JayB

The Boot! Can't say I was a regular there, but I do recall doing a bit of pre-liminary vow-testing with the then-fiancee' on the drive between Whistler and Lilloet after a certain relation of your's bachelor party. "So, what'd you guys do last night." "Well, uh, we ended up drinking quite a bit and then we went to this low-end strip joint and that had a mix of pros and lifties dancing for cash, and then the crowd goaded some late-30's trophy-wife swinger chicks from Bellevue into flashing the crowd and making out onstage." The fact that this testimony brought forth laughter instead of a scowl was a very good sign. "UP...ON...STAGE!"* Hahaha. I could swear I saw Extremo there in the crowd, scoring free table dances and showing the rest of the crowd how to..RIP IT UP!! LOL... I doubt that'll be a high priority couples-destination for us when we're out there in April, but do advise on the status after the trip.

Or maybe not... "Changes in the jet stream configuration will continue during the upcoming week, and by next weekend, we will see a ridge of high pressure building over the west coast of the U.S. and Canada. The polar vortex is finally being dislodged from the pole, which will help set up a cross-polar flow by the week of the 15th. Western Canada is growing colder, and that cold is spreading eastward across the Prairie Provinces, so the air that arrives from the high latitudes won’t moderate as much as in recent weeks. The first [profanity omitted] of cold will flow into the northern Rockies and northern Plains, but low level cold air will also be pressing into the east. With an upper level trough over the Southwest, the flow aloft over the East will continue to be from the west southwest, and as that air overruns cold, dense air near the surface, the stage is set for a series of increasingly colder systems to ride along the boundary. I think that during the week of the 15th, snow cover will be laid down from north to south with time, and sleet and freezing rain will be quite common in the transition zone. One of the analog winters that is very similar to what we have seen thus far in ’06 and ’07 is ’77-’78. Folks in the Northeast, particularly in southern New England, remember the Blizzard of ’78, which paralyzed the region and dumped upwards 54” of snow (Manville, RI). What isn’t so well remembered is the ice storm that preceded the blizzard by a couple of weeks, as the reversal from a very warm December and early January got underway. It would not surprise me at all to see a significant icing event or two as we transition back to winter over the next 2 weeks or so. North of any icing zone we will find more and more snow as the month progresses, and by the 20th or so, it looks to me as though an upper level trough will be anchored over the east, and cold air will be in the region to stay for a while. As long as the southern branch of the jet, reinforced by the weakening El Nino, doesn’t get suppressed too far to the south, we could be looking at a very stormy period in late January and early February. The jet will get pressed to the south as the cold air starts to become more dominant, which will push the mean storm track further south...that means that resorts in the southern Appalachians are going to get their fair share of snow from this turnaround, as well. Weak El Ninos typically produce back-loaded winters, and indications are that we are going to see that happen once again. The other analog years that most resemble this season, ’57-’58 and ’65-’66, also brought about a dramatic mid-winter reversal to cold that lasted through February and into March, so there is reason for optimism that once the cold air returns, it will dominate for the bulk of the remainder of the season. In the West, the pattern change is also good news. The Pacific Northwest and far northern Rockies, where heavy snows fell much of December as the Pacific jet roared ashore, have received a good [profanity omitted] of snow in the past several days, on the order of 2-3 feet in the Cascades. More snow is falling today, along with strong winds, so avalanche danger is going to rise rapidly this weekend. The pressing of arctic air into the region during the next week will produce drier snow, but when the upper level ridge takes shape along the west coast in the next week to 10 days, the jet energy will be deflected far to the north. That will effectively [profanity omitted] of the snow for a while in that region, but they have plenty “in the bank” for any dry run that may develop. The southern branch of the jet, again, fueled to some extent by the weakening El Nino, has generated snows in the southern Rockies (and Denver), and that part of the country will continue to pick up its fair share of fresh powder as we move through the winter. It’s the I-70 corridor from Salt Lake City to Denver that worries me a bit, as they look to be too far north for southern branch snow and not far enough east to collect from the Clippers that will move down the east side of the western ridge. I expect powder days to be down north of I-70 from late January onward, but overall, the snow thus far is more than enough to sustain the resorts. Ski areas that pick up lake effect snow (Michigan, Ohio, western PA, West Virginia, Maryland, and upstate New York) are about to cash in on an unusual mid winter bonanza. Water temperatures are in the low to mid 40’s...more like those found in early November, and very warm for January. When the seriously cold air flows over those lakes later this month, the snow squalls are going to explode, due to the extreme difference between the water surface temperatures and the air at 5,000 feet. Northern Vermont and the Eastern Townships of Quebec are included, too, as Lake Champlain is going to get in this act. We could see some obscene amounts of snow in lake effect resorts...of course, getting to that powder could be an issue to contend with, as well. While the change to winter will not come in one [profanity omitted], and the transition promises to be a messy one in many locations, but the message I want to convey in the strongest terms possible is that the change is coming, and it is going to be dramatic to produce some fantastic skiing and riding in areas where that notion is just about unimaginable right now. The season will be a shorter one, to be sure, but we do have some terrific days on the slopes to look forward to in the not too distant future."

I still think a reform or two would provide less opportunity for the public to get the wrong impression about this situation, and that nothing will galvanize public opinion in a manner that's contrary to the interests of folks who make their living persuing medical liability claims like a single payer system, but I am aware that there are quite a number of other factors to consider beyond the costs associated with medical liability. From my vantage point, it seems as though these costs are, at a minumum, having a very-real effect on the decisions people make about what speciality they want to practice, and where they want to practice it, and that this has implications that might also be worth considering - but again, that's part of a larger discussion.

Looks like I jumped the gun on the salvation front. It was like 70 today, and the rain in the Berkshires hit to late for me to make the drive out there to take advantage of the paddling to be had there. Hey Ken: I sprained the bejesus out of my thumb skiing, then managed to crush it between a rock and the hull of my boat just as it was recovering enough to climb on, so I have yet to touch anything outside of Damnation Gully at this point. Sad, sad, sad performance to be sure. I hope to redeem myself a bit before I serve out the end of my sentence here, but if weather like this makes itself a repeat visitor to these parts in the winter...

I think you are correct in that sense Mat. I don't think that public control over a given sector is always sub-optimal, and I think it's a safe assumption that no doctor that I know of intentionally goes about their job in an unsafe manner. The doctors that work at the VA, for example, don't seem to care about their patients any less, but I am not sure I'd be comfortable extending that model to the entire medical economy, especially the segment driven by innovation. I count myself amongst those who think that attorneys have played and do play a significant role in insuring that patients get quality care. This includes everything from doctors being careful to hospitals trying to devise redundant mechanisms to prevent lapses in care. Nothing focuses the mind like the prospect of a significant hit to the pocket-book. This isn't to say that I think that the role that they play is perfect, or couldn't be enhanced by some prudent regulatory reform - reform which, incidentally, might improve their public image quite a bit - but I am not sure that I'd necessarily want them to disappear from the medical ecosystem altogether. I am also not sure that the advantages and disadvantages associated with state control over a given sector are equal in all circumstances, but that is a topic for another discussion.

BTW - I know where insurance companies make most of their profits, so the problem must have been with my writing rather than my reading.

This is a sidebar, but under a single-payer system, I assume that the government also assumes responsibility for all of the costs associated with medical liability. I am not sure how it could be otherwise, but maybe someone can enlighten me here. Even if the premiums come out of the physicians' salaries, it's not terribly hard to see where the money to pay the premiums is ultimately going to have to come from. One of the grander ironies of a single-payer system is that I suspect that few lobbies would fight more rabidly against its implementation than the trial lawyers. If the government actually assumed liability for medical malpractice under this system, suddenly the light would go on and there'd be a broad recognition that "Hey - the people who bear the costs associated with medical liability are...us." I suspect that shortly after this epiphany, you'd see an almost immediate imposition of caps on liability claims, and there'd be precious little opposition to their implementation. Bye-bye spectacular settlements, or any settlements beyond those specified in the spread-sheet, for that matter. Same costs, borne by the same people - anyone who pays for medical care - but now made more concrete by the absence of any intermediaries. I suspect this is the primary reason why these caps on payouts are a frequently found in conjunction with single-payer systems. This might also give people who think that attorneys that earn their living in the realm of medical practice actually play an important and constructive role in insuring that patients actually get quality care something to think about with regards to a single payer system. If you get hosed by a doctor in a single payer system, what recourse do you have?

It'd be interesting to read through an independent analysis of what is responsible for the dynamics of malpractice insurance pricing. In the absence of collusion, it seems like it'd be hard for an insurer to arbitrarily raise rates beyond those necessary to cover their potential liabilities without sacrificing market share to competitors who run the numbers and find that they can cover their liabilities and still turn a profit with lower premiums. I would be quite surprised to learn that what's responsible for driving premiums ever-higher are the evil masterminds sitting in the CEO chair at the insurers. I suspect that there's more to it than that. Greed has been with us forever, so if the rate of premium increases is substantially higher than the historical norm, the odds are good that other forces are at play here. I'll also add that while it would be rediculous for anyone to claim that there are no bad doctors, and all malpractice suits are without merit, it'd be equally rediculous to claim that there were no lawsuits brought forward in cases where the claim has no merit. It's not a medical malpractice suit per-se, but one only need look at the example of silicone breast implants to see that it's possible to win a major legal victory in a case where the central claim has no scientific merit whatsoever. I think this points to a larger problem with using a jury of people who have no scientific or medical training whatsoever to make this sort of determination, but that's another topic all-together.

The single-payer issue is a whole separate discussion, so I'll leave that alone for now. I certainly wasn't suggesting that you can reliably asses the merits of an idea by the magnitude of the public's support for it or rejection of it, only that you need to take this into account when discussing the political feasibility of a given idea or reform. As far as the insurance issue is concerned, I'd agree with the notion that there needs to be better mechanisms to weed out incompetent practitioners, and more transparency with respect to physician evaluations. Right now it's quite a bit easier for people to get objective information on plumbers than physicians. This is a more complicated issue than it seems, as doctors that agree to treat severely-ill patients who need high risk treatments could be unfairly stigmatized unless some serious thought was given to how the information would be reported. In a case like this, I think that classifying surgeons according to the risk-profile of the patient population that they agree to treat would be better than a global comparison of all surgeons who practice the same specialty. One thing that I think that you've omitted from your analysis is the costs associated with doctors ordering a more comprehensive battery of tests than they think is necessary or prudent as a precaution against getting sued. Judging from all of the Dr. gossip that I've been exposed to, this happens all of the time, and I suspect that the costs are hardly inconsequential. I do think that there are some other things that could be changed. Placing reasonable limits on the length of time that someone has to bring a claim against a physician would be one thing. The prospect of being liable for claims made on behalf of babies that they delivered 18 years ago means that they have to carry "Tail Coverage" 18 years into retirement. At least this is the consensus amongst the people who I know who have considered that specialty. Some kind of pro-rated claims system coupled with a larger risk-pool funded by other means might be a better system. I personally think that this risk could be securitized and sold to people who are willing to bear it, in much the same way that insurance companies securitize and sell the risk from hurricanes via high-yielding bonds that get wiped out in the event of damages that exceed a certain threshhold. These things do have quite an impact on medical students when they are deciding what specialty to pursue and where to practice. Here's an excerpt from a med-student's forum: "Originally posted by kem Good question NewGuyBob! I have no idea as to the answer but maybe the insurance company that was covering the doctor at the time of the incident would still be liable? Kem Umm typically not unless you have occurence based malpractice. I don't know of any insurance companies that allow this for OB/GYN although there may be a few out there. With the standard malpractice you have to buy a "tail" coverage for when you retire or change malpractice carriers (this happaens actaully quite a bit, if you move or change jobs and your new group uses a different carrier). Tail coverage covers you basically forever although some sleazy companies are now only covering you for a defined period (1-5 years, which is obviously unacceptable in OB). In OB these tails are very expensive as they are in any high risk specialty. Typically these run 3 times your annual payments. I know of OB docs that had tail coverage in the 150K range. With some of the states now having premiums in the 100k range their tails must be very high. This just doesn't just affect retirement. I know one OB who can't leave a group that he is miserable with and move to another state because he can't afford the tail of over 100K. HOw many docs can come up with that type of cash? NewGuyBob 01-17-2004, 12:30 PM Goober said: Typically these run 3 times your annual payments. I know of OB docs that had tail coverage in the 150K range. With some of the states now having premiums in the 100k range their tails must be very high. Jesus Christ, I have no idea how anyone can pay this!! :wow: That is insane! Basically I'll have to live looking over my shoulder for lawsuits until the day I die?!? :scared: NOW, I'm starting to have second thoughts about this specialty. Hey I love Ob/Gyn, but this is to much to ask. Is it even possible to pay 150K a year while retired? I'll start to buy lotto tickets, if I win, then maybe I'll go into this specialty. DAMN!"

The Central Committe with be dealing with you shortly.

My personal favorite is a case where the authorities notified the public that they'd begin fluoridating the water on day X. Day X arrives, and there's a rash of complaints about headaches, chills, dizzyness, tremors, menstrual irregularities, etc, etc, etc. The complaints rise to a fevered crescendo, and then the utility announces that they hadn't actually begun fluoridating the water, but intended to do so in one month's time. Fluoridation commenced without incident. Classic.

Hey Matt: iven the fact that no one is seriously proposing to implement a universal single-payer system at the moment, but there is some political momentum behind insurance/liability reform - do you have any ideas for reforms that would help alleviate some of the problems that you cited in your post? I am kind of surprised that people across the country haven't taken more notice of the hybrid plan that they've just implemented in Massachussetts. Now, just like auto-insurance, health care insurance is compulsory. Children and the elderly are covered by the state if they aren't covered, low-income people are entitled to graduated subsidies, indigents are fully covered by medicaid - but able bodied adults that exceed a given income level must be insured. I think that this kind of plan makes a lot of sense, and I think that the fact that the risk-pool will now include more people who are less likely to require costly medical care will be especially helpful.

2KA9oakKDoA Possibly even funnier. " haaw d comments r mean lol im a paki lol n still u cant b hatin off em dat bad man..der onli people!!chil man" "omg YEAH M8 DAT IS WELL COOL I WANNA SHIT ON YOU NOW INET DO YOUNS WANNA WATCH MY VIDS CURSE YOU DO CUZ IM SOOO FIT N PROPER CHAVIN IT UP YO?? DFWOAAH M8 LOOL!" "haha dis so fkin funi!! wt dik eds da luk wudnt ya jst luv t wlk up t em n smak im in da face! omg wt a bunch ov pricks! ginger joe gt da best deal stayin outta it hahaha!!" Word to Ginger Joe.

I must have been the last person in the world to see this clip, but just in case I'm not, I thought I'd share... 1dmVU08zVpA&eurl=

I think that you owe it to your child to make sure you understand those indisputable medical facts, and that you can weigh the risks and benefits yourself before making the decision to go forward with any particular treatment. I'm not saying that you shouldn't put a cast on a broken arm, or treat cancer with the amazing drugs that are coming out. I'm just saying that you have a responsibility as a parent to know the medical facts about those drugs. Especially when, like in most cases, those fact are disputable. I agree with most of what you've said, but in those cases when it's not clear what the best medical decision is - and this is most assuredly not the case with regards to vaccination - the responsible thing to do is seek a second or third opinion from someone who has the qualifications necessary to make an informed decision. Everyone is entitled to their own opinion. No one is entitled to their own facts. I would venture that Strumpet can get 456 opinions from pediatricians, and not one of them will support her decision. I also think that her children should be barred from public schools - this includes universities - until the time that they are vaccinated.

Don't listen to JayB....his cronies secretly planted explosives in the WTC in the biggest cover up know to modern man Wolfowitz just elbowed me, pointed to the screen and said "Shh."

Thank you for the kind words. As far as doing what we are told. Every time we see the pedestrian, she spends the first 25 minute of the 30 minute visit spewing propaganda about why we need to vaccinate. It’s a little disturbing. It makes me wonder who writes her paychecks. The vaccine company’s? We will not be seeing her anymore. Once again, thanks all for the input. It’s a very serious and personal choice to be made and not one to be taken lightly. You'd better be ready to do a hell of a lot of searching if you're out to find a board certified pediatrician who is going to concur with your analysis of the risks and benefits associated with vaccination. Maybe they have an office next door to the physicist has some doubts about the existence of gravity.

How do you all feel about parents who do refuse to treat their children's life threatening medical conditions, like diabetes, because they've elevated their personal convictions over medical facts that have been established beyond all doubt? Ritalin is one thing, vaccination is another. Critical thinking about debatable benefits when the data is preliminary and ambiguous is one thing, irrational delusions that fly in the face of both common sense and indisputable medical fact are another.

You're welcome.

Sorry, Strumpett. I am going to give you some unsolicited feedback on your choice. Failing to vaccinate your children is both irresponsible and irrational. The only reason that people have the luxury of engaging in such idiocy without putting their own children at risk is because of the actions of others who have been vaccinated or have had their children vaccinated. This has all but eliminated the diseases that would otherwise ravage children unfortunate enough to be born to parents who are misguided enough to withhold vaccines from them. When and if there's a significant percentage of children cruising around without immunity to these diseases, this will no longer be true. Unfortunately if this situation ever comes about, it will be the children, rather than their parents, that will bear the brunt of the suffering when the inevitable outbreak takes its toll.

I think I'd choose Kim Jong Il because he seems to be inspired by simple megalomania, rather than barbaric, messianic, fanaticism, and I'd rather not give Osama and co the satisfaction. That FNMA info is legit by the way. Some other players in the MBS market are starting to get a bit gun-shy as well, which may well have implications for anyone trying to get non-traditional stuff funded in the months ahead.

Civilizational Stockholm-Syndrome. Are you sure that this isn't the result of some internalized self loathing on account of the vast incongruity between your commutopian ideals and the grim, day-to-day realities that must confront someone attempting to earn his daily bread via low-end residential real-estate manipulation? BTW - FNMA announced that as-of January 30th, they'll only purchase I/O loans and arms issued to borrowers who demonstrate that they can afford to pay off the loan under a fully amortizing schedule.

Does this include speedballs and meth?

It's really hard for me to concentrate on the TV with you trying to talk to me like that.

I figured you wouldn't mind if I spent a couple of grand on a new stereo system and a video game console, so I went ahead and took the money out of our savings.