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Medicare Wants to Try a New Way of Paying for Expensive Drugs

by ChristoMighell Posted on March 9, 2016

Mother Jones

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For drugs administered in clinics and hospitals, Medicare reimburses doctors a flat 6 percent of the price of the drug. This has never really made much sense, since it doesn’t cost any more to attach a $1,000 vial to an IV line than a $100 vial. So now the Obama administration is proposing a five-year test of a new system that pays a flat fee plus a smaller percentage of the cost of the drug. Here’s what it looks like:

The current rule is an update of an older rule that was even stupider than reimbursing based on price. But it’s still pretty stupid. If two drugs are about the same, and you can make $6 from one and $60 from the other, then you might as well prescribe the more expensive one. That’s exactly the wrong incentive. Not everyone sees it this way, of course:

The test program is also likely to meet stiff opposition from the pharmaceutical industry and some providers—especially cancer centers where many high-price specialty drugs are used—because of the drop in reimbursement….Providers may also feel they are being pressured by the federal government into selecting cheaper drugs they don’t feel are as effective.

This makes no sense. No one is being pressured into selecting cheaper drugs. You just won’t get paid an artificial bonus for avoiding them in favor of more lucrative options that don’t work any better. If that’s your idea of “pressure,” I’d recommend you go into a less demanding field.

The new system, I assume, is designed to recognize that administering a drug is mostly—but not entirely—a flat cost operation. The reason the cost isn’t completely flat is that clinics and hospitals have to pay for the drugs up front and keep them in stock. There’s a carrying cost involved in that, which means that expensive drugs really do cost a little more to administer than cheaper ones.

But not that much more. The new system seems well worth a try.

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Medicare Wants to Try a New Way of Paying for Expensive Drugs

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Canada and U.S., longtime frenemies on climate change, join forces at last

by Lino9076rj Posted on March 8, 2016

Canada’s Prime Minister Justin Trudeau (L) and U.S. President Barack Obama conclude remarks in Manila, Philippines, November 19, 2015. Reuters/Jonathan Ernst

Canada and U.S., longtime frenemies on climate change, join forces at last

By Melissa Croninon 8 Mar 2016comments Share

At long last, two countries that share a border will also share a comprehensive plan for climate action.

Serious climate conversations between the U.S. and Canada have been few and far between over the years. This week, the two countries are expected to present a unified front with a climate change agreement, a rare event, given that they have long been on opposite ends of the climate action spectrum.

The two nations’ leaders, U.S. President Barack Obama and Canadian Prime Minister Justin Trudeau, will announce a series of joint measures this week during a meeting at the White House. According to The Guardian, the agreement is expected to include pledge to cut up to 45 percent of methane emissions — a greenhouse gas that is roughly 80 times more potent than carbon dioxide — from oil and gas industries. During a White House press call on Tuesday, Todd Stern, U.S. special envoy for climate change, said that the meeting would focus on short-lived pollutants like methane, hydrofluorocarbons (potent greenhouse gases used in refrigerators, aerosols, and air conditioners), and black carbon (a particulate component of soot). Officials also expect the agreement to call for a decrease in diesel fuel and more funding for Arctic climate research.

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One major focus for the two Arctic neighbors is addressing warming at the pole, a region which is warming twice as fast as the rest of the world.

“There’s a kind of canary-in-the-coalmine quality to the Arctic, and it’s important to let people around the world know what’s going on there and the impacts there, which will, in turn, have impacts around the world,” Stern told reporters.

It’s a rare breakthrough for the two leaders — one at the end of his tenure and the other just four months in. For much of the past decade, the two countries have been at odds on climate policy. Before Trudeau’s election last October, Canada was led by conservative Stephen Harper, who steered Canada into a pit of dirty oil. Harper kept the oil sands industry afloat throughout his tenure, beginning in 2006. Harper turned Canada into a booming petrostate, muzzling climate scientists who spoke out and pushing hard for companies to be able to suck up the dirty substance lying under massive tracts of forest in Alberta. At the very same time, Canada’s neighbor to the south elected a Democrat in 2008, Obama, who promised to cut greenhouse gas emissions, amp up investments in clean energy, and was rumored to veto the Keystone pipeline (an action that he did in fact take in February 2015).

Before Harper’s administration, Canada had more of an appetite to fight global warming. Former Prime Minister Paul Martin, a liberal who served in office from 2003 to 2006, ratified the Kyoto Protocol, a global treaty to cut emissions. But the U.S. was under the eight-year reign of President George W. Bush, who opposed Kyoto, allegedly tried to block public scientific data on climate change, and broke campaign promises to limit carbon dioxide emissions from coal plants. “To the reticent nations, including the United States, I say this: There is such a thing as a global conscience,” Martin said about his southern neighbors in a 2005 conference in Montreal.

It’s not yet know exactly how far-reaching the terms will be in the expected climate agreement announced this week. But in a town hall hosted by The Huffington Post this week, Trudeau said that the moment was a “nice alignment between a Canadian prime minister who wants to get all sorts of things done right off the bat and an American president who is thinking about the legacy he is going to leave in his last year in office.” If all goes well, that legacy will finally include climate policy that crosses both country borders and longstanding ideological divides.

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Now That We Know These Disturbing Numbers, Can We Trust Air Marshals?

by GregOneill Posted on March 8, 2016

Mother Jones

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This story was originally published in ProPublica.

Seven and a half years ago, as a new reporter at ProPublica, I filed a Freedom of Information Act request for all reports of misconduct by federal air marshals.

It had been several years since the U.S. government rapidly expanded its force of undercover agents trained to intervene in hijackings after 9/11. And a source within the agency told me that a number of air marshals had recently been arrested or gotten in trouble for hiring prostitutes on missions overseas.

I knew the FOIA request would take a while—perhaps a few months—but I figured I’d have the records in times for my first ProPublica project.

Instead, I heard nothing but crickets from the Transportation Security Administration.

Finally, last Wednesday, an email popped into my inbox with the data I had been fighting for since my fourth day at ProPublica.

The saga to get the air marshal data reveals a lot about the problems with FOIA, which is supposed to guarantee the public’s access to government records, as well as what happens when an agency decides to drag out the process.

Even though the Federal Air Marshal Service insists it has taken steps to build an agency steeped in professionalism with no tolerance for misconduct, it continues to face the same issues it was battling when I filed my FOIA request in 2008.

While waiting for the data, I found dozens of air marshals who had been arrested for crimes ranging from aiding a human trafficking ring to attempted murder. One air marshal used his badge to smuggle drugs past airport security while another used his to lure a young boy to his hotel room, where he sexually abused him.

Air marshals had hired prostitutes in Barcelona and gotten into a fight with security guards after patronizing a brothel in Frankfurt.

Another marshal’s in-air behavior concerned flight attendants so much that they reported it to the agency, saying “I can’t believe he is able to carry a gun!” (That officer was later convicted of bank fraud for trying to cash a $10.9 million check that he said was a settlement after he was a scratched by a friend’s cat.)

As time passed, the problems continued.

Last year, several other news outlets published troubling reports about air marshals that sound remarkably similar. A few selections: Air marshals accused of hiring prostitutes in Europe and recording the sex on their phones. Air marshals describe a “party-hearty” atmosphere. Air marshal kicked off plane after throwing a fit when he was offered only one dinner choice instead of three.

Oddly, when the TSA finally responded to my seven-year-old request, it included its own analysis of the data along with an unsolicited statement.

“The vast majority of FAMs federal air marshals are dedicated law enforcement professionals who conduct themselves in an exemplary manner,” it said. “TSA and FAMS continually strive to maintain a culture of accountability within its workforce.”

The statement also said the agency saw a “significant reduction” in misconduct cases in 2015 as a result of its initiatives. But notably, the agency only provided data through February 2012, even though in my last email exchange with the office last month I requested the entire database.

This has become standard practice for many agencies. By delaying FOIA requests for years, the TSA gets to claim the data it releases is old news. (The agency made the same claim back in 2008, which—because of the data we received recently—we now know wasn’t true.)

So what did the data tell us about misconduct by air marshals?

For starters, air marshals were arrested 148 times from November 2002 through February 2012. There were another 58 instances of “criminal conduct.”

In addition, air marshals engaged in more than 5,000 less serious incidents of misconduct, ranging from 1,200 cases of lost equipment to missing 950 flights they were supposed to protect.

Is that a lot or a little? It’s hard to say because the number of air marshals is classified and the estimates of the size of the force don’t include turnover.

The TSA says the misconduct represents just a “handful of employees.” But concerned air marshals I spoke with said they should all show sound judgment, given that air marshals are allowed to carry guns on planes and must make split-second life-and-death decisions.

Some other highlights found in our analysis of the data:

250 air marshals have been terminated for misconduct; another 400 resigned or retired while facing investigation.
Air marshals have been suspended more than 900 times, resulting in more than 4,600 days lost to misconduct.
The Washington field office had the most incidents with 530 cases, followed by New York with 471, Chicago and Dallas with 373 each and Los Angeles with 363. There were 85 cases at air marshal headquarters, highlighting that in some cases, misconduct has extended to the top brass.

After our story ran in late 2008, Robert Bray, the director of the air marshal service at the time, vowed to create a “culture of accountability” within the agency and raised the penalty for drunk driving arrests to a 30-day suspension.

We now know the number of misconduct cases remained fairly steady, about 600 a year, in the years before and after our investigation.

It’s unclear if the agency got tougher or weaker. Before the story ran, only 4 percent of air marshals who had been arrested received a suspension of 14 days or longer. After the story ran, that number jumped to 20 percent. But at the same time, a much higher percentage of arrested air marshals got off with minor discipline such as a letter of reprimand, a warning or no action at all.

After the story, I continued to talk to air marshals and pursue the FOIA request. Inspired by the Obama administration’s memo on transparency, and armed with new information that there was a specific misconduct database, I filed a second FOIA request in 2010.

This was perhaps a mistake. Rather than respond to my first request, the TSA merged it with my new request.

In 2012, the agency responded. But the TSA only released two columns —one showing allegations against air marshals, the other listing disciplinary actions taken in response. Notably, there were no dates, which would have allowed us to check if the agency’s “culture of accountability” was working.

I immediately appealed. In addition, I filed another FOIA request for the entire database—”all columns and rows.”

Two more years passed. Meanwhile, air marshal director Bray himself became embroiled in a misconduct investigation. A supervisor was accused of obtaining free and discounted guns from the air marshals’ weapons supplier and providing them to top officials, including Bray, for their personal use. In 2014, Bray retired.

Around that time, I partially won my appeal. But the data was still incomplete.

After nearly six years, I had pretty much given up.

Until late December. That’s when an email arrived from TSA telling me my request from 2012 had been sitting in a backlog and wanting to know if I was still interested.

Indeed I was. (The TSA had asked me this question a few times during my pursuit of these records.)

A month later, I had the information I had been seeking. It only took seven years, seven months and 29 days.

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Now That We Know These Disturbing Numbers, Can We Trust Air Marshals?

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Hillary Clinton’s Big Shift on Fracking

by Irving73Y91 Posted on March 7, 2016

Mother Jones

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This story originally appeared in Grist and is reproduced here as part of the Climate Desk collaboration.

A college student asked Bernie Sanders and Hillary Clinton a simple question at the Flint, Mich., debate on Sunday night: “Do you support fracking?”

And Bernie Sanders had a simple answer: “No, I do not support fracking.”

Read MoJo’s Investigation: How Hillary Clinton’s State Department Sold Fracking to the World

Hillary Clinton, though, needed more time to outline three conditions in a more nuanced answer on fracking. She’s against it “when any locality or any state is against it,” “when the release of methane or contamination of water is present,” and “unless we can require that anybody who fracks has to tell us exactly what chemicals they are using.”

Until those conditions are met, “we’ve got to regulate everything that is currently underway, and we have to have a system in place that prevents further fracking.”

“By the time we get through all of my conditions, I do not think there will be many places in America where fracking will continue to take place,” she added.

Clinton offered qualified support for fracking well before Sanders even registered in the presidential race. Addressing the National Clean Energy Summit in 2014, Clinton said, “we have to face head-on the legitimate, pressing environmental concerns about some new extraction practices and their impacts on local water, soil, and air supplies. Methane leaks in the production and transportation of natural gas are particularly troubling. So it’s crucial that we put in place smart regulations and enforce them, including deciding not to drill when the risks are too high.”

Yet, she sounded much more rosy on natural gas and fracking years ago than she does now. “With the right safeguards in place, gas is cleaner than coal. And expanding production is creating tens of thousands of new jobs,” she said in 2014. “And lower costs are helping give the United States a big competitive advantage in energy-intensive energies.”

As secretary of state in 2010, Clinton argued in favor of gas as “the cleanest fossil fuel available for power generation today,” and said that “if developed, shale gas could make an important contribution to our region’s energy supply, just as it does now for the United States.” Her office, meanwhile, promoted fracking in developing nations.

After leaving the Obama administration in 2014, Clinton still emphasized the benefits of fracking, implying that strict limits on fracking should be the exception to the rule. In 2016, Clinton has flipped her emphasis, as Sanders has gained an edge from his anti-fracking stance: Now, she suggests it will be a rare, unlikely case when fracking should be allowed.

Hillary Clinton’s Big Shift on Fracking

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Donald Trump Says Mitt Romney "Would Have Dropped To His Knees" For Him

by MagaretNazario3 Posted on March 3, 2016

Mother Jones

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Donald Trump addressed a frenzied crowd in Portland, Maine, on Thursday afternoon during a campaign press conference.

The GOP front-runner hit all his usual marks—calls for building a border wall and deporting undocumented immigrants, reading polls from pieces of paper he pulls from his inside jacket pocket—but devoted a fair chunk of his time to lashing back against former Massachusetts Gov. Mitt Romney, who publicly criticized Trump and questioned whether he was fit to be president.

“Mitt is a failed candidate. He failed. He failed horribly,” Trump said. “That was a race—I have to say, folks—that should have been won. That was a race that absolutely should have been won. He disappeared, and I wasn’t happy about it, to be honest, because I am not a fan of Barack Obama.”

Romney had begged for his support, Trump claimed, during Romney’s bid to unseat President Obama in 2012: “You can see how loyal he was, he was begging for my endorsement. I could have said, ‘Drop to your knees!’ and he would have dropped to his knees.”

Trump also claimed he intimidated Romney, who “choked” and “chickened out” of running for president in 2016.

Romney responded to Trump’s comments in a tweet posted on 2:13 p.m. Eastern.

If Trump had said 4 years ago the things he says today about the KKK, Muslims, Mexicans, disabled, I would NOT have accepted his endorsement

— Mitt Romney (@MittRomney)

March 3, 2016

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Donald Trump Says Mitt Romney "Would Have Dropped To His Knees" For Him

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Coal use is down in the U.S. and China — and it’s not a blip

by DarrylSkurrie Posted on February 29, 2016

People wear protective masks near the Bund during a polluted day in Shanghai. Reuters/Aly Song

Coal use is down in the U.S. and China — and it’s not a blip

By Rebecca Leberon 29 Feb 2016comments Share

China and the U.S. — the world’s two largest economies — are finally breaking up with coal.

China’s National Bureau of Statistics reports that coal consumption dropped in 2015, for the second time in two years, by 3.7 percent. That’s even faster than coal’s decline the year before, when consumption fell 2.9 percent. China’s carbon pollution has also declined by 1 to 2 percent since 2014, due in part to a slowing economy and the decline in cement and steel production.

Put another way, the “fall in coal use over past two years was equal to Japan’s total yearly coal consumption,” says Greenpeace (Japan is heavily reliant on coal itself).

This likely isn’t a two-year blip: China plans to close more than 1,000 coal mines in 2016 and has halted approval for new coal mines for the next three years as part of its new front in the battle with air pollution. Its renewable energy industry, meanwhile, is expanding at an astounding rate. The country’s wind and solar capacity increased 34 and 74 percent respectively, which met the country’s growing electricity demand.

Before you get too excited about this rare good news for climate change, there’s one big disclaimer: We know that China’s reporting of emissions data isn’t always accurate; last November, we learned that Chinese officials had underreported 2012 emissions data.

But if these numbers are indeed accurate, it’s no small feat for fighting climate change. China is responsible for half of the world’s coal consumption. Meanwhile, the U.S. is also cutting coal in the power sector much faster than expected.

According to a February report from the Business Council on Sustainable Energy, coal accounted for just over a third of U.S. electricity sources in 2015, at 34 percent. At it’s peak in 2005, the industry accounted for 50 percent of the electricity sector. The precipitous drop in coal use — which hit a 35-year monthly low last November — puts the U.S. halfway to the Obama administration’s goal of cutting carbon emissions from the power sector by one-third over 2005 levels.

Even if coal is on the way out — an outcome most of the world agreed is necessary when it adopted the United Nations Paris climate agreement in December — the question is whether it’s happening fast enough. China promised to reach peak carbon emissions around 2030, but signs suggest that date may come much earlier.

“Nowadays people are talking about, ‘Wait a second, maybe the coal peak already happened in 2013,’” Director of the Brookings-Tsinghua Center for Public Policy Qi Ye told Foreign Policy last year. Last fall, Goldman Sachs promised that, on the global scale, “Peak coal is coming sooner than expected.”

That said, most breakups have some bumps along the way — coal included. There have been been mixed developments on coal and greenhouse gas emissions around the world since the Paris summit: European Union now looks like it may overshoot its earlier emissions targets, while Australia’s carbon emissions are back on the rise after the repeal of its carbon tax.

The road to coal’s demise will certainly be long and fraught, but at least we have an idea now that it’s headed in the right direction.

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This GOP Congressman’s Crusade Against Scientists Just Got Even More Insane

by BrockCecil Posted on February 26, 2016

Mother Jones

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Congressman Lamar Smith’s crusade against the National Oceanic and Atmospheric Administration keeps getting weirder.

Smith (R-Texas), who chairs the House Committee on Science, Space, and Technology, suspects that NOAA scientists may have “changed” climate research data to make it appear as though a possible slowdown in global warming over the last decade-and-a-half didn’t really happen. In other words, the congressman seems to believe that government scientists somehow manipulated the facts in order to support President Barack Obama’s climate agenda.

It turns out that the scientific debate over the extent to which climate change took a so-called “hiatus” is far from settled and extends far beyond NOAA’s research. Chris Mooney at the Washington Post has a detailed rundown of the latest research on this surprisingly difficult question here. Of course, the basic existence of man-made global warming is not in dispute by scientists, Smith’s opinion notwithstanding.

But in any case, Smith is determined to get to the bottom of what he sees as an insidious plot by NOAA to falsify research. His original subpoena for internal communications, issued last October, has been followed by a series of letters to Obama administration officials in NOAA and other agencies demanding information and expressing frustration that NOAA has not been sufficiently forthcoming. In December, for example, he wrote to Commerce Secretary Penny Pritzker complaining that NOAA showed a “pattern of failing to act in good faith.” (NOAA is part of the Commerce Department.)

Now, a new letter gives some insight as to his specific grievances: Smith claims that NOAA’s internal search for documents responsive to the subpoena has been “unnecessarily narrow,” limited only to documents containing the terms “hiatus,” “haitus,” “global temperature,” and “climate study.” A NOAA spokesperson confirmed that those were the only search terms the agency used to find the relevant documents. On Monday, Smith asked NOAA to expand that field to include the words below (“Karl” presumably refers to Thomas Karl, the NOAA scientist behind the research Smith is interested in):

In Smith’s defense, NOAA’s four terms (three, really, since one is just a misspelling of another) are incredibly narrow and, if there really was any scientific malfeasance, would quite possibly miss it. At the same time, the new list further illuminates what Smith is really after: Some evidence of a nefarious political conspiracy involving Obama, the United Nations, the Paris climate agreement, and temperature buoys.

Sure, NOAA should be transparent about its activities. But the whole thing seems more and more like a wild goose chase by Smith—I’m not holding my breath for any bombshell revelations.

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This GOP Congressman’s Crusade Against Scientists Just Got Even More Insane

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Sanders is destroying Clinton in coal country, despite backing climate action

by TVUDerrick Posted on February 25, 2016

Sanders is destroying Clinton in coal country, despite backing climate action

By Rebecca Leberon 25 Feb 2016comments Share

In theory, Hillary Clinton should have no trouble appealing to primary voters in coal country. Last year, she put forward what amounts to a stimulus package for revitalizing Appalachia, proposing a $30 billion investment in job training, education, and health programs for hard-hit coal miners. She earned an early endorsement from pro-coal West Virginia Democrat, Sen. Joe Manchin last fall. Recently, in a February presidential debate, Clinton made overtures to coal-sympathetic blue-collar voters by pointing back to her plan: “You know, coal miners and their families who helped turn on the lights and power our factories for generations are now wondering, has our country forgotten us?”

And yet, Clinton can’t catch a break in West Virginia. She’s losing to an opponent who says things like, “To hell with the fossil fuel industry” — and she’s losing by nearly a 2-to-1 margin.

A MetroNews West Virginia poll conducted before the Nevada caucus and released this week shows Bernie Sanders leading Clinton, 57 percent to 29 percent among primary voters. Sanders performs strongest among young voters, 18-34, but he still leads Clinton 43 percent to 36 percent among senior-age voters.

That’s quite a change from the last time Clinton ran for president. In 2008, Clinton won 67 percent of votes in West Virginia’s primary, compared to Barack Obama’s 28 percent.

West Virginia’s primary is late in the election season — in May — but Sanders’ rise may offer some interesting lessons nonetheless about whether a strong climate platform is a big deterrence. His strong endorsement of climate change policies like a carbon tax and interest in banning fossil fuel production would seem to be a turn-off for West Virginia. And his sympathy for coal miners sounds no different from Clinton’s. “What we have to say is, ‘Look, through no fault of your own, you’re working in an industry which is helping to cause climate change and in fact having a negative impact on the country and world,’” Sanders told The Washington Post last year. “What the government does have is an obligation to say: ‘We’ll protect you financially as we transition away from fossil fuel.”

Then why are pro-coal voters overlooking Sanders’ aggressive support for climate action?

One theory is that Clinton’s ties to Obama (who only had 24 percent support in West Virginia) and his plan to regulate carbon pollution from coal-fired power plants make her particularly unpopular there. The only problem with that theory is Sanders too backs regulating coal plants, and wants to go even further.

Another theory is that Sanders’ populist, anti-corporate message is resonating with young and blue-collar voters. Remember, this is a state that just fined and jailed Freedom Industries executives for a 2014 chemical spill. Sanders has used working-class economic concerns to appeal to West Virginia, saying in the fall, “We have millions of working-class people who are voting for Republican candidates whose views are diametrically opposite to what voters want. How many think it’s a great idea that we have trade policies that lead to plants in West Virginia being shut down? How many think there should be massive cuts in Pell grants or in Social Security? In my opinion, not too many people.”

A second, important, factor is that coal represents a shrinking portion of Appalachia’s economy. It means both pandering to coal miners and claims of a “war on coal” to stop climate change may resonate less today than they did a decade ago. A statewide survey in 2014 after the Freedom Industries’ spill showed that environmental issues like clean water are key priorities for West Virginians, as well. David Weigel also offers the theory that Clinton’s landslide in 2008 had more to do with white voters’ backlash to Obama than Clinton’s popularity.

If Sanders’ rise in coal territory shows one thing, it’s that candidates can embrace strong action on climate change and still manage to earn support in Appalachian counties.

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