Tuesday, June 27, 2017

Another GOP Stealth Bill Moves Toward Passage - While We're Distracted By The Senate Health Bill













You have to hand it to the Machiavellian Repukes who love to make legislative moves of a dastardly nature, and now more covertly than ever before.  This is especially true with the cynically named 'Better Care Reconciliation Act. of 2017.'   which has now been scored by the CBO.  Let's also note that  the Director of the Congressional Budget Office is  Keith Hall - a card carrying Republican - not a Dem!  This is important to reference as assorted 'pukes try to blast Hall's report as "inaccurate" or "incomplete".

What the CBO scoring found is that an estimated 22 million Americans would lose their health insurance under the "Better Care" Act the Senate GOP is trying to foist on the country.  Worse, no fewer than 15 million would lose out next year alone. How would this occur, by what processes? As noted on p. 8, the biggest attrition would arrive by massive increase in deductibles for low income people.   Thus, a deductible soaring to $10,000 a year for a low income family would mean they simply wouldn't purchase health insurance, hence they'd be left out in the cold - with the only option to go to ERs.

The other aspect concerns the soaring premiums which the CBO report estimates will spike as much as 74 percent.  While the "individual market" premiums would average about "20 percent lower" this is precisely because these markets would be composed almost entirely of the young and healthy who'd make few annual health visits or exact much cost.  Meanwhile, older Americans - say 64 years of age and earning $56 k/yr. - would see their premiums go to $16,000 year from $4,400 currently under the ACA formula.

The 74 % premium  increase figure outside the individual market is based on an 'apples to apples' comparison between what ACA covered citizens have now and what they'd get under "Trump Care".  To fix ideas, if ACA insured folks (say for a family of 4)  are currently paying a $500 a month premium they'd pay $870 if the GOP "Better Care" scam passes.   This spike would also clear many off health care rolls, which is exactly what the GOP's free market denizens hope for.

Left unreferenced amidst all the distraction with the "Better Care"  bill is how another disastrous GOP stealth regulatory bill is working its way toward manifestation. This "Financial Choice Act" - so called-  would give Trump the automatic power to fire the heads of the Consumer Financial Protection Bureau (CFPB) and the Federal Housing Finance Agency.  The former keeps oversight over the behavior of players in the financial market place to ensure they don't screw you, overcharge you for services or unload Ponzi schemes masquerading as proper investments. The latter oversees Fannie Mae and Freddie Mac, which oversees housing matters to ensure consumers aren't buying bogus mortgages, overpaying in interest or processing charges and generally ensuring that realtors, sellers are abiding by the laws.

This "Financial Choice Act" - unknown to most - also gives congress the power over the Consumer Financial Protection Bureau's budget,  which means lawmakers could defund the agency entirely.  In other words, it would literally give Trump and the GOP congress absolute power to wreck consumers' credit and financial stability - by leaving them open to all manner of shyster exploitation with zero protections.  (The CFPB has cracked down on debt collectors, the credit card industry, payday lenders, for profit colleges, banks and mortgage lenders)

For reference, in the past six years the CFPB has provided nearly $12 billion in relief for more than 29 million consumers - many victims of financial or credit card scams. Trump and the GOP may sympathize with the plight of possible future shyster victims, but the bottom line is that they don't want to shell any money out to victims.   Recall here that the CFPB was created out of the Dodd-Frank banking legislation to enforce federal consumer financial laws and protect consumers in the financial marketplace.  The agency's main goals have been to:

- Root out unfair, deceptive or abusive practices by writing appropriate rules, supervising companies and enforcing laws.

- Solicit and respond to consumer complaints.

- Enhance financial education.

- Research consumer experiences for assorted financial products, e.g. annuities.

- Monitor financial markets for new risks to consumers.

All of these have been found to be more than warranted, which is why the CFPB reaped $12 billion in relief for more than 29 million consumers the past six years. Had the assorted financial outfits been adhering to the existing laws the CFPB would not have been needed by all those citizens. The fact that 29 million got screwed shows the need for thorough regulation and an agency to oversee such. That Trump and the Republicans would destroy this agency shows they have no more concern for the financial welfare of their voters than they do for wayward bugs that might invade their vacay homes.

Section 841 of the Financial Choice Act has been particularly noteworthy in its potential to undermine and overturn the interests of investors, especially retirement savers.   Under Sec. 841 the Labiior Department's fiduciary rule would e repealed. To refresh memories, that rule stipulates that anyone handling retirement assets - and gives financial advice to savers - has a duty to work in their clients' best interests and disclose any conflicts where and when they exist.   By Jan. 1, 2018, under the impetus of the GOP's Sec. 841 of the "Financial Choice Act", the fiduciary rule will no longer likely to be enforced.

If your financial planner doesn't inform you of his conflicts, or takes you for a ride by selling you some mutual fund that is front loaded with fees he can make $$$ off of, it's all on you. Added to your new healthcare spiking premiums, welcome to Trump World, Year II.

This elicits the question of what new nightmares await us next year compliments of Trump and his Reptiles.


Monday, June 26, 2017

Otto Warmbier: A Casualty Of Excessive Desire To Join A "Secret Society"?

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The tragic end of Univ. of Virginia student Otto Warmbier merits the maximum sympathy from all reasonable citizens.  Otto, 22. would have graduated in May had he not been taken into N. Korean custody in January.  By all accounts the kid was knock out brilliant including pursuing two majors, commerce and economics. Not exactly astrophysics, but still, any serious double major is worthy of respect.  In addition. he did an exchange at the London School of Economics. His minor was in global sustainability.  The planet definitely could have used more brains like his.

But this elicits the question of why such a brain (also salutatorian at his high school in Wyoming, Ohio) could have allowed his future to be so derailed and terminated by a brainless stunt. Did he not know the North Koreans are merciless and fetishistic about their leaders as well as their  images, to the point of worship? Don't just take my word. See via the link below how the North Koreans practically fall all over themselves in adulating their "dear leader" from a  NatGeo documentary (Inside North Korea):

https://www.youtube.com/watch?v=AlJUGZPanB8

So touching any images of them  far less appropriating one, would be regarded as intolerable as a Vulgarian going into a Church and urinating on a crucifix. Of course in the latter case there'd likely be few consequences other than social, but in the Hermit Kingdom there are monstrous repercussions and totally out of proportion (to Westerners) sanctions - as Otto later learned.

The U.S. media has emphasized the "sham trial" and  overbearing nature of the punishment: 15 years at hard labor,  for stealing a propaganda poster from a hotel (googling assorted videos will bring it up) but other commentators mainly from the UK, Australia,  have not been so generous. And one Univ. of Delaware prof (Kathy Dettwyler)  even went off on Warmbier,  tying him to the sort of entitled, white frat boy culture that believes it can do anything and get away with it. See e.g.

https://www.usatoday.com/story/news/nation-now/2017/06/24/professor-otto-warmbier-got-what-he-deserved/425661001/

According to Dettwyler on her FB page:

"These are the same kids who cry about their grades because they didn't think they'd really have to read and study the material to get a good grade. ... His parents ultimately are to blame for his growing up thinking he could get away with whatever he wanted. Maybe in the US, where young, white, rich, clueless white males routinely get away with raping women."

Ouch!  But I suspect there is a less antagonistic explanation, that might have everything to do with the needy "joining" psychology  of too many college kids. Especially those who go ga-ga over joining social organizations like frats and even purported secret  societies on campus. Because such joining has the potential to set them apart as "special" relative to their peers. A similar dynamic was plausibly at work with Timothy Piazza, who so desperately wanted to join a UPENN frat  (Beta Theta Pi) that he trusted his life to his would be frat brothers in an alcohol hazing....and lost.

In connection with this there are two questions that fairly cry out for addressing in the Otto Warmbier case:  1) Did Warmbier take the poster as part of a 'deal' made with an organization, church or fraternal entity?  2) If so, why did he allow himself to be manipulated into such a dangerous act by these groups or group?

Well, the second question almost answers itself, given we already saw how desperately Tim Piazza at UPENN wanted to join his frat, and that wasn't even a "secret" organization.  Thus, the answer inheres in forgoing all caution in the desperate need to join to attain a kind of specialness relative to peers. It is not enough to simply be one of the vast, motley pack at a school, or even a large subset.

The top suspect  in Otto Warmbier's joining yen appears to be the UVA's "Z Society" - which like too many crypto-patriot societies (e.g. 'Skull and Bones' at Yale) seems to breed wannabe spooks in droves as well as would -be elder statesmen.. (John Kerry was a member of Skull and Bones like George Bush Sr., and Woodrow Wilson was a member of the "Z Society").  Whatever the reason, joining such secret outfits appears to feed young egos who might fancy themselves - even at age 20 or 22 - among the future Overclass or global elites.

In the case of  Z Society it's evidently been around at UVA since 1892 and if you asked most of the school's students they've never heard of it. Which is a good testament to the group's covert nature and keeping a low profile. Anyway, the word circulating in the foreign press is that young Otto had a Jones to join the group but they required just one major test of singular bravery. So  one Z-member on learning of Warmbier's side trip to North Korea via the "Young Pioneer's" tour, suggested the poster snatch.

At the secret group's suggestion, and understanding the not yet developed risk -averse regions in the brains of most 21-year olds, it is totally believable Otto would have jumped at the opportunity. For a 70-year old like me -  with major risk averse centers in the neocortex now prominent -  the immediate response to such suggestion would be: "Snatch a North Korean poster? Are you fuckin' nuts? Go to hell!"

 Again in much the same way Timothy Piazza at UPENN  would have jumped at the chance to go through an alcohol quaffing "gauntlet" to join his favorite frat . Little knowing at the time he'd end up falling 15 feet and brain- damaged at the bottom of stairs, though a risk-averse older person would have projected that outcome as a distinct possibility.. Along with the possibility that the "brothers"  might not want to involve themselves as being proactive in an accident, so would just hang around for 12 hours without lifting a finger to phone 911 for help.

There's another possibility:according to Warmbier's statement, he wanted the banner with a political slogan on it as a trophy for "a church member, who was the mother of a friend."   Elaborating, Warmbier said he was offered a used car worth $10,000 by a member of the church.

He said the church member told him the slogan would be hung on its wall as a trophy. He also said he was told that if he was detained and didn't return, $200,000 would be paid to his mother in the form of a charitable donation. Warmbier identified the church as the Friendship United Methodist Church, which is in his hometown of Wyoming, Ohio. 

There is no reason, none,  to dispute this account or believe Otto just made it all up on the spot. Shit like this you just can't make up, and after decades of parsing political BS and PR one develops a sixth sense to discriminate fact from fable.  Warmbier's testimony has the ring of truth and besides he had to know that no skewed story he blabbed would save him now.  And the kicker: Warmbier also  then related to reporters in Pyongyang that he was encouraged to do the deed by the UVA's Z Society which he admitted he was trying to join.  Again, maybe he had visions of becoming some future super star elite luminary or statesman. But that is the effect (and hold) most of these college secret "patriot" societies have on wannabe members. It's far more intoxicating than joining a regular frat for sure. 

The question remains of why he'd allow himself to be manipulated or used by either a church or secret society to commit such a reckless act, and in a dangerous rogue nation where  the protections of his home country would be next to useless. Was he not thinking? Did he not care? Or, did the future image of him as a Z Society member trump any immediate reflection (or refusal to act) geared to risk assessment?

Four years ago, UVA Magazine published a piece giving outsiders insight to the secret societies on campus. In the article, UVA's then-protocol and history officer Alexander "Sandy" Gilliam Jr. is quoted saying "nowadays the two ring societies, Z and IMP, probably represent the true undergraduate leadership of the university.  Evidently, Z prides itself on unpublicized leadership and volunteer opportunities.  Perhaps not the stuff of spookery like Skull and Bones, but replete with that exotic aura of secrecy that lures many white, college males into joining regular frats or others with "secret" rituals.

 In 2012, then student body-president Dan Morrison put it this way to UVA Magazine: "The idea that there's something interwoven beneath the surface of the University's history that makes this a better place is very appealing to a lot of students—that there's more here than meets the eye."

True, but it's always been thus. Since the year dot undergrads across the country have sought specialness in whatever venue and those societies and organizations that promoted it often have had to ration memberships.  At Loyola University, ca. 1964-65, the aura of enchantment and mystery surrounded the fraternity called "BEGGARS".  Word had it that members were preordained to become part of New Orleans' elite society - including associated with Mardi Gras Krewes. Every manjack wanted to be part of the special group but certain secret tests had to be passed. Of course, the very mystery surrounding these "tests" lent even further to the Beggars' mystique and yen for so many to be part of it.

So why not Otto Warmbier with Z Society?  In any event, some formidable impetus or compact had to have  been delivered to push him toward this reckless act. Becoming a select member of Z might well have done it. Think of the mystique surrounding it, i.e. members are allowed to reveal themselves only at graduation by wearing a ring bearing the society symbol. BUT they can never divulge any inner workings.  This harkens back to Loyola's  Beggars fraternity (the school's oldest) with members taking a solemn vow to never reveal the secret handshake. (A handshake defined by such ritualistic aspects that once given only another Beggar can recognize it.)

I still recall two Mississippi first year students across the hall (on the 6th floor of Biever Hall Dorm) insisting they had to, HAD to pledge the Beggars. And....if they didn't make it in, weren't accepted, they could as well just pack up and go back home to Jackson. It wasn't worth staying at Loyola. I'm not saying Warmbier felt the same about Z Society but he could have, explaining why he'd resort to such a risky stunt to try and prove his worth and acceptability.

Wayne Cozart, vice president for development at the UVA Alumni Association, said in a 2010 article published on the university website:

"If members of the group are asked about their membership, they must leave the room rather than answer the question (or lie), a turn of events that is quite interesting to watch," 

Wow! And yet more delicious humbug and aura added!  Again, I don't mean to belabor this but there is a certain  subset of male university student - often an under appreciated type (or who believes he is) - who eats this stuff up. He firmly believes it's his ultimate ticket to future success and the good life.  It is quite plausible Otto was amongst this set. And to get in all he needed to do was to pick off a stupid poster.  What's so hard about that? Well, everything in the cosmos to a risk conscious adult!

Consider the mind-blown look on Otto's visage as he was being processed. It showed that only then did he likely realize the full folly of his actions. Also that a frickin' membership in some stupid secret society wasn't worth what it had cost him - 15 years of his life (then).  The etchings of shocked disbelief spoke to that and also likely led him to ask how he could have possibly taken the stupid bait for a stupid act. (We can argue all day about the North Koreans' laws and punishments, but bear in mind many regimes around the world have such fierce laws, sanctions and even little Barbados can toss a tourist into jail if he's caught wearing camouflage pants.)

Again, many will blame the North Koreans for their over the top draconian laws and punishments, but as one Aussie put it who'd also gone on the Young Pioneer tours: "We knew before we got there what you could do and what you couldn't. Also to stay with the guide and not deviate from the norms set by the tour. Any questions, we'd ask."

So why didn't Warmbier ask? Well, because he had to have known it was a major infraction. Indeed, he claimed a church member even told him that if he was detained 200 grand would be donated to his parents. Even if he made this up it revealed his background knowledge of potential consequences.

The inescapable fact appears to be that Warmbier's yearning to be part of a secret group - never mind it was merely "philanthropic" - cost him his life in the end. Just as much as Timothy Piazza's yearning to be part of a UPENN frat  cost him his life when he accepted their hazing gauntlet to indiscriminately down hard liquors over a short time.

The takeaway for up and coming young college males might be to think several hundred times before accepting a challenge or hazing ritual just to get into some prized organization, secret or other. Hey, it may well work out! But as the Tim Piazza and Otto Warmbier cases prove, it may also invite disaster. Do you really want to make that bet? If you do, be sure you know what the odds are in your favor.
------------------

Footnote: Prof. Dettwyler has since been terminated in her employment at Univ. of Delaware. See e.g.

http://www.delawareonline.com/story/news/2017/06/25/ud-professor-who-said-american-held-n-korea-deserved-die-wont-return/427192001/


So much, again, for the much vaunted "freedom of speech" in this country.  You can exercise it, but beware of the inevitable repercussions, including losing your job.

Saturday, June 24, 2017

The Wall Street Journal's Misplaced Malarkey On The Senate "Health Care Advance"

These days words and meanings are everything, and are often deployed with special aplomb to distort and divert inquiring minds from truth. I've already - in previous posts  - noted many historical examples, such as the substitution of the vanilla term "scandal" for actual, multi-layered conspiracies such as Watergate and Iran -Contra. The effect being to divert the historically purposive mind from political conspiracy to well, something "scandalous" - like the Clinton- Monica Lewinsky nonsense. Thus are events riven with historical and political gravitas reduced to gossip-style, forgettable one offs.

Similar word twisting perversion occurred with using the term "death taxes" for estate taxes, the better to spare the wealthy from having to pay their fair share in a democratic, supposedly fair society.  Now, the latest addition to this sordid verbal jui jitsu involves the terms used for the atrocity known as the Senate health care bill which demolishes Obamacare and has cynically been named the  'Better Care Reconciliation Act. of 2017.'

The Wall Street Journal added to this perversion in its editorial yesterday ('The Senate Health Care Advance') by first using the term "Senate" when only the Reepo contingent pushed it through, and second, calling it "health care" when in it is all about tax cuts, and third, using the word "advance" when it is in fact a major regression for 75 million fellow citizens.

There are other aspects of the WSJ editorial I also want to call into question and criticize from a historical, economic and political perspective. Why? Because getting at the true nature of this misbegotten piece of "legislation" requires doing so, at least to the same degree as when I take care to classify solar flares by their x-ray output.   Hence, I cannot in good faith conflate an X-1 flare with an X-9 event, like the WSJ does with its ACA and Medicaid "facts".  But WSJ editorials are not known for being factual but circulating  Rupert Murdock propaganda.

For example:

"The legislation replaces Obamacare's subsidies with tax credits for people who buy insurance on the individual market"

The use of "tax credits" betrays the true intent of this bill as a tax plan, as opposed to a health care bill. Tax credits are the standard conservo solution to genuine fiscal holes, but are really useless gestures. After all, they do absolutely nothing for people in  serious medical distress, say to be able to afford actual, meaningful tresatments. They are little better than a useless dollop or dressing, and as one mother of an autistic child put it in a TIME essay last year, would barely cover $1200 of her $30,000 yearly needs.  But they do create the illusion of offering something, I mean look at the term "credit",  after all.  But in terms of health care which I already noted increases inexorably, it is subsidies that pay the freight, not "tax credits!"!

And subsidies would more than be the solution if this country pared back its defense spending to half the GDP proportion, say to what it was before 9/11.  After all, a nation that outspends the next 13 together in defense can't possibly be "on the ropes"! Only a moron would believe so.  Hence, as former defense analyst Chuck Spinney once put it, let's cut the defense share of GDP  back to 2.4 % to 2.2 %. THEN we can make room for providing subsidies via the original ACA which, let us be clear, was the reincarnation of an original REPUBLICAN health care law (also known as "Romney Care")

"Medicaid was originally meant for poor women, children and the disabled - which Obamacare opened to able-bodied, working age adults above the poverty level".

This takes no account whatsoever that health care access (and needs) must expand as a population increases and economic legislation alters over time.  Point of fact, the population of the U.S. was about half what it is today at the time (1965) Medicaid came onstream. In addition, the poverty level has barely changed since then, remaining far too  statistically "lowballed" for the very purpose of limiting access to benefits.

Now add in the economic forces of globalization - globalized labor markets (and destruction of the U.S. manufacturing sector), and mass corporate downsizing in the 90s, and the case can be made that the original intended beneficiary base of Medicaid was simply way too meager, too small, by 2000. To put it another way, most lower middle and working class citizens - even with jobs - were in essentially the same economic position as "poor women and children" in the late 1960s.  Of course, it is in the Journal's best propaganda and spin interests not to process this.

To fix ideas,  consider the Denver Post article ('4 in 5 Adults Face Poverty At Some Point In Lives', July 29, 2013).   According to the article:

"Although ethnic and racial minorities are more likely to live in poverty, race disparities in the poverty rate have narrowed substantially since the 1970s, census data show.

Economic insecurity among whites also is more pervasive than is shown in government data, engulfing more than 76% of white adults by the time they turn 60, according to a new economic gauge to be published next year in the Oxford University Press."

The Post article further notes that "measured across all races" the risk of economic insecurity rises to 79% or nearly 4 in 5. Pardon me, but this indicates a nation of rising inequality and the degradation of most citizens in terms of their economic welfare. Above all, it shows the need for vastly expanded medical benefits given the deplorable economic inequality ensures most can't afford the health care they need- so must depend on a decent federal government to provide it.  An "entitlement"? Perhaps, but how else will our people get the medical treatments they need and deserve?

"The Senate waits four years instead of three but pegs the (block) grants to inflation with no adjuster."

As former Medicaid administrator Andy Slavitts observed last night ('Last Word') this translates on average to a state cut of 25 percent per individual beneficiary.  This portends serious losses of benefits for most of a state's population especially given no adjuster. But again, this exposes this sham law for what it is, a tax cut plan for the rich as opposed to providing for the most medically disabled and adversely affected among us. Unless states trapped in a zero sum budget scenario compensate - say by taking funds from roads or preschool-  thousands of state citizens will be left to scramble.  The very Darwinian nature of the Repuke bill is here exposed, pitting one segment of citizen interests (and citizens) against all others. In other words, a return to the law of the jungle but in economic warfare form.

"The Senate includes about $100 billion for a stability fund .....and could be used by creative Governors to support insurance markets in states like Maine and Alaska"

In other  words, the Reep Senate bill creates a slush fund that can be used to bribe state Governors (especially in high premium states)  to cooperate with the for -profit sharks to set up costlier protection rackets - passed off as health insurance. (See William Rivers Pitt's sterling analogy at the end of yesterday's  post.) By use of creative accounting the state Governors can then make it appear health exchanges are really working - as they would be under a properly redone ACA- when they're only on temporary support from the limited slush fund. When the slush fund is exhausted the premiums across the board will shoot through the literal roof.

"The Senate wouldn't allow states to apply to relax the community ratings regulation which limits how much premiums can vary among individuals with different health risks."

In other words, if instead of being a  70 y/o Medicare beneficiary with prostate cancer, I was ten years younger and lived in a high premium state (e.g. AK) , insurers could charge me up to five times more in premiums (say $5,000 a month instead of $1,000) precisely because my health risk would be recognized as greater from being diagnosed with prostate cancer. It doesn't take a genius to figure out that the end result of this sort of draconian solution would necessarily see fewer men going in for PSA tests, for the very reason they would wish to escape a possible negative diagnosis with adverse consequences to their insurance premiums.  By the same token we'd likely see fewer people going in for colonoscopies as well as skin exams (which I also recently had - with one suspicious mole removed for biopsy).

"Importantly, the Senate bill also repeals all of Obamacare's tax hikes .....including the 3.8 percent surtax on investment income."

Left unsaid is that it was precisely these tax hikes that helped pay for the individual subsidies for the low income citizens with unmet health care needs.  What the Reeps have done is to basically cut out the tax hikes and gut the subsidies, replacing them with "tax credits". So, whereas before a citizen might have had $20,000 to cover the costs of a prostate cancer treatment he will now be lucky to get a chump change $500 tax credit.  This would barely be enough to cover his pain meds and basic tests, far less any kind of real treatment (say focal cryotherapy) Again, all of this exposes the Senate bill as an outright sham, a tax cut bill NOT a health care bill.  For reference  a person with a $1 million annual income would gain $54,000 each year in tax cuts. Almost enough to buy a new Lexus.

The Journal even confirms this tax cut imperative when the editorial states:

"Some Senators pushed to keep the surtax to avoid the tax cuts for the rich label and spend the revenue on something else."

Too late now, assholes, you're busted! We all know this is a damned tax cuts for the rich   Trojan horse being rolled out like a new health plan.  Only a certified halfwit would believe otherwise.

"It's not too much to say that this is a defining moment for whether the GOP can ever reform runaway entitlements. If Republicans, the next stop is single payer."

Then by all means let us hope they fail and miserably!

To summarize, these are the facts not processed in the WSJ's editorial:

1) There are vastly more poor citizens than rich in the U.S. of A.

2) The medical needs of an expanding population with few resources, income to begin with will always grow exponentially in relation to economic budgets for which yearly predictability is sought.

3) At the same time the costs of those medical needs must always expand, never decrease because medical inflation always exceeds other forms.

4) Therefore, by dint of (1)-  (3) it is budget allocations for genuine health care which must always be given priority in a nation that seeks genuine national security. After all, a sick population can never be a secure one, nor - by extension - can the nation they inhabit.

5) Tax cuts even disguised in a health care bill (so called) can never work and have  been proven not to work. They only increase deficits by cutting revenue and make a country less able to come to terms with its long term liabilities. To use economist Paul Krugman's term, they are a "zombie idea" because the Repukes keep bringing them back even after their efficacy has been disproven.



Friday, June 23, 2017

Fighting Prostate Cancer At -90 C: My Cryo-therapy Experience At UC Health

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3D image shows tumor which was subjected to  three freezing cycles, with temperatures as low as 90 degrees below zero, centigrade.


Almost five years to the day after being diagnosed with stage 1 prostate cancer I found myself Tuesday at the University  Of Colorado  Anschutz Medical  Campus  - Inpatient Bldg. to check in for focal cryotherapy surgery under Dr.  E. David Crawford.  After the requisite  initial processing of insurance  cards, ID and answering prelim questions (Would you like to see a pastor?, Do you have an advanced directive?)  I was checked in to the Urology pre-op station,  and met by a perky  RN I will call 'Greta'.   She took my vitals, then  had me change into  the standard issue gown and yellow  happy socks,  after which  my  belongings were  bagged  (taken away by Janice).  I was then connected  by Greta to an IV after some initial difficulty finding a vein.

As with my earlier experience with the 3D staging biopsy in January, I was first met by rounds of specialists, to  answer   further questions, i.e. What  is the name of the procedure you're having?, When did you last eat and drink?  Do  you have an advanced directive or living will?  Will you accept a blood transfusion if one is needed?  Do you have any allergies?  Do you suffer from sleep  apnea?  Have you had general anesthesia before?

The sole remaining formality was to sign an acknowledgement of risks form, always being told these risks (e.g. fistula) are "relatively low". But, of course, they have to disclose every possible permutation or possible outcome - much like the horrific (possible) side effects of Pharma drugs. Oh, there is also an acknowledgement that no guarantee is made that the treatment will eliminate the cancer. Well, that one's fairly straightforward and no sensible person would expect some magic cure! At least for prostate cancer.

By 7.25 a.m. Dr. Crawford and a  urological resident appeared and asked if I had any last minute questions (I had a few, e.g. 'How long does the catheter stay in?') and then I was wheeled into the OR by an anesthesiology resident. Once there I had to move myself to an adjacent table where an oxygen mask was  affixed to my face and the anesthesiologist (Dr. Erin Tracy) instructed me to breathe deeply.   Within about a minute the slight stinging sensation of fentanyl was noted and then.....lights  out.

When I came to it was nearly 10.30 a.m. in the recovery room, and the attending  nurse - Shannon - asked how  I was feeling.  As in January,  I noted the burning sensation in  the urethra - now the pain arising not only from the insertion of the indwelling (Foley) catheter. - but also  a  cystoscope to locate the bladder position as the freezing needles (cryoprobes) were inserted into the prostate.

Each cryoprobe from 1-3mm in diameter  inserted through the perineum,  used Argon for super cooling to sub-zero temperatures. The effect was to freeze the cells of the tumor creating an "iceball" with colder temperature at the center and warmer at the periphery. However, this difference is eliminated by repeated freezing and thawing cycles.  To protect the urethra a warming catheter remains in place during all the cycles.

To relieve the post -op urethral pain,  Shannon gave me two hydrocodone pills (which UCH calls  "narco)' and the pain subsided but the feeling of grogginess increased.  This was somewhat  different from the  3D biopsy when I came rather quickly out of general anesthesia with little or no hangover.  By contrast, this time I had to ask for a barf bag whereupon I did one or two dry heaves.

By 11.30  when Janice arrived, I was able to eat:  a couple of saltines with some ginger  ale. Janice told me that Dr. Crawford met with her in the main conference room and informed her the procedure went "very well" and  a total of three freezing cycles (at different temperatures) were done, including one at -90 Celsius or - 130 F.  (Cell death occurs at -40 C which is also - 40 F).  This sequence of freezing was why the procedure took longer, and hence the need for more anesthesia.

Only later, once I was dressed, did I realize another source of discomfort was a "scrotal support" that had been appended to me after the procedure. I asked the RN why this had been put on and she explained it was to prevent or inhibit "scrotal edema" - a swelling of the testicles to potential football size that sometimes accompanies insertion of the cryo-probes.  I asked how long I needed to have it on and she replied: "Maybe two to three days". Well, after 2 days I cut if off with a jack knife I brought with me to the hotel.

This morning, barely two hours ago, Janice used a saline syringe given to us by the UC staff to change the pressure inside the catheter to release the bulb and the connection. "Liberation" arrived with immense relief but also lots of blood and clots, much of which was probably associated with the dead cancer tissue that had morphed into the "ice ball".  After drinking quarts of water the urine has gradually begun to return to the usual (straw)  color. The pain has also subsided enough to sit down and write this post - to bring interested readers up to date-  also indicate why no posts appeared the past three days.

Anyway, the takeaway is that now I will have to get PSA tests done at 6 month intervals, and then hopefully, see it dive down to negligible levels in about 12-18 months. Otherwise, another biopsy may be needed. But in any case, I've made it clear no further treatments after this.

The prognosis, however, is very good and by all accounts from Dr. Crawford the tumor ought to be literally terminated as an ice ball that subsequently turns to dead cell slush.

Fortunately, I've not had to pay for any of the treatments, tests, biopsies I've had over the past five years. Ok, I take that back, I had to cough up about $1200 for the HDR Brachytherapy treatment I had at UCSF in 2012. But the total I would have had to pay for all cancer treatments, had I not had Medicare, is estimated to be around $115,000 when the cryo-ablation is factored in. In fact, without Medicare, we'd likely have had to declare bankruptcy.

That brings up the question as to what millions of Americans will now do that this misnamed Senate health care bill ("Better Care Reconciliation Act Of 2017") is ready to pass.   And by the way, let's also cut the crap this is a health care bill. It  is not. It is a revival of the zombie tax cut paradigm that the GOP has turned into an abiding fetish. This despite the fact that NO evidence exists that cutting taxes for the rich or corporations increases economic growth..  That canard was last exposed during the Gee Dumbya Bush reign, but now has been revived by Paul Ryan and Co. Never mind, the Repukes are salivating to cut the critical medical access for tens  of millions to give the richest more gold-lined tubs, yachts, 20,000 sq. ft. vacay homes and blood diamonds that they don't need.

So this vile tax cut bill  - in the words of one commentator - "takes a meat axe to their health care.". That is, to Medicaid, through which $800b would be cut, lowering the bottom on 75 million Americans. What if the males  in that population get a cancer like I have, what can they do? Well, the Repuke bill will ramp up their deductibles, increase co-pays (by an average of 20%)  and limit access, while offering only measly tax credits - if they pass an income test. End result? Most would either have to go bankrupt accessing the treatments needed, or allow the cancer to progress.

For people with disabilities, Medicaid is the primary benefit that allows them to stay in their own homes.  Without it they will be homeless on the streets, hence the reason for their plaintive cries yesterday (in front of Bitch McConnell's office)  to "Save our liberties!"

For lower income folks, the bill amounts to the most massive transfer of resources in history from them to the wealthy for $600b in tax cuts. The low income people will be left with virtually nothing by 2025, or be at the mercy of private insurers. Here in Colorado, Medicaid access will revert back to what it was before the ACA arrived, with draconian qualification measures applied - given the extirpation of Medicaid expansion will leave us with a $750 m. plus deficit. That means a low income mother of 2 kids in 2025 will have to earn no more than $300/ month to qualify to receive Medicaid benefits after this god -awful plan allows only limited block grants to the states. The worst hit will be the underclass disabled and seniors barely making ends meet living in high premium states. Seniors alone will have to cough up 5 times more in premiums thanks to this misbegotten atrocity.

And for a take on the for profit health insurance industry we have these words from  William Rivers Pitt - who wrote in a recent Blog post (on 'smirkingchimp.com')- on how they compare to a Mob protection racket:

"The health insurance industry, for the most part, is the Mob painted over with a veneer of legitimacy. They're a protection racket. The Mob got people to pay by offering "protection" for your restaurant or store, and would burn it down if you didn't pay up. With the insurance industry, your body is the store, and as all flesh is inevitably weak, your store will eventually burn down, taking your financial stability with it unless you pay the insurance middleman in full. Nice health you got there, be a shame if something happened to it. That's only if they don't turn down your claim because of a typo on your claim form, which is hardly rare. I had ICU nurses telling me insurance horror stories that made one wistful for the ringing sound of guillotines in the town square.

The problem is the fact that health care in the United States is a for-profit industry, like petroleum speculation or automobile manufacture. It's a few people making a lot of money off of sick people, and after so many years of this being the status quo, they have the political system wired to keep it that way."

Question: If the health insurance lot are analogous to the Mob in a protection racket, what does that make Bitch McConnell, Paul Ryan and the GOP?

Answers?  Inquiring minds want to know.

See also:


http://www.edavidcrawford.com/targeted-prostate-cancer-treatment

Monday, June 19, 2017

The REAL Reason Too Many Companies Can't Find Good Workers

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Two recurring puzzles to do with the current job market are: 1) Why are so many job openings going unfilled? and 2) Why does wage stagnation remain entrenched?  It is also possible to inquire if the two are somehow related, i.e. are relatively low wages for certain jobs (e.g. STEM occupations, in science, technology, engineering, math) putting workers off applying for them?

In respect of (2),  Lauren Weber, in a recent WSJ piece, noted that a "global market" is one factor holding U.S. wages in check. In effect, factory workers in Pennsylvania compete for jobs not only with each other but also in China and Mexico where wages are lower. Nothing Trump has done up to now has changed that in a significant way.

Weber also investigated why so many companies are having a difficult time filling their openings.  What she found was the "companies are reluctant to raise pay, in part to protect their profit margins".  They also prefer right now to have more money set aside to buy back their own shares if it can help their bottom line, increase share prices.

According to managing director of Aspen Advisors, Andrew Gadomski, that is "holding back hiring".   He notes that when companies lament they can't find workers to fill key openings, that is code for: "I can find talent, I just don't want to pay them as much as they cost."

In other words, these employers are quite capable of finding the workers with the background they need, they just don't want to pay them what they are worth.  Well, what's an employee to do? The answer is to either stay out of the cheapskate job market until employers shape up, move to another location to find a similar job, or perhaps look at changing skills, professions. (Though there is no guarantee the same cheapskate bosses won't dominate other areas too)

Note also that this is despite job openings being at "all time highs" according to Beth Ann Bovino, chief U.S. economist for S&P Global Ratings. Thus: "Businesses are struggling to fill these positions in an increasingly tighter market." As per a Denver Post article highlighting the situation ('Sounds of Silence Greet Colorado Employers Looking for Summer Help', June 11)::

"Steve Homolka needs to hire just five workers this spring to help him with his family masonry-staining business.Finding them has proven much more difficult than he ever imagined. And it isn’t about unqualified applicants. Nobody is responding to the numerous ads he has posted on Craigslist, Facebook, Instagram and other sites."

Thus, it appears that there is a surfeit of positions but not enough takers. But why aren't there takers? Is it that the qualified employees don't exist, or not enough, OR is it because the companies aren't prepared to pay a proper remuneration? In the Colorado example cited above, it may just be that summer work is an insufficient lure and people (e.g. college grads) want something a tad more long term to be able to move out of the family basement.

In the more general context employers may simply be cheapskates and unwilling to part with good money for good talent, whatever the job.  This is apparent given the remark ("I just don't want to pay them as much as they cost.") of the employer cited by Andrew Gadomski.  In other words, the companies have brought this situation on themselves.

Adding to that, is what employers often view as a labor shortage is in reality a retention problem, this also according to Gadomski. Obviously if you are losing workers - chasing better pay or benefits - you have to replace them. This is especially the case now when employees are willing to jump ship for a raise after many years of being expected to work harder - but getting only ulcers and overtime offers for their trouble.

Again, it is evident that the companies have largely brought their predicament on themselves.  To substantiate that, Weber reports that "workers are voluntarily quitting jobs this year near the highest rate since the recession ended".  This according to Labor Department data.

While the stinginess of employers could well explain the lack of openings filled in skilled occupations, e.g. STEM jobs (in Colorado last year there were 15.3 openings for every potential candidate), this may not translate to the lower wage domain.   Here, the attacks on immigration and immigrants by the Trumpies could account for labor shortages in agriculture, for example. An open question in the vast agro fields of California and Florida is 'who is going to pick the produce now?'   The working class unemployed white Americans aren't prepared to go into the fields, so who will?

Similar labor shortages apply in landscaping as well as construction with thousands of jobs going begging here in Colorado alone. The unemployment rate in CO is currently 2.3 %, the lowest in the nation. In metro Denver, labor markets are even tighter, with the unemployment rate dropping down to 2.1 percent.  Much of this has been on account of an influx of over 20,000 millennials to grab any jobs they can in the banking, energy, or MJ sectors.  The problem is that these newcomers have basically left the door "closed" for others unless they want to take a seasonal- only job. (See above)

Meanwhile, as  Trump's crusade against immigrants, especially Hispanic, continues - the lower wage labor shortages are likely to reach crisis level.  To give an example - as cited by Lauren Weber- the scale of the problem is already such that some growers, e.g. in CA, FL, have discarded portions of their harvest. They have no choice if they are unable to get the workers to do the harvesting.

Added to this, temporary workers across the board are more consistently demanding higher wages and full time work. This according to Rachel Chapman, owner of a staffing office in Huntsville, AL. The problem is that most of her clients can't afford to pay the $12 /hour now demanded.

What seems ever clearer to me is that employers who could formerly pick their workers at their leisure and fire them for the slightest infraction, will now have to vigorously compete to fill positions. That also means paying them what they are really worth instead of stiffing them.

Conservative Knuckle heads Protest "Julius Caesar" Play In Park - Prove They're Hypocrites and Pro-Censorship

The Public Theater's Free Shakespeare in the Park production has caused controversy 
Scene from 'Julius Caesar'  in Shakespeare in Park performance. Idiot Trumpies who rushed the stage can't tell fiction from reality.

We are in parlous times indeed when morons of the Right are unable to even parse reality from a fictional play and actors from actual personae. And so it was several days ago conservative lamos tried to interrupt the current Shakespeare in the Park performance of Julius Caesar because they believed it was portraying the "assassination" of their scumball hero prez who loves to grab pussies and insult the disabled.

The bimbo who did the main interruption later identified herself on social media as Laura Loomer . This half wit had jumped onto the stage just after the assassination of Caesar and began shouting, “Stop the normalization of political violence against the right,” and, “This is violence against Donald Trump.” Ms. Loomer described  herself as a “a right-wing investigative journalist and activist” who has previously worked with James O’Keefe, the guy who loves to confabulate false news using edited videos.

Subsequently,  her compatriot emerged shouting  to the crowd: “You are all Goebbels,” a reference to the Hitler aide and Nazi propagandist Joseph Goebbels.  Again, this sorry fool unable to distinguish a genuine Nazi piece of filth from a crowd who's merely gathered for some free entertainment. He really needs to go back to his meds, or ECT.

On social media,  this looneytune - Jack Posobiec-   describes himself as an activist who supports President Trump and has been associated with conspiracy theories, identified himself as Ms. Loomer’s collaborator. Well, nuts of a kind are equally blind.

Loomer, however, is little different from the odd knuckleheads who dispatched tweets to 'Fox n' Friends' this a.m. with such stellar observations as ; "The Left must stop killing our POTUS!"  And, paying a genuine tribute to free speech and artistic independence: "The Left must learn it has to temper what it says and does".  Oh really, you asswit? Like you do when you screech about the Left denying Anne Coulter a speaking gig? Gimme a break!

The earlier tweet about "killing our POTUS" shows how fucking dumb these fools are, they can't even tell a play from reality. But it's no surprise given how they indiscriminately gobble up fake news. In fact, no one is being "killed" as it's a play with actor Gregg Henry (of "Rich Man, Poor Man" fame) playing the role of Julius Caesar. That he might happen to look slightly like the Donald doesn't make him the Donald.  A point that shouldn't need repeating but to people who can't tell fable from fact it does.

Other deranged half wits attempted to disrupt the final performance yesterday. One protester, Jovanni Vale, even stormed the stage and shouted “Liberal hate kills” before being quickly grabbed by security, according to the New York Daily News. Soon after, Salvatore Cipolla did the same while yelling “Goebbels would be proud.”  No, asshole, the same Goebbels who oversaw massive Nazi book burnings would be proud of a loser like you it you managed to shut down the production!

What are more apropos remarks than the Right's squealing included New York Times theatre critic, Jesse Green, writing: “Its depiction of a petulant, blondish Caesar in a blue suit, complete with gold bathtub and a pouty Slavic wife, takes onstage Trump-trolling to a startling new level.”

Well, uh yeah, but let's not forget how the Trumpies  (not to mention Trump himself) trolled the rest of the country all the way through the 2016 campaign and then after.

David von Drehle in his TIME article ('Never Mind Trump, We Need Shakespeare More Than Ever', June 26, p. 17) was probably more on target when he pointed out that:

"With Trump in power, dressing a blonde actor in a long necktie and calling him Caesar is, for an impressario, as obvious as Wonder Woman 2"

He goes on to describe how and why the play so easily adjusts and adapts to different settings in space and time, because - there will always be tyrants, or wannabe tyrants, and they can always be made to come alive anew in the right casting.

Adding:

"Shakespeare would revel in the hypocrisy of Trump's shocked, shocked defenders".

Indeed. Because these nitwits are blind to their hypocrisy and how they enjoyed - not doing actual plays as artistic license- but straight out hanging Obama in effigy and claiming "free speech" e.g.
Image result for obama lynched images

Actor Gregg Henry  was quoted by the UK Telegraph:

"The Roman emperor became drunk with ego, drunk with power, drunk with ambition and the belief that he and he alone must rule the world. The idea for me was to try and show you that this could be Trump.”

Adding:

 “When a tyrant comes to power, it’s very important how you then try to deal with the problem - because if you don’t deal with the problem in a proper way, you can end up losing democracy for like, 2000 years.”

Ouch! Don't go there, Mr. Henry or the Reich's imbeciles will believe you actually are pretending to BE Trump!

Meanwhile, the unhinged freakazoids of the Right keep on with their petty victimizations. Though the  Times has been sponsoring the  Public Theater for over 20 years, and said they would continue to do so for reasons of artistic independence - the right wing website The Daily Caller published a story with the headline: "The New York Times is sponsoring an assassination depiction of Donald Trump."

Again, the historical and literary retards can't discern it's a depiction of the assassination of Julius Caesar in a modern setting, wearing suits instead of togas. Not Donald Trump.

If we are now going to allow the Right to try to enforce censorship of artistic productions, we are really in deep shit as a nation. Dick Cavett, when asked about his opinion by Ari Melber yesterday evening was blunt: "I'm against any kind of censorship. That's not what this nation is about."

But make no mistake, the weenies and hypocrites of the Right - after the shooting last week - will try their level best to use it to snuff out creative productions, as well as intense criticism of their agenda. The Left and Democrats must not allow this, and stand up to this lot each time they try to conflate fiction and reality.

Words from Shakespeare to remind us of the times we're in where too many can't discern reality from fable:

"Indeed, it is a strange disposed time:

But men may construe things after their fashion,

Clean from the purpose of the things themselves."

Saturday, June 17, 2017

How Explain The Sad State Of Undergrad Physics Lab Teaching In U.S.?

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Physics lab instructors mentored on how to set up and run a quantum optics experiment.

The news as reported in a recent issue of Physics Today (April, p. 26) was shocking to say the least. That is, that the state of undergraduate physics laboratory teaching in the U.S. is one of total disarray and economic disconnection. How bad are things?  Let's list them:

- Much of  the equipment is dilapidated and beyond practical use

- Experiments are not up to date, e.g. many school are still doing the Millikan oil drop experiment and Cavendish gravitational force experiment.  Many others are also decades or centuries old.

- Many schools are so impoverished in equipment they can't offer labs beyond the first year (mostly associated with General Physics courses)

- Funding for maintaining and updating labs is lacking, and note here that maintaining labs is time consuming and often requires knowledge beyond any one person's research experience.

- Faculty get scant credit for investing time in the labs, including jury rigging dilapidated equipment

The preceding betray the extent of an embarrassing problem that currently affects roughly 750 institutions including "elite" schools. In effect, among those schools that offer a physics bachelor's degree "there has been a collapse" in lab courses. This according to Illinois Weleyan University's Gabriel Spalding.

Given that physics is ultimately a practical science as much as theoretical, it was disheartening to read of the state of labs across the country. Given the university labs I've been associated with have all been thoroughly supplied it was difficult to conceive the basis for the downslide (But at the same time, I am referencing my last teach of labs some 25 years ago.)

What happened?

Basically this is really an economic question: how is it the money dried up to support undergrad labs including maintaining equipment? We have to go back to 1985 when the National Science Foundation (NSF)  established the Instrumentation and Laboratory Improvement (ILI)  program.  The ILI made matching grants available for lab equipment across many disciplines.

From 1985-95, according to program records, ILI awards were made to 1185 institutions totaling $158.6 million. The discrete awards varied from as low as $5,000 to $100,000.  Over time, however, the program became more educationally diffuse so initiatives that once focused on equipment alone expanded to broader educational missions. While the latter may well have been worthwhile, they siphoned money away from purchasing new lab equipment and maintaining existing equipment.   The end result was a zero sum game with the laboratory aspect getting the shorter stick over time.

Worse, a competition was set up within institutions pitting instructors needing physics education equipment against those wanting pure research equipment.    The NSF instructions for declaring need for grants  insisted on "being clear of the knowledge generating aspects" of the proposal. Basically, one had to choose between "physics education research" (i.e. money for lab equipment to teach students) or physics research per se needing equipment for specific experiments. As one prof quoted in the piece put it:

"If I want money for equipment, I don't want to do physics education research. If someone wants to do physics education research they don't want to approach an experimental lab the way I go about it."

The result? According to Gabriel Spalding:

'There really is no significant federal money for instructional lab equipment any more".

So we can afford to piss $3.1 b a month down the drain in Afghanistan for a "war" we can never win, while our universities - supposedly training the next generation of physicists -  go begging for lab equipment.

Fortunately, a decade-old professional organization: the Advanced Laboratory Physics Association (ALPhA), has stepped in to help reduce the problems facing undergrad physics lab teaching.  Their efforts have included: conferences, training sessions and other activities. Complementing these efforts, there is the company TeachSpin -created by Jonathan Reichart-  to promote and support undergraduate physics laboratory instruction.   Part of TeachSpin's mission is to disseminate new experiments, such as the one shown on quantum optics in the graphic, for more advanced lab instruction.  This has been enormously valuable in conjunction with ALPha's  'Beyond the First Year' (BFY) college lab conferences to showcase many new lab experiments.

But let's not kid ourselves here. While ALPha's and TeachSpin's efforts and contributions are laudable and important, they will still not be sufficient to sustain undergraduate lab teaching in the long run. For that, greater federal funding is needed, namely a reversion to the original ILI program sponsored by the NSF.