The Trump Administration has vowed to put an end to “surprise medical bills.”  But this may be easier said than done.

Reports of “sticker shock” have exponentially grown over the years and consumers want transparency of what their health care visit is going to cost.  However, the average physician, nurse practitioner, physician assistant, hospital, medical center, etc. don’t know themselves until the insurance company sends an EOB “Explanation of Benefits” delineating what is discounted, what is covered, and what is the patient responsibility.

So to start, President Trump is asking Congress to address those charges incurred by “out of network” facilities to which patients go to in an emergency setting.  Wanting to hold “insurance companies and hospitals accountable,” President Trump wants to put an end to patients getting charged for “services they did not know anything about, and sometimes services they did not have any information on.”

Can he do it?  Politicians on both sides of the aisle want to help curb health care costs, but both sides want to get the credit.  There’s race to see who could do more for healthcare before the 2020 election.

Why can’t health costs be predictable/fixed?

There’s a few reasons why cost transparency in an emergency medical setting is challenging.

Firstly, insurance companies aren’t transparent to hospitals. They only inform the medical facility of the out of pocket costs once they take weeks to review the claim.  This can be streamlined and cut down in time with software, but same day pricing by an insurance company is impeded by the need to see if the patient paid (or will pay) their premiums that month, or if they are still employed and have the same active insurance.

Secondly, patients don’t always know what their diagnosis is when they walk up to the front counter. Some may think they have a “cold,” but actually end up having a bout of pneumonia. Some may think they have a “stomach bug,” but after CT confirmation, learn they have appendicitis. Hence until the medical provider performs the evaluation and testing, a diagnosis and then “cost to treat”, cannot be given.

Finally, patients may not prefer the “cost factor” added into their facilities’ decision making.  If they pay a certain amount for a visit and end up needing more pain control, a repeat breathing treatment, or some extra bandages, they may not want to have to take out their wallet, sort of speak, each time they need more services.

As a physician who, for years, pleaded with insurance companies to give us an idea of what they would want a patient to pay, I’m for any campaign to increase price transparency and offer patient’s more choice.  However, since medicine and health can be unpredictable, coming up with predictable “costs” may prove difficult.

---- 

Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Published in Health

Watching President Trump host a national day of prayer at the White House—immediately after Nancy Pelosi spewed impeachment talk at her press conference—reminds me of a favorite story about my late friend, Oral Roberts.

 

President Roberts was, of course, the biggest fan of the Oral Roberts University basketball team, for which my then Tulsa radio station, KTRT, created a network to distribute the broadcasts which we originated.  But ORU was an independent at the time and had to hire referees from the Big Ten, Missouri Valley and other conferences.  Sometimes, they didn’t get the best refs.

 

One of the features at an ORU home game was an invocation, usually given by a student in the divinity school.  As students are wont to do, the invocations began getting longer and longer until they began to irritate President Roberts.  The kids were spending time blessing everything in the building…the hardwood, the rims, the band etc.

 

One night, prior to a fairly big game, President Roberts caught me in the hallway of the Mabee Center and asked if we cut away during the invocation and the National Anthem.  The answer was an emphatic no, we did not because I always found that carrying a message to God and to our nation is also good business and was unashamed then and now. (That is our policy even today.)

 

He smiled and said, “good, tonight will be interesting.”

 

At the appointed time, public address announcer Doc Blevins waited for the lights to go down and said something like, ladies and gentlemen, giving tonight’s invocation is the founder, President and Chancellor of Oral Roberts University…Oral Roberts!

 

The spotlight went on, President Roberts strode to the center of the court, put a microphone to his mouth and said, “Heavenly Father, please bless the referees’ eyesight. Amen” And walked off the court.

 

Then, he came over to our table, sat down next to me, smiled and asked, “How did I do?”

 

He later told me that he never prayed for a win.  That God doesn’t determine wins and losses.  He just gives you the talent to win.  Winning is up to you.

 

But things which stood in the way of winning—poor officiating, as an example—were fair game.

 

To a great extent, that’s where President Trump finds himself today.

 

He is a very talented individual who won the Presidency against all odds.  God gave him that talent. Think of the Democrat controlled House as a mediocre referee who has a decided vendetta against a very non-establishment, independent public official.

 

The House is trying to use every opportunity to make a call against the President.

 

As usual, when officiating gets in the way of the game, there are no immediate winners and almost everybody involved loses.

 

Frankly, the House Democrats are just like the refs who screwed the Vegas Golden Knights in the last game of round one of the Stanley Cup Playoffs.  And the results are most likely the same in the long term because it is the fans (the voters in this analogy) that get to make the ultimate decision.  In sports, the decision shows up in attendance and TV ratings over the long term.  Think Colin Kaepernick and the NFL.

 

Do you really think that the Democrats, running on investigating the President, will be successful?

 

So far, they are not only out of control on investigations but on the positions being staked out by the 20-some candidates who think they have what it takes to become President.

 

You can’t beat a horse without an equally talented horse—unless some state employee gets involved (think last week’s Kentucky Derby) and we’ve already been through that in the past two years.

 

I guess it all gets down to Oral Roberts’ position that you never pray for a win.

 

That’s what the Democrats are doing because the only reason any of them can give to get elected is that they are not Donald Trump.  Americans are not that stupid.

 

----

 

Fred Weinberg is a columnist and the CEO of USA Radio Network. His views and opinions, if expressed, are his own and do not necessarily reflect the opinions of GCN. Fred's weekly column can be read all over the internet. You can subscribe at www.pennypressnv.com. His column has been reprinted in full, with permission. 

Published in Opinion

American Progressives today like to talk about their Green New Deal, free higher education for all and slavery reparations.  But recently the eminent economist Dr. Thomas Cargill addressed Reno’s Hayek Group about Progressives’ original cause: eugenics.

Eugenics is a dark and troubling part of US history – one not accurately reflected in standard accounts and teaching today of that history.  The “scientific” racism of eugenics ideology flowered in the second half of the 19th Century through the 1930s.

It classified persons as “fit” or “unfit” based on traits assumed to be hereditary, including race and ethnicity, mental and physical characteristics, and country of origin.  Because “fitness” was assumed to be genetic, it was hereditary and thus immutable: not subject to alteration via environment, nurture or other conditioning methods.

Eugenics gained wide acceptance, even being reflected in decisions of the Supreme Court of The United States.  “Three generations of imbeciles are enough,” said Chief Justice Oliver Wendell Holmes in the case of Buck v. Bell, a 1927 decision upholding a Virginia law that authorized the state to surgically sterilize certain “mental defectives” without their consent.

Eugenics doctrine had a broad reach from justifying slavery to the alleged superiority of Nordic peoples (“Aryans”) to other races.  It was fostered in the US by the mushrooming of the administrative state during the progressive period, and it also provided some ostensible intellectual foundation for that mushrooming.

German Nazism also drew greatly on the developing American eugenics tradition.  As much as anything, the fall of the Third Reich undid eugenics.

After the Civil War, it was used first to justify low military compensation for blacks and then to support barriers to non-Nordic immigration.  Implementation of eugenics was helped by the rise of progressivism’s administrative and interventionist government over-riding the outcomes of free markets.  By 1905, 32 states had sterilization laws fostered by eugenics, and thousands of people were sterilized.

One scholar recently noted, “Eugenics and progressivism were made for each other.”  The doctrine was an excuse for the exercise of extreme coercive collectivism, the fundamental means employed by progressivism.

Minimum wage legislation was also originally related to eugenics, as it proposed to let the market pay low or no wages to the unfit persons (mainly races) so they would over time die off.  Even the famous Yale economist Irving Fischer bought into such dogma.

Perhaps the most (in)famous proponent and activist in favor of eugenics and its abuses of human beings was Planned Parenthood founder Margaret Sanger, who was an outright racist.  Her 1933 article in the journal Birth Control Review was also a strong argument against immigration to America.  And sterilization of the mentally ill was a popular birth control idea from the start.

The notable surprise beyond the flourishing of eugenics in America is that it has been almost completely omitted from modern history and government texts.  Since almost all high school students must take a US history course, this omission has given them a completely false account of very important US history, politics and government.  Eugenics and its disastrous history as a key part of progressivism are at best mentioned in passing, and mostly minimized and treated as not a significant part of our history.

Why?  The writers of the books don’t themselves seem to know much about this central subject.  Some authors are aware, but seem to consider it unimportant; eugenics is viewed by many progressives as the crazy uncle in the family.  Also, eugenics’ relationship to abortion makes it a taboo subject for many advocates of that practice.  And almost all these writers are progressives with a bias in support of the over-reaching administrative state, and discussing eugenics undermines that key advocacy.

What do students lose due to these biases and omissions?  First, balanced and reasonably complete perspective on US history, politics and government and the roles of various factions then and now. Second, a necessary skepticism of the ideology of catastrophe supported allegedly by science.  (See also climate change deniers.)  Third, the perils of small groups, especially of self-selected elitists, controlling social power; this often leads to bad decisions and social disasters.  (See also China’s one-child policy.)  Finally, a profound understanding of the power of even a bad idea.

 

--

 

Ron Knecht is a contributing editor to the Penny Press - the conservative weekly "voice of Nevada." You can subscribe at www.pennypressnv.com. His column has been reprinted in full, with permission. 

 

 

 

 

Published in U.S.
%PM, %09 %807 %2019 %18:%May

Parkinson risk tied to appendix removal

Those who have had their appendix removed may be at 3X greater risk of later developing Parkinson’s.

Researchers at Case Western Reserve University and University Hospitals Cleveland Medical Center looked at 62 million health records from 26 institutions throughout the US and found that those who had an appendectomy, surgical removal of the appendix, had a 3-fold risk of developing Parkinson’s later in life.

Internal medicine second year resident and study author, Dr. Mohammed Z. Sheriff, states,

“RECENT RESEARCH INTO THE CAUSE OF PARKINSON’S HAS CENTERED AROUND ALPHA SYNUCLEIN, A PROTEIN FOUND IN THE GASTROINTESTINAL TRACT EARLY IN THE ONSET OF PARKINSON’S.”
“THIS IS WHY SCIENTISTS AROUND THE WORLD HAVE BEEN LOOKING INTO THE GASTROINTESTINAL TRACT, INCLUDING THE APPENDIX, FOR EVIDENCE ABOUT THE DEVELOPMENT OF PARKINSON’S.”

Researchers suggest more research to be done, with investigational focus on gut health as it relates to neurological health.

The Appendix: NOT a useless organ

What is Parkinson’s Disease?

Parkinson’s disease is the second most common neurodegenerative disorder, next to Alzheimer’s, and the most common movement disorder that affects 1% of the world’s population over 60 years old. In the US, 60,000 new cases are diagnosed each year.  It affects several areas of the brain, primarily the substantia nigra, altering balance and movement by affecting dopamine producing cells.

It was first described in 1817 by James Parkinson as a “shaking palsy.”

What are the Symptoms of Parkinson’s?

Common symptoms of Parkinson’s include:

  • Stiffness and rigidity
  • Poor balance
  • Tremor at rest, especially a pill-rolling tremor
  • Slow movement
  • Inability to move
  • Shuffling steps, gait

and patients may later develop…

  • Depression
  • Anxiety
  • Memory loss
  • Constipation
  • Decrease ability to smell
  • Difficulty swallowing
  • Erectile dysfunction
  • Pneumonia
  • Fractures from falling
  • Hallucinations
  • Delusions
  • Dementia

Who is at Risk for Parkinson’s?

Most cases are idiopathic, meaning the disease arises with no specific cause.  However some cases are genetic and multiple genes have been identified that are associated with the disease.

The average age of onset is 60, but some cases may occur as “early onset”, before the age of 50, and if before the age of 20, it is known as juvenile-onset Parkinson’s.

Men appear to be more affected than women at twice the rate.

Risk may be enhanced with a history of head trauma.

Exposure to herbicides and pesticides has been linked to an increase risk of Parkinson’s as well.

How Quickly do Parkinson’s Symptoms Progress?

Average progression rates can last years to decades, however, earlier onset disease may manifest much quicker.

How is Parkinson’s treated?

Although there is no cure for Parkinson’s, symptoms can be treated by a variety of measures.

  • Levadopa – converts to dopamine in the brain, helping replace the deficient hormone.
  • Carbidopa (Sinemet) – if given with levadopa prevents the latter from being broken down before it reaches the brain.
  • Dopamine agonists – mimic dopamine
  • MAO-B inhibitors – helps block the enzyme MAO-B, which breaks down natural dopamine
  • Other medications including COMT inhibitors, amantadine and anticholinergics
  • Medications to treat anxiety and depression
  • Deep brain stimulation – a surgeon implants electrodes into the brain, allowing stimulation of parts that help regulate movement.
  • Stem cell therapy – being investigated as a means to create dopamine-producing cells
  • Physical and occupational therapy

Famous People Diagnosed with Parkinson’s

  • Michael J. Fox
  • Janet Reno
  • Robin Williams
  • Muhammad Ali
  • Casey Kasem
  • Johnny Cash
  • Linda Ronstadt
  • Pope John Paul II
  • Peanut’s creator Charles Schulz
  • Rev. Jesse Jackson
  • Neil Diamond

---- 

Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Published in Health

 It’s the kickoff for hurricane season and forecasters are predicting as many as 14 named storms with anywhere from 3 to 6 of these storms growing into major hurricanes. Here on the Gulf Coast, we certainly perk up when this time of year rolls around.  For years, a good story in south Louisiana went like this:

 “I’m a Catholic, so I certainly know a good bit about suffering,” she would say.

“Yeah, I’m a Louisiana homeowner, he answered.

“Oh, so you understand.”

Louisiana homeowners know a good bit about suffering, particularly when it comes to being stuck with the highest property insurance rates in the nation. The Clark Research Group determined that Louisiana has some of the highest insurance costs, coming in at an average of more than $6000.00.  No other state in the South comes close. If you live in industrialized New Jersey, the cost is $1,318.00, a drop of some $300.00 in the past 10 years.  California, with wildfires and massive rain caused mudslides, pays an average of $1,988.00.

But that’s not the whole story. Congress merely put its finger in the flood insurance dike with legislation that supposedly capped the skyrocketing rates of property owners in flood prone areas. But what our minions in Washington didn’t tell us is that the rates will continue to climb dramatically in the years to come. The legislation is just a quick fix to hoodwink voters in order to get through the next election cycle.

Because of the devastating hurricanes that seem to hit the gulf coast at least once a decade, the federal government has bailed out these southern states, literally and financially, time, and time again. Some cynical members of Congress have even suggested that it’s time for many homeowners to relocate. But attitudes are beginning to change, because other oxen are being gored. Mother Nature has given the Gulf South a pass in recent years, but she is causing havoc in other parts of the nation.

Oklahoma has suffered an unprecedented surge in both earthquakes and tornadoes and are clamoring for federal help. New York and New Jersey have a long way to go to recover from last year’s Hurricane Sandy. In Texas, hurricanes and wildfires have cost some $28 billion in recent years. California witnessed rapid growth in both drought and wildfires, and earthquakes remain a constant threat. A Wall Street Journal study published recently concluded that almost every state in the nation is subject to some major disaster.

So has a national plan that doesn’t use taxpayer dollars been proposed which is both comprehensive and affordable? Yes. Such a proposal was unveiled in New Orleans in May of 1995 at a catastrophe insurance conference sponsored by the American Insurance Services Group. I attended as Louisiana’s Insurance Commissioner. The proposal called for a Natural Disaster Insurance Corporation (NDIC) that would sell disaster reinsurance for residential and commercial properties while also providing primary coverage for residential properties. We all agreed back then that there would be a huge problem with catastrophic insurance losses all over America unless a national disaster program was put in place.  And that’s just what’s happening across the country now.

Here is how it would work. Private insurance would take a small portion of its premiums and contribute to a state created fund.  The state fund would then be backed up by a nationally created fund.  The national fund could borrow to pay for any shortfall, but no federal tax dollars would be involved.  Each state could buy in and have a rate set according to the risk.  Hurricane prone states like Louisiana would pay more than a state like North Dakota that experiences much less in natural disaster damage.  That was the plan then. And the good news is that in reaction to the devastation of Hurricane Sandy and the tornados in Oklahoma and Missouri, a number of states are coalescing around this same plan now.

It’s taken almost 24 years, but it looks like it could be the right time for problem solving.  It’s just not a handout for the coastal states.  The whole country will benefit.  And at a price that’s affordable.  We certainly cannot be any worse off than we are now.

Peace and Justice

Jim Brown

 

---

Jim Brown is a guest contributor to GCN news. His views and opinions, if expressed, are his own. His column appears each week in numerous newspapers throughout the nation and on websites worldwide. You can read all his past columns and see continuing updates at http://www.jimbrownusa.com. You can also hear Jim’s nationally syndicated radio show, Common Sense, each Sunday morning from 9:00 am till 11:00 am Central Time on the Genesis Communication Network.

Published in Opinion
%PM, %08 %944 %2019 %21:%May

Should we panic over Measels?

In general, it is not a good idea to panic about anything. The panic itself often causes more harm than the original threat.

Crisis situations, real or contrived, lead to new intrusive laws that the public would never accept otherwise. We supposedly cherish freedom, but if we believe that the world will end if we don’t act NOW, then we may clamor for the government to save us. Cynical politicians bent on increasing their power never let a crisis go to waste.

Something like the Green New Deal—the end of our comfortable, prosperous lifestyle—takes a truly apocalyptic threat. But to eliminate our freedom to decline a medical treatment, the threat that “millions will die” of measles is evidently enough. Or if not millions (most older people had measles and recovered fully), a few especially vulnerable children, who can’t be vaccinated themselves, might catch measles and die.

There are several hundred cases of measles nationwide, more than in 2014, and bills are being pushed through state legislatures to eliminate all but very narrow exemptions to the 60 shots now mandated for school attendance.

In New York City, people are receiving summonses based on Mayor Bill de Blasio’s emergency order. Everybody, adult or child, who lives in four ZIP code areas must get an MMR shot or prove immunity, or face the prospect of a $1,000 fine ($2,000 if you don’t appear as ordered). Your religious exemption is overridden. The threat of 6 months in prison and the prospect of forcible vaccination were removed before a hearing on a lawsuit brought by five mothers. The judge dismissed the case.

Health Commissioner Oxiris Barbot said that the purpose of the fines is not to punish but to encourage more people to proclaim the message that vaccines are safe and effective. Get it? If you say something to avoid a fine, that makes it true.

It’s about the need for herd immunity, they say. We need a 95 percent vaccination rate for herd immunity to measles. With only 91 percent or so we are having outbreaks! If we could just vaccinate another 4 or 5 percent!

Mayor De Blasio has a point about vaccinating everyone. Adults are getting measles because their shots have worn off. It is likely that we have survived for decades with a large part of the adult population vaccinated—but not immune. So where do the mandates stop?

Outbreaks have occurred in populations with a near-100 percent vaccination rate. Was it vaccine failure? Or was the vaccine not refrigerated properly? Or was a claimed outbreak real? One in Ann Arbor, Michigan, was called off when a special test, a reverse transcriptase polymerase chain reaction (RT-PCR) showed a vaccine-strain measles virus rather than a wild-strain measles virus. Some 5 percent of vaccinees may get an illness that looks like measles, but it is just a “vaccine reaction.” Can they shed live virus? Yes. Should you keep your immunocompromised child away from recently vaccinated people? Just asking.

Like all medical treatments, vaccines are neither 100 percent effective, nor 100 percent safe. Read the FDA-required, FDA-approved package inserts. Arizona defeated a law that would have required making these available to parents in obtaining informed consent. (You can get them on the internet.) Vaccine Court has paid out about $4 billion in damages—recently for two children with severe brain damage from encephalopathy (that’s brain inflammation) after a fight lasting about 15 years. Just incidentally, they had an autism diagnosis also. Parents bring their severely injured children to hearings. You won’t see these children on tv, only pictures of babies with measles. No “fear-mongering” allowed about “rare,” possibly coincidental problems from vaccines.

There are trade-offs with vaccines: risks and benefits. But in the panic about measles, the right to give or withhold informed consent—fundamental in medical ethics as well as U.S. and international law—is being sacrificed. And so is free speech. The AMA wants to censor “anti-vaccine” information on social media. I happened on a factual article by investigative reporter Sharyl Attkisson, but was not able to retweet it because it had been removed.

The threat of infectious diseases is real and increasing. We need more robust public health measures, better vaccines, and improved public knowledge and awareness. Deploying vaccine police and shutting down debate will erode trust in health authorities and physicians, although more people may get their shots. But such heavy-handed measures will not defeat the enemy—measles and worse diseases.

Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. Her views and opinions, if expressed, are her own and do not necessarily reflect the opinions of GCN.  Her column can often be found at www.pennypressnv.com. Her column has been reprinted in full, with permission.

Published in Health

A Peek into How Doctors Think – An Introduction to “Columns”

Anyone who is on their path to becoming a successful physician needs to be able to take a good history and perform a thorough physical.  However in this day and age, patient care is performed in a very speedily process and thus the boards test a medical student on how succinctly they can perform a patient history.

Thus students and licensed medical providers need to be adept at “data gathering” no matter what the patient presents with.  Our job is to figure out what’s going on, no matter how difficult the task, and do so quickly.  So how do we accomplish this?

We start by looking at the cause and then breaking down what could be occurring resulting in that cause, or in other words, forming a differential diagnosis.  So if someone has chest pain, one may form a differential consisting of heart attack, pericarditis and costochondritis. But other issues may be at play such as a pneumonia or an esophagitis.

So when we look at a person with chest pain, we consider all the body parts or causes that could be causing the symptoms.

Hence with a patient presenting with chest pain, one would consider a cardiovascular cause, pulmonary cause, gastrointestinal cause, musculoskeletal cause, and even psychiatric cause.

This is the basis of forming one’s columns. For every chief complaint we form columns either mentally or on paper and then ask associated symptoms (or pertinent positives or negatives) to determine which column we’re in.  Usually a few “power questions” will help discriminate which column you are in. Once you hit the correct column you will ask further questions along that line.

book cover 2

True there are many more questions we could ask than just the “power questions,” but during a time crunch we need to ask very specific ones to determine if we are on the right track.  If we receive multiple “no”s along a column, we know to move onto the next column.

Hence if a patient with chest pain denies dizziness and diaphoresis or sternal pain upon palpation but admits to cough, shortness of breath and sputum production, we have just narrowed down the chest pain patient to a pulmonary cause as opposed to assuming it was cardiac in nature. Then we would continue down the pulmonary column, thinking our differential may be a pneumonia/bronchitis/pulmonary embolism, and ask about hemoptysis, fever, chills, etc.

So for each patient one must create columns depending on the chief complaint and then ask power questions to help focus down your differential.

Now these columns can also assist with the physical exam component of data gathering.  If the above patient presenting with chest pain could have a cardiac/pulmonary/GI/musculoskeletal condition, one would examine his heart, lungs, upper abdomen and palpate the sternum and ribs.

For an added bonus, the columns can additionally assist one in forming their differential for the SOAP note. 

Chest pain r/o

  • Pneumonia
  • Bronchitis           
  • PE
  • MI
  • GERD
  • Costochondritis

If a case involves a not so clear-cut symptom, columns could be used as well.

For example a patient presenting with hair loss.  If one complains of hair loss, a variety of differentials could be at play.  One column could be an endocrinology source (such as hypothyroidism or diabetes), another could be psychological (such as stress or trichotillomania), a third could be medications (such as chemotherapy agents), and a fourth could include genetics.  Narrowing these down with power questions could exclude non-contributing columns.

So whether it’s a direct body system or cause, columns help one focus down the differential and allow an easy visual that enables one during a timed test to think quickly and know which questions to ask.

Again these columns are instituted after the History of Present Illness in which a student obtains onset/chronology, palliative/provocative factors, quality of symptoms, radiation, severity and timing (OPQRST).

They will be written down in the SOAP note after the HPI.  

Example:  Mary is a 25-year-old female presenting with acute onset right foot pain.  It began 6 hours ago after she went for a job. Ice provides some relief but walking on it worsens the pain.  The pain is sharp, constant with a severity of 7/10. She denies fever, chills, open wounds, swelling, redness, temperature changes, numbness or tingling.

Since during this step in the history most medical students find it challenging to know “which questions to ask.”  The columns and power questions simplify this.

To learn this method to improve one’s data gathering skills click here.

---- 

Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

 

Published in Health
%PM, %02 %034 %2019 %23:%May

Polls won't tell you who can beat Trump

Pollsters love to do general election matchup polls early in the process to figure out which candidates would fare the best against a sitting incumbent president like Donald Trump. The idea is to give primary voters of one party or another an idea of which candidate is the most “electable.”

For example, in April 2011, Democracy Corps published a poll that showed Mitt Romney could defeat then-President Barack Obama, 48 percent to 46 percent. In Oct. 2011, another CNN-Opinion Research poll showed Romney leading 50 percent to 45 percent.

But we all know how it turned out. Even after showdowns with House Republicans over the debt ceiling in 2011 — which resulted in budget sequestration that helped reduce the deficit — Obama went on to comfortably win re-election in 2012.

So, how much stock should we put in the Politico-Morning Consult poll that shows former Vice President Joe Biden at 42 percent versus President Donald Trump at 36 percent? Almost none.

The question, particularly for first term presidents, is whether voters think it is time for a change, or if they are willing to be patient while the incumbent party finishes what it started.

In modern history, since 1952, that has yielded a fairly high re-election rate for incumbent parties in their first terms. Dwight Eisenhower was re-elected in 1956, Lyndon Johnson won John Kennedy’s second term in 1964, Richard Nixon was re-elected in 1972, Jimmy Carter was ousted in 1980, Ronald Reagan was re-elected in 1984, Bill Clinton was re-elected in 1996, George W. Bush was re-elected in 2004 and Barack Obama was re-elected in 2012.

All told, in modern history, in 87.5 percent of the cases where the incumbent party had served one term it tended to be re-elected.

Readers will note that George H.W. Bush is not included in that listing. The reason for that is he won Reagan’s third term — that is, the third consecutive term that Republicans had held the White House. So, his being ousted in 1992 was less surprising because it came after 12 years of uninterrupted Republican rule in the White House. The same applies to Gerald Ford, who in 1976 was running for essentially Nixon’s third term, and Lyndon Johnson and then Hubert Humphrey in 1968 running for a third Democratic term.

But even if you include Bush and Ford in the mix as far as how sitting presidents have fared in a general election, in 70 percent of cases they have won since 1952. If you want to go back to World War II, Harry Truman won election in 1948 as a sitting president, and the number jumps up to about 73 percent.

If you look as far back as the beginning of the republic, sitting presidents who have stood for re-election in the general election have won about 70 percent of the time, although it is worth noting that until the 1800s, state legislatures generally chose electors.

So, there’s a distinct incumbency advantage, especially for first-term presidents that should give Trump an edge in 2020 no matter who the candidate is.

Particularly when it comes to presidents, in modern history, the American people, particularly independents, do not aspire to one-party rule. Swing voters tend to decide elections nowadays, and after just one term, they are still a lot more likely to give the incumbent the benefit of the doubt.

Where the rubber meets the road, and what separates one-term presidents from two-term presidents, will be the primaries. Biden or whoever is going to win the Democratic nomination must first compete and win the nomination, and do so in commanding fashion (rather than being bloodied along the way), to have a good chance to oust the incumbent.

Simultaneously, whoever the Democrat nominee is would need President Trump to have a bruising primary contest for the nomination to even out the odds. If Trump is vulnerable, it should be revealed in the primaries. But is William Weld really a credible threat to Trump? We’ll find out soon.

In modern history, unchallenged incumbents have tended to cruise to reelection. The likelihood of unseating an incumbent in the primary is close to zero, but real damage can be wrought to harm to his re-election chances. For more information, check out Stony Brook University Professor Helmut Norpoth’s primary model, which offers a guide to some of these trends. (Disclosure: I took his class!)

President Trump and Republicans have been in power for just two years and change. Is it already time for a change? History says the odds are - not yet.

--

Robert Romano is the Vice President of Public Policy at Americans for Limited Government. He is also a guest contributor to the Penny Press - the conservative weekly "voice of Nevada." You can subscribe here at www.pennypressnv.com. His column has been reprinted in full, with permission. 

Published in Politics

Recently, the outstanding economist Richard Vedder penned a column in the Wall Street Journal on the problems of higher education in America.  He titled it: “College Wouldn’t Cost So Much If Students and Faculty Worked Harder.”

The piece was a preview of his book on the subject, Restoring the Promise: American Higher Education Today to be published May 1.  From his summary and from reading his previous writings on the subject, I’m certain the book will be outstanding

His analyses have coincided with my own as a Nevada legislator, higher education regent, college teacher and state controller, and he has brought good data to illustrate issues I have observed in those roles.  So, here, I’ll present a summary of his WSJ piece, and in future column I’ll detail from my experience and his book some major issues and solutions to the serious challenges U.S. higher education faces.

Vedder begins: “One reason college is so costly and so little real learning occurs is that college resources are vastly underused.  Students don’t study much, professors teach little, few people read most of the obscure papers the professors write, and even the buildings are empty most of the time.”

As a regent and part-time community college instructor for four years, I observed all these phenomena and more first hand.  They are some key reasons higher education costs have increased faster in real terms than the incomes of students and their families while those students are being ever more poorly prepared for life and the job market.  And taxpayers are shorted.

His first observation is that surveys show college students today spend about 27 hours a week in class and studying, while taking classes only about 32 weeks a year.  Or, fewer than 900 hours a year on academics – “less time than a typical eighth-grader and perhaps half the time their parent work to help finance college.”

He notes other researchers have found that in the middle of the 20th Century students spent 50 percent more time – around 40 hours weekly.  Grade inflation has vitiated their incentives to work hard because the average grade received has risen from B-/C+ in 1960 to B/B+ now.

Vedder notes that on some campuses students study much more.  And, “Engineering majors probably work much harder than communications or gender studies majors.”  Ditto, law and medical students.  As a sometimes engineering major at Illinois, recipient of a masters from Stanford in Engineering Economic Systems and later law student, I know all that’s not new.

But neither he nor I are suggesting that students responding to the changing incentives is the only problem.  Vedder confesses: “I’m part of the problem: I’ve been teaching for 55 years, and I assign far less reading, demand less writing, and give higher grades than I did two generations ago.”  Most other professors are less demanding and productive in teaching and useful research than he is, while mostly hard-sciences instructors put in similar teaching and productive research time.

When I taught 15 years ago, I told my community college students at the start of the semester I would teach them just as I would at any four-year college, including the same reading, writing, homework and testing.  However, I felt guilty because I succumbed to the grade inflation trend.  On the other hand, because a third of them needed remedial English, writing and math skills (having been shorted by their grade and high schools), I provided that service.

Another point he makes is that objective measures show the results of college education today are underwhelming.  Similarly, I noted in my controller’s annual reports that American K-12 students’ achievement scores in international tests are in the middle ranks of those for advanced countries, while our per-student spending is among the highest.

A major point I learned as a regent is that much of higher education’s problem is the proliferation of administrative and other non-teaching staff relative to all instructors.  Because colleges and universities work hard to cover up this phenomenon, I had trouble getting data on it, and I look forward to his book for more information here.

When we understand the full dimensions of the problem, we can begin crafting remedies.  Stay tuned.

 

--

 

Ron Knecht is a contributing editor to the Penny Press - the conservative weekly "voice of Nevada." You can subscribe here at www.pennypressnv.com. His column has been reprinted in full, with permission. 

 

Published in Opinion

So, Sunday morning, I opened the electronic version of the only local newspaper I subscribe to and trust, the Las Vegas Review Journal, and I see, buried on page A8, a story headlined “Poll shows Democrats more trusted with health care”

 

Which was true…sort of.  Because I’m pretty sure the story reported the numbers of the poll accurately.

 

The “poll” was an “Associated Press-NORC Center” poll which, you had to read seven paragraphs to the bottom of the story—by the Associated Press—to find out that “The poll of 1,108 adults was conducted April 11-14 using a sample drawn from NORC’s probability-based AmeriSpeak Panel. The margin of sampling error for all respondents is plus or minus 4.1 percentage points.” Let me be the first to ask the question:  If that factoid had been in the headline or in the first paragraph, would anyone take this seriously? What if the story read like this:

 

“A poll of 1,108 adults paid for by the company selling this story to news outlets says that Democrats are more trusted to handle healthcare in the United States.  The pollsters say that the 1108 adults can predict the sentiments of the 128,824,246 voters who cast a ballot in 2016 with a margin of error of 4.1 percent.”  

 

Would anybody actually believe—especially after the 2016 election—that a sample of .0000086 percent of the voting electorate has a margin of error of 4.5 percent? But, in my favorite local newspaper, it is presented as fact. If this kind of polling were accurate, why did virtually every pollster predict Hillary by 7 points on the day of the 2016 election.

 

Polling used to be easier because, for most purposes, you could at least get a sample which was demographically sound.  We could tell roughly where you lived by your telephone number and who you were. Today, with the advent of cell phones and cheap VOIP services, we cannot even tell with certainty what state you are in. Further, there is the built-in bias of many news organizations which sponsor such polls.  If you believe that the AP is some kind of neutral news behemoth, guess again.  Ditto for CBS, NBC, CNN, ABC and, yes, even Fox.  They all come at stories from a predominately liberal viewpoint (with the occasional exception of Fox) so why would you believe that their polling selections would be much different?

 

Then, there’s the “if you see it in the media it must be true” school of thought. It’s today’s version of Hitler’s propaganda minister Joseph Goebbels’ Big Lie theory which, simply stated, says if you tell a lie big enough, many people will have to believe it. Inevitably, these “polls” are presented by the same people who populate organizations like the White House Correspondents Association and are soooo offended by the term Fake News and the President’s assertion that those who willfully present Fake News are the enemies of the people.

 

But the truth is not only is President Trump correct, but the average voter knows bullcrap when he or she sees it.  Journalists have a tendency to see themselves as more knowledgeable and more important than average voting citizens.  Many times, in conversation, journalists use terms like “them” and “those people” to describe and differentiate average voters.  As if journalists, somehow, fall into a different category. Like Hillary and the word deplorable.

 

Want some proof? Watch those panels on FNC and CNN.  Watch the Sunday morning shows.

 

It’s that sort of hubris which allows them to write headlines and lead paragraphs like the one I referred to above—even in my favorite local newspaper. (And I’m not kidding about that.) I’ve been in this business since I was 12.  But I live about 2,600 miles from Washington and my neighbors remind me daily that I’m pretty average.  I would hate for it to be any other way.

 

----

 

Fred Weinberg is a columnist and the CEO of USA Radio Network. His views and opinions, if expressed, are his own and do not necessarily reflect the opinions of GCN. Fred's weekly column can be read all over the internet. You can subscribe here at www.pennypressnv.com. His column has been reprinted in full, with permission. 

Published in Opinion
Page 7 of 31