Rand Paul was always a Piece of Shit

[Brisketexan 104637]

7 minutes ago, bernorange said:

Link to any references where fucktards suggested or made theater about assassinating Obama were championed by me, my ilk, or anyone with half a brain at shaggy/surly?

Umm, there's stuff short of suggesting assassination of political rivals.  How about accusing them of being secret Kenyan muslim terrorists?  The LEADER of that movement.....is now our PRESIDENT.  Or wanting to jail your political opposition -- not for any criminal conduct, but simply for being the opposition.  The fucking PRESIDENT OF THE UNITED STATES was leading a rally chanting "lock her up!" about a senator that had just opposed him.  Come on, man.  Stop.  The "fringe" is actually in power, right now, at this exact moment.  The President espouses violence at his rallies, chants for the imprisonment of his political opposition...just stop.

Edited October 10, 2018 by Brisketexan

[bernorange 8348]

14 minutes ago, Js1 said:

Rand Paul - the king of BUT MY BELIEFS until it comes time to vote or move legislation and he votes right along with what Mitch tells him to do.

Rand has disagreed with McConnell anywhere from 20% of the time this session to 29% last session:

https://projects.propublica.org/represent/members/P000603-rand-paul/compare-votes/M000355-mitch-mcconnell/115

[sidis 9755]

2 minutes ago, bernorange said:

Link to any references where fucktards suggested or made theater about assassinating Obama were championed by me, my ilk, or anyone with half a brain at shaggy/surly?

Good lord.  I said "popular opposition".  I'm referring to the unwashed masses that epxress their outrage on facebook, twitter and so forth - the masses of women so upset over K that they are going to vote in a massive blue wave next month.  The ones that are so mad, it encourages the extremists on the left to talk about assassinations.

I do thank you for acknowledging the reality of the theater being what it was though.  It's a sad commentary on America that K's opposition could not just state their reasoned objections on the merits.

There are precious few actors in DC that are willing to address issues that I consider fundamentally important.  Rand is one.  He's not perfect.  He doesn't have enough support to directly affect or effect legislation on the matters. But he is trying in his own way. 

i could say the same things re: half a brain, etc...  clearlakehorn on tos was temporarily banned multiple times for stating the president should be assassinated.  there were others as well.  but ultimately the most damning evidence regarding the validation of the types of people who were calling for violent uprisings against the government under obama's presidency is simply a look around me today...and ten seconds on the president of the united states' twitter account.

of course it was theatre to congress.  that isn't to say that the inquiry didn't reveal things about kavanaugh that confirmed my perspective on the type of person he is and why i do not think he should be one of the nine most powerful and directly influential people in the country.  but it was a hail mary for the public.  but no one has been murdered and hopefully it will stay that way.  that said, i agree that it would have been nice if the opposition could just state their objections on merits.  oh wait, they did.  and it is hard to do so when the nominee will not answer a single question directly.  finally, what is the point of those reasoned objections if no one on the republican side is even interested in hearing them and they have all the requisite votes?  for example, rand paul.  if he is as principled as you naively believe, then such objections should have had more potential or direct impact on someone like him.  but ultimately, we all know exactly what rand paul is.  all fucking talk...and mitch's bitch boy when mitch wants it and sadly enough, trump's bitch boy whenever donald tells him to jump. 

regardless of his "support," he absolutely had the power to directly affect kav's nomination.  he chose not to.  he simply fell in line like the party loyalist he is.

[bernorange 8348]

1 minute ago, sidis said:

... if he is as principled as you naively believe, ...

I can assure you, I'm not blind to his faults.  I think you are overly dismissive of his advocacy and efforts to reel in the surveillance state, militarization of the police, civil asset forfeiture, etc.

[sidis 9755]

he just voted to confirm a political operative justice that was nominated because a corrupt president wanted his voice regarding the investigation and prosecution of a (corrupt) sitting president on the court.  there are few things i can possibly think of that are more directly reflective of tyranny than that.  you just posted a list of 16 times out of 527 votes when rand voted differently than the turtle and there was not a single one in which he could have changed the outcome.  most of them were carried or defeated by more than 30 votes.

he just had a chance to actually do something for something that would have actually made a difference.

we see what happened.

[hayden_horn 11360]

7 minutes ago, sidis said:

he just voted to confirm a political operative justice that was nominated because a corrupt president wanted his voice regarding the investigation and prosecution of a (corrupt) sitting president on the court.  there are few things i can possibly think of that are more directly reflective of tyranny than that.  you just posted a list of 16 times out of 527 votes when rand voted differently than the turtle and there was not a single one in which he could have changed the outcome.  most of them were carried or defeated by more than 30 votes.

he just had a chance to actually do something for something that would have actually made a difference.

we see what happened.

and his vote was never one of the ones in question, despite his supposed wildcard status.

 

Edited October 10, 2018 by hayden_horn
i'm an iodiot

[bernorange 8348]

When the folks at Hot Air are (were) less critical of Rand (a Republican Senator) on this issue than you are, it should give you pause:

https://hotair.com/archives/2018/07/02/uh-oh-rand-paul-quietly-iffy-kavanaugh-scotus-nominee/

 

[sidis 9755]

11 minutes ago, bernorange said:

When the folks at Hot Air are (were) less critical of Rand (a Republican Senator) on this issue than you are, it should give you pause: 

https://hotair.com/archives/2018/07/02/uh-oh-rand-paul-quietly-iffy-kavanaugh-scotus-nominee/

 

wait, hold on...what you are telling me is that i should take pause because i am judging rand's actual actions with regards to an affirmative vote to confirm kavanaugh to the supreme court (something i do not believe is in dispute) contrasted with something called hotair and a writer using the nom de plume of "allahpundit" speculating IN JULY that rand may not actually be an in the bag affirmative vote for kavanaugh when we know his speculation turned out to be entirely unfounded?

okay...seems reasonable.

[bernorange 8348]

No, you missed the point entirely.  They aren't in Rand's corner, but they analyzed Rand's opposition to Kavanaugh and discerned that he would likely vote for confirmation and that his reasoning for it would not be a complete violation of every principle that he purportedly stands for.  You guys are making him out to be the biggest sellout/whores in DC here in this thread.  While it's clear that he isn't as pure as the wind driven snow, you peeps are lost deep in hyperbole land.

Edited October 11, 2018 by bernorange

[Celery Man 20886]

Interesting that Rand Paul is the only member of the Foreign Relations Committee to not sign the letter to Trump about the probable murder of the Saudi journalist, which should trigger an investigation under the Magnitsky act.

https://thehill.com/policy/defense/410865-senators-force-trump-to-investigate-disappearance-of-saudi-journalist

[Hugo Stiglitz 23362]

4 hours ago, Celery Man said:

Interesting that Rand Paul is the only member of the Foreign Relations Committee to not sign the letter to Trump about the probable murder of the Saudi journalist, which should trigger an investigation under the Magnitsky act.

https://thehill.com/policy/defense/410865-senators-force-trump-to-investigate-disappearance-of-saudi-journalist

He’s a non-interventionist!

 He would gladly let fascists and terrorists take over half the globe and not bat an eye.

A true leader.

[Anastasis 23397]

Wonder how ol' lindsey and corker going to vote next time a SA arms deal is forced to go to vote in the Senate.  Oh nevermind, you already know. But they signed a letter!

https://thehill.com/blogs/floor-action/senate/337614-senate-rejects-effort-to-block-saudi-arms-sale

Senators voted 47-53 on advancing the resolution, falling short of the simple majority needed to move forward. GOP Sens. Mike Lee (Utah), Rand Paul (Ky.) Todd Young (Ind.) and Dean Heller (Nev.) voted with most Democrats to advance it.

Democratic Sens. Joe Donnelly (Ind.), Claire McCaskill (Mo.), Bill Nelson(Fla.), Joe Manchin (W.Va.) and Mark Warner (Va.) voted against moving the measure.

The motion faced an uphill climb in the Senate, despite growing concerns about Saudi Arabia’s involvement in Yemen's civil war. 

Top Republicans, including Majority Leader Mitch McConnell (R-Ky.), signaled ahead of the vote that they were opposed to the motion, arguing that reneging on the arms agreement would undercut a key U.S. ally.

It's hard for me to understand why people would oppose the selling of precision guided missiles," Corker told reporters, stressing they help lower unintended casualties.

[bernorange 8348]

This Khashoggi business is pretty interesting:

https://www.aljazeera.com/news/2018/10/jamal-khashoggi-case-latest-updates-181010133542286.html

If the reports are correct that the Saudi Crown Prince himself ordered a hit squad to assassinate Khashoggi in their consulate, it's a new low for Saudi Arabia.  But they are the lynchpin supporting the petrodollar, so the USA can't treat them like Libya or Iran. 

[Anastasis 23397]

Rand has consistently opposed the arms sales to SA on the basis of their actions in Yemen and other human rights abuses. He will use this situation to further press his position, but will fail because war mongers gonna war monger. And in the confines of the current brain dead twitter-addled CR, thinking that maybe we shouldn't be selling 100+ billion dollars worth of arms to a human rights and terrorist shit hole equates with letting fascists and terrorists take over half the globe without batting an eye.

 

 

 

 

[Pig Bellmont 8692]

Also Rand Paul: Only member of Senate Foreign Relations Committee to not sign letter requesting the President impose Magintsky Act sanctions on Saudi Arabia

 

 

[Brisketexan 104637]

45 minutes ago, Pig Bellmont said:

Also Rand Paul: Only member of Senate Foreign Relations Committee to not sign letter requesting the President impose Magintsky Act sanctions on Saudi Arabia

 

 

He really is bucking to win the "Do as I Say, Not as I Do" lifetime achievement award.

I used to think Rand Paul might be a difference-maker.  Nope. Just another compromised whore, almost certainly motivated by either negative or positive personal/financial motives.

[HenryJames 65890]

It's called Randstanding.

[GRHorn 105]

 

[lemonlime 5503]

Someone's gonna have one hell of a hangover tomorrow after the day drinking today.  This whole thread is gold.

[ADHD 28]

He talks like a UT frat boy from the 80s.

[ADHD 28]

I bet he was a FIJI with John Teltschik and Jeff Ward. They all had Jeeps, wore oxfords, shorts and sandals everyday and worshipped Steve Dallas from Bloom County. (Oh who am I kidding, we all did!)

[ADHD 28]

[Parliament 14140]

Senator Paul's annual Festivus Tweets are pretty good, and he upped his game this year.

[SuingToGetAMessageBoard? 3861]

1 hour ago, lemonlime said:

Someone's gonna have one hell of a hangover tomorrow after the day drinking today.  This whole thread is gold.

I'm quite impressed.  That thread shows a pretty good sense of humor.

[SuingToGetAMessageBoard? 3861]

lulz at his last tweet ending with "even the haters and losers," in reference to probably the worst tweet of all time.

[Hugo Stiglitz 23362]

2/ Since the day in March 2017 when John McCain called him out ON THE FLOOR OF THE US SENATE for objecting to Montenegro joining NATO, Rand Paul has been a veritable lobbyist for the Kremlin. On matters large and small, Paul has supported Moscow’s positions.

3/ Rand Paul has pushed for open and active dialogue with the nation that engaged in cyberwarfare against us. He’s argued for the lifting of sanctions on Russian individuals close to Putin.

4/ Rand Paul was one of few politicians who defended Trump after his disastrous showing in Helsinki, when Trump kissed the ring of the Russian dictator—the most pusillanimous display by a US leader in my lifetime, if not ever.

5/ Rand Paul joined Trump in seeking the revocation of a security clearance on John O. Brennan, after the former CIA director denounced the Helsinki summit as “nothing short of treasonous.” He may as well have announced this in Russian.

6/ The dissemination of Putinist propaganda is bad enough. But let us not forget that Rand Paul has served as a Trump/Russia intermediary, on one occasion flying to Moscow to deliver a handwritten letter from the president to Putin.

7/ Paul visited Moscow on 6 August 2018. “Engagement,” was his reason for making the journey. It was in service to “engagement" that the trip was paid for by the Cato Institute, the libertarian think tank underwritten by the Koch brothers.

But this is about more than US dark $.

8/ Rand Paul met w/ Sergei Kislyak, former Russian amb. to the US — the same Sergei Kislyak who in 2016 held illicit meetings w/ Paul Manafort, Jared Kushner, Jeff Sessions, Carter Page & Mike Flynn, to name a few, & who was photographed guffawing with Trump in the Oval Office.

 

9/ What sort of “engagement” did Paul seek from Kislyak?

Seriously, the only reason you meet with that multi-chinned jackoff is to do to him what Rand Paul's neighbor did to Rand Paul.

10/ Moscow’s point person for the meeting was Konstantin Kosachev, a Russian senator & the chair of its Foreign Affairs Committee. 

Kosachev is a staunch ally of Vladimir Putin, and was among the Russian politicians placed on the US sanctions list of April 2018.

Here they are:

 

11/ When he returned from Moscow, Rand Paul went golfing with Trump, lobbying the president to allow Kosachev and other sanctioned Russian politicians to visit the United States. You know, because "engagement."

12/ Here's where it gets interesting: remember the Steele dossier, and the meeting Michael Cohen was alleged to have had in Prague? The meeting that was dead-to-rights collusion?

Guess who Cohen was alleged to have met with?

KONSTANTIN KOSACHEV.

13/ Again: the Putin surrogate who allegedly set up the key meeting between Trump’s people and the Russians two years ago is the same guy Rand Paul met with in Moscow this past summer.

14/ No doubt there's a perfectly innocent explanation for all of this, and that John McCain was joking when he called out Rand Paul for being a Russian asset, ON THE FLOOR OF THE US SENATE. I mean, engagement, amirite?

15/ Before we can write off Rand Paul as a useful idiot rather than an active Russian asset, however, we need to better understand the relationship between the Senator from Kentucky and Konstantin Kosachev.

16/ What did they discuss in Moscow? What was in that letter? Why is Paul so eager to have him visit the United States?

And: when and where did Rand Paul and Konstantin Kosachev first meet?

17/ That brings up a whole bunch of questions.

18/ You can read the full piece about this here. It is hardly exhaustive, as helpful folks on here have pointed out.

https://medium.com/@gregolear/red-paul-the-senator-from-kentucky-is-now-working-for-vladimir-putin-5ecad382f623

19/ There's the whole Ron Paul/Russia rabbit hole:

https://www.theatlantic.com/politics/archive/2014/07/ron-paul-is-putins-new-best-friend/439533/

20/ I guess this stuff runs in the family...or maybe "libertarian" means something different in Russia?

21/ Here's more (h/t @a_team1983 😞

https://ross-elder.com/2015/08/30/the-ron-paul-революция/

22/ And this, which link a helpful reader sent me. Simes is a key player in the Mayflower Hotel speech, a key Trump/Russia event:

https://freebeacon.com/politics/rand-pauls-russian-connection/

I could probably go on all day, but I think I've made my point. 

When John McCain accuses a sitting US Senator of working for Vladimir Putin, I take him at his word.

[END]

[DixonHur 11230]

You just can't make this shit up.

Kentucky Sen. Rand Paul is going to Canada for hernia surgery

Quote

Kentucky Sen. Rand Paul, one of the fiercest political critics of socialized medicine, will travel to Canada later this month to get hernia surgery. 

 

Edited January 14, 2019 by DixonHur

[Hornius Emeritus 12420]

8 minutes ago, DixonHur said:

You just can't make this shit up.

Kentucky Sen. Rand Paul is going to Canada for hernia surgery

 

 

Linky no worky.

[DixonHur 11230]

Just now, Hornius Emeritus said:

 

Linky no worky.

Oops, I blame the shutdown...here ya go

Rand goes to Canada

[JimmyJames 12271]

Fake news. Rand is going to a privately owned totally non socialist hospital that just happens to be located in Canada. It only takes American Express. In fact, the Canadian military has been trying to shut this particular hospital down for years but American marines keep them at bay. 

So stop trying to portray Rand as a completely hypocritical piece of dog shit because it just ain’t working. 

[DixonHur 11230]

22 minutes ago, JimmyJames said:

Fake news. Rand is going to a privately owned totally non socialist hospital that just happens to be located in Canada. It only takes American Express. In fact, the Canadian military has been trying to shut this particular hospital down for years but American marines keep them at bay. 

So stop trying to portray Rand as a completely hypocritical piece of dog shit because it just ain’t working. 

Maybe Canada should build a wall

[Chad Fuck 17567]

5 minutes ago, DixonHur said:

Maybe Canada should build a wall

Who could blame them?

Wait...

 

[bernorange 8348]

18 hours ago, JimmyJames said:

Fake news. Rand is going to a privately owned totally non socialist hospital that just happens to be located in Canada. It only takes American Express. In fact, the Canadian military has been trying to shut this particular hospital down for years but American marines keep them at bay. 

So stop trying to portray Rand as a completely hypocritical piece of dog shit because it just ain’t working. 

lulz...

Quote

Kelsey Cooper, a spokeswoman for Paul, said the hospital is privately owned and people come from around the globe for their services. The hospital's website outlines payments it accepts, including cash, check or credit card for those patients who are not covered by Ontario's insurance plan for its residents or a provincial health insurance plan.

“This is more fake news on a story that has been terribly reported from day one — this is a private, world renowned hospital separate from any system and people come from around the world to pay cash for their services,” Cooper said in an email to the Courier Journal.

Quote

The Global Leader in Non-Mesh Hernia Repair.

For over 70 years, we have been the only licensed hospital in the world dedicated to repairing hernias. More than 98% of our cases are performed with our natural tissue technique...without the use of mesh.

https://www.shouldice.com/

[Hugo Stiglitz 23362]

The criticism about Rand getting surgery in Canada is weak sauce, I’ll admit.

[Dertyberd 394]

55 minutes ago, Hugo Stiglitz said:

The criticism about Rand getting surgery in Canada is weak sauce, I’ll admit.

Bullshit.  It shows that two-tiered medical systems work quite well all over the 1st world and Rand and his "Death Panels" ilk are nothing but fear mongering hypocrites.  Fair criticism.

[Hugo Stiglitz 23362]

14 minutes ago, Dertyberd said:

Bullshit.  It shows that two-tiered medical systems work quite well all over the 1st world and Rand and his "Death Panels" ilk are nothing but fear mongering hypocrites.  Fair criticism.

Yeah okay, I'll give you that but among the ocean of hypocrisy in Rand Paul, this wasn't a big fish.  

[Js1 85119]

34 minutes ago, Dertyberd said:

Bullshit.  It shows that two-tiered medical systems work quite well all over the 1st world and Rand and his "Death Panels" ilk are nothing but fear mongering hypocrites.  Fair criticism.

Its okay, bernorange came quickly to white knight Rand. Nuh-uh, not hypocritical, quote Paul's hired lackey.

[JimmyJames 12271]

46 minutes ago, Hugo Stiglitz said:

Yeah okay, I'll give you that but among the ocean of hypocrisy in Rand Paul, this wasn't a big fish.  

Maybe not but it’s pretty hilarious seeing anti socialized medicine zealot Rand Paul taking his talents to Canada for a medical procedure, then trying to justify it by pointing out most people besides himself can’t really afford it or pay for it anyway. 

[bernorange 8348]

16 minutes ago, JimmyJames said:

... trying to justify it by pointing out most people besides himself can’t really afford it or pay for it anyway. 

wat?

[JimmyJames 12271]

2 minutes ago, bernorange said:

wat?

Stop being dumb. Do you think most people just walk into a hospital and plump down thousands of dollars in cash (not to mention international flight costs and hotels)  for a medical procedure? 

[bernorange 8348]

Your statement is not congruent with facts, but you are just wanting to dogpile, so it doesn't really matter.  It's a govco paid hospital?  He's a hypocrite!  It's a private pay hospital?  He's elitist scum!

I won't fault anyone for seeking out the best care they can afford.  I'm guessing if a hospital specializing in the "non-mesh hernia repair" existed here in the USA, he'd be going there instead.  Why doesn't one exist here anyway?

[JimmyJames 12271]

3 minutes ago, bernorange said:

Your statement is not congruent with facts, but you are just wanting to dogpile, so it doesn't really matter.  It's a govco paid hospital?  He's a hypocrite!  It's a private pay hospital?  He's elitist scum!

I won't fault anyone for seeking out the best care they can afford.  I'm guessing if a hospital specializing in the "non-mesh hernia repair" existed here in the USA, he'd be going there instead.  Why doesn't one exist here anyway?

Because Rand Paul and hypocritical assholes like him have a say over our health care. That’s why. 

[hobbes2702 12849]

14 minutes ago, bernorange said:

Your statement is not congruent with facts, but you are just wanting to dogpile, so it doesn't really matter.  It's a govco paid hospital?  He's a hypocrite!  It's a private pay hospital?  He's elitist scum!

I won't fault anyone for seeking out the best care they can afford.  I'm guessing if a hospital specializing in the "non-mesh hernia repair" existed here in the USA, he'd be going there instead.  Why doesn't one exist here anyway?

Ummmm, because our healthcare system sucks compared to the rest of the industrialized world. Thanks Rand 

[Anastasis 23397]

Our healthcare delivery is among the best in the world (for most things other than a very specialized hernia procedure developed by a Canadian surgeon apparently). Our healthcare financing system, on the other hand, is a total disaster. 

 

Oh, and he had to anticipate that the political optics were bad. While Shouldice appears to be the international leader in the development and execution of the technique, there are stateside surgeons using the same procedure, albeit with much less experience than Shouldice.  Hard to defend not using one of those options to be honest.  

Edited January 15, 2019 by Anastasis

[sidis 9755]

25 minutes ago, bernorange said:

Why doesn't one exist here anyway? 

hmmm.

[Anastasis 23397]

28 minutes ago, bernorange said:

Why doesn't one exist here anyway?

The technique was developed by a Canadian surgeon, and "perfected" at Shouldice. The technique has superior outcomes relative to other techniques.  It really has nothing to do with the national healthcare system, but gotcha is the most important thing in American politics. 

[Hugo Stiglitz 23362]

Let’s not forget Rand Paul is an enormous piece of shit.  There’s a damn good reason he needs special medical attention.  

[Bama Chick 28596]

Well, here’s a place right in Washington DC that does the no mesh procedure

https://www.medstarwashington.org/our-services/surgery/treatments/hernia/mesh-and-no-mesh-repair/

US News ranks in the 5th best hospital out of 58 in the DC metro area.

Here’s a clinic in Boston that’s literally modeled after the hospital in Canada and the doctor went and studied their techniques and is having the same success. He acknowledges the Canadian clinic has been doing the procedure longer but he is doing everything exactly as they do.

https://www.google.com/amp/s/bostonhernia.com/hernia-faq/i-want-a-no-mesh-repair-where-should-i-go/

This doctor at Stonybrook has done the Shouldice procedure 700 times.

https://www.stonybrookmedicine.edu/patientcare/surgery/patient-care/clinical/general-surgery/patient-education/faqs-about-the-shouldice-hernia-repair

And a dissenting opinion on this clinic from a Canadian physician -

https://www.google.com/amp/s/canadianfemalesurgeon.wordpress.com/2015/05/19/the-problem-with-shouldice-or-the-most-dangerous-phrase-in-the-english-language-weve-always-done-it-this-way/amp/

The problem with Shouldice or The most dangerous phrase in the English language- “We’ve always done it this way.”

I have just been chastised online for daring to criticize the Shouldice clinic on Twitter. So I’m going to outline some of my problems with the Shouldice clinic, which is held up around the world as a great Canadian healthcare success story. I am not going to comment on specific cases, just generalities here. I have never worked at, or been involved with the Shouldice clinic, so this blog comes from my own professional opinion as a general surgeon/hernia fixer and defender of evidence based medicine and socialized healthcare, discussions with many patients who have gone or are considering going to the Shouldice clinic, going to a talk some years back given by a surgeon who worked there, and the Shouldice clinic website.

The Shouldice Clinic is a private clinic operating in the Toronto area which has been open for decades. It was originally founded during World War 2 to allow for young men to have their hernias repaired before going off to fight. It was then allowed special licence by the Ministry of Health to continue operating. It has been repairing hernias for decades. It was recently taken over by a private company and is no longer in the hands of the original Shouldice family. The clinic sits on luxurious grounds and offers one thing and one thing only. Hernia repairs at the Shouldice are done with local anesthetic, no mesh insertion, and with a long stay in their hospital to recover.

Now as a confession of a conflict of interest here, I am a general surgeon who does lots of hernia repairs at a hospital about an hours drive from the Shouldice. I think 3 or 4 tomorrow in fact. The standard of care when the Shouldice was formed was a primary (suture) repair and lots of days in hospital recovering from the pain of having your own tissues reamed together to repair the hernia. I really don’t want to get into a lot of detail about the complex world of hernia repair here, but the world surgical community has moved on from primary repair with lots of inpatient days and the Shouldice has not. Is this because Shouldice thinks this is good care? Is it because they make lots of money off the patients and the taxpayers? Or is it because, here it comes, that dangerous phrase “We’ve always done it this way”? Likely some of all three. Another confession, I also make money doing hernia repairs, but I don’t make nearly as much as the Shouldice does off their patients. The “standard of care” now is to do hernia repairs with mesh, a plastic like substance which allows for less pain (if inserted properly), earlier return to work, and decreased recurrence rates. If I was doing the Shouldice repair with no mesh and keeping my patients in hospital for 5 days after hernia surgery, I would probably have my competence questioned, and with good reason. I would also, I hope, be getting angry calls from our hospitals administrators asking what the hell I was doing keeping patients in hospital for so long after such a simple procedure. Groin hernia repair is a day surgery procedure in Ontario (anywhere but the Shouldice clinic) with no overnight stay required, unless complications arise or in very frail or sick patients. I cannot recall a patient ever having been in hospital for 5 days after elective hernia repair. The Shouldice clinic admits patients the day BEFORE their surgery. I find this mind boggling- this approach was abandoned in the rest of medicine decades ago. I honestly cannot recall the last time I admitted a patient the night before surgery, except when I was a clinical clerk, and that is going back a long time now. The vast majority of procedures are day surgery, or what we call same day admits, where they are admitted (usually after a lot more major surgery than hernia repair) after their operation. Being in hospital has its own set of complications, with hospital acquired infections, pneumonias, blood clots in the legs or the lungs, and other problems. But my main problem with this approach as a taxpayer is that this is a huge waste of healthcare dollars. The Shouldice clinic charges patients for a private room for up to 5 days (this adds up to many hundreds of dollars). Sometimes this cost is paid out by private insurance companies if the patient has a health benefits plan, or by the patients themselves. The Shouldice then also bills the Ministry of Health for each inpatient day a patient stays overnight. So yes, that is you, the taxpayer, footing the bill for unnecessary care being provided by a private company. Now some of the Shouldice clinic patients come from out of country and should be paying for all of their care but what this percentage is, I do not know. Shouldice also does not require a doctor’s referral to see patients and bill the Ontario health care system. As a specialist, I am not allowed to bill OHIP to see patients without a referral from another doctor, and so we see the double standard growing.

Now the Shouldice clinic does do something I agree with in part. Patients are required to be within 20 % of their ideal body weight, and are refused surgery at the Shouldice if they do not meet this criteria or lose the weight. The average North American is gaining 1-2 lbs per year, and obesity is a clear risk factor in hernia recurrence. The more you weigh and the more weight you gain after hernia repair, the more your risk of recurrence rises. Now I do on call, a lot, at a smaller hospital, and it is not my practice to refuse hernia repair to overweight patients, unless it is a very large, recurrent hernia, in a very obese or frail patient, where there is little risk of bowel obstruction. Odds are, I am going to be the one digging out a blocked or gangrenous piece of bowel from this hernia in the middle of the night if I do not fix it electively. So while I agree with patients having to lose weight for some surgeries, I cannot on a practical level be that picky about it. Shouldice of course sends most of the patients it sees back to where they came from, and does not have to worry about complications or ongoing issues from their repairs. They do not have to do emergency general surgery, ever, how convienient. Most general surgeons will tell you that they cannot get patients to lose weight before surgery, and that has certainly been my experience. Shouldice effectively skims off elective procedures in a very healthy, wealthy, and slim segment of the population that is extremely motivated to get their hernias repaired at this private clinic. This makes any numbers they publish about their recurrence rates completely out of touch with the reality of what myself and other general surgeons are dealing with in our practices. The other thing about hernia repairs is that recurrence rates have always been very hard to measure. You have to follow patients for decades to know your real recurrence rate, and patients also are not likely to go back and see the same surgeon (or a clinic) once they have had a recurrence. This makes anyone’s numbers on hernia repair difficult to interpret, but the Shouldice’s number in particular should be viewed with a grain of salt. One patient told me he didn’t want to go back to Shouldice with his recurrence because he couldn’t afford it. I wonder if they know about him, or does he go into their success pile?

Now patients will generally think that more care is better care. So five days in hospital must be better than no days in hospital, right? We know that asking patients about their satisfaction with their care has nothing to do with the quality of care provided. In fact, the most over investigated, over treated patients are likely to think they have great care, when the opposite is the truth. The Shouldice clinic is a good example of that. I am also not a fan of the idea of “Centres of Excellence.” The idea that high volumes of doing one thing only makes you better at it. I went into general surgery because it’s well, general. I love doing a variety of different procedures in patients of all ages, sexes, shapes and sizes. It’s one of the great things about my job. If I was doing only one operation, the only thing I would be is bored. There is some evidence that using generalists is a cheaper, better way to run a health care system and I believe that.

This is a microcosm of what happens when you introduce private interests into a socialized health care system. In Australia, the introduction of private healthcare has resulted in exactly what has happened here, albeit on a much larger scale. A skim off of the healthy and the wealthy to the private system, leaving the public system to deal with the emergency, unhealthy, and poorer patients. I do not believe in the argument that the Shouldice doing so many repairs allows for more hernias to be repaired in our public system. The amount of money being drained away by this clinic from the public system is opportunity cost, not just for hernia repairs, but all healthcare spending.

So one last confession. I had two hernias repaired in November last year. I got a colleague to do it, with mesh, and a general anesthetic, as day surgery, in one of our local hospitals. I went back to work in less than 48 hours and I am very happy with my scar. I would recommend this approach (and frequently do) to anyone, including my patients.

So, sounds like there’s options in the US for this procedure and like all things, just because it’s touted as the gold standard doesn’t mean it is.

[DixonHur 11230]

1 hour ago, Anastasis said:

The technique was developed by a Canadian surgeon, and "perfected" at Shouldice. The technique has superior outcomes relative to other techniques.  It really has nothing to do with the national healthcare system, but gotcha is the most important thing in American politics. 

 

It's fucking hernia surgery, not brain surgery.  I'm sure this guy has some super-duper special technique, but at the end of the day, you're just sticking some intestine back in the abdominal cavity.

Edited January 15, 2019 by DixonHur

[Anastasis 23397]

2 minutes ago, DixonHur said:

It's fucking hernia surgery, not brain surgery.  I'm sure this guy has some super-duper special technique, but at the end of the day, you're just sticking some intestine back in the abdominal cavity.