10 Podcast Topics in "Difficult People" Season 2

The Hulu Comedy Series “Difficult People” Live Table Read was the highlight of Vulture Festival 2016. Julie Klausner, creator, producer and star of the TV show “Difficult People” cited her podcast, “How Was Your Week,” as a primary source for her brilliant TV storytelling. Below are 10 “How Was Your Week” topics referenced in Season 2 of “Difficult People.”

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Tim Burton

“What else did I hate about the King’s Speech? I did wonder if Helena Bonham Carter is like that in real life. I do feel like she’s always sort of scurrying in and out and being like “Yes, it’s me.” You know, very supportive and very loving and understanding and kind and you know completely accepting of her really really handsome husband and adorable stutter and wads and wads of cash. But. I do think she is like that, with Tim Burton, at home. I get the sense that she’s sort of, popping in and out, and wearing tiny hats and being intermittently supportive and like just vanishing.”

 Episode 128 “America’s Morning” Aug 16, 2013

“So Kinky Boots exists. Matilda I didn’t see, I would like to see, hint hint if anyone would like to take me or donate tickets. I did enjoy that the score sounds like it was written by the band Jellyfish. It seems a little Tim Burton-y so good for them. Will history ever know that Tim Burton and Roald Dahl were different people or will future generations just mesh them? In which case, I don’t know. I have given up.”

Episode 119 “Curating the Linens” June 14, 2013

Bryan Singer

I grapple with Millenials. Hi, I am Bryan Singer and I grapple with Millenials. There are not enough Bryan Singer jokes. It is a horrible, horrible thing that he did. Never rape children. I still want more jokes about it. I want more jokes about how he and Kevin Spacey are collaborating. Kevin Spacey has been reading the news and has hired him to direct season 3 of House of Cards. Can we just laugh at things that are horrible Millenials? Is that ok? Oh, it’s the thought police. I don’t care about thought policing. Sometimes Millenials annoy me. Do you know what? I am going to take that back, retract, retract, retract. Millenials sometimes do annoy me, but what I am about to say has nothing to do with being annoyed. The Mean Girls anniversary was a big thing on the internet. Everyone was talking about Mean Girls. Ok, it’s a fine movie. I saw it in the theater. Ok.

Episode 165: “A Working Heart” May 2, 2014
 
9/11 Truthers

He brought up his friend and said, “By the way she’s a 9/11 trooper, truther. Starship Truthers would have been a different movie. I said, “What did you realize that is related to your friend, daughter of Too Many Dogs screenwriter Joey Joeselstein?” He said, “I just realized the reason why her theory doesn’t make sense,” as you know the Truthers say that there’s no way the plane that exploded at a temperature hot enough to melt steel girder and so forth, “I just realized that even though she was taking the fuel and the butane in the plane into account what she wasn’t factoring in was the human fat of the passenger being combustible. ” I said, “Please don’t talk about this right not.” It’s not that I was at a spa or getting the kind of massage where I just want to forget my day and indulge in some ‘me’ time. That wasn’t that kind of mommy-blog experience. It was a sports massage, yah sports. Everybody loves those sports, right? You never want to hear about human fat being combustible in a massage environment and arguably ever. I will also mentioned that because I am, even then, in situations macabre, I will be girly. So after I said, “WHAT! STOP!! What are you talking about? Please No, that’s upsetting and disgusting. I also hope that the notion of human fat didn’t come into your mind because you were working on my fat back.” “No, no, no” “Ha, ha, ha-just kidding.”
 
We can never let go of our gender shackles. Gender, gender, gender.
 

Episode 183: “Starship Truthers” September 12, 2014
 
Candy Crush

I try to keep myself in that state for the sake of, I don’t know, seeming productive. I am productive. I’m a productive person. I do a lot of things, and stuff, and jobs, and work. Therefore when I downloaded Candy Crush to my phone this week I thought to myself this will be relaxing. I’ll enjoy this in moderation. It won’t get in the way of my work, my life, my productivity. At first what is it? You just have to find 3 things of the same color? Boring. Now predictably I am completely addicted to Candy Crush. I find it’s a good icebreaker for people who are looking over your shoulder. Instead of saying, “Respect my personal space.” You take your eyes off of the–what are they? The red ones are Mike and Ikes. What are the blue ones? I hope they’re not mints. The green ones are Chiclets or maybe they are Certs gum. God I think about this too much. Orange ones are jelly beans, yellow are lemon drops. The woman behind me in the elevators goes, “What level are you up to?” Level addicted. “It’s good for your brain.” Fair enough. She got off the elevator and probably died because she was old. Candy Crush is so embarrassing. It’s so embarrassing that I am a Candy Crush person. I haven’t connected it to my Facebook.

 Episode 141: “Congratulations” November 15, 2013
 
Film Forum

I went to the Film Forum today, by the way, which is also still around. The Film Forum is the home of some of the best film revivals, the least comfortable seats, and the weirdest people that work there, both in the box office and behind the cafe bar. They will always look at you like you are insane if you ask for anything and they only take cash. I’m not here to badmouth the Film Forum. The Film Forum has provided me with many a classy date when I have wanted to appear that I liked, I don’t know Preston Sturges. In the past when I have wanted to seduce a man of a particular, kind, type, or breed, I have gone to the Film Forum. I have adjusted my makeup in that bathroom a few times. I went there earlier and it is just nice that place is still around and is still staffed by people that look like they could be mentally ill or homeless until you see their tattoos. Then you think they are fine just a nightmare to their parents. The people who take your tickets are the nicest people in the world. What is up with that, right?

Episode 165: “A Working Heart” May 2, 2014
 
Ice Bucket Challenge

I’m not even going to treat this ice bucket water discussion with any respect by mentioning it, or speaking about it at length. I will say that I think the reason why this ice bucket–Lou Gehrig’s Disease nonsense has caught on is because Americans only like charity when their names are in lights and the notion of celebrities tagging other celebrities with the ice bucket thing adjacent to it…the reason why I think this is popular is because it is a new form of social media and I think people like videotaping themselves and telling the internet that they have friends or that they can reach others. If the people see them they can say, “Hey Kim Kardashian you do it.” The people other’s are calling out are absurd. It is a way for celebrities to be cozy with each other. It’s what we did when we discovered social media in the first place. At least we didn’t do it under the guise of giving charity to diseases. We weren’t full of goddamn lies. My impression of this ice bucket situation is…
 
Hi Jimmy. Aw, there’s my joy boy. Hi handsome. Hi handsome, are you going to sit on the couch with Mommy? There you go. There you go.
 
My impression of this ice bucket hoo-ha is that you can either pour yourself with water or you can give money to charity. All of these dummies who are pouring water on their keppes are saying, “I’m not going to give to charity–your turn Willie Nelson.” Here’s the thing, if they are going to give to charity in addition to throwing water on their faces they are going to make a point of saying, “I’m going to give anyway,” at the end which is not the highest form of tzedakah. If you are a Jewish person who learned about charity in Hebrew School, or as I know it tzedakah–my favorite tzedakah was Neil Tzedakah. There are different scales of charity giving. Rabbis were the original Buzzfeed. They loved listing things. They would say, “The highest form of tzedakah is if somebody gives and the person who gets it doesn’t know who gave it and the person who gave it doesn’t know who gets it. The lowest form is when you make sure the getter knows you’re the one who gave it. Enjoy your ice buckets America.

 Episode 181: “STANLEY” August 22, 2014
 
Transgender

I refused to dig myself into a pit with a sorbet spoon by addressing any issue in the LGBT community because god forbid I as a member of the cisgender community have an opinion about that because it is just not cute. I am not being completely facetious; therefore I will not say that the LGBT and queer and questioning community should literally everyday get down on their knees and thank Ru Paul for being Ru Paul. I will not say that Ru Paul takes where Oprah left off and goes into outer space. We are so lucky to be alive when Ru Paul is alive. He is funny, wise, soulful, smart, entertaining and talented. Most of all Ru Paul is kind and compassionate. That we would ever attack him, question his intentions, take advantage of a show and an outlet so essentially sensitive who listens to what people who have otherwise been marginalized have to say, that would be a mistake. I’ll leave it at that. If you are going to come for RuPaul, don’t be surprised if I throw myself in front of him and take whatever punches you have to throw because there is nothing I can say that will articulate how precisely lucky we are to be living in a time with him around and in it.

Episode 164: “That’s The Twist” April 25, 2014
 

Cheek to Cheek
 

Lady Gaga has an album out at this point with Tony Bennett who was tricked into recording an album with her and does not know where he is. He looks very happy. He’s not in pain at all. “This kid has such a taste for jazz. I just love to sing with her. These are classics. These songs go and they come, but jazz is jazz. This little kid over here, she knows jazz. I really like singing jazz with her so we are…where are we? We’re here at what is this? The Today Show? Yeah, now Cole Porter worte…” Lady Gaga says, “I love him. I love Tony Bennett. He’s my man.” She poses with him flirtatiously. She’ll touch him. She doesn’t need to touch Tony Bennett. “Look at us together Tony. Look at this photo of us, don’t we look great together.” “Oh yeah kid you know that’s a great photograph. You know Nathalie Wood…uh, who are you? Do you know Maria from Sesame Street? Where am I”
Where are they going to play that album? Which store? Are they going to play it at CB2? I was going to say Starbucks but I think it’s a little weird for Starbucks, “We like the idea of standards maybe if it were a Christmas album, but no; we don’t want to play Fly Me to the Moon as sung by a confused Tony Bennett.” Again, I strongly believe that he thinks she is Dinah Shore.
 
Speaking of corporations or chain stores I had a question about McDonald’s apple slices. Have any of you ever eaten some or one? Because they really gross me out. I’ve heard of them, obviously I’ve never eaten one because I am asking you about them but I have a feeling that they are uniquely gross, not in a typical way that apples can be gross. I think it’s weird that they are sliced already. I don’t know if they are brown. I would like to know the following things, honestly if you’ve eaten them, I don’t judge you. Please, you are doing the best you can. So this is what I anticipate McDonald’s apple slices being like, I picture them coming from a sweaty little package like if you take baby carrots and don’t refrigerate them or you take baby carrots and you do refrigerate them but the bag is smaller so for some reason they’re not all wet. I hate baby carrots. At this point in my life I hate baby carrots because they are dripping with cold water. Fuck hummus–the whole thing. Please, can’t we come up with better snacks?

Episode 186: “IF HIS NAME WAS WOODEN SPOON” September 26, 2014
 
Prison

The Daily News renews our faith in tabloid journalism today with its gleeful cover story about the so-called “Cannibal Cop,” who is currently “stewing” in Manhattan Correctional Center while his lawyers file appeals. In an interview with former officer Gilberto Valle’s mother, the News learns that her son–who faces up to life in prison for conspiring to kidnap and eat several women–is working as a chef in the jail. His specialty, sources say, are his “Wardenchiladas.” “‘Don’t stand too close to the oven, and that kind of thing,'” is what Valle’s fellow inmates are known to quip, according to his mother Elizabeth Valle,
 
Well that’s nice–Wardenchiladas. A warden is someone who works in a jail right? That’s funny. Everyone has a good time. God bless you Gothamist. They posted Cannibal Cop’s OKCupid profile. That’s no good. He writes that his favorite foods are Italian, Mexican, Chinese, Japanese, I’ll try anything and I’m not picky at all. Boy oh boy, wow, be careful out there everybody. Be Careful online dating world.

Episode 166: “That Bellevue Glow” May 9, 2014

Park Walks

So this guy is standing next to me. I’m enjoying watching this beautiful basset hound, and he says to this woman, he says “Oh. Boxers make me laugh.” First of all, thank you very much sir. And then there’s this Boxer who was very cute and he had this like dopey tongue like there are some dogs that can’t put their tongues in their mouths, or, they just like at rest, their tongues are just kind of out. and it’s really cute. So they had noticed that, and he laughed a little too loud loud. And said to the dog, but like for the benefit of the woman he was with, he goes “Hey buddy…. your tongue’s supposed to go INSIDE your face.” Oh was that embarrassing.
 
If I were a dog I would have just ripped his face off, chimp style. I would have gone Charla Nash on him. So that was the first thing that just was irritating. Also, I can’t emphasize enough, he was right next to me. He must have been an inch away. And there was plenty of room on either side of the Angry Walking Girl. So the girl that he is on a date with is-is just kind of smiling and nodding as, was her, as she was tasked to do. I mean I guess he was an OK looking guy, and God knows, Ladies, I do not envy, there is not a lot of good guys. Am I? I don’t mean to be like “Oh there’s a man drought! I’m gonna write a trend piece!” but like..there really is a disparity of like, I mean you put up with a lot, is what I’m saying.
 
So I’m like alright, this girl’s, you know, just trying to make the best of it, this guy’s decent looking, but you know he really is just a schmuck in so many ways. So then, he goes after he gives his opinion about Boxers, he sees the Basset Hound— he sees my pride and joy bounding back and forth, lust for life, Perfect 10, this dog is like absolutely, a, you know, just a-just-a beautiful, beautiful dog..and HE SAYS to his date, this moron, he says “Oh check out the Bassett Hound. Bassett Hounds are infamous for being dumb”

Episode 40 “Twittertudes” Dec 9, 2011
 
Difficult People Season 2 premieres on Hulu July 12th. Catch up on Season 1 now, especially if you like Curb Your Enthusiasm.

Catch up with “How Was Your Week” podcast here. Transcripts of the podcast monologues are available at HowWasYourWiki.com.

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Terahertz laser tech could scan for bombs at airports

Terahertz spectrum scanning is potentially ideal for finding bombs due to the sheer range of materials it can detect, but it’s not exactly practical for luggage checks when you need both a suitcase-sized machine and up to half an hour to conduct a sc…

ASUS GeForce GTX 1080 Founder’s Edition Graphics Card Unveiled

ASUS GeForce GTX 1080 Founder's Edition

ASUS has unveiled their newest graphics card, the GeForce GTX 1080 Founder’s Edition. Driven by the new NVIDIA Pascal architecture for delivering the amazing performance, innovative new gaming technologies and immersive next-gen VR, this high-end graphics card is packed with 2560 CUDA Cores, a 256-bit memory interface, a core clock of 1607MHz, a boost clock of 1733MHz and an 8GB of GDDR5X memory set @ 10,000MHz.

Coming with its own tuning utility ‘GPU Tweak II’, the GeForce GTX 1080 Founder’s Edition is built with a single-fan cooling system and provides 1x dual-link DVI-D, 1x HDMI2.0 and 3x DisplayPort output ports. Unfortunately, there’s no word on pricing and release date yet. [Product Page]

The post ASUS GeForce GTX 1080 Founder’s Edition Graphics Card Unveiled appeared first on TechFresh, Consumer Electronics Guide.

Draymond Green Kicks Steven Adams Where It Hurts The Most, Again

Oklahoma City Thunder center Steven Adams has taken some awful knocks this Western Conference Finals, and we’re only at Game 3. 

As you can see above and below, this latest — and probably most painful — blow came Sunday night at home against the Golden State Warriors.

Everyone knows how much this hurts. Women giving birth know this pain, too. The point is: poor Steven Adams. He never saw it coming. 

The culprit today, and in Adams’ Game 2 blow to the “midsection,” is Warriors forward Draymond Green, who was called for a Flagrant 1 foul for tonight’s nasty play. 

Green told reporters on Friday that his goal wasn’t to get in Adams’ head this series. Ostensibly, Green’s aim hasn’t been the head. 

Here’s the blow Adams took on another Green drive to the basket on last Wednesday night at Oracle Arena: 

Despite putting his ability to reproduce at stake, Adams will take solace in his team’s performance and his individual toughness. At halftime against the Warriors, a top five NBA defense in the regular season, the Thunder had run up 73 points to the Warriors’ 47. The teams are tied 1-1 in the series.

The 25-point deficit is the largest halftime deficit the 73-win defending NBA champions have faced this season. Adams heads into the locker room with 8 points and 5 rebounds, while Green is struggling (1 of 8 from the field, -31 plus-minus). To make matters worse the for Warriors: No playoff team has ever come back down 25 points at halftime. 

Draymond Green isn’t playing the best, or smartest night of basketball.

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Get Trippy With Adele In Her Gorgeous New Video For 'Send My Love (To Your New Lover)'

After teasing a snippet of her new video earlier this week, Adele premiered the gorgeous new video for “Send My Love (To Your New Lover)” at the 2016 Billboard Music Awards on Sunday. 

Wearing a gorgeous floral Dolce & Gabbana dress, the trippy video will have you grooving (just like Adele) to the third single off the singer’s hit album “25.” It sort of feels like dancing with four versions of Adele at the same time, which is just fine with us. 

Below is the teaser that Adele tweeted out:  

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The Libertarian Party Could Provide Insurance for Hillary Clinton

Two former Republican governors are running for president and vice president on the Libertarian line. They are Gary Johnson, former New Mexico governor, and William Weld, former governor of Massachusetts. The Libertarian Party holds its nominating convention in Orlando, Florida, over Memorial Day weekend.

The Libertarian Party could play the spoiler role in 2016 for Donald Trump, just as Ralph Nader did in 2000, but this time helping to tip the election to the Democrat.

Its minor-party counterpart on the left, the Green Party led by standard bearer Jill Stein, is far less likely to draw a comparable level of support from disaffected Bernie Sanders supporters. Sanders himself has already said he’ll support the Democratic nominee.

Unlike the typical third party candidates, Johnson and Weld are experienced mainstream politicians. Johnson, a former construction company entrepreneur, served two terms from 1994 to 2002, winning both elections by ten points. Weld was a highly popular and moderate governor of the Bay State. He won re-election by the largest margin in state history in 1994.

Polls are notoriously unreliable on third-party campaigns, especially this early in an election year, when low name recognition understates appeal. But it looks as if the Libertarians could easily take 5 to 10 percent of the total vote and more in key states. Almost all of this will come at the expense of Donald Trump.

A Fox poll conducted Friday had support for Johnson at surprising 10 percent of the national vote.

Once the campaign moves to the general election phase, the Libertarian ticket will get more attention. In 1980, Republican Congressman John B. Anderson of Illinois, who could not abide Ronald Reagan, mounted an independent challenge and won just under 7 percent of the vote.

In what seems an increasingly close election, even five points drawn off from Trump in such key swing states as Colorado, Florida, or Ohio, or possibly Arizona, could lock those states into the blue column and provide some insurance for Hillary Clinton.

Of course, many of the Republicans who are most appalled by Donald Trump are far from libertarian. They are traditional business types or social moderates. On the other hand, they are fervent tree-traders — like the Libertarians and unlike Trump. The presence of a ticket with two former mainstream GOP governors gives them a way to disdain Trump without crossing all the way over and supporting Clinton.

In addition, the Republican Party is home to many genuine libertarians such as Kentucky Sen. Rand Paul and his legions of young supporters. Libertarians tend to support very limited government, both at home and in limiting military adventures abroad. They also are big on rights, such as abortion rights and the right to smoke or grow marijuana, and the right to freely migrate.

Gary Johnson not only supports the right to grow and smoke marijuana. He’s a pot entrepreneur, the CEO of a company called Cannibis Sativa.

Trump, with his defense of traditional Social Security and Medicare, and a military stance that swings wildly between intervention and isolation, seems the opposite of libertarian. Bill Weld, the former popular three term governor of Massachusetts, told the New York Times that Trump’s views on Muslims reminded him of Kristallnacht, the Nazi rampage on Jewish shops and synagogues in 1938.

The spurned Republican kingmakers and donors so far have failed to get a high-profile figure like Mitt Romney or Paul Ryan to mount a third party run against Trump. But two former GOP governors on the Libertarian ticket could well end up playing that role. Even though most Republican elected officials have fallen in line behind Trump, a lot of Republican voters would dearly like to cast their ballots for someone else.

Robert Kuttner is co-editor of The American Prospect and professor at Brandeis University’s Heller School. His latest book is Debtors’ Prison: The Politics of Austerity Versus Possibility.

Like Robert Kuttner on Facebook.

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Kesha Delivers Moving Performance Of 'It Ain't Me Babe' At Billboard Music Awards

After controversy surrounding her performance at the Billboard Music Awards, Kesha took to the stage on Sunday night and sang a moving cover of Bob Dylan’s “It Ain’t Me Babe.” 

Joined by Ben Folds onstage, Kesha had the entire audience speechless from the moment she opened her mouth. Once again, the singer proved she’s got some pretty impressive pipes. When she finished the song, it was clear the 29-year-old was grateful for the applause from the crowd. 

You can watch a snippet of the performance below: 

Last week, Kesha’s performance was up in the air after Lukasz “Dr. Luke” Gottwald’s record label, Kemosabe, rescinded, then subsequently restored, its approval. The label reportedly feared the singer would try to use her performance to make a statement about Gottwald, or bring up their legal battle. 

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San Antonio Bound in the BMW 3 Series

The vehicle is as classy as the city where I headed to test it out, the 2016 BMW 3 Series 340i, a sporty rendition of a luxury sedan offering comfort, style and power behind the wheel. This year all the 3 Series offerings have been tweaked a bit inside and out with not only suspension improvements, but also a name change from 335i to 340i and under the hood there is more power in the 340i than in the previous incarnation.
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You can opt for a sedan or wagon body style in the BMW 3 Series and there are four trim levels; the 320i, 328i, 328d and 340i. Go for the 340i and you won’t be disappointed because it is certainly a road trip vehicle for both the front and back seat passengers and the seats move and recline in a variety of configurations. Take note of the gauges too, which are easy to read and a throwback to pre-BMW design. The 6.5-inch infotainment will give you everything you need to know and there is also the iDrive controller with a menu that works intuitively.
It’s a wonderful driving experience the 340i, the ride is smooth and since this one is a sportier version you can definitely feel that ramped up aspect when driving it. Even better, it’s 22 miles per gallon in the city and 33 miles per gallon on the highway. Not bad for a road trip so I headed to the very chic La Cantera Hill Country Resort part of the larger Destination Hotels collection. Sitting on 550 acres of prime San Antonio land close enough to anything you might want to do (like the River Walk or the Alamo), but far enough away for you to enjoy a peaceful vacation.
There are five pools on the property so there is never a crowd, two championship golf courses, a soon-to-be very high-end spa to open and 498 rooms.
Since I write about food and spa and the spa wasn’t ready yet (there were plans to open this month), let’s focus on the tasty aspect of La Cantera because part of being on a good road trip is eating a good meal. The folks at La Cantera Hill Country Resort are certain they have created not only a relaxed style when it comes to dining, but added to that luxury and sophistication too.
Chef John Zaner, La Cantera’s Director of Culinary Operations who hauls from The Ritz Carlton-Kapalua in Hawaii says “We want them to say that our food is as unique and satisfying as the thoughtfully designed dining settings we offer.”
Actually, the new restaurants he is speaking of are part of the resorts multimillion-dollar transformation that included a refresh all around – and that includes the aforementioned spa that I can hardly wait to visit.
From casual to gourmet there are nine locales to enjoy a meal at La Cantera. I enjoyed SweetFire Kitchen with its American menu and an open-air exhibition style kitchen. Other options are the Primero Cantina with an indoor/outdoor bar, Sire Bar (try a hand-crafted cocktail), Topaz and Vista Grille (that one offering up healthy cuisine).
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So if you are looking for a resort that offers everything with comfortable rooms and a friendly staff, this is a prime go to destination. In fact, you really don’t even have to leave the premises during your vacation whether you want to eat healthy farm-to-table, want to relax and dive into a week of golf, spa and happiness, whatever the case may be head to La Cantera Hill Country Resort for a real Hill Country experience that won’t disappoint.
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San Antonio’s River Walk

Of course it’s quite certain that you will want to head to the River Walk in San Antonio to get a feel of the vibe there so when you do take a meal at Las Canarias at the Omni La Mansion del Rio. Picture a Spanish colonial type of architecture with a bit of a European vibe and take in the great views outside the restaurant as you dine on the patio overlooking the River Walk. The menu features an American cuisine and the chef uses local ingredients for fresh tastes from local farmers and artisans in the area. If you want a signature dish from the kitchen try the Lockhart Quail or the Veal Tenderloin and you are definitely not going to want to leave without trying one of the hand-made margaritas. Texas is all about the perfect margarita and Las Canarias has the perfect blend so make sure you make this your first stop while taking in the river.
Nearby the Omni La Mansion del Rio is the Mokara Hotel & Spa – also part of the Omni family. These guys at Mokara have their own reason to boast with specialty tequilas, more than 70 labels in all, but it was the spa I was seeking when I visited this destination.
Mokara’s spa lays claim to 17,000 square-feet all of it a truly fine oasis of relaxation. There are a variety of spa treatments to choose from on the spa menu and a very comfortable environment in the restful lounge before and after your treatments. It’s the only world-class spa in the heart of downtown San Antonio and there is plenty to go around with 17 treatment rooms. Of course, you don’t want to miss the outdoor poolside café and rooftop views at Mokara either.
For more information visit https://www.omnihotels.com/hotels/san-antonio-la-mansion-del-rio/wellness.

For more auto and travel tips follow Rita @RitaCook13.

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Doubling Down on Errors: Urban Institute Defends Its Ridiculously High Single Payer Cost Estimates

Last week we posted a critique of the Urban Institute’s (UI) absurdly biased report that claimed Sen. Bernie Sanders’ proposal for single-payer health reform would cause a massive increase in health spending. Now, the report’s authors have issued a 12-page rejoinder to our criticism. But that response is riddled with distortions, misinterpretations and glaring factual errors. Moreover, they now make it clear that they didn’t even try to estimate the costs of Sanders’ (or our) single-payer proposals. Instead, they made up their own reform proposal and costed that out.

Our critique identified three main problems with the UI’s projection that implementing single payer would boost total health spending by $519 billion in 2017. First, UI ignored about 75 percent of the administrative savings that single-payer reform would achieve. Second, it substantially underestimated single payer’s savings on prescription drugs. And finally, it posited an absurdly large increase in the utilization of health care under single payer, far more than could possibly be provided by the current supply of doctors and hospitals.

Below, we briefly discuss the UI’s response to those criticisms, and the facts of the matter.

1. Administrative savings, Part 1: The original UI report projected that single payer could cut insurance overhead from the current 9.5 percent of health spending ($341 billion) to 6 percent ($215 billion). As they now admit, they were modeling a compromised single-payer system, in which private managed care insurers like UnitedHealthcare would continue to play a major role, as they do in the Medicare Advantage program. (Neither we nor Sanders have suggested such a continued role for private insurers.) We pointed out that Canada’s single-payer system runs for 1.8 percent overhead (a figure they impugn, but which is taken directly from Canada’s official health statistics), and is similar to the overhead in the traditional Medicare program. Reducing our insurance overhead to the Canadian level would mean cutting it to “only” $65 billion. There’s no reason to believe we can’t be as efficient as Canada if we, like Canada, proscribe participation by private insurers.

The UI rejoinder argues that “it would be inadvisable to cut administrative costs so much that important functions could not be carried out effectively under a new system. Such functions include rate setting for many different providers of different types facing different costs across the country; quality control over care provision; development, review, and revision of regulations; oversight for fraudulent activity; provider oversight and enforcement of standards; bill payment to providers; consumer services; and more.” Of course traditional Medicare (and Canada) are already doing all of those things, and the UI response gives no reason why $65 billion can’t do the job.

2. Administrative savings, Part 2: The original UI estimate projected that single-payer reform wouldn’t realize any savings on the vast amounts hospitals and doctors currently spend on billing and paperwork. Yet, Sanders’ (and our) proposals would enormously simplify this billing and paperwork. We noted that reliable studies published in the most respected medical and policy journals have documented these provider administrative savings, and that numerous single-payer estimates by the Congressional Budget Office, the Government Accountability Office and private consultants have all assumed that these savings would occur.

In response, our UI colleagues continue to project zero administrative savings for providers, but say: “We agree that administrative costs would fall, but we do not agree they would be close to zero as HW [Himmelstein and Woolhandler] assert.” Actually, we never asserted any such thing. We wrote that “U.S. hospitals spend one-quarter of their total budgets on billing and administration, more than twice as much as hospitals spend in single-payer systems like Canada’s or Scotland’s. Similarly, U.S. physicians, who must bill hundreds of different insurance plans with varying payment and coverage rules, spend two to three times as much as our Canadian colleagues on billing.” Our estimate that cutting U.S. providers’ administrative costs to Canadian levels would save about $2.57 trillion over 10 years was based on this well-established (and peer-reviewed) data.

3. Drug prices: The latest UI piece restated their conviction that a U.S. single-payer system could get only half the discounts that single-payer systems in other nations have gotten from drug companies (and would actually raise drug prices for patients currently on Medicaid). They continue to offer no reason why the discounts would be so small. Moreover, they now claim that Himmelstein and Woolhandler “argue incorrectly that we ignored savings from paying less for prescription drugs.” In fact we didn’t ignore their estimated savings, but said they should be two-fold higher than the 25 percent they projected.

4. Utilization of care, Part 1: The original UI report estimated that single-payer reform would cause a $519 billion increase in health spending in 2017, even accounting for some savings on administration and drugs. But we noted that there just aren’t enough hospital beds or doctors to meet the huge surge in visits and hospitalizations they predict. To back up our claim we cited data from Canada (when its single-payer reform was implemented) and the U.S. (when Medicare and Medicaid were implemented). These data document that no, or very modest increases in society-wide use of care, occurred, and that instead care shifted from the rich and healthy to the sick and poor.

In response, the UI rejoinder says: “Contrary to HW’s [Himmelstein and Woolhandler’s] claim in their article, health care use and spending for the elderly population did increase substantially once the Medicare program was implemented in 1965.” Here (as in their claim about our statement on providers’ administrative costs) they have misquoted us. We wrote that “between 1964 (before Medicare) and 1966 (the year when Medicare was fully functioning) there was absolutely no increase in the total number of doctor visits,” and that “the same thing happened in hospitals.” While we are well aware that utilization by the elderly and the poor went up after Medicare and Medicaid were implemented, the point is that there was a compensatory, slight reduction in utilization by other Americans, reflecting the limitations imposed by the existing supply of hospital beds and doctors (most of whom were already working full time).

Here’s the actual data on the number of doctor visits per person (not just the elderly) before and after Medicare/Medicaid:

2016-05-23-1463969735-8480639-ScreenShot20160522at8.33.28PM.png

And here’s the actual data on the total number of hospitalizations:

2016-05-23-1463969780-6322384-ScreenShot20160522at8.34.04PM.png

In sum, we were correct in stating that the overall utilization of care showed no surge.

5. Utilization of care, Part 2: We noted in our critique that the lack of a surge in overall utilization in Canada, or with the start-up of Medicare/Medicaid, reflected a shift of care, with the newly insured poor and sick patients getting more of the care they needed, and the healthy and wealthy getting less elective and unnecessary care.

The UI rejoinder disputes that such a shift could occur. “HW [Himmelstein and Woolhandler] indicate that use would increase for the newly insured but would decrease by a similar amount for those already covered as physicians cease unnecessary services for those otherwise covered and perform additional necessary care for those otherwise uninsured. This assumption is faulty for two major reasons. First, no uniform definition of what is necessary and unnecessary exists in medical care; if such a definition existed, insurers would stop paying for all unnecessary care under our current health system. Second, there is absolutely no reason to believe that higher-income, currently insured individuals would lower their use of care under provider supply constraints.”

Their puzzlement displays a lack of familiarity with the considerable literature on variability in the utilization of care between different areas in the U.S., as well as the actual practice of medicine. John Wennberg and colleagues long ago observed that the number of surgical operations in a community showed only modest correlation with needs of the population, but was strongly correlated (r=.64) with the supply of surgeons.

As any doctor knows, doctors play a large role in regulating the amount of care they deliver. If we have no free appointment slots for the next month we’re likely to put off seeing our healthy patients a bit longer. Gastroenterologists often perform unnecessary screening colonoscopies. That’s not something many patients would demand. Indeed, the Aday paper referenced (to support a different point) in the UI rejoinder makes exactly our point: “After Medicare and Medicaid were introduced, providers may have begun to ration the number of visits by the ‘well-to-do’ to accommodate the influx of low-income patients with newly acquired purchasing power and a backlog of unmet need.”

In sum, there’s considerable evidence that doctor routinely adjust the utilization of care by their patients, and that when many additional people gain coverage, doctors shift care to this newly insured group, and compensate by reducing unneeded care for the wealthy and healthy.

6. What system was the UI analyzing? The UI researchers claimed to be estimating the budgetary impact of Sen. Sanders’ proposal. Yet now they tell us, “To be politically acceptable, compromises would have to be made, and those compromises are reflected in our assumptions.” In other words, their estimates are not actually based on the reform that Sanders (or we) have recommended. Instead they assume that the insurance and drug companies are too powerful to really rein in.

Overall, the UI response misrepresents key elements of our critique, and fails to address the erroneous assumptions that underlay their original analysis. Single-payer systems elsewhere provide more and better care at a lower price than we pay. The administrative bloat of our market-driven payment system accounts for much of the difference. While we recognize that a transition to a true single-payer system faces stiff political headwinds, it’s medically and economically feasible. And as Sen. Sanders has shown, political climates can be changed.

Drs. Woolhandler and Himmelstein are internists in the South Bronx, professors at the City University of New York School of Public Health at Hunter College, and lecturers in medicine at Harvard Medical School. The opinions expressed do not necessarily reflect those institutions’.

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Celine Dion Performs Emotional Tribute At The Billboard Music Awards

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Celine Dion brought down the house at the 2016 Billboard Music Awards with an emotional rendition of Queen’s “The Show Must Go On.” The performance was especially personal for Dion, who lost both her husband, René Angélil, and brother, Daniel, this year to cancer

The 48-year-old was honored with the Icon Award at the show and received a warm welcome from singer Seal and a video tribute. Dion looked stunning in a gorgeous, sparkling gown with a dramatic slit. 

Dion’s teenage son, René-Charles Angelil, surprised the singer by handing her the Icon award personally after her performance. 

“Rene, this one’s for you,” Dion said. “The show must go on.” 

Many celebrities tweeted their support and admiration for Dion after she sang and spoke. 

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