I like Josh, but I was a little surprised with his hot take about the current state of the Dem party. He doesn’t really seem to think the Dems need to change much despite admitting multiple times their standard positions on some hot button issues are more or less hard R Retarded…I don’t know how to reconcile that. He calls it close but they got smoked by a historically unpopular president…and some of their own voters feel actual relief they lost.
Agreed. In spite of the fact that Harris lost ground almost everywhere and Trump gained. And the fact that Dems lost Latino, working class, some Black voters etc. That's a very distorted view.
A little late here, but I was also shocked by how partisan Barro sounded. He said with a straight face that Harris "almost" won, which either comes off as nonsensical copium ("Aw shucks, we were so close!") or just plain ignorant of the fact that preelection polls being "close" don't have anything to do with the ultimate margin of victory (this isn't a basketball game where the polls represent the first 3 quarters and the election represents the fourth quarter where Trump eked out a victory; the election IS the game). Barro's characterization also ignores how Biden was set to lose even worse. I have a hard time finding any left of center analyst credible if he can't even acknowledge this pretty basic fact.
So as someone who is in healthcare and happens to be a radiologist I can maybe give my view from inside the beast of healthcare with of course my own biases. First off, Kmele’s quote about radiologists didn’t really make sense to me as my job is simply to read scans on my list and do occasional image guided procedures. I don’t reject anyone or have any say over anything like that. I simply read off my list for the few hospitals my group is contracted with. My pay is based off of an RVU or “relative value unit” which is set by the government and is currently around 32-37 dollars for 1 RVU (very arbitrary and wierd I know). So if I read an x-ray of the chest which is considered 0.2 RVU’s by the govt. I get 8 dollars or so. CT’s and MRI’s are weighted higher but also take more time to read. So whenever you see someone charged 200 bucks for a chest x-ray just know that the greedy doctor who reads it and takes all the liability for it gets 8 dollars of that total pool. Another example is a spine MRI which costs the patient thousands but I only get about 60-100 bucks for each one and depending on complexity they can take a while.
Getting back to the debate about Bluecross and Anesthesia. My main issue with this discussion was the entire idea about Anesthesia setting how long a case is. This is absolutely false because the surgeon who is performing the procedure sets how long the procedure is. So effectively by the govt. or Bluecross saying that you will only be paid for a certain time period you are essentially not paying the physician after a certain point if a case runs long due to complexity, slow surgeon, or unforeseen circumstances. Lastly, the idea of this massive Anesthesia overbilling operation is somewhat overblown if you take a deep dive into the actual report. Anesthesia providers were essentially rounding up cases to whole numbers that were multiples of 5 or 0. For example, if a case took 115 minutes, they put down 120 minutes. This wasn’t some shady practice of putting down 4 hours for procedures that took 2 hours. Also if you know any Anestheisa providers, you would know they are trying to quickly wake you up and turn over the room. Again to me this is hardly a big deal and definitely not the reason why Anesthesia is highly paid or the reason why healthcare is so expensive.
These are just my 2 cents on the current discussions and sorry for the long rant.
Administrative costs, on the other hand are “15-25%” of all U.S. healthcare costs (https://jamanetwork.com/journals/jama/fullarticle/2785479), and I bet there’s a lot more fat to trim there than with the people who are actually doing medicine.
Whenever you see these international comparisons of how doctors are paid, you also get into the question of “for what?”. U.S. doctors work long hours compared to some (but not all) comparitors (e.g. https://www.statista.com/statistics/1097227/proportion-primary-physicians-by-weekly-hours-worked-select-countries-worldwide/). As an American who studied in Australia, doctors work longer hours in the U.S. by far. As with all such comparisons, I’m not saying that one way is better, simply that if you’re going to point out that U.S. physicians are highly paid, you also have to acknowledge that our training standards are higher than any other country (we literally do not accept training from other countries and require all foreign physicians to retrain here), our work hours are long, our malpractice costs are huge, etc. etc. So saying American doctors are paid more than others is not an apples to apples comparison.
I have been disappointed lately with the approach of otherwise thoughtful commentators to the healthcare conversation. Nick Gillespie made a similar claim about physician salary being the primary driver for healthcare cost. I don’t see how anyone empirically makes this argument. A better argument would be that healthcare provider allocation of resources via overtreatment and overdiagnosis is a greater driver for healthcare expense. This is not because physicians get fat kickbacks (this is explicitly prohibited by Stark Law) but because of cultural expectations, defensive medical practices, the increasing prominence of patient experience in corporate medicine professional evaluations, or failure to adhere to the most recent evidence based guidelines. This is a problem that is well recognized by the medical profession, and there are any number of campaigns working to mitigate it. This discussion regarding physician pay is often matched with a similarly decontextualized conversation about the physician shortage. those discussions, I have never heard mention of the residency position bottleneck or how it is the direct result of the 1997 Balanced Budget Act-another “cost saving“ venture by Congress that was opposed by physician groups.
Also important to understand that no matter what the reimbursement policy is, it creates incentives. If pay for time is capped, then the incentive is to rush. If you are going in for a complex surgery, do you really want your surgical team rushing even more than they already do? OR availability is already valuable, and right now the incentive to run up the bill for time is competing with other incentives which already favor moving quickly.
This was a great episode. I do think Josh was wrong on one thing - the HR bullshit cannot be separated from the crime/immigration stuff. They are inextricably linked. Neither crime nor immigration can be addressed while the Dems clutch pearls every time someone says "homeless" or "illegal."
Unrelated edit: the Communists at Jacobin once called Josh Barro a "Barrometer" that identifies policies that should automatically by opposed by the DSA/psycho wing of the party. I still LOL at this every time I read/hear Josh
Yeah the language policing definitely keeps from reasonable discussion on issues. But I think most reasonable people have pushed back and stopped caring about the "right language" and just talk like normal people. Some in the language police camp are starting to follow as most of them think it's ridiculous but wanted to be part of the "in" group.
As part of my job, I deal with a lot of West Coast companies/orgs. Lots of pronouns in the signature block although no one has ever addressed it in a meeting. This week I had a meeting with a homeless org South of San Jose. I was shocked the were using the term "homeless" rather than the term "unhoused." Even the lefties are sick of this shit.
Before listening- for those of us who live on the other side of the world and couldn’t attend the second Sunday - is there a recording of it? I feel neglected and socially isolated. Thank you!
Please know that I am the only one of the three who spends any time answering comments, and also the only one of the three who does not edit audio. Adjust expectations accordingly.
I like Josh Barro and won’t ever stop laughing at his comments on Vivek Ramaswamy being section guy, but imho his comments re the Ds acting like HR hall monitors and dismissing it as really just prevalent in academia is just not accurate and indicates he’s wearing blinders on this point.
I’m flabbergasted that Josh’s insights of not being far off from being successful and that Harris was actually really close to winning are…patently wrong?
Up until that point he seemed like an even keel Democrat, but that kind of outlook feels insane from where I’m standing.
How was it not close? The popular vote ended up 49.9 to 48.4. If you were in a room with a hundred people and 50 chose one guy and 48 chose the other, you'd call it close.
If Kamala had punched some hippies, gone on Rogan, and spoken comprehensible English she might have eked out a win.
I look at it this way - winning the popular vote by 2 million is close as a percentage but 2 million more people is a lot of people. So if he won by like…10,000 then that would be close.
But also, he performed better than before almost everywhere. Harris performed better than Biden almost nowhere. He won 30 out of 50 states. The electoral vote wasn’t particularly close.
When I think of close, I think of single states determining the outcome of an election. I think of how meddlesome arson of mail voting boxes could affect the outcome. I think of how the preamble of needing weeks or months after the election to determine a winner is thoughtful necessity. But that’s just me.
If you only look at it from that angle, then it seems close, but that angle also isn't how the winner is calculated. If the race was decided by popular vote, the candidates would have employed different strategies for trying to win them. Trump reverses course on issues all the time, so I don't doubt he'd have been able to pivot and effectively develop an appealing strategy had it been a contest of the popular vote. She couldn't even distance herself from the nuttiest ideas she'd ever espoused that research told her were incredibly unpopular. The contest being what it is, she got 42% of electoral college votes and he got 58%. That's a 16% difference, and with America already having gotten a taste of what a shitty job he'd do.
Yeah, but the winner takes all effect amplifies small differences into big victories. The fact is that Trump won several swing states by only a few percent. A relatively small shift in those swing states could have tipped the election the other way. There was absolutely a path to victory for Kamala if she had run a slightly less incompetent campaign.
312 versus 226 electoral votes, and Trump won the total votes by over 2,000,000 — Is how it was not close. Hits harder when it is written out in regular form.
It's the second closest election since 1980. Electoral College naturally favors the Rs so much at this moment, that the only other two closer elections in the last half century (76, '00) had EC gaps was 57 and 5. Trump won by 86, and he won by <5% in all the states that made the difference. Trump ran the inside straight with swing states, and that's on Kamala, but it was a close election.
That is close in a nation the size of America. It was close when he won the first time, it was close when he lost, it was close when he won this time. And with a candidate as awful as kamala??? And after they all pretended it wasn't weekend at Bernie's white house edition Lol the democrats did WAAAAAAY better than they should have.
Trump won every single swing state. Harris lost ground just about everywhere. Electoral college win was not close. Dems ignore this at their own peril.
But several of those swing states were close. A few percent changing their minds in Michigan, Pennsylvania, and Georgia would have swung the election the other way.
I used to follow Josh really closely… but over the past few years I’ve found his commentary more and more off base. I’m not sure what’s happened, but I wonder if he’s found himself in a bubble post-Left, Right, and Center.
I could NEVER bring myself to say he's a host with less virtues that LR&C's current anchor David Green, mostly because that guy can't ask a single question of Democrat standards/priorities without pissing himself in fear.
It was close. But I do think there is something of a disconnect. Harris was slightly less popular than the craziest, most self-aggrandizing fabulist jackass whoever lived. Being slightly less popular than a burning pile of feces sitting on your living room floor is a problem.
I had just finished Jonathan Rosen’s “The Best Minds” when the Daniel Penny thing happened. Much of the book explains de institutionalization and its tragic ramifications. Seems like we could come up with some reasonable legislation to help those that can’t and won’t help themselves.
I constantly harangue people here and in my real life to read this book; it's gripping but even more importantly it provides key background information for substantive conversations about this tragic and very thorny issue
Just want to pop in and say that only about 8-10% of healthcare costs go to actually paying physicians and while other reimbursements have drastically increased physician pay has been relatively stagnant. Doctors come out of medical school with 200-500,000 dollars of debt and get paid essentially minimum wage for 3-7 years in residency (plus 1-3 years in fellowship) while working 70-80 hours a week. The number one cause of death of residents in the United States is suicide. We have no savings, and we give up the largest part of our youth to do this job.
It drives me up a wall to hear people talk about healthcare when they have no idea how it runs or what it takes to be a physician. We all know that there’s a problem, but blaming our pay when it is at most a tenth of the actual cost is asinine. Please have a physician who knows what they’re talking about on the pod at some point please. (enjoyed the rest of the pod though, don’t get it twisted. Love you boys, the only “news” I have time or brain space for. Which may flatter or terrify you.)
All of this is true, and additionally malpractice is wildly out of control in the U.S., and there are also a lot of other costs to being a physician. In a lot of settings, that malpractice liability is effectively a shield for an entire army of NPs and PAs who are quite well paid but are often supervised by physicians. We are also paying quite a substantial amount of money to professional credentialing cartels (an issue on which Rand Paul has notably fought) of dubious importance.
And if you think going to the DMV is bad, try getting a medical license. I paid Georgia $500 in April, plus at least that much over again to other entities to verify various things, and I still haven’t gotten my license in December (thankfully I had the luxury of leaving and going to a state with a medical board that actually wants doctors). I paid $1500 plus travel costs to take a Step II CS exam that doesn’t even exist anymore because it was BS, and another several thousand for other stages of board exams. A $500 application fee and then another $2100 to be board certified (plus more renewal fees). $880 to the DEA for the privilege or prescribing controlled substances. I literally had to pay $500 to a translation service to have my foreign medical degree translated, and it’s from Australia! Tell that to Szeps.
Going into private practice is prohibitive now due to the level of regulation and the declining reimbursement and the labor force has rapidly consolidated into employed physicians of huge healthcare conglomerates that keep merging into bigger and bigger blobs. Physicians are not exactly riding high in this country.
Right on target. People really don’t understand what is going on, the administrative bloat and the dangerous push for completely independent practice of NPs and PAs who are not trained for independent practice. Even in places where independent practice isn’t legal, the “supervising physician” is often legally responsible for the NPs and PAs working under them but have no time or resources to actually supervise them. There’s a big pushback against this stuff happening overseas, but we are so behind here and the nursing lobby is incredibly strong (while I might add doing NOTHING for bedside nurses who hold the system together and are leaving the system in massive waves)
NP and PA program slots are exploding (which also limits clinical experiences for medical students and residents in some hospital systems) while medical school slots are stagnant. That is a government regulatory problem that needs fixed, like the majority of problems created in healthcare (employment tied to insurance, billing bullshit due to Medicare reimbursements)
I do NEED to know if Luigi is related to Chuck Mangione, master of the flugelhorn. Super pressing journalistic issure. Am I the only one who knows "Feels So Good"??
As the sister of a schizophrenic, I appreciate the discussion. I hate everything about this case. Thankfully my brother isn’t meds/treatment resistant but it’s not uncommon for him to have episodes. There have been times when he’s needed to be institutionalized in a psych ward until he stabilizes again. Not even an option. Instead he gets no treatment, loses housing, ends up on the streets etc. Our current situation is a nightmare for families and unfair to the public. And they often (as was our case at one time) end up in jail/prison anyways. Enraging…
You have my sympathy. I've been working professionally with people with schizophrenia for around 45 years. But I go home when the work day is done. For families there is often no break or time off. It's a tough situation without easy answers.
On the title “Centrism Kills” - the first time Trump won, I had a fb friend say loud, confidently, and with ringing endorsements that all centrists deserve a brick in the face for enabling Trump voters.
If some people had their way, yes, centrism would kill.
Loved Josh on Left Right and Center. After he left, the bubbled idiots at NPR couldn’t seem to find another centrist to moderate. The current guy is insufferable.
Same. Went from must listen to unsubscribe within a month. The guy before Josh was good too but I think he got a job at a consulting firm and had to resign. I do remember one of Josh’s first actions as host was to stop having that kooky old hippy on as the ‘Left’
I wish Nick Gillespie was in the room when Michael said, "Every Italian in American history has been guilty."
You mean he wouldn't whole-heartedly agree?
What do you think Catholic Guilt means when you've left the Faith?
Guilty of exposing America to proper pizza
I like Josh, but I was a little surprised with his hot take about the current state of the Dem party. He doesn’t really seem to think the Dems need to change much despite admitting multiple times their standard positions on some hot button issues are more or less hard R Retarded…I don’t know how to reconcile that. He calls it close but they got smoked by a historically unpopular president…and some of their own voters feel actual relief they lost.
Agreed. In spite of the fact that Harris lost ground almost everywhere and Trump gained. And the fact that Dems lost Latino, working class, some Black voters etc. That's a very distorted view.
A little late here, but I was also shocked by how partisan Barro sounded. He said with a straight face that Harris "almost" won, which either comes off as nonsensical copium ("Aw shucks, we were so close!") or just plain ignorant of the fact that preelection polls being "close" don't have anything to do with the ultimate margin of victory (this isn't a basketball game where the polls represent the first 3 quarters and the election represents the fourth quarter where Trump eked out a victory; the election IS the game). Barro's characterization also ignores how Biden was set to lose even worse. I have a hard time finding any left of center analyst credible if he can't even acknowledge this pretty basic fact.
Disappointed that "Luigi Mangioni, murderer of my holes" didn't make the cut for episode title, fellas.
'Murder me, Luigi' would have been a good title.
Right?!
So as someone who is in healthcare and happens to be a radiologist I can maybe give my view from inside the beast of healthcare with of course my own biases. First off, Kmele’s quote about radiologists didn’t really make sense to me as my job is simply to read scans on my list and do occasional image guided procedures. I don’t reject anyone or have any say over anything like that. I simply read off my list for the few hospitals my group is contracted with. My pay is based off of an RVU or “relative value unit” which is set by the government and is currently around 32-37 dollars for 1 RVU (very arbitrary and wierd I know). So if I read an x-ray of the chest which is considered 0.2 RVU’s by the govt. I get 8 dollars or so. CT’s and MRI’s are weighted higher but also take more time to read. So whenever you see someone charged 200 bucks for a chest x-ray just know that the greedy doctor who reads it and takes all the liability for it gets 8 dollars of that total pool. Another example is a spine MRI which costs the patient thousands but I only get about 60-100 bucks for each one and depending on complexity they can take a while.
Getting back to the debate about Bluecross and Anesthesia. My main issue with this discussion was the entire idea about Anesthesia setting how long a case is. This is absolutely false because the surgeon who is performing the procedure sets how long the procedure is. So effectively by the govt. or Bluecross saying that you will only be paid for a certain time period you are essentially not paying the physician after a certain point if a case runs long due to complexity, slow surgeon, or unforeseen circumstances. Lastly, the idea of this massive Anesthesia overbilling operation is somewhat overblown if you take a deep dive into the actual report. Anesthesia providers were essentially rounding up cases to whole numbers that were multiples of 5 or 0. For example, if a case took 115 minutes, they put down 120 minutes. This wasn’t some shady practice of putting down 4 hours for procedures that took 2 hours. Also if you know any Anestheisa providers, you would know they are trying to quickly wake you up and turn over the room. Again to me this is hardly a big deal and definitely not the reason why Anesthesia is highly paid or the reason why healthcare is so expensive.
These are just my 2 cents on the current discussions and sorry for the long rant.
Great episode, but Josh was factually wrong around doctor pay being one of the big reasons why healthcare costs are high in the US.
Physician pay is ~6% of total healthcare costs. Pay doctors nothing and you reduce costs by 6%.
Two things can be true at the same time.
1) Yes, doctors here make more than those in other countries.
2) Physician pay makes up a negligible amount of the money that goes into healthcare spending.
For full disclosure, my wife is an OB, but numbers are numbers. Please don't murder me.
Administrative costs, on the other hand are “15-25%” of all U.S. healthcare costs (https://jamanetwork.com/journals/jama/fullarticle/2785479), and I bet there’s a lot more fat to trim there than with the people who are actually doing medicine.
Whenever you see these international comparisons of how doctors are paid, you also get into the question of “for what?”. U.S. doctors work long hours compared to some (but not all) comparitors (e.g. https://www.statista.com/statistics/1097227/proportion-primary-physicians-by-weekly-hours-worked-select-countries-worldwide/). As an American who studied in Australia, doctors work longer hours in the U.S. by far. As with all such comparisons, I’m not saying that one way is better, simply that if you’re going to point out that U.S. physicians are highly paid, you also have to acknowledge that our training standards are higher than any other country (we literally do not accept training from other countries and require all foreign physicians to retrain here), our work hours are long, our malpractice costs are huge, etc. etc. So saying American doctors are paid more than others is not an apples to apples comparison.
I have been disappointed lately with the approach of otherwise thoughtful commentators to the healthcare conversation. Nick Gillespie made a similar claim about physician salary being the primary driver for healthcare cost. I don’t see how anyone empirically makes this argument. A better argument would be that healthcare provider allocation of resources via overtreatment and overdiagnosis is a greater driver for healthcare expense. This is not because physicians get fat kickbacks (this is explicitly prohibited by Stark Law) but because of cultural expectations, defensive medical practices, the increasing prominence of patient experience in corporate medicine professional evaluations, or failure to adhere to the most recent evidence based guidelines. This is a problem that is well recognized by the medical profession, and there are any number of campaigns working to mitigate it. This discussion regarding physician pay is often matched with a similarly decontextualized conversation about the physician shortage. those discussions, I have never heard mention of the residency position bottleneck or how it is the direct result of the 1997 Balanced Budget Act-another “cost saving“ venture by Congress that was opposed by physician groups.
Also important to understand that no matter what the reimbursement policy is, it creates incentives. If pay for time is capped, then the incentive is to rush. If you are going in for a complex surgery, do you really want your surgical team rushing even more than they already do? OR availability is already valuable, and right now the incentive to run up the bill for time is competing with other incentives which already favor moving quickly.
This was a great episode. I do think Josh was wrong on one thing - the HR bullshit cannot be separated from the crime/immigration stuff. They are inextricably linked. Neither crime nor immigration can be addressed while the Dems clutch pearls every time someone says "homeless" or "illegal."
Unrelated edit: the Communists at Jacobin once called Josh Barro a "Barrometer" that identifies policies that should automatically by opposed by the DSA/psycho wing of the party. I still LOL at this every time I read/hear Josh
Yeah the language policing definitely keeps from reasonable discussion on issues. But I think most reasonable people have pushed back and stopped caring about the "right language" and just talk like normal people. Some in the language police camp are starting to follow as most of them think it's ridiculous but wanted to be part of the "in" group.
As part of my job, I deal with a lot of West Coast companies/orgs. Lots of pronouns in the signature block although no one has ever addressed it in a meeting. This week I had a meeting with a homeless org South of San Jose. I was shocked the were using the term "homeless" rather than the term "unhoused." Even the lefties are sick of this shit.
Before listening- for those of us who live on the other side of the world and couldn’t attend the second Sunday - is there a recording of it? I feel neglected and socially isolated. Thank you!
This will be posted, as soon as tomorrow.
Thank you!!
Hallelujah!
And with that Cohen is stuck in my head for the day.
https://youtu.be/YrLk4vdY28Q?si=OFH4IUizWxdX6dNj
You’re welcome!
Matt,
There are three types of lies in this world. Lies, damned lies, and releasing the Balko cut.
Please know that I am the only one of the three who spends any time answering comments, and also the only one of the three who does not edit audio. Adjust expectations accordingly.
I was teasing you. Appreciate everything you do.
Or maybe not.
That’s good. Moynihan should know that secrecy is for losers.
Metoometoometoo
Pressure baby!
🥰
I like Josh Barro and won’t ever stop laughing at his comments on Vivek Ramaswamy being section guy, but imho his comments re the Ds acting like HR hall monitors and dismissing it as really just prevalent in academia is just not accurate and indicates he’s wearing blinders on this point.
Yeah he was off on Dems
I’m flabbergasted that Josh’s insights of not being far off from being successful and that Harris was actually really close to winning are…patently wrong?
Up until that point he seemed like an even keel Democrat, but that kind of outlook feels insane from where I’m standing.
How was it not close? The popular vote ended up 49.9 to 48.4. If you were in a room with a hundred people and 50 chose one guy and 48 chose the other, you'd call it close.
If Kamala had punched some hippies, gone on Rogan, and spoken comprehensible English she might have eked out a win.
I look at it this way - winning the popular vote by 2 million is close as a percentage but 2 million more people is a lot of people. So if he won by like…10,000 then that would be close.
But also, he performed better than before almost everywhere. Harris performed better than Biden almost nowhere. He won 30 out of 50 states. The electoral vote wasn’t particularly close.
When I think of close, I think of single states determining the outcome of an election. I think of how meddlesome arson of mail voting boxes could affect the outcome. I think of how the preamble of needing weeks or months after the election to determine a winner is thoughtful necessity. But that’s just me.
Except we still have an electoral college - CA/NY throws off the curve as always - but the pickup was massive across the country.
If you only look at it from that angle, then it seems close, but that angle also isn't how the winner is calculated. If the race was decided by popular vote, the candidates would have employed different strategies for trying to win them. Trump reverses course on issues all the time, so I don't doubt he'd have been able to pivot and effectively develop an appealing strategy had it been a contest of the popular vote. She couldn't even distance herself from the nuttiest ideas she'd ever espoused that research told her were incredibly unpopular. The contest being what it is, she got 42% of electoral college votes and he got 58%. That's a 16% difference, and with America already having gotten a taste of what a shitty job he'd do.
Yeah, but the winner takes all effect amplifies small differences into big victories. The fact is that Trump won several swing states by only a few percent. A relatively small shift in those swing states could have tipped the election the other way. There was absolutely a path to victory for Kamala if she had run a slightly less incompetent campaign.
312 versus 226 electoral votes, and Trump won the total votes by over 2,000,000 — Is how it was not close. Hits harder when it is written out in regular form.
It's the second closest election since 1980. Electoral College naturally favors the Rs so much at this moment, that the only other two closer elections in the last half century (76, '00) had EC gaps was 57 and 5. Trump won by 86, and he won by <5% in all the states that made the difference. Trump ran the inside straight with swing states, and that's on Kamala, but it was a close election.
popular vote is irrelevant in a presidential election
... in the word of Donald Trump himself, 'wrong'
That is close in a nation the size of America. It was close when he won the first time, it was close when he lost, it was close when he won this time. And with a candidate as awful as kamala??? And after they all pretended it wasn't weekend at Bernie's white house edition Lol the democrats did WAAAAAAY better than they should have.
I think it's WILD to think otherwise.
Trump won every single swing state. Harris lost ground just about everywhere. Electoral college win was not close. Dems ignore this at their own peril.
But several of those swing states were close. A few percent changing their minds in Michigan, Pennsylvania, and Georgia would have swung the election the other way.
Correct!! Wait.. Not about the Rogan thing. But yes it was way closer than people like to pretend.
popular vote is irrelevant
I used to follow Josh really closely… but over the past few years I’ve found his commentary more and more off base. I’m not sure what’s happened, but I wonder if he’s found himself in a bubble post-Left, Right, and Center.
I followed him closely, too, until the judge told me to keep it at least 500 feet.
I could NEVER bring myself to say he's a host with less virtues that LR&C's current anchor David Green, mostly because that guy can't ask a single question of Democrat standards/priorities without pissing himself in fear.
Kind of makes one question how sound his judgement is on a few things they discussed…Thais one really surprised me.
Yeah these centrists who can't quit the dems are just baffling to me at this point.
It was close. But I do think there is something of a disconnect. Harris was slightly less popular than the craziest, most self-aggrandizing fabulist jackass whoever lived. Being slightly less popular than a burning pile of feces sitting on your living room floor is a problem.
I call it The Hilary Condition
I had just finished Jonathan Rosen’s “The Best Minds” when the Daniel Penny thing happened. Much of the book explains de institutionalization and its tragic ramifications. Seems like we could come up with some reasonable legislation to help those that can’t and won’t help themselves.
OMG! Same. I just came here to post about Rosen's terrific book. He really dives deep into the dangers of the anti-psychiatry movement.
It’s a great book. I was shaken for a while after I finished it.
Agreed, best nonfiction book I read that year.
I constantly harangue people here and in my real life to read this book; it's gripping but even more importantly it provides key background information for substantive conversations about this tragic and very thorny issue
After I read The Best Minds I read Darkness Visible and The Center Cannot Hold. Both are very good 👍
I read the latter (very good) and I'll look for the former, thanks
I feel like it's been too long since we've had a ben Dreyfus disaster.
I mean, Chicago was only four months ago.
Exactly. Too long.
ah, i think i might have missed that one. it was never on the podcast feed, right? wasn't it only available on yt?
https://www.youtube.com/live/42nOkXDCde8
Just want to pop in and say that only about 8-10% of healthcare costs go to actually paying physicians and while other reimbursements have drastically increased physician pay has been relatively stagnant. Doctors come out of medical school with 200-500,000 dollars of debt and get paid essentially minimum wage for 3-7 years in residency (plus 1-3 years in fellowship) while working 70-80 hours a week. The number one cause of death of residents in the United States is suicide. We have no savings, and we give up the largest part of our youth to do this job.
It drives me up a wall to hear people talk about healthcare when they have no idea how it runs or what it takes to be a physician. We all know that there’s a problem, but blaming our pay when it is at most a tenth of the actual cost is asinine. Please have a physician who knows what they’re talking about on the pod at some point please. (enjoyed the rest of the pod though, don’t get it twisted. Love you boys, the only “news” I have time or brain space for. Which may flatter or terrify you.)
- A resident who is tired in more ways than one
All of this is true, and additionally malpractice is wildly out of control in the U.S., and there are also a lot of other costs to being a physician. In a lot of settings, that malpractice liability is effectively a shield for an entire army of NPs and PAs who are quite well paid but are often supervised by physicians. We are also paying quite a substantial amount of money to professional credentialing cartels (an issue on which Rand Paul has notably fought) of dubious importance.
And if you think going to the DMV is bad, try getting a medical license. I paid Georgia $500 in April, plus at least that much over again to other entities to verify various things, and I still haven’t gotten my license in December (thankfully I had the luxury of leaving and going to a state with a medical board that actually wants doctors). I paid $1500 plus travel costs to take a Step II CS exam that doesn’t even exist anymore because it was BS, and another several thousand for other stages of board exams. A $500 application fee and then another $2100 to be board certified (plus more renewal fees). $880 to the DEA for the privilege or prescribing controlled substances. I literally had to pay $500 to a translation service to have my foreign medical degree translated, and it’s from Australia! Tell that to Szeps.
Going into private practice is prohibitive now due to the level of regulation and the declining reimbursement and the labor force has rapidly consolidated into employed physicians of huge healthcare conglomerates that keep merging into bigger and bigger blobs. Physicians are not exactly riding high in this country.
Right on target. People really don’t understand what is going on, the administrative bloat and the dangerous push for completely independent practice of NPs and PAs who are not trained for independent practice. Even in places where independent practice isn’t legal, the “supervising physician” is often legally responsible for the NPs and PAs working under them but have no time or resources to actually supervise them. There’s a big pushback against this stuff happening overseas, but we are so behind here and the nursing lobby is incredibly strong (while I might add doing NOTHING for bedside nurses who hold the system together and are leaving the system in massive waves)
NP and PA program slots are exploding (which also limits clinical experiences for medical students and residents in some hospital systems) while medical school slots are stagnant. That is a government regulatory problem that needs fixed, like the majority of problems created in healthcare (employment tied to insurance, billing bullshit due to Medicare reimbursements)
I do NEED to know if Luigi is related to Chuck Mangione, master of the flugelhorn. Super pressing journalistic issure. Am I the only one who knows "Feels So Good"??
Played it in high school jazz band (and dad a big fan) since Chuck & Gap are hometown heroes. (So I am inclined to say no relation.)
Maybe it will lead to a revival in his career and he can finally move out of the Mega Lo Mart.
The melody is playing in my head as I type this reply.
As the sister of a schizophrenic, I appreciate the discussion. I hate everything about this case. Thankfully my brother isn’t meds/treatment resistant but it’s not uncommon for him to have episodes. There have been times when he’s needed to be institutionalized in a psych ward until he stabilizes again. Not even an option. Instead he gets no treatment, loses housing, ends up on the streets etc. Our current situation is a nightmare for families and unfair to the public. And they often (as was our case at one time) end up in jail/prison anyways. Enraging…
You have my sympathy. I've been working professionally with people with schizophrenia for around 45 years. But I go home when the work day is done. For families there is often no break or time off. It's a tough situation without easy answers.
“This kid” - nah, the minute you assassinate someone, you stop being a kid.
On the title “Centrism Kills” - the first time Trump won, I had a fb friend say loud, confidently, and with ringing endorsements that all centrists deserve a brick in the face for enabling Trump voters.
If some people had their way, yes, centrism would kill.
With 95% of Americans in the center. Yikes.
Loved Josh on Left Right and Center. After he left, the bubbled idiots at NPR couldn’t seem to find another centrist to moderate. The current guy is insufferable.
The funniest shit to ever happen on that show was Ross Douthat and Liz Bruenig verbally joining hands as catholics to flip the script on Josh.
Same. Went from must listen to unsubscribe within a month. The guy before Josh was good too but I think he got a job at a consulting firm and had to resign. I do remember one of Josh’s first actions as host was to stop having that kooky old hippy on as the ‘Left’