A young lady was caught taking a goat out for a late-night walk. She should have said that they were out picking up litter.

I thought AT&T’s tiered data plan was one of the coolest things that any of the major carriers have done lately. So it’s disappointing that they’re being so uncool when it comes to texting by taking the opposite tactic (no more tiers, either unlimited or per-use fees, both of which are exorbitant).

A drunk moose was found in/on a tree. Article includes picture.

Doctors-in-training are experiencing widespread burnout. Which is, of course, historically a goal of the whole hazing process. One of the unfortunate aspects of all of this is that it unleashes a bunch of doctors who have sacrificed obscene amounts to get where they are and by-gawd are going to make as much money as they can. Not all doctors, of course. Maybe or maybe not most. But the temptation is there.

As news breaks that Apple has lost another iPhone, some people are wondering why phones are tested “in the wild.” Mindstorm did this when I worked for them, though they ultimately made a hash of it. They made everybody use their own SIM card. That meant for those that didn’t have a SIM card, they couldn’t test it. And people limited usage to whatever their plan was since it was on their dime. Developers and testers at Mindstorm are actually cheap bastards. This hurt the test lab, too, because much of my testing involved two phones and I would have to borrow someone else’s SIM card to run the test. During which, they couldn’t use their phone. By and large, I found Mindstorm to be a surprisingly well-run operation, considering my experiences with their end-product, but this one really threw me for a loop. Counterproductive cost-cutting in the extreme.

The death of free checking. Critics of Obama’s Credit CARD Act point to this sort of thing as proof that it was a bad idea. As mentioned before, I disagree. As Salmon points out, free checking was never free. It was just covered by some dope who lost track of how much he had in the bank.

According to Investor’s Business Daily, the Green Jobs revolution is being clogged by Davis-Bacon, the government contracting wage regime. The IBD is not an unbiased source, but it’s a point I’ve seen made elsewhere that I find convincing: The more posh you make government jobs, the harder it is to ramp up hiring. In this case, the same goes for government contracts.

Mental health experts psychoanalyze Batman villains..


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10 Responses to Linkluster 50-9

  1. web says:

    As far as “free checking”… I get mine free right now. But I have a minimum-balance requirement now, where before it was enough to have direct deposit from my workplace.

    Having the minimum balance isn’t all bad. It’s a worthwhile emergency fund.

  2. web says:

    Also, I refer to your earlier post:

    As far as I am concerned, if free checking rests on taking advantage of those that have difficulty keeping things straight, it’s not something worth having. I feel the same way about speed traps. Getting rid of them will only result in increased taxes, but so what? That’s far preferable than artificially low speed limits and cops hiding behind rocks.

    You have no idea how tempted I am these days to add the word “corrupt” to that last sentence, right in front of the word “cops.”

  3. ? says:

    There are already some limitations on physicians’ ability to game the system to make money. First, at least for Medicare, the OIG zealously roots out those who inappropriately beef up billing codes related to specific work. In some of the ancillary specialties (e.g. radiology, radiation oncology, anatomic pathology), most (~70%) of the money is associated with the technical component of each billing code, and hospitals and (nowadays) procedural specialist clinician groups are at least if not more likely than these ancillary specialists to own scanners, linear accelerators, or tissue processing labs. Even if proceduralist clinicians that own these facilities overutilize to juice reimbursement (as may have been the case with some urology groups and their in-house radiation therapy facilities profiled about a year ago in WSJ), the ancillary specialists who provide professional services don’t even order the tests and so don’t even control how much work they are expected to do. I’ll bet that any measures to curb overutilization will unfairly penalize the ancillary specialists and the measly professional reimbursements, though. That has been the pattern in the past, perhaps because their lobbies aren’t as strong as the procedural clinical specialists’. It goes without saying that primary care and evaluation/management clinical specialists (endocrinologists, neurologists, infectious disease docs, etc.) are not easily able to juice up their earnings.

  4. Mike Hunt says:

    @web

    To refer to cops as corrupt is to refer to marshmallows as white.

    @trumwill

    In what number system is 59 represented by 50 – 9?

    ===

    Texting has become so popular so quickly that the telecoms will use it as a cashcow. People will do anything to avoid an actual telephone conversation in 2011, especially on a cell phone. Since I’m a luddite, I don’t text. Either call my home phone, or email me. If I am out, that means I’m busy, so I don’t want to be bothered. A text or a cell phone call would be a bother. After all, very few people call/text in order to do something FOR you; they generally want something FROM you.

    ===

    The reason why hazing rituals are so sticky is that the people in charge generally went through the hazing, so they are disinclined to end it for future employees. After all, if they had to go through it, why not the next generation? That’s why you need a third-party to end the nonsense; they don’t have a dog in the fight, so they can be reasonable.

    ===

    The death of free checking. Critics of Obama’s Credit CARD Act point to this sort of thing as proof that it was a bad idea.

    I love when banks act like they have no control over their own actions. If they wanted to offer free checking, they would. Since it is no longer profitable for them to do so, they don’t. There is no inherent reason checking SHOULD be free. It is a service that is worth something, and the consumer should pay for it. Who the hell would want to go to the post office and buy money orders to pay their bills? Not I, said the fox.

    Besides, my bank is reasonable. They waive the fee as long as I get paid via direct deposit.

  5. trumwill says:

    As far as “free checking”… I get mine free right now. But I have a minimum-balance requirement now, where before it was enough to have direct deposit from my workplace.

    We have the same. I’m not sure DD is even required, though we keep a pretty high balance.

    On the one hand, it’s people who can keep the balance and have formal enough employment to have DD that evade the fees. On the other hand, it’s the opposite people that were most likely to get screwed by overdrafts, anyway.

  6. trumwill says:

    In what number system is 59 represented by 50 – 9?

    FreeTranslation.com spit that out when I put “fifty-nine” into it. I got a kick out of it so I went with it, even though most people are likely going to think it’s Linkluster 41.

    Texting has become so popular so quickly that the telecoms will use it as a cashcow. People will do anything to avoid an actual telephone conversation in 2011, especially on a cell phone.

    Yeah, though the savvier users will simply transfer texting from voice to data. This was the type of thing that was easier to do with regular phones. I expect Android will at some point make it all automatic.

    After all, if they had to go through it, why not the next generation? That’s why you need a third-party to end the nonsense; they don’t have a dog in the fight, so they can be reasonable.

    Further, ending the practice meant that you went through it for no g*d reason. So you convince yourself it was necessary and beneficial.

    There is no inherent reason checking SHOULD be free. It is a service that is worth something, and the consumer should pay for it. Who the hell would want to go to the post office and buy money orders to pay their bills? Not I, said the fox.

    I quite agree. Transparency. Giving away something “free” here because you’re ganging up on somebody over there just makes the situation seem more benevolent than it is.

    On the other hand, I will never pay an annual fee for a credit card. So I am a hypocrite.

  7. trumwill says:

    Omega,

    There’s no doubt that some degree of fraud occurs. But the biggest issue, I think, isn’t fraud so much as gray areas. Areas where you can order this test or that test, perform this procedure or that procedure. Offer this or that. There seems to be enough latitude for McAllen to happen. I can understand the desire to crack down… but how to do so without cutting off other doctors at the knees.

    Not unlike how Florida’s cracking down on Doctor Feelgood is scaring pain management specialists spitless. What do you do?

  8. ? says:

    “Areas where you can order this test or that test, perform this procedure or that procedure…I can understand the desire to crack down… but how to do so without cutting off other doctors at the knees.”

    One of the reasons for testing variability is that patient situations are not always exactly the same. I trained at academic hospitals that stressed published guidelines and algorithms, and there was still variability. Given that all of the faculty were salaried, income maximization can’t have been a major impetus for the variability in that setting.

    The issue of potentially cutting off some doctor’s at the knees in the process of overzealous reform/crackdown was actually one of my points. It is likely that health care reform is going to attempt to achieve much of its savings by slashing payments to physicians. The ancillary specialists are likely to get hit among the hardest despite the fact that they aren’t even the ones who order the tests (almost always ordered by clinicians).

    The physician-slashing strategy for cost control is ultimately foolish for a few reasons, among which that one can’t explain (or solve) rising health care costs as a function of physician incomes that have remained stagnant or even declined. Moreover, physician reimbursement only represents something like 20% of the health care spending pie. It is, however, likely to be adopted thanks to a combination of the politics of envy and tactical ease due to the fact that physicians, split as they are among many specialties with competing interests, don’t present as united a front as hospitals, pharma or insurers. Ultimately, after a decade+ of expensive, unpleasant training with nothing to show for it financially (too recently out of training) and a stunted social life, I am exasperated beyond what I can easily express. For all younger physicians, procedural specialists or otherwise, it sucks that we’re going to be the ones to take all the cuts despite the fact that we aren’t the ones who have made the money.

  9. Samson says:

    Good Lord, doctors-in-training experience burnout? William Osler, call your office!

    One of the unfortunate aspects of all of this is that it unleashes a bunch of doctors who have sacrificed obscene amounts to get where they are and by-gawd are going to make as much money as they can. Not all doctors, of course. Maybe or maybe not most. But the temptation is there.

    I have occasionally tried over the past several years to assess just how many doctors really are like this. Honestly, it’s tough to gauge. But there is a *lot* of under-the-surface bitterness in medicine, certainly.

    And, the American healthcare system is so byzantine!

    =================

    Since I’m a luddite, I don’t text. Either call my home phone, or email me. If I am out, that means I’m busy, so I don’t want to be bothered. A text or a cell phone call would be a bother.

    Agreed.

    After all, very few people call/text in order to do something FOR you; they generally want something FROM you.

    Ha, ha, agreed.

  10. trumwill says:

    One of the reasons for testing variability is that patient situations are not always exactly the same. I trained at academic hospitals that stressed published guidelines and algorithms, and there was still variability. Given that all of the faculty were salaried, income maximization can’t have been a major impetus for the variability in that setting.

    There are also doctors with different philosophies. Clancy is generally of an anti-interventionist bent, particularly when it comes to induced labor and c-sections. Other doctors are more aggressive. Given the same set of circumstances, Clancy would do one thing and another doc would do another. It’s all within the gray area. The current system rewards the aggressive doctors. When you reward a particular behavior, you get more of it.

    I don’t think that McAllen and El Paso are inherently so different that one demands intervention so much more than the other. More likely, there are just different cultures of medicine. One is responding to the incentives a lot more than the other.

    I agree that there is a lot of variability in circumstances. Which is one of the reasons it’s so hard to pass any hard rules on this sort of thing. But when we look at increased medical costs, overutilization is a big, big part of it. There’s no way to combat that which doesn’t involve somebody either saying “no.”

    Do you have a source on the 20% figure? I’d like to know more about what exactly is meant by that number.

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