Health Care Delivery and Health Care Reform?

Posted on 02/16/2013 by carl

For too many US citizens, even after passage of the PPACA (Patient Portability & Affordable Care Act, usually referred to as Health Care Reform, or, pejoratively—Obamacare) and the minor improvements in the US economy after the zenith of the Grand Recession, the delivery of health care in the country is inadequate, mostly due to unaffordable cost. A USA Today poll in 2007 found that, “an overwhelming 80% of respondents said they were dissatisfied with the total tab the nation spends on health care…” Not much has changed between then and now. Federal politicians are, by their natures, unable even to begin a process of workable correction in a timely manner. No state alone can correct the national problem, and it is doubtful if even the most progressive and efficient state can fully correct even its own internal problems. There are a host of competing interest groups and industries, all with their own agendas and little incentive to compromise. We, The People, have an American problem, and the American public must become the catalyst to get useful and lasting improvements done. We must view it as a war, one which can only be won by a good faith and determined volunteer effort by a heretofore disinterested but perhaps now aroused public after the recent election cycle. Only then will our government act decisively.

Costs of the “System”
The problem is serious and getting worse. Utah Senator Bob Bennett commented on conditions since President Clinton’s universal health care plan imploded in the early 1990s, “In the intervening…years, the whole system has just gotten continually worse, more expensive, less responsive, and it desperately needs to be addressed”. That is true in 2013. Former Utah Governor and unsuccessful Republican presidential hopeful, Jon Huntsman said, “The way we go about handling health care is economically unsustainable.”  The National Coalition on Health Care (NCOHC) observed that, “by several measures, health care spending continues to rise at the fastest rate in our history”. The Kaiser Family Foundation tells us that “premiums for employer-sponsored health insurance…have been rising four times faster on average than workers’ earnings since 2000”. According to Thomas R. Russell, MD, FACS, speaking for the American College of Surgeons, “The fragmented and labyrinthine schematics that define our current health care system regularly frustrate surgeons’ efforts to deliver, and patients’ attempts to receive optimal care. Consumers, surgeons, other physicians, health care professionals, policy-makers, and other stake holders all recognize the need for patients to receive care that is more coordinated than our current system allows…[T]hese cumbersome processes lead to wasted resources, unaccountable voids in coverage, loss of information, and a failure to build on the strengths of all health care professionals”. Everyone of those statements applies in 2013 and would have applied if expressed ten and even twenty years ago. We are losing ground.
Reports indicate that some 125+ million Americans have chronic illnesses, disabilities, or functional limitations. For example, in 2004 there were an estimated 11.4 million US adults aged 18 and older who were diagnosed with chronic obstructive pulmonary disease. That disease alone constitutes a staggering cost–$32 billion per year–for American insurance companies, their customers, and American taxpayers. 122,283 Americans died from the disease in 2003. And it is largely preventable by getting people not to start smoking (80-90% of cases were caused by smoking). Some 78 million out of our population of 300 million have undiagnosed, Type I, Type II, or pre-diabetes mellitus and 1.3 million new cases are diagnosed every year of this disease which is the sixth most common cause of death in our country. There is a direct correlation between obesity (a preventable condition) and diabetes. The disease is highly manageable, but costly.
Heart disease and stroke—the two leading causes of death–are as much as four times more common in diabetics. Hypertension effects more than 65 million people; nearly 1/3 of the population. 90% of middle-aged adults will develop high blood pressure in their lifetime at a cost of $63.5 billion for one year alone (in 2006); and despite a monumental effort by the governments at all levels and care providers, we have hardly improved at all. This disease, too, is fully treatable. Chronic gastro-esophageal reflux disease (GERD) costs Americans nearly $2 billion a week in lost productivity, and those symptoms are largely treatable, but with very expensive medications. In 1990, the most recent year for which verifiable estimates are available, the indirect costs alone of mental illness imposed a $79 billion loss on the US economy. Direct costs from diagnoses, hospitalizations, medications, and providers in 1996 for mental disorders including psychoses, dementias, and substance abuse ($13 billion) were on the order of $100 billion. 53% of the costs came from public coffers. In the past twenty years, the annual growth rate of these costs was 7% overall with 23% increases in Medicare and Medicaid for mental illness. Among the consequences of our overly expensive and demonstrably inadequate mental health care system is the spate of gun and automobile homicides and mass murders in the country. Practically speaking, a dollar spent in one government health care program is a dollar less for another program.
All specialties and providers agree that there are woeful inadequacies in patient-to-provider and provider-to-provider communication. There is documentation that about half of patients leave an office visit not understanding what the physician said, and only about a quarter of primary care physicians receive a specialty consult report within a month of the time that their patient saw a specialist. There are financial roots to this problem: there are too few physicians who see too many patients for too short of a time and are paid for rapid throughput, a decided change from two decades earlier. Only recently have states and municipalities begun requiring that providers and hospitals publicly divulge their performance, errors, success and failure records—a measure that has resulted in drastic changes for the better for some hospitals and the people they serve. A survey of physicians carried out by the Annals of Internal Medicine indicated that some 45% of physicians do not report their own or other physicians’ errors, however. The PPACA has legal requirements for medical care delivery to be patient centered and accountable and has introduced a strong push for instant computer records and messenging. Unfortunately, at the grass roots level—and even at the state level in many states—there has been a great deal of confusion and intentional foot dragging, and not much has been done.
There are superlative models for how these aspects of health care can be managed, such as the Mayo Clinic, Marshall Clinic, Kaiser Permanente, and Intermountain Health Care for example, but many of the rest of the nation’s clinics, large and small, lag behind and, when scrutinized, present a rather poor comparison.
In the ten years between 1993 and 2003, according to John Maa, MD, FACS, et. al, demand for emergency room care increased rapidly; emergency room visits grew nationally by 26 percent, an increase fueled in large part by the number of Americans without insurance—more than 47 million of them, 1/6th of the population. The other uninsured group comes from the ranks of  undocumented immigrants, many of whom (of the 12-20 million illegally in the country) receive their primary care in ERs because they cannot afford to or dare not to have a primary physician or to see a specialist otherwise. Utah businesses that provide health benefits to their employees pay a “hidden” 17% premium tax to cover the cost of care for the 300,000 uninsured Utahns including 90,000 children, according to the Utah Hospitals and Health Systems Association (UHA)—360,000 according to Utah Governor Jon Huntsman. Fewer than 60% of Utah businesses now even offer health insurance to their employees. Although the PPACA mandates insurance for almost all Americans, the impact of the law will not be felt until after 2014. For the time being, we continue to languish in inefficiency and mediocre care for many of our most vulnerable citizens.
A Brigham Young University (BYU) study revealed that many companies are now offering wellness programs. Their findings indicated that for every $1 spent on wellness classes and programs resulted in a savings of $3.50 in care costs and $4 in absenteeism. Some employers are even suggesting that their employees go to Thailand, Singapore, and 25 other countries to get medical care for high-cost procedures. Jan Woodman, author of Patients Without Borders, expects the number of outsourced operations to exceed 200,000 per year for Americans, Canadians, and Europeans at a cost of nearly $3 billion. Granted, 70% of the procedures are cosmetic, there are, nonetheless, a substantial number of hip replacements, gall bladder surgeries, rotator cuff repairs, and the like, being done outside the United States. What a commentary that is on the delivery of health care to Americans.
Over 40 million American citizens cannot afford adequate health care and go without prescribed drugs (19 million), eyeglasses (15 million), medical procedures (15 million), or dental treatment (25 million) according to a federal government report released in mid-December, 2007, and that set of statistics is only worsening. A study by the American Cancer Society published in the journal Cancer demonstrated the grim fact that uninsured cancer patients are twice as likely to die within five years as those with private health care coverage. The Associated Press reports data that indicate that 20,000 people of the 560,000 cancer victims in the US are uninsured at the time they die. Medicare and Medicaid may not be available or, due to their administrative inertia, may provide the necessary care too late.
During the past ten years, the number of emergency departments in the United States declined by 425, and the number of hospital beds declined by an astonishing 198,000. The losses continue to mount since those statistics were announced a few years ago. A major contributor to the failure of these providing institutions is the inability to continue financially in a system that requires that everyone receive medical care but provides woefully inadequate or no compensation at all for too many recipients even after passage of the PPACA in 2010. Dr. Maa, in his article in the Bulletin of the American College of Surgeons, went on to document that “ambulances are frequently diverted from overcrowded emergency rooms to other hospitals that may be farther away and may have inferior services”. In 2003 alone, the authors assert, “ambulances were diverted 501,000 times”. Nothing has happened in the intervening decade to change the abysmal fact. This is chaotic and unhelpful at best and dangerous at worst. The overcrowding, long waits, and significant financial losses associated with this unfortunate set of facts exacts a serious financial toll on the American public in having to prop up suffering institutions and to subsidize the health care of a huge proportion of the body politic who contribute less than the cost of their care, to say nothing of the human toll.

To be continued…

What do you think?  Share you views, opinions, insights etc. by leaving a comment below.

Carl Douglass – Author
Carl Douglass Books
www.carldouglass.com

“Neurosurgeon Turned Author Writes With Gripping Realism”

To experience Carl’s compelling works, follow the link below:

Books By Carl Douglass

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Is Self Publishing Books A Good Idea?

Posted on 02/05/2013 by carl

Like the majority of aspiring writers, I have always wanted to hold my published book–

English: A Picture of a eBook Español: Foto de...

books–in my hand, to be able to give a copy to a friend, to feel the pride of success when I hand over a book personally to a real buyer. The words, paragraphs, and chapters of my books are like my children. The editing process with its necessary trimming and removal has been for me, and for many authors, like killing off one’s children. However, the final product is much the better for doing so, and the pride of bringing forth a full-fledged and strong adult (published book) is well worth all the effort and the angst.

It has always grated on me to see LAST PHOENIX, my first published book, gathering dust on my storage shelves at home. I was convinced from the beginning that it is a great story and is told with good writing. It is interesting, informative, exiting and a book that deserves wide and profitable distribution. For a time, my lack of success in bringing the book into the hands of a receptive public stymied my ambitions. It did not stop me from writing other books, however.

I wrote SAGA of a NEUROSURGEON originally as one long book with the more prosaic and less interesting title of NEUROSURGEON largely for my own interest and to share with a small circle of friends and family because it is such an auto fiction book. That is, my autobiography is interwoven into the warp and woof of the story. After my attempts at self advertising and promoting LAST PHOENIX, I was too timid to try the expensive and, for me, unprofitable–even costly–self-publishing route again.

So, I did inquire about what it would cost me to self-publish with the original publishers of LAST PHOENIX–Publication Consultants in Anchorage. The cost for my large book would be something on the order of $4.00 a page–a drastic increase since LAST PHOENIX was first published. That cost was beyond what I could afford and was discouraging. However, at the end of our conversation, Evan Swenson, the intrepid head of Publication Consultants, offered to purchase my rights to my new book, and we agreed upon a working contract. He would print the book with his usual high quality work, provide copies at a wholesale price to me, and provide copies for venues that were willing to accept the book. I would receive a 10% royalty for each book sold. On my part, I became a retailer of my books at whatever venue I could find. Evan prints advertising materials and provides educational opportunities for me as a novice.

The obvious advantage for me as the unknown author is that the publisher produces an excellent product–a trade level book, as opposed to a bulk paperback at a reasonable price. His supply system is a limited distribution one but is reliable and fairly responsive to my need for new copies on an as-needed basis. It is a frugal system, but unfortunately not one that is at all in favor with major book outlets.

The disadvantage of this distribution system–one that is widely used by thousands of little known authors–and it is a major one, is that venues like the few remaining book store chains like Barnes and Noble and big city libraries, the major chain store systems like Costco, Sam’s Club, and Walmart refuse to do business with limited distribution publishers.

Costco will give a limited opportunity–usually a one-time chance for an author to do a book signing–and then will refuse to afford either the author or another book from that author another chance. It is a classical vicious circle.

Although better than straight self-publishing, the limited distribution publishing option effectively disables the author from entrance into the major book world as seen by the majority of book buyers and readers. Until the author himself or herself can generate substantial sales–in the thousands–such as I described for Richard Paul Evans in a previous blog–there is no access to major marketing outlets.

That leads to the less satisfying option of bowing to the electronic age and losing the gratification of holding your book in hand. An author’s book can be sold directly online to be read–rented–as an e-book or outright purchased electronically by Amazon’s kindle books, or Nook, etc.

The e-books are relatively quite cheap for the consumer, but more widely distributed and purchased. The author gets only a small margin from the price of the book but does avoid the up-front costs to a large degree. Some advertising comes from the e-book venue, but again, some prior success in selling is important to be able to hope for success in e-book sales. Some authors even offer initial free e-books to get the electronic process a jump-start.

I have come to some conclusions about what writing, getting published, and selling books means to me. In the next several blogs, I will give some details of my book-selling odyssey which I think should be enlightening to those of you who are novice aspirants and may even give a few pointers for those at my early level of progress. I intend to share some very valuable things I am learning with practical advice from experts to get an author started in such personally uncharted territory as the bewildering world of social media. I have to say, I still like to hold that lovely book of mine in my appreciative hands.

Carl Douglass – Author
Carl Douglass Books
www.carldouglass.com

“Neurosurgeon Turned Author Writes With Gripping Realism”

To experience Carl’s compelling works, follow the link below:

Books By Carl Douglass

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Are You Wondering How To Sell Your Book?

Posted on 02/05/2013 by carl

If you are wondering how to sell your book, there are basically four general options for an author to get a book before the public. There are very few opportunities to make a profit out of your efforts. And all of the efforts entail hard work and more writing work than you have yet imagined.

1) I have described self-publishing, at least my experience with it. There are any number of self-publishing companies to help; many of them are inexpensive; some have fairly good artists that work with them or to whom you can be referred. Get online and search out the field. I will give specific recommendations in later blogs, but if you are a fledgling, you need to do some of the work of floundering around online to get a feel for what is available. Enjoy your writing; share with friends; and be content to have the publishing be a vanity process. Maybe, with intense effort at marketing, you will be able to make a profit, but by and large, it is a negative inflow enterprise.

2) Every aspiring and as yet inexperienced author sees the book he or she created as being a good one–well written, inspiring, informative, and salable. The old time concept of sending in a completed manuscript, even one that needs some copy reading touch-up and having the publisher discover you, distribute your books all over, and make you rich and famous–like the experience of Hemingway, Grisham, and Michener. That day is over–history. At the very least, it is the rarest of scenario for an aspiring author to make it rich.

Instead, to attract the interest of a big publishing house, you must first garner the enthusiasm of a well-known and successful literary agent. That requires that you write an excellent query letter. Look up how to do so on line and believe what you are told. You have ten seconds to get the agent’s attention, just as television and radio adds do to catch yours. You must right a hook sentence–one sentence–that grabs the attention.

Remember, the agent and the publishers are not really interested in good writing and only somewhat in good storytelling. This is a business, and they are in it to make money. The value of your offering depends upon whether or not they think you can make them money. I will talk more about all of that in future blogs.

3) Find a limited distribution publisher like Jolly Fish in Orem, Utah or Publication Consultants in Alaska and deal directly with the publisher. They do good work and give limited help, but do not expect them to launch an expensive campaign or to do the work of selling–that is up to you.

4) Self-publish and beat the bushes. Go to every library, bookstore, grocery outlet, and obscure book store you can find. The big bookstores, and just about the only national one left is Barnes and Noble, won’t take your books. Sell 100 books a year for four years and get a publisher to re-publish the book under a different title which may help you sell another 100 books in the next couple of years. Then go electronic. E books are the thing. They are relatively easily to do, and nobody much cares about the content or quality of the writing or even if you know how to punctuate.

Finally, if you love to hold your book in your hands and to share it with other people you like–and I readily confess that I do–find an inexpensive self-publishing company, do it yourself online, or go to Kinkos. It is better than sitting around and dreaming. If you really want to get your story and your name out there and can live without having a physical book, go the e-book route from the beginning. Think about it.

Carl Douglass – Author
Carl Douglass Books
www.carldouglass.com

“Neurosurgeon Turned Author Writes With Gripping Realism”

To experience Carl’s compelling works, follow the link below:

Books By Carl Douglass

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Are You Having Trouble Marketing A Book?

Posted on 02/05/2013 by carl

The difficulties and expenses of marketing came as something of a jolt once I had 3300 copies of LAST PHOENIX in my possession. The number of books was non-negotiable, and the cost was daunting. So, I set about to market my Great American Novel (tongue very much in cheek).

My publisher arranged several dozen telephone radio call-in show appearance at $50.00 cost for a 30 minute segment. I had the opportunity to sell myself and my books and to be subjected to a truly diverse set of questions coming in from the radio audience and other planets. I never fancied myself to be much of a public speaker let alone a radio personality, and it was a nervous beginning. With time, I learned how to talk about the book without hemming and hawing and saying “uummm”.

I came to enjoy the repartee with the talk show hosts and to be able to divert the call-in audience’s questions back to the issue at hand that I cared about for the most part. I developed a spiel that was short, too the point, and catchy–at least I thought so.

However, the other planet people spend a lot of time on call-in shows, and some the questions they posed were so bizarre and tangential that they defied an answer. On one Nevada show, I was deluged with conspiracy theories as soon as I mentioned that my book had to do with the CIA. That allowed the Martians, Klingons, and Nevadans who stay up late to ventilate about their own pet conspiracy concepts.

I am pretty sure that I had several opportunities to provide talk therapy to more than a few schizophrenics.

Anyhow, suffice it, that avenue of marketing did not pan out. Next I placed books in grocery stores, freebies in libraries, and finally hired a distributor of books who assured me that he regularly put books on shelves of stores of all kinds. He was primarily a distributor for aspiring authors of themes related to the locally predominate religion.

I checked in the stores. No books there. In time, I went to his office, and he was out. My books, however, were in. They were all neatly stacked in a their boxes in a far corner of the warehouse. When I confronted the crook, I learned that he suffered from several fairly severe disease processes: deafness, dumbness, amnesia, and a thought process disorder that interfered with his capacity to do math or to make difficult decisions like giving me back my money.

I looked into getting a publicist and found that they abound. The cost for an advertising blitz is prohibitive. At that time, the price was around $20,000 for a region and 10-15 times that for the nation.

Unfortunately, even with that cost, it was extremely unlikely that the big book stores (where intelligent readers actually buy books) would ever put one of my books on their shelves because they did not come from from a national distribution publisher–one of the big publishing houses like Random House, Harcourt Brace, or Doubleday.

Marketing was certainly not my forte, and I decided that I would just write novels and nonfiction for the love of writing and giving my efforts to friends. Think about it.

Carl Douglass – Author
Carl Douglass Books
www.carldouglass.com

“Neurosurgeon Turned Author Writes With Gripping Realism”

To experience Carl’s compelling works, follow the link below:

Books By Carl Douglass

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Is Gun Control Or Confiscation Enough Or Even Likely? Part 2

Posted on 01/30/2013 by carl

What can we do to prevent massacres?

Unfortunately, the problems of guns and massacres have become an issue of politics. Politicians exist and work to be re-elected as their primary career goal. They appear to have little interest or, in fact, have an aversion to dealing forthrightly with major political issues where the voters are nearly equally divided on a question and the differences are stark and emotional.

We the People must achieve protected safe environments for our schools, shopping malls, sports and entertainment venues, and wherever citizens gather, the apathy and indecision of our politicians notwithstanding. Protecting innocent life trumps all other concerns—cost, political correctness, partisan politics, or convenience.

I therefore propose an unpalatable and imperfect but hopefully reasonably effective set of solutions to this wearying conundrum. The short term solution is to create a guardian force throughout the country having at least the following attributes:

1.  Every school should have armed guards inside its buildings patrolling the hallways and entrances and exits throughout every place were humans congregate, work, or study.
School grounds and perimeters should be scrutinized frequently—say once an hour—by both foot patrols and in vehicles.

2.  All guards should be armed with non-lethal and lethal weapons and have available restraints to secure threatening individuals. Guards should be protected with body armor and bullet resistant clothing.

3.  All guards should be thoroughly vetted, trained, certified, and bonded; and they should undergo regular refresher training and testing to be recertified.

4.  All guards should function under the aegis and discipline of local or state law enforcement. Alternatively, a federal program similar to the TSA could be established.

5.  Unpaid volunteers could well be used as guards, particular for perimeter patrol.

All rules (1-5) would apply for these volunteers just as they do for licensed law enforcement personnel. The NRA already has in place firearms training programs with a heavy emphasis on personal responsibility and accountability. In an atmosphere of compromise, I am confident that the NRA would step up to help and to be an important asset to save our law-biding, our most vulnerable, and our least protected citizens—those law-abiding citizens without guns.

Federal, state, county, local and school district funding will be required. And, yes, that would necessitate a modest raise in taxes. Our children are of infinite worth—they are our treasures and our future—and stinginess that leaves them unprotected is morally reprehensible when viewed in that perspective. In addition, philanthropic foundations, charitable groups, and enlightened individuals should be invited to make contributions to help defray the attendant costs of providing the necessary safeguards.
Metal detectors and screening devices should be in place at every entrance and should be manned by competent trained officials.

All guards, teachers, school administrators, and other personnel—even cooks, janitors, and bus driver–should have communications devices that are supervised by law enforcement for controlled person-to-person information transmission in a timely fashion.

By local or state consensus and acting under statutory law, teachers and other personnel may also have weapons but should not be compelled to do so. All such personnel who choose to be armed in their school should be required to comply with the same requirements that guards must obey.

Schools should be retrofitted to have secure panic rooms located in several strategic locations throughout the school. The rooms should be bomb and fire proof and procedures should be established to allow safe communication from within and without the rooms.

I suggest that somewhat similar protective procedures be tailored for and put into place in shopping centers, theater complexes, sports venues and similar gathering places. While the individual private venues should bear primary responsibility for funding the protection, government will have to assist in funding. That governmental help should be linked to an attendant obligation on the part of the owners and managers of private facilities to provide protection to the public.

Finally, there is the thorny issue of gun control in the short term. As a minimum, new laws should be enacted to make it an imprisonable felony to have in the possession of a person any form of a firearm, explosive, or incendiary device either on the individual’s body or in his or her vehicle within 500 yards of any school. Arrest and conviction for such an offense should be a felony punishable by a heavy fine and automatic imprisonment.

Even in the short term, the time has come for both sides to compromise on gun possession. To start with, AR-15 and other semi-automatic or automatic hand guns or rifles can be owned privately but must be controlled under lock in a registered gun range and only used there. No one needs a machine gun for hunting or self-protection. There are already laws in every state forbidding sawed-off shotguns, etc. and those laws need to have more vigorous enforcement. The same kind of restrictions should apply to large capacity ammunition dispensers for firearms, conversion devices for semi-automatics, and anything else that can serve to further the possession of weapons of mass murder.

There is a major political stumbling block for any national debate let alone major changes on gun issues—the disproportion in money and power in favor of gun advocates. NRA membership is 4,300,000 as opposed to Brady Campaign membership at under 28,000 Americans. Since 2009, the NRA and associated advocates for gun rights have spent nearly 25 times more in Washington than those advocating for gun control, according to the Center for Responsive Politics. Gun advocacy groups have spent $20 million on political contributions and lobbying over that time, while gun control groups have spent $832,000. The NRA has a $300 million budget. Last election, more than 250 candidates for the House of Representatives received the NRA’s endorsement, about a quarter of them Democrats. The association spends millions of dollars every campaign cycle, both on direct campaign contributions and independent expenditures. In 2010, the NRA ranked tenth for outside spending groups in that election, according to the Center for Responsive Politics.

Candidates receive an average of about $2,000, which increases the odds that multiple candidates in an election will support gun rights. After a string of victories in the courts and Congress, the NRA has increased its funding and power and has both Democrats and Republicans courting its favor and avoiding its wrath. Combined, sources such as fundraising, sales, advertising and royalties produced about $115 million in 2010 with more than 50 firearms-related companies giving at least $14.8 million. Not unexpectedly, the legal and political debate over gun laws has followed a familiar trajectory: toward fewer restrictions.

Anti-gun advocates must compromise to admit the rights of law-abiding gun enthusiasts to bear arms in compliance with the above restrictions and any other safety laws that may be enacted. There should be an end to the useless wrangling which so obfuscates the overridingly crucial need to protect our precious children and other innocents.

In a compromise, everyone and every position has to give—give some to get some. In the United States, there has developed such rancor and animosity that neither pro nor anti-gun factions dare to compromise for fear that a concession will allow the camel’s nose under the tent flap and to compromise their heart-felt concepts and agenda. It is time, posthumous, for that kind of mind-set to be set aside mutually. It is time to stop obscuring the issue of the crucial need for protection.

Being practical and real, such compromises will no more launch a police state than having the TSA protect our air travel or requiring driver licenses and proof of auto insurance. Such compromises will not deprive gun advocates from owning and using firearms. It is a right under the constitution to do so, but nowhere is there a right to have any and every weapon, particularly those capable of launching a massacre.
If the short-term goals, limited as they are, can be achieved, then perhaps We the People can come to a long-term solution about how to deal with the broader issues of managing the manufacture, distribution, and sales of firearms and to establish effective laws to control who can have weapons.

Long-term goals should–at least–include:

Registry, storage, use, and accountability for military and law enforcement weaponry including any and all weapons capable of waging a massacre. Ownership can be allowed, but the weapons, ammunition, and magazines should be limited to legitimate hunting and self-protection needs, and more destructive weapons and ordnance should be seriously controlled. In the current political climate, that suggestion seems to be naive and likely doomed to the fate of most attempts to gain control over dangerous firearms being in the hands of dangerous people. As recently as January 13, 2013, David Keene, President of the NRA, stated that, “The likelihood is that they (Congress) are not going to be able to get an assault weapon ban through this Congress.” With his organization’s powerful hold on members of Congress and the NRA’s immense wealth and influence, it would be a poor gamble to bet against Keene’s statement.

Voluntary buy-back programs for weapons currently in the possession of U.S. citizens should be widespread, convenient, and fair, not compulsory. Currently owned guns, with the exception of those capable of aiding and abetting a massacre should be grandfathered in otherwise.

A more rigorous set of laws and enforcement procedures is needed. No one with a verifiable history of felonious criminal activity or a conviction for weapons violations, domestic violence, substance abuse (including alcohol and marijuana), DUI, public intoxication, sexual predatory offenses, or a mental illness should have the privilege of having in his or her possession any explosive, firearm, or large bladed weapon. Arrest and conviction for violations of these laws should be treated as imprisonable felonies and punishments should also include heavy fines.

Sales of any and all firearms should be rigidly enforced. No firearm, no ammunition, and no explosives should be sold to any person who has ever been convicted of crimes as described in item 3 or to individuals with established mental illness or who takes any of the 31 antipsychotic medications which have adverse psychological effects.
No flea-market type or person-to-person sales or gifting of firearms may be used to convey fire arms. No law enforcement organization may confiscate and then re-distribute confiscated weapons.

Explosives of any kind and in any amount and for any purpose may only be sold to appropriately licensed individuals, and companies. Military grade explosives transactions must require licensing, proof of citizenship, security clearance and proof of up-to-date, training and competency.

It is not that reasonable restrictions about who can possess guns under law have failed to be passed. After the Virginia Tech massacre in 2007, Congress passed a law to keep guns out of the hands of the mentally ill, a measure that was signed into law by President George W. Bush. One of the law’s principle purposes was to strengthen an earlier National Instant Criminal Background Check System by establishing new and firmer incentive and penalties to prod the states to submit records of people legally barred from buying firearms. The 2007 law included those who had been committed to mental institutions. Less than half of the states have provided mental health records to the federal government database that law-abiding gun dealers are required to use for background checks on buyers. States have dithered over which of their mentally ill citizens should be included in the base, and they cannot agree sufficiently to permit a cohesive and effective policy nationwide—or even statewide in most states. Technically, most states have been unable to figure out how to gather the requisite records given the powerful restrictions imposed by HIPPAA guidelines and due to a stumbling block clause in the 2007 law, one that the NRA has championed because it allows its contention that only violent schizophrenics should be restricted. The clause, simply put, requires states to establish a standard appeals process so that mentally ill persons (including those involuntarily admitted to mental hospitals) can have their gun rights restored. The current administration has publically stated that the laws are not clearly enough written and what is written has not been implemented. I agree with the Obama administration that it is high time such laws were revisited and drastically improved.

Concealed carry permit holders should be subject to periodic retraining and recertification. When indicated, physical and psychological certification may be required. Anyone who fails the tests described in item 3 above should automatically lose the carry permit.

No illegal or undocumented person should ever have any permit to have a gun. If found with a gun on his or her person or on his or her property during a legally sanctioned search, should be subject to serious criminal sanctions and not simply deported.
In short, to quote the Brady Campaign recommendations, we need a policy to keep guns out of the hands of criminals and other dangerous people and public health and safety programs to inspire safer attitudes and behaviors around the 300 million guns in our homes and communities.

A long-term solution will take a long time to achieve and will require a genuine effort to compromise, patience, and exercise of common sense and good will directed towards potential future victims of would-be shooters. No one can get everything he or she wants, and no compromise will succeed or persist if the agreement is forced or is unequal. NRA and Brady Campaign (Brady Center to Prevent Gun Violence) opponents alike will have to agree on the way to achieve the common good—saving our citizens while protecting legal gun use for qualified, law-abiding, and responsible citizens. It might be a good idea to pay attention to what the American public as a whole actually wants, politics aside. In major polls for decades, gun control, in general, has not been politically popular. Since 1990, Gallup has been asking Americans whether they think gun control laws should be stricter. The answer, increasingly, is that they do not. Gallup reports, “The percentage in favor of making the laws governing the sale of firearms ‘more strict’ fell from 78% in 1990 to 62% in 1995, and 51% in 2007.” In 2010, Gallup found only 44% in favor of stricter laws. However, Americans do not tend to prefer a blanket avoidance of stricter gun laws. An August, 2012 CNN/ORC poll asked respondents whether they favor or oppose a number of specific policies to restrict gun ownership. Asked pointedly, respondents supported many policies, including banning the manufacture and possession of semi-automatic rifles, which are being proposed by Vice-President Biden’s committee in the first of the new year, 2013.

The goal of having a responsibly behaving armed citizenry is a quality of our American culture which should be fostered. The negative violent quality of American culture needs to be brought under effective control and diminished significantly if we are to have a decent country in which to live free of fear. Perhaps the first day of the new debate should center on obtaining agreement on those two principles.

What do you think?  Share you views, opinions, insights etc. by leaving a comment below.

Carl Douglass – Author
Carl Douglass Books
www.carldouglass.com

“Neurosurgeon Turned Author Writes With Gripping Realism”

To experience Carl’s compelling works, follow the link below:

Books By Carl Douglass

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Is Gun Control Or Confiscation Enough Or Even Likely? Part 1

Posted on 01/30/2013 by carl

Since the most recent horrific massacre of school children in the Newtown School, Sandy Hook, Connecticut, Friday, December 14, 2012, there has been the expected spate of media articles and pundit opinions in all levels and types of media. Once again the heated question of gun control or outright confiscation has found a conspicuous place in the list of important national debates in the United States. And once again, very little is going to be done. It is my contention that we are having the wrong debate. Guns are not going to be controlled or confiscated to the degree that no evil or mentally unbalanced perpetrator can obtain one or more of them to commit mass murder. Instead, we should narrow our focus to the question of how can our school children, theater goers, mall shoppers, or any other people who gather in groups be made safe.
I am seventy-two years old and grew up in the West. I have a long history with guns, target shooting, and hunting. My house has trophy heads; my gun safe is full; and I carry a concealed weapon as a necessary self-protection from cougars and coyotes in the hills around my home and occasionally for social forays into cities. I am a member of the National Rifle Association. I spent ten years in the navy during the Viet Nam war. I have never shot at or killed anyone; no one in my family has ever used a gun in a crime or had a gun accident. Nevertheless, I am an advocate of serious measures to protect people from violence including select measures of gun control. I would like to share my seemingly conflicting opinions because I strongly wish to see a safer society in my country and especially for my grandchildren in elementary school, high school, and college. I also believe that the second amendment to the US constitution guarantees the right of law abiding citizens to bear arms and that the self-protection and sport value of certain weapons is a privilege that should be protected.
The ever recurrent national debate is in full swing at the time of this blog post and has descended, as it always does, to a partisan political issue. There is the “money” congress and the “gas” congress. This issue, like abortion and immigration, is a gas congress vote-getting project for both sides of the debate. Facts, factoids, truths, lies, and statistics fill the airwaves and the Ethernet. There are three kinds of lies: lies, damned lies, and statistics; and I will take up some space here to deal with statistics.

Do We the People have a violence and gun problem: Yes, we do.
15 of the 25 worst mass shootings in the last 50 years took place in the United States. An organization called Mother Jones has tracked and mapped gun use and shooting incidents, especially massacres, in the United States for at least thirty years. From 1982 until the hideous crimes in Newtown, Connecticut in December, 2012, there have been 62 mass murders with firearms involving thirty states all the way from Massachusetts and Connecticut to Utah and Hawaii. Twenty-four incidents occurred in the seven years since 2006 alone. 90% of the guns used were illegal; 9% were illegal; and in the last 1%, investigators failed to make a firm determination. Daniel Webster, director of the Johns Hopkins University Center for Gun Policy, a relatively objective think-tank, reported that violent crime and murder rates have fallen in the United States but that mass murders have increased somewhat. Between 2006 and 2011, the general murder rate declined by 19% to a low of 4.7 per 100,000 people in the population. There is controversy about whether gun-based homicides are increasing, and most investigators do not see any major increase at least, particularly when the rapid increase in the population is taken into consideration.
The evidence for mass killings with guns—or any other form of lethality—is quite clear that there is no increase, in fact, the opposite. During the first decade of the 2000s, mass killings with guns dropped to the lowest rate in fifty years. The peak incidence year for mass killings was 1929. In the decade of the 90s there were 42 massacres, and there were 26 in the first ten years of the 2000 era.
There does seem to be some increase of late. All one has to do is turn on any news program on any television or radio program or read any national newspaper on any given day to see the alarming tendency in our country. The Newtown School event resulted in the second largest mass killing of innocent civilians in American history. Gun deaths by homicide, suicide, or accident peaked at 37,666 in 1993 before declining to a low of 28,393 in 2000, the data show. Since then the total has risen to 31,328 in 2010, an increase of 2,935, or eight more victims a day.
Mass murders are uncommon if not outright rare, but any sentient person in the United States has to be aware that shooting injuries and deaths are not. On average, 85 Americans are shot to death every day; 53 of them suicides and 32 homicides. Every day, one of those killed by firearms is age 14 or younger and still more children die in accidents, suicides, and from homicide and neglect. More than 200 people go to U.S. emergency rooms every day with gunshot wounds. In 2008 alone, the U.S. had over 12,000 firearm-related homicides. An embarrassing and tragic fact is that of the world’s 23 most developed, best educated, and most affluent countries, the U.S. gun-related murder rate is almost twenty fold greater that of the other 22. The same year, all of Japan—a nation with the most stringent gun laws and the fewest guns per capita—experienced just eleven gun murders. This was fewer than were killed at the Aurora, Colorado theater shooting alone. The University of Chicago Crime Lab and the Centers for Disease Control estimate the annual cost of gun violence in U.S. society to be $100 billion.
According to the Atlanta-based Centers for Disease Control and Prevention, shooting deaths in 2015 will probably rise to almost 33,000, and those related to autos will decline to about 32,000, based on the 10-year average trend. That prognostication is probably not far off the mark, but it does not pertain directly to the mass murders in schools, shopping malls, theaters, and other places where people gather for public interaction. There is a significant anti-gun bias in media reporting with pro-gun advocates being given short-shrift; for example, almost nothing is ever reported about individuals who protect themselves and others by producing a gun—yet rarely having to resort to killing to achieve that protection. There is a non-stop barrage of “news” mixed with opinion about the evils of guns every time an incident occurs. As indicated above, the anti-gun bias is loath to comment on the decline in massacres or to the increasing population of the United States. This blog post relates not to murders in general but to mass murders, and it is the opinion of the writer that there are active, positive, real-world things that can be done to prevent them.
The National Rifle Association (NRA) based in Fairfax, Virginia, and other pro-gun advocates point to Israel and Switzerland as exemplars of a society where guns abound but the violent crime rate is low. Both countries have requirements for at least certain households to keep and maintain in readiness fully automatic assault rifles, and concealed weapons licenses and an assortment of serious firearms are easily obtainable by law-abiding citizens. In fact, the proponents of the argument say, the presence of so many guns is an actual deterrent to crime. A decade ago, that argument was correct; but times have changed. Now gun ownership among citizens of both countries has decreased to the point that neither have high levels of gun ownership as a personal choice, at least in comparison to gun ownership rates in the United States. Both countries now require citizens to have a reason to have a gun, i.e. gun ownership is a privilege, not a right. One needs a reason. Further, gun owners are required to go back to the permitting authority every six months to assure them the reason given is still valid. In Switzerland the laws are done canton by canton (province). Everyone in Switzerland serves in the army, and formerly the cantons required their citizen-soldiers to have the guns at home. Over the past decade, the Swiss government has adopted an active policy of moving guns into depots. The Swiss are, by culture, very law-abiding, and the removal of their guns has not been accompanied by any apparent level of protest.

Would We the People be free of massacres if guns were somehow removed in toto from private ownership? No, unfortunately, we would not.
Violence is as American as apple pie and always has been. The massacre by terrorists on September 11, 2001 involved airplanes. The non-gun violence statistics are appalling from that heinous event. The total number killed in New York was 2,753. The number of firefighters and paramedics killed was 343, NYPD officers 23, and Port Authority police officers 37. 115 foreign nationals were killed. No remains of 1,717 victims were ever found. 1,609 people lost a spouse or partner. 3,051 children lost a parent. An estimated 422,000 New Yorkers suffer from post-traumatic-stress disorder as a result of 9/11. 1,506,124 tons of debris were removed from the site.  An estimated amount of insurance paid worldwide related to 9/11 was $40.2 billion. It cost $7.5 billion to overhaul lower-Manhattan subways; the cost of cleanup was $600 million; and FEMA spent $970 million on the emergency. The U.S. economy was devastated: In New York City, alone, there were approximately 430,000 jobs lost and $2.8 billion in lost wages over the three months following the 9/11 attacks, and 18,000 small businesses were destroyed. When the NYSE reopened it recorded a point drop in the Dow Jones industrial average of 684.8. Indirectly, the 9/11 attacks led to the war in Afghanistan with a cost of more than $5 trillion to the time of this blog post.
The American terrorist, Timothy McVee, perpetrated the Oklahoma City bombing attack on the Alfred P. Murrah Federal Building in middle of Oklahoma City on April 19, 1995. It remained the most destructive act of terrorism on American soil until the September 11, 2001 attacks. According to Wikipedia, The Oklahoma blast claimed 168 lives, including 19 children under the age of 6, and injured more than 680 people. The blast destroyed or damaged 324 buildings within a sixteen-block radius, destroyed or burned 86 cars, and shattered glass in 258 nearby buildings. The bomb was estimated to have caused at least $652 million worth of damage. That act of terrorism was not a mass shooting; it is no less a mass murder for the lack of gunfire.
The statistics above on guns do not include killing and wounding by knives—poisons such as strychnine, arsenic, and Fumitoxin pellets which, when mixed with water, release deadly phosphine gas—blunt force trauma, strangulation, intentional starvation, arson murder, torture, carbon monoxide poisoning, being thrown from a height, or intentional vehicular murder. In 2003, an 86-year-old man mistakenly stepped on the gas pedal of his car instead of the brake and then panicked, plowing into an open-air market in Santa Monica. Ten people were killed and 63 injured. In Los Angeles on August 29, 2012, a 100-year-old man backed his car on to a sidewalk and hit 11 people, including nine children, across from an elementary school in South Los Angeles just after classes had ended. Four children were critically injured. It is apparent that those deaths and injuries were accidental, but cars, like airplanes could easily be a means of causing something of a mass murder if an evil or mentally impaired individual lacked a gun but had homicidal intentions.
I am told that Mexico has triple the homicide rate of that in the United States and a significant percentage of them are by knife owing to the poverty of the people which limits their access to guns. In June 2001, a 38-year-old unemployed man, Mamoru Takuma, burst onto an elementary school in Osaka and stabbed eight children to death with a knife and injured 13 other students and two teachers. There is a news story that a school invader in Japan used a katana sword to behead 17 children. If true, it was the worst school-related killing in Japan’s history. If not, the 2001 stabbings qualify for that dubious honor. Japan has extremely stringent gun restrictions and negligible homicides by firearms. During the second week of January, 2012 there was an attack on 22 students in a Chinese elementary school by a disturbed man wielding a knife. None of the children or teachers were killed. On August 27, 2012, Taliban militants beheaded 15 Afghan men and two women with swords because they participated in a party where music was played. No guns were used or needed.
It would be difficult to forget the murder of innocent Japanese subway riders by cultists employing sarin gas. The sarin attack on several Tokyo subways, was an act of domestic terrorism perpetrated by members of Aum Shinrikyo cult on Monday, March 20, 1995. A single drop of sarin the size of a pinhead can kill an adult. On the day of the attack, ambulances transported 688 patients and nearly five thousand people reached hospitals by other means. Hospitals saw 5,510 patients, seventeen of whom were deemed critical, thirty-seven severe, and 984 moderately ill with vision problems. Eight people died, and most of the remaining patients were well enough to go home the following day, and within a week only a few critical patients remained in hospital. Japan has gone to considerable lengths to ensure that such a poison attack never occurs again. The potential for using sarin to cause a catastrophe if employed by determined and better equipped and trained terrorists is incalculable in a crowded urban society.
I witnessed almost all of the inhumanities of man to fellow man during my medical and surgical training and during my service in the navy in the Viet Nam era and included them in my two books, SAGA of a NEUROSURGEON, a novel in six books, and LAST PHOENIX, a novel of the CIA’s Phoenix Program in Southeast Asia. Take away guns, and there are other tools. I am fully confident that killers will find a way.

Why is America so violent, and why do we have so many killings and massacres involving guns? The answer is convoluted and unclear—or unproved.
In the short run, it probably is not particularly important why a small fringe of our population is so violent. At least for the purposes of this blog post, the fundamental issue remains: how do we prevent further massacres? In the long run—over decades—perhaps our society will become less vehement about the “right” to bear any and every weapon and will agree to put the most dangerous firearms in a certified and managed depository in a gun range.
There are multiple hypotheses about why we kill innocents with guns (or knives, or poisons or with arson) but no scientific theory that holds up against evidence to the contrary. Many people, especially parents, blame the desensitization of our youth by long exposure to violence in the media. Others blame the dissolution of the traditional family. Still others blame the NRA, gun manufacturers, arms dealers, and an ignorant gun-loving populace.
For the most part, the killings do not appear to be revenge killings, although youth who have been bullied are sometimes involved in both accomplished or thwarted violent attempts. It is speculated, but unproved, that the mass murderer may be delusional or otherwise mentally or psychologically impaired and has the motive—almost incomprehensible to the rest of us—centered on the desire to have a few days of fame (or infamy) and publicity derived from them even though the shooter is more likely than not to be dead and unable to enjoy his fifteen minutes of notoriety. Most of the rest of us attribute such thinking to a delusion. There may be something to the apparent trend that each new attacker is seeking to top the one that came before in some way in a clear bid for a place in the evil hall of fame. Despite their own pundits voicing the opinion that the action may be generated by the desire for such fame, the media continues to indulge a twisted obsession by unbalanced people. The general public overwhelmingly believes that the reward for this behavior should be anonymity and be awarded instead the label of unstable loser. Most rational people think that approach would cause the attacks to taper off.
We blame our significant population of mentally ill citizens, mentally challenged individuals, and lenient courts who treat them carelessly. Mental illness does appear to be one of the most likely factors. A survey by Mother Jones found that at least 38 of the 62 mass shooters in the past three decades “displayed signs of mental health problems prior to the killings.” Nevertheless, the accumulation of careful scientific studies leads to the disheartening conclusion that researchers still do not fully understand the exact connection between the mental illness and crime—especially mass murder. That is an important deficit in our understanding because we cannot accurately predict which mentally ill person will snap and go on a shooting spree, and we cannot lock up every mentally ill patient simply because he or she has a psychiatric condition. Advocacy groups for the mentally ill such as the National Association for the Mentally Ill (NAMI) bristle at any attempt to stigmatize mentally ill people by declaring them incompetent to handle firearms, and label such attempts as invasions of privacy and infractions against the civil rights of the mentally ill. They generally strive to prevent such characterizations on a social and legal basis and oppose serious gun handling limitations.
We blame the medications they take for their psychiatric illnesses. Careful observes note that anti-depressants and similar drugs were introduced in the 1980s and billions of pills have been used by millions of Americans. It may not be coincidence that the spate of massacres in the United States showed a crescendo rise at about that same time. These medications have helped many disturbed people to have better lives but have also been clearly linked to homicidal ideation—thoughts of murder and suicide. In 2010 a publication from Harvard Medical School and a Wake Forest research team found that 31 drugs were statistically significantly connected with actual violence against others.
Finally, it is common to blame government for failing to pass effective legislation to control guns, police forces for failing to pursue the laws already on the books, and ourselves for lacking courage to stand up to big business and the rich and uncompromising gun lobby.
There are certainly cultural differences among the different regions of the country. The southern states, roughly those which seceded from the union prior to the War Between the States, have the highest gun possession per capita, the highest membership in the NRA, the most so-called assault rifles, the highest violent crime rates, the lowest educational achievement, and the lowest socioeconomic status of the several US regions. American cultures and the society in general differ strongly from other nations. We are more diverse and less homogeneous, less bound to tradition, less socialistic, more independent, more affluent, more paranoid, less willing to obey the dictates of governments with which we do not agree or to obey laws that we consider inappropriate or plain wrong. Guns were taken from the British, the Australians, the Germans, and the Japanese with very little objection and with mixed results on their crime rates. In the matter of gun control and obedience to unpopular laws, we are not British, Australian, German, or Japanese. There are estimated to be some 300 million guns in the United States in the hands and gun safes of stubborn citizens—1.8 per adult—who are not going give all of them up to any governmental unit.

Is it as simple as the availability of guns being the most important factor as most anti-gun advocates like Piers Morgan, the television personality, would have us believe? It is impossible to verify how many guns are owned legally or illegally in the United States, Johns Hopkins University reported. A survey in 2005 estimated the number of firearms around 300 million. In late 2012 and early 2013, following the terrible school attack in Sandy Hook and the threats of gun control measures to be enacted by governments, gun dealers have recorded all time record sales of all sorts of firearms throughout the nation. AR-15 semi-automatic rifles have continued to sell at rates that tax the ability of gun stores and manufacturers to keep up—many stores report AR-15 sales in one day that exceed sales during an average month previously. The percentage of gun-owning households has fallen since 2004 to 32 percent in 2010, according to the General Social Survey by NORC at the University of Chicago. The survey indicates that there are at least 1.8 firearms per household, in at least 70 million households nationwide, Tom Smith, the General Social Survey’s principal investigator, reported in a statement that antedated the abrupt rise in purchase rates as the nation enters 2013. Sociologists studying graphs of gun ownership plotted against acts of violence reached the following conclusion: The most striking features of the data are how much more violent the U.S. is than other OECD countries—except possibly Estonia and Mexico
Researchers have found a fairly clear-cut connection between the availability of guns and homicide; more guns generally tend to lead to more murder, and guns make any mass attack far deadlier than attacks with knives. The Harvard Injury Control Research Center assessed the literature on guns and homicide and found there to be substantial evidence that more guns means more murders. This holds true whether you’re looking at different countries or different states. This finding is certainly not infallible: consider the regional differences in the United States. Gun owners in the West do not murder as often nor have many victims as gun owners in the South. Israelis and Swiss have a fairly high gun ownership per capita somewhat comparable to the United States, but their murder rate is far smaller. Mexicans have more murders and fewer guns.
None of these hypotheses alone appears to be a complete or even an adequate explanation of causation for the violence that prevails in America, especially for the gun-based rampages resulting in mass murder; perhaps a combination of several or all of them is responsible. An article in the American Journal of Public Health, 2010, came to that conclusion. They stated: “To understand and prevent rampage violence, we need to acknowledge that current discipline-based violence research is not well suited to this specific challenge. There are numerous important, unanswered research questions that can inform policies designed to prevent rampage violence.”

To be continued….

What do you think?  Share you views, opinions, insights etc. by leaving a comment below.

Carl Douglass – Author
Carl Douglass Books
www.carldouglass.com

“Neurosurgeon Turned Author Writes With Gripping Realism”

To experience Carl’s compelling works, follow the link below:

Books By Carl Douglass

 

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