Was reading a piece in the Journal about emergency room vists, and how expensive they are, and it's really too bad that so many people go to the ER when they feel ill. It went on to say that as long as the emergency room is the only 24/7 medical facility, they are gonna get a lot of business.
Been thinking about that. Just how expensive is an emergency room visit, really? Wanna bet the hospital takes the total cost of running an emergency room divided by the number of patients served? Which is a cute statistic but it doesn't mean anything. Like if zero patients came in the cost per visit is infinite? If a zillion people came in the cost goes to zilch?
In actual fact, it costs money to run an emergency room whether anyone uses it or not. The true cost when someone comes in, waits two hours, and leaves with a prescription for Amoxicillin, is pretty close to zilch. particularly when the ER people spend most of their time doing paperwork about the visit rather than diagnosing and treating the patient.
Accounting is important in any real business. Accurate accounting tells management where the money is going to and coming from, which management needs to know if it is going to work on reducing out go and increasing income. Ideally the doctors and nurses would fill out time cards, charging their time to each patient served. Today they could use an app on their smart phones, just swipe the patient's wrist band against the phone and punch "start". Punch "done" as they leave the patient's bedside.
Monday, September 28, 2015
Sunday, September 27, 2015
More thoughts on John Boehner
I'm listening to some pundit saying that Boehner didn't fight hard enough for something or other. He was too ready to compromise.
There speaks a pundit with his head wedged.
Speaker of the House has just his own single vote. To get anything passed, he needs to get 51% of reps to vote for it. Which means that 51% has to like the speaker, trust the speaker, and go along with the speaker even when their constituents may not agree. The speaker cannot go about offending people by constantly fighting over issues, he has to be seen as fair, unbiased, and trustworthy. If he throws his weight around, he pisses people off, and then he won't have the votes next time he needs them.
Given the deep differences inside the Republican party, and the differences with the Democrats, I think Boehner has done the best that can be done. There is only so much that oil poured on troubled waters can do. I'm sorry to see him go.
I wish his successor, whom ever that may be, the best possible luck. He is gonna need it.
There speaks a pundit with his head wedged.
Speaker of the House has just his own single vote. To get anything passed, he needs to get 51% of reps to vote for it. Which means that 51% has to like the speaker, trust the speaker, and go along with the speaker even when their constituents may not agree. The speaker cannot go about offending people by constantly fighting over issues, he has to be seen as fair, unbiased, and trustworthy. If he throws his weight around, he pisses people off, and then he won't have the votes next time he needs them.
Given the deep differences inside the Republican party, and the differences with the Democrats, I think Boehner has done the best that can be done. There is only so much that oil poured on troubled waters can do. I'm sorry to see him go.
I wish his successor, whom ever that may be, the best possible luck. He is gonna need it.
Saturday, September 26, 2015
What John Boehner's replacement ought to do
Once elected that is.
No more "continuing resolutions" no more "omnibus spending bills, no more"one-big-fund-everything" bills. From here on in, we will pass single bills, one to fund each Federal government activity. A defense bill, a highway bill, Justice department bill, a FAA bill, a HHS bill, a Homeland Security bill, and so on.
This is the way it was done from George Washington's time down to very recently. Recently something fell thru the cracks and the necessary appropriation bills were not passed. When the end of the fiscal year came up, Congress would pass a stop gap to keep the government running. One huge stop gap. And they are still doing it.
Trouble with the one-big-funds-everything bill is it gives every special interest group enormous leverage to get their pet gravy train funded. Fund us or we vote against the bill and the entire government takes a hit. Today it's the Planned Parenthood special interests. Tomorrow it will be some one else. I forget who was threatening government shutdown last time. When everything depends upon a single bill passing, it isn't too hard to threaten to stop it.
If we went back to doing it the right way, the special interest groups would have less leverage. Assuming Planned Parenthood funding comes out of HHS, all the special interests could do is threaten passage of the HHS funding. Which doesn't have nearly the punch of threatening a government shut down.
You would think you could find enough Congress Critters to do this. Weakening the special interests would pass control back to elected Congressmen. Right now, the Congressmen have to vote the one-big-spending-bill thru. They don't get a chance to amend things, or bargain, all they can do is vote for it. Plus, the entire federal budget is so vast, and so complicated that no one understands it. Whereas a Congressman has a chance to learn a smaller piece of it, defense say, fairly well. Knowing where the bodies are buried, a Congressman can insist on changes in the bill before the vote. With a one-big-funding-bill nobody knows it well enough to make any changes. So all the agencies will get what they got last year, plus an inflation booster, and things go on, Federal spending rises, and unnecessary activities get funded, just 'cause they got funded last year.
No more "continuing resolutions" no more "omnibus spending bills, no more"one-big-fund-everything" bills. From here on in, we will pass single bills, one to fund each Federal government activity. A defense bill, a highway bill, Justice department bill, a FAA bill, a HHS bill, a Homeland Security bill, and so on.
This is the way it was done from George Washington's time down to very recently. Recently something fell thru the cracks and the necessary appropriation bills were not passed. When the end of the fiscal year came up, Congress would pass a stop gap to keep the government running. One huge stop gap. And they are still doing it.
Trouble with the one-big-funds-everything bill is it gives every special interest group enormous leverage to get their pet gravy train funded. Fund us or we vote against the bill and the entire government takes a hit. Today it's the Planned Parenthood special interests. Tomorrow it will be some one else. I forget who was threatening government shutdown last time. When everything depends upon a single bill passing, it isn't too hard to threaten to stop it.
If we went back to doing it the right way, the special interest groups would have less leverage. Assuming Planned Parenthood funding comes out of HHS, all the special interests could do is threaten passage of the HHS funding. Which doesn't have nearly the punch of threatening a government shut down.
You would think you could find enough Congress Critters to do this. Weakening the special interests would pass control back to elected Congressmen. Right now, the Congressmen have to vote the one-big-spending-bill thru. They don't get a chance to amend things, or bargain, all they can do is vote for it. Plus, the entire federal budget is so vast, and so complicated that no one understands it. Whereas a Congressman has a chance to learn a smaller piece of it, defense say, fairly well. Knowing where the bodies are buried, a Congressman can insist on changes in the bill before the vote. With a one-big-funding-bill nobody knows it well enough to make any changes. So all the agencies will get what they got last year, plus an inflation booster, and things go on, Federal spending rises, and unnecessary activities get funded, just 'cause they got funded last year.
Friday, September 25, 2015
Cruel and Unusual Punishment
Should be inflicted upon telemarketers and political callers who ring my phone but don't answer when I pick up. Tar and feathers. Boiling in oil. Stuff like that.
Pope Francis does good
The Pope has been getting all day coverage on cable TV. I seen him at the White House, saying Mass, at Congress, at the UN. Everywhere the TV shows massive crowds, come from far away, just to see the Pope in person, live and not on TV. The Pope's saturation TV coverage has complete eclipsed the visit of China's president. China is an important country and its president visiting the US ought to be newsworthy, but the Pope has "sucked all the oxygen out of the room", to borrow an overworked cliche from the TV newsies. The Pope is getting better TV coverage than the Donald.
What to make of this? Well, the vast crowds of believers indicate that God is alive and well in the United States. Even among Protestants, the Pope commands enormous respect. The sight of huge crowds, attending services in massive churches, sited on prime city real estate, shows there is loads of support among the citizens for both Catholicism and the Protestant churches. Many Protestant churches have veered off into either extreme liberalism or intense fundamentalism, adopting stances beloved of their pastors but awfully way out for many members. At this time, the Catholic Church teachings are a moderate mainstream view point broadly acceptable to many Americans, which gives the Pope even more importance than he ordinarily would have.
I heard Obama say something like "This church contributes to the strength of America." Which is very true, although I expect churchmen shuddered at hearing this. Good churchmen think in terms of strengthening their church and bringing their parishioners into a better relationship with God, rather than contributing to the strength and power of a secular nation-state. Certainly the Christian teaching that all men are brothers does a lot for good for civil order, loyalty to country, and reduces enmity in the society. This are all good things.
What to make of this? Well, the vast crowds of believers indicate that God is alive and well in the United States. Even among Protestants, the Pope commands enormous respect. The sight of huge crowds, attending services in massive churches, sited on prime city real estate, shows there is loads of support among the citizens for both Catholicism and the Protestant churches. Many Protestant churches have veered off into either extreme liberalism or intense fundamentalism, adopting stances beloved of their pastors but awfully way out for many members. At this time, the Catholic Church teachings are a moderate mainstream view point broadly acceptable to many Americans, which gives the Pope even more importance than he ordinarily would have.
I heard Obama say something like "This church contributes to the strength of America." Which is very true, although I expect churchmen shuddered at hearing this. Good churchmen think in terms of strengthening their church and bringing their parishioners into a better relationship with God, rather than contributing to the strength and power of a secular nation-state. Certainly the Christian teaching that all men are brothers does a lot for good for civil order, loyalty to country, and reduces enmity in the society. This are all good things.
Thursday, September 24, 2015
Volkswagen, microprocessor scams, and NOx
The great Volkswagen emissions scam is breaking big. They canned the CEO of Volkswagen yesterday over the matter. Apparently, the microprocessor in the diesel VW's was able to sense when the car was undergoing an EPA emissions test and adjust something to make the engine run cleaner. Sensing when the car is being tested isn't all that hard, if the engine is revving up above idle but the car isn't moving, it's on a test stand getting tested. The anti skid sensors on each wheel will let the microprocessor know if the wheel is turning. Unless all four wheels are turning, the car isn't moving and it doesn't take great programming skill to make a few adjustments to engine operation.
Just what the microprocessor can do on a diesel is less clear to me. Diesels don't have ignition systems (spark plugs) so there is no ignition timing to fiddle with. There is the fuel air mixture, I suppose setting the mixture extra lean will spoil the combustion, lower combustion temperatures, which reduces the "NOx" emissions. It also ruins fuel economy and power output. In engines, running hotter give you more power and better fuel mileage.
It could be the problem is the US standards for nitrogen oxide ("NOx") emissions. The air is 80% nitrogen and 20% oxygen. Heat air up enough and the nitrogen and oxygen go together in various combinations, NO2, N2O4, etc. The temperature inside the cylinders of an engine as hot enough to form "NOx". The is the basis of the famous Haber process for making "fixed nitrogen" for fertilizer and explosives. Plants need fixed nitrogen, ("NOx") and cannot make it them selves. Another fact from freshman chemistry, All nitrates are soluble. Which means all the "NOx" in the air will come down in the rain and fertilize the fields.
So why is "NOx" called a pollutant? Partly because the EPA likes to call as much stuff pollutants as it can because it gives them more areas to throw their weight around. In the case of "NOx" the source of LA smog was found to be a combination of "NOx" and oily hydrocarbon vapors, unburned gasoline. Under the impulse of sunlight the two chemicals will combine and make smog. The correct solution would have been to clamp down on unburned hydrocarbons, all sources of which represent poor engine performance or leaks and spills. Without any unburned hydrocarbons, you can have all the NOx in the air you want and not get smog.
Well, the EPA didn't do that, they are off on a "NOx" kick, have been for 40 years. And it hurts. Diesel is more efficent that spark ignition engines. In Europe half the automobile fleet is diesel. In the US nobody drives a diesel. Reason? US "NOx" standards are much tighter than they are in Europe. Apparently the only way to get a diesel car to pass US emissions tests was to cheat, which is apparently Volkswagen's solution to the problem.
It's time to have a public debate on "NOx" standards.
Just what the microprocessor can do on a diesel is less clear to me. Diesels don't have ignition systems (spark plugs) so there is no ignition timing to fiddle with. There is the fuel air mixture, I suppose setting the mixture extra lean will spoil the combustion, lower combustion temperatures, which reduces the "NOx" emissions. It also ruins fuel economy and power output. In engines, running hotter give you more power and better fuel mileage.
It could be the problem is the US standards for nitrogen oxide ("NOx") emissions. The air is 80% nitrogen and 20% oxygen. Heat air up enough and the nitrogen and oxygen go together in various combinations, NO2, N2O4, etc. The temperature inside the cylinders of an engine as hot enough to form "NOx". The is the basis of the famous Haber process for making "fixed nitrogen" for fertilizer and explosives. Plants need fixed nitrogen, ("NOx") and cannot make it them selves. Another fact from freshman chemistry, All nitrates are soluble. Which means all the "NOx" in the air will come down in the rain and fertilize the fields.
So why is "NOx" called a pollutant? Partly because the EPA likes to call as much stuff pollutants as it can because it gives them more areas to throw their weight around. In the case of "NOx" the source of LA smog was found to be a combination of "NOx" and oily hydrocarbon vapors, unburned gasoline. Under the impulse of sunlight the two chemicals will combine and make smog. The correct solution would have been to clamp down on unburned hydrocarbons, all sources of which represent poor engine performance or leaks and spills. Without any unburned hydrocarbons, you can have all the NOx in the air you want and not get smog.
Well, the EPA didn't do that, they are off on a "NOx" kick, have been for 40 years. And it hurts. Diesel is more efficent that spark ignition engines. In Europe half the automobile fleet is diesel. In the US nobody drives a diesel. Reason? US "NOx" standards are much tighter than they are in Europe. Apparently the only way to get a diesel car to pass US emissions tests was to cheat, which is apparently Volkswagen's solution to the problem.
It's time to have a public debate on "NOx" standards.
Wednesday, September 23, 2015
Hillary comes out against Keystone XL
She offered no reasons for her newish stand. She called the project a "distraction". Which means nothing. Since she offers no reasons for her new public stand, I gotta think it's politics. She is appealing to the party's greenies, at the expense of the unions. Unions like Keystone XL 'cause it will employ a million of their members, which is important to unions. Obviously she thinks there are more greenie votes out there than there are union votes.
I wonder who does Hillary's polling and did they get this right? Somehow I think there are more union people (union members and their families) out there than card carrying Sierra Club greenies. I might be wrong, but so might Hillary.
Maybe some union people will see the light and vote Republican.
I wonder who does Hillary's polling and did they get this right? Somehow I think there are more union people (union members and their families) out there than card carrying Sierra Club greenies. I might be wrong, but so might Hillary.
Maybe some union people will see the light and vote Republican.
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