Stupidity can be liberating

Don’t do stupid shit is a good guiding principle for almost anything going forward.

Kevin Drum makes a predictable but real point about how no longer doing stupid shit leads to good results.:

We were poisoning our children with a well-known neurotoxin, and this toxin lowered their IQs, made them into fidgety kids, wrecked their educations, and then turned them into juvenile delinquents, teen mothers, and violent criminals. When we got rid of the toxin, all of these problems magically started to decline….

 In the end, we’ve learned a valuable lesson: don’t poison your kids. [my emphasis]

As some level, not dumping massive amounts of powerful neurotoxins into the air is blindingly obvious and simple. At other points, it is profound at how much a simple change in what we allow dumped into the commons has and will have in our society. Getting most of the lead out of the air and decreasing the amount on surfaces radically alters the political profile in this country and allows for greater liberalism as crime is less salient now than it was thirty years ago. Going to unleaded gas was fixing a stupid, self-inflicted problem vector.

Cleaning up other people’s stupid shit is a full time career for policy wonks and promoters.  I was lucky enough to have a good two hour walking coffee tour of Boston with Tom Levenson last weekend, and as we were talking, he asked me what I would do if I was the health care dictator for a day in the United States.  That was one hell of a good question that took a good block for me to formulate my thoughts as there were so many opportunities.  The reason why there are so many opportunities is that there are numerous areas of stupid shit that are inherent to the current American health care system.  We batted around some ideas:

  • Changing graduate medical education
  • Changing medical education finance
  • Changing scope of practice regulations for CRNPs and Physician Assistants (PAs)
  • Standardizing electronic medical records
  • Changing the ideal model of doctor as an Olympian diagnostician towards a model where the doctor uses far more decision supports and the expertise is in the edge cases
  • Changing how we fund public infrastructure to encourage more walking/biking and less car trips
  • Allowing big buyers of medical services to act like big buyers of anything else in this country by being able to negoatiate hard

At some level, that is depressing as all of these changes would have massive impact on at least one factor of well-being or health costs, and none involve fundamental paradigm busting.  They merely require significant changes to current practices and habits to produce better results.  There are minimal new technological demands in most of these areas of discussion, there are no hopes for pie in the sky molecular development, the changes are mostly organizational and thought process based changes.  I settled on saying that if I could change one thing, it would be to allow Medicare to truly leverage its size and budget in order to actively drive prices down instead of being effectively a price taker.  That would involve breaking a cartel (the AMA) which sets its own rates for the government to pay, and it would probably lead to a few doctors leaving the Medicare network, but it would address the biggest problem in American healthcare — we pay too much, compared to the rest of the world, per unit of care delivered. 

At the same time, the fact that there are so many stupid practices embedded within the American health care financing and delivery systems means there are numerous opportunities for systemic improvmeent without causing too much pain or taking too much non-political risk.  Stupidity can be liberating as there are numerous opportunities for change and improvement.  So much like the simple lesson that we should not poison our kids with powerful, persistant neurotoxins, once we remove stupidity, the long term effects can be massive and pervasive.

84 replies
  1. 1
    Steeplejack says:

    Eh, might want to change the typo in your headline, unless that’s a deliberate joke.

  2. 2

    “Don’t do stupid stuff” is the guiding principle behind my weekly Tennessee Gun Report. This week’s a doozy where teh stooopidz is concerned.

    Seems like the first rule of “don’t do stupid stuff” is to not arm every fucking yahoo in the country. But silly me.

  3. 3
    BGinCHI says:

    Walking around Boston with Levenson sounds fun, except it takes forever because he is always stopping to take a big painting out of one of his pockets. What with the unfurling and explaining of allegories, you never really get anywhere.

    He does look good in a trench coat, though.

  4. 4
    Betty Cracker says:

    I would definitely endorse you for healthcare dictator.

  5. 5
    Richard Mayhew says:

    @Steeplejack: yep — that is it — it was an intentional joke :)

    as I sheepishly check my spelling…

  6. 6
    Elizabelle says:

    I would feel safe with you and Tom Levenson running this country, as you walk around swilling coffee.

    But this is not the eternal realm.

    Richard, you would make a damn fine healthcare dictator, as Ms. Cracker endorses. A benevolent dictator, at that.

  7. 7
    Elizabelle says:


    What were it?

  8. 8
    Richard Mayhew says:

    @Elizabelle: I was missing the “i” after the “d”

  9. 9
    Davis X. Machina says:

    ‘Stupid’ has a powerful and well-organized constituency of its own.

  10. 10
    Citizen_X says:

    I swear, I am going to make an Obama commemorative t-shirt in a couple of years, and it will have the Great Seal of the US on it. But instead of E Pluribus Unum, it’ll say Don’t do stupid shit.

  11. 11

    The thing that annoys me about Hillary Clinton and Bill too for that matter is all the fucking angst and agita and controversy that alway swirls around them.

  12. 12
    MomSense says:

    I have a friend whose field is medical decision making. She is in incredible demand and I think Sebelius practically had her on speed dial. I haven’t heard whether or not she has been involved with DHHS lately but I’ll ask her. She was working previously on changes to Medicare reimbursement.

  13. 13
    Missouri Buckeye says:

    @Southern Beale: Of course, with all the “disturbances” in Ferguson this week, gun sales have gone up 50%.

  14. 14
    Cacti says:

    @Southern Beale:

    The thing that annoys me about Hillary Clinton and Bill too for that matter is all the fucking angst and agita and controversy that alway swirls around them.

    When the Bill and Hill show was in the White House, all of the energy of the national party was sucked into propping them up. Meanwhile at the Congressional and State level, all the Dems did was lose for the next 8-years.

  15. 15
    Soprano2 says:

    I agree, on Monday my husband paid $190 for a 1-month supply of one of the two insulin pens he uses to manage his diabetes. He is not overweight, in fact during the past year for awhile he was seriously underweight, but the weight loss had zero effect on his diabetes. He’s on Medicare and is now in the donut hole, mostly because the insulin he takes is so ridiculously expensive. It’s no wonder people have to choose between food and medicine, I think people whose health insurance covers most of the cost of medications like this have no idea how expensive it really is. Letting Medicare negotiate with drug providers would fix some of this problem for sure.

  16. 16
    Violet says:

    I’d totally endorse you for healthcare dictator! How do we make this happen?

    Standardizing electronic medical records

    Can we first just make the ones we have work? As some people here are aware, I’ve been visiting a lot of doctors lately with my parents who have had health issues. The number of times the computer has been down and thus the EMR are not accessible is shocking. It completely shuts down the ability of the medical professional to do their job–from the nurse entering the vital signs to the doctor looking over the chart.

    This situation has come up in a variety of places–hospital, doctors offices, even Medicare was offline when we had to take my mom to the ER so they couldn’t check her eligibility. It has led to appointments not being made–I had to follow up a few weeks later when I hadn’t heard back from them about follow up appointments and got the whole song and dance–“Our computer was down that day and a bunch of people slipped through the cracks! Your mom was one of them. I’m so glad you called to follow up!”

    I’m all for EMR when they work but so far they seem to cause more problems than they’re solving. I am surprised at how poorly they seem to work. And that’s not even taking into account the next levels–that doctors at affiliated institutions (hospital and medical practice under same umbrella) should be able to access the same EMR chart and yet they can’t. That seems to be the whole point of EMR and it’s not working either.

  17. 17
    jheartney says:

    The problem with “Don’t do stupid stuff” as an organizing principle is that we humans rarely agree on what constitutes teh Stoopid. Sometimes in retrospect (invading Iraq = stupid; ending leaded gas != stupid) it becomes clear, but in many cases there’s a big constituency for bad ideas, and they’ll come up with lots of rhetoric about why we have to keep doing them.

  18. 18
    Violet says:

    I will say that the surgeon who operated on my mom told us he was paid on salary not by procedure. This was in the context of deciding whether or not she should have the surgery. He recommended it and I said something like, “He is a surgeon and doing surgery is what they do.” He made a point of letting us know he wasn’t be paid by procedure.

    I’m all for this change. I think this is a part of changes that are happening as a result of the ACA but I’m not sure.

  19. 19
  20. 20
    jheartney says:

    @Violet: I’m guessing it has something to do with this country’s mania for private enterprise solutions, overlaid with a generally neglected public health care sector. Private solutions means there’s a patchwork of incompatible systems, and since the public sections are more associated with the old and/or poor, there’s not much pressure to fix those.

  21. 21
    jheartney says:

    My recollection is that back in Reagan era, going to unleaded gas was something of a wingnut whipping boy, sort of like high-efficiency lightbulbs today. That darn gummint messing around with me and my high-polluting gas guzzler, what will those damn libs think of next?

  22. 22
    OzarkHillbilly says:

    @Citizen_X: I’ll buy one.

  23. 23
    OzarkHillbilly says:


    Can we first just make the ones we have work?

    I have a new pet peeve: Doctors who spend more time “conversing” with their computers, than they do their patients. I was at pulmonary specialist and in the 5-7 mins he was in the room with me, we had about 90 secs of discussion. The rest of the time he had his nose in his laptop. I have already decided that the next time I run into this, he/she will either close it when I request or I will just get up and walk out.

  24. 24
    HinTN says:

    @Richard – I totally approve of your one big idea but the problem, as I see it in almost every craptastic system we have today, is that it takes quite a while to unspool from the way the system operates today without crashing huge swaths of society. Your doctors (and hospitals) have huge sunk costs that they have to support. In the military industrial complex we have a similar problem where a huge percentage of the funding for a considerable proportion of the population is based on the building and maintaining of free constituent components of the system. We would have to articulate a long term goal and a plan to get there that didn’t result in the immediate destruction if great swaths of the country. How we come to that sanity escapes my poor pea brain. Great idea, though. I endorse Betty’s nomination.

  25. 25
    Stella B. says:

    @Violet: This is what lead to my early retirement. I might have worked a few more years without EMR. Mind you, I was a software engineer and a mighty fast typist before I went to medical school and I eagerly awaited the arrival of my first “real” EMR. What a fiasco! 1980s interface design with craptastic reliability at a 2010s price! And communicating with other systems mostly consisted of an army of worker bees scanning printed documents into our system.

  26. 26
    Suffern ACE says:

    @BGinCHI: no wonder getting stoned was such a horrible experience for her.

  27. 27
    jake the antisoshul soshulist says:

    I find it interesting that so little attention was paid to the AMA in the battle over the ACA and in reforming healthcare generally.
    Of course, it is one their shibboleths, but killing the NEA is a huge part of the “education reformers” agenda. However, I can’t remember anyone saying kill the AMA for healthcare reform. Though I suspect in many ways, the AMA subverts many of the necessities of healthcare reform.

    But then, I think that destroying teachers unions is a separate goal of the “education reform” movement. While I don’t think destroying the AMA is any part of the goal of healthcare reform movement.

  28. 28
    HinTN says:

    D’oh – not free, “the”

  29. 29
    Emma says:

    @BGinCHI: What the heck happened to that woman’s face? I know it’s kinda shallow but she looks like something sucked out her cheekbone fat!

    And no, I didn’t read the effin’ thing. I have enough agitas at the moment.

  30. 30
    Davis X. Machina says:

    @Citizen_X: You want Ne res inanis fiat. (Let no stupid shit be done/So that no stupid shit be done. Clean paraphrase, suitable for coinage…)

  31. 31
    Davis X. Machina says:

    @jake the antisoshul soshulist: Whom does the membership of the AMA bankroll? Whom the NEA?

  32. 32
    BGinCHI says:

    @Emma: Safe click. TPM reads it for you….

  33. 33
    burnspbesq says:

    My pet peeve about the health-care system is this: because of compulsory-licensing and similar schemes in most of the rest of the world, American consumers pay the world’s highest prices for on-patent prescription drugs, and end up indirectly funding substantially all of the private-sector drug research going on in the world.

    That’s the real reason why Soprano2’s hubby pays $190/mo for each of his pens (FWIW, I pay a $25 co-pay on my Blue Shield platinum plan).

    I don’t have an answer. There may not be anything the United States can do to (for example) force India to change its patent laws. But I’ma vent about it.

  34. 34
    Villago Delenda Est says:

    The problem is that a great deal of the stupid stuff done is great for profits.

    Ferengi stupidity is the doom of the human race.

  35. 35
    terraformer says:

    Don’t forget greedy along with stupid. I probably shouldn’t be, but I am continually amazed at how simple human greed – perhaps with a dollop of sociopathy – contributes to or even directly causes declines in our collective health.

    We know that fossil fuels are killing us, that high fructose corn syrup is contributing to obesity, that dumping toxic waste into watersheds destroys our habitat and our water, that a host of various foodstuffs are generally bad for us, and that alternatives exist for most if not all of these and other issues, but we largely do nothing about them or we even actively seek to misinform and obfuscate about their impacts – all in the name of profit.

    Sometimes ignorance is indeed bliss…

  36. 36
    Richard Mayhew says:

    @Villago Delenda Est: Yep — someone’s systemic stupidity or waste is someone else’s primary personal income and/or vacation to Europe this fall.

  37. 37
    Jay C says:

    Agree with you completely, Richard: but I think you overlook one significant factor in the US healthcare debate:

    “…the fact that there are so many stupid practices embedded within the American health care financing and delivery systems means there are numerous opportunities for systemic improvement enormous profits by huge transnational mega-corporations

  38. 38
    JCT says:

    @OzarkHillbilly: This is a real problem and very generational . As one of the relative old-timers (I remember going to the clinical labs in the basement of a huge Bronx hospital to look up lab results in a BOOK every afternoon ) I just dislike having a screen on my desk while seeing patients. Part of the problem is that computers and EMRs vastly improve our ability to follow sequential results, the sort of info that we use to inform patients regarding their disease progress and make treatment decisions. The sorts of things you cannot really trust to memory. My patients now laugh every time I turn to the damn screen because I still apologize every time I do it. My trainees, however, IMO, spend too much time looking at the screen, drives me nuts because it does disrupt the interactions. But this is the way they have trained.

    And I’ve used 3 different EMRs in my career- none are great. Just went through a switch to EPIC last year – it’s better than the old system, but he switchover was sheer hell.

    The AMA? Amazing how much power they have given that most docs are not and have never been members. The “old” AMA was filled with bigots and misogynists. While they have “reformed” – docs of my generation stayed away. The scary part is that they have info about me that I never authorized them to have – and have complained to no avail.

    I agree with your list, Richard – don’t forget med school cost reforms or more extensive payback options. Huge impediment to growing primary care.

  39. 39
    Tom Levenson says:

    As Richard’s foil, may I say I heartily endorse him for health care dictator.

    And while we dissect each of the options he mentions, it’s important to remember the larger point: the health care system has so many stupid things wrong with it that it is possible now (or would be, with a functioning second party) to create a better and cheaper health care system without fundamental change (e.g., move to a single payer). The national benefit of that is obvious, I hope — and renders the Red Army-before-Hitler scorched earth strategy of the Republican party to be more than politics as usual; it rises to the level of a threat to the long term financial (and hence national) security of the United States.

    Just sayin….

  40. 40
    SiubhanDuinne says:


    What the heck happened to that woman’s face? I know it’s kinda shallow but she looks like something sucked out her cheekbone fat!

    I had the same initial reaction. Had to look very carefully before I saw that it’s just the way a strand of hair falls over her cheek. A very odd and disagreeable optical illusion!

  41. 41
    Walker says:

    So by this

    Changing graduate medical education

    do you mean making it an undergraduate program, like in New Zealand?

    I am not saying this a bad idea, but you do understand what this would do to the university system in this country? A significant portion of undergraduate students at liberal arts colleges are pre-med. Heck, at my university, upwards of 60% of the applications I read are students interested in pre-med.

    This is not going to be easy to do in this country.

  42. 42
    catclub says:


    He’s on Medicare and is now in the donut hole,

    I could have sworn that I heard the ACA eliminated that.

    Also, Dean Baker’s solution is bringing in foreign trained doctors. I bet none of you people knew that.
    Given that the lead fix seems so far from ‘adjustments to the healthcare system’. I would bet on the bicycle/walking/infrastructure. People in healthier countries walk more.

  43. 43
    catclub says:

    @Tom Levenson: The refusal to allow Medicare and medicaid to negotiate drug discounts is not just crazy, but self-destructive. Like the Post Office being required to fund 75 future years of pensions. Simply crazy penalties on public functions of the government.

    ETA: My editing time ran out on the above.
    Plus, total vehicle miles are falling even as the economy improves. The youth are less car dependent.

  44. 44
    Richard Mayhew says:

    @catclub: ACA is slowly eliminating the donut hole. I think it is completely gone by 2020 (don’t have the reference with me right now). The donut hole is shrinking each year by ~$250, but is still out there.

  45. 45
    dww44 says:

    @Richard Mayhew: Richard, I came to BJ specifically to address a concern and request to you, only to find that you were the most recent post. How convenient!

    How would your respond to Jim Cramer’s remarks on his pre market show on CNBC this morning when he referred to the ACA needing to be called the UCA for ” unaffordable”? Primarily because of rapidly increasing deductibles that will result in many people opting not to get the treatments they need or want. Specifically he said that people won’t be able to afford babies and that his remarks are not political and are based on his conversations with business health care professionals. About how the ACA was to ratchet down healthcare costs in the country and if so seems to be doing it on the backs of health care users.

    Comments like his need to be addressed at the forums where they are made. Is he right about this issue?

  46. 46
    Richard Mayhew says:

    @Walker: Nope, we riffed on a couple of different things. I think we were talking about how long docs spend in post-graduate education, how it is financed (students willing to go PCP get a deep discount/no tuition education, students who want to go Radiology, Audiology, Optometry, ophthalmology, anesthesiology, Dermotology (the ROAD to riches) pay full price etc, moving away from the master-apprentice system and a few other mildly informed areas of speculation. Honestly, it is something that I think could be a massive public policy win but I don’t know enough to have truly informed speculation much less truly informed knowledge.

    The big thing is importing foreign docs. I know two friends or at least the parents of my daughter’s playmates who were OECD trained docs with full home country licensure who have had to go back and repeat 5 years or more of training to be self-practicing docs in the US. Crazy.

  47. 47
    gogol's wife says:


    My husband and I just had this argument again this morning, only this time it was Vietnam, not Iraq. We watched that Dick Cavett’s Watergate special last night. It led to some lively discussion.

  48. 48
    Villago Delenda Est says:

    @dww44: Jim Cramer should be put on a rocket that is to be shot into the sun.

    End of comment on Jim Cramer.

  49. 49
    Richard Mayhew says:

    @dww44: It depends — right now looking at what types of plans are being bought on the Exchange (mostly Silver, cost-sharing assistance Silver, Gold, Platinum) with only 20% Bronze or Catastrophic, and the Bronze/Catastrophic more likely to be young/healthy, there will be cases where deductibles aren’t met, but the relevant set of question is “compared to what….”

    Paying full cash out of pocket — deductible payment is far better than that
    Instead of a “platinum employer provided plan” — most Exchange policies are worse than that.

    What Cramer and most other people neglect is that big deductibles have been the healthcare trend of the past fifteen or more yeatrs, pre PPACA, and PPACA embraced it.

  50. 50
    JimV says:

    Great post. I hope it gets linked to widely. It would be a great discussion for this nation to have.

  51. 51
    Seanly says:

    “Don’t do stupid stuff” is a great principle, but often it takes a long, long time to realize what we’re doing is stupid. Then, something that was just for convenience (like adding lead) becomes a Gawd-given right (catalytic converter is a tool of Communist stooges!) even when the evidence shows it is terrible.

    Another stupid thing we do is continue with this terrible golem of health care. We don’t necessarily need single payer, but there’s gotta be a better way out there.

  52. 52
    gene108 says:

    @Southern Beale:

    The thing that annoys me about Hillary Clinton and Bill too for that matter is all the fucking angst and agita and controversy that alway swirls around them.

    Just wait till a talking-head declares “we are in the cycle of Obama fatigue“, with questions swirling about his leadership, due to various crisis in the ME and Europe and on the Southern border, etc. Americans just want to have a news cycle, where President Obama’s capability as President is not constantly being called into question.

    I look forward to this after the 2014 mid-terms.

  53. 53
    Davis X. Machina says:

    @Walker: How many of them survive P-Chem?

  54. 54
    sempronia says:

    @Richard Mayhew:

    argh….. the ROAD specialties are radiology, ophthalmology, anesthesiology, and dermatology. Optometry and audiology aren’t physician specialties.

  55. 55
    dww44 says:

    @Richard Mayhew: Thanks for responding. This does explain it. Wish you could get on his show. Since I’ve posted I’ve been searching for the relevant video at CNBC from the Squawk on the Street show (my husband’s hobby is the stock market) and can’t locate it.

    See, Cramer kept making the point that he wasn’t being unpolitical. but that UCA label is gonna stick.

  56. 56
    Poopyman says:

    @Tom Levenson:

    … the Red Army-before-Hitler scorched earth strategy of the Republican party to be more than politics as usual; it rises to the level of a threat to the long term financial (and hence national) security of the United States.

    “Oh, how shrill!” Clutches pearls, and our heroine Chuck Todd slumps to the floor of the MTP set. Aaaand, fade to commercial.

    Is there some corollary to the Big Lie? The Big Truth?

  57. 57
    big ole hound says:

    @JCT: If med school was free to those who qualified in exchange for serving where shortages existed for 5 years two problems might be solved, geography and cost which would hopefully make reasonable medical care available to a lot more of us.

  58. 58
    texasdem says:

    @Violet: Physicians are very aware that EMRs have changed the way we practice. Fortunately, my notes can be dictated, but many EMRs require that the notes be entered manually, often with checklists,etc. If a physician tries to do that during a visit, his/her eyes are on the computer and not the patient. There is so much that you learn from nonverbal cues during an evaluation–I can’t help but think this has an adverse effect on patient care as well as patient satisfaction. Not mentioned so far is the fact that EMRs do not make you more efficient–in fact, they slow you down, which is why some offices are hiring scribes to enter data. I am an oncologist, and our system makes it much harder than it was in the past to review a patient’s chemotherapy history, so hard that I now dictate it into every note. You could make up for the incovenience if all of a patient’s records, wherever they were seen, were available via the EMR. Now we’ll spend billions of dollars to allow different software systems to talk to one another. Ah, free enterprise at work!

  59. 59
    burnspbesq says:


    but there’s gotta be a better way out there.

    There are about as many better ways as the United States has major trading partners. If I got to pick one, I think it would come down the French or the Swiss.

  60. 60
    gene108 says:


    My recollection is that back in Reagan era, going to unleaded gas was something of a wingnut whipping boy, sort of like high-efficiency lightbulbs today. That darn gummint messing around with me and my high-polluting gas guzzler, what will those damn libs think of next?

    I think it also had something to do with the change in engine design brought on by the catalytic converter and fuel efficiency standards, along with higher gas prices.

    The glory days of big, but powerful, gas guzzling cars was over and small wimpy cars were taking over.

  61. 61
    Seanly says:

    @Richard Mayhew:

    Employer plans have been trending towards the high deductible plans. My employer dropped our PPO-type plan and is now only offering two plans: a high deductible one and a higher deductible one. Premiums aren’t too bad, but the $9000 out of pocket max isn’t very bank account friendly. We went higher deductible thinking that even though we both have a couple of problems we are managing them pretty well. Then my wife was diagnosed with Acute Lymphoblastic Leukemia on January 29.

  62. 62
    Richard Mayhew says:

    @gene108: But just on basic HP/Torque concerns today’s my Scion Xa has more power than the base model 1966 Mustang (

  63. 63
    Cervantes says:

    Might be interesting to see what Brad thinks about your bullet points.

  64. 64
    Richard Mayhew says:

    @Seanly: yep, the risk got shifted and shafted onto you and your wife. I hope she has a fast and full recovery.

  65. 65
    Davis X. Machina says:

    @Seanly: Two high-deductable plans added here in the most recent contract. I expect the two legacy PPO plans they are presently continuing to offer here to go in the next contract, leaving just the two new ones.

  66. 66
    Richard Mayhew says:

    @Cervantes: They’re not fully fleshed out ideas — just conversation pieces during a very enjoyable walk and conversation with a very smart guy asking very good questions

  67. 67
    Patrick says:


    See, Cramer kept making the point that he wasn’t being unpolitical. but that UCA label is gonna stick.

    You mean stick like the way this one stuck:

    On the March 11, 2008, episode of Cramer’s show Mad Money, a viewer named Peter submitted the question “Should I be worried about Bear Stearns in terms of liquidity and get my money out of there?” Cramer responded “No! No! No! Bear Stearns is not in trouble. If anything, they’re more likely to be taken over. Don’t move your money from Bear.”[48][49] On March 14, 2008, Bear Stearns stock fell 92% on news of a Fed bailout and $2/share takeover by JPMorgan.[5

    One can only assume that Cramer does not have regular health insurance like the rest of us, since he has no clue what he is talking about. The deductible on my company’s health insurance has gone up every year since I started there. Why wasn’t Cramer concerned about the deductibles before ACA? Like the rest of the pundits, he is so concerned about the ACA, but couldn’t possibly have cared less about the same issues prior to ACA.

  68. 68
    FlipYrWhig says:

    @Richard Mayhew: Plus preventive care visits are zero-deductible now, correct?

    Also, Jim Cramer is a big fucking moron whose friends are even bigger fuckinger moronier big fucking morons.

  69. 69
    Villago Delenda Est says:

    @Poopyman: Chuckles the Toddler would be in the vanguard of the tumbrel parade if I were the Robespierre of America.

  70. 70
    Villago Delenda Est says:


    Like the rest of the pundits, he is so concerned about the ACA, but couldn’t possibly have cared less about the same issues prior to ACA.

    Hence the need to put his ass on a rocket ship to be shot into the sun.

    Or, as a more thrifty alternative, simply give him a tumbrel ride. Wall Street villagers are every bit as tumbrel worthy as the Villagers of the Beltway.

  71. 71
    Villago Delenda Est says:

    @texasdem: The important thing is that some dudebros have a steady revenue stream from you doctor types.


  72. 72
    the Conster says:

    @Richard Mayhew:

    Companies with high income earners are only offering HSA high deductible plans more and more, because of the demand – the money for the deductibles is pre-tax and is yours, so it provides another way for high income earners to save for retirement. Plus, it can be used for dentists and eyeglasses. When our family transitioned to it I hated it, but if you’re relatively healthy, it’s better than giving your monthly premiums to an insurance company. I wish car insurance worked the same way, because for what I’ve paid over the last 40 years in insurance premiums, I could be driving a Maseratti because I’ve only had one accident.

  73. 73
    Cervantes says:

    @Richard Mayhew: Glad you enjoyed your visit with Tom. Not surprised.

  74. 74
    JCT says:

    @Davis X. Machina: No joke- my husband teaches P-Chem at a large state university and was commenting that most of the students taking the class in their senior year were pre-meds, too late for their grade in the course to kill their med school chances. He thought it was amusing – until I had to admit I did the same thing.

  75. 75
    gene108 says:

    @Richard Mayhew:

    Modern cars are much more powerful than 1960’s cars. Modern car technology has done some impressive things getting power and fuel efficiency out of engines.

    It’s just that after we went to unleaded gas in the mid 1970’s, plus I guess he oil shocks and fuel standards, the end result were smaller, less powerful cars compared to what was being crunched out in the early-1970’s and 1960’s.

    Look at late 1970’s and early 1980’s cars the HP was much less than predecessors.

    1980 was a year of change. The OPEC crunch of the 70s caused a disappearance of the 302 ci V8 and gave the Mustang a new 255 ci V8. This engine was a de-bored 302 and was the only V8 available in 80 and 81. The heads didn’t help the cause, and the result was a pathetic 119hp – earning the distinction of the slowest Mustang V8 engine ever. If that wasn’t enough to make Carroll Shelby toss cookies in his sleep – the lack of performance in this motor was further strangled by a 3-speed automatic transmission. Snore.

    You either had big, inefficient V8’s that were not powerful, like the mustang above or relatively tiny cars, by today’s standards.

    My 2003 Corolla is bigger than the mid-size car Toyota was making 30 years ago.

  76. 76
    Davis X. Machina says:


    My 2003 Corolla is bigger than the mid-size car Toyota was making 30 years ago.

    Everyone grew…
    The Yaris is the size of the first Corolla I owned, or larger.
    The Corolla is the size of a fairly recent Camry.
    The Camry is the size of the original Avalon.
    The Avalon is the size of a small Humvee.

  77. 77
    gelfling545 says:

    @Citizen_X: I would buy this. Words to live by, if there ever were any.

  78. 78
    JoyfulA says:

    @catclub: I thought the ACA eliminated the doughnut holes, too, but my only expensive med (which I previously ordered from India once I paid for the initial bottle) is now off patent, so I have no personal experience.

    Maybe it’s next year?

    Also, with foreign-trained doctors, I’ve seen many, many of them, here in the sticks and in Philly, from many different countries, Turkey, India, Pakistan, Ivory Coast, off the top of my head.

  79. 79
    catclub says:


    Now we’ll spend billions of dollars to allow different software systems to talk to one another.

    Another place where the lessons learned by the VA medical system will be squandered. Although they have the advantage of being a pretty big, integrated system.

  80. 80

    I don’t see anyone else having suggested it, so I will: Change the research funding structure for pharmaceuticals, making a giant pool of money with disease targets set by scientists and not profit motives. If Sanofi wants to invest a lot of their money in a boner pill, that’s their own business, but the fact that it wouldn’t be profitable shouldn’t be stopping us from developing the next generation of antibiotics.

  81. 81
    boatboy_srq says:

    @Violet: A not insignificant part of the problem is that information technology and medical technology have vastly different lifespans. Medical tech ages in the 20-30 year range (the functional lifespan of a given medical tech device, such as MRI or CAT scanner), while info tech ages in the 2-5 year range (2 for laptops, 3 for desktops, 5 for servers is a good basic rule). Most medical enterprises are all for technology and will spend unimaginable sums on it – but they expect the info tech to last as long as the medical tech. I’ve lost track of the places I visited as a consultant where, on asking about the nearly-antique desktops, I was told, “But these are new machines! We only got them five years ago.” And there’s a distinct disconnect between the MDs’ fascination with their new personal gadgetry (they snapped up BlackBerrys about as fast as the attorneys did) and their disinterest in their office equipment – and a consequent lack of understanding why the former can’t talk to the latter. It doesn’t help that, no matter how skilled a professional, nobody without multiple advanced degrees will ever be viewed by an MD as anywhere near as intelligent or knowledgeable, so advice from anyone not an MD or PhD will always be viewed with distrust (not of the person per se, just from the “s/he isn’t properly schooled like me, so s/he doesn’t know what s/he’s talking about” attitude).

    As some level, not dumping massive amounts of powerful neurotoxins into the air is blindingly obvious and simple. At other points, it is profound at how much a simple change in what we allow dumped into the commons has and will have in our society.

    This is an understanding of the commons that the Teahad will – deliberately – never grasp unless forced to. To them, there is no such thing as The Commons – only the Potential for Individual Ownership. We cannot address the Reichwing’s insistence that any and every attempt to make the public sphere (and hence ourselves) healthier/safer/sustainable/whatever is some Soshulist plot to take away their possessions and destroy their Ownership Society until they agree that things like soil, air and water are vital to us all – and what we do with them affects all of us.

  82. 82
    Matt McIrvin says:

    @Richard Mayhew: That’s today. It took a long time for, especially, the US auto industry to figure out how to make decent cars to more modern efficiency and emissions standards, and they had to get pummeled by Japanese companies first.

  83. 83
    Matt McIrvin says:

    @Davis X. Machina: There seems to be a general pattern in which every specific named model of car tends to get larger and fancier over time, and the manufacturer introduces models with new names at the low end to fill up the hole there.

    I remember when the Honda Civic was a tiny econobox; now it’s a mid-sized sedan (well, I guess it’s still what they call “compact” today) and the Fit is in that niche (though the Fit’s larger than the Civic was then).

  84. 84
    Villago Delenda Est says:

    @catclub: I can access my test results over the internet. I can communicate with my general care physician over the internet. I can order prescription refills over the internet, and arrange for renewals that way, too, via my general care physician.

    The VA system is…well, great! If only I didn’t have to wait so long for appointments due to staffing shortages caused by…

    …wait for it…


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