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Three million Californians are newly insured thanks to Obamacare, but they can't find any doctors willing to take them. One of the big philosophical problems with Obamacare is that it makes the assumption that getting someone health insurance will inevitably lead to that person getting health care. That isn't true.

Thinn Ong was thrilled to qualify for a subsidy on the health care exchange. She is paying $200 a month in premiums. But the single mother of two is asking, what for?

"Yeah, I sign it. I got it. But where's my doctor? Who's my doctor? I don't know," said a frustrated Ong.

Nguyen said the newly insured patients checked the physicians' lists they were provided and were told they weren't accepting new patients or they did not participate in the plan.

Dr. Kevin Grumbach of UCSF called the phenomenon "medical homelessness," where patients are caught adrift in a system woefully short of primary care doctors.

"Insurance coverage is a necessary but not a sufficient condition to assure that people get access to care when they need it," Grumbach said.

Those who can't find a doctor are supposed to lodge a complaint with state regulators, who have been denying the existence of a doctor shortage for months.


The NYT has a great piece about direct primary care: doctors who have stopped taking insurance and instead work for cash. Like a normal business. Surprise! It works pretty well.

Lee Spangler, vice president of medical economics with the medical association, said Texas was seeing an increase in practices like these because they gave doctors more flexibility to determine the services they provide and to cut costs for their practices.

"A physician has very little ability to negotiate all policies and procedures that come with insurance contracts," Mr. Spangler said, adding that some insurance companies can even dictate the business hours during which doctors can be paid. "Basically you get rid of all those shackles in terms of having a carrier dictate to the practice how to deliver medical services."

It is the direct primary care business model that proves most attractive, Mr. Spangler said, adding that doctors "want to get out from under what has been stacked up on them."

Bizarrely, "some people" seem to be more worried about health insurance than actual health care. Could it be that these "some people" make their livings as middlemen who don't want patients to go straight to doctors?

Some health care specialists worry that if too many practitioners choose this path, the state could be left struggling to find doctors to accommodate patients with insurance as the federal health care overhaul is making such coverage mandatory for most Texans. So far, efforts to enroll Texans in the federal insurance marketplace -- crucial to the success of the Affordable Care Act -- have made a small dent in the state's uninsured population, which has reached 6 million, according to United States Census Bureau data. The federal Department of Health and Human Services reported that 295,000 Texans had signed up for insurance coverage in the federal marketplace as of March 1.

"We have to find ways of stretching the current number of primary care doctors to meet that demand," said Dr. Clare Hawkins, president of the Texas Academy of Family Physicians. "Direct primary care goes in the other direction."

What if you passed a law mandating insurance, but no doctors showed up?


Guess what? The penis is not the worst place to be stung by a bee.

"The Schmidt Sting Pain Index rates the painfulness of 78 Hymenoptera species, using the honey bee as a reference point. However, the question of how sting painfulness varies depending on body location remains unanswered. This study rated the painfulness of honey bee stings over 25 body locations in one subject (the author). Pain was rated on a 1-10 scale, relative to an internal standard, the forearm. In the single subject, pain ratings were consistent over three repetitions. Sting location was a significant predictor of the pain rating in a linear model (p < 0.0001, DF = 25, 94, F = 27.4). The three least painful locations were the skull, middle toe tip, and upper arm (all scoring a 2.3). The three most painful locations were the nostril, upper lip, and penis shaft (9.0, 8.7, and 7.3, respectively). This study provides an index of how the painfulness of a honey bee sting varies depending on body location."

beefig.jpg

Ok, so I'm estimating the number of bee-stings... the actual number could be as few as 75 if the author didn't test all 78 species. But still.


Everyone has heard about BitCoin by now, but did you know that crypto-currencies are just a subset of Distributed Autonomous Corporations?

Distributed Autonomous Corporations (DAC) run without any human involvement under the control of an incorruptible set of business rules. (That's why they must be distributed and autonomous.) These rules are implemented as publicly auditable open source software distributed across the computers of their stakeholders. You become a stakeholder by buying "stock" in the company or being paid in that stock to provide services for the company. This stock may entitle you to a share of its "profits", participation in its growth, and/or a say in how it is run.


Get a better night's sleep by picking the right type of pillow just for you! Yes, Pick-A-Pillow Guide is my first app! It's inspired by this Lifehacker post and data from SleepLikeTheDead.com.

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After installing Windows 8.1 on my wife's laptop it would not connect to wifi or the internet. The computer kept saying "limited" connectivity and none of the built-in troubleshooters could fix the problem. I reset the router numerous times, rebooted the computer, updated everything, reset the TCP/IP stack, etc. In the end, the problem was that while installing 8.1 Microsoft removed my wireless adapter drivers and replaced them with a new Microsoft version! Argh!!!! What the hell?

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Reverting back to the manufacturer's drivers solved the problem.


A downward revision from the non-partisan Congressional Budget Office on the effect of Obamacare on employment. If you think think this number is unlikely to be revised further downward in future years, you haven't been paying attention to all the "unexpected" bad news recently.

The agency previously estimated that the economy would have 800,000 fewer jobs in 2021 as a result of the law. In that analysis, the CBO looked primarily at how employers would respond to a new penalty for failing to offer insurance to employees who work more than 30 hours a week. That response would include cutting people's hours, hiring fewer workers and lowering wages for new jobs.

On Tuesday, the agency released a more detailed estimate that includes how ordinary Americans would react to those changes by employers. Some would choose to keep Medicaid rather than take a job at reduced wages. Others, who typically do not work full-time, would delay returning to work in order to keep subsidies for private insurance that are provided under the law.

As a result, by 2021, the number of full-time positions would be reduced by 2.3 million, the report said.

The CBO also predicts that compensation will also suffer:

The CBO is now estimating the law will reduce labor force compensation by 1 percent from 2017-2024 -- twice the reduction it previously had projected.


So net neutrality is over, at least for now. What is net neutrality anyway? It's simple to explain, but the implications are murky. Short explanation: net neutrality means that your internet service provider has to treat all your internet data the same. ISPs can't throttle some kinds of data, or charge you extra for other data, or block data from competitors.

On the surface net neutrality sounds good, right? However, it also prevents ISPs from experimenting with new business models and pricing structures. For example, at peak times Netflix accounts for something like 30% of internet traffic in America. Netflix makes a ton of money from this, but they don't pay anything for the bandwidth. ISP subscribers pay for all that capacity as a part of their monthly service fees. This is fine if you use Netflix, but if you don't (as I don't) then you're paying for someone else's Netflix bandwidth. Why shouldn't Netflix kick in some money to pay for the bandwidth their subscribers are using?

Ok, so now you're convinced that net neutrality is bad! Those big internet content companies should pay for the bandwidth they use! Right?

Well, what happens when your ISP signs a contract with Netflix? Netflix pays some money to your ISP to get super-fast data to your livingroom during peak TV-watching hours, and maybe your internet bill goes down. However, Amazon doesn't want to pay for access, or maybe they're just outbid by Netflix. So if you prefer Amazon Prime's movie selection to Netflix, you either can't get it at all or your bandwidth is throttled. Lame! (Not to mention start-up companies that won't be able to afford to buy access.)

It's not really clear if net neutrality is all-good, but the internet has managed to thrive with the philosophy in place. I can understand some theoretical advantages to removing net neutrality, but considering how good things have been for the past 20 years I'm not willing to take the risk.


Absolutely amazing to see the confluence of all these technologies more than 45 years ago. The video is quite long, but you can skip around to see early incarnations of technology that is now ubiquitous.

"The Mother of All Demos is a name given retrospectively to Douglas Engelbart's December 9, 1968, demonstration of experimental computer technologies that are now commonplace. The live demonstration featured the introduction of the computer mouse, video conferencing, teleconferencing, hypertext, word processing, hypermedia, object addressing and dynamic file linking, bootstrapping, and a collaborative real-time editor."


Here's an Orwellian use of the word "demand". Does Sebelius remember that the law requires people to buy this product? The "demand" is entirely on the government side.

"The numbers show that there is a very strong national demand for affordable healthcare made possible by the Affordable Care Act," said U.S. Health and Human Services Secretary Kathleen Sebelius.

79% of Obamacare enrollees are received subsidies from taxpayers. I hope that's not sustainable.

Most of the people who bought coverage on the exchanges this fall got subsidies to help them afford the premiums. That's in contrast to the first month of the program, when less than one-third of buyers were subsidized. People earning up to four times the poverty rate--as much as $96,000 a year for a family of four--can get help buying coverage.


As 2014 dawns there are fewer people with health insurance thanks to Obamacare. Considering that the goal of Obamacare was to increase coverage even with increased costs, this is a sad state of affairs -- because costs have certainly gone up. Americans are unquestionably worse off as a group thanks to Obamacare, and only two questions remain: how bad will it get? and when will it end?

America deserves better.

The White House used a Sunday morning statement to admit that only 1.1 million people have used the federal Obamacare website to sign up for the president's healthcare network by Christmas Day.

News reports and advocacy websites say roughly 1 million people have enrolled with health-benefit companies via state websites, including 400,000 in California and 157,000 in New York, by the Dec. 24 deadline, which allows coverage starting Jan. 1.

The 2 million federal and state signups are roughly two-thirds the planned goal of 3.3 million enrollments by Dec. 31. They're also only one-third of the 7 million customers sought by March 31.

The total reported signups are at least 3 million fewer than the 5 million people whose health-insurance policies were cancelled prior to Christmas by President Barack Obama's ambitious tax-and-healthcare scheme.

The minus-3-million score is only partially offset by the extension of Medicaid coverage to perhaps 2 million other people, few of whom earn enough to afford commercial insurance.

Of critical note, the administration is using a deceptive definition for the word "enrolled": it is not known how many of the "enrolled" participants have actually paid for their plans.


Since the early 20th century we've lived in the miraculous age of antibiotics: almost every bacterial infection that had previously killed or crippled millions of people could be cured with a simple pill. However, recent trends indicate that the age of antibiotics may be waning, and that civilization itself may be crippled if we don't discover some new strategies to combat our ancient foe.

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Indeed, a deadly form of MRSA had sprung from nowhere, picking off otherwise healthy people. The cases thrust Iqbal and his colleagues to the front lines of modern medicine''s struggle against antibiotic resistant bacteria - perhaps the nation's most daunting public health threat. No drug-defying bug has proved more persistent than MRSA, none has caused more frustration and none has spread more widely. In recent years, new MRSA strains have emerged to strike in community settings, reaching far beyond hospitals to infect schoolchildren, soldiers, prison inmates, even NFL players.

A USA TODAY examination finds that MRSA infections, particularly outside of health care facilities, are much more common than government statistics suggest. They sicken hundreds of thousands of Americans each year in various ways, from minor skin boils to deadly pneumonia, claiming upward of 20,000 lives. The inability to detect or track cases is confounding efforts by public health officials to develop prevention strategies and keep the bacteria from threatening vast new swaths of the population.

(HT: Paul Hsieh.)


The Obama administration is deploying a fog of useless statistics to obscure the true state of Obamacare. They're hiding the real information and releasing big numbers that don't mean anything. It doesn't matter how many people "selected a plan" -- it matters how many people wrote a check. It doesn't matter how many people visited the website, or called a call center, or "liked" Obamacare on Facebook. None of those numbers speaks to the crucial issue: will enough young, healthy people sign up and overpay? Or will the system collapse under the weight of new Medicare recipients, the poor, the old, and the sick?

A charitable reading suggests that ObamaCare's net enrollment stands at about negative four million. That's the estimated four million to five and a half million people who had their individual health plans liquidated as ObamaCare-noncompliant--offset by the 364,682 who have signed up for a plan on a state or federal exchange and the 803,077 who have been found eligible to receive Medicaid.

HHS is boasting of enrollment for November that was four times as high as October, yet 62% of the total was in the state exchanges, some of which are marginally less prone to crashing than the federal version. Then again, 41 states posted sign-ups only in the three or four figures, including eight states that run their own exchanges. Oregon managed to scrape up 44 people. Among the 137,204 federal sign-ups, no state is reaching the critical mass necessary for stable insurance prices.

The larger problem is that none of these represent true enrollments. HHS is reporting how many people "selected" a plan on the exchange, not how many people have actually enrolled in a plan with an insurance company by paying the first month's premium, which is how the private insurance industry defines enrollment. HHS has made up its own standard. ...

HHS is trying to conjure the appearance of progress and specificity even as it conceals everything that is relevant to ObamaCare's performance. The bureaucracy will tell you it fielded 3,495,276 inquiries at the federal call centers and that 28,412,684 people visited Healthcare.gov. But it will not tell you the demographics and health status of new beneficiaries, or what type of plans they're selecting, or HHS's enrollment goals over time.


So despite being high in fat and calories, nuts appear to have all sorts of health benefits. It's almost as if fat and calories aren't the end-all of health and weight management.

Those who ate a handful of nuts each day, approximately the recommended 1.5-ounce serving, had a 20 percent lower chance of dying from any cause during a 30-year period, compared with those who did not eat nuts every day. Additionally, the researchers saw a 29 percent reduction in the number of deaths that resulted from heart disease - the leading cause of death in the United States - and an 11 percent reduction in the risk of dying from cancer.

"Somebody might read our study and say that's fine, but if we start encouraging nut consumption, that might lead to a greater chance of obesity, which is a major problem in the United States," said Charles Fuchs, director of the Gastrointestinal Cancer Treatment Center at the Dana-Farber Cancer Institute, and a senior author of the report. "But interesting, what we find is that regular nut consumers are actually lighter. There's less obesity in that group."


It's silly enough that Obamacare requires single men, infertile people, and old people to buy insurance plans that include maternity care, but don't worry! People under age 30 are exempt. Yes, the people who are most fertile and most likely to have babies are exempt from the requirement to buy insurance that pays for having babies.

[Rep. Renee Ellmers (R-NC)]: You also brought up the issue that when you were in Kansas [as health Commissioner and governor] that you fought against discriminatory issues... As far as [ObamaCare's] essential health benefits, correct me if I'm wrong: do men not have to buy maternity care?

[Health and Human Services Secretary Kathleen Sebelius]: Policies will cover maternity coverage. For the young and healthy, uh, under ythirty year-olds will have a choice also of a catastrophic plan that has no maternity coverage.

Ellmers: But men are required to purchase maternity coverage.

Sebelius: Well, an insurance policy has a series of benefits whether you use them or not...

Ellmers: And that is why health care premiums are increasing, because we are forcing them to buy things that they will never need. Thank you.

Sebelius: The individual policies cover families. Men often do need maternity care for their spouses and for their families, yes.

Ellmers: A single male, aged 32, does need maternity coverage. To the best of your knowledge, has a man ever delivered a baby?

(HT: James Taranto.)


As a kid I had always been told that airplane wings work under the Bernoulli principle. Everyone has seen the demonstration where you hold a piece of paper under your mouth and then blow across the top: the paper rises! But airplane wings work completely differently and you only need to understand Newton's laws of motion to get it.


"If you like your health care plan, you can keep your health care plan" said President Obama on August 11, 2009. However, hundreds of thousands of families are having their health insurance policies canceled right now. These folks are being told they have to sign up for new insurance through the Obamacare exchange, which is currently not operational.

Florida Blue, for example, is terminating about 300,000 policies, about 80 percent of its individual policies in the state. Kaiser Permanente in California has sent notices to 160,000 people - about half of its individual business in the state. Insurer Highmark in Pittsburgh is dropping about 20 percent of its individual market customers, while Independence Blue Cross, the major insurer in Philadelphia, is dropping about 45 percent.

For the families who had these policies these cancellations are a major life-changing event. Despite any opposition to Obamacare, one can only hope that these families are not too severely impacted by this completely avoidable disruption to their health care.


Some of the details surprised me, but the overall conclusion did not: even modest results from anti-aging research will be more beneficial than huge results from disease specific research. This makes sense for a couple of reasons:

  1. Everyone ages, but only a small number of people get any specific disease.
  2. The low-hanging fruit have already been picked when it comes to specific diseases, but the anti-aging field is very new. There are probably lots of "easy" discoveries waiting to be made.
An analysis, from top scientists at USC, Harvard University, Columbia University, the University of Illinois at Chicago and other institutions, assumes research investment would conservatively lead to a 1.25 percent reduction in the likelihood of age-related diseases. In contrast to treatments for fatal diseases, slowing aging would have no health returns initially, but would have significant benefits over the long term. With even modest gains in our scientific understanding of how to slow the aging process, an additional 5 percent of adults over the age of 65 would be healthy rather than disabled every year from 2030 to 2060

The study showed significantly lower and declining returns for continuing the current research "disease model," which seeks to treat fatal diseases independently, rather than tackling the shared, underlying cause of frailty and disability: aging itself.

Lowering the incidence of cancer by 25 percent in the next few decades -- in line with the most favorable historical trends -- would barely improve population health over not doing anything at all, the analysis showed. The same is true of heart disease, the leading cause of death worldwide: About the same number of older adults would be alive but disabled in 2060 whether we do nothing or continue to combat cancer and heart disease individually. The findings are in line with earlier research showing that curing cancer completely would only increase life expectancy by about three years.

"Even a marginal success in slowing aging is going to have a huge impact on health and quality of life. This is a fundamentally new approach to public health that would attack the underlying risk factors for all fatal and disabling diseases," said corresponding author S. Jay Olshansky of the School of Public Health at the University of Illinois-Chicago. "We need to begin the research now. We don't know which mechanisms are going to work to actually delay aging, and there are probably a variety of ways this could be accomplished, but we need to decide now that this is worth pursuing."

The bolding above is mine. Curing cancer would only increase average life expectancy by three years? That's a surprise to me, and actually makes me worry less about cancer than I had previously.


I learned a new term this morning: "climate departure":

A city hits "climate departure" when the average temperature of its coolest year from then on is projected to be warmer than the average temperature of its hottest year between 1960 and 2005.

Assuming the data is right the article doesn't explain why climate departure in any particular city is a particularly worrisome thing. Of course the cities that will be hardest hit are in the equatorial regions -- they'll get even hotter than they are now. That sucks, but they're already too hot for me to want to live there. On the other hand...

Temperate cities in Europe and the United States look a bit better, but we're talking about a difference of maybe 20 years separating Western capitals from Kingston or Lagos. In the long run, 20 years is not much of a difference. The study published in Nature projects 2047 for Washington, D.C., and New York City -- just 34 years from now. Los Angeles will hit the mark the next year and San Francisco the year after. Even the best-off cities, such as Moscow and Oslo, have just 50 years before passing the milestone. That feels like a long time right now, but in historical terms it's not.

Do you think Moscow and Oslo will complain if they get warmer? I doubt it. Even aside from the cities, huge tracts of northern North America and Asia will thaw and become quite attractive.

The universe is not a static place. We humans need to continue to adapt to our planet, just as it adapts to us.


This WSJ article really slams the self-checkout machines at the supermarket, primarily because the customer has to use the screens to look up codes for various fruits and veggies. I find this process to be remarkably easy myself, and always use the self-checkout line unless I have too many groceries to fit on the tiny shelf.

In my opinion the author misses the primary benefits of the self-checkout line.

1. Usually people form a single line that feeds into multiple machines. With a human cashier you have to take your chances in a line that feeds to a single register. Even if some customer fumbles and stalls you won't be stopped for long because one of the other self-checkout terminals will open up.
2. Everyone pays by credit card. The machines appear to have many payment options available, but I never see anyone try to pay by check or food stamps or cash with exact change.
3. The lines never get held up for price checks or because the customer forgot to grab something.

I agree that human cashiers are better than the robots, but human customers are often terrible. Self-checkout lines repel the worst customers.

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