Rationing health care in a disaster

DALLAS MORNING NEWS If you read one article health care-related this week, make it this extraordinary Sheri Fink/NY Times Magazine article on the impossible choices that the heroic doctors — including Dr. Anna Pou — faced at the former Memorial Medical Center in New Orleans in rationing limited medical and evacuation services for their patients during the chaotic aftermath of Hurricane Katrina.

Ms. Fink summarizes the issues raised by the issues that Dr. Pou and her colleagues well:

The story of Memorial Medical Center raises other questions:

Which patients should get a share of limited resources, and who decides?

What does it mean to do the greatest good for the greatest number, and does that end justify all means?

Where is the line between appropriate comfort care and mercy killing?

How, if at all, should doctors and nurses be held accountable for their actions in the most desperate of circumstances, especially when their government fails them?

Interestingly, after the federal, state and local governments largely failed the doctors, other workers and patients at Memorial in the aftermath of Katrina, get a load of how the government forces acted once the decision was made to arrest Dr. Pou:

AT ABOUT 9 P.M. on July 17, 2006 — nearly a year after floodwaters from Katrina swamped Memorial hospital — Pou opened the door of her home to find state and federal agents, clad in body armor and carrying weapons. They told her they had a warrant for her arrest on four counts of principal to second-degree murder.

Pou was wearing rumpled surgical scrubs from several hours of surgery she performed earlier in the day. She knew she was a target of the investigation, but her lawyer thought he had assurance that she could surrender voluntarily. “What about my patients?” she asked reflexively. An agent suggested that Pou call a colleague to take over their care. She was allowed to freshen up and then was read her rights, handcuffed and ultimately driven to the Orleans Parish jail.  .   .   .

Read the entire article. Whose judgment do you trust more? Dr. Pou and her colleagues? Or that of those governmental officials who decided to arrest her?

Hitchens lays the wood to an apologist for Islamic jihad

Christopher Hitchens at his best (H/T Reuben Moore).

The Five Minute University

Food for thought from Father Guido Sarducci to collegians starting the new school year.

A real head scratcher

James Davis The Stanford Financial Group scandal has been anything but typical, but yesterday’s developments may have been the most bizarre yet.

The big news, other than the hospitalization of R. Allen Stanford, was the guilty plea that Stanford’s right-hand man and long-time friend, James Davis, entered in connection with a plea bargain that he worked out with federal prosecutors.

The background section of the plea deal makes for some entertaining reading (bribes to, and a blood oath with, an Antiguan bank regulator?). But the more interesting aspect is that Davis’ plea is the latest chapter in a most curious defense strategy.

From almost the outset of the Stanford Financial scandal, Davis’ attorney — Dallas-based attorney David Finn — has been telling any media outlet that was willing to quote him that his client was guilty of a huge fraud on Stanford investors and that Davis was going to plead guilty to charges as soon as he could work out details of a plea deal with federal prosecutors. Even the most rabid prosecutors would never risk making such public statements, so effectively Finn has been doing much of the prosecutors’ public relations work for them.

And now we finally know the terms of the plea deal between the prosecutors and Davis.

On one hand, David pled guilty “in exchange for” a Level 43 under the Sentencing Guidelines (reduced from a Level 46 — do the Sentencing Guidelines even go up that high?!) “with acceptance” deal. Based on my understanding, that means that Davis has agreed to a prison sentence of 30 years to life. Davis is 60, so assuming that he gets the full benefit of the the traditional 1/3rd off under the guidelines for being a good snitch (no cinch bet in Judge Hittner’s court), Davis will do 20 years and be 80 by the time he shuffles out of prison.

On the other hand, the prosecution "gets” Davis as their primary witness, who — according to the prosecution’s own theory of the case — was one of the key participants in a six billion dollar scam from the beginning. If, as prosecutors alleged during the hearing, Stanford Financial was a “giant house of cards," then why cut a “deal” with the guy who was one of the lead architects of the scam?

Well, we now have the answer to that question. The plea deal is not a "deal" at all. It’s total surrender.

Davis is reportedly working as a day laborer at $10 per hour to pay his legal fees. From the looks of it, he is getting the quality of representation that he is currently capable of paying for.

Ali and Arnie

Ali The Observer provides this entertaining compilation of quotes from Muhammad Ali, who just turned 67. My two favorites:

On his Parkinson’s disease: "It wasn’t the boxing, it was the autographs." (2003)

On his biggest battle: "My toughest fight was with my first wife." (1967)

Arnold Palmer And don’t miss this Tom Callahan/Golf Digest piece on Arnold Palmer, who turns 80 on September 10th. Palmer’s old friend, Dow Finsterwald, makes an interesting observation about Palmer that some current Tour pros should take to heart:

"But the thing Arnie and I truly had in common, the thing both of us enjoyed most of all, was playing golf. That may sound funny, but you’d be surprised how many good players, how many pros, weren’t able to enjoy it nearly as much as we did. To us it was an avocation as well as a vocation. I think of him as the greatest amateur-professional who ever lived. By that I mean he never stopped playing the game for the love of it, like an amateur. Sure, he liked making a nice living. But he loved to play. Still does."

Re-tracing Graham Greene’s journey across Mexico

The Lawless Roads In the first of a series of upcoming blog posts that will interest most Texans, The Atlantic‘s Graeme Wood addresses many of the difficult issues facing Mexico that have been a frequent topic on this blog. Wood is re-tracing the journey across Mexico of Graham Greene of The Lawless Roads fame seventy years ago:

Seventy years ago, Graham Greene crossed the US-Mexican border into a land blighted by violence, unrest, insurgency, and religious and counter-religious mayhem. If he came back today he would find a country riven by other forces, but in some ways just as chaotic, and just as worthy of the title he gave his account of the journey, The Lawless Roads.

The news out of Mexico is all bad. When I was a kid, my parents and I went across the border at Reynosa, Matamoros, and Tijuana to take awkwardly posed photos on the backs of burros, buy cheap Kahlúa, and eat frog-legs at Garcia’s. Now the drug war has re-ignited, the rules of engagement between police and crime syndicates have changed, and the environment has become more savage. The government of Felipe Calderon has challenged the narco-traffickers and has militarized the border. Garcia’s is still open, but tourists have vanished. College kids don’t head down here from South Padre so much, which is a good indicator of the downturn, because they are college students, and that Kahlúa was awfully cheap. There are serious questions of whether Mexico is becoming that scariest of things, a military state in only partial control — i.e., a Latin American Pakistan.

Only some of the drama is on the border. Greene’s trip through Mexico crossed the country on its long axis and reported how Mexicans were dealing with the effects of the Cristero War, its violent suppression of the Catholic church, and the armed discontent that suppression sparked. Over the next cycle of posts, I will steer my rented Mexican Ford (an inglorious chariot that feels like it would crumple like a soda can, if I were to give it a bear-hug) along Greene’s path, with deviations, to see whether that lawlessness is a permanent condition.

Amazingly bad decision-making

ashby-highrise-renderingOne fringe benefit of economic downturns is that local public officials generally defer their financial decisions, which tend to be uniformly bad even during good economic times.

Except apparently in Houston.

Over the past few days, Houstonians have been bombarded with a flurry of bad decisions by their public officials, who seem undeterred by the growing consensus that the nation is going through the worst economic recession since the Great Depression of the 1930’s.

First, as Kevin Whited notes, the City of Houston publicly announced this past Friday that it had removed the final local regulatory roadblocks to the construction of the long-delayed Ashby high-rise condominium project in a tony residential subdivision near the Texas Medical Center. In so doing, the City forgot to tell the news to the most interested people, namely the owners of the property where the project is to be built.

At any rate, the City’s announcement ended an egregious example of local governmental interference with productive development of private property. Of course, in the present climate for financing high-rise condos, the chances of the owners being able to revive the project any time soon are about as good as the Stros’ chances of leaping into World Series contention.

Thus, rather than having dozens of wealthy condo owners paying substantial amounts of property taxes and for other City services, the City continues to enjoy the “benefit” of a run-down apartment complex on the property where the Ashby high-rise was to be built.

So, not only did the City fail to take advantage of the opportunity to increase its tax base through re-development of the Ashby high-rise site, it benefited the owners of the site by deterring them from taking the financial risk that would have generated that financial boon to the City.

Now, that type of government mismanagement really takes some effort.

Meanwhile, as if trying to one-up the City’s bungling of the Ashby high-rise deal, local governmental officials were reported on Monday to be on the “home stretch” of putting together a financing package for construction of a new downtown soccer stadium, a new jail facility and the redevelopment of the Astrodome.

I mean, really. Where to start?

As noted many times, the City has already paid millions at a top-of-the-market price for the site of the proposed soccer stadium while at least maintaining that it’s up to the owners of the Dynamo soccer club to put together the private financing for the construction of the stadium itself.

Now, the City is going to finance the construction of the soccer stadium itself through selling TIRZ bonds? When did the prior approach change? Did I miss something?

Similarly, there’s not much left to say about the City and the County governments’ reprehensible handing of the Harris County and City jails, both of which have both been condemned by the Department of Justice because of their horrific condition and mismanagement (the latest on the City jail conditions is here).

It’s clear that the true problem of the existing jails is a combination of underfunding and needless overcrowding from sloppy processing of prisoners who do not need to be incarcerated pending their trial. So, what do local governmental officials do? Wait until the conditions become so barbaric that all they can do is throw tens of millions of dollars (perhaps illegally?) at constructing yet another jail facility in an attempt to placate federal officials.

But both the proposed soccer stadium and jail facility pale in comparison to the potential boondoggle that is the Astrodome redevelopment project.

After years of assuring local citizens that they would not be called upon to pick up the financing of redeveloping the Dome, local governmental officials are now proposing that the citizens do just that.

And as if to make that change of policy even more galling, the governmental officials who leaked the information on the financing plans to the Chronicle did not even bother to spell out what the Dome is to be turned into as a result of the redevelopment.

So much for transparency, eh?

In the meantime, as City and County officials dither over the details of these proposed boondoggles, City officials continue to ignore this ticking financial time bomb (see also here) while wasting billions on yet another boondoggle, the spending on which swamps even the quarter of a billion proposed for the current round of boondoggles.

Frankly, it’s difficult to imagine how even the traditionally resilient Houston economy is going to withstand the dead weight of such pervasive financial mismanagement.

Stros 2009 Season Review, Part Three

Drayton McLane2 Given the inexplicable popularity of NFL football practice in these parts, who cares about Major League Baseball anymore, anyway?

As expected, the Stros (59-62) faded into obscurity during the third quarter of the 2009 season, going 19-21 during that stretch. Although the mainstream media reported mainly that the Stros fell apart during the third quarter, the truth is that they did not play all that much different from the first two quarters of the season (18-22; 23-19). The 2009 Stros simply is not — and never has been — a good baseball team.

Reviewing basic productivity statistics reflects what happened to the Stros during the third quarter of the season. As regular readers of this blog know, the RCAA ("runs created against average") and RSAA ("runs saved against average") statistics, developed by Lee Sinins for his Sabermetric Baseball Encyclopedia, provide a simple but revealing benchmark of how an MLB player or MLB team is performing during the long MLB season.

RCAA reflects how many more (or fewer) runs that a player generates relative to a league-average player (an exactly league-average player’s RCAA is zero).

Similarly, RSAA measures how many more (or fewer) runs that a pitcher saves relative to a league-average pitcher (an exactly league-average pitcher RSAA is zero).

Thus, a club’s positive RCAA number reflects how many more runs a club’s hitters are generating relative to what a league-average club would generate using the same number of outs. Likewise, a club’s positive RSAA number reflects how many more runs the club’s pitching staff is saving relative to what a league-average pitching staff would prevent in the same number of innings. Negative RCAA and RSAA numbers are just the opposite. A negative RCAA reflects how many fewer runs a club’s hitters are generating relative to a league-average club and a negative RSAA indicates how many more runs a pitching staff is giving up in comparison to a league-average staff.

As a result, good teams generally have a positive net RCAA/RSAA figure, while bad teams tend to have a negative net RCAA/RSAA statistic. Occasionally, a good team will have a high RSAA statistic and a negative RCAA figure (i.e., the Stros’ 2005 World Series team), but it’s almost never the case that a good team will have a high RCAA and a substantially negative RSAA. In other words, you can win with really good pitching and poor hitting, but it’s hard to win consistently with really good hitting if your pitching is poor.

The following charts shows the NL Central clubs’ net RCAA/RSAA figure at the All-Star break and after the third quarter of the 2009 season, along with their current percentage chance of making the playoffs, as calculated by Coolstandings.com:

Through 2nd Quarter

Team

RCAA

RSAA

Net

Record

% Playoffs

Cardinals

10

36

46

49-42

45.5 %

Brewers

45

-45

0

45-43

25.4 %

Stros

12

-17

-5

44-44

11.0 %

Cubs

-36

35

-1

43-43

19.7 %

Reds

-68

29

-39

42-45

3.9 %

Pirates

-14

-8

-22

38-50

4.4
%

 

 Through 3rd Quarter

Team
RCAA
RSAA Net Record % Playoffs
Cards 43 33 76 70-53 87.0
Cubs -33 57 24 61-58 16.5
Brewers 52 -89 -37 58-62 0.9
Stros 2 -60 -58 59-62 0.3
Reds -78 -21 -99 51-69 <0.1
Pirates -39 -43 -82 49-70 <0.1

As you can see, the Stros were muddling around with a .500 record based on slightly above-average hitting and slightly below-average pitching as of All-Star break. However, the Stros pitching fell apart during third quarter, saving an astounding 43 fewer runs during that 40-game stretch than a National League-average pitching staff would have saved over those games. Combine that with a downturn in hitting resulting from a DL stint by slugger 1B Lance Berkman and slumps from regular players such as SS Miguel Tejada and RF Hunter Pence, along with the Cardinals’ upsurge in hitting primarily from the acquisition of Matt Holliday, and it’s not surprising that the Stros are 10 games out of first place in the NL Central.

As noted in the preview of the 2009 Stros back in April, this performance level was easily predictable given what Baseball Prospectus has dubbed the "stars-and-scrubs" Stros roster. Frankly, the Stros are an organization playing out a weak hand while attempting to deal with the long-overdue rebuilding program that has became necessary — but was generally ignored — during the final years of the Biggio-Bagwell era. GM Ed Wade has just completed his second straight strong draft in terms of numbers (36 out of 51 drafted players signed), so the rebuilding program is in full swing. But it’s going to take another 2-3 years before any appreciable amount of that investment begins to payoff at the MLB level.

So, hang in there, Stros followers. In the meantime, please pray that the Stros don’t do anything idiotic in the free agent market, similar to what they did in regard to the Carlos Lee deal. Tejada and closer Jose Valverde will become free agents after this season and neither of them is good enough at this stage of their career to command an expensive contract. The Stros would be much better off giving younger, cheaper and likely just as productive players the playing time that fading and overrated veterans such as Tejada and Valverde would otherwise take up.

By the way, the Stros’ trade of C Ivan Rodriguez this past week to the Rangers for a couple of marginal prospects did not indicate, as some mainstream media commentators suggested, that the Stros were "giving up on the season." A club does not "give up on a season" by trading the dead weight of one of the least productive regular players in the National League. Rather, the deal would be better characterized as getting "something for nothing."

The 2009 season statistics for the Stros through the first 80 games are below, courtesy of Lee Sinins‘ sabermetric Complete Baseball Encyclopedia. The abbreviations for the hitting stats are defined here and the same for the pitching stats are here. The Stros’ active roster is here with links to each individual player’s statistics:

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