Tag: Premium

Why Not Have A Two-Tiered Medical System?

Richard Gunderman argues in favor of concierge medicine, a system in which patients pay hefty fees to spend more time with their doctors:

The concierge model of practice is growing, and it is estimated that more than 4,000 U.S. physicians have adopted some variation of it. Most are general internists, with family practitioners second. It is attractive to physicians because they are relieved of much of the pressure to move patients through quickly, and they can devote more time to prevention and wellness….

Of course, there are drawbacks to concierge practice. For one thing, some patients cannot afford it, and others will choose not to pay the fee. Critics also see such models as promoting a two-tiered system of healthcare, in which those with more money get better care.

“But we have always had a two-tiered system,” [internist Frederic] Becker counters, “and it is better to care for 600 patients well than just adequately for three or four times that number. Someday patients, physicians, and healthcare payers will recognize that slower-paced but truly high-quality medical care is a better value than the fast medicine many physicians feel pressured to practice today.”

Meanwhile, Christopher Flavelle fears the rise of specialists who demand cash payments:

The slice of the population that’s willing and able to pay for specialty care in cash is small; the share of physicians in cash-only practices was just 6 percent last year. But that’s double the level from 2011. And if the income gap keeps growing, so will the number of doctors who can find enough cash-only patients to stop taking insurance. …

If the trend accelerates, it may call for new guidelines from the American Medical Association. The AMA now says doctors moving to cash-only practices must “facilitate the transfer of their non-participating patients to other physicians” – for instance, not charging for the transfer of medical records. If no other physicians are available in the community, the doctor “may be ethically obligated to continue caring for such patients.” The AMA also reminds doctors of their “professional obligation to provide care to those in need.” Those guidelines may start to look too vague if the best specialists drop out of the insurance system altogether.

Previous Dish on concierge medicine here.

The Most Egalitarian Of All Possible Worlds?

poverty world

Pointing to a new study showing that income inequality is rapidly declining at the global level, Tyler Cowen argues that the redistribution favored by egalitarian movements in the US would end up hurting international prosperity:

Although significant economic problems remain, we have been living in equalizing times for the world — a change that has been largely for the good. That may not make for convincing sloganeering, but it’s the truth. … Many egalitarians push for policies to redistribute some income within nations, including the United States. That’s worth considering, but with a cautionary note. Such initiatives will prove more beneficial on the global level if there is more wealth to redistribute. In the United States, greater wealth would maintain the nation’s ability to invest abroad, buy foreign products, absorb immigrants and generate innovation, with significant benefit for global income and equality.

Mark Perry backs up Cowen’s thesis with the above chart. But Daniel Little criticizes Cowen’s “Panglossian” picture of global inequality:

Cowen bases his case on what seems on its face paradoxical but is in fact correct: it is possible for a set of 100 countries to each experience increasing income inequality and yet the aggregate of those populations to experience falling inequality. And this is precisely what he thinks is happening.

Incomes in (some of) the poorest countries are rising, and the gap between the top and the bottom has fallen. So the gap between the richest and the poorest citizens of planet Earth has declined. The economic growth in developing countries in the past twenty years, principally China, has led to rapid per capita growth in several of those countries. This helps the distribution of income globally — even as it worsens China’s income distribution.

But this isn’t what most people are concerned about when they express criticisms of rising inequalities, either nationally or internationally. They are concerned about the fact that our economies have very systematically increased the percentage of income and wealth flowing to the top 1, 5, and 10 percent, while allowing the bottom 40% to stagnate. And this concentration of wealth and income is widespread across the globe.

Ryan Avent pushes back as well:

There is an alternative hypothesis, however, which Mr Cowen mostly disregards: that redistribution provides insurance against economic dislocation and therefore softens resistance to globalisation. It’s worth pointing out that the world has experienced two great eras of globalisation. The first combined minimal redistribution with minimal political power for non-elites. The second combined universal suffrage with substantial redistribution. I don’t think it’s unreasonable to conclude that redistribution is the price democracies pay for globalisation.

And that makes perfect sense! Reducing barriers to trade generates net gains, but those gains will occasionally be distributed in highly unequal fashion. If gains are concentrated and no provision is made for redistribution, then a voting majority might well conclude that openness is a losing proposition. Mr Cowen seems to want voters to recognise that whether or not they personally are made better off by globalisation it is a good thing to support, because it enables the enrichment of poor areas of the globe. But few voters are content to have their economies run as charities (and a good thing for economists that they aren’t, as that would make a baseline assumption of rational self-interest look pretty absurd).

Are We Abetting Central American Gangs? Ctd

EL SALVADOR-GANGS-TRUCE

Alec MacGillis shines a light on US gun trafficking to Central America, making the argument that our loose gun regulations are contributing to these countries’ gang violence problem:

According to data collected by the ATF, nearly half of the guns seized from criminals in El Salvador and submitted for tracing in the ATF’s online system last year originated in the U.S., versus 38 and 24 percent in Honduras and Guatemala, respectively. Many of those guns were imported through legal channels, either to government or law enforcement agencies in the three countries or to firearms dealers there.

But a not-insignificant number of the U.S.-sourced guns—more than 20 percent in both Guatemala and Honduras—were traced to retail sales in the U.S. That is, they were sold by U.S. gun dealers and then transported south, typically hidden in vehicles headed across Mexico, though sometimes also stowed in checked airline luggage, air cargo, or even boat shipments. (Similar ratios were found in traces the ATF conducted in 2009 of 6,000 seized guns stored in a Guatemalan military bunker—40 percent of the guns came from the United States, and slightly less than half of those were found to have been legally imported, leaving hundreds that were apparently trafficked.)

“It is a problem,” says Jose Miguel Cruz, an expert in Central American gang violence at Florida International University. “The problem is we don’t have any idea how many [of the trafficked guns] there are. It’s a big, dark area.”

Cynthia Arnson, director of the Latin American Program at the Woodrow Wilson International Center for Scholars, tells Dylan Matthews that an effective US response to the crisis must address its root causes:

Of the $3.7 billion requested by the administration for dealing with the child migrant crisis, a very small percentage of it, about $295 million, goes to addressing root causes of the violence. I think that ever since the United States, starting with the end of the Bush administration, began to pay more attention to Central America as the drug violence was spilling over from Mexico to Central America, there’s been an overemphasis on security and controlling drug trafficking and also just not enough resources overall. …

There’s been a focus in the US and elsewhere in the region on capturing drug kingpins, but I think a lot of people who have looked at this, given the weakness of institutions, including police and law enforcement, including the judiciary, have said that a better approach is to try to reduce the violence connected with local illegal markets, and focus on providing citizen security to the general population. You can’t abandon the attempt to capture major traffickers, but you cannot do that without providing for safer communities and creating greater resilience at the individual and the community level.

Previous Dish on the violence in Central America and the US’s role in it here and here.

(Photo: A member of the “18 street” gang takes part in an event to hand in weapons in Apopa, 14 Km north of San Salvador, El Salvador on March 9, 2013. Gang leaders surrendered about 267 weapons as part of the truce process between gangs in El Salvador. By Jose Cabezas/AFP/Getty Images)

All-You-Can-Read

Hayley Tsukayama urges consumers to be honest with themselves about their reading habits before signing up for Amazon’s new literary service:

Kindle Unlimited is $9.99 per month. So you’ll be paying Amazon, whose chief executive Jeffrey Bezos owns The Washington Post, around $120 per year for the unfettered e-book access. If you’re habitually spending money on more than one book per month, then it’s a service to think about. It has its perks for big book buyers – namely that don’t have to worry about spending money on a book you end up hating.

But, chances are, you aren’t reading more than one book per month. In January, the Pew Internet and American Life Project asked how many books the typical American had read in the past year.

The answer? Five.

Maria Bustillos contends that “it shouldn’t cost a thing to borrow a book”:

For a monthly cost of zero dollars, it is possible to read six million e-texts at the Open Library, right now. On a Kindle, or any other tablet or screen thing. You can borrow up to five titles for two weeks at no cost, and read them in-browser or in any of several other formats (not all titles are supported in all formats, but most offer at least a couple): PDF, .mobi, Kindle or ePub (you’ll need to download the Bluefire Reader—for free—in order to read ePub format on Kindle.) I currently have on loan Alan Moore’s Watchmen, Original Sin by P.D. James, and The Dead Zone by Stephen King.

Alison Griswold concentrates on the business angle:

Kindle Unlimited will add a new layer of complexity to negotiations between Amazon and publishers. So far, it seems that most of the big-name publishers haven’t agreed to let their titles onto the subscription platform. Books published by HarperCollins and Simon & Schuster aren’t offered and those from Penguin Random House are notably absent. Amazon has not said how authors and publishers will be paid for participating in Kindle Unlimited, but it’s unlikely that the models currently used for e-book sales through its store will do the trick.

Brian Heater is concerned that writers like him will get screwed:

We’ve all heard the horror stories of the fractions of cents being doled out by Spotify, with the justification that many musicians make their mint touring anyway. For one thing, that’s hardly a universal and for another, where’s the author’s analog to touring? Unless you’re, say, Hillary Clinton pulling in $200,000 per speaking engagement, no one’s paying big bucks to watch you read. You’re there to sell more books.

The other justification for music-streaming services is the notion that people who really love a record will go out and buy it. Perhaps I’ve just become too immersed in the world of e-books too quickly, but I’m having difficulty imagining a scenario in which I run out and buy a hard copy of a book after reading the electronic version. It certainly hasn’t happened to me yet – I also haven’t found myself going back and re-reading too many e-books to this point.

Joshua Gans fears that Amazon’s new service will discourage the creation of long books:

Amazon’s payment to authors is similar to its payment to them for the Kindle Owner’s Lending Library. There is a fund (amount = F) that is set monthly by Amazon. If there are a certain number of books downloaded that month (N) and your book is downloaded n times, you receive (n/N)*F in payments that month. That’s for lending. For books under the Unlimited plan, they have to be at least 10% ‘read’ (on the assumption that flipping 10% of the pages is the same as reading them). And so your share is based on how often your book is minimally read. Basically, people can try before they buy with their attention.

Now this plan isn’t all rosy because while it rewards books that are readable, it does so asymmetrically. For instance, Piketty’s recent book has 696 pages whereas mine most recent one has 93. Suffice it to say, Piketty will receive the same payment for another book read this month beyond 70 pages as I would get for 10. That strikes me as amiss.

Konnikova, meanwhile, looks at the impact digital devices have on the reading experience:

When Ziming Liu, a professor at San Jose State University whose research centers on digital reading and the use of e-books, conducted a review of studies that compared print and digital reading experiences, supplementing their conclusions with his own research, he found that several things had changed. On screen, people tended to browse and scan, to look for keywords, and to read in a less linear, more selective fashion. On the page, they tended to concentrate more on following the text. Skimming, Liu concluded, had become the new reading: the more we read online, the more likely we were to move quickly, without stopping to ponder any one thought.

The online world, too, tends to exhaust our resources more quickly than the page. We become tired from the constant need to filter out hyperlinks and possible distractions. And our eyes themselves may grow fatigued from the constantly shifting screens, layouts, colors, and contrasts, an effect that holds for e-readers as well as computers.

Shifty Work Conditions

McArdle contemplates the current state of part-time labor:

Unfortunately, the weakness in the labor market has coincided with yet another market development: scheduling software and technology that allows retailers to manage their workforce as another just-in-time input.

Workers are asked to input blocks of hours when they will be available; the software then crunches through everyone’s availability and spits out a schedule that takes account of everything from weather forecasts to the danger that a worker will go over the maximum number of hours to still be considered part time. Obviously, you can’t string together multiple jobs this way, because each job requires that you block out many more available hours than you will actually work. Meanwhile, Steve Greenhouse reports on even worse practices that I hadn’t heard of: requiring workers to be “on call” at short notice or scheduling them for shifts and then sending them home if business looks light.

In this situation, no matter how hard you are willing to work, stringing together anything approaching a minimum income becomes impossible. That makes it much more deeply troubling than low pay.

Update from a reader, who brings up unions:

This is why anyone who works at a part-time job in a non-union shop is essentially a wage slave.

My company – a major grocery chain – uses similar software for scheduling, but union rules specifically rule out “on call” employees, or sending employees home during unexpectedly light business without their consent. In addition, it is strictly against the rules – and grounds for a grievance – to schedule an employee outside their available hours.

Thus many of our employees can work multiple jobs – several spend three or four days with us and another two or three with another employer (the only stipulation being it cannot be a competitor, obviously). Some even work making deliveries for our suppliers on their “off days”. It also means working moms can schedule themselves to be home when the kids arrive from school or daycare, students can reliably schedule college classes without worrying about work conflicts, etc.

Without union rules, none of this would be possible.

In Case You Need Another Reason To Hate Mosquitos …

Last week, Maggie Koerth-Baker warned that chikungunya, a mosquito-borne disease that’s not typically fatal but currently has no cure, is inevitably making its way to the US:

The virus has been known since the 1950s, but because it was largely non-lethal and largely confined to developing countries in Africa and Asia, the Western medical establishment didn’t much care about it until 10 years ago. That’s when chikungunya showed up on the French-controlled island of La Réunion, in the Indian Ocean, where it infected 40 percent of the population. Since then, it’s exploded in parts of Asia where it hadn’t been seen in decades (and other parts where it hadn’t been seen at all), reached Australia and Taiwan, and made landfall in Italy and France. And all of that was before the outbreak in the Caribbean.

So what changed? The sudden spread of chikungunya seems to be related to two things. First, the virus itself mutated. The strain that’s spreading around the world is different from the one that hung around sub-Saharan Africa. Specifically, it’s much more efficient at replicating itself in the guts of mosquitoes. That seems to have increased both its ability to move into new places and its ability to be carried by different species of mosquito.

That same day, the CDC announced the first locally acquired case of the virus in Florida. Vanessa Vitiello Urquhart explains why medical entomologists (like her wife Cassandra) are freaking out:

To understand why it’s chikungunya, not dengue, that makes entomologists so nervous, you’ll need to know a bit about another mosquito; Aedes albopictus (more pronouncably known as the Asian tiger mosquito). The Asian tiger mosquito is an invasive species that has spread over much of the eastern half of the United States since its introduction in 1985. These back-and-white-striped jerks are capable of spreading all sorts of diseases, including West Nile, dengue, and yellow fever. However, they often do so pretty inefficiently, with viruses found in only the tiniest minority of the mosquitoes tested. In the case of chikungunya, however, at least one strain has been shown to spread as easily in tiger mosquitoes as in Aedes aegypti. …

Adding to the reasons for alarm is the fact that chikungunya doesn’t need a reservoir—it can be spread directly from one human host to another. This is in contrast with several other mosquito-borne pathogens, including West Nile virus, which needs to replicate inside a bird before it can pass from a mosquito to a human. The special characteristics of tiger mosquitoes once again exacerbate the problem—these particular mosquitoes prefer feeding off of, and living close to, humans. (Many mosquitoes, in contrast, feed opportunistically on humans, while primarily targeting other animals.) Tiger mosquitoes are also daytime feeders, which means that while other species are taking a break, preferring to feed at dawn or twilight, the tigers keep chomping during the times of day when humans are most active.

Superhero Social Justice

Kevin O’Keeffe relays the big news out of the comic book world:

Continuing the trend of diversifying their lineup of heroes, Marvel announced on last [week’s] episode of The Colbert Report that the next Captain America will be Sam Wilson – currently known as The Falcon. … It’s the second big change for Marvel’s Avengers this week. On Tuesday, the women of The View announced that the next Thor would be a woman. Like with Thor, the new Captain America isn’t an off-shoot series – this is the primary Captain America, and the first black Captain America to officially hold the title.

Freddie sighs at those he believes are confusing symbolic firsts for real progress:

The glee with which these changes have been met, contrasted with the bleak state of structural change and economic justice, will tell you pretty much all you need to know about a certain strain of contemporary American liberalism. We’re mere weeks away from a Supreme Court decision where an alliance of religious crazies and corporatists was able to remove a legal provision requiring employers to pay for emergency contraception, but don’t worry, ladies! You too can now be portrayed as a heavily-sanitized version of a minor god from a long-dead pantheon. Black Americans continue to lag national averages in a vast number of metrics that depict quality of life, and in some of them have actually lost ground, but never fear. The guy portrayed punching people while wearing red white and blue spandex will now be black.

Lighten up, Freddie. Progress comes in all forms, big and small. And it’s often the small cultural changes, added together, that have the most lasting impact. Ta-Nehisi put it best, in a post written four years ago, reacting to the news that Captain America was headed to the big screen:

One thing that makes me sad–I wish they’d been ballsy and made Captain America black. … The subtle power of a black Captain America–in the age of a black president–really could be awesome.

Also awesome:

So far, the Hollywood version of Captain America hasn’t made the same move as Marvel, but here’s hoping. Meanwhile, Danny Fingeroth explains the business logic behind these sort of decisions:

[T]he challenge for comics is how to retain the existing audience and also grow new readers. How do you keep the attention of someone who has read thousands of stories and also take advantage of the visibility and familiarity that the movies and TV shows have brought to the characters? (Interestingly, in recent years, more girls and women have started reading superhero comics again, perhaps lured to the comics by the popular movies and TV series.) One of the answers is to make seemingly radical changes in a character, such as having Thor become a female (or to have a black man become Captain America). The Internet buzz indicates that as many fans are outraged by the gender switch as there are those who are intrigued.

But Liz Watson remarks that “slightly unconventional decision—from casting Heath Ledger as the Joker to putting pants on Wonder Woman—is met with a level of feverish debate normally reserved for schisms within the Catholic Church”:

The equivalence between comic books and scripture is telling of how seriously canon is taken by these fans. To violate the status quo is akin to sacrilege.

The irony is that a format characterized by the boundless scope of imagination is ultimately extremely conservative when it comes to risks with character or story. Major developments like deaths or marriages are almost always undone, via fantastic contrivances ranging from deals with the devil to time-travel. Characters are de-powered, murdered, raped, aged up and down, and yo-yoed between universes with an alarming lack of fanfare. It’s the same problem suffered by long-running soap operas, where catastrophes are regularly smoothed over or forgotten in order to keep the premise going. At least on soap operas, actors leave over contract disputes or pass away. In comics, the stories can go on indefinitely. As such, the limitless nature of comic book fantasy is used, by and large, to keep limits in place.

Related Dish here on the recent move to introduce the first black woman as a major character to the Star Wars franchise. Update from a reader:

Great to see Marvel Comics finally catch up with the times, and finally catching up with DC Comics. However, like most things in the comic world, don’t expect this to be new normal. Don’t expect that Sam Wilson will be Captain America for 30 years, unlike DC’s Jon Stewart, an African American who’s been a Green Lantern for over 3 decades. Hell, for readers of a certain age group, Jon Stewart is the REAL Green Lantern due to having a prominent role in the acclaimed Justice League animated series. Or let’s not forget that Wonder Woman has been a pillar of DC’s “Trinity” (Superman, Batman, Wonder Woman) for over 6 decades, and has been headlining her own comic book for over 70 years.

There’s no doubt that the comic book industry (and its fandom) has a long way to go. Misogyny is still rampant, and there still exists an undercurrent of racism. But I think the current hagiography regarding Marvel does a disservice to the industry as a whole. Comic books have been at forefront of social issues from the very first Action Comics, when Superman was a crusading populist who was willing to kill slum lords, through Green Arrow having to deal with teen a sidekick who was a heroin addict (Green Lantern vol. 2, #85, August 1971, “Snowbirds Don’t Fly”), to an openly gay Golden Age superhero (Alan Scott, the original Green Lantern from the ’40s).  Did you also know that one of Green Arrow’s other sidekicks was HIV-positive? Google Mia Dearden.

If I’ve learned anything from my decades of reading comics, it’s that the more things change, the more things stay the same. Steve Rogers will be Captain America again, Thor will be male again, and we’ll wait another 5 years for some great barrier that was broken earlier to be broken again.

The View From Your Obamacare, Ctd

A reader has a jaded view:

It’s nice to see some of the stories you post about how much the ACA has helped people. The President Obama Visits Boston To Talk About Health Carestories where people mourn for those who refuse it and need it are sad. Allow me to present you with a third type, the people who aren’t eligible due to system bugs.

Yep. Jack and shit for my family. I tried to sign up, since my wife and kids’ coverage ended in May and the ACA won’t cover them. We aren’t rich. We’re lower-middle class, according to the federal poverty line, but out of red state Medicaid income levels. I tried the site – nothing but errors. I spent an hour or more on the phone and neither the persons I spoke to or their supervisors understand why they can’t process it for us. I could call my senator or congressman, but I doubt Lindsey Graham or Trey “Benghazi” Gowdy will investigate.

I’m disabled and currently get Medicare. Prior to May, my wife, two small kids and I all received Medicaid.

It was my secondary provider and the only coverage for my wife and kids. My wife had been in school full time and started working two jobs at the end of last year – one ultra low-paying factory job and another seasonal government position. A few months later she was offered a permanent position at the government agency. Our income went from close to the poverty line to significantly higher than that. Not wealthy or even upper middle class, but not subsistence level either. Our income increased and I didn’t want to accept benefits fraudulently, so I called up Medicaid and told them about the income change (not easy to do since the state has minimized the number of social workers) and they set coverage to end that month.

Next I use the ACA website calculators and make sure we are eligible. I try to process an application and there are tons of errors. This is on the federal site. My state (South Carolina) didn’t do anything regarding ACA exchanges. I then call up the ACA support line. He walks the app through the same way I just did and it says my family isn’t eligible. Nothing. He puts me on hold for long periods to consult supervisors. Nothing. My family’s coverage ended, we meet all criteria for coverage, we are all US citizens – born and raised here. Nothing.

No explanation. No assistance. Nothing. They couldn’t figure out why. We are eligible to get coverage outside of the yearly switch period due to loss of coverage according to the rules and staff. So we meet the requirements but the computer hates us.

Anyway, glad it’s working for someone I guess. Must be nice.

Update from a reader:

I’m confused about one notable detail – the writer mentions a wife who recently started a permanent government position. If this is a Federal position, the writer and the kids would almost certainly be eligible under the FEHB (Federal Employees Health Benefit program) – the full family coverage is more somewhat more expensive than individual plan, but very likely a pretty reasonable deal out of the wife’s paycheck.

If this were a state position – or certain (fairly common) local government positions – I think the family would be eligible for the different options available under the South Carolina’s Public Employee Benefit Authority coverage. It looks to me that the deals here are a bit more expensive than the options under the FEHB options, but that’s a pretty quick peek.

Only wrinkle I’d be able to imagine seems a little bit arcane/improbable to assume: if the wife were divorced and there were a former spouse that had a divorce decree requiring the wife to provide coverage, that might be an issue, since SCPEBA only allows one spouse to be covered, and the divorce decree’s mandate might trump the current spouse’s coverage.

In any case, I think that the wife checking with her benefits administrator about expanding coverage from individual coverage to full family coverage would be a more economical strategy than trying to insure the spouse or spouse and children under a separate ACA plan. Hopefully, this sort of request would be pretty common and straightforward for the wife’s benefits admin.

The original reader follows up:

Those options for federal workers don’t apply because it’s a union job and the contract provides for some weirdness. She can join the union any time but can’t get healthcare until she’s been working her contract for a year. Even then she wouldn’t be eligible for most of the other normal federal benefit programs like life insurance until she is “converted” to a career position.

Welcome to the new United States Postal Service. Career-track mail clerks and carriers begin in a position that pays similar to career posts or even more, while having virtually no other benefits except annual leave (paid time off). The USPS will pay for a large portion of our insurance premiums come next year, but until then we are out in the cold.

The family is in great health with the exception of me (here’s a plug for CIDP – Chronic Inflammatory Demyelinating Polyneuropathy – similar to MS). We were broke with insurance and now we’re less broke with the possibility of being broke again if a medical situation arrises.

It’s disappointing, but hey, my 2nd grader was doing algebra two years ago and his little sister is on the same path. They’ll be in college by 12 or 13. I can still type, knock on wood. Sometimes you win, sometimes you lose. I count myself lucky if anything this nation manages to do is actually aimed at helping me. If it doesn’t hit the mark, at least Obama tried.

(Photo by Yoon S. Byun/The Boston Globe via Getty Images)

Retroactive Reform

On July 18, the US Sentencing Commission voted unanimously to retroactively apply new sentencing guidelines and allow almost 50,000 federal drug-offense prisoners the possibility of shorter sentences. Dara Lind provides background, including the Obama administration’s role, or lack thereof:

The US Sentencing Commission is independent of the Obama administration. In fact, the Department of Justice originally wanted the Sentencing Commission to approve a much more limited plan — one that would only let about 20,000 prisoners apply for shorter sentences. This week, reports surfaced that Department of Justice officials had been meeting privately with the Sentencing Commission, and had softened its position a little: it now wanted something that would affect about 40,000 prisoners. It’s not clear if the plan the Sentencing Commission approved today is the one the DoJ was lobbying for in private, or a different one.

Chris Geidner passes along Holder’s response to the new development:

“The department looks forward to implementing this plan to reduce sentences for certain incarcerated individuals. We have been in ongoing discussions with the Commission during its deliberations on this issue, and conveyed the department’s support for this balanced approach. In the interest of fairness, it makes sense to apply changes to the sentencing guidelines retroactively, and the idea of a one-year implementation delay will adequately address public safety concerns by ensuring that judges have adequate time to consider whether an eligible individual is an appropriate candidate for a reduced sentence. At my direction, the Bureau of Prisons will begin notifying federal inmates of the opportunity to apply for a reduction in sentence immediately. This is a milestone in the effort to make more efficient use of our law enforcement resources and to ease the burden on our overcrowded prison system.”

Douglas Berman asks how many of the eligible prisoners will be able to get a lawyer:

As hard-core federal sentencing fans likely already know, most lower federal courts have ruled that federal prisoners do not have a Sixth Amendment right to counsel applicable at the sentence modification proceedings judges must conduct to implement reduced retroactive sentencing guidelines.  Consequently, none of the nearly 50,000 federal drug offense prisoners who may soon become eligible for a reduced sentence have any right to legal assistance in seeking this reduced sentence.

Fortunately for many federal prisoners seeking to benefit from previous guideline reductions, many federal public defender offices have traditionally made considerable efforts to provide representation to those seeking reduced sentences.  But even the broadest guideline reductions applied retroactively in the past (which were crack guideline reductions) applied only to less than 1/3 of the number of federal prisoners now potentially eligible for reductions under the new reduced drug guidelines.  I suspect that pubic defenders are unlikely to be able to provide significant legal help to a significant number of drug offenders who will be seeking modified sentences under the new reduced drug guidelines.

Jim Newell focuses on the muted response to from the right:

Had the Sentencing Commission and Holder made such moves even just a decade ago, there’s no question they would have been lambasted by Republicans — The Obama administration is setting dangerous drug addicts into the streets to eat your babies, et cetera. And yet, after the announcement Friday, there was relatively silence from the party, even though we’re just ahead of midterm elections.

How Does Ukraine’s Civil War End?

Ivan Katchanovski predicts that attempts “to solve the conflict in Donbas by force will lead to mounting casualties among civilians, Ukrainian forces and armed separatists”:

Even a military defeat of separatists is unlikely to end the conflict because it reflects significant regional divisions since Ukraine’s independence in 1991, including a history of separatism in Crimea and Donbas. And Russia, with significant military, political, and economic leverage over Ukraine, is there to stay.

An internationally mediated negotiated settlement — which would include international investigations of the shooting down of the Malaysia Airlines plane and other mass killings — could preserve Donbas as a part of Ukraine. An example of one such peaceful resolution of an armed conflict between separatists and the central government is in Macedonia, in the former Yugoslavia. A negotiated settlement can also stop an escalation of the civil war in Ukraine and the growing conflict between the West and Russia. But such a peaceful resolution in Ukraine is not very likely to happen.

Maxim Eristavi’s report suggests that fighting won’t stop anytime soon:

On Friday, Putin called again for peace talks—but nobody in Kyiv is listening at the moment.

The Ukrainian public and its leaders insist they will go all the way to defeat the rebels.“It is time to put an end to this aggression, and the world should join us in the eliminating of terrorists. It doesn’t matter where they are,” Oleksandr Tyrchynov, the speaker of parliament said in a public statement, most likely hinting at a possible military campaign along the Russian border.

The war has its political upsides. Local analyst Yuriy Romanenko told me that the new ruling elite has the same core problem as the old one—corruption—which makes Western countries especially wary of providing more assistance, absent major economic and political changes. It also makes Kyiv less willing to compromise. “But the second they realize that they are losing the Eastern Ukraine war, peace talks will probably have a big comeback moment,” Romanenko said. “It’s an easier thing for them to do than go through painful reforms.”

But, even if Kyiv wanted a peace deal, it’s doubtful that many of the rebels are capable of negotiation. For example, Motyl does a close reading of rebel leader Pavel Gubarev’s “Methodological Guide for Struggle Against the Junta.” His take-away:

Is compromise possible with the likes of Gubarev? Probably not. He detests Ukraine and Ukrainians, and his agenda consists of little more than terrorism. Can Russian President Vladimir Putin control him? That, too, is by no means clear: fanatics such as Gubarev are by definition uncontrollable.

If so, the Poroshenko government may have no choice but to attempt to crush Gubarev and his militant groups. The bad news, for Kiev, is that Gubarev is implacable and is willing to die. The good news is that his manual clearly, if unintentionally, reveals that the militant groups are isolated, on the run, and in constant fear of exposure. His open admission that “[w]inning people’s confidence will not be easy” hardly reflects deep popular support. As the document stresses, the terrorists cannot trust the local population, not even the local criminals who in the early days of the insurgency actually comprised a significant portion of the fighters. Nor can they rely on their own comrades to remain silent, if captured, for more than a “few hours.”