Tag Archives: photos

Hillary’s Brain: A New Classic of American Sleazance Fiction from Karl Rove

Mother Jones

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Steve Benen thinks that Karl Rove’s drive-by shot at Hillary Clinton has failed:

If Karl Rove hoped to generate some chatter with his cheap shot at Hillary Clinton last week, he succeeded — the political world has now been chewing on the “brain damage” story for nearly a week. But by all appearances, Rove has started a conversation that’s focused more on his propensity for sleazy tactics than the former Secretary of State’s health.

….Nearly all the major Sunday shows discussed Rove’s latest salvo, but the focus was on Rove, not Clinton and her 2012 illness. Sen. Claire McCaskill (D-Mo.) blasted Rove for “struggling to be relevant.” Sen. Dianne Feinstein (D-Calif.) dismissed Rove’s rhetoric as “stupid” and “pathetic.” Former Mayor Michael Bloomberg (I) called Rove’s offensive “outrageous.”

Karl Rove wanted to manufacture a story about Hillary Clinton. He instead created a story about Karl Rove.

I disagree. The press has been talking about Rove’s sleazy tactics for more than a decade. Rove is used to that and obviously doesn’t care. There’s just nothing new on that front, and even if this did somehow damage Rove, it wouldn’t have any effect on the Republicans actually running against Hillary in 2016.

But there’s not much question that Rove has generated a lot of buzz about Hillary’s health. By itself, this isn’t a big deal, but as part of the nonstop mudslinging that Hillary will have to endure for the next couple of years, it’s perfect. Every one of these incidents will be designed to sow a small seed of doubt, and eventually one or two of these seeds might catch on and blossom into an acorn. And from tiny acorns, mighty oaks sometime grow. Mission accomplished!

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Hillary’s Brain: A New Classic of American Sleazance Fiction from Karl Rove

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Friday Cat Blogging – 16 May 2014

Mother Jones

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This is nature red in tooth and claw. Today, Domino can barely even rouse herself to stare disdainfully at the camera. To make up for her lethargy, however, we have additional wildlife blogging this week. Our mama hummingbird has built herself a little hummingbird nest and is now patiently waiting for her teensy tiny little eggs to hatch. When I took this picture, Domino was plonked out about five feet away, blissfully unaware that anything was going on. Jasmine probably would have scoped this situation out pretty quickly and figured out a way to shinny up the bush and snag the eggs. But Domino? Anything more difficult to hunt than a bowl of cat food is just not on her radar. At our house these days, the wildlife all lives in a state of peaceful coexistence.

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Friday Cat Blogging – 16 May 2014

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Raw Data: America Is Still Producing Lots of Inventive Young Companies

Mother Jones

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Here’s a quick follow-up to my post last week about the decline in new business startups over the past few decades. Does this suggest that America is getting less entrepreneurial? In one way, yes: some of it is probably due to big national chains making it harder to start small family businesses, and some of it is probably due to an aging population. Economically, however, the triumph of gigantic chain stores isn’t necessarily a bad thing, and the aging of the baby boomers should be thought of as a separate demographic issue, not a business startup issue.

Still, economists all agree that the key to a healthy economy is young, growing companies (not small businesses pe se). So how are we doing on that score? Over at Slate, Jordan Weissman points to a study by Paul Kedrosky that tries to quantify the number of startups that grow to $100 million or more in a fairly short period. The chart on the right shows his results. There’s a spike during the dotcom boom of the late 90s, and a dropoff during the Great Recession—a period too recent to have yet produced very many $100 million companies anyway—but there’s basically no secular decline at all. Roughly speaking, America has been producing about 150 small, fast-growing companies per year for the past three decades.

This is just a single data point, and Kedrosky warns that his data is necessarily pretty rough. But it does suggest that although America might be producing fewer new coffee shops and boutique clothing stores, it’s not necessarily losing its inventive edge.

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Raw Data: America Is Still Producing Lots of Inventive Young Companies

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Maybe Cable Bundling Is OK, But We Should Unbundle Sports

Mother Jones

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Josh Barro makes the case today that unbundling cable channels and offering them a la carte wouldn’t really benefit consumers. This point has now been made so many times that I don’t think it counts as counterintuitive anymore, but Barro makes one additional point that represents my real gripe with channel bundling:

Not everyone would lose out. For example, if you never watch sports, you might be better off not having to pay for ESPN, which charges the highest carriage fee of any basic cable channel. But Mr. Byzalov estimates that sports channel carriage fees would more than triple under unbundling, as most subscribers opt out and only die-hard sports fans buy in. Consumers who don’t care about sports at all would be better off, but casual sports fans would be worse off: They wouldn’t find it worth paying $37 for an unbundled cluster of sports channels, even if they would have paid the roughly $9 that it costs to get those channels as part of a bundled package.

Most people don’t know just how much sports channels cost them, but they can account for nearly half of your average cable bill in some areas. Not everywhere, mind you, but the explosion of sports channels (Fox Sports 1, the NFL channel, the Golf channel, the NBC Sports Channel, etc.) and rise of dedicated team channels (the Lakers channel, the Dodgers channel, the Pac-12 channel, etc.) have steadily pushed the price of sports skyward in big media markets like Southern California. You don’t pay $9 for that collection. Carriage fees are a closely guarded secret, so it’s hard to say how much you do pay, but it’s probably something like $25 or more.

This doesn’t hurt me, since I watch enough sports to (mostly) make this worthwhile. And the fact that all you non-sports watchers have to pay for this stuff basically subsidizes my habit. So thanks! But honestly, I don’t think you should have to. When Time Warner demands that the Dodgers channel be part of basic cable—my latest hobbyhorse—it basically amounts to a Dodgers tax on every family in the LA area. But I’m afraid I don’t really see why Time Warner should be allowed to levy a tax on every family in the LA area.

So go ahead and keep bundling. Maybe it’s more efficient in the end, and doesn’t really cost most of us very much money. But unbundle sports. It’s a big expense, and those of us who are sports junkies ought to be the ones paying it. Plus there’s this: if we all paid the true cost, instead of forcing everyone to subsidize the rest of us, it might finally provoke some serious pushback—and maybe the astronomical and absurd upward spiral of sports rights would finally abate. If this means the Dodgers are worth only $1.7 billion instead of $2 billion, that’s OK with me.

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Maybe Cable Bundling Is OK, But We Should Unbundle Sports

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Heartbleed is a Sucking Chest Wound in the NSA’s Reputation

Mother Jones

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On Friday, Bloomberg’s Michael Riley reported that the NSA was aware of the Heartbleed bug from nearly the day it was introduced:

The U.S. National Security Agency knew for at least two years about a flaw in the way that many websites send sensitive information, now dubbed the Heartbleed bug, and regularly used it to gather critical intelligence, two people familiar with the matter said….Putting the Heartbleed bug in its arsenal, the NSA was able to obtain passwords and other basic data that are the building blocks of the sophisticated hacking operations at the core of its mission, but at a cost. Millions of ordinary users were left vulnerable to attack from other nations’ intelligence arms and criminal hackers.

Henry Farrell explains just how bad this is here. But later in the day, the NSA denied everything:

“NSA was not aware of the recently identified vulnerability in OpenSSL, the so-called Heartbleed vulnerability, until it was made public in a private-sector cybersecurity report,” NSA spokesperson Vanee Vines told The Post. “Reports that say otherwise are wrong.”

The White House and the Office of the Director of National Intelligence echoed that statement Friday, saying neither the NSA nor any other part of the U.S. government knew about Heartbleed before April 2014….The denials are unusually forceful for an agency that has historically deployed evasive language when referring to its intelligence programs.

You know, I’m honestly not sure which would be worse. That the NSA knew about this massive bug that threatened havoc for millions of Americans and did nothing about it for two years. Or that the NSA’s vaunted—and lavishly funded—cybersecurity team was completely in the dark about a gaping and highly-exploitable hole in the operational security of the internet for two years. It’s frankly hard to see any way the NSA comes out of this episode looking good.

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Heartbleed is a Sucking Chest Wound in the NSA’s Reputation

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Friday Cat Blogging – 11 April 2014

Mother Jones

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Here she is, the Queen of Sheba, keeping a watchful eye on her domain and her loyal subjects. Soon she will take a well-deserved nap.

But before you take a nap, how about donating a few bucks to our investigative reporting fundraiser? Our goal is to raise $100,000 over the next three weeks. As you all know, we’re a reader-supported nonprofit, so those dollars aren’t going to come from big corporations or super-rich political donors. They’ll be small contributions from regular people who read Mother Jones. If you value our reporting—or hell, even if you only value our catblogging—please donate $5 to the Mother Jones Investigative Fund. If you can afford it, make it $10. We’ll put it to good use. Here’s how to make a contribution:

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Friday Cat Blogging – 11 April 2014

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Senate Torture Report Starts to Leak

Mother Jones

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In an entirely unsurprising development, it appears that the Senate report on CIA torture is starting to get leaked. Today, McClatchy reports the complete list of findings from the report, including these:

The CIA’s use of enhanced interrogation techniques did not effectively assist the agency in acquiring intelligence or in gaining cooperation from detainees.
The CIA inaccurately characterized the effectiveness of the enhanced interrogation techniques to justify their use.
The CIA’s use of enhanced interrogation techniques was brutal and far worse than the agency communicated to policymakers.
The CIA impeded effective White House oversight and decision-making. The CIA has actively avoided or impeded congressional oversight of the program. The CIA impeded oversight by the CIA’s Office of Inspector General.
The CIA manipulated the media by coordinating the release of classified information, which inaccurately portrayed the effectiveness of the agency’s enhanced interrogation techniques.

The whole story is here, along with the complete list of findings. I expect more like this in the future unless the CIA stops slow rolling its declassification process and allows the report to be substantially released.

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Senate Torture Report Starts to Leak

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Quiz: Who’s More Metal, the Cat or the Owner?

Mother Jones

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Metal Cats, a new book that compiles photos of headbangers with their felines, made us wonder: Who’s more metal, cat or owner? Take the quiz below, featuring some of the book’s photos, to find out.

(function($)

function make_default_how_you_did_html(nCorrect, nQuestions)
var answersWord = nCorrect === 1 ? ‘answer’ : ‘answers’;
return ‘You got ‘ + nCorrect + ‘ ‘ +
‘correct ‘ + answersWord + ‘ out of ‘ + nQuestions + ‘ questions’;

function make_default_how_you_did_htmls(nQuestions)
var ret = [];
for (var i = 0; i <= nQuestions; i++)
ret.push(make_default_how_you_did_html(i, nQuestions));

return ret;
}

$.quiz = function(quiz_data, results_data, options)
var container_elem;
var self;
var cover;
var cheater_answer_tracking = [];
var answer_tracking = [];
var how_you_did_element;

var quiz =
defaulting_behavior_on : true,
defaulting_flag : ‘!default’,
container : ‘quiz_container’,
not_finished_html : undefined,
cheating : false,
possible_display_elements :

name : ‘backgroundimage’,
finder: function(container)
return container.find(‘.’ + this.name);
,
create_element : function(slide)
if (!slide) return ”;
return $(‘<div class=”‘ +
this.name +
‘” style=”background-image: url(” +
slidethis.name +
”); height: 100%; width: 100%;position:absolute;z-index: -1″>’
);
}
},

name : ‘topimage’,
finder: function(container)
return container.find(‘.’ + this.name);
,
create_element : function(slide)
if (!slidethis.name) return ”;
return $(

);
}
},

name : ‘topvideoembed’,
finder: function(container)
return container.find(‘.’ + this.name);
,
needs_aspect_ratio : true,
create_element : function(slide)
//check aspect ratio
if (!slide.topvideoembedaspectratio) return ”;
return $(” +
slidethis.name + ”
);
}
},

name : ‘title’,
finder: function(container)
return container.find(‘.’ + this.name);
,
create_element : function(slide)
if (!slidethis.name) return ”;
return $(‘

‘ +
slidethis.name + ”
);
}
},

name : ‘middleimage’,
finder: function(container)
return container.find(‘.’ + this.name);
,
create_element : function(slide)
if (!slidethis.name) return ”;
return $(

);
}
},

name : ‘middlevideoembed’,
needs_aspect_ratio : true,
finder: function(container)
return container.find(‘.’ + this.name);
,
create_element : function(slide)
//check aspect ratio
if (!slide.middlevideoembedaspectratio) return ”;
return $(” +
slidethis.name + ”
);
}
},

name : ‘subhed’,
finder: function(container)
return container.find(‘.’ + this.name);
,
create_element : function(slide)
if (!slidethis.name) return ”;
return $(” +
slidethis.name +

);
}
},

name : ‘text’,
finder: function(container)
return container.find(‘.’ + this.name);
,
create_element : function(slide)
if (!slidethis.name) return ”;
return $(” +
slidethis.name +

);
}
},

name : ‘bottomimage’,
finder: function(container)
return container.find(‘.’ + this.name);
,
create_element : function(slide)
if (!slidethis.name) return ”;
return $(”
);
}
},

name : ‘bottomvideoembed’,
needs_aspect_ratio : true,
finder: function(container)
return container.find(‘.’ + this.name);
,
create_element : function(slide)
//check aspect ratio
if (!slide.bottomvideoembedaspectratio) return ”;
return $(” +
slidethis.name + ”
);
}
}
],

init : function(quiz_data, results_data, options)
self = this;

if (options)
for ( var option in options )
selfoption = optionsoption;

}

if (typeof(quiz_data) === ‘string’)
// is a google spreadsheet.
// Will call init_data in a callback
self.load_from_google_spreadsheet(quiz_data);
else
if (!results_data)
results_data = make_default_how_you_did_htmls(quiz_data.length);

self.init_data(quiz_data, results_data);
}

return self;
},
init_data: function(quiz_data, results_data)
self.quiz_data = quiz_data;
self.results_data = results_data;

self.calculate_aspectratios(quiz_data);
self.create_cover();

for ( var i = 0; i < self.quiz_data.length; i++ )
self.append_question(i);

self.append_how_you_did_section();
self.update_how_you_did_element();
self.preload_answer_images();
},
append_how_you_did_section: function()
how_you_did_element = $(”);
cover.append(how_you_did_element);
,

load_from_google_spreadsheet: function(spreadsheet_id)
Tabletop.init(
key: spreadsheet_id,
proxy : ‘https://s3.amazonaws.com/mj-tabletop-proxy’,
callback: function(data)
var quiz_data = self.make_quiz_data_from_spreadsheet_data(data);
var results_data = self.make_results_data_from_spreadsheet_data(data, quiz_data);
self.init_data(quiz_data, results_data);

});
},
calculate_aspectratios: function(data)
for (var i = 0; i < data.length; i++)
var row = datai;
for (var k = 0; k < row.possible_answers.length; k++)
var answer = row.possible_answersk;
self.find_aspectratio_for_each_type_of_video_embed(answer);

self.find_aspectratio_for_each_type_of_video_embed(row.question);
}
},

find_aspectratio_for_each_type_of_video_embed : function(slide)
for (var i = 0; i < self.possible_display_elements.length; i++ )
var display = self.possible_display_elementsi;
if ( display.needs_aspect_ratio && slidedisplay.name )
slidedisplay.name + ‘aspectratio’ =
self.find_aspectratio(slidedisplay.name);

}
},
find_aspectratio: function(videoembed)
var height = videoembed.match(/height=”d+”/);
if (!height
height = parseInt(height0.replace(/height=”/, ”).replace(/”/, ”), 10);

var width = videoembed.match(/width=”d+”/);
if (!width || !width0)
console.log(‘Your video embed code needs a width.’);
return ”;

width = parseInt(width0.replace(/width=”/, ”).replace(/”/, ”), 10);

return (height / width)*100;
},
pull_answer_value_from_spreadsheet : function(row, value, wrong_number, correct)
correct = correct ? ‘right’ : ‘wrong’;
if (rowcorrect + wrong_number + value && rowcorrect + wrong_number + value !== self.defaulting_flag)
return (rowcorrect + wrong_number + value);

if ((self.defaulting_behavior_on && rowcorrect + wrong_number + value !== self.defaulting_flag) ||
(!self.defaulting_behavior_on && rowcorrect + wrong_number + value === self.defaulting_flag)
)
return (rowcorrect + value && rowcorrect + value !== self.defaulting_flag ?
rowcorrect + value :
(row’answer’ + value && row’answer’ + value !== self.defaulting_flag ?
row’answer’ + value :
row’question’ + value
)
);
else
return ”;

},
get_possible_answers : function(row, is_correct)
var possible_answers = [];
var right_or_wrong = (is_correct ? ‘right’ : ‘wrong’);
if (rowright_or_wrong)
possible_answers.push(self.make_possible_answer(row, ”, is_correct));

for (var i = 0; i < 10; i++ )
if (rowright_or_wrong + i)
possible_answers.push(self.make_possible_answer(row, i, is_correct));

}
return possible_answers;
},
make_possible_answer: function(row, row_number, is_correct)
var right_or_wrong = (is_correct ? ‘right’ : ‘wrong’);
var answer =
answer: rowright_or_wrong + row_number,
correct: is_correct
;
for (var i = 0; i < self.possible_display_elements.length; i++ )
var display_element = self.possible_display_elementsi.name;
answerdisplay_element = self.pull_answer_value_from_spreadsheet(
row, display_element, row_number, is_correct
);

return answer;
},
make_quiz_data_from_spreadsheet_data: function(tabletop)
var i, j, sheetName, data;
var quiz = [];

// Find a sheet that _isn’t_ named “Results”.
for (sheetName in tabletop)
if (tabletop.hasOwnProperty(sheetName) && sheetName !== ‘Results’)
break;

}

data = tabletopsheetName.elements;

for (i = 0; i < data.length; i++)
var row = datai;
var possible_wrong_answers = self.get_possible_answers(row, false);
var possible_right_answers = self.get_possible_answers(row, true);

var right_answer_placement = [];
for (j = 0; j < possible_right_answers.length; j++)
right_answer_placement.push(
Math.round(Math.random() * possible_wrong_answers.length)
);

// IMPORTANT TO SORT THIS. rather than check if a value is in, we only check the first
right_answer_placement.sort();

var possible_answers= [];
var right_answers_placed = 0;
for (j = 0; j <= possible_wrong_answers.length; j++)
while (j === right_answer_placementright_answers_placed)
//push right answer
possible_answers.push(possible_right_answersright_answers_placed);
right_answers_placed++;

if (j === possible_wrong_answers.length)
continue;

possible_answers.push(possible_wrong_answersj);
}

var question =
question :
,
possible_answers : possible_answers,
rowNumber : row.rowNumber – 1
};
for (j = 0; j < self.possible_display_elements.length; j++)
var display_value = self.possible_display_elementsj.name;
question.questiondisplay_value = row’question’ + display_value;

quiz.push(question);
}
return quiz;
},
make_results_data_from_spreadsheet_data: function(tabletop, quiz_data)
var ret = make_default_how_you_did_htmls(quiz_data.length);

var data = tabletop’Results’ ? tabletop’Results’.elements : [];
for (var i = 0; i < data.length; i++)
var index = datai.numberofrightanswers;
if (index) index = parseInt(index, 10);
if (!isNaN(index))
if (!retindex)
console.log(“Invalid number of correct answers: ” + index);
else
retindex = datai.html;

}
}

return ret;
},
append_question : function(question_index)
var question_data = self.quiz_dataquestion_index;
var question_container = $(‘<li class=”question_container row-fluid question_’ +
question_index +
‘”>’
);
question_container.append( self.build_question_element_from_row(question_data) );
question_container.append( self.build_possible_answer_elements_from_row(question_data, question_index) );
container_elem.append(question_container);
,
build_question_element_from_row: function(row)
var question_container = $(”);
for (var i = 0; i < self.possible_display_elements.length; i++)
question_container.append(
self.possible_display_elementsi.create_element(row.question)
);

return question_container;
},
build_possible_answer_elements_from_row : function(question, question_index)
var answers_container = $(”);

function bindClick(question_index, answer_index, possible_answer)
possible_answer.bind(‘click’, function()
// was it the right answer?
var was_correct = self.quiz_dataquestion_index.possible_answersanswer_index.correct;

// Add correct classes to possible answers
answers_container.find(‘.selected’).removeClass(‘selected’);
$(this).addClass(‘selected’);
$(this).removeClass(‘possible_answer’);
answers_container
.find(‘.answer_’ + answer_index)
.addClass(
was_correct ? ‘correct_answer’ : ‘wrong_answer’
);

//track how many you got right the first time
cheater_answer_trackingquestion_index = was_correct;
if ( typeof(answer_trackingquestion_index) === ‘undefined’ )
answer_trackingquestion_index = was_correct;
cover.find(‘.question_’ + question_index).addClass(
‘first_guess_’ +
(was_correct ? ‘right’ : ‘wrong’)
);

self.update_how_you_did_element();

//show new slide
self.display_answer(self.quiz_dataquestion_index, question_index, self.quiz_dataquestion_index.possible_answersanswer_index);

// track that this was selected last
self.quiz_dataquestion_index.previously_selected = self.quiz_dataquestion_index.possible_answersanswer_index;
});
}

for (var i = 0; i < question.possible_answers.length; i++)
var answer_data = question.possible_answersi;
var possible_answer = $(” +
answer_data.answer +
”);
bindClick(question_index, i, possible_answer);
answers_container.append(possible_answer);
this.note_answer_images(answer_data);

return answers_container;
},
answer_images : {},
preload_answer_images: function()
for (var url in this.answer_images)
var img=new Image();
img.src=url;

},
note_answer_images: function(answer_data)
var image_elements = ‘backgroundimage’, ‘topimage’, ‘bottomimage’;
for (var i = 0; i < image_elements.length; i++)
if (!answer_data[image_elementsi]) continue;
this.answer_images[answer_data[image_elementsi]] = true;
}
self.possible_display_elementsi.name;
},
add_display_in_correct_place: function(container, place_in_display_elements, slide)
for ( var i = place_in_display_elements; i > 0; i– )
if (self.possible_display_elementsi – 1.finder(container).length )
self.possible_display_elementsi – 1.finder(container)
.after( self.possible_display_elementsplace_in_display_elements.create_element(slide) );
return;

}
container.prepend(
self.possible_display_elementsplace_in_display_elements.create_element(slide)
);
},
display_answer : function(question, question_index, answer)
var displayed_slide = question.previously_selected ?
question.previously_selected :
question.question;
var slide = container_elem.find(‘.question_’ + question_index + ‘ .question’);
slide.addClass(‘revealed_answer’);
for (var i = 0; i < self.possible_display_elements.length; i++)
var display_value = self.possible_display_elementsi.name;
if ( answerdisplay_value !== displayed_slidedisplay_value )
if ( !answerdisplay_value )
self.possible_display_elementsi.finder(slide).remove();
else if ( !displayed_slidedisplay_value )
self.add_display_in_correct_place(slide, i, answer);
else
self.possible_display_elementsi.finder(slide).replaceWith(
self.possible_display_elementsi.create_element( answer )
);

}
}
},

create_cover : function()
cover = $(‘#’ + self.container);
container_elem = $(”);
cover.append(container_elem);
container_elem.addClass(‘quiz_container’);
container_elem.css(‘padding’, ‘0px’);
,
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right_answers++;

}
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html = this.not_finished_html;
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if (!options) options = results_data; results_data = null;
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var quiz = jQuery(‘#quiz_container’).quiz(‘0Apogs1tjp7w0dEZLUnB3QTJYVVdjUDJMUTZXU2ZzMmc’);
Photos from Metal Cats by Alexandra Crockett, published by powerHouse Books.

See original article: 

Quiz: Who’s More Metal, the Cat or the Owner?

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Two French Unions Ban Work Email After 6 pm

Mother Jones

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Huh. A couple of white-collar unions in France have signed a new labor agreement:

The legally binding deal, signed by employers’ federations and unions representing almost one million workers in the digital and consultancy sectors, stipulates that employees should be left alone when they are out of the office.

Staff will be ordered to switch off their professional phones and avoid looking at work-related emails or documents on their tablets and computers. Businesses will be required to ensure that workers are under no pressure to check their messages.

The ban takes effect at 6 pm each night. Remarkable.

Link:  

Two French Unions Ban Work Email After 6 pm

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Behind the Scenes on Those Enormous Medicare Billing Numbers

Mother Jones

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Yesterday’s data dump of how much Medicare pays doctors has generated predictable outrage about the vast amounts some of the top doctors bill. Obviously there are a lot of reasons for high billing rates, but Paul Waldman points to an interesting one: the way Medicare reimburses doctors for pharmaceuticals is partly to blame. The #1 Medicare biller on the list, for example, was a Florida ophthalmologist who prescribes Lucentis for macular degeneration instead of the cheaper Avastin. Since Medicare pays doctors a percentage of the cost of the drugs they use, he got $120 for each dose he administered instead of one or two dollars. That adds up fast. (More on Avastin vs. Lucentis here.)

In the LA Times today, a Newport Beach oncologist who’s also near the top of the Medicare billing list offers this defense:

For his part, Nguyen, 39, said his Medicare payout is misleading because all five physicians at his oncology practice bill under his name, and much of that money overall is reimbursement for expensive chemotherapy drugs on which he says doctors make little or no money. Other high-volume doctors voiced similar complaints about the data.

Anyway, Waldman wonders why we do this:

If nothing else, this story should point us to one policy change we could make pretty easily: get rid of that six percent fee and just give doctors a flat fee for writing prescriptions. Make it $5, or $10, or any number that makes sense. There’s no reason in the world that the fee should be tied to the price of the drug; all that does is give doctors an incentive to prescribe the most expensive medication they can. That wouldn’t solve all of Medicare’s problems, but it would be a start. Of course, the pharmaceutical lobby would pull out all the stops trying to keep that six percent fee in place. But that’s no reason not to try.

The backstory here is that Medicare used to set the reimbursement rate for “physician-administered drugs” based on an average wholesale price set by manufacturers. This price was routinely gamed, so Congress switched to reimbursing doctors based on an average sales price formula that’s supposed to reflect the actual price physicians pay for the drugs. Then they tacked on an extra 6 percent in order to compensate for storage, handling and other administrative costs.

I don’t know if 6 percent is the right number, but the theory here is reasonable. If you have to carry an inventory of expensive drugs, you have to finance that inventory, and the financing cost depends on the value of the inventory. More expensive drugs cost more to finance.

However, this does motivate doctors to prescribe more expensive drugs, a practice that pharmaceutical companies are happy to encourage. I don’t know how broadly this is an actual problem, but it certainly is in the case of Avastin vs. Lucentis, where the cost differential is upwards of 100x for two drugs that are equally effective. And the problem here is that Medicare is flatly forbidden from approving certain drugs but not others. As long as Lucentis works, Medicare has to pay for it. That’s great news for Genentech, but not so great for the taxpayers footing the bill.

Originally posted here: 

Behind the Scenes on Those Enormous Medicare Billing Numbers

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