Trump Press Conference

I don’t know what the fuck I just watched. I honestly don’t. There was so much bullshit and so many lies I don’t even know where to start.

I remember when I was in high school and went to Kennywood and I drank a couple bottles of grape Mad Dog 20/20, and thought it was a good idea to get on the spinner or whatever the fucking ride was, and puked all over everyone in a 360 degree radius, including myself, while Joe Walsh’s “Life’s Been Good” was cranking at ear bleeding volumes. That’s the closest experience I have ever had to that press conference.

Story of Russian Meddling in U.S. Election Has Legs


Following up on Adam’s excellent post yesterday about the DNC server hack, it looks like the story is indeed gaining legs, with an assist from the president.


President Barack Obama won’t rule out the possibility that Russian President Vladimir Putin could be attempting to tip the US presidential election toward Donald Trump.

His comments came after US officials said this week that there is strong evidence that the Democratic National Committee data breach was carried out by hackers working on behalf of Russian intelligence.

“Anything’s possible,” Obama responded when asked during an interview whether Russians could be working to influence the contest between Republican nominee Trump and Democratic rival Hillary Clinton.

“Donald Trump has repeatedly expressed admiration for Vladimir Putin,” Obama said during the sit-down with NBC News that aired Tuesday. “And I think that Trump’s gotten pretty favorable coverage back in Russia.”


President Obama on Tuesday waded into the controversy over the leak of Democratic National Committee emails, saying the hack of party records was characteristic of Russian government behavior and suggesting a potential motive for that country to meddle in the U.S. presidential election.

“What we do know is that the Russians hack our systems, not just government systems but private systems,” Obama told NBC. “What the motives were in terms of the leaks, all that — I can’t say directly. What I do know is that Donald Trump has repeatedly expressed admiration for Vladi­mir Putin.”

Obama’s comments align with those made Sunday by Democratic nominee Hillary Clinton’s campaign manager, Robby Mook, who said the Russian government was behind last week’s release of DNC documents on the website WikiLeaks as a way to help Trump.

The New York Times:

American intelligence agencies have told the White House they now have “high confidence” that the Russian government was behind the theft of emails and documents from the Democratic National Committee, according to federal officials who have been briefed on the evidence.

But intelligence officials have cautioned that they are uncertain whether the electronic break­in at the committee’s computer systems was intended as fairly routine cyberespionage — of the kind the United States also conducts around the world — or as part of an effort to manipulate the 2016 presidential election.

The emails were released by WikiLeaks, whose founder, Julian Assange, has made it clear that he hoped to harm Hillary Clinton’s chances of winning the presidency. It is unclear how the documents made their way to the group. But a large sampling was published before the WikiLeaks release by several news organizations and someone who called himself “Guccifer 2.0,” who investigators now believe was an agent of the G.R.U., Russia’s military intelligence service.

Even the Trumpenführer felt moved to address it today, though of course he filtered it through his narcissistic prism and missed the point entirely:

For the record, Putin never called Trump a “genius” — that description is rarely bestowed on the critter at the business end of the leash. Now release your tax returns like a good boy, Deadbeat Don.

PS: This episode removes all doubt (as if there were any) that Julian Assange is an unmitigated douchebag.

Operation and payment reform updates

Just a few updates before I get coffee.

First an interesting paper looking at surgical performance as a function of concentration on certain procedures instead of sheer volume of procedures**:

For all four cardiovascular procedures and two out of four cancer resections, a surgeon’s degree of specialization was a significant predictor of operative mortality independent of the number of times he or she performed that procedure: carotid endarterectomy (relative risk reduction between bottom and top quarter of surgeons 28%, 95% confidence interval 0% to 48%); coronary artery bypass grafting (15%, 4% to 25%); valve replacement (46%, 37% to 53%); abdominal aortic aneurysm repair (42%, 29% to 53%); lung resection (28%, 5% to 46%); and cystectomy (41%, 8% to 63%). In five procedures (carotid endarterectomy, valve replacement, lung resection, cystectomy, and esophagectomy), the relative risk reduction from surgeon specialization was greater than that from surgeon volume for that specific procedure. Furthermore, surgeon specialization accounted for 9% (coronary artery bypass grafting) to 100% (cystectomy) of the relative risk reduction otherwise attributable to volume in that specific procedure.

The argument this paper makes is that surgeons who are mainly doing one thing are better at that one thing than if they are doing lots of different things even if the total volume count on a given surgery is the same.

Intuitively, this makes sense. A surgeon who is only doing one thing can recognize at an intuitive level when something is odd and adjust or correct before there is a crisis.

Now the other payment reform piece is the Medicare bundles for cardiac care and extending hip fracture bundles:

During a conference call with members of the media, Patrick Conway, MD, Acting Principal Deputy Administrator and Chief Medical Officer at the Centers for Medicare and Medicaid Services (CMS), described three policies included in the proposal:

  • New bundled payment models for cardiac care and the extension of the joint model to include treatment for hip and femur fractures
  • A new model to increase cardiac rehabilitation
  • A proposed pathway for clinicians and physicians in bundled payment models to qualify for payment incentives under the Medicare Access and CHIP Reauthorization Act
  • Under the proposed cardiac-care bundled payments, hospitals would receive quality-adjusted pricing for heart attack and bypass episodes of care, including 90 days after a hospital inpatient stay, according to a CMS factsheet.

    What this is telling me is that the combination of bundled payments and quality accrual due to specialization is that the general surgeon and the general specialist will be declining in importance. Instead, hospitals will have emergency departments that can handle stabilization of patients and then they’ll ship the patients out to county or regional centers of excellence. If someone has a broken hip, there will be two or three hospitals in a metro area with a dozen surgeons who just do hips and nothing else. If there is a need to do a bypass, a hospital will have two bypass surgeons who do 90% of those procedures between the two of them.

    If thees results hold and if these policy changes continue to accumulate where payments are based on quality of the entire episode of care, I don’t know what the general community hospital looks like in fifteen years. It won’t be a one stop shop for 90% of a town’s needs. The quality and two sided risk arrangements won’t allow that financially.

    ** BMJ 2016;354:i3571 accessed 7/27/2016

    Wednesday Morning Open Thread: History Made

    This woman is my spiritual sister. Not my actual baby sister, who has kept herself in much better shape, but I could easily pass for this lady’s cousin. (And I too still have my ERA YES pin!)

    Apart from looking forward to this evening’s speakers, what’s on the agenda for the day?

    Later Night Calming Open Thread

    Commentor Linnaeus linked this clip on Adam’s late-night bearcam post last night. Since I live in scenic New England, I could almost see a thought balloon over that bear’s head: “Dammit, there’s always a line during tourist season… “

    And then I had to go look for this:

    Late Night Open Thread: #NotAllBernistas

    From the Yahoo article:

    Even in this sea of sadness, Sean Kehren, a 22-year-old Sanders delegate from Minnesota, stood out. For one, he was wearing a Peter Pan-style hat (which represents a “Robin Hood tax” on Wall Street). His expression of pure anguish as Sanders spoke earned him the title of “breakout star” among all the crying Sanders delegates…

    Kehren, however, told Yahoo News that he is not a Bernie-or-buster. He said he was crying in part because he found it very noble that Sanders was encouraging his fans to back Clinton for the good of the nation after such a hard-fought and idealistic campaign. (Kehren also wept earlier Monday when Sanders was loudly booed by his delegates for telling them to get behind Clinton.)

    “I was getting emotional over the fact that he was doing his best to unify the party and I think that’s such a noble cause,” Kehren said. “Bernie has led a revolution, he’s led a movement, and now that movement has to get behind the party.”…

    Kehren said he’s not a privileged “Bernie Bro” who hates Clinton, as some on social media have branded him. He said he was raised by a struggling single mom and will vote for Clinton in the election. “She’s done her best to make deals with Bernie and to embrace his side, and I have to giver her credit for that,” he said of Clinton…

    Good for Mr. Kehren. As others have pointed out, a big part of the problem with Sanders delegates is that the experienced political people overwhelmingly chose to work for Clinton’s campaign. By default — as much as inclination — the Sandernistas knew less about what acting as a delegate would mean, from paying their own expenses to accepting that the convention rules, however labyrinthine or ‘illogical’, would have to be followed even if one’s candidate didn’t win the ballots.

    DNC Night 2: This Is What My America Looks Like

    I have no idea where the other FPs are, but I expect John to bigfoot this one moments after I post. But it does look the like we could use a part 2 before Bill Clinton steps up to the plate.

    I’ve been clicking around youtube and found this, and believe it or not, I had never heard it in its entirety before:

    And then of course I had to rewatch this, just to remember the joy of that night:

    This here’s a DNC open thread…waiting for the Big Dog….

    ETA: I swear there were no posts in process when I started editing this one. Now I’ve bigfooted Betty Cracker. Sigh. Apologies.

    DNC Open Thread


    Here’s a fresh thread to discuss the proceedings, or even other topics. Will the Big Dog bring it tonight?

    [Illustration stolen from Wonkette]

    A Moment In History – Letting It Sink In


    I was more emotional than I thought I would be….but my niece is sitting in my guest room, talking back to my floor guy regarding Trump (she’s 9, he’s for Trump) and all I can think is…this is historic. We have to win this for her and all the other children who need to grow up in a world where Love trumps Hate.

    PHILADELPHIA — Hillary Clinton is now officially the Democratic presidential nominee, making history as the first woman ever to secure the backing of a major American political party.

    Clinton was formally nominated on the second evening of the Democratic National Convention on Tuesday, more than nine years after launching her first presidential bid. It was largely an evening of unity after an opening night marked by resistance from die-hard supporters of Democratic runner-up, Vermont Sen. Bernie Sanders.


    ETA: By request. Here’s a link to the live stream (I didn’t realize I posted the wrong link in my previous thread).

    Tuesday Evening Open Thread: Good for Sen. Sanders

    Of course, he had some serious backup…

    Apart from another long evening watching the convention, what’s on the agenda?

    Added bonus, tonight:

    Darlene McBride: Take Back America Tour

    Fifteen years ago, this was so controversial, Nicole Sullivan was booed. She had to hide.

    We were doing that Darlene McBride sketch, and it was so offensive that the audience started booing. I had to hide behind a monitor. And that’s the clip that’s gone viral, because it’s exactly Donald Trump’s platform. That’s what’s so f–ing crazy. It was the one sketch where the audience was like, “That’s too much. No one would ever say that stuff,” and yet…

    Today it’s the RNC platform.

    DNC Day 2 open thread.

    On Parenting

    I’ve been giving a little bit of thought to what lies ahead after Carlos and Christion move out, and some of that thought has been put into perhaps fostering a child. I’ve been looking into it, and checking out the requirements, all of which I meet, but I think I am going to spend the rest of the year losing some weight and getting in shape so there is no doubt about the physical health aspect. I saw this and it made me sad:

    The characteristics that are used to describe special needs are defined as:

    Over the age of 8 which presents a barrier to adoption
    A physical or mental disability
    Serious emotional maladjustment
    A recognized high risk of physical or mental disability
    Over the age of 2 and has a racial or ethnic factor
    A member of a sibling group who should be placed together
    Has been certified as a special needs child by the department

    Many children awaiting adoptive families were removed from their biological families due to abuse, neglect or abandonment. These children have endured hardships, sadness, loss of relationships, and abuse. All of these children deserve a permanent home. Without a permanent, loving adoptive home, these children face the likelihood of entering adulthood with no parental guidance or support. We believe that all children deserve a loving, safe home.

    That’s messed up. Where I live would be a great place for a kid over the age of 8, so I’m going to put this on the backburner and get my fat ass in shape. Do any of you have any experience with adoption/fostering?

    We Are at Cyber War! So What, Exactly Do We Do About It?

    As more information is released about the hack on the DNC servers – and I don’t mean the dribbling out of emails with people’s personal identifying information (PII) at Wikileaks – it is becoming much, much clearer that the attacks were broader and deeper than originally estimated. As has been reported, the FBI is investigating the attack as an act of cyber espionage. Specifically, that the hack is a Russian Intelligence cyber operation and US government officials have begun to speculate that it was done to impact the upcoming Presidential election in a manner preferred by the Russian government and Vladimir Putin. This has also been suggested by Clinton campaign officials. CNN has reported this morning that the DNC was warned by US government officials of the weakness of their system during a time period when similar attacks were being made against the White House and other US government systems. Russia seems to be intensifying its attacks against US cyber systems similar to state sponsored active measures used to achieve political effects:

    “The release of emails just as the Democratic National Convention is getting underway this week has the hallmarks of a Russian active measures campaign,” David Shedd, a former director of the Defense Intelligence Agency, told The Daily Beast. Shedd said that additional leaks were likely, echoing an opinion expressed by U.S. officials and experts who said that the release of emails on Friday may just be an opening salvo.

    It is important to note that despite the compelling, but circumstantial case that Josh Marshall has laid out at TPM, that Putin’s preference for a Trump Administration may be solely rooted in the simple fact that Trump has long espoused views about American involvement in the global system that overlap with Putin’s understanding of Russia’s interests and his strategy for achieving them. In 1987 Trump spent about a $100,000 to pay for ads in several major newspapers attacking the Reagan Administration for allowing our allies and partners – NATO and non-NATO – for taking advantage of us and not treating us fairly. You can see a copy of the ad below:


    Trump’s anti-NATO and anti other alliance position is not something that he just adopted last Fall or because one of his advisors with ties to Russia suggested it. Rather it is a very long standing position of his and I’m not sure anyone knows how he came by it. Given two candidates for President of the United States, one who has expressed a willingness to be somewhat more hawkish than the current President in US-Russian relations and the other who has, for at least 30 years, held the position that the US is being taken advantage of by its NATO allies, as well by its non-NATO allies  and partners, it would make sense that Putin would prefer the latter to the former as the next President of the United States. In the most basic terms: Trump has long held views that Putin shares, Putin is smart enough to know this, therefore Putin using his resources to independently try to assist Trump would make perfect sense. Given what we know of both men’s long standing preferences on US involvement with NATO and other alliances there is no need to go looking for dots to connect here on the affinity of one for the other on this issue.

    What this leaves us with is a very important concern: what does the US do now to protect the integrity of its electoral system and election infrastructure. Dave Aitel, the CEO of Immunity Inc., in a very thought provoking guest editorial at Ars Technica, makes the argument that the Russian Intel hack on the DNC is very clearly an act of cyber war. And that it raises critical questions about the ability to safeguard the integrity of the upcoming election. Here’s an excerpt, but you should really click across and read the whole thing:

    The US government has a decision to make here. If it does not come out strongly against this action by the Russian intelligence services now, then when will it? How is our election system not to be considered “critical infrastructure” that foreign governments are forbidden to interfere with, unless they wish to trigger a serious confrontation with the US? If hacking a presidential campaign and dumping its strategy on the Web is not interference and disruption of a critical institution, then what is? Should we wait until foreign operatives interfere with the primary process? Is the red line only to be drawn around hacking actual voting machines and changing the results?

    Bottom line: the US must have an escalatory policy in place for this type of foreign interference. If we do not respond strongly to Russia’s actions in this election cycle, then we risk weakening our country’s deterrence and opening the door to future attacks, which may be even more disruptive to this country’s most fundamental democratic process—that of electing new leaders. Likewise, we should reach an agreement with other nations that we will not interfere with the nuts and bolts of their electoral processes, either. It’s either that, or we need to invest in robust cyber-protections for all presidential candidates at the federal level, stretching our already understaffed Secret Service.

    People in the policy area often consider “cyberwar” actions limited to things that causes physical harm or casualties, or things that can replace a 500 pound bomb. But if you cannot manage your people, or protect the American economy, or elect a new President, you have lost a war.

    Aitel’s editorial raises the important question: what do we do about this? We know that our electronic voting machines are vulnerable to hacking. Given that we decentralize our elections to the state and local level, we have 50 states and 3,144 counties that use different electoral systems, processes, and machines. This makes US elections highly vulnerable because there isn’t just one system that needs patching or one process that needs to be reviewed in regard to its security protocols be they cyber, personnel, or material. Florida and Utah have already seen cyber attacks on elections, elections processes/systems, or governmental processes/systems in those states.

    One of the real concerns going forward, apart from embarrassing email chains with PII being posted on Wikileaks, is not just that Russian Intelligence can get in and look around and take information out of these systems in the US, but what happens if they decide to mess with what’s there? Voter registration information, voter donation information, electoral results, and more are all stored electronically. The next attack may not be interested in embarrassing staffers and causing a few days of reporting about what they wrote. Rather it might seek to remove voters from the rolls or change the reported results of an election in specific locations before they can be reported. And since our system is decentralized, securing all of it is going to be difficult and expensive.

    I’m not a cyber expert. I have taught a course on cyber crime and cyber terrorism and supervised graduate research on these issues, but the technical side of this is not my bailiwick. That said the US, as Aitel identifies, has to respond. And here we are back to where I’m familiar: ends, ways, and means. The end state – the objective to be achieved – is deterrence against these attacks. This deterrence must take two different forms. The first is to get the best possible safeguards in place to protect the numerous and varied systems and processes in place at the Federal, state, and county level in the US. The second is to respond to Russia’s cyber attack in such a way that they get the point that they’ve gone to far and any future attempts will be dealt with quickly and harshly, but without causing an escalation of the cyber warfare or, even worse, moving the skirmish from the cyber domain into the actual Land, Sea, and Air domains. Again, I have no idea how this should be done, let alone what is even possible, but the objective has to fall within these two reinforcing dimensions of defensive and offensive deterrence. Ways and means are a bit tougher to estimate as so much of what is done in this arena is just not known even to the vast majority of people with clearances. We all joke about the NSA being unwilling to send us backups of our hard drives and/or complain that they’re probably listening to our calls, but this is what we have the NSA for! And several other agencies and departments of the US government and counterparts at the state level. The subject matter experts and technical specialists in these departments and agencies must be tasked to develop the ways and means to achieve these ends. Even if its just randomly turning the lights on and off wherever Putin is trying to sleep at any given time or making the meow mix theme song play on a repeating loop every time he turns on the TV, radio, or his iPod until he gets the message that the US can reach out and touch him in the cyber domain as well whenever it wants to.

    The other thing that has to happen is that the news media needs to stay on top of this as an important, ongoing event to be investigated and reported on within this year’s election. Americans need to be kept fully informed that for once the often used, but seldom accurate, assertion that someone is tampering with a US election is actually true this time. Americans have been primed for decades to worry about voter fraud and vote tampering because of partisan efforts to use the almost non-existent threat of voter fraud, and the news media’s obsession with scandal, for partisan ends. Staying on top of this story, a story that is about electoral manipulation for a foreign power’s advantage, is right in the news media’s sweet spot.

    It was interesting to watch Chris Matthews last night make a parallel comparison to the actual Watergate break in. He explained to his panelists that that was a physical break in on the DNC and this was a virtual break in. When Michael Steele correctly indicated that Watergate was really about the corruption of the President/Presidency, Matthews responded that this is about the corruption of electing a President. A lot of journalists, both reporters and commentators, came up during Watergate and view the news media’s reporting as a clear sign of how to do proper journalism. Many who came up after Watergate do as well – almost too much given the chasing of every possible shiny object as a potential scandal to be reported on creating the next Woodward, Bernstein, and Hersch and giving us “gate” affixed to everything. This story seems to be developing legs and the longer the news media stays on it, the better it will actually be for Americans and the upcoming election. It will keep the pressure on to secure our electoral systems and processes. And it could, if handled correctly, lead to long needed reforms to better secure these systems in the future in order to ensure that every eligible voter that wants to vote and does so, has that vote accurately counted and faithfully restored.

    SATSQ: Conservative wonk edition

    Via Vox, an answer to stupid or evil:

    This revisionism, according to Roy, points to a much bigger conservative delusion: They cannot admit that their party’s voters are motivated far more by white identity politics than by conservative ideals.

    “Conservative intellectuals, and conservative politicians, have been in kind of a bubble,” Roy says. “We’ve had this view that the voters were with us on conservatism — philosophical, economic conservatism. In reality, the gravitational center of the Republican Party is white nationalism.”

    No fucking shit.

    At least it updates our priors to weight willfully blind if not stupid.

    Open thread