Come for the politics, stay for the snark.

It’s not hopeless, and we’re not helpless.

You don’t get to peddle hatred on saturday and offer condolences on sunday.

Hey Washington Post, “Democracy Dies in Darkness” is supposed to be a warning, not a mission statement.

When do we start airlifting the women and children out of Texas?

Accused of treason; bitches about the ratings. I am in awe.

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

It is possible to do the right thing without the promise of a cookie.

Their freedom requires your slavery.

A democracy can’t function when people can’t distinguish facts from lies.

Black Jesus loves a paper trail.

People are complicated. Love is not.

A lot of Dems talk about what the media tells them to talk about. Not helpful.

… gradually, and then suddenly.

fuckem (in honor of the late great efgoldman)

Many life forms that would benefit from greater intelligence, sadly, do not have it.

They were going to turn on one another at some point. It was inevitable.

Come on, media. you have one job. start doing it.

Everyone is in a bubble, but some bubbles model reality far better than others!

The Supreme Court is corrupt. Democrats must win in November and force court reform.

Republicans don’t trust women.

We’ve had enough carrots to last a lifetime. break out the sticks.

I desperately hope that, yet again, I am wrong.

Let’s not be the monsters we hate.

The media handbook says “controversial” is the most negative description that can be used for a Republican.

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Archives for February 2019

Tuesday Afternoon Open Thread

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Posted this on Twitter earlier during my trip into town:

This RV driver did a fair job of projecting “gullible asshole” based solely on his vehicle’s rear window, though he loses a couple of points for a lack of pro-gun and anti-choice representation.

I remember being amazed to see a lady at a MAGA rally break down in tears when complaining about how the media treats the orange fart cloud during a TV interview. She and the RV driver seem to sincerely believe a selfish shithead who wouldn’t piss on their heads if their hair was on fire is sacrificing himself for them.

I’ve got plenty of MAGA chuds in my family tree, but they’re garden variety bigots who aren’t quite dumb enough to think Trump cares about them personally. I’m not sure which is worse.

Open thread!

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Cardiac prevention saves money and lives

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Last week, I stated that prevention very seldom led to direct cost savings:

Some prevention efforts may lead to higher net costs (however we have determined them).  And that can be okay if we think that the improved health is worthwhile.  Prevention is mainly about preventing bad outcomes and not about saving money.  Saving money sometimes is an intended goal but the goal of improving mortality or quality of life even at a net increase in expense is also a legitimate goal.

Prevention should be judged on what it is seeking to be doing instead of expecting it to prevent disease and other negative outcomes while also saving money.

This week a great paper in Health Affairs came out by Cutler et al that shows a massive exception case.  Preventative services for cardiac diseases for Medicare beneficiaries improves mortality and lowers costs:

 Decomposing spending by condition, we found that half of the spending slowdown was attributable to slower growth in spending for cardiovascular diseases. Spending growth also slowed for dementia, renal and genitourinary diseases, and aftercare for people with acute illnesses. Using estimates from the medical literature of the impact of pharmaceuticals on acute disease, we found that roughly half of the reduction in major cardiovascular events was attributable to medications controlling cardiovascular risk factors. Despite this substantial cost-saving improvement in cardiovascular health, additional opportunities remain to lower spending through disease prevention and control.

 

A lot is going on. Half of the cardiovascular savings were due to the prolific prescription of effective risk management drugs. These drugs have become increasing affordable over time for several reasons.

1) Medicare Part D made drugs more affordable over time
2) Quite a few of the first generation drug classes went off patent with significant generic introduction
3) Continued push by providers for prevention

There is still a lot of space for improvement as the low cost generics are still very low cost but not prescribed to every one who is at elevated risk.

There may be a few other areas where the combination of effective prevention treatments with very low costs after a reasonable number needed to treat (NNT).

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Nancy Nailed It

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We’ve never had a president who is more needy and attention-seeking than Trump, so Nancy Pelosi’s move to deny him an invitation to deliver the SOTU during the government shutdown was brilliant, as most of us appreciated in real time. A report from The Times yesterday reveals for the record just how significant a role Pelosi’s use of the SOTU as both carrot and stick played in reopening the government:

Mr. Trump, aides said, views the speech and all of the pomp and circumstance that accompany it with some reverence, and aides said he puts more time into his script because it is one instance where he usually sticks to it. For all of the president’s fabled norm-busting, there are aspects of the conventional presidency that appeal to him, none more so than standing in the hallowed halls of Congress, with all eyes on him speaking to the nation…

In fact, the dark-wood venue and the history of the address appeal so much to Mr. Trump that his reluctance to deliver the speech in an alternative venue — something that was briefly discussed in the White House after Speaker Nancy Pelosi initially canceled the speech because of the partial government shutdown — was part of Mr. Trump’s calculus for reopening, at least temporarily, the government.

Take that in for a moment: Trump abjectly surrendered on the shutdown — humiliating himself politically, infuriating creatures like Ann Coulter, underscoring his entire party’s capitulation to its leader’s stupidity and irresponsibility — all so he could flap his gums and wave his stubby fingers in front of official Washington, DC and live on all the networks.

I’ve read reports that McConnell and Co. were ready to pull the plug on the shutdown anyway since Trump’s and the rest of the GOP’s approval ratings were cratering and they feared the damage would haunt them next year. Well, that’s to Pelosi’s credit too since she held her caucus together.

But from what we know of Trump — his addiction to adulation, his disregard of collateral damage inflicted on anyone not named Donald J. Trump, his craving for unearned respect — my money’s on the SOTU as the chief factor in the shutdown cave. Well played, Madam Speaker.

Are y’all going to watch the shit-show tonight? We may or may not — it’ll be a game-time call for us, depending on our mood at 9 PM ET.

According to The Times report linked above, it sounds like xenophobic incel goon Stephen Miller is wrestling with more conventional GOP turd-polishers over the tone of the speech. So, it might be interesting as a rhetorical artifact to watch the theme ping-pong between white nationalist scaremongering and pseudo-lofty pablum.

Open thread!

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My Views On Nuclear Power

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Last night we learned that Cory Booker feels that nuclear power will be important in our response to global warning.

So let me give a short summary of my feelings about nuclear power. They haven’t changed since I wrote this in August 2017.

We need nuclear power. I think that we can make it work. But there are a lot of reasons we might not. The fear of radioactivity is a big one. It’s irrational, it comes from a lack of education, the media fan it, and it seems impervious to any sort of persuasion.

The belief that there is no way to deal with the wastes is related, but separate. The repository at Yucca Mountain would be just fine except for politics. Nevada has decided that it won’t take other states’ radioactive garbage. So there. I can sorta sympathize, but not really. We do have a lot of empty space out here in the west, and not many people.

The time it takes to build a new reactor and the cost overruns, as they exist now, are disqualifying. This seems to be a problem in all sorts of areas, though. The solution may have more to do with contracting practices and bad incentives than anything else.

The new, smaller reactors that are being developed may be part of the solution. But it will take time to have them ready to go. Older reactors should not be shut down simply because natural gas is now cheap. Booker is right about that.

Overall, don’t give up on nuclear power. Learn about what radioactivity is. The nuclear industry and its proponents at DOE have to do a better job.

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On the Road and In Your Backyard

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On The Road and In Your Backyard is a weekday feature spotlighting reader submissions. From the exotic to the familiar, please share your part of the world, whether you’re traveling or just in your locality. Share some photos and a narrative, let us see through your pictures and words. We’re so lucky each and every day to see and appreciate the world around us!

Submissions from commenters are welcome at tools.balloon-juice.com

Have a wonderful day and weekend and enjoy the pictures!

 

Ah, Paris…

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Tuesday Morning Open Thread: Happy Year of the Pig!

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Obvious jokes aside, Pig years are supposed to be prosperous — good for getting one’s house in order, taking care of those nagging health issues, and wrapping up old business before making a fresh start. Pretty safe goals! It’s predicted to be a good year for Sheep/Goats like me (and Rabbits/Cats like the Spousal Unit) so I’m going to greet the Spring Festival with a positive attitude… while it lasts.

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Trump Crimes Open Thread: Follow the (Inaugural Committee) Money

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Remember all those stories about the immense sums that somehow leaked away during the preparations for Trump’s extremely underwhelming inauguration? How “The bill from the Trump International Hotel was more than $1.5 million. And there was a documentary, overseen by a close friend of Melania Trump’s, that was ultimately abandoned…. “?

Well, it may not technically be illegal to throw money at one’s cronies — or at least it might be hard to document — but the rules about who gets to donate those funds are strict. Per the Washington Post:

… Only U.S. citizens and legal residents can legally donate to a committee established to finance presidential inaugural festivities…

The subpoena also specifically seeks all communications with one donor, Los Angeles venture capitalist Imaad Zuberi, as well as the firm with which he is affiliated, Avenue Ventures. The company donated $900,000 to the inaugural committee, records show…

Trump’s inaugural committee raised a record $107 million to fund events and parties surrounding his assumption of office in January 2017, more than twice the amount raised to fund President Barack Obama’s inaugural in 2009.

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