TOP "Four Pinocchios" of 2015 (Washington Post)

The Washington Post just published the "The Biggest Pinocchios of 2015". I don't always agree with the Washington Post, and my selection of 2015 fibs and fibbers wouldn't be exactly the same as their top "Four-Pinocchio Ratings". However, I think their list is well worth considering.

I've divided the Washington Post list into two groups:
A) The better known fibbers and fibs (depicted in the above graphic), and
B) The lesser known fibbers (depicted in the lower graphic).


Here are the liars and lies from the Washington Post piece by Glenn Kessler (direct quotes from the piece are surrounded by quote marks):

DONALD TRUMP
The Donald is credited with three items in the "Biggest Pinocchios of 2015" list (although they say he earned no  fewer than 11 Four-Pinocchio ratings in the past six months).

FALSE>>>“I watched thousands and thousands of Muslims in New Jersey cheer as the World Trade Center fell.”

"Donald Trump falsely and repeatedly asserted that he saw television images of Muslims in New Jersey celebrating the collapse of the twin towers after the 9/11 attacks. Despite repeated debunking of this claim, Trump continued to assert he was correct, even though he could produce no evidence except a handful of news stories that made brief mentions of alleged celebrations — which never could be confirmed."

FALSE>>>“The Mexican Government is forcing criminals, drug dealers and rapists into the United States.”

"... a range of studies show there is no evidence immigrants commit more crimes than native-born Americans."

FALSE>>>“Obama plans to admit 250,000 Syrian refugees.”

Donald Trump first said President Obama planned to admit 200,000 Syrian refugees, a figure conjured out of thin air. Then it became 250,000. But the real figure is 10,000. The United States is only planning to admit 180,000 refugees from all countries in the next two years."

RALLYING CRY PROTESTING POLICE SHOOTINGS OF BLACKS
FALSE>>>“Hands up, don’t shoot.”
"This phrase became a rallying cry for protests after the fatal shooting of a black 18-year-old by a white police officer, Darren Wilson. Witness accounts spread after the shooting that Michael Brown had his hands raised in surrender, mouthing the words 'Don’t shoot' as his last words before being shot execution-style. Democratic lawmakers raised their hands in solidarity on the House floor. But various investigations concluded this did not happen — and that Wilson acted out of self-defense and was justified in killing Brown."

SENATOR HILLARY CLINTON
FALSE>>>“DOMA had to be enacted to stop an anti-gay marriage amendment to the U.S. Constitution.”

"Former secretary of state Hillary Clinton, the Democratic front-runner, defended her husband’s signing of the anti-gay Defense of Marriage Act as a defensive action, to prevent a constitutional ban on same-sex marriage. But there is little evidence in the public record that was the case, even though Clinton claimed 'there was enough political momentum' at the time to amend the constitution. (Clinton later said it only had come up in 'private discussions.')"

PRESIDENT BARACK OBAMA

FALSE>>>“The Keystone pipeline is for oil that bypasses the United States.”

"Long before President Obama killed the Keystone pipeline project, he made a number of dubious claims about it, including that the pipeline would have no benefit for American producers at all. But the crude oil would have traveled to the Gulf Coast, where it would be refined into products such as motor gasoline and diesel fuel; the State Department said odds were low that all would be exported. Also, about 12 percent of the pipeline’s capacity had been set aside for crude from North Dakota and Montana."

SECRETARY OF STATE JOHN KERRY

FALSE>>>“With Al Gore, I helped organize the first hearings in the Senate on climate change in 1988.”

"Secretary of State John F. Kerry for years has said he organized the first Senate hearings on climate change with then-Sens. Al Gore and Tim Wirth. But that was false. Kerry was not at the pivotal 1988 hearing in the Senate — and neither was Gore, who organized the first hearing in the House in 1981. On top of that, Kerry described witnessing events that did not happen."

SENATOR RAND PAUL

FALSE>>>“A man was put in prison for conspiracy just for having dirt on his land.”

"Sen. Rand Paul (R-Ky.) loved to tell the story of an elderly man sitting in prison for 10 years after being accused of racketeering and organized crime — just for putting dirt on his land. But just about every aspect of Paul’s recounting was inaccurate and misleading. The man, Robert Lucas, was convicted of mail fraud, conspiracy and environmental violations for his role in developing 67 mobile home lots inside federally protected wetlands, building on wetlands without approval and knowingly selling land with illegal sewage systems that were likely to fail."

SENATOR ELIZABETH WARREN

FALSE>>>“Auto dealer markups cost consumers $26 billion a year.”

"Sen. Elizabeth Warren (D-Mass.), pushing for new regulations of loans made by car dealers, cited a figure based on a misleading and dated report from the Center for Responsible Lending, an advocacy group. But then she also wildly mischaracterized the number, as even the advocacy group conceded that the figure includes reasonable compensation owed to car dealers."

SENATOR CHRIS MURPHY

FALSE>>>“Since Sandy Hook there has been a school shooting, on average, every week.”

"Sen. Chris Murphy (D-Conn.) made this claim in June, which indicated 128 school shootings since December 2014. The number came from the anti-gun group Everytown for Gun Safety, but its methodology was deeply flawed, including suicides, accidental discharges and so forth. Official government statistics are much lower, indicating the political peril of relying on advocacy groups."

MAYOR RUDOLPH GIULIANI

FALSE>>>“Obama never says the United States is exceptional or great.”

"Former New York City Mayor Rudolph Giuliani (R) asserted that Obama, unlike other Democratic presidents such as Bill Clinton, Jimmy Carter or Harry Truman, never said the United States was a great or exceptional country. This was a bizarre claim. We concluded Giuliani must have muted the sound whenever Obama spoke, because there are many examples of Obama saying exactly that."

GOVERNOR MIKE HUCKABEE

FALSE>>>“The science on climate change is not settled because in 1970s we were worried about ‘global freezing.’”

"Former Arkansas governor Mike Huckabee (R) cited the “covers” of Time and Newsweek to claim global freezing had been a serious concern 40 years ago. But these were not cover stories, just isolated examples of speculative journalism. It was never a serious concern; researchers found that peer-reviewed articles on global cooling were in a distinct minority compared to those concerned with global warming."  

[I (Ira) think this Huckabee Pinocchio is not fully justified and should not be in the top Four-Pinocchio list. See my NOTE below.]

Ira Glickstein

NOTE ABOUT THE HUCKABEE PINOCCHIO: 

The threat of man-made global COOLING perceived in the 1970s was apparently not featured on the covers of Time or Newsweek. So, technically, Huckabee was fibbing when he claimed COVER stories. However, global COOLING was fairly widely reported at the time, including pieces in both Time and Newsweek.  

Here is what the Washington Post RECENTLY wrote about 1970's press coverage of the threat of man-made global COOLING:

Time magazine in 1974 titled an article “Another Ice Age?” and said “climatological Cassandras are becoming increasingly apprehensive, for the weather aberrations they are studying may be the harbinger of another ice age.”

Newsweek, in 1975, ran an article titled “The Cooling World,” which said: “Meteorologists disagree about the cause and extent of the cooling trend…. But they are almost unanimous in the view that the trend will reduce agricultural productivity for the rest of the century.” Newsweek suggested that one solution was “melting the arctic ice cap by covering it with black soot.”

(The Washington Post scooped them both with a 1970 article titled, “Colder Winters Held Dawn of New Ice Age.”)

Furthermore, the threat of excessive cooling due to human activities was considered serious enough to prompt the prestigious National Science Board in 1974 to make serious predictions based upon falling global temperatures experienced during that decade (as I posted to my Blog in 2009).  

Here is a link to the actual 1974 official US Government report that included the following:

 "... growing industrialization and the spread of agriculture introduced increasing quantities of dust into the atmosphere which reduced the amount of solar radiation reaching the earth. ... the cooling effect of the dust particles more than compensated for the warming effect of the carbon dioxide, and world temperature began to fall."

"Several consequences [of colder temperatures] have been observed: ... southward intrusion of sea-ice ... unusually large numbers of severe storms ... development of a calamitous drought belt extending around the world ..."

Finally, here is what I posted to my Blog in 2009

National Science Board Prediction: Global COOLING 

The US National Science Board (part of the National Science Foundation) issued a report titled Science and the Challenges Ahead that makes six interesting science-based observations and predictions. (Three relevant paragraphs from pages 24-25 of the linked document are reproduced here. Click on image to make it larger.)

Direct quotes are indicated by numbered arrows:

1- "Human activity may be involved on an even broader scale in changing the global climate."

2- "During the last 20-30 years, world temperature has fallen ..."

3- "... there is increasing concern that man himself may be implicated, not only in the recent cooling trend but also in the warming temperatures ...

4- "... activities of the expanding human population - especially those involved with the burning of fossil fuels - raised the carbon dioxide content of the atmosphere, which acts as a 'greenhouse' ..."

5- "But simulataneously ... growing industrialization and the spread of agriculture introduced increasing quantities of dust into the atmosphere which reduced the amount of solar radiation reaching the earth. ... the cooling effect of the dust particles more than compensated for the warming effect of the carbon dioxide, and world temperature began to fall."

6- "Several consequences [of colder temperatures] have been observed: ... southward intrusion of sea-ice ... unusually large numbers of severe storms ... development of a calamitous drought belt extending around the world ..."

Oh, I forgot to mention, the report was issued in 1974! (Well before Climategate :^)

The more things change,

the more they remain the same!

Warming, cooling, ... whatever - it is always MAN's fault!

(And, of course, WOMAN's too :^)

Could it be NATURAL CYCLES not within Human Control?

Nope - No grant money in that!

Ira Glickstein

Go and Do the Right Thing - VOTE

You are on the Board of Directors of a large enterprise in severe financial trouble. Will you vote to stick with the current executive team or hire a new one?

THE CURRENT EXECUTIVE TEAM

The current team admittedly inherited a tough situation four years ago, but all they have done is spend more than they could ever take in on schemes that are not economically viable. They wasted our money rewarding their cronies with “stimulus” schemes that have not panned out.

The leader of the current team is a charming and engaging speaker who had no leadership or economic experience when he took office, and does not seem to have learned anything in those departments in the past four years. He has sold us a bill of goods of “hope and change” and all he can promise is four more years of the same.

His sidekick has no visible qualifications except having fed at the political table for decades (which explains his “gravitas”). He seems to stick his foot in his mouth whenever he opens it (which explains his clean feet and dirty mouth).
 

THE ALTERNATIVE NEW TEAM

The new team under consideration offers an alternative vision based on solid business principles and demonstrated leadership and achievement.

Sadly, when it comes to campaigning, the leader of the new team  is a bit lacking in the charm department. He sometimes gets into trouble for speaking the plain truth directly and in clear language. However, he is an experienced executive with tremendous business and leadership knowledge and a sterling record of success in turning troubled enterprises around.

His sidekick is a bit of a “policy wonk” with a great deal of legislative experience. He may be the only lawmaker who has actually read and understood most of the bills he supported or opposed. He has detailed knowledge of the budget but also the ability to explain it in plain language we ordinary people can understand.

The new team has an economic plan that is admittedly a bit painful, but it is the only hope (short of Divine Intervention) of getting our enterprise out of the ditch and back on the highway to progress towards economic viability.

It is your choice. Now, go and do the right thing! VOTE!

Ira Glickstein

PS: If you liked the above, you may also be interested in:
The Problem with High Intellect Twits (HITwits)
Affordable Food Care Act
Uncle Sam's Illness
Once I was Young and a Democrat
VP Candidate Paul Ryan Talks Medicare at The Villages, FL
 

Once I was young and a Democrat

[from billlifka] It was a fine time and a good thing to be. I had many friends and relatives who were Democrats. In fact, most were. Now, most of them are dead but I have new friends and relatives who are Democrats, although not so many.

I was a Democrat longer than I was Independent and that longer than I was Republican. However, I wasn’t registered as a Democrat which may be like Bill Clinton’s having smoked pot but not inhaling. Barack Obama has inhaled with pleasure, which may explain a lot. The point is that my credentials as a past Democrat may be questioned but, I assure you, Democrats of my age would recognize me as a kindred spirit. I was born as a Democrat as I was born as an American and a Catholic, all being quite compatible at the time. I chose to be a paper boy and a Cub Scout at the age of nine. These were the first observable signs I had started to think on my own although there’d been covert outbreaks of latent Libertarianism from the age of three.

I never thought much about why I was a Democrat other than as a blessing of birth. When FDR ran for his second term as president, my mother explained that all should vote for Roosevelt because, “He was for the poor people, like us.” Being six years old, I always accepted what my mother told me so long as it didn’t interfere with my plans for that day. Even then, I thought it was a strange argument since I didn’t feel particularly poor. Starting with my being a paper boy, it seemed even stranger since all I needed to do to have money in my pocket was to do a little work and just doing the work made me feel good about myself, also. Then too, I found it hard to understand why FDR was great if he was for losers. At the time, I was for the Chicago Cubs but in those days the Cubs won two pennants so I didn’t think of them as losers until I got a little older. If my mother had said FDR was going to turn losers into winners I would have understood it was like hiring a new manager for the White Sox.

Despite my confusion at an early age, I did come to understand why people would vote for FDR even if they weren’t born as a Democrat. In fact, I think I would vote for him, if I were over twenty one at the time because he did talk a good story and engaged the federal government in a lot of activity, especially for a guy who needed to operate out of a wheelchair. Now I know that activity shouldn’t be mistaken for progress, but in those days it caused most people to feel better even though the depression just went on and on until the war. When it came to the war, FDR was one of the better presidents because of his ability to convince Americans all would turn out well in the end. It also helped that he picked an outstanding leader for the military forces and was convinced, mostly by his wife, to let businessmen lead industrial mobilization. Like his cousin, an earlier president, FDR was not comfortable with the private sector and distrusted all who were in it; they just wouldn’t kowtow to his economic ideas and lack of experience in their field.

By the time Harry Truman came along, I was learning things that caused doubts about FDR but, still a born Democrat, I would have voted for Harry if I were twenty one because Tom Dewey’s moustache made him look sneaky to my eyes. On the other hand, it seemed clear that Harry was straightforward and outspoken and I liked the sign on his desk, “The buck stops here!” He was a guy who took responsibility for his actions and had made tough decisions without flinching over what people might say about him. Even then, I knew those were important traits for a leader. He made some mistakes but if I were transported back in time with my present knowledge, I’m sure I would vote for him and not because I was born a Democrat.

My family never got anything from the Democratic Party, even though FDR was for poor people. Mostly, the Party functioned in the large cities, like Chicago, and they got people work. This was a good thing that people had to work for their money, like being a garbage man. It was true that higher ups might be building inspectors and depended on bribes for extra money but they had to support their families and come election time they had to work hard for no pay in “getting out the vote” which meant getting people out to vote. This is harder than it might seem, especially when some people lived in cemeteries. On a national level, FDR did find work for many in the CCC where they built forest preserve shelters and other public works. My relatives found work for each other like when my father introduced his brother and two brothers-in-law to his boss. That didn’t stop them from being good Democrats even if they made a living on their own

Even though I was a born Democrat, Ike seemed to be an obvious choice over Adlai Stevenson. Adlai was a very bright guy and witty speaker but had the real world depth of a driveway puddle. With Eisenhower, I drifted away from my Democrat birthright but only to that place in between called Independent. I don’t blame Independents for giving up on both Political Parties. Both have earned that treatment. On the other hand it’s sort of like the idea of Purgatory, a place neither heaven nor hell. I can understand why one might choose hell for all the fun that comes before or heaven for all the fun that comes later. Choosing the in-between is hard to fathom. Nevertheless, I felt comfortable there and then John Kennedy came along.

In retrospect, I should have suspected all wasn’t right about Kennedy. But he looked so good, had such an endearing family and talked so convincingly, it was easy to succumb to his charm. By that time, I had forgotten I was born a Democrat, but not that I was born a Catholic and was offended that the presidency had eluded Catholics and the previous one who had tried had been rejected primarily because of his religion. JFK was assassinated and, therefore, deserves to be an “American Saint.” If he had served a full two terms, he might well be remembered differently.

Ronald Reagan came upon the scene. Admittedly, he was running against a guy who had failed in his first term miserably. Nevertheless, he was dismissed as an actor, forgetting his success as Governor of California and as President of the Actor’s Guild, a working job. As an Independent, I had no problem voting for him and became converted to the Republican Party during his time in office while retaining the right of occasional dissent over peripheral items of dogma. I think I have learned how to judge an effective leader of my country based on his past performance in responsible jobs and his character traits as displayed in those positions. I listen to what he says he will do and strongly discount what others say he will do, especially those who have reason to lie about him. I give no thought whatever to whether we share a political party, religion, ethnicity or the many peripheral social preferences that exist in abundance.

Most importantly, I imagine how this blessed country of ours will fare under his leadership. I’ve been around for the great depression, being totally unprepared for WWII, engaged in five other major military adventures and countless minor ones and many social and economic crises. All has not yet been manifested, but we are in the midst of what I believe will be the greatest testing of America in its history. The foundations of our government, economic system and social structure are under siege without restraining influence of experienced leaders with the prudence and wisdom to chart and navigate safe passage through dangerous reefs for the ship of state.

My purpose in this writing is to convince those who choose the Democratic Party as theirs to vote for the opposition candidates, Mitt Romney and Paul Ryan and that, in their doing so, they will act to save their Democratic Party as well as their country. I write as one who once shared membership in their party, although in simpler times, and one who has voted for rational reasons and for not-so-rational reasons, for candidates of my party and for candidates of another party.

Like many Republicans, I disagree with some opinions of my fellow Republicans. I believe most Republicans respect members of the Democratic Party and accept that contention between the two major Parties is important to the well-being of America. I believe most Republicans accept that elected officials from the two parties must find a way to conduct the business of the country in a manner that addresses major needs of the country without violating reasonable and critical beliefs of either Party. It goes without explanation that many of the less important desires of both Parties may not be agreed upon but can be subjected to continuing debate. Such debate should be open and with courteous regard for opposing beliefs. I believe that Democrats in my youth displayed many traits that are consistent with my beliefs and exist today in many members of the Democratic Party. These include patriotism, importance of the U.S. Constitution, belief in open debate and legislative process, personal responsibility, the value of work, the opportunity for all to improve their status in life and that it’s wrong to set one group of people against another group of people in open warfare. If you share these beliefs, you should vote for Romney and Ryan and for legislators who have demonstrated the same beliefs, regardless of their party affiliation.

It’s dangerously foolish to assume Barack Obama, in a second term, will change his stubborn march to turn America into a second class nation subject to domination by world organizations. He will continue to violate the Constitution as necessary to further his totalitarian ambitions. His acolytes in Congress will continue to block open debate to provide the excuse for government by executive order and bureaucratic mandate. He will continue to pit one group of Americans against another and seek majority backing through mindless wealth transfers that drive the country ever faster into bankruptcy. It’s dangerously foolish to assume that a very large minority of the public will accept this without resisting in ways that will result in widespread violence. At least worst, the Democratic Party would lose it’s acceptability as a governing body. At the very worst, the country would be torn by violence that would rival that in the American Civil War.

On the other hand, there is Romney and Ryan. Romney has proven he can govern effectively in an overwhelmingly Democratic State and obtain support from egotistical foreign Olympic czars. Ryan has proven he can work across the aisle and prefers reasonable compromise to mindless contention. Both know the solution to America’s critical problems lies in economic actions of the type in which both are highly experienced. They are good people, just like most Democrats.

billlifka

VP Candidate Paul Ryan talks Medicare at The Villages

Paul Ryan (center) with his mother and Lee Greenwood who introduced him with his famous "Proud to be an American" song this morning in The Villages, FL. Video available at http://www.realclearpolitics.com/video/2012/08/18/paul_ryan_addresses_the_villages_with_his_mother.html

It was my pleasure to cheer Congressman Paul Ryan as he addressed an enthusiastic audience at "Florida's Favorite Hometown", the retirement community of The Villages, in central Florida, where my wife and I have lived for the past nine years. The banner behind him and in front of the podium said "Protect and Strengthen Medicare" and a good part of Ryan's talk had to do with that topic.

He introduced his mother, a snowbird who lives in Ft. Lauderdale, Florida and he reminded us that the Romney/Ryan plan would not affect current recipients nor anyone 55 years of age or older, which, at a show of hands, included at least 80% of the crowd. He said that President Obama had taken $716 billion out of the Medicare trust fund and that could cause one in six hospitals and nursing homes to close. In contrast, he said, the Romney/Ryan plan would save the program for those at or near the eligibility age, and strenghten it for the next generations by offering choices based on competition between private plans and the government plan.

A video of his complete talk is available at: http://www.realclearpolitics.com/video/2012/08/18/paul_ryan_addresses_the_villages_with_his_mother.html

Just to be sure both sides of the Medicare issue were represented, a yellow airplane flew over and around the square pulling a sign that said: "PAUL RYAN: HANDS OFF OUR MEDICARE!"

Also see this ABC News report on Ryan's talk that includes a contrary view of the $716 billion dollar Medicare cuts:  http://abcnews.go.com/Politics/OTUS/paul-ryan-defends-medicare-plan-accuses-president-obama/story?id=17034339

As we say down here "It's a beautiful day in The Villages" and this day was no exception. My friend Jerry and I arrived via golf cart and passed through the airport-like security cordon without much delay into Lake Sumter Market Square where Lee Greenwood was entertaining the crowd. We found a good standing position on a raised wooden platform about 100 feet from the podium. We enjoyed several more songs and then we heard from some local politicos.

From where we were standing we had a good view of the building Ryan and his party would exit to get to the square. Security and coordination people walked between the square and that building and then we saw Ryan, in a dark blue shirt, standing at the ready with his mother, in bright yellow, and other dignitaries. Then we saw them cross the street to the square and out of our view.

I noticed "Campaign Carl" Cameron to the left of the podium broadcasting to his Fox News audience. Then Greenwood sang his famous and very moving "Proud to be an American" song and introduced Ryan and his mother to lots of good-natured cheers. (See the video at http://www.realclearpolitics.com/video/2012/08/18/paul_ryan_addresses_the_villages_with_his_mother.html)

I found Ryan's talk very well done, and even better than the talk I saw Mitt Romney give here in the same square back in 2008 during the GOP primaries that he lost to Sen. McCain. At that time, the crowds were smaller and security more relaxed and I had the priviledge of shaking hands with Romney after his talk. My wife and I also attended the talk given by VP candidate Sarah Palin in our square in 2008. Although we arrived hours early, over 40,000 other people showed up and we couldn't get into the specially secure area of the square that afforded a direct view and had to watch the proceedings on large "Jumbotron" TV displays set up around the square.

By contrast, we arrived for Ryan's appearance less than an hour before he gave it and were able to get into the standing room only part of the secure area. Thousands of others, who brought folding chairs which were not allowed in the secure area, chose to watch via "Jumbotron" on the streets around the square. Of course, the "Jumbotron" view is much clearer and better than the direct live view, and sitting is much better than standing for an hour, but, by some strange quirk of human psychology, a direct view is preferred.

At one point, near the beginning of his talk, Ryan noticed that someone had a medical emergency and he interrupted his talk to be sure the medics were on the way. Given the August heat, and the fact that residents of The Villages are beyond retirement age, medics are always at the ready. Later in Ryan's talk I saw a woman in a stretcher being whisked out of the secure area.

The crowds were very polite and supportive, with absolutely no pushing to get the best view. We did crowd together, and sometimes a standing supporter waving a sign did block the view, but it was all done in a festive spirit.

After the talk was over, a light rain began to fall. We sauntered out of the secure area, along with over a thousand others, which took some time given that we are mostly retirees and some of us have trouble walking. We remembered where we parked my golf cart and followed the traffic through happy people walking to their carts and cars in the light drizzle, and, with a minimum of delay, got back home in good humor.

All in all, a great way to spend part of a Saturday morning.

Ira Glickstein

Raising Cain

[from billlifka - images added by Ira. (Neither Ira nor billlifka specifically endorse any candidate in this posting)]

At the moment, many of the national polls rank Herman Cain highest among those campaigning to become the Republican candidate for the presidency. It’s still two months before the earliest presidential primaries so the polls have questionable value. Nevertheless, Cain is so unusual, in comparison to the others, that his current popularity is amazing. He is different mainly in his not being a career politician and this may be a major reason for his appeal. There are other reasons.

Both of Cain’s parents are African-American. They were poor and worked hard to raise a family. The mother was a cleaning woman and the father was a janitor, barber and, eventually, chauffeur to the president of Coca Cola. Herman was educated in segregated schools. He received a B.S. from Morehouse College in Mathematics with a minor in physics. His Masters is in Computer Science from Purdue University. He holds eight honorary degrees from various universities.

Cain was a (civilian) ballistics analyst for the U.S. Navy. At Coca Cola, he worked his way up to become its top IT executive. Recruited by Pillsbury, he managed a 400 store Burger King region near Philadelphia from least to most profitable. Assigned CEO of Godfather’s Pizza, Pillsbury’s subsidiary, he improved its performance and led a leveraged buyout, continuing as its CEO. He was CEO of the National Restaurant Association. On behalf of that organization, he debated Bill Clinton on his Universal Healthcare Bill in a Kansas City town hall meeting; it was judged to be a Cain win. He served on the board of directors (and, later, its chairman) of the Federal Reserve Bank of Kansas City. He has served on the boards of eight corporations and one bank. This is the man who Hillary Clinton demeaned as a pizza man. She remembers who spiked her health plan.

Cain has lived all over the country, because of his career. He’s been married for 43 years and has two children and three grandchildren. He was diagnosed with stage IV colon cancer, metastases in his liver. With a 30% survival prognosis, he underwent surgery and chemotherapy. After five years, he has remained cancer-free. He’s assistant pastor at his Baptist Church. He’s been a talk radio host and a syndicated columnist. Most people would admit this guy is pretty impressive.

The problem with Cain is he came late to the campaign party without an organization for fund raising and campaign operations. Without massive funding, a modern political campaign is at a huge disadvantage, perhaps hopelessly so. On the other hand, the Tea Party really likes him. The good news is the Tea Party has great influence. The bad news is it’s very loosely organized, also. Unless Cain shows up well in the early state primaries, he’s toast. That would be unfortunate; he is a good comparison to the other Republicans and would be an effective opponent to Obama.

As the currently leading Republican prospect, Cain is the target of most criticism. His 9-9-9 tax plan is torn apart by many in both political parties. No doubt some valid criticisms will emerge, eventually, but not so far. Arthur B. Laffer, a credible, well known economist, gives the plan high marks. Newt Gingrich, another prospective Republican Presidential Candidate praises Cain for his boldness in coming forth with a useful idea while others just carp about the situation. The other main criticism of Cain is lack of international experience. Cain believes America should name its friends and its enemies and treat its friends like friends. That’s refreshingly original.

billlifka

Political Signs of the Times

In light of the controversy over inappropriate signs at Tea Party gatherings, I paid special attention to the signs at the rally I attended yesterday, here in The Villages, FL. The headliners were possible 2012 Presidential candidate Gov. Mitt Romney (who lost in the 2008 primaries despite my vote) and businessman Rick Scott (who won the 2010 primary for Governor of Florida despite my vote for his opponent).

Well, the strongest sign I saw said "FIRE PELOSI". Mine said "How About COMPETENCE for a CHANGE?" The others were boldly printed "SCOTT CARROLL" (for Rick Scott and his running mate, Jennifer Carroll) plus hand-written signs the organizers had passsed out saying things like "Chicks for Rick" and "Vote for Rick".

**********************

I arrived around 3PM, two hours before the main event. By that time, however, all seating in and around Market Square was occupied by happy residents of "Florida's friendliest home town." The central area around the pavillion from which the headliners would talk was for standees only and was already 1/3 full.

I got a $1 hot dog and watched one of the jumbotron TVs showing video of the 2008 visit by President George W. Bush. They also showed the presidential primary appearances I had attended for Mitt Romney and John McCain, plus videos of the visits of Rudy Guilliani and Fred Thompson. The video highlight for me was the gigantic Sarah Palin for VP rally I had attended along with 70,000 others.

A nice lady gave me a flag. I stuck it into a hole in my hat. I politely turned down several offers of political signs since I had brought my own.

It was a brilliantly sunny and beautiful day in The Villages. I needed a shady place to sit. Folding chairs, coolers, and signs with sticks were banned from Market Square proper, but I was able to find a spot for my chair and cooler in the shade of a golf cart parked on Canal Street adjacent to the Square. I watched the musical group Rio Diamond via jumbotron TV and enjoyed the fellowship of the friendly crowd, sipping a can of soda from my cooler and reading the AARP Bulletin that had arrived in the mail that day.

Right on schedule, 5PM, the headliners arrived and I left my seat and found a great place to stand. It was about 10 feet from the pavillion, on the west side where the sun would not be in my eyes.

Introductions were quickly accomplished. In addition to Romney and Scott, they included Scott's wife of 38 years; his running mate Jennifer Carroll; Florida AG candidate Pam Bondi; plus some local politicos. Romney's talk was short and direct. He has been in The Villages several times before. I actually shook hands with him along the rope line after his 2008 talk.

Scott gave a nice speech, starting with his childhood in public housing. His first business, while in college, he said, was selling the donuts his mother made. He sold to airlines and other commercial customers and got to the point where his mother had to start making them 8PM the previous evening and work all night. As expected, he did not mention his time as CEO of Columbia/HCA, where he was ousted by the board in the aftermath of a big Medicade and Medicare fraud.

And then it was over and we all went home.

*****************************************

I though about how easy it would have been for me to have hidden any kind of disgusting sign in my car or golf cart and unfurled it at the rally. That is why I think it is totally unfair to blame the organizers for the inappropriate display of racist, sexist, or otherwise offensive signs that happen to show up at any event in a public place. (See Huffington Post for an opposing opinion.)

Ira Glickstein

Cost-Effective Health Care Compromise

President Obama has mounted a new full-court press this week to finally pass a version of the Senate Health Care bill, using the "nuclear option" if necessary.

It seems he is assuming that the televised summit conference between Democratic and Republican politicos this Thursday (25 February) will fail to reach a bipartisan compromise. I hope a cost-effective compromise can be reached, but I am not sanguine.

If there is no compromise, the plan is for the Democratic-controlled House to pass a version of the bill already passed by the Senate (before Sen. Ted Kennedy passed away). Then the Senate, by a simple majority of 51, can confirm it and it will become law. I hope this "nuclear option" is not attempted. I do not believe it will work because anyone who votes for it and is up for re-election this year will understand that he or she faces a high probability of being defeated.

Here is my outline for a bipartisan compromise, based on my previous postings here and here, partially based on Democrat David Goldhill's reasonable proposals in his 2009 piece in The Atlantic. This is a very serious plan that I think has a chance of gathering bipartisan support.

1) Universal digititized patient data, securely accessible by any doctor chosen by the patient. This part should be easy to sell to President Obama and both political parties and all medical specialties. It has been technically feasible for a decade and it is past time we do it.

2) Mandatory Catastrophic Insurance coverage for all that would cover only medical costs incurred in any one year of over $50,000 or a chronic condition that incurs costs of over $5,000 per year for ten years. That coverage would include a voucher for a basic checkup once a year. The government would subsidize coverage for those who could not afford the relatively low premiums for catastrophic coverage. Goldhill estimates a yearly premium of $2,000 for this type of coverage. (By comparison, my wife and I are paying around $10,000 each if you include our out-of-pocket insurance and Medicare costs plus the contribution of my former employer and of government Medicare funding.) This is an approximation of the universal health insurance that President Obama and the majority party favors in a cost-conscious form that should be palatable to the minority party.

3) Nationwide competition by health insurance companies certified in any state to sell insurance in any other state. This will provide far more competition and bring down costs. This will be an easy sell to most members of the minority party but may be resisted by the majority party that is obligated to state health care regulators and to insurance companies that have near-monopoly positions in some high-cost states.

4) Mandatory Health Savings Accounts for all that would be tapped into for actual medical costs incurred, but would remain the property of the owner of the account (you, or your heirs) if not fully expended, as proposed by Goldhill. Employers and employees/retirees would pay into the Health Savings Accounts the difference between what they are currently paying for comprehensive insurance and out-of-pocket medical costs now and the lower cost of Catastrophic-only insurance. (For example, my wife and I would see about $8,000 per year for each of us pass into our Health Savings Accounts.) Young, healthy families with low medical expenditures would see their Health Savings Accounts grow by thousands of dollars per year, accruing as savings to prepare themselves for the likely increasing medical costs as they age. Those not so fortunate, who incur medical costs, would expend the funds in their Health Savings Accounts until the accounts were tapped out, and would then pay the remainder out of their pockets and savings, until they hit the catastrophic limits and then Catastrophic-only insurance would kick in. This is a further approximation of the universal health insurance that President Obama and the majority party favor in a cost-conscious form that should be palatable to the minority party.

The point would be to make the recipients of health care more conscious of the actual costs. Instead of calling an ambulance for every event, they would be more likely to drive the injured person to the hospital or use public transit if possible. Instead of accepting the first doctor's advice for expensive medicines or tests or procedures (that may be in the doctor's self-interest - he or she may have a boat payment due) they would be more likely to shop around for lower-cost options. That would drive down the costs of medical care for everybody and make the providers more responsive to their customers, who would be the actual recipients of health care rather than the government and insurance companies.

5) Tort reform to eliminate high malpractice premiums and defensive medicine with unnecessary tests that add up to 10% to costs. This will be a hard sell to the majority party that is in the pocket of trial lawyers, but it is an absolute necessity for support by the minority party.

6) Outcome-based reimbursement to eliminate costly surgery and medications that do not yield comparative effectiveness based on quality-adjusted life years. Though President Obama earlier seemed to favor an approach of this type, it will be a hard sell to the minority party. Some politicos in both parties who originally proposed it have backed away due to the onslaught of opposition based on "death panels" and "pulling the plug on granny".

7) No denial of insurance based on pre-existing conditions or boosting of premium costs due to illness. Given (2) and (4), anyone who has complied with the mandatory coverage requirement, which would be partly subsidized by the government for those who cannot afford it, would be protected from subsequent denial of coverage or premium increases based on illness.

Ira Glickstein

LIES, DAMNED LIES, AND STATISTICS (Part 6)

STATISTICS OF HEALTH CARE SPENDING
Health Care reform has been a hot topic where statistics have been used to: Abuse anecdotal math to falsify the truth and truthify falsehood.

(This is the sixth of the series on misuse of statistics. For the earlier postings, click: 1-Going to St. Ives, 2-Playing Percentages, 3-Correlation and Causation, 4-Fun with the Normal Curve, 5-Global Warming.)

In a December 2009 posting, I pointed out that the map of per capita Medicare spending by county in the US looked a lot like the political division between the "Blue Counties" (Democrats, L-Minds) and the "Red Counties" (Republicans, C-Minds).

Since counties are so numerous and therefore confusing, I used Congressional Budget Office 2004 statistics of per capita Medicare spending on a statewide basis to show that the top five Highest Spending States tended to be Blue States and the top five Lowest Spending States tended to be Red States.

(My stated purpose -agenda if you like- was to indicate that Liberals consume an outsized share of the common pot of health care resources, as compared to Conservatives who take a smaller piece of the pie per capita.)

Lawyers Have Not Changed Since the 1700's

Our recent discussion of the current movie, The Invention of Lying, about a modern society where there was no concept of a lie, led me back to the story of a similar society, written in 1726 by Jonathan Swift. One of best tales in Gulliver's Travels is his adventure in the country of the Houyhnhnms, a society of cultured horses where lying is also unknown.

I was struck by Gulliver's description of the lawyers of his time and how similar they are to many of today's lawyers (and judges and, especially, professsional politicians)!

Here are some excerpts where Gulliver explains, to his Houyhnhnm host, how justice works in his native England:

There [is] a society of men among us, bred up from their youth in the art of proving, by words multiplied for the purpose, that white is black, and black is white, according as they are paid.

To this society [of lawyers] all the rest of the people are slaves.

For example, if my neighbour has a mind to my cow, he has a lawyer to prove that he ought to have my cow from me. I must then hire another to defend my right, it being against all rules of law that any man should be allowed to speak for himself.

Now, in this case, I, who am the right owner, lie under two great disadvantages: first, my lawyer, being practised almost from his cradle in defending falsehood, is quite out of his element when he would be an advocate for justice, which is an unnatural office he always attempts with great awkwardness, if not with ill-will.

The second disadvantage is, that my lawyer must proceed with great caution, or else he will be reprimanded by the judges, and abhorred by his brethren, as one that would lessen the practice of the law. And therefore I have but two methods to preserve my cow. The first is [bribery of] my adversary's lawyer [or] for my lawyer to make my cause appear as unjust as he can, by allowing the cow to belong to my adversary: and this, if it be skilfully done, will certainly bespeak the favour of the bench.

... these judges are persons appointed to decide all controversies of property, as well as for the trial of criminals, and picked out from the most dexterous lawyers, who are grown old or lazy; and having been biased all their lives against truth and equity, lie under such a fatal necessity of favouring fraud, perjury, and oppression, that I have known some of them refuse a large bribe from the side where justice lay, rather than injure the faculty, by doing any thing unbecoming their nature or their office.

It is a maxim among these lawyers that whatever has been done before, may legally be done again: and therefore they take special care to record all the decisions formerly made against common justice, and the general reason of mankind. These, under the name of precedents, they produce as authorities to justify the most iniquitous opinions; and the judges never fail of directing accordingly.

[Lawyers have] a peculiar cant and jargon of their own, that no other mortal can understand, and wherein all their laws are written, which they take special care to multiply; whereby they have wholly confounded the very essence of truth and falsehood, of right and wrong; so that it will take thirty years to decide, whether the field left me by my ancestors for six generations belongs to me, or to a stranger three hundred miles off.

[Lawyers and judges,] in all points out of their own trade, [are] usually the most ignorant and stupid generation among us, the most despicable in common conversation, avowed enemies to all knowledge and learning, and equally disposed to pervert the general reason of mankind in every other subject of discourse as in that of their own profession.

Well said and so true, so true!

Ira Glickstein

Grand Illusion of Motion (NOT!)

Double-click on the image to make it larger.

The wheels appear to be turning but I assure you it is a static picture.

If you stare at a black dot, the movement stops in that area.

I don't know what logical or philosophical point this makes.

Perhaps that some politicos claim to be making things happen and change but are not too successful at it. (But, I'm not complaining. Some of the best Congresses have been those that did the least damage!)

Ira Glickstein

We Need COST-EFFECTIVE Health Care Reform

Shout it from the rooftops!

WE NEED COST-EFFECTIVE HEALTH CARE REFORM!

This posting details the THREE changes we need in US health care to save the money we will need before we expand the system further.

1) Universal digititized patient data, securely accessible by any doctor chosen by the patient. This part should be easy to sell to both political parties and all medical specialties. It has been technically feasible for a decade an it is past time we do it.

2) Tort reform to eliminate high malpractice premiums and defensive medicine with unnecessary tests that add up to 10% to costs. This will be a hard sell to the majority party that is in the pocket of trial lawyers.

3) Outcome-based reimbursement to eliminate costly surgery and medications that do not yield comparative effectiveness based on quality-adjusted life years. This will be a hard sell to the minority party, some of whose members originally proposed it but who have backed away due to the onslaught of opposition based on "pulling the plug on granny".

WARNING: This posting will make you angry no matter which side you are on in the current debate. Please give it a chance because I think it is the best we can do now to control health care costs and get the best "bang for the buck".

1. Universal Digititized Patient Data

This is the easy one.

Every time I go to a new doctor I have to complete a detailed medical history form. Fortunately, my wife has all the major stuff memorized, but I think most people forget some of their medical history and just guess at the dates for past medical procedures if they do remember, so the new doctor does not have complete or correct information. At each doctor visit I have to update my list of pills. Every time I get my blood and other fluids tested along with a record of my blood pressure, weight, temperature and other information, it is done by computerized equipment, but the records are printed out and sent to my doctor in hard-copy form.

All this is error-prone and a waste of time for the patient. Since the data is hand-written and hard-copy the doctor has to paw through pages and pages of paper records. There is no opportunity for a computer to assist him or her in detecting counter-indications for various medications or procedures.

By now, all hospitals and most doctors store at least some of their data on computers, most of which are networked. We buy our prescription medications from large companies that are fully computerized. Even my non-prescription pills are purchased online so there is a computer record of all those transactions.

There is role here for the government to work with a medical industry organization to standardize the format and contents of universal digitized patient medical data. Of course, with universal patient data there is a security issue. We want only doctors and hospitals authorized by the patient to have access to our medical data, and only to that portion of the data that is applicable to the type of medical procedure being performed.

The government has already specified the Real ID drivers license that is being issued by some states. The security aspects of Real ID have been watered down to something called Pass ID, which is unfortunate in my opinion, but even Pass ID will be secure enough for medical record access. Nearly all adults have drivers licenses. Children could be ID'd via their parent's ID and non-licensed adults could be ID'd by their spouses or adult children's or medical proxy's IDs.

Your regular doctors and hospitals would scan your Real ID or Pass ID to access your records. If you change doctors, or go to an emergency medical facility, they would scan your ID card to get secure access to your medical records. Of course, each doctor or hospital would have a specified set of medical specialties and his or her ID card would limit their access to only those parts of your medical records applicable to that specialty. Periodically, doctor and hospital access would expire and require a new ID scan.

All the government needs to do is: 1) Authorize a medical industry organization to set up the data standards, the rules for secure access, and to certify the competing companies that will securely store the data for patients, funded by fees when the data is accessed, 2) Authorize the use of Real ID and Pass ID for secure access, 3) Require all doctors, clinics and hospitals to adopt the new standards within five years and, 4) Where necessary, subsidize computer equipment and software for doctors, clinics, and hospitals in less affluent areas.

It is estimated that at least 10% of Medicade/Medicare funds are stolen by fake or unscrupulous doctors and medical equipment and service providers. A side-benefit of use of Real ID and Pass ID will be a double check that the actual patient has really been serviced. The government and insurance companies will also be able to check the frequency of use of services by any given patient ID number which will help identify unscrupulous providers who claim to have serviced a given individual with unreasonable or conflicting items.

2. Tort Reform and Defensive Medicine

If passed, this will be costly to the trial lawyers (like former Presidential hopeful Senator John Edwards). The current system is a full-employment program for lawyers. They make emotional arguments and parade the sad cases of patients who have had bad outcomes from medical treatments and expect to be reimbursed for both the cost of the care and "pain and suffering".

Medicine is not an exact science and some patients will have bad outcomes no matter how competent their doctors and hospitals. Trial lawyers can always find an "expert" who, for pay, will testify convincingly that "if only" such and such a test had been done, or a different course of treatment had been followed, the patient might have recovered to full health and vigor. This type of "Monday morning quarterbacking" is easy because, after the fact, the actual outcome is known, and the "expert" is free to speculate on what might have been had a different path been chosen with absolutely no way to prove him or her wrong.

We already have caps on "pain and suffering" awards in some states. This helps the medical malpractice insurance companies a bit. Unfortunately, when a doctor is accused of malpractice his or her time is not compensated, nor is the inner turmoil he or she feels, even if the accusation is baseless and the plaintiff's case fails. I would like to see our legal system more in line with other countries that require the losing side to pay the reasonable legal costs of the winner as a way to discourage frivolous cases.

We need a professional review system that prevents cases from being filed unless the accuser can show not just that he or she has had a bad outcome -all too often juries will award big damages out of sympathy for a seriously ill plaintiff- but that the doctor or hospital has willfully ignored the normal standards of care. A review board should determine if there is probable serious malpractice and not simply a misdiagnosis within the limits of professional practice or ordinary human error. The review board should have the power to dismiss the case or offer some reasonable compromise.

Our current system has doctors ordering unnecessary tests as a form of defensive medicine that adds upwards of 10% to medical costs while inconveniencing the patients.

Medical malpractice is a full employment program for lawyers. Will we get tort reform? Probably not, since trial lawyers control one of the major parties and most of the senators and representatives of the other are also lawyers.

3. Outcome-Based Reimbursement

This should have bi-partisan support. Unfortunately, some of the more extreme conservative talk-radio hosts and opinion writers have blown it out of proportion "pull the plug on granny?" On the other side, proponents of the congressional bills have been ordered not to use the words "rationing" of health care - in other words be dishonest. We need an honest discussion here, so, please, check you emotions at the door for the next few paragraphs.

The main reason health care costs have gone up so much faster than inflation is that health care technology is advancing rapidly. We can now save people with medical conditions that would have been considered terminal only a decade or two ago. That is great news for those people who can be restored to high quality, healthy and productive lives. The problem is that this new technology can also extend the low quality lives of people who will have to be connected to machines for the rest of their lives or be bedridden or undergo expensive periodic medical procedures or take high cost medications, or all of the above.

Last April President Obama gave an interview to the New Your Times Magazine (reported here by Blooomberg) where he said some important things that I agree with.

Some opponents say the Congressional health bill limits expenditures for the elderly. They have been accused of raising "fishy" issues and talking about "rationing health care". But they are correct when they say Pres. Obama has recently favored such limitations.

Obama's opinion is (or was as of last April) that we should limit major cost surgeries for the aged and chronically or terminally ill, BUT, if they have the money or their children or grandchildren are rich (like Obama) it is OK to pay for major cost items with private money! I AGREE!

He said it is NOT a "sustainable model" if paid for out of public money because, in Obama's words “The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total healh-care bill out here.”

Now, I assume Obama got that 80% number from some expert on health care. He is not an expert and would not have just made it up. I have heard that the current number is around 50% which means, on average, half of the money that will ever be spent on your health care is likely to be spent in the last year of your life! Of course, that is an average of those people who have very little spent on medical during the last year of their lives, the majority of people who have a moderate amount spent, and the relatively few people who have hundreds of thousands of dollars spent during that period. Perhaps the experts are projecting that, as health care technology advances further to the point where we can extend life indefinitely, the costs of care for the chronically and terminally ill will grow to 80% of the total. We should be spending our limited resources on preventitive care for the young, and on care that will restore health and vigor.

Regarding hip replacement for his terminally ill grandmother, Obama said “I would have paid out of pocket for that hip replacement just because she’s my grandmother.” (Obama's grandmother had her hip replacement mere WEEKS before she passed away - tragically just a couple days before her grandson won election to the highest office in the land).

Based on his statement that major expenditures for the chronically and terminally ill are not a "sustainable model" and that these costs could grow to 80% of the total, it would appear Obama favors some level of rationing of public-funded health care for those who are near the end of their lives.

UNLIKE SOME CONSERVATIVE TALKERS, I TOTALLY AGREE WITH OBAMA ON THIS ISSUE. DO YOU ???

For some reason, Obama and the proponents of the Congressional health care bills -and both the conservative and liberal press- have been absolutely silent on two key concepts:

• Comparative Effectiveness Research (CER), and


• Quality-Adjusted Life Years (QALY)

Have you heard either term and, if so, do you know what they mean?

They are discussed in a 2007 report from the Congressional Budget Office (during the Bush administration, so I am not making points againt the current administration): http://www.cbo.gov/ftpdocs/88xx/doc8891/12-18-ComparativeEffectiveness.pdf

Here are some key quotes from that report [emphasis added]:

More generally, the relative cost-effectiveness of treatment
options is clear when a less expensive treatment yields
comparable or superior health gains. In other cases, however,
determining whether the additional medical benefits
of a more expensive treatment warrant their added costs
is complex. Typically, the benefits of different treatments
are summarized as an increase in life expectancy or, more
commonly, as an increase in quality-adjusted life years
(QALYs) to account for effects on morbidity as well as
mortality. That calculation reflects estimates of how
much people value improving their health or avoiding
various side effects, which are combined to create a single
metric. By convention, cost-effectiveness analyses report
results as the cost per QALY gained, so a lower dollar
amount indicates a more cost-effective service. If that
metric is used to determine whether specific health procedures
are covered by an insurance program, choosing a
cost-effectiveness threshold can be a controversial
endeavor—but that need not be the manner in which
such research is applied.

A variety of evidence suggests that opportunities exist to
constrain health care costs both in the public programs
and in the rest of the health system without adverse
health consequences. Perhaps the most compelling evidence
of those opportunities involves the substantial geographic
differences in spending on health care—both
among countries and within the United States—which
do not translate into higher life expectancy or measured
improvements in other health statistics in the higherspending
regions. For example, Medicare’s costs per beneficiary
vary significantly among different regions of the
country, but much of the variation cannot be explained
by differences in the population, and the higher-spending
regions perform no better on available measures of average
health outcomes than the lower-spending regions do.

As applied in the health care sector, an analysis of comparative
effectiveness is simply a rigorous evaluation of
the impact of different options that are available for treating
a given medical condition for a particular set of
patients. Such a study may compare similar treatments,
such as competing drugs, or it may analyze very different
approaches, such as surgery and drug therapy. The analysis
may focus only on the relative medical benefits and
risks of each option, or it may also weigh both the costs
and the benefits of those options. In some cases, a given
treatment may prove to be more effective clinically or
more cost-effective for a broad range of patients, but frequently
a key issue is determining which specific types of
patients would benefit most from it. Related terms
include cost–benefit analysis, technology assessment, and
evidence-based medicine, although the latter concepts do
not ordinarily take costs into account.
Just last month President Obama gave a hint of his thinking when he said on ABC:



"What I've proposed is that we have a panel of medical experts that are making determinations about what protocols are appropriate for what diseases. There's going to be some disagreement, but if there's broad agreement that, in this situation the blue pill works better than the red pill, and it turns out the blue pills are half as expensive as the red pill, then we want to make sure that doctors and patients have that information available to them."



It is a pity Obama took the easiest case. The blue pill costs half as much and works better than the red pill. That is a "no-brainer" - use the less expensive AND more effective blue pill. But, what if the blue pill is only 90% as effective as the red pill but it costs 50% less? On the basis of CER and QALY, you would use the blue pill even if it is a bit less effective because, based on cost per QALY, the blue pill is much more cost-effective.



What do you think?

Ira Glickstein

PS: Yes, that is me pictured on the roof of our house. A couple days ago I screwed up the courage to go up and clear out some rain gutters that were full of leaves from the live oak tree in front of our home. This was the first time I've been on a roof in at least six years. In my younger days I was more happy using a ladder, going up on the roof of our two-story NY home many times. Of course, the hardest part is getting off the ladder onto the roof and, especially, off the roof and back onto the ladder. My dad, even in his senior years, had no trouble with ladders. I would watch in amazement and envy as he climbed them as if they were a set of stairs. He would step off and onto the ladder with absolutely no hesitation.