Medicaid: A primer

Believe it or not, I recently had a conversation with a friend who is a psychotherapist, who bills Medicaid for many of his clients, and he didn't know some of the basic facts about the program. I told him that the Republicans would try to convert it into a block grant, and he thought it already was. So I think I'd better lay out the basics.

 

Medicaid is an entitlement program, like Social Security and Medicare. That means anyone who meets eligibility requirements can receive it. There's a somewhat complicated history regarding who has been eligible. Originally it was for families that qualified for Aid to Families with Dependent Children, what was usually meant by "welfare" back in the day, which was abolished under the Clinton Administration. Originally states also had the option to include people who were "medically indigent," including not only beneficiaries of AFDC and disability, but also people over 65. 

As all people over age 65 were now to be covered by Medicare, perhaps it did not occur to people that this provision would be important. However, as people tended to live longer past age 65, and to develop costlier medical needs, notably including long-term care that Medicare does not pay for, states increasingly were compelled to provide Medicaid to Medicare beneficiaries who had unaffordable medical and long-term care costs. This “dual eligible” population now accounts for 19% of Medicare beneficiaries and 14% of Medicaid beneficiaries, but 30% of Medicaid spending. The median cost of a nursing home stay is about $8,000 per month nationally. In Connecticut, it’s more than $13,000, that is $156,000 per year. As you can see very few retirees have incomes approaching this amount, and that is why they account for such a disproportionate amount of Medicaid spending.

But it continued to be the case that only poor families with children qualified, along with people who were eligible for Medicare. That meant that poor people under 65 who didn't live in households with children were not eligible. The Affordable Care Act gave states the option to expand eligibility to anyone under 135% of the federal poverty level, regardless of whether they are caring for dependent children. Most have done so, but there are a few holdouts. A program called the Children's Health Insurance Program also covers children in families that aren't poor enough to qualify for Medicaid, but who have expensive health care needs. Most states essentially fold this into the Medicaid program and it works in a similar way. Right now there are about 72 million people enrolled in Medicaid, and 7.2 million enrolled in CHIP. Of the total 79 million, about half are children. 

 

However, despite being just 14% of Medicaid beneficiaries, so-called "dual eligible" Medicare and Medicaid beneficiaries, mostly people over 65, account for 30% of spending, because long-term care is so costly. Next, I'll explain how the program is financed, and what the Republicans want to do to it.

 

 

Sunday Sermonette: No new thing under the sun?

Sorry I haven't posted much lately. It's hard to find the right response when the occupant of the office of president of the United States is a demented lunatic with the mentality of a two year old who spends his time playing golf, spouting absurdities, and surrendering the national interest to the country's most dangerous and depraved adversaries; while the government is actually run by a drug-addled psychopathic foreigner whose ultimate goal is to destroy it and put all power in the hands of a cabal of billionaires. That's kind of bad. But evildoers have seized power before, and it doesn't last forever. Viz. Isaiah 57. 

57 The righteous perish,
    and no one takes it to heart;
the devout are taken away,
    and no one understands
that the righteous are taken away
    to be spared from evil.
² Those who walk uprightly
    enter into peace;
    they find rest as they lie in death.

³ “But you—come here, you children of a sorceress,
    you offspring of adulterers and prostitutes!
⁴ Who are you mocking?
    At whom do you sneer
    and stick out your tongue?
Are you not a brood of rebels,
    the offspring of liars?
⁵ You burn with lust among the oaks
    and under every spreading tree;
you sacrifice your children in the ravines
    and under the overhanging crags.
⁶ The idols among the smooth stones of the ravines are your portion;
    indeed, they are your lot.
Yes, to them you have poured out drink offerings
    and offered grain offerings.
    In view of all this, should I relent?
⁷ You have made your bed on a high and lofty hill;
    there you went up to offer your sacrifices.
⁸ Behind your doors and your doorposts
    you have put your pagan symbols.
Forsaking me, you uncovered your bed,
    you climbed into it and opened it wide;
you made a pact with those whose beds you love,
    and you looked with lust on their naked bodies.
⁹ You went to Molek^[a] with olive oil
    and increased your perfumes.
You sent your ambassadors^[b] far away;
    you descended to the very realm of the dead!
¹⁰ You wearied yourself by such going about,
    but you would not say, ‘It is hopeless.’
You found renewal of your strength,
    and so you did not faint.

¹¹ “Whom have you so dreaded and feared
    that you have not been true to me,
and have neither remembered me
    nor taken this to heart?
Is it not because I have long been silent
    that you do not fear me?
¹² I will expose your righteousness and your works,
    and they will not benefit you.
¹³ When you cry out for help,
    let your collection of idols save you!
The wind will carry all of them off,
    a mere breath will blow them away.
But whoever takes refuge in me
    will inherit the land
    and possess my holy mountain.”

Comfort for the Contrite

¹⁴ And it will be said:

“Build up, build up, prepare the road!
    Remove the obstacles out of the way of my people.”
¹⁵ For this is what the high and exalted One says—
    he who lives forever, whose name is holy:
“I live in a high and holy place,
    but also with the one who is contrite and lowly in spirit,
to revive the spirit of the lowly
    and to revive the heart of the contrite.
¹⁶ I will not accuse them forever,
    nor will I always be angry,
for then they would faint away because of me—
    the very people I have created.
¹⁷ I was enraged by their sinful greed;
    I punished them, and hid my face in anger,
    yet they kept on in their willful ways.
¹⁸ I have seen their ways, but I will heal them;
    I will guide them and restore comfort to Israel’s mourners,
¹⁹     creating praise on their lips.
Peace, peace, to those far and near,”
    says the Lord. “And I will heal them.”
²⁰ But the wicked are like the tossing sea,
    which cannot rest,
    whose waves cast up mire and mud.
²¹ “There is no peace,” says my God, “for the wicked.”

Footnotes

1. Isaiah 57:9 Or to the king
2. Isaiah 57:9 Or idols

Wednesday Bible Study: The restoration

As promised, we're now skipping ahead to so-called Trito-Isaiah, chapters 56-66. It's entirely unclear why this material was tacked on to the earlier two books, as it is completely unrelated both in context and meaning. These chapters were written by anonymous people -- yes, probably several of them -- during the Persian period of the Judean restoration, i.e. about 520 - 400 BCE. 

 

Since there's obviously no longer any need to prophecy the restoration of Judah, this material appears to concern theological and political disputes of the time. Note that the early period of the restoration is described in two versions, in the book of Ezrah/Nehemiah, but we don't know exactly when any of this was written and whether it corresponds with that period. 

 

Anyway, Ch. 56 is interesting because it asserts that eunuchs can fully participate in religious life, which is a direct contradiction to Leviticus 21 and Deuteronomy 23. Specifically, the latter says "He that is wounded in the stones, or hath his privy member cut off, shall not enter into the congregation of the LORD." The declaration in Leviticus is just as clear and absolute. Clearly the absolute decrees of the Torah were by now open to dissent. Also, like the Book of Ruth, this chapter allows for converts from other nations to join the congregation -- again a direct contradiction to the Torah but a feature of modern Judaism.

 

56 This is what the Lord says:

“Maintain justice
    and do what is right,
for my salvation is close at hand
    and my righteousness will soon be revealed.
² Blessed is the one who does this—
    the person who holds it fast,
who keeps the Sabbath without desecrating it,
    and keeps their hands from doing any evil.”

³ Let no foreigner who is bound to the Lord say,
    “The Lord will surely exclude me from his people.”
And let no eunuch complain,
    “I am only a dry tree.”

⁴ For this is what the Lord says:

“To the eunuchs who keep my Sabbaths,
    who choose what pleases me
    and hold fast to my covenant—
⁵ to them I will give within my temple and its walls
    a memorial and a name
    better than sons and daughters;
I will give them an everlasting name
    that will endure forever.
⁶ And foreigners who bind themselves to the Lord
    to minister to him,
to love the name of the Lord,
    and to be his servants,
all who keep the Sabbath without desecrating it
    and who hold fast to my covenant—
⁷ these I will bring to my holy mountain
    and give them joy in my house of prayer.
Their burnt offerings and sacrifices
    will be accepted on my altar;
for my house will be called
    a house of prayer for all nations.”
⁸ The Sovereign Lord declares—
    he who gathers the exiles of Israel:
“I will gather still others to them
    besides those already gathered.”

God’s Accusation Against the Wicked

⁹ Come, all you beasts of the field,
    come and devour, all you beasts of the forest!
¹⁰ Israel’s watchmen are blind,
    they all lack knowledge;
they are all mute dogs,
    they cannot bark;
they lie around and dream,
    they love to sleep.
¹¹ They are dogs with mighty appetites;
    they never have enough.
They are shepherds who lack understanding;
    they all turn to their own way,
    they seek their own gain.
¹² “Come,” each one cries, “let me get wine!
    Let us drink our fill of beer!
And tomorrow will be like today,
    or even far better.”

 

Health Equity

I know they're trying to beat us down with outrage fatigue, but it's not going to work with me. I take a lot of president Musk's violence and hatred personally, including his trying to censor scientific research on disparities in health and health care associated with socioeconomic status, including race, ethnicity and gender.  We know that rich people live longer, healthier lives than poor people. We also know that even after adjusting for education and income, white people live longer and healthier lives than Black people. As Drs. Alladina, Hardin and Rabin write in the linked article, "In recent weeks, studies that would help us answer . . . health equity questions have come under attack from the federal government for their “wokeness” and “shameful” agenda. They have, in a word, been censored. . . ."

The assault on science began on Jan. 20, when diversity, equity and inclusion programs in the federal government were explicitly ended. Days later, researchers noticed that the Food and Drug Administration had quietly removed guidance on recruiting patients with diverse backgrounds for clinical trials. And by the end of January, Centers for Disease Control and Prevention scientists were instructed to freeze publication, or even retract, articles submitted for publication, to check if they contained newly forbidden words like “gender.” Online tools for navigating public health databases such as the Centers for Disease Control’s Behavioral Risk Factor Surveillance System have disappeared, researchers are being muzzled and meetings to review grants at the National Institutes of Health have been canceled, then rescheduled, then canceled again.

 

Recognition of health equity is not wokeness or a shameful agenda, it is simply facing the truth, a truth I have dedicated my professional career to understanding and combating. You might as well know that I have been a member of the Institutional Review Board of Latin American Health Institute; a member of the Scientific Advisory Council, Latino Health Policy Council of Massachusetts; Research Director and Steering Committee Member ex oficio, New England Coalition for Health Equity; member, Massachusetts Department of Public Health Hispanic Births Task Force; Symposium Director for “Who Counts: The Classification and Application of Race and Ethnicity in Public Health Data,” New England Coalition for Health Equity; member, Disproportionate Minority Contact Peer Review Committee, U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention;  Symposium Director for “Everybody Counts: State Policy to Eliminate Health Disparities,” New England Coalition for Health Equity; member, Executive Committee, Massachusetts Disparities Action Network; and member, Steering Committee, Tufts University Community Research Center. Much of my published research concerns disparities in health care access and delivery based on race, ethnicity, sexual orientation, gender and stigmatized conditions.

 

So I can tell you that this is absolutely real. The reason  -- the entire reason -- that the United States has lower life expectancy and worse health status than all the other wealthy nations, and even some that aren't so wealthy, is because of these disparities. If we could eliminate them, we could join the rest of the world in reaping the benefits of modern medical science and spending on public health and medical services, for which right now we are not getting our money's worth. We don't need a racist, South African Nazi to tell us we can't try to understand and solve this problem.

Sunday Sermonette: Gobbledeygook

I had to shovel and plow this morning so I'm getting to this a bit late. 

 

As I've said, I'm going to skip much of deutero-Isaiah -- material that was written during the Babylonian exile and consists of God bragging about his own greatness and predicting the fall of Babylon to the Persian emperor Cyrus, basically. Again, it does introduce the most overt monotheism we've seen so far, although God still favors the descendants of Jacob, and Christians have co-opted the prophecies about the restoration of Judah to pretend they are somehow predictions of Jesus as the Messiah, which they very clearly are not. But this is basically very repetitious and also uses a lot of obscure imagery, so there's not good reason to read it all. I am going to give you Chapter 50 however, before we skip ahead to Trito-Isaiah, which was written after the return to Jerusalem. 

 

I just couldn't resist sharing this inscrutable imagery. Of course theologians, both Jewish and Christian, will find ways to interpret it, but it can mean whatever you want it to. This is true of much of the Bible, so it really isn't a useful guide to anything -- it's a Rorschach test. 

50 This is what the Lord says:

“Where is your mother’s certificate of divorce
    with which I sent her away?
Or to which of my creditors
    did I sell you?
Because of your sins you were sold;
    because of your transgressions your mother was sent away.
² When I came, why was there no one?
    When I called, why was there no one to answer?
Was my arm too short to deliver you?
    Do I lack the strength to rescue you?
By a mere rebuke I dry up the sea,
    I turn rivers into a desert;
their fish rot for lack of water
    and die of thirst.
³ I clothe the heavens with darkness
    and make sackcloth its covering.”

⁴ The Sovereign Lord has given me a well-instructed tongue,
    to know the word that sustains the weary.
He wakens me morning by morning,
    wakens my ear to listen like one being instructed.
⁵ The Sovereign Lord has opened my ears;
    I have not been rebellious,
    I have not turned away.
⁶ I offered my back to those who beat me,
    my cheeks to those who pulled out my beard;
I did not hide my face
    from mocking and spitting.
⁷ Because the Sovereign Lord helps me,
    I will not be disgraced.
Therefore have I set my face like flint,
    and I know I will not be put to shame.
⁸ He who vindicates me is near.
    Who then will bring charges against me?
    Let us face each other!
Who is my accuser?
    Let him confront me!
⁹ It is the Sovereign Lord who helps me.
    Who will condemn me?
They will all wear out like a garment;
    the moths will eat them up.

¹⁰ Who among you fears the Lord
    and obeys the word of his servant?
Let the one who walks in the dark,
    who has no light,
trust in the name of the Lord
    and rely on their God.
¹¹ But now, all you who light fires
    and provide yourselves with flaming torches,
go, walk in the light of your fires
    and of the torches you have set ablaze.
This is what you shall receive from my hand:
    You will lie down in torment.

Flooding the Zone

President Musk's strategy is basically to commit so many outrages so quickly that nobody can focus on any one of them sufficiently to resist effectively. Meanwhile, the nominal president just spouts insanity and inanity, essentially as a distraction. The New York Times doesn't have to write a serious policy analysis explaining why the U.S. is not going to take over Greenland or the Gaza Strip, but they do it anyway, which both dignifies delusions and takes up space that otherwise might be put to meaningful use.

 

I'm going to focus, at least for now, on the question of whether president Musk really wants to destroy the scientific research enterprise in the U.S. and if so, why. First of all, that would be the effect of executive actions taken so far, and further proposed. They've put a raving lunatic in charge of HHS, which includes NIH, the CDC, Agency for Healthcare Research and Quality, Substance Abuse and Mental Health Services Administration*, and some smaller pockets of money for public health promotion and research. The abrupt, unilateral cap on indirect costs of 15% affects all of these agencies, and the National Science Foundation, NASA, Advanced Research Projects Agency, and others that fund scientific research. Musk has also suspended all review panel and national advisory committee meetings, which are the mechanism for actually awarding funds. We'll see where that goes.

 

I've explained the indirect costs issue before, and I won't repeat myself, but take my word for it, with a 15% cap it will be impossible to sustain more than a shadow of the current scientific enterprise in the U.S. And no, private corporations do little or no basic research. They only invest where they can see a likely financial payoff, and that means they'll do some applied research but with basic science a) there's not telling whether and how it might lead to profit and b) you can't patent scientific facts. The pharmaceutical industry turns discoveries made by NIH-funded investigators into billions in profits, but it doesn't invest in making the discoveries itself.

 

The basic problem for president Musk is that his rule depends on a vast edifice of lies. Truth is the enemy, and truth is part of the mission and the culture of the university. The first thing the Nazis did when they invaded Poland was not to hunt down the Jews, but rather to murder the so-called intelligentsia, "the university-educated people of a society who engage in the complex mental labours by which they critique, shape, and lead in the politics, policies, and culture of their society;^[1] as such, the intelligentsia consists of scholars, academics, teachers, journalists, and literary writers.^{[2][3] . . .} After the invasion of Poland on 1 September 1939, the Nazis launched the extermination of the Polish intelligentsia, by way of the military operations of the Special Prosecution Book-Poland, the German AB-Aktion in Poland, the Intelligenzaktion, and the Intelligenzaktion Pommern." Stalin did the same thing in the east.

 

I don't think Musk intends to murder us, but he does want to put us out of business. He's gotten a long way down that road.

*SAMHSA doesn't technically fund research, but they fund many demonstration and capacity building projects that typically included 15% for evaluation, which amounts to implementation research. If a university or other research institute has the subcontract for evaluation, they'll get their indirect costs as part of that 15% of the grant.

Wednesday Bible Study: The theodicy problem solved!

 Chapter 45, and the rest of so-called Duetero-Isaiah, is a more of Yahweh boasting about his own greatness. I'm going to skip most of it, but I do want to give you this chapter because, first of all, it is the most direct and uncompromising statement of monotheism we have encountered so far. In the Torah and Deuteronomistic History, Yahweh is one god among many, the one who chose the Hebrews and maybe the greatest of them all; but while worshiping other gods is a grave offense for the chosen people, their existence is not denied. It is here, strenuously.

 

Also of considerable interest is verse 7.  NIV translates it "⁷ I form the light and create darkness,   I bring prosperity and create disaster;  I, the Lord, do all these things." Here's the KJV:

"I form the light, and create darkness: I make peace, and create evil: I the LORD do all these things. "

Apparently the NIV translators didn't have the nerve the KJV translators did. This solves the one problem that has most vexed theologians: If God is beneficent and all-powerful, why is there injustice and suffering in the world? Answer: He isn't benevolent. He is the creator of evil, by his own assertion. Problem solved.

 

 

45 “This is what the Lord says to his anointed,
    to Cyrus, whose right hand I take hold of
to subdue nations before him
    and to strip kings of their armor,
to open doors before him
    so that gates will not be shut:
² I will go before you
    and will level the mountains^[a];
I will break down gates of bronze
    and cut through bars of iron.
³ I will give you hidden treasures,
    riches stored in secret places,
so that you may know that I am the Lord,
    the God of Israel, who summons you by name.
⁴ For the sake of Jacob my servant,
    of Israel my chosen,
I summon you by name
    and bestow on you a title of honor,
    though you do not acknowledge me.
⁵ I am the Lord, and there is no other;
    apart from me there is no God.
I will strengthen you,
    though you have not acknowledged me,
⁶ so that from the rising of the sun
    to the place of its setting
people may know there is none besides me.
    I am the Lord, and there is no other.
⁷ I form the light and create darkness,
    I bring prosperity and create disaster;
    I, the Lord, do all these things.

⁸ “You heavens above, rain down my righteousness;
    let the clouds shower it down.
Let the earth open wide,
    let salvation spring up,
let righteousness flourish with it;
    I, the Lord, have created it.

⁹ “Woe to those who quarrel with their Maker,
    those who are nothing but potsherds
    among the potsherds on the ground.
Does the clay say to the potter,
    ‘What are you making?’
Does your work say,
    ‘The potter has no hands’?
¹⁰ Woe to the one who says to a father,
    ‘What have you begotten?’
or to a mother,
    ‘What have you brought to birth?’

¹¹ “This is what the Lord says—
    the Holy One of Israel, and its Maker:
Concerning things to come,
    do you question me about my children,
    or give me orders about the work of my hands?
¹² It is I who made the earth
    and created mankind on it.
My own hands stretched out the heavens;
    I marshaled their starry hosts.
¹³ I will raise up Cyrus^[b] in my righteousness:
    I will make all his ways straight.
He will rebuild my city
    and set my exiles free,
but not for a price or reward,
    says the Lord Almighty.”

¹⁴ This is what the Lord says:

“The products of Egypt and the merchandise of Cush,^[c]
    and those tall Sabeans—
they will come over to you
    and will be yours;
they will trudge behind you,
    coming over to you in chains.
They will bow down before you
    and plead with you, saying,
‘Surely God is with you, and there is no other;
    there is no other god.’”

¹⁵ Truly you are a God who has been hiding himself,
    the God and Savior of Israel.
¹⁶ All the makers of idols will be put to shame and disgraced;
    they will go off into disgrace together.
¹⁷ But Israel will be saved by the Lord
    with an everlasting salvation;
you will never be put to shame or disgraced,
    to ages everlasting.

¹⁸ For this is what the Lord says—
he who created the heavens,
    he is God;
he who fashioned and made the earth,
    he founded it;
he did not create it to be empty,
    but formed it to be inhabited—
he says:
“I am the Lord,
    and there is no other.
¹⁹ I have not spoken in secret,
    from somewhere in a land of darkness;
I have not said to Jacob’s descendants,
    ‘Seek me in vain.’
I, the Lord, speak the truth;
    I declare what is right.

²⁰ “Gather together and come;
    assemble, you fugitives from the nations.
Ignorant are those who carry about idols of wood,
    who pray to gods that cannot save.
²¹ Declare what is to be, present it—
    let them take counsel together.
Who foretold this long ago,
    who declared it from the distant past?
Was it not I, the Lord?
    And there is no God apart from me,
a righteous God and a Savior;
    there is none but me.

²² “Turn to me and be saved,
    all you ends of the earth;
    for I am God, and there is no other.
²³ By myself I have sworn,
    my mouth has uttered in all integrity
    a word that will not be revoked:
Before me every knee will bow;
    by me every tongue will swear.
²⁴ They will say of me, ‘In the Lord alone
    are deliverance and strength.’”
All who have raged against him
    will come to him and be put to shame.
²⁵ But all the descendants of Israel
    will find deliverance in the Lord
    and will make their boast in him.

Footnotes

1. Isaiah 45:2 Dead Sea Scrolls and Septuagint; the meaning of the word in the Masoretic Text is uncertain.
2. Isaiah 45:13 Hebrew him
3. Isaiah 45:14 That is, the upper Nile region

 

I don't really have much to add to this . . .

William Saletan makes the case, conclusively, the Donald J. Trump is just nuts. The technical term for it is batshit insane. It's not that he's a liar, and it's not that he's a bullshitter who doesn't care whether anything he says is true. He really believes everything he says. He believes he won the 2020 election. He believes the Canadian people will happily become the 51st state. He believes the Gazans will be relocated to Arab countries, the U.S. will take over the territory, and redevelop it as a resort. He believes that USAID is a totally corrupt fraud. He believes the people of Greenland want it to become a U.S. dominion and that Denmark will sell it. He believes that tariffs will pay for his tax cuts and increased military spending, and that foreign governments pay them. And so on. He actually believes all this.

 

He believes all this because the way his mind works is that whatever he wants to be true, is true. That's an extreme narcissism that becomes a form of psychosis. Oh, and by the way, he's more popular now than he has ever been.

Explaining the latest insanity

Reporters generally don't know much, if anything, about the subjects they cover, and pundits generally know nothing at all about the subjects of their bloviations. To some extent, this can't be helped. They are required to be generalists, and they can't be experts on everything. There are exceptions who cover specific fields. There are some good science writers, people who understand military strategy, Krugman of course who actually understand economic reality unlike most economists. Obviously that means most pundits are actually useless.

Anyway, I'm not seeing any adequate explanation of the sudden announcement by president Musk that he's going to restrict NIH indirect costs to 15%. I have to assume that more than 90% of people have little or no idea what this means, and the people who write about it for the New York Times and CNN definitely don't (Fox News reporters know nothing at all about anything, they just make shit up), so let me tell you. 

Research institutions -- mostly universities, including medical schools, schools of public health, and biology departments -- depend on NIH and other federal sources for most of their funding.  Smaller federal sources include the Agency for Healthcare Research and Quality, National Science Foundation, Advanced Research Projects Agency, CDC, and functional departments that fund some research related to their activities including the Department of Defense, the Agriculture Department, NASA, and others, but NIH is the most important. There is some private foundation funding for biomedical and public health research, but it amounts to a quite small percentage. (Right now, 100% of my own funding is actually private, but I'm semi-retired and I'm not bringing in the kind of bucks that make my bosses like me.)

Federal grants consist of two parts, called direct and indirect costs. Direct costs are pretty much what it sounds like -- the incremental expenses necessary to conduct the research. This includes salaries for the investigators, research assistants, data analysts, and other personnel who do the tasks to get the answers. It may also include equipment, supplies, use of computer resources, compensation for research subjects, travel to scientific conferences -- whatever is spent for the specific project.

Indirect costs are how research institutions pay for their ongoing infrastructure. That means buildings, utilities, administration; physical and technical infrastructure that is shared among researchers such as the Institutional Review Board, tech support, and grant administration (which is quite complicated because federal proposals and contracts are extraordinarily elaborate); and yes, the research institution's share of the university's overhead including the arguably inflated salaries of the president and other potentates, the faculty lounge, and the homecoming parade. However the latter is pretty small. (We negotiate it with the university.)

Each institution negotiates its indirect cost rate with the federal government. The same rate applies to every grant, which may or may not make sense but it makes things easier. The typical rate for a research university is above 50%. Last I checked ours was something like 62%. That means if I get a grant for $250,000, the university actually gets $405,000. Maybe that sounds unreasonable, but it's the result of a process in which the university spelled out, line by line, what it actually costs them to house an investigator -- offices, support staff, utilities, expenses for recruitment and hiring, information technology, grant and contract administration, all the stuff I mentioned above; and federal bureaucrats looked at the number, asked questions, raised objections, and ultimately set a rate which was somewhat less than the university asked for.

Does that mean there's no possibility it might be higher than it needs to be? Certainly not. Bureaucracies tend to metastasize, and get involved where they don't really need to be. I could do with a bit less of it. But simply declaring, across the board, that we're going to slash the rate by 75% is, well, insane. The research enterprise cannot possibly survive that. It will put biomedical and public health research in the U.S. out of business because it will be economically impossible to conduct it. Nobody will apply for federal research funding because it will cost them more to try to do it than the government will pay. That's what this means -- Musk wants to shut down extramural research supported by the federal government. That will be more "efficient." 

Just so we're clear.

Sunday Sermonette: Bragadoccio

Chapters 42-44 consist of Yahweh bragging at tedious length about his own greatness. We've seen plenty of this already so I'm just going to skip 42 and 43. Chapter 44 is (barely) worth a look because, after an extraordinarily turgid warning against making idols, and some additional bragging about his own greatness, the Big Guy in the Sky lets us know that the people will return to Judah, and specifically credits Cyrus the Persian emperor who conquered Babylon. As I've been telling you all along, Cyrus must have gotten word of his intentions to the exiles while they were still under Babylonian control, and that is what this is all about. And no, it isn't about Jesus coming in 600 years -- as you can plainly read in verse 21, this, and everything else in Isaiah, is about the restoration of Judah. Which did indeed happen, in about 539 BC.

44 “But now listen, Jacob, my servant,
    Israel, whom I have chosen.
² This is what the Lord says—
    he who made you, who formed you in the womb,
    and who will help you:
Do not be afraid, Jacob, my servant,
    Jeshurun,^[a] whom I have chosen.
³ For I will pour water on the thirsty land,
    and streams on the dry ground;
I will pour out my Spirit on your offspring,
    and my blessing on your descendants.
⁴ They will spring up like grass in a meadow,
    like poplar trees by flowing streams.
⁵ Some will say, ‘I belong to the Lord’;
    others will call themselves by the name of Jacob;
still others will write on their hand, ‘The Lord’s,’
    and will take the name Israel.

The Lord, Not Idols

⁶ “This is what the Lord says—
    Israel’s King and Redeemer, the Lord Almighty:
I am the first and I am the last;
    apart from me there is no God.
⁷ Who then is like me? Let him proclaim it.
    Let him declare and lay out before me
what has happened since I established my ancient people,
    and what is yet to come—
    yes, let them foretell what will come.
⁸ Do not tremble, do not be afraid.
    Did I not proclaim this and foretell it long ago?
You are my witnesses. Is there any God besides me?
    No, there is no other Rock; I know not one.”

⁹ All who make idols are nothing,
    and the things they treasure are worthless.
Those who would speak up for them are blind;
    they are ignorant, to their own shame.
¹⁰ Who shapes a god and casts an idol,
    which can profit nothing?
¹¹ People who do that will be put to shame;
    such craftsmen are only human beings.
Let them all come together and take their stand;
    they will be brought down to terror and shame.

¹² The blacksmith takes a tool
    and works with it in the coals;
he shapes an idol with hammers,
    he forges it with the might of his arm.
He gets hungry and loses his strength;
    he drinks no water and grows faint.
¹³ The carpenter measures with a line
    and makes an outline with a marker;
he roughs it out with chisels
    and marks it with compasses.
He shapes it in human form,
    human form in all its glory,
    that it may dwell in a shrine.
¹⁴ He cut down cedars,
    or perhaps took a cypress or oak.
He let it grow among the trees of the forest,
    or planted a pine, and the rain made it grow.
¹⁵ It is used as fuel for burning;
    some of it he takes and warms himself,
    he kindles a fire and bakes bread.
But he also fashions a god and worships it;
    he makes an idol and bows down to it.
¹⁶ Half of the wood he burns in the fire;
    over it he prepares his meal,
    he roasts his meat and eats his fill.
He also warms himself and says,
    “Ah! I am warm; I see the fire.”
¹⁷ From the rest he makes a god, his idol;
    he bows down to it and worships.
He prays to it and says,
    “Save me! You are my god!”
¹⁸ They know nothing, they understand nothing;
    their eyes are plastered over so they cannot see,
    and their minds closed so they cannot understand.
¹⁹ No one stops to think,
    no one has the knowledge or understanding to say,
“Half of it I used for fuel;
    I even baked bread over its coals,
    I roasted meat and I ate.
Shall I make a detestable thing from what is left?
    Shall I bow down to a block of wood?”
²⁰ Such a person feeds on ashes; a deluded heart misleads him;
    he cannot save himself, or say,
    “Is not this thing in my right hand a lie?”

²¹ “Remember these things, Jacob,
    for you, Israel, are my servant.
I have made you, you are my servant;
    Israel, I will not forget you.
²² I have swept away your offenses like a cloud,
    your sins like the morning mist.
Return to me,
    for I have redeemed you.”

²³ Sing for joy, you heavens, for the Lord has done this;
    shout aloud, you earth beneath.
Burst into song, you mountains,
    you forests and all your trees,
for the Lord has redeemed Jacob,
    he displays his glory in Israel.

Jerusalem to Be Inhabited

²⁴ “This is what the Lord says—
    your Redeemer, who formed you in the womb:

I am the Lord,
    the Maker of all things,
    who stretches out the heavens,
    who spreads out the earth by myself,
²⁵ who foils the signs of false prophets
    and makes fools of diviners,
who overthrows the learning of the wise
    and turns it into nonsense,
²⁶ who carries out the words of his servants
    and fulfills the predictions of his messengers,

who says of Jerusalem, ‘It shall be inhabited,’
    of the towns of Judah, ‘They shall be rebuilt,’
    and of their ruins, ‘I will restore them,’
²⁷ who says to the watery deep, ‘Be dry,
    and I will dry up your streams,’
²⁸ who says of Cyrus, ‘He is my shepherd
    and will accomplish all that I please;
he will say of Jerusalem, “Let it be rebuilt,”
    and of the temple, “Let its foundations be laid.”’

Footnotes

1. Isaiah 44:2 Jeshurun means the upright one, that is, Israel.

Rules

I'm getting some thoughtful comments by one or more people who are trying to comment anonymously. Again, let me repeat -- and it's on the sidebar -- that is not allowed. I'd like to publish your comments but you must choose a handle.

Turning to other rules, a lot of people are saying some of what needs to be said right now. I'll gift you Jamelle Bouie, for starters. President Musk is blatantly violating the law and the constitution, and the only people who can do anything about it -- the Republican majorities in both houses of Congress -- are apparently more than happy to sit back and watch. As Bouie says, there's no going back. Now that the method has been shown to work, we'll need new and different institutional arrangements if we're ever to have a functioning liberal* democracy again. That's a difficult, complicated problem and I'm not going to try to pull the answer out of my hat.

That said, our other problem is that the nominal president is clearly a raving lunatic. The corporate media decided that Joe Biden was not fit to run for re-election because he appeared feeble and tired in the presidential debate and lost his train of thought. They excoriated his close associates for allegedly covering up his incapacity. However, it was perfectly alright with them that his opponent was, and is all the time even more so, a demented lunatic. Why is that not equally newsworthy?

*The word liberal in this context does not mean "as opposed to conservative." Liberal democracies can and often do have conservative governments. Also, the term "liberal arts" has nothing to do with political orientation. I'm not going to try to explain this now, if you don't already understand it you'll just need to do your own research.

What's wrong with science

There is no such thing as the "scientific method." Scientists use many different methods,  engage in many different kinds of activities, and ask many different kinds of questions. What defines science might best be characterized as an attitude -- an attitude that is more about what it forbids than what it enables. The scientific attitude is that the only legitimate way to answer any scientific question is to observe reality -- the truth is out there. The ultimate test is that if more and more people follow the same observational procedures, what they see will be the same.

That may strike you as banal, but it was a most uncommon attitude, in fact largely non-existent, for the first 300,000 years or so of the existence of Homo sapiens, and it is still actually fairly uncommon today. A few of the ancient Greeks engaged in what we now call science, but for the most part the Greek philosophers engaged in very different activities. They essentially invented ideas by introspection and imagination, and argued for them on largely esthetic grounds. Thus the universe was made of earth, air, fire and water; or may just air, or just water. Aristotle was fond of what we call teleological explanations -- things are made in a way that serves a purpose. It is the nature of things to want to be in the center of the universe, which also happened to be the center of the earth, which accounts for the downward pressure we call gravity. But it is not the in nature of the celestial spheres to want to be there. Living things are animated by a force that seeks their ends, whatever those may be. 

In Europe a few hundred years later, everybody knew that God made the world, and that the purpose of humans was to worship God, obey his laws, enrich his priests, and serve and obey the nobles who ruled by his divine will. What was known specifically about practical matters was to be found in authoritative ancient texts, including Aristotle and the Roman era Greek physician Galen. As feudalism gave way to nationalism, the imagined community of the nation state gave a new kind of meaning to existence, even as people gained more choice of religions, although not having one at all was not considered a legitimate choice.

A few thinkers who were ahead of their time -- Francis Bacon -- began to express something like the scientific attitude as early as the 17th Century, but it didn't really start to catch on until what we call the Enlightenment of the 18th and 19th Centuries. The word "scientist" was coined by the Cambridge academic William Whewell in the 19th Century. Galileo really did practice science, in the late 16th and early 17th Century, but Isaac Newton, whose lifespan was approximately 80 years later, is credited with being the key figure in the so-called scientific revolution. 

Newton was actually devoutly religious, and after hours he practiced rather mysterious inquiries in alchemy. But he is important because he compartmentalized. When he did science, that's all he did, and what that means is that he did not even try to develop any explanation beyond what he observed. Gravity is an attractive force between two masses which is proportional to their total mass, and inversely proportional to the square of the distance between them. That's it. With that equation he could predict the motions of the heavily bodies (elucidated more precisely by Kepler), and the motion of projectiles. He had no idea why this was true, and given that he had no evidence that could bear on the question, he didn't even ask it. 

Einstein later concluded that in fact, massive objects warp space-time, and that this accounts for gravity. However, Einstein did not know, did not speculate, and did not even ask why massive object warp space-time. This is the problem with science -- it does not allow for speculation, for what is called metaphysics, and it doesn't offer any meaning or reasons. To many people, that is not just unsatisfying, it is intolerable. They need meaning, they need reasons, and if they aren't getting it from scientists, they'll get it somewhere else. 

This is a grave challenge, because, while science has given us the technology that doubled our lifespans and lessened our toil, that same technology is threatening to do us grave harm or even destroy us, and the only way out is to believe in the science that tells us so, and wield its power to save our sorry asses. This was not a good time to make a demented criminal lunatic president.