Understanding century 21 - IT, Globalization and urban-urban migration

In the 90s the world kind of made sense. Since then, not so much. I don’t know if teens truly are experiencing an anxiety epidemic, but any American growing up in the new millennium has reason to be anxious.

I think the root causes of our disruption are globalization (China and India) and information technology (AI, robots, advertising supported web, etc) leading to peak human/mass disability and the collapse of the GOP.

I’m now considering a third factor — namely urban-urban migration (though it may be a consequence of globalization and IT rather than a root cause). The population required to sustain a viable local economy keeps increasing; this is absolutely not what we expected when the net was young. Once a city of 10,000 was viable, then a city of 50,000, then a few hundred thousand. We seem too heading towards a million as baseline.

This is politically potent here because the structure of American government gives disproportionate power to low population density regions. The pain of these communities is politically consequential. This is usually described as a “rural” crisis, but these aren’t “rural” in the traditional sense. They are regions around large towns and small cities that are no longer economically viable.

I was a family medicine resident and a young physician in communities like these. Recent stories feel familiar — they remind me of my desolate drives along the Erie Canal and the IT driven end of the mill town. It’s a worldwide thing.

Humans have been migrating from rural areas to cities for centuries. It’s often been socially disruptive. It still is, particularly because of the way American government works. The dying regions have power, and as they lose their cognitive elite they are ever more desperate and easier to deceive.

See also

• Gordon’s Notes: Crisis-T: What’s special about rural? 2016. Similar ideas from a year ago.

Saint Paul Minnesota mayoral race: bikes and peds

The extraordinary St Paul Bicycle coalition has a couple of useful references on our upcoming mayoral race:

• Candidate statements
• Voter Guide

They are careful not to make a recommendation; they need to work with the winner.

Pat Harris is the Dem establishment favorite. He’s not bad on pedestrians but relatively weak on bicycles. Melvin Carter is probably the progressive favorite - strong on bikes and peds. Elizabeth Dickinson is green party - and as supportive as one would expect. I’d put Dai Thao between Harris and Carter/Dickinson.

We have started doing ranked choice voting. It will be interesting to see how it plays out. Bike/ped/transit is big for my family, so I do like Mr Carter’s statements.

Small traps to watch out for: My Merrill Lynch unexpected brokerage fees

Life has lots of small traps. Sharing this one in case it’s useful.

I once worked for a firm that granted me stock options that were held by Merrill Lynch. I appreciated them. When I left that firm I thought I’d cleaned out the brokerage account. I was warned I’d need to pay $65 a year to keep it so I wanted the money out.

I didn’t quite close it though [1], so a late dividend of $72 went into the account. I missed that — busy with other things and Emily manages our statements. When she was able to get me to look Merrill Lynch said I was too late — a yearly fee of $65 had left only $7.

This time I did close the account — so next year I won’t owe them $58!

Moral of the story — don’t leave inactive accounts lying around. They will bite you in the butt. Get the damned things closed.

[1] Actually, I thought I did close it. I wonder if the dividend reopened it. Maybe there really isn’t a useful lesson to this story … except to have as few accounts as possible so you can track the darned things …

Elenco SnapCircuits 500 block layout

I have bought things for my children that I dreamt of as a child — but were out of my parent's price range.

Shockingly, my children have not always appreciated these gifts. For example — I think the Elenco Snap Circuits Pro 500 is a brilliant toy. I tried it on all 3 kids and was 0 for 3. No interest whatsoever.

Years later I needed to find a good home for it — but the parts had been scattered in a storage bin. Even though the components are in perfect shape the box had been water damaged by a minor basement flood and the “block layout” guide was unreadable. I tried to find one online but came up empty — though in writing this I discovered Elenco had it online all along. Happily I had a photo I’d taken and I found nothing was missing. I even have a candidate victim child to give the unused kit to.

Today, since I couldn’t find a photo on the web and Google couldn’t find the dang block layout, here’s one for anyone searching for it. (Assuming, of course, that Google indexes this page. It doesn’t index this kind of content anywhere near as well as it once did. Not coincidentally, once Google would have found that layout.)

I bought the extra books too!

and here’s the box …

Faughnan-Lagace Herald -- now Dilbert free

The first thing I did on the web, as a class assignment sometime between 1994 and 1995, was a personal profile. I just reread it. Ouch. I was pretty young well into middle age.

The Faughnan-Lagace Herald might have been the second thing I did. It was a quick way to visit a variety of favored news sources years before RSS, Reeder.app and Feedbin. The FLH would have started as HTML 2, but somewhere around 1995 or so I started using Microsoft FrontPage to edit it. It hasn’t needed many changes, which is good because about ten years ago I gave up on running FrontPage in an old XP VM.

It hasn’t needed many changes … but recently it started to become … irritating. It had a Dilbert problem:

Yes, a link to Dilbert — visible every time I visited my old news page. Once up on a time it kind of fit. It’s hard to remember now, but Scott Adams wasn’t always a de facto spokesperson for the white nationalists (Nati). Twenty years ago his comic strip was often entertaining. Today it’s embarrassing. 

Fixing this has been on my todo list for a while. It’s not that hard to edit FrontPage output in a text editor so today Arts & Leisure is much improved …

If only the rest the Trump world was as easy to fix.

CrossFit 58

I’ve had a habit around each birthday to review where I’m at with my exercise addiction. This past week was the 58th. I bought myself a Canon SL2 and Emily made me a fabulous Black Forest cake. So time for an update.

I started on the hard stuff at 53. I’d done some exercise before that - mostly road biking, nordic skiing, inline skating and other soft stuff. At 53 though, I fell into CrossFit. Actually, I was pushed. By a friend.

Four and a half years later I’m 58 and I’m still a regular at CrossFit St Paul. I average 3-4 CF workouts a week, mountain bike 1-2 times a week, and do 1-2 days a week of recovery weights or road biking or ice hockey or nordic skiing.

I’ve had soft tissue strains and pains from all of those things, but by now I’m good at rehab. I have a suite that covers hamstring/gluteal/“piriformis”, lower back strain, shoulder things, achilles stuff, chondromalacia patellae and more. “More” includes a familial arthritis syndrome affecting my hands and knees. Sooner or later that will do me in, but hydroxychloroquine seems to slow the progression. When it was diagnosed 2 years ago I figured I’d be out of CF by now, but the arthritis hasn't been a big deal yet.

I work the rehab into my workouts. It’s all one thing. Mostly I’m pretty good.

Over time I lost about 20 lbs of fat and gained about 5 lbs of muscle. Alas, at 58 I have no more muscle stem cells — those seem to go away in the 30s. I may yet get a bit stronger with practice, but not a lot. I’ve bumped up some of my weightlifting records, but recently my overhead squat and snatch have sucked. Seems the small amount of muscle I added to my shoulders came along with decreased range of shoulder motion. Gives me something else to work on.

I still can’t do consecutive double-unders, I have to mix singles and dubs. I may set a record for longest time practicing without success. It’s a coordination thing — I’ve always been clumsy but age sucks. I’ll try a fourth jump rope; some say a slower, heavier rope works better for the old. I have a rope for every occasion now.

I haven’t been able to do a muscle-up - neither bar nor ring. I work on it. Maybe someday.

I got into this to keep my formerly bad back better and because the only things that seem to slow dementia onset are sleep and exercise. I need to slow the dementia - family circumstances mean my brain has to work until about 85, when I can finally keel over and die. It’s too early to tell if it works for the dementia, but my back is pretty good.

Happily I enjoy CrossFit. I travel for work and always drop in on a CF gym — they are almost everywhere (not Hot Springs South Dakota though). I’m almost resigned to being the slowest and weakest person in the box.

It’s a living.

Moving the body - how much is too much?

I’ve read that our national dumpster fire believes exercise is unwise. That’s not a surprise.

It does remind me though of an open medical question — what is the optimal amount of physical activity?

We know the optimal amount of activity is far more than most Americans do. We suspect there are limits though. Most people should not try to deadlift 400 lbs without a lot of training and some helpful genetics. Likewise few bodies will do well running a marathon every other week.

That’s a pretty wide range though. It would help to have a guide for various ages. For example, I’ve found I run into trouble if I do full CrossFit workouts more than 3-4 times a week, but I bet 30 years ago I’d have been ok at 5-6 times a week. Once I’d have done well mountain biking daily, now my arthritic knees prefer 2-3 times a week.

When our stem cells are happy we don’t wear out like a camera shutter. When they’re depleted we may truly have a limited number of clicks. On the other hand, sometimes a set of heavy back squats puts my knees right for a week or more. That’s just weird.

There’s quite a bit of research on this question. It’s worth following …

Uninsured patients in US (mostly) no longer pay crazed "list price" for hospital care

I had no idea this situation had improved — and I follow health care fairly closely ….

The Pricing Of U.S. Hospital Services: Chaos Behind A Veil Of Secrecy Uwe Reinhardt

… Until recently, only uninsured, self-paying U.S. patients have been billed the full charges listed in hospitals’ inflated charge masters, usually on the argument that the Medicare rules required it.21 This is how even uninsured middle-class U.S. patients could find themselves paying off over many years a hospital bill of, say, $30,000 for a procedure that Medicaid would have reimbursed at only $6,000 and commercial insurers somewhere in between.22

Because uninsured patients often are members of low-income families, many of them ultimately paid only a fraction of the vastly inflated charges they were originally billed by the hospital, but only after intensive and morally troubling collection efforts by the hospital.23 After a series of searing exposes of these collection efforts in the press—notably by staff reporter Lucette Lagnado of the Wall Street Journal—Congress held hearings on these practices.24 Partly under pressure from consumers and lawmakers and partly on their own volition, many hospitals now have means-tested discounts off their charge masters for uninsured patients, which bring the prices charged the uninsured closer to those paid by commercial insurers or even below.25 Some very poor patients, of course, have received hospital care free of charge all along, on a purely charitable basis…

The whole article is essential reading for journalists and anyone working in health care policy or as a healthcare executive. Hell, I didn’t know California mandated publication of hospital charge masters. Progress really is being made.

Reinhardt, by the way, is 80 years old. Long may he write.

All those "Democrats and white middle class" articles explained in four lines.

I’m going to translate the subtexts and signals of What’s Wrong With the Democrats? - The Atlantic into plain language:

1. Democrats should have disowned Black Livers Matter.
2. Democrats shouldn’t run a woman for the presidency.
3. Democrats should have lied more.
4. Democrats should have paid more attention to the economic collapse of the non-college (peak human, mass disability)

I agree with the fourth. I was worried about that before Trump took over. I don’t agree with #3, I think lying works a lot better on the GOP base than the Dem base.

Number one and two remind me of the Al Gore’s choice to embrace gun management measures. It was a progressive and brave act, but Americans showed they didn’t want it. Dems have not pushed it since.

I don’t think we’ll see a woman running for the presidency of the United States in the next ten years. Maybe 20 years. I was shocked that almost half of white college educated women voted for Trump. HRC was less excellent than Obama, but she was pretty good. Since white men are  hopeless the lack of support from white women was a killer.

I also think Dems will shy away from BLM like movements - at least for another decade. We won’t say that loudly, but watch what happens. American racism is stronger than many thought.

The are sad predictions. I hope I’m wrong, but I don’t have a lot of faith in post-Trump America. 

Now that we’ve got that out of the way, can journalists top writing these articles?

Escape from the Wheel of Time

I finished ‘A Memory of Light’. And the thirteen Wheel of Time volumes before that. I feel like I’ve been released from Compulsion.

It’s not high art. Some of it was a slog and not every thread was accounted for. The twists and retcons reminded me of long run comic book sagas. It can entertain though. Jordan turned a single volume book into a trilogy and then into a monster — and he more or less held it together. That’s worthy of a prize, or, in his case, a fortune.

Jordan died after book 11 and Brandon Sanderson wrote books 12-14 from notes and imagination. I thought there were some odd word choices in his first chapters, but either he settled in or I got used to his style. It was fun that three of the heroic characters were writers; I don’t think any villains were.

Game of Thrones, which I abandoned after a particularly misogynistic volume, is clearly an heir to WOT. I read that there will be a WOT inspired TV series — that will require a bit of editing.

I can’t exactly recommend WOT, but if you get sucked in the ride isn’t all bad. Most libraries will have it and there are many used volumes floating around, so you don’t have to buy every volume new. I bought about 5 and borrowed the rest from a friend and the library.

United airlines passenger assault: Blame the Feds.

Involuntary bumped seat leading to assault on a United Airlines passenger?

Blame the Department of Transportation (emphases mine):

If you’re involuntarily denied boarding, the Department of Transportation regulates what you’re entitled to. Here are the rules, as published by the DOT …

… If the substitute transportation is scheduled to get you to your destination more than two hours later (four hours internationally), or if the airline does not make any substitute travel arrangements for you, the compensation doubles (400% of your one-way fare, $1350 maximum)….

The US government sets the maximum compensation amount. I suspect that amount was set years ago and hasn’t changed

The article I found this in calls $1,350 “sizable”. No. That is not “sizable". I was almost bumped myself because Delta couldn’t find takers of a similar offer. $1,350 was a reasonable offer in 1990. In our 2017 lives a reasonable offer starts at $5,000. If there has to be a  limit that limit should be around $10,000 — regardless of ticket price.

So, yeah, I hate United as much as most travelers. But this one the Feds own.

Broken world: applying for a minimum wage job via a corporate HR web site

My #1 son is a special needs adult. He’s excited to start at $10/hour job running food around a sports stadium. It’s work he can do — he’s got a great sense of direction and he is reasonably fit.

The job engagement process is run by an archaic corporate web site that looks like it was built for IE 3. The site claims to support Safari but warns against Chrome. It is not useable on a smartphone.

The HR process requires managing user credentials, navigating a complex 1990s style user interface, and working around errors made by the HR staff — who probably also struggle with the software. He would not have the proverbial snowball’s chance without my ability to assume his digital identity.

Sure, #1 is below the 5th percentile on standard cognition tests — but this would have been a challenge to the 15th percentile back in the 90s. In the modern era, where most non-college young people are primarily familiar with smartphones, this is a challenge to the 30th percentile.

Which means the people might want to do this job are being shut out by the HR software created to support the job. Which probably has something to do with this.

The world is broken.

#massdisability

All our family healthcare visits are now billed as CPT E&M Code "Level Four"

Very few people will understand what that subject line means.

The short version is that the way we account for physician services was born broken in 1994 and it is now in a state of advanced collapse.

It can’t go on and it can’t stop.

Don Berwick, the best CMS administrator we’ve ever had (forced out by GOP) said this five years ago:

.. Dr. Donald Berwick, the immediate past administrator of the Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program, said a small portion of the billing increase is likely caused by outright fraud, but in the majority of cases hospitals are legally boosting profits by targeting the vulnerabilities of Medicare’s payment system. “They are learning how to play the game,” Berwick said about the hospitals....

... Berwick, the former CMS head, said patients haven’t changed. What’s changed is the aggressiveness of how hospitals bill. “They are smart,” Berwick said. “If you create a payment system in which there is a premium for increasing the number of things you do or the recording of what you do, well, that’s what you’ll get.”...

See also

• Gordon's Notes: Health care reform. Be humble. Be afraid of the accounting rules. 1/2009. RBRVS. We had such good intentions.
• Gordon’s Notes: Electronic health records and payment increases: It’s not fraud. 10/2012. 

Curious Priceline credit card fraud today

Around 2:30pm Amex.app tells me a $1.00 authorization charge has been placed for Priceline. Which I didn’t do. 

I’m in a meeting so I figure I’ll follow up later.

Around 4pm I get a Google Voice transcription from “Cynthia” of the “Priceline.com fraud prevention department” asking me to call 203-441-8455. Someone has ordered two plane tickets on my Amex card.

I call Amex and they do see the transactions. They never made it to my account though, so they must have run hard into Amex fraud detection (best in the industry AFAIK). I’m issued a new card. Noteworthy: I’m told my many recurring online transactions won’t break and later in the day Apple Pay tells me it’s automatically updated my information with the new card — though I won’t get the physical card for a few days.

I do call 203-441-8455. They claim to be Priceline Fraud Prevention, but they sound awfully shady. I already knew I wasn’t going to give them any personal data so I carried on. (I later googled the number, found a 2012 ref that said this was indeed them.)

I was told two plane tickets were bought on my card — and there’s a name attached to each ticket (vaguely Indian/middle eastern sounding names). The harried woman says the plane leaves in 30 minutes so they probably can’t block them. Which is, of course, Priceline’s problem. There’s a reason I like American Express.

Note to Priceline.com: your Fraud Prevention department should sound less like an international call shop scam operation.

I checked my ancient and little used Priceline account. It had a robust password, had no transaction records, and it didn’t hold my Google Voice number. I don’t think it was hacked. I changed the password anyway.

It’s a bit weird. Why would someone use a stolen credit card to buy plane tickets when they have to match the name on the tickets to their personal ID? It seems a risky behavior! And how did Priceline get my Google Voice number? (Maybe from AMEX?) Least odd is that someone stole my AMEX credentials (the physical card is at home). I assume all my credit card numbers are available online for a few dollars.

I wonder if Priceline is a particularly effective way to buy plane tickets with a stolen credit card number? I doubt Priceline will report any of this to the police, even though they probably have the traveler’s true names.

A change to my publishing streams

These are the last days of app.net. It ends in 3 days. App.net has been good to me. Great tools, smart and interesting people, RSS integration (albeit grudgingly at first) and the best communication/conversation platform I’ve worked with. App.net was what Twitter should have been. It has made clear how badly Twitter has failed.

These are, surprisingly, also the end times for Maciej’s Pinboard as a publishing platform. I have 33,236 pins there, and something is broken. Neither pinner.app or pushpin.app are able to connect and download the streams. From what Maciej has written in the past I may have passed some throttling limit. I’m using Pinboard in ways he did not intend — and the iOS apps don’t scale either. 

So I need to make some changes. Gordon’s Notes and Tech will stay on Blogger for now — it’s been surprisingly robust and trouble free for many years. It helps that there’s an exit strategy to WordPress if Google kills it, but as best I can tell Google is going to keep Blogger limping along.

My DreamHost wordpress microblog has mirrored my pinboard stream for years. I’m going to see if there’s a way to make it a true microblog publishing platform. I’m not sure how to do that, in particular it’s not obvious how I can conveniently post via Reeder.app. It will take me a while to work that out.

In the meantime there are several app.net spinoffs in the work. I’m tracking several of these as much as my time allows - especially pnut.io (@jgordon) and 10centuries (@jgordon). March 2017 is a heck of a month for me so things have gone slowly.

Uncertain times! For now if you follow kateva.org/sh you’ll see what I’m up to, no matter how the process evolves.