Thinking in public about anything that matters.

Author: SydneyKendall (Page 1 of 13)

Cutting out the Third Party in Medical Care

‘Three years ago, Dr. Keith Smith, co-founder and managing partner of the Surgery Center of Oklahoma, took an initiative that would only be considered radical in the health care industry: He posted online a list of prices for 112 common surgical procedures. The 51-year-old Smith, a self-described libertarian, and his business partner, Dr. Steve Lantier, founded the Surgery Center 15 years ago, after they became disillusioned with the way patients were treated at St. Anthony Hospital in Oklahoma City, where the two men worked as anesthesiologists. In 1997, Smith and Lantier bought the shell of a former surgical center with the aim of creating a for-profit facility that could deliver first-rate care at a fraction of what traditional hospitals charge.’

And it appears that they’ve been very successful in accomplishing their purpose.



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Obamacare’s “Independent Payment Advisory Board”


I believe in government as policeman.  Its job is to be the legal power that pursues those who commit violence and fraud, who initiate physical force against others.   Its job is to punish right’s violators.  It’s job is to go after criminals and defend against foreign aggressors.  It’s job is the use of force in retaliation against those who initiate it and to stop those who threaten to initiate it.

It is *the* legal entity that has the right to use violence in pursuit of rights violators and to use violence, if necessary to stop, to imprison, or even to kill those who do not demonstrate through their actions a willingness to avoid initiating violence or using fraud against their fellowman.  That job is complex enough and requires vigilance on the part of the population to ensure that the coercive power of the state doesn’t get out of hand.

But there are many people who think that government should not be limited to the policing power.  It should provide a security net for senior citizens and for the poor, it should pay for or at least help with health care, and a whole host of other duties that are not normally coercive… except that when government gets into them, they become so.  At the very least, the taxpayer is forced to pay into funds that he or she might otherwise opt out of, on pain of some legal punishment.  But beyond that, there is the addition of layers of bureaucracy and the expense and complications that that brings.  And there is the narrowing of choice, in order to make the administration of the sphere involved simpler and less expensive for the bureaucracy to handle.  Instead of the expansion of alternatives, bureaucratic management tends toward a one size fits all model.

This is one of the reasons I don’t approve of government involvement in health care insurance.  As long as it’s guarding against fraud in the industry, it’s doing its job.  But when it interferes in the market itself, things get complicated.  And coercive.

Sometime I’d like to explore the case for alternative solutions to our health care cost/payment troubles instead of the government-controlled ones.  But the topic I want to put up for discussion  is a particular part of Obamacare: the Independent Payment Advisory Board (IPAB).

Howard Dean,  governor of Vermont from 1991 to 2002 and a former chairman of the Democratic National Committee, has written an article for the Wall Street Journal.  Unlike me, Mr. Dean favors Obamacare overall, but like me he sees that the IPAB – Obamacare’s health-care rationing body – is a serious threat to individualized care necessary to suit the needs of actual patients.

Here is an excerpt from his article:

“One major problem is the so-called Independent Payment Advisory Board. The IPAB is essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them.

“There does have to be control of costs in our health-care system. However, rate setting—the essential mechanism of the IPAB—has a 40-year track record of failure. What ends up happening in these schemes (which many states including my home state of Vermont have implemented with virtually no long-term effect on costs) is that patients and physicians get aggravated because bureaucrats in either the private or public sector are making medical decisions without knowing the patients. Most important, once again, these kinds of schemes do not control costs. The medical system simply becomes more bureaucratic.

“The nonpartisan Congressional Budget Office has indicated that the IPAB, in its current form, won’t save a single dime before 2021. As everyone in Washington knows, but less frequently admits, CBO projections of any kind—past five years or so—are really just speculation. I believe the IPAB will never control costs based on the long record of previous attempts in many of the states, including my own state of Vermont.”

I invite readers to join a serious discussion of a serious topic that will affect us all in the near future.  If you take part in the discussion, please do not resort to deliberate personal attacks on your opponents, no personal insults or moral accusations that can distract from dealing with the very important matters at hand.  Everyone needs to sort out the complex of issues here, to understand them and think seriously and honestly about them.   It’s our health and perhaps even our lives at stake.



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Donations for an Inquest?

The cousin of a friend of mine was found dead on December 2, 2010.  She died under unusual circumstances and the police closed the case as a suicide.  But the family believes it was murder.   They want to find out for sure what really happened, and have convinced the coroner to hold an inquest, but it’s going to cost the family $60,000, and they don’t have that kind of money.  Yes, the family has to pay for it.

This is a real case. 

Phoebe Handsjuk web page.

Finding the truth about a possible murder and seeing justice done is in all of our interests, so I have given $20.  I can’t spare much, and I do give to other causes.  But if enough people give a little it can greatly ease the burden of a family seeking the truth and seeking justice.

To donate, please click HERE.

There are only 3 days left to meet the funding goal.

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More thoughts on Critical Thinking

THinking_3_light_2_withBackground_signedCritical thinking is a mental process of identifying what you actually know and what is assumption, what is real evidence and what is mere assertion or faked.  (It also deals with what is a valid or an invalid or fallacious argument, but I’ll just deal with the issue of evidence here.)

When someone makes a claim, but doesn’t tell you their evidence for that claim, it’s good to point out to that person that he hasn’t presented sufficient evidence to convince you of his claim.  “Sufficient evidence” includes telling you where he got that evidence – the source – of the information, so that you, too, can go to the source and evaluate whether it is a “primary” and reliable source.

For example, there has been a screen capture, purportedly of a Facbook page, being used in discussions about the character of Trayvon Martin, the young man who was shot and killed in a physical fight with George Zimmerman, a neighborhood watchman in a gated community in Florida.  This capture is being used as evidence to show that Trayvon was a user of a drug mixture called “lean” which can make some people paranoid and aggressive.

The capture shows Trayvon’s photo with the name “Trayvon Slimm Martin” having a discussion with another young man about the ingredients of lean, clearly with the aim of getting the ingredients together and using it.

Many people seem to believe that that capture is evidence you can count on.  But with Photoshop, I’m pretty sure that I could create such “evidence” myself, if I could find a conversation about lean on someone else’s Facebook page, make a screen capture of it, go to Martin’s Facebook page and screen capture a conversation between him and a friend, then copy and paste Trayvon’s and a friend’s photos and names over those of the people who were *really* having the naughty conversation.

Now, one could seek out “Trayvon Slimm Martin” on Facebook, which I’ve tried to do, and check to see that the discussion is on a real Facebook page.  (I’ve tried.  If the page once existed under “Trayvon Slimm Martin”, I can’t find it now.)

But even if I found such a page, I’d have to somehow verify that it belonged to *the* Trayvon Martin in question, that someone else faking that name (or who actually shares that name) didn’t just lift a photo of the famous Trayvon because he thought it would be “cool”.  That is not a farfetched possibility.  Those kinds of fakes are easy and some people love to do that kind of thing.

Critical thinking requires a person to be aware of when alleged evidence hasn’t yet been *proven* to be evidence, and to make yourself aware of what it would take to actually prove it to be evidence.  Until you can see for yourself that it is true, you should not accept it as such.  One needs to keep oneself aware of the actual status of an alleged piece of evidence in your context of knowledge.

Someone else may know it to be true, but they have to help you to know that it’s true, from the evidential source and through sound reasoning, or they should not expect you to accept their claims.

One of my points in my earlier post is that this is not an easy task, and even the most conscientious people make errors, sometimes accepting alleged evidence too soon.

I say “Conscientious people, unite!”  We should all happily help each other in a friendly way to be strict in our critical thinking.  And, because critical thinking is so important to such things as justice, we should do what we can to help those with really bad thinking habits to develop better ones by patiently pointing out errors and showing, by example, how critical thinking works.

I say “patiently” because if you treat a person with impatience it’s like saying “Don’t you know this already?  How could you make such a mistake?  Why aren’t you getting this without my help? You must be a stupid fool.”   So instead of focusing attention on the issue at hand and creating an atmosphere conducive to an objective examination of facts, you’re setting up the other person to feel defensive.  Now he feels like he has to defend his character and intelligence and feels all emotionally stirred up.  I hate seeing that happen when something constructive could actually be happening instead.

Whether it’s an error made by a habitually conscientious mind, or an error made by someone with horrible thinking habits, if you make the effort to address the error without attacking the person making it, you’re offering a small contribution toward making the world a more just and reasonable place.

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Thoughts on Critical Thinking


Critical thinking.   I try to be conscientious about it.   I’ve always been super-demanding with myself about this, even as a young child.  And it’s not easy, because you have to be on your mental toes all the time.  It can get exhausting, especially when you enter the world of the issues of the day and are confronted with so freakin’ many assertions that need to be hunted down to their sources in sound, reliable evidence.  And even when a person is super-conscientious – I know this first-hand – you can still slip up and accept something on less than a fully sound foundation from time-to time.

So it’s great to surround oneself with others who are also conscientious about evidence, who can catch one’s own boo-boos when they occur.

But the most important thing is *not* to somehow hunt every key assertion down to sound evidence.  That’s actually impossible.  One doesn’t have to know the answer about everything, the whole truth and nothing but the truth in every case, as much as some of us might feel compelled to do so.  One only has to be careful to keep aware of when you don’t actually know enough to draw a conclusion.

And you can help others by identifying when they have not presented enough evidence to convince a careful mind of their case.


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Happy Independence Day, 2013!

Learning Liberty - (c) Barbara A H Marinakis

When the American colonies finally agreed to separate from England in order to establish a country where liberty was the law of the land, it was a turning point for liberty in the world.  The American Founders declared their reasons for the separation in the Declaration of Independence.

July 4th, 1776 was the day that the Declaration was officially adopted by Congress.

From The Charters of Freedom – Declaration of Independence: A History:  “Jefferson’s account reflects three stages in the life of the Declaration: the document originally written by Jefferson; the changes to that document made by Franklin and Adams, resulting in the version that was submitted by the Committee of Five to the Congress; and the version that was eventually adopted.

“On July 1, 1776, Congress reconvened. The following day, the Lee Resolution for independence was adopted by 12 of the 13 colonies, New York not voting. Immediately afterward, the Congress began to consider the Declaration. Adams and Franklin had made only a few changes before the committee submitted the document. The discussion in Congress resulted in some alterations and deletions, but the basic document remained Jefferson’s. The process of revision continued through all of July 3 and into the late morning of July 4. Then, at last, church bells rang out over Philadelphia; the Declaration had been officially adopted.”

This should be a precious document to anyone who knows the crucial value of living by his or her own honest intelligence, free from those who would impose their own beliefs and will through coercion.   Liberty enables the honest and the intelligent to go their own way (as well as the dishonest and stupid to go theirs, as long as they don’t use force or fraud to gain their ends), and to thus live with self-respect and to pursue happiness  according to their own judgment and conscience.  The result is an outpouring of intellectual, scientific, and material discovery and invention, a contentious but productive marketplace of ideas and goods.

When all agree on the principles of liberty, the widest variety of views can live in physical peace with each other (although the field of argument can become verbally heated and even ugly), and live by their own judgment and conscience.  It is when someone’s conscience includes the view that he must enforce his own particular ideology or religion on his ideological opponents that the protective wall of liberty is broken and a society of free people needs to rally against that breach. Continue reading

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