Hell if I should know

A Daily Dish reader describes a quandary.

How do we decongest our overcrowded and dangerous emergency departments?

I am a pediatric emergency room physician. The vast majority (statistics say about 75%) of our patients do not need to be in the emergency room. Ask anyone who does the job--we routinely see children for colds, for diaper rashes, even for pimples. I once treated a 6 year old girl for gum stuck in her hair, and last week I treated a teenager with a sore throat who had an appointment in 30 minutes with her doctor but couldn't wait that long.

[snip]

The problem is easily identified, but the solution is not. If we stop accepting everyone, chances increase that someone with a real emergency will be turned away by a secretary, a nurse, or by EMS personnel. As it stands, chances are increased that someone with a real emergency will be forced to wait too long to be seen as their condition worsens or that mistakes will be made because of the increasingly chaotic environment. Despite President Bush's statement 2 years ago that “people have access to health care in America, after all, you just go to an emergency room,” the system is completely overwhelmed.

The problem is due, in part to this: "The law (known as EMTALA) states that we must see everyone who presents to the department, regardless of the frivolousness of the complaint." The doc goes on the describe the merits of the law, but laments some of the consequences.

As a primary care physician, I have seen the tendency for patients to over-access the ED many, many times. I saw it in Manhattan, and I see it in Maine. I often see patients on follow-up from ED visits who went in for reasons that were clearly non-emergent, and I will talk with parents at night who are unwilling to wait until the next morning for an appointment. The ED is always open, and what's the down-side if you're not paying for the visit anyway?

As I have mentioned before, the tendency to over-access care is not limited to ED visits. I have patients whose parents bring them in for things that clearly do not need medical attention, or who aren't improving from their colds rapidly enough to suit them. ED visits are particularly costly, in part because (and this may be an unfair generalization, but it has been my experience) of a tendency by ED physicians to over-treat and over-test. Having to cough up some kind of payment tends to disincline people to access care they don't need, and I am moving more and more toward supporting a single-payer system that requires some kind of affordable co-pay (the cost of a pack of cigarettes seems reasonable). As draconian as that may seem, our current system is unsustainable.

Cornering the market on crazy

The Plank had not one but two delightful quotes today from our friends at The Corner. I don't read the National Review, because for all the amusement it might provide, I would also be at serious risk of having my head explode. (My friend and occasional fellow commenter Elizabeth has made this mistake occasionally, and has warned me that the effects on her blood pressure have been dire.) Thus, I am grateful to the good people at The New Republic for doing it for me. (Kudos for the award, guys!)

First, there was this:

It would be interesting to see the results of a more finely calibrated poll, one that compares how well-respected, competent, and effective the subject is perceived to be relative to similarly situated individuals. As a friend succinctly puts it, "When that big asteroid finally heads toward Earth, who's the person you'd most want to be in charge?" I suspect Cheney would score at or near the top.

Oh, goody. I love games like this. What if the Earth were invaded by aliens? (I vote Obama, what with his being a Vulcan and all.) What about aliens in pantsuits? (Clinton, natch.) But I disgress...

Seriously, I'm not sure who Peter Kirsanow is, or what goes on in his mind, but I'm pretty sure the uniform response of any person in charge if an asteroid heads toward Earth would be "blow that [one with carnal knowledge of mothers] up," regardless of political party. As amusing as he might find it to imagine Obama demanding that the asteroid be properly Mirandized, Mr. Kirsanow's ridiculous question is embarrassing, even for The Corner.

Luckily for Peter Kirsanow, Mitt Romney has done him a solid, and said something even stupider about Dick Cheney.

Vice President Cheney has been the target of every media, from mainstream to comic. But he spoke today as before without regard to the politics but with abiding respect for the truth. Barack Obama is still hanging on to the campaign trail. He said that the last thing he thinks about when he goes to sleep at night is keeping America safe. That's a big difference with Vice President Cheney—when it came to protecting Americans, he never went to sleep.

No sleep, huh? Maybe if he'd had a little shut-eye, he wouldn't have had all those heart attacks. (I treasure the mental image of Dick Cheney demanding that his eyes be prised open in defiance of the terrorists, a la A Clockwork Orange.) Yet, even sleep-deprived, he'd still blast the hell out of any meddlesome asteroids.

So, again, a tip of the hat to The Plank. In addition to its nice little recap of the Obama v. Cheney security speeches today, it's given me enough fodder to keep chuckling all night.

*cue muffled giggling*

Via TPM:

Adult film actress Stormy Daniels has officially announced that she has formed an exploratory committee for the 2010 Senate race, in which she is widely expected to run in the Republican primary against Sen. David Vitter -- the Christian right conservative whose career became mired in the D.C. Madam prostitution scandal of 2007.

[snip]

If she does run, Daniels' campaign would be widely viewed as an effort to remind the state's conservative voters about Vitter's own indiscretions.

Oh, Stormy. Stormy, Stormy, Stormy. The state's conservative voters know about Vitter's own indiscretions. They just don't care. I don't care all that much, though his rank hypocrisy rankles me a little. I am more concerned with his being a mouth-breathing, knuckle-dragging moron that his personal peccadilloes.

Then there is this from her press release:

I do not take this step lightly. While I have been humbled by the overwhelmingly positive response my potential candidacy has generated thus far, my decision to run for United States Senate will only be made after I have had the opportunity to discuss this prospect with as many people across the state as possible.

I suppose that peals of laughter are a happy sound, and could thus be mistaken for an "overwhelmingly positive response."

Honestly, the only think that clouds my mirth upon reading this is a creeping dread that this is being masterminded and bankrolled by some Democrat.

Failing marks for "uses time wisely"

Oy, vey.

Via Politico:

The Republican National Committee approved a resolution Wednesday calling on Democrats to “stop pushing our country toward socialism.”

The approved resolution was a watered-down version of a previous measure that referred to Democrats as the “Democrat Socialist Party.”

What did they call it, the "Neener, Neener, Neener" Resolution? Boys and girls, if your party is tanking pretty much across the board, maybe now is not the very best time for meaningless and juvenile rhetorical gestures.

And this is just rich:

“The Republican Party strongly believes that a government which spends without restraint, incurs record amounts of debt, owns banks and makes cars is not the right kind of ‘change’ America needs. Republicans are united in opposition to the destructive policies of the President and Congressional Democrats."

Let's just step back and look at that for a moment. The Democrats were not the party that went on a simultaneous orgy of tax cutting and deficit spending over the past several years, so the GOP can go back to buffing its glass house, as far as I'm concerned. Further, "owns banks and makes cars" is a particularly slanted take on "rescues large financial institutions and major parts of the manufacturing sector from failure."

Randy Pullen, the chairman on the Arizona Republican Party, told POLITICO that Steele’s position was supported by a number of committee members.

“That was the right thing to do,” Pullen said. “It does reflect the sentiment of the committee that Democrats are marching toward socialism.”

Look, Randy. (May I call you Randy?) The financial and auto industries were taking on a lot of water, and the government has been handing them large, costly buckets for the past several months. I'm not sure what your brilliant plan for rescuing the economy was, but I don't know if it counts as "marching toward socialism" if one is trying to keep the banking and auto industries solvent. When Obama has your farm seized, let me know, and I'll reconsider my position.

What HuffPo is good for

I like to make cracks about the Huffington Post, in large part because it's one-stop shopping for idiotic opinions offered with grave seriousness by famous people. However, I feel that it's only fair to point out that it's good for something.

It's good for keeping me informed about popular culture trends I can't be bothered to track otherwise.

Exhibit A is American Idol. I watched for the first season with some regularity, and then the bloom plopped unceremoniously off the rose and I haven't cared since. Apparently, it's still quite the television phenomenon, proving that celebrity insanity is a bankable commodity. And I guess they crowned this season's "winner" last night.

Let's get to it, shall we?

Kris Allen's smooth vocals and boy-next-door image propelled him to "American Idol" victory Wednesday, turning the theatrical powerhouse Adam Lambert into the most unlikely of also-rans.

"I'm sorry, I don't even know what to feel right now. This is crazy," said a stunned Allen, 23, of Conway, Ark.

As host Ryan Seacrest said in announcing the result of the viewer vote, "The underdog, the dark horse, comes back and wins the nation over."

I think I speak for much of "the nation" when I politely inquire, "who"? On the other hand, I am grateful to the Huffington Post for this article, as it would have been terribly embarrassing to have been won over without knowing it.

I also was particularly tickled by this:

Chris Daughtry and Jennifer Hudson, who finished fourth and seventh in their respective seasons, have gone on to huge success. As for "Idol" winners, they range from blockbuster artists like Carrie Underwood to the mostly under-the-radar Taylor Hicks.

I like that "under-the-radar." It's so much nicer than "thudding failure." From what I understand, and was able to observe from snippets of his performances while channel-surfing, a major flaw in Mr. Hicks's pursuit of a singing career is that he is lousy singer. (While lack of talent in one's chosen field is no guarantee of failure, neither is it a particularly helpful attribute.)

Earlier this week, Allen said he hoped the outcome wouldn't be decided by "having the Christian vote."

"I hope it has to do with your talent and the performance that you give and the package that you have. It's not about religion and all that kind of stuff," he said.

I'm tickled by how easily that quote could have been mistaken for a secret confession by Mitt Romney.

Finally, I am so very, very grateful to the HuffPo for filling me in on who won without my having to witness this:

Rod Stewart sang "Maggie May" after the male finalists opened for him with "Do Ya Think I'm Sexy."

No, Rod, I don't. And watching you singing it, with or without the male AI finalists, would probably make my eyes bleed.

For those of you oblivious to the ongoing juggernaut that is American Idol, you can now consider yourselves informed. Feel free to sink back into benign indifference.

Lars von Trier hates you

Breaking the Waves is one of those films that I don't inflict on many people, despite the fact that I happen to love it. Poor Emily Watson, in a wonderful performance, is put through such a painful and humiliating set of ordeals that, despite its redemptive ending (and you've got to wait for the very end to experience the redemption), it's incredibly difficult to watch.

I had no such love for Dancer in the Dark, von Trier's next cinematic offering. Bjork's tribulations are piled on to such an improbable degree that it strains credulity past the breaking point, and veers into the cartoonish. In addition, though we are clearly meant to view her as an innocent victim, her abject refusal to defend herself eventually makes her complicit in her own demise (and the pointless orphaning of her child). I also began to wonder if maybe von Trier liked being mean to women a wee bit too much.

With Dogville, it became apparent that Breaking the Waves was a one-off, and that I was destined to detest its director with ever-growing passion. In a kind of backhanded tribute to a film directed by a man who hates America without ever having bothered to visit, I decided to hate the film without bothering to see it. I don't think I missed much, since seeing Nicole Kidman put through the von Trier treatment didn't hold much appeal to me.

Today I learned (thanks to Chris Orr at The Plank) that von Trier is at it again, with a piece of cinematic excreta called Antichrist. It is, apparently, causing quite a stir at Cannes. For those of you curious to know why, you can search around in the embedded links above until you find out. For my part, my mother reads this blog, and I have no desire to inadvertantly put her off her dinner for the next week. (You're welcome.) The only thing I will add is that it sounds like The Joy of Sex, adapted for the big screen by Hannibal Lecter.

Taking it in his stride, von Trier had this to say about the reaction to his little film:

Booed at his own press conference and asked why he chose to make this film, von Trier waxed philosophical: “I never have a choice. It’s the hand of God. And I am the best film director in the world. I’m not sure if God is the best God in the world.”

I couldn't help but recall the thoughts of Michael Haneke, director of the similarly vile, hypocritical cinematic emetic Funny Games:

Are you prepared for the reaction to the movie here in America?
I hope that the slap in the face that I’m trying to give works here as well.

(I would like to thank the reviewer for the Houston Chronicle for the basic decency displayed in her review, thus sparing me the remote possibility of actually seeing it.)

So, Mr. von Trier and Mr. Haneke, consider this my big, fat middle finger, extended enthusiastically in your direction. If you both think that ugliness is the same as truth, and that provocation is the same thing as art, then heaven help you both. (We seem to have slid a long way from Keats.) For all its flaws, America is a better and more beautiful place than you understand, and its people are better on balance than I'd wager either of you are. That you are so smugly assured of your right to assault your audiences for their own good only serves to keep me out of them from here on out.

Oh, bra-VO Senate Democrats!

From Politico:

In a setback for President Barack Obama, Senate Democrats said Tuesday they will strip out $80 million in new funding in a wartime spending bill to begin the process of closing the Guantanamo detention facility.

The action comes as Senate Republicans have warned that they will offer an amendment to the same $91.3 billion measure barring the administration from relocating any of the detainees to American soil.

Pa. Thetic.

This whole meme about how the Guantanamo detainees are too dangerous to be held on US soil is so inane, I cannot believe that the Democrats are caving over it. (Note to self -- don't forget, this is the Democrats you're talking about.) The GOP makes it sound like the President is planning on releasing suspected terrorists to work at the Piercing Pagoda at a mall near you, and the majority party folds.

Well done, ladies and gentlemen. This bodes well for the upcoming Supreme Court confirmation fight. With backbone like this on display, I may as well start saying "Justice Gingrich" to get used to the sound of it.