Tuesday, September 23, 2014

A drunkard's walk amid silly people... Left and Right

Okay, this blog entry is going to be a bit rambling and angry... somewhat of a drunkard's walk, while ranting at the lamp posts! Hope it at least entertains. Here goes.

bullshit-asymmetry-brandoliniWe’ve all known this and said it for a long time. I laid it out in explicit detail in my Disputations Arenas. Still, it’s nice to see a cogent naming of the phenomenon -- Brandolini’s law - or, as Alberto Brandolini suggests, the Bullshit Asymmetry Principle:
"The amount of energy needed to refute bullshit is an order of magnitude bigger than to produce it."
== Heading for war? ==
On the left side of the spectrum, and in some places on the right, folks are asking whether "Obama is playing into Bush's bad policies. Now he's taking the U.S. back into Iraq with more bombing."
democrats-republicans-wage-warSorry, this is a wrongheaded reflex. Back in 2002 - 2003, the issue was never "should Saddam Hussein be toppled and replaced?" Nor was it "should the Taliban - who supported and helped bin Laden to attack us be toppled and replaced?" 

We needed to do both things. (Though in Saddam's case it deserved genuine policy debate and not a festival of Bushite lies.)
No, the real issue, re U.S. involvement/meddling over there, is and was "should it be done in the stupidest and most expensive ways possible? In a calamitous, gruesomely thuggish methodology that would cost us trillions, damn-near ruin our military and our reputations and leave only two winners: Iran and Haliburton?"
If you actually (astonishingly) think that there will be any resemblance between the coming Obama-led engagement and the Bushite quagmires, you really need to read about the diametrically opposite ways that Democrats and Republicans wage war.
==Decaying Infrastructure== 
And so the drunkard turns and veers in another direct, to rant that --

America's transportation infrastructure, once a continental engine of mobility, productivity and opportunity, has fallen into such disrepair that it's become an economic albatross. Consumers shell out billions of dollars for extra car repairs every year. Insufficient and poorly maintained roads mean costly bottlenecks for businesses, which discourage expansion and hobble American companies competing in the global economy. We all have heard of 60,000 bridges in desperate need of maintenance. Why is almost nothing being done?
BUDGET-DEFICITAt a time of steeply declining budget deficits (always true during democratic administrations and never true during GOP ones) it might seem simple to put middle class blokes back to work, stimulating the economy with high velocity cash while fixing the damaged streets and bridges and getting tons of benefits. One obstacle though. The do-nothing US House of Representatives… the laziest and least accomplished in the history of the republic… has refused to fund infrastructure repairs.
Moreover, several gopper congressfolk have openly admitted their reason — that the resulting improvements and economic boost might help democrats at the polls. It is the Hastert Rule. Never cooperate or negotiate in good faith with democrats, ever. (The last GOP leader who did negotiate - Newt Gingrich - managed to put together with Bill Clinton both the highly successful Welfare Reform Bill and the Budget Bill that led to several years of fiscal surpluses. But Gingrich was dumped and jettisoned for that very reason by Hastert, DeLay, Boehner and other leaders of the madness that has taken over today’s Republican Party.)
Anyone who continues to support this mutant betrayal of true conservatism/libertarianism is a rationalizing fool.

Let's see... any other lamp-posts to yell at?  Oh yes....
 ==War against Nerds==
Salon runs a fun article eviscerating how explicit has become the mad-right’s Assault on Nerds. It has got so clear and full-pitch that even William F. Buckley’s once-intellectual National Review has joined the War Against All Smartypants. Scientists and members of every knowledge caste have been driven out of today’s hijacked version of conservatism. God help us if this relentless campaign drives them all the way across -- past moderate liberalism -- all the way to the opposite madness on the far left.
sensible-problemsI doubt that will happen. All we want is a sensible society where adults negotiate with each other mixed-pragmatic solutions to problems, aiming for a future that will be vastly better than the past that nostalgic loonies (of both the far-left and the entire-right) yearn for. Is that too much to ask?
More evidence?  In late May, the Republicans in the House put an amendment in the Defense Spending Authorization Bill that forbids the Defense Department from spending any money preparing for the consequences of climate change. This article -- House Votes to Deny Climate Science and Ties Pentagon's Hands on Climate Change - on an admittedly liberal site - nevertheless lays this latest lunacy bare and lists an impressive array of serving and retired officers and military contractors who are deeply concerned.


The Bill is now in the Senate.
One of you in the community commented: “Our military wargames all kinds of scenarios. Preparedness is part of the job of our military planners, and having a plan prepared is the first step to winning a fight. I expect that somewhere the US military has a plan to deal with a threat from just about any conceivable direction. Oh, but not waves of hungry and thirsty refugees from all over the world, not that. We cannot plan for that contingency.”

denialismTo be clear, as we speak both the Canadian and US navies are struggling as fast as they can, to build capabilities to match the twelve  new military bases the Russians are building around the Arctic Sea, now that it is ice-free or navigable for much of the year. Denialism is a cult that borders on treason.

Ah... but now the drunkard does one of his patented veers... and aims some of his ire in the other direction!
==Divisive Politics==
HaidtSocial psychologist Jonathan Haidt and his colleagues have thrown another grenade. “Psychologists have demonstrated the value of diversity-particularly diversity of viewpoints-for enhancing creativity, discovery, and problem solving. But one key type of viewpoint diversity is lacking in academic psychology in general and social psychology in particular: political diversity.”
Read that between the lines.  It is an indictment of the political correctness that rules in several hundred university soft studies departments.  Along with San Francisco, Berkeley and Illinois, these are the places where you get to see the reason why moderate liberals are rightfully wary of their lefty allies.  And I will not be squelched in reminding you folks that there is danger there!  I remember campus lefty bullies.  I remember the Soviet evil empire (that was fought so effectively by George Soros.)  Just because the US right is currently more dangerous and crazy, that does not mean we can ignore warnings like the one issued by Haight.

But again... a few hundred university soft studies departments are a far cry from the worst danger to our republic and freedoms and planet. True, they hate and persecute science fiction!  That is one good reason to glance, askance at those allies of ours.
I am wary of that direction. But I am bloody furious at the New Confederates who are (at present) vastly more damaging and lethally dangerous to civilization.  For example...
==  Where are the Chicken Littles hiding, all of a sudden? ==

I predicted that, once the tepid and minimal “healthcare reform” called “Obamacare” kicked in, it would start applying market forces that would work fairly well, reducing both the ranks of the uninsured and the rates of increase of US medical costs… all of which is happening.  At which point (I also predicted) GOP pundits  - who had been proclaiming the sky would fall and America would collapse into the stone age - would simply DROP the subject, hoping that their viewers would forget their chicken little end-of-the-world ravings. (And given their viewership, that amnesia is pretty much guaranteed.)

 Indeed, I said that after using this “issue” to lock down and destroy all political processes in the United States of America, that suddenly GOP politicians would start pragmatically adapting to the ACA and even… claiming it as their own.

Which… they are somewhat justified to do!  Since “Obamacare” was cloned from “Romneycare” and “Gingrich-care” and the standard, Heritage-Foundation-designed Republican Healthcare proposal on every GOP platform for ten years.  Watch as that fact is suddenly remembered!  But do not let them forget the hell they put us through, the hysterics and frozen American political life.  The screeching.

== Ironies abound ==

sovereign-citizensMy sci fi author colleague John Shirley dissects “sovereign citizen”… a cult-like movement among those who take the anti-government wing of our widely shared Suspicion of Authority ethos to an extreme that denies any legitimacy of common bonds with three hundred million fellow Americans. 
While I agree with John, on many levels, I believe his approach is more left-versus-right than it needs to be, regarding this matter. (Indeed, while they are fewer - today - there ARE would be tyrants whose metaphors of outrage and hate come from (shall we say) the opposite direction. Surfaces can be misleading.)
In fact, it can be dissected very simply. Those who deny any validity to shared institutions that derive their legitimacy from the electoral political processes... institutions that in-turn reflect consensus of a great and educated nation ... are not simply asserting autonomy — (while hypocritically depending on that nation, utterly). They are either ignoring 6000 years of brutal feudal rule by armed thugs, or else deeply committed to becoming precisely those same armed thugs and feudal lords.
Civilization-FlashI attempted to portray this in The Postman, way back in the 1980s… and it is one part of the book that Kevin Costner translated to the film with utter accuracy! Especially Will Patton’s delightful General Bethlehem, who conveyed where all this would inevitably lead.
Indeed, I wrote The Postman specifically as a direct answer to these fellows. How average folks would not just cower before these would-be lords, but instead might (if properly inspired) rise up to restore that gracious consensus nation, once again.
Having tasted civilization, many of us will fight to the death, to keep it.
In an impromptu interview at a Portland restaurant, I gave a six minute run down of why I think the American political process has so broken down that we are effectively in phase eight of the U.S. Civil War. Not one of the factors that I mention has a scintilla to do with so-called “left-versus-right” or any of the matters that you are being told to hate-over.
==The Tea Party and the Confederacy==
And finally...

Not a Tea Party, a Confederate Party -- Here’s a somewhat too-radical but interesting essay about how the Confederacy lost phase four of the Civil War, in 1865, then won phase five with the collapse of Reconstruction and minority rights, in 1877. Indeed, things have swung back and forth, ever since, including the Civil Rights phase that was won by Blue America - finally crushing the vileness of segregation - but at a cost that resulted in the complete flip-reversal of the two U.S. political parties. In that light, today’s raging “culture war” is only the latest phase.
TAXES-REVOLTClearly the Tea Party is not heir to the 1776 Founders. Their romantic delusions about that Revolution are dissected elsewhere…
… but the crux is clear; instead of wearing three-cornered hats, our Tea Party neighbors should wear gray, for they are the neo-confederate party. In fact, more and more of them are realizing this. Their devotion to the rising, worldwide oligarchy is identical to the feudal loyalty that their forebears gave to plantation lords. (Yesss Massa Koch an' Marse Rupert.) The aim - to tear down the future-oriented, change-welcoming, scientific and pragmatic Blue America, in order to replace it with classic nostalgia and feudal hierarchy - is identical to that of the southern tories who rode with Cornwallis and Tarleton.
I trace out the phases of the Civil War, from 1776 to today, here.

PHASES-CIVIL-WARWhich phase was the most important?  My own, earlier take: The crucial phase of the Civil War, phase three, started in 1852, when waves of southern irregular cavalry began 8 years of violent raids into Northern states to enforce the Fugitive Slave Act. This was never the “war of northern aggression.” It was the diametric opposite. And it is time to re-learn the Battle Hymn of the Republic.

Picture the drunkard now, careening off into the dim night shadows, crashing into trash cans and - hoarsely - singing at the top of his lungs...

"... He hath trampled out the "newsroom" where the Fox of wrath has whored..."


Tacitus2 said...

Mostly old topics. Gnawing on dry bones conversationally.

But the next round of Mideast conflict and the final destination of health care reform....both too soon to judge.

Health care reform in particular is effectively an expanded medical assistance program. Not a bad thing, that. But the true costs won't be known for a few more years.

I can tell you it is not reducing ER use a whit. Still seeing plenty of folks wandering in with colds or even with nothing particular wrong, just want an off work slip....


LarryHart said...


I can tell you it [Obamacare] is not reducing ER use a whit. Still seeing plenty of folks wandering in with colds or even with nothing particular wrong, just want an off work slip....

Serious question: What does that have to do with Obamacare? Wouldn't they have done that anyway? Or are they enabled now by insurance that pays enough for ER visits without a diagnosis?

LarryHart said...

locumranch (in the previous thread):

Horace Mann, the founder of the US educational system, believed
that women were morally superior to men. This superiority,
according to Mann, would permit females to instill their morals
in the common school students they taught, allowing them to "remove the evil” that resided within their masculine students and replace it with a feminine virtue, conduct and character more appropriate to republicanism and good citizenship, the converse being likewise true, meaning that 'homo sapiens', by virtue of being 'more evolved' than their brutish and animalistic predecessors, must also be more feminine and/or feminized, insomuch as terms like 'civil', 'moral' and 'proper' have become modern euphemisms for the condition of being feminine.

Well, the opposite view is out there too. I spent many years as a fan of Dave Sim and his 300-issue "Cerebus" comic book. But Dave became convinced that feminism was literally the root of all evil. And he spoke in self-fulfilling rhetoric that equated anything bad with the feminine and anything good with the masculine.

It got really weird around 9/11, because on the one hand, Dave hated the terrorists as uncivilized. Yet he also had an affinity for Islam as humanity's last bulwark against encroaching feminism. Which, strangely enough, was an idea also implicit in George Bernard Shaw's "Man and Superman", when the protagonist flees the woman who wants to marry him by hiding in "Mohammedan" Spain.

Tacitus2 said...


The notion being that folks who actually have health care coverage at a clinic that will, you know, agree to see them won't use the obscenely high cost option of going to the ER where by law we have to see them. And by medicolegal tradition we have to test for everything hypothetically bad.

This may seem alien to you as a responsible citizen but a large percentage of ER patients are not there for emergencies, have no concern about what things cost and have no intention of paying anything out of their own pockets.

The costs are "shared". Shorthand version, it comes out of your pocket and mine. But when health care is a right and a non/ill defined one at that, we have no standards at all.

sorry. having a grumpy day.

trent shipley said...

What's wrong with the Hastert rule? Sure it's not very statesmanlike. But why, pray tell why, does that matter. Except for
occasionally playing chicken with the debt limit or shutting down the
government it seems to work very, very well for Republicans.

David Brin said...

Does anyone else use Yahoo/ATT email/webmail? Any way to change the default type face and size that always starts each email attempt? It has somehow gotten fixed at super-small!

David Brin said...

Yes trent, it is a perfect strategy, if your aim is to reduce american politics to the level of snotty girls choosing sides at a six year old's birthday party.

If, on the other hand, you look back across 200 years at important work that Congress has done to advance the nation -- creating interstate highways and NASA, or eliminating the over-regulatory CAB and ICC -- and you can imagine a great citizenry actually negotiating mature compromises and win-win improvements over time...

...then the Hastert rule is out and out treason.

Tacitus2 said...

noted he same thing last night with att/yahoo fonts. No reason for it. might just go away?

LarryHart said...


The notion being that folks who actually have health care coverage at a clinic that will, you know, agree to see them won't use the obscenely high cost option of going to the ER where by law we have to see them. And by medicolegal tradition we have to test for everything hypothetically bad.

This may seem alien to you as a responsible citizen but a large percentage of ER patients are not there for emergencies, have no concern about what things cost and have no intention of paying anything out of their own pockets.

I get that. What I don't get is what it has to do with Obamacare. Didn't you have to accomodate those deadbeat patients even in the pre-Obamacare system?

If the patients still aren't going to non-emergency doctors or clinics, it may be that Obamacare isn't doing what it's supposed to, but you're going beyond that. You're saying that because of Obamacare, you're getting more people in the ER than you did before. And I'm wondering how that happens.

Robert said...

Simple. Since they now have some form of insurance, they are more likely to go to the hospital because it's paid for to some extent. They would avoid going to the doctor or hospital before unless they had no choice or were already so in debt it wouldn't matter.

So you have more people going earlier because of insurance. Sadly, they haven't thought of going to the doctor's... or tried to set up an appointment, found it's going to be a week or more before they can be seen, and go to the emergency room instead because it's faster and easier.

Rob H.

Duncan Cairncross said...

Hi Robert

Your explanation is a tiny bit tortuous
I would be surprised if any significant percentage (even of Americans) thought that way

If I have not been able to afford something and then suddenly I can I would be very aware of how to use my new facility

Anonymous said...

If people are going because they have insurance, they're still getting billed by their insurance for the visit. It may take them some time (and education by their insurance companies) to adjust to the alternative options, but no insurance I'm aware of covers ER visits for free (although some do waive the cost if you're admitted), and they generally have doctor visits and urgent care visits at a far cheaper copay.

Also keep in mind that part of the reduction in ER visits is going to be of a more long term nature, as people are more likely to take advantage of preventative care and get better care for chronic conditions which previously would lead to more hospital visits (diabetes and asthma being 2 of the more common examples).

I did some looking for trends in actual statistical data on ER visits, but the most recent year I can find data for is 2010 so it may be a few years before we have detailed data.

LarryHart said...

Tactitus is relaying first-hand experience, and I have no reason to think he's lying. So I'm not trying to prove that what he says about ER patients who don't really belong there is wrong.

I'm only questioning whether that is a consequence of Obamacare or if it is just something Obamacare failed to fix. And if the former, I'd really like an explanation of the cause and effect.

Tacitus2 said...


This is mostly in the category of things not fixed....that were supposed to be a way to "bend the cost curve downward". In part it is a practical issue. You issue someone a card and tell them they now are insured. Yay! But then they try and get a clinic appointment and are told see ya next week. (and some clinics are not at all good about seeing difficult patients in any convenient time frame). So the patients say, heck with that I am going to the ER to have my pain for the last year looked at.

And it is partly expectations. If health care is a "right" then ever the impatient Americans it is an absolute right and "right" now. Promise people something and they expect it. With gold level benefit package please. And usually without the "please".

Another example. I work at a local free clinic. Over the years it has evolved into more or less a "fill my prescriptions" destination. Not much complicated diagnosis and management. Well, in the last six months demand for free clinic spots has declined considerably. Good news! This probably does reflect fewer uninsured patients. And I do mean that, it is a good thing. But think about it. It is a cohort of patients who were receiving free medical care and brand name prescriptions. Now they are getting the same thing and most assuredly a lot more diagnostic testing and so forth at a cost to the system.

The ACA really did nothing to stem that other bugaboo of health care expense, prescription drug costs. There seems to be little pressure to go generic anywhere in the system.

My primary point was that it is early days, you won't know what things are really going to cost for a while yet. Costs will go up. I don't know how much. Probably a lot.

Is care going to be better? I don't know that either. But you see why the VA system is a worry to folks. Big system, major access problems. Not much transparency.


Robert said...

Duncan, I have in the past called to make a doctor's appointment because I'm sick. Inevitably I am not able to see the doctor for a couple of days - usually longer as it's near even odds you'll get sick on a Thursday to Saturday, and even if you were to luck out with a two-day wait, if it lands on a Saturday or Sunday you're not going to see the Doctor until Monday.

So someone gets sick, finds out they won't be able to see the doctor for four days. Are they going to suffer for four days? Or are they going to go to the Emergency Room?

(And given that the flu often has a life cycle of under a week unless it's a nasty strain, you're often feeling better by the time you see the doctor. So it's a wasted visit anyway outside of getting a note from the doctor saying "he might have been sick but he's better now so his sick days were valid.")

And think of it this way. When do you inevitably crack a tooth or lose a filling? Is it on a Monday or Tuesday? Or is it always at the end of the week or on a weekend and you have to suffer for days before you can see the dentist?

This is why people go to the emergency room instead of the doctor or dentist. Because they don't want to wait.

Rob H.

Alex Tolley said...

@Tacitus2 There seems to be little pressure to go generic anywhere in the system.

You may Rx brands, but fulfillment in pharmacies is very definitely generic. I suspect that there is also a profit motive too.

On the general point of ER use. Yes, ER use does not seem to have diminished. But is it for the reasons you state. More likely it is just ingrained behavior. Has the ACA, or rather the insurance carriers, done much to re-educate the newly insured? I tend to think Robert and Anonymous have the more correct interpretation.

What I dislike is the presumed case that the previously uninsured are increasing hospital use and driving up H/C costs. There is no evidence for that. The bulk of H/C costs are for the elderly, and they are covered Medicare. Hospitals are going to see their ability to try to charge full freight to the uninsured (or well over real costs) diminished because most patients are insured. Insures tend to make seeing the appropriate specialist more difficult to see costs down on their side, which reduces specialist income. Our local hospital ER physicians have clearly been told to try to get patients in for overnight stays for billing. I was almost threatened that I needed to do this rather discharge myself. This most likely was to bring in more revenue - the inevitable result of the financialization of H/C.

Anonymous said...

And a drunkard's walk of responses...

Transportation infrastructure?

The rails were abandoned in favor of trucks and roads. Then the rails were dug up to make way for many miles of bike paths that aren't used between cities. Then everyone wanted light rail, but not near them, and there was no place to put it because they'd have to dig up the bike trails!

As far as roads are concerned, it's entirely possible to build a road that lasts for 40 years or more. According to an expert friend of mine (retired now, but used to give lectures at concrete conventions), there's a half mile of road actually built to spec in my area. It's lasted 40 years. But it costs more, so the politicians will never insist on it. And the guys who build roads don't want roads that last 40 years, because they make more money rebuilding every 10. And no one wants to hear about the lost productivity the general populace suffers when the roads are under construction.

Airlines? TSA, 'nuff said.

Nerds: The Salon article has the broad strokes correct. Those puny non-athletic weaklings are now billionaires. And nothing invites imitation like success. And I don't doubt that like all imitation, some imitate the form and not the function. But having some nerds at the top of the popular culture heap beats the hell out of getting beat up because you get good scores in science and math.

In politics, you always co-opt what's working. I'm still not sold on the long-term affect of the ACA, as I can't recall any instance where regulating the middle-man actually solved the problem, but it's certainly masking some of the symptoms. It's not my solution of choice, but it better than the nothing there was before.

Thugs: My vote is that they want to be the thugs. Or at least enough of them do that they're willing to put in the effort to get the rest to forget those 6000 years. It would fit a historical pattern, wouldn't it?

I am amused and horrified at the idea of the Tea Party as a new Confederacy.

Tacitus2 said...

Alex, I really wonder just how much effort hospitals really expend in trying to collect "full freight" from the uninsured. It is a low yield proposition that generates bad PR. I know in an anecdotal sense that they are pretty ready to make deals.

Ah, health care financing. It has famously been said that you can make health care cheap, high tech or speedy, but you only can have two out of three. Generations of political non leadership has refused to make the choices. And btw by even mentioning the high costs of caring for the elderly you are clearly a beast who wants to let my grandmother die in a cold dark alley. (kidding of course).
My gripe with the ACA is that it was sold dishonestly. It promised to make the Triad possible. Cheap, high tech, right now...but without making the hard choices. Instead we got cosmetic change and a blank check for whatever it ends up costing, with the real tab not being clear until some future administration has to face it. And of course once a gigantic government program is well entrenched it is difficult to change and nigh impossible to eliminate.
The current administration did not negotiate with the citizenry in an honest fashion.
I say this as a (mostly) conservative who feels the only real solution for our health care woes would/will be a radical change in the system.
But we instead have a huge, creaky, poorly understood machine that is notoriously vulnerable to abuse and cronyism.
Hey, it appears I will personally be shopping the ACA exchanges in the next couple of months. I will post dispatches from the front from time to time!

Tacitus2 said...

Regards the microfont on ATT/Yahoo mail, I solved it on my system. I suspect you are blocking cookies. Generally a good plan. But go to manage cookie blocking and permit att to use a third party cookie. This lets you save whatever font size you select.
Hopefully this is not a hideous idea for some other reason but so far, so good.

locumranch said...

Tacitus' assessment about the US healthcare system coincides with mine -- it's been over-burdened for years -- but what he doesn't tell you is the ACA just exacerbates this problem by driving up demand without increasing supply.

Due to declining reimbursement & an ever increasing productivity requirement, I closed my private medical practice about 10 years ago in favour of an hourly wage, many of my friends have followed suit, and it's the best career decision we've ever made.

Our decision to opt-out of primary care has only worsened the patient access problems in my area as the average wait for a non-emergent patient visit is 6 weeks & none of the remaining private practices (my area, again) are accepting new patients, but most patients just go to the nearest ER for their routine care now which means more job security for me.

That said, things will get much worse over the next 5 years as more baby boomers retire AND close to 35% of all licensed US doctors & nurses (baby boomers, also) plan on joining them IF they can afford to, assuming that their 401K's maintain their current value. I hope to join them, too, which means it will be a wonderful time to be a (mercenary) doctor but a lousy time to be a patient, at least until the entire system collapses under its own weight.

And, even though the ACA quick-fix has fixed nothing, we can't really blame Obama for this. After years of denial, as our many bills come due, we can only blame ourselves. We've overbuilt our infrastructure despite economic regression, our schools despite a declining primary student population, and our social safety net despite a shrinking social 'buy in', just as we've over-fished our oceans, leaving us with only one fiduciary option:



Tacitus2 said...

locumranch is substantially correct. And if there is something I am "not telling you" it is only because I am just getting warmed up.

The law of unintended consequences. It bites at all of us but I wonder if it sinks the fangs into progressives a little more. Conservatives tend to go with what has worked (or in the case of health care at least limped along). Progressives seem more inclined to Leap Forward. Into the void sometimes.

Two more examples, with lots more to go. Another reason for lack of primary care access is the laudable goal of chronic disease management. If we could only control hypertension and diabetes better, the cost curve will bend downward. Well, what that translates to is an extra slice of reimbursement for clinics that can show better numbers. If you have a cohort of patients and can demonstrate a 5% improvement in BP or diabetes control, you get more money.

So of course primary care appointments are largely devoted to that goal. Acute illness....see you in two weeks. Difficult patients, folks who miss appointments, etc...sorry, no appointments available at all.

Another point. Remember when electronic medical record systems would save us all a pile of health care money? Well, not so much. They are largely configured to maximize billing. Add enough data points even if extraneous ones and you get to "upcode". (to be fair there are some advantages and hypothetical cost savings but that is another topic).

ACA has not fixed our health care system. And we have not seen the bill yet.


Alex Tolley said...

@Tacitus2, locumranch

I grew up in the UK with the NHS. For all its failings, everyone could get treatment, and no-one ever even had an inkling that H/C could bankrupt you. The US has a private system (still) with social medicine for the elderly and the very poor. The latter is never really gauranteed due to state legislators. I would prefer a "Medicare for all" system with private insurance to help with electives and extreme care. This sort of system seems to work globally, at 1/2 the relative US cost and with similar to better outcomes. We know why that didn't happen in the US.
As conservatives, what system would you prefer?

It is also important to understand who pays. Saying the ACA costs more when the older stystem just pushed costs onto the patient (insured or not) or simply failed to treat, is not a good argument, IMO.

Yes, the shortage of physicians, especially primary care is a problem. In my area (semi-rural) the best GPs are generally older, although the best GP I ever had (in any country) was a younger woman when I lived in Silicon valley. I just wish I could find the like of her again where I live. I really don't know whether the shortage is due to impossible cost constraints (I doubt it) or artificial shortages from Med schools. What is clear to me is that specialists are the preferred form of practice and they offer more opportunities to milk the insurance companies by self-dealing. I am well aware that teh decision making of teh GP is being taken away by the insurers, which is a shame. But they have teh best data on treatments and outcomes, so I do not entirely begrudge them their increasing control.

Given the high cost of US H/C, it is no wonder this country leads the world in finding ways to reduce costs - from greater use of nurses to treat, avoiding expensive ERs with emergency clinics, to medical tourism. IMO, we would be better off giving med students free education, but reducing expectations of making fortunes from medical practice. Hospitals need to be run as community service providers, and run by physicians who care about H/C as a service. Professional management should be got rid of. Funding would be from the government, and I would prefer that hospitals ran as non-profits to keep to their mission.

Big Pharma - well we know the issues there. Political influence pays off in the US. I used to be in that business, but it is clear that any pleading that they need huge profits for research is just pretense. Federal funding of Rx with strong negociating powers would go a long way to keeping drug prices down, keeping expensive me-toos off the market and forcing a focus on truly innovative drugs (anti-biotics, anyone?). The FDA could help by revising their rules for drug trials, and the government might [partially] fund them too. Given how much primary medical reserach is university based, there is an argument for ensuring that pharma profits not be allowed to be super-normal, and that new drugs should be useful, not targeted at chronic and "life style diseases". The nedical equipment companies seem to be following suit, but are still a few decades behind the Big Pharma curve.

thrig said...

Back up a step or two, and the 'burn all the carbon' Republicans look mighty the same as the 'burn all the carbon' Democrats. Alas, with affordable oil busy pricing itself out of the market, the roads must naturally fall into a 'bluff, fold, or pay me my money down' state. I'm anticipating much in the way of bluff and fold, as road repair at $100+ a barrel will be a skosh more expensive than when carbon was priced a little lower back in the 50s and 60s. I also doubt that Roman-style slave labour is in the cards. The Romans did build better roads, though. Given the ~75 year lifespan of our concrete, most of that hurt is yet to come, good fun!

In related news, the Seattle roads are in hilarious disrepair, and they are shedding bus service hours like a dog does its winter coat. This will doubtless make things worse for the car drivers who from where I walk look like they already spend ludicrously large amounts of money for the chance to be stuck between all those other car drivers. Not a healthy sign, but then I'm sure something will come along that will magically repair all those roads, and then y'all can go back to growing out your suburbs. Amen.

David Brin said...

Tacitus, the ironies abound. Very few of us non-conservatives (pretty much the only way to describe me, as I have many libertarian/liberal/weird views) actually LIKE “Obamacare.” It is a cludge that was designed from the start with one TOP goal of benefiting insurance companies and drug makers, with the secondary aim of insuring more people and reducing cost spirals. It appears to be accomplishing all of that…

… and it remains an awful approach to dealing with a commodity that is inherently non-fungible and not subject to market forces. Most sane folks look at Canada and say “why can’t we just try that?”
The VA is “socialized” medicine. Only dig this. ALL of the complaints about the VA consist of it being under-funded to hire enough doctors to meet demand. Almost ZERO complaints about the actual care vets receive, which is generally rated very highly, both in quality and efficiency. The solution? Allocate funds to hire… more…. doctors.

“My gripe with the ACA is that it was sold dishonestly.” Whaaaaaaaa? Obama offers up the GOP’s own… damn… plan… and suddenly it has cooooooties! Are you kidding me? ANY perceived flaw in the ACA could have been targeted by the GOP and negotiated. BHO was desperate to find anyone at all in the republican plan to talk to about pragmatic matters and was met by blanket screams of “communism!” re their… own… damn… plan.

Tacitus adds: “The current administration did not negotiate with the citizenry in an honest fashion.”

Sorry… time to get rude. That is utter utter utter bullshit, diametrically opposite to truth, and moreover you know it to be so.

The irony that dems implemented a deeply flawed REPUBLICAN plan because it was the only way to improve a truly horrific status quo… and for republicans to then screeech at their own… damn… plan… is beyond anything credible in fiction. For republicans, who gave us Medicare Part D and insisted the ACA come with zero ability to negotiate drug costs, to then complain about drug costs, is hypocrisy exponentiated.

“Then the rails were dug up to make way for many miles of bike paths…” Um… yeah. I grew up in LA where the commuter Red Car rails were ripped up at command of GM and Standard Oil. But we can’t look to oligarchs as being at fault! Never! Let’s blame… hippies!!!! Yipee we found a narrative to protect our side’s oligarch lords!

Tacitus2 said...

David you have picked a bad day to "get rude" with me, but in the interests of civil discussion, is the Republican plan of which you speak the 2006 Mitt Romney Massachusetts experience or something else?


who does not appreciate being called something very close to a liar. I have other places in which I could choose to spend my time on this mortal coil....

David Brin said...

Tacitus I am sorry to get flamey. But seriously, we have seen political discourse in America reduced to exactly that, and I do not appreciate being fed the fox line that the side that keeps saying "let's negotiate" is responsible...

...and the side that has a Hastert Rule proclaiming openly "we will never, ever negotiate, even over our own... damn... plan..." is somehow the white hats in all this.

Robert said...

Maybe, just maybe, Democrats should have taken a second pass. If Obamacare had failed in Congress... would Republicans have had as strong a case to take as many districts? If when they saw how overwhelmingly against Obamacare not only Republicans but the general public had become, Democrats could have said "nevermind" and we might have seen less turnover on the State level, less redrawing of districts for massive gerrymandering for Republicans, and a more balanced House.

Republicans are guilty of a multitude of sins. I despite them to the point I will not vote Republican except on the local level (primarily because you don't find too many Libertarian candidates, sadly enough). But that does not mean I should hold my nose and vote Democrat. It says they should be held to a higher standard. Democrats should elect Democrats who sign contracts not to cheat on their spouses, not to lie, and basically to uphold a code of ethics that most Americans would probably fail to uphold under normal circumstances - but that Democrats SHOULD uphold to show they are better than Republicans.

That they didn't shows Democrats are the same as Republicans with the exception that their chap is in office right now. And I know right well that the moment the Republicans regain the White House, Democrats will become so obstructionist that it will be like watching the Republicans all over again.

There is a way out. Because if the Democrats go with that Code of Ethics and uphold it... then they can hold that over the heads of Republicans. "Why don't you all sign a Code of Ethics Contract as well? Or do you feel you can't hold yourself up to a higher standard?"

Those Republicans that refused to sign would be out of office in the next election.

Rob H.

Tacitus2 said...

a less than fulsome apology but I will accept. Now, to repeat myself, is this Republican Plan of which you speak the Massachusetts 2006 plan? If so we can continue with what I was finding an enjoyable discussion. Robert in particular can give us some good insights on his home state.

Tacitus2 said...

Oh, and a primer in case the Daily/Colbert folks call again.



Robert said...

I would not rely on me as a source concerning Romneycare. When it was enacted I was in New Hampshire. When I was living in NH and working in Massachusetts I had a company-derived health insurance and didn't bother looking for a new one. And when I moved back to Mass. I didn't bother to change things at all.

The only thing you would get from me is grousing at the Leftists in power, the inability of Republicans to get their act together, and the stupidity of voters who accepted a referendum allowing the sales tax to remain high after fearmongering from Democratic politicians.

Rob H.

Rob Perkins said...

Tacitus -- I can already point to a reduction in premiums of 18% with a balance on the remaining costs, due to the ACA. In fact, the ACA has imparted my family of seven over $6000 of cost reduction for the year so far, along with the assurance of a specific out of pocket maximum smaller than any of previous few years.

We have been on the individual insurance market for 15 years now; this is the first year overall costs have gone down, and it isn't even a policy bought through the health care exchanges.

I can't remember where you do your ER work, but I have to ask whether it's in a state which took the Medicaid expansion, or whether there are enough primary care and urgent care clinics close to the poor of your area who will take them in.

Alex Tolley said...

It is hard to argue that the public disapproves of the ACA. Here is a chart of historical Kaiser polsl.

And this is with the right wing drumbeat of the ACA has failed meme.

David Brin said...

Tacitus thanks for your patience. Though the roots of Obamacare include not just Romneycare but also Gingrichcare, and the PLATFORM health plan of the GOP all across the Clinton Administration. All of those were — if you squint slightly — almost identical to the ACA. Close enough that there is no excuse for disowning their… own… damn… plan… just because BHO gave it cooties.

Robert, we should face the fact that democrats span the spectrum of “normal” politics, which means many are flawed and some are corrupt. That is different than pervasive and uniformly rabid insanity. Please be careful not to let anecdotes mask statistics. Fox will happily supply anecdotes on this or that democrat… though seldom offer any dirt on any WOMAN democrat… except Pelosi.

“” You claim to “know” this. But it isn’t true. Republican presidents get budgets and appropriations bills passed by democratic congresses. They submit legislation that those congresses deliberate and sometimes pass. Show me one year, ever, when there weren’t congressional dems negotiating with a gopper prez.

In contrast, there is ONLY one year in the last thirty when a GOP congress has negotiated with a dem prez. One year. 1995, when Gingrich committed the cardinal sin of violating the Hastert Rule and we got both Welfare Reform and the Budget Act.

David Brin said...

BTW re the Daily Show, I have noticed a drop in the number of top conservatives coming on to talk to Stewart. He used to have them on all the time... and they came gladly to hawk their books! Which shows something about Stewart's audience. Despite being liberal, they are polite to guests (as Stewart is) and enough of them then BUY the books (!!) to make the appearance worthwhile.

This is diametrically opposite to Fox, in all ways, where ONLY O'Reilly ever has on guests of stature to challenge him.

But yes, I have noticed fewer top conservatives coming on TDS lately. Has some sort of "word" gone out?

Alex Tolley said...

@Robert . If Obamacare had failed in Congress... would Republicans have had as strong a case to take as many districts? If when they saw how overwhelmingly against Obamacare not only Republicans but the general public had become, Democrats could have said "nevermind" and we might have seen less turnover on the State level, less redrawing of districts for massive gerrymandering for Republicans, and a more balanced House.

Then what is the point of being in power if you cannot legislate? This seems to be a counsel for doing nothing just to "control" a do nothing congress. back in the late 1980's, when H/C reform was on the table and sunk by the antipathy towards "Hillarycare", Paul Wellstone put together a serious teach-in with a panel of the public and various experts pitching their approaches. The panel overwhelmingly ended up preferring the Canadian model, the same model that many Republicans have been brainwashed to deride as awful. I had only a brief flirt with the Canadian system when I was a student there in the mid-1970's and it seemed fine to me - like an uprated UK NHS (anecdotal evidence only).

Robert said...

My point is this: you cannot expect to undo everything that is wrong with society and the nation in one fell swoop. The more you try, the more offense grows. Obamacare killed the chances of Democrats in the House.

Let's consider for a moment if they had tried for something else. Let's say they went for Immigration Reform. Democrats pushed through legislation allowing Illegals to become citizens after paying back taxes and fines. Those who were lawbreakers (outside of being here illegally) would be sent home.

The end result? Republicans would have howled bloody murder. They would have said "with such high unemployment you allow all these immigrants in!" They probably would have won the House. For a couple years.

Then as more and more immigrants got in and started creating jobs, you'd see more job growth (because immigrants create jobs and bring in capital). The economy would have improved at a faster rate. And more and more immigrants would have voted for Democrats because Republicans are dead set against them... but Democrats lost their majority in the House for immigration reform.

If Obama had pushed immigration reform first, then in 2012 the House majority would have declined more significantly. And Republicans would be seeing the writing on the wall. They'd start negotiating because if they didn't they KNOW they'd lose House Seats because all the anti-immigrant rhetoric, combined with an increased number of immigrants, would destroy the balance of power that benefited Republicans.

Worse, Democrats would be bringing up stories similar to Elon Musk, an immigrant who created two companies that hired hundreds of people and fostered innovation. We'd be seeing other Elon Musks in immigrant groups. And they'd be job creators unlike rich people keeping every cent of their tax breaks.

Democrats pushed Obamacare because Hillary failed to during the Clinton Years. They didn't want another failure like Hillarycare hanging over their heads. But they should have. Because with decent immigration reform the Democrats would be looking good.

They squandered their chance. I blame Ted Kennedy. They wanted to pass healthcare reform on Kennedy's watch. And they failed. And as a result they got this monstrosity that Republicans will keep in place but constantly say "look at what's wrong with this!" as an excuse why Democrats cannot be trusted.

Rob H.

locumranch said...

Politics don't seem to play as big a role in US healthcare as some people think.

As a medical student in Chicago, I saw EMTALA close almost 50% of the ERs in Chicago under Reagan. Then, in the 1990's, I saw similar cuts under Clinton as many of the same hospitals reduced capacity (cut their bed counts) by almost the same percentage.

What matters most in US healthcare, IMO, is the corporate model of pairing liabilities to assets, debts to income and productivity to overhead, even though this model only 'booms' during periods of non-sustainable economic expansion and goes 'bust' shortly thereafter.

It's as if the whole of Western Culture, from governance to transportation to food, energy, healthcare & CO2, has remade itself in the image of Crispy Creme Donuts, and the bust, she is a-coming, with tactical bankruptcy being our only reorganizational option.


David Brin said...

Fox News regular Ann Coulter wants to drown voters who might be inclined to support a Libertarian candidate for the U.S. Senate. Here’s what she wrote in a recent column: “If you are considering voting for the Libertarian candidate in any Senate election, please send me your name and address so I can track you down and drown you.”


I spoke at Freedom Fest a few months ago and was appalled by the pervasive reflex that libertarians MUST be some deviant, mad-cousin version of republicans who will come back, like prodigal sons, come election day. Almost no one (other that me) pointed out that the GOP betrays EVERY libertarian principal, top to bottom, (though giving lip service to a couple. While the dems disagree with at-most a third of sane libertarian ideas. Especially if libertarians return to wanting competitive markets... and break away from the Fox-preached adoration of oligarchy.

So long as monsters like Coulter represent not a fringe but the mainstream CORE of the New Confederacy, there is but one hope for the party of Lincoln and Ike and even Reagan...

... to be crushed into exile and re-evaluate whether they really want to be the party that hates science and the future.

Jumper said...

I learn from Tacitus so keep it coming please, sir.

Re. Daily Show, it's changed. He's coasting. And friction slows anything coasting.

Re. libertarians, they are half crazy. So are Democrats. Republicans aren't political, so their non-crazy side doesn't show up in politics much. My Republican brother knows nothing about public policy, but he practices medicine. His political thinking is on the level of Clive Cussler.

Alex Tolley said...

What the right wing hears about the ACA. Ezra Klein: In Conservative Media, Obamacare Is a Disaster. In the Real World, It’s Working

LarryHart said...


Ah, health care financing. It has famously been said that you can make health care cheap, high tech or speedy, but you only can have two out of three.

That's true of anything.

In the more general case, the saying is you can have quality, speed, or low-cost, but you can't have all three because it's kinda like conservation of matter and energy. Improving one of those things happens only at the expense of the others.

LarryHart said...


in the interests of civil discussion, is the Republican plan of which you speak the 2006 Mitt Romney Massachusetts experience or something else?

I'm pretty sure he means that Obamacare, which Mitt Romney implemented in Massachusetts, was essentially the Heritage Foundation's response to Hillarycare back in 1993.

Tacitus2 said...

I am not conversant with the Heritage plan but suspect that anything from 1993 would be pretty dated. Of course certain ideas will be constants.

Regards Mitt Romney and Massachusetts. I rather like Mitt. It takes some valuable personal qualities to be a Republican gov in a deep blue state. This would have served him well had he been elected President. I wonder if Presidential aspirations were not on his mind when he, roughly at the same time as the D legislature, proposed a state wide plan that does indeed share many features with the ACA.

The plan was bipartisan in its origins. It was signed by Romney after he vetoed 8 parts of it. All 8 vetoes were over ridden.

So I think it would be more fair to call it a bipartisan plan rather than a Republican one.

As to whether it "works" there is ongoing discussion on that. Lower percentage of uninsured, no change on ER use, costs hard to say as the big recession hit right after it was enacted in 08.

My point at the beginning of the thread was that it was too soon to tell how ACA will shake out. Heck, we don't have the full book on Massachusetts yet. And there are reasons to doubt whether it can be scaled up to a nation wide plan. Fun fact, Mass has more doctors per capita than any other US state (462/100K) but DC has 799!

More in a minute


Tacitus2 said...

Regards bipartisan health plans I rather liked the Baucus plan. It was negotiated by some solid members of both parties (Snow, Grassely and Enzi on the R side). And it was honest. Too damn honest I guess as it was given polite nicey talk by Obama then dropped when the rest of the country did not like what they heard. (i.e. Truth). Unions hated the "Cadillac tax". Republicans hated an Individual Mandate that actually had some fangs in it.

So that frittered away a lot of time. When Scott Brown won his remarkable victory in....by God!...Massachusetts, Obama should have taken that message to heart. And maybe he actually did but came to the wrong conclusions. Instead of an honest plan with some degree of transparancy we got a Beijing phone book of stuff that has to be carried along with various executive orders. I still don't know to what extent "risk corridors" are keeping the financial outlook appearing viable.

In response to a prior question I live in Wisconsin. Rumored increase of 3% in ACA plans. That would be nice, but I have not seen any details.

Regards health care reform I am more radical than conservative. I would favor something like the Baucus plan. Selling the harsh reality of it, larger individual mandate fees, medical device taxes, etc. would be beyond my political skills. As it was beyond Obama's.

Show me some system by which real evidence based medicine factors into what gets paid for. Lets have a bit of malpractice reform please. And as I have said more than once here, any health care reform that does not cut my income by 25% is probably hogwash.

(and btw I would be fine with that, but if it is necessary to cut specialists more and primary care less or even give 'em a raise, well, OK)


Tacitus2 said...

And while I am at the keyboard, a brief word on the middle east.

It is little noted in the US press but there is a wider front in this conflict. Last week Australia arrested a bunch of folks alleged to be preparing to abduct and decapitate someone in support of IS. A couple of days ago a Frenchman in Algeria was captured then beheaded in the usual fashion.

This is asymmetric warfare at its most extreme. If carried on with fanaticism, which seems likely, Westerners will stay away from the entire region. Egypt, Pakistan, in theory even Turkey, Israel, Indonesia, Philippines. Any place where a few madmen have a video camera and a knife. The world may not want American Marines on their soil but this would also bar aid workers, tourists, businessmen. I can think of no greater weapon to reduce Western influence in the world.

It is a demonic strategy.

who is more supportive of the Administration in matters of War and Peace.

raito said...

“Then the rails were dug up to make way for many miles of bike paths…”

Perhaps it would have been better if I said, 'and made way'. Certainly big oil had something to do with the shift to trucking from rail (though there were other factors, too). I truly did not intend to make is sound as though people pushing for more bike paths caused the rails to get torn up.

But around here, there's no denying that the old rail corridors are being grabbed by the yuppies (they aren't hippies any more) for bike paths, etc. The old downtown railyard has been made into a park.

But now that those railroad right-of-ways have been put to alternate use, it'll be damned near impossible to make them back into railroads of any sort, including the mantra of 'light rail', if anyone ever wises up and realizes (again) that its a pretty fuel efficient way to move things around, and has enough political oomph to get it done.

Rob Perkins said...

Tacitus, I wouldn't expect ER use rates to change in Wisconsin; Medicaid wasn't expanded, those between abject poverty and a health plan still have nowhere else to go.

Medicaid enrollment around here has ballooned so much that the largest urgent care provider recently announced that it would add no more Medicaid patients. Meanwhile, companies like ZoomCare are beginning to fill in the gaps.

I like ZoomCare. They tell you the price of things before putting you on a scale.

Tacitus2 said...

Wisconsin already had a quite functional program called Badger Care that was aimed at the in between folks. Although I don't doubt that old fashioned politics went into turning down the medicare expansion, this was only part of a complex puzzle.
As I mentioned, Massachusetts who went a different route and had quite a bit more "health care capacity" has also not impacted ER use.

Jonathan S. said...

Meanwhile, Washington accepted the Medicare expansion. As a result, I qualified for "AppleCare" (as it's called here), and will be going in soon for the PSA test that I should have gotten years ago (given the number of relatives who've died of cancer, including my father).

Without the evil Obamacare, I wouldn't get that at all, as I appear to be unemployable. (I suspect the root of the issue is high-functioning autism, but I haven't found anyone who takes AppleCare that's willing to touch neurological or psychological diagnoses with a ten-meter cattle prod.)

I can't testify as to its effectiveness in emptying ERs, as I haven't been to one since I fell and broke my arm a few years back. (I still owe over ten thousand dollars in costs incurred then, with no idea how I'm ever to pay it off when I can't get a job and don;t seem to qualify for any form of disability.)

On another note, the reason we can't have a Canadian-style system is the same reason the roads around here (as noted earlier) are in such poor repair - because nobody wants to have to pay taxes. Washington used to have fine roads, and a fleet of well-maintained ferries to carry passengers across Puget Sound - until a fellow named Tim Eyman became irate over how much Motor Vehicle Excise Tax (MVET) he'd have to pay on his two brand-new Mercedes SUVs, and founded a "grass-roots" (actually astroturf) movement to repeal it. Then another to require any increase in taxes to be approved by a supermajority of legislators and/or voters. Then a lawsuit to classify all fees charged by state agencies (including cafeteria prices at the University of Washington) as "taxes" for the purposes of the above act. Then... well, you get the gist. Taxes went way down.

Guess what pays for infrastructure maintenance and improvement? Hint: it ain't the asphalt fairy, folks.

If we can't get folks to shell out a few bucks on car tabs (the price actually went up for poor folks, as their old heaps were charged as much as Eyman's SUVs) to maintain roads, or an extra, say, $12 per year for school levies (because the state's running short on tax money for education, too), how are we ever going to get them to consent to the tax levels required for a single-payer health system?

Canadians don't seem to have a problem thinking of taxes as their membership dues in a civilization, but that's not a common attitude in the States.

atomsmith said...

> BHO gave it cooties

Stealing that. What a meme!

Tacitus2 said...


To go off politics momentarily, PSA testing is a matter that demands close consideration. Do your research. Age, family history, years (hopefully many) of projected lifespan...all factor in. Be prepared to consider what you will do with elevated, normal and borderline results. It is a tool, not a crystal ball.

At 56, albeit with a negative family history. I said no thanks.

You mileage may vary.


David Brin said...

Jonathan S... good luck!

Tacitus, as I said, I do not particularly like Obamacare, which is a cludge and only an improvement compared to the catastrophic non-“system” we had before it. Its version in Mass was enacted because the dems there figured: “how can they say no to their own.. damn… plan?” And that logic worked! With Romney.

BHO’s mistake? To think it would work in A-Murdoch-a. Please dig it. I am not enraged by folks like you pointing out that the ACA’s results so far have been just tepidly positive in some ways (while very good, in others.) Fine. Quibble away. We’ll see. As I said, the ACA ain’t MY bill… it’s a republican one.
(From ancient days when republicans proposed anything, at all.)

No, what angers me… and should offend any sane person… is the volcanic fury that Fox-riled up in A-Murdoch-a, demolishing American political life, over what now is very clearly at least a 60% positive tweak of our commercial-competitive insurance system, with some flaws that should have been negotiated-over… and that STILL might be negotiated-over, if the screeching ever stopped.

As for E-room visits, sorry. The onus is now on YOU to talk your patients - now that they have insurance - into not coming back to the E-room, next time. Many of them are creatures of habit… like folks who vote republican. But they can change.

Gator said...

Somehow every other industrialized nation manages to provide health insurance to residents with much less cost. Yes Obamacare is not great, but what we had was worse. We can do better, and that better will look more like the EU, Switzerland or Canada.

David Brin said...


locumranch said...

'As for E-room visits, sorry. The onus is now on YOU to talk your patients - now that they have insurance - into not coming back to the E-room, next time'

Tacitus, forgive them; for they know not what they do, so speakth a man who has lost more than one ER job for doing exactly what they propose.


Jonathan S. said...

Age 51. Father died in his late 60s of pancreatic cancer, so that's kind of an area of concern for me...

Naum said...

Regarding TDS and Tacitus2 link to McArdle article advising conservatives not to appear and David's remark about guests and their books -- these are 2 distinct matters -- McArdle writes about the "senior correspondent (comedian) bits" where the interview footage is chopped and diced, and indeed, often composed to solely illicit a laugh, from an audience that indeed possesses liberal allegiances.

OTOH, when the guest appears in the chair to hawk their book, Stewart is always respectful, and I'm sure that the guest, no matter the ideological leanings, enjoys a big boost in book sales, as the guest's book is prominently featured and plugged by Stewart. Though, in looking at recent guest list for the show, David is correct that there haven't been a lot of conservatives, recently, though going back last few years, lots of conservatives have appeared as "honored" guests.

Agree that Stewart has been "coasting" of late. Sad that Colbert show has eclipsed (it is my all-time favorite TV program, and on some nights, makes me laugh so hard), but Colbert departing and that character to be put to rest (though I hope he pulls it for bits but all likeliness, it will be as tame, neutered and milquetoast as Jimmy Fallon & Tonight show).

Randy Winn said...

About Emergency Departments and Obamacare:

The experience at Seattle's Harborview is that they have about as much business as usual, but but now it is being paid for.

"Last year alone, Harborview provided $219 million in so-called “charity” care... Harborview expects to spend $73 million on charity care in 2014".

No doubt some of that improvement comes from taxpayer money providing from insurance premium subsidies, but the rest of it is wages or other income passed through an insurer. It might have been more efficient simply to bypass the middleman ("single payer"), but that's not the American way; we apparently prefer to let insurance companies connect patients to medical care, presumably in the hopes that the market will encourage insurers to educate their customers in ways to cut expenses.

From tacitus' and locum's description, the relationship between hospital administration and those who provide actual care seems to be ... complex.

Anonymous said...

The powers that be seem to feel that the working class (middle class ) is too expensive. Removing insurance is seen as a way to cut wages. It's not about insurance. It's about removing an expense. As long as there is cheaper labor else ware wages will fall. The lower 80% of Americans are seen as excess to needs and will be disposed of.