Never Forget What Got Us Here

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(Image via)

So this happened:

Senate Majority Leader Mitch McConnell says he’s committed to supporting Donald Trump’s presidential bid.
But, the Kentucky Republican wrote, he has expectations of Trump — who he said “now has the opportunity and the obligation to unite our party around our goals.”

McConnell said in a statement Wednesday night that he plans to support the real estate mogul, who became the GOP’s presumptive nominee once Texas Sen. Ted Cruz ended his campaign after losing Indiana’s primary on Tuesday night and Ohio Gov. John Kasich then dropped out of the race on Wednesday.

“I have committed to supporting the nominee chosen by Republican voters, and Donald Trump, the presumptive nominee, is now on the verge of clinching that nomination,” McConnell said.

“Republicans are committed to preventing what would be a third term of Barack Obama and restoring economic and national security after eight years of a Democrat in the White House,” he said. “As the presumptive nominee, he now has the opportunity and the obligation to unite our party around our goals.”

There’s going to be a whole bunch of #nevertrump wankery in the upcoming months, but that doesn’t mean they will do anything to defeat him. They may choose to sit out as these two profiles in courage, Bush 41 and Bush 43, but they won’t actually vote for the only other option in the race. But it needs to be said over and over and over again. We are hear because of the Establishment GOP.

For the last couple decades, the GOP has been eagerly supporting the political equivalent of suicide bombers. You can go through the list of the top tier un-elected idiots, whether they be Joe the Plumber, Rush Limbaugh, Sarah Palin, the entire coterie at Red State and Hot Air and the National Review, and the gun nutters and fascists and Bundy bros that they all play footsy with, and every one of them was all in on the teahadists and shit fer brains when it served them. And then the elected nutters from Steve King to Bachmann to that you lie shitbird to on and on and on. I’m not even going to waste your time and give you acid indigestion listing all these toilet bowl clingers.

So yeah, now you’re against Trump. You’re so fucking principled. It’d be horrible for conservatism if Trump wins.

Fuck you.



Wednesday Evening Open Thread: Be of (Comparatively) Good Cheer

Yes, we must all buckle down and do our very damndest to ensure Hillary Rodham Clinton becomes our next President. But at least we’re not any of these guys!


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NHL/NBA Playoffs Open Thred

AL has a thread in the works for you non sportsball people.

GO PENGUINS!








Team Clinton Has Been Waiting For a Couple Decades

To beat the fuck out of a Republican, so they aren’t even waiting until she has the nomination.

People keep saying that Hillary isn’t going to know what hit her when Trump unloads. I think she does. She’s been dealing with it for decades.

I don’t think Trump knows what it is going to feel like to be bludgeoned by Clintonites who have had negative ad blue balls for a couple decades. They didn’t unload on Bernie and they got warned off Obama in 2008, so Trump is going to get the full treatment. It’s going to be fucking beautimous.








Bets and the Beanstalk (Open Thread)

One feature of living in the sun-blasted hellscape of Florida, in addition to the giant, flying, indestructible cockroaches and invasive alien reptiles — one of whom has purchased the governorship — is the option to start spring gardening in February.

Our beanstalks are already 11 feet tall! Here’s today’s haul:

The best way to cook these beauties is to sauté them gently in olive oil, add a split garlic clove, then finish them with some lemon zest and pecorino cheese. Unbelievably good.

But tonight, we’re gonna fry some up in beer batter and dip them in homemade boom-boom sauce. What are you having for dinner?

Anyway, open thread!








He’s a bandit and a heartbreaker

It’s still hard for me to believe that #NeverTrump wasn’t able to make a dent in the Donald by hammering away at Trump University and Trump’s misogyny.

This ad about Trump University was pretty good:

As was this ad about Trump’s misogyny:

The media will try to recast Trump as a serious reformicon maverick between now and November. And we’ll certainly get a lot of this:

[T]he Clinton campaign and its surrogates will bring up Trump University and Trump’s bankruptcies and Trump’s mob ties and history of racial discrimination — but these stories will reported with the asterisk “On the other hand, the Clinton Foundation blah blah blah blah blah,” or “In the 1990s, Mrs. Clinton’s cattle-future trading was investigated….” Both Sides Do It, so the press will feel the need to yoke every Trump scandal to a Clinton scandal. This tendency is likely to be extended even to such matters as Trump’s racism: Yes, Trump calls Mexicans “rapists” and wants to ban Muslims, but Hillary Clinton said “off the reservation” that one time.

But I think that the reaction to the Trump University scam and “she’s a dog” etc. is visceral in a way that Both Sides Do It can never be. I think the only question is how voters react to MenaGate, TravelGate, MonicaGate, BenghaziGate, and so on. My guess is that most of it is too complicated for non-wingers to understand. I wonder if we’ll see some longer documentaries about the murder of Vince Foster on our teevee screens this fall.



You Think I’m Cute: Barack and Michelle Love Story

I know, I know, I’m a total fan girl. Thanks to Germy for sharing this.

I predict heads exploding from the usual suspects.

Consider this a pleasant afternoon open thread.



Reducing errors

One of the better ways to reduce errors is to admit what went wrong and then how to solve those problems.  538 and Nate Silver got the Republican race fundamentally wrong as they were applying a modified “The Party Decides” framework as a core assumption to their analysis. Nate Silver has a good tweet on how he is changing his thinking now that Donald Trump is the Republican nominee:

This applies to hospitals and medical decision making errors.

Brigham and Women’s Hospital in Boston has an interesting approach about errors that are made at the hospital. They treat their errors as learning and process improvement opportunities. More importantly, they publish their errors.  Here is one sample:

What Happened
Nurse A was caring for a patient, Susan, and administered a dose of cough suppressant, which could be taken on an as needed basis every 8 hours, at 7:00 AM. Susan’s next dose, if needed, could therefore be given at 3:00 PM. That afternoon, a second nurse (Nurse B) was assigned to care for the patient while Nurse A was off the unit. Nurse B administered the next dose of medication because Susan was coughing. When Nurse A, resumed care of Susan, she gave her what she believed was Susan’s second dose of cough suppressant at 2:30 PM. Nurse A administered the medication at 2:30 p.m. because Susan was scheduled to leave the unit for testing and would not be back by 3:00 PM when the dose was originally scheduled. The nurse received a message in the electronic health record that the dose was being given early, “Based on the ordered frequency, this medication is possibly being administered too close to another administration.  Please review previous administrations to verify appropriateness.”  The message wasn’t surprising since she was purposefully giving her the second dose 30 minutes early. What she didn’t know is that Susan had already received the second dose from Nurse B. Fortunately, Susan was not harmed by this additional dose. 

What We Are Doing
When Nurse A filed the safety report about this event, she included an idea for avoiding similar events in the future. She suggested that the warning box in the electronic health record that highlights the early medication time, also include the time the last dose was given.  In this case, the warning would have alerted her to the time Nurse B administered the medication and prevented the duplicate dose.

Based on this error, safety report and improvement suggestion, IS (Information Services) is adding a best practice alert (BPA) displaying the last administration time for all PRN (as needed) medications.

We learn by our mistakes. We only learn when we figure out why a mistake was made and we can then re-adjust either our mental model or our practical routines to incorporate that new and valuable information.



Oh thank god

Now that Trump has become the only game in town for Republicans, Bill Kristol sounds a lot less firm about #nevertrump. I can maybe handle David Frum as long as he stays on the lawn and doesn’t try to mingle. Bill Kristol on the other hand can keep the fuck out of my political coalition.

I am also pleased to see that Dick Morris has adapted from dumb Why Trump will implode tomorrow this time for real pieces to dumb explanations of why Morris was sure all along that Ted Cruz was toast (find your own links to Newsmax). I will feel a lot better about November with the two most reliably wrong pundits in American history on Trump’s side.

Seriously though, Dick Morris. Hillary Clinton. At this point he doesn’t have much choice but get with Trump, does he?

But in general I see no reason why all those Republicans running from Trump necessarily have to jump in bed with the Democrats.

No_Homers_Club

They could always start a new party! Let Trump have his Front National voters and focus on the GOP’s core values of low taxes for rich people, slashing Medicaid/Medicare/Social Security, and military belligerence. Surely racist stupidity could not explain that much of the GOP’s continued relevance as a national party. Why not put the question to a test?



Canada Providing a Preview of the Trump Presidency

mcmurray

Only because I have Canadian friends (and so do you all- Redkitten!) am I aware that Canada is dealing with a horrifying forest fire:

The sky in Fort McMurray now looks like a wall of fire and smoke as a mammoth inferno swallows parts of the Canadian city.

Authorities ordered the evacuation of about 80,000 people, including the entire city of Fort McMurray in northern Alberta, the Regional Municipality of Wood Buffalo said Wednesday.

The blaze has already destroyed 80% of Fort McMurray’s Beacon Hill community, RM Wood Buffalo said. Well over a dozen homes burned down, but the full breadth of the destruction remains unclear.

The videos are terrifying. Let’s keep our neighbors to the north in our thoughts.








And Then There Was One

Kasich is dropping out.

Welcome to the Apocalypse.








This Is One For Every Patriots-Hater Out There

The invaluable Charles Pierce on Donald Trump’s distinct political superpower:

It was Jeb (!) Bush who learned the second-worst thing for a candidate to be if he’s running against He, Trump—which is a humorless, privileged fop. The worst thing to be is what the Tailgunner was—a self-important dweeb with delusions of sacred grandeur. In both cases, you are a big bag of hot air in search of a needle. That is He, Trump’s only consistent political skill. No wonder Tom Brady loves him. Nobody is more skilled at deflating people than He, Trump.

I’d add — it’s hard for me to read this as anything but Barack I’m-So-Going-To-Miss-This-President Obama’s parting gift to that self important dweeb with delusions of sacred grandeur:

The White House is considering the creation of a national monument to the gay rights movement on a small piece of Greenwich Village parkland across the street from the Stonewall Inn, where a 1969 uprising helped inspire the push for equality, advocates said on Tuesday.

I know, I know. Not a done deal yet; just kicking the tires; who thought to get this out there today…

But still, even if it is a coincidence (and I’m really not sure that it is), a fine story becomes that much sweeter juxtaposed with Torquemada Cruz (you can’t torque ’em ada anything) on the occasion of his exit, stage far right.

Pedro_Berruguete_Saint_Dominic_Presiding_over_an_Auto-da-fe_1495

So yeah, while as many here have noted, Trump is a terrifying existential threat to the idea of the Republic, I still get some naches any day that Ted Cruz gets his comeuppance upside and down.

Open, the thread, it is.

Pedro Berruguete, Saint Dominic Presiding Over an Auto-da-fe, 1495



No One Could Have Predicted, Garland Edition

garland

Barack Obama, Jedi Knight.

barack-obama-jedi



Information not leading to informed decisions

The Journal of the American Medical Association**  has an interesting article on the utilization of patient centered consumer driven decision support tools that are supposed to allow for people to choose cost-effiecient and effective treatments that they pay for with their deductible dollars.

Results  ….After adjusting for demographic and health characteristics, being offered the tool was associated with a mean $59 (95% CI, $25-$93) increase in outpatient spending. Mean outpatient out-of-pocket spending among those offered the tool was $507 in the year before introduction of the tool and $555 in the year after….. Being offered the price transparency tool was associated with a mean $18 (95% CI, $12-$25) increase in out-of-pocket spending after adjusting for relevant factors. In the first 12 months, 10% of employees who were offered the tool used it at least once.

Conclusions and Relevance  Among employees at 2 large companies, offering a price transparency tool was not associated with lower health care spending. The tool was used by only a small percentage of eligible employees.

This is an interesting study, but I think it is a limited study.  The two employer groups that were studied had deductibles ranging from $500 to $2,500.  Not all of the those deductible dollars would have been used for outpatient care (the measure being used.)  Furthermore, for most people, outpatient care is only a fraction of total medical spending.  This leads to a problem of the analysis.

Deductibles put 100% of the burden of a procedure’s cost on the patient until that patient hits the specified deductible level.  When a patient is below that level, they may or may not care that Provider A is less expensive but somewhat further away than Provider B.  We would expect to see some shopping behavior when people are below their deductible.  However once the deductible has been met, the patient has no reason to care (absent co-insurance) that Provider A is less convenient but cheaper than Provider B.  At that point, the tool fails.

What are the policy implications.  The simplistic one is that ever increasing deductibles will eventually make people good shoppers.  That has not yet been the case and it should not be the preferred policy solution.  There are two other solutions that are possible.  The first is to switch deductible cost sharing to co-insurance cost-sharing.  People will respond to a 30% cost-share far longer than they will to a satisfied deductible even if the actuarial value of the plan is the same, more services are exposed to cost sharing.

The second plausible solution is to remove some of the smart shopping expectations from that patient and put it back on the insurance companies and other expert support systems.  This means insurers should be tiering their networks, this means insurers should be engaged in value based insurance design where high value procedures are subject to no cost-sharing and low value procedures are subject to high cost sharing, insurers should be paying their members to go to efficient and cost effective providers with physical checks to create loss aversion strategies.

But the patient as a shopper is not working well, and this study is indicative of that.

** Desai, S., Hatfield, L. A., Hicks, A. L., Chernew, M. E., & Mehrotra, A. (2016). Association Between Availability of a Price Transparency Tool and Outpatient Spending. Jama, 315(17), 1874. doi:10.1001/jama.2016.4288








Wednesday Morning Open Thread: Gonna Have to Face It

This badly Photoshopped image was inspired by a comment from Corner Stone last night, in which he noted that Trump’s victory speech tableau resembled a Robert Palmer video:

image

It’s not the fault of Trump’s spouse and female relatives / hangers-on that they seem to form a phalanx of interchangeable backup singers whenever they gather behind the presumptive Republican nominee. But it is funny in an OMG-a-strutting-pageant-maestro-has-a-significantly-lessGREATER-than-zero-chance-of-becoming-POTUS kinda way.

Good Christ, Hillary and Bernie — don’t fuck this up!

We are having a hellacious storm this morning in West Central FL, complete with frequent lightning and sideways rain. One bolt of lightning struck so close that it propelled my hard-sleeping teen from her bed to the hallway before she was even fully awake.

As for me, Imma get more coffee; the adrenaline shot wasn’t sufficient. Open thread!