Divemedic

Aloha Snackbar

More people from the religion of peace have murdered 6 people who were standing at a bus stop. They were stopped from doing even more damage by a student who got his a gun license about a year ago, and who shot the terrorists.

I used to carry my J frame for quick runs to the store. Not anymore. I have been only taking my 9mm Shield plus, or lately my M&P 10mm. That 10mm holds 16 .45ACP sized bullets and launches them at 9mm velocity. It’s the best of both worlds, with the only downsides being that it’s a bit tougher to conceal, and it has stiff recoil. My split times are about 10 percent slower and I have been wearing more Hawaiian shirts.

I like the ones from Tommy Bahama. They look good and the patterns both hide the gun well and bring the look of Aloha.

By Divemedic, ago

Bloat

This is a Sunday, and I am sleeping in. So I thought I would give you a repost of something that I said more than ten years ago.

Ignorance of the law, the judges and cops are fond of saying, is no excuse. In 1925, this is what a complete copy of all Federal laws looked like:

That one volume represents all of the laws that were passed by Congress in the first 150 years of this country’s existence. That Federal Law library has now expanded immensely.

What was one volume in 1925 expanded to become 22 volumes just 90 years later. That isn’t all, though. There is also the United States Code:

The number of federal crimes you could commit as of 2007 (the last year they were tallied) was about 4,450, a 50% increase since just 1980. A comparative handful of those crimes are “malum in se”—bad in themselves, which include things like rape, murder, or theft. The rest are “malum prohibitum”—crimes because the government disapproves, such as owning a machine gun made after 1986, when owning one made in 1985 is perfectly legal.

In 1982, the Justice Department tried to determine the total number of criminal laws. In a project that lasted two years, the Department compiled a list of approximately 3,000 criminal offenses. This effort, headed by Ronald Gainer, a Justice Department official, is considered the most exhaustive attempt to count the number of federal criminal laws. In a Wall Street Journal article about this project, “this effort came as part of a long and ultimately failed campaign to persuade Congress to revise the criminal code, which by the 1980s was scattered among 50 titles and 23,000 pages of federal law.” Or as Mr. Gainer characterized this fruitless project: “[y]ou will have died and [been] resurrected three times,” and still not have an answer to this question.

So you see, even the Justice Department of the US government is not sure of how many laws there are, yet each and every one of us is responsible for knowing every one of them, along with the court cases that modify and define them, upon penalty of prison.

That isn’t all. The laws passed by Congress are just the beginning. There are also several dozen Federal bureaus that have had the power to write laws since 1940. The laws that they write are called regulations, and they are found in the Code of Federal Regulations:

In 2013, the Code of Federal Regulations numbered over 175,000 pages. Only a fraction of those pages involved regulations based on something spelled out in legislation. If a regulatory agency comes after you, forget about juries, proof of guilt beyond a reasonable doubt, disinterested judges and other rights that are part of due process in ordinary courts. The “administrative courts” through which the regulatory agencies impose their will are run by the regulatory agencies themselves, much as if the police department could make up its own laws and then employ its own prosecutors, judges and courts of appeals.

Then there are all of the court cases that decide what these laws all mean and how they will be applied. Here is a picture of the SCOTUS cases from 1790 to 1956:

Add in all of the cases from your Federal District and Circuit, plus all state and local courts, and you have quite a bit of reading to do.

The result of all of this is that each and every one of us is responsible for reading, understanding and following over 750,000 pages of laws, regulations, and court decisions- with complete understanding. If one were to begin studying these laws at age 12 and you read 50 pages per day, by age 53, you would finally have read all of them. The only problem is that, at the current rate, the government would have added another 500,000 pages of laws, and 28 years of reading to your quest. You would spend 75 years of your life trying to understand the laws that you must obey.

Remember, though: Ignorance of the law is no excuse. If you are spraying insect killer on some ants, and the can label says spray from 6 inches away, but you spray from 8 inches, you are a Federal criminal. If you are buying a gun, and you live in Florida, you had better use the abbreviation of FL as your address, because using the old abbreviation of FLA is a felony and can land you in prison.

Why is this happening? Ayn  Rand gives us an insight into this:

The only power any government has is the power to crack down on criminals. Well, when there aren’t enough criminals, one makes them. One declares so many things to be a crime that it becomes impossible for men to live without breaking laws.

Truer words were never spoken.

By Divemedic, ago

No One Knows the Cost

We talked about the high cost of healthcare. When people talk about how the US healthcare system is “broken” they are mostly complaining about cost. Getting costs down is tricky, and it’s a problem that was caused by government interference.

The Medicare Physician Fee Schedule is a 1,348-page document, and the final rule for hospital inpatient payment systems is 773 pages long. For some services, it’s impossible to know how many pages of regulations and price controls there are. For example, The Centers for Medicare & Medicaid Services (CMS) does not condense the Medicare payment rules for ambulances into a single, definitive document. The regulations for ambulance charges are spread across multiple manuals and chapters, all of which are constantly being updated and revised. A definitive page count for the rules does not exist, because no one knows for sure what all of the rules are.

All of this adds to the cost, as medical providers have to hire entire departments just to take a guess at what they can and should charge you, and even then, they often get it wrong, because the rules are contradictory.

Every time the government steps in to fix it, they add pages and chapters to the manual, but instead of fixing things, they make it more complex with carve-outs, backdoor deals that kickback money to big donors, and the need for an even larger hospital billing department.

I do want to respond to one comment, where someone said that reading a CT scan shouldn’t cost $1500 because it only takes an experienced radiologist 30 minutes or so to do it. Remember that you aren’t just paying for the radiologist. You are also paying for his malpractice insurance, the costs of compliance with government electronic charting and recordkeeping, the costs of his staff to include the billing department, and other associated administrative overhead. That radiologist is only getting a small fraction of that money, in many cases, less than a fifth of it.

  • Malpractice insurance for a radiologist is around $25,000 per year
  • Costs for electronic health records: for a smaller practice, you are looking at around $400,000 for initial costs, plus another $50,000 per year. In the case of radiologists, it will be even more to integrate with the output of proprietary CT machines.
  • Plus staff and administrative costs
  • So a radiologist is paying $200k or so a year just to read those CT scans. If he isn’t charging that kind of money, he might as well go be a plumber.

Keep in mind that an hour’s work from a plumber costs about the same as that radiologist is going to cost you.

By Divemedic, ago

Just the Tip

Read this guy’s perspective on rights:

Ludwig believes that all rights come from government. That’s patently ridiculous. If I were alone on an island, I would have the right to speech. I could keep and bear arms. The only way that I can lose those rights is if someone takes them from me.

That’s why government morally exists- to keep others from taking your rights. This is why we have a Constitution that lays out the powers of government- what that government CAN do, and what it CAN NEVER do.

Not so in Mr. Ludwig’s world. He believes that, unless there is a government present that tells me I may speak, I simply don’t have the right to do so. That’s fundamentally out of line with the ideas of the Founders of this Nation, whose thoughts on this were based upon the philosophies of John Locke and Thomas Hobbes.

This is where the left gets the idea that food, shelter, clothing, and healthcare are human rights. They are not, and they never have been. If I have a human right to any of those things, it follows that I can force someone to provide it to me.

Enter a law forcing someone to pick my cotton, my oranges, build my houses, and perform free healthcare services. Even enacting price controls is a form of slavery, and to claim otherwise is exactly the same thing as saying “if I only put the tip in, it isn’t rape.”

The saddest part of this, is that Mr. Ludwig is an attorney. His college failed him when they failed to teach the basics of the Constitution and its underlying philosophy.

By Divemedic, ago

Costs of Care

I had a tough week recently. You wouldn’t believe how tiring it is to use your brain at a high level, with lives in the balance, for 12 hours straight. It’s a high stakes, high stress endeavor. When I work and the day is especially stressful, I am in bed asleep within an hour of getting home, and I sleep until it’s time to go back to work. Let’s look at one of the patients I had on one of those days:

A woman decided that she was going to kill herself by taking every pill she could find in her house. Three hours later, she changed her mind and called 911. She was a frequent visitor to the emergency room and had been placed on involuntary psych holds (called a Baker Act) a few times before, due to suicide threats that turned out to be cries for attention.

She was my patient.

EMS handed me a bag of empty pill bottles, all of which the woman claimed to have taken. A final count of the pills revealed that she had taken most of a 90 day supply of Digoxin, Wellbutrin, Sotalol, Xarelto, and a few other drugs. I think we finally estimated 50-60 pills of each were unaccounted for.

I asked the doctor if he wanted to do a gastric lavage. He said he didn’t want to, because it had already been 3 hours and any pills she had taken were likely digested by now. He also pointed out that her vital signs were unchanged, and this was a good sign that she was again acting out, but hadn’t actually taken anything.

I told him that, since the drugs she had claimed to have taken were mostly extended release, we would be looking at some real trouble in about another hour. He told me to watch her and call him if anything changed.

I had three other patients, including another Baker Act. Those involuntary admissions require a lot of paperwork, so I was busy.

About an hour later, I got a call from the telemetry operator that the woman’s heart rate had suddenly dropped from 62 to less than 35. I ran into the room and found her in a junctional escape rhythm at 32 beats per minute. I called the ED doc, who was on the other side of the department, and told him what I had. I recommended Atropine and Glucagon and asked for the order. He concurred and said he was on his way.

By the time he got to me, I had called a Resuscitative Medical Alert. That gets me the ED rapid response team, including a charge nurse, three other nurses, two techs, a respiratory therapist, and Xray tech with a portable Xray machine, and the ED doctor. I gave her two doses of Atropine and two of Glucagon. It didn’t do a bit of good.

I suggested that we start pacing immediately. He agreed, and we started external pacing. Her blood pressure was shit, so as the Dr prepared to intubate, we got orders for and hung an Epinephrine drip. Then it was Ketamine, Rocuronium, intubation, and a Ketamine infusion. By then the ICU doctor and a dose of Digifab had arrived. We got the Digifab running and took her to ICU.

She lived for 5 days in the ICU. That was 1 of the 22 patients that I had that day. She was also 1 of the 7 suicide patients I had that week, and the only one that didn’t survive. In fact, I had 81 patients that week and only 3 of them didn’t survive.

While she was there, she received over $300,000 in medication. The Digifab alone was almost $100,000 of it. They tried dialysis, it didn’t work because the Digitalis molecules were too large to dialyze out. Her total bill was well over a million bucks.

Some of the drugs she got were specialized and aren’t given to many people, so they are costly.

She isn’t going to pay that bill, because she is dead. So who pays it? We all do. The hospital spreads those costs out across every patient. It’s like going to a restaurant where everyone gets to eat whatever they want, they can order one of everything on the menu, and about a quarter of them don’t pay, so everyone else has to pony up the difference.

It’s an ethical conundrum. Who decides what treatments will be offered? If we leave it up to the hospital, does the patient get a choice? Does the insurance company? There are pitfalls to each answer, and trust me, it’s one that healthcare workers debate frequently.

Someone has to pay for all of the education and experience of the providers. Not only while they are actually providing care, but also for UHU reasons. Now UHU is a concept that originated with EMS, but applies to the ED as well. UHU stands for “Unit Hour Utilization” and symbolizes the amount of time in each hour, on average, that an asset is busy treating a patient.

If the UHU is too low, you are spending money to have expensive assets sitting around. If your UHU is too high, there is a chance that someone will need their help and it won’t be available because it’s being used elsewhere.

All of that must be paid for, and that’s the issue.

Americans demand the best of everything. They want to have top notch care, they want it available at a whim, they won’t tolerate errors, and that is expensive. Every one of the actions taken in that woman’s case were areas where mistakes could have been made. They have to be done every time, without error, and it must be the right thing at the right time, no exceptions.

Now multiply that by the 200-500 patients a day in that ED. That isn’t cheap.

That’s the issue- Americans want it perfect and they want it on demand. The best of everything. Cost is no object. Sure, Americans complain that healthcare is expensive, but mention a system where an official controls cost by denying your claim, or as in the case of Canada, recommending euthanasia, and see people howl.

So you could control costs by making it easier to be a medical professional, but that would mean lowering standards, more medical errors, worsened medication quality controls, and more frequent things like hospital acquired infections.

Or make it cheaper through rationing. You could wait 2 years for an MRI.

I’m not saying that there aren’t examples of waste and fraud. I know there are. I also have a problem with hospitals not disclosing their rates up front. You should know that it’s going to cost $20,000 for a CT scan, another $1500 for the radiologist to read it, etc. Trump tried to do that, and the hospital lobby shut it down through Congress.

However, how do you control that in a nation as large as ours? Anyone who says there is an easy answer is being childishly naive or doesn’t really understand what’s going on.

If you passed a law mandating that anyone could have dinner at any restaurant they wish, could order whatever they want, and the restaurant couldn’t demand payment up front, and people could buy “dinner insurance” to pay for it, what would people eat, where would they eat, and how much would dinner cost?

By Divemedic, ago

Walz Wants Your Guns

He claims that Australia and Scotland are “just as free as we are.” Let’s check into that.

Police Scotland has warned the public not to spread misinformation after a 12-year-old girl was charged for brandishing weapons in Dundee when she was being attacked. Police can arrest you for “spreading misinformation.”

In Australia, people who have COVID or have been exposed to COVID were sent to internment camps until late in 2022. If you escape, you were arrested. Democrats in the news media denied this, saying that camps in Australia aren’t technically internment camps because they were only for the quarantine of travelers, even though that’s exactly what the Aussies were calling them. As to the claim that it was a quarantine camp for arriving travellers, well, let’s hear from one of the internees:

Go ahead, Tim. Start sending police to confiscate people’s guns. Light that match and see what happens.

By Divemedic, ago