Day: June 29, 2025

The soundtrack of my life

jeffcnichols

Not sure why, but I recently thought about how my musical obsessions have changed over the years – or in some cases, not changed much. I spent some time this afternoon reviewing audio and video recordings of my past musical loves, and it was…interesting. Fun. Bittersweet. The resultant list is unavoidably biased because I’m not the same person I was in decades past, but I’ve done my best to recall what I actually loved Way Back Then and jot it down here. Here’s a list of the music that I remember most from each era of my life and some of the context.

1965-ish

I remember listening to Chicago AM radio (WLS, AM 890!) on my beloved little six transistor radio with a telescoping antenna. Walking around the eastern KY countryside at the age of 10-11, holding the radio to my ear and being amazed at listening to music from another city/state. I don’t remember a particular song (maybe The Beatles?), but the wonder of getting that low-fi music in my ear was memorable. That was the beginning.

1970-ish James Taylor, Fire and Rain

I remember this song as I was walking down the country road, above Shopes Creek, still listening to my trusty portable six transistor AM radio. “Sweet dreams and flying machines, in pieces, on the ground…” Damn. This also blew my 14 year old mind because I read the lyrics in the Encyclopedia Yearbook at my grandparents house. Poetry, not just music. A little validation that my tastes were OK, even good.

1972 – Grand Funk Railroad, MC5, Blue Oyster Cult, Elton John, Michael Jackson

Album-oriented rock was what they called it back then, and I thought it was the key to the universe. I mostly listened to this on a gigantic stereo console of my parent’s located on the 3rd floor of our new house. I moved the heavy furniture piece to the window and played basketball to the too-loud and distorted sound track. Mostly albums, some radio. Grand Funk was my main jam. MC5’s Kick Out The Jams was what I played to punish my parents.

1974 – Blue Oyster Cult, Yes, Bruce Springsteen, Rush, Be Bop Deluxe, Eagles, Pink Floyd, Linda Ronstadt, Emerson Lake & Palmer

The golden age. Can you imagine me listening to this on my mongo stereo (a big Luxman receiver and dual-stacked Large Advents) in my freshman dorm room while my poor roommate (hi Al, sorry about all that!) wanted listen to Kool & The Gang or Ohio Players? Truth be known, I actually liked those bands too, but I stuck to my prog-rock and hard rock music. Yes’s Tales From Topographic Oceans was literary nonsense and stupid hard to listen to. I loved it. Couldn’t be seen to be too open minded way back then.

1978 – Jackson Browne, Linda Ronstadt, Eagles, Warren Zevon, Rush

By ’78 I was fully immersed in a deep pool of self-pity and sad music. I was a mess. Jackson Browne’s The Pretender and Late for the Sky didn’t help. I graduated from college and got married in spite of it all. Didn’t have a clue about life.

1982 – Prince, Talking Heads, John Prine, ZZ Top, Tom Waits, Rush, Phil Collins

The party years. My work friends and I listened to all this and more at The Bucket Shop in west Akron, at jet engine decibel levels. Seriously room-shaking volumes. Some of the best days of my life. I miss you, John Wiseman, RIP. My Bucket Shop days (nights) ended when Emily was born, and that’s more than OK. A good tradeoff.

1990s – Mary Chapin Carpenter, Jackson Browne, Nirvana, Indigo Girls

I remember hearing Mary Chapin for the first time at a mall in downtown San Diego. I bought the CD on the spot. She still has the best lyrics and smoothest voice.

2000 – Bruce Springsteen, Jackson Browne, Alison Krauss, Guster, John Mayer

Some new voices. I was in yet another tectonic shift of life’s path, having decided that managing people wasn’t for me and recreating my professional self as a technology expert. And another marriage. Those both turned out fine.

Mid 2000s – Jackson Browne, Mark Knopfler, Pink Floyd

The beginnings of my really productive financial years. I traveled a lot – constantly – so I don’t remember being attached to any particular music. I do have a tiny iPod from that era, tucked away in a desk drawer somewhere. There’s probably a treasure trove of music on it, but I lack the patience or the digital interface to access it.

I do remember listening to KFOG 104.5 FM in the Bay Area as I traveled every week to SF and Walnut Creek. Was my favorite radio station back then.

2010 – Keb Mo, Sarah McLachlin, Beck (maybe), who else I don’t know

Kind of a musical desert during these years. I was so totally immersed in work/career that I forgot how to live. Music was just another casualty. I really fucked up by missing Tame Impala’s peak from 2015 to 2022. But at least I discovered them ex post facto. Better late than never.

And I fucked up again in a big way by not going to some Rush concerts as they wound down in the mid 2010s. Their last shows were 2013-2015, when I was fully consumed in making sure that we’d have enough money to retire. That money quest was successful, but at a cost. By the time I realized they were never going to play together again, it was too late.

Today, 2025 – Tame Impala, Khraungbin, Billie Eilish, RUSH!, Diana Krall, Jackson Browne, BOC, Knopfler, David Gilmour – and anything else with a great recording. Sadly, there are no great Rush or BOC recordings. Their recording engineers and/or the technology at the time sucked. Figures.

Today’s essay shows that I’m consistent with a few bands and music types. Rush, Prine, Jackson Browne, Pink Floyd, Springsteen, Linda Ronstadt…they’re constant. In every era, I can listen to them and be happy.

Current favorite song: It Might Be Time, Tame Impala, from The Slow Rush. Soooo on point…just listen to the lyrics. Every time I hear it I’m happy. Same with The Last Days of May by BOC. Rock poetry.

Just hired – a Research Assistant

jeffcnichols

I’m reading this morning about the Republican funding bill making its way through Congress, and the dire effects of Medicare cuts on rural hospitals. While I have a vague idea as to why this happens, I asked Google’s gemma-3-12b about it.

Me: why do cuts in medicare hurt rural hospitals?

Gemma:

Okay, let’s break down why cuts to Medicare disproportionately hurt rural hospitals. It’s a complex issue with several interconnected factors. Here’s a detailed explanation, broken down into categories:

1. Medicare as a Primary Payer (and the Dependence on It)

  • High Medicare Patient Volume: Rural hospitals rely heavily on Medicare as a primary payer. This is because rural areas generally have:
    • Older Populations: Rural communities tend to have a higher proportion of elderly residents, who are eligible for Medicare.
    • Higher Rates of Chronic Illness: Rural populations often experience higher rates of chronic diseases (diabetes, heart disease, etc.) that require ongoing medical care covered by Medicare.
    • Limited Private Insurance: Rural residents are less likely to have private insurance, further increasing their reliance on Medicare.
  • Percentage of Revenue: A significantly larger percentage of a rural hospital’s revenue comes from Medicare compared to urban hospitals. Estimates vary, but it can be as high as 60-80% or even higher in some cases. For urban hospitals, it’s typically lower (often 40-50%).
  • Financial Vulnerability: This high dependence makes rural hospitals extremely vulnerable to any cuts or changes in Medicare reimbursement rates.

2. Reimbursement Rates & Cost Structures

  • Lower Reimbursement Rates: Historically, Medicare reimbursement rates for rural hospitals have often been lower than those for urban hospitals. This is due to a variety of factors, including:
    • Cost-Plus vs. Prospective Payment System (PPS): Historically, rural hospitals were often paid on a cost-plus basis (reimbursing their actual costs), which was seen as more equitable. However, the shift to PPS (a fixed payment based on diagnosis) has created challenges for rural hospitals with higher costs.
    • Geographic Cost-of-Care Index (GCC): While the GCC is supposed to account for higher costs in rural areas (due to things like transportation, staffing challenges), it doesn’t always fully capture the differences. The GCC adjustments have been criticized as inadequate and not keeping pace with rising costs.
  • Higher Operating Costs: Rural hospitals face significantly higher operating costs than their urban counterparts:
    • Staffing Challenges: Recruiting and retaining qualified medical professionals (doctors, nurses, specialists) is difficult in rural areas due to lower salaries, limited career opportunities, and geographic isolation. This leads to higher staffing costs (e.g., reliance on traveling nurses, overtime pay).
    • Transportation Costs: Patients often have to travel long distances to reach a rural hospital, increasing transportation costs for both patients and the hospital (e.g., ambulance services).
    • Economies of Scale: Rural hospitals are typically smaller, lacking the economies of scale that larger urban hospitals enjoy. This means they have higher per-patient costs for things like equipment, supplies, and administrative overhead.
    • Limited Ancillary Services: Rural hospitals often have limited or no specialized services (e.g., cardiology, oncology), requiring patients to be transferred to urban hospitals for care. These transfers add costs and complexity.

3. Specific Medicare Cuts & Their Impact

  • Site-of-Service (SOS) Payments: A major point of contention has been changes to SOS payments. Medicare pays less for services provided in a hospital outpatient department (OPD) compared to an independent physician’s office. Rural hospitals often rely heavily on their OPDs for revenue, and cuts to these payments have significantly impacted them.
  • 340B Drug Discount Program: The 340B program provides discounts on drugs for hospitals that serve vulnerable populations. Rural hospitals rely heavily on this program to offset drug costs and provide care. Attempts to restrict or limit 340B have threatened their financial stability.
  • Payment for Telehealth: While telehealth has been a lifeline for rural hospitals, changes to Medicare reimbursement policies regarding telehealth services (particularly after the COVID-19 public health emergency) have created uncertainty and potentially reduced revenue.
  • IPPS (Inpatient Prospective Payment System) Cuts: Annual cuts to IPPS payments, mandated by the Budget Control Act of 2011 (sequestration), have consistently reduced Medicare reimbursement for inpatient services, further straining rural hospitals.

4. The Result: Hospital Closures & Reduced Access to Care

  • Hospital Closures: The cumulative effect of these factors has led to a concerning trend: rural hospital closures. Since 2010, over 180 rural hospitals have closed in the United States.
  • Reduced Services: Even if a hospital doesn’t close, cuts can force it to reduce services (e.g., emergency room hours, specialized programs) or delay necessary investments in equipment and technology.
  • Limited Access to Care: Hospital closures and reduced services create “healthcare deserts,” where residents have limited access to essential medical care. This can lead to:
    • Increased emergency response times
    • Worse health outcomes
    • Greater reliance on already strained ambulance services
    • Increased travel distances for care

In summary, cuts to Medicare disproportionately hurt rural hospitals because of their high dependence on Medicare as a payer, coupled with their unique cost structures and challenges in providing care. These cuts threaten the financial viability of rural hospitals, leading to closures, reduced services, and ultimately, diminished access to healthcare for millions of Americans living in rural communities.

Resources:

Pretty damn impressive, I’d say. I’ve now got a full-time research assistant.