If you want to really know what your friends and family think of you
—die broke, and then see who shows up for the funeral.
Gregory Nunn
Another JOTY Nominee: Hillary Clinton
I was sharply critical about Hillary Clinton's clearly rehearsed "What difference does it make?" feinted outrage while questioned by Sen. Johnson (R-WI) earlier this year. There are details emerging (see an excellent post here by Bryan Preston (HT Jim Geraghty of National Review), e.g.,
- Ambassador Stevens was in Benghazi to accommodate Clinton's politically motivated request to make the Benghazi mission permanent despite repeated concerns about security
- Former deputy diplomat Greg Hicks personally spoke with Clinton the night of the attack at her own initiative (with other State Department personnel conferenced in), specifically calling it a terrorist attack and never discussed a fictitious Youtube video protest
- Hicks' own team reached the scene before the end of the attack. The US military was told to stand down at least twice, one time before Hicks' team arrived.
Not only did the [Benghazi] security situation fail to improve in the months leading up to the attack, it actually deteriorated, and security personnel were reassigned even as the number of violent incidents against the Western presence increased. (In its after-action reports, Hillary Clinton’s State Department either dismissed these security failings or laid them at the feet of middle managers below the level of Senate confirmation.)
In his 22 years of diplomatic service, Hicks testified, every congressional delegation he has ever received has been afforded one-on-one meetings with chargés d’affaires. But in the aftermath of Benghazi, State Department lawyers explicitly instructed Hicks not to speak to Representative Jason Chaffetz, nor to allow Chaffetz to speak with security personnel, without their presence as babysitters — a massive breach in protocol.
The whistleblowers’ testimony is recounted here with little adornment, because to read it is to understand its import. It shows an administration characterized ex ante by incompetence and ex post facto by panic and cold calculation, willing to subvert national security for campaign-season politics. And it paints Hillary Clinton’s inner circle as eager to shift blame from political appointees to mid-level career employees, to intimidate foreign and civil servants into toeing the company line, and to punish those who refused (Hicks was demoted).What about the Congressional Democrats' reaction? Pathetic; as you might guess, there was an attempt to blame budget cuts. Clearly they are not the sharpest knives in the drawer: they are repeating Biden's debunked assertion during the VP debate last fall:
The post-debate fact checkers are taking Vice President Joe Biden to task for saying the administration never received requests for more diplomatic security in Libya. when in fact the State Department has already admitted it rejected those very requests. [Charlene Lamb, a deputy assistant secretary of state for diplomatic security admitted it wasn't a money issue.]It would be entirely predictable for Dems to personally attack whistleblowing witnesses (e.g., suggest that Hicks' testimony is payback for his demotion). But facts are stubborn things. We know Clinton herself made the Benghazi mission a priority, she did not make related security a budgetary priority, Hicks who personally briefed Clinton on the attack never discussed a video-related protest, Clinton, Obama, and Rice knowingly blamed an Internet video (versus the presence of Al Qaeda affiliates in the unstable region on the symbolic anniversary of 9/11) without a scintilla of evidence--and in the process embarrassed the Libyan president whom publicly called it terrorism. In the process they subordinated diplomacy to domestic politics, the upcoming Presidential election.
Hillary Clinton now owns two of the most notorious sound bites in recent American history, with the paranoid "vast right-wing conspiracy" and now "what difference does it make?" (I wonder if she would have said the same about investigations into the Watergate cover-up--which did not leave 4 dead Americans in its wake). Additional facts now make this flawed politician the front runner in this year's mock JOTY contest
A Step Forward: Greater Transparency in Health Care Charges
I did a commentary on Time Magazine's "Bitter Pill" cover story a few weeks back--which, among other things, discussed the mysterious "chargemaster". each hospital's legacy price list that can be arbitrarily adjusted upward over time, without an explicit link to costs or prices across providers. Government program reimbursements in theory are linked to costs. Insurance plans have often been priced at some positive offset off government prices, although Brill claims that hospitals are increasingly pricing at a discount to chargemaster. The only people who really are charged list are those without pricing power, e.g., the uninsured.
For the first time, CMS, the Medicare/Medicaid department under HHS, is providing aggregate pricing Medicare information relative to the most common inpatient procedures,
The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2011. These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges.The data show significant variances not only between regions of the country but hospitals within the same area. Keep in mind these data reflect chargemaster prices, not Medicare reimbursements or insurance payments to providers, all significantly lower. According to Washpo:
Experts attribute the disparities to a health system that can set prices with impunity because consumers rarely see them — and rarely shop for discounts. Although the government has collected this information for years, it was housed in a bulky database that researchers had to pay to access.
The hospital charges being released Wednesday — all from 2011 — show the hospitals’ average list prices. Adding another layer of opacity, Medicare and private insurance companies typically negotiate lower charges with hospitals. But the data shed light on fees that the uninsured could pay.How significantly different can the list prices be?
Las Colinas Medical Center just outside Dallas billed Medicare, on average, $160,832 for lower joint replacements. Five miles away and on the same street, Baylor Medical Center in Irving, Tex., billed the government an average fee of $42,632.
In downtown New York City, two hospitals 63 blocks apart varied by 321 percent in the prices they charged to treat complicated cases of asthma or bronchitis. One charged an average of $34,310; the other billed, on average, $8,159.We who believe in a free market are always saying information is the best form of regulation. That the Obama Administration is releasing this information is a step forward, long overdue. Uninsured patients often pay higher than the government or insurers pay. (I wouldn't mind a pricing regulation that caps charges for uninsured customers needing urgent medical care at a modest markup over average procedure payments; there is an asymmetrical relationship here,)
There is another graphic involving two Miami hospitals in the same neighborhood where one of the hospital (the University of Miami) charges nearly a third to 100% more for 3 procedures. (It's not immediately clear to me why the hospital with the lower list prices is actually reimbursed more for the same procedures.) It's worth noting reimbursements in these examples are less than half list prices.
I thought Jeb Bush while governor of Florida did something similar about posting certain Medicaid-related price data (prescriptions? medical charges?) on the Internet but my Internet query didn't pull up the program in question; I did pull this Heritage piece on Medicaid reform and certain pilot projects.
Hospitals have been acting in a noncompetitive fashion by failing to disclose pricing. It would be like going to a restaurant which doesn't put prices on the menu. Patients/consumers have a need to know so they can manage their budget.
Entertainment Potpourri
It's Official: Candice Glover v. Kree Harrison. Any faithful reader knows that I predicted this American Idol finale match-up weeks ago. Candice has easily won the last few weeks, so I cast my first vote of the season for Ms. Harrison. I'll wait until next week's performance to decide my vote, but you would have to say Harrison is the underdog; a lot depends on the songs, including any original songs, I wouldn't rule out a Harrison victory because predecessor country singers Carrie Underwood and Scotty McCreery have won, and Harrison may be the best country talent since Underwood. Glover has a great voice, but prior winning artists of color have not enjoyed the kind of success enjoyed by Kelly Clarkson and Underwood. Some see in her the next Whitney Houston. I could easily envision Glover covering, say, a new Bond movie theme, but I'm not sure that Whitney could have broken out in today's music scene. A lot depends on the material, but if I was in her position, I would probably include some retro cover duets with Tony Bennett and Harry Connick on the first album, maybe looking for new songs from established songwriters like Diane Warren, Lionel Richie, etc. But I would advise against doing, say, Broadway/Oscar/torch singer compilations until she's got some original hit albums under her belt.
The biggest rumor is that AI will dismiss all the judges after this season; Randy Jackson has already announced, in what I regard a face-saving move, his departure from the show, and Mariah Carey has decided to change managers (Jackson has been her manager). I saw one rumor show producers might try to reunite the original judges, but Cowell is still involved with X Factor and Jackson's announcement seems to rule that out. I'm not sure that dumping the divas Carey and Minaj will be enough. I've mentioned some suggestions in past segments, but they might also consider gimmicks like a Youtube audition and song nominations/selection by fans and more of a playoff (say, grouping by genre vs. single-elimination) format.
Political Cartoon
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| Courtesy of Gary Varvel and Townhall |
Bruce Springsteen & the E-Street Band, "Badlands"
