Later On

A blog written for those whose interests more or less match mine.

Archive for February 10th, 2019

“All the best people”: A must-see graphic

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What a brilliant concept. Click any of the Best People in the menu at the top, and get a report of exactly what they’re best at.

You know, it’s not all that common for a sitting president to be connected with and surrounded by so many criminal investigations, guilty pleas, convictions, …

I suppose we are to believe President Trump and not our lyin’ eyes.

Written by LeisureGuy

10 February 2019 at 12:45 pm

Much of the world seems stuck in the Dark Ages

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The Middle East is a good example of badly functioning societies.

Vivian Yee reports in the NY Times:

The princess known as Sheikha Latifa had not left Dubai, the glittering emirate ruled by her father, in 18 years. Her requests to travel and study elsewhere had been denied. Her passport had been taken away. Her friends’ apartments were forbidden to her, her palace off-limits to them.

At 32, Sheikha Latifa bint Mohammed al-Maktoum went nowhere without a watchful chauffeur.

“There’s no justice here,” she said in a video she secretly recorded last year. “Especially if you’re a female, your life is so disposable.”

So it was with a jolt of astonishment that her friends overseas read a WhatsApp message from her last March announcing that she had left Dubai “for good.”

“I have a very uncomfortable feeling,” one of them, an American sky diver named Chris Colwell, messaged back. “Is this real,” he added. “Where are you.”

“Free,” she responded. “And I’ll come see you soon.” She added a heart.

Her escape — planned over several years with the help of a Finnish capoeira trainer and a self-proclaimed French ex-spy — lasted less than a week.

Within a few days of setting sail on the Indian Ocean in the Frenchman’s yacht, bound for India and then the United States, the Sheikha went silent. She has not been seen since, except in a few photos released in December by her family, which says she is safely home after surviving what they said was a kidnapping.

Yet thanks to the video she made before fleeing, the sheikha’s face and voice have made their way around the world, drawing more than 2 million views on YouTube, spurring avid news coverage and marring Dubai’s image as a world capital of glitz and commerce like a graffiti tag.

Like the young women who have fled Saudi Arabia’s restrictive regime, Sheikha Latifa has made sure no one can forget how few freedoms are allotted to women in the Middle East’s most conservative societies — or how costly crossing Dubai’s ruler can be.

For all its megamalls, haute cuisine and dizzying skyscrapers, Dubai can flip at speed from international playground to repressive police state. It has drawn headlines in the West for detaining foreigners for holding hands in public and drinking alcohol without a license.

Last year, it was widely condemned for holding a British academic, Matthew Hedges, after accusing him of being a British spy. In recent years, the authorities have also intensified a crackdown on internal dissent.

“It doesn’t matter whether you’re an ordinary Emirati citizen or a member of the royal family or an expat from a close ally like the U.K.,” said Hiba Zayadin, a researcher at Human Rights Watch. “If you’re harming that carefully tailored image,” she added, “you will face the consequences.”

Over the video’s 39 stark minutes, her voice composed and forceful, Sheikha Latifa described in fluent English her life of constricting privilege and stunted hopes. She hoped it would change if she could win political asylum in the United States.

“I don’t know how, how I’ll feel, just waking up in the morning and thinking, I can do whatever I want today,” she said. “That’ll be such a new, different feeling. It’ll be amazing.”

Fearing for her life if she was caught, she said she was recording the video in case she failed.

“They’re not going to take me back alive,” she said. “That’s not going to happen. If I don’t make it out alive, at least there’s this video.”

Sheikha Latifa first faced rigid restrictions after her sister’s failed escape attempt years earlier.

When she was 14, her older sister Shamsa escaped from her family’s security detail on a trip to England. Her father, Sheikh Mohammed bin Rashid al-Maktoum, the ruler of Dubai and prime minister of the United Arab Emirates, owns a large estate and a prominent thoroughbred racing stable, Godolphin, there.

News reports at the time said Emirati personnel eventually tracked Shamsa to a street in Cambridge, forcing her into a car. When a Scotland Yard detective began investigating her case as a kidnapping, Dubai authorities refused to let him interview her. The case dead-ended there.

Sheikha Latifa said Shamsa, the only of 30 siblings to whom she was close, had been drugged into docility ever since, “basically like walking around with a cage following her.”

Horrified by Shamsa’s treatment, she said she tried to escape across the border to Oman. Retrieved almost immediately, she said she was held in solitary confinement for more than three years. . .

Continue reading. There’s much more.

This is a sick and destructive culture.

Written by LeisureGuy

10 February 2019 at 8:10 am

Posted in Daily life

Grandma Goes to Jail in Illegal Voting Sweep

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The GOP is a party of bad faith. Kevin Drum notes:

We are finally bringing the scourge of illegal noncitizen voting under control:

A 66-year-old woman from North Carolina was sentenced to two months in prison this week for encouraging her boyfriend to vote and helping him fill out his voter registration form, even though he was not eligible.

….On the voter registration card she helped him fill out, they left a question about citizenship unanswered, the release said. Paige told investigators that she then submitted the form to the Board of Elections for processing. But later on in the process, another person erroneously checked the citizenship question “Yes,” so Espinosa-Pena was registered to vote, Higdon’s office says.

So the form was actually filled out correctly, but then someone working for the Board of Elections ticked “Yes” in the citizenship box? But grandma is going to jail for two months anyway?

And in case you’re wondering: Yes, this case was brought by a U.S. Attorney, Robert Higdon Jr., who was appointed by Donald Trump. It never went to trial because Higdon apparently made it plain that if Paige fought the charges she faced a potential sentence of five years in prison and $250,000 in fines. We really have our priorities straight, don’t we?

Written by LeisureGuy

10 February 2019 at 7:55 am

“What I’ve Gained by Leaving the Republican Party”

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Peter Wehner writes in the Atlantic:

m a politically homeless person these days. For most of my life, I’ve been closely affiliated with the Republican Party. My first vote was cast for Ronald Reagan in 1980. I worked in his administration, as well as that of George H. W. Bush; for seven years, I was a senior adviser to President George W. Bush.

Most of my professional friends and almost all of my former colleagues—those with whom I served in government as well as in the think-tank world—have been Republican. The GOP has been my political home since college, a party I was once proud to be a part of, and a source of cherished relationships. Part of my identity was undoubtedly shaped by my party affiliation.

I saw in the Republican Party a commitment to human freedom, democratic capitalism, and a traditional social order; to upward mobility through self-reliance; to the dignity of work; to the cultivation of character and respect for the Constitution; and to a foreign policy that placed a high priority on human rights, a strong national defense, and American leadership. Republicans argued for limited government, economic growth, and free trade. The party respected the role of religion in public life and envisioned America as a welcoming society to immigrants and the unborn. It was hardly a perfect party. Like all political institutions, it fell short of its ideals; it was also led by some deeply flawed individuals. Yet in the main, it stood for principles that I believe promote human flourishing.

The GOP was also the party of Lincoln, the greatest of all Americans; and the party of Reagan, whose personality and outlook I prized, including largeness of spirit, graciousness and gratitude, and freedom from bitterness and resentments. What John F. Kennedy was to a generation of young liberals, Ronald Reagan was to a generation of young conservatives.

But since the political rise of Donald Trump, I’ve found myself at first deeply disappointed and now often at odds with the GOP. The party of Reagan has been fundamentally transformed. It’s now Donald Trump’s party, through and through.

That’s turned out to be quite a problem for me, because from the moment he announced his run for the presidency, I believed that Trump was intellectually, temperamentally, and psychologically unfit to be president. Indeed, I warned the GOP about Trump back in 2011, when I wrote an op-ed in The Wall Street Journal decrying his claim that Barack Obama was not born in America. From time to time, people emerge who are peddlers of paranoia and who violate unwritten codes that are vital to a self-governing society, I wrote, adding, “They delight in making our public discourse more childish and freakish, focusing attention on absurdities rather than substantive issues, and stirring up mistrust among citizens. When they do, those they claim to represent should speak out forcefully against them.”

Instead of rejecting him, however, the Republican Party eventually nominatedDonald Trump. His defenders say, with some justification, that he has delivered on the agenda that they wanted. But that is hardly the whole story. Trump has shown himself to be a pathological liar engaged in an all-out assault on objective facts—on reality and truth—concepts on which self-government depends. The president is also cruel, and dehumanizes his opponents. He’s volatile and emotionally unstable. He relishes dividing Americans along racial and ethnic lines. He crashes through norms like a drunk driver crashes through guardrails. And he’s corrupt from stem to stern. The difference between Trump supporters and right-leaning Trump critics is how we balance the scales of his conservative achievements (like with the courts) against the harm he’s caused and the ways he’s changed the Republican Party and the country, as we weigh what will be most definitional to his presidency.

Some Republicans quiescently accept Trump’s transgressions, unwilling to take him on, fearful of incurring his wrath. Others convince themselves that the Trump agenda is worth the price of lavishing praise on him and turning a blind eye to his offenses. Still other Republicans protect and defend him at every turn, serving as his attack dogs. As an institution, the party rallied behind him. The few Republicans who have challenged Trump from time to time—Jeff Flake, Bob Corker, and Mark Sanford come to mind—feel the anger of the party’s base. It cost all three their seats in Congress. The Republican Party is both shrinking and getting more Trumpified.

At the same time, unlike some vocal Trump critics who have left the GOP, I remain philosophically conservative. This means that the modern-day Democratic Party, lurching further and further to the left, doesn’t have room for me. (A 2018 Pew Research poll found that 46 percent of Democratic and Democratic-leaning voters identified themselves as liberal, compared with 28 percent a decade before.) Two  illustrations of the journey the party has taken: First, it wasn’t that long ago that referring to a Democratic Party politician as a democratic socialist was viewed as a libel; today democratic socialists like Bernie Sanders and Alexandria Ocasio-Cortez galvanize the party’s base. Second, the Democratic Party has moved from a stance that abortion should be “safe, legal, and rare” to Governor Andrew Cuomo lighting up New York City’s Freedom Tower in pink after signing a bill “celebrating the legal right to abort fetuses that could survive outside the womb,” as Alexandra DeSanctis put it in The Atlantic.

More than ever before, then, I identify with the words of the 20th-century French journalist and philosopher Raymond Aron. “To me, loyalty to one party has never been a decision of fundamental importance,” he said. “According to the circumstances I am in agreement or disagreement with the action of a given movement or a given party.” He added, “Perhaps such an attitude is contrary to the morality (or immorality) of political action; it is not contrary to the obligations of the writer.”

The main thing i’ve gained in unfastening myself from the GOP is critical distance and detachment. One can see certain things from outside the silo that one cannot see within it.

When I was a card-carrying member of a political party, I wasn’t automatically blinded to other points of view, or unable to challenge conventional orthodoxy. I did it on issues ranging from climate change, to the Tea Party’s anti-government rhetoric, to the characterological and temperamental defects of Newt Gingrich; so have many others. Nor did I knowingly put party above country. That’s a common charge made against party loyalists, when in fact most members of a political party believe that the success of their party is tied to the success of their country. They might be wrong, but that’s how many of them see things.

But here’s what I think does happen. People who are part of a tribe—political, philosophical, religious, ethnic—are less willing to call out their own side’s offenses. That’s human nature. To be sure, some are more willing to show independence of judgment than others, but none shows complete intellectual independence. I certainly didn’t.

Some of this has to do with feelings of solidarity, of not wanting to alienate those whose affirmation and support are important to us. Some of it has to do with the fact that our brains filter information differently, depending on whether it confirms or challenges our preexisting political commitments and affiliations. When we’re part of a team, we have a natural tendency to let our sympathies shape our views and opinions of others. As a result, we perceive the world differently, often more narrowly and sometimes incorrectly.

And some of it has to do with being willing to overlook certain things, consciously or subconsciously, that should trouble us, because we give the benefit of the doubt to those in our tribe. They’re advocates for most of the causes that we share, after all, and that we believe to be right and just. (The flip side is that we are often unforgiving and not inclined to give those in the other tribe any benefit of the doubt.)

Here’s a concrete example of how I see things differently today than in the past. In 1988, the then–presidential candidate George H. W. Bush focused on a furlough program supported by his opponent, Michael Dukakis, governor of Massachusetts. The Bush campaign ran ads (“Revolving Door”) on the furlough program—and then a political action committee ran an ad (“Weekend Passes”) that featured a menacing mug shot of Willie Horton, an African American man who had been released as part of a weekend furlough, from which he failed to return. He was later convicted of a brutal rape and assault.

At the time the ads ran, and for years after, I thought that they were fair criticisms of Michael Dukakis for his furlough policy. Liberals took them as self-evidently racist; I thought that charge was toxic and partisan.

Willie Horton was a real person who committed awful crimes; to say that this couldn’t be pointed out in an ad because of his race struck me as wrong. In addition, it was Al Gore who first raised the furlough program (if not Horton directly) in the 1988 Democratic primary. Further, I didn’t know any Republicans whom I considered remotely racist; the idea that this ad was a Republican “dog whistle” was one I considered misguided. I didn’t for a moment think that appealing to overt or subliminal racist sentiments would garner anything other than a few votes on the malicious fringe of American politics—and believed that any such gains would come at the expense of the majority of Republicans, who would be repelled by that kind of appeal. If Horton had been white and committed the same crime because of the same furlough program, I believed, an ad with a white Horton would have been made. The point was the criminal who committed the crime, not the race of the criminal who committed the crime.

Similarly, I assumed that the claim that the Republican Party’s effort to win the South’s support in the late 1960s was part of a “southern strategy” relying on a coded racial appeal was unjust. Enforcing law and order is certainly a legitimate issue for politicians to run on, and a basic function of government.

Today I see the Republican Party through the clarifying prism of Donald Trump, who consistently appealed to the ugliest instincts and attitudes of the GOP base—in 2011, when he entered the political stage by promoting a racist conspiracy theory, and in 2016, when he won the GOP nomination. He’s done the same time and time again during his presidency—his attacks on the intelligence of black politicians, black journalists, and black athletes; his response to the deadly violence in Charlottesville, Virginia; and his closing argument during the midterm elections, when he retweeted a racist ad that even Fox News would not run.

It would be deeply unfair to claim that most Republicans are bigots. But it is fair to say that most Republicans today are willing to tolerate without dissent, and in many cases enthusiastically support, a man whose appeal is based in large part on stoking racial and ethnic resentments, on attacking “the other.” That has to be taken into account. At a minimum, their moral reflexes have been badly dulled.

It’s impossible for me to know with any precision how much of the Republican base is motivated by ethnic nationalism and racial resentments and anxieties, but it’s certainly a higher percentage than I’d thought. A conservative friend of mine recently had a meal with a prominent Republican officeholder who, when asked what explained Trump’s growing appeal in his state, told my friend it was in reaction to Obama and it was mainly a matter of race.

So the rise of Trump has led me to reexamine these earlier episodes in the party’s history. I’m not insisting that my most recent interpretation is the only reasonable one, in part because discerning the motivations of others is difficult. (My own motivations are complicated enough to understand, let alone those of people I don’t know.) All I can say is, I’m much more open to the case that the political operatives who produced the Willie Horton ad intended at least in partto appeal to racist attitudes, and that it fit into a two-decade-old strategy. (Lee Atwater, the legendary Republican political strategist who was Bush’s campaign manager, admitted in a 1981 interview—the full interview was published in 2012—that the GOP’s southern strategy used coded language such as forced busing and states’ rights to make racist appeals. And as he was dying of brain cancer in 1991, Atwater apologized to Dukakis for the “naked cruelty” of a remark he made about Dukakis in the campaign and for his comments about making Horton Dukakis’s running mate.)

Here’s what I hope: . . .

Continue reading. There’s much more.

Written by LeisureGuy

10 February 2019 at 7:53 am

American law enforcement in action

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This seems quite bad. David Biscobing reports for KSHB:

On July 27, 2017, Johnny Wheatcroft was a passenger in a silver Ford Taurus when a pair of Glendale, Arizona,
police officers pulled in front them in a Motel 6 parking lot.

The stop was for an alleged turn signal violation.

Minutes later, Wheatcroft was handcuffed lying face down on the hot asphalt on a 108-degree day. He’d already been tased 10 times, with one officer kneeling on his back as another, Officer Matt Schneider, kicked him in the groin and pulled down his athletic shorts to tase him a final time in his testicles, according to a federal lawsuit and body camera footage obtained by Scripps sister station KNXV-TV.

The scene was witnessed by his 11- and 6-year-old sons.

“I have never seen anything like this before… This is just beyond the pale. It’s outrageous conduct.”

Multiple independent law enforcement experts, who agreed to review the incident, said the officers’ conduct was unlawful, potentially criminal, and one of the most cruel and troubling cases of police misconduct they’ve ever seen.

“I have never seen anything like this before,” said Jeff Noble, an attorney and former deputy chief of police in Irvine, Calif., who’s testified in hundreds of cases including Tamir Rice and Philando Castile. “ It reminds me of a case in New York where an individual was sadistically taking a broom handle and shoving it up (the suspect’s) anus. This is just beyond the pale. It’s outrageous conduct.”

Former LAPD detective supervisor T.T. Williams echoed his shock.

“That’s not even borderline,” said Williams, an expert witness who testified in the Philip Brailsford case on behalf of the prosecution. “That’s inhumane.”

Schneider was suspended for 30 hours and remains an active officer on the force, records show. [He did this and his “punishment” was a day off?? – LG]

The experts said it was appalling that Officer Schneider, who has won multiple awards from the police chief and has represented Glendale twice on the TV show Cops, was not terminated. They also believe Glendale should have referred the case for outside criminal investigation and prosecution.

“If he intentionally struck a passenger in the testicles, and then intentionally tased him in or near the genitals, I’m surprised he hasn’t been prosecuted,” said Seth Stoughton, a former police officer who’s now an attorney and professor at the University of South Carolina School of Law. “It raises half a dozen red flags that suggest the need for a thorough review, including a review to determine if the officer committed any crimes.”

The Police Department release is full of omissions and information that does not match up with the departments own records.

Read more on our analysis of their statement here.

But the lawsuit, filed in the U.S. District Court of Arizona by attorneys Marc Victor and Jody Broaddus, alleges that the officers violated the constitutional rights of Wheatcroft and his wife, Anya Chapman, and engaged in the “excessive use of force and torture.”

Wheatcroft and Chapman, who were arrested and charged with aggravated assault on a police officer, spent months in jail after the incident because they couldn’t afford bail.  . .

Continue reading.

There’s much more at the link, including video of the encounter. Something is going wrong in the US.

Written by LeisureGuy

10 February 2019 at 7:08 am

Black Twitter and the Future of Digital Disobedience

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David Thigpen has an interesting article at the Institute for the Future blog:

In an interview not long ago, Twitter co-founder Biz Stone was asked if he had ever heard of “Black Twitter.” Stone admitted he had not, but wondered if it was connected to Black Lives Matter.

Stone is not alone. But even if you’ve never heard of Black Twitter, chances are you’ve heard of one or more of the issues it has pushed into mainstream attention.

From serious political issues like #Blacklivesmatter (fighting unjust police violence against blacks) to #Oscarssowhite (exposing Hollywood’s discriminatory hiring practices) to the funny and trivial #Epicbraidslevel (ridiculing Marie Claire magazine’s suggestion that TV celebrity Kendall Jenner popularized braided hair), Black Twitter has emerged as a voice for African-American concerns, challenging and sometimes upending dominant narratives in politics, media, and culture. Black Twitter’s success also signals something important about the ways cultural and activist driven movements will use ambient communications technologies in the next decade.

As even Biz Stone now knows, Black Twitter is not a separate entity from Twitter at all but rather an informal platform within the platform—a space hacked out by young African-American tweeters weighing in on everything from celebrity culture to politics. Crackling with wit and often outrage, it is a place for participants to engage, have fun, collaborate, bond over slang and in-jokes, and express empathy in ways that push back on racism, privilege, or insensitivity. For example, in the new popular meme #IDontworkhere, tweeters recount incidents in restaurants or hotels when they are mistaken by white people for waiters or salespersons. Black Twitter hashtags trend so regularly now that in the summer of 2016 the Los Angeles Times newspaper hired its first ever Black Twitter reporter.

The CNN of the Ghetto

To understand how activist and cultural movements will work in the future, it’s helpful to know how they developed and how they work now. Forty years ago in New York City, low-income black and Latino teenagers who felt they were without a voice in popular culture took an existing piece of equipment—the record turntable—and repurposed it, turning it into a new kind of instrument. This led to the birth of hip hop music. Hip hop started off as fun and engaging, but quickly became a vessel for much more, carrying messages of empathy, persuasion, politics, and all sorts of activism, including raising awareness about police brutality.

The artist Chuck D of the rap group Public Enemy described this connection best when he referred to hip hop music as “the CNN of the ghetto,” transmitting bulletins about the struggles of daily life on urban America’s mean streets. While hip hop once paralleled CNN, in a future connected by ambient communications, activists will use Black Twitter, and platforms like it, to send bulletins through a wider variety of channels—including phones, wristwatches, eyeglasses, virtual reality, and multisensory devices—to witness what’s happening on the ground. Through the use of this new palette of ambient communications technologies, Black Lives Matter and movements like it will be able to encourage greater collaboration and exercise more control and persuasion over their messages, engaging followers more deeply.

The Underground Railroad of Activism

Another important facet of how activists will work was touched on by a blogger writing under the digital pen name Feminista Jones, who asked, “Is Twitter the underground railroad of activism?” Jones saw a connection between the use of Black Twitter today as a kind of modern guidepost with the underground railroad of the 19th century. In the American South before the Civil War, underground railroad “stations” were safe houses providing shelter to runaway slaves risking their lives to escape to freedom. The “railroads” they followed were actually not railroads at all but footpaths between safe houses.

Whether woven into a woolen quilt or carried digitally, coded symbols and slang allow a community to hide in plain sight, using existing channels and platforms to share challenging or subversive messages, often right under the noses of the powers-that-be. Black Twitter users and activists on other platforms will use a constantly changing vocabulary as reference points to help their followers interpret events, reject false information, and guide them not just through physical space but also through virtual landscapes of ideas.

The increasingly rich flow of information we will see in the next decade will likely help activists and community builders expand their followings by capturing and sharing their most compelling experiences.

Streams of Trust and Empathy

Whether it’s taking to the streets for civil disobedience, singing along to a protest song at a concert, or simply sharing inspiring narratives, ambient communications will allow these experiences to carry greater immediacy and persuasive power than ever before. Even routines of daily life may take on new significance. Activist Shaun Tai, executive director of Oakland Digital—a digital training center in Oakland, California—shares his daily life through Snapchat. He captures photos, conversations, text, video and audio clips, and uploads it all to Google Drive each day. “These streams of regular information—when shared—can build up trust and empathy, even among people who never meet face to face,” says An Xiao Mina, a technologist and writer at the San Francisco-based Meedan organization. “We are already seeing immense benefits of communities of color being able to challenge a dominant narrative quickly.”

Unlike today, these new connections will no longer be built on a YouTube or Facebook style format where personal celebrities engage and motivate audiences. Although there will always be a place for charismatic individuals in activist movements, command of a richer and more ubiquitous range of media experiences will spread influence among wider numbers of activists.

Hacking and Repurposing Existing Digital Spaces

With media extending more deeply than ever into the real world, and Internet connectedness moving beyond the screen, activists will also have opportunities to occupy or digitally mark physical space for each other. As MIT researcher and Internet activist Ethan Zuckerman observed, games like “Pokémon Go” “are already showing some amounts of activism around the edges.” Zuckerman describes  . . .

Continue reading.

Written by LeisureGuy

10 February 2019 at 6:48 am

Americans have healthier hearts. We have a healthier budget, too.

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Catherine Rampell has an interesting column in the Washington Post:

Thanks to preventive medicine, older Americans have healthier hearts. Which also means, incidentally, that federal budgets are healthier, too.

At the turn of the millennium, health spending growth was spiraling out of control. Economists projected that the already ginormous health-care sector would soon gobble up monster portions of the federal budget and the entire economy. But something strange happened over the past decade and a half.

Rather than rocketing upward at ludicrous speed, health spending growth slowed — dramatically so.

That’s true whether we’re talking about public- or private-sector health spending; for Medicare, Medicaid, private insurance and out-of-pocket spending, annual outlays have been way lower than the doomsday forecasters anticipated. Curiously, too, the sharpest slowdown has occurred with Medicare.

In fact, about three-quarters of the health spending slowdown nationwide was due to slow-as-an-(almost)-trickle growth in spending on the elderly. From 1992 to 2004, per-capita spending among Medicare beneficiaries grew by 3.8 percent each year, adjusted for economy-wide inflation; since 2005, the rate has been a mere 1.1 percent, according to a new Health Affairs study.

In plain English, that means total spending per elderly person hasn’t fallen, per se, but we’re spending thousands of dollars less today than was projected to be the case back in the early 2000s.

So who gets credit?

Some have attributed the spending slowdown to lousy economic conditions, although in retrospect the timing isn’t exactly right. The deceleration appears to have begun before the Great Recession, and it continued long after it ended. What’s more, Medicare spending should be relatively shielded from the business cycle, at least relative to the private sector.

Some have credited structural changes to the health-care system, including some of Obamacare’s cost-control measures. Maybe bundled payments and accountable care organizations are responsible — though studies so far suggest their effects have been modest compared with the magnitude of the overall changes in health spending trends. What’s more, the slowdown pre-dates Obamacare.

That new study suggests a different cause: Americans taking better care of their hearts.

The study, from a team of researchers led by Harvard economics professor David M. Cutler, focuses specifically on medical spending for the elderly. The authors began by disaggregating spending into categories, based on the condition a patient was being treated for — cancer, dementia and so on.

They noticed something striking. The categories with far and away the biggest slowdown in spending were related to heart health. Spending on cardiovascular and cerebrovascular diseases (heart attack, cardiac arrest, stroke, etc.) declined by $827 per person, relative to earlier trends. Spending on a related category called cardiovascular risk factors (high blood pressure, high cholesterol, diabetes) also fell $802 per person below the trend line.

Altogether, the researchers calculated that more than half of the elderly spending slowdown was because of slower spending on cardiovascular diseases and conditions. In dollar terms, this means the slowdown in cardiovascular spending growth effectively saved the Medicare program about $34 billion in 2012 (the most recent year of data available).

You can see similar results in other health stats. Elderly death rates for cardiovascular diseases, for instance, have plummeted, according to data from the Centers for Disease Control and Prevention.

These are significant findings, with major policy implications.

The conventional wisdom among health policy experts has long been that preventive medicine does not save money. It has other virtues — including, well, making people healthier. That’s quite a good thing! But study after study has found that in dollar terms, at least, investing more in preventive care doesn’t pay off.

This new paper suggests that at least when it comes to heart health, that’s not the case.

Lower-than-expected cardiovascular spending appears to be primarily due to successful use of preventive measures, the authors find. Greater use of statins, anti-hypertensives, diabetes medications and aspirin has helped prevent lots of expensive health events and contributed to outright declines in hospital admissions for heart disease and stroke.

“We think that half of the reduction in cardiovascular cost growth is a result of more people taking medications and taking them more regularly,” Cutler said.

Why are people taking their meds more regularly? The authors don’t know for sure, but there are a few possibilities. There’s more awareness of the need for treatment, for one. But also, a bunch of existing drugs went off patent and got cheaper. And in 2006, we got Medicare Part D, which reduced out-of-pocket prescription costs for many older people and probably led to more compliance. . .

Continue reading.

Written by LeisureGuy

10 February 2019 at 6:31 am

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