Linky Friday: The Scientific Darkness
Science:
Image by AmateurArtGuy 
[Sc1] Bill Nye’s new show is something else. Really. Something. Else.
[Sc2] But more seriously, Crippled Scholar takes issue with his handling of disabled people. I’m glad to hear the perspective, but frankly not sure what to do with it.
[Sc3] Possibly related to that, artificial wombs are coming. Christine Rosen was worried about it over a decade ago. It certainly turns the whole viability debate on its head, but I expect it to change the abortion debate very little.
[Sc4] Daniel Sarewitz argues that science has become self-destructing
[Sc5] This is a superhero origin.
[Sc6] When Settled Science made us all fat.
[Sc7] I recommend what Carl Philips and Nicolas Bourbaki have to say about science and the Science March.
Healthcare:
Image by Mr Wabu
[H1] Doctors need to get a grip. It’s kind of important.
[H2] It’s less than clear to me whether this is the result of a community blacklisting or official government policy (or some combination of the two). Coming soon to the United States? Probably not, but I suspect in the coming years I am going to have to put more effort into explaining why my wife should be allowed to deliver babies.
[H3] Kristian Niemetz would like Brits to admit that the NHS is one of the most overrated, inefficient systems in the world. After ours, of course. I think the US should take note because while I am mildly skeptical that Single Payer will ever happen here, two-tiered system with an NHS (or, technically, 51+ of them) as the lower of the two may be in our future.
[H4] What happens when, in addition to everything else, a rural community loses its only hospital. Of course, sometimes it’s the state that done it.
[H5] That time when in order to prevent opioid dependency we started killing people with Tylenol. (“That time” just now ended.)
[H6] If you’re in hospitals enough for the soft drinks there to make you obese, the soft drinks are probably not what’s killing you. (Well, unless you work there.
[H7] Quick! Let’s give it to all the cattle.
Flight:
[F1] This strikes me as a somewhat reasonable way to handle the overbooking issue.
[F2] Huh. On airplanes, the center seat could become the most desirable.
[F3] Among the lesser adverse effects of climate change, our plane rides may start sucking (more).
[F4] I reject the premise of this article. Technology has made the flying experience better, both in preparation and in flight.
[F5] Steve Waldman has some worthwhile thoughts on airline economics, including pushing back against the notion that our airlines are crap because that’s what we collectively chose.
[F6] Good news, everybody! Airbus has figured out how to jam 80 more people into one of their jets.
[F7] Flying cars are coming! Flying cars are coming!
Planet:
Image by Oregon State University
[P1] They said that there would be green jobs, but they never said Americans would be getting them. Some employers, though, are claiming to be hard up.
[P2] The UK looks at tackling its roads to clean its air.
[P3] David Bookbinder looked at Obama’s climate policy and found it lacking.
[P4] Japan is backing away from clean-energy projects.
[P5] Well, if climate change really is the threat that people say it is, of course. #TerraformEarth.
[P6] Taking a look at the underwater volcanoes that are pushing our continents apart (and, on the other end, together).
Space:
[Sp1] We need a term for “Earth-Like but not in the sense that anything could really actually live there.”
[Sp2] Man, I hate it when I run out of fuel at the most inopportune times.
[Sp3] We’re all gonna die.
[Sp4] How we can use an astronaut to make Mars livable. I’m not sure how I feel about this “Don’t need to use the whole planet” business. It seems like our options for terraforming manipulation decrease once we have people living there.
[Sp5] Good? It seems like it’s probably mildly less difficult to create continents than to create oceans. Related: Question for science geeks: What do we gain from Earth being 2/3 ocean instead of, say, 1/3?
[Sp6] I make this an item instead of the side image mostly because NSFW. But it cracks me up.
The links are a bit biased towards the right-wing this week.
Sc3: The lamb thing is pretty cool. It looks like one of those special cooking bags chefs use though.
Sc4: I don’t really really see the point of this article besides being an apology for the Department of Defense and arguing that liberals should be more subservient to the military. Perhaps the reason a lot of these programs like the breast cancer treatment study get run by the DoD is that is the only way to make them politically palpable to many Americans.
Sc7: I largely dissent. This seems to be a variant of the “smug liberals” chestnut. Anyway there was the further left sneering at why they wouldn’t march with “liberal nerds” too. This is because American political discourse can’t evolve beyond a junior-high school cafeteria.
H3: I suspect it is because they are the first or among the first truly universal systems. Plus for Labourites, it is still their crowning achievement.
H4: I’m surprised by the number of people in their 80s and 90s who are living alone. I’m sure some can handle it but I’ve had conversations with some elderly people living alone that made me question their lucidity levels. The broader issue is that there is very little reason for these remote rural communities to exist anymore because of automation and improvements in production and transportation. But you have enough people who grew up in these communities that would be psychologically cruel to take them away. But I have no special love for rural places or do I think they should be held in higher-esteem despite what much of American culture says on the matter.
F5: Because anecdote is the plural of data 😉 One of the thing that my girlfriend and a lot of her friends are very good at and obsess with is maximizing points and deals. I don’t know this is a business thing or not. A lot of them love the Chase Sapphire card because of the points and they will probably switch to a different card if it becomes more points-riffic. They also all seem to belong to one flight alliance or another and all they care about is building miles on that system or getting diamond or whatever preference. I’ve never cared for that because it is too time consuming. Just give me a reasonably priced aisle seat and I am good to go. My girlfriend only cares about building Singapore Airline miles and this requires flying United domestically because they are in Star Alliance. She dislikes United but miles.Report
h4,
why not let them live where it’s cheap?Report
H4 living in a town or city that is entirely automobile centric in its design, as an elderly person, can be incredibly isolating. And not cheap at all when you include the cost of caring for people whose wellbeing is compromised by isolation.Report
Every Great Plains town of any size that I’ve ever spent time in has an unofficial elderly widows “club”. Basically, women who outlived their husbands, who have never lived outside that particular county, and whose kids have moved relatively far away. They call each other on the phone a lot. Most days you can find some subset of them having lunch together at a fast food place. The ones who can still drive provide an informal chauffeur service for the ones who can’t, getting them to the doctor or dentist. It’s not uncommon for them to nag other members who still live in the old farmhouse into moving into town. And, when one of them gets so bad that they can’t possibly stay in their own home, for other members to call the kids to tell them “It’s time for you to come get your mom.”
When I worked for the state legislature, my portfolio included services for the elderly. My experience then suggested that the isolation problem was at least as bad, and possibly worse, in Denver, even though Denver had by far the most extensive official transit and support services in the state.Report
@michael-cain
There are also plenty of old people who live alone and die alone in and near big cities. I spoke with a 90 plus something guy last week and he lived alone. But his granddaughter and maybe other family members were near by and there are a lot more doctors.
It is entirely possible for someone to out live their family and/or support structures but it would seem to me that an elderly person living alone in a rural location is more likely to go without eating and medical care. I could be wrong though.
There were a lot of stories during the height of the housing crisis about elderly people being kicked out of their very low rent apartments.Report
It could be that some mid-sized but not tiny towns are easier to live in without a car than most bigger cities – things like benches or low garden walls you can sit on in the shade to rest, destinations like stores and coffee shops that aren’t deep at the back of vast tracts of surface parking – those can make a difference in how much walking a person in fading health can do. They’re not necessarily uniformly associated with larger cities at all.
For what it’s worth, it’s hard to find examples of really walkable / age-in-place-able cities anywhere in North America. Even our best cities are way down in mediocre territory compared to the European norm.
(e.g. not exactly the same thing but related – the #1 city in North America for cycling mode share is Portland, OR. It’s something like #157 in the world – down in the territory of European cities notable for being terrible to cycle in.)Report
You’re right that it’s hard to find age-in-place cities in the US, particularly as walking ability declines. I assert that the people working on autonomous vehicles who so often talk about the benefits of being able to work during an arduous commute, are missing the boat. The big market will be Boomers’ kids buying small electric AVs so Mom can stay in her house. The AV will drop her off at the front door of the market, or doctor, or wherever, and pick her up when she’s done. Park itself at home and charge wirelessly.
@saul-degraw ‘s point about outliving your assets is also important. Based on the places I visited during the inter-session when I worked for the state legislature, I hate the facilities that are provided at assisted living facilities whose expected clientele are people living on SS and Medicaid.
One of the reasons so many rural elderly stay in their house is that it’s paid for, so the costs are basically utilities and taxes (with, in many places, subsidies for those). For all the bad things people say about the longevity of stick-built houses, they tolerate minimal maintenance for a surprisingly long time.Report
Michael,
I don’t think we’ll let boomers live in their houses for too much longer. Not if we’re having trouble feeding people. “Mandatory Nursing Homes” start sounding a lot better for the “generation that ruined everything.”Report
I see this where I live. Usually church or club membership also plays a factor, in that people who belong to the same church or same group (e.g., Fortnightly) tend to look out for each other. I know there are people at my church I’d classify as “elderly” driving other people around because they still CAN drive.
We have an ‘elder bus’ system but anecdotally it seems unreliable. (A friend of mine from church, before she died about 10 years ago, occasionally called me to pick her up somewhere when the bus either failed to show or left before its appointed time.)
In my parents’ town there’s a group (Called Faith in Action, so I assume it is church/other religious group affiliated) that will provide driving services for people who can no longer drive. From what I’ve seen of that, it seems to work pretty well, but then again, my parents’ town is larger and there are quite a few volunteers in the group.Report
F5 balances the scales by itself
That’s a big yada yada.
It’s like saying: I don’t know enough about the details of the USSR; I suspect it had flaws. But still, as long as this is a debate about “capitalism” we’ll make no progress.Report
I appreciate its pushback against the “it’s your fault flying sucks” meme, and that is pretty bipartisan. I would add to its analysis that the underlying assumption is that we, the consumers, should use price as a proxy for non-suckiness of the experience. How many milliseconds would it take for the airlines to game that system, given the chance?Report
Well, I do work in the airline business, and this article is very insightful.
The thing is, the major airlines indeed want to compete on service. In fact, they’re desperate to figure out how to do this. Much stands in the way, however, and few doubt that the “price aggregators” are part of the problem. Certainly the airlines believe that they are. Given that I work for a price aggregator, yeah, it seems like consumers do behave this way. Furthermore, there is currently no good way to quantify things like leg room. It seems as if there should be (32 inches is 32 inches), but there are all sorts of dumb technical reasons this doesn’t happen. Furthermore, airline schedules change. Weather happens. There are maintenance problems. Planes get swapped out. Just because you paid for something does not mean you’ll get it.
Your ticket is actually a legal contract that guarantees transit within a certain time frame. It is separate from your booking, which is a seat on a plane. Furthermore, there is no legal meaning to “cabin class.” The regulations surrounding this are long-standing and, frankly, weird. On the other hand, trying to summarize all of this in a list of flights on a website is legitimately hard.
We might rant that United Airlines is terrible, but honestly this was all dumb luck. In reality all the airlines terrible in different ways on different days, and quite nice otherwise. On the other hand, if you pay for first class, you’ll likely get treated pretty well.
(Although last time I flew first class, the drunk “suit guy” sitting next to me spilled a whole drink on my lap, cuz everything is terrible. The flight attendants were wonderful, but still, assholes are assholes, and assholes in first class are as bad as any.)
A big problem is getting all the major players to agree on standard formats. The airline business has many stakeholders. The industry consortiums run mostly on consensus. Their IT systems have to work with everyone else’s IT systems, and some of this stuff is COBOL era hellscapes.
Anyway, blah. I liked the article a lot.
Yep.
All models are false. Some models are useful. Blah blah blah.
Great article. I think I’ll read the entire blog.Report
Science is neither left wing nor right wing, Saul.
It’s just people who understand things or people who deny them.Report
Here is a perfect example of a “smug liberal.” It’s from a recent NPR interview with the former head of the CDC Mark Rosenberg about Rep. James Dickey.
ROSENBERG: When I first met him, I thought he must have been duped by the NRA. Eventually, we came to understand each other. And we came to trust each other, and we came to share our views.
Clearly anyone who like guns must be a an NRA dupe, right?
http://www.npr.org/2017/04/25/525604434/jay-dickey-arkansas-congressman-who-blocked-gun-research-dies-at-77Report
It’s NPR.
What do you expect? Honest, advocacy free neutral reporting? LOLReport
Ezra Klein wonders if the Singapore health system can work for the United States, his conclusion is no despite allegedly being a left and right wing hybrid:
http://www.vox.com/policy-and-politics/2017/4/25/15356118/singapore-health-care-system-explained
Klein’s conclusions are:
Americans would never put up with how much the Singaporean government controls the medical industry itself from having largely public/government run hospitals and most doctors as state employees and what programs they are willing to let you have and help with for your savings. Plus the medical savings accounts are mandatory and Americans generally don’t like mandatory.Report
Singapore’s free market healthcare system seems to require a lot of government intervention to make it work. The government forces you to save money that you pay at government hospitals with state employed doctors and government approved drugs to keep costs down. They also have a lot of state paternalism when it comes to things that could aversely effect public health like narcotics, alcohol, tobacco, and driving. When you try to create a free market health care system without these interventions than you are going to get chaos.Report
Well, yeah, the last is essentially the problem with healthcare in the US.
Of course, there are many ways the markets involved really aren’t very free at all (common to modern healthcare systems) that sure doesn’t help any if you’re expecting the market to do the work for you.
The result is a system that combines the fairness of capitalism with the efficiency of socialism.Report
Just as a side note what is the difference between the chaos that is being discussed here and what a free market is supposed to be?
It is the individuals choice to choose which product they need right? What you might see from that will look a little chaotic. A healthy market should see range in the triangle, cost, time, and quality.
Order has been made the priority, so what we see in control of the markets is first quality, that sends cost into escalation, then controls are enacted to control costs. Time is one of those things you negotiate for either way, but escalates with quality.
So by people creating the order to control the market they begin the damage of free markets. Looking at hundred year horizons, Singapore’s march into control of the markets is relatively young, it will eventually suffer.
I find current policies on the matter wanting. The leg is broken, instead of fixing the leg, there is an insistence that some political faction or nation is offering the best of crutches.Report
There are a lot of differences, but one major one is that it’s often impossible for anybody to know what anything is going to cost. A lot of patients aren’t (for the most part) spending their own money, providers often face considerable uncertainty about how much they’ll get paid to do anything, and price signals get all scrambled to hell.Report
It’s impossible for a patient to know what something costs because a lot of the time the doctor won’t know.
Surgery cost? Depends on complications.
An illness? Depends on what’s wrong with you.
Tests? Depends on which one actually manages to determine what’s wrong with you…..
You can price a CAT scan or an MRI or an X-ray and publish those prices. But if you’ve got a sore shoulder, you can’t price “treating it” because it can range from anything from 10 minutes of a doctor’s time and a prescription anti-inflammatory to X-rays, CAT scans, MRI’s, and surgery….
There are so many drugs, medical tests, and the like that even if you had the time to compare prices between “the Doctor saying you need it” and “you needing to get it/have it done”, it’s unlikely you could do a good job. Which is why it’s worth it to pay a third party to figure out all possible tests, figure out their average costs, and make deals on your behalf to get it down to a reasonable sum….
Which is one reason “health insurance” is not like “car insurance”, because your car insurance company does not require nearly as much effort to determine reasonable prices — the solution space for car repairs is orders of magnitude smaller (and also, they can just write your car off even when it can be fixed good as new…)Report
morat20,
Except when you have two hospitals within spitting distance of each other, and the MRI costs double in one than it does in the other. (Demand, Demand, Demand).
You can always price treating things, but you get into expected values pretty quickly. and then your confidence intervals…Report
Well, this is true, but a lot of the time the cost for the same test or procedure varies wildly, and much of that isn’t really under the control of the provider—there’s an amount that the insurance company will reimburse, and an amount that the patient is responsible for, and they vary a lot.
You’re not entirely wrong about the problem with health insurance, but a lot of additional problems are piled on top of it.Report
Yes but look at what your insurance company is doing for you — they’re trying to flatten out that price disparity. Negotiated prices are, effectively, “Yeah, you want 3k for that CAT scan? Place down the road does it for 800. I’ll pay no more than that if you want my customers”.
Now with stuff like CAT scans (if they’re not emergency) you’ve often got time to use tools that might show price differentials between places on your plan and pick one accordingly. Less so with emergencies or when you’re AT a doctor’s office and they want to do tests right there.Report
When having these discussions, emergency medical care should always be considered the edge case (despite the fact that some people use it as primary care). Obviously people are not going to be price sensitive in emergencies.Report
Here’s the thing — why are insurance companies so bad at negotiating prices? I mean they’re not awful — those big price disparities are generall “cash up front” pricing, whereas I’ve found that the negotiated prices are pretty close to the same across multiple doctors or clinics.
But they’re still pretty bad — especially out-of-network.
But they shouldn’t be. Insurance companies have access to Medicare pricing, full databases of all possible procedures, complications, and drugs, and actuarial data on area pricing. Why are they not more efficient?
I can sort of see why they don’t care about out of network — the big prices and big deductibles means you’re more likely to remain in-network, where they have the highest leverage on prices. But even in-network, why is there so much variance?
It seems to run around 10 to 15% internally (negotiated rates between in-network sources) which is a lot.Report
morat20,
My insurance company negotiates with ITSELF.
Does that answer your question?Report
Here’s the thing — why are insurance companies so bad at negotiating prices?
Because their primary goal isn’t to drive down their own costs (tho that’s part of it, tho one they abuse hence some provisions in the ACA) but to cover their profit expectation, which they attain by increasing premium prices. Don’t blame them for just responding to the market.Report
A lot of it is our insistence that we get to “keep our own doctors”… back when HMO’s were going to be the order of the day, a lot of that was to give insurance companies leverage. They would control who their insured would go see. But people didn’t want that and networks had to be very wide, which gave hospitals and physician groups the leverage.
The Kaiser model is great… but only for a country that wants it.Report
A lot of it is our insistence that we get to “keep our own doctors”…
Are you making the argument that insurance companies and providers both leveraged their price increases against insuree’s observable desire to keep their own doctor? Dude, c’mon. That’s not why prices are going up. The leverage of “keep your own doctor” claim is a laughably ridiculous political point that only gained traction in the laughably ridiculous GOP governed by Cleek’s law.Report
I wasn’t even aware that “keep your own doctor” was a GOP talking point. They seem no less likely than Democrats to raise hell if people start talking about forcing people to change doctors.
There are a lot of reasons why costs keep going up. That wasn’t what I was addressing. I was addressing the question of why insurance companies aren’t able to negotiate better ratres. The answer is that they lack the leverage to. The main threat an insurance company has against a provider is “If you don’t play ball, we’ll direct our customers elsewhere.”
That only works if the insurees go along. Insurance companies have tried and tried to go narrow network precisely so that they can have this kind of leverage. They keep running into resistance.Report
I don’t think the resistance is real insofar as it effects price, but insofar as it is, the blame (heh) falls on providers who won’t take carriers “negotiated rate” for in-network service provision. And personally speaking here (my experience is obviously limited) I’ve never heard of that happening, and for what I think are obvious reasons: a provider who denies the negotiated rate is not in-netowrk with that carrier. They can’t see patients (except on cash-pay) for the services provided. Which is, in most situations, a serious economic hit to their bottom line. I’m not saying it doesn’t happen, but that it makes no economic sense for the provider, so they suck it up and take what’s offered. All that inclines me to believe that the desire to “keep your own doctor” has a negligible effect on healthcare costs and is (almost) entirely a political issue.Report
I wasn’t even aware that “keep your own doctor” was a GOP talking point.
Heh. Sarcasm right?Report
Mis-statement. I meant that I wasn’t aware it was partisan to make the connection I did about keeping your own doctor affecting negotiations.
The threat of an insurance company taking away a providers’ business seems hollow to me because insurance companies have been really reluctant to go narrow network. It’s the sort of thing they can lose business over.
That’s why insurance companies have had such a hard time narrowing their networks. It’s also why companies had to start offering PPO’s alongside HMO’s. If the insurance companies could get people to sign on to tight HMO’s, they’d have a lot more leverage.Report
For a company with success in this area, see Molina Healthcare. They built skinny networks from the ground up. They then targeted communities that had historically lacked insurance and told insurees that this was what was availableReport
they’re trying to flatten out that price disparity. Negotiated prices are, effectively, “Yeah, you want 3k for that CAT scan? Place down the road does it for 800. I’ll pay no more than that if you want my customers”.
In my experience it goes the other way. A practice that didn’t provide CAT scans will opt to do so on the expectation that they receive “industry standard” remuneration for the service provided. So increasing availability of the service and increasing consumer “choice” (heh) won’t lower the price, it just allows more people to make money AT that price. Individual providers are not price setters, they’re price takers, and as far as I can tell, Big Hospital is the only price setter for all this stuff. Everyone else piggybacks along, driving up prices.
Further, the people who write insurance contracts just ain’t that smart dude. (In my experience anyway.) Nor are they accorded the authority to “negotiate” prices at that level of specificity except at the really radical margins.Report
“when you’re AT a doctor’s office and they want to do tests right there.”
Do you mean, the doctor thinks it’s an emergency? Or do you mean that the doctor wants to do the test right now because there’s a lab next door and he gets a slice of whatever testing gets done there?Report
I’d say about half the family practices I’ve been to have basic diagnostic machines (X-ray machines and such) as well as blood draw facilities, although they only perform a few actual lab procedures (generally stuff like white blood cell counts — the sorts of things with a five minute turn around) and send the rest out.
So if they want, say, blood samples — the expectation is you toddle down the hall, get it drawn, and head home.
The rest just say “We use Quest” (or equivalent) and offer directions.
And the general gist is “We can’t know what’s wrong until we get these back, although we can treat symptoms until then”.
That’s the most common visit — recite symptoms, get tests ordered, go to wherever the Doctor says for the tests (their own lab, Quest, wherever) get results, acquire treatment.
We can say “shop around” all we want, but it doesn’t fit into how people use health care, so it’s not going to solve any problems.
The closest we can get is, well, utilizing third parties to collate pricing data and negotiate prices for you with your doctor ahead of time.
(And seriously, it’s not like doctor’s aren’t complicit in this. I believe the latest is getting ‘consults’ from out-of-network doctors to drive up payments to the practice…often while you’re under or recovering from anesthesiology).Report
And yet somehow my vet can give me a range of costs from best case to worst case. So can my dentist, for that matter. My orthopedic surgeon handed me a flat number as well.
The problem isn’t that it’s too complicated, it’s that many doctors are pretty much divorced from any knowledge of the costs, unless it’s a private practice, and even then, it’s tough for them to know the cost because each insurance company has different negotiated rates and what not.
Of course, any hope of figuring out a cost beforehand goes out the window for emergency medicine, but ideally emergency medicine should be the edge case, not the norm.Report
Dentists are tricky because you have to find a good one. I find that a lot of dentists try to upsell you on cavity filling.
When I first moved to SF, a dentist here told me I had 10 cavities that needed filling and it would cost me 3000 something dollars. But I wasn’t in any pain and waited and saw my family dentist back home over the summer.
He said that he would only recommend filling those cavities if I was going to spend 10 years at the South Pole.Report
Ptui! I hate this about dentists. Part of the issue I think is that large practices with in-house specialists want to use those specialists, so the general guys are under pressure to upsell. It occurs to me that the last dentist I had that I liked was a guy in a converted old house who had a receptionist, assistant, and one or two hygienists and that was it. If he said I needed to see a specialist, he wasn’t making any money off that specialist visit. I think I need to go find a guy like that around here.Report
You just described my old family dentist. He worked in a converted house and had a minimal staff. The upseller was the San Francisco had a fancy downtown office.
I did find a dentist I liked in SF. They are a family firm (Dad and Two sons) and they clean the teeth themselves. No hygienists. The office decor looks like it hasn’t really been updated since the 1970s but the equipment is new.
I also suspect that it is because many people don’t have dental insurance and dental insurance does not cover much.Report
That explains something. I was shocked when the dentist I started going to down here seemed to take a decidedly wait-and-see attitude on small cavities if there was no pain.
I have pretty good dental insurance, but this guy seems only really to want to treat things that are either painful or structurally bad. (Like: when I broke a tooth once.)
That said: there are an awful lot of “country dentists” around here who are quick to pull bad teeth and that idea makes me nervous. Mine seems to have the attitude of “if I can save the tooth, I will” – he was able to put a crown on the tooth I broke, there was enough to salvage.Report
My dad had the opposite problem – there was one tooth that caused him years of pain, and the dentists he saw had the attitude that no measure was too extreme to save a tooth. The thing probably cost him a few grand over who knows how many procedures.
He finally found someone willing to just pull the thing, and immediately felt miles better.Report
Your vet bills you, directly, and asks for cash up front (or close enough). Mostly because “letting the dog die because you can’t afford it” is a lot more acceptable than when it’s little Timmy.
Doctor’s bill the insurance company. Scratch that. Doctor’s chart what they did, and their staff bills the insurance company, the amount of which they bill is covered by complicated contracts governing network status, each unique to a given insurance entity.
My doctor rarely knows what a drug costs. They often know what their own base visit rate is and have a rough idea of their in-house lab costs. They don’t know what, say, Quest will charge if they don’t do in house labs.
It’s because, well, it’s not part of their job. There’s too many drugs, too many tests, too much stuff for someone to keep track of unless it’s full time. You’re best bet is that a Doctor knows the really pricey drugs and tries to avoid them (mostly due to people complaining) and that his staff is set up to similarly push down costs when Doctor’s order tests or prescribe drugs.Report
morat20,
The pricequote for killing little Timmy is $50k more or less (well, that AND making it look like an accident. So sad.)Report
I totally get that, but there’s a lot of distance between the doctor not being able to predict every complication in surgery and nobody knowing whether a hospital bill for some relatively routine tests will be $100 or $1,000 or $10,000 until after they’ve printed the invoice. We have a very, very long way to go before we get to where the unpredictability of medical procedures is the limiting factor.
Even then, none of that means that doctors should be allowed to shrug like idiots when you ask them how much something will cost. My father is a construction superintendent for a commercial building contractor, and they crack open 100 year old buildings for deep rework all the time. Sometimes they find something horrifying that adds huge unexpected. This is understood. But they still have to produce an estimate, and barring unexpected complications, they have to come in near that estimate. If something changes, they have to be able to explain why or they lose customers. And at the beginning, they usually say, “It will cost $X based on these assumptions. Some potential problems with your building are A, B, C, and those could cost as much as $Z to fix.”
If the client asked, “How much will it cost to add a bathroom to this floor?” and he said, “Well, we can start demolition on Wednesday and you’ll know when you get the bill,” it would be considered… abnormal. I don’t get why we put up with it in this one case.Report
“none of that means that doctors should be allowed to shrug like idiots when you ask them how much something will cost.”
Agreed. However, the only solution that anyone has figured out to solve this problem involves a fair amount of govt regulation. Turning a medical visit into a visit to a car dealership ain’t easy.Report
“none of that means that doctors should be allowed to shrug like idiots when you ask them how much something will cost.”
Well, things are a’changin, but the reason doctors can’t tell you what a service costs isn’t because they’re dumb or even that the “market” doesn’t work. It’s because the vast majority of the time the “customer” (technical term) isn’t the patient but the insurance company who pays that insuree’s bill. And that’s all set via very complex contracts that are for the most part unilaterally price-set by the carrier. And docs just wanna be in-network.
One of the things I’m persistently confused by when it comes to these debates is the idea that price discovery will perceptibly change the dynamics of healthcare provision and cost. In my view it won’t. Again, the vast majority of people in the system just don’t give a shit about price, and that’s endemic to our system.Report
Oh, I don’t think it will fix things, but I expect it would help a bit.
The whole healthcare mess is the epitome of, “A billions dollars here, a billion dollars there, and pretty soon you’re talking big money.”Report
I read a quote the other day from a European person (you know how uppity they can be) to the effect that they’re healthcare systems work because (para) “not every country is as corrupt and greedy as America is.”
Personally, I think the guy was on to something. Corruption and greed (and punition…) really are defining American ideals. So of course that sets a real and perhaps insurmountable constraint on the possible, ya know?Report
The insurance model is definitely the biggest confounding factor in the whole thing, and the insurance companies intentionally make it as opaque to the patient and the doctor as possible because it’s good for them to handle everything without anybody asking any questions.
But if insurance really just paid for everything, there’d be a lot fewer people complaining. The reality is that the bill and what the patient pays vs what the insurance company pays is often a complete surprise. The patient knowing in advance whether they’re likely to get an out-of-pocket shock would be a huge improvement, and it’s not something that seems unreasonable to expect.Report
I hold no weight in something so distorted to be able to come up with a reasonable cost or price signal.Report
Spontaneous order is a different animal altogether than factional constructed rule based order.Report
Sure, but in the case of the US healthcare system, we really don’t get a hell of a lot of either. I wouldn’t describe any old market as “chaos”, but I think @leeesq is right to use the word to describe the dysfunctional market that we have in the US.Report
We have the guild order of the doctors, the guild order of the nurses, the entrenched order of the equipment manufacturers. The pharmaceuticals are highly rent sought market.
Diagnosis again pretty well ordered, within all the other order. The older the markets become the more rigid it becomes.
There is no real threat of demand destructions of any of those orders. It’s not competitive.
“competition is a sin”
There is little to no spontaneous order that rises up to destroy the rent seeking. We get less even though we pay more. Often paying much more than a free uncaptured market in its infancy.
All this over many decade life cycles. If The American market is destroyed and opened up as a young market and Singapore continues to age, we would likely see the reverse. Where we were getting more and paying less than Singapore.Report
Right, but we have a lot of those cartels and they have misaligned or even opposed interests, and then we try to make things function like a free market as well and it’s a garbled mess.
I also disagree about the age thing—the German system is very old by the standards of such things (it goes back to like the 1880s), and has kept on ticking with periodic reforms while delivering decent care at a manageable cost.Report
Germany looks interesting, although there are some parameters I would question about whether the markets experienced considerable churn that might have reset the age scale.
Also it may be useful to expand the time horizons of systems that make decentralization a priority or at least bring to bear what spontaneous order is capable of creating change.
I agree we have a garbled mess, one without a simple reset button.Report
‘Chaos’ – You keep using that word. I do not think it means what you think it means.
A market, free or otherwise, is by definition an ordered system, and is the opposite of chaos. A free market is simply a market where the rules are formed in a more bottom-up approach by the market participants, but markets can not function without some degree of order.
The fact that the dominant order does not satisfy your preferences does not make the market chaotic, or any synonym of the the word chaos.
So, @leeesq , how about you stop using that word in this manner.Report
I disagree; I think the sort of rules (i.e., reasonably clear and reliable ones) necessary for an functioning market really aren’t there for the US healthcare system. It’s pretty easy to point to signs that it’s not functioning, like the fact that a lot of the time providers can’t even give you a range of costs you might pay for procedures, and that (as @kimmi noted) a lot of time the cost of a given procedure will vary wildly between providers that are just a few miles apart.Report
That isn’t chaos, it isn’t even chaotic. It’s obtuse, obfuscated, needlessly complex, etc., but it is most certainly not chaotic.Report
Are you using the word in a nonlinear dynamics sense or something?
Because in a colloquial sense, I think it qualifies.Report
I am a fluids dynamics guy, so yeah, my definition of chaos may be more than some colloquial interpretation.
However, Lee was not claiming the US healthcare market is chaos, he was claiming a free market healthcare system would be chaos. I’m claiming neither position is true. A market is an ordered system. It has rules and some mechanism to enforce those rules.
The US system is needlessly complex and obfuscated. It feels chaotic because the rules are hard to see and even when they are discernable, they are hard to follow. The complexity is an artifact of insisting upon the market creating specific results, and the obfuscation is an artifact of insisting we use insurance to handle the costs.Report
I made the (perhaps unwarranted) assumption that Lee meant that a healthcare system which seeks to get those specific results (which most every healthcare system does) won’t function as a market without a lot of other controls.
If we got rid of a lot of the other rules we have, we would likely something that functions as a market. But we’d also get a ton of other things we don’t want.Report
Exactly! But that doesn’t mean what we have is chaos, only that the market as it exists is failing to provide results we feel are important.
A big part of the problem with US healthcare is the controls to force the desired results were essentially hammered into the system (long time ago, in a lot of cases), often times with a pile driver and little regard for the potential consequences beyond the desired result. And when those consequences turned ugly, another control was hammered in.
We are starting to grasp the reality that you can’t just hammer in a control, you have to install it carefully, but even knowing that, new controls almost have to hammered in, because of politics and entrenched interests, and cultural inertia.Report
I’m with Pillsy on this. A market does require an underlying order to operate, but it’s fair to call a free market chaotic, particularly in comparison to the alternatives.Report
@oscar-gordon — Can you make this formal? After all, I suspect that real-world economies are very much chaotic.
The definition here involves three factors. I can see how actual economies might lack a clear “periodic orbits,” and thus lack “dense periodic orbits.” But it seems like nature is seldom like our simplified models of nature (no spherical cows), and outside of “nice” systems (such as the solar system), many things can be described as “chaotic” where in practice the “periodic orbits” will get disturbed by outside forces anyhow.
Plus, stuff like this exists: http://www.sciencedirect.com/science/article/pii/S0164070405000881Report
@veronica-d
I’m betting JamesK or BrandonBerg could formalize it even more so, but to me, a chaotic market is one where the rules are purely transactional and there is no higher authority to appeal to in the event of disagreement. A higher authority could still reign over a chaotic market as long as it enforces no rules beyond the arbitrary decisions it makes.
For example, take a bazaar (a place most people might find highly chaotic). Even back in ancient times, bazaars had rules and a governing authority that enforced those rules. However, if we had a bazaar with no rules, where any ‘rule’ was purely transactional (decided upon by the parties of a transaction, at the time of the transaction), and the only rules the authority enforced were also transactional (thus the authority, if presented with two cases that were for all intents & purposes exactly the same, could issue contradictory rulings in each, and enforce each as it was decided), we’d have a chaotic market. The closest thing we have to that is a black market.
Black markets are certainly free, but not exactly popular, and not terribly functional since the degree of uncertainty is very high. Very few Libertarians want that degree of freedom in their markets, some rules and order is always desired, the debate is over how much is too much/not enough.
ETA: The fact that an ordered system is dependant upon a certain amount of chaos is not the mark of a chaotic system, it’s just life.Report
The benefit of an ordered market is that it allows foreknowledge of the conditions under which defection will be punished. So if those conditions obtain, one can assume that the cost of defection will be raised high enough that cooperation becomes the preferred strategy.Report
@oscar-gordon — I guess I’m thinking in terms of markets in terms of dynamical systems. But then, as soon as you do that you’re not talking about real world markets, inasmuch as dynamical systems theory is based out of continuous nonlinear differential equations and real world markets are made of a large population of discrete actors. That said, in macroeconomics I guess we can model markets using continuous systems of equations. If we do that, and if the model is fairly good, we may observe chaotic behavior. In turn, I wouldn’t be surprised to see such systems match real world behavior in the statistical aggregate. If so, I would be willing to call those systems “chaotic.”
Of course, better models will use discrete “agents” in large scale simulations, which I know that some economists are sociologists play with now days. Certainly the outcome of such models is unpredictable and complex to a degree similar to “chaotic systems.”
In any case, economies clearly do not have “simple attractors.”
Regarding rules and decision makers, aren’t they part of the “system” that has to be modelled along with the rest?Report
If we accept that definition, then you can not have a non-chaotic market if there are any discrete agents that can inject variability into the works. If I was to fix Lee’s claim, it would be that a healthcare market without interventions would be more chaotic than it is now, for certain subjective values of chaos (the degree of chaos would be dependent upon the POV, some people would find the system more straightforward, others would not).Report
Someone wrote this and got paid for doing so. I get that different ideologies are going to exist but this is getting to junior high school levels of maturity, possibly less:
http://thefederalist.com/2016/04/22/why-conservative-women-are-so-pretty/#.WQI5-JGGRY4.twitter
I have a bet in my head about whom will say this is no big deal and liberals shouldn’t be outraged about it.Report
Wait, we’re supposed to be outraged? Groupthink is groupthink and I can cite just as many lefties saying the same damn thing (at least I figure a quick google will get me ONE. Dude, Just One).Report
Outrage will just give them sweet, sweet hate-clicks.
Anyway, I’m not sure why you’d expect The Federalist to stop being a garbage fire at this late date.Report
Sp5 – my semi educated (and semi uneducated) guess is that less water means more variability in day to day weather and faster shifts in climate trends, as you’re taking out half of the thermodynamic sink.Report
Pretty much this, the oceans are massive heat sinks. You’d also lose a lot of the warm higher latitude coastal regions (like the Puget sound).Report
There’s also a chemical equilibrium that it helps to maintain vis a vis oxygen and carbon, among other things.Report
And salinity. We don’t want the oceans to be dead seas.Report
One thing to keep in mind is that a water planet with a rocky core does not mean vast, deep oceans. It could have some deep reservoirs, and a whole lot of relatively shallow places. Also, if we can cross the void to colonize such a planet, chances are we will either have the technology to do undersea mining, or we’ll just mine local asteroids for the raw materials to build islands or floating cities.Report
Damn it, Will! We need to coordinate stories if you have science & tech links you want to post.Report
How is Sp6 NSFW?Report
That one planet is showing too much mantle.Report
I think there is some ejaculate as well…Report
Subduction can lead to orogeny
(I knew a guy – a geologist – who had that as a bumper sticker)Report
Subduction I knew, but orogeny I had to look up. Still funny, even if I had to look things up.Report
Wait, is this a sex joke? I don’t get it. Help a girl out.Report
Subduction sounds like seduction and is the process up one crustal plate diving under another, which can lead to orogeny, which is the upthrusting of mountain ranges.Report
Usually if you have to ask yourself, “Is this a sex joke,” the answer is “yes.”Report
@fillyjonk — I like to think that every joke has the potential, if we believe in ourselves.Report
Kind of like how every New Yorker cartoon can be captioned with “Hello, I’d like to add you to my professional network on LinkedIn”
(I’ve informally tried it out on about two dozen cartoons, and remarkably, it works)Report
OMG!Report
Or like adding “in bed” to the end of every Fortune Cookie saying.Report
My favorite bumper sticker is an archaeology one
“Relative dating it’s not incest”Report
[Sc6] Inequality is going to exist. Do you really think that the very very rich will tolerate a bunch of peasants harshing their ride? The only way this trendline changes is violent revolution or collapse. Choice one baby.
[F2] It’s not the width of the seat that I have a problem with, generally, it’s the seat pitch. With an aisle, you can shove you let into the aisle.
[Sp3]: This really isn’t news. One day a “planet killer” will his the planet and all life as we know it is done for.Report
Also, Sc6 is not about science and obesity, although it is interesting nonetheless. And the author really likes Robert Reich.Report
[Sc4] That article was way into teal deer territory, but it still bugged me much less than I expected to, and pace @saul-degraw , I didn’t read it as an apologia for the DOD so much as an argument that science should be driven by a focus on solving particular problems. I don’t know if the argument works—indeed, he ended up roping in a lot of bad results that were all about addressing specific problems. Still, I left academic science for industry years ago, and one major reason was the sense that I was engaged in a rather pointless and aimless enterprise.Report
pillsy,
The man doesn’t understand the problems he wants to solve. Solving breast cancer (greater than 50% increase in its prevalence since the turn of the century) is not about CURING it.Report
Sp4 – Asteroid, not astronaut, as there’s no mention of MATT DAMON in the link.Report
SC1: I tend to feel when people go outside of their “wheelhouse,” stuff can go off the rails fast. Looks like that’s what’s happening here. Yes, Nye knows some science – he is, I guess, an engineer? But I’m a biologist and I’d never talk about quantum physics or metals chemistry other than very, very casually, and I’d be open to being corrected by someone with more experience than I have….
I confess, I’ve always been suspicious of “science popularizers.”Report
filly,
I like the science trolls better, myself.Report
I dunno, orcs tend to have better lab technique.Report
Orcs are terrible grant writers though. The trolls get the funding, for better or worse.Report
Naw, you wanna get grants? You have to get the elves to write ’em.Report
The Bill Nye video is going to get President Ivanka a second term.Report
I thought you said science is neither left wing or right wing earlier in this thread?Report
Oh, he’s not talking about science.Report
The ice cream video that swung from “you shouldn’t try to change other people!” to “we’re going to try to change you!” in less than a few minutes? Pure perfection.
I suppose if we get enough people to see the new Bill Nye series, enough people will change their minds.Report
I once thought my choice of ice cream was a matter of taste, but now I realize my choice is fraught with moral implications. Am I doing this right?Report
Almost.
Instead of saying “I realize my choice is fraught with moral implications”, saying “I realize *YOUR* choice is fraught with moral implications.”Report
But he can’t say that unless he thinks HIS choice is imbued with moral implications otherwise he wouldn’t think choosing differently entailed moral fraughtness.Report
If my experience in the church is any indication of how this stuff goes, it goes straight from “I used to think it was a matter of taste” to “It’s a matter of morality and, thank goodness, I’m already doing the moral thing” to “HEY HEY HEY HEY YOU’RE DOING IT WRONG!”
That middle one? There generally isn’t enough time spent in that state of mind to allow for a deep breath.
So, sure, you go through it. But it’s not like “spending the night there” going through it.
It’s a “sneeze and you’ll miss it” going through it.Report
That middle one? There generally isn’t enough time spent in that state of mind to allow for a deep breath.
And the irony is that even tho you think it IS worth a deep breath, and that there should be plenty of time to spend, you gasp! and move immediately to your own breathless condemnation of how people are so breathlessly condemning.Report
There are two “I have seen the Face of God” reactions that I have tended to see.
“I have seen the Face of God and I need to change my life!”
“I have seen the Face of God and you need to change your life. I happen to have a list of things here.”
I suppose I could see how someone might see someone telling someone doing the latter to buzz off as being ironic.
I don’t see it as particularly ironic, though.
Trees, fruit, etc. I’m sure you’re familiar with the drill.Report
That only makes any sense in context if you think everyone everywhere who says anything anytime reduces to an “I have seen the face of God” paradigm. You gotta do a lot of work to make that argument.
On the other hand, if those folks are your antagonist you should spend more time on twitter.Report
Ahh. I think I figured out what’s confused me for all these years. You’re an evangelical at heart trying to convert people to The Truth, even tho the Truth changes over time. Is that right? A “The Truth will set us free” sorta thing?Report
Close. I’m a former evangelical who still sees the dance moves everywhere and recognizes the Young Earth Creationist argumentation techniques that I was taught when I see them in the wild.Report
While I was out running errands this afternoon, I spent some time behind a car with a bumper sticker that said, “A quick stroll through the insane asylum suggests faith doesn’t prove anything.”Report
When things are subject only to eschatological verification techniques, you’ve only got but so many ways to deal with people who disagree.
For example, you might have to put people who disagree in an asylum.Report
I tend to think that second reaction means the person hasn’t actually seen the Face of God, either they just think they have or they’re trying to control the second party.Report
I suppose if we get enough people to see the new Bill Nye series, enough people will change their minds.
And here you are commenting on a public forum apparently trying to change people’s minds.
So I don’t think THAT’S the issue you want to hang your hat on.Report
On the Bill Nye thing, I cannot change a single mind.
Only watching the video can change it.
I suppose I can nudge people to see it.Report
Is it the recent Nye music video that once seen, can’t be unseen?Report
Yes.
I got a co-worker to see it. When I told her about it, she said “Oh… I *LOVE* Bill Nye!”
I told her to google it.
Later that day, she came up to me and said “I’m not talking to you anymore.”Report
Ha!Report
There was a meme I saw yesterday that compared Dolph Lundgren to Bill Nye and suggested that Bill should probably go back to school.Report
Sp2 – it is kinda remarkable that all the space research missions either last 3-5 times or more past their expected service life, or fail prematurely and spectacularly. But I guess that’s the nature of the business.Report
Sc4,
Fuck this guy, and fuck Quehanna and “oh, wow, Science should be done only by the DoD”.
We still have “do not live here” zones because of the DoD.
And really, he’s doing fucking breast fucking cancer? The one cancer that we’ve got an epidemic for? The one where it’s pretty damn fucking CLEAR that no research on CURING it is going to fix the ACTUAL ISSUE which is how the FUCK we are causing breast cancer???? (Allow me to educate you on intersexed fish)
Honesty? Artisans produce honesty? We can cite Milliken and more for “honest researchers”…
Climate, in general, is pretty fucking easy to predict. Catching the falling knife is difficult. Knowing where it is going to land is difficult. Climate is easy.
We know what salt does to people. Metaanalyses are a stupid point of reference, as Salt Reduction is only an issue with people with hypertension. Of course, if you fail to pull those people out of the whole sample, you get “this doesn’t help”.
And all this obscures the points that he could make. Liquid IV is just as important an advance in modern medicine as antibiotics (same level of usefulness). That was a quick and easy invention, too.Report
Given that you dropped more F bombs in two minutes than I’ve dropped all day (it’s still early), maybe you ought to go and cuddle with your cats or something.Report
Sp1 – how about just “Venus-like” for this one? We’re well past this after all.Report
Sc1 is just evidence on why re-tooling a kid’s show for an adult audience is generally a bad idea under all circumstances.
Sc3: I can’t see artificial wombs really changing the abortion debate. Not only are going to have same issues regarding abortion, your going to have even more troublesome issues about who pays for bringing the kid to term in the artificial womb and who raises the babies to adulthood.
Sc5: He didn’t seem to get that many superpowers out of his ordeal.
Sc6: This reminds me of a dark joke from my high school years about “reading about what causes cancer, causes cancer.”
The vending machine picture: I miss Japanese vending machines. They carried a wider variety of soft drinks and junk food than American vending machines and had a cooler design. Japanese vending machines are designed to give out bills and coins as change so they are easier to use to.
F1: They can’t just program things so that once a flight is filled, they don’t sell anymore seats?
F2: That’s just crazy talk. The only advantage to the center seat is that you need to bother one person rather than two if you want to go to the bathroom.Report
Re F1 – the thing is that almost always there is some percentage of no-shows and last-minute cancellations on flights. If they only sold as many tickets as the airplane has seats, they’d be wasting fuel and its assocated carbon emissions, payroll, runway time, etc. by flying a partially full airplane after turning away would-be passengers.Report
This. There are good economic and environmental reasons to allow overbooking.
We could also demand that if an airline does not want to hand out cash for bumping, and would prefer instead to use vouchers, the vouchers can not have blackout dates or expiration dates of less than a year (they should be the equivalent of cash except only valid for the airline or its partners).Report
And make them transferable. That means they can be sold for near face value, which makes them almost as good as cash while still being cheaper than cash for the airline. And if they can’t do that, JUST PAY CASH. Jeez.
If it’s going to cost between $800 and $1300 to bump somebody involuntarily, you should never have to get to that point. Offering 8 crisp $100 bills would clear most airplanes. I’d be shocked if you couldn’t get a volunteer for a few hours of delay $200 cash 99% of the time, given that the median hourly income is and how easy it is to sit in the airport and play on your phone.Report
Right. and if traffic or lack of a parking space means you miss your flight, you’d have to pay for the entire ticket.
(If the airlines ever switch to a policy where you have to anyway, then I no longer support overbooking. I believe that’s why they haven’t.)Report
F2 – I usually look at the article’s address along with its description to figure out if it’s something I’d like to read. This description said, “Huh. On airplanes, the center seat could become the most desirable.” The address incudes this string:
aircraft-design-thatll-make-love-middle-seat-no-joke
So I start wondering, desirable? Making love in the middle seat of an airplane? What airline is allowing that? And why the middle seat? If you’re going to permit mile-high sex, why the most uncomfortable, most visible, seat in the plane?Report
[H1] My mother tells stories of doctors who would intentionally grab scalpels from you in a way where, if you were holding the scalpel wrong, it would cut your hand. They figured if you got cut, well, that was a good lesson in why you should do things the right way.
One big takeaway for me is the case study at the end, where the doctor is quoted:
Report
This seems like not so much a doctor thing as an “employee that’s hard to replace” sort of thing. A certain part of the population is temperamental assholes with no social skills. They get canned from most jobs because they’re not worth it. If you’re a good surgeon, actor, musician, basketball player or whatever, people will put up with your crap because you’re hard to replace.
And of course, being in that position brings out the worst in that type of asshole. Being deferred to on everything and knowing that you’ll always get your way can do terrible things to *nice* people.Report
And boy does it attract the naturally inclined assholes.Report
[P1] “Employers are having the most difficult time finding candidates with adequate soft skills, as well as some form of hands-on electrical, roofing, or construction experience.”
So what this means is, they don’t want employees, they want franchise owners. Like, they want to hire someone who just sits down on Day 1 and does all the sales work and handles the contracts and goes out and gets the materials and takes them to the job site and bolts them onto the roof of the house and does the electrical hookups and gets all the permits and inspections and blah, blah, blah.
But still an employee, still someone who does what they’re told. Not, like, management authority or anything.Report
That, or they are just angling for more H1-B visas, because this is the same crap I hear everytime H1-Bs are getting negative attention.Report
Combined with the Trump aide who told Politico “this shit is hard”, I think we have the documents of the Trump admin:
http://www.reuters.com/article/us-usa-trump-100days-idUSKBN17U0CAReport
Is It Illegal to Wear Masks at a Protest? It Depends on the Place
https://www.nytimes.com/2017/04/26/us/protests-masks-laws.html?module=WatchingPortal®ion=c-column-middle-span-region&pgType=Homepage&action=click&mediaId=thumb_square&state=standard&contentPlacement=61&version=internal&contentCollection=www.nytimes.com&contentId=https%3A%2F%2Fwww.nytimes.com%2F2017%2F04%2F26%2Fus%2Fprotests-masks-laws.html&eventName=Watching-article-click
Now we know why the Berkley snowflakes can hide their faces.Report
Justices Alarmed by Government’s Hard-Line Stance in Citizenship Case
https://www.nytimes.com/2017/04/26/us/politics/supreme-court-naturalization.html
I guess some lies are ok with the court.Report
Like Clarence Thomas saying under oath that he’d never discussed Roe v. Wade with anyone. Deport him.Report
Justices Alarmed by Government’s Hard-Line Stance in Citizenship Case
https://www.nytimes.com/2017/04/26/us/politics/supreme-court-naturalization.html
I guess some lies are ok with the court.Report
Under the government’s argument, we’d be able to revoke the citizenship and deport the First Lady.
Strange to see you arguing for such incredible levels of government power.Report
I expect the govt to enforce the laws as written by Congress. If the standard is no lies, then that is the standard, no more and no less. Not the court substituting its judgement to change the standard to only material lies.Report
So, in your perfect world, would everybody who does 56 on the freeway automatically get a ticket?Report
Naturalized citizenship can be revoked for a variety of reasons set down in law.
In contrast, the government can’t touch natural born citizenship. To renounce it, you pretty much have to nuke a city while proclaiming that you are renouncing your citizenship, making it clear that you no longer want to be a citizen, in triplicate, in which case the government might or might not grant your request.Report
Could, “Some lies are OK,” be rephrased as, “The punishment should fit the crime?” I mean, I bet there’s false information on at least one of your tax returns. A dollar, a rounding error. Something. And if the IRS finds it, they’ll likely send you a letter saying, “You got this wrong. Pay us the right amount and here are some penalty charges for getting it wrong.” They don’t kill you and your family and then burn your neighborhood to the ground. There’s a sense of proportion.
US citizenship is an incredibly valuable asset. It seems like the only reason you could fairly deprive somebody of it is:
1) They do something really bad such that losing that asset is actually a proportional punishment.
2) The falsehood was actually material to the naturalization case.
And #1 still seems crazy because to my knowledge, citizenship is not something we ever strip from somebody as a punishment, no matter the crime. The standard the government is arguing for basically makes naturalized citizenship meaningless. There’s probably not a single adult naturalized citizen in the country that couldn’t be denaturalized by a motivated government official with access to the right records.Report
In the case at hand, the woman lied about her husband being a potential war criminal. Not that I think there’s anything wrong with war criminals, but the government has a right to know who they are accepting as citizens.
Under current US law, not revealing that you are a communist, or joining a communist or other totalitarian group once you are here, will get you stripped of naturalized citizenship.
It’s basically voiding a contract between the government and the naturalized citizen.
The government can’t do that with natural born citizens because voiding the contract would mean no more US government, as the naturalized citizens are the ones who designed, created, and empowered it to serve their own ends.Report
So Sebastian Gorka could have his citizenship revoked?Report
That’s all good and fine, but the government isn’t arguing that the falsehood was material to the contract. If they want to make the argument that her lie was material to the government’s decision to grant her citizenship, that seems perfectly reasonable and is probably a winning argument. But that’s not what they’re arguing. They’re arguing that literally anything that’s not true is good enough. That’s insane. There’s no end to the possible perverse outcomes from that kind of a standard.Report
You don’t like the standard under which you filled out “religion:” as “Christian” and then get kicked out because based on [insert 182 obscure Biblical references] you’re not really following the teachings of Christ?
In any event, I’m kind of assuming that the lawyers arguing the case were Obama appointees looking to screw up anything to do with Trump, or they’re just really bad lawyers.Report
I don’t think we need to read that far into the motivations of the lawyers. By their nature, they seem to argue for the absolute maximum most insane thing possible knowing that they’ll get something less.
The shamelessness of the starting point for negotiations never ceases to amaze me. Normally if we think we’re going to settle on $15, I’ll offer $10 and the other guy will offer $20, but it seems like a good number of lawyers will start at $100,000,000 plus I give them my dog and then we’ll eventually end up at $15. You never want to agree to $15 and spend your life wondering if you could have gotten $100,000,000 plus a dog.Report
What surprises me are A: the number of people who have never heard of a hypothetical before and B: that a Supreme Court justice would be surprised when someone answers a weird extreme one in a weird extreme way.
I mean, what, they expected the guy to stand up in court and say “the government should pick and choose how it enforces the law based on how cute someone is”?Report
Trump is increasingly sounding like an emperor who throws gladiators at the lions to keep the people entertained. Are you not entertained?Report
Some time ago, I read that North Korea’s most likely response to a strike by the US would be to put nukes on cargo ships and sail them into the ports of LA/Long Beach, Oakland, and Seattle and light them off.
I’m close enough to the Port of Long Beach that my best guess is that I’ll die from severe radiation poisoning.
So, yeah, entertained.Report
They would probably go after South Korea first causing hundreds of thousands of causalities there. For some odd reason they do get forgotten, like somehow the main conflict is between us and NK. It’s between SK and NK, we are an ally but not the main player.Report
In the event that NK desired to strike against an “enemy” they wouldn’t choose South Korea first. They’d choose the US, and short of that Japan. SK would be last on their list, one which makes less strategic or political sense than attacking the US. Unless they think China will back them when the shit hits the fan. (I don’t think China will.)
This is one area where I give Trump some credit (accidental tho it is since he doesn’t actually know a damn thing about geopolitics or strategry): he’s managed to leverage China into attempting to curtail NK military buildup/aggression. It may not work, but it strikes me as the best-case first option wrt reining in the whackjob in charge over there.Report
The biggest danger to NK is across the DMZ. They can hurt SK far far easier then they can hurt us. If they can hurt SK enough, which they can, that will lead SK to tell us to STFU. We are distant and hard to hurt without risking huge retaliation. If they nuke us, we nuke them. If they stay conventional and hurt SK what are we going to do, invade NK??? SK is their focus and arch enemy.
Prez’s have been trying to get China to really push NK hard for quite a while. It’s fine to try that but there are limits to what China is willing to do. They aren’t going to bring down the current regime. They don’t’ want a unified SK/NK that would be dominated by SK since they are solidly in our camp. It suits China to have the NK ruled by the current nutjobs but they don’t want to much trouble from them.Report
If they can hurt SK enough, which they can, that will lead SK to tell us to STFU.
Wha??? That’s not how it works. Neither SK nor the US would tolerate it. An attack on SK is functionally equivalent to an attack on the US.Report
NK has made some minor attacks on SK. They have infiltrated peeps over the border and as i remember even assassinated some SK’s.
If they retaliate to an attack by us by hitting SK then that is one major problem. Is SK completely behind our attack? If they aren’t then why are they necessarily going to war. SK knows how bloody a war with NK will be. If SK is fully behind an attack by us then they are already open to full scale war. Is there any evidence SK is willing to be part of a full scale war with NK with all the giga gallons of blood that will spill? I don’t see them willing to go full Götterdämmerung in NK. I mean how do you even say that is Korean.
Any preemptive attack on NK risks full conventional war that will occur in Korea. They will suffer far more than us. Unless SK is willing to go there, then they likely won’t unleash all the dachshunds of war even if NK hits them since that isn’t in their interests. At least as long as NK doesn’t go to far with their strikes.
Again, China does not want regime change in NK. They don’t want millions of NK refugees flocking into China nor do they want a North subsumed into SK. The only way that makes sense for China is if they assume it will take a decade or three for SK to raise up NK so that SK will be weakened in the short to middle term. In the long term all of Korea being in our sphere of influence is not in China’s interest.Report
I meant to suggest that NK would nuke west coast ports once it was clear that it was going to be defeated. Would we really drop a nuke on Pyongyang if we already had marines there?
In light of the current situation, if I were in the NK leadership I would have nukes at sea already.Report
Oh sure make it all about your horrific death by radiation.
I agree with that though. If NK knows they are doomed then we should expect nukes to be in play. I’ve never read anyone say we can easily or quickly decapitate the NK leadership or take out their nukes. Still Seoul has more to fear from that than us but i wouldn’t want to be in a western US port city nonetheless. Defeating NK likely leads to tens or hundreds of thousands of causalities from conventional war and very possible use of nukes. Which means preemptive strikes are really really not likely and not without SK and Japan and China being fully on board with all the risks. Unless of course Trump acts without our allies and China’s knowledge and approval. My guess is the senior military is strong enough to explain to him how much of disaster that would be.Report
I wouldn’t worry about North Korean ships. They are all being tracked. If a conflict breaks out they’ll probably all be sunk, too.Report
I’m surprised the artificial womb story didn’t get more traction with this crew. Even if you tested it on monkeys and the little things grew up looking like and acting like ordinary monkeys, how could you possibly get permission to place a human embryo in there?
Even if an infertile couple were begging to use the technology, it just seems really perilous. Do we know remotely enough about the process of pregnancy to be comfortable that we can recreate the entire process artificially?Report
You’d think it’d be easy to have a parasite/blob of cells transferred.Report
Well, sorta. That’s not too far off from the way surrogates work, albeit in-vitro fertilization >> surrogate implantation vs embryo transplant. I’m not sure what may have been done with animals that way.
The zygote is a pretty aggressive little parasite that’s not terribly picky about where it takes root. That’s how you get ectopic pregnancies and such and why unrelated surrogates work out. But this artificial womb is basically just a plastic bag so there’s no tissue for the zygote to latch on to. No placenta; just a mechanical connection via the umbilical cord to a kind of heart/lung machine for oxygenation.Report
My understanding from the article was that they’re aiming this at real little preemies to give their lungs and brains and such more baking time to develop properly.
I know, the mind tends to immediately jump to the sci-fi scenarios but the researchers are declaiming that intent.Report
What @road-scholar said. Think of it as an extreme NICU instead of a uterine replicator.Report
If you add an entertainment option it’s a NICUlodeon.Report
Take one rim shot out of petty cash.Report
I read a sci-fi short once that had (sorta incidentally, not the main thrust of the story) a couple get “pregnant” by in-vitro fertilization and then having the zygote implanted in a living cow. It was just the normal way to do it.
And, you know… that might just actually work. It sounds kind of gross, but it’s not really that far out scientifically.Report
The Vorkosigan series uses uterine replicators as a way to easily control for virth defects & genetic conditions.Report
virth defects
Vintage Vorkosigan. Veerily.Report
As well as making things a whole lot easier on the mother.Report
“Having to organize a commando raid to get the damn uterine replicator back” isn’t a typical complication of pregnancy, however.Report
I read Brave New World at an impressionable age. I’m already foreseeing legions of Delta-Minuses who are used to do the menial jobs that robots won’t do.
I mean, I hope I’m wrong and that all that results from this is that people who are unable to carry a pregnancy to term can use it as a way of doing so, but our species doesn’t have the greatest track record of using “discoveries” in a purely ethical way.Report
Sc2: Attention Disabled Community. After decades of effort and some success at re-definition of yourself from “[disablement] person” to “person with [disablement]”, such that you are no longer defined by your condition, please understand that efforts to cure or prevent your particular problem are aimed against the thing that no longer defines you, not you as a self-realized petson. Thank you.Report
Sc4: I’m going to generate hate mail with this comment, but contra Saul’s interpretation that the article was an homage to the DOD, I read it as a condemnation of Hayekian bottom-up philosophy in favor of a more top-down, goal directed approach.Report
The problem with a strict top down approach is that it can be very difficult to know from where a breakthrough will come. A materials breakthrough could be made because of an unrelated bit of work with protein folding, or physics could find inspiration from some mathematical brain droppings.
That said, there is value in a top down directed effort when there is a concise goal to be pursued, as long as the person’s directing the effort are able to check their egos, etc. when efforts stall, and put the pursuit on a back burner until something pops from left field.Report
There is a gray area between science and engineering. Once a specific goal is set — eg, land a man on the moon — the work is into that gray area. I’ve always talked about it as “bleeding edge engineering.” People often fool themselves. In Real Genius, Mitch thinks he’s doing science: “Yeah, let the engineers figure out a use for it. That’s not our concern.” Lazlo points out that, in fact, they’ve been doing bleeding edge engineering, providing a piece of tech for a specific goal.
DOD has always been big on bleeding edge engineering. So has DOE; their RFPs are never for a chemical reaction that might lead to a better battery, it’s always for a battery that meets specific performance goals.Report
This is the fundamental error the author makes, confusing engineering for science. Science has to push in every direction to expand the domain engineering can operate in. Engineering works best when it has a goal, and a sufficiently ambitious goal could direct the efforts of science to expand knowledge in certain areas, but part of what science does is to expand the realm of the possible by asking the strange questions the author seems so keen to dismiss as wasteful.Report
Actually, let me walk that back a bit. He’s not confused, he’s looking for a way to break the mess that is modern science. He’s also not suggesting that all science should be managed and directed, only that we should start getting in the habit of funding more science toward solving specific problems, and is using places like DOE & DOD (ONR & DARPA) to show how it can work.
In that vein, I think the NSF, etc. should start setting aside grants specifically to fund reproducibility studies. If a big part of the problem is that grant money goes toward novel research, then we should stop putting all our money toward chasing novel things, and start funding efforts to validate what we already think we know.Report
Sp1: As near as I can tell, exo-planetologists use the term “earthlike” to mean “not a gas giant” with maybe an additional qualifier of “very roughly earth-sized” thrown in. We need to get started on the Star Trek style classification system so we can reserve our excitement for the discovery of a nearby Class M planet.Report