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A good post about activism... [Apr. 30th, 2016|11:11 am]
John
In an ADHD support forum, I would sometimes have discussions with people are angry that doctors don't do anything but give kids medications. (Well... they didn't say "medication" - they always said "Ritalin". At the time there were at least four different front-line meds for ADHD but Ritalin was and remains the one that's name-ganked.)

(PSA: while they used to believe that children grew out of ADHD, it's more likely that the symptoms and signs changed - and for some adults, coping skills were enough, and for others, they were decreed to have problems for other reasons, because grown-ups clearly didn't have ADHD, because it was a childhood issue, because children have it, not adults. I'm sorry - but that really does seem to be the "logic" (technically "reasoning") they used.)

People had all kinds of ideas of what doctors should do. Encourage children in sports! Meditation! Meaningful Spiritual Practices! Focusing Exercises! Careful Habit Creation!

Because, yeah!!! Doctors get to be responsible for children and their upbringing 24x7, from the moment the mommy doctor gives birth... uh... wait, no, that's the *parents.

My argument was, no, doctors should work their magic where they could, and that was the physical, and that meant they should restrict themselves to prescribing medications and providing advice about other well established treatments, while noting that other methods may work too. A doctor who pooh poohs the idea of meditation, rather than merely pointing out that it's not proven to work - but it seems like a reasonable idea - deserves to be admonished, at the least.

(I was going to state that as "doctors should fight their battles on the field that they are knowledgeable" - and the thought jumped into my head that violent metaphors aren't apt here, and are probably far too overused.)

Anyway: I don't know how you, the reader, might feel about the Black Lives Matter movement, but I consider this post spot-on:
http://www.lawyersgunsmoneyblog.com/2016/04/should-black-lives-matter-compromise-no

What it's saying is, some people exist to build a fire, and hold people's feet to it, to try to force action. Other people - and good, wonderful, effective people like a community organizer named Barack Obama - should then try to make things happen. And neither side is *wrong*. A younger Obama wasn't wrong for compromising and working the art of the possible, and Black Lives Matter aren't wrong for being angry and demanding.

The one thing I will say is: they do need to be tightly controlled and disciplined (in the sense of ensuring no one in the organization is committing actions of violence or property destruction)... but they don't need to be quiet, or calm, or compromise. Anger is good, if kept in check.

I do think that it's important for activists to be gracious when winning, of course, even if the win is minor. Not *too* gracious - but enough to let the people who fought on your side know that, while it wasn't *enough*, you do appreciate the efforts they made, especially if sacrifices were made.

Anyway: there's lots of work to be done, and I firmly agree that we should be careful not to disagree with someone who's chosen an acceptable job to do - even if it doesn't fit our notions of how the overall project will be completed.
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Thoughts about politics [Apr. 23rd, 2016|12:47 pm]
John
So, I saw this long article on Vox about how us EEEEVIL Libruls (in the US, naturally - but I know that "liberal" in the US is often pretty darn conservative in a lot of other parts of the world) are so, so SMUG and condescending and awful.

And I can't deny there's a bit of that. I see people at Trump rallies, and I know some of them are foolish and wrongheaded. Do I feel smugly superior to a lot of them, thinking I know what's better for them, than they do?

Shrug. Yes, I do. Guilty as charged, but I want to point out there are mitigating factors.

long, political, and slanted against the US Republican party - read at your own risk. Collapse )
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Texas... [Mar. 27th, 2016|11:21 am]
John
So, tomorrow I'm flying out to Texas. Las Colinas/Irving, for training at the Microsoft offices out there. It's near the DFW airport - and not too far from Dallas.

Microsoft is flying me out - but they won't rent me a car. And honestly, I'll have Monday night, and Wednesday night, to use the car anyway - so going carless is probably best anyway.

I don't think I'll have time for touristy stuff but - anyone know of any good cuisines to look for, and any good places in that area? I have a generous meal budget. I wouldn't mind trying Texas chili or barbecue while I'm down there. (There's a good barbecue place near me that calls itself "Texas barbecue" but how can you trust Texasness in Washington?)

Of course, I wouldn't mind just finding a good restaurant of any type. It's just, I'd hate to pass up an opportunity if it presents itself. I'm not likely to travel to Texas all that often for other reasons.
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While I'm still too tired to have any fits of despair... [Mar. 27th, 2016|11:09 am]
John
Medical testing came up blank. And I picked up the cold-from-hell. I'm not the only person - my cube-wall has been referencing it, something that migrates to your lungs and then stays there. Just this morning - four weeks since I first showed symptoms? - I had more lung-coughing that wasn't quite unproductive but wasn't quite productive either.

This is driving me buggy, because whatever cold I have, my body should have its number and viruses should be getting served up cold, on toast. But I'm not the only person who isn't feeling 100% recovered after way-too-damn-long.

But when I'm too exhausted to have any real emotional reactions, I'm also too exhausted to have any huge, wailing-and-gnashing-of-teeth episodes of despair. Just the ordinary, day to day stuff, which I can mostly handle.

You know - without having to ask - that it's been an unusually busy time, right? So I've been doing a lot of work, pulling the normal "more than 40 billable hours in a week" for the past few weeks, right?

But I've also been too tired to talk to my boss about this. And next week, I'm out in Texas for training. Microsoft now has a special on-boarding training for all support engineers (and other folks too - all parts of the services team) and one of the things they go over is forging a career path. So, that's a good thing. I'm hoping I can learn what a person can do with fatigue issues holding them back. I might end up having to take a shot at management positions. It might not be as much fun as being a troubleshooter, but it might be what I can do for a living.

And who knows? It might not be boring management - it might be leading a technical team and helping them actually solve problems. So I have to keep pushing for more information, and not despairing because my first two months at work are ending in a really bad, exhausted, and almost-despairing state :-).

(Yes, that's a smiley. I have a real sense of humor about this. But you wouldn't see it today. There's a joke about how it takes more muscles to frown than to smile, but it takes none at all to have a completely blank expression....)
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Heard of an interesting study... [Mar. 15th, 2016|10:00 pm]
John
...and I'm not trying to be scientific or anything, but some social scientists have been measuring what happens when economic opportunity leaves a place, and they find broken families and drug use and increases in crime and, well, basically, all of the things people use to blame black people for causing their own problems.

So, go figure. Human beings who are robbed of economic activity aren't the perfect "Leave It To Beaver" families imagined earlier.

And it's come full circle. I saw a conservative rag attacking these people for having these problems. And I couldn't help but wonder if there's some added anger, at the thought that they're acting like "those people".

I also had the ugly thought that some of these folks may have been staunch "conservatives" and yet liberal folks still have to fight to try to make their lives better. And if it worked well, in one location, they might go right on back to hating "those people" and scorning folks who have problems with broken families and drug use and crime... something about "no good deed goes unpunished" comes to mind.

But I've also been pondering. Do you know, since NAFTA was signed, Mexico's done a lot more manufacturing? But their GDP per capita hasn't really risen. Someone's making money - but it's not spreading to the people. How does a nation advance, these days?

That's a more important question than it might seem, because the next question could well be "how do we bounce back?"
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Interesting followup... [Mar. 13th, 2016|06:32 pm]
John
So, there was a bit a while back about horrible waits at the VA. I followed this link - I'm not sure where I saw it.

This is really bothersome. "Privatization" is a big thing, and the reason it's a big thing is that any time there's a big pile of money involved in some service - like education, or medical care that's not already private - there's a relatively natural desire to try to pick up a piece of the action. This feels a bit dirtier; data deliberately being manipulated to make the splashy headline, and as always, follow up investigation is never quite as headline-grabbing, or as widely seen, heard, and discussed. As the article points out, Bernie Sanders can be said to look bad for sticking up for the VA, in spite of having been correct.
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Context... [Mar. 9th, 2016|09:23 pm]
John
"Context is important. A favored rule of chemistry teachers is 'do as you oughta, and acid to watah (water)', but that rule does not apply to Neti pots. Trust me on this."
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Really have to start doing this... [Mar. 8th, 2016|10:55 pm]
John
So, I went into the office. One rule: no critsits. I'm sick, I'm at the "coughing the gunk out of the lungs" stage, I need *rest*. So I need to go home on time.

You know where this is going right?

A case gets transferred to me - and immediately gets raised in severity because of a completely unrelated problem. (Yes, really. This case was raised in severity by the equivalent of a Pointy Haired Boss decision.)

Part of this is my fault - when I was told the conference call had disbanded and no one was getting through to the customer, I knew that they'd soon reduce severity, and I could go home. They didn't as I waited patiently for them to do so... then the customer called me. And although there was nothing useful we could do, he's not allowed to reduce severity on his own.

9:15 - three and a quarter hours late - I finally got out. I know part of this was my fault; even though I knew they were going to reduce severity, I should have demanded a handoff. That part was in my control, and I might not have gotten it, but I could have asked, at least.


I need to talk to my boss about this - the worst part is, if it's invisible, and cost free, ain't no one going to care.
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Finally.... and HSA discussions [Mar. 6th, 2016|06:09 pm]
John
So, there's this idea that's in the ACA. There should be a tax on high-value health care plans. It never made sense to me - but I finally tracked down the reasoning.

It basically comes down to this: if you take your typical employee, and offer them a selection of health care plans, and you'll pay for the most expensive one - but give them the difference in cost if they pick any of the cheaper ones - the odds are high that they'll pick a plan that's below what's called the "Cadillac plan" limit.

So what? What's the big deal? The big deal is, if you pay $10,000 for an employee's health care benefits, it's totally tax free. It's a deduction to the corporation (or the partnership/sole-P), and it doesn't get counted as employee income. If you pay $5,000 in health care benefits, and give them $5,000 in cash, that's instead $5,000 in income, possibly subject to Social Security taxes, and so forth. So, there's a lot of revenue lost by people parking part of their pay in their health care plans instead. (In fact, this is a reason why *Democrats* negotiated a one-year delay on the Cadillac plan tax - a lot of unions had plans at that level or higher.)

There's also an idea that if people have more "skin in the game" - if they are affected more by the health care costs they rack up - they'll make more careful choices. If you can take X_New_Drug for a condition, or Y_Old_Off-Patent drug, you'll pick Y over X. And if you have a severe abdominal pain, starting in the lower side quadrant, radiating out toward your entire abdomen, and a high fever, you might decide to tough it out, rather than go to the ER and have an appendectomy.

Yeah, I was being a bit facetious there, obviously. The thing is, so far, all the studies I know of say that when there are higher imposed costs, there's lower quality of care and poorer outcomes. Economists say that, over time, people will make more rational economic decisions, in line with their desires, and there's some truth to that, but people don't have the medical training to make good health care decisions based upon cost.

There was a story going around the web of a person with a severe infection given a prescription for antibiotics and pain killer, and who, having the money for just one, chose the painkiller. I'm not sure if this was a fatality or not - and while a lot of educated folks might say something about the Darwin awards, remember that person might have needed to work to make the money to get the antibiotic - and the painkiller might have been what they needed to try to tough it through a work day.

Anyway. If you want to control costs, you need to control it at the medically trained level. If there's a higher copay, or just some hoops to jump through, for the newest, most expensive treatments, versus old treatments that work just as well, those can be good. But I don't agree that people shop for medical care like they shop for groceries, and pile up costs for no reason, or refuse to take adequate substitutes of lower cost.

Mind you: I'm not saying these aren't annoying. I have a friend with severe sleep apnea issues, and s/he was considering surgery, but was diverted first to a - 12 week? - CPAP class. Now, I can see this really easily from the insurance company's perspective. If some people never even go to the class, that's 0 cost. If the class costs $5k (a made up number!) and the surgery costs $25k (similarly made up...), and half the people who finish the class don't get the surgery, that's a massive savings - $20,000 saved from those who don't get the surgery, versus the extra $5,000 for those who got the surgery; that's $15,000 per person saved!

That said: from what my friend said of the apnea, I was pretty darn sure that a CPAP class wouldn't do a damn big of good, and I wished doctors could submit cases to skip the class. Done right, it saves the insurance company the class cost with minimal loss. But, alas, it's human nature to find and empathize with special cases; I wouldn't be surprised if the insurance actuaries found that there were too many special cases that might have been diverted from surgery.

Where was I? Right: Cadillac plans. Microsoft is well known for having very generous benefits, and their health care plan was likely to hit the limit. So they've changed tactics. They have an HMO which I believe I tried for a bit, and I've heard good things about. A well run HMO, if used by some subset of VIPs at Microsoft, can be inexpensive and have high satisfaction ratings. But I have some long-term investigations, and some prescriptions that I'd hate to have to fight for again....

So, I'm in one of the newest goodies, the belle of the Republican Ball for controlling health care costs, the high-deductible plan with a health savings account.

This is a great plan for me. I'm well-off, and even though there's a chance I'll max my out-of-pocket expenses this year, even if I do, if I contribute enough to my HSA, I can have a big start on the deductible for next year. Or, if I want to pay my own health care costs, I can let the money in the HSA grow - there are options to invest in mutual funds.

I can see why this is so beloved by the Republican Party. It's a great deal for people who want to park their money somewhere tax free, and let it accumulate with tax free earnings, and, as above, there's a widespread claim that it only makes sense that people would become savvy shoppers for health care if it's their own money being spent. But there's something I hadn't realized.

You don't need to use your HSA money. Ever.

You can max your HSA contribution, and if you can still cover all your health care expenses out of pocket, you get to keep the entire amount collecting earnings. Those of you who don't understand the power of compound interest might not realize how big a deal this can be. But money invested can double in value every 7-10 years, even if invested in index funds. (In fact, especially if invested in index funds - it's extremely rare that anyone can beat the indexes consistently.) So: a 30 year old can see that 3350 invested today turn into 30,000 or more before retirement. It's a nice bit of change, and it might happen quite a few years in a row.

I'm not sure this is a horrible thing; there are many things that the rich gain more advantage from than the poor. But it still annoys me, maybe a bit irrationally. I'd known that HSAs were a way to be of benefit to the well-to-do, but I hadn't realized how much of a benefit they were intended to be.

Anyway. Today, I had to prime my HSA with an up-front injection, and that's when I realized/learned about the possibilities. Well, it's nice to think about, though it's annoying that it's such a big part of the "Repeal!" crowds' plan for "replace!"

And, more importantly, I finally got the time and energy to do it. My heart monitoring is done for closing in on two weeks now, and I should be back to normal, but... but, I caught a cold. Life's funny that way, isn't it?
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About Scalia [Feb. 22nd, 2016|09:50 pm]
John
One of Scalia's famous bits was how, the Constitution doesn't actually forbid the execution of the factually innocent if due process was followed.

And this is one of those things that's both better and worse than it sounds.

It's better than one might think, because really, the law doesn't give a damn about reality - it can and must be cared about what can be properly established. If the police use an illegal search, and find perfect evidence of criminal behavior on my part, and the courts toss that out, and toss out everything that they derived from that evidence (under the "fruit of the poison tree" doctrine), it's *true*, it's a *fact* that I've engaged in criminal behavior - but as far as the law is concerned, I'm perfectly innocent.

And, yes, if I'm convicted of a crime, by a jury finding, having had all of my rights respected, in the law's eyes, I'm guilty and under the state's authority... even if there's evidence that I'm perfectly innocent. (This is far stronger if that evidence was introduced at my trial and the jury disregarded it - or if the prosecutor discovered it, handed it to my attorney during discovery, and we chose not to follow up on it.)

The Constitution really shouldn't muck around with truth, because what is obviously, objectively true to some people will be an obvious fraud to others. Instead, the Constitution can and should deal with human institutions in a way that's fair, and with transparency - so everyone knows what's going on. For example, jurors should be aware of their duties, and their powers, and what it will mean if they return a finding of fact that isn't true. Similarly, those who provide information to those jurors should be constantly aware of what it means, and be in proper awe of their power and responsibility.

Because the Constitution can't - and won't - make guarantees about evidence or truth, so long as due process is followed A statement to this effect is both accurate and true, and it's hardly nasty to point it out... most of the time.

Ah, but there's the rub. Scalia is not just writing about the Constitution for a lecture or a presentation. He was, in fact, seated as a justice who was given the power and authority to decide if a potential injustice should be reconsidered, and possibly reversed.

The Constitution can't care about abstracts like truth - it must leave that to people. And he, in essence, stated that he was willing to lay down that duty, and instead, do only what the law required.

I'm never *glad* about a person's death. The closest I'd come is being glad that someone's suffering has ended. But I am glad that Scalia will no longer judge my country's laws, or its people.
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