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9:00 AM EST, Tuesday, June 2, 2009. Wow. What a contrast. The strong stockmarket. The weak economy. The contrast has bamboozled virtually every "professional" investor, whose shorts have been crucified. Meanwhile many technicals have been broken -- suggesting that we're going higher. Reports one commentator this morning,

They were finally able to punch the S&P through the top of an eight month old rectangle (which topped out @ 930)…And in the process, the index took out its 200 day moving average on a closing basis for the first time in just over a year…I am not saying that this move to the upside will not turn out to be legitimate, and we move higher now that the resistance at the top end of the range has been flushed out (a 1000 test probably is not the craziest thought out there)…So bottom line, no doubt the path of least resistance is up, and the momentum guys seem pretty content to stay in motion…So what does an 80% run in oil tell us about the global economy?...It is recovering obviously, right?...You would certainly think so…Or…Oil’s run has little to do with pricing in a global recovery…Instead, its a bunch of hedge funds/foreign central governments piling into oil looking to capture the ride up as the US dollar has gotten decimated?...

Health reform. Good luck. When my doctor heard that I was now a certified alta kaka and on Medicare, he whooped for joy. He became more concerned about health. His tests and procedures rose. When I got the first accounting from Medicare, I could see why. His charges had skyrocketed. And since I wasn't paying any part of them, I should clearly no longer care.

Health care reform is everyone's campaign reform. I always knew reforming it was complex. But I never figured how complex -- maybe impossible. Atul Gawande is a surgeon who's written a must-read piece in the latest New Yorker called "The Cost Conundrum. What a Texas town can teach us about health care." Excerpts:

+ 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.

+ 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.

+ She wasn’t the only person to mention Renaissance. It is the newest hospital in the area (McAllen, Texas). 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 totaled thirty-four million dollars.) Romero and others argued that this gives physicians an unholy temptation to overorder.

+ 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.

+ 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.

+ When you look across the spectrum from Grand Junction, Colorado (low cost medicine) to McAllen, Texas —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.

The next time I visited my doctor, I declined his tests for problems and diseases I didn't have. And, guess what? I'm still alive, though at a lower cost to the Federal Government.

The perfect graduation gift: A subscription to the Economist. You give a t-shirt, full access to the well-organized Economist's well-organized website and 51 issues. $77. Worth every penny. Click here.

Bing versus Google versus Wolfram? Comparing search engines gives boredom a whole new meaning. Microsoft has launched Bing. It's a Google look-alike. Wolfram is an entirely different fish. It's a sort of scientific search engine. I don't find it especially useful.

Google's new ventures. Coming soon: Google Wave Developer. Click here. Google Voice. Click here.

Congratulations to Apple and Seagate: Great responsive PR people.

Sierra Trading Post is running specials. Sierra sells great stuff eminent manufacturers offload for whatever reason. They typically sell at 40% to 50% off retail. They have great stuff for the outdoors. They have great brands, like Ralph Lauren, ExOfficio, Carhartt, Eagle Creek.

I just bought a pair of Salomon Goretex hiking shoes for $74. Get on their mailing list. It's fun. Click here for the bargains.

Commodities are taking off: My old commodities fund was up 12.9% in May. It's now up 10.1% for the year. The escalation in commodities is not because of increasing demand -- the world economy is still dragging. It's because of speculation. (See above.)

French Tennis Open 2009 TV Schedule -- US broadcast times. Nadal and Roddick are out. Federer is still in. Fortunately for them all, they've never come up against me. Well, maybe. With this insane TV coverage, you can watch the same match three times and highlights of it at least six times.

Tuesday, June 2 - QUARTERS
8:00 am - 12:00 PM: French Open Quarterfinals - TENNIS CHANNEL (HD) - LIVE
12:00 PM - 6:30 PM: French Open Quarterfinals - ESPN2 + ESPN2 HD - LIVE and tape
6:30 PM - 5:00 AM: French Open “Tonight” show - TENNIS CHANNEL (HD) - tape

Wednesday, June 3 - QUARTERS
8:00 am - 12:00 PM: French Open Quarterfinals - TENNIS CHANNEL (HD) - LIVE
12:00 PM - 6:30 PM: French Open Men’s Quarterfinals - ESPN2 + ESPN2 HD - LIVE and tape
6:30 PM - 5:00 AM: French Open “Tonight” show - TENNIS CHANNEL (HD) - tape

Thursday, June 4 - SEMIS
5:00 am - 8:00 AM: French Open Men’s Doubles Semifinals - TENNIS CHANNEL (HD) - LIVE
8:00 am - 1:00 PM: French Open Women’s Semifinals - ESPN2 + ESPN2 HD - LIVE
1:00 PM - 6:30 PM: French Open Women’s Semifinals - TENNIS CHANNEL (HD) - tape
6:30 PM - 5:00 AM: French Open “Tonight” show - TENNIS CHANNEL (HD) - tape

Friday, June 5: - SEMIS
5:00 am - 10:00 AM: French Open Women’s Semifinals - TENNIS CHANNEL (HD) - tape
10:00 am - 1:00 PM: French Open Men’s Semifinals - NBC - LIVE
4:00 PM - 11:00 PM: French Open Men’s Semifinals - TENNIS CHANNEL (HD) - tape
11:00 PM - 6:00 AM: French Open Men’s Semifinals - TENNIS CHANNEL (HD) - tape

Saturday, June 6: - FINAL
9:00 am - 12:00 PM: Women’s FINAL - NBC - LIVE

Sunday, June 7: FINAL
9:00 am - 2:00 PM: Men’s FINAL - NBC - LIVE

Favorite recent cartoons.

The New York Times has just sharply increased their prices for their print edition. The Wall Street Journal has just sharply decreased their prices for their print edition. Guess who'll win this one?

This column is about my personal search for the perfect investment. I don't give investment advice. For that you have to be registered with regulatory authorities, which I am not. I am a reporter and an investor. I make my daily column -- Monday through Friday -- freely available for three reasons: Writing is good for sorting things out in my brain. Second, the column is research for a book I'm writing called "In Search of the Perfect Investment." Third, I encourage my readers to send me their ideas, concerns and experiences. That way we can all learn together. My email address is . You can't click on my email address. You have to re-type it . This protects me from software scanning the Internet for email addresses to spam. I have no role in choosing the Google ads on this site. Thus I cannot endorse, though some look interesting. If you click on a link, Google may send me money. Please note I'm not suggesting you do. That money, if there is any, may help pay Michael's business school tuition. Read more about Google AdSense, click here and here.