“Bueller? Bueller? Bueller?” - Ferris Bueller’s Day Off.  

“Mueller? Mueller? Mueller?” Just when I thought Robert Mueller had earned his day off. Anyway, a few weeks ago when his report was released, I almost thought we wouldn’t hear from Mueller again. But now Congress wants unredacted report and wants Mueller to testify because Mueller sent a letter claiming that Barr misrepresented his report. President Trump said, “It should be up to the AG if Mueller testifies,” but then AG Barr said to Congress, “I don’t care if Mueller testifies, ” but then Barr didn’t show up for his second day of testimony, and now Congress wants to hold AG Barr in contempt. But then, the President changed his mind saying Mueller shouldn’t testify. So, now, of course, Mueller will testify before Congress. But then … President Trump invoked Executive Privilege to prevent Congress from seeing the unredacted Mueller report, which will probably delay Mueller's testifying.

How naïve of me to assume this was over and done.

Anyway, I tried to read the entire Mueller report. But I’m only one guy, and it clocks in at 450 pages, and I have other work to get done. I got through about a third of it and mostly skimmed the rest, stopping to fully read a page or two that seemed important or to focus on some of the redacted bits to see if I could figure out what it was redacted (usually - no). Now, I know that “skimming” is not an exact science, but I suspect I’ve read much more of the full report than the vast majority of folks. And so, I tackle the following issues with a reasonable amount of knowledge.

A couple things I noticed. It’s very clear that Mueller found large amounts of evidence outlining Russian interference in the 2016 Presidential Election. Like, a jaw dropping amount of evidence! The other thing I noticed is that there is also, a jaw dropping amount of evidence - linking Trump staffers, advisors and family members to meetings and information swaps with the Russians.

BUT, as clearly stated in the opening statement summarizing the report, Mueller says, “... the investigation did not establish that members of the Trump Campaign conspired or coordinated with the Russian government in its election interference activities.” And the reason Mueller states this is because there was no long term agreement between the Russians and the Trump campaign. That’s it. There was no “long term” agreement. Not, “The Russians and the Trump campaign never met up.” Because the report says they did. Only that there was no, “long term agreement,” to fit the legal definition of collusion.  

Did the Russians sabotage the election in favor of Trump? The report says “yes.” Did the Trump Campaign meet with the Russians to get said stolen information? The report says “yes.” It’s just that there was no “long term coordination,” for it to be legally considered collusion. The Russians, realizing that a Trump White House would be much more sympathetic to their cause, committed cyber terrorism against the US, then stole a bunch of documents from the DNC,  then gave the stolen information to the Trump Campaign in hopes to help Trump win, and then went on to commit huge amounts of additional interference from outright misinformation campaigns on social media to fraud. The Mueller report literally says there is huge amounts of evidence supporting all those claims, it’s just that there was no long term agreement between the two parties for it to legally constitute collusion.

Wow. That, um - forgive me for saying this but … that does NOT sound like “total exoneration.”  

The next thing I noticed is that - not much of the report is redacted. The redacted parts come sometimes in giant black chunks, and sometimes in lots of little snippets. All in all, I would say, of the 450 pages there are about 20 total redacted pages. And certainly not in a row, they are scattered all over. Of course, our two political parties see those 20 pages in a completely different light.

Republicans, “We see the majority of the report and we understand the spirit of what is being said, and so no one has to read the redacted twenty pages - because it won’t change anything. Also, the report clearly says “No collusion. Total exoneration,” so any additional investigation is a waste of time.”

Democrats, “We see the majority of the report and we understand the spirit of what is being said but too much information can be hidden behind twenty redacted pages that might shed more light into an investigation that clearly states Russia sabotaged the 16’ Presidential Election. Also, the report does not say, “total exoneration,” in fact it says the opposite of “no exoneration,” so we would like more information.”   

Hrmmmm. Well, they can’t both be right! You know? One side is clearly in the wrong here. Alas, we all know the day and age we live in. Our side is always right. No common ground attempted. The other side is always wrong. Ad nauseam.

Republicans like to think they are one hundred percent altruistic, perfectly just and always correct, while simultaneously believing that Democrats are devil worshiping, lying, “libtards,” who are one hundred percent wrong, one hundred percent of the time.

Democrats like to think they are one hundred percent altruistic, perfectly just and always correct, while simultaneously believing that Republicans are faux-Christian, lying, “deplorables,” who are one hundred percent wrong, one hundred percent of the time.

*long sigh*

Common sense and reason appears to have gone the way of the dodo.

Well, allow me to apply some common sense and reason to this new Mueller … happening. Let Congress read the unredacted report and allow Mueller to testify, because there is no reasonable explanation for blocking Congress from the full report. Members of Congress have security clearance on all matters of national security up to and including investigations that look into - if a hostile foreign power sabotaged a Presidential Election - which the report universally found Russia to have done! That sounds like National Security to me. Which Congress has clearance for. Therefor, common sense and reason suggest Congress should receive the full report.

And now Trump is invoking Executive Privilege to prevent Congress from receiving the full report. Which, if you are not exactly familiar with Executive Privilege, from Wikipedia:  

Executive privilege is the power of the President of the United States and other members of the executive branch of the United States Government to resist certain subpoenas and other interventions by the legislative and judicial branches of government in pursuit of information or personnel relating to the executive.”  

Fair enough. That is the right of the President (and members of the executive branch) and it’s an important protection. In fact, many modern day Presidents have invoked Executive Privilege, some have done it much more than once, including - Nixon (a few times), Reagan, Bush, Clinton (several times), Bush Jr. (several times), Obama and now Trump.

Of course, it should also be noted that Congress can breach EP but must sue in federal court. It’s happened before, and in two notable cases, Nixon and Clinton, the President lost. Nixon invoked EP to avoid Watergate, Clinton invoked EP to avoid the Lewinsky scandal. Congress sued and won in court. The rest, as they say - is history.

So, this is really nothing new. The cover ups. The investigation. The lying. The testifying. The “I don’t recalls.” The invoking of Executive Privilege. The lawsuit. So people should really stop their fake outrage because we’ve seen this happen over and over.

These new shenanigans are nothing new but will add to the cost of the investigation and the amount of time we have to hear about it. Apparently, the overall cost of the Mueller investigation, so far, is a bit more than $16 million. Maybe that sounds like a lot to you, maybe it doesn’t. For context, the 9/11 Commission was funded with a $15 million budget. I’m sure you folks remember the 9/11 Commission. If not, it was an investigation into how and why the largest terrorist attack on the US occurred, and what can be done to prevent future attacks. Which, is the exact definition of “a matter of National Security.” (I just scanned over the 9/11 report and did not notice a single redacted item, which, I know, is NOT exactly the same thing we have going on today with Mueller report, but was still something I thought was interesting).

Now we have a new report, that is literally looking into a matter of National Security, investigating if a hostile foreign power sabotaged the 16’ Presidential Election. One would think, when applying common sense and reason to this dilemma - the Mueller Report is an important investigation into the National Security of the country.

And if you feel annoyed that the Mueller report cost more than the 9/11 Commission, allow me to remind you that the Clinton Impeachment cost taxpayers more than both investigations combined. To break it down:

Clinton Impeachment - “Did the President lie to Congress while under oath, about weather or not he cheated on his wife?” Cost to taxpayers: $70 million dollars (adjusted for inflation that’s $105 million today).

9/11 Commission: “An investigation into the largest terrorist attack on US soil and, as a matter of National Security, a report on how we can be better equipped to thwart future terrorist attacks.” Cost to taxpayers: $15 million dollars (adjusted for inflation that’s $22.5 million, today)

Mueller Report: “As a matter of National Security, an investigation into if a hostile foreign power sabotaged the 16’ Presidential Election?” Cost to taxpayers: $16 million dollars (but could go up).

If you honestly can’t see which of the above is not like the others, well - then you can’t. But common sense and reason should tell you that two of them are matters of National Security, and one of them is total BS that wasted a lot of taxpayer money.

Republicans used to be the security party, the military party. Even President Obama had a Republican Secretary of Defense. Speaking of Obama, we all know the truth of this next statement, if a two year Special Prosecutor investigation uncovered Russian interference in 2012’s Obama vs. Romney election that involved stolen information from the RNC in a way that handed Obama the win - Republican heads would have exploded from rage induced aneurysms!

I bet then, with that ridiculous Russian/Obama scenario, Republicans would have been very interested in security and in preserving election integrity.

Now … meh, not so much.

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Should we panic over Measels?

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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.

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.

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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.

 

Last month in the United Kingdom, more than 5,000 people stood in line in the rain - for hours, to see if they were a potential stem cell match for a young boy battling cancer. You see, back in December 2018, 5 year old Oscar Saxelby-Lee had been diagnosed with “acute lymphoblastic leukaemia” when the family took him to Birmingham Children’s Hospital over Christmas. Oscar was just feeling, “unwell.” The family was certainly not expecting to hear that Oscar had leukemia.   

But he did. And it was a particularly rare and aggressive kind of cancer, too. Only a few hundred people, in the UK (where all of this took place) per year are afflicted.  Oscar underwent four weeks of successful chemotherapy but then the doctors said he would need a stem cell transplant within a few months. 

Oscar's community and school reached out via social media and told the UK about Oscar and his cause. Tens of thousands of people reached out to help including the aforementioned 5,000 that stood in the rain. Usually in these circumstances, a family member would donate stem cells but neither of the parents were a close match. Thankfully, three people, out of several thousand - were found to be a perfect match for Oscar. 

From the Hand in Hand for Oscar Facebook page: 

"We have the best news to share! Oscar has a match!!!! Absolutely thrilled to announce Oscar has finally got a stem cell match, not just one but three and will be undergoing transplant very soon!! What an emotional rollercoaster it's literally been a journey of heartache and dread continuously, but...WOW!!!  What a feeling of relief and positivity to help Oscar kick cancer's butt!! It's been so so traumatic but we are over the moon with being given a chance to tackle the next step in treatment. Thank you, thank you, thank you, from the bottom of our hearts to all of you out there who have registered, supported and continued to spread the word for our beautiful boy and those in need of wonderous bone marrow cells. We could never have done this without you all!!”

Before the transplant could happen, Oscar needed four days of radiotherapy, which he received, and last week - Oscar was found to be free of leukaemia blast cells. The stem cell transplant is the only thing left. 

I’ll update more on Oscar as soon as I hear.

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Polls won't tell you who can beat Trump

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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.

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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. 

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.

 

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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. 

 

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.

 

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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. 

Earlier this week, news erupted about the Boy Scout’s “Perversion Files.” The Perversion Files (which the Scouts call, “ineligible volunteer files,”) detail as many as 12,000 boys that, while participating in scout programs - were sexually abused by Scout leaders.

Now, portions of the Perversion Files have leaked before, so the general information is nothing new. What has recently come forward is that the number of abused boys and abusers is much, much higher than previously reported.

The way I understand it is that the Boy Scouts of America (BSA) hired someone to do a five year internal investigation and that investigation concluded the number leaders who sexually assaulted boys in the program is not the 3,000 as had been previously reported, but is actually closer to 8000.

Let that sink in for a moment. That’s eight thousand men - volunteer leaders in the BSA, that have been accused of molesting more than 12,000 boys. So the “Ineligible Volunteer Files” is a detailed list of all the men who have “had their registration with the Boy Scouts revoked - because of reasonable allegations of child sex abuse.”

This all came to light when attorney Jeff Anderson released sworn testimony from Janet Warren, a psychiatry professor at the University of Virginia. Warren had been hired by the Boy Scouts to conduct the above mentioned study of the sex abuse files. Warren found that the evidence in the files was actually much worse than what the BSA imagined. She found the number of abused boys and abusers was thousands more than initially thought. Warren also made it clear that she found no evidence of a cover up by the BSA to hide this information and that she will present a more detailed report sometime during the summer.  

Unlike the Catholic church, who just shuffles abusers around to new parishes and/or different cities - at least the Boy Scouts fired the abuser and didn’t allow them to work with youth ever again. I mean, it’s not much, but at least it’s that.

With something like two and a half million children participating in the Boy Scouts, if there are thousands of victims who come forward (and hundreds and hundreds of them are coming forward - some as young as 15, and one as old as 75) - this could be a financial disaster the BSA. As a non profit organization, they would not be able to financially handle thousands of lawsuits and would probably declare bankruptcy, which would shield them from lawsuits but allow them to continue operations.

Michael Surbaugh, the Chief Executive of the Boy Scouts said this at a lengthy press conference:

"I want to reiterate our steadfast support for victims of abuse. We are outraged that there have been times when individuals took advantage of our programs to abuse innocent children …  We care deeply about all victims of child abuse and sincerely apologize to anyone who was harmed during their time in scouting. We believe victims, and we pay for unlimited counseling by a provider of their choice, and we encourage them to come forward. At no time have we ever knowingly allowed a perpetrator to work with youth, and we mandate that all leaders, volunteers and staff members nationwide immediately report any abuse allegations to law enforcement. Throughout our history, we have enacted strong youth protection policies to prevent future abuse, including mandatory youth protection trainings and a formal leader-selection process that includes criminal background checks. Since the 1920's, we have maintained a Volunteer Screening Database to prevent individuals accused of abuse or inappropriate conduct from joining or re-entering our programs, a practice recommended in 2007 by the Centers for Disease Control for all youth-serving organizations."

Okay. Well, I do believe him. I doubt BSA leadership “knowingly allowed” predators to work with youth.  Again, the Perversion Files clearly state that abusers were fired after “reasonable evidence.” Which suggests that the BSA knew about the allegations, believed the victim and fired the alleged abuser. But, and here’s the sticky point - didn’t contact authorities. Which might have been a problem.   

Interestingly enough, I just read that the Boy Scouts filed suit against several of their insurers for “refusing to cover its sex abuse legal liabilities.” But, like insurance companies everywhere, said insurance agents found a way not to pay a cent of coverage for the BSA by claiming, “the Boy Scouts neglected to take meaningful precautionary action.”

Hrmmm. Okay. Maybe. The Boy Scouts claim they have a screening process and a “protection system” in place. Which makes sense. Clearly, their process doesn’t work as well as they thought, but it certainly suggests they are “taking meaningful precautionary action,” so I don’t know what the F those insurance companies are talking about.  I even found a part of their screening process / protection system listed in a CNN story:

  • Youth protection training is mandatory for all registered leaders.
  • … a youth is never alone with an adult leader during scouting activities and that no youth is permitted to sleep in a ten with other adults other than the parent or guardian.
  • ...prohibited one-on-one texts and social media communication between adult and youth members.  

Sounds like meaningful precautionary action to me. Anyway, - the courts will work all that out. Until then, more and more victims continue to come forward.

The latest challenge sweeping social media is the “Shell On” challenge in which teens Snapchat videos of themselves eating through fruit skin, cardboard boxes and plastic bags containing their food.

Although this appears to not be as dangerous as the Tide Pod or Boiling Water Challenge, it can cause choking and asphyxiation.

In the video linked on the front page the teen takes bites out of fruit with their peel, and then bites through a cereal box.

What other dangerous challenges are out there?

Last year we learned of the “Boiling Water Challenge” in which kids drink boiling water from a straw or have it poured all over their body. Then they topped it off with a more dangerous challenge, the “Fire Challenge.”

The Fire Challenge is executed by pouring rubbing alcohol on one’s body and then setting oneself on fire.  A video records the victim running into a tub or shower to wash it off, and this trend has gone viral.

Unfortunately it’s one of the most dangerous.  A 12 year-old girl from Detroit who participated in this challenge is undergoing multiple surgeries to repair burns afflicting close to 50% of her body.

Multiple cases of the “Fire Challenge” have been reported over the years, including a 12 year-old boy from Georgia.

One would think children, especially teens, innately know that fire is dangerous but maybe the younger generation has been so protected that they haven’t experienced the basic concepts of danger and inadvertently underestimate its force.

 

fire-challenge

Challenges that involve dangerous stunts have been around for some time.  The Choking Challenge induced children to suffocate themselves for the high of feeling asphyxiated.  The Tide Pod Challenge tempted kids to put colorful cleaning packets in their mouths, hoping they wouldn’t burst.

 

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The Cinnamon Challenge sparked thousands to inhale the common kitchen spice and cough till they puked.  Then the Condom Challenge offered two options where one dropped a condom filled with water on a friends face, or snorted one through the nose.

 

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We adults can’t for the life of us figure out what the reward is in performing these challenges, but presume it's fame and awe among friends and social media followers.  But these challenges prove dangerous and in some cases deadly.  Unfortunately the YouTube Clips never show the after effects of these pranks…maybe they should.

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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.

Intensified by the early fight for money and backers among Democratic presidential hopefuls, Medicare for All and similar single-payer insurance programs have been promoted with increased volume. While there are differences among the “I’ll give you more for less” sales pitches, they share the common central premise that such plans have far lower administrative costs than private insurance, so their version of reform will produce a massive infusion of available resources.

However, the “proof” offered for those administrative cost savings claims mainly consists of constant repetition, with candidates then quickly moving on to the free lunches they would supposedly enable. But given that claim’s central place in their proposals, we must question that premise and with it, the glib answers claimed for it.

How Should We Measure Administrative Efficiency?

For health care plans, the standard measure of efficiency is administrative costs as a percentage of total costs. And in those comparisons, Medicare appears substantially more efficient. But that does not mean there would be savings if people were moved from private insurance to Medicare for All.

The primary reason is that Medicare beneficiaries are far older and less healthy than the population. That makes health care costs far higher per Medicare beneficiary. In fact, before Obamacare, medical expenditures per Medicare beneficiary were routinely more than double those for the privately insured. However, nonmedical administrative costs are only slightly related to total medical expenditures. They are primarily related to the number of persons covered. This causes the standard measure to grossly exaggerate Medicare’s relative administrative efficiency.

Consider an example. Say both Medicare and private insurance beneficiaries had identical administrative costs of $500 each, but the Medicare patient received $5,000 in benefits, while the private patient received $2,500 in benefits. Medicare would show a 10 percent share of administrative costs, and private insurance would show a 20 percent share. In other words, despite the same administrative cost per beneficiary—that is, the same actual efficiency—the standard measure makes private insurance administrative costs look twice as expensive as Medicare.

Simply ask what would happen to administrative expenses if one private insurance beneficiary was moved into Medicare in the example above. Despite Medicare supposedly being half as costly in that regard, administrative costs would not change. No resources would be freed up. And given that the administrative cost per Medicare beneficiary is actually higher than for private insurance, the shift of someone into Medicare would increase administrative costs—leaving fewer resources, rather than more—available for medical care.

What Should Be Included in Medicare’s Administrative Costs?

The public-private comparison also typically compares the administrative costs of private insurance to those that show up in Medicare’s budget. But many of the administrative costs do not show up there. They appear in other agencies’ budgets. The costs of collecting taxes appear in the IRS budget. The costs of collecting premiums appear in Social Security’s budget. Many of the accounting, building, and marketing expenses appear in the Health and Human Services budget. Including those costs would roughly double Medicare’s reported administrative costs.

How Should We Count Taxes on Private Insurance?

Private insurance administrative costs are generally defined as premiums paid in minus claims paid out. However, that means everything except claims payments are counted as administrative costs whether or not they have anything to do with administration. For example, many states impose a premium tax (averaging about 2 percent) on health insurers, and those tax payments are incorrectly categorized as administrative costs. This also makes Medicare, which is exempt from such taxes, look relatively more efficient than it really is.

How Should We Count Disease Management and On-Call Consultation Services?

As with taxes, counting private insurance administrative costs as total premiums minus claims paid introduces other measurement distortions, as well. Insurance companies offer disease-management and on-call nurse consultation services. However, those services do not generate insurance claims. Consequently, those costs are also counted as administrative rather than medical.

How Should We Count Fraud and Fraud Prevention Efforts?

Waste, fraud, and efforts at their prevention also complicate administrative efficiency comparisons. Consider what happens if Medicare (estimates of whose excess spending exceed $50 billion yearly) spent less on prevention efforts. It would look more efficient because its administrative costs would be lower and because undetected excess spending would be counted as medical expenses, not waste. In contrast, insurance companies, whose bottom lines are at stake, are much more diligent about eliminating such excess spending. But those efforts, even though they can generate very large overall savings ($1 of fraud prevention has been estimated to reduce those costs by as much as $15), raise their measured administrative cost percentage, making them look less efficient.

How Should We Treat the “Excess Burden” Caused by Switching to Single Payer Systems?

In addition to all these biases exaggerating private insurance administrative costs and understating Medicare’s administrative costs, another large difference should be noted. When people pay more to get better private insurance coverage, they don’t treat it as a tax, but as part of their employee compensation. Under Medicare for All, however, higher payments into the system will not provide greater benefits. That means that Americans will rationally start treating those payments as taxes in exchange for nothing.

It will, therefore, act as a large income tax increase with correspondingly large economic distortions. Those distortions, created by the wedges taxes impose between what buyers pay and what sellers keep, reflect the wealth destroyed by the reduction in mutually beneficial market arrangements that result, which economists call excess burdens. While not incorporated in official comparisons, they are very large added costs of single-payer systems compared to private medical insurance.

One study found that even the “lowest plausible assumption about the excess burden engendered by the tax system raises the true costs of delivering Medicare benefits to about 20-25 percent of Medicare outlays,” imposing costs far higher than any supposed private insurance administrative cost deficiency.

It is striking how much single-payer promoters rush past their repetitions of administrative cost savings claims before quickly turning to their vote-buying promises in large part funded by them. It almost seems that they don’t want voters to think carefully about those claims. And that might reflect an accurate judgment. If people questioned the basis of those promised solutions, it would reveal supposed administrative cost savings to be the opposite once the compounded mismeasurements are deciphered, and it would not be anyone’s ticket into the White House.

 

Gary M. Galles is a professor of economics at Pepperdine University and a guest columnist to the Penny Press. His recent books include Faulty Premises, Faulty Policies (2014) and Apostle of Peace (2013). This piece was originally published on fee.orgm then pennypresslv, reprinted here in full, with permission.

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