SciFi Weekend: The Doctor’s Wife; Canceled and Renewed Shows

Fans have been anxious to see a continuation of the storyline  started in the first two episodes of Doctor Who this season. Many were disappointed by The Curse of The Black Spot which repeated the ambiguity over Amy being pregnant and showed the woman with the eye patch, but did not really advance the storyline. There was far greater anticipation for this week’s episode, The Doctor’s Wife, written by Neil Gaiman. Instead of advancing this season’s arc, the story went back to the origins of the entire series.

The Doctor’s Wife is his constant companion and perhaps true love- the TARDIS.  The actual story was merely a device to have the TARDIS appear in the form of a woman. Karen Gillan had one of the best lines of the episode, asking the Doctor, “Did you wish really hard?” At the conclusion of the episode it was clear that the Doctor wanted her back.

Idris, also known as Sexy, revealed more about the origins of the Doctor, who “borrowed” a TARDIS which he found unlocked. From Idris’ account, it was she who picked the Doctor because she wanted to see the universe. While it might be the case that the TARDIS doesn’t always go where the Doctor wants, Idris pointed out that she always takes the Doctor where he needs to go. Most importantly, Idris finally got the opportunity to say “hello” to the Doctor.

As the story was primarily a mechanism to have the Doctor and Idris interact, it was necessary to work in an excuse to have Amy and Rory elsewhere. They spend most of the episode running through the corridors of the TARDIS, including yet another sequence in which Rory appeared to die and return.  It was also amusing to see Idris be unaware of which companion was which, ultimately identifying the pretty one, which she believed to be Rory.  It is a shame that the budget only allowed them to run through corridors as opposed to actual rooms during the bulk of the episode. Gaiman had wanted to have a view of the swimming pool but they didn’t have the budget for this. At least the old TARDIS set from the David Tennant era still exists, allowing them to say that the TARDIS has archives of all these old control rooms.

While this was primarily a stand-alone episode, there was on line which appears to pertain to the current story line. Idris told the Doctor, “The only water in the forest is the river.” Would this mean River Song, and does the forest refer to the forest in The Forest of The Dead?  That was part of the two part story in which the Doctor first met River, and the last time River saw the Doctor due to their crossed time lines.

Neil Gaiman will be taking questions about the story on Monday.

Also this week we received news on which shows were renewed or canceled. Cancellations include The Event, V, and No Ordinary Family. All of these were expected.  Cancellations of non-genre shows include Brother’s and Sisters, which ended the season with an episode which worked well as a series finale. Two of the female stars of Friday Night Lights, Minka Kelly and Adrianne Palicki appeared in pilots (Charlie’s Angels and Wonder Woman). The first was picked up but the second was not.  Parenthood, which Minka Kelly had a recurring role in, was also renewed.

There is speculation that Netflix might pick up The Event out of a desire to have their own shows with a following. In principle this does make sense as there are so many ways to watch movies. If not for their original shows, I probably would have dropped HBO, Showtime, and Starz by now. While it makes sense in principle, I’m not sure that The Event is the best choice for Netflix to go with. If it returns on Netflix I will probably watch it, but if I didn’t already have a Netflix account I doubt having The Event would be enough to sell me.

In addition to the announcements this week, The Cape, Dollhouse, Terminator: The Sarah Connor Files and FlashForward also failed to survive. While genre shows have generally done poorly on television the last couple of years, there have been multiple blockbuster genre movies, such as Thor this week. I wonder why genre titles are doing so much better at the movies than on television. Some of these genre shows suffered from mediocre writing, but an excellent show such as Fringe is also failing to do all that well in the ratings.  Perhaps it is partially the higher budgets for movies. Maybe there is a larger audience for intermittent blockbuster events as opposed to following a show weekly. Regardless of the reason, I still find the support for genre movies as reason to hope that a well-done genre television show can still be successful on network television.

Quote of the Day

“Newt Gingrich announced that he’s running for president on Twitter and Facebook. I think his concession speech will be on YouTube.” –David Letterman

Newt Gingrich As The Voice of Moderation In The GOP?

I might not agree with Newt Gingrich in many areas, but he is at least making more sense than the other Republicans at the moment. Of course that is a pretty low bar to reach, and Gingrich has the benefit of not having had to actually cast any votes in recent years. National Review accuses Gingrich of tacking left with these comments on Meet the Press:

Newt Gingrich’s appearance on “Meet the Press” today could leave some wondering which party’s nomination he is running for. The former speaker had some harsh words for Paul Ryan’s (and by extension, nearly every House Republican’s) plan to reform Medicare, calling it “radical.”

“I don’t think right-wing social engineering is any more desirable than left-wing social engineering,” he said when asked about Ryan’s plan to transition to a “premium support” model for Medicare. “I don’t think imposing radical change from the right or the left is a very good way for a free society to operate.”

As far as an alternative, Gingrich trotted out the same appeal employed by Obama/Reid/Pelosi — for a “national conversation” on how to “improve” Medicare, and promised to eliminate ‘waste, fraud and abuse,’ etc.

“I think what you want to have is a system where people voluntarily migrate to better outcomes, better solutions, better options,” Gingrich said. Ryan’s plan was simply “too big a jump.”

He even went so far as to compare it the Obama health-care plan.”I’m against Obamacare, which is imposing radical change, and I would be against a conservative imposing radical change.”

In another surprising move, Gingrich also reiterated his previous support for a “variation of the individual mandate” for health care. “I  believe all of us — and this is going to be a big debate — I believe all of us have a responsibility to help pay for health care,” he said, insisting there is “a way to do it that make most libertarians relatively happy.”

“It’s a system that allows people to have a range of choices that are designed by the economy,” he said. “I don’t think having a free rider system in [health care] is any more appropriate than having a free rider system in any other part of the economy.”

It is a stretch to call Obamacare “radical change” but  I do disagree with one component which Gingrich might call “left-wing social engineering.” I noted some of the problems with Accountable Care Organizations (ACO’s) in the previous post.

Gingrich is being more honest and consistent regarding the individual mandate than his fellow Republicans considering this is an idea which was originally promoted by Republicans. It is especially favorable that Gingrich opposes the GOP-supported plan which would, for all practical purposes, end the Medicare Program.

I hope this is due to actual opposition to the Ryan plan as opposed to responding pragmatically to the degree of opposition to the idea. I am glad to see Gingrich opposing this, but he hardly has a good record at opposing “right-wing social engineering.” We are in a bizarre world if Newt Gingrich is now the voice calling for moderation in the Republican Party–or perhaps a sign of how far right the Republican Party has moved in recent years.

Managed Care Was The Problem. Neither HMO’s or ACO’s Are The Solution

Health care policy is a very complex subject, but that doesn’t stop bloggers from writing on the topic well beyond their level of understanding. While liberal bloggers have been far more accurate than those on the right, I’ve seen quite a lot of uniformed opinions coming from the liberal blogosphere. This has included some liberal bloggers, while too young to have meaningfully experienced the failed experiment in managed care first hand, tout managed care as a realistic means of controlling health care costs.

I don’t happen to have any good links handy from those with this view as I had not intended to post a response until I came across this post from Wendell Potter. Potter is a former insurance company executive who has exposed many of the practices of the insurance industry. I present his comments on managed care in the hopes they will be recalled whenever seeing HMO’s being presented as a good solution:

Soon after the Clinton reform plan failed in 1994, insurance companies offered up managed care as a “private sector solution” to the country’s health care crisis. Government involvement would be unnecessary, we argued, because the invisible hand of the market and the techniques of managed care would simultaneously bring down both costs and the number of people without coverage.

Employers bought it. By the end of the decade, they had moved almost all of their workers into HMOs or similar types of managed care plans.

But for many people, managed care turned out to be more of a nightmare than a solution. One of the ways insurance companies controlled costs was by refusing to pay for care for a variety of reasons. HMO patients were out of luck, for example, if they received care, even unknowingly, from a doctor or hospital outside of their HMO’s network. Many women were especially disadvantaged. Citing actuarial data as justification, their HMOs refused to pay for more than a 24-hour stay in the hospital after a woman delivered a baby or had a mastectomy.

Insurance companies also became especially vigilant in searching for evidence that a policyholder’s medical treatment might be related to a “preexisting condition,” as the president’s mother, Ann Dunham, found out.

In other words, managed care and HMO’s were the major mechanisms by which insurance companies have performed the abuses which made health care reform necessary. HMO’s were a large part of the problem, not the solution.

Today some liberal bloggers see managed care as a meaningful tool to bring down health care costs, failing to understand the degree to which they were the problem. Even more troubling, the Obama administration is now promoting Accountable Care Organizations (ACO’s) to reduce health care costs. Unfortunately this largely is a matter of a change in acronyms from HMO’s, with some attempts to revise the plans to reduce the problems. ACO’s as presently devised do not appear likely to accomplish the desired goals.

Beyond all the old problems seen with HMO’s, the latest fad in health care reimbursement is to pay less for services and offset this by paying larger incentive payments based upon results. The problem is that this is difficult to measure, and outcomes are only partially affected by medical intervention.

For example, an insurance company might pay based upon lowering of the Hgb A1c (a measure of long term control of diabetes) to under 7 in diabetic patients. Lowering the HgbA1C to under 7 (or ideally under 6.5) is certainly beneficial, but it is difficult to pay physicians based upon this. Every year I get a number of new diabetic patients with a Hgb A1c of 12 to 14, and sometimes higher. As this is a test of long term control, it takes a matter of months to see any meaningful change. By the end of the year, when incentive payments are being calculated, I might have only had time to get this down to around 8 or 9.  In this case, my incentive payments are reduced despite all the efforts it took to make a considerable improvement in the patient’s diabetic control. The numbers will be even worse if I didn’t receive the patient until the fall or early winter and didn’t have time to bring about improvement.

It takes far more physician effort to get a diabetic patient under control when they have been out of control for several years. This extra work is most likely to be done under a fee for service system which rewards physicians for the extra effort as incentive systems fail to account for many real world situations. Even worse, the physicians who are gaming the system by dropping their patients with an elevated HgbA1c (for others such as myself to pick up) might wind up with higher payments by limiting their practice to patients who are already healthy.

While I have seen many insurance plans pay based upon an absolute number, I have yet to see one which will pay for achieving a marked improvement such as described above. This is just one example, and there are many other limitations in any plan based upon flawed attempts at measuring quality. Moving away from fee for service will only exacerbate problems  in treating complex patients as it will often be far more profitable to avoid complex cases if there is not adequate reimbursement for all the extra physician time required for their care. The move towards ACO’s is likely to just return us to the problems of the managed care era, both due to improper incentives as well as excessive controls upon medical decisions.