Docs, guns and population health payments

Doctors occupy a privileged position in our society. They are among the most trusted professions and they have significant but not absolute legal protections for the advice and conversations that they have with their patients. These two factors make doctors an excellent delivery mechanism for public health advice because people will give their doctor a fair hearing instead of automatically disregarding a message delivered from a less trusted source.

When I was a kid, the major messages that my pediatrician delivered to my parents was to use seatbelts, delead the house and minimize the amount of time us kids spent around lit cigarettes. The goal of these questions were to reduce the probability of harm from easily avoidable vectors. Today, pediatricians and other PCPS will often inquire about gun ownership as guns are one of the leading causes of death for individuals under the age of 25.

Kevin Drum is uneasy about these questions:

That said, should physicians ask about gun ownership? I’m not so sure. Carroll says he only wants to discuss “health risks,” and that’s appropriate. Doctors have expertise in the area of human health: that is, the biology and physiology of the human body. But that’s not the same thing as the safety of the human body.

Maybe in an ideal world where there are public health/enviromental/behavioral safety and risk assessment advisors that are fully trusted by the vast majority of the population and who sees people on a routine basis, this is a relevant beef, but I think in this world Kevin is wrong, and we will see a trend towards medical providers asking more lifestyle choice questions in the future. Right now, doctors are motivated to ask about guns because they are a major cause of preventable injuries and death to a group of people who die due to preventable deaths in large numbers. If there was a safety culture where every bullet is a strict liability of the weapon owner, where every weapon is properly locked up in secure gun safes, where the amount of firepower that is publiclly available is sufficient for hunting and home defense instead of the start of an insurgency, gun questions would be a minor question seldom asked unless the parents of the kids are open carrying with the safety off and a closed chamber.  We don’t live in that world. 

This trend will continue becuase providers are begining to get paid for population health metrics instead of a fee for service system. Fee for service could see added gun violence as a positive for the income of doctors and hospitals because more trauma victims means more procedures which means more billing opportunities.  Reducing preventable serious injuries and death were a social good but under the fee for service payment model, the public health incentives were at long term conflict with provider payments.   Insurance companies always had that motivation in order to reduce claims payout, but savings produced by providers giving good public health advice had not been shared with the providers actually doing the work.  If anything, providers were expected to be altruistic and not get paid or not get paid well for their time. 

 That conflict is changing.

Population health payment systems through strict capitation, Accountable Care Organizations, or global budgets for large groups means providers want to avoid extremely expensive emergency and trauma utilization, they want to avoid six months of rehabilitation for a kid who statistically should be perfectly healthy or merely worried about a fractured tibia due to a shitty slide tackle during soccer practice. The payment systems are moving towards population health management where the doctor needs to know how to perform acute interventions, but their payments and livelihoods are far more dependent on helping people avoid the really easy ways of landing in the hospital.






80 replies
  1. 1
    rikyrah says:

    Michelle Obama on Sesame Street: The Most Important Meal of the Day

    http://youtu.be/RaTMdOeZzVo

  2. 2
    japa21 says:

    In what way, if any, is asking about accessibility to guns any different than asking about lead paint, advising use of seatbelts or avoiding cigarettes? Yet, I doubt if Drum had any qualms about those questions.

  3. 3
    Keith P says:

    @rikyrah: Is it “COOKIES!!!”?

  4. 4
    raven says:

    I’m not sure postal carriers should be checking to see if old people are ok,.

  5. 5
    Warren Terra says:

    Certainly when I was a kid one aspect of visiting the pediatrician was that the parents would be lectured on locking up household hazards, and would be given a roll of Mr. Yuk stickers. I see a conversation about responsible gun ownership as being entirely in line with this practice.

  6. 6
    Cacti says:

    Speaking of doctors, guns, and “only in Arizona”…

    A top researcher at the Barrow Neurological Institute in Phoenix was arrested at Sky Harbor airport, for negligently pointing his shoulder-carried AR-15 rifle at a pair of women while he was getting coffee.

    He’s been charged with 2 counts of disorderly conduct with a weapon and released on $5,000 bond.

    The good doctor is also very caucasian. Now raise your hand if you think this encounter would have ended peacefully had he been of African, Mexican, or Middle Eastern ancestry.

  7. 7
    Villago Delenda Est says:

    @Keith P: YES!

  8. 8
    Villago Delenda Est says:

    The NRA has kittens if anyone dares to factor gun ownership into the mix of various public health risks, for obvious reasons.

    Their paymasters are pushing death pen!ses. They don’t want to be hindered in any way by uncomfortable (and unprofitable) coincidences between gun ownership and higher public health risk.

  9. 9
    Betty Cracker says:

    It’s hard to image the transition from a fee-for-service to capitation environment will move the needle on this issue because we’re not talking about what constitutes valid points for physician-patient discussions — or at least, our opponents aren’t. Our opponents are unhinged fanatics who are bent on making all rights, laws and public policies subservient to their misinterpretation of the 2nd amendment.

  10. 10
    Tone In DC says:

    I won’t even ask why Doctor No was packing an assault rifle in an airport.

    And this ammosexual is a brain surgeon.

    Did someone mention a meteor?

  11. 11
    sempronia says:

    @japa21:

    yeah, agree. And how does asking about gun use differ from asking lifestyle questions pertaining to helmets with bikes or un/safe sex, which are also high-risk activities?

    Individual trauma surgeons may get paid more for taking care of ultra-sick gunshot victims who need surgery and long ICU stays, but hospitals generally eat a lot of cost. Who do you think gets shot? Not people with great insurance who can pay up. This is why many trauma surgeons in medium-volume trauma centers also specialize in something else -because medicare doesn’t pay enough for them to be able to practice trauma only.

    Many trauma centers run violence-prevention outreach programs with inner-city kids. No one’s getting rich off GSW victims (although there’s nothing a trauma surgeon likes better than a hot penetrating-violence case….).

  12. 12
    Shakezula says:

    Doctors have expertise in the area of human health: that is, the biology and physiology of the human body. But that’s not the same thing as the safety of the human body.

    Wow. There’s a lot of wrong packed into those two sentences.

    Medical societies make safety recommendations all of the time, because they tend to have insight into things that make us break. The recommendation that doctors ask about guns in the home comes from the American Academy of Pediatrics and was co-signed by a lot of other medical societies.

    But according to Kdawg, they should hush up because they don’t know what they’re talking about.

  13. 13
    a hip hop artist from Idaho (fka Bella Q) says:

    In addition to pediatricians, psychologist, psychiatrists, and any doc who is prescribing antidepressants to patients needs to know if there are firearms in the residence. Sort of an uncounted category of gun deaths are suicides. Many of which might be avoided without a lethal mechanism ready at hand.

  14. 14
    Villago Delenda Est says:

    @Tone In DC: Back in 1985, I was selected to go on a six month temporary tour of duty in Honduras. One of the requirements was that I bring my assigned weapon with me…which happened to be an M16A1. How I was supposed to transport this weapon across the country from Fort Lewis, WA, to Miami, where I’d catch a flight to Tegucigalpa was left up for me to figure out.

    It was pretty obvious that carrying a slung M16A1 over my shoulder through the Miami International Airport was NOT a viable option. I contacted security at the Miami International Airport and asked them if they had any ideas on how I could go about doing this. They suggested I pack it in my checked baggage and not make any declarations about this because it would just raise too many alarm bells that would take a lot of time to sort out. The individual I talked to did record the conversation in his log so there was a reference if any questions might arise.

    So what I wound up doing was breaking the weapon down into the upper assembly group, the lower assembly group, and the bolt, and packing each inside a separate piece of checked baggage (along with a copy of my orders with each) and transporting it that way. The idea being that if one piece of luggage got lost or stolen, a complete weapon would not fall into the wrong hands.

    Brandishing a fully automatic weapon in an airport is, well, not a good idea even for military personnel with a legitimate reason to have a firearm on them.

  15. 15
    Steve in the ATL says:

    I was a faithful reader of Kevin Drum until I could no longer stand the whiny, sky-is-falling mopery and navel-gazing.

  16. 16
    Cacti says:

    @Tone In DC:

    I won’t even ask why Doctor No was packing an assault rifle in an airport.

    And this ammosexual is a brain surgeon.

    Did someone mention a meteor?

    I’ll just label him as Exhibit A for why it’s become impossible to reason with GOPers anymore.

    Even the ones with the most advanced of educations are Sarah Palin-esque nucking futs on the inside.

  17. 17
    beth says:

    When we moved to Florida from up north, our new pediatrician spent a lot of time with my daughter at her first visit asking about things like whether she wore a bike helmet and telling her the dangers of not wearing sunscreeen and reaching, unseen, into underbrush for toys (spiders, snakes and gators, oh my!) and always having a buddy when swimming. I’m pretty sure he also told her never to pick up or touch a gun and to call an adult if she found one. I remember being so impressed by that; it’s a shame the gun nuts object to it. It really made an impression on her hearing it from an authority figure. It’s not like her told her guns were bad or not to ever use one.

  18. 18
    CONGRATULATIONS! says:

    Kaiser CA started asking a couple of years ago. I’m sure, as only Kaiser can, that the only reason they ask will be to deny people benefits and raise their premiums. God knows the welfare of their actual patients comes in a distant third to those two goals.

    Two more weeks and I’m done with Kaiser for good, thankfully. They’ve already managed to kill two friends of mine through inexcusable negligence and I’d prefer not to be one more casualty.

  19. 19
    cleek says:

    @Steve in the ATL:
    so you came here?

  20. 20
    Cassidy says:

    @Tone In DC: Surgeons tend to be a special bunch.

  21. 21
    cckids says:

    @Warren Terra:

    Certainly when I was a kid one aspect of visiting the pediatrician was that the parents would be lectured on locking up household hazards

    This. I had a pediatrician who was incensed with me for not having my son’s seizure meds in a “locking cabinet at least 5 feet off the floor”. At the time, I had one child, who was quadriplegic. But I got the message; I had a little sister, nieces & nephews, the odd neighbor child . . . so, the meds got locked up.

    And I didn’t get pissy with the doctor about it.

  22. 22
    Seanly says:

    @Cacti:

    WTF? He says he went to the airport just to get a cup of coffee? Who gets up the morning and decides to go to the airport just for a cup of coffee (to say nothing of wanting to stroll around with a rifle).

  23. 23
    swbarnes2 says:

    Do doctors ask about pools too? Pools kill more kids, because there are so many more of them.

  24. 24
    Villago Delenda Est says:

    @cleek: I see what you did there.

  25. 25
    Villago Delenda Est says:

    @Seanly: I think it’s because the JP4 vapors interact with the coffee filters to enhance the flavor of the brew.

    Or something.

  26. 26
    Cassidy says:

    @swbarnes2: This should be good. Should I save us all a lot of time and guess your next comment is about how cars kill more people than guns?

  27. 27
    Villago Delenda Est says:

    @Cassidy: Cars don’t kill people. People driving cars kill people!

  28. 28
    cckids says:

    @swbarnes2:

    Do doctors ask about pools too? Pools kill more kids, because there are so many more of them.

    Out here in Vegas they do. They give the kids the lecture about not ever going into a pool alone, etc, etc. Because there are so many of them out here. And, again, parents understand it as a safety lecture, not a evil plot to restrict their rights of pool ownership.

    Gun nuts are weird.

  29. 29
    Shakezula says:

    @swbarnes2: More pools than guns? More kids than pools? More guns than kids??

  30. 30
    Amir Khalid says:

    @Tone In DC:
    He’s a neuroscientist, which is different from a neurosurgeon.
    ETA: Not, I hasten to add, that I disagree with you.

  31. 31
    gogol's wife says:

    @Cassidy:

    On the thread down below he’s using “Stan Gable.”

  32. 32
    SatanicPanic says:

    @Seanly: Yeah, that’s definitely suspicious. for real he should be on a watch list. No one in their right mind goes to an airport if they don’t have to.

  33. 33
    Steve in the ATL says:

    @cleek: Point taken, but I like it here. Fewer trolls than at LGM, fewer firebaggers than at FDL and DK, and I don’t have to wade through hundreds of what-I-had-for-lunch and my-nose-is-running comments like at Atrios’ place.

  34. 34
    Richard Mayhew says:

    @swbarnes2: My kids’ pediatrician has asked about swimming lessons and whether or not we have a backyard pool for my 5 year old at her last visit. Drownings by the way are significantly lower probability cause of death than gun shot wounds, so please get better talking points.

  35. 35
    Roger Moore says:

    @Tone In DC:

    And this ammosexual is a brain surgeon.

    No, he’s a brain researcher. He probably spends a lot more time taking brains apart than fixing them. Actually, he probably spends much more time writing grants than both put together.

  36. 36
    Richard Mayhew says:

    @cleek: But here, we use Fuck frequently and correctly in all parts of speech :)

  37. 37
    a hip hop artist from Idaho (fka Bella Q) says:

    @Villago Delenda Est: It made me LOL, as they say.

  38. 38
    Literalreddy says:

    @Steve in the ATL: LGM instituted registration for commenting and according to hosts they lost 30% of commenting traffic. However it was the 30% that was trolls and responses to trolls. It is much better, at least for now.

  39. 39
    raven says:

    Not the first time: It was at least the second time the Johns Hopkins trained scientist showed up to the Phoenix airport with a weapon. The last incident came two days after a deadly shooting at LAX and Steinmetz’s son was there, as well, and also armed. – See more at: http://www.coloradonewsday.com.....72WLu.dpuf

  40. 40
    Roger Moore says:

    @swbarnes2:

    Do doctors ask about pools too? Pools kill more kids, because there are so many more of them.

    No they don’t. Drowning is a more common cause of accidental death than firearms, but suicide and homicide more than make up the difference.

  41. 41
    Trollhattan says:

    @Cassidy:
    Yeah, about that.

    Nevada is one of 14 states where there are more gun-related deaths than motor vehicle fatalities. That’s according to a new study conducted by the Violence Policy Center, a nonprofit organization that advocates for gun control. The study, which used data collected in 2011, found that there were 376 gun-related deaths in Nevada that year. It includes suicides, homicides and deadly unintentional shootings. That’s compared to the 281 traffic fatalities our state had that year.

    “I’m not surprised,” said Teresa Crawford, who volunteers for several gun violence prevention organizations.

    Crawford believes gun violence is a public health issue.

    “We’ve spent billions of dollars in research, engineering, legislation, consequences for unsafe driving. All of those serve to decrease deaths on the highway. Whereas for gun violence, we’re really not doing much,” she said.

    However, not everyone agrees with the study’s findings, claiming the Violence Policy Center is biased.

    “I believe it’s coming from the left – those that are looking to see total disarmament of the United States,” said Leon Novak, a firearms instructor at Urban Civil Defense in Henderson.

    Urban Civil Defense runs background checks on its customers ahead of firearms purchase. Novak doesn’t believe further restrictions on firearms is the answer to ending gun violence.

    “When somebody wants to deprive or somehow suppress my right to keep and bear arms, I definitely have a problem with that,” he said.

    “Nobody’s banning anything,” Crawford said. “We’re just talking about making our communities and schools safer.”

    Nationwide, the study found more than 32,000 people died in gun-related incidents in 2011. More than 35,000 died in motor vehicle deaths that year.

    Ohio and Illinois topped the list with more than 1,000 gun-related deaths in 2011, according to the study. Gun deaths also outnumbered auto deaths in Arizona and Utah, researchers found.

    http://www.fox5vegas.com/story.....ties-in-nv

    Driving becomes safer and safer as the years go on. The magical gun keeps taking more and more.

  42. 42
    HR Progressive says:

    I don’t think there’s anything wrong with a physician asking about gun ownership in a home, because with any weapon, there’s definitely a nonzero chance that something could happen that causes injury.

    However, the only way I think asking the question would be of any use would be if they were allowed to start asking profiling-type questions related to mental state and/or hatred of the government.

    The simple act of owning a firearm, or even multiple firearms, does not automatically make you a statistic waiting to happen. Should an actual, rare-to-be-seen-in-the-wild, responsible firearm owner, be lumped in with the drunken hillbillies or the armchair commandos who can’t wait for civilization to collapse so they can strut around like the pretend soldiers they think they are?

    I submit that those two classes of people – whatever the actual disparity in terms of numbers between them – are not, and should not, be treated the same way.

    However, I also don’t see how any doctors/physicians groups would “get away” with profiling the tinfoil-hat types, so…

  43. 43
    a hip hop artist from Idaho (fka Bella Q) says:

    @Literalreddy: In honor of here (and the new registration at LGM) I picked a new name there.

    I’m now FYWP over there. It’s short, sweet, and relevant.

  44. 44
    r€nato says:

    @Cacti: Well, it certainly could have been an interesting test of Arizona’s version of SYG laws if the two in question had also been packing heat and fired on him…

  45. 45
    r€nato says:

    @HR Progressive:

    The simple act of owning a firearm, or even multiple firearms, does not automatically make you a statistic waiting to happen.

    actually, it does. Must it be pointed out to you that it’s almost a daily occurrence that some Very Responsible Gun Owner injures or kills themselves or someone else due to carelessness in handling and storage of their firearm? FFS, just the other day a pregnant woman got shot in the head and killed by someone who wanted to show off their .22. Not long before that, some dipshits in Baltimore killed their buddy by trying to see if a bulletproof vest really worked (they missed the vest).

  46. 46
    pluege says:

    1) Kevin Drum is an idiot that is hazardous to your mental health and should be avoided or risk being dumbed down.

    2) compartmentalization of “health” is EXACTLY the primary thing WRONG with western medicine. The human being is not in any way, shape, or form compartmentalized within itself, or from its environment; it is a fully integrated entity: mentally, spiritually, physiologically among its parts and its environment. Treating a piece and ignoring the whole is no treatment at all.

    3) A medical practitioner’s job and interest is the “health” of their patience. Treating physiology alone, while ignoring hazardous environmental factors, especially such threatening elements as gun fetishists (mentally unstable by their very existence) is no treatment at all.

  47. 47
    Pogonip says:

    There is no excuse for someone being injured by an accidental discharge. None. The gun’s always loaded, you shouldn’t be pointing it at anything you don’t plan to fire at, and until the moment you fire your finger should be off the trigger. This is kindergarten level gun safety, akin to ” Never cross the street without looking both ways.”. I don’t understand why people can’t follow these few simple rules.

  48. 48
    Shakezula says:

    @HR Progressive:

    However, the only way I think asking the question would be of any use would be if they were allowed to start asking profiling-type questions related to mental state and/or hatred of the government

    Why? That’s not why a ped. is asking about guns in the home. The ped. is asking because unless it is properly stored, a gun in the home creates an opportunity for Junior will put a hole in himself or another person.

  49. 49
    a hip hop artist from Idaho (fka Bella Q) says:

    @Pogonip:

    I don’t understand why people can’t follow these few simple rules.

    They don’t because they know what they’re doing – just ask them. Actually you probably won’t need to. Every ammosexual styles her/himself a (self-designated) firearms expert. Plus, freedom.

  50. 50
    pluege says:

    @HR Progressive:

    I submit that those two classes of people [wingnut gun owner and mythical “responsible gun owner”] – whatever the actual disparity in terms of numbers between them – are not, and should not, be treated the same way

    .

    They are in fact exactly the same, differing only by degree. Both are mentally and psychologically insecure; both harbor fantasies of killing; both will in fact act on those fantasies in some form, with some manufactured rationalization at some time; both are unsuited to possess dangerous weapons.

  51. 51
    Shakezula says:

    @a hip hop artist from Idaho (fka Bella Q): “I know what I’m doing!”

    Often the last words someone utters. Or hears.

    p.s. I wondered who was FYWP over at LGM. It made me giggle.

  52. 52
    Trollhattan says:

    @r€nato:
    Correct. A home becomes less safe, from an actuarial and epidemiological standpoint, the moment a gun enters.

  53. 53
    Anoniminous says:

    We used to have a semi-functional Public Health system. Ronnie RayGuns put paid to that and I don’t expect it to be rebuilt until white people start contracting/dying from dengue fever, West Nile fever, yellow fever, Chikungunya, and/or encephalitis as the Tiger mosquito wings its merry way across the US.

  54. 54
    CONGRATULATIONS! says:

    The simple act of owning a firearm, or even multiple firearms, does not automatically make you a statistic waiting to happen. Should an actual, rare-to-be-seen-in-the-wild, responsible firearm owner, be lumped in with the drunken hillbillies or the armchair commandos who can’t wait for civilization to collapse so they can strut around like the pretend soldiers they think they are?

    I submit that those two classes of people – whatever the actual disparity in terms of numbers between them – are not, and should not, be treated the same way.

    @HR Progressive: I do, and I belong to one of those groups. The good one. And we are such a minority that you would be foolish to waste your time trying to determine whether a gun owner is responsible or not. Because virtually none of them are.

    ETA: I don’t mind taking the time to explain to the few people who know I have them how I deal with them. I tell very few people.

  55. 55
    rikyrah says:

    Anyone following the McDonnell trial in VA?

    It’s only the second day and it’s hilarious.

  56. 56
    JoyfulA says:

    @Betty Cracker: Medicare has some kind of new program for each patient to talk with the family doc about things that bother them or things they don’t get around to talking about in regular visits.

    I brushed it off—I do chat with my doc, and email her—until she told me the office gets demerits or brownie points depending on whether such visits take place. I’ll let you know if she asks about my Enfield with no firing pin.

  57. 57
    mclaren says:

    Ignorant incompetent doctors should be quizzed about Bayes’ Theorem. Those unable to answer need to be fired. A doctor needs to understand Bayes Theorem because it tells you the probability that if you test postive for some illness, you actually have it.

    85% of doctors tested were unable to correctly apply Bayes’ Theorem. This means that ignorant incompetent doctors are killing people because of their ignorance of the basic scientific method. It needs to stop.

    Doctors also have little to no concept of the interaction of various drugs they prescribe. That also kills people.

    The average doctor in America has the approximate level of skill of a plumber. It’s shocking.

  58. 58
    Roger Moore says:

    @Pogonip:

    I don’t understand why people can’t follow these few simple rules.

    Dunning-Kruger effect. They’re sure they know what they’re doing, so they don’t bother to learn the right way.

  59. 59
    Betty Cracker says:

    @pluege: I’m for much stronger gun control, but I don’t go quite that far. There are hunters, people who live way out in the country, folks have livestock to protect, people who have to deal with poisonous snakes on their property, etc., who have a legitimate need to own a gun. That doesn’t make the fact that they have a gun in their house less of a risk factor, of course. But not everyone who has a gun is an insecure weirdo, IMO. Military-style assault rifles? Yeah. Weirdos. Unless they’re soldiers.

  60. 60
    Pete Gaughan says:

    Doctors have been asking my kids how much time they watch television for over ten years now, and a gun in the house is a much bigger risk factor than TV for death or serious injury. I support doctors putting “avoid guns” right up there with “avoid meth and get plenty of exercise”.

  61. 61
    PeorgieTirebiter says:

    Last week I informed my Doctor that come Oct., we could expand the types of diagnotics and care available to me when I will covered by Blue Cross/Blue Shield of Texas. I went on to say that this turn of fortune was a function of the ACA. “You mean Obamacare.” she replied, as if she’d just thrown up a little in her mouth. I was more than a little shocked and after some back and forth I said, if I hadn’t told you, you wouldn’t have known anything other than I was now covered by a mid level Blue Cross plan. She went on to insist that I was ignorant, it would not be “normal” Blue Cross but an “Obamacare version”. Beside finding a new provider in Oct. is there a short tract I can give here when I request mt records? This can’t be a one off anecdote.

  62. 62
    Yatsuno says:

    @mclaren:

    The average doctor in America has the approximate level of skill of a plumber

    You need a podiatrist. Your continual hoof-in-mouth disease is astounding. Plumbing is actually a highly skilled and technical profession, but that doesn’t fit your holier-than-thou narrative now does it?

  63. 63
    SatanicPanic says:

    @Yatsuno: Maybe mclaren meant it as a favorable comparison?

    I can’t talk, I find doctors annoying and routinely compare them to mechanics.

  64. 64
    Amir Khalid says:

    @Betty Cracker:
    Switzerland’s aside, I have not heard of any army that lets soldiers keep their issued weapons at home. And even the Swiss don’t let soldiers keep issued ammo at home anymore.

    I’ve seen some ammosexual YouTube videos. Grown men playing with firearms like excited seven-year-olds on Christmas morning, firing gleefully at targets and whatnot. That’s the flip side of the insecurity that drives ammosexuality, I guess.

  65. 65
    scav says:

    It’s all about free speech until it’s the second amendment dictating what doctors can discuss with their patients. Oh, and religious corporate conglomerate persons dictating what medical workers can tell or do to patients, damed be what their personal moral values are, or the best accepted practices of medicine or, or the moral tenants of the profession. Because, you know, reeeeligious freedumb and the free-market creating the best possible system of healthcare when unfettered by regulations and govt death panels. Same old same old. They’re very conservative of their basic foundational illogic.

  66. 66
    Trollhattan says:

    @PeorgieTirebiter: Jesus, I’d run like hell, too. Seriously doubt you’re going to be given the opportunity to sway her opinion, which must have been formed at the club (golf, tennis, shooting, County Republicans, who the hell knows?).

    Now stop eating with your hands and use your entrenching tool!

  67. 67
    Mike J says:

    @swbarnes2:

    Pools kill more kids, because there are so many more of them.

    6 million backyard pools in the US ()according to the freakonomics guy you stole your argument from)
    310 million guns

    Had you cited your argument as coming from Levitt people could have known it was moronic and wrong without having to do any further research.

  68. 68
    Roger Moore says:

    @Yatsuno:

    You need a podiatrist. Your continual hoof-in-mouth disease is astounding.

    I think mclaren is more in need of the services of a psychiatrist.

  69. 69
    Betty Cracker says:

    @Amir Khalid: The US Army doesn’t either. One of my favorite baseball players reported a burglary in which his AK-47 was stolen awhile back. All I could think was, “Why did you have an AK-47, you asshole?”

  70. 70
    Tone In DC says:

    @Villago Delenda Est:

    That was cool, VDE.

    The most, uh, awkward item I have ever tried to get through an airport is a fifth of rum.

  71. 71
    Tone In DC says:

    @Cacti:

    Heh. Indeed.

    Maybe this guy is just frightened or agitated by of flight attendants.

    “I WANT MY DAMN PEANUTS, NOW!!!1!”
    /winger on most flights

  72. 72
    Tone In DC says:

    @Amir Khalid:

    Not, I hasten to add, that I disagree with you.

    I stand corrected.

    Still wanna know what the hell he’s doing with that Bushmaster in that terminal.

  73. 73
    Stella B. says:

    @PeorgieTirebiter: as a retired doctor, I would like to give you a copy of the Planned Parenthood flyer that I use as a volunteer to help people sign up for Obamacare. However, since that is unlikely, may I just suggest you choose a different PCP. Since most of us favor the ACA (although we are less likely to be Ds than the science PhDs, even R docs are often pro-ACA), you’re chance of hitting a second FOX-fan doc is less than 50%.

  74. 74
    Tone In DC says:

    @Tone In DC:

    Eesh. Preposition fail.
    (slinks away in shame)

  75. 75
    Mnemosyne says:

    @CONGRATULATIONS!:

    Out of curiosity, are you with Kaiser Northern Cal or Kaiser Southern Cal? Kaiser Southern Cal is okay. Kaiser Northern Cal had their permission to do organ transplants taken away because they kept killing people.

  76. 76
    burnspbesq says:

    @Pogonip:

    I don’t understand why people can’t follow these few simple rules.

    You’re implicitly assuming that the average gun fetishist (1) is aware of these few simple rules and (2) agrees that he should be governed by societal norms. Both of those assumptions seem, shall we say, shaky.

  77. 77
    PeorgieTirebiter says:

    @stella, thanks- I wasn’t actually looking for a way to improve my relationship with her, I was thinking here was an outside chance she’d read the pertinent portion of whatever I find to give her and perhaps reevaluate. Being in rural N.TX presents some challenges but with my new policy, my choices increase at least ten-fold. I have a number of good resources available to me to wade through the process. Thanks for the help.

  78. 78
    another Holocene human says:

    @Roger Moore: you must put up a six fooot opaque fence around a residential inground pool bc it is an attractive nuisance.

    Where are the prosecutions for not securing and locking up guns around children?

  79. 79
    Pogonip says:

    @Richard Mayhew: I can conjugate it!

    Although the last time I conjugated, I ended up pregnant…

  80. 80
    efgoldman says:

    @Pogonip:

    I don’t understand why people can’t follow these few simple rules.

    Because people are idiots.
    SATSQ

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