its name one would think is in charge of making sure we get our preventive medicine testing as advocated by Nancy Pelosi. Except Nancy has changed her mind.

The Obamacare legislation has transformed the USPSTF from its former status as a mere (one might say milquetoasty) advisory board, which made recommendations on preventive health that doctors and patients could take or leave alone, into an extraordinarily powerful GOD panel (Government Operatives Deliberating) that determines, definitively, which preventive services are to be covered and not covered by private insurers, Medicare, and Medicaid.

If USPFTF determines that something will not be paid for, God help you in getting it done. I first noticed this when I was at Dartmouth. It was found that many men with positive PSA tests, which suggested the presence of prostate cancer, did not die of prostate cancer, at least for many years. These tended to be older men and men with lower levels of PSA. The result was a drive to educate men to NOT have PSA tests. Too many men were having the test and undergoing radical prostatectomy.

I was in some sympathy with this view. I had seen examples of overtreatment. Still, it seemed more fair to allow the patient to choose. I see no similar movement to deny mammography to women although the recent dustup about youngest age at which Medicare will pay from mammography does seem similar

just yesterday, the New York Times published a “news analysis” which aggressively begins selling the public on that very notion – that medical screening tests are, by and large, a bad thing to do.

Even DrRich thought the Progressives would be somewhat circumspect about breaking such remarkable and counter-intuitive news to us in the great unwashed – especially considering that they have just spent the last three decades teaching us just the opposite. But then he recalled their smooth, unapologetic and entirely unremarked transition, around twenty years ago, from sounding the alarm about global cooling to catarwauling about global warming.

And he reminded himself that when you are a Progressive, history always began 10 minutes ago. And this turns out to be a great convenience.

In this case it is particularly convenient, when you consider the passionate declarations by Ms. Pelosi and others in 2009 that the watchword of Obamacare – indeed, the very key to the dramatically lower costs we would realize with this new legislation – would be “prevention, prevention, prevention.”

Expect to hear about this. Here’s another way of

The British medical journal Lancet reported last month that 32% of elderly American patients undergo surgery in the year before they die, a statistic culled from Medicare data. In an accompanying editorial, Dr. Amy Kelley of Mount Sinai School of Medicine labeled the 32% figure a “call to action”—to reduce costly surgeries, intensive-care stays and other high-intensity care for the elderly. Her call was parroted in hundreds of media outlets nationwide. But advocates for limiting health-care spending on the elderly are distorting science to make their argument.

Don’t be bamboozled: The Lancet investigators looked only at patients who died, making surgery appear unsuccessful. That’s like saying Babe Ruth struck out 1,333 times so he must have been a poor ball player—even though he had a .342 lifetime batting average and 714 home runs. Investigators should have considered how all surgery patients fared, including those who recovered, returned home from the hospital and resumed active lives.

The day is coming when divided loyalties will be the most serious problem in medicine. Who has YOUR best interest at heart ?