CNBC has been paying very close attention and keeping a running tally of actual spending as well as the commitments involved.

Try $4.28 trillion dollars. That’s $4,284,500,000,000 and more than what was spent on WW II, if adjusted for inflation, based on their computations from a variety of estimates and sources*.

Some 68-percent of the sum falls under the Federal Reserve’s umbrella, while another 16 percent is the under the Troubled Asset Relief Program, TARP, as defined under the Emergency Economic Stabilization Act, signed into law in early October. (The TARP alone is bigger than virtually any other US government endeavor dating back to the Louisiana Purchase. See slideshow.)

*References includ US National Archive, US Dept of Defense, US Bureau of Reclamation, Library of Congress, NASA, Panama Canal Authority, FDIC, Brittanica, WSJ, Time, CNN.com, and a number of other websites.

Have you ever had an MRI, CAT scan or other radiological test? The use of such tests has surged by 50% in the last 5 years. They’re potentially life-saving tests. But they’re also over-prescribed by doctors who are afraid of being hit with a malpractice suit for not running the tests. This is also known as “defensive medicine.”

Well according to Clark Howard, the big insurers are now using RBMs — radiology benefits managers — to assess whether they want to cover the procedures or not. A Wall Street Journal reporter found case after case where an insurer would pre-certify a radiological test and then, after the fact, turn around and deny payment based on the recommendation of their RBMs.

So what can you do?  Clark says that before proceeding with any radiological test, get approval in writing — even if pre-authorization isn’t necessary. Don’t settle for approval over the phone; you must get it in writing.

If you’ve already had a test done, and you’re getting a referral to another doctor who is suggesting another test, take your films with you instead of undergoing a duplicate test.

Read the full Wall Street Journal story.

Congress is looking to pass a stimulus package to help jump start the flagging U.S. economy. Recent stimulus packages have come in the form of checks from Uncle Sam. This time think concrete, as the recent debate has turned to using federal spending on infrastructure projects as an economic stimulus.

In late September, the House passed a $57 billion stimulus package that sprinkled $30 billion worth of infrastructure spending to a variety of projects: $12.8 billion for highways and bridges; $11.5 billion for water infrastructure (wastewater treatment, dams and levees); $3.6 billion for transit capital projects and $1 billion for transit energy cost relief; and smaller amounts for Amtrak and airport improvement projects. The Senate’s response: thanks, but no thanks.

The question is whether infrastructure expenditures will provide the type of short term boost to the economy that will help turn the current downturn around quickly. Infrastructure spending is a net positive, because when you are done there are tangible improvements to the nation’s roads, airports, and water systems. Because the current economic downturn is expected to be fairly lengthy, some believe the time is ripe to use infrastructure spending to stimulate the economy, despite the longer lead time to get these projects moving.

The problem with this approach is that it is deficit spending, leaving taxpayers on the hook to pay for these projects. In addition the short-term benefits are limited, especially as stimulus spending. As a result, any stimulus package including infrastructure projects should be limited as well. Some are of the opinion that funding for ready to go projects, especially road repairs, could be justified as stimulus spending, but any larger infrastructure investment should be considered long-term and should be paid for.

Many advocates of increased highway and transportation spending like to point to the rosy figure that every $1 billion in new highway spending generates more than 47,000 new jobs, a figure derived from a study by the Department of Transportation (DOT). While widely cited, this number is false. DOT actually calculated the number of jobs supported by $1 billion in highway spending, not created. And only about half of that number would be direct construction jobs; the rest are jobs created when the dollars the construction workers spend percolate through the economy. It’s also important to note that the DOT adjusted this number downward in April 2008 to less than 35,000 jobs supported for every $1.25 billion in highway spending.

In its September package, the House stipulated that only those projects that could be started within 120 days are eligible for funding. If we are going to target infrastructure in the stimulus, Congress should go further to prioritize the funding. Any infrastructure related stimulus should require that these dollars be spent only on maintenance projects that will improve the safety and efficiency of our current infrastructure, not build new infrastructure that will require increased outlays in the future for maintenance and upkeep.

Trying to spend our way out of a fiscal crisis is a dicey proposition, so any effort must be very limited and focused. The recent talk of another $150 billion to $200 billion stimulus is far too high. Congress must be prudent, and remember that profligate spending is part of what got us into this mess in the first place.

Information was obtained from Taxpayers for Common Sense.

Mayport Naval Station will soon become home to a nuclear-powered aircraft carrier that will bring more than 3,000 military personnel to the Jacksonville area.

(D) Senator Bill Nelson of Florida has worked for more than three years to convince the Navy that Mayport is the ideal site for a nuclear carrier, so you can imagine my delight when Secretary of the Navy Donald Winter called me with the news.

Currently the Navy has all of its East Coast carriers stationed in Norfolk, Virginia. Getting all of the nuclear carriers out of one port is in our national security interest, and for Floridians, the move is certain to bolster the state’s role in national defense, as well as the local economy.  The move will bring in an additional 3,190 military personnel to the area.

Housing a nuclear carrier at Mayport was one of 13 options the Navy considered to strategically disperse its carrier fleet.  The Navy said it expects such a move would be completed within five years or so, and has already finished an environmental study due out Friday that says there are no significant barriers to having a carrier at Mayport.

The Navy’s decision underscores the importance of Mayport to our national defense, and helps maintain the strong Navy presence in the Jacksonville community that has welcomed and served it so well.

PNC is a Pittsburgh-based bank that is among the largest of U.S. banks. It received $7.7 billion under the Treasury Department’s Capital Purchase Program (CPP). PNC recently acquired National City Corp., a bank that was denied funding under the CPP. The acquisition has not been without controversy. However, National City was reportedly considering filing for bankruptcy prior to the takeover.

According to the annul Fortune 500 rankings, PNC, is the country’s 14^th largest commercial bank while National City was the country’s 11^th largest.

A controversial change to federal tax law made in the wake of the financial crisis will benefit PNC in its acquisition on National City. One analyst estimates the benefit will bring $5.1 billion in tax breaks to PNC. Through the acquisition, PNC will become the nation’s 5^th largest bank and will expand its operations into the Midwest.

11-06-2008 PNC Financial Services Group 10-Q

10-24-2008 Overview of PNC and National City merger

10-24-2008 PNC and National City Merrger Form 8-K

3-28-2008 PNC Financial Services Group Proxy Statement

12-31-2007 PNC Financial Services Group 10-K

12-31-2007 PNC Financia lService Group Annual Report

USAspending.gov (last accessed 11/17/08)

Lobbying reports (if any)

Political Contributions

Center for Responsive Politics (Last Accessed 11/17/08).

Related Articles

2008: PNC to Acquire National City, Doubles in Size (Press Release)

November 17, 2008 Kentucky’s banks fending off frenzy Even with PNC merger, many firms avoid upheaval (Lexington Herald-Leader)

November 16, 2008 Bank’s demise one for textbooks (Columbus Dispatch)

November 16, 2008 PNC-National City bank deal draws criticism (Cleveland Plain Dealer)

November 16, 2008 PNC’s sweet takeover deal (Pittsburgh Post-Gazette)

November 16, 2008 Ohio lawmakers demand info on National City sale (Ohio.com)

November 14, 2008 PNC, U.S. Bank Lead Infusions as TARP Deadline Nears (Bloomberg)

November 11, 2008 National City sale staved off shutdown by regulators, PNC filing shows (Cleveland Plain Dealer)

November 10, 2008 National City mulled bankruptcy before PNC deal (Reuters)

November 7, 2008 PNC Outlines Risks to National City Deal (U.S. News & World Report)

October 30, 2008 PNC Stands to Gain From Tax Ruling (Wall Street Journal)

October 25, 2008 PNC’s $5.2 Billion National City Purchase Is Takeover Template (Bloomberg)

Information obtained from Taxpayers for Common Sense.

The National Health Service of Great Britain costs the taxpayers about $200 billion per year. And by the way, that is more than double what it cost ten years ago … but that is beside the point. The NHS is getting to the point where it must choose between buying expensive drugs for terminally ill patients or providing more care to more people.

Is that really a choice that you want anyone to make about your healthcare? Even worse, why should the government be the one making that choice for you?   Because you’ve virtually begged for it. Americans now think that their health care is someone else’s responsibility: either their employer or the government. We’re asking for it and begging for but the truth is that we’re not going to be pleased with it at all. Politicians will love it though.  Just think of the power! How powerful you must feel when you tell an elderly American that they can’t have a specific drug or medical procedure because someone younger needs it more.  Sorry people, but that’s the truth.

In Great Britain, 800 out of every 3,000 cancer patients lose their chance at getting life-saving drugs because it would cost too much for the NHS budget. And that number is only going to get bigger and bigger. In fact, the UK is now considering making a permanent ruling that certain medications that are “too expensive” should be excluded from government-funded treatment. So even if there are better treatments out there, you can’t have them because the government doesn’t want to pay for it.

Of course though, Americans have been taught all their lives that government is the answer for everything.  That government is supposed to make all our problems go away and that we don’t need to take any responsibility for ourselves or our children.  I just can’t believe how many pathetic people live in this country that are willing to sacrafice their childs future just so government can support their lazy fat ass.

The NHS has frequently been the target of criticism over the years. Examples of such criticism include:

Access controls

Treatments determined by NICE to be ineffective (e.g. homeopathy) or relatively cost-ineffective (i.e. drugs that have only minor effect at great cost) are simply not offered by the NHS though may be available privately. These controls have been labelled “rationing” though others argue that these are a sensible cost-control mechanism to fund only cost-effective^, evidence-based medicine although this argument is controversial as many drugs with proven efficacy (e.g. anticholinesterase for Alzheimer’s Disease^, are not fully funded.

In the NHS, GP referrals are needed to access specialist care and one of the original roles of general practitioner was to act as ‘the gatekeeper’. This role as gatekeeper has become more prominent in the 1990s with the introduction of the ‘internal market’ with GPs managing funds to buy clinical services. In 2000s, the role of gatekeeper has been increasingly moved to primary care trusts (PCTs) that issue guidelines to limit referrals to secondary care. ‘Referral management centres’ are also another recent innovation to divert referrals from GPs to cheaper nursing or therapy-led alternatives.

It has been argued that a nominal charge for an appointment with a GP could be introduced to prevent patients consulting their GP for frivolous reasons. To date, this has never been introduced to avoid the danger of patients avoiding consultations (for financial reasons) for conditions which might be potentially serious.

Politicisation

Over time, increased demand leads to continual political pressures to increase spending and widen the range of treatments available.

Supporters of the NHS would point out that the NHS has wide public support and the English population has as good a health outcome as many other similar countries, and often at much lower cost. Political pressure could work both ways, but the Blair government was elected in 1997 largely on a promise to invest more taxpayers money in health to bring spending closer to the European average. Most people would prefer to see gradual improvements within the current framework and be able to hold politicians to account for the service. This is the position of all the major political parties, none of which has an agenda to replace or make a wholesale reform to the system. The Conservative Party says its policies are aimed at “Protecting and improving our health service by putting patients back at the heart of the NHS, and trusting the professionals to ensure that they are able to use their skills to make the fullest possible contribution to patient care.”

“Paying twice”

Taxpayers who choose to pay for private healthcare must nonetheless still contribute to the NHS via taxation, and in effect “pay twice”, although the vast majority of emergency medical treatment is carried out by the NHS. This is not an effect specific to the NHS, and occurs whenever a choice between a publicly-funded and privately-funded service exists.

Some patients with complex illnesses pay for some medical services privately, while turning to the NHS for the rest of their care. In one recent case a cancer patient was told that if she paid privately for a drug that was not covered by the NHS she would have to pay for the rest of her care. NHS officials argue that allowing the practice would give wealthy patients an unfair advantage and undermine the philosophy of the system.

Waiting lists and the 18 week target

Rationing is a part of all health care systems because resources are necessarily finite. In purely private systems, health care is rationed via the price mechanism, with those being able to or wanting to pay for care getting it immediately and those not able waiting indefinitely (until they can afford it, which may be never). In the NHS, which aims to give a broad coverage of care to all without charging, health care is rationed on the grounds of clinical need, meaning that emergency cases (e.g. heart attacks) get instant access where those with less urgent needs (e.g. cataract surgery) are given lower priority and so wait longer.

Although there are obvious arguments in favour of prioritising by clinical need rather than ability to pay, it can mean that waiting lists vary widely between regions. Patients waiting can choose to have a procedure done outside their local NHS district in order to be seen more quickly, and if the waiting time is long can often get private treatment at public expense, either in the UK or abroad. A major programme is underway in the NHS to reduce all wait times to 18 weeks by December 2008. This new target starts at the point the time the patient’s own doctor writes to the hospital specialist and ends when treatment begins. It therefore includes the time to make the first appointment, and the time for all diagnostic tests to be completed, evaluated, and discussed with the patient, which were not in the previous target. It has been widely criticised by doctors, healthcare professionals, and think-tanks as diverting resources from more serious conditions to achieve politically-motivated goals, and doubts persist over its achievability.

The term bed-blockers is often used to refer to patients still receiving care, even though their acute ailment has been treated and they are fit for discharge. This strains hospital resources, through both increased costs and longer waiting times for other patients. In the UK, bed-blockers are frequently geriatric patients awaiting a placement in a nursing or residential facility.

“Superbugs”

Fatal outbreaks of antibiotic-resistant bacteria (”superbugs”), such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, in NHS hospitals has led to criticism of standards of hygiene across the NHS.

Both C. difficile and MRSA are, however, not exclusive to the NHS, existing in British private hospitals and throughout other western healthcare systems; for instance, cases doubled in the USA’s private healthcare system between 1999 and 2005, and the UK’s death rate is half that of the USA’s. The introduction of Private Finance Initiative cleaning contractors into the NHS and the associated “cutting corners on cleaning” have been blamed for the problem, as has increased drug resistance due to inappropriate prescribing of antibiotics and patients failing to complete courses of antibiotics.

Another viewpoint is that the spread of communicable diseases in hospitals is facilitated by the overcrowding in NHS hospitals with high bed occupancy rates (as the NHS has a low bed:population ratio produced by hospital bed closures and the increasing emphasis on increasing bed ‘turnaround time’).

Computerisation

The NHS has been criticised over the implementation of its National Programme for IT which is designed to provide the infrastructure for electronic prescribing, booking appointments and elective surgery, and a national care records service. The programme has run into delays and overspends, with the initial budget of £2.3 billion over three years officially revised to £12.4bn over 10 years and some sources putting it as high as £20bn. Critics including the House of Commons Public Accounts Committee and the National Audit Office claim the project is falling behind schedule. In addition, 93% of doctors within the NHS are not confident their patients’ data will be secure, some GP practices have begun to advise all their patients to opt-out of the scheme, and privacy campaigners have claimed the national care records system breaches patients’ privacy rights.

The Government and NHS national leadership have consistently argued that major capital investment in IT is necessary to transform services. Fragmented information systems, as in the US, prevent health services providing consistent data and can damage patient care where doctors may not have an overview of patients records held by another NHS body.

Dentistry

There has been a decreasing availability of NHS dentistry following the new government contract and a trend towards dentists accepting private patients only, with 10% of dentists having rejected the contract offered.

Coverage

The lack of availability of some treatments due to their perceived poor cost-effectiveness sometimes leads to what some call a “postcode lottery”.

NHS supporters would argue that the NHS has a duty to ensure that taxpayers money is used wisely and such denials are effective controls. People can always choose to go private, if they can afford it, if the treatment is legally available in the UK or elsewhere.

Deficits

Some hospitals and trusts were running a financial deficit and getting into debt.

Scandals

Several high-profile scandals have occurred within the NHS over the years such as the Alder Hey organs scandal, Harold Shipman and the Bristol Royal Infirmary inquiry.

Supporters would argue that there is nothing endemic about such issues which might equally have occurred in other types of health care establishments. They might also point out that the detection of such issues leads to better controls being established throughout the NHS for the benefit of all.

An October 14, 2008 article in The Daily Telegraph stated, “An NHS trust has spent more than £12,000 on private treatment for hospital staff because its own waiting times are too long.”

Some interesting articles to read:

George Will says that the best way to save Detroit is to let it go bankrupt. Here here!

The big news of the week: The Obama girls will have to wait until after they move into the White House to get a dog.

Bush is going to leave half of the $700 billion bailout for Obama to decide what to do with it. Meanwhile, Bernie Sanders wants to make sure Bush sticks with that plan.

John McCain and Barack Obama sat down to talk yesterday. They say that they are going to work together in the coming years. Work together for what? Did anyone bother to ask that question?

Here’s the latest on our Georgia Senate run off. You knew this one was coming - Jim Martin admits that he will be Barack Obama’s dog washer. Add those duties to being Harry Reid’s sock puppet and Martin will be a very busy man indeed …. Unless, that is, you actually show up at the polls.

Howard Kurtz explores the current pop-culture fascination with Barack Obama. Come January 20th, expectations become reality.

Rupert Murdoch says that the media has dug itself into a hole because it has failed to maintain the readers’ trust.

Mayors across the country are looking for Barack Obama to implement FDR-style public work projects to help their cities get back on their feet.

Sen. Tom Carper of Delaware says that there should be significant consequences for Joe Lieberman, who supported John McCain for president.

This statistic should astound you (then again … maybe not): Since 2000, government spending has increased by more than55%.

A sign of the times from the San Francisco Chronicle: “Are you an idiot to keep paying your mortgage?”

There is an Irish film out there challenging the current global warming hysteria.

Apparently it is “Green Week” on the Today Show so you can see first-hand the affects of climate change. I’m sure this is must-see television.

A church in Kansas refuses to remove a sign saying “America we have a Muslim president. This is sin against the Lord.” Sigh.  If you goto church, you need to stop doing that.  Religion is for weak minded people.

The mayors—Michael Nutter of Philadelphia, Shirley Franklin of Atlanta and Phil Gordon of Phoenix—made their request in a letter to Treasury Secretary Henry Paulson. The three mayors proposed providing loans to help cities pay pension costs. They also want $50 billion in loans for investment in infrastructure, and additional one-year loans to cities unable to borrow cash because of the tight credit markets.

Nutter said cities are facing an economic crisis not seen since the Depression and need help just like financial institutions.

“I want to make sure that cities and metro areas are at the table, that their voices are being heard, that our challenges and problems are well understood, so that we can get relief,” Nutter said.

The federal government opened up a can of worms with this bailout.  Everybody and there brother is coming to them for money now.  This kind of reminds of the movie “The Jerk” with Steve Martin and when he became very wealthy all these organizations showed up at his house and was asking for money from him.  They would give these sad stories and he would just stroke these checks until he went BANKRUPT!

Read the full story.