House Healthcare Bill

October 29, 2009

Below is the complete text of the House Healthcare Bill – all 1990 pages. I haven’t read it but a quick search finds “tax” in it about 275 times. I wonder if anyone has read it.

House HCR bill

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How to Get off a Plane Stuck on the Tarmac

October 28, 2009

About 400,000 airline passengers a year get stuck on the tarmac for three hours or more. This counts only domestic flights. Congress has been debating a Passenger’s Bill of Rights since before Abraham was circumcised. The airlines have an infinity of reasons against its enactment. The gruesome details can be read here.

As should be clear by now Congress is not good at problem solving. Individual initiative is required. So here’s how to get off of a plane that’s stuck on the tarmac. Fairness requires that this technique only be used after three hours of waiting time and when basic humanitarian needs are not being met, ie the lavatories no longer work, there’s no food or water available, the baby next to you is puking and screaming – you know the complete list of horrors. While this will work 100% of the time be prudent with its use.

Tell the flight attendant that you have chest pain. If you want to gild the symptomatic lily tell her its sub-sternal (below the breast bone) and that it’s radiating down your left arm. You’ll be off the plane faster than you can say “deregulation”. The plane will most likely return to the gate allowing everyone to exit after you’ve been carried off on a stretcher. But there’s the possibility that an ambulance may be sent to the plane allowing only you to leave. Thus it’s best to recruit a few fellow passengers to also complain of crushing chest pain. This epidemic of putative acute coronary disease will ensure that the plane returns to the gate.

Once off the plane (be sure to take you carry on items with you) you can get up from the stretcher and declare that you want no further treatment. The the paramedics cannot force you to go to the hospital. Parenthetically, this method also gets you to the front of the line at any hospital emergency room, but here the consequences may be undesirable.

Travelers of the world complain. You have nothing to lose but your clots.

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Aida in HD

October 24, 2009
Photo: Marty Sohl/Metropolitan Opera

Photo: Marty Sohl/Metropolitan Opera

Verdi’s love triangle extravaganza was  broadcast today (Oct 24, 2009) live throughout the known world in HD. This performance was one of the series most successful. The singing and orchestral playing were responsible for the emotional energy that flowed from the 1109th performance by the Met of an opera which everyone knows, but which requires great voices and a great orchestra to succeed.

Violeta Urmana - Photo: Marty Sohl/Metropolitan Opera

Violeta Urmana - Photo: Marty Sohl/Metropolitan Opera

Lithuanian soprano Violeta Urmana made her Met debut in 2001 as Kundry in Parsifal. She then sang Eboli (a mezzo role) in Verdi’s Don Carlo. She is now a full time soprano. She’s currently alternating Isolde with Aida at different venues. She has an edgy voice that occasionally is shrill in its high register. Nevertheless, she managed to float some lovely high notes though there’s a break in her voice when she makes the transition from loud to soft. If Zinka Milanov was the ultimate Aida and Leontyne Price was the next level down, Urmana is one further stage below, but she still is very good.

Johan Botha - Photo: Marty Sohl/Metropolitan Opera

Johan Botha - Photo: Marty Sohl/Metropolitan Opera

Tenor Johan Botha was about as good as you can get as Radames. A heldentenor his voice is the same type and quality as was Ben Heppner’s before Otello knocked him out. Botha has survived that test having negotiated a run of Otello’s at the Met (as well as elsewhere) last season. He has a large and smoothly produced sound which he can modulate easily. His solution to the high B-flat at the end of “Celeste Aida” was to hit the note full voice and then to take a diminuendo which was effective without being spectacular. His singing thereafter was full voiced and nuanced. At 44 he’s got the heavy Verdi and Wagner roles to himself if he’s able to maintain his current level for a while.

Dolora Zajick - Photo: Marty Sohl/Metropolitan Opera

Dolora Zajick - Photo: Marty Sohl/Metropolitan Opera

Delora Zajick has been the queen of the Verdi mezzos for the past 20 years. She’s still unrivaled. She did everything during the Judgment Scene except detonate a hydrogen bomb. Beautiful sound, ringing high notes, and enough volume to jump start the hearing aid business, opera lovers will be talking about her for generations.

Carlo Guelfi’s baritone was tired and not bright. A journeyman performance at best. Roberto Scandiuzzi had a woolly sound that’s not particularly appealing. Amazingly, Adam Laurence Herskowitz was stressed by the Messenger’s brief appearance. Stefan Kocán did little with the thankless role of the King.

Daniele Gatti conducted well though I think the Met’s orchestra could do the opera just about as well as it did without a conductor. Gatti failed the tympani test in Act 2. Near the beginning of his solo Amonasro sings “Morte invan cercai (Death I vainly sought). This line is immediately punctuated by a thud on the drum that emphasizes the starkness of what he’s saying. This note should strike like a thunderbolt. Instead we got a hiccup. Any real Verdi conductor should understand what’s needed here.

Donald Palumbo’s chorus, as is the norm, was brilliant. Verdi’s management of large forces is beyond praise. When Aida get’s a chorus and orchestra of the very first rank an audience can understand why Benjamin Britten thought that Verdi in his later works had discovered the secret of perfection. It’s easy to take this war horse, chestnut, bromide, old saw, etc for granted given the usual pedestrian performance that’s usually encountered. But when you get great singers on a great stage the unique genius that conjured this work glows like a blue diamond.

The Met’s staging of Aida is more than 20years old, but it still looks great. The house’s super-sized stage is perfect for the opera’s epic scenes. The staging was suitably scaled for the piece’s intimate conclusion. Alexei Ratmansky was brought in to redo the choreography. The result was interesting and appealing but one doesn’t go to Aida for the dancing.

Not only were the opera’s great climaxes realized, but it’s poignant and gentle ending was just as well done. An outstanding performance. Just one final note. The three protagonists, especially Botha, were animated ads for the metabolic syndrome. I fear for their continued good health absent a dietary readjustment.

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Bing vs Google

October 19, 2009

On the basis of a completely non-scientific survey, it appears to me that Microsoft’s relatively new search engine Bing is doing a better job at finding stuff than Google. Just a short while ago Google would find posts to blogs or small web sites within hours of their appearance. Now it seems to take the Goliath of search a week to find posts from small sites.

Why this is happening, assuming my impression is right, is hard to know. It may be that Google’s parabola from birth to death will turn out to be very rapid. Remember that the company, big as it is, is still new. The great Austrian economist Joseph Schumpeter, famous for “creative destruction”, argued that capitalism and by extension each successful business inevitably nurtured the seed of its own destruction. Google having got so big so fast may decline just as rapidly.

Regardless, you might want to give Bing a try. It’s free. You can go here for a side by side comparison of the two search engines.

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Flatland Film Festival Opens

October 16, 2009

quiet marriageLubbock’s  5th Annual Flatland Film Festival opened last night (Oct 15) at the Louise Hopkins Underwood Center for the Arts. The first half of the program offered four shorts films . The second presented a full length ( 85 minutes) feature, A Quiet Little Marriage. Spoiler alert! The plots of these films are discussed in detail below.

Expectations at a relatively new and small film festival should be appropriately scaled. The four short films were made by local film makers though only the first two were shot in Lubbock. The first movie, The Last Red Leaf by Arif Kan, was the longest at 20 minutes. It was about a dying mother who recollects the death of her son about 20 years earlier in an automobile accident. I’m not sure what its point was other than bad things often happen out of the blue. The second film, (Llano Estacado Blues by Amy Kim) was equally depressing. It detailed the effect of a minor bureaucracy on two poor people trying to get food from a local food bank. The three main character repeated the same lines (each one had a different one) throughout the film’s 11 minutes. While much great art is depressing it also offers more than depression. If all I want is depression I can stay home and look in the mirror.

Things improved with the last pair of shorts. Matt Chauncey’s Frame was shot in Brooklyn. It depicts the visit for a dinner to the apartment of a cohabiting couple by the man’s mother. They have told her that they are just “roommates”. She is skeptical. She tends to believe the arrangement after sneaking a look at the apartments two bedrooms. One is neat and well kept – presumably the young woman’s. The is other a mess – what you’d expect from a young man with no woman to clean up after him. But when mom returns to the living room and spots a picture, in a glass frame, of the couple in an affectionate pose her suspicions rekindle.

Some time passes and the young woman notices that the incriminating photo is gone. She asks the man is he knows where it is. He doesn’t know. They wonder if mom has taken it. The man doubts that she has but says he call her and ask. He does while the woman goes into the neat bedroom and spots the picture in its unbroken frame under the cover of the bed as the man enters with the phone connected to mom. A good joke

The final offering was a cartoon. Tattoo. There’s only one character – a man living alone who passes a tattoo parlor on his way to work. The next time around he gets a tattoo of a swan on his abdomen. The swan moves and responds to the man’s environment. Soon after it lays three eggs from whence hatch three cygnets. The grow up and fly away. The man ages and eventually dies whereupon the swan flies away. Clever and moving.

The feature A Quiet Little Marriage is about a thirty something couple (Dax and Olive) who are very happy at least until Olive decides she wants a baby. Dax who comes from a mentally unstable family refuses even to talk about it. He also feels the world is in such bad shape that it’s crazy to bring a child into it. So Olive puts holes in her diaphragm. Dax accidentally finds out and spikes her coffee with birth control pills. Their happy little marriage is now shifted to a foundation of deception.

Sub plots include Olive’s demented father whom she love and visits regularly. But she can’t accept the reality of his deteriorating condition. Dax has a druggie brother whom he regularly enables by giving him money, food, and shelter.

Things crash when Olive discovers that her morning coffee’s been adulterated. Dax hits her with the leaky diaphragm. Just before the confrontation Olive had made a fruit Slurpee into which she had poured every pill in the house including the hidden birth control pills. She didn’t drink it, but when Dax returned from a jog he saw poisoned beverage and slurped it down. Thus the argument about “No copulation without population” is stopped when Dax collapses from the overdose. Since it’s hard to die from an overdose of birth control pills, Dax is treated at an emergency room and sent home.

The couple splits, but they’re miserable apart. Olive’s father dies suddenly from a stroke and she runs back to Dax for consolation. They decide to get back together and Dax suggests they have a baby after all. They both agree whereupon Dax’s drugged out brother shows up with a baby which he’s had by a druggie girl friend (maybe he married her).

The brother says he can’t take care of the baby and leaves it with Dax. He takes into the house and shows it to Violet. The movie more or less ends at that point. Dax’s original idea of remaining childless seems the best course at this story’s end though it’s too late.

Mary Elizabeth Ellis and Cy Carter are effective and attractive as the superficially sane couple. Jimmi Simpson is appropriately spaced out as Dax’s addict brother. Michael O’Neill is convincing as Olive’s father mid way through dementia. Director Mo Perkins has the annoying tic of depicting time’s passing by fast motion. Otherwise he kept things running reasonably well. But it’s hard to identify with the protagonists or take away much from their situation  It’s equally hard to imagine any future for this film apart from the film festival circuit or the occasional showing at an art house. It sounds funnier than it plays.

The Flatland Film Festival ends tomorrow Oct 17. LHUCA shows films and houses other cultural events throughout the year.

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Tosca in HD

October 10, 2009

MattilaThe Met’s new production of Puccini’s “shabby little shocker” (the only utterance Joseph Kerman will be remembered for) Tosca was broadcast throughout the world today in HD. It was booed at its premiere on the Met’s opening night of this season. Let’s get this out of the way first. There’s nothing in this pedestrian mounting that merits booing. It’s tame compared to the usual stuff inflicted on European audiences. Director Luc Bondy didn’t even change the time or locale of the piece. I would have moved it to the present and set it in Naypyidaw. All he did that’s even slightly out of the ordinary is add three whores to the beginning of Act 2 and eliminate Tosca’s shtick with the candles and the cross at the conclusion of the same act. There was nothing in the production that would interfere with success given the right performers, which the show more or less has. This austere staging was an understandable reaction to Franco Zeffirelli’ s flamboyant and grandiose mounting which has held sway at the Met for the last quarter century.

Karita Mattila was better in this encounter with Puccini than she was last year as Manon Lescaut. But she’s still not a fit with Verismo opera. her voice does not have the sound required for late Italian opera; it lacks both the velvet and the steel needed to bring Puccini’s diva to life. Her acting is also not right. Her gestures are awkward and sometimes out of place. For example, her hand motions encouraging her pursuers to come to her just before her fatal leap seemed more Al Pacino than Tosca. Also the closeup is not kind to her. She’s had some bad cosmetic surgery that have made her eyes look odd. No one in the house would notice, but when your face is 10 feet in diameter every flaw is magnified, especially when you’re pretending to be someone half you age. Despite all these problems she still managed a credible impersonation. “Vissi d’arte” was particularly well sung.

alvarez toscaCavaradossi, of course, is one of opera’s greatest tenor roles. It requires both lyric and spinto singing. I wasn’t expecting much from Marcelo Álvarez whose singing has sounded gruff and forced the previous times I’ve heard him. Earlier this season he was very unimpressive as Manrico in Il Trovatore. But something happened today. His tone was burnished and his high note had squilo and were free. Even “La vita mi costasse, vi salverò” probably the most awkward line Puccini ever wrote was delivered smoothly and with ease.  His reading of “E lucevcan le stelle” was impassioned and poetic. His was clearly the best performance of the day. Whether this was a freak or an augury will soon be revealed. Regardless, it’s been decades since I’ve heard the role this well sung.

gagnidzeGeorgian baritone George Gagnidze (sorry about all those Gs) was Puccini’s mustache (he didn’t have one, but he should have) twirling  villain Baron Scarpia. Neither he nor Bondy aimed at subtlety. But it’s true that Scarpia is a “son of a bitch” which was what costume designer Milena Canonero called him during the second intermission. Gagnidze has a dark baritone which he used to great effect as Puccini’s only real SOB. A first rate villain. I’d like to hear some more from him.

Paul Plishka has gone from comprimario parts to leads and back to small roles over the past 42 years and more than 1500 performances at the Met. He played the Sacristan as a mean dried up reactionary which is what he pretty much is.

Joseph Colaneri took the baton from James Levine after the opening night performance of this production. Maestro Levine is undergoing back surgery which will keep him off the podium for at least several months. Colaneri who was very impressive leading the Glimmerglass company’s Cenerentola this summer led a fast paced performance. He more than made up for Levine’s absence.

This was the Met’s 897th performance of Puccini’s masterpiece – forget about the “shabby little shocker” nonsense. There’s nothing any company can do that will diminish Tosca’s stature. Scarpia’s henchmen wore sunglasses in the first act, but so what. Ditto for Tosca’s leap (by a stunt double or a dummy) to a blackout at the opera’s conclusion. Give an audience great voices and a first rate conductor and Puccini will do all the rest. With the usual post-premiere tinkering this staging should last a while. It’s stark, dark, and spare decor won’t need much maintenance as there not much to maintain.

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PSA Screening

October 9, 2009

Below is an excerpt from an email sent out a few days ago by the American College of Physicians. It tells doctors that they should discuss the implications of PSA screening before offering the test to their patients. Why they are so far behind the curve is hard to understand. Here’s what I said on this subject two years ago: “Patients should talk to their doctor about the risks and benefits of undergoing prostate cancer screening before being tested. If their doctor doesn’t bring it up and just includes it (PSA testing) as part of his clinical evaluation call him on it. Ask your doctor what tests he’s going to order before they’re done. If he won’t spend the time talking to you about the issue, get another doctor.” Put “Prostate Cancer” into the search box on the right and you’ll get all the information needed to put you up to speed on screening for this disease.

That the ACP needs to alert physicians about something so basic and elementary and that the Archives of Internal Medicine has to publish two editorials telling doctors to do something that they should have figured out years ago on their own suggests that the best minds are no longer going into medicine.

The ACP email follows in italics.

PSA screens need more discussion

Physicians need to involve men more in the decision to undergo prostate-specific antigen (PSA) tests, concluded two studies and two editorials in Archives of Internal Medicine.

Clinicians strongly influence men’s decisions to undergo PSA screening, but the conversations about screening fail to qualify as shared decision making because patients received more information about the pros than the cons, had limited knowledge of their importance, and were not routinely asked for their preferences.

In one study, researchers conducted a telephone survey of 375 men who had either undergone or discussed with clinicians PSA testing in the previous two years. Researchers assessed the character of the discussion, the patient’s knowledge of prostate cancer and the importance of decision factors.

Almost 70% of patients discussed screening beforehand. Clinicians most often raised the idea of screening (64.6%), and 73.4% recommended PSA testing. Clinicians emphasized the pros of testing in 71.4% of discussions but addressed the cons in 32% of talks.

Researchers then asked the patients three questions to test their knowledge:

* “Of every 100 men, about how many do you think will die of prostate cancer?”
* “Of 100 men, about how many will be diagnosed as having prostate cancer at some time in their lives?”
* “For every 100 times a PSA test result suggests the need for further testing, about how many times does it turn out to be cancer?”

Although 58% of patients reported they felt well-informed about PSA testing, 47.8% failed to correctly answer any of the three questions, and only 7.2% of respondents could correctly answer more than one.

Only 54.8% of subjects reported being asked for their screening preferences. The clinicians’ recommendations were the only discussion characteristic associated with testing (odds ratio, 2.67; 95% CI, 1.08-6.58). “Indeed, few subjects sought second opinions,” researchers wrote.

An editorial concluded the research was an important step in prompting discussion about the tradeoffs between overdiagnosis and treatment complications versus the benefits of reduced risk of prostate cancer-related mortality.

A second editorial chided, “Today’s practice environment presents few incentives or support tools for those clinicians and patients who prefer a discussion rather than simply marking a checkbox for PSA on a laboratory requisition form.” It also noted some physicians may not ask to screen beforehand, but instead piggyback PSA tests onto other bloodwork.

A second study aimed to support individual decision making by creating a model of the likely benefits and harms.

Researchers in Australia created a model for men aged 40, 50, 60, and 70 years at low, moderate and high risk for prostate cancer. A Markov model compared patients with and without annual PSA screening using a 20% relative risk in prostate cancer mortality as a best-case scenario. The model estimated numbers of biopsies, prostate cancers and deaths from prostate cancer per 1,000 men over 10 years and cumulated to age 85 years.

Benefits and harms vary substantially with age and familial risk, the model found. As an example, among 1,000 60-year-old men with low risk screened annually, 115 would undergo biopsy triggered by an abnormal PSA screen. Among screened men, 53 would be diagnosed with prostate cancer over 10 years, compared with 23 men diagnosed as having prostate cancer among 1,000 unscreened men.

Among screened men, 3.5 would die of prostate cancer over 10 years compared with 4.4 deaths in unscreened men. For every 1,000 men screened from 40 to 69 years of age, there would be 27.9 prostate cancer deaths and 639.5 deaths overall by age 85 years compared with 29.9 prostate cancer deaths and 640.4 deaths overall in unscreened men. Higher-risk men have more prostate cancer deaths but also incurred more prostate cancers diagnosed and related harms.

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