Friday, August 21, 2009

The Farmer in Chief

President Obama fielded softballs on Thursday at his so called "Town Hall" titled the “Organizing for America National Health Care Forum.” Though it was tough to watch him mendaciously smother these balloons, it was far better than the national embarrassment endured by millions watching him “throw out” the first pitch at the All Star game. If we are determined to appoint Czars fully funded yet totally unaccountable to the American taxpayer and their representatives, could we please appoint someone whose sole responsibility is to make sure the President does not further embarrass this once proud nation? That is the one Czar I would be willing to approve and fund. This may actually be a two or three person czarship. In addition, can we make it illegal for Democratic Presidents or candidates to attempt to demonstrate athletic skills, especially on baseball fields or in bowling alleys?

But we digress. During this illuminating Town Hall event the President was challenged with this profound query from one of his cloying sycophants:

I have a two-part question. One is choice, the choice that we make to eat the foods that we eat and the lifestyle that we choose to engage in. And the second part, your family is very fit. What do you and the First Lady and the girls do to encourage physical fitness, and what can we—not the government, not private corporations—do to encourage activity in the public-school system and in young people?

Yes, enough with this tedious healthcare debate, lets cut right to the burning issues of the day. The President responded in kind with the typical scholarly reply we have come to expect from the “smartest guy ever to become President” (at least according to Presidential historian Michael Beschloss); and no, this is not a reference to the President's erudite description of Washington insiders as "wee weed up." While in character, that comment occurred earlier; but the audience continued to be wowed with these pedantic thoughts from our Commander in Chief:

When it comes to food, one of the things that we are doing is working with school districts. And the child nutrition legislation is going to be coming up. We provide an awful lot of school lunches out there and—and reimburse local school districts for school-lunch programs. Let’s figure out how can we get some fresh fruits and vegetables in the mix. Because sometimes you go into schools and—you know what the menu is, you know? It’s French fries, Tater Tots, hot dogs, pizza and—now, that’s what kids—let’s face it, that’s what kids want to eat, anyway (Laughter.) So it’s not just the schools’ fault.

A, that’s what kids may want to eat. B, it turns out that that food’s a lot cheaper, because of the distributions that we’ve set up. And so what we’ve got to do is to change how we think about, for example, getting local farmers connected to school districts, because that would benefit the farmers, delivering fresh produce, but right now they just don’t have the distribution mechanisms set up.

So, you know, Michelle set up that garden in the White House?

One of the things that we’re trying to do now is to figure out, can we get a little farmers’ market—outside of the White House—I’m not going to have all of you all just tromping around inside—(laughter)—but right outside the White House—(laughter)—so that—so that we can—and—and—and that is a win-win situation.

It gives suddenly D.C. more access to good, fresh food, but it also is this enormous potential revenue-maker for local farmers in the area. And—and that—those kinds of connections can be made all throughout the country, and—and has to be part of how we think about health.

The President’s reply to this inquiry, inane as the inquiry (and answer) were, offers significant insight into his larger view of the role of government, individual liberty, and the responsibility such liberty entails. In addition it portrays a staggering lack of appreciation for the potential effects of government intervention in what heretofore had been a free market economy.

After listening to the President for seven months I have to ask is there anything the man likes about this country? Am I the only one who feels this way? Does the President believe there is anything worthwhile that has ever been singly achieved by this nation? Is there any evidence that he believes anything worthwhile has ever occurred in this nation that did not result from government intervention? Does the President believe there is any redeeming value to a critical contributor to American exceptionalism, the free market?

The assumption in the President’s statement is that families cannot feed their children. If that is true, how did we get to this point? Were school lunch (and breakfast) programs considered a necessity prior to the wondrous achievements of Lyndon Johnson’s Great Society and the evolution of the welfare state? Question authority? That is a liberal privilege. Just like global warming, the fact that parents cannot feed their children is established fact; and of course, we have to do something, and who better to do something than the government. Right? Well, not so fast. According to the President, the government run school lunch programs don’t have it right…yet. Not to worry though…there is nothing that government can’t fix.

The President and First Lady are “on it” and have analyzed identified the reason for inadequate school lunches. It seems that fresh fruits and vegetables have yet to be discovered by the stewards of school lunch programs, though it is not their fault. Government has just not evolved the power required to adequately address the problem. The purchasers of school lunch programs simply do not have access to local farmers and their produce. What "we" have to do is figure out how to connect local farmers to schools and improve the food distribution system. As one listens to Mr. Obama you would assume that he is President of the Sudan. One would never suspect, based on the President’s comments, that we are the most agriculturally proficient nation in the world.

The President cites Washington, DC as being particularly lacking in access to “good, fresh food.” Has the President, during the few years he has spent in Washington, ever taken a break from his campaigning career to look around the city? There are too numerous too count farmers markets in the DC area. Any failure of government bureaucrats to make fresh foods available to public school students, in DC or anywhere for that matter, is not due to lack of supply. If the President feels compelled to comment on deficiencies in DC schools, he might have tried something new, non-fiction. Under the watchful eye of city fathers, DC schools have garnered the title of most expensive and ineffective schools in the world. The Washington Post reported in 2008 that the cost per pupil in the DC system is an astounding $24,600. This compares to an average of $10,000 per pupil in DC private schools. One can only assume that after further discussion with Arne Duncan (Secretary of Education) and Bill Ayers that the President will be getting back to us with a plan for building on the staggering success only John Dewey could have envisioned after decades of expensive and destructive statist educational experimentation.

As regards Ma and Pa Obama, the citizens of DC do not require the first family to establish a White House Farmers Market. Further, if the President understood (or cared about) the free market and basic economics, he would appreciate that a White House Farmers Market would attract legions of Obama fawners (that would be the majority of District and Northern Virginia residents) who would no longer support pre-existing markets. On the other hand, if the President took a real interest in operating such a market, it would offer him business and supervisory skills which we all might benefit from.

Mr. Obama’s comments on the need for a White House Farmers Market offer irresistible analogies to his views on medical care. Many Americans cannot feed their own children and a village is required to fulfill this obligation to our youngest citizens. The government has been charged with this task for years but has performed poorly. Despite substituting cheaper, less effective services, the needs of our children are not being met. They are being offered substandard food. An expansion of government authority is required here to achieve the necessary goal. If we are truly to make certain that children in our schools have universal access to proper food, government must not only control distribution, which it has managed poorly, it must control production. Similarly, the President sees only benefit to government assuming control of the production, pricing and distribution of healthcare services. It is as intuitive to the President that government should exert its beneficent hand in food markets as it is that government would assume control of auto makers, insurers and the home finance industry.

Dissent is patriotic in this nation well, for, liberals. The unfortunate problem for hardcore liberals is that their core convictions are built on a foundation of antipathy to the United States envisioned by the Founders. The intent of leftists and Alinskyites is to destroy the historical and traditional systems of order and governing established in Western democracies and this nation over hundreds of years. It is near impossible to find any comments by the President that suggest the American governmental experiment is exceptional, that the dream of millions worldwide is to come here, even under risk of death, or that in our short history that we have uniquely offered heroic service and sacrifice on an unprecedented scale to the larger world community. No, for our President any American achievements are always suffused in a melange of moral equivalence.

It may be that the President has never seen “It’s a Wonderful Life”. I suggest that Gordon Brown might send it to him next Christmas…or holiday season. Imagine the world over the last century without the United States. Any reasonably honest analysis of such a proposition should leave champions of individual liberty, responsibility, freedom, and free markets with an overwhelming sense of nausea.

It would seem that the Bill Ayers, Saul Alinsky, Jeremiah Wright, Louis Farrakhan, Eric Holder, Rahm and Zeke Emmanuel, Arne Duncan, Michelle Obama and Barack Obamas of the world have spent decades committed to the obliteration of American tradition without taking any time to consider how they would govern, if they ever got the opportunity. Driven by an instinctual urge for power, they have always presumed, against overwhelming historical evidence, that absolute government control was the way to utopia. Despite proclaiming concern for the common man as their battle cry, the agents of hope and change have always presumed that it was they that possessed the wisdom to determine how utopia would be defined. It would be a core group of imperious government elitists who would determine what would best serve the citizenry and more importantly, how the citizenry would best serve.

The President creates an interesting metaphor…President Obama as the Farmer in Chief. Consider the power exercised by the farmer as he oversees his land with the express intent of generating the most bountiful harvest. Individual plants are of little interest to the industrious farmer. There is no individualism recognized by the farmer raising his crops. Fertilizer and water are distributed equally to all. Diseased plants are sacrificed for the greater good. Weeds considered a threat to the well being of the larger crop are destroyed. Hardier genetically engineered crops may take precedence over natural growth. The farmer takes all steps to protect the greatest percentage of his crop, the crop which he and the market judge as valuable.

Based on the principles of the President’s plans for healthcare “reform”, his commitment to redistribute wealth, and his demonstrated and espoused willingness to pursue control of key industry sectors, can there be any doubt that the President sees himself as the Farmer in Chief. As master of the American estate he believes his responsibilities include proper watering, feeding, fertilizing and culling of the harvest. The farmer is an American hero. He supports what most of us consider to be an exceptional and unique creation. Mankind. The Farmer in Chief is surrounded by gentrified political utilitarians who not only deny American exceptionalism, but who advocate political philosophies which will ultimately require questioning the exceptionalism of mankind.

Quite simply it is anathema to the President that anything other than government should control the healthcare, finance and energy industries. So when you are that committed and catechized to the most radical liberal progressivism, why wouldn’t the White House assume responsibility for disbursement of one more critical resource?

American Gothic, meet the Obamas. This is contemporary horror, of the non-fiction variety, that even Stephen King could not imagine. Welcome to the Green House.

Quaere Verum

Thursday, July 30, 2009

Summit on Peace Street

We journeyed to Raleigh to show the President hear how we feel about his vision of government and the need to go “all in” on healthcare. It was a great crew. Mom of eight accompanied us and she is amazing. The QVs have our hands full with three. Mom of eight makes it look easy….and she and her family were the talk of Peace Street. Eric unsheathed our most powerful weapon in this battle, and led us all in the rosary. This was a particularly powerful repellent for Planned Parenthood sign wavers who packed up and sought more secular shelter. Other protesters and concerned citizens joined us in prayer. It was quite a sight as we all took it to the streets of Raleigh. We are front and center proudly waving our signs. The post here describes events well.

The whole exercise was reasonably peaceful. There was a little yelling, but no physical altercations. There were at least 500 citizens on the corners of Peace and St. Mary’s. Numbers in opposition to the President’s policies and proposals were easily 3:1. Opponents were vocal but all activities were G rated and there were no threats or personal attacks targeting our President. I did not hear one person opposed to the President's policies state, "Not my President." This likely seemed pretty tame to our friends who are used to conducting business a little differently.

The good news and bad news is that while there were lots of citizens opposed to the President’s proposal, this was a grass roots activity with poor organization. The Wake County Republican Party and NC branch of Americans for Prosperity had sponsored a healthcare event pre-rally and attempted some organization but it was invisible at Broughton High School. We were initially directed, as the post describes, to a location which never saw Obama. We all noticed the lower level of security in this staging area, the lack of news crews and pressed on to an area the GOP had explicitly advised those opposing the President’s policies to steer clear from. The note from Wake County Republican Party stated, “We have been asked to NOT have people congregate at the corner of Peace and St Mary's as the people will be occupying that space.” Hundreds of us ignored this request. St. Mary’s and Peace was where we needed to be.

We greeted the President as loudly as we could as he whizzed past. He then went into the school and, from all accounts, wowed enthralled “townhallers” pitching softballs with his well worn diatribes against the “naysayers” and “chatterers” unable to appreciate the need to hand healthcare over to a government that lists the impending failure of the postal service as its achievement for the week.

Interestingly, after the President’s motorcade passed, the local ABC affiliate stood on the corner of Peace and St. Mary’s with Obama supporters tight and bunched up, yelling and screaming. He then began filming. No doubt the evening news will be filled with shots of the “throngs” of Obama supporters out to greet the President. A few of us crossed the street after the President had passed to inject some reality into the news broadcast being fabricated by the TV crew. Some of us engaged the President’s supporters in animated and ultimately thoughtful discourse.

Once the shouting stopped, we talked race, we talked racism on the part of the President, we talked religion and faith, we talked abortion, and we talked about the current healthcare legislation. We talked about the implicit and explicit racism of current government policies. We talked about the comments of Justice Ginsburg in which she stated that she always assumed the Roe decision would lead to public funding of abortions to decrease “population growth and particularly growth in populations that we don’t want to have too many of.” We also talked real possibilities for building on the best healthcare system in the world and assuring care for the 10-15 million who desperately need a safety net. Our dialogue ranged from eliminating state insurance mandates, to delinking health care from employment, to tax credits for insurance purchase, to malpractice and tort reform, and then to a discussion on the wisdom of guaranteeing that illegal immigrants be guaranteed a government healthcare benefit.

It was a bit heated at times and while the police allowed us to continue the discussion they were standing by. One African American Obama supporter got an answer he didn’t seem to expect when he stated, “You have to know this is a white man’s world. Black people have had to struggle for everything and now we have to fight for healthcare.” The response…pretty close though probably some paraphrasing, “You know why that is? It’s because the African Americans of this country have for 60 years been willing to be the victim of liberal politicians and Great Society mad scientists. They have devised a government run social support system that promises blacks everything…healthcare, homes, income and food…and yet ultimately has delivered nothing but decimation of the black family, destruction of a sense of individual responsibility, destruction of black neighborhoods and livelihoods, and absolute dependence on the government. Blacks continue to vote for politicians who promise the moon and deliver only more dependence. Government dependence is a drug worse than crack. You may have broken out of your shackles 150 years ago, but you are still on the plantation. And if you give this government absolute control over your health, you will never escape.” Not sure of what the response to this would be, the speaker braced. The Peace Streeter considered this and said. “You make some good points brother.”

I’m not sure any of us changed anyone’s minds today. It was an open and brutally honest exchange, however. I certainly doubt the President was influenced by the crowds you will not see on the evening news tonight. The folks we interacted with on Peace St and St. Mary’s were willing to listen, as were we. Our new friends on Peace Street made it crystal clear that there is deep frustration within the African American community. There was a knee jerk reaction of our colleagues on Peace Street to blame this frustration on the failure of “government” to help black people. We argued that this frustration is a result of failed government policies which have decimated the African American community. In the end the Peace Streeters did not disagree.

Ultimately this frustration can be channeled in one of two ways. As the President has done, it can be channeled to develop support for more government intervention in all our lives. The President has made a life of exacerbating racial tensions and class warfare in pursuing his objective of an increasingly powerful centralized state which subjugates the needs of the individual to the needs of the state. He called his grandmother a “typical white woman”, he would sit in the pew of Jeremiah Wright for 20 years, he portrayed Midwestern voters as bitter and clinging to their guns or religion or antipathy to people who aren’t like them and he described the textbook performance of a model white policeman as “acting stupidly”, fueling unsupportable charges of racial profiling as he prefaces his comments with the admission that he did not know all the details of the case.

Alternatively, if race baiters like the President, Jesse Jackson, Al Sharpton and the rest would stand down and allow individuals like those of us talking on the corner of Peace Street and St. Mary’s today, we might channel this frustration in more constructive directions. One of the corner delegates said, “All we want is the American dream man. Not sure we will ever get it.” With a black community committed to supporting “leaders” and politicians whose survival requires that African Americans believe they are perpetual victims, while they peddle more government dependence and the lure of guaranteed outcomes, I sadly had to agree.

Our friends on Peace Street have been promised much, little of which has been delivered over the decades. Another community, the Hispanic community, is now marching down the same road. They also have lots of checks in the mail. They have taken their number as the next minority group to be consigned to the ash heap of terminal liberal victimhood as politicians say anything to gain their support.

Would that politicians would commit themselves to strengthening the America which has been the incubator for the “dream”, an America which fosters individual growth, liberty, independence, self-reliance and reverence for our divine origin, not the reflexive expectation that it is government that can and must provide. It takes a village? The village is government. Government, for many of us, exists to support the freedoms which build self-reliance, faithful individuals and strong families. Such a “dream” includes not only the enormous possibility of success, but the risk for failure. A nation which supports a government which guarantees mediocre outcomes determined and measured by prejudiced bureaucrats is not free. This is not an incubator for the American dream my Peace Street friend is after. This was one thing we all agreed on at the corner of Peace Street and St. Mary’s today.

Despite a provocative discussion, a sobering comment was made by one of the delegates as we packed up to head home. After admitting that the black community at this point has to bear some responsibility in who leads it, a remark was made, "Well, we do have a black President. Doubtful many civil rights warriors thought that would happen in their lifetimes." The response from the African American Peace Streeter was laughter followed by "The President ain't black. He's half white."

Back to square one.

Is it really possible to reverse the course of victimhood set over the past sixty years?

Quaere Verum

Saturday, July 18, 2009

Say Anything...Its Now or Never

According to our President, it is now or never for healthcare reform. Familiar message? “Now or never” for the nation-saving prokulus stimulus bill. “Now or never” for the auto industry. Now or never for the finance industry. Now or never for reduction of CO2 emissions and saving our planet from global warming. Anyone notice a record low “high” of 64 in Wisconsin Friday? Thank goodness Hillary apologized to the world yesterday for America's role in "climate change." Now it is “now or never” for healthcare.

The government already owns 50% of health care in Medicare, Medicaid, Tricare (the military health system) and the Veterans Administration. The portion of healthcare that Fed and state administrators operate is insolvent and headed to bankruptcy. The portion not owned by the statists is used to cover the losses hospitals, practices and health plans suffer at the hands of government bureaucrats. Government masters have refined the art of waging an administrative and pricing war while demanding that healthcare subsidize the health costs for 15 million illegal aliens here as a result of another failed government failure, the lack of enforcement of standing immigration law.

Now the Obama administration wants the whole medical enchilada...and they want it now. Those who say this requires a broad, detailed discussion and analysis are demonized by the President. This is a favortie tactic of the Obamamafia, rolled out on Day 1, when those who failed to see the need for speed with porkulus, or for legislators and constituents to read a 1000 page bill before it was signed, were demonized. The President builds the perception of crisis in healthcare. He fiddles as the government consumes 46% of GDP, his minions develop plans for more governement spending and unemployment is at 9.5% and headed north.

VP Biden told us this week that "We have to go spend money to keep from going bankrupt." There is no other description, while entertaining, the VP is an imbecile, the court jester who regularly creates media distractions for the President. The President, however, is a conniving liar. He will spare no deception or duplicity in attempting to build a consensus that the root of all evil in America is our useless, wasteful medical system. Does this President like anything about this country? Re this miserable medical system of ours, will the President be flying to Italy for his healthcare, as the Italian Prime Minister, Silvio Berlusconi flew to the Cleveland Clinic for care of his cardiac condition? Will the President be the first to sign on for the “government option” which will offer consumers so much choice? I think we know the answers. Teddy Kennedy flew to Duke University for treatment of his advanced brain cancer.

Memo to any of the 47 million uninsured who have brain cancer: Taxpayer funded trips to Duke University for the most advanced medical care will only be approved for "treasured" politcal VIPs. Generally consideration will only be given to liberal misogynists who have lived a life demonstrating absolute contempt for the common man. Lest your friends refer to you as a "Lion of the Senate", chances are you will be taking a number with everyone else. Last Canadian time check shows that the MRI you need will be scheduled in 110 days! The good news is that by the time Obamacare diagnoses and begins treatment for your condition flying to Duke would only be necessary if the University's historic Maplewood cemtery is your final resting place.

“A bankruptcy occurs every thirty seconds occurs as a result of American healthcare costs.” Lie. “My plan will allow for greater choice and competition.” Lie. “My plan will save money.” The Congressional Budget Office weighed in on this two days ago. Lie. America has embarrassing infant mortality rates.” Only if you fail to account for the counting and care we give the most fragile of infants, extremely low birth weigh newborns not even considered as live by most nations. So, another lie. America has unacceptable life expectancy rates given the money we spend on healthcare.” If one considers violent deaths (mainly a result of 50 years of Great Society liberal do-gooding experimentation in our inner cities) and car accidents, we top the world in life expectancy. More lies.

“Government programs have far less administrative cost than private programs.” Medicare, Medicaid and Tricare put all the administrative costs back on to the hospital or facility. In addition, the government spends relatively little time and money in trying to prevent fraud and abuse. In the end hospitals charge private payers more because they have to make up losses on the government side, which is…yes, 50% of the current system. “At least 47,000,000 are without insurance.” A half lie. The inference is that these people are without healthcare. No one is without healthcare in this country. See EMTALA and the legal requirement to treat anyone who walks into an emergency room. However, the 47,000,000 without “insurance” are one third illegal aliens and one third are individuals who could afford insurance if it was a priority for them. That leaves approximately 12-15,000,000 who truly are unable to get the insurance they need. That’s less than 4% of a population of 305 million. For this we need to nationalize 17% of our nation's $14 trillion economy and change the current care that 89% like? Surely there are other solutions, but not when its “now or never.” If the President’s lips are moving and healthcare is mentioned, he is not telling the whole story.

Well, we all know Americans support Big Pharmaceutical Companies committed to one thing and one thing only, profit. Other governments, however, have tamed the pharma monster. Sure. Has the President told us, as a result of regulation and safety requirements, that it currently costs a drug company $1 Billion to bring a drug to market? Has he mentioned that only 0.1% of new drugs actually make it to market and this process takes 10 years? This is asking a lot, but how about our fearless leader telling America that just as we are the only free nation left in the world willing to defend itself and its allies, we are also in a league of our own in developing new drugs and medical technology? Americans pay the freight because we can. Want to get tough Mr. President, tell our freedom loving foreign friends, if any remain, that the time has come for them to pay the bill not only in national defense but in healthcare research. The President believes the solution for healthcare is to build on his successes in revitalizing the American auto industry. More lies. Big lies.

The push for government control of your healthcare system is on. Even reasonable citizens will have a hard time voting for less government when your healthcare is completely state run. If you ever cared about anything, you should care about this. If the President rams through “healthcare reform”, more properly called “healthcare destruction”, by his artificial and mandated August 7th deadline, your life and the lives of generation of your family members, will be irrevocably changed.

One might ask why such a short time frame to make such a monumental decision? Well, if citizens, and more importantly voters, had time to really consider this issue and think about their healthcare being directed by the same folks who run the DMV, public schools, and screen your bags at the airport, you might want to consider other options. Crisis, diversion, deceit, lack of transparency and complacency on the part of the American citizenry are the only ways this Machiavellian power grab can occur.

There are two hopes here. Even if united in opposition, the Republican party will not be able to derail this freight train. There is hope in the possibility that the American electorate will wake from the change and hope stupor. There is also hope that sensible, thoughtful patriots remain in the Democratic party. As of this week there appear to be some Dem lawmakers willing to break the Obama-Reid-Pelosi omerta. These supposedly centrist, fiscally conservative Democrats are the "blue dogs". It is refreshing to know that there may be some on the Dem side of the aisle who have not succumbed to the pressure to completely sell their souls and who have begun to appreciate the true intentions of the Obama administration. The last patriots left in the Democratic party can be reached through the Captiol switch board or their web sites. If emailing be sure to use a return address from their district on the contact form, otherwise your message will not be accepted.

Capitol switchboard is 202-224-3121:

Reps. John Barrow (D-Ga.)
Bart Gordon (D-Tenn.)
Baron Hill (D-Ind.)
Jim Matheson (D-Utah)
Charlie Melancon (D-La.)
Mike Ross (D-Ark.)
Zack Space (D-Ohio)

As we have watched the development of a system of thirty plus “czars” put in place by the President, with no funding accountability and no oversight, these Democrats appear to be poised to rise and provide the infusion of courage which will be required for this nation to resist its current descent into socialism.

As for our part, we the citizens need to be letting our representatives know how we feel about a takeover of one of the great American industries, healthcare, by the federal government. Visit, call or email your representatives, in that order. Also contact the “blue dog” Democrats willing to consider defying their liberal masters in DC. These individuals are listed with their office contact numbers.

For those of you who are more visually inclined, if you doubt that the inefficiencies that exist in some areas of our current health care system could ever be worse, try this on for size:

To the parapets. Let your representatives hear you. Fill their waiting rooms, flood their servers, burn up their phone lines, shut down the switchboards. The socialists are still coming!

Quaere Verum

Saturday, July 4, 2009

Independence Day 2009: "A republic...if you can keep it"

"It is impossible to rightly govern the world without God and the Bible."

~ George Washington (1789 - 1797), first President of the United States

Quaere Verum

Monday, June 29, 2009

Dissecting the Obama Healthcare Infomercial

For those of you unable to stomach the Charlie Gibson-Barrack Obama Healthcare Love Fest last week, this is required viewing. The CATO Institute has performed an outstanding service in distilling the President's paternalisitc pedantics down to a five minute video clip. Included in this presentation are responses to the President's comments which the most transparent Presidency ever has been unwilling to honestly address.

Quaere Verum

Sunday, June 28, 2009

We're Burning Daylight

The healthcare debacle will put our nation in socialist chains, cap and trade and the global warming snake oil salesmen will destroy the one means to avoid the coming socialist catastrophe…the engine that had once been the American economy. While some people may be able to get job training making windmills for a time, the end result will be a loss of 2-3 jobs for every job that might be created (or will it be created or saved) in the “green economy”. Sky high energy prices (will conservatively cost the average family of four $2000/year) are coming if this passes folks. More detail on the great global warming scam, and the impact of cap and trade (cap and tax), here, here and here.

Our fear mongering President tells us that “we have to have courage. The time is NOW.” Apparently for everything….healthcare reform, energy reform etc. Anyone who is not on board is guilty of spreading disinformation or is a coward. Everything you need to know about the honesty and transparency of this administration was on display last Wednesday night. The President’s infomercial on healthcare, produced by ABC “news”, permitted no formal presentation of opposing views regarding healthcare reform. Courage Mr. President? Your subjects, I mean the American citizenry, might ask that you, Sir, find the courage to debate the reasonable concerns regarding all these matters, and put away the Rahmbo porculus (stimulus) bill tactics. That will not be happening in this Administration.

The House of Representatives was handed a 1000 plus page piece of legislation related to cap and tax Friday night. There was not even time to package the bill and its 300 amendments in a single document. The President shifted into the only real gear he knows…crisis. “We need this now.” “We have to have the courage to face the future.” “America can no longer continue on its current path.” “If we don’t get it done now we never will.”

Madame Speaker, reminiscent of Gollum responding to her master’s call for action, pushed this bill through with an extremely tight vote. Eight Republican House members provided cover for the Democrats. These GOP pretenders, in obtaining prime seating on the Speaker’s taxpayer funded jet services, sold their souls in order to obtain the liberal cred they perceive they need to maintain RINO status and hold onto their office. For pols it’s generally not about principle, it’s about staying in office.

These turncoat Republicans allowed eight challenged Democrats to vote no on this legislation. These Democrats, with electoral challenges in 2010, are now able to return to their districts and report that they courageously stood on principle to vote against this bill.

Pictured are the GOP traitorous eight. If they supposedly represent you, please let them know how you feel. The cap and tax bill will now go to the Senate. It is not clear when a vote will take place. Start the calls to Senators now. Melt the phone lines. Your calls, letters and visits matter! Info for Senate contacts is available here.

To some it may seem far fetched that Dem leadership could be so conspiratorial in nature. If you feel this way, you simply aren’t paying attention. Did you miss porculus (the “stimulus bill”), the auto takeover, the ownership of banking firms and co-opting of the home finance business by the government?

At this point healthcare is a crapshoot for the Administration. We can only hope the President’s reform push will fail, but at this point it is not absolutely critical for the administration. Whether it has been the plan all along or not, healthcare has become a screen for getting cap and trade through. The Obama gang MO, orchestrated by Chief of Staff Rhambo Emmanuel, is to push 2 or 3 major issues hard and see how the shot sets up. It is all about misdirection, overwhelming the public and GOP leaders and isolating a target. Right now, the administration may lose healthcare (I may be a little too optimistic here), but they have a good chance at sap and trade, cap and tax, or knee cap our trade. Whatever you call it, it is economic suicide. The Obamafia reran the porculus drill for this. You know, produce a 1000 page cap and trade bill which doesn’t even really exist (there was no complete, physical comprehensive bill for legislators to review, even for the speed readers in the group), throw it into the House and Rahm it through. In this case even make some of our fine Democratic colleagues from challenging districts look good with the help of some GOP traitors.

The President can bide his time on healthcare, if he doesn’t get it now. Cap and tax he needs now. Some of the wheels are coming off the global warming bus (like the coolest temps in decades, reports suppressed by the EPA and the defection of numerous scientific types). Re healthcare, the government already owns 50% of the current system. With budget cuts at the state and Center for Medicare and Medicaid level, payments will be whittled away. As payments for government patients dives, provider organizations (hospitals etc) will be put in crisis mode. More and more cost will need to be shifted to private payers. There is not much more cost shifting room there. Purchasing groups (insurers, brokers etc) will be driven to make tremendous cuts, eventually being driven out of the market. As more and more folks are unable to get the private insurance they need at a reasonable price (unreasonable because the government calls the ball on the reimbursement for services), choice will become limited. Hospitals and provider groups will be forced to limit services, cut personnel, and go out of business. If unsuccessful now, there is still possibly time for our President to resurrect this issue and offer the hope of a government takeover later.

Simply put, a frontal assault on healthcare may not matter at all because, if one takes a little longer view, the administration has the tools right now to erode the healthcare system and make perhaps even a stronger case for Obamacare later.

The question is when do people wake up and see these arrogant, self-serving, power hungry miscreants for what they are? Despite quadrupling down on Hoover’s progressivism and laying the socialist ground work for a depression within the Depression, FDR was re-elected in 1936. We have a long history in this nation of obsession with personalities and inability to grasp the issues of the day, even when they directly threaten us as individuals.

There is ZERO leadership emerging on the GOP side. At this point the GOP is worse than the gang that couldn’t shoot straight. It seems that even a gathering of the most unfortunate village idiots could not repetitively inflict so much injury on themselves (see Sanford, McCain still supporting cap and tax, defectors on porculus and cap and tax, alternative healthcare bills offered by Republicans). It almost seems that this is intentional and that some GOP members are complicit in this absolute failure of leadership.

Bottom line, there is no visible GOP party leader, no rallying voice. I fear 2010, an enormous opportunity to propose an agenda to advance the principles which have led to America's exceptionalism, could turn into a route of the few remaining loyal GOPers. The hope is in new blood at the local and state levels but there needs to be a national voice differentiating and identifying a clear Republican alternative to the statism of the left. I would recommend that this effort be unapologetically based on the foundation laid by the Founders and the Constitution.

If loyal opposition is to be a memory, at least let Americans know that they have made a clear decision to make it so by discarding the principles of our founding. Without this type of clarity it will be extremely difficult for even the best of new local candidates to break through the mind numbing rhetoric from the left which saturates all elements of our lives.

Who will supply this leadership? Divine intervention formed us; will it continue to maintain us? I absolutely believe that such leadership exists. Time is running short, however, and she or he is burning daylight.

Quaere Verum

Wednesday, June 24, 2009

Getting Back To Normal?

In my industry we pay very close attention to the Consumer Confidence Index. Primarily because this helps us gauge the consumers desires to buy or not buy things. As the U.S economy and my industry is largely based on consumerism this helps us forecast future trends.

We have noticed recently an increase in consumer interest to purchase as well as following through with such purchases over the last three weeks. There doesn't appear to be any significant market conditions that would encourage this behavior. I could argue just the opposite and that certain indicators trend to a further slowing of the economy.

One idea I have as to why this sudden surge is that the Obama hysteria is fading. It has been over two years of fanatic slobbering of what was to come from this self proclaimed messiah that reality is starting to settle in that he isn't anything more than a community organizer with no business experience. Many who voted for this accomplished party guy are beginning to awake to a hangover illuminating a President who really does want America to become a Socialistic Country.

Any good American politician understands that the United States people are conservative in nature. So when Obama starts inviting Iranian leaders to our 4th of July celebrations or entertains Huffington post bloggers at an international press conference the hearts of these elected officials start to skip a beat.

So as the Obama rage disappears then the political rhetoric of both aisles increases thus the grinding engine of the U.S. Congress begins to slow. I believe Americans are now seeing things getting back to normal and thus are able to come out of there homes and start living their lives again.

Monday, June 22, 2009

Leader of the Free World

The world is in turmoil. North Korea is threatening nuclear war and a missle launch at Hawaii. Iran is in flames as freedom fighters attempt to topple its Mullah Thugocracy. Can you identify the Leader and Best Hope for the Free World? Polls are open.



Quaere Verum

Friday, June 19, 2009

Wile I was Away

So it has been a bit since I last wrote and as I sit overlooking the ocean I wonder why write now? It is because now while I am alone with nothing but the ocean breeze in my face and a cardinal chirping do I have some peace to reflect that I believe I was in moat mode. Moat mode is when you say 'I'm out of here' to the rest of the world. I am going to take my family, secure them in my castle and protect them from the outside evils with my moat and other capable tools.

Building a moat is different then sticking your head in the sand. I know what the threats are out there in the real world I just don't want my family to have to confront them. I understand sticking your head in the sand and not wanting to even acknowledge the problems but that's not beneficial long term.

With a clear head I realize that at some point I am going to have to come out of my castle, lower the bridge and take on the wicked head on. Its a battle that I subconsciously chosen to avoid thinking it may just pass us by but it won't and as I overlook the sea realize I must come out strong, with a fierce will not to fail because its not me I am fighting for, its my babies back in the castle.

Monday, June 15, 2009

How to Destroy a Healthcare System (Part IV)

The "Uninsured" Masses

In case you hadn’t heard within the past hour, there are reportedly 46,000,000 Americans without healthcare insurance.

Where did this number come from? This number is derived from the American Community Survey (ACS) conducted annually by the Census Bureau and supplemented with data from the Annual Social and Economic Supplement (ASES). This is a staggering figure endlessly cited by collectivists home and abroad as exhibit one in the case for the need to rush to a government run medical system in America. Those interested in this socialist vision disingenuously create the image that 46,000,000 are wandering aimlessly through our streets ravaged by diseases with no opportunity to receive medical care.

This horrifying picture should prompt at least two comments. First, could this picture possibly be a reasonable rendering of current conditions? The answer would be no. Under EMTALA (Emergency Medical Treatment and Labor Act) it is illegal for a hospital to deny emergency and delivery care. Secondly, who are these 46,000,000 unfortunate victims who, while they do have access to medical care, may not have access to what we all might consider optimal medical care? Can it be possible that we as a nation have ignored the plight of 46,000,000 citizens who lack health insurance, requiring us to radically revise an irreparable healthcare system?

In order to determine who the 46,000,000 are it is necessary to consider definitions used by the Census Bureau. This number repeated ad nauseum by proponents of a single payer, government run system is based on the annual Census Bureau estimates of individuals who have spent at least part of the year without health insurance. The Census defines an individual as “uninsured” if they were not covered by any type of health insurance at any time in that year. The report does not specify the periods of time that individuals might have been uninsured. Included in this number are uncertain numbers of citizens who after being laid off or switching jobs may have had some period without insurance but were back on insurance roles during the year.

In addition, the latest Census Report states, “Health insurance coverage is likely to be under reported in the Current Population Survey (CPS). While under reporting affects most, if not all, surveys, under reporting of health insurance coverage in the latest ASES appears to be a larger problem than in other national surveys that ask about insurance. Some reasons for the disparity may include the fact that income, not health insurance, is the main focus of the ASES questionnaire.”

Somewhat more reliable data is available from the Congressional Budget Office (CBO). In a report issued in 2003, “How Many People Lack Health Insurance and For How Long?”, the CBO, commenting on the most recent year of reliable data (1998), “In recent years, the number of uninsured people in the United States has been pegged at approximately 40 million, or about 16 percent of the non-elderly population. By CBO's analysis, that estimate overstates the number of people who are uninsured all year and more closely approximates the number who are uninsured at a point in time during the year. A more accurate estimate of the number of people who were uninsured for all of 1998--the most recent year for which reliable comparative data are available--is 21 million to 31 million, or 9 percent to 13 percent of non-elderly Americans.” There is no more recent CBO estimate of the number of individuals who may be uninsured for a significant portion of the year. So, if CBO estimates are to be believed, over a given year and based on current numbers, there might currently be closer to 25 to 35 million with sustained lack of medical insurance.

So the numbers of individuals going without health insurance for a full year is far less than some would have us believe; but for some, not all, a short period without health insurance could be difficult. Who are the individuals being denied the opportunity at least 245,000,000 of us now enjoy? The medically uninsured is talked of as a homogeneous group but nothing could be further from the truth. Many individuals move in and out of this group based on employment transition over the course of a year. For those truly interested in developing the best possible healthcare system in this nation, it is critical to further describe the remaining very heterogeneous group of “uninsured”.

The CPS provides reasonable descriptions and estimates of the subgroups which constitute this whole. Based on the CPS, at least 9.7 million foreign born, non-citizens are part of this group. These are illegal aliens, generally in low income categories based on the CPS, who are not on the current insurance roles. The federal government has abetted the influx of illegal aliens for decades. We now are counting 10,000,000 of them as uninsured “Americans.” No other nation on the planet assumes they have an obligation to provide medical care to illegal aliens. There is none.

The CPS also reports that 8.4 million households with an income greater than $50,000 and 9.1 million households with an income greater than $75,000 are without insurance. According to the American Health Insurance Plans (AHIP) survey for 2006-2007, the average national individual and family medical policy premiums were $2613 and $5799 respectively. A significant number of these households are single wage earners but that data is not readily available from the CPS. The Commonwealth Fund reports that one of the fastest growing segments of the uninsured population is the 19-29 demographic. While many in the $50,000 to $74,999 category may be single, let’s assume these are all large families incapable of purchasing medical insurance. We then have 9.1 million households (uncertain number of individuals) that should reasonably be able to afford medical insurance with an income above $75,000.

The catch is that the average policy costs are significantly higher in a number of states. This is because of government meddling. The cost of insurance is directly related to state required mandates placed on health insurance policies offered within the state. The largest number of mandates, is, not surprisingly, found in blue states. In New Jersey, for example, the average individual and family premiums were an astounding $5326 and $10398. Like it or not policy purchasers in New Jersey will be covered for in vitro fertilization, autism, ostomy supplies, breast reconstruction and contraceptives.

The last subgroup to be considered in the pool of 46,000,000 is those who are eligible for government insurance (Medicaid, SCHIP and Medicare) but are not enrolled in the proper program. This number is estimated at 12-14,000,000 individuals.

So lets put this all in context. After subtracting illegal aliens, households which theoretically could afford insurance (>$75,000 income only) and those eligible but not enrolled in government programs, we are left with approximately 13-15 million who fall into the category of without health insurance for some period of time during the year. This number (perhaps 8-10,000,000) includes a large number of individuals with chronic medical problems who are chronically underinsured and are unable to support their healthcare needs. In the end, we are talking generously about approximately 10-15,000,000 individuals whose needs are not capable of being met by the current healthcare system. This constitutes at most 5% of the current population of the United States.

One would never know that the real crux of the healthcare debate is 5% of the population. Those interested in a government run healthcare system lie and distort numbers to create the picture of a nation abandoned and without medical services. Government should play a role in supporting a free market environment which is encouraged to provide care for the 5%. That, however, is not what the President and his minions have in mind. The President is interested in the federal government assuming the power and responsibility for the healthcare sector, which is now responsible for 16% of GDP. Car companies, tobacco companies, even the banking industry takeovers pale in comparison to what government ownership of healthcare would mean.

Healthcare is the Holy Grail of statists in America. Once less than 50% of people pay income tax and the central planners control their healthcare, the citizenry has become a ward of the state.

And who wouldn’t want the government to oversee the healthcare industry. The 45 year old government adventure in health care, Medicare and Medicaid, is bankrupt and unsustainable. It only makes sense that in the name of 5% of the population we would hand over the remaining 50% of healthcare to the lunatics who are burning down the asylum.

Quaere Verum

Friday, June 12, 2009

How to Destroy a Healthcare System (Part III)

As the rhetoric of the healthcare debate heats up, the quality of American health care is a prominent target. Daily we are hectored with tales of the inadequacy of our medical system. We’re told by the President regularly that we have the most expensive health care system in the world but we are not any healthier for it.

From President Obama on May 18th in New Mexico:

We spend more per capita than any nation on Earth…in some cases we've got worse outcomes. We've got higher infant mortality rates; we've got higher rates of some deadly diseases. That doesn't make sense.

WHO You Gonna Believe?

You’re right Sir, it doesn’t make sense. Do we really believe that we rank 37th in the world behind Cyprus, Morocco, Colombia, Portugal and Costa Rica? That’s what the last World Health Organization (WHO) Report (2000) claims and that’s what supporters of a government run health system proclaim.

There is much to critique in the WHO Report. Thinking people might ask are the measures used defined similarly in all countries, or is it apples and oranges time? On the subject of infant mortality, which is a critical element in calculating life expectancy, the Colombians, ranked ahead of us, would say "confundir la mierda con la pomada". Nevertheless, WHO uses its calculated value of life expectancy, built on faulty assumptions to derive life expectancy as an indicator of health system performance.

An additional reason for the head scratching view of healthcare systems which results from the WHO survey is the heavy weighting of “fairness” of health care distribution in developing rankings. From the Report:

Together, the levels of health and of responsiveness receive a weight of three-eighths of the total. The three distributional measures, which together describe the equity of the system, account for the remaining five-eighths.

Lets review this statement. WHO is not interested in whether your nation's care is good. WHO is most interested in everyone getting the same care, good or bad. Even if WHO could determine accurately the “distribution of healthcare”, a nation with overall stellar care, super stellar at one end of distribution and stellar at the other end, would be penalized! Yes, health tourism in Morocco is booming.

Nations unwilling or unable to invest in healthcare, who sentence all their citizens to the same mediocre care, are revered by the WHO. Commitment to mediocrity, our battle cry! Welcome to the brave new world of socialized medicine.

Infant Mortality

Infant mortality in the US is regularly cited by WHO and others as an indicator of the poor return we get on our health care dollars. The fact is that the US reports on all births more completely than any other nation. A livebirth in the US refers to any infant who on birth shows any evidence of life, including respiration, pulsation of the umbilical cord, or voluntary muscle movement. While there is some state variation for reporting, almost all states mandate reporting for infants greater than 20 weeks gestational age.

From US News and World Report (2006) and Dr. Bernadine Healey:

In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (mean length at 22 weeks gestation) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country.

Infant mortality in developed countries is not about healthy babies dying of treatable conditions as in the past. Most of the infants we lose today are born critically ill, and 40 percent die within the first day of life. The major causes are low birth weight and prematurity, and congenital malformations. As Nicholas Eberstadt, a scholar at the American Enterprise Institute, points out, Norway, which has one of the lowest infant mortality rates, shows no better infant survival than the United States when you factor in weight at birth.

Form Kramer at al in Pediatric Perinatal Epidemiology in 2002:

The huge disparities in the ratio of fetal to infant deaths less than 750 grams (1.6 lbs) and in the proportion of live births less than 750 grams among these developed countries probably result from differences in birth and death registration practices. International comparisons and rankings of infant mortality should be interpreted with caution.

Infant mortality rankings are not an issue of poor quality of care for the US, they are an issue of our willingness to attempt to support extremely tiny babies and reporting bias. There are disparities in infant outcomes in the US, especially along racial lines, but these have less to do with the healthcare system than societal and cultural factors which the healthcare system has little control over. Our strict definitions of live birth lead to the reporting of thousands of infant deaths annually which are never given a second thought even in Western Europe, the purported mecca of high quality healthcare.

Life Expectancy

Life expectancy in the US is another crude indicator of healthcare system quality frequently cited by critics of American healthcare as emblematic of our deficiencies. While average life expectancy in the US is 78, we still rank behind thirty other countries including Japan, France, Sweden and Hong Kong. What life expectancy as an indicator of quality in healthcare fails to account for are detrimental cultural and societal behaviors which limit life expectancy. US reporting of infant mortality certainly has a negative impact on this number but so do two other vital factors, homicides and car accidents. For 2004, the US homicide rate was 5.9/100,000. The rate was 1.95 in Canada, 1.64 in France and 0.98 in Germany. The US auto fatality rate is also higher. In 2006 the rate was 14.2/100,000 in the US. The rate in Canada was 9.25, in France 7.4, and in Germany 6.19.

The fact that the U.S. has a disproportionate number of individuals who die as the result of fatal injuries compared to the other wealthy nations of the world should be considered in any discussion of life expectancy rankings, but rarely is this recognized by those eager to find fault with American medicine. The destruction of inner city communities and mandates for a nation of automobile nomads to drive increasingly more fuel efficient and less safe automobiles does not reflect upon the quality of health care in the U.S. Death in these situations almost universally occurs independently of the condition of health of the individuals who die as a result of these factors.

When authors Robert Ohsfeldt and John Schneider in The Business of Health (2006) adjusted international life expectancy data for these variables, it turns out the US leads the world in life expectancy:

Table 1-5: Mean Life Expectancy at Birth, OECD Countries, Actual and Standardized by OECD Mean Fatal Injury Rates, 1980-99

OECD Nation 5

Actual (Raw) Mean (Does Not Account for Fatal Injuries)

Standardized Mean (Accounts for Fatal Injuries)

United States



United Kingdom













































The President is correct when he reports that Americans experience higher rates of deadly diseases. Specifically, America has high rates of heart disease and diabetes. The cause of this, however, is not the American Healthcare system. It is directly related to the fact that 31% of Americans are obese compared to 14% of Canadians, 13% of Germans and 9% of the French. According to Ron Bailey, science correspondent at Reason Magazine:

Taking all these unhealthy proclivities into consideration, the American health care system is most likely not to blame for our lower life expectancies. Instead, American health care is rescuing enough of us from the consequences of our bad health habits to keep our ranking from being even lower.

Statists interested in further expansion of government power eagerly proclaim that medicine has neglected its responsibilities in wellness and preventative care. Speaking to a crowd in Wisconsin this week the President, when asked about wellness and personal responsibility, immediately redirected the question to the responsibility of employers, government and medicine to keep individuals slim, trim and disease free. The canard of wellness will be used by statists interested in tightening control over the medical sector, which has no ability to influence societal ills created by decades of central planning. This heavy club will also be used to bludgeon other industries (tobacco, food) into submission, all in the name of health and “bending the healthcare cost curve downwards.”

Miracles of American Healthcare and the Mediocrity of a Single Payer System


For those genuinely interested in maintaining the best medical system in the world, there are many factors well beyond the control of the healthcare system which determine an individual’s health. While US critics are fond of inaccurately attributing quality deficiencies of our healthcare system, rarely do we hear of the incredible success stories that have resulted from American medicine. It is more likely that we will hear about the wonders of Cuban medicine in mainstream media.

“Cancer” is the word that strikes fear into the heart of all when they sit in a physician’s office. Should it strike more fear for patients in different healthcare systems? Short answer, yes it should.

From an article entitled Socialism and Cancer, written by Dr. David Gratner, a Canadian, in The New Atlantis:

A working group associated with CONCORD (the European NGO Confederation for Relief and Development) recently completed a study comparing five-year cancer survival rates for several malignancies: breast cancer in women, prostate cancer in men, and colon and rectal cancer in both women and men. Combining the efforts of some hundred researchers and drawing data from almost two million cancer patients in thirty-one countries, the study, published in the August 2008 issue of The Lancet Oncology, is groundbreaking.

The CONCORD study finds that the United States leads in the field of breast and prostate cancer. France excelled in treating women’s colorectal cancer and Japan in men’s colorectal cancer. And the United States clearly leads other nations in overall survival. Regrettably, great discrepancies do exist between white and black Americans and among residents of different cities. That said, given a cancer diagnosis, patients overall do better here than anywhere else.

Why the difference in cancer care in the American healthcare system? The short answer is better access to screening (preventative care), specialists, medications (expensive chemotherapeutic agents) and technology. Yes, you read that right, we do cancer prevention better than any country on the planet.

Heart Disease

While cancer takes a considerable toll on residents of developed nations, heart disease remains the number one cause of death. There have been multiple developments in the field of cardiology and cardiothoracic surgery over the last several years. Significant advances include the introduction of cholesterol lowering medications, use of aspirin and other medications in the face of heart attack (MI), emergency percutaneous coronary interventions (PCI) for unstable MIs, use of coronary stents and advances in by bypass surgery.
The British Medical Journal in 2006 published “National variations in the provision of cardiac services in the United Kingdom: second report of the British Cardiac Society Working Group, 2005.” The report is notable for several findings:

The UK cardiology workforce has grown significantly over the past five years (fig 4 , table 1 ). This has been most obvious in England (180 new posts advertised and appointed in the past three years), which initially had the fewest cardiologists per million population. Cardiologists are therefore now more equally distributed across the UK; nevertheless, staffing levels remain well below those reported in comparable western European countries and much lower than those recommended by the BCS workforce committee.

An analysis of audit data from the National Pacemaker Database for the period 1998–2002 has shown that the UK as a whole implants far fewer ICDs than most western European countries… Expert commentators have pointed out that these stark differences probably stem from limited access to cardiac catheterisation laboratories or a shortage of appropriately trained electrophysiologists or device specialists in many parts of the UK.

Cardiac resynchronization therapy (CRT) is a complex form of pacemaker therapy that has been shown to improve the morbidity and mortality of selected patients with heart failure. The working group has found evidence of a very patchy uptake of this technology across the UK and believes that this reflects a shortage of the relevant expertise and difficulties in funding. Our first report identified alarmingly low coronary intervention rates in Wales.

Even allowing for the substantial number of patients who reside in North Wales but are referred to England
for treatment, most forms of specialist activity in Wales remain worryingly low. There seem to be two reasons for this. Firstly, there have been difficulties in commissioning. The NSF for CHD has never been adequately funded in Wales and has become aspirational rather than pivotal in healthcare planning. Tertiary cardiac and other specialist services are commissioned nationally by Health Commission Wales; their budget has not been increased in line with the emergence of NICE-approved evidence-based technologies, and the new arrhythmia chapter to the NSF, which was introduced in England more than a year ago, is still to be approved in Wales. Secondly, the consultant cardiology workforce appears to comprise many physicians who have substantial general medical duties and relatively few specialists with skills in coronary intervention and electrophysiology. Unfortunately there seems little prospect of eliminating these inequalities in the near future.

This report should be required reading for misinformed supporters of nationalized health care. While there are some bright spots in the UK’s efforts to upgrade its cardiology services, the report overall is a critical look at a healthcare system struggling to support the cardiac needs of its citizens. For us it might be a look into the future.

Heart Surgery

Surgery remains a mainstay of therapy in severe cases of coronary disease. Most disconcerting is wait times for surgery for bypass cases. It is known that exceeding recommended deadlines for CABG, staged on the basis of a patient’s clinical condition, absolutely affect mortality. While coronary artery bypass surgery is serious business, it is not exempt from efforts by nationalized health care systems to push the envelope for waiting times.

The Canadian Medical Association published in 2008 “The Economic Cost of Wait Times in Canada.” This study evaluated the economic impact of having disabled Canadians wait to receive definitive medical care. Costs were reflected in loss of productivity, support payments and ongoing non-surgical medical care. The impact of just four conditions was examined. The analysis concluded that waits for these conditions cost Canada $14.8 billion in 2007. How long are the waits?

Waits are long. For cardiac patients not treated within the maximum recommended period, the average wait for coronary artery bypass surgery is over 3 months, more than double the maximum recommended wait. The situation for patients requiring an MRI is grave. The maximum recommended wait is 30 days, but the median patient still waits 56 days, while patients who do not get their scan within that maximum recommended period wait an average of 85 days.

From the vaunted Swedish single payer system comes a report published in 2005, in which the median wait times for patients classified as imperative (recommend surgery within 14 days), urgent (recommend surgery within 12 weeks) and routine (recommend surgery within 6 months) were analyzed.

The median waiting time for the 5453 patients that underwent CABG was 55 days (interquartile range 21 to 105 days). The median waiting time was 17 (7–39) days for the patients in the imperative group, 82 (49–133) days for the patients in the urgent group, and 100 (67–172) days for the patients in the routine group. A total of 3014 patients (55%) were operated on within the intended waiting time in their respective groups: 46% in the imperative group, 44% in the urgent group, and 77% in the routine group).

The authors, based on delays in surgery for patients at all acuity levels, were able to determine, unfortunately, the increase in deaths related to each month on the waiting list. From a previous analysis of this data the authors reported that “mortality risk increased with time after acceptance by 11% a month.”

There is no wait list for a CABG in the US. When Italian Prime Minister Berlusconi needed heart surgery in 2006, he didn’t use his nationalized health service. He flew to the Cleveland Clinic.

Other Surgeries

In Canada, wait times for surgery and other diagnostic procedures would be incomprehensible to most Americans. The major Canadian wait time metric is 90% wait time. This is the time at which 90% of cases are completed. Each province has set a goal for the 90% wait time for multiple procedures, and also carefully reports the actual 90% wait times for same procedures. The data is horrifying. For example, in the province of Ontario (includes Toronto), the provincial target for wait time for breast cancer surgery is 84 days. Fortunately, most centers achieve this benchmark, but the overall provincial wait time is still 38 days…for breast cancer surgery. While as inadequate as this may seem, it is clear breast cancer surgery has received the attention it deserves, especially when compared with prostate least attention by Canadian standards. The provincial target for prostate surgery is a wait of 84 days. The actual overall wait is 89 days!

For overall cancer surgeries, the targeted wait time is 84 days in Ontario. The actual wait time outperforms the benchmark, however. In Ontario the average wait for a cancer surgery is 61 days. That would be two months waiting for a potentially curative surgery living with the fear that your cancer is growing.

Orthopedic surgeries are rarely life saving surgeries, but they have an enormous impact on productivity and quality of life. In Manitoba (Winnipeg), the median wait time for a hip replacement is 14 weeks. Not days, weeks, and that’s the median. At this point another 50% of replacements are still not complete. In New Brunswick the median wait time is 12 months. That would be a dream, however, for natives of Nova Scotia, living the glory of a single payer healthcare, where the 90% wait time for a hip replacement is 540 days. Nineteen months!

Well, it’s nationalized healthcare right. We have to ration services somewhere. Why not start with the aging population? While it might seem insensitive to some that we send early the message to the aging that they have a duty to die, surely a compassionate, government run, single payer system will make certain the children are cared for.

So how about children’s surgical services? The province of Ontario includes several well known Children’s facilities, most notably the Hospital for Sick Children in Toronto. The 90% wait time for all pediatric surgeries in the province is 226 days! When one considers subcategories for more serious surgical conditions, the 90 day wait for neurosurgery is 71 days. The same wait for cardiovascular surgery is 206 days! There are not words to describe what I expect would be the reaction of anyone familiar with medical care, especially pediatric care, if the President told them the truth.

Diagnostic Tests

If the wait times for surgeries make you shudder, consider the fact that most surgical plans are formulated only after proper diagnostic testing is done. How long does it take to get these studies performed in a nationalized healthcare system?

A key imaging study performed regularly and with minimal delay in the US is MRI. In Ontario, the provincial target is a wait of 28 days, the actual wait time is 105 days! Well, maybe MRI is an expensive and overused technology whose value is totally overstated by greedy American hospitals and physicians. Okay, while many will point to the deficiencies of CT in numerous diagnostic areas, maybe the Canadians are just better at it. Surely that would mean easy access as well. The Ontario provincial benchmark for CT wait is 28 days, the actual wait time is 40 days!

So while it may seem that waiting 6-12 months for your hip replacement or 70 days for your child’s neurosurgical procedure is a lifetime, add in the time that has already passed as you waited for the imaging study required prior to a surgical intervention.

The National Health Service in Great Britain is no better. According to the Times (in 2005):

Ms Rachel King, 32, from Erith, Kent, was knocked down by a car in January. She suffered a broken collarbone, five broken ribs, a shoulder blade broken in three places and head injuries. She was in hospital for 17 days. After she suffered dizzy spells and reduced vision, her consultant referred her for an MRI scan. She said that she was appalled to receive the letter from King’s, saying that, because of “heavy demand”, the scan would be delayed.

What added insult to injury was the handwritten note on the bottom, which read: “If you want to go privately call 0845 6080991 for prices.”

When she did, the telephone was answered by King’s College Self Pay, who said that the cost of such a scan was £983, and she could have the procedure in a couple of weeks.

“It’s insulting” she said. “I was absolutely distraught. I need reassurance that the damage isn’t permanent. All I want is to know if it is going to get better.

“I still have falls, and I can’t return to work or drive. I’ve never signed on the dole in my life but I have had to now.”

King’s College Hospital said in a statement that it recognised that an 80-week wait for scans was unacceptable. It had recently received funds to expand its services, with the aim of getting waiting times down to 26 weeks by next March.

Ms King’s case is the starkest example yet of widespread delays in diagnostic tests across the health service. One in five trusts has waiting times of more than a year for MRI scans, and two in five have waits of more than six months.

A quarter of trusts said that 25 per cent or more of their scanning capacity was not used but lack of staff and resources prevent increased usage.

From the Telegraph:

An ex-serviceman is being left to go blind in one eye before the National Health Service will consider treating him for a condition affecting 250,000 people in the UK. Leslie Howard, 76, noticed problems with his right eye in November and was diagnosed with wet age-related macular degeneration (AMD) two months ago.

His sight could be saved by a course of treatment involving new drugs which could cost more than £6,000 a year.
But the local Primary Care Trust has told him it will only considering funding in his case once he has gone blind in one eye and developed wet AMD in the other.

A study sponsored by the Canadian Medical Association reports on the hidden cost of wait times:

Wait times in just 4 areas — joint replacement, sight restoration, cardiac bypass surgery and MRI scans — cost Canada $14.8 billion last year and lowered government revenues by $4.4 billion during the same period. The data, from a study done for the CMA by the Centre for Spatial Economics, were released in Toronto during a Jan. 15 speech by President Brian Day. “Our estimates are extremely conservative,” Day said. “Moreover, they do not include the costs, short and long term, of the deterioration that occurs while waiting. As an orthopedic surgeon, I have seen patients develop chronic and severe, irreversible damage, addiction to painkillers, and depression. And it need not happen.” Day looked back at the causes of today’s problems and ahead to potential solutions. He said causes range from decisions to cut medical school enrollment in the early 1990s to “self-serving” moves to protect the status quo.

Day also said Canada has fallen to 24th among OECD countries in physicians per capita, after ranking fourth in 1970. “How many of you have a doctor who is 50 or older? Who do you think will look after you when you are older and need medical attention?” Just to reach the OECD average of 3 physicians/1000 people, said Day, Canada would need to add 26 000 physicians, or more than 10 years’ output from its medical schools, at once. “It is not our role as physicians to passively accept the prolonged suffering of patients,” Day concluded. “We want to manage patients, not wait lists.”

The Canadians dedicate significant time and resources to trending and documenting waiting times in their medical system. While we all will be subjected to rationing and waiting periods that severely impact our health and welfare as we leap to a single payer system, the upside is that there will be more of the jobs created which the President makes best...government jobs. Armies of government agents charged with reporting on and examining time management in US healthcare will be put to work.

Medical Research

Stated simply, the United States puts more money into medical research than any nation on the planet. From Tyler Cowen in the NY Times in 2006:

In real terms, spending on American biomedical research and development (R&D) has doubled since 1994. By 2003, spending was up to $94.3 billion (there is no comparable number for Europe), with 57 percent of that coming from private industry. The National Institutes of Health’s current annual research budget is $28 billion, All European Union governments, in contrast, spent $3.7 billion in 2000, and since that time, Europe has not narrowed the research and development gap. America spends more on research and development over all and on drugs in particular, even though the United States has a smaller population than the core European Union countries. From 1989 to 2002, four times as much money was invested in private biotechnology companies in America than in Europe.

The 2009 NIH Budget alone is $40.9 billion. The pharmaceutical industry spent an additional $40 billion on R&D last year. America produces more than half of the health care technology products purchased globally. The Canadian 2009 budget allocates $5.1 (US) billion for all science and technology research. The Canadian Institute for Healthcare Research (CIHR) is budgeted $917 million for research this year. In Canada there are minimal contributions from the private sector given government regulation of the healthcare market. The UK through the Office of Strategic Coordination of Healthcare Research (OSCHR) has budgeted $2.75 (US) billion on medical research. US GDP is (was) 9.4 times larger than Canada’s and 5.3 times bigger than the UK’s.

One may argue the role of government support for scientific research of any sort, but the national commitments to medical research based on public funding alone are clear. As a percentage of GDP the US government spends four times as much as Canada and the UK on medical research. This does not include private funding for medical research, which at least doubles health research spending in America, dwarfing the commitments of other nations to research. Much as we militarily support the survival of the “great” European democracies, so do we support advances in their healthcare.

Quality Conclusions

While many have noted the so called “poor performance” of American health care with regard to the strawmen of infant mortality and life expectancy, what is rarely noted is that social and political experimentation in this nation over the last fifty years has created a Tower of Babel, not only linguistically but culturally. Health care is saddled with government mandated multilingual requirements and the need to support expensive interpreting services. We have an enslaved underclass in our inner cities who generations ago abdicated personal responsibility in favor of the snake oil peddled by statists who still find believers in the promise of a government sponsored utopia. We are bending under the weight of an illegal alien population lured here by open borders policies supported by politicians on both sides of the aisle.

The real wonder is that the American healthcare system functions at all. The fact that we achieve what we do is nothing short of miraculous, and is a tribute to the amazing men and women who are committed to health care service in all its facets.

“Worse outcomes” Mr. President? Compared to who? The President views a takeover of healthcare as one more brick in the wall of massive government expansion and central planning. The President assured us yesterday in Green Bay that he has no interest in a government run healthcare system. This would be the same President who now appoints the Board for Chrysler, GM and AIG.

The question is not what the motives of a statist President and liberal Congress are, those are clear. The President and the rubber stamp statists in the Congress tell us American medicine is in crisis, we have to reform now! Deja vu all over again...the banking industry, the housing industry, the auto industry. Next up, medicine and energy. Remember the battle cry of Rahm Emmanuel, "Never let a good crisis go to waste." The Alinsky corollary is to never miss an oppoortunity to create a good crisis. Team Obama is actively making the case that, despite the well meaning intentions of some, American medicine is failing the citizenry on all fronts.

The question is not what tactics the White House will employ in attempting a complete governement take over of healthcare. They will lie as they will diminish the amazing acheivements of Amercian medicine. They will ignore the terrible results of failing or failed governement run healthcare sytems across the globe. They will demean the benefits of capitalism and free markets which has made this country the greatest example of freedom and liberty the world has ever known. They will resort to the tactics which have successfully overwhlemed our nation and suckered a majority of Americans into believing they live in a hopelessly mediocre and greedy country whose success, if any, has been built on the exploitation of its citizenry.

Once again the President and Congress, creating an atmosphere of fear and chaos, will attempt to convince the American people that more government is the answer. We witnessed the President demanding "stimulus" legislation earlier in the year that "could not wait." In fact, the President, promising to be the most transparent President of all time, didn't even give legislators 24 hours to read a 1000 page spending bill! Americans and Congress yielded to our flim flam Presdient. The President, speaking about healthcare, has stated several times over the last week,"If we don't get it done this year, we're not going to get it done." Who says so? Why the rush? The rush is designed to prevent any reasoned discussion of the issues.

So the strategy in the White House is clear here. The important question is have Americans learned anything over the last year? Will Americans wake up and recognize what the President offers in trade for our current healthcare system? If we are willing to scratch beyond the rhetoric and look, we have clear previews. At home Medicare, Medicaid, SCHIP, Tricare and the VA are the 50% of our healthcare system the government currently operates. The government side of the house, if it were a business, would be bankrupt…much like Social Security. We only have to look across our border to see the full effects of government run healthcare.

Is this what we want as Americans? Do we want to wait a year for an MRI scan when we are experiencing dizzy spells and blurry vision 2 weeks after a car accident? Our healthcare system is imperfect but, when objectively examined, is the best healthcare system on the planet. There is a role for government in our health care system but history here and abroad demonstrates that it needs to be defined and limited. The current level of involvement has been devastating to our country, has destroyed the health care systems of other Western nations and has led to a stampede of nationalized health care systems trying to restore the private options they outlawed.

The reform required for American healthcare is not a government takeover, it is government divestment.

Wake Up America!!!!

Quaere Verum