Come for the politics, stay for the snark.

If senate republicans had any shame, they’d die of it.

The snowflake in chief appeared visibly frustrated when questioned by a reporter about egg prices.

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

Not rolling over. fuck you, make me.

This is dead girl, live boy, a goat, two wetsuits and a dildo territory.  oh, and pink furry handcuffs.

One lie, alone, tears the fabric of reality.

“In the future, this lab will be a museum. do not touch it.”

Putin must be throwing ketchup at the walls.

Narcissists are always shocked to discover other people have agency.

Too often we hand the biggest microphones to the cynics and the critics who delight in declaring failure.

Motto for the House: Flip 5 and lose none.

Wow, I can’t imagine what it was like to comment in morse code.

You are either for trump or for democracy. Pick one.

Fear and negativity are contagious, but so is courage!

Someone should tell Republicans that violence is the last refuge of the incompetent, or possibly the first.

They punch you in the face and then start crying because their fist hurts.

Some judge needs to shut this circus down soon.

This country desperately needs a functioning fourth estate.

Oppose, oppose, oppose. do not congratulate. this is not business as usual.

Republicans: The threats are dire, but my tickets are non-refundable!

Well, whatever it is, it’s better than being a Republican.

“Everybody’s entitled to be an idiot.”

Rupert, come get your orange boy, you petrified old dinosaur turd.

Following reporting rules is only for the little people, apparently.

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Healthy Pennsylvania in Utah?

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One of the big delays in the negoatiation between Pennsylvania and the Department of Health and Human Services (HHS) for the Healthy PA Medicaid expansion was the initial request by Pennsylvania to tie Medicaid eligibility to work or work-search requirements. 

HHS held firm and said that Medicaid eligiblity can only be tied to income or health condition for Legacy Medicaid and can not be tied to employment or job search status.  Pennsylvania pushed back, and HHS gave a fig leaf to Pennsylvania.  Pennsylvania can use its own funds to encourage without repurcussion Healthy PA members to use a state built job search resources.  If someone participates, great, if not, great.

Utah seems to be going this route as well for Medicaid expansion as reported by the Salt Lake Tribune:

The Obama administration has agreed in concept to Utah’s novel alternative to expanding Medicaid, including the notion that able-bodied people who get insurance subsidies should accept the state’s help with finding work, Gov. Gary Herbert said late Tuesday….

HHS did not agree that insurance subsidies would be contingent on recipients holding a job or looking for work, but the agency did agree that employment can be a goal of Utah’s program, Healthy Utah.

I am reading these statements to mean that Utah can use its own funds to do a job search/training program for Healthy Utah members but participation or non-participation will not change eligibility determination.  It will be the same response that Pennsylvania received.  Federal money won’t pay for the job related activities nor will the federal money be contigent on job search requirements.

That is my guess. 

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Hands Up, Don’t Shoot

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Here’s an explosive new video of two contractors in the aftermath of the execution of Michael Brown, in which two contractors who know no one in Ferguson react to seeing Officer Darren Wilson murder Brown:

Not sure how there are still people trying to justify this, but I am sure people will find a way to try to explain it away.

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Doctor Owned Hospitals – a reader’s request

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I received a good question from a good friend of the blog, and I will try my best to answer it:

I would like to see some details about physician owned hospitals, why they are treated differently, if they are good or bad for healthcare in general, etc. The one we had Mobile Messball #1 and TummyTimeKing #2 at is nice for the few things it specializes in but sucks ass if you need emergency care, etc. Plus they spent the whole time bitching about obamacare and how it was screwing them.

Doctor owned hospitals are a distinct subset of privately owned hospitals.  They are odd in a number of ways.  Roughly 5% of the entire hospital universe in the US is doctor owned hospitals.  These hospitals tend to be very small (less than 20 beds) and very specialized.  The common specializations are Ob/Gyn, cardiology, plastic surgery and orthopedic surgery.  As you’ll note, these are all high reimbursement specialties. 

On average, a doctor owned hospital has a profit margin closer to that of a drug manufacturer (20% to 35%) compared to generally privately owned hospitals with profit margins of 5% to 7% and public hospitals with contribution margins of 2% to 5%.  Some of that profit margin is due to cutting out the adminstrators and Vice Presidents of Institutional Awesomeness proliferation.  Most of that increased profit margin is due to taking only patients who have good insurance who reimburse at high rates.  This basically means people with plans that will be paying Cadillac taxes on it or millionaires paying out of pocket.

The upside of this system is that doctor owned hospitals tend to score very well on quality metrics (although we need to be aware of the law of very small numbers here) but they are expensive as all get out.  A very plausible upside is that these hospitals tend to be extremely specialized so their staff gets really good at doing two or three things including sending patients elsewhere for anything outside of their expertise.  There is good evidence that doing something more often leads to much better outcomes. 

PPACA is not friendly to doctor owned hospitals. 

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Early Morning Open Thread — Post-Speech Reax

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Does anyone disagree with Mr. Engel here? I watched the speech last night. As usual, PBO seemed refreshingly rational. Unlike his predecessor, PBO doesn’t have grandiose delusions about the US stomping through the region all Godzilla-like to alter the course of history.

But, for me, at least, it keeps coming back to this: Is widening US involvement in the Middle East a good idea? Does it serve our interests? And, for me, at least, the answer is: NOPE.

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Open Thread: Reddit and Weep

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When it comes to writing our little lives, the Trickster God is a lazy, cliche-dependent novelist. The douchecanoe responsible for sluicing “The Fappening” upon our attention turns out to be just what anybody would have predicted — an unemployable oddball who is severely butthurt that (even) the Washington Post successfully tracked him down. Is there no privacy in this cold new world?!?…

And, of course, now comes another “reveal”, per Jessica Roy at NYMag:

Official internet garbage heap and misogynist watering hole Reddit made enough money off of those stolen nude celebrity photos to keep their expensive server racks running for almost a month, reports Wired.

The moderator of r/thefappening, the subreddit that published the photos until administrators banned it over the weekend, broke down just how much revenue his evil empire generated for Reddit. Thirty-three-year-old John Menese said users of r/thefappening bought enough $3.99 Reddit Gold subscriptions (like a premium account) to fund server costs for at least 27 days…

Roy was also responsible for the earlier “Should We Ban That Subreddit? A Flowchart Look Inside the Mind of Reddit Admins“, so… not a fan, I’m thinking. She linked there to Reddit administrator Yishan Wong’s extremely libertechnerd defense, “Every Man Is Responsible for His Own Soul“:

… [W]e are unlikely to make changes to our existing site content policies in response to this specific event.

The reason is because we consider ourselves not just a company running a website where one can post links and discuss them, but the government of a new type of community. The role and responsibility of a government differs from that of a private corporation, in that it exercises restraint in the usage of its powers…

Uh, no. Reddit is no kind of government, and it’s not a community so much as a whole bunch of communities using the same private corporation’s servers for their own ends, while being used by said private corporation as advertising clickfodder. Much like very large swathes of the internet, only with even less adult supervision!

I prefer the analogy that “the Internet” is a very large, mostly dysfunctional clan — brother against brother, brothers against cousins, cousins against the outside world. And Reddit is the snot-nosed, sticky-fingered, hyperactive Little Brother who gets access to more mature goodies than it can safely handle, because the older kids don’t want it ratting them out. (It also gets kicked around on the regular, sometimes just because those kids need an outlet, not that it doesn’t work at earning those beatdowns… )

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I Guess We Sit Back and Watch Now

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Maybe if the President suggested raising taxes to pay for this we could get Congress to vote on the issue.

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