Where's the Outrage?

Sometimes, when I see what the mainstream media is talking about, I get physically nauseated. Probably 80% of the time, we are focused on nothing. Whether it is Britney Spears or Reverend Wright or, currently, a pay freeze for all federal employees, we continue to miss the big picture. Freezing pay for federal employees will not solve the deficit. It won’t even come close. It is an excellent example of a stupid policy.

Back to healthcare. About 18 months ago, I sat down to write a book on healthcare. I thought I knew a little bit about healthcare. I’ve been a trauma surgeon for over 15 years. My father, whom I used to help in his office, was a family practitioner. So I’ve been around healthcare for more than 30 years. I have seen something as simple as an examination table cost more than $1000. In the course of my health care research, though, I became overwhelmed by the amount of data and the simple size of the task. Healthcare is a vast monstrosity. It is extremely difficult to get your arms around the whole problem. Therefore, it makes sense to me that we need to examine this problem in small pieces. Let’s look at the intensive care unit. In the intensive care unit, physicians practice some of the most advanced medicine that can be found anywhere in the world. Although I do not like to use case reports (anecdotes) as inspiration for action, they can illustrate a larger point.

Case 1: a 90-year-old gentleman was driving a golf cart on the road when he swerved to miss a car. The golf cart rolled down an embankment and the gentleman was thrown from a golf cart and hit his head on a rock. A witness saw this crash and called for an ambulance. The patient was awake and alert when the ambulance arrived and he was taken to the trauma hospital. The patient arrived at the trauma center complaining of a headache. The CT scan of his head revealed a small subdural hematoma (a collection of blood between the skull and the brain) near the temporal lobe. There was a small contusion (bruise) of the temporal lobe. The rest of the CT scan was perfectly normal for a 90-year-old gentleman. (This subdural hematoma does not require neurosurgical intervention.) At this time, the patient began having some language difficulties, was becoming a little confused and was admitted to the intensive care unit. Interestingly, the patient’s son was a pathologist. He was informed of his father’s condition. The next morning, per protocol, the patient had a repeat CT scan of his head. It was completely unchanged. Approximately four hours later, the patient’s mental status began to deteriorate. He was now having severe difficulty finding the correct words to express himself and was becoming agitated. At this time, the patient’s son came by for visitation. The son, extremely alarmed at the deterioration of his father, demanded that something be done. He informed the critical care physician that this patient lived independently was highly functional. The pathologist wanted a repeat CT scan. The critical care physician asked a few questions – what if the CT scan was worse? Did he want his father to undergo a neurosurgical procedure/surgery if necessary? How aggressive did he think they should be with a 90-year-old gentleman who was previously healthy? The pathologist, a physician, was unable to answer any of these questions. (Please remember that none of the patients presented here are real, but are presented to illustrate a point.)

What do you think should be done? Should we get a repeat CT scan emergently? Should we just keep the patient in the ICU (at a cost of $1000 – $1500/day) and watch him closely with continued IV fluids and supportive care? Should we transfer this patient out of the ICU to a regular room and institute “comfort measures?” (Case 2 tomorrow.)

Update: To continue with this case, the patient did undergo a repeat CT scan at the request of the family. The repeat CT scan was unchanged. Neurology was consulted. They came by and explained to the family that the patient’s symptoms were due to the bruise in his temporal lobe. It was unclear if these symptoms would resolve themselves or not. Over the next 24 hours, the patient’s symptoms improved and the patient was transferred out of the intensive care unit to a regular room. Over the next 48 hours, the patient continued to improve and was back to baseline. (He was walking, talking and eating without difficulty.)

I posted this case not as some sort of “miracle,” but as an exercise in thinking about end-of-life issues. How can a physician whose father is 90 years old not have some sort of plan with regard to end-of-life issues? If a physician cannot have a plan then what chance do the rest of us have?

Finally, I would like to address a sentiment that I noticed over at the Daily Kos (I posted this case there also) and also here on my blog, “hurry up and die.” If you read this case and you feel that the medical team was trying to push this 90-year-old man into the grave, you’re sadly mistaken. Instead, all medical teams should be weighing the risk versus the benefit of all therapies. A craniotomy in a 90-year-old has a survival rate of less than 5%. On the other hand, watching, waiting and evaluating turned out to be the right thing to do. By making sure that the patient’s blood pressure was adequate, giving the patient an adequate supply of oxygen and providing appropriate nutrition, the medical team put this patient in a position in which he could heal himself. What was the risk of a repeat CT scan? Not much. That’s why the medical team thought it was okay to order repeat scan. Yes, there was added expense, but it also put the family’s mind at ease. This is also important.

Tags: Healthcare by ecthompson md
4 Comments »

Healthcare is a huge topic. I’m going to try to define the problem and lay out thoughtful solutions over the next several days. We can all look at the report that came out several months ago and see a large part of the problem. 50.7 million people who live in the United States do not have health insurance. This is up to 16.7% of the total population in the United States. The number of Americans with private health insurance has dropped to 194 million people. (There are over 310 million people in the United States.) So, the question is, how do we get all Americans covered? Secondly, how to we make sure that everyone who has private insurance is “adequately” covered? Finally, how are we going to pay for this?

One of the cries that we hear constantly from conservatives is that we need to “stop cost shifting” in the United States. This is a practice whereby those who do have insurance pay for those who don’t. Cost shifting clearly drives up the cost of healthcare for those people who have coverage.

Fictitious scenario (none of the patients presented in this scenario are real): a 40-year-old hemophiliac is on his motorcycle when he loses control and crashes. The patient arrives at a trauma center in extremis. His blood pressure is low and he is bleeding into his abdomen and into multiple fractures. The patient receives blood, fluid and plasma in order to stabilize his blood pressure. The hematology specialist recommends a specific drug which costs $20,000 per dose, the recommended dose being given every four hours until the patient does not require surgery anymore. Over the next several days, the patient undergoes abdominal surgery where his ruptured spleen is removed and orthopedic surgery for his fractured femur and fractured humerus. The patient is discharged from the hospital two weeks after admission. (The patient hospital bill is well over $1 million.)

The point I’m trying to make here is that healthcare is sophisticated and unfortunately, extremely expensive. Drugs, medical devices (orthopedic rods, scooter chairs and implantable defibrillators) are extremely expensive. Physician fees, nurses and hospital space is also extremely expensive. Who needs that hair cut?

During the 1980s (Ronald Reagan) and the 1990s (Bill Clinton), reimbursements to hospitals and doctors were cut. As a result of these cuts, physicians became bitter and skeptical of government intervention. Hospitals responded to these cuts by cutting back nursing personnel and requiring the remaining nurses to take on more patients and, therefore, to assume more risk. Many nurses dropped out of nursing. The remaining nurses are overworked and underpaid (my opinion, as a physician who works with nurses everyday). As a group, doctors and nurses have not seen a significant pay raise in over a decade. Doctors have moved from specialties with lower pay into specialties that pay much better. Internal medicine, family practice and pediatrics are some of the worst paying specialties in medicine (and are also the most needed). Many young physicians have gone into cardiology (invasive cardiology), interventional radiology and plastic surgery, where the reimbursement is more lucrative. Many nurses have gone into doctors’ offices in order to get better hours and weekends off.

Back to my scenario, suppose this 40-year-old patient does not have insurance. Suppose that he makes approximately what the “average” American makes – $42,000 a year. How can he be expected to pay this back, ever? On the other hand, suppose he has private insurance. Insurance coverage may be capped at $1 million; therefore, none of his rehab would be paid for. Rehabilitation is critical to getting patients back to work quickly. The Affordable Care Act prevents insurance companies from dropping patients who need to use their health insurance. It will prevent insurance companies from dumping patients just because those patients have had a catastrophic injury or illness. Unfortunately, the Act does not prevent pharmaceutical companies from charging $20,000 per dose of vital medication. Without this medication, this patient would’ve died. With this medication, this patient becomes the $6 million man, almost.

So, how would you describe the problem?

Tags: Healthcare by ecthompson md
13 Comments »

This week I’m going to have a series of posts on Healthcare and Healthcare Reform. Tell your friends to join the conversion. I should have my first post in this series up early this evening.

Now, START needs Congress to act but the Senate has been stuck.

From TP:

Sen. Richard Lugar (R-IN) has been the leading Senate Republican urging the upper chamber of Congress to ratify the New START arms control treaty with Russia. However, the Republican obstructionism that has become so routine throughout the past two years of President Obama’s tenure is standing in the way. Sen. Jon Kyl (R-AZ) has been the face of the GOP hamstringing and despite the fact that this non-controversial treaty — one that closely mirrors the one President Reagan signed with the Soviet Union — has been thoroughly debated in the Senate for nearly a year, Kyl told the New York Times, “If they try to jam us [in the lame-duck session], if they try to bring this up the week before Christmas, it’ll be defeated.”

Lugar has been reluctant to criticize his colleagues’ obstruction. When asked last week if they were just playing politics, Lugar said, “I am not ascribing motivations to anybody.” But other Republicans don’t seem to be holding back. Brent Scowcroft served as national security adviser to two Republican presidents and has been pleading with Congress to ratify New START. Profiling Lugar’s awkward position vis-a-vis other Senate Republicans on this issue, Politico reports today that Scrowcroft isn’t being as diplomatic as Lugar on the GOP’s incentive for holding up START:

In an attempt to rally bipartisan support for the treaty, the White House has enlisted the kind of GOP foreign policy wise men that Lugar exemplifies – among them former secretaries of state Henry Kissinger and James A. Baker. But they have had no success with members of their own party, and it has left them scratching their heads over the source of the GOP opposition.

“It’s not clear to me what it is,” said Brent Scowcroft, a former national security adviser to President George H.W. Bush who noted that this START treaty is not very different from previous ones negotiated and ratified under Republican presidents. “I’ve got to think that it’s the increasingly partisan nature and the desire for the president not to have a foreign policy victory.”

Tags: Foreign Affairs, Senate by ecthompson md
5 Comments »

The FBI just arrested a Somali born teenager who wanted to detonate a bomb in Portland, Oregon. I’m kind of surprised at how much we know about the plot already. This young man contacted somebody in Pakistan who put him in touch with another man. This second man, an FBI informant/agent, was supposed to have information on how to make a bomb. The FBI sting was elaborate. The FBI proved the bomb was real. They took the young man to some deserted portion of Oregon and detonated a similar device.

If you listen to the mainstream media, they would have us convinced that Barack Obama loves terrorists. It appears that nothing could be further from the truth. The Obama administration has been outstanding, so far, at combating these terrorist threats. I’m still worried about the guys that we haven’t caught. They guys that aren’t stupid. The guys that are trying to stay under the radar.

Kudos, congratulations and a high five to the FBI. The FBI has been much maligned about their counterterrorism prowess. They’ve dropped the ball on the number of occasions. They seem to be getting their act together.

From NYT:

The terrorism attempt was the latest is a string of plots since last year involving Americans or immigrants who had become radicalized, often through exposure to extremist Web sites. In May, a Pakistani-born American was arrested in the plotting of a car bomb attack in Times Square, and later pleaded guilty.

But in contrast to that plan, which the authorities learned about only at the last minute, the F.B.I. had been tracking Mr. Mohamud since 2009 and his planning unfolded under the scrutiny and even assistance of undercover agents, officials said.

The F.B.I.’s surveillance started in August 2009 after agents intercepted his e-mails with a man he had met in Oregon who had returned to the Middle East, according to a law enforcement official who described the man as a recruiter for terrorism. According to the affidavit, the man had moved to Yemen and then northwest Pakistan, a center of terrorism activity. (more…)

Tags: Al Qaeda, Terrorism by ecthompson md
2 Comments »

This is the Thanksgiving spirit. I wish we could see more of this -

From Informed Consent:

In Memphis, Tennessee, Christians, Muslims and Jews are jointly commemorating Thanksgiving, behaving like real Americans and proper human beings. The Heartsong Christian church congregation and a Muslim community center in the Cordova district of Memphis, held a joint Thanksgiving celebration in Memphis on Wednesday. They asked a Jewish American to read the opening prayer.

Pastor Steve Stone explained to a local news reporter, “The Islamic Center bought the land right across the street from us, and that makes them neighbors, and Jesus teaches us to love our neighbors.”

Now that’s Christianity.

Of course, the classic Thanksgiving was also multicultural. The poor starving Christians at Plymouth Colony were taught New World farming and fishing techniques by the Wampanoag Native Americans, who worshipped Kehtannit, the Great Spirit and were not Christians. The noblest in American traditions are the multi-cultural and tolerant, and Thanksgiving should exemplify those values.

In fact, one of the things we should be giving thanks for on this day is that we live in a society where, ideally, it should make no difference if you are Christian or Muslim, Jewish or Buddhist, agnostic or Hindu. You can build your place of worship anywhere you like, within the boundaries of civic zoning laws, no matter which path you follow. The liberties of the US Constitution require no religious test before they can be enjoyed. They are universal. “We hold these truths to be self-evident, that ALL men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the Pursuit of Happiness. That to secure these rights, Governments are instituted among Men…” Americans are not Americans because they are white, or Christian. Everyone born here or naturalized is an American. Muslim-Americans are Americans.

Ironically, the district of Memphis where the joint event was held is known as Cordova. It was originally a farming village east of Memphis founded in 1835, which was named for Cordoba (Qurtuba) in Spain. It seems to me likely that these American pioneers knew about Cordoba through Washington Irving’s 1832 Tales of Alhambra, about Muslim Spain (he also spelled it with a “v”). Pastor Stone thus stands in a long line of Tennesseean urbane tolerance. And, Cordoba itself was the site, under the later Umayyads of a remarkably tolerant society of Jews, Christians and Muslims that is described so brilliantly by Maria Rosa Menocal in her book, Ornament of the World. It wasn’t perfect, and didn’t last, but at its best it was a damn sight better than the hell of bigotry and religious rancor fanned by the hateful in New York, Gainesville and Murfreesboro this fall. Between the two, Pastor Stone and the hateful mob, I know which one I think is the authentic American true to the ideals of the Founding Fathers.

BTW, I hope that you and your family had a happy and healthy Thanksgiving.

Tags: Domestic Issues, General by ecthompson md
2 Comments »

The Republicans have been arguing as hard as they could that extending the Bush era tax cuts would be good for the economy. Not extending the tax cuts would stifle the economy and kill job growth. When Americans didn’t buy that argument, the Republicans came back with the uncertainty over whether to extend the tax cuts or not would stifle the economy and job growth. It would kill business.

There’s probably no better example of the Republicans willingness to forsake the American people for the ultra rich than the discussion over these tax cuts. This discussion clearly proves the Republicans do not care about the deficit. The deficit is just something to with but voters. It is been clearly shown that tax cuts do not pay for themselves. If we extend the tax cuts to the rich, this will cost the American people close to $700 billion over 10 years. Do you have an extra $700 billion? I don’t but Goldman Sachs does. (Please note that corporate profits are up… Way up.)

Visit msnbc.com for breaking news, world news, and news about the economy

I think is important for president Obama the stand with the American people. He needs to clearly articulate why the Bush era tax cuts need to expire. Basically, the rich get a tax cut and we get nothing for $700 billion. This is why these tax cuts need to expire.

Tags: Economy, Party Politics, Taxes by ecthompson md
3 Comments »

I hope the you and your family have a happy and healthy Thanksgiving. It really is time for us to be thankful. I know that it is fashionable to hate Democrats or Republicans. It is fashionable to call liberals, socialists. It is fashionable to use Hitler or Nazi rhetoric to describe the other side but I have tried to refrain from that. In the end, America does not prosper until we all prosper. Until we all come together, we can’t move forward. I have tried moderation. I’ve tried to find reasonable topics. I’m sure, from time to time I have failed in my quest. I’ve also tried to be reasonable in my discussion. I think, deep down, I believe that thoughtful discussion will point this country in the right direction. It is the ability to come together, discuss, argue and come up with a reasonable solution that will get us through these difficult times.

I hope you and your family have reasonable discussions. I hope you laugh. I hope you have good food. I hope you’re well.

Tags: General by ecthompson md
1 Comment »

For years now I’ve had to put up with conservatives telling me that former House #2 Republican leader, Tom DeLay, had done nothing wrong. Well, a jury in Texas seems to disagree. I know that many people are rejoicing right now. I wish they wouldn’t. I will not rejoice at another man’s downfall. It seemed to me that Tom DeLay knew where the boundaries were and stepped all over those boundaries. (Look for conservatives to attack the jury. Soon we will know how many Republicans and how many Democrats were on the jury. There will be cries about how “liberal” the jury was. Let’s get one thing straight, (and this is from someone, me, who has lived in Texas most of his life), there is no such thing as a liberal jury in Texas.)

From the Austin Stateman:

Tom DeLay, the former U.S. House majority leader whose name became synonymous with the Republicans’ controversial rise to power in the Texas House, was found guilty this evening of laundering money in connection with the 2002 elections.

Jurors sent a note on yellow legal paper that a verdict had been reached to the judge at 4:46 p.m. They had deliberated for nearly 19 hours, since Monday afternoon.

The unanimous verdict on two criminal charges was read to a hushed courtroom three minutes later. DeLay, who moments earlier had been smiling, appeared shocked as the 12 jurors — six men and six women — reported their decision one by one.

DeLay, at one time one of the most powerful men in Washington, was charged with money laundering and conspiracy to commit money laundering. He faces a possible sentence of five to 99 years in prison and a maximum $10,000 fine on the money laundering charge, and two to 20 years in prison and a possible $10,000 fine on the conspiracy charge. (more…)

Tags: Domestic Issues, House of Representatives by ecthompson md
1 Comment »

Editor’s note: I have two posts on the history of the United States and North Korea (here and here). I think that they are worth reading.

North Korea has lobbed shells at South Korea.

Two South Korean marines were killed and many houses were destroyed.

(Above–North Korean soldiers peering into South Korea. Like you and I, these troops in the picture are people in a world they did not create.)

This took place on Yeonpyeong Island. This is not the first conflict between the two Koreas over this island.

President Obama has said that the United States will help defend South Korea if that is what is required.

With all this trouble, I found myself wondering if Mitch McConnell and John Boehner had taken over North Korea.

We already know the Republican Party wants the economy to fail as long as President Obama might get the credit for things going better.

We also see with the START Treaty that Republicans will undermine our foreign policy  for no other reason but to offer up opposition.

A New Korean War could be used to attack Mr. Obama in many ways—

* President Obama could be blamed for failing to keep the peace.

* When focusing on war strategy, the President could be criticized for not working on job creation.

* The need to fund the New Korean War could be used as a pretense to further gut the social safety net.

* Munitions blasted into the air during the war could be blamed for climate change— Though even better for this purpose would be an exchange of nuclear weapons.

* Both North Korea and South Korea are in Asia. Since many Muslims live in Asia and since Obama is a Muslim, the New Korean War would be the fault of Muslims like Obama.

* And, of course, a New Korean War would show that this is the right time for tax cuts. The fact the sun rises in the morning is also a reason for tax cuts. [Read more →]

Tags: Books, Foreign Affairs, North Korea, Party Politics by Neil Aquino
2 Comments »

I go to work and work all day and of a sudden there is a crisis in Korea. What the hell? Where did this come from? Is South Korea ready for a final showdown? How many Patriot Missiles do we have in South Korea? Is it enough? This is bad.

From Political Animal:

• Crisis on the Korean Peninsula: “South Korea warned North Korea on Tuesday of ‘enormous retaliation’ if it took more aggressive steps after Pyongyang fired scores of artillery shells at a South Korean island in one of the heaviest attacks on its neighbor since the Korean War ended in 1953.”
• For crying out loud: “For months, the secret talks unfolding between Taliban and Afghan leaders to end the war appeared to be showing promise, if only because of the appearance of a certain insurgent leader at one end of the table: Mullah Akhtar Muhammad Mansour, one of the most senior commanders in the Taliban movement. But now, it turns out, Mr. Mansour was apparently not Mr. Mansour at all.” [Editors note: This might not be the dumbest act of 2010 but I'm it is in the top 10!]
• Maybe someone should do something: “Top Federal Reserve officials expect the unemployment rate to remain around nine percent at the end of next year and eight percent at the end of 2012, according to internal forecasts that drove the central bank to take new efforts to boost the economy three weeks ago.”
• Also not encouraging: “Sales of previously owned homes slipped slightly in October as the housing market struggled in the face of high unemployment and tight credit.”
• When dealing with congressional Republicans, if Dems “hope for the best, and plan for the worst,” they’ll be on the right track.
• The dispute among Senate Republicans over ethanol subsidies continues to get even more interesting.
• The fact that incoming House Budget Committee Chairman Paul Ryan (R-Wis.) is considered a leading Republican voice on economic policy is rather horrifying.
• Harold Pollack reports on encouraging developments in combating AIDS.
• The Daily Caller‘s transition from credible to dubious to ignominious to cover-your-eyes-ridiculous was completed today.
• Daniel Luzer takes a closer look at some of the ethical issues surrounding Melanie Sloan’s departure from Citizens for Responsibility and Ethics in Washington (CREW).
• Fox News refuses to air paid advertising featuring U.S. troops, apparently because they don’t like what the servicemen and women have to say about repealing “Don’t Ask, Don’t Tell.”

So, what’s on your mind today?

Tags: Afghanistan, Domestic Issues, North Korea, Party Politics by ecthompson md
2 Comments »

American companies have reported record profits for the third quarter of 2010.

From the New York Times-–

“The nation’s workers may be struggling, but American companies just had their best quarter ever. American businesses brought in $1.66 trillion at an annual rate in the third quarter, according to a Commerce Department report released Tuesday. That is the highest figure recorded since the government began keeping track over 60 years ago, at least in nominal or non-inflation-adjusted terms. Corporate profits have been going gangbusters for a while. Since their cyclical low in the fourth quarter of 2008, profits have grown for seven consecutive quarters, at some of the fastest rates in history. This breakneck pace can be partly attributed to strong productivity growth — which means companies have been able to make more with less — as well as the fact that some of the profits of American companies come from abroad.”

What do you think these profits mean for working people?

Layoffs?

Wage cuts?

Benefit cuts?

More temporary workers instead of full-time positions?

Who should we blame for the hard times facing the American worker?

Muslims?

Obama?

Immigrants?

What a country this is right now.

Tags: Domestic Issues, Economy, Poverty by Neil Aquino
7 Comments »

Baseball fans may be aware of the saying “Spahn and Sain and pray for rain.”

(Above–Spahn on the left and Sain on the right.)

These words are about the 1948 Boston Braves. Warren Spahn and Johnny Sain were two starting pitchers on the ’48 Braves team that won the American League pennant and then lost the World Series to the Cleveland Indians.

The Boston Braves, after a stop in Milwaukee for a few years, are the current Atlanta Braves.

The words are, as I have learned in researching  this post, from a poem written by a Boston sportswriter named Gerald Hern.

Here is the poem—

First we’ll use Spahn
then we’ll use Sain
Then an off day
followed by rain
Back will come Spahn
followed by Sain
And followed
we hope
by two days of rain

The poem conveys the idea that the only decent starting pitchers for the Braves where Spahn and Sain. It suggests the only way the Braves could win was to have Spahn pitch one day, Sain another day, and then hope for rainouts that would get Spahn and Sain back on the mound without having to use other pitchers. [Read more →]

Tags: General, Sports by Neil Aquino
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Sometimes when I argue with conservatives I get a headache. In one discussion group, a conservatives is trying to argue that Warren Buffett knows nothing about the economy. The same conservative acknowledges that Warren Buffett understands the markets and start prices. I find the argument awfully convenient. Convenient? Painful is a better word. It is nonsensical. It gives me a headache. It’s like saying that I’m a great critical care surgeon but I don’t know anything about medicine.

It is my personal opinion that the middle class is shrinking. The middle class is shrinking because jobs are being shipped overseas and we have policies that benefit the rich over the rest of America.

From HuffPo:

Pulitzer Prize-winning journalist David Cay Johnston says it’s no accident that the middle class has been shrinking.

In fact, in a recent conversation with Aaron Task and Daniel Gross on Yahoo’s Tech Ticker, Johnston argues that the middle class is a direct result of a maze of subsidies and sweetheart deals that states and cities have doled out to big companies. (Johnston is the author of “Free Lunch: How The Wealthiest Americans Enrich Themselves At Government Expense (And Stick You With The Bill.”)

“We’ve changed the government rule book in tremendous ways this enormous growth of incomes at the top is not the result of market forces,” Johnston says, “it’s the result of all these rules nobody knows about.”

Among the questionable benefits that Johnston identifies are the deals received by teams in America’s biggest four sports which, he says, get subsidies that are worth more than their combined profit. Cabelas, a sporting goods store, got $1.37 in subsidies for every dollar of profit it brought in, he notes.

Tags: Economy, Party Politics, Taxes by ecthompson md
5 Comments »

Republicans have now argued for over 30 years that we need to cut taxes and the rich will have more money to spend on all of us. It is the core of supply-side economics. It has NEVER worked.

From EPI:

Contrary to the predictions of supply-side proponents, the 1981 tax cuts did not lead to better economic performance.  Economists generally measure performance from one business cycle peak to the next.  The last three peaks occurred in 1979, 1989, and 2000.  It is instructive to compare the performance of investment, productivity, and output in the 1979-89 cycle, which was influenced by the 1981 tax cuts, with the 1989-2000 cycle, which was little affected by those cuts.

Click on graph for larger version

Warren Buffett has been saying this for years. He was on This Week and repeated that we needed to raise taxes on the rich.

From HuffPo:

“I think that people at the high end, people like myself, should be paying a lot more in taxes. We have it better than we’ve ever had it,” he told ABC’s Christiane Amanpour in a clip played on “This Week” on Sunday.

When Amanpour pointed to critics’ claims that the very wealthy need tax cuts to spur business and capitalism, Buffett replied, “The rich are always going to say that, you know, ‘Just give us more money, and we’ll go out and spend more, and then it will all trickle down to the rest of you.’ But that has not worked the last 10 years, and I hope the American public is catching on.”

Tags: Economy by ecthompson md
15 Comments »

Let’s start off with the best plays of last week (week 10).

NFL Week 10 plays of the week [ 2:38 ] Play Now | Play in Popup | Download

Okay the Thursday night football game was a complete snoozer. The Chicago Bears beat the Miami Dolphins 16-0. There’s a lot of talk about how great Tyler Thigpen could possibly be. All you can do is laugh.

Early Games (all the games that are indented, in my opinion, will be worth watching)

Baltimore Ravens versus Carolina Panthers – Carolina has no playmakers outside of Steve Smith on either side of the ball. Baltimore Ravens have shown that their defense is suspect. Carolina will not be able take advantage of this. The Ravens by 10.

Buffalo Bills versus Cincinnati Bengals – I continue to question whether Carson Palmer is “the man.” If he plays better, that opens up the running lanes. If he plays better, that gives defense more rest and it allows his defense to play with the lead. If the Bengals can control turnovers, they should win this game.

Detroit Lions versus Dallas Cowboys – I don’t think this game will be worth watching. Although Detroit is improving, they really still don’t have a quarterback. Without a quarterback, it’s near impossible to win in this league. On the other hand, Dallas has Jon Kitna who played very well last week. Throughout his career he has shown periods of brilliance followed by large time spans of mediocrity. Can the offensive and defensive lines of the Dallas Cowboys win in the trenches? The only thing that is sort of interesting in this game is that the Lions have not won on the road and over two years. The Cowboys haven’t won at home this year. Something has to break. If the Cowboys can control turnovers (and this is a big if) they can win this game.

Cleveland Browns versus Jacksonville Jaguars – David Garrard has been playing lights out the last two or three weeks. The Browns seem to play a style of offense reminiscent of the Jaguars of four or five years ago. The Browns are pounding the ball and controlling the clock. This game will come down to turnovers. I think both teams have improved significantly over the last month. Jacksonville is playing at home. I’m leaning towards them but only slightly.

Arizona Cardinals versus Kansas City Chiefs – Watch this game at your own risk. Extreme boredom may breakout. Arizona Cardinals are simply awful. There bad on both sides of the ball.  I feel sorry for Larry Fitzgerald, a greater receiver in search for a quarterback. Look for Kansas City to win this game easily.

Green Bay Packers versus Minnesota Vikings – Why is Brett Favre still in the game? Look at his numbers (10 TDs, 16 Ints, 18 Scks, 5 Fumbles with a passer rating of 72.2). He is been awful. Yes, he has conjured up some of that old “Brett Favre magic” to win a couple games but the reason they were behind was because Brett Favre was turning the ball over like it was written in his contract. The Green Bay Packers have yet to hit their stride. Aaron Rodgers is playing well. Minnesota cannot generate a pass rush with their front four. I don’t know what’s happened. Maybe everybody got old all at once. Maybe, the league figured out how to block these guys. All I know is without a significant pass rush, Aaron Rodgers is going to carve them up like a Thanksgiving day Turkey. Look for Minnesota to lose another one and for football pundits to speculate when Brett Favre will be benched (you can pay me an extra $7 million for me to ride the bench. I can do that. I promise.)

Houston Texans versus New York Jets – I think this can be pretty good. The Texans have problems on defense. They also seem to have a lack of focus at times on offense. The combination has allowed several games to get away from them. The New York Jets seem to be improving on both sides of the ball. I think they’re playing better on defense and better offense than they did three or four weeks ago. Mark Sanchez is playing better. He is making better decisions with the football. I just don’t think that the Houston Texans will be able to get their ground game going against the New York Jets. Andre Johnson, the best receiver in the league, will be double or triple covered with some exotic zones. If they’re able take him away, the Houston Texans are in trouble. I look for the New York Jets to pound out a victory.

Oakland Raiders versus Pittsburgh Steelers – What happened to the Pittsburgh Steelers last week? Tom Brady and the gang made the “vaunted” Steeler defense appear average. Look for the Oakland Raiders to try to do some of the same things that the Patriots did with two and three tight end sets. It was a match up nightmare for the Steelers. The Oakland Raiders for the first time in four or five years are playing some pretty good football. I think the Steelers need a better core of receivers. Outside of Wallace, the rest of the receivers are average at best. Hines Ward is way past his prime. Because they’re playing at Pittsburgh, I’m given the Steelers a slight edge.

Washington Redskins versus Tennessee Titans – the Redskins are still licking their wounds from being embarrassed on national TV. The Redskins have problems at all of their skill positions on offense. I don’t think they really have any wide receivers that make defenses tremble. Who is their running back? They have well-documented problems on defense. The Tennessee Titans are getting better. I’ve been impressed with Vince Young’s performances over the last several weeks. He seems to be making good decisions and seeing the field well. I look for Tennessee to rack up another victory at home. [Read more →]

Tags: Sports by ecthompson md
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It appears that someone is going down. We just don’t know who. Now, before conservatives start yelling that this investigation is “proof” that the Obama administration is hostile to Big Business, this investigation was started three years ago. Get out your calculators. That was during the Bush administration.

From WSJ (may need a subscription):

The criminal and civil probes, which authorities say could eclipse the impact on the financial industry of any previous such investigation, are examining whether multiple insider-trading rings reaped illegal profits totaling tens of millions of dollars, the people say. Some charges could be brought before year-end, they say.

The investigations, if they bear fruit, have the potential to expose a culture of pervasive insider trading in U.S. financial markets, including new ways non-public information is passed to traders through experts tied to specific industries or companies, federal authorities say.

One focus of the criminal investigation is examining whether nonpublic information was passed along by independent analysts and consultants who work for companies that provide “expert network” services to hedge funds and mutual funds. These companies set up meetings and calls with current and former managers from hundreds of companies for traders seeking an investing edge. (more…)

Tags: Bush Administration, Business, Obama administration by ecthompson md
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(play that nostalgic American music, softly)

I have no trouble with anyone who wants to make money. As a matter fact, I kind of like having money. Yet, if you’re a business, there should be a balance between making money and customer satisfaction. Currently, the balance is out of whack. From time to time, on this blog, I have talked about the fact that customer service is dead. It isn’t any one company, it’s almost everyone. In the mid-1990s, I switched from Gateway computers to Dell because of service. Once Dell gained market share, customer service became an afterthought. I’ve had problems with AT&T, GMAC, American Express and probably a few others.

Hey, let’s be honest. The calculations have already been done. If we scale back our customer service and ship our call centers to India, how many customers will we lose and tick off? Do we make more money compared to the amount of money we lose for ticking off customers? This is the big business calculus. Big Business is saying that it is okay to piss off some number of customers. That’s okay because they’ll will make more money in the long run.

The following is a tale that I’m sure you and I have lived through way too often.

From WaPo:

This column was written entirely while on hold with eBay customer service.

John: My name is John. What is the nature of your problem?

Me: The nature of my problem is that I’ve been on hold for one hour and 11 minutes, listening to staticky Beethoven. Every 30 seconds a woman’s voice has told me the call was important to her and then a man’s voice has told me that someone will be with me “in just a moment.” So eBay has been serially lying to me four times a minute for a total of 284 lies. It was in the middle of the 285th lie when you picked up and told me your name was John, which I am thinking, from your voice, is a 286th lie.

John: My name is really John.

Me: Where are you, John?

John: San Jose.

Me: I don’t think so.

John: We are located in San Jose.

Me: You are not. Admit it.

John: Okay. We are an offshore center. Calls are routed through San Jose.

Me: Two hundred eighty-six!

John: How may I help you?

Me: You can admit your name is not John.

John: My name is John.

Me: It is not. Is it? Is it?

John:

Me: Two hundred eighty-seven!

“John“: What is the nature of your problem?

Me: My original problem now seems so trivial, compared with the length of my wait that it no longer matters to me. If that is eBay’s business plan, it is brilliant! But now I’m just so angry, I am going be totally unhinged. I am going to ask you, for the record, if eBay embraces the Big Lie as an homage to Joseph Goebbels, or is your policy just similar to, but independent of, actual Nazi ideology?

“John”: We’ve been trying to accommodate members as fast as we can. …

Me: By subjecting your customers to this sort of wait, is eBay actually trying to exasperate people into cerebrovascular accidents, otherwise known as strokes?

“John”:

Me: Okay, I will now tell you my little problem. (I do.)

“John”: Let me look into this.

Me: Whatever you do, don’t put me on … (Seventeen minutes of staticky Beethoven, and 67 more lies.) (more…)

Tags: Business by ecthompson md
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As usual, I don’t understand Republican obstructionism. The new START treaty needs to be ratified. What is their thoughtful objection?

From TP:

Sen. Jon Kyl (R-AZ) has become the face of GOP obstruction regarding President Obama’s push for the Senate to ratify the New START nuclear arms control treaty with Russia. Without the treaty in place, the U.S. has no legal authority to monitor Russia’s nuclear arsenal. And if New START isn’t ratified, not only will U.S.-Russian relations suffer but so will American credibility on issues such as Iran and nonproliferation. “The world’s nuclear wannabes, starting with Iran, should send a thank you note to Senator Jon Kyl,” the New York Times editorialized this week referring to Kyl’s obstruction. Today on MSNBC, Sen. Rich Lugar (R-IN) urged Republicans such as Kyl to support the treaty and called on Majority Leader Harry Reid (D-NV) to hold a vote on it in this lame-duck session of Congress:

LUGAR: Please do your duty for your country. We do not have verification of the Russian nuclear posture right now. We’re not going to have it until we sign the START treaty. We’re not going to be able to get rid of further missiles and warheads aimed at us. I state it candidly to my colleagues, one of those warheads…could demolish my city of Indianapolis — obliterate it! Now Americans may have forgotten that. I’ve not forgotten it and I think that most people who are concentrating on the START treaty want to move ahead to move down the ladder of the number of weapons aimed at us.

More on the New START treaty here, here and here.

Tags: Foreign Affairs by ecthompson md
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Many of you know that I really love Brian’s blog, Advanced NFL Stats. Brian does some amazing things with numbers. I’m not sure where he gets his numbers, what statistical program he uses to squeeze out answers, but his information is sure intriguing. His basic premise is that football is just like baseball, that it can be broken down into numbers. So, he asks, who has had the best performance since 2000?

From Advanced NFL Stats (his glossary is here [your going to need it!]):

Michael Vick blew up the Redskins Monday night with 333 passing yards, 4 passing TDs, 80 rushing yards, 2 rushing TDs, and no turnovers. It was an almost flawless individual performance from beginning to end, worth 29.4 Expected Points Added (EPA). How does it compare to the top individual performances since 2000?

The decade’s top performance belongs to Tom Brady, 2007 edition. His performance in the Patriots’ 59-12 win at Buffalo was worth 33.3 points. Here are the rest of the top performances:

Tags: Domestic Issues by ecthompson md
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I appreciate Representative Rangel and his service but it now time for him to go.

From TPM:

The ethics committee has found that Rep. Charlie Rangel (D-NY) violated congressional ethics rules.

The committee ruled that Rangel was guilty on 11 counts. Rangel had been accused of 13 violations. On one, the committee was deadlocked. The committee dismissed another charge, rolling it into one of the others.

The subcommittee that found the violations will now forward the convictions to the full ethics committee. The full committee will then hold another hearing, during which it will vote on whether to recommend a punishment for Rangel. If they do, they will send that recommendation — be it admonishment, censuring, expulsion or otherwise — to the full House for a vote.

The violations stem from four different actions: Rangel used official Congressional resources to raise funds for an educational center in his name; he failed to report taxable income on a rental villa in the Dominican Republic; he filed inaccurate financial disclosure forms; and he used a rent-controlled apartment in Harlem as a campaign office. (more…)

I saw this cartoon and I had to add it.

Tags: Domestic Issues by ecthompson md
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