Eric H. Doss's Posterous Site

The electric company shows you the truest words that you ever heard anybody say

THE United States Chamber of Commerce's campaign against climate-change legislation is causing an exodus of electric utilities that don't want to be associated with a bunch of troglodytes who deny scientific and economic reality. ThinkProgress reports that Exelon, the largest utility in America, is the latest to leave; Pacific Gas & Electric and New Mexico's PNM quit the Chamber last week. Matthew Yglesias wonders why the rest of America's businesses are still so stubborn on the climate-change front, unlike business leaders in Europe. I think it partly has to do with specific incentives for different businesses, but part of it is due to political dynamics created by America's two-party system and our penchant for Manichaean thinking. It's not surprising that electric utilities

Some things are better when they're not free.

If Craigslist charged a dollar for every listing, what would happen?

Well, the number of bogus listings and repetitive listings would plummet, making the site far easier to use.

The number of scam artists using the site would go down, because it's more difficult to be anonymous when money changes hands.

The revenue of the site would soar, which means that the people running the site could get (far) richer, or fund digital journalism or change the economy of an emerging nation.

Money creates a sort of friction. In the digital economy, magical things can happen when there is no friction. You can scale to infinity. On the other hand, sometimes you want friction.

If you lead a group that allows anyone to join, for free, your group might be large, but it's not tight, it's not organized to make important change. Commitment slows things down in the short run, but ultimately aligns interests.

From Bill Easterly's, Can the West Save Africa.

Hat tip to for the link and table to Hit and Run.

Read more of this story at Slashdot.

The Insurance Institute for Highway Safety (IIHS) celebrated its 50th anniversary the same way we all celebrate our major milestones: by smashing up a classic car and putting footage of it on the Internet.

They performed a crash test of a 1959 Chevrolet Bel Air and a 2009 Chevrolet Malibu to show the advances made in auto safety in the last fifty years—thanks in large part to the IIHS. Their original video was a hit on YouTube, and the results were no surprise to anyone with a passing familiarity with cars. What the car-buying public has lost in awesome tailfins, we have gained in safety.

Today, Consumer Reports Cars posted an extended "director's cut" of the video, featuring extra footage and commentary on what exactly you're seeing in the video.

Incidentally, if you feel like watching newer cars get smashed up a bit, or are just curious how your own vehicle would fare in a crash, check out the Consumer Reports crash test video player, which can provide minutes upon minutes of fiberglass-smashing edutainment.

Video: Director's cut - 2009 Chevrolet Malibu vs 1959 Bel Air crash test [Consumer Reports Cars]

I see people on the news screaming that they don't want "bureaucrats" between them and their doctor, and are afraid that's what government health care will bring.

WTF? THAT'S THE WAY IT IS NOW, PEOPLE!!! I hear my nurse Annie on the phone all day trying to get approval from non-government insurance companies for tests, medications, physical therapy, ANYTHING that I order.

Look at your insurance card. Doesn't it say things like "in-network" and "formulary"? Who the hell do you think came up with those? Not us docs. Dat be dem dere byoo-row-kratz!

Look back at some of my posts (like this, or this). I routinely have medications (both brand name and cheap generics) and tests refused by insurance companies. For an excellent commentary on this from the pharmacy side, this was written by FranticPharmacist.

So if you don't want bureaucrats between you and your doctor- TOO BAD. They've been there for years. THE ONLY PEOPLE WHO DON'T HAVE THIS PROBLEM ARE PAYING CASH FOR EVERYTHING!

In fact, for those of you don't want the government running this, THEY ARE ACTUALLY ONE OF THE BETTER ONES TO WORK WITH! Just ask Annie. Medicare doesn't question the majority of my tests, or meds. Yes, they don't cover everything, nor should they, but they don't fight with me over stuff like MRI's on stroke patients. Uncle Sam (unlike BCBS, Aetna, Cigna, United, Humana, and many others) tends to leave these things to the doctor's discretion. Annie prefers Medicare patients for this very reason - they make her life easier.

So what happens to you the way it works NOW, with your non-government insurance?

You come to me for some neurological issue, which requires further work-up. So I order, say, an MRI and MRA of your head.

Annie gets the order, and calls Bozo Insurance, Inc. (BII) to schedule it. BII refuses, saying they want more information. So they fax us a 5 page "pre-auth" form, which Annie spends 20 minutes filling out and faxes back. Then they say the form wasn't enough, and they also want copies of your office notes, so we send those, too (yup, when you joined BII you agreed that they can read your medical records).

So a few days go by. BII will claim they never got our fax. Or that we filled the form out wrong. Or that they don't cover Capricorns when the moon is in Pisces. And we don't know this until Annie calls back after a few days, because they're hoping we forgot about it.

Eventually they'll deny the whole thing, on the grounds that you don't meet criteria for an MRI and MRA. This decision is usually made by a non-medically trained person with a minimum of a GED. They do this because they want to see just how badly I want the test.

So they tell me I can appeal this via "peer-to-peer" review. Which means I need to personally call their "physician reviewer" to argue with them as to why I want the study.

So, during my insanely busy day at the office I have to call them. I'm promptly put on hold for 10 minutes, before finally reaching the reviewer. This person is a doctor- but NOT necessarily in my specialty. In fact, it's usually something like a retired dermatologist, who hasn't done neurology since medical school in 1938. Or an OB/GYN who hated his job, and is doing this now instead. Or some doctor who immigrated from Lower Swazbodiaczk and can't get a U.S. medical license (but your insurance company hired him to decide what medical care you need). But it's almost NEVER someone actually in my field, who might understand why I want the study.

So after telling your life history to Dr. Denial, one of 2 things will happen. They'll deny both studies, and want you to try medication or psychotherapy or holistic reflexology or whatever, and if you fail that THEN I can try to resubmit a request for the test. OR they will flip a coin and say they will cover the MRI, but not the MRA. Or vice-versa. They'll say that if the first test is fine, THEN I can start over trying to get the other covered. Maybe.

And many of these companies actually pay these "reviewers" bonuses based on HOW MUCH MONEY THEY SAVED THE COMPANY BY DENYING TESTS.

This can at times become comical. One of my patients is a doc who works part-time as one of these insurance company "physician peer reviewers". And when he needed an MRI, guess what? HIS OWN COMPANY DENIED IT! He paid out of pocket for it (and yes, it was abnormal).

So how did I get on this tangent? Because yesterday I was walking by Annie's office, and heard her losing it over the speaker phone. And, as always, she was totally awesome.

Annie: "I'm calling because you people denied an MRI on a stroke patient?"

Pinhead: "Before we discuss this, I have to inform you that this is a recorded line."

Annie: "Oh, good, hopefully someone will actually be listening to me then. Thus far it hasn't happened."

Pinhead: "Let me look up the tracking number... Okay. I have to inform you that we are unable to approve this study. Your doctor will need to make a peer-to-peer call."

Annie: "Oh, now THAT's a surprise."

Pinhead: "What do you mean?"

Annie: "Is this line really being recorded?"

Pinhead: "Yes. It's to improve customer satisfaction."

Annie: "Oh, goody, because I'm sure not satisfied, and neither is the doctor, or the patient. Your company, and whoever is listening, never approves anything. In fact I can say that 100% of the time you require peer-to-peer review."

Pinhead: "We do this to save our customers money on unnecessary testing."

Annie: "Okay. Then let's just stop wasting each others time. Forget the intake coordinator, forget you. Since your only job is apparently to tell me that my doctor needs to call your doctor, couldn't your company save money by firing you?"

Pinhead: "Um, I hadn't..."

Annie: "Think about it. You have benefits and a salary, right? I mean you're not doing this as a volunteer job, are you?"

Pinhead: "No, but I..."

Annie: "So wouldn't your company save money by firing you and instead getting a computer that automatically denies every damn test and sends a fax telling us to call for a peer-to-peer review? Then we can just let the doctors talk directly to each other from the beginning, which is what you bozos want anyway. Think of the money saved by cutting all of your jobs."

Pinhead: "Oh, but you can't mean that?"

Annie: "Oh but I do mean that. And I'm glad we're being recorded. Let's consider the current situation. You are basically a worthless automaton. A computer could do your job for far less. And at this point you've incurred the wrath of all the medical professionals in the country as well as the patients. You and all of your superiors ought to be out of a job due to your blatant inefficiency. And don't think we don't save your denial forms, and your names, and document it all in the chart."

Pinhead: "I..."

Annie: "Nothing personal you understand, just a suggestion. I'll have my doctor call your doctor. Have a nice day".

Pinhead: "No, wait! I..."

Annie hung up.

So bottom line here: if you don't think bureaucrats are currently between you and your doctor- THEY ARE! GET REAL! IT'S BEEN THAT WAY FOR THE LAST 10 YEARS OR MORE!

A nifty graphic that shows you how subtle differences make all the difference (via).

Print the pledge and ask all your teabagger/libertarian friends and family to sign it!

The Teabagger Socialist-Free Purity Pledge

I, ________________________________, do solemnly swear to uphold the principles of a socialism-free society and heretofore pledge my word that I shall strictly adhere to the following:

I will complain about the destruction of 1st Amendment Rights in this country, while I am duly being allowed to exercise my 1st Amendment Rights.

I will complain about the destruction of my 2ndAmendment Rights in this country, while I am duly >being allowed to exercise my 2ndAmendment rights by legally but brazenly brandishing unconcealed firearms in public.

I will foreswear the time-honored principles of fairness, decency, and respect by screaming unintelligible platitudes regarding tyranny, Nazi-ism, and socialism at public town halls. Also.

I pledge to eliminate all government intervention in my life. I will abstain from the use of and participation in any socialist goods and services including but not limited to the following:

• Social Security

• Medicare/Medicaid

• State Children's Health Insurance Programs (SCHIP)

• Police, Fire, and Emergency Services

• US Postal Service

• Roads and Highways

• Air Travel (regulated by the socialist FAA)

• The US Railway System

• Public Subways and Metro Systems

• Public Bus and Lightrail Systems

• Rest Areas on Highways

• Sidewalks

• All Government-Funded Local/State Projects (e.g., see Iowa 2009federal senate appropriations--http://grassley.senate.gov/issues/upload/Master-Approps-73109.pdf)

• Public Water and Sewer Services (goodbye socialist toilet, shower, dishwasher, kitchen sink, outdoor hose!)

• Public and State Universities and Colleges

• Public Primary and Secondary Schools

• Sesame Street

• Publicly Funded Anti-Drug Use Education for Children

• Public Museums

• Libraries

• Public Parksand Beaches

• State and National Parks

• Public Zoos

• Unemployment Insurance

• Municipal Garbage and Recycling Services

• Treatment at Any Hospital or Clinic That Ever Received Funding From Local, Stateor Federal Government (pretty much all of them)

• Medical Services and Medications That Were Created or Derived From Any Government Grant or Research Funding (again, pretty much all of them)

• Socialist Byproducts of Government Investment Such as Duct Tape and Velcro (Nazi-NASA Inventions)

• Use of the Internets, email, and networked computers, as the DoD's ARPANET was the basis for subsequent computer networking

• Foodstuffs, Meats, Produce and Crops That Were Grown With, Fed With, Raised With or That Contain Inputs From Crops Grown With Government Subsidies

• Clothing Made from Crops (e.g. cotton) That Were Grown With or That Contain Inputs From Government Subsidies

• If a veteran of the government-run socialist US military, I will forego my VA benefits and insist on paying for my own medical care

I will not tour socialist government buildings like the Capitol in Washington, D.C.

I pledge to never take myself, my family, or my children on a tour of the following types of socialist

locations, including but not limited to:

• Smithsonian Museums such as the Air and Space Museum or Museum of American History

• The socialist Washington, Lincoln, and Jefferson Monuments

• The government-operated Statue of Liberty

• The Grand Canyon

• The socialist World War II and Vietnam Veterans Memorials

• The government-run socialist-propaganda location known as Arlington National Cemetery

• All other public-funded socialist sites, whether it be in my state or in Washington, DC

I will urge my Member of Congress and Senators to forego their government salary and government-provided healthcare.

I will oppose and condemn the government-funded and therefore socialist military of the United States of America.

I will boycott the products of socialist defense contractors such as GE, Lockheed-Martin, Boeing, Northrop Grumman, General Dynamics, Raytheon, Humana, FedEx, General Motors, Honeywell, and hundreds of others that are paid by our socialist government to produce goods for our socialist army.

I will protest socialist security departments such as the Pentagon, FBI, CIA, Department of Homeland Security, TSA, Department of Justice and their socialist employees.

Upon reaching eligible retirement age, I will tear up my socialist Social Security checks.

Upon reaching age 65, I will forego Medicare and pay for my own private health insurance until I die.

SWORN ON A BIBLE AND SIGNED THIS DAY OF ____________ IN THE YEAR ______________.

___________________________ ___________________________

Signed Printed Name/Town and State