Chaos Manor View, Tuesday, March 29, 2016
“This is the most transparent administration in history.”
Liberalism is a philosophy of consolation for Western Civilization as it commits suicide.
Under Capitalism, the rich become powerful. Under Socialism, the powerful become rich.
Under Socialism, government employees become powerful.
The AT&T technician is here, and he has looked into my outside box and now has to go down the street; so it looks as if the static in my landlines is theirs, not mine, and Roberta’s call to the phone company – the number on the bill, NOT 611 which is fruitless misery – has paid off. Now my phones are dead. A call to the house phone on my cellphone produces endless ring, no answer, on the cellphone, but it doesn’t ring here at all. Hope that’s a good sign, but it’s been fifteen minutes and there is no sign of him.
Ah. He’s back, and closing up the box. We still have static, but it’s not as bad as it was. Can’t use the phone for radio interviews, but it’s usable. The phone technician was a middle aged white guy. I told him of our attempts to use 611, and he laughed like hell. Apparently no one ever gets him through 611. You have to use the number on your phone bill.
There’s enough static that I’m going to have to do this again if it doesn’t go away in a week or so, but at least we have the phone now. ‘Tis not so loud as a bell, nor so large as a church door, but ‘tis enough, ‘twill serve.
And Lo! He’s back, having discovered the problem in another test just to be sure – and he’s fixing it now. It’s like the old Phone Company, competent technicians who cared, and an office bureaucracy that didn’t. And now he’s done, something on the outside box, and there is no static at all. Loud dial tone, no static, everything great again. Hurrah. And no cost.
The article from the Washington Post about colonoscopies and the Sedasys machine had one major error.
“And sedation with the Sedasys machine cost $150 to $200 for each procedure, compared to $2,000 for an anesthesiologist, one of healthcare’s best-paid specialties. “
While anesthesia is a well paid specialty, I’m not sure where they got $2000 cost for colonoscopy sedation by an anesthesiologist. My wife is a recently retired anesthesiologist and the outpatient surgicenter where she worked did many colonoscopies each day. The charge from her group was well below that figure.
Anesthesia is different from most specialties in that they charge by “relative value unit”. A procedure is billed by taking the “base units”, a measure of how complex the case is and accounts for time talking to the patient and reviewing records; adding units if the patient is especially ill or has complicating factors (transfusion required, heart problems, grossly obese, diabetes, etc.); and adding units for time, one every 15 minutes. A typical colonoscopy on a healthy patient would have 3 base units and last about 20-30 minutes time for 2 more units. So a typical case would charge 5 units. In 2014, the median charge for a unit in the US was $66 according to a study I found. So a typical case would be charged $330. The highest charge in the US was $200/unit somewhere in the northeast, for a charge of $1000.
So the Sedasys had a fee of $150-200 to Johnson and Johnson, plus there would be a fee from the facility for hooking you up to the monitors and the IVs. Net – not much savings and higher risk to the facility in case of something going wrong. And if something does go wrong, the GI doc doing the colonoscopy would need to get situational awareness to figure out what to do, or wait for an anesthesiologist to be summoned. (This is one of the things the human factors experts worry about in automated cars and planes, getting oriented when things go pear shaped.)
One thing that TV and movies get wrong is that if a surgical patient “crashes”, the anesthesiologist is in charge and barks out orders, not the surgeon. The anesthesiologist is in charge of patient care. They are your advocate in the OR. They are there “to keep you alive while the surgeon tries to kill you”. It is also one of the specialties trying to figure out what goes wrong and how to prevent it in the future. Every closed malpractice claim against an anesthesiologist in the US is studied for that purpose and any trends and other findings sent out each quarter.
Thank you for the data – information, actually. I know little about anesthesiology, although my mad friend’s widow was an anesthesiologist and professor of medicine at USC medical school and teaching hospital. Haven’t seen her for years, of course, and I’ve quite lost track of the field. If a live doctor is only $300 and letting a machine do it is $299, I know I’d choose the human; which is probably why they aren’t going to make this robot any more. This year. I suspect we have not heard the last of it, though.
The Tiresias program which did diagnostics from its internal data base after being fed patient data information was said to be pretty successful back in the early 80’s; I don’t hear much about it lately. It seems to have evolved into an expert system and not to have gone much further; and I don’t hear much about medical diagnostics programs any more. I see I enquired about this sixteen years ago http://www.jerrypournelle.com/archives2/archives2view/view103.html without much result.
At one time, the idea of using computers in medical diagnosis was a big deal; and it actually scared some young interns who feared that computers would put them out of a job. Since then computers have got more powerful, but their utility in medical diagnosis gets little attention. I’m not sure why.
After all, good medical diagnosis is very much like flying an airplane: before you take off, you go through an elaborate mandatory check list, and if you get past that, you can go. Lately, even the go process is mostly pushing buttons and turning the job over to a robot.
Same with medical diagnosis: you list symptoms, take a clinical history, and compare to what you learned in medical school; there’s some room for intuition, but not a lot: the check lists, whether written or memorized, pretty well govern the process.
A robot does check lists better than you do.
I wrote many years ago about an episode that happened to a psychiatrist friend of mine who worked for the government, I think at Walter Reed at the time. He had a patient with some weird delusions who otherwise exhibited no symptoms that seemed familiar. My friend remembered a lecture he heard in medical school years before: rather part of a lecture, a casual mention of a rare tropical disease, one its symptoms being weird delusions. He asked the patient if he had been abroad recently.
Of course he had been; he was a Foreign Service Officer; and he had been in Borneo, to the specific place mentioned in the nearly forgotten lecture. It turned out that he had a rare parasite. My friend had never seen a case of that, nor had he ever met anyone who had. The story has a happy incident: they were able to cable to a hospital in Indonesia where one man had some familiarity with this, and he knew an Indonesian physician who knew more, and eventually they could correspond with someone who knew what to look for, and they found the parasite.
A good enough computer data base would know about the Borneo parasite, and would never forget it; and anyone connected tothe Internet could find out without having to recall a five minute segment of a lecture he heard fifteen years ago…
I suppose many diagnostic programs are in use now so routinely that no one thinks about them; but I suspect the era of robot expert systems being able to do diagnostics better than Dr House is only beginning; but it will come. No human can be a better expert that a robot which has access to everyone’s checklists…
Chicago Teacher’s Union Plans Day of Tantrum
Chicago Teachers Union executives have spent weeks whipping their members into a froth over this Friday’s planned classroom walkout.
They’ve stoked members’ anger over Chicago Public Schools’ bid to phase out a generous pension deal the near-bankrupt district can no longer afford.
They’ve whipped passions over the district’s decision to order furlough days because of a huge budget shortfall, and over its move to withhold a category of raises that’s based on teachers gaining further education and experience.
Still, the vote in the union’s House of Delegates to authorize the April 1 strike was a lopsided but far from unanimous 486-124.
That’s 124 union officials rejecting their leadership’s proposed one-day strike. That’s a big contingent of CTU delegates saying no, let’s teach our students that Friday, not spend the day brandishing banners and hollering slogans in the Loop for … what?
The hastily planned, unfocused Day of Tantrum that union leaders demand evokes a famous line in the 1953 movie classic “The Wild One.” Motorcycle gang leader Marlon Brando is asked what he’s rebelling against. “What have you got?” he retorts.
This is probably self-commenting. It can’t go on: punishing the pupils because the government won’t give the teachers’ unions what their leaders want. I invite comments from teachers. Chicago hasn’t the money. Must the pupils suffer?
Dear Mr. Pournelle;
I do question whether Trump “says what he thinks.” As I understand his business practice, he says what he thinks will make the deal. Typically, that has been some glittering fantasy.
Allan E. Johnson
I did not mean that Trump never calculates what he going to say; I do say he often does that. He doesn’t feel that his casual comments and expressions are an actual commitment; they’re more of a proposal, or rather, an invitation for comment. I don’t know Trump, but Newt Gingrich used to do that: say outrageous things in the sure and certain knowledge that one or more of his friends around him at the time would say, “Uh, not, really. That’s idiotic.” After which would follow a reassessment, a discussion, and from it quite possibly a good idea.
But the difference between skillful and professional politicians and Mr. Trump is that with the pro’s that seldom happens in public and you never hear anything but the considered and refined idea, not the beginning remark which may well have been imbecilic.
When Mr. Trump is paying attention because he is bargaining for a deal, I suggest you not only check your wallet often, but also that you be mindful of your back teeth.
The Ancient Agreement
Cats only moved in after dogs domesticated humans. This is the cause of the cat – dog feud. Dogs view cats as claim jumpers! 🙂
I like that notion.
How Clinton’s email scandal took root from The Washington Post
Subject: Oh yes…Climate Change – The Greatest-Ever Conspiracy Against The Taxpayer
Climate Change – The Greatest-Ever Conspiracy Against The Taxpayer
by James Delingpole
28 Mar 2016
Climate change is the biggest scam in the history of the world – a $1.5 trillion-a-year conspiracy against the taxpayer, every cent, penny and centime of which ends in the pockets of the wrong kind of people, none of which goes towards a cause remotely worth funding, all of it a complete and utter waste.
Here is an edited version of a speech on this subject I gave last week to the World Taxpayers’ Associations in Berlin.
More data and talking points for the Unbelievers and Deniers and Skeptics
Cryptography explained in understandable terms
Pretty good explanation of Cryptography:
What wasn’t discussed is salting, this is a good site for that, but beware, it’s considered a hacking site:
Is college worth it? Goldman Sachs says not so much (USA Today)
By Brooke Metz December 10, 2015 8:30 am
College is certainly an investment, but it’s worth it — right?
Maybe not, according to new research from Goldman Sachs.
The company said in a research note published in early December that the average return on college is falling. In 2010, students could expect to break even within eight years of finishing school. Since then, that has increased to nine years. And if this trend continues, students who start college in 2030 without scholarships or grants, it said, may not see a return on investment until age 37.
Recent graduates can relate to the report. Mary Kate Baumann, a 2010 graduate of a private college in upstate New York who also graduated from journalism and business graduate programs at the University of Missouri this year, said, “My undergraduate education was over $200,000 in total and my first job paid only $28,000. That’s a large disparity.”
Goldman Sachs calculated the economic return on college education as the “total all-in cost of college (net of grants and scholarships) and the wages foregone during the 4 years of study versus the wage premium that undergraduate degree holders enjoy versus high school graduates over their working life.”
While the National Association of Colleges and Employers reported in October that the job market for grads has seen recent improvements, Goldman Sachs said wages still aren’t cutting it to make up for education costs.
Of course, many students still say college is money well spent.
“I think it’s worth it to grow as a person, and there are so many other experiences that college teaches you,” said Vanderbilt University senior Chris Wolk, who plans to go into the consulting field. “Involvement outside of class and learning how to balance your life and live independently is worth the cost of college.”
Wake Forest University senior McKenzie Ziegler, who plans to pursue a career in sports agency and representation, agreed. “College is extremely expensive,” she said, “but there is no price tag in terms of the conversations you hold and the community you make.”
Brooke Metz is a student at Wake Forest University and fall 2015 USA TODAY College web producer.
Has it got better? And the grade and high schools are deteriorating from an abysmal level…
post CoDO universe
I have long wondered if you were going to do a book on what happens after the events of Prince of Sparta? I am curious to see how that played out, bridge the gap between formation of the first Empire of Man, and the Sauron wars. I thank you for your time, and I have enjoyed all of your books!!!
I seldom write about what I don’t believe in, and the CoDominium vanished with the Berlin Wall; it might have been revived, but Clinton and Albright infuriated Putin to no discernable national interest or purpose, and no one has moved in that direction since.
I liked the CoDominium universe, but we are taking another path – and we didn’t develop faster than light either.
“It’s the Ikea of Neolithic monument building.”
The psychiatric matrix creates the politically correct victim – Personal Liberty®
Something to consider…
“Individual [Harvard law] students often ask teachers not to include the law of rape on exams for fear that the material would cause them to perform less well. One teacher I know was recently asked by a student not to use the word ‘violate’ in class — as in ‘Does this conduct violate the law?’ — because the word was triggering. Some students have even suggested that rape law should not be taught because of its potential to cause distress.” — Jeannie Suk, The New Yorker
“When you have medical services at colleges all over the country making psychiatric diagnoses and dispensing drugs, day in and day out, what do you suppose is going to happen to those students? They’re going to wear their mental-disorder labels like badges, and they’re going to think of themselves as vulnerable, and they’re going to look for new ways to prove how vulnerable they are. They’re going to say that hearing certain words can cause them to go into a tailspin…” — Jon Rappoport, The Underground
The current official list of mental disorders hovers at 300. That’s 300 separately defined, treatable and covered by insurance plans.
On a cultural level, this means the population is being tuned to the idea that they are vulnerable and at high risk. The right trigger at the right moment, a slight change in brain-chemical balance, and there it is: a disorder, with a title, a professional diagnosis and the need for treatment.
This cultural programming — no surprise — has been a major factor in influencing people to believe they are victims. The obsessive focus on politically correct words that could offend and traumatize is, in reality, an extension of the psychiatric matrix.
September 23, 2014
It’s Time to Take the Islamic State Seriously
Islam has no central or definitive body or figure authorized to define what exactly it is. Opinions about its essence and scope vary widely according to the political or philosophic background of its own interpreters. The current effort to establish an Islamic State, with a designated Caliph, again to take up the mission assigned to Islam, brings to our attention the question: “What is Islam?”
The issue of “terror” is a further aspect of this same understanding. Many outside Islam seek to separate “terror” and “Islam” as if they were, in their usage, independent or even opposed ideas. This latter view is almost impossible seriously to maintain in the light of Islamic history and the text of the Qur’an itself.
John Kerry, however, insists that what we see is “terrorism” with nothing to do with Islam. The Obama administration seems to have a rule never to identify Islam with “terrorism,” no matter what the evidence or what representatives of the Islamic State themselves say. The vice-president speaks of “Hell” in connection with actions of the Islamic State. Diane Feinstein speaks of “evil” behind the current slaughters in Iraq and Syria. The pope mentions “stopping aggression.” The English hate-laws prevent frank and honest discussion of what actually goes on in Islamic countries or communities in the West. Not even Winston Churchill’s critical view of Islam is permitted to be read in public.
Ecumenism and liberalism both, in their differing ways, because of their commitment to tolerance and free speech, make it difficult to deal with what is happening in Islamic states. Islam is not friendly to relativism or to subtle distinctions.
Is terror intrinsic to Islam?
What I want to propose here is an opinion. An opinion is a position that sees the plausibility but not certainty of a given proposition. But I think this opinion is well-grounded and makes more sense both of historic and of present Islam than most of the other views that are prevalent. I do not conceive this reflection as definitive. Nor do I document it in any formal sense, though it can be. It is a view that, paradoxically, has, I think, more respect for Islam than most of its current critics or advocates.
This comment is an apologia, as it were, for the Islamic State at least in the sense that it accepts its sincerity and religious purpose. It understands how, in its own terms, the philosophic background that enhances its view does, in its own terms, justify its actions, including the violent ones.
The Islamic State and the broader jihadist movements throughout the world that agree with it are, I think, correct in their basic understanding of Islam. Plenty of evidence is found, both in the long history of early Muslim military expansion and in its theoretical interpretation of the Qur’an itself, to conclude that the Islamic State and its sympathizers have it basically right. The purpose of Islam, with the often violent means it can and does use to accomplish it, is to extend its rule, in the name of Allah, to all the world. The world cannot be at “peace” until it is all Muslim. The “terror” we see does not primarily arise from modern totalitarian theories, nationalism, or from anywhere else but what is considered, on objective evidence, to be a faithful reading of a mission assigned by Allah to the Islamic world, which has been itself largely procrastinating about fulfilling its assigned mission.
Has there been any evidence that this analysis was wrong/
Freedom is not free. Free men are not equal. Equal men are not free.