Kevin Drum

Obama Signs Order to Take Away Your Antibiotics

| Fri Sep. 19, 2014 10:30 AM EDT

Here's the latest from the White House:

The Obama administration on Thursday announced measures to tackle the growing threat of antibiotic resistance, outlining a national strategy that includes incentives for the development of new drugs, tighter stewardship of existing ones, and improvements in tracking the use of antibiotics and the microbes that are resistant to them.

....John P. Holdren, the director of the White House Office of Science and Technology Policy, told reporters that the new strategy — established by an executive order that President Obama signed on Thursday — was intended to jolt the federal government into action to combat a health crisis that many experts say it has been slow to recognize.

I guess we can all see where this is going, right? It'll start with Alex Jones, maybe, and then Glenn Beck will catch the infection. Drudge will get it next, then Limbaugh, and finally the entire crew of Fox News will come down with it. The tyrant Obama is taking our amoxicillin away from us! Think of the children and their earaches!

Sadly, there's no treatment for this airborne virus. We just have to let it burn itself out. Maybe someday scientists will find a cure for vox bardus.

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Don't Worry, the Crazy Is Coming Soon in the House Benghazi Hearing

| Thu Sep. 18, 2014 4:01 PM EDT

Yesterday's Benghazi hearing, chaired by Rep. Trey Gowdy (R–SC), was shockingly calm. Aside from a bit of gotcha over a 15-year-old report, there were no conspiracy theories, no hot buttons pressed, no shrieking clown shows. The extremely sober topic was whether the State Department has been successfully implementing the recommendations made by the Accountability Review Board shortly after the attacks. Everyone was on their best behavior, and even Ed Kilgore was impressed:

Now it's possible Gowdy will be taken to the woodshed by other Republicans (not to mention the conservative media that has made Benghazi! a sort of national security counterpart to Agenda 21), and come back snarling and ranting. But for the first time since September 11, 2012, the subject is being discussed by Republicans in an atmosphere that isn't reminiscent of a Tea Party street rally.

Go ahead and call me a stone partisan blinded by my own ill will toward Republicans, but come on. Gowdy doesn't need to be taken to the woodshed by anyone. This is just well-played theater from a guy who's a mite smarter than the usual tea party crackpot. He's gulling everyone into treating this like a serious investigation so that he'll have some credibility stored up when it comes time for the hundredth repetition of the stand-down myth or the latest insane parsing of the White House talking points. That's what this is all about.

I'll apologize if Gowdy manages to keep the tone of this hearing civil and judicious all the way to the end. But I'm not too worried about having to eat any crow here.

How to Discriminate Against Pre-Existing Conditions in Two Easy Tiers

| Thu Sep. 18, 2014 2:37 PM EDT

Via ProPublica, here's an editorial published yesterday in the American Journal of Managed Care:

For many years, most insurers had formularies that consisted of only 3 tiers: Tier 1 was for generic drugs (lowest co-pay), Tier 2 was for branded drugs that were designated “preferred” (higher co- pay), and Tier 3 was for “nonpreferred” branded drugs (highest co-pay)....Now, however, a number of insurers have split their all-generics tier into a bottom tier consisting of “preferred” generics, and a second tier consisting of “non-preferred” generics.

Hmmm. What's going on here? In some cases, this new non-preferred tier is reserved for higher-priced medicines. That's pretty easy to understand: insurers are trying to motivate their patients to choose cheaper drugs when they're available. That's the same reason copays are lower for generics compared to brand name drugs.

But it turns out that sometimes all the generic drugs for a particular disease are non-preferred and therefore have high copays. What are insurance companies trying to motivate in these cases? Charles Ornstein takes a guess:

The editorial comes several months after two advocacy groups filed a complaint with the Office of Civil Rights of the United States Department of Health and Human Services claiming that several Florida health plans sold in the Affordable Care Act marketplace discriminated against H.I.V. patients by charging them more for drugs.

Specifically, the complaint contended that the plans placed all of their H.I.V. medications, including generics, in their highest of five cost tiers, meaning that patients had to pay 40 percent of the cost after paying a deductible. The complaint is pending.

"It seems that the plans are trying to find this wiggle room to design their benefits to prevent people who have high health needs from enrolling," said Wayne Turner, a staff lawyer at the National Health Law Program, which filed the complaint alongside the AIDS Institute of Tampa, Fla.

If all your HIV drugs are expensive, then people with HIV will look for another plan. Technically, you're not discriminating against anyone with a pre-existing condition, but you're sure giving them a reason to shop around someplace else, aren't you?

At the moment, this practice appears to be confined to just a few insurers and a few classes of drugs. But if it catches on, it will prompt everyone to follow suit. After all, you can hardly afford to be the insurance company of choice for chronically sick people, can you? This is worth keeping an eye on.

IHOP Has Cut Back Its Menu By 30 Items

| Thu Sep. 18, 2014 12:11 PM EDT

Here's an interesting factoid: in 2008 we apparently reached Peak Menu. That year, the average menu contained 99.7 items. Then the housing bubble burst, we entered the Great Recession, and menus began to shrink. Today's menus feature a paltry 92.6 items.

Why is this? Cost is one reason: it's cheaper to support a smaller menu. But Roberto Ferdman writes that there's more to it:

The biggest impetus for all the menu shrinking going on is likely tied to a change in the country's food culture: Americans are becoming a bit more refined in their tastes.

"Historically, the size of menus grew significantly because there wasn't the food culture there is today," said [Maeve Webster, a senior director at Datassential]. "People weren't nearly as focused on the food, or willing to go out of their way to eat specific foods."

For that reason, as well as the fact that there were fewer restaurants then, there used to be a greater incentive for restaurants to serve as many food options as possible. That way, a customer could would choose a particular restaurant because it was near or convenient, rather than for a specific food craving (which probably wasn't all that outlandish anyway). But now, given the increasing demand for quality over quantity, a growing appetite for exotic foods and a willingness to seek out specialized cuisines, Americans are more likely to judge a restaurant if its offerings aren't specific enough.

"The rise of food culture, where consumers are both interested and willing to go to a restaurant that has the best Banh Mi sandwich, or the best burger, or the best trendy item of the moment, means that operators can now create much more focused menus," said Webster. "It also means that the larger the menu, the more consumers might worry all those things aren't going to be all that good."

Hmmm. Let me say, based on precisely no evidence, that I find this unlikely. Have American tastes really gotten more refined since 2008? Color me skeptical. And even if American palates are more discriminating, are we seriously suggesting that this has affected the menu length at IHOP, Tony Roma's, and Olive Garden—the three examples cited in the article? I hope this isn't just my inner elitist showing, but I don't normally associate those fine establishments with a "growing appetite for exotic foods and a willingness to seek out specialized cuisines."

So, anyway, put me down firmly in the cost-cutting camp. Long menus got too expensive to support, and when the Great Recession hit, casual dining chains needed to cut costs. They did this by lopping off dishes that were either expensive to prep or not very popular or both. Occam's Razor, my friends, Occam's Razor.

Apple Gives Its Middle Finger to the NSA

| Thu Sep. 18, 2014 10:54 AM EDT

I'm a little late getting started this morning, even though I actually woke up much earlier than usual. What happened is that I wrote a post; then lost it by hitting the wrong key and blowing away my browser window; then recreated it; and then decided not to publish it after all. I'm still not sure if this is because the post was genuinely ill-conceived, or because I'm just too cowardly to put it up. Questions, questions....

In any case, I'm fascinated to see this tidbit among all the boring recent Apple iPhone news (bigger screen, thinner profile, yawn):

Apple said Wednesday night that it is making it impossible for the company to turn over data from most iPhones or iPads to police — even when they have a search warrant — taking a hard new line as tech companies attempt to blunt allegations that they have too readily participated in government efforts to collect user information.

....The key is the encryption that Apple mobile devices automatically put in place when a user selects a passcode, making it difficult for anyone who lacks that passcode to access the information within, including photos, e-mails and recordings. Apple once maintained the ability to unlock some content on devices for legally binding police requests but will no longer do so for iOS 8, it said in the new privacy policy.

I'm not sure how universally this kind of technical fix can be applied elsewhere. I have a feeling that in practice, it's probably a limited solution. But it would certainly be a bit of poetic justice if the NSA's overreach and the government's unwillingness to rein them in led to a sea change in private security that simply makes it impossible to respond to mass requests for customer data.

Of course, this might not be the end of things. For the time being, actual traditional governments with police forces and courts are still more powerful than even the highest of high-tech corporations. If Congress passes a law requiring Apple to maintain unlock codes, then they'll have to do it whether they like it or not. I wonder how this is all going to play out?

The MoJo Investigative Fund Needs Your Help

| Thu Sep. 18, 2014 6:50 AM EDT

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Quote of the Day #2: Pick an Issue, Any Issue

| Thu Sep. 18, 2014 12:21 AM EDT

From self-declared visionary Newt Gingrich, asked what the Republican agenda should be for this year's campaign:

I don’t actually care what it is, for the next seven weeks, as long as it exists.

Come on, folks! Just pick anything that sounds good and rally around it. Does Newt have to do all your thinking for you?

Scotland Should Plan On Having Its Own Currency

| Wed Sep. 17, 2014 5:38 PM EDT

When provinces propose a split with the mother country, they usually insist that they'll continue to use the old currency. This is odd on its face since having your own money is usually considered one of the key attributes of a sovereign state. So what's the appeal of keeping the old country's currency? Greg Ip ponders the question:

Facilitating trade and capital movements is only one part of the story. Another, I think, is political and emotional. Forming a new country is fraught with risk. For savers, in particular the elderly, one risk looms especially large: that one’s retirement savings are suddenly redenominated in a new currency whose value is then inflated away. In both Quebec and Scotland, independence is mostly a movement of the left, and a separate currency would create the ever-present temptation to use the printing press to accommodate fiscal expansion and industrial policy. By promising to keep the old currency, separatists are reassuring savers that they will not succumb to the temptation of inflation.

I wonder if this is true? I hope it's not. I don't have a strong opinion about Scottish independence, but I do have a strong opinion about this. Here it is: if you favor independence, but only if Scotland holds onto the British pound, you're an idiot. If you don't trust a Scottish government to run its own monetary policy, then you don't trust a Scottish government. Period.

There are other arguments for currency union, of course, but I don't think they add up to much. Nor do I truly believe them. They mostly seem like post hoc rationalizations to provide people with a more palatable reason for keeping the British pound than fear of a reckless Scottish monetary authority. Generally speaking, the history of currency unions is simply too fraught for anyone who's paying attention to really think it's a good idea. And as Ip points out, they rarely last very long anyway.

An independent Scotland should have its own currency and its own monetary policy. If this makes you nervous, then the whole idea of independence should make you nervous.

Prison Rates are Down. Thanks to Lead, They're Going to Stay Down.

| Wed Sep. 17, 2014 1:18 PM EDT

Yesterday the Bureau of Justice Statistics released the latest numbers on incarceration rates, and the headline news is that we're sending fewer people to prison. But there's an interesting wrinkle in the numbers that few news outlets have picked up on, even though it's a trend that's been obvious in the numbers for a long time. Here it is:

That's from Rick Nevin, and you know what's coming next, don't you? Lead. It explains a lot of what's going on here.

The US started phasing out gasoline lead in 1975, which means that children born after 1975 were exposed to steadily less lead. And the effect was cumulative: the later they were born, the less lead they were exposed to and the less crime they committed when they grew up. However, children born before 1975 were unaffected by all this. They were born in a high-lead era, and since all that matters is exposure during early childhood, the damage had already been done.

In 2013, this means that the statistics show a reduction in crime rates in adults under the age of 40, and the younger the cohort the lower the crime rate. Unsurprisingly, this also means they're incarcerated at lower rates. The chart above shows this fairly dramatically.

But it also shows that incarceration rates have stayed steady or increased for older men. Those over the age of 40 had their lives ruined by lead when they were children, and the effect was permanent. They're still committing crimes and being sent to prison at the same rate as ever. It's hard to explain both these trends—lower prison rates for kids, higher prison rates for the middle-aged—without taking lead into account.

This is one of the reasons that the lead-crime hypothesis is important. In one sense, it's little more than a historical curio. It explains the rise and fall of crime between 1960 and 2010, but by now most environmental lead has been cleaned up and there's only a limited amount left to worry about. So it's interesting, but nothing more.

But here's why it matters: if the hypothesis is true, it means that violent crime rates aren't down because of transient factors like drug use or poverty or harsh penal codes. The reduction is permanent. Our children are just flatly less violent than the lead-addled kids who grew up in the years after World War II. And that in turn means that the decline in incarceration rates is permanent. We don't need as much prison space as we used to, and we don't need punitive penal codes designed to toss kids behind bars for 20 years at the first sign of danger.

In other words, we can ease up. Our kids are less violent and our streets are less dangerous. Nor is that likely to change. The lead is mostly gone, and it's going to stay gone. We're safer today not because of broken windows or three-strikes laws or 20-year sentences for dealing cocaine. We're safer because we're no longer poisoning our children in ways that turn them into hair-trigger thugs. And guess what? If we cleaned up the ambient lead that still remains, we'd be even safer 20 years from now.

Quote of the Day: Go Away, I'm Performing Brain Surgery

| Wed Sep. 17, 2014 12:03 PM EDT

From the campaign of GOP Senate candidate Monica Wehby, declining to respond to allegations of plagiarism:

Dr. Wehby is too busy performing brain surgery on sick children to respond, sorry.

This might be the most brilliant refusal to comment ever in the history of politics.