August 28, 2009

How about that for an August?!

Not that I remember much of it.

That was one of the good things about all those years of obsessive blogging--I had a way of recording all the silly and serious stuff that happened before it left my brain pan. But the now-no-longer-new job leaves not a lot of time for reflection and/or mindless drivel. Actually, the volume of work means I don't really get to do the job very well, either. At the moment, I've got about 40 various construction jobs from a few thousand to a few million dollars worth for which I'm supposed to provide varying degrees of oversight, and even the smallest nickle-and-dime jobs require constant babysitting and butt-covering. I can't get one thing done for having to go and do twelve other things that are suddenly CRITICAL. What time I have left over is devoted to trying to scoop my neurons back into a pile. I get to check in a little with folks online and read a few news feeds occasionally, but it's hard to get into the swing of trying to formulate a pithy comment about anything. You have to get into a groove for that sort of thing, y'know.

You'd think that with my current schedule (four 10 hour days with Fridays off) that I'd be able to maybe take that Friday and have a great big Possumpalooza of stupid junk to read, but alas, Friday is now just as busy as Saturday and Sunday used to be (and, in fact, still are). F'rinstance, this morning I took Cat to school, went to do the Winn-Dixie leg of the grocery bill, went to the bank to pay the mortgage, stopped beside the road briefly to weep uncontrollably for my bank account that has the integrity of a cotton candy fishnet, unloaded groceries, put up the ironing board that Rebecca left out, came upstairs to gather up the laundry, stopped to write this, and afterwards will separate the clothes, put the blue jeans in the wash, go do the Aldi leg of the grocery bill, come unload the groceries, fold jeans and prepare to do the other six loads of laundry to be done this afternoon, go pick Catherine up from school, maybe get Jonathan to take him to the stadium for the football game tonight, go to the game tonight (10,000 STRONG!), come home late and help the kids pack to go white-water rafting with the other kids from church tomorrow morning, and then collapse in the bed to try to get ready for tomorrow. I don't mind doing that stuff, but all that makes it difficult to do much of this here thing. Good thing I quit doing this here thing!

Anyway, if I were still blogging, I would have many uncomplimentary things to say about our current Administration. And for the people who seem shocked and dismayed that it's turned out this way. As Dr. Reynolds is fond of saying, "So, who are the rubes again?" But some people just refuse to pay attention.

Not that it would have been any better with the alternative. I really like Sarah Palin, but she wouldn't have been the President, it would have been Mr. Unpredictable Maverick. And unlike now, he wouldn't have had the press fawning over his every move, and actively supporting his agenda, and proclaiming how wonderful it is to have all these wonderful funemployment opportunities for urban swells, and would probably take more than a little interest had Mrs. Palin said anything about bankrupting the country in order not to bankrupt the country. Hard to tell what would have happened in an alternative universe of a Republican win, but even if the status quo of the Bush days had held on, we'd have never heard the last of how awful it was. And, again, that's assuming it would have still been good--as it is, Senator McCain's one consistent quality is his fundamental inability to be consistent. Add to that the fact that he has just about as much spendiness and government-interventionalism in his genes as a regular old Democrat, and that he would have had to work with a Democrat-dominated Congress. I'm afeared the spending and stupidity would have been just about as reckless as now. But, again, the press wouldn't have been so cautious in squealing about it.

Anyway, I guess America is just fated to occasionally have to be reminded of how awful it is to try to answer every problem by letting a Washington full of bureaucratic nannies handle it.

Just remember--if you thought FEMA's reaction to Katrina was bad, what makes you think that the same people could do any better with universal government-funded and controlled healthcare? Sheriff Joe and The Lightworker, despite their good press and the overwhelming confidence they place in their vast intellectual depth, cannot make this work.

Yeah, I know--I'm just an ignorant racist idiot who can't be compelled to vote or think the right way, even when it's just so obviously in my financial best interest to do so.

But then you all already knew that!

Anyway, I'm gonna go do my laundry.

Posted by Terry Oglesby at August 28, 2009 10:40 AM

What reams me about the current bills is that they don't reduce costs. I was reading at Doc Joyner's site in the comments that a colonoscopy that Anjin-san had was billed at $12,000.

Maybe he misread the doctor's bill, or he was just kidding, but we need to get a handle on costs.

Another example, from a commenter at the Washington Post, I can't show you, is a routine urinalysis for $700.

I want transparency on cost.

Posted by: Janis Gore at August 28, 2009 11:23 AM

They aren't intended to cut costs. They're intended to provide coverage for whatever the number of people currently without insurance, and to make everyone who has insurance to give it up for government insurance.

As with any commodity, price is based on supply and demand. And as with any commodity, price subsidies (either by tax breaks, insurance, or other) don't make the price go down, it only masks the total cost.

The only way to control price is to provide an opportunity for competition. In Alabama, this is stymied by the Certificate of Need Board that regulates what services and facilities a healthcare provider can offer.

Transparency is a separate issue, but if done the way other services are done (you know up front how much stuff costs before you agree to pay for it), it could (possibly) allow a customer to better shop for affordable service. But again, the way payments have been made in an insurance-based system, the effect of that subsidy and the manner in which the facility receives it makes it easy to mask the total cost.

Other cost issues include the perceived need to (over)prescribe diagnostic testing or procedures in order to mitigate potential legal liability. Despite this, mistakes still get made, and there is still a large legal cost associated with defending a physician, and believe it or not, there are people who bring fraudulent or frivolous lawsuits. (Yeah, I know that one's difficult to believe, given how scrupulous the legal profession is.)

Further costs include those necessary to comply with all the various federal and local health, safety and welfare regulations, recordkeeping, employee benefits, training, etc.

So there is a tendency to be shocked when you see that an aspirin costs $50 (or however much it might cost to dispense to you) in the hospital, but the same could be said for sweet fizzy water and coloring that costs a few cents to make, and costs a buck and a half for you to buy out of a drink machine, and might cost five dollars at an amusement park or movie concession stand--you're paying a premium for the same item. In the hospital, you're paying for the lights, the rent on the building, the layers of recordkeeping to make sure you were supposed to just get one aspirin, the salaries of the pharmacist, the doctor, the nurse, the orderly, the housekeeping staff, the parking attendant, and the cost of the aspirin itself.

In the end, whatever the solution, it cannot come from more intensive bureaucratic involvement from Washington.

Posted by: Terry Oglesby at August 28, 2009 11:54 AM

You've been talking to your sister.

Posted by: Janis Gore at August 28, 2009 12:43 PM

Huntsville could use your project oversite expertise. Our jail is now $50 million over an original estimate of $30m.

If you went to 12 hour days you'd be able to blog daily.

Posted by: Larry Anderson at August 28, 2009 01:47 PM

In the interest of full disclosure, my sister is now in private practice as a rheumatologist. She has an undergraduate degree in medical technology and graduated from medical school in 1980. After doing her internship and residency, she spent the next twenty years or so doing complement research at UAB and at WashU. in St. Louis before going into private practice.

In all of the places she's lived, she's had to do rotations through the local VA hospitals, and in her own words, if you think socialized medicine is the answer to your problem, you oughta see how it works at a VA hospital.

Now lest you think she's just part of the right-wing medical establishment, politically, I'd say she's pretty far to the left of me, voting for Clinton I and maybe even II, and actually thinks Jimmy Carter is a decent man.

But laying aside what I would consider a viable critique of the system, I think it's still obvious that the basic economics of the various proposals don't make sense.

There is no such thing as a free lunch, or free healthcare.

Posted by: Terry Oglesby at August 28, 2009 01:59 PM

And Larry, you are not being helpful.

Posted by: Terry Oglesby at August 28, 2009 02:01 PM

The VA is lazy, until you have an urgency. My brother has found good care at the Sonny Montgomery hospital in Jackson.

Posted by: Janis Gore at August 28, 2009 07:36 PM

The confounding thing is that many of the doctors at a VA are the same ones round about in private practice who are doing rotations through the hospital. Hard to believe that they'd suddenly become incompetent once they walk through the doors, so you have to think the system is so full of procedures from the road-to-Hell paving department that it simply cannot compete with private medicine either in efficiency or in quality.

Sorta reminds me of Churchill's observation, "The inherent vice of capitalism is the unequal sharing of blessings; the inherent virtue of socialism is the equal sharing of misery."

Posted by: Terry Oglesby at August 29, 2009 06:57 PM

Dang. I can hear that whining all the way down here. Almost as loud as the we-won't-take-your-stimulus-money govenahs whinging all the way to the bank.

Posted by: vachon at September 2, 2009 04:49 PM

Automatic gainsaying?! The deuce you say!

Posted by: Terry Oglesby at September 2, 2009 05:11 PM

Oh. Is this the right room for an argument?

Posted by: vachon at September 2, 2009 06:30 PM

I'm sorry - it's getting hit on the head lessons in here

Posted by: skinnydan at September 3, 2009 09:01 PM