Come for the politics, stay for the snark.

When someone says they “love freedom”, rest assured they don’t mean yours.

There is no right way to do the wrong thing.

There is no compromise when it comes to body autonomy. You either have it or you do not.

The most dangerous place for a black man in America is in a white man’s imagination.

Hey hey, RFK, how many kids did you kill today?

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

Some judge needs to shut this circus down soon.

In my day, never was longer.

Most of you should go to bed and try to be better Jackals in the morning.

Impressively dumb. Congratulations.

Tick tock motherfuckers!

Giving up is unforgivable.

You’re just a puppy masquerading as an old coot.

He really is that stupid.

The party of Reagan has become the party of Putin.

A snarling mass of vitriolic jackals

Fuck these fucking interesting times.

Michigan is a great lesson for Dems everywhere: when you have power…use it!

The republican speaker is a slippery little devil.

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

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

Within six months Twitter will be fully self-driving.

Republicans cannot even be trusted with their own money.

I’m starting to think Jesus may have made a mistake saving people with no questions asked.

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Bad directory data is persistent

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In a new Health Affairs Scholar article, Haeder and Zhu conduct a follow-up study on Pennsylvania insurance directories on the entries that they had identified as being wrong in their first study. The short version of the results is that bad data sticks around for a long time:

We re-surveyed inaccurately listed Pennsylvania providers (n = 5170) between 117 to 280 days after a previous secret-shopper survey. Overall, 19.0% (n = 983) of provider directory listings that had been identified as inaccurate were subsequently removed, 44.8% (n = 2316) of provider listings continued to show at least 1 inaccuracy, and 11.6% (n = 600) were accurate at follow-up. We were unable to reach 24.6% (n = 1271) of providers.

Why does this matter?

Currently, we regulate networks on the basis of their directories. We assume that the data is good and that it accurately-ish represents reality in the very recent pass. However, we know that the data is seldom good. The types of errors range widely from office hours being wrong (an error might be the directory listing hours from 9:00-6:00pm when it is really 9:00 to 5:00) or a doctor not working at an address any more as they completed their fellowship and are now three states over to the office not accepting a particular insurance at all or accepting new patients with that insurance.

Insurers have an obligation to update and correct their directories. Speaking as someone who was responsible for the UPMC Health Plan provider file from 2011-2014, that is an extremely difficult task. When I was working that task, directories were neither a profit center or a heavily regulated activity. We did our best but there was minimal competitive advantage to having a pristine directory. Newer regulations have put some teeth and cash incentives to having better directories but those are not huge.

Haeder and Zhu are showing that these incentives aren’t strong. Less than 1 in 8 identified errors were confirmed to be updated after they were identified. I would bet that if they resurveyed the good locations from their previous study, there would be a decent number of new errors. Data only stays good for short periods of time unless very substantial and expensive efforts are made to keep the data good.

As long as we rely on directory based network adequacy standards, insurers will have incentives to be optimistic about their reported networks. The Centers for Medicare and Medicaid Services is proposing to move towards wait time network adequacy standards. That approach will change insurer network directory maintenance incentives to more accurately reflect who is actually able to take patients. I think that might help a little bit.

* Why yes, I am in that weird liminal space between submitting my dissertation and defending it. More details tomorrow!

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Wednesday Morning Open Thread: Good News

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biden very deliberately targeting hispanic voters at a hugely cheap ad buy.

[image or embed]

— not an art thief (@famousartthief.bsky.social) Jun 25, 2024 at 10:43 PM

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COVID-19 Coronavirus (& H5N1) Updates: June 26, 2024

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This is really good — here’s a gift link, so you can read the whole thing:

… Right now public health experts have the difficult task of urging authorities who can do something about H5N1 to take action while maintaining public trust. Americans have just been through a pandemic that resulted in over one million U.S. lives lost. They may feel weary of more bad news or fear-based messaging. It is not easy but is important to communicate that the threat level for most people is low but that if nothing is done, it could become quite high.

No one knows whether H5N1, if left unchecked, will become the deadly pandemic that public health experts like me worry it could. Many of us have been watching H5N1 with alarm for more than 20 years…

Milk drinkers and meat eaters probably have little to worry about if they follow recommendations. Tests conducted by the U.S. Department of Agriculture and the Food and Drug Administration have so far confirmed that pasteurized milk and beef cooked to at least medium is unlikely to make anyone sick. (Though a recent experiment showed that milk may retain infectious virus after pasteurization if it is contaminated with high levels of H5N1, it seems unlikely that this will occur with pasteurized milk produced under real-world conditions.)

It’s riskier to consume raw milk or undercooked meat, both of which may carry infectious H5N1 virus and have caused outbreaks of other pathogens. Though we don’t yet know of anyone who got H5N1 from consuming milk or meat in the United States, cats that drank raw milk on H5N1-infected dairy farms have died.

Even if the food supply is largely safe, H5N1 threatens our economy. The virus is lethal to birds and has caused hundreds of millions of dollars in losses to the poultry industry and left consumers with skyrocketing egg prices last year. The response to H5N1 and other avian flu viruses on poultry farms has prompted swift containment actions that continue. The U.S.D.A. requires farmers to kill entire flocks if just one infection is identified.

In comparison, the response to H5N1 on dairy farms has been sluggish. Though cows are less likely to die from H5N1, the virus can make cows quite sick and decrease their milk production. Farmers in multiple states have killed infected cows that have not recovered from H5N1 infections.

Of great concern is that surveillance and response to infections on dairy farms is largely voluntary. Testing on farms is not systematic or fast enough to protect workers before they are exposed to infected cattle. In some states, health officials have been unable to get access to farms to monitor workers and investigate how the virus is spreading. This is why if anyone is kept up at night over bird flu, it should be those leading our agriculture and health organizations, who can protect farm workers and prevent a pandemic.

H5N1 is enough of a risk now to warrant action, before the virus becomes a pandemic threat to America. By that point, everyone will have to worry.

***********

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On The Road – snarlymon – Upper Antelope Canyon, Arizona

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snarlymon

In February of 2023 I flew from Denver to Phoenix to visit my sister who was competing in a tennis tourney there. The plan was to take a mini vacation to Sedona to visit a friend of hers after the matches. My sister had also booked a tour of Upper Antelope Canyon as a side trip, so early one morning we headed up to Page to catch our 12 o’clock tour.

The canyon is on the Navajo Reservation and can only accessed by booking a tour with a Navajo guide. Tour slots fill up fast, so if you are planning to visit you should sign up several months in advance. Lynn, my sister, made our February reservations in early November. Cindy, our guide, drove our van on the short drive out to the canyon, including a sandy bumpy ride over what resembled a trail.

Tours are managed so that you are not rushed through or pushed along by a crowd.  Cindy pointed out landmarks and features, gave tips on taking photos that she gleaned from professional photographers, took pics of individuals and the group and most importantly let you have time to appreciate the canyons space in solitude.

I didn’t bring my DSLR since I tend to obsess over shots spending time bracketing exposures and playing with different framing and focal lengths so all these photos are taken with an iPhone. If you do bring a dedicated camera make sure you have a good wide angle lens

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On The Road - snarlymon - Upper Antelope Canyon, Arizona 9
Upper Antelope Canyon, AZFebruary 6, 2023

This is the entrance to the canyon. The picture doesn’t really show the height of the rocks which is thirty to forty feet above the floor. The entry is the darker area to the left.

Late Night Open Thread: CO Primary Update

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Well, let’s rip off the bandage – Boebert won her primary bid – but as predicted, had there not been 5 other candidates, she may have lost decidedly, so far she’s not breaking 50% (UPDATE: her vote total has dropped to 43%). But the CO GOP is in disarray, so that happened. And CO4 gets what they deserve.

I know I said last night that I didn’t think the DEMS stood a chance in hell in that district (CO4), but looking at the numbers, I’m not as sure now – so I’m not going to write off that just yet. I think it might be worth throwing some of my time and money at it because it still feels like the Boebert hate is strong. If Republicans stay home this election – which is more possible here than in most states – or just refuse to vote for Boebert (she’s that divisive) the Dems might just squeak out a win. Improbable, but not as impossible as it was before she won the primary. See CO3 which she was in danger of handing over to a Democrat for the first time in decades.

The good news, and the only reason I’m bothering you with local politics is because the Colorado GOP leadership that endorsed burning Pride flags and hate and violence during Pride month and also changed all their rules so they could endorse primary candidates (all of them far, far right) got their asses handed to them tonight. Most of their endorsed candidates lost by 60/40 margins or worse. That includes the leader of the GOP, Dave Williams.

This also meant that a majority of Trump-endorsed candidates went down in flames, too.

I suppose this means that despite the takeover of the GOP party by these hate-filled nutjobs, the actual voters could see through their BS. That doesn’t mean any of the actual primary winners are anything but right of center, but aren’t MAGA, so that’s a start.

Those big losses might just be enough for the CO GOP to boot Williams ass out as party leadership, but who knows, they are all as bat shit crazy and hateful as he is, so getting the 60% needed to oust him seems iffy.

Here’s a breakdown of candidates endorsed by the MAGA CO GOP party vs what voters actually decided. Enjoy.

Otherwise, this is an open thread.

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And to cleanse your palate here’s cute Reggie photos – does he take any other kind?

Reggie on the highest counter in the kitchen
And they said he wouldn’t be able to jump. LOL

 

Reggie sleeping with a stuffed elephant
Snuggled down with his stuffed Elephant (which was actually Bixby’s)

 

 

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War for Ukraine Day 853: A Brief(ish) Tuesday Night Update

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Painting by NEIVANMADE. It has a white background an in the center are Soldiers in green doing air defense by firing at incoming Russian missiles in the upper right. The missiles are red and yellow. In the upper left, written in green, is the text: "SAVE THE BRAVEST PEOPLE IN THE WORLD!" Below the Soldiers, also written in green, is "SUPPORT FOR KHARKIV"

(Image by NEIVANMADE)

Quick housekeeping items: First, Rosie is still doing well on the day after her chemo treatment. Thank you all for the good thoughts, well wishes, prayers, and donations.

Second, very long day today. Got a couple more this week, so I’m going to try to keep this as brief as possible tonight.

Here’s the butcher’s bill from Russia’s attacks on Kharkiv over the past 24 hours.

Over the past 24 hours, russian forces targeted the city of Kharkiv and the Kharkiv Oblast with 42 aerial bombs. The bombardment destroyed or damaged 40 houses and shattered more than 1,000 windows in Ukraine’s second-largest city. Footage taken right after three russian air bombs struck Kharkiv this morning.

Here is President Zelenskyy’s address from earlier today. Video below, English transcript after the jump.

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Can’t Win for Losing Open Thread: ‘An Inconvenient Gift: Green Jobs’

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I can certainly see Repubs, given the chance, cutting off their constituents’ economic noses to spite President Biden… but I don’t see how this is bad news for *Biden*. Lots more at the link, from Bloomberg:

The single largest investment in the burgeoning US green energy supply chain involves a construction site the size of 121 football fields near Greensboro, North Carolina, and a check for $13.9 billion. By 2030, the Toyota Corp. facility could be employing more than 5,000 people cranking out enough batteries to power half-a-million new electric vehicles each year.

What’s not to like about that? This seemingly rhetorical question actually demands an answer given America’s partisan divide over climate change.

The Toyota project, which began with a $1.3 billion initial investment announced in 2021, massively expanded after passage the following year of the Inflation Reduction Act (IRA), President Joe Biden’s signature green legislation offering hundreds of billions of dollars in subsidies for clean technology. The IRA was unanimously opposed by Republicans in Congress. Its cousin, the Infrastructure Investment and Jobs Act, containing a smaller set of cleantech subsidies, was nominally bipartisan but only drew 13 “yeas” from House Republicans when it passed in 2021.

One Republican critic of the IRA said, using fairly typical language, that it would “raise taxes” and “throw money at woke climate and social programs that won’t work.” That critic, Rep. Richard Hudson, represents North Carolina’s 9th district, which happens to be where Toyota is building that mammoth battery plant.

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