Assorted links


re: Japanese toilets
Home Depot sells the highest rated (by Consumer Reports) toilet for $98 USD.

It's a mystery indeed why bidets have not caught on in the USA. Anybody who uses more than a single sheet of toilet paper is really gross IMO. A second best solution is to use those euro-style telephone receiver hand held shower heads to wash your bun, but then the residue goes into your tub rather than the toilet, which is a bit unsightly but not a big deal. In the States with American style fixed showerheads I've learned to take a shower right after I've shitted. I wonder if shit will be censured by marginalrevolution? Only one way to find out, and that's to hit the Enter key...


" American style fixed showerheads": really? Still?

Back in the dim days of the late 1970s and early 1980s, the disease then called manic-depression was considered to be straightforward to identify - if after approximately two weeks of taking lithium in a controlled institutional environment, a patient was still acting in a schizophrenic manner, they weren't manic depressive. Those who benefitted from the lithium were then identified as manic-depressive. (Still pretty much the only physically provable diagnosis in the field of mental health, actually.)

At the time, lithium was the first true 'cure' of a mental illness. and apart from the cost of blood testing to ensure that lithium blood concentration remained in the effective range while not approaching toxicity, it provided the chance for cheap and effective treatment, as there was no way for the pharmaceutical industry to make money from selling a patented preparation. (Lithium was, and is, not perfect, of course - the blood testing is quite necessary, as is ensuring adequate fluid intake.)

Strangely, what was once seen as a major breakthrough into understanding and curing a mental illness on a physical level was swept away. In large part, to prepare for a wave of medications with minimal to no provable benefit (and in the case of some medications, causing actual deaths as was found out, necessitating very clear warnings about how such medications needed to be carefully reduced over time while the patient was extensively monitored, to reduce the extreme risk of suicide). Well, no benefits except for company profits, of course. But then, marketing sells the sizzle, not the steak, after all.

Shame, really.

The other shameful part is that after a person has been casually and incorrectly diagnosed as bi-polar, friends and family tend to start slotting all behavior into that paradigm, accurate or not - and the mis-diagnosed person, too.

It is interesting that diagnoses are so linked to treatment. Not just patented pharmaceuticals, but that's part of it. It's more of a gravitational attraction to a paradigm. Thus the dismissiveness of a diagnosis as well.

'It is interesting that diagnoses are so linked to treatment.'

As an honest question - do you have any experience with people who have been institutionalized for either schizophrenia or manic-depression? Because one of the greatest breakthroughs in treating mental illness a generation ago was discovering a simple and inexpensive treatment which allowed a significant fraction of previously untreatable mental patients to leave the institutions they were committed to.

And anyone who has dealt with someone who is seriously delusional and has been involuntarily committed will also recognize this is has nothing to do with a diagnosis, except in the broadest fashion. Lithium allowed a significant number of people, many of who had been previously classified as schizophrenic, to resume a life outside of an institution.

You are being simplistic. Yes Lithium was / is great but it has its downsides. The other drugs have their strengths and weaknesses too. Psychiatrists aren't idiots.

Is it merely coincidental that states began to dramatically overhaul their involuntary commitment laws at the exact time "Lithium" was getting so many patients out of institutions? It is much harder to commit someone now then in the 70's.

My father-in-law took lithium from age 30. By age 60 he had lost a dangerous proportion of his kidney function. His blood pressure wouldn't regulate, he suffered from numerous small strokes, he was bed-ridden and barely conscious for three years, and then he died.


Bipolar Disorder is being over-created. Most psychiatric drugs remodel the brain in various ways. If you fool with serotonin levels, eventually the number of receptors will change, rendering a person dependent on the very drugs that broke them in the first place. This is one, probably of many, disorders that are essentially iatrogenic in nature.

Medicaid expansion is just like treating the symptom and not the disease.
Our healthcare system is full of flaws that is why there is no money left in the bank.
The uninsured and homeless use the expensive emergency room just like a primary care office, it is a revolving door. The dying and futile cases with no DNR use up expensive ICU resources. This country has the brightest experts in all fields you could imagine
but we need an insightful group of experts on how to fix the system.

This country has the brightest experts in all fields you could imagine but we need an insightful group of experts on how to fix the system.

In: "Group of experts . . . fix . . system"


I used to do some work with troubled kids, many of whom were seeing both therapists and psychiatrists (because you need a psychiatrist to write prescriptions). The usual pattern was for the therapists (some but not all of whom were psychologists) to make a number of diagnoses, which never in any of my cases included bipolar disorder. But nearly all the psychiatrists diagnosed the kids as bipolar. I figured it was because bipolar disorder is one of the few things they have medications for. If the only tool you have is a hammer ....

All psychiatric disorders are over diagnosed, for at least 2 reasons.

1) Without a diagnoses, your insurance will not pay for repeated treatment sessions. This creates a stong incentive for your psych provider to provide... a dianoses.

2) Without a diagnoses, you cannot prescribe meds, and psych meds are big, big business.

1. Do Japanese bidets spread to France?

I wish I had known about these fancy bidet seats as I recently completed a bathroom remodel, and I would have bought this. Why don't toilets accommodate a more natural squatting position as opposed to the seated position?

How easy is it to read the morning paper while squatting?

What you possibly missed in your remodel was putting an electrical outlet near your toilet. The toilet you bought would have come with a standard seat, even if it was a Toto, unless you go for the $7,000 model. So if you have power available, you can replace the dumb seat with a Washlet just as if you had done so in the remodel and for the same price it would have cost then. They are wonderful.

You're too short?

You need a trip to the Orient.

I'd imagine that for most Westerners, squatting is no longer a natural position. Sitting, on the other hand, is.

I, for one, never liked squatting, even as a child.

There are inexpensive bidet attachments that just use the water input to the toilet, and they are a great improvement over toilet paper. I recommend trying one.

Or one can follow the example of many Muslim households in the US, and install a high-tech "jug" next to the toilet. Total cost: $1 from dollar tree.

On the Medicaid expansion, if I were a governor, I would question just how likely is it that the Federal government will continue to pick up 90% of the cost of expansion indefinitely.

What if you're only going to be governor until 2014, or even 2018?

The issue for Republican governors on health care is whether they will ever run for office in the future:
1. are they running for reelection for governor? if yes, then will expanding Medicaid get them primaried?
2. are they thinking of running for the Senate or president? if yes, then expanding Medicaid will disqualify them. Period.

Once 2016 comes round, Obamacare will be institutionalized like Medicare and Medicaid, and Republicans will be constantly defending the government entitlements of the doctor fee-for-service pay and medical corporate profits, the benefits to their base voters, while making a show of eliminating them.

When the Heritage Institute took a Republican proposal of the 1990 and made a white paper of it to attack the Clinton reform effort, and then when the Swiss voters ratified it, and then Mitt decided this was his ticket to the White House, the conservatives and Republicans lost on health care. Obama picked up the conservative Republican idea and got it passed by Congress.

With the number one issue of 2012 being taking away Obama's success passing the Republican health reform, but without a single Republican willing to run against the person who successfully passed a Republican plan, other than Mitt Romney who passed the same Republican plan to get to the White House, universal health care access policy was removed from the table in 2012 and forever after.

The State governors and legislatures are now dealing with the health care industry more than Obama. SCOTUS in many ways screwed the Republicans - they can be pure and screw the medical industry, or serve the medical industry and doom their political future. In the end, the States will comply when no one is looking using methods that has no Republican names on it.

From the link:

"Missouri’s newly reelected Democratic Gov. Jay Nixon told reporters he’ll reveal his intentions by the time he releases a budget in January. He told reporters last week that he wants to make sure expansion dollars don’t end up on the table during federal budget talks."

"Colorado Gov. John Hickenlooper, a Democrat, filed a budget earlier this month that cited lack of guidance from Washington as a reason to delay a final decision. Hickenlooper told POLITICO in July that he anticipates his state embracing expansion but possibly later than 2014, when expansion could first take effect."

"Other governors, including the newly reelected Earl Ray Tomblin, a West Virginia Democrat, have pressed the Obama administration for more details."

Medicaid expansion is only a mostly partisan issue.

So according to Mr. Sides' logic, the money itself doesn't determine who wins, but because politicians believe it matters, they give influence to big spenders. Isn't Mr. Sides making the matter worse then, by continuing to perpetuate the myth that money matters a great deal in politics? One wonders what his goal is.

The article inspired me to impulse-buy the $35 mechanical bidet attachment.

"mechanical" bidet? Is that the one out of Russia?

Like a bottle brush on a hammer drill motor?

The Red State bidet presents an inverted skunk that urinates on your anus. And you don't need the vent fan because you can just blame the smell on the skunk.

You know, it's not a skunk's urine that's the problem.

All of the power comes from water pressure, the control just a faucet. With no electricity it is simpler, cheaper, and less dangerous. (But also colder and without any cool features.)

My groundwater in the winter is 40 degrees F. This sounds...unpleasant.

"Why don’t Japanese toilets spread to the U.S.?"

Probably because people are afraid of this:

'96 is Clinton's welfare reform...
90s & 00s show an increase in a mental issue that is specifically listed in the SSA's disability "impairment" manual...
"Cognitive impairment" shows amongst the lowest labor participation rates of disabled workers...

Surely these are connected

At first I thought #1 meant traditional japanese toilets, in which case they don't spread because they are terrible and even the Japanese don't make them anymore.

The VP of marketing at a former employer had a couple of stories about the Japanese. One was about a U.S. engineer who went to work in Japan, and he ordered a western toilet. He hired a local plumber to install it while he was at work. He gets back and meets the plumber who tells him what a difficult job it was to install the toilet. It was so much work! The plumber dug a hole to make the seat of the toilet level with the floor.

Yeah, that's a story alright.

1. Toilets are a religion in the West. Children are exposed to western toilets while very young, and powerful but benevolent creatures beyond the child's understanding compel them to learn how to use them. Thus traditional western sit toilets are imprinted on children as the one and only true way to relieve one's self. But in Japan, the traditional squat toilet has been overthrown in living memory. As a result, they are in a state of toilet flux. The midst of a toilet reformation. If the squat toilet is no longer god, then they will find, or make, better gods for themselves. And I salute them in this noble quest.

Yes on the religion thingee. During my misspent youth, I found myself praying to the porcelain God from time to time.

Who will be the one to nail 95 feces to the lavatory door?

6. Old age used to be a common cause of death, but it's not used anymore. So do we then assume that heart disease and respiratory disease are now over-diagnosed as a cause of death? Likewise people don't just have a break down anymore, instead they acquire a label and a prescription and a therapist. It's unclear how much the authors engage the idea that this condition may have been underdiagnosed in the past, particularly as you move down the spectrum. Personally, I wish the diagnostic and treatment tools of bipolar disorder were more settled and precise, but I am thankful for the care that is out there.

Doesn't Medicaid become a federalism issue? Wouldn't most states rather have their own exchange rather than have the Feds control things? I can see the exchanges as a precursor of Medicaid block grants next time the Reps get control. Wonder when the politics will flip?

Re: tax hikes vs. spending cuts. It seems to me that another aspect of the tax hikes vs spending cuts question, separate from the short-term economic effects of each, is that tax hikes don't actually solve the problem of intergenerational equity, or not burdening future generations with debt. Future generations are burdened with aggregate --- public plus private --- debt, not just public debt.

There are four components that contribute to aggregate debt: public spending and public revenue (taxes), which contribute to public debt, and private spending (consumption) and private income, which contribute to private debt. If one cuts public spending, holding the other three components fixed, then public debt decreases as does aggregate debt. In contrast, if one increases taxes, holding the other three components fixed, then public debt decreases, but private debt increases by the same amount. Thus, aggregate debt is unaffected. Spending cuts (public or private) reduce the goods and services consumed now and thus increase national savings or decrease addition to aggregate debt. Because we consume fewer goods and services now relative to goods and services produced, we can consume more goods and services in the futures. Tax hikes only transfer wealth from the private sector to the public sector. The tax hikes do not directly reduce the goods and services consumed now and thus do not increase the goods and services that can be consumed later. The tax hikes only affect the relative size of public debt to private debt.

With respect to placating bond vigilantes, sure, one can decrease public debt with tax hikes. However, doing so increases private debt, holding public and private spending fixed. Thus, the government's balance sheet may look better after the tax hikes, but the private sector's balance sheet will look dollar-for-dollar worse. So, the vigilantes' attention switches from the public sector to the private sector.

Re: intergenerational equity. I think there is in fact a clear intergenrational equity aspect to taxation, on accounta of the unusual demographics most developed countries face. This is actually the main reason I favor tax increases now. I've never seen it discussed, but it seems obvious to me that we were always going to have lower taxes than we "should" have during the period when the baby boomers were moving through their peak earnings years, lest we accumulate awkward surpluses. I think this in part explains the rationale for the Social Security surplus, for example.

Well, we're pretty much near the end of the baby boomers' peak earnings years now, and we all know how hard it is to extract taxation from old people, who of course vote in large numbers. I don't want to let those buggers escape without paying their fair share. The fact that this country has racked up unprecedented debt precisely during these years is doubly shameful. Raise taxes now while the later boomer cohorts are still in the mix. Otherwise, a big rise in consumption or wealth taxes in the years ahead, which means staring down rich old people. Otherwise, we're screwed by the original 'Me" generation.

A "japanese toilet" is just a toilet seat bidet, correct? Is the Toto brand significantly better than any other?

The bidet doesn't do much for me, but the Toto toilets with the heated seats are very nice. Highly recommended.

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