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November 24, 2009

DARWINIAN MEDICINE

As Published On
→ The Out-Lawyer’s Blog: http://www.jaygaskill.com/blog1
And
The Policy Think Site: http://www.jaygaskill.com
All contents, unless otherwise indicated are
Copyright © 2005, 2006, 2007, 2008 and 2009 by Jay B. Gaskill
Permission to print all or part of this article (except for personal use) is needed. [Permission for use in group discussions is almost always routinely given.]
Please contact Jay B. Gaskill, attorney at law, via e mail at law@jaygaskill.com
PERMISSION TO FORWARD LINKS TO THIS BLOG OR INDIVIDUAL ARTICLES IS HEREBY GIVEN

 

As published on The Policy Think site - http://jaygaskill.com/DarwinianMedicine.htm
Darwinian Medicine

 

The brave new world of medicine started innocently enough with the HMO health care delivery model, pioneered by Kaiser Permanente.  The essential features of the model are now all too well known:  A self contained, hospital-anchored system of linked physicians and support personnel, not portable, a system where bureaucratic cost management operates in the background.  When funding is limited (hint – funding is always limited), the pressure is felt in delays, especially in access to specialists, in long waits and abbreviated visits with the frontline physicians.  The Kaiser model, which began as a sort of company town health care-for-employees model, was emulated by the fee-for-services insurers as a way to keep costs within margins acceptable to employers and the unions. 

 

The typical HMO is a virtual Kaiser, one tied together by contractual agreements where the former general practitioner/family doctor mutated into a services-gatekeeper (the “primary care physician") who was placed under relentless fiscal pressures to see more patients a day, utilizing fewer and fewer minutes of “face time” per each.  Over time, a new pattern emerged: physicians jumped ship with burned out specialists leading the way. Shorter visits with “family doctors” and delayed access to specialists inevitably followed.

 

In the mean time, insurance providers were placed in an intolerable cost squeeze.  They were contractually required to cover everyone in the assigned groups (typically negotiated between employers and employee representatives) at fixed costs – impossible in an environment where new life-saving technologies were constantly emerging and being demanded by patients.  As any insurer knows, the primary duty is to the existing pool of insured.  This included the absolute obligation to secure sufficient funds to full cover that group.  Is it a surprise that insurers caught in the vise of conflicting obligations might be reluctant to take on new patients outside the required group unless they were (a) healthy and (b) otherwise a low risk of catching something expensive?

Because of the employer-employee vise, fewer and fewer individuals have been able to break out of the bureaucracy to obtain care outside the HMO trap.

 

All of the complaints about this country’s over-bureaucratized health care delivery system can be traced back to this dynamic.  Even before the specter of health care reform, the ghost of a Darwinian life-death struggle had entered the picture.   This is why we spend hours researching our own health care issues on the web; we insist on having a friend or loved one as a guardian in the hospital whenever possible; and we are starting (when possible) to save up a little money to break out of the system for a reality check.  This is Darwin at work:  the smart, proactive patients survive and the dull, passive ones die.  I do not exaggerate here ...by much.

 

Cutting through the fog of rhetoric, political spin and legal jargon, the huge difficulty with the liberal health care reform juggernaut (now opposed by a durable majority of the American people) is that it will accelerate the Darwinian trend, while closing most of the private Exit pathways. 

 

The most promising model (about which I’ve written earlier – see, < http://www.jaygaskill.com/HeathCareTrainWreck.htm  >) is one that gradually moves Americans back to a customer-driven model where patients are given cost transparency and empowered to select treatment modalities on a personally determined cost-benefit basis.  This is a much less bureaucratic system wherein insured groups are folded into much large ones to spread the risk as widely as possible, participation made available to individuals, with selected subsidies for indigent patients, using a voucher format, so as not to distort the cost-containing pressures of a market-based model.  That will never happen if Americans are allowed to become addicted to the top-down Darwinism of “liberal” health care.  We need – desperately need – an intelligent, not-crisis-driven national conversation about this. 

 

As I’ve already argued (see < http://www.jaygaskill.com/HEALTHCAREIsItReallyTimeToSayNO.htm > ) the best REAL conversations usually start after a definitive NO.

 

JBG

November 16, 2009

STUPIDITY IN HIGH PLACES - THE NEW YORK CITY 911 TRIAL

As Published On
→ The Out-Lawyer’s Blog: http://www.jaygaskill.com/blog1
And
The Policy Think Site: http://www.jaygaskill.com
All contents, unless otherwise indicated are
Copyright © 2005, 2006, 2007, 2008 and 2009 by Jay B. Gaskill
Permission to print all or part of this article (except for personal use) is needed. [Permission for use in group discussions is almost always routinely given.]
Please contact Jay B. Gaskill, attorney at law, via e mail at law@jaygaskill.com
BUT PERMISSION TO FORWARD LINKS TO THIS BLOG OR INDIVIDUAL ARTICLES IS HEREBY GIVEN
 
READ ABOUT JAY GASKILL'S NEW THRILLER: http://www.jaygaskill.com/TourTheStrandedOnes.pdf  

 

STUPIDITY IN HIGH PLACES:
THE NEW YORK CITY 911 TRIAL

Jihasists - Khalid Sheikh Mohammed, Ramzi Bin al-Shibh, Walid bin Attash, Ali Abdul Aziz Ali and Mustafa Ahmed al-Hawsawi - the 911 Five, will be tried in a New York City civilian court by order of the President of the United States 

Our president tells us, that “Khalid Sheikh Mohammed will be subject to the most exacting demands of justice”. 

Obviously our new president has never tried a criminal case.

A STAGGERINGLY INEPT MOVE

Not one of 911 defendants is legally entitled to be in the United States, and not one of them would be legally entitled to a civilian trial here but for the wishes of our president.  

I was in Manhattan on September 11, 2001, a transformative experience about which I have written elsewhere.  Suffice it to say that New York City is a spectacularly bad venue choice for security reasons alone.  Every juror called to serve in the trial will be identified as a possible jihad target.  They might as well paint bulls-eyes on each juror’s forehead.  Will any Jewish jurors be called to serve?  Will they be excused for security reasons?  If they are, will appeal issues later be raised? 

This boneheaded venue decision is another Grand Gesture by an administration that seems to be intoxicated with such things.  If something untoward happens and lives are lost because this trial takes place in New York City, the Attorney General and the President should publicly apologize to the victims, to the American people and the world. 

The can of worms that Attorney General Holder and our Lawyer-in-Chief President have created would take a law review length article to describe.  For now, the smell should suffice.

But the choice of trial venue was not this administration’s worst mistake.  The most catastrophically stupid move, in my opinion, was to direct the adjudication of these terrorists’ guilt (especially after they had proffered a guilty plea) into the American civilian justice system in the first instance.   These were terrorist acts that reached the scope of actual war: The diversion of hijacked airlines to destroy New York’s financial center, the Pentagon and the White House would be acts of war if done by a sovereign. 

Using the civilian court system for such a case is like attempting to conduct the Nuremberg Nazi trials in a civilian court in a corner of Italy while still under fire.  But the terror-jihad war is not yet over and staging a risky show trial won’t make it so. 

Civilian criminal jury trials differ from military trials and the Bush terrorist tribunals that were outlawed by an improvident Supreme Court decision.  Among the prominent differences:  civilian criminal cases are notorious for delays, defense grandstanding, publicity-seeking jurors, the suppression of solid evidence for technical reasons, outrageous acquittals and endless, endless appeals, especially when the death penalty is imposed.

The Risk of Excluded Evidence

In a civilian criminal case, evidence of questionable reliability can be excluded from the trial on due process grounds.  This is one application of the so-called “exclusionary rule”.  The court has an ultimate responsibility to safeguard the reliability of the jury’s fact-determining function.  So a judge is occasionally asked to decide whether evidence of questionable provenance should be allowed, and will exclude such evidence when it might mislead the jury.  Few would quarrel with that kind of exclusion.  But in a typical American criminal case there is another kind of exclusion, one where evidence is kept out in spite of the fact that such evidence is highly reliable.  This is the punitive exclusion of otherwise good evidence, designed to teach the authorities a lesson, that the evidence was obtained in the wrong way, no matter that it leads to the truth.   This is the murder gun seized from a drug dealer’s rented dive before a proper warrant was obtained, the admissions about where the other weapons were hidden made without a proper Miranda warning and so on.  

If I were Attorney general Holder, I’d lose sleep during this unnecessary and risky show trial. 

JBG

 

November 13, 2009

Defang Iran, Save the World

This is not for the faint of heart , but neither are the consequences of inaction in the face of genocide. 

The key to the "Iran problem" is to study "The Godfather".  Then read the article posted at http://www.jaygaskill.com/ModestProposal.htm

Don't say you weren't warned.

JBG

 


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