Later On

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Archive for December 23rd, 2015

Republicans Aren’t Delusional, Just Dishonest

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Kevin Drum has an interesting post at Mother Jones:

Today Jon Chait writes what must be about the millionth blog post explaining that nearly all conservative criticisms of Obamacare are wildly cherry-picked and intentionally deceptive. In fact, Obamacare is doing pretty well. Not that it matters. Nothing Chait says will have any effect because conservatives just don’t care. Obamacare is bad because it taxes rich people and provides health care to poor people. All the rest is just chaff.

Take this paragraph, for example. It’s about the Cadillac Tax, which partially removes the tax-exempt status of high-end health plans as a way of trying to rein in costs. It was supposed to take effect in 2018, but it’s now been moved out to 2020 because everyone1 hates it:

As bad as this news is for Obamacare, it’s absolutely catastrophic for Obamacare replacements. Every Republican plan to replace Obamacare relies on the same financing mechanism: limiting or repealing the tax break for employer-sponsored insurance. The Cadillac Tax is a smaller, more painless version of this same policy. If both parties can’t abide a partial rollback of the tax break for the most expensive health plans, they’re never, ever going to go along with eliminating the entire tax break for all health plans. The conservatives cackling over the demise of the Cadillac Tax are delusional — it’s as if they’re watching the backlash against the Iraq War in 2008 with fingers tented, anticipating that this will encourage war-weary Americans to support a land invasion of Russia. The bipartisan support for maintaining the tax break for employer insurance will hurt Obamacare, but it can survive. The Republican plans to replace it would all be wiped out.

This would be a devastating point—if all these conservative plans were actually serious. They aren’t. Republicans haven’t the slightest intention of ever enacting any of them. Their opposition to the Cadillac Tax doesn’t show that they’re delusional, it just shows that they’ve never taken their own plans seriously and couldn’t care less if any of them ever see the light of day.

1 Except for health wonks. But nobody cares about them.

Paul Krugman also points out that Obamacare is doing extremely well:

One of the remarkable aspects of the politics of health reform is the way conservatives — even relatively mild, seemingly informed conservatives — have managed to keep believing that Obamacare is unraveling, despite the repeated failure of disaster predictions to come true. Part of the way this works is that captive media and the right’s pet “experts” hype every bit of bad news, but go silent when the news is good (and, often, when the bad news turns out to have been a false alarm.) How many will even hear about the news that enrollments are once again running above expectations, and thepool is getting younger?

Anyway, it’s really helpful to have this new report from the Commonwealth Fund comparing actual performance with pre-implementation predictions. Premiums came in far below expectations; part, but only part, of this positive surprise was given back by 2016 premium hikes, with overall costs still looking very good.

On enrollments: fewer people than expected signed up for the exchanges, but an important reason was that fewer employers than expected ended coverage and moved their employees into the individual market. Meanwhile, Medicaid expanded more than expected — and the overall reduction in the number of uninsured was pretty much in line with forecasts: . . .

Continue reading.


Written by Leisureguy

23 December 2015 at 3:44 pm

The dark side of capitalism: Why airlines deliberately increase your suffering

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Tim Wu reports in the New Yorker:

This fall, JetBlue airline finally threw in the towel. For years, the company was among the last holdouts in the face of an industry trend toward smaller seats, higher fees, and other forms of unpleasantness. JetBlue distinguished itself by providing decent, fee-free service for everyone, an approach that seemed to be working: passengers liked the airline, and it made a consistent profit. Wall Street analysts, however, accused JetBlue of being “overly brand-conscious and customer-focussed.” [Wall Street analysts also bad-mouth Costco for paying good wages, even though paying a living wage reduces staff turnover and improves customer satisfaction and loyalty. Near as I can tell, Martin Shkreli would fit right in with Wall Street analysts, who seem to have a curiously high self-regard in terms of their actual accomplishments. – LG] In November, the airline, under new management, announced that it would follow United, Delta, and the other major carriers by cramming more seats into economy, shrinking leg room, and charging a range of new fees for things like bags and WiFi.

It seems that the money was just too good to resist. [Under capitalism, any increase in profit seems to be irresistible, regardless of long-term consequences: CEOs want to cash in and get out. – LG] In 2013, the major airlines combined made about $31.5 billion in income from fees, as well as other ancillaries, such as redeeming credit-card points. United pulled in more than $5.7 billion in fees and other ancillary income in 2013, while Delta scored more than $2.5 billion. That’s income derived in large part from services, such as baggage carriage, that were once included in ticket prices. Today, as anyone who travels knows well, you can pay fees ranging from forty dollars to three hundred dollars for things like boarding in a “fast lane,” sitting in slightly better economy-class seats, bringing along the family dog, or sending an unaccompanied minor on a plane. Loyal fliers, or people willing to pay a giant annual fee, can avoid some of these charges; others are unavoidable.

The fees have proved a boon to the U.S. airlines, which will post a projected twenty-billion-dollar profit in 2014. To be fair, airlines are not just profiting because of fee income. Reduced competition, thanks to mergers, helps. There is also the plummet in the price of oil, which the airlines seem to have collectively agreed is no reason to reduce fares or even remove “fuel surcharges.” But for the past decade it is fees that have been the fastest-growing source of income for the main airlines, having increased by twelve hundred per cent since 2007.

If fees are great for airlines, what about for us? Does it make any difference if an airline collects its cash in fees as opposed to through ticket sales? The airlines, and some economists, argue that the rise of the fee model is good for travellers. You only pay for what you want, and you can therefore save money if you, for instance, don’t mind sitting in middle seats in the back, waiting in line to board, or bringing your own food. That’s why American Airlines calls its fees program “Your Choice” and suggests that it makes the “travel experience even more convenient, cost-effective, flexible and personalized.”

But the fee model comes with systematic costs that are not immediately obvious. Here’s the thing: in order for fees to work, there needs be something worth paying to avoid. That necessitates, at some level, a strategy that can be described as “calculated misery.” Basic service, without fees, must be sufficiently degraded in order to make people want to pay to escape it. And that’s where the suffering begins.

The necessity of degrading basic service provides a partial explanation for the fact that, in the past decade, the major airlines have done what they can to make flying basic economy, particularly on longer flights, an intolerable experience. For one thing, as the Wall Street Journal has documented, airlines have crammed more seats into the basic economy section of the airplane, even on long-haul flights. The seats, meanwhile, have gotten smaller—they are narrower and set closer together. Bill McGee, a contributing editor to Consumer Reports who worked in the airline industry for many years, studied seat sizes and summarized his findings this way: “The roomiest economy seats you can book on the nation’s four largest airlines are narrower than the tightest economy seats offered in the 1990s.”

Boarding for non-élite flyers has also become a miserable experience. There are far more efficient ways to load planes than the current back-to-front method. . .

Continue reading.

I traveled quite a bit on airlines when they were still subject to government regulation, and the experience was quite good and sometimes excellent. Deregulation turned out to cost a lot.

Written by Leisureguy

23 December 2015 at 2:52 pm

Posted in Business

Why Police Need to Start Second-Guessing Their Decisions

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Seth Stoughton, Geoffrey Alpert, and Jeff Noble report in the Atlantic:

The trial of Officer William Porter, the first of six officers charged in the death of Freddie Gray, ended in a mistrial last week after the jury heard sharply conflicting accounts about the inner workings of the Baltimore Police Department. The prosecution emphasized the department’s comprehensive and clearly written policies and procedures, while the defense asserted that, in practice, officers ignore the formal rules as a matter of course. The two accounts revealed the limitations of a legal approach to police reform, and the necessity for departments and officers to self-critique their practices.

Often, when another officer provides critical feedback that does not affirm the officer’s decisions, such feedback falls on deaf ears. Comments like “You weren’t there” or “You don’t know what you would have done in that situation” are a common refrain. In some respects, this makes sense. In a seminal Fourth Amendment case, Graham v. Connor, the Supreme Court held that an officer’s use-of-force decisions “must be judged from the perspective of a reasonable officer, rather than with the 20/20 vision of hindsight.” It would not be appropriate or fair, for example, to judge an officer based on information that the officer did not have and could not have had at the time he or she acted. But this sensible limitation has, at times, been used in ways that undermine the police mission of ensuring the community’s safety.

In many departments, officers have developed a pathological aversion to “second-guessing.” There is a pervasive belief that scrutinizing officer’s use-of-force decisions will lead officers to hesitate, exposing them to dangers that swift action might have averted. The result is a reluctance to engage in an in-depth, critical review of incidents in which an officer injures or kills a civilian and resentment when an outsider calls for such a review. That’s a problem. When an incident ends badly, it should be critically dissected to identify what contributed to that result, as is done when an officer is seriously injured or killed. The primary purpose is not to blame an officer, although poor judgment and failures to follow policy and training must be addressed, but to learn how best to avoid a similar situation in the future.

The aversion to what officers derisively refer to as “second-guessing” does not only make officers less receptive to a critique of their actions, it also makes them reluctant to provide their own complete and honest critiques. That, too, is a problem. Informal interactions between officers shape agency culture and affect officer actions at least as much, and often more, than formal rules. But while empowering officers to engage in peer conversations may help in the effort to self-critique, policing culture also needs to be addressed.

Much of the issue made evident in the Baltimore trial stems from a culture in which officers see themselves as soldiers on the front lines in a war on drugs, crime, and terrorism. Military equipment, weaponry, and tactics were introduced to policing in the 1960s in the form of Special Weapons and Tactics teams, but the so-called warrior culture did not become a visible mainstay of day-to-day policing until the massacre at Columbine High School in 1999.

Officers began wearing alternative uniforms, such as BDUs, that created a more military appearance. Police agencies increasingly acquired and deployed armored vehicles, high-powered rifles, and other military equipment. Officers were taught, formally and informally, to view themselves as warriors, seeking out enemies and ready to attack at the first sign of crisis. The warrior culture has since become more ingrained with every sporadic active shooter, act of domestic terrorism, and ambush that takes the life of a fellow officer.

But using these incidents to justify an aggressive, adversarial approach to policing is a dangerous trend. The warrior culture undermines police-community partnerships, public trust, and the level of cooperation that effective policing depends on. The result, therefore, can be increasing amounts of violent crime, the amount of force that officers use, and even police misconduct. In short, such a culture compounds the very problems that officers and police agencies are struggling to address.

In California, the Peace Officer Standards and Training Commission has used a series of PSAs to encourage officers to have what it calls “courageous conversations” about officers’ driving habits, seatbelt use, speeding, and fatigue. The goal is to reduce the number of officers injured or killed in crashes. This concept could be expanded to other areas where peer correction can be a powerful motivation to change. Telling a fellow officer that they created a needless confrontation with a suspect by using an inappropriately hostile tone or that they put themselves into an avoidable use-of-force situation with unnecessarily aggressive tactics may be difficult, very difficult. But as Travis Yates, a commander with the Tulsa Police Department and the director of training for a police training company, is quoted as saying in one of the PSAs,“If these conversations were easy, they would not be called courageous.” . . .

Continue reading.

It will be a new era when the police subject officers guilty of misconduct to opprobrium, and tell them that they have let down the side. It will be a good day the police become as loyal to the standards of good policing as they are now to the occasional criminals in their midst.

And what is referred to as “second-guessing” seems in fact to be an after-action report and an effort to learn from experience to improve one’s competence.

Written by Leisureguy

23 December 2015 at 2:43 pm

Posted in Law Enforcement

Red-lentil soup with lemon

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I just made this soup, which is very tasty.

I used 1/4 c lemon juice. No need to purée: red lentils take care of that themselves. Otherwise I followed the recipe. (I used two medium carrots.)

Written by Leisureguy

23 December 2015 at 2:21 pm

Posted in Food, Recipes & Cooking

Bernie Sanders: The Quiet Revolt

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Simon Head writes in the NY Review of Books:

In 2003 I wrote in my The New Ruthless Economy that one of the great imponderables of the twenty-first century was how long it would take for the deteriorating economic circumstances of most Americans to become a dominant political issue. It has taken over ten years but it is now happening, and its most dramatic manifestation to date is the rise of Bernie Sanders. While many political commentators seem to have concluded that Hillary Clinton is the presumptive Democratic nominee, polls taken as recently as the third week of December show Sanders to be ahead by more than ten points in New Hampshire and within single-figure striking distance of her in Iowa, the other early primary state.

Though he continues to receive far less attention in the national media than Hillary Clinton or Donald Trump, Sanders is posing a powerful challenge not only to the Democratic establishment aligned with Hillary Clinton, but also the school of thought that assumes that the Democrats need an establishment candidate like Clinton to run a viable campaign for president. Why this should be happening right now is a mystery for historians to unravel. It could be the delayed effect of the Great Recession of 2007-2008, or of economists Thomas Piketty and Emmanuel Saez’s unmasking of the vast concentration of wealth among the top 1 percent and the 0.1 percent of Americans, or just the cumulative effect of years of disappointment for many American workers.

Such mass progressive awakenings have happened before. I remember taking part in antiwar demonstrations on the East and West coasts in the Fall and Winter of 1967-1968. I noticed that significant numbers of solid middle-class citizens were joining in, sometimes with strollers, children, and dogs in tow. I felt at the time that this was the writing on the wall for Lyndon Johnson, as indeed it turned out to be. We may yet see such a shift away from Hillary Clinton, despite her strong performance in the recent debates and her recent recovery in the polls.

If it happens, it will owe in large part to Sanders’s unusual, if not unique, political identity. Consider the mix of political labels being attached to him, some by Sanders himself: liberal, left-liberal, progressive, pragmatist, radical, independent, socialist, and democratic socialist. Sanders’s straight talk about the growing inequalities of income and wealth in America has been much written about, notably in a long profile of him inThe New Yorker in October. But most of this writing has been of the campaign trail genre, and has not gotten very far in sorting out the strands of radicalism that have come together in Sanders’s run for the presidency and that have attracted large numbers of Americans dissatisfied with their deteriorating economic circumstances and with the politics that has helped create them.

Sanders is unusual because he brings together three kinds of radicalism, each with very different roots. First is Sanders’s commitment to bringing the progressive ideas of Scandinavian social democracy to the United States, including free and universal health care, free higher education at state colleges and universities, mandatory maternity and sick leave benefits, and higher taxes on higher incomes. In American political history you have to go back to Lyndon Johnson’s Great Society or even to the early New Deal to find anything comparable.

The second strand of Sanders’s radicalism is his excoriating account of contemporary American capitalism, and with this he neither looks nor sounds like a consensus-minded Scandinavian social democrat. Here Sanders is willing to name and denounce the new economic royalists—what he calls collectively the “billionaire class”—in a way that Hillary Clinton, who has relied heavily on their financial backing, has not. These include the leading Wall Street banks and their lobbyists; the energy, health care, pharmaceutical, and defense industries; and the actual billionaires deploying their wealth on behalf of the far right, foremost among them the Koch brothers, the Walton family of WalMart, and the real estate tycoon Sheldon Adelson.

From these great concentrations of wealth and power, Sanders argues, derive multiple injustices: the corrupting of electoral and legislative politics with the Supreme Court’sCitizens United ruling; the steady erosion of the American middle class, which has suffered stagnating income and declining benefits, even as corporations return to profitability and enjoy historically low interest rates; and the emergence of an American workplace where most employees are putting in longer hours, earning less, and suffering from less job security than ever before.

Sanders can support these claims with substantial bodies of empirical data and research. There are the monthly figures put out by the government’s Bureau of Labor Statistics (BLS), which show a steady decline in real hourly and weekly earnings of most working Americans since the 1970s. There is the work of the French economists Thomas Piketty and Emmanuel Saez documenting a growing and overwhelming concentration of income and wealth in the US in the hands of the top 1 percent—and especially the top 0.1 percent—of taxpayers. There is also the research of Jacob Hacker of Yale, showing how the disposable income of middle-income Americans has been further eroded by health care and pension costs dumped on them by their corporate employers, what Hacker calls the Great Risk Shift.

But the challenge for Sanders is not the arguments themselves, which are widely acknowledged (Piketty’s book Capital in the Twenty-First Century was a runaway bestseller last year). The challenge is . . .

Continue reading. Note that the disconnected opposition (the networks of yesteryear—functioning Democratic political machines in large cities, labor unions—have been eliminated or seriously degraded in terms of power. So Head characteristics the classes suffering under the system are isolated. Oddly, he doesn’t mention (that I see) the way that the connection is evident: the internet provides a communication and connection capability that rivals anything of the past. And certainly it has been the Internet that mostly has reported on the Sanders campaign: the mainstream media have gone out of their way to avoid any reporting on Sanders, a point made in the article. This internet connection is probably what’s behind the urgency of telecomm efforts to destroy net neutrality: they may not be able to control the content of the messages, but they can damn sure choke off the communications of those messages and funnel people to corporate/capitalist message-givers (mainstream media, quite often).

See also Brad De Long’s article at TPM, The Melting Away of North Atlantic Social Democracy,” which begins:

Hotshot French economist Thomas Piketty, of the Paris School of Economics, looked at the major democracies with North Atlantic coastlines over the past couple of centuries. He saw five striking facts: First, ownership of private wealth—with its power to command resources, dictate where and how people would work, and shape politics—was always highly concentrated. Second, 150 years—six generations—ago, the ratio of a country’s total private wealth to its total annual income was about six. Third, 50 years—two generations—ago, that capital-income ratio was about three. Fourth, over the past two generations that capital-income ratio has been rising rapidly. Fifth, the flow of income to the owner of the dollar capital did not rise when capital was relatively scarce, but plodded along at a typical net rate of profit of about 5% per year generation after generation. He wondered what these facts predicted for the shape of the major North Atlantic economies in the 21st century. And so he wrote a big book, Capital in the Twenty-First Century, that was published last year.

It has been a surprise bestseller. Thomas Piketty’s English-language translator, Art Goldhammer, reports that there are now 2.2 million copies in print and e-book form in 30 different languages scattered around the globe.

Piketty’s big surprise best-selling book has one central claim: Two generations ago the major North Atlantic economies were all four stable social democracies—relatively egalitarian places when viewed in historical perspective (for native-born white guys, at least), with political voice widely distributed throughout the population, the claims of wealth to drive political directions and shape economic structures not neutralized but kept within bounds. That was the North Atlantic economy that we lived in and had grown used to as recently as one generation ago. That, Piketty argues, was an unstable historical anomaly. It is now passing away.

Piketty believes that the rising inequality trends we have seen over the past generation and see now are simply returning us to what is the pattern of unequal income distribution and dominant plutocracy that is normal for an industrialized market economy in which productivity growth is not unusually fast. We had thought otherwise, and grown used to the social-democratic structure of two generations ago only because it came at the end of an era in which productivity growth had been unusually fast; the various political, depression, and revolutionary shocks to overturn established and inherited wealth had been atypically large.

The social democratic economy model the major North Atlantic economies followed as recently as a single generation ago had five salient features. First, . . .

Continue reading.

And another “see also”: “Is the DNC Throwing Up Roadblocks to Bernie Sanders’ Campaign?“, in Wall Street on Parade, by Pam Martens and Russ Martens.

Written by Leisureguy

23 December 2015 at 12:36 pm

Almost half of those shot to death by Georgia police were unarmed and/or shot in the back; no charges filed

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That’s just one of Radley Balko’s links today. A few others:

  • Supreme Court to rule on whether using public roads means you give the government the right to forcibly take your blood.
  • Atlanta Journal-Constitution analysis of 184 Georgia police shootings since 2010 finds that nearly half the victims were unarmed or shot in the back. None resulted in criminal charges.

There are more at the link.

Written by Leisureguy

23 December 2015 at 11:34 am

Posted in Law Enforcement

Internet freedom is being actively destroyed in the US

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Jason Koebler reports for Motherboard:

It’s the end of 2015, and one fact about the internet is quickly becoming clear this year: Americans’ freedom to access the open internet is rapidly dissolving.

Broadband access is declining, data caps are becoming commonplace, surveillance is increasing, and encryption is under attack.

This is not merely my opinion. The evidence is everywhere; the walls are closing in from all sides. The net neutrality victory of early this year has rapidly been tempered by the fact that net neutrality doesn’t matter if you don’t have solid access to said ‘net.

A Pew Research Center survey released earlier this week showed that at-home broadband adoption has actually decreased over the last two years, from 70 percent of people to 67 percent of people. Among black Americans, that number has dropped from 62 percent to 54 percent; among rural residents, the number has dropped from 60 percent to 55 percent.

There’s a relatively simple explanation for these stats: The percentage of people who have only a smartphone plan instead of broadband internet at home has increased from 8 percent in 2013 to 13 percent in 2015; among black Americans it has nearly doubled from 10 percent to 19 percent; among rural residents it has gone from 9 to 15 percent.

It doesn’t take an economist to suss out why this is happening: Broadband is expensive, smartphone data is expensive, and at some point you’ve got to make some tough choices. Pew notes that people who go smartphone-only are likely to be poorer and often have to “cancel or suspend service due to financial constraints” and that the most common reason people don’t have broadband internet is its high cost. . .

Continue reading.

You can find interesting charts at the link

Written by Leisureguy

23 December 2015 at 11:19 am

What the Falling Price of Oil Is Telling You

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Very interesting column at Wall Street on Parade, by Pam Martens and Russ Martens. From the column:

Exactly one year ago today, the headline story at Wall Street On Parade was titled: “Oil Crash: Don’t Believe the Happy Clatter.” We explained that there was a “mushrooming false narrative taking over the business airwaves” predicting that the rapid price decline in oil would lower gas prices at the pump, fueling a healthier consumer with more disposable income and thus a more robust economy for 2015. Our counter prediction was that the oil price collapse “will decidedly not lead to a more robust economy in the United States for very long.” . . .

And where are we today in terms of industrial commodity prices? Are prices stabilizing? Surely they must be if the Federal Reserve just hiked interest rates to keep U.S. economic growth from overheating.

Unfortunately, according to a report today at the Dow Jones web site, MarketWatch, the U.S. coal industry is in the midst of “serial bankruptcies”; the two major oil benchmarks, West Texas Intermediate and Brent, “have lost more than a third of their value” in 2015; copper is off by over 27 percent, iron ore by over 45 percent, with platinum and palladium each off by over 30 percent.

Welcome to the new normal – where the Fed tells us how good things are as the materials used in a growing economy continue to collapse in price from slack demand and growing gluts.

Written by Leisureguy

23 December 2015 at 10:55 am

Posted in Business, Daily life

Oxycontin maker bankrolls efforts to undermine prescription painkiller reform

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The cigarette industry is a notable example: once a customer is addicted, price becomes irrelevant. (Drug dealers are familiar with this dynamic, though of course one cannot obtain from a person more money than they have—but addicts generally go to considerable lengths, including crime, to get the funds necessary to satisfy their addiction.)

Obviously, drug dealers fight drug legalization. (When I grew up in Oklahoma, liquor was illegal, and efforts to legalize liquor were fought strenuously by a cooperative effort on the part of bootleggers and Baptist ministers.)

Lee Fang reports in The Intercept:

The pharmaceutical companies that manufacture and market OxyContin, Vicodin, and other highly addictive opioid painkillers — drugs that have fueled the epidemic of overdoses and heroin addiction — are funding nonprofit groups fighting furiously against efforts to reform how these drugs are prescribed.

While the Centers for Disease Control and Prevention was close to finalizing voluntary prescribing guidelines for opioid painkillers next month, it abruptly changed course. According to a report from the Associated Press, the CDC was forced to “abandoned its January target date, instead opening the guidelines to public” comment after a number of “industry-funded groups like the U.S. Pain Foundation and the American Academy of Pain Management warn[ed] that the CDC guidelines could block patient access to medications.”

The new guidelines would encourage doctors to prescribe opioids as a last choice for chronic pain, a sharp departure from the status quo, in which many doctors, under pressure from pharmaceutical sales representatives, often prescribe painkillers for mild back pain or a toothache. As experts note, many painkiller and heroin addicts start abusing opioids after receiving a legitimate prescription for pain-related medical issues.

An investigation by The Intercept has found that the pharmaceutical companies that dominate the $9 billion a year opioid painkiller market have funded organizations attacking reform of the prescribing guidelines:

  • The Washington Legal Foundation, a nonprofit that litigates to defend “free-market principles,” threatened the CDC with legal action if the agency moved forward with the proposed opioid guidelines. The WLG claimed the CDC’s advisory panel for the guidelines lacked “fair ideological balance,” because it included a doctor who is part of an advocacy effort against opioid addiction. The WLG does not disclose donor information, but has filed friend of the court briefs on behalf of Purdue Pharma, the makers of OxyContin. In a recent article with Pain News Network, a spokesperson for Purdue Pharma conceded: “We’re long-standing supporters of WLF, in addition to several other business and legal organizations. We’ve provided them with unrestricted grants.”
  • The Pain Care Forum organized opposition to the CDC prescribing guidelines, mobilizing regular meetings among stakeholders opposed to the idea, according to an investigation by AP reporter Matthew Perrone. A recently re-filed complaint by the City of Chicago found that Burt Rosen, the chief in-house lobbyist for Purdue Pharma, controls the Pain Care Forum. A former drug company employee allegedly told investigators that Rosen tells the Pain Care Forum “what to do and how we do it.” The Pain Care Forum is funded through contributions by Purdue Pharma, as well as major opioid manufacturers Cephalon, Endo, and Janssen, a subsidiary of Johnson & Johnson.
  •  The Power of Pain Foundation, a group funded by Purdue Pharma, asked supporters to contact the CDC in opposition to the guidelines, claiming that, “taking away pain medication and making providers afraid to prescribe due to your guidelines is only going to make more abusers, increase suicides, and tear apart the lives of millions.”
  • The U.S. Chamber of Commerce, a corporate lobbying group that represents opioid manufacturers, including Johnson & Johnson, issued a press release masquerading as a news story criticizing the CDC guidelines (The U.S. Chamber operates a public relations effort dressed up as as a bonafide media outlet called Legal Newsline, which it uses to disseminate stories that support the political priorities of its member companies.) . . .

Continue reading.


Written by Leisureguy

23 December 2015 at 10:39 am

New Jersey Psychology Practice Revealed Patients’ Mental Disorders in Debt Lawsuits

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Charles Ornstein reports in ProPublica:

When a New Jersey lawyer named Philip received legal papers last year informing him that his former psychologist’s practice was suing him over an unpaid bill, he was initially upset they could not work out a payment arrangement outside of court.

It was only later, Philip said in an interview, that he scanned the papers again and realized something else: The psychology group to which he’d confided his innermost feelings had included his mental health diagnosis and treatments he received in publicly filed court documents.

The greatest fear of many patients receiving therapy services is that somehow the details of their private struggles will be revealed publicly. Philip, who requested his last name not be used to protect his privacy, said he felt “betrayed” by his psychologist. He worried that his legal adversaries would find the information and try to use it against him in court.

“It turned my life upside down,” he said.

Short Hills Associates in Clinical Psychology, the group based in New Jersey that treated Philip, has filed dozens of collections lawsuits against patients and included in them their names, diagnoses and listings of their treatments.

In cases in which the patients were minors, the practice sued their parents and included the children’s names and diagnoses.

The Health Insurance Portability and Accountability Act, the federal patient privacy law known as HIPAA, allows health providers to sue patients over unpaid debts, but requires that they disclose only the minimum information necessary to pursue them.

Still, the law has many loopholes, which ProPublica has been exploring in a series of articles this year. One is that HIPAA covers only providers who submit data electronically — and apparently Short Hills Associates does not.

Between 2010 and 2014, Short Hills Associates filed 24 collections cases in which patients’ diagnoses were listed, New Jersey court records show. The defendants included lawyers, business people and a nonprofit official.

The suits identified diagnoses by unique codes listed in the Diagnostic and Statistical Manual of Mental Disorders, the reference work on mental illness published by the American Psychiatric Association. An online search of the codes quickly provides their meaning.

Short Hills Associates’ managing partner, Barry Helfmann, has been a leader in New Jersey psychology circles. He is a past president of the New Jersey Psychological Association and serves as its director of professional affairs. He has also served on the board of the American Group Psychotherapy Association.

In other contexts, Helfmann has been a champion of patient privacy. In 2010, he was a plaintiff in a lawsuit against two insurance companies and a New Jersey state commission, accusing them of requiring psychologists to turn over their treatment notes in order to get paid.

Philip is now countersuing Helfmann and his partners, the psychology group and the practice’s debt collection lawyers for invasion of privacy, breach of the psychologist-patient privilege, fraud and misrepresentation and other claims. He is seeking the court’s permission to represent other patients as part of a class action.

Jon, another person being sued by Short Hills Associates for unpaid bills, said he was surprised to learn from a reporter last week that his son’s name and diagnosis was included in court papers. He hadn’t noticed at the time. . .

Continue reading.

Written by Leisureguy

23 December 2015 at 10:24 am

Posted in Daily life, Law, Medical

What is “price gouging”?

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I have the idea, perhaps incorrect, that “price gouging” occurs only when someone actually pays the (gougish) price quoted. If I decide to sell my Wilkinson “Sticky” for $35,000, no one would buy and no one would be gouged. The price is ridiculous, but it’s not “gouging” until someone is gouged.

And even then, since it’s a completely discretionary purchase, the transaction seems to lack an element needed for true gouging: the buyer presumably is willing to pay the $35,000 because, from his perspective, the razor is worth more to him than the $35,000 price. Perhaps he’s a hedge-fund manager whose salary (taxed at a substantially lower rate than ordinary income) is $1 billion per year, which would not even get him into the top three on the list at the link. Assuming an 80-hour work week, that’s just over $240,000/hour from salary alone (ignoring income from his investments). Thus if he spends 9 minutes or more on the purchase, that would be more than $35,000 worth of his time. (This notion was popularized a few years back when it was calculated that stopping to pick up a $100 bill that he dropped would cost Bill Gates more than $100.)

Perhaps it would be better to look at shotguns. Do the prices of Purdey shotguns reflect price gouging? (Here’s a catalog of some secondhand models that are for sale.) Certainly they cost a lot of money, but OTOH, they apparently are worth that much money to those buying them—actually worth a bit more, since the buyer feels he’s coming out ahead in exchanging the money for the gun (with the seller finding the money worth more (to him) than the gun.)

The key is that in buying a razor or a Purdey gun, the purchase is discretionary.

Contrast that with a medication that is needed if you are to continue living, or water in a desert, or food during a famine. People who must have the medication or die, or who must have water or food or die, will have no choice but to pay the price. That lack of discretion makes applying a price that represents an enormous profit, above and beyond the cost of the (required) good being sold, is price-gouging, as I see it. In this case the purchase is not discretionary but required, so excessive prices must be paid, and that is the gouging.

This occasionally comes up in shaving forums for expensive razors: “price gouging” is quickly attributed to the sellers, but that really doesn’t make sense to me. Those who buy the razor think it’s worth more to them than the price, and those who refuse to pay the price are not gouged.

Written by Leisureguy

23 December 2015 at 10:19 am

Posted in Business

The dark side of capitalism: Jacking up the price of old drugs to increase profit

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Capitalism and free enterprise are highly thought of in the US in general, and by the GOP in particular. While it’s fairly common to laud the benefits of capitalism and only a little less common to bemoan government “interference” in the free operation of the mark, common decency and justice obliges us to recognize that capitalism has a very dark side—for example, the 29 miners killed in a mine explosion when Don Blankenship, in the pursuit of greater profits, refused to observe safety standards imposed by the government. Here’s another instance of the downside of capitalism, reported by Sabrina Tavernise in the NY Times:

Fred Kellerman, a retired car salesman from Los Angeles, was bedridden with a rare neuromuscular disease when he started taking a drug in the 1990s at Duke University in North Carolina. It changed his life.

“I had to have a wheelchair to get onto the airplane, but by the time I left, I could walk on,” he said.

Mr. Kellerman has been using the drug ever since, paying nothing but postage. In an unusual act of charity, a small family-run drug company in Plainsboro, N.J., has been giving it away. The drug was never formally approved by the Food and Drug Administration, but was provided under an obscure federal drug provision.

But one company’s generosity is another’s opportunity. Catalyst Pharmaceuticals, a Wall Street-traded company, last week completed an application to the F.D.A. for formal approval of a slightly modified version of the drug that does not need refrigeration. In a presentation to investors last spring, Catalyst estimated that it could make $300 million to $900 million a year from the drug, named Firdapse, that could eventually benefit as many as 8,000 patients. That works out to possibly more than $100,000 per patient.

Catalyst’s move has brought fears among patients of a punishing price increase and led to a recent call from more than 100 neuromuscular doctors for “ethical and just pricing.” Catalyst says it has not yet chosen a price and that patients’ fears are misplaced. Jacobus Pharmaceutical, the private company that has been giving away the drug, says it will also seekF.D.A. approval. The winner is likely to receive seven years of exclusive rights to sell the drug. The F.D.A. does not consider price in its evaluations, though the doctors argue that perhaps it should.

The showdown between the companies powerfully illustrates the growing tension in the United States over the rising prices of drugs. The issue has drawn increased scrutiny from policy makers and prompted rising public outrage, much of it directed at Martin Shkreli, a former hedge fund manager who has become a symbol for pharmaceutical price gouging. Turing Pharmaceuticals, the company he formerly headed, and others have been harshly criticized for abruptly raising the prices of medicines after acquiring them — without having taken the risks involved in research and development.

The neuromuscular doctors who signed an editorial in the journal Muscle and Nerve this month argue that Catalyst is seeking to profit from old medical research. But other experts credit the company with spending the time and money to get the drug approved. That will eventually make it possible for doctors everywhere to write prescriptions, instead of the few willing to fill out paperwork for each patient, said Kenneth I. Kaitin, director of the Tufts Center for the Study of Drug Development.

Catalyst’s drug has been granted special status under the Orphan Drug Act, a law passed by Congress in 1983 to stimulate the development of drugs for rare diseases that would otherwise not be profitable, offering fast-track approval, tax breaks and seven years of market monopoly. But the law has been abused, critics say, with drug companies “salami slicing” more common diseases into small categories, or repurposing older drugs that have been in general use for many years but never had F.D.A. approval, or were approved for different treatments.

“The Orphan Drug Act has been turned on its head in recent years,” said Henry A. Waxman, the former Democratic congressman who sponsored the law. “It has created a special status for orphan diseases that offer large potentials for making generous profits.”

In an analysis published in November in the American Journal of Clinical Oncology, Dr. Martin A. Makary, a professor of surgery at Johns Hopkins University School of Medicine, calculated that 44 percent of drugs approved by the F.D.A. last year qualified as orphan drugs. Prices for orphan drugs have soared, but insurance companies often cover them because they affect such small populations of patients.

“The Orphan Drug Act was intended to promote new drug development, not price gouging of old drugs,” Dr. Makary said. . .

Continue reading.

It’s not totally clear-cut, of course. Things seldom are. FDA approval is achieved only after a fairly expensive process, and until that approval is secured, the drug is barely on the market. Still, Martin Shkreli showed the weaknesses of the purely capitalistic approach in several ways.

Written by Leisureguy

23 December 2015 at 8:59 am

Wet Shaving Products soap, the Wee Scott, and the Wilkinson “Sticky”

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SOTD 23 Dec 2015

Yet another excellent shave. The Wee Scott had no trouble holding lather for a three-pass shave, and some of that is due to the excellence of the soap. Unlike the Formula T (tallow) Wet Shaving Products soap, this is their “rustic” shaving soap, which has a vegan formula: Stearic acid, water, coconut oil, potassium hydroxide, glycerin, and fragrance. They were trying for a knock-off of Martin de Candre’s excellent shaving soap, and indeed this soap lathers like a house afire. The size shown is their 1-ounce size, perfect for travel. I’m impressed by this soap.

The razor today is the Wilkinson “Sticky,” one of the few razors I have in which a Feather blade works well for me, and it worked quite well today, providing a very comfortable shave with a BBS finish.

A good splash of Saint Charles Shave’s Dark Rose, and we on the threshold of Christmas eve. I pick up the roast today.

Written by Leisureguy

23 December 2015 at 8:29 am

Posted in Shaving

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