mid-wit-certified by wife, Little League Coach, MIT baseball turned Giants/Cardinal homer, inventor 10^2+, CEO @ https://xitter.cf/t.co/5Nyr8kezJX

Bay Area / Aspen
Joined July 2009
It’s 2075. There is only one hospital in the entire country. It is 8 square miles in the middle of Kansas and owned by United Healthcare. Premiums are $47,000 per month. The only medications left are Ozempic and boner pills. Life expectancy is 38. Government: “I can’t believe doctors did this to us.”
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Nothing annoys me more than this….
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Yair Einhorn
@yaireinhornOct 5
🚨🚨WOW! This is absolutely amazing to see that Karl Deisseroth, Peter Hegemann and Georg Nagel have won the Nobel prize in medicine for their optogenetic research! Visual optogenetics is a therapeutic modality that uses Gene Therapy to deliver a light-sensitive protein to cells in the retina. This mechanism of entering light to the eye can then stimulate these cells to produce a visual signal that is sent to the brain and thus “overriding” the retinal cells and to restore vision to vision impaired patients. This mechanism is already in clinical development and the most advanced optogenetic therapy is currently Nanoscope Therapeutics’ MOGENRY (formally known MCO-010) - an Optogenetic Gene Therapy aimed to restore vision in Retinitis Pigmentosa (RP) patients with a severe vision loss which is waiting for an FDA approval! Absolutely amazing!
BREAKING NEWS The 2026 #NobelPrize in Physiology or Medicine has been awarded to Karl Deisseroth, Peter Hegemann and Georg Nagel “for their discoveries concerning light-gated ion channels and optogenetics.”
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Another internet baseball expert made a Mike Trout “88–91 mph” meme like he just uncovered the Dead Sea Scrolls. News flash: one off-the-cuff quote doesn’t rewrite baseball history. In 2011, I was scouting for the Padres, and one of my primary clubs was the Detroit Tigers. I wasn’t watching YouTube. I wasn’t scrolling X. I was behind home plate doing my job. Verlander could light up the radar guns at 100 whenever he wanted. Scherzer had premium-plus-plus velocity—mid to upper 90s. Porcello was 92–94 with command. Fister showed up throwing 91–93 with a filthy two-seam fastball. That was one rotation. But somehow I’m supposed to believe everyone was 88–91 because somebody made a meme? Here’s the difference: you have memes. I have years of scouting reports and hundreds of games in the ballpark. Stop trying to teach baseball history to the people who were actually there. Memes don’t beat experience. They just expose the dumbasses who think they do.
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This story has laid largely dormant in my mind for 25 years. Never gone, but very hard to think about the horror of that morning and I’d rather not. This is my morning of September 11, 2001. At this point in my life, I am a pitching coach for The Brooklyn Cyclones, the Mets’ minor league baseball team. I have a sponsor’s softball game at our ballpark at 10 AM. My house in Jersey is about an hour drive away. I’m at my kitchen table having coffee, getting ready to head in at around nine. I put on the news. The traffic report mentions it’s a little heavy so I decide I’ll leave early. Just as I’m heading out the door the news breaks that a small plane appears to have hit one of the Twin Towers. I stopped to listen. The news reporter looks concerned and confused, but not panicked. It’s an unfolding moment and she’s keeping her cool. The look of disbelief was unstable; no answers, just confusion. She was trying her best, in her own way, to not create a mass panic. Whoever she was, she deserves a ton of credit, along with the other reporters who did the same thing. I head to my car and put on 1010 WINS. I decide to head up Route 36. There is a bridge that crosses the Shrewsbury River that allows a direct view to the city. When I get there, I’m in disbelief. There is smoke coming from the top of one of the towers, yet still no panic on the radio, just reporting of what is currently known. I call my daughter, who works in the city. I asked her where she is. She tells me she’s coming up the escalator from the bottom floors of the World Trade Center, exiting the subway. We stay on the phone. I hear the strain in her voice. Whatever has happened is not good and she is witnessing it firsthand. The radio does not betray the gravity of what happened. They are in disbelief along with all of us. I step on the gas, and race up 36. By now I figure I’ll turn left, head into the city, pick up my daughter, and then drive on to the ballpark in Coney Island. We get cut off on the phone. The confusion on the radio continues and escalates. She calls me back a few minutes later. “Dad, I just came up the escalator and there are people jumping out of the windows, there’s people jumping out of the windows.” I ask her how high they are jumping from, trying to get a feel for what is happening. I am not ready for what she’s about to say. “80 floors.” A second plane hits the other tower. This is a nightmare, and I begin to feel panic coming up within me. I take the Staten Island exit off of the parkway and approach the Outerbridge. I see cars stopped. Then the news comes over the radio. All bridges and tunnels are closed to the city. At the last possible moment, I turned off to the right and circled back down, heading back to my house. I’m doing over 100 miles an hour. I highly doubt a cop is going to stop me. I’m thinking, “What now?” I call my friend Lenny and say “I need your boat!” He asked me,“Where are you going?” I said, “To the city to get my daughter.” He’s well aware of what’s going on, and says, “I’m going with you.” I said, “No you’re not. I don’t know what I’m getting into. I don’t know what’s gonna happen. I don’t even know if I can get there but I have to try. I appreciate your offer, but I got it.” We plan to meet at his boat within 20 minutes. I pause going over the bridge on 36, take a look back, and it is beyond horrific. There’s people in those buildings and I hope one is not my daughter. I call my daughter back, thank God I get a hold of her, and let her know the plans. I tell her to stay at her office. “Stay there until I get there. Stay put!” I swing by my house real quick. I have an idea I’m probably gonna need my father's flag. He was an army veteran who spent time in Iwo Jima. I plan on hanging it off the side of the little boat. Hopefully that will let the authorities know I’m on the home team. I run in the house and remove it from the triangle box in which I keep it and head down to the marina. My friend’s there and insists on going. We jump in and off we go. Within minutes, a little comic relief. We need gas. Thankfully, there’s a fueling marina at Bahr’s Landing. We pull in. The young man working the pump was curious about where we are going. We fill up, he says good luck, and on our way. The radio is on. The news is still confusing but becoming clearer. Both towers have been hit. Both towers are on fire. We look at it. We see it in front of us, knowing we’re heading in. I call my daughter. I tell her I should be there within a half hour, if we lose contact, I tell her to make her way down to the ferries evacuating people off the island. “Get to the top deck and look out to the open water. I’ll be in a small boat with grandpa‘s flag hanging off the side. Get to the top deck and wave and wave. If I see you, I’ll turn around and follow the boat back. If not, I’ll keep going.” We’re a few miles out from the Verrazano Bridge. At this point, I think it’s going to be a dead end. I can’t imagine there won’t be police and Coast Guard closing off from that point. Suddenly, a small biplane with wings painted red and white appears. It is flying towards us but very erratically. I have no idea what that was about. I have my daughter back on the phone. She finally arrived at her office on Wall Street. I tell her our ETA and then she feels something. The building shakes. “Dad, what was that?” I hear on the radio, which has made this whole scenario surreal. The radio has one report, my daughter has the live report, and we’re in the middle, trying to make sense of the whole thing…it’s impossible. You cannot make sense of this moment. I hear on the radio that the building collapsed, but I tell my daughter not to worry about it. It’s probably just all the trucks and everything rumbling around. I make up some nonsensical answer, and she was not in the mood to analyze anything. She was terrified. Still no Coast Guard or police boats. We keep going under the bridge. Smoke billowing in front of us. The smell is unimaginable. It just smells like burning everything. It’s an acidic, rancid smell. Heartbreaking. Because I know what it is. We’re beginning to approach Governors Island. I tell Lenny to stay to the right, we’ll go around and then go straight towards Pier 11. So far, everything is going according to plan, a plan that is being made up as I go. I’m looking at the smoke, the haze and everything and I’m in disbelief. My mind makes up that the tower is still there. “I can see the tower Lenny, can you see the tower?” “I can’t see it.” “It’s right there.” But it wasn’t there. It was gone. It was a pile of rubble. Confirmed by the papers, worksheets and everything flying through the air over our heads. Literally, pieces of paper. Pieces of paper that somebody sitting at their desk was working on an hour ago are now floating through the air, as well as the poor soul who was doing the work. We’re around Governors Island and then, the inevitable. A small Coast Guard boat, that looks like a red inflatable boat, makes a B-line right for us. Machine gun mounted on the bow. I stand up on our bow and I’m frantically waving my father's flag that I’ve tied to the side of the boat. They come racing up in a no nonsense mood, helmets, guns, everything pointing right at us. They come right up next to our boat. “Where are you going?” “I’m going to pick up my daughter.” They turn, have a short conversation, I don’t know what’s gonna happen, then they turn back to me and say “Go ahead.” I could’ve fallen over. I call my daughter again and thankfully get through and tell her head to the water. I’m coming up to Wall Street now. We head for the pier and pull up. lt’s kind of bouncy because of all the tugboats loading people on and getting them off the island. It was organized chaos but it was organized. I have so much respect for the men and women who handled that without panic. We pull up next to the pier. It’s about a 5- or 6-foot reach to the railing. I grab it. I’m holding on, ready to let go, throw my leg over the railing, and Lenny yells, “Don’t let go!” “Why? What’s the matter?” The engine died. This is great, I’m this close and I’m gonna fall in the water. I’m holding on with one hand on the boat and the other on the railing, being stretched like I’m in a torture device. Between the current and the bouncing, I don’t know how I stayed up. The longest 30 seconds of my life when he goes, “OK, OK. I got it.” I let go of the boat and climb over the side. I tell him to circle around right here. I’ll be back. I begin to run up Wall Street. Unbelievably the first police officer I see on shore is from my hometown. He is directing people to the massive tugboats and the ferry boats getting people off of the island. He sees me and asks what I’m doing there. I explained to him that I’m going to get my daughter. He says good luck, I’ll see you at home. Seconds later, strangely, an older lady comes up to me and says, “Excuse me, aren’t you Bobby O?” “Yes I am.” “Oh, I just love you. You are so fun to watch.” Then her son, who understood the gravity of the situation, says, “OK mom, come on, we gotta go.” I thanked her and her son and went on my way. Can’t make that stuff up. I continued making my way up Wall Street. Incredibly, there’s my daughter coming down. It’s like a miracle. It’s a miracle in front of my eyes. I grab and hug her. We head back down to the water. We get to the water’s edge where the railing is, she looks down. Lenny has pulled up by then and she looks down and I said “Look, you gotta jump. There’s no other way, you’ve gotta jump.” It’s probably at least a 5-foot jump down to the deck to a bouncing boat with a wet bow being pushed around by the current and choppy water. She looks at me one last time, looks at the boat, and jumps. She lands and rolls but she is fine. I look around one last time at the surreal scene of I don’t even know what to call it. I jump down, hug my daughter again, sitting in our seats. We turn and head back down home. No one deserves this to happen to them. This weekend, I am reminded of and send nothing but respect to the individuals, first responders, ferry and tug boat captains beside me, who organized amongst the chaos to help one another on a horrific day.
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The greatest problem in healthcare ? Hospitals, even market dominant hospitals, won’t walk away from the big ins companies that underpay, late pay, clawback, deny claims, waste their time in denial appeals, and require them to pay up to 8 pct of revenue to RCM consultants so they think they are getting what they are owed. Here is the crazy part. The ins companies ARE NOT THE ONES ACTUALLY PAYING THEM on commercial plans. Employers are. 60 pct of employees get their insurance from their self insured employers. The ins carrier is just a middleman that pretends to add value. All the clinical “value” they add, the hospital could do better, for both medical and pharmacy. Most hospitals have no idea whether they make or lose money with their big ins contracts. They are just afraid to lose patient flow. But. They actually know which companies their patients are coming from. They actually know or can find out, how much more the employers are paying the ins company, than what the ins company pays them (the spread, just like in pharmacy ) And to make it worse, those ins companies negotiate their rates as a discount from the “charge master “, which is like WAC in pharmacy. Just a made up list price. Because the hospitals are afraid or too uninformed to walk away from these deals, the hospitals use the inflated charge master prices as the basis to charge uninsured , or out of network , or insured but not covered for their care, at charge master rates. Which of course the patients can’t afford. And it crushes their finances or they go without care I’ll summarize. Employers , and their members , are paying far more than they should to companies they don’t like working with , that effectively rip off both the employer and hospital , and they could eliminate the middlemen if they went directly to to the employer. It’s so simple. Sell your services to the employers that use your services at a price that is less than what nine companies charge for your services and you will make MORE money and employers will save a ton And if they did this, they could dump the chargemaster and reduce the price they bill patients when they are at their most vulnerable But they don’t want to change. And don’t get me started on how much hospitals over pay for drugs and devices because of the GPO deals they do. It’s just stupid. Which in turn leads to the hospital being a bad actor with 340b , facilities fees and afraid of their doctors who demand they pay more for things like glue and implants so they can get vacations. If you are a politician and reading this. Now you know why this is so fucked up and it’s not about capping rates. The insurance companies are smarter than you. They will just move the money to other places. It’s not about giving money to patients. You can’t shop for care from hospitals that are too gutless to walk away from the ins companies that distort all of healthcare economics Go to your local hospitals , particularly those at risk of closing and ask for their profitability by carrier. Fully burdened. Ask how much they spend on RCM and consultants. In many cases they could survive if they ran like a real business and hired execs that could do the work rather than just manage consultants. They could work out contracts in their communities rather than with ins companies and benefit everyone. The middlemen are not needed. Get rid of them
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Talking to independent physicians, it's obvious that the big insurance carriers are doing to them, what their PBMs are doing to independent pharmacies. They deny, underpay, slow pay, clawback, and create administrative mazes, knowing their victims don't have the time or resources to fight. Why ? By putting financial pressures on physicians and pharmacies, it makes them more likely to sell their businesses to them , close their doors, or refer the business to their captive pharmacy or provider. All benefitting the biggest insurance companies We need to ditch the concept of "claims" and make every delivery of medications or care as a billable event that must, by law, be paid on a timely basis , with interest charges for any delays. If the physician or pharmacy doesn't deliver , the carrier has plenty of legal options already. As does the patient. This is not an efficient market. This is the big guy abusing the little guy. It needs to change to better the care we get in this country
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My daughter faced a big disappointment this week. Here’s what I told her: You’re not defined by things outside of your control—you’re defined by how you respond to them. I’ve found that when something feels like a loss, it often turns out to be a blessing in disguise over the long term. I could give you many examples across my lifetime where—in hindsight—a “loss” was actually a dodged bullet. It’s self-fulfilling—*you* determine whether it’s a blessing or curse by how you choose to move forward. Here’s one thing I know: If you consistently put positive energy into The Universe, it will eventually be returned tenfold. It usually doesn’t happen on our preferred timeline, but someday—when you look back—you’ll understand why.
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Layers of warm air along the coast were the right ingredients for a stratified sunset topped by an emerald Green Flash. (Zoom in) Half Moon Bay. 8/31/2025
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Get me to God’s country
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Replying to @lyokvr @memecrashes
the square approaches the limit of the circle in the sense that the greatest distance between any two points of the two objects converges to 0, but the perimeter doesn't converge as it doesn't change. In general convergence of a surface doesn't imply convergence of it's perimeter
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A common phenomenon is to label a trial single-blind, double-blind etc. But is this helpful? 1/8 #MethodologyMonday #103
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I am at the #acs2024 meeting today. Lots of discussion at various talks about implementing robotic surgery technologies for a variety of operations. To me, much of this didn’t make sense. Robotic appendectomy? Really? Surgeons need to keep in mind that robotic technologies have consumed billions of dollars from the healthcare system. See: jamanetwork.com/journals/jam… Meanwhile, physician reimbursement goes down every year as is seen in this posting. It’s a zero sum game- as we surgeons use more and more expensive technologies, we will get paid less. The decision where the money goes is up to the surgeons by virtue of their using very expensive machinery. Perhaps one way to think about all this is for every time a surgeon decides to use a robot for something that can be done without one, they should view it as them paying out-of-pocket from their own salary to support the machine
Physician conversion factors: 2000: $36.6173 2003: $36.7856 2006: $37.8975 2009: $36.0666 2012: $34.0376 2015: $35.7547 2018: $35.9996 2021: $34.8931 2024: $32.7442 UHC stock up 8,556% Insurance premiums up 342% Inflation up 86% Physician pay down 10% We should keep cutting physician pay so families have more money in their pockets through reduced costs and reduced premiums based on the last 25 years of experience.
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I'll end by plugging the 'Deranged Physiology' website. If you'd like to read about the physiologic aspects of any aspect of critical care, written by someone that obviously has spent an enormous amount of time writing it, check it out. derangedphysiology.com/ ⬛️
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KNBR
@KNBR26 Sep 2024
Scenes from the last game in The Town 🌳 A thread 🧵
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"I didn’t just like Stan Musial, I wanted to be like Stan Musial.” Hank Aaron After the color line broke in baseball, black players were often isolated socially. At one All Star Game, Willie Mays, Frank Robinson, Hank Aaron & Ernie Banks were all sitting together playing cards, when Stan Musial walked over and said, ”Deal me in.” It was Stan’s way of saying “I accept you” when many others did not. Musial at the Polo Grounds
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Awful Announcing
@awfulannouncing5 Jul 2024
"New pitcher for the Braves...Kenny Powers takes over -- no, it's Grant Holmes, on for Atlanta." Dave Flemming.
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I find Jon Miller to be one of the most wonderful radio broadcasters in the business. He’s detailed without being overbearing and he paints a vivid picture with his words that makes you feel like you’re watching the game with your own eyes. I love listening to him on the radio!
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Unsurprisingly, dodgers beat writer completely unfamiliar with what happens when you win a World Series
Spencer Bivens just won the World Series ... or appeared to based on his celebration/reaction after striking out Shohei Ohtani for the second time today
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Here’s 50-year-old Willie Mays making a ridiculous catch in an Old Timers Game at Shea Stadium in 1981. RIP
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