Later On

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

Archive for November 21st, 2013

Filibuster reforms short of abolition

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Kevin Drum explores some interesting alternatives.

So, the filibuster. Did Harry Reid do the right thing getting rid of it for judicial and executive branch nominees?

I’d say so. And yet, I think Republicans missed a bet here. I’ve never personally been a fan of the idea that the Senate’s raison d’être is to be the slowest, most deliberative, and most obstructive branch of government. Hell, legislation already has to pass two housesand get signed by a president and be approved by the Supreme Court before it becomes law. Do we really need even more obstacles in the way of routine legislating?

Still, I’ll concede that my own feelings aside, the Senate really was designed with just that in mind. It wasn’t designed to be an automatic veto point for minority parties, but it wasdesigned to slow things down and keep the red-hot passions of the mob at bay. So here’s what I wonder: why weren’t Republicans ever willing to negotiate a reform of the filibuster that might have kept it within the spirit of the original founding intent of the Senate?

What I have in mind is a reform that would have allowed the minority party to slow things down, but would have forced them to pay a price when they did it. Because the real problem with the filibuster as it stands now is that it’s basically cost-free. All it takes to start a filibuster is a nod from any member of the Senate, which means that every bill, every judge, every nominee is filibustered. The minority party has the untrammeled power to stop everything, and these days they do.

But what if filibusters came at a cost of some sort? . . .

Continue reading.

Written by LeisureGuy

21 November 2013 at 5:38 pm

Posted in Congress, Government

Superb example of chutzpah

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Kevin Drum has it. The weakness, of course, is that someone will propose a bill to cover those 8 million that the GOP is so concerned about it, and then we can enjoy once more the spectacle of the GOP fighting its own measure.

Previous episodes include the intense GOP battle against the GOP idea cap-and-trade, the hatred the GOP has for the GOP-designed (and adopted) healthcare model (the Heritage Foundation proposed it, the Republican governor of Massachusetts implemented it), and even Mitch McConnell filibustering his own bill in the Senate.

Gotta say this: they’re consistent. In an odd sort of way.

Written by LeisureGuy

21 November 2013 at 5:29 pm

Posted in Congress, GOP, Politics

Ding dong! The filibuster is dead! (For adminstration offices and judicial nominations)

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This is good news. As Ezra Klein points out in the Washington Post (in an article in which he lists 9 reasons this is a big deal):

The practical end of the Senate’s 60-vote threshold is not plunging the chamber into new and uncharted territories. It’s the omnipresence of the filibuster in recent decades that plunged the chamber into new and uncharted territories. At the founding of the Republic, the filibuster didn’t exist. Prior to the 1970s, filibusters — which required 67 votes to break for most of the 20th century — were incredibly rare.

killing-filibuster

5. As Gregory Koger, a University of Miami political scientist who researches the filibuster, told me: “Over the last 50 years, we have added a new veto point in American politics. It used to be the House, the Senate and the president, and now it’s the House, the president, the Senate majority and the Senate minority. Now you need to get past four veto points to pass legislation. That’s a huge change of constitutional priorities. But it’s been done, almost unintentionally, through procedural strategies of party leaders.” . . .

Written by LeisureGuy

21 November 2013 at 10:49 am

Posted in Congress

How things work when the GOP controls healthcare

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Texas is quite solidly in the grip of the GOP, which even now is closing down all the abortion clinics in the state—a highly dangerous step from the point of view of public health. Back-alley abortions are dangerous, and it’s silly to think that abortions will simply stop. They won’t, as we know from decades of experience. But it’s even worse: read this Texas Observer article by Dr. Rachel Pearson:

The first patient who called me “doctor” died a few winters ago. I met him at the St. Vincent’s Student-Run Free Clinic on Galveston Island. I was a first-year medical student then, and the disease in his body baffled me. His belly was swollen, his eyes were yellow and his blood tests were all awry. It hurt when he swallowed and his urine stank.

I saw him every Thursday afternoon. I would do a physical exam, talk to him, and consult with the doctor. We ran blood counts and wrote a prescription for an antacid—not the best medication, but one you can get for $4 a month. His disease seemed serious, but we couldn’t diagnose him at the free clinic because the tests needed to do so—a CT scan, a biopsy of the liver, a test to look for cancer cells in the fluid in his belly—are beyond our financial reach.

He started calling me “Dr. Rachel.” When his pain got so bad that he couldn’t eat, we decided to send him to the emergency room. It was not an easy decision.

There’s a popular myth that the uninsured—in Texas, that’s 25 percent of us—can always get medical care through emergency rooms. Ted Cruz has argued that it is “much cheaper to provide emergency care than it is to expand Medicaid,” and Rick Perry has claimed that Texans prefer the ER system. The myth is based on a 1986 federal law called the Emergency Medical Treatment and Labor Act (EMTALA), which states that hospitals with emergency rooms have to accept and stabilize patients who are in labor or who have an acute medical condition that threatens life or limb. That word “stabilize” is key: Hospital ERs don’t have to treat you. They just have to patch you up to the point where you’re not actively dying. Also, hospitals charge for ER care, and usually send patients to collections when they cannot pay.

My patient went to the ER, but didn’t get treatment. Although he was obviously sick, it wasn’t an emergency that threatened life or limb. He came back to St. Vincent’s, where I went through my routine: conversation, vital signs, physical exam. We laughed a lot, even though we both knew it was a bad situation.

One night, a friend called to say that my patient was in the hospital. He’d finally gotten so anemic that he couldn’t catch his breath, and the University of Texas Medical Branch (UTMB), where I am a student, took him in. My friend emailed me the results of his CT scans: There was cancer in his kidney, his liver and his lungs. It must have been spreading over the weeks that he’d been coming into St. Vincent’s.

I went to visit him that night. “There’s my doctor!” he called out when he saw me. I sat next to him, and he explained that he was waiting to call his sister until they told him whether or not the cancer was “bad.”

“It might be one of those real treatable kinds of cancers,” he said. I nodded uncomfortably. We talked for a while, and when I left he said, “Well now you know where I am, so you can come visit me.”

I never came back. I was too ashamed, and too early in my training to even recognize why I felt that way. After all, I had done everything I could—what did I have to feel ashamed of?

UTMB sent him to hospice, and he died at home a few months later. I read his obituary in the Galveston County Daily News.

The shame has stuck with me through my medical training—not only from my first patient, but from many more. I am now a director of the free clinic. It’s a volunteer position. I love my patients, and I love being able to help many who need primary care: blood pressure control, pap smears, diabetes management. We even do some specialty care. But the free clinic is also where some people learn that there is no hope for the chemotherapy or surgery that they need but can’t afford. When UTMB refuses to treat them, it falls to us to tell them that they will die of diseases that are, in fact, treatable.

St. Vincent’s is the primary care provider for more than 2,000 patients across Southeast Texas. Our catchment area is a strip of coastal plain strung with barrier islands. Drive inland and you start to see live oaks; go toward the coast and the oil refineries loom up over neighborhoods. The most polluting refinery in the nation is here, in Texas City. Our patients are factory workers, laborers, laid-off healthcare workers, the people behind the counters of seafood restaurants. . .

Continue reading.

Written by LeisureGuy

21 November 2013 at 8:30 am

Posted in Healthcare

A cleaner-burning wood stove

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My grandmother used a wood stove to heat her house, and as a boy I enjoyed making the fire, poking sticks into the flames, and so on. But woodstoves now are high-tech, as described in the NY Times by Matthew Wald:

Only blocks away, the Energy Department manages the search for quarks and NASA scours the heavens for Earth-like planets. But inside a big white tent on the National Mall, the focus is on something simpler: oak, ash and elm, and how to make them heat a house with as little pollution as possible.

It is not rocket science, but the 12 teams that are competing to solve the problem are finding ways to get twice as much heat out of a log of firewood. The effort preserves woodlands, reduces the labor and expense for the mostly low-income people who use wood, and cleans the air.

The stoves on display here, in a tent with a dozen chimneys incongruously poking through the roof, use combinations of computer controls, catalytic converters and sophisticated gas-flow modeling.

“It’s a combination of low tech and high tech,” said James B. Meigs, one of the judges. “It’s a humble area that doesn’t get enough attention.”

Late Tuesday, the judges announced a winner, based on efficiency, cleanliness, consumer appeal and price: an entry by Woodstock Soapstone, of Woodstock, Vt., which builds stoves that are not only clean and efficient, but are intended to be eye-catching, too. The company was awarded $25,000, but the bragging rights are probably worth more, said John Ackerly, president of the Alliance for Green Heat. His group ran the competition, which was sponsored by the New York State Energy Research and Development Authority, the federal departments of Energy and Agriculture, Popular Mechanics magazine and others.

Mr. Ackerly, citing census data, said wood was the primary source of heat for about 2.3 million American households, largely in rural areas.

Wood stoves typically deliver only 40 to 50 percent of the energy potential of the wood in the space they are supposed to heat. Some of the models in the competition deliver more than 90 percent and make the smoke cleaner. In wood stoves, cleanliness and efficiency turn out to be the same thing.

“If you can see it, if you can smell it, that’s energy that isn’t heating your house,” said another judge, Philip K. Hopke, a professor at Clarkson University and the director of the Institute for a Sustainable Environment there. Parts of the smoke that can be smelled or seen are particles and gases that failed to burn, Professor Hopke said.

The stoves are mostly cast iron or steel, and some are covered in enamel or soapstone. They look like low-tech devices, but in the tent they have been hooked up to digital meters that count their output of carbon monoxide and fine particles, which, like the particles from coal plants, cause respiratory problems. In places with many stove-equipped houses and unfavorable topography, the particles can build up to high concentrations.

A successful stove produces a white ash, made up of minerals like silica, calcium and magnesium, and not much else, because all the wood has been burned. Managing the combustion for efficiency and cleanliness — a problem recognized for hundreds of years — means providing just enough air for thorough burning, but not too much because the more air that enters, the more heat leaves the room as exhaust. Some stoves use oxygen sensors, like the ones in cars, to adjust a fan or valve to keep the balance right. . .

Continue reading.

Here’s a Popular Mechanics article about one of the entries, which sounds quite intriguing.

Written by LeisureGuy

21 November 2013 at 8:25 am

Posted in Technology

“Best healthcare in the world” – Not the US, for sure.

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However, the Affordable Care Act will help a lot once it’s up and running—and it will not only improve the nation’s health (because millions and millions will at last be able to get healthcare), it will save money. Look at the Congressional Budget Office calculations of Medicare and Medicaid costs over the past few years (Aug 2010, Aug 2011, Aug 2012, May 2013):

medicareoutlays

The chart is from a WaPo article by Sarah Kliff, which explains that this decline is probably structural, not cyclical.

But the US has a lot of catching up to do. I urge you to look at the charts in Sarah Kliff’s article comparing US healthcare expenditures and outcomes with those of other countries. We are doing a very poor job. Click that link and see.

I have an acquaintance who strongly opposes the Affordable Care Act, much less a universal single-payer system as used in more advanced countries, because providing healthcare to the poor will “create dependency.” Better that they die, apparently.

Written by LeisureGuy

21 November 2013 at 8:07 am

Posted in Government, Healthcare

Fine shave

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SOTD 21 Nov 2013

My second Petal Pusher Scent-off shave, this time with a horsehair brush, as shown. Lather comments later, but with an Astra Superior Platinum blade in the vintage Merkur slant, I easily achieved a smooth finish. A good splash of D.R. Harris Pink Aftershave finished the job. Based on the color, I thought this was a rose-fragranced aftershave when I purchased it, but it’s not. But it’s quite bracing and pleasant.

Written by LeisureGuy

21 November 2013 at 7:44 am

Posted in Shaving

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