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<\/a><\/p>\nAt about 0515 this morning I managed to fall out of bed, smashing my face on the open drawer of the nightstand. There was less blood than I would have expected, and I was never unconscious. I don\u2019t have much memory of how it happened \u2013 I presume I must have been trying to get up to go to the can \u2013 but I remembered everything that happened after I hit, so there\u2019s no permanent damage.<\/p>\n
Roberta decided it was Emergency Room time, and I was going to argue until I looked at myself in the mirror, so half an hour later we were in the Kaiser Emergency Room at Woodman and Roscoe, where once again I decided that what the United States needs is more Kaiser members. There was no shortage of technicians, nurses, equipment, and when needed a physician who sewed up the cut in my cheek both outside and inside my mouth since it had gone all the way through.<\/p>\n
It also got me thinking. How many years has it been since something that severe can happen to you at 0515 and you\u2019re on the way back home, all sewed up, with a new tetanus shot, a bottle of anti-biotic tablets, and nothing worse than some dull pain by 0950? <\/p>\n
I got there at shift change time so I managed to meet a number of nurses and technicians (only one physician \u2013 first to shoot me up with Novocain in about seven places, then, after technicians cleaned everything out and got it all ready, he showed up again to do the actual stitching. It hasn\u2019t been a pleasant day, but it could have been a lot worse.<\/p>\n
Meanwhile progress in Washington seems to be a bit slower. I still think that the only way to start reducing the deficit is to stop spending more money than you\u2019re taking in, meaning that while we must fully service the debt, we can sure start reducing government expenses by 1% a year. We can also eliminate bunny inspectors and other federal tasks that may or may not be worth doing, but are almost certainly not worth borrowing money to do. Of course none of this will happen. The nation has become accustomed to obedience to the ruling class and there is a large political interest group who wants to continue to increase entitlement spending \u2013 not only those who get the entitlements, but those who make their living collecting and paying them. We seem to be approaching a point of no return.<\/p>\n Of course if something can\u2019t go on forever, it will stop.<\/p>\n Of course the pledge drive continues. I want to thank the new subscribers who have responded, and all the long time subscribers who have renewed. Some had forgotten about renewal for a while and came back aboard. Some renew regularly. Thanks to all. <\/p>\n Chaos Manor operates on the Public Radio model: it\u2019s free, but it will only stay open if it has enough subscribers to make it worthwhile keeping it open. So far it has done so, and again thanks. For those who have not subscribed, this would be a good time to do that. http:\/\/www.jerrypournelle.com\/paying.html<\/a> For those who have subscribed but haven\u2019t renewed your subscription for a while \u2013 if, for instance, you can\u2019t remember when you renewed \u2013 this would be a great time to renew. http:\/\/www.jerrypournelle.com\/paying.html<\/a> I\u2019m not encouraging those who read this place and don\u2019t feel they can support it to stop reading it. I am encouraging everyone to subscribe if you can. I\u2019m not after eating money or rent money. I am asking for beer and wine money\u2026<\/p>\n <\/p>\n I\u2019ll have to get to bed early. It has been a long day. I\u2019m fine \u2013 well, better than you might expect for what has happened to me \u2013 and the good news is that I am recovering from the cold I had. Now all I have is a lot of bruises and stitches. And of course a shingles shot, a flu shot, and today a tetanus shot. Ain\u2019t modern medicine grand?<\/p>\n And I am serious about Kaiser as the model we ought to be following. My experiences have been very positive.<\/p>\n Scaling up — misspent funds<\/p>\n Dr. Pournelle,<\/p>\n You wrote "I do think that if part of the TARP funds had been invested in raising the quantity of those going through health care training, many of our health care problems wouldn\u2019t exist."<\/p>\n I remember Mr. Heinlein, in an essay, proposed putting nuclear power plants offshore and under U. S. Navy control — his (fictional) hypothesis being that Naval engineering quality could be used in a different context than submarine and carriers, even out-of-scope, as a method of preventing nuclear accidents. His argument seems similar to yours.<\/p>\n While I’ve met many good-to-excellent military health care professionals, and agree that we would benefit by applying that quality of care across the board, I don’t think the specific issue you are discussing could be repaired with more medical technicians, nor would the level of quality scale up to the number needed for public health care needs. I think we may have had a similar discussion some years ago regarding applying DODDS school system standards to the District of Columbia, or even the entire country. Military discipline, regulations, and\/or civilian support, have seldom been exported out of that strict context under which they are normally applied, in my experience, and just do not scale up well. IMO, the military contractor and outsourcing programs have pretty much destroyed what little integrity may have remained in DOD.<\/p>\n It also seems we’ve both stated elsewhere that quantity and quality are often enemies.<\/p>\n I agree with your point: that the economic incentive money spent has been squandered in particularly useless ways. Spending it on energy or directly on healthcare training couldn’t have done any worse, but I’ve my doubts about any such spree actually "solving" either of those families of problems. <\/p>\n -d<\/p>\n<\/blockquote>\n I think you have misunderstood my point. I do not think we can or should replace free enterprise with something else. My model for prosperity requires economic freedom \u2013 and it is helped by low cost energy. Of Roosevelt\u2019s anti-depression programs, many were successful. The County Agent system of distributing modernized agricultural methods and techniques is an example. One of the most expensive, was TVA \u2013 but it also brought cheap energy to the South and ushered in a new industrial revolution there.<\/p>\n If we determined to spend money on TARP and \u201cstimulus\u201d programs, then let it be spent on something that produces results. Low cost energy is one of them. A big expansion in trained workers in key trades is another. A national medical technician training program would not seek to train everyone \u2013 only those who want to be in the program and thus will put up with being trained by methods the military has known for a long time. Spend the money on something that will get results. It isn\u2019t as if we would swamp the land with too many well trained and competent workers. By do not scale you seem to mean a much larger upscale operation than I have in mind.<\/p>\n <\/p>\n And yes, I very much understand that quality and quantity are often enemies \u2013 and giving any organization a monopoly will produce a bureaucracy subject to the Iron Law, as witness the results of giving the power of credentials to an organization monopoly. <\/p>\n You’ve probably already seen it, but just in case – the newest SpaceX Grasshopper video<\/p>\n http:\/\/www.youtube.com\/watch?feature=player_embedded&v=9ZDkItO-0a4<\/a><\/p>\n There is still hope. Despair is a sin.<\/p>\n <\/p>\n View 794 Tuesday, October 15, 2013 \u201cTransparency and the rule of law will be the touchstones of this presidency.\u201d President Barack Obama, January 31, 2009 Christians to Beirut. Alawites to the grave. Syrian Freedom Fighters What we have now is all we will ever have. Conservationist motto At \u2026 Continue reading <\/a><\/p>\n<\/a><\/p>\n<\/a><\/p>\n<\/a><\/p>\n\n
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