Why does coal get a free pass on pollution? Isn't energy generation profitable enough for private ventures to contain all the mercury, thorium, lead, uranium and other heavy metals from escaping and polluting? Why aren't coal power plants financially responsible for all the mercury warnings in majority of the lakes?
Those are good questions. Several years ago, I wrote some stories for an environmental magazine trying to answer them.
It seemed to me that if I was breathing clean air, then a power company should have to restore their emissions to be clean enough that my air would stay just as clean.
Apparently that was technically impossible. The engineers can clean a coal plant's emissions as much as you want, but you can only get asymptotically clean. The more you clean, the more it costs, and it's increasingly expensive to get those last remaining pollutants. At a sufficiently low level of pollutants, the cost of removing pollutants equals or exceeds the value of electricity produced.
The coal companies used to run their emissions through these big bags which removed a lot of particles. They reduced the power output by 10%. There were different technologies but they were all expensive and reduced efficiency.
(This assumes that you remove the mercury, thorium, lead, etc. in the form of sludge, and you find someone who doesn't mind if you bury it in a clay-capped hole in the ground, er, waste disposal site, and monitor it forever.)
But we need some electricity from somewhere. I believe that, in principle, we should be able to generate all the electricity we need from non-polluting non-nuclear sources, which ultimately means solar power. But when I read even the optimistic projections in Science magazine by people who are actually trying to do it, it doesn't look like we'll be able to do more than (I'd guess) 20% or 30% in the next 20 years.
Or perhaps you'd prefer hydropower, like the Three Gorges Dam.
I went without an air conditioner for several years. Then one summer during a heat wave, I gave up. My local Sierra Club, I noticed, had an air conditioner.
From the perspective of single-minded engineering and business efficiency, if you need electricity as soon as possible, coal power plants are great, as the Chinese government has decided. The less pollution control, the more efficient. From the perspective of lungs, they're not so great. The pollution in Beijing is so bad that some people can't live there. Even in the U.S., the pollution from traffic by the side of a busy road is so great that it increases the incidence of asthma and lung disease dramatically.
Too bad everybody laughed at Jimmy Carter. He saw this coming.
Oh, I see what you mean. Forgive me for not distinguishing clearly enough from your own viewpoint and the viewpoint you were trying to understand.
I'm trying to figure these people out myself, and they're not using logic as we understand it. They'll draw deductive conclusions based on their pseudo-free market ideology, and ignore the facts. They don't seem to understand the scientific method of comparing your theory to the facts.
But actually, end-of-life decisions don't work the way some economic theories would predict.
Actually, many doctors do take time to have end-of-life conversations with elderly patients, even though they don't get paid for it. That was the point of the bill, to reimburse doctors for it so they wouldn't lose money, and more doctors would do it.
They often get infants or elderly patients who are hopeless, who are almost certain to die in a month or 6 months, and hospitals will spend a fortune to keep them alive in an intensive care unit, because the family insists on it. They will very occasionally go against the family's wishes, but it usually takes a court order. Hospitals write it off on their debt. It comes out of general resources. Sometimes it gets controversial, like in the Terry Schaivo case, but usually they make these decisions privately.
That happens in England too, although sometimes they also get controversial and go to court.
The insurance companies can't control costs by refusing treatments like that. They raise their premiums instead.
The fact is that we *don't* control costs with death panels or anything like it. Maybe it would be more rational if we did. But it's a myth.
I admit I have a hard time dealing with people who get their facts from Fox News/Rush Limbaugh, and refuse to believe anything else. I say, "Here's an article from the New York Times," and they say, "The New York Times! You don't expect me to believe that, do you?"
People who get all their news from The New York Times and NPR as every bit as ignorant as those who get all their news from Fox and The Wall Street Journal.
And vice versa.
There's an important point about journalism that you're getting exactly wrong.
I've been reading the New York Times and Wall Street Journal daily for 35 years. Both newspapers are supposed to be writing their news stories (as distinct from the editorial pages) in a way that gets all sides of the story, preferably in the same story, or at least over a series of stories. That's what journalists mean by objectivity or balance.
They've done a fair job. I think the WSJ used to do a better job of giving all sides, which is why I bought it, but in recent times they've become more alike and Murdoch has been doing unprecedented interference in the news reporting.
Even a Wikipedia story has a section called "Controversy." A news story that gives both sides, or different sides, is going to inform you better than a story that only gives one side.
I also think it's good to read the left and right extremes. My best source on the left is http://www.democracynow.org./ For the right, I read the WSJ editorial page, but they're not the principled conservatives they used to be.
This is my point! It can logically be defined that broadly, and the issue at hand is the shift of control from the insurance companies to the government. That is the essence of it, right there. So the 'what' is troubling, but the 'who' becomes crucial.
It can illogically be defined that broadly.
It would provide for your doctor talking with you about what you would like him to do if you were in a situation where you couldn't communicate and it was 99.999% likely that you would never survive to open your eyes in bed and see what was going on around you.
If you take the issue of 'death panels' with an open mind, for example, you will find that there is some substance to the fear that underlies it. In a given system with limited resources, someone has to decide who lives and who dies. In a capitalist system this decision is based on who can pay for the treatments and who cannot. In some other system it would be dealt with in some other way, but with limits on the resources it will have to be dealt with. Since 'socialized medicine' is still a capitalist system with a government payer, then it stands to reason that the government would be deciding who lives and who dies by virtue of what it pays out.
At the risk of being boring, and oversimplifying, I'm a health policy wonk and I know a bit about the "death panels" and rationing.
The person to popularize the idea of "death panels" was Betsy McCaughey, a Republican activist who used similar attacks against the Clinton health care bill. I've read her stuff for years in the Wall Street Journal editorial page. She took up one issue, hand-washing, which is a motherhood-and-apple-pie issue in medicine, and made some good points. She's not a doctor, and she has no particular training in health policy.
A lot of doctors had a recurring problem with patients at the end of their life. They'd wind up with an elderly, very sick patient who was unconscious, deteriorating and unlikely to recover. The family would be waiting day and night in the hospital lounge, the patient would be costing the hospital (or Medicare, or the insurance company, or somebody) $2,000 a day in the ICU, and the family wouldn't know what to do. Families sometimes had arguments that tore them apart. Doctors tell stories about the adult child who hasn't seen the parent in 20 years, who suddenly calls on the phone and insists that they do "everything" for their hopelessly dying parent.
That's probably the way you will die.
Most doctors have always felt that they should have a discussion with their elderly patients *before* they get sick, with their families, to decide how they want to be treated in such a situation. Many of them do have discussions. The problem is Medicare doesn't pay for those discussions. (That's one of the standard criticisms of medical reimbursment: they pay for procedures, but they don't pay for discussions with patients.)
So a pair of Republican and Democratic congressmen got together and offered a bill that would provide for Medicare to pay for those discussions.
That's what Betsy McCaughey blew up into the "death panels." Probably the best discussion of this was Jon Stewart's interview with Betsy McCaughey (which tells you something about the news today). McCaughey took some language from the bill and misinterpreted it with wild speculation, as Stewart pointed out. If you want to plow through the details, the New England Journal of Medicine had several articles about it and I think those articles are free on the http://www.nejm.org/ web site.
It doesn't really have anything to do with limited resources, or rationing, or the economic limits to health care. It was a deceptive political attack. Its purpose was to make the Democratic health reform bill fail, and to replace an honest discussion with a shouting match.
Probably a lot of books written on it -- Atul Gawande did a pretty big "study" with safety checklist prior to OR activation. We have several checklists (independent of anesthesia) before starting any invasive procedure, so this is kind of behind the times.
An OR nurse once explained to me, there's a huge number of pieces of equipment in an OR, and you can't possibly check every one prior to every complicated procedure.
It's easy in hindsight to say, "Why didn't you check the collimator?" But there were a hundred other things you also could have checked, and if you went through a checklist like that, the procedure would take twice as long, and you'd be checking for problems that were so rare that they might have been reported only once or twice to the FDA in the last 30 years.
The trick with these checklists is to come up with a checklist that includes everything that can realistically happen, but not so long that it takes an unrealistic amount of time to get through and looks like a 100-page lawyer's contract.
Even handwashing can be a problem. If you have to check 20 patients in the morning, and you have to do a 5-minute surgical scrub between each patient, that's a lot of extra time.
even in the USA under Medicare, Medicaid, military and veteran health care,
Lul wut? Have you ever -used- or know people who have used those services? They are terrible. Its much worse than any insurance provider
I don't get this. Do you have any first-hand experience with those services? I moved from private insurance to Medicare when I turned 65, and the only difference was that my premium went from $525 to $90 a month, same doctors, same services.
I'm not in the Veterans' Health Services, but I know doctors who have joint appointments and perform surgery at the VA health center and at the top New York City academic medical centers. I've seen studies of different conditions, like BPH and cancer, where the VA hospitals had some of the best treatment outcomes in the country.
I'm sure you can find one person who was dissatisfied with Medicare, or the VA health care system, but when you look at the treatments overall, they do a great job.
(Medicaid is a special case with payment problems and access problems in some parts of the country, but that's the fault of legislators who don't want to pay to treat poor (black and hispanic) people.)
People here are speculating, and don't know the facts, because Butler69 didn't tell us the facts.
Of course it's understandable that somebody would be upset and angry and make wild accusations after his wife got injured, but the rest of us don't have to join in.
This fiasco sounds like it was at least somewhat avoidable with the application of a modest amount of discipline.
You have no idea whether it was a fiasco or an unavoidable consequence of surgery. Why was she getting a hysterectomy? What were her coexisting conditions? You don't know, and none of us know, because butler69 didn't tell us.
Nobody is going to improve the health care system by making wild, unsupported accusations.
Have you ever heard of the AFL CIO? In 2000 they spent 4.1 million on federal campaigns.
I believe the total spent on the 2008 campaign was $1 billion for both parties. Fill in the current numbers. The union share is significant but doesn't come close to corporate spending.
I was following health care lobbying for a while, and as I recall the health care industry spent at least $100 million on campaign contributions to each party, with more to the Democrats. The financial industry spent another $100 million on each party.
If any Slashdotter wants to show off, I'd be glad to see links to better statistics.
Why should I bother reading about what the NYT has to say about Haiti when there are people there right now who are blogging about it in more detail than any non-local reporter ever could?
As a journalist, let me defend my existence.
There are bloggers in Haiti who haven't seen the president because Preval has been avoiding going out in public. The people who work for the Times can get to him or know how to track him down.
There are bloggers in Haiti who know only that there's devastation all around, and they don't have any food, water or medical care, but they can't get around. The Times has people all over, including the airport, the surviving government buildings, emergency organizations back home, Washington DC and the Haitian neighborhoods in Brooklyn and Florida, who can pool their information and figure out what's going on. When things work right, they can hold the responsible people accountable. The Times can talk to earthquake experts to find out about the geology, they can talk to civil engineers to find out why so many of the buildings weren't earthquake-proof, they can talk to disaster experts to find out how they deal with an earthquake like this, what kind of supplies they're getting, and whether they're getting them.
(For that matter, the Times also has its own blogs.)
I've been reading the New York Times all my adult life, and I could give you a long list of its faults. Conversely, there are a lot of great blogs (pax salam's blog in Iraq, for example) that do things newspapers can't do. But newspapers like the Times cover news in a comprehensive way that you can't replace with some bloggers with limited resources.
Actually, the market can work just the opposite way.
I used to work for a computer magazine for lawyers and law firms. We charged I think $50 a year for a magazine filled with ads.
Eventually they broke it up into separate newsletters -- one for Word, another for Excel, etc. -- which they sold for $200 a year. They had a little bit more content on Word, for example, than the original magazine, but not much.
People were actually willing to pay more for the parts than the whole magazine together.
H1N1 killed 3,000 so far in the U.S., almost all of them 45, most of them 30 and a large number of them 5. This is unusual. These are healthy people who would have gone on to live full, healthy lives if they hadn't died of H1N1.
How do you know that? My crystal ball remains cloudy.
New England Journal of Medicine. http://www.nejm.org/ I think most of their articles on the flu are available free. http://h1n1.nejm.org/?ssource=rthome They had a couple of articles in particular reporting on the experience of H1N1 in the U.S. I had some problems inserting the urls when I posted before, and that's my fault.
I'll leave the debate to people who have Citation Manager.
As I said above, which you would have seen if you had read the entire thread, I was referring to deaths in the U.S., which were about 650,000. The number of worldwide deaths were much larger, but they're not known as accurately.
You don't seem to be following the conversation. I was arguing that the possibility of another strain like that is a serious danger. So the worldwide figure just makes my argument stronger.
In your own words, influenza kills 50,000 a year in the U.S. The current worldwide number of deaths for H!N! is just over 14,000.
You left out the part about age distribution.
Influenza kills 50,000 a year in the U.S., almost all of them >60 years old and most of them >70 years old, usually with serious concurrent heart of lung disease, so that influenza finishes off a sick person who would have died soon anyway.
H1N1 killed 3,000 so far in the U.S., almost all of them 45, most of them 30 and a large number of them 5. This is unusual. These are healthy people who would have gone on to live full, healthy lives if they hadn't died of H1N1.
On a per-patient basis, influenza vaccines are one of the cheapest, most effective things the health care system can produce. You can divide the total cost of the H1N1 vaccine in the U.S. BY 3,000 lives at risk to get an idea of how much it costs to save a life. (That's just a Fermi exercise.)
Most public health people feel that if you can save 3,000 lives for a reasonable amount of money, and you've got the money, do it. And if there's a small chance that it will save 100,000 lives, even more reason to do it.
I'm not going to argue any more; if anybody wants the facts they can go to the New England Journal of Medicine.
There was a reasonable likelihood of a megadeath sized pandemic.
Actually no. There was a small percentage of people that might have died, and a larger pool of people that would have been pretty sick for a few days. And even at the height of the thing, they were never sure if the percentage of people dying was all that high, because there was such a small sample rate to work from...
That was it.
There was never a call to get as worked up as everyone did, where they practically were driving down the streets with bullhorns demanding citizens get flu shots.
Incredible ignorance. Where do you get your information from? According to the New England Journal of Medicine, an additional 3,000 young people died from influenza this year in the U.S., and that's unusual.
The influenza epidemic of 1917-18 caused 650,000 deaths in the U.S. When a new influenza virus comes up, how do you know it's not going to be another virus like that -- in time to produce vaccines? How do you know it's not going to cause 100,000 deaths? or even 10,000 deaths? You don't.
The UN and the doctors running this operation made the right choice.
To me it seems like the WHO overreacted, people and governments bought in to it, and now they are looking for a scape goat
To you. Are you a doctor? Are you a virologist? What the fuck do you know? Nothing. Do you think anybody in his right mind is going to risk the lives of hundreds of thousands of people by paying attention to you?
Influenza kills 50,000 people a year in the U.S., usually elderly people who are sick with something else. If that goes up or down by 10%, that's a lot of people. According to the New England Journal of Medicine, 3,000 children, teenagers and young people died this year from the H1N1 flu. These are otherwise healthy young people who would not otherwise have died. A lot of them were infants under 5 years old. The vaccine seemed to have provided significant protection. It's hard to tell how many people would have died without the vaccine, but twice as many is reasonable.
3,000 deaths is the same number of people who died in the World Trade Center. Did you get upset about that? Or did you laugh it off like you're doing with the flu?
The 1918 flu caused 650,000 deaths. Nobody really knows why. We could have another epidemic like that any year. When the new flu comes up, nobody knows until it's all over whether it's going to be the big one until it's all over.
People get into a position of responsibility because unlike you, they're doctors and they know the facts. They're not going to take a chance with 3,000 lives at stake. It's a pretty easy decision: order the vaccine, and take the risk of not needing it, or don't order the vaccine, and take the risk of killing 10,000 people -- or 100,000 people -- or 650,000 people.
You're like people who say it was a waste of money to build earthquake-resistant buildings because we didn't have an earthquake. Or to build flood-resistant levies because we didn't have a flood.
You are suffering from stupidity, which is an even worse disease than the flu, and it's going around Slashdot.
Actually, cigarette smoking lowers public expenditures. Cigarette smokers are likely to die younger.
The main savings is in pensions, social security, and health care for the aged.
An Eastern European country required a cigarette company to submit data on the costs of cigarettes. The company handed the job over to their usual health economists and PR guys, who came up with a report that cigarette smoking would save the country money for those reasons.
It was nice to see such refreshing candor from a cigarette company. Or maybe I should say, I'm glad they didn't stop to think about it before they released the report.
I'd like to look at whatever statistics you're using.
In my understanding, the center cities in the North are substantially worse in all public health indicators than Cuba. I know the infant mortality and life expectancy in The Bronx, NY is worse than Cuba.
In fact, Fidel Castro invited a dozen Americans to attend Cuban medical school, and they did. One guy came from The Bronx. A doctor from the New England Journal of Medicine visited their school, and reported favorably on it. Castro also offered to send Cuban doctors to underserved areas of the U.S., but Bush turned him down.
U.S. health care for the poor really is terrible. It's like being in the third world. 22,000 people died in 2006 because they didn't have health insurance, according to the Urban Institute. http://www.urban.org/UploadedPDF/411588_uninsured_dying.pdf
Don't believe me. Don't believe Michael Moore. Try to get health care for somebody who can't afford it. Call up a hospital, or try to get Medicaid. Go to a hospital emergency room and talk to the people waiting there.
For the middle class, the problem is not that you won't be able to get health care, but that you'll get a serious disease and it will drive you bankrupt. Harvard law professor Elizabeth Warren said that under all the current proposals, you'll still go bankrupt.
Slashdot Mirror
Why does coal get a free pass on pollution? Isn't energy generation profitable enough for private ventures to contain all the mercury, thorium, lead, uranium and other heavy metals from escaping and polluting? Why aren't coal power plants financially responsible for all the mercury warnings in majority of the lakes?
Those are good questions. Several years ago, I wrote some stories for an environmental magazine trying to answer them.
It seemed to me that if I was breathing clean air, then a power company should have to restore their emissions to be clean enough that my air would stay just as clean.
Apparently that was technically impossible. The engineers can clean a coal plant's emissions as much as you want, but you can only get asymptotically clean. The more you clean, the more it costs, and it's increasingly expensive to get those last remaining pollutants. At a sufficiently low level of pollutants, the cost of removing pollutants equals or exceeds the value of electricity produced.
The coal companies used to run their emissions through these big bags which removed a lot of particles. They reduced the power output by 10%. There were different technologies but they were all expensive and reduced efficiency.
(This assumes that you remove the mercury, thorium, lead, etc. in the form of sludge, and you find someone who doesn't mind if you bury it in a clay-capped hole in the ground, er, waste disposal site, and monitor it forever.)
But we need some electricity from somewhere. I believe that, in principle, we should be able to generate all the electricity we need from non-polluting non-nuclear sources, which ultimately means solar power. But when I read even the optimistic projections in Science magazine by people who are actually trying to do it, it doesn't look like we'll be able to do more than (I'd guess) 20% or 30% in the next 20 years.
Or perhaps you'd prefer hydropower, like the Three Gorges Dam.
I went without an air conditioner for several years. Then one summer during a heat wave, I gave up. My local Sierra Club, I noticed, had an air conditioner.
From the perspective of single-minded engineering and business efficiency, if you need electricity as soon as possible, coal power plants are great, as the Chinese government has decided. The less pollution control, the more efficient. From the perspective of lungs, they're not so great. The pollution in Beijing is so bad that some people can't live there. Even in the U.S., the pollution from traffic by the side of a busy road is so great that it increases the incidence of asthma and lung disease dramatically.
Too bad everybody laughed at Jimmy Carter. He saw this coming.
Oh, I see what you mean. Forgive me for not distinguishing clearly enough from your own viewpoint and the viewpoint you were trying to understand.
I'm trying to figure these people out myself, and they're not using logic as we understand it. They'll draw deductive conclusions based on their pseudo-free market ideology, and ignore the facts. They don't seem to understand the scientific method of comparing your theory to the facts.
But actually, end-of-life decisions don't work the way some economic theories would predict.
Actually, many doctors do take time to have end-of-life conversations with elderly patients, even though they don't get paid for it. That was the point of the bill, to reimburse doctors for it so they wouldn't lose money, and more doctors would do it.
They often get infants or elderly patients who are hopeless, who are almost certain to die in a month or 6 months, and hospitals will spend a fortune to keep them alive in an intensive care unit, because the family insists on it. They will very occasionally go against the family's wishes, but it usually takes a court order. Hospitals write it off on their debt. It comes out of general resources. Sometimes it gets controversial, like in the Terry Schaivo case, but usually they make these decisions privately.
That happens in England too, although sometimes they also get controversial and go to court.
The insurance companies can't control costs by refusing treatments like that. They raise their premiums instead.
The fact is that we *don't* control costs with death panels or anything like it. Maybe it would be more rational if we did. But it's a myth.
I admit I have a hard time dealing with people who get their facts from Fox News/Rush Limbaugh, and refuse to believe anything else. I say, "Here's an article from the New York Times," and they say, "The New York Times! You don't expect me to believe that, do you?"
People who get all their news from The New York Times and NPR as every bit as ignorant as those who get all their news from Fox and The Wall Street Journal.
And vice versa.
There's an important point about journalism that you're getting exactly wrong.
I've been reading the New York Times and Wall Street Journal daily for 35 years. Both newspapers are supposed to be writing their news stories (as distinct from the editorial pages) in a way that gets all sides of the story, preferably in the same story, or at least over a series of stories. That's what journalists mean by objectivity or balance.
They've done a fair job. I think the WSJ used to do a better job of giving all sides, which is why I bought it, but in recent times they've become more alike and Murdoch has been doing unprecedented interference in the news reporting.
Even a Wikipedia story has a section called "Controversy." A news story that gives both sides, or different sides, is going to inform you better than a story that only gives one side.
I also think it's good to read the left and right extremes. My best source on the left is http://www.democracynow.org./ For the right, I read the WSJ editorial page, but they're not the principled conservatives they used to be.
This is my point! It can logically be defined that broadly, and the issue at hand is the shift of control from the insurance companies to the government. That is the essence of it, right there. So the 'what' is troubling, but the 'who' becomes crucial.
It can illogically be defined that broadly.
It would provide for your doctor talking with you about what you would like him to do if you were in a situation where you couldn't communicate and it was 99.999% likely that you would never survive to open your eyes in bed and see what was going on around you.
If you take the issue of 'death panels' with an open mind, for example, you will find that there is some substance to the fear that underlies it. In a given system with limited resources, someone has to decide who lives and who dies. In a capitalist system this decision is based on who can pay for the treatments and who cannot. In some other system it would be dealt with in some other way, but with limits on the resources it will have to be dealt with. Since 'socialized medicine' is still a capitalist system with a government payer, then it stands to reason that the government would be deciding who lives and who dies by virtue of what it pays out.
At the risk of being boring, and oversimplifying, I'm a health policy wonk and I know a bit about the "death panels" and rationing.
The person to popularize the idea of "death panels" was Betsy McCaughey, a Republican activist who used similar attacks against the Clinton health care bill. I've read her stuff for years in the Wall Street Journal editorial page. She took up one issue, hand-washing, which is a motherhood-and-apple-pie issue in medicine, and made some good points. She's not a doctor, and she has no particular training in health policy.
A lot of doctors had a recurring problem with patients at the end of their life. They'd wind up with an elderly, very sick patient who was unconscious, deteriorating and unlikely to recover. The family would be waiting day and night in the hospital lounge, the patient would be costing the hospital (or Medicare, or the insurance company, or somebody) $2,000 a day in the ICU, and the family wouldn't know what to do. Families sometimes had arguments that tore them apart. Doctors tell stories about the adult child who hasn't seen the parent in 20 years, who suddenly calls on the phone and insists that they do "everything" for their hopelessly dying parent.
That's probably the way you will die.
Most doctors have always felt that they should have a discussion with their elderly patients *before* they get sick, with their families, to decide how they want to be treated in such a situation. Many of them do have discussions. The problem is Medicare doesn't pay for those discussions. (That's one of the standard criticisms of medical reimbursment: they pay for procedures, but they don't pay for discussions with patients.)
So a pair of Republican and Democratic congressmen got together and offered a bill that would provide for Medicare to pay for those discussions.
That's what Betsy McCaughey blew up into the "death panels." Probably the best discussion of this was Jon Stewart's interview with Betsy McCaughey (which tells you something about the news today). McCaughey took some language from the bill and misinterpreted it with wild speculation, as Stewart pointed out. If you want to plow through the details, the New England Journal of Medicine had several articles about it and I think those articles are free on the http://www.nejm.org/ web site.
It doesn't really have anything to do with limited resources, or rationing, or the economic limits to health care. It was a deceptive political attack. Its purpose was to make the Democratic health reform bill fail, and to replace an honest discussion with a shouting match.
IFuck You! You're not a good doctor, you're a piece of shit!
From the ever-quotable Albert Einstein:
"I have neither the time nor the strength to participate in your polemic."
Probably a lot of books written on it -- Atul Gawande did a pretty big "study" with safety checklist prior to OR activation. We have several checklists (independent of anesthesia) before starting any invasive procedure, so this is kind of behind the times.
An OR nurse once explained to me, there's a huge number of pieces of equipment in an OR, and you can't possibly check every one prior to every complicated procedure.
It's easy in hindsight to say, "Why didn't you check the collimator?" But there were a hundred other things you also could have checked, and if you went through a checklist like that, the procedure would take twice as long, and you'd be checking for problems that were so rare that they might have been reported only once or twice to the FDA in the last 30 years.
The trick with these checklists is to come up with a checklist that includes everything that can realistically happen, but not so long that it takes an unrealistic amount of time to get through and looks like a 100-page lawyer's contract.
Even handwashing can be a problem. If you have to check 20 patients in the morning, and you have to do a 5-minute surgical scrub between each patient, that's a lot of extra time.
Does that sound right?
even in the USA under Medicare, Medicaid, military and veteran health care,
Lul wut? Have you ever -used- or know people who have used those services? They are terrible. Its much worse than any insurance provider
I don't get this. Do you have any first-hand experience with those services? I moved from private insurance to Medicare when I turned 65, and the only difference was that my premium went from $525 to $90 a month, same doctors, same services.
I'm not in the Veterans' Health Services, but I know doctors who have joint appointments and perform surgery at the VA health center and at the top New York City academic medical centers. I've seen studies of different conditions, like BPH and cancer, where the VA hospitals had some of the best treatment outcomes in the country.
I'm sure you can find one person who was dissatisfied with Medicare, or the VA health care system, but when you look at the treatments overall, they do a great job.
(Medicaid is a special case with payment problems and access problems in some parts of the country, but that's the fault of legislators who don't want to pay to treat poor (black and hispanic) people.)
Mod parent up.
People here are speculating, and don't know the facts, because Butler69 didn't tell us the facts.
Of course it's understandable that somebody would be upset and angry and make wild accusations after his wife got injured, but the rest of us don't have to join in.
This fiasco sounds like it was at least somewhat avoidable with the application of a modest amount of discipline.
You have no idea whether it was a fiasco or an unavoidable consequence of surgery. Why was she getting a hysterectomy? What were her coexisting conditions? You don't know, and none of us know, because butler69 didn't tell us.
Nobody is going to improve the health care system by making wild, unsupported accusations.
http://www.opensecrets.org/orgs/all_summary.php?id=D000026667&nid=3868
Intuit Inc
Rank: 598th
2008 total combined contributions: $818,259
2008 federal-level contributions: $394,475
2008 state-level contributions: $423,784
That's a pretty good return on the dollar.
They did.
Either you are very insightful, or you read TFA.
Have you ever heard of the AFL CIO? In 2000 they spent 4.1 million on federal campaigns.
I believe the total spent on the 2008 campaign was $1 billion for both parties. Fill in the current numbers. The union share is significant but doesn't come close to corporate spending.
I was following health care lobbying for a while, and as I recall the health care industry spent at least $100 million on campaign contributions to each party, with more to the Democrats. The financial industry spent another $100 million on each party.
If any Slashdotter wants to show off, I'd be glad to see links to better statistics.
Why should I bother reading about what the NYT has to say about Haiti when there are people there right now who are blogging about it in more detail than any non-local reporter ever could?
As a journalist, let me defend my existence.
There are bloggers in Haiti who haven't seen the president because Preval has been avoiding going out in public. The people who work for the Times can get to him or know how to track him down.
There are bloggers in Haiti who know only that there's devastation all around, and they don't have any food, water or medical care, but they can't get around. The Times has people all over, including the airport, the surviving government buildings, emergency organizations back home, Washington DC and the Haitian neighborhoods in Brooklyn and Florida, who can pool their information and figure out what's going on. When things work right, they can hold the responsible people accountable. The Times can talk to earthquake experts to find out about the geology, they can talk to civil engineers to find out why so many of the buildings weren't earthquake-proof, they can talk to disaster experts to find out how they deal with an earthquake like this, what kind of supplies they're getting, and whether they're getting them.
(For that matter, the Times also has its own blogs.)
I've been reading the New York Times all my adult life, and I could give you a long list of its faults. Conversely, there are a lot of great blogs (pax salam's blog in Iraq, for example) that do things newspapers can't do. But newspapers like the Times cover news in a comprehensive way that you can't replace with some bloggers with limited resources.
Actually, the market can work just the opposite way.
I used to work for a computer magazine for lawyers and law firms. We charged I think $50 a year for a magazine filled with ads.
Eventually they broke it up into separate newsletters -- one for Word, another for Excel, etc. -- which they sold for $200 a year. They had a little bit more content on Word, for example, than the original magazine, but not much.
People were actually willing to pay more for the parts than the whole magazine together.
http://h1n1.nejm.org/
H1N1 killed 3,000 so far in the U.S., almost all of them 45, most of them 30 and a large number of them 5. This is unusual. These are healthy people who would have gone on to live full, healthy lives if they hadn't died of H1N1.
How do you know that? My crystal ball remains cloudy.
New England Journal of Medicine. http://www.nejm.org/ I think most of their articles on the flu are available free. http://h1n1.nejm.org/?ssource=rthome They had a couple of articles in particular reporting on the experience of H1N1 in the U.S. I had some problems inserting the urls when I posted before, and that's my fault.
I'll leave the debate to people who have Citation Manager.
As I said above, which you would have seen if you had read the entire thread, I was referring to deaths in the U.S., which were about 650,000. The number of worldwide deaths were much larger, but they're not known as accurately.
You don't seem to be following the conversation. I was arguing that the possibility of another strain like that is a serious danger. So the worldwide figure just makes my argument stronger.
In your own words, influenza kills 50,000 a year in the U.S. The current worldwide number of deaths for H!N! is just over 14,000.
You left out the part about age distribution.
Influenza kills 50,000 a year in the U.S., almost all of them >60 years old and most of them >70 years old, usually with serious concurrent heart of lung disease, so that influenza finishes off a sick person who would have died soon anyway.
H1N1 killed 3,000 so far in the U.S., almost all of them 45, most of them 30 and a large number of them 5. This is unusual. These are healthy people who would have gone on to live full, healthy lives if they hadn't died of H1N1.
On a per-patient basis, influenza vaccines are one of the cheapest, most effective things the health care system can produce. You can divide the total cost of the H1N1 vaccine in the U.S. BY 3,000 lives at risk to get an idea of how much it costs to save a life. (That's just a Fermi exercise.)
Most public health people feel that if you can save 3,000 lives for a reasonable amount of money, and you've got the money, do it. And if there's a small chance that it will save 100,000 lives, even more reason to do it.
I'm not going to argue any more; if anybody wants the facts they can go to the New England Journal of Medicine.
The 1918 flu caused 650,000 deaths.
Actually, most estimates put it at 50,000,000 to 100,000,000 deaths.
/Mikael
Correct. I meant to say 650,000 deaths in the U.S.
There was a reasonable likelihood of a megadeath sized pandemic.
Actually no. There was a small percentage of people that might have died, and a larger pool of people that would have been pretty sick for a few days. And even at the height of the thing, they were never sure if the percentage of people dying was all that high, because there was such a small sample rate to work from...
That was it.
There was never a call to get as worked up as everyone did, where they practically were driving down the streets with bullhorns demanding citizens get flu shots.
Incredible ignorance. Where do you get your information from? According to the New England Journal of Medicine, an additional 3,000 young people died from influenza this year in the U.S., and that's unusual.
The influenza epidemic of 1917-18 caused 650,000 deaths in the U.S. When a new influenza virus comes up, how do you know it's not going to be another virus like that -- in time to produce vaccines? How do you know it's not going to cause 100,000 deaths? or even 10,000 deaths? You don't.
The UN and the doctors running this operation made the right choice.
To me it seems like the WHO overreacted, people and governments bought in to it, and now they are looking for a scape goat
To you. Are you a doctor? Are you a virologist? What the fuck do you know? Nothing. Do you think anybody in his right mind is going to risk the lives of hundreds of thousands of people by paying attention to you?
Influenza kills 50,000 people a year in the U.S., usually elderly people who are sick with something else. If that goes up or down by 10%, that's a lot of people. According to the New England Journal of Medicine, 3,000 children, teenagers and young people died this year from the H1N1 flu. These are otherwise healthy young people who would not otherwise have died. A lot of them were infants under 5 years old. The vaccine seemed to have provided significant protection. It's hard to tell how many people would have died without the vaccine, but twice as many is reasonable.
3,000 deaths is the same number of people who died in the World Trade Center. Did you get upset about that? Or did you laugh it off like you're doing with the flu?
The 1918 flu caused 650,000 deaths. Nobody really knows why. We could have another epidemic like that any year. When the new flu comes up, nobody knows until it's all over whether it's going to be the big one until it's all over.
People get into a position of responsibility because unlike you, they're doctors and they know the facts. They're not going to take a chance with 3,000 lives at stake. It's a pretty easy decision: order the vaccine, and take the risk of not needing it, or don't order the vaccine, and take the risk of killing 10,000 people -- or 100,000 people -- or 650,000 people.
You're like people who say it was a waste of money to build earthquake-resistant buildings because we didn't have an earthquake. Or to build flood-resistant levies because we didn't have a flood.
You are suffering from stupidity, which is an even worse disease than the flu, and it's going around Slashdot.
I'm sorry, we really don't have any cure.
Not a very good one.
Actually, cigarette smoking lowers public expenditures. Cigarette smokers are likely to die younger.
The main savings is in pensions, social security, and health care for the aged.
An Eastern European country required a cigarette company to submit data on the costs of cigarettes. The company handed the job over to their usual health economists and PR guys, who came up with a report that cigarette smoking would save the country money for those reasons.
It was nice to see such refreshing candor from a cigarette company. Or maybe I should say, I'm glad they didn't stop to think about it before they released the report.
Sorry I don't have a citation.
I'd like to look at whatever statistics you're using.
In my understanding, the center cities in the North are substantially worse in all public health indicators than Cuba. I know the infant mortality and life expectancy in The Bronx, NY is worse than Cuba.
In fact, Fidel Castro invited a dozen Americans to attend Cuban medical school, and they did. One guy came from The Bronx. A doctor from the New England Journal of Medicine visited their school, and reported favorably on it. Castro also offered to send Cuban doctors to underserved areas of the U.S., but Bush turned him down.
U.S. health care for the poor really is terrible. It's like being in the third world. 22,000 people died in 2006 because they didn't have health insurance, according to the Urban Institute. http://www.urban.org/UploadedPDF/411588_uninsured_dying.pdf
Don't believe me. Don't believe Michael Moore. Try to get health care for somebody who can't afford it. Call up a hospital, or try to get Medicaid. Go to a hospital emergency room and talk to the people waiting there.
For the middle class, the problem is not that you won't be able to get health care, but that you'll get a serious disease and it will drive you bankrupt. Harvard law professor Elizabeth Warren said that under all the current proposals, you'll still go bankrupt.