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Mon Aug 20 20:10:54 BST 2007

No Pret what you'd get is even more of the same greasy-palmed leadership
because when you give away  power and money, the power-and-money hungry
are the ones that show up to get it. The more money that Washington
controls the more that they steal.

The reason that you "remember" when government agencies used to do some
good is mostly because the press used to root for the government and not
report evidence of incompetence, graft, and waste. Today it's a
spectator sport.

Eg — the bridge to nowhere (Stevens -R) the 50 people that the bridge
would service don't even want it but the bridge would make his son in
law millions. Harry Reid -( D) — wants to name hundreds of acres of
land a national park, lo and behold his ranch abuts the area and would
immediately double in value. Jefferson (D) bribe money in the freezer
— and doesn't even lose his committee seats much less the support
of the CBC. 

Those are just the 3 off the top of my head that piss me off the most.

I agree with you it's an execution problem. We need to execute most of
Congress.

Bill

>>> "Bjorn, Pret" <pbjorn at emh.org> 08/20/07 2:01 PM >>>
Dr. Mattox,

Skunk-poker in hand, he advances on the unsuspecting thread...
I'm missing something: you expect to solve this national problem via
your admirable example?
National problems would seem fit for national responses.  Granted,
pretty much all US federal agencies are rife with incompetence,
corruption, and cronyism; but that's less a matter of design than
execution, isn't it?
Imagine if the feds would spend -- let's grab a number out of the air
--
a HALF TRILLION DOLLARS on domestic priorities... 
I bet we could build one hell of a national EMS system, with only a
couple of hundred million wasted on trauma care.  Probably have change
left over for OTHER healthcare initiatives.  Or public education.
Immigration control.  Cold fusion.
But then, if you can't blow it up or send young people to their deaths
for it, then we'd have to raise taxes.  I retract the suggestion.

Funny; I'm old enough to remember when FEMA used to do some good.
Likewise the FDA, HUD, the FCC, the departments of Energy, Veterans'
Affairs, Agriculture, Education, Transportation, Justice...

Our problem isn't nationalization of anything.  It's spit-for-brains,
greasy-palmed leadership.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
Sent: Monday, August 20, 2007 12:25 PM
To: trauma-list at trauma.org 
Subject: Time for CHANGE and HONESTY

Dr. Smith:   Thank you for that observation.   It is time we
nationally
came to grips with this "not uncommon occurrence."   We know it, our
patients know it, and we all expect better.    We are talking about
loosing YOUNG people here, not persons at the end of their life with
terminal futility issues.    
We are talking about our own neighbors, friends, and even family, and
even medical colleagues.  Off line and on another list server is an
impassioned plea from a surgeon who has a close friend in an ICU of a
well recognized facility.   He is an agent for the family, and is
encountering great barriers in information and has significant
questions, as would each of us.    
Just what is happening when General Surgeons with certificates from
the
American Board of Surgery are AFRAID to be in an open laparotomy?  
What
is happening when surgeons refuse to respond at night to a plea that
they or any surgeon come to the hospital at night to assist in clearly
a
surgical problem.   
What is happening when staff surgeons punch a clock and use an 80
hour(or even 40 hour/week) rule to say they can work no more hours,
even
if a trauma patient is bleeding to death.  What is happening when a
catheter based vascular surgeon is afraid to explore a neck, groin, or
god forbid, an abdomen full of blood from a fresh vascular injury; yes
I
said AFRAID.   Afraid to do anything which cannot be done with a
scope.

Well, OK, I will let those who desire to use their medical training to
limit their practice to whatever suits their desires and life style.
However, big bad trauma and big bad surgical problems still occur
which
need the knife and someone that knows how to use it.  Where and how is
this "top knife" surgeon of the future going to be trained when even
the
role models are dying off or retiring.  Sadly, Universal Health Care
as
proposed by Presidential wantabees on both sides will not solve this
problem, such will make it worse. If you like what FEMA did after
Katrina, you are going to love a governmentally designed Universal
Health Care system.   

More than anything else, society expects us to be there when they need
us for the big bad surgical problems.  I for one plan to be there to
respond.  
That is what I do.   

k 

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