Just Don't Ask...

Some will say this is an untimely posting, but so be it.  Strike while the iron is hot.

This week has been a tough week in Mississippi.  Two police officers were shot and killed in the line of duty.  A Mississippi firefighter died while on duty.  There was a loss of three teenagers in a motor vehicle crash near my hometown.  You'll note that us in the rescue field use the term "motor vehicle crash", as opposed to "accident".  Accidents, by nature, are things that cannot be prevented from happening.  Poor choices, inattention to surroundings, and a host of other factors, some singularly, others cascading together lead to bad outcomes.  Preventable outcomes.  Fall and break a leg on the ice in winter?  Bad outcome, not an accident.  But I'm not here to talk about accidents.

You see, anytime we work through a crash, a shooting, a heart attack, a house fire, or any other form of human tragedy that you can dream of, we're often asked to share information and details.  Most often times, the request comes from well-meaning, but ill-informed people.

Here's a tip:  Just don't ask.

Why? 

First, in most cases we're legally prohibited from telling you.  You know, that whole "patient privacy thing."  But first, put yourself in the other person's shoes.  Do you want us describing the efforts we used to resuscitate you, or how we had to pry your broken body from the car?  Or what it was like pulling you from a house fire?  Or how your spouse beat, stabbed, or shot you?  If you don't want those details of your life out there, then have respect for those we're called to help.

Secondly, your prayer chain doesn't need details in order to effectively pray for someone.  Did you see an ambulance at the neighbors?  Did you see a fire engine working through a road congested with inattentive drivers, headed to a growing column of smoke on the other side of town?  You can stop right there and pray for whoever is on the receiving end of that.  You can pray for the hands, hearts and minds of those delivering the aid.  It doesn't matter whether the smoke is just a pile of brush, or if that EMS crew is feverishly working against all odds to breathe life back into someone.  What matters is someone needs help.

Most importantly, we just don't want to talk about it.  Sure if it's a simple trash fire, then no big deal.  But if it's a really bad case, we're doing all we can to forget as much of it as possible.  The bad part is, we'll never forget it all.  We'll carry some image around, or some smell will linger in our nose, and it'll last even longer in our memories.  One day years from now we'll smell a similar smell, and it'll all come rushing back.  Firefighters, police officers, and EMS personnel on average, in one year's time, see the same amount of human tragedy that you'll see in an entire lifetime.  Think about that.  How many times in your life will an ambulance be at your house, or how many times will you call the fire department or the police department for an emergency?  How many deaths of very close friends or loved ones will you personally experience?  Or how many of those will die while you're pouring all of you energy into trying to keep them alive, even if just for a little while longer?  We see your entire lifetime's worth of tragic circumstances each year that we work.  We don't want to re-live those moments.  We get enough to keep us busy without telling the stories all over again.  Yeah we'll tell the stories amongst ourselves, but we're family like that.  It's hard to understand if you're not inside that circle.  Just trust me.

Before you say I'm going off half-cocked, which I probably am, just know that I believe God has a plan for each and every one of us.  I believe in prayer and what it does for us.  But I also know that a simple prayer is an effective prayer.  Have faith, practice faith, and live according to that faith.

But please, just don't ask us what happened.  I don't know how many fatalities I've worked in 30-ish years.  I don't care to know.  I remember a few, mostly those that presented the most difficult situations from a technical point of view.  I remember some that stuck with us for emotional reasons.  But for the most part, I don't remember the vast majority of them.  We get pretty good at building a huge mental wall to keep all that in a safe place.  Don't ask us to poke holes in the wall.

Post-script: If you're Fire, EMS, or Law Enforcement and need a safe place to let these stories out, find a peer counselor in your area.  A peer counselor is another firefighter, medic, or officer trained in critical incident stress management.  We get this training so we can help our brothers and sisters in this business.  We help the helpers, and we do it confidentially and without question.  We'll listen, we'll guide you, and if we think you need more help than we can offer, we'll get  you in contact with a mental health professional.  You're not crazy, you're normal.  We want to keep you normal.

Government Schools and Santa Letters...

The No. 1 Rule for dealing with media:  Never, ever argue with people who buy ink by the barrel.

Which brings us to The Enterprise-Tocsin of Indianola, Mississippi, and Lockard Elementary School in the same town, and the annual tradition of printing the letters of school children to Santa.

In today's edition (December 19, 2013), the year's collection of letters was printed along with the note you see above.

Santa Letters are fun because of the spelling and grammar used.  They reflect an innocence that is quickly being lost.  They represent the dreams and wishes of young children.  Santa Letters aren't intended to represent a school, or the school's academic standing (or lack thereof?). 

So, why were these Santa letters edited by the school?  Was a statement being made by editing these letters?  Who directed the editing?  What was the purpose for doing this?

Are school administrators trying to "put on airs" that the first- and second-grade students don't make spelling and grammatical errors in their writing? 

Is this a subliminal way of exercising government censorship over the children's writing?  Isn't that just what it is?  A public entity altered the printed word of civilians prior to release for publication.

What is going on here?

Handicapped?

To the two mouth-breathers at Wal-Mart today: A physical therapist and an EMT, both with many years of training and experience watched you walk halfway across the parking lot before you got in the two disability shopping carts. You had no physical deficiencies notable. We're reminded though, that mental issues aren't always visible. We hope you enjoyed the ride.

Help Replacing Batteries???

We recently purchased a Roku device for our television.  If you're not familiar with one, they connect your TV with your internet service, allowing you to stream services from Netflix, Amazon, Hulu, etc.  I've enjoyed having the device, because we're able to pick movies and a growing selection of television shows on-demand for free or using existing service subscriptions.  There's very little technical skill needed to set up the Roku; it is no more difficult than adding a laptop computer to your wireless network.

Today, I got the following email from Roku - just a regular customer-service type email.  Now, if one can't change the batteries without screwing up, how, exactly, did one get the thing connected in the first place???

I'm very concerned about the future of our country, and stuff like this confirms my fears.

Hi !

Next time you're ready to change the batteries in your Roku remote, we thought you'd appreciate a few good tips when it comes to battery handling.

Inserting batteries:

When inserting the included batteries, be sure to insert each battery, negative (-) side first, pushing into the coil and then into the compartment. Never insert batteries positive side first.

Replacing batteries:

Always replace dead batteries with two brand-new batteries from the same manufacturer. Never use damaged batteries. If your remote gets warm/hot during use, discontinue use and contact Roku Customer Support immediately at roku.com/support

Disposal of batteries:

Always dispose of batteries following federal guidelines or local ordinances. And while this one may surprise you — never dispose of used batteries in open fire!

Health Care Reform

This video comes from the Henry J. Kaiser Family Foundation, and outlines the coming health care reform (Obamacare).  Take a few moments and watch it.  The notes that follow are a collection of points I picked out of the video, along with my thoughts and impressions.  The comments section is open, so feel free to jump in with your views.

PHASE 1 - Now until 2014
1.  The government will stipulate how insurance companies spend the premiums collected.  If "too much" is spent on administrative costs and profit, then a rebate to the consumer will be required.  This raises several questions.  First, other than taxes levied, does the government have the constitutional authority to determine how private businesses spend their revenues?  Secondly, who makes the determination that "too much" was spent on administrative costs and/or profit?  What is the definition of "too much"?

2.  Under the new plans, "free services" will be offered by providers and insurance companies.  Certainly, if a service could be rendered at absolutely no cost to a provider, would not that provider already be delivering those services, in the interest of promoting better health to their customers?  We know this isn't the case, as personnel, utilities, and supplies have a cost to the provider.  Business cannot simply give away their product or services, without facing certain closure when funding from investors dries up.  Skilled personnel have, at personal expense, invested in their education and continued certification.  What right does society have to demand they share their skill without compensation?

3.  Medicare will provide greater coverage for medications.  Where does Medicare get its operating funds?  If greater coverage is planned, doesn't that necessitate an increase in funding?

4.  "Children" can remain on their parent's insurance until the age of 26.  I'm sorry, but once my children have graduated college and are on their own, they will be responsible for their own bills, and thus responsible for their own money management skills.  Additionally, by the time they're 26, if I'm retired, who's to say that I'll have the disposable income to continue to carry them on insurance?  This is passing the buck, and denies the opportunity to learn responsibility.

5.  Tax breaks will be given to businesses, presumably to encourage them to provide or expand health insurance coverage for their employees.  This isn't a bad idea, but wait...there's another point coming later.

6.  No lifetime limit on benefits.  This, again, is the government dictating business practices to the insurance companies.  Every insurance policy I've engaged represented a contractual relationship with the insurer.  Policy standards are communicated as part of that relationship.  If I have entered into a poor contract, then shame on me.  Certainly there is the need for consumer protection in cases that insurance companies don't live up to their end of the agreement.  It is incumbent on the buyer to fully understand the terms of the policy.

7.  No pre-existing conditions can be used to deny coverage for children.  As with the previous point, an insurance policy is a contract, negotiated by private entities.  This means the insurance company has the right to not offer coverage if a condition already exists.

8.  Those who can't get coverage due to pre-existing conditions or for being high-risk can get coverage from a government-run "high risk pool."  As with the expansion of Medicare/Medicaid, where will the funds come from to pay for this coverage?

PHASE 2 - Starting in 2014
1.  Medicaid will be expanded to cover all low-income people.  States currently budget huge sums of money to Medicare/Medicaid.  When new people come onto the rolls, where will the funds come from to provide coverage?  Will they come from other areas of state budgets (cuts to other agencies, programs)?  Or will there be tax increases?

2.  Depending on level of income, tax credits will be given to individuals who lose their job or are under-insured.  This, in effect, puts money back keeps money in the pockets of taxpayers, to use for purchasing insurance.  If we look to other programs that use tax credits to allow people to use their money to raise themselves to a better station in life, how many have actually done so?  Or have those dollars been used on frivolous purchases?  What causes us to think that history will not repeat itself?

3.  If you have no insurance, you'll be able to shop for insurance through an exchange.  This exchange will be set up and managed by the government.  Presumably, the exchange will be an open market (with government supervision) for you to get "fair" access to various policies.  The question for this:  does not the market currently provide for open shopping of policies?  It does, but it does so with relatively little influence (read: school-yard bully) from the government.  Having the government police, and possibly approve, the policies offered on the market is an effective limit to the market.

4.  The "no pre-existing conditions" provision for children will expand to include adults.  We've covered this previously.

5.  If you have no insurance, or choose not to have it, then you will be subject to paying a "fine" to the government.  One can only assume this is a form of revenue to offset costs associated with expanded coverage in other programs. (Side note:  how much will it cost just to administer all of this?  As opposed to what insurance company revenues are?  Something tells me the net cost of government administration will be greater than that of insurance profits annually.)

HOW TO PAY FOR IT ALL
1.  It is estimated this will cost $938 billion over a ten-year period.  In 1966 at its start, Medicare cost $3 billion.  Estimated costs by 1990, including adjustments for inflation, showed Medicare costing $12 billion.  In reality, the 1990 cost was $107 billion - almost 9 times more than estimated. (source link)

2.  "Savings", or ways for the government to spend less money on healthcare, will come from healthcare providers.  Most would use the term "indentured servitude" for this (working for free, or less).  While not supporting the history of indentured servitude, there was some exchange for services rendered, however paltry and unequal the payment was.  These "savings" are not defined in the video provided above, but the implication is there will be pressure from the government to providers to reduce costs.  Low-bid healthcare isn't something that thrills me as I grow older.

3.  Government will limit the escalation or rise in fees paid to providers and hospitals by Medicare/Medicaid.  Skilled and knowledgeable labor, and the technology they employ, will seek more lucrative markets for their trade.  They'll be replaced with less skilled, or less motivated personnel, and inferior or out-of-date technology.

4.  Government will "create experiments" to explore different ways to pay doctors/providers to be more efficient.  Again, what can the government do here that the market cannot do on its own?  When the government finds a solution that works in one area, they attempt to standardize that solution across a wide spectrum of issues and areas.  One size does not fit all, not in politics, nor in healthcare and the administration thereof.

5.  High income earners will pay higher Medicare taxes.  These taxes, as revenue, will be used (distributed) to those who fall under the newly-expanded Medicare/Medicaid coverages.  This is simply taking from those who have earned their pay, and passing it through to those who earn little or none.

6.  New taxes will be assessed against businesses and insurers that offer "high-end" insurance plans.  If we go back to Phase 1, point #5, this seems to punish the efforts that were supposedly encouraged by offering a tax break so businesses could offer better plans.  It is a classic "catch-22" where the government gives you a tax break to offer your employees more, then tax you for offering them more.

7.  Tax on those using tanning beds?  I'm at a loss.  The Fourteenth Amendment to the U.S. Constitution dictates that "no State...shall deny to any person within its jurisdiction the equal protection of the laws."  Obviously the use of a tanning bed is a decision, and not a required activity.  However, taxing one small portion of the citizenry for engaging in a private activity?

Holiday slide....

The EMT babies are halfway through their two nights' worth of final examinations.  Having passed their comprehensive written test, they'll be challenged to prove themselves with hands-on skills testing later this week.  They'll get their certificates, and we'll all go out somewhere to celebrate their entrance into the world of emergency medicine.  In a few short months they've gone from knowing relatively little about about emergency medical care, to knowing just enough to get in the back of an ambulance.  That's where their career-long path of continuous learning will start.  Textbook patients are just that - "textbook normal".  Real-world patients are anything but "normal".  Best of luck to the students.  I hope they keep an open mind, always ready to learn.  Hopefully they'll take to the net, and learn from some great bloggers like The EMT Spot, Notes from Mosquito Hill, Paramedicine 101, The Happy Medic, Insomniac Medic, Hybrid Medic, and Rescuing Providence, just to name a few of the ones I read.  Another great blog comes from a police officer across the big pond in England, Minimum Cover.  Minimum Cover hits hard sometimes, this post and this post are especially important for those in the medical world.

For me...just fast-forward to New Year's.  Or better yet, spring.  A tip-o-the-hat to EDNurseasauras for her post on Christmas annoyances.  So "bah-humbug", let me get through the next few weeks and I'll be better.  Don't get me wrong, I love seeing the kids have fun through Christmas.  Wouldn't trade it for anything.  I detest all the artificial pomp of the season though.  And it's cold in the Delta.  Cold and wet, at the same time.  Eeech...bring forth spring!

U.S. Representative Hank Johnson from Georgia's 4th Congressional District.  The esteemed Congressman Johnson is questioning a US Navy Admiral about excessive troops being stationed on the island of Guam.  Listen carefully, especially to his question at about 1:20 on the video timer.



All I can say is the admiral has way more "cool" than I would have had in the same circumstance.  And that I'm SO glad that Mississippi didn't send this guy to Washington!

Government

I have a set of skills, that through some negotiation, have been determined valuable to the State of Mississippi, and in trade for me supplying those skills, the state compensates me for my time, effort, and expertise.  Fair trade in my book.  I'm satisfied with what they pay me, and apparently they're satisfied with my work.  We're both happy.

Now let's consider a smart, highly intelligent person, who decided to challenge themselves to the long months and years of medical school.  They invested their own monies (borrowed probably from family, sometimes through student loans to be paid back) and sacrificed a long portion of their lives to gain a highly valuable skill - the ability to offer a healing hand to the sick and injured.  As a patient, I recognize both my need for the physician's skills, and I agree to pay them for their time, their effort, and their expertise.  Again, a fair trade in my book.  If at any time I don't like it, I am free to find another physician.  If I've chosen live my life in a manner that brings me the rewards offered in a free market environment (getting paid for what I can do for someone else), maybe I'm able to pay my physician directly.  Perhaps I've also chosen to watch after my own health, monitor my diet, exercise, be proactive in being educated about my own health and limit the time I spend seeking the counsel of my doctor, I can save money over the long term.  And on the outside chance that I suffer a devastating illness, I chose to enter into a private contract with a firm that is in mutual contract with other individuals, who pay a small fee to the company to invest.  Should I ever need to exercise the contract (insurance) then I will be paid from those investments.  I know what that insurance contract will cover, and what it will not.  Again, a pre-arranged business contract; I pay for a service.  Simple.

Now.....

WHAT IN THE WORLD leads ANYONE to think that because they've chosen not to gain marketable job skills, and don't give a flying darn about their own general health....WHAT DO THEY THINK gives them the RIGHT to tap into MY pocket to fund THEIR health care?  WHAT DO THEY THINK gives them the RIGHT to demand the physician to GIVE them what he's worked so hard to develop into a MARKETABLE job skill????

If you chose a poor health lifestyle, you get heart disease, you get diabetes, you toast your liver from alcohol abuse, you get lung cancer from chain smoking.  Those were your CHOICES.

Because of your poor choices, you're expecting me to fork over more taxes, and because you want insurance to pay for pre-existing conditions, they'll raise their rates to match the looming payouts.  More money out of my pocket. 

If you came to my house, broke in, and demanded money from me, you would be arrested for a crime.

But now you reach into my pocket, but with the backing of government.  Without my consent!

Project 365/69

A few months ago, I wrote about wasting good tax dollars when the US Postal Service sent me a letter, telling me they were going to send me another letter in a few days.

This week, I received another letter, this time from the US Census Bureau, informing me that in a few days, I would be receiving my census packet in the mail.  I have one question.....WHY??

Another blogger did some calculating, and while I cannot verify his estimates, he postulates that it cost you and I an easy $42 million to send us these advance letters.

A reader left the following comment on a news website:

Our government spends huge sums over our money on an add campaign to solicit us to fill out a census so the government can give our communities back huge sums of our money that it has taken from us at the point of a gun. They call it getting "our fair share". How about just let us keep our money.

And furthermore, the letter uses the phrase "fair share" twice when talking about government funds for roads, schools, and other programs.  I thought the Constitutional basis for the decennial census was for the apportionment of Representatives and direct taxes...nothing was mentioned about "helping each community get its fair share of government funds."

Thoughts on Taxation

I'm working on my taxes.  It seems that every year, I get more and more frustrated when I consider just how much I pay in taxes at many different levels (income, sales, property, etc).  It's probably a good thing that I don't really know how much of my income is spent in taxes alone.

In 2008 we saw the rise of the TEA Party - for Taxed Enough Already.  I agree with their basic premise, but really haven't looked deeply into everything they stand for.  But after today, I may be looking more closely.  I added a $16 interest earning to my tax calculator, and my tax bill went UP by $7.00!  Dangit!  Almost half of the little sixteen dollars earned in interest is going to the government!

What's the point?  Heck, I'd come out better closing my accounts and keeping my money in a sock under the mattress!!!!!

I've never used this forum to promote a political agenda.  But let me encourage you to look at the FairTax initiative outlined on their website and here.  Basically it calls for the elimination of ALL federal income taxes (direct income, capital gains, etc.) and replace it with a national sales tax.  That means you take home ALL of your paycheck, put it in the bank and let it set.  The you pay taxes on any goods or services you purchase.  Taxes paid on certain household necessities would be returned to you, the taxpayer, thus making their purchases tax-exempt.  You pay taxes based on your purchasing habits, nothing more.

Instead of a huge government determining how much it "needs" each year, and adjusting tax rates accordingly, the FairTax plan puts me and you in charge of how much we "give" the government.

Just a rant....I'm still peeved about losing $7, almost half of the interest earned on a little bank account.  I guess I'm one of those "dirty rich" folks who have can "afford" to "pay some back" to society.

A Rant...

You know I work for the government, and while the institution of government isn't known for its frugality, most everyone that I work with tries to be conservative when it comes to spending your tax dollars.

However, there are the occasional times when one is driven to contemplate how vast the government's reserves of extra cash must be, or how deep the depth of credit (debt) is.

Last week, I received a little postcard in the mail. It was from the United States Postal Service, and it was signed by Delores J. Killette, Vice President & Consumer Advocate. Ms. Killette was writing to inform me that she would soon be sending me a customer satisfaction survey, and emplored me to participate in the survey in order that the USPS could better service me. How nice, a piece of mail to tell me I would be getting more mail.

Well as expected, a few days later, the eagerly-awaited Customer Satisfaction Survey, complete with USPS logo and Ms Killette's signature arrived. My sheer joy was indescribable, as I'm not still yet certain whether I was happier in receiving the aforementioned mail, or in quickly and decisively placing it in the proper receptacle conveniently located beside my desk.

Now imagine the inexplicable degree of pleasure that was mine today as I opened my mailbox to find yet another postcard from Ms. Killette! If I didn't know better, I'd think she may secretly like me...three pieces of mail in a week's time? Therapist won't be too happy when she finds out I've been getting mail from Ms. Killette on such a regular basis. But alas, my ill-conceived fancies were dashed when I found that Ms. Killette was taking this occasion only to remind me that she had sent me the survey, and truly wished that I would return it forthwith.

So, being the good steward that I am of you tax dollars, I quickly retrieved the previously discarded survey from the waste receptacle, for I was now indeed curious! The Vice President and Consumer Advocate of the United States Postal Service had taken time out of her hectic schedule to mail me announcing the expectation of a survey, then she mailed me the survey, then mailed me yet a third time to tell me she had indeed sent the survey. Ahh but now my keen eye noticed a pattern here...something was amiss! I had carelessly discarded the first postcard, but the survey itself, and the second postcard contained a curious mark in the upper right corner. It says "PRESORTED FIRST-CLASS MAIL POSTAGE & FEES PAID USPS PERMIT NO. G-10." Did the U.S. Postal Service pay itself to send its own mail? Please tell me it didn't?!?!

On with the story... Enclosed in the survey envelope was, as expected, the survey and a reply envelope addressed to The Gallup Organization. Hmm, so the USPS has contracted Gallup to gather data about itself. But wait - this envelope is marked differently! It says "NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES," and in smaller print "POSTAGE WILL BE PAID BY THE UNITED STATES POSTAL SERVICE."

Now by my calculations, dear friends, for us mere mortals to send four pieces of mail would cost $1.76 in U.S. currency. And the Postal Service is asking me to tell them how I think they're doing??? They "paid themselves" to send mail - the only courier service in the United States that is authorized to deliver first-class mail to your mailbox paid themselves to do just that?

Well, here is my analysis:

• The Postal Service has a very unique business model. While other competitors in the parcel/package market (UPS, FedEx, DHL, etc) can guarantee you shipment on a a certain date, the USPS will only give you a range of possible delivery dates. Obviously, those who are shipping time-sensitive materials will naturally drift to the private carriers who offer timed delivery guarantees, even though at a higher price. Noting the flight of customers, the USPS responds not by assuring better delivery times...no...they instead raise their shipping rates on a regular basis to offset the decreased revenue. So for all you future business leaders out there, if your competitor is doing better than you are in the service market, don't worry, just raise your consumer pricing.
• I pay around $30 each month for internet service, including email access. I have around 300 contacts in my email address book, which means if I emailed every one of them once a month, it would cost me 10 cents per email, which is 34 cents cheaper than the old-fashioned, but often nostalgic letter-writing method of communicating. Naturally, I don't email all 300 people every month; there are probably 50 that I email occasionally, and of those, about 20 that probably get tired of getting emails from me. Although I haven't worked out the cost per email, it is still cheaper than the regular mail system, and I know almost instantly (or within a few hours for reply) that the email was delivered.
• I have my salary deposited electronically by my employer, thus saving postage in delivering my check to me. I also pay the vast majority of my bills electronically, thus saving postage for both the bill itself, and my payment reply mail. A double-savings, if you will. A result of this? I receive practically NO mail at my house, except for those completely unsolicited advertisements that seem to come weekly, offering to sell me things that I have no interest in. If I want to know about your product and/or service, I have the internet that I already mentioned.

If the Postal Service wishes to know how good of a job they're doing, why not take a look at the decline in use of the postal system for personal communications and time-sensitive business communications? Why not take a look at their business model? And since we're on a rant about government spending (how many of you got these same cards and letters from Ms. Killette?), why not just scrap the USPS completely? Take the annual USPS budget and subsidize internet access and email for everyone in the nation, complete with electronic banking and bill-paying? That would certainly cut down on the consumption of paper (environmentally friendly!), and would give our nation a boost of computer skills (as well as create a whole new job market for technical support hotlines.)

I'm sorry, but if you have to send me 3 pieces of mail to alert me to a survey, you're doing something wrong. And finally, the survey even has an option for me to go online to complete it! Why didn't Ms. Killette just say that in her first postcard??

**Note: I have two beloved relatives who are retired from the U.S. Postal Service, and this rant is in no way meant to disparage their many years of service. I remember those days, when stamps were 18 cents!**