Thursday, April 24, 2014

Cruising the Web

The State Department had a day to come up with accomplishments from the Clinton time as Secretary of State. You can read what they came up with, but it's not very impressive. They're proud that she traveled overseas promoting trade and focused more on women and girls. They also did some bureaucratic reorganization and created some new bureaus. That's it. The reporter who asked the original question was not impressed.
There it was. With plenty of time to prepare, the State Department came up with a number of mostly bureaucratic reorganizations as the legacy of Secretary Clinton's QDDR. Lee was not impressed. "Were there any of these that didn’t simply involve rearranging of the bureaucratic deck chairs or shuffling responsibilities between one bureau to another or creating a new level of bureaucracy?" he asked. "Were any of the accomplishments in – outside of that, those areas?"

"Absolutely, Matt," answered Psaki. "I would say the whole process, if it works well, as it did in 2010, or leading up to 2010, is to better determine priorities and how to make things work better in a large functioning bureaucracy."

After a bit of back-and-forth, Lee tried again: "I'm asking for actual demonstrable outcomes, not the creation of a new position or a new job." Lee wondered whether beyond turning this office into that bureau, or signaling that this or that issue would now be a priority for the Secretary of State -- whether beyond that sort of organizational business the QDDR had actually done things. After an exchange about the accomplishments, or lack of accomplishments, of a Clinton-created entity known as the Energy and Resources Bureau, Lee and Psaki appeared to call it a draw, and the briefing ended.

Hillary Clinton's memoir of her time as Secretary of State, Hard Choices, is scheduled to come out in June. If, as many observers believe, it is part of the rollout of Clinton's 2016 presidential candidacy, the recent statements from the State Department raise a question: Will voters care if Clinton reorganized the Under Secretary for Economic Growth, Energy, and the Environment? Or will they be looking for something much, much bigger?
If Hillary does indeed run in 2016, the GOP slogan can be to rerun Walter Mondale's question of Gary Hart in 1984, "Where's the Beef?"

George Will analyzes the tropes of Barack Obama's rhetoric and finds it rather...adolescent.
First came the invocation of a straw man. Celebrating the ACA’s enrollment numbers, Obama, referring to Republicans, charged: “They said nobody would sign up.” Of course, no one said this. Obama often is what political philosopher Kenneth Minogue said of an adversary — “a pyromaniac in a field of straw men.”

Adolescents also try to truncate arguments by saying that nothing remains of any arguments against their arguments. Regarding the ACA, Obama said the debate is “settled” and “over.” Progressives also say the debate about catastrophic consequences of man-made climate change is “over,” so everyone should pipe down. And they say the debates about the efficacy of universal preschool, and the cost-benefit balance of a minimum-wage increase, are over. Declaring an argument over is so much more restful than engaging with evidence.

A third rhetorical move by argumentative adolescents is to declare that there is nothing to argue about because everything is going along swimmingly. Seven times Obama asserted that the ACA is “working.” That is, however, uninformative because it is ambiguous. The ethanol program is “working” in the sense that it is being implemented as its misguided architects intended. Nevertheless, the program is a substantial net subtraction from the nation’s well-being. The same can be said of sugar import quotas, or agriculture subsidies generally, or many hundreds of other government programs that are, unfortunately, “working.”

Finally, the real discussion-stopper for the righteous — and there is no righteousness like an adolescent’s — is an assertion that has always been an Obama specialty. It is that there cannot be honorable and intelligent disagreement with him. So last week, less than two minutes after saying that the argument about the ACA “isn’t about me,” Obama said some important opposition to the ACA is about him, citing “states that have chosen not to expand Medicaid for no other reason than political spite.”

If you'd been worried about the unchecked power given the Independent Payment Advisory Board or IPAB in Obamacare, there is another unchecked agency, the Center for Medicare and Medicaid Innovation, that is just as worrisome. The way the law is written the Center gets regular appropriations and doesn't have to go through the regular appropriations process.
The statute also gives the Center wide-ranging authority to alter the Medicare and Medicaid programs without further congressional action. It is supposed to be testing new ways to pay providers of medical services. Changes that are found through pilot programs to reduce costs without harming quality, or found to be budget neutral while improving quality, can be implemented nationwide through regulatory fiat.

The agency's broad mandate reveals the mind-set of ObamaCare's authors. The premise is that the federal government is best positioned to lead an effort in innovation in medical delivery, despite all evidence to the contrary. The history of Medicare's payment systems over four decades is one of politicized decision-making by regulators, protection of incumbent providers, and roadblocks to new medical technologies and new ways of doing business, such as using information technology to consult with patients, or employing non-physician clinics for routine patient care. It's the opposite of an environment conducive to innovation. Consequently, inefficiency is rampant in Medicare's traditional fee-for-service program.
As Lanhee J. Chen and James C. Capretta point out, what the Center is now promoting are the same tools used in Medicare Advantage, a program that Obamacare is in the process of shutting down.
Ironically, the Center for Medicare and Medicaid Innovation is now trying to promote initiatives, such as accountable-care organizations and bundled payments, that are the same tools already in use in Medicare's private-plan option, called Medicare Advantage. Medicare Advantage plans have the flexibility to test new payment methods and models of care, and have been doing so since the Medicare HMO program (Medicare Advantage's predecessor) began in 1982. These plans pioneered benefits like clinical care management, necessary to properly care for the sickest Medicare enrollees. Medicare Advantage plans also routinely cut costs by using clinical and claims data to screen out the most costly and lowest-quality providers of services in a community.

According to the Medicare Payment Advisory Commission, Medicare Advantage's HMOs provided patients with covered services for 92% of the cost of the traditional fee-for-service program in 2013. Nearly 30% of Medicare beneficiaries are now enrolled in Medicare Advantage plans, and new entrants are enrolling at an even higher rate.

Rather than build on this progress, ObamaCare cuts payments to Medicare Advantage plans by more than $150 billion over a decade—and relies instead on the Center for Medicare and Medicaid Innovation to prop-up the more costly fee-for-service program with government-led innovation. What's likely to transpire isn't innovation but price controls on medical procedures to give fee-for-service a chance to compete against more efficient Medicare Advantage plans. The agency's authority is broad enough to allow across-the-board cuts in payments to hospitals and physicians, and lower reimbursements for pharmaceuticals and related products as well, all in the name of innovation.

Bjorn Lomborg warns us that the deadliest environmental threat today is not global warming.
Many think the biggest global environment problem is global warming. After all, the issue gets the lion’s share of headlines and accounts for much of the hell-in-a-hand-basket environmental news we come across. But by any reasonable measure, this is entirely wrong. The most important is in fact indoor air pollution.

One-third of the world’s people — 2.9 billion — cook and keep warm burning twigs and dung, which give off deadly fumes. This leads to strokes, heart disease and cancer, and disproportionately affects women and children. The World Health Organization estimates that it killed 4.3 million people in 2012. Add the smaller death count from outdoor pollution, and air pollution causes one in eight deaths worldwide.
But indoor air pollution doesn't provide activists with the opportunity to excoriate those in the West for their lifestyle and to expand the power of government over people's daily lives as well as the economy. The solution to indoor air pollution is economic growth and that's just not of interest to environmentalists.

Jim Gaeraghty has a lot of fun contrasting Charlie Crist's previous avowals of being pro-life with his claim now that he is running as a Democrat for Florida's governor, that he has always been pro-choice.
There are a lot of Florida Democrats who will probably tell you they care about abortion – er, “abortion rights” or “reproductive rights.” The vast majority of them will, this fall, vote for a man who, during his 2006 race for governor, told a priest in Pensacola that he would sign a bill outlawing abortions except when the mother’s life was at stake. But then he told an AP reporter that he would only sign such a bill if it included exceptions for rape and incest. Also during that race, Charlie Crist attacked his GOP rival for being pro-choice. And as recently as January 2010, “Crist’s Republican U.S. Senate campaign released a statement saying he would ‘fight for pro-life legislative efforts.’”

And now he can come along and say, “even though I am pro-life, which I mean, for life, doesn’t mean I want to tell a woman what to do with her body, and I never have,” and almost every self-proclaimed pro-choice Florida Democrat will nod approvingly.

Because they don’t give a [insert your colorful metaphor here] what the heck Charlie Crist did in the past. They only care that he has a “D” after his name.
Mollie Hemingway contrasts some of the brouhahas that American feminists get upset about to the violence facing women around the world, particularly in Muslim countries. On those issues, most feminists are rather silent. It rather puts the concerns of American feminism in context.