Month: July 2014

The Price-Cut On Medicare

Medicare Costs

Sarah Kliff is impressed by the above chart:

This simple, four-line chart is amazing news for the federal budget. It shows that the government is expected to spend about $50 billion less paying for the Medicare program this year than it had expected to just four years ago. What this chart shows is how much the Congressional Budget Office expects we’ll need to pay for each and every Medicare beneficiary. And over the past four years, the forecasting agency has consistently downgraded the price of covering one senior’s health care costs.

Saving $1,000 per patient adds up quickly in a program that covers about 50 million people. More precisely, it adds up to about $50 billion in savings this year. The reduction in expected costs grows to $2,369 in 2019. With an expected 60 million seniors enrolled in Medicare that year, it would work out to more than $120 billion shaved off the total cost of the program.

Drum expects Medicare costs to continue declining:

There are two reasons for this. First, the growth rate of medical costs in general has been declining steadily for the past 30 years, and this has now been going on long enough that it’s highly unlikely to be a statistical blip. After a surge in the 80s and 90s, we really are returning to the growth rates that were common earlier in the century, and obviously this will affect Medicare.

Second, Obamacare really will have an impact. Not everything in it will work, but it includes a lot of different cost-cutting measures and some of them will turn out to be pretty effective. And who knows? If Republicans ever stop pouting over Obamacare, we might even be able to experiment with different kinds of cost reductions.

Tricia Neuman and Juliette Cubanskigo go into more detail on the factors at play:

In addition to scheduled reductions in Medicare’s more formulaic payment rates, providers may be tightening their belts and looking to deliver care more efficiently in response to financial incentives included in the ACA, and it is possible that these changes are having a bigger effect than expected.  For example, CMS recently reported that hospital readmission rates dropped by 130,000 between January 2012 and August 2013.  It is also possible that hospitals and other providers are using data and other analytic tools more successfully to track utilization and spending and to reduce excess costs.  Another more straightforward factor is that several expensive and popular brand-name drugs have gone off patent in recent years, which has helped to keep Medicare drug spending in check.

Whatever the causes may be, the slowdown in spending is good news for Medicare, the federal budget and for beneficiaries—at least for now, and as long as it does not adversely affect access to or quality of care.

A Serious Plan To Fight Climate Change

A new report outlines what the world would need to do to head off severe global warming:

Given what we know about the sensitivity of the climate to added greenhouse gases, it’s possible to calculate how much more carbon dioxide we can admit while still having a reasonable chance of staying within the two degree Celsius envelope. What’s striking about these calculations is how many large changes we’ll have to make in order to get there. According to Jeffrey Sachs of Columbia University’s Earth Institute, the per-capita emissions would have to drop from five tons annually (where they are now) to 1.6 tons by 2050.

To accomplish this, Sachs says that all nations will have to undergo a process he calls “deep decarbonization,” which is part of the title of a report he’s helped organize and deliver to the UN [earlier this week]. Pathways to Deep Decarbonization, prepared by researchers in 15 different countries, looks into what’s needed to achieve sufficient cuts in our carbon emissions. The report finds that current government pledges aren’t sufficient, and the technology we need to succeed may exist, but most of it hasn’t been proven to scale sufficiently.

Plumer looks at what Sachs’ plan would mean for the US:

The United States eventually gets 30 percent of its electricity from nuclear power and 40 percent of its electricity from renewable sources like hydro, wind, and solar by 2050. Electric vehicles would handle about 75 percent of all trips. Large trucks would get switched over to natural gas. The coal plants that remained would all capture their carbon-dioxide emissions and bury them underground. Every single building would adopt LEDs for lighting.

David Unger reads through the report’s recommendations:

The biggest need: research and early-stage development. The world underinvests in clean-energy research, development, and demonstration by roughly $70 billion a year, according to the Center for Clean Energy Innovation, a Washington-based organization that designs and advocates for clean-energy policy. That amounts to only 13 percent of what the world spends on global fossil-fuel subsidies, according to CCEI, and 27.5 percent of what it invests in deploying clean-energy technologies.

“The main lesson in history is that targeted R&D works,” says Sachs, who says clean energy needs a large public-private effort along the lines of the Manhattan Project or the push to put a man on the moon. “The remarkable fact is that we have not invested [enough] in an issue that is of existential importance to the planet.”

Chart Of The Day

Immigrants

Casselman debunks common misconceptions about the origins of America’s immigrants:

The immigration debate, now as then, focuses primarily on illegal immigration from Latin America. Yet most new immigrants aren’t Latinos. Most Latinos aren’t immigrants. And, based on the best available evidence, there are fewer undocumented immigrants in the U.S. today than there were in 2007. … The immigration debate gets one thing right: The foreign-born population is growing. In 2012, according to data from the Census Bureau, there were more than 40 million people living in the U.S. who weren’t born here, up 31 percent since 20001; the native-born population grew just 9 percent over that time. The foreign-born now represent 13 percent of the population, near a historical high. The drivers of that growth, however, have changed significantly in recent years.

Furthermore, the Latinos who have already arrived are rapidly assimilating:

Political commentary often treats the issues of immigration and Hispanic ethnicity as two sides of the same coin. But U.S. Latinos are looking more and more like other Americans. Nearly 68 percent of U.S. Hispanics speak English fluently, up from 59 percent in 2000; more than a quarter report speaking only English at home. Latino high school graduates are now more likely than whites to enroll in college, although they are still less likely to graduate. Latinos are becoming less likely to be Catholic and choosing to have smaller families, and they more closely resemble the population at large on social issues such as abortion and gay rights. Nearly half of all Hispanics and about two-thirds of native-born Hispanics consider themselves to be “a typical American.”

Neither A Boy Nor A Girl

Charlotte Greenfield examines the medical profession’s response to intersex children:

During the 1990s, intersex adults who had received surgery as infants came forward speaking about their sense of mutilation. At the same time, an experiment from Johns Hopkins University that claimed to prove young children could safely be assigned any gender with surgical “reinforcement” was revealed to be a failure. The study had been initiated in 1967 by psychologist John Money, who claimed to have successfully given a boy female anatomy and had the child live as a girl. The child, whose penis was burnt off in a circumcision accident, was castrated and operated on to look female at the age of 22 months – eight months before the age at which Money claimed gender became fixed.

Until the 1950s, intersex children had largely been left alone, but Money’s experiment provided support for early surgical intervention. However, one of Money’s rival researchers tracked down his study’s subject and, in 1997, showed that the child had never been happy as a girl and had converted back to living as man, sending shockwaves through the medical profession. Nevertheless, the surgeries continue.

Unquestionable Right, Unbearable Stunt

Last week, after Target asked customers not to bring guns into its stores, Waldman commented that “just as there’s a culture of guns, and cultures where guns are plentiful, there are also tens of millions of Americans for whom an absence of guns is a cultural value”:

Despite what some extreme gun advocates believe, no right is unlimited, whether it’s your right to own a gun or your right to practice your religion or your right to freedom of speech. But beyond the legal limits, there are also the limits we all respect in order to have a society where we can get along despite our differences. My neighbor has a First Amendment right to write pornographic “Hunger Games” fan fiction, but if he hands his manuscripts to my kids he’s just being a creepy dirtbag, First Amendment or not. And depending on the laws of your state, you may have a legal right to take your rifle down to the Piggly Wiggly. But that doesn’t mean that doing so doesn’t make you a jerk.

Barton Hinkle is sort of on the same page. Though staunchly pro-gun rights, he argues that the antics of the open carry movement are bad for the cause:

Gun-rights advocates who delight in making suburban mothers nervous are practicing libertarian brutalism. They resemble those abortion-rights supporters who think it’s funny to wear a shirt that says, “Why did the fetus cross the road? Because they moved the dumpster.” Feeling put-upon, they have an urge to lash out at the other side, to rub the other side’s nose in the dirt and teach it a lesson. But lashing out rarely achieves much. Often such brutalism does nothing but generate resentment. Having a given right means never having to show consideration for how others feel about it, if you don’t want to. But advocates for individual rights should want to. We make a more persuasive case for liberty when we show such consideration. If, as one of the Carytown gun-toters put it, they wish to raise awareness about “responsible gun ownership,” then behaving responsibly would be a good place to start.

Update from a reader, one of several skeptical of Hinkle’s quote:

You quote Barton Hinkle as saying at reason.com that those who flaunt open-carry are like “those abortion-rights supporters who think it’s funny to wear a shirt that says, ‘Why did the fetus cross the road? Because they moved the dumpster.'” That didn’t pass the smell test for me – sounded sort of like “welfare queen driving a Cadillac” apocrypha. A Google search on that phrase doesn’t bring up anything except standard-issue “dead-baby” jokes (not using “fetus”), and certainly no T-shirts. What is Hinkle’s source for this? Because I can’t imagine anyone buying or wearing such a shirt, and I was surprised you quoted it unquestioningly. I’d comment at reason.com, but that’s predictably turned into a 2nd Amendment slugfest.

Tinker, Tailor, Soldier, Scandal

Germany is investigating another suspected spy in Berlin:

[Yesterday] German police raided the Berlin-area apartment and office of a man suspected of spying for the US, the second case in less than a week. The investigation is ongoing, but German authorities are taking it “very seriously,” a spokesperson told reporters. Last week, a German intelligence officer was arrested for working as a double agent and feeding documents back to Washington. The 31-year-old intelligence officer, which The Daily Beast has dubbed “Herr Wannabe,” apparently volunteered to work for the CIA. He got caught when he tried to spy for Russia as well.

All this comes, of course, after revelations that the US had been tapping German chancellor Angela Merkel’s cellphone since 2002. Germany tried to use this embarrassing fact to negotiate a non-spying agreement similar to the ones the US has with the UK, Canada, and other countries. However, the US has resisted out of fear that more countries will want the same thing.

Today, the German government asked our top CIA official there to leave the country. Morrissey is somewhat surprised at this reaction:

One has to assume that the Germans are not so blinded by outrage here as the public stances might suggest, as they know well how the intelligence game is played.

The French have been stealing industrial secrets for years, even though the two nations work much more closely together on the EU project than the US and Germany do in other areas. When these details about business-as-usual get made embarrassingly public, it forces everyone to make a public show of the outrage. Removing a key link in the partnership through the mechanism of a diplomatic expulsion, though, goes a bit farther than contrived outrage. That’s a step one would expect to see between two antagonists, or two loosely-affiliated nations, not between close partners like the US and Germany.

Kirchick defends our espionage activities in Germany, which he calls “a less than trustworthy ally.” In particular, he highlights the country’s ties to Russia and Iran:

German outrage at American spying would also be easier to swallow if it weren’t so hypocritical. According to former NSA intelligence and computer systems analyst Ira Winkler, the BND has penetrated the SWIFT financial messaging network, passing on the information to German businesses. In his book Spies Among Us, he writes of “the apparent willingness of German businesses to funnel sensitive information and technology to nations that are hostile to the United States,” including Iran. Germany remains one of the Islamic Republic’s largest trading partners.

American espionage in Germany—home of the Hamburg Cell, the circle of 9/11 hijackers who hung out in the port city, unmolested, for years—is aimed at protecting the national security of both America and its allies, Germany foremost among them. And while the BND cooperates extensively with America’s intelligence services, it also has worked toward giving a leg-up to German businesses, an unwritten no-no in the intelligence world.

But the latest news doesn’t much trouble Mataconis:

Understandably, there will be some degree of a diplomatic price to pay from these latest spying allegations. Allies spying on allies is, as I said, one of those things that everyone does to some degree but which is never spoken of publicly. At the same time, though, it strikes me that we shouldn’t really be all that embarrassed about what’s been revealed here, except to the extent that we got caught and the President apparently spoke to the Chancellor without being aware of what had happened earlier that week. There are good reasons to keep an eye on what’s going on in Germany and, indeed, some of those reasons ultimately benefit the national security of Germany as well as the United States. Furthermore, foreign espionage does not raise the same civil liberties issues that the N.S.A.’s domestic programs do so it’s best not to conflate the two. Foreign intelligence is sometimes an unpleasant business, but that doesn’t mean it isn’t necessary and in this case it seems like its necessary.

Mental Health Break

One reason many Americans can’t take the World Cup too seriously:

Update from a reader:

I appreciated today’s MHB because I think Neymar is the perfect example. Here is Neymar and his various dives. Here is Neymar and his real injury. When a player is acting, he rolls around on the ground and makes a spectacle of himself. When he is truly hurt, he lies still and tries to minimize the pain.

But another reader points to a video compilation “from the American sport with just as much flopping as soccer”:

Readers Hate Sponsored Content

That’s the good news as the journalism industry morphs into a branch of public relations. A new study has followed up on Tony Haile’s evidence that no one reads the damn stuff anyway. Its findings?

Two-thirds of readers have felt deceived upon realizing that an article or video was sponsored by a brand.
54 percent of readers don’t trust sponsored content.
59 percent of readers believe a news site loses credibility if it runs articles sponsored by a brand.
As education level increases, so does mistrust of sponsored content.

So I’m not alone among the consumers of journalism; I’m just almost alone in being a journalist who is publicly prepared to call this ethical swamp what it is. When asked if they would prefer old-fashioned, honest banner ads rather than this morphing of advertising, journalism and PR, the answer is overwhelming: by almost 2 -1 readers preferred traditional advertising.

But the core legal and political question is whether there is active deception going on, in violation of FCC rules. On that level, today’s media machers have some ‘splaining to do:

Screen Shot 2014-07-10 at 12.43.39 PM

When an industry is engaged in the wholesale deception of its consumers, the public interest is involved. At the very least, it seems to me, we should have Congressional hearings on whether this level of deception can be defended under the law.

Update from a reader:

“But the core legal and political question is whether there is active deception going on, in violation of FCC rules. On that level, today’s media machers have some ‘splaining to do”

Not so fast! The FCC, which regulates radio, TV, and common carriers, does not involve itself with online advertising. Those of us in the Radio/TV industry are familiar with the “sponsorship identification rule,” which requires that advertisers and their related content be identified in those media. There were some serious fines levied recently for this ($44,000 to a Chicago radio station for 11 instances of playing a “news” show that didn’t identify that the content was sponsored, and not actual news). Historically, the practice of payola led to these regulations, to prevent disc jockeys from accepting money to play records and thereby popularize them – a deceptive form of advertising.

Dissent Of The Day, Ctd

A reader quotes an earlier one:

Perhaps we should apply that same formula to heterosexuals. Who needs another human being when there’s God? In fact, it’s pretty obvious that any relationship OTHER than one’s relationship with God is inferior, a distraction from our one and only necessary relationship. Right?

Although I don’t think he sincerely believed it, my evangelical, heterosexual father expressed precisely the theological stance this reader posits sarcastically: Marriage was provided by God as a moral option for humans too weak in the flesh to commit fully to a relationship with God. Of course this in no way supports an argument that heterosexual marriage is fine and homosexual isn’t, but it does display a fascinating worldview. There is a higher morality that humans are invited, but not expected, to achieve.

The evangelical reader who started the thread follows up:

I’m very grateful for your posting of my earlier comments on this topic! I don’t want to fill up your inbox and use too much of your team’s time. But I get the impression that you don’t get too much evangelical input. This email is sent in reaction to your reader in Dissent of the Day, Ctd.

Your reader is absolutely right that the evangelical church cannot talk with credibility about same-sex marriage without a coherent theology of singleness and heterosexual marriage.  Western society seems to treat single people as though they are living a kind of maimed half-life, robbed of ultimate fulfilment and human wholeness (and devaluing aromantic friendship, as you pointed out recently). It’s unsurprising that opposition to same-sex marriage attracts such ire in this context.

The Biblical viewpoint is very different (even if, sadly, that isn’t always what we see in churches). According to the Apostle Paul, singleness (for whatever reason) is a gift, neither superior not inferior to marriage. Indeed, he insists that marriage has tremendous dangers:

the spouse may become an idol, competing with God for attention (1 Corinthians 7:32-35). If a prospective marriage is going to stop the couple from giving “undivided devotion to the Lord”, they shouldn’t get married. Christian marriage is for those who will glorify God better together. It is, emphatically, not to fill some sort of gap in our hearts/ we should be looking to Christ to fill that gap. As Vaughan says, the fulfilment of our relational longings is found in knowing the God who made us: the evangelical position would be inexcusable were it not for this fact.

Every Christian – male or female, gay or straight, married or single – in reality already has a bridegroom. In Hosea 2, God declares his intentions regarding his rebellious people:

Therefore, behold, I will allure her, and bring her into the wilderness, and speak tenderly to her… I will betroth you to me forever. I will betroth you to me in righteousness and in justice, in unfailing love and in mercy. I will betroth you to me in faithfulness. And you shall know the LORD.

And let’s not forget that the word “know” here is the same verb used when Adam “knew” Eve; intimacy with God is total intimacy in every dimension. From the Biblical perspective, earthly marriage is just a shadow of this heavenly union, when Christ will become “one flesh” with his church (Ephesians 5:25-33).  I was foolish to describe God giving himself to us “in return”, as though this were some kind of transaction; I meant that walking more closely with God is always worth it (not just theologically, but emotionally and experientially) because one is walking more closely with God. Whenever we disobey his commands, we are defrauding ourselves of our joy, precisely because we have taken our eyes off God.

Another responds to that reader’s first email:

The “dissent of the day” reflects why all too many Americans, especially young Americans, are moving further and further away from evangelical and fundamentalist churches.  Once, as a very young, enthusiastic (and often naively egotistical) evangelical several decades ago now, I used a “Christian cliche” in a college class, the metaphor from the Revelation about “the blood of the lamb.” Some astute “non-believer” (to me) asked me if I meant literal lamb’s blood.  I had a difficult time explaining what the metaphor even meant, let alone why I was using it, because I was conditioned to use it within “the tribe,” the evangelicals with whom I had associated.

These types of Christians, in their attempt to explain their theology of sex do themselves no favor by wrapping their fear of their own bodes and the world around them with such a high view of God that God ends up being so ultimate, so necessary to our existence that anything short of “Him and Him alone” means a failed life.  How demeaning is that to our full humanity, one shared even by God Himself, to those of us who hold to the incarnation?  How much this clap-trap sounds like the same old tired God who claims to give us free will but only if we willingly deny that free will for him, a God who sounds more like a kidnapper, holding us hostage and saying we have the freedom to leave but He will kill us if we do?  What kind of freedom is that?

I don’t think too many of those in the American evangelical camp can quite grasp the disdain all too many have to them in this culture because no matter how hard they try, sincerity comes across as sanctimony.