• Good News From the ER: Hospital Mistakes Are on the Decline


    Let’s continue our good news theme this morning. For the past few years, via several different programs, the federal government has been working hard to get hospitals to adopt practices that rein in the curse of “hospital acquired conditions”—also known as HACs. These are things like prescription mistakes, central line infections, slips and falls, and so forth. Today, the Agency for Healthcare Research and Quality released a report showing that HACs have been declining since these programs began in 2010.

    The chart on the right tells the basic story. HACs declined a bit in 2011, and then fell even further in 2012 and 2013. By now, they’ve declined by a cumulative total of 17 percent. The AHRQ reports estimates that this represents 1.3 million HACs that have been prevented and 50,000 lives that have been saved. It’s also reduced health care costs by about $12 billion.

    Much of this has been due to a laundry list of reforms introduced by Obamacare. So not only has Obamacare provided affordable health coverage for millions, but it’s reduced hospital errors by one out of every six and saved tens of thousands of lives in the process. Not bad.

  • Good News From Iraq: Baghdad Finally Cuts a Deal With the Kurds


    Politically, the primary challenge facing Iraq’s new Shiite leaders is forging a government that includes significant participation from the Sunni minority and slowly regains their trust in a unified state. It’s been Job 1 from the start. That said, building a political accommodation with the northern Kurds is a close second, and today brought some good news on that front:

    In a far-reaching deal with the potential to unite Iraq in the face of a Sunni insurgency, the government of Prime Minister Haider al-Abadi agreed on Tuesday to a long-term pact with the autonomous Kurdish region over how to divide the country’s oil wealth and cooperate on fighting Islamic State extremists.

    The deal unites Baghdad and Erbil, the Kurdish capital in the north, over the issue of oil revenues and budget payments, and is likely to halt a drive — at least in the short term — by the Kurds for an independent state. It includes payments from the central government for the salaries of Kurdish security forces, known as the pesh merga, and also will allow the flow of weapons to the Kurds from the United States, with the government in Baghdad as intermediary.

    ….The reconciliation between Baghdad and the Kurdish region also appeared to validate one element of President Obama’s strategy in confronting the Islamic State: pushing for a new, more inclusive leader of Iraq. When the extremists swept into Mosul, Iraq’s second-largest city, in June, Mr. Obama decided that Mr. Maliki had to go before the United States would ramp up its military efforts against the Islamic State.

    A deal with the Kurds was always going to be easier than regaining the participation of the Sunnis. Kurdistan has long had de facto autonomy from Baghdad, and negotiating over oil wealth is a fairly straightforward bit of dealmaking. An accommodation has been possible all along whenever Baghdad was willing to compromise—and the ISIS threat gave the new government there plenty of motivation to do just that.

    The same can’t be said of accommodation with the Sunnis. The Sunni-Shia divide in the Arab regions of Iraq is deeper and more fundamental, and there’s no single, well-defined Sunni region with established leadership and relatively clear demands that can be negotiated with cleanly. There are just years—or decades or centuries, depending on how you want to count—of mistrust and bad blood. Combine that with nearly a decade of rampant corruption and tribal jingoism under Nouri al-Maliki’s Shiite government and you don’t have a problem that can be solved either quickly or easily.

    Still, the Kurdish deal suggests that Haider al-Abadi may be genuinely willing to do the work necessary to rein in tensions and provide the Sunni minority with the representation and influence it wants. Maybe. As always, it’s not wise to read too much into this. But it’s a good sign.

  • Chart of the Day: White vs. Black on Ferguson


    Earlier today I linked to an Ed Kilgore post suggesting that polarization over Ferguson was even worse than polls suggest. And that may be true. But as you can see in the chart on the right, the polls are still pretty damn bad.

    A new ABC/Washington Post poll shows that among whites, 58 percent approve of the grand jury decision not to indict Officer Darren Wilson, while 35 percent disapprove. That’s a net approval rating of +23 percent. Among blacks, 9 percent approve and 85 percent disapprove. That’s a net approval rating of -76 percent. It’s hard to imagine a much more polarizing result than that.

  • Vladimir Putin Has Careened From One Diplomatic Disaster to Another


    From the “things that make you go hmmm” file:

    President Vladimir V. Putin said Monday that he would scrap Russia’s South Stream gas pipeline, a grandiose project that was once intended to establish the country’s dominance in southeastern Europe but instead fell victim to Russia’s increasingly toxic relationship with the West. It was a rare diplomatic defeat for Mr. Putin, who said Russia would redirect the pipeline to Turkey. He painted the failure to build the pipeline as a loss for Europe and blamed Brussels for its intransigence.

    Say what? Militarily, Putin has had a mixed year: a clean and quick military victory in Crimea on the upside, but an ongoing military quagmire in eastern Ukraine on the downside. Diplomatically, though, it’s been an endless succession of bad news. Ukraine is more firmly allied to the West than ever. Finland is wondering if it might not be such a bad idea to join NATO after all. The Baltic states, along with just about every other Russian neighbor, are desperate to reinforce their borders—and their NATO commitments. Russia has been dumped from the G7 and Putin himself was brutally snubbed by practically every other world leader at the G20 meeting in Brisbane. Economic sanctions are wreaking havoc with the Russian economy. China took advantage of all this to drive a harder bargain in negotiations over the long-planned Siberian gas pipeline. Even Angela Merkel has finally turned on Putin. Diplomatically, this year has been a disaster for Russia.

    Or am I missing something here? I gather that the Chinese public loves “Putin the Great” for standing up to the West, but that’s about it. Where are all the other diplomatic triumphs Putin is supposed to have won this year?

  • Ferguson Is Even More Polarizing Than Polls Suggest


    Georgia expat Ed Kilgore reports on a recent visit to his home state:

    I’ve just spent nearly a week back home in exurban Atlanta, and I regret to report that the events in and in reaction to Ferguson have brought back (at least in some of the older white folks I talked with) nasty and openly racist attitudes I haven’t heard expressed in so unguarded a manner since the 1970s. The polling we’ve all seen about divergent perceptions of Ferguson doesn’t even begin to reflect the intensity of the hostility I heard towards “the blacks” (an inhibition against free use of the n-word, at least in semi-public, seems to be the only post-civil-rights taboo left), who have the outrageous temerity to protest an obvious act of self-defense by a police officer.

    I’m not sure there’s really anything useful I can say about this. I just thought it was worth passing along.

  • The Scary Mystery of Angela Merkel Is….Still a Mystery


    Last night I got around to reading George Packer’s long New Yorker profile of German chancellor Angela Merkel, and it turned out to be a surprisingly absorbing piece. Unfortunately, that’s due more to Packer’s skill as a writer than to anything he ends up revealing about Merkel. In fact, the truly astonishing thing is that he manages to write 15,000 words about Merkel without really enlightening us in any serious way about what makes her tick. Apparently she’s really that enigmatic. Here, for example, is what he says about why a sober-minded East German chemist, who had never before displayed any political ambitions, suddenly decided to visit a political group that had formed after the Berlin Wall fell to ask if she could help out with anything:

    Merkel’s decision to enter politics is the central mystery of an opaque life. She rarely speaks publicly about herself and has never explained her decision. It wasn’t a long-term career plan—like most Germans, she didn’t foresee the abrupt collapse of Communism and the opportunities it created. But when the moment came, and Merkel found herself single and childless in her mid-thirties—and laboring in an East German institution with no future—a woman of her ambition must have grasped that politics would be the most dynamic realm of the new Germany.

    Well, OK then. Packer reports that Merkel is smart, methodical, genuinely unpretentious, and “as lively and funny in private as she is publicly soporific.” But her political views? Apparently she barely has any:

    Throughout her Chancellorship, Merkel has stayed as close as possible to German public opinion….“The Chancellor’s long-term view is about two weeks,” [a Merkel adviser says]. The pejorative most often used against her is “opportunist.” When I asked Katrin Göring-Eckardt, the Green leader, whether Merkel had any principles, she paused, then said, “She has a strong value of freedom, and everything else is negotiable.”

    ….“People say there’s no project, there’s no idea,” the senior official told me. “It’s just a zigzag of smart moves for nine years.” But, he added, “She would say that the times are not conducive to great visions.”

    ….The most daunting challenge of Merkel’s time in office has been the euro-zone crisis, which threatened to bring down economies across southern Europe and jeopardized the integrity of the euro….Merkel’s decisions during the crisis reflect the calculations of a politician more mindful of her constituency than of her place in history. When Greek debt was revealed to be at critical levels, she was slow to commit German taxpayers’ money to a bailout fund, and in 2011 she blocked a French and American proposal for coördinated European action.

    ….Throughout the crisis, Merkel buried herself in the economic details and refused to get out in front of what German voters—who tended to regard the Greeks as spendthrift and lazy—would accept, even if delaying prolonged the ordeal and, at key moments from late 2011 through the summer of 2012, threatened the euro itself. The novelist and journalist Peter Schneider compared her to a driver in foggy weather: “You only see five metres, not one hundred metres, so it’s better you are very careful, you don’t say too much, you act from step to step. No vision at all.”

    It’s kind of scary, but all wrapped up in a hazy ball of pragmatism that’s hard to get a handle on. Take the eurozone crisis, for example. Over the past five years, Germany has seemed almost spitefully hellbent on destroying the European economy simply because Germans disapprove of the spendthrift southerners responsible for the mess—all the time self-righteously refusing to admit that they themselves played a role that was every bit as lucrative and self-serving in the whole debacle. Because of this, the European economy is now headed for its third recession since 2008.

    Does Merkel share this view of things? Or does she recognize what needs to be done but simply doesn’t have either the will or the courage to challenge German public opinion? That’s never clear. And yes, I guess I find that a little scary. This is why I don’t quite get the comparison Packer makes between Merkel and Obama. Initially, he says, Merkel was put off by Obama’s lofty rhetoric:

    As she got to know Obama better, though, she came to appreciate more the ways in which they were alike—analytical, cautious, dry-humored, remote. Benjamin Rhodes, Obama’s deputy national-security adviser, told me that “the President thinks there’s not another leader he’s worked closer with than her.” He added, “They’re so different publicly, but they’re actually quite similar.” (Ulrich joked, “Obama is Merkel in a better suit.”)

    During the Ukraine crisis, the two have consulted frequently on the timing of announcements and been careful to keep the American and the European positions close. Obama is the antithesis of the swaggering leaders whom Merkel specializes in eating for breakfast. On a trip to Washington, she met with a number of senators, including the Republicans John McCain, of Arizona, and Jeff Sessions, of Alabama. She found them more preoccupied with the need to display toughness against America’s former Cold War adversary than with events in Ukraine themselves. (McCain called Merkel’s approach “milquetoast.”) To Merkel, Ukraine was a practical problem to be solved. This mirrored Obama’s view.

    Personality-wise, perhaps, Obama and Merkel are similar. “No drama” could apply equally well to either of them. But politically? I don’t see it. Obama doesn’t strike me as someone with no vision who hews as close as possible to public opinion. It’s true that he can’t always get what he wants, and obviously he faces the same constraints as any politician in a democratic system—especially one who presides over a divided government. But certainly his broad political views are clear enough, as are his political sympathies. He hasn’t been able to change the course of American politics, but not because he wouldn’t like to. He just hasn’t been able to.

    So: who is Angela Merkel? After 15,000 words, I still don’t feel like I know. Is she really just someone who’s skilled at keeping her political coalition together and doesn’t much care about anything more than that? It’s a little hard to believe. And yet, that sure seems to be the main takeaway from all this.

  • Could Immigration Sink Obamacare at the Supreme Court?


    David Savage writes today that President Obama’s executive order on immigration could have an unintended consequence: convincing Chief Justice John Roberts that Obama really is riding roughshod over the rule of law and needs to be reined in. And perhaps the latest challenge to Obamacare is just the place to start:

    Two years ago, the chief justice surprised many by joining liberals on the court to uphold the constitutionality of Obama’s Affordable Care Act. And he probably holds the deciding vote in a second legal challenge to the healthcare law — one that seeks to eliminate government insurance subsidies to low- and middle-income enrollees in two-thirds of the nation.

    But Roberts, an appointee of President George W. Bush, has shown an increasing skepticism toward what conservatives call Obama’s tendency to overreach….The question now is whether the president’s immigration action will influence the thinking of the justices, and particularly of Roberts, as they consider in the upcoming healthcare case whether the president exceeded his authority.

    ….Critics are appealing to Roberts and the court’s conservatives, arguing the president and his advisors have no power to unilaterally change a law passed by Congress. Their argument echoes the criticism voiced over Obama’s immigration directive, accusing the president of trying to fix a broken system by acting on his own rather than waiting for Congress.

    Experts say that legally the healthcare case is a close call. If so, the outcome may turn on whether the justices are inclined to give the president the benefit of the doubt, or whether they believe it’s time to rein him in.

    Granted, Savage is just speculating here. He really has no evidence for this at all and quotes nobody aside from a single legal expert from the Cato Institute. Still, you have to assume that perhaps he’s been hearing rumors that prompted him to write this. And it certainly fits into speculation that Roberts might be hunting around for an excuse to atone for his apostasy two years ago when he upheld Obamacare in the first place.

    It’s kind of unnerving to even suspect that Supreme Court justices might really think this way. But it’s hardly inconceivable. The law itself, along with the real-world consequences of the court’s actions, don’t seem to occupy a large share of the justices’ minds these days. These are becoming bleak times in Supreme Court land.

  • Black Friday Now Just Another Opportunity to Mock the Poor


    Luke O’Neil regales us this weekend with a roundup of media coverage of Black Friday:

    Consider the jocular hosts’ grinning affect as they relate news of brawls throughout the country in this clip from Fox & Friends First today, for example, or how numerous Web sites will round up the best brawl videos. As Yahoo News writes on the spread of Black Friday violence to Britain this year, “That means even more grown adults fighting over discounted underwear, and more opportunities to for us to gawk at them.” Or take this video of a fight inside of a Houston Wal-Mart. You’ll notice producers from a variety of television programs — “Good Morning America,” Fox News, CNN — all asking for permission to use the video on their broadcasts, because they know this type of shopper-on-shopper violence is a huge draw.

    So what does it all mean? O’Neil points out that coverage of Black Friday brawls is a big ratings draw, which makes it the perfect place for yet more commercials to promote Black Friday sales:

    It’s hard to avoid the message of those ads. We’ve been bombarded with them for weeks now, from corporations eager to entice shoppers with so-called “door-buster” deals. And then, once the shopping public falls for them, a privileged segment of the population sits back and dehumanizes them for its collective amusement. Look at these hilarious poor people, struggling to take advantage of a deal on something they might not otherwise be able to afford on items that we take for granted, we joke on Twitter. The message is the same: this is shameful, materialistic behavior. And by pointing it out, we differentiate ourselves, reaffirm our class status as being above the fray of the lowly and desperate.

    If you read this wrong, it can seem like just a bit of tiresome PC tsk-tsking. Do we have to feel guilty about everything these days?

    But O’Neil has a point, and it’s one that irks me as well. It’s similar to my irkitude over loyalty cards. Some of this, I’ll admit, is just my own personal brand of curmudgeonliness, but mainly it’s because the discounts they provide have become so damn big in recent years. For me, loyalty cards are optional if I feel like being cranky about it, but most people no longer have that luxury. If you’re living on a working-class income, you flatly can’t afford to give up a 10 or 15 percent discount on your food every week. You have to fork over your loyalty card number, and that means everything you buy is sliced, diced, tracked, and sold to every marketer in the world. Don’t like it? If you’re poor, that’s tough. Your privacy is no longer even an option.

    In a sense, of course, these are both just routine examples of how the lives of the poor are harder than the lives of the non-poor—and there’s hardly anything insightful in pointing out that the poor lead hard lives. Still, there are limits. Do we really have to mock them for the mere fact of having incomes low enough that Black Friday sales are meaningful to them? Do we really have to create a marketplace in which merely having a low income forces you to make the most intimate details of your life available to anyone willing to pay a few dollars for it?

    These are hardly the biggest problems of the poor. I don’t even know if they’d make the top 100. But they’re both examples of the way in which being poor doesn’t just mean you can’t afford as much nice stuff as richer folks. They’re examples of ways that we rob the poor of dignity for no real reason other than being poor. So even if they aren’t the biggest problems in the world, they’re worth thinking about occasionally.

  • Did Ray Rice Get What He Deserved?


    Over at Vox, Amanda Taub easily dismantles the argument that the NFL and Roger Goodell initially went easy on Ray Rice because they didn’t know the details of exactly what he had done. The arbitrator’s report makes it crystal clear that (a) they knew, and (b) they could easily have viewed the damning elevator videotape if they’d had even the slightest interest in it. There was obviously something else at work:

    The reason Rice wasn’t given a more severe punishment in the first place is that the NFL didn’t take the assault seriously enough….In the arbitration, the NFL claimed that Rice misled them by saying that he only “slapped” Palmer, and that she had “knocked herself out” on the railing, rather than that he had knocked her out. (The other witnesses to the disciplinary hearing deny that, and Rice claims that he not only used the word “hit,” he also demonstrated to the Commissioner how he had swung his fist across his body during the assault, making its force clear.)

    But the fact that the NFL made that argument suggests that they still don’t understand domestic assault, or take it seriously enough. The idea that it is somehow morally superior to “slap” one’s girlfriend than to “hit” her is bizarre, particularly in a situation in which the alleged “slap” knocked the victim unconscious.

    Yep. The NFL has since tightened its standard disciplinary action for domestic violence, but only time will tell if their attitude lasts—or, better yet, becomes even less tolerant.

    Still, the stock liberal narrative that Rice was essentially let off with a slap on the wrist leaves me uneasy. What Ray Rice did was horrific, and it’s inevitable that any hesitations on this score will be taken as some kind of defense of his action. For the record, that’s not what I mean to do here. But I’m uneasy nonetheless and want to make two related points.

    First, although Ray Rice’s assault of Janay Palmer was horrible, any sense of justice—no matter the crime—has to take into account both context and the relative severity of the offense. And Ray Rice is not, by miles, the worst kind of domestic offender. He did not use a weapon. He is not a serial abuser. He did not terrorize his fiancée (now wife). He did not threaten her if she reported what happened. He has no past record of violence of any kind. He has no past police record. He is, by all accounts, a genuinely caring person who works tirelessly on behalf of his community. He’s a guy who made one momentary mistake in a fit of anger, and he’s demonstrated honest remorse about what he did.

    In other words, his case is far from being a failure of the criminal justice system. Press reports to the contrary, when Rice was admitted to a diversionary program instead of being tossed in jail, he wasn’t getting special treatment. He was, in fact, almost a poster child for the kind of person these programs were designed for. The only special treatment he got was having a good lawyer who could press his cause competently, and that’s treatment that every upper-income person in this country gets. The American criminal justice system is plainly light years from perfect (see Brown, Michael, and many other incidents in Ferguson and beyond), but it actually worked tolerably well in this case.

    Second, Ray Rice committed a crime. We have a system for dealing with crimes: the criminal justice system. Employers are not good candidates to be extrajudicial arms for punishing criminal offenders, and I would be very, very careful about thinking that they should be.

    Now, I’ll grant up front that the NFL is a special case. It operates on a far, far more public level than most employers. It’s a testosterone-filled institution, and stricter rules are often appropriate in environments like that. Kids take cues from what they see their favorite players doing. TV networks and sponsors understandably demand a higher level of good behavior than they do from most employers.

    Nevertheless, do we really want employers—even the NFL—reacting in a panic to transient public outrage by essentially barring someone for life from ever practicing their craft? Should FedEx do that? Should IBM do that? Google? Mother Jones? Perhaps for the most serious offenses they should, and it’s certainly common to refuse to hire job candidates with felony records of any kind. (Though I’ll note that a good many liberals think this is a misguided and unfair policy.) But for what Ray Rice did?

    I just don’t know about that. Generally speaking, I think we’re better off handling crimes through the criminal justice system, not through the capricious judgments of employers—most of whom don’t have unions to worry about and can fire employees at a whim. I might be overreacting, but that seems like it could become a dangerous precedent that hurts a lot more people than it helps.

    I’m not unshakeable about about this, so please argue about it in comments—though I’d really prefer it if we could avoid ad hominem attacks that I just “don’t get” the scourge of domestic violence. I have precious little tolerance for domestic violence, and that generic accusation gets us nowhere anyway. My actual argument is this: (a) Rice is a one-time offender who made a momentary mistake, not someone who’s a serial abuser; (b) this is normally grounds for relative leniency; (c) Rice was treated reasonably by the criminal justice system; (d) that’s the appropriate place for handling crimes like this. We should not applaud workplaces being turned into arbitrary kangaroo courts simply because a case happens to get a lot of public attention. It’s a slippery slope that we might come to regret.

    POSTSCRIPT: Looking for counterarguments? I’ll give you a few:

    • Rice was not acquitted. If he completes the diversionary program the case will not show up on his record. But he was indicted on felony aggravated assault charges, and more than likely would have been convicted if the case had gone to trial.
    • For reasons noted above, the NFL has a special responsibility to be tougher than most businesses on domestic violence offenders (and, I might add, other crimes as well—drunk driving, for example, is potentially far more dangerous than what Rice did).
    • We need to send a message about domestic violence, and a high profile case like this makes more difference than a thousand routine convictions. If, as a result, one millionaire athlete ends up being treated slightly unfairly, that might be an acceptable tradeoff.

  • Friday Cat Blogging – 28 November 2014


    Today’s theme is cat TV. On the left, Hilbert is camped out in front of the small TV in the dining room, perhaps hoping for a rerun of the squirrel docudrama that aired last week. On the right, Hopper is entranced by the big-screen TV in the study, probably watching the hummingbird reality series that seems to air constantly around here. It never gets old, though.

    Have a happy black-and-white Friday. Also, a happy gray-and-white Friday. And be sure to watch lots of cat-approved TV.