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Wednesday, February 27, 2013

Medical Training


The medical training and compensation world has changed a lot in the past 30 years. The millionaire physicians of the '80's have largely died out thanks to the cost of medical education and the rise of interest rates and insurance companies following Medicare's lead in lowering compensation.  I have a concerned doctor's response to Slate's America's Overpaid DoctorsTime’s long investigation of American health care prices missed one thing: We pay our doctors way too much." 

As an aside, Time magazine's feature article this month,  Bitter Pill: Why Medical Bills are Killing Us, I would recommend to anyone to better understand the behemoth that health care in the United States has become after the emergence of large hospital groups, which in turn arose in response to the rise of medical supply companies and insurance companies. Healthcare indeed gets higher profit margins than anywhere else in the private sector. Generally speaking - this doesn't mean that doctors and all hospitals operate this way, and particularly not smaller community doctors and hospitals.

Here's the response to the Slate article, though: found in the comment section.
This "journalist" needs to interview some doctors.  
 
Pardon me if I am myopic about this topic and only examine it from my perspective, but my perspective is important and deserves to be noted. 
 
I am a Family Physician, practicing in the medical trenches of rural Kansas. I deliver babies, take care of inpatients, run a busy outpatient clinic, all for approximately $30 per hour, usually working over 100 hours per week. ON TOP of that, I cover call for our very busy ER for our community about 20% of the time. For this additional load, I am paid $17 per hour. I could make much more working in the city, but I love rural America, and I feel like I make a difference and that I'm appreciated for it. I don't complain about my income, but compared to many I have a right to. 
 
My young children have asked my wife "if daddy is coming to visit today" because I'm gone to the hospital so often. My family pays the price for my career calling. 
 
Meanwhile, our small hospital, due to bad debt and declining payments from Medicare, Medicaid, and insurance companies barely breaks even from year to year, and hasn't been able to invest in infrastructure. Our hospital staff (myself included) has had one small raise in 5 years, and it was a fraction of the cost of living for a single year. 
 
I recently quietly endured the whining of an entitled patient who is a 20 year-old union truck-loader for a well-known shipping company as he complained about his hourly wage, which was twice what I make. Where I get my 12 year old pickup serviced, they charge $60 per hour for labor. 
 
I'm not trying to be a martyr here, honestly. I went into this work with eyes wide open, and this lifestyle was my choice. But there are few people like me. And this brings me to my point: 
 
I should be paid LESS? REALLY? Let's get out of the ivory tower and enter the real world. Who do you know in the current "Millennial" generation who is willing to go to college, med school, and residency for a minimum of 11 years, accumulate a quarter-million dollars of education debt, and then work 100+hour weeks (minimal fun personal time!) for less than the neighborhood mechanic? Seriously, with Obamacare expansion, we're going to need you to give us about one hundred thousand names of motivated socialist humanists who are ready to make such a Mother Theresa-esqe commitment (oh, and they need to be able to get into, survive, and pass medical school).  
 
"OK, well we can just hire an army of nurse practitioners!" you assert. Your quoted research is not based on reality. The average nurse practitioner has an average of 500 hours of supervised medical practice, where the average Board Certified Family Physician has over 18,000. Whom would you have take care of you in the ER when you have a difficult to diagnose and potentially life-threatening problem? Does this question even need asked? 
 
I have helped scores of patients who were misdiagnosed and mismanaged by a mid-level practitioner (PA or NP--Physician's Assistant or Nurse Practitioner) who was practicing virtually on their own. Mid-levels have a major role to play out here, but it's NOT in solo practice. We have 4 mid-levels in our group and they all do an excellent job, partially because when there's something that they can't handle, they call a doctor and we help them. Which, is, of course, the idea. 
 
Last year a member of this community who had Lou Gehrig's Disease had been misdiagnosed for over a year. After his 3rd trip to his local solo-practicing NP, he finally sought an opinion from one of my partners, a Family Physician, who quickly made the diagnosis from his history and exam alone. The man died 2 weeks later from this devastating illness. Had he gone to a Family Physician or a mid-level with proper supervision, he would have had a year to plan, get what treatment is available, and make arrangements. We have many stories like that.  
 
If you're trying to save money, here's something you can take to the bank. I *GUARANTEE* that replacing the primary care workforce with undertrained "mid-level practitioners" will save money, but that savings will come at a devastating price: human life and human suffering. I'm already seeing it every week. 
 
Real solutions to this crisis: 
1) MAJOR TORT REFORM. This has been avoided by current administration altogether because of political corruption. Savings: tens of billions. 
2) COMMON SENSE END OF LIFE CARE. This sounds harsh, but the fact is, we all die eventually. We must stop putting people who are doomed on dialysis, in the ICU, & in the cath lab. Savings: tens of billions. 
3) ENCOURAGE QUALITY PRIMARY CARE AND PREVENTION. You won't get this product without paying for it. Pay good primary care docs what the specialists make. 
4) INSURANCE REFORM. Allow competition. Punish corruption. 
5) STRICT TERM LIMITS. Minimizing legislative corruption will help achieve the first 4 items in this list. 
6) MINIMIZE GOV'T INTRUSION: Face it, they bankrupt everything.

Here's a current medical resident's comment on the same subject:
As one currently training in medicine I can tell you that given the amount of work I’m putting in (and have put in), the amount of debt I’ve undertaken, and my future earning potential, medicine is definitely NOT worth it financially. I am doing to this to care for others, not for the money. However, even at present levels medical school is almost financially unfeasible for many young people. Lowering physician compensation will discourage the brightest minds out there from becoming your doctor, as well as lead to increasing numbers of physicians leaving medicine sooner which will only worsen current shortages.
Allow me to enlighten you of the plight that young people thinking about a career in medicine face. I was a good student and had a full ride scholastic scholarship for college so I had no undergraduate debt. I went to a top ten medical school with an $80,000 scholarship, and my family was on Medicaid to further help us save $40,000 in insurance premiums during that time. We lived frugally, but in spite of the $120,000 assistance I’ve just mentioned, after four years of medical school I had $230,000 of debt. Interest rates are 6.8% and compounding throughout my residency training so by the time that I will finally have a physician salary, at age 36, I’ll have around $340,000 to pay off. If it had not been for my $120,000 in assistance, I would have around $520,000 debt from medical school alone.  
My specialty’s average salary for a newly practicing physician is about $160,000 per year. So while I pay off my loans let’s assume that I will live at the standard of the US median household income of $46,000, the government will take about $39,000 in taxes (FICA, fed/state income tax), which leaves me $75,000 to pay toward those student loans (which are still compounding at 6.8% costing about $23,000 in annual interest).  At this rate, it will take me six years to pay off my loans, at which point I will be 42 years old when I can finally start living above the average US household standard of living and saving for retirement. If I had the full $520,000 debt it would take me ten years to pay off those loans, at which point I would be 46 years old when I could finally start living above the average US household standard of living and saving for retirement.  And remember that I had no undergraduate debt either, but many students do.
In the meantime, for years on end I have been sacrificing almost all of my evenings and weekends to studying, waking at 3:15 am to begin long days of surgery training, working 30 hour shifts, and otherwise giving all of myself to the pursuit of serving others through medicine. That is what physicians do. So I’ll let you ask yourself the question posed by this article, do we really “pay our doctors way too much”? You can be the judge. 

Tuesday, February 26, 2013

Keep your eyes on this

This from American Spectator makes the most sense in explaining what's at stake in this sequester battle that I've come across thus far.
Instead of allowing the Pentagon — and the rest of the agencies — to manage their money by moving it between accounts, the Obama-congressional sequestration mandates cuts across the board. Because of this, major weapon system contracts will be cut back or canceled, the flow of new technologies defense depends on will be interrupted, and the resulting mess will end up costing taxpayers more in the long run for what could and should be bought now. And the stuff that shouldn’t be bought at all — e.g., Navy Secretary Ray Mabus’s incredibly wasteful “green energy” program that pays hundreds of dollars for a gallon of algae-based fuel instead of regular diesel fuel that could be bought for $3.20 a gallon — will continue to be bought but at even higher prices.
Sequestration prevents money management and Congress isn’t going to fix that before Friday. Obama wants the pain to be felt so that spending can be restored. The only thing we can predict is that as soon as sequestration happens, Congress will remain in crisis mode trying to fix sequestration so that the pain is reduced.
The only way Obama will allow that to happen is if spending is restored, minuscule cuts are imposed, and taxes are increased again. The “balanced” approach he preaches is nothing of the sort. When Obama says “balanced,” he means that more spending is paid for by higher taxes. He won’t agree to spending cuts, so the only way Congress can fix the problems created by sequestration is for Republicans to surrender — again — on taxes and spending. 
That, at least, is the current political wisdom. And it’s wrong. If congressional Republicans try to fix the sequestration problem now, they’ll lose the battle because they gave away their leverage in January. 
Last month, congressional Republicans kicked the federal spending problem down the road until May, foregoing the debt ceiling debate they should have insisted on. That means the sequestration problem shouldn’t be dealt with until then, when they regain their leverage. 
It also means that they have more than two months to revise the deeply-embedded political equation. 
I don't know what will happen, but I don't know that I'll be surprised with whatever happens. The Republicans are spineless enough for anything. Yet Obama's been bullying them so much that they may just stand their ground. Of all the options, the best option (at least according to the American Spectator) I think is the least likely to occur, though it would make a lot of sense to do exactly as is written here - supposing this is a good representation of all that's at stake.

Monday, February 25, 2013

Federal Budgets: Case in Point

found this about the National Renewable Energy Laboratory, located in Golden, CO. They are the secretive national lab behind defunct Abound Solar and the push for ethanol, among other things. They get paid and pay too well:
It’s also the place where highly paid staff decide how to spend hundreds of millions in taxpayer dollars.
And the public pays those decision-makers well:  NREL’s top executive, Dr. Dan Arvizu, makes close to a million dollars per year. His two top lieutenants rake in more than half a million each and nine others make more than $350,000 a year.
As if that isn't bad enough, take their operating budget as a function of time:
Funded by the U.S. Department of Energy, NREL started in 1977 as the Solar Energy Research Institute, a Jimmy Carter-era response to the 1973 Mideast oil crisis. Its budget, then about $100 million, was slashed during the Reagan era.
By the time Perlmutter was elected [in 2006], NREL’s budget was $209.6 million. It increased steadily before ballooning to $536.5, a beneficiary of President Obama’s stimulus plan and a $135 million contract spread out over five years to construct a new science center. Its current $352 million budget is down slightly from last year’s $388.6 million. 
This is exactly what I mean when I say that all federal budgets increase annually by as much as 10%, regardless of necessity or federal revenue. This is exactly what I mean when I say additional funding is rolled into the next year's baseline for calculating the new budget. Federal budgets compound. They increase exponentially. The drop in budget in 2013 is a slight surprise, but that may be because of how the stimulus money was spread out over time. $352 million is still a far cry from the $209.6 million just seven years ago! Likewise the $209.6 million is nowhere near the $100 million it began with some 30-odd years earlier - even with cuts during Reagan.

Again I say: the federal government is growing and it has officially outpaced the growth in the private sector to the point that the private sector will never grow and can never grow (and fund government sustainably) unless we get spending cuts. Period. Government growth is a big reason for the economic hardships we face, but when that debt bubble collapses it will be far worse. (Read the link for more.)

You may say that it's too late to do anything, that no one will ever go for spending cuts and there is no way we can force our legislators to do what we want them to do anyway. This is only true to a point. To the point that we are willing to open our mouths and talk about what the government is doing to our economy and the consequences of continued federal government growth in the long term (not only the short term as the media and various administrations are bent on doing) we will see changes and hope. Already fiscal conservatives are improving their ground games to meet just this objective.


Saturday, February 23, 2013

Mental Illness and LDS membership

Of course there are plenty of "crazies" who belong to the Church of Jesus Christ of Latter-day Saints just like within any other group of people, and I've interacted with quite a few of them myself.  I really appreciate this man's story about how he deals with his mental disorders onset late in his life, how he still tries to live the gospel as much as he can within his personal limitations (as described), and more importantly how he rightly asks for understanding.
However basic this may sound, if I could convince readers of one thing in this essay it would be this: Mental illness is real. I can't count the number of times when people have suggested, in essence, that I just "get over it." Or the number of times my wife has had to explain why I don't sit with the family in sacrament meeting and she gets doubting or disapproving looks. Mental illness is a real medical condition, and it's hard enough when people believe you; it's infinitely worse when they don't, or when they offer cures that obviously don't understand the problem. (No one gives a pneumonia patient a book about how to think happy thoughts in order to cure their pneumonia.)
Fortunately, church leadership seems to understand this much better than the layperson; I don't know if it's because they get training, or if they're in tune with the spirit, or simply have a lot of experience, but Ive been blessed to have bishops who have been completely understanding and whose counsel has been consistent with that of my doctors. Elder Alexander Morrison, of the First Quorum of the Seventy, published a book on the subject, "Valley of Sorrow: A Layman's Guide to Understanding Mental Illness," in which he states:
No small part of the suffering experienced by those with mental illness is the direct result of the ignorance, prejudice, and wrong-headed thinking of family members, friends, business associates, Church members and others. I firmly believe that as in other areas of life, conveying the truth is the key to banishing ignorance, stigma and prejudice that surround mental illness. Such truth will, I trust, encourage sufferers from mental disorders to seek appropriate and ecclesiastical and professional assistance, and help dispel their own debilitating fears, feelings of guilt, and self-doubt.

YES, YES, YES! Erase the stigma already! Sorry to beat a dead horse. Except that most people don't know it's dead, I think. I'll get off my soap box now and leave you with this man's conclusion because it's so beautiful.
And in all of these solutions, the real key is obvious: Love unconditionally; seek to understand; act with kindness. It's the solution to dealing with those with mental illness, but it's the very core of the gospel itself.

LDS Missions

The Church of Jesus Christ of Latter-day Saints announced a policy change in the ages acceptable for missionary service this past October. Men may now serve as young as age 18 instead of 19 with a high school graduation or its equivalent, and women may serve at age 19 instead of 21. This announcement was met with an enormous surge in applications - beyond a four-fold increase in applications processed each week!
Further, Purdy noted that "slightly more than half of the applicants are women." Prior to the announcement, women made up 14 percent of full-time LDS missionaries.
This is exciting for us Mormons.

More exciting still are the changes being made to LDS missions to accomodate this surge in missionary service. Many missions within the United States will roughly double the number of missionaries serving within it since foreign visa levels will remain essentially unchanged. Missionaries from foreign countries will continue to predominantly serve in their own areas and boost the numbers of missionaries within their own countries. However, now 58 new missions (split off from preexisting ones) have been announced. Here's what that means in the long term:
"Of course, there will be a surge that will last for about three years," he said, alluding to a "pent-up demand" in the numbers of young people now able to serve missions as a result of the lowering of the age of eligibility.
"But what we are doing is building and creating missions to what we expect will be needed after the peak part of the surge. So we anticipate not needing to close any of the missions as we go forward."
Thus, even after the surge, the number of missionaries will be much higher than what it has heretofore been, Elder Evans said. 
If you are interested in the what new missions have been created or the new mission presidents, please go here.  Mission presidents serve for three years and new ones are called once each year for a third of all missions, so the number of mission presidents on that list (on the link) represent about a third of all LDS missions plus 58 more. Missionaries serving in a mission that will be split will staff both the original mission and newly formed mission along with many new missionaries sent to both.


Friday, February 22, 2013

The world of Medical Costs

Time's lead article is Bitter Pill: Why Medical Bills are Killing Us. It is well researched and well written. It takes some serious time to read (I haven't even yet finished it - it's 11 internet pages!) but if you want to better understand what is broken in our healthcare system I recommend reading it anyway. Obamacare is rightly blamed for not bringing down costs at all, but even exacerbating them. From what I can tell thus far, the litigious world (and lack of tort reform in Obamacare) we live in is not blamed for the unnecessary expensive cutting-edge medical testing which healthcare providers and doctors order to cover their backs in the event of a lawsuit, which is called practicing defensive medicine. This is, however, a big reason for costs whether or not that aspect of medical costs is investigated. The costs charged by healthcare providers (especially large hospital systems) are exorbitantly inflated for those on insurance, to be sure, but that problem is deeply described in the article. The problem is an antiquated "chargemaster" system, from which costs are adjusted upward annually even if prices have dropped for a given product or service in the real world. For more on this topic, please read the actual article!

UPDATE: medical tort-reform was appropriately mentioned:
His rationale speaks to the real cost issue associated with medical-malpractice litigation. It’s not as much about the verdicts or settlements (or considerable malpractice-insurance premiums) that hospitals and doctors pay as it is about what they do to avoid being sued. And some no doubt claim they are ordering more tests to avoid being sued when it is actually an excuse for hiking profits. The most practical malpractice-reform proposals would not limit awards for victims but would allow doctors to use what’s called a safe-harbor defense. Under safe harbor, a defendant doctor or hospital could argue that the care provided was within the bounds of what peers have established as reasonable under the circumstances. The typical plaintiff argument that doing something more, like a nuclear-imaging test, might have saved the patient would then be less likely to prevail.
When Obamacare was being debated, Republicans pushed this kind of commonsense malpractice-tort reform. But the stranglehold that plaintiffs’ lawyers have traditionally had on Democrats prevailed, and neither a safe-harbor provision nor any other malpractice reform was included.



Thursday, February 21, 2013

This chart says it all













*Image found here.

See that? The debt took off at a gallop as soon as Obama took office, and it wasn't growing slowly before that. The Federal Reserve is buying oodles of US debt these days. I don't like that. I don't know what it means, exactly, but I don't trust the Federal Reserve to act in the interest of the American public. Shoot! Racking up debt at all isn't in the interest of the American public!

Think of it this way. The US is spending more money every year "in the interest of stimulating the economy" so they say. All that it means is that the markets won't adjust to reality for longer. The more artificially inflated the economy, the greater the difference between the economy before and after the debt bubble burst.

The harder we'll fall.

If, on the other hand, if we prepare for the eventual inevitable collapse of the debt bubble (similar to the housing bubble in fate) then we'll experience less pain overall because we won't have spent even more and made the collapse more precipitous.

If we elect politicians who are seriously committed to financial reformation then a) we can preserve entitlement like Social Security and Medicare for the future. There is no such guarantee of their existence once the debt bubble collapses. b) it might incentivize a more responsible, efficient government rather than the one full of waste and corruption we have now. And c) we can privatize many elements of government to contribute to the efficiency and effectiveneess of certain programs, likewise stimulating the private sector where all money is made and where the economy grows.

You cannot grow the economy by enlarging government. Government is a leach using up money created in the private sector. It has its place, to be sure, but that place is not in parasitically devouring its host as is its course at present.

Give me spending cuts! Even the sequester doesn't involve real cuts - just cuts to the projected increase in budgets. Every single year since 1974 the federal budgets have increased annually by as much as 10% regardless of revenue or necessity. Any additional funding awarded provides the basis for the next year's budget calculation. Exponential growth.

Needless to say though I'll say it anyway, this is unsustainable (as admitted by the GAO audit/report) without an exponentially growing private sector to support it (which we do not have). Needless to say though I'll say it anyway, all the taxation in the world (taking private sector funds) cannot pay for this kind of spending. It must stop.

Now, the Democrats and their buddies the media won't show you charts like these or do anything other than agree with each other that life is fine with liberals in power (and vice versa), but it doesn't make it true! Don't say you have not been warned. The media's failure to report things that should concern us all as Americans merely makes them not worth your business.

Wednesday, February 20, 2013

Mental Health Advocacy

The former Representative Patrick Kennedy resigned, in part, because of issues with mental health. From a recent report by conservative paper Deseret News (link above):
Since leaving Congress, Kennedy has not only gotten well, he has also made the leap from mental health poster boy to mental health policy advocate. Shortly after leaving Congress, he helped launch One Mind for Research, an intensive 10-year project designed to unify and advance treatment research on mental health and substance addiction.

This can only mean good things for mental health care. We need to have these conversations! The stigma against talking about mental disorders is hurtful to everyone, not just the few percent who suffer from or know someone well who suffers from mental illnesses. It is the lack of this discussion and resultant inadequate mental health care and mental health policies that contributes to the Adam Lanzas of the world.

However, why can't I find any mention of Patrick Kennedy's mission in the news beyond his actions are as a recently resigned representative back in May 2011? That was the last media mention made, and it was only on HuffPo and CNN, not the big ones like ABC/NBC/CBS/WashPost/NYT. Some few smaller local papers (like Deseret News) have written about him, but not many.

This is a rare instance where proper media attention could do a world of good. Yet they drop the ball. To this day they'd rather talk about the liberal ideology behind gun control (prohibited the Constitution) than the mental illnesses behind the mass murderers - who can easily and effectively stopped by, yes, guns.


Tuesday, February 19, 2013

The Income Tax

A week or two ago, I found an article explaining shell companies and how state and country laws can manage to keep them away or become shell company havens. Now, get this:
Meanwhile, many ultra-wealthy Americans and many of the most profitable corporations in the country pay little to nothing in taxes.  In fact, as you will see below, there are dozens of very prominent corporations that make billions of dollars in profits and yet don't pay a dime in taxes.  Tax avoidance has become a multi-billion dollar industry in the United States.  Those that have the resources to "play the game" use shell companies, offshore tax havens and the thousands of loopholes in our tax code to minimize their tax burdens as much as possible.  Meanwhile, the rest of us get absolutely hammered.  This is fundamentally unfair.  The federal income tax system is irreversibly broken at this point, and it is time to abolish it.  If you think that the federal income tax system can be "fixed", then you probably have never studied it.  
It's true that politics is all a game in politcian's minds, including those who run companies and are big donors - I lump with in with the politicians with whom they play the game.  Maybe that's why so many of them seem to feel it's no big deal to cheat and lie - it's only a game in their minds. You can tell a lot about someone's personal morals by how they play games. This is a sideline, however.

As far as taxes goes, why do businesses get taxed directly at all? The employees are already taxed. Why does the government want to tax the profits a certain company makes (for those without lobbyists, at least) at all, when that money is reinvested in growing the company and hiring more employees - more taxpayers? That doesn't make sense. If a company is investing in stocks, I have no problem with taxing that interest, but if the company is taxed just on profits, it cuts the rate of growth that could be achieved. I don't believe for a second that taxing businesses is fair when their employees have already been taxed - supposing that their employees make more than the line at which refunds occur (varies depending on credits). However, I do not support American companies "growing" their holdings internationally while not paying US taxes on that interest.

We absolutely  need a fairer system such as the 10% across the board rate that Dr. Ben Carson proposes - not that the politicians in Congress will ever give us one, because they're mostly part of that elite who get around paying taxes themselves and they're the ones writing the laws to soak the middle class and spare the rich. I'm not naive enough to think that abolishing the income tax will solve America's problems either.  We've spent far too much borrowed money for that.


Monday, February 18, 2013

Technological Advances in Energy

I found a most interesting report (at least to nerdy me) about something that may just bring the Keystone Pipeline into a reality:

Spawned in space, the latest in pipeline leak detection systems can save lives, save the industry money, and has the potential to do the unthinkable: bring environmentalists and industry leaders together. 

If you're interested in how it works exactly, then use the link above. I'll spare you the nerdiness here! But the cost?
Pipeline operators could spend 10 times more on than they currently do on leak detection and still end up spending less than they do in response to accidents.
Sounds like a deal! Let's hope that the environmentalists who have Obama's ear (and that of Democrats in Congress) agree. The world runs on fossil fuels whether they like it or not, and the industry as a whole has already come a long way in protecting the environment as well as demonstrating that fossil fuels are by no means running out.

"Green" energies are their own problem - they  just don't compare in productivity, safety, or affordability in comparison with traditional fossil fuels. Yet. I'm not saying they should give up research and development, but I am saying that green energies need more time and testing before forcing them upon the public. Mercury light bulbs costing folks  $2000 in hazardous waste removal if they break, for example? Chevy Volts spontaneously combusting? No thanks.

Meanwhile the "green" crowd publishes faulty information against safe and effective practices in the world of fossil fuels such as fracking. If you don't know much about fracking, please consider reading that article linked - it is scientifically based instead of hyped-up rot claiming to be scientific.

An "all of the above" approach should most certainly include the vigorous development of proven resources, such as the Keystone Pipeline and will have the added benefit of providing employment and stimulating the economy. Call or contact your Congressmen today.


Friday, February 15, 2013

Bureaucracy

The VA struggles with delays and errors greeting returning warriors.
The processing time for disability claims at the Department of Veterans Affairs worsened in a majority of its regional offices last year, and the VA has struggled with its much-anticipated plan to correct its problems, according to two recent audits and a review of department data.
The result for veterans is longer waits – often for disability decisions that are incorrect.

Read more here: http://www.mcclatchydc.com/2013/02/14/183132/as-va-struggles-delays-and-errors.html#storylink=cpy
Needless to say, our veterans deserve better.
The Government Accountability Office, which functions as Congress’ investigative arm, said the VA is proceeding without a clear, comprehensive plan. (...)
According to a McClatchy review of department data, the performance at regional offices deteriorated throughout 2012. The department’s long-term goals are that no disability claim is pending more than 125 days and that errors occur in just 2 percent of claims.
From fiscal 2011 to fiscal 2012, the VA's processing speed jumped from an average of 188 days complete a claim to 262 days, according to the VA. The error rate went down slightly, from 16 percent to 14 percent.

Read more here: http://www.mcclatchydc.com/2013/02/14/183132/as-va-struggles-delays-and-errors.html#storylink=cp

Read more here: http://www.mcclatchydc.com/2013/02/14/183132/as-va-struggles-delays-and-errors.html#storylink=cpy
Those are absolutely horrible rates compared to the private sector, just as healthcare claim fraud is rampant in Medicaid and Medicare but virtually nonexistent in the world of private insurance. Can you imagine what you would do if your insurance company took so long to process claims and made so many errors? You'd switch providers if at all possible!

Need I remind you that bureaucracies have now taken more formerly private health care and we await the same fate as Obamacare continues implementation? The benefit of privatized systems is that companies compete for your business. They have to be competitive by offering up-to-date services at a cost competitive with other businesses or you the customers will switch providers. Errors cost private companies money, business, and threaten a companies' existence if not resolved (Carnival Cruise Line is a great example for the time being).

In comparison, when the VA (or any other government entity) runs low on funds they just slow down their services because "customers" have no alternative. There is no where else for them to go, no where else to turn. This is why privitization of most government bureaucracies would be more efficient, cost-effective, and produce better results for consumers!


Thursday, February 14, 2013

Tolerance: a civic virtue

In my neck of the country, Valentine's Day celebrations have disappeared from public education alongside Halloween, Christmas, Easter, Hannukah, and everything else. Pretty pathetic, if  you ask me. Kids like to have fun and Valentine's Day hasn't been a religious holiday for decades if not longer!

I don't understand why Christians aren't acknowledged the right to be offended (by the left) when their beliefs are confronted either with the nature of scientific instruction or by the removal of any remotely religious element in public education, while those who are offended by any religious "instruction" are allowed the right to change education for everyone else.

Here's the deal. If atheists or agnostics or secularists don't want to believe in God, that's fine. If they want to teach their children not to believe in religion, that's also fine. But when they want to teach my children and any other child that religion is to be shunned, mocked, and ridiculed (with the help of the ever-complicit liberal media) that's not fine at all. I've said this before. Tolerance is a two-way street. No, I do not approve of the sentiment expressed in the bumper sticker below: tolerance should not be conditional.


Wednesday, February 13, 2013

Gallup results


This is the Gallup poll showing just how unpopular Obama's positions are (and why the GOP shouldn't cave in to him). Will this poll make a difference in governance? No. Unlike Bill Clinton who was very interested in his popularity and polled even about where he should go on vacation, Obama seems to be purely agenda driven. When his agenda doesn't work and instead makes existing problems worse, he doesn't care to change his position, but digs in his heels- with the media happily trotting along side him despite all the failures. 

Obama probably thinks that if he had more things in his direct control he'd be more successful at implementing his Eurporean-style agenda, yet what he's done thus far would suggest otherwise. Consider the wise words of Dr. Ben Carson, admonishing the administration for their bullying and lack of consideration for those in the areas of expertise in their policy changes such as Obamacare (see yesterday's post).


Tuesday, February 12, 2013

Haley and Carson on Obamacare

Nikki Haley, governor of South Carolina, on Obamacare and her refusal to set up a state exchange in her state. (Note there are 20 states total who have refused to set up an exchange). 


But let us ask a simple question.  “Are taxpayers getting the most health for the money they spend on health care?”  My answer is no – not by a long shot. We spend more money for health services per person than any nation on earth. Year after year we devote a larger and larger portion of our paychecks, our payrolls and our state and federal budgets to health care services. Maybe we wouldn’t worry about all of this spending if our outcomes were better, but they aren’t. The United States is falling behind the rest of the world in infant mortality and life expectancy – and here in South Carolina we have one of the lowest life expectancies and highest infant mortality rates in the U.S. With such high costs and such poor outcomes, why would we throw more money at the system without first demanding improved efficiency, quality, and accessibility? The Affordable Care Act, known as ObamaCare, says expand first and worry about the rest later. Connecticut expanded early under ObamaCare and just reported a $190 million Medicaid deficit – in spite of subjecting their citizens to a massive tax increase. California just raised taxes in part to cover their Medicaid deficit and yet needs $350 million more to pay for ObamaCare next year. That’s not us.   That’s not South Carolina.
Thank you Governor Haley. Please consider running for president in 2016. Conservatives desperately need more leaders like you out there in the public square. Read this partial explanation for her stance on states' independence in healthcare:
She went on to explain the current state of healthcare in South Carolina, saying “We started with one of the lowest rates of insured children in the country and now South Carolina is recognized for leading edge strategies to start to cover kids. We started with mental health and addictive disorder programs that have been really cut, we’ve reinvested in both of those. We didn’t have a lot of accountability in our Medicaid program. Now we have really gone after getting the most quality of health for the cost that we’re spending. The focus that our country needs to have on healthcare doesn’t need to be on cost as much as it needs to be on outcomes, because we as a country, we’re falling behind on infant mortality, we’re falling behind on life expectancy and money’s not going to fix that problem. What will fix that problem is when we start demanding that we have efficiency, quality and accessibility and that’s basically what South Carolina wants to do. So while Obamacare says, you know, go ahead and expand this and we’ll deal with it later, well that’s what Washington, DC has done for years and that’s why we’re in the mess we’re in. South Carolina is not going to do that. What we are doing is we’re saying we’re going to start to improve healthcare and we’re not just complaining about Obamacare, we are actually doing things.”
Someone else is vocally standing up to criticize Obamacare in a publicly recognized arena, and that is Dr. Ben Carson. He is a top-of-the-line neurosurgeon at Johns Hopkins who grew up as an impoverished African American in Detroit, yet was taught (and learned) the value of education. He spoke at the prayer breakfast, recently, saying important things like incentives in our health care policies, etc. Here are some of the things he has said:
DR. BENJAMIN CARSON: There are a group of people who would like to silence everybody and have everybody go along to get along, but that's not going to be very helpful for us in the long run, in terms of solving our problems. And somebody has to be courageous enough to actually stand up to, you know, the bullies. (...)

DR. CARSON: Here's my solution: When a person is born, give him a birth certificate, an electronic medical record, and a health savings account to which money can be contributed -- pretax -- from the time you're born 'til the time you die. When you die, you can pass it on to your family members, so that when you're 85 years old and you got six diseases, you're not trying to spend up everything. You're happy to pass it on and there's nobody talking about death panels.
Number one. And also, for the people who were indigent who don't have any money we can make contributions to their HSA each month because we already have this huge pot of money. Instead of sending it to some bureaucracy, let's put it in their HSAs. Now they have some control over their own health care. 

DR. CARSON: There’s no question that [President Obama] has advocated, you know, basically a policy of tax the rich. And I have advocated a policy that comes from the Bible, which is a very fair policy of proportional taxation. If it was good enough for God, why wouldn’t it be good enough for us? The minute you deviate away from that, you begin to get into all kinds of biases. And one could legitimately make the argument that the rich pays too many taxes. The top 1% pays 37% of the taxes, the top 5% [pays] 59% of the taxes, but they don't make that much of the income. One could make that argument. (...)
 NEIL CAVUTO, FOX NEWS: Obviously, you got a quite a round of applause there. Some in that room and elsewhere since that video has gone viral have said you should run for president. What do you think of that?
DR. BENJAMIN CARSON: Well, actually I've had people tell me that for many years now. If I had a nickel for everybody who told me that, I could finance my campaign.
Yes, please!


Monday, February 11, 2013

Shell Companies

I'm not a businessman. I know next to nothing about illegal or legal business activities. Yet I find articles about studies like this one in the Deseret News fascinating, probably because I find the business world so mysterious. Here is the study:
The study entitled, “Global Shell Games: Testing Money Launderers’ and Terrorist Financiers’ Access to Shell Companies” found that nearly half of corporate service providers around the world do not collect legally required identification from customers seeking to form a shell company.
Tax havens like the Cayman Islands complied with international laws far better than many wealthy nations, the study found.
Shell companies have no assts [sic] or employees and are established to conduct transactions and have other legitimate uses. However, when when company owners are anonymous and untraceable to law enforcement they become potential vehicles for bribes, money laundering and financing of terrorism.
Here is how a shell company works to evade the law.
Such shell companies can be set up online in dozens of countries in days or even hours for as little as a few hundred dollars, he said. The companies that cannot be linked back to the real individuals in control can create near impossible obstacles for regulators and law enforcement officials to overcome, the report stated.
He said he biggest problem was in wealthy nations, including Canada, England and especially the United States. In the U.S., corporate law is handled by the states, he said.

And the findings? This is the part I find most fascinating.
Conversely, he said it would be very easy to get an untraceable shell company in Montana, Nevada, South Dakota and Wyoming.
“Easier than almost anywhere in the world,” Nielson said. The places that rivaled those states where the nations of Kenya and our neighbor to the “Great White North”, he said.
“Canada is very bad,” he said. “It’s easy to get an anonymous shell company in Canada.”
Nielson said having such lax laws makes those places much more susceptible to potential criminal activity.
“It makes them havens,” he said. “(Those states) make it easy to incorporate anonymously and therefore facilitate illicit movement of money.”
He noted that New York was “not much better.”  
No surprise to me about Nevada and New York, but I am a little surprised California and Illinois aren't on this list too! Those states, as poorly managed as they are, must be doing at least something right.

Saturday, February 9, 2013

Bush plan?

Apparently the mental health plan pushed forward by the Obama administration is very similar to the one pushed for by George W. Bush. This is the first I've heard of a previous plan. That says enough about Bush's media coverage right there. They ignore anything good about Republicans but can't find anything wrong with Democrats - which also tells you why you need to read both sides. You miss out on way too much information otherwise!

And what happened to Bush's proposals? No one seems to know.
The group of lawmakers has re-submitted the list of Bush recommendations to HHS Secretary Kathleen Sebelius and are requesting to be updated on what happened with them when Bush originally put them forward. 
The lawmakers asked Sebelius to provide them with answers by Feb. 21st. 
Good luck with that, lawmakers.

Friday, February 8, 2013

The most bizarre thing I've ever read

The dude writing The Economic Collapse Blog is a scare-mongerer, but he brought to my attention the existence of a world central bank in Switzerland, which controls all the other central banks without any oversight from any country or group of countries and all its meetings are top secret! Meaning, the Bank for International Settlements is mysterious at best and the most powerful bank in the world at worst, controlling directly or indirectly the economies of most countries, and all countries to the extent that we share a global economy.

The most interesting thing to me is that he backs up his assertions very well from other sources like the Wall Street Journal and CNBC, meaning it is real! I don't know whether we should be scared of it or not, but it is real and we do know a few things about it and the things we do know should be alarming to everyone outside the elite.

Quoting from the middle of his post:

In a recent article entitled "Who Runs The World? Solid Proof That A Core Group Of Wealthy Elitists Is Pulling The Strings", I included a quote from Georgetown University history professor Carroll Quigley from a book that he wrote all the way back in 1966 in which he discussed the big plans that the elite had for the Bank for International Settlements...

[T]he powers of financial capitalism had another far-reaching aim, nothing less than to create a world system of financial control in private hands able to dominate the political system of each country and the economy of the world as a whole. This system was to be controlled in a feudalist fashion by the central banks of the world acting in concert, by secret agreements arrived at in frequent private meetings and conferences. The apex of the system was to be the Bank for International Settlements in Basle, Switzerland, a private bank owned and controlled by the world’s central banks which were themselves private corporations.
Back then, the Bank for International Settlements was only just starting to play a major role in global affairs. But over the years the BIS began to become increasingly important. The following is an excerpt from an article by Ellen Brown...
For many years the BIS kept a very low profile, operating behind the scenes in an abandoned hotel. It was here that decisions were reached to devalue or defend currencies, fix the price of gold, regulate offshore banking, and raise or lower short-term interest rates. In 1977, however, the BIS gave up its anonymity in exchange for more efficient headquarters. The new building has been described as “an eighteen story-high circular skyscraper that rises above the medieval city like some misplaced nuclear reactor.” It quickly became known as the “Tower of Basel.” Today the BIS has governmental immunity, pays no taxes, and has its own private police force. It is, as Mayer Rothschild envisioned, above the law.

OK, that's disturbing. A democracy doesn't function well if a few people or groups are above law. We're all supposed to be subject to laws equally! He then explains why the markets jump when Bernanke talks but not Obama - because Bernanke controls the money (and he says that Bernanke takes orders from the BIS, which he backed up with a source, on investorsinsight.com ).

Here's the other bit you should read if you don't hop over to The Economic Collapse Blog to read it all in its entirety:

 The Bank for International Settlements is above the law...
Maybe we'd feel better about the BIS if it were more transparent, but most everything about it, including its bi-monthly member and board meetings, is shrouded in secrecy. And perhaps more worrisome is that the BIS is free from oversight. By rights granted under its agreement with the Swiss Federal Council, all of the bank's archives, documents and "any data media" are "inviolable at all times and in all places." Furthermore, officers and employees of BIS "enjoy immunity from criminal and administrative jurisdiction, save to the extent that such immunity is formally waived . . . even after such persons have ceased to be Officials of the Bank." Finally, no claims against BIS or its deposits may be enforced "without the prior agreement of the Bank."
In other words they can do whatever they want, without consequences. How's that for a leak-proof legal umbrella?
If the BIS wants to "intervene" in the financial markets, they simply just do it.
If the BIS wants to bail out big banks or even entire nations, they simply just do it.
The BIS reminds me of this old joke...
Q: Where does an 800 pound gorilla sit?
A: Anywhere it wants to.
So what is next for the Bank for International Settlements?
Well, many have speculated that eventually the goal is to have just a single global currency which will be administered by a single global central bank. The BIS is already using Special Drawing Rights (SDRs), which are considered to be a precursor to the coming global currency. The BIS played a big role in the adoption of the euro, and more currency integration is almost certainly on the way in future years...
But in the end, how you feel about the BIS may come down to how you feel about a one-world currency. The bank was a major player promoting the adoption of the euro as Europe's common currency. There are rumors that its next project is persuading the U.S., Canada and Mexico to switch to a similar regional money, perhaps to be called the "amero," and it's logical to assume the bank's ultimate goal is a single world currency. That would simplify transactions and really solidify the bank's control of the planetary economy.
But if the United States ever did give up the U.S. dollar, it would be a massive blow to our national sovereignty.
When someone else controls your money, it doesn't really matter that much who makes the laws.

It's a good thing to be aware of, if nothing else. It's not like we can do anything about the BIS directly - they're above all laws!

Meanwhile, the Fed bought more debt than the treasury issued.



Wednesday, February 6, 2013

"Pearls of wisdom"

For those of you unfamiliar with Rush Limbaugh's show, you should know that he understands and explains the liberal news media better than anyone else out there (which is why he is regularly demonized by said media).  Prime example right here:

"The 16-page memo, a copy of which was obtained by NBC News," which means the administration gave it to 'em, "provides new details about the legal reasoning behind one of the Obama administration’s most secretive and controversial polices: its dramatically increased use of drone strikes against al-Qaida suspects abroad, including those aimed at American citizens."
Remember all the grief that George Bush got for warrantless wiretaps on phone calls?  Do you remember that?  I remember when Bush was president, the American left was literally having conniption fits.
Does that mean Nixon coulda killed Bill Ayers?  It does mean that.  Bill Ayers or the Weathermen. He had an active plot against the US, bombed the Pentagon.  If Nixon had assumed the kind of power that Obama's assuming, he could have sent a commando team out to wipe out Bill Ayers.  You can't kill rogue leaders.  No, you cannot.  By law, we cannot assassinate foreign leaders.  We can now kill Americans, as long as we say they are related to Al-Qaeda somehow.  And that link isn't too tough.  Al-Qaeda hates America.  All you have to do is hate America and it could be said that you are an associated force. 
Remember all of the anger that the left had over waterboarding.  And look at this now.  I think I have this right.  Constitutional scholar Barack Obama is demanding the right to kill American citizens without making his case to a judge, as long as he thinks the American in question is in an upper tier of operations of Al-Qaeda or a related group.  But he can't waterboard the guy.  You can kill him, but we can't waterboard him.  We can kill the son of a..., but we can't torture him.  Have I got this right?  I think I do.  I thought you should know. 


 Take this, for another example:
Now, in this story, the New York Times cites a professor who says, quote, "Voting is one of the most sacred rights you have.  They should make it as painless as possible," implying that it's really painful now to vote.  It's really hard.  It's too hard.  The Republicans are out there demanding everybody have a picture.  The Republicans are demanding that everybody who vote actually be a citizen.  The Republicans are demanding that everybody who vote actually be registered.  That's too hard.  And it's undemocratic.  And the justices have gotta sweep all these restrictions away.  
Now, is voting any more of a sacred right than owning a gun?  Because these same people want to make that as painful as possible.  Same people, same people want to make owning a gun as painful as they can make it, and voting as painless as they can make it.  " "With studies suggesting that long lines at the polls cost Democrats hundreds of thousands of votes in November, party leaders are beginning a push to make voting and voter registration easier, setting up a likely new conflict with Republicans."  Now, what does voter registration have to do with long lines to vote?  Voter registration doesn't have anything to do with Election Day.  But it will.  Because if they get their way you're gonna be able to do both on the spot. On the spot registration, you register, then you go vote, same thing, same time.  Yep.  That's the next phase. 

And another:
Now, on health care law: Actually, the original number was $900 billion, and the Iraq war cost was a trillion. We were actually gonna "save" $100 billion by doing Obamacare. Now they're saying that the overall ten-year cost is $1.3 trillion, and that is going to escalate even more. Now, here's a piece in TheHill.com. I'm not gonna read a bunch of excerpts, but I'll just tell you this. If you read to the middle of this piece, you'll find all you need to know about this supposedly "nonpartisan" CBO.
Here's what it says: "The CBO has concluded that health care reform, in spite of its price tag, will ultimately reduce the deficit because of revenue-raisers within the bill."
Whereas, "A House GOP bill to repeal the law would raise the deficit by $109 billion over about 10 years, the CBO said in 2012." You see? The cost of Obamacare, $1.3 trillion, will lower the deficit. But doing away with it would raise the deficit. I kid you not. That's what passes for "nonpartisanship" from the Congressional Budget Office, and it's what passes for news. So we're gonna spend $1.3 trillion that we don't have, and somehow we're gonna lower the deficit.


Rush Limbaugh is also a master of seeing the consequences and political reasons behind the moves of politicians and their policies. Take this, as yet another example (and for full context and explanation please follow the link):
"This brings us back to Kasich and his decision." Now, again to refresh your memory, remember Obamacare has a bunch of cuts. From Medicaid, it cuts $700 billion. See, they had to bring Obamacare in under a trillion dollars. They didn't have to, but they wanted to as a means of telling voters it wasn't gonna cost anything. The Iraq war... Remember these numbers? The Iraq war cost us a trillion dollars, and so they said, "We're gonna end the Iraq war, and we're gonna do health care. So it's a net wash in terms of money at present being spent. There no new money!"
This is what they said. But in order for them to be able to say that (with a wink and a nod), the number as scored by the CBO had to come in under a trillion dollars. Well, the way this was achieved, in part, was the federal government, via Obamacare, makes the states pick up all these Medicaid expenses. All of it. That was the only way to do it, because the states can't print money like the federal government can. They have to come up with the money.

Tuesday, February 5, 2013

Education and Choice and Open Minds

A Democrat head honcho for education in Washington D.C. understands the school voucher system benefits! I appreciate this because this lady took time to listen. She had her opinions but decided she wanted to listen to the parents and understand their points of view, and from that experience she learned that she does in fact support school vouchers. It was no longer logical for her to say that we should all just wait a few more years for the system to be fixed while kids suffering in failing schools were denied a chance for a decent education.

I'd be willing to bet (if I were a betting person) that Democrats might change their minds on quite a few liberal policies if they learned about the inevitable unpleasant consequences. Democrats in power like to stop conservative changes in policies as Obama did in 2009 - because they work, and they won't stand the other guy's ideas working and not theirs. They do it through the courts (legislating from behind the bench) and sometimes through executive action as Obama does. All of it is technically unconstitutional, but with the courts stacked with mostly liberal judges, what can anyone do about it?

It's all about power in the Democrat book - not what's best for Americans. Yet Americans always act in their own best interests according to their best knowledge and understanding - not as a group, collective, or voting bloc.

If people took the time to listen to conservatives, they''d learn a thing or two about gun control consequences, health care exchanges, immigration policies, high taxes on any income level, the effects of overregulation, and most importantly the state of our economy as directed by Obama and his ilk: benefitting the very class he says he despises and hurting the rest of us. Conservative positions (NOT Republican positions necessarily) are all common sense once you look at the effects of various laws and policies.

Note that the liberal media doesn't ever report conservatism that way, instead demonizing any conservative position, but that doesn't mean they're right. They're in the same boat with the Democrat Party. You cannot trust a foe to praise the strengths of its enemy.

Most fascinating read of the day

In my opinion.

Tea Pary 2.0: Focus on the four R's and Fight Back is posted at RedState, written by a self-described "former mobilization coordinator for the other side." In other words, Tea Party, you need a ground game! With the RINO Republicans now organized against conservatives and the Democrat/media machine effectively obliterating the Tea Party in the minds of unaffiliated Americans before they get a chance to define themselves, this is definitely a top priority to conservatives.

Here's a bit of his introductions:
While their naivete is not their fault, I was left wondering: Where has all the money gone from all the donations given to the legacy groups? Though it is, in many cases, too late now, why didn’t anyone teach these amateur leaders of a movement how to lead a movement?

And here's a bit of the four R's he mentions. If you conservatives don't read the full article, at least read this much.
Rebrand: ...There has been a target on the big tent called the Tea Party, and the assaults have come from all sides–nearly destroying the tent and turning people away from the essential ideas that originally spawned the Tea Party: Fiscal Responsibility and limited government.
As a result, activists need to think differently.
One such way would be to break off into smaller, more mobile groups that are less identifiable, yet just as effective as the original army of activists once was.
Keep the mission, dump the name, go forth and multiply.  
RetoolOne of the major disadvantages of the Tea Party movement has been the unwillingness of certain legacy groups (as well as grassroots groups) to work together, to share technology, information, as well as on-the-ground efforts for GOTV. (...)
Rebuild: ... Move beyond the “Obama did it again…” emails and establish a mission and vision that your group stands for—one that can be articulated in messaging, that others will find appealing.
Then, develop a simple way to communicate your message to people of like mind. It’s called recruitment and really isn’t that difficult.
As I told the group last Monday, if 50 people recruited five people each, then you’d have 250 people. If each of them recruited five more, then you’d have 1250 and so on.
It’s called the Power of Five and it works for both building a movement and getting out the vote.
Re-engage: ... Get over it. (...)  The other side has been doing a better job of it, but not all is lost.
Unlike the Left, there are no union treasuries to fund our activities, nor can we fight full time. However, with minimal dollars, and more focused collaboration, America can be restored. 

As much as I hate sales personally, I recognize this sort of plan as exactly what conservatives need to  restore America to founding principles including fiscal sanity. We all know that the media isn't going to tell Americans anything that hurts Democrats' chances including the full truth about the debt, spending, failed policies, etc. It is up to us to reach the low-information voters and nonvoters. Polls still show that a majority of Americans trend conservative. If we fail to do reach out to them and translate this majority into votes, we have only ourselves to blame for a permanent Democrat takeover.