The ass is Grassley

Everyone--EVERYONE-- in politics (Grassley, Obama, McCain, Biden, Reid, Kerry, Pelosi) is a hypocrite. You have to be in order to survive modern politics. Hypocrisy in politics is not limited to the USA either--there is plenty to dish out worldwide. Word of advice to the Reveres: Dudes, stick with science which you are good at and drop the underlying political pontificating BS.. If we wanted that we wouldn't be here learning about science and sharing our scientific two cents--we would be over at the MSNBC or Fox blogs.
Now on to science: What about that IOM report that came out this week that shat on the CDC and stated N95 masks need to be used in HCW caring for influenza stricken pt? CDC hired the IOM to answer the question do N95 masks need to be used but at the start of the meeting, a CDC official announced that they needed the IOM panel to recommend just surgical face masks since there wont be enough N95 masks to go around (manufacturing capacity is 120 million masks/mo). Humm, I wonder what the IDSA or SHEA is going to say. Only 3 N95 mask making plants in the USA and all 3 of these makers have said most of the orders are going overseas and no one in USA is ordering them. Also only 1 surgical mask company in USA. I see opportunity knocking on ebay.

bostonERdoc; Grassley is about health care. Hence we talk about him (as we have when he crusaded against conflict of in interest in academic medicine). It is not true that everyone in politics is a hypocrite, any more than that every doc is a grasping profiteer, although many are. Bernie Sanders is not a hypocrite, now was Ted Kennedy or Russ Feingold. Politicians make less money than you do and work just as hard. Like a lot of docs that make a lot of money and work hard, many of them are hypocrites. Most aren't, however. I disagree with Baucus on the issue and he has taken money for his vote, but he isn't a hypocrite like Grassley or Ensign or Sandford or Foley, etc., etc. He's just corrupt because his vote is for sale. Lots of docs diddle the codes to make more money and prescribe procedures because they make money from them. That's corrupt, but unless they go around crusading about the high cost of health care they aren't hypocrites. Grassley is a hypocrite as well as being corrupt.

The biggest enemy of democracy is cynicism. It sounds like you have a bad case.

Word of advice to the Reveres: Dudes, stick with science which you are good at and drop the underlying political pontificating BS.

I don't believe you'd ever dream of taking this "advice." But now seems like a good time to point out that you're extremely good at political analysis as well as writing about science, and that many of us come here for both.

I'd even go so far as to suggest that it's the commitment to science that makes a lot of the political conclusions expressed here so logical and forceful.

In any case, telling people what to write about on their own blog is kind of boorish.

As an Iowan who once voted for Grassley, I can assure you that Iowa politics is not much different from anywhere else. Grassley was one of the few Republicans that I could tolerate because he really did have an independent streak that was admirable. Part of it was due to him believing his own press, and part of it was due to him being of rather average intelligence. To be crass, Grassley isn't bright enough to be a scheming political whore.

What's strange is why he's gone off the deep end. The Iowa GOP has gotten progressively weirder since the Reagan administration. Some of that has got to play a part in Grassley's turn. Let's face it, you cannot win a primary in Iowa without appealing to the batshit insane wing of Jesus freaks in Western Iowa. One thing to keep in mind is that he's up for re-election next year and he pissed off an awful lot of people when he want after the televangelists a few years back. There was talk of running a challenger against him, so he's paying penance now. Even someone as slow witted as Chuck knows when his career is being threatened.

I think it was Molly Ivins who said that, in Texas, an honest politician was one who'd take their money, drink their booze, screw their women...and _still_ vote against them.

I don't comment often, but your blog is a regular read for me. Your analysis (as usual) is spot on -- political and otherwise.

Please don't ever stop, Revere.

I'm anti-republican (I'm not Democrat but I have voted against the repubs ever since they put their "morality" first). You've got blinders on as bad as the Huffington Post or FOX News.

Some of us who have looked into health reform have realized all the focus on the insurance companies is DOOMING health care reform because that is like 10% of the problem. That 10% centers around pre-existing conditions and lifetime maximums. Sure, eliminate the pre-existing conditions but people with bad lifestyle choices - morbidly obese or smokers - do need to pay more. People with bad luck - genetic defect should not.

The 90% problem is that all the worthless (e.g. CYA tests that are done just so the doctors/hospitals don't get sued later) and inefficient (e.g. most back surgeries) medicine. Also, the doctor patient relationship needs to be changed from a procedure-dollar relationship to more of a real relationship. If everyone would focus on this issues instead of the insurance companies, we might could actually have the health care reform we actually need including helping solve the bed shortage problem you have ranted about.

Why does everyone focus on insurance? Because it is an easy target so they can claim reform without solving the actual problem.

I worked for the government for about 10 years. I know how poorly they execute everything (at least in this country). I wouldn't take the public option even if it was cheaper.

FYI: I only come here for the science. Everytime I see your politics/religions I just shake my head and I'm agnostic.

GeorgeT: I'm afraid that you'd have a hard time substantiating your 90% conjecture. There is some wastage in practicing defensive medicine, but all the data shows it pales in comparison to the out of pocket losses from malpractice that are never compensated. I don't know if you are a physician, but I am. If we had singlepayer we wouldn't have this problem because doctors would be indemnified and people would be able to get decent care and get errors or unfortunate outcomes fixed. But if you have data, let's see it. We pay more in this country and get less, so there is oviously a fix for it and frankly, cutting down on lab tests doesn't seem like it will do that much (it will help). I presume, though, that what you want to do is prevent people from recovering their losses. I guess I don't agree. Less than 10% of all civil cases are tort cases anyway. It is business cases that are clogging the courts. Let's stop them.

For successful reform we should stop focusing on the insurance thing. We need:
1. More physicians and nurses and beefed up medical infrastructure. Look at the mess in MA (my state) of passing universal health care carelessly. They rammed it down our throats without regard to the primary care physician workforce supply or whether the medical infrastructure could handle the increased volume. Have you gone into an ER lately? Every encounter I have starts off with the patient whining about the 6 hr wait or complaining that he is unable to see his primary for 3 months or that his doc only takes 5 minutes with him during a visit. It is simple supply and demand.

2. Forget an electronic medical record requirement or reduce paperwork burden. It takes way too long to do patient contact documentation. We physicians are spending hours making sure we document those bogus things such as whether or not the pt feels safe at home or has ever been exposed to TB at the computer. Only the think tanks in DC or the out of touch ivy tower professors don't get this one. Electronic records don't save money because they require more physician time at the computer rather than at the bedside so productivity takes a nose dive. Just go to a hospital that uses EMR (like mine) and you will find most docs and nurses at the computer rather than the bedside.

3. Make it worthwhile to be a primary care doctor. Money talks.

4. Malpractice tort. I suggest we follow the socialist countries in Europe and Uk on this: You lose the case, you pay the winners full legal costs. Since 95% of malpractice is won by the physician such a requirement would eliminate the bogus suits. Also, move malpractice to a medical panel court and eliminate current jury system of common folk who know nothing about the complexities of medical decision making.

5. Ration care. I don't understand why everyone is up in arms about this. Fellow readers we need to have some rationing of care. Such spending can not go on forever. Is it really justified to place an AICD (internal defibillator) in a 95 yo demented Nursing home pt at a cost of $75K? It is right now because their loved ones will sue if we don't. We need to inform patients and their families that the sky is not the limit and part of life is dying.

BostonERdoc: I agree with all your points but the tort reform. There has to be a way to compensate people who are harmed. Maybe the government should indemnify docs working within its system. The jury system is part of the constitution. If you want to change it (and I don't) you'll have to amend the constitution, IMO. Studies who only a fraction of costs are recovered by those truly harmed. Juries usually opt for the doctor and suits add little to the cost of care. Otherwise, I prety mucy agree with your points. We are already reationaing through indusrance converage anyway.

Don't they understand ... politics within the Republican party?

I'm not sure that I do. My impression is that the lunatics are running the asylum.

Revere - thanks for holding Grassley's feet to the fire. His lies about health care reform (the "death panels" stuff has a racist undercurrent to it) are inexcusable and given that people in our country without medical insurance are more likely to die from diseases that the insured can survive with treatment, he's going to be responsible for some needless deaths if he and his insurance co buddies succeed in killing needed reform.

I don't know how these people sleep at night.

Personally I think this healthcare stuff needs to have a lot more review rather than this ramdown that Pelosi, Reid and Obama are doing. If they are smart they will just back off. The businesses in America are lining up to take them all out in the mid-terms and I think that they have sealed their fate. They might get healthcare in, but its going to come right back out in the next Congress. Congress's numbers are almost the lowest in polling history now and that means change that you will believe in.

By the way can someone show me the legal justification for a"czar" in the Constitution? Its an excuse I think to go and spend more money on ACORN.

Hitler and Obama and yes on the same line.

H took over manufacturing...Obama is.

H took over healthcare... Obama wants to.

H took over the banks...Obama did.

H changed the schools into little propaganda machines. Obama tried his first shot at that today. What can my kid do to make Obama a better President. Baby boy took this one up on his own and submitted it...He got into trouble for his opinion.

"I Barack Hussein Obama do hereby resign the Presidency of the United States of America on this day, September 8th, 2009 with immediate effect."

Yep, you bet I got a call from school on that one as he was required to read that in class in his "discussion" about that line item. The principal wanted to suspend him for it. I asked what for and the principal couldnt give me an answer other than he was being disruptive. I had to explain that 17 year olds are not disruptive nor are they insubordinate as that is a term used in the civilian and military applications. I also told him that he would find himself in a court for a very lengthy trial for civil rights violations... He changed his mind and tune very quickly. I also told him that it was better when parents told kids to stay in school, off drugs, and become something. Again, the all encompassing government bullshit... Hitler youth!

Then we have:
H decided what businesses were in and which were out... Obama is in charge of GM and Chrysler. They account for almost 1/5th of the total sales in the US. Cant turn it around because well, we have EPA'd and OSHA'd and Union'd our asses right out of our jobs.

H took over the boy scouts. Well Obama might try.

H had his czars but their names were Himmler, Goebbles, Eichmann to name a few. Obama had to cut a commie friend out of it today with his resignation. Who is going to take the post? Bill Ayers?

H to the best of anyones knowledge never entered a church for any reason. Obama went to one that was clearly a racist.

H got rid of all the weapons so no one would shoot at the jack booters. Obama wants a 100,000 man police force as did Clinton to be fitted out to the same levels as the US military. And what enemies of the state would the Gestapo be after? First thing to go is the guns.

Yeah, Change that we can believe in.

And Revere, the insured pay more in this country but do they really get less? UK and Canada have people coming here all the time so do they have more. In their Utopias they dont have these services that their people are driving and flying to the US for? Now thats nonsense really and the reason they cant get it is that the governments of those countries will not pay for it. So you get more for less?

Non sequitur statement. You cant back it up. Its an opinion. So we put in only government healthcare and then everyone gets the same shitty services as everyone else and instead of 1/6th of the economy going, it becomes 1/4th in taxes. Its a cash flow scheme is all. The number of people that will go out of work IMMEDIATELY is estimated at 25 million if it goes in.

So it goes in, then it gets snatched right back out. Fining people for not procuring insurance..? Keep it in Massachusetts with the rest of the Swine Flu Reich and their impositions of radical laws. I really want to see them when they show up to start enforcing this stuff. They are going to need a few good men, and a lot of ambulances.

Besides, George Soros is behind it all.

Hey, Kruger!

You better call the INS and turn in your maid and maybe the garden boy. They've been messing with your stash, man.

And flush that shit. It's making you weird.

Greg.... Uh-huh...

Funny, I just cant understand how some people are so out of it that they are in.

http://news.yahoo.com/s/afp/20090908/pl_afp/usattackschildrenoffbeat_20…

I can talk later on the effects of being 11.3 trillion in debt but it wont matter. The government is going to either have to cut this crap out or the US is going to default on its bonds. Kind of like what Bush said would happen if runaway borrowing started to take place. Wont even be able to tax and spend in the near future.