Elkhorn Creek Lodge

Obamacare; Throwing S#*t Up Against The Wall

mountainmusings — Tue, 27 Oct 2009 22:36:03 +0000

And seeing what sticks.

The benefit of substantial Democratic majorities is to allow the glib leadership (in both houses and the oval office) a chance to fully take the reins and render perfection out of our oh so obviously broken-down health care system. Now that they’re in control, they can rectify those glaring deficiencies with their brilliant solutions that seems to have just eluded millions of doctors, nurses and sundry health professionals too dim-witted to see the obvious solutions only apparent to the enlighten few that now run the executive and legislative branches our the federal government.

Except that three hundred million people have unique medical needs that somehow don’t fit into any tight delivery scheme. Certainly not the lowest common denominator expectations that Obama’s “best practices” will generate. ”Best practices” really do work except in the cases of exceptions. Exceptions that occur about every time a new patient walks into your office.

Now that the Democrats literally have the votes to pass anything they want, they also discover that they will own what ever mess they will create when they move this country into the Nirvana of “reformed” and “universal” health care.

And, everyone is starting to discover, now that the Democrats are seriously scheming to destroy the best health system in the world, that as bad as our system may be, every alternative is worse.

There was a reason to rush this “reform” through in the dark of night. That reason became abundantly clear when a whole summer’s worth of town hall meetings laid bare some of the myths that drove this reform need–those pesky peasants from fly-over country; just don’t know what’s best for them. Those same said peasants also objected to the price tag because one trillion dollars is a lot of money. 900 billion dollars is a lot of money. In fact, in the hurly-burly of making your household budget balance, 100 bucks is a lot of money.

In the process we learned that there are, as Mark Twain noted, lies, damn lies and statistics. We learned that American medicine does the best job in treating cancer, shortest waiting times and bringing the latest medical innovations to the patient fastest. We learned that American life expectancy is increasing. We learned that, factoring traffic accidents and homicide, we have the best life expectancy on earth. We learned that our infant mortality rate isn’t the best because we count premature births as live births unlike other countries who only count full-term births as live births. And, we have highly skilled neonatologists that that actually try to save these premies.

We learned that for all the griping, most Americans are satisfied with their medical coverage.

We learned, surprise, surprise, that there will be rationing. That rationing will be borne, in particular, by the elderly. That rationing will be forced by penalizing the the top ten percent of doctors (in terms of resource use).

We learned, courtesy former Labor Secretary Reich, that if you’re old we’re going to let you die. Further, don’t expect further increases in life expectancy since money for innovation will no longer be there. Yet, for all the contractions and cuts in care and resources for care; for all the taxes proposed–many to fall squarely on the middle class–we still have “reform” that will destroy the level of care we have now and beggar this country, our children and their grandchildren.

Yet, folks like Reid and Pelosi persist. Especially with their stalking horse for socialized medicine–the “public option.” In some respects, it is almost an obsession of a gambling addict that keeps doubling the ante in the center of the table in hopes of winning the jackpot.

There is no reason for this “reform” when more reasonable alternative are available. Equal tax treatment for all insurance plans whether purchased by an employer or an individual. Allowing insurance companies to purchase plans across state lines.

No, the real reason is the push to bring the entire medical system under governmental control. And, the folks pushing it the most are the Democratic leadership in both houses who all share a common trait of being superannuated Woodstock hippies who sense that this will be the last time, in a generation, that they can push medical socialization through. For them, the leadership in particular, it will be the last time in their lives since most of these individuals are 70 or older. These were the folks who were going to “change the system” by “working in the system.” Now, at the end of their careers, having labored for so long in the vinyards of the hall of congress, they finally have the perfect convergence to get their dream of socialism through. But, even now, their overreaching with things like the “stimulus” leave them just inches short.

They need to do this because socialized medicine is the surest vehicle to wreck a country. France and Britain used to be major players in world affairs–with military muscle to back it up. But, thanks to the enormous drain of resources by their respective social welfare programs, they are now, well, second rate. Now, it is our turn. This an attempt to so consume our country in spending and taxes so as to bleed every other priority dry–especially defense. And, to run individual initiative and economic into the ground; bye bye American Exceptionalism. These aging hippies will finally have the sure-fire solution to any future “Vietnams.” A solution to America’s “horrible oppressions” in the world. Bankrupt America.

The AMA’s Acid Test

mountainmusings — Wed, 21 Oct 2009 16:50:35 +0000

Now the Democrats are dangling the promise of averting planned Medicare reimbursement cuts before the AMA in return for support for “health care” reform. And, we shall see if the AMA will truly stand by our nation’s physicians and the finest health care system built by their hard work. Or, will they fall for the fraud.

Even if the “cuts” are restored, we still have a system that so grossly underpays that physicians will still need to cost shift in order to break even. Further, this “restoration” will only avert a cut in reimbursement from the current levels. Levels so bad that seniors are having trouble, even under the current reimbursement rates, finding physicians in the first place.

Also, in many respects, the Democrats aren’t really giving anything away. Seniors vote and any Democrat should know a political third rail when they see one; after all they made Social Security one such. The net effect is that those Medicare reimbursement rates were going to be raised back (er, maintained) to their current levels anyhow.

Ultimately, the only answer is “no.” No, because this whole process of reform is a lie and fraud. Baucus’ plan was supposed to be paid in part by a 500 billion dollar reduction in Medicare. The 247 billion dollars to be “restored” is half of the money slated to “pay” for health care “reform.”

The docs at the AMA should look to the object lesson of the insurance companies. They signed on to “reform” under the supposition that community ratings and no pre-existing conditions would be offset by a robust mandate to sign up young uninsured persons. But, when someone’s constituency got stepped on the mandate got watered down and the insurance companies got stuck with adverse selection nightmare that will, frankly, bankrupt them. The insurance companies no longer had anything to lose by releasing the PriceWaterhouseCooper study. They’re screwed anyway.

Ultimately, the real goal is a banana-republic style expropriation of one sixth of the economy. It say no is to stay free. Accepting the Medicare bribe is just negotiating the terms of your serfdom.

The Fraud of Bacus-care

mountainmusings — Thu, 08 Oct 2009 19:26:45 +0000

Smoke, mirrors and accounting slights of hand and we have health care “reform” for only about 829 billion dollars. It conveniently comes in under under Obama’s price tag of 900 billion dollars. Wow. Bacus may look and talk like Montana, but he’s been in Washington much too long; and gone totally native. Because while 829 billion dollars is a real saving compared to 900 billion, here in fly-over land, 829 billion dollars is still a lot of money.

But, this is all a wink and a nod to sell a very expensive new entitlement that will cost far more than the 829 billion dollar loss leader. This will be an entitlement that will grow to consume the federal budget and, indeed, the economy to transform America into a no-growth, no-job zone like everyone of Europe’s nanny states. England, France and Germany used to actually be major players on the international stage. But with social welfare, with “universal” health care leading the way, so consuming every mark, franc and pound (sorry, euro) there’s no money for the real priorities of a nation-state such as defense. No, with universal health care coverage brought to you by the snuggle bears of Health and Human Services, we won’t have to worry about Afganistan, Islamo-fasism or the war on terror. We simply won’t have the money to fight.

Let’s go through the fraud. First, Obama will sign anything, something that carries the label of “health care reform.” For all of his new found fiscal rectitude, he’ll sign if it cost ten bucks or ten trillion bucks. Since the Bacus bill is only the skeleton for the final reform, we can more than expect the price to go up. But, fear not, whatever the price, we can depend on an immediate loss of any fiscal scruples on Obama’s part.

About 500 billion dollars will come out of Medicare “savings.” Like that’s going to happen. Say what you will about making the wealthiest senior generation in the history of mankind footing more of the bill, they vote. Expect, after a proper chastising at the polls in 2010, Congress to come back and restore every penny of Medicare. You’d think, after the Democratic Party made Social Security the “third rail” of politics, that Bacus would recognize a third rail when he saw one.

Then, we have the taxation of the so-called Cadillac health plans. This was supposed to raise some serious money. I’ve read somewhere as much as 200 billion dollars. Well, my dynamic scoring scores this income stream at zero. You can expect every health insurance plan to carefully calibrate premiums to fall just under the limits of $8000 and $21,000 for individuals and families, respectively. And, big labor hasn’t weighed in yet.

How about a tax on durable medical goods and devices. Who uses such things as artificial hip and knee replacement? Pacemakers? Wheel chairs? The same said seniors who are going to clobber the Democrats in 2010 over Medicare. Another 30 billion dollars or so that are purely mythical.

So, what you have is a massive benefit cut for seniors. And, we haven’t started to account for the most spoiled generation, the boomers, who will be joining demanding, with a capital “D,” services as Medicare beneficiaries.

And, after looting the seniors, you have a bill that amounts to a huge middle class tax.

In some respect, it’s good that the Democrats have the majorities that they now possess. Because they, in their arrogance, thought they somehow knew better and could in a mere six months remake the finest health care system on earth. That they had answers and solutions, that somehow eluded the millions of professional that populate the health care system, that only they could see. Of course its a creaky system; how could it be otherwise in dealing with the health needs of 300 million Americans. So, we can now sit back and see the Democrat philosopher-kings, lead by Obama, Reid and Pelosi, come up with something better that the worker bees in the trenches are just too stupid to see.

Go ahead vote that bill. And, better yet, do it in the dark of night before any has a chance to read it. That bill will provide 1000 plus pages of GOP campaign material for 2010 and 2012.

Aging Hippies and Congressional Leadership

mountainmusings — Wed, 07 Oct 2009 17:15:55 +0000

The headlong, damn-the-torpedoes approach to health care “reform” is a function of democratic congressional leadership in the hands of a bunch of aging Woodstock era hippies. Much of the top leadership hails from the early 1970’s, especially from the class of 1974; Democrats elected at the height of the Watergate scandal. Many of these were the hippies or fellow travelers who were going to carry the revolution to the establishment by working “in the system” and thereby undermine the “system.”

But, their 30 year journey was greatly frustrated by a misalignment of stars. The last time the Democrats held the balance of power as they do now was in Jimmy Carter’s first two years (1977-78). At that time these hippies were much too junior to exert much influence in the House and Senate. And, so the dream to radicalize America fizzled.

But, now comes the next opportunity. But, for the leadership, their last opportunity since many of them are in their 70’s and will literally be pushing up daisies when the next opportunity comes around. So, we see the most heavy handed legislative pushes on record to move health care “reform,” cap and trade and card check to remake America as some socialist utopia.

True to their boomer roots this leadership will push this agenda forward with out the slightest care about the consequences and damages their children and grandchildren will have to bear. They care not a whit for unintended consequences since they will live their remaining years on a lush congressional pension and then be dead shortly thereafter. They have exempted themselves from the maw of rationing that will be unloaded on the rest of America thanks to their socialized medical monstrosity. And, they will be able to avail themselves of what was once the finest medical system on earth before their “reforms” grind American medicine into the socialized mediocrity that now graces England and Canada.

Reid plans to jam health care reform through on reconciliation or some other obscure parliamentary trick to side it through on 51 votes. This will in effect kill the filibuster and turn the Senate into a more grandiose version of the House. Frankly, Reid has the votes; it only takes 51 votes to kill the filibuster right now. But, once that rule is gone, it’ll never come back. But, what does Reid care that he’ll turn the deliberative functions of the Senate into an over-glorified student senate. He’ll be departed from the scene; hopefully as soon as November 2010.

And, this same leadership is fighting to jam this bill through before anyone has a chance to read it. This may give Reid, Pelosi and company some cheap thrills. But, it’ll be murder for their party. Because the Republicans, going into 2010 and 2012 will have over a thousand pages of selective quotes from that unvetted bill to bludgeon the Democrats. Remember, the actual reform doesn’t take place until 2013. So, the actual vote buying potential of this entitlement will not be around until after the 2010 mid-term elections. Nor the 2012 presidential election.

To hell with all of you left on the Titanic, suckers, I’ve already got my place on the lifeboat.

Iran, Obama and Intellectual Masturbation

mountainmusings — Sun, 21 Jun 2009 12:43:01 +0000

In the crush of the 2008 presidential election campaign, the MSM made a lot over Obama’s “cool” and “nuance.” As opposed to McCain’s high stung temperament and “gut” reactions.

Now, with Iran, we can truly see what “cool” and “nuance” are really worth. Because in the world of power politics where there is evil and real enemies. Where there are people who will just as soon as kill you as look at you. Where there are evil people who have the means to kill you; and a thousand times over. You need the guts of a fighter pilot closing in at 400 knots. The guts of a fighter who know you have one chance to get it right. Someone who’s already thought through the complex permutations and can render judgement without hesitation. Because at 400+ knots, if you hesitate, you’re dead. You are now in the world of brutal black and white, where you need to make definitive yes and no decisions. This is real executive decision making. And, this is no longer the midnight dorm room bull session where you mixed pot, alcohol and trendy discussion on some vogue Marxist theory.

This is the world of Churchill, May 1940. Dunkirk, France. 330,00 of your forces trapped on the beaches. What do you do? Sue for peace? Become Vichy England? There are historians that theorize that Hitler pulled his punches at Dunkirk to work out a peace deal. Or, with little to hope for, evacuate, re-group and hope for better fortunes in battle; hope for eventual victory. D-day, the 8th Air Force, V-E day with Britain as one of Berlin’s occupiers were, in 1940, dreams that would buy a ticket to a padded cell.

Yet, this is real history. As Mark Steyn once pointed out, crucial decisions at crucial junctures of history are never clear distinctions between unalloyed good and unalloyed bad. In many cases, in the maw of the circumstances of that decision, you have no idea that your decision will be the crucial tipping point.

So, what’s it going to be? Yes or no? Surrender to the Nazis or fight on? Pick sides with the “street” that is literally dying in its challenge of the mad mullahs that run Iran or throw you lot with the power establishment–the ruling Mullahs? The fact is that neither presidential candidate–Ahmadinejad or Mir Hussein Mousavi–is some paragon of Jeffersonian democracy. Both have had active roles in setting policies that makes Iran the pariah it now is.

Both candidates are just two flavors of dung, take your pick. Both required approval by the ruling mullahs to even run in the first place. But, the significance is that the “street” is taking this debate beyond the a presidential election. Now, the people are asking for accountability from the ruling mullahs. And, in this respect, Obama’s been handed a gift. Because there is a clear choice; to come down on the side of an electorate that wants accountability. To come down on the side of true democracy.

Yet, all we get, after a week of waffling, is Obama steps up to the plate. And, we get a kumbaya response. Let’s just all get along. The folks on the street are dying so they don’t have to get along. Instead of a response of solid and unequivocal support for the demands of accountability, Obama publicly urinates on the sacrifice of those protesters demanding that accountability; demanding the right to a vote equal to anyone else’s.

This is the 3 a.m. phone call; launch missiles or not? As far as 3 a.m. phone calls go, this is a relatively simple choice. You blow this choice and the next 3 a.m. phone call won’t be as easy. Maybe an Israeli nuclear retaliation against an Iranian nuclear attack. Standing on the side of democracy is generally the best default position you can take because democracies generally don’t make war on democracies.

But, Obama and many of his supporters have had little to do in the world of hard decision making. In the brutal world of decision making were, you as president, have your options winnowed down to two, yea or nay. Nuance has other words and synonyms. Trying to have your cake and eat it. Dithering. Waffling. Bullshitting. Intellectual Masturbation. Obama’s out of the bubble of unreality of Chicago machine politics where decisions are made by the bosses and “ratified” by bought elections to maintain the thin veneer of democracy–like Ahmadinejad’s election. But, whereas Chicago machine politics has just run a city into the ground, here we have a high stakes nuclear game afoot, a game being run by a two-bit machine politician who’s idea of high negotiation is greasing the right palms.

Socialized Medicine; More Snuffing

mountainmusings — Sun, 31 May 2009 12:54:48 +0000

Let’s start with Clive Cook’s commentary about medical care in the US being far too expensive for the results is obtains; as compared to statistics of such things as longevity when compared to other countries around the world.

The cost differential is the cost of treating patients out on the margins. But, before we discuss that more specifically, we need to explore some fundamental concepts that animate our attitudes about the worth of the individual. The United States and its founding documents–Declaration of Independence, Constitution, Bill of Rights–reflect the highest attainment of the ideals undergird the amalgam of concepts and ideas that we call Western Civilization. And, on its own as well as part of that amalgam is Judeo-Christian morality. These ideas and the institutions that they spawned all have a common thread of elevating the rights of the individual and preserving those rights.

These are moral precepts based on a God that created man in His own image, gave him the knowledge to know Him and the free will to acknowledge God. This is the God of the Ten Commandments; rules that supersede any majoritarian or human authority. This is a God that will require every human to stand alone, at the final judgement, and be judged worthy of Heaven on his actions alone. No Nurembergian “collective guilt.”

It is with this in mind, we have developed a sense of individual worth through the ages that is designed to protect those rights conferred upon the individual by his Creator. And, our secular institutions reflect that philosophy. Trial by jury of one’s peers; so as to check the power of governmental authority. The jury stands as the highest officers of the court, who’s decision is final. Not guilty will stand regardless of the case the state may have made. Rule of law. Due process. Presumption of innocence. The burden of proof on the accuser, not the accused. A Constitution and Bill of Rights that acknowledges and secures right; not grants them.

This commitment to the individual is reflected in all our activities, economic and otherwise. It is reflected in our medical care and medical system. Is it more expensive than any other country in the world? Heck, yes! But, that’s American Exceptionalism. Besides, for all the blathering about how much we spend, as a percentage of GDP, on medical care, I’d rather have 84 percent of the American economy than, say, 95 percent of the Canadian economy.

But, medical care today is being fought on the margins. Just like the defense of our rights secured by the Bill of Rights. All the easy stuff has been done. The big gains in life expectancy and infant mortality rates came largely because of public health measures. Public sanitation; sewers and clean water. Immunizations. Better nutrition.

Medical progress is now being made into rarer disorders. And, in pushing the frontiers in the care for the critically ill. Or, neonatology. It is reflected in the medical economic fact that eighty percent of a group of insured persons consume only twenty percent of the benefits paid out. And, the sickest twenty percent consume the other eighty percent of those benefits.

The most expensive year of your life, medically, is your last year of life. As is your last hospitalization. About thirty to fifty percent of Medicare dollars fund this phenomena.

Infanticide is still practice in many portions of the world. In many of these societies, poverty so rampant, that resources aren’t available to try to salvage these “defective” babies. Even in the case of a cleft lip/palate baby. These are otherwise fully functional humans; but the care, rehab and surgery to repair these deformities is enormous. The US doesn’t fare well in statistics regarding infant mortality rates since we count premature babies in our statistics of live births. While the field of neonatology has made great strides in salvaging many of those babies, many, more than full term infants, still die pushing up our infant mortality rates.

To take a completely mechanistic view of human life, to equate life as some many parts that make the machine of society function; you can ask why we keep some many “defective’ people around. Or, at least, if we don’t immediately discard them outright, why we spend so much in giving them medical care above and beyond those in society who are still working. Those persons who are still functioning cogs.

All of the above creates hundreds of billions of dollars of temptations to deny care. Dead people are much cheaper than keeping sick people alive. In a single payer system this temptation can go unchecked. Only in a private, market-based system, where 300 million people interact in their own respective self interests do checks exist against such base temptations.

Those temptations are in operation even as we speak. The British system deny renal dialysis for any over the age of 59. Your kidneys go out, you die. Here in America, cigarette taxes are jiggered to maximize revenue, not to discourage smoking. And, those same said state treasury officials know that smokers usually die at the age of sixty; no state Medicare or Medicaid costs for these folks since they never make it to age 65. State helmet laws for motorcyclists are being questioned; not wearing a helmet usually kills outright. That’s much cheaper than surviving and requiring medical care.

There are lots of illnesses that, at the margins, require very esoteric and very expensive medications. How about Infliximab (Remicade) for Rheumatoid Arthritis. It wholesales for about $20,000 per year per patient. Or, do you just draw the line and let them become cripples. The Remicade lobby isn’t very big since sick people, by virtue of their debilities, will have very little economic pull. In the brave new world of government health care all medical decisions will be political. The sickest will likely be on the margins economically as well. Unless you have the cash, serious cash, like the amounts to buy a recently vacated Senate seat from Illinois, you’re not going to get some health care bureaucrat to score you twenty grand worth of Remicade.

It’s very easy to fudge the statistics to truly marginalize the sickest twenty percent, create billions in savings and even show, statically, that our new governmental health care system is superior to the old system. Stop counting pre-term infants as live births. With no pre-term infants, it becomes easier to stop funding such care. Those babies die, but, no one’s counting.

Of course, no health bureaucrat is going to order pulling the plug on granny sitting, comatose, on a ventilator in some intensive care unit if she’s surrounded by tons of loving family. But, how many old folks live, alone, moldering in some nursing home out on the wrong side of the tracks. Why bother with that last hospitalization, that last year. They won’t live long enough to matter as a vote. No witnesses. No real advocacy. As mentioned above that last year, last hospitalization is something like 50 percent of Medicare expenditures. Over 100 billion dollars per year. That would go a long way to Obama’s goal of saving one trillion dollars over the next ten year. So tempting.

Fifty bucks of Pentothal is so much cheaper than 100 thousand dollars of hospice care. And, in Oregon, assisted suicide is legal. So tempting.

GM; An Abortion Known As “Industrial Policy”

mountainmusings — Sat, 30 May 2009 23:17:14 +0000

“What’s good for GM is good….” You know the rest. The irony, is that GM and the US government has been bound at the hip for nearly three quarters of a century. It started with the Wagner National Labor Relations act. And, ended there. For this company, in particular, became the vehicle that has been the government-mandated honey pot for the UAW.

Indeed, with governmental help, GM evolved into a Social Security agency and a Medicare agency; with three out of every four UAW members drawing down on retirement benefits. It a wonder that GM had any time to make cars. This charade led to GM’s current business model of manufacturing large cars, SUV’s and trucks to generate the profits needed to subsidize the lush benefits that the UAW now enjoys. Moreover, the CAFE standards were originally conceived to keep small car production in the US, thereby guaranteeing more UAW jobs. So, those same said large cars and trucks also had to subsidize small car production as well.

This delicate homeostasis succeeded until energy became politicized by the environmentalists. The act of pumping gas became political statement. And, scientific inquiry about global weather patterns became similarly politicized.

An energy policy designed to create scarcity, to drive up the price of gas, succeeded with four dollar per gallon gas last summer. And, GM’s balancing act collapsed. Not that any of this ever had to happen. Because, most Americans like large cars. We are, generally, a country that has a very low population density. Ours is under 100 persons per square mile as opposed to populations densities in the hundreds if not over a thousand persons per square foot in Europe or Asia. We therefore, on average travel farther for a given trip. And, given these longer trips will want to carry more. Hence the need for a bigger car.

Energy policy that abandoned the flat-earth mythology of global-warming (sorry, climate change), could easily provide the necessary gas, well under two dollars per gallon, by off-shore drilling. Extraction of shale-oil. Nuclear power. The energy densities of these sources outstrip all other sources. It is only because of energy production politicization that “alternative” power sources are remotely economically viable.

Yes, there are people who live in very congested inner-city areas who would want a very small car. But, the free market is more than capable of providing such cars. But, in America, we engage in gigantic carbon-footprint activities such as having, instead of aborting, children and that, with our low population density makes for a demand for larger vehicles–like Obama’s Tahoe. But, how about letting individuals choose what they want to drive? I guess not in Obama’s command economy.

So, welcome to the brave new world of econo-boxes. Mandated by Obama’s acolytes in the EPA and department of transportation. Actually, the brave-old world of econo-boxes. Once again, thanks to Reagan and the prosperity his policies engendered, we have a whole generation of people who simply forgot or never experienced the world of the 70’s. Remember the le Car? Or, the Gremlin, Pinto or Maverick? How about the incredibly sexy 1974 Mustang? Or, a car so bad, it became the official wheels of Wayne’s World–the AMC Pacer.

And, so, the picture at the top of this post is supposed to represent the new, Obama controlled GM (h.t., Drudge). What we have is a state controlled car company capable of being as innovative as the old Soviet block manufacturers that gave us the Lada or the Trabant. GM is going to require permanent government subsidies to give away these cars. Because, for those with some pocket change left after Obama’s systematic looting via taxes, you aren’t going to lay down one penny more on something out of GM. We’ll also know when some lowly bureaucrat is out an about since they’ll be driving one of those ridiculous GM econo-boxes. The GSA is going to become the official buyer of all products, GM. How else to prop up the US Treasury’s investment in GM.

Since, Obama’s GM will keep the Cadillac nameplate, we’ll also be producing the Zil. So, our solons will be able to look down upon all of us unwashed rubes as they are whisked to their oh so important governmental meetings. We could even, like in the old Soviet Union, have special lanes reserved for the limousines of the high party big-shots.

In a way, it’s fitting. Keep GM. Because GM has been the province of the government and the UAW since 1935. Produce exactly the kind of cars that the enviro’s get wet dreams over. And, keep the UAW as an object lesson, with three retirees for every worker on the line, for the future of Medicare and Social Security.

Spilling Secrets

mountainmusings — Mon, 18 May 2009 17:28:03 +0000

We learn that our Veep, Joe Biden, spilled the beans on the existence and location of a top-secret bunker reserved for the Vice President at the Vice Presidential residence at the Naval Observatory. What was disturbing was the dissemination of such information was done at the Gridiron Club in a manner to set up a shot at former Vice President Cheney to create a impression of a “bunker mentality” and thereby Cheney’s off-the-wall policies.

Here again is another manifestation of a patently unserious administration that now thinks that state secrets are not only to pillory former out-of-office figures from the former administration. Now, these same secrets are to serve as fodder for jest and humorous talking points. Not once does it seem to occur that people, like Biden, are given a public trust and entrusted to keep this country safe. And, this means keeping certain knowledge safe; safe for enemies who would use this information to harm our country and its citizens.

There is a quaint practice, in the Senate, for the Senators to refer to each other as the Senior or Junior Senator from thus and such state. Not, notice, a reference to a given Senator by his name. But, this practice points to a fundamental fact that in filling a Constitutionally mandated office, you the individual lose that identity and become that office. There is not to be a cult of personality, rather you the individual is subordinated to the Constitution and the office and duties that the Constitution mandates. Your “feelings” and your “empathy” do not matter when wearing the mantle of power as specified by the Constitution.

Yet, Joe Biden seems to regard those awesome duties as matter of personal choice. That the person of Joe Biden is more important than the office of Vice President. This is a man that barely two years out of law school, won an election as Senator. And, has spent his entire adult working life drawing a paycheck as a US Senator; and now Vice President. He is so inured to the trappings of power that he no longer has the perspective to understand the need to subordinate his person to the public trust that serves as the source of his power. But, what perspective does he really have? None, because his entire adult life has been in the bubble of power and prestige of being a Senator. Never, ever, having to derive income by holding down a job that actually requires productivity.

So, Joe Biden the person, now Joe Biden the Constitutional officer, who so regards all this power as his personal entitlement, makes jokes about state secrets.

The Perniciousness Of Evidence Based Medicine

mountainmusings — Sun, 17 May 2009 14:23:41 +0000

Here, from Hugh Hewitt is the outline of Waxman’s health care reform bill. I’d like to specifically comment on the provision for “evidenced based medical practices.” And, to comment on how pernicious a practice that can be. Medicine in not pure science, rather it is more like engineering. It is a reflection that the human body is too complex to accurate model on the lab bench and expect those results from the lab to work in the day to day real world.

The best examples of this concept can be drawn from the world of engineering. One can create a small chemical reaction on the lab bench and prove out that a certain new material can be made, say a plastic. It can then be determined that this new material will have thus and such properties. And, those properties can be deemed desirable enough to make in large quantities for commercial purposes. But, miniscule variables, to small to be detected on the lab bench because of the small quantities involved, now become major problems in creating the same material on an industrial scale as you scale up from making a few ounces of this material to now making hundreds or thousands of pounds per hour of that same material.

One does not create a new aircraft merely by drawing a blueprint and going directly into production. You create models, test the aircraft in wind tunnels. Then you hand craft your first full scale model, the prototype. Then you take that prototype out for a first flight. Which amounts to taking the aircraft off and landing it. Just proving that the basic concept works.

Human bodies, like the examples cited above, involve the concept of the “black box.” Inputs go in and reactions/outputs come out. We, sort of know what happens inside, but not quite. Therefore, we carefully tweek the inputs until we get the desired outputs. Science may give you the ball park figures the basic inputs, but engineering empiricism makes the final adjustments. At every aircraft plant. At every chemical refinery. In every surgical procedure, in every operating room, every day.

The effects of Evidence Based Medicine will be the following. The most important would be to render vast stores of medical knowledge, knowledge that is the reflection of literally thousands of years of empiric experience, “suspect.” In fact, going back and instituting double blinded studies to brings this medical knowledge into the evidence based medicine” clubhouse would be immoral and unethical.

The ancient Egyptians knew that one treated a boil or abscess by incision and drainage. Penicillin was never involved in double blinded trials for bacterial meningitis. What was once a disease that had essentially a one hundred percent mortality was now cured by penicillin. Much of our modern knowledge in handling trauma came from our experiences in handling combat casualties from the Vietnam War. The appendectomy was invented about 120 years ago and has been a well established procedure for the once lethal disease, appendicitis.

And, now we’re going to double blind all of the above? Of course the all-wise solons who will run Obama care will avoid the bad publicity of denying antibiotics for bacterial meningitis sans a double blinded study. But, in the name of cost containment, there are a lot of more obscure treatments and diseases that can be denied for that reason. Because, absent the imprimatur of “evidence based,” these treatments can be denied because they are “experimental.”

The fact is that double blinded studies forever run against the constraint that you are purposely denying a potentially life-saving treatment to one half of the cohort you intend to test for efficacy of some new treatment. And, unless you truly do not know which alternative is indeed better, you are embarking on an unethical and immoral practice of medicine. Further, you must have provisions to break into the blinded study should you discover, mid-study, that one group is indeed benefiting. Yet, with hundreds of billions of dollars at stake, there will be plenty of temptation to start to cut ethical corners.

The second factor will be to freeze new treatments, procedures and drugs from ever making it to the market; to the patient. With the government controlling the purse strings, it will have an enormous financial incentive to not advance medical knowledge. With money controlled and curtained to test new advances, we have no way to meed the “evidence based” standard. And, absent that standard, empiric experience gets buried. Medical advances, for what they will be worth, will be few, highly selective and highly politicized.

Consider the parachute. This was a humorous article published in the British Medical Journal in 2003; but a profound commentary on the serious shortcoming “evidence based medicine.” It pointed out that the efficacy of the parachute had never been tested in a double blinded study. And, why not? People have survived falls from airplanes with out wearing parachutes. People have died despite the proper use of a parachute. Do people who choose to wear (or not wear) parachutes self-select? We have all sorts of variables left unanswered and yet we spend millions of dollars equipping our military pilots and paratroopers with these untested (from an evidence based perspective) devices. Maybe we should take the advice of the authors and put together a “double blind, randomized, placebo controlled, crossover trial of the parachute” for the advocates of evidence based medicine. Maybe Obama, with his cool faith in science, can volunteer his administration.

Knifing Pelosi

mountainmusings — Wed, 13 May 2009 20:42:04 +0000

Rep. Steny Hoyer will allow investigations of “torture” to proceed with he inclusion of investigations of Pelosi’s knowledge. Oh, there are the usual bromides about how the GOP diverting attention from the “truth” to a witch hunt about what the Democrats knew and when.

The real truth is that Hoyer knows that everyone knew, the practice of water-boarding was very circumscribed and used with specific intent on specific suspects. And, that specific intent was the fact that there was information, life saving information, that had to be extracted. Hoyer also knows that this use of so-called torture was not used gratuitously to extract a confession for some Stalin-purge show trial.

In sum, this subject as a useful weapon against the GOP is kaput. And, Hoyer knows that too. So, Hoyer is now going to use this weapon against an equally inviting target–Pelosi. He’s got a payback to deliver. Force her out and he’s the speaker. Hoyer also knows that the minute Pelosi gets sworn in, these hearing are going to turn into the when-did-Pelosi-know hearings. At this point, it won’t matter if former vice-President Cheney gets arrested with thumbscrews in his back pocket.

And, then the law of unintended consequences kicks in. First, you can bet that if Pelosi gets called on the rug, she’s going to be sure she’s got as many fellow democrats who “knew” up there with her. Further, with the long knives out, there’s a very good chance that just about every other agenda on the Hill is going to be dropped. Especially, if there’s any chance that there’s going to be a shake up in the House leadership. And, Obama might as well as take his teleprompter to Death Valley to yammer on about having his program priorities delivered to his desk by thus and such a date.

All of which points to the lack of leadership and executive experience of either Pelosi or Obama. Obama farmed out his agenda to rich dilettante, by virtue of marrying well, whose first act was to come up with a “stimulus” bill that beyond caricatured the “tax and spend” liberal. Then Obama came up with these torture memo releases with the full knowledge, despite his protestations to the contrary, that his fellow travelers would immediately use them in an anti-Bush show trial vendetta.

All of which, increasingly, will distract from issues that will really make or break Obama’s presidency–putting the country back on track to prosperity. Executive experience would inform Obama that you need to focus your agenda, sort through all the chaff and distractions to find the real issues that need to be addressed and to pick your lieutenants very carefully. Of which, Pelosi turned out to be a very poor choice. Not that I’m complaining that hard. There’s a very good chance that Obama’s agenda is going down in flames all over informed executive experience that would have told our President that there are somethings you just leave alone.