Monday, September 15, 2014


Those who know and/or follow me or my wife on Facebook, Twitter etc., know that we were opposed to the recent Amendment 1 or the so-called "Right-to-Farm" amendment to the Missouri Constitution.

It was extremely close. In fact so close that a recount was conducted. But as usually happens, the outcome did not change. The Amendment passed by a narrow 2,500 votes or so. This in a state of perhaps 4 million voters.

OK, we lost. Life doesn't always turn out like we want nor is it fair.

I hope in the future, our legislature (Bob Dixon, Eric Burlison?) can change the way these things are presented, proposed and passed. They need to set a higher bar. We amended our State Constitution with just under 25% of registered voters actually voting.

By comparison, our U.S. Constitution (Article 5) has a much tougher road to be amended. First it takes a 2/3rds majority in Congress OR 2/3rds of ALL State legislatures to call for a Constitutional Convention just to get an Amendment underway.

Then if it makes it through one of the above, 38 our of our 50 States must ratify the Amendment. I can't seem to find if this State ratification stage takes only a simple majority or more but regardless, this is a much more rigorous process than simply getting something on a ballot and voting for it.

Maybe next time.

Thursday, September 4, 2014

What's wrong with emergency care?

I had an all-night experience in a local emergency room with my daughter - nothing life-threatening and she's fine.

 We arrived at the ER at approximately 11 PM. The place was packed. It didn't take as long to get checked in but then another couple of hours before anyone was even able to take vital signs. These were  done in one of the so-called triage rooms with a nurse.

About six hours later I went to the front desk and ask where we might be because by then the emergency room had begun to clear out considerably and there wasn't a lot of activity

From my vantage point I could not tell if there were ambulances coming on a regular basis bringing additional patients. These would obviously have critical needs and folks arriving that I could not see.

I did hear one helicopter land on the roof above us.

I approached the desk around 5 AM after having sat for 6+ hours I was told, we were next in line once a room in the back became available.

90 minutes later we were finally taken to one of these rooms. 45 minutes after that a doctor finally arrives. At this point things moved fairly quickly, although the doctor did get called out very early to deal with another patient and it was a while before she came back. To her credit she took time with Anna and paid attention to her. I can't fault her in any way.

On a trip across the ER looking for a restroom I noticed a sign-in board labeled "East Team" where all the nurses and staff were listed and at the top, the names of two doctors. Since the ER was laid out in a certain way I assume there was an east and a west side. We were on the west.

There appeared to be at least 35 of these rooms (by their identifying numbers) with beds that patients were checked into. There could have been more but we were in 34. 35 was right next door to us.

Do the math and you realize that one doctor would be taking care of somewhere at least eight patients simultaneously on an ongoing basis.

I have no idea what traditional numbers are across the nation at ERs but this seems like a pretty high ratio. Given that we waited 7 1/2 hours before we even got to a room and another 45 minutes to see a doctor, I have to conclude that this is part of the reason for the long lengthy wait.

I realize they can't predict how many patients nor the severity and type of injuries etc. that will arrive on a given evening but I'll bet they have enough data to predict fairly well what is likely to happen.

We got a real doctor. She seemed 30-ish, professional. In the past we have sometimes been attended to by PAs and DOs (no offense to either of them!). But what ever they are, and whatever they cost, why just four doctors on a busy weekday evening? Cost-cutting? Cost-savings?

I'll admit a large portion of the ER crowd last night were probably using it as their primary care because they can. And they are willing to wait hours for whatever care they might receive. Another contingent looked like the typical homeless population. Every few minutes a young orderly or nurse would walk amongst us and call out a name or two. Often they got no response.

Patti shared a story today about someone she met who was in a similar situation but decided not to wait. His bill was still $800! Is that crazy, or what? I was tempted to leave many times but figured Anna's little plastic bracelet could be an expensive one. Probably still will be!

This is a large not-for-profit hospital. I can not imagine the scenarios when the ACA kicks in full-bore and even more folks show up at the ER. If, and this is an unproven and big if, IF having more folks insured, keeps them OUT of the ER and showing up during regular hours and regular clinics and offices so the truly critical and injured can more quickly receive trauma care, then one part of the ACA will be working right. But I fear we'll only see longer waits. If the hospital has only enough financial incentive now to put (by my count) 4 docs on the ER, what's going to happen when they lose some of that incentive? 

The ER was freezing. But at least the hospital had a stash of blankets. If this keeps up, they are going to need cots and beds for people to overnite. Let me tell you, spending 7 & 1/2 hours trying to make a chair comfortable, is a tall order! My comfy bed awaits!

Monday, September 1, 2014

A Syria(us) Strategy for ISIS

Much has been made about Obama's so-called "lack of strategy" for what we should do in northern Iraq, Syria, etc. about ISIS.

I am no foreign policy wonk but here's my simplistic idea in three parts:

1 - We DO make a deal with Assad but it involves him stepping aside, leaving the country, turning over every last shred of chemical or any other WMD he might have. War crimes trials are possible.

2 - IN EXCHANGE we promise to obliterate ISIS from Syria and Iraq. This could stop the civil war that has claimed way too many lives in Syria and allow the millions of refugees to return (to what's left of) home.

3 - We will work with our allies to help establish some type of valid representative government in Syria to avoid a vacuum etc. We have to realize this might not be a democracy as we know and love them. Use whatever lessons we learned from Iraq and apply to Syria.

Finally and this is a bonus part. We also help establish a Kurdish nation in exchange for their help with removing any vestiges of ISIS, protection and movement of refugees off ALL faiths, protecting Iraq's northern oil supplies etc.

This would mean a massive air strike and no doubt some ground troops. But we don't go it alone. I think other countries would get on board and most Americans would like to see the Syrian crisis end.