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Indian gay sex ban prompts protests BBC News India's gay community and human rights activists say they "will continue to fight" for equality, after the country's top court upheld a law which criminalises gay sex. The Supreme Court ruling reverses a landmark 2009 Delhi High Court order which had ... and more »

White House Photographer Pete Souza snapped this photo of the former President showing off his paintings on his iPad to everyone on Air Force One yesterday, while on route to the Mandela memorial.

The unidentified man seen around the world on television next to leaders like U.S. President Barack Obama "was moving his hands around but there was no meaning in what he used his hands for."

As a doctor, I have been struck watching CNN by the many perspectives on the Affordable Care Act, better known as Obamacare. There are stories about customers’ sticker shock at plans with deductibles as high as $12,700 for families. There are stories on US president Barack Obama criticizing the insurance companies for having substandard plans. And there are stories about people blaming the president after losing their current insurance.

Yet in none of these were doctors even mentioned. It’s as if doctors do not know the intricacies of the health-care system. As if doctors are not there for their patients 24 hours a day. As if doctors are not dealing with denials from the insurance companies on a daily basis, losing valuable hours to menial paperwork.

Doctors have a duty to care for their patients and are the engines that put health care into motion. Unfortunately, doctors’ voices are largely excluded from the discussion of health-care reform. Their valuable insight into the day-to-day operations of this health-care machine is ignored. This strikes me as misguided. Would you want to build a plane with no input from a pilot? Or design a curriculum without a teacher’s input?  These insider insights are essential. Unless we look to doctors to help solve these dilemmas, we will be doomed to spiraling costs, dysfunctional insurance companies, and, of course, more talking heads on TV blaming others.

A doctor’s view on what’s wrong with Obamacare

The new system being implemented under Obamacare will ultimately lead to sicker patients and low-quality care for three reasons:

1. Older doctors will retire early, fed up with the system. These older doctors mourn the loss of the patient-physician relationship. The burdensome paperwork chokes their ability to provide good care.  Additionally, even as doctor expenses increase under the new regulations, projected cuts in reimbursement of up to 26% threatens doctors’ livelihoods. These cuts could force doctors to stop seeing Medicare patients because the expense of treating them is exceeding the reimbursement, which has already declined steadily over the past several years.

2. Smart young people will no longer enter the field of medicine due to rising debt (which averages more than $200,000 after medical school) and severe cuts in reimbursement.  If young college students realize that they cannot provide for a family despite going to school and training for a total of 14 years, they will turn to different professions.

3. Today’s younger doctors will become more demoralized by lawmakers dictating how they provide care.  They are increasingly being treated as machines, expected to answer patient calls at 2am, work 24-hour shifts, do more procedures for less, and fill out a growing mountain of paperwork. And they’re expected to do all this while the threat of getting sued for any mistake hangs over them. This will produce a high burnout rate and poor care.

Unfortunately, with all the unnecessary documentation and regulation, doctors are losing the bond with their patients that is so critical for high-quality care. For those doctors who choose to stay in the field, many of them will instead elect to practice direct-pay or “concierge” medicine, taking the insurance company out of the equation.  This will create a massive shortage of doctors and threaten the health of our citizens.

Here’s what the doctor orders

As a doctor, I do not want this to happen. I consider medicine a calling and went into this field to help others and take this role seriously. To help patients and address their health needs, I expect to have time to sit down and talk with my patients, to share stories with them—without watching the clock, and without administrators or computers documenting every move I make.

I—and other doctors—are also concerned with the equality issues that lawmakers raise. We too want every person in America to have access to quality health care at a reasonable price. But that elusive goal cannot materialize unless lawmakers look to those of us on the front lines of care for input. We know why costs are high, and we can help inform the public about how it all works. But we need a representative sample of practicing doctors advising Congress on these issues.

Here are my ideas for better and more affordable care:

Costs and reimbursement must be simple and transparent.

Lawmakers and the media need to stop attacking doctors for how much they earn and perpetuating misconceptions.

A recent New York Times headline announced: “As Hospital Prices Soar, a Stitch Costs $500.” But these inflated numbers have nothing to do with what the doctor actually gets paid. In fact, those bills do not go to the doctor at all, but rather to the hospital.  When a hospital or doctor submits a bill, the insurance companies or Medicare/Medicaid use a fee schedule to determine the payment. This is often called the “allowable charge” on patients’ bills.

To complicate matters, there are usually two different charges in a patient’s bill: a “professional” charge from the doctor, and a “facility or hospital” charge. The doctor does not collect any of the hospital charge, and receives only a small fraction of the professional charge because these allowable payments do not include overhead expenses for the practice, which can range from 30% to 60%.

It’s understandable that this is confusing to patients. Other professionals get paid what their bill says.  If a handyman comes to fix your sink and charges $80, you pay him $80. If your lawyer says he charges $250 an hour and he works four hours for you, you owe him $1,000. Unfortunately, medical billing is much more confusing.

Even our leaders, who should know better, seem to misunderstand this. In this video of Obama discussing foot amputations caused by diabetes, the president claims that surgeons get paid “30, 40, 50 thousand dollars” for a foot amputation.  Looking at the Medicare Fee schedule, however, the code states that the surgeon would get paid $738.90.  This $738.90 needs to cover his office space, staffing, medical liability, and years of training necessary to perform this life-saving operation. Our leaders are clearly confused.

Another example of confusing costs of medical treatment hits closer to home as my own mother presented to the ER with sudden blurry vision a few weeks ago. Concerned for serious causes for this symptom, several tests were run to rule out causes such as stroke or tumor. Thankfully, her diagnosis was nothing life threatening and she is recovering. She then received the following bill two weeks later in the mail explaining her charges. A copy of the bill appears below:

She was shocked at how high the charges were and could not decipher this bill. Referring to the explanations above, under “professional/physician charges”, it appears a physician gets paid $450 to interpret a CT head and $580 to interpret an MRI of the brain. This is far from the truth.  Looking at the fee schedule, code 70450, a CT head would pay a doctor $29 for a Medicare patient—far lower than the $450 shown on the bill. In fact, it is only 6% of what the bill states! Likewise, an MRI brain, code 70558, would pay a radiologist $109—a way off from the charge of $580. There are other inflated fees for the hospital as you can see in this bill totaling over $11,000, but these are not related to a doctor’s compensation. This clearly illustrates that doctors’ payment systems are confusing for patients and create much anxiety when trying to decipher a bill in the mail.

It is apparently even confusing to lawmakers and the president who are trying to modify reimbursement yet do not know how doctors get paid. Even though a stitch may cost $500, the doctor got paid $28 dollars to read a complex CT scan of the brain. We need real costs to health care, not inflated charges from hospitals. This needs to be addressed so patients and lawmakers can understand where doctors are coming from and realize that doctors are getting paid much less than meets the eye.

The fee schedule strangles doctors’ flexibility by ordaining flat-rate payments no matter what the circumstance. Doctors are not paid extra for talking on the phone to patients or other doctors, writing prescriptions, ordering lab work or radiology tests. If we drive to the hospital in the middle of the night to perform a procedure, the payment is the same as a scheduled operation during office hours. If one procedure takes longer than average or is more complex, a doctor does not collect any additional payment.

Do I speak with patients in the evening, or spend the extra 30 minutes to help patients get the quality care they deserve?  Of course. I willingly do this, because I went into medicine to help those in need. I do worry, however, that this may become impossible for some doctors if reimbursement models are not modified and doctors’ fees not corrected for inflation and overhead expenses.

The solution is to make costs and charges more transparent, so that patients can see the true (not inflated) costs and benefits of medical devices, services, and materials.  If patients know the real costs of their health care, they will be able to make educated choices.  It would also increase competition among providers, which would lower prices and offer patients more options.

The next necessary step is to enact tort reform.

Doctors’ first goal is to help patients. But we all are human, and mistakes will happen. Patients who are injured by mistakes must be compensated in accordance with the law, but the current system is broken. With no set standards, decisions on malpractice suits vary widely, jury to jury. This unreliability leads to defensive medicine, where doctors order tests and procedures just to prove that they did something, or they excessively document trivial facts to prove they looked at everything.  Gallup estimates that a quarter of all health care dollars are spent on defensive medicine—about $650 billion per year.

Here is a typical example of defensive medicine: If a family physician deduces that a patient’s headache is likely due to tension and there are no warning signs for a more serious condition, the doctor would probably not, under normal circumstances, order a CT scan, and instead would just have the patient follow up if symptoms persisted. But in rare cases, such a headache could be caused by a tumor or bleeding in the brain. In such a rare case, the patient could sue the doctor for not ordering the CT scan earlier. Knowing this, a doctor practicing defensive medicine would order scans with only the slightest justification—simply to avoid a frivolous lawsuit. This concern interferes with the doctor’s ability to use her knowledge and training to determine the nature of a patient’s ailment, or the best treatment for it.

The patient also loses under the current tort system. In fact, the only winners are the lawyers. Thirty-nine percent of cases take three years to settle and 60 cents on the dollar are used for lawyer fees and administrative costs.  Patients should be compensated when they experience poor health care, but this current system fails them, as well as doctors.

The answer to this rests in the health care courts described by Common Good chair Philip K. Howard. He suggests that expert judges—without juries—should determine what is good versus bad care. Health care courts would allow judges to dispose of weak and invalid claims quickly after filing, while also discouraging doctors and insurers from fighting cases in which they are clearly at fault. They would provide consistent standards for various health care situations.  They would let us doctors do our jobs without lawyers looking over our shoulder. And they would provide patients with fair, consistent rulings when they are wronged.

Use health savings accounts to increase patients’ roles in their own health.

Patients could use pre-tax dollars, contributions made by employers, and in some cases a government subsidy to fund the accounts. With actual money in the accounts, patients would be able to better plan their health care spending, and to use this money as if they were consuming any other good or service.  This money could grow each year, like an investment account and even be passed on to heirs after death.

As discussed above, for these accounts to work, hospitals’ and doctors’ prices must be more transparent and reflect true costs, so that patients know what they are buying.  Under the current system, a patient with a knee injury has no reason to question it when a doctor orders an expensive MRI. The patient’s insurance covers the MRI, making the costs a non-issue for that patient.  There is no incentive to try ice, physical therapy, and rest before agreeing to the MRI. If the actual price of the MRI were clear, patients would know what they are “buying.” Patients could shop for MRI scanners just as they would for any other service, giving them control over how they spend their health care dollars.

This informed decision-making is particularly important for terminally ill patients. During the last six months of our lives, we spend up to 50% of our own total lifetime health care dollars; a quarter of all spending on Medicare, or more than $125 billion, goes toward services for the 5% of beneficiaries in their last year of life. Our practice in America, when patients are extremely sick and brought to the hospital, is to use everything in our medical repertoire to keep them alive. Costs can run at up to $10,000 per day of intensive care, not including other aggressive measures. Patients may not know these costs, or their options for palliative or hospice care—which is both cheaper and sometimes preferable. With patient-funded health savings accounts, patients would have more of a role in their own care, and could decide, based on a doctor’s recommendation, the best course of action, considering the prognosis, benefits, risks, and costs. Of course, every human being is unique in his or her health needs, and must make decisions in consultation with families. But some patients are now expressing a preference to avoid spending their last months hooked up to breathing tubes, postponing the inevitable. Doctors themselves, according to a recent article on the Health Care Blog, often make the decision to eschew aggressive medical treatments in their own last days. All in all, health savings accounts—as well as frank discussions between patents and their doctors—could facilitate better decisions about end-of-life costs.

Lastly, prevent chronic illnesses that end up costing Americans dearly as they age.

We are very good at treating complex medical problems in patients who are very sick, but not so good at reducing medical costs through preventative medicine.  We are good at bringing a new blood-thinner drug to the market, but bad at preventing the conditions that require that drug in the first place.

Studies often point out that Americans spend a huge amount on health care, and yet are ranked lower than many other countries on health care outcomes. Here’s why: We spend a lot to prolong the lives of patients who are very sick—patients with multiple chronic medical conditions such as obesity, diabetes, kidney and heart disease—but we do little to prevent them from getting sick.   In fact, 50% of our health care dollars ($623 billion) are spent on the sickest 5% of patients (30 million) in America. Within this group, the top 1% of health care “spenders” accounted for 20% of the total health care expenditures in America.

Recently, CNN’s Sanjay Gupta offered a practical solution to this problem. Obamacare will not in itself make people healthier, he wrote. Instead, he advised people to take ownership of their own health, and to hold themselves accountable.  Eating better, exercising more, and reducing stress can go a long way to everyday health. It also helps avert those expensive chronic medical conditions.

Doctors experience first-hand all of the above issues on a daily basis and we have plenty to share with lawmakers, who are unfamiliar with the inner workings of doctor’s offices or hospitals. I believe that by empowering patients through health savings accounts, reforming our tort laws, making costs more transparent, being more realistic about end-of-life issues, and living healthier, we can make a real difference. I just hope that we can work with lawmakers to create a system that benefits everyone.

We welcome your comments at ideas@qz.com. 

Read this next: I went into $230,000 in debt to become a doctor in America

beastlyart:

shadow-of-a-whisper:

literal-ghost:

lightneverfades:

beahbeah:

confuzzeldmind:

WHOEVER BUYS THIS FOR ME WINS MY ETERNAL LOVE

I OWN THIS

EVERY MORNING HE SAYS SOMETHING DIFFERENT ABOUT HOW THE WORLD NEEDS YOU AND YOU HAVE TO GET UP

AND WHEN YOU PRESS THE BUTTON TO HUSH HIM HE SAYS “DEFTLY DONE, MADAM,” OR “IF IT’S NOT TOO FORWARD OF ME, THAT DID TICKLE, MADAM”

IT WAKES YOU UP WITH THE SOUND OF CHIRPING BIRDS BEFORE STEPHEN FRY’S VOICE

EVERYONE SHOULD HAVE ONE

THIS IS LIKE JARVIS. 

A REAL JARVIS EXCEPT HE’S A CLOCK.

VOICED BY STEPHEN FRY?!

This is going on my Christmas Wish List.

Liz we both need one so they can go off at the same time.

Call it Black Wednesday. Recreational marijuana goes on sale legally in Colorado on Jan. 1, and Denver officials are worried that the city’s retail shops won’t be anywhere close to meeting demand.

The ownCloud software for running your own private cloud server for storing files is up to version 6. With ownCloud 6 comes some very exciting features for this open-source private cloud software...

You have just one day left to get a bunch of family-friendly RPG PDFs, including Happy Birthday, Robot! Just go to the Bundle of Holding site and pay whatever you like. Beat the average threshold and you'll get even more RPGs!

Here's the complete list on offer:

• Hero Kids: An ideal introduction to fantasy roleplaying for children aged 4 to 10.
• Mermaid Adventures: Exciting undersea adventures and strange mysteries. (Ages 6-11.)
• The Princes' Kingdom: Young heirs to the throne of Islandia, visiting the citizens of their land and solving problems. This bundle is the first .PDF version of The Princes' Kingdom sold anywhere! (Ages 5+, plus an adult.)
• Happy Birthday, Robot!: The charming storytelling game by Daniel Solis for families or classrooms. (Ages 9+ -- and especially good for grownups.)
• Adventures in Oz - Fantasy Roleplaying Beyond the Yellow Brick Road: A loving journey into the lands of L. Frank Baum. (Ages 8+.)
• Project Ninja Panda Taco: Jennifer (Jennisodes) Steen's game of competing Masterminds and their biddable Minions. (Ages 8+.)
• School Daze: It's high school the way you wish it could be. (Ages 13+.)
• Camp Myth: The RPG: Third Eye's adaptation of the Chris Lewis Carter YA novel series about mythic creatures at summer camp. (Ages 8-13.)

 So what are you waiting for? Go to Bundle of Holding right now!

alphatel writes "The Swedish company Resarchgruppen has discovered a flaw in the Disqus commenting system, enabling them to identify Disqus users by their e-mail addresses. The crack was done in cooperation with the Bonnier Group tabloid Expressen, in order to reveal politicians commenting on Swedish hate speech-sites."

Read more of this story at Slashdot.

BBC News

Pope Francis 'scores goals' for image of Catholic Church BBC News Very recently, it was hard to find a good word about the Catholic Church in the world's press, amid sex abuse and other scandals. That has changed dramatically, with Pope Francis riding the crest of a wave that has culminated in him being named Time ... Pope Francis gets high ratings from Catholics, according to pollWashington Post Inside the crosstabs: Pope Francis vs. Pope John Paul IINBCNews.com Is Pope Francis Really 'The People's Pope?'NPR Christian Science Monitor -euronews -The Globe and Mail all 618 news articles »

A stuffed toy wolf from Ikea has become an anti-government protest symbol in Hong Kong where it’s sold out at Ikea stores, rankled local toy makers (paywall), and become a general global media sensation with fans from Taiwan (video in Chinese), where stocks are also running low, to Sweden. How does a toy wolf clutching a grandmother become such a potent political symbol?

The first reason is pretty straightforward. Hong Kong’s unpopular chief executive CY Leung, who had the toy thrown at him over the weekend, is nicknamed “the wolf” by political opponents who call him ruthless and dishonest. Some Hong Kong residents consider his government illegitimate because he won his seat last year in what was seen as an appointment from Beijing instead of a real election. Leung is also called “689,” a reference to the number of votes he won from electors on Hong Kong’s election committee who are seen as loyal to Beijing.

The most important reason for the toy’s popularity is a play on language that makes the toy the perfect way to curse out a hated politician. The toy’s Swedish name ”Lufsig” in Mandarin Chinese is lu mu xi (路姆西), which is a transliteration that doesn’t mean much except for when you pronounce the characters in Cantonese. (The two languages share the same characters.) Then the name sounds rather like lo mo sai, or “Your mother’s ___,” and “throw lo mo sai” sounds like a profane Oedipal command that is common to many languages.

Little Lufsig, thus, highlights one of the biggest grievances Hong Kongers have with Leung and his support from Beijing: the intrusion of mainland China into Hong Kong’s politics and culture, symbolized by the slow creep of Mandarin into the territory. Cantonese, a rich, slangy, fast-changing language, is the most prominent dialect of Chinese in mainland China after Mandarin—and for decades was the language most often heard in Chinatowns around the world.

Ever since Hong Kong, a former British colony, returned to Chinese control in 1997, Beijing has worked on promoting Mandarin via mandatory Mandarin classes in some schools, raising concerns that Beijing is attempting to gradually erase Cantonese. An influx of tourists, students, and business people from the mainland has added to the cultural shift. As of last year, Mandarin replaced English as the second most spoken language in Hong Kong.

That makes Ikea’s toy a triple whammy: A nod to Leung’s derogatory nickname, a profane insult, and a cry of protest against mainland China’s linguistic encroachment. If Ikea’s smart, they’ll restock Lufsig as fast as possible.

Gang Yang contributed additional reporting.

Fresh questions about Steve Jobs’ liver transplant have been raised after it emerged that the doctor who performed the surgery spent two years in the Memphis, Tenn., house Jobs bought for his recovery.

New leaked documents from Edward Snowden reveal that the NSA and British intelligence have been spying on people in World of Warcraft and other online games. And Neal Stephenson's epic spy novel REAMDE predicted this whole mess back in 2011.

Read more...

Red Sonja #1 is free TODAY ONLY on Comixology.com as part of their 12 Days of Christmas promotion.

You don’t need to buy anything, the app is free, the download is free, it’s all right here.

http://comixology.tumblr.com/12days

This download also includes variant covers and some ‘making of’ pages exclusive to the digital edition! 

Not four dollars, FREE, today (12/11/13) only! 

Seriously, a great chance to hear what all the fuss has been about for an investment of exactly zero pennies. :)  Try it!

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submitted by zombiearclight
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Menswear Dog’s 2013 Holiday Gift Guide

Check out some of MWD’s picks this holiday season. Links below

A. Beckett Simonon Bailey Chukka Boot

B. Pilot & Captain Tees

C. Manekibook Leather Goods

D. Mondaine Simply Elegant

E. One Star Leather Belt

F. Baxter of California Safety Razor Set

G. Best Made Co. Enamel Steel Bowls

H. Todd Snyder x Champion Sweatshirt

I. The Tie Bar

ekjohnston:

robotlyra:

opera-ghoost:

tubofgoodthings:

Calvin’s snowmen are breathtaking achievements and I will accept no disputes

I freaking love Calvin’s snowmen

They forgot the best one though!

We never got enough snow to do this after we moved into town. It made me sad.

I used to evangelize blogging the way people now promote the idea that everyone should "learn to code." I never said learning to blog would mean people would listen to you -- they're separate things. Blogging, imho, is good to do even if no one but you reads what you write. You formulate your thoughts in a different, more complete way, when you write as if someone else could understand them. But people didn't hear that. They thought if they blogged they would become influential. That people would read them. And when they realized this wasn't so, there was a backlash.

I think when people hear "Learn To Code" they think "Get rich like Zuck or Steve Jobs." When they learn to code their next question likely will be: "Where do I collect my millions of dollars?" Of course most people who code, if they make any money at all, make a modest living. When you reach a certain age, you're put out to pasture to fend for yourself. People seem to think "coding" is a young person's activity (even though it isn't), and if you're lucky enough to get a job doing it, you'll have to find something else to do when you're 35 or so, and that's not going to be so easy.

Learning to code is good if you have a calling, if you feel it's what you must do to express yourself. If you have ideas that you can implement in code that no one else is doing. Or if you just love the puzzles that programming is constantly presenting you with. You have to have a certain amount of self-hatred to love programming, btw, because it's a grind. And to do it well you have to have a lot of all of these things.

You might think that by learning to code you get to be the Man Behind the Curtain, the all-powerful person who makes the digital world work. But that's not what coding is about. If you want power, and I've said this many times -- rather than learn to code -- first learn to run a server. That's real power. And it's far easier than programming. You can learn to run a server in a few days or weeks. There's not much to it. Servers are just computers, like a laptop, that are always on and have a net connection that never goes away. They run software that's a little different from the stuff you run, but if you can install a word processor or a graphics program, you can learn how to run a web server. And you will be able to publish whatever you want. But then you kind of have to be a blogger to appreciate that, so we're back to the beginning.

Also, running a server is a good gateway to becoming a programmer. Sooner or later you'll want to customize your server and that's done (drumroll please) with programming! ;-)