Don’t bash your face in. The Pledge Drive continues.

View 794 Tuesday, October 15, 2013

“Transparency and the rule of law will be the touchstones of this presidency.”

President Barack Obama, January 31, 2009

Christians to Beirut. Alawites to the grave.

Syrian Freedom Fighters

What we have now is all we will ever have.

Conservationist motto

At about 0515 this morning I managed to fall out of bed, smashing my face on the open drawer of the nightstand. There was less blood than I would have expected, and I was never unconscious. I don’t have much memory of how it happened – I presume I must have been trying to get up to go to the can – but I remembered everything that happened after I hit, so there’s no permanent damage.

Roberta decided it was Emergency Room time, and I was going to argue until I looked at myself in the mirror, so half an hour later we were in the Kaiser Emergency Room at Woodman and Roscoe, where once again I decided that what the United States needs is more Kaiser members. There was no shortage of technicians, nurses, equipment, and when needed a physician who sewed up the cut in my cheek both outside and inside my mouth since it had gone all the way through.

It also got me thinking. How many years has it been since something that severe can happen to you at 0515 and you’re on the way back home, all sewed up, with a new tetanus shot, a bottle of anti-biotic tablets, and nothing worse than some dull pain by 0950?

I got there at shift change time so I managed to meet a number of nurses and technicians (only one physician – first to shoot me up with Novocain in about seven places, then, after technicians cleaned everything out and got it all ready, he showed up again to do the actual stitching. It hasn’t been a pleasant day, but it could have been a lot worse.

Meanwhile progress in Washington seems to be a bit slower. I still think that the only way to start reducing the deficit is to stop spending more money than you’re taking in, meaning that while we must fully service the debt, we can sure start reducing government expenses by 1% a year. We can also eliminate bunny inspectors and other federal tasks that may or may not be worth doing, but are almost certainly not worth borrowing money to do. Of course none of this will happen. The nation has become accustomed to obedience to the ruling class and there is a large political interest group who wants to continue to increase entitlement spending – not only those who get the entitlements, but those who make their living collecting and paying them. We seem to be approaching a point of no return.

Of course if something can’t go on forever, it will stop.

Of course the pledge drive continues. I want to thank the new subscribers who have responded, and all the long time subscribers who have renewed. Some had forgotten about renewal for a while and came back aboard. Some renew regularly. Thanks to all.

Chaos Manor operates on the Public Radio model: it’s free, but it will only stay open if it has enough subscribers to make it worthwhile keeping it open. So far it has done so, and again thanks. For those who have not subscribed, this would be a good time to do that. http://www.jerrypournelle.com/paying.html For those who have subscribed but haven’t renewed your subscription for a while – if, for instance, you can’t remember when you renewed – this would be a great time to renew. http://www.jerrypournelle.com/paying.html I’m not encouraging those who read this place and don’t feel they can support it to stop reading it. I am encouraging everyone to subscribe if you can. I’m not after eating money or rent money. I am asking for beer and wine money…

I’ll have to get to bed early. It has been a long day. I’m fine – well, better than you might expect for what has happened to me – and the good news is that I am recovering from the cold I had. Now all I have is a lot of bruises and stitches. And of course a shingles shot, a flu shot, and today a tetanus shot. Ain’t modern medicine grand?

And I am serious about Kaiser as the model we ought to be following. My experiences have been very positive.

Scaling up — misspent funds

Dr. Pournelle,

You wrote "I do think that if part of the TARP funds had been invested in raising the quantity of those going through health care training, many of our health care problems wouldn’t exist."

I remember Mr. Heinlein, in an essay, proposed putting nuclear power plants offshore and under U. S. Navy control — his (fictional) hypothesis being that Naval engineering quality could be used in a different context than submarine and carriers, even out-of-scope, as a method of preventing nuclear accidents. His argument seems similar to yours.

While I’ve met many good-to-excellent military health care professionals, and agree that we would benefit by applying that quality of care across the board, I don’t think the specific issue you are discussing could be repaired with more medical technicians, nor would the level of quality scale up to the number needed for public health care needs. I think we may have had a similar discussion some years ago regarding applying DODDS school system standards to the District of Columbia, or even the entire country. Military discipline, regulations, and/or civilian support, have seldom been exported out of that strict context under which they are normally applied, in my experience, and just do not scale up well. IMO, the military contractor and outsourcing programs have pretty much destroyed what little integrity may have remained in DOD.

It also seems we’ve both stated elsewhere that quantity and quality are often enemies.

I agree with your point: that the economic incentive money spent has been squandered in particularly useless ways. Spending it on energy or directly on healthcare training couldn’t have done any worse, but I’ve my doubts about any such spree actually "solving" either of those families of problems.

-d

I think you have misunderstood my point. I do not think we can or should replace free enterprise with something else. My model for prosperity requires economic freedom – and it is helped by low cost energy. Of Roosevelt’s anti-depression programs, many were successful. The County Agent system of distributing modernized agricultural methods and techniques is an example. One of the most expensive, was TVA – but it also brought cheap energy to the South and ushered in a new industrial revolution there.

If we determined to spend money on TARP and “stimulus” programs, then let it be spent on something that produces results. Low cost energy is one of them. A big expansion in trained workers in key trades is another. A national medical technician training program would not seek to train everyone – only those who want to be in the program and thus will put up with being trained by methods the military has known for a long time. Spend the money on something that will get results. It isn’t as if we would swamp the land with too many well trained and competent workers. By do not scale you seem to mean a much larger upscale operation than I have in mind.

And yes, I very much understand that quality and quantity are often enemies – and giving any organization a monopoly will produce a bureaucracy subject to the Iron Law, as witness the results of giving the power of credentials to an organization monopoly.