TheAmericanBoy

Buyer Beware: Car Salesmen, Doctors.

Mikey — Sun, 04 Jan 2009 22:02:47 +0000

Everyone knows to beware of a good salesman, especially when making major purchases like a car or house. The reason for concern stems from the perceived level of objectivity of the information being considered. Presented with a perfect stranger seeking to make a one time commission, the buyer is concerned that the salesman’s vested interest is making the most profitable sale rather than best value and match for the buyer. The bias of the sales person toward his own interests creates a situation characterized by misinformation and can result in erroneous and harmful decisions being made. The same phenomena can occur within the field of health care research if the selected methods and population samples of a study have not neutralized the possible bias of those administering it.

If providers and payers continue the trend of the last 30 years and merge into fewer but larger group organizations and as such inherit more market power, should health care consumers be concerned about possible bias, when confronted with formularies, best practices and clinical guidelines developed by these organizations? In order to determine whether or not the characteristics of the individuals making up a group influence the outcomes and conclusions of formal consensus amongst health policy makers, Hutchings and Raine conducted a large meta-analysis of 52 different studies. The data was collected by executing designed searches of various medical databases such as MedLine or PsychInfo. For inclusion into the meta-analysis, studies had to use one of three formal consensus methods (NGT, Delphi, or RAND/UCLA) and differentiate the two groups or individuals based on their characteristics and perceived level of appropriateness for whatever treatment being considered. After the data was aggregated, Hutchings and Raine calculated the overall percentage agreement, kappa coefficient, and odds ratios were calculated. Based on this information, they were able to conclude that practitioners who performed a procedure regularly were more apt to approve of it than those who did not. Furthermore, they were able to conclude that those who were judged by a specific criteria were also more apt to conclude the criteria was an appropriate measurement of evaluation. (2006)

If the sample of studies included in this meta-analysis is an accurate representation of the total population of decision makers, this research suggests that true objectivity does not exist. And as such, just as consumers are concerned about the bias of information they receive from other sources, they are justified to feel similarly about who the guidelines and practices presented by their payers and providers are actually best for.

Andrew Hutchings, Rosalind Raine. (2006). A systematic review of factors affecting the judgments produced by formal consensus development methods in health care. Journal of Health Services Research & Policy, 11(3), 172-9. Retrieved January 4, 2009, from ProQuest Health and Medical Complete database. (Document ID: 1097750171).

Post from: TheAmericanBoy

Buyer Beware: Car Salesmen, Doctors.

Where my Gubs At, Put One Hand Up

Mikey — Wed, 31 Dec 2008 11:38:06 +0000

I don’t understand the Republican and NeoCon love affair with Illinois Gov Rod Blagojevich; I just can’t get it. When the first news of this possible scandal hit the airwaves was my thoughts were, “Damn this is going to revitalize the neocon base and start the wood chopping all over again.”, but I was wrong. Today I was asked by an ultra conservative, fundamentalist christian about what I thought of Rod Blagojevich. Previously I’ve had conversations about politics with this person and figured that they’d use the Blagojevich news to demonstrate the lack of moral fortitude of my side of the ballot. So I sheepishly replied that I thought he should be thrown in jail and that any abuse of power by an elected official, republican or democrat, for personal or political gain, should be considered almost treasonous, as it puts the country at war with one mans self interest. I should have known better. I should have watched more FoxNews. Her response, “Ehh I don’t know, my husband read a book, and Rod did a lot of great things for the state of Illinois. Did you know that he gave a book to every child every month in order to get them out of a rutt? He did a lot of good, I don’t know…” I was floored. I didn’t have to disown him, which I gladly would have, because she had already adopted Blagojevich.

These people don’t care at all about Blagojevich’s actions, at all. The only thing they care about is whether or not they get to point the “I told you Obama is no saint” finger as soon as they can. It’s as if they’re already printing out a presidential pardon for Blagojevich as long as he can somehow connect himself to Barack Obama. It’s incredulous. Look at a recent interview with Karl Rove on FoxNews, we have some of the transcript here:

And second, we’re also going to see — we’re going to find out somewhere along the lines where did Governor Blagojevich develop the opinion that he wasn’t going to get anything out of dealing with the Obama people? You know, the report written by the Obama general counsel says nobody recommended, nobody proposed anything or suggested any quid pro quo. There was never any discussion of a personal benefit for Governor Blagojevich. Well, if that’s the case, how did — if there was never any discussion about it, how did he arrive at the conclusion that there wasn’t going to be anything in there for him? It’s an interesting question, and we’ll see it play out over the next couple of weeks and months.

This is a perfect summation of the Republican argument.

A. Rod Blagojevich develops opinion that he wasn’t going to get anything out of dealing with the Obama people.

Therefor: Obama (or aides) must have discussed the quid pro quo with Blagojevich in order for him to form his opinion. And if Obama (and aides) knew about the process of selling the senate seat quid pro quo, despite their non-involvement, they are just as guilty for not flagging it.

Of course, Karl Rove is not nearly as good of a logician as his is a poo sling-er, so he forgot to mention a few confounding variables to his logical sequence.

I. Rod Blagojevich doesn’t need to discuss with Obama aides and merely supposes that he’ll gain little to nothing from it due to the political environment. Further he feels that it might be too risky to try to involve / shed light on a scandal in front of a president elect that has run a campaign against that sort of underhanded dealing.

But back to the point. Republicans don’t care at all about Blago. If this were law and order, Blago would be the perp cutting a deal for less public shame and outcry in order to bring down the “big fish”. Except on law and order, the cases against the big fish are a lot more substantial. Luckily in the court of Republican Spin circumstance is always enough to hang or save a man.
By the way, after responding to the woman, “Well… I’m pretty sure he tried to hold back millions of dollars for a children’s hospital for personal gain and fire some kid working at the Chicago Tribune because he didn’t write nice stories for him, not to mention that whole selling the senate seat, undermining the government thing…”

She said, “Yeah, well I don’t like Obama”

Post from: TheAmericanBoy

Where my Gubs At, Put One Hand Up

Americans The Ugly Racists, a Song.

Mikey — Tue, 30 Dec 2008 13:33:16 +0000

Normally I would never re-publish anything racially/gender offensive or irrationally critical, but in order to understand how significant the underlying problem behind any person, let alone a lawmaker, finding it appropriate to disseminate this material in public, it is necessary to see / hear it. The thought that the guy who passed this song around the GOP wants to become its leader isn’t nearly as scary as the blind ignorance of the people making most of the comments on the YouTube comment thread. However, a wise man once said, if life hands you lemons make lemonade, so with that in mind, let’s learn a lesson about the justification bigots use for being racist.

Apples to Oranges Argument: Making fun of Sarah Palin for being an idiot is perfectly acceptable as long as your standard of judgement is universal to men, women, blacks, and whites. It’s crazy that people actually justify racism under the assertion that making fun of Sarah Palin’s gaffs is somehow as egregious.

LOL! The Democrats are spitting chips over this video being put on cd and sent to GOP members to laugh at! I guess it was OK to have a crush on Obama and make fun of everyone else, or call Palin a dummy…but it’s not OK to laugh at Obama! LOL! I like you black guys.you took some hits for the team thats for sure…You guys do know that there’s a whole bunch of white people who don’t believe BamBam was naturally born American right? I figure you might want to talk to them ya? - http://www.youtube.com/user/badnetprac

Two Wrongs Make a Right Argument: This guy acknowledges that the song is racist, but he thinks that because someone (a comedian in this case) else made a racist joke once, it’s OK for a congressman to publicly acknowledge and condone the existence of a song, which the commenter agrees is racist, as acceptable.

Remember all the white boy jokes, do you think that there are still occasionally white boy jokes told? Well I am glad that so many from the black community are calling this racist, because I will just take that as them admitting those black comics were in fact racist. Jokes done in poor taste come from both sides.

One Bad Therefor All Bad Argument: This is classic racial stereotyping showing blatant prejudice.

I’m sure his inauguration will be ghetto fabulous. He’ll do wonders to the WHITE House…maybe some down home cook outs on the front lawn with some fried chicken, mac and cheese and kool aid. He can have Marion Barry be the guest of honor and make Pennsyvania Ave. one big slum of a block party. How about hiring some up and coming rap acts from the drug infested streets of D.C.? It would help to alleviate the unemployment problem and he would be helping out the brothers.- http://www.youtube.com/user/spru64

Misinformation Categorical Mistake Argument: Sort of like the Apples to Oranges argument, this commenter equates a completely unrelated and misinformed opinion as having something to do with race. If what this person were saying were true (it’s not), it still wouldn’t be a racial issue.

This is so awesome!!! So true and they need to nail him on all the crooked ties he has and what about the fact that he will not show a birth certificate??? Have to show it to be president, yet he will not, hmmm strange don’t you think. He is a loser and only won due to the crooked votes from Acorn and a bunch of idiots that have no clue. http://www.youtube.com/user/sweetnhappy71564

It’s pretty sad that people like the aforementioned exist. Even worse, most of the people on the comment thread are well above the age of 12. I’m a fan of free speech just as much as the next guy, but it’d be nice if the free speech were informed.

Post from: TheAmericanBoy

Americans The Ugly Racists, a Song.

Retailers Expect Lousy Christmas; Penniless Maintain Status-Quo

Mikey — Wed, 24 Dec 2008 18:53:14 +0000

“Retailers are forecasting less than positive numbers and in turn are slashing prices, staying open longer, and advertising more in order to entice consumers to buy the worthless crap they’re used to selling at 400% profit margins.” Maybe you’ve heard that? Today? Five or more times? Apparent doom is on the horizon for retailers; fire and brimstone are waiting in the wings, ready to rain down on capitalists everywhere. Your mission: Make the reindeer work overtime! Go buy everything and there by save the economy, planet, and humankind with just a swipe of the credit card. Read between the lines and it’s a little hard to feel bad for these whiners.

Let’s operate under the basic micro economic assumption that retailers would close doors if the revenue of selling product x didn’t cover the cost of selling product x. That is, even during this crazy-low demand, terrible shopping season we’re having, retailers would rather keep inventory than sell it for a loss. Why should you care? Maybe you shouldn’t, but have you set foot in a store recently? Today I bought a pair of Timberland boots for less than 50% of the suggested retail price. I also bought a Zoo York sweatshirt for 20.99, regular price $49.99. Have to figure even with the increased work force retailers employ during this time of year and the increased cost associated with the higher manpower, the longer hours they’re staying open and more money being spent on advertising, they’re still turning a profit with the “rock bottom prices”. Bottom line, if the economy were good, we would pay far closer to the suggested retail price for all our gifts, and retailers would make much more money.

So while the retailers might not be laughing as hard this season on the way to the bank as they might have, remember there are some who never laugh in the face of 400% mark-ups. Feeling bad for them still? Try donating to a charity worth giving to. How about one that doesn’t get a lot of media coverage, the weak and weary, the meek, the poor. No matter how much profit Old Navy make this year compared to last year on fleeces, not noticing the plight of the actual poor, doesn’t make it go away.

Post from: TheAmericanBoy

Retailers Expect Lousy Christmas; Penniless Maintain Status-Quo

If the ER Can’t Handle Today, What About Tomorrow?

Mikey — Wed, 17 Dec 2008 19:49:11 +0000

The American College of Emergency Physicians recently reported that there is definite reason for concern about the country’s ability to supply emergency medical services for the current status quo day to day demand. While it would be irrational to think that in a time of crisis or disaster all emergency medical services would be provided inside an ‘emergency room,’ the apparent inability to provide necessary care in the traditional setting should shake public confidence as to the readiness of emergency medicine providers to work outside of their comfort zone in a school gymnasium or baseball stadium. However unlikely the statistical probability of such a disaster occurring, events such as Hurricane Katrina, show that things do happen and prove that having anything less than a complete plan for response is wholly irresponsible.

As the College of Emergency Physicians points out, the current state of emergency medical service delivery is unable to be wholly relied upon in the event of disaster. Integrating community, state, and national organizations roles in disaster preparedness will be key to any effective health care reform plan. Administrators at all levels will need to be able to rapidly and effectively direct services to needed areas on a micro and macro level without having to worry about breaks in the supply or communication chain. Establishing a national protocol for disaster response and preemptively disseminating it throughout community and local organizations will reduce confusion as to what role each organization will provide in a high stress dynamic environment.

In a privatized system of health care delivery in which various health services are provided and paid for by a diverse group of organizations, cohesion in a time of crisis becomes harder to plan and less likely to succeed. As a health care delivery system becomes more universal, inherent to that change comes solidarity with respect to goals and motives. Solidarity amongst providers at the community, state, and national level will make the likelihood of a proper response more likely. Of course, measures must be taken to insure that proper logistical planning has already taken place.

Administrators at various levels will have to hope that policy makers create an environment that facilitates developing a good plan of response for disaster services, but none the less, will be left in charge of its design regardless of the political environment. And as such, administrators must be equally prepared to effectively run their organizations in times of crisis as they are during normal operations.

Post from: TheAmericanBoy

If the ER Can’t Handle Today, What About Tomorrow?