--Mori Dinauer

At the heart of the problem is that device makers, unlike the drug industry or health providers, don't receive Medicare payments directly from the government. Instead, as the Times article explains, the government gives a flat fee to hospitals, who are left to negotiate individually with device makers and manufacturers. Hospitals, however, often have little data to be able to gauge the relative effectiveness of different devices. Moreover, they're often contractually prohibited from disclosing how much they end up paying. As a result, hospitals -- and public entitlement programs -- end up relying on devices whose cost can vastly outstrip their value.

What's more, given the current fee-for-service model, hospitals themselves can also profit from inflated prices. In a separate Times story, David Leonhardt reveals how the Intermountain hospital chain managed to negotiate a significant price reduction for a certain medical device but still decided to charge patients -- and insurers like Medicare -- the old price:

A few people in the meeting were clearly bothered by this. They asked the finance executive, participating by speakerphone, if anything could be done. One committee member argued that Intermountain (which is nonprofit) should not overcharge for a treatment, even if it helped the hospital cover its overall expenses. The finance executive replied, apologetically, that changing the reimbursement rate would cost Intermountain millions of dollars and that there did not seem to be any way to make up for the loss.

Unfortunately, the current health-care legislation doesn't do anything to change this payment system, and legislators decided not to hit up hospitals themselves on the issue of medical-device payments. Unable to use Medicare price negotiations as a point of leverage, Congress ended up having to use a sledgehammer instead of a scalpel: they imposed a direct $40 million tax on the device industry itself. The device lobby lashed out and immediately rounded up a slew of Democratic legislators to protest the tax on the grounds that it would stifle innovation and job creation in their home states. And it seems like the device lobby has won: the House decided to halve the tax to $20 million, and the Senate is likely to follow suit.

Given the fact that medical-device costs are rising even faster than drug costs, such a measure hardly seems like it will squeeze adequate savings from the industry. It is a small consolation, at least, that the bill's comparative-effectiveness research will enable hospitals to make better cost-value judgments. But, in the end, it doesn't seem like it will be enough to fix a faulty, bloated payment system.

--Suzy Khimm

The danger is that Hasan's despicable crime will subtly and slowly change these perceptions for the worse. Overnight, Twitter feeds and message boards pulsed with anti-Muslim anger. This kind of venting is important to a free society. But it could also be an ominous sign of tensions to come. It is thus no surprise that groups like the controversial Council on American-Islamic Relations have been so quick to condemn the violence. The vast majority of Americans recognize that Hasan doesn't represent all Muslims, just as the Virginia Tech killer Seung-Hui Cho didn't represent all Korean-Americans. Yet people who are on the fence about whether Muslims can be trusted could tip over into believing that they can't. Back in 2004, a survey sponsored by Cornell University found that 29 percent of Americans believed that "all Muslim Americans should be required to register there whereabouts with the federal government," a policy that would be a massive propaganda coup for America's rivals.

I think Salam is, in some sense, correct--Hasan's alleged crime will have the practical effect of making some non-Muslim Americans more mistrustful of American Muslims and more likely to support counterproductive policies that will benefit America's enemies.

I also can't help but be frustrated by the fact this is another example of collective guilt--Muslims aren't just responsible for themselves individually, they're responsible for making sure people don't hold bigoted feelings toward them. There's no sense in Salam's piece that the people who hold anti-Muslim views, or the people who will be inclined to indulge their prejudices against Muslims and use Hasan's actions as an excuse, who hold Muslims as a people collectively guilty for Hasan's actions, are at all responsible for doing so.

This is the paradox of being a minority in America--you're not only responsible for your own actions as an individual, but the bad acts of everyone in your community. Yet while we are all utterly aware of this reality, we seem to rarely question the logic behind it. 

-- A. Serwer

The main insight Kleiman draws from the program is that punishment is most effective as a deterrent when it is swift and certain, not necessarily severe. Our current method of dealing with crime, inconsistently doling out long, draconian prison sentences, Kleiman argues, is counterproductive and imposes significant social and financial costs on society--particularly in the communities offenders call home.

While Kleiman's ideas have gotten a lot of traction in the blogosphere, today is where some of those ideas begin to become policy. Earlier, Democratic Rep. Adam Schiff of California -- a state struggling to cope with a massive prison population -- joined with Republican Rep. Ted Poe of Texas in announcing the introduction of the The Honest Opportunity Probation with Enforcement (HOPE) Initiative Act. The bill would create a grant program for states interested in replicating Hawaii's HOPE program, in order to "reduce drug use, crime, and recidivism by requiring swift, predictable, and graduated sanctions for noncompliance with the conditions of probation."

It's worth mentioning that both Poe and Schiff are former prosecutors -- Poe also used to be a judge. The ideological landscape of criminal justice policy has shifted so significantly in recent years that ending the nightmare of mass incarceration is becoming a bipartisan proposition -- often with current and former law enforcement officials leading the way.

-- A. Serwer

Right now, independent voters are astonishingly volatile. Democrats did poorly in elections on Tuesday partly because of disappointed liberals who think that President Obama is moving too slowly, but mostly because of anxious suburban independents who think he is moving too fast.

Brooks makes no attempt to justify the idea that Obama is moving too fast, in part because it's hard to find evidence that supports such a statement. Since the passage of the American Recovery and Reinvestment Act last winter, the president hasn't convinced Congress to pass a major piece of legislation. That's not to say he hasn't done anything -- he has shepherded health-care reform through a long and thorough public debate, he has made numerous important executive-branch appointments and decisions, he has developed a budget that will cut the deficit in half in four years.

Of the major parts of his legislative agenda, though, he has yet to achieve ... any of them. True, congressional Republicans have been in the habit of saying things are moving too fast, but in comparison to what, they don't say. Nor do they offer any real alternatives for solving problems. If they don't like what the Democrats are offering, they can vote against their agenda, but requesting time to talk and then having nothing to say doesn't cut it. Meanwhile, I'm not the first to note, Republicans are demanding that Obama make immediate decisions on foreign-policy matters. It's hard to take them seriously.

In any case, I'd be very curious to hear what Brooks thinks Obama is doing so quickly that it alarms independents, and why he thinks that his fast action on these policies with which I'm unfamiliar is of greater concern to independents than, oh, the economy.

-- Tim Fernholz ]]> http://www.prospect.org/csnc/blogs/tapped_archive?month=11&year=2009&base_name=obamas_so_speedy_it_looks_like http://www.prospect.org/csnc/blogs/tapped_archive?month=11&year=2009&base_name=obamas_so_speedy_it_looks_like Economy Fri, 06 Nov 2009 15:20:58 -0500 Next week the Supreme Court will be hearing oral arguments about two cases in which juveniles were sentenced to life without parole for non-homicides. The most disturbing thing about these cases that is that both sentences seem egregiously unjust even before considering the age of the defendants. One of the convicted teenagers received the draconian sentence even though he had been fairly convicted only of one robbery and a parole violation, a remarkably disproportionate sentence.

The case of Joe Sullivan, sentenced to life without parole at 13, is even more appalling. His conviction is riddled with so many potential constitutional deficiencies that his sentence would be utterly indefensible irrespective of his age. The evidence used to convict him of sexual assault would need quite a bit more heft to even be considered "thin": the uncorroborated testimony of two self-interested accomplices and the victim's claim that her attacker's voice -- she never saw him -- "does sound similar." Even more problematic, however, was the performance of Sullivan's counsel, Mack Plant, who has now been suspended from practicing in Florida. Amy Bach has the grim details:

Plant punted at every step, beginning with his failure to address whether Sullivan was even competent to stand trial. Social science research shows that most teens don't have the ability to determine whether to take a plea deal, much less make decisions about strategy for trial. But from the record, it appears Plant never had his client's reasoning and comprehension skills evaluated.

The lawyer declined to give an opening statement, which is like a batter not taking a swing. Plant also failed to cross-examine witnesses vigorously. He did not explore Gulley's and McCants' backgrounds to show they had a motive to lie. He never asked: "Did you get a deal here?" Michael Gulley had an extensive criminal history that included one sexual offense, according to court papers. A lawyer might have used this information to cast Gulley as a possible suspect instead of Sullivan. Plant did not. Instead, he focused on the fact that Gulley had to have his memory refreshed about the entire crime before testifying. This was a good point, but Plant blew through it. (Entire cross: a little more than a page.) And he never challenged the victim's identification of her assailant's voice as Sullivan's or asked her to listen to the other two boys' speech.

If this constitutes an adequate defense, we might as well just repeal the Sixth Amendment right now and be done with it. The idea that anyone -- let alone an adolescent -- was locked up for life with this kind of representation is an abomination.  And just for the poison cherry on top, the judge didn't seem to understand the sentence he was doling out.

And if all this isn't depressing enough, Sullivan -- who, at least based on the evidence presented in court, should never have been anywhere near an adult prison -- was repeatedly sexually assaulted in prison and is now confined to a wheelchair with multiple sclerosis. The Supreme Court overturning his sentence can't repay him for what he's lost, but it would be a start.

--Scott Lemieux

David Boaz read all 1,168 pages of Atlas Shrugged in four days during his senior year of high school. "It was the most fascinating thing I'd ever read," he announced to the Cato Institute audience. As Cato's executive vice president, Boaz launched last week's Ayn Rand book forum with a clarion call for "individual rights, free enterprise, and strictly limited government." Conservative groups of every stripe were represented: the gun-toting U.S. Bill of Rights Foundation; the protectionist Manufacturers Alliance; and the Atlas Society, heir to the original Objectivist Institute. These varied delegates all could pinpoint the feverish moment in their adolescence when they experienced a Randian epiphany. One audience member testified that he, too, "was one of those 19-year-olds" who discovered The Fountainhead
and thought he was "the only rational person on the earth."

The publication of two new Rand biographies by Jennifer Burns and Anne Heller coincides with Rand's apparent resurrection. In February, CNBC's Rick Santelli inspired the tea party movement when he decried President Barack Obama's housing bailout as anti-Rand and encouraged every freedom-loving American to go John Galt. That same month, Atlas Shrugged's sales ranking on Amazon.com surged into the top 100, well above its place in the 500s over the past two years. After languishing at the sidelines of the political arena, Rand has entered into public discourse. Will this "Ayn Rand moment" last?

KEEP READING ...

Given the orgy of gloating on the right and the hand-wringing on the left that followed this week's elections, it would not seem unreasonable to conclude that next year's midterm elections have already been decided via Tuesday's results.

The parties -- and their associated franchises in the punditocracy -- have split in predictable ways. Progressives see the two congressional special elections, which Democrats won in New York and California, as way more predictive of the national political mood than the two governor's races, which they lost in Virginia and New Jersey. Meanwhile, Republicans are ecstatic about their high-profile gubernatorial victories and what the results portend for 2010. The truth is that Tuesday's wins and losses tell us next to nothing about next year's elections.

KEEP READING ...

But what these wary Dems seem to be overlooking is just how extreme such a prohibition would be. Those who advocate for cracking down on illegal immigrants always insist that taxpayer money shouldn't be spent on supporting their welfare. But the federal government wouldn't be spending any more money if it allowed unauthorized immigrants to purchase private plans on the exchange, as they wouldn't be receiving any subsidies to do so. And, yes, while taxpayer dollars are subsidizing the infrastructure for the private insurance exchange, the same can be said for the nation's public transportation system, energy supplies, and agricultural output. Should unauthorized immigrants also be prohibited from riding buses, filling up a tank of gas, or buying groceries because these industries are supported by federal subsidies and infrastructure? That's essentially the logic that those who want to exclude illegal immigrants from the exchange are subscribing to.

--Suzy Khimm

Two days before New Jersey's gubernatorial election, Wall Street Journal columnist and voter-fraud hype-man John Fund warned the election might be stolen away from Republican Chris Christie through voter fraud. "Local politicos," he wrote, "tell me Philly operatives associated in the past with Acorn may now be advising their Jersey cousins on how to perform such vote harvesting."

That's quite a hedge -- and understandably so, given that ACORN had "conducted absolutely no political or voter registration activity" in New Jersey during the 2009 cycle. A few hours later Fund went on The Glenn Beck Show to strike fear into the hearts of Beck's viewers: "People are going door to door in parts of Camden with Hispanics that don't have very much knowledge of English, and they're saying, 'We have a new way for you to vote, la nueva forma de votar; just fill out these papers.'"

KEEP READING ...

The White House, while realistic, tried to focus on the good signs: unemployment declined at a slower rate, again, with fewer jobs lost in October than September, and there was an up-tick in temporary employment, traditionally a sign that economists look for to see if the labor market is improving (employers hire temporary workers first, then make permanent hires as recovery looks to stick around). The real question now is what the governing Democrats will do, and I think Steve Benen has a nice framework for looking at this problem: Go Big, Go Home or Take a Detour.

To my mind, this situation calls for "take a detour." The administration should push Congress to finish health care as soon as possible, let the relevant committees continue working on financial regulation, and devote the rest of its efforts to the problem of unemployment, whether by passing a jobs tax credit or fiscal aid to states. While Going Big is awful tempting, it's not clear to me that Congressional Democrats have the stomach to do what is necessary to get through the president's agenda against the substance-less carping of the opposition party, which wants to take more time to talk about the ideas they don't have. Given that, doing what can be done and focusing on the economy seems to make the most sense. But I'm certainly in agreement with Matt: Going home isn't an option, and the moderate Democrats who want to use the economic situation as an excuse to do nothing at all ought to be ashamed. Democrats were elected to solve problems, and if they fail in that responsibility, not only will they be booted out of office, they'll deserve it.

-- Tim Fernholz]]> http://www.prospect.org/csnc/blogs/tapped_archive?month=11&year=2009&base_name=what_the_new_unemployment_numb http://www.prospect.org/csnc/blogs/tapped_archive?month=11&year=2009&base_name=what_the_new_unemployment_numb Economy Fri, 06 Nov 2009 11:10:17 -0500 Dave Weigel reports that the conservative Committee for Justice is complaining in the aftermath of the nomination of one Latino and one African American to the federal bench, that President Obama's judicial nominees aren't diverse enough because there aren't enough southern white men among them.

Does President Obama or his advisors believe that southern white men are likely to be bigoted, making them unfit to serve on the second most powerful court in the land? We hope not and readily concede that it is difficult to know if any such stereotype lurks in the White House. The absence of southern white male circuit nominees could, instead, be an innocent coincidence or the not-so-innocent byproduct of a judicial selection process dominated by racial and gender preferences.

But regardless of the reason for the pattern we noted in 2007 and again now, even the appearance that Democrats are biased against southern white men is a potential problem for the party generally, and for President Obama’s goal of transcending old racial divisions.

Just to put this in perspective, a whopping 18 percent of judges on the federal bench are people of color. But in the eyes of this conservative group, assigning more white men to the federal bench "transcends racial divisions," and that doing otherwise reflects a selection process "dominated by racial and gender preferences." Conservatives regularly try to cast affirmative action as racially discriminatory, but rarely does someone openly admit that their only issue with the process is simply who is being discriminated against. 

There's something to be said for considering diversity of life and professional experience in picking judges, but some conservatives often don't seem too concerned about such things unless -- as in this case -- they're making the argument on behalf of white men.

-- A. Serwer

But CAIR's fears were sadly confirmed quite quickly, as John Nichols wrote yesterday evening. Michelle Malkin, whose book In Defense of Internment advocated for the use of racial profiling against Arabs and Muslims, quickly recycled a 2003 column suggesting that there was something wrong with allowing Muslims to serve in the armed forces. "Political correctness is the handmaiden of terror," Malkin tweeted. Don't you see? If we had just listened to her, and treated those people as enemies to begin with, this would never have happened. There are thousands of Arab-Americans serving in the armed forces, and many have given their lives defending this country -- Malkin would have us see all of them as potential traitors.

This is not unusual. In every community, there are those who make it their role to assign collective responsibility of the group's miseries to outsiders. Shortly after the shootings at Virginia Tech -- the immediate aftermath of which was rife with the same sort of Islamophobia -- Pat Buchanan was shrieking about immigration because the shooter, Seung-Hui Cho, was a South Korean national.

Indeed, the attempt to assign collective responsibility to Muslims worldwide for the murderous actions of a few is sadly predictable. Doing so is the first step in rationalizing the unthinkable and justifying the unjustifiable. But where this sort of reaction is to be expected from the likes of Malkin and Buchanan, far more shocking was the exchange between Sen. Kay Bailey Hutchinson and FOX News anchor Shepard Smith. Upon discovering Hasan's name, Smith said "The name tells us a lot, does it not, Senator?" to which Hutchinson responded, "It does. It does, Shepard."

How shameful. At the time, it told us literally nothing. But here were a sitting senator and a man whose job it is to report the news indulging their personal prejudices on national television. They were as ready to assign collective responsibility for the Ft. Hood massacre to Muslims as a whole as the pundits who do it for a living.

In the past few months, we've seen a number of shootings performed by white men with right-wing fringe beliefs. But while an attempt to assign the responsibility for the murder of George Tiller, or the killing of police in Pittsburgh, or the assault on the Holocaust Museum to white men as a whole would rightfully be seen as idiotic, there are those who sit poised and prepared assign the alleged actions of one man to an entire people. This is, quite frankly, the best reaction groups like al-Qaeda could hope for: The strength of their narrative of a war between Islam and the West ultimately rests on our own actions. We should not indulge them or those that share a similar worldview.

I'm glad Hasan is alive so that he can be tried for his alleged crimes -- if he is guilty, he will be a martyr to no one's cause. His motivations will be clear in time. But even if his motives were religious or political, the responsibility is his and his alone. In the meantime, I only hope that Americans will listen to the better angels of their nature.

-- A. Serwer

This piece in the Times emphasizes something that comes up a lot regarding the McChrystal report, and many other approaches to Afghanistan: Whether or not a given strategy is a good idea, the ability to actually implement it in a reasonable time is simply nonexistent. This goes for the "civilian" surge, which is severely delayed; troop deployments, which are severely constrained by U.S. dwell policies; and now it applies to the training of Afghan troops, which is at the center of both the COIN view of Afghanistan and those who take a more middle-ground approach. It turns out that current timelines just aren't that realistic.

The latest reports offer new details that show just how tough it will be to meet General McChrystal’s training goal. Among the previously undisclosed conclusions: one out of every four or five men in the security forces quit each year, meaning that tens of thousands must be recruited just to maintain the status quo. The number of Afghan battalions able to fight independently actually declined in the past six months.

It seems that new NATO involvement may speed things up, but NATO troops often decline to accompany their Afghan partners into the field -- this probably doesn't help -- which is a critical part of the mentoring process. Once again, it seems that what the U.S. might like to do in Afghanistan may not even be possible.

-- Tim Fernholz

One of the gunmen, Army Major Malik Nadal Hasan, was killed and two others -- also soldiers -- were reportedly taken into custody. Much will likely be made of the fact that Hasan was a recent convert to Islam, and reawaken the temptation to treat Muslims as a group that, unlike other demographics, does not make meaningful distinctions between its peaceful and violent adherents.

The Council on American-Islamic Relations (CAIR) issued the following statement in response:

We condemn this cowardly attack in the strongest terms possible and ask that the perpetrators be punished to the full extent of the law. No religious or political ideology could ever justify or excuse such wanton and indiscriminate violence. The attack was particularly heinous in that it targeted the all-volunteer army that protects our nation. American Muslims stand with our fellow citizens in offering both prayers for the victims and sincere condolences to the families of those killed or injured.

--The Editors