Our guest blogger is Lindsay Rosenthal, Special Assistant for Health Policy and Women?s Health and Rights at the Center for American Progress.
In order to combat an impending budgetary crisis related to spending on Medicaid, Oregon will take the lead on implementing a model that the Affordable Care Act has invested in at the Federal level. Yesterday, the Gov. John Kitzhaber (D-OR) and the Obama Administration announced a Federal-State Partnership for a coordinated care initiative that is projected to save $11 billion dollars in Medicaid spending over the next decade. These savings offer reason to celebrate, given the burden rising health care costs have placed on the economy. But perhaps more important than the savings alone is the way that they will be achieved: by investing in increased quality of patient care.
Effectively implementing this reform will require a fundamental shift in the way we pay for care, which Kitzhaber has explicitly proposed to his legislature. A cornerstone of the coordinated care effort is a change in the way that the doctors are paid for their services, away from the current fee-for-service system that incentivizes quantity and towards an integrated payment system that incentivizes quality. The concept is simple: If we want a doctor?s goal to be controlling diabetes, then we should pay her for controlling diabetes, not the number of tests she runs or medications she prescribes. We should pay her to collaborate with her peers and to communicate with her patients to track improvement, not to sign a higher volume of referrals and prescription slips.
The initiative will target Medicaid patients with chronic conditions like diabetes and severe mental health problems, who require particularly complicated treatment regimens that account for 80 percent of all Medicaid spending. More than one in four Americans have multiple concurrent chronic conditions and in the more severe cases are unable to manage their daily care on their own, leaving them dependent on a relative or in-home caregiver to help them negotiate their treatment. In the current system, care for chronically ill patients is administered through a diffuse and patchwork system comprised of different doctors, providers, and hospitals that is difficult to navigate and results in unnecessary complication, error, duplication and inefficiency. Patients with chronic conditions often report receiving conflicting advice from different physicians for the same symptoms (and even different diagnoses); they are often prescribed contraindicated or interactive medications that lead to life-threatening complications; and they frequently experience multiple, expensive hospital admissions that could easily have been prevented with better coordinated care.
Oregon has committed to improving patient outcomes and reducing costs by two percentage points in two years by investing in coordinated care. ?With unprecedented collaboration between local communities, health care providers and our federal partners, Oregon is on the right track to create a system that will both improve care and reduce costs,? said Kitzhaber in a statement announcing the proposed initiative. The state is asking communities and doctors to work together to give sick patients the services they need to prevent acute care incidents and serial hospital readmissions, which are not only bad indicators for patient health but also come with an exorbitant price tag.
Integrating and coordinating care so that all responsible parties have the information they need to take care of a chronically ill person seems like it should be the way our health system functions intuitively, but practically speaking the challenges of implementing coordinated care within our current health system are greater than one might expect. It will require a concerted effort at developing a collaborative network between primary care physicians, in-home care providers, and relative caretakers. To that end the coordinated care initiative in Oregon will likely invest both in hiring and training caseworkers and in technology that will allow providers to share important information about a patient?s health.
This shift in the focus of the health care delivery system?moving towards coordination and a focus on patient outcomes? can only happen with a parallel reform in the payment system that incentivizes collaboration between primary care physicians and other providers. Paying for quantity instead of quality is costly both in terms of health and in terms of cost. The initiative in Oregon will provide a strong demonstration of both the cost-saving and lifesaving potential of the reforms enacted by the Affordable Care Act.
The GOP-led House’s version of the Violence Against Women Act (VAWA) would not only strip away Senate-passed protections for undocumented, LGBT, and Native American victims, it also contains a dangerous provision that violates an undocumented victim’s confidentiality by allowing immigration officials to speak with, and ask for evidence from, his or her abuser.
Visas offered to undocumented victims of domestic violence are called “U Visas” and the Senate version of the bill expanded the number of U Visas offered to victims. The House bill not only strips out the additional visas, it also contains a new provision enabling government officials to inform “the accused” that their victim blew the whistle on their abuse:
During the adjudication of each petition under this paragraph, an investigative officer from a local service center of United States Citizenship and Immigration Services shall conduct an in-person interview of the alien who filed the petition. The investigative officer may also gather other evidence and interview other witnesses, including the accused United States citizen or lawful permanent resident, if they consent to be interviewed.
Undocumented victims already fear calling the police because they risk deportation in doing so. This portion of the bill adds on another level of fear by alerting their abusers that they’ve sought help — under current law, immigrant victims enjoy a right to confidentiality that would be seriously undermined by this bill. Allowing perpetrators of domestic violence to play any role in the deportation or protection of their victims is a cruel fate, but alerting an abuser to a victim’s complaint adds yet another level of emotional abuse on top of the physical abuse that the victim already faces.
This is an interesting trend, one kicked off by M.I.T. a few years back. I have to think that at some point, employers will consider these certificates in hiring, since formal education is almost out of reach for most people. (One reason why Occupy groups around the country are offering free classes.) Good for these schools for taking that leap forward!
In what is shaping up as an academic Battle of the Titans ? one that offers vast new learning opportunities for students around the world ? Harvard University and the Massachusetts Institute of Technology on Wednesday announced a new nonprofit partnership, known as edX, to offer free online courses from both universities.
Harvard?s involvement follows M.I.T.?s announcement in December that it was starting an open online learning project to be known as MITx. Its first course, Circuits and Electronics, began in March, enrolling about 120,000 students, some 10,000 of whom made it through the recent midterm exam. Those who complete the course will get a certificate of mastery and a grade, but no official credit. Similarly, edX courses will offer a certificate but will carry no credit.
But Harvard and M.I.T. are not the only elite universities planning to offer a wide array of massively open online courses, or MOOCs, as they are known. This month, Stanford, Princeton, the University of Pennsylvania and the University of Michigan announced their partnership with a new for-profit company, Coursera, with $16 million in venture capital.
Meanwhile, Sebastian Thrun, the Stanford professor who made headlines last fall when 160,000 students signed up for his Artificial Intelligence course, has attracted more than 200,000 students to the six courses offered at his new company, Udacity.
While President Obama has decided to not issue an LGBT nondiscrimination executive order for federal contractors at this time, legal scholars agree that a recent EEOC ruling will have a significant impact on existing nondiscrimination rules and regulations for federal contractors.
Last week, the EEOC issued a watershed ruling giving transgender individuals sorely needed federal protections against workplace discrimination. According to the ruling, employers who discriminate against employees or job applicants on the basis of gender identity can now be found in violation of Title VII of the Civil Rights Act of 1964?specifically its prohibition of sex discrimination in employment.
A report released today by the Williams Institute ? a public policy think tank at the University of California, Los Angeles ? demonstrates that this ruling has significant implications for federal contractors. Executive Order 11246 (EO 11246) already prohibits government contractors from prohibiting on the basis of sex (in addition to race, color, religion, and national origin). According to Williams, the Department of Labor?s Office of Contract Compliance Programs (OFCCP), which monitors contractor compliance with EO 11246, will similarly prohibit discrimination against transgender employees working for federal contractors following the EEOC?s decision:
It is the OFCCP?s policy and practice to interpret EO 11246?s non-discrimination requirements to be the same as Title VII?s requirements. This policy and practice indicates that the OFCCP will likely treat complaints of gender identity discrimination filed under EO 11246 as actionable complaints of sex discrimination, consistent with the EEOC?s recent Title VII decision.
Williams? report goes on to say that going forward OFCCP will need to address how it will implement EEOC?s ruling in its forthcoming rulemaking as it pertains to sex discrimination. Doing so will significantly help combat discrimination against transgender workers, who continue to face astonishingly high rates of discrimination on the job.
The GOP's pathetic attempt at swift boating President Obama over the raid on bin LadenI don't normally give advice to Republicans, but when I saw the newest swift boat attack ad to come from a Republican front-group, I couldn't resist. The problem with the ad, which comes from a one-man Koch-funded organization called "Vets For a Strong America" isn't that it is based on a totally false premise. Any effective swift boating must be based on a lie. The problem is that it lies about the wrong thing.
If you've seen the ad, you know it claims that President Obama never thanked the heroes who took out bin Laden?that he took all the credit for himself. That's patently false. But as I said, even though that's a lie, it's lying about the wrong thing, because the best case scenario with the ad is that people who see it are convinced that Obama is a dick...but even if they are convinced he's a dick, he'd still be the dick who killed bin Laden.
And the last thing you want to do is talk about how President Obama killed bin Laden. It would be as if the swift boaters in 2004 had acknowledged John Kerry's heroism. You just can't do it.
But it's easier to say what's wrong with the ad than to say what the swift boaters should have done instead. And to answer that question, I needed inspiration. And for that inspiration, I asked myself the question that any good God-fearing Republican operative asks themselves: WWJCD?
What would Jerome Corsi do?
The answer came to me immediately. Jerome Corsi wouldn't fuck around with some piddly little ad calling Obama a dick. He'd go straight to the heart of the matter and ask the big question: why hasn't anybody seen Osama bin Laden's dead body? Why was he buried at sea? Where is the death certificate? Why hasn't anybody come forward to say they spoke with him in the afterlife?
In short, the question Jerome Corsi would ask is this: why should anybody really believe that Osama bin Laden is dead? Today's swift boaters keep on asking why President Obama keeps on spiking the football. Well, that's a bad question to ask if you concede he scored a touchdown. So Republicans should do what Jereme Corsi would do and point out that Obama cannot prove that Osama bin Laden is really dead.
He's probably alive and well. In Hawaii, perhaps. Or maybe even Kenya. Hidden with Obama's birth certificate. The real birth certificate.
Our regular featured content-On This Day In History May 4 by TheMomCatPunting the Pundits by TheMomCatThese featured articles-Sprockets by ek hornbeckBring Me DeMarco's Head by TheMomCatFed- We Fucking Give Up! by ek hornbeckThis is an Open ThreadThe[...]
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That's video released by Sen. Scott Brown's campaign to show his amazing (and at the same time totally regular guy who loves sports) half-court basketball shot. Except, well, maybe not so amazing.
Sinking a half-court shot is the latest testament to ?Downtown Scotty Brown?s?? basketball prowess, but it turns out it wasn?t quite the lucky basket it appeared to be.There's also a teensy problem that it was a Senate staffer rather than a campaign staffer, and the campaign is using this video for the campaign and that's kind of blurring the line on ethics. But that's minor, as is the whole "amazing" bit considering it did take five tries to make it happen.
An aide confirmed for the Globe Thursday that Brown sunk the shot, but on the fifth attempt.
Brown lies about the little stuff, but he lies about the big stuff, too. Like when he said the stimulus bill "didn't create one new job." Or that he didn't cover his adult daughter under Obamacare, but under Romneycare. There's a good litany of sort of casual lies provided by ProgressMass, from the giving up drinking beer, to not watering down the Dodd-Frank financial reform bill. His lies occasionally veer into the bizarre, like his insistence that Rachel Maddow was going to run against him.
Probably the most important lie, though, is that he's an independent, bipartisan kind of guy. You only need to look at the litany of lies to know that's not true. He's a Republican through and through.
President Obama holds a solid seven point lead over Mitt Romney in Virginia, according to a new Washington Post poll.[...]
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NY Post writer thinks that Brooklyn Nets should be called the Brooklyn Niggers Phil Mushnick a “writer” for the NY Post obviously doesn’t like Jay Z or that fact that he has anything to do with the Brooklyn Nets. The choice of uniform color seems to have really bothered Mushick. So much that he turned [...]
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Paul Waldman's post about the uselessness of motives in evaluating politicians reminds me of a question a student asked me this week when assessing the Johnson administration. To paraphrase, my student said that his impression was that while LBJ may have signed two important civil rights bills, his motives for doing so were far from altruistic. My answer was that 1) this is right, but 2) I don't mean that as a criticism of LBJ.
One way of thinking about the importance of motives and principles is to consider Lincoln and slavery. While Lincoln was opposed to slavery in principle, the way he considered and dealt with slavery as a public figure was always intertwined with political considerations and compromises with evil. Injecting slavery into national political discourse was, among other things, a brilliant act of political entrepreneurship by the Republican Party. Lincoln was never an abolitionist, and consistently thought that the federal government should not interfere with slavery in the states. The Emancipation Proclamation was surely motivated in part by antislavery principles, but it was also motivated by the fact that the Union Army needed African American troops and the necessity to keep European countries from siding with the Confederacy. But to say that Lincoln always had political motivations isn't a qualification of his greatness; it was his greatness. He freed the slaves; John Brown, who had much purer antislavery motives, didn't, and dozens of John Browns wouldn't have.
And one can say the same thing about Johnson. Johnson?as Robert Caro's often brilliant ongoing biography makes clear?always believed that it was never a politician's job to stand on principle as an end in itself. But Caro's schematic of a "light" and "dark" LBJ fails him when it comes to evaluating LBJ's civil rights record. The "dark" LBJ, Caro reminds us many times, had a perfect record of voting against civil rights legislation before 1957. But the apparent paradox vanishes if we more usefully amend this to say that LBJ had "a perfect record of casting (politically beneficial) votes against civil rights legislation (that had a 0 percent chance of passing because LBJ wasn't yet a powerful Senate majority leader.)" The LBJ who voted against no-hope anti-lynching legislation was the same LBJ as the one who signed the Voting Rights Act?the Johnson who was never a white supremacist despite growing up in Texas Hill Country in the 1920s. He was a politician who had no use for noble losses, but when he had actual power in the Senate he passed the best civil rights bill that was possible, and as president he did far more for civil rights than could have been expected when he took office (and far more than his martyred predecessor.)
Does this mean that the civil rights record of the "good" LBJ had pure motives? Of course not. Did he ram (largely symbolic) civil rights legislation through as Senate majority leader (and refuse to sign the Southern Manifesto) in part because of his national political ambitions? Sure. Was his remarkable civil rights record as president partly the result of unprincipled motivations such as the importance of the legislation to key Democratic constituencies and his desire to show that he could do things that Jack and Bobby Kennedy were never able to? Absolutely. But is this a bad thing? Absolutely not. When evaluating politicians, as Paul says, the proof of the pudding is in the eating, and being a good person has very little to do with being an effective political leader either way.