Sunday, December 24, 2017

Twitter Treasure -- The Night Before Christmas, 2017

Chris Sampson‏ @TAPSTRIMEDIA

Twas the night before Christmas, when through the White House
Not a Kushner was resting, not even his spouse;
The documents were hung by the shredder with care,
In fears that Bob Mueller soon would be there;

The staffers were nestled all snug in their beds,
While visions of subpoenas danced in their heads;
And Melania in her babushka, and Trump in his cap,
Flew to Mar-a-Lago for a long winter's nap,

When on the TV there remained such a matter,
There was Brennan, Podesta and man named Jim Clapper.
With bribes fresh in hand, they flew like the flash,
The greedy corporations did suck up the cash.

The Congress rejoiced the records will show
Feigned promises of riches to the peasants below,
When, what to amazement FoxNews should appear,
Took aim at Bob Mueller, with permission to smear,

With disinfo flying, so rapid and thick,
I knew in a moment it must be Bolshevik.
More rapid than vultures his hackers they came,
And they posted and trolled, as they sought to defame;

"Now, Fancy! now, Cozy! now, Seaduke and BlackEnergy!
On, Havex! on Sandworm! on, Skipper and CrouchingYeti!
To the DNC server! Past the paper's firewall!
Now exfiltrate, exfiltrate, exfiltrate all!"

Then the Kremlin called Julian, their reliable guy,
To leak to the world, the docs that they plied,
And the Stone who was named Roger bragged on it too,
With the dirty tricks methods that Vladi knew.

And they carried on lying that there was never the proof,
They fogged and distracted and acted aloof.
But their plan would unravel, spin wild to the ground,
And the FBI went digging and looking all around.

Then came the big man, he was Special Counsel to be,
And he hired top lawyers, and then empaneled grand jury;
There were interviews and hearings, this man would not slack,
And he pressed forward justly, with a determined knack.

His eyes were like eagles, they missed not a thing,
His presence was heavy, his targets would sing!
His sleuthing was famous, if you must know,
And his integrity was solid, like the ground below;

The facts that were surfaced he held tight in his teeth,
And as he dug for truth morsels that were buried beneath;
He was focused on the crooked, the wretched and smelly,
They did shake full of fear as we watched on the tele.

He questioned each of them from the son to the elf,
And I rejoiced at the justice, then I thought to myself;
Under orange little man with weird hair on his head,
The great justice of America was certainly not dead,

He did push and did pull but it just would not work,
And did hit Twitter daily, to act like a jerk,
And he threw little tizzy fits, like a toddler in chief,
But we saw he was crooked, though no ordinary thief;

Though it took time, and labor we could would no longer bristle,
As we finally saw Congress call for his dismissal.
And as justice was served, he was hauled out of sight,

Wednesday, November 22, 2017

Remembering the JFK Assasination

I noted these memories of November 22, 1963 at my old blog in 2004 and 2005.

It was about this time in the afternoon. I was in one of those lecture hall classes, a core curriculum survey of world history. The professor was so far away that I couldn't make out the details of his facial expression, but we could hear clearly because he used a microphone. Someone walked in from the right of the room, interrupted the lecture and spoke with the teacher. He then turned to the class and said, "We have just received word that the President has been shot in Dallas. We don't know whether he was killed, but he has been shot."

He paused for a few seconds. Nobody said anything. He then said, "Anyone who thinks that by killing the president they will stop his policies does not understand history. Shooting him will do nothing to stop what he was trying to do."

The place was Tallahassee, Florida and the campus had at that point been polarized over the picketing of two off-campus eating establishments because they refused to serve Negroes, as they were then respectfully called. In 1962 the graduate school at Florida State Uiversity had accepted its first black student. And that year, 1963, the first undergraduate student was attending classes.

I was only nineteen at the time, but something in me felt that if those restaurants, which only existed because the students and faculty of that school were there, refused to allow a black student to be served, something was badly out of balance. As a Southern Baptist I had already been struck by a contradiction of the same sort when an African student who came to America was not able to stay at a Baptist school because the dormitory was reserved for white students only. That had struck me wrong also.

Acting on a blind and unreasonable impulse that makes young people sometimes hard to endure because they can't understand why wrong things can't just change for the better, I allied myself with a group of students meeting weekly at a Unitarian Church at the edge of the campus, calling itself -- and it sounds so corny now -- The Liberal Forum. We had contributed to the closing of one of three restaurants, and were picketing the second. I was kicked out of my cheap off-campus room because of my activities and had put up with an even cheaper space, a garage apartment, shared with one of my radical peers.

The news of John Kennedy's assasination was devastating. The days which followed were among the saddest I can remember. The university arranged for continuous television coverage of the news and funeral, which of course included the subsequent killing of Lee Harvey Oswald. I still remember the endless playing of Chopin's funeral dirge and the funeral procession. It was the beginning of a turbulent chapter in modern history.

The teacher was right. The Civil Rights Act of 1964 was passed the following year and the Public Accommodations section validated the reason that we were picketing.

Anyone old enough to remember will recall that time stood still. Those memories are frozen with every detail -- when and where we were, how the word was passed and how people around reacted. Later, the assassinations of Robert Kennedy and M.L. King would have a similar impact, but it was the death of Jack Kennedy that shook the nation to its roots.

I sometimes think that the Sixties in all their madness were a visceral response to that event. Children who have lost parents are known to internalize that trauma as guilt. At least that was the theory a few years back and the basis of trauma counseling for kids. I have seen it expressed both in movies and real life so there must be something to it. It's an irrational reaction, of course. There is no reason that a child whose parent has died as the result of an accident or medical condition should feel personally responsible, but that is how it is perceived. It was my fault. I was not good enough. I should have done more to protect him or her. I must have done something wrong.

There are cases, though, where the child really did do something to bring about the loss of the parent. Playing with fire, distracting a driver, handling a loaded firearm... In these cases the guilt is earned. The parent really is lost because of the actions of the child. Forgiveness and release does not come as easily in these cases, but "life goes on," such as it is, as the pain of loss fades but never quite disappears. Such was the case of the Sixties.

Some of us glimpsed a better way. We knew there were social habits that had to change. We knew that a war was underway somewhere in South Asia that should not have been started. We knew that conscripting young men for that war was not the same as doing so for World War II. We knew that the government was not being faithful to the truth, the whole truth and nothing but the truth. And we knew that if we didn't correct these wrongs then we would have to live with the results. Like the child whose horseplay in the back seat caused the death of a parent in a car wreck, we looked at life with exaggerated seriousness. We sought to correct problems in a generation that later we would learn are endemic to the human condition.

In the process we lost our innocence. And like the young person who has smoked the first pack of cigarettes, finished the first bottle of alcohol with his buddies, or waked up after that first night of lovemaking, a whole generation embarked on a decade or so of boundary-testing. We learned the hard way that boundaries serve a practical purpose. We learned that without boundaries there is no order. We learned that role-modeling good behavior is more important to generational development as saying Do as I say, not as I do.

Unfortunately, and this is the legacy of the Clinton years, we learned too late. It took nearly three decades for the Sixties to work its way through the system to become manifest at the highest office in government. Bill Clinton's presidency represents in many ways the culmination of what began in the Sixties, with all the excitement and hopes for the future, but also with its dark underside of moral turpitude. Having been there and done that I now hope that the lessons of that time have been learned and internalized. Unfortunately, it seems politically impossible for anyone to change his mind or behavior without being called a hypocrite. We saw that plainly in the last election with the pathetic and failed attempt of John Kerry to reconcile the contradictions of his past with mandates of the present.

For many of us the last year or two have been deja vu. I know that Iraq is not Vietnam and the attack on the WTC is not the same as Kennedy's assassination. White phosphorus is not the same as napalm and Abu Ghraib is not My Lai. But our behavior as a nation strikes me as inappropriate and irrational as that of the Sixties. I almost said the "children" of the Sixties, but it was not all done by young people. Many of those whom we followed, who guided our behavior, were adults. They were mature, solid, wholesome, responsible adults. Some were already old and would never live to see the results of what they were encouraging, not because they were killed or sacrificed, but simply because they were too old to live that long.

To the degree that adults can make the same mistakes as children, that happened to us as a nation in the Sixties. And in many ways, the same thing is happening again today.

Tribalism In America: a Case Study

I'm grabbing this Tweet and thread for the file for future reference. No way to know if it marks an end or beginning of big changes. Either way it's like a flash mob, a happening, a sign of the times. Decades from now this may seem quaint or faddish but at the moment it strikes me as just amusing.
America is once again experiencing a retrograde period in our young history as a nation. Many writers are describing the current administration and Congress as one of the most corrupt on record, perhaps even the worst. In any case, the retraction of "net neutrality" (and the improving skill sets of hackers, leakers and armies of robots) means the web, like some wild animal, is being captured and tamed by forces beyond the reach of democratic oversight. 
Most people, distracted by bread and circuses, are oblivious. But this development is hugely important. 
It challenges my optimism. 
But just as I'm grateful to have seen first-hand two terms of a black president, I know we are living in the historic aftermath of those eight years. 
A year ago whoever we elected president was called Leader of the Free World. During the following months that title lost meaning. Germany, Russia and China, like sports teams competing for a World Series or Super Bowl, are now challengers for that title. 
Here is the Propublica link inspiring these reactions. 
Meantime, enjoy the clown show between featured attractions...

Tuesday, November 14, 2017

Child Poverty & Other Trends -- A Twitter Thread by Noah Smith

[Curating note: This is clumsy reading because I failed to uncheck "parent tweet" when copying the embed code. I discovered my mistake about halfway through and decided to finish with the mistake for the sake of consistency. I will not make that mistake in future. Too much hard work to correct.]

Saturday, November 11, 2017

Social Security Comments, January, 2005

An article by Will Wilkinson, HOW LIBERTARIAN DEMOCRACY SKEPTICISM INFECTED THE AMERICAN RIGHT [their all-caps font, not mine] was linked by 3Quarks Daily.
It caught my eye with the word "libertarian." I read with interest (and more than a little bad attitude) until I noticed the name of the writer, Will Wilkinson.
That name rang a bell, and sure enough I came across him seven or eight years ago and noted something he wrote then at my old blog. The title here links the original, but it loads slowly and all the hyperlinks have since gone dark, so I curated it here at my new blog for easier access.


Individual Security, a new phrase

As the national debate about Social Security heats up (or maybe we need to change the name to Individual Security, since many of the arguments I am reading aim to torpedo any "Social" aspects of the program) it gets harder to see through the smoke and mirrors. I sense yet another polarization in progress, very much like the debates about gay marriage, abortion and the war in Iraq: if you ain't fer it, then you must be agin' it.

I'm biased because my own experience witnessed my parents with nothing to show for a lifetime of work by my father and a lifetime of homemaking by my mother, other than Medicare, Medicaid, Social Security, supplemented by the resources of my sister and me in our parents' declining years.

I feel assured that our safety nets will probably not be disturbed by the current debate. Politicians have learned that any problems they create will be ticking bombs that only detonate after they are no longer around to catch the flack. Can you say "social security"?

Yesterday I received a billet-doux from the Social Security Administration summarizing my "account" (with only the last four digits printed, incidentally, "to help prevent identity theft") and spelling out what my "benefits" would be under various scenarios. This morning I came across a helpful on-line "calculator" [link now vanished] sponsored by the Heritage Foundation, to calculate the startling improvements that would be available to owners of private accounts when compared with the dismal results to be obtained by the current system of Social Security.

I came by this site via another site called The Fly Bottle, attracted by a headline that read "How Much Does SS Screw You?"  I read the comment "Now, what's supposed to be the problem with this, exactly, especially when much poorer folk than me can also expect to be doing a lot better? Why are so many people so eager to oppose a program that makes almost everyone better off? I find it truly baffling."

I next checked the source. Will Wilkinson. Policy analyst for the Cato Institute. Smart young man, born in 1973, worked at George Mason U. Interested in a bunch of important-sounding, challenging intellectual stuff...
My areas of philosophical interest as I write are metaethics, political philosophy, the philosophy of the social sciences, the cognitive sciences, and evolutionary psychology. I am especially interested in contractarian moral and political theory, the nature of moral progress, and the relation of findings in the cognitive sciences to the theory of rational choice. My historical interests include, inter alia, Aristotle, Hobbes, Kant, Reid, Hume, Nietzsche, and Sidgwick. My contemporary-ish philosophical influences include W.V. Quine, Friedrich Hayek, David Armstrong, Robert Nozick, David Gauthier, and John Rawls. I have a longstanding interest in libertarian [Edit: this link still works, but I have no way of knowing if the content has changed since 2005] political theory, especially the development of libertarian conceptions of equality and positive liberty.
Metaethics? My emphasis above. word for me. Have to look that one up.
[The term has disappeared from Mr. Wilkinson's current bio sketch. ]

I've learned to watch out for that word libertarian because I really like most of what they talk about. Problem is, I read Atlas Shrugged in high school, when it was all the rage, and it struck me as wildly over-romantic, fantastical, and pretty unrealistic, with all that hand-shaking going on to clinch deals, with no witnesses or lawyers pouring over the details, and spectacular results deriving from clever people making all the right choices. I never read that entire speech of John Galt in detail, because I could see that a droning litany such as that would never catch the imagination of simple people on the sidewalk any more than the inscrutable remarks of Alan Greenspan when he talks to Congress.

Have I said enough to reveal all my biases? I hope so. Because what I say next is not spin. It is reality. Easy to grasp ideas and numbers that are not misleading in any way. Please follow me...

This fellow Will Wilkinson is certain that Social Security is one of the evil remnants of our unhappy past. Otherwise that title reference to "screw you" would not have been the idiom of choice. He must further believe that the Heritage Foundation's calculator is a reliable tool for analytical purposes or he would not have linked to that site. I would like to respectfully disagree with both of those points.

I am more impressed with the WSJ column Thursday by David Wessel [another vanished link] who interview David Gremlich, a former Fed governor who once served on a Social Security advisory commission. Mr. Gremlich is in favor of encouraging people to save, but doesn't think that a 100% tax credit, dollar for dollar, against Social Security contributions is the way to do it.

(I think that's what's being proposed...earmarking individual tax dollars for those from whom they were collected, thus upsetting the actuarial benefit of their untimely early demise by passing those earmarked assets to their respective estates rather than using them as part of the collective safety net for survivors. The next step, not being discussed at this point, of course, will be the proportional reduction of survivor benefits for those whose estates have been awarded to survivors. Otherwise, survivors of individual accounts would fare better than those who failed or opted not to participate in any proposed plan.)

He said:
I'd like to protect the basic benefits, but we need more saving. We need it because people don't save enough for retirement. We need it to finance the benefit system we have. And need it for the nation's macroeconomics. One way to get new saving is to raise payroll taxes. I didn't think that was either politically feasible or necessary. Another way is to mandate that people save a bit on top of Social Security. This differs from a tax increase because they would ultimately get the money back, but the main motivation is to increase national saving. Increasing national saving implies reducing consumption. It's not a surprise that this is a hard sell.

He added a dose of reality when he said...
With carve-out individual accounts, we erode social protections at a time when we also seem to be witnessing the collapse of the corporate defined-benefit pension system. If we go to a retirement system that is entirely individual accounts, we also lose opportunities for income redistribution.
Two comments.
First, anytime the phrase "income redistribution" is used out loud, in public or in print, with no sense of shame or apology, I know that the person using it may as well be advocating Communism. I have been labeled Socialist and worse myself, so we'll just have to let the matter pass without further comment on my part. I have no interest in debating the phrase, but I want plainly to admit that I recognize the inflamatory effect that the phrase has on a good many people. People who have no problem with large estates being passed to heirs who never hit a lick at a snake in their life but thanks to an accident of birth can enjoy a lifetime of self-indulgence if they choose. "Income redistribution" in that instance takes the form of pissing it all away.

Second, a more important point about "the collapse of the corporate defined-benefit pension system" that he mentioned.

The Pension Benefits Guaranty Corporation  [New link. This one works.] did not just blossom into existence because a lot of politicians in Washington had a fit of generosity one session and decided to do something nice for folks. It was a political response to thousands of employees losing retirement benefits because the outfits for whom they worked went out of business with no safety net for those liabilities. It didn't happen because of the depression, by the way. It happened decades later when that great American economic engine we call Free Enterprise had plenty of time to prevent and protect against disasters like "How can we protect our people in case we go out of business?"

If memory serves, I think that a lot of companies didn't even officially "go out of business." There was an era of mergers and acquisitions, hostile takeovers and the like that also contributed to the problem, with a lot of "private" pension benefits' being leveraged out of existence or liquidated outright, also resulting in pensions evaporating before the eyes of people whose only remaining pinch of the economy became their Social Security income.

Today, as the man said, companies are figuring all kinds of ways to get out from under company paid (read defined benefits) pension plans by shifting the responsibility of retirement security (I almost used the word "burden", but I wouldn't want anyone to think I want companies to be overburdened on the way to the bottom line just because they were obsessed with the security and future well-being of employees.) to individual, employee-paid plans.

I'm not going to repeat the last paragraph just to help dull readers catch on.
I know it is full of sarcasm, as well as ideas not yet in the public debate. Trying to paint it another color isn't going to make it any easier to read and understand. It's up to the reader to do the homework.

Finally, a word about that Heritage Foundation calculator.
It asks for only two pieces of data. First, your age. Second, if you are Male or Female.
When you click the magic button it announces...
You can expect to pay [Big Dollar Amount here] in Social Security taxes over your working life for retirement and survivors benefits.
I would love nothing better than to "expect to pay" that amount over my working lifetime, but in my case I have barely come close. And that includes all the contributions matched by my employers and what I will likely earn in the remaining years until I can claim full benefits. The document I got from Social Security fell way short of the amount indicated, and as the years unfold, I can reasonably expect that the amount will never reach the target. That calculator seems to presume that everyone using it will earn the social security maximum during their "working life"!

Just a few questions...
  • How many people consider their employer's matching taxes as part of their earnings? (Yeah, I know self-employed and educated people do, but in a random population of a thousand people from the street, how many think in those terms? 800? 500? 100? 10? Any?)
  • How many people will earn the Social Security cap during their lifetimes? 
  • And for how many consecutive years?
  • In fact, how many people even know that a cap exists?
In fairness, the calculator has a way to customize results by keying in variable data (ZIP, gender, etc.) and it carries a disclaimer.
This calculator is intended to be used solely as an educational tool to help citizens better understand public policy issues associated with Social Security. It is not intended for use as a retirement planner. The data, assumptions and formulas used in this calculator are based on information currently available to The Heritage Foundation.
"...not intended for use as a retirement planner..."  Damn right. But I don't think that will be a problem with most people using that site.


Here we are six months later and Mr. Wilkinson seems to have some up with a good suggestion:
Hey liberals! Since you insist on talking about social insurance, why not stop dissembling and plump for a system that is actually sort of like insurance? Why not not defend a disability insurance model of old-age insurance, where you get it only there is some actual threat of immiseration? We can fund it with a dedicated payroll tax and everything. It really will not function like a pension at all. It will be a safety net for people who need it funded by people who don't. Isn't this exactly what liberals should want?  [LINK]
He's bright enough to understand that any such plan would be D.O.A. in today's political climate, but I, for one, would be very much in favor. His suggestion, of course, is clearly tongue-in-cheek, but it shows that at some level he is smart enough to see the need.

Since my post was first written a rising tide of companies have announced their inability to meet pension plan obligations. United Airlines, notably, is among the biggest. In a competetive environment that no longer even pretends to look out for its employees' retirement security, old-line companies that cling to that quaint old notion can't afford to stay in the game. We are seeing the unintended consequences of IRA's, Roth's and 401-K plans -- and the corresponding termination of defined-benefits pension plans.

Problem is the tired and flawed old FICA system with all its shortcomings is all we have, and an uninterrupted string of Congresses and Administrations have misappropriated that revenue stream from the beginning.
During the intervening years since this was written, assaults on Social Security have continued. Defined pension plans are as obsolete as drive-in movies, land line phones and 35mm photography. Individual employee-paid plans have surged, but remain opt-in instead of opt-out (which would insure more widespread participation, but companies instinctively know that those "matching funds" are just another drain on profitability so there is zero support for making these plans opt-out.) Actually, the idea of employee-paid retirement plans is a good one, especially for workers with no ownership in the companies where they are employed. Here again, however, there is no mechanism to discourage those who "own" those plans from borrowing against them, thereby releasing employers from contributing "matching funds" to sweeten those pies. As if that were not enough, current tax-reform proposals include taxing contributions on the front-end before letting them grow tax-sheltered.

Meantime, business plans cutely called the gig economy are proliferating as rentier capitalism marches on, contemporary analogues to mill towns, sharecropping, indentured labor and their historic predecessors all the way back to lords and vassals -- endless ways for the haves to get more, and the have-nots to get children. 

Tuesday, November 7, 2017

Charles Clymer's Mass Shootings Twitter Thread

This Thread is worth curating and keeping.

Charles Clymer 🏳️‍🌈‏Verified account @cmclymer

1/ I have some things to say about the Texas shooting. It’s gonna piss some people off, and that’s too bad. It needs to be said. (thread)

2/ I served in the Army. I was trained as an infantryman. A grunt. That’s about as nuts-and-bolts as it gets in the military.

3/ Infantry training is ongoing. Infantry units train constantly. All the time. It’s always something. To the point of being monotonous.

4/ If we weren’t at the firing range, we were doing hands-on tactical training. If not tactical, then classroom prep. Always. Something.

5/ Thousands of hours of training and learning how to kill other people. I am a trained killer. That’s what an infantryman does. They kill.

6/ Other soldiers will laugh this off. “Okay, killer.” But they know I’m right. Deep down, that’s your purpose as an infantryman: to kill.

7/ It starts early. Basic training is psychological. You’re supposed to get comfortable with killing. You’re prepared to face this reality.

8/ In my barracks at basic training, there was a giant mural of a skull-and-crossbones on the floor. Our official nickname: “Death Dealers”.

9/ We were taught call-and-response chants. Ex: “What makes the grass grow?” “Blood, blood, blood makes the grass grow!”

10/ So many drills have the cry “Kill!” in them. I’m surprised we weren’t required to shout it after eating a meal. Maybe we were. I forget.

11/ And it is what it is. I’m not here to tell you military training is bad. I am not a pacifist. Evil threats exist. Someone has to kill.

12/ And because someone has to kill and the killing falls to the military, psychological training like that makes killing easier.

13/ That’s a cold thought, and many will disagree with it. Not the point. The point: taking accountability of it in the civilian world.

14/ Thousands of hours of learning how to kill other human beings. Day after day, month after month, year after year. Rewiring.

15/ I’m a flaming liberal. I’m a gun owner but don’t collect them. My idea of “fun” is singing karaoke in a tiara, not a day shooting guns.

16/ But there is no doubt in my mind that, if needed, I could kill other human beings efficiently. Tactically. Without hesitation.

17/ I haven’t worn a uniform in almost six years, but it would be like riding a bike. It’s ingrained. I doubt it’ll ever go away.

18/ That’s the point of military training: muscle memory, acting without hesitation, resorting to a part of your brain on autopilot.

19/ In April 2009, Homeland Security released a report warning of the recruitment of veterans by radical groups: …

20/ Noted as catalysts for a heightened national security risk were basically what we’ve seen come to fruition eight years later:

21/ Predictably, DHS Secretary Janet Napolitano was derided as disrespecting the troops. She was forced to issue several apologies.

22/ Never mind that Napolitano had only ever demonstrated the utmost respect for women and men in uniform.

23/ Never mind that a 2008 FBI report identified 203 military veterans in white supremacist terrorist groups:

24/ Never mind Charlottesville and the mix of military vets among the little boys playing soldier:

25/ Never mind that a Marine killed JFK or that an Army infantryman was behind the Oklahoma City Bombing.

26/ Or the higher rate of violence against women (in this case: IPV) among Active Duty military and veterans versus civilians:

[Edit:Intimate partner violence (IPV) is a serious, preventable public health problem that affects millions of Americans. The term “intimate partner violence” describes physical, sexual, or psychological harm by a current or former partner or spouse.]

27/ Or that the higher rate of IPV in the military is linked to PTSD and traumatic brain injuries: …

28/ Or—and this is important—the well-established relationship between mass shootings and violence against women.

29/ A great piece on that subject by @rtraister can be found here: …

30/ Surely, that link between violence against women and subsequent mass shootings must count as evidence of terrorism.

31/ This is how the FBI defines domestic terrorism: …

32/ Not sure why a mass shooting inspired by hatred of women doesn’t qualify as terrorism… unless, maybe, we don’t respect women as people?

33/ Not exactly the most comfortable truth in the national discourse, particularly in a sea of “as a father of daughters” statements.

34/ The other side of that coin is white maleness. A political system and media dominated by white men isn’t eager to be self-reflective.

35/ Why would I examine a system of white supremacy that gives me unearned benefits and being forced to recognize they’re unearned?

36/ Why would I admit, despite all evidence, that my white maleness protects me from all sorts of threats and accountability? Scary stuff.

37/ A brown “Muslim” man killing several with a vehicle is terrorism, but a white male killing 27 w/ a gun out of sexist rage? “Lone wolf.”

38/ All these are connected: white male entitlement, mental illness, racism, sexism, violence against women, terrorism. Rinse, repeat.

39/ White men see a loss of power, feel victimized, have that entitlement radicalized through propaganda, and commit acts of terrorism.

40/ But because they’re white and not shouting “Allahu Akbar”, they’re dismissed as "nuts", or more charitably: “nice guys gone wrong.”

41/ To admit to “terrorism” by ordinary white men would require asking deeper questions of ourselves, especially those of us in power.

42/ To admit to “terrorism” by military veterans would require a vast reworking of our systems of recruitment, training, and mental health.

43/ Instead, we grant an access of powerful weaponry to those most trained to use it and most likely to do so in brutal acts of terrorism.

44/ An irony of all this is that though we fall back solely on the excuse of “mental health” to wave away acts of terrorism by white men…

45/ …we neither 1) attempt to comprehensively address mental health in our country nor 2) effectively restrict access to weapons due to it.

46/ If your takeaway from ANY of this = a hatred of white men, the military or guns, then you’re a moron who lacks critical thinking skills.

47/ And if your takeaway is a bizarre, insecure notion that I’m putting women and folks of color on a pedestal, that also makes you a moron.

48/ I'm a white male, and I have no reason to hate that about myself. I love my country. I'm proud of my military service. I'm a gun owner.

49/ And even I can see there are deep, deep issues here we’re ignoring. And they’re not going away. This will happen again and again.

50/ We need to stop pretending that military service is the grand seal of moral rightness. It’s not. We can be grateful w/o being stupid.

51/ We need to stop allowing patriotism to be co-opted by white supremacists preaching a nationalist agenda driven by fear and hatred.

52/ We need to call terrorism in this country for what it is and recognize how white men are often radicalized.

53/ We need to recognize the link between misogynist power structures, violence against women, and white male terrorism.

54/ We need to respect the 2nd Amendment by restricting access to guns from those who don’t (or can’t) respect gun ownership.

55/ Legally owning and using a gun in this country should be harder than legally owning and using a car. Why is it the exact opposite?

56/ Why am I bio-scanned every time I fly, but it’s totally fine in many states if I waltz down the street open-carrying a powerful firearm?

57/ Why am I more likely to be killed by a white male terrorist with a gun in this country than a brown terrorist who claims to be “Muslim”?

58/ We should all want answers to these questions and elected officials with the courage to address them. We should want that NOW.

59/ I’m tired of the carnage, and I want to believe we’re better than this. Prove to me, prove it to yourself, that we are. /thread

Thursday, October 26, 2017

Whitefish Twitter Thread

This Twitter thread about the multi-million-dollar contract to oversee reconstruction of the Puerto Rico power grid is self-explanatory. 

Thursday, October 5, 2017

Baseball, Hot Dogs, Apple Pie, Chevrolet and Mass Killings

Starting a collection...

The 1927 Bombing That Remains America’s Deadliest School Massacre
Ninety years ago, a school in Bath, Michigan was rigged with explosives in a brutal act that stunned the town

Elaine race riot -- Wikipedia article

Tulsa Race Riots (May 31-June 1, 1921)

The Colfax massacre, or Colfax riot the events are termed on the 1950 state historic marker, occurred on Easter Sunday, April 13, 1873, in Colfax, Louisiana, the seat of Grant Parish, when approximately 150 black men were murdered by white Southern Democrats.

And finally, this summary prompted by the Las Vegas massacre which prompted this post...

Al Jazeera noticed the same items. Hard to know which was first.

Monday, September 25, 2017

The War Over MOC Heats Up

This important Medscape article is easier to read in single-page form. Go to the link for heavily-notated notes & supporting sources deleted here. 

The Growing Anti-MOC Movement

Although many things make doctors angry, only one issue has made them angry enough to join together in a unified effort to demand relief from their medical societies and representatives in state legislatures: mandatory maintenance of certification (MOC), particularly for hospital credentialing and insurance network membership.

Pressing state lawmakers to enact anti-MOC legislation has become a cause célèbre for disparate grassroots doctor organizations that have sprung up from Florida to California. Among them are the National Board of Physicians and Surgeons (NBPAS), American Association of Physicians and Surgeons (AAPS), Practicing Physicians of America (PPA), and the Association of Independent Doctors (AID).

"We have amassed almost 50,000 physicians who are communicating about this on Facebook," claims Westby Fisher, MD, director of cardiac electrophysiology at NorthShore University Health System in Evanston, Illinois. Dr Fisher is a cofounder and treasurer of PPA. Formed this year, PPA is a coalition of grassroots physician groups.

These groups are joined by a growing cadre of physician bloggers, some claiming to have tens of thousands of readers. Dr Fisher, who is author of the blog Dr Wes, in which he posts regular updates on the progress of anti-MOC legislation, says he has almost 17,000 followers on Twitter.

Individual doctors are also emailing, writing, and calling their state medical societies and legislators to demand relief from MOC.

Together, these forces have coalesced into a movement that has been influential in spurring medical societies to propose legislation to ban mandatory MOC requirements by hospitals and insurers in at least 17 states this year.

"What these groups have in common is that their members are exhausted by the liberties taken by unaccountable organizations, at the expense of patients and physicians," says Marni Jamison-Carey, executive director of AID.

Formidable MOC Proponents

Seeking to block anti-MOC legislation, say movement leaders, are the American Board of Medical Specialties (ABMS), which sets the standards for physician certification in partnership with 34 member boards, and some hospitals and health insurers operating in a given state.

These pro-MOC forces have mounted lobbying campaigns to convince state legislators that hospitals requiring MOC for physician credentialing and insurers requiring MOC for physician reimbursement and network participation should be permitted to continue in the interest of quality of care and patient safety, say physician-legislators who have sponsored anti-MOC legislation.

"It's a David vs Goliath battle," Dr Fisher says.

As to why MOC should remain mandatory, Susan Morris, ABMS director of communications, sent the board's rationale to Medscape in an email:

Patients rely on certification by an ABMS Member Board as an indicator that their physician has the knowledge, skills, and professionalism to practice in a specialty. The ABMS Boards concluded decades ago, based on substantial evidence, that ongoing assessment is necessary to assure that their knowledge and clinical judgment are up to date in their specialty.

Legislation being introduced in states across the country seeks to remove requirements that physicians demonstrate that they are up to date in their specialty. Some of these bills would prevent hospitals or health plans from requiring physicians to hold a current certificate. Others would regulate private, voluntary certification programs to lower competency standards for medical specialists.

ABMS believes that this legislation puts patients at risk. Patients deserve to know that their physicians are up to date. Faced with a physician who was initially certified after residency but who has not kept the certificate current, patients will be in the dark. They will not know whether that physician chose not to participate, or failed to earn recertification, or was denied the certificate for unprofessional behavior.

But doctors in the anti-MOC movement charge that whereas initial board certification is a legitimate requirement, MOC has evolved into a money-making scheme that forces them to pay recertification testing fees that are too costly and are required too often.

"ABMS has been desperate to maintain the monopoly of their testing cartel using strongman tactics against us," contends Dr Fisher. "The fight against the onerous and expensive ABMS continuous certification requirement that was born of an insatiable thirst for physician testing and educational fees in the name of healthcare 'quality' was the catalyst that finally sparked the war between these opposing forces."

"Every time you reach into your wallet to get $2800 to pay for recertification every 10 years, you start thinking, 'Why am I doing this?'" Dr Fisher says. "I have recertified three times. Each time, it has gotten more laborious, with more time away from my patients and family. Who are these people to tell me how to practice medicine? I've been doing this for 30 years. They have no idea of what we do in our individual practice settings."

ABMS has tried to meet the doctors halfway. "Physicians have raised several legitimate concerns about the MOC process and the ABMS Member Boards have adopted several changes that lower the costs, increase the relevance of the process to practice, increase flexibility for meeting the standards, and make the whole process more convenient," the email from Morris explained.

Among the changes ABMS cites are remote proctoring or online assessment and other innovations that eliminate the expense and time cost of the exam; the use of resources to simulate the way physicians practice at the bedside; new testing approaches that are more customized to practice and more formative, to help doctors focus their learning; a focus on clinical judgment and decision-making rather than recall of medical facts; and more convenient access to practice-relevant learning and improvement activities.

However, none of these attempts at appeasement, or anything short of making MOC nonmandatory, is stopping doctors in the anti-MOC movement from seeking legislative relief. How successful have their efforts been? Let's take a look.

MOC Battles in Arizona, Kentucky, and Michigan

Meg Edison, MD, a pediatrician in Grand Rapids, Michigan, is author of the blog Rebel MD, in which she tracks legislative skirmishes over MOC in the states. "The states are laboratories of democracy," Dr Edison observes, "and as these MOC battles demonstrate, each state tackles the issue in different ways that best suit their legislative climate."

Last year, medical societies in Arizona, Kentucky, and Michigan tried to get legislation passed to stop MOC from being used as a precondition for hospital credentialing and insurance network membership. But the bills that were passed fell short of this goal. They only stipulated that state medical boards "may not require a specialty certification or maintenance of a specialty certification as a condition for licensure," as the Arizona law put it. Any mention of hospitals or insurers was dropped.

Decoupling MOC from medical licensure is a solution in search of a problem, Dr Edison believes, because no state currently conditions medical licensure on MOC. But in 2012, the Federation of State Medical Boards (FSMB) sought to convince the Ohio legislature to require MOC for medical licensing renewal in the state. Over 15,000 Ohio doctors rebelled, uniting 15 Ohio medical organizations to successfully defeat the measure.

This factual account was meticulously detailed in an article in the Journal of Community Hospital Internal Medicine Perspectives by Paul Kempen, MD, PhD.

However, Lisa Robin, FSMB's Chief Advocacy Officer, disputes this version of events. "We never advocated that any state medical board require MOC for renewal of licensure," she insists. "There was no effort in Ohio to require MOC for licensing renewal. That simply did not happen. It was a myth that just went viral."

Be this as it may, many doctors fear this could happen in other states, so passing a law that explicitly forbids it does address a real concern, even if removal of mandatory MOC requirements by hospitals and insurers are battles to be waged another day.

In Michigan, Dr Edison's state, where she had high hopes, the result was even more disappointing. "The legislation didn't go anywhere," she says. "We had a hearing, and it never went to a vote or even get out of committee, because the pressure from the insurers and the hospitals was just too great. So we had to put ours on pause."

This year, four significant attempts to get anti-MOC legislation passed have already taken place—in Oklahoma, Tennessee, Florida, and Georgia.

Oklahoma: A Win Overturned on a Technicality

In 2016, the Oklahoma State Medical Association (OSMA) supported anti-MOC legislation coauthored by Rep Mike Ritze, DO, a family physician. "For many physicians, MOC makes sense," OSMA said in a statement. "But it is not a one-size-fits-all solution for all physicians. [The bill] would still allow hospitals and health plans to 'fast track' someone who has MOC, but it would say MOC can't be the only way in and would require them to have some alternate pathway by which physicians could be credentialed."

For example, NBPAS offers an alternative to ABMS testing for recertification.[6] A doctor is required to take 100 hours of continuing medical education (CME) in the previous 24 months, and prove it with either CME certificates or transcripts from the CME provider. The cost of a recertification certificate is $169.

The bill passed the state House of Representatives and the state Senate unopposed. On April 12, 2016, Governor Mary Fallin signed it into law. Oklahoma thus became the first state to enact legislation aiming to remove MOC as a requirement for physicians to obtain a license, get hired and paid, or secure hospital admitting privileges.

"Oklahoma stunned everyone last year when they passed the first Right-to-Care legislation protecting patients and their doctors from MOC red tape, in bipartisan fashion, without a hitch," Dr Edison observes. "Unfortunately," she adds, "the language was not as tight as first thought, and hospitals found wiggle room to continue forcing MOC on some doctors while exempting 'grandfathered' doctors."

Dr Ritze introduced a new bill earlier this year to clarify the language for hospitals.

"The bill looked like a slam dunk," Dr Edison recalls. "The hospitals didn't seem to oppose it. The medical society didn't even make it a priority for physicians to call prior to the vote." But in the final 24 hours before the vote, she says, ABMS and Oklahoma hospitals "went on a lobbying and misinformation tirade, pouring incredible amounts of lobbying pressure and money upon the legislature."

"The bill, as drafted, unnecessarily interferes with the ability of Covered Hospitals to select the best-trained and most appropriate individuals to staff their facilities and unduly burdens their ability to contract with such individuals," countered an ABMS legal analysis that offered talking points to hospitals and insurers opposed to the legislation. "Please do not let Oklahoma become the only state in the nation that puts its patients' quality of care at risk by removing Maintenance of Certification requirements for physicians practicing specialized medicine."

"The doctors were caught off guard and were completely flatfooted to respond to such an outpouring of lobbying power and misleading information," Dr Edison blogged. In the end, the bill "failed miserably 71-22." The previously passed anti-MOC law still stands but remains "in legal limbo."

"Not surprisingly, those who are profiting from MOC don't want their gravy train to end and have launched a disinformation campaign to scare my fellow legislators into blocking this needed reform," Dr Ritze responded. "And unfortunately, they have succeeded in stopping [the revised bill] this year." He vowed to keep fighting. "Take a moment today and contact your state legislators and ask them to support MOC reform in 2018," he urged Oklahoma doctors.

"The takeaway point here," Dr Edison concludes, "is that ABMS will spare no expense to stop state legislation."

Tennessee: An 'Elegant' Bill Rendered 'Impotent

In 2016, the Tennessee Medical Association passed a resolution to "oppose and defeat efforts by American Board of Medical Specialties and the Federation of State Medical Boards to require physicians to impose mandatory Maintenance of Certification (MOC) and Maintenance of Licensure (MOL) as conditions of employment, licensure, reimbursement or professional insurance coverage."

"Imposing such certification requirements upon the practice of medicine in Tennessee amounts to interference in the patient-physician relationship and threatens to interpose needless regulation between physician and patients in Tennessee," the resolution continued. "There is no evidence that MOC and MOL requirements improve patient care, but rather decrease access to physicians by excluding non-certified licensed physicians who do not repeatedly re-certify, thereby placing an undue time and financial burden on physicians and encouraging early retirement."

The resolution became the basis of an anti-MOC bill that was introduced in the Tennessee State Assembly in April.

"An elegant MOC bill," Dr Edison deemed it. But, she continued, "the hospitals and insurers had such a fit and lobbied so hard against the bill, pushing delay upon delay, that the senate subcommittee had to strip any mention of hospitals and insurers from the bill for it to move forward. The sad, impotent Tennessee bill now simply says that MOC can't be required for a medical license."

"We were running into a lot of opposition," concedes cardiothoracic surgeon Richard Briggs, MD, the Tennessee state senator who sponsored the bill. "It was going to be a tough sell—with two or three insurance companies; some hospitals; and HCA Healthcare, a for-profit hospital chain headquartered here, opposed to it."

Cigna led the opposition among insurers. BlueCross BlueShield of Tennessee, the state's largest insurer, doesn't require its member physicians to maintain their certification. "They have said they couldn't maintain their networks if they did," Dr Briggs says. An ABMS representative also flew down to Knoxville, the state capital, to testify against the bill, he recalls.

Dr Briggs could have made a convincing case to his colleagues in the General Assembly about the problems with mandatory MOC, based on his own experience.

"Even though I'm a cardiothoracic surgeon, I haven't done heart or lung transplants since the 1980s," he explains. "We don't even admit children to my hospital. But if I have to take maintenance of certification, I've got to take courses on heart transplants, lung transplants, and congenital heart surgery. That's very expensive, and it has nothing to do with my specialty. Why not do the things I need to do for my continuing medical education that actually affect my patients—transarterial valve replacements, for example, and robotic coronary artery bypass grafts, robotic mitral valves, and minimally invasive lung surgery that would really improve the quality of care in our entire region?"

"The other issue I have as a state senator is that ABMS is usurping our authority to decide who practices medicine here in Tennessee and who doesn't," Dr Briggs says. "ABMS is a testing company. It's not a professional organization. It isn't the American College of Surgeons. It isn't the American Association for Thoracic Surgery. We should not be allowing a for-profit corporation to decide who practices medicine in the state of Tennessee. It needs to be our own Board of Medical Examiners."

But those arguments, for the most part, didn't get made. "I had several other bills I was sponsoring, and I couldn't work on all of them at once," Dr Briggs admits. However, "we plan to have a 'summer study,' where we sit down with the folks from ABMS this summer and look at this together, because we're going to bring the bill back next year. It's the number-one legislative priority of the Tennessee Medical Association, and I think we have a good chance of getting this thing through."

Florida: Realpolitik or Act of Betrayal?

A bill drafted by the Florida Medical Association (FMA) was introduced in the Florida legislature in Tallahassee in April. It precluded the state board of medicine, department of health, licensed healthcare facilities, and health insurers operating in Florida from requiring recertification "as a condition of licensure, reimbursement, employment, or admitting privileges for a physician who practices medicine and has achieved initial board certification in a subspecialty."

"Finally, legislators are taking notice of the abuse of MOC in Florida and proposing laws to stop it," proclaimed St Petersburg neurosurgeon David McKalip, MD, president of the Florida chapter of AAPS, which had helped to shape the legislation.

But then something unexpected happened.

Florida has more doctors (over 52,000) than any state except California and Texas. With a constituency that large, and with ample funding to lobby state legislators, FMA should have had the clout to get the legislation passed, Dr McKalip contends. It didn't. To get the bill out of committee, FMA was forced to rewrite it from scratch.

The new version did not address the MOC concerns of Florida doctors at all. On the contrary, it directed the state to regulate its subspecialty boards, with a complicated plan to control MOC rather than make it voluntary. As long as a subspecialty board registers with the state, is a 501(c)(3) corporation, has a brick-and-mortar building with full-time employees, and doesn't require additional testing, the doctors under its aegis could be compelled to maintain their certification in order to say they are board-certified.

For Dr McKalip, the completely rewritten legislation was an act of betrayal. "No one in medicine wants that," he told Medscape. "Why would we ever want the government to have more authority to put a seal of approval on MOC?"

The final draft of the legislation "was made to differ from the initially filed bill because we were told that if the bill wasn't changed, it wasn't going to get a hearing," explains Jeffrey Scott, JD, FMA's general counsel. "It would have died exactly as it was. So we took our direction from the committee chairman, who was also the bill sponsor. When the sponsor who chairs the committee the bill's being heard in tells you to do something if you want to have any chance of moving forward, you do it."

FMA was directed to rewrite the legislation because ABMS, the Florida Hospital Association, and the Florida Healthcare Association, representing the state's insurers, applied significant pressure, Scott maintains. "A number of senators on the Health Policy Committee expressed some concern," he says. "To get the bill out of that committee, it needed to be less controversial."

The earliest FMA could introduce a new bill that addresses MOC requirements in the Florida state legislature is 2018, Scott says. "We're going to be meeting with all the folks who have an interest in coming up with a game plan," he adds. "I can't say at this point what it will be. We're going to study it over the summer."

Georgia: A True Anti-MOC Bill Becomes Law

Georgia's anti-MOC legislation, proposed by the Medical Association of Georgia (MAG) in January, states that MOC "shall not be required as a condition of licensure to practice medicine, employment in certain facilities, reimbursement, or malpractice insurance."

The state House of Representatives passed the bill on March 1 (the vote was 171-2). The state Senate passed the bill on March 28 (the vote was 52-1). Governor Nathan Deal signed the bill into law on May 8, making Georgia the only state that currently lifts MOC requirements for staff privileges at "certain" hospital facilities and for insurance network membership, as well as for medical licensure.

"That was pretty stunning," Dr Edison remarks. "That one went completely under the radar. No drama. That was a pretty big win."

"Georgia was a biggie," Dr Fisher agrees. "That's got all the conflicts. They can't use MOC for hospital credentialing. They can't use it for licensure. Or for insurance reimbursement of physicians. So it fills the entire bill."

What accounts for this political victory? Dr Fisher credits the leadership of Rep Betty Price, MD, who cosponsored the bill. Dr Price, an anesthesiologist, is married to Health and Human Services Secretary Tom Price. "She made a very compelling argument for why this is bad for patients," Dr Fisher maintains.

But compelling arguments for removing MOC requirements have been made in other states, without success. Why no drama in Georgia? Georgia has over 23,000 practicing physicians. Oklahoma, with only 8854 physicians, had plenty of drama. Why didn't ABMS, and Georgia's hospitals and insurers, mount an effective lobbying campaign to defeat or at least water down the bill, as they have done in other states?

As it turns out, ABMS did make an effort to block the Georgia bill. "ABMS contacted several lobbying firms to see whether they could have that battle fought down here, and I think many of them declined," says Derek Norton, MAG's Director of Government Relations. "With the strength of our legislative team and our position in the capital, I don't think they thought they could win that battle."

However, the law prevents MOC from being mandated at certain facilities, Norton emphasizes. The key word is "certain." The removal of MOC requirements only applies to state hospitals. The bill does not apply to general hospitals in Georgia that require MOC for credentialing. "That's why the Georgia Hospital Association didn't mount a big fight," Norton explains. "It really wasn't a huge deal to them."

The initial draft of the legislation was directed at all the hospitals in the state. "Once we took that out, the hospital association was okay with it," Norton says, "and so we just went forward from there."

Georgia has six state hospitals, which are covered by the new law. But the state has nearly 150 acute care hospitals, 17 long-term and rehabilitation hospitals, and 20 psychiatric and chemical dependency facilities that are still free to require MOC.

The law represents progress for the anti-MOC movement, but it's not as dramatic a win as some observers believe. In Norton's words, "It was more of a preemptive strike."

Other States to Watch This Year

Anti-MOC legislation is currently pending in Maryland, Missouri, North Carolina, and Texas, and bills have been introduced earlier this year in Alaska, California, Maine, Massachusetts, New York, and Rhode Island.

California, with over 100,000 physicians, is often a bellwether state. The California Medical Association considered but didn't pass an anti-MOC resolution at its October meeting, according to Los Angeles anesthesiologist Karen Sullivan Sibert, MD, who reports on anti-MOC legislation in the state in her blog A Penned Point. "However," she says, "there is enthusiasm for pursing the resolution again in 2017, and it appears to have a strong chance of passing." The title of the resolution: "Maintenance of Certification should not be used as criteria to assess physician competence."

In Alaska, passage of anti-MOC legislation is a practical necessity, Dr Edison believes. "It doesn't make any sense that nonprofit companies in the lower 48 states should have any influence on a doctor's ability to practice medicine in Alaska," she reasons. "If you try to do your MOC, and you live and practice a long way from a city where you can attend a board review class and then take your exam, as many doctors in Alaska do, it would mean taking weeks off from work. It's a big deal, and you'd be leaving patients in your community for significant periods of time without a doctor."

In Texas, "an anti-MOC bill unanimously passed in the House and went to the Senate, where their public health committee passed it on May 16," Dr Edison reports. "Now it's just waiting to be scheduled for a vote. But it's moving forward despite significant opposition from different special interest groups. I'm very confident in Texas being able to do this." People in Alaska and Texas are fiercely independent, she says.

Last year, the movement got a boost from the House of Delegates of the American Medical Association (AMA), which adopted a policy stating that "MOC should not be a mandated requirement for licensure, credentialing, reimbursement, network participation or employment."

In April, the AMA's leadership went a step further, proposing model anti-MOC legislation. Medscape obtained a copy via a personal communication. It is difficult to find online. Called "The Right to Treat Act," it provides state legislators with a template for drafting new anti-MOC laws, and it lends medical establishment legitimacy to the anti-MOC movement. "No facility...shall deny a physician a hospital's staff or admitting privileges based solely on the physician's decision not to participate in maintenance of certification," a key clause reads. States another, "A health insurance entity...shall not deny reimbursement to or prevent a physician from participating in any of the entity's provider networks based solely on a physician's decision not to participate in maintenance of certification."

Meanwhile, What Recourse Do Doctors Have?

As the movement seeks to involve more doctors and broadens its fight to other states, what about in the meantime? Do you have any option other than to periodically recertify, and pony up the fee, if hospitals and insurers in your state require it?

Dr Fisher doesn't beat around the bush. "No option," he flatly states. "And therein lies the problem."

Dr Edison actually tried to buck the system. "On December 17, 2015, in the middle of my busy day seeing patients, I voluntarily gave up my American Board of Pediatrics (ABP) certification," she recalls. "They say recertification is voluntary. So I said, 'Let's see how voluntary it is.'"

Dr Edison had passed her pediatrics boards twice. She had recruited patients for research projects and submitted her data to the board, as she was asked to do. She had completed the mandatory CME. "It came down to them saying, 'Give us $1300 or you lose your certification,' she told Medscape. From an educational standpoint, I didn't need to recertify until 2023. Yet every few years, they want me to give them more money. So I said, 'You know what? I'm not going to pay.' It's ridiculous!"

Last year, she sent an outraged letter to ABP and posted it on her blog for other physicians to read. "Within days, I had 40,000 views," she claims. "Within weeks, I had 100,000. Clearly, I had hit a nerve."

Her name abruptly vanished from the database of board-certified pediatricians on the ABP website. "You cease to exist," Dr Edison says. "It's as if you never passed your boards to begin with. And it caused all sorts of grief with insurers."

Within days after her name was removed, Blue Cross Blue Shield of Michigan, the state's largest insurer, contacted her. "They aggressively hunt down doctors, and if you aren't doing MOC, they kick you off their panels, Dr Edison explains. "They told me I was no longer board-certified. I had to pay the money or I wasn't going to see my patients. Right away, they were sending letters to my patients telling them that I was no longer a Blue Cross provider and that they were going to be reassigned to a new doctor. My patients were calling the office, upset. My billers were stressed out. I couldn't put my patients and staff through that. So I paid the money—$1300, plus a $200 late fee. Within seconds, I was emailed a PDF file saying that I was magically board-certified again. Within hours, Blue Cross backed down. It's all about the money."

"What some doctors in Michigan who don't want to do MOC are doing is hiring nurse practitioners (NPs) and physician assistants (PAs) to see their patients, because the insurance company will credential an NP or PA," Dr Edison says. "But they won't credential a doctor with years of experience, and who has passed multiple board exams, but who finally decides that they're done with MOC."

The only other alternative is to join the fight. "If you live in a state where MOC is mandatory, it's all about getting anti-MOC legislation to a vote," Dr Edison says. "It's calling up your lawmakers. Doctors, like most people, often don't know who their lawmakers are, so it can be intimidating. But once you jump in, it's nice. You get to talk to people who are creating the laws in your state, and they care about you calling. I don't think doctors call that much, so when one of us does, they listen to our concerns."

The movement is gaining momentum, Dr Fisher believes. "There's a growing group of us who get up every day and head out to work, and in brief moments of quiet, we are sending messages to our friends and working hard to get the word out that we need to stop this," he says. "If nothing else, it's helped us regain our profession and understand what really matters."

Medscape Business of Medicine © 2017 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this article: Neil Chesanow. The War Over MOC Heats Up - Medscape - Jun 21, 2017.

Wednesday, September 20, 2017

Noah Smith's Economics Lesson About Immigrants, Economics & Taxes

Noah Smith is an economist who needs no introduction. 
Today's Twitter thread about immigrants and immigration policy is short & easy to grasp.

Get it?
It's not about wages or welfare spending.
It's about identity. 
If you don't know by now that means "white nationalism" you haven't been doing enough homework. 

Friday, September 15, 2017

Iceland -- The Government Falls

A salacious tale of corruption is breaking in Iceland. This twitter thread offers a synopsis.

heard of this source but it appears to be in Iceland. 

Update and follow-up, September 18, 2017
I am surprised that at this writing over two-thousand visitors have been to this link. I never imagined a scandal in Iceland would trigger so much interest. 
While you're here, newcomers, feel free to drill around in my little web-scrapbook. 
My bio is in the sidebar and this is my post-retirement playground and journal.

More at the link...