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.