Month: March 2014

One of
the more vivid political talking points to come out of Washington
in the midst of Russia’s military incursions into Ukraine is that
Russian President Vladimir Putin carried out such provocative
actions because Obama’s failure to enforce his “red line” on Syria
and commence with a bombing campaign this past fall signaled to
Putin he would not face consequences. Whenever the United States
fails to act with violence abroad—a rarity, writes John Glaser—you
have politicians and pundits howling about America’s “credibility”
being at stake. But anyone who actually believes Putin took
military action in Ukraine because Obama backed away from his plans
to bomb Syria illegally, doesn’t know anything about international
relations.

View this article.

A story that ran on the front page of yesterday’s
New York Times describes
an “unlikely” alliance between Attorney General Eric Holder and
libertarian-leaning Republicans that “may make politically possible
the most significant liberalization of sentencing laws since
President Richard M. Nixon declared war on drugs.” The
Times is right that the alliance is significant, but
its gloss on the motivation of Sen. Rand Paul (R-Ky.) and
other Republican reformers is a bit misleading:

For Mr. Holder, addressing sentencing laws is central to a
second-term agenda that also includes defending voting rights and
same-sex marriage. Black Americans have disproportionately received
lengthy prison terms and are extremely overrepresented in the
inmate population.

Libertarian-minded Republicans see long prison sentences as an
ineffective and expensive way to address crime.

Shorter version: Holder wants justice, while Republicans are in
it for the money. Yet Paul has passionately and eloquently
condemned the injustices caused by mandatory minimum sentences. At
a Senate hearing last September, he
said:

The injustice of mandatory minimums is impossible to ignore when
you hear the stories of the victims….There is no justice here. It
is wrong and needs to change.

During the same hearing Paul highlighted the racially
disproportionate impact of mandatory minimums:

If I told you that one out of three African-American males is
[prohibited] by law from voting, you might think I was talking
about Jim Crow, 50 years ago. Yet today a third of African-American
males are still prevented from voting because of the war on drugs.
The war on drugs has disproportionately affected young black males.
The ACLU reports that blacks are four to five times more likely to
be convicted for drug possession, although surveys indicate that
blacks and whites use drugs at about the same rate. The majority of
illegal drug users and dealers nationwide are white, but
three-fourths of the people in prison for drug offenses are African
American or Latino.

Paul took up the same theme in an April 2013
speech at Howard University. Furthermore, the sentencing reform
bill that Paul and Sen. Patrick Leahy (D-Vt.) introduced last March
goes farther than the bill
approved by the Senate Judiciary Committee in January, which is
the one the Obama administration is backing. The Paul-Leahy bill,
known as the Justice
Safety Valve Act, would effectively make mandatory
minimums optional, authorizing judges to depart from them in the
interest of justice. By contrast, the Smarter
Sentencing Act, introduced by Sens. Richard Durbin (D-Ill.)
and Mike Lee (R-Utah) last July, would make the 2010
reductions in crack sentences retroactive, cut the mandatory
minimums for certain drug offenses in half, and loosen the criteria
for the “safety valve” that allows some defendants to escape
mandatory minimums. Those are
important reforms, but they are substantially less
ambitious than the change proposed by Paul, who told the Senate
Judiciary Committee, “I am here to ask that we begin today the end
of mandatory minimum sentencing.”

In short, while Holder deserves credit for
decrying and seeking to ameliorate the harm caused by our
excessively punitive criminal justice system, he does not have a
monopoly on sympathy for people who do not belong in prison,
outrage at their predicament, or concern about the relationship
between skin color and draconian sentences. If anything, Rand’s
record on these points is stronger.

Looking beyond sentencing policy, the civil libertarian
credentials of Paul and several of his Republican allies are also
impressive, especially when compared to the Obama administration’s.
The Times notes that they “have accused the Obama
administration of trampling on personal freedom with drones,
wiretaps, tracking devices and too much government.” In fact, “Some
Republicans say that they are the ones being consistent on matters
of protecting liberties, and that Mr. Holder’s push for changes to
the sentencing laws is a step in their direction, not the other way
around.”

Ready for another bureaucratic
headache? On October 1 of this year, under federal government
rules, most medical providers and insurers will have to switch over
to
ICD-10, a new coding system for patient diagnoses and inpatient
procedures. The new standard has almost ten times as many codes as
ICD-9, which it supersedes. That’s supposed to allow for greater
precision. It also increases complexity, however,
as I’ve reported, and has the health industry concerned over
confusion and costs in the course of the massive transition.

The ICD-10 changeover would be daunting no matter what, but the
hard deadline plays a big role in fears. Last week, Marilyn
Tavenner, administrator of the Centers for Medicare and Medicaid
Services,
insisted that the deadline is firm and fast (it was already
delayed once), though CMS may allow for some hardship exceptions.
That’s not really calming anybody, as Grace-Marie Turner and Tyler
Hartsfield of the free-market Galen Institute note in an
op-ed for Investors Business Daily which refers to
ICD-10 as an “avalanche of time-wasting paperwork for doctors.”

Dr. Susan Turner, president and CEO of Medical Group Management
Association (MGMA), says the transition will be “one of the most
complex and expensive changes our health care system has faced in
decades.”

The ICD-9 has about 17,000 codes, while the new ICD-10 will have
more than 140,000. These cumbersome new administrative
responsibilities will take away from the time doctors can spend
with their patients. …

In a recent letter to HHS Secretary Kathleen Sebelius, Dr. James
Madara, CEO of the American Medical Association, said it will cost
a small practice up to $226,000 to comply. And there is no
opportunity to phase in the new system and iron out glitches. (We
saw how this worked out with the ObamaCare website … )

Because this coding system directly facilitates payments,
physicians who do not transition on time will experience a delay or
cessation of payments. To weather this transition, CMS suggests
that small and medium-size practices should have access to “reserve
funds or lines of credit to offset cash flow challenges.”

Turner and Hartsfield refer to Canada’s somewhat speed-bumpy
transition to ICD-10 a decade ago. That changeover,
according to Carl Natale of HealthCareITNews, was
staggered over the period from 2001 to 2005. Natale cites Gillian
Price, who was a consultant for Canadian healthcare organizations
during the transition.

Speaking of productivity, it tanked. The reduction ranged from
23 percent to 50 percent. And Price said productivity never fully
recovered. There was no way it could given the complexity of the
new codes and the changes needed in the healthcare
organizations.

Natale’s 2011 article doesn’t bash the new coding system, but it
does provide some hard lessons acquired over a phased-in adoption
of the system. It’s hard to see how the American experience,
planned for one day while the system is already reeling from
Obamacare, will be easier.

As it turns out, my wife and her fellow pediatric providers are
spending their lunch today going over ICD-10 changes at the local
hospital. They’re not even affiliated with the hospital—my wife’s
practice is independent—but they round on newborns whose parents
pick them as their pediatricians. In the course of rounding, they
need to know a couple of codes that will update with the new
system. That apparently requires an hour-long meeting.

The rest of ICD-10 my wife is handling in-house, including
training, updating her electronic health records system, and
socking away cash reserves. So far, she’s pretty confident in her
preparations. She’s leaning on payers on whom she relies
(**cough** Medicaid **cough**) to test their
systems.

October 1 is also supposed to be the next deadline after which
health plans must be Obamacare compliant to be renewed,
if that isn’t delayed.

For people who like watching bureaucratic trainwrecks, this
promises to be an interesting year.

President Obama’s budget proposes raising tax
revenue above its historical average over the next decade in order
to pay for federal spending. So where does all the new revenue come
from? Tax hikes and tax-code changes on high earners, the energy
industry, tobacco, and more.

The Cato Institute’s Nicole Kaeding samples a
few of the revenue raisers in the new White House budget
plan: 

The folks at Americans for Tax Reform have more detail on the
energy tax changes
here. 

The European Parliament elections will be held this May, and
there are some
European
politicians who are worried that some voters may turn to
anti-E.U. or racist parties.

One of the most prominent of the euroskeptic parties is the
United Kingdom Independence Party (UKIP). Nigel Farage, the leader
of UKIP, is known for not speaking ambiguously and for his animated
speeches in the European Parliament (a collection of highlights
below).

Earlier this month British Deputy Prime Minister and Leader of
the Liberal Democrats Nick Clegg
challenged Farage to a debate on the U.K.’s membership of the
E.U. Today it was reported that Farage has
accepted and that the televised hour-long debate will be held
on April 2.  

Clegg is a strong pro-E.U.
advocate. He speaks five European languages, has Dutch and
Russian ancestry, is married to a Spaniard, and served as a member
of the European Parliament from 1999 to 2004.

The pro-E.U. Liberal Democrats are one of the two parties in the
U.K.’s coalition government. Their coalition partners, the
Conservative Party, has some euroskeptic members. Indeed, much of
UKIP’s support comes from disgruntled former Conservatives
supporters, who are not happy about the Conservative’s position on
British membership of the E.U. British Prime Minister and Leader of
the Conservative Party David Cameron has pledged to
hold a referendum on the U.K.’s membership of the E.U. in 2017
if the Conservatives win the next general election.

What shouldn’t be overlooked regarding this debate is what the
British public think of Clegg, Farage, the Liberal Democrats, and
UKIP.

Unfavorable opinion towards Clegg has skyrocketed since the last
general election. A day after the 2010 general election only 19
percent of poll respondents of a
YouGov poll said that Clegg was doing “badly.” A year later
that figure was 71 percent and the most recent figures from last
month shows that 70 percent of respondents believe Clegg is doing
“badly.” Another collection of polling by
YouGov shows that currently only 9 percent of respondents would
vote for the Liberal Democrats, down from 18 percent in June
2010.

UKIP, which is currently polling slightly
above the Liberal Democrats, has enjoyed some recently increased
popularity but remains marred by embarrassing
scandals, prompting the party to ask members who are interested
in standing for office to declare that they have no
“skeletons in the cupboard.” Dan Hodges recently wrote a blog
post for The Telegraph titled
“UKIP is now a racist party” in which he outlines some of the
unpleasant behavior on display at UKIP’s recent spring
conference.

After the announcement of the debate YouGov put together

some polling information of Farage and Clegg. It doesn’t look
great for either of the men. I can’t see how putting them in the
same room for an hour to talk about the U.K.’s membership of the
E.U. is going to change these perceptions very much.