Be Prepare

No one can predict the future. This is why it is important to be able to go with the flow and not to have too great a stake in your predictions. Obama has fallen into that trap by now trying to defend his position on opposing the surge in Iraq while at the same time championing one in Afghanistan. He is doing the same thing by defending his outdated position concerning offshore and ANWR drilling. The defense of a position in light of new or changing information can be seen as courageous, but actually is hubris, a belief in your own ability to predict more than in reality.

After the fall of the Soviet Union, believers in socialism have taken the position that socialism is great, just a few problems in its execution or external events prevented it from prevailing. The same is heard about communism. Now, we are getting a communism-light here in the USA, with equality trumping freedom as the policy of the democrat party. Many public (ie, socialistic) programs get priority even though the proof of their superior (or even equal) outcomes over private, free enterprise is not there.

Politicians should stick to who they are and use that as a way for us to determine if they will be strong enough to consider new information and change with the changing events that are unpredictable, yet certain to occur. It is not a policy that will shape the future, but a mind that is ready to incorporate the new information and events and recalibrate with the times. Amazingly, Obama, for all his youth, has not been as open to changing his mind as the older McCain. Remember that two days from now tomorrow will be the past.

Please note that Obama can change with the times. While his policies about taxing us (higher and more unequal in the service of equality) have not changed, he has changed his friends. He has removed Ayres, Wright, and Ludacris from his BFFs. If the new greatness is being able to ditch friends and keep ideas, Obama will be the role model.

John Edwards

John Edwards was caught with his mistress this past weekend, according to the National Inquirer. While not always accurate, the Inquirer does get the dirt sometimes. DocBrain thinks the story may be false, if only because the picture circulating of the woman shows a woman desperately in need of a $1000.00 hair styling, something that Mr. Edwards certainly could arrange for her!

Is the John Edwards dalliance important to anyone but his wife and family?

At least one middle aged woman has told DocBrain that it matters little to her who he sleeps with as long as he can perform his duties in public life to her liking.

DocBrain sees several problems with having no concern over Mr. Edwards dalliance.

• DocBrain concedes that leading a dissolute life does not make one bad in politics or government. Winston Churchill was not a paragon of virtue and yet was arguably the greatest politician of the century. However, hiding one's behavior and lying about it are two issues that show a lack of courage and a lack of honesty, both needed in public life. One is given pause thinking of the President (or VP) hiding in the bathroom when it is time to give the nuclear launch codes.
• If Mr. Edwards wife was your daughter/mother/sister, dying of breast cancer, how would you feel about Mr. Edwards trysts? Would you find them irrelevant in your support of him? Looking at the world with passion only for your own position is both narrow-minded and cruel. I think many Germans during WWII believed in the value of economically uniting Europe, which turns out to have been a good idea. It is in their lack of empathy for those suffering that we hold them most responsible. With the exception of a few minutes of his personal life, O.J. Simpson has led an exemplary life as a football hero, actor, and celebrity. So, taking a few moments out of a person's life, separating personal from professional, has its risks. Just as some have held Newt Gingrich to account for similar dalliances during his wife's bout with breast cancer, John Edwards is not any better.
• The President and Vice President lead by the bully pulpit, not by any specific power. The ability to lead is based upon not only fear but also trust. If a person would cheat on a dying wife, what is sacred? How much trust would still be there for most people? Could you count on the person's promise to be there for you and your causes even when securely in office?

The decision to cut someone a break for bad personal behavior depends on how desperate you are and how irreplacable that person is. DocBrain does not feel any desperation and does not believe that John Edwards is irreplacable.

Oy, L

We could stop buying foreign oil and could increase our exports of oil tomorrow just by doing one thing. Lets all stop our addiction to oil. So, starting tomorrow, lets all stop using anything that uses fossil fuel for our personal lives and for our businesses and government.

There you go! Oil problem solved!

That is basically what the democrats say when pressured about the oil crisis.

There are only a few problems with their scenario.

1. We just can't stop cold turkey. There is nothing to replace the oil that is practical and ready to be brought to market. If there was, you can be sure that private business would have done it already. Unless there are some crazy laws interfering with it. You know, like laws that would interfere with establishing a wind farm wherever you wanted to, or a nuclear reactor from being built, or dams with hydroelectric plants from being built. You know, the typical places where government gums up the works for private enterprise.
2. A transition period of decades will be needed, during which time those who supply us with oil will increase their profit margins.
3. The unknown issues that will arise are, well, unknown. Who would have thought that using biofuel would increase the cost of a pizza? Will the electric cells in cars be so powerful as to create a cancer risk in drivers? Will the electric cells require the use of a precious metal that is only available from a foreign country? Too many unknowns to be predictive of the future.

The best approach is to conserve and to increase national production at the same time that we look into alternative fuels. Listening to democrats say, "We can't drill ourselves out of this" or "We need to preserve the pristine wilderness" or "We need to develop alternative fuels" is driving DocBrain crazy! Its like listening to some teenager saying "Cleaning up my room won't give me better grades".

What is the problem? Here it is. Truth. What is truth? It is the truth, the whole truth, nothing but the truth and only the relevent truth. Anything less is untrue or deceptive. The democrat lines are partial truths and therefore deceptions at best, and lies at worst. Yes, we cannot drill ourselves out of a situation when we do not plan to conserve or develop alternative fuels, but that doesn't mean that drilling is useless. Yes, we need to have pristine wilderness, but we also need to preserve our economy for ourselves and our children. Yes, we need alternative fuels, but in an environment of legal morass, this is much harder than just basic science and economics.

Most annoying is the condescending attitude the democrats take as they recite their deceptions, daring anyone to disagree. How can one disagree with a need to keep our wilderness pristine? If subtracting from pristine wilderness is bad, then is adding to it good? If so, then let's start with the homes of all democrats. Level them. Turn them into parklands. Let democrats live in high rise buildings, in small efficiency apartments that can be easily heated and cooled. Take their cars. Let them all use mass transit. Take their computers, as computers have toxic wastes in them. Let them set an example for all the rest of us to follow. Brave liberals, like Martin Luther King, have always walked the walk, leading by example. None of this BS energy credits, but true conservation, limitation, reduction of energy footprint in a way that would make Gandhi proud. Ask not what your neighbor can do for your country, but what you can do. And just do it!

Walk the walk, tough guys!

Health 101

DocBrain sees red when people blame others for them not taking care of themselves. Except in extreme circumstances where you have no control (ie, in a POW camp), every person has some control and some freedom.

The big things that prevent health problems are well known and there is no logical excuse for not doing them. The excuses are mainly emotional "Its toooo haaaard!" "I can't control myself!" "I know its wrong, but I just can't stop." Pseudorational justifications are just that...pseudorational. "If cigarettes cause lung cancer, how come everyone who smokes doesn't get lung cancer and how come some nonsmokers get lung cancer?" "My aunt Esther smoked 3 packs a day from the age of 12 and lived to be 110."

You don't need to be a rocket scientist, nor even have listened to anything over the past 30 years to know what the serious risks are. They are all just common sense. Just in case you don't know, here are the tried and true things you can do to live longer and healthier.

1. Don't smoke. The surgeon general put that on the packs of tobacco in the 1960's.
2. Keep your weight under control. Being larger than a SUV went out of style when Haystacks Calhoun died!
3. Drink in moderation (10 drinks/week or less). When your mama checked your temperature, she stuck the thermometer in alcohol to kill the germs. Do you really think that alcohol only kills germs? What about liver and brain cells?
4. Get enough sleep, at least 7 hours.
5. Exercise your muscles and your heart with aerobic and resistive exercises
6. Avoid fatty foods
7. Keep your mind active. Read, think, talk, learn.
8. Laugh more than you get angry or cry
9. Wear your seatbelt; drive carefully
10. Don't drink and drive.
11. Don't get too burned by the sun too often
12. For extra credit, get your blood pressure, blood sugar and cholesterol checked.
13. New: cancer screening for colon, prostate, breast, among others.

Actually, thats all. Do that and live long and prosper! All else is just bad luck!

I's been framed!!!

Last week, many House republicans broke party ranks and voted for a flawed medicare bill that would provide physicians with a reprieve of an anticipated 10.6% cut in reimbursement for services. Senate republicans stood firm with the President and voted against this bill. In the final analysis, physicians now have to deal with a major cut in reimbursement at precisely the time that many costs are skyrocketing, including fuel, labor, and insurance. Furthermore, new regulations require more and better documentation that require physician investment in electronic health records and other costly office upgrades.
The average cost of operating a medical practice is between $100-200/hour (all costs, not including physician income, divided by 40 hours/week, 52 weeks/yr). Prior to July 1, Medicare paid on average $130/hour for evaluation and management services. With reimbursement now down to $116, and, after Jan 1, 2009, down to $110, few practices will be able to cover costs while seeing Medicare patients. In markets where other insurers index their coverage to Medicare (some might call this price-fixing), the physician will not be able to offset the loss with income from other patients.
Some physicians will retire. Others will restrict medicare patient visits. Others will create medicare mills, where patients with mild problems are processed rapidly through an impersonal system and complicated cases are referred out or dismissed from the practice. Others will use the visits as loss leaders to fuel diagnostic and therapeutic procedures that will pay well enough to keep the practice profitable. Others will limp on, trying to be healers at work and dealing with poverty at home.
The democrats have positioned themselves as the saviors of physicians, military families and the elderly while republicans have been manipulated into being the party that would rather support an insurance company than physicians and patients. If there ever was a recipe for electorial failure, this is it! The elderly, the military and physicians are generally more conservative than liberal. These groups see themselves has having been dissed by the republicans in the Senate and the White House. The only hope for the Republicans for this fall is to find a way to prevent this cut from going into effect.
Gas prices are beyond any party to control, and the argument will be spun. The war is less of an issue each day. Health care will be handed to the democrats on a silver platter. Swing states with many old people and health care workers (think Florida and Ohio) will go democrat in a big way. Senators such as Arlen Specter and John Cornyn will likely lose their seats. And not because republicans don't care. But because they were outfoxed. Stupid is as stupid does. You can't allow yourself to be framed as uncaring about the elderly and military dependents. The republicans will have to be in a position of defending their position. Nixon said that he was NOT a crook and look where it got him!
If the cuts go into effect, then the republicans will be through for this year, and perhaps for a very long time.

The axis of medical evil

If you are ever injured or ill, what do you want? Perhaps a caring and knowledgable physician; a hospital that is well equipped, well staffed by dedicated nurses, technicians and other employees, and effective and safe medications and devices to help you heal and relieve suffering. If you give a thought to anything else, it would probably be to have insurance that will pay for what you need, government that will not gum up the works, and honest lawyers that will charge a fair fee and will help you get what you deserve, nothing more and nothing less.

Here are the problems as seen by an insider.
1. The cost of running a medical practice has skyrocketed with no increase in reimbursement to keep up with the costs, and in fact, reductions, including a 10.6% medicare cut that went into effect 7/1/08. In order to stay in business, physicians must see more patients to cover expenses.
2. Government regulations impact everything in health care, from the number of hours a week a physician can work to the words the physician must use in your report in order to get paid.
3. Hospitals are inundated with red tape and regulations. The money to pay to comply with the regulations pales in comparison with the money it costs to document compliance.
4. Managed care organizations have managed to take the focus of concern off the patient and on to the organization. It is no longer what the patient and physician agree upon, but what the managed care organization is willing to pay for. As these behemoths of health care battle for patients, spending huge amounts on advertising, political favors, and the like, their subscribees beg for coverage for the most appropriate medications and procedures for their conditions.
5. If something should go wrong and you need to sue a physician or hospital, at a minimum 1/3 of the settlement will go to your attorney. Plus expenses. If the court agrees that you were harmed 1 million dollars worth, you will be lucky to get $600,000. The doctor who screwed up may have been paid as little as $150. The attorney who helped you point that out will get no less than $333,000.
6. Hospitals are loaded with experienced, well educated nurses who... you thought I was going to say "deliver care to you". No. What they do is sit at the nurses station, extract information from the medical records, and call insurance companies each day to beg for one more day of hospitalization for sick patients. On the other end of the phone are insurance representatives, paid by you, whose main job is to say no.
7. Doctors are graded on how promptly they get patients out of the hospital. Previously, they were graded on how well they did in school; how well they diagnosed patients; and how well they did on exams in medical school. It is hard to break old habits, and doctors still want to get a good grade, so sometimes patients are sent home too soon to please their insurance overseers.
8. Information that may help you is kept secret. In one of the most appalling events in health care, the makers of gabapentin were successfully sued for millions for telling doctors that their product was effective for pain control, based upon scientific studies on patients. A few years later, managed care organizations will not pay for the use of FDA approved medications for pain unless gabapentin is tried first. Yes, the same gabapentin, still without FDA approval for pain control.
9. The concept of medicaid has been largely a failure. What you get for free you don't cherish nearly as much as what you pay for. So, those on medicaid do not seek out health care much more than they previously did when charity care was part of the landscape of health care. Now, however, we have a bureaucracy which adds a layer of expense.

The solution is simple. Return health care to a relationship between physicians and patients. Let the hospitals and pharma companies do their thing without so much red tape, regulations, documentation. Let those in health care work with consultants, IT and others to devise better methods of safety and quality control. Set a fixed reimbursement schedule for harm done and focus on correcting the problem so it won't happen again. Managed care organizations should be in the business of paying for what the patient and doctor decide. They should be a source of information about what does and doesn't work, based on their data. Information that may impact medical decisions should be as available as an internet connection, to assist physicians in their decision making process. And payment for health care providers should reflect the reality of the world, the expenses of running a small business, and the relative value one places on having the brightest and best there 24/7/365 for each of us. And, bring back charity care. Doctors, hospitals and pharma would love it. All we need is a more reasonable reimbursement by those who can pay us.