Big Government

Russia to healthcare in one day. What now ?

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Last Friday, the Mueller report was submitted to the DOJ. Monday, left wing media saw ratings collapse.

What next ? Why Healthcare, of course.

Obamacare, which is a form of expanded Medicaid, costs too much and provides too little care (high deductibles) unless you are a Medicaid recipient. It was designed to shift costs to the insured from the poor. It also was a gift to certain sectors of the healthcare industry. Ted Kennedy criticized healthcare as a “cottage industry” with lots of independent doctors doing their own thing as small businesspeople. That is why doctors have traditionally been conservative. Obamacare changed that. Healthcare is now an industry with doctors mostly on salary and controlled by administrators.

I talked to a young ophthalmologist last week, who had treated a mild eye disorder. He told me he moved to Tucson to work at U of Arizona medical center, which used to be called “UMC” by everybody in Arizona. He explained that the UMC administrators had gotten deeply into debt installing a new “Electronic Health Record” system and sold the UMC to Banner Health. This is a chain that runs the former UMC and has seen an exodus of university faculty physicians. Even my barber noticed. He told me several weeks ago that his surgeon, who had operated on him, got tired of constantly being told he only had 15 minutes to see each patient and left for the VA. The ophthalmologist was disappointed as he had looked forward to working at the academic center.

Traditionally, administrators hated doctors. We made their lives more difficult by advocating for patients. I once told an administrator that if the hospital did not reduce the markup on pacemakers, I would testify for the patient if they sued him for the balance of the bill. They didn’t like it but knew I could go elsewhere,and take my patients there. If I had been an employee, I would not have that choice. Several years ago, I explained how we started a trauma center in our hospital. Since then, the hospital has been sold to a non-profit run by nuns. The surgical group that ran the trauma center for 35 years was fired two years ago. They had declined to sell the group to the hospital. They were replaced by six female surgeons no one had ever heard of and who had never applied for privileges at the hospital or been evaluated by the Surgery Department. No one knew anything about them except one member of this new group had applied for a job at the trauma group and been turned down.

There were a few comments about some less satisfactory results on trauma cases but that has quickly gotten quiet.

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The 737 MAX and the Death of MIL-STD-499A SYSTEM ENGINEERING MANAGEMENT

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One of the life experiences that comes with being a three decade veteran of military procurement is you have been around long enough to know where all the important bodies are buried — case in point, the Boeing 737 MAX.   What we are seeing in the two recent 737 MAX crashes is the the 20 year accumulation of professional toxic waste and decay in Boeing management that came with the first Clinton Administration’s cancellation of MIL-STD-499A SYSTEM ENGINEERING MANAGEMENT.

737 MAX Jetliner in South West Airline Colors.

I was e-mailed a link today to this Daily Kos post on the 737 MAX :

Did Boeing ignore basic SW engineering principles?
Thursday March 21, 2019 · 8:34 AM CDT

and this passage just jumped out:

A few software engineering principles:

  • Software engineering 101: validate your inputs.
  • Software engineering 201: when something goes wrong, provide useful data to the human.
  • Software engineering 301: for life-critical decisions, avoid single point of failure.

Until today, I had thought that aviation was *good* at software engineering. But my faith is shaken by the New York Times description today of what went wrong with the Boeing 737 MAX.

The above passes my professional “Bozo Test” of whether the poster knows what he is taking about regards software development.   He does.

This is where that “military procurement life experience” I mentioned comes in.   The timing of the development of the 737 MAX MCAS software was roughly 20 years after the Clinton Administration cancelled the majority of Mil-Specs in the mid-1990’s and in particular the one for system engineering management.

See:

MIL-STD-499A (NOTICE 1), MILITARY STANDARD: SYSTEM ENGINEERING MANAGEMENT (27 FEB 1995) [NO S/S DOCUMENT]., MIL-STD-499A (USAF), dated 1 May 1974, is hereby canceled without replacement.

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California agonistes.

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I moved to California in 1956 to attend college. Los Angeles was a paradise. The weather was great. The traffic was no problem. I learned that the LAPD did not take bribes and was not amused at attempts to offer them. After growing up in Chicago, I had learned to put a ten dollar bill behind my driver’s license in case I was stopped. In Los Angeles, I did so and was lectured about the consequences of offering a bribe by a stern LAPD officer.

I lived in the fraternity house and one year slept on an outside second floor porch. I had four blankets on my bed but no problem, with flies or mosquitoes. I remember flying back to Los Angeles one New Year’s Eve from Christmas vacation in Chicago. The palm trees told me I was home. There was a brush fire in the hills but it was nice to be back. I would sometimes drive up to Sunset Boulevard just to see the city at night. The TV show, “77 Sunset Strip” showed just what it looked like. We would drive into Hollywood and sometimes eat at Villa Frescati. We had a lot of fun. Too much fun as I lost my scholarship.

The first sign of trouble was described in Victor Davis Hanson’s book, “Mexifornia.” There was trouble before that as the Watts Riot in 1965 began the endless pandering to the angry mobs.

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Freezing in the Dark

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There has been much concern about possible hacking of the power grid by Russia, China, and others.  Here we have a segment from Rachel Maddow, inspired by a threat analysis from the US Intelligence Community.  From the analysis:

China has the ability to launch cyber attacks that cause localized, temporary disruptive effects on critical infrastructure–such as disruption of a natural gas pipeline for days to weeks–in the United States.  Russia has the ability to execute cyber attacks in the United States that generate localized, temporary disruptive effects on critical infrastructure.

Maddow:  It’s like negative 50 degrees in the Dakotas right now. What would happen if Russia killed the power today?  What would happen if all the natural gas lines that service Sioux Falls just poof on the coldest day in recent memories?

What would happen?  Nothing good.  These are serious threats, and I doubt that Russia and China are or will continue to be the only entities able to conduct such cyberattacks.  And there is also plenty of risk for non-cyber attacks…physical-world sabotage…which could have similarly malign impact on energy infrastructure.

But we don’t need to wait for a foreign adversary or domestic terrorist organization to cripple our energy infrastructure.  We can quite effectively do it to ourselves.

In late January, it was very cold in Minnesota.  And there wasn’t a lot of wind.  Natural gas, also, was in short supply, as a result of pipeline capacity constraints.  Xcel Energy urged its gas customers to turn down thermostats and water heaters, and to use electric heaters as necessary.  The electricity was coming from primarily coal plants (40 GW) and natural gas plants (about 23 GW)–the gas plants, of course, are also dependent on pipeline capacity.

Also in Minnesota, here’s a large solar farm covered with snow.  Wonder if it’s melted or been swept off yet?  And here’s a cautionary story from Germany, where long, still, and dim winters do not mix well with wind and solar power generation.

Solar and wind in most parts of the US are now small enough in proportion to overall grid capacity that shortfalls can be made up by the other sources.  What happens if they come to represent the majority of the grid’s power capacity–not to mention the exclusive source of capacity, as demanded by some?

It may be feasible to store a few hours of electricity without driving costs out of sight…but what about the situation in which wind and solar are underperforming for several days in a row?  Interconnection of sources and demands over a wide area (geographical diversity) can help, but is by no means a comprehensive solution. So far, the gas, coal, and hydro plants have been there to kick in where necessary.

Almost every day, there are assertions that new solar is cheaper than its fossil-fuel equivalents.  This may be true in some areas if you ignore the need to match supply and demand on an instantaneous basis.  But if the fossil-fuel plants are there to handle only those periods when wind, solar, and limited battery storage aren’t sufficient to meet demand, then the total energy production against which their capital cost is charged will be much lower, and hence, the cost per unit will go up. (See the California Duck Must Die for a nice visual portrayal of how widespread solar adoption has changed the load curve for the other sources.)  In some states with net metering, a home or business owner can sell excess power to the grid when loads are low and buy it back at the same unit price when loads are at their maximum. This becomes especially problematic when “renewables” become a major part of the mix.  Unless incentives are intelligently crafted–unlikely, given politics–“renewable” sources will effectively be subsidized by conventional sources and potentially make the construction and maintenance of those conventional sources impossible.  See If Solar and Wind Are So Cheap, Why Do They Make Electricity So Expensive?

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The very bad Continuing Resolution and how we got here.

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We now have a a terrible non-compromise Continuing Resolution on border security. The Appropriations committee reported out HR31, the Continuing Resolution.

The Homeland Security division of this bill upholds Democratic values and funds smart and effective border security including construction and screening technology at ports of entry, where most drugs illegally enter the country.

The $1.375 billion it provides for border barriers is 76% less than the President demanded for a concrete wall, and critical protections are put in place for environmentally sensitive areas.

Neither Democrats nor Republicans got everything they wanted, yet every Democrat and nearly every Republican who served on the conference committee to write this bill has signed it in support.

Boilerplate. The real story is what was inserted in conference.

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