At CMS.gov., the Centers for Medicare and Medicaid Services released data that supposedly is everything you ever want to know about the prices being charged by regional Medical Centers throughout the US for common diagnoses and treatments.

As part of the Obama administration’s work to make our health care system more affordable and accountable, data are being released that show significant variation across the country and within communities in what hospitals charge for common inpatient services.

The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2011.

From The Huffington Post came the headline "Hospital Prices No Longer Secret As New Data Reveals Bewildering System, Staggering Cost Differences" - followed by the lede:

When a patient arrives at Bayonne Hospital Center in New Jersey requiring treatment for the respiratory ailment known as COPD, or chronic obstructive pulmonary disease, she faces an official price tag of $99,690.

Less than 30 miles away in the Bronx, N.Y., the Lincoln Medical and Mental Health Center charges only $7,044 for the same treatment, according to a massive federal database of national health care costs made public on Wednesday.

Well, the HuffPo got a bit carried away since few hospitals truly know what their procedures really cost. Hospital accounting, you see, is a world of cost allocations - also known in the number-crunching trade as :the "Accountants Full Employment Act." Allocations mean spreading indirect and institutional costs back to any item that can be billed to a patient and/or insurance company. The Fort Wayne Journal Gazette calls this practice "cost shifting" which is justified to recover the cost of running emergency services and getting paid for treating the uninsured.

The other information revealed in the CMS data is the average reimbursements actually made by the government.  In the case of the Bayonne Hospital Center, the payment was only $5,690. Medicare payments for all procedures to all hospitals represents only 27% of claim amounts submitted. The same discounting happens with private insurance based upon an agreement between the hospitals and the insurance carriers and between employers and insurance claim processors. Brian Tabor, vice president of the Indiana Hospital Association, tells us to beware of the incomplete information provided.

“The charges are just an artifact of the system we have,” he said. “It’s just a sticker price. The true price is what’s been negotiated with your insurance carrier.”

All this hullabaloo is a waste of time and a pointless campaign to beat-up on medical providers about excess costs instead of tackling the real problems. Long before Obamacare (soon to be single payer) healthcare, rising costs had to be attacked at the source of the problem. Third-party settlement of healthcare has been unsatisfactory as the provider/insurer cabal has been free to collect whatever it chooses from patients (and their employers) through insurance premiums. We do not use third-parties to negotiate other major purchases so we need to return to the patient/provider transactions of the past. Those wishing to insure against catastrophic healthcare losses can do so by dealing directly with the insurance carrier - but payment must come from the patient. To add insult to injury, another free rider, called various names such as HMO or PPO or whatever, is also sucking-up patient payments.

Obviously, more fakery from CMO and government control-freaks needs to stop and Obamacare needs to be repealed - NOW! Regulation is killing businesses and the healthcare industry is spending billions to collect data required by government goons. Hospital administration costs have become ginormous.

Skepticism is part of my makeup, but the recent publication of pro-gun-control editorials in the New York Daily News  and the New York Times under the byline "Gabrielle Giffords" should test everyone's credulity - everyone, that is, except Glenn Beck's The Blaze and the left-leaning Balloon Juice blog. She supposedly wrote the editorials before being dragged in front of a national television audience to be a prop for Barack Obama's angry rant against the Senate for voting down all gun control legislation yesterday. She said: "Shame on them."

On April 10, Giffords, along with her husband, appeared on CNN with Dana Bash - and the conversation went like this:

BASH:  In your recovery process, do you want to find and discover the old Gabby Giffords or do you want to sort of rediscover another, new Gabby Giffords?

GIFFORDS:  Stronger.  Stronger, better, tougher.  Stronger, better, tougher.

BASH:  Not resentful?

GIFFORDS:  No.  No.

BASH:  How is that possible?

GIFFORDS:  No.  Move ahead.  Move ahead.

 For those who do not know, Gabby Giffords suffers from aphasia as a direct result of taking a bullet to the brain in January 2011.

Aphasia (pronounced uh-fay-zhuh), is a loss or reduction of language following brain damage, typically as a result of a stroke, or an injury or trauma to the brain. Although intelligence remains intact, those affected by aphasia experience difficulty with speaking, understanding, reading, and/or writing.

A contributor over at (of all places) Daily Kos can help us imagine the horrors of the affliction. She writes that there is "nothing more horrible than not being able to talk, or think clearly".  She  spent three years "in a fog" even though her case was a milder occurrence that was due to an MS brain lesion - but notwithstanding, adequate recovery took five years.

Listening to Gabrielle Giffords speak today made me cry, and I'm sure I'm not the only one.  It also reminded me how horrible it is not to be able to speak coherently.  It's a nightmare to be trapped in your own head, but not be able to say the words that you're thinking.  You're reduced to the level of an animal - having to grunt and point, because by the time you remember the word that goes with the object you need, it'll be two days later.

I can relate. In 2006, I started having some strange symptoms that I couldn't pin down.  I had problems speaking.  Words would get confused between my brain and my tongue.  I would set out to say one word and end up saying another.  Sometimes while talking on the phone I would forget not only what I was about to say next, but what we were talking about, or even who I was talking to.  I also had problems with recognizing faces.

I started to go through the process of diagnosis in 2007.  More symptoms were cropping up.  Now I was having trouble coming up with the words I wanted.  I had a hard time stringing sentences together.  Even if I could come up with a sentence, I'd forget what I wanted to say halfway through.  When I managed to speak, it was slurred, and had no inflection.

Even typing was a struggle.  You'd think that at least I would be able to write down what I wanted to say.  But no - every time I typed a sentence, ti wulod ocme uto kile htis.  Our eye wood youse homonyms.  (It's funny how many homonyms there are!  I think I found all of them.)  So communicating even with written words became a real struggle.

Aphasia is indeed cruel and unusual suffering and those of us who have had loved ones afflicted will never forget the frustration on the faces of the aphasia patient and how we felt frustrated because we could not help nor could we communicate fully.

But watching the Democrats use Gabrielle like a puppet to tug at the heartstrings of the American public for partisan political agendas reveals their pathetic politics. Husband Mark Kelly is a bastard as were the Democrat leaders who dragged her to the House floor to vote for Obamacare when she could not possibly have been well enough to comprehend what was going on. It is plain to see that some Democrat organization or the liberal newspapers that published the editorials in question, gifted a ghost writer and free publicity to further Obama's gun-control agenda.

In 1955, in the midst of the Cold War, Leonard Wibberley wrote a six-part novel for the Saturday Evening Post which was later published in Great Britain and then was turned into a movie in 1959 entitled "The Mouse That Roared," with Peter Sellers starring in three roles. Great satire, indeed, involving a small country getting access to a bomb more powerful than a nuke deciding to invade the United States in order to lose the war and get American aid as a vanquished enemy. A cautionary warning (that was supposed to be funny) was included (see above) in the film. The movie plot in a nutshell is reproduced below:

"The Americans always rush to the aid of the people they defeat....They pour money into the country of their former enemies and do anything to save the people they've beaten." -- Peter Sellers, as Prime Minister Mountjoy, explaining his plan to Peter Sellers, as Grand Duchess Gloriana XII.

"You must remember that the Americans are a very strange people. Whereas other countries rarely forgive anything, the Americans forgive everything. There isn't a more profitable undertaking for any country than to declare war on the United States and be defeated." -- Sellers as Prime Minister Mountjoy.

"We declare war on Monday, we are defeated on Tuesday, and by Friday we will be rehabilitated beyond our wildest dreams." -- Sellers as Mountjoy.

My mind went to this film when I immediately decided that North Korean dictator, Kim Jong-un was looking to become a vanquished enemy as well, with his recent nuclear threats against the United States and South Korea. But the Brits and Russians, after being warned by Kim Jong-un that their nationals might be in danger, are getting ready to pull out their diplomatic contingents from Pyongyang.

Meanwhile, Chinese internet junkies are laughing their heads off, even suggesting that "in case of war, China might be obligated to fight itself, as its treaty with North Korea requires it to support the Hermit Kingdom, but its position on the UN Security Council could obligate it to provide troops if the UN resolved to send peacekeepers to North Korea to stifle Kim’s aggression."

A Jon Stewart video entitled, "Nuke Kid on the Block," has gone viral on the Asian web. This Jon Stewart comedy piece is very funny but perhaps he should have added the above cautionary warning somewhere in the dialogue.

Many groups, scientific and otherwise, have claimed earthquakes occurring at shallow depths of under 10,000 feet can largely be attributed to anthropogenic misadventures - anything from quarrying, coal mining, oil and gas drilling (fracking), building a surface dam, or too many too tall buildings! The latest study published in Geology magazine on March 26, 2013 involves a series of quakes that occurred on November 6, 2011 with an epicenter 6 miles north of Prague, OK. The research concludes that "earthquakes were likely attributable to underground injection of wastewater derived from dewatering - separating crude oil from the soupy brine reaped through a drilling technique that allows previously inaccessible oil to be pumped up."

Michael Behar at Mother Jones appears to be the writer picked to "sell" these findings to low information Americans. His article, complete with quotes from the lead writer on the Prague quake, was prepared and ready to print at the time the Geology paper appeared.

The impact of fossil fuels is no secret, but until now the short list of dirty energy's villains never included water. Together, oil and gas extraction and production generate about 878 billion gallons of wastewater annually, roughly what tumbles over Niagara Falls every two weeks. More than a third is injected back into disposal wells. With natural gas production on the rise—it has jumped 26 percent since 2007, chiefly because fracking now makes it economically viable to pursue gas trapped in shale deposits—and unconventional practices such as dewatering [and] ramping up domestic oil development, the wastewater deluge is expected to get worse.

Unfortunately, Mr. Behar did not proofread his copy well, since his article is entitled "Fracking's Latest Scandal? Earthquake Swarms," which would indicate that the USGS report blamed hydraulic fracturing for the seism; further, he did not rationally explain to us how it is that 878 billion gallons of wastewater injections annually, spread across the country over many wells is somehow more destructive than the 23 trillion gallons of water falling 167 feet over just 3,660 feet (a little more than one kilometer) of brink at the Niagara escarpment. Why is no one badmouthing the Niagara River for causing earthquakes and why haven't we rerouted the river? Yes, I suppose the tourists would be mad as would be the hydroelectric folks.

The USGS database shows that there is a 1.102% chance of a major earthquake within 50 miles of Niagara Falls, New York within the next 50 years. The largest earthquake within 50 miles of Niagara Falls, New York was a 3.8 Magnitude in 1999.

Not mentioned in Mother Jones is a this important Obama administration statement by Dept. of Interior Deputy Secretary David J. Hayes.

Not all wastewater disposal wells induce earthquakes. Of approximately 150,000 Class II injection wells in the United States, including roughly 40,000 waste fluid disposal wells for oil and gas operations, only a tiny fraction of these disposal wells have induced earthquakes that are large enough to be of concern to the public.

. . . and by USGS seismologist Bill Ellsworth:

“We don’t find any evidence that fracking is related to any of these magnitude 3 earthquakes that we have been studying,” “We simply don’t see any evidence that fracking is related to earthquakes that are of concern to people.”

This 5.6 quake was detected by three seismographs to have originated just 3 miles underground and "had the power of 3,800 tons of TNT, which is nearly 2,000 times stronger than the 1995 Oklahoma City bombing" while normal tremors from hydraulic fracturing are mild. But to have a reading this large, pressure and movement from within a seismic fault is required. As can be seen in the diagram, the Wilzetta Fault, also known as the Cherokee Uplift is undeniably right next door. According to U.S. Geological Survey seismologist Paul Earle. "You can have an earthquake that size anywhere east of the Rockies. You don't need a huge fault to produce an earthquake that big. It's uncommon, but not unexpected."

There appears to be an ulterior motive that is overriding a balanced look at earthquake activity in general - and that motive comes from environmentalists, Greenies, and George Soros-sponsored radical websites such as ProPublica and The Center for American Progress, intent on finding excuses for shutting down the extraction of carbon-based fuels. There is another theory, related to interviews with geophysicist Seth Stein and other scientists by Pete Spotts of the Christian Science Monitor and for ABC News about earthquakes occurring in regions where the earth's major tectonic plates do not grind against one another.

In regions known for relatively frequent, large quakes, such as the west coasts of North and South America . . . sources of stress on faults are well known. And the faults themselves are increasingly well-studied, allowing scientists to estimate repeat rates for major temblors along these shifting cracks in Earth's crust.

In the middle of the continental US, however, research over the past decade suggests that trying to estimate future quake activity may be more like a high-stakes game of "Whac-A-Mole."

One fault system might generate a cluster of quakes over a period of a few years, then it delivers diminishing set of aftershocks for centuries while stress migrates to a new fault system, explains Seth Stein, a geophysicist at Northwestern University in Evanston, Ill.

The past of any one fault system may not be a prologue to its future. Trying to divine that future may represent "an exercise in closing the barn door after the horse has gone," he says. Oklahoma sits squarely in the portion of the country that appears most susceptible to this wandering seismic activity, some studies suggest. [ . . . ]

Throughout 2009 and 2010, the state [of Oklahoma] has experienced unusually high earthquake activity, although the activity may be typical for the state when viewed over long periods of time, according to the state geological-survey office in Leonard. No one has a good handle on why the activity has increased. This week's quakes may well be part of this "swarm," Dr. Stein says. [ . . . ]

Stein says this week's fore shock and main shock were too strong to attribute them to oil and gas extraction. Others note that this week's quakes have appeared at depths significantly deeper than deposits where fracking takes place. The area hit by this week's quakes doesn't show up as vulnerable on the US Geological Survey's hazard map for the state. The vulnerable area sits in southwestern Oklahoma, along the Meers fault, the only fault in the state for which geologists have found evidence at the surface. Its last significant break occurred about 1,300 years ago in a quake estimated at magnitude 6.5 or 7.

Another case of migration? If so, it could fit a pattern Stein and other researchers posit after studying the New Madrid fault zone, centered under southeastern Missouri. That fault was responsible for a set of four intense quakes between 1811 and 1812. Each quake has been estimated to have reached at least magnitude 7, and perhaps as high as magnitude 8. It has been shuddering at weaker levels ever since.

Stein and University of Missouri geophysicist Mian Liu have studied aftershock patterns from earthquakes along plate boundaries, in the wider regions around such boundaries, and in mid-continent. Quakes along plate boundaries appear to have the shortest periods of aftershocks, on the order of 15 years. Mid-continent quakes appear to have the longest period of aftershocks – 200 years and counting.

Meanwhile, nearly a decade of GPS measurements around the region show that any "reloading" of the New Madrid fault is happening at a glacial pace. The crust is deforming at a pace of roughly half the width of a human hair per year. That's all that plate tectonics seems to be contributing to the stresses on the fault, compared with tens of millimeters a year along a plate boundary such as the San Andreas fault.

On the basis of those measurements, it's hard to see how the New Madrid fault stands a 25 to 40 percent chance of a magnitude 6 quake or stronger over the next 50 years, the researchers say. These observations have led Stein, Purdue University geophysicist Eric Calais, and colleagues to propose that many quakes taking place in mid-continent may be aftershocks of large quakes that happened hundreds of years ago.

If the reader can simply grasp the enormity and complexity that is our earth's biosphere, we do not have to have instant gratification about why something, we do not completely understand, happened. Scientific inquiry has no shortcuts and sound science theories are refined minutely after much inquiry and testing. Instant gratification, unfortunately, has become the mantra for hungry young researchers seeking grant money.

The Oklahoma Geological Survey supported by its own records, examined the USGS-sponsored study and arrived at a reasoned response which rejected the findings that the injection well was the source of the temblor. Water injection operations, OGS pointed out, have been in place in the Prague/Wilzetta area for more than 55 years without incident (which means that the dewatering operations are servicing conventional oil wells.) Further, the quake is likely natural and was part of the "swarm" of earthquakes in the state over the past several years. At best, it would seem likely that the injections might have served as a trigger mechanism for an earthquake that would have occurred anyway.

As seems to be the case in all of earth's natural sciences, seismology is as mysterious as say, climatology. So much is being learned, but the bent toward discovering the evils of man are distorting the definition of what new knowledge might yet be extracted from the mountains of data that is becoming available. Our seismic limits begin with instruments that measure tremors at the surface which are too few in number for useful data collection. When the earthquake occurred in Prague, there were 3 seismographs near the epicenter and one week later the USGS team had added 35 more. Then there is the magnificent discovery just announced by Scripps Oceanography on March 20:

Scripps Scientists Discover 'Lubricant' for Earth's Tectonic Plates

Hidden magma layer could play a role in earthquakes and other aspects shaping the geological face of the planet.

Today is Cesar Chavez's Birthday

In 1962, Arizonan Cesar Chavez co-founded and organized the United Farm Workers union with the intent to better wages and working conditions for contract farm laborers in California and elsewhere.  His efforts were met with organized recruitment of  Mexican "Wetbacks" by corporate farms.

Yes, Chavez was fighting for better wages for Mexican-American workers underpaid and abused by California growers. One way he did that was by helping the INS prevent the growers from importing wetbacks as strikebreakers.

But in the end, unions will be unions, imposing their will on employers, union members and non-union workers with any an all means including open violence. Predictably, in the end, the UFW failed:

In California, only three birthdays are official state holidays: Jesus Christ’s, Martin Luther King’s, and Cesar Chavez’s. Beatification as a secular saint, though, isn’t always good for the soul. A . . . four-part exposé by reporter Miriam Pawel in the Los Angeles Times revealed how the labor leader turned revered ethnic icon descended into paranoia, megalomania, and general crack-pottery in the 15 years before his death in 1993.

Today, his United Farm Workers functions less as a union—it represents only 2 percent of the California agricultural workforce—than as a lucrative Latino-pride fundraising machine providing sinecures for a dozen Chavez relatives. Pawel writes, “Chavez’s heirs run a web of tax-exempt organizations that exploit his legacy and invoke the harsh lives of farm workers to raise millions of dollars in public and private money. The money does little to improve the lives of California farm workers, who still struggle with the most basic health and housing needs and try to get by on seasonal, minimum-wage jobs.”

From 1965 to 1981, the UFW succeeded in raising wages significantly for stoop laborers in California. Since then, their pay has fallen, and they've lost most of the fringe benefits they had won. Today, most make less than $10,000 per year. Hundreds were discovered near Salinas living in caves, a mass indignity that even that town’s most famous son, John Steinbeck, barely anticipated in The Grapes of Wrath.

Unfortunately, in focusing on gossip about the personal foibles of Chavez and his successors, the LA Times series completely ignored the politically incorrect paradox of who was most responsible for wiping out the gains Mexican-American farm workers had achieved through strikes and consumer boycotts: illegal immigrants from Mexico.

"The labor unions have done a masterful job of pantsing the taxpayers."

Back in 1979, famed Chicago Tribune columnist Mike Royko called the state of California “the world’s largest outdoor mental asylum." He added that "if it babbles and its eyeballs are glazed, it probably comes from California.” Royko went on to name the then state governor, Jerry Brown, "Governor Moonbeam." Well, as we all know, Moonbeam is back to deal with the problems created when he approved collective bargaining rights for public employees in 1976 - to the delight of the state's liberal rent seekers. California's ruling class politicos, unions, environmentalists, liberal activist courts and the new Mexican majority mob are running the state into the ground. Conservatives and "Big L" Libertarians are not welcome at the trough. Neither are the city and county governments struggling to attain fiscal sanity in a world gone mad.

In 2012, three California municipalities, Stockton, San Bernardino and Mammoth Lakes filed for bankruptcy as these cities struggled with rising personnel costs emanating from public-sector union contracts and the poorly managed and corrupt Calpers retirement system. Bankruptcy appears to be the only way around untenable union contracts but also puts municipal bondholders and creditors at risk. John Seller at Cal Watchdog sums up the common reasoning for these Chapter 9 filings:

“Previous city councils were bought and paid for by the public-employee unions. Those councils ripped off the taxpayer by giving wildly excessive pay, perks and pensions to city employees. We can’t afford that anymore, so we’re declaring bankruptcy. Let a federal bankruptcy court sort it out. Then we can start over.”

There are more and more California cities facing this crisis, but this tale involves the Orange County community of Costa Mesa where a forward-looking city council, dominated by Republicans and led by freshly-minted councilman Jim Righeimer, made positive and innovative efforts to end its long slide toward fiscal chaos - but have so far failed to achieve its goals.

Twenty months ago, faced with budget shortfalls, Costa Mesa (in compliance with Section 14.2 of its Memorandum of Understanding with the union) advised 213 employees of an impending lay off in six months when as many as 18 municipal services that they were performing would be contracted out. Predictably, the Costa Mesa local of the Orange County Employees Association filed suit, claiming that the union had been bypassed in the issuance of the lay off notices. O.C. Superior Court Judge Tam Nomoto Schumann issued a temporary injunction against the city, prohibiting the lay offs until the city satisfied the court of its compliance with proper legal steps. City attorneys appealed but the Court of Appeals denied the lifting of the injunction.

At issue in the lawsuit was what restriction existed as to what services could be outsourced but the appeals court ruling seemed to indicate that only "special services" outsourcing was allowed. So Righeimer and the council want back to work to draft a city charter, which would remove it from any such restrictions. Cities wishing to avoid any restrictions of the California municipal code needed to operate as a charter community (which all large cities have chosen to do.) The city voters would have to approve of such a change.  In 2012, the OCEA spent a half million dollars in opposition to the charter and when the election was held in November, 59% of voters rejected Measure V (the charter adoption proposal.) The Republican majority in the city council was weakened in the election but remains in place.

Shortly thereafter, on 11/28/2012, the CA Supreme Court declined to hear a Costa Mesa appeal on the still active injunction against layoffs, leaving unsettled some vital points of law.

That denial could have widespread effects in other California cities. As they seek to privatize services such as street sweeping to save costs, some municipalities may be blocked by this appeals court ruling, some legal experts have said. The appellate decision essentially prohibits the majority of cities from privatizing except for certain "specialized services" such as legal or financial functions.

On 2/1/2013, the O.C. Superior Court lifted the temporary injunction against outsourcing but the union lawsuit has yet to be settled.  Jim Righeimer and company have vowed that a new charter, written by a committee comprised of Costa Mesa citizens will be prepared for the next election in 2014.

So what is behind all this hullabaloo?  In the run-up to these contentious confrontations, Costa Mesa employees numbered 497 -  85 of which made over $200,000 a year with the median average for all employees at $130,000 - in a city where the average taxpayer makes only $62,000 or $75,000 with benefits.  This chart for 2011 counts only full-timers who worked all year.
To add insult to injury, employee pension costs paid to Calpers in 2011 were $14.7 million, up from $5.2 million in 1999-2000 as a result of sparse investment earnings (1.1%) lately and a state-wide benefit improvement passed in 1998. Calpers is not doing well in finding sources to adequately fund pension liabilities. According to Moodys, unfunded liabilities have been revised upwards from of $128.3 billion statewide to $328.6 billion which, of course, will drive future city pension contributions skyward. If Costa Mesa had to pay off its pension obligations today, even before Moody's projected change, its costs would be $221.7 million - so there will definitely be insolvency in this O.C. community's future if nothing changes. In the past year, Costa Mesa pensions in excess of $100,000 have risen by 50% in just one year. It seems that 65 retirees average just over $129,000 each. Total annual cost is about $8,184,000.

The union representing Costa Mesa's municipal employees, Orange County Employees Association (OCEA) has been quite successful in selling the "market" argument that neighboring towns, not Costa Mesa, really set the standard for pay and benefit raises.

The City Council then essentially guaranteed rising salaries: They would either be at the average or median of surrounding cities or at the pace of economic growth, whichever was climbing faster at the time of contract talks. The same generally applied to benefits. As surrounding cities approved the most generous pension plans, Costa Mesa followed suit. Also, in 2001, the state Legislature signed a bill that made city workers eligible for boosted pension packages.

Meanwhile under a budget crunch, Costa Mesa's quality of life has suffered as public parks and ball fields often go unmowed, streets and sidewalks maintenance has slowed, planned improvements for storm water drainage has been shelved and the many bands of infamous Orange County coyotes roam the streets undeterred.

Raising taxes in the face of higher state level taxation is not an option.  All reserves have been spent. Costa Mesa's ridiculous costs have to be lowered. Union influence inside the state government would indicate that getting rid of unionists will be much harder and much more expensive than a divorce. There is no going back to void pension contracts but the Governor is proposing less generous defined-benefit plans for new employees, which may be helpful twenty years into the future. One more time at bat to hit the charter city homer or Costa Mesa will join many other California cities in the U.S Central District of California Bankruptcy Court.