In Addition to the Number of Women in the Niagara Falls Area

So the lady friend was rather upset that many of you were under the impression that the dogs do not like her, which is my fault because when I was calling Rosie and Thurston assholes, it seemed to imply they were assholes because they do not like her. That’s not the case- they’re just assholes because they are all up in her grill like they are with me and everyone else. Thurston is particularly relentless (and she loves him the best for some reason). At any rate, proof:

That’s the two top fillies in my herd getting along famously. At any rate, we (that’s a royal we, because other than drill the hole in the bottle I have done nothing) are making lamps out of bottles because apparently to the person in this house who isn’t used to living in a cave, the lighting situation here is horrible, in that I do not really own any lamps. She’s also enjoying a fabulous margarita because it is National Margarita day, and one of the perks of dating an alcoholic is they know how to make a mean drink.



Wednesday Evening Open Thread: History Starts Over Every Morning for Some People

As an acquaintance once said about his cat, “Every time she blinks, she opens her eyes to a whole new world.”

Except for the grudges! Those, they can carry around for a lifetime! THANKS, REPUBLICANS!
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Apart from remembering to thank whatever powers that we were not made as morans, what’s on the agenda for the evening?



Rainy Day Open Thread

Well, it’s rainy here, anyway, so no birds to watch at my feeders. But here’s a handsome cardinal who stopped by a few days ago:

He’s definitely giving me the stink-eye. And here’s his lovely mate with a seed shell hanging out of her beak; she doesn’t look too happy about the paparazzi either:

I’d post a photo of my chickens, but they’re pitiful today. There’s plenty of covered space in their coop where they could stay dry, but they prefer to stand around in the rain and hate the world. I know the type!

Speaking of disgruntled clucking, looks like some former shitgibbon campaign staffers are sharing their tyrant toddler handling techniques with Politico. An excerpt:

President Donald Trump’s former campaign staffers claim they cracked the code for tamping down his most inflammatory tweets, and they say the current West Wing staff would do well to take note.

The key to keeping Trump’s Twitter habit under control, according to six former campaign officials, is to ensure that his personal media consumption includes a steady stream of praise…

The in-person touch is also important to keeping Trump from running too hot. One Trump associate said it’s important to show Trump deference and offer him praise and respect, as that will lead him to more often listen. And If Trump becomes obsessed with a grudge, aides need to try and change the subject, friends say. Leaving him alone for several hours can prove damaging, because he consumes too much television and gripes to people outside the White House.

Emphasis mine. Six campaign staffers? Good Christ. Four-point restraints would have been more effective. The portrait that emerges is of a sulky oaf whom a normal person wouldn’t trust to look after a potted fern. A fake potted fern, even. FSM bless us, every one.

Open thread!



A Pictorial Guide to Targeted Voter Outreach

Controversies frequently arise in comments here and elsewhere when the topic of Trump voters comes up. It goes something like this:

PERSON A: Fucking Trump-voting assholes! They’re either racist, sexist, xenophobic shitheads or didn’t think their candidate’s racism, sexism and xenophobia were deal-breakers. So fuck those motherfuckers!

PERSON B: Neo-liberal losers gonna keep neo-liberal losing with that neo-liberal voter outreach strategy! Just get ready for eight years of Trump, neo-liberal establishment purity mavens!

Setting aside the fanciful notion that anyone venting on an almost top-10,000 left-leaning blog is officially in charge of Democratic Party voter outreach and is sharing tactics here, let’s review some pertinent facts in graphic form, put on our thinking caps and tackle the hard questions:

Assuming that this data is accurate, the question is, would it make more sense for Democrats to pursue the “Voted Trump” group (19.5%) or the “Didn’t Vote” segment (29.9%)? Now, I’m really dumb at math and statistical inference, but I’m pretty sure that not only is the second group larger, its members have not already signaled outright hostility to our coalition.

So, if I were the Democratic Party’s outreach coordinator (I’m not!), I’d make the second group my top priority — helping folks overcome registration issues, building relationships at the local level, etc., to get them off the sidelines.

Now, let’s consider variances among the Trump voters. I don’t claim any special insight, but I have observed over the years that people aren’t always rational in their actions. They don’t always take their civic duties seriously. Some folks just aren’t all that bright.

Sometimes people will vote for an asshole because they “want change” or they “hate politics” or they have a dumb but typically American reverence for rich people and a belief in plutocrats’ superhuman powers. Maybe their minds were poisoned by Iron Man, I don’t know.

Anyhoo, is there a meaningful distinction between those folks and hardcore Trumpers? I’d say yes. Here’s a crude drawing to illustrate how that difference might look:

So, to recap: If I were in charge of outreach for the Democratic Party (which I’m not!), my objectives would be to 1) keep the base that voted with us in 2016 and won the popular vote by nearly 3M on board, 2) see if we can get folks who DIDN’T vote and who share our values off the sidelines, and 3) hope some of the dumbasses who zigged toward Trump last time zag toward Democrats in 2018 now that they see what a fucking disaster their candidate is as president. The end.



Running scared

A song for all those special snowflakes in Congress:

Most Republicans in swing districts are steering clear of in-person town hall gatherings this week, hoping to avoid the anti-President Trump protesters determined to make them the star of a viral YouTube video.








Arrow’s healthcare primer

Kenneth Arrow passed yesterday.  He was my second favorite economist who made their bones in the 50s and 60s.  Much like Herb Simon (my favorite) he makes my head hurt whenever I try to think hard about what he is saying in whatever field he is commenting on and thus leading it in a new, intriguing and useful direction.  Here is a link to his seminal healthcare insight  and paper

The key insight is that the medical market operates under massive uncertainty and time variance of knowledge.  Risk can be priced but uncertainty can not be priced.  This leads to extraordinarily inefficient outcomes if we assume a traditional competitive market framework.

If you want to gain a good understanding of health policy, read this paper and then read Akerlof’s Lemons paper.  And then reread them until your head hurts.

We lost a giant but his ideas and influence will remain.








Weaponized Fragility

If you’re willing to read one more piece connected with the Yiannopoulos shit-show, make it this essay by Laurie Penny: “On the Milo Bus with the Lost Boys of America’s New Right.” (Brought to our attention in the overnight thread by valued commenter TheMightyTrowel.)

As the title suggests, the article isn’t so much about Yiannopoulos himself but his entourage, a crew one can imagine comprises involuntarily celibate young men who bonded over online gang-harassment of anyone who’s visibly female or nonwhite while hiding behind ironically customized Nazi frog avatars. An excerpt:

Many of them don’t agree with what Yiannopoulos says, let alone what Trump says. They agree with the way he says it, because their life experience does not extend beyond interpreting being criticized as censorship. Yiannopoulos’ brand is all about “fuck your feelings.” But the kids following him around are nothing but feelings…

These boys will be allowed to forget everything but their own immediate feelings for as long as society allows them, and this society allows straight white boys to dodge personal and emotional responsibility until at least the age of 70. The current man-child president would be Exhibit A, but not every lost boy gets a golden throne. In this culture war, most of them are cannon fodder.

The post-election media coverage of Trump voters focuses obsessively on white working class economic anxiety, even though there’s much evidence to suggest that focus is misplaced. Anecdote isn’t data, but the Trump voters I know have more in common with the “lost boys” described in this article than out-of-work coal miners.

They may be grown-ass adults with jobs and mates, but they share the militantly anti-PC, “you’re not the boss of me” pose that disguises deep insecurity and a gibbering fear of victimhood. Small wonder they fell for conmen like Trump and Yiannopoulos.

As for how we address it electorally, my feeling is we have to turn out our own and get unengaged people who share our values off the sidelines. Could be the “lost boys” are just that — lost.



Open Thread: Democracy, Down at the Pointy End

The (lazy, bothsiderist) NYTimes is forced to notice — “At Town Halls, Doses of Fury and a Bottle of Tums“:

FAIRVIEW, Tenn. — Representative Marsha Blackburn may have expected to draw a friendly crowd by scheduling a town hall-style meeting in a Tennessee community that had voted overwhelmingly for President Trump, but she instead faced a hurricane-strength blast of disapproval on Tuesday.

Ms. Blackburn, an eight-term Republican, was sharply questioned about a wide range of issues that have unsettled Mr. Trump’s first month in office, including health care, the environment, education and the president’s links to Russia.

At many moments, her replies elicited boos or shouts to “tell the truth.”…

Ms. Blackburn, who represents a safe Republican seat west of Nashville, was among the latest wave of Washington lawmakers to face angry constituents in what, inevitably but perhaps prematurely, has been called a progressive echo of the Tea Party anger that boiled over in town halls eight years ago.

During the first weeklong recess of the new Congress, many Republicans have chosen not to hold events at all, wary of protests that might greet them…

Apart from cheering democracy, what’s on the agenda for the day?
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A response to AER re evaluating by Excel

I recently read an interesting but I think incomplete and less than pragmatic paper in the American Economic Review by Fang and Gong. In that paper they use Medicare Part B claims data to advance what they argue is a good first pass claims fraud detection methodology. They seek to identify individual National Provider Identification (NPI) numbers which perform more than 100 hours of billable work per week over the course of a year of claims. They then contend that these individuals are likely fraud investigation targets. From there, they build an interesting model that looks at time utilization and cost.

I have several major objections to this paper. The first is a pragmatic objection which I think renders the data as they interpreted it to be less than useful. The second objection is more of a critique of their methodological choices to model fraud. But first, I want to highlight something I wrote when the Center for Medicare and Medicaid Services (CMS) started to release Medicare billing data:

  • Claims rolling up to a provider’s NPI or Medicare ID. Non-MD/non-D.O. clinicians such as Certified Nurse Practitioners, Physician Assistants, Master and Doctorate level Physical Therapists etc. often will roll their billing up to a doctor’s Medicare billing number. This means we can’t do a simple time management bullshit detection study based solely on “This provider is claiming he is doing 17 Medicare Part B procedures a day. Each of these procedures takes 30 minutes… IMPOSSIBLE”. That type of first level analysis might identify odd situations, but most will be explained by seeing three or four CRNPs/PAs doing most of the work that the doctor than bills for.
  • Medicare Advantage is not in this data set. Some regions have lots of Medicare Advantage enrollment. Others don’t Some docs have a lot of Medicare Advantage patients. Others don’t. We can’t generalize too well to the entire Medicare population from the CMS data set.
  • No way to determine medical neccessity/particular skill. This is pure counting data, it is not quality data…

Fong and Gong only look at the provider NPI. They neglect to examine the possibility that there is significant number and time of services being performed by non MD/DO providers who are performing services incidental to the supervising physician’s practice and billing under the MD/DO NPI.

There is nothing in the paper that addresses non-MD/DO providers rolling up their billing to an MD/DO NPI. This is quite common and allowed. Some master’s level clinicians in some states routinely bill independently. This information is captured in this study and noted in footnote 5. However many non-MD/DO providers will bill via their supervising MD/DO. The Wall Street Journal noted this arrangement in 2014 for an orthopedic practice in the middle of an article about the problems of analyzing outliers by Excel without contextual knowledge. The physical therapists that practiced underneath the surgeons billed with the surgeon’s NPI. This is legal and common. I think this paper is missing the non MD/DO provider universe as implied in Footnote #6;

For expositional simplicity, we will refer to all individual providers as physicians even if a small fraction of them are nurses or physician assistants

Nowhere in the paper did I see the phrase “incidental” or “modifier code” or any other indicator that a significant portion of primary care and first level specialty work is now being performed by non-MD/DO providers who routinely roll up their billing to an MD/DO provider.

The Office of Inspector General at CMS has examined very high implied time billing practices in the past. What they have found is the services were being legitimately performed although at times they were being performed by clinicians who were not authorized by either license or law to perform a set of services as services incidental to the MD/DO who supervised them. Here the better assumption is that this is either waste or abuse rather than deliberate fraud unless there is extraordinary evidence to argue for fraud.
If there is limited to no inclusion of master’s level clinician service rendering then the analysis performed by Fang and Gong will lead to numerous false positives which renders their tool an inefficient use of time and resources to detect actual incidents of fraud.

My second major concern with this paper is their modeling choice of time utilization. Read more








On The Road

Folks,

We’re trying a new feature here, so let’s see how it goes for the next week or so before it’s fully automated.

This post is for Balloon Juicers who are on the road, travelling, etc. and wish to share notes, links, pictures, stories, etc. from their escapades. As the US mainland begins the end of the Earth day as we measure it, many of us rise to read about our friends and their transient locales.

So, please, speak up and share some of your adventures, observations, and sights as you explore, no matter where you are.

Have at ’em, and have a safe day of travels!



Under Cover of Darkness Open Thread: CPAC, Milo, and the Limits of Cleek’s Law (Part the Second)

Cleek’s Law: Today’s conservatism is the opposite of what liberals want today, updated daily.

Roy Edroso, at Alicublog:

I see Milo Yiannopoulos’ friends have turned on him. Just kidding — they were never his friends; just a bunch of conservatives and libertarians who took him up because, one, he hated things they also hated (liberals, women, the transgendered, et alia); two, he celebrated things they also celebrated, primarily the vicious, spiteful treatment of anyone weaker than themselves; and three, because he was ostentatiously gay — indeed an old-fashioned caricature of homosexuality straight out of the Liberace playbook — and allowed himself to be associated with them, which gave conservatives and libertarians two things they thought would advantage them in the dreary Culture Wars they’re always pursuing: glamour and victim status…


Read more



Post-Midnight Open Thread: Russophilic Nesting Dolts

Adam will no doubt keep explaining these spy-vs-spy shenanigans far more cogently, but I couldn’t resist the chance to re-up the last video clip here…

The Times reported that the meeting was called to discuss a peace plan being pushed by a Ukrainian lawmaker, Andrey Artemenko, who is associated with a former Ukrainian leader backed by Russian president Vladimir Putin and advised by Paul Manafort, Trump’s former campaign chairman.

Manafort is the subject of an FBI inquiry over his Ukraine dealings, and the FBI is also investigating whether any Trump associates colluded with the Russian campaign to interfere in the U.S. presidential election.

In an interview with NBC News Monday, Michael Cohen confirmed that Felix Sater, a former Trump associate with a criminal past, asked him to come to a meeting in New York last month, and brought along Artemenko.

“I acknowledge that the brief meeting took place, but emphatically deny discussing this topic or delivering any documents to the White House and/or General Flynn,” Cohen said. “I didn’t see Gen. Flynn while I was at the White House, and I didn’t spend two seconds talking about this, not even one second.”

The Times told NBC News that it stood by its story, saying Cohen told the newspaper he did take a sealed envelope to Flynn’s office….

NICE JOB, REPUBLICANS!



Late Evening Open Thread: Time to Rethink the Whole Top of the Food Chain Thing…

Video at this link!

Real or photoshopped?

That might be your reaction when you see a photo of a bobcat dragging a 4-foot-shark from the water.

YouReporter John Bailey sent the picture to us which he said he took at Sebastian Inlet State Park.

He claims the cat leaped into the water, caught the shark, and dragged it to shore.

The photographer thinks he ended up getting too close and may have caused the cat to drop the shark and run off into the forest.

Wildlife experts say it’s not uncommon for bobcats to be wandering Florida beaches.

They say it’s possible the cat is a female and might have been trying to catch food for its babies.

“My first reaction was amazement that somebody actually took that picture  because bobcats are generally very, very reclusive. You don’t really see them out and about too often,” said Busch Wildlife Sanctuary Animal Care Director Amy Kight.

Bobcats are normally not considered aggressive.



Tuesday Evening Open Thread: Ya Think?

Liberal organizers, actually (for the distinction between activists & organizers, see Al Giordano’s twitter feed), who are doing very much what the Tea Party Talibangelicals did in 2009, only without the generous support of the Kochs or the Mercers. More power to them (us)!
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Apart from pissing off the Mango Menace, what’s on the agenda for the evening?



Today In Be Careful What You Wish For: Not So Strange Bedfellows Edition II

Shortly after the election the American Jewish Congress and the Islamic Society of North America formally entered into a civil rights protection and promotion and civil society defense agreement. Today, in response to yesterday’s violence and vandalism at St. Louis’s Chesed Shel Emeth Cemetery, Linda Sarsour and Tarik El-Messidi have started a fundraising campaign to help repair the damage done.

You may remember Linda Sarsour, the Executive Director of the Arab American Association of New York, as one of the co-chairs for the Women’s March. Tarik El-Messidi is the founder of Celebrate Mercy, an educational outreach program intended to inform both Muslims and non-Muslims about Islam and the life of Prophet Muhammed.

So well done currently unknown dickheads and domestic terrorists – your stupidity has just drawn Muslim and Jewish Americans closer together. Give yourselves a round of applause for achieving exactly the opposite of what you intended to achieve: to scare Americans of different faiths and ethnicities in order to drive them apart and make them easier to prey upon in the future. Morons!