Ne’er So Well Expressed

November 30, 2009 at 12:27 am (By Amba)

Doctor Zero at Hot Air’s Greenroom just said something that has been knocking and nagging at me to get said, too.  I concede with relief:  it has found a much better outlet.  This is what has been lost in the partisan and ideological tug-of-war between alternating derangement syndromes.  This is the country, one nation, under God, indivisible, to which too many have abandoned allegiance in favor of allegiance to their “side,” their team, their half a brain.  I will try to resist the temptation to quote it all.

I wonder how truly desirable these uncompromising contests between capitalism and socialism are. Aren’t elected officials, especially Congress and the President, supposed to represent all of their constituents? Wouldn’t that mean listening to the concerns of both liberals and conservatives, and trying to craft legislation that satisfies both sides to some degree? Are the members of a winning political coalition supposed to have absolute power to do whatever they want, even if they won with only about half the popular vote, while the other side sits in obedient silence until their next chance at the ballot box?

In the course of endorsing a Dick Cheney run for the Presidency in 2012, Jon Meacham of Newsweek writes:

One of the problems with governance since the election of Bill Clinton has been the resolute refusal of the opposition party (the GOP from 1993 to 2001, the Democrats from 2001 to 2009, and now the GOP again in the Obama years) to concede that the president, by virtue of his victory, has a mandate to take the country in a given direction.

I don’t think most Americans are under the impression they’re voting for a dictator every four years. Bill Clinton won the Presidency with a mere 43% of the popular vote. What sort of “mandate” did that give him to “take the country in a given direction?”

Of course, we cannot parcel out presidential powers based on the scale of the candidate’s electoral victory. The proper functioning of our government, and the harmony of our democracy, demand that we acknowledge the full legitimacy of the man or woman who sits in the Oval Office. The Left did their country no favors by bitterly dragging the 2000 elections out until 2008. The complementary aspect of this principle is that strong electoral victories cannot logically yield enhanced “mandates” to take the country in various radical directions. If close elections don’t produce miniature Presidents who just keep the seat warm until the next election, then landslide victories don’t produce super-Presidents with turbocharged authority. A President who carries 49 states, and wins 70% of the popular vote, is not entitled to stuff the opposing 30% of the electorate in the trunk and take America out for a joy ride. [...]

The American understanding of democracy does not envision voters as slaves who enjoy the privilege of voting for a new master every few years. When the Declaration speaks of the right – and, later the duty – of the people to abolish tyrannical governments, it renders the notion of “mandates” to impose radical change on unwilling citizens absurd. [...]

The dissent of a minority is not rendered irrelevant by victory in a popular vote… but the health-care debate in the Senate proceeds on the assumption that victory in a parliamentary struggle between a hundred elected officials will compel the consent of the millions of citizens – now a sizable majority of the population, based on the latest polls – who strenuously object to ObamaCare. [...]

The vital role of consent in the structure of a just government is one of the most powerful ideas ever advanced by the human race. [...] The need for your consent is not respected when your only hope of withholding it lies in historic midterm electoral victories and the rapid construction of huge Congressional majorities.

Go, read the whole thing.  Now how to put this (I’m in an inarticulate phase):  I do not quite see the health care bill in such dire terms as Doctor Zero does.  I see it as unacceptable — burdensome, bureaucratic, inefficient, vastly overpriced, with many little pit traps hidden in its obfuscating length –  but not as the calculated first step in a Stalinist power grab.  Democratic socialism, European style, may not ever suit America, but neither is it dictatorship.

What bothers me more than the health care bill itself, or inseparably from it, is the way it is being rushed and rammed through.  The majority of Democrats, the Congressional leadership above all, care only about party power and vanity.  They have to grab their chance to piss on the country and put their territorial mark, their stink, on it.  Many Republicans would do exactly the same (thank God or the BFFs — Best Founding Fathers evah — it takes more votes than most majorities get to amend the Constitution), but it’s hard to separate out their motives right now because all they can do is try to stop this juggernaut — whether for partisan or nonpartisan reasons.

But what kind of country is it when whichever rogue fragment is in power tries to impose its will, while the other merely does its best to sandbag that?  The best that can happen is that we go nowhere, because each loco motive is trying to drag the train off the rails.  Why has Afghanistan been subjected to an exhaustive review of all points of view, while health care has been all hugger-mugger?  If you really cared about the state of the country, why would you try to force a prefabricated and dated agenda on it?  Wouldn’t you start fresh, take your time, listen to your citizens, and invite the best ideas from all sides?

Wouldn’t that, among many other things, have been the best way to get reelected?

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What’s On My Mind

November 29, 2009 at 1:20 pm (By Amba)

My “tweet cloud” for the past month:

words (ordered by most used)

  • people
  • time
  • maybe
  • love
  • makes
  • true
  • obama
  • actually
  • look
  • read
  • palin
  • wall
  • theyre
  • mean
  • hasan
  • party
  • probably
  • remember
  • kids
  • theres
  • friend
  • word
  • thanks
  • women
  • book
  • life
  • world
  • name
  • care
  • else
  • hate
  • tweet
  • berlin
  • president
  • sound
  • trying
  • quotes
  • taking
  • funny
  • guess
  • seen
  • story
  • call
  • looks
  • hear
  • wrong
  • words
  • real
  • list
  • anyway
  • reading
  • sleep
  • bill
  • understand
  • sounds
  • house
  • gotta
  • heard
  • matter
  • start

I just love that “maybe” is one of the top three words.  Ambivalence is my middle name!

(Where’s “time” in the cloud, though?  I don’t have time — that’s probably the sense in which I most often tweet the word!)

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Songs of the Season

November 27, 2009 at 1:27 pm (By Randy)

It’s Beginning to Look a Lot More Riskless

The Dollar & Its Diving (“The Holly & the Ivy”)

Cinders of Ayn Rand (“Winter Wonderland”)

Marcy Shaffer’s entire Holiday Songbook is available on the Versus website. Other hits include:

Malay Ride

Exchanges Have Occurred on High

The Reindeer Sing (“Hark! The Herald Angels Sing”)

Just Following Borders (“God Rest Ye Merry Gentlemen”)

Go Tell It In Accountin’

Enjoy!

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So Much to Be Thankful For!

November 26, 2009 at 5:09 am (By Amba)

That we and everyone else (two-legged and four-legged) escaped the fire unhurt.

That blogfriends gathered around and wove me a magic carpet to camp out on.

That by so doing, they gave my steadfast and uncomplaining family a welcome break from doing the same.

That my parents are not only still alive but enjoying it to the hilt.  (That the state of Florida just renewed their drivers’ licenses at 86 and 92.  That settles it, I know where I’m spending my golden years.  VROOOM.)

That my sibs and their growing and grown kids and new grandkids are all healthy — incredible!  So blessed!

That I still have my health and strength, enough to keep J home, enough to move 35 boxes of books by myself and not have to lean on everyone for everything.

Hospice, just in time.

That hospice and the Red Cross and the landlord and the emergency reconstruction/relocation service they hired have made the dislocation as easy as it could possibly be for us.

That I get to practice slash-and-burn (oh no!) housekeeping — to move into a fresh new apartment instead of cleaning up!

That my rent has actually gone down.

That J slept through all of the moving this morning, including my getting him dressed and up and into his wheelchair so the movers could move the bed.

That friends IRL are being friends this year, and making the holidays holidays instead of hellidays:

  • Chris the physical therapist, who (putting to shame my complaints about her one-time no-show) warned me to mop the dust off the floor of the newly renovated apartment (she wanted to get down on her knees and do it herself, but she was going out of town; I easily did it dojo-style, scooting a folded wet towel back and forth across the floor), and who then came back and cleaned the whole kitchen for us before we moved into it; who found me a wool Oriental rug for the bedroom at the thrift shop for $100 (I was worried that J would pee on it; he already has).  (Thankfully,  not much.)
  • Chris (another Chris), the attentive and courteous dojo student/young father in his 30s, who came over today with his wife, moved all our kitchen stuff and much more while we were at J’s gym (this I slept through), and then welcomed us back with a coffee housewarming.
  • Kris (I know, it’s ridiculous, like half of Russia being named Sasha), the sole residential karate student, in his 20s, who’s unquestioningly moved stuff for us and regaled us with tales of his native Hawaiian/Southern/German/Cherokee clan.  He and Chris (#1 above) are coming over for sage-and-garlic-butter-basted turkey breast tomorrow.
  • Erin, another student in the dojo, young mother (including of a baby girl adopted from Somalia) who’s invited us and Kris for a second Thanksgiving on Saturday.
  • Nathan, the karate instructor, and the reason we moved here in the first place, with whom we’ve had our ups and downs (which just goes to show that the relationship is a close one), but who showed an amazing efficiency at coping with crisis on the day of the fire, and who (while out of town himself) may be quietly behind this flurry of hospitality.

That after the housewarming, we wheeled into our southwest-facing new bedroom — and a rose and violet sunset.

My new tree.  (More when I figure out where I put the photo-transfer cable.)

Charlie Miller!

Ron!  (Yeesh!  So many close calls!)

Lucy!

Someone new on the way who is fiercely anticipated and celebrated (just not public news yet).  A Cat, perhaps.

And neither last nor least (this list could go on and on) — mysterious rumblings of optimism from my beleaguered employer, made palpable and plausible by an unexpected paycheck in full.

I can’t improve on the way Charlie Miller’s father put it:  “Yeah, times are tough for everyone [...] and the world may be going to hell in countless ways — but I have never in my life had a Thanksgiving in which I was so filled to the brim with gratitude.”

Me neither!  I mean, me too!

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Models are fine. People stink.

November 26, 2009 at 5:03 am (By Ron)

Gasp, a topic I have a fair amount of experience with! I’ve built tons of models, simulations of all kinds of things, as a part of my profession for years now. I even have a certain fondness for them. But I have to admit most of them are useless in practice, and frankly I’m glad I haven’t built any for awhile, for the problem is not the modeling of a system but the people who use it.

Look, why build a model? It allows you the ability to test hypothetical things and designs for a tiny fraction of the cost of actually building them. With the best models, people give you accurate data, make their assumptions explicit, and tweak, tweak, tweak the damn thing until it more or less works the way you would like to see. This would be about one project in fifty. A well designed model clarifies the mind and makes it clear to as many people as possible why you choose to build something in a specific way. Transparency, repeatability, and explicit thoughts and designs are what you should communicate with a model. But I can count the projects where that was so on one hand.

But how do I put this? People are lazy, vain, pompous liars who want a model to be some kind of Magic Ju-Ju that somehow make the stupid seem brilliant. Nearly every person who has hired me to make a model wants me to lie to somebody; it’s a lie with a technological sheen, so they can be unquestioned by people who don’t have contradictory models, which is nearly always the case. At least half the time people have made it very clear to me how my getting paid was tied to how pretty a lie I was able to give them. They never wanted to go through the process to begin with; they were just ordered to urk up a model which would make it look like they were serious.

Groupthink, like we see in the climate people, I think is the norm, and no model will override that. When language comes up with a fool-proof way to prevent lying, then many, many things in human life will go much better than they do…

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The Disease of the 21st Century?

November 25, 2009 at 11:36 pm (By Ennui)

I seem to recall coming across a quote from Martin [edit: actually Kingsley] Amis to the effect of “much of what was wrong about twentieth century literature can be summed up in the word workshop.” I find no reference to this quote online and it’s possible (verging on probable) that I’ve either mutilated it beyond recognition or invented it out of whole cloth in a fever dream. In any case … real or imagined, the quote put me to thinking about “climategate” and the significance of using computer models that cannot, in practice, be tested experimentally, to make predictions used to direct large scale social and economic change. This thought, in turn, put me in mind of the calamities wrought by the use of computer models to calculate risk in the stock and bond markets … I’m on the point of issuing my own dictum along the lines of “much of what was wrong at the beginning of the 21st century could be summed up in the word model.”

And, whether Amis actually uttered the phrase I alluded to above, or whether I only imagined it, the quote captures a parallel and essential truth – that there is all the difference in the world between a hothouse reconstruction of the world (whether in equations or the sentences of a novel) catalyzed by groupthink and untested (and untestable) by experience and the real thing (or, compare, real science that makes definite predictions).

Simulation is not science, anymore than it’s literature.

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The Signal Must Be Costly.

November 24, 2009 at 3:06 am (By Amba)

This explains so much, somehow.

The basic idea behind [the costly-signaling] hypothesis is that animals need a means to communicate, i.e., to signal to kin and strangers their abilities, intentions, and fears.  In order for individuals to trust the veracity of the information that is presented, it is argued that the signal must be costly to produce.  If it were not costly to communicate, then individuals would regularly lie and cheat.

The classic costly signal is the peacock’s tail.  The tail makes the bird more vulnerable to predators, but the message to the potential mate is, “I have survived in spite of this huge tail, hence I am fitter.” Similarly, it is possible that mobbing behavior is an honest signal by which adult male tarsiers advertise their quality as potential mates.  The idea of mobbing as a costly signal is intriguing, because by approaching a predator, an individual can advertise very specific information.   While aggregating around a potentially lethal snake, tarsier males may demonstrate their current physical condition, agility, and speed.  This information would be very useful for a subadult female who is making a decision about whether to stay longer in her parental group, or disperse and establish her own group.  Mobbing may be a way for young females to evaluate the ability and willingness of males to protect them and their future offspring against potential predators.  The observation that males are more likely to join mobbings outside their territory [especially when subadult females are present] provides some potential indication that intense mobbing by spectral tarsiers males may represent costly signaling.

~ Sharon Gursky, “Function of Snake Mobbing in Spectral Tarsiers”
American Journal of Physical Anthropology 129:601–608 (2006)

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Newsbreak

November 23, 2009 at 10:27 am (By Randy)

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“Frankly, I Call It Fraud”: A Guest Post on Healthcare [UPDATED]

November 23, 2009 at 3:14 am (Guest Post)

The following was written by a woman whose husband died of a dementia similar to J’s.  It is reproduced here with her permission.

Did anyone see “60 Minutes” tonight where they addressed end-of-life care?  It was quite interesting and certainly appropriate for what many are going through.  They were discussing whether putting people in hospitals when they were at the end of life was more costly, and one woman told of the thousands of dollars worth of bills for her mother, who was terminal with heart and liver failure; yet they did a Pap smear on her, took all kinds of tests, called in a psychiatrist because she was “depressed.”  She told them that she, of course, was depressed because she was dying.

I assume it was a doctor speaking, and one of the things mentioned was that hospitals have to have beds filled and tests given to keep their profit level up.  They also have several doctors “looking after” the patient, mostly so that each can bill separately.

I can certainly relate to that.  When my husband first went to the hospital for a broken bone, he was immediately put on Hydrocodone, even after I told them he didn’t do well on strong pain meds.  Then, they called in a psychiatrist, because he was hallucinating – duh???  [ed:  This is a common feature of "our kind" of dementia -- though J mostly doesn't have it -- that can be exacerbated by medications.] Each doctor referred him to another doctor, and at the end of three days, I don’t know how many doctors had supposedly seen him.  Then, he was referred to the rehab hospital, where again, another psychiatrist was called and proceeded to give him several different antipsychotic drugs.  Again, he was referred to several doctors, when all that was supposed to be done was rehab on his injury.

They said that many patients never read their hospital bills, because Medicare of Medicaid is paying for it.  Believe me, every one of his bills was gone over by me, and I was appalled at the cost of things and the number of drugs that he had been prescribed in addition to his Aricept and antidepressant.   I counted the meds they gave him, and between the meds, supplements, etc., he was given 16 different types of pills.  I checked them on the drug interaction site and some of the ones he was taking should not have been used with others, and some it said not to be given to patients with dementia.

The bills from the nursing home were absolutely incomprehensible, and when I would question them, they couldn’t even answer the questions.  If you don’t think there is fraud in the system, just check things out.  While he was on a catheter for several weeks, they still billed for Depends.  I checked them each time I was there, and the package had the same amount in it every day.  When I asked about this, they told me that’s what was allowed.  When he was taken off food and water on the last day of the month, they still ordered his Aricept, Celexa, Seroquel, and other drugs when they knew he was dying and were expecting it any moment.  So, where did those drugs go?  He certainly didn’t receive them.  I could cite many more examples.

I continued to receive notices from Medicare and his secondary carrier for more than two years after his death.  Some were notifications of payment to doctors I didn’t even know he had seen.  One had even moved out of the area.

The hospital where he went now has hospitalists who direct hospital care rather than the patient’s own doctor.  Then, they refer different doctors for each thing.  So, he had psychologist, neurologist, urologist, physical therapist, and I don’t know what all referrals; each one billing separately.  If I recall, they even had a different doctor that billed for his dismissal.
When I figured up all his bills for the approximately last two years of his life, they were nearly $80,000, and that did not include the cost of the nursing home care.

Needless to say, I have a lot of pent-up feelings about the medical profession, and as long as we have greedy doctors, hospitals, and nursing homes, we are going to have fraud.

Have I stirred up a hornet’s nest?

Ed.:  The woman who tells this story says that she doesn’t blame Medicare or Medicaid for this state of affairs (her own experience, as I understand it, was solely with Medicare), but rather “the greedy medical profession,” “including insurance companies, doctors, hospitals, etc.,” and that her specific objection is to the unnecessary overtesting, overtreatment, overmedication, and overbilling, whether due to defensive medicine or profit-seeking.

How should sensible healthcare reform tackle this problem?  It is wasteful, costly, and as often as not, harmful to the patient.

UPDATE: Ed.: I asked my doctor sister to comment.  Here’s what she said:

I don’t know what to say. It’s hard to read about someone’s awful health care experience and be able to say anything meaningful. But the majority of Dr’s aren’t venal and evil or see awful end of life situations such as this as opportunities to make a buck. The hospitals I’m not so sure of.

The way medicine is practiced now is by individual specialists who take care of their little niche and don’t want to be bothered about anything else. Why? Many Dr’s avoid primary care because it’s hard to be the jack of all trades and the master of none.  And the reimbursement sucks. And the paperwork is unconscionable. And more. Plus if you’re a specialist and do procedures you get paid more the more of them you do. Duh. So no one is really taking care of the whole patient, they’re just shoving their tube in their orifice of expertise.

But I also have a serious problem with patients’ expectations. Everyone wants more health and more testing and more access. What happened to common sense?  When a dying demented person is admitted to the hospital the institution takes over to some degree.  The nurses want the patient to be quiet and not too much bother (sorry but it’s true). The Dr’s dread the sad and often angry family who wants their loved one not to suffer and it’s up to us to FIX IT. And it’s not unusual to have several family factions who want different things and we get caught in the middle. Hospitals are terrible places for the dying and one of these health bills will also have provisions for expanding hospice care.

That would be worth a lot.  I can attest that hospice is probably one of the most cost-effective, as well as compassionate, things you could do.  It only kicks in when there is a condition that is incurable and eventually fatal.  Heroic, expensive, and futile efforts are over or have been forsworn.  They will leave no stone unturned when it comes to physical and emotional comfort, but that is mostly low-tech and relatively low-cost.  SAVING is the word.  It won’t save your life, but it can save money and it can save your sanity.  It minimizes both expense and suffering.

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Phone Store Hell, Part Deux [UPDATED]

November 21, 2009 at 9:56 am (By Amba)

J was sleeping soundly yesterday evening, so on my way to get milk and eggs at Whole Foods, on a side trip I darted into the AT&T phone store to switch out my defective phone.  (This is the crappy model that cost $1 to make somewhere offshore, for which they charge $29.99; the “Select” button would scroll instead of select — I’d pick a ringtone, press “Select,” and it would go to the next one.  I’d also have to make several tries to unlock the keypad.)  All three cash registers were busy, but I managed to get a floating floor rep to cut in on one during long negotiations between another rep and a customer.

While I was waiting (the state sales tax percentage had apparently changed in the past month, making the swap mathematically challenging), I read, upside down, a printout on the service podium that was titled, I kid you not, TRIAGE.  It was a script, detailing word for word how to elicit, massage, and shepherd the customer’s concerns.  [wording approximate] “I understand that you are frustrated with your phone.  If I can’t help you with that, I’ll connect you with someone who can.”  “While you’re waiting for your [product], why don’t you take a look at this one?”

He told me I didn’t have to return the box to avoid the $35 “restocking fee,” but I did have to try one more time with the same model phone.  No upgrade without punishment for having been a cheapskate the first time.  I felt as if I’d married the damn phone, had gone in for an annulment on the grounds that it had misrepresented itself, and was getting marriage counseling instead.

He told me it’s a very good model and they’d never had this problem with it before.  (He acknowledged that he himself had the problem when trying to work the phone.)  He switched the SIM card into an identical model and, all in all, the transaction with wait time only took about half an hour.  (I wondered if J was freaking out and slinging his leg over the bed railing.  It can happen if I’m gone for more than half an hour.  I had set up the old-fashioned corded phone for him — he doesn’t understand the cordless — but was afraid to call him because I’d put the phone in the bed beside his hip, the only place it would fit, and there was a good chance he wouldn’t be able to figure out where it was and would then freak out, if he hadn’t before.  Fortunately, he was fine this time.)

When I got home I forgot to plug the phone in immediately.  I’m not that into cell phones, brain tumors, etc.  So maybe what happened next is my fault.

When it started peeping piteously this morning, begging for juice, I plugged it in and it immediately said, “SmartChip registration failed.”

I called the local-looking number below the store address on the receipt.  Ten minutes of phone tree later, I was talking to someone in India.  I hung up.

Maybe that was a mistake.  Maybe the guy in India, reading from his own TRIAGE script, would have held my hand and guided me through taking the SIM card out and putting it back in.  Maybe he could have sent it a remote signal all the way from Bangalore that would have straightened it up.

I just had this sinking feeling that after another half hour on the phone, he was going to send me back to phone store hell.

UPDATE: Theologically corrected, per Ruth Anne:  phone store purgatory.

As I wrote in the comments:  “I went over to the phone store. The guy turned the phone off, turned it back on again, and it worked. The guy on the phone in India could’ve told me that. This one was from India, too. Those guys from India are smart!”

I spoke too soon.

I got it home, and the first time I tried to do something with it, it said again, “Smart Chip Registration Failed.”

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