Sunday, July 14, 2013
Bill Quick is a little slow on the uptake
Wiliam T. Quick, also known as Margaret Allan, is an elderly California science fiction novelist who is also "a gullible, credulous, junk-science guzzling idiot". That's what he called me anyway so I guess that I am entitled to return the compliment.
Bill has fallen for the popular fad of taking vitamin and mineral pills to improve his health. Epidemiologists have known for years that life-style changes, including "supplement" intake, give no improvement in longevity and may even shorten lifespans. But people want to believe that they can put something in their mouth that will improve their health so the practice will continue. The witch doctors of old did a good trade with their pills and potions too.
So I endeavoured to point out to Bill that it might be beneficial to his health to review his "supplement" habit. But he would have none of it. I immediately suspected that he was too old and set in his ways to change anything in his life but I persisted anyway. I sent him a whole bunch of links to epidemiological and experimental articles which found at least no benefit and sometimes harm from consuming "supplements". See here and here and here and here and here and here and here and here and here and here, for instance.
Bill is a libertarian/conservative blogger so I thought he might be interested in looking at the facts. But he showed no sign of having read any of the links and made only abusive replies -- culminating in the insult I have mentioned above. He would make a good Leftist. He seems a very angry man who "just knows" what the truth is and answers rational argument with abuse. But libertarians are a lot like Leftists sometimes so that may be it
Strange doings at the Gettysburg re-enactment
Barry Rubin is something of a hero of mine. When rubbish is printed about Israel it is often Rubin who replies, setting out the facts of the matter in reply to lies and distortions. It is an Augean task but he continues.
For some reason, however, he took part in the recent Gettysburg re-enactment, despite a lot of complaints from him about the inconvenience of it. I gather that the re-enactment was an interest of his son and he went along with it in the name of family solidarity -- a good Jewish value, I would think.
Anyway, the following is a little tale about it that he put up on Facebook:
Finally, before we leave the topic of Gettysburg, I have an exclusive for you--I have no idea where I would publish it--just on this Facebook. I hope you enjoy it.
We were sitting in the enlisted “fly,” the social area in the Federal headquarters camp at Gettysburg. We were all wearing period uniforms from the Civil War and keeping in historical era. Suddenly, the Captain, Willard Longnecker, walked up. “We have to mount an honor guard because the prime minister of Israel is about to visit the camp.”
“What?” I said. “That’s not possible.”
”That’s what they told me.”
“It can’t be. He’s not even in the country!”
“Well that’s what the staff is saying.”
“If you are teasing me,” I told Willard, I’ll never let you forget it!” But he really did seem serious. Clearly, he himself believed it was true.
Since I and my son, the unit’s drummer boy, are Israeli of course that would be amazing. But it can’t be. We scrambled to the tent and put on our equipment: musket with fixed bayonet, canteen, cartridge box with the bullets and cap box with the mercury caps that set off the spark for firing. Our unit then got back fast and were positioned around the headquarters tent.
A few minutes later, a group came in, with bodyguards, families, and perhaps some journalists. Of course it wasn’t Bibi, who as I knew was in Jerusalem meeting Secretary of State John Kerry for the sixth time.
“Who is it?” I said in Hebrew to a woman.
“The ambassador, Michael Oren, and my husband, the military attaché.”
She seemed unsurprised that the Union sentry spoke Hebrew, which I thought delightful. Perhaps the entire Union Army did so and we were just keeping in character.
I asked, “Where are you from?”
“I’m from Tel Aviv.” Then she realized that she had come perhaps across the only Israelis among about 13,000 re-enactors there. She took my picture.
Then the general began his welcoming speech. “We are glad to welcome Israel’s prime minister to the camp…” Oren broke out in a grin but as a good diplomat issued no correction.
Two soldiers—Sergeant Ross and Private Joshua Withrow--then gave a demonstration of “loading in nine times,” the way a musket is fired. To be taken into the army you had to have your teeth, explained the colonel, to tear the cartridge.
The soldiers stand the musket on the ground, pull a cartridge out of the leather case on their belt, tear the paper that wraps the black powder with their teeth, and pour it down the barrel, they then put it under their right arm in position, cock the hammer back and fish out the cap to put it on the small nipple. Then they go to full cock along with the order ready, aim, fire. A bright flash and loud sound, followed by white smoke erupts.
The audience applauded and laughed.
“Now you try it,” said the colonel. The soldiers turned over their muskets to the real major general and ambassador. “Wait!” said the colonel. He ran the few steps to his tent and got an over-fancy officers’ hat with plumes and gold braid and put it on Oren’s head.
They actually did pretty well.
Then the (real IDF) general was handed a Henry cavalry semi-automatic carbine and fired off shot after shot like an old pro, smiling in delight.
Now, of course, privates are totally unimportant but I leaned over to an officer and asked if I could say hello to Oren since I knew him personally.
The officer nicely agreed quickly, though he told me to wait just before Oren’s party left, not knowing the protocol and figuring there was no harm in it.
So when he signaled I could step out of line I went over and introduced myself. Oren’s eyes opened wide and asked me to repeat who I was. My forage cap was pulled down low and I was, of course, wearing Civil War gear and carrying an 1862 Springfield musket.
Figuring out that it really was me, the ambassador threw his arms around me, said he reads my articles and several other nice things, and brought his family over to meet me. High-ranking officers in the Union or other armies are not pleased to be upstaged but were also partly baffled.
What are the odds?
My son, Daniel, was very pleased at noting that one of the embassy kids his age looked at him enviously.
You're Too 'Cynical'
The President rolls out another plan for 'smarter government.'
President Obama gave a speech Monday instructing Americans not to be so "cynical" about government. This is not a setup for a punch line. He then explained that the major problem with government is that it does not run as efficiently as "one of the most inclusive and most successful campaigns in American history." His own.
It was unclear if Mr. Obama was referring to his 2008 political operation or the 2012 reprise, but in any case he said he is developing a new "management agenda" to deliver a "smarter and more accountable" government, "just like we did on that campaign." Call us cynical, but is there an American outside of Washington nostalgic for the last election?
"What matters in the end is completion. Performance. Results. Not just making promises, but making good on promises," Mr. Obama continued. Sorry, that was George W. Bush in 2001 debuting what he also called a new "management agenda." Perhaps Mr. Obama's version is an homage, though he didn't acknowledge the debt, nor did he mention Al Gore's "reinventing government" program of the 1990s.
President Obama's management agenda is also indebted to President Obama's 2011 call for a scrubdown of the regulatory state for duplicative rules, as well as President Obama's 2012 proposal to consolidate and reorganize the executive branch. The authorities have since issued Amber Alerts for both projects.
Presidents always summon such initiatives that go nowhere when the polls show the public distrusts government, which is usually when it is largest and most activist, and no more so than the present moment. But it's especially rich for Mr. Obama to try to ride this painted pony one more time, as government is dumber and less accountable than ever.
The President actually cited the Affordable Care Act as an example of his idea of more user-friendly government: People will be able to shop for insurance, he said, "like you go online and compare the best deal on cars." Yet the unfortunate government official charged with designing this online tool declared in March that his team had given up on creating "a world-class user experience," adding, "Let's just make sure it's not a third-world experience."
Amid what has recently become a full regulatory panic, ObamaCare will be lucky to rise to third-world standards though it isn't the only part of government Mr. Obama has expanded that could use a "management agenda." Three years after passage, regulators still haven't written the Volcker Rule or other parts of Dodd-Frank financial re-regulation. The stimulus cost a lot but never did kickstart a real recovery. And where was "smarter government" when Mr. Obama told his agencies to administer this year's 5% sequester cuts as painfully as possible so voters would force Congress to oppose any cuts?
Americans might be less cynical about government if Mr. Obama's real preference wasn't for the government status quo, only much more of it.
What ObamaCare Is Going To Do To Your Doctor
You should care a lot about how health reform will affect your doctor. The reason: it will also affect you.
Here's what's happening: hospitals are merging and they are acquiring doctors. In the process, they are making the market less competitive, gaming third-party payment formulas and doing other things that make our health insurance premiums and our taxes higher than they otherwise would be.
None of this is the result of any plan the administration ever announced, however. What did the Obama administration intend to happen? The clearest explanation of their vision of health reform comes from Harvard Medical School Professor Atul Gawande, who thinks that medicine should be more like engineering — with all doctors following the same script, rather than exercising their individual judgments:
"This can no longer be a profession of craftsmen individually brewing plans for whatever patient comes through the door. We have to be more like engineers building a mechanism whose parts actually fit together, whose workings are ever more finely tuned and tweaked for ever better performance in providing aid and comfort to human beings."
Karen Davis, president of the Commonwealth Fund, explains what this will mean for the organization of medical practice:
"The legislation also includes physician payment reforms that encourage physicians, hospitals, and other providers to join together to form accountable care organizations [ACOs] to gain efficiencies and improve quality of care. Those that meet quality-of-care targets and reduce costs relative to a spending benchmark can share in the savings they generate for Medicare."
To assist in this effort, millions of dollars have been spent on pilot programs and demonstration projects to find about "what works" so the ACOs can go copy them. We've had demonstration projects for coordinated care, integrated care, medical homes, electronic medical records, pay-for-performance and just about every other faddish idea. Unfortunately, the Congressional Budget Office has found in three separate reports that that none of this is working (see here, here and here.)
When I say that none of these techniques work, what I really mean is that projects designed, approved and paid for by the demand side for the market aren't working. Many of these techniques actually do work when they are instituted by entrepreneurs on the supply side. But these innovations have nothing to do with ObamaCare. They are happening in spite of ObamaCare.
[Oops, there was one demo project that actually worked and worked well. The government is shutting it down.]
Meanwhile, more than half the doctors are working for hospitals and other institutions, rather than working in private practice. And hospitals are using their new doctor employees to get more money out of Medicare. Even the Medicare Payment Advisory Commission (MedPac), the federal agency responsible for overseeing Medicare fees, has noticed — although belatedly — that hospitals can charge Medicare more for the same services than doctors can charge if they bill Medicare as an independent practitioner. As reported in The New York Times:
"Medicare pays $58 for a 15-minute visit to a doctor's office and 70 percent more — $98.70 — for the same consultation in the outpatient department of a hospital. The patient also pays more: $24.68, rather than $14.50.
Likewise, the commission said, when a Medicare beneficiary receives a certain type of echocardiogram in a doctor’s office, the government and the patient together pay a total of $188. They pay more than twice as much — $452 — for the same test in the outpatient department of a hospital. (The test is used to evaluate the functioning of the heart.)
…From 2010 to 2011, the commission said, the number of echocardiograms provided to Medicare beneficiaries in doctors' offices declined by 6 percent, but the number in hospital outpatient clinics increased by nearly 18 percent."
On the positive side, a major unintended consequence of health reform is the boost to consumer directed health care. In the health insurance exchanges, the cheapest plans are going to have deductibles of $5,000 or more. And lots and lots of people are going to choose the cheapest plans. Avik Roy reports that employers are going for Health Savings Accounts (or Health Reimbursement Arrangements) in a big way. Bottom line: millions of patients are going to be buying care with their own money, rather than with a third-party payer's money.
I'm sure this thought is causing heartburn for those on the left who view high deductible plans as "under-insurance." But this development is viewed as opportunity by health care entrepreneurs.
One study is predicting that the number of walk-in clinics is going to double in the next few years. The Obama administration doesn't like them because they are not part of integrated care/coordinated care/medical homes/etc., etc., etc. Even so, they are doing what the ACOs are unlikely to do: lowering costs, increasing quality and improving access to care.
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Posted by JR at 12:40 AM