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The official blog of the National Center for Public Policy Research, covering news, current events and public policy from a conservative, free-market and pro-Constitution perspective.

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Medicare's Victims: How the U.S. Government's Largest Health Care Program Harms Patients and Impairs Physicians

Two months from today, the National Center for Public Policy Research will be releasing my book, Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians.  It is currently available for pre-order at Amazon. 


In 35 words or less, the book examines patients and physicians who suffer because of Medicare and finds that what they have in common is a lack of political power sufficient to compel Congress to make changes to Medicare’s policies.  A more detailed description is below.

John C. Goodman, president of the Goodman Institute, author of Priceless: Curing the Healthcare Crisis, and godfather of Health Savings Accounts, has had this to say about Medicare’s Victims: “David Hogberg has produced a tour de force. He has identified Medicare’s hidden victims and explained why bureaucracy, price-fixing, suppression of the marketplace and unwise regulations all combine to deny millions of patients the high quality, low cost medical care they should be receiving. I know of no other place where you can find a more comprehensive treatment of Medicare’s worst problems. This is must reading for everyone in health policy.” 

For those who want a sneak peek, Chapter 7, which deals with primary care physicians, was published as a National Policy Analysis a few years ago here.  Parts of Chapter 9, which shows how big hospitals used Medicare to shut down smaller competitors, are available here.

Here is the full description:

Medicare’s Victims examines Medicare beneficiaries and physicians who are harmed by Medicare’s policies. The patients who are victims are often the sickest of the sick, whether it is the disabled who are on Medicare’s two-year-wait period; seniors who fell into Part D’s donut hole; or patients who are harmed because they receive too much treatment or not enough. The physicians who are victims are ones who struggle to provide the best care for their patients while Medicare’s reimbursement system, in effect, punishes them for it. They all tend to have one thing in common: lack of political power. For example, people who are seriously ill are relatively few in number. As such, they do not have the numbers necessary to impact elections. Further, people who are ill are generally not engaging in the networking, meetings and other activities necessary to form effective political organizations. Thus, Congress seldom feels the pressure to change the policies that harm these people. In this book, you’ll read the intimate stories of patients and physicians who have struggled with Medicare, and then you’ll learn how the particular Medicare policy has caused their plight. In the end, you’ll learn how we can reform Medicare so that patients and physicians are put in control of their own medical decisions and, thus, will be much less likely to be victimized.


Surprise! ObamaCare Medicaid Expansion Leads to Increase in ER Visits

That title of this blog post, of course, is intended to be sarcasm.  That an expansion of Medicaid would lead to a rise in emergency room (ER) visits is about as unexpected as looking to the east sometime early in the morning and seeing the sun.

ERs have long been the haven of Medicaid patients in large part because its low reimbursement rates make it difficult for such patients to find physicians willing to see them.  Exactly how expanding Medicaid under ObamaCare was supposed to result in anything different was never clear. (Perhaps Governor John Kasich was going to ask God to produce a miracle).

Anyway, a new survey by the American College of Emergency Physicians finds that 75 percent of emergency room physicians have seen an increase in ER visits in the last year:

As the Manahattan Institute’s Avik Roy put it in USAToday, “It goes to the false promise of the ACA… [Medicaid recipients are] given a card that says they have health insurance, but they can’t have access to physicians.”

Adding to the false promise is the fact that Medicaid is ineffective an improving the health of recipients, as the Oregon Experiment study found back in 2013.  

So, the Medicaid expansion hasn’t resulted in easier access to health care and probably has not led to any improvement in health for recipients.  But, hey, at least some hospitals seems to be making money.

UPDATE:  One commenter on our Facebook page asked how I knew that the increase was largely due to the Medicaid expansion.  Good question.  According to the article, “56% of doctors in the ACEP poll reported increases in Medicaid patients.”


Project 21 Members Speak Out on Baltimore Riots

Beginning on the night that the Baltimore riots started, members of the National Center’s Project 21 black leadership network have been in demand by a media trying to figure out why the looting and rioting there is being favorably compared by some to the historic protests of the Civil Rights Movement.

Project 21 members have done or are scheduled to do dozens of interviews on Canadian television, two 50,000-watt stations in Detroit and another 50,000-watt station in Boston as well as with nationally-syndicated talk radio hosts such as Mike Siegel.

On 4/27/15, Project 21 member Joe Hicks appears twice on the Fox News Channel.  On “The Kelly File,” Joe explained to host Megyn Kelly:

There’s no correlation between poverty and trying to burn down our own centers of the city in places that you need… to have places to go to work at…

What I think has happened here… is a pattern that’s emerged, starting with the Trayvon Martin case… But then we had Ferguson, and the Staten Island case.  And now we have a series of other incidents concluding with Freddie Gray.  And it’s almost this notion that this has become the new civil rights movement… [T]his has gotta have people like Martin Luther King spinning in their grave, to hear people describing this as some sort of movement now…

[T]here’s almost an infantile urge here [on the part of the protesters] to get what they want and get it now… That’s not the way things operate… We knew what the protesters were trying to get in the old days, if you will, of Dr. King and others.  It was about justice.  It was about becoming a part of American society…  The early civil rights folks were after something very different.

The question needs to be asked: what are these folks after [today]?  And that’s the mystery.  If you ask them, you get a mélange of all sort of issues from “capitalism is horrible” to “we want jobs.”  But then there seems to be an impulse [in which] they’re burning down places offering jobs…

After all the progress, after a black president, after a black attorney general, you’ve got these thugs in the street that do create real issues for race relations in this nation.

Joe was also on later, well past midnight on the East Coast.  During continuing live coverage of the violence in Baltimore, Joe spoke about the radicalism of some members of the protests.

Later in the week, on the 4/29/15 edition of “The Rick Amato Show” on the One America News Network, Project 21 Co-Chairman Horace Cooper also brought up the suggestion that the Baltimore rioters were akin to the Civil Rights Movement.

Horace told host Rick Amato:

[Martin Luther King] would be heartbroken.  This goes completely counter to the whole notion of the Dream that he told us we ought to, as a nation, embark upon — a dream where people were going to be judged not by the color of their skin but by the content of their character…

There is some frustration over the fact that the aspirations that every American has hasn’t been achieved.  It’s not the case that it’s okay to engage in these kinds of criminal actions as a result.

In assigning blame, Horace said that President Barack Obama and his policies share much of the responsibility for the way people are being motivated these days.  And, when things don’t go as planned, race is used as a means of drawing blame elsewhere.

But we also have to look at the President and the policies that he has promoted and watch and see why what people said when they were first being presented — they wouldn’t work, and they haven’t, and they have made it more difficult for people.  In fact, black America is worse off under the Obama Administration than it was before he arrived.

[Obama] has continued to push us further and further down the track of saying “it’s just that we haven’t done it enough.”  We’ve spent almost a trillion on his stimulus plan.  We did a near government takeover of the health care industry.  We’ve regulated the Wall Street community.  We continue to push efforts to eliminate our access and availability to one of our greatest resources — natural gas and oil.  But [he says] we need to do it more, and then we would see all of these great results.  Meanwhile, you need to understand that the reason that you are not seeing the great achievements that you should expect is that white America is holding you back.


Justin Danhof Explains Our Work at GE on the O'Reilly Factor

For those who missed it, here's Justin Danhof's appearance on the O'Reilly Factor in which he describes asking General Electric's Jeff Immelt if he will release GE's written communications with the State Department relating to State helping GE with a $1.9 billion deal -- and GE making a nice donation to the Clinton Foundation.

For more information, read our press release here.


Black Conservatives on Baltimore Looting, Violence: “Felons Don’t Need ‘Space to Destroy’”

With the nation captivated by the rioting in Baltimore and the initial shocking pro-rioter statement of the city’s mayor, members of the National Center’s Project 21 black leadership network are speaking out about this civic crisis.

Violence there was sparked by the death of Freddie Gray, a young black man with a long string of prior arrests, while Gray was in police custody.  It brought the current trend of anti-police tensions to Baltimore.  As opposed to most other recent incidents reported in the mainstream media, this time the heightened emotions led to attacks on police and innocent bystanders, property damage and looting.

What really didn’t seem to help things at all was a statement essentially endorsing mayhem that was made by Baltimore Mayor Stephanie Rawlings-Blake.  At a press conference, she said:

I’ve made it very clear that I work with the police, and instructed them to do everything that they could to make sure that the protesters could exercise their right to free speech.  It’s a very delicate balancing act because while we tried to make sure they were protected from the cars and the other things that were going on, we gave those who wished to destroy space to do that, as well.  And we worked very hard to keep that balance and to put ourselves in the best position to deescalate.  And that’s what you saw.

Now, with spread of horrific violence in the city she is charged with leading, she’s tried to walk back the comment.  She is presiding over a nightly curfew (starting on Tuesday!), cancelled baseball games and school trips and National Guard involvement.

Project 21 Co-Chairman Horace Cooper, a legal commentator and former professor of constitutional law, said:

Felons don’t need “space to destroy”

Criminals and looters don’t need an excuse to destroy property and to engage in mayhem.  They don’t prey on the rest of us because of perceived societal injustice.  They do so because they are lawless.  It’s incumbent upon our elected officials, including the mayor of Baltimore, to stand with those in her city who respect order and safety — not take actions which sanction criminal acts.

Unfortunately that what she’s done with her misguided rhetoric. 

And, as all the nation can see, tonight’s activities clearly show the need that all Americans — regardless of color — have for law enforcement.   I call upon Mayor Stephanie Rawlings-Blake to switch sides and join with law-abiding citizens against the street thugs who make life miserable for inner city residents all over Baltimore.

Bishop Council Nedd II, a Project 21 member and rector of St. Alban’s Anglican Church in central Pennsylvania, added:

The riots in Baltimore are a beast of the Mayor Stephanie Rawlings-Blake’s own making.

Giving space to those who wish “to destroy” is not a responsible statement from a mayor and chief executive.   In one statement, Mayor Rawlings-Blake effectively gave disgruntled youth an excuse to riot and hamstrung the ability of the police to respond.

I come from a family of police officers.  My father and brother were both police officers in Washington, D.C.  I had several uncles who also served as police officers, as well as two of my closest friends.  While I have never served in law enforcement, my comments are not being made totally void of some insight.

Riots are interesting things.  You have people drawn to those situations for a variety of reasons.  There are those who are interested in perpetrating violence and those who are merely interested in watching and observing the goings-on.  As untenable of a situation as it is, it unfortunately falls on police officers to use their discernment and training to determine the intent of the groups and individuals.

Rioters throwing rocks and bricks at police officers should never be tolerated.  However, under no circumstances do police officers have the luxury of throwing the rocks and bricks back indiscriminately into the crowds.

Project 21 member Nadra Enzi, a community policing advocate in New Orleans, said:

“Will Baltimore burn?” is the question I asked after last weekend’s wild protests struck the city’s downtown to (dis)honor Freddie Gray, the man whose in-custody death still has many scratching their heads.

It’s burning now.

I see visions of the Watts super-riots from 1965 and 1992 being repeated in Charm City.  The fact that this place is already ultra-violent joins the notion that Gray died when he could apparently offer officers no threat.  There is now the threat of recreating and expanding the Watts-style carnage, and Americans are wondering if their town is next.

Black male-police relations are emotional embers soaked with rocket fuel.  There is intensity in the racial resentment.  So soon after the shooting of Walter Scott in South Carolina, this case could spark national rioting.  Advocating police-community unity — always an uphill climb — has now become nearly insurmountable.

The protesters have center stage, and in their ranks are criminals committing chaos in the same way they do when publicized marches aren’t underway.  Protesters who aren’t vandals nonetheless mistrust police.  Advocates for police-community unity who are among them are few and far between.

America’s most logical anti-crime alliance, inner citizens who are against violence and allied with the police, is shoved even further aside as chanting shouts down cooperation.  Against this backdrop, I must ask, will Baltimore and more cities burn on the funeral pyre of failed police-community unity?


The Health Care You Get Will Depend on Your Political Clout--Specialty Drug Edition Redux

Ben Boychuk of the Manhattan Institute is having trouble with ObamaCare.  Specifically, his son Benjamin needs injections of human growth hormone, a specialty drug.  According to Boychuk:

My son Benjamin has a serious growth hormone deficiency. He’ll be 13 years old in May but could easily pass for a boy of 8 or 9. In fact, many 8- and 9-year-olds are taller than him. He’s a full head shorter than all of his pals in seventh grade….

Several trips to his pediatrician along with a couple simple tests to assess Benjamin’s bone age confirmed with data what we could see with our own eyes. Our boy wasn’t just in the bottom percentile in average height for kids his age – he was in the sub-basement. 

Shouldn’t Benjamin’s growth hormone be covered under health insurance, especially after ObamaCare’s coverage mandates went into effect?  Well, no:

Obamacare’s critics – many on the left as well as the right – weren’t wrong when they complained that the law would be a gift to insurance companies. Although the law capped out-of-pocket medical expenses, specialty drugs were exempt. But that only perverted an already distorted marketplace, encouraging insurers to raise consumer costs while narrowing their choices.

I’d highly recommend reading the full article to see the frustrations the Boychuks are going through as they try get a drug approval from their insurance company and deal with the constantly shifting amount they will have to pay out of pocket.  If you haven’t already guessed, it’s not cheap.  Here’s a Gofundme account to help cover the costs of Benjamin’s treatments that you can donate to, if you are so inclined.

So, why are specialty drugs exempt from ObamaCare’ out-of-pocket cap?  After all, it is generally the sickest of the sick who need specialty drugs, and aren’t those the people that the oh-so compassionate ObamaCare are supposed to protect?

Back in spring of 2013, some press reports came out noting that specialty drugs were exempt from ObamaCare’s out-of-pocket caps.  Here is how I explained the exemption:

The very sick are relatively few in number, which means they amount to a very limited number of voters, too limited to have much impact on elections…

It’s not entirely clear how many people take specialty drugs.  The best statistic appears to come from this study by the Center for Studying Health System Change which estimates that “specialty drugs are prescribed for only one in every 100 commercial health plan enrollees.”

To apply that to enrollees in the exchanges, we’ll add the number of people who, according to the Census Bureau, bought their insurance directly (i.e. didn’t get it from their employer) to those who are uninsured. The first is about 30,244,000 and the second is 48,613,000 for a total of 78,857,000.  One in 100 of those equals 788,570, and that is how we get a rough estimate of the number of people in the exchanges who will need specialty drugs.

So, how much political power is that?   Well, divide it by 435 House Districts and you get about 1,813 potential voters.  Most House elections are decided by margins considerably larger than that.   Divide it by 50 states and you get about 15,771 votes.  In 2012 only two Senate elections, North Dakota and Nevada, were decided by margins less than that.

And…let’s not forget that people aren’t taking specialty drugs unless they’re quite ill.  That means they probably aren’t organizing get-out-the-vote drives, protests, lobbying efforts, etc.

We’ll be seeing a lot more of this in ObamaCare in the months and years to come.


Clinton Foundation May Have an Enron Problem


The Clinton Foundation just announced that it will revise its tax returns for 2010, 2011, and 2012 after revelations by the Reuters news organization that it neglected to report foreign government grants on its tax returns as required by law.

Charities are required to provide a breakout of their government grants, including from domestic and foreign sources, in Part VII, line 1e of IRS form 990.

In a statement on its website, the Clinton Foundation explained that it had apparently "mistakenly combined" its foreign government funding with other funding.

This isn't just highly questionable... it's downright improbable.

Having served in senior management of a non-profit with the same tax status as the Clinton Foundation for nearly 30 years, I can testify that it's very hard to mess this up year after year.

Not only would the Clinton Foundation's management need to get it wrong repeatedly, but its CPA would as well.

And even if the CPA messed up, the errors most certainly would have been caught during an annual audit.

Auditors don't just take a charity's word for the sources and amounts of grants, but contact the sources to verify the information supplied is correct.

So, I wondered which firms could have served the Clinton Foundation so poorly from 2010-2012.

It turns out that it wasn't two firms, but a single firm: the Little Rock, Arkansas branch of BKD, LLP.

That the Clinton Foundation chose to use a single firm for both CPA services and its independent audit for multiple years is significant as it violates charitable best practices.

Ever since the Sarbanes-Oxley Act (formally, the Public Company Accounting Reform and Investor Protection Act) was adopted in 2002, the splitting of general accounting and auditing services has become standard practice, not just for publicly-held corporations but charities, too.

The splitting of accounting and auditing services was a direct result of the Enron scandal.

And now, it appears that the Clinton Foundation may be the charitable equivalent of Enron.

The accounting firm Arthur Andersen helped Enron cook its books because by doing so it could also keep much more lucrative contracts with the company.

During the early 1990s, Arthur Andersen learned that it could considerably boost its profits if its auditors approved what the Wall Street Journal called, in a 2002 article, "aggressive accounting tactics" by some of its clients.

One of its first big financial successes from using these tactics was when it helped Boston Chicken hide franchise losses in advance of an IPO.

In the auditor's performance review, he was praised for turning "a $50,000 audit fee into a $3 million full-service engagement."

BKD could have been the Clinton Foundation's Arthur Andersen, approving "aggressive accounting tactics" to hide millions of dollars in controversial government grants in the one document that the public has an absolute right to see - the Clinton Foundation's federal tax return.

It is troubling, too, that like Arthur Andersen, BKD's professional conduct has been questioned by government regulators.

The Little Rock Arkansas branch of BKD, the very branch the Clinton Foundation used for its audit and other accounting services, is currently being sued by the Federal Deposit Insurance Corporation (FDIC) for $17.5 million in connection with the failure of the First Southern Bank of Batesville.

Between December 2008 and September 2010, First Southern Bank purchased $23 million in fraudulent district improvement bonds from Little Rock attorney Kevin Lewis. BKD was the bank's accounting firm at the time and the FDIC says the firm failed to do its job.

Lewis was sentenced to 10 years in prison in 2011 and BKD's association with the case certainly became widely known at that time.

Yet, the Clinton Foundation did not make its curiously-timed switch to the firm Price Waterhouse Coopers until 2013.

If the IRS can free itself for a moment from its witch hunt of conservative non-profits, it might want to examine the books of the Clinton Foundation.

With so much smoke, there's likely to be one heck of a fire.


Bill O'Reilly is All Over Our Question to GE's Jeff Immelt

***Media alert: Tune in to Fox's O'Reilly Factor tonight to see our Justin Danhof discuss his question to Jeffrey Immelt, our colleague David Almasi's question to Boeing CEO W. James McNerney, and the crime of honest services fraud. It promises to be an exciting show.***


On Thursday Evening, Fox News Channel's Bill O'Reilly covered our Justin Danhof asking General Electric CEO Jeffrey Immelt if he would release GE's written communications with the State Department during the time State was helping GE with a deal in Algeria, and GE was donating to the Clinton Foundation.

Folks will recall that Secretary Clinton used a personal server for her emails while she was employed by the State Department, so any copies of emails at this point presumably are on the servers of those with whom she was corresponding.

O'Reilly discussed the situation at length in his "Talking Points Memo," and then went on to discuss it throughout his show, including with Fox's Bret Baier...

...and Judge Andrew Napolitano...

The National Center has been questioning why corporations receiving help from the State Department have been donating to the Clinton Foundation since April 2014, when the National Center's Executive Director, David Almasi, a Boeing shareholder, asked Boeing CEO W. James McNerney about possible conflicts of interest between Boeing's philanthropy and actions by senior public officials. David raised the question of whether Boeing had unnecessarily exposed itself to the danger of being prosecuted for honest services fraud.

A description of David's confrontation at Boeing, and Washington Post coverage of it, is available here.

On Thursday night, Bill O'Reilly discussed our question to GE's CEO with Charles Krauthammer, who didn't seem to have heard of honest services fraud. (Again, I suggest he read the press release we issued after David Almasi attended the Boeing shareholder meeting.)

Charles Krauthammer insists this is about specific politicians. We disagree. Politicians and government officials come and go. Corporations have been paying for access for decades. If the public, and corporate shareholders, confront these CEOs, and insist they stop, there is hope for reform.

When it comes to Boeing and General Electric, it is important to note that we have no evidence anything illegal happened here, and there may well have been no wrongdoing at either company. Our concern as shareholders -- and we did approach both companies as shareholders -- is that honest services fraud is vague (once again, see our Boeing press release). A company can be totally innocent and yet get caught up in a defense that costs a lot of money and harms the company's brand. It is much safer for companies to avoid contributions to ALL charities connected to ALL politicians and government officials entirely, but CEOs, at least so far, don't seem to be aware of this.

As Americans, too, we're better off not wondering if our government officials are doing things because they believe those things are in the best interest of the United States, or because a foundation the official is connected to received a contribution.

In short, when it comes to making contributions to government-official-connected foundations, even contributions made with the best and most pure intentions, corporations should "just say no."

On Friday night, Justin is scheduled to appear on the O'Reilly Factor to discuss his question to Jeffrey Immelt, our colleague David Almasi's question to Boeing CEO W. James McNerney, and honest services fraud generally, in much more detail. We encourage everyone to tune in!


ObamaCare’s Amazing Wayback Clause

The above is the title of a piece by David Catron at the American Spectator.  The “Wayback Clause” in ObamaCare is responsible for the law’s ability to impact phenomena prior to the law going into effect.  Catron noted that “most celebrated effect of this amazing provision is its retroactive reduction of medical inflation during the years preceding the law’s implementation.”

That includes, apparently, the recent slow rate of Medicare growth too.  Last week the, the Ministry of Truth Department of  Health and Human Services (HHS) released a document entitled “Medicare Spending Growth Since 2009.”  Here’s Table 1 from the document:

“What policies have contributed to the Medicare spending growth slowdown?” HHS asks.  Here’s one:

Tying Medicare Advantage (MA) payment benchmarks to Traditional Medicare, and implementing the MA Quality Improvement Program, has created new incentives for MA plans to become more efficient while improving quality.

The document doesn’t make clear which benchmarks are being referred to.  Perhaps it means the provision limiting MA plans to spending “no more than 15 % of their Medicare payment on administrative costs, insurance company profits and non-healthcare related items.”  That, however, is much like the MA Quality Improvment Plan in that neither began until 2014. And that’s what’s so remarkable about the ObamaCare’s Wayback Clause: Those programs were able to lower growth in Medicare Advantage beginning in 2009.  

Here’s another supposed contribution to slow down in Medicare growth according to HHS:

The Medicare program is implementing a wide range of delivery system reforms to improve quality and lower costs such as fostering the growth of Accountable Care Organizations and testing bundled-payment arrangements. Initial results from some models suggest some promising impacts on both costs and quality. 

Thus far, the savings achieved thus far by Accountable Care Organizations (ACOs) in Medicare have been miniscule, about $372 million, or .08 percent of Medicare’s budget.  But, more importantly, the first ACO project didn’t begin until 2012.  For a lesser law that would be a problem, but thanks to ObamaCare’s Wayback Clause, ACOs started generating savings back in 2009 if that’s when Obama Administration says that they did.

For another example of ObamaCare’s Wayback Clause in action, read Catron’s article on Jonathan Cohn’s analysis of an Urban Institute report. 


Human Toll of California's Drought A "Man-Made Disaster" 

National Center Senior Fellow Dr. Bonner Cohen was featured today on “Money with Melissa Francis” on the Fox Business Network, where he discussed the government-caused disaster that is occurring as a result of California’s tough drought restrictions.  Going back further to the current dilemma’s origins, Bonner noted this disaster is rooted in misguided policies to save a fish already considered by many to be a lost cause.

As previously reported on the Fox News web site, Bonner called the California drought a “man-made disaster.”  He said:

Southern California is an arid part of the world where droughts — even severe droughts — are commonplace, and knowing this, you’d think the government of California would have included this mathematical certainty in its disaster preparedness planning, but the government has done nothing, not even store rain, as the population has continued to grow.

On his 4/20/15 Fox Business News interview, Bonner was also quick to point out that Californians and their businesses and, by extension, all of the people who benefit from them are at risk because the government is “trying to keep the delta smelt and other related fish alive.”

Bonner noted:

[W]hat you have here is an attempt, through a diversion of water from where it should have gone — namely, to the people of California.  Instead, it has gone for the purpose of flushing water to provide habitat for a fish that is on the verge of extinction anyway.

Reiterating that California’s environment is predictable enough to anticipate and prepare for droughts, Bonner said officials there have nonetheless failed in their duty to protect their constituents:

What does any responsible government do?  It adopts policies that enable the citizenry to be prepared for what they know is coming.  And precisely that hasn’t happened in California.

You have seen water directed away from agriculture, away from drinking water, away from water to bathe in for the sake of a fish which is so far gone now they can’t even find breeding pairs for them.

Watch the entire interview below.


California Water Shortage Was Caused by Environmentalists

Lake Tahoe Dam

Our Bonner Cohen says humans are to blame for the suffering caused by the California drought:
This is a man-made disaster. Southern California is an arid part of the world where droughts -- even severe droughts -- are commonplace, and knowing this, you'd think the government of California would have included this mathematical certainty in its disaster preparedness planning, but the government has done nothing, not even store rain, as the population has continued to grow.
He's not the only one. Carly Fiorina, former Hewlett-Packard CEO:
Droughts are nothing new in California, but right now, 70 percent of California's rainfall washes out to sea because liberals have prevented the construction of a single new reservoir or a single new water conveyance system over decades, during a period in which California's population has doubled. This is the classic case of liberals being willing to sacrifice other people's lives and livelihoods at the altar of their ideology.
Rep. Kevin Dunes (R-CA):
The environmental groups did not expect to run everyone out of water, but they got greedy, shut down the whole system, and ran the whole damned state dry.
There's lots more here.

Another Reason to Oppose the Medicare Doc Fix Bill

I’m trying really hard to support the “Medicare Access and CHIP Reauthorization Act” (MACR).

Yesterday, I pointed out that it included a new Medicare payment system called the Medicare Incentive-Based Payment System (MIPS) that will incentivize physicians to avoid the sickest patients.  I concluded:

One of the goals of MACR, eliminating the unworkable Sustainable Growth Rate, is a worthy one. Getting rid of this perennial problem, however, should not come by way of a new payment system that will make it harder for sicker patients to obtain physician care. The Senate should remove MIPS. Otherwise, lawmakers risk installing an IPAB-style payment system in Medicare.

Unfortunately, the bill also contains an incentive under Medicare to encourage physicians to join accountable care organizations (ACOs).  For those of you who are unaware, an ACO is a relatively large group of physicians and other health care providers that are responsible for a group of patients.  If this sounds like bureacratic medicine, it is.  It’s not clear that ACOs are working as intended, and there is also evidence that smaller physician practices may be better for patients.

Nevertheless, Republicans have included in MACR a 0.75 Medicare payment increase for physicians who join an ACO and 0.25 percent increase for those who don’t.  (Those who don’t join will also be subject to the MIPS system).

Here’s the kicker: ACOs were the creation of ObamaCare.  

This leads to two questions:  First, why would Republicans be reinforcing a component of ObamaCare, especially one that incentivizes bureaucratic medicine?  Second, what were Republicans thinking when they drafted this bill?  (“They weren’t thinking!” —the Wife.)

At the very least, the Senate needs to remove MIPS.  MIPS imposes a penalty on physicians who don’t meet certain benchmarks.  Without that, there is less incentive for physicians to join an ACO.

I’m reluctantly willing to let slide the $147 billion increase in costs over ten years that MACR entails, as there is a decent case to be made that the other changes this bill makes to Medicare will generate savings over the much longer term.

I would so love to see the Sustainable Growth Rate (SGR) be repealed.  As I’ve argued elsewhere, it probably isn’t good for Medicare patients either as it incentivizes physicians to see fewer Medicare patients.  But with both MIPS and the ACO incentives in this bill—forget it!  Those costs are greater than the benefits of repealing the SGR.

Either remove MIPS or scrap this piece of junk and start over.


Medicare Doc Fix Bill Is IPAB-Lite

The Daily Caller has run our David Hogberg's new paper, "Medicare Doc Fix Bill Is IPAB-Lite":

David Hogberg

When the Senate returns from recess this week, it will consider the "Medicare Access and CHIP Reauthorization Act" (MACR). The bill has acquired many names such as "The Doc Fix Fix" and "Budget Buster," but a more appropriate one is "IPAB-lite."

IPAB -- the Independent Payment Advisory Board -- was created as part of Obamacare to cut Medicare expenditures whenever those expenditures grew too quickly. Thankfully, IPAB's unpopularity has thus far prevented it from getting off the ground. Unfortunately, the changes MACR makes to Medicare's payment system seem very much along the lines of what IPAB would do. After all, the new payment system within MACR is consistent with IPAB's mission, incentive structure, and likely outcomes...

Read it all here.

If this bill is not changed before passage, Medicare literally will have incentives in it that cause doctors to get paid more if they avoid the sickest patients. This is morally wrong. The House has already passed this bill, so we have to look to the Senate for any improvements. Here's hoping the Senate sees fit to make them.


Leftist Concern for Black Lives Seems More Political than Compassionate, Says Project 21’s Cooper On “O’Reilly Factor”

Debunking the left-wing narrative that police-related killings of black men proves a “systemic problem in America” Project 21 co-chairman Horace Cooper pointed out on the Fox News Channel’s “The O’Reilly Factor” that the facts show there is really “an elevated risk of death that will not come from law enforcement, but that will come from other black Americans.”

Debating liberal talk radio Alan Colmes on the 4/9/15 edition of the show, Horace noted the risk of police-related deaths in the black community needs to be seen in context:

The truth is… if you consider the elevated number of times that black Americans encounter law enforcement versus the actual number of deaths, it turns out that black people are not actually at risk.  They’re actually in a favored category.

Citing government statistics showing homicide as the second-highest risk of mortality for black men and greatly outpacing other demographics, Horace said this is “a sign that there is a disparate amount of criminality happening in this one group… [and] there will be a higher level of encounter with  law enforcement.”

Another disparity Horace revealed was a disinterest on the left when it comes to addressing the crime problem within the black community:

This is the progressive impulse.  Every single police killing is documented.  We understand all of the details of every police killing.  But what we don’t need is to have that argument made that there is a systemic problem when the evidence shows that there are other problems that progressives don’t care about.

They say black lives matter….  But when, in Chicago, there are more black deaths that happened in 2014 than in the last ten years… they say nothing about it.

Horace further suggested:

In the black community, we need to have a conversation that’s unencumbered by the radical left and progressives’ agenda that tries to use government coercion to address some problems.

Watch the full segment here.


As Liberal Congressman Blames Conservatives for SC Shooting, Project 21's Horace Cooper to Speak Sense on O'Reilly Tonight

According to veteran liberal Congressman James Clyburn (D-SC), commonsense conservatives are to blame for the shooting in South Carolina.

I'm not exaggerating: Clyburn claims the climate for the shooting was created by people who believe in self-defense, voter ID -- even redistricting!

Horace Cooper on O'Reilly

He calls these people "a cancer eating at the innards of our society," and ties our views directly to the shooting by saying "that's why you have these rogue police officers feeling they have license to do what they want to do and there will be no consequences paid for it."

Our Project 21 black leadership group isn't sitting still for this. Tune in to Fox's O'Reilly Factor tonight, April 9, to see Project 21's Co-Chairman Horace Cooper defend you and me and conservatives everywhere.

And sign up for free our e-mail newsletter to follow our work to defend YOUR RIGHT to hold commonsense conservative views without being falsely accused of murder.

Don't let Congressman Clyburn get the last word!


Black Conservatives on South Carolina Police-Involved Shooting

Members of the National Center’s Project 21 black leadership network are speaking out about the shooting of an apparently unarmed black man during a foot chase after a traffic stop in North Charleston, South Carolina.

Caught on video by a witness and alleging showing the officer firing eight bullets at and killing Walter Scott, Michael Thomas Slager has since been fired from the North Charleston Police Department and is charged with Scott’s murder.

Project 21 member Nadra Enzi, a community policing activist in New Orleans, said:

The South Carolina police shooting involving now former North Charleston officer Michael Slager illustrated the unfortunate cold-bloodedness of some police officers.

Supporters of the police and anti-crime activists shouldn’t be timid in loudly demanding the severe punishment of officers who blatantly murder and then hide behind their badges to try to cover up their handiwork.

Legitimate outrage can be easily drowned out by the rogues’ gallery of predatory protesters, such as those who wrought havoc in the Michael Brown case.  Conservative voices denouncing this crime can help dampen the racial flames fanned by radical protesters’ rhetoric.  

Americans can also unite around this issue and use it to strengthen the frayed ties that bind us.  Not doing so lends aid and comfort to professional cop-haters, career criminals and skeptics who use atrocities to justify and spread profound mistrust.

When an innocent man is unjustly killed, it should remind police supporters and skeptics alike that violent crime isn’t the exclusive province of callous citizens.  A privately owned camera phone recorded the officer’s alleged crime and possible attempt to plant evidence.

When officers do this, society is less safe — especially the segment from whence this particular victim hailed.

Project 21 member Christopher Arps, a resident of the St. Louis area who was witness to the violence in Ferguson, Missouri after the death of Michael Brown and subsequent grand jury decision not to indict the officer involved in Brown’s death, added:

The video showing the tragic shooting of an unarmed African-American man in the back, who was fleeing from a police officer, has now convinced me that body cameras should be standard equipment for all law enforcement personnel.

Until the amateur cell phone video surfaced, the officer’s account of a life-and-death struggle between him and the victim over the officer’s Taser may have prevailed.  Police body cameras safeguard everyone involved, and the time for their widespread use has come.

According to North Charleston Mayor Keith Summey, 101 body cameras are already on order for the city.  Additionally, 150 more cameras were ordered in the wake of the shooting.  There is also legislation currently under consideration in the state legislature to require that all members of South Carolina law enforcement to wear body cameras.

Project 21 member Stacy Swimp, a community activist in Michigan who is a native of South Carolina, said:

It seems that the officer not only murdered this man, but also tried to place an object by his body to justify killing him.

South Carolina has the death penalty.  I believe this officer acted maliciously and then tried to cover up his evil deed.

He should be considered for the same death penalty he handed down, except in his case it should be decided upon and administered under the law.


Good News for Rare Diseases: Big Profits

For people who had a rare disease, defined as an ailment that strikes less than 200,000 Americans, there was often little hope, at least when it came to pharmaceuticals.  Drug companies didn’t see much profit in sinking resources into developing drugs to treat them.

Thankfully, that’s changing. As the Wall Street Journal notes:

Incentives from the U.S. Food and Drug Administration to develop so-called orphan drugs can mean quicker approval, tax benefits for the developer and seven years’ protection from competition after approval. Conventional drugs typically get five. Patient groups have raised hundreds of millions of dollars to give to firms for development of orphan drugs, defined as experimental treatments for diseases with fewer than 200,000 patients at any one time.

But perhaps most persuasive: Drug companies have found that they can charge towering prices for such drugs, which often treat deadly conditions for which there are few or no options.

Those “towering” prices may seem undesirable, but they are in part responsible for the big profits on these drugs.  And it is the profits which will drive innovation.

When companies and their investors realize there is a lot of profit to be made in a certain area, they will start directing resources to that area in hopes of reaping some of the profits.  This leads to competition which, eventually, will help lower the drug prices.

But if it wasn’t for the ability to make a profit, drug companies wouldn’t be moving into the area of rare diseases.  Right now, there is no drug therapy to treat primary-progressive multiple sclerosis, the worst kind of MS.  Now that drug companies have an incentive to make money off of it, one can hope there will soon be some drug treatments for primary-progressive MS.

I’ve occassionally heard people on the political left decry profits in health care.  Companies should make a profit off of people’s illnesses, they argue.  But that’s incorrect.  Companies aren’t making a profit off of illness; they are making a profit from curing illness.

So here’s hoping that many areas of health care become very profitable.  Profit is what attracts investment in cures.


Winter Blues Can’t Be Blamed for Poor Economy — “About Those Jobs Numbers” For March 2015

It’s not a good Friday for the Obama Administration.  A new report on jobless numbers, compiled by the federal government, came out today.

The official unemployment rate is 5.5 percent.  That’s unchanged from last month, and that’s no cause for celebration.  Even though this official number did not go up, the more complete and nearly double alternative unemployment measure and the workforce participation rate still points to peril.  There are even more reminders that the American economy continues to underperform despite the assurances from the Obama Administration that things are getting better.

As he does every month, Project 21 member Derryck Green provides his monthly analysis of these unemployment statistics and the general state of the economy in the Obama era:

Spring is finally here, but the harsh winter is no real excuse for the poor economy.

Bad weather — snow, in particular — often gets blamed for a lull in economic activity.  That is being used as an excuse right now, and there was plenty of snow across the United States this past winter to take the blame.

That being said, a lot of the problems with the American economy likely have more to do with Barack Obama’s fiscal stewardship than Jack Frost’s prolonged and prodigious visit.

Today’s report on jobless figures issued by the federal Bureau of Labor Statistics helps make that point.

According to the official government estimate, there was an unemployment rate of 5.5 percent in March.  But this unchanged rate pales to the alternative — and much more sobering — U-6 jobless rate of 10.9 percent.  This is the rate that tends to be a clearer indicator of the employment situation because it includes those who are unemployed, underemployed and have removed themselves from the job market altogether.

As Jim Clifton of the Gallup polling firm recently pointed out, this official unemployment rate can be made to seem lower than it may truly be through all sorts of manipulative trickery.

And that more unforgiving alternative rate is, per usual, around twice the official rate the media will focus on and the Obama Administration will cite.  Disappointment will likely be explained away as a result of a bad winter.  For example, state labor reports in Massachusetts and Connecticut already blame snow for slowed job growth and even losses.

But any positivity or assurances of a snowy anomaly cannot cover up how the labor force participation rate is an appallingly low 62.7 percent and has been no higher than 62.9 percent through many seasonal changes of the past year.  Nothing can deny that the estimated 126,000 jobs created in March fell below expectations and marked the end of a year-long streak of monthly job creation over 200,000 jobs.  ADP, a private company that works in payroll processing, was actually optimistic earlier in the week when it estimated 189,000 jobs were created.  Both numbers are below the 225,000 that were projected.

There’s also should be concern about joblessness in key demographics that are long-term and hurting constituencies allegedly of the utmost concern to this presidency.  For example, the black teen unemployment rate was 25 percent — a sky-high number that improved but has nonetheless hovered around 30 percent for much too long.  Overall black unemployment was also way too high at 10.1 percent, which was a slight decrease from February.  Hispanic unemployment was up to 6.8 percent.

These higher-than-average unemployment rates were not just during the winter months.  Black unemployment, for example, was 11 percent in November of 2014, before a lot of snow began falling.  The unemployment rate has been dismal, whether there was snow or leaves on the ground.

These unemployment numbers could be getting worse in the future as more illegal immigrants come “out of the shadows” to benefit from the President’s recent executive action allowing some families to benefit from what’s everything short of full amnesty.  In news that should not surprise anyone, the Center for Immigration Studies revealed that Department of Homeland Security statistics indicate that over 2,000 youth are still crossing the border into the United States each month.  The lure of what is believed to be real amnesty is obviously an incentive to those flooding the border.

According to the CIS, 84 percent of these kids currently crossing the are teenage boys.  They are, or soon will, be competing in the workforce — legally or not — rain, snow or shine.  And they will be going head-to-head with unemployed American citizens for similar jobs.

It’s clearly a build-up for disaster.

Getting back to the change in seasons, unemployment is not the only poor economic indicator being blamed on the snow when it really should not.

Construction of new homes, for instance, fell the furthest in February than in the previous four years.  Housing starts were down 17 percent from January and, according to IHS Global Insight, this “poor” Commerce Department report suggests that reduced spending on construction could drag down the entire economy for the first quarter of 2015.

Bank of America’s Michelle Meyer dispelled the weather myth as it pertains to housing, telling Bloomberg: “While the initial reaction is to dismiss much of the drop because of the bad weather, the level of home construction continues to be depressed.”  There are also still 1.4 million fewer construction jobs than in 2006.

In addition to problems in the construction industry, there is a potential problem for auto sales as well.  It appears the expected drop in sales of new cars has arrived, with automakers such as Ford and Nissan reporting March sales were down by three percent.  Honda sales were down by five percent.  Volkswagen fared even worse with an 18 percent decline.  General Motors also lost two percent.

Some people want to blame a snowier March, but it is still generally supposed to be a good month for car sales.  Alec Gutierrez of Kelly Blue Book told the Associated Press that “we’re at a point where sales are going to grow at a much slower pace.”

What are government officials thinking?  Over at the Agriculture Department, while many families are planting their own vegetable gardens this spring, it would appear bureaucrats are instead trying to find better ways for Uncle Sam to deliver fruits and vegetables to those on public assistance.  They are apparently less focused on helping people in need do things themselves, and would prefer spending more on enhanced benefits.

SNAP/food stamp participation more than doubled since the start of the Great Recession.  It is expected to cost an estimated $80 billion in 2015.  At least $31 million of that is allegedly to be spent on encouraging “incentive strategies to help SNAP participants better afford fruits and vegetables.”

It would appear as if there is more emphasis on using welfare dollars to meet the desires of bureaucrats than in encouraging recipients to not need them at all.  It’s like there is no expectation of an end of attempts to slow the economic malaise that has gripped the nation throughout the Obama Administration.

Seven winters have come and gone while Barack Obama has lived in the White House.  The economy has remained in a rut throughout these winters and the following springs, summers and falls.

Even the New York Times article on these latest unemployment numbers can’t find much of merit: “This latest jobs report underscores what has been a persistent theme: that in the recovery, many working Americans have received only scant benefits from the upswing.”

It’s not the rain or the snow probably as much as the drip at 1600 Pennsylvania Avenue at fault!


Celebrity Chef Tom Colicchio Divides Us Between Red Plates and Blue Plates 

Vegetable sandwich LW

In a National Review piece just out today, food writer Julie Kelly and I review the divisive activism of celebrity chef and MSNBC food correspondent Tom Colicchio.

We write that,

If you’re looking for practical dinner advice, look elsewhere.  

I’m confident that National Center for Public Policy Center Research readers are erudite enough to already know that an MSNBC food correspondent isn’t the guy you should look to for recipes. 

Recall, for instance, when I told The Washington Post not to give mainstream credence to the 2013 National Food Policy Scorecard sponsored by Mr. Colicchio’s group, Food Policy Action. 

Jeff Stier, senior fellow at the conservative National Center for Public Policy Research, said there’s a good reason for Republican lawmakers’ performance on the scorecard. “It does not, as FPA claims, ‘reflect the consensus of top food policy experts,’ ” he said. “Rather, it represents the narrow views of a select group of some of the nation’s most ideologically divisive activists.”

Stier called the scorecard a “sham,” saying it has all the validity of an “NRA scorecard on gun ownership. But they’re playing it off as otherwise, which I think is misleading.”

Well, not much has changed since 2013. 

Celebrity chef Tom Colicchio probably doesn’t cook much these days. Having built his reputation preparing expensive entrées for his well-heeled customers at Craft Restaurants, Colicchio is now cooking up liberal food policy to expand the government’s ever-encroaching role in how we eat, and what.

 His self-promotion schedule and branding pursuits could put Kim Kardashian to shame. He’s the star and producer of two reality shows on Bravo, Top Chef and Best New Restaurant. Colicchio owns several pricy restaurants and “ethical sandwich” joints on both coasts. He lends his name to a collection of expensive artisanal kitchenware, including a coffee mug for only $46.

 But apparently television and restaurant fame don’t hold enough gravitas for this wannabe political star. Over the last few years, Chef Colicchio has emerged as the face of the food movement, culinary elitists who insist that every bite of food is a political statement (think climate-change folks going after your shopping cart instead of your SUV). 

Testifying before Congress a few years ago about the school-lunch program whet his appetite for politics. Since then, Colicchio has visited Capitol Hill several times to promote mandatory labeling of genetically modified foods, and as the guest of organic farmer Representative Chellie Pingree (D., Maine) he even attended the State of the Union address in January. No doubt the chef will want a seat at the table to spin the now controversial update to the Dietary Guidelines for Americans, due for approval later this year.

Read the full piece here.


Repealing the SGR Without Adding (Too Much) to the Deficit

Today the House passed the “Medicare Access and CHIP Reauthorization Act of 2015” which will repeal the dreaded Sustainable Growth Rate.

Unfortunately, the bill is not without its problems, not the least of which is it will cost $141 billion over ten years.  

Thanks to the folks at the Heritage Foundation for pointing out to me that there is at least $57.6 billion worth of Medicare changes in President Obama’s budget that could be used to defray some of the cost.  They include:

-$62.5 billion by increasing income‐related premiums under Medicare Parts B and D.

-$6.6 billion by increasing the Part B deductible for new beneficiaries.

-$0.8 billion by introducing home health co‐payments for new beneficiaries.

-$17.7 billion by encouraging  the use of generic drugs by low‐income beneficiaries.

-$5 billion by introducing a Part B premium surcharge for new beneficiaries who purchase near first‐dollar Medigap coverage.

That adds up to about $92.6 billion. The House bill already incorporates about $35 billion of it, meaning that there is another $57.6 billion that the Obama Administration is willing to go along with.  Include the rest and the cost drops to $83.4 billion.  

I’d still like to see that final $83.4 billion paid for, but if that was the only thing standing in the way of SGR repeal, it might be worth it.

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