Month: June 2013

Eric Morath calls attention to the first time that the medical cost index has posted a monthly decline since 1975:

The effects of the federal health care overhaul — the Affordable Care Act that passed in 2010 —and constrained government payments to doctors and hospitals seems to be trickling down to consumers, both those directly purchasing insurance plans and those buying drugs and treatments. “The slowing of healthcare inflation right now seems to be driven by onset of new policies,” said Alec Phillips, a Goldman Sachs economist who follows health care trends. “That is probably going to be a temporary factor.” In the coming year, the next phase of the health care overhaul will expand coverage and increase subsidy payments and could, in turn, push medical costs back up, Mr. Phillips said.

Drum throws cold water:

[M]edical inflation has been outrunning overall inflation by about 1.5 percentage points ever since the 1950s, and, roughly speaking, that’s still the case. There’s been a bit of a slowdown over the past decade, but only a bit.

Laurie McGinley examines a report that “concludes that if present trends continue Medicare savings will be $1 trillion more in the next 10 years than the savings projected by the Congressional Budget Office in May”:

The changes, Al Dobson said in an interview, are the result of marketplace pressures and the Affordable Care Act, which set new penalties for hospital readmissions, and included bundled payments and other incentives for hospitals and doctors to find ways to cut costs without hurting patients.

But why assume present trends will continue? For one thing, won’t the aging of the Baby Boomers drive up Medicare spending? The answer Dobson argues, is counter-intuitive: At least for the next several years, Baby Boomers will be the youngest people on Medicare, a positive trend, cost-wise. That gives the nation a “respite,” he contends, to figure out how to handle needed entitlements changes. “We have 10 years to figure this baby out,” he says. “If we don’t, it could be pretty messy.”

Tim Fernholz, meanwhile, profiles a firm that thinks keeping healthcare costs in check could be as simple as a little more transparency:

Castlight [is] a big data firm that launched a service to help big employers, from companies like Safeway to the state of Indiana, cut health insurance costs. Castlight uses each employer’s historical data on insurance claims and payments to develop price and quality comparisons for local health-care providers, from physicians to pharmacists. That data is provided to people on the insurance plan, who use web and mobile apps to find the best combination of cost and quality for their needs. That can mean big savings if the cost of a procedure like a colonoscopy varies by as much as a factor of seven. Right now, 4 million people use Castlight’s service, and the company is set to grow. But it can do better, according to its CEO and co-founder, Dr. Giovanni Colella, if it gets more data from the government.

Richard Restak describes how the brain processes jokes:

All humor involves playing with what linguists call scripts (also referred to as frames). Basically, scripts are hypotheses about the world and how it works based on our previous life experiences. Consider what happens when a friend suggests meeting at a restaurant. Instantaneously our brains configure a scenario involving waiters or waitresses, menus, a sequence of eatables set out in order from appetizer to dessert, followed by a bill and the computation of a tip. This process, highly compressed and applicable to almost any kind of restaurant, works largely outside conscious awareness. And because our scripts are so generalized and compressed, we tend to make unwarranted assumptions based on them. Humor takes advantage of this tendency.

Consider, for example, almost any joke from stand-up comedian Steven Wright, known for his ironic, deadpan delivery:

—I saw a bank that said “24 Hour Banking,” but I didn’t have that much time.
—I bought some batteries, but they weren’t included. So I had to buy them again.
—I washed a sock. Then I put it in the dryer. When I took it out it was gone.
—I went into a store and asked the clerk if there was anything I could put under my coasters. He asked why I wanted to do that. I told him I wanted to make sure my coasters weren’t scratching my table.

In each of these examples, everyday activities are given a different spin by forcing the listener to modify standard scripts about them. Indeed, the process of reacting to and appreciating humor begins with the activation of a script in the brain’s temporal lobes. It is the brain’s frontal lobes that make sense of the discrepancy between the script and the situation described by the joke or illustrated by the cartoon.

This ability is unique to our species. Though apes can engage in play and tease each other by initiating false alarm calls accompanied by laughter, they cannot shift back and forth between multiple mental interpretations of a situation. Only we can do this because—thanks to the larger size of our frontal lobes compared with other species—we are the only creatures that possess a highly evolved working memory, which by creating and storing scripts allows us to appreciate sophisticated and subtle forms of humor. Neuroscientists often compare working memory to mental juggling. To appreciate a cartoon or a joke, you have to keep in mind at least two possible scenarios: your initial assumptions, created and stored over a lifetime in the temporal lobes, along with the alternative explanations that are worked out with the aid of the frontal lobes.

Speaking of standup, Patton Oswalt reflected recently on some of its most contentious aspects:

The comedians I’ve known who joke about rape—and genocide, racism, serial killers, drug addiction, and everything else in the Dark Subjects Suitcase—tend to be, internally and in action, anti-violence, anti-bigotry, and decidedly anti-rape. It’s their way—at least, it’s definitely my way—of dealing with the fact that all of this shittiness exists in the world. It’s one of the ways I try to reduce the power and horror those subjects hold for me. And since I’ve been a comedian longer than any of the people who blogged or wrote essays or argued about this, I was secure in thinking my point of view was right. That “rape culture” was an illusion, that the examples of comedians telling “rape jokes” in which the victim was the punchline were exceptions that proved the rule. I’ve never wanted to rape anyone. No one I know has ever expressed a desire to rape anyone. My viewpoint must be right. Right?

I had that same knee-jerk reaction when the whole Daniel Tosh incident went down. Again, only looking at it from my experience. And my experience, as a comedian, made me instantly defend him. I still do, up to a point. Here’s why: He was at an open mic. Trying out a new joke. A joke about rape. A horrible subject but, like with all horrible subjects, the first thing a comedian will subconsciously think is, “Does a funny approach exist with which to approach this topic?” He tried, and it didn’t go well. I’ve done the same thing, with all sorts of topics. Can I examine something that horrifies me and reduce the horror of it with humor? It’s a foolish reflex and all comedians have it.