What happens when folks have no skin in the game

This was posted by DocRocket, an Emergency Room physician in Texas.  DocRocket is a frequent contributor at 24hourcampfire.  This post must have touched a nerve.  It quickly generated nine pages of comments in less than ten hours.  This is reposted with his permission:

Well, yesterday I had a surfeit of empty-headed young females seeking medical attention, and at the end of the day I was literally questioning how our species can be expected to survive.

First idiot was a 22-year-old gal with a blister on her hand from being "forced" to mop the floor at work. Wanted to make a Workers Compensation claim, the whole nine yards. Now, we're not talking about much of a blister at all... less than 2cm across, not infected, but it hurt so bad she couldn't use her hand for Anything. I observed that she had clearly spent a lot of time and effort on her makeup that morning, and asked if she had done it all with her left hand? At which she goggled at me, offended as if I'd told her she was stupid. Which I guess I had done, when I think about it...

Second idiot was a 21-year-old gal who got stung by a scorpion on her foot. She was wailing and crying and carrying on, afraid she was going to die. I couldn't even see a sting site on her foot... just a little redness. I told her she would live, against terrible odds, and thanked her for causing a $400 ER charge against the Texas Medicaid account.

Third idiot was a 23-year-old mother of an infant child who was "sick". Mother was almost panicked by this. Child had coughed several hours earlier, but had been fine since. That was it. That was why she was in the ER. One cough from an 18-month-old child.

I have long held the opinion that if idiot young females were removed from the population, America would be a much healthier place, and our medical care system would be in a damned sight better financial position. I wish the above 3 cases were exceptional, but they aren't. These idiot young females flood our ER's and clinics with their hair and makeup flawlessly in place, their outfits perfectly matching, and their presenting complaints so trivial as to be ridiculous. "I just want to get it checked out," they explain, betraying the fact that they KNOW their complaint is ridiculous and the cost they are incurring to the system is unjustifiable.

Consider this: the number one ER complaint in America is abdominal pain. Guess which sex accounts for better than 75% of ER visits for abdominal pain? Yep, females, most under 35. Guess what the most common cause of abdominal pain in ER's is? Constipation. Our health care system is spending billions of dollars annually to address the fact that most women ( and most people in general ERJ comment) have lousy dietary and bowel habits (and do not engage in regular exercise, moving make you move. ERJ comment), and don't have a clue about how to deal with their own schitt.

I could go on. But we have an erroneous assumption in health care in America that the customer is always right. And the customer rarely IS right, when it comes to emergency care. And it's bankrupting our health care system.

God only knows what will happen to these idiot young females when the free medical care gravy train grinds to a halt. I expect most of them will die of infected broken fingernails, curling iron burns, and the like.

And all I can think at the end of the day is, "Thank God I'm not young enough to consider these pneumoceph's attractive, let alone to be married to one." Seriously.

One comment that stood out was this one written by 260Remguy:

Many years ago, I was involved in healthcare management. Both of the major medical centers that I worked for had more than their share of medicaid patients. Since the care was "free", it held no value for many of these people and they missed appointments nearly 40% of the time at our urban clinics. As such, we typically over-booked the primary care clinics by 15%, so that a physician was scheduled to see 29 patients during a seven hour clinic, assuming that he would actually see 25.

Interestingly, rural medicaid patients were much more likely to make their appointments or, if they couldn't, they would usually call, apologize for disrupting our schedule, and reschedule.

Entitlement is a dangerous slippery slope. While a little is good, the line between a little and too much isn't well defined and entitlement is highly addictive.

I read this with some chagrin.  Belladonna is acting a little bit spacy just before she goes off to college.  Mrs ERJ assures me that it is a common phenomena.  Folks regress when stressed.  Bella is retreating to her "comfort zone" and Mrs ERJ assures me that she will bounce out of it just fine.

Time will tell.

Silicon Valley Democrats

Tyler Cowen at Marginal Revolution posted a link to an analysis of Silicon Valley Democrats.  California is the dominant electoral block in the United States, Democrats are the dominant party in California, and Silicon Valley is the dominant source of funding of the Democratic Party in California.   Consequently, Silicon Valley throws a very long shadow.

Hubris

Professor Ronald Rosenburg (MSU circa 1980) paced the front of the classroom. 

I am going to teach you how to model systems that integrate mechanical, hydraulic and electrical systems.  Some of you will try to model the US economy and other complex systems with these techniques.  You will fail.  You will fail because these techniques rely on predictable, linear responses from its components.  Nearly all components that you select off-the-shelf are linear devices, at least they are if you selected components that are of the proper size.

There is nothing stable or linear-in-the-long-run in the real world.  Some of you will still try to model the economy, either because you are not listening to me now or because you think your are smarter than me.  Good luck with that.

The Butterfly Effect

In 1960, Edward Lorenz wanted to show a visitor a interesting weather phenomena that his computer had generated.  To reproduce it, he reentered the state-space of the atmosphere that caused the phenomena.

He was not able to reproduce the phenomena.

Later investigation revealed that very, very minute changes in initial conditions caused vastly different, diverging results over time.  It was as surprising as if I changed my aim by 25mm at 100 meters (1 MOA)....and I hit a spectator in the parking lot behind me.

Attempting to capture the degree of divergence, Lorenz coined the term Butterfly Effect.  A butterfly taking off from a dandelion in China can trigger a typhoon in Baja California a month later.  Obviously, the timing of every insect launching from every surface on the earth is not an input that can be modeled.

Central Planning

Ultimately, the Butterfly Effect topples the long term effectiveness of Central Planning.  Even if the guys who are funding the effort are really, really smart people.

Even very simple systems can generate complicated trajectories.  This is a double pendulum.  Now imagine the complexity that will result if one of the weights varies over time...the way people do or like nylon (a hygroscopic material that absorbs moisture from the atmosphere proportional to the humidity).  Image from HERE

These people want to run my life and they cannot draw a picture of this trivial system at T=10 minutes.

Good luck with that.

French Scientists

A nation that cannot compete in the global technology market must compete in the fashion arena.

French scientists were at the forefront of scientific discovery throughout the 19th Century and into very early 20th Century.  They were leaders in Mathematics, Biology, Chemistry and atomic Physics.  And then something happened.

Histogram of  year of death of "30 Greatest French Scientists". The bin for 1951-1975 has two Curie siblings (who were, arguable, included  in the list based on name recognition).  Removing them would have the (almost) seventy years from 1919-1987 with half the number of "great" scientists as the decade from 1900-1910.

The most common explanation(s) are the two world wars.

The first world war was a meat grinder.  French and British generals spent lives very freely.  The problem with this explanation is that the soldiers in the trenches were not forty, fifty and sixty year old scientists....the ones who could be expected to die in the next 6-to-31 years. 

A competing narrative is that the giants of 1900-1910 studied radiation and three of them (Curie, Becquerel, and Moissan) died in their early-50s due, in part, to naivete with regard to safety requirements.  That is, they were killed by their research. Had they lived to a more typical 75 or 80 they would have fallen into the next "bin" and perhaps we would not make sport of French science.

The second world war resulted in a massive flight of scientific talent to "safe havens" like the United States and Canada.  This is a more compelling narrative than the WWI meat grinder explanation, in part, because the Nazi specifically targeted "intellectuals" and Jewish people, both were highly represented in the Universities and Corporate research labs.  Even if the researchers did not flee before being invaded, if their research had military applications, they were likely expatriated to Nazi Germany.

The WWII brain-drain clearly impacted the research in "formerly occupied" countries for decades.

What is harder to discern is what, if any, cultural trends may have created headwinds for French people and organizations that wanted to excel at "science".  Those trends could have been taxation, glorification of other professions or it could have been an unwillingness to study progress that was made in other countries (Not Invented Here syndrome).

Another thought is that great scientists are developed.  They do not come into full flower overnight.  Having four of the French Superstar scientists die within a three year period (1906-to-1908) might have put a bubble in the development siphon.  It would be as if four heavy-weight, world champion boxers died in the ring in quick succession.  Many aspiring athletes would seek different venues to showcase their prowess.

Why does it matter?

It matters because fashion and "taste" are a fickle thing.  The ability to invent and produce is less sensitive to manipulation.  A country that cannot compete head-to-head in technology is reduced to hoping that customers will find this:

attractive and be willing to pay a premium for "that" look.

Did I pay MY rent today?

Most adults of my age harbor the premise that we must earn our day's oxygen, that we must pay our rent for taking up room, we must earn our place on life-boat earth.  We learned it by osmosis.  It was part of the culture we grew up in: Westerns, War movies, Scouting, church.

Most bloggers eventually write a piece bemoaning the entitlement mentality.  The entitlement mentality is the opposite of "paying my rent" thinking.

There are a myriad of reasons why the entitlement mentality is winning.

Perhaps one of those reasons is that we, the adults, do not explicitly verbalize that premise.  I intend to be very conscious about verbalizing it today.

Pick up a piece of trash?  I am paying my rent for a another day on earth.

Help a neighbor with yard work?  I am earning my oxygen.

Give a kid a ride to practice?  It is the cost of a ticket on life-boat earth.

Someday I will be evicted from this planet. 

I cannot prove that there is an afterlife.  But if there is, I want to have a sheaf of references attesting to my good character...and to the fact that I always pay my rent on time.

...did not pay its rent.

My property is in a state of constant flux.  This is the third summer I am retired and I made some major changes.  Most of the wine grapes are gone.  The pawpaws are pulled out.  The dying hybrid poplar (NM6) have been cut down.

Sometimes family asks me "How do you decide what to keep and what to  get rid of?" 

My stock answer is, "I keep the plants that pay their rent and evict the rest."

I am not sure they always understand what I am trying to say.

Price Discovery

Charles Hugh Smith wrote a very clear essay on bubbles.  To summarize,  the foundational "price" for any asset is based on the net return and a defensible discounting rate.  Any price in excess of that is speculation based on the expectation of

• Increasing rates of return (i.e., inflation)
• Accelerating rates of return (i.e., increasing rate of inflation)
• An increasingly distorted discounting rate (i.e., interest rates...how much would you have to invest in bonds to match that net income)
• An expectation that the discounting rate will see even greater rates of distortions in the future
• An ample supply of Greater Fools. 

Any hiccup in those requirements will prick the bubble.

Price discovery presents a puzzle.  Is there even an organic rental market for 4000 square foot, Ikea filled homes 70 miles from job markets?  And then, what is a proper discounting rate?  And what is a realistic depreciation rate given that some of the "appeal" of the home is based on factors that will become obsolete long before their functionality ceases?

Back to food bearing plants

What "rent" do I expect from my food bearing plants?

The devil is in the details.  Just as the "rent" of a house is based on how well it integrates with local factors.....   The "rent" for a plant involves how well it fits with my management methods, local consumers and with local weather conditions.

Wine grapes were evicted because my management involves herbicide application and very minimal insecticide applications.  Grapes are very sensitive to herbicides so weed control took me out of my management sweet-spot.  In short, it did not get done.  Grapes are also a prime target for Japanese Beetles.  I was not religious about spraying them.  Consequently, yields were almost non-existent. 

Liberty on semi-dwarf rootstock will easily exceed 160 pounds per tree year-after-year-after-year.

The vineyard was next to the orchard.  It was a simple decision to extend the orchard.  My expectation is an incremental 1600 pounds (700 kg) of apples and pears with no increase in management complexity.

In the case of Pawpaws, I could not find anybody who really enjoyed eating more than one.  And they are as perishable as ripe bananas.  The row of Pawpaws has been replaced with a row of hazelnuts.  Nuts keep.  Many people like hazelnuts.

Gratuitous garden pictures

Root cellar garden  planted July 6. From right-to-left carrots (not up) two rows of beets, a row of rutabagas, a row of Korean radishes.

Winter Long Keeping (aka, Lutz Green Leaf) beet.  Open pollinated.

Red Ace hybrid beet.  A little bit more vigorous germinating than the Winter Long Keeper.

Rutabaga.

Radishes.

Potato bug update

The bird feeder has been attracting birds.  The raccoons also found it.  They pull it down.  I put it back up.  It does seem to help reduce the number of potato beetles.  The bird feeder is definitely paying its rent.

Magazine subscriptions

Wild Willie has been Kubota's stalwart friend.  WW moves around a lot.  In the last couple of years he lived in Charlotte (11 miles away), Lansing (17 miles away), Waverly (15 miles away), Laingsburg (40 miles away) back to Eaton Rapids and now in Charlotte (11 miles away).  And they remained friends.

WW just had his sixteenth birthday and I was surprised to learn that he never had a magazine subscription.  Ever.  In his life.

I figured that would be easy to fix.

We went to the local Wally-World last week and he gravitated to the magazines on modern firearms.  I was a little bit dismayed as there were not very many selections.  I told Wild Willie that we were going to hold off and check out the selection at a real bookstore (aka, Barnes and Noble).

Today we went to Barnes and Noble and he changed genres.  He picked out a magazine called "Empire".  Unfortunately, a subscription costs $174/year.

So, gentle readers, I need some advice.  I think we are back to the modern firearm genre.  Can you recommend a solid, meat-and-potatoes publication that will not lead this young man astray?

Perhaps something that has a section on builds in the $700-$900 range without too much non-value-added, foo-foo gingerbread.  Wild Willie cuts grass and $800 is within dreaming range.

Opinions and other options/suggestions will be much appreciated.  I am willing to pay fifty bucks for a one year subscription.  The only caveat is that Willie is living with his Grandma and any magazine must meet with her approval or it won't make it into her house...so no T-N-A, please.

Tone Deaf?

In response to the shootings at the Naval recruiting stations in Chattanuga, Tennessee, the Defense Department released a comprehensive plan to protect the health and wellbeing of our swabbies.

Banning Fried Foods

Yup.  The Navy is banning fried foods.  Now that is proactive!

And in the spirit of egalitarianism, I propose that EBT cards (food stamps for poor folks) not pay for any shortening, oils, butter, margarine, fried foods (like potato chips and many other snack foods) or any food (like bacon, cheese, whole milk or hamburger) where fats contribute more than 30% of the total calories.

After all, if it is good enough for our fighting men then it is good enough for our poor, disadvantaged citizens who are mercilessly exploited and force to eat bad food.