Friday, August 28, 2009

Squaring the Circle

The blog The Gormogons has a post by Ghettoputer, Doctors and the CIA, that discusses an ObamaCare issue that has also been puzzling me.

Conspicuously absent from the bill is any mention of tort reform regarding medical malpractice. When Howard Dean was asked why such reform was not addressed in the bill he bluntly answered:

"Here’s why tort reform is not in the bill. When you go to pass a really enormous bill like that, the more stuff you put in it, the more enemies you make, right? And the reason that tort reform is not in the bill is because the people who wrote it did not want to take on the trial lawyers in addition to everyone else they were taking on. And that is the plain and simple truth."
It is generally accepted that the real cost of malpractice law suits is not so much the cost of settlements, but rather the need for doctors to practice defensive medicine by ordering the maximum number of tests conceivable in any diagnosis.

ObamaCare attempts to address that problem by establishing boards, agencies and the like that will review medical best practices and mandate the scope of what treatments and tests should be performed (and for those who, like me, are too lazy to read the bill The Gormorgans has a good series of posts where he live blogs his reading of the bill in 100 page chunks).

That is ObamaCare seeks to reduce medical costs by setting up a set of guidelines that will free doctors from the need to do unessential medical procedures to protect themselves from lawsuits. Ignoring for the moment any questions about the wisdom of such a remote "top-down" approach to diagnosis, I wonder how malpractice suits will be impacted by the bill, especially in light of the fact that trial lawyers are such an important Democratic constituent that no attempt to reign them in is even considered?

The obvious answer is that, while the government insurance plan will be shielded from malpractice suits, the private insurers will still be exposed to them. However, it is rather more complicated than that, because over time the private insurers will be rolled into the treatment and testing guidelines mandated by the government. Would all insurers then not be shielded?

What then of the powerful trial lawyers lobby?

I think Ghettoputer might have squared that circle when he considers Holder, and the CIA investigation. The CIA interrogators had acted under Congressional and Justice Department review, yet at this late date the rules can simply be shifted and their cases opened again. Will the doctors end up facing a similar set of fluid rulings?

If they and private insurers are allowed to layer supplemental insurance on top of a government mandated minimum, does Holder and the CIA set the precedence of the rules being redefined after the fact move them into malpractice territory? Will that be the hidden fund the trial lawyers can expect to draw their settlements from?

Tuesday, August 25, 2009

Roh-oh! Bill might be in trouble again...

...but this time not with Hillary.

In addition, individuals interviewed during the Review identified other techniques that caused concern because DoJ had not specifically approved them. These included the making of threats, blowing cigar smoke, employing certain stress positions, the use of a stiff brush on a detainee, and stepping on a detainee's ankle shackles.

Saturday, August 22, 2009

The Political Theater of the Absurd

In Henan Province, China, a local ordinance requires that the road-facing sides of all adobe or brick homes be painted white or blue. This is apparently an attempt to address urban blight by making people improve their properties.

This has translated to grand facades, like the one shown to the left, being attached to decaying houses.

Looking at the picture, I wondered why a poor Chinese villager would spend so much money building such a ridiculous facade instead of just improving their home? Were these facades status projects, a brick and mortar version of a peasant's "Sunday Best", or were they something else altogether?

An article in Weird Asia News sheds some light with the following:

When the time arrives for inspection, the view is always from a passing car and there is no way for those inspectors to know that behind the shining walls lie deteriorating adobe homes. (Whether or not they would care or not if they knew the truth is another issue.)
Keeping up appearances often comes at a terrible price. This ordinance is vainglorious and obviously only a band-aid solution to the growing problem of urban decay and neglect. In addition and even more insulting to the local populace, this ordinance is a non-remedy sponsored by wasting taxpayers’ money.
How much better could these funds have served the local peasants and farmers who need financial aid so badly?
Ah, it all becomes clearer. Chinese tax dollars at work under the unerring hand of a bureaucrat. There is a certain mad logic at work; it is the appearance of urban decay that disturbs the passing inspectors, so a bit of whitewash and plaster is all that is needed to solve problem. No doubt the expenses saved go into the nearest deserving pocket.

This post is of course an extreme example; none the less, the problem with large government solutions is that you can't distill the scoundrels and buffoons out of them. Worse, once in place the scoundrels and buffoons become the voice of authority. So, when you need your faucet to stop leaking, like it or not you end up with a two-story monstrosity tacked onto your hovel instead.

What could possibly go wrong?

Monday, August 17, 2009

Mongolian death worm revealed

That's it - I'm canceling my vacation to Ulan Bator.

I recently stumbled across an article detailing the plans for an expedition to locate the fabled Mongolian Death Worm.

What is a Mongolian Death Worm you ask?

The Mongolian Death Worm is a creature rumored to live in the Gobi Desert. It is said to hide in the sand and spring out to spit a fatal dose of acid on its prey (which includes humans). Also, if you try to sneak up behind one of the worms it will jolt you with a lethal bolt of lightning it shoots out of its butt.

This summer two New Zealand TV journalists, David Farrier and his cameraman Christie Douglas, have mounted an expedition to try to document one of the beasts. They have already left for Mongolia. Like most of humanity, I'm waiting with baited breath to hear their results.

The accompanying photo is of the camera man Douglas. I assume the microphone is to catch Farrier's screams as he gets fried by an electric bolt, or whimpers as his face is being melted by acid.

Apparently, much like the Grabazoids in Tremors, the Death Worms are attracted to vibrations, so they plan on blasting off a lot of dynamite to attract them. Sounds like a plan to me. You can read more about their expedition, and even donate to it if you're in the mind to fund oddball scientific endeavors, at their website Death Worm 2009.

Tuesday, August 11, 2009

ObamaCare -- a return to house calls?

Obama's remarks about the postal service got me thinking... why not combine ObamaCare with the Post Office to form a new Federal Agency to handle both?

It would not only be super efficient, it would also extend much needed, and healthy, competition for not only UPS and FedEx, but also to BlueCross/Blue Shield and other major insurers.

Also, along with your mail, you could get medical house calls to aid you with your coughs, colds, bumps, bruises and end-of-life planning.

Finally, if Obama played his cards right in appointing the first Surgical Post Mistress General, he could solve the problem of African students getting yelled at for asking about you-know-who.


Monday, August 10, 2009

Analysis of Talking Points Against HR3200 (Healthcare/Insurance Reform)

Old Lurker, a regular on Just One Minute, posted an email he had received listing a bunch of talking points against HR 3200, the House Healthcare/Insurance Reform Bill. The Bill is 1018 pages long, and creates a bureaucracy of commissions, commissioners, task forces, study groups, funding for all of that and, incidentally, some general requirements for public and private health care which will be supplemented by the usual Regulations to be developed by the bureaucracy this monstrosity creates. I have undertaken to compare the talking points in the email with the parts of the Bill it cites for its points.

Here is the first installment:

Pg 22 of the HC Bill MANDATES the Govt will audit books of ALL EMPLOYERS that self insure

Not exactly. This section sets up a committee to study and compare large market self-insured and employee benefit plans, including financial solvency of the employers providing self-insured plans.

Pg 30 Sec 123 of HC bill - THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you receive

This is essentially true. The committee will be patterned on the current committee that does the same thing for Medicare

Pg 29 lines 4-16 in the HC bill - YOUR HEALTHCARE IS RATIONED. You can only receive a certain amount of "care" per year

This is inaccurate. The annual limitations specified in this Section ($5,000 per individual and $10,000 per family) relate to co-pays or cost sharing by the insured, not to services covered by the plan.

Pg 42 of HC Bill - The Health Choices Commissioner will choose your HC Benefits for you. You have no choice.

The statutory language is ambiguous on this point. The HCC has this duty under Section
142 (a)(1):
QUALIFIED PLAN STANDARDS.—The establishment of qualified health benefits plan standards 8 under this title, including the enforcement of such standards in coordination with State insurance regulators and the Secretaries of Labor and the Treasury.

PG 50 Section 152 in HC bill - HC will be provided to ALL non US residents, illegal or otherwise

Not explicitly, but certainly possibly. Here’s the actual language:

(a) IN GENERAL.—Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.

Pg 58HC Bill - Govt will have real-time access to individuals finances & a National ID Health Card will be issued.

Partly true. Government will have access to National ID Health Card, but Section 163 deals with an electronic system to allow determination of coverage and co-pay in “near real time”. It does not even implicitly give the government the right to record or see an “individual’s finances”.

Pg 59 HC Bill lines 21-24 Govt will have direct access to your banks accts for funds transfer

Not accurate. The system will allow electronic funds transfers to providers and will allow automated reconciliation with “related health care payment and remittance advice”.

PG 65 Sec 164 is a payoff subsidized plan for retirees and their families in Unions & community orgs (example -ACORN).

Not accurate. This Section sets up a reinsurance program for defined group health plans; eligibility for that program is not limited to union plans.
Pg 72 Lines 8-14 Govt is creating an HC Exchange to bring private HC plans under Govt control.

Accurate that HC Exchange is created by Title II (which begins on P. 72., and ends on P. 143). Title II covers all HC public and private health care plans including Medicare and Medicaid. Title II gives very broad powers to HC Exchange. Unless this federal statute is different from all predecessors (not likely), HC Exchange will exercise significant control over all health care plans.

PG 84 Sec 203 HC bill - Govt mandates ALL benefit pkgs for private HC plans in the Exchange


PG 85 Line 7 HC Bill - Specs for Benefit Levels for Plans = The Govt will ration your Healthcare.

Accurate that Section 203 specifies benefit levels for plans. It does not expressly specify the power to ration, but that will be a likely result of this system.

PG 91 Lines 4-7 HC Bill - Govt mandates linguistic appropriate services...... Example - Translation for illegal aliens

Accurate that bill requires “linguistically appropriate services”. What this means is not specified, but there is no limitation on who is entitled to this treatment, so illegals presumably would benefit.

Pg 95 HC Bill Lines 8-18 The Govt will use groups i.e., ACORN & Americorps to sign up individually for Govt HC plan

Unclear, but possible and maybe probable under this administration. Section 205 allows the Commissioner to use “…other appropriate organizations” to conduct outreach and informational functions. What is “appropriate” is undefined in the bill.

Tuesday, August 04, 2009

For just a dollar a day

I snapped the cellphone picture to the left at Florida Caverns State Park. It was a monument to the workers of the Civilian Conservation Corps. The passage through the caverns had been improved by the CCC.

At one point on the tour, to the left of the path you were on, you could see the original passage. It was little more than a crawl space that was two to three foot tall. The guide said the boys cut the larger passage with nothing more than pickaxes, hammers and chisels. They hauled the excess rock out one pail full at a time.

Their pay was a dollar a day, of which they only got to keep $5 a month, the other $25 was sent to their families.

The CCC was a popular and successful New Deal Program. Anybody who has been to a National or State Park has seen the result of their handiwork in the lodges, visitor centers and trails they built. In addition they planted over 3 billion trees, cut miles of road and strung miles of telephone cable.

The program's popularity is such that from time to time calls are made to create a modern version of the CCC. Obama is only the most recent of a long line of politicians, from both parties, who has evoked them as a model for paid volunteerism.

As potent as such appeals may be, that was then and this is now. The CCC was very much a product of the Great Depression. Because of the high level of unemployment of the day, its ranks were filled by young men looking for a pay check. Many of the boys were dirt poor, had little education (an 8th grade average) and few prospects. Further, it was ran largely by the military. It was organized into the same eight districts as the state-side army was, staffed by officers and its camps started out as tent cities and only later were military style built for the workers. They ate in mess halls and discipline was strict.

Still, the young men were happy for the work. Many of them speak fondly of their days in the CCC. If nothing else, three squares a day and a bit of cash lifted their spirits. However, the true effectiveness of the program was in the night classes it offered and the skills it taught. Many of them parlayed their experiences in the CCC into careers. The Justin Oral History Center has a pages with numerous anecdotes for those interested.

In reading about it for this post what stands out is how pragmatic the program was. No-nonsense managers exerted discipline and the boys worked hard. However, what they worked hard at wasn't busy work, rather it was work directed at strengthening the infrastructure of our parks and wilderness areas. To this day we can see the fruits of their labors.

As compelling as the CCC mythology may seem to modern ears, it is hard for me to imagine such a program working today. The thought of a graduate with a degree in the Social Sciences trying to supervise hordes of forced volunteer slackers leaning on their shovels and text messaging each other all day is not a pretty picture, but it is hard to imagine anything else. Hopefully it is a scheme that, while it may get mentioned from time to time, never gets beyond the speechifying phase.

Note: I edited this post to add a title and clarify the final paragraph.

Sunday, August 02, 2009

Alligators in Ellesmere Island?

Ellesmere Island, which lies within the Canadian Arctic Archipelago, appears to have once been the home of alligators, according to the fossil records of the Eocene epoch (see After the Dinosaurs: The Age of Mammals, 2006. By Donald R Prothero. Bloomington (Indiana): Indiana University Press). Alligators cannot tolerate freezing temperatures for long. Such tidbits are of interest to any folks who want to take a long view concerning temperature variations of the earth.

Moving to more contemporary pursuits, Richard Lindzen, the Alfred P. Sloan Professor of Atmospheric Science at MIT, suggests the signature of Greenhouse warming (that the warming should be accompanied by rather large changes in atmospheric temperatures in the tropics) has not occurred. The warming levels that have occurred in the atmosphere of the tropics imply that perhaps only a third of surface warming has been due to the greenhouse effect, and it is unclear how much of that small effect could be attributable to humans. Lindzen says:

This contradiction is rendered more acute by the fact that there has been no statistically significant net global warming for the last fourteen years. Modelers defend this situation by arguing that aerosols have cancelled much of the warming, and that models adequately account for natural unforced internal variability. However, a recent paper (Ramanathan, 2007) points out that aerosols can warm as well as cool, while scientists at the UK’s Hadley Centre for Climate Research recently noted that their model did not appropriately deal with natural internal variability thus demolishing the basis for the IPCC’s iconic attribution (Smith et al, 2007). Interestingly (though not unexpectedly), the British paper did not stress this. Rather, they speculated that natural internal variability might step aside in 2009, allowing warming to resume. Resume? Thus, the fact that warming has ceased for the past fourteen years is acknowledged. It should be noted that, more recently, German modelers have moved the date for ‘resumption’ up to 2015 (Keenlyside et al, 2008).
So should we hope that the political class taxes us to save us from ourselves? Who has lobbied hard for Kyoto? Enron (will we see some revisionist history on that score), Goldman Sachs lobbies fro cap and trade. If Healthcare is a 1000 page bill, how big will a final cap and trade bill be? If a bill is too big to read, maybe it's too big to pass.