Index Home About Blog
From: B. Harris)
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 15 Apr 1999 09:05:48 GMT

In <7f2nbj$mgo$> (George
Conklin) writes:

>  The proper comparison can be found in comparing Utah to
>Nevada, and it has been properly done, and not by
>self-serving fee-for-service MDs either.

    I wait with bated breath.  Utah and Nevada are certainly natural
comparison states.  Utah has twice the population density.  Both states
are Mormon, except Nevada.  Utah has the youngest population in the
country, with all those children sucking education dollars out of the
state tax budget that is trying to pay medicaid.  Nevada, where there
are no state taxes, since the population is older and idiots in casinos
provide money for medicaid.

    Nevada, where prostitution is legal, except in 3 counties.  Utah,
where prostitution is legal except in 29 counties (there are only 29).
Except when prostituting the state itself for the Olympics, which is
not a county function, but rather an offical function.  Nevada, where
gambling is legal.  Utah where it's illegal to gamble, except when
passing a Utah driver on the left.  Las Vegas, where you can get
married on the spur of the moment, by Elvis.  Utah, where the wedding
plans take 6 months, and although the bride isn't pregnant, her mother
is.  Utah, which has the tertiary care and cachement center for sick
children for 5 states, who arrive by helicopter.  Nevada, which has the
cachement center for sick elderly for 40 states, who arrive by bus.
Utah, which has the lowest lung cancer rate in the country.  Las Vegas
which has the highest of any city, and the casinos have installed
defibrillators for all those older smokers who have MIs when too many
lemons come up.  Vs. Utah where the defibrillators are for public
school teachers when the the word "condom" comes up.

   I will admit that Southern Utah is pretty dry, and looks like
Nevada.  Sort of.  If you don't know them well.  Is that your point?

                                      Steve Harris, M.D.

From: "Steve Harris" <>
Newsgroups: sci.econ,
Subject: Re: Catastrophic Collapse of Socialism: SARS and AIDS
Date: Tue, 3 Jun 2003 17:24:53 -0700
Message-ID: <bbje8k$obi$>

"David Lloyd-Jones" <> wrote in message
> The streets (and the lobbyists offices, and the Republican politicians'
> sties) of DC, and the Indian reservations of the Dakotas, are free
> enterprise at its most naked.
> Utah is a state with an effective government *plus* a massive Church
> operated social welfare establishment.
> It would be difficult to imagine a set of opposites which more
> dramatically illustrate the evils of the American free enterprise
> insurance system and the virtues of socially administered health care.
>                                    -dlj.

The Utah church welfare system is free enterprise.  Only 70%
of Utahns belong to it, they pay 10% of their income to do
it, and it's all voluntary. No government is involved,
except that it does get to run tax-free, like any charity.

Even if they didn't want to be Mormon, the folks on the res
on in the streets of D.C. could do the same with their own
churches or religious organizations, but they are too stupid
or lazy or unwise to do so.  This says nothing about US
medicine or the US federal government. It does say something
about the folks who don't live in Utah.

After having lived in Utah for 20 years (as well as in
California and other states for even longer) I can tell you
that Utah's government is no more effective than anybody
else's state government (though it's probably better than
California's). Utah, in fact, has a number of severe
problems which handicap state government attempts to run
state medicade. Not least of which is Utah's comparitive
lack of natural resources to tap for taxes, unlike
California, Nevada, Wyoming, Texas, and many other states.
And yet Utah gets by.  Its people live healthier life
styles, so health cost there are something like 1/5th per
capita than they are in California.

The problem is not so much govenrment health care, as it is
Federal vs. State funded healthcare. If you want to see a
nightmare of a healthcare system run ONLY federally, look
indeed at D.C.   Or, at the V.A. system. Neither of these
monstrosities convinces me that the Feds should have
anything to do with
healthcare.  The bloated Medicare system has enough problems
even transferring money from the 85% to take care of the
15%. If you want to see misery, try that transferring money
from 100% to 100%, with the Feds in the middle.


From: "Steve Harris" <>
Newsgroups: sci.econ,
Subject: Re: Catastrophic Collapse of Socialism: SARS and AIDS
Date: Tue, 3 Jun 2003 20:32:18 -0700
Message-ID: <bbjp81$s6s$>

"David Lloyd-Jones" <> wrote in message
> Steve,
> Everything you report is what we both know to be true: the US does stuff
> backwards. The profit-sharks loose in politics. This means private
> corporations get the gold, the taxpayer pays for the hard parts.
> You run medicine, which is inherently unprofitable, as a socialist
> bureaucracy, and you let private enterprise loose in the lucrative
> insurance function.
> In Canada we do it the other way around: we have socialised the
> insurance function, and run it on a spartan 0.5% of throughput for all
> expenses: advertising, bosses' limousines, computers, staff, buildings,
> paper shuffling, everything.
> This contrasts with the US, where the overhead for these functions is
> about 5% of GDP, or about a third of everything supposedly spent on
> "health." (Again, to be clear: the Canadian figure is 0.5% of all
> medical costs, not of GDP. The American figure is 5% of GDP, not of
> medical costs. The relative difference in scale is thus roughly 60 to
> one, or logarithmically four orders of magnitude.)

Not if you use base 10 logs.  Don't mess with the common
expression "order of magnitude." It's in general usage in
science for a reason, and it doesn't mean factor of 2.7 or

> The governance of Canadian medicine, by contrast, is left to doctors,
> medical societies, and the "Royal colleges," which are the top level of
> the medical societies.
>                              * * *

And as I've said before, I think Canada, which spends half
what we do per capita on health care, gets better bang for
the buck. OTOH, Canada may not do nearly as well when
compared with North Dakota or Wisconsin or Maine.  Or
Alaska, if you must. Some of US problems are big city high
population density problems that Canada doesn't inherrently
have as badly.

I've BEEN a doctor in ERs and Urgent care facilities in both
Utah and California (in which states I still hold medical
licenses), and the difference between the folks you see in
downtown LA and Salt Lake city is night and day.

> Utah, I think we both agree, is a somewhat anomalous case. This is why I
> felt that it was fair to treat the Church there as a "social"
> institution. I don't think your calling it a free enterprise one makes
> it so.

Calling it other won't make it so either. The Mormon Church
is a social institution, and has nothing to do with
government, here we agree. We disagree on whether or not
churches are "free enterprise" things, like what cable
company or phone company you plug into. But I've seen too
many advertisements for churches, and had to deal with too
many Mormon missionaries, to see them as anything else. I
will tell you that the Mormon Church runs Salt Lake City
like the Casinos run Las Vegas. They have the biggest and
fanciest buildings, and they get what laws passed that they
choose. This doesn't happen without wads of cash. Calling it
other than it is, won't make it so, either. To me it quacks
like a duck.

> Your message said the ugly usual about the victims of DC and Reservation
> government health systems.

Yes, the government sure has done ugly things to those

> When or where has there ever been a group colonised by a distant,
> racist, and alien government who were not blamed -- usually in horrid
> personal terms like the ones you used -- for their own misfortunes?
> It was a nasty surprise to see you, of all people, casting yourself as
> such a crude model of the race-baiting yahoo in your commentary there.

Oh, I think you misunderstand me.  African Americans have
been mistreated badly all over the US, but they've been
ESPECIALLY badly mistreated in Washington, D.C. where nobody
but the FEDERAL government is responsible. The same goes for
Amerinds on reservations vs. Amerinds elsewhere. And in the
V.A. medical system, everybody gets treated equally badly,
regardless of race.

Spare me, BTW, the usual picture of Natives in the Americas
as peaceful nonracist ecologists. Lewis and Clarke found the
Shoshones eating roots because the Sioux killed them
whenever they tried to come down from the mountains. The
Hurons and the Aztecs and the Maya spent most of their time
fighting other tribes so they could capture victims for
torture or human sacrifice ceremonies. Columbus found the
Caribes doing the same thing to other tribes so they could
get people to eat (see also lots of paleontological evidence
of Canibalism among the Anasazi). And so on. The only reason
these guys didn't do more damage to each other and the
environment is they didn't have the techology.


From: "Steve Harris" <>
Newsgroups: talk.politics.drugs,talk.politics.medicine,,,
Subject: Re: War on Legal Drugs Ensnares Doctors Instead of Dealers
Date: Sun, 29 Jun 2003 12:53:31 -0700
Message-ID: <bdng3r$ncv$>

"George Conklin" <> wrote in
>     If the AMA came out in favor of universal health care, insted of
> opposing it in order to maximize income for its members, we would not
> have what WHO has shown to be the system ranked #37 in results and #1 in
> costs.

As has been pointed out to you, the relatively poor results
of US health have nothing to do with US health care.  If US
heath stats were based on Utah's results, for example, we'd
not only be close to #1 in the world in results, but
considerably less expensive than average for the rest of the
country, as well (I know that Utahns can bill Medicare only
about 50% for a hospital day as compared with California;
Utah is penalized for being efficient). But Utah uses
essentially the same system of health care access and
delivery at all levels, as does the rest of the US. They
also use physicians from all over the US. For example, a
fair fraction of my instructors at the University of Utah
School of medicine were Jewish, and (no) they weren't born
in Salt Lake City.

The US has many social problems which impact health of its
citizens. But they have to be gotten at directly. Changing
the health care system will not fix them. You can't fix the
problem of premature crack babies with more free incubators
and neonatal ICUs. Firearms deaths don't happen in the US
because people shot in the head in the US can't get into ERs
without insurance cards. You can't fix emphysema and lung
cancer by having society pay for home ventilators for
everybody who needs them. And so on.


From: "Steve Harris" <>
Subject: Re: salt bath
Date: Fri, 1 Aug 2003 16:39:16 -0700
Message-ID: <bgetn4$3s5$>

"Ken Leander" <> wrote in message
> "Steve Harris" <> wrote in message
> news:bgeak3$o2a$
> > If you've been swimming in the Dead Sea or Great Salt Lake, you know
> > that swimming in maximally salty water is perfectly safe, albeit
> > annoying.
> ...
> Did you actually jump into the Great Salt Lake with all those stinky
> brine shrimp?  What was that like?
> Ken :)

Stinky.  It's not the brine shrimp that smell, it's the
algae they live on. And that smell comes and goes.

There are times of the year when the Great Salt Lake is
really quite pleasant. And as somebody noted, it's great for
bathers who are afraid of drowning. You could drown in
theory, but you can't sink. You'd have to drown by losing
consciousness and floating face down, as in a mud puddle.
Otherwise, so long as you're conscious, it's about like
having a built-in life preserver.


From: "Steve Harris" <>
Newsgroups: talk.politics.drugs,,alt.politics.usa,
Subject: Re: Legalising illegal drugs will decrease cost to only 33% of current 
Date: Sun, 10 Aug 2003 12:04:35 -0700
Message-ID: <bh657p$a37$>

"Mot" <motton@whim.bat> wrote in message
> In article <>, anom@anom says...
> > Jasbird wrote:>>
> >
> >  > a) Current costs of illegal drugs in USA (source NIDA)
> >
> > Legalize drugs that are banned and what happens? Your kid can go to
> > the local convenience store and get high. On his way home he's run
> > over and killed by some asshole also high on drugs.
> Legal drugs would likely be controlled the same way alcohol is
> controlled, and probably with similar pros and cons.  It's not as if
> bags of weed would be displayed for sale in every corner gas station,
> available to all, as soon as it became legal.  Such thinking is very
> shallow.

Alcohol is available in every corner gas station in places
like AZ and CA.

A better model for control of hard drugs would be to make
them available to people with proof of age in dedicated
state stores, much like the State Liquor Stores in Utah, but
(legally) nowhere else (unlike the case with alcohol, which
can still be bought at establishments with a liquor license
in Utah, such as bars and restaurants).

Utah's full of Mormons who don't like the effects of alcohol
on society. But they're happy to have bottled alcohol (save
for 3% beer) sold exclusively by state liquor stores, which
collect all the sales revenue, which sort of amounts to a
tax on non-Mormons to fund Mormon projects (in this case,
the revenue goes for K-12 education, and Mormons have far
more kids). Both sides have struck a deal with the devil,
but it works.


From: "Steve Harris" <>
Newsgroups: talk.politics.drugs,,alt.politics.usa,
Subject: Re: Legalising illegal drugs will decrease cost to only 33% of current 
Date: Sun, 10 Aug 2003 15:27:43 -0700
Message-ID: <bh6h0q$26s$>

"zzz" <zzz@zzz.zzz> wrote in message
> On Sun, 10 Aug 2003 12:04:35 -0700, 
> Why do you think state-run stores are less likely to sell to minors than
> private stores?

Because when one thing is all you do, you tend to do it
better. Quality control is also better if you're only having
to inspect and oversee a few hundred state stores, vs.
thousands upon thousands of (sometimes transiently in
business) mom and pop joints.

> The fact is, increased enforcement since I was a minor means I get
> carded almost as frequently in my 30s as I did when I was buying or
> attempting to buy alcohol at state stores when I was 19 and 20.

It isn't just carding that's the issue. In California it's
no doubt possible to shoplift small bottles of booze from
supermarket liquor section shelves. You'll never get away
with that in a Utah state liquor store; they're too small.

> BTW, I had about a 50% success rate of buying at state stores when I was
> underage.

Not in Utah you didn't.

> In some states, people are taken to jail for selling to minors.

Only if they do it knowingly.

> >Utah's full of Mormons who don't like the effects of alcohol on
> >society.
> or pornography, but don't try to tell them not to marry their 14 year
> old daughters.

That's the "appostates" hiding out in the 4 corners area.
It's certainly not the people who run Utah.

> >But they're happy to have bottled alcohol (save
> >for 3% beer) sold exclusively by state liquor stores, which
> >collect all the sales revenue, which sort of amounts to a
> >tax on non-Mormons to fund Mormon projects (in this case,
> >the revenue goes for K-12 education, and Mormons have far
> >more kids). Both sides have struck a deal with the devil,
> >but it works.
> Not if you're trying to get a buzz during an afternoon of skiing and
> stopping off for beers between runs.  Those bastards should be required
> to INFORM people that they're only buying 3.2 beer.

Read the can. You shouldn't be on the slopes with a "buzz"
anyway. What are you, a moron? Give my regards to Sonny Bono
and Michael Kennedy when next you see them in ski-doofus

From: Steve Harris <>
Newsgroups: soc.culture.indian,,,,
Subject: Re: Blueberries lower LDL cholesterol better than statin drugs
Date: 8 Jan 2005 18:01:10 -0800
Message-ID: <>

>>Steve Harris is one of the best writers I have ever read. He knows I
>>think that. I am not alone in my thinking. As soon as I posted some of
>>his work to my health policy advocacy listserve, the board lit up. This
>>guy is fantastic. Who is he? Is there more? I sure as hell hope so.
>As far as we know, there's only one of him. But I always enjoy his
>posts, even the ones I disagree with (those mostly revolve around
>economic issues). As far as I know, he's a geriatrician in Salt Lake


I am blushing. No, I don't do that any more, as the money ran out of
the programs and they disappeared in several places in that city,
mainly associated with Medicare's decision not to turn itself into an
HMO. Sometime, however, I'd like on my tombstone "He Tried To Practice
Outpatient Geriatrics in Utah".  Sort of like "Attempted Pediatric
Practice in Sun City, AZ" or "Assaulted Eiger North Face in Spring."
Had to be winched down in a basket, but you have to admire the spirit.

I will explain. Utah, being full of growing Mormon families, is the
demographically youngest state in the country, and higher-ed
budget-wise, one of the poorest. It has no oil or gambling to pay the
bills, and lots of public schools to maintain for all those kids.
Outpatient geriatrics in other states is usually supported by academic
affiliations, since it can't possibly pay for itself on Medicare office
visit reimbursement, but in poor Utah, academic medicine doesn't really
have any money. The other proximate reason for that is that the only
medical school in Utah is affiliated with the University of Utah, which
is the officially secular university in a Mormon-dominated state. So
the state is not about to give it much of the little tax money it has
left after paying for K12, and that results in the U of U having about
enough grant-getting power to pay for the type of overeager types who
screw up the first artificial heart, or discover cold fusion in a jar.
The Mormons themselves prefer to give their higher ed academic money to
Mormon-operated BYU. But alas, BYU doesn't have a medical school. BYU
put in a law school instead, which was a lot cheaper-- just a law
library to buy and a nice building. Medicine was never the route to
power, anyway, as we all know. Better to know how to legislate or sue.

The Mormons run all the Utah medical care they are interested in
through IHC (Intermountain Health Corp), a big hospital corporation
controlled by Mormons, and which owns both the hospital where Mormon
leaders go for their bypasses (LDS Hospital) and where really ill
pediatric cases go (Primary Children's Med Center). All the rest of
Utah academic medicine-- stuff involving medicaid, complex inpatient
geriatrics, rare adult diseases, the homeless, or people with AIDS, or
anything that sounds like the Democrats might be interested in it, goes
to the apostate godless University Medical Center. Where Jewish doctors
take care of it as best they can, on a budget, like New Jersey.

There ARE a few geriatricians left in Utah, but they are a bad-tempered
and mangy lot, fighting over a rapidly diminishing pile of scrap bones
with little meat on them. Mostly they survive by doing inpatient
long-term care work, which is seeing a lot of demented people in
nursing homes, very fast, in order to survive on Medicare payments.
"Hi, Mrs. Jones, do you know where you are? No? You're in Limbo, that's
where you are. Let's listen to your chest. How's that old bedsore? Ah,
your ten minutes are up." That sort of thing.

But I couldn't take that, so now I do medical research in California.
Every state has its particularly brand of nuttiness, but at least in
So-Cal, it's *warmer* nuttiness.


Index Home About Blog