Distancing Rural Health Care

A growing problem in rural America is the growing distances its citizens must travel for health care, thanks to years of hospital and clinic closures as large companies buy and consolidate facilities in rural areas. But also because insurance companies don’t include nearby facilities in their networks. And federal regulators are institutionalizing this trend.

Carol Miller, a community organizer in New Mexico, comprehensively writes about this issue in The Daily Yonder, focusing on the chart below showing how federal regulators propose to allow insurers to discriminate against rural populations and still participate in the markets set up by the Affordable Care Act.

One of the worst things about this table is that it exists and is in the public realm. I am extremely concerned that it might dangerously take on a life of its own. Remember, that just as the Health Professions Shortage Area designation was originally created for use by a single program, there are now are more than 20 programs using it. The standards proposed in this table need to go away and never be used by any program. The goal needs to be access to care for people living in rural and CEAC communities [counties with a population density of less than 10 per square mile], not distances and travel times that will guarantee not only worse access, but also worse health.

ruralInsurance
source: Centers for Medicare and Medicaid Services, Dept. of Health and Human Services

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craigcrawford

Author: craigcrawford

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128 thoughts on “Distancing Rural Health Care”

  1. thanks for the new thread alert and thanks for bringing up this issue.

    not just health care that rural folks can’t easily access.  been a trend to cut out availability of a lot:  post offices closing, tv transmission no longer analog is hard to receive if at all with digital (therefore less national/state news info for the country folk), trains gone or completely changed to freight, computer connections difficult for those who can’t afford satellite/cable/cell phones, small general stores closing down, no bus/mass transit and so on.

    one bright spot tho’  very quiet and fewer crazy people to contend with

  2. Yep Pat it is across the board wholesale abandonment of rural folks.

    Here is something I just learned in the fallout of a parent’s death (might not be a surprise to some but it was to me): No matter when you die in the month, even if it’s the very last day of the month, you lose that entire month’s social security payment. The efforts I found in congressional records to prorate last month SS payments were not even brought up for a vote in the House.

  3. My father was getting social security payments on the 3rd of the month.  He died on December 31, 2003.  His social security payments did occur on January 3rd and was clawed back within the month.  One of the very few times I have seen any government function work so quickly!  They did not touch his December payment.

  4. I think in some ways it is just the way the world is working. In my neighborhood there is no neighborhood doctor and if you have to ride the bus you are 30 min from your doctor. Doctors have moved out of neighborhoods and are clustering around hospitals and medical centers.

    As to rural areas the small town( pop. 350) that I grew up in had 2 doctors when I was growing up. Now it has none and hasn’t for many  years. So this isn’t a new problem for rural folks.

     

    Jack

  5. patd,

    Excellent list. May I add education to the mix. I grew up in a rural, poor area of Southern-Central NYS. I was lucky that my early years were spent attending a small, local school. My teachers had the time & creativity to teach me, not just teach to the masses or teach ‘for the test.’ I was lucky & am thankful for it.

     

     

     

  6. purple – Amazing how the gov’t can be efficient when it’s convenient for them.

     

    My hometown does not have a hospital.  They built one in the late 60s, but it quickly turned into a long-term care facility.  We have a little clinic and a couple of docs; they have some ER capabilities at the hospital, but usually transport them to the real ER and hospital 30 minutes away.

    The families out on the farms in out county, of course, have always had it much tougher.

    My insurance company has a new tele-doc function (which some doc groups are fighting, but it’s safe intil June), so you can call about somethings.  That could help rural folks, but  doesn’t solve the problem if you need to get a RX filled.

    The way the ACA was set up has jacked up my premiums and co-pays, while burying benefits behind the deductible, until it has been met.  Tele-doc is the only good thing that has happened.

    With some people working from home and moving further out, I wonder if some things will improve? Poor and rural vs gentrified rural.

  7. now that boomers are becoming elders and less able to drive, there may come an upsurge in mobile services, docs making house calls or outfitted medical vans capable of going to suburbs and rural areas.  should be some gold to be found in some of those golden agers.   heck, amazon is working on drone delivery so there must be a promise of money out there in the boonies.

  8. The way it is is the way it is. I don’t see it changing. Docs want the intellectual stimulation of working with their fellows in group settings, and they want to be current in the art of healing. Both of these desires detract from rural practices even if remuneration were equal.

    There are gap fillers such as my niece who earned a doctorate in nursing and spent a career in Tuba City, Arizona until illness forced her retirement. She provided services to women on the Navajo reservation.

  9. I hope you guys on the east coast are stocked up for the weekend.

    The GOP will surely be using the footage of the Obama motorcade stymied by the little bit of snow that’s fallen so far.

  10. patd…  from former thread…   the only part of NH that would pay attention (or see a copy of) that paper from Brattleboro is the far south western part.  If you are familiar with the state… the closest city would be Keene.  And I doubt it would influence them much.  Hell even the state’s largest major newspaper…  The Union Leader… doesn’t have sway much anymore.  The last election they endorsed Gingrich…  now Christie.  The former didn’t win the state and the latter won’t either.

  11. Yup…  I have a 30 minute drive to my doctor’s office.  There is one just up the street…  but I ain’t going to see that doc.  The nearest pharmacy is 20 minutes away…   along with the nearest hardware or grocery store.  But then…  we expected to have to do some driving for services when we moved here back in 1978.  I agree with Flatus…  that’s the way it is.  And if one doesn’t like it…  one can always move.  Rick and I have already decided to move to a small city with lots of services just east of here (Milford) when we hit our mid-70s.

     

    Craig…  you and David stay safe with the upcoming storm.   It sounds like a doozy.  Glad it won’t make it this far north…  even Rick says he’s fine with it staying south.

  12.  

    A growing problem in rural America is the growing distances its citizens must travel for health care, thanks to years of hospital and clinic closures as large companies buy and consolidate facilities in rural areas. But also because insurance companies don’t include nearby facilities in their networks. And federal regulators are institutionalizing this trend.

     
     
     
    It is not just rural areas, insurance companies, or healthcare.  The large multinational companies buy and consolidate facilities all over.  This is the result of the “Mergers and Acquisitions” (M&A) philosophy and view from on high that enables empire building toward the eventual goal of monopoly power and unfettered by any government interference.
     
     
     
    I do not care what you call them, Republicans, Wall Street Democrats, Boardroom Liberals, Neoliberals, New Democrats, Centrist Democrats, Clinton Democrats, Moderate Democrats or the Third Way, their central tenet is that the government should help the rich. The explanation is that the rich know how to create wealth so in the end everyone is better off (supply-side or trickle-down economics).  President Obama and the Clintons appear to believe in a dominant role for the large multinational corporations and the wisdom on the part of elites. They believe that the world works best when these elites use their power magnanimously, not when they’re forced to share it.  This group loves the government, they love creating government laws that speed transfer of wealth to the wealthy
     
     
     
    A number of President Obama’s signature efforts have rested upon alliances of the government with various major interests. For health-care reform, it was certain insurance companies and other favored groups. The president’s financial policies and the continued insistence upon Too Big to Fail have helped encourage some large banks to grow even larger. On immigration, the administration has relied upon a network of major foundations, activist groups, and corporate behemoths. Many of the “green” initiatives proposed by the White House involve or would involve large sums of crony-capitalist redistribution (from the taxpayers to some lucky interest).
     
     
     
    The four pillars to this the neo-liberal approach all of which involve liberalization (the reduction of rules and restrictions).  It is an extension of the traditional liberal philosophy, which argues for a separation of politics and economics and that markets should be “free” from interference of government. This approach is based on four principles:
     
    ■ Economic growth is paramount: corporations and their agents need to be free to pursue whatever gives them an economic advantage and, in consequence, internal and global markets must be free to operate with little government constraint or regulation.
     
    ■ Free trade benefits all nations – rich or poor – because every nation has a comparative advantage.
     
    ■ Government spending creates inefficiency and waste: although most neo-liberals agree that not all public expenditure is wasteful, many argue that it can be reduced and advocate for privatization.
     
    ■ In the distribution of economic goods, individual responsibility replaces the concepts of public goods and community.
     
     
     
    Within industrialized countries, the economic agenda has been dominated by policies associated with the “U.S. model.” These include deregulation of financial markets, privatization, weakening of institutions of social protection, weakening of labor unions and labor market protections, shrinking of government, cutting of top tax rates, opening of international goods and capital markets, and abandonment of full employment goals, all under the guise of the natural rate. International economic policy has been dominated by the “Washington Consensus,” which advocates privatization, free trade, export-led growth, financial capital mobility, deregulated labor markets, and policies of economic austerity.
     
    reductions in government spending in order to enhance the role of the private sector in the economy
     
     
     
    Their economic agenda is dominated by policies associated with:
     
    • Economic austerity in government spending in order to enhance the role of the private sector in the economy,
     
    • Deregulation of financial markets,
     
    • Privatization,
     
    • Weakening of institutions of social protection,
     
    • Weakening of labor unions and labor market protections,
     
    • Shrinking of government,
     
    • Cutting of top tax rates while abandoning the middle class,
     
    • Opening of international goods and capital markets for the large Multi-national Corporations, and
     
    • Abandonment of full employment goals.
     

  13. The tele-doc benefit has no co-pay through my insurance plan.  The insurance co knows the tele-doc probably won’t send you to a lab for a blood draw.  You’re much more likely to get extra testing if you go to a clinic.  The docs just have to be licensed in the same state as the patient.  One of my co-workers ended up with a doc in Isreal, although licensed in TX.

    You can also face-time or email pics of whatever you have going on.

    Technology can help in rural settings (if they have access to it), but again, if you require a prescription, etc., tech isn’t going to handle that.   Rural folks have also been left behind with regard to technology, as well.

    I see the ads in TV here, selling 5-acre lots in outlying areas.  They also offer custom homes.  What kind of infrastructure is out there? Where do you get groceries?   So many rural towns no longer have stores for even basic necessecities, thanks to superstores sucking the life out of them.  Some folks in small towns now have to drive further for groceries.  They were sold down the river in many ways.

  14. blueid,  small towns also were hurt when the trains stopped stopping in them.

    too bad we can’t see the value of a good rail system as other countries do.

  15. P.I.T,

    Neo-Liberalism? Nonsense. It’s a return to the Robber Barons who created a serfdom of American wage earners in the late 19th century. And, I think it has been accomplished by self serving SOBs pulling the wool over the eyes of people eager for change, any change and convincing them that the cure is such things as a Tea Party platform that will be just what the doctor ordered.

  16. Purple, that is exactly what happened to us and how I found out about this Social Security deal. They actually deposited her December check and several days later withdrew it, creating an overdraft on her account. The bank helpfully wiped out the overdraft charge under the circumstances, but this was the first I knew that when you give the feds Direct Deposit access to your account they also have the power to withdraw funds without notice. SPOOKY!

  17. Craig…

    my mother was getting an electronically direct deposited monthly pension check from my father’s work place that was transferred to her upon his death.  When she passed away, a check had just been deposited.  It was electronically withdrawn shortly thereafter without my knowledge because it was not transferrable to one’s children.  I saw it on her statement and received a notice from the company managing the pension funds a week later.  I didn’t think it was spooky…   with all the thousands of loose ends I had to attend to as executor of the estate, it was a relief to have something taken care of that I didn’t have to think about.  I felt the same way about her SS check.

     

  18. Having taken care of affairs several times, I’ve learned some things. The provider of final arrangements should inform the family of what the government expects and requires and all about death certificates, etc. In Kumcho’s case, the financial implication was great. Her earned SS was gone along with the the dependent’s portions of both my service retired pay and my VA disability compensation. All of our household obligations remained the same. Send her back and they can keep the money.

    Oh, I just found the letter in which I notified SS of her demise and returned her unearned payment. The last two paragraphs are interesting:

    “I will not claim the death benefit. Let it be used to reduce the public debt.

    My wife appreciated receiving her Social Security every month. God Bless F.D.R.”

    Sincerely,
    Flatus
    Kumcho’s Husband

  19. Flatus…

    it’s a hard enough thing to lose the person you love and to have to learn to live alone.  It sucks that one’s income also is immediately halved.  Meanwhile… with the exception of a slightly lower food bill… the expenses remain the same.

     

    Sending you and Craig’s father much love and light…

  20. Yesterday I happened to meet a new doctor courtesy of a change in insurance carriers.  He was originally from New York and moved south as his wife was from Florida.  We got to laughing over the WA computerized system used by ALL of the clinics, hospitals, and insurance carriers.  His judgement:  I called all my former associates and told them they really needed to move.  He was new enough to the system to still be amazed by the ease of use.

    Quite simply once you have entered your whole history and okayed the sharing among licensed medical personnel to access, virtually everything is instantly available and just needs to be updated complete with warning flags for more serious conditions that may need testing or treatment based on new info.

    It makes it possible for an ARNP (Advanced degree for a Nursing Practitioner) to be the primary care person in even the remotest area.  They act in association with a medical team in all specialties.  Many actually still do that old fashioned thing known as a “house call” if required.  This means that basic care is nearby and only the most serious of conditions & treatments call for travel.  Certainly there is room for improvement for the simple reason, there is a major need for more of them.  WGU has a high demand program to educate as many as possible as fast as possible.

    In the larger cities such as where I live such as Tacoma, some programs have clinics located in service areas around a county or in the case of my current provider in one four story building housing everything from pharmacy to specialists offices that happens to be on the same street with three different hospitals for surgery & long term care/recuperation that are also tied into the clinic system.

    All of the treatment possibilities such as acupuncture, physical therapy etc are coordinated.   It truly is as close as you can get to universal health care as you can get in American healthcare.  Coverage is mandatory and income adjusted which can still be hard on some families, but I have to say it is the best medical service I have ever had in my life.

     

  21. Blue,

    We have a great mountain, lots of lakes, an ocean, long stretches of green green trees and excellent entertainment.  It does get cold.  We are facing five days of rain.  Potholes have been known to swallow automobiles, and that pretty mountain might blow its top at some point.  It’s up to you.  🙂

     

  22. blueid, wapo says goper establishment favors trump over cruz…. seems for the same reasons you’ve been saying.

    “Between Trump and Cruz, it’s not even close,” said Rep. Peter King (R-N.Y.), a longtime House moderate who has not endorsed a candidate. “Cruz isn’t a good guy, and he’d be impossible as president. People don’t trust him. And regardless of what your concern is with Trump, he’s pragmatic enough to get something done. I also don’t see malice in Trump like I see with Cruz.”

  23. also in wapo today  “In politics and business, women just can’t win”

    here’s an excerpt:

    Few women find themselves more tormented by impossible, Goldilocks-like expectations than female politicians, given their very public roles and the huge numbers of people judging them against wildly different benchmarks.

    Research has shown that the public expects politicians and other leaders to be tough and strong, while women are generally associated with traits such as compassion and warmth, notes Kelly Dittmar, a political scientist at Rutgers University and a scholar at the Center for American Women and Politics. These conflicting stereotypes mean that virtually any female politician, exhibiting virtually any behavior, may be seen as either not “woman” enough or not “politician” enough. Or both.

    Some manage this delicate balance better than others. Sarah Palin, Dittmar observed, effectively portrayed herself as a “pit bull [in] lipstick.” Just feminine enough, just macho enough.

    Others, notably the always-too-cold-yet-also-somehow-too-emotional Hillary Clinton, have struggled.

  24. Living on the edge of the frontier  and trying to assist the recruitment of physicians and support personnel for six years I saw the lack of medical professionals who want to work in rural settings for the compensation offered in those settings. Of course compensation was only one consideration, others being a lack of social,  cultural and potential for advancement, lack of colleagues in their specialties, etc.  Those are not issues that the hospitals, clinics, etc. have control over.

  25. Sarah seems to forget that the GOP establishment ran her as VP candidate in 08 and THE VOTERS rejected her and her icebox hayseed politics (to say nothing of her Wasilla gibberish).

  26. pogo, any success making use of the grants that pay med school expense (“northern exposure” doc) in exchange for working in the boonies?   how do small communities find those kind of docs?

  27. from cnn’s “The Ted Cruz pile on: GOP senators warn of revolt should he win nomination

    A large number of GOP senators say Cruz’s divisive tactics, which have included describing his colleagues as part of a corrupt “Washington cartel,” will make it hard — if not impossible — to get behind him if he’s the nominee.

    “It would be a major challenge because of the wounds that are deep,” said Indiana Sen. Dan Coats, who is neutral in the race so far.

    “An awful lot of us really didn’t like to be targeted as corrupt, establishment bought by the lobby establishment,” Coats added. “It sure looks like someone was using it as a way to gain notoriety as the only true conservative in Washington.”

  28. patd

    NW people are about as worried over subduction and exploding calderas as California people are about earthquakes:

    It could happen someday but at least we don’t have hurricanes and/or blizzards every year.  If it does happen we probably won’t care for long. 🙂

     

  29. Uh oh, the weather is starting in NE Columbia. Sprinkle at the rate of 0.06-in/hour, air temp 33-degF, wind chill 30-deg.  There is a coating of ice starting to form on the thin branches of the trees outside the house.

    Given the unfamiliarity of local drivers with navigating in icy conditions, we’d be much better off with a rapid blanketing with half a foot of snow; but, the forecasters say that’s not going to happen. Just have to hope the starry-eyed fools stay inside until the temps rise a couple of degrees. Fortunately, most of our utilities are undergrounded in our part of town.

  30. Loved the Colbert on the bible bit with Trump.  It made me think that Hillary being a good Methodist girl probably likes one of my favorites since it seems to capture her ethos:  Second Timothy 2:15

    “Study to show thyself approved under God, a workman that need not be ashamed, rightly dividing the word of truth.”

     

     

     

  31. Flatus,

    All the best to you & your community. Yep, snow is preferable to ice. I’ll vouch for that 😉

    Take care, stay warm.

  32. Thank you, SJ. I grew-up to the East of Cleveland. Not as blessed with snow as you in Buffalo, but I could always count on having cash in my pocket thru shoveling sidewalks. 🙂

  33. Good morning…thanks for the topic of medical care in NM…I live it everyday and it is a more nuanced issue than the charts depict.  The entire population of New Mexico is a bit over 2. 086 million.  One in five New Mexicans lives in poverty.  Our distribution of wealth is starkly representative of the have and have-nots.  I know both sides as when I moved her I was a middle class have and have turned into a old poor woman (who is hugely rich, but has no $).

    My husband and I became poor as we lost our entire life savings to medical payments and I lost an IRA holding my 401K to some crooks.  So we made the best of the system and when we were eligible for the expansion of 2014, we finally landed on Centennial Care (Medicaid).   Many of you know my plight.   I live in the second largest city in NM — population 100,000+.   We have two hospitals.  Plenty of doctors, but most are rejecting Centennial Care.  Recently one of our surgical centers quit taking Medicare and Medicaid.  Thousands were turned away.  There are no dermatologists that will take Centennial Care.  I have to travel over 100 miles (even out-of-state) if I am to see one.  AND not all of the dermatologists are republicans.  I sat next to one dermatologist many years ago at a $500. plate fundraiser for Bill Richardson (who has made-up with the Clintons).  He won’t take Centennial Care.  The insurance companies support these same doctors through their other plans, but we don’t take ‘no medicaid, no Obamacare.   So the shortages?  Attitude.   There is enough to go around…insurance remains inefficient.  I have filled two grievances with my insurance company.  They do not keep the doctor lists updated and they could easy send a van of dermatologists from Albuquerque to help their ‘family’ here!

    Hello to Pogo…you know your rural medicine!

    For those who hate government and aren’t impressed with the social security direct deposit and payment system?  We will never convince them.

  34. Stay safe out there, Trailmixers.  I hope those in the storm’s path will keep their electrical power and endure Mother Nature as she is in the climate change.

  35. Blonde Wino,

    A few years back there was a thread on what we can do as individuals to cut back on energy use. This ties in with your comment on climate change & curves back to this thread on health care. Loop-dy-loop logic maybe, but our everyday actions play a part influencing our environment. The air we breathe, the water we drink = good/bad health.

  36. sjwny

    I am even getting stingy with my electronic cyberspace as it is part of the human gobbling of the planet.

    Alas, no fish camp….the beautiful and tasty creatures are over fished and vanishing.  Plastic will soon crowd most of our waterways.  Just not as tasty.

  37. patd…

    I don’t think there is such a thing as a perfect choice in anything in life….  there’s always tradeoffs.

    One can only go with the info you have and make a choice based on the most upsides pertaining to oneself.

     

    At least for Democrats there’s only a choice between 2 competent individuals.  O’Malley is too low in the polls for me to count.   The fight for the soul of the Republicans that now seems to be between Trump and Cruz is a weird thing to see….  but oh how they asked for it.

  38. Have a chuck roast and veggies in the crock pot, and hunkered down with our brand new gas furnace

  39. am just about done with cnn-again- they are doing it again.  one would never know that she is 25% ahead nationally- no mention however .  all of them but especially alison camarata, who is out of her league and should go back to playing in the dirty sandbox at fox, is only comparing the polls of iowa to 2008-  it is beyond demoralizing.  and no mention of sanders years in washington-somehow he is the newcomer-

  40. Glad you all have food for the snow event.

     

    BW – The policy my company brokered for us is “alternate funding” that UHC bought.  It was created due to the ACA but isn’t technically ACA.  The first thing my clinic asked was if it was Obamacare; they wanted to dump me.   This is the thing about Bernie’s plan I don’t get:  You can force a doctor to take your coverage.  So, unless that’s the only game in town (except for the uber-rich & Congress), how does that work?   I want it to work!  They are even having trouble in the UK with docs, at the moment.

     

    Stay well, stay warm & Happy Friday!

  41.  
    I see that Hillary and Bill Clinton believe in the 1950s saying of UCLA Bruins football coach “Red” Sanders “winning isn’t everything; it’s the only thing.”  Hillary and Bill sent out the attack dogs against both the Intelligence Community Inspector General, who exposed the fact that Hillary Clinton’s e-mail server included material exceeding ‘Top Secret’ and Bernie Sanders.
     
     
     
    On Wednesday, January 20, a Hillary Clinton’s spokesperson accused the Intelligence Community Inspector General of working with Republicans to attack Hilary without any evidence. Inspector General Charles McCullough III was nominated by Obama and confirmed in the Senate by unanimous consent.  General David Petraeus is looking at a possible demotion for his mishandling classified information.  That will affect his pension.  When will Hillary get what she deserves? An I don’t mean the Presidency.
     
     
     
    Then on Tuesday January 19, Hillary supporter Senator Claire McCaskill (D-MO) intimated that Sanders was a Communist to the New York Times.
     
     
     
    Admitted liar and a top Hillary Clinton ally David Brock, he admitted he lied about Anita Hill who accused Clarence Thomas of sexual harassment in his book ‘The Real Anita Hill: The Untold Story‘, said that black lives don’t matter much to Bernie Sanders.  ‘I Was Prepared to Bring Up’ Sanders’s Medical Record David Brock, founder of the pro-Hillary Clinton super-PAC Correct the Record, confirmed he was planning to go after Sanders over the release of his medical records as early as last weekend
     
     
     
    What are the Clintons are trying to do?  Make “Greed is Good” Gordon Gekko look like an alter boy.
     

  42.  
    <a href=”http://www.huffingtonpost.com/robert-l-borosage/hillary-and-bernie-the-cr_b_9038508.html”>Panic now grips the Clinton campaign. Polls show Bernie Sanders surging to a dramatic lead in New Hampshire and closing in Iowa. The Washington Post reports that Hillary’s national numbers are dropping faster now than they did in 2008. The Clinton campaign has started throwing everything and the kitchen sink at Sanders, with the gutter award captured, thus far, by Senator Claire McCaskill who smeared him with the “hammer and sickle,” transparently attributing the red-baiting to future Republican attacks of her own imagination.</a>
     
     
    But the question isn’t what’s wrong with Bernie — he’s soaring beyond all expectations. The question is what’s wrong with Hillary? She has universal name recognition, unparalleled experience, the support of the big money and the political gatekeepers, the Hollywood glitz, the best political operatives, the pollsters, the ad makers, the establishment policy mavens, and political press coverage. Having learned from 2008, she’s got the best ground operation in the history of Iowa caucuses that still may rescue her there. But she’s sinking rapidly against a 73-year-old political maverick who is still just introducing himself to the American people.

  43.  
    Craig,
     
     
     
    We con not use html in our comments anymore?  What is with the paragraph spacing?
     
     
    PIT

  44.  
    Craig,
     
     
     
    I heard that DC has already gotten 14 inches with more on the way.  I hope all is well and you have power.
     
     
     
    PIT
     

  45. PIT….  yeah… the Democratic race is tightening… IMO, that is a good thing.  A race between 2 competent candidates is healthy.  The GOP race is a joke.

    BTW…  how is your grandson?  What’s he up to nowadays?

  46. Pat, I took a few minutes to wander around the entrance to the legalinsurrection site. I was impressed. It appears to be a supervised project by faculty from Amherst College, an institution for which I have a special fondness as one of the founders of my school in Pennsylvania attended that institution before he went off to the Great War. In any case, if you haven’t already done it, go back and take a look at the comments below the main content.

    The music switch reminded me so much of Radio Moscow back in the 1950s–I think the ‘as-changed’ ad should be required viewing to show how easily we can be manipulated one way or another.

  47. PiT, Craig’s setup already adds a space when you do a carriage return. If your software adds a space on its own, then everything is doubled. You can do a work-around by pressing ‘shift’ ‘enter’.
    The result will be like this sentence, i.e., no extra line inserted.

  48. “should be required viewing to show how easily we can be manipulated one way or another”

    flatus, I agree.  1st lesson in madison avenue 101.

  49. Our newest crop of eligible Voters were born the same year as Malia Obama. Thinking back to 2008, her Father’s campaign did a brilliant job tapping the younger ( & especially ) first time Voters. The surge of Senator Sanders is following this path. I note this just as an observation of evolving politics. Old style politics from both Parties is taking a hit. For all the money spent, the feeling of “I matter” may be most important to the success of the eventual Dem/GOP nominees.

  50. re trevor “Daily Show” host Trevor Noah will be a keynote speaker at the House Democratic Caucus issues retreat next week, sources familiar with the event said. [….] Democratic lawmakers use the retreat to settle on messages and polices for the upcoming year. The theme of the 2016 retreat is “United for Opportunity.”

    “United for Opportunity”?  wonder how the p(arty) u(nity) m(y) a(ss) folks will respond to that?

  51. I find it fascinating that Russia has made a comeback, even if for all the wrong reasons. Going to date myself, but images of Alan Arkin, Jonathan Winters pop into my head. And Sputnik: …beep…beep………beep.

  52.  
    RR, Thanks for asking.

    Me168 is a senior and turns 18 before the November election but after the Florida’s Presidential primary election in March.  He hopes to vote for Bernie Sanders. He will be voting in Florida’s norma1 primary in August.  He completed the AP government course during the first semester.  He is auditioning at Florida Southern University’s music school next week and trying for a full boat scholarship.  He will also be taking pre- Veterinarian courses.  He completed AP micro economics this summer and is now taking AP Macro Economics.  I have to laugh at how different economics is now taught compared to the mid-1960s when I took those courses in collage.
     

  53. PIT…

    what do you mean he’s almost 18?!!…. why just last year he was posting here at the age of 11.  🙂

    Seriously…  sounds like a great kid…  I wish him the best.

  54. PiT
    Me168 certainly has confirmed the intellectual bent that he exhibited here. When I did my executive MBA, about half the class of 24 were professionals (MDs, lawyers, engineers, etc.) running their own businesses but finding that they didn’t have the business tools that they needed. If Me168 does plan to be a vet in private practice, he quite probably will find himself in the same position.

    Since he’s made it through macro and, especially, micro, if he can possibly manage the time and stress and you think it’s appropriate, I would urge enough added business courses to earn academic competence in Finance, if not a dual major in that specific area of study.

    Since there’s no booze allowed at Florida Southern, that should remove that external competition for his time 🙂

  55. Hmmm, msnbc saying Bloomberg considering billion dollar self financed run as an indy if Trump or Cruz are the candidate on the repug side and Bernie is the one on the Democratic side. Will commit in March.

  56. flatus, so how many different indy parties and candidates on ballots can you foresee out there?  perot’s old reform party is still alive (think I linked a few days ago that it wants jim webb among others) and the libertarians would probably like rant.

  57. purple, even tho’ cornell and cal-davis are ranked tops, have heard really good things about the auburn vet school and ufl is known to have a terrific animal hospital.   give him my best wishes. hope he’ll give a tho’t to native wild animal work. they need all the help we can give them.

  58. flatus, and what’s your opinion on this re lindsey graham who

    ….received a boost on Thursday when a wide-ranging authorization he wrote for the use of military force (AUMF) against ISIS was fast-tracked by Senate Majority Leader Mitch McConnell (R-KY).

    The war powers resolution can skip consideration by the Senate Foreign Relations Committee and move straight to the floor for a vote, though one hasn’t been scheduled yet.

    Graham’s resolution places no geographic limits on U.S. military operations against ISIS, contains no restrictions on the deployment of troops to battle the extremist group, and offers no timeline for ending the effort.

    Getting McConnell’s nod for his AUMF is a victory for Graham, a senior member of the Senate Armed Services Committee, who used his long-shot candidacy to draw attention to national security issues.

    If Graham’s AUMF does get a vote, it will put his former 2016 rivals on the spot about how far they are willing to go to defeat the terror group.

     

  59. Interesting, Pat, that Graham resolution’s greatest impact will be on the home front. It opens the door for military intelligence getting involved in domestic surveillance/operations under the guise of protecting us from ourselves/ISIS. The oversea portion is hollow if it is not accompanied by a funding mechanism.

  60.  
    Patd,
     
    He is looking at the University of Florida veterinary school.  He found out that you have a better chance of being accepted into the vet school if you don’t get your pre-vet from UF.

  61. Thirty some years ago I went to USF’s St Pete’s Campus before it became a free standing, separately accredited institution under the USF umbrella. It was a marvelous place. And, from what I can tell, it’s even better now. It has earned a deservedly tremendous reputation. When I went there, top professors from Tampa eagerly stepped forward to teach courses there. The students were more mature than the ones they normally taught in Tampa, and they came to class prepared to learn.

  62. “He found out that you have a better chance of being accepted into the vet school if you don’t get your pre-vet from UF.” PiT

    I bet the grad school admission policy is something like applicants must be in the top 30-pct of their graduating class or have a 3.25 GPA. Either of those could be perceived as being discriminatory by someone not making the cut. He should seek clarification. I would think that UF would be a nice diploma to have on the office wall.

  63. We are 1 and half hour from in person medical care.  We make use of email and telephone consultations but in the case of a real emergency — helicopter ambulance service would be required.  It is a negative of living in a sparsely populated rural area.  What I think is crappy is the reimbursements from medicare and medicaid are lower for rural areas…it is not cheaper to live here

  64. perhaps this is why we haven’t heard from fearless leader for awhile.  hope that crock pot meal finished cooking before any power went out.

    this morning wapo’s A blizzard for the ages shuts down Washington area 

    It brought Washington and its suburbs to a standstill, with all but a few major highways made impassable by more than two feet of snow. The winds that spared the region for the storm’s first 24 hours arrived at gale strength Saturday afternoon, pushing snow back onto the few cleared roads and sidewalks and threatening to take down power lines that serve 6 million people.

    Authorities warned that it would take days before all the roads became passable or power was restored if the number of outages mounted during the night. With Sunday forecast to be sunny, if cold, authorities feared that people housebound since Friday would be eager to get out.

  65. a shout out to tony

    hey, all we droolers, knuckle-draggers, groupies, firebrands, pitchforkers and donor elites in hermetically sealed society need each other.  we need to mix it up, share the wisdom and listen to one another.  so come back, tony, the fun has just begun.

     

  66. 7.1 magnitude earthquake hits Alaska
    The quake’s epicenter struck near Cook Inlet, about 162 miles southwest of Anchorage, and was about 50 miles deep.
    The USGS reported that there was a low likelihood of casualties and damage, and that “weak” shaking could be felt in cities nearby.

    The National Weather Service said there was no tsunami threat from the quake because of how deep it struck.
     

  67. patd…  I did private message Tony via Facebook.  He said he’d take a look around here to see what’s happening.  I hope he comes back too…    I miss him dearly.

    Yo Tony…    we wants you back!  🙂

  68. bernie and hillary on health care according to Bloomberg
    see vid:
    2016 Democratic presidential candidate Hillary Clinton addressed health care at a campaign event in Vinton, Iowa on Thursday. “It was called Hillarycare before it was called Obamacare,” she said. The former secretary of state said that rival Bernie Sanders? single-payer health plan is too disruptive and that she wants to improve the Affordable Care Act. “I don’t want to rip up this accomplishment and begin this contentious debate again.”

  69.  

     

     

    Sunday Serendipity.

    A beautiful aria and a wonderful voice. Handel at his best. Just right for a snow bound morning.

    Enjoy the music and enjoy the day.

  70. Hey Tony,

    Hope you are lurking at least.

    Don’t think badly of any of us. This a passionate place, most of us wear it on our sleeves.

    Our passion has never caused us to draw lines in the sand. There are no roadblocks on the ‘trail’.

    Come back and join us sooner rather than later. your passion is greatly missed.

     

    jace

  71. Jamie, thanks for the snl link.  actually, I think the real (maybe not the best adjective here) sarah did a better tina doing a sarah than tina did doing sarah last night….  surreal- iality  and hard to tell the difference

  72. Beck thinks Cruz is like Prez Washington?  He gave Cruz Washington’s compass to use? Jeez.  Just when you think the GOP can’t get any wackier.

     

    Bernie made an excellent point about Bloomberg stepping into the ring.  It’s a money game; your own or big, Wall Street money.  Bernie is the voice of the 99%.

     

    SNL was great.  Despite some political figures already being, somehow, caricatures of themselves, they still managed to make it funny.

    If SNL has to give equal time to all candidates, since Trump hosted and Hillary has done a pop-up, it would be interesting to see others.

     

    Bernie won’t have to since Larry David will be hosting.  I wouldn’t be surprised to see Bernie make a cameo while his doppelgänger hosts, though.  Expect the audience to go wild.

  73. craig, an old quote attributed to ben franklin for jim webb or any other indy out there:

    Democracy is two wolves and a lamb voting on what to have for lunch. Liberty is a well-armed lamb contesting the vote.

    of course, “well-armed” can mean and apply to being well-armed– not with guns– but with knowledge, experience, etc.

  74. That Darius Rucker video shows great scenery in and around Charleston SC…

    nice sentiment, but I’m really beginning to actually detest what they try to pass off as “country music” these days…….if you listen to the “country” station for any length of time you begin to notice that Every Single Song has the Exact Same Drumbeat…..they’re startin’ to gripe my ass with that…..

  75. Sturg, before I lost the remote control to my radio, it was set to the public broadcasting station. Once every two weeks, they have some olde style country.

  76. “Is anybody from the DC area accounted for?”

    flatus,  is d.c. ever accountable…. or its denizens therein?

  77. Good morning, mixers.

    KGC…the perfect point regarding rural healthcare…attracting doctors.    The payment tiers of federal and private insurance brings me to tears.   No one wants to work more hours for less pay.  The recession, however, has placed most Americans in that position.  The medical community is the last to adjust.  We need to get the insurance CEOs out of the doctor’s office, too.  I await the outcome of Colorado’s single payer vote.

    RR…The 50th Super Bowl is already special because of the groovy graphics in an anniversary year…this will be the clash of the old and young.  Manning has been unwilling to give-up the torch, so far and we are all hoping it is not a rout.

    Tony…stay away from the light.  Trust me, HRC will get the nomination.   The media is totally a mess and has given in to the ‘mythunderstanding’ of the repugs.   Everyone is dancing to the Faux News drumbeat for ratings.

    Trump…If you shoot someone in the street for no apparent reason, I believe you will be arrested.  No one is above the law.    Although I do believe this guy thinks he can get away with murder.  He still is a one-hit wonder and with no political record to attack?  He is untouchable.  Now do you get it media?  Flawless in the eyes of the flawed humans who need to be told what to do and how to do it, i.e. the repug base.  And he is using the cyber world to campaign…he one of the only repugs who is not for voter suppression.   I do believe a great block of his supporters think they can vote for the POTUS, online.   A danger to the establishment and he doesn’t mind killing people.   A perfect, lovable renegade to the repug base.

    Bananas…I am trying to find a good banana cookie recipe.   This household runs on bananas.  Bologna takes her pills with them, hubby and I have the golden fruit everyday.  But, we like our bananas a bit unripe…so we have a lot of  leftover bananas.  I freeze the old fruit for baking.  Never tried a cookie.  I think it wold be good with nuts or chocolate.  Anyone with banana cookie experience?

  78. Flatus

    David posted a picture on Facebook that Craig had took out their front window of somebody digging out ( I assume David) He said that Craig was making Vegetable soup, so things look fine in fearless leader land.

     

    Jack

  79. Yesterday afternoon I watched SC’s Women’s Gamecocks Basketball team overcome Mississippi State. That makes the Gamecocks 19-o for the season. The kids and I have season tickets for the home games. I am so proud of the players; I believe they are wonderful role models for girls in that they achieve no matter what. And they work together to prove that 2 + 3 = 7 (and 0 in the SEC,)

  80. Howdy fellow trail busters.  Was this the worst blizzard I have experienced?  No, not even close.  It was a nasty thing and has balled up D.C. pretty good.  I live on a little peninsula out in the Chesapeake Bay so we were in the high wind area.  About twenty inches on the flat, deeper where it could drift.  One canopy crashed and crumpled under the weight, no other damage.

    Took the weekend to really cook, first time in several years.  Beouf bourgongion and cherry cobbler.  Lots of wine and good beer to make the trudge of breaking trail out to the second wood pile a little more tolerable.  Hint: if you are expecting bad weather and the possibility of losing power, start your fire before it hits.  You will not need to do it in the cold and dark.  It will already be going and you will be happier.

    I wrote a little thing about snow, Craig apparently has not seen it.

    The worst blizzard was actually three three foot blizzards, one each Friday for three weeks.  That is nine feet of snow.  A good purchase at the liquor store made that one survivable.

  81. BW

    This is close to the one in my recipe box except I used chopped nuts instead of chocolate chips.  Remember them as good, but it’s been a long time.  Anyway, they require very ripe bananas so should suit your purposes.

    Banana Chocolate Chip Cookies

    Oh and bananas go well when included in a basic Oatmeal cookie.

  82. BlondeW…

    as a football fan…   it’s been a pleasure watching the likes of Brady, Manning, Brees, Roethlisberger, and Rodgers do their quarterback magic.  But I have to admit….  once again…  as a football fan…  I love the up and coming of Newton, Wilson, Bridgewater, and hopefully Kaepernick too, do their quarterback thing.

    The Panthers offense is awesome…  but so isn’t the Broncos defense.  Hopefully…  it’s a good game.

    ps… if it were me… I’d take Jamie’s suggestion of chopped nuts, but I would never consider skipping the chocolate chips. 🙂

  83. yes…we don’t want a repeat of te last time the bronco’s went to the superbowl…yikes

  84. I am disappointed in the position Clinton has taken on medicare for all.  Doesn’t make her sound like someone who will fight for you.   I am planning on voting for her in the California primary but I find this very disturbing.

  85. Katherine,
    I live in a state where the government led by Governor Haley wants nothing less than to drive a stake thru the heart of Obamacare. They are incredibly pleased that they have been able to stave-off the Medicaid supplemental aid program for our indigent.

    The mindset of these deeply conservative areas is so different from what you have in Callyfornia–what is obviously clear and rational to folks such as you, is anathema to them.

  86. The lead editorial in today’s Journal is about independent runs for the presidency and the practical implications of Mr Bloomberg’s.

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