Morning Ed: Health {2017.12.12.T}

[He1] The ship has sailed on continuity of care, I fear, both over there and over here.

[He2] My wife’s last two employers have leaned very heavily on Professional Obligation to keep her working in excess of 60 hours a week and get the family accustomed to her not coming home for days on end (her last couple months resulted in over $1500 in hotel bills because she was too tired to drive home at the end of the day), and while EMR shoulders much of the blame, but physician burnout is ultimately going to do its thing.

[He3] On the other hand, hospitals are facing some really big financial pressures, and have reasons to be pushing physicians as hard as they are. One expects that they will become among the biggest voices pushing for things like…

[He4] Nurses vs the AMA. If the physicians want to handle all of this, they needed to make sure they had the numbers to do so. I am married to a doctor and it took me nine months to establish care. While the role of the AMA and physicians in all of this is exaggerated, whether out of greed or professional pride they have been on the wrong side of this until somewhat recently.

[He5] Ooooh, a successful uterus transplant birth.

[He6] Everything is more dangerous than everything else. BUT! Some good news on vaping.

[He7] In addition to being grotesque graphically and spiritually, “plain packaging” laws may also be just flat ineffective.

[He8] If there’s a lot of pollution outside, don’t bother exercising.

[He9] Pollution has deleterious effects on job performance. Makes sense. Not good for China.


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Will Truman is a former professional gearhead who is presently a stay-at-home father in the Mountain East. He has moved around frequently, having lived in six places since 2003, ranging from rural outposts to major metropolitan areas. He also writes fiction, when he finds the time. ...more →

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115 thoughts on “Morning Ed: Health {2017.12.12.T}

  1. H2-H4: Do other developed countries with some type of universal healthcare have this problem? Burning out physicians through overwork during and after residency is something that I do not understand. On occasion yes, its necessary. It should not be a routine practice though because it seems suboptimal and lives are at stake. Likewise, I do not understand why having people drive home after putting them through exhausting labor is a good idea either. They aren’t really in a position to concentrate that much. Seeing doctors and nurses passed out on NYC transit is a fairly common occurrence. Its just that America seems determined to create a system of misery through inertia and ideological hostility to gentleness.

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    • I think its a given that European physicians work fewer hours. This comes up time to time in discussions in which physician salaries are identified as a large source of the disparity in healthcare costs w/ other OECD countries. A physician will say that perhaps physician salaries need to be rolled-back, but then Americans need to expect physicians to keep banker’s hours, except for emergency care. It seems fair, but I don’t know what it would mean in practice.

      A physician friend quit her Obgyn practice several years ago because she was burned out, wanted to spend more time with the children and calculated that with her husband’s salary, taxes and the cost of childcare, the financial motivations to work were not strong. Her husband is a colon/rectal surgeon and his hours are more easily planned around a 9-5 schedule, and his on-call duties were becoming less over time. After quitting, her group hired her back as a part-time physician with no birthing duties and set hours at the clinic 3-4 days a week. I suppose that this is an example of one career per spouse.

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      • Scott Lemieux of LGM frequently brings up the point that the biggest obstacle to affordable healthcare in the United States is physician’s salaries. To really bring down healthcare costs, your going to need to find a way to reduce them. Physicians are going to fight this tooth, claw, and nail.

        Your reference to banker’s hours seems quaint though. Most people in finance work long hours and play hard. The time when bankers worked limited hours compared to many other people included well-educated professionals is long gone. In New York, the state courts were closed for everything but criminal matters from Memorial Day to Labor Day into the 1990s. Lawyers still went to their offices and worked on cases, did federal work if they had it, and criminal cases but it was understood that you get to work less hard in the summer. This type of thing really got hit hard by globalization.

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        • Well, the physician was referring to banks. The lobby of the bank I use (PNC) has hours of 9 to 5 M-F. This is the main downtown office, and there are other branches that have their own hours, but my office used to be in that building and the bank’s hours used to be longer each day and a half-day on Saturdays. Frankly, that seems to be the tend to me in a lot of areas.

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        • Last I checked, physician salaries are roughly 10% of the costs of health care, and according to the famed MGI report of 2006, was responsible for roughly 10% of the cost overruns ($60b out of of $650b). About the same for nurses, if I recall (each get less, but there are many more of them). I think you’d basically have to look at salaries across the entire industry.

          I maintain that the more pressing thing is not how much people are getting paid, but how they’re getting paid and what the incentives are.

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            • I’m not sure about the comparison. The physician is a pinnacle employee in the operation, whose salary will influence the salaries of employees lower in the pyramid, justify more layers of employees including administrative personnel to maximize cost-extraction. Drugs/technology can be justified in terms of alternative cost structures to physician-led approaches. And now social workers are being brought into the doctor-patient communications to allow the doctor to see more patients per hour.

              And this is not a dig at doctors at all; it’s a diagnosis of why I think doctors can become alienated from their job. Physicians in France get paid half of what they do in the U.S., and I assume this is partly because payment comes in the form of leisure, but I also think it likely changes incentives in other ways.

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              • I dunno. When my mom was going through chemo, she said that 1/3 of her oncologist’s staff were people dedicated solely to keeping track of various insurance company forms/requirements/covered drugs and harassing those companies into actually paying.

                Seems like that might be part of the difference here vs France in terms of staffing costs.

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                • My health care policy prof used to use an example from some of his field work, comparing two hospitals, one in Washington State and one across the border in British Columbia. About the same number of beds, same number of patients, same level of care. The US hospital’s business office had 30 employees to deal with the patient finance end. The Canadian hospital’s business office had three.

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            • Yup, but it’s really easy for the less-informed (or manipulators of same) sorts who want to gin up anger to point to the professionals, because they’re the “public face” of the institution. (No one ever, it seems, in their talk about “rising college costs,” considers the ton of new legislation that must be complied with, and the additional legal teams we need to have because of that)

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    • My understanding is that Canada has some degree of the turf war dynamic described in H4.

      For example when Alberta moved to begin funding midwifery care, obstetricians lobbied against it. (Midwifery is a registered medical profession here, with a four year course of study. I understand that varies from state to state, from something like Canada’s situation, to “if you can spell midwife you can be one”, to midwifery being a section of the state criminal code).

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      • I’ve never heard of midwifery being criminalized in the present. I know that some states put more requirements on mid-wives than others. New York licenses them and requires them to have a back up plan, getting mother and baby to hospital fast, if things go wrong. Midwifery mainly seems popular with a certain type of hippie-leaning liberal person. Its an ideological choice. Other people including most liberal people prefer to go the modern medical route incase things go wrong.

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        • It’s regulated state by state. I think the trend will be towards it becoming an NP specialization, especially if states keep expanding the scope of unsupervised practice. I’d be very surprised if anywhere allows someone other than an emergency responder to deliver children for pay without at least being an RN. The criminalization could fall under practicing a profession/medicine without a license.

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        • According to this chart http://narm.org/pdffiles/Statechart.pdf, midwifery is illegal in North Carolina, Georgia, Hawaii, Illinois, and the District of Columbia. As InMD notes – the criminalization is that the state simply doesn’t recognize the CPM certification, so anyone practicing as a midwife is doing so without a recognized license.

          Midwifery in North America does have some hippyish associations, yes. Only 3 or 4% of births are midwife-attended here. In the UK, it’s about half of births, and there’s no particular hippy association that I know of.

          In terms of medical outcomes, we did what research we could – the closest to our context (Alberta) was a study from British Columbia (http://www.cmaj.ca/content/181/6-7/377), which found that births attended by midwives at home, by midwives at hospitals and by obstetricians at hospitals, all had quite similar medical outcomes for mother and child, and where there were statistically significant outcome differences, the lowest risk group was the midwife-attended home birth group.

          So we felt comfortable going with our inclinations for home births attended by midwives. Whether that makes us hippies or anglophiles I’m not sure.

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    • Lee, the SlateStarCodex (which I believe you are familiar with) had an article about 18 months ago talking about this, in the context of solidarity with the junior British doctors and how overworked they are. Its good, you should read it.

      People have all sorts of misunderstandings about the realities of health care and its providers and I think that post does a bit to clear it up.

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  2. [He9] It would be nice if American journalist would learn the difference btw/ reporting and advocacy, and not every WaPo piece has to have a gratuitous mention of Trump.

    I think this is misleading: PM10 “particles come from vehicle exhaust, construction dust, industrial sources, wood burning and other sources.” Other sources are natural like dust, pollen and mold spores. A lot of dust in Germany, the source of the study, comes from the Sahara. The referenced study is gated, so I don’t know if or how they identify actual sources of the particulate matter, but I don’t think it was surprise any American that if there are allergens in the air, that work productivity suffers.

    More likely though, this is about diesel fueled vehicles in Germany, which emit over twenty-times as many particulates as gas-fueled. And I’m confident that German automakers are quite capable of defeating this problem.

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      • INORITE?
        When they wrote about that guy building a rocket to prove the Flat Earth Theorem the article never once acknowledged that opinions of the shape of the earth vary.

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        • Counter counter-thought:

          Not the most humiliating, no. Hyperbole does have it’s place though. Just another in a long series of examples of the lack of professionalism, bubble journalism. They either lied or didn’t do their job. Either of those would get my ass fired, or at a minimum, disciplined at work.

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        • Greenwald is Greenwalding, but the media is having a really bad stretch. They can either acknowledge it and try to do better, or they can equate criticism of it with Post-Factism and all that. Issuing corrections is good, but will only take you so far.

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          • The bad stretch has been going on since the election results came in.

            Corrections never get as far into the audience as the initial reporting, so there’s still lots of people who “know the story is true” when it isn’t. Besides, the story supports their narrative, so, even if this report is “technically” not true, we’ll, he’s still guilty of something similar.

            It’s just as bad as “birthers”.

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            • It’s just as bad as “birthers”.

              No. It is definitely NOT “as bad”.

              What, they got the date wrong on a story, then issued a correction?
              Thats “as bad” as insistently claiming the President was born in Kenya?

              Here is the danger, and why this point needs to be probed: One of the primary tools of an unjust regime is to make the distinction between truth and falsehood blurry, to where the citizens are unable to know fact from fiction.

              Both siderism, whataboutism, “teach the controversy”, the “one detail destroys the entire narrative” tactics;
              We’ve seen these things countless times used by 9-11 truthers, Holocaust deniers, and apologists for dictators.

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              • “It’s just as bad as “birthers”.”

                That rabid conviction that “the other guy” is evil, and that SOMETHING SOMETHING must be done. What can we find?! It’s not about the details, it’s the tone, the desperation, the need to show that they were right all along that this guy is evil….EVIL.

                But I will agree with this: “One of the primary tools of an unjust regime is to make the distinction between truth and falsehood blurry, to where the citizens are unable to know fact from fiction.” And frankly, CNN’s reporting did just that.

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                  • I”m going to assume that you’re talking about conventionally understood propaganda. In a sense, yes they are. Do you really think that the MSM is going to sacrifice their access to “the important people” by reporting on stuff that is “inconvenient”, especially foreign policy stuff? Or that their “sources” have agendas that reporters are willing to allow themselves to be conduits for? Who was that recently? Judith Miller?

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                    • So how do you decide what news reports you believe to be true, versus ones you think are false?

                      Its like the liberals over at LGM, who ritually denounce the NYT as a right wing rag even as they quote it as gospel.

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                      • “So how do you decide what news reports you believe to be true, versus ones you think are false?”

                        I listen to a lot various sources and distill a decision from them. It’s fairly easy to pick up on bias in a lot of sources. It’s fairly obviously to read what parts of reports are facts and what’s likely opinion.

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          • Can you tell me what this bad stretch is? I think they have been on a good stretch. Is the Roy Moore story an example of a bad stretch? Harvey Weinstein? I agree that they aren’t perfect

            There seem to be a lot of people out there who, even if they don’t like Trump, seem kind of pleased with Trump’s Presidency because it pisses off liberals, adds to a general chaos (and they are chaos monkeys), or gets them off in some other way. Or they think there is a huge Trumpian majority out there and are in awe of it to save themselves.

            The Trump admin is going to take the slightest misstep and go with it. Nothing is going to stop them.

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            • I don’t know about good stretch or bad stretch, but as far as Harvey Weinstein goes, the fact that the story ended up being broken in *The New Yorker*, which no one tends to think of as a “breaking news” source, because the traditional news media wouldn’t touch it…. I don’t think of that as a particularly good sign. I mean, it’s a good sign about the New Yorker, not so much about NBC etc.

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            • ABC ran a story suggesting that Trump was making contact with Russia during the campaign. Turned out it was during the president-elect phase.

              A CNN story indicated that Russia told Junior about leaks before they happened and isn’t that damning but no they got the date wrong.

              There was also a story they had to retract claims that Mueller was going after Trump’s personal banking records.

              The media had (rightly, I’d thought) hammered Jeff Sessions on not disclosing meeting with Russians, only to now find out that he’d been advised to by the FBI that he didn’t need to, losing a chunk of that story.

              That’s a lot to come out in a relatively short period of time, and notably they’re all in the same direction. Yes, there are people who want to discredit the media. The media is giving them a lot of ammunition right now, and it’s reached a point where I don’t trust their reporting on the Russia story until it’s had time to settle.

              If you don’t believe me about the week the media has had, maybe believe the Columbia Journalism Review.

              Weinstein is outside of the span I’m talking about, but it’s worth noting that NBC had the story of the year and chose not to run it.

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              • I’m trying to figure out whether this is more about the always-liberal MSM no longer being able to maintain their non-partisan veneer in the face of Trump’s many sins, or if it’s more that they’re responding to the fact that partisanship sells better than non-partisanship these days (cf. late show ratings)

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                  • Let’s unpack that…

                    Who is CNN losing credibility with? Why?

                    Who has FNC lost credibility with? Who have they not? Why?

                    ETA: If POTUS and GOO leaders consider FNC more credible than CNN, than we aren’t actually discussing credibility.

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                    • CNN has lost credibility with me, personally. And a fair number of people in my boat.

                      The people who should be most pissed at ABC ought to be Trump’s critics. The Trump-Russia story just got muddier with fewer people knowing what happened and what didn’t.

                      The (respectable) media needs to get this right. They need to get the Trump stories right. They need to avoid weeks like the one they’ve had. They need to approach every Trump-Russia story with the care that the Washington Post approached the Moore allegation, which I think they did specifically knowing the skepticism with which it might be received.

                      That may not be enough to take Moore down, but it looks like it swayed people. If they’d run before it was ready, or had fallen for an O’Keefe con, I think things would look different.

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                    • Kazzy, Will is not some random internet guy — why would you think for a moment that he’s saying any of the right-wing sources are better than CNN? He didn’t say a word about any of them until Chip brought them up — has he ever had a word of praise for them?

                      Perhaps you & Chip should consider doing some self-evaluation to figure out why you react so defensively to criticism of anyone associated with your side and leap to the assumption that the critic must then prefer the other side even when you have tons of information to the contrary.

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                      • I’m looking bigger picture.

                        On one side, we have news outlets that have made real errors which may indicate broader underlying issues but are otherwise doing a decent job yet are sunject to perpetual attack by the President.

                        On another side, we have outlets that are basically propoganda, pushing unsubstantiated or demonstrably untrue nonsense which the President and others take their lead from.

                        Which is a bigger problem?

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                      • What I leapt at was the assertion that the “MSM” was “as bad as the birthers”.

                        That’s not a criticism, that’s a really wild and dangerous flattening of very different things.

                        Sloppy reporting is NOT the same as deliberate propaganda.

                        Birtherism is not some opinion that should be equated with mere political bias.
                        It is at best a woo theory that should be mocked, or a hateful slander that should be roundly attacked. Its on the order of Protocols of the Elders of Zion in its implications.

                        We used to be able to dismiss Kennedy assassination fantasists or fluoridation nuts but we live in a time now when the power of all three branches of government are attacking the free press and demanding its loyalty.

                        So when I hear voices making these sweeping assertions that no one can be trusted and every source of information is as good as any other, my hackles get raised.

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                        • Sloppy reporting is NOT the same as deliberate propaganda.

                          So the problem isn’t that they’re lying, the problem is they’re so totally incompetent at covering anything related to Trump because of their biases that we end up with the same effect, i.e. that I can’t trust them.

                          This is not something Trump is doing to them, this is something they’re doing to themselves. Trump screaming “fake news” wouldn’t matter much if the news were impartial.

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                          • When you say that you “don’t trust” a media source, what does that mean, practically speaking? That any claims made by them don’t cause your current belief to diverge from your priors? Or simply that you take the claim to be probably true but not 100%? Something else?

                            I see a lot of people talking about “trust” in a media source as if it’s some sort of binary thing and any error causes the value to go from 1 to 0, but I can’t imagine adult humans being actually living their lives that way, just ignoring all of the data that’s flowing in because no source is 100% reliable. So there’s something going on here, and I don’t think it’s, “All news is no better than propaganda so we can’t trust anything.”

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                            • “Briefly stated, the Gell-Mann Amnesia effect is as follows. You open the newspaper to an article on some subject you know well. In Murray’s case, physics. In mine, show business. You read the article and see the journalist has absolutely no understanding of either the facts or the issues. Often, the article is so wrong it actually presents the story backward—reversing cause and effect. I call these the “wet streets cause rain” stories. Paper’s full of them.
                              In any case, you read with exasperation or amusement the multiple errors in a story, and then turn the page to national or international affairs, and read as if the rest of the newspaper was somehow more accurate about Palestine than the baloney you just read. You turn the page, and forget what you know.”

                              – Michael Crichton

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                              • “You read the article and see the journalist has absolutely no understanding of either the facts or the issues. Often, the article is so wrong it actually presents the story backward—reversing cause and effect. I call these the “wet streets cause rain” stories. Paper’s full of them.”

                                I suppose the question is… is the paper actually full of them?

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                                • @troublesome-frog

                                  On the subject of media bias and how far they can be trusted, it’s worse than “wrong sometimes because they don’t know anything”.

                                  I pay attention to stories about immigrants and immigration for personal and professional reasons. Ever since Trump’s election, I’ve noticed a LOT more stories about immigrants which put them in a good light, or humanize them, or make our hearts bleed for them, or paint the foes of immigration in a bad light. I didn’t notice these sorts of stories before the election and I would have.

                                  I assume this isn’t because the creators of these stories consciously decided to “resist Trump”, but the effect is the same. I understand the anti-immigrant point of view, I don’t agree with it, but that point of view is totally absent in what I’ve heard. It’s like it doesn’t exist.

                                  People with that point of view aren’t inside the media bubble. The media figured out immigrants and immigration are a ‘thing’ so they do stories, and these stories are all written by members of the media who (more or less) have the same view.

                                  The media presents the media’s point of view. It’s not “we know we’re lying” propaganda, but it is “our viewpoint is the correct one”.

                                  Immigration-as-a-topic is way less emotional than Trump-as-a-topic. “Which of Trump’s various misdeeds gets him impeached” is a story that gets resources to develop. “Has Trump’s order to reduce gov regulation increased economic growth” does not. That’s over and above the whole “see what I want to see” which results in negative stories about Trump not being vetted enough to be accurate.

                                  The economic numbers I see look pretty nice, I’m not hearing about absurd problems with his administration (other than Trump himself), and there’s no way the media is carrying his water. So my general assumption is, other than the drama and Trump’s personality, things are going reasonably well. Whether that’s his doing (as opposed to, say, Pence) is a different question.

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                                • I suppose the question is… is the paper actually full of them?

                                  Well, I don’t know if Michael Crichton is lying or not. But let’s look at what he said about his own knowledge.

                                  You open the newspaper to an article on some subject you know well. In Murray’s case, physics. In mine, show business. You read the article and see the journalist has absolutely no understanding of either the facts or the issues.

                                  Can we assume that Crichton is knowledgeable about the subject of show business? Like, knowledgeable enough to say that he knows it well?

                                  I don’t think that it’s a stretch to say that Crichton knows show biz well. Right? Now when we re-read his statement about reading about show biz in the papers, we’re stuck guessing at whether he’s telling the truth or not.

                                  I think we can say that he’s probably exaggerating a little bit (“full of them”) but he’s probably spot on when it comes to finding yet another story where the reporter screwed stuff up.

                                  I suppose a good question for you would be as to how many stories you encounter on stuff that you know well that get basic stuff wrong?

                                  Like if you read an article about the field of education, do you walk away saying “wow, they nailed that!”?

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                                  • I suppose a good question for you would be as to how many stories you encounter on stuff that you know well that get basic stuff wrong?

                                    Every now and then NPR interviews this guy on the evils of computerized day trading. I think he was the head of technology for some Billion dollar operation in Canada.

                                    It’s hysterical.

                                    The head of technology in a Billion dollar operation didn’t understand, in 2009, that speed was important and how it could be used against him if he didn’t have it. This is like the head of technology at Ford or GM not knowing there are four tires on a car.

                                    Further he’s trying to present himself as the champion of the little guy (and the interview let him). He’s claiming that the evil speed traders are the ones extorting money from the little guy.

                                    Problem #1, at the scale normal people function at, this is impossible. A one off trade doesn’t give any signal.

                                    Problem #2, this guy’s operation would historically be charging MUCH higher transaction fees to get into or out of the market (i.e. fees paid for out of the little guy’s pocket), and the reason he can’t do that any more is because the day traders under cut him. This is the reason he dislikes them so much.

                                    The competitive nature of the market (which is what he’s really protesting against) has resulted in much lower fees, which means money stays in the pocket of the little guy.

                                    And from his point of view, that’s a really bad thing.

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                            • “trust” in a media source as if it’s some sort of binary thing and any error causes the value to go from 1 to 0,

                              This is what I was referring to about how leftists like at LGM cuss and bitch about the NYT, but faithfully quote it like Gospel…when it suits their purpose.
                              Conservatives too- Its a liberal rag, but wrt the Clintons, its the gold standard.

                              I think skepticism is good, and scanning a wide variety of sources to compare and contrast is good.

                              But its critical to see a gradation, a ranking of trustworthiness, from “Near Unimpeachable” to “Utterly Worthless” with various values for deliberate versus accidental error, partisan slant versus vague worldview framing, and so on.

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                    • I’d second Will on this. I’m not comfortable saying there’s nothing there in re: Russia-Trump because of the whole prove a negative thing but I’m hesitant to believe anything the MSM says on it at this point. Too many outlets have claimed a smoking gun of some kind only to retract, significantly qualify, or have some context-altering new information render the initial reports a lot less damning. It’s clear that these institutions at least on some level want something to be there.

                      I pay no attention to right wing news, though in fairness I’ve been skeptical of the MSM since events circa 2002-2003. Not the same way I am of right wing media, but skeptical nonetheless, and this hasn’t helped.

                      I kind of wonder if a lot of the big networks, news channels, etc. don’t feel guilty about the platform given to candidate Trump. Now masks are falling off and standards dropping to push a corrective. It’s a shame because the guy’s boobery and these terrible policy pushes on healthcare, tax ‘reform’ and foreign policy speak for themselves.

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                      • The thing is if you drop all the stuff CNN etc have been wrong on and just go with what has been admitted to, plead to, been confirmed by multiple sources and not contradicted you can get a lot of good info out of that.

                        No source should ever been completed trusted. But it’s possible to have increasing trust in a claim when some conditions are met.

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                        • Unless there’s something I’ve missed (and I’ve been wrangling a newborn for the last 2.5 months so its possible I have), the best I feel I can say I’m convinced of is the following:

                          1. Figures within the Trump administration had contact with Russian officials once Trump was president-elect. I do not love this but as best as I can tell no one has found anything to show these contacts were objectively more unseemly than other episodes involving foreign officials and presidents-elect post WW2.

                          2. Russian actors took part (or caused others to take part) in the information wars during the election, maybe directed by the Russian government, maybe not. I do think the Russian government preferred a Trump win, but thats a far cry from playing a decisive role in making it so. The best we’ve got is the DNC emails and as a transparency advocate I can’t muster much anger about that. The dates of the hacks make coordination highly improbable and t’s not like Trump’s dirty laundry hasn’t been all out there for decades anyway.

                          3. American intelligence services want people to think the Russians played a decisive role in the election whether they did or not. This doesn’t mean this is not true, but their agenda is murky, they themselves are often involved in interfering with the politics of other countries, and I find them generally not credible absent making their evidence fully public.

                          4. Many in the American MSM wants Trump to have in fact colluded with Russia. I think they feel guilty and uncovering something will clear their conscience.

                          5. American right wing media is the same as it has been since roughly the late 90s, probably worse.

                          You will note that none of these things preclude a Trump-Russia scandal/illegal activity/general awfulness. Just my view from my couch.

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                          • There have also been repeated and admitted meetings between Trump officials during the campaign and Russian high ups. One of those meetings included T jr, Kushner and Manafort with a very connected Russian lawyer who said Russia wanted to offer help. So that ain’t chopped liver.

                            FWIW i doubt they will prove direct collusion. I’m not sure there was any but even if there was it will be hard to prove. However we know a crime was committed and have a fair amount of decent evidence who committed it. We have many years long connections between the likely perps and many figures connected to Trump and Trump. We also have many many lies told by high Trump figures about their connections and meetings between them and high Russian figures. Again, that is a hellava lot of smoke. The investigation will tell us what happened not each of the news reports.

                            I dont’ like to see news agencies F up like they have. Even more i don’t’ like to see Fox speakers actively trying to fatally cripple it by sowing paranoia and fear. That is, to me, far worse. That is far greater danger to our democracy then failed scoops.

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              • Just to be clear… we’ve just agreed to sweep outlets like Breitbart, Hannity, and much of FNC into the dustbin? If not… “all in one direction” is just wrong.

                These were errors that were accounted for. And possibly the result of flawed processes and we’ll see if those are corrected. The outlets I listed? Show me a correction.

                We can also unpack which of those outlets are influencing politicians and which aren’t (e.g., the Uranium One “scandal”).

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  3. He2-4: I really think the AMA is just going to have to give it up and start accepting nurses & PAs as higher-order partners in primary care.

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    • They’ve already lost the battle in a lot of states and I think its (mostly) a good thing. There’s an opportunity to increase the supply of care without a material decline in quality, as long as the regulation is done right. Hard to say what it does to cost (i.e. does the availability of more providers for routine care make said care cheaper or do those providers increase their prices commensurate with the new responsibilities).

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    • My sister is a nurse practitioner in oncology and seems to enjoy a wide range of independence. In particular, she will travel to clinics in smaller cities in the area without the physician to see patients. I assume this is because treatment in this area tends to be more standardized, but my sense is that the AMA concern is not about medical care that is over 90% provided by a para-professional, but that it never reaches 100%.

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      • For example, the AMA was upset with a recent Pennsylvania Supreme Court ruling that the physician’s duty to obtain informed consent to non-emergency surgery could not be delegated to a non-physician. Specifically, the information shared with the physician’s assistant about the relative risks of removing a non-malignant recurring tumor was not admissible to show informed consent. Basically in this scenario the AMA is approving the use of para-professionals as necessary realities of today’s practice.

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  4. Semi-related to health (mental), and our discussion on the other thread about and AI companions.

    What happens when we form an abusive relationship with our robot companions?

    A personal note: After the election I liked and followed a bunch of Resistance sites on Facebook; and true to its algorithm, FB offered me up a constant stream of “dopamine hits” of outrage.
    After a few months I realized I was exhausted and drained, that my relationship to social media was not healthy or constructive; its about that time I disappeared from here, and my other political blogs. I finally cut off all my FB feeds except the ones on art, architecture, steampunk and spirituality.

    See, thats the thing about abusive relationships. They are similar to machine learning in that they are interactive. Nobody starts hitting on the first date, instead it grows slowly over time, as the partners form an interlocking web of codependency and dysfunction that is imperceptible at first, and almost impossible to tell when it crosses a line. They learn from each other what hot buttons to push, what words and phrases are most effective, what memories to trigger.

    And what is most tragic, is that in many cases for the abused partner, the only thing they can imagine as being worse than the abuse, is losing the abusive person.

    As AI and machine learning grows more sophisticated, how would or will we react to destructive abusive codependent relationships between humans and their machine companions?

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  5. The Electronic Medical Records link in He2 goes to the same Australian tobacco packaging story as He7.

    It’s troubling that EMR is increasing the workload on physcians, because, of course, the whole point is that it was going to do the opposite of that (even at the price of additional non-physician staff increases)

    For that matter, is ‘medical transscription services’ still a thing?

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    • Yes transcription still exists. Most of the big/rich hospitals and provider groups in metro areas are on Epic or Cerner. There’s a middle tier of EMRs of varying quality, but most are being eaten up by the bigger fish. You’ve then got a lot of poorer/rural hospitals and practices running on MediTech, some home grown solution, or nothing at all. You get a really interesting perspective on American healthcare when you talk to the Podunk County Hospital, and learn about the where they are with technology taken for granted elsewhere.

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  6. The AP has called it for Jones.

    And CNN just did as well.

    Fox, too.

    Doug Jones, a Democrat, won the Senate seat in Alabama vacated by Jeff Sessions, chosen by Trump to be his AG, who won an uncontested race in 2014.

    That’s sure something.

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  7. Reading now that Jones likely won’t be seated before the tax bill is voted on. Strange will cast the vote for that seat.

    By McConnell logic, shouldn’t he vote as Jones would? Or not vote? Or something insane because, hey, the voters have weighed in and indicated what they want? No? That’s not going to happen? A SCOTUS seat will sit empty for over a year because something-something will of the voters but we’ll just pretend what happened didn’t happen because it’s inconvenient? Cool beans!

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    • The Democrats dragged their feet with Scott Brown, and they were able to delay for about two weeks. So that’s roughly the amount of time the GOP has, presumably.

      It wouldn’t be too hard for a Republican senator who wants the tax bill to go down but also wants to vote for it to refuse to do so until Jones is seated, though. Not sure if that’ll happen, but I don’t presently like the GOP’s odds here.

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      • Corker and Collins and maybe a couple others just rubbed their hands together with fiendish Mr. Burn’s glee saying “advantage mine.” Doesn’t mean they won’t fold, but they will want something for their vote.

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      • If McConnell had any principles (HA!), he’d have suspended all votes in the Senate once the special election was called. He didn’t. And he may very well try to accelerate a tax bill vote to avoid Alabama voters having their will reflected in the decision.

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        • What I’m personally interested in what the commentators and especially our own conservative and libertarian voices here will say. By the Scott Brown logic they should call for the Tax Cut to be stopped and for the GOP to start over with more effort (which would be easy since they unambiguously shut the Dems out despite the Dems offering to help under certain conditions*) towards bipartisanship.

          To lay my cards on the table I didn’t think Scott Brown represented some mass rejection of the ACA and I don’t think Jones represents some mass rejection of the GOP’s horribad tax cut.

          *Unlike the ACA where the GOP resolved in advance to oppose whatever was proposed and then lied about it.

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          • Jones won because of Trump and a stroke of luck (Moore being found out a pedophile too late to replace him on the ticket).

            I think had Trump been popular, Jones would have lost. Had Moore only dated ONE 14 year old (his current wife), he’d have won — unpopular Trump or not.

            That’s how red Alabama is. It took both.

            OTOH, the Senate map for 2018 went from “Ha, no” to “Probably not but maybe?” for Democrats, which is a hard blow no matter the fact that Jones is certainly going to be a single-term Senator.

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            • Oh certainly, but that doesn’t address my main point. A lot of folks said Scott Brown’s election was a blaring stop signal for work on the ACA ;which spent a year winding its way through the legislative process, pleading for GOP support and going through committee. Should those same people not say that Jones’ election is a blaring stop signal for the work on the GOP Tax Cut which was has been rushed through the legislative process at a spectacular speed and never even tried to get Dem buy in despite the Dems laying out some pretty reasonable conditions for their cooperation. Shouldn’t it be even more of a blaring stop sign?

              I mean I know consistency is the hobgoblin of little minds, tax cuts are special and deficits only matter when Dems are in power but I’m still very curious to get their take on it.

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              • The difference between Brown 2010 and Jones 2016 is that Brown expressly campaigned on PPACA. Jones ran a more general campaign, with added focus on not touching children.

                So I think Republicans actually had a better case than Democrats do here that it was related to the specific legislation. Though in both cases there were/are a lot of poll numbers that are probably more relevant to the legislation question.

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                • I’m quite confident that Jones indicated he would not support the tax cuts as currently constituted and that was one of the things he campaigned on though I willingly grant it wasn’t the centerpiece of his campaign the way Browns crusade against death panels was.

                  And of course looking at the polls, the tax cut could only dream of having numbers as ‘good’ as the ACA ‘enjoyed’ in 2009.

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            • Honestly, I think Democrats taking the Senate is more likely than not at this point.

              Even before this, I thought it was at least 50/50: One Nevada seat and two Arizona seats will do it, provided that they hold on to the others (and poll numbers are looking pretty good for red state Democrats.

              Now if they win all three of those they can even afford to lose Missouri and they’ll still end up on top.

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      • The Democrats dragged their feet with Scott Brown, and they were able to delay for about two weeks. So that’s roughly the amount of time the GOP has, presumably.

        It would be great if every Congress was held to the level of sleaziness of the previous ones, but I’m going to guess that McConnell will not feel bound to that precedent.

        You take what you can get away with taking, always.

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