Later On

A blog written for those whose interests more or less match mine.

How healthcare is delivered in the US

leave a comment »

Nicholas Kristof provides an example in the NY Times:

For a man who needed 18 teeth pulled, Daniel Smith was looking chipper.

Anxious, too, for he was facing a pair of forceps. But Smith, 30, a contractor with no health or dental insurance, who hadn’t seen a dentist in more than 20 years, was looking forward to an imminent end to the pain and rot in his mouth.

“I’ve always worked, since I was 14, but I’ve never had dental insurance,” Smith told me. After his teeth are out, he has a lead on low-cost dentures.

“I’d like to have a straight smile,” he said. “I’ve never had one in my life.”

All around Smith were uninsured patients receiving free dental or medical care, including dozens of men and women in side-by-side dental chairs in the open air. Organizers mercifully arranged the long line of people waiting to have teeth pulled so that they were facing away from those currently enduring extractions.

The patients swamped the county fairground here for a three-day health extravaganza of free care organized by Remote Area Medical, an aid group that holds these events across the country. This one involved about 1,400 volunteers serving 2,300 men and women who needed care of every kind.

Some patients camped out for three days at the fairground gate before the clinic opened to make sure they would be treated.

The health fair reminded me of scenes I’ve witnessed in refugee camps in South Sudan. But here in America?

The sight is a wrenching reminder of how many Americans slip through the cracks. No other advanced country permits this level of suffering — and if the G.O.P. health care plan goes through, millions more will lose their health coverage.

“Walking around, listening to people, it breaks your heart,” said Gov. Terry McAuliffe, a Democrat, whom I encountered on the fairground. “We need a healthy work force, and this is a disgrace.”

“Shame on us as a nation,” McAuliffe added. “This is an embarrassment to our country.”

That’s what I feel, too: humiliation that Americans need to be rescued by a group originally intended to help people in the world’s poorest countries (mixed with pride at the altruistic spirit that attracted so many volunteers, paying their own expenses to come here). To me, the fundamental lesson is that even under Obamacare, too many people don’t have coverage, and we urgently need a single-payer universal health care system along the lines of Medicare for all.

Remote Area Medical is the brainchild of Stan Brock, 81, a onetime British cowboy who in the 1950s managed one of the world’s biggest ranches, overseeing 50,000 cattle in Guyana in South America.

When he was badly injured by a wild horse, Brock was told it would be a 26-day hike to the nearest doctor. So he recovered on his own — but began to think about supplying health care to deprived areas.

Brock ended up founding Remote Area Medical to work in places like the Amazon, Haiti and Uganda. But then one day he had a call from Sneedville, Tenn., where the hospital had just closed and the dentist moved out. “Can you come here?” the caller asked.

Brock loaded a dental chair on the back of a pickup truck and brought in a dentist as well — and 150 people lined up, desperate for oral care. The result is that while it continues some international work, Remote Area Medical also treats people in the world’s superpower.

Brock is a character: He discovered a species of bat that is named for him, and today he has no home but unrolls a pad each evening and sleeps on the floor of Remote Area Medical’s permanent offices in Tennessee. At 5 a.m. on the first day here, Brock opened the gate and began admitting people eager for care.

As they surged past, many stopped to thank him; one man had tears in his eyes as he did so.

“I wish Mr. Trump would come,” Brock told me. “The health of these people is appalling.” . . .

Continue reading.

Written by LeisureGuy

27 July 2017 at 11:59 am

The tangled path DNA testing can take

leave a comment »

Full disclosure: I am awaiting the results of my 23andme test. So I found this lengthy report in the Washington Post of particular interest. Libby Coleman writes:

Five years ago, Alice Collins Plebuch made a decision that would alter her future — or really, her past.

She sent away for a “just-for-fun DNA test.” When the tube arrived, she spit and spit until she filled it up to the line, and then sent it off in the mail. She wanted to know what she was made of.

Plebuch, now 69, already had a rough idea of what she would find. Her parents, both deceased, were Irish American Catholics who raised her and her six siblings with church Sundays and ethnic pride. But Plebuch, who had a long-standing interest in science and DNA, wanted to know more about her dad’s side of the family. The son of Irish immigrants, Jim Collins had been raised in an orphanage from a young age, and his extended family tree was murky.

After a few weeks during which her saliva was analyzed, she got an email in the summer of 2012 with a link to her results. The report was confounding.

About half of Plebuch’s DNA results presented the mixed British Isles bloodline she expected. The other half picked up an unexpected combination of European Jewish, Middle Eastern and Eastern European. Surely someone in the lab had messed up. It was the early days of direct-to-consumer DNA testing, and’s test was new. She wrote the company a nasty letter informing them they’d made a mistake.

But she talked to her sister, and they agreed she should test again. If the information Plebuch was seeing on her computer screen was correct, it posed a fundamental mystery about her very identity. It meant one of her parents wasn’t who he or she was supposed to be — and, by extension, neither was she.

Eventually, Plebuch would write to Ancestry again. You guys were right, she’d say. I was wrong.

We are only just beginning to grapple with what it means to cheaply and easily uncover our genetic heritage.

Over the past five years, as the price of DNA testing kits has dropped and their quality has improved, the phenomenon of “recreational genomics” has taken off. According to the International Society of Genetic Genealogy, nearly 8 million people worldwide, but mostly in the United States, have tested their DNA through kits, typically costing $99 or less, from such companies as 23andMe, and Family Tree DNA.

The most popular DNA-deciphering approach, autosomal DNA testing, looks at genetic material inherited from both parents and can be used to connect customers to others in a database who share that material. The results can let you see exactly what stuff you’re made from — as well as offer the opportunity to find previously unknown relatives.

For adoptees, many of whom can’t access information about their birthparents because of closed adoption laws, DNA testing can let them bypass years, even decades, of conventional research to find “DNA cousins” who may very well lead them to their families.

But DNA testing can also yield uncomfortable surprises. Some testers, looking for a little more information about a grandparent’s origins, or to confirm a family legend about Native American heritage, may not be prepared for results that disrupt their sense of identity. Often, that means finding out their dad is not actually their dad, or discovering a relative that they never knew existed — perhaps a baby conceived out of wedlock or given up for adoption.

In 2014, 23andMe estimated that 7,000 users of its service had discovered unexpected paternity or previously-unknown siblings — a relatively small fraction of overall users. The company no longer provides data on surprise results. However, its customer base has more than doubled since 2014, and now contains more than 2 million people — and as more people get involved with recreational genomics, bloodline surprises are certain to become a more common experience. The 2020s may turn out to be the decade that killed family secrets, for better and for worse.

“We see it every day,” says CeCe Moore, a genetic genealogist and consultant for the PBS series “Finding Your Roots.” She runs a 54,000-person Facebook group, DNA Detectives, that helps people unravel their genetic ancestries. “You find out that a lot of things are not as they seem, and a lot of families are much more complex than you assume.”

Alice Plebuch found herself in this place in the summer of 2012. To solve the mystery of her identity, she needed more help than any DNA testing company could offer. After all, genetic testing gives you the what, but not the why.

Plebuch would turn out to be uniquely suited to the role of private eye in her own detective story. Now living in the suburbs of Vancouver, Wash., she worked as an IT manager for the University of California before her retirement. “I did data processing most of my life, and at a fairly sophisticated level,” she says. Computers do not intimidate her, and neither do big questions that require the organization and analysis of complex information. She likes to find patterns hidden in the chaos.

Just the skills necessary to solve a very old puzzle. . .

Continue reading.

It’s long, and there are surprises.

Written by LeisureGuy

27 July 2017 at 11:41 am

Posted in Daily life, Science

Scaramucci does a better job on CNN than a dead mackerel would do. Watch it.

leave a comment »

James Fallows points out a jaw-dropping performance from Anthony Scaramucci (who I note is careful to say that he met with “the President of the United States” so that we don’t think he met with the President of, say, Paraguay. Fallows writes in the Atlantic:

More than two years ago, soon after Donald Trump entered the presidential race, I noted online that no one like him—with no political, military, judicial, or public-service experience, with no known expertise on policy matters, with a trail of financial and personal complications—had ever before become president. Therefore, I said, it wasn’t going to happen this time.

Quite obviously that was wrong. Penitent and determined to learn from my errors, I’ve avoided any predictions involving Trump and his circles ever since.

But a few days ago, I edged back into the danger zone, after my very first look of the just-named White House communications director, Anthony Scaramucci, on TV. Via the ever-perilous medium of Twitter, I observed that he seemed more at ease on camera than Sean Spicer ever had, and less committed to flat-Earth stonewalling denials than Kellyanne Conway or Sarah Huckabee Sanders. Maybe his smooth-schmoozy approach would be what the Trump team needed? Maybe the press should get ready to be handled by a pro?

Ooops. That looks wrong, too. Scaramucci’s half-hour live call-in to Chris Cuomo on CNN’s New Day this morning was unlike anything ever witnessed from other political “communicators,” and not in a good way. Among its charms is one David Graham quickly noted: Scaramucci’s off-hand reference to his relationship with Reince Priebus as being “like brothers” — as in “Cain and Abel.” I’m not quite sure which role—Cain as killer, or Abel as victim—Scaramucci thought looked better for him.

The whole thing, embedded below, is riveting, in a “Darwin Awards” or demolition-derby way. Congrats to Chris Cuomo for keeping his cool. I’d predict that your jaw will drop further, the longer you watch and listen—but that would violate my newly reinforced commitment to avoid any forecast whatsoever about Donald Trump and his team. Still, give it a look.

The clip begins with Scaramucci trying his best to repair the obvious damage from a stupid and uninformed tweet, well described by Kevin Drum in his post “How Long Can the Mooch Last?“, a post well worth reading before you watch the video (really, an audio).

Written by LeisureGuy

27 July 2017 at 11:05 am

The response from the Chairman of the Joint Chiefs of Staff

leave a comment »

Watch the brief video.

Trump is losing support left and right.

See also this CNN story: US Joint Chiefs blindsided by Trump’s transgender ban.

Written by LeisureGuy

27 July 2017 at 10:48 am

Donald Trump Eats First

leave a comment »

Conor Friedersdorf writing in the Atlantic:

This week, as Donald Trump publicly attacked Attorney General Jeff Sessions, an assault one restrained observer described as “a multitiered tower of political idiocy, a sublime monument to the moronic, a gaudy, gleaming, Ozymandian folly,” even David Horowitz, the anti-Leftist intellectual and author of Big Agenda: President Trump’s Plan to Save America, felt compelled to admit something to his Twitter followers: “I have to confess, I’m really distressed by Trump’s shabby treatment of Sessions.”

Trump has always been vehemently opposed from the left and distrusted on the right by Never Trump conservatives, who continue to be dismayed by his behavior. But this week as never before, public doubts surfaced among Trump boosters and apologists, prompting Jay Cost to quip, “at the end it’s just gonna be Sean Hannity huddled in a corner, quietly whispering to himself that Trump is a great American.”

Trump’s attack on Sessions is the biggest reason. Victor Davis Hanson, who made the case for Trump to National Review’s readers before the election, characterized it this way:

If Trump were to fire Sessions, it would be suicidal; if he thinks berating him encourages other independent and respected cabinet officers to get in line, he is sorely mistaken; if he moves on, lets Sessions do his needed work, and forgets this unfortunate diversion from critical issues, he will be wise.

Tucker Carlson, whose  Fox News program panders to the right’s populist mood at every opportunity, has repeatedly criticized Trump over Sessions, suggesting he’s concluded that the position won’t damage his populist credibility.

And Breitbart, typically among the most sycophantic pro-Trump web sites, has openly criticizing the president, publishing a Matthew Boyle bylined article, “Jeff Sessions: A Man Who Embodies the Movement That Elected Donald Trump President.”

Its scolding of Trump includes these passages:

  • “Sessions was a critical part of the ‘movement’ that elected Trump to the presidency. Losing Sessions could endanger the administration and the split the critical coalition that helped Trump to the presidency. Doing that is something Trump supporters nationwide do not want to see … it might be wise for the president to slow down and think about this one before he fires away too harshly and quickly.”
  • “Sessions, the intellectual leader of the future of the conservative movement, has provided the brainpower behind the populist nationalist revolt against political elites…”
  • “Only a handful of House GOP members and some Republicans from around the country had gotten on board with Trump’s campaign by this point. But in Madison, Alabama, Sessions stepped up to endorse Trump. He became the first U.S. Senator to back the now-President of the United States. It was, as we reported at the time, a ‘game change’ moment in the campaign—as big a deal as any other moment over the two years of Trump’s meteoric rise to the Oval Office.”

As Trump’s treatment of Sessions provides another stark example of his willingness to betray those around him, more general mistrust of the president seems to be growing, reflected not only in his dismal approval ratings, but also in anecdotes like one Rush Limbaugh offered on his talk-radio show the morning after the president celebrated himself at a campaign-style rally in Youngstown, Ohio:

I got a lot of complaints about Trump at the rally last night. They loved it, but they thought it was six-month-old stuff. They said, ‘Hey, you don’t need our vote. We already voted for you. What is this, a campaign rally? We love you. We love you already. Do the agenda! You should tell us what’s wrong in Washington. Tell us what you’re up against so we can help you out. Don’t tell us what we already heard during the campaign.’ I’m hearing that complaint. I don’t think that’s the way to look at it, folks.

Rush Limbaugh is wrong. Trump is failing to govern in the manner that he promised his voters. And insofar as they are getting suspicious, that is warranted, even if the talk radio host is back to his habit of carrying water for Republican hucksters, rather than leveling with the listeners who are taken in by his golden voice.

Trump is even giving anti-Trump conservatives new reasons to lament his rise.

At National Review, veteran David French, an earnest commentator who agrees with the substance of banning transgender Americans from the armed forces, complained that the president announced that policy in a most irresponsible, counterproductive manner. And Charles C.W. Cooke, a principled conservative who is allergic to anything resembling groupthink that emanates from the mainstream media, finds Trump wearing on his patience after the president has spent just six months in the White House.

He writes:

Calvin Coolidge was a great president not solely because he sought to limit the federal state, but because he did not feel a need to inject himself into the nation’s consciousness every single day. Donald Trump is the least Coolidge-like president we have ever had. Compared to him, Barack Obama looks like a Carthusian monk. Every morning Trump is in the United States is a morning during which he is drawing attention to himself.

The pattern is familiar: He wakes up, he picks up his phone, and he throws grenades onto Twitter—most of which, it should be said, rebound immediately off the wall and explode in his face. He announces policies in the most counter-productive way imaginable; he defends himself as might a cartoon character; he dredges up old fights and throws punches at skeletons. And then, of course, come the responses: Online, on Twitter, on TV, in the newspapers, in the magazines, on the streets, at the Oscars, at dinner tables across the land.

In effect, the president is deciding daily what America will discuss, and more often than not that “what” is him. Whatever one’s politics, this is extraordinarily unhealthy. The president is the head of the executive branch within a free republic, he is not a King or spiritual leader. When the government is as big as it is, we will inevitably be forced to care what he thinks.

But the attention that this man insists upon bringing upon himself transcends that inevitability, and ranges into the realm of narcissism and vaingloriousness. This is, in other words, a choice. It is a decision that Trump is making, day in, day out. Those who want to live their lives without constantly being dragooned into endless political hostility should band together and speak with one voice: “Mr. President. Please, please, please be quiet.”

Then there is Rod Dreher. . .

Continue reading.

Written by LeisureGuy

27 July 2017 at 10:27 am

A Longtime Republican Senate Staffer, on John McCain

leave a comment »

James Fallows has an interesting post with remarks by Michael Logren:

I’ve had my say about John McCain’s decision to support the rushed consideration of the Republican drive to repeal Obamacare. Installment one was here, and two was here. The theme of both was that McCain missed a historic opportunity to match the scolding-and-uplift of his much-praised words, about the need to avoid simple fights for partisan victories, with the weight of his actual votes, which in the crucial showdown this week supported just such partisan warfare.

Now Mike Lofgren, who spent 28 years as a Congressional staffer mainly working for Republicans, and has since then become a noted author of The Party Is Overand The Deep State, writes in about the McCain he came to know from long observation on Capitol Hill. I’ve learned over the decades to take what Mike Lofgren says seriously, and in that spirit I invite close reading of what he has chosen to say:

Let us respectfully acknowledge John McCain’s past sacrifice to the United States and his present health struggles. Still, the media’s fawning over both his return to the Senate and his sanctimonious jeremiad against partisanship is difficult to bear. He rightly excoriated a grotesquely unfair Senate process, but then became the deciding vote allowing that process to move forward. Compounding his duplicity, he claimed he could not support the underlying legislation, but a few hours later voted in its favor—although nine of his Republican colleagues found the courage not to, defeating the measure.

Regardless of his vote on subsequent health care measures, should one of them pass and deprive millions of Americans of health insurance, McCain will have been the key enabling factor. The “Conscience of the Senate” would deny to those Americans the blessing which he takes for granted. But this chasm between his pretenses and his behavior has been a consistent feature of his Senate career.

His rhetorical denunciation of torture during the Bush years was loud and long—yet he never followed up, despite the fact that his moral prestige as a former POW would have carried great legislative weight. A ban on torture came only with Obama’s executive order. Likewise, a persistent feature of his career has been to bitterly scold pork-barrel spending in defense bills.

Yet, invariably, he fails to offer amendments to remove those offending provisions; nor does he vote against the underlying bill. As a staffer, I recall that almost all Senate Republicans, hardly a sensitive and swooning lot, really couldn’t stand his moral preening. But his tactics were a mechanism by which McCain got cheap credit from a lazy press looking for the One Righteous Republican they could lionize.

None of us vain creatures can bear scrutiny of the gap between our words and our deeds—but few, I fear, would suffer from that scrutiny more than John McCain.

His present obeisance to the reptilian Mitch McConnell, his strange non-reaction to Trump’s sliming of his wartime service, and his curious passivity towards the Bush campaign’s scurrilous attack on his family (later supporting Bush’s reelection as he stood by while Karl Rove defamed fellow Vietnam vet John Kerry), are all inexplicable incidents if one believes the standard narrative about McCain. The man who inflicted Sarah Palin on our suffering country and started us on the inevitable slide to the nightmare of Donald Trump is a far more complex, interesting, and fraught human being than the heroic caricatures depicted in the establishment media. . .

Continue reading.

Written by LeisureGuy

27 July 2017 at 10:20 am

iKon open-comb and Phoenix Artisan Honeysuckle soap with WSP Baroness

leave a comment »

Instant great lather from Phoenix Artisan’s Honeysuckle shaving soap—great in fragrance, great in consistency. The Baroness is a very nice little brush with a knot that, though full, is not dense: very good capacity and very nice action.

I used the iKon open-comb with the bar alignment, and again it struck me as slightly less comfortable than the iKon Shavecraft short-comb. Both are excellent in terms of efficiency, and certainly I found the razor today comfortable and not inclined to nick (and it didn’t), but the Shavecraft short-comb is just a bit more comfortable and feels smoother on the face. Next step is to change the baseplate and try the bar-guard baseplate.

Three passes, a fine result, and a splash of Phoenix Artisan Cavendish to get me through the day.

Written by LeisureGuy

27 July 2017 at 10:13 am

Posted in Shaving

%d bloggers like this: