Where Did Barbers Go?

Of Plumbers And Barbers
02/23/09 - RiehlWorldView by Dan Riehl

Barbers were regulated out of existence.

[edited] In the 70's and 80's many states merged their Barber and Cosmetology Boards into one. A young man who could make a decent living as a Barber couldn't do a partly paid apprenticeship, taking just months to learn a career that could serve him for life. He had to pay to attend a Community College or private tech education program that could last two years, while making him learn a variety of skills he'd never employ. And he, or she was also taught to charge much more for the service.

Costs of a haircut more than doubled, and businesses saw their overhead costs rise dramatically. All because the government was just looking out for you, or perhaps they were paid off by the tech education and cosmetic industries. Maybe they found a clever way to extract more dollars from a male public that never actually needed them in the first place

Nurse Practitioners

Bilateral Queckenstedt's sign
02/20/09 - Throckmorton's Other Signs by Throckmorton

It seems that nurse practioners (NP's) are not a good replacement for doctors in an emergency room. But, they are "cost effective".

[edited] Nurse practicioners are nurses with 17 months of extra training. They replace an MD or DO who has 4 years of medical education plus 3-4 years of speciality emergency medical training.

ER cases that a doctor could treat and release can not be handled by NP's who either can't or don't know how. Worse, I am often called in for one problem and find that there is something totally different wrong with the patient. I wonder how many of the patients have been sent home with something badly wrong!

I asked a hospital administrator why the NPs are not discussing patients with their supervising MD's. He informed me that the supervising MD only reviews patient's charts. Further, the NPs can act independently.

Why don't they hire MD's? MD's cost too much because of their liability insurance. Nurse Practicioners are cheaper, with minimal insurance, because they are not held to the same standards! With EMTALA in the mix, I get called in for everything.

Elevator Lawsuit Safety

Elevator Logic
02/18/09 - Throckmorton's Other Signs by Throckmorton

I suppose the legal theory of "attractive nuisance" is used here. Escape doors are so attractive and dangerous that people must be protected against themselves. There could be a sign "Warning: Only professionals should attempt to escape from this elevator." I have wondered, if I am supposed to escape, where is the ladder?

[edited] The hospital has fancy ceilings in their elevators, and I wondered what I would do if I got stuck. The maintenance man explained that the escape door was behind the lighted panel in the ceiling. It was almost impossible to get to, and the escape doors are locked from the outside. Someone has to let you out.

There have been lawsuits when people stuck in elevators have hurt themselves climbing out or when the elevator starts moving. So, the escape hatches are locked from the outside. If you are trapped in the elevator in a fire? He said, "Hope someone can get you out before you burn!"

It is even code to have the escape hatches locked! I wonder if the glass in the fire alarm box that states "break glass in case of fire" is unbreakable to prevent lawsuits because of people cutting themselves!

Medicare Witch Hunt

Dear Mr President, Medicare Stinks
02/03/09 - Distractible.org by Dr. Rob

Medicare is controlling waste, fraud, and abuse by driving doctors out of Medicare. We can wonder who will be left to treat Medicare patients "for free".

[edited] I am a primary care physician. About 20% of my patients are covered by Medicare. I consider it an honor to be a doctor to the elderly. The complexity of a person’s medical problems goes up exponentially as they near the end of their life. I spend more time per patient for my Medicare population - which is OK if I can be paid for my extra time and effort.

If Medicare auditors find “problems” with our charting we will be told to send money back to CMS for our whole Medicare population. We are obligated to prove that we did not defraud Medicare to reclaim the money for the work we did. We will be presumed guilty unless we can prove that we are innocent.

They are looking for inconsistencies in the charting and the billing. These can be little things like:

• Failure to mention in the note the EKG we ordered, even if it is in the chart.
• The appearance of a “cookie-cutter template” in our notes. If all of our physical exams, review of systems, or impressions look similar, then it will be assumed we are trying to defraud Medicare.
• Forgetting to document a discussion about a diabetic eye exam.
• Certain ICD-9 codes will be accepted, but will “flag” that we are possibly trying to cheat Medicare. We need to be specific in our coding to avoid immediate suspicion.

We practice very good medicine and probably save money for the system, as a higher percentage of primary care in a community means lower cost. We use an EMR and are NCQA recognized for our diabetes care, and I think that our quality of care and documentation is in the top 10%. Yet we fear that your government employees are going to use us as scapegoats for the out-of-control costs of Medicare and put us out of business in the process.

We see what is being done to the hospitals by not accepting “No Pay” diagnoses (Never Events). That debacle is irrational and unfair, but the hospitals have no recourse.

That makes us extremely pessimistic about our odds when facing the hit-men from CMS. If a hospital with its lawyers and other resources can be hung out to dry, what chance does a primary care physician have?

We have never considered our acceptance of Medicare as something that actually makes business sense - we just like to care for the patients. But the increasing hostility we are seeing from the witch-hunters with their torches and angry mobs is making us really consider whether we can afford to stay on board.

Delayed Medical Tests

Emergency Primary Care (Not)
02/18/09 - DocsOnTheWeb by 911Doc

The Stark law (below) "stops" waste, fraud, and abuse by eliminating effective services. The government favors one-stop, no-other-choice shopping when the government provides medical services, but they require private doctors to fragment and delay their services.

[edited] Doctor's clinics are no longer allowed to provide on-site lab and Xray. The "Stark" law comes to mind. I witnessed a combination of poor primary care skills and the heavy hand of government.

An old man went in to his physician's office yesterday for a checkup. He 'wasn't feeling well' and the doc took him off one of his anti-hypertensive meds. Today he feels worse and WOW! the labs drawn at his checkup were resulted today and showed kidney failure and high potassium.

When the patient got to us in the emergency department, he was 'almost dead' with a pulse of 30. We brought him back from the precipice. I asked his primary doctor why the labs took so long to be resulted. He said, "We have to send out all labs".

This adds another pressure point to ER medicine. People know that their primary physician will not get answers that day. In this case it was almost a day late and a dollar short. Thanks Uncle Sam, you have prevented primary care physicians from committing fraud by over-ordering tests. Good job. Bunch of freaking putzes.

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Physician self-referral

The Stark law governs physician self-referral for Medicare and Medicaid patients.

Self Referral is a physician referring a patient to a medical facility in which he has a financial interest, be it ownership, investment, or a structured compensation arrangement.

Critics of self-referral allege an inherent conflict of interest, because the physician can benefit from the referral. They suggest that such arrangements may encourage over-utilization of services, in turn driving up health care costs. They believe that it would create a captive referral system, limiting competition by other providers.

Others say that some problems may exist, but are not widespread. Physicians are responding to a need which would otherwise not be met, particularly in a medically underserved area.

Most laws are not written with a delicate hand. Instead of auditing abuse, our government eliminates efficient services, including standard lab tests, for all of the patients and doctors who are not defrauding the system. Broad-brush laws have real consequences.

AGW Scientists Can't Predict

The Caine Mutiny Teaches Us about Global Warming Scientists
02/17/09 - PajamasMedia by Frank J. Tipler

Academic degrees mean nothing if you can't say what is going to happen. Watch out for global warming scientists who can't predict the details. And watch out for "economists" who fiddle some equation as a reason to take your money to improve your life.

[edited] Anthropogenic global warming (AGW) is justified via argument from authority: a consensus of “experts” holds that humans are responsible for the increase in the Earth’s average temperature.

I was once a leader in forming a scientific consensus based on expert opinion. In the late 1970s, most cosmologists believed the universe could not accelerate, based on very weak experimental evidence. In the late 1990's, we discovered that dark energy is accelerating the universe. I now regard “scientific consensus” as a synonym for “wrong.”

I am struck by the lack of accomplishments by the leaders of the AGW consensus. In fact, it is the leading opponents of AGW who have genuine scientific achievements in climatology. Reid Bryson was the “father of climatology,” a leading AGW skeptic, and had the achievements of a genuine scientist.

A true scientist demonstrates his knowledge by making predictions which can be confirmed or refuted. What counter-intuitive predictions have the Global Warmers ever made? I invite you to look.

I could not find a single counter-intuitive prediction made by any major Global Warmer. But, I have found cases of them trying to cover up failed predictions.

No Sports Economic Multiplier

Evidence against the multiplier
02/17/09 - CafeHayek by Russell Roberts

[edited] Almost all academic economists agree about the impact of subsidies and spending on sports stadiums. Building a stadium "creates" jobs, but the best estimates of NET job creation are ZERO.

From the survey paper "Do Economists Reach a Conclusion on Subsidies for Sports Franchises, Stadiums, and Mega-Events?" (PDF), 09/2008 :

Sports subsidies are unwarranted, based on economic intuition, a survey of economists, and a review of the literature on the economic impact of professional sports. There may be some local economic benefits, but the empirical findings strongly reject sports subsidies due to a lack of economic benefits.

There is a large and growing peer-reviewed economics literature done by economists, as opposed to that of scholars in public policy, urban development, and planning departments. This research is almost unanimous that stadiums, arenas, sports franchises, and sport mega-events have no consistent, positive impact on jobs, income, or tax revenues for the associated communities.

Teleprompter President

In All Fairness
02/16/09 - American Spectator by The Prowler
Via RiehlWorldView.

It seems that Obama gets real-time advice on what to say, along with scripted settings to say it.

[edited] A former Obama communications advisor has been giving notes and suggestions to the White House team, and worked with them on the inauguration.

The press conference speech looked scripted beyond the scripted part. Every president uses some pre-arranged questions or journalists to be called on, but this press conference was pretty ham-handed.

The White House wants to install a small computer screen into the podium for press conferences and events in the White House. The screen would indicate whom to call on, seat placement for journalists, notes, and points to hit. It would make it easier for the communication guys to pass along information without being obvious.

Using a screen is nothing new for Obama. Almost everything he said in supposedly unscripted townhall campaign events was scripted, down to many of the questions and their answers. Teleprompter screens showed his opening remarks, and also statistics and information he could use to answer questions.

Stimulus and Terpentine

The Stimulus Bill Smells of Turpentine
02/16/09 - AmericanThinker by Paul Shlichta

[edited] A farmer had a sick horse and wanted to call in a veterinarian. His neighbor said "You don't need no vet. Just feed him turpentine: two spoonfuls a day."

The farmer tried it, and the horse got sicker. The neighbor said, "You're not giving him enough; double the dose." The farmer followed the advice, increasing the dose several times, until the horse finally died. The neighbor drove by while the farmer was burying it. The neighbor hissed, "You didn't give him enough," and drove away.

The turpentine ploy provides politicians with a win-win situation. If their project succeeds, it's because of their brilliant leadership. If it fails, it was inadequately funded and needs more money.

No Effect On Unemployment

The Obama-Geithner Bear Market
02/13/09 - Forbes.com by Robert Lenzner

[edited] The spectacle of nasty political infighting between Democrats and Republicans must be disturbing to investors everywhere. They question whether the $787 billion stimulus plan is sufficiently robust or properly focused.

Robert Albertson is a principal at Sandler O'Neill and a former Goldman Sachs banker:

[edited] After 18 years of record spending, much of it on credit, consumers must and will save the next $1 to $2 trillion of income to reduce their debt. Only private businesses create job multiplication and true future spending power. That requires a savings and investment program, not a doomed spending program.

Spending programs ate up resources for six years during the 1930s Depression, with little or no effect on unemployment.