A lot rhetoric but not much action from the Israelis, just sound like more saber rattling to me.. But what if Iran and Syria held joint military exercises in preparation for attacking Israel???  We would never hear the end of that shit, and it would be called the most dire of threats.

The Israeli military holds its most extensive nationwide drill, signaling its intentions for a possible attack on Iran which they admit can ignite an all-out war in the region.

http://www.presstv.ir/detail.aspx?id=95915&sectionid=351020202

The nationwide exercise "Turning Point 3" will begin on May 31 and will last five days, Ynetnews reported.

During the drill, Israeli forces and civilians will exercise a war against Hamas, Hezbollah, Syria and Iran and will also practice counterinsurgency tactics against Israeli Arabs.

Last week, Israel's Air Force held a three-day drill to exercise possible missile and air strikes by regional countries -- a clear warning to regional foes such as Syria and Iran.

Israel's hawkish Prime Minister Benjamin Netanyahu in Sunday's cabinet meeting tried to placate Israel's regional countries, saying "this is a routine drill, which was planned several months ago and is held every year in order to coordinate between civil and military systems."

Tel Aviv accuses Tehran of nuclear weapons development - a charge rejected by both Iran and the UN nuclear watchdog, which has so far made over 14 snap inspections of the country's nuclear facilities.

This is while Tel Aviv is widely regarded as the sixth-largest nuclear power in the world and the sole possessor of an atomic arsenal in the Middle East.

In the early 1970s, Israel had already developed missiles capable of delivering nuclear warheads to most countries in the region, including Iran and Russia.

Moreover, Israel reportedly houses at least 100 bunker-busting bombs, which come in the form of laser-guided mini-nukes with the ability of penetrating underground targets.

The right-leaning government of Israeli Prime Minister Benjamin Netanyahu has repeatedly threatened to bomb Iran's enrichment facilities out of existence.

http://www.telegraph.co.uk/finance/newsbysector/energy/5383923/Shell-played-role-in-activist-executions.html

Royal Dutch Shell is due in court on Wednesday this week to face charges of being complicit in the execution of Nigerian activist Ken Saro-Wiwa 14 years ago.

The Anglo-Dutch petrochemicals giant will be accused of asking Nigeria's military dictatorship to silence Mr Saro-Wiwa and other activists campaigning against ecological damage allegedly brought about by oil extraction.

Mr Saro-Wiwa and eight other campaigners were executed by hanging in November 1995 after being found guilty of what were widely seen as trumped up murder charges.

If found liable, Shell would be forced to pay damages that amount to hundreds of millions of dollars.

"While Shell didn't tighten the noose or pull the trigger, they played a critical supporting role for which they must be held accountable," said Jen Nessel from the Center for Constitutional Rights, one of the organisations involved in the trial, which opens in New York on Wednesday.

"May 27th will see Ken Saro Wiwa's prophesy fulfilled that Shell would one day be on trial for what it did to the Ogoni people."

The plaintiffs in Wiwa v Shell, a consolidation of several long-running cases, will also argue that the company is guilty of crimes against humanity, torture and illegal detainment.

Royal Dutch Shell vigorously denies all the allegations, which are being brought by relatives of Mr Saro-Wiwa and other victims of Nigeria's military dictatorship.

Mr Saro-Wiwa co-founded the Movement for the Survival of the Ogoni People, established in 1990 to fight against alleged exploitation of the inhabitants of Nigeria's oil-rich Ogoni region by oil multinationals. Shell has since stopped working there, but still has large operations elsewhere in south-eastern Nigeria.

Mr Saro-Wiwa's vociferous campaigning brought a greater international awareness of environmental damage said to be caused by oil extraction, especially details of repeated oil spills and the practice of gas-flaring.

"Shell refuses to apologise for its role in the execution of Ken Saro-Wiwa," said Ben Amunwa, of Platform, a British pressure group involved in the case.

"Worse still, Shell continue to pollute and flare gas with impunity in the Niger Delta, poisoning land and aggravating locals.

"The legitimate grievances of Saro-Wiwa and the Ogoni remain unaddressed, Shell's ongoing environmental abuses fan the flames of conflict between oil companies and host communities."

Nigeria's military has recently launched its heaviest crackdown yet on militants in the Niger Delta, bombing their creek-side camps and reportedly killing key rebel leaders.

Amnesty International says there are reports that "hundreds" of civilians have died during the operation, although Nigeria's government denies this.

"The allegations made in the complaints against Royal Dutch Shell concerning the 1995 executions of Ken Saro-Wiwa and his eight fellow Ogonis are false and without merit," a Shell spokesman said.

"Shell in no way encouraged or advocated any act of violence against them or their fellow Ogonis. We believe that the evidence will show clearly that Shell was not responsible for these tragic events."

The trial could result in the first successful prosecution brought under the Alien Torts Statute, which gives non-US citizens the right to file suits in US courts for international human rights violations.

The trial comes after a 12-year legal battle in which Shell has made repeated efforts to have the case thrown out of court in the US.

http://www.washingtonsblog.com/2009/05/dallas-federal-reserve-unfunded-pension.html

You've heard some big numbers thrown around.

For example, total U.S. government liabilities are at least $65 trillion dollars.

But the head of the Dallas Federal Reserve bank says:

    [There is a] "very big hole" in unfunded pension and health-care liabilities built up by a careless political class over the years.

    "We at the Dallas Fed believe the total is over $99 trillion," he said in February.

Over $99 trillion? That's a serious shortfall.

http://www.marshallhall.org/hanson.html

Was John Hanson the first President of the United States?

The new country was actually formed on March 1, 1781 with the adoption of The Articles of Confederation. This document was actually proposed on June 11, 1776, but not agreed upon by Congress until November 15, 1777. Maryland refused to sign this document until Virginia and New York ceded their western lands (Maryland was afraid that these states would gain too much power in the new government from such large amounts of land). Once the signing took place in 1781, a President was needed to run the country. John Hanson was chosen unanimously by Congress (which included George Washington). In fact, all the other potential candidates refused to run against him, as he was a major player in the Revolution and an extremely influential member of Congress.

As the first President, Hanson had quite the shoes to fill. No one had ever been President and the role was poorly defined. His actions in office would set precedent for all future Presidents. He took office just as the Revolutionary War ended. Almost immediately, the troops demanded to be paid. As would be expected after any long war, there were no funds to meet the salaries. As a result, the soldiers threatened to overthrow the new government and put Washington on the throne as a monarch. All the members of Congress ran for their lives, leaving Hanson running the government. He somehow managed to calm the troops and hold the country together. If he had failed, the government would have fallen almost immediately and everyone would have been bowing to King Washington.

Hanson, as President, ordered all foreign troops off American soil, as well as the removal of all foreign flags. This was quite a feat, considering the fact that so many European countries had a stake in the United States since the days following Columbus. Hanson established the Great Seal of the United States, which all Presidents have since been required to use on all official documents. President Hanson also established the first Treasury Department, the first Secretary of War, and the first Foreign Affairs Department. Lastly, he declared that the fourth Thursday of every November was to be Thanksgiving Day, which is still true today.

The Articles of Confederation only allowed a President to serve a one-year term during any three-year period, so Hanson actually accomplished quite a bit in such little time. He served in that office from November 5, 1781 until November 3, 1782. He was the first President to serve a full term after the full ratification of the Articles of Confederation – and like so many of the Southern and New England Founders, he was strongly opposed to the Constitution when it was first discussed. He remained a confirmed anti-federalist until his untimely death.

Six other presidents were elected after him - Elias Boudinot (1783), Thomas Mifflin (1784), Richard Henry Lee (1785), Nathan Gorman (1786), Arthur St. Clair (1787), and Cyrus Griffin (1788) - all prior to Washington taking office.

HOUSE BILL 218
By Fincher
AN ACT to amend Tennessee Code Annotated, Title 38,
Chapter 1, Part 2, relative to scrap metal and
jewelry dealers.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Section 38-1-202, is amended by deleting
subsection (b) in its entirety and substituting instead the following new subsections:
(b) No person acting as a buyer or dealer under this section shall purchase any
item covered by this section from a person under eighteen (18) years of age, nor accept
any item covered by this section from anyone who appears intoxicated, nor from any
person known to the person to be a thief, or to have been convicted of larceny, burglary
or robbery, without first notifying a police officer. Any person acting as a buyer or dealer
under the provisions of this section shall exercise due care to comply with the provisions
of this section.
(c) No person acting as a buyer or dealer under the provisions of this section
shall take any item covered by this section under a buy-sell agreement, when the article
is known to the person to be stolen.
SECTION 2. Tennessee Code Annotated, Section 38-1-203, is amended by deleting the
section in its entirety and substituting instead the following:
(a) Every person or corporation dealing in the items described in § 38-1-201 shall
keep a log in duplicate and shall enter on the log:
(1) A clear and accurate description of any items of jewelry or precious
metals purchased including, if applicable:
(A) Brand name;
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(B) Model number;
(C) Serial number, if issued by the manufacturer and not
intentionally defaced, altered or removed;
(D) Size;
(E) Color, as apparent to the untrained eye, not applicable to
diamonds;
(F) Precious metal type, content and weight, if indicated;
(G) Gemstone description, including the number of stones; and
(H) Any other unique identifying marks, numbers, names or
letters.
(2) Information on the seller, including: the name, race, sex, height,
weight, date of birth, residence address and numbers from the items used as
identification. Acceptable items of identification are one (1) of the following
documents:
(A) A state-issued driver license;
(B) A state-issued identification card;
(C) A passport;
(D) A valid military identification;
(E) A nonresident alien border crossing card;
(F) A resident alien border crossing card; or
(G) A United States immigration and naturalization service
identification; and
(3) The date and amount of money paid for such items.
(b) The seller and the purchaser shall sign the log below the description of each
transaction.
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(c) On each day the purchaser shall transact business of the type described
within this section, the purchaser shall deliver to the sheriff and the chief of police of
each county or municipality in which the business is conducted a copy of the log
concerning that day's business, and the copy of the log shall be delivered by twelve
o'clock (12:00) noon of the day following the date of the transaction. The book shall be
carefully preserved without alteration and shall at all times be open to the inspection of
the sheriff of the county and the chief of police or any deputy or police officer of the city
or county.
SECTION 3. Tennessee Code Annotated, Title 38, Chapter 1, Part 2, is amended by
adding the following language as a new section:
§ 38-1-205.
(a) When any person sells property to a buyer or dealer subject to § 38-1-201,
the buyer or dealer shall obtain and record the information provided for in § 38-1-203
and obtain a statement of the seller that the seller is the lawful owner of the item, and
have the record signed by the seller. This record shall be made available to any law
enforcement agency or officer upon request.
(b) (1) The party asserting ownership of any property, which the party alleges is
stolen and which is in the possession of a buyer or dealer subject to § 38-1-201, may
recover the property by making a report to any law enforcement agency of the location of
the property and providing the law enforcement agency with proof of ownership of the
property; provided, that a report of the theft of the property was made to the proper
authorities within thirty (30) days after obtaining knowledge of the theft or loss; and
provided further, that the party asserting ownership will assist in the prosecution of the
seller of the item. Upon the receipt of proof of ownership, any law enforcement officer is
authorized to recover the property from the buyer or dealer, without expense to the
- 4 - 00161065
rightful owner thereof, unless the buyer or dealer presents evidence of having received
proof of ownership of the property by the seller. Any property recovered from a buyer or
dealer subject to § 38-1-201, shall be returned to the rightful owner thereof, subject to
evidence in any criminal proceeding.
(2) In the event that the party asserting ownership of the article has provided a
timely report of the theft or loss of the article, and the buyer or dealer presents
acceptable evidence to the law enforcement agency of having received proper proof of
ownership from the seller of the property, then and only then shall the law enforcement
agency have satisfied its processes, duties and responsibilities. It shall then inform the
party alleging ownership that it will be necessary for that person to commence an
appropriate civil action for the return of the items within thirty (30) days of receiving the
notice. The buyer or dealer shall not be required to surrender the property to any law
enforcement officer or agency or any other person absent an appropriate warrant.
(3) If for any reason after the local authorities have seized certain property and
are unable to locate the rightful owner of the property after due diligence, then the
property may be returned to buyer or dealer upon the buyer or dealer executing a holdharmless
agreement to the local authorities pursuant to title 40, chapter 33.
SECTION 4. Tennessee Code Annotated, Section 38-1-204, is amended by deleting the
language "Class C misdemeanor" and substituting instead the language "Class A
misdemeanor".
SECTION 5. This act shall take effect July 1, 2009, the public welfare requiring it.

http://www.marketwatch.com/story/even-jack-bauer-couldnt-stop

ARROYO GRANDE, Calif. (MarketWatch) -- Two mind-numbing fast-paced dramas. Two parallel worlds. One real, one fiction, both deadly. Jack Bauer, mythic hero of "24." Dying from a deadly bio-pathogen leaked from weapons developed by Starkwood, a rogue mercenary army attacking the presidency, hell-bent on taking over America.

The other drama in play: "Hank the Hammer" Paulson, iconic Wall Street hero, a Trojan Horse placed inside Washington by Goldman Sachs as Treasury Secretary in control of America's $15 trillion economy. Goldman, a modern dynasty with vast financial powers much like those once used by the de' Medici, Rothschilds and Morgans to control nations.
Is a correction imminent?

One of the confounding aspects of bear market rallies is that the longer they last, the more likely investors are to expect a correction, says Barron's Bob O'Brien.

Both dramas play high-stakes games with financial WMDs that have lethal consequences. Jack compresses thrills, kills and chills into 24 hours. Hank, Goldman and their army of Wall Street mercenaries move with equally blinding speed, heart-pounding action.

Drama? You bet. Six short months ago Hank led an assault on Congress. The scene parallels one in "24:" Sangala War Lord Juma's brazen attack inside the White House. But no AK-47s necessary. The Hammer assaulted Congress with just a two-and-a-half page memo in hand. Like a crack special-ops warrior, he took down the enemy, demanding $750 billion, absolute control, total secrecy, no accountability and emergency powers to act immediately ... warning that inaction was not an option, that collapse of America's banking system was imminent, would bring down the global monetary system, pushing world's economies into a "Great Depression II." Congress surrendered.

Here's the whole plot:
Scene 1. American government is now run by the 'Goldman Conspiracy'

Oh, you really think just I'm plotting a television series? Or just paranoid, exaggerating this power grab? You better read "The Usual Suspects," Matthew Malone's brilliant article in Portfolio magazine: He "exposed" the "Goldman Sachs 'conspiracy' to take over the U.S. financial system." Read it in this context: America's financial sector has exploded from 19% of corporate profits in 1986 to 41% today, becoming a magnet for every wannabe billionaire. They know why Wall Street must control Washington.

Malone focuses on the incestuous "conspiracy" of Goldman alumni in Treasury, Bank of America, Merrill Lynch, AIG, Citigroup, Washington lobbyists and politicians.
Scene 2. Huge conflicts motivating Wall Street's 'Trojan Horse'

And just in case you think any emphasis on The Hammer's conflict of interest was invented purely to increase drama, please remember that he worked at Goldman for three decades after serving under Nixon. He got $38 million his last year as CEO in 2006 before becoming Treasury Secretary.

Then during the market meltdown six months ago the $700 million personal fortune he built at Goldman was threatened by Goldman's huge $20 billion derivatives exposure at AIG: Suddenly his responsibilities at Treasury merged with a strong self-interest in protecting his personal fortune. AIG was "saved."
Scene 3. Wall Street's 'quiet coup' also runs world's banking system

There's another equally disturbing expose in "The Quiet Coup," Simon Johnson's great article in Atlantic magazine. A former chief economist at the International Monetary Fund, Johnson also warns that America's "financial industry has effectively captured our government" and is "blocking essential reform."

Worse, he says that unless we break Wall Street's stranglehold (unlikely in the new Washington) we will be unable "to prevent a true depression," warning that "we're running out of time," echoing many of our predictions of the "Great Depression II" coming soon. See previous Paul B. Farrell.
Scene 4. Wall Street used the meltdown to take over America's government

Matt Taibbi, author of "The Great Derangement," captured this drama in a Rolling Stone piece, "The Big Takeover, how Wall Street insiders are using the bailout to stage a revolution." A must-read: "As complex as all the finances are, the politics aren't hard to follow. By creating a crisis that can only be solved by those fluent in a language too complex for ordinary people to understand, the Wall Street crowd has turned the vast majority of Americans into non-participants in their own political future. ... in the age of CDS and CBO, most of us are financial illiterates."

Wall Street "used the crisis to effect a historic, revolutionary change in our political system -- transforming a democracy into a two-tiered state, one with plugged-in financial bureaucrats above and clueless customers below."

 Scene 5. How Obama is keeping alive Bush's 'disaster capitalism'

Back in 2007 at the start of the meltdown, Hank was misleading us in Fortune: "This is far and away the strongest global economy I've seen in my business lifetime." In the real world, Naomi Klein, author of "The Shock Doctrine: Rise of Disaster Capitalism," was warning us that "during boom times it's profitable to preach laissez faire, because an absentee government allows speculative bubbles."

But "when those bubbles burst, the ideology becomes a hindrance and goes dormant while big government rides to the rescue." Then, free-market "ideology will come roaring back when the bailouts are done. The massive debts the public is accumulating to bail out the speculators will then become part of a global budget crisis." TARP paybacks: Obama has a new "disaster capitalism."
Scene 6. Wall Street's CEOs rule like dictators in a banana republic

Seriously, here's how bad Taibbi sees it: "Paulson and his cronies turned the federal government into one gigantic half-opaque holding company, one whose balance sheet includes the world's most appallingly large and risky hedge fund, a controlling interest in a dying insurance giant, huge investments in a group of teetering megabanks, and shares here and there in various auto-finance companies, student loans, and other failing business."

And let's include $5.5 trillion in Fannie Mae and Freddie Mac. Wall Street's greed and stupidity resembles the self-destructive reigns of banana republic dictators.
Scene 7. Wall Street makes an un-American bet on 'disaster capitalism'

Today as you ponder buying some Goldman stock, remember, you're really betting that "disaster capitalism" is back, strong, tightening its stranglehold on Washington and on the American taxpayers, who will guarantee all Wall Street's future failures. Yes, this is un-American, but so what?

The "Goldman Conspiracy" is still probably a good short-term buy ... if you're interested in betting on America's new "democracy of capitalists, by capitalists, and for capitalists," with "The Conspiracy" leading the joint chiefs of this new mercenary army ... and it only took six short months for their "Quiet Coup!"
Scene 8. Banks recycle TARP money, pump earnings, cheat America

Here's how it worked: The Hammer conned a clueless Congress, then shelled out $350 billion of our taxpayer money (Helicopter Ben Bernanke helped by upping the ante with a couple trillion side-bet), buying toxic debt to save his ol' Wall Street buddies. They stopped lending and used the dough to doctor their balance sheets.

So no surprise that Goldman, Wells Fargo and J.P. Morgan Chase are now reporting "blockbuster" first-quarter earnings, says the New York Times, while just months ago "many of the nation's biggest banks were on life support."

Get it? They screwed taxpayers and borrowers so they can repay TARP with (you guessed it) our recycled TARP money. Now it's back to business-as-usual, with no restrictions on CEO pay and bonuses ... no thank-yous ... no admissions of guilt ... while some even arrogantly deny that they ever needed TARP money.
Scene 9. Wall Street's already set the stage for new disaster

Right after the election in November, at the peak of the banking crisis, when Hank, Goldman and the Wall Street mercenary armies were divvying up the $350 billion TARP money, we detailed 30 reasons for the "Great Depression II" likely coming around 2011. We quoted John Whitehead, former Goldman Sachs chairman, former chairman of the New York Fed, former Reagan deputy secretary of state. He warned America's problems will take years, burn trillions, result in massive deficits:

"This is a road to disaster," he said. "I've always been a positive person and optimistic, but I don't see a solution here." He did see a depression at the end of that road, one you can call the "Great Depression II."
Scene 10. Obama turned 'The Goldman Conspiracy' into a superpower

Do you see the parallels: Jack and Starkwood, Hank and Goldman? Jack's a great mythic hero. We need to believe a hero will defend the little guy, stand between us and total annihilation. But Jack Bauer's "dead." Yes, dead. Jack's not real. Never was "alive." Jack's a fiction, a figment of Main Street America's vivid imagination, the symbol of "hope" for a populist revolution. Hope that Jack, Barack or some other new hero will emerge, take power back from Wall Street and return it to the people.

Unfortunately that won't happen, folks. Yes, on TV Jack will come back from near-death, again. But in real life, Hank, Goldman and Wall Street's mercenaries are winning the war. Read and weep Portfolio's chilling finale: "Obama's victory and Geithner's appointment are the completion of Goldman's meticulously crafted plan to become a superpower. The firm now has the clout to impose its will on the financial markets, and the world."

GOP or Dems? Conservatives or liberals? It doesn't matter. We'll all controlled by "The Conspiracy." So why not surrender, let them have the power? The truth is, through their lobbyists and surrogates in Washington, they already rule America. Surrender is a mere formality.

Accept reality. Hold them accountable later. After the next crisis. After the next meltdown of disaster capitalism -- if there's anything left after the "Great Depression II" sweeps like a pandemic across the planet, consuming all economies, for a long time. But for now, Goldman and other banks may well be short-term buys. Just be ready to dump them in the near future ... a scenario that will be here sooner than you think.

http://www.msnbc.msn.com/id/30628634/
By JoNel Aleccia
Health writer
updated 8:12 a.m. CT, Mon., May 11, 2009

In hindsight, maybe Jesse Ashlock shouldn’t have walked out of the New York emergency room last summer, only a couple hours after being knocked unconscious in a Brooklyn bicycle crash.

Medical crews told him he needed a blood test, chest X-rays and probably a CT scan to check for head injuries. And he certainly should have had treatment for major road rash, including raw scrapes on his face, neck and hands.

But the 31-year-old editor for a design magazine was between jobs, briefly without health insurance and afraid of being stuck with a sky-high hospital bill. The doctor on duty dismissed Ashlock’s questions about cost, telling him she was “a physician, not an accountant,” he said.

So Ashlock stalked out of Woodhull Hospital without treatment, becoming part of a small but growing number of patients turning down emergency care because they fear they can’t afford it.

“I’ve heard all kinds of horror stories … I could easily imagine it being $5,000,” said Ashlock. “I was worried about having a concussion and worried about going to sleep, but I was fine.”

Even as rising unemployment strips people of health insurance, sending many to emergency departments for care, doctors on the front lines say the lingering recession is also prompting an unexpected outcome.

More patients, they say, are refusing potentially costly procedures ranging from tests to confirm heart attacks to overnight stays to monitor dangerous infections.

“I have definitely seen an increase in this problem,” said Dr. Sara L. Laskey, who works in the emergency department of MetroHealth Medical Center in Cleveland, Ohio. “They’re really making conscious decisions about what they do and don’t want done.”

Just last month, Laskey saw a woman with bronchitis and pneumonia with life-threatening oxygen levels who refused hospital admission because she had no insurance. Even when Laskey arranged for her to have an oxygen kit to take home, the woman turned it down because of the cost.

“She refused, saying she would share her husband’s oxygen,” Laskey said. “Ultimately she left without the oxygen or an admission.”

Discharged ‘against medical advice’
Increasingly, such cases are raising ethical dilemmas for doctors, forcing them either to persuade patients to agree to treatment or else to discharge them “against medical advice.” That’s a formal designation that signifies a patient is knowingly disregarding a doctor’s guidelines.

About 119.2 million visits were logged in U.S. emergency departments in 2006, according to a report last year by the federal Centers for Disease Control and Prevention. Of those, about 1.5 million, or 1.3 percent, ended with discharges against medical advice, or AMA. Doctors believe those numbers are both underreported and growing.

“Even without the recession it goes on all the time, but it probably goes on more now,” Dr. Neal K. Chawla, who works at a stand-alone emergency clinic run by Inova Fairfax Hospital in Falls Church, Va.

“It’s like, ‘OK, I’m not dying of a heart attack, let me go home,’ ” he said. “I have similar conversations two or three times a day.”

Just this month, Chawla, a spokesperson for the American College of Emergency Physicians, said he argued with a man who refused hospitalization to drain a large abscess on his buttocks; another man who declined admission for an infected kidney stone; a woman with low-risk chest pain who didn’t want to pay for further cardiac exams; and a patient with acute appendicitis who needed emergency surgery but didn’t want to pay for an ambulance.

“He called his mother to drive him over,” Chawla said.

Some patients can be convinced to submit to care, but others can’t, said Dr. David J. Alfandre, a researcher with the National Center for Ethics in Health Care run by the U.S. Department of Veterans Affairs.

“Everyone has a right to decide what’s done with their body,” said Alfandre, who reviewed studies of discharges against medical advice in a report for the Mayo Clinic Proceedings in March. “The hard part is ensuring that the patient understands the risks and benefits.”

Rates of hospital discharges against medical advice are about the same as for emergency rooms: between 1 percent and 2 percent, Alfandre found. Of some 39.4 million hospital discharges in 2006, about 390,000 were classified as AMA, according to statistics from the federal Agency for Healthcare Research and Quality.

Overall discharges grew by 14 percent between 1997 and 2006, but AMA discharges, the smallest category, jumped by 48 percent in that period.

“Early leavers,” as they’re sometimes known, are most often men on state-sponsored Medicaid or with no health insurance who have serious social and financial concerns, research shows. About 21 percent of people discharged against advice had no insurance, compared to about 7 percent of routine discharges, according to AHRQ.


‘If they leave the ER now, they’re likely to go back’
People who leave against advice are at higher risk for ending up back in the hospital, or for becoming seriously ill or dying, Alfandre said. Asthma patients who leave AMA are about four times more likely to be readmitted, his review showed. General medical patients are about seven times more likely to wind up again in the hospital.

“Patients should be told, ‘If they leave the ER now, they’re likely to go back,’ ” Alfandre said.

Several emergency department doctors said they see many more reluctant patients than they ever sign out against medical advice.

“If it’s a really dumb decision, I’ll sign them out AMA,” Chawla said. “Cardiac is one of the big ones. We’re very cautious about the heart.”

Other doctors said even when they don’t sign patients out against advice, they do have detailed conversations about the value of certain tests and procedures.

“In my mind, that’s not necessarily a bad thing. Testing is out of control,” said Dr. Jeffrey Sankoff, who works in the emergency department at the Denver Health Medical Center in Colorado. “I think it’s good we’re having those conversations about risks and benefits."

Those talks can help direct patients to solutions less dire than refusing treatment. Most hospitals provide charity care, though the amounts and conditions vary widely. Many also offer help connecting patients with services such as Medicaid. And most hospitals will set up payment plans, if nothing else, to allow patients to manage the bills.


No care, but billed anyway?
Not every doctor is so proactive, however. In Jesse Ashlock’s case, no one stopped him as he stripped off an X-ray vest, put on his shirt and strode out of the emergency room, still bleeding from the scrapes on his face and hands.

“I think the frustration is that they didn’t want to discuss the cost,” he said of his decision to leave.

Adding what he regards as insult to injury, Ashlock later received a bill for $618.67, which he still hasn’t paid. He called Woodhull Hospital officials to ask why he was being charged for services he didn’t receive, but the bill still stands.

It covered the cost of his evaluation, according to a spokeswoman for the New York City Health and Hospitals Corp., which operates the hospital. After being contacted by msnbc.com, hospital officials contacted Ashlock to resolve his bill, said Pamela McDonnell, HHC's director of media relations.

In the end, Ashlock said he’ll probably pay the bill in installments so it won’t damage his credit. And he’s grateful overall that his injuries from the bicycle accident have healed, leaving only small scars.

“You just have to look on the bright side. I’m walking around and talking to you,” he said. “Still, $600 is a lot of money.”

The Government can't even run it's self right.  Let alone trillion dollar businesses.
 

"Who says that governments cant run banks?"

Who says the government can run any business? Almost none of them has any experience in running a business of any kind.