Saturday, May 31, 2008

Fixing America, Maybe

I was happy to hear that the democratic party has settled its self-inflicted wound regarding the Florida and Michigan primaries, and that this will make Obama their presumptive nominee. He has run a clean and respectable campaign, and this bodes well for what he might do as president.

With all due respect to Hillary Clinton, we don't need any more royal families in America. She may be qualified to be president, but she has too much personal baggage and she owes too many favors to too many people. And, I really hate to mention it but I don't savor the thought of Bill Clinton being back in the White House where his personal conduct disgraced him and poisoned his administration.

Hopefully, the race for president is now mostly over. I've watched and listened to John McCain, and he's a loser. He is a man of another age, not the 21st century. He's consumed with the military and the threat of terrorism, not with making America internally strong again. He's flip-flopped on several major issues in order to court the right wing of the republican party, and these flip-flops will be highlighted by Obama's campaign. Does he really believe in anything? And, McCain is just too old. As a robust almost 64-year-old, more robust than McCain, I can tell you that I don't have the energy to be president. The oval office is not for afternoon naps! Obama should win in November.

My hope is that Obama will act deliberately to address the systemic issues that afflict America today. We don't need inflammatory rhetoric like "the war on terror". We need rational discourse, fact-based deliberations, and legislation and regulation that will slowly bring us to a new place. That will require Obama to marginalize both the wacko right and the wacko left. Can we get out of Iraq smoothly? Can we fund the entitlements without going bankrupt? Can we make major progress on energy independence? Can we fix education? Obama will need a really smart team to solve these problems, and I hope he is smart enough to recruit them.

The future is always uncertain, and things often go in unanticipated directions. But we can only do what we truly believe is the "right thing" at each moment, and then go from there. Tonight I think Obama is on the right track, and I've sent him some cash. Here's hoping it turns out to be a good investment!

Tuesday, May 27, 2008

The Ambulance Business is Changing

As you may know, I'm a fairly busy EMT. I'm also currently the president of a volunteer ambulance corps that has about 100 members and gets about six calls every day. I've been a medic since 1999 and covered about 2,000 calls since then. It's mostly routine for us, but I and my partner often make a stressful situation much more bearable for the people we serve . In recent years, however, the ambulance business has changed a lot and not always for the better.

The first change was the gradual increase in the number of calls coded for paramedic support. Paramedics are highly trained emergency medical providers, and they get paid. What they do is called "advanced life support", which includes cardiac monitoring, invasive breathing support, and administration of powerful drugs ususally via IV. They can also do heart pacing and other cool things. The thing is, their specialized skills are required only in potentially life threatening situations. The great majority of patients simply need a ride to the hospital, or some oxygen, or to have their broken bone stabilized prior to being transported. But paramedics are being dispatched on many more calls than previously, partly because there are more of them and partly as "defensive medicine". EMT's are going the way of the dinosaurs, since they run fewer and fewer calls on their own and often stand by while a paramedic performs unnecessary procedures on a patient.

You may say, "This is great!". You get a more qualified person to help you when you're sick or hurt. That part is true. The other side of the coin, however, is that you get a much bigger bill for ambulance services. The company that employs the paramedic is going to charge you (or your insurance) about $400-$500 for 15-20 minutes of monitoring you on the way to the hospital, whether you really need it or not. EMT's, on the other hand, are pretty well trained to evaluate symptoms and determine whether or not a paramedic is needed. We are much less expensive, or even free of charge, like me. But we are being pushed out in favor of much more costly professionals. I may ultimately stop doing this work because cases I used to handle without incident are now being coded for paramedic involvement. The patients are seldom any better off, but they pay a lot more and I get bored.

The second issue involves reporting requirements. When I started we had one version of a written report. A few years later we got a new report form, much improved in my opinion, with lots of check boxes for what we found and what we did for the patient. Recently we have gone to computer input of our reporting - we have laptops on the ambulances and we can access the software from any internet computer. Completing this computer-based reporting (about 8 screens worth) takes at least 30 minutes per call - after the call. We once were able to come back to the base, write one or two more things on our mostly completed paper-based reporting, and be done. Now we need 30 minutes to finish the call on the computer. If we get three calls in quick succession, we get to do 1.5 hours of keypunching when we finally get home to the base. That stinks! Worse yet, it's hard to see whether this adds anything of value to what we've already done. Why should a volunteer have to put up with this?

This tirade is aimed at those who think that more is always better. It's not. Life is all about trade-off's. "More" costs more. "Is it worth it" is seldom asked. In my view the cost of living in America is going up in many cases simply because that simple question is not being asked or answered. There is little doubt that many more paramedic jobs, paying from $15-25 per hour, often with benefits, are being created. Also, electronic reporting provides a great mass of data about ambulance calls. But are these things really improvements? In my view, we pay a hidden tax by being provided with more qualified care than is necessary or requiring ambulance personnel to spend more time preparing a report than they just spent taking care of a patient.

Am I the only one who feels this way? No. My own physician complained bitterly about his own computer-based reporting when I last visited him, and I know he's not allowed to do simple procedures that my family doctor routinely performed 50 years ago. The medical profession is being overwhelmed at all levels by the bureaucracy and defensive medicine.

If we are ever going to have an excellent and efficient national health care system, those who implement it will have a lot of choices about where the money gets spent. If they opt for defensive medicine at every level, which seems to be the trend, health care will bankrupt our country. Think of an agency like the boneheaded Homeland Security agency for health care - bureaucracy in triplicate and job #1 for everyone is to cover their "behind". Sanity is needed, but government seldom has it. So, a fine volunteer agency like mine has experienced people with great records pissed off and ready to quit because government is getting overly cautious and intrusive. Is this the America of self-reliance and freedom, or is this the coming America of the bureaucrats?

Thursday, May 22, 2008

Government Spending - A "Secret Place"

You know what really bugs me? It's the constant harping about the government not spending enough money on just about every service it provides. Armed forces pay, teacher pay, prescription drugs and medical procedures, farm subsidies, food inspections - you name it, somebody is bitching about how we don't spend enough money on it. Well, here's what I think. If we really knew what was spent on this stuff, we'd want to throw up. That's why we're never told in straight terms what the government pays.

Here's an example. In 2008, a junior officer (Army captain, for example) with six years experience (age, about 30) will get a base pay of $57,156 plus a free 0n-base home or an off-base housing allowance. He and his family will get free medical care, and he'll be able to retire at half pay after 20 years of service. Granted, he has an important job and some risk, but the great majority of officers at this rank will never see combat. It's a darn good job if you're willing to move around at the government's pleasure, sometimes to some pretty good places. You'd have never guessed it if I didn't tell you, and I can think of plenty of harder jobs that pay less.

Teacher pay. Teachers in my school district can make $90,000 and full medical coverage, plus retire at something like 2/3's of their final pay and full medical after 30 years. That's for teaching about 185 days each year. Competition for these jobs is unbelievable, and you can see why. Why is it, I wonder, that teacher pay is a big issue around here? It's because the average person has no facts.

Medicaid spending. It's the largest single component of my county's budget, by far, and it's growing like topsy and forcing property tax increases. I've never seen an analysis as simple as this: the per-person cost for each Medicaid recipient in this county, and the breakdown by doctor bills, prescriptions, and hospital costs. If we taxpayers saw these numbers, we would go crazy because they are so much higher than what we pay for our own care. But we're never told. Medicaid is an industry, and we provide the revenue for it.

Today the U.S. senate passed a $290 billion farm bill - $290 billion in farm subsidies, the lion's share going to larger agribusinesses. This at a time when farmers are experiencing a bonanza in crop prices and recond profits. It's an election year, you see, and congress wants those farm state votes. They're paying for them with your money.

And so it goes. "Big Government" is out of control. There is no accountability, and the only brake on spending is potential taxpayer revolt. The government takes what the market (you and me) will bear. The great size of government, and its multitude of functions, keep us from understanding it. And that's exactly how "Big Government" wants it to be.

OK, you say. That's the problem. What is the answer? Probably two things: first, information like what I've presented above. Put the big spending items into some perspective that the average person can understand. Second, more citizen input on spending, such as referendum and initiative. It's not surprising that New York is one of the top taxing states, does not have referendum and intiative, and that the special interests and the politicians won't even consider them.

You may think I'm some wild-eyed libertarian. I'm not. I think the government needs to handle many functions in our complex society. I just don't think the rest of us should be stuck with a much bigger bill than is necessary. Think about that when you cast your votes in the fall...there are candidates who are serious about managing the cost of government. Give them a chance to work for all of us, to uncover and eliminate the secrecy of government spending.

Sunday, May 18, 2008

Islamic Doublethink?

I'm no Islamophobe. I've got Muslim friends and friends who adhere to other religions, or no religion, as well. I believe God speaks to people in many ways. However, I'm confused about why Islam is so paranoid about "images" of animals or people, thinking that they may arouse idolatry, and so protective of the Quran itself. It seems to me that perhaps one can so revere two pieces of cardboard with paper inside that reverence for God might take second place to this physical thing as well.

I'm a Christian, so the Bible is important to me. In my view, it is the most important source of God's word to man. Yet I'm not at all protective of the Bible itself. If someone wants to step on it, burn it, or deface or ruin it in any way, I'm not going to take offense. Rather, I'm likely to feel sorry for the person and try to find out what would make a person want to do that. In my view, God alone can judge, or perhaps punish that person for their intent. For my part, the Bible is cardboard and paper. Harming it does not do actual harm to God in any way, and God does not need me to help defend the Almighty. God is surely capable of self-defense against such puny creatures as we.

Today I read a story about an American soldier shooting up a Quran. A general ended up apologizing profusely, another officer produced a new Quran and kissed it before handing it over to some Islamic clerics, and the soldier was brought home in disgrace. I'd say the soldier was stupid and wrong to do what he did, and his act was disrespectful to Muslims, but I'd leave the idea of defending God out of the conversation about this incident. Allah can take care of Allah's interests, no doubt. The soldier's act was the latest in a series of such Quran desecrations where violent revenge was threatened or taken for the insult. It seems to me that the book itself has just as much potential for idolatry as a picture. It is a material thing, and it seems to me that it can become just as much an icon as any graven image or picture.

More broadly, I view this situation as another of the millions of situations where members of one faith "insult" members of another either verbally or by some sort of desecration. We have civil laws against the more flagrant of these situations - painting swastikas on temples, turning over gravestones, messing around with stuff on an altar, discriminating against someone of another religion, etc. At some point even repeatedly calling people names becomes harassment. These are the laws that should pertain to things like shooting a Quran or taking a Bible out of a church and tearing it up. But when those of the "offended" faith start talking about revenge (in the name of God), things have got way out of hand and often the retribution is out of proportion to the offense.

Perhaps I have a Muslim reader who can explain why this man-made thing that eventually will fall apart on its own is so important to defend with violence? I wouldn't misuse a Quran simply out of respect for this reader and his/her co-religionists, but I can't imagine why some Muslims hyperventilate when idiots do what idiots will do. Is a book really worth rioting and killing for? Just curious.

Friday, May 16, 2008

Optimistic About America

"Necessity is the mother of invention". Trite, but true. Often the only way to get action started is to create a crisis. Well, America has finally got a crisis on its hands with gas prices, and soon we will also realize that America's fiscal affairs also represent a crisis of major proportions. This is good, for we will finally, if belatedly, roll up our sleeves and do something about changing out our energy supplies and fixing our entitlement imbalances.

It's hard to be optimistic when a big chunk of previously disposable income is now exiting the exhaust pipe and the American dollar is under water, but I think we should be happy. Our country is blessed with millions of smart, creative people and a political/economic system that is flexible enough to undergo dramatic change without breaking. Our country will be a lot different in ten years, and the metamorphosis won't be too painful.

Not sure about this prognostication? Just remember what we did when we finally decided to stop Hitler. Our moribund industrial sector flipped its priorities and ramped up in an incredibly short time to produce everything we needed to win a worldwide war. And when the Russians beat us to space, we responded by standing on the moon within ten years using less computer power than my cell phone now has. America is just as capable now as then - we just seem to need a kick in the pants to get going.

I'm excited about the future. At almost 64, I have perhaps one more generation of time to view the evolution of America. All we need now is some leadership to get us on the same page and free us to get busy. Take heart! Our new world is just around the corner, and getting there will be fun.

Wednesday, May 14, 2008

Hillary's Strength is America's Weakness

Recent polling statistics and election results have shown that Hillary Clinton's likely voters fall into three categories: whites without a college education, the elderly, and government/teacher union members. I can understand why she gets these votes, but America will not prosper if the new president is indebted to these groups for supporting her.

It's telling that educated democrats favor Obama over Clinton, but uneducated ones favor Clinton. Part of the answer is "race" consciousness, part of the answer is ignorance (or, to be more genteel about it, lack of information and critical thinking), and part of the answer is Clinton's outrageous pandering to what she calls "hard-working Americans". Except that they didn't work hard in school, nor do they have much in the way of marketable skills. Obama, on the other hand, gets support from Paul Volker and three past heads of the SEC. Whose opinion counts the most?

The elderly are, generally speaking, the segment of the population who are most race-conscious (after West Virginians and Arkansans (?), of course). These folks also are the largest constituency for the government entitlements that are bankrupting our country. Do we really want our next president elected by those who depend on government for their financial security - by our debtor class, so to speak? Government spending on the elderly needs to be controlled, not enhanced, and Obama speaks much more cogently on this issue.

I live in New York, a state that ranks at the top of highest-taxing states largely because it has a bloated population of unionized state employees and powerful teacher unions. Per capita of population, New York has twice as many state employees as California. It also has a huge debt that neither democrat nor republican administrations has been able to control. The fact is that public employee and teacher unions, who are powerful Clinton supporters, care a lot more about their overly generous retirement and health care plans than they do about the long term success of our state, just as GM employees cared more about their pay and benefits than about GM's continued competitiveness. Do we need a president who owes her success to these groups?

Obama is about change, which is going to mean tackling America's problems in a straightforward manner. He's been pretty clear about this in major speeches. Clinton is about change that benefits her constituencies and diminishes America because resources will be diverted to non-productive purposes. Will we buy into her populist demagoguery and her pandering to entrenched special interests in the party? I hope not.

Wednesday, May 07, 2008

Schizophrenic on "Free Will"

We're schizophrenic when it comes to "free will". Generally speaking, we humans want our own way. We don't want to be controlled, we glorify the idea of freedom, and we often rebel even at the idea of listening seriously to the advice of others. We love our independence. But, only to a point.

Most of us readily jettision our facade of self-determination and independence when we face a serious situation where we are clearly unable to cope. When we, or a loved one, become desperately ill or face an uncontrollable peril. When our financial situation deteriorates into desperation. When we have screwed up our lives to the extent that our family, friends, or boss can't take us anymore. When hope of safety or security is gone, we turn to God and offer up our "free will" in exchange for divine intervention. We verbalize our need and what we are willing to do if we are somehow saved. In my view, God has little reason to listen to us when we make this offer.

It's not that God is hard of hearing or hard-hearted. I think God knows exactly what is going on in our lives and how events inside or outside our control can leave us totally frightened or depressed. But God did not give us free will and a somewhat predictable environment for "free". The bargain has already been made - we got free will and a world that operates on fixed natural laws in exchange for the chance to live with those things. Individually, and as a species, God allows humanity to do what it wants to do and enjoy or suffer the consequences. We express our self-determination within this framework. It's God's gift.

People I know say prayers for many things - good health, success, healing, others in need, and themselves. Recently on an ambulance call I heard a woman in mental distress repeatedly call out to Jesus for succor, but no miracle occurred. I've many times heard God invoked for aid in dealing with catastrophes around the world. "God be with them, God help them." I can understand the urge to beg for supernatural assistance, but I wouldn't count on getting any. God's assistance came when each of us was born and entered creation.

Notwithstanding the above, I don't totally discount the idea that God might intervene in creation from time to time. God made it and God can do what God wants to do with it. Miracles may happen from time to time. Revelation may be granted us, and likely has been. Just not on our schedule. And yes, I do pray. "Thank you God, for this wonderful creation, my life, and my freedom. May I reflect the goodness I see in You, may I accept whatever life sends my way, and may I find peace with You when the end comes."

Then again, if things get really bad - "O God, rescue me!". I'm probably schizophrenic, too.

Saturday, May 03, 2008

School Discipline

As Mr. "RWorld" joyfully reminded us, George Bush has only 200 and some days left in his term. Unfortunately, that still leaves him as America's #1 problem, but we know he will go away (AFTER TOO LONG!). Problem #2 is America's education system, and it outranks the entitlement finance gap because America will not remain competitive in the world unless our children get smarter. At present, they're getting dumber, and that needs to change. But poor discipline stands in the way.

Here in Rochester, NY, the city school teachers are petitioning the superintendent to take action to improve their safety. Teachers are being threatened with bodily injury even at the middle school level. Classroom disruptors spoil the educational opportunities for the remainder of students, according to these teachers. Are the teachers "crybabies"?

One of my sons teaches eighth grade math in the "combat zone" of a large city. The great majority of his students are Hispanic, and the area leads the city in crime. But he loves to teach these kids, and they respond to him. His students score high (relatively) in standardized testing, and he is regarded as one of the better teachers in his district. He is no giant, but he is physically imposing, so no eighth grader is going to challenge him. But discipline is still a big problem in his classroom.

According to this fine teacher, one or two disruptive students in a class of 22-26 students can create enough chaos to seriously diminish educational opportunity for the rest. The teacher spends excessive time monitoring and correcting the disruptors, and they distract the other students continually. The process for removing these children is ineffective. This situation is absurd.

Doesn't common sense require that students who routinely disrupt classrooms be segregated into special, highly monitored learning environments? These students need activities that burn off their high energy and teachers who cannot be intimidated. They, and the students who are no longer disrupted, would greatly benefit from the self-selection that resulted in their being segregated.

The Rochester teachers have a legitimate complaint. No teacher should have to teach in a threatening environment, and no student should be forced to learn in a classroom ruled by violent children. Whatever the cost of implementing disciplinary classrooms at all grade levels and supervising the students assigned to them, it would be money well spent in terms of achieving good outcomes for all students.

The education system must be aligned with the capabilities and needs of the students. High performers should have maximum opportunity and flexibility. Low performers should get more attention from specially trained teachers. The mass of more average students should have interesting educational experiences, plenty of challenges to extend themselves, and a classroom free of routine disruption. Those children with sub-standard socialization should have educational experiences that focus on this problem first.

Does it really take someone with a Ph.D. to understand that "education" requires teachers who feel safe and students who are focused primarily on the teachers rather than on out-of-control students? I don't think so.