ROSARITO SPANISH STUDY GROUP - Today's word

el ñoño - a "mamby-pamby" or "mama's boy." Can be used as "nerd" in Mexico. Another expression for the same thing is "teto" (although this can also border on a meaning of just "silly" or "daft").

A Mexican comic caracter

In Panama, el ñoño can be used for someone who cries often.

HAM radio licensing exams in San Diego

From: Howard, KY6LA:

In case you know anyone who wants to get their Technician or General License, the San Diego Yacht Club is holding their annual Christmas Holiday Courses on December 28th and 29th.

Signup and details are to be found at:  http://www.sdyc.org/arg/

Classes and Exams are open to everyone but seats are limited to 25 so sign up early.

We are holding an Open ARRL Exam Session at 3PM Dec 29th so even if you do not need the classes you can upgrade General or Extra.

Last year most candidates got both the Tech and General at the same session so the course works very well.

If you want to sit the exams only contact me at ky6la@ky6la.com

(for info on disaster defense operations, his website is: http://www.ky6la.com/)

ROSARITO SPANISH STUDY GROUP (Tuesday & Thursday sessions)

On Tuesdays and Thursdays, Beginner's classes will be conducted at the Club Marena old club house. The classes are designed for those who have little or no experience with the Spanish language.

Sessions begin on Tuesday, the 11th of January, from 2:30 P.M. to 3:30 P.M.

Club Marena is at Km 38.5, on the Tijuana-Ensenada "free road."

Directions heading south from Rosarito (paralleling the toll road):

After you pass Las Rocas Hotel, you will see a 5-story tall statue of Jesus on the east side of the toll road (can’t miss it). Once you pass Jesus, look for a series of tall white buildings on the coastal side of the free road; that is Club Marena.

When you turn off the highway into the complex, the guard caseta will be directly in front of you. Ask the guard to direct you to the old club house.

Bring a Spanish dictionary or an English-Spanish dictionary, 3X5 index cards, and note-keeping materials.

Another Beginning group is currently in progress on Mondays in Rosarito, at the Las Mañanitas restaurant in Rosarito. The classes are held from 1:30 P.M. to 2:30 P.M.

The Intermediate group meets every Monday at 12 Noon at Las Mañanitas.

Rosarito Spanish Study Group (Monday sessions)

There will be no formal class sessions until January 10th, 2011.

However, the Study Group will be available to those who desire to participate in self-directed study sessions on the regularly scheduled Mondays during December and January. Please go to the meeting room at Las Mañanitas if your schedule permits and interact with other members of the group:

Intermediate group - 12 Noon until 1 P.M.
Beginner group - 1:30 P.M. until 2:30 P.M.

Conrad and Eunice fell in love, married, and moved to San Antonio del Mar

They are great neighbors and have nice children. They enjoy taking their puppy for walks on the beach.

Their story is here:
Siobhan Braun "How a Trip to Tijuana Changed My Heart." San Diego Reader 23 November 2010.

26 November. http://www.sandiegoreader.com/news/2010/nov/23/cover-trip-tijuana/

Two-bedroom home on the northwest Baja California Pacific coast

Beautiful ocean views of las Islas Coronados from two seaside terraces. It is one of the reasons we live here.

1 ½ baths, fully furnished, washer and dryer

Easy beach access
$750/month with minimum six month lease

Located in the coastal colonia of San Antonio del Mar, Carretera Escénica Tijuana/Ensenada HWY 1D, kilometer 19.5, just north of the Real del Mar bridge.*

This home is located 30/40 minutes from the Tijuana / San Ysidro International border crossing and a few minutes away from Playas de Rosarito, to the south.

Contact Gerry:
US: 619 415 3143
Mexico: 110.52.664.631.2206

*The Real Del Mar Championship Golf Course is just across the highway from San Antonio

From Arlene:

I went across the border today (SENTRI lane) and asked the fella at the gate - I heard you cannot take aluminum cans, plastic bottles across, etc.

He said that is right.

I said why? Because the stores take a DEPOSIT and I want my money back.

He said it is a BUSINESS.

I said, oh, come on - that is STEALING. You are taking money as a DEPOSIT and I am only getting the DEPOSIT BACK. I am NOT gaining money - I am WASTING gas getting this stuff to you so it doesn't end up in the DUMPS. So I am out money!  Now, I said, WHAT IS THE REAL REASON THIS IS HAPPENING!!!!!!!! What you are telling me doesn't make sense???

He said this has been on the CUSTOMS' books for a very long time that you cannot take cans/plastics across the border - they have been very lenient - until NOW!!

I wasn't going to let him get away with it - I said, WHY?

He said, well, they found drugs in the center of these large bags crossing the border so CUSTOMS is stopping it COMPLETELY - Oh, I said, since I worked with a criminal law attorney for over 10 years, I knew you were telling me something fishy.

So it is the DRUG BUSINESS that is stopping the crossing of the aluminun cans, etc.?????  Pretty well, he said, that was right.

He said you can go to CUSTOMS in Otay Mesa and get the cans/plastics through that way. I said, Oh, geez, that means paperwork - and a cost involved??? Not worth it to me to cross with a bag every 8 to 9 months.

I would suggest anyone wanting to take cans/plastics across to check further with CUSTOMS and the SENTRI office to make sure you don't lose your SENTRI pass! I am sure if there are large amounts an organization is collecting to make some money, you can probably still do so if you go through CUSTOMS. But check first as to exactly what you have to do!!

BTW the Rosarito Theater Guild is no longer collecting cans and bottles

Twitter:

A quote from the 20th President of the United States, James Garfield,

as he delivered his centennial speech to Congress in 1876.

"Now, more than ever before, the people are responsible for the character of their Congress. If that body be ignorant, reckless, and corrupt, it is because the people tolerate ignorance, recklessness, and corruption. If it be intelligent, brave, and pure, it is because the people demand these high qualities to represent them in the national legislature. If the next centennial does not find us a great nation it will be because those who represent the enterprise, the culture, and the morality of the nation do not aid in controlling the political forces."

Posted with thanks to Lyle Davis.

Daylight Saving time In Baja California - 2010

Today, the last Sunday in October, daylight saving time fell back to Standard Time at 2:00 A.M. local time in Baja California and the rest of Mexico.

The Congress of Mexico passed legislation in December 2009 which allowed ten border municipios to adopt a daylight saving time pattern consistent with the United States. The municipalities which are now permitted by law to observe daylight saving time consistent with the United States are:

Municipality, State, neighboring U.S. city

Ciudad Acuña, Coahuila (Del Rio, Texas)

Anáhuac, Nuevo León (Laredo, Texas)

Juarez, Chihuahua (El Paso, Texas)

Matamoros, Tamaulipas (Brownsville, Texas)

Mexicali, Baja California (Calexico, California)

Nuevo Laredo, Tamaulipas (Laredo, Texas)

Ojinaga, Chihuahua (Presido, Texas)

Piedras Negras, Coahuila (Eagle Pass, Texas)

Reynosa, Tamaulipas (McAllen, Texas)

Tijuana, Baja California (San Ysidro, California)

The observation of daylight saving time for these ten municipalities began at 2:00 a.m. local time on the second Sunday in March, 2010. On the first Sunday in November, 2010, these areas will return to Standard Time at 2:00 a.m. local time.

Neither the American State of Arizona nor the Mexican state of Sonora observe Daylight Saving Time.

Personal and family counseling

We at Mission Logistics International offer personal and family counseling at no charge as a part of our Missionary activities here in the State of Baja California.  We are located in Playas de Rosarito. We can be reached at: (619) 274-8490 (this is a San Diego, California, telephone number) or at E-Mail address: chi_rhoskid@hotmail.com.  

BUSINESS CONSULTING

My name is David Wignall. I have over forty years of successful business experience. I started working when I was just seven years old, and owned my first business when I was nine years old. And I have been working ever since. My areas of expertise are in: general business; the food services industry; the transportation industry (with specialization in trucking, warehouse development and operations, and truck stop/travel plaza development and operations); and publishing (to include the production of advertising for the print media, radio, television, and billboards).

I have spent over two decades doing consulting in the above stated areas (to include the areas of finance recognition and development, demographics, and interfacing with government at every level; including internationally).

If you are looking to start up a business; or enhance/expand an existing one, please contact me at: (619)-274-8490, or E-Mail me at: chi_rhoskid@hotmail.com. Come on, let's talk! The coffee is on!!

Keiko the orca

Those of you who know me may have already guessed I am not always a patient man.  Moreover, I have an attitude about movies and plays.  They are like people.  Most of the ones you encounter are full of bullsh*t, and there is too much background music.  A few are very enjoyable.  Keiko the Untold Story was more than enjoyable, it was intense. Watching it was an experience.

I was not involved in any part of it during the four years it was being produced, and was only aware of the content in a general way.  My brief encounters with the movie staff were perplexing to me because my familiarity with the subject matter was superficial, and I did not understand why this group of intelligent and accomplished people were so adamant that the movie be produced.

After I viewed the screening last Friday, the entire production procedure made sense (some things take time for me to process). 

The movie is due for release in June and I highly recommend you see it with a couple of friends or family; do not go alone, and be ready to hang on for a hard ride.

Saludos,

Pat

Keiko the Untold Story, produced by Theresa Demarest, sceened on:

Friday, October 15 at 12 P.M., at the Sixth Annual LA Femme Film Festival -- Located at 1125 N McCadden Pl., Los Angeles, CA 90038-1212 – just off Santa Monica Blvd.

Phone: (323) 860-7302

The the Sixth Annual LA Femme Film Festival ran October 14- 17, 2010. Keiko the Untold Story screened at the Davidson Valentini Theater, The Village at Ed Gould Plaza in Hollywood, on Friday, October 15, at 12 P.M.

Four years in the making, this compelling documentary presents never before seen footage of Keiko, the Free Willy star, the first and only captive Orca to released back into the wild.  I believe you will find this movie very unique, worthwhile and superbly produced.

For more information see URL: http://www.keikotheuntoldstory.com/

Or Twitter: http://twitter.com/KeikoDoc
_________________________________________________

Review of Keiko: The Untold Story at Denver Film Festival, October, 2010
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Keiko the Untold Story USA, 2010, 74 Minute Running Time
Genre/Subjects: Animals, Art/Filmmaking, Documentary, Family Friendly
Program: Documentary Films
Language: English
DIRECTOR: Theresa Demarest
Producer: Theresa Demarest
Editor: Theresa Demarest
Screenwriter: Theresa Demarest
Cinematographer: Julie Murray

Principal Cast: Colin Baird, Mark Berman, Naomi Rose, Paul Spong, Thorbjorg Valdis

Though the orca whale known as Keiko starred in the 1993 movie Free Willy, he lived most of his life in captivity. It was only with the launch of a campaign based on drawings by schoolchildren that enough money was raised to rehabilitate him and return him to the wild. Those who trained and cared for Keiko, the second-longest-lived orca in captivity, believe it was his indomitable spirit that kept him alive so long.

The story of his life is told by director/producer/writer/editor Theresa Demarest through footage from an array of conservation and environmental organizations, including that of Jean-Michel Cousteau. Keiko the Untold Story was made in large part to counteract the widespread perception that the rehabilitation and release efforts were a failure and that Keiko died soon after his release into the waters off his native Iceland. In fact, the orca, carefully trained for two years, spent the transition traveling with pods of wild killer whales; undertaking a solo journey from Iceland to Norway; and living in a seawater fjord, attended by his trainers, for 18 months before his abrupt death from disease in late 2003 at the age of 27.

But new Keikos are born every day: the heartrending capture of another baby orca, caught on camera, is narrated by marine mammal scientists who go into depth about the structure of orca society and the suffering a young whale endures when confined to the concrete tanks of aquarium facilities. No less poignant are the scenes of young children expressing their shock, with indignant and quavering voices, that the lives of many Willies have no Hollywood ending.

—Val Moses

In cooperation with Sea Shepherd Conservation Society

Trafficking

One Sunday, sitting on the side of the highway waiting to catch speeding drivers, a State Police Officer sees a car puttering along at 22 MPH.

He thinks to himself, "This driver is just as dangerous as a speeder!" So he turns on his lights and pulls the driver over.

Approaching the car, he notices that there are five old ladies - two in the front seat and three in the back - wide eyed and white as ghosts. The driver, obviously confused, says to him, "Officer, I don't understand, I was doing exactly the speed limit! I always go exactly the speed limit. What seems to be the problem?"

"Ma'am," the officer replies, "you weren't speeding, but you should know that driving slower than the speed limit can also be a danger to other drivers."

"Slower than the speed limit? No sir, I was doing the speed limit exactly! Twenty-two miles an hour!" the old woman says a bit proudly.

The State Police officer, trying to contain a chuckle explains to her that "22" was the route number, not the speed limit.

A bit embarrassed, the woman grinned and thanked the officer for pointing out her error.

"But before I let you go, Ma'am, I have to ask . . . Is everyone in this car OK? These women seem awfully shaken and they haven't muttered a single peep this whole time," the officer asks with concern.

"Oh, they'll be all right in a minute officer. We just got off Route 119."

•••••

While creating Husbands, God promised Women that good and ideal Husbands would be found in all corners of the world.
And then he made the earth round.
Golf and Whisky...

An 80-year-old Scotsman went to the doctor for a check-up.

The doctor was amazed at what good shape the old fellow was in and asked: 'How do you stay in such great physical condition?'

'I am Scottish and I am a golfer,' said the old fellow: 'and that is why I am in such good shape. I am up well before daylight and out golfing up and down the fairways. I have a wee glass of whisky, and that's it.'

'Well,' said the doctor, 'I am sure that helps, but there has to be more to it. How old was your Dad when he died?'

'Who said my Dad died?'

The doctor was amazed. 'You mean you are 80 years old and your Dad is still alive. How old is he?'

'He is 100 years old,' said the old Scottish golfer. 'In fact he golfed wi' me this mornin', and then we went to the topless beach for a walk and had anither wee dram and that is why he is still alive. He is a Scot and he is a golfer, tae.'

'Well,' the doctor said, 'that is great, but I am sure there is more to it than that. How about your Dad's Dad? How old was he when he died?'

'Who said my Grandad is dead?'

Stunned, the doctor asked, 'You mean you are 80 years old and your grandfather is still living! Incredible, how old is he?'

'He is 118 years old,' said the old Scottish golfer.

The doctor was getting frustrated at this point: 'So, I guess he went golfing with you this morning too?'

'No. Grandad couldnae go this mornin' because he is getting married today.'

At this point the doctor was close to losing it. 'Getting married! Why would a 118 year-old Scotsman want to get married?'

'Who said he wanted to?'
South Dakota

A group of South Dakota friends went deer hunting and paired off in twos for the day. That night, one of the hunters, Curt, returned alone, staggering under the weight of an five by five buck.

"Where's Bob?" the others asked.

"Bob had a stroke of some kind. He's a couple of miles back up the trail," the successful hunter replied.
"You left Bob laying out there and carried the deer back?" they inquired.

"A tough call," nodded the hunter. "But I figured no one is going to steal Bob!"
Georgia

The owner of a golf course in Georgia was confused about paying an invoice, so he decided to ask his secretary for some mathematical help.

He called her into his office and said, "You graduated from the University of Georgia and I need some help. If I were to give you $20,000, minus 14%, how much would you take off?"

The secretary thought a moment, and then replied, "Everything but my earrings."
Louisiana

A senior at Louisiana was overheard saying ... "When the end of the world comes, I hope to be in Louisiana."

When asked why, he replied, "I'd rather be in Louisiana because everything happens in Louisiana 20 years later than in the rest of the civilized world."
North Carolina

A man in North Carolina had a flat tire, pulled off on the side of the road, and proceeded to put a bouquet of flowers in front of the car and one behind it. Then he got back in the car to wait.

A passerby studied the scene as he drove by and was so curious he turned around and went back. He asked the fellow what the problem was.

The man replied, "I have a flat tire."

The passerby asked, "But what's with the flowers?"

The man responded, "When you break down they tell you to put flares in the front and flares in the back. I never did understand it neither."
Oklahoma

An Oklahoma State trooper pulled over a pickup on I-65. The trooper asked, "Got any ID?"

The driver replied, "Bout whut?"
Texas

The Sheriff pulled up next to the guy unloading garbage out of his pick-up into the ditch.

The Sheriff asked, "Why are you dumping garbage in the ditch? Don't you see that sign right over your head."

"Yep", he replied. "That's why I dumpin it here, cause it says: 'Fine For Dumping Garbage'."

You can say what you want about the South, but you never hear of anyone retiring and moving North.
A Norwegian’s Secret to a Long and Happy Marriage

At All Saints Lutheran Church they have a weekly husband's marriage seminar. Recently, the Pastor asked Ole - who was approaching his 50th Wedding Anniversary - to take a few minutes and share some insight into how he had managed to stay married to the same woman all these years.

'Vell,' Ole replied to the assembled husbands, 'I've tried to treat her nice, spend da money on her, but best of all I took her to Norvay for da 20th Anniversary!'

The Pastor responded, "Ole, you are an amazing inspiration to all the husbands here! Please tell us what you are planning for your for your 50th Anniversary."

Ole proudly replied, 'I'm a-gonna go back to Norvay and get her."
The Good Old Days

Remember the old-time Jewish comedians of Vaudeville days - Shecky Green, Red Buttons, Totie Fields, Milton Berle, Henny Youngman, and others? You've may have only heard of them, but don't we all miss their their kind of humor?

Not a single swear word in their comic routines:

A car hit an elderly Jewish man. The paramedic says, "Are you comfortable?" The man says, "I make a good living."

I just got back from a pleasure trip. I took my mother-in-law to the airport.

I've been in love with the same woman for 49 years. If my wife finds out, she'll kill me!

What are three words a woman never wants to hear when she's making love? "Honey, I'm home."

Someone stole all my credit cards, but I won't be reporting it. The thief spends less than my wife did.

We always hold hands. If I let go, she shops.

My wife and I went to a hotel where we got a waterbed. My wife calls it the Dead Sea.

My wife and I revisited the hotel where we spent our wedding night. This time I was the one who stayed in the bathroom and cried.

She was at the beauty shop for two hours. That was only for the estimate. She got a mudpack and looked great for two days. Then the mud fell off.

The Doctor gave a man six months to live. The man couldn't pay his bill, so the doctor gave him another six months.

The Doctor called Mrs. Cohen saying, "Mrs. Cohen, your check came back." Mrs. Cohen replied, "So did my arthritis!"

Doctor: "You'll live to be 60!" Patient: "I AM 60!" Doctor: "See! What did I tell you?"

A doctor held a stethoscope up to a man's chest. The man asks, "Doc, how do I stand?" The doctor says, "That's what puzzles me!"

Patient: "I have a ringing in my ears." Doctor: "Don't answer!"

A drunk was in front of a judge. The judge says, "You've been brought here for drinking." The drunk says "Okay, let's get started."

Why do Jewish divorces cost so much? They're worth it.

Why do Jewish men die before their wives? They want to.

The Harvard School of Medicine did a study of why Jewish women like Chinese food so much. The study revealed that the reason for this is because Won Ton spelled backward is Not Now.

There is a big controversy on the Jewish view of when life begins. In Jewish tradition, the fetus is not considered viable until it graduates from law school.

Q : Why don't Jewish mothers drink?
A : Alcohol interferes with their suffering.

Q : Have you seen the newest Jewish-American-Princess horror movie?
A : It's called, "Debbie Does Dishes."

Q : Why do Jewish mothers make great parole officers?
A : They never let anyone finish a sentence.

Q : What's a Jewish American Princess's favorite position?
A : Facing Bloomingdale's.

A man called his mother in Florida. "Mom, how are you?" Not too good," said the mother. "I've been very weak. "

The son said, "Why are you so weak?" She said, "Because I haven't eaten in 38 days."

The son said, "That's terrible. Why haven't you eaten in 38 days?"

The mother answered, "Because, I didn't want my mouth to be full in case you should call."

A Jewish man said that when he was growing up, they always had two choices for dinner - Take it or leave it.

A Jewish boy comes home from school and tells his mother he has a part in the play.

She asks, "What part is it?"

The boy says, "I play the part of the Jewish husband."

The mother scowls and says, "Go back and tell the teacher you want a speaking part."

Q : Where does a Jewish husband hide money from his wife?
A : Under the vacuum cleaner.

Q : How many Jewish mothers does it take to change a light bulb?
A : (Sigh) "Don't bother. I'll sit in the dark. I don't want to be a nuisance to anybody."

A Poem
I was shocked, confused, bewildered
As I entered Heaven's door,
Not by the beauty of it all,
Nor the lights or its decor.

But it was the folks in Heaven
Who made me sputter and gasp--
The thieves, the liars, the sinners,
The alcoholics and the trash.

There stood the kid from seventh grade
Who swiped my lunch money twice.
Next to him was my old neighbor
Who never said anything nice.

Bob, who I always thought
Was rotting away in hell,
Was sitting pretty on cloud nine,
Looking incredibly well.

I nudged Jesus, 'What's the deal?
I would love to hear Your take.
How'd all these sinners get up here?
God must've made a mistake.

'And why is everyone so quiet,
So somber - give me a clue.'
'Hush, child,' He said,
'they're all in shock.
No one thought they'd be seeing you.'
How To Ask for a Raise

Employee: Excuse me sir, may I talk to you?

Boss: Sure, come on in. What can I do for you?

Employee: Well sir, as you know, I have been an employee of this prestigious firm for over ten years. Sir, I would like a raise. I currently have four companies after me and so I decided to talk to you first.

Boss: A raise? I would love to give you a raise, but this is just not the right time.

Employee: I understand your position, and I know that the current economic down turn has had a negative impact on sales, but you must also take into consideration my hard work, pro-activeness and loyalty to this company for over a decade.

Boss: Taking into account these factors, and considering I don't want to start a brain drain, I'm willing to offer you a ten percent raise and an extra five days of vacation time. How does that sound?

Boss: Before you go, just out of curiosity, what companies were after you?

Employee: Oh, the electric company, gas company, water company and the mortgage company!

----- Forwarded Message ----


From: Dennis Vernacchia

Sent: Fri, September 24, 2010 1:29:35 PM

Subject: Tom Martin's wife e-mail address book has been compromised - do not open mail from rbg3cm@aol.com

Mail from

rbg3cm@aol.com

Do not open - It directs you to a bogus site tha could possibly infect your computer with Trojan, Re-mailer or Virus

Tom Martin ( KG6RCW ) of Rancho Bernardo Glass is aware and taking care of issue

Dennis N6KI

The Mexican drug cartels now have a new source of revenue ($50 million for starters)

-------------------------------------------------------------------------

I had not learned this information until someone had cut it out of the LA times and mailed it to a friend here in Mexico. He gave it to me today, voicing his great concern.

I can only comment that this is terrible news for everyone in North America, viz., the Mexican cartels are implementing systematic terrorist and kidnapping operations against PEMEX employees. PEMEX officials are completely dumbfounded and have no idea how to address the problem. The inherent ramifications of this situation are far-reaching. For this brief moment in time, the problem exists south of the border; but it will soon reach everyone’s doorstep who lives in North America.

The Mexican drug war has taken a very nasty turn; it is now the North American drug/oil war.

Holy sh*t, amigos; the cartel fracaso is becoming uglier. Cartel influence in the U.S. and Mexican economies is becoming more entrenched.

Pat

Don't leave home without your Lifesaver Card


By Ronald W. Jensen

Special to The Baja Times



Americans living in Mexico should know about the Binational Emergency Medical Care Committee: a reputable non-profit organization that will get them out of Mexico in case of a life-threatening medical emergency. Based in Chula Vista, California, the organization cost $45 to join. Membership includes the following services and benefits:

•A Lifesaver Card you can carry in your wallet that allows you to call collect anywhere in Mexico, 24 hours a day to activate emergency assistance in case of a sudden illness or accident.

•Expert coordination of your emergency evacuation from Mexico via land or air ambulance transport.

•Bilingual support staff on duty 24 hours a day, seven days a week.

•Bilingual legal assistance.

•10% discount on auto insurance with Instant Mexico Auto Insurance Services.

•Annual membership renewal for a discounted price of $40.

As soon as your call is received, the Binational Emergency Care Committee – known by the acronym BEMCC – will immediately assist you in obtaining proper medical care while working on your safe return to the United States. By becoming a member, BEMCC will have all the information that is needed for your safe return.

Your personal information such as your Social Security number, health insurance information, and emergency contact is kept in BEMCC's secure database and is accessible only by the bilingual BEMCC staff. This information is crucial to arrange your evacuation to the United States when you are involved in a medical emergency in Mexico. This information is kept strictly confidential and is never sold or used for marketing purposes, according to Celia Diaz, the director and founder of BEMCC.

Your medical insurance will be billed for the cost of the actual transport plus any other medical service fees. BEMCC does not pay for the transport service. BEMCC coordinates the emergency evacuation. They eliminate the uncertainty and confusion during a medical emergency, she explained.

As a retired paramedic now living in Mexico, I have personally used and benefited from these services on numerous occasions. The organization has contacts ranging from Mexico City to Washington D.C., and it works closely with the U.S. Coast Guard, U.S. Customs and Border Protection, U.S. consulates and numerous Mexican federal, state, and regional public safety agencies to facilitate the safe and timely return of sick and injured Americans traveling or living in Mexico.

Members can call collect from anywhere in Mexico 24 hours a day, seven days a week, to activate emergency medical or legal assistance. That number is: 619-425-5080.

You may also apply online or renew your current membership and pay with a credit card. All applications processed online will be active once BEMCC obtains credit card confirmation from their credit card merchant services organization. Your BEMCC Lifesaver Card will be sent to you via the US postal service.

The online address is: bemcc@bemcc.org

Jensen is a former Mexico correspondent for United Press International and other U.S. new agencies. Email address: bajaronjens@live.com

Mexican Radio call signs


The International Telecommunication Union has assigned Mexico the following call sign blocks for all radio communication, broadcasting or transmission:

Call sign block

XAA - XIZ

4AA - 4CZ

6DA - 6JZ

While not directly related to call signs, the International Telecommunication Union (ITU) further has divided all countries assigned amateur radio prefixes into three regions; Mexico is located in ITU Region 2.   Mexico is in ITU zone 10 and CQ zone 6.

Call sign assignments for amateur radio

The Comision Federal de Telecomunicaciones issues call signs in the XE and XF series for amateur use, the latter mainly for offshore use.

The separating numeral is used to identify the region in which the amateur is licensed:

Call sign prefix Region

XE1: Central Mexico Colima, Distrito Federal (Federal District, most of Mexico City), Guanajuato, Hidalgo, Jalisco, Mexico (the state surrounding the Distrito Federal on 3 sides, includes some parts of Mexico City), Michoacan, Morelos, Nayarit, Puebla, Queretaro, Tlaxcala, and Veracruz

XE2: Northern Mexico Aguascalientes, Baja California (northern half of the peninsula), Baja California Sur (southern half of the peninsula), Chihuahua, Coahuila, Durango, Nuevo Leon, San Luis Potosi, Sinaloa, Sonora, Tamaulipas, and Zacatecas

XE3: Southern Mexico Campeche, Chiapas, Guerrero, Oaxaca, Quintana Roo, Tabasco, and Yucatan

XF1:  Islands around the Baja California peninsula in the Pacific Ocean or the northern part of the Gulf of California

XF2:  Close central islands off the Pacific coast of the Mexican mainland, in the Gulf of Mexico, or in the southern Gulf of California, generally west of 90°W.

XF3:  Caribbean islands Carribean islands, generally east of 90°W.

XF4, XFØ:  Revillagigedo Revillagigedo island group, in the Pacific Ocean
Call signs for foreign hams

Typically a permit to operate in Mexico will state the call sign you are to use, and can be one's home call sign with a further XE prefix. For instance if your home call sign is WA1ZZZ, you might be assigned XE1/WA1ZZZ.

Further, if you operate outside of the XE1 area, you would add a further identifying suffix - for instance XE1/WA1ZZZ/XE2 if you were operating in northern Mexico.  The call sign must be given always as enumerated on the permit, and the operator's location must also be stated in Spanish.

The permit does not automatically allow operation in XF island areas. Special permission must be sought for island operation.

Special Events

Call signs in the 6DA-6JZ block have been used for special event call sgins on a temporary basis. In 2007 6G1LM was assigned to Federacion Mexicana de Radioexperimentadoes for their 75th anniversary as was 6F75A.

6H1 also replaced the XE1 prefix, 6I2 replaced the XE2 prefix, and 6J3 replaced the XE3 prefix. 6E4 replaced XF4 for the Revillagigedo island group.

URL: http://links.assetize.com/links/c0b231 has further information.

Raw Food Diet in Rosarito

The Mongolian Grill News


August 2010

July has been an awesome month for us as well as for Rosarito businesses in general. Our sign on the freeway has brought many new customers our way as well as served as a reminder that we’re still here to those who haven’t visited us for a while. When you’re away for a spell, we really do miss you. We thrive on your repeat business.

We were pleased that USBC allowed us to cater their Hawaiian Luau luncheon. In addition to feeding the 104 people present, I had the opportunity to dance a few hula songs with some of the ladies from my dancercize class. It was fun for us even though we were a little nervous.

To shed a few pounds before dancing the hula, I went on a 5 day raw food diet and lost 7 pounds. The raw food diet is a diet based on unprocessed and uncooked plant foods, such as fresh fruit and vegetables, sprouts, seeds, nuts, grains, beans, nuts, dried fruit, and seaweed. I want to do it again for another 5 days and want to know if any of you want to join me. From all the ends and peelings of the vegetables that we cut up, I made a healthy broth. Everyday I heated the broth up and added raw veggies and cut up avocado to make a hearty soup. I also took melons, grapes and other fruits and blended them with spinach and other veggies to make a drink in the mornings. For snacks I had grapefruit, apples, and nuts (but not too many). I will be selling the soup for $60 pesos if you want to come in. Of course you can do it yourself at home, but I have all the veggies already cut up and vegetable broth, rich with vitamins. Your body gets a real good cleansing. The first 2 days are the hardest. Chris and I are starting tomorrow, Friday the 30th, but feel free to join us anytime.

For those of you who do not want to diet, come in and try our Thai Coconut Curry with Chicken, Shrimp and Bamboo Shoots. We will try to serve this every Friday and on some Saturdays.

Dancercize is free and is held on Tuesday mornings at 9:30 a.m. This coming Tuesday, August 3 will be the last class until August 24. NO DANCE CLASS FOR 2 WEEKS! We’ll be going to Rio de Janeiro for a week and then we need time to recuperate and catch up on things.

Our August Bunco luncheon will still be held on Wednesday, August 11 at 1:00 p.m. and we will be having our “make your own Asian Chicken Salad bar” available with our 3 different dressings (Chinese Rice Vinegarette, Mandarin Orange, and Thai Peanut) and toppings. The cost of $15 includes lunch, beverage, dessert, tip, and contribution toward Gift Certificate Prizes to other restaurants. For 24 players, we give out $40 for 1st place, $20 for 2nd place, $20 for lowest score, $20 for most buncos, and $10 gift certificates for highest scores in the 1st and 2nd rounds. Please email the_romeros@yahoo.com (underscore between “the” and “romeros”) to reserve a spot.

Hope to see you soon . . . Lee

Return to Tarawa/Ex-Marines chase phantoms at battle site

TOM HENNESSY Knight-Ridder Newspapers
SUN HOUSTON CHRONICLE, Section A, Page 35, 2 STAR Edition

BETIO, Republic of Kiribati - The chartered plane, a British Aerospace 748, rumbled toward the island with determination, as if on a bombing run. Inside the cabin, gray-haired men peered through the windows at a lagoon. It was lime-colored on this Friday afternoon in November. But they remembered a time, 66 years ago, when it was pink with the blood of their Marine buddies. The men on the plane were survivors; returning to a place that meant terror and sorrow in the dark autumn of 1943.

Returning to Tarawa.

There were 27 of them aboard the plane. They came to this atoll 6,000 miles from California to dedicate a monument. And to chase phantoms.

"Buddies told me if I went back to Tarawa, I should watch for ghosts," said Pat Didlake of Glendora , Miss. "You might even see yourself there," they said. "In a way, a lot of us do think we're still there. There aren't too many days when you don't think about Tarawa ."
Most of them were 18 and 19 when they fought at Tarawa, then part of the Gilbert Islands and now belonging to the nine-year-old nation of Kiribati .

Today, the Marines of Tarawa are grandfathers, several of whom brought their wives to see the place that made headlines in 1943.

"The wives are looking for a lot of answers," said Dorothy Pavel of Captiva Island , Fla. "Over the years, every wife I've talked to - their husbands have gone through the same thing - nightmares, screaming at night."

The battle was a 76-hour hell, the first American amphibious assault on a heavily fortified island. During it, 1,113 Marines were killed, 2,290 wounded. Of the 4,832 Japanese defenders, only 17 survived.

The trip to Tarawa was arranged by Bob Reynolds, whose Sausalito , Calif. , travel agency, Valor Tours, has returned nearly 5,000 veterans to World War II battlegrounds, to places of sometimes terrifying memory. For almost all of them, said Reynolds, the trips are therapeutic.

"After them, we find wives and sons and daughters are hearing Dad speak (about combat) for the first time. For the (postwar) years, these guys were silent, inarticulate. `Dad doesn't talk about the war."'

At first, the Marines showed little emotion at seeing their old battleground, mostly because they did not recognize it.

When they left 65 years ago, Betio, the two-mile coral strand on which the battle took place, was an island with no native population, no structures save for Japanese bunkers, and no vegetation, all of the latter having been destroyed by shell fire.

But Betio (pronounced BESS-i-o) is now a lush island home for about 9,000 natives, which makes it something of a metropolis by Pacific Island standards.

"This is just not the same island we landed on 66 years ago," said Pete Pavel.

As the Sunday monument dedication ceremony concluded with a floral wreath thrown into the sea and the playing of taps, 66 years suddenly collapsed for the visiting Marines. Many wept openly for fallen friends, for their own youth lost to war, for years of nightmares and pain.

"As I looked out on the water, I did not see the wreath," said Paul Du Pre, a retired Marine colonel from Port Hueneme , Calif. "Instead, my mind's eye saw the floating bodies of my friends, the floating bodies I had seen in that very same area 60 years ago."

Before leaving, the survivors sought out the places on Betio that held the poignant individual memories.

Carroll Strider of Tryon, N.C., found the beach designated "Red Beach 3" during the invasion. "That's where I landed in the second wave. I started remembering that day and looked for where we went inland. And what I saw instead were houses and little children and families."

John Downing of Long Beach , Calif. , waded into the Tarawa 's lagoon, looking for his tank. The last time he saw it, on Nov. 20, 1943, it was tumbling from a bombed landing craft and plunging, upside down, into the sea. After an afternoon's search, Downing failed to locate it, but did find a wrecked tank that belonged to his battalion.

Angelo Pace of Riverside , Calif. , strolled the beach where he had been wounded and was stopped by a native offering a gift, a canteen. The man obviously had saved the war relic for years. "But when he put it in my hands," says Pace, "I immediately felt hostile. I couldn't accept it. It was a Japanese canteen."

On a plane taking the Marines back to the United States , a flight attendant in her early 20s sat down beside a passenger. She was curious about the group of gray-haired men on board.

"They are Marines," she was told. "They fought at the Battle of Tarawa in 1943 at other battles in World War II."

"Who were they fighting?"

"The Japanese."

She weighed that information momentarily, then asked: "Who won?"

Originally posted on a Yahoo discussion group; I am posting it here for the convenience of regular readers of this blog:

BP GULF OIL DISASTER

Another oil rig operated by BP apparently is at risk of creating a bigger spill

CBS interview with Mike Williams, Oil Rig Worker

The gusher unleashed in the Gulf of Mexico continues to spew crude oil. There are no reliable estimates of how much oil is pouring into the gulf. But it comes to many millions of gallons since the catastrophic blowout. Eleven men were killed in the explosions that sank one of the most sophisticated drilling rigs in the world, the "Deepwater Horizon."

This week Congress continues its investigation, but Capitol Hill has not heard from the man "60 Minutes" correspondent Scott Pelley met: Mike Williams, one of the last crewmembers to escape the inferno.

He says the destruction of the Deepwater Horizon had been building for weeks in a series of mishaps. The night of the disaster, he was in his workshop when he heard the rig's engines suddenly run wild. That was the moment that explosive gas was shooting across the decks, being sucked into the engines that powered the rig's generators.

"I hear the engines revving. The lights are glowing. I'm hearing the alarms. I mean, they're at a constant state now. It's just, 'Beep, beep, beep, beep, beep.' It doesn't stop. But even that's starting to get drowned out by the sound of the engine increasing in speed. And my lights get so incredibly bright that they physically explode. I'm pushing my way back from the desk when my computer monitor exploded," Williams told Pelley.

The rig was destroyed on the night of April 20. Ironically, the end was coming only months after the rig's greatest achievement.

Mike Williams was the chief electronics technician in charge of the rig's computers and electrical systems. And seven months before, he had helped the crew drill the deepest oil well in history, 35,000 feet.

"It was special. There's no way around it. Everyone was talking about it. The congratulations that were flowing around, it made you feel proud to work there," he remembered.

Williams worked for the owner, Transocean, the largest offshore drilling company. Like its sister rigs, the Deepwater Horizon cost $350 million, rose 378 feet from bottom to top. Both advanced and safe, none of her 126 crew had been seriously injured in seven years.

The safety record was remarkable, because offshore drilling today pushes technology with challenges matched only by the space program.

Deepwater Horizon was in 5,000 feet of water and would drill another 13,000 feet, a total of three miles. The oil and gas down there are under enormous pressure. And the key to keeping that pressure under control is this fluid that drillers call "mud."

"Mud" is a manmade drilling fluid that's pumped down the well and back up the sides in continuous circulation. The sheer weight of this fluid keeps the oil and gas down and the well under control.

The tension in every drilling operation is between doing things safely and doing them fast; time is money and this job was costing BP a million dollars a day.

But Williams says there was trouble from the start - getting to the oil was taking too long.  Williams said they were told it would take 21 days; according to him, it actually took six weeks.

With the schedule slipping, Williams says a BP manager ordered a faster pace.

"And he requested to the driller, 'Hey, let's bump it up. Let's bump it up.' And what he was talking about there is he's bumping up the rate of penetration. How fast the drill bit is going down," Williams said.

Williams says going faster caused the bottom of the well to split open, swallowing tools and that drilling fluid called "mud."

"We actually got stuck. And we got stuck so bad we had to send tools down into the drill pipe and sever the pipe," Williams explained. That well was abandoned and Deepwater Horizon had to drill a new route to the
oil. It cost BP more than two weeks and millions of dollars.

"We were informed of this during one of the safety meetings, that somewhere in the neighborhood of $25 million was lost in bottom hole assembly and 'mud.'  And you always kind of knew that in the back of your mind when they start throwing these big numbers around that there was gonna be a push coming, you know? A push to pick up production and pick up the pace," Williams said.

Asked if there was pressure on the crew after this happened, Williams told Pelley, "There's always pressure, but yes, the pressure was increased."

But the trouble was just beginning: when drilling resumed, Williams says there was an accident on the rig that has not been reported before. He says, four weeks before the explosion, the rig's most vital piece of safety equipment was damaged.

Down near the seabed is the blowout preventer, or BOP. It's used to seal the well shut in order to test the pressure and integrity of the well, and, in case of a blowout, it's the crew's only hope.  A key component is a rubber gasket at the top called an "annular," which can close tightly around the drill pipe.

Williams says, during a test, they closed the gasket. But while it was shut tight, a crewman on deck accidentally nudged a joystick, applying hundreds of thousands of pounds of force, and moving 15 feet of drill pipe through the closed blowout preventer.  Later, a man monitoring drilling fluid rising to the top made a troubling find.

"He discovered chunks of rubber in the drilling fluid. He thought it was important enough to gather this double handful of chunks of rubber and bring them into the driller shack. I recall asking the supervisor if this was out of the ordinary. And he says, 'Oh, it's no big deal.' And I thought, 'How can it be not a big deal? There's chunks of our seal is now missing,'" Williams told Pelley.

And, Williams says, he knew about another problem with the blowout preventer.

The BOP is operated from the surface by wires connected to two control pods; one is a back-up.  Williams says one pod lost some of its function weeks before.

Transocean tells us the BOP was tested by remote control after these incidents and passed.  But nearly a mile below, there was no way to know how much damage there was or whether the pod was unreliable.

In the hours before the disaster, Deepwater Horizon's work was nearly done.  All that was left was to seal the well closed.  The oil would be pumped out by another rig later.  Williams says, that during a safety meeting, the manager for the rig owner, Transocean, was explaining how they were going to close the well when the manager from BP interrupted.

"I had the BP company man sitting directly beside me. And he literally perked up and said 'Well my process is different.  And I think we're gonna do it this way.'  And they kind of lined out how he thought it should go that day.  So there was short of a chest-bumping kind of deal.  The communication seemed to break down as to who was ultimately in charge," Williams said.

On the day of the accident, several BP managers were on the Deepwater Horizon for a ceremony to congratulate the crew for seven years without an injury.  While they where there a surge of explosive gas came flying up the well from three miles below.  The rig's diesel engines which power its electric generators sucked in the gas and began to run wild.

"I'm hearing hissing. Engines are over-revving. And then all of a sudden, all the lights in my shop just started getting brighter and brighter and brighter.  And I knew then something bad was getting ready to happen," Williams told Pelley.

It was almost ten at night. And directly under the Deepwater Horizon there were four men in a fishing boat, Albert Andry, Dustin King, Ryan Chaisson and Westley Bourg.

"When I heard the gas comin' out, I knew exactly what it was almost immediately," Bourg recalled.

"When the gas cloud was descending on you, what was that like?" Pelley asked.

"It was scary. And when I looked at it, it burned my eyes. And I knew we had to get out of there," Andry recalled.

Andry said he knew the gas was methane.

On the rig, Mike Williams was reaching for a door to investigate the engine noise.

"These are three inch thick, steel, fire-rated doors with six stainless steel hinges supporting 'em on the frame. As I reach for the handle, I heard this awful hissing noise, this whoosh.  And at the height of the hiss, a huge
explosion.  The explosion literally rips the door from the hinges, hits, impacts me and takes me to the other side of the shop.  And I'm up against a wall, when I finally come around, with a door on top of me.  And I remember thinking to myself, 'You know, this, this is it. I'm gonna die right here,'" Williams remembered.

Meanwhile, the men on the fishing boat had a camera, capturing the flames on the water.

"I began to crawl across the floor.  As I got to the next door, it exploded.  And took me, the door, and slid me about 35 feet backwards again.  And planted me up against another wall. At that point, I actually got angry. I was mad at the doors. I was mad that these fire doors that are supposed to protect me are hurting me. And at that point, I made a decision. 'I'm going to get outside. I may die out there, but I'm gonna get outside.' So I crawl across the grid work of the floor and make my way to that opening, where I see the light. I made it out the door and I thought to myself, 'I've accomplished what I set out to accomplish.  I made it outside.  At least now I can breathe.  I may die out here, but I can breathe,'" Williams said.

Williams couldn't see; something was pouring into his eyes and that's when he noticed a gash in his forehead.

"I didn't know if it was blood. I didn't know if it was brains. I didn't know if it was flesh.  I didn't know what it was.  I just knew there was, I was, I was in trouble.  At that point I grabbed a lifejacket, I was on the aft lifeboat deck there were two functioning lifeboats at my disposal right there.  But I knew I couldn't board them. I had responsibilities," he remembered.  His responsibility was to report to the bridge, the rig's command centre.

"I'm hearing alarms. I'm hearing radio chatter, 'May day! May day! We've lost propulsion! We've lost power! We have a fire! Man overboard on the starboard forward deck,'" Williams remembered.

Williams says that, on the bridge, he watched them try to activate emergency systems.  "The BOP that was supposed to protect us and keep us from the blowout obviously had failed.  And now, the emergency disconnect to get us away from this fuel source has failed.  We have no communications to the BOP," he explained.

"And I see one of the lifeboats in the water, and it's motoring away from the vessel. I looked at the captain and asked him.  I said, 'What's going on?'  He said, 'I've given the order to abandon ship,'" Williams said.

Every Sunday they had practiced lifeboat drills and the procedure for making sure everyone was accounted for. But in the panic all that went to hell. The lifeboats were leaving.

"They're leaving without you?" Pelley asked.

"They have left, without the captain and without knowing that they had everyone that had survived all this onboard.  I've been left now by two lifeboats.  And I look at the captain and I said, 'What do we do now? By now, the fire is not only on the derrick, it's starting to spread to the deck. At that point, there were several more explosions, large, intense explosions," Williams said.

Asked what they felt and sounded like, Williams said, "It's just take-your-breath-away type explosions, shake your body to the core explosions.

Take your vision away from the percussion of the explosions."

About eight survivors were left on the rig.  They dropped an inflatable raft from a crane, but with only a few survivors on the raft, it was launched, leaving Williams, another man, and a crewwoman named Andrea.

"I remember looking at Andrea and seeing that look in her eyes. She had quit.

She had given up. I remember her saying, 'I'm scared.' And I said, 'It's okay to be scared. I'm scared too.' She said, 'What are we gonna do?' I said, 'We're gonna burn up. Or we're gonna jump,'" Williams remembered.  Williams estimates it was a 90-100 foot jump down.

In the middle of the night, with blood in his eyes, fire at his back and the sea ten stories below, Williams made his choice.

"I remember closing my eyes and sayin' a prayer, and asking God to tell my wife and my little girl that Daddy did everything he could and if, if I survive this, it's for a reason. I made those three steps, and I pushed off the end of the rig. And I fell for what seemed like forever. A lotta things go through your mind," he remembered.

With a lifejacket, Williams jumped feet first off the deck and away from the inferno. He had witnessed key events before the disaster.  But if he was going to tell anyone, he would have to survive a ten-story drop into the sea.

"I went down way, way below the surface, obviously. And when I popped back up, I felt like, 'Okay, I've made it.'  But I feel this God-awful burning all over me.  And I'm thinking, 'Am I on fire?' You know, I just don't know.  So I start doin' the only thing I know to do, swim. I gotta start swimmin', I gotta get away from this thing. I could tell I was floatin' in oil and grease and, and diesel fuel.

I mean, it's just the smell and the feel of it," Williams remembered.

"And I remember lookin' under the rig and seein' the water on fire.  And I thought, 'What have you done? You were dry, and you weren't covered in oil up there, now you've jumped and you've made this, and you've landed in oil.  The fire's gonna come across the water, and you're gonna burn up.'  And I thought,

'You just gotta swim harder.' So I swam, and I kicked and I swam and I kicked and I swam as hard as I could until I remember not feelin' any more pain, and I didn't hear anything.  And I thought, 'Well, I must have burned up, 'cause I don't feel anything, I don't hear anything, I don't smell anything. I must be dead.' And I remember a real faint voice of, 'Over here, over here.' I thought, 'What in the world is that?'  And the next thing I know, he grabbed my lifejacket and flipped me over into this small open bow boat.  I didn't know who he was, I didn't know where he'd come from, I didn't care.  I was now out of the water," he  added.

Williams' survival may be critical to the investigation. We took his story to Dr. Bob Bea, a professor of engineering at the University of California, Berkeley.

Last week, the White House asked Bea to help analyze the Deepwater Horizon accident. Bea investigated the Columbia Space Shuttle disaster for NASA and the Hurricane Katrina disaster for the National Science Foundation. Bea's voice never completely recovered from the weeks he spent in the flood in New Orleans.

But as the White House found, he's among the nation's best, having investigated more than 20 offshore rig disasters.

"Mr. Williams comes forward with these very detailed elements from his viewpoint on a rig. That's a brave and intelligent man," Bea told Pelley.

"What he's saying is very important to this investigation, you believe?" Pelley asked.

"It is," the professor replied.

What strikes Bea is Williams' description of the blowout preventer. Williams says in a drilling accident four weeks before the explosion, the critical rubber gasket, called an "annular," was damaged and pieces of it started coming out of the well.

"According to Williams, when parts of the annular start coming up on the deck someone from Transocean says, `Look, don't worry about it.'  What does that tell you?" Pelley asked.

"Houston we have a problem," Bea replied.

Here's why that's so important: the annular is used to seal the well for pressure tests. And those tests determine whether dangerous gas is seeping in.

"So if the annular is damaged, if I understand you correctly, you can't do the pressure tests in a reliable way?" Pelley asked.

"That's correct. You may get pressure test recordings, but because you're leaking pressure, they are not reliable," Bea explained.

Williams also told us that a backup control system to the blowout preventer called a pod had lost some of its functions.

"What is the standard operating procedure if you lose one of the control pods?" Pelley asked.

"Re-establish it, fix it. It's like losing one of your legs," Bea said.

"The morning of the disaster, according to Williams, there was an argument in front of all the men on the ship between the Transocean manager and the BP manager. Do you know what that argument is about?" Pelley asked.

Bea replied, "Yes," telling Pelley the argument was about who was the boss.

In finishing the well, the plan was to have a subcontractor, Halliburton, place three concrete plugs, like corks, in the column. The Transocean manager wanted to do this with the column full of heavy drilling fluid - what drillers call "mud" - to keep the pressure down below contained. But the BP manager wanted to begin to remove the "mud" before the last plug was set. That would reduce the pressure controlling the well before the plugs were finished.

Asked why BP would do that, Bea told Pelley, "It expedites the subsequent steps."

"It's a matter of going faster," Pelley remarked.

"Faster, sure," Bea replied.

Bea said BP had won that argument.

"If the 'mud' had been left in the column, would there have been a blowout?" Pelley asked.

"It doesn't look like it," Bea replied.

To do it BP's way, they had to be absolutely certain that the first two plugs were keeping the pressure down.  That life or death test was done using the blowout preventer which Mike Williams says had a damaged gasket.

Investigators have also found the BOP had a hydraulic leak and a weak battery.

"Weeks before the disaster they know they are drilling in a dangerous formation, the formation has told them that," Pelley remarked.

"Correct," Bea replied.

"And has cost them millions of dollars. And the blowout preventer is broken in a number of ways," Pelley remarked.  "Correct," Bea replied.

Asked what would be the right thing to do at that point, Bea said, "I express it to my students this way, 'Stop, think, don't do something stupid.'"

They didn't stop. As the drilling fluid was removed, downward pressure was relieved; the bottom plug failed. The blowout preventer didn't work. And 11 men were incinerated; 115 crewmembers survived.

And two days later, the Deepwater Horizon sank to the bottom.

This was just the latest disaster for a company that is the largest oil producer in the United States. BP, once known as British Petroleum, was found wilfully negligent in a 2005 Texas refinery explosion that killed of its 15 workers. BP was hit with $108 million in fines - the highest workplace safety fines in U.S. history.

Now, there is new concern about another BP facility in the Gulf: a former BP insider tells us the platform "Atlantis" is a greater threat than the Deepwater Horizon.

Ken Abbott has worked for Shell and GE. And in 2008 he was hired by BP to manage thousands of engineering drawings for the Atlantis platform.

"They serve as blueprints and also as a operator manual, if you will, on how to make this work, and more importantly how to shut it down in an emergency," Abbott explained.

But he says he found that 89 percent of those critical drawings had not been inspected and approved by BP engineers. Even worse, he says 95 percent of the underwater welding plans had never been approved either.

"Are these welding procedures supposed to be approved in the paperwork before the welds are done?" Pelley asked.

"Absolutely. Yeah," Abbott replied. "They're critical."

Abbott's charges are backed up by BP internal e-mails. In 2008, BP manager Barry Duff wrote that the lack of approved drawings could result in "catastrophic operator errors," and "currently there are hundreds if not thousands of Subsea documents that have never been finalized."

Duff called the practice "fundamentally wrong."

"I've never seen this kind of attitude, where safety doesn't seem to matter and when you complain of a problem like Barry did and like I did and try to fix it, you're just criticized and pushed aside," Abbott said.

Abbott was laid off. He took his concerns to a consumer advocacy group called Food & Water Watch. They're asking Congress to investigate. And he is filing suit in an attempt to force the federal government to shut down Atlantis.

"The Atlantis is still pumping away out there, 200,000 barrels a day, and it will be four times that in a year or two when they put in all 16 wells. If something happens there, it will make the Deepwater Horizon look like a bubble in the water by comparison," Abbott said.  In an e-mail, BP told us the Atlantis crew has all the documents it needs to run the platform safely.  We also wanted BP's perspective on the Deepwater Horizon
disaster.

The company scheduled an interview with its CEO, Tony Hayward. Then, they cancelled, saying no one at BP could sit down with "60 Minutes" for this report.

In other interviews, Hayward says this about Transocean, the owner of the Deepwater Horizon: "The responsibility for safety on the drilling rig is with Transocean. It is their rig, their equipment, their people, their systems, their safety processes."

"When BP's chief executive Tony Hayward says, 'This is Transocean's accident,' what do you say?" Pelley asked Professor Bea.

"I get sick. This kind of division in the industry is a killer.  The industry is comprised of many organizations. And they all share the responsibility for successful operations.  And to start placing, we'll call it these barriers, and pointing fingers at each other, is totally destructive," he replied.

Asked who is responsible for the Deepwater Horizon accident, Bea said, "BP."

We went out on the Gulf and found mats of thick floating oil. No one has a fix on how much oil is shooting out of the well. But some of the best estimates suggest it's the equivalent of the Exxon Valdez spill every four to seven days.

Scientists are now reporting vast plumes of oil up to ten miles long under the surface.

The spill has cost BP about $500 million so far. But consider, in just the first three months this year, BP made profits of $6 billion.  There are plenty of accusations to go around that BP pressed for speed, Halliburton's cement plugs failed, and Transocean damaged the blowout preventer.

Through all the red flags, they pressed ahead.  It was, after all, the Deepwater Horizon, the world record holder, celebrated as among the safest in the fleet.

"Men lost their lives," survivor Mike Williams told Pelley. "I don't know how else to say it. All the things that they told us could never happen, happened."the first three months this year, BP made profits of $6 billion.

There are plenty of accusations to go around that BP pressed for speed, Halliburton's cement plugs failed, and Transocean damaged the blowout preventer.

Through all the red flags, they pressed ahead. It was, after all, the Deepwater Horizon, the world record holder, celebrated as among the safest in the fleet.

"Men lost their lives," survivor Mike Williams told Pelley.  "I don't know how else to say it.  All the things that they told us could never happen, happened."

From the "America's Most Wanted" website:

Charles Mark Maxey -- High-Rolling Swindler Makes Millions, Lives High Life -- May be in TJ

Charles Mark Maxey is believed to be the figurehead of the now-defunct internet-based ponzi scheme called EZBucks.

For a brief time, cops say Charles Mark Maxey lived the American dream. He reveled in the excesses of capitalism, driving exotic cars and making absurd amounts of money faster than he could spend it.

But according to the FBI, he was one of the most prolific fraudsters of the early millennium's infamous dot-com boom. Authorities allege that in a rather small time frame, Maxey swindled millions of dollars from thousands of people throughout the world.

It all started in 2002, when Maxey devised EZBucks, which the FBI has deemed to be a net-based ponzi scheme.
From his home in San Diego, Maxey registered the EZBucks domain in the U.K. and offered investors the opportunity to receive substantial returns on their investments.

But according to the site's Frequently Asked Questions section, "EZBucks is a private program and to protect our competitive advantage in the industry, we cannot offer the source of our investments to the public."

And for the longest time, no one questioned EZBucks' investment methodology -- that is, until the losses started piling up. Eventually, the victims of EZBucks' scam wised up, and many contacted the feds.
The FBI got involved in the EZBucks saga when allegations came forth that some investors -- both domestic and international -- were receiving nothing in return from EZBucks. As a matter of fact, quite a few investors lost nearly every dollar they'd spent with them. In some cases, hundreds of thousands of dollars disappeared in the click of a mouse button.

The FBI says the scheme worked like this: Investors would buy, for example, $200 worth of gold from a legitimate West Indies-based corporation called E-Gold. Then, they'd deposit their E-Gold credits into a different E-Gold account, operated by EZBucks.

Within 30 days, EZBucks' Terms of Service stated that the investors would receive varying rates of return on their deposits: 1) a 2 percent return, every day for 365 consecutive days, with a minimum deposit of $1; 2) a 200 percent return on deposits after 30 days, with a minimum deposit of $25; and 3) a 300 percent return on deposits of $5,000 after 30 days.

As promised, within a month, the investors' EZBucks account would indeed show that their account balance had grown significantly -- only EZBucks wouldn't allow some investors to access their funds, keeping any and all returns to itself.

Though some folks did get to cash out their earnings, many did not.

In February 2003, about eight months after EZBucks went into “business”, the FBI tried to access the EZBucks website. When an error message appeared on their browsers stating, "This site has been temporarily suspended. Please contact technical support," the Bureau knew something was awry.

By the time the FBI would uncover the lengths EZBucks went to in order to stay ahead of law enforcement, it was too late. The company was defunct.

According to the FBI, EZBucks' figurehead, Charles Mark Maxey, hit the road with a ton of cash lining his wallets. Some estimates put his take at more than $4 million dollars.

Now authorities need your help to bring this alleged fraudster down.

FBI Hopes To Detain Alleged Fraudster With Public's Help

The FBI alleges that Mark Maxey lives a life of luxury, while those who invested in EZBucks must regain their trust in humanity.

With Maxey's “earnings” from the EZBucks scam, the FBI tells AMW that he purchased a 2003 Jeep Grand Cherokee in November 2002.

But that was just the beginning of his spending spree.

Less than six weeks later, a stretched limo pulled into a San Diego Jaguar dealer's sales lot. Inside the luxury car, Maxey and a female acquaintance were seen downing expensive champagne, toasting one another like they owned the world.

That afternoon, authorities allege Maxey used his newfound funds to buy a late-model Jaguar sports car, retailing for almost $100,000.

Though the Jeep and the Jaguar have since been repossessed by the feds, they say Maxey still has plenty of cash at his disposal.

He has connections throughout the southwest, including San Diego and Houston -- though authorities believe he may be hiding out in Tijuana.

Wherever he is, Maxey may be using a number of aliases, including Allan Bennett or Danny Jacobs. Maxey is an only child, and authorities tell us he's paranoid about law enforcement. His alleged paranoia stems from the belief that the FBI is not a real entity and that a shadowy government agency is trying to track him down.

For instance, when an FBI agent in Southern California tried contacting Maxey by phone, authorities say Maxey would not cooperate because he felt something was not right.

Then, to quell his fears, that same FBI agent told Maxey to meet him in person at the FBI building in San Diego -- but again, Maxey was skeptical and never showed.

A short time later, it's believed Maxey high-tailed it to Mexico, leaving his Jeep at the border -- with his dog still inside it. He then called a friend and told them to pick the vehicle up. Maxey hasn't been seen since.

Spiritual Scammer On The Lam

Charles Mark Maxey is an extremely spiritual individual, and is affiliated with the "Order of Thelema" and "Mission Vi."

Maxey is known to seek the guidance of spiritual advisers -- and with the hefty funds the FBI claims is at his disposal, he is able to afford the best ones money can buy.

As a matter of fact, Maxey is so devoted to his spirituality, authorities allege that he gave the Jaguar to the Order of Thelema as a gift. Unfortunately, the FBI seized it from them, as it was one of the largest assets Maxey was known to have purchased with his EZBucks funds.

Though life as he knew it came to an abrupt end in the months following his March 2004 indictment, Maxey has managed to remain on the lam for more than five years. He probably has the funds to stay free for even longer, but the FBI wants to make sure that doesn't happen.

If you know where Charles Mark Maxey is hiding out, you've got to call our Hotline right away at 1-800-CRIME-TV 1-800-CRIME-TV .

N6MD has requested that this information be forwarded to Baja California:

Published on East County Magazine http://www.eastcountymagazine.org/


MISSING WOMAN FOUND DEAD NEAR JULIAN

May 29, 2010 (Julian) -- Stephanie Brehm-McCabe, 44, was found dead May 27 n her vehicle in a remote mountain area near Julian. Cause of death has not yet been released by the coroner's office.

A resident of Santa Margarita, she had been reported missing by family on May 25. She was last seen May 24 at approximately 8 a.m. after putting a knife to her wrist. She left in her truck, then phoned an acquaintance and left a message indicating she intended to commit suicide.

She was an accomplished equestrian and is familiar with back roads and trails in both the Cleveland National Forest and Anza Borrego Desert State Park.

San Diego Sheriff mounted a search including the ASTREA helicopter and help fromthe California Highway Patrol and State Parks and Recreation personnel.
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Source URL (retrieved on 06/01/2010 - 10:02): http://www.eastcountymagazine.org/node/3401

Unity of the Californias Is Main Message For the 5th Binational Mayor's Summit In Rosarito

MAY 10, 2010

Rosarito Beach Mayor Hugo Torres in opening remarks thanked all those who attended, while citing a recurring theme: "Having a shared border is not what separates us; it is what brings us together."

Kassner's discussion of rootkits is good stuff! (Dated but germaine information)

The complete article is available as a .pdf download with hyperlinks at URL: <http://i.i.com.com/cnwk.1d/i/tr/downloads/home/dl_10_things_rootkits.pdf>, and is more pleasing to the eye than the text formatting in this Email.

He has an ability to translate computereese into English (He actually defines his terms and presents a bibliography. *GASP*). You may want to download and peruse the complete article regardless of your experience or lack of experience with Operating Systems or Unix.

10+ things you should know about rootkits September 17, 2008

By Michael Kassner

Rootkits are complex and ever changing, which makes it difficult to understand exactly what you're dealing with. Even so, I'd like to take a stab at explaining them, so that you'll have a fighting chance if you're confronted with one.

#1 - What is a rootkit?

Breaking the term rootkit into the two component words, root and kit, is a useful way to define it. Root is a UNIX/Linux term that's the equivalent of Administrator in Windows. The word kit denotes programs that allow someone to obtain root/admin-level access to the computer by executing the programs in the kit -- all of which is done without end-user consent or knowledge.

#2 - Why use a rootkit?

Rootkits have two primary functions: remote command/control (back door) and software eavesdropping. Rootkits allow someone, legitimate or otherwise, to administratively control a computer. This means executing files, accessing logs, monitoring user activity, and even changing the computer's configuration. Therefore, in the strictest sense, even versions of VNC are rootkits. This surprises most people, as they consider rootkits to be solely malware, but in of themselves they aren't malicious at all.

One famous (or infamous, depending on your viewpoint) example of rootkit use was Sony BMG's attempt to prevent copyright violations. Sony BMG didn't tell anyone that it placed DRM software on home computers when certain CDs were played. On a scary note, the rootkit hiding technique Sony used was so good not one antivirus or anti-spyware application detected it.

#3 - How do rootkits propagate?

Rootkits can't propagate by themselves, and that fact has precipitated a great deal of confusion. In reality, rootkits are just one component of what is called a blended threat. Blended threats typically consist of three snippets of code: a dropper, loader, and rootkit.

The dropper is the code that gets the rootkit's installation started. Activating the dropper program usually entails human intervention, such as clicking on a malicious e-mail link. Once initiated, the dropper launches the loader program and then deletes itself. Once active, the loader typically causes a buffer overflow, which loads the rootkit into memory.

Blended threat malware gets its foot in the door through social engineering, exploiting known vulnerabilities, or even brute force. Here are two examples of some current and successful exploits:

*IM: One approach requires computers with IM installed (not that much of a stretch). If the appropriate blended threat gains a foothold on just one computer using IM, it takes over the IM client, sending out messages containing malicious links to everyone on the contact list. When the recipient clicks on the link (social engineering, as it's from a friend), that computer becomes infected and has a rootkit on it as well.

*Rich content: The newest approach is to insert the blended threat malware into rich-content files, such as PDF documents. Just opening a malicious PDF file will execute the dropper code, and it's all over.

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#4 - User-mode rootkits

There are several types of rootkits, but we'll start with the simplest one. User-mode rootkits run on a computer with administrative privileges. This allows user-mode rootkits to alter security and hide processes, files, system drivers, network ports, and even system services. User-mode rootkits remain installed on the infected computer by copying required files to the computer's hard drive, automatically launching with every system boot.

Sadly, user-mode rootkits are the only type that antivirus or anti-spyware applications even have a chance of detecting. One example of a user-mode rootkit is Hacker Defender. It's an old rootkit, but it has an illustrious history. If you read the link about Hacker Defender, you will learn about Mark Russinovich, his rootkit detection tool called Rootkit Revealer, and his cat-and-mouse struggle with the developer of Hacker Defender.

#5 - Kernel-mode rootkit

Malware developers are a savvy bunch. Realizing that rootkits running in user-mode can be found by rootkit detection software running in kernel-mode, they developed kernel-mode rootkits, placing the rootkit on the same level as the operating system and rootkit detection software. Simply put, the OS can no longer be trusted. One kernel-mode rootkit that's getting lots of attention is the Da IOS rootkit, developed by Sebastian Muniz and aimed at Cisco's IOS operating system.

Instability is the one downfall of a kernel-mode rootkit. If you notice that your computer is blue-screening for other than the normal reasons, it just might be a kernel-mode rootkit.

#6 - User-mode/kernel-mode hybrid rootkit

Rootkit developers, wanting the best of both worlds, developed a hybrid rootkit that combines user-mode characteristics (easy to use and stable) with kernel-mode characteristics (stealthy). The hybrid approach is very successful and the most popular rootkit at this time.

#7 - Firmware rootkits

Firmware rootkits are the next step in sophistication. This type of rootkit can be any of the other types with an added twist; the rootkit can hide in firmware when the computer is shut down. Restart the computer, and the rootkit reinstalls itself. The altered firmware could be anything from microprocessor code to PCI expansion card firmware. Even if a removal program finds and eliminates the firmware rootkit, the next time the computer starts, the firmware rootkit is right back in business. John Heasman has a great paper called "Implementing and Detecting a PCI Rootkit" (PDF).

#8 - Virtual rootkits

Virtual rootkits are a fairly new and innovative approach. The virtual rootkit acts like a software implementation of hardware sets in a manner similar to that used by VMware. This technology has elicited a great deal of apprehension, as virtual rootkits are almost invisible. The Blue Pill is one example of this type of rootkit. To the best of my knowledge, researchers haven't found virtual rootkits in the wild. Ironically, this is because virtual rootkits are complex and other types are working so well.

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#9 - Generic symptoms of rootkit infestation

Rootkits are frustrating. By design, it's difficult to know if they are installed on a computer. Even experts have a hard time but hint that installed rootkits should get the same consideration as other possible reasons for any decrease in operating efficiency. Sorry for being vague, but that's the nature of the beast.

Here's a list of noteworthy symptoms:

*If the computer locks up or fails to respond to any kind of input from the mouse or keyboard, it could be due to an installed kernel-mode rootkit.

*Settings in Windows change without permission. Examples of this could be the screensaver changing or the taskbar hiding itself.

*Web pages or network activities appear to be intermittent or function improperly due to excessive network traffic.

If the rootkit is working correctly, most of these symptoms aren't going to be noticeable. By definition, good rootkits are stealthy. The last symptom (network slowdown) should be the one that raises a flag. Rootkits can't hide traffic increases, especially if the computer is acting as a spam relay or participating in a DDoS attack.

#10 - Polymorphism

I debated whether to include polymorphism as a topic, since it's not specific to rootkits. But it's amazing technology that makes rootkits difficult to find. Polymorphism techniques allow malware such as rootkits to rewrite core assembly code, which makes using antivirus/anti-spyware signature-based defenses useless. Polymorphism even gives behavioral-based (heuristic) defenses a great deal of trouble. The only hope of finding rootkits that use polymorphism is technology that looks deep into the operating system and then compares the results to a known good baseline of the system.

#11 - Detection and removal

You all know the drill, but it's worth repeating. Be sure to keep antivirus/anti-spyware software (and in fact, every software component of the computer) up to date. That will go a long way toward keeping malware away. Keeping everything current is hard, but a tool such as Secunia's Vulnerability Scanning program can help.

Detection and removal depends on the sophistication of the rootkit. If the rootkit is of the user-mode variety, any one of the following rootkit removal tools will most likely work:

*F-Secure Blacklight

*RootkitRevealer

*Windows Malicious Software Removal Tool

*ProcessGuard

*Rootkit Hunter (Linux and BSD)

The problem with these tools is that you can't be sure they've removed the rootkit. Albeit more labor-intensive, using a bootable CD, such as BartPE, with an antivirus scanner will increase the chances of detecting a rootkit, simply because rootkits can't obscure their tracks when they aren't running. I'm afraid that the only way to know for sure is to have a clean computer, take a baseline, and then use an application like "Encase" to check for any additional code.

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Final thoughts

Opinions vary when it comes to rootkit removal, as discussed in the NetworkWorld article "Experts divided over rootkit detection and removal." Although the article is two years old, the information is still relevant. There's some hope, though: Intel's Trusted Platform Module (TPM) has been cited as a possible solution to malware infestation. The problem with TPM is that it's somewhat controversial. Besides, it will take years before sufficient numbers of computers have processors with TPM.

If you're looking for additional information, I recommend the book ROOTKITS: Subverting the Windows Kernel, by Gary Hoglund and James Butler, of HPGary.

Michael Kassner has been involved with wireless communications for 40-plus years, starting with amateur radio (K0PBX) and now as a network field engineer for Orange Business Services and an independent wireless consultant with MKassner Net. Current certifications include Cisco ESTQ Field Engineer, CWNA, and CWSP.

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The Cost Conundrum : What a Texas town can teach us about health care

by Atul Gawande
June 1, 2009
From the New Yorker, June 1, 2009

It is spring in McAllen, Texas. The morning sun is warm. The streets are lined with palm trees and pickup trucks. McAllen is in Hidalgo County, which has the lowest household income in the country, but it's a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten per cent. McAllen calls itself the Square Dance Capital of the World. "Lonesome Dove" was set around here.
McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.

The explosive trend in American medical costs seems to have occurred here in an especially intense form. Our country's health care is by far the most expensive in the world. In Washington, the aim of health-care reform is not just to extend medical coverage to everybody but also to bring costs under control. Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It's also devouring our government. "The greatest threat to America's fiscal health is not Social Security," President Barack Obama said in a March speech at the White House. "It's not the investments that we've made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation's balance sheet is the skyrocketing cost of health care. It's not even
close."

The question we're now frantically grappling with is how this came to be, and what can be done about it. McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers.

From the moment I arrived, I asked almost everyone I encountered about McAllen's health costs—a businessman I met at the five-gate McAllen-Miller International Airport, the desk clerks at the Embassy Suites Hotel, a police-academy cadet at McDonald's. Most weren't surprised to hear that McAllen was an outlier. "Just look around," the cadet said. "People are not healthy here." McAllen, with its high poverty rate, has an incidence of heavy drinking sixty per cent higher than the national average. And the Tex-Mex diet has contributed to a thirty-eight-per-cent obesity rate.

One day, I went on rounds with Lester Dyke, a weather-beaten, ranch-owning fifty-three-year-old cardiac surgeon who grew up in Austin, did his surgical training with the Army all over the country, and settled into practice in Hidalgo County. He has not lacked for business: in the past twenty years, he has done some eight thousand heart operations, which exhausts me just thinking about it. I walked around with him as he checked in on ten or so of his patients who were recuperating at the three hospitals where he operates. It was easy to see what had landed them under his knife. They were nearly all obese or diabetic or both. Many had a family history of heart disease. Few were taking preventive measures, such as cholesterol-lowering drugs, which, studies indicate, would have obviated surgery for up to half of them.
Yet public-health statistics show that cardiovascular-disease rates in the county are actually lower than average, probably because its smoking rates are quite low. Rates of asthma, H.I.V., infant mortality, cancer, and injury are lower, too. El Paso County, eight hundred miles up the border, has essentially the same demographics. Both counties have a population of roughly seven hundred thousand, similar public-health statistics, and similar percentages of non-English speakers, illegal immigrants, and the unemployed. Yet in 2006 Medicare expenditures (our best approximation of over-all spending patterns) in El Paso were $7,504 per enrollee—half as much as in McAllen. An unhealthy population couldn't possibly be the reason that McAllen's health-care costs are so high. (Or the reason that America's are. We may be more obese than any other industrialized nation, but we have among the lowest rates of smoking and alcoholism, and we are in the middle of the range for cardiovascular disease and diabetes.)

Was the explanation, then, that McAllen was providing unusually good health care? I took a walk through Doctors Hospital at Renaissance, in Edinburg, one of the towns in the McAllen metropolitan area, with Robert Alleyn, a Houston-trained general surgeon who had grown up here and returned home to practice. The hospital campus sprawled across two city blocks, with a series of three- and four-story stucco buildings separated by golfing-green lawns and black asphalt parking lots. He pointed out the sights—the cancer center is over here, the heart center is over there, now we're coming to the imaging center. We went inside the surgery building. It was sleek and modern, with recessed lighting, classical music piped into the waiting areas, and nurses moving from patient to patient behind rolling black computer pods. We changed into scrubs and Alleyn took me through the sixteen operating rooms to show me the laparoscopy suite, with its flat-screen video monitors, the hybrid operating room with built-in imaging equipment, the surgical robot for minimally invasive robotic surgery.

I was impressed. The place had virtually all the technology that you'd find at Harvard and Stanford and the Mayo Clinic, and, as I walked through that hospital on a dusty road in South Texas, this struck me as a remarkable thing. Rich towns get the new school buildings, fire trucks, and roads, not to mention the better teachers and police officers and civil engineers. Poor towns don't. But that rule doesn't hold for health care.

At McAllen Medical Center, I saw an orthopedic surgeon work under an operating microscope to remove a tumor that had wrapped around the spinal cord of a fourteen-year-old. At a home-health agency, I spoke to a nurse who could provide intravenous-drug therapy for patients with congestive heart failure. At McAllen Heart Hospital, I watched Dyke and a team of six do a coronary-artery bypass using technologies that didn't exist a few years ago. At Renaissance, I talked with a neonatologist who trained at my hospital, in Boston, and brought McAllen new skills and technologies for premature babies. "I've had nurses come up to me and say, 'I never knew these babies could survive,' " he said.

And yet there's no evidence that the treatments and technologies available at McAllen are better than those found elsewhere in the country. The annual reports that hospitals file with Medicare show that those in McAllen and El Paso offer comparable technologies—neonatal intensive-care units, advanced cardiac services, PET scans, and so on. Public statistics show no difference in the supply of doctors. Hidalgo County actually has fewer specialists than the national average.

Nor does the care given in McAllen stand out for its quality. Medicare ranks hospitals on twenty-five metrics of care. On all but two of these, McAllen's five largest hospitals performed worse, on average, than El Paso's. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it's delivering better health care.
One night, I went to dinner with six McAllen doctors. All were what you would call bread-and-butter physicians: busy, full-time, private-practice doctors who work from seven in the morning to seven at night and sometimes later, their waiting rooms teeming and their desks stacked with medical charts to review.
Some were dubious when I told them that McAllen was the country's most expensive place for health care. I gave them the spending data from Medicare. In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average. But since then, year after year, McAllen's health costs have grown faster than any other market in the country, ultimately soaring by more than ten thousand dollars per person.

"Maybe the service is better here," the cardiologist suggested. People can be seen faster and get their tests more readily, he said.

Others were skeptical. "I don't think that explains the costs he's talking about," the general surgeon said.
"It's malpractice," a family physician who had practiced here for thirty-three years said.
"McAllen is legal hell," the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn't lawsuits go down?
"Practically to zero," the cardiologist admitted.

"Come on," the general surgeon finally said. "We all know these arguments are bullshit. There is overutilization here, pure and simple." Doctors, he said, were racking up charges with extra tests, services, and procedures.

The surgeon came to McAllen in the mid-nineties, and since then, he said, "the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about 'How much will you benefit?' "

Everyone agreed that something fundamental had changed since the days when health-care costs in McAllen were the same as those in El Paso and elsewhere. Yes, they had more technology. "But young doctors don't think anymore," the family physician said.

The surgeon gave me an example. General surgeons are often asked to see patients with pain from gallstones. If there aren't any complications—and there usually aren't—the pain goes away on its own or with pain medication. With instruction on eating a lower-fat diet, most patients experience no further difficulties.

But some have recurrent episodes, and need surgery to remove their gallbladder.

Seeing a patient who has had uncomplicated, first-time gallstone pain requires some judgment. A surgeon has to provide reassurance (people are often scared and want to go straight to surgery), some education about gallstone disease and diet, perhaps a prescription for pain; in a few weeks, the surgeon might follow up. But increasingly, I was told, McAllen surgeons simply operate. The patient wasn't going to moderate her diet, they tell themselves. The pain was just going to come back. And by operating they happen to make an extra seven hundred dollars.

I gave the doctors around the table a scenario. A forty-year-old woman comes in with chest pain after a fight with her husband. An EKG is normal. The chest pain goes away. She has no family history of heart disease. What did McAllen doctors do fifteen years ago?

Send her home, they said. Maybe get a stress test to confirm that there's no issue, but even that might be overkill.

And today? Today, the cardiologist said, she would get a stress test, an echocardiogram, a mobile Holter monitor, and maybe even a cardiac catheterization.

"Oh, she's definitely getting a cath," the internist said, laughing grimly.

To determine whether overuse of medical care was really the problem in McAllen, I turned to Jonathan Skinner, an economist at Dartmouth's Institute for Health Policy and Clinical Practice, which has three decades of expertise in examining regional patterns in Medicare payment data. I also turned to two private firms—D2Hawkeye, an independent company, and Ingenix, UnitedHealthcare's data-analysis company—to analyze commercial insurance data for McAllen. The answer was yes. Compared with patients in El Paso and nationwide, patients in McAllen got more of pretty much everything—more diagnostic testing, more hospital treatment, more surgery, more home care.

The Medicare payment data provided the most detail. Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received twenty per cent more abdominal ultrasounds, thirty per cent more bone-density studies, sixty per cent more stress tests with echocardiography, two hundred per cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and five hundred and fifty per cent more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits. The primary cause of McAllen's extreme costs was, very simply, the across-the-board overuse of medicine.

This is a disturbing and perhaps surprising diagnosis. Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state's quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

In a 2003 study, another Dartmouth team, led by the internist Elliott Fisher, examined the treatment received by a million elderly Americans diagnosed with colon or rectal cancer, a hip fracture, or a heart attack. They found that patients in higher-spending regions received sixty per cent more care than elsewhere. They got more frequent tests and procedures, more visits with specialists, and more frequent admission to hospitals. Yet they did no better than other patients, whether this was measured in terms of survival, their ability to function, or satisfaction with the care they received. If anything, they seemed to do worse.

That's because nothing in medicine is without risks. Complications can arise from hospital stays, medications, procedures, and tests, and when these things are of marginal value the harm can be greater than the benefits. In recent years, we doctors have markedly increased the number of operations we do, for instance. In 2006, doctors performed at least sixty million surgical procedures, one for every five Americans. No other country does anything like as many operations on its citizens. Are we better off for it? No one knows for sure, but it seems highly unlikely. After all, some hundred thousand people die each year from complications of surgery—far more than die in car crashes.

To make matters worse, Fisher found that patients in high-cost areas were actually less likely to receive low-cost preventive services, such as flu and pneumonia vaccines, faced longer waits at doctor and emergency-room visits, and were less likely to have a primary-care physician. They got more of the stuff that cost more, but not more of what they needed.

In an odd way, this news is reassuring. Universal coverage won't be feasible unless we can control costs. Policymakers have worried that doing so would require rationing, which the public would never go along with. So the idea that there's plenty of fat in the system is proving deeply attractive. "Nearly thirty per cent of Medicare's costs could be saved without negatively affecting health outcomes if spending in high- and medium-cost areas could be reduced to the level in low-cost areas," Peter Orszag, the President's budget director, has stated.

Most Americans would be delighted to have the quality of care found in places like Rochester, Minnesota, or Seattle, Washington, or Durham, North Carolina—all of which have world-class hospitals and costs that fall below the national average. If we brought the cost curve in the expensive places down to their level, Medicare's problems (indeed, almost all the federal government's budget problems for the next fifty years) would be solved. The difficulty is how to go about it. Physicians in places like McAllen behave differently from others. The $2.4-trillion question is why. Unless we figure it out, health reform will fail.
I had what I considered to be a reasonable plan for finding out what was going on in McAllen. I would call on the heads of its hospitals, in their swanky, decorator-designed, churrigueresco offices, and I'd ask them.

The first hospital I visited, McAllen Heart Hospital, is owned by Universal Health Services, a for-profit hospital chain with headquarters in King of Prussia, Pennsylvania, and revenues of five billion dollars last year. I went to see the hospital's chief operating officer, Gilda Romero. Truth be told, her office seemed less churrigueresco than Office Depot. She had straight brown hair, sympathetic eyes, and looked more like a young school teacher than like a corporate officer with nineteen years of experience. And when I inquired, "What is going on in this place?" she looked surprised.

Is McAllen really that expensive? she asked.

I described the data, including the numbers indicating that heart operations and catheter procedures and pacemakers were being performed in McAllen at double the usual rate.

"That is interesting," she said, by which she did not mean, "Uh-oh, you've caught us" but, rather, "That is actually interesting." The problem of McAllen's outlandish costs was new to her. She puzzled over the numbers. She was certain that her doctors performed surgery only when it was necessary. It had to be one of the other hospitals. And she had one in mind—Doctors Hospital at Renaissance, the hospital in Edinburg that I had toured.

She wasn't the only person to mention Renaissance. It is the newest hospital in the area. It is physician-owned. And it has a reputation (which it disclaims) for aggressively recruiting high-volume physicians to become investors and send patients there. Physicians who do so receive not only their fee for whatever service they provide but also a percentage of the hospital's profits from the tests, surgery, or other care patients are given. (In 2007, its profits totalled thirty-four million dollars.) Romero and others argued that this gives physicians an unholy temptation to overorder.

Such an arrangement can make physician investors rich. But it can't be the whole explanation. The hospital gets barely a sixth of the patients in the region; its margins are no bigger than the other hospitals'—whether for profit or not for profit—and it didn't have much of a presence until 2004 at the earliest, a full decade after the cost explosion in McAllen began.

"Those are good points," Romero said. She couldn't explain what was going on.

The following afternoon, I visited the top managers of Doctors Hospital at Renaissance. We sat in their boardroom around one end of a yacht-length table. The chairman of the board offered me a soda. The chief of staff smiled at me. The chief financial officer shook my hand as if I were an old friend. The C.E.O., however, was having a hard time pretending that he was happy to see me. Lawrence Gelman was a fifty-seven-year-old anesthesiologist with a Bill Clinton shock of white hair and a weekly local radio show tag-lined "Opinions from an Unrelenting Conservative Spirit." He had helped found the hospital. He barely greeted me, and while the others were trying for a how-can-I-help-you-today attitude, his body language was more let's-get-this-over-with.

So I asked him why McAllen's health-care costs were so high. What he gave me was a disquisition on the theory and history of American health-care financing going back to Lyndon Johnson and the creation of Medicare, the upshot of which was: (1) Government is the problem in health care. "The people in charge of the purse strings don't know what they're doing." (2) If anything, government insurance programs like Medicare don't pay enough. "I, as an anesthesiologist, know that they pay me ten per cent of what a private insurer pays." (3) Government programs are full of waste. "Every person in this room could easily go through the expenditures of Medicare and Medicaid and see all kinds of waste." (4) But not in McAllen. The clinicians here, at least at Doctors Hospital at Renaissance, "are providing necessary, essential health care," Gelman said. "We don't invent patients."

Then why do hospitals in McAllen order so much more surgery and scans and tests than hospitals in El Paso and elsewhere?

In the end, the only explanation he and his colleagues could offer was this: The other doctors and hospitals in McAllen may be overspending, but, to the extent that his hospital provides costlier treatment than other places in the country, it is making people better in ways that data on quality and outcomes do not measure.
"Do we provide better health care than El Paso?" Gelman asked. "I would bet you two to one that we do."
It was a depressing conversation—not because I thought the executives were being evasive but because they weren't being evasive. The data on McAllen's costs were clearly new to them. They were defending McAllen reflexively. But they really didn't know the big picture of what was happening.

And, I realized, few people in their position do. Local executives for hospitals and clinics and home-health agencies understand their growth rate and their market share; they know whether they are losing money or making money. They know that if their doctors bring in enough business—surgery, imaging, home-nursing referrals—they make money; and if they get the doctors to bring in more, they make more. But they have only the vaguest notion of whether the doctors are making their communities as healthy as they can, or whether they are more or less efficient than their counterparts elsewhere. A doctor sees a patient in clinic, and has her check into a McAllen hospital for a CT scan, an ultrasound, three rounds of blood tests, another ultrasound, and then surgery to have her gallbladder removed. How is Lawrence Gelman or Gilda Romero to know whether all that is essential, let alone the best possible treatment for the patient? It isn't what they are responsible or accountable for.

Health-care costs ultimately arise from the accumulation of individual decisions doctors make about which services and treatments to write an order for. The most expensive piece of medical equipment, as the saying goes, is a doctor's pen. And, as a rule, hospital executives don't own the pen caps. Doctors do.
If doctors wield the pen, why do they do it so differently from one place to another? Brenda Sirovich, another Dartmouth researcher, published a study last year that provided an important clue. She and her team surveyed some eight hundred primary-care physicians from high-cost cities (such as Las Vegas and New York), low-cost cities (such as Sacramento and Boise), and others in between. The researchers asked the physicians specifically how they would handle a variety of patient cases. It turned out that differences in decision-making emerged in only some kinds of cases. In situations in which the right thing to do was well established—for example, whether to recommend a mammogram for a fifty-year-old woman (the answer is yes)—physicians in high- and low-cost cities made the same decisions. But, in cases in which the science was unclear, some physicians pursued the maximum possible amount of testing and procedures; some pursued the minimum. And which kind of doctor they were depended on where they came from.

Sirovich asked doctors how they would treat a seventy-five-year-old woman with typical heartburn symptoms and "adequate health insurance to cover tests and medications." Physicians in high- and low-cost cities were equally likely to prescribe antacid therapy and to check for H. pylori, an ulcer-causing bacterium—steps strongly recommended by national guidelines. But when it came to measures of less certain value—and higher cost—the differences were considerable. More than seventy per cent of physicians in high-cost cities referred the patient to a gastroenterologist, ordered an upper endoscopy, or both, while half as many in low-cost cities did. Physicians from high-cost cities typically recommended that patients with well-controlled hypertension see them in the office every one to three months, while those from low-cost cities recommended visits twice yearly. In case after uncertain case, more was not necessarily better. But physicians from the most expensive cities did the most expensive things.

Why? Some of it could reflect differences in training. I remember when my wife brought our infant son Walker to visit his grandparents in Virginia, and he took a terrifying fall down a set of stairs. They drove him to the local community hospital in Alexandria. A CT scan showed that he had a tiny subdural hematoma—a small area of bleeding in the brain. During ten hours of observation, though, he was fine—eating, drinking, completely alert. I was a surgery resident then and had seen many cases like his. We observed each child in intensive care for at least twenty-four hours and got a repeat CT scan. That was how I'd been trained. But the doctor in Alexandria was going to send Walker home. That was how he'd been trained. Suppose things change for the worse? I asked him. It's extremely unlikely, he said, and if anything changed Walker could always be brought back. I bullied the doctor into admitting him anyway. The next day, the scan and the patient were fine. And, looking in the textbooks, I learned that the doctor was right. Walker could have been managed safely either way.
There was no sign, however, that McAllen's doctors as a group were trained any differently from El Paso's. One morning, I met with a hospital administrator who had extensive experience managing for-profit hospitals along the border. He offered a different possible explanation: the culture of money.
"In El Paso, if you took a random doctor and looked at his tax returns eighty-five per cent of his income would come from the usual practice of medicine," he said. But in McAllen, the administrator thought, that percentage would be a lot less.
He knew of doctors who owned strip malls, orange groves, apartment complexes—or imaging centers, surgery centers, or another part of the hospital they directed patients to. They had "entrepreneurial spirit," he said. They were innovative and aggressive in finding ways to increase revenues from patient care. "There's no lack of work ethic," he said. But he had often seen financial considerations drive the decisions doctors made for patients—the tests they ordered, the doctors and hospitals they recommended—and it bothered him. Several doctors who were unhappy about the direction medicine had taken in McAllen told me the same thing. "It's a machine, my friend," one surgeon explained.
No one teaches you how to think about money in medical school or residency. Yet, from the moment you start practicing, you must think about it. You must consider what is covered for a patient and what is not. You must pay attention to insurance rejections and government-reimbursement rules. You must think about having enough money for the secretary and the nurse and the rent and the malpractice insurance.
Beyond the basics, however, many physicians are remarkably oblivious to the financial implications of their decisions. They see their patients. They make their recommendations. They send out the bills. And, as long as the numbers come out all right at the end of each month, they put the money out of their minds.
Others think of the money as a means of improving what they do. They think about how to use the insurance money to maybe install electronic health records with colleagues, or provide easier phone and e-mail access, or offer expanded hours. They hire an extra nurse to monitor diabetic patients more closely, and to make sure that patients don't miss their mammograms and pap smears and colonoscopies.

Then there are the physicians who see their practice primarily as a revenue stream. They instruct their secretary to have patients who call with follow-up questions schedule an appointment, because insurers don't pay for phone calls, only office visits. They consider providing Botox injections for cash. They take a Doppler ultrasound course, buy a machine, and start doing their patients' scans themselves, so that the insurance payments go to them rather than to the hospital. They figure out ways to increase their high-margin work and decrease their low-margin work. This is a business, after all.

In every community, you'll find a mixture of these views among physicians, but one or another tends to predominate. McAllen seems simply to be the community at one extreme.

In a few cases, the hospital executive told me, he'd seen the behavior cross over into what seemed like outright fraud. "I've had doctors here come up to me and say, 'You want me to admit patients to your hospital, you're going to have to pay me.' "

"How much?" I asked.

"The amounts—all of them were over a hundred thousand dollars per year," he said. The doctors were specific. The most he was asked for was five hundred thousand dollars per year.

He didn't pay any of them, he said: "I mean, I gotta sleep at night." And he emphasized that these were just a handful of doctors. But he had never been asked for a kickback before coming to McAllen.

Woody Powell is a Stanford sociologist who studies the economic culture of cities. Recently, he and his research team studied why certain regions—Boston, San Francisco, San Diego—became leaders in biotechnology while others with a similar concentration of scientific and corporate talent—Los Angeles, Philadelphia, New York—did not. The answer they found was what Powell describes as the anchor-tenant theory of economic development. Just as an anchor store will define the character of a mall, anchor tenants in biotechnology, whether it's a company like Genentech, in South San Francisco, or a university like M.I.T., in Cambridge, define the character of an economic community. They set the norms. The anchor tenants that set norms encouraging the free flow of ideas and collaboration, even with competitors, produced enduringly successful communities, while those that mainly sought to dominate did not.

Powell suspects that anchor tenants play a similarly powerful community role in other areas of economics, too, and health care may be no exception. I spoke to a marketing rep for a McAllen home-health agency who told me of a process uncannily similar to what Powell found in biotech. Her job is to persuade doctors to use her agency rather than others. The competition is fierce. I opened the phone book and found seventeen pages of listings for home-health agencies—two hundred and sixty in all. A patient typically brings in between twelve hundred and fifteen hundred dollars, and double that amount for specialized care. She described how, a decade or so ago, a few early agencies began rewarding doctors who ordered home visits with more than trinkets: they provided tickets to professional sporting events, jewelry, and other gifts. That set the tone. Other agencies jumped in. Some began paying doctors a supplemental salary, as "medical directors," for steering business in their direction.

Doctors came to expect a share of the revenue stream.

Agencies that want to compete on quality struggle to remain in business, the rep said. Doctors have asked her for a medical-director salary of four or five thousand dollars a month in return for sending her business. One asked a colleague of hers for private-school tuition for his child; another wanted sex.
"I explained the rules and regulations and the anti-kickback law, and told them no," she said of her dealings with such doctors. "Does it hurt my business?" She paused. "I'm O.K. working only with ethical physicians," she finally said.

About fifteen years ago, it seems, something began to change in McAllen. A few leaders of local institutions took profit growth to be a legitimate ethic in the practice of medicine. Not all the doctors accepted this. But they failed to discourage those who did. So here, along the banks of the Rio Grande, in the Square Dance Capital of the World, a medical community came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers.

The real puzzle of American health care, I realized on the airplane home, is not why McAllen is different from El Paso. It's why El Paso isn't like McAllen.

Every incentive in the system is an invitation to go the way McAllen has gone. Yet, across the country, large numbers of communities have managed to control their health costs rather than ratchet them up.
I talked to Denis Cortese, the C.E.O. of the Mayo Clinic, which is among the highest-quality, lowest-cost health-care systems in the country. A couple of years ago, I spent several days there as a visiting surgeon. Among the things that stand out from that visit was how much time the doctors spent with patients. There was no churn—no shuttling patients in and out of rooms while the doctor bounces from one to the other. I accompanied a colleague while he saw patients. Most of the patients, like those in my clinic, required about twenty minutes. But one patient had colon cancer and a number of other complex issues, including heart disease. The physician spent an hour with her, sorting things out. He phoned a cardiologist with a question.

"I'll be there," the cardiologist said.

Fifteen minutes later, he was. They mulled over everything together. The cardiologist adjusted a medication, and said that no further testing was needed. He cleared the patient for surgery, and the operating room gave her a slot the next day.

The whole interaction was astonishing to me. Just having the cardiologist pop down to see the patient with the surgeon would be unimaginable at my hospital. The time required wouldn't pay. The time required just to organize the system wouldn't pay.

The core tenet of the Mayo Clinic is "The needs of the patient come first"—not the convenience of the doctors, not their revenues. The doctors and nurses, and even the janitors, sat in meetings almost weekly, working on ideas to make the service and the care better, not to get more money out of patients. I asked Cortese how the Mayo Clinic made this possible.

"It's not easy," he said. But decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors' goal in patient care couldn't be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible.

No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs.

"When doctors put their heads together in a room, when they share expertise, you get more thinking and less testing," Cortese told me.

Skeptics saw the Mayo model as a local phenomenon that wouldn't carry beyond the hay fields of northern Minnesota. But in 1986 the Mayo Clinic opened a campus in Florida, one of our most expensive states for health care, and, in 1987, another one in Arizona. It was difficult to recruit staff members who would accept a salary and the Mayo's collaborative way of practicing. Leaders were working against the dominant medical culture and incentives. The expansion sites took at least a decade to get properly established. But eventually they achieved the same high-quality, low-cost results as Rochester. Indeed, Cortese says that the Florida site has become, in some respects, the most efficient one in the system.
The Mayo Clinic is not an aberration. One of the lowest-cost markets in the country is Grand Junction, Colorado, a community of a hundred and twenty thousand that nonetheless has achieved some of Medicare's highest quality-of-care scores. Michael Pramenko is a family physician and a local medical leader there. Unlike doctors at the Mayo Clinic, he told me, those in Grand Junction get piecework fees from insurers. But years ago the doctors agreed among themselves to a system that paid them a similar fee whether they saw Medicare, Medicaid, or private-insurance patients, so that there would be little incentive to cherry-pick patients. They also agreed, at the behest of the main health plan in town, an H.M.O., to meet regularly on small peer-review committees to go over their patient charts together. They focussed on rooting out problems like poor prevention practices, unnecessary back operations, and unusual hospital-complication rates. Problems went down. Quality went up. Then, in 2004, the doctors' group and the local H.M.O. jointly created a regional information network—a community-wide electronic-record system that shared office notes, test results, and hospital data for patients across the area. Again, problems went down. Quality went up. And costs ended up lower than just about anywhere else in the United States.

Grand Junction's medical community was not following anyone else's recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls an accountable-care organization. The leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care.

This approach has been adopted in other places, too: the Geisinger Health System, in Danville, Pennsylvania; the Marshfield Clinic, in Marshfield, Wisconsin; Intermountain Healthcare, in Salt Lake City; Kaiser Permanente, in Northern California. All of them function on similar principles. All are not-for-profit institutions. And all have produced enviably higher quality and lower costs than the average American town enjoys.

When you look across the spectrum from Grand Junction to McAllen—and the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine. Somewhere in the United States at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor. And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.

There is no insurance system that will make the two aims match perfectly. But having a system that does so much to misalign them has proved disastrous. As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country's best electrician on the job (he trained at Harvard, somebody tells you) isn't going to solve this problem. Nor will changing the person who writes him the check.

This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here's how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some "skin in the game," and then they'll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen.

One afternoon in McAllen, I rode down McColl Road with Lester Dyke, the cardiac surgeon, and we passed a series of office plazas that seemed to be nothing but home-health agencies, imaging centers, and medical-equipment stores.

"Medicine has become a pig trough here," he muttered.

Dyke is among the few vocal critics of what's happened in McAllen. "We took a wrong turn when doctors stopped being doctors and became businessmen," he said.

We began talking about the various proposals being touted in Washington to fix the cost problem. I asked him whether expanding public-insurance programs like Medicare and shrinking the role of insurance companies would do the trick in McAllen.

"I don't have a problem with it," he said. "But it won't make a difference." In McAllen, government payers already predominate—not many people have jobs with private insurance.

How about doing the opposite and increasing the role of big insurance companies?

"What good would that do?" Dyke asked.

The third class of health-cost proposals, I explained, would push people to use medical savings accounts and hold high-deductible insurance policies: "They'd have more of their own money on the line, and that'd drive them to bargain with you and other surgeons, right?"
He gave me a quizzical look. We tried to imagine the scenario. A cardiologist tells an elderly woman that she needs bypass surgery and has Dr. Dyke see her. They discuss the blockages in her heart, the operation, the risks. And now they're supposed to haggle over the price as if he were selling a rug in a souk? "I'll do three vessels for thirty thousand, but if you take four I'll throw in an extra night in the I.C.U."—that sort of thing? Dyke shook his head. "Who comes up with this stuff?" he asked. "Any plan that relies on the sheep to negotiate with the wolves is doomed to failure."

Instead, McAllen and other cities like it have to be weaned away from their untenably fragmented, quantity-driven systems of health care, step by step. And that will mean rewarding doctors and hospitals if they band together to form Grand Junction-like accountable-care organizations, in which doctors collaborate to increase prevention and the quality of care, while discouraging overtreatment, undertreatment, and sheer profiteering. Under one approach, insurers—whether public or private—would allow clinicians who formed such organizations and met quality goals to keep half the savings they generate. Government could also shift regulatory burdens, and even malpractice liability, from the doctors to the organization. Other, sterner, approaches would penalize those who don't form these organizations.
This will by necessity be an experiment. We will need to do in-depth research on what makes the best systems successful—the peer-review committees? recruiting more primary-care doctors and nurses? putting doctors on salary?—and disseminate what we learn. Congress has provided vital funding for research that compares the effectiveness of different treatments, and this should help reduce uncertainty about which treatments are best. But we also need to fund research that compares the effectiveness of different systems of care—to reduce our uncertainty about which systems work best for communities. These are empirical, not ideological, questions. And we would do well to form a national institute for health-care delivery, bringing together clinicians, hospitals, insurers, employers, and citizens to assess, regularly, the quality and the cost of our care, review the strategies that produce good results, and make clear recommendations for local systems.

Dramatic improvements and savings will take at least a decade. But a choice must be made. Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can't do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone—because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health-care system in the world.

Something even more worrisome is going on as well. In the war over the culture of medicine—the war over whether our country's anchor model will be Mayo or McAllen—the Mayo model is losing. In the sharpest economic downturn that our health system has faced in half a century, many people in medicine don't see why they should do the hard work of organizing themselves in ways that reduce waste and improve quality if it means sacrificing revenue.

In El Paso, the for-profit health-care executive told me, a few leading physicians recently followed McAllen's lead and opened their own centers for surgery and imaging. When I was in Tulsa a few months ago, a fellow-surgeon explained how he had made up for lost revenue by shifting his operations for well-insured patients to a specialty hospital that he partially owned while keeping his poor and uninsured patients at a nonprofit hospital in town. Even in Grand Junction, Michael Pramenko told me, "some of the doctors are beginning to complain about 'leaving money on the table.' "

As America struggles to extend health-care coverage while curbing health-care costs, we face a decision that is more important than whether we have a public-insurance option, more important than whether we will have a single-payer system in the long run or a mixture of public and private insurance, as we do now. The decision is whether we are going to reward the leaders who are trying to build a new generation of Mayos and Grand Junctions. If we don't, McAllen won't be an outlier. It will be our future. ♦