MaxedOutMama
Friday, November 20, 2009
AGW Info Just Wants To Be Free
See Shrinkwrapped, Watts Up, The Reference Frame. ClimateAudit is unobtainable, but will have lots good. www.climateaudit.org.
I'm still reading the healthcare bill, so I can't really read this massive group of files, but this is hawt:
In other words, there ain't no science in climate science. The reason for this attitude can be explained by the flood of grant money it produces. It is easy to believe anything when you get millions of dollars for believing it.
This is no surprise to anyone who has been watching the mutatis mutandis of official climate records over the last decade. It's merely very entertaining.
Also see James Delingpole and Andrew Bolt who both have a bunch of excerpts.
Langmuir's "Colluquium On Pathological Science" is online at this site, and may be relevant. This talk was given in the 1950s. I had heard about it and read an excerpt but I had never encountered the whole lecture. I got the link from comments on this Althouse post.
Symptoms of Pathological Science:
I'm still reading the healthcare bill, so I can't really read this massive group of files, but this is hawt:
From: Tom Wigley [...]The ah, implicit mind set is that they can do anything with the data they want - there is no respect for whatever the real measurements may be - but the result should be plausible.
To: Phil Jones [...]
Subject: 1940s
Date: Sun, 27 Sep 2009 23:25:38 -0600
Cc: Ben Santer [...]
Phil,
Here are some speculations on correcting SSTs to partly explain the 1940s warming blip. If you look at the attached plot you will see that theland also shows the 1940s blip (as I’m sure you know).
So, if we could reduce the ocean blip by, say, 0.15 degC, then this would be significant for the global mean – but we’d still have to explain the land blip. I’ve chosen 0.15 here deliberately. This still leaves an ocean blip, and i think one needs to have some form of ocean blip to explain the land blip (via either some common forcing, or ocean forcing land, or vice versa, or all of these). When you look at other blips, the land blips are 1.5 to 2 times (roughly) the ocean blips—higher sensitivity plus thermal inertia effects. My 0.15 adjustment leaves things consistent with this, so you can see where I am coming from.
Removing ENSO does not affect this.
It would be good to remove at least part of the 1940s blip, but we are still left with “why the blip”.
In other words, there ain't no science in climate science. The reason for this attitude can be explained by the flood of grant money it produces. It is easy to believe anything when you get millions of dollars for believing it.
This is no surprise to anyone who has been watching the mutatis mutandis of official climate records over the last decade. It's merely very entertaining.
Also see James Delingpole and Andrew Bolt who both have a bunch of excerpts.
Langmuir's "Colluquium On Pathological Science" is online at this site, and may be relevant. This talk was given in the 1950s. I had heard about it and read an excerpt but I had never encountered the whole lecture. I got the link from comments on this Althouse post.
Symptoms of Pathological Science:
- The maximum effect that is observed is produced by a causative agent of barely detectable intensity, and the magnitude of the effect is substantially independent of the intensity of the cause.
- The effect is of a magnitude that remains close to the limit of detectability; or, many measurements are necessary because of the very low statistical significance of the results.
- Claims of great accuracy.
- Fantastic theories contrary to experience.
- Criticisms are met by ad hoc excuses thought up on the spur of the moment.
- Ratio of supporters to critics rises up to somewhere near 50% and then falls gradually to oblivion.
Thursday, November 19, 2009
Senate Health Care Bill
Update: While I'm reading, go check out Carl at NOFP's post on how many Americans are really uninsured. I believe the data he cites to be good, and my conclusion on these bills has so far been that they would raise, not lower, the number of uninsured Americans. The reason for this is that they will all raise the cost of insurance and mandate additional coverage; the inevitable result will be that many Americans will lose coverage. End Update.
Patient Protection and Affordable Health Care Act, now substituted for the original text in 3590. You can read it here.
I copied the table of contents below. I am going to concentrate on the revenue section first. I highlighted all the sections I'm going to read with special attention.
Curiosity drives the interest in the hospice programs and the "nondiscrimination" provisions relating to assisted suicide (coverage?). Hospices that don't manage to shuffle their patients off to the mortuary have been under severe pressure lately; people think that hospices save a great deal of money, but they often don't. It will be interesting to see what they come up with next. My guess is they want 'em dead within two weeks. The problem is that sometimes terminally ill people recover on their own or experience substantial remissions, so the only way to accomplish the two week plan is basically to off the hospice patients by giving them enough drugs to suppress their breathing, knock 'em out, no liquids - they die quickly from pneumonia.
Patient Protection and Affordable Health Care Act, now substituted for the original text in 3590. You can read it here.
I copied the table of contents below. I am going to concentrate on the revenue section first. I highlighted all the sections I'm going to read with special attention.
Curiosity drives the interest in the hospice programs and the "nondiscrimination" provisions relating to assisted suicide (coverage?). Hospices that don't manage to shuffle their patients off to the mortuary have been under severe pressure lately; people think that hospices save a great deal of money, but they often don't. It will be interesting to see what they come up with next. My guess is they want 'em dead within two weeks. The problem is that sometimes terminally ill people recover on their own or experience substantial remissions, so the only way to accomplish the two week plan is basically to off the hospice patients by giving them enough drugs to suppress their breathing, knock 'em out, no liquids - they die quickly from pneumonia.
‘‘PART A—INDIVIDUAL AND GROUP MARKET REFORMS
‘‘SUBPART II—IMPROVING COVERAGE
‘‘Sec. 2711. No lifetime or annual limits.
‘‘Sec. 2712. Prohibition on rescissions.
‘‘Sec. 2713. Coverage of preventive health services.
‘‘Sec. 2714. Extension of dependent coverage.
‘‘Sec. 2715. Development and utilization of uniform explanation of coverage
documents and standardized definitions.
‘‘Sec. 2716. Prohibition of discrimination based on salary.
‘‘Sec. 2717. Ensuring the quality of care.
‘‘Sec. 2718. Bringing down the cost of health care coverage.
‘‘Sec. 2719. Appeals process.
Sec. 1002. Health insurance consumer information.
Sec. 1003. Ensuring that consumers get value for their dollars.
Sec. 1004. Effective dates.
Subtitle B—Immediate Actions to Preserve and Expand Coverage
Sec. 1101. Immediate access to insurance for uninsured individuals with a preexisting
condition.
Sec. 1102. Reinsurance for early retirees.
Sec. 1103. Immediate information that allows consumers to identify affordable
coverage options.
Sec. 1104. Administrative simplification.
Sec. 1105. Effective date.
Subtitle C—Quality Health Insurance Coverage for All Americans
PART I—HEALTH INSURANCE MARKET REFORMS
Sec. 1201. Amendment to the Public Health Service Act.
‘‘SUBPART I—GENERAL REFORM
‘‘Sec. 2701. Fair health insurance premiums.
‘‘Sec. 2702. Guaranteed availability of coverage.
‘‘Sec. 2703. Guaranteed renewability of coverage.
‘‘Sec. 2704. Prohibition of preexisting condition exclusions or other discrimination
based on health status.
‘‘Sec. 2705. Prohibiting discrimination against individual participants and
beneficiaries based on health status.
‘‘Sec. 2706. Non-discrimination in health care.
‘‘Sec. 2707. Comprehensive health insurance coverage.
‘‘Sec. 2708. Prohibition on excessive waiting periods.
PART II—OTHER PROVISIONS
Sec. 1251. Preservation of right to maintain existing coverage.
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Sec. 1252. Rating reforms must apply uniformly to all health insurance issuers
and group health plans.
Sec. 1253. Effective dates.
Subtitle D—Available Coverage Choices for All Americans
PART I—ESTABLISHMENT OF QUALIFIED HEALTH PLANS
Sec. 1301. Qualified health plan defined.
Sec. 1302. Essential health benefits requirements.
Sec. 1303. Special rules.
Sec. 1304. Related definitions.
PART II—CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH
HEALTH BENEFIT EXCHANGES
Sec. 1311. Affordable choices of health benefit plans.
Sec. 1312. Consumer choice.
Sec. 1313. Financial integrity.
PART III—STATE FLEXIBILITY RELATING TO EXCHANGES
Sec. 1321. State flexibility in operation and enforcement of Exchanges and related
requirements.
Sec. 1322. Federal program to assist establishment and operation of nonprofit,
member-run health insurance issuers.
Sec. 1323. Community health insurance option.
Sec. 1324. Level playing field.
PART IV—STATE FLEXIBILITY TO ESTABLISH ALTERNATIVE PROGRAMS
Sec. 1331. State flexibility to establish basic health programs for low-income individuals
not eligible for Medicaid.
Sec. 1332. Waiver for State innovation.
Sec. 1333. Provisions relating to offering of plans in more than one State.
PART V—REINSURANCE AND RISK ADJUSTMENT
Sec. 1341. Transitional reinsurance program for individual and small group
markets in each State.
Sec. 1342. Establishment of risk corridors for plans in individual and small
group markets.
Sec. 1343. Risk adjustment.
Subtitle E—Affordable Coverage Choices for All Americans
PART I—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS
SUBPART A—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS
Sec. 1401. Refundable tax credit providing premium assistance for coverage
under a qualified health plan.
Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified health
plans.
SUBPART B—ELIGIBILITY DETERMINATIONS
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Sec. 1411. Procedures for determining eligibility for Exchange participation,
premium tax credits and reduced cost-sharing , and individual
responsibility exemptions.
Sec. 1412. Advance determination and payment of premium tax credits and
cost-sharing reductions.
Sec. 1413. Streamlining of procedures for enrollment through an exchange and
State Medicaid, CHIP, and health subsidy programs.
Sec. 1414. Disclosures to carry out eligibility requirements for certain programs.
Sec. 1415. Premium tax credit and cost-sharing reduction payments disregarded
for Federal and Federally-assisted programs.
PART II—SMALL BUSINESS TAX CREDIT
Sec. 1421. Credit for employee health insurance expenses of small businesses.
Subtitle F—Shared Responsibility for Health Care
PART I—INDIVIDUAL RESPONSIBILITY
Sec. 1501. Requirement to maintain minimum essential coverage.
Sec. 1502. Reporting of health insurance coverage.
PART II—EMPLOYER RESPONSIBILITIES
Sec. 1511. Automatic enrollment for employees of large employers.
Sec. 1512. Employer requirement to inform employees of coverage options.
Sec. 1513. Shared responsibility for employers.
Sec. 1514. Reporting of employer health insurance coverage.
Sec. 1515. Offering of Exchange-participating qualified health plans through
cafeteria plans.
Subtitle G—Miscellaneous Provisions
Sec. 1551. Definitions.
Sec. 1552. Transparency in government.
Sec. 1553. Prohibition against discrimination on assisted suicide.
Sec. 1554. Access to therapies.
Sec. 1555. Freedom not to participate in Federal health insurance programs.
Sec. 1556. Equity for certain eligible survivors.
Sec. 1557. Nondiscrimination.
Sec. 1558. Protections for employees.
Sec. 1559. Oversight.
Sec. 1560. Rules of construction.
Sec. 1561. Health information technology enrollment standards and protocols.
Sec. 1562. Conforming amendments.
TITLE II—ROLE OF PUBLIC PROGRAMS
Subtitle A—Improved Access to Medicaid
Sec. 2001. Medicaid coverage for the lowest income populations.
Sec. 2002. Income eligibility for nonelderly determined using modified gross income.
Sec. 2003. Requirement to offer premium assistance for employer-sponsored insurance.
Sec. 2004. Medicaid coverage for former foster care children.
Sec. 2005. Payments to territories.
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Sec. 2006. Special adjustment to FMAP determination for certain States recovering
from a major disaster.
Sec. 2007. Medicaid Improvement Fund rescission.
Subtitle B—Enhanced Support for the Children’s Health Insurance Program
Sec. 2101. Additional federal financial participation for CHIP.
Sec. 2102. Technical corrections.
Subtitle C—Medicaid and CHIP Enrollment Simplification
Sec. 2201. Enrollment Simplification and coordination with State Health Insurance
Exchanges.
Sec. 2202. Permitting hospitals to make presumptive eligibility determinations
for all Medicaid eligible populations.
Subtitle D—Improvements to Medicaid Services
Sec. 2301. Coverage for freestanding birth center services.
Sec. 2302. Concurrent care for children.
Sec. 2303. State eligibility option for family planning services.
Sec. 2304. Clarification of definition of medical assistance.
Subtitle E—New Options for States to Provide Long-Term Services and
Supports
Sec. 2401. Community First Choice Option.
Sec. 2402. Removal of barriers to providing home and community-based services.
Sec. 2403. Money Follows the Person Rebalancing Demonstration.
Sec. 2404. Protection for recipients of home and community-based services
against spousal impoverishment.
Sec. 2405. Funding to expand State Aging and Disability Resource Centers.
Sec. 2406. Sense of the Senate regarding long-term care.
Subtitle F—Medicaid Prescription Drug Coverage
Sec. 2501. Prescription drug rebates.
Sec. 2502. Elimination of exclusion of coverage of certain drugs.
Sec. 2503. Providing adequate pharmacy reimbursement.
Subtitle G—Medicaid Disproportionate Share Hospital (DSH) Payments
Sec. 2551. Disproportionate share hospital payments.
Subtitle H—Improved Coordination for Dual Eligible Beneficiaries
Sec. 2601. 5-year period for demonstration projects.
Sec. 2602. Providing Federal coverage and payment coordination for dual eligible
beneficiaries.
Subtitle I—Improving the Quality of Medicaid for Patients and Providers
Sec. 2701. Adult health quality measures.
Sec. 2702. Payment Adjustment for Health Care-Acquired Conditions.
Sec. 2703. State option to provide health homes for enrollees with chronic conditions.
Sec. 2704. Demonstration project to evaluate integrated care around a hospitalization.
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Sec. 2705. Medicaid Global Payment System Demonstration Project.
Sec. 2706. Pediatric Accountable Care Organization Demonstration Project.
Sec. 2707. Medicaid emergency psychiatric demonstration project.
Subtitle J—Improvements to the Medicaid and CHIP Payment and Access
Commission (MACPAC)
Sec. 2801. MACPAC assessment of policies affecting all Medicaid beneficiaries.
Subtitle K—Protections for American Indians and Alaska Natives
Sec. 2901. Special rules relating to Indians.
Sec. 2902. Elimination of sunset for reimbursement for all medicare part B
services furnished by certain indian hospitals and clinics.
Subtitle L—Maternal and Child Health Services
Sec. 2951. Maternal, infant, and early childhood home visiting programs.
Sec. 2952. Support, education, and research for postpartum depression.
Sec. 2953. Personal responsibility education.
Sec. 2954. Restoration of funding for abstinence education.
Sec. 2955. Inclusion of information about the importance of having a health
care power of attorney in transition planning for children aging
out of foster care and independent living programs.
TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF
HEALTH CARE
Subtitle A—Transforming the Health Care Delivery System
PART I—LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE
MEDICARE PROGRAM
Sec. 3001. Hospital Value-Based purchasing program.
Sec. 3002. Improvements to the physician quality reporting system.
Sec. 3003. Improvements to the physician feedback program.
Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation
hospitals, and hospice programs.
Sec. 3005. Quality reporting for PPS-exempt cancer hospitals.
Sec. 3006. Plans for a Value-Based purchasing program for skilled nursing facilities
and home health agencies.
Sec. 3007. Value-based payment modifier under the physician fee schedule.
Sec. 3008. Payment adjustment for conditions acquired in hospitals.
PART II—NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY
Sec. 3011. National strategy.
Sec. 3012. Interagency Working Group on Health Care Quality.
Sec. 3013. Quality measure development.
Sec. 3014. Quality measurement.
Sec. 3015. Data collection; public reporting.
PART III—ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS
Sec. 3021. Establishment of Center for Medicare and Medicaid Innovation
within CMS.
Sec. 3022. Medicare shared savings program. (739)Sec. 3023. National pilot program on payment bundling.
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Sec. 3024. Independence at home demonstration program.
Sec. 3025. Hospital readmissions reduction program.
Sec. 3026. Community-Based Care Transitions Program.
Sec. 3027. Extension of gainsharing demonstration.
Subtitle B—Improving Medicare for Patients and Providers
PART I—ENSURING BENEFICIARY ACCESS TO PHYSICIAN CARE AND OTHER
SERVICES
Sec. 3101. Increase in the physician payment update.
Sec. 3102. Extension of the work geographic index floor and revisions to the
practice expense geographic adjustment under the Medicare
physician fee schedule.
Sec. 3103. Extension of exceptions process for Medicare therapy caps.
Sec. 3104. Extension of payment for technical component of certain physician
pathology services.
Sec. 3105. Extension of ambulance add-ons.
Sec. 3106. Extension of certain payment rules for long-term care hospital services
and of moratorium on the establishment of certain hospitals
and facilities.
Sec. 3107. Extension of physician fee schedule mental health add-on.
Sec. 3108. Permitting physician assistants to order post-Hospital extended care
services.
Sec. 3109. Exemption of certain pharmacies from accreditation requirements.
Sec. 3110. Part B special enrollment period for disabled TRICARE beneficiaries.
Sec. 3111. Payment for bone density tests.
Sec. 3112. Revision to the Medicare Improvement Fund.
Sec. 3113. Treatment of certain complex diagnostic laboratory tests.
Sec. 3114. Improved access for certified nurse-midwife services.
PART II—RURAL PROTECTIONS
Sec. 3121. Extension of outpatient hold harmless provision.
Sec. 3122. Extension of Medicare reasonable costs payments for certain clinical
diagnostic laboratory tests furnished to hospital patients in certain
rural areas.
Sec. 3123. Extension of the Rural Community Hospital Demonstration Program.
Sec. 3124. Extension of the Medicare-dependent hospital (MDH) program.
Sec. 3125. Temporary improvements to the Medicare inpatient hospital payment
adjustment for low-volume hospitals.
Sec. 3126. Improvements to the demonstration project on community health integration
models in certain rural counties.
Sec. 3127. MedPAC study on adequacy of Medicare payments for health care
providers serving in rural areas.
Sec. 3128. Technical correction related to critical access hospital services.
Sec. 3129. Extension of and revisions to Medicare rural hospital flexibility program.
PART III—IMPROVING PAYMENT ACCURACY
Sec. 3131. Payment adjustments for home health care.
Sec. 3132. Hospice reform. (page 836)
Sec. 3133. Improvement to medicare disproportionate share hospital (DSH)
payments.
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Sec. 3134. Misvalued codes under the physician fee schedule.
Sec. 3135. Modification of equipment utilization factor for advanced imaging
services.
Sec. 3136. Revision of payment for power-driven wheelchairs.
Sec. 3137. Hospital wage index improvement.
Sec. 3138. Treatment of certain cancer hospitals.
Sec. 3139. Payment for biosimilar biological products.
Sec. 3140. Medicare hospice concurrent care demonstration program.
Sec. 3141. Application of budget neutrality on a national basis in the calculation
of the Medicare hospital wage index floor.
Sec. 3142. HHS study on urban Medicare-dependent hospitals.
Subtitle C—Provisions Relating to Part C
Sec. 3201. Medicare Advantage payment.
Sec. 3202. Benefit protection and simplification.
Sec. 3203. Application of coding intensity adjustment during MA payment
transition.
Sec. 3204. Simplification of annual beneficiary election periods.
Sec. 3205. Extension for specialized MA plans for special needs individuals.
Sec. 3206. Extension of reasonable cost contracts.
Sec. 3207. Technical correction to MA private fee-for-service plans.
Sec. 3208. Making senior housing facility demonstration permanent.
Sec. 3209. Authority to deny plan bids.
Sec. 3210. Development of new standards for certain Medigap plans.
Subtitle D—Medicare Part D Improvements for Prescription Drug Plans and
MA–PD Plans
Sec. 3301. Medicare coverage gap discount program.
Sec. 3302. Improvement in determination of Medicare part D low-income
benchmark premium.
Sec. 3303. Voluntary de minimis policy for subsidy eligible individuals under
prescription drug plans and MA–PD plans.
Sec. 3304. Special rule for widows and widowers regarding eligibility for lowincome
assistance.
Sec. 3305. Improved information for subsidy eligible individuals reassigned to
prescription drug plans and MA–PD plans.
Sec. 3306. Funding outreach and assistance for low-income programs.
Sec. 3307. Improving formulary requirements for prescription drug plans and
MA–PD plans with respect to certain categories or classes of
drugs.
Sec. 3308. Reducing part D premium subsidy for high-income beneficiaries.
Sec. 3309. Elimination of cost sharing for certain dual eligible individuals.
Sec. 3310. Reducing wasteful dispensing of outpatient prescription drugs in
long-term care facilities under prescription drug plans and
MA–PD plans.
Sec. 3311. Improved Medicare prescription drug plan and MA–PD plan complaint
system.
Sec. 3312. Uniform exceptions and appeals process for prescription drug plans
and MA–PD plans.
Sec. 3313. Office of the Inspector General studies and reports.
Sec. 3314. Including costs incurred by AIDS drug assistance programs and Indian
Health Service in providing prescription drugs toward the
annual out-of-pocket threshold under part D.
Sec. 3315. Immediate reduction in coverage gap in 2010.
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Subtitle E—Ensuring Medicare Sustainability
Sec. 3401. Revision of certain market basket updates and incorporation of productivity
improvements into market basket updates that do not
already incorporate such improvements.
Sec. 3402. Temporary adjustment to the calculation of part B premiums.
Sec. 3403. Independent Medicare Advisory Board.
Subtitle F—Health Care Quality Improvements
Sec. 3501. Health care delivery system research; Quality improvement technical
assistance.
Sec. 3502. Establishing community health teams to support the patient-centered
medical home.
Sec. 3503. Medication management services in treatment of chronic disease.
Sec. 3504. Design and implementation of regionalized systems for emergency
care.
Sec. 3505. Trauma care centers and service availability.
Sec. 3506. Program to facilitate shared decisionmaking.
Sec. 3507. Presentation of prescription drug benefit and risk information.
Sec. 3508. Demonstration program to integrate quality improvement and patient
safety training into clinical education of health professionals.
Sec. 3509. Improving women’s health.
Sec. 3510. Patient navigator program.
Sec. 3511. Authorization of appropriations.
TITLE IV—PREVENTION OF CHRONIC DISEASE AND IMPROVING
PUBLIC HEALTH
Subtitle A—Modernizing Disease Prevention and Public Health Systems
Sec. 4001. National Prevention, Health Promotion and Public Health Council.
Sec. 4002. Prevention and Public Health Fund.
Sec. 4003. Clinical and community preventive services.
Sec. 4004. Education and outreach campaign regarding preventive benefits.
Subtitle B—Increasing Access to Clinical Preventive Services
Sec. 4101. School-based health centers.
Sec. 4102. Oral healthcare prevention activities.
Sec. 4103. Medicare coverage of annual wellness visit providing a personalized
prevention plan.
Sec. 4104. Removal of barriers to preventive services in Medicare.
Sec. 4105. Evidence-based coverage of preventive services in Medicare.
Sec. 4106. Improving access to preventive services for eligible adults in Medicaid.
Sec. 4107. Coverage of comprehensive tobacco cessation services for pregnant
women in Medicaid.
Sec. 4108. Incentives for prevention of chronic diseases in medicaid.
Subtitle C—Creating Healthier Communities
Sec. 4201. Community transformation grants.
Sec. 4202. Healthy aging, living well; evaluation of community-based prevention
and wellness programs for Medicare beneficiaries.
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Sec. 4203. Removing barriers and improving access to wellness for individuals
with disabilities.
Sec. 4204. Immunizations.
Sec. 4205. Nutrition labeling of standard menu items at chain restaurants.
Sec. 4206. Demonstration project concerning individualized wellness plan.
Sec. 4207. Reasonable break time for nursing mothers.
Subtitle D—Support for Prevention and Public Health Innovation
Sec. 4301. Research on optimizing the delivery of public health services.
Sec. 4302. Understanding health disparities: data collection and analysis.
Sec. 4303. CDC and employer-based wellness programs.
Sec. 4304. Epidemiology-Laboratory Capacity Grants.
Sec. 4305. Advancing research and treatment for pain care management.
Sec. 4306. Funding for Childhood Obesity Demonstration Project.
Subtitle E—Miscellaneous Provisions
Sec. 4401. Sense of the Senate concerning CBO scoring.
Sec. 4402. Effectiveness of Federal health and wellness initiatives.
TITLE V—HEALTH CARE WORKFORCE
Subtitle A—Purpose and Definitions
Sec. 5001. Purpose.
Sec. 5002. Definitions.
Subtitle B—Innovations in the Health Care Workforce
Sec. 5101. National health care workforce commission.
Sec. 5102. State health care workforce development grants.
Sec. 5103. Health care workforce assessment.
Subtitle C—Increasing the Supply of the Health Care Workforce
Sec. 5201. Federally supported student loan funds.
Sec. 5202. Nursing student loan program.
Sec. 5203. Health care workforce loan repayment programs.
Sec. 5204. Public health workforce recruitment and retention programs.
Sec. 5205. Allied health workforce recruitment and retention programs.
Sec. 5206. Grants for State and local programs.
Sec. 5207. Funding for National Health Service Corps.
Sec. 5208. Nurse-managed health clinics.
Sec. 5209. Elimination of cap on commissioned corps.
Sec. 5210. Establishing a Ready Reserve Corps.
Subtitle D—Enhancing Health Care Workforce Education and Training
Sec. 5301. Training in family medicine, general internal medicine, general pediatrics,
and physician assistantship.
Sec. 5302. Training opportunities for direct care workers.
Sec. 5303. Training in general, pediatric, and public health dentistry.
Sec. 5304. Alternative dental health care providers demonstration project.
Sec. 5305. Geriatric education and training; career awards; comprehensive geriatric
education.
Sec. 5306. Mental and behavioral health education and training grants.
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Sec. 5307. Cultural competency, prevention, and public health and individuals
with disabilities training.
Sec. 5308. Advanced nursing education grants.
Sec. 5309. Nurse education, practice, and retention grants.
Sec. 5310. Loan repayment and scholarship program.
Sec. 5311. Nurse faculty loan program.
Sec. 5312. Authorization of appropriations for parts B through D of title VIII.
Sec. 5313. Grants to promote the community health workforce.
Sec. 5314. Fellowship training in public health.
Sec. 5315. United States Public Health Sciences Track.
Subtitle E—Supporting the Existing Health Care Workforce
Sec. 5401. Centers of excellence.
Sec. 5402. Health care professionals training for diversity.
Sec. 5403. Interdisciplinary, community-based linkages.
Sec. 5404. Workforce diversity grants.
Sec. 5405. Primary care extension program.
Subtitle F—Strengthening Primary Care and Other Workforce Improvements
Sec. 5501. Expanding access to primary care services and general surgery services.
Sec. 5502. Medicare Federally qualified health center improvements.
Sec. 5503. Distribution of additional residency positions.
Sec. 5504. Counting resident time in outpatient settings and allowing flexibility
for jointly operated residency training programs.
Sec. 5505. Rules for counting resident time for didactic and scholarly activities
and other activities.
Sec. 5506. Preservation of resident cap positions from closed hospitals.
Sec. 5507. Demonstration projects To address health professions workforce
needs; extension of family-to-family health information centers.
Sec. 5508. Increasing teaching capacity.
Sec. 5509. Graduate nurse education demonstration.
Subtitle G—Improving Access to Health Care Services
Sec. 5601. Spending for Federally Qualified Health Centers (FQHCs).
Sec. 5602. Negotiated rulemaking for development of methodology and criteria
for designating medically underserved populations and health
professions shortage areas.
Sec. 5603. Reauthorization of the Wakefield Emergency Medical Services for
Children Program.
Sec. 5604. Co-locating primary and specialty care in community-based mental
health settings.
Sec. 5605. Key National indicators.
Subtitle H—General Provisions
Sec. 5701. Reports.
TITLE VI—TRANSPARENCY AND PROGRAM INTEGRITY
Subtitle A—Physician Ownership and Other Transparency
Sec. 6001. Limitation on Medicare exception to the prohibition on certain physician
referrals for hospitals.
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Sec. 6002. Transparency reports and reporting of physician ownership or investment
interests.
Sec. 6003. Disclosure requirements for in-office ancillary services exception to
the prohibition on physician self-referral for certain imaging
services.
Sec. 6004. Prescription drug sample transparency.
Sec. 6005. Pharmacy benefit managers transparency requirements.
Subtitle B—Nursing Home Transparency and Improvement
PART I—IMPROVING TRANSPARENCY OF INFORMATION
Sec. 6101. Required disclosure of ownership and additional disclosable parties
information.
Sec. 6102. Accountability requirements for skilled nursing facilities and nursing
facilities.
Sec. 6103. Nursing home compare Medicare website.
Sec. 6104. Reporting of expenditures.
Sec. 6105. Standardized complaint form.
Sec. 6106. Ensuring staffing accountability.
Sec. 6107. GAO study and report on Five-Star Quality Rating System.
PART II—TARGETING ENFORCEMENT
Sec. 6111. Civil money penalties.
Sec. 6112. National independent monitor demonstration project.
Sec. 6113. Notification of facility closure.
Sec. 6114. National demonstration projects on culture change and use of information
technology in nursing homes.
PART III—IMPROVING STAFF TRAINING
Sec. 6121. Dementia and abuse prevention training.
Subtitle C—Nationwide Program for National and State Background Checks
on Direct Patient Access Employees of Long-term Care Facilities and Providers
Sec. 6201. Nationwide program for National and State background checks on
direct patient access employees of long-term care facilities and
providers.
Subtitle D—Patient-Centered Outcomes Research
Sec. 6301. Patient-Centered Outcomes Research.
Sec. 6302. Federal coordinating council for comparative effectiveness research.
Subtitle E—Medicare, Medicaid, and CHIP Program Integrity Provisions
Sec. 6401. Provider screening and other enrollment requirements under Medicare,
Medicaid, and CHIP.
Sec. 6402. Enhanced Medicare and Medicaid program integrity provisions.
Sec. 6403. Elimination of duplication between the Healthcare Integrity and
Protection Data Bank and the National Practitioner Data
Bank.
Sec. 6404. Maximum period for submission of Medicare claims reduced to not
more than 12 months.
13
O:\BAI\BAI09M01.xml [file 1 of 9] S.L.C.
Sec. 6405. Physicians who order items or services required to be Medicare enrolled
physicians or eligible professionals.
Sec. 6406. Requirement for physicians to provide documentation on referrals to
programs at high risk of waste and abuse.
Sec. 6407. Face to face encounter with patient required before physicians may
certify eligibility for home health services or durable medical
equipment under Medicare.
Sec. 6408. Enhanced penalties.
Sec. 6409. Medicare self-referral disclosure protocol.
Sec. 6410. Adjustments to the Medicare durable medical equipment, prosthetics,
orthotics, and supplies competitive acquisition program.
Sec. 6411. Expansion of the Recovery Audit Contractor (RAC) program.
Subtitle F—Additional Medicaid Program Integrity Provisions
Sec. 6501. Termination of provider participation under Medicaid if terminated
under Medicare or other State plan.
Sec. 6502. Medicaid exclusion from participation relating to certain ownership,
control, and management affiliations.
Sec. 6503. Billing agents, clearinghouses, or other alternate payees required to
register under Medicaid.
Sec. 6504. Requirement to report expanded set of data elements under MMIS
to detect fraud and abuse.
Sec. 6505. Prohibition on payments to institutions or entities located outside of
the United States.
Sec. 6506. Overpayments.
Sec. 6507. Mandatory State use of national correct coding initiative.
Sec. 6508. General effective date.
Subtitle G—Additional Program Integrity Provisions
Sec. 6601. Prohibition on false statements and representations.
Sec. 6602. Clarifying definition.
Sec. 6603. Development of model uniform report form.
Sec. 6604. Applicability of State law to combat fraud and abuse.
Sec. 6605. Enabling the Department of Labor to issue administrative summary
cease and desist orders and summary seizures orders against
plans that are in financially hazardous condition.
Sec. 6606. MEWA plan registration with Department of Labor.
Sec. 6607. Permitting evidentiary privilege and confidential communications.
Subtitle H—Elder Justice Act
Sec. 6701. Short title of subtitle.
Sec. 6702. Definitions.
Sec. 6703. Elder Justice.
Subtitle I—Sense of the Senate Regarding Medical Malpractice
Sec. 6801. Sense of the Senate regarding medical malpractice.
TITLE VII—IMPROVING ACCESS TO INNOVATIVE MEDICAL
THERAPIES
Subtitle A—Biologics Price Competition and Innovation
Sec. 7001. Short title.
Sec. 7002. Approval pathway for biosimilar biological products.
14
O:\BAI\BAI09M01.xml [file 1 of 9] S.L.C.
Sec. 7003. Savings.
Subtitle B—More Affordable Medicines for Children and Underserved
Communities
Sec. 7101. Expanded participation in 340B program.
Sec. 7102. Improvements to 340B program integrity.
Sec. 7103. GAO study to make recommendations on improving the 340B program.
TITLE VIII—CLASS ACT
Sec. 8001. Short title of title.
Sec. 8002. Establishment of national voluntary insurance program for purchasing
community living assistance services and support.
TITLE IX—REVENUE PROVISIONS
Subtitle A—Revenue Offset Provisions
Sec. 9001. Excise tax on high cost employer-sponsored health coverage.
Sec. 9002. Inclusion of cost of employer-sponsored health coverage on W–2.
Sec. 9003. Distributions for medicine qualified only if for prescribed drug or insulin.
Sec. 9004. Increase in additional tax on distributions from HSAs and Archer
MSAs not used for qualified medical expenses.
Sec. 9005. Limitation on health flexible spending arrangements under cafeteria
plans.
Sec. 9006. Expansion of information reporting requirements.
Sec. 9007. Additional requirements for charitable hospitals.
Sec. 9008. Imposition of annual fee on branded prescription pharmaceutical
manufacturers and importers.
Sec. 9009. Imposition of annual fee on medical device manufacturers and importers.
Sec. 9010. Imposition of annual fee on health insurance providers.
Sec. 9011. Study and report of effect on veterans health care.
Sec. 9012. Elimination of deduction for expenses allocable to Medicare Part D
subsidy.
Sec. 9013. Modification of itemized deduction for medical expenses.
Sec. 9014. Limitation on excessive remuneration paid by certain health insurance
providers.
Sec. 9015. Additional hospital insurance tax on high-income taxpayers.
Sec. 9016. Modification of section 833 treatment of certain health organizations.
Sec. 9017. Excise tax on elective cosmetic medical procedures.
Subtitle B—Other Provisions
Sec. 9021. Exclusion of health benefits provided by Indian tribal governments.
Sec. 9022. Establishment of simple cafeteria plans for small businesses.
Sec. 9023. Qualifying therapeutic discovery project credit.
Wednesday, November 18, 2009
Treasury Yields
Treasury yields. Look at 'em. Scream. Pass out.
Wake up. Get off floor. Stagger weakly to toilet. Vomit.
CF Economics. Zero Hedge.
I have come to have such scorn for Geithner and the rest of them that I can't even write about this stuff. I don't watch TV. All I read are articles about statistics and so forth, plus buys and sells. An awful lot of what's out there is the economic equivalent of Fantasia.
Wake up. Get off floor. Stagger weakly to toilet. Vomit.
CF Economics. Zero Hedge.
I have come to have such scorn for Geithner and the rest of them that I can't even write about this stuff. I don't watch TV. All I read are articles about statistics and so forth, plus buys and sells. An awful lot of what's out there is the economic equivalent of Fantasia.
Why I Say We've Already Crested
I think I owe you guys an explanation, and let me know if this does not serve. I am doing my best, and now trying pretty pictures.
The operative forces hauling the economy back down in the short term are energy prices plus lower incomes for a large portion of the population plus underlying cost increases for producers. Because the incomes are lower, producers cannot pass their costs fully onto consumers. Because consumers are still pressured and cannot seek more income from earnings in general, consumers can only increase their financial stability by spending less and paying off debt (if they have it), or just defaulting on it.
The reason that producer costs are rising is basically energy costs.
CPI-U October:
Note the difference between food at home and food away from home. There are increasing cost impulses in this economy, and the only way a majority of the consumers can cope is to cut their spending. Food away from home has a different group of consumers that are somewhat more comfortable, and thus can sustain more of the cost increases.
Today's housing starts report is just another symptom of growing economic problems which are slowly diffusing again through the economy and have prevented us from climbing up that necessary next step to achieve a self-fueling recovery.
One of the broadest measures of economic activity in the US is CFNAI, published by the Chicago Fed. The three-month moving average (CFNAI-MA3) is a broad measure of growth (or contraction) impulses moving through the economy.
Now here I made you some pretty pictures; this data is through September.
Click on this to get a larger image.
Zone A (-0.25 to -0.50) is an adjustment range. Growth can fiddle around here for some time and go either way.
However, if we drop into Zone B (-1.00 to -.75), things get very serious very quickly.
In general, when the economy has been humming along and growth falls into Zone A stimulus measures may be considered depending on other factors. But it is never a time to significantly raise taxes - doing so would often precipitate a correction.
This is exactly the same graph as above rotated to give you a different perspective. The first view conveys the shocking cliff-diving routine we've been through; this view shows you a bit more of what has been happening in the last five months.
By September CFNAI had been going down for three months and had fallen back into Zone B; the latest October releases strongly suggest that it will keep going down. The latest three months of CFNAI (July, August, September) are currently listed as -0.42, -0.65, -0.81. So it now appears that in October we are probably in Zone B; history suggests that over the next four months sorrowful things will happen as growth impulses fade and contraction takes hold once more.
And any talk about good retail sales is missing a very obvious point - the inflation adjustment. Sales tax receipts are a very important component of state revenues; real sales tax receipts have to rise at least at the rate that the population is rising over time, or per capita expenditure needs will not be met. Just from looking at today's CPI release one can tell that real retail sales are still oscillating around the low point (this graph of the real retail sales figures from St. Louis Fred contains data only through September, but October won't rise that much):
Now if you guys will stare thoughtfully at this thing for a bit, you will notice that real retail sales have returned to the 2002-2003 level after the last recession. The reason they have done this is that a bulk of consumers are largely coping with reduced per capita incomes (see this prior post about household incomes over the past decade), and are no longer able to fool themselves into borrowing to spend.
You will also notice that the 2001 recession really began in 2000, and did not really end until 2003. The growth reported was obtained through a monetary easing which created growth, but we really do not have the same options right now due to the prior explosion in debt.
There are two things that will work to provide economic growth. The first would be a government program that would help people write off debt. The Joy-Boots plan is as good as any other. However, it is clear that Congress isn't interested in that. The second is needed infrastructure spending. Just fix the roads and bridges, and you'll send a sharp boost through the economy and generate a ton of jobs.
But the bottom line is that monetary policy cannot accomplish much - we shot those bullets already. The target they could hit was was shot to pieces before the 2008 cliff exhibition. The economy is now being driven by changes in energy prices, not changes in credit. At this point, very low US rates have appear to already have produced a new slide into contraction; the dollar is being carry-traded and everyone's hedging with oil and other commodities. That is a monetary disaster which is going to hurt far more than the US economy. Yes, it's speculation. But internal US financial regulation cannot cure international speculation.
Over the long term, simply producing more energy internally will bolster our trade balance, support the dollar somewhat and ease pressures on other economies. But in order to produce energy internally, it must be cost-effective energy. Spending on conservation will achieve far more that spending on high-cost energy sources such as marginal wind (wind can work in some areas, for a few percentage points) and high-cost solar. Solar also is cost-effective in some applications.
But the US can never fuel a return to growth with current green energy. The reason our stimulus package is not working is that it was badly designed. We keep throwing more and more money into futile projects such as trying to prevent foreclosures for people who don't have jobs, funding home purchases for people at 50% DTIs, building energy production that no one can afford to consume, and giving income tax proceeds from the boom years back to companies (financials and home builders) that profited from the boom.
We can begin the process of stopping the pain whenever we want to get serious. We haven't gotten serious yet. Unfortunately, the next few months are going to prove my point.
We got about what we are going to get from the inventory restocking; that pulse will start to drain by January, and we'll be left with the same old, same old:
The worst of it is that September freight showed indications of trouble. BTS Transportation Index:
To the Anon commenter on the last post who asked about velocity.
Freight is one of the best non-monetary ways to assess velocity (the rate at which money is changing hands). That is one of the reasons I spend so much time on it.
We appear to have hit one trough in May, but we do not see the pattern of rising freight we should at this stage in emerging from a recession. We never achieved escape velocity and thus have not slipped the surly bonds of earthy economics!
October rail showed declining shipments for commodities along with rising intermodal; a classic pattern that bodes no good for 2010.
The operative forces hauling the economy back down in the short term are energy prices plus lower incomes for a large portion of the population plus underlying cost increases for producers. Because the incomes are lower, producers cannot pass their costs fully onto consumers. Because consumers are still pressured and cannot seek more income from earnings in general, consumers can only increase their financial stability by spending less and paying off debt (if they have it), or just defaulting on it.
The reason that producer costs are rising is basically energy costs.
CPI-U October:
Note the difference between food at home and food away from home. There are increasing cost impulses in this economy, and the only way a majority of the consumers can cope is to cut their spending. Food away from home has a different group of consumers that are somewhat more comfortable, and thus can sustain more of the cost increases.
Today's housing starts report is just another symptom of growing economic problems which are slowly diffusing again through the economy and have prevented us from climbing up that necessary next step to achieve a self-fueling recovery.
One of the broadest measures of economic activity in the US is CFNAI, published by the Chicago Fed. The three-month moving average (CFNAI-MA3) is a broad measure of growth (or contraction) impulses moving through the economy.
Now here I made you some pretty pictures; this data is through September.
Click on this to get a larger image.
Zone A (-0.25 to -0.50) is an adjustment range. Growth can fiddle around here for some time and go either way.
However, if we drop into Zone B (-1.00 to -.75), things get very serious very quickly.
In general, when the economy has been humming along and growth falls into Zone A stimulus measures may be considered depending on other factors. But it is never a time to significantly raise taxes - doing so would often precipitate a correction.
This is exactly the same graph as above rotated to give you a different perspective. The first view conveys the shocking cliff-diving routine we've been through; this view shows you a bit more of what has been happening in the last five months.
By September CFNAI had been going down for three months and had fallen back into Zone B; the latest October releases strongly suggest that it will keep going down. The latest three months of CFNAI (July, August, September) are currently listed as -0.42, -0.65, -0.81. So it now appears that in October we are probably in Zone B; history suggests that over the next four months sorrowful things will happen as growth impulses fade and contraction takes hold once more.
And any talk about good retail sales is missing a very obvious point - the inflation adjustment. Sales tax receipts are a very important component of state revenues; real sales tax receipts have to rise at least at the rate that the population is rising over time, or per capita expenditure needs will not be met. Just from looking at today's CPI release one can tell that real retail sales are still oscillating around the low point (this graph of the real retail sales figures from St. Louis Fred contains data only through September, but October won't rise that much):
Now if you guys will stare thoughtfully at this thing for a bit, you will notice that real retail sales have returned to the 2002-2003 level after the last recession. The reason they have done this is that a bulk of consumers are largely coping with reduced per capita incomes (see this prior post about household incomes over the past decade), and are no longer able to fool themselves into borrowing to spend.
You will also notice that the 2001 recession really began in 2000, and did not really end until 2003. The growth reported was obtained through a monetary easing which created growth, but we really do not have the same options right now due to the prior explosion in debt.
There are two things that will work to provide economic growth. The first would be a government program that would help people write off debt. The Joy-Boots plan is as good as any other. However, it is clear that Congress isn't interested in that. The second is needed infrastructure spending. Just fix the roads and bridges, and you'll send a sharp boost through the economy and generate a ton of jobs.
But the bottom line is that monetary policy cannot accomplish much - we shot those bullets already. The target they could hit was was shot to pieces before the 2008 cliff exhibition. The economy is now being driven by changes in energy prices, not changes in credit. At this point, very low US rates have appear to already have produced a new slide into contraction; the dollar is being carry-traded and everyone's hedging with oil and other commodities. That is a monetary disaster which is going to hurt far more than the US economy. Yes, it's speculation. But internal US financial regulation cannot cure international speculation.
Over the long term, simply producing more energy internally will bolster our trade balance, support the dollar somewhat and ease pressures on other economies. But in order to produce energy internally, it must be cost-effective energy. Spending on conservation will achieve far more that spending on high-cost energy sources such as marginal wind (wind can work in some areas, for a few percentage points) and high-cost solar. Solar also is cost-effective in some applications.
But the US can never fuel a return to growth with current green energy. The reason our stimulus package is not working is that it was badly designed. We keep throwing more and more money into futile projects such as trying to prevent foreclosures for people who don't have jobs, funding home purchases for people at 50% DTIs, building energy production that no one can afford to consume, and giving income tax proceeds from the boom years back to companies (financials and home builders) that profited from the boom.
We can begin the process of stopping the pain whenever we want to get serious. We haven't gotten serious yet. Unfortunately, the next few months are going to prove my point.
We got about what we are going to get from the inventory restocking; that pulse will start to drain by January, and we'll be left with the same old, same old:
The worst of it is that September freight showed indications of trouble. BTS Transportation Index:
To the Anon commenter on the last post who asked about velocity.
Freight is one of the best non-monetary ways to assess velocity (the rate at which money is changing hands). That is one of the reasons I spend so much time on it.
We appear to have hit one trough in May, but we do not see the pattern of rising freight we should at this stage in emerging from a recession. We never achieved escape velocity and thus have not slipped the surly bonds of earthy economics!
October rail showed declining shipments for commodities along with rising intermodal; a classic pattern that bodes no good for 2010.
Tuesday, November 17, 2009
Couple 'O Teeny-Tiny Minor Little Details
1) That really nice third quarter Japan reported? That's the real number. Nominally speaking, Japanese GDP shrank. This is the thing we call "deflation", and when your national debt is rapidly approaching 200% of GDP, it kind of makes matters worse. A Bloomberg article that covers the high points:
A couple of graphs for you. HI (the 2.9% Medicare tax) is charged on wages and self-employment income. Since it is flat and uncapped, these tax receipts as reported in the Monthly Treasury Statement can be used to check earnings. Without further ado:
Because, after all, we are not in a hugely different situation.
This is going to catch up with us; personal consumption expenditures cannot continue to grow with declining earnings unless a huge amount of debt is written down.
Looking at it this way makes things look better, doesn't it?
And our household debt is dropping rapidly.
It's important to remember that wages and self-employment earnings are not the only money US residents have to spend. The wealthier groups have dividends and interest (no joy recently there - if we figured it over two years most have lost considerably in those quarters too).
Then there are welfare payments, food stamps, unemployment checks and Social Security. One of the purposes of unemployment is to keep incomes from dropping too quickly and gutting a nascent recovery.
3) So aren't we in recovery? I think we are in a mid-recession growth cycle. I also suspect that October-November will be about the peak of this one. A lot depends on what our government wants to do and how realistic we are all going to be about our situation.
We can't keep hiking up our public debt forever by throwing money into personal transfer payments. Even if we resume nominal wage and self-employment growth next year, the Medicare/Social Security bust has been brought years forward. Currently both programs appear to be in deficit, which means that general funds (personal and corporate taxes) have to be diverted for these very necessary programs.
But here are other extraordinary draws on general funds:
Industrial production growth came in at a marginal 0.1% (not surprising, given the trends at oil refineries), and may be weaker yet in November. As of October we were still down 7.1% over 12 months. Final products:
Materials are still turning in some oomph:
And then there are producer prices. The twelve month changes as of October:
Rail employment had been turning up in the early parts of this growth cycle; in September Class I rail employment started to fall again. See STB rail employment. October data should be published soon.
Eventually, we will eliminate enough debt to help disposable incomes. Chargeoffs at banks continued to rise in the third quarter. Seasonally adjusted annualized rates for the quarter:
Between the drag from debt and the drag from the government contraction (which has to happen), there is a lot of quicksand ahead next year.
“The biggest worry to us is that consumption growth has been too strong relative to incomes,” said Hiromichi Shirakawa, chief Japan economist at Credit Suisse Group AG in Tokyo, who used to work at the central bank. ... Without adjusting for prices, Japan’s economy shrank an annualized 0.3 percent last quarter, the sixth straight contraction.2) Since we are turning Japanese, we might want to think about their situation. This is definitely one of our possible futures, and we have the same excess consumption growth relative to our economy as they do - even in the middle of a very steep recession in which we are now seeing quite deflationary signals.
A couple of graphs for you. HI (the 2.9% Medicare tax) is charged on wages and self-employment income. Since it is flat and uncapped, these tax receipts as reported in the Monthly Treasury Statement can be used to check earnings. Without further ado:
Because, after all, we are not in a hugely different situation.
This is going to catch up with us; personal consumption expenditures cannot continue to grow with declining earnings unless a huge amount of debt is written down.
Looking at it this way makes things look better, doesn't it?
And our household debt is dropping rapidly.
It's important to remember that wages and self-employment earnings are not the only money US residents have to spend. The wealthier groups have dividends and interest (no joy recently there - if we figured it over two years most have lost considerably in those quarters too).
Then there are welfare payments, food stamps, unemployment checks and Social Security. One of the purposes of unemployment is to keep incomes from dropping too quickly and gutting a nascent recovery.
3) So aren't we in recovery? I think we are in a mid-recession growth cycle. I also suspect that October-November will be about the peak of this one. A lot depends on what our government wants to do and how realistic we are all going to be about our situation.
We can't keep hiking up our public debt forever by throwing money into personal transfer payments. Even if we resume nominal wage and self-employment growth next year, the Medicare/Social Security bust has been brought years forward. Currently both programs appear to be in deficit, which means that general funds (personal and corporate taxes) have to be diverted for these very necessary programs.
But here are other extraordinary draws on general funds:
- FDIC insurance fund bailout. Easily 700-800 banks could fold this cycle. Congress is going to have to throw in a few hundred billion.
- Fannie bailout. Every quarter they show up asking for just 10-20 billion. We just hope it stays that low.
- FHA bailout. Only Barney Frank doesn't realize this is coming.
- TARP losses. Some already and plenty coming.
- And then there's the Fed. How it gets out of buying mortgages I don't know; just about any way it tries to exit it takes a loss on what it has.
Industrial production growth came in at a marginal 0.1% (not surprising, given the trends at oil refineries), and may be weaker yet in November. As of October we were still down 7.1% over 12 months. Final products:
Materials are still turning in some oomph:
And then there are producer prices. The twelve month changes as of October:
Crude: +5.4%The margins are squeezing; this is not laying the foundation for growth in business investment. The monthly figures for finished food and energy were both +1.6% for October, so the compression is occurring in all other goods, which came in at a staggering -0.6% - by far the deepest drop of the last twelve months. Oops.
Intermediate: +0.3%
Finished: -1.9%
Rail employment had been turning up in the early parts of this growth cycle; in September Class I rail employment started to fall again. See STB rail employment. October data should be published soon.
Eventually, we will eliminate enough debt to help disposable incomes. Chargeoffs at banks continued to rise in the third quarter. Seasonally adjusted annualized rates for the quarter:
- Credit cards: 10.24% (08: 5.73%)
- All consumer loans: 5.86% (08: 3.63%)
- Residential mortgages: 2.43% (08: 1.48%)
- Commercial mortgages: 2.58% (08: 1.19%)
- Total Loans and Leases: 2.88% (08: 1.52%)
Between the drag from debt and the drag from the government contraction (which has to happen), there is a lot of quicksand ahead next year.
Sunday, November 15, 2009
House Health Care Reform Bill
It's worth taking a look at the actuarial analysis on HR 3962 done by CMS (Medicare/Medicaid agency). The report can be found here, and is relatively concise. The first 17 pages contain the analysis, and the rest of the 31 pages are basically tables.
The analysis I did looks at what will really happen to business and individual coverage, and is not generally covered here. But what is covered here are the changes to Medicaid, Medicare and the new CLASS coverage (a high-risk pool).
The bottom line:
We don't have that trillion. This will of course not prevent Congress from promising to spend it, but the point is that we won't be able to borrow that trillion either.
The small banks mostly believe we are in a depression. It's not even discussed or debated much; here is a quote from Mary Beth Guard of Bankers Online discussing current issues:
Rosenberg is even more negative, especially on the heading of unemployment. I still think we cap out at about 11%. Rosenberg is willing to look at 12-13%.
So I am now something of a middle-of-the roader; that hideous fried egg is still cooking on the reality range, and what that means is that either we bite the bullet and cut down the size of government quickly, or we end up doing it slowly with a much deeper total contraction.
I'm quite depressed over my interim conclusions. I went out to gossip around with farmers, grocers and other small business owners, and they all seem dourly pessimistic. I am afraid that ag loans will become the next casualty of this downturn. Worse yet, the best-case for the global economy is losing the positive end of the possibility branches. Japanese capacity utilization is still only about two-thirds; I don't know quite how they get out of this.
I still have Q3 growth in the mid 2% range, and Q4 about half a percentage point above, and then I see it sagging again. But I need one more month's worth of data to be able to pin that range down.
I'll post more as I pull this stuff together.
And I do not care if Obama bows to the Japanese emperor, although it is a gross violation of US tradition, based in our founding national precepts, if he would only start bowing to reality. If we do not take our medicine ASAP, we could easily be looking at a double-digit GDP loss by the end of several more negative cycles - and that is net!
The analysis I did looks at what will really happen to business and individual coverage, and is not generally covered here. But what is covered here are the changes to Medicaid, Medicare and the new CLASS coverage (a high-risk pool).
The bottom line:
- Over 200 billion of the Medicare savings are bogus, because they have to do with the cuts to primary care providers and will be substantially reversed in another bill now pending.
- The balance of the Medicare savings (about 300 billion) are ridiculous, and this report gently points that out, predicting that the cuts to institutional payments are not possible, and would end in Medicare patients not being served. See page 8, and look at the footnote.
- CLASS ( the new high-risk pool) is unsustainable and will contain adverse selection features such that it is DOA and likely to require significant federal funding as long as coverage is provided.
- The provisions associated with Medicare Advantage (the Medicare HMO program) would pretty much destroy the plans - most of the enrolled users would shift out.
We don't have that trillion. This will of course not prevent Congress from promising to spend it, but the point is that we won't be able to borrow that trillion either.
The small banks mostly believe we are in a depression. It's not even discussed or debated much; here is a quote from Mary Beth Guard of Bankers Online discussing current issues:
The change of administration, shifts in power and influence in Congress, the throes of an economic depression and an ongoing process at the Federal Reserve Board to review and revise Truth in Lending rules have formed the "perfect storm" for regulatory upheaval in several areas, not the least of which is the open end portions of Regulation Z.Mr. Muddle-Through, John Mauldin, who is neither a wacky optimist nor a doom-and-gloomer is heading toward capitulation in his last newsletter. I would recommend reading that one, because it is heavy on data, especially the tax gap. He now believes that we are doomed to a double-dip in 2011 unless the scheduled tax increases are terminated.
Rosenberg is even more negative, especially on the heading of unemployment. I still think we cap out at about 11%. Rosenberg is willing to look at 12-13%.
So I am now something of a middle-of-the roader; that hideous fried egg is still cooking on the reality range, and what that means is that either we bite the bullet and cut down the size of government quickly, or we end up doing it slowly with a much deeper total contraction.
I'm quite depressed over my interim conclusions. I went out to gossip around with farmers, grocers and other small business owners, and they all seem dourly pessimistic. I am afraid that ag loans will become the next casualty of this downturn. Worse yet, the best-case for the global economy is losing the positive end of the possibility branches. Japanese capacity utilization is still only about two-thirds; I don't know quite how they get out of this.
I still have Q3 growth in the mid 2% range, and Q4 about half a percentage point above, and then I see it sagging again. But I need one more month's worth of data to be able to pin that range down.
I'll post more as I pull this stuff together.
And I do not care if Obama bows to the Japanese emperor, although it is a gross violation of US tradition, based in our founding national precepts, if he would only start bowing to reality. If we do not take our medicine ASAP, we could easily be looking at a double-digit GDP loss by the end of several more negative cycles - and that is net!
Thursday, November 12, 2009
Oil Inventories
As we get closer to the end of the year, this data gets ever more astounding. Inventories of all classes are above the upper bound of the average level except for propane, which is in the upper half of the average range.
On a YTD basis compared to last year's YTD, domestic production has increased 6.8%. Total net imports have dropped 10.2%. Total product supplied down 4.7%.
Four week trends are worsening; motor gasoline demand is down by 1% over last year and diesel is down by 13.8% over last year. Last week refineries operated at 79.9% of capacity. When this feeds through to the industrial production reports, it will not be a pretty picture.
On the brighter side, initial claims dropped to 502,000, which finally managed to come in below the comparable week last year. That's a milestone!
I don't know when unemployment will stop rising, but it won't be soon. I just see more and more reports of companies paring. Even with the retirements to help us out, we will still have to be generating some net new jobs a month to start unemployment declines - and the moment things improve, a bunch of those discouraged workers are going to stampede back into the job market.
On a YTD basis compared to last year's YTD, domestic production has increased 6.8%. Total net imports have dropped 10.2%. Total product supplied down 4.7%.
Four week trends are worsening; motor gasoline demand is down by 1% over last year and diesel is down by 13.8% over last year. Last week refineries operated at 79.9% of capacity. When this feeds through to the industrial production reports, it will not be a pretty picture.
On the brighter side, initial claims dropped to 502,000, which finally managed to come in below the comparable week last year. That's a milestone!
I don't know when unemployment will stop rising, but it won't be soon. I just see more and more reports of companies paring. Even with the retirements to help us out, we will still have to be generating some net new jobs a month to start unemployment declines - and the moment things improve, a bunch of those discouraged workers are going to stampede back into the job market.
Wednesday, November 11, 2009
Veterans Day 2009
On Veterans Day, which began life as Armistice Day, we celebrate all our armed forces personnel who have served or are serving.
Obviously this year's celebration is a rather somber one due to the worries over Afghanistan and the Fort Hood massacre. But this should only serve to highlight our debts to our veterans, who devote their lives to the cause of our autonomy and security.
There are many veterans groups out there. Soldiers' Angels provides ways for those of even very limited incomes to demonstrate support. My chosen project is Valour-IT, which provides specially equipped laptops and now other types of electronic gadgets to help soldiers who have lost normal function in one way or another and need this equipment to function.
I don't have a tip thingie on this blog, and I don't run advertising. I do have that Valour-IT button, and if you would like to contribute, I'd be exceptionally grateful. As a person with a severe neurological disease I know what a difference this equipment can make to a wounded soldier's recovery and self-confidence.
There is one other quiet request I would like to make. I was very shaken up by reading comments calling for the deportation of all Muslims, etc in the aftermath of Fort Hood. Please remember there are well over ten thousand Muslims currently serving, and I doubt there has been a time in recent decades when there haven't been Muslims serving. Think about what you are saying - there are painful implications here, and it raises the specter of Japanese-Americans enlisting in WWII with their families in concentration camps, or German veterans who had received high military honors losing everything including their lives during Hitler's time in power. We must not walk down that road.
Our soldiers serve to defend our way of life, which includes as its most fundamental proposition the idea that a person should be condemned not on the basis of others' supicions, but upon only their own criminal deeds, and that until a person is condemned by their own acts, their lives, property and civil rights must and shall be defended by the full might of all our institutions.
There was obvious blindness in the military's response to Malik's behavior before the shooting, but that does not negate in any way the honorable and loyal service of thousands of others, nor the rights of their families to full citizenship. If our soldiers, who offer their lives of service for very modest compensation, can sacrifice wealth and risk dismemberment and death for the American Constitution, wimpy and frightened civilians should not be advocating violating it. To live in a constitutional democracy takes some courage - but not nearly as much as the millions of American veterans have shown.
Obviously this year's celebration is a rather somber one due to the worries over Afghanistan and the Fort Hood massacre. But this should only serve to highlight our debts to our veterans, who devote their lives to the cause of our autonomy and security.
There are many veterans groups out there. Soldiers' Angels provides ways for those of even very limited incomes to demonstrate support. My chosen project is Valour-IT, which provides specially equipped laptops and now other types of electronic gadgets to help soldiers who have lost normal function in one way or another and need this equipment to function.
I don't have a tip thingie on this blog, and I don't run advertising. I do have that Valour-IT button, and if you would like to contribute, I'd be exceptionally grateful. As a person with a severe neurological disease I know what a difference this equipment can make to a wounded soldier's recovery and self-confidence.
There is one other quiet request I would like to make. I was very shaken up by reading comments calling for the deportation of all Muslims, etc in the aftermath of Fort Hood. Please remember there are well over ten thousand Muslims currently serving, and I doubt there has been a time in recent decades when there haven't been Muslims serving. Think about what you are saying - there are painful implications here, and it raises the specter of Japanese-Americans enlisting in WWII with their families in concentration camps, or German veterans who had received high military honors losing everything including their lives during Hitler's time in power. We must not walk down that road.
Our soldiers serve to defend our way of life, which includes as its most fundamental proposition the idea that a person should be condemned not on the basis of others' supicions, but upon only their own criminal deeds, and that until a person is condemned by their own acts, their lives, property and civil rights must and shall be defended by the full might of all our institutions.
There was obvious blindness in the military's response to Malik's behavior before the shooting, but that does not negate in any way the honorable and loyal service of thousands of others, nor the rights of their families to full citizenship. If our soldiers, who offer their lives of service for very modest compensation, can sacrifice wealth and risk dismemberment and death for the American Constitution, wimpy and frightened civilians should not be advocating violating it. To live in a constitutional democracy takes some courage - but not nearly as much as the millions of American veterans have shown.
Tuesday, November 10, 2009
Lockhart Sent Me Into A Fetal Ball
I'm not uncurling until I can read Lockhart's speech and laugh until I cry instead of just crying. See CR. Oh, our inanity is transforming into insanity.
There were contributing factors; I unwarily took a look at Treasury yields. The news of the ultimate fate of the Kelo condemn-the-unblighted properties case. Green energy for our future. Shrinkwrapped's post yesterday elicited some remarkably bizarre suggestions, such as to deport all Muslims.
On the other hand, just as in science, when the old theories break down under the weight of evidence, one is often on the threshold not of hopeless confusion, but of a new and great discovery. Let it be so here. Herbert abruptly is able to criticize Obama (less than two months after describing criticism of Obama as racism). Hiatt points out that progressives may like the goal of the health care reform legislation, but that if the price tag is too high, ultimately it is a danger to progressive goals:
There were contributing factors; I unwarily took a look at Treasury yields. The news of the ultimate fate of the Kelo condemn-the-unblighted properties case. Green energy for our future. Shrinkwrapped's post yesterday elicited some remarkably bizarre suggestions, such as to deport all Muslims.
On the other hand, just as in science, when the old theories break down under the weight of evidence, one is often on the threshold not of hopeless confusion, but of a new and great discovery. Let it be so here. Herbert abruptly is able to criticize Obama (less than two months after describing criticism of Obama as racism). Hiatt points out that progressives may like the goal of the health care reform legislation, but that if the price tag is too high, ultimately it is a danger to progressive goals:
Under his plan, according to a CBO analysis, the government will be spending 24.5 percent of gross domestic product -- the total value of the national economy -- by 2019 while raising only 19 percent in revenue: a huge, unsustainable gap.When we are driven to the point of absurdity, the ability to recognize the contradictions and seek a new solution is often the key to a much brighter future.
In the kind of fiscal crisis that might ensue, as progressive budget expert Robert Greenstein said recently, "the risk is high that the people with the least political power in this country could bear a disproportionate share of the burden even though, by and large, they're lower on the income scale." The government would spend more and more on interest payments while likely stinting on college scholarships, inner-city schools, and, above all, aid to the poor and near-poor here and abroad.
Expanded access to health care has rightly been a goal for decades. No civilized nation should allow sick people to go untreated. Yet neither should a civilized nation saddle its coming generations with a lower standard of living, a likely effect of U.S. profligacy if unchecked. No civilized nation should leave its government too bankrupt to help the poor.
Monday, November 09, 2009
RBC CASH Index
I'm stil dead on my feet, so I won't be posting again today. My work on the understanding banking series was rudely interrupted by Friday's Fort Hood massacre and then the dog's death.
But one item I normally follow is the RBC CASH (Consumer Attitudes and Spending by Household) index. The last release was November 5th, and it was deeply disturbing. October's had taken an uptick, but for November:
However, this is serious:
Given that PCE last quarter had achieved its highest share ever of the economy, indications that consumer expectations are worsening have a sinister connotation. I am pretty sure that gas and energy prices are having something to do with this, but job and stock market expectations were low as well.
But one item I normally follow is the RBC CASH (Consumer Attitudes and Spending by Household) index. The last release was November 5th, and it was deeply disturbing. October's had taken an uptick, but for November:
The RBC Index for November 2009 stands at 30.2, down 21.6 points from October's 51.8 reading. Higher gas prices, slumping retail sales, volatile stock markets and continuing joblessness resulted in the sharpest one-month drop in consumer sentiment since last autumn's financial crisis.All four components fell. Gas prices are one big problem; concern over personal finances and local economies is a big factor, but job and investment expectation fell too.
However, this is serious:
Consumer expectations for the near-term economic future fell substantially in November, driven primarily by weakness in attitudes regarding local economies. The RBC Expectations Index for November 2009 plunged to 21.9, a 32.3 point drop from its 54.2 reading in October, which had been the strongest level of consumer expectations in 2009. The primary reason for concern in the near term is with consumers' local economies. Currently, fewer than one-third of Americans (30 per cent) expect their local economy to be stronger six months from now, down from 36 per cent in October.See page 3 of the underlying survey here for more detail. The low was 29 last December; and the trajectory from July through October was 31; 34; 38; 36. Results like these strongly suggest that many local economies WILL be weaker in six months.
Given that PCE last quarter had achieved its highest share ever of the economy, indications that consumer expectations are worsening have a sinister connotation. I am pretty sure that gas and energy prices are having something to do with this, but job and stock market expectations were low as well.
Saturday, November 07, 2009
They Passed HealthCare Tonight
The House, that is. Soon the country will be sick as a dog. See the CBO letter at their website. The bottom line is that an awful lot of money is supposed to be transferred from Medicare to the program; but what is not included is that those changes would force up the cost of health care to private insurers (or the govmt), so their scoring is wrong. The other thing, of course, is that most of the new CARE proposals don't kick in for years, whereas the revenue provisions do, so the estimate is flawed that way.
If you want to achieve a quick death from disgustion, read this Watts Up post about an aluminum factory that had to shut down because it couldn't buy electricity. In Montana.
This is another article which I think explains the situation more clearly. However people have to understand that all the existing mandates are raising, not lowering the cost of power, and that it is making many US manufacturers uncompetitive. The future of manufacturing is highly automated, but that does use a lot of power, and eventually, all the plants will wind up where power is cheapest.
Update: Washington Post has a nice sortable table of the votes on the bill. You can click on the headings and sort it any way you want. I knew my weasel was a Y, but I won't fail to write him a nice note telling him what I think of his vote and asking whether he read it, and giving a quiz he can answer to see if he understood it. All of this, of course, is to no avail. A version will pass in the Senate and will be reconciled and will be foisted upon the public.
If you want to achieve a quick death from disgustion, read this Watts Up post about an aluminum factory that had to shut down because it couldn't buy electricity. In Montana.
This is another article which I think explains the situation more clearly. However people have to understand that all the existing mandates are raising, not lowering the cost of power, and that it is making many US manufacturers uncompetitive. The future of manufacturing is highly automated, but that does use a lot of power, and eventually, all the plants will wind up where power is cheapest.
Update: Washington Post has a nice sortable table of the votes on the bill. You can click on the headings and sort it any way you want. I knew my weasel was a Y, but I won't fail to write him a nice note telling him what I think of his vote and asking whether he read it, and giving a quiz he can answer to see if he understood it. All of this, of course, is to no avail. A version will pass in the Senate and will be reconciled and will be foisted upon the public.
And If I Fall Asleep, The Dog Dies?
I don't know if anyone can help.
Since I woke up from an afternoon nap at about 4:00, I've been going through this. RD's last regular insulin was at 11:00 AM, and his total morning dosage was about 12 units lower than normal (35) because his blood sugars have been running lower.
At 4:00 the dogs wanted to go out. I took them out. Rescue Dog (RD) was running around, then looked shaky, then started going in circles. I dashed in the house for honey, and by the time I made it back out he was in major seizures.
Honey, honey, honey. After about 15 minutes he looked to be stabilizing. I got him in the house - two more doses of honey, then I took his blood sugar. 246? He started to go again (head bent to the side, his eyes rolled up, shaking). It had been too short a time for the honey I had given him (close to three tsps) to have really shown up on this meter that much, so I gave him two units of insulin. He went again. And again. And again. Deciding that was a mistake, honey, honey, honey. After about 25 minutes he appeared to be stabilizing. After about an hour he claimed he felt fine, went out, took a pee and took a dump. Less than 5 minutes, we headed back in, then he started to go again. I dragged him through the door as he was starting to convulse and administered honey, honey, honey. His blood sugar low measured during that sequence was about 180.
In a desperate series of maneuvers, since that time I have given him a total of about 7 ounces of honey, a cup of meat, about two cups total of dried dog food, and five dog biscuits which I usually used to adjust his blood sugar when it's too low. After two hours of honey administration, he stabilized somewhat, then I fed him some dinner in small quantities for an hour, then he showed up in the kitchen wanting dinner. He started to seize there, more honey. He ate dinner. He looked cheerful and wanted to go out. He just made it out the door and seized again, the worst yet, I couldn't even get near him for about five minutes. It took me 45 minutes out there and about 3 ounces of honey before I could get him on his feet and in again. I tested him out there, and his low was 130 but during that 45 minutes his blood sugar oscillated from 273 to 130 (he was 273 right after eating and before he walked out the door, about 20 minutes into it he hit 130, and no, I hadn't given him any insulin.)
His blood sugar for the last 30 minutes has average about 349, but he keeps beginning to go. Only the honey is stopping it. I tried to give 2.5 units of insulin, which has not yet lowered his blood sugar, but since that time I have to give him about 1/2 tsp of honey every 8 minutes to keep him from seizing again. (It's easy to tell - his neck always starts to arch and then his eyes roll up.)
I don't think the insulin is helping. Earlier his low after the 246 was 130, but it would oscillate wildly by approximately 100 points in less than 10 minutes.
No vet is open. If I stop giving him the honey he'll definitely die. Anybody got a clue? His body must be secreting some insulin on its own, because if it weren't his blood sugar would be well into the 600s by now. It seems to be punching it out about every 5 minutes. I suspect he's having some sort of brain seizures which are causing the adrenal gland to fire wildly, and the rest of it is his body trying to cope.
The minute he starts to go to sleep he seems to go again.
This is atypical; he has had similar (although much less dire) occurences but not since I put him on ciprofloxin months ago. Since then his blood sugar has mostly stabilized and he has been pretty chipper.
Note: while writing this post I gave him four doses of honey and a handful of dried dog food. Just after I posted I gave him more honey and some more food. Then he wanted to go out, he did, and he took another dump. In between incidents he appears almost entirely normal, aside from some stiffness (which is definitely due to the seizures). Right after coming in he wanted more, so I gave him another dog biscuit. But that wasn't enough - I then had to resort to the honey again.
Since I woke up from an afternoon nap at about 4:00, I've been going through this. RD's last regular insulin was at 11:00 AM, and his total morning dosage was about 12 units lower than normal (35) because his blood sugars have been running lower.
At 4:00 the dogs wanted to go out. I took them out. Rescue Dog (RD) was running around, then looked shaky, then started going in circles. I dashed in the house for honey, and by the time I made it back out he was in major seizures.
Honey, honey, honey. After about 15 minutes he looked to be stabilizing. I got him in the house - two more doses of honey, then I took his blood sugar. 246? He started to go again (head bent to the side, his eyes rolled up, shaking). It had been too short a time for the honey I had given him (close to three tsps) to have really shown up on this meter that much, so I gave him two units of insulin. He went again. And again. And again. Deciding that was a mistake, honey, honey, honey. After about 25 minutes he appeared to be stabilizing. After about an hour he claimed he felt fine, went out, took a pee and took a dump. Less than 5 minutes, we headed back in, then he started to go again. I dragged him through the door as he was starting to convulse and administered honey, honey, honey. His blood sugar low measured during that sequence was about 180.
In a desperate series of maneuvers, since that time I have given him a total of about 7 ounces of honey, a cup of meat, about two cups total of dried dog food, and five dog biscuits which I usually used to adjust his blood sugar when it's too low. After two hours of honey administration, he stabilized somewhat, then I fed him some dinner in small quantities for an hour, then he showed up in the kitchen wanting dinner. He started to seize there, more honey. He ate dinner. He looked cheerful and wanted to go out. He just made it out the door and seized again, the worst yet, I couldn't even get near him for about five minutes. It took me 45 minutes out there and about 3 ounces of honey before I could get him on his feet and in again. I tested him out there, and his low was 130 but during that 45 minutes his blood sugar oscillated from 273 to 130 (he was 273 right after eating and before he walked out the door, about 20 minutes into it he hit 130, and no, I hadn't given him any insulin.)
His blood sugar for the last 30 minutes has average about 349, but he keeps beginning to go. Only the honey is stopping it. I tried to give 2.5 units of insulin, which has not yet lowered his blood sugar, but since that time I have to give him about 1/2 tsp of honey every 8 minutes to keep him from seizing again. (It's easy to tell - his neck always starts to arch and then his eyes roll up.)
I don't think the insulin is helping. Earlier his low after the 246 was 130, but it would oscillate wildly by approximately 100 points in less than 10 minutes.
No vet is open. If I stop giving him the honey he'll definitely die. Anybody got a clue? His body must be secreting some insulin on its own, because if it weren't his blood sugar would be well into the 600s by now. It seems to be punching it out about every 5 minutes. I suspect he's having some sort of brain seizures which are causing the adrenal gland to fire wildly, and the rest of it is his body trying to cope.
The minute he starts to go to sleep he seems to go again.
This is atypical; he has had similar (although much less dire) occurences but not since I put him on ciprofloxin months ago. Since then his blood sugar has mostly stabilized and he has been pretty chipper.
Note: while writing this post I gave him four doses of honey and a handful of dried dog food. Just after I posted I gave him more honey and some more food. Then he wanted to go out, he did, and he took another dump. In between incidents he appears almost entirely normal, aside from some stiffness (which is definitely due to the seizures). Right after coming in he wanted more, so I gave him another dog biscuit. But that wasn't enough - I then had to resort to the honey again.
