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The Annual Medicare Doc Fix: Not as Bad as You Think!

by ElliottClaudio Posted on April 28, 2014

Mother Jones

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Here’s a bit of contrarianism for you today: Austin Frakt says that the much-maligned Medicare “doc fix” actually works pretty well. This is Congress’s annual charade in which it overrides the formula for Medicare reimbursements to doctors, resulting in doctors getting paid more—but without ever changing the formula itself. (Why? Because changing the formula would cost money, and they’d have to figure out how to pay for it. Better to just kick the can down the road each year.)

So from one point of view, the formula is just a joke. However:

From another point of view, the formula — as flawed as it is — has helped keep Medicare spending lower than it might otherwise have been. Instead of cutting physician payments by the large amount the S.G.R. demands, Congress has increased payment rates, but typically by only tiny amounts — at an annual rate of just 0.7 percent. That pace does not keep up with the typical cost of care.

The gap can be seen in the chart below. The bottom line illustrates how Congress has permitted Medicare physician payments to grow. The middle line shows an index of medical spending — spending at a typical physician’s practice over time — that is a proxy for the change in price for a typical, or average, medical treatment.

….The relatively gentle increases in Medicare payment rates makes clear that the formula is not the problem. I think that the formula has actually helped Congress be more fiscally responsible than it otherwise might have been. To physicians who fear a double-digit decrease in payment rates called for by the formula, a 0.5 percent or a 1.5 percent increase that Congress passes looks like a great deal.

So there you go. Two cheers for the Sustainable Growth Formula!

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The Annual Medicare Doc Fix: Not as Bad as You Think!

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Anti-Obamacare Hysteria Almost Killed Dean Angstadt

by CatharineKoerst Posted on April 28, 2014

Mother Jones

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Robert Calandra of the Philadelphia Inquirer tells the story today of Dean Angstadt, a guy who listened to Republican hysteria about Obamacare and almost paid for it with his life:

“I don’t read what the Democrats have to say about it because I think they’re full of it,” he told his friend Bob Leinhauser, who suggested he sign up….From time to time, Leinhauser would urge Angstadt to buy a plan through the ACA marketplace. And each time, Angstadt refused. “We argued about it for months,” Angstadt said. “I didn’t trust this Obamacare. One of the big reasons is it sounded too good to be true.”

January came, and Angstadt’s health continued to decline. His doctor made it clear he urgently needed valve-replacement surgery. Leinhauser had seen enough and insisted his friend get insured….Leinhauser went to Angstadt’s house, and in less than an hour, the duo had done the application. A day later, Angstadt signed up for the Highmark Blue Cross silver PPO plan and paid his first monthly premium: $26.11.

“All of a sudden, I’m getting notification from Highmark, and I got my card, and it was actually all legitimate,” he said. “I could have done backflips if I was in better shape.” Angstadt’s plan kicked in on March 1. It was just in time. Surgery couldn’t be put off any longer. On March 31, Angstadt had life-saving valve-replacement surgery.

Roger Ailes must be so proud.

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Anti-Obamacare Hysteria Almost Killed Dean Angstadt

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Donald Sterling is a Creepy Egomaniac

by Glenn10Daxplpsh Posted on April 27, 2014

Mother Jones

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I don’t have much to add about the whole Donald Sterling affair. The appalling nature of his comments is pretty obvious, after all. But for those of you who don’t live in Los Angeles, I thought I could at least acquaint you with a tiny tidbit about the guy’s titanic level of egotism that you might find fascinating. Sterling is a major advertiser in the LA Times. I don’t mean Sterling’s companies. I mean Sterling, himself. He gives away lots of money, and when he does he makes sure everyone knows about it. Ads thanking Sterling for his good deeds simply litter the Times.

The one below, from today’s paper, is typical. They’re all the same: they have terrible, amateur production values; they all use the exact same cutout portrait of Sterling; and they all feature photos of the people honoring Sterling that look like they were taken with a 60s-era Instamatic. These ads appear multiple times a week. Sometimes multiple times a day. Sterling is constantly being honored for something or other, and every single honor is an occasion for him to advertise the fact in the LA Times. And always with the exact same cutout photo of himself. It’s kind of creepy.

Sterling’s vanity ad today happens to be on a page facing an ad that features Kobe Bryant pitching Turkish Airlines. The irony was amusing enough that I figured I’d share.

UPDATE: More here from Franklin Avenue, who’s been tracking Sterling’s ads for years.

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Donald Sterling is a Creepy Egomaniac

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Why Was the Right Caught Flat-Footed By Cliven Bundy’s Cranky Racism?

by Kelvin85Yxpqhdj Posted on April 24, 2014

Mother Jones

By now I assume you’ve all heard about Cliven Bundy’s remarks to the New York Times yesterday? In case you’ve been vacationing on Mars, here they are:

“I want to tell you one more thing I know about the Negro,” he said. Mr. Bundy recalled driving past a public-housing project in North Las Vegas, “and in front of that government house the door was usually open and the older people and the kids — and there is always at least a half a dozen people sitting on the porch — they didn’t have nothing to do. They didn’t have nothing for their kids to do. They didn’t have nothing for their young girls to do.

“And because they were basically on government subsidy, so now what do they do?” he asked. “They abort their young children, they put their young men in jail, because they never learned how to pick cotton. And I’ve often wondered, are they better off as slaves, picking cotton and having a family life and doing things, or are they better off under government subsidy? They didn’t get no more freedom. They got less freedom.”

I don’t have anything to add that (a) isn’t obvious and (b) hasn’t already been said by someone else, but I do share Paul Waldman’s reaction: “Is anyone surprised that Cliven Bundy, the Nevada rancher who has become a Fox News hero because of his stand-off with the Bureau of Land Management, turns out to be a stone-cold racist?”

That’s a good question. Is anyone on the right surprised by this? (I think it’s safe to say that exactly zero lefties are surprised.) That’s not a rhetorical question on my part. Look: conservatives should never have rallied around Bundy in the first place, but if they’re even minimally self-aware about his particular niche in the conservative base, surely they should have seen something like this coming and kept their distance just out of sheer self-preservation. But apparently they didn’t. They didn’t have a clue that a guy like Bundy was almost certain to backfire on them eventually. They seem to have spent so long furiously denying so much as a shred of racial resentment anywhere in their base that they’ve drunk their own Kool-Aid.

On a tangential note, as near as I can tell Paul Ryan never embraced Bundy publicly. Does anyone know if that’s right? It’s one reason I think he could be a dangerous presidential candidate. Despite his “inner city” gaffe of a few weeks ago, he’s smarter about this stuff than most folks who have managed to stay on the right side of the tea party.

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Why Was the Right Caught Flat-Footed By Cliven Bundy’s Cranky Racism?

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Here’s a Great Argument for Easing Up on Professional Licensing Restrictions

by LanoraKitamura Posted on April 24, 2014

Mother Jones

Adrianna McIntyre has a fascinating little tidbit up today about how Medicaid expansion affects access to health care. Here’s the question: By increasing demand for doctors, is it likely to result in longer wait times for everyone?

A trio of researchers took a look at dental care to get an idea. Some states cover it for adults, some don’t. So what happens in states where adult Medicaid is expanded to cover dental care? The first-order answer is surprising: more dentists participate; their incomes go up; and wait times barely budge. But how is that possible? The second-order answer is even more interesting:

Dentists accomplish this mainly by making greater use of hygienists: following the expansion of public coverage, dentists employ a greater number of hygienists and hygienists provide about 5 additional visits per week. As a result, dentists’ income increases following the adoption of Medicaid adult dental benefits by approximately 7 percent. These effects are largest among dentists who practice in poor areas where Medicaid coverage is most prevalent.

We also find that these coverage expansions cause wait times to increase modestly less than a day, on average. However, this effect varies significantly across states with different policies towards the provision of dental services by hygienists. The increased wait times are concentrated in states with relatively restrictive scope of practice laws. We find no significant increase in wait times in states that allow hygienists greater autonomy.

Licensing and “scope of authority” restrictions are sort of a hot topic these days, and this is a pretty good example of why. I haven’t yet dived into the whole thing enough to have a settled opinion, but it’s becoming fairly common to believe that licensing restrictions are far too strict in some professions, acting more as a way of propping up salaries than as genuine public safety measures. Nurses and hygienists could be given more autonomy, for example, but this is often resisted by doctors and dentists who don’t want to give up a lucrative monopoly on the services they provide.

The arguments are sometimes arcane, but this example brings it down to earth. Ease up on the restrictions placed on hygienists, and dental practices can provide more and better service to the poor—and, in the end, do it without sacrificing income. That’s worth knowing.

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Here’s a Great Argument for Easing Up on Professional Licensing Restrictions

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Here Are Baseball’s 2 Least Loved Teams

by Lucile2956 Posted on April 24, 2014

Mother Jones

Over at The Upshot, a crack team of researchers has put together an interactive map showing which baseball teams are preferred in which regions of the country. The overall results are pretty predictable, of course, but the authors make a few interesting points about exactly where the geographical dividing lines are between traditional rivalries. I thought the most interesting part was which teams were left out completely. Here’s the map:

There is not a single zip code in the entire country that favors the New York Mets. Even in 11368, the home of Citi Field, fans prefer the Yankees by 53 to 25 percent.

And the Oakland A’s have it even worse. In 94501, the home of the Oakland Coliseum, fans prefer the San Francisco Giants by a whopping 59 to 18 percent. This is spectacularly embarrassing. The Mets, after all, are at least in the same city as the Yankees, so divided loyalties are natural. The A’s are in Oakland, a different city with a culture of its own. Sure, maybe there’s no there there, but that’s a culture! And yet, even the working-class East Bay has apparently been so taken over by yuppified San Franciscans escaping sky-high rents that the A’s can’t get any love even after being canonized by Michael Lewis and Brad Pitt as the champions of Moneyball. Sad.

(The Toronto Blue Jays aren’t on the map either, but I assume that’s because the map doesn’t include Canada. I draw no conclusions about Toronto’s fan base, though I suspect we can assume it’s pretty minimal too.)

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Here Are Baseball’s 2 Least Loved Teams

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The Fourth Amendment Takes Yet Another Body Blow

by ShaniHMTjxkn Posted on April 23, 2014

Mother Jones

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This week the Supreme Court has handed down decisions on affirmative action and child porn that have gotten a lot of press. But the affirmative action decision was probably inevitable, and the child porn case is an oddball example of statutory interpretation that probably has no greater significance.

More important is Navarette vs. California, which has real potential to do some long-term damage. In this case, a 911 caller reported an erratic driver, who was then pulled over and eventually convicted of transporting four bags of marijuana. The police had no probable cause to stop the driver except for that one anonymous phone call, but the Court upheld the conviction anyway. Justice Scalia is typically apoplectic in his dissent, but nonetheless makes some good points:

It gets worse. Not only, it turns out, did the police have no good reason at first to believe that Lorenzo was driving drunk, they had very good reason at last to know that he was not. The Court concludes that the tip, plus confirmation of the truck’s location, produced reasonable suspicion that the truck not only had been but still was barreling dangerously and drunkenly down Highway 1. In fact, alas, it was not, and the officers knew it. They followed the truck for five minutes, presumably to see if it was being operated recklessly. And that was good police work. While the anonymous tip was not enough to support a stop for drunken driving under Terry v. Ohio, it was surely enough to counsel observation of the truck to see if it was driven by a drunken driver.

But the pesky little detail left out of the Court’s reasonable-suspicion equation is that, for the five minutes that the truck was being followed (five minutes is a long time), Lorenzo’s driving was irreproachable. Had the officers witnessed the petitioners violate a single traffic law, they would have had cause to stop the truck, and this case would not be before us. And not only was the driving irreproachable, but the State offers no evidence to suggest that the petitioners even did anything suspicious, such as suddenly slowing down, pulling off to the side of the road, or turning somewhere to see whether they were being followed. Consequently, the tip’s suggestion of ongoing drunken driving (if it could be deemed to suggest that) not only went uncorroborated; it was affirmatively undermined.

The problem here is obvious: the Court has basically said that an anonymous 911 call is sufficient all by itself to justify a police stop and subsequent search of a vehicle.

In this particular case, it’s likely that the 911 caller was entirely sincere. But that’s surely not always the case, and this decision gives police far greater discretion to stop pretty much anyone they like for any reason. You don’t even need to roll your front bumper a foot over the limit line in an intersection to give them a pretext.

If we’re lucky, this case will become a footnote, with the precise nature of its facts giving it little value as precedent. But if we’re not so lucky, it’s yet another step in the Supreme Court’s decades-long project to chip away at the Fourth Amendment. When an unknown caller is all it takes to trigger a search, the entire notion of “probable cause” is pretty much consigned to the ash heap of history.

UPDATE: A regular reader points out that my summary isn’t entirely accurate. Under Navarette, an anonymous tip is enough for police to stop a vehicle, but to search it they still need some suspicion of illegal activity. In this case they “smelled marijuana.”

That’s true, and I should have said so. The reason I didn’t is that I figure this was basically pretextual. There’s always a post hoc reason if the police decide they want to search your car. And even if you think the cops really did smell something, they never would have gotten there without the stop, and there was no reason for the stop in the first place. This strikes me as pretty direct line from anonymous tip to search, with only the thinnest pretense of probable cause.

I admit that my cynicism here isn’t legally relevant. But honestly, once you allow the stop, cops will find a reason the search the car. There’s simply nothing in their way any longer.

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The Fourth Amendment Takes Yet Another Body Blow

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Most Independent Voters Aren’t, Really

by MichellKen Posted on April 23, 2014

Mother Jones

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I write from time to time about the myth of the independent voter, which goes something like this: there aren’t any. Oh, lots of people say they’re independent, but it turns out that most of them lean in one direction or another, and when Election Day rolls around the leaners vote just as reliably as stone partisans. True independents—the ones who switch between parties from election to election—make up only about 10 percent of the electorate.

Still, 10 percent is 10 percent. It’s not quite nothing. But it turns out that it really is. Today, Lynne Vavreck breaks things down a bit further and explains just how these folks vote:

Only a small percentage of voters actually switched sides between 2008 and 2010. Moreover, there were almost as many John McCain voters who voted for a Democratic House candidate in 2010 as there were Obama voters who shifted the other way….On average, across districts, roughly 6 percent of Obama voters switched and just under 6 percent of McCain voters switched.

So, yes, there are some true switchers. But mostly they’re going to cancel each other out. The net result from a huge push for swing voters is likely to be no more than 2 or 3 percentage points. In a few high-stakes states in a presidential election, that might make them worth going after. But in your average congressional election, it’s a waste of time and money. So what does make the difference?

On turnout, the numbers were not evenly balanced for Democrats and Republicans. Only 65 percent of Obama’s 2008 supporters stuck with the party in 2010 and voted for a Democrat in the House. The remaining 28 percent of Mr. Obama’s voters took the midterm election off. By comparison, only 17 percent of McCain’s voters from 2008 sat out the midterms.

….It may seem hard to believe that the 2010 shellacking was more about who turned up than about who changed their minds between 2008 and 2010, but it lines up with a lot of other evidence about voters’ behavior. Most identify with the same political party their entire adult lives, even if they do not formally register with it. They almost always vote for the presidential candidate from that party, and they rarely vote for one party for president and the other one for Congress. And most voters are also much less likely to vote in midterm elections than in presidential contests.

The problem is that going after turnout is every bit as hard as picking up the crumbs of the swing voters. Traditional Democratic constituencies—minorities, low-income voters, and the young—simply don’t turn out for midterm elections at high rates. They never have, despite Herculean party efforts and biannual promises that this time will be different. But it never is. They’ll vote for president, but a big chunk of them just aren’t interested in the broader party.

So what’s the answer? Beats me.

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Most Independent Voters Aren’t, Really

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The Latest "Cosmos" Explains How Corporations Fund Science Denial

by ZVJArletha Posted on April 21, 2014

Mother Jones

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The most amazing thing about Fox’s new Cosmos series is that it exists at all. A program that is, at its core, educational, airing at 9 p.m. on Sunday and competing with shows like Game of Thrones…in what universe does that happen?

Today’s audiences are not accustomed to this sort of fare, and the show certainly hasn’t been a runaway success when judged by the most traditional metric: ratings. Last night, though, Cosmos powerfully demonstrated that those who haven’t watched it yet really ought to give it a shot (watch here). Simply put, Cosmos told a magnificent scientific story that drew together (yes, really) the tale of how we determined the age of the Earth (about 4.5 billion years old) and of how one courageous scientist showed, in the face of intense challenges, the dangers of leaded gasoline.

The story centers on on Clair Patterson, a researcher at the California Institute of Technology whose personal research trajectory explains this surprising overlap. Who knew that environmental-health insights would emerge from an inquiry in geology and physics? But that’s the thing about science: It leads you in surprising directions, and sometimes, vested interests don’t like where you end up.

Patterson’s life epitomizes that pattern. As Cosmos host Neil deGrasse Tyson explained last night, we are able to calculate the ages of rocks—and thus, ultimately, the age of the Earth—because we know that various radioactive elements decay, over time, at a fixed rate. Take uranium: It ultimately decays into lead. Thus, by measuring the lead content of rocks (or, in the case of determining the age of the Earth, in meteorites that are the same age as our planet), Patterson would ultimately manage to calculate the Earth’s age. (For more explanation, see here.)


America’s Real Criminal Element: Lead


Is There Lead In Your House?


An Interview With Pioneering Toxicologist Howard Mielke


How Dangerous Is the Lead in Bullets?


Does Lead Paint Produce More Crime Too?


How Your Water Company May Be Poisoning Your Kids

More MoJo coverage of the dangers of lead.

The task turned out to be very difficult, however: Patterson’s early experiments were constantly being contaminated by the presence of environmental lead in his laboratory. Ultimately, Patterson had to design a completely sterile environment, a “clean room,” in order to get a reliable measurement. That’s how he got the basic answer that is still accepted today: The Earth is about 4.5 billion years old. (Sorry, creationists.)

And that’s also where the two narrative threads of last night’s Cosmos episode connect. “His award for this discovery?” explains Tyson of Patterson’s insight. “A world of trouble. He didn’t know it, but he was on a collision course with some of the most powerful people on the planet.”

Given his immense ordeals in conducting his measurements, it’s small wonder that Patterson grew attuned to the fact that lead, a potent neurotoxin, is all around us (this was the 1950s). So fresh off discovering the age of the Earth, Patterson started researching lead in the environment. He was ideally positioned to do so: After all, he really, really knew how to measure lead.

But now, Patterson wasn’t ticking off the creationists any longer; rather, he was about to encounter another source of science denial in America: corporate and special interests. “In searching for the age of the Earth, Patterson had stumbled on the evidence for a mass poisoning on an unprecedented scale,” relates Tyson.

Cosmos’ image of a pro-industry scientist Fox

The story of leaded gasoline, and the attempts to call into question its dangers, has been extensively told. Along with the stories of cigarettes and perhaps asbestos, it is part of a series of historic tales of how corporate interests have tended to challenge and attack science that demonstrates the risks emanating from their practices or products. “This was one of the first times that the authority of science was used to cloak a threat to public health and the environment,” says Tyson.

Also at the center of last night’s Cosmos episode was a scientist named Robert Kehoe, whose work was funded by the lead industry and who was a “longtime scientific advocate for leaded gasoline,” in Tyson’s words. The episode depicted a historic clash between Patterson and Kehoe before the US Congress over the science of lead in the environment. It also explored just how hard it was for Patterson to take on this topic. “Patterson’s funding from the oil industry vanished overnight. In fact, they tried to get him fired,” asserted Tyson. (For a history of the battle over the safety of leaded gasoline, including Kehoe’s role, see this extensive 2000 article in The Nation. For a fascinating feature story by Mother Jones‘ Kevin Drum on the surprising connection between lead exposure and crime rates, see here.)

But of course, Patterson’s science ultimately won out on lead, just as it did on the age of the Earth. Tyson ended last night’s episode like this: “Today, scientists sound the alarm on other environmental dangers. Vested interests still hire their own scientists to confuse the issue. But in the end, nature will not be fooled.” As he says these words, we are looking down from above on a rotating Earth—a not-too-subtle allusion to global warming.

On our most popular episode of the Inquiring Minds podcast, Tyson explained why he doesn’t debate science deniers, and much more. You can listen here (interview starts around minute 13):

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The Latest "Cosmos" Explains How Corporations Fund Science Denial

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Quote of the Day: Will Obamacare Deliver More Votes Than Medicare?

by MiquelCuriel Posted on April 21, 2014

Mother Jones

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From Jonathan Bernstein, questioning whether Obamacare will ever be a vote winner for Democrats:

After Medicare passed in 1965, voters “rewarded” Democrats for Medicare with big midterm losses in 1966 and then by putting Republicans in the White House in five of the next six presidential elections.

Actually, that’s….true, isn’t it? Even granting that there was a lot of other stuff going on in 1966, let’s hope that history doesn’t repeat itself.

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Quote of the Day: Will Obamacare Deliver More Votes Than Medicare?

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