Don Berwick today issued the following statement on the Supreme Court’s decision that companies cannot be required to cover some types of contraceptives:
“Today’s abhorrent Supreme Court decision is yet another affront to women’s health. Every woman deserves access to quality reproductive health care, and I hope that Congress will take swift action toward ensuring that contraceptives are available to women, regardless of their employer’s religious affiliation.
“This ruling also serves as a reminder that it is past time to decouple health coverage from employment and move to a publicly accountable single payer health care system, similar to Medicare for all.”
Please share widely!
We spent an hour discussing this issue and many more for a future episode of my local access TV show. He won’t get into the on-air rotation for a couple of weeks – Suzanne Bump and Karen Spiewak are already in the rotation – but the YouTube version will be ready by Wednesday, I’m planning to put it into a post here at BMG.
John,
I very much look forward to your post here.
Yesterday Don was the guest on channel 4’s “Keller At Large.” Don did a great job and didn’t let Jon Keller, whom I remember seeing at the State Convention, get away with inaccurate statements about Single Payer Health Care and revenue from Casinos. Here is the link where you can scroll down to view part’s 1 & 2.
http://boston.cbslocal.com/2014/06/29/keller-at-large-gubernatorial-candidate-don-berwick-on-casinos-healthcare/
You’re right, Don did a great job refuting Keller’s BS – you’ll hear a few of those same points on my show, but of course, I didn’t preface them with nonsense…
I’ll get the YouTube version tomorrow, will have it on the web by Thursday. He was a tremendous guest, we talked about every single issue bullet on his web site.
Jon Keller usually has his facts straight and he said repairing a detached retina as he had on his eye would require him to wait 6 months in Canada under their single payer system. Don seemed to suggest those long waiting lines are fictional.
If we move to single payer, we should not over promise the public or oversell like what happened with Obamacare.
“This edition of Waiting Your Turn indicates that waiting times for elective medical treatment have increased since last year. Specialist physicians surveyed across 12 specialties and 10 Canadian provinces report a total waiting time of 18.2 weeks between referral from a general practitioner and receipt of elective treatment.”
http://www.fraserinstitute.org/research-news/research/publications/Waiting-Your-Turn—Wait-Times-for-Health-Care-in-Canada,-2013-Report/
Dan,
The web site you reference here speaks of wait times for elective procedures. I am not a doctor, but I think having a “detached retina,” which Keller spoke of, likely would be considered an emergency and this would certainly make a difference in wait time. I recall in Michael Moore’s documentary film, “Sicko,” he interviewed folks who had to go to a Canadian Hospital emergency room and they reported that wait times were quite short.
They are largely fictional. Those types of wait times are highly cherry-picked and used by conservatives to scare people about single payer. Also, the report you cite, like most of the reports you cite, is from a conservative think tank and should be taken with a giant grain of salt.
And, even if true, universal coverage with better results at much lower cost would be a very fair trade for vastly increased wait times.
I couldn’t get a first appointment with a new primary care physician for seven months. Same thing for my wife. Three months wait to see an orthopedic specialist for three minutes. My experience in one not-quite single-payer system (France) was much better in terms of attention paid to the patient.
It’s not like we’re good at those things at all. Even if our wait times are better than Canada’s, they beat us on most other metrics, especially the most important ones.
We’re great at providing a high level of care for complicated illnesses. That coverage, however, is not available to enough people, is incredibly expensive, and also rare in comparison to more routine procedures and care.
So, yeah, while we are great at treating rare cancers, we’re terrible at treating the bulk of the population for routine ailments.
And it’s not like we have to give up entirely on one in order to have the other, as many conservatives will howl.
I had to wait 4 or 5 months for to schedule my “first” appointment with my primary care doc, because as with most practices it is a longer appointment so the doc can do a full exam and take a proper history and they typically have fewer of those longer appointment slots in the schedule. Once I scheduled that, I was able to actually schedule another shorter appointment to see him for my immediate issue a day or two later.
I also have not had to wait very long to see either of the orthopedists I have gone to nor any other specialist.
Do you know why you and your wife had to wait? Did you choose popular doctors with large oversubscribed practices? Does your insurance force you to use a limited number of providers?
The wait time for virtually ANY “first appointment” is months, especially with specialists. Try setting up a new dermatologist, ob/gyn, or sleep specialist.
At that first appointment, once waited for, the initial step is the “wallet biopsy”, where the office staff confirms that you have insurance coverage and explores the extent of the coverage with respect to their services.
From that point onwards, you will be encouraged to submit to any and all procedures, “preventative” screens, and such that they know your insurance company will fund. The standard is “will the insurance company cover it”, not “is it necessary”. Interestingly, those “followup” visits have wait times measured in days.
The entire racket is set up to perform as many regularly-scheduled procedures as possible, transferring as much money as possible from the insurance company to the provider, and with only cursory regard to patient convenience, quality of care, actual outcome management, and similar metrics.
We have created a money-mill, using the ruse of “health care” as a way of churning as many patients as possible through as many “medically necessary” and easy-to-schedule-and-manage procedures as possible, in order to move money from wherever it starts, through the insurance company, and to the providers.
The loser, as always, is the patient.
In the past year, I have seen two different orthopedists for the first time and only had to wait 2-3 weeks in each case.
The last time I saw a dermatologist, I didn’t have to wait more than a week or two for an initial appointment. In fact, I have never had to wait more than a month to see any specialist.
Now I understand that some people do indeed have to wait a long time to see some doctors, but that has not been my experience at all, so clearly this doesn’t happen to everyone.
Tom,
Sadly, a great deal of what you say here is true. Our current medical system is desperately in need of reform, but moving to a Single Payment System would allow for and should provide the incentives to make the change that is so needed. Don Berwick understands this and is one doctor who is committed to making our Health Care System what it should be.
That’s one reason why I’m an enthusiastic supporter of Don Berwick.
The Fraser Institute is a widely-documented right-wing front group funded by illustrious far-right people and groups like the Koch brothers, the Sarah Scaife Foundation, British American Tobacco, Phillip Morris, Exxon-Mobil, and others.
It has published similarly discredited screeds on behalf of the tobacco industry, a flood of patently dishonest attacks on climate change, and a barrage of right-wing garbage.
Mr. Berwick didn’t “seem to suggest”, he called out Jon Keller on a wrong and dishonest premise. I do not share your opinion of Mr. Keller — I think a more accurate characterization is “Jon Keller usually agrees with whatever right-wing cranks are listening”.
I had an extensive conversation with Canadians, and Americans living in Canada, about this topic. Basically, single payer doesn’t solve for the typical annoyances of a doctors office. What it does solve for is the stressful answer of “how am I gonna pay for all this?”. That anxiety-the fear that tests may reveal the need for more specialists, more follow ups, more drugs, or even surgery is non existent. Your healthcare experience is focused on just that-your healthcare.
One Canadian said “it’s probably just as bad as your doctors office-the difference is I know I’m covered. When I switched jobs or even when I lost a job-I knew I was covered. I couldn’t imagine how it feels for you guys.”
Yes — countries who have Single Payer don’t have the stress that we Americans have lived with under our health-care system and we all know that stress is one of the largest causes of ill-health. Even with the improvements of the Affordable Care Act; the additional peace of mind of Single Payer “Medicare For All,” would likely result in less illness and allow for better healing.
Seems like hip and knee replacements are way short of expectations. I can’t find anything on CT-scans.
To be fair, Don said we won’t replicate Canada. But with recent history teaching us how Obama lied about his own healthcare bill will impact how Don can persuade us to go single payer, even though Don knows what he is talking about in regards to healthcare overall. Like most people, I want the truth, both the good and the bad and the trade offs.
http://waittimes.cihi.ca
This is another example of you pathetic hatred of the actually elected president of the United States. I would go so far as to say, that your claiming to want the “truth, both the good and the bad” is in an of itself a lie. There is absolutely no connection between method of payment and the wait times for procedures. None whatsoever! And yet, you want to mix them all together and throw them at the wall and see if anything sticks.
You hear about the wait times at the VA? Or is that our duly elected 43rd president, George Dubya Bush’s fault?
You do know Obama apologized last year for insurance cancellations “I am sorry that they are finding themselves in this situation based on assurances they got from me” Obama told NBC News.
I don’t want Don Berwick to be put in the same situation, with no credibility and low approval ratings. Don needs to be careful what he says, especially to Jon Keller, who I bet, will go back and research his initial findings.
It is so obvious.
When Bush lied, people died.
Don Berwick was pushing for single payer around the time Obama refused to fight for his nomination, like he refused to fight for Warren’s nomination. If the latter resulted in a great Senator, here is hoping the former results in a great Governor!
Of course I already know Dan’s argument:
“*something something Bhenghazi Obamacare**
via Family Guy: “Something, Something, Something, Dark Side”
That’s why when the usual suspects start the fearmongering about single payer in the U.S., what we’re always told about is wait times for hip and knee replacements. They’re not representative of system wait times as a whole.
But this is another reason why I find Berwick’s openness to discussion and genuine interest in problem-solving so encouraging (and refreshing). Everything about his past and the choices he’s made suggests that he’s interested in looking at problems and trying to solve them, not in trying to pretend they aren’t there.
Since my dad was on an elective wait list for his knee replacement for almost four or five years here in the States with a private insurer. So again, it’s not like our system is any more efficient. The issue isn’t a question of quality, which is comparable; but a question of affordability and access. And there simply is no question that single payer cuts down on costs and makes healthcare accessible to the greatest number of people.
But there are wait lines here to as well, even for organs, and that is just a deficiency built into modern medicine.
I went on a hunt through the statistics a few years ago, because I’ve got orthopods in the family and up until then, they were always pointing out the orthopedic wait times in Canada as proving that there were intolerable waiting times across the whole Canadian system. And I’m acquainted with some in the specialty who will refer to themselves as refugees from the Canadian system.
But this sounds like another instance of the old truism that the plural of anecdote is not data. Anecdotally, I know of no one who’s been faced with any wait time at all on a knee replacement — or at least, no wait time that wasn’t a consequence of either medical issues or the patient’s own indecision about whether to have it done or not. I’d have said, maybe if you presented with special complications and had reasons to book it with not merely a specialist, but a microspecialist who’d seen your specific complication a hundred times in the past year, then you’d have to wait for a spot on the schedule to open. So obviously experiences vary on this side of the border too.
But back to the point: when I did take that look, it was always elective orthopedics that the think tanks cited, and always orthopedic patients that reporters were sent to talk to. Once that became clear, the orthopedic surgeons at all the family dinners and all the parties I go to stopped attributing the wait times they’d heard about, or were personally familiar with, to the Canadian system overall.
At the time he wasn’t 60 yet and insurance would only cover it if he was, but then he ended up getting the surgery when he was 58 since his doctor petitioned successfully that it was an emergency case. My point simply was-dealing with any hospital bureaucracy is frustrating-and that won’t change under single payer. What will change is the elimination of the profit notice, lowered costs for most surgeries, standardization and efficiency in the delivery and access if care and affordability. But the idea that we are getting a system less efficient than the one we have or that wait times are the gold standard by which we evaluate a healthcare system both ring false to me and according to the data.
Single payer just means that health care is funded by the government through some form of taxation. It would still be for profit on the part of the docs, device manufacturers, drug cos., many hospitals and the insurance companies that administer the program, the way Medicare and Medicaid today are administered by one or more for-profit insurance companies contracted to perform all of some of the sevices associated with a health insurance plan – enrollment, provider networks and credentialing, utilization management, call center/customer service, and claims payment. Single payer *may* reduce costs by allowing providers to deal with less overhead in billing different payers. You don’t necessarily get this benefit, though, if you do single payer on a state level and if (as is certainly the case here) providers and hospitals treat a large number of out-of-state patients.
I stumbled across this website regarding wait times in Canada. http://www.health.gov.bc.ca/swt/
Perhaps this can give us a better idea so we are all informed about what a single payer system would mean to Massachusetts. My kid tore her ACL, MRI within a week, results a few days after, and within 2 months, surgery at Children’s Hospital and I chose to wait that long b/c I wanted a certain MD to do it and she returned to sports in 8 months. From what I read on the net, Canadians have to gruel through a long arduous wait, depending upon where they live, for knee surgery.
Thus when Keller raised his eye surgery and knowing the top notch/fast care my kid received here, I was a little surprised Don was so dismissive of Keller’s question.
I went to the url you cited and looked up your child’s ACL.
For BC as a whole, 50% of the cases were serviced within 7.9 weeks (two months). That’s the same as you cited. The 90% level was 21.8 weeks, less than the 8 months you chose to wait.
Your “argument” here is total bullshit.
When Mr. Keller raised his red herring, Mr. Berwick responded accurately.
Regarding Mr. Keller’s claims about eye surgery, and so long as we’re using anecdotes instead of data, I invite you to consider the experience of Michael Dukakis, as broadcast on NECN. The relevant portion starts at about 5:30 in the piece.
Greece also has uniform national health care service.
Meant as an uprate, my tendency to accidentally downrate is becoming a pre-existing condition.
Because, seriously, even if we assume that the orthopedic wait times are significantly longer in Canada than they are here, the point is still that those were an anomaly: one practice area where for whatever reason there weren’t enough surgeons to satisfy demand for elective care. Right now we have a worse distortion in the U.S. system: we don’t have nearly enough general practitioners to meet demand. If I needed a knee replacement here I could schedule it for the minute all the pre-surgery screening work was done. If I needed a new primary care doctor, I would wait for many months. “Canada! Wait times!!” is a silly scare tactic.
And when a tv host uses information on elective surgery — which is, you know, elective, the sort of thing people don’t need urgently and may elect not to have at all — to suggest that there are long wait times for emergent care, that verges on active dishonesty to the audience. It’s not something an informed interviewee should treat respectfully; to do so would only misinform the audience further.
That was my whole point. Something that only ever was true of one tiny sliver of medical care, and that may only have been true for one period of time, is being cherry-picked and used to suggest something that’s not true, on an issue of great public importance where we need to work with accurate information. It’s not an approach to this discussion that deserves any respect or validation.
50% of ACL surgeries for kids/teenagers occurred within 2 months of injury. 50% a good number? Perhaps it is, but reading on ACL tears, full recovery is less successful unless operated on and repaired within 3 months. So the stats out of Canada that Tom kindly provided is less than stellar.
Overall, IMO single payer is the way to go but I doubt it is the utopia some here makes it out to be. That was my point in all this.
Even Don has said that he is Not interested in a poorly run Single Payer System, but a Well run “Medicare For All.” Just moving to a single payment system will free up serious resources for improvement of our current Health Care and to pay for other priorities.
IMHO we need Single Payer Health Care that is Both Universal And Integrative. Step one is Single Payer and then move to make the system one that integrates best practices for best results. A system focused not just on managing disease, but one that promotes Prevention and Wellness. A system that finally rewards physicians whose patients achieve the highest quality of health — the British system strives for this I believe. This would save a ton of money and give our citizens a much higher quality of life. I envision a system where Clinical Nutritionists would be talking to Allopaths and where Naturopaths and Allopaths could work side by side and so forth. A system that would utilize the best of both Western and Eastern medicine. A system that truly respects, honors and nurtures body, mind and spirit. This is happening in small wellness centers in the private sector, by why not ultimately system-wide.
I actually discussed this once with Michael Dukakis at an off-year Issues convention and when I heard Don speak at last year’s convention I was drawn to him for his knowledge and refreshing openness to thinking with vision and possibility. And as he has grown as a candidate he has only expanded in his ability to communicate in this way.
That is why “Medicare for All” is a lousy characterization of the health care system we need. Don Berwick’s vision and experience, as I have heard him describe it, has some really important elements to it, like care coordination with robust utilization of skilled nurses. But it’s still very much in the medical model. Has anyone heard him talk about alternative care?
As a chiropractor, I am frustrated by Medicare every day because its definition of my profession’s care that is appropriate (and the only care that it pays for) is acute care for spinal conditions. Supportive care is lumped in with “maintenance care” and is considered unnecessary. Supportive care, i.e. management of a chronic condition so it doesn’t get worse, is exactly what most elders need. That doesn’t even touch prevention: do you have any idea how much of the morbidity and even mortality in the elderly population is triggered by losing balance and falling? So if we are going to look to Medicare as a model, it has to be a very different Medicare or I am not on board.
IMHO, getting the profit motive out of the provider side as well as the payer side of health care is crucial if we are to get a system that makes any sense. Single payer doesn’t do this automatically. It can impose some strictures on the wallet mining that Tom describes above. But any discussion of the payer side needs to include a robust critique of the provider side.
‘Medicare for All’ is a simple framing to describe the payment system of a newly designed, comprehensive, single payer system. This way, instead of calling it ‘single payer’ which confuses some, or ‘universal’ or ‘socialized’ which sounds foreign, it takes a popular program and expands it to include everyone.
That said, he has also called for improving wellness and preventative care as well. One of the few strengths of the ACA from a policy standpoint is that it also encouraged wellness, more reliance on ACO’s, and makes checkups and preventative care (including contraception) covered and free from out of pocket costs. So, we don’t need to have the cumbersome definitions that prevent some alternative forms of preventative or rehabilitative care from getting included.
Everything I can find about Berwick’s approach to both problem-solving in health care and problem-solving overall indicates that both by inclination and by training and experience, he looks well beyond whatever the common wisdom within a field is about a given issue. That’s how IHI has been successful in reducing in-hospital mortality and morbidity: by looking at all the information available and seeing what could be done differently. And if you listen to one of his healthcare fora — or better, get in line to ask questions in one — I think you’ll find that he’s not only ready to have the conversation you want to have, but enthusiastic enough about it that his team will have to interrupt the impromptu colloquy for reasons of time.
It’s one of the reasons I’m so enthusiastic about the prospect of seeing him in office. He’s interested in evidence, and he’s interested in fixing things; really interested, that is, in the sense of finding both deep knowledge and the cognitive work of evidence-based problem-solving absorbing and pleasurable. (Or at least, so it appears from what we can see in public; I don’t mean to claim either omniscience or a close acquaintance.) No one person is going to fix the healthcare system, or be able to focus on every area where improvements are possible at once, but there’s every reason to believe that Berwick would look at the big systemic anomalies like the bias against provision of supportive care and take the need to address them seriously. And that he’d bring the same kind of approach to the myriad other policy issues that the next governor is going to have to address.
I agree with Margot here, she is spot on as far as what needs to be covered/included in an effective Medicare For All. Traditional medicine has referred to these other modalities as CAM (complimentary and alternative), but they need to be integrated in what is covered if we want to really provide the best results and to make the best use of our health care dollars. I think that Single Payer is step one toward making this happen.
It is interesting to note that the first Surgeon General and the only doctor to sign the Declaration of Independence, Benjamin Rush, once observed:
“Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship to restrict the art of healing to one class of men and deny equal privileges to others; the Constitution of the Republic should make a special privilege for medical freedoms as well as religious freedom.”
Unfortunately the framers didn’t take his advice.
The Supreme Court Majority seems to think the Framers thought that the religious freedom of corporations trumped the medical freedoms of women. But Dr. Rush was ahead of his time, on multiple fronts, and I am hopeful we can finally add that, along with the rest of Roosevelt’s Four Freedoms, at some point in my lifetime.
…I resolved to never believe the nonsense about wait times again. Back in 2005 I was in Belgium with a study-abroad class. A classmate of mine fell ill – nothing too serious, a bug of some sort. She made an appointment with the local doctor for the next day. She paid the equivalent of 20USD each out of pocket for the appointment and the prescription. Belgium has the kind of system you would expect a European nation to have and her own insurance never came into play. They took care of her without a real wait and nominal copays and she was not a Belgian or European citizen. They take care of their people (and apparently foreigners) without the handwringing about costs, etc.
and therefore, treated like a second class citizen and dragged through the mud and screamed at by “Anti-Choice Protesters”, before she could be probed before she received this medical care? You’re telling me that they treated her like a normal human being. How completely un-American!
…though to be clear this particular ailment had nothing to do with her reproductive system.
or is that just Virginia Republicans.
I know Canada is actually pretty strict with access to their system, my friend still pays via her parents insurers in the States since her student VISA expired and she has yet to get made a permanent resident. Interesting to see the Lowlands are less stringent, especially considering their immigration issues.
But I wouldn’t praise Belgium too much today-we’re gonna give em a whoopin’!
Look, folks: this entire thread has been derailed into a rehash of the debate we had five years ago, in which one writer drags out, as is his want, the zombie distortions and downright lies that made the ACA the only politically feasible solution.
We’re too busy for this. I wrote about the problems of trolls here: http://vps28478.inmotionhosting.com/~bluema24/2013/02/preparing-for-the-trolls/ ; they’re extremely dangerous to web communities.
If I want to see a Republican endlessly rehashing old talking points, I can read the comments at our Red counterpart any time. But it’s a total waste to go round and round about Canadian wait times: everyone who cares about the issue, and who has enough political savvy to read BMG, already knows.
We’ve got important work to do to win this election, and playing games with the troll is not helping anything. Someone is wrong on the internet. I think it would be better if he were wrong somewhere else, but 20 posts/day, none of them closely related to the topic (which was, I remind you, Berwick’s response to HOBBY LOBBY) is pernicious.
We should be talking about how to overturn these decisions, We aren’t likely to be able to pass a constitutional amendment about anything in the foreseeable future. That means we either have to live with this decision forever, or we a court that will overturn it. That means, in turn, a reorganization of the judiciary and an increase in the size of the supreme court. And unless we can get 61 Democrats in the Senate again, that also means ending the filibuster for legislation.
Those are big changes; rehashing talking points about Canadian health care from 20 years back are not part of the solution.
His was the first comment on my most recent diary which left me reluctant to engage on my own post:(
Is BMG the place where we discuss progressive ideas?
Or is it the place where we debate with two or three designated Republicans?
Essentially everything in BMG these is either esoteric or it’s dominated by two outspoken posters, one of whom is certainly no progressive and the other of whom is chiefly interested in criticizing a few local personalities. We’ve got two months before a critical primary, and we can’t talk about Don Berwick or Maura Healey or the supreme court or just about anything because we only talk about our troll — and we say the same things again and again and again.
If I’m not mistaken, at least a majority of our editors find the commenting on Daily Kos so very, very tedious that they want, at all costs, to avoid that here. Indeed, the sheer volume of commenting on dKos makes it repetitive.
As an antidote, they want to have non-liberals with whom to debate. There’s some merit in that, actually. Debating Frum, Drouthat, and A. Sullivan could be kind of fun. There are conservatives that take liberals seriously without agreeing to us. But we don’t have that and it’s structural.
You could say that there are two kinds of non-liberals that show up at BMG: those immune to social disapproval and those sensitive to it. The latter are going to be your more interesting commenters but they’re going to have a tough time here with people pointing out how wrong, immoral, stupid, etc. they are. The non-liberals immune to disapproval end up being permanent fixtures. JohnD for example used to dominate threads here for years before he disappeared and was replaced by DFW.
So what happens is we liberals get to feel annoyed and smugly superior to conservatives here because their only representatives are the most boorish and least least informed among them.
So I say, either exclude the boors or find some way regularly to praise ideological opponents who put together well-sourced, well-thought out arguments.
This blog actually functions pretty well at discussing the issues, in my opinion.
If you read it long enough you realize that it fluctuates between passionate and boring. Passionate happens when someone posts here who’s slightly outside the pure-as-the-driven-snow ultra-liberal consensus, and then gets beat up on (for instance I remember there being quite a negative reaction to Maura Healey at first because of her association with Coakley). That is the fun part! Boring happens when those people and their defenders get tired of the incessant combat and withdraw, and then the near-trolls like DanInWaltham emerge. (I say near-trolls because I think the moderators do a good job of keeping them from going over the edge into full-fledged trolldom, probably realizing they can just take on different identities. In fact, they may have several identities now. One is not me, though.)
So why did jimC and hrs-kevin have to respond to the bait in the first place? JimC pointed out that there were no links and hrs-kevin poked holes in the argument. Would you or someone else have felt compelled to do the same? Why didn’t ignoring his comment not work?
Your diary raised a question about using these rulings in the upcoming midterms. As far as I can tell, that discussion never happened.
The way you get rid of trolls is to ban them. Period.
If someone came into your house and started insulting you would you simply tell everyone to ignore him and hope he goes away? Of course not!
Sadly, banning trolls is far more difficult than keeping a real person away from your house.
Trolls eventually plague every on-line community with any significant number of participants, going all the way back to Ward Cunningham’s very first Wiki in 1997. Those communities have found that the most effective techniques of troll management are:
– Limiting the rate at which they can post
– Ignoring them as much as possible
– Banning them as much as possible
– Installing automated bots that find and remove troll-originated comments and changes.
The reason that trolls are so hard to ban is that it is essentially impossible to ensure that one real human is associated with one and only one login account. A dedicated troll enjoys the challenge of being banned on one account, and will simply create another — and then use the other to loudly proclaim the “censorship” of the site in question.
One reason that troll-originated comments and changes must be removed is that newcomers to the site don’t know who the trolls are, and therefore tend to come to their defense — this increases the attention shown the troll, as waves of “meta” discussion sweep the community. All of this encourages not just the first troll, but others waiting in the wings.
Hmmm … sounds a lot like “terrorist”. There’s a meme.
You don’t say.
“Meta-discussion” is discussion about the blog rather than the topic of the thread. Exchanges like this are more food for the troll, because they shift the focus away from the topic at hand and to the troll.
For hrs-kevin, the experience of moderated communities (like Ward Cunningham’s several wikis or several of the Accuweather blogs) is that the same people come back with different login names and IP addresses. Efforts to ban them often only intensify the problem — they view the attempted ban as a challenge, and then the game is on.
Often, the troll’s response to an attempted ban is to create four or five sock puppets that then come to the troll’s defense, complaining of censorship, unfair persecution, and that sort of thing.
It is, in fact, very hard to stop an actual human from participating in a given online community.
Since meta was brought up, I point to the community weblog MetaFilter, which has several full-time paid moderators, and does not suffer trolls. They have tens of thousands of users, most of whom paid $5 to join. When a troll makes himself known (you know they’re all guys), he’s warned, possibly blocked from commenting for a period. If he breaks the cardinal rule, he’s immediately banned. Repeated warnings and suspensions lead to banning. Unless he buys a new account with a different IP address, he’s gone for good. It’s a left-leaning community, but has conservative commenters as well. BMG’s trolls would not fare well over there.
The use of a team of moderators significantly lessens the burden on the site operator (like the three editors here).
The only quibble I have with your comment is that five dollars and a new IP address is a low bar for any wannabe troll — it’s easy to spend that much playing Candy Crush Saga, and new IP addresses are essentially free.
I’m not enough of a techie to know how they do it, but they seem able to identify returning trolls and somehow block them. One technique they may use is hellbanning, which renders a banned user’s comments invisible to everyone – except himself. It’s discussed here and here.
If you have a moderated community, you simply ban them. As long as the troll is an actual human, they won’t come back that many times if you keep booting them.
Yes, trollbots are harder to stop, but that is not what we are talking about here.
If you are going to respond to him, it would be better to respond in manner that stops discussion.
If someone came to my house and started insulting me, I’m sure I’d wouldn’t ask the person for sources, point out the contradictions in his or her insults, and then engage in point-by-point rebuttals. But that’s what you got into.
Rather I’d aim to get the person gone and quiet quickly.
So I’d advocate short dismissive responses and I would avoid referring to DFW in the second person ever. All this “Dan, what do you say about…?” stuff is just an encouragement. Third person, please, third person. DFW is always “he” and never “you”.
No one has to do anything here. That’s part of the point.
I saw a statement asserted as fact, got more information, and then was in a position to debunk it.
Try this link.
This is the very best comment I’ve seen here in YEARS.
Seriously!
I understand your goal, but it doesn’t work if it means limiting my options. There was nothing wrong with me asking for his source. I’m not obligated to do homework, nor is anyone else.
I’m out on this discussion, for now. I will say I do think the editors should consider banning DFW, but it looks to me like they’ve already decided not to.
But let that go. It was Don Berwick who mentioned the need for single payer in his response to Hobby Lobby, it’s in the actual diary. How is this hijacking the thread?
It was Ispinti who linked the Keller/Berwick interview and I commented on it which others joined in.
Let’s make it diary #10 Mark. Write a diary asking members who want me to be booted. If you get 25 other members to agree with you, I will leave for the rest of the year. Offer valid for next 24 hours
I started this thread by posting Don Berwick’s statement on the recent SCOTUS decision. While both parts of his statement are important, I was intrigued by his point regarding how this would be impacted if we had Single Payer. The discussion has been interesting — I don’t think it has been hijacked. Dan in my view should be welcome here even if he leans to the right of many of us — I say, let all flowers bloom. And after all, the majority of the voters in our Commonwealth are independent (un-enrolled). I don’t know how Dan defines himself politically, but I am hoping that Don Berwick catches the interest of many across the political spectrum because of his ethical values, vast knowledge and high level of integrity. He will need their votes to win.
But, DFW does hijack at times. There’s no denying that.
As to the decision by the editors alluded to above, it’s clearly been made. He’s staying here. So the decision to the rest of us should be: blog on. IF WE WANT. But only if we want.
I am an unenrolled voter who (gasp) votes for Republicans and Democrats (Will Brownsberger and Steve Lynch last year, Obama in 08).
I too respect Don Berwick and intend to vote for him in the primary. I support him fighting casinos and I deeply respect his honesty. Don isn’t lying to my face and promising to cut my property taxes like Deval did in 2006 or Obama telling me I’m going to save $2500 on my health insurance premiums under Obamacare or Papa Bush read my lips no new taxes or Clinton/Gore promising the great benefits of NAFTA as we lose our mfg blue collar jobs and replaced with poker and black jack dealers at the local casinos.
I didn’t want Berwick get into that mold of overselling an idea or what I thought was being dismissive of Jon Keller’s assertion with waiting times in Canada. Don could be 1000% correct, I just never heard such a defense of the Canadian system.
If Don makes it to the general, I could see myself voting for him (never Coakley or Grossman) but it may not be a good omen, the last Democrat I voted for governor was also a Dr. and he lost the general in 1990.
The fact that danfromwaltham clearly plans to pull a Democratic Party ballot in the upcoming primary speaks eloquently to why primaries should be limited to voters who have been registered with the party in question for some period prior to the primary.
Dan, if you want to vote in the Democratic Party then I suggest you should have to register as a Democrat some reasonable period (6-8 weeks) prior to the primary. That is a light burden to bear in exchange for the privilege of participating in the party’s nomination process. No meetings to attend, no dues to pay, none of the participation required to vote in virtually ANY other entity’s internal elections.
Would any church, synagogue, or community organization allow random participants from the street to select their corporate officers? Is there any choice more fundamental for a political party than the selection of its nominees?
The purpose of a primary is to choose the nominee for a particular primary. That selection process should be limited to party members.
Not sure when it changed but when I pulled a Dem ballot, I remained a Dem until I went to City Hall and changed party affiliation back to Independent. Now it is done automatically at the polls.
Don’t you believe in a big tent?
It is the law that if you are an unenrolled voter (registered to vote, but without a party designation) you are allowed to both sign the nominating petition of a candidate in any party and more than one (except for municipal elections which have different rules) and vote in the primary of any party, but of course only one. What an unenrolled voter cannot do is participate in the nominating caucus of any party. This partly addresses the concern you raise,Tom. Since currently a majority of our state’s voters are unenrolled, ie., for whatever reason they do not wish to register with a party, allowing them to vote in a party primary may help a party choose a candidate who has a better chance to win in the general election.
I’m aware of the current law. I’d like to see it changed.
I want the voters in a Democratic Party to be registered Democrats. That strikes me as a very low bar.
I can embrace diversity of opinion, and I can still think banning DFW is long overdue.
I often run to the defense of a number of substantive conservative contributors. DFW contributes to an atmosphere at BMG that is actually toxic for conservatives.
1) All the Diaries about the Patriots.
2) All the Diaries about the Bruins.
3) All the Diaries about your Man-Crush on Scott Brown.
4) All the Diaries about the XL Pipeline.
5) All the Diaries attacking ObamaCare with fake Republican Talking Points.
6) All the Diaries attacking Senator Warren.
7) All the Diaries praising Stephen Lynch.
And what do you have left: If I had to guess, less than 30 Diaries.
Mark Bernstein has written 9 diaries more interesting than a certain other person.
It could be that that certain other person is a cleverly programmed bot that emits diaries automatically generated from right-wing talking-point lists.
Then a team of under-paid or free interns working for the MA GOP might be running the sock-puppet to handle comments (drawn from the same lists).
Nah, that’s too crazy. Computers can’t do that anyway.
It’s not unheard of.
There are two or three persona on the accuweather climate change blog that are clearly sock-puppets run by denier organizations. They occasionally trip themselves up during shift-changes (one person running the persona talks of being in one place over the weekend, the next person talks of being on the other side of the country during the same time), and occasionally answer from the wrong persona (sock-puppet A answers in the first person to a question directed to sock-puppet B).
I’m not saying that’s happening here, just that it is possible.
If you may recall last months DFW was against the ACA because single payer would be superior. This month’s DFW is against single payer because of various Canadian deficiencies.
Also you’ll notice that the more recent DFW has gotten into trying to engage people in irrelevant exchanges. That’s a technique not formerly practiced.
So, yeah, maybe.
Anyone? KBusch believes I have changed my opinion on this topic. Besides believing health care is a right (most procedures, taxpayers should not pay for sex changes), I thought the tradeoff of moving to single payer would be a drop in quality. I can be wrong, I raised the question since Don dismissed it in his interview with Jon Keller and that was that. Perhaps I am diabolical for saying this, but cities and towns are burden with health care costs and I would like to offload this burden thru single payer. Waltham has $500 Million in h/c debt, NYC is like $90 billion. Thus, we would not only decouple h/c from private employees, but from municipalities as well, amirite?
Rest assured, I am one person. If BMG has a 10 year anniversary party in Nov, and if it’s near Waltham, I hope to be there.
You could have told us, we’d have organized an e-kegger or something.
I believe in medicare for all, but much of our economy and millions of jobs are tied up in the insurance industry. How could all of the people who currently work in jobs related to the health care industry be maintained? if they were maintained that would be in opposition to one of the reasons for medicare for all which is greater efficiency and less money spent on processing.
We don’t seem to address whether health procedures are necessary and how we define necessary. When researchers who looked at multiple studies say that women do not benefit from have yearly mammography, the world goes crazy, but some of those who go crazy have a financial interest in women having yearly mammograms.
Healthcare is a mess and cost and reimbursement is only one piece of the mess.