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25 October 2016

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Doug Colwell

I'm with you on the Flashman books (and much else) sir. I discovered them in the late seventies and couldn't get enough. My father was a historian and I would ask him about details now and again. Macdonald did good research as far as I could tell.

Jay

We just love to play dangerous games. Think the Russians are playing chicken? Here is my two cents. Zero will happen prior to Nov 8th. But all locks are off after the 8th. Is the Borg this stupid? Well $500M up in smoke training 100 moderate forces, moderate forces jumping ship, etc. Do I have to say anymore? Now it's about saving the children...... Yes they are this stupid.

Swampy

His endorsement wasn't a signal for "us" but rather for "them". He just ensured his seasonal invitation to the only Washington parties that matter.

kao_hsien_chih

Odd typos in the last post. Corrections follow, although the substance doesn't change, although these numbers would actually make sense while the previous ones did not.

The likely share of minorities in the voting age population will be about 30%. The actual turnout will be lower for various reasons, which will bring down their share of the electorate to about 25% or less. Those who do vote will still be overwhelmingly in favor of the Democrats, though.

The non college whites will make up about 35-40%. The point about these two groups being heavily, but not quite overwhelmingly pro-Republican still holds, with their concentration giving Trump an advantage in several key Midwestern states (and making possible scenarios where Trump can lose popular votes and still win electoral votes.)

The point remains that, taken together, these voting demographics roughly cancel themselves out, with slight advantage to the Republicans because of geographic distribution. This still leaves the college whites, making up around 40% of the electorate, as the decisive demographic. Normally, Republicans hold a small edge with these folks, but Trump seems to have lost it according to the polls, although, historically, these are the groups that consistently vote party.

trinlae

Ok, sir, i will send you a new one as a momento, just small size for opening envelopes. They also have glass kukuris filled with rum (like glass liquer-filled AKs).

I'll also suggest to Gen. Rana (retired) to enjoy yur SST.

trinlae

Good Gurkha documentary here:

https://youtu.be/5Q5DA-iRgbE.

johnf

The BBC is featuring this stgory prominently too:

http://www.bbc.co.uk/news/election-us-2016-37766786

The Daily Telegraph is reporting that the Spaniards are going to refuel the Russian aircraft carrier on its voyage to Syria:

http://www.telegraph.co.uk/news/2016/10/25/nato-fears-russian-battle-group-may-be-used-for-indiscriminate-t/

Old Microbiologist

Perhaps you have over-simplified the problem. There is a lot more to it than that. Profit motive is the largest problem and expectations by physicians and pharmaceutical companies as well as for-profit institutions and insurance providers to get rich. In the US and Canada physician salaries are insane. Couple that with the bizarre acceptance of foreign trained "doctors" who only hold baccalaureate degrees has been disastrous.

I live in Hungary which has a national health care system which works more or less fine. It is relatively no frills service but reliable and dependable. Not state of the art but modernized enough. We have MRI's and CT scans and up to date diagnostic equipment. Sometimes it is centralized and you may have to travel for a particular instrument and there might be a wait of a week or so. Not the months we have in the US. The physicians are all medical doctors and specialists all have bonafide PhD's from real universities. (I say that tongue in cheek as I have friends who "own" medical universities on Grenada and Niue, NZ. Few of procedures are actually performed by technicians and most are done by doctors, often by the one you are seeing. The benefit is they order what diagnostic tools are necessary and interpret the results immediately.


For example my 91 y/o mother who lives with us has had recurrent UTI infections, something not uncommon in elderly women. I made her an appointment with the urologist at our neighboring medical center and she was seen 2 days after making the appointment. We saw the doctor (not privately but as exactly as anyone else here) who ran the urinalysis right there in the clinic, and was obtained by supra-public aspiration to ensure it was clean. That alone would be considered a surgical procedure in the US with attached exorbitant costs. The culture was done immediately right there while we were watching as well. She (the doctor) immediately did a diagnostic ultrasound of my mother again right on the spot. Mind you, we have no functional insurance here (only military Tricare overseas which is less than useless) and are strictly on a cash for service basis. The total cost for everything including antibiotics and a blend of herbal teas was under $40. Add in a $20 tip and it came to $60. As another example, my 75 y/o next door neighbor just had cataract surgery done, again on a cash basis using a private doctor here of high reputation. The costs including lenses, surgery, examinations and follow up visit was $265 (75,000 HUF) per eye.

If we were citizens our cost for insurance would be roughly $25 a month but doesn't include pharmaceuticals or dental. However, dentistry here is a similar story and about 10% the costs as in the US. The biggest difference I see here is that physicians here are mostly government employees and receive a fixed salary of roughly $1500 a month. There is also a lot less poured into having fancy modern buildings. On the other hand they are insane about cleanliness and it helps a great deal to cut down on nosocomial infections. Anyway, $1,500 a month is a relatively high salary in Hungary. They are supplemented with "tips" which generally run between 10,000 to 20,000 HUF ($35 to $70) for insurance customers and zero for cash only patients like ourselves. I tip when I feel the have gone out of their way to help us but it isn't obligatory for anyone. They supplement their income in evenings seeing cash patients. I do sometimes give a good bottle of whiskey which is always appreciated.

Like you indicate though things we assume will be done in the US just aren't done here and it is a societal difference. When you get old here (over 75) they know you are going to die fairly soon and if you have a fatal illness they will only provide palliative care through the national medical insurance. As sad as that sounds it makes financial sense. They don't pour tons of money on elderly care. In a sense you have a responsibility to die here when it is your time. The same is true for expensive medications. There is a robust pharmaceutical industry in Hungary and Croatia so generics are super cheap. If a generic works then they will not even look for something else. Additionally, in every country in the EU pharmaceutical prices are fixed by the government and negotiated for all of the EU simultaneously. This makes them as affordable as possible and yet the pharmaceutical companies are still making profits. Everyone in the EU pays the exact same price for medications. In fact there is only one country in the world which doesn't do this, the USA. It is somewhat shocking to buy pharmaceuticals here and see the insanely cheap prices compared to the US. Often it is less than 1% what you pay in the US and yet they still make a profit.

I think the big problem, just like University education, they are now being run on a for-profit business model. IMHO some things cannot be done that way which is why socialism is acceptable.Should we ever decide to create a new Constitution perhaps they will include education, pensions, vacations, work hours, and health care as basic unalienable rights.

Nuff Sed

To all: FYI, I responded to Miletus's reply to one of my posts in the "The Turks want Mosul and Aleppo "back." " thread, in case Miletus or any anyone else is interested.

Procopius

"... funds that can invest in high-risk investments, where transaction fees are much higher." ...and returns are somewhat lower than low-load index funds. There, fixed that for ya.

bks

Zerohedge seems like a bizarre source for political wisdom. Their focus is U.S. markets and they've been dead wrong about that arena for years on end. Each time I am led there by your correspondents, I am reminded of my brother-in-law. He came to my house each Thanksgiving and regaled us with the need to accumulate silver and gold, to divest from the stocks, and to disdain fiat currency. The collapse of the markets was always imminent. He passed away in 1999.

Nancy K

Trump as president that is what is not to like.

ex-PFC Chuck

Not everything posted at ZH should be ignored:
http://www.zerohedge.com/news/2016-10-25/michael-moore-trumps-election-will-be-biggest-fuck-you-ever-recorded-human-history

Fred

Good luck. I want to see some mule steak photos in the near future.

Fred

johnf,

NATO has sprung into action:
http://www.telegraph.co.uk/news/2016/10/25/nato-fears-russian-battle-group-may-be-used-for-indiscriminate-t/

I can't imagine the Russians were not aware that fueling a ship at sea would be a requirement but maybe they are just playing rope-a-dope with the press as a giant distraction from what they are actually doing.

tim s

You can't just say "minority votors" and then conclude that they will overwhelmingly go for HC. I'd not think that the great majority of Hispanics can necessarily go for HC. Hispanics tend to more traditional families and similar values. It seems to me that the Dems are shooting themselves in the foot regarding Hispanics by pandering to the LGBT base (and the BLM base too, for that matter), who I'd imagine would hold those types in low regard overall. I'd also think that a great number of Hispanics are not in favor of illegal immigration. Those who've established themselves here have the most to lose from uncontrolled immigration.

Asians are a minority that probably are fairly conservative. Whether they go for a Republican clown show is unknown, but they are likely as repulsed by the current Dems as are the rest of the many sensible people these days.

Blacks - OK, overwhelmingly for HC is pretty likely, but as an overall percentage of the "minorities" population they're surely not a majority.

turcopolier

mike allen

128som reel. Read "The General Danced at Dawn." I have read a great deal of military history, all kinds of history actually, and a fair amount of biography. I read the big thick early biography of Slim. He was an admirable man and a great soldier. You seem to agree with RE Lee in his statement that he did not read fiction because it weakened the mind. I obviously do not agree with that. I chose to write my WBS trilogy as literature rather than history because I believed then and now that much more can be well and truly said in fiction than can be said in a discipline in which human nature is often "ironed out" of the work. pl

eakens

The irony of the Democrats putting in Obamacare, and then setting up open enrollment (and when premiums would be readjusted) to begin in November right around the election time is rather delectable. Did they really believe that Obamacare was something they could use to gain votes every other November, or did they just overlook the fact that open enrollment would coincide with the presidential election?

Babak Makkinejad

That is true; all I needed to learn about WBS, I learnt from Margaret Mitchell.

Eric Newhill

wxrlly,

It's the amount of high tech and the frequency of its use that drives the cost.

What a provider charges a non-insured patient is not what they are typically paid b/c most patients have insurance. One of the huge value adds that insurance companies provide is contract negotiation that sets reimbursement rates. If you had insurance, the insurance company probably would have paid $120 for you Dr visit and the antibiotics might have been around $60.

That savings is then passed along to the patient in via lower premiums.

Norbert M Salamon

I am happy that you brought it up for the readers herein [I was aware of the notes]. The cited analysis is but a new take on the long time hypothesis by the peak oil community. They talked about EROEI, the nominal cost of hydrocarbon recovery under different conditions from Saudi to oil sands, through shallow or deep sea operation.

The dream of technology improvement is marginal in most instances, for it only covers the drilling/fracking/etc., is not applicable to refining, transportation, ecological damage [e.g. methane leaks in fracked areas].

The thermodynamic analysis underlines the long time position of the peak oil community, that there is a demarcation between recoverable hydrocarbons and total hydrocarbons in earth's crust. This germane point is often dismissed by economist and talking heads of MSM

jld

Doesn't work because of the '.' stuck at the end.
To everybody, please take care to end every URL you post with a space, otherwise it confuses the Typepad script about where the address actually end.

Fred

How did this happen?
http://thehill.com/blogs/ballot-box/presidential-races/302836-poll-trump-up-by-2-points-in-florida

On a bright note DOJ is going to gin up the outrage machine:
"In 2014, a local grand jury refused to indict the NYPD officer Daniel Pantaleo most involved Garner’s death."If you don't get the indictment you want, just change the venue.
http://www.slate.com/blogs/the_slatest/2016/10/24/justice_department_reportedly_replaces_investigators_in_eric_garner_chokehold.html

kao_hsien_chih

Numberswise, about 90% of blacks, about 75-80% of Hispanics, and about 70% of Asians will choose the generic Democrat, if the pattern from 2012 will continue (and there is no evidence that it will be otherwise). So, all told 80-85% Democratic votes out of all minorities is not unreasonable, and that's pretty overwhelming out of an electorate that will make up almost 30% by population and will still make up around a quarter of the votes (see below for corrections to earlier numbers). It IS true that there will be variations among the subgroups--for example, Cubans are still relatively more Republican. Puerto Ricans care little about immigration (even though they are heavily Democratic). (Older) Koreans are more Republican than other East Asians, etc. In the actual calculations, these were taken into considerations, but these variations are too small to really make much difference.

The bottom line is that, when the numbers are added up, Trump and HRC are roughly even (with a few percentage differences one way or the other) depending on turnout assumptions, when minority voters and non-college white voters are accounted for. The election is left to turn on college educated white voters, especially those who voted Republican in the past. That places HRC's campaign strategy, of trying to turn these voters (esp. women) in context. We'll see how that has worked out in less than a couple of weeks.

Eric Newhill

TTG,

I agree that there is a lot of greed driving costs. Actually, there is no doubt it.

However, I'm going to be a broken record here, but I'll try to reframe in a way that makes the point a little better and incorporates your excellent point about providers having "a lock" on their customers.

There are two ways that cost go up; 1. increased utilization 2. increased unit cost. What we have is both 1 and 2 occurring. Why? because advancing technology means that more people can be treated for a greater variety of conditions. And the new tech comes, usually, at a higher unit cost. Very little - so little as to be irrelevant - of the tech advancement is unit cost reducing.

Some day, perhaps we're almost there, *anything* that is wrong with you can be medically addressed with at least some level of success (even if it is an expensive new drug that increases that avg length of survival of a diagnosed cancer patient (say pancreatic) from 6 months to a year. What is that extra 6 months worth? If you're the patient, you may say $millions. We can now perform cataract surgery with minimum difficulty and routinely excellent results. There are all kinds of precision high tech tools employed. So lots of people are getting the surgery. Total cost per eye is around $5k when all is said and done. What is the ability to see again worth? And on and on and on with conditions where we used to tell patients that there is nothing that can be done or reserve treatment for only the most serious situations.

But it's not just that. Look at a hospital room these days. Hoses, tubes, monitors, gizmos with LED lights, machines that go "beep" all over the place. In every room. These things need to be replaced every so often and they "need" to be replaced with the latest and greatest. So simply entering a hospital room - forget the procedure that will be done - will be very expensive. Avg cost of room and board alone is around $3500/day.

So, let's say you eliminated the provider greed factor and things were made to cost what they are worth (already we see that is a difficult price point to set). You might see a reduction in cost. However, it would be a one time reduction only because cost would resume increasing as more people are treated for more conditions (in aggregate and as individuals). This is the usually overlooked patient greed factor. I want all the healthcare I can have and screw the cost.

The only way to stop the trend is to make tough rationing choices.

This is why I think that the government does not want to own healthcare. No politician wants to have to run on a platform of being the one who will ration your healthcare. No politician wants to have to deal with an angry AMA. It is also recognized that some other politicians would run on a platform of expanding coverage and that would run costs further out of control. Healthcare would be a political weapon to a much greater extent than it already is.

That is why the feds turned over much Medicare and Medicaid admin to the private companies a few years ago.

Drug costs are NOT a major driver in the overall picture.

Physician malpractice insurance can be a driver in certain specialties, but is not a significant contributer overall.

The typical medium sized town family practice physician is netting around $200k - $250k/year. They'll tell you they deserve it (went to med school, work hard, etc). Big city surgeons are making much more. Surgical centers and nursing homes are big business; very profitable. Hospitals not so profitable, but everyone who works in them are well paid.

My idea to fix the system is that medicare would be expanded to include anyone of any age who has certain serious conditions. Medicaid would be expanded to cover people of higher income level than currently (with a sliding scale for patient responsibility as income level increases - the feds would have to chip in to the states on this). Make the economy strong again with good paying jobs and healthcare benefits through private companies (what we have, but just with higher employment levels).

I am all for a socialized single payer system, conceptually as long as there is rationing and common sense involved. My reservations about that are already outlined above. US politics are different than European and the greed factor on both the provider and patient part seems to be greater in the US. Or, as you say, "That would mean not being able to get every freaking procedure or pill or being kept alive long after you're supposed to die naturally"

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