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In a new article, Bitter Pill: Why Medical Bills Are Killing Us, Time Magazine delves into why medical bills are so high.
I had a fibrous cyst creating a boil on my neck several years ago. After a round of antibiotics, a doctor performed a 15 minute outpatient surgery, assisted by a nurse, in an examination room. It wasn't even an operating room. Local anesthetic was used. The incision was about 3/4", and I was given a prescription for Vicodin I really didn't need before I left.
The bill was about $850. I was shocked. I might have expected $250, but $850?
Well, $850 is nothing in today's medical world.
Time describes instances of non-life threatening household accident injuries that run up bills in the five figures. More serious problems like treating cancer can run up bills in the six- and seven-figure range with ridiculous line items described in excruciating detail in the article.
What makes the pain of high healthcare costs worse is that the health care providers seem to be profiteering with markups that are as outrageous as they are unjustified. So-called "nonprofit" hospitals are actually profit-making institutions. Have you noticed how your local hospital is adding on new additions like crazy while the rest of the economy is slow. It's a boom economy in healthcare, forcing unjustifiable costs on a public suffering in a totally separate economy.
The article argues something I've already written about here: the healthcare industry isn't a normal market and doesn't really operate in the normal economy the rest of us have to live in. It doesn't compete for the business it gets and there's very little operating to restrain their costs. Yes, your insurance company probably gets a discount of 40%-50%, but even with that discount it's hard to justify the line items on the bills.
Of course, there are people who can't pay their bills and become write-offs and they become part of the high cost of healthcare, but not such a large part that bills need to be as high as they are. Likewise, insuring themselves against lawsuits filed by people who can't accept that (a) shit happens or that (b) some people's conditions are terminal no matter WHAT care they get is a costly problem.
Putting some controls on the legal problems the industry faces is an obvious need, and one that can be addressed. However, the reasons for high healthcare have mostly to do with greed—getting whatever the traffic will bear—rather than providing the best service possible at a reaonable price. It's an industry that has forgotten that its primary purpose is to provide a service, not to break the back of those it serves with unjustifiably high expenses.
Look, I like capitalism, but I've come to decide that there are places where capitalism doesn't work. We don't want police and fire departments, libraries, and parks to be run on a "what the market will bear" basis. I would think that we especially don't want our healthcare system run that way.
You have no better argument for socializing medicine than the system we have now.
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I'm in the U.S and there is at least 4 months for hip replacements here as well btw
Re-anchoring thread from http://www.thinkatheist.com/xn/detail/1982180:Comment:1263940
The US tax/GDP ratio is very deceiving. By privatizing prisons and medical care, entire sectors considered 'social expenditure' in other countries are counted as GDP in the U.S. - which is fucking ridiculous. The U.S. is the only country on the planet that improves it's "production" numbers when more people are sick and/or in prison.
Add to that the arms producers being counted in GDP even though they are being paid directly out of public funds - and American GDP has absolutely nothing to do with 'production'. Essentially American 'GDP' reflects the 'production' of their 17 TRILLION dollar debt.
Why not just toss the output of the Federal Reserve debt notes into the GDP numbers and be done with it?
My 5/20 rates weren't intended to reflect base rates but more to reflect the problem that those born into big capital are continually revealed to be paying a far lower percentage in tax than the working poor.
And this is a problem exactly why?
Firstly, they will probably pay on par with a poor person, but lower than a middle class person. Secondly, a rich person hardly use more of the government's resources than a poor person. If a 5% tax rate means $2m in the government coffers, that person will probably contribute 100x more than consumed while a poor person at twice the tax rate will probably only contribute 1/10th of what that person consumes. I'm a more absolute than relative numbers person. Lastly, you dodged the point that you distorted your rhetoric to make a point, either by making a bullshit argument (in case you didn't care to know the CG rate) or you were caught in a lie (if you knew the CG rate).
A rich person also requires less of their earnings for survival than a poor person. The problem I'm trying to address here is that the flow of wealth to the top has become exponential - and the reason is because too much wealth is there already.
Those who primarily earn from their capital have lobbied for so many loopholes that they can sometimes get their marginal tax rate down into the single digits. Those who primarily earn from wages can't keep enough of their salary to save the sort of capital required to access those sorts of loopholes.
If you are more about absolute than relative numbers then please stop using percentages.
Of course they require less of their earnings for survival, but their money is still primarily their money, and not a common resource. Globalization has certainly made the potential for vast returns possible. To illustrate, if J.K. Rowling had written 200 years ago her market may have been 1m Britons paying £1 each (in today's money), with globalization it's 2b world citizens at £1 each. Now, lets say an investor had given her £50k for a 10% stake in '95... Point is, world GDP has more than doubled in 10 years, and investors who hit it big will become fantastically wealthy, and rich people tend to be the best at picking investments (or hiring investment pickers).
I don't think their marginal tax rate (the rate on the last earned dollar) is in the single digits, however the effective rate may be. And loopholes should be made away with, specifically the interest deduction rate, which encourages debt and property speculation. Another major loophole that could at least be capped is charity deduction. The remainder of the major loopholes (pension contribution, health care, min. income, etc) is generally supporting the weakest members of society and should stay in place, and other loopholes don't really bring in any revenue.
As I previously stated, I don't think taxes on income is a good idea in the first place, and especially not on low incomes. I also think minimum wages should be at least $15, as most of those jobs are non-exportable anyway.
I did use absolute numbers, you neglected to comment on them.
I also want others to pay higher taxes. ;)
The main problem in the US is that everyone needs to pay higher taxes. Well, at least pretty much everyone. A 10% across the board increase would do it. Of course, that's unless you prefer getting smart about taxes, and everybody could pay a more appropriate amount.
They do by counting personal debt interest and bond interest (which is non existent right now) as both rights off's (if you make enough money) and capital gains tax. Its the reason no one wants to change the tax code. All our cooking of the books would go bye bye. We don't see the tree's in the forest any longer. The money is not backed by anything but debt. So the gov. prints the money and then takes it back in taxes but it never really pays anything back because it's only good as long as the US and worlds people do not demand equality. If we all stop complaining about taxes (which are not real just paper transactions) and stop looking at our wages as gross and only as net then the govt will have to change.We are all duped into a jedi mind trick so that growth seems plausible. You make 100k a year but only take home 60k a yr, i take the 40k and pay for stuff for you. Pretend you have it and then complain about giving it back so it seems real. and then maybe give you more "back" from time to time. Its all a way to make it SEEM so real but its not. In the scenario above you make 60k. Sometimes you get a break and 65k but really the part everyone complains about in taxes is not real just less money printed but yet put ont he books as if it was.
"The money is not backed by anything but debt."
Except, of course, the productive capacity of the US.
"So the gov. prints the money and then takes it back in taxes"
Actually, they sell bonds to investors - who, at the moment, is actually paying the government for the privilege to buy the debt - and then turn around and use the proceeds to buy goods and services from the people of the US so that they will avoid a severe depression.
"but it never really pays anything back"
Why would it? Investors have so much money that they are paying the government to take it, hardly seems as if they need it.
"because it's only good as long as the US and worlds people do not demand equality."
Can't really demand economic equality, it needs to be achieved. China is working hard at it.
YES! I was just going to suggest that. In NZ we have GST (Goods and Services, Value Added, sales) tax. but the retailer is required to include this in the price. So, if you see an item on sale for $5, you take it to the counter and give the clerk $5. In the States, you are not only mightily inconvenienced by pockets full of pennies, you are reminded, with every transaction, how much tax you're paying.
Why can't the same jedi mind trick be used for income tax. Instead of the employer paying you $1000 and you having to pay the govt $200, why not put net up front. Tell the employee, "Your salary is $800. Here it is. Go spend it." Then the employer (or banker, or investment co,) can pay your income tax for you invisibly. Of course there's an administrative burden on the company, but the burden would be a hundred times less than the cumulatively administrative burden on the individuals.
If they were independent of each other then they shouldn't be counted together. However, there exists strong reasons why to double count them, specifically that the tax burden impacts both the value of a firm and the dividends its able to pay. As the double tax rate is considered relevant by the investor, its relevant for the calculation of total tax burden.
Lets say you start investing in property, and end up with 10 units that gross you $100k profit each year. You are considering whether to incorporate or not. If you don't you are taxed at your personal rate of 35%, thus you net $65k. If you incorporate you will first pay corporate tax of 35%, and then personal tax of 35% on dividends, thus you net $42.3k. Clearly you would choose to be personally liable, which will make you vulnerable and restrict your growth potential. I think that's quite relevant points and worthy of consideration.
The CEO wouldn't be liable anyway, unless he is also a shareholder. Auntie Marie with a few thousand dollars in shares through her 401-k, on the other, hand would be in the compromise you outlined.
While there certainly are possible to close loopholes, the average tax rate will almost always be lower than the corporate tax rate since general and tax accounting rules are different. Two large "loopholes" is that losses in one year count towards profit in another year, and depreciation is usually linear in the general accounting and percentage based (accelerated) in the tax accounting. That's not to say unnecessary loopholes don't exist and can't be closed, but a lower corporate tax in the US would make tax planning less profitable, and may in fact bring in more revenue. A sector tiered tax system would be even better, taxing extraction and domestic end-consumer companies at a substantially higher than those who face international competition.
I dislocated my shoulder several years ago, and had no insurance. I normally pushed the shoulder back into place, but this time even an 80lb tool box was not enough. A friend took we to the ER, I waited nearly 3 hours before I was seen, by then I was going into shock! Finally, I was wheeled in, they looked it over, they knocked me out, and I woke up a few hours latter with a re-located shoulder and a bill that seemed to indicate that I had been also raped! $1200.
For some reason they could not just use Demeral, which had always worked before, and I could stay conscious, they thought they needed to dope we up on a medication that interfers with short term memory!
Finally, I was able to get medical for a few months and had surgery for the shoulder, good ever since!
During the period I attempted to make payments, I was told by the billing department, after mentioning that the bill was absurd and no sane person should be stuck with it, that 'docters are wonderful, you should be happy that they put you back together!' In short, docters are F--king god, how dare you complain!
I hope, if this becomes a closer match to 'the best of all possible universes', that doctors get a 6 figure reality check! Thanks for being there, when I needed you!


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Havana Nights: A Celebration of Cuban Music & Food
Fri · December 6, 2019
9:00 pm
World Cafe Live Philadelphia - Upstairs
Havana Nights
Join us for our monthly Cuban music & food series, which features authentic Cuban cuisine, cocktails, and music courtesy of Philly's most exciting Cuban band, Conjunto! The night is FREE to attend w/ a variety of food and drink specials. A perfect date night or just a night out with friends.
Conjunto Philadelphia
Conjunto Philadelphia is a musical ensemble based in the Philadelphia area performing the music of Pre-Revolutionary Cuba. The group's main aspiration is to maintain the authenticity of the music while performing it in a way that pays homage to Cuba's deep and treasured musical history. Genres include Son, Cha-cha-chá, Bolero, and Danzón.
Venue Information:
World Cafe Live Philadelphia - Upstairs
3025 Walnut Street
Philadelphia, PA, 19104
World Cafe Live Philadelphia - Upstairs
3025 Walnut Street
Philadelphia, PA, 19104


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Radar for Oconomowoc, WI
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After going 0-3 earlier in the week against Boston, Indiana and Chicago, the Knicks took care of the feisty Hornets today at Madison Square Garden. Offensively, the Knicks were much better than what we'd seen the previous two games. They were able to hit 11 threes and move the ball effectively, racking up 24 assists. New Orleans is one of the worst defensive teams in the league and the Knicks should've been better offensively, but given New York's recent run of terrible play, I'll take this W.
Here are my notes from the game:
- Let's start with Melo. His start was atrocious (1/10 shooting), but he rebounded nicely to finish with 27 points on 25 shots. I haven't been in love with Melo's decision making lately, as he's taking a lot of bad shots. However, with Felton out, the offense has been calling for more creation in isolation as opposed to easy spot up looks. I will say, Anthony does need to improve his first quarter shooting. One of the hallmarks of the Knicks early season success was first quarter domination, largely due to Anthony getting off to fast stars offensively. As we can see here, Anthony is far better in the first quarter of victories and has been pretty bad in the first quarter of losses:
- As the great Jared Dubin was constantly pointing out on the twits during the game, the Knicks seem to be much better with two point guard lineups that feature Jason Kidd at the 2-spot. I couldn't agree more. Kidd has been very effective as an off-ball quarterback that shoots open spot up threes and swings the ball well. He's no longer a starting caliber point guard, which is why I wasn't a fan of the Knicks bringing him in to begin with. Unfortunately, with Felton injured, the Knicks only have two point guards on the team. Kidd can't play the two-spot for the entire game, but I think Woodson would be wise to get the Prigioni-Kidd combination as many minutes as possible.
- Amar'e Stoudemire put in 12 points on 3/6 shooting today. Defensively, he didn't kill the Knicks. He had some bad plays, and soem really bad fouls, but the Knicks got away with it against an average team like New Orleans. Grabbing three boards in 23 minutes is still really bad, but I didn't think Stoudemire got manhandled as much on the boards by Robin Lopez as he could have. I'll say this. Through these handful of games we've seen STAT play, he's clearly not the same athlete, or not yet at least. He looks like a shell of himself, but I do think he's trying hard. He had a play where he dove out of bounds to grab a ball, another where he fought for an offensive board. Stoudemire has a lot of pride. If he continually proves to be a detriment, it won't be due to a lack of effort.
- Ronnie Brewer continues to be laughably terrible on offense. He missed a layup, missed a put-back dunk and passed out of this look: (via @MikePradaSBN)
- Defensively, the Knicks were much better than they have been recently. The question is whether it was New Orleans being bad, or the Knicks being good. I think it's a bit of both. I thought New York did a great job of defending Ryan Anderson. They got up on him and didn't give him many open looks all game. Robin Lopez has been a good player this season, but Chandler did a really nice job of dominating him. Lopez shot just 5/14 from the floor. New Orleans is one of the better three point shooting teams in the NBA, but the Knicks held them to just 4/21 shooting. I'll say this about the Knicks defense. From a personel standpoint, you can see why they're not great on defense. They don't have any guards who can keep guys out of the paint. With Sheed and Camby injured, they have nobody other than Tyson who can protect the rim. While we'd love to see the Knicks return to their top-5 form of last season, I'm beginning to believe that may not happen. Iman Shumpert's return will help, but we don't know how effective he'll be coming off a torn ACL. The Knicks are the third best offense in basketball, averaging 108.9 points per 100 possessions. If they can take away what teams do well and hold opposing offenses in check, they'll win the majority of their games. They took away what New Orleans does best today, the three pointer, and scored more than enough points to win. At this point, the Knicks defense needs to take positive baby steps and I think this would be a good start.
- Copesanity! With JR having another poor shooting game, the Knicks needed scoring from elsewhere today. Enter Chris Copeland. The forward also known as Optimus Cope scored 22 points on just 15 shots today. As bad as Melo was in the first quarter, Copeland was cool beans, splashing three after three after three. I really think highly of Copeland. You can see why he wasn't on an NBA roster, because he's horrible defensively, but he really is a good offensive player. He can handle the ball, shoot the three and create his own shot. Unfortunately, the Knicks can't always afford to have him on the court because somebody has to defend, but he definitely has a role on this team. Cheers to you, Cope!
- Last and least, the MSG back-up PA announcer is the poops. He is horrible.
Follow Taylor on twitter @tarmosino


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Updated 30 Jun 2017
Snapshot: The Apple (2018) iPad 9.7" MP2G2B 32GB cellular has a 9.7 inch screen and 4G connectivity. But what's it like to use?
Unlock all of Consumer from just $12 a month
Overall score includes:
Performance (10%)
Screen quality (20%)
Convenience (20%). Includes score for virtual keyboard.
Multimedia (25%). Includes music, movies and photos.
Battery (15%)
Design & functionality (10%). Includes score for construction quality.
Price is from a November 2018 survey.
Unlock all of Consumer from just $12 a month


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By ,
Published January 13, 2015
The European Union is tightening sanctions against Iran, concerned about alleged violations of human rights in the country.
EU foreign ministers, meeting Monday in Brussels, added nine people they said were "responsible for serious human rights violations" to the list of those subject to a travel ban and an asset freeze, bringing the number of people sanctioned in this way to 87. The foreign ministers also decided to freeze the assets of one "entity," meaning a company or organization.
The measures will be valid until April 13, 2014. The names of those sanctioned will be published Tuesday.
Iran carried out at least 55 public executions in 2012, U.N. spokeswoman Cecile Pouilly has said. Some 400 people were reportedly put to death in the country last year.


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Torrey Pines - North
Marvel at what may be one of the most beautiful Golf Courses in San Diego, California. Towering above the Pacific Ocean you will find the Torrey Pines North Golf Course. With just the most amazing views of the coastline, deep ravines and classic Championship golf holes; this is the Golf Course we are sure you will never forget. Torrey Pines houses two incredible 18-Hole Golf Courses, this and the South Course. Another spectacular piece of evidence that this is sure to be the course you will want to have your Golf Vacation at is that this was also the place for the memorable 2008 U.S. Open. This course is excellent for any skill of golf player and with golf professionals and one of the top 100 golf shops in the world, you are sure to feel at ease with your Golf Vacation Package to Torrey Pines Golf Course in San Diego, California.


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Former Russian prime minister Mikhail Kasyanov [BBC profile] on Monday testified that former president Vladimir Putin [official website; JURIST news archive] ordered the arrest of former oil executive Mikhail Khodorkovsky [defense website; JURIST news archive] for political reasons. Testifying before the Khamovnichesky District Court, Kasyanov stated [Moscow Times report] that after questioning Putin on the subject several times, he finally indicated that Khodorkovsky had funded the Communist Party [party website, in Russian] without first getting approval to do so from the president, prompting the arrest. The left-leaning Union of Right Forces and Yabloko [party websites, in Russian] have acknowledged receiving funding from Khodorkovsky, which, according to Kasyanov, was authorized by Putin, but the Communist Party has denied ties to Khodorkovsky. Kasyanov went on to criticize [NYT report] the practice of seeking secret presidential approval for the otherwise legal funding of political parties. Kasyanov served as prime minister under Putin from 2000 to 2004, before being dismissed along with the entire cabinet, and has since become critical of Putin. Putin currently serves as prime minister under President Dmitri Medvedev [official website; BBC profile].
Last week, Khodorkovsky ended a two-day hunger strike [JURIST report] after a spokesperson for Medvedev indicated that Medvedev was familiar with a complaint Khodorkovsky made regarding the three-month extension of his detention. Also last week, Khodorkovsky sent an open letter to Russia's Supreme Court [official website, in Russian] contending that Russian courts are ignoring recent changes in the law that allow people charged with economic crimes to be released on bail pending the outcome of their trials. Khodorkovsky indicated the goal of his hunger strike had been achieved [press release], and that his intention was to change the judicial system going forward and not his current situation. Khodorkovsky and his business partner Platon Lebedev [defense website] are currently serving eight-year prison sentences after being convicted [JURIST report] in 2005 on fraud and tax evasion charges stemming from an attempt to embezzle and strip their Yukos [JURIST news archive] oil company of valuable assets. They are now charged with embezzling [JURIST report] USD $25 billion worth of oil produced by Yukos. The men have pleaded not guilty [JURIST report] to the current charges, and face up to 20 additional years in prison if convicted.


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Google buys BumpTop, could target 3D interface at iPad
Apple passes 1m sales with launch of 3G tablet
After the US launch of the 3G/Wi-Fi version of the Apple iPad, the tablet has passed the one million sales mark, prompting the firm's co-founder Steve Wozniak to say the PC-Mac war was over as the new formats took Apple well beyond its traditional user base.
But other players will bid for the upper hand in the hybrid PC/mobile space too, with Hewlett-Packard and Nokia among those readying products based on new platforms. And of course, in its escalating war with Apple, Google is unlikely to stand still. It is putting the finishing touches to its new Chrome OS, geared to tablets, smartbooks and the cloud, and has acquired its latest start-up, BumpTop, maker of a 3D user interface.
BumpTop's technology will be incorporated into Chrome OS, bringing an advanced user experience to future tablets, whether this is licensed to third party device makers, or Google decides to repeat its Nexus One gamble with an own-branded 'cloudbook'.
Canadian BumpTop makes a desktop environment that currently runs on PCs. It supports 3D and multitouch, allowing users to make stacks of files to drop into other applications or upload. The price of Google's fourth acquisition in a month was undisclosed, though informed estimates said $35m to $40m.
The start-up, which was founded in February 2007, was set up with $1.65m in funding from angel investors and venture capitalists GrowthWorks and Xtreme Venture Partners. It describes its product as a "desktop workspace with a visually intuitive way to organize and access pictures, video, and documents".
Back at Apple, analysts at Piper Jaffray estimated that 300,000 of the new 3G/Wi-Fi iPads were sold between Friday and Sunday, about the same as the first weekend sales for the Wi-Fi-only model. This may worry AT&T, the exclusive carrier for the cellular version, which seems to have been banking on most users going for the cheaper Wi-Fi gadget. iPad sign-ups are good for AT&T's customer numbers and data revenues, but could put a further strain on its HSPA network.
So far, Apple says, iPad users have downloaded 12 million apps, developers have created 5,000 programs specifically for the device and the new iBookstore has sold 1.5 million ebooks, although games were the dominant category, at 32 per cent of all apps downloaded. According to FierceMobileContent, about 80 per cent of the apps were paid-for, with an average price of $4.67, which is good news for developers and for the positioning of the iPad as a premium software device. By contrast, 73 per cent of iPhone or iPod Touch apps are paid-for, with an average tag of $3.82.
Copyright © 2010, Wireless Watch
Wireless Watch is published by Rethink Research, a London-based IT publishing and consulting firm. This weekly newsletter delivers in-depth analysis and market research of mobile and wireless for business. Subscription details are here.


text: This graphic shows a client process with two sessions. Each session submits the same SQL statement: SELECT department_id FROM departments. Each session retrieves the result set from the Client Result Cache. The Result Set contains the values 10,20,30,40, and so on. A vertical dotted line divides this part of the diagram, labeled Client, from the part labeled Server. A database icon is shown interacting with the cache, with the label "Keeps Consistent."


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Please validate you are human"
CB Destrukce of the Czech Republic is one of the country's top ten contractors providing drilling and blasting services for the construction industry – and it's all about CARE.
Czech drilling and blasting specialist CB Destrukce is celebrating its 25th year in the industry this year following a record 2015. Founded in 1991, the company made its name in small scale quarrying, later moving up to large-scale mining of raw materials for the construction of roads, highways, railways and pipelines. Last year, it recorded a record 300 000 drillmeters – its best performance ever – and has expanded its equipment fleet with two new SmartROC T40 rigs, backed up by an Atlas Copco CARE agreement – a combination that helps the firm to live up to its brand promise of quality and reliability.
M&C asked Jan Šebor, owner of CB Destrukce, why the CARE agreement is so important. "We used to have a servic e contract with Atlas Copco for the ROC F9C, but at that time it was a full contract," he said. "We wanted to change it for the future, so with new machines we decided on a more flexible service solutio n and CARE was the best choice." He continues: "What convinced us was the professional way Atlas Copco takes care of its machines. We used to do the service ourselves, but the results were never as perfect as with Atlas Copco."
" What convinced us was the professional way Atlas Copco takes care of its machines. We used to do the service ourselves, but the results were never as perfect as with Atlas. "
Since the CARE agreement has been in place the company says there has been no downtime and every job has been carried out on time. "That's what differentiaties us from our competitors," he says. But the most important aspect for the company is the fixed cost. "Every month we pay a fixed price for the contract and we don't have to worry about any unpredictable failure which might cause a big problem for our customer and for us," Šebor explains. "We calculate this as price per drillmeter and it enables me to plan for the current year as well as for the following year. "As an owner, it is important for me to know the costs in advance. If I can plan better, I can be more competitive." Another big advantage, he says, is peace of mind. "We don't have to worry about a rig breaking down in high season, causing huge losses for the customers, and for us. The contract gives me reassurance that the rig is under control, that all preventive maintenance is done at the right time. "Also, as the contract is directly with the manufacturer, every repair is prescribed with original spare parts which means you can rely on them and don't have to be afraid that something will break down and cost more money." Šebor makes it clear that previous attempts to save money on parts did not succeed. "We have our own service center with our own technicians and we previously did the service work," he says, "but the quality and reliability did not compare with having a machine under a CARE agreement."
Read the full story at Mining & Construction online.


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I've been buying raw (unpasteurized) milk straight from a local dairy farmer for awhile now. It's about time for me to share the good news! To be honest, it took some time for me to warm up to the idea of drinking whole milk, unpasteurized. Wouldn't I gain weight? (Hah, I was glad to learn that the opposite is true!) Was it dangerous? To put it lightly, I wasn't immediately comfortable with the idea of drinking milk straight from a farm animal, without any disinfection. I initially made the decision out of necessity. Now, almost a year into it, I can honestly say that raw dairy including full-fat milk, yogurt, cheese, cream, butter is my favorite food group, and that I've only experienced health and weight loss from drinking the stuff; never any kind of health issue or disease. What? You need more details to believe me? Well, read on, dear friends
What is raw milk?
Raw milk is milk straight from the cow, goat or sheep whole, unfiltered, unheated, unrefined, with full fat. It is unpasteurized and unhomogenized.
Not all raw milk is equal. Most people who are proponents of it, when they discuss raw milk, are referring to milk from pasture-raised cows that are at least mostly grass-fed, and that are free of antibiotics and growth hormones. However, when anti-raw-milk people discuss it, they usually refer to studies that do not take the source of the milk into account, and might include milk from feedlot (conventionally-raised) cows. It also does not necessarily take into account practices, whether raw milk is from cows that are tested, how frequently they are tested, etc. All is lumped into one raw category typically.
What is pasteurization and homogenization?
All milk sold in grocery stores even the organic ones are pasteurized. While pasteurization kills bacteria that could be harmful, it also kills good bacteria and destroys enzymes that are helpful for digesting the milk (this is why many people are lactose intolerant). Most milk nowadays yes, even organic – is ultra-pasteurized (UHT)which means that its been subjected to even higher temperatures (i.e. kills more bacteria and destroys more nutrients and enzymes) and can last for several weeks (sometimes up to 2 months) in the fridge. But if you leave the carton of pasteurized or UHT milk out on the counter for a day, or when its past the date, it rots and smells putrid. It becomes completely unfit to drink or cook with. Raw milk on the other hand doesn't really rot or expire; it just sours. Clabbered milk, or soured milk, is a whole food that is perfectly safe to drink or use in cooking. Heat-sensitive lactic acid producing bacteria in the raw milk proliferate, and you are left with a probiotic-rich drinkable yogurt that is actually good for your digestion.
Raw unhomogenized milk produces a natural creamline, where the lighter fat molecules rise to the top and separate from the liquid. Homogenization is an invasive process that breaks down the milks fluffy fat moleculesinto tiny parts that are integrated into the liquid part of the milk. The problem with this process is that it subjects these fats to oxidation. There's a lot of evidence to suggest that oxidized fats are a real health problem; and that they contribute to heart disease and high blood pressure. If you're curious about the process, this is what happens:
"The milk is pumped under high pressure which smashes the milk molecules so hard. Homogenization splits and exposes the molecules." The hard science goes like this: A raw milk molecule is surrounded by a membrane, which protects it from oxygen. Homogenization decreases the average diameter of each fat globule and significantly increases the surface area. Because there is now not enough membrane to cover all of this new surface area, the molecules are easily exposed to oxygen, and the fats become oxidized.
We dabbled with lactose-free dairy for a bit, but it was too processed for my liking, and it tasted nothing like the real whole milk we have been used to drinking all our lives. And cheese almost no lactose-free cheese existed in stores and those that were available did not taste good. We exhausted all conventional options before exploring others.
After days of online research, I came across this FAQ about raw dairy, which gave me a glimmer of hope:
Chances are good that you may [be able to digest raw milk], even if you're of African or Asian descent, assuming you can find a reliable source near your home. Unheated milk contains its full complement of enzymes and lactase-producing bacteria needed by our bodies to break down and assimilate the milk sugar lactose. These helpful bacteria are killed in the pasteurization and homogenization process. Fermented milk products, such as yogurt and kefir, naturally lower in lactose due to the actions of various Lactobacillus and other lactic acid-producing bacteria, may be better tolerated by some.
Prior to reading this, I had no idea that unheated (unpasteurized) milk has lactase already in it! That's why so many people are lactose-intolerant. They've been drinking denatured milk, with a whole lot of lactose and no enzyme to effectively digest it! After reading many anecdotal experiences online of people whose digestive systems, allergies, and other serious conditions have been alleviated or even healed by drinking raw milk, I was skeptical. It can't be this simple, I thought. These stories have to be so few and far between, and there must be a good reason why pasteurization came about! Weren't people dying left and right before this noble process? (Actually, the story of pasteurization is more complicated than it seems.)
I did what anyone considering raw dairy would do: I consulted with a physician. Not so smart, it seems, because apparently physicians have almost no nutritional training, and most have no idea that there are people who actually still consume raw milk. The basic response from the doc amounted to Youre nuts. Your husband should just quit the dairy and keep taking the lactase pills whenever necessary. I was not thrilled with his answer, and so I discarded it.
After we found a source for raw milk that met every one of these criteria, we placed an order through email, and went to the designated pick-up location to pick up the dairy in the city.
We went home, and took out two glasses for the both of us. Hands a little shaky, I twisted the tin caps off the glass jars, and carefully poured half a glass first. I brought it up to my mouth, and sniffed a bit before gulping down a generous sip. Seriously and I swear I'm not exaggerating it was the tastiest sip of cool creamy milk I had ever tasted. I had fallen in love, and I was never going back to that ultra-pasteurized grocery store junk that pretended it was real milk ever again.
You want to know the craziest part? The raw milk (and other raw dairy) was not only fully tolerated by my lactose-intolerant husb; but it actually improved his overall digestion over time. The probiotics in the milk helped his gut flora repopulate over time, making his digestion more resilient. (FYI, it was found that healthy gut flora improves immunity.)
Yes, I know what you may be thinking: Its rash. There are risks associated with raw milk. To that, I have two answers:
Isn't there a risk with everything in this life? Crossing the street, driving a car, eating at many restaurants (each sourcing its food from random places), flying a plane, confessing your love to a good friend; I can go on but you get the point. At the same time, risks can be controlled in different ways: for example, I would never in a million years drink unpasteurized milk from conventionally raised cows. The criteria I mentioned above for selecting my source of raw milk certainly mitigates the risks substantially. What I am not trying to do in this post is try to defend the decision to drink raw milk; but I am simply sharing my experience as well as some resources you may find interesting or helpful. I am by no means implying that everyone should drink raw milk or even drink dairy at all if it does not make sense to you but I want to share some of the information I have come across recently, because knowledge is power or something like that.
If you listen to government health officials and conventional medical staff, you will probably not relate to this post. That's up to you. But I personally don't trust that the government is in a position to make reliable health recommendations and I find most government guidelines to be misguided or problematic at best, especially when it comes to food freedom. And I'm not alone. Apparently, a small survey revealed that 93% of raw milk drinkers don't trust the government for dietary advice either. This is also why I don't believe that the government cracking down on local farms is ethical. In fact, if you take the time to watch the documentary Farmageddon, you'll see why I think these crackdowns are downright evil.
Well, they're not evil if they actually save people from infections; right? If raw milk is dangerous, as the CDC insists it is, then these crackdowns on small family farms would be understood. But heres the thing: the crackdowns have nothing to do with the milks safety, and everything to do with the dairy industrys monopolyand its connection to government officials. Take family farmer Vernon Hershberger for instance who faces up to three years in prison, and fines up to $10,000 simply for providing organic raw milk to consenting persons who have never been sick from consuming the milk he provides! Simultaneously, with twenty-nine people dead from a recent listeria outbreak from cantaloupes, another outbreak from ground turkey, what are the legal actions that have been taken against these producers, who actually caused people to get sick and a number of them to die?
Someone somewhere decided that raw milk isnt safe to consume, but raw fish (sushi), raw meat (steak tartar), and raw eggs (eggnog) are perfectly fine despite the lack of scientific evidence that raw milk is inherently dangerous and somehow more dangerous than other raw foods which are sold in stores, and also despite the fact that some of the sources of these other raw foods might be highly questionable and people have gotten sick from them! Whack. I won't go into details here, but just consider that the largest foodborne salmonella outbreak related to milk was in 1985. In that case, the pasteurized low fat (2%) milk came from a large dairy farm and yet, it killed 9 people and infected 5,295 people.
In Hershbergers case, raw milk sales aren't legal in his state. Yes, raw milk is illegal in 15 states, and restricted in 26 others, which I find udderly ridiculous (pun intended). Besides the obvious fact that the U.S. laws should guarantee the freedom of buying whatever foods you deem fit for your consumption (and should not control individuals buying choices), this article from Counter Think does a good job of humorously explaining the irony behind the governments choice to ban raw milk specifically while failing to regulate or ban actually harmfulartificial ingredients in processed foods and carcinogenic chemicals in personal care products But, I digress raw milk is not only not harmful; in many cases (if you know the source) it is one of the most beneficial sources of nutrition for humans!
In Texas, I can buy raw milk directly from a farmer, which is legal. However in states like Florida and Virginia, you would have join a cow-share (also known as a herd share). So, instead of buying milk; you technically own a part of a Guernsey cow, and the milk it provides is yours to deal with. Yes, its not the most convenient way to get the milk, but its there as an option, because otherwise, it would be technically completely illegal to even drink the milk. Whack again, I know.
So, why do I think raw milk is so great? Oh let me count the ways these are just off the top of my head:
(1) Knowing the source of your dairy, and being sure your milk doesnt have the rBGH (hormone) or antibiotics – Nowadays, most conventional milk is laced with a ton of antibiotics (antibiotic-resistance, anyone?) and some are even tainted with growth hormones. Gross! I'd steer clear from that kind of milk if you're looking for good health.
While organic milk is better than conventional milk because it at least guarantees that the animal received no antibiotics or growth hormones, buying organic milk does not guarantee that the animal is pasture-raised (free roaming) or grass-fed (it could be grain fed, and that's not traditional cow/goat/sheep food because they are naturally grazing animals). If you buy milk from a local farm, you can visit the farm yourself to see the way the animals are raised, where they're milked and how the milk is handled.
And let me tell you, its very reassuring to know where your food comes from (as was customary in the days prior to the industrial revolution), and to visit the farm yourself if you want to see the cows grazing on lush grass, as I did last year when deciding on a local farm to own my cow share and get my dairy.
(2) Vitamins, bacteria and enzymes are preserved According to this post from Nourished Kitchen, raw milk is a living food:
Several of milk's natural components including beneficial bacteria, food enzymes, natural vitamins and immunoglobulins are heat-sensitive. These health-promoting components of natural, raw milk are destroyed by heating and therefore not present in pasteurized or UHT milk. Indeed, many foods – milk included – provide best nutrition when consumed in a raw or minimally cooked state. While heating milk doesn't change the mineral composition to any great degree, it does, however, change its bioavailability rendering all that lovely calcium less absorbable.
Here's a more specific fact for you: raw grass-fed milk has five times more cancer-fighting conjugated linoleic acid (CLA) than regular milk; it contains more omega-3 fats, as well as more beta-carotene.
(3) Protection from asthma and other health disorders There's a lot of anecdotal evidence to show that many have been healed by consuming raw milk. Improvements in autism, asthma, metabolic syndrome, mood disorders, irritable bowl syndrome (IBS), Crohns disease I can go on. To read some testimonials, click here. But for all you doubters out there, a large European study known as the GABRIELA study has shown that children who drink raw milk are 40% less likely to develop allergies and asthma than children who drink pasteurized milk. In my husbands case, raw milk was not only more digestible; the probiotics (good bacteria) therein actually helped repair his digestion. And frankly, thats good enough evidence for me.
(4) Supporting local agriculture as opposed to oppressive feedlots Buying milk that has been shipped from miles away compromises the milks freshness and supports big agribusiness which often has less than stellar practices within the dairy industry. Besides the antibiotics, hormones, and damaging effects of homogenization and pasteurization mentioned earlier, the milk in a carton in your local grocery stores is not from one or two or three cows. It's a mix of hundreds of cows from different dairies, so its practically impossible to trace back to one farm or source. You can't verify the quality even if you wanted to. Additionally, the cost of the milk is divided among many: the grocery store, the supplier, the dairy farm and the farmer. If you buy locally-produced milk, you can know your farmer and your cow, and the money you pay for your milk goes to support an honest worker in your local economy. Local farming is beyond a doubt more sustainable for the environment, your health, and your local economy. Wins all around.
Even if you're not passionate about raw milk, or if you're not even convinced its a food that you would like to consume, you should still advocate for food freedom. How would you like it if your favorite local foods certain vegetables, nuts, sushi, etc were not only heavily regulated, but also banned in your area? Wouldnt you be outraged?
If you're interested in obtaining raw milk for you or your family, your best bet is to navigate this page Where Can I Find Raw Milk? on the Real Milk website, which lists local farmers by state. It's definitely not an exhaustive list though, because some farmers who have gotten in legal trouble are wary of posting their information so publicly. Another good resource is the Weston A. Price Foundation, a nonprofit with the sole goal of educating people about real food, traditional food preparation, and supporting local farmers. You can find a local chapter leader of the foundation in many parts of the world. Don't be shy to send a short email to ask about raw milk in your hometown (feel free to link this post and say that I sent you). To my knowledge, these are the best two resources. You can also always ask people you trust who drink raw milk about the sources they use to buy it.
Having read this expose, Im curious to hear your thoughts: how do you feel about raw dairy? Have you tried it?Would you try it?
Hi my name is Jacque, I'm 31 years old and live in the beautiful state of California. I enjoy a variety of different hobbies and activities, but truly love spending my time with family and friends. I have a passion for cosmetology, fitness, and healthy living. I'm always searching to try new adventures and hope you will join me in this exciting journey of life. Please feel free to contact me with any questions or thoughts you may have.
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A thank-you to EPRD from Indian Hills
I would like to shout out a loud THANK-YOU to the fine people running the park and rec department. You not only poured your Heart (pun intended) and sole (boots on the ground from EPRD) into our beautiful new Arrowhead Park here in Indian Hills, but you throw us a bone at our community center and keep it mowed and trimmed to perfection. You have no idea how much you are appreciated!
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When I first heard of Bright Star (alternate title: A Girl Sitting at a Window with Her Cat), I was dubious. I have that very particular feeling, that sense of snobbish ownership, about Keats and his works. It's really hard to fight the rising aggression that surfaces whenever a quotation is out-of-place, so strangely transplanted in an alien context (my only other real qualm is something many period movies are guilty of. When a woman moves from one room to the next carrying her embroidery with her, but not bringing any extra thread or scissors. Irritated!). But that's a silly attitude to have--movies about real people aren't really about them at all, and besides all that, it's just one little image, one rendering of a version of a story about a person who existed. Not to mention (but I'm going to mention it anyway) that anyone who says this is a movie about Keats is surely missing every point ever pointed. It's a movie about Fanny, and after decades and ages of scholarship maligning her, I think this is a nice reprieve. I love that the movie parallels Keats and writing, with Fanny and sewing, making her a poet in her own sense.
But besides all of that, the movie is a gorgeous watch. It has become a site of my primary spring inspiration this year--all dotted swiss, strange collars, light cotton blouses, pastels, stripes in pale colors, and triple-strap flats. I especially love that we see Fanny wearing the same items over and over in different ways. The sea-green over-dress she wears pops up in springy scenes with a blouse in the same shade, and later she wears it over a cotton tunic lounging around the bed in hot weather. One of my favorite details is that both Fanny and her sister have dresses in matching fabrics--because of course, you wouldn't just buy enough to make one dress, but enough to get several items out of it. I think my favorite is the light brown and cream striped dress that pops up a few times (under a pink striped jacket--not shown--with white blouses both frilly and plain).
I also love the men's dress in this, although my interest there is mostly limited to Samuel Brawne, following around the background with his tall straw hat and light-colored spring suit (my favorite though, must be the striped jacket he wears in the kitchen and in the fields catching butterflies).
And of course, I can't resist a movie with a girl and a cat.
(Since I am incapable of controlling myself, I tried to use smaller versions of the stills to save you from too much extra scrolling and giant images!)


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The Federal Agencies listed in this section have duties established by statute, executive order, or Presidential directive which may apply to Federal response actions following, or in prevention of, the discharge of oil or release of a hazardous substance, pollutant, or contaminant. Some of these agencies also have duties relating to the rehabilitation, restoration, or replacement of natural resources injured or lost as a result of such discharge or release. It is recognized that Native American authorities, responders, and communities are entitled to the same cooperation and protection arrangements as the States.
The U.S. Forest Service is the designated USDA representative to RRT. USDA maintains a Regional Emergency Team in each of the 10 Standard Federal Regions to provide liaison and coordination with Federal Agencies operating on a Regional basis. Regional Emergency Teams are composed of representatives of USDA agencies having essential emergency functions at the Regional level. These are:
DOC, through the National Oceanic and Atmospheric Administration (NOAA), has three roles within Region 5:
Scientific Support Coordinator (SSC): In accordance with the NCP, the SSC provides scientific advice to support the Federal OSC in operational decisions that will protect the environment effectively, mitigate collateral harm, and facilitate environmental recovery. The SSC advises on other technical issues (as requested by the OSC) after consulting with the appropriate NOAA Emergency Response Division (ERD) resources or other Federal, State, or academic networks. This includes considering advice from the trustee agencies (including the NOAA ERD RRT member), and any divergent opinions.
National Resource Trustee: The Secretary of Commerce acts as trustee for natural resources managed or controlled by DOC, including their supporting ecosystems. 40 CFR 300.600(b), (b)(1). Pursuant to the Great Lakes Critical Programs Act of 1990, 33 USC 1268 (Great Lakes Act), and the Great Lakes Water Quality Agreement of 1978, as amended by the Water Quality Agreement of 1987 (Great Lakes Water Quality Agreement), the United States, in part through DOC, manages and/or controls the water and sediments of the Great Lakes System.
The Secretary of Commerce also acts as trustee for natural resources managed or controlled by other federal agencies that are found in, under, or using waters navigable by deep draft vessels, tidally influenced waters, or waters of the contiguous zone, the exclusive economic zone, and the outer continental shelf. All federally managed or controlled resources that are found in these waters, such as water and sediments that form navigation channels and that are managed, controlled, and maintained by the Army Corps of Engineers, and the fisheries that are controlled by the Food and Drug Administration through derivation of action levels, fall within DOC trusteeship. Similarly, the water and sediment of the Great Lakes System are within the administrative jurisdiction of the United States, and are federally managed or controlled pursuant to the Great Lakes Act and the Great Lakes Water Quality Agreement.
The Secretary has delegated his authority to act as trustee to the Administrator of NOAA. Pursuant to these delegations, NOAA has trusteeship for the water, sediment, and biological resources of the Great Lakes and their supporting ecosystems. The NCP also cites as examples of DOC trusteeship the following natural resources and their supporting ecosystems: migratory birds, anadromous fish, and endangered species and marine mammals. 40 CFR 300.600(b)(1), (b)(2).
Under OPA and the NCP, NOAA has specific responsibilities as a natural resource trustee that include
All of these activities are intended to minimize impacts and to restore the environment.
Carries out this goal by
This member can provide:
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DOE provides the designated OSC/RPM for responses to releases on or from any facility or vessel under its jurisdiction. DOE administers, implements, and coordinates the Federal Radiological Monitoring and Assessment Center (FRMAC). Under the Federal Radiological Emergency Response Plan (FRERP), DOE provides advice and assistance to the RRT regarding the identification of the source and extent of radioactive contamination, and removal and disposal of radioactive releases.
FEMA requires the development, evaluation, and exercise of all-hazard contingency plans for all FEMA-funded jurisdictions at the State and local levels. SARA Title III plans are often annexes of the all-hazard plan. FEMA monitors and provides technical assistance regarding public sector emergency response training and planning for incidents involving hazardous materials. In a response, FEMA provides advice and assistance to the lead agency on coordinating relocation assistance and mitigation efforts with other Federal Agencies, State and local governments, and the private sector.
If the President declares a disaster or emergency, FEMA coordinates all Federal assistance, including temporary housing. The OSC coordinates with the Federal Coordinating Officer in situations where both authorities are active.
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GSA is capable of providing:
The GSA Regional Emergency Coordinator (REC) provides a team that may consist of one or more of the following: a REC and/or team leader, contracting officer, telecommunications specialist, and real estate/leasing specialist, if needed, to coordinate the provision of support at the incident site or operating location. Support may be furnished through GSA employees and contractor personnel who are located at the scene of the oil or hazardous material release, or at their regular duty stations, depending on the specific requirements of the emergency situation.
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HHS assists with the assessment, preservation, and protection of human health and helps ensure the availability of essential human services. HHS provides technical and nontechnical assistance in the form of advice, guidance, and resources to other Federal Agencies, as well as to State and local governments.
The principal HHS response comes from the U.S. Public Health Service (PHS). Within PHS, the primary response to hazardous materials emergencies comes from ATSDR and the Centers for Disease Control (CDC). Both ATSDR and CDC have 24-hour emergency response capability whereby scientific and technical personnel are available to provide technical assistance to the lead Federal Agency and State and local response agencies on human health threat assessment and analysis, and exposure prevention and mitigation. Such assistance is used in situations requiring evacuation of affected areas, dealing with human exposure to hazardous materials, or advice on mitigation and prevention.
Agency for Toxic Substances and Disease Registry: ATSDR is the lead Federal public health agency for hazardous material incidents under CERCLA. Two ATSDR representatives are assigned to each US EPA Region to assist in US EPA/ATSDR communications. Regional representatives can also assist in emergency response events that involve RRT5 issues by coordinating with ATSDR headquarters Emergency Response and Consultation Branch and with the CDC RRT5 representative. Under CERCLA Section 104(i), ATSDR is required to
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Other PHS agencies involved in support during hazardous materials incidents, either directly or through ATSDR/CDC, include the Food and Drug Administration (FDA), the Health Resources and Services Administration, the Indian Health Service, and the National Institutes of Health (NIH).
DHS, through USCG, provides the Co-Chair of RRT5 and predesignated OSCs for the Great Lakes Coastal Zone and specified ports and harbors in Region 5, based on an MOU signed in 1992. Through USCG, the DHS
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DOI can provide information concerning the lands and resources specifically under DOI jurisdiction, as well as offer technical expertise related to geology, hydrology, minerals, fish and wildlife, cultural resources, and recreation resources. Under Executive Order 12580, DOI is designated by the NCP as a Federal Trustee for Natural Resources.
DOI has direct jurisdiction for protection of resources on its own lands, as well as trustee responsibilities for certain natural resources, regardless of location. The DOI natural resource trusteeship that extends beyond DOI site boundaries includes migratory birds, anadromous fish, and endangered/threatened species and their critical habitat.
Bureaus may provide assistance in investigations to evaluate the magnitude and severity of discharges on or affecting facilities or resources under their jurisdiction, and may conduct activities as natural resource trustees as set forth in Subpart G of the NCP.
Bureaus may also provide:
Within the Department, individual bureaus and offices have specific responsibilities and capabilities as follows:
The Biological Resources Division performs research in support of biological resource management; inventories, monitors, and reports on the status and trends in the nation's biologic resources; and transfers the information gained to resource managers and others concerned with the care, use, and conservation of the nation's natural resources.
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As a consequence of DOJ's primary role as litigation counsel for the Federal Government and as legal counsel on enforcement and interagency matters, its participation in RRT5 activities will ordinarily focus on litigation concerns regarding response activities and interagency coordination. The DOJ representative might provide
DOL, through the Occupational Safety and Health Administration (OSHA)
The Nuclear Regulatory Commission (NRC) will
DOS will
DOT, through the Pipeline and Hazardous Materials Safety Administration (PHMSA), establishes oil discharge contingency planning requirements for pipelines, transport by rail and containers, or bulk transport of oil.
US EPA provides the Co-Chair of RRT5 and provides OSCs for all inland areas for which an ACP is required. US EPA also generally provides the Support Center for responses in the inland zone.
US EPA is responsible for providing expertise regarding environmental effects of pollution and environmental pollution control techniques. US EPA will also


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Wednesday, July 22, 2009
The Horse's Mouth
Within the past few weeks I have been able to speak with chairs of various academic medicine departments. I have done this under the cover story of "I am working on an article" (true), or "I am working on a book and would like your input" (sorta true). The responses I have received are repetitive, infantile, and quite scary.
The number one reason that academicians WANT universal health care is to put some teeth behind RATIONING. They all believe that extraordinary care at the extremes of life will collapse the system. For instance, one particular academician I talked to wants to do away with dialysis for folks with certain criteria (having to do with her ideas about of 'quality of life'). These criteria will be decided by committees (because all the best things in life have come from committees), so no one person will be to blame.
Now this is quite amazing to me. First of all, academics have sat on their hands (and cheered) while regulations have tied private corporations' hands to the extent that their ability to perform procedures such as dialysis is severely limited. The mounds of paperwork required to open a clinic were scary enough to keep me from doing it (more power to you 'Cat).
Also, academic physicians all have a a little help with their workload and it comes with the names tenure, medical students, interns, and residents. This is a kind way of saying they have no freaking clue about private practice, they believe it is beneath them, most have never worked outside the academy (because once you do it's hard to get back in the club), and yet they want to make policy that forbids or severely limits private practice. How do you like your power Doctor? Absolutely? I thought as much. Pussies. Sell-outs. Turncoats.
I am sick of the AMA and ACEP.
ACEP sent out a blitheringly idiotic email today asking us to 'pass it on' so that emergency physicians can be helped by the big pile of money building in Washington. Screw you ACEP. Screw you AMA. Count me out.
Also, the academics have been behind the self-flagellatory demonization of drug companies. I understand that junkets to the Caribbean for docs may be a bad idea, but now the drug companies are prohibited, in large degree, from giving out drug samples and even from giving out pens.
As it turns out I am particularly susceptible to the free pens. If I get one that says "Rocephin" on it that's all I will prescribe. Even for erectile dysfunction. Until the pen peters-out.
"Hey doc, my weenie don't work... ain't this Rocephin stuff for infection?"
"Sir, you know your medicine! But look at this cool pen I got!"
The academics want the government to be the bad guy behind letting granny die from her chronic illness which is all I need to confirm my suspicion that they are COWARDS of the worst variety.
21 comments:
All I can say is "THANK YOU"!!! I opted out of the AMA years ago when they agreed that a fetus is not worthy of support, care or protection, and now I am SO glad that I did.ReplyDelete
The profession is dying in front of us and no one seems to care. I'm just glad that I'm on the down side of my time in the valley of tears.
- Anonymous9:32 AM, July 23, 2009
Psst don't tell anyone but I think Obama's got Lung Cancer... Notice that little change in the timbre of his voice? That twitch in his left eyebrow???ReplyDelete
Like I said, don't tell anyone,
I do miss the pens. I once got one that lights up. It was pretty cool.ReplyDelete
You and I know we can't go on this way. It sucks for everybody. That is why I quit. I can't do that much data entry. I just can't. I do have hope that some day this will turn around and get better. I have this hope because if feels better than complete deprsssion.
- Stalwart Hospitalist10:27 PM, July 23, 2009
Should, then, thousands and thousands of individual inpatient physicians take it upon themselves, in case after ridiculous case of 7th-line chemotherapy for metastatic colon cancer or CPR in a patient approaching her 6th year of nonverbal status from dementia, to explain and convince family members and caretakers as to the futility of some care that we collectively currently provide?ReplyDelete
This is what we have now, and the path of least resistance is (often enough) to proceed with the care in question.
I'll be honest -- since these patients are not spending their own or their family's money on this care, but rather everyone's collective current and future assets to be claimed by federal taxes for Medicare, it may not be unreasonable at all for the people paying the bill (all of us) to attempt to set some limits at the extremes.
The choice is often not between "letting granny die" and returning granny to weekly canasta games and personal independence; it is often between the former situation and restoring just enough health to granny to allow her to exist -- however temporarily -- outside the highly controlled and monitored environment of an acute care hospital.
This isn't about Soylent Green. This is about what society should be asked or expected to provide for its members. At least the older generation gets to vote. My 2-year old son, destined to grow up in a world of inflated dollars and excruciating tax burdens due to the decisions already made in years past, has no such input.
dear stalwart hospitalist,ReplyDelete
first of all, i sympathize with your position though i disagree. but here's why and it is simply this. decisions about life and death have to remain with the individual. the solution is not obvious and i don't have it, but it would be along the lines of requiring everyone to be educated on and sign advance directives. but everyone also has to pay SOMETHING for their care. otherwise we have a no win and the abuse that is now rampant.
but the moment you take this liberty away from the individual is the day that we step ever closer to a 'logan's run' society and it is definitely a slippery slope. having worked in the VA and the military system i have seen the large government bureaucracy in action and not only is it slow and redundant, it is also HEARTLESS.
also, tough cases, such as you present, make bad law. an axiom of first year law school. because of your work, lack perspective (as do I), and it is not my job, nor do i want it to be, to make these decisions. they must remain with the family and with the individual however unreasonable their responses seem to us. this is the land of personal choice and liberty, for good and bad.
but your financial argument is more persuasive, and since i haven't seen you on the blog before i must tell you that the minute that medicine and the costs of it were shuffled from the individual to 'society' is the minute that we started down this stupid and sometimes cruel path.
EMTALA is unconstitutional and should be rescinded. every single individual has to be made to feel some kind of responsibility for their care. your are correct... as it stands now there are tens of thousands of people in each state that know their care is 'gratis' and after a while it becomes easy to just 'go to the ER'.
and the amount of free care i personally delivered to patients only in residency who were in the country illegally boggled my mind. but that's another issue.
thanks for your comment.
- Anonymous6:39 AM, July 24, 2009
" it may not be unreasonable at all for the people paying the bill (all of us) to attempt to set some limits at the extremes."ReplyDelete
I think your line of reasoning is a trick and we're going to end up with all sorts of rationing. In full disclosure, I'll tell that that I'm an ill person with expensive meds to lose.
"The Royal College of Obstetricians and Gynaecologists (RCOG) says the huge efforts to save babies born under 25 weeks are hampering the treatment of other infants with a better chance of survival and a healthy life."
Are we going to ration care for premature infants but still pay for IVF? NHS does.
"Health trusts in North Staffordshire have the toughest restrictions. Patients must have a body mass index below 30 and have not smoked for three months to qualify for any routine operation."
Read more: http://www.dailymail.co.uk/health/article-505467/Smokers-drinkers-obese-beware-fit-risk-losing-NHS-care.html#ixzz0MAmWWwVw
"We oncologists agree that this drug represents a tremendous breakthrough after decades of research in the treatment for kidney cancer and needs to be made available for our patients," states Dr. Knox on behalf of leading experts from across the country.
Despite this, the CDR has recommended government drug plans (outside of Quebec) not cover NEXAVAR."
It might not be unreasonable for us to believe that when the political party we don't like is controlling Congress that the rationing might happen in a way that we repulsive. Perhaps the followers of homeopathy and naturopathy have more votes than parents of preemies.
- PeggyU12:44 PM, July 24, 2009
LOL! I remember my dad had ashtrays from pharmaceutical companies. Bet they don't do that any more.ReplyDelete
Whoa. I just chanced on the whole government medicine debacle. Coming from Britain, I've never known any other sort of medicine, and all we have here is Michael Moore's 'Sicko' telling us that HMOs rule the American medical system, and that some government control might not be a bad thing (warning! Stupid foreigner POV!).ReplyDelete
Then again Britain's NHS has good points going for it, but many many bad points too. More power to you! Stupid foreigner, out.
hey angry medic,ReplyDelete
long time. michael moore is loved by America's looney left and then, apparently, by all of europe. i'd like to punch him in the face.
was thinking more about stalwart hospitalist's comments. fifteen years ago doctor's did a very poor job with end of life stuff. we did everything because we wanted to, and the heme-onc guys were the worst.
however, at least at the 12 places i've worked back into residency, we allow people to die now. we 'get' the concept of 'futile care' for the most part.
i think the concept of 'futile care' is a way out of this conundrum and that educating people on 'futile care' can be done a lot better than we do it now. but the decisions need to be left with the family and patient.
and angry medic, the dirty little secret about health care in the US is that we are in trouble not because people do not get care, but because ANYONE can get the best care available up to and including major surgery for ANYTHING with or without money. now this is, i guess, ideal, however, the folks that 'eat' that money are the doctors, nurses, and taxpayers.
getting some personal responsibility back into the game will be unpopular, but IS the answer. only then will our ERs decompress a bit from the 'just go to the ER' answer, which, was the truth when it was uttered by GWB, but has placed the burden of financing the best care in the world for everybody on me and stalwart hospitalist and everyone who gets consulted from the ER.
- Stalwart Hospitalist7:55 PM, July 24, 2009
911DOC --ReplyDelete
I cite tough cases not to suggest any statutory law that ought to exist, but merely to point out that there are cases of extremely futile care, seen routinely, wherein "society" (for lack of a better collective noun) would likely agree that the value for the care provided is not there.
I suspect we agree on more than we disagree. I agree that families and patients should be responsible, at least in some small part, for the care provided. And you obviously agree with me that when the person electing to receive the care also elects to have other persons provide the financing, then we end up in the unsustainable situation we have now.
I'm not an ED doc, but I also agree with you that EMTALA, however originally well-meant, has morphed into an incredibly overburdensome unfunded mandate on EDs and hospitals.
Where we probably disagree most is in the concept of a slipper slope: I remember learning (with some surprise, admittedly) in Logic 101 in college that the concept of a slippery slope is actually a logical fallacy. We don't have to end up at Logan's Run, and the idea that our ever saying "no" must result in a future in which we allow everyone who is not a productive taxpaying citizen to die, is probably overstating things.
Anonymous --
We ration now, except we do it by means and intelligence (it is challenging to navigate the medical system, and those who have difficulty do not do as well medically). What we don't ration we bill to our grandchildren via China.
I don't want the status quo, but I don't think we need to be quite as stringent as the NHS either. I'm perfectly happy if we as a society elect to spend more GDP on medical care. It just can't be ever increasing in an unsustainable way.
dear SH,ReplyDelete
i agree that if we were to sit over coffee or a beer that we would probably come to a point of agreement.
i will not dispute that logic 101 teaches that a 'slippery slope' is a logical fallacy, but simply look at what the NHS has done with it's decreasing ability to do what in our country would be routine breast cancer chemo, routine, cardiac interventions, etc... call it what you want, but once a governmental or pseudo-governmental body has power over life or death they will grab more and more until 1. a huge black market for medicine will spring up or 2. a two tiered system will spring up, essentially what we have now but the folks with the government insurance will have their care rationed.
come on back and let's talk some more.
- Stalwart Hospitalist8:49 PM, July 24, 2009
At the risk of inviting the wrath suggested in the initial post, I will admit to being an academic hospitalist. (Separate issue: whether residents, in this new area of work hour restrictions, take away from my work, or actually add to it. I regularly clock 75 to 80 hours a week on service, right there with the allowed maximum for housestaff.)ReplyDelete
I would counter your example of the NHS and the degree to which they restrict care by saying that we as Americans are not, nor are we likely to ever be, as willing to have such restrictions placed upon us. If our government did not worry about the opinion of the American people, they would never have allowed Medicare to build up a tens-of-trillions-of-dollars unfunded future liabilty.
It's only a "black market" if it is illegal. I do not think we will ever approach the Canadian setup of disallowing ANY care outside the government system. Right now it's called "retainer" on "concierge" medicine, and its pros and cons deserve a separate hearing (there are certainly both).
We have a two-tiered health care system now. Having experienced the care restrictions I currently have with my Medi-Cal (California Medicaid) inpatients, especially with regard to formulary restrictions and whether certain outpatient clinics will see them in follow up, I can say that rationing is here now.
I agree with DrRich that we currently tend to covertly ration care, and that we are not honest about how it is done.
I don't want to play God with people's health care either. I would settle with having the hurdles for reimbursement and requirements for documentation ratcheted back so that I would have more time on the wards to discuss prognosis, options, and quality of life on the patient's terms, and less time making certain that my intern reviewed at least 10 systems on the history and physical.
I'm a fairly raging moderate, neither in the anti-FREE=MORE camp (TM) of The Happy Hospitalist nor in league with the single-payor advocates. I just see us doing some unreasonable things with dollars not yet earned.
Since we've wandered into logic theory (fun!), I will state the following in closing: this boils down to an argument of actuality versus potentiality. In the current approach, we WILL go broke. With a new approach, we MIGHT end up making bad decisions about over rationing and restriction of care.
I hope the debate never ends. The idea that this could be settled for all time is, I think, more dangerous than the reluctance to debate at all.
no wrath. thanks for being honest. this will part 1ReplyDelete
generate some good questions.
i would love to believe that Americans will not fall for the NHS excesses but there's very little one can do after a law is enshrined. witness EMATALA, as far as i know the most we've ever done is say, 'wow, this sucks'. and it did not take long for the general public to figure out what it meant. it meant that a certain portion of the population was actually better served by dropping their insurance coverage.
i would disagree with your medicare/medicaid example too... looking back at the genesis of the program the funding was initially set up for an extremely small group of people but now, between those programs and social security and disability the funding is about to bankrupt either our economy or the programs they support.
and i disagree about never going to the Canadian extent. obama stuttered and stumbled over a question from a liberal blogger which asked, 'sir, is it true that under your bill people would be forbidden to establish new insurance policies' and his answer was, 'i'm not familiar with that provision of the bill'.
in fact, if the 'new system' is to work at all people MUST be discouraged from going outside the system because otherwise the inequities between rich and poor will be hugely exacerbated and i don't think anyone wants that, especially not obama.
you are correct about concierge practices. i suspect that they will be outlawed. just my opinion but again, if they are not, then private hospitals will once again spring to the fore with care that others can't get and that will keep the libs out of power for a century.
part 2ReplyDelete
as to formulary or non formulary meds if we would simply untie 'big pharma's' evil hands this would largely go away but they are the demon of the last decade as i tried to make light of in the original piece. can't believe that my training program was so nasty to all the drug reps, they were bringing all us poor residents FOOD for god's sake. and the notion that all of us college and med school grads would somehow be poisoned by the drug reps to prescribe improperly is INSANE and stupid.
we do, in fact, have a two tiered system now and i have no problem with writing THAT into law with catastrophic coverage for everyone and private options.
'rationing' IS here now, but not in the sense that i am scared of. emergent care is not rationed. primary care is by more of a market economy. look at the dentists for god's sake.
and biliary colick. come in to the ER thirty times until your gall bladder is infected because surgeons are not under EMTALA for elective procedures and i'm on THEIR SIDE. otherwise this is merely stealing and the only reason it goes on to the extent it does in our current system is that everyone thinks we are 'rich' and therefore PLUNDERABLE.
also, our academic 'leaders' have taken it upon themselves to advocate for patients and not their physicians which is the height of stupidity. the ABA does not go to washington to lobby for their clients, they lobby for themselves which is the essence of capitalism and capitalism, as terrible as it seems withing the walls of the academy, is the most efficient way to distribute resources. end of story. every middleman or committee put in between the consumer and the deliverer of services takes dollars out of the equation and now we have hospitals full of parasites who do nothing but make patient care harder and are all RELIGIOUS FANATICS, though their religion is 'diversity' and 'equality' and whatever the latest fad is.
and you touch on this with the requirements for documentation etc... being so burdensome that you do not have the time you want to have with your patients. the people with clipboards are worse than jihadists in my book... they think they are helping but they should be waterboarded (or forced to work for themselves in perpetuity).
agree with your last except to say that we don't have to go broke at all. and my solution is to charge ten dollars per ER visit or ten dollars per ambulance ride. this would provide rationing of a sensible sort... patient directed. it would also force folks out of the ER and back to primary care physicains whom they would have to PAY, just like they do the dentists.
thus endeth my rant.
grist for the mill... i answer medical questions on a website for cash... here's one i just stumbled on...ReplyDelete
hy my son is18 month old and has a lesions on the left arm since february is a long whitespot starting from sholder and finishing next to index finger and his pediater told me it colud be tuberouse sclerosis i am very concerned i need the advice from a dermatologist i am from montreal the next appointement is i january 2010 i wiil get crazy tiil thant what i have to do, i passed yesterday a renal ultrasound and it was allright.
please, please help me
- Stalwart Hospitalist11:33 PM, July 24, 2009
I think the extent to which the scope of our discussion has expanded is extremely telling.ReplyDelete
NONE of these aspects of the system, taken alone, constitute the sole or even the major problem (if there even is one major overriding problem to be had). In a single comment thread, we've managed to bring in EMTALA, Pharma, academics, the AMA, residency training, formularies, Medicare/Medicaid, social justice, Canada, and Britain. I think we only forgot medical school debt and malpractice issues. :)
You seem to agree that we should at least ration more sensibly -- some "skin in the game" as it were, for ambulance rides, etc. In turn, I will certainly concede your point on Medicaid/Medicare -- if the slope is not quite slippery, it is, at least, well lubricated.
What should we do? Part of the problem is that people are trying to figure out how to get "there" from "here," since there seems to be consensus that America will not stand for a radical overhaul.
I do not have the answer. I would hope that any reform would have some guiding principles:
-- Generous coverage or subsidy for preventive care, immunizations, screening endorsed by the USPSTF, and things of this stripe;
-- A deregulated market (across states) for catastrophic insurance coverage, which would bring the label "insurance" back into its correct venue, with assistance for those unable to afford the catastrophic coverage;
-- Some progress on restriction of lawsuits for failure to diagnose: wouldn't it be nice to order only the tests you think you need rather than the ones you think you have to have on the books?
-- An enormous, gargantuan, relentless educational drive aimed at the American populace about keeping themselves healthy. We will all have enough to do treating the trauma, the cancer, the infections (H1N1!), and the surgical emergencies that everyone gets without piling on the issues generated from drug use, alcoholism, smoking, obesity, and a sedentary lifestyle.
The one I can't seem to come up with an idea for is the one likely to break the bank anyway -- what do we do with/for the segment of the population with chronic, expensive disease. These folks need lots of care, lots of coordination, and are high risk for multiple expensive hospitalizations. All of the data to date on medical homes and care coordination is underwhelming in terms of outcomes and cost-effectiveness. This, I think, is where society will (eventually) end up having the open debate about what the collective population is willing to pay for.
I do miss the Pharma food. One of the big draws of internal medicine back when I was a student. We write the scripts, after all. :)
- Anonymous8:27 AM, July 25, 2009
Oooh! Ooooh! Oooooh! 9-11! I know whats wrong with that Canuck's Kid....ReplyDelete
Well actually I don't, so I'll do what Dermatologists do and describe it in Latin...
lets see.... OK, its a clear case of "Punctatus Albus", now give me $$400...
Kid probably needs his tonsils out, some ADD meds, and I'd give him a good wash and wax just to be complete...
I know a shady ENT that'll split that outrageous Surgical fee... How much is $79 divided by 3??
- PeggyU4:51 PM, July 25, 2009
Lichen striatus? I had a cousin who had that when he was little. Could she send you a photo of the lesion so you could get a better idea?ReplyDelete
If so, as I recall, it wasn't something horrible, and I'm sure it would put this mother's mind at ease if there were a way to diagnose that.
Ok Frank,ReplyDelete
I just about pissed myself with your comment. thanks for the belly laugh.
okay SH,
i've been asleep since your last and am now back in the ER taking care of a chronic copd patient with 'flames' coming up with his cough. i think i can fix him.
i guess you and i simply have a different approach to problem solving in this particular instance. i'm a strong but minimal regulation with free market solving problems guy. i just don't think about how to solve the health care 'crisis' (where everyone who can pick up ap phone or walk or call a cab and get every single thing they need) TODAY DAMNIT! not saying you want to fix it without a nice long conversation about it, but OBAMA sure does. he wants to 'fix it' next week.
skin in the game is the big thing. if we do this i think much of the stuff we can't seem to get a hold of will simply vanish because people will do what they should have been doing for twenty years, getting in with a pcp, managing chronic conditions there, and using the ER and hospital in true emergencies.
agree with all of your suggestions except the educational drive. it wont work. i have just quit telling people to stop smoking and drinking and, in fact, though i do not tell my alcoholic patients this, i think it would be a lot more sensible to tell them, 'never stop drinking', that way, they will come in with their variceal bleed or pancreatitis and we can just admit them and plug them right into rehab. can't get 'em there otherwise.
as to how to fund the chronic care i think if we deregulate the market that it will be solved. i do think catastrophic coverage as our 'nationalized health care' with every single citizen paying $50 into the pot every month is the simple and sensible way to go and then let folks pick their private coverage, HSA, what have you.
i still honestly believe that $10 for an EMS ride and $10 at the ER door will cut a huge amount of wasted $ from the equation and folks will have to spend $5 at walgreens for their home pregnancy and might even figure out that giving tylenol to kids with fevers is, in fact, okay.
- Anonymous11:54 PM, August 08, 2009
Loved this post...might I suggest the following link to a post on a very good site that deals with Liberty from an economics perspective...ReplyDelete
I sincerely hope that we wake up and take our country back; if not at the polls in 2010/2012 then by other means in order to prevent the decay into National Socialism.
www.english.pravda.ru/opinion/columnists/107459-0 --->even the enemy sees what's going on!
God Bless!