2:00PM Water Cooler 8/1/2018

By Lambert Strether of Corrente.

Patient readers, I spent most of the morning writing on the neoliberal assault on Canadian Medicare, so this is a little sparse; I’ll add more material in a bit. (Tomorrow I’m going to work on the UK’s NHS, so the same conditions will apply.) Talk amongst yourselves! –lambert UPDATE 4:20PM All done!


“Key takeaways from Stifel’s deep dive on trade war risk” [Freight Waves]. “Even a large-scale trade war is unlikely to reshore large volumes of industrial production back to the United States because the country is already experiencing a widespread shortage of blue-collar labor (it manifests itself in the trucking industry as a driver and maintenance technician shortage), [Stifel’s equities analysts] said. And shippers will wait to see how severe, and more importantly how permanent the tariffs will be before undergoing costly adjustments of their supply chains…. Stifel believes the mode [of transportation] most exposed to trade war risk is maritime shipping, particularly dry bulk haulers carrying commodities like steel, iron ore, coal, bauxite, and grains that have been specifically targeted by tariffs…. Railroads are slightly less exposed trade war risk than maritime shipping, but more threatened than trucking or air cargo…. [G]lobal freight forwarders and logistics providers could see an increase in volumes due to tariffs, as shippers lean on them to provide access to capacity across modes, to help redesign and manage supply chains to offset the cost of tariffs, and to navigate complex regulatory and customs frameworks.”

“China Slams U.S. ‘Blackmailing’ as Trump Weighs Higher Tariffs” [Bloomberg]. “China warned the U.S. against ‘blackmailing and pressuring’ it over trade as the Trump administration mulls trying to force officials back to the negotiating table through threats of even higher tariffs….. At the same time, representatives of U.S. Treasury Secretary Steven Mnuchin and Chinese Vice Premier Liu He are having private conversations as they look for ways to reengage in negotiations, according to people who spoke about the deliberations on condition of anonymity. Holding an open door to talks while threatening worse consequences represents yet another increase in tension in the months-long standoff between the world’s two largest economies over commerce.”



Baked in:

(The Dog Tag bakery helps veterans and military families, not bad in and of itself, destructive though militarization may be.)


“Veterans Hit a Breaking Point With Trump” [The American Conservative]. • The veterans didn’t like Trump calling out the press. However, there’s no indication that “Helsinki means Trump is weak” got any traction.

UPDATE “Trump is going to use America’s strong economic numbers to ensure a GOP midterm victory” [NBC]. “[T]here’s enough substance in the numbers and in the nearly 3 percent growth rate for the five complete quarters he’s been president that a salesman as good as Trump can sell the success. Democrats were left to grumble about the rich benefiting most, and the mainstream press pointed to farmers hurrying silos of soybeans to China ahead of looming tariffs. But others recognized the seriousness of 4.1 percent growth. The Twitter feeds of House Minority Leader Nancy Pelosi (D-Calif.), and potential presidential candidates like Sens. Cory Booker (D-N.J.), and Kamala Harris (D-Calif.), were silent on the numbers…. The president can help elect Republicans with the economic numbers because the 2018 midterms are going to be all about Trump.” • If indeed the midterms are nationalized, that’s not a bad tactic for the Republicans to use. Of course, I don’t think a “You’ve never had it so good!” message is full of win, because the material conditions of most voters don’t support that, but given Trump’s well-deserved reputation for puffery, voters might well convert his triumphalism into “Things are way better than the nay-sayers said they would be.” And (modulo an October crash) they’d be right.

UPDATE “Is Trump colluding with Democrats?” [Steve Israel, The Hill]. “There’s no sound reason for a shutdown threat, so I’m sticking with my original theory that our Republican president is secretly rooting for the election of a Democratic majority. He may even be taking a dive for Democrats.” • For more on Steve Israel, “grotesquely corrupt Blue Dog,” see Down with Tyranny.

UPDATE MO: “Ferguson Prosecutor Faces First Political Test Since Michael Brown Shooting” [Governing]. “Now, McCulloch — currently Missouri’s longest-serving elected official — faces perhaps his most serious challenge since first winning the job back in 1990. ‘This is the event that has marked our region, that is literally in the history books already,’ says Wesley Bell, a member of the Ferguson City Council and McCulloch’s opponent in the Aug. 7 primary. ‘Most people don’t agree with the way that he handled Ferguson.’ Still, McCulloch remains a favorite for reelection. At the end of June, he reported a fundraising total of nearly $250,000, which was more than six times the size of Bell’s campaign treasury. The incumbent is a close ally of leading area politicians, including U.S. Sen. Claire McCaskill and County Executive Steve Stenger. He’s also backed by a number of labor unions, which are running a sizable get-out-the-vote effort in support of a ballot measure that could overturn Missouri’s right-to-work law. And he has the endorsement of every living former police chief in St. Louis County.”

2016 Post Mortem

“Mic Daily: Why Bernie Sanders’ campaign strategist is caught in the Manafort trial and more” [Mic]. • Ukraine money. Shocking, I know. This sentence caught my eye: “A review from Slate found that Devine shared at least $10 million worth of commissions with a Virginia-based ad firm that placed some of the millions in television advertising Sanders ran during his failed primary bid.” (Such a commission structure is the, er, norm for political consultants.) This may be pie-in-the-sky about the real cost of campaigning, but just suppose…. This strikes me as a fine example of the Air War vs. Ground War permathread. Suppose we wanted to have 10 organizers in each of the 50 states and we paid them $2500 a month for a year. That would be [breaks out calculator, follow me closely here for errors] 10 * 50 * 12 * 2500 = $15,000,000. So, Devine’s commission — never mind the total funds raised by the Sanders $27-average-contribution campaign — would pay for an awful lot of AOC-style doorknocking. Too idealistic?

New Cold War

“Poll: Majority of Americans say FBI showed bias in Trump, Clinton probes” [The Hill]. • See under Plague, Both Houses?

“Why We’re Sharing 3 Million Russian Troll Tweets” [FiveThirtyEight]. “FiveThirtyEight has obtained nearly 3 million tweets from accounts associated with the Internet Research Agency. To our knowledge, it’s the fullest empirical record to date of Russian trolls’ actions on social media, showing a relentless and systematic onslaught.” • I would love to see some comparative studies made on this; 3 million tweets is not that many, given that 500 million tweets are sent per day. I would especially like to see how many Tweets were the result of the million-dollar troll farm run by David Brock for the Clinton campaign. Which was more damaging to “our democracy”?

The Liberal Democrats Have Lost Their Minds

“Facebook Identifies an Active Political Influence Campaign Using Fake Accounts” [New York Times]. • An “active political influence campaign”? On Facebook? Who could have known? Guess how many Facebook pages this campaign has; it’s right in the lead.[1] Nobody knows where the “active” — as opposed to passive, I suppose — “influence campaign” comes from, either. Imagine my surprise. Attribution is hard….

Realignment and Legitimacy

At the borders. Thread:

UPDATE “How to tell the difference between persuasion and manipulation” [Aeon]. “What makes an influence manipulative and what makes it wrong are the same thing: the manipulator attempts to get someone to adopt what the manipulator herself regards as an inappropriate belief, emotion or other mental state. In this way, manipulation resembles lying. What makes a statement a lie and what makes it morally wrong are the same thing – that the speaker tries to get someone to adopt what the speaker herself regards as a false belief. In both cases, the intent is to get another person to make some sort of mistake. The liar tries to get you to adopt a false belief. The manipulator might do that, but she might also try to get you to feel an inappropriate (or inappropriately strong or weak) emotion, attribute too much importance to the wrong things (eg, someone else’s approval), or to doubt something (eg, your own judgment or your beloved’s fidelity) that there is no good reason to doubt. The distinction between manipulation and non-manipulative influence depends on whether the influencer is trying to get someone to make some sort of mistake in what he thinks, feels, doubts or pays attention to.”

Stats Watch

ADP Employment Report, July 2018: “ADP has underestimated the strength of the last two employment reports making perhaps today’s much higher-than-expected 219,000 result for July a noticeable indication of strength” [Econoday].

Purchasing Managers Manufacturing Index, July 2018: “New order growth is strong and backlogs continue to pile up” [Econoday]. “Orders, however, are centered in the domestic economy with export sales flat…. The text of the report is clearly downbeat warning, as it first did back in June, that manufacturing is beginning to struggle with supply shortages, rising prices and weak exports.” But: “Based on these surveys and the district Federal Reserve Surveys, one would expect the Fed’s Industrial Production index growth rate remain about the same as last month. Overall, surveys do not have a high correlation to the movement of industrial production (manufacturing) since the Great Recession” [Econintersect].

Institute For Supply Management Manufacturing Index, July 2018: “A useful easing in what were enormous and perhaps unsustainable rates of growth” [Econoday]. “A contrast between this report and the PMI manufacturing report released earlier this morning is exports, strong in this report and weak in the latter. Otherwise the themes of both are the same: strong demand, strong activity, and capacity stress.” And: “This was below expectations…. and suggests manufacturing expanded at a slower pace in July than in June. Still a solid report” [Calcuated Risk].

Construction Spending, June 2018: “Volatility once again appears in construction spending data” [Econoday]. “Part of the weakness in construction spending is likely tied to shortages of construction workers, especially skilled labor. High prices for construction materials is another likely negative. And for the residential sector, weakness in new construction will continue to limit buyer choices and overall home sales. Still, stepping back and looking at the year-on-year change offers a reminder that construction is overall very strong.” And: “This was well below the consensus forecast of a 0.3% increase for June. However, construction spending for April and May were revised up (most residential construction spending was revised up)” [Calculated Risk]. And but: “The primary reason this month was soft was due to the significant upward revision of the last few months of data. The rolling averages improved. Also note that inflation is grabbing hold, and that inflation adjustments bring this series barely into expansion” [Econintersect].

MBA Mortgage Applications, week of July 27, 2018: “Purchase applications for home mortgages fell” [Econoday].

Real Estate: “The latest leasing prices in New Jersey are a stark sign of the growing value of logistics space near consumers. The WSJ’s Keiko Morris reports that asking rents in the hot warehouse market jumped 7.4% in the second quarter to $7.80 a square foot, the 10th straight quarter in which real-estate services firm Transwestern has measured record rents in the market. E-commerce and logistics firms have been willing to absorb the higher rent to get closer to New York City and the surrounding, densely populated areas, with new sites filling up faster than developers can build them. That’s a trend playing out nationally” [Wall Street Journal].

Retail: “Links in 7-Eleven’s Chain Threaten to Snap as Store Owners Balk at Contract” [New York Times]. “The relationship between 7-Eleven and its store owners has been deteriorating for years. In the early 2000s, the company and franchisees split profits equally. But 7-Eleven has taken an increasingly bigger cut, franchisees say, and is now saying that store owners who do not renew their contracts by the end of 2018 could see their profits shrink further….. The dispute underscores the shifting nature of the franchise business, traditionally a path to the middle class for would-be entrepreneurs….. Seven & I Holdings, the Japanese company that owns 7-Eleven, said gross profit margins at its overseas convenience stores, including those in the United States, fell half a percent in the most recent fiscal year.”

Retail: “Auto Sales Plunge Amid First Cut in US Discounts Since 2013” [Industry Week]. “The drop in sales caps a rough month for the auto industry during which Detroit’s carmakers all reined in their earnings guidance and Ford Motor Co. embarked on a five-year restructuring plan. The sales month will underscore investor fears that auto sales have peaked and that, without ever-higher sales incentives to keep consumers interested, demand will continue to soften…. Part of the reason for the pullback is that it’s getting more expensive to offer incentives, especially those tied to loans. The Federal Reserve hiked interest rates three times last year, once this year and has signaled that it will bump them two more times in 2018. That makes subsidized interest rates more expensive to offer and undercuts sales…. Another issue, said Charlie Chesbrough, senior economist for Cox Automotive, is that while carmakers are pulling back on new-vehicle incentives, there are great deals on the used lot. Cars are coming out of leases in huge numbers, giving consumers a low-priced alternative just across the parking lot from the showroom.”

Retail: “How Sellers Trick Amazon to Boost Sales” [Wall Street Journal]. “As Amazon has cracked down on fake reviews, some sellers are leaving five-star, fake-looking reviews on rival listings so they trigger Amazon’s scam-detecting algorithm and get the rival seller suspended, according to the people familiar with the practices. Another tactic is to vote rivals’ bad reviews the most helpful. Others buy the product and leave safety complaints, which typically trigger an immediate listing suspension as Amazon investigates.” • Moderation in all things….

Shipping: “U.S. Seaborne Imports Surging as Retailers Stock Up Early” [Wall Street Journal]. “Cargo streamed into U.S. seaports at a rapid rate in June, as businesses pulled in goods in an apparent rush to stock up ahead of new tit-for-tat tariffs between the U.S. and China. Container imports at California’s ports of Los Angeles and Long Beach, Calif., the biggest U.S. gateway for seaborne trade, rose 8.4% in June from the same month a year ago.”

The Bezzle: “Tesla earnings should be a doozy: Live blog” [MarketWatch]

Transportation: “13 Things We Learned by Rigorously Testing St. Louis’ New Lime Scooters” [Riverfront Times]. “5. Everyone Will Stare at You. And mostly with disgust. People in cars are angry with you for holding up traffic; people on bicycles are angry with you for taking up space in the bike lane. In the Loop, I actually had a man boo me, from across the street. “Boooo!” he yelled. He looked me dead in the eyes, too, and then repeated it, his stare unblinking. “BOOOO!” These things have quite the reputation for being hated in the cities in which they’ve so far been rolled out; St. Louis will, predictably, be no different.” But: “13. They Are Fun As F” • So, there you go. Public goods vs. Fun. The eternal question!

Transportation: “MH370 probe considered risks from batteries and fruit” [Flight Global]. “Investigators have disclosed that they analysed the potential hazard posed by the combination of fruit and lithium batteries during the probe into the disappearance of Malaysia Airlines flight MH370…. The fruit and batteries, in their own protective containers, were loaded in close proximity in the aft hold. Mangosteen juice is electrically conductive, as was the damp sponge used keep the fruit fresh. ‘There were concerns that the mangosteen extracts could have got into contact with the batteries and produced hazardous fumes or, in a worst-case scenario, caused a short circuit [or] fire,’ says the latest detailed update to the MH370 inquiry. But after testing the items – both individually and in combination – Malaysian Science & Technology Research Institute for Defence was ‘convinced’ that they ‘could not be the cause’ of MH370’s disappearance, a conclusion backed by the investigation team.”

The Bezzle: “Elon Musk offers billionaire David Einhorn a ‘box of short shorts’ to comfort him after his Tesla short bet put a big dent in his fund (TSLA)” [Business Insider]. Einhorn: “We doubt the entry-level Model 3 will be produced profitably anytime soon, if ever.” • Hmm. Assuming the tear-downs are legit, it’s not clear Einhorn is right on that.

Health Care

“Physicians aren’t ‘burning out.’ They’re suffering from moral injury” [STAT]. “The term ‘moral injury’ was first used to describe soldiers’ responses to their actions in war. It represents ‘perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations’… We believe that burnout is itself a symptom of something larger: our broken health care system. The increasingly complex web of providers’ highly conflicted allegiances — to patients, to self, and to employers — and its attendant moral injury may be driving the health care ecosystem to a tipping point and causing the collapse of resilience.” • “So many vows… they make you swear and swear. Defend the king. Obey the king. Keep his secrets. Do his bidding. Your life for his. But obey your father. Love your sister. Protect the innocent. Defend the weak. Respect the gods. Obey the laws. It’s too much. No matter what you do, you’re forsaking one vow or the other.” –Jaime Lannister. However, another way of saying this is that we’re optimizing our health care system to select for providers who have no problem throwing people under the bus for money. Go, neoliberalism!

Staff needed:

I can’t think of many reasons to be passionate about bipartisanship. None of the ones I came up with are good. Ka-ching.

Staff strong-armed:

One of the many ways administrators let you know who’s in charge, and for whose benefit institutions are really run.

“A big overlooked flaw with health tech: Patients hate going to the doctor” [CNBC]. “Ample studies have found that many avoid it because the experience sucks, while others are put off by the cost.” • I’ve never understood the neoliberal “skin in the game” argument, which implies that co-pay is needed to prevent patients from over-using the system. “Hmm. What shall I do this afternoon? Garden, or go to the doctor’s office?” Do people really think that way? (Note that the link to those “put off by the cost” refers to regular checkups, which are medically necessary.)


“Calley declares emergency in Kalamazoo County over tainted water” [Detroit News]. “Lt. Gov. Brian Calley on Sunday declared a state of emergency for Kalamazoo County after high levels of contaminants were found in the drinking water…. Health officials say long-term exposure to the [Perfluoroalkyl and polyfluoroalkyl (PFAs) in drinking water could harm human health, with links to issues such as thyroid, kidney, heart and reproductive problems.” • Idea: Give Flint’s bottled water to Kalamazoo?


“Here’s How America Uses Its Land” [Bloomberg]. Many handy maps, of which this is my favorite:

At bottom right, we seem to be devoting a disproportionate amount of land to “ethanol.” And it’s pretty cheeky to put “golf” inside “ethanol”! Any Georgites in the house?

Class Warfare

“Uniting the Working Class Across Racial Lines” [Law and Political Economy]. “What affirmative vision could unite both old and new working class across these divisions? What democratic demands could a united working class make of capital? I think this part is easy, actually. Ocasio-Cortez has it right—it’s Socialism 101: a political economy that responds democratically to the needs of the working class. Universal healthcare they can access. Free college tuition or retraining. Housing that they can afford. Economic security and opportunity for advancement. The end of state violence (for example, dismantling ICE) against vulnerable people. A country that affords them dignity. These goals span the old and new working classes, and significantly, extend even to Trump voters. Survey research analyzing the five types of Trump voter suggests that for close to 40% of the Trump vote in 2016, economic issues were very high priority. Reforming health care, securing economic opportunity, shoring up Social Security, all ranked quite high among these voters’ priorities.” Importantly:

Fight for Fifteen was able to organize across racial lines without scrubbing race out of the picture. Three aspects of the campaign have seemed important to their success in that regard. First, organizers worked hard to create coalition across racial lines. In fact, the first major F4F campaign at the Seattle-Tacoma airport got off the ground when white working class organizers joined together with Somali Muslim airport workers to demand that their subcontractor employer continue to allow Muslims to pray throughout their shifts. Religious leaders from many denominations manned the front lines in marches, providing moral clarity around the Somali workers’ demands. Faith organizations would prove to be a crucial player in the subsequent campaign for a fifteen-dollar wage.

Second, Fight for Fifteen organized around a distinctive and unambiguous goal: $15 an hour. An affirmative, measurable goal that benefited all workers proved key to persuading key white players to commit to the campaign. When racial tensions flared over who had the requisite experience to lead, the campaign could defuse those tensions by pointing out that both union and community group experience would prove useful in organizing for a wage increase.

Third, Fight for Fifteen scaled its campaign carefully, moving from local to city to state to nation in a series of steps. F4F organized first at the local level, focusing on the particularity of local communities.

“Eliminating Gender Bias at WCCO Belting” [Industry Week]. “When the company wanted to expand the role of women in its workforce they viewed this goal from the perspective of respect and so focused on ability and not gender. ‘To attract more women, especially in a tight labor market, we adopted a strategy of driving gender bias out of our company,’ said [Jean Voorhees, vice president of Business Development]. “And that strategy worked. Women comprise almost half of the production floor jobs and 45% of the management jobs…. Using a kaizen-type of process, in 2014 the company asked employees for improvements. The 1000 improvements that were made based on these suggestions had nothing to do with who made the suggestions… Another issue that many women have about working in manufacturing is rotating work schedules. Schedules often change based on production demands. But WCCO chose another route. ‘We found that by using a known schedule, it would be easier for women to be able to plan around the demands on their personal lives,’ said Voorhees.”

Our Famously Free Press

I’m noticing a trend toward data projects tuned to electoral politics. Here are two:

“categorized tweets” [Categorized Tweets]. “Enter your zipcode to catch up on the candid thoughts of individuals who represent you.” • Well, as candid as Twitter ever is (modulo BigFoot eruptions). Still, interesting!

“Political Ad Collector” [ProPublica]. “The Political Ad Collector is a tool you add to your Web browser. It copies the ads you see on Facebook, so anyone, on any part of the political spectrum, can see them in our public database.”

The tool I wish I had: I would input zip code or (better) Congressional District, and get the media venues that cover it (including blogs). Maybe it’s out there and I just don’t know about it, because, very oddly, Google and Facebook make it hard to find stuff!

* * *

“News From Your Neighborhood, Brought to You by the State of New Jersey” [New York Times]. “The state’s lawmakers have embarked on a novel experiment to address a local news crisis: putting up millions of dollars in the state’s most recent budget to pay for community journalism. While public television and radio stations have long received government funds, new media experts like Kelly McBride of the Poynter Institute say they have not heard of any other efforts on this scale, with a state helping to pay for reporting projects among a range of news media, including for-profit outlets… The effort has come at a moment of instability, but also invention, for the news media. National news organizations like The New York Times and The Washington Post have attracted a surge of new readers* since President Trump’s election, even as he has persisted in his attacks on journalists. (The momentum has trickled downward: The Village Green gained 100 new subscribers after the presidential election, a not insignificant sum, Ms. Mann said.)” NOTE * The very last thing they want is for Trump to stop tweeting.

News of The Wired

“I tracked my daughter’s first words from 12-18 months [OC]” [Reddit]. • I wonder how cross-cultural this would be….

UPDATE “Open offices can lead to closed minds” [The Economist]. “The supposed aim of open-plan offices is to ensure that workers will have more contact with their colleagues, and that the resulting collaboration will lead to greater productivity…. [T]he [Harvard Business School] authors found that face-to-face interactions were more than three times higher in the old, cubicle-based office than in an open-plan space where employees have clear lines of sight to each other. In contrast, the number of e-mails people sent to each other increased by 56% when they switched to open-plan. In the second company, face-to-face interactions decreased by a third after the switch to open-plan, whereas e-mail traffic increased by between 22% and 50%. Why did this shift occur? The authors suggest that employees value their privacy and find new ways to preserve it in an open-plan office. They shut themselves off by wearing large headphones to keep out the distractions caused by nearby colleagues. Indeed, those who champion open-plan offices seem to have forgotten the importance of being able to concentrate on your work.”

UPDATE “The simplicity of dropping Google in 2018” [MacWright]. “lowly, and without intention, I left it all behind: they shut down Google Reader, and I switched to Feedly. GitHub replaced Google Code. I switched from Google Search to DuckDuckGo. From Docs to Dropbox Paper, iA Writer, and Notion. From Picasa to Flickr and a simple folder of images. Google Analytics grew obtuse and unusable, so I switched to gaug.es, and then eventually removed analytics from all my sites. Google Groups, once a forum for discussion, has been overtaken by Discourse, Slack, and GitHub Issues. Switching off of Google in 2018 is easy because you’ve probably abandoned most of their products anyway, and the ones you’re still using are stagnating.” • What the heck are Google’s programmers doing with their time? Search is crapified, and UI/UX is getting worse and worse all the time? Some kinda moon-shot? Any Google shorts out there? Probably not, you’d think there’d be one or two….


[1] 32. Now, if it had been 42, that would be different. The accounts had 290,000 followers. There are 214 million (214,000,000) Facebook accounts in the United States. We’re really not looking at analysis here. We’re looking at a moral panic about ritual contamination from a political class that has lost its mind.

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Readers, feel free to contact me at lambert [UNDERSCORE] strether [DOT] corrente [AT] yahoo [DOT] com, with (a) links, and even better (b) sources I should curate regularly, (c) how to send me a check if you are allergic to PayPal, and (d) to find out how to send me images of plants. Vegetables are fine! Fungi are deemed to be honorary plants! If you want your handle to appear as a credit, please place it at the start of your mail in parentheses: (thus). Otherwise, I will anonymize by using your initials. See the previous Water Cooler (with plant) here. Today’s plant (winstonsmith):

Smith writes: “) In response to yesterday’s antidote, this is a milkweed plant on the edge of a clearing in the woods near our house. I took the photo of the caterpillar yesterday evening and the photo of the butterfly today.” That is a very inviting garden path!

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. Timmy

    That’s “golf” inside of ethanol. I would like to see a graph of land use scaled to pesticide/herbicide density or, alternatively, to water use… In either case, I suspect golf would be the size of California. Perhaps the next graph could be the proportion of income of senior government officials to that activity.

    1. Observer

      The “Golf” probably refers to Hilton Head Island, technically South Carolina, not Georgia.

      1. Carolinian

        Myrtle Beach is covered up with golf courses. Not sure what you mean by “technically.”

      2. Lambert Strether Post author

        The map is not geographical. The areas are arranged to fit. For example, Maine (at right) is not all urban housing; it has forest land (all at the left).

  2. Shane Mage

    That map, only a very small share of it depicting farmland for “food we eat,” is revelatory as to how easy it would be, given a universal basic income, to revitalize rural America by providing good farmland to all would-be farmers and growing even a surplus of healthy organic food for the whole population.
    By the way, did you notice that your word processor “corrected” *golf* so that it came out *gold*?

    1. Lambert Strether Post author

      I don’t use a spellchecker. Thanks for fixing my typo!

      Although the connection between “golf” and “gold” is as close as the change of a single letter would suggest….

      1. ChiGal in Carolina

        I am inordinately pleased to find another person who doesn’t use spellchecker–and one so literate!!

    2. Darthbobber

      But the map has a few problems. Most of KS, Nebraska, for example, acreage-wise, are wheat, corn, soybeans. Not cattle ranching.

  3. DJG

    Sorry, Lambert, the map of land-use, and the various other sparkly ones at Bloomberg, are mainly disasters. I will go full Edward Tufte on you: You can’t display data against any old background. What percent of the U S landmass is used for pasturage? And even if the Great Lakes States are virtual Edens, the food we eat isn’t grown in a band between Illinois and Ohio. Michigan and Wisconsin are anything but fallow. The data call for numbers and percentages, not the fakery of a “reformed” map of the U S of A.

    The whole shebang could have been set up as a simple table of data–heck, a list is all that’s required. The map and colors are designed to impress and mislead. Using area incorrectly is typical of the badly made display of data. Western Pennsylvania is all about corn syrup? How much of it? How did I ever drive through it on the Turnpike?

    It is true, though, that coastal South Carolina is mainly devoted to golf.

    No wonder so many people still think that Hillary Clinton had an normal AOL account that went wild, because of yoga and Colin Powell, and so many think that hordes of Muslim immigrants are ravaging the borderlands.

    1. Darius

      It’s not meant to show where these activities are taking place. Just how much land. It’s a schematic. A graphic. Not to be used for purposes greater than information only. A table doesn’t communicate like a graph, picture or map.

      BTW, I wonder how much rural housing includes exurban sprawl.

    2. Rojo

      I don’t think the location of the blocks is important, it’s just for show. Where else are you going to put the timber block but the PNW?

      I think pasture land is misleading however. You can designate huge tracks of land as pasture-land that have only a smattering of cows.

    3. Carolinian

      It is true, though, that coastal South Carolina is mainly devoted to golf.

      We have our priorities. The golf, though, should probably be a subset of “tourism.”

      The coast was once devoted to rice and Sea Island cotton which led to that unpleasantness in the 1860s.

      1. The Rev Kev

        The great thing about golf courses is that if society collapses, that you will have large tracts of cleared land near towns and cities ready to plant food crops in. Probably find that that most of them were farmls once a long time ago.

    4. polecat

      Said map shows absolutely NO MJ development .. er ..uh .. ‘growth’, especially in the great northwest …. or is that supposed to be bundled under “private family ‘timberland'” .. ??

    5. ObjectiveFunction

      Fair points, but not everyone processes data in the same way as you, or is very concerned with land use by locality

      For many casual readers, sorting all these squares into a bar chart or %s isn’t going to be nearly as memorable or compelling as being able to scale it instantly to areas we ‘know’.

      I will agree though that including the state boundaries from the base template is misleading; apples and oranges

  4. Mark Gisleson

    People who think average people would abuse free healthcare are mostly upscale and go to parties where doctors who cater to affluent patients tell horror stories about hypochondriacs. It’s a tight little loop that lets in very little fresh air.

    1. pretzelattack

      going to a doctor’s office is right up there with waiting an hour to talk to social security or medicare on my list of personal faves. how else will i keep up with what people magazine was saying 5 years ago? or field and stream, or golf today?

      1. WobblyTelomeres

        Don’t forget the condition of the people who were reading those clinic waiting room magazines for the days, months, and years before you picked them up.

        And I always wonder where my primary care physician’s hands have been since he last washed them before accepting the proffered hand shake when he walks in the examining room.

        Prolly why I bring my own reading material and wipes when I see a physician and try really hard to get the first appt of the day (when it is an option). What is good for their business is not really good for me…

        [father was a physician, mom a med tech, the family is filled with nurses, learned the germ theory of disease when I was 3, etc].

        1. The Rev Kev

          Always thought that doctor’s surgeries and hospital waiting rooms are a great place to catch a communicable disease. It is, after all, a place full of sick people by definition.

      2. Hana M

        The people who overuse the healthcare system are probably in the ‘Talented Tenth’. I loved this little sketch of the aging and anxious affluent from Barbara Ehrenreich:

        Most of my educated, middle-class friends had begun to double down on their health-related efforts at the onset of middle age, if not earlier. They undertook exercise or yoga regimens; they filled their calendars with upcoming medical tests and exams; they boasted about their “good” and “bad” cholesterol counts, their heart rates and blood pressure. Mostly they understood they the task of aging to be self-denial, especially in the realm of diet, where one medical fad, one study or another, condemned fat and meat, carbs, gluten, dairy, or all animal-derived products. In the health-conscious mind-set that has prevailed among the world’s affluent people for about four decades now, health is indistinguishable from virtue….

        I doubt these folks ever suffer from high deductibles. The whole article is well worth a read: https://lithub.com/barbara-ehrenreich-why-im-giving-up-on-preventative-care/

        1. rojo

          Good point.

          And if you have a shift job, it’s pretty hard to fit in a Dr.’s appointment.

        2. Summer

          “I doubt these folks ever suffer from high deductibles.”

          All the wage and compensation gains going to them means that employer based healthcare system keeps subsidizing the high cost of private care for THEM.

          Look at an employer plan. Whatever costs are onerous to the average employee are still bargain basement for the higher ups taking part in the plan – because they keep getting all the wage benefits and tax cuts to keep up with the high cost of necessaties.

          Would they be doing all the “doctoring” without the stagnant wage employees subsidizing them?

    2. jrs

      well people might go to psychotherapy gladly and that would be nothing new. I don’t know if it’s really abuse exactly as everyone has mental health problems these days.

  5. jsn

    “Here’s How America Uses Its Land”

    I thought cats really ran the country, it looks like it’s actually cows, but they do pay a heavy price for their hegemony!

    In any case, I remain convinced cats are the reason humans haven’t yet exterminated themselves in a nuclear war.

    1. Wyoming

      …. it looks like it’s actually cows, but they do pay a heavy price for their hegemony!

      I have maintained for a long time that the price the cows pay is exactly what the 1% need to pay – though I plan on feeding them to my dog rather than making burgers out of them for me. But maybe I am planning too far ahead.

  6. savedbyirony

    Since this is a partial “talk among yourselves” open thread day with the water cooler, i would very much appreciate hearing any observations and insights NC readers may have concerning the Ohio Senate race between Jim Renacci and Sherrod Brown. I know the latest polls show a lead for Brown between 10% to 15%, but time and again I have seen Renacci win political offices where I live in N.E. Ohio, starting with his time as my small city’s mayor. In this part of Ohio, print media-wise i see mostly pro-Renacci coverage by journalists and plenty of letters to the editors in support of him, though talking with people and supporting the Brown campaign, one has a difficult time meeting people on the street who have anything but contempt for Renacci. I do not know about the TV news coverage because i never watch any, but earlier this spring/summer we where being flooded with his campaign ads (mostly attack) thought they seem to have tapered off for now on the few mostly sports related channels i watch. As of the latest reporting, the two candidates are planning 3 debates but nothing has been made definite.

    If any other Ohioans have any observations about how this race is running form their perspectives and locations, or the chances of Renacci actually winning i would love to hear them.

  7. Lee

    “A big overlooked flaw with health tech: Patients hate going to the doctor” [CNBC].

    I love going to the doctor. Not only do I have real health problems, all save one male specialist are attractive women who laugh at my jokes. What’s not to like? Does this make me a bad person?

    1. MyLessThanPrimeBeef

      In cases with male doctors and female patients, I’ve seen often the need of a third person in the room.

      What about with female doctors and male patients? Does the male patient, or the female doctor, need a third person in the room, or both? Or is there no need at all in those situations?

      1. Synapsid


        My doctor is a woman and I’m a man. During a physical or anything similar there will be a third person in the room who leaves afterwards.

        1. Lee

          That seems weird to me. I go to a teaching facility, so there is occasionally but not always a student in the room in addition to the caregiver. Maybe it’s because we’re in the SF bay area but the caregivers I see seem pretty relaxed around differences in gender, race and ethnicity. Not only are most of those I see women, but they are from a broad spectrum of racial and ethnic backgrounds.

          1. barefoot charley

            Up here in California’s Deep North, my wife came with me to see our doc, but the doc, an excellent young woman, invited my wife to leave for my front and rear excretory exam. I wish I could have left too! No chaperone ever came up, unless you count my prostate.

        2. pretzelattack

          i was examined by a female pa. nobody else in the room. she kept cracking double entendres, but i figured she was just nervous or something.

      2. JTMcPhee

        Sex and death, the immutable human constants, the theme pair of so much of fiction and non—… James Bond, 24, Tom Cruise, the Vin Diesel franchises, horror movies, Jerry Springer, behavior of Imperial GIs in foreign lands, ASStronauts, on and on… And for those who haven’t run across it, a semi-autobiographical novel of Life And Death In A New York City Hospital, “The House of God” by ‘Samuel Shem.’ Funny, in that way that pulling a chair out from under a disabled person trying to sit down is funny…

        But of course experience in the real world, as well as political correctness, argues in favor of a threesome in any therapeutic or diagnostic setting. Though no guarantee that a majority of the three will be of good moral character, and decent people…

      3. rfdawn

        My doctor never summons an audience when/if she checks my prostate. Should I demand one? Anyway, it is consciousness-raising – for both of us.

        1. The Rev Kev

          After a few lawsuits several decades ago in the UK, doctors were advising each other that if a female patient lowered so much as her voice to bring in a nurse/chaperone.

    1. Edward E

      Thanks, that is so awesome as I was watching that earlier. Made my day… week maybe, what a wonderful place

  8. Hameloose Cannon

    And so it goes. The Bernie Sanders campaign redistributed small campaign contributions from working families, funneling the donations to 1%’ers like Tad Devine [Devine Mulvey Longabaugh], wealthy, elite political mandarins [“Our brand is Crisis,” says Tad Devine, re: Bolivia Pres. Campaign, 2002, “That’s our brand. We must own crisis and we must brand crisis.”]. Well that’s not typical socialist orthodoxy. Seems like that money could have been better spent on down-ballot candidates, in solidarity, like a proper political “revolution” would have done. I guess you got to pay the people in power for the privilege of railing against the people in power, in an epic game of “why bother?”. This isn’t your dad’s Kabuki theatre—this is the Noh Revolution.

    1. Elizabeth Burton

      Bernie Sanders didn’t run as a socialist, so condemning his campaign for non-socialist activity is specious. And borders on trolling, frankly.

      1. Hameloose Cannon

        Sorry, didn’t mean to hold anyone accountable for their actions. Am I a troll or am I somebody trying in vain to get the preterite to reach for the throne for a change, and not buy into false prophets. It’s a fight to the death, and because I must have Hunter Thompson-ed out at the Wynn, Las Vegas during the Dem primary debate in October 2015 where Sanders said “Why I’m a Democratic Socialist […]” followed by some solid arguments and honest convictions. It must have been Bayard Rustin, a true giant of the cosmos. The point being, Sanders is not doing a very good at his job as a politician in case you haven’t noticed. Vermont is in terrible shape. Sanders is horrible with money, but he only had to be marketed well enough to bleed the democratic donors dry. Sanders was only a true threat to the letter and spirit of campaign finance laws [his wife holds everything in her name, his campaign kept shoddy records of foreign donors, not enough time to go into it.] He’s basically the “Like Cola” of politics. Cool bumper stickers, though.

        1. pretzelattack

          supporting evidence for vermont being in terrible shape, and sanders being the cause, would help you “hold him accountable for his actions”. also, support for “sanders is terrible with money” and the assertions you didn’t have time to go into would be helpful.

        2. Lambert Strether Post author

          > not enough time to go into it.

          Well, that’s settled then.

          * * *

          In essence, the Sanders campaign in 2016 went for the Air War not the Ground War, and if that’s the direction you go, then you hire that set of professionals and pay them their commission for television advertising*. You can argue that the Ground War is the way to go, and IIRC there was a muffled but acrimonious dispute about that when Our Revolution was founded. I think that’s a real issue, as I indicated in the post. Sadly, this comment doesn’t advance that discussion.

          NOTE * “Corruption. They’ll be discovering bloody steam next.” –John LeCarré, The Honorable Schoolboy

  9. PlutoniumKun

    I’ve never understood the neoliberal “skin in the game” argument, which implies that co-pay is needed to prevent patients from over-using the system. “Hmm. What shall I do this afternoon? Garden, or go to the doctor’s office?” Do people really think that way?

    Unfortunately, some do. There is always a small percentage of patients who will turn up every day to a doctors office/clinic/emergency room if they can. Sometimes they are lonely, or hypochondriacs, or have social/mental problems, or chronic undiagnosed issues, or domestic issues and they want somewhere to go – many reasons. But its a constant issue in all free or subsidised health care systems that a small percentage of patients take up a disproportionate amount of time, and they are not always the ones in most genuine need. A basic fee is I think the most common way to try to prevent this – maybe there are better ways (I’m sure they’ve been tried), but its a pretty much universal issue for public health providers.

    I should add the disclaimer here that I’m not a medical professional – but there are quite a few in my family and I hear the stories and complaints all the time.

    1. Harold

      Hypochondria is a legitimate psychiatric diagnosis and sufferers should not be stigmatized or their conditions trivialized. If such people are overusing the medical system, then they have a medical condition for which aren’t getting appropriate or effective treatment. They are victims of a brain condition and not morally deficient.

      In any case, the argument that some people will “overuse” the system seems to me an inadequate reason for denying care to millions of genuinely ill people or for forcing ill people into bankruptcy or homelessness, as happens in our current system.

      1. Dave

        I’ve heard the stories of people in the UK going to the ER for a cold, or a headache, or a “case of the blahs”. I do think most of it is just a few rare occurrences getting re-told, I doubt most people go for kicks. And even if they do – well, a good general practitioner would probably tell you that “talking to an old lady who doesn’t have anyone else to talk to” for half an hour a week is phenomenally good for the patient’s health, even if there’s no pill prescribed or diagnosis made. But that sort of thing doesn’t result in billable treatments, so the modern provider network doesn’t prioritize it. In she goes, she gets her temperature taken, and let’s move her out the door again.

    2. Jeremy Grimm

      I think your characterization of the small percentage of patients who show up at the doctor’s office everyday as “lonely, or hypochondriacs, or have social/mental problems, or chronic undiagnosed issues, or domestic issues” suggests another problem with our society and the lack of help available to deal with mental illness.
      Using fees to deal with the problem so as to make sure patients have “skin-in-the-game” just makes sure only the affluent can receive whatever succor those who are “lonely, or hypochondriacs, or have social/mental problems, or chronic undiagnosed issues, or domestic issues” derive from a visit to the doctor, while it places a twofold burden of extra competition for service and additional cost on other more deserving and less affluent patients. Further I suspect the fees less than adequately compensate physicians for their time and the nuisance.

      I think our society is creating a lot of mental illness and has never provided anything approaching adequate care for the mentally ill.

      1. Eureka Springs

        ‘We’ could ask doctors from several dozen other countries who have dealt with all of this with far better results at far lower rates, just what they do with hypochondriacs. I vaguely recall a scene in SICKO where Moore asked a Dr. in London about this.

        Bars have barflies. Clothing stores have clotheshorses., etc. This ain’t rocket science and plenty of us can tell others who struggle with basic human relations how best to deal with it.

      2. polecat

        Does ’17spooks-induced paranoia’ fit under mental illness .. ?? .. Anyone ? .. Bueller ?….. Bueller ? ……… Ok ..Trump ??

        1. Jeremy Grimm

          It all depends. Are the 17 spooks real or only some of the spooks. It’s only paranoia if the spooks are unreal. It is rational to fear real spooks whether CIA, FBI or from one of the other 17 agencies. Of course if you have nothing to hide they can always find something or construct it.

          [As a kid I was scared of the 13 Ghosts for a while until I threw away my 3-D glasses.]

    3. RUKidding

      I believe what you say, but I truly wonder how large that cohort is of those who visit their doctors “too often” because they are “lonely, or hypochondriacs, or have social/mental problems, or chronic undiagnosed issues, or domestic issues.” Not snark. I’d really like some concrete figures on this.

      I say this because for decades this is has been one of the gold-standard “excuses” for why subsidized health care simply won’t work. I’ve heard it ad nauseum throughout my working career, especially when I worked in the private sector. My employers whiiiined and complained about how staff were “abusing” their health insurance by going to the doctor “too often.”

      I’d really love to know the real percentage of people who go to doctors “too often.” In addition, it would be good to know why they visit their doctor so often. If someone has “chronic undiagnosed issues,” then what’s the solution? Stay home and STFU?

      1. KB

        Kip Sullivan wrote a great book about under-utilization in America with stats.
        “The Health Care Mess: How We Got Into It and How Well Get Out of It”
        Book by Kip Sullivan
        Myself, a retired DC never saw the over-utilizer but a few times in 25 years…

      2. Jeff W

        I’d really love to know the real percentage of people who go to doctors “too often.” In addition, it would be good to know why they visit their doctor so often.

        I’d love to know that, too. It sounds to me like one of those things that (certain) people conjecture endlessly about but, in practice, turns out to be a minuscule percentage of the population.

        The other thing is what is “too often,” anyway? People in Japan go to the doctor on average 13 times a year (that’s four times more than the US average)—is that “too often”? What’s the relationship, if any, between that average and the fact that people living in Japan has the highest life expectancy in the world? I wouldn’t be surprised if living in a society where doctors visits are not thought of in terms of “moral hazard” or “abuse”—you know, something more like a “high-trust society”—has something to do longer life expectancies.

        1. ObjectiveFunction

          “a society where doctors visits are not thought of in terms of “moral hazard” or “abuse”—you know, something more like a “high-trust society”—has something to do longer life expectancies.”

          This! Every last word.

      3. cuibono

        as a doctor I can say there are those patients to be sure. In my experience, they constitute a tiny fraction of my patients; less than 3% as a guess. Of course in terms of visits they are far more than 3%.
        Fact is, the rest of the developed world has patients seeingn the doctor more often in outpatient and inpatient settingns AND does so for lower costs and better outcomes…

        Over treatment is not the main issue we need to be dealing with. So many other more important ones

    4. ChiGal in Carolina

      part of the issue is learning to think in terms of lifestyle and preventive medicine. as a medical social worker (and as a flawed human being myself), I know people often do NOT make recommended changes and then wind up at the ER in a diabetic crisis or whatever the case may be.

      we need less focus on dramatic interventions and more routine support for people who need it, including for example home visits from nurses and such.

      it is human nature to do what comes easily and then when it’s time to pay the price, often it involves a trip to the doctor. no one should have a prohibitive copay imho, and for those below the poverty line there should be none, but a token $5 may even the scales a bit and make someone think twice about eating those candy bars or skipping their medication.

      of course, in this country Black people have good reason to avoid doctors even when they need them.

    5. jsn

      It is certainly true there are outlier personalities who will abuse any system.

      But if you design the systems for the outliers, you end up treating everyone like they’re cheating: design systems for most people and develop work arounds for the outlier personalities.

      The other way around is what neoliberalism does and results in treating everyone as if they are as dishonest as neoliberals are.

      1. JTMcPhee

        “Outlier personalities who will abuse any system:” Zuckerberg, Gates, Dimon/Blankfein, Clintons, Cheney and the Bush League, Obama and his clan, obligatory mention of Trump, pick your favorite. There’s a wide selection to choose from.

      2. Copeland

        Interesting! Those who claim that we “cant have nice things” because some will overuse and abuse are exactly those people who would overuse and abuse. So in their minds it makes perfect sense, whereas is sounds absurd to everyone else.

    6. Lambert Strether Post author

      > a small percentage of patients who will turn up every day

      Seems kinda weird to structure an entire system around a small number of patients. Perhaps there are other factors in play?

    7. Darius

      I took my mother to the doctor yesterday. Medicare. She paid no copay. Do Medicare recipients chronically abuse the system?

    8. HotFlash

      Sometimes they are lonely, or hypochondriacs, or have social/mental problems, or chronic undiagnosed issues, or domestic issues and they want somewhere to go – many reasons.

      These are all public health problems and should be included in a public health program. Perhaps a GP is not the person nor ER the place, but our local health centre has on staff social workers including home visitors, psycho- and physiotherapists, a dentist, a naturopath, a podiatrist (!) and hosts more than a dozen meeting groups which are social in nature.

      And do you remember Gilda Radner, the very, very funny lady who was one of the SNL originals? Complain, complain, complain, always going to the doctor, who always found nothing wrong. After a while even her hubby (Gene Wilder) was joining in the eye-rolls. When they finally diagnosed ovarian cancer it was too late.

    1. Kurt Sperry

      “Skin in the game” is right-wing code meant to elicit the moral panic of lazy, undeserving, poor people getting “free stuff”. As opposed to all the “free stuff” that is routinely handed out to the industrious, deserving people with wealth. Like regressive tax cuts.

      1. Skin

        Reason I ask is because the way, e.g., Taleb uses the expression – paying the price and taking the consequences of your own decisions – would be useful in combatting neoliberalism and therefore I can’t see it as an inherently neoliberal term and having this inherent function. Unless you argue otherwise.

        E.g., Swedish politicians have given themselves a life-long pension in the form of income guarantee. Only thing you have to do is to sit 5 years as minister or 8 years in the Riksdag then you get money until you are 65. Nice if you get it.

        However, for the rest if the population they have gutted the social benefits, implementing neoliberal policies without suffering the consequences themselves. If they would have been forced to work or enter the current social benefit hell of Sweden, they may have legislated differently.

        Chicken hawks that never see the frontline because they are based on the other side of the world is another category that would do well from being sent to Afghanistan to suffer the consequences of their own decisions of perpetual war.

        Ok, I get it that this term can be used and misused, just like neoliberalism itself, but I was curious to see whether there was an inherently neoliberal term.

        1. Kurt Sperry

          I do. Right-wing “liberal”. Ten years ago, that formulation would have struck me as an oxymoron; not any more.

    2. False Solace

      “Skin in the game” when it comes to health care is particularly egregious. Our bodies are the health care game, literally. Why should more be needed?

      A small number of patients will always constitute the bulk of health care spending: the ill will always be with us. Far too easy to punish the chronically sick (who are the main driver of costs) while pretending to punish hypochondriacs.

  10. Summer

    “I’m noticing a trend toward data projects tuned to electoral politics…”

    Because all problems can be reduced to lack of data in the world of technocrats.

    I notice a trend toward data collection in many areas and industries whenever there is an epic fail of imagination, compassion, or intellect.

  11. anon y'mouse

    perhaps people hate going because of what health care has turned into?

    15 minutes to talk to your doctor. only one issue can be relayed at a time. each issue needs its own appointment, and thus copay. doctor is harried, thinks you are an idiot wasting their time, and treats you like your are too stupid to know what is going on with you. tries to behave as though a 30 minute questioning session can suss out whatever it is that you are complaining about.

    doctor doesn’t really want to find out what is wrong with you, because then they might have to do something (probably involving much paperwork). gives you a prescription to deal with symptoms and sends you away. the prescription does little to help, and you are still stuck with the issue and out the copay, time, frustration, etc. and this is if you are LUCKY!

    no wonder people don’t want to go!

    1. Howard Beale IV

      Add into this equation getting surprised after surgery that your anesthesiologist isn’t “In-Network”, and you have an $11k stop-loss for Out-of-Network care….

    2. Richard

      What I’ve found helpful and healthful in the past: A medical practioner sitting across from me, making eye contact, mostly just listening, then examining and then using their wealth of learning and experience to treat me. Completely transparent through the process, so I can understand, or ask questions, and fully help get myself better.
      Here’s what I run into too often: They ask questions, I answer, and they’re starting at a monitor most of the time. They’re running through a protocol, which puts any concerns, questions or “extraneous” information I have at the end of the line. This is pretty much the opposite of caring behavior, and with that in mind, it can’t possibly contribute to best practice for treatment.

      1. JTMcPhee

        Algos to the rescue? I like (not at all) having a “medical scribe” tickling the keyboard of her laptop, sitting off to the side, listening with a blank face and supposedly taking down all the salient information that I impart to my “provider” and she imparts to her “client,” so it will be “flowed into the chart data” that supposedly captures all that is needed to be known about me medically, to ensure the Best Possible (note the conditionality of that word) Care. Though they somehow can’t ever get my medication list correct, since apparently the provider pulls up a copy of the note of my last office visit, which because of ‘code,’ undoes any changes that to correct the list. I’ve bothered to obtain copies of the notes, and it’s kind of appalling what mis-statements get carried forward and injected. And they report a medical history full of fanciful flights that have little to do with what I have experienced. Though of course that is now my “permanent record,” that if I change providers may or may not get “flowed” into the data base of the next Electronic Medical Record System. And if it does get “flowed,” it will be through some filter or over some rocky stream bed that induces lots of flat-out turbulent falsehoods and misinformation, of the sort that is guaranteed, at some point, to result in what the “profession” calls one or more “signal events,” those nosocomial and iatrogenic medical whoopsies that result in morbidity or mortality…

        Maybe my experience as a nurse is with clinics of a particular type, with patients with chronic and serious problems, strokes, spinal cord and brain injuries, para- and quadruplegia, skeletal problems, neuropathy and so forth. Not your basic primary care office. Though I have been in those often enough myself, and I don’t know where the commenter who says that there are a significant number of frequent flyer types infesting the waiting rooms of “providers” across the nation. Would dearly love to see what statistics might give any weight to that claim.

  12. Oregoncharles

    ” regular checkups, which are medically necessary.)”


    We were on the American Plan (don’t get sick) for a couple of decades. Now we’re on Medicare and can afford checkups, but I don’t notice that they help in the slightest, aside from maybe monitoring blood sugar. So I haven’t gone for a couple of years, which my doctor doesn’t like. I go when there’s a problem, and there are now enough to justify a visit when I get around to it. And just as there are people who would be there everyday if they could, there are those who are doctor-phobic and only go if they have to. My wife is one of them.

    1. Yves Smith

      Healthy people do not need annual physicals:


      However, if you are on any meds, even for something which is very stable and the meds really don’t need monitoring (ie, a blood test is probably all you need), the MDs are able to toll you into having a physical as a condition of renewing your scrip. A real racket. In Oz, doctors will do phone consults (I was paying out of pocket and in the early 2000s it was A$15) for an established patient, and a similar low cost for writing a scrip. You’d just need to go to a lab to get the monitoring test.

      1. Whoa Molly!

        > Healthy people don’t need annual checkups.

        Not my experience. I go to the VA for health care. They are big on annual checkups because it saves money. They catch problems before they kill people. Like silent cancer that can be cured if caught early.

        The problem is that people don’t always know when they are ill. A few diseases that come to mind: type 2 diabetes, high blood pressure, and cancer.

        This scheme works best if people can see the same doctor for decades. As soon as the “15 minutes with whichever doctor is available” policy starts, much of the benefit of an annual exam goes out the window.

  13. Summer

    “However, another way of saying this is that we’re optimizing our health care system to select for providers who have no problem throwing people under the bus for money.”

    Already optimized for that. So it’s not a matter of raising awareness or prevention, it’s how do you get out of the situation?

  14. Pat

    “Skin in the game” somehow never applies to corporate persons and/or the investment class.
    For instance why can’t we demand a small fee for every formerly made in the USA part, cookie, tv, etc. Or like all human persons make corporations prove they have earned their tax cuts to create jobs by showing the jobs that have been created in America in the last year.

    I am truly over the self righteous gate keeping of propaganda level memes like “Skin in the game” which rarely have any real purpose except to reduce, deny or eliminate things to improve, enhance, or just make bearable the life of th e masses. Don’t get me started on “failing schools”

    1. polecat

      I think “pound of flesh” is more precise, considering the Corpserate ghouls behind the nebulous white curtains, that run the whole fn show !!

    2. John

      Removing limited liability for corporate officers would put some of their “skin in the game”. Same thing for gun manufacturers and a host of others. I think it is a lot of skin in the game for thee, but little to none for me. Sorta like privatize the profits, socialize the costs.

  15. clarky90

    I have been studying to be a “gardener”. I came upon it late in my life. What I learned;

    “Feed the soil”.

    Grasses and ruminant animals (cattle, sheep, goats…), who ate the grasses, evolved, side by side, from about 25 million years ago. Ruminants turned the grass of the grasslands into the deep, black top-soils of Eastern Europe and North America.

    Cropping is destroying our top-soil.

    There is a huge push by “The Love Our Democracy Ecology Happiness and Peace Foundation” (quietly funded by Health Food Inc ) to vilify grazing animals and meat eating. “If we all ate plant based diets, everything would be Hunky-Dory again”. My ancestors fled Europe to escape from “plant based diets”. They were sick (literally) of being serfs, slaves, convicts, peasants.

    In fact, ruminant animals feed the soil. Cropping destroys the soil.

    “There is only one option, I’ll repeat to you, only one option left to climatologists and scientists, and that is to do the unthinkable, and to use livestock, bunched and moving, as a proxy for former herds and predators, and mimic nature. There is no other alternative left to mankind”.

    Allan Savory’s General Session address at the 2018 No-till on the Plains Winter Conference, Jan 30, 2018.


  16. crittermom

    Open thread, eh?
    Then I have to ask if anyone else (besides me) got a good belly laugh from watching the POTUS on TeeVee this morning (in reference to our borders) when he said that people have to show a picture ID when purchasing food?
    I noted even the reporters were incapable of stifling their laughs, as others asked when was the last time he’d bought groceries?
    Too funny.

    I think I may have finally fixed my sore neck from shaking it back & forth when I noted a story that said the NTSB had to get involved to tell people idiots that they should not be jumping out of moving cars to try & make YouTube with their version of a song. Idiots are getting hurt, it seems. Duh?

    Not having had TeeVee for thirty years but now receiving it for free where I live (I’d never pay for it), I find the news much more entertaining than any actual shows.
    Dissecting the commercials can be very interesting, as well.

    I suspect all the remakes of ‘old shows’ the networks are bringing back are to fool us into believing ‘our country is great again’, right?
    Opinions, readers?

      1. crittermom

        Lambert, you were carded? Lucky you.
        It’s been far too long since I was carded. I think I’m envious!

        1. crittermom

          Correction: I should have said his statement was in reference to voting rather than the border. I was probably still laughing/crying while typing it.

          I wish it WERE fake news instead of our POTUS.

          1. Edward E

            He is pretty messed up though… Recently “collusion is not a crime…” I’m wondering if we’ll see…
            Donny Boy’s tweet saying: “Indictment is not the same thing as conviction.”

    1. Carolinian

      Some of us would readily watch a news show or channel that promised to include no references to Donald
      Trump at all–just what’s happening in the rest of the country and the world. It would be beautiful, as DT might say.

      Same would have applied to Obama. Who has time for these preening peacocks?

    2. neighbor7

      Norman Mailer has an amusing account somewhere of dissecting TV commercials back in the 1950s when he was smoking a lot of marijuana.

  17. Plenue

    “To our knowledge, it’s the fullest empirical record to date of Russian trolls’ actions on social media, showing a relentless and systematic onslaught.”

    Once again, were these accounts attempting to ‘influence’ American politics, or were these bots attempting to gin up traffic for a clickbait ad scam? Where is the evidence that the IRA (that acronym though…) was running any sort of Kremlin operation?

    Just saying ‘Russian’ tells me absolutely nothing. Unless of course the goal is just to make me blindly hate and fear 144 million people based on their nationality, which is I game I refuse to play.

  18. Schtua

    The formatting here is confusing:

    50 * 12 * 2500 = $15,00,000

    You got the correct number of zeros but moved your comma. It should read:

    50 * 12 * 2500 = $1,500,000

    1. Whoa Molly!

      Looking at the condition of the Democratic party’s bench when he left office, I’d wager that he’s about 10 years too late for that particular activity. Good PR though.

  19. ewmayer

    o Re. “Trump is going to use America’s strong economic numbers to ensure a GOP midterm victory [NBC] … Democrats were left to grumble about the rich benefiting most…” – without the least sense of irony, apparently. Hmm, under which recent presidential administration did “the rich benefit most” from a surge in financial-asset prices? Nixon, maybe? No, that’s not it…

    o “How Sellers Trick Amazon to Boost Sales” [Wall Street Journal] — Another apparently-common seller scam I’ve seen both on eBay and Amazon: made-in-China products whose main product picture prominently displays an American flag.

  20. Summer

    Re: Open Office Spaces

    Just thought of another consequence: workers can also observe managment’s comings and goings better. Bad for morale when they peek how little upper management is actuallu doing….

    1. cyclist

      In a medium size company that I am intimately familiar with (ahem!) the execs have a row of a about a dozen parking spaces labeled CEO, VP, etc. It does not escape the attention of the proles how often most or all of them are empty on a nice summer day. I hope employees take that into account the next time they get one of those ‘sacrifices will be needed’ to meet the xxx goal meetings.

  21. Carolinian

    Re dropping Google–Google Reader has been gone for years. I don’t care for Feedly myself. Other than search I don’t use any of those other products except Google Code on rare occasions. Two biggies that are not mentioned: Android with all its Google apps and Gmail.

    And just for laughs I checked the page source for this very page and found eight references to Google in the HTML, not the body text.

    So even if dropping Google is virtuous, given their recent embrace of censorship (“fake” news filtering), it may not be so simple.

  22. Dale

    South Georgia plants cotton, peanuts, soybeans, field corn; vast timber tracts, after being clear cut, are being converted to pecan orchards.

  23. KimberStormer

    I’ll take the scooters over cars absolutely any day. People hate them because they’re not cars, which they’re used to; they hate bikes too, or anything that’s not cars. And I see lots of West Oakland teens riding and goofing around on them — they don’t seem nearly as de facto segregated as the public bikes. It’s not a choice between fun and public good, because they’re much more on the side of public good than the alternative of cars. I’d rather people be on bikes; I’d rather it all be publicly owned rather than for private profits; but these things seem to be working to me.

    I don’t have a smart phone, and I’m not a fan of the appification of the world. I’ve never taken an Uber and I never would. I think self-driving cars are a bullshit idea that would make things worse even if they ever worked, which I don’t think they ever will, and Musk’s tunnel nonsense is ludicrous, and the perennially stupid idea of PRT needs to die — but I don’t see what there is to dislike about the scooters, even if, quelle horreur, liberals and bourgie techies like them too. Get cars off the road, get people on the streets, as fast as humanly possible. If people don’t like them being left lying around willy-nilly, regulate them, fine — just take away one parking spot in like a hundred and make it scooter parking, something like that.

  24. audrey jr

    I will weigh in on the scooter problem today; and a problem it certainly is.
    I am currently on jury duty in the downtown San Diego Courthouse and the sidewalk takeover of these things must be seen – and experienced – to be believed.
    Yesterday I was almost knocked down by one that came around the corner at high speed and today while exiting the courthouse there were three scooters driving at high speeds and apparently manned by people traveling together which just missed taking down a homeless fellow in a wheelchair.
    I am aghast that there are myriad policemen standing around for these instances and that they do nothing about these vehicles with wheels and motors occupying pedestrian sidewalks in a busy downtown area.
    There would seem to be clear laws regarding motorized vehicles of any type being on sidewalks teeming with pedestrians and yet no one is ever stopped or even called out on these things.
    So, yeah, after a couple of weeks now encountering these scooters I can now attest via my own personal experience that these things are a real and dangerous hazard.
    Maybe my next jury assignment will be a tort case involving death or injury by scooter.

    1. Kurt Sperry

      The first time I visited Amsterdam I had some quite close calls with bicycles while walking. There is an obvious etiquette for riders and walkers that seems to prevent frequent collisions, although I’m not sure it’s been accurately codified or even written. It was particularly bad for me one Koningsdag when the streets in the center where closed to car traffic and pedestrians and bikes shared the roads. Even if you don’t consciously learn an explicit set of rules, you’ll develop an intuitive feel for how stuff works if an etiquette has developed.

      1. JJ139

        Basically, the rule is:
        if a car hits a cyclist, the car is automatically liable/in the wrong, unless the cyclist did something demonstrably stupid/illegal
        If a cyclist hits a pedestrian, the cyclist is automatically liable/in the wrong, unless the pedestrian did something demonstrably stupid/illegal.

        In other words, the onus is always on the faster/stronger to avoid accidents.

  25. Oregoncharles

    Children’s first words: ” I wonder how cross-cultural this would be….”

    Some version of “Ma” is remarkably cross-cultural; apparently because it’s usually the first thing babies say. It’s often the word for “mother” BECAUSE of that, not vice versa.

    That said, it’s very situational; my son’s first word was “hot” (pronounced “toh”), because we had a wood stove we were very concerned about. I let him touch it when it was hot, but not dangerous, so he knew what that word meant.

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