Mailbag - Peter and Paul Edition

Gentle Readers:

One could misconstrue The Czar's posting of the magnificent Operative BG's transmission as him running his own version of PRISM on your other Gormogons, but the reality is that BG's communication, like many receive is an open letter to our collective brilliance. Usually one of us takes some initiative to answer letters in our sphere of influence, but sometimes things get hectic. Indeed, Dr. J. spent the weekend in the Florida Panhandle as Lil Resident and her dance troupe were laying the proverbial smackdown at Nationals, winning three titles (Age&Skill Category in Small Group, Large Group, and Line) and the Judges Choice award for best number (aka the Whole Enchilada Trophy™) for their line, so BG's missive festered like a boil in our collective inboxes until The Czar decided to give Dr. J. a little hint to get off his duff via public shaming, rather than by the less effective but more showy tauntaun head in his bed.

Point made loud and clear Mr. The Czar!

Now, Good Operative BG, to answer your question:

The obvious answer is that between our Hippocratic Oath and the EMTALA law, emergent care is to be provided regardless of ability to pay. Even if it weren't the law of the land, a doctor's desire to heal the infirm is such that we would, by and large, still provide that care.

The real question is how does this emergent and necessary care get paid for. The easiest answer is that the institution providing the care doesn't get paid and writes it off, paying for it out of their margin (aka profit in for-profit land).

When medicine and healthcare was a booming business, before the dark-times, before the Empire, the overage in private practice clinics and hospitals was such that it was seen as the cost of doing business. You always had that patient who paid in chickens or apple pie because that's what they could do, and because your other patients were bringing in enough money it afforded you the opportunity to help the needy.

Given that third parties are paying physicians and the amount for physician reimbursement has gone down both from Medicare/Medicaid and private insurance, and with the aging population, that payor mix has become less favorable, private practice physicans are going out of business and being bought up by hospital owned multispecialty groups.

These multispecialty groups have reduced costs by less per physician overhead and cost sharing across specialties. A rheumatologist can be full time, not needing to supplement their income with internal medicine visits because the cardiologists' revenues are helping prop them up.

As a consequence do dwindling reimbursement and the cost of doing business in the new environment, the immediate and necessary care will be delivered and come out of the shrinking margin.

Lets add Obamacare into the equation.

Obamacare is basically a shell game with federal reimbursement. The idea is that subsidized insurance will increased the pool of insured patients and thus there will be less 'no pay patients.' What this means is that you will make less money from medicare patients, and probably less money per insured patient, BUT you will be getting sufficiently more insurance patients compared to no pay patients that many hospitals should come out ahead. Unfortunately the folks who came up with this plan also front-loaded the bill with 4 years more money going into the treasury than coming out to get it under $1T that they can't be trusted with anything involving mathematics.

So, if you're an illegal alien, you're 'no pay' and we will take care of you at no charge. We might send you a bill, and if you send us $10 a month to pay it we'll take it (hey, that happens). If all of this amnesty stuff happens and you are ineligible for the dole, more of the same, unless you end up getting insurance because your income is now being tracked making you participate in Obamacare. If you get a job where your employer provides insurance as a consequence of becoming legal, good on ya. If the bill passes in a way that you are eligible for the dole, well, then it's medicaid for you.

Dr. J. hopes that that answers your question. Thanks for writing in!

As a follow up to Little Red 1's earlier email, apparently Princeton University has created a golden parachute for its senior faculty in response to the demographic crisis in the academy where there are so many healthy productive senior faculty members that it is choking off the pipeline of junior faculty members that have the opportunity to grow into tenured senior faculty. This may not appear to be a crisis to many, but the backlog will have a ripple effect such that when they depart, their successors will likely not be ready to have the baton passed. Think about the effect that Elizabeth II's reign has had on Prince Charles and you get the idea. Its a real problem and tough to reconcile given that 60, 65 and 70 are not what they once were. But this is added proof that we need to shift the age of medicare and social security for life expectancy.

A Thoroughfare of Freedom Beat

On the subject of “America the Beautiful,” and whether it would make a good national anthem, Borepatch himself writes in to remind you:

Agree 100%. Ray Charles used to do a beautiful rendition of this, and would often open the song with the second verse.

Unbiased Political Radio? Let Us See...

Special secret ghost operative, helpfully named Ghost, writes in from the Mandarin’s Proving Grounds Road Tour:

Dread Lord,

I was driving through Dallas the other day, and this ad kept replaying on XM radio about a new channel that is supposedly "colorblind" and brings together both parties in order to fix problems in government, under a tag called "No Labels"

http://www.siriusxm.com/potus

This could either actually work, I think, or is just a lousy PR stunt by people no one actually cares about. More likely the second, as seen through the eyes of a jaded Millennial.

Your humble minion--
-- Ghost

Gotta agree with your analysis, Ghost. This is a bad PR move to trick listeners, which of course is doomed to fail if and when people actually, you know, listen.

First, as you know, the whole “No Labels” gimmick is a ruse by liberals who want to appear reasonable by pretending not to be Progressives. You can listen to this interesting and pragmatic blend of liberals, conservatives, and indepedents for about five minutes before you realize only one of the three is actually welcome there.

Second, you can mix up the conservatives and liberals as much as you want on a station; that does not make it balanced. It takes little effort to realize what the slant is—who does their morning drive and who does their afternoon drive? Those are the peak hours for audiences, and therefore you can determine everything about a station based on who it puts in those slots. The morning drive is hosted by uber-liberal MSNBC personality Michael Smerconish, and the afternoon slot is held by Julie Mason, who is a major Obama supporter in the White House Press Pool (and is considerably anti-conservative).

Third, you also know that conservative radio stations enjoy killer ratings, and liberal stations tend to fizzle and melt after a short while. POTUS is clearly an attempt to claim political neutrality in an effort to sustain a slightly longer lifespan than Air America and its clones. But reality will set in once the audience realizes it is smarter than the station.

The saddest part is that POTUS probably has no clue what a partisan bubble it is. It may honestly think it is balanced and neutral; however, it is clear that any pretense of neutrality will soon evaporate after a few minutes, if it has not done so already.

What are your thoughts? By the way, nice job Millennials: you are waking up to political reality at a much earlier age than the Gen Xers did. Already half of you are done with the Democratic Party, per latest polls.

Problem With Comprehensive Immigration Reform?

Long, long-time Operative BG sends this in by home-made satellite transceiver:

I keep hearing radio this commercial extolling how tough comprehensive immigration reform will be, telling me I should support it because Marco Rubio and Paul Ryan support it. Big selling point – illegals who get amnesty are “legalized” won’t be eligible for Obamacare and won’t be eligible for welfare benefits.

Well, that all sounds fine and dandy, but what happens when the guy mowing your neighbor’s lawn gets just a little too close to the guy with the weed whacker and saws off a foot just below the ankle? Are they going to patch it up right there?

Don’t be ridiculous. They’re heading to the emergency room.

But they don’t have Obamacare.

And Medicaid isn’t insurance; it’s welfare for the medically indigent. And Rubio and Ryan assure us there will be no welfare for illegals who get amnesty are “legalized.”

So either Rubio and Ryan are lying to me, or Mister One-Foot is going to bleed to death right there in the emergency room.

One is inclined to let Doc answer this one, but almost certainly it will be handled as such cases are handled today: the hospital will treat the man since they turn no one away, knowing full well he has no ability to pay.

And the taxpayers will fund this as in some certain measure they do now; it will have little to do with either Paul Ryan or Marco Rubio.

Boughs of Holly

A trio from Island Dweller, who now posts here more frequently than our own Confucius,* now concludes:

Your immenseness:

It would seem we have our lower-level supervisor who, according to the media, was directly responsible for providing guidance to anti-tea party IRS employees who were harassing those individuals and trying to make life miserable for them. I have enclosed a couple of photographs (Ein und Zwei) of this individual for your review.

This young lady seems just out of college, although that's not the case. I can remember my own days in the service of the Crown when supervision generally had grey hair, white hair, or no hair. They did, however, have a fair amount of field experience and were sometimes capable of making sound judgments. It's looking like the IRS is afflicted with the same problem my old agency had, and still has - older personnel are too smart to apply for supervisory positions, knowing the political bullying and toadying that nowadays goes along with such a position.

In my own case, I turned down consideration for supervision twice. The source material states this young lady is an Obama donor who sat in, face-to-face, on IRS IG employee interviews - thus guaranteeing whoever spoke the truth would receive instantaneous punishment upon completion of the interview. This procedure is unheard-of, and is certainly unethical (there's that "ethics" topic again!) if not downright illegal. She is reportedly an attorney, no less! No doubt this was done at the behest of her supervisor, not in the interests of fairness and the obtaining of the truth. Looks like they have their own IG buffaloed. If we're going to bring the IRS to heel, now is the time to do it.

Island Dweller

*For those who came in late, Confucius is the Gormogons’ Œcumenical Volgi.

A Different Kind of "Bail Out"

And another from Island Dweller worth your time:

Your most imperial highness,

"Politico," June 13 2013, reports members of both houses of Congress and their staffers are beginning to leave Capitol Hill en masse as their govt-subsidized health plans will be closed in 2014 and they will be directed into health care exchanges, which will make their benefits exhorbitantly expensive. Senator Charles Grassley of Iowa in his wisdom sponsored and inserted an amendment to Obamacare stating the government can only offer members of Congress and their staff plans that are “created” in the bill or “offered through an exchange” — unless the bill is amended. This forces them to take a big bite of that giant s--t sandwich they're created for the rest of us, or publicly exempt themselves from Obamacare - which will infuriate their constituents.

The article reports many in leadership positions in Congress are talking earnestly behind the scenes about this problem. They believe this situation will create a "brain drain" (I seriously doubt that, there's plenty of "book larnin'" among them, but very little common sense) among the staffers and some members. According to the story the problem is especially acute in the House, where the wealth of the members and their staffs is not what it is in the Senate (a fine commentary on things, by the way), hence the cost of coverage will be much more of a burden to them.

You can bet conservative media and J. Q. Public will be watching these proceedings with intense interest. If the Senate and Congress vote themselves an exemption to Obamacare there will be a revolt at the polls next time around. What's more, no one will want to run for these posts in future, or serve as a staffer, since their health care will have become so enormously expensive. Assuming some form of common sense begins to prevail here, it's possible we may finally be seeing the beginning of the end of unadalterated "Obamacare," and the beginnings of a hybrid system take shape.

This whole thing reminds one of the cartoon showing the revolver with the barrel bent around to deliver the bullet to the shooter. I can't think of a better analogy.
Your most devoted serf,
Island Dweller

Well, in most respects, Congress has its own health plan that practically bypasses Obamacare, so one is not confident that there will be such an impetus; further, you are right: the potential political windfall this could create would be too much to bear, and more than likely prudence will win out over showboating of this kind. In other words, Congresspeople will talk a lot about bugging out but basically they know they can win re-election either way. They’ll be here to stay, one fears.

Barack Hussein Houdini

Island Dweller could pretty well give the Czar a week off with his submissions! Here is one of three:

Your illustrious majesty:

A recent string-telephone conversation with Esteemed Associate, still in the bowels of the Federal beast, prompted me to set pen to blood, then parchment, for your consideration. A cable television movie network recently replayed one of your humble subject's more fondly-remembered films, "Houdini," starring Tony Curtis and Janet Leigh. As anyone who has studied the magician's trade knows, a key element in his or her success is the ability to distract the audience from the most critical part of the act and thereby confuse them on how the illusion was pulled off.

After the film concluded, your subject took time in this aquatic hinterland to devote some thought to what he had just seen. He was struck by the similarity between what Harry Houdini, an absolute master of his craft, had done in furtherance of his goals, and what our illustrious Immaculate One is doing in furtherance of his own goals. Where he differs from Houdini is in his ability, planned or otherwise, to create not just a few distractions, but more and different "acts" every day, in order to draw everyone's attention away from key issues that deserve dissection to their uttermost level. It's almost as if The Enlightened One is either on purpose or accidentally bombarding the American people, mouth-breathers and thinking citizens alike, with more and more scandals and outrages in an attempt to swamp them with sheer numbers of issues until they are numbed by the sheer size and reach of it all. He would hope this in turn dulls their sense of outrage and further gives them a sense of hopelessness and submission. There will never be a "smoking gun" found specifically tying The Enlightened One to any of this activity. This is because everyone behind each scandal thinks like him anyway, so would engage in this activity without being specifically told to do so by him. I would hope he didn't plan for everything to unravel or be exposed in such a serio-comic fashion as it has - but he's a keen-enough Chicago politician to take advantage of every Red Herring provided to further his agenda on a few specific items and distance himself from the rest, and so distract his enemies and keep his personal approval numbers pretty high. We need to stay on target, choose the issue that is potentially the most damaging to the fabric of our Constitution and society, and bear down on it, disregarding the others until we can handle them in their turn.

BTW your humber serf subject, while impressed by 'Puter's fondness for Cole Porter and his "drip, drip, drip of the raindrops," can also enjoy Dion musically moaning about his own "Drip Drop" problems. His bride can still move across the dance floor pretty well to that one.

Island Dweller

Grilling Peas

The Czar has been remiss, and has much mail to go through. Through which to go? Yeah, probably the latter.

Anyhow, erc wrote in a while back:

Your Czarness:

Your post of June 8th reminded me of the old joke:

   "Why don't Mexicans do much barbequing?

   Because the beans keep falling through the grill."

And a variant:

   "Why don't Italians do much grilling?

   Because they forget to put the spaghetti at right angles to bars of the grill."

Both of course are factually untrue, since Mexicans grill a lot of great stuff, although it is not common in restaurants in the US. Particularly good beef in the Northern Mexican provinces and grilled seafood in Baja, for example.

And, Italian grilling goes back even before your time, to the Romans and probably the Etruscans.

Jokes based on ethnic stereotypes (speaking of Stephen Foster) have pretty much faded away and many of them were not funny when they were current. I suspect you have seen these things come and go in cycles over the centuries.

You are extraordinary, not ordinary, and based on the evidence, not nice either. But, who needs nice in a Prince. (c.f. Sr. Machiavelli' works).

Please do not grill me for this possible act of lese majesty.

(I've got to try grilling peas, now.) / erc

Thanks, erc. A couple of pointers:

Mexicans are utter champions of grilling. Flank steak, once among the worst meats to try and grill, is a particular specialty of Mexican grillers who long ago solved the problem of making this tough and chewy meat both edible and deliciously moist in minutes on the grill. Use a cross-cut (make criss-cross slashes with a sharp knife) on the meat and soak in a marinade for a few hours. The meat literally will grill to perfection in a few minutes, but let it set: meaning, of course, you let it sit on a surface for about five minutes so that evaporated juices re-condense inside the tissues. This is very important on tough meats (less so on thicker, softer cuts).

As you say, the North of Mexico enjoys a plethora of superb meats, and the South has a superb assortment of seafoods (especially red snapper).

Likewise, Italians are superb at grilled seafood, and in the North, do very well with meats of all kinds. The Czar particularly likes to grill octopus in an Italian style, but has done well with bracciole, which again is often a cheap flank steak transformed into a thing of beauty.

As you suspect, the Romans and Etruscans long predate the Czar by a long time! But grilling meats goes back even further—in fact, some folks wager that grilling is one of mankind’s oldest social constructs. It is the oldest form of cooking, presumably, and was among the first communal acts that turned basic survival—eating—into a social bonding ritual.

Grilling peas? Here is how we do it: take a piece of aluminum foil and curl up the edges all around to prevent the little bastards from rolling off. Dash a little olive oil onto the foil.

Throw on a handful of frozen or thawed peas and roll ‘em around on the oil. Then, using your fingers, sprinkle powdered garlic and sea salt on them. Grill for about five minutes indirectly—that means, newcomers, you don’t put the peas directly over the flames. Put them off to the side or on a higher rack until they start to crisp up. Nothing to it.

More and More Czar, the Final Day

The Czar once cut off the entire left side of a guy’s body, but he’s all right now.

There are some things the Czar is good at that most folks might not have expected. These include:

—Dishwashing. The Czar enjoys washing the dishes. He uses really hot water (most people find it intolerably scalding), and does the glassware first, dishes next, pots and pans third, and finally the silverware. Soap, soaking, and careful rinsing result in extremely clean dishes. And he is quite good at getting long-stained cookware perfectly like-new clean again. Hint: bleach is your friend.

—Ambidexterity. The Czar is able to write with both hands, and is adept at doing things with either hand. This has been very useful over the years. However, it turns out, the Czar can do little with his feet.

—Place Setting. You should see the Czar set a table. You could easily photograph it when done for a book on etiquette. The Czar knows where to put the forks, in what order, and where the bread plates go, and all that. Plus, he is able to fold napkins into interesting and sometimes whimsical shapes for each setting. And, just as importantly, how to set the table differently for different events or traditions.

—“America the Beautiful.” The Czar knows the second and third verses by heart. Do you? No, that’s okay—this song does not get as much airplay as it should. It would make a very nice national anthem.

—Animal Tracking. Know that mountain lion footprint in your driveway? The Czar will prove to you it’s the neighbor’s dog. The Czar can identify animal tracks of all different animals and birds, including fairly exotic ones like cheetahs and zebras. He can tell you how many people walked in an area, their approximate heights, gender, whether they were carrying things, and all that stuff. It’s a lot of fun, and easy to teach.

All right, you have spent enough time getting to know the Czar. Back to bashing liberals starting tomorrow.

Father's Day with your Gormogons

Happy Fathers Day to all of our readers who are fathers or who have fathers! Let's take a look around Castle Gormogon to see what the Fathers Day Fairy brought your Gormogon Overlords, Fathers to All, muah ha ha ha ha.

The outRAGEous Czar received a Red Lantern Corps T-Shirt and Power Ring. He has the axe construct down and has been chasing Dat Ho around the courtyard taking random swings.

Confucius, the Œcumenical Volgi, (the Notorious ŒV) received a Cthulhu coffee mug with a Ann Repp Book Binding gift card inside (presumably to respine an old tome, or to bind his latest work on ancient Turkish magick).

Puter, our resplendent chef received a Hello Kitty slow cooker. Given how busy he gets at work, we're sure the fairy figured that sometimes he could use the timesaving device.

The Inscrutable Mandarin, ever the fashion maven, received, you guessed it, the official gift of Fathers's Day, a tie. But this tie has rifles on it.

What do you get for the titanium robot who has everything? Well, GorT doesn't have everything. He's had his eye on this 3D printer. Unfortunately it only speaks the binary language of moisture evaporators (BLoME).  GorT may have to go the Manhole on droid-night, as there's one droid Dr. J. knows whose first job was programing binary load lifters, a programing language a lot like BLoME, and he frequents that watering hole. 

Last but not least, Dr. J. Dr. J. suspects that the Lil Resident and Medstudent had something to do with the fairy's gift selections:

The Lil Medstudent is sick of Dr. J.'s current reading selection....

...he think's its time that Dr. J. deal with the burgeoning adolescent.

The Lil Resident, of course, would pick something out that she'd use more than Dr. J.

Happy Fathers Day!

Getting to Know the Czar Better, Day 9

The Czar’s first job was, well, Czar.

The Czar has been around almost 750 years and in that time has learned many languages, worked on many skills, seen considerable amounts of history, and read many books. But there are some things the Czar just cannot do and probably never will learn.

First, as many of us know, the Czar cannot throw a football. He can throw many things, often with lethal accuracy, across distances. But he can throw a football about as well as you can throw a frozen chicken. It certainly does not spiral: it just sort of falls sideways through the air.

Also, the Czar is terrible at woodworking. He can design wonderful furniture, identify types of cuts and knows which screws to use for maximum strength. He can measure with accuracy to 1/32nd of an inch quite quickly, and can eyeball level. But he cannot cut wood straight, cannot trim or carve without smashing the wood to pieces, and basically when done with a woodworking project, it looks like a birdhouse if the birdhouse was built by the birds hoping to live in it.

Most surprisingly, the Czar is terrible at billiards. What makes this surprising is that he is so bad at it, that he is certain death to anyone playing on his side. The Czar cannot count how many times he has had skillful pool players reassure him that they will cover his bad play, only to have them say a few minutes later &147;You are easily the worst pool player ever.” The Czar does not merely miss shots or scratch here and there: within minutes, the pool table is on fire and all the cues are bent at weird angles. He is that bad. If you fancy yourself an awesome pool player, and agree to have the Czar be on your team for a little two-on-two, we guarantee you will never lose so badly in your life.