He supports gun control, yet he's blowing people away?

Liberals. Can't live with them, can't shoot them.

He's also a fan of Piers Morgan.

I wasn't sure before, but wow, this dude is crazy...

It's not uncommon for mass murderers to say that they shouldn't have been able to get away with what they did. (And yes, often while simultaneously bragging that they'll never be caught.) In addition to the general point that insanity inhibits one's ability to make logical arguments, I think it's another way in their warped minds to make "society" in general responsible for their heinous actions: If society weren't so ###### up to begin with, then I couldn't even be doing this.

Similarly, note that he requests that his brain be studied to, essentially, see what went wrong. The '60s University of Texas bell tower shooter, for instance, also did this. So, despite endless pages of how it's everyone else's fault, he ultimately does know that something is wrong with him and that what he's doing is wrong.

Anyway, the guy seems to be intelligent, and we know he's tried to do admirable things in the past, but to say he's "snapped" is the understatement of the century. It's a horrible tragedy. (Lines like "Guess I'll miss shark week" are almost funny in a sad way.)

Wow, I can't wait until they start using drone to take out cop killers.

Does it also work on cop killers?

Worst programming bug ever:

drone_targets = 'select * from automobile where type='pickup' and color='blue'

(leaving off the 'and license_plate = 'CA7ADE223' clause)

drone_targets = 'select * from automobile where type='pickup' and color='blue'

Then some idiot trying to fix the problem manages an accidental Cartesian join (write your joins properly people) and now we have SkyNet on the loose with Arnold killing all the Sarah Conners. It starts in California, oh yes it does.

Ah yeah, the old cross join. Those are burned in my memory after having missed a question about them in an interview. They're pretty hard to use accidentally, though, since they're pretty rare.

Ah yeah, the old cross join. Those are burned in my memory after having missed a question about them in an interview. They're pretty hard to use accidentally, though, since they're pretty rare.

If yuou bring in a table and don't join to it with conditions it will just Cartesian that bad boy in without any additional effort (In most databases).

EDIT: My apologies to everyone with the SQL talk.

Bruce Willis on gun control:

"You can't legislate insanity."

The fundamental problem with the liberal argument on gun control, neatly summed up.

Yeah, so let's go all in on facilitating the damage insanity can do.

Cartesian joins definitely should not be the default for the "no join" SQL. It should be a join that you must call for explicitly. I'd rather have a no-join SQL fail.

Cartesian joins definitely should not be the default for the "no join" SQL. It should be a join that you must call for explicitly. I'd rather have a no-join SQL fail.

Yeah but the syntax - the more modern SQL syntax that all the kids use :) - is slightly more annoying to use, so of course I don't unless forced. Stupid SQL Server (and others).

Aside: Oh look Ray doesn't understand a liberal position. It must be today.

Similarly, note that he requests that his brain be studied to, essentially, see what went wrong. The '60s University of Texas bell tower shooter, for instance, also did this.

He had an amygdaloid tumor. Basal ganglia represent!

I'm pretty sure that inner joins are the default joins if you don't specify what type of join you want for most flavors of SQL. I could be wrong about that, so I'll test that later. Nobody should do that, anyway.

Looking over what wikipedia has to say I ran across Natural Joins. I have never heard of any such thing before and I have been doing this stuff since the early '90s. Natural joins? Huh.

Anyway I am talkng about implicit cross joins, which SQL server allows (I just tried it, and I am near positive Oracle allows it), though of course it is a terrible idea (if you need to do it, which does happen, make it explicit).

Next up normalization: Do you ever really need to go past 3rd Normal Form?

[212] It is in T.

I dont always write SQL, but when i do I use an orm.

orm

You still have potential potential impedence issues.

I want to do more OO and/or no-SQL stuff, but not much opportunity.

Dr. Hibbert: Homer, I'm afraid you'll have to undergo a coronary bypass operation.
Homer: Say it in English, Doc.
Dr. Hibbert: You're going to need open-heart surgery.
Homer: Spare me your medical mumbo-jumbo.
Dr. Hibbert: We're going to cut you open and tinker with your ticker.
Homer: Could you dumb it down a shade?
— The Simpsons

- \"#### Layman's terms, do you speak English?"
— Event Horizon

Press more buttons

I dont always write SQL, but when i do I use an orm.


Announcer: "His Cartesian joins have subsecond reponse times. He is the most interesting man in the world."

Bush's paintings--from the email hack--are stranger than I expected. They aren't great, but I had him pegged as a lighted cottage on a snowy hillside kind of guy. They might not be good but they aren't sappy.

first one

second one

All of this SQL talk brings me back to the longest 2 1/2 years of my life. Hotline database support in the early days of PC databases (mostly Zim and Ingress if anybody cares)

Do you ever really need to go past 3rd Normal Form?

Only in an interview (or similar)

Bush's paintings--from the email hack--are stranger than I expected. They aren't great, but I had him pegged as a lighted cottage on a snowy hillside kind of guy. They might not be good but they aren't sappy.

It reminds me of the ED ads with the couple in the bathtubs in the forest.

There's something weirdly poignant about the disembodied eyes in the shower mirror looking back at him and us. It's like the stuff in the Folk Art Museum, naive but not dumb. This makes perhaps two things--with jogging--that George Bush can do better than me.

This makes perhaps two things--with jogging--that George Bush can do better than me.

You sound like a hell of a brush-clearer.

My favorite crazy politician doodles are Sarah Palin and especially Newt Gingrich. Feel free to post crazy doodles by liberals, I'm sure they're out there but I just don't know about them.

My favorite crazy politician doodles are Sarah Palin and especially Newt Gingrich. Feel free to post crazy doodles by liberals, I'm sure they're out there but I just don't know about them.

Semi-related.

I expected Palin's to have more unicorns on it.

This makes perhaps two things--with jogging--that George Bush can do better than me.

Wow, you can fly jet fighters and have been elected to national office?!?

Fear not, your secret identity of mild-mannered wannabe academic is safe with me, Delusions of Grandeur Man!

Semi-related.

The rigorously unfunny Hagel response should be enough to disqualify him from the Secretary of Defense spot by itself. But wtf with Santorum and Hollings writing back to say they enjoyed laughing but couldn't think of a joke?

Fear not, your secret identity of mild-mannered wannabe academic is safe with me, Delusions of Grandeur Man!

Who you calling a wannabe academic?

Late last month, Rick Brattin, a Republican state representative in Missouri, introduced a bill that would require that intelligent design and "destiny" get the same educational treatment and textbook space in Missouri schools as the theory of evolution. Brattin insists that his bill has nothing to do with religion—it's all in the name of science.

"I'm a science enthusiast...I'm a huge science buff," Brattin tells The Riverfront Times. "This [bill] is about testable data in today's world." But Eric Meikle, education project director at the National Center for Science Education, disagrees. "This bill is very idiosyncratic and strange," he tells Mother Jones. "And there is simply not scientific evidence for intelligence design."

HB 291, the "Missouri Standard Science Act," redefines a few things you thought you already knew about science. For example, a "hypothesis" is redefined as something that reflects a "minority of scientific opinion and is "philosophically unpopular." A scientific theory is "an inferred explanation...whose components are data, logic and faith-based philosophy." And "destiny" is not something that $5 fortune tellers believe in; Instead, it's "the events and processes that define the future of the universe, galaxies, stars, our solar system, earth, plant life, animal life, and the human race."

The bill requires that Missouri elementary and secondary schools—and even introductory science classes in public universities—give equal textbook space to both evolution and intelligent design (any other "theories of origin" are allowed to be taught as well, so pick your favorite creation myth—I'm partial to the Russian raven spirit.) "I can't imagine any mainstream textbook publisher would comply with this," Meikle says. "The material doesn't exist."

The bill also establishes a nine-person committee (who must work for free) responsible for developing ad-hoc textbook material until appropriate textbook material is found.

Science!

Fairfax County parent wants ‘Beloved’ banned from school system

The book Laura Murphy wants removed from Fairfax County classrooms is considered a modern American classic. It is a Pulitzer Prize winner and a masterpiece of fiction whose author’s 1993 Nobel Prize in literature citation said that she, “in novels characterized by visionary force and poetic import, gives life to an essential aspect of American reality.”

But Toni Morrison’s “Beloved,” Murphy said, depicts scenes of bestiality, gang rape and an infant’s gruesome murder, content she believes could be too intense for teenage readers.

...

“I’m not some crazy book burner,” Murphy said. “I have great respect and admiration for our Fairfax County educators. The school system is second to none. But I disagree with the administration at a policy level.”

...

Now a freshman at the University of Florida, Blake Murphy, 19, recalled reading the book before bed and having night terrors after he fell asleep.

“It was disgusting and gross,” he said. “It was hard for me to handle. I gave up on it.”

School officials point out that AP English is a college-level class that often involves discussions of adult topics.

Blake Murphy sounds like a really fun guy.

They aren't great, but I had him pegged as a lighted cottage on a snowy hillside kind of guy.

There's one of those in the last Smoking Gun image.

The one of him standing in the shower, I'm curious if him and the mirror not lining up was intentional (which would be kind of interesting) or if he just screwed up the angles.

My favorite crazy politician doodles are Sarah Palin and especially Newt Gingrich. Feel free to post crazy doodles by liberals, I'm sure they're out there but I just don't know about them.

I have a disturbing number of random MS Paint doodles that I'm not sure why I doodled. I'd be sort of embarrassed 30 years from now if someone found my doodle of Calvin Pickering decapitating Syd Thrift or John Boehner having a child's tea party with Snuffleupagus. And my dream log is a whole additional level of derangement.

Having trouble deciding which is more Galt-y - The rugged individualism to demand someone turn over their property to you with no compensation, or personal freedom to call in the UN for help.

Dagny, Dagny, you oughta go ahead and hang me....

With the current brouhaha between Rick Perry and Jerry Brown, I just like to say that Rick Perry is a dick. That is all.

232. spike Posted: February 09, 2013 at 06:15 PM (#4366204)
Having trouble deciding which is more Galt-y - The rugged individualism to demand someone turn over their property to you with no compensation, or personal freedom to call in the UN for help.

Dagny, Dagny, you oughta go ahead and hang me....

don't you see, if a person doesn't own his own name, what does he own?

my doodle of Calvin Pickering decapitating Syd Thrift or John Boehner having a child's tea party with Snuffleupagus

Please post.

Being President is a very hard job. Two of the reasons that's true work against each other, kind of: 1) it requires making thousands of decisions about incredibly varied and complex subject areas, and 2) screwing up any one of the big decisions can be utterly devastating. Grady Little waited too long to remove Pedro Martinez from an elimination playoff game, and was fired on that basis. I'd like to think I wouldn't have made that mistake if I were the Red Sox manager (I called it correctly on my couch ;-) That would indeed constitute a plausible argument that I'd be a better manager than Grady Little: I wouldn't have made a career-ruining mistake that he did make. But I'm reluctant to say that, because Little had innumerable other responsibilities and decisions in his managerial career, and I don't know if I would have been better on those (realistically, it's very likely that I would not have been). Similarly, I'd like to think I wouldn't have gone to war with Iraq, but I'm still reluctant to say I'd have been a better President than George W. Bush.

Answers like "I can't think of a particular joke I like, but I enjoy laughing" are part of the reason people hate politicians...

And 3) the President unlike, say, a CEO of a company, or a manager of a baseball team, has a shadow government instituted in the system always trying to undermine him every step of the way.

Little known fact: Mr. Snuffleupagus has a first name, and it is Aloysius.

Little known fact: Mr. Snuffleupagus has a first name, and it is Aloysius.

My baloney has a first name, and it's O-S-C-A-R.

Please post.

Here's the tea party one. I literally have no idea what the reasoning behind it was. It feels like there was going to be more. I like doodling on MS Paint.

BILLY IS BACK? GLORIOUS.

Dan, this is the coolest thing you've ever done, including ZiPS.

Being President is a very hard job. Two of the reasons that's true work against each other, kind of: 1) it requires making thousands of decisions about incredibly varied and complex subject areas, and 2) screwing up any one of the big decisions can be utterly devastating. Grady Little waited too long to remove Pedro Martinez from an elimination playoff game, and was fired on that basis. I'd like to think I wouldn't have made that mistake if I were the Red Sox manager (I called it correctly on my couch ;-) That would indeed constitute a plausible argument that I'd be a better manager than Grady Little: I wouldn't have made a career-ruining mistake that he did make. But I'm reluctant to say that, because Little had innumerable other responsibilities and decisions in his managerial career, and I don't know if I would have been better on those (realistically, it's very likely that I would not have been). Similarly, I'd like to think I wouldn't have gone to war with Iraq, but I'm still reluctant to say I'd have been a better President than George W. Bush.

But it can be argued that the least valuable president, or most damaging president, might have more competence than someone who absolutely couldn't do the job. Like one could argue that GWB was a worse president than Carter because he managed to get re-elected. The worst possible president probably has some assets - charisma, appearance of being a strong leader, decisiveness - that cause people to continue to follow him. As far as leaders go, a strong, decisive leader who leads in a horrible direction is better than a weak-kneed pantywaist that quickly becomes unpopular. Kind of like how Ken Reitz could do a couple of thing well (not make errors, hit okay for average, hit well in April) that caused people to ignore his utter lack of skill in anything else. So Reitz arguably was more damaging that someone getting a cup of coffee would be.

So on one of this morning's talking-heads shows, it was opined Marco Rubio is exactly the candidate needed by the GOP to connect w/younger voters. After all, "he knows who Tupac is."

Voting in the 2016 election will be a not small number of people who were born after Tupac was killed (Sept. 13, 1996).

So, Ted Nugent is going to the SOTU as a guest of a Tea Party congressman who threatened to introduce bring articles of impeachment. With friends like these...

Who knew that receiving a letter on Saturday instead of Monday was that delicate thread keeping our society together?

What impact would two day interruption of delivery have on small businesses in rural communities - say an Etsy shop or something - that relies on USPS pickups to delivery their wares to other regions?

What impact would two day interruption of delivery have on small businesses in rural communities - say an Etsy shop or something - that relies on USPS pickups to delivery their wares to other regions?

I think package delivery continues on Saturday under the plan. Just not regular mail.

I have a disturbing number of random MS Paint doodles that I'm not sure why I doodled. I'd be sort of embarrassed 30 years from now if someone found my doodle of Calvin Pickering decapitating Syd Thrift

Did you post this? I seem to recall seeing this one. Also, a Calvin Pickering callback! Old school SDCN hipsters!

Obama, still a pretty good speaker.

And (as I said in the other thread) Joe Biden looks like a super villain behind Obama.

I think package delivery continues on Saturday under the plan. Just not regular mail.

This is my understanding as well, though he did specify 'pickups' and not simply delivery. I'm not sure USPS will be open to receive packages.

Have there been many successful reorganization plans where reducing the amount of service you provide to customers has proven successful in the long term?

Hell, you could make the argument that a better solution would be Sunday delivery/pickup of packages and registered/express mail.

Mark Rubio's response was brought to you by "Poland Spring Water".

"Poland Spring 100% Natural Water - Born Better."

The war on drugs is doing a great job.

WAKE UP! The Lounge had a story writing contest this winter. Here are some entries.

Time had an article on how ###### up medical billing is. Basically, hospitals are ######## with their billing practices and aren't called out on it nearly enough.

252

Is it still open? What are the rules?

Time had an article on how ###### up medical billing is. Basically, hospitals are ######## with their billing practices and aren't called out on it nearly enough.

3 years ago, my mother died from a slip and fall in her home. Long story short, a few months later I got an itemized bill from the hospital: $36,000 total, of which medicare paid $3,000, $32,000 was written off, and my father on the hook for $1,000. We paid it. 6 months later we got a bill for the outstanding $32,000. I called medicare and they said we weren't responsible, and I told the hospital. They apologized and claimed a clerical error. 6 months later we got a bill for $32,000. Same deal, but this time they blamed a new billing management company. 6 months later we got a bill for $32,000. I told them I don't care what the excuse is, but if I get another one, they will be hearing from my lawyer. Never got another one.

There's a reason for divorcing care and billing. The administrative side to billing can be flagrantly outrageous. If you get too uppity, then they try to make you feel as if you are obstructing an eleemosynary enterprise. They're so overworked helping people, and what with lawyers and government they have to dot every i and cross every t, boo hoo hoo.

People go in for tests and procedures and they outsource to third party labs and specialist not covered on your insurance and then expect you to pay--you, somehow, are supposed to know they were going to do that and taken preventive action. The medical provision has no shame, yet wants you to think to them as a secular religion.

People go in for tests and procedures and they outsource to third party labs and specialist not covered on your insurance and then expect you to pay--you, somehow, are supposed to know they were going to do that and taken preventive action.

Another personal story. I had to have a tooth pulled and get a bone graft before getting an implant. I checked the insurance disclaimers, and there was no mention of the extraction and bone graft requiting pre-approval, but the implant did. So I had the procedure, knowing it would be 6 months before I could get the implant. My claim for the bone graft was denied, because they said bone grafts are only covered as part of a pre-approved implant procedure, like that was common knowledge. It took 6 months to get that straightened out.

Just noticed I've got a lot of "6 months" in the last 2 posts. Consider it rounding up or down.

So, earlier this week there was a huge environmental protest at the White House: tens of thousands of people turned out.
The President didn't just miss it.
He didn't just miss it because he was off playing golf.
He missed it because he was off playing golf with oil and gas executives (plus Tiger Woods).

Isn't this the kind of thing that used to be a big joke to Democrats, when George W. Bush did it?

A bill introduced by Montana state Rep. Steve Lavin would give corporations the right to vote in municipal elections:

Provision for vote by corporate property owner. (1) Subject to subsection (2), if a firm, partnership, company, or corporation owns real property within the municipality, the president, vice president, secretary, or other designee of the entity is eligible to vote in a municipal election as provided in [section 1].

(2) The individual who is designated to vote by the entity is subject to the provisions of [section 1] and shall also provide to the election administrator documentation of the entity’s registration with the secretary of state under 35-1-217 and proof of the individual’s designation to vote on behalf of the entity.

Corporations *are* people, my friend ...

So, earlier this week there was a huge environmental protest at the White House: tens of thousands of people turned out.
The President didn't just miss it.
He didn't just miss it because he was off playing golf.
He missed it because he was off playing golf with oil and gas executives (plus Tiger Woods).

Isn't this the kind of thing that used to be a big joke to Democrats, when George W. Bush did it?

Agreed (and I'm a liberal Democrat). But the Wall Street-Ivy League power structure knows Obama can get away with it because he has a "progressive" aura about him, not to mention that he's black (and who wants to look like a racist?) It's why they are committed to shoving Hillary down our throats in 2016; she's as much a phony progressive as Obama is, and is as much a corporate tool as her husband was (but you don't dare criticize the first woman president, even if she probably wouldn't have stood a chance to get where she is had it not been for whom she married).

Personally, I'd rather see Biden get into the White House in 2017 -- for all his so-called "gaffes," he seems to have more empathy for the powerless in his little finger than Obama or Hillary have in their entire bodies. And that scares the hell out of a lot of people who run things.

I only work about 5 blocks or so from the White House and the bus I take goes right by the White House. I don't recall tens of thousands of people protesting around the White House last Sunday.

Personally, I'd rather see Biden get into the White House in 2017 -- for all his so-called "gaffes," he seems to have more empathy for the powerless in his little finger than Obama or Hillary have in their entire bodies. And that scares the hell out of a lot of people who run things.

You know Biden has been in Washington for 40 years, right, and has been your standard Democrat, not some sort of progressive champion, right? Biden's empathy extends to the limits of other people's wallets.

Again, Nate Silver is triumphant after many had again scoffed.

You know Biden has been in Washington for 40 years, right, and has been your standard Democrat, not some sort of progressive champion, right? Biden's empathy extends to the limits of other people's wallets.

You're not one of the people who disagrees when someone calls lawyers scumbags just because they are lawyers, I hope.

You know Biden has been in Washington for 40 years, right, and has been your standard Democrat, not some sort of progressive champion, right? Biden's empathy extends to the limits of other people's wallets.

Biden is arguably our last link to the Hubert Humphrey tradition; I apologize if he's not a cool technocrat.

Biden is arguably our last link to the Hubert Humphrey tradition; I apologize if he's not a cool technocrat.

I like Biden a fair amount, but I am less confident he would win, as compared to HRC who would coast. A less good D is better than an R every day for progressives. I guess that makes me a sell out or something.

I like Biden a fair amount, but I am less confident he would win, as compared to HRC who would coast. A less good D is better than an R every day for progressives. I guess that makes me a sell out or something.

No, it just makes you a realist. As long as the corporate POV controls the Supreme Court and Congress, there's only so much a president can do.

Time had an article on how ###### up medical billing is. Basically, hospitals are ######## with their billing practices and aren't called out on it nearly enough.

I wouldn't call it wholly a hospital ####-up...

It really goes back to our nation's PPS model... and the blame - quite frankly - can be pretty evenly divided between the private for-profit system and our public care (at least on the reimbursement side) systems. Donald Berwick - former/recess appointment to head the CMS is a really good source to read on why this doesn't work. Another guy who's had a lot of thoughtful input on why PPS is a bad model is actually Howard Dean.

Ultimately - PPS is entirely based on payment for individual services delivered. Hence, it's less about wellness and 'treatment' -- and more about maximizing billing. This is where the for-profit care providers are at fault -- you wouldn't believe the financial modeling that goes into hospital group planning and how deeply it permeates everything from physician recruitment and hiring to actually providing guidance for care decisions.

As much as I'm a supporter of Medicare and public insurance models -- they actually tend to make the problem worse... In order to forestall fraud - Medicare has a truly byzantine web of groupings, modifiers, coding requirements, etc. These all exist - in theory - to ensure that providers are actually rendering appropriate care and services. But in reality - what it does it put a huge burden on public care providers, who have enough trouble just keeping up... while playing right into the wheelhouse of private/for-profit providers who are extremely good at modeling which services are going to yield the best returns.

Berwick drew a lot of criticism (and it's generally why he never got a confirmation vote) because he had supposedly said nice things about the UK's NHS.... but if you strip away the partisan angle, what he was actually talking about was the manner in which an NHS-style system is wellness-based rather than service-based.

Howard Dean has written and spoken about the same -- I was at a discussion where he talked about a time near the end of his residency when the chief of cardiology was struck with a heart attack... they stabilized, but while this guy was just 12 hours out of near death - another patient in the cardiac unit codes, and this stricken doctor is wheeling himself down the hall, IV still attached, to get into the room where the other patient is being attended. The point being - even for the experts - medical decisions are not something people make logically. A fee-for-service model just doesn't work because patients - even well-studied experts like this chief of cardiology - don't make good decisions when it comes to care. When you have a heart attack, you're simply not in a position and good frame of mind to logically and reasonably examine different courses of treatment and choose the most effective and efficient one.

Personally, I'd rather see Biden get into the White House in 2017 -- for all his so-called "gaffes," he seems to have more empathy for the powerless in his little finger than Obama or Hillary have in their entire bodies. And that scares the hell out of a lot of people who run things.

You know Biden has been in Washington for 40 years, right, and has been your standard Democrat, not some sort of progressive champion, right? Biden's empathy extends to the limits of other people's wallets.

He's been in office for 40 years - but up until getting the veep's residency, he was commuting from DE to DC... I'm not saying that makes him a progressive champion, but I do think it gives him a bit of insight that someone... sequestered... in DC wouldn't necessarily have.

The tricky thing is that it's actually possible to see how Biden and Hillary match up and it's more complicated than that:

110th Congress, Hillary 13th most liberal, Biden 28th
109th--Hillary 12th, Biden 25th
108th--Hillary 12th, Biden 24th
107th--Clinton 13th, Biden 24th

(These are all from the voteview DW-Nominate scores)

Now there are lots of ways of defining liberal and conservative, and it's possible that there are measures where Biden comes across as more progressive and possible that some of those may speak to income inequality issues, though I doubt it.

Caveats: Biden presents as more working-class friendly, so may run better among Dem white working-class voters than Clinton even if his record is somewhere between indistinguishable or worse. And it's possible Biden has been restrained by representing Delaware, which is very Democratic but less liberal than New York. Or other factors.

The idea that Biden represents the last gasp of the Humphrey tradition is wrong on a couple of levels: Biden has been consistently dead-center in the middle of the Democratic cohort in the Senate for most of his career, and it seems California and Maryland (and Minnesota when a Dem wins) have been producing the most consistently liberal senators in the Humphrey tradition. So the tradition still exists, which is the good news. Biden's never really staked out a position on that wing, for better or worse.

Biden is arguably our last link to the Hubert Humphrey tradition; I apologize if he's not a cool technocrat.

I like Biden, but he is a Delaware politician, i.e. he has been in the pocket of corporations, credit card companies, MBNA, etc. etc.

You know, if calling a nine year old a #### is wrong, I don't want to live in world that's right. #PCgonemad

Biden presents as more working-class friendly, so may run better among Dem white working-class voters than Clinton even if his record is somewhere between indistinguishable or worse.

Well, last time Hillary was the beer-track candidate and Obama was the wine-track candidate. Hillary was kicking Obama's butt in Appalachia and other "working class areas". Now, of course some of that could be racism, but 1) we could assume those areas are sexist as easily as we could assume they're racist, if we're going to be like that, and 2) some of the margins were so large in an otherwise 50/50 race that I find it hard to believe race accounted for most of it.

If Hillary wants to run, Biden will bow out. If Hillary doesn't want to run, Biden will run, barring personal preferences to call it a career. At that point, if both Hillary and Joe decide to opt out, it becomes anyone's ball game.

Well, last time Hillary was the beer-track candidate and Obama was the wine-track candidate. Hillary was kicking Obama's butt in Appalachia and other "working class areas". Now, of course some of that could be racism, but 1) we could assume those areas are sexist as easily as we could assume they're racist, if we're going to be like that, and 2) some of the margins were so large in an otherwise 50/50 race that I find it hard to believe race accounted for most of it.

I don't disagree with you. In responding to an argument that Biden had a better record on the issues, I said he didn't but maybe--maybe--presents as better. How he fares against Hillary, and who would be prepared to vote for him over her, I don't know. I have my doubts we will find out. If she runs, the people who will take her on will be governors from the outlands positioning themselves for future runs or Veep spots, would be my guess.

A fee-for-service model just doesn't work because patients - even well-studied experts like this chief of cardiology - don't make good decisions when it comes to care. When you have a heart attack, you're simply not in a position and good frame of mind to logically and reasonably examine different courses of treatment and choose the most effective and efficient one.

People always use that example. But most medical bills are not incurred as the result of heart attacks. Emergency care (and by that I mean care during a medical emergency, not care provided in an emergency room) often¹ does not allow for shopping around, no. But only a small portion of medical treatment requires decisions to be made on the spot.



¹You can't shop around at the time, but you can sometimes shop around in advance.

The idea that Biden represents the last gasp of the Humphrey tradition is wrong on a couple of levels: Biden has been consistently dead-center in the middle of the Democratic cohort in the Senate for most of his career, and it seems California and Maryland (and Minnesota when a Dem wins) have been producing the most consistently liberal senators in the Humphrey tradition. So the tradition still exists, which is the good news. Biden's never really staked out a position on that wing, for better or worse.

Right; Biden was a member of the DLC when the DLC was a going concern, before Al Gore took it out back and shot it in 2000.

But only a small portion of medical treatment requires decisions to be made on the spot.

Does that help matters? A doctor says I need a blood test. I ask how much will it cost? He won't be able to give me an answer. The hospital itself generally won't be able to give an answer.

Does that help matters? A doctor says I need a blood test. I ask how much will it cost? He won't be able to give me an answer. The hospital itself generally won't be able to give an answer.

I'm not particularly well educated on this topic but I do have an example that has always perplexed me. I'm a type 1 diabetic. Visits to my diabetes specialist ALWAYS require a blood glucose test that is billed at $30, of which I am usually charged $25. That is, my insurance will pay $5 for the test.

However, the test is exactly the same as any test I can run, myself, using a monitor I'm required to bring with me to the appointment (so they can download my results). A few years ago I put my foot down and refused the test. It took a lot of argument with the doc and, really, her staff, but they went for it.

The cost of the test if I do it myself? Approximately 85 cents. Of which, insurance usually covers about 75 cents.


I have no idea why anyone is having diabetics, who test their own blood, pay 30 bucks for a test they run several times a day on their own, but I suspect it speaks to much of the "problem" of health care costs. Simple, cheap tests are charged at very high rates while complex, expensive tests aren't billed high enough to cover the actual costs.

People always use that example. But most medical bills are not incurred as the result of heart attacks. Emergency care (and by that I mean care during a medical emergency, not care provided in an emergency room) often¹ does not allow for shopping around, no. But only a small portion of medical treatment requires decisions to be made on the spot.



¹You can't shop around at the time, but you can sometimes shop around in advance.

But it's emergency care -- or rather, inpatient care generally -- that drives the overwhelming majority of cost within our system.

You can shop around for drugs, you can shop around for band-aids, for vitamins, etc.... but the single biggest driver - to an enormous, huge, overwhelming extent - does not work with a PPS model.

Even some outpatient options - i.e., anything surgical - don't really work.

For example, the big brouhaha last summer around what eventually became a big Medicare fraud scandal...

A surgeon with an MD provider (heavily recruited and showered with goodies from Abbott Labs to push the devices) had managed to bill more than 1.2 million in stent insertion work in a single day... He was clearly running a stent mill - and the hospital was profiting handsomely.

There doesn't seem to be any dispute that he was providing unnecessary services - but no one denies that he didn't actually perform the service and from a medical perspective, it becomes a lot hazier to determine which stents were a good idea and which were medically questionable.

Forget heart attack - if you or I go to see a doctor tomorrow and s/he says "I think you've got a blockage/blockage forming and we really ought to implant a stent to work around it" -- how do you comparison shop that? Google? Consult another physician? You could do all those things - but even within the medical community, the chances are excellent (beyond cases on the edge) that there wouldn't necessarily be a perfect answer.

So - under a PPS model, what happens? You inevitably get a 'service' sold to you.... A health care system based on wellness isn't pushing any specific services and there's also not a layer of financial modelers constructing a system to maximize revenue/profit underlying those services. Rather - the issue is looked at from a pure wellness perspective... What are the chances the blockage advances to needing emergency care? Should a regimen of drugs and diet be attempted first... with appropriate monitoring and follow-up... etc.

But it's emergency care -- or rather, inpatient care generally -- that drives the overwhelming majority of cost within our system.

There was a massive bait-and-switch in that sentence. Emergency care and inpatient care are not remotely the same thing. It's only the former that makes it impossible to shop around.

Forget heart attack - if you or I go to see a doctor tomorrow and s/he says "I think you've got a blockage/blockage forming and we really ought to implant a stent to work around it" -- how do you comparison shop that? Google? Consult another physician?

Uh, yeah? I didn't realize the idea of a second opinion was so foreign nowadays.

There are well run, efficient and effective health provision models in the world that control costs and don't have these massive levels of over billing. They're not hard to find.

There was a massive bait-and-switch in that sentence. Emergency care and inpatient care are not remotely the same thing. It's only the former that makes it impossible to shop around.

No, it's really not... at least, not if we're talking about costs.

Uh, yeah? I didn't realize the idea of a second opinion was so foreign nowadays.

Second opinions aren't free - and what's more, you're still ultimately deciding between two (or more) highly trained professionals who are going to be talking in terms that the average patient isn't going to remotely be able to make a qualified decision about.

If doc 1 says "we should put a stint in", doc 2 says "We should put you on this new drug", and doc 3 says "let's give it 6 months - but I want you to change your diet and exercise more".... Who are you gonna believe?

All three might be perfectly valid courses of treatment. All three might be dead-ends... All three might also have pressures beyond the care of the patient (doc 1 in particular).

In the end, a PPS model inevitably means the fulcrum of the decision and the information the ultimate decision maker has available will be centered around services... not wellness. Everybody involved - excepting the patient, I guess - certainly has a secondary interest in the wellness of the patient... but the primary course of debate is about which services to sell, which services to cover, etc.

In the first case study mentioned in the Time article, the "first opinion", before any treatment had started, cost $48,900. Are you really going to pay that money again for a second opinion?

In the first case study mentioned in the Time article, the "first opinion", before any treatment had started, cost $48,900. Are you really going to pay that money again for a second opinion?

Well that's because the market has been corrupted by the pernicious grasp of Big Gummint. As usual the artificial barriers to market participation have only served to increase costs and enrich the connected. Instead of a free market which allows patients to shop around properly, unfortunates looking for medical advice are limited to a pool of "licensed" doctors with special "training" and "certificates", plying their flimflam in "registered" facilities operating under the crushing thumb of government authorization.

I have a fluoroscope in my lab and have placed numerous stents in both pigs and dogs without issue, but I am precluded, AT GUNPOINT, from offering my services to informed consumers. Indeed, even hanging out a shingle advertising my expertise in any of a number of minor medical procedures, such as suturing up wounds or performing neuters, would immediately draw the ire of the "legitimate" medical cartel and bring the wrath of their government thugs upon my head.

And who benefits from these shameful impositions on the market? Corporate hospitals with their billion-dollar profits, sneering egghead physicians with their white coats and condescending airs, Big Pharma able to exploit the system by bribing both of the above to get their snake oil into unsuspecting physiologies - where is the benefit to the common man? Given a free and open market, a consumer would finally be able to make their own determinations about their futures. Perhaps a well-equipped veterinary clinic would be perfectly adequate for their needs - a physician, after all, is merely a veterinarian who specializes in one species. Perhaps your dentist could parlay his surgical training and well-equipped office into a proper side-business in cosmetic surgery. Perhaps traditional healers and shamans could best serve a specific population for specific concerns. Even a self-educated man exhibiting the sort of gumption and self-reliance that made this country great could offer quality service at affordable prices if only granted access to medicines and technologies currently denied him by the heavy jackboot of the government.

But oh no, all you hippies want to do is talk about how to best prop up the current abomination designed to stuff pockets more than heal. We can't have our fancy lad doctors forced to justify their exorbitant prices and labyrinthine payment scams. Shameful. Those who support the current system of rationed access to medical expertise have blood on their hands.

If Hillary wants to run, Biden will bow out. If Hillary doesn't want to run, Biden will run, barring personal preferences to call it a career. At that point, if both Hillary and Joe decide to opt out, it becomes anyone's ball game.

I agree with this, sort of. If HRC runs, HRC wins the nomination (and likely becomes President). Biden is not beating her, and likely no one else is either. However "the field" could beat Biden (If HRC does not run). I think Biden would be a favorite over any individual, but I might take the field against him.

I agree with this, sort of. If HRC runs, HRC wins the nomination (and likely becomes President). Biden is not beating her, and likely no one else is either. However "the field" could beat Biden (If HRC does not run). I think Biden would be a favorite over any individual, but I might take the field against him.

I agree that Hillary would be the frontrunner based on what we know today, but she's starting to look OLD, and she's already had some moderately serious health issues. Four years is a long time; leaving aside an ennervated GOP that appears to have misplaced its business plan, I'm starting to think Hillary and Biden are both at risk for being displaced by a younger, more dynamic dark horse.

Health issues are the wild card I agree. I think Biden is much more vulnerable to an insurgant outsider campaign.

Well that's because the market has been corrupted by the pernicious grasp of Big Gummint. As usual the artificial barriers to market participation have only served to increase costs and enrich the connected. Instead of a free market which allows patients to shop around properly, unfortunates looking for medical advice are limited to a pool of "licensed" doctors with special "training" and "certificates", plying their flimflam in "registered" facilities operating under the crushing thumb of government authorization.

I have a fluoroscope in my lab and have placed numerous stents in both pigs and dogs without issue, but I am precluded, AT GUNPOINT, from offering my services to informed consumers. Indeed, even hanging out a shingle advertising my expertise in any of a number of minor medical procedures, such as suturing up wounds or performing neuters, would immediately draw the ire of the "legitimate" medical cartel and bring the wrath of their government thugs upon my head.

You wrote this in jest, but there are real life clinics running in the L.A. barrios that are doing this. They're usually unlicensed doctors from another country, willing to offer medicine or treatment frown in country or nurses who are taking on more than what their current training would allow. But the advantage they have is that they list their prices ON THEIR WINDOWS for minor stuff, so even people without insurance can get some level of care without needing the Government.

It's working well enough that the L.A. health board is trying to figure out how to help implement in its reform talks of the system and see if they can include it in some way.

I agree that Hillary would be the frontrunner based on what we know today, but she's starting to look OLD, and she's already had some moderately serious health issues. Four years is a long time; leaving aside an ennervated GOP that appears to have misplaced its business plan, I'm starting to think Hillary and Biden are both at risk for being displaced by a younger, more dynamic dark horse.

Generally speaking, the nomination race on the Democratic side has almost always been anti-"your turn"ism... Dems tend to like to pick the dark horses (and tend to be more electorally successful with them) - Obama of course, but also Kennedy... Carter (believe it or not)...

I remain unconvinced that HRC actually wants to run... I suppose I'm probably wrong about that, but it honestly would not surprise if she is really and truly done.

The Democratic nomination fight always seems to come down to the question of whether there's a darkhorse that can excite people without imploding. If one exists - the Dems usually go with the darkhorse. If one doesn't, they'll latch onto the next closest thing (Hart against Mondale for example, Dean over the 2002-early2003 favorite Kerry) -- but unexcitedly fall in line behind the favorite, and then lose in the general.

You read it here first - but the 2016 Dem darkhorse will be Brian Schweitzer and I think he's got the chops not to fall apart.

I agree that Hillary would be the frontrunner based on what we know today, but she's starting to look OLD, and she's already had some moderately serious health issues. Four years is a long time; leaving aside an ennervated GOP that appears to have misplaced its business plan, I'm starting to think Hillary and Biden are both at risk for being displaced by a younger, more dynamic dark horse.

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These are legit points, but I also think that the country's collectively getting older would help HRC and Biden in terms of the age thing. I also believe that HRC will run if she is healthy enough to do so. I see HRC as a far stronger candidate than Biden.

Generally speaking, the nomination race on the Democratic side has almost always been anti-"your turn"ism... Dems tend to like to pick the dark horses (and tend to be more electorally successful with them) - Obama of course, but also Kennedy... Carter (believe it or not)...

I remain unconvinced that HRC actually wants to run... I suppose I'm probably wrong about that, but it honestly would not surprise if she is really and truly done.

The Democratic nomination fight always seems to come down to the question of whether there's a darkhorse that can excite people without imploding. If one exists - the Dems usually go with the darkhorse. If one doesn't, they'll latch onto the next closest thing (Hart against Mondale for example, Dean over the 2002-early2003 favorite Kerry) -- but unexcitedly fall in line behind the favorite, and then lose in the general.

You read it here first - but the 2016 Dem darkhorse will be Brian Schweitzer and I think he's got the chops not to fall apart.

Chelsea Clinton will be 36 in 2016. You talk about a person who will unite the Bill Clinton nostalgia camp, Youths, PUMA, and every other Democratic wing.

Also, it would drive Republicans nuts.

Chelsea Clinton will be 36 in 2016.

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"I agree that Hillary would be the frontrunner based on what we know today, but she's starting to look OLD, and she's already had some moderately serious health issues. Four years is a long time; leaving aside an ennervated GOP that appears to have misplaced its business plan, I'm starting to think Hillary and Biden are both at risk for being displaced by a younger, more dynamic dark horse."

Agreed. To the question of 'Will the 2016 Dem nominee be 1) HRC or Biden, or 2) 'other', I bet you could get pretty good value odds on 'other' right now.

Chelsea Clinton will be 36 in 2016.

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And Guess Who is going to be 49---four years older than Hillary was in 1992.

Agreed. To the question of 'Will the 2016 Dem nominee be 1) HRC or Biden, or 2) 'other', I bet you could get pretty good value odds on 'other' right now.

Agreed as well. My sense is that HRC is genuinely taking a long rest and going to assess what her health and energy status is before she decides to run. If she does feel healthy enough to run, she will likely win both the nomination and the election. While that would certainly be better for the nation and the world than a Republican winning, I'm not so sure it would be the best outcome, given that the dark horse Dem candidate has tended to be a better choice than the old warhorse. (Of course, this assumes a strong young dark horse will emerge, which isn't a given.)

EDIT: Deleted double post

One thing I'll find interesting, if Hillary does run and win, is whether the Cabinet will then be viewed as more of a plausible stepping stone to the Presidency. It used to be that the Secretary of State was the most direct path to a future Presidential run -- the role that the Vice-Presidency (or even losing a run for the Vice-Presidency) now fills. But that has not been true for, what, a century at least?

It would seem to make sense that a Cabinet member is not viewed as being "political" as a VP, and thus has some ability to rise above partisanship, while still staying in the public eye and building competence cred. There's no doubt in my mind that Hillary is more popular after being Secretary of State than she would be had she either been VP, or not taken any position in Obama's government.

Chelsea Clinton will be 36 in 2016.

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You are old.