Category Archives: Government

Memorial Holyday

Memorial-Day

The word holiday was once just a different spelling for holyday, but has come to mean something quite different to many people. That’s unfortunate, because we tend to remember the specific meaning of our holydays; we do not confuse Passover with Christmas or Eid al Fitr. On the other hand, we do confuse holidays.

In the United States of America, today is Memorial Day. I observe Memorial Day, but do not celebrate it, since it is dedicated to those who gave their lives in the defense of our country. Veterans Day, on the other hand, recognizes all who served or are serving in the military.

It is an ancient custom to honor the dead by placing flowers on their grave. After the American Civil War, this practice became an annual ritual and was originally known as Decoration Day. There are a number of people and organizations who have been credited with initiating it from both the Union and Confederacy.

To me, Memorial Day, is when I remember when I was deployed and we lost someone. The theater–which was also used as a chapel–would have the inverted rifle, helmet, boots, and dog tags representing the lost warrior, and too many times it was not just one. The building was packed by men and women in camouflage uniforms; under the seats, the pre-staged boxes of tissue were intermingled with rifles. Friends paid tribute, and no one was too proud to cry.

Military rituals are often misunderstood, but the link provides a good explanation. One misunderstanding is that at a military funeral, the honor guard fires a 21-gun salute. Actually, they fire three volleys, a 21-gun salute is reserved for heads of state.

Except for Memorial Day.

On Memorial Day, those who, as Abraham Lincoln said, “gave the last full measure,” are accorded the same honor as a head of state. On Memorial Day, the fallen are recognized with a 21-gun salute.

Magic with Numbers!

SONY DSC

Albert Einstein and Stephen Hawkins were rank amateurs because they were handicapped by their pathetic math skills.

The real math pros are accountants.

As the old joke goes:
A businessman needed to hire someone who knew math. For the interview, he had written on a white board “2 + 2 =.” The mathemetician wrote “4,” as did the physicist. When an acountant arrived, he looked at the whiteboard, locked the door, checked to make sure the window was locked, and pulled the curtains. He leaned close to the businessman and whispered,
“What do you want it to be?”

Creative accounting requires more mental gymnastics than figuring out how the universe began or will end. Here’s a great example:

Forestt Gump, the movie, cost $55 million dollars to produce. It earned nearly $680 BILLION, but according to the accountants, it lost money. Some of the contributors (like author Winston Groom) had agreed to a percentage of the net profits. However, since it never made a dime, their share was zero.

Let’s review the math:

$679,850,637,000
–        $55,000,000
             ZERO*
* After depreciation, marketing, amortization, title, and dealer preparation charges–and other “Generally Accepted Accounting Principles”.

I didn’t include taxes, because if it “lost money,” I’m not sure whether or not they had to pay any.

Albert Einstein and Stephen Hawking, eat your hearts out!

 

 

My How Things Change

The United States Constitution is a marvelous document–a framework for what was a radically new form of government in 1787–but a living document that has changed with the times.

TheNationalArchivesholdstheUnitedStatesConstitutionOriginalDocument

And the times have so changed.

Legend has it that, during the war, a British military commander sent a note addressed to ‘Mr. George Washington.’ General Washington accepted the note and placed it in his pocket saying that he was aquainted with Mr. Washington, who was a planter in Virginia, and he would deliver the note after the war. The next day, a similar–and possibly identical note–was sent, addressed to ‘General George Washington.’

After the war, General Washington appeared before the Continental Congress to return his commission to them. He had done his duty, and no longer needed or wanted the rank of general and handed the paperwork that had made him a general back.

Initially, there was a populist movement to make Washington king. He would have no part of that. There is a place in the Capitol Building that was intended to be his crypt, but he had left clear instructions that precluded his internment there.

Often, he closed his correspondence with “Your obdt (obedient) servant, George Washington.”

Regardless of your political views, it is reassuring that our nation is not based on birthright, caste, or class, but on a set of ideals laid out in the Constitution. It is a set of ideas that bonds Americans together.

 

Teenagers Are Cheap?

As a newly acclaimed Philosopher-without-portfolio, I have taken my responsibilities seriously, to think about whatever needs to be thought about–without restrictions. I recently completed and submitted my income taxes. Naturally, that involves a great deal of thought, usually such things as, “I need something for my headache,” or “I don’t usually drink hard liquor, but it’s beginning to sound better and better.”

I use TurboTax, which is causes mixed feelings. Yes, it is helpful and yes, it’s about 1/10 the cost of having someone prepare it for me; however, it’s parent company, and all the companies that have anything to do with tax preparation, were the ones who lobbied (a polite term for hiring and unleashing high paid but unscrupulous experts) to prevent the simplification of the tax code. After all, if taxes were simple enough to submit on a post card, these people might have to get honest jobs.

But I digress (it’s a philosophical thing).

One of the many oddities in the tax code is the child tax credit. This is means you can reduce your federal tax by up to $1000 per child. The criteria include that the child lived with you, is your dependent, you paid for their support (food, clothing, etc.). It also requires that the child be younger than seventeen.

Now, I’ll reserve my opinion about politicians, the Internal Revenue Service, lobbyists, etc., but do they have any idea as to how costs change as a child gets older. I could clothe both my kids for a year for the same amount of money as I now spend on their shoes. Once they hit that magic age to get a driver’s license, auto insurance increases.

With two teenagers with drivers licenses I spend as much on car insurance in two years as what my first house cost. One of them is away at college, can’t have his car on campus, but since it’s less than 100 miles, the price stays the same. Add in the class photos, yearbooks, formal dances, etc., and those incidentals for college, like books, tuition, room and board, and you get the picture.

But someone has decided that kids must be cheaper after they turn 17 and included it in the tax code. They must be in one of those states where recreational marijuana is not only legal, but can be written off as a business expense.

Freedom of the Press

In a discussion with my wife, I had one of those Eureka moments.

The Constitution speaks to “freedom of the press,” although we apply it to all media. What struck me today is that there is a significant difference between the press—or the written word—as opposed to other communications methods.

On television, we have twenty-ish minutes of “news” presented by anchors, or as they are commonly referred to as “talking heads.” With more than one newsreader on television, it is virtually impossible to dispense with the small talk when moving from one story to another. This injects the attitude or even the opinion of the newsreader into the message. In many cases—choose your network—the news is much closer to (or, indeed) commentary in support of an agenda rather than the news.

The press isn’t perfect, but a news item in print has durability, and that includes an extended time to challenge it. A printed version must be able to stand on its own today, tomorrow, next week, and perhaps into the next century. That is why the press is unique. In addition, in most major cities, anonymous comments are not printed the way they are online. If you have something to say, then you identify yourself as Thomas Jefferson, not “mount76”. Acknowledging authorship requires a whole different dynamic when responding. The press has far fewer—if any—trolls compared to online sources.

Journalism isn’t a lost art, but it’s best seen in print. The old story rings true:

A young reporter had submitted his story to the editor, who called him in. “This is good,” the editor began, “very good. However, you mentioned that Alderman Johnson responded angrily. How did you know he was angry?”

“Because he was shouting and his face was red!” replied the reporter.

“Then,” replied the editor, “that’s what you write—he was red faced and was shouting—but first you need to find out if he doesn’t always shout, and his face isn’t always red. If that’s his normal demeanor, then it is not worthy of mention.”

Fake News!

There is no truth to the allegation that Vladimir Putin said:

In America, people take advantage of other people.                                                       In Russia, it’s the other way around.

I just don’t know how such rumors get started!

It’s Different for Some People

Nice shirts!

I noticed that the story about the UCLA jocks who were arrested for shoplifting in China disappeared pretty quickly. Some stories stay on the Internet news sites as “Breaking News” for weeks, but not this one.

I wonder why.

You had to love the press conference that was arranged for their public apology where they were all wearing matching UnderArmour shirts with the UCLA logo.

Do you think they all might have stopped to buy those shirts together at the campus bookstore? I’m not saying the company gave them to the school, who then gave them to the ball players. But, then again . . . .

What if, instead of jocks, this incident had involved science, technology, engineering and mathematics students? Would the President have gone to the Chinese leader and asked for them to be released?

Silly question:

  1. Chinese e-commerce giant Alibaba would never invite boring science, technology, engineering, and mathematics students for an all-expense paid trip to China.
  2. Those are the kind of people who know that it’s wrong to steal sunglasses from anybody on any continent for any reason.

Good Old Virginia Politics

Greetings from post-election Virginia, the state commonwealth where gerrymandering isn’t merely a despicable political ploy, but a lifestyle. But then, when you’re home to the longest continuously running political fiasco legislative body, what do you expect?

Some of us wonder if the English who disappeared from the lost colony of Roanoke did so on purpose. They likely moved in with the Croatoan nation when they found out that these Native Americans did not engage in political campaigns. It can’t be proven, but no one has ever seen a Croatoan political poster, billboard, or campaign button.

I’ve enjoyed several days of not having to listen to negative campaign ads–Alleluia! The weird part is that all of these ads seem to be recorded using the same female announcer. Is she just so angry at the world that her voice is perfect for negative ads? Maybe she’s pissed off because negative political ads are the only type of gigs her agent can get for her? Maybe she’s angry at the world because she wanted to be an actress, but instead, the best she can do is to record negative campaign ads.

I think her friends ought to take her out for a few drinks and help her sort through her feelings; of course, that presumes she has friends, which, given her demeanor, may not be true. Now that I think of it, it may not be a good idea to take her drinking, anyway. She might be even more obnoxious after a couple of skinny margaritas.

In any case, the negative ads are over until the campaigns for the 2018 elections start cranking up.

In a week or two.

In the meantime, the worst I’ll have to listen to are those ads that run every three minutes for the personal injury lawyers as they promise to get the victim every dollar possible from the insurance companies. Less their cut, of course, and after tax, title, fees, and the dealer preparation charge.

Maybe that’s why I listen to so little radio and watch even less television. Give me a book; if I don’t like it, I can take it right back to the library—neither the book nor I any the worse for wear.

(Yes, I know the picture is of Huey Long from Louisiana–but he just so perfectly embodies the spirit of politics, yesterday and today.)

Educational Cause and Effect

I realize that people in general, and Americans in particular, have never been genteel when it comes to discourse. Throughout history we attributed it to our pride in rugged individualism and the Protestant work ethic. Anyone can be president; I can achieve anything I set my mind out to do; we celebrate Edison, Bell, Fulton, because those individuals invented things to change the world.

We claimed territory, as our right under “Manifest Destiny,” without regard to who or what stood in our way. Passenger pigeons? Bison? Native Americans? Forests? These speed bumps were quickly removed.

We settled our differences by swordfights or pistol duels. Our politicians—those we elected to represent us—settled arguments by shouting, spreading lies, and even bludgeoning one another with walking sticks in the very halls of Congress.

Not much has changed. Today, if you disrespect me, there’s today’s version of a duel—I drive 60 miles per hour through the neighborhood blasting away and hope that you are one of the people I hit. It doesn’t matter that: a) the bullet most likely will hit someone other than the intended target, and b) there’s a high likelihood that one (or more) of the gazillion security cameras will catch me and be used to send me away for twenty-five-to-life.

Today, there’s a lot of shouting, with nobody listening. It’s far more important that I get my position clearly stated—”I’m right and you’re not only wrong, but also an idiot—not to mention that your mother was ugly and you have terrible taste in clothes!”

Although I just clearly stated my position (the paragraph above, you buffoon!) you can’t tell me what it is. I can’t either, but that doesn’t matter, does it? The fact remains that I’m right and you’re wrong.

[Okay, let’s all take a deep breath, grab a cold one—if you like, and smoke ’em if you got ’em—assuming you can afford to pay eight dollars a pack.]

A theory—presented for you to think about and challenge in a professional, factual manner. Perhaps, when we began to focus on standardized testing, the school systems were forced to teach the correct answers, not how to arrive at a correct answer. What to think, not how to think. Ideas are no longer the raw material used for thinking; they are pre-packaged and ready to serve. No human interaction required.

There are parallels—in a world in which our youth do not know how to interact with others except via social media, we no longer teach etiquette or how to write a letter. They are not taught to introduce their friends to their parents or when a thank you note is appropriate. Civility is at the bottom of the required skills list.

Teachers didn’t make the rules and probably dislike them more than anyone although they have to abide by them.

But we all can teach. What if each of us added the following to our more contentious discussions:

  1. “Why?”
  2. “Tell me more.”
  3. “How would you solve it?”

Then listen—actively, intensively listen.

This just might prove interesting.

My Life in Guitars (Part 3) – the Desert

I’d been quite happy with my Peavey Predator, so although I looked—and occasionally drooled, I didn’t seriously plan to buy another guitar. I became a geo-bachelor in Oakland, California, and had my Peavey, but no amplifier. In my teeny-tiny one room apartment, I could hear my playing well enough to keep my sanity.

Then I got the word that as a reservist, I was being recalled and would soon be in Southeast Asia. Obviously, the military pretty much dictated what would go on the plane, so the word was—mail yourself the survival gear you’d need in a plastic footlocker, with the fiberglass reinforced packing tape in every direction. Contents included books, electronic games, civilian clothes (sometimes referred to as “mufti”), and, in my case, a small ham radio station. If the footlocker was shattered, the tape would keep everything together.

What? No guitar?

No guitar. I did not want my Peavey damaged, and, besides, the military exchange system was there to take our money and send us whatever we desired. I’d just order a new guitar once I got there.

I did.

The order was cancelled.

I placed a second order with AAFES (Army and Air Force Exchange System)—the store for our men in women in uniform who are deployed.

Cancelled again.

I called the AAFES command—I mean, why be a senior officer if you can’t call the military’s retail headquarters? As a civilian I can call Radio Shack headquarters—never mind.

When military are deployed their mail is routed through a system to an FPO (fleet post office) or an APO (Army post office) so that mail to overseas bases is treated—and costs—like it’s within the continental United States. However, AAFES claimed they didn’t ship to APOs or FPOs.

Huh? Isn’t that why the Military Exchange System exists?

I suspect that items like musical instruments are “drop-shipped” from the manufacturer directly to the customer. If the manufacturer was not located in the USA, then it couldn’t be sent as US mail to a US APO/FPO address. (Damn bean counters!)

Fortunately, I realized that the horse was dead, so I should stop whipping it, and went over its head, straight to . . . . . .

eBay!

Peavey Acoustic

I found a nice used acoustic guitar in the “Buy it now” section. I even talked with the seller (if you could dial back to a US base via the military system, you could then use your prepaid WalMart 5 cents-per-minute account to make a prepaid call elsewhere within the US). The seller was a nice guy who told me that he had changed out the bridge from white to black for a customer who changed his mind. Did I want it changed back?

No—just send it to me.

The vendor was either Music 123 or Musicians’ Friend—it doesn’t matter, they’re all part of the Guitar World now. The neat part was that for deployed military (you know, those with the dreaded APO and FPO addresses), these vendors, replaced the shipping cost with “Thank you for your service.” (To this day, they’re still my primary source for anything and everything musical—thanks, folks!)

For my new guitar, oddly enough I had picked a Peavey acoustic (imagine that). It arrived in short order in perfect condition. When I was “home” I tried to practice regularly and I also played at church. St. Augustine said that “He who sings, prays twice.” If you sing at a service at which I’m playing guitar, your prayers are probably worth a hundred-fold. On the other hand, one could always count dealing with my playing as penance.

After Mass one evening, Rubin, a fellow officer, approached me and asked if I wanted to play in a Beatles band. I laughed and pointed out my general (if not total) lack of talent, but Rubin (and I’m spelling his name the way I THINK he spelled it) said, “No problem, it was just for fun.” I thought about it, and figured that at the very least I’d get free guitar lessons out of the deal, so I agreed.

We didn’t get a lot of USO activity at our location, and what little we did always happened when I was on the road. There was a fair amount of excitement when a women’s volleyball team stopped by (so I hear) and Charlie Daniels performed, after which he autographed the guitar of one of the other Beatle band members. He had a black guitar with a mother-of-pearl Statue of Liberty inlay on the fretboard that had been custom made when he was stationed in Korea. Charlie signed it with a bold silver marker of some kind. The final result couldn’t have been more awesome.

But I digress, although I’m digressing about guitars, so it’s okay.

Just before Christmas, after weeks of rehearsing in a warehouse, WE became the USO show and did about 30 minutes of Beatles music for a crowd of fifty or so (after all, there was not much else to do if you weren’t on duty). However, a good time was had by all, and I had my 30 minutes of fame.

Next—a different guitar for an encore presentation.

Founding Fathers vs Today’s Leaders

In my many years, I have come to a conclusion that one useless man is a shame, two is a law firm, and three or more is a congress.

John Adams

The Founding Fathers, for all their myriad imperfections, did manage to design a workable form of government. The operative word is “work.”

The Congress was tasked with making laws, the President with either signing or vetoing those laws—although the President’s veto could be overridden with a two-thirds majority of Congress—and the judiciary with interpreting how the laws should be applied.

Congress is made up of two houses; the House of Representatives, with 435 voting members elected for two years, who represent the states and 6 non-voting members, who represent the US territories. The House focuses on the latest legal or social fad.

Each state has two senators, who are elected for six-year terms and are expected to be more deliberative and sophisticated. However, the Senate has spawned members like Joe McCarthy, who are generally dangerous to the country.

Sometime in the last century, Congress decided that certain laws would be unpopular, meaning that a member might not get re-elected and have to get a real job, so many laws were made by virtue of the decisions of the Supreme Court. This gave the members of Congress more time to pontificate and profess their principles without actually doing anything, other than raising campaign funds and running for re-election. Since this gave them more time to talk, even (if you ever watch C-SPAN) if most of their colleagues were not in attendance, they were happy. They rarely had to do anything, except talk, talk, talk. Making sense was optional (and rare).

On those occasions that Congress did pass a law, the law was prepared by lobbyists and most members of Congress were ignorant of most of its content (except for pork barrel amendments inserted to get them re-elected).

Eventually, the President wanted to get in on the action and began to issue Executive Orders. Even though the Constitution stipulates that Congress has the power to declare war, it has not done so since 1941. The Korean War, the Vietnam War, the Gulf War—and the sequel to the Gulf War, and the War in Afghanistan were not wars but “police actions” initiated by various presidents. While it may have been war to those who fought, were wounded, or died, Congress maintained plausible deniability by not declaring them as actual wars.

Executive orders worked so well that presidents began issuing them for whatever issue caught their attention at the moment. Some were good, some were not. The problem with executive orders is that they can be issued by one president and cancelled by the next.

How do we fix it? All we have to do is follow the US Constitution. If you haven’t read it within the last year, please do. It has been amended 27 times to reflect changes in society and its needs. For a copy, go to https://www.gpo.gov/fdsys/pkg/CDOC-110hdoc50/pdf/CDOC-110hdoc50.pdf.

Labor Day

According to the US Department of Labor, Labor Day was first celebrated in New York City in 1882, although there is some disagreement as to whether the machinists’ union or the carpenters’ union can claim credit. It was a municipal holiday, and other cities were invited to follow suit. After 23 states recognized it in 1894, the US Congress passed legislation making it a national holiday.

As one trained in management, it was repeatedly pointed out to us in college that the real job of management is to remove the roadblocks that prevent workers from being productive. Except in very small businesses, managers and owners produce no products nor do they provide services to the customer. Everybody’s paycheck comes from the efforts of the workers.

In many ways, we seem to have forgotten that and tend to believe that the people in the big offices and the expensive suits are the producers. Meetings don’t generate revenue. PowerPoint slides, slickly bound and printed reports, consume a lot of resources, but belong solely to the Expense side of the ledger.

Even as automation takes over many jobs, reports are that the demand for workers is increasing. The workers may perform different functions, but they are still critical to the process, no matter how much the elites may wish to believe otherwise.

Today there are many industries that produce nothing. Instead they move money around, mix it up, and in so doing make a profit. Some of this “profit” is virtual—it exists on paper, but may never translate into cash. Other profits occur when money is moved from one owner to another; this is a transfer—profit means that there is more, not that we’ve moved it around.

We are becoming a banking and finance nation, which is one of the places where a nation moves when it ceases to be great. The great nations of only a few centuries ago—The Netherlands, Spain, Portugal, France, Great Britain, etc. are only a shadow of their former selves.

So, to those of you who build, grow, design, or otherwise create, thank you. It’s your day—enjoy.

It’s Good to Be the Tsar!

putin

Vladimir Putin, according to reports, is wealthier than the next two richest people combined with a net worth of $200 billion. Pretty good for someone who grew up as Communist with enough commitment to work for the KGB.

His career with the KGB was unremarkable (his highest rank was lieutenant colonel), but once he got into politics, he found his niche. Trained as a lawyer, he adopted the Don Corleone business model (“One lawyer with a briefcase can steal more money than 100 men with guns.”–The Godfather). When the Soviet Union fell, various Russians began to acquire wealth. Putin apparently made many of them an offer they couldn’t refuse.

It might be good to keep that in mind before considering doing business with Putin.

Fixing Healthcare – Part Three

Physician’s Assistants (PAs) and Advanced Registered Nurse  (ARNPs) are helping lower costs and increase access. While some nurse practitioners, can operate relatively independently; other nurse practitioners and most physicians’ assistants, cannot. Why?

Physicians are adamant that they maintain a high degree of control over these and other healthcare workers. This is a throwback to the nineteenth century—which is kind of interesting in a weird sort of way. The story, and I cannot vouch for its accuracy, although all my research seems to support it, is that the country was besotted with traveling medicine shows hawking patent medicines (You’ve seen it in the movies—“One for a man, two for a horse”). The physician industry supposedly promised to get things under control if they were put in charge of medical practitioners, i.e., physicians and surgeons (MD). It, at best, minimized, if not blackballed, osteopathic physicians (DO), chiropractors (DC) and chiropodists, now known as podiatrists (DPM).

A physician, at the time, could authorize any hireling under his license to perform any duty under the concept that the doctor was “the captain of the ship” and was responsible for everything. Therefore, he had authority to authorize any employee to do anything—hopefully, but not necessarily, after some training.

Today, many non-physician healthcare workers are licensed in their own right; in most states this includes nurses (of all levels), therapists (of all varieties), and technologists (ditto). These people are trained and possess technical skills that physicians do not. Generally speaking, only television doctors leave their practice in order to operating high technology devices. It’s good theater but bad economics.

Many of the other healthcare careers such as nurse practitioners, physicians’ assistants, etc., have made significant advances Unfortunately, old attitudes die hard, and there are too many physicians who try to maintain an inordinate control over everything, including these other professionals. Nurse anesthetists and physicians’ assistance must be “supervised” by a physician, although such supervision does not require actual observation or even the presence of the supervising physician.

Efforts to keep others under control have led to some bizarre arrangements. In radiology, for example I’m told that the technologists are now required to periodically retake the examination that initially proved their competence even though there has been continuing education requirements for 40 years. If true, I believe this is a unique requirement, but a warning to all others. Of all the physicians’ assistants, only those specializing in radiology are not permitted to interpret x-ray or other diagnostic images.

Why?

Some blame the American Medical Association, a very powerful organization with effective lobbyists. However, it apparently speaks for a self-selected group of physicians. Out of 923,308 practicing physicians, the most recent numbers available indicates that only 228,000 belonged to the AMA. If you don’t round, that’s just less than 25 percent.

Nobel Laureate Milton Friedman and his wife, who wrote the book Free to Choose, asserted that the AMA functions more like a guild with the goal of increasing physicians’ wages and fees by limiting both the supply of physicians and the competition from non-physician groups.

This is yet another issue that must be addressed if we are truly interested in fixing healthcare.

Medical School Rationing

Fixing Healthcare – Part 2 — Doctors

I’ve known many intelligent, talented, committed young people who aspired to become doctors, but couldn’t get into medical school. Some were resigned to their fate and used their degree in biochemistry to become medical technologists; others made arrangements to attend medical school outside the United States—primarily in the Caribbean. In one case, in order to study at a school in the Caribbean, the aspiring medical student’s parents sold virtually everything to finance her education. She’s nearly complete with her rotations back here at US hospitals and plans on serving rural or tribal underserved areas.

While we don’t have enough graduates of United States medical schools, we grant 85,000 special visas to foreign medical graduates every year because it’s a “critical shortage.” Today, roughly one quarter of all practicing physicians are foreign medical graduates. I’ve worked with many, and while their initial desire is to return home, after about six months the sports car and the arm-candy significant other appears. When I ask if their plans have changed, I’ve been told, “If I return home, I will be paid in chickens and melons. If I stay here, I will be paid in dollars. I like dollars better than chickens and melons.”

So, we import thousands of non-American doctors every year even though we have many Americans who want to study medicine but are turned away.

A decade or so ago, when more students wanted to study law, the educational industry had no difficulty in adding seats—even if they had to build new schools. Why won’t (not can’t) we do the same for medical schools?

Some claim there wouldn’t be enough residency opportunities if we graduated more doctors from US schools, yet foreign medical graduates can and do get residency positions at US hospitals. In any other industry, this might be viewed as restraint of trade.

I suggest that the goal of US medical schools should be to increase their capacity so that by 2030 ALL US residency openings can be filled with US citizens who graduated from US medical schools.

Next, I would change the entry criteria to include the following:

  1. Accepting students with a commitment to actually practice medicine; better yet a commitment to practice whatever type of medicine is in short supply, wherever needed, for at least three years. After that, every accommodation should be made to place that individual in a residency or fellowship of their choosing for which they have the talent, without a decrease in salary.
  2. While academic achievement is important, the ability to work as a team is critical. History is full of brilliant people who didn’t succeed because they could not work with others, and medicine is now a team sport—whether the person with MD or DO after their name likes it or not, they are teammates with the nurses, technologists, therapists, etc. No one is a superstar.
  3. Children of doctors or other elites should have to prove themselves more—not less—than other medical school candidates. They’ve grown up exposed to the field, often in an environment of privilege, so they should demonstrate their desire to serve, not their pedigree.

In short, we need more doctors, but our current method of selecting them is less than optimal.

Fixing Healthcare in America

First in a series

To correct healthcare and get costs under control, we must first acknowledge, then change the healthcare industry’s unique and outrageously dysfunctional business model.

  1. Physicians and other practitioners who decide which resources will be used in a hospital are often neither the direct provider, the one who pays, nor the beneficiary of the service. Basic economic rules, therefore do not apply. Medical tests, which are intended to provide information that will in some way impact the patient’s course of treatment, don’t. Many test and other procedures are ordered even when the outcome of the test will in no way affect the treatment of the patient or its results.
  2. Medical products and services are priced without any rationale. Often, prices are set artificially high in order to allow large discounts to insurance companies. This means that patients without insurance can be charged list price; eighty dollars for an aspirin or $100 for a BandAid®. Hospitals, which were once a ministry, stewardship, or public service have changed their priority to the bottom line. Some hospitals now own and operate their own collection agencies augmented by a small army of lawyers to guarantee that they collect what they have billed. This is why it is not uncommon for a small-town hospital to have millions of dollars in the bank—and still retain their not-for-profit status.
  3. And the insurance companies that get those big discounts? The hospital needs a staff of trained bureaucrats to generate the paperwork that is sent to the insurance company in order to receive payment. Payments may not be received for several months (for the MBAs out there—remember the first rule of finance—a bird [dollar] in the hand is worth two in the bush [accounts receivable]). When payment does arrive, administrative staff must reconcile the payments and file additional paperwork as necessary. All this adds to the hospital’s costs without adding any value. The insurance companies, on the other hand, are usually quite profitable, even after spending a lot of money on lobbyists. But just like Don Corleone said, “It’s nothing personal, it’s strictly business.”

So, what do we do?

First, it would be valuable to have the physicians evaluate how tests really affect the outcome for their patients and develop appropriate protocols. Malcolm Gladwell relates an excellent example in his book, Blink. The cardiology staff at Cook County Hospital was able to reduce tests while simultaneously improving patient outcomes.

[Gladwell, Malcolm (2005). Blink: The Power of Thinking Without Thinking. New York: Little, Brown.  ISBN 0-316-17232-4 (Especially the chapter on Cook County Hospital Cardiologists)]

Second, revise medical pricing so that it reflects reality—and that must include adequate margin to offset costs for necessary but expensive services. Emergency rooms are expensive to operate while an intensive care unit for patients suffering from burns is actually cost prohibitive. However, hospitals have an obligation to the community to provide necessary services—either directly or by affiliation—to the community. The community, in turn, must ensure the hospital is resourced to provide a wide range of services. If hospital prices reflected cost plus a reasonable margin to offset other costs, and everyone paid the same price—patient or insurance company, it might lead to more rational decisions—outcomes first, but economics as a consideration. If Grandpa—God love him—is a 96-year-old heavy smoker with high cholesterol and other morbidity factors who was hospitalized because of a stroke, a battery of tests that will not affect his quality of life or his longevity are not appropriate, and the insurer should not be expected to provide carte blanche payments. However, if the prices are realistic, the family may decide that they would be willing to pay for those additional procedures on their own.

Third, emphasize cooperation over competition. Is there any other business, other than hospitals, that would allow someone to work in their facility AND directly compete with it? Radiologists have their competing imaging centers, surgeons may have their private surgery centers, etc. Should specialty practitioners be entitled to benefit from the hospital’s patients and compete with the hospital for those same patients? It should be the practitioners’ choice—one or the other, but not both.

Two excellent resources for these issues are:

Brill, Steven (2015), America’s Bitter Pill: Money, Politics, Back-Room Deals, and the Fight to Fix Our Broken Healthcare System. New York. Random House. ISBN 978-0812996951

Rosenthal, Dr. Elisabeth (2017). An American Sickness, New York: Penguin Press. ISBN 9781594206757

If you want to fix American healthcare, pass this along to your friends, neighbors, doctor, etc. I’ll get a lot of hate mail, but we need to have the discussion.

More to follow.

The Decision and the Declaration

Today, on July 4th, we celebrate the Independence Day, when the Declaration of Independence was approved by the Continental Congress in 1776.

However, history is more interesting than just the event and the date.

On June 7, 1776, the senior Virginia member of Congress, Richard Henry Lee introduced a resolution stating:

Resolved, That these United Colonies are, and of right ought to be, free and independent States, that they are absolved from all allegiance to the British Crown, and that all political connection between them and the State of Great Britain is, and ought to be, totally dissolved.”

Congress adopted the Virginia motion on July 2, 1776, thereby refuting our status as a colony; this is why John Adams believed that we would celebrate our independence on July second, the date of the decision.

The Declaration of Independence was approved two days later, on July 4, 1776.

While the Declaration of Independence is a masterpiece, and I recommend that everyone read it today, it was not the decision, but merely the explanation to the world as to why the decision had been made. Although we have seen many portrayals of all the Founding Fathers assembled together in Independence Hall to sign the document on the fourth of July, most, but not all, signed on August second; one signer, who was not a member of the congress until later in the year, signed in November.

As is often the case, history is more complex, and far more interesting than the snapshot presented in civics class.

* Thanks, once again to Wikipedia. If you use it, kick in a donation—even a dollar helps.

 

Memorial Day

Graves at Arlington on Memorial Day.JPG

 

I don’t celebrate Memorial Day.

I do cook out and consider it to be the summer season and I enjoy the three-day weekend, but celebration brings to mind happier events. I do not wish people a “Happy Memorial Day.” Instead I observe Memorial Day as a day of remembrance, when we honor those who gave, in Abraham Lincoln’s words, “The last full measure.”

There arguments as to how it started, but even though decorating the graves of fallen warriors is an ancient tradition, it took root in America after the Civil War. The Civil War was devastating not only in terms of bullets, but disease that swept through the armies before, during, and after the battles.

The North credits the Grand Army of the Republic—the veterans of the Union military—for starting it in 1868. They called it “Decoration Day” because of the flowers on the graves; its first observance was on May 30th because that date did not coincide with any significant Civil War battle.

There are others (including the US National Park Service) who claim that it began in Columbus, Georgia in 1866. There it was called “Memorial Day,” although after the North co-opted the idea (and the title), they called it “Confederate Memorial Day.” There was not a specific date throughout the South.

There is one other theory.  In South Carolina, Union soldiers were held in a makeshift prisoner of war camp that was actually a race course.  At least 257 Union soldiers who died in the camp were buried in unmarked graves. In 1865 freedmen—African-Americans who had been slaves—cleaned and landscaped the site and built an enclosure with an arch that said, “Martyrs of the Race Course.”

Regardless of its history, we now celebrate it on the last Monday in May with lots of sales at every retail store, and not enough thought of those who died in while in the service.

For clarity’s sake:

Memorial Day—the last Monday in May—honors service members who died while serving.

Veterans’ Day—November 11th commemorating the Armistice of World War I, which occurred at the 11th hour on the 11th day of the 11th month—honors all who served in uniform.

Armed Forces Day—The third Saturday in May—honors those currently serving.

 

 

The Candidates (Revised)

After being politically correct for the past few weeks (some by omission), here we go.

The Clintons at the Trumps’ 2005 Wedding

 

Now that the presumptive candidates (and, they’re both quite presumptuous, thank you [rim shot—bada-bing]) are in place, the world is beginning to react.

Great Britain: “I say, old chap, do you miss King George the Third yet?”

Vladimir Putin (AKA Russia): “Of course this is all according to my plan, but I assure you that no Russian military troops were involved!”

Mexico: “Here’s our counter offer:

  1. “We are willing to pay to build a wall, but we propose a different—but better—location. The wall would be more beneficial to the citizens of both countries if it were constructed about fifty meters outside the right-hand lane of I-495, thereby encircling Washington, DC. This would help maintain control of politicians’ entry into the United States of America mainland.
  2. “The wall will be funded by charging a toll for travel through the numerous tunnels that already exist under the border between our two countries. Since the tunnels are well-engineered, structurally sound, well lit, and either paved or equipped with rail service, it should be easy to add electronic toll transponders. Of course, after the election, there may be many US citizens who will utilize the tunnels to head south in a search for a more placid place to call home, and they would be responsible for paying the toll as well. Please ensure that the EZ-Pass transponder system deposits the fees into Los Estados Unidos de Mexico National Bank.
  3. “Incidentally, we revised our immigration laws in 2011. If you’d like a copy, you can easily get it online.”

North Korea: “As a gesture of confidence in our future relations, we would be most willing to host any of your e-mail servers. I assure you that the DPRK has many well-trained computer specialists, and we would treat your computer as we would treat one of our own.”

Canada: “Hey! No way, hoser! Take off, ay? There are reasons that we prefer to be neighbors rather than family. We like our prime minister just fine, thank you, since he’s cultured and refined. Besides, our beer is much better than yours!”

Lies, Damn Lies, and Statistics

The media try to help everyone avoid facts that might interfere with their willingness to accept, without question, the latest sound bite. Combine these efforts with an overall lack of critical thinking skills and a lack of understanding of mathematics among the population and it’s little wonder that we are in the position we are today. With the possible exception of big pharmaceutical companies, no one understands this better than politicians.

Take the debate swirling around firearms, for example. It is rife with anecdotal stories and inaccurate generalizations that lead you to the conclusion that murder most foul is rampant. However, according to a study by the Pew Research Center, gun deaths grew from 6.6 per 100,000 people in 1981 to a high of 7.0 per 100,000 in 1993, then dropped to 3.6 per 100,000 people in 2010. The Center for Disease Control and Prevention, on the other hand, reported 10.6 per 100,000 people in 2010, which then dropped to 3.5 per 100,000 people in 2013. Although each group gathers their data differently, the conclusion is the same—deaths due to firearms are lower than 35 years ago. Interestingly, they’re at about the same level as deaths due to automobile accidents.

Then there’s the brouhaha over photo identification in order to vote. The purpose, to prevent voter fraud seems reasonable, as does the statement that you need a photo ID card to get a library card, etc. However, is voter fraud really a problem, and if so, how much of one? Figures are difficult to find, but according to NBC in 2012, “A new nationwide analysis of 2,068 alleged election-fraud cases since 2000 shows that while fraud has occurred, the rate is infinitesimal, and in-person voter impersonation on Election Day, which prompted 37 state legislatures to enact or consider tough voter ID laws, is virtually non-existent.” That’s quite a crime wave—about 172 alleged cases throughout the country, every single year. I’m not certain what other crime occurs at a similar rate—attempts to steal the Statue of Liberty?

Then there’s the arguments between Pro-Choice and Pro-Life (arranged in alphabetical order). The emotional issue that always comes to the forefront is that it would be wrong to deny abortions to victims of rape or incest. Is that a significant group? Needless to say, accurate statistics are difficult to find, but the most frequent numbers buried in the fine print are either “one percent” or “less than two percent.”

I am not attempting to sway your opinion or your vote. I am merely demonstrating how so many issues are presented in a manner so as to elicit an emotional response rather than a rational one. As Jethro Tull sang, “I may make you feel, but I can’t make you think.”

Think back to school when your math teacher deducted points from a test because, even though you had the correct answer, you didn’t show your work. The media has mastered the technique of not showing its work (and some might claim it’s on purpose). In many cases the media loves to report a percent, but rarely do they share the denominator. The number upon which the statistics are based.

What is a 50 percent increase? If you start with 100,000 a 50 percent increase leads to 150,000. Of course, if you start with two, you can claim a fifty percent increase if you get to three.

As the political ad barrage season begins, ask yourself:

  • Is this a significant issue?
  • Is this an issue that can be resolved, or is it an emotional issue?
  • Are those making claims telling “the truth, the whole truth, and nothing but the truth?”

You may have to do a little research (Isn’t Google Wonderful?) to determine what the real facts are, but trust me—it’s worth it.