These are serious allegations and they should be looked into  State Rep. Jamilah Nasheed from St. Louis wants incoming Governor Jay Nixon to investigate allegations that Maj. Gen. King Sidwell and his chief of staff, Col. Glenn Hagler, discriminated against black and female members of the Missouri National Guard and that Nixon should look at replacing him as the commanding officer when he becomes Commander in Chief of the Missouri guard in two weeks.  “The allegations of systematic racial and gender discrimination by Missouri National Guard Adjutant General King Sidwell merit a swift but thorough investigation by the Department of Defense,” said Nasheed, D-St. Louis. She urged Nixon to hold off on keeping Sidwell with the National Guard until an investigation can be completed.  Nixon, who met with Sidwell last week, was noncommittal about the controversy but said he expects the National Guard is “one area we would make some changes.”

For years I have told people all over the country world that the best neighbors anywhere are in Missouri and I have a feeling that Reverend Vernon Self would back me up on that.  The 79-year-old is alive today because of the quick thinking and follow-through of his neighbors in Poplar Bluff.  On December 23 he lost control of his car on a patch of ice and landed upside down, dangling from his seat belt, with his head in the freezing water.  He would surely have drowned if not for those neighbors.  One man waded into the freezing water and held his head up so he could breath while another man went to find a tractor to get his car out of the ditch and yet another went to get his wife so she could be there with him and help keep him calm during the hour it took to free him from the car.  The outcome could have been horribly grim, but instead he escaped with a few stitches and a but of stiffness.

NCMC considers going to a four-day week North Central Missouri College (formerly Trenton Junior College) is considering holding classes four days a week instead of five in an effort to help their largely-commuter student body save money on transportation costs.  1500 students attend classes at NCMC, located in Trenton, miles and miles from everywhere and in some cases they are driving up to 90 miles one way to attend classes.  I am intimately familiar with the commute to TJC – I did it four nights a week for night classes, driving  from Harrison County when I was a teenager.  

The first step is always to admit you have a problem  And the journey of a thousand miles begins with one step, you know, and State Sen. Jason Crowell, a republican from Cape Girardeau, is at least willing to put a foot on the path.  He is pushing for legislation that would provide health care workers tax breaks as an incentive for them to see more Medicaid recipients.  Low reimbursement rates have led many health care providers to avoid treating Medicaid patients, creating a bottleneck for those patients to find care and stressing the public health system practically to the breaking point.  In the year that ended June 30, Medicaid payments to health care providers was $206.7 million. Crowell estimates his bill would provide tax savings to those providers of about $12.4 million.  Ultimately, Crowell said he’d like to see the Medicaid payments closer to those of Medicare, a health program for the elderly that comes closer to matching actual costs.  The down side of the equation is, of course, that a significant chunk of change would come out of the revenue pool, and we would be better off gritting our teeth and modestly increasing taxes and providing some services for our citizens, but we are caught in an endless cycle of “pull yourself up by your bootstraps” mode – and by the way, nobody wants to hear you whine about being barefoot.  There goes that vein in my temple again…

Murder rate among black teenagers continues to climb  even as the rates for violent crime either remain static or even fall among other demographic groups.  I have not collected any empirical data, but I could have predicted the results.  I worked on a trauma team in an inner city hospital until one year before I took my marbles and went home because I was exhausted from daily losing battles to save the lives of black teenaged GSWs.   The beginning of the end for my medical career was the three brothers shot on Christmas Eve 2004.  I was the lab scientist who went with Alvin Brooks (iirc – could have been a different community activist, but I think it was Alvin) to get their Mama to donate their organs, and whose job it was to swing into action and get the typing and crossmatching and blood cultures started the instant consent was obtained.  When that poor devastated woman said “Of course.  It’s Christmas.  You have to save somebody else’s babies since you can’t save mine,” it was all I could do to not lose it right there on the spot.  I kept it together, of course.  I am a professional, after all.  But I was out of that hospital within six months and I was out of medicine entirely within 18.  

For over two decades I had a front row seat to the slow-motion train wreck that is the American healthcare system.  I know how screwed up it is.  I have seen it from the bottom up and I fought a losing battle for expanded access to quality care all the way down the hill.  

I have seen a side of health care that most people have no idea even exists.  When most people hear ‘public health’ they think of the health department, but only have a vague idea what the health department actually does besides keep track of  STD rates and a few other statistics that most people never have occasion to think about.

When I hear the words ‘public health’ I think of how to say “OK, there’s going to be just a little stick now” and “I’m sorry” and “What a beautiful child!” in ten or twelve different languages.  I have worked in the trenches of public health.  What started as youthful idealism and an altruistic bent evolved over the years.  At times I felt a deep sense of pride, and at others I felt cynical, or put-upon, and frequently I was pissed off.  At the end, all that was left was defiance.  

I have watched as the ground beneath the system crumbled.  But when it was just public health, not too many people paid attention.  Their doctor was still there, taking appointments and passing out samples and ordering all the right tests and writing the designer prescriptions that their years of Oprah-watching had ‘educated’ them to know they needed.   And as long the status quo held, they were disinterested in the health of the healthcare system itself.  

But now that the tentacles that have strangled me and my kind for the last two decades have snaked their way into the suburbs and started to affect the internal medicine group practices in those banal suites in the beige, nondescript office parks, the problem is starting to garner a little attention.  

At age 51, David Wilt calls himself “the young one” at his medical office.

Wilt’s colleagues are in their 50s and 60s. Retirement is on their minds.

And that could mean big trouble for Kansas City area patients in need of a doctor.

The area’s physician population is rapidly aging, and many practices are having a hard time recruiting young doctors.

It is a predicament that puts the area at a serious disadvantage just as experts are predicting a national shortage of physicians that will grow steadily in the years ahead.

In the Midwest, we are double-whammied.  Not only are we getting hit by the lack of interest in new docs to go into internal medicine or family practice, we are also a net-exporter of medical students trained in our area.  Kansas City has two medical schools and an osteopathic college as well.  Nearly all of our hospitals have residency training programs.  But as soon as they graduate they look for residencies in other areas, and as soon as the residents who train here are done with the program, they are outta here.  

And we are about fifteen years away from physician attrition taking down the whole system.  

So who wants to know how to fix it, before it’s too late?  Because I can tell you how.  But there is a down side.  It’s going to cost money.  Those who are allergic to the notion of paying taxes should stop reading blogs this instant and go study up on how to tincture herbs.  

Because these things unfold in slow motion, the tipping point is rarely recognized other than in hindsight.  We may have reached it.  But if we haven’t, we are damned close to it.  

We need a whole new way of thinking about not just how health care is delivered in this country, we need to rethink who is delivering it.  The AMA has set those rules for over 160 years, and along the way they have fought against Medicare and Medicaid, the licensure of nurse midwives, nurse practitioners and every other expansion of duty on behalf of allied health professionals.  That organization has been on the wrong side of too many issues for too long for us to have to suffer the indignity of letting them continue to set the agendas and make the rules.  I’ll say it here and I’ll say it to their face, too.  I don’t kiss doctor butt.  I come from the one part of medicine where the doctors are intimidated  because they know that we are the smart half of the exchange…I come from the lab.  Without us, and our science and our analyzers, they might as well have a jar of leeches and an amulet.  We take the guesswork out of their job, and most of them will tell you that if they had been required to go beyond O-Chem or basic calculus, they wouldn’t be doctors.  We, on the other hand, have to not just pass exams and balance basic equations, we have to actually be able to do math and science.  We have to be able to set up and run metabolic panels by titration, and do the accompanying manual calculations if the analyzers go down, or be able to step in and do manual blood counts and crossmatches for transfusion protocols.

I could recruit ten people to become primary care physicians within 90 minutes, but only if they could take another path to get there than the one that currently exists.  There are a lot of people like me who have finished that first career and still have a lot of years left on the calendar.  

I would be a kick-ass doctor, and sometimes I think about going to med school and finally making my mother proud.  But then I come to my senses and shake off that nonsense.  I’ll be damned if I am going to go a hundred grand in debt and not only not increase my living standard appreciably, but give up a lot of my quality of life as part of the bargain.  Fuggedaboudit.   And I am sure as hell not going to take a bunch of abuse at the hands of some snot-nosed punk masquerading as a teaching doc when I remember full well that I used to have to go find their sniveling ass when they went and hid in the supply closet to cry when they were a resident.  

Now if the state and the medical schools could get together and set up a program tailored to allied health professionals who meet a set of criteria and train to specialties and license the graduates to work in conjunction with  M.D.s and D.O.s like nurse practitioners and physicians assistants do now.  Can you think of anyone better to help a Hematologist (specialist in blood disorders) pick up the slack than a person who spent the first decade or two of their professional life as a blood banker?  I can’t imagine a better second career for a radiology tech than as a practitioner in an orthopedics practice.   For that fact, we could redefine what constitutes a general practitioner and create an abbreviated medical curriculum for nurses and allied professionals with bachelors degrees and confer full physician rights upon completion of classroom and clinical requirements.  

We have an aging population and we have a lot of burned out health professionals.   I know both of those facts first hand – I can see fifty from here, and I qualified as the latter before I was a member of the former.  

I have time, and I have inclination.  What I don’t have is money to burn or the patience to jump through a bunch of hoops that are ultimately pure and utter bullshit.  But if the lege would codify some new rules into law, and fund a program, I would gladly go through it and spend at least a decade, maybe even two, as a front-line provider in an underserved area or specialty.    Unfortunately, if they do get around to doing something like that, it will be so far into the future that I will be too old to participate.    

In Missouri the answer to that question seems to be that if exiting Republicans can’t follow the example of soon-to-be ex-Governor Mat Blunt and secure lucrative sinecures in the private sector, they just might remain to haunt the legislature.  Take, for instance, the case of Neil St. Onge, the term-limited Chairman of the House Transportation Committee who failed in his bid for the 7th District State Senate seat that went to “Crazy Jane” Cunningham.

According to the Columbia Tribune, St. Onge, with a little help from pals in the legislature, managed to name himself

… to the top staff job on a legislative committee he co-chairs. The job, inspector general of transportation, pays about $60,000 annually but has not been filled for the past three years. … .

That St. Onge himself, as co-chair of the Joint Committee on Transportation Oversight, left this position unfilled for the last three years is somewhat perplexing given his eagerness to fill it now that he is on his way out. The other co-chair, Sen. Bill Stouffer, R-Napton, is so emphatic that it no longer needs to be filled that he has responded to St. Onge’s appointment by filing a bill to abolish the position.

St. Onge claims that the infrastructure spending promised by the Obama stimulus package will create a need for “additional” oversight that this postion could provide.  (You can hear him discuss his appointment in greater detail on St. Louis’ KMOX radio here)

However, even in this future context, as the Columbia Tribune points out, there seems to be some evidence for Stauffer’s claims that the position duplicates existing State positions:

The transportation department’s staff audits contractors who work with the agency, a spokeswoman said. The department hires a private firm to conduct annual financial audits. And the state auditor checks into federal funds that are expended by state agencies each year.

So  what, you may be inclined to say, just one more case of a little political back-scratching on the public tab, nothing new and fairly penny-ante in the scheme of things.  But there is a further question, and that is, based on what we know about St. Onge, do we really want him hanging around and putting in his two-cents on transportation issues?

According to Missourians for Tax Justice (MTJ), in a November 2007 report, governmental planning for Missouri’s transportation future, led by St.Onge, Stauffer and Pete Rahn, director of the Missouri Department of Transportation:

is centered entirely on highways. This follows the usual pattern of neglect of all other forms of public transportation

St. Onge is friendly to the idea of toll roads, but bows to the political reality that it is “politically unfeasible to install toll ways.”  Instead, he has  embraced sales taxes of all stripes. St. Onge has proposed raising car and truck license fees, gas and diesel taxes and sales taxes, specifically to fund improvements to I-70. Although there might be other arguments for gas taxes, this approach is ultimately one that puts greater onus on poorer citizens to fund the building of roads.  

St. Onge is also itching to privatize transportation infrastructure.   The Vice-Chair of the MTJ, Barbara Ross, noted that at a  July 2007 meeting of the Joint Transportation Committee, which St. Onge co-chairs, “privatization and toll roads”  were the only financing options considered.

So think about it.  The guy with a vision for Missouri transportation that is left over from 1955 (and it was wrong-headed then), manfully grappling with ways to fund public resources by means of regressive, back-door taxes or by simply selling them off to private bidders, will get the job of exercising just one little soupcon more of “oversight” over transportation infrastructure projects.  It must be great to be a Republican in Missouri.

The Power of One

by Nightprowlkitty, Docudharma, December 26, 2008

Crossposted at Docudharma, Daily Kos, My Left Wing, Open Left, The Sanctuary, and OOIBC

If you wish to repost this essay you can download a .txt file of the html here (right click and save). Permission granted.

Give Bush and Cheney a fair trial — something they have not bothered with since they stole office.

It’s funny how the powers that be in the media and government are running around with their big fat excuses as to why we can’t hold these criminals accountable for their crimes.  It all boils down to “It’s too hard!!!”

It’s too hard.  It would affect too many people.  It would interfere with the crucial work of restoring our economy.  Blah blah blah.  Not one of these folks say, however, that no crime has been committed, no law has been broken.  No one says that.

I find that stunning.  We all know, at least those of us who have been paying attention, that Bush and his crew of crooks have broken the law over and over again.

And Cheney says “What you gonna do about it?”  And Cheney says “oh, the Dems knew about this and approved it, hell they wanted us to be even tougher than we were!”

And we should believe Cheney … why?

I don’t want speculation any more.  I want the truth, the facts, what really happened.  Only a special prosecutor can get that information, someone who is inured to the politics of Washington D.C. by being given the independent power to investigate.

What I like about this petition is that it shows the power of the individual citizen.  This is not a grassroots effort decided by committee.  A couple of folks got together and came up with the text and others jumped in to work further on it and spread it around.

The power of the individual citizen.

I am extremely annoyed at the argument that we citizens are somehow childlike creatures who don’t know all the real problems of our country and so we shouldn’t cry and whine about our “pet issues” when the government knows so much more about what is important and should be made a priority.

Bleh.

We ARE the government.  The only people who will take back power as citizens, are citizens!  That’s us.

To me, Obama’s election is a signal that we can now start taking back that individual power, our individual rights.  It’s not for Obama or any elected representative to tell me what I should make a priority.  I get to decide that for myself.  They’ll do their jobs, and I’ll do mine.

The measure of our success with this petititon will be the resistance from the powers that be, the Dems, the Repubs, Obama, the media.  The more we read about how this is not a good idea, getting a special prosecutor, the more we’ll know we have them on the run.

Many of us have sent this petition to friends and family, whether they be politically agreeable to us or not.  One by one people will sign.  This isn’t “organized” grassroots and it’s netroots only insofar as the structure.

To me, this is about the power of each indviidual citizen, not resting happy with the decisions of our elected representatives but standing up for what we feel is right and making our voices heard.

We need to know the truth about the crimes committed in our names.  We need to have every American citizen aware of what has been done so there can be no denials or excuses.

At this time, the only line between tyranny and freedom is an informed citizenry.  By signing this petition and working to make it known we will not accept anything less than full accountability for torture being done in our name, we are exercising our power, not the power one step removed of the three branches of government.

We have power collectively and we also have power individually.  I think the citizenry of this country are going to be tested enormously as we have to let our representatives know we are not asking for favors on our “pet causes” but taking our government back, of, by and for the people.

I can tell you exactly when I became a died in the wool Democrat in my own right.  

It was an autumn afternoon in 1972, and Jerry Litton came to Cainsville and answered every question that the 20 or so people who bothered to show up in Velma Francis’ restaurant under the town square cared to ask.  One of those questions came from a nine-year-old girl who stubbornly went to the event even though it meant missing the school bus and a potential five-mile walk.  Her question was answered without a trace of condescension or irritation, and the die was cast at that instant, and would have been even if he hadn’t taken down my information and sent a Christmas and birthday card every year for the rest of his life.    

Four years later, when he, his wife and their two children were killed in a plane crash on the way to a victory party after winning the Senate primary on August 3, 1976, I was crushed.  I cried for two days.  I felt like our legacy – and on a selfish note, my future Senate internship and my fantasy of being the first female West Point appointment – had been snatched away.  

Still today, if I were to drive into Chillicothe from the north, I would be overwhelmed with a crushing sense of loss over what might have been as I passed the Litton Charolais farms.  I would look to the east and take in that beautiful home and tear up.  

Today, that loss is flooding back.  I just learned that Congressman Litton’s mother, Mildred Litton, passed away on Christmas morning at the age of 98.  Parents are not supposed to bury their children, much less face a loss like Mildred Litton bore with grace and dignity for 32 years.  May she rest in peace.