So, I just got home from a motorcycle trip from Pennsylvania to Milwaukee, around the Great Lakes, through Canada to Niagara Falls, and home again.  This is a beautiful country. 

http://pjmedia.com/lifestyle/2012/12/22/the-sleep-deprived-doctor-saving-your-life/2/

 I went max of 36 hours at a shift during residency, which is long, but not much different than "pulling an all-nighter" which I did frequently during college.  The argument against these shifts is clear, but we should also consider the cost (everything in life is a trade-off).  If you are working less hours per year in training, (we did 100-120 and the current standard is 80) and there is the same amount of material to learn/practice (actually there is more now) do we want less trained young physicians, or do we want to extend residencies to minimums of 6 years, to more than 15-20 years for neurosurg?  Keep in mind also, that when I was in practice, there was no protected sleep, or limited hours.  I slept more than residency, but I was available.  Is this something we can train for, or how does it change availability patterns if during training you are told how important "protected time" is?  We all know it is harder to get physicians to take call nowadays.  Does this have something to do with it, and is that a fair trade-off? Are we willing to have less doctors available at night?  Does this mean we keep all new parents from working, since I slept less when I had a newborn at home? At least during residency it was one night in three or four, not every night! How about mandatory curfews for any doctor who has to work tomorrow? 

http://www.weeklystandard.com/blogs/obama-asks-doctors-help-deal-guns_696121.html

How about an addendum to allow doctors NOT to discuss this?  I don't want any responsibility for this.  What makes us think that we are experts on this subject?   I've never held a gun in my life;  should I be telling an ex-Marine how he should store his weapon?  If there is a violent member of their household, I think they probably already know.  What expertise do I have to add to this situation?

Economics and Emergencies

 This is actually my Economics course homework.  But it kinda belonged on my blog!  

I'm starting to think that everyone should be required to take economics before they are allowed to serve in government.  We already have a good example of what happens on a small scale with the kind of "reforms" Obamacare creates.  What makes us think that expanding it from tiny Massachusetts to the entire USA will make it work better?

http://www.wwlp.com/dpp/news/massachusetts/emergency-room-costs-way-up-in-ma-but-lawmakers-think-it-will-go-down

A timely article I found concerning prices is the attached article from the Boston Globe discussing the price of emergency room visits in Massachusetts recently.  The background information required to analyze this price change includes the enactment in 2006 of the Massachusetts health care insurance reform.  This law required everyone in Massachusetts to maintain health insurance and provided free insurance for residents making less than 150% of the federal poverty level.   The supply of emergency rooms is held constant, both by government regulation, and by the practicality of building new hospitals. 

                The price increase in emergency room services has resulted from an increase in demand.  As more people have insurance for emergency visits, they are more likely to go to the emergency room, thereby increasing demand.  If a person is required to pay for health insurance, he will have more of a tendency to “get his money’s worth” and visit the emergency room for health issues he may not have in the past.  Also, the subsidy for poor residents has increased their demand for health services over all, including emergency visits.   Another driver of increasing demand is the change in expectations that occurred with the health insurance reform.  The law was passed as an increase in access to health care for everyone, and when the patient feels he is entitled to immediate care, he frequently arrives at the emergency room.  These changes all result in a large shift of the demand curve to the right.

                Another interesting aspect of this article is the result of the change in the substitute service of primary care physicians.  As the supply of family physicians has decreased*, the price (either as money or as waiting times or as inconvenience) of their services has increased.   Since emergency care acts as a substitute good for primary care, this has shifted the demand curve to the right.  In the last few paragraphs of the article, the state is attempting to shift the supply curve of primary care to manage the equilibrium point of emergency room care.   

                It remains to be seen how the contradictory aims of health insurance reform will play out in Massachusetts as well as the far larger national reform.

*http://www.ama-assn.org/amednews/2011/10/10/prsc1012.htm

http://www.washingtonpost.com/opinions/michael-gerson-romney-should-lead-americas-solution-of-class-problem/2012/07/12/gJQA7eOQgW_story.html

My response:

Your recommendations for Romney at the end of the article are all wrong.  Early childhood education (Head Start) has been shown to make no long-term difference at a high cost.  High school completion leads to "social advancement" i.e. graduating seniors who can't read.  College education was the reasoning behind the higher education bubble,where graduates are $100,000 in debt and can't find jobs.  Wealth-building was the reason behind getting people in houses to "build equity" which led to the real estate bubble and sub-prime mortgages.  Every one of your ideas has led to problems and worsening effects.  Is your point that Romney should support these for political reasons regardless, or do you really think that government can do something useful about class?
Mobility comes from a family that pushes it's kids to achieve, and the government's role should be to equalize opportunity.  Fix the schools to emphasize learning, not fuzzy self-esteem.  Ensure that what you make you get to keep.  Simplify the process of starting a business, getting rid of unnecessary regulations.
The most important, however, is a family that pushes kids.  If your parents don't have any respect for learning, or any belief that you can succeed, there is no upward mobility.   Do you have any ideas on how Romney can fix the culture that mocks studying and hard work?  I am an immigrant who spoke no English when I hit kindergarten in Detroit's public schools.  My mother ensured that I could at least count to one hundred before I started so that "they won't think you are stupid".  I arrived to find that kids who were native English speakers couldn't count to ten.  My family is the source of my success, and I don't see where the government could do much but harm.

A Late Post for Father's Day (I was working)

The most important thing my father said to me about work was "It doesn't take a genius to be a good doctor;  it just takes enough guts to keep getting up and doing the right thing".  It's not hard to know that when a nurse calls at 3 a.m. and says a baby "doesn't look right", the proper thing to do is to get out of bed and go look at the baby.  The difference between a bad doctor and a good doctor is how many times you can keep doing that.  It's obvious that when an insurance company (or Medicare) denies your patient care that you think is needed, the right thing to do is call till you get someone you can argue with and get your patient the care he needs.  It doesn't matter if that is the first time or the thousandth time you have had to make that call, or how long it takes to get someone. 

Do you see that problem with this?  To be a good doctor, you have to fight the bureaucracy, and they will make it longer and harder and as miserable as they can.  What do you do?  Do you hold to your principles and spend your entire life fighting with bureaucrats rather than seeing patients?  Or do you compromise and become less and less of a "good doctor"?  Or do you stop practicing and decide not to be a doctor at all if you can't be a good one? 

So, in our system, who is left as the doctor you count on?

Silliness

I've been following the Elizabeth Warren story fairly closely for someone who has no vote in Massachusetts.  I'm fascinated by the affirmative action side of this silliness.  I think that most people would assume that Elizabeth Warren, whether she believed it or not, put down that she was a Native American for affirmative action purposes.  It got her a position at Harvard Law.  I'm not challenging her abilities, but the plain fact is that there are hundreds of people who are qualified to teach at Harvard Law, so why did they pick her?  She is the only professor at Harvard not to graduate from a top ten law school.  Her degree from Rutgers is the second lowest ranked school of all the Ivy League professors.  She had no spectacular accomplishments before being picked for Harvard Law, and they started touting their "diversity".  Doesn't take rocket science to figure out what got her there. 

Now, regardless of what you think of Elizabeth Warren, this shows the silliness of affirmative action.  She is a middle-class woman from Oklahoma, who never suffered any discrimination from her "diversity".  Why should she be in the affirmative action group at all, regardless of her family background?  A girl whose parents came from the Cambodian boat people, who emigrated without a dime and no English, who works incredibly hard and does well in school, gets no preference because she is not "diverse".  What? 

The rationale for affirmative action has always been that people who have been unfairly discriminated against in the past should have an advantage now.  Well, how many generations does that carry through?  Are we down to the "drop of blood" rule?  If my parents were discriminated against, and overcame it, does my son deserve an advantage?  How about my grandson?  If your parents made it to a comfortable middle class life, how do you deserve an advantage, regardless of the color of your skin?