Come for the politics, stay for the snark.
Working on a couple posts that I will put up later, but here is an open thread for now.
BTW- sometime in the last couple of days marks four months since I quit drinking. Not keeping count or track and the only reason I know is because my insurance finally took care of all their part and I got my bill today. Not bad- only about 2k over all. I’m cool with that. Cheaper than drinking, that’s for damned sure.
Just a few good ideas that I saw this morning:
Question: if there’s no medical reason for the quarantine tent in New Jersey, would the nurse’s insurance company fight the bill?
— Niels Lesniewski (@nielslesniewski) October 27, 2014
Really good question. Medical insurance tends to pay for “medically necessary” care and little else above and beyond that. If there is no good reason for a quarantine, the lawyers will have fun.
A good idea for the Sustainable Growth Rate/doc fix problem:
The solution to the SGR mess, then, may be simpler than convoluted formulas and political horse-trading. The Medicare Advantage program can serve as a “baseline” for physician reimbursements. For instance, traditional Medicare can take the second-cheapest MA plan in each county across the country, and base physician payments on that plan’s reimbursement schedule, plus any penalties/bonuses required under the program….it would make sense to test such an approach before implementing it across the board. Medicare could pick, at random, a set of counties where reimbursements would be based on private plans for a set period of time. Quality and cost data could then be analyzed to determine whether this method is worth it.
That is from Yvegeniy Feyman at Forbes, and this type of proposal is one that should, in a normal functional political environment be able to be debated, get through committee with a couple of tweaks and then piloted for a couple of years to see if it works. And if it works, or mostly works, a slightly tweaked out proposal would be rolled out nationally. Medical reimbursement, after the decision has been made that medical care for the elderly is a social obligation, should be a technocratic discussion under a functional political system. Unfortunately, I don’t think this idea is going anywhere.
Utah had been on my list of highly probable Medicaid expansion states for a while now. They’ve been in talks with Health and Human Services (HHS) for a 1115 waiver and their discussions have been wide ranging. Last Friday, it looks like the outlines of a deal have been agreed to:
“They are giving us more flexibility than has been given to any other state in America. We are breaking some new ground,” Herbert announced in his monthly press conference on KUED.
Herbert said he soon will send to the Obama administration a letter outlining the agreement they’ve reached on Utah’s alternative, his Healthy Utah plan…
The governor expects to share details of his plan with legislators in mid-November, and there will be a 30-day comment period for the public as well….It provides “more individual responsibility, to have people take care of their own health care,” and has them pay part of their premiums, he said.
I want to see the deal. My bet is that it will be closer to Healthy PA than the pure Arkansas private option, as some of the buzzphrases are irrelevant to premium support models.
So when can we expect to see people covered? My bet is enrollment starts in March with coverage starting in April 2015, assuming the plan is approved in November.
Medicaid expansion is coming in many different flavors, and each flavor has different lead times.
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GOP tricks, scienterrific treat, per the NYTimes — “To Improve A Memory, Consider Chocolate“:
In a small study in the journal Nature Neuroscience, healthy people, ages 50 to 69, who drank a mixture high in antioxidants called cocoa flavanols for three months performed better on a memory test than people who drank a low-flavanol mixture.
On average, the improvement of high-flavanol drinkers meant they performed like people two to three decades younger on the study’s memory task, said Dr. Scott A. Small, a neurologist at Columbia University Medical Center and the study’s senior author. They performed about 25 percent better than the low-flavanol group.
“An exciting result,” said Craig Stark, a neurobiologist at the University of California, Irvine, who was not involved in the research. “It’s an initial study, and I sort of view this as the opening salvo.”
He added, “And look, it’s chocolate. Who’s going to complain about chocolate?”…
Well, I’m sure they’ll find someone. Details at the link, with all the predictable cautions about small samples, large doses, the need for further studies, and the inadvisability of gorging on Halloween chocolate bars that have been processed to remove most of the vital flavanol epicatechin. But, hey — chocolate!
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Apart from hoping this won’t just be the next resveratrol, what’s on the agenda as we start another week?
Monday Morning Open Thread: Delicious NewsPost + Comments (61)
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Canadian Jeet Heer, in the New Yorker, on “The Line Between Terrorism and Mental Illness“:
… According to Dr. Thomas Hegghammer, the director of terrorism research at the Norwegian Defence Research Establishment, Zehaf-Bibeau fits a profile of “converts with a history of delinquency among the Westerners in ISIL. He’s a little older than average; otherwise, there is nothing unusual about his profile.” Conversion to Islam itself isn’t a cause of violence, as we well know—Dave Bathurst, for instance, is an apparently peaceful citizen, disturbed by his late friend’s act of mayhem. What seems to be the problem, rather, is the fusion of radical jihadist ideology with other personal problems, whether they be alienation, anomie, or various shades of mental illness. In a world where “clash of civilizations” rhetoric is pervasive, it is possible that radical Islam offers the same appeal to some unstable individuals that anarchism had for Leon Czolgosz, who killed President William McKinley in 1901, and that Marxism had for Lee Harvey Oswald. If you are alienated from the existing social order, the possibility of joining, even as a “lone wolf” killer, any larger social movement that promises to overturn that society may be attractive. For a person radicalized in this manner, the fantasy of political violence is a chance to gain agency, make history, and be part of something larger.
“Islamic-extremist online recruiters are very good at pulling in people who are mentally vulnerable,” Heather Hurlburt, of the Washington-based think tank New America, said. She suggests that an effective response to the problem will draw at least as much on the insights of mental health as on the intrusions of the security state…
The War Nerd, from his teaching position in Kuwait City, is more direct:
… So, two soldiers are now dead, Canada’s uncommonly flustered, and all because the RCMP didn’t do the obvious, and let these guys go where they wanted to go. If the RCMP had taken DNA samples, front and side photos, and seen them off at the airport with a “Mazel tov!”, Canada would be a lot better off. It took both Rouleau and Zehaf-Babeau weeks, between being refused a passport and their final act, to work up the courage to kill at home. Most wannabe jihadis feel a certain grudging sentimentality for the country where they grew up, which makes them more willing to kill for God far, far away from home than to kill people who look like the kids they grew up with. These two only killed at home when the Syrian option was shut down for them.
So what was the downside of letting them go? The most likely outcome was that both would have been cannon fodder, dead in their first month.
Late Night Horror Stories: Terrorist or Head Case?Post + Comments (58)
If the only achievement of Pope Francis is to get Ross Douthat to leave the church, this will rank as a great papacy.
— Jeet Heer (@HeerJeet) October 26, 2014
Seriously, Ross Douthat is about 3 months away from joining the crazy breakaway Catholic cult Mel Gibson's dad belongs to.
— Jeet Heer (@HeerJeet) October 26, 2014
I don’t waste my time reading Ross Douthat (pronounced, in my head, Doubt-That) because life’s too short, but his latest tantrum provoked someone on twitter to wonder if the NYTimes had given him precious op-ed space as a subtle insult to the Catholic Church. As someone who spent twelve years in parochial school, I can attest that this column is the doctrinal equivalent of Doubthat’s ‘chunky Reese Witherspoon’ reminiscences — entirely too revealing about a psychological kink he believes is universal law. If you don’t trust my judgement, here’s Mark Kleiman at The Reality-Based Community:
Shorter Ross Douthat: All Popes are infallible, but reactionary Popes are more infallible than others.
Note especially two extraordinary claims:
* That what Douthat admits is a traditionalist minority deserves deference because of its energy. Apparently Douthat wants his faction to dominate the Church the way the Tea Party dominates the GOP.
* That it would be outrageous for Pope Francis to use the power of appointment to move the Church into the future in precisely the way his two predecessors used it to move the Church into the past…
Seriously — this is all about Doubthat’s sexual terrors:
… The church’s attitude toward gay Catholics, for instance, has often been far more punitive and hostile than the pastoral approach to heterosexuals living in what the church considers sinful situations, and there are clearly ways that the church can be more understanding of the cross carried by gay Christians.
But going beyond such a welcome to a kind of celebration of the virtues of nonmarital relationships generally, as the synod document seemed to do, might open a divide between formal teaching and real-world practice that’s too wide to be sustained. And on communion for the remarried, the stakes are not debatable at all.
Sunday Evening Self-Indulgence: More Capital-C Catholic Than the PopePost + Comments (118)
Obama met with Dallas nurse Nina Pham after she was declared cured of the Ebola virus (PHOTOS) http://t.co/ZqUWDQqYZG pic.twitter.com/gsEAF2XEU2
— Talking Points Memo (@TPM) October 24, 2014
From ABC News, Friday:
Before returning to her “normal life” in Texas, newly Ebola-free Dallas nurse Nina Pham got a hug from President Barack Obama in the Oval Office.
Hours earlier, Pham had walked out of the National Institutes of Health Clinical Center, where she has been in isolation since Oct. 16, to a round of applause. She thanked everyone who cared for her since her Oct. 11 Ebola diagnosis, and said she would finally go home to her dog, Bentley…
Pham also thanked Dr. Kent Brantly, the American missionary who had been treating Ebola patients in Liberia when he contracted the deadly virus in late July. Brantley was declared virus-free in September and has donated plasma to Pham and other American Ebola patients in the hopes of boosting their ability to fight the virus with his antibodies.
Pham’s dog, Bentley, was taken to an animal shelter following her diagnosis. He has tested negative for Ebola, but his 21-day incubation period isn’t over until Nov. 1. They will likely reunite a few days later.(City of Dallas & Dallas Animal Services)Vinson’s family announced on Oct. 22 that she, too, tested negative for the virus at Emory…
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Any other happy news as we wrap up the weekend?
Sunday Evening Happy Nice Thoughts Open ThreadPost + Comments (105)
