of what I call O-Trauma Care!
See Mike Luckovich, Atlanta Journal-Constitution who seems to have coined "O-Trauma-Care" on 4 March 2014, before I independently came up with that term.


Organizations that applied for tax-exempt status and had their applications forwarded to the team
of specialists experienced substantial delays. As of December 17, 2012, many organizations had
not received an approval or denial letter for more than two years after they submitted their
applications. Some cases have been open during two election cycles (2010 and 2012). [my bold]
"The IRS must apply the law in a fair and impartial way, and its employees must act with utmost integrity.
“This report shows that some [IRS] employees failed that test. I’ve directed Secretary Lew to hold those responsible for these failures accountable, … so that such conduct never happens again.
“But regardless of how this conduct was allowed to take place, the bottom line is, it was wrong."The IG Report included a detailed list of some of the "unnecessary" questions asked of targeted organizations by the "specialists" to delay approval.
1 Requests the names of donors. 2 Requests a list of all issues that are important to the organization and asks that the organization indicate its position regarding such issues. 3 Requests 1) the roles and activities of the audience and participants other than members in the activity and 2) the type of conversations and discussions members and participants had during the activity. 4 Asks whether the officer, director, etc., has run or will run for public office. 5 Requests the political affiliation of the officer, director, speakers, candidates supported, etc., or otherwise refers to the relationship with identified political party–related organizations. 6 Requests information regarding employment, other than for the organization, including hours worked. 7 Requests information regarding activities of another organization – not just the relationship of the other organization to the applicant.Were "Progressive" Organizations also Targeted?
If any Administration, whether Democrat or Republican, misuses an agency of the government for political profiling purposes, as the Democrats have clearly misused the IRS for two election cycles, how can we trust them not to similarly misuse the awesome snooping powers we now know have been entrusted to the NSA ?
“… nobody is listening to your telephone calls…
“… you can't have 100 percent security, and also then have 100 percent privacy and zero inconvenience. We're going to have to make some choices as a society…
"I don't welcome leaks … There's a reason these programs are classified." [my bold and italic]
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| "Dr. Mitt", Uncle Sam, and "Dr. Barry" A Responsible Approach vs Hopey Changey Happy Pills |
Way back in 2009, I posted No OIL in Afghanistan along with the graphic shown here, making three key points:It is now beyond time to put Afghanistan on "simmer", protecting a few major population areas with a minimum number of boots on the ground, and continuing to use drones and Special Ops to suppress any Taliban or Al Queda training camps and command centers as well as interrupt supplies to them and protect supplies to the Afghan government. This will minimize our cost in blood and treasure while keeping our enemies from taking control of Afghanistan. It will also protect our interests in keeping Pakistan relatively cooperative.
Afghanistan Has No OIL
"Operation Enduring Freedom - Afghanistan" (OEF-A) is the official name for our military action in Afghanistan. (The original name was "Operation Infinite Justice" which offended those who believe the source of "infinite justice" is God.)
According to Wikipedia, "The initial military objectives of OEF-A, as articulated by Former President George W. Bush in his Sept. 20th [2001] Address to a Joint Session of Congress and his Oct. 7th [2001] address to the country, included the destruction of terrorist training camps and infrastructure within Afghanistan, the capture of al Queda leaders, and the cessation of terrorist activities in Afghanistan." Multi-national military action began in 2002, just a year after the 9/11 terrorist attack on the US mainland.
The Bush administration has been criticized for emphasizing military action in Iraq, which had little or nothing to do with 9/11, rather than in Afghanistan where the Taliban allowed Al Queda to train the terrorists responsible for 9/11. The Obama administration is now being asked by the commander, Gen. McChrystal, to deploy tens of thousands of additional troops there and repeat an Afghan version of Gen. Petraeus's Iraq surge. As in Iraq, the generals say we need US "boots on the ground" to gain and hold territory.
After much reading and consideration, I have come to the conclusion the US should not greatly increase troop strength now. We should revert to the previous Bush administration policy of a "light footprint" that defends key population centers and uses mainly airborne strikes to prevent the Taliban and whatever remnants of Al Queda remain in Afghanistan from making too much progress. Given the terrain, population and history of Afghanistan, there is nothing to be gained by adding more US blood to that already left by the British in the 1800's and the Russians more recently.
I think history will eventually recognize that the Bush strategy of a relatively low-level war in Afghanistan, where our allies took a large percentage of the responsibility, was correct. Those of you who have played chess know it is sometimes safer to hold back and exercise force from a distance, using your Rooks, Bishops and the Queen on clear diagonals and columns, rather than commit your pawns and Knights to a "boots on the ground" attack.
Iraq, a strategic source of oil, required both boots on the ground and airpower. Afghanistan, especially now that we have unmanned air vehicles capable of pinpoint attacks, should be addressed mostly with remote airpower. I believe VP Biden has been advocating a position similar to mine and that Obama will eventually accept that policy.
Lots of OIL in IRAN
I hope it does not come down to it, but, if Iran continues to build its nuclear weapons program, the US and our allies will have to take military action of some sort. That country has a large percentage of the world's supply of oil and it is therefore important to keep it stable and peaceful.
But, Iran is not Iraq. There is a considerable level of well-organized internal opposition to the current leadership and the Ayatollahs are not crazy. Perhaps we can persuade the Iranians to take a more reasonable approach. With the cooperation of the Russians and French, Iran can have a peaceful nuclear power program and we can have guarantees it is not directed at nuclear weapons.
PS: There are some 26 Comments at the end of my No OIL in Afghanistan thread, mainly a lively discussion between Howard Pattee and myself. I think that conversation is worth reading now.
The Runaway Trolley thought experiment was introduced in a previous Topic, on this Blog.PRESIDENT OBAMA'S GRANDMOTHER
As a case-in-point, the President brought up the hip replacement received by his terminally-ill grandmother mere weeks before she passed away. During his campaign, she was diagnosed with terminal cancer and then, probably due to a mild stroke, she fell and broke her hip. Her condition was analyzed by her doctors who told her she had three to nine months to live due to the cancer. They also told her that a weak heart posed risks for the invasive surgery hip replacement.
In the absence of cost-effectiveness data or guidelines to the contrary, she chose the hip replacement, which was approved by Medicare and done mostly at public expense. She passed away two weeks later, sadly just days before Obama won. It appears the stress of the operation may have shortened her life by several months.
I don't know if Obama's grandmother got approval for the hip replacement because she was related to a prominent person. That would be bad enough, but it would be even worse if we are giving hip replacements and other stressful and expensive treatments to all terminally ill grandmothers and grandfathers.
QUOTING THE PRESIDENT AGAIN
"... in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. ... So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right? I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here."
QUALITY ADUSTED LIFE YEARS
A concept called "Quality Adjusted Life Years" (QALY) is in use in the UK and, IMHO, should be adapted for use in the US. The basic idea is to estimate, before approving very expensive, public-funded medical procedures, the probability the procedure will be successful, and, if successful, the number of years the recipient is likely to live and the subjective quality of those years.
Subjective quality is a difficult measure. Fortunately for us, based on experience and practice in the UK and elsewhere, there are fairly well-established guidelines. For example, mobility is an issue in quality of life. If a person is able to walk without assistance that is better than being wheelchair-bound, and a wheel chair is better than being bedridden. Being alert and awake and mentally competent is better than lack of those qualities. Being able to take food by mouth is better than IV, etc.
In the UK, if each QALY is estimated to cost less than about $40,000, and if the recipient wants the medical procedure, it is approved for public funding. On the other hand, if the cost is more than $40,000 per QALY, or if the recipient does not want the procedure, only palliative care, consisting of pain management along with love and attention, is provided, even if this level of care will reduce the likely life span of the patient.
The QALY concept may also be utilized to compare alternative treatment options. For example, if medical treatment procedure A will cost substantially more per QALY than medical treatment procedure B, only B will be approved, even if both are under the $40,000 limit.
Examples:
1) Alice is a candidate for treatment A that is estimated to cost $150K for the treatment and care, has a probability of success of 80%, and, if successful, will provide a subjective quality of life of 60%. Based on her age and medical condition, if the procedure is successful, Alice has a life expectancy of 10 years. The calculation gives her QALY = 5 years, so each QALY will cost about $31,000, which is below the limit of $40,000. The Treatment A is therefore approved for public funding if Alice is willing to accept it.
2) Bob is a candidate for treatment B that is estimated to cost $90K for the treatment and care, has a probability of success of 50%, and, if successful, will provide a subjective quality of life of 40%. Based on his age and medical condition, if the procedure is successful, Bob has a life expectancy of 5 years. The calculation gives him QALY = 1 year, so each QALY will cost about $90,000, which is above the limit of $40,000. The Treatment A is therefore NOT approved for public funding and Bob is entitled to palliative care only.
3) Carl is a candidate for treatment C that is estimated to cost $50K, or treatment D that is estimated to cost $100K.
Treatment C has a probability of success of 90%, and, if successful, will provide a subjective quality of life of 60%. Based on his age and medical condition, if the procedure is successful, Carl has a life expectancy of 5 years. The calculation gives him QALY = 3 years, so each QALY will cost about $19,000, which is below the limit of $40,000.
Treatment D has a probability of success of 80%, and, if successful, will provide a subjective quality of life of 70%. Based on his age and medical condition, if the procedure is successful, Carl has a life expectancy of 5 years. The calculation gives him QALY = 3 years, so each QALY will cost about $36,000, which is below the limit of $40,000.
Both treatment C and D are below the limit of $40,000 per QALY, but C is substantially less expensive and, therefore, only treatment C is approved for public funding if Carl is willing to accept it.
A STORY MY FATHER TOLD ME
Once upon a time, there was a boy in China and he saw his father carrying a large basket on his shoulders. "What do you have in the basket?" he asked.
"Well," said the father, "It is your grandfather."
"What are you doing with grandpa?" asked the boy.
"Well," he replied sadly, "Your grandfather is quite old and he is so sick that we cannot take care of him anymore, so I am going to dump him in the river."
The boy thought about it awhile, and then he said: "OK, Dad, ... But remember to bring back the basket!"
Back in March 2009, I did a posting titled Prediction: Big Market Recovery This Year! That included the above graphic.
At the time of my prediction, the Dow was down at around 7,000. In the graphic, I showed what I thought the "true" value was (the green dots). and I wrote:
"The good news is that the market will probably recover nearly as fast as it dropped. I predict we will see it around 9,000 or more by year end and over 10,000 in a few years."
Well, the Market overachieved. It ended 2009 at 10,428.
OIL and the Iraq War