Tuesday, April 28. 2009
Can You Get What You Pay For? Pay-For-Performance and the Quality of Healthcare Providers
Misconceptions about the interrogation memos. WSJ
Truman's decision to recognize Israel
Hatikva 2009. A Guiness world record.
Nickel Creek with "Ode to a Butterfly" from their record "Nickel Creek." (h/t, LGF)
 The news mills are ginning up yet another medical crisis storm these days in an effort to pave the way for gummint medical care by the same good folks who run the DMV and the post office. They seem to imagine a problem with cost, access, and insurance. Maybe we are a nation of crybabies, because we have the best medical care in the world with which to pamper our so-called precious selves.
It's time we got beyond that self-love, and cared about the Greater Good. I have a few simple, rational, Utilitarian solutions.
Cost: Cost is driven by technology and modern pharmacology, cancer treatment, crocks (people obsessed with their health), gomers ("gomers go to ground"), and futile, guilt-driven end-of-life treatment for annoying old or sick relatives. The cost of American medical care can be dramatically reduced by forbidding all cancer treatment other than Oxycontin and at-home 10-gallon morphine pumps, all medical treatment for those over 57 (the children are our future!), all CT and MRI scans, all blood tests, and all medicines other than friendly, holistic, herbal organic ones. No more vaccinations - they cause Autism. No more antibiotics - everybody knows that they make people sick. Eliminate Dermatology (just stay out of the sun, people). Eliminate Opthalmology (bad eyesight is from masturbation - it's your own fault). Eliminate Psychiatry (mental illness is socio-political mind control). Eliminate Urology (do you want a #3 gauge tube stuck up your urethra?). Eliminate Surgery - it is physical assault on comatose victims. Eliminate Neurology - it's just nerves.
Access: Doctors are like waterfront trade unions: they limit their numbers to keep their payments high enough to join country clubs, to buy boats, and to take vacations. My idea: anybody who gets a C or better in Organic Chem is automatically admitted to a government medical school. Lots of good, caring people are weak in math and chem and bio and stuff, but that's who we need more of. My medical school flunk-out rate was 18%: what a waste of talent. Plus there are too many Jews and Asians in medicine anyway, and too few people of color or of gender identity diversity. So, with this increase in the numbers of docs, fees could go down to $5 per office visit and the docs who don't like it can open dry cleaning shops, cigar shops and wine shops like they do in Canada.
Insurance: Medical insurance is a dumb idea. Why expect your neighbor to pay your medical bills when they will be so low under my plan anyway? They will be cheaper than your garbage pick-up, your newspaper subscription, your cigarette costs, your car payment or your monthly payment for your big screen TV. (Did you ever notice how nobody complains about the cost of their TVs, computers, or Life Insurance?) Or just save your money if you want and die quietly without complaint, dude, and make space for the next generation. Too many people on the planet and, let's face it, life isn't all it's cracked up to be anyway. A vale of tears and toil, a tale told by an idiot, full of sound and fury, signifying nothing. What's the big deal about death? Didn't your parents teach you that life is a bitch?
Another Big Rug: A floral carpet in Brussels. Thanks, reader.
Fisheries: "it is at least something that, after 25 years, the EU is recognising that one of its longest established policies has failed. It has yet to understand, however, the reason for that failure."
Woopsy. A mistake, viewed in retropect. The consequences of letting Lehman fail. This was new territory for everyone, but the fallout of this error were ginormous. Related: The amazing story of Paulson, The B of A, and Merrill.
Ben Stein on the honorable business of selling. h/t, Tiger
Masochist play makes $ for Pakistan. What's ouroboros? All sex play is good, in our view. At Maggie's, leather and whips are my fave, but sometimes we're in the mood for French maid outfits on the chicks, and maybe a little light bondage.
Deification of the planet. I thought culture had evolved past that. Why worship a rock spinning in space? There are millions of 'em. But OK, it's our rock. Our Pet Rock?
Krugman now admits that Laffer was right
Record declines in the newspaper biz. Except the WSJ. Seems odd to me. Everybody enjoys the papers, even if they also enjoy getting mad at them. How else would you know who starred in the high school basketball game against Pittsfield High?
The O talks to his teleprompter. Imagine if Bush...
From Lucianne:
100 days: Obama dumps Bush's
world view, but now what?
Monday, April 27. 2009
Anchoress emails:
This actually made me kind of sick. I threw up a little in my mouth. Please excuse the mass mailing...I think everyone should see it. To me it's sick and sycophantic, but it is also so cowardly. Insult the Christians, because you can, and never mind that we're still in Easter.
This makes me think less of Obama, who should have gotten out in front of this messianic talk, instead of silently encouraging it. It speaks volumes about the artist, but Obama's silent consent also speaks volumes about him.
CAPTION: "The Truth" by Painter Michael D'Antuono which will be unveiled on President Obama's 100th Day in Office at NYC's Union Square. (PRNewsFoto/NOAH G POP FAM)
Update: The artist changed his mind about doing that (see Dr X's comment below)
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Thanks, reader:
From the Center for Media & public Affairs at George Mason University
MEDIA BOOST OBAMA... HE ATTRACTS MORE EARLY COVERAGE THAN G.W. BUSH AND BILL CLINTON COMBINED
A quote: During his first 50 days in office, the three broadcast network evening news shows devoted 1021 stories lasting 27 hours 44 minutes to Barack Obama’s presidency. The daily average of seven stories and over 11 minutes of airtime represents about half of the entire newscasts. By contrast, at this point in their presidencies George W. Bush had received 7 hours 42 minutes and Bill Clinton garnered 15 hours 2 minutes of coverage, for a combined total airtime five hours less than Mr. Obama’s.
CBS led the coverage with 365 stories and 10 hours 46 minutes of airtime, followed by NBC with 327 stories and 9 hours 38 minutes, and ABC with 329 stories and 7 hours 20 minutes. Thus, CBS has given more coverage to the Obama administration than all three networks combined gave to the first 50 days of George W. Bush’s presidency.
scientism
- The belief that the assumptions, methods of research, etc. of the physical and biological sciences are equally appropriate and essential in all other disciplines including the humanities and the social sciences.
 Quantity vs. Quality
Pelosi plays defence on "torture"
Newspaper circulation crumbles (h/t, Insty)
Should you look out for "people who keep to themselves"?
Stereotyping: It's natural. I stereotype everybody: a-holes until proven otherwise.
From the mouths of babes
$ rules too onerous for unions. It's payoff time. Related, The strategery of the unions: Kaus
Latin leaders declare war on Capitalism. And freedom, too.
Anarchy at UNC. Mike Adams
The social challenge of speaking honestly about race
Apparently some people do not want to know what an assault rifle is. But our readers know an assault rifle is one with a full-auto setting.
Cannot do it without the teleprompter. Man, that is lame.
 Save the Humans! Reason
In cold blood. The Talibanz are taking over Pakiland.
The O tries to steal their prime time - for the 4th time. They have a biz to run.
Upper photo: My nooner date today, thanks to friend Theo who shares his girlfriends. Lower photo via Never Yet Melted
Thanks, Reader.
Our own new metal signs will say "Warning: You are entering the MF Assault Rifle Range at your own risk" That ought to work for everybody but the deer hunters who are half in the bag at 4 AM and do not give a damn. We considered having "You are being monitored by video camera," but that did not seem country style. Too much like England - and a lie, too.
I don't want to ruin it by understanding it. Hmm. Music. Gardening. Love.
Sipp
 It looks like our Dylanologist will be moving back north to Yankeeland - to New Haven, of all places. One of his great-grandfathers grew up in Woodbridge, and one of his gramps is a retired Yale prof.
With a new bride, too. Hope he will be able to find time to write more for us.
(Between law school, building stone walls and rebuilding kitchens, he has been truant here at Maggie's. If he doesn't get back on the job, that large monthly check, which is his share of the overly generous RTC donation we receive for mindlessly echoing Repub talking points, will stop coming to him.)
Ya gotta go South to find them high-quality brides. But everybody knows that.
Photo: Got dimples? The Dyl on a water taxi on Lago Maggiore last summer.
Peter Orszag is the guy in charge of Obama's domestic agenda. From The New Yorker's Letter from Washington:
Orszag dismissed the criticism as a caricature. “I don’t see how it interferes with the doctor-patient relationship to suggest that it would be better if your doctor had more information about what would work for you,” he said. “The best way of putting it is that your doctor shouldn’t have disincentives to give you the higher-quality care, which often happens now.” Far from a huge government bureaucracy, he proposes a simple adjustment of incentives: “You get paid more if the treatment has been shown to be effective and a little less if not.” Orszag seems more right than wrong about how to bring down health-care costs, but the truth is that, while there is obviously a great deal of waste in the American medical system, nobody knows for certain whether Orszag’s plan—which is now Obama’s plan—will work.
As Orszag explained his ideas, I couldn’t help remembering an encounter I had with him one day in the hallway at O.M.B. I told him that I had read his Princeton undergraduate thesis. He looked at me and smiled a little sheepishly. He said that at some point after his arrival at graduate school, in London, he had had a sudden realization: that he had made a mistake, and the crucial formula that he had used in his thesis, the one that had won him the prize, was incorrect. “It was so innovative,” he said, “that it was wrong.”
 Andrew Lloyd Webber on the UK's new taxes. Related: Envy and social behavior
Dear Greens: Why not start here?
Quel horreur. Swine Flu hysteria. Must be a slow news week. Not worth linking.
Support your local Islamophobe
This is what I call an exciting cruise
How to solve MA's deficit: Jules
Why the Law is foreign to Justice Ginsberg. Am Thinker
A shortage of primary care docs?
MADD is mad, but they have some power now. At Maggie's, we say "Don't drink and drive: you might hit a bump and spill your drink."
More on the Ricci case. Ricci may be the rock upon which America's racial spoils system finally founders.
Al Gore: Raging Capitalist
Prince Charles gets it: It's about conspicuous virtue, not reality
Judd Gregg: Elections have consequences. A quote:
...while the aspiration for universal coverage may be noble, the practical realities of getting there may prove harder for the American public to swallow. "There's no question," the senator says, "that this is a debate about rationing to a large degree. All your single-payer systems are rationing systems. It's also a debate about technology and innovation. Because you will not have capital pursuing technology, innovation and science if it's health-care related, because the return on capital won't be there. And these things are so expensive, especially on the pharmaceutical side and the biologic side, that you'll dramatically slow improvements in the quality of health care through science with a single-payer plan." Mr. Gregg thinks that critique will resonate with the public.
Even so, given the balance of power in Washington, Mr. Gregg gives the Democrats good chances of success in nationalizing our health-insurance market. "I think the odds are pretty good that it's going to happen -- that you'll have a major health-care reform bill pass." As he says, "Elections have consequences."
Via Driscoll:
Judith Klinghoffer’s article, “Obama’s Polls Trail Those of W.; Gallup Covers it Up,” notes that Bush’s approval rating taken by Gallup stood at 62 percent after his first 100 days, while Obama’s currently stands at 56 percent.
A few minutes later, moderator John Scott returned to the subject:
JON SCOTT: And in the first term, George Bush had a 60 percent approval rating after his first 100 days-
PINKERTON: And Bush 41 as well, who I worked for way back when. And Laura Bush has a higher rating than Michelle Obama.
SCOTT: Is that going to get mentioned in the press?
PINKERTON: You just wouldn’t know it from reading the mainstream media.
 Story at Rug Rag
Sunday, April 26. 2009
 Terrific stuff. Cheap, too. We have had Crab Cake recipe wars here recently, but here are some more simple recipes. I put no flavorings in the cakes, because I like the main taste to be the tender, succulent, subtle crabmeat, which is why my favorite food in the world is sauteed soft-shelled crab.
Except maybe Halibut with capers, or Shad Roe with bacon, or Bluefin Tuna belly just seared on the grill, or rare roast beef with horseradish and Yorkshire pudding, or Shepherd's Pie, or barbecued short ribs with cornbread, or Chicken Pot Pie, or black bean soup with jalapenos and mashed potatoes, or plain mashed potatoes, or a real Gumbo made by my Louisiana pal, or a Woodcock dumpling with gibier sauce, black truffle, and Porcini mushrooms, or ...
To prosecute or not. I was going to write this, but somebody else got to it first.
Our Bastiat quote du jour, from this site. Fortunately, it's simple French:
Laissez faire! — Je commence par dire, pour prévenir toute équivoque; que laissez faire s'applique ici aux choses honnêtes, l'État étant institué précisément pour empêcher les choses déshonnêtes.
Cela posé, et quant aux choses innocentes par elles-mêmes, comme le travail, l'échange, l'enseignement, l'association, la banque, etc.; il faut pourtant opter. Il faut que l'État laisse faire ou empêche de faire.
S'il laisse faire, nous serons libres et économiquement administrés, rien ne coûtant moins que de laisser faire.
S'il empêche de faire, malheur à notre liberté et à notre bourse. À notre liberté, puisqu'empêcher c'est lier les bras: à notre bourse, car pour empêcher, il faut des agents, et pour avoir des agents, il faut de l'argent.
À cela les socialistes disent: Laissez faire! mais c'est une horreur! — Et pourquoi, s'il vous plaît? — Parce que; quand on les laisse faire, les hommes font mal et agissent contre leurs intérêts. Il est bon que l'État les dirige.
Voilà qui est plaisant. Quoi! vous avez une telle foi dans la sagacité humaine que vous voulez le suffrage universel et le gouvernement de tous par tous; et puis, ces mêmes hommes que vous jugez aptes à gouverner les autres, vous les proclame inaptes à se gouverner eux-mêmes!
 A friend highly recommends Monty Roberts' Shy Boy.
 100th Daygasm: Michelle
What's going on with Mr. Sun?
What happened to the H-word?
Good brief summary of Frederic Bastiat and the negative railroad
From the UK: Obama is confused about who the enemies are. I know other people who think that way.
From the 1984 Is Not A Handbook Department: In the UK Every Phone Call, Email, and Website Visit will be Monitored. Who are these people?
The political and economic consequences of dangerous CO2
What is truth? A quote from Dr. Bob:
Ideas have consequences, philosophies have predicates, and the rejection of absolutes absolutely dehumanizes us, for we devolve from a species of high principles and moral light to denizens of a depravity far lower than the animals. For animals have rational restraints on behavior, brutish though it may be, while there is no end to evil for the human mind unleashed from absolutes.
1 John 3:1-7
How great is the love the Father has lavished on us, that we should be called children of God! And that is what we are! The reason the world does not know us is that it did not know him. 2Dear friends, now we are children of God, and what we will be has not yet been made known. But we know that when he appears,we shall be like him, for we shall see him as he is. 3Everyone who has this hope in him purifies himself, just as he is pure.
4Everyone who sins breaks the law; in fact, sin is lawlessness. 5But you know that he appeared so that he might take away our sins. And in him is no sin. 6No one who lives in him keeps on sinning. No one who continues to sin has either seen him or known him.
7Dear children, do not let anyone lead you astray. He who does what is right is righteous, just as he is righteous.
Saturday, April 25. 2009
 Ain't Spring wonderful?
The youngest BD pupette is away, visiting a pal at Brown. I had a 3-mile walk with Mrs. BD and the puppy early this morning, then I played 1 1/2 hours of singles tennis outdoors (for the first time this year. Warm-up time with my best old tennis buddy, with plenty of bloopers.). He also explained to me why commercial real estate will drop 35%. The math is quite simple, really. It's a lagging indicator. He says give it two years, barring strange commie political surprises.
Since then I have been shampooing the carpets, because it's the first day of the year when I can open all doors and window. That chore requires a few semi-cold beers.
After that, I have been assigned a number of planting chores. With a bit of luck, it may get dark first.
Cleanliness is next to Godliness....
Starting to write about the US debate over torture, I first turned to Merriam-Webster’s Online Dictionary. The word derives from the Latin, to twist. Three current definitions are offered: 1. to cause anguish of body or mind; or more drastically, 2. to inflict intense pain to punish, coerce, or afford sadistic pleasure; and 3. “straining” as in distortion or overrefinement of a meaning or an argument.
That definition allows greater clarity about the positions being argued about torture.
The Geneva Conventions apply to restricting the first definition unduly against enemy state soldiers and civilians. The applicability to nonstate terrorists is not addressed. Thus, the Bush administration labeled them “enemy combatants” and tried mightily – in the midst of great uncertainty, confusion, danger, and rapidly changing events -- to blend civilized restraints with practical considerations of gaining intelligence.
The Associated Press report of the speech by the very liberal President of the Israeli Supreme Court at Princeton a few days ago highlighted the problem facing Western governments, “that one of the main challenges the court faces is that international law has yet to fully adapt to modern terrorist threats.” This learned lesson is important from someone widely hailed by the Left for her other positions. Israel, like other parliamentary governments, does not have a Constitution like does the US, so its supreme court ranges more widely – and liberally -- in deciding right and wrong, legal and illegal. Israel, uniquely, sits on the frontline, within and without, facing existential terrorist attacks.
Israel has taken extensive measures to restrict its armed forces from breaching this elusive line between proper actions and excessively avoidable harm to civilians and to enemy combatants. In the US, the bipartisan Congressional remedy, led by John McCain, was to restrict our military. The argument is that our military does not have the necessary professional experience to apply extensive interrogation techniques, undue use undermines the order necessary to our military, and that leads to undermining both discipline and self-respect in energetically fighting for what is right.
The Bush administration went further in, pardon the pun, agonizing or torturing itself in defining restrictive conditions for the use of extensive interrogation techniques by CIA professionals upon leading captured terrorists.
None of this has satisfied those who take a more restrictive posture. There’s the camp, including some with dedication to fighting terrorists, who believe that a purist conception of Americans requires that we don’t use extensive interrogation techniques regardless of the possible benefits or risks. Then, there’s the camp that outright opposes US battles against terrorists, sometimes trying to mask their position with support conditional on impossible and impractical crippling hamstringing, borrowing from the self-righteousness of the first camp to distract from their own true priority. This camp is allied with a third camp, politicians whose primary motivation is to exploit the arguments for their own benefit. Democrats who, in the wake of 9/11’s awakening, supported or argued for extensive use of interrogation techniques in recognition of Americans’ expectations of firm resolve then denied and flip-flopped in their pursuit of power in unseating the Bush administration and Republicans in Congress. These Democrat politicians “strain”, the third definition of torture, in distortion or overrefinement of their argument, relying upon the idealistic or contorted arguments from the first two camps.
So, now, the Obama administration is hoisted by its own petard of its own most ardent supporters in confronting the practical needs to govern and to be held responsible for America’s security.
Those within the Obama administration who argued from experience and proper caution for moderation were overruled and selective release of documents and photos launched that seek to discredit the Bush administration’s efforts, and even criminalize policy. Opponents decry this as reckless self-endangerment and self-denigration of America, and call for fuller release of the record to demonstrate both the care taken and the needed survival results. Even the New York Times recognizes the danger but, true to its Obama-lean, couches it in the politician Obama’s self-interest: “Mr. Obama and his allies need to discredit the techniques he has banned. Otherwise, in the event of a future terrorist attack, critics may blame his decision to rein in C.I.A. interrogators.”
So, there we are, tortured for the past six years by tendentious and selfish attacks from within upon our ability to withstand and overcome tenacious, brutal and serious attacks from without. Now, due to the Obama administration’s irresponsibility, we face at least three more years of torture, of undue agony, that fruitlessly weakens our unity and resolve and exposes us all to potentially greater physical threats to our well-being and very lives. Our troops on the frontline are not bemused by this Obama administration recklessness with their safety and missions, nor should be the rest of us placed closer to frontline dangers as our intelligence professionals seek cover by retreating from their duties.
 New Canaan, CT, is known for the residential architecture of "the Harvard 5." Video.
Photo: The Bridge House
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