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These days, even the boring Republicans are nuts.

But frankly mr. cole, I’ll be happier when you get back to telling us to go fuck ourselves.

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This must be what justice looks like, not vengeful, just peaceful exuberance.

Today’s gop: why go just far enough when too far is right there?

Bad people in a position to do bad things will do bad things because they are bad people. End of story.

To the privileged, equality seems like oppression.

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Not loving this new fraud based economy.

Mediocre white men think RFK Jr’s pathetic midlife crisis is inspirational. The bar is set so low for them, it’s subterranean.

Republicans do not pay their debts.

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Republicans: slavery is when you own me. freedom is when I own you.

When you’re in more danger from the IDF than from Russian shelling, that’s really bad.

The party of Reagan has become the party of Putin.

The real work of an opposition party is to hold the people in power accountable.

They want us to be overwhelmed and exhausted. Focus. Resist. Oppose.

A tremendous foreign policy asset… to all of our adversaries.

One lie, alone, tears the fabric of reality.

Also, are you sure you want people to rate your comments?

No Kings: Americans standing in the way of bad history saying “Oh, Fuck No!”

Their boy Ron is an empty plastic cup that will never know pudding.

People really shouldn’t expect the government to help after they watched the GOP drown it in a bathtub.

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You are here: Home / Archives for 2014

Archives for 2014

Head charges and disease charges

by David Anderson|  December 19, 201410:05 pm| 21 Comments

This post is in: Anderson On Health Insurance

Weavermom asked a good question about the difference between capitation payments and bundled payments:

Is this the same as capitation? Where doctors basically get paid more when they provide the least treatment? I believe that this has been tried, and I find it personally terrifying. The minute I get expensive, I’m expendable. The minute I get really sick, I am ‘stealing’ my doctor’s take-home pay. If I am mis-construing the point, please let me know….

Capitation payments are when a provider group gets a set fee per person it covers per month to maintain their patient pool’s health.  If the provider group spends less than the total payment, they keep the difference as profit.  If they spend more than the total payment, the provider group eats the loss.  The goal of this payment structure is to encourage providers to perform efficient and effective care on patients while also encouraging preventative and low cost early interventions instead of high cost emergency/acute interventions.  Capitation models have been around for a couple of generations now, and it effectively shifts some of the popualtion health management risks and responsibilities away from the insurance company and towards the primary care providers.

Bundled payments are also lump sum payments which are intended to promote efficient, effective care while shifting some of the treatment and outcome risk onto the providers.  However, bundled payments are far more targetted than general capitation payments.  In the example that Weavermom respnded to, the bundle payment was for less than a dozen types of cancer diagnosises.  The providers are given a big lump of money per person with the specific diagnosis and that money can be spent however the doctors think is appropriate.  The goal, in the example that I used this morning, would be to encourage doctors to use a shorter treatment at higher doses which is as safe and effective as a longer course of treatment at lower dosing while being significantly less expensive and disruptive of patients lives.  Bundled payments are often calculated as the sum total of the best practice course of treatment plus a small percentage added in for contingencies and profit.  The goal is to not pay for expensive and ineffective treatments.

Both of these payment schemes do provide an incentive for doctors to undertreat initially.  That is a downside to the system when the current treatment levels are either at the ideal point or are already under the ideal point. However, from a system/policy perspective, most Americans are overtreated for mimial real gain in health (see the cancer example from this morning, back surgery versus physical therapy etc) but at great additional cost, so as long as there are strong quality metrics built into the program that monitor results for performance similar to or better than traditional payment schemes, I think this is a risk worth taking.

Finally, as a side note, bundled payments and capitation payments can be quasi-blended together when capitation payments are aggressively risk adjusted.  For instance, if a diabetic individual is in a capitated group where the baseline capitation payment is $450 per person per month, the fact that the person is diabetic might lead to a risk adjustment of 100%, so the diabetic person would be a revenue stream of $900 per month as diabetics are significantly more expensive to keep in good health than non-diabetics, all else being equal.  So there is a back door way of a chronic condition becoming a quasi-bundled payment within a capitation scheme.

 

Head charges and disease chargesPost + Comments (21)

Friday Recipe Exchange: Holiday Sweet Treats

by Anne Laurie|  December 19, 20149:02 pm| 31 Comments

This post is in: Cooking, Recipes

tamara assorted-cookies1

From our Food Goddess, TaMara:

Lots of cooking going on. And look what Santa dropped off early:

tamara mystery-machine

Just in time to hold the assortment of cookies I made this week. Most of them are going into gift boxes, but I’ll hold enough back for my annual Christmas Eve dinner.

Let’s get right to it. Pictured above:

Dark Chocolate Chip Cookies, recipe here.

Spritz Cookies, recipes and instructions for using a cookie press here.

Not pictured because I still have to make them, Chocolate-Walnut Flourless Cookies, recipe here. I love these because you’d never know they were flourless and they taste like brownie bites.

Looking for side dishes for your holiday dinner? You can click here for a lot of different types. And for the pet lovers, Bixby posted an update here and here is photo evidence of how the cats torment him, try not to laugh, it hurts his feelings.

How about you, what’s on your menu for the holidays? Share your holiday traditions, both edible and otherwise.

tamara mexican-russian-pecan-cookies

Tonight’s featured recipe had a bit of a serendipitous beginning.

show full post on front page

Friday Recipe Exchange: Holiday Sweet TreatsPost + Comments (31)

A Few of My Favorite Things

by @heymistermix.com|  December 19, 20146:33 pm| 79 Comments

This post is in: Glibertarianism, Open Threads

Ayn Rand Reviews Children’s Movies:

“Snow White and the Seven Dwarfs”

An industrious young woman neglects to charge for her housekeeping services and is rightly exploited for her naïveté. She dies without ever having sought her own happiness as the highest moral aim. I did not finish watching this movie, finding it impossible to sympathize with the main character. —No stars.

“Bambi”

The biggest and the strongest are the fittest to rule. This is the way things have always been. —Four stars.

(via Hal in the comments)

A Few of My Favorite ThingsPost + Comments (79)

Friday Afternoon Open Thread

by Betty Cracker|  December 19, 20144:45 pm| 96 Comments

This post is in: Open Threads

My daughter dragged me to a hipster cafe in Tampa the other day. Tampa is becoming this improbable foodie Mecca. Anyhoo, I had a cocktail that was garnished with CANDIED BACON!

IMG_3462.JPG

It was pretty tasty too — a fancy old fashioned. I considered having two since my chauffeur was on the scene, but they were $12 a pop, which I’m shocked — shocked! — flies in Tampa. This ain’t fucking New York City.

What are y’all up to this evening? I’m awaiting furry guests — my kiddo is watching a schoolmate’s bunnies over the holidays. BUNNIES! I’ll share pictures later.

Friday Afternoon Open ThreadPost + Comments (96)

Bill O’Reilly: America’s Racist Treasure

by Elon James White|  December 19, 20141:54 pm| 65 Comments

This post is in: This Week In Blackness

Maybe you’ve said to yourself recently, I wonder how Bill O’Reilly thinks about all these “I Can’t Breathe” T-shirts that NBA players have been wearing? Well, O’Reilly not only schooled America on racism, but he did it in a conversation with Martin Luther King III. His message? Stop getting pregnant at 14 and abandoning your community, black people.

Bill O’Reilly really is America’s straight-talking treasure.

Team Blackness also discussed a St. Louis judge actually ruling in favor of protestors over police for once, the rise of sexual assaults in the millitary, and a cruel punishment for an eight-year-old blind child.

Subscribe on iTunes | Subscribe On Stitcher | Direct Download | RSS

Bill O’Reilly: America’s Racist TreasurePost + Comments (65)

Thanks, North Korea

by Tim F|  December 19, 20141:28 pm| 119 Comments

This post is in: General Stupidity

Reflecting on the historic pantsing that some North Korean hackers gave Sony Pictures, I think some could fairly describe it as the best possible thing to happen right now. And by ‘some’ I do not mean Sony’s competition. You can bet their own schadenfreude is heavily tempered by a frantic code brown review of their own data security. Rather I mean experts like Richard Clarke who have been screaming, begging and tearing their hair out about digital security.

When you think about how many ways that a hostile power, or a hostile group of teenagers with a laptop, can screw with us the main question about a digital 9/11 is when and how bad.

As it turns out the answer is now and pretty bad, but importantly not the end of the world. A company lost money and a lot of people got embarrassed. Blackmailers got what they wanted, which will no doubt encourage underpowered states to screw with big powers more in the future. But in the end no one died, even if a few sys admins probably wish they had. Overall I think people will eventually look back and feel very, very lucky that it shook out that way. Let me lay out my thinking.

By now it should be clear that most of our digital infrastructure has shit security. College compsci majors can usually red team their way into our electrical grids. Lockheed might put up a fight (the Chinese get through anyway) but 2014 taught some hard lessons about how most companies neglect their computers. Sony’s admins basically kept an unencrypted folder titled ‘everyone’s password’. Target stepped on a rake and Home Depot protected customer data like your great-aunt protects her AOL account. It is not terribly gratifying when you give up begging her to use something more challenging than ‘password1’ for the eighty seventh time and the next day she ‘donates’ $42,000 to a teenager in Sevastopol loses the payment and personal information of every goddamned customer for the last six months.

You could ask, why should the Sony hack do any good? Earlier breaches did not persuade Target to overhaul it security and the Target disaster somehow failed to dislodge Home Depot’s head from its ass. I think it has a lot to do with who got hurt. The earlier breaches embarrassed Target and Home Depot and pissed off shareholders, but aside from sacrificial scapegoats in mid-management the breaches were mostly a customer problem. That let businesses regard these things coolly, from a risk-reward perspective. In broadest terms you could describe the hacks as someone else sneaking in and shearing some more wool off of the sheep.

Sony more or less inverted that story. Some customers got fleeced, for example I might avoid the Playstation Network for now, but that does not begin to describe what happened to Sony. Instead of sneaking in an open barn door and making off with livestock in the dark, North Korea made a public spectacle out of Sony’s humiliation. They screwed with employees’ computer monitors. They released emails, scripts, drafts, planning documents, IT records and anything else they could find on Sony’s hard drives. Nobody likes having their private business written on a banner pulled behind a slow-flying plane, and I imagine it comes as an especially rude shock to corner office executives long used to lavish deference and (limited) untouchability.

When you are humiliated, more than anything else you want the story to fucking please go away already. Sony for example sent some very expensive lawyers on a futile quest to get the press to leave this story alone. Yet the story just. will. not. die. In part this has to do with Sony being an entertainment company. We Americans go embarrassingly gaga for stage managed little news bites about our favorite celebrities and the films they make, so we have no defense against all that stuff shooting unedited out of a fire hose for everyone to consume all at once. What’s wrong with the next Bond movie, what might happen to Spider-Man, what do Sony employees think about Adam Sandler? (not highly.) You have an academic look at one of the larger businesses in entertainment, suddenly rendered completely transparent. You have the national security angle for us policy wonks. Then you have the safety versus freedom angle about releasing the movie, a tough call that I would not necessarily second guess. You never know how much more damaging material they might have held back as a threat. The disaster has an absolute, seemingly bottomless wealth of story hooks.

It all adds up to an astonishing ordeal for Sony: a public humilitation and a financial disaster that just drags on and on, exposes and hampers their long term business plans and then, adding insult to injury, Sony becomes the goat for pulling the movie. Put me in the place of a senior executive at some other business or utility and I will do two things, basically right away. First I will look hard at who I might piss off and how I can avoid it. Like that reaction or not but you better learn to live with it. Power has moved around some since days when America’s most dangerous neighbors were Canada, Mexico and sharks. Nowadays the walls around your castle are only as secure as a password, and most passwords are shit. Nobody with a corner office and a Bentley wants to sacrifice himself for your principles.

However, I also find it pretty damn self-evident that we have entered a bull market for computer security. Nothing bumps security up the cost-benefit ledger like this seemingly neverending public ruin and humiliation of a company that probably did a better job at securing its networks than you do. After all, you can’t please everyone all the time. Stepping lightly earns some peace of mind but people sleep a lot better when they don’t have to. For that reason I suspect, and by that I mean I desperately hope, that Sony will provide that extra psychological nudge for people who run things from radio stations and online stores to airports and electrical grids to spend a little more resources red teaming their network security. The next time someone puts that kind of effort into attacking a network they could have more in mind than a dumb movie.

***Update***

From the comments.

My day job is network security. Sony is not going to be the wakeup call, because others will simply think they’re different, and it can’t happen to them.

It will take either a major months-long disabling attack on an electrical or water grid, or a major attack on a financial system (you wake up and your bank account, and a few million others, are zeroes) for companies and citizens to finally take this shit seriously.

Hell, even the basic lesson from the Sony hack – that YOUR email can be read by someone/anyone other than the intended recipient – has not gotten through the heads of any users I’ve talked to recently.

Sigh. Gonna start huffing glue early today.

Thanks, North KoreaPost + Comments (119)

Today in the funny pages

by Tim F|  December 19, 201410:52 am| 58 Comments

This post is in: Blogospheric Navel-Gazing

Happy Hanukkah, John.

Today in the funny pagesPost + Comments (58)

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