Quick hits

1) NYT on the divisions in the NC Republican Party.  We’ll know just how divided it actually is when the Senate primary occurs next month.

2) How zebras got their stripes.   Best evidence suggest that stripes deter biting flies.

3) Charter schools are not the solution to educational inequality.

4) Forget ADHD, now we’ve got Slow Cognitive Tempo.  Seriously.

5) Chait provides a long summary of his much longer piece on Obama, race, and racism.

6) Politico on “is there a wonk bubble?”   Uhhhh, yes!  I love it.  Though sometimes I hate how much high-quality wonk content there is to read every day now.

7) The full story on the Jameis Winston rape “investigation.”  So disturbing and depressing.

8) Former MLB player gives account of being racially profiled shoveling snow in his own driveway.

9) Evan Osnos on politicians literally shooting legislation in their advertisements and what it all means.  It’s not good.

10) Short version of a man convicted of armed robbery and accidentally not sent to jail for 13 years who turned into a totally productive citizen.  Longer version.   This American Life version.  Seriously calls into question a lot about how we think about crime and punishment.

11) Research suggests students retain more when reading from “real” books than e-books.

12) Mark Kleiman on how legalized pot would change America.

13) Best thing I’ve read on the Cliven Bundy travesty.  This guy and anybody out there with a gun “defending” him needs to be in jail.  Seriously.  Timothy Egan:

Imagine a vendor on the National Mall, selling burgers and dogs, who hasn’t paid his rent in 20 years. He refuses to recognize his landlord, the National Park Service, as a legitimate authority. Every court has ruled against him, and fines have piled up. What’s more, the effluents from his food cart are having a detrimental effect on the spring grass in the capital.

Would an armed posse come to his defense, aiming their guns at the park police? Would the lawbreaker get prime airtime on Fox News, breathless updates in the Drudge Report, a sympathetic ear from Tea Party Republicans? No, of course not.

So what’s the difference between the fictional loser and Cliven Bundy, the rancher in Nevada who owes the government about $1 million and has been grazing his cattle on public land for more than 20 years? Near as I can tell, one wears a cowboy hat. Easterners, especially clueless ones in politics and the press, have always had a soft spot for a defiant white dude in a Stetson.

Truly atrocious and deplorable the support he’s been getting from the right.

14) Way too many teachers have been resigning from Wake County, NC during the school year.  Surely because the legislature has made it quite clear just how little the value educators.

More mammograms

Great post from Aaron Carroll on the futility of routine universal (i.e., not based on individual risk factors) mammograms.  A big part of the problem is perception vs reality, very nicely summed up in this chart:

NEJM

 

And a nice take from Drum.

And it’s important to remember that many women are traumatized– both physically and psychologically–due to something with very little statistical likelihood of saving their life.

American health care insanity– it’s the prices

Why it’s the prices is complicated, but suffice it to see this is largely a matter of policy.  And it’s pretty clear that ours gets it wrong.  Obamacare is a step in the right direction, but just a modest step.  Here’s one example, from a series of 15 charts at Vox.

Copaxone

Oh, and all the countries that pay less?  They are not doing it through health savings accounts or allowing insurance purchases across state borders, but generally through more (and more importantly) more coherent government regulation of health care policy.

Beyond meat!

So, as my regulars know I really love the idea of high-quality plant-based replacement for meat.  I was excited to learn of a new replacement that gets great reviews.  My far-and-and away favorite part is that it is not soy-based (it’s actually from pea protein) as my wife seems to have developed a soy sensitivity which prevents the substitutions we had been doing (50/50) when making ground beef dinners.  We used this recently in meat sauce with pasta and it worked great.  I don’t know that it’s ready for a 100% replacement, but blending with meat to cut down meat use worked great.   Been trying to get my wife to use it more, but she’s still a little freaked out about her soy sensitivity.

On a related note, I enjoyed this Mark Bittman column about fat.  Here’s the meat part I’m totally on-board with:

So at this juncture it would be natural for a person who does not read volumes of material about agriculture, diet and health to ask, “If saturated fat isn’t bad for me, why should I eat less meat?”

The best current answer to that: It’s possible to eat as much meat as we do only if it’s grown in ways that are damaging. They’re damaging to our health and the environment (not to mention the tortured animals) for a variety of reasons, including rampant antibiotic use; the devotion of more than a third of our global cropland to feeding animals; and the resulting degradation of the environment from that crop and its unimaginable overuse of chemicals, soil and water.

Even if large quantities of industrially produced animal products were safe to eat, the environmental costs are demonstrable and huge. And so the argument “eat less meat but eat better meat” makes sense from every perspective. If you raise fewer animals, you can treat them more humanely and reduce their environmental impact. And we can enjoy the better butter, too.

Was that so hard?

Mark Begich’s campaign embraces the good of Obamacare:

And, I’ll just throw in a quote I love here from a recent Krugman column:

What’s amazing about this wave of rejection is that it appears to be motivated by pure spite. The federal government is prepared to pay for Medicaid expansion, so it would cost the states nothing, and would, in fact, provide an inflow of dollars. The health economist Jonathan Gruber, one of the principal architects of health reform — and normally a very mild-mannered guy — recently summed it up: The Medicaid-rejection states “are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.” Indeed.

Indeed.

And while supposed Obamacare horror stories keep on turning out to be false, it’s already quite easy to find examples of people who died because their states refused to expand Medicaid. According to one recent study, the death toll from Medicaid rejection is likely to run between 7,000 and 17,000 Americans each year.

But, hey Obamacare is evil totalitarian socialism.  So there’s that.

Quick hits

1) I loved seeing “Sue” the T. Rex in Chicago a few years ago.  Here’s the story of how Smithsonian was blindsided on how expensive she would be and was massively outbid.

2) Here’s a school system that thinks making a fellow student “uncomfortable” (in this case by twirling a pencil) should lead to a suspension and psychiatric evaluation.

3) I was prepared to think Jezebel was over-reacting, but these ads are truly horrible.

4) The reason that acceptance rates at top colleges are down is because too many kids are applying to way too many schools.  And you get this:

Bruce Poch, a former admissions dean at Pomona College in Claremont, Calif., said he saw “the opposite of a virtuous cycle at work” in admissions. “Kids see that the admit rates are brutal and dropping, and it looks more like a crapshoot,” he said. “So they send more apps, which forces the colleges to lower their admit rates, which spurs the kids next year to send even more apps.”

5) The marijuana legalization opponents predicted a major crime way if marijuana became legal.  Not at all surprisingly, they are wrong.

6) Not just unemployment, but labor force participation rate is a real problem these days.

7) All those constant Lumosity pitches are not based on a lot of actual science, but here’s some evidence that brain-training really works.  Time to start playing the N-back game?  (I’ve actually been thinking this might really benefit my son with ADHD).

8) The best evidence Obamacare is working.  Drum on how you’ll never actually hear even a modest admission of that from conservative sources.

9) I love looking at American health care in a comparative perspective.  A really good article on how the German system works and what we can learn from them.

10) Tell white people they will be a minority and they become more conservative.  Yikes.  Jamelle Bouie on how this means the whole country could end up like Mississippi (double-yikes!)

11) American’s are hopelessly resigned to the fact that we can’t make meaningful changes in campaign finance.  And I’m one of them.  Larry Lessig says we need to get past this.  He’s right, of course.  But I’m just too skeptical of real change.

12) Vox explains the oil curse.  Simple but compelling.

13) I started reading this column about the recent Ebola outbreak and thinking about the book I read last summer by David Quammen about zoonotic diseases.  Then I noticed the column was by Quammen.

14) Listened to a fascinating Fresh Air interview about a new book detailing how Michael Rockefeller (of those Rockefellers) was likely killed and eaten by cannibals.  And here’s a Slate piece on the book.  Pretty amazing and compelling stuff.

15) Been reading for a while about how caffeine can improve your athletic performance.  Here’s a nice how-to guide from Vox.  (Before our 5-mile doughnut run, I actually gave my 14-year old son some caffeine– something he otherwise never has).

16) Totally deserves it’s own post, but since I haven’t gotten around to it yet… Here’s how a recent study find tens of thousands “suspicious votes” in NC.  But history very strongly suggests that when they are examined more closely, only a very small handful will be the result of malfeasance.  Not surprisingly, Republicans are simply pretending otherwise.

17) I’ve long known Jim Demint is a moron.  He argued this week that “big government” had nothing to do with ending slavery.  Jamelle Bouie’s takedown.  Adam Gopnik’s is even better:

This is, in plain English, so ignorant that, as I say, there has been no shortage of corrections. A debate about whether big government freed the slaves is pretty much the only debate that a liberal is guaranteed to win. The Civil War was the original big-government overreach: it came from Washington, D.C.; it involved raising new taxes (in fact, it is the origin of a number of taxes); it confiscated rifles from rebels; it did special favors for minorities (in this case, the special favor of recognizing them as human beings and setting them free from lifelong bondage); and, in the end, it imposed a bureaucracy on an unwilling population (that is, it imposed the Union Army on the South). Many things can be said about the Civil War, but not that it was done with the benign neglect of the federales. The moral point was argued for decades, as it is with most issues in a democracy. But that big government freed the slaves is as sure a fact as any in history.

 

Obamacare on the upswing?

Maybe.  But at least so far, it is safe to say the fantastical conservative proclamations of doom have not been borne out. The thing is, it seems that many conservatives actually believed these fantastical proclamations of doom and don’t know what to do about a law that has many problems, but is basically working.  Are many individuals worse off from Obamacare?  Surely.  Lots of them because Republicans refused to expand Medicaid.  Or young healthy people who are seeing their insurance go up (of course, they’ll benefit when they are not so young and not so healthy and can still get affordable insurance).  And others.  You make changes this big, people are going to get hurt.  But Jon Cohn has a nice piece yesterday that argues this is all definitely worth it:

The Affordable Care Act has unleashed a great many changes—some good, some bad, some in between. And it’s going to be a long time before there’s enough evidence to assess them carefully. But the available data points offer hints about what is happening. And while they don’t add up to a clear, definitive vindication of the law, they are enough to justify some real optimism—the kind that hasn’t been possible since October 1, the day healthcare.gov launched, crashed, and nearly took the whole liberal cause into cyberhell with it…

Four years after enactment, and six months into the final stage of implementation, the starter home may not look great. But it’s weathered the political and technological storms, albeit better in some parts of the country than others, and it is still standing. People are using the new marketplaces to get insurance. And the available evidence—a combination of state-specific data from places like Washington, Kentucky, and New York, along with fuzzy polling data and fuzzier anecdotes—suggests strongly the number of people without insurance is declining…

It’s impossible to tell by how much, so you should ignore anybody, left or right, who claims to know the answer. But the fact that enrollments through the marketplaces are approaching what the Congressional Budget Office and other experts once predicted ought to make you more confident about their other projections. And these authorities predicted the law would mean many more people had real, stable health insurance coverage. One reason, often overlooked in this debate, is that lots of people are getting coverage through other sources—like Medicaid or, if they are young adults, through their parents’ employers—that would not have been available without Obamacare. Another is that conservative stories of several million people losing coverage because insurers cancelled plans last year overlook one key fact: Nearly all of those people got new insurance, usually through the same carriers as before.

It may sound self-evident, but giving more people decent health insurance makes a real difference in people’s lives. [emphasis mine]

Molly Ball suggests we have turned a political corner:

Further gladdening Democrats, some polls are now even showing voters beginning to change their negative views of the law. Is Obamacare finally turning the corner?

The answer is … maybe.

Nonetheless, it’s clear the doomsayers’ predictions for the Affordable Care Act—that the website was totally unworkable, that enrollment would fall dramatically short, that the whole structure of healthcare reform would collapse of its own weight—aren’t coming to pass. [emphasis mine]

The big question, especially for politics, is what the next round of polls looks like. Does today’s flurry of good Obamacare news begin to change Americans’ minds about the virtues of the law? Does that, in turn, do anything to lift the president’s sagging approval rating and Democrats’ gloomy midterm prospects? We’ll have to wait and see.

As for Ball’s questions, to some degree I think a real change means that Democrats actually need to find back on the issue.  And maybe the latest good news will give them the courage to do so.

“I don’t have enough time for patients; I’ll keep rich people healthy”

Interesting article on primary care physicians feeling frustrated with how rushed they are with patients and how many are opting out of basic practices.  Having seen lots of doctors (mostly pediatricians) over the years and do agree that far too many of them really are just rushed.  My kids’ pediatrician and Alex’s neurological specialists never actually like they are rushed (even if they are)– and you can believe I always have plenty of questions– that’s why they are awesome and we are fortunate.

My own physician when I first got here was great, but he left for a “concierge” medical practice where doctors get fewer patients and more money and the patients get more access to the doctor and pay way more for the privilege.  Doctors in these practices keep rich people healthy.  Okay, fine, to each their own, but this part of the article just really bugged me:

Indeed, one of the drivers of physician dissatisfaction is their sense that they are shortchanging patients: that they are too rushed, don’t have time to listen and aren’t always providing good care.

Kanovsky said he used to worry about what might have eluded him because of his relentless pace. Now that he sees fewer patients, he said, he is more relaxed — and his patients are happier, too. Working with a consultant called MDVIP, which helps doctors switch to a concierge model, he went from 1,200 patients to 400.

Alright, I don’t want to judge Kanovsky too harshly, but the idea that the solution to being rushed is to simply become a doctor for rich people only really bugs me.  As does this:

At the same time, her income lagged far behind that of her peers in specialties. Salaries of primary-care physicians were around $220,000 in 2012, according to the 2013 Medical Group Management Association’s Physician Compensation and Production Survey, while specialists were averaging close to $400,000, with cardiologists and orthopedic surgeons earning more than half a million dollars.

$220,000 is just fine for a PCP.  More than fine.  Based on international comparisons you could easily argue this is overpaid.  Just because cardiologists are even more over-paid (again, international comparisons) doesn’t mean these GP’s are exactly suffering.  I know, though, human nature.  Always comparing.

The last part of the article addresses electronic records.

Perhaps the single greatest source of frustration for many physicians is a tool that was supposed to make their lives easier: electronic medical records.

Many do not merely dislike them — they despise them, said physician Mark Friedberg, a co-author of last year’s RAND study…

But many physicians say that instead of speeding things up, digital records have slowed them down. They say the designs often frustrate meaningful interaction — with the doctor’s face often turned to the computer screen while the patient is talking…

Using electronic medical records is more time-consuming for primary-care physicians than for specialists because they often are taking more comprehensive medical histories than specialists, tracking more tests and lab results, and filling in more fields.

I don’t doubt this is true and frustrating, but again, I feel like I’ve got a decent sample size of office visits (four kids and one with a special needs will do that for you) and that my interaction with the doctors is any worse.  Yes, they do spend a lot of time entering stuff into the computer while we talk, but before they were entering stuff onto sheets of paper.  I’m sure the process could be streamlined and improved, but from this patient’s (or patient’s parent) perspective, it does not seem nearly so onerous as the article suggests.

Anyway, lots of interesting stuff to think about in this one.

Is there any point to polling on the ACA?

Okay, of course there is.  But you could almost get the same results just from reporting Party ID.  From Gallup:

The Odds of Disapproving of the Healthcare Law, 2013-2014 results

Party Affiliation of Those Who Approve and Disapprove of Healthcare Law, August 2013-March 2014

On a political level, we’ll know that the law is seriously succeeding when we see meaningful increase in the percentage of Republicans who approve.  Conversely, if Democrats begin to abandon support, safe to say the law will be in trouble.

How to lie with statistics/ how to create graphics for Fox News

Obviously, this should not be news to anybody who pays attention to how Fox does things.  It’s just sad and funny.  And it doesn’t speak well of how the estimate the intelligence of their audience:

Below, via the alert watchdogs at Media Matters for America, is a graphic that Fox News posted during a broadcast on Monday. It’s pretty simple. On one side you have the number of people who had signed up for insurance via an Obamacare marketplace as of March 27, the last time the Administration offered an official number. On the other side you have the original projection, from the Congressional Budget Office, of what enrollment would be at the end of March. Here’s what it looks like:Obamacare Enrollment, via Fox News

Notice something funny? Here’s the same graphic, but with a baseline appropriately placed at zero.

Obamacare Enrollment According to Reality

It’s like the people at Fox read this awesome book and decided to use it as a guide.

And, if you’d like some intelligent discussion of these sign-up numbers, you can’t beat Jon Cohn.

Quick hits

On time this week.  Enjoy.

1) Are you really so busy?  Probably not (okay, DJC is pretty busy– though not too busy to read this blog).

2) How phthalates may be affecting male fertility.

3) Right-wing columnist says Republicans should just stop worrying about non-white people.

4) I love this study that clearly demonstrates causality (an actual experiment) on how money buys access in DC.

5) This one takes a while, but totally worth it.  How malaria keeps developing resistance to whatever we throw at it and the desperate (and very important) fight to prevent the latest resistant strain from spreading.

6) Republicans in NC continue to make it harder for college students to vote.  Just a coincidence.  They probably didn’t even know that young people are more Democratic these days.

7) Quality and profit in higher education are inversely related.

8) Body language really isn’t so great for detecting lying.  Also, a fun little test you can take yourself with it.

9) Fortunately my kids have never had lice.  But if they do, it’s good to learn that schools are becoming more rational about it.  Lice are basically harmless, it’s just that we’re grossed out by them:

Lice are not particularly contagious, they hurt basically no one, and they’re not a public health risk. Lice don’t actually matter. It’s high time that squeamish parents and school administrators stop acting like they do.

10) Probably not a good idea to get a degree in art or education from a lower-tier public university (at least economically speaking).

11) Hooray.  Now thanks to the success of the gun nuts, we’ve got a “knife rights” movement.

12) Nice Kristof column on the “takers” that conservatives never complain about.

13) I grew up right near Mclean, VA and I totally get that way too many parents are way too obsessed with their kids going to the most elite colleges and doing everything in their power to make that happen.  Personally, I went to Duke, Kim went to Duke, but we’ll be quite happy to have the kids go to NC State (or any other fine NC public institution).

14) How about a pill that increases the plasticity of your brain so you can learn things like you could when you were a kid.  It’s coming.  Brave new world.

 

Start fighting on Obamacare already!

Now, I’m not political strategist, but the idea that Democrats can succeed politically with “well, we no Obamacare needs some tweaks and we’re going to work on that” is, of course, ludicrous.  Republicans are pounding Democrats on the issue and all we get is “yeah, but you are exaggerating– we’ll fix the problems.  Oh, and it helps some people.”  Or something like that.  How about instead of all those “Obamacare ruined my life ads.” An “Obamacare saved my life.  Literally.”  ad.  You know there’s absolutely got to be those stories out there now.  And heck, stretch the truth if you need to– that’s politics.  A young mom with subsidized Obamacare coverage had a cancer screening and caught her cancer in State I and now is cured?  Put her and her kids on TV, damnit.  That’s how you do these things.  Here’s Drum from today:

From Kathy Bentzoni of Slatington, Pennsylvania, who signed up for Obamacare after giving up her “useless” old coverage because it was too expensive and denied all her claims. A few weeks ago, knowing she could afford it, she went to the ER complaining about numbness in her fingers:

Where would I be without Obamacare? ER, 3 units of blood, multiple tests in the hospital and a 5-day inpatient stay without insurance? Probably dead.

I have to thank Obamacare for saving my life.

Bentzoni would have been treated in the ER regardless of her insurance status. Without insurance, though, she might not have gone. Or she might have waited too long. But on March 1, knowing that it wouldn’t bankrupt her, she went in time to avoid the worst. And thanks to Obamacare, she can afford the ongoing care she’ll need to treat her rare blood disorder.

This is from a piece at CNN highlighting five Obamacare success stories. More like this, please.

Democrats own Obamacare.  Period.  There’s just no running away at all.  So Democrats need to start playing hardball themselves and talking about people who would have died (heck, that’s a lot worse than oh, no, my insurance premium went up $100 and I had to buy it!) if not for Obamacare.  Why isn’t this happening?  If Democrats don’t fight back at all on the issue it becomes a complete self-fulfilling prophecy that it’s a losing issue.  Time to get past the website and tell some stories about bankruptcies avoided and lives saved.

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