Video of the day

So, I was checking in on Radley Balko’s blog to follow up on the crazy Swat team shoots the Marine story (had a great class discussion about that today) and I came across this video of a totally different SWAT team raid.  Basic point being, if the SWAT team comes after you, better hope your dogs aren’t at home, or they’re going to shoot them.  We’re not talking Pit Bull guard dogs, you get the feeling these guys would have shot a chihuahua .

Here’s Balko’s very strong commentary, which is hard to disagree with:

We have another video of a raid by the Columbia Police Department. The action starts at 5:30. There’s more violence. More perfunctory dog killing. (I didn’t hear a single menacing growl, and the dogs were shot while retreating.) There’s more careless tossing of flash grenades. (They threw five  three, then, bizarrely, two more to prove that the previous three grenades had done no damage.) This raid, once again, was for marijuana….

This isn’t like watching video of a car accident or a natural disaster. This doesn’t have to happen. You’re watching something your government does to your fellow citizens about 150 times per day in this country. If this very literal “drug war” insanity is going to continue to be waged in our name, we ought to make goddamned sure everyone knows exactly what it entails. And this is what it entails. Cops dressed like soldiers breaking into private homes, tossing concussion grenades, training their guns on nonviolent citizens, and slaughtering dogs as a matter of procedure.

Hospitals and the ACA

One of the really frustrating things about the Republican claim that we need Ryan’s “vouchercare” is that Democrats are actually going to cause the end of Medicare by letting it go bankrupt through rising costs.   Vouchercare would, in all likelihood, lead to higher overall health care expenditures, whereas Democrats enacted a little-known piece of legislation entitled The Affordable Care Act (yes, that’s sarcasm) that has a number of methods to make Medicare more efficient and bring down the rates of health care inflation.  Among the very useful ideas in the ACA is holding hospitals accountable for the quality of their treatment.  Right now, if a patient acquires an infection at the hospital due to poor medical management practices, that is actually in the hospital’s financial interest, as they earn lots more money caring for the hospital-acquired infection in addition to the original reason for the visit.  Talk about perverse incentives.   Fortunately, Medicare reforms are designed to address this problem (from the Times):

For the first time in its history, Medicare will soon track spending on millions of individual beneficiaries, rewardhospitals that hold down costs and penalize those whose patients prove most expensive.

The administration plans to establish “Medicare spending per beneficiary” as a new measure of hospital performance, just like the mortality rate for heart attack patients and the infection rate for surgery patients.

Hospitals could be held accountable not only for the cost of the care they provide, but also for the cost of services performed by doctors and other health care providers in the 90 days after a Medicare patient leaves the hospital.

The major point of the linked article, though, is that Hopsitals don’t actually like this.  Yglesias sums up this fact much better than I could:

Naturally, as Robert Pear reports, incumbent hospital administrators hate this idea and feel that the government ought to reimburse them for as much treatment as they can sell to patients, regardless of whether or not it makes anyone healthier.

Again, the ACA Medicare reforms certainly aren’t perfect, but they definitely are a good start and this program is a prime example.  If Hospitals are upset because they’ll be making less profit from sick patients regardless of their overall performance, that’s not such a bad thing.

Lies, damn lies, and Medicare Part D

So, I’ve read on several occasions how Republicans point to Medicare Part D (the prescription drug benefit) coming in below cost projections as strong evidence for their claims that shifting more costs onto medical consumers (i.e., Ryan’s voucher plan for Medicare, etc.) will will actually drive down medical costs.  If you follow health care policy, you know that this cost shifting leading to lower overall spending is an entirely specious argument, but I was wondering just what the story is with Part D.  CBPP once again has done yeoman’s work in completely rebuffing this Republican distortion.  Short version: all prescription drug spending has come way down in recent years so it’s not at all surprising that Medicare Part D has, too.  A number of hugely popular drugs have gone generic without equally popular new drugs in the pipeline.  The consumer-driven spending has nothing to do with the cost-savings in part D.  The details:

The sharp decline in growth in spending for prescription drugs throughout the U.S. health care system.   In the late 1990s and early 2000s, prescription drug spending grew rapidly, reflecting the availability of new “blockbuster” drugs, rising prices for existing drugs, and greater utilization by beneficiaries. [3]  Drug spending growth began to moderate unexpectedly and then slowed more significantly around the time the Medicare prescription drug benefit took effect in 2006.  But this was not caused by enactment of the drug legislation, as is evidenced by the fact that growth in spending on pharmaceuticals slowed throughout the health care system. ..

On average, about 93 percent of Medicare Part B beneficiaries were expected to enroll in the Medicare drug benefit (or receive employer-sponsored retiree drug coverage subsidized by Medicare) during its first eight years. [7]  CBO now estimates, however, that only about 77 percent of Part B beneficiaries enrolled in Part D… That means roughly 6.5 million fewer beneficiaries were enrolled in Medicare Part D last year than originally projected, causing costs to be substantially lower than CBO originally assumed.

Moreover, there is evidence that, far from reducing costs, the use of private plans to deliver the Medicare drug benefit has increased costs.   [Followed up by lots of good evidence based on Medicaid vs. Medicare comparisons.  Click through if you are curious.]

Thus, I return to one of the fundamental questions about Congressional Republicans in modern political discourse: lying or stupid?  Seriously– this analysis is not in the least bit complicated.  Do Paul Ryan et al., simply not understand that the savings in Part D largely reflect lower costs throughout the prescription drug section or do they simply not care.  Neither answer is flattering.

Where the Onion meets the Republican Congress

From the Times’ Green blog:

Representative Dana Rohrabacher, Republican of California, needs to hit the science books, forestry experts suggest.

They reached that conclusion after hearing Mr. Rohrabacher declare during a Congressional hearing on Wednesday that clear-cutting the world’s rain forests might eliminate the production of greenhouse gases responsible for climate change.

On the witness stand was Todd Stern, the Obama administration’s climate change envoy, who was questioned on whether the nation’s climate policy should focus on reducing the more than 80 percent of carbon emissions produced by the natural world in the form of decaying plant matter.

“Is there some thought being given to subsidizing the clearing of rain forests in order for some countries to eliminate that production of greenhouse gases?” the congressman asked Mr. Stern, according to Politico.

“Or would people be supportive of cutting down older trees in order to plant younger trees as a means to prevent this disaster from happening?” he continued.

Forestry experts were dumbfounded by Mr. Rohrabacher’s line of questioning, noting that the world’s forests currently absorb far more carbon dioxide than they emit — capturing roughly one-third of all man-made emissions and helping mitigate climate change.

Just, wow.  And to think, these guys get to make policy now.

Caught by the Boob Cam

Oh my this is funny (and I found it from Roger Ebert’s facebook feed no less). Of course, since my wife reads this blog I should mention that I would never have looked.
 

Caught by the Boob Cam – Roger Ebert’s Journal, posted with vodpod

All for non-existent marijuana

This story by terrific libertarian criminal justice blogger Radley Balko is really good and really distressing.  Short version: cops bust into house of Marine searching for marijuana; Marine presumably doesn’t know they are cops and grabs his assault weapon (honestly, it defies credibility to think that he would have done so had the assault team identified themselves as law enforcement given that the man was home with his wife and young child).  Cops see Marine with gun and shoot him dead with 60 bullets while his wife and child hide in close.  Cops do everything they can do cover-up they’re obviously abusive an inappropriate actions.  It’s a damning, damning indictment of the excesses of the war on drugs.  And a good Marine with no criminal record (or marijuana trafficking involvement) is dead. Whole thing is well worth a read.

Doctors as pit crews

When Ezra Klein tells me I need to read something by Atul Gawande, I do.  When Ezra Klein and me tell you that you should read something by Atul Gawande, you should (he’s a practicing physician and a New Yorker staff writer who writes great articles for the magazine as well as a couple very thoughtful books I’ve read).  This is his commencement speech to Harvard Medical school this year.  Basic theme: doctors need to stop thinking like cowboys are start thinking like members of pit crews (lots of cooperation, communication, and clearly defined roles).