Kevin Drum

Medicare Just Keeps Producing Great Budget News

| Wed Jul. 9, 2014 2:20 PM EDT

Medicare has been a bastion of good news lately. Every year, the CBO reduces its baseline estimate of Medicare costs, which have dropped by more than $1,000 since 2010. So what's going on? Tricia Neuman and Juliette Cubanski of the Kaiser Family Foundation round up the evidence:

It is clear that the Medicare savings provisions in the ACA, such as reductions in provider payment updates and Medicare Advantage payments, have played a major role....In addition, the Budget Control Act of 2011 also exerted downward pressure on Medicare spending through sequestration that reduced payments to providers and plans by 2 percent beginning in 2013.  And yet even after incorporating these scheduled payment reductions in the baseline, CBO has continued to lower its projections of Medicare spending.

So what else might be going on here? In addition to scheduled reductions in Medicare’s more formulaic payment rates, providers may be tightening their belts and looking to deliver care more efficiently in response to financial incentives included in the ACA, and it is possible that these changes are having a bigger effect than expected. For example, CMS recently reported that hospital readmission rates dropped by 130,000 between January 2012 and August 2013. It is also possible that hospitals and other providers are using data and other analytic tools more successfully to track utilization and spending and to reduce excess costs. Another more straightforward factor is that several expensive and popular brand-name drugs have gone off patent in recent years, which has helped to keep Medicare drug spending in check.

No one knows for sure if these reductions are permanent, or whether high growth rates will reappear in the future. But even if the low growth rates of the past few years can't be sustained, I suspect that Medicare growth will continue to be lower than anyone expected. There are two reasons for this. First, the growth rate of medical costs in general has been declining steadily for the past 30 years, and this has now been going on long enough that it's highly unlikely to be a statistical blip. After a surge in the 80s and 90s, we really are returning to the growth rates that were common earlier in the century, and obviously this will affect Medicare.

Second, Obamacare really will have an impact. Not everything in it will work, but it includes a lot of different cost-cutting measures and some of them will turn out to be pretty effective. And who knows? If Republicans ever stop pouting over Obamacare, we might even be able to experiment with different kinds of cost reductions.

There's a fair amount of year-to-year variability in health care inflation, and we should expect to have some years of high growth. But I'll bet the average over the next decade is somewhere around 2 percent above the general inflation rate. That's not too bad.

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Vladimir Putin Abandons His Erstwhile Allies

| Wed Jul. 9, 2014 10:31 AM EDT

Julia Ioffe writes about the latest from Ukraine:

As the Ukrainian army chases separatists from the strongholds they've held for months, Moscow has barely said anything—despite its springtime rants about protecting Russians wherever they may be in the world....As I wrote back in May, now that he's sown chaos in Ukraine—but uneager to participate in someone else's civil war—President Vladimir Putin has thrown the rebels under the bus. In June, rebel leader Igor Strelkov said that "Putin betrayed us," and that betrayal has only deepened as Kiev launched its all-out offensive last week. Moscow, having started all this, has offered no help to the rebels.

The betrayal, it seems, may be even nastier than that. According to a Ukrainian security council spokesman, the Russians have sealed their border, shutting down three key crossings. Not only are they not letting men and materiel into Ukraine from Russia, but they're also blocking men and materiel from flowing in the opposite direction. That is, the very men that Moscow has riled up to the extent that they have taken up arms and are ready to die in order to get the region out of Ukraine and into Russia are not welcome to seek refuge in Russia. (Not even, it seems, the ones originally from Russia.) A group of 300 fleeing rebels reportedly even came under fire by the Russians as they tried to escape into Russia.

That Putin. He's quite the guy, isn't he? It appears that he eventually figured out that Ukraine wasn't going to fall neatly into his lap, and the cost of fomenting an all-out war there was simply too great. It turned out that Ukrainians themselves didn't support secession; Western powers were clearly willing to ramp up sanctions if things got too nasty; and the payoff for victory was too small even if he had succeeded. So now he's had to swallow a new, more pro-Western Ukraine—the very thing that started this whole affair—along with the prospect of renewed anti-Russian enmity from practically every country on his border.

But he got Crimea out of the deal. Maybe that made it worth it.

Yet Another Day in Republican Scumbaggery

| Wed Jul. 9, 2014 1:00 AM EDT

Today President Obama asked Congress to approve $3.7 billion in emergency funding to help deal with the surge of minors crossing the border. You may color me unsurprised over the Republican response:

The proposal was quickly met with broad skepticism among Republican lawmakers, who were doubtful that the package would be approved quickly — if at all....GOP leaders, who have called on Obama to take stronger action, said they were reluctant to give the administration a “blank check” without ­more-detailed plans to ensure that the money would help stem the crisis at the border.

The president “is asking to use billions of taxpayer dollars without accountability or a plan in place to actually stop the border crisis,” Rep. Bob Goodlatte (R-Va.), chairman of the House Judiciary Committee, said in a statement.

Asked if he thought lawmakers would approve the proposal, Sen. Marco Rubio (R-Fla.) said, “No, given the mood here in Washington, I don’t have confidence it will happen.”

Well, of course it won't happen. The crisis along the border is tailor made for Republicans. It makes their base hopping mad, it juices their campaign fundraising, and anytime the government is unable to address a problem it makes Obama look bad. Why on earth would Republicans want to do anything to change any of this?

As long as Obama is president, chaos is good for Republicans. After all, most voters don't really know who's at fault when things go wrong, they just know there's a crisis and Obama doesn't seem to be doing anything about it. Exploiting that may be cynical and revolting, but hey, politics ain't beanbag. And in case you haven't heard, there's an election coming up.

Finally, Someone With the Guts to Call for Obama's Impeachment

| Tue Jul. 8, 2014 2:34 PM EDT

I see that Sarah Palin is apparently starved for attention again. Here's her latest:

President Obama’s rewarding of lawlessness, including his own, is the foundational problem here. It’s not going to get better, and in fact irreparable harm can be done in this lame-duck term as he continues to make up his own laws as he goes along, and, mark my words, will next meddle in the U.S. Court System with appointments that will forever change the basic interpretation of our Constitution’s role in protecting our rights.

It’s time to impeach; and on behalf of American workers and legal immigrants of all backgrounds, we should vehemently oppose any politician on the left or right who would hesitate in voting for articles of impeachment.

The many impeachable offenses of Barack Obama can no longer be ignored. If after all this he’s not impeachable, then no one is.

Quite right. Minors are swarming our borders because American exceptionalism is at risk thanks to Obama's failure to help the Ukrainians which means our enemies no longer fear us and the dollar is being debased. Or was it because he failed to arm the Syrian rebels? I forget. Something to do with Putin, though. And the Fed. Plus, um, recess appointments and one-year extensions to TyrannyCare mandates. And Benghazi.

Whatever. Impeach Obama! I sure hope every Republican in the country is asked to weigh in on this.

Will the Washington Post Destroy "Incidental" NSA Intercepts When It's Done With Them?

| Tue Jul. 8, 2014 12:27 PM EDT

A couple of days ago the Washington Post published an article based on a cache of thousands of surveillance intercepts that it got from Edward Snowden. That produced the suggestion—not widespread, I think, but still out there—that the Post was now violating privacy just like the NSA has been. Glenn Greenwald thought this was pretty dumb, but Julian Sanchez wasn't so sure:

Doesn't seem TOTALLY frivolous. I hope you & WaPo are destroying copies of intimate communications once reporting's done.

This is actually....a good point. The charge against the NSA isn't just that it ends up surveilling thousands of innocent people who are merely innocent bystanders in court-approved investigations. Even critics concede that this is inevitable to some extent. The problem is that once the NSA has collected all these "incidental" intercepts, they keep them forever in their databases and make them available to other law enforcement agencies for whatever use they want to make of them. At the very least, privacy advocates would like these incidental collections to be destroyed after they've served their immediate purpose.

So will the Post do this? Once they've finished their immediate reporting on this, will they destroy these intercepts? Or will they keep them around for the same reason the NSA does: because, hey, they have them, and you never know if they might come in handy some day?

There's always been a tension inherent in Edward Snowden's exposure of the NSA's surveillance programs: Who gets to decide? You may think, as I do, that the government has repeatedly shown itself to be an unreliable judge of how much the public should know about its mass surveillance programs. But who should it be instead? Snowden? Glenn Greenwald? The Washington Post? Who elected them to make these decisions? Why should we trust their judgment?

It's not a question with a satisfying answer. Sometimes you just have to muddle along and, in this case, hope that the whistleblowers end up producing a net benefit to the public discourse. But this time we don't have to muddle. This is a very specific question, and we should all be interested in the answer. Do Greenwald and the Post plan to destroy these private communications once they're done with them? Or will they hold on to them forever, just like the NSA?

POSTSCRIPT: Yes, there's a difference here. On the one hand, we have the government, with its vast law-enforcement powers, holding onto massive and growing amounts of incidental surveillance. On the other we have a private actor with a small sample of this surveillance. We should legitimately be more concerned with possible abuses of power by the government, both generally, and in this case, very specifically. But that's a starting point, not the end of the conversation. Sanchez is still asking a good question.

Quote of the Day: Bizarro John Boehner Joins Twitter

| Tue Jul. 8, 2014 11:42 AM EDT

Steve Benen points me to the latest foray into social networking from Speaker John Boehner:

Democrats like to say they want to fix #ObamaCare, but where’s their plan? They don’t have one.

It's not worth belaboring the fact that this is epically dumb. What I'm curious about is what Boehner thinks this will accomplish. Who is it supposed to appeal to? To the tea party true believers, it's too weak to be effective. They want red meat. To liberals it's just laughable. To folks in the middle it's incomprehensible. To the media—which knows perfectly well that Dems have plenty of ideas and Republicans are hopelessly fractured over health care—it's idiotic.

So who's the audience for this?

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Defining Stalinoid Down

| Tue Jul. 8, 2014 11:05 AM EDT

Last night I was paging through the New Republic and, for some reason, ended up torturing myself by reading Leon Wieselter's latest exercise in pretension and self-regard. It was fairly ordinary, as these things go, but included this aside about supporters of the Iraq War:

(The other day Rachel Maddow, who has never been significantly wrong about anything, published this Stalinoid sentence in The Washington Post: “Whether they are humbled by their own mistakes or not, it is our civic responsibility to ensure that a history of misstatements and misjudgments has consequences for a person’s credibility in our national discourse.”)

Stalinoid? Seriously? For a very mild suggestion that people with a history of being wrong should be thought less credible in the future? That sounds more like a bare minimum of common sense than a cultural pogrom aimed at neocons and liberal hawks.

I've suggested in the past that we should all calm down a bit over analogies to Hitler and Nazis in popular discourse, so I'm hardly one to complain about using Stalin in the same way. But this is still a pretty reprehensible slur. Wieselter needs to find a better outlet for his frustration over being wrong about the Iraq War.

Yet Another Chuckleheaded Covert Op in the US-Cuba Relationship

| Tue Jul. 8, 2014 12:24 AM EDT

Remember that story a couple of years ago about Sen. Robert Menendez supposedly cavorting with teenage prostitutes in the Dominican Republic? Well....

According to a former U.S. official with firsthand knowledge of government intelligence, the CIA had obtained credible evidence, including Internet protocol addresses, linking Cuban agents to the prostitution claims and to efforts to plant the story in U.S. and Latin American media.

....The intelligence information indicated that operatives from Cuba’s Directorate of Intelligence helped create a fake tipster using the name “Pete Williams,” according to the former official. The tipster told FBI agents and others he had information about Menendez participating in poolside sex parties with underage prostitutes while vacationing at the Dominican Republic home of Salomon Melgen, a wealthy eye doctor, donor and friend of the senator.

....The allegations against Menendez erupted in public in November 2012, when the Daily Caller, a conservative Web site, quoted two Dominican women claiming Menendez had paid them for sex....Last year, three Dominican women who had initially claimed to reporters that they had been paid to have sex with Menendez recanted their story.

Is there any other pair of countries in the world responsible for launching more stupid covert ops against each other than Cuba and the United States? Apparently the brains of intelligence operatives in both Havana and Washington DC turn to tapioca at the mere mention of the other country. It's just astounding.

Murder Is Down 63% in San Francisco. Lead Probably Isn't the Reason.

| Mon Jul. 7, 2014 7:21 PM EDT

Every time a city reports a big drop in crime, someone sends me a link to a story about it. San Francisco is the latest:

During the first half of the year, the city saw 14 killings — a 36 percent drop from the 22 recorded at the midpoint last year and a 63 percent decrease from the 38 in 2012.

...."The best guess one can make is that they're associated with a national trend of lowered homicide rates over the last 20 years," said Robert Weisberg, a law professor who co-directs the Stanford Criminal Justice Center. "They have settled a bit, but they have gone down in some places."

Weisberg said one big factor in the national drop in killings is "just smarter policing, which requires more police and smarter police, and that includes the use of technology, the targeting of hot spots and CompStat-style policing and gang intervention."

I know what you're wondering: is it lead, Kevin? What about this "smarter policing" stuff? Here are a few things that should help you think about this stuff:

  • The long-term trend in San Francisco is pretty familiar, and pretty similar to other mid-size cities. Over the past 20 years, a big part of San Francisco's drop in violent crime is probably due to the phaseout of leaded gasoline between 1975 and 1995.
  • However, lead isn't responsible for short-term changes. It has nothing to do with the 63 percent drop in homicides since 2012.
  • Generally speaking, you have to be careful with homicide numbers. Overall violent crime statistics are based on a large number of incidents, so they're fairly reliable. But even big cities don't have that many murders, which means the numbers can bounce around a lot from year to year just by random chance.
  • A drop in crime can create a virtuous circle, because it allows police to spend more time on the crime that remains. So lead might well have acted as a sort of tailwind here, producing a drop in violent crime that allowed systems like CompStat to be more effective, thus producing further drops even after the impact of lead has flattened out.

The phaseout of leaded gasoline did its job in San Francisco, but at this point any further drops will most likely have to come from other sources. More effective policing strategies are certainly one of the things that can make a difference.

In Defense of Optics

| Mon Jul. 7, 2014 5:57 PM EDT

Here's a Twitter conversation this afternoon between Jamison Foser and me:

Foser: Dumbest words in politics: “Optics,” “Gaffe,” “Hypocrisy.” (That latter one is a real thing, but misused to the point of meaninglessness.)

Drum: But “optics” is just short for “how this will look to others.” Nothing really wrong with that.

Foser: “Optics” = “I cannot articulate a substantive problem with this, so I’ll just suggest others won’t like it.” It’s a house of cards.

Drum: But don't politicians routinely consider the optics of their actions? I mean really, genuinely, think about it. It's a real thing.

Foser: Not sure why that means anyone should care, or how that validates 99% of use of word by reporters/operatives/pundits....And I’ve really, genuinely thought about it for a couple decades.

Drum: What word would you suggest instead? The concept itself is pretty ordinary.

Foser: I don’t think we need a word for “people might not like the Congressman’s cheesesteak order.” I think we need to shut up about it.

Drum: Hmmm. It's a slow day. Maybe I'll blog about this since I think my disagreement is more than 140 characters long.

Foser: Then here’s another angle: To the extent “optics” claims are about “analyzing” rather than sneakily influencing reactions, I find that pointless as well. “Here’s what I think people will think” is generally dull & unimportant.

Here's the thing: like most anything, there are good uses of the word optics and dumb uses of the word optics. To the extent that it becomes an excuse for fatuous preoccupations with Al Gore's earth tones or Hillary Clinton's speaking fees, then yes, it's dumb. The world would be a better place if campaign beat reporters spent a lot less time on this kind of soul-crushing imbecility.

But that's not the only use of the word. As I mentioned in my first tweet—though see the note below for more about this—it's also used as a shortcut for a specifically political meaning of "how something will look to other people." And if you object to that, then you're just railing against human nature. Unless you're clinically autistic, obsessing with how our actions will appear to others is fundamental to the human condition. Ditto for obsessing with other people's appearances.

That's especially true for anyone in the sales and marketing business, where appearances are literally what the job is all about. And who's more in the sales and marketing business than a politician? Sure, they have actual products—universal pre-K, cutting tax rates, whatever—but most people don't buy their products based on a Brookings white paper outlining the pros and cons. They buy it based on how it fits into their worldview, and that in turn owes more to how it's sold than to what's actually being sold.

So when you try to figure out why, say, Marco Rubio's immigration reform plan crashed and burned, you're missing half the story if you only look at the details of his plan. If you're covering a campaign, you're missing half the story if you don't report about how the campaign is trying to mold public perceptions. If you're writing a history of the Iraq War, you're missing half the story if you don't spend time explaining the marketing campaign behind the whole thing. For better or worse, politicians spend a lot of time thinking about how various audiences—supporters, opponents, undecideds, pundits, members of Congress, the media—will react to their proposals, and they shape their messages accordingly. If you're reporting on politics, you have to include that as part of the story, and optics is as good a word as any to describe it.

That said, we'd be better off if there were fewer dumb appeals to optics. If you're going to talk about optics, it should be based on either (a) ground-level reporting about what someone's political operation is actually doing, or (b) empirical data like poll numbers about how people react to things. If all you're doing is inventing stuff that no one on the planet would have noticed if you hadn't been hard up for column material, then you're responsible for making us collectively stupider and giving optics a bad name. Knock it off.

FULL DISCLOSURE: I've defended the word optics against critics before, which suggests that in my mind I really do think it's OK to use it:

When someone says "optics," for example, I know that they're talking not just about general appearances, but about how something plays in the media and how it plays with public opinion. Using the word optics also suggests that you're referring to a highly-planned operation managed by media pros, not just some random event on the street.

On the other hand, I don't actually use the word very much myself, which suggests that in my heart I agree with Foser more than I'm letting on.