Fire Hydrant of Freedom

The only thing I remember about this when I was somewhere around the age of seven was my sister hogging the TV and sitting Indian style (I hope I didn't offend anyone) in front of our little black and white TV with the antennae (no remote back then) and giddily screaming and screeching over these guys.  I couldn't figure it out. 

It was as though she was possessed.    My oldest sister felt that way about Elvis I think.

http://news.yahoo.com/ed-sullivan-beatles-39-item-headed-nyc-auction-051556647.html

"When I wrote Brave New War back in 2006, I made this aggressive projection on how rapid technological change would change warfare:

    The threshold necessary for small groups to conduct global warfare has finally been breached, and we are only starting to feel its effects.  Over time, in as little as perhaps twenty years and as the leverage of technology increases, this threshold will finally reach its culmination — with the ability of one man to declare war on the world and win."

This is only true because the US military and/or the politicians have decided that conducting war in the modern era is a police action.  We could easily wipe out Irans nuclear facilities.  We choose not to.  We could easily put away that guy in N Korea - we choose not to.

As for Iraq and Syria etc.  They are not really enemies of the US but if they were we make them into parking lots.

We are too kind.

We only had 3 million illegals now there are probably more than five times that.

"The America of Carter was a desperate place too, yet Reagan spoke of opportunity, growth, and how to get there."

Don't kid yourself.  The Clintons will use the same lines. 

So did and does the Brock.  And he won twice.

http://freebeacon.com/report-4-in-10-government-security-breaches-go-undetected/

Yet rep King asks who can show one shred of proof of NSA abuse.  Then I asked oh really?  How would any average person know?  How could any average person do anything about it?

Even the government doesn't even know when they are hacked.  So how the hell would we know?

And we have the FBI telling us the mafia is broken.  What a laugh.  Organized crime is bigger and more invisible then ever.

Until this country wakes up and realizes the terrorism is not just clowns with bombs (including you google facebook and the rest) then we are all screwed.

Yep.  Just when they are achieving success the African Americans are seemingly unwittingly giving their country away to the world.  Some I know from personal talks  do see this but....   

   
******INVASION USA

Republicans to rescue Dems, betray the nation

Thomas Sowell likens illegal aliens to embezzlers or burglars 'living in the shadows'
      
Thomas Sowell is a senior fellow at the Hoover Institution in Stanford, Calif. He is the author of 28 books, including "Dismantling America" and "Basic Economics: A Common Sense Guide to the Economy."   

Some supporters of President Obama may be worried about how he and the Democrats are going to fare politically, as the problems of Obamacare continue to escalate and it looks like the Republicans have a chance to win a majority in the Senate.

But Democrats may not need to worry so much. Republicans may once again come to the rescue of the Democrats, by discrediting themselves and snatching defeat from the very jaws of victory.

The latest bright idea among Republicans inside the Beltway is a new version of amnesty that is virtually certain to lose votes among the Republican base and is unlikely to gain many votes among the Hispanics the Republican leadership is courting.

One of the enduring political mysteries is how the Republicans can be so successful in winning governorships and control of state legislatures, while failing to make much headway in Washington. Maybe there are just too many clever GOP consultants inside the Beltway.

When it comes to national elections, just what principles do the Republicans stand for? It is hard to think of any, other than their hoping to win elections by converting themselves into Democrats lite. But voters who want what the Democrats offer can vote for the real thing, rather than Johnny-come-lately imitations.

Listening to discussions of immigration laws and proposals to reform them is like listening to something out of “Alice in Wonderland.”

Immigration laws are the only laws that are discussed in terms of how to help people who break them. One of the big problems that those who are pushing “comprehensive immigration reform” want solved is how to help people who came here illegally and are now “living in the shadows” as a result.

Is liberty on life support for good? There is hope … read Manny Edwards’ book “The Truth About Liberty: How the Tea Party Can Save America”

What about embezzlers or burglars who are “living in the shadows” in fear that someone will discover their crimes? Why not “reform” the laws against embezzlement or burglary, so that such people can also come out of the shadows?

Almost everyone seems to think that we need to solve the problem of the children of illegal immigrants, because these children are here “through no fault of their own.” Do people who say that have any idea how many millions of children are living in dire poverty in India, Africa or other places “through no fault of their own,” and would be better off living in the United States?

Do all children have some inherent right to live in America if they have done nothing wrong? If not, then why should the children of illegal immigrants have such a right?

More fundamentally, why do the American people not have a right to the protection that immigration laws provide people in other countries around the world – including Mexico, where illegal immigrants from other countries get no such special treatment as Mexico and its American supporters are demanding for illegal immigrants in the United States?

The very phrase “comprehensive” immigration reform is part of the bad faith that has surrounded immigration issues for decades. What “comprehensive” reform means is that border control and amnesty should be voted on together in Congress.

Why? Because that would be politically convenient for members of Congress, who like to be on both sides of issues, so as to minimize the backlash from the voting public. But what “comprehensive” immigration reform has always meant in practice is amnesty up front and a promise to control the border later – promises that have never been kept.

The new Republican proposal is to have some border-control criteria whose fulfillment will automatically serve as a “trigger” to let the legalizing of illegal immigrants proceed. But why set up some automatic triggering device to signal that the borders are secure, when the Obama administration is virtually guaranteed to game the system, so that amnesty can proceed?

What in the world is wrong with Congress taking up border security first, as a separate issue, and later taking responsibility in a congressional vote on whether the border has become secure? Congress at least should come out of the shadows.

The Republican plan for granting legalization up front, while withholding citizenship, is too clever by half. It is like saying that you can slide halfway down a slippery slope.

Republicans may yet rescue the Democrats, while demoralizing their own supporters and utterly failing the country.

 

Read more at http://www.wnd.com/2014/02/republicans-to-rescue-dems-betray-the-nation/#s4jLsSpXbDdKLpGJ.99

Woman On The Rebound Wants Back In Ex's Court
.
By Abigail Van Buren 10 hours ago Dear Abby
 
     
DEAR ABBY: After a two-year relationship ended, I got pregnant on the rebound. I called my ex and told him I was having a baby with another man because I wanted to hurt him. Apparently it worked -- at least that's what his best friend told me.

Now that a few months have passed, I ran into him and all those loving feelings I had for him came rushing back. Should I tell him? The father of this baby is a good-for-nothing deadbeat. He wants to be father-of-the-year without helping me financially.

What should I do about my feelings for my ex, and what should I do about the father of my baby? -- CAN'T DECIDE IN NEW JERSEY

DEAR CAN'T DECIDE: It is time for you to grow up and accept responsibility for the situation you're in right now. Your behavior has been immature and irresponsible. The child you're carrying is going to need someone who can provide for him or her financially and emotionally.

Because you have feelings for your ex, contact him and let him know, but don't count on him wanting to reconcile. Then you should also contact a lawyer about ensuring that "Babydaddy" lives up to his financial responsibilities.

And in the future, when you decide to have sex with someone, recognize there could be consequences and use birth control. Every time!

"Don't think Hillary will try to have it both ways.  She will position herself as a champion to all these interest groups while trying to distance herself from the Brock as someone who is a champion for America."

I meant don't think Hillary will *not* try to have it both ways.  I can see her outrunning the stupid ass Republicans even now.  The repubs will be claiming her policies will be a threat to America.   She will be way ahead of them and play she is the champion of American not this globalization thing.  But a version of  American that plays into all the lefts identity politics thing where women of people of color sexual orientation, religion can have equal opportunity etc., etc.   

She will outrun the Republicans.  The repubs always play chess with the Clintons one step behind.  They will criticize them for something and the next day the Clintons have their media machine out in public twisting it all around to negate or neutralize the opposition.  And the adoring media allows them to do this.  And the Repubs just look stupid.

We right just doesn't have the wise political strategists the left does. 

I can already see the RNC failing to really prepare for this. 

Folks it is hopeless unless some unexpected event occurs to change the dynamic.

And Christie was never the answer.   We don't have one so far. 

Thank you BBG.

This clarifies my latest confusion about the right's claims temperatures in the US fall but the left's claims global temps are nearly highest recorded.
Like I have questioned before I don't know what to think or believe because we are rarely getting unbiased balanced views.  This article indeed does address this:

*******Global Temperatures

And we’d be remiss not to review the global temperature for 2013.

The liberal-leaning press reports the 2013 global temperature as the seventh (or fourth) highest on record, while the conservative-leaning press reports it as another year in which the global temperature has refused to rise (Figure 4).



Figure 4. TOP: Annual global surface temperature history, 1880-2013, as compiled by NOAA (blue) and NASA (red) (figure source, NOAA/NASA Joint Briefing). BOTTOM: Monthly global surface temperature anomalies, 1997-2013 (source: U.K. Hadley Center).

But all can agree that the temperatures in 2013 further extended the “pause” in the global surface temperature record-which now stands at some 17 years. A lot of people are at work trying to explain what’s behind the “pause,” but no matter the cause the longer that it continues, the further from reality climate model projections become (Figure 5).



Figure 5. Observed (blue) and projected (red) temperatures, 1980-2013. The projected temperatures are the annual mean of 106 climate runs (data source, Climate Explorer).

The most viable explanation that ties everything together is that the climate sensitivity-that is, how much the earth will warm in response to a doubling of the effective carbon dioxide concentration-is much larger in the climate models than it is in reality.

If this is indeed the case, and there is plenty of evidence to suggest that it is, than the urgency to “do something” about climate change is reduced and so too the level of support for federal regulations aimed at limiting carbon dioxide and thus limiting our energy choices.*******

I would be curious to also find out if the hospitals that encouraged admission to be able to bill also encourages rapid as possible discharge to avoid accumulating costs vs. the fixed reimbursements.  The latter happens all the time not always unethical or wrong but the other end of the same coin I guess:

******Suits: How a Hospital Chain Schemed to Boost Profits

'NYT' looks at lawsuits against Health Management Associates

By Arden Dier,  Newser Staff

Posted Jan 24, 2014 9:41 AM CST

 (Newser)  – The New York Times today takes a look at whistle-blower lawsuits claiming for-profit hospital chain Health Management Associates employed a strategy to up admission—whether or not patients needed care—in order to boost Medicare and Medicaid payments. The paper shares one tactic, in which ER scorecards were posted daily, showing doctors who met an admission target in green. Doctors who were close to the figure were in yellow, and failing doctors in red. That target? Admitting at least half of patients over 65 who visited the emergency room. In another case, a baby was admitted with a "fever" despite a normal temperature of 98.7 degrees.

When the CEO of an HMA-owned North Carolina hospital reported that his doctors wouldn't go along with the revenue-boosting policies, former HMA chief exec Gary Newsome—who made $22 million in three years—allegedly replied, "Do it anyway." Threats and financial incentives were also allegedly used, while execs who questioned the policies were often fired and reports on admission rates were burned, the Times adds. So far eight whistle-blower lawsuits have been filed against HMA in six states; last month, the Justice Department joined in, but one expert says typical penalties number in the 8-figure-range—pennies compared to the profits. She predicts it would take a settlement of at least $500 million to make an impact. To wit, the Times reports that when HMA revealed the DOJ was stepping into the lawsuits, its stock hardly moved.*****

***What Dr. Samadi fails to say is that only 1 in 36 men actually die of it****  Please see yahoo post response to this article included below.  Autopsy studies suggest that 75% of men have microscopic prostate cancer in their gland when they died.  Proportionately few will even know much less even die of it.  Not to say prostate cancer can be ignored - 25 000 die of it every year in the US.  So it is very serious.  I don't like this guy promoting a procedure he and probably the institution he works with both making a mint from this touting it as the greatest thing since sliced bread.  We see this a lot in the medical field.  Conflict of interests are Everywhere.  And they are not readily reported as pretended by publications like the New England Journal of Medicine.  That is not to say there are not very ethical men and women who ARE doing the best they can for humanity and if they can make money from it that is fine.  But I am very skeptical this guy is one of them.

******For Prostate Cancer, Radiation Complications May Outweigh Risks

LiveScience.com
By Dr. David Samadi, Lenox Hill Hospital in New York City January 31, 2014 7:36 PM
   
Dr. David Samadi is the chairman of urology and chief of robotic surgery at Lenox Hill Hospital in New York City and is a board-certified urologist and oncologist specializing in the diagnosis and treatment of urologic diseases, kidney cancer, bladder cancer and prostate cancer. Samadi also specializes in many advanced, minimally invasive treatments for prostate cancer; is one of the few urologic surgeons in the United States trained in oncology, open-, laparoscopic- and robotic-surgery; and was the first surgeon in the nation to successfully perform a robotic surgery redo. He contributed this article to LiveScience's Expert Voices: Op-Ed & Insights.

Radiation for prostate cancer has shown once again that it leads to more complications than surgery. For men with prostate cancer, deciding whether to opt for radiation or surgical removal of the gland can be overwhelming. How does one decide with the risks, such as the unpleasant side-effects of erectile dysfunction and incontinence?

Prostate cancer is the second most common malignancy, second only to skin cancer. Unfortunately, doctors diagnose more than 240,000 men in the United States with the disease every year, which translates into 1 in every 6 men being affected by prostate cancer. A new study published last Thursday in the Lancet Oncology Journal found that "men treated with radiotherapy had fewer minimally invasive urological procedures compared to those who chose surgery." However, over time, "the radiation group had a higher proportion of hospital admissions, rectal or anal procedures, related surgeries and secondary cancers."

Men need to take the time to do their research on how "radiation" really works and what side effects they will have to live with. There are two kinds of radiation, external beam and brachytherapy, which involves radioactive material inside the prostate. We as men have all the control in the world to decide what form of treatment is best for us. Do you just want a quick fix that will sometimes show you upfront results from radiation, but will cause you to suffer from side effects in the long run or would you rather choose robotic prostatectomy with minimal bleeding, 95 percent to 97 percent continence rate, and an overall better quality of life? Put aside the temporary leakage and erectile dysfunction that you may receive from robotic prostatectomy, because a year from your surgery those minimal side effects will dissipate.

The questions I suggest my patients ask themselves are:
Do you want to be admitted to the hospital more frequently?
Do you want to likely bleed from your bladder or rectum?
Do you want to risk a second cancer?

This can be the reality for patients who undergo radiation treatments and how it can decrease your confidence and overall quality of life. In the recent study, radiotherapy complication rates were 2- to 10-times higher than complication rates in men who were treated with robotic prostatectomy. Choosing surgery after radiation makes the surgery more complicated. Radiation destroys the surrounding healthy tissue causing the prostate to be embedded in scar tissue. This makes the surgery more complex than operating on tissue that has not been affected by radiation.

Once the prostate is removed, surgeons like myself monitor the prostate-specific antigen (PSA) levels to ensure that the cancer doesn't come back. If radiotherapy is performed prior to the surgery, the PSA will fluctuate due to radiotherapy and pieces of the prostate that are left behind, confusing that monitoring process.

Following a prostate cancer diagnosis, men are flooded with tons of informationand must try to make sense of the different treatment options — it can make even the most educated patient uncertain. [Prostate Cancer Screening Test May Prevent 17,000 Advanced Cases Yearly]

Do your homework and really look at the outcomes one month to one year to a lifetime from now and ask yourself: "Will I be happy with these results?" As the numbers point to robotic prostatectomy, the decision lies in your hands.*****

___________________________________
A very good reply from someone in the same specialty who has no financial conflict of interests very unlike this Fox news guy who for quite sometime now has lost my respect as not much more than a self serving charlatan:

****This is a very self-serving & misleading piece of pro-surgery propaganda. Full disclosure: I'm a retired urologist who practiced 20 years privately and was also a clinical prof. at the local medical school. The first item is that the DaVinci robot is currently under multiple suits over its design and propensity to cause serious injuries at surgery leading to major complications, reoperations, permanent urinary incontinence, permanent impotence (erectile dysfunction), and death. It is true that radiation therapy (XRT) has a higher incidence of 'radiation proctitis' (inflammation & bleeding of & from the rectal blood vessels)... since surgical prostatectomy, done correctly, doesn't affect the rectum, that's not surprising since radiation is less precise; although brachytherapy ('seeds') has a far lower incidence. It is also important to understand that all urologists have a vested interest in treating prostate cancer aggressively since the advent of effective medical treatment for benign enlargement of the prostate ('BPH') has rendered the prior 'bread & butter' operation for it (TURP) infrequent. What Dr. Samadi does by waving the scare statistic of 1 in 6 men getting prostate cancer (ACP) is to try and create a stampede of fearful men seeking any means of not dying of prostate cancer. What Dr. Samadi fails to say is that only 1 in 36 men actually die of it (Google: What are the key statistics about prostate cancer?) and that dying of ACP is more a function of the aggressiveness of the cancer than of its treatment - that is; men with aggressive prostate cancers die of it more often than men with less aggressive tumors regardless of how early it's detected or how it's treated. Lastly, the vast majority of men's prostate cancers are detected within the last decade or two of their lives and, if followed until evidence of local growth is note, and XRT given then (followed by hormonal therapy for those rare progressions after XRT) most can live very comfortably and without complications of treatment until their other disease processes take them away... and in my book, even if there's evidence of active prostate cancer, that's effectively a 'cure'.


.
Expand Replies (1)  Reply 

Though they try Fox cable and talk radio simply cannot balance the liberal media bias.

I think it clear Christie knew of the bridge closings.  I do believe there is a chance he may have been told the reason was for a "traffic study" and did not know the real reason for the closing, but on the face of it, is certainly stretches reasonable credibility. 

As one who "leans Republican", though I no longer call myself one, I certainly do find it disheartening how the national candidate Democrats always seem to slip out of any SIMILAR scrutiny when they are caught red handed.  Even OBVIOUS lying before an election does not bring the same media outrage.  A simple stupid email is all it takes it appears to bring someone down but months of making up fabricated stories and lies and obvious cover-ups means nothing.   
The left controls 90% of the media. 

And most people either don't keep up with the news, don't care or just want the paychecks I guess.  It really is astonishing when we see the occasional reporter going onto the street and asking random people what they think about certain current events or history etc and not only do they not have a clue they make up answers.  To think people like this vote.....

It really is who controls the hearts and minds (and pocketbooks) of many of the people that makes all the difference.   No Republican is on the national scene as yet who can do this.  Walker sounded good.   The Ex Senator from Mass. who lost to Warren was good a few night ago.  I agree with Crafty Huckabee is worth another look.  Walker from Wisconsin was good recently.  Maybe Jindal?  My nephew works very closely with him.


*****Christie going on offensive about accusation
Associated Press
By ANGELA DELLI SANTI and PHILIP ELLIOTT 16 hours ago
     
TRENTON, N.J. (AP) — New Jersey Gov. Chris Christie is going on the offensive after a former loyalist said he has evidence the Republican governor knew more than he has admitted about an apparently politically motivated traffic jam ordered by one of his staffers last year.

GOP ponders scandal's toll on Christie's future Associated Press
NJ Democrats combine traffic jam probes Associated Press
Lawyer: Evidence contradicts Christie on closures Associated Press
Lawyer: NJ probe of Christie office can proceed Associated Press
10 things you need to know today: February 1, 2014 The Week (RSS)

The governor's political team sent an email Saturday to donors, along with columnists and pundits who might be in a position to defend Christie, bashing the man Christie put in a top post at the Port Authority of New York and New Jersey and the accusations the man's lawyer made in a letter Friday.

The email says the former Port Authority official, David Wildstein, "will do and say anything to save David Wildstein."

The action from Christie's supporters comes as Republicans are debating the implications of the scandal that this year has surrounded the administration of the possible 2016 presidential contender. It was sent at a moment when Christie is in the spotlight with his state hosting Sunday's Super Bowl.

Christie's team criticizes the initial report Friday about lawyer Alan Zegas' letter as "sloppy reporting," noting that Wildstein did not present any proof to back up the claims that his lawyer made. The note also denies that Christie knew about the traffic jam or its political motive until after it was over and bashes Wildstein on a variety of fronts, characterizing him as a litigious teenager, a controversial mayor and for his past career as an anonymous political blogger.

The email, headlined "5 Things You Should Know about the Bombshell That's Not a Bombshell" was obtained by The Associated Press and confirmed by Christie's office. It was first reported by Politico.

A lawyer for Wildstein, who was the first of four people with Christie connections to lose a job because of the scandal, did not immediately respond to emails from The Associated Press on Saturday.

The implications of the scandal for Christie have become a source of debate not just for Democrats but also for Republicans.

Some said the accusations could derail hopes of Christie running for president if he can't shake the scandal soon, while others were quick to express faith in the governor while discrediting his accuser and questioning his motives.

"It's not good for him," said Matt Beynon, a Republican operative who worked on former Sen. Rick Santorum's 2012 presidential campaign and still has him as a client. "The longer the story goes on, the worse it gets for him. If this is still an issue a year from now, he's going to have trouble pulling the trigger. ... Gov. Christie will have to think long and hard about running."

But Ken Langone, a co-founder of Atlanta-based Home Depot Inc. and a staunch Christie supporter, expressed no such reservations.

"I have complete faith and trust that the governor is telling the truth, and I continue to believe that he would be a superb president if he were elected in the future," Langone said.

Matt Mackowiak, a Texas-based Republican consultant, agreed that Christie's chances on a national stage won't be harmed so long as he has been honest about what he knew.

"As long as he was telling the truth, he is fine," Mackowiak said. "But if he knew about this, it brings him in directly and adds — potentially — dishonesty to the charges."

Christie, who has kept mostly to the sidelines during the run-up to this year's Super Bowl, which his state is hosting, received a smattering of boos and some cheers during a pre-game ceremony in New York on Saturday. He didn't appear affected by the crowd's reaction during the Times Square ceremony.

As the new head of the Republican Governors Association, Christie's priority this year is raising money for the party's gubernatorial candidates around the country. Republicans maintain that donors are staying loyal to Christie so far.

"My donors are saying they believe what Gov. Christie is saying. They're giving him a lot of rope," said Ray Washburne, who leads the Republican National Committee's fundraising effort.

"He's not raising money for himself," Beynon added. "If you're a donor in Cleveland, you're thinking about (Ohio Gov.) John Kasich and not Chris Christie."

Also Saturday, the lawyer for a state legislative panel investigating the traffic jams said he was confident the probe can continue without impeding a federal criminal investigation.

Reid Schar, special counsel to the panel, said he had discussed the parallel probes with officials from the U.S. Attorney's office Friday and said the committee "would be mindful" not to interfere with the ongoing criminal investigation.

The lawmaker who chairs that panel said Wildstein's new allegations validate the skepticism committee members have expressed throughout the probe, an investigation Christie once referred to as the Democrats' obsession and some state Republicans have called "a witch hunt."

This is interesting as I had patients coming in reporting they did not want drugs I prescribed because they were too expensive.  I was shocked since these were drugs that should have been quite inexpensive. 

Now I connect the dots.

Thanks again Brock and your liberal revolutionaries:

http://www.breitbart.com/Big-Government/2014/01/31/Why-Are-Costs-For-Generic-Medications-Soaring

What a great well meaning guy he is.....

The person who asked me thought something was pressuring Beck.  Like the IRS, he was caught with a hooker, smoking something, I dunno.

I guess he was suspicious that the left was had something on him.  It really is remarkable how we keep seeing those who go after Obama being targeted.

The pattern is obvious.   

One politburo member's answer. 

****Why Does Health Care Cost so Much in America? Ask Harvard’s David Cutler

BY Paul Solman  November 19, 2013 at 5:23 PM EST

By David Cutler

The American health care system is structured differently from systems in other countries, making it more expensive. Photo courtesy of Joe Raedle/Getty Images.

Paul Solman: Harvard’s David Cutler is among the country’s foremost health economists, famous for — among other research — a controversial paper arguing that even our exorbitant health care industry, in terms of increased productivity and life span outcomes, delivers more than what we pay for it.

Cutler, who was profiled by Roger Lowenstein in the New York Times Magazine in 2005, subsequently worked for President Barack Obama on health care issues, and talked to us recently for a story about cost savings. But far more of what he had to say seemed worthwhile than what we have time to air. Here is some of it.

Paul Solman: Why does health care cost so much in America?

David Cutler: Let me give you three reasons why. The first one is because the administrative costs of running our health care system are astronomical. About one quarter of health care cost is associated with administration, which is far higher than in any other country.

Paul Solman: What’s the next highest?



MORE FROM THE BUSINESS DESK:

Harvard’s David Cutler on How to Cut Health Care Costs


David Cutler: About 10, 15 percent. Just to give you one example, Duke University Hospital has 900 hospital beds and 1,300 billing clerks. The typical Canadian hospital has a handful of billing clerks. Single-payer systems have fewer administrative needs. That’s not to say they’re better, but that’s just on one dimension that they clearly cost less. What a lot of those people are doing in America is they are figuring out how to bill different insurers for different systems, figuring out how to collect money from people, all of that sort of stuff.

The second reason health care costs so much in America is that the U.S. spends more than other countries do on many of the same things. Drugs are the most commonly noted item, where a branded drug will cost much more in the U.S. than in other countries. But, for example, doctors also earn more for doing the same thing in the U.S. than they do in other countries, and a lot of suppliers charge more for things like durable medical equipment in the U.S. than in other countries.

Paul Solman: And that’s not only doctors being paid more in this country, but the United States making the decision as a government not to buy drugs in bulk and therefore to bid down the price that pharmaceutical companies can charge.

David Cutler: The lowest prices for pharmaceuticals, and a variety of other medical devices and payments to physicians, are in government plans. So Medicaid gets the best prices on pharmaceuticals. In terms of physician payments, Medicaid payments are the lowest. Medicare payments are above that and private payments are above that. The more leverage the buyer has, the lower the price they get. That’s true in every industry. In health care, the United States doesn’t utilize that leverage as much as other countries do.

Paul Solman: Okay, so that’s two and what’s the third reason?

David Cutler: The third one is Americans receive more medical care than people do in other countries, not so much in terms of doctor visits, but if a person has a heart attack in the United States, they’re much more likely to get open heart surgery than they are in most other countries.

Go back to Canada. In all of Ontario there are 11 hospitals that can do open heart surgery. Pennsylvania has roughly the population of Ontario and it has a bit over 60 hospitals that can do open heart surgery. So there’s no way you can operate on as many people in Ontario as you can in Pennsylvania even if you operated around the clock.

Paul Solman: But that means that the people in Canada or in Ontario have to wait longer right?

David Cutler: Sometimes they wait longer. What’s much more common is that there’s a lot of gray area where it’s not clear if you need the open heart surgery or not, and in the U.S., people will get it and in Canada, they don’t. The interesting thing about it is that life expectancy or one-year mortality after a heart attack is the same in the two countries.


Is The Rise of Costs Inevitable?


Paul Solman: Are medical costs going to inevitably go up because there will always be new technologies and new technologies are always expensive?

David Cutler: Technology is the underlying driver and there will always be some of that, which is why health care will not be like other industries in terms of always, always going down in price.

On the other hand, there’s so much waste in the system — our best guess is that about a third of medical spending is not associated with improved outcomes — that for the next 15 to 20 years people believe that costs could be stable or falling as a share of the economy without cutting into necessary services — just by eliminating the things that are not necessary…

What we’ve done in Massachusetts is we’ve said, don’t just give people very high cost-sharing in general; do what’s called tiering it — that is, tell people that if you look for basic levels of care, you’re not going to face very high costs, but if you want to go to the teaching hospital for the routine procedure, you’re going to have to pay a lot for that. And we mandate that insurance companies have to tell people the price of any service. So if your doctor says you need an MRI, you can go on the computer and your insurance company’s website and figure out exactly your cost sharing at each place where they would do the MRI.

Paul Solman: So that will provide comparison shopping.

David Cutler: That’s on the demand side. Give people more skin in the game and give them the information so they can do real shopping.

Paul Solman: More skin in the game, meaning higher co-pays?

David Cutler: Higher co-pays. We know that people respond to co-payments and they like cheaper care. So the hope is to steer people to less expensive sites. We’ve also pushed very strongly that insurance payments to doctors and hospitals and other care providers not be based on volume (so-called “fee for service”), but instead be value-based payments.

So say, here’s a person with coronary artery disease. Pay a fixed amount for that person and let the medical professionals figure out how to treat that person, not with the incentive to do more and earn more, but with the incentive to figure out how to do what’s right and keep them from using very expensive services.

Paul Solman: But doesn’t that provide an incentive or a prod to the provider to stint on the services, stint on the MRI, say, that I might otherwise get?

David Cutler: What that’s being coupled with is a very aggressive approach to measuring quality. … Really what we’re doing is two things: one is on the demand side trying to make people smarter consumers, and the second is on the provider side, eliminating the monetary incentives to do more testing and procedures. Instead, let’s move to a system that says, “do what’s appropriate, make the patients better and you’ll get rewarded for it.”


What If I Want a Certain Procedure?


Paul Solman: Well it sounds ideal, but I just keep thinking that I’d want to go to the dermatologist every six months, say, just to check out every possible discoloration. I’m a little crazy that way, but also, I feel, maximally prudent.

David Cutler: A lot of provider organizations are putting the doctors on a salary basis. Let’s gather our doctors together to figure out what the evidence says is right. If the literature is clear, let’s make sure we do that 100 percent of the time. If the literature is not clear, let’s go through our records and see how we can do better. If the patient then wants more, then say, “Okay, fine, you can have that, but you’re going to pay a little more because that’s not what the literature says is necessary in your case.”

Paul Solman: Well, of course, presumably my insurance company is already trying to do that.

David Cutler: Typically they’re very bad at it though, and when they tell the doctors they’ve imposed this, it goes poorly.

Paul Solman: So right now, I go to a dermatologist on a regular basis — I’ve always had some skin difficulties, but I’ve never had a melanoma — and that’s covered by my insurance. You’re saying, hey, if I’m a little paranoid with regard to discolorations, fine, let me go, but then I ought to pay to do that?

David Cutler: Increasingly, I believe insurers will make you pay more for care that you want to do that’s not medically necessary.

Paul Solman: Well medically necessary by what standards?

David Cutler: Care that’s ordered; that’s not following some accepted standard. You see this in certain parts of the country where the insurers say, “We’ll pay only a fixed amount for a knee replacement. We’ve determined that high quality knee replacement can be had for $8,000 nearby you. So we’ll give you $8,000. Now if you want to go to someone else who charges $20,000, fine, but you’re gonna pay the extra $12,000.”

Paul Solman: And my insurer did that recently with regard to a bronchial inhaler and said, “No, you can’t get that one; you can only get this cheaper one.”

David Cutler: Exactly, it’s what they’ve been doing with drugs for quite a long time. The generic version is very cheap; the branded drug is much more expensive.

In a lot of parts of the country, they’re just saying, “Look, if you want this service at all, you’re going to pay a lot of money.” The trend in health care nationally is to put more and more on the patient.****

GM,

Yes the economy is improving for the few, and not the wealthy.  Like Forbes said, my father taught me one can make far more money recommending stocks than investing in them.  Wesbury knows he can make far more money giving advice than following it.

In health care the big businesses are getting wealthy.  There is huge consolidation, huge squeezing of smaller guys and increased demands on all the workers.  I believe it is the same every other segments of the economy.  I don't recall in my lifetime seeing the gap from the very rich to the vast majority of Americans expanding any faster as it has under this President.

Yet the Republicans seem totally unable to articulate any consistent messages to reach those same "vast majority of Americans".   The ineptitude of the Republican leadership (in what is not any longer my party) is breathtaking.

I have no motivation to vote.  Why bother?  Should I vote for the big government Republican or the outright liberal?  Little difference.  They are all giving the citizens country away.

Victor David Hanson was on Marc Levin last PM.  He more or less agreed the immigration cave in is quite likely the end of the ball game for America as we knew it.  He doesn't understand why Republicans cannot reach out to the  majority of citizens and connect. 

All I can say is many talk show hosts blow away any political articulators in the repub leadership.

As of now I will stay home and not vote period.  I didn't bother to vote for Christie either.  I don't like him and he has done nothing for me or the bill payers in NJ - nothing.

http://www.indianchild.com/mahatma_gandhi.htm

Now near $1200.   I wonder if even one person bought then and still owns now?   Lets see $1000 then now ~ $775,000 now.   The dreams stock markets are made of:

http://finance.yahoo.com/echarts?s=PCLN+Interactive#symbol=pcln;range=my;compare=;indicator=volume;charttype=area;crosshair=on;ohlcvalues=0;logscale=off;source=;

From drudge but I think he is right.  Immigration leniency is bad for American workers.  Look we can always scour the world and find people who will do any work whatsoever for less than someone who is already here.  Allow them in by the tens of millions and at the same time raise the minimum wage.  It is all crazy.

****Sessions Warns House GOP: Immigration Bill Is Bad Politics, Bad Policy

Offers a better way forward.

11:18 AM, Jan 29, 2014 • By DANIEL HALPER

Yesterday afternoon, before President Obama's State of the Union Address, Senator Jeff Sessions' staff hand-delivered to each Republican member of the House an important memo on the so-called immigration reform bill being debated on Capital Hill. The 3-page document, written by Sessions, argues that pushing the current immigration legislation forward is bad politics, bad policy, and that there's a better way for Republicans.

Sessions believes House Republicans are at risk of falling into President Obama's trap. "[A]ccording to news reports, House Republican leaders are instead turning 2014 into a headlong rush towards Gang-of-Eight style 'immigration reform,'" writes Sessions. "They are reportedly drafting an immigration plan that is uncomfortably similar to a 'piecemeal' repackaging of the disastrous Senate plan—and even privately negotiating a final package with Democrat activists before consulting with their own members."

It's bad politics, Sessions writes. "In the rush to pass an immigration bill, there has been a near absence of any serious thought about the conditions facing American workers. The last 40 years has been a period of record immigration to the U.S., with the last 10 years seeing more new arrivals than any prior 10- year period in history. This trend has coincided with wage stagnation, enormous growth in welfare programs, and a shrinking workforce participation rate. A sensible, conservative approach would focus on lifting those living here today, both immigrant and native-born, out of poverty and into the middle class—before doubling or tripling the level of immigration into the U.S.

   
 
 

 

"Anyone think this wasn't the plan all along?"

Bush was hamstrung in Iraq and Afghanistan.  I don't guess (because I really don't know) that he would have allowed this otherwise.  I certainly don't thing Rumsfeld or Cheney would have.  I admit myself I didn't see this back in '03.  I was for bombing Iraq and now I admit it was a mistake though all those horror stories coming out of Saddam's tortured country were hard to read and think how can we just sit here and allow this to continue.  Yet after all America has done for Iraq the killing still goes on and Iran was unchecked.  We should have been bombing Iran's nuclear facilities all along IMHO.  Now while still not too late, there is no will.

As for Obama he certainly couldn't care less about Israel or Jews.  The American military does seem to have concluded 'containment' is better than pre-emptive attacks fro some years now.

Any talk of "military action is still on the table" was and has been just PR crap.  It never was "on the table".  Obviously Iran's leaders saw through this for the past decade.

Israel has been suckered.  I guess we can only hope for an outcome similar to the Cold war.

 

Many chronically ill Americans unable to afford food, medicine

Reuters
By Allison Bond 42 minutes ago

NEW YORK (Reuters Health) - One in three Americans with a chronic disease such as diabetes, arthritis or high blood pressure has difficulty paying for food, medications or both, according to a new study.

People who had trouble affording food were four times more likely to skip some of their medications due to cost than those who got plenty to eat, researchers found.

"This leads to an obvious tension between 'milk' or 'med,'" said Dr. Niteesh Choudhry, who worked on the study at Brigham and Women's Hospital in Boston. "If you have a fixed income, should you treat or should you eat?"

The findings are based on data collected by the 2011 National Health Interview Survey, a questionnaire that offers a snapshot of the U.S. population as a whole. Nearly 10,000 people age 20 and up filled out the survey and reported having one or more chronic illnesses like cancer, asthma, emphysema or a psychiatric illness.

Among those participants, 23 percent took their medication less often than prescribed because of the cost, 19 percent reported difficulty affording food and 11 percent said they were having trouble paying for both food and medications. In the end, about one in three had trouble affording food, medication or both.

These rates are high but are similar to figures found in previous studies, said lead author Dr. Seth Berkowitz, from Massachusetts General Hospital in Boston.

Yet the link between difficulty paying for food and for medications is a novel one.

"The idea of tradeoffs that people might make (between buying medications or food) is something we haven't seen before," said Berkowitz.

The researchers also found that patients who had difficulty paying for both food and meds were 58 percent more likely to be Hispanic or African American.

With each additional chronic illness the patients reported, their risk of having a tough time affording those items went up by 56 percent, according to the findings published in The American Journal of Medicine.

Finally, people having trouble affording medications and food were 30 percent less likely to have public, non-Medicare insurance like Medicaid, and about 60 percent less likely to participate in the Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC. This program provides supplemental food and healthcare referrals for certain women and children up to age five.

By removing some of the financial pressure from people struggling to afford food, assistance programs like WIC may also help them afford their medications, Berkowitz said.

For that reason, for people struggling to pay for either food or medications, the authors recommend looking into eligibility for food assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP) and WIC, along with community support services like food banks.

When it comes to medications, there may be cheaper alternatives or assistance programs for the medication a patient is already taking.

"The most important thing people can do is talk with their doctors about it," said Berkowitz.

It's also important for people to be honest with their doctor if they are unable to afford enough food, since that may affect which medications and dosages are best.

"If you are eating very irregularly, a medication that might be perfectly safe when you are eating regularly could cause low blood sugar," or other complications, Berkowitz told Reuters Health.

If patients don't bring up the fact that they are struggling to afford medications or food, Berkowitz said, the doctor won't know to adjust medications accordingly.

He said people should "not be embarrassed or ashamed" to bring up the topic with their doctor.

SOURCE: bit.ly/1evzX7V The American Journal of Medicine, online January 21, 2014.*****

*****""This leads to an obvious tension between 'milk' or 'med,'"  Only a liberal could say this. 

""The most important thing people can do is talk with their doctors about it,"

Is this guy putting me on.  Patients have always complained when they can't afford health care.

""The idea of tradeoffs that people might make (between buying medications or food) is something we haven't seen before," said Berkowitz."

How old is this fool.   This has always been the case.  How about people who always seem to afford cigarettes or booze when they want to yet are always short for more important stuff.   Oh this never happens. 

This is the problem with Ivy league liberals.  This was not a "study".  Did tax money go to fund this stuff?

Correction.  The chart was what I meant to post:

http://finance.yahoo.com/echarts?s=ISIS+Interactive#symbol=isis;range=my;compare=;indicator=volume;charttype=area;crosshair=on;ohlcvalues=0;logscale=off;source=;

Iran can now break out if it chooses to do so.    

http://www.timesofisrael.com/iran-now-has-nuclear-breakout-capability-us-intel-reports/?utm_source=dlvr.it&utm_medium=twitter

I haven't paid attention to Isis in years.  I remember when anti- sense was all the rage late 90's.  Then fell out of favor after it didn't work.  I recall posts on the old DMG board on this.  Now look at it.  Hindsight is everything in the stock market.  I recall my uncle telling us the story of how his friends advised him to buy into resorts international in the 70's which was the first Atlantic City casino approved by the regulators.  He thought it too risky.   His friends made millions.  He then added, "everything I did in the stock market was wrong...."

I am not sure if I every bought ISIS but I know I watched it for years.  I look at this and weep:

http://finance.yahoo.com/q/pr?s=ISIS+Profile

"Intellectuals’ obsession with income statistics — calling envy “social justice” — ignores vast differences in productivity that are far more fundamental to everyone’s well-being. Killing the goose that lays the golden egg has ruined many economies."

And last night we just had a President who will force this upon us whether we like it or not.

Someone should tell him, "hey we won" [Congress].   

Why so many in the media insist he is a "nice" guy I do not know.

http://www.cdc.gov/flu/weekly/usmap.htm