OK... so what are my liberal friends willing to surrender in return? It's got to be something near and dear to their hearts.:)
Right now the conservatives have cut food stamps, and they want to eliminate it entirely.
Food stamps are one of the most effective welfare programs we have, supported until recently by Democrats and Republicans alike.
Without food stamps, we'd be back to third world hunger like we were in the 1930s, with people stealing bread and children with rickets.
Is that a realistic compromise? Can I in good conscience bargain away food stamps and let people go hungry again?
I don't believe in false balance. Both sides aren't equally wrong. When you ask the Republicans what they want on health policy, they say, "Abandon Obamacare and leave the free market in its place." I can't go back to that. This is the free market. http://www.nejm.org/doi/full/10.1056/NEJMp1312793 Obamacare was already a compromise with the Republicans, modeled on Romneycare and the Heritage Foundation plan. Obama gave them everything they wanted, and they were still against it. How can you negotiate with people like that?
The parent post said that there were no studies showing that speed causes more deaths.
I posted one study. There are many others. When they correct for other factors, more people die at higher speeds.
There are two kinds of studies:
(1) studies by automotive engineers in the peer-reviewed scientific literature.
(2) Studies by economists, political scientists, and other non-scientists in economics and policy journals, or offhand comments by highway safety cops who have eyeballed the data.
The first kinds of studies, which I read, are usually more accurate and reliable. The second kind of studies are not reliable. A lot of economists don't know how manage scientific data.
For example, when you study trends for traffic fatalities, you have to correct for the weather. In a bad winter, fatality rates go up dramatically. If you have one year with bad weather and low speed limits one year, followed by good weather and high speed limits the next year, you won't see the effect of the higher speed limit. Another confounding factor is the seat belt usage rate. If you raise speed limits, and increase seat belt wearing rates, you won't see the effect of the higher speed limits.
Most important, you have to be able to distinguish between statistically significant results and normal variation. That becomes especially difficult when you divide the data into smaller cells, for example by state. One thing I noticed in that PDF was that the author compared the fatality rates in different states with different speed limits, but he didn't give the p values for the fatality rates.
The original discussion was about whether it's responsible for someone to drive across the country at over 100 mph. I think the evidence shows that it's not.
I've seen graphs of death rates against speed. They start to go up above 55 mph. They go up sharply above 65 mph. Automobile accidents are a major cause of death. Most people know somebody who died in an auto accident. If you want to lower your risk of death significantly, don't drive above 65 mph.
The fallacy of that is that safety vs. speed isn't a linear function. There's no benefit to having a maximum speed limit below 55 mph on a well-designed road.
If you looked at the curves in the engineering studies (like the Bohlin study), you'd see that the death rates are pretty low below 55 mph, then they begin to increase up to 65 mph, and they start going up really steeply after 70 mph. Deaths increase at roughly the square of the velocity.
The crush space was the same in 1967 as it is today. I remember an article in Automotive News which reported on a lecture by a Mercedes-Benz engineer on the problem of designing a car that would let the occupants survive a front-end collision into a barrier.
The engineer described the physical constraints. They had to decelerate the car at a maximum number of Gs. They had 50 inches of crush space between the passenger compartment and the front end. In order to decelerate to a stop through that distance, you couldn't be driving any faster than about 50 mph. It didn't have anything to do with the mechanical capabilities of the car, that was the maximum theoretical speed you survive at. The crush space increased as the square of the initial velocity, so it wasn't feasible to increase the crush space in the hood. You can't make a practical car with 16 feet of crush space.
I used to work for the Society of Automotive Engineers, and I worked on the papers that they used to design seat belts and air bags. (That's why I know about Bohlin's paper.) The lap-and-shoulder seat belts (which Bohlin originally designed) were actually safer in a collision than the airbags. The airbags only make sense if people aren't wearing seat belts.
There's a big difference in safety between a 1959 Chevrolet and the cars that came later. Ralph Nader published Unsafe at Any Speed in 1965. The lawsuit Larsen vs. General Motors was decided in 1965, and made auto manufacturers responsible for designing safer cars. And Volvo, which Bohlin worked for, were always designed for safety. Bohlin's study is only one of the best studies, but it was followed by many, many studies that all showed that the faster you drive, the more likely you are to die in an accident.
It's just basic engineering physics. 60 mph is like falling off a 10- or 15-story building. The faster you go, the more kinetic energy you have, and if that car becomes unstable, as it will in an accident, that energy has to get dissipated somewhere. The higher the speed, the less likely the occupants are to survive.
Don't take my word for it. Look up the engineering literature.
The Solomon Curve speaks more directly to the real issue of speed and accidents and relates to speed differentials. Solomon's results have been duplicated many times and the issue is that there is a higher likelihood of being in an accident as an individual's speed varies from the average speed. Interestingly, going much slower than the average speed seems to indicate a higher likelihood of being involved in an accident.
So what? Design roads so that you don't have cars next to each other traveling at widely different speeds. But whatever the distribution of speed, when you have an accident, you're much more likely to have fatalities at higher speeds than at lower speeds.
Simply having a lower speed limit does not, in itself, result in lower accident rates.
Other things being equal, lower speeds result in lower fatalities. That's been demonstrated from accident investigations and statistics, from crash tests, and from the physics of accidents. I used to look those studies up in the Engineering Index.
Accident Analysis & Prevention Volume 22, Issue 2, April 1990, Pages 137–149 The effects of the new 65 mile-per-hour speed limit on rural highway fatalities: A state-by-state analysis
This paper examines the effects of the new 65 mile-per-hour (mph) speed limit on U.S. rural highway fatality counts. Separate analyses are conducted for each of the 40 states that had adopted the new (higher) limit by mid-1988. Using monthly Fatal Accident Reporting System (FARS) data from January 1976 through November 1988, time-series regression equations—including policy variables, seasonal variables, and surrogate exposure variables—are estimated for each state. The results suggest that the new laws have increased fatalities on both rural interstate and rural noninterstate highways in most states, but also that these effects differ substantially across the states. For rural interstate fatalities the estimates suggest a median (among the 40 states) effect of the increased speed limit of roughly 15% more fatalities; the median estimates for rural noninterstates suggest a 5% increase in fatalities due to the increased speed limits. Estimates such as those reported here should be revised as more information becomes available.
no one ever cites those studies that show lower speed limits are safer... Because they don't exist.
Here's a study that shows lower speeds are safer. Among people who were wearing a seat belt, nobody driving 60 mph or less died. People driving over 60 mph died, because in an accident above 60 mph, the car rolls and the passenger compartment starts to fall apart. (Unfortunately the full paper is paywalled, but it had a nice chart of fatalities increasing with speed.) This happens to be a classic paper from 1967; there have been studies coming to the same conclusion ever since. You can look them up in the Engineering Index.
Driving fast is safe as long as you don't have an accident. When you do have an accident, the faster you're going, the more energy you have to dissipate, and the more likely the car is to crush in a rollover or tear apart and send you flying unprotected at 60 mph. It's pretty hard to hit the ground at 60 mph and survive. That's roughly equivalent to falling off a 15-story building.
A Statistical Analysis of 28,000 Accident Cases with Emphasis on Occupant Restraint Value
Paper #: 670925
Published: 1967-02-01
DOI: 10.4271/670925
Citation:
Bohlin, N., "A Statistical Analysis of 28,000 Accident Cases with Emphasis on Occupant Restraint Value," SAE Technical Paper 670925, 1967, doi:10.4271/670925. Author(s): N. I. Bohlin
Affiliated: Passenger Car Engineering Dept., AB Volvo
Abstract: The value of the three-point safety belt has been evaluated by a statistical analysis of more than 28,000 accident cases, which concerned mainly two cars only and in which 37,511 unbelted and belted front-seat occupants were involved. The safety harness concerned is the Volvo three-point combined lap and upper torso harness with a so-called slip-joint. The average injury-reducing effect of the harness proved to vary between 0 and 90%, depending on the speed at which the accident occurred or the type of injury. Unbelted occupants sustained fatal injuries throughout the whole speed scale, whereas none of the belted occupants was fatally injured at accident speeds below 60 mph. Slight injuries only, mostly single rib cracks, bruises, etc., caused by the safety belt were reported in some cases. The three-point belt proved to be fully effective against ejection out of the car. Almost all cars involved were equipped with safety belts, of which, however, only 26% on an average were used. The frequency of use increased with the age of the occupants.
The New Scientist had an article about this. If it's just big enough to destroy a city, but not to destroy the planet, the most practical solution would be to evacuate the city.
To an non-American all this is just too fucking bizzare to be real, it's just as bat-shit crazy and "mean spirited" as the nutty General in Burma who suddenly decided the entire economy should be based on the number '3', unsurprisingly the Burmese economy fell into an open sewer and drowned at that very same moment.
We have this problem with billionaire right wingers who managed to pack the Supreme Court with judges who think it's OK for billionaires to pay politicians to do their bidding.
It seems that if you spend enough money on TV attack ads, you can win elections. At least in America.
If I'm shopping for something, I want to know how much it costs. I don't care what the list price was before the discount, I want to know how much I have to write on the check.
It's perfectly reasonable for Healthcare.gov to give both the unadjusted price together with the premium after the subsidy. That's the way I, as a user, would want it. And it shouldn't be a major programming task, since the Kaiser Foundation did it on their web site. http://kff.org/interactive/subsidy-calculator/
There are a lot of reasons why Healthcare.gov fell apart, but I don't think there's any evidence that this was one of the problems, and if there is evidence I'd like to see it.
I think the reason this became an issue is that the Republicans want users to have sticker shock, and want it to be as difficult and discouraging as possible. They see any effort to make it simpler and more useable as somehow underhanded.
"you know perfectly well that the GP means free at the point of delivery"
I know no such thing. The statement was: "No one should have to be paying for health care in this country"
This must be the 100th time I've seen some right-wing retard repeat that stupid meme, "It's not free, it's paid for by the taxes the government stole from us!"
If you have enough command of English to pass the high school finals, you know that in American English we use the term "free" as in "free library" or "free highway" to mean that the consumer doesn't have to pay for it at point of service.
So you're obviously playing stupid (which doesn't exclude the possibility that you really are stupid).
As that notorious Communist Adam Smith said, the wealthy, who have benefited from society, have an obligation to pay more for the costs of running society.
So yes, our jackbooted Storm Troopers are going to take your money and make you pay your fair share of running our society. And if you don't like it you can go to a country without a society, like Somalia or Afghanistan.
Every vendor tells you what your final price is going to be (unless they're trying to put something over on you).
If I buy a book from Amazon, I don't care what the "actual cost" is, I care what the price is going to be when they include shipping.
If one vendor is selling "Atlas Shrugged" for $1 (plus $4) shipping, and the other vendor is selling it for $2 including shipping, which one is cheaper?
Similarly, if I'm buying health insurance -- any health insurance, including private insurance -- I want to know how much I'm finally going to write on my monthly premium check. So the list price, or what you call the "actual cost", doesn't matter to me. I care about my final cost, after all the discounts.
Yeah, the Republicans would like Obamacare to fail by discouraging people to sign up, and one way to do that would be to show them an enormous premium that they couldn't afford, without telling them that after government subsidies, they'll be paying next to nothing.
Krugman said that Obamacare is complicated because political constraints made a straightforward single-payer system unachievable. It keeps private insurance companies in the mix and holds down government outlays through means-testing. That means, it holds down government outlays by making the insurance buyers pay more.
http://krugman.blogs.nytimes.com/2013/10/26/why-is-obamacare-complicated/ Why Is Obamacare Complicated? Paul Krugman October 26, 2013 So does this mean that liberals should have insisted on single-payer or nothing? No. Single-payer wasn’t going to happen — partly because of the insurance lobby’s power, partly because voters wouldn’t have gone for a system that took away their existing coverage and replaced it with the unknown. Yes, Obamacare is a somewhat awkward kludge, but if that’s what it took to cover the uninsured, so be it.
That was a good blog post at Next New Deal. There's more.
Konczal said that There were four problems that were at the root cause of the failure: (1) Means testing, which requires information from multiple government agencies. (2) Linking to private insurers. (3) Adverse selection. (4) States refusing to set up their own exchanges.
Failure of Healthcare.gov "highlights the problems inherent in the move to a neoliberal form of governance and social insurance, while demonstrating the superiorities in the older, New Deal form of liberalism."
Social insurance programs can be divided into Category A, neoliberal, which is means-tested, provided by private agents, and dependent on the states; and Category B, like the New Deal, which is universal and government-run.
How's that neoliberal health care system working out for you?
PubMed doesn't index all journals. They don't index Topics in Language Disorders. (You can get the index list of PubMed titles in http://www.ncbi.nlm.nih.gov/pubmed/advanced ).
It is annoying. Some of the interesting ones are free, but some of the interesting ones are not.
I agree with you, of course. Knowledge should be free. Of course, there's the question of who's going to pay for it. It looks like the easy days for the commercial academic publishers are over.
Ah, yes. The METRO cards. It worked, but I had to go to the NYPL in person to fill out the card, and then take the card to the cooperating library (usually Columbia U. medical library) and use their collection. Technically I was supposed to only read a maximum of four journals or something, but once I got in to the library I could use the stacks just like any other reader.
Actually the public university libraries aren't always open to the public, even though they're paid for by public taxes. I used to live around the block from John Jay College, which had a pretty good collection of core science journals and an excellent collection of criminal justice publications. I used to use their library regularly, but then their new librarian decided to end public access. It was like going blind.
The bottom line is that you can get a lot of journals with some effort, but you can't get them all and sometimes by the time you get the journal through ILL your article is already written. One librarian told me, "You can get it elsewhere. You only want to use our library for convenience." Yeah, it is convenience. I can get a lot more work done in a library that closes at 11pm every night like a university library, than I can at a public library that closes at 6pm or 8pm. http://www.nypl.org/locations/sibl . It often makes the difference between getting the job done and not getting it done at all.
Another problem with the public library is that some publishers charge libraries for online access based on their number of clients. For university libraries, that's the number of students and faculty, but for public libraries, as one public librarian told me, some publishers count the entire population of New York as their clients. That's why you can't get the online-only material in the New England Journal of Medicine. The director of the NYPL made this brilliant move to the digital library, but many of the digital subscriptions are prohibitively expensive. The last time I went to SIBL, I needed to use Science Citation Index, but they didn't have it because it was too expensive. In some ways they had better collections before computers.
The problem is, this isn't the digital library of the future that they promised us 50 years ago. like Vannevar Bush's memex. When I read about the libraries of the future, I always wondered, "Who's going to pay for all this?" and I assumed that the public libraries would still be there. Now the public libraries have gone through such cutbacks that you can't use them for research the way you used to. They've suffered from this anti-tax and anti-government movement.
We have a digital divide between the people who have access to information and the people who don't. Do you have a medical question? If you're in the digital underclass, you can curry together an answer from Wikipedia and Medscape, and a million hits from sites that are trying to sell you something. Or you can do what I do, and what the medical librarians recommended to me, which is to start with review articles in the major journals -- New England Journal of Medicine, JAMA, and Lancet. It's a lot easier and more reliable to just go to the reliable sources in the first place.
Do you want to live in a country where all people have access to academic-quality public libraries, as we used to have until the cutbacks of the 1970s? Or do you want people to live in ignorance? To most of us here the answer is obvious, but there are people out there who just want to cut taxes.
That should have been the entire article right there.
Almost all specialty libraries I've heard of offer visitor access or special (paid) access to professionals in affiliated fields. It sounds like this Doctor didn't put a lot of effort into trying to find a way around the pay wall.
I just checked the websites of Medical School libraries in my State and neighboring States, they almost all have a way for people unaffiliated with the school to gain onsite access./Though one requires an annual membership and charges extortionist prices for photocopying articles.
I've been through that in New York City. Most of the medical school libraries in Manhattan don't allow public access. One of them offered to let me use their library for about $2,000 a year. It's a real problem.
If you actually tried to do it, rather than just looking at their web site, I think you'd find it was difficult to impossible. Unless you happened to find a small friendly library that had everything you needed.
Slashdot Mirror
You mean, bring back the Confederacy.
Maybe that's the end-plan of the Tea Party. Paralyze the government and bring in a dictatorship.
OK ... so what are my liberal friends willing to surrender in return? It's got to be something near and dear to their hearts. :)
Right now the conservatives have cut food stamps, and they want to eliminate it entirely.
Food stamps are one of the most effective welfare programs we have, supported until recently by Democrats and Republicans alike.
Without food stamps, we'd be back to third world hunger like we were in the 1930s, with people stealing bread and children with rickets.
Is that a realistic compromise? Can I in good conscience bargain away food stamps and let people go hungry again?
I don't believe in false balance. Both sides aren't equally wrong. When you ask the Republicans what they want on health policy, they say, "Abandon Obamacare and leave the free market in its place." I can't go back to that. This is the free market. http://www.nejm.org/doi/full/10.1056/NEJMp1312793 Obamacare was already a compromise with the Republicans, modeled on Romneycare and the Heritage Foundation plan. Obama gave them everything they wanted, and they were still against it. How can you negotiate with people like that?
The parent post said that there were no studies showing that speed causes more deaths.
I posted one study. There are many others. When they correct for other factors, more people die at higher speeds.
There are two kinds of studies:
(1) studies by automotive engineers in the peer-reviewed scientific literature.
(2) Studies by economists, political scientists, and other non-scientists in economics and policy journals, or offhand comments by highway safety cops who have eyeballed the data.
The first kinds of studies, which I read, are usually more accurate and reliable. The second kind of studies are not reliable. A lot of economists don't know how manage scientific data.
For example, when you study trends for traffic fatalities, you have to correct for the weather. In a bad winter, fatality rates go up dramatically. If you have one year with bad weather and low speed limits one year, followed by good weather and high speed limits the next year, you won't see the effect of the higher speed limit. Another confounding factor is the seat belt usage rate. If you raise speed limits, and increase seat belt wearing rates, you won't see the effect of the higher speed limits.
Most important, you have to be able to distinguish between statistically significant results and normal variation. That becomes especially difficult when you divide the data into smaller cells, for example by state. One thing I noticed in that PDF was that the author compared the fatality rates in different states with different speed limits, but he didn't give the p values for the fatality rates.
The original discussion was about whether it's responsible for someone to drive across the country at over 100 mph. I think the evidence shows that it's not.
I've seen graphs of death rates against speed. They start to go up above 55 mph. They go up sharply above 65 mph. Automobile accidents are a major cause of death. Most people know somebody who died in an auto accident. If you want to lower your risk of death significantly, don't drive above 65 mph.
The fallacy of that is that safety vs. speed isn't a linear function. There's no benefit to having a maximum speed limit below 55 mph on a well-designed road.
If you looked at the curves in the engineering studies (like the Bohlin study), you'd see that the death rates are pretty low below 55 mph, then they begin to increase up to 65 mph, and they start going up really steeply after 70 mph. Deaths increase at roughly the square of the velocity.
The crush space was the same in 1967 as it is today. I remember an article in Automotive News which reported on a lecture by a Mercedes-Benz engineer on the problem of designing a car that would let the occupants survive a front-end collision into a barrier.
The engineer described the physical constraints. They had to decelerate the car at a maximum number of Gs. They had 50 inches of crush space between the passenger compartment and the front end. In order to decelerate to a stop through that distance, you couldn't be driving any faster than about 50 mph. It didn't have anything to do with the mechanical capabilities of the car, that was the maximum theoretical speed you survive at. The crush space increased as the square of the initial velocity, so it wasn't feasible to increase the crush space in the hood. You can't make a practical car with 16 feet of crush space.
I used to work for the Society of Automotive Engineers, and I worked on the papers that they used to design seat belts and air bags. (That's why I know about Bohlin's paper.) The lap-and-shoulder seat belts (which Bohlin originally designed) were actually safer in a collision than the airbags. The airbags only make sense if people aren't wearing seat belts.
There's a big difference in safety between a 1959 Chevrolet and the cars that came later. Ralph Nader published Unsafe at Any Speed in 1965. The lawsuit Larsen vs. General Motors was decided in 1965, and made auto manufacturers responsible for designing safer cars. And Volvo, which Bohlin worked for, were always designed for safety. Bohlin's study is only one of the best studies, but it was followed by many, many studies that all showed that the faster you drive, the more likely you are to die in an accident.
It's just basic engineering physics. 60 mph is like falling off a 10- or 15-story building. The faster you go, the more kinetic energy you have, and if that car becomes unstable, as it will in an accident, that energy has to get dissipated somewhere. The higher the speed, the less likely the occupants are to survive.
Don't take my word for it. Look up the engineering literature.
The Solomon Curve speaks more directly to the real issue of speed and accidents and relates to speed differentials. Solomon's results have been duplicated many times and the issue is that there is a higher likelihood of being in an accident as an individual's speed varies from the average speed. Interestingly, going much slower than the average speed seems to indicate a higher likelihood of being involved in an accident.
So what? Design roads so that you don't have cars next to each other traveling at widely different speeds. But whatever the distribution of speed, when you have an accident, you're much more likely to have fatalities at higher speeds than at lower speeds.
Simply having a lower speed limit does not, in itself, result in lower accident rates.
Other things being equal, lower speeds result in lower fatalities. That's been demonstrated from accident investigations and statistics, from crash tests, and from the physics of accidents. I used to look those studies up in the Engineering Index.
Here's the first study.
Accident Analysis & Prevention
Volume 22, Issue 2, April 1990, Pages 137–149
The effects of the new 65 mile-per-hour speed limit on rural highway fatalities: A state-by-state analysis
This paper examines the effects of the new 65 mile-per-hour (mph) speed limit on U.S. rural highway fatality counts. Separate analyses are conducted for each of the 40 states that had adopted the new (higher) limit by mid-1988. Using monthly Fatal Accident Reporting System (FARS) data from January 1976 through November 1988, time-series regression equations—including policy variables, seasonal variables, and surrogate exposure variables—are estimated for each state. The results suggest that the new laws have increased fatalities on both rural interstate and rural noninterstate highways in most states, but also that these effects differ substantially across the states. For rural interstate fatalities the estimates suggest a median (among the 40 states) effect of the increased speed limit of roughly 15% more fatalities; the median estimates for rural noninterstates suggest a 5% increase in fatalities due to the increased speed limits. Estimates such as those reported here should be revised as more information becomes available.
no one ever cites those studies that show lower speed limits are safer... Because they don't exist.
Here's a study that shows lower speeds are safer. Among people who were wearing a seat belt, nobody driving 60 mph or less died. People driving over 60 mph died, because in an accident above 60 mph, the car rolls and the passenger compartment starts to fall apart. (Unfortunately the full paper is paywalled, but it had a nice chart of fatalities increasing with speed.) This happens to be a classic paper from 1967; there have been studies coming to the same conclusion ever since. You can look them up in the Engineering Index.
Driving fast is safe as long as you don't have an accident. When you do have an accident, the faster you're going, the more energy you have to dissipate, and the more likely the car is to crush in a rollover or tear apart and send you flying unprotected at 60 mph. It's pretty hard to hit the ground at 60 mph and survive. That's roughly equivalent to falling off a 15-story building.
http://papers.sae.org/670925/
A Statistical Analysis of 28,000 Accident Cases with Emphasis on Occupant Restraint Value
Paper #: 670925
Published: 1967-02-01
DOI: 10.4271/670925
Citation:
Bohlin, N., "A Statistical Analysis of 28,000 Accident Cases with Emphasis on Occupant Restraint Value," SAE Technical Paper 670925, 1967, doi:10.4271/670925.
Author(s): N. I. Bohlin
Affiliated: Passenger Car Engineering Dept., AB Volvo
Abstract: The value of the three-point safety belt has been evaluated by a statistical analysis of more than 28,000 accident cases, which concerned mainly two cars only and in which 37,511 unbelted and belted front-seat occupants were involved. The safety harness concerned is the Volvo three-point combined lap and upper torso harness with a so-called slip-joint. The average injury-reducing effect of the harness proved to vary between 0 and 90%, depending on the speed at which the accident occurred or the type of injury. Unbelted occupants sustained fatal injuries throughout the whole speed scale, whereas none of the belted occupants was fatally injured at accident speeds below 60 mph. Slight injuries only, mostly single rib cracks, bruises, etc., caused by the safety belt were reported in some cases. The three-point belt proved to be fully effective against ejection out of the car. Almost all cars involved were equipped with safety belts, of which, however, only 26% on an average were used. The frequency of use increased with the age of the occupants.
Thank you for your stupid, uninformed anti-UN comment.
The New Scientist had an article about this. If it's just big enough to destroy a city, but not to destroy the planet, the most practical solution would be to evacuate the city.
To an non-American all this is just too fucking bizzare to be real, it's just as bat-shit crazy and "mean spirited" as the nutty General in Burma who suddenly decided the entire economy should be based on the number '3', unsurprisingly the Burmese economy fell into an open sewer and drowned at that very same moment.
We have this problem with billionaire right wingers who managed to pack the Supreme Court with judges who think it's OK for billionaires to pay politicians to do their bidding.
It seems that if you spend enough money on TV attack ads, you can win elections. At least in America.
Thank you for your uninformed, knee-jerk anti-UN comment.
They did eradicate smallpox, you know.
If they ship it by U.S. mail, I'll never get it anyway, since the government can't do anything right.
If I'm shopping for something, I want to know how much it costs. I don't care what the list price was before the discount, I want to know how much I have to write on the check.
It's perfectly reasonable for Healthcare.gov to give both the unadjusted price together with the premium after the subsidy. That's the way I, as a user, would want it. And it shouldn't be a major programming task, since the Kaiser Foundation did it on their web site. http://kff.org/interactive/subsidy-calculator/
There are a lot of reasons why Healthcare.gov fell apart, but I don't think there's any evidence that this was one of the problems, and if there is evidence I'd like to see it.
I think the reason this became an issue is that the Republicans want users to have sticker shock, and want it to be as difficult and discouraging as possible. They see any effort to make it simpler and more useable as somehow underhanded.
So how do you figure out what your subsidy is going to be? If you're a single person with an income of $27,000 a year, how much is your subsidy?
"you know perfectly well that the GP means free at the point of delivery"
I know no such thing. The statement was: "No one should have to be paying for health care in this country"
This must be the 100th time I've seen some right-wing retard repeat that stupid meme, "It's not free, it's paid for by the taxes the government stole from us!"
If you have enough command of English to pass the high school finals, you know that in American English we use the term "free" as in "free library" or "free highway" to mean that the consumer doesn't have to pay for it at point of service.
So you're obviously playing stupid (which doesn't exclude the possibility that you really are stupid).
As that notorious Communist Adam Smith said, the wealthy, who have benefited from society, have an obligation to pay more for the costs of running society.
So yes, our jackbooted Storm Troopers are going to take your money and make you pay your fair share of running our society. And if you don't like it you can go to a country without a society, like Somalia or Afghanistan.
The Soviets put the first satellite in space, and put the first man in space.
The Soviets were the best rivals we ever had. They were the best thing that ever happened to the American education system.
Every vendor tells you what your final price is going to be (unless they're trying to put something over on you).
If I buy a book from Amazon, I don't care what the "actual cost" is, I care what the price is going to be when they include shipping.
If one vendor is selling "Atlas Shrugged" for $1 (plus $4) shipping, and the other vendor is selling it for $2 including shipping, which one is cheaper?
Similarly, if I'm buying health insurance -- any health insurance, including private insurance -- I want to know how much I'm finally going to write on my monthly premium check. So the list price, or what you call the "actual cost", doesn't matter to me. I care about my final cost, after all the discounts.
Yeah, the Republicans would like Obamacare to fail by discouraging people to sign up, and one way to do that would be to show them an enormous premium that they couldn't afford, without telling them that after government subsidies, they'll be paying next to nothing.
Nice try.
Paul Krugman had a column about Konczal's blog.
Krugman said that Obamacare is complicated because political constraints made a straightforward single-payer system unachievable. It keeps private insurance companies in the mix and holds down government outlays through means-testing. That means, it holds down government outlays by making the insurance buyers pay more.
http://krugman.blogs.nytimes.com/2013/10/26/why-is-obamacare-complicated/
Why Is Obamacare Complicated?
Paul Krugman
October 26, 2013
So does this mean that liberals should have insisted on single-payer or nothing? No. Single-payer wasn’t going to happen — partly because of the insurance lobby’s power, partly because voters wouldn’t have gone for a system that took away their existing coverage and replaced it with the unknown. Yes, Obamacare is a somewhat awkward kludge, but if that’s what it took to cover the uninsured, so be it.
That was a good blog post at Next New Deal. There's more.
Konczal said that There were four problems that were at the root cause of the failure: (1) Means testing, which requires information from multiple government agencies. (2) Linking to private insurers. (3) Adverse selection. (4) States refusing to set up their own exchanges.
Failure of Healthcare.gov "highlights the problems inherent in the move to a neoliberal form of governance and social insurance, while demonstrating the superiorities in the older, New Deal form of liberalism."
Social insurance programs can be divided into Category A, neoliberal, which is means-tested, provided by private agents, and dependent on the states; and Category B, like the New Deal, which is universal and government-run.
How's that neoliberal health care system working out for you?
Name one other country with a political party who is so hellbent on reality distortion to do such silly things with tax payer money?
Nigeria?
PubMed doesn't index all journals. They don't index Topics in Language Disorders. (You can get the index list of PubMed titles in http://www.ncbi.nlm.nih.gov/pubmed/advanced ).
Here's a list of free articles in Topics in Language Disorders.
http://journals.lww.com/topicsinlanguagedisorders/pages/viewallmostpopulararticles.aspx?WT.mc_id=HPxADx20100319xMP
It is annoying. Some of the interesting ones are free, but some of the interesting ones are not.
I agree with you, of course. Knowledge should be free. Of course, there's the question of who's going to pay for it. It looks like the easy days for the commercial academic publishers are over.
Ah, yes. The METRO cards. It worked, but I had to go to the NYPL in person to fill out the card, and then take the card to the cooperating library (usually Columbia U. medical library) and use their collection. Technically I was supposed to only read a maximum of four journals or something, but once I got in to the library I could use the stacks just like any other reader.
Actually the public university libraries aren't always open to the public, even though they're paid for by public taxes. I used to live around the block from John Jay College, which had a pretty good collection of core science journals and an excellent collection of criminal justice publications. I used to use their library regularly, but then their new librarian decided to end public access. It was like going blind.
The bottom line is that you can get a lot of journals with some effort, but you can't get them all and sometimes by the time you get the journal through ILL your article is already written. One librarian told me, "You can get it elsewhere. You only want to use our library for convenience." Yeah, it is convenience. I can get a lot more work done in a library that closes at 11pm every night like a university library, than I can at a public library that closes at 6pm or 8pm. http://www.nypl.org/locations/sibl . It often makes the difference between getting the job done and not getting it done at all.
Another problem with the public library is that some publishers charge libraries for online access based on their number of clients. For university libraries, that's the number of students and faculty, but for public libraries, as one public librarian told me, some publishers count the entire population of New York as their clients. That's why you can't get the online-only material in the New England Journal of Medicine. The director of the NYPL made this brilliant move to the digital library, but many of the digital subscriptions are prohibitively expensive. The last time I went to SIBL, I needed to use Science Citation Index, but they didn't have it because it was too expensive. In some ways they had better collections before computers.
The problem is, this isn't the digital library of the future that they promised us 50 years ago. like Vannevar Bush's memex. When I read about the libraries of the future, I always wondered, "Who's going to pay for all this?" and I assumed that the public libraries would still be there. Now the public libraries have gone through such cutbacks that you can't use them for research the way you used to. They've suffered from this anti-tax and anti-government movement.
We have a digital divide between the people who have access to information and the people who don't. Do you have a medical question? If you're in the digital underclass, you can curry together an answer from Wikipedia and Medscape, and a million hits from sites that are trying to sell you something. Or you can do what I do, and what the medical librarians recommended to me, which is to start with review articles in the major journals -- New England Journal of Medicine, JAMA, and Lancet. It's a lot easier and more reliable to just go to the reliable sources in the first place.
Do you want to live in a country where all people have access to academic-quality public libraries, as we used to have until the cutbacks of the 1970s? Or do you want people to live in ignorance? To most of us here the answer is obvious, but there are people out there who just want to cut taxes.
That should have been the entire article right there.
Almost all specialty libraries I've heard of offer visitor access or special (paid) access to professionals in affiliated fields.
It sounds like this Doctor didn't put a lot of effort into trying to find a way around the pay wall.
I just checked the websites of Medical School libraries in my State and neighboring States, /Though one requires an annual membership and charges extortionist prices for photocopying articles.
they almost all have a way for people unaffiliated with the school to gain onsite access.
I've been through that in New York City. Most of the medical school libraries in Manhattan don't allow public access. One of them offered to let me use their library for about $2,000 a year. It's a real problem.
If you actually tried to do it, rather than just looking at their web site, I think you'd find it was difficult to impossible. Unless you happened to find a small friendly library that had everything you needed.