ER

When you try to force-fit healthcare into the Standard American Business Model, you're probably going to get some pretty ugly results.

NYT:

In 1990, there were 2,446 hospitals with emergency departments in nonrural areas. That number dropped to 1,779 in 2009, even as the total number of emergency room visits nationwide increased by roughly 35 percent.

Emergency departments were most likely to have closed if they served large numbers of the poor, were at commercially operated hospitals, were in hospitals with skimpy profit margins or operated in highly competitive markets, the researchers found.

The number of ERs went down by 27% while the number of ER Visits went up 35%.  In any other business I can think of, that would indicate an impressive increase in Productivity.  But healthcare is not any other business; and Emergency Medicine is a perfect illustration of that fact.

The logic chain is fairly simple.  More patients going to fewer ERs means there are fewer caregivers per patient, which means less time can be allotted for each patient.  But treating Gun Shot Wounds and Blunt Force Trauma and Ischemic Attacks won't take any less time just because your business plan requires a greater throughput of patients.  Even with the amazing tools available to help staffers do things better, medicine is always more art than science.  It's about people; not gadgets.  The proper care of people requires time.  Take away their time, and people die.  Simple.

Jay Smooth

Gutless

The very concept of taxation has gotten so politically toxic, our esteemed "leaders" have adopted a strategy of using code words and phrases rather than risk being the subject of public wrath if they dare utter any form of the term "tax".

David Frum:

But what this default talk looks like is that the GOP wants a crisis, not a deal. A deal would involve real pain for real voters: Medicare reductions, farm spending reductions, military reductions, and revenue measures. A crisis creates an exciting substitute for such a deal – especially if the GOP can temporarily and delusively convince itself that it can pin the blame for the crisis on President Obama. That will not be true. The whole world will see that the crisis was avoidable, and will see who insisted on forcing it. And however high you imagine the financial and political price – it will be higher.

It's been going on for a while of course, but it seems we've become so accustomed to the nonsense about how burdened we are; and how the gubmint just takes and takes and takes, that we've made it impossible for analysts and politicians even to say the words.

Frum is trying to make a good point about the difference between what his guys are saying they want and what their actions are saying about what they want, but I think he knows that if he so much as mutters "increased taxation" under his breath, the Tea Harpies will swarm down on him and pluck out his eyes, and nobody will hear what he's trying to say over the ruckus.

The same thing popped up in remarks Obama was making a little while back - maybe a coupla weeks ago.  He was talking about budgets, and he mentioned spending several times, but as he listed the spending cuts, he turned a brilliantly perverse phrase that stuck in my brain. He said (approx), "we also need to look at cutting spending from the standpoint of revenue".

Ever the optimist, I'd like to think all this means they're starting to talk about sensible tax increases in the meetings, and they're just trying to wink at us to let us know they're trying to get something done that includes fixing the revenue problems.

And BTW:
4,000,000 miles of streets and roads
75,000 dams
88,000 miles of coast line
12 super carriers
2 1/2 wars
1,431,000 people on active military duty (plus 200,000 in Nat'l Guard units)
800,000 miles of sewer lines
1,000,000 miles of water lines
95,000 Schools & Colleges
650,000 Cops
1,200,000 Fire & Rescue

All of that requires oversight and maintenance, and expansion to keep up with growth. Contrary to the kind of Wal-Mart mentality that passes for critical thinking these days, you don't get Great for Cheap.  

If we spend the money necessary to bring it all back up to acceptable standards, we’d see an economic recovery that’d blow your lip up over your forehead.

At Random

I just picked (everybody's favorite crazy) Uncle Ron here to illustrate a point.  One of the basic features of political rhetoric is the hypothetical If/Then/Else: "If we do (or don't) adopt my (or my opponent's) policy, then this or that terrible (or really great) thing will (or won't) happen".

They all say this shit all the time, and I have yet to hear any of the Press Poodles ask any one of 'em the basic question:
"Can you give me some examples of predictions you've made that actually came true?"
--AND--
"What predictions have you made that turned out not to be true?"

And when they give you the inevitable bunkum about how "the policy didn't fail; those other guys just failed to do it right", then you could possibly point out that that's almost exactly what some guys in the former USSR said about communism.

Are You Kidding?

This guy is making the case that fast food joints comprise the "new face of American manufacturing", and that it's a good thing.  Seriously, are you fucking kidding me?

Go into the kitchen of a Taco Bell today, and you'll find a strong counterargument to any notion that the U.S. has lost its manufacturing edge. Every Taco Bell, McDonald's (MCD), Wendy's (WEN), and Burger King is a little factory, with a manager who oversees three dozen workers, devises schedules and shifts, keeps track of inventory and the supply chain, supervises an assembly line churning out a quality-controlled, high-volume product, and takes in revenue of $1 million to $3 million a year, all with customers who show up at the front end of the factory at all hours of the day to buy the product. Taco Bell Chief Executive Officer Greg Creed, a veteran of the detergents and personal products division of Unilever (UL), puts it this way: "I think at Unilever, we had five factories. Well, at Taco Bell today I've got 6,000 factories, many of them running 24 hours a day."

So OK, let's make sure we're doing everything we can do to study and improve methods for efficiency and throughput etc, but let's at least acknowledge that we're talking about  assembling a burrito and not a car or a vacuum cleaner or a toaster;  and we need to understand that while there's dignity in all work, it's not cool to consider a job at Taco Bell making chimichangas to be the same as a job at Suzlon building windmills.

Do you not get the feeling that we're being set up for something?

Sound Familiar?

When you hear any of the latest blather from almost anybody on DumFux News or most politicians (particularly those of a certain "conservative" bent), try to keep this in mind:

Ganser Syndrome:

...a rare dissociative disorder previously classified as a factitious disorder. It is characterized by nonsensical or wrong answers to questions or doing things incorrectly, other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual pseudohallucinations and a decreased state of consciousness. It is also sometimes called nonsense syndrome, balderdash syndrome, syndrome of approximate answers, pseudodementia, hysterical pseudodementia or prison psychosis. This last name, prison psychosis, is sometimes used because the syndrome occurs most frequently in prison inmates, where it may represent an attempt to gain leniency from prison or court officials.

"Death Panels"
"the social safety net is bankrupting the nation"
"Obama is a Kenyan usurper"
"FEMA camps"
"school vouchers will strengthen public education"
"the states are broke because they pay teachers too much"
"this is a Christian nation"
"thousands of black soldiers fought on the side of the Confederacy"

I keep believing everybody really has the best interests of the USA at heart (in spite of how some of the things I yell about sound otherwise), but I wish some of these clowns would try just a little harder to meet me somewhere closer to reasonable.

Colbert

Why does it always take this kinda weird shit to get us to pay attention?  Maybe we have such a great need to be seen as hip enough to get the joke that it forces us to look into the background to figure out why it's supposed to be funny(?)

Dunno - but it's really interesting.

Huckabee

Mike Huckabee announced he's not running for president in 2012.  I had him pegged as the the guy with the best chance to get the nomination so it comes as a surprise to begin with, but his stated reason seemed a bit odd to me.

“All the factors say go,” Huckabee said during a live, final segment of his eponymous Fox News Channel show Saturday night. “But my heart says no.”

Huckabee noted that while all of the “external” factors pointed toward him running, he only found an “inexplicable inner peace” when he decided not to enter the race.  (from Chris Cillizza, WaPo)

 These guys always talk a huge game about service and sacrifice; and they aren't exactly reluctant about saying Obama is 10 kinds of horrible for the country, but apparently Huck's inner peace just couldn't possibly stand the inconvenience of it all.  Plus, Huckabee did a lot of complaining in 08 about all the mean things people were saying about him.  I guess saving us from the evil Obama just ain't really worth all that.  Phony fuck.

The Maverick Abides

This does not absolve John McCain for having become such a complete dick over the last dozen years or so, but I still hafta throw him a bone for trying to get back to his old self.

“The trail to bin Laden did not begin with a disclosure from Khalid Sheikh Mohammed, who was waterboarded 183 times. The first mention of Abu Ahmed al-Kuwaiti—the nickname of the al-Qaida courier who ultimately led us to bin Laden—as well as a description of him as an important member of al-Qaida, came from a detainee held in another country, who we believe was not tortured. None of the three detainees who were waterboarded provided Abu Ahmed’s real name, his whereabouts or an accurate description of his role in al-Qaida. In fact, the use of ‘enhanced interrogation techniques’ on Khalid Sheikh Mohammed produced false and misleading information.”

Here's a decent piece by Joe Conason at Truthdig

Today's Wacky Pix

Police State

Calling all Libertarians and Anti-Gubmint Independents:  This is what's happening in Indiana, after many years of "conservative" erosion of civil rights in the guise of "common sense laws and law enforcement"; and under the watchful eye of a very popular Republican, Governor Mitch Daniels.

This is what's happening because of who you've been allowing to get elected.  Make no mistake here.  Every time you say something like "they're all bad" or "they're all the same" or "why can't the ballot say None Of The Above" or anything else that's just fuckin' stupid, you're taking yourselves and others out of the process, which is exactly what these shit-heels want you to do.

(hat-tip to Little Green Footballs)

INDIANAPOLIS— People have no right to resist if police officers illegally enter their home, the Indiana Supreme Court ruled in a decision that overturns centuries of common law.

The court issued its 3-2 ruling on Thursday, contending that allowing residents to resist officers who enter their homes without any right would increase the risk of violent confrontation. If police enter a home illegally, the courts are the proper place to protest it, Justice Steven David said.

“We believe … a right to resist an unlawful police entry into a home is against public policy and is incompatible with modern Fourth Amendment jurisprudence,” David said. “We also find that allowing resistance unnecessarily escalates the level of violence and therefore the risk of injuries to all parties involved without preventing the arrest.”

Chicago Tribune

And the circular logical is impeccable.  The police break down your door; they take whatever they want; they can stomp you and your family if you "resist" (and of course you will get stomped, because of course the cops will claim you resisted); and if you claim they've made a mistake, you can hire a lawyer (with whatever you can scrape together after  the cops have taken everything) and go to court; but since you had no right to "resist" in the first place - even when it was an UNLAWFUL entry - you have no case.

Let me be clear (if that's at all possible at this point): The scenario above is not meant to illustrate what's bound to happen every time the cops go to somebody's door.  There will be many more legitimate incursions than not.  But that's not the point (that's NEVER the fucking point).  The point is that when you grant the kind of power that this bullshit decision entails, you will get abuse - because you're inviting abuse.  Get it?

Let Fly

The prize for Scary-Freaky Zealotry today goes to the commenters at the DumFux News website.

A few samples from the comments section on the post regarding the "poetry event" at the White House, featuring a rapper called Common (via: Little Green Footballs).

nativeson1 6 minutes ago in reply to nickthecat

DONT RE-NIG IN 2012 !

——————

elsargento 6 minutes ago in reply to idahojon

HOW TO WINK AT A N I 6 6 E R. HOLD YOUR WEAPON OUT STRAIGHT AND CLOSE ONE EYE. NUFF SAID.

——————

paintaz Just now

Another classless move, from a classless president………….they will be bustin out some fortys !

——————

contributorj Just now

i wonder if moochelle will sneak off and perform a common bj…..

——————

kingtiger44 Just now

All in attendence will recieve a white lawn jockey statue, and a coupon for KFC.

——————

kingtiger44 18 minutes ago

Animal Control responded after a report of loose porch monkey’s.

Sometimes, it's all just a fucking circus.

Today's Inspirational Messages

New From Pew

Let's put this in front of Congress and see where the real power is.

Oops

Who do I talk to about a refund?

We Are So Fucked

Back to a once-familiar theme of this blog from about a year ago: bend over and grease up, America.

Daily Censored (by Michael Collins):

Official unemployment is around 9%. That excludes the marginally employed and under employed. Adding those two groups takes unemployment up to 15.9%. Add the long-term unemployed and the figure climbs to nearly 23%.

When you have 23% real unemployment/underemployment among those willing and able to work, you have budget deficits at every level of government. Businesses fail or slow down. Governments reduce or eliminate services. People lose their homes and health insurance. Credit ratings dive, making it more expensive or impossible to borrow for any reason, including emergencies. The unemployed contribute much less to the economy, which shrinks substantially, leading to more under or unemployment. There future darkens. All that’s left is hope, a commodity of little use today.

If you’re part of the financial elite in crowd, you don’t need hope. You’re about to get another big payday. Much lower taxes and relaxed regulation of foreign exchange derivatives are on the way.

Wow

Brings a whole meaning to the phrase "holy crap".
(hat tip to The Daily Show with Jon Stewart)

A Prediction

Red State Update