March 8, 2017

Posted by orrinj at 6:08 PM


WikiLeaks Has Joined the Trump Administration : The anti-American group has become the preferred intelligence service for a conspiracy-addled White House. (MAX BOOT, MARCH 8, 2017f, Foreign Policy)

As a presidential candidate, Donald Trump declared, "I love WikiLeaks!" And he had good reason to display affection to this website run by accused rapist Julian Assange.  [...]

Is it just a coincidence that WikiLeaks dumped a massive database pertaining to CIA hacking and wiretapping just three days after Trump made wiretapping a major political issue? Perhaps so. But there is cause for suspicion.

In the first place, WikiLeaks has often timed its leaks for maximum political impact. It released 20,000 stolen DNC emails just three days before the Democratic National Convention on July 25, 2016. As expected, WikiLeaks generated headlines about DNC staffers disparaging Sen. Bernie Sanders, buttressing a Trump campaign effort to prevent Clinton from consolidating Sanders supporters. DNC Chairwoman Debbie Wasserman Schultz resigned as a result, and the Clinton campaign suffered significant public relations damage.

In the second place, WikiLeaks, which has often leaked American but never Russian secrets, has been identified by the U.S. intelligence community as a front for Russian intelligence. In January, the Office of the Director of National Intelligence released a declassified estimate that found "with high confidence that Russian military intelligence ... relayed material to WikiLeaks." This was done with a definite purpose: "Putin and the Russian Government aspired to help President-elect Trump's election chances when possible by discrediting Secretary Clinton and publicly contrasting her unfavorably to him."

Posted by orrinj at 5:36 PM


Former Trump aide Flynn says lobbying may have helped Turkey (STEPHEN BRAUN and CHAD DAY, Mar. 8, 2017, AP)

A lawyer for the former U.S. Army lieutenant general and intelligence chief said in paperwork filed Tuesday with the Justice Department's Foreign Agent Registration Unit that Flynn was voluntarily registering for lobbying that "could be construed to have principally benefited the Republic of Turkey." we're just haggling over the price....

Posted by orrinj at 3:24 PM


Booming again: U.S. poised for record oil output in 2018 (Matt Egan, March 8, 2017, CNN Money)

Following a painful war with OPEC, U.S. oil output is poised to rebound this year, thanks to healthier prices and a strengthened business model.

That could set the stage for America to set a record-breaking 2018, taking out the all-time oil production high set in 1970, according to new forecasts published this week by the U.S. Energy Information Administration.

The U.S. oil comeback is being led by the Permian Basin, a hotbed of shale drilling in Texas and New Mexico. The Permian is so rich in shale oil that frackers can profitably drill even in today's modest prices in the low $50-a-barrel range.

"Shale has proven to be remarkably resilient. The key is that any dollar invested today is double as efficient as it was two years ago," said Tamar Essner, energy director of Nasdaq Advisory Services.

Posted by orrinj at 12:39 PM


Pete Carril Saw the Future of Basketball (BEN COHEN, March 7, 2017, WSJ)

Carril, the 86-year-old basketball sage known as "Yoda," was the architect of an eccentric offense designed to give his Ivy League school a chance against more talented teams, which was almost every team it played. But his work was always seen as part brilliance, part gimmick--even when Carril retired in 1996. Only since then has something unexpected happened.

It has become clear in recent years, as basketball has evolved, that Carril was ahead of his time.

The Golden State Warriors aren't running backdoor cuts, and the Cleveland Cavaliers aren't running down the entire shot clock. But in many ways, the game has caught up to Carril. The trends of today's NBA are the same as his ideas from decades ago.

Carril was bullish on 3-pointers. "I love the 3-point shot," he once wrote. "You know why? Because it means they're giving us three points for the same shot we used to get two for."

He valued big men who could play small ball. "All five guys could step outside and make a 3-point shot," said Bob Scrabis, who played for him in the 1980s. "If you couldn't shoot, you couldn't play."

He also hated mid-range shots. "If you charted our shooting and looked at how many shots were layups or 3-point shots," said Princeton alumnus Matt Lapin, "it had to have been 90%. And maybe even higher."

NBA teams play the way Carril always believed the game should be played because they have data that proves it works. But that information wasn't available when Carril was coaching. And others were curious about Princeton's unusual style. Carill still recalls one clinic when former Arkansas coach Nolan Richardson cornered him to ask why Princeton only seemed to shoot high-percentage, highly efficient shots: 3-pointers and layups.

Posted by orrinj at 11:42 AM


Russian diplomat under U.S. scrutiny in election meddling speaks (KEVIN G. HALL, PETER STONE, GREG GORDON AND DAVID GOLDSTEIN, 2/15/17, McClatchy)

A Russian diplomat who worked in the Washington embassy left the country last August while federal investigators examined whether he played a key covert role in the alleged Kremlin-directed plot to influence last fall's U.S. elections.

Two people with knowledge of a multi-agency investigation into the Kremlin's meddling have told McClatchy that Mikhail Kalugin was under scrutiny when he departed. He has been an important figure in the inquiry into how Russia bankrolled the email hacking of top Democrats and took other measures to defeat Hillary Clinton and help Donald Trump capture the White House, said the sources, who spoke on the condition of anonymity because of the sensitivity of the investigation. [...]

Kalugin was "withdrawn from Washington at short notice because Moscow feared his heavy involvement in the US presidential election operation . . . would be exposed in the media," the former British MI6 officer Christopher Steele reported. "" [...]

McClatchy reported in January that several law enforcement and intelligence agencies, led by the FBI, are collaborating in the investigation of Russia's influence on the election. Five congressional panels, including the House of Representatives and Senate Intelligence committees, are conducting their own inquiries.

Several members of Congress, both Democratic and Republican, said Monday's resignation of retired Army Lt. Gen. Michael Flynn as Trump's national security adviser reaffirmed the need for investigations into Russia's meddling. In resigning Monday, Flynn acknowledged that he had discussed U.S. sanctions with Russia's ambassador before Trump's inauguration and had misled others about the nature of the conversation.

Flynn was mentioned in Steele's reports as one of several U.S. citizens Russia cultivated. In December 2015, Flynn was paid an undisclosed sum to speak at a Moscow gala, where he sat beside Russian President Vladimir Putin.

Although Steele began sharing what he'd learned with the FBI last July, it is not clear whether he alerted U.S. investigators to Kalugin or they already were scrutinizing his activities.

Steele, who built a strong reputation in the intelligence world, spent much of his career spying on Moscow and tapped a longtime network of Russian sources. He spent months gathering research about Trump for a Washington consulting firm. Last fall, Mother Jones magazine quoted him, before he was publicly identified, as saying he was so alarmed by what he found that he began sharing information with the FBI. [...]

A Steele report, dated Sept. 14, 2016, said Kalugin was involved in moving "tens of thousands of dollars" to cyber hackers and other operatives through a system that distributes pension benefits to Russian military veterans living in the United States.

One of the sources familiar with the federal investigation gave credence to parts of that statement, saying: "The Russian embassy was known to funnel payments and make contacts with current Russian citizens, former Russian citizens who are now American citizens, and American citizens."

Posted by orrinj at 10:53 AM


How GOP bumbling just made single-payer health care more likely (James Pethokoukis, 
March 8, 2017, The Week)

A smart, comprehensive, center-right plan would have tried to significantly expand the role of markets and consumer choice in the American health-care system. Many conservatives, for instance, wanted a plan that would give Americans more control over their health-care spending and allow them to take their plan from job to job. But the AHCA won't offer its new tax credits for those currently offered workplace insurance. Nor does it put U.S. health care on such a path.

Others on the right envisioned a dramatically deregulated ObamaCare that eventually would have swallowed up Medicare and Medicaid. Yet the House GOP plan mostly keeps the "essential health benefits" regulations of ObamaCare that dictate what benefit plans purchased on the exchanges must offer.

Nearly seven years after President Obama signed the Patient Protection and Affordable Care Act, House Republicans have failed in their big attempt to offer FreeMarketCare. And this may well have been their final chance to do so. Health care isn't the only item on the GOP agenda, after all. Congressional Republicans are also desperate to cut business taxes, while the Trump White House keeps promising a major infrastructure plan. And don't forget Ivanka Trump's pricey paid leave and child care ideas.

Meanwhile, the ACA remains desperately in need of reform as too few of the young and healthy sign up. "ObamaCare is so poorly constructed it is literally an anti-selection machine," health-care analyst Bob Laszewski writes at his popular blog, adding,"The Republican proposal is worse."

Well, Sanders had an answer for that -- he called his version "Medicare for All" -- and it's an answer that many Democrats wanted all along. Indeed, one way Obama sold Democrats on health reform that kept for-profit, private insurance central was by suggesting it was merely a way station to single payer. That idea is probably looking better and better to Democrats right about now, especially as the party continues to drift left. And maybe to the Republican president, too.

...universal catastrophic/HSAs or National Health. The former is preferable because it builds individual wealth. The party has wasted an awful lot of energy on a fight they were never going to win.

Posted by orrinj at 10:44 AM



THE NATION IS in serious danger. The creeping spread of Islam is pushing out Christianity. The country's borders are swarming with drug-slinging criminals, and its veterans are dying in droves. Heartless, power-hungry liberals snatch guns away from poor, defenseless citizens while openly mocking Gold Star widows. Meanwhile, Democratic operatives are planning a coup from a bunker not far from the White House and wiretapping Trump administration officials, not to mention Trump Tower itself--a looming scandal of Watergate proportions.

The worst part? The propagandistic left-wing media (that subhuman species) won't report a word of it.

At least, that's what I learned spending a few weeks on a self-imposed binge of President Trump's media diet--a virtual smorgasbord of Breitbart, Fox News, front-page newspaper headlines, presidential Twitter, and a smattering of Infowars for flavor. 

The national security investigation into the Trumpies is the perfect lens for seeing how willfully detached from reality the Right is.

Trump Aides Address His Wiretap Claims: 'That's Above My Pay Grade' (GLENN THRUSH and MAGGIE HABERMAN, MARCH 7, 2017, NY Times)

"No, that's above my pay grade," said Sean Spicer, the White House press secretary and a feisty Trump loyalist, when asked on Tuesday at an on-camera briefing if he had seen any evidence to back up Mr. Trump's accusation. The reporters kept at him, but Mr. Spicer pointedly and repeatedly refused to offer personal assurances that the president's statements were true.

"No comment," Attorney General Jeff Sessions said earlier in the day. Last week, Mr. Sessions recused himself from any investigations involving the Trump campaign's contacts with Russia.

"I don't know anything about it," John F. Kelly, the homeland security secretary, said on CNN on Monday. Mr. Kelly shrugged and added that "if the president of the United States said that, he's got his reasons to say it."

Representative Devin Nunes, Republican of California and the chairman of the House Intelligence Committee, and Senator Richard M. Burr, Republican of North Carolina and the chairman of the Senate intelligence panel, have said they will add Mr. Trump's request to pre-existing inquiries into intelligence community leaks.

But Mr. Nunes and Mr. Burr said they had not seen specific evidence backing up Mr. Trump's claim.

Other Hill Republicans have responded with similar verbal shrugs. Senator John Cornyn of Texas, a member of the Intelligence Committee, said on Tuesday that he "didn't know what the basis" of Mr. Trump's statement was.

Mr. Trump's Twitter posts, viewed with amazement outside the West Wing bubble, often create crises on the inside.

Posted by orrinj at 10:32 AM


Survey: Private employers added robust 298K jobs last month, the most in three years (LA Times, 3/08/17)
U.S. private businesses added the most jobs in three years last month, a private survey found, a sign that hiring is picking up seven years after the recession ended.

Payroll processor ADP said Wednesday that businesses added 298,000 jobs in February, up from 261,000 in January. The gains were led by a huge 66,000 increase in construction, the most in 11 years, and 32,000 manufacturing jobs.

W and the UR left us in such good shape even Donald will have trouble screwing it up, especially if the Deep State stops him on immigration and trade.

Posted by orrinj at 10:27 AM


White House official terrorizes network green rooms (ANNIE KARNI, 03/07/17, Politico)

White House official Boris Epshteyn, a combative Trump loyalist tasked with plugging the president's message on television, threatened earlier this year to pull all West Wing officials from appearing on Fox News after a tense appearance on anchor Bill Hemmer's show.

Epshteyn, according to multiple sources familiar with the exchange, got in a yelling match with a Fox News booker after Hemmer pressed him for details of President Donald Trump's controversial executive order cracking down on immigration from Muslim-majority countries -- a topic he was not expecting to be grilled on.

"Am I someone you want to make angry?" Epshteyn told the booker, the sources said. When he threatened to pull White House officials from the network, the fed-up booker had had enough.

Posted by orrinj at 8:50 AM


How a Slave Spiritual Became English Rugby's Anthem (ANDREW KEH, MARCH 7, 2017, NY Times)

It is a famous refrain and melody. For many in the United States, "Swing Low, Sweet Chariot" enjoys a hallowed status as one of the cherished of 19th-century African-American spirituals, its forlorn lyrics invoking the darkness of slavery and the sustained oppression of a race.

But here, across the Atlantic, the song has developed a parallel existence, unchanged in form but utterly different in function, as a boisterous drinking song turned sports anthem.

"They start singing it when the game starts because they want everyone to get hyped up," said Helen Weston, 53, an England fan at the France game on Feb. 4. "There's nothing like hearing 80,000 people singing 'Swing Low, Sweet Chariot.'" [...]

English fans first sang the song on a large scale at Twickenham Stadium on March 19, 1988, as England recorded a memorable comeback victory over Ireland. Multiple people and groups since then have claimed responsibility for starting the chant.

The motivation is a matter of some intrigue. Over the years, English newspaper articles mentioning the chant's genesis that day matter-of-factly tied its emergence to the race of Chris Oti, who was the first black player to represent England's rugby team in almost a century, and who played a starring role in that game.

Dudley Wood, the former secretary of the Rugby Football Union, was quoted in The Independent in 1991 as saying that Oti "was totally mobbed on the way to the dressing room. It's a delicate situation in a way, in that it's a Negro spiritual. But we poor English don't really have the songs to sing."

Posted by orrinj at 8:44 AM


Assad's Control Erodes as Warlords Gain Upper Hand : Bashar Assad's power over the areas of Syria under government control is slipping. Armed militias are growing stronger and the country's dictator can do nothing to stop them. (Fritz Schaap, March 08, 2017, Der Spiegel)

For months, Assad's army has been on the advance across Syria. But its military success has only been possible due to the significant assistance the dictators' troops have received from Iran and Russia -- and from local Syrian militias. Now, these fighters are taking over control in many areas, committing murder, looting and harassing civilians. And nobody can stop them, not even Assad himself. Indeed, the militias are now more powerful than even the country's dictator and have become the real holders of power in Syria.

Even long before the Syrian revolt of 2011, Assad depended primarily on the loyalty of his fellow Alawites in the top ranks of the armed forces and intelligence services. But the religious group only makes up between 12 and 15 percent of the Syrian population. In 2012, Assad's position became even more tenuous as the army began shrinking rapidly: Tens of thousands of soldiers deserted, conscripts failed to show up for duty and many of those who did fight ended up dead. In September 2015, when the Russians joined the war, the Syrian army only had 6,000 soldiers who were fit for active duty, according to Charles Lister of the Middle East Institute in Washington. He bases his estimate on confidential testimony of Russian officials.

To preserve its regular troops, the regime was forced to make a Faustian bargain, allowing armed loyalists to form their own militias. In many cases, the leaders of smuggling rings or criminal gangs became local kingpins, who were then able to expand their business empires unimpeded in exchange for loyalty to Assad. The two largest militias, the Desert Hawks, headquartered in the northern port city of Latakia, and the Tiger Forces from Hama, each have between 3,000 and 6,000 armed fighters. Additionally, there are hundreds of smaller pro-regime militias.

Bread, gasoline, medication -- there are shortages across the entire country. And those who control the distribution of these goods can profit handsomely, enabling them to purchase more weapons and hire more fighters. As a result, the warlords have replaced the state security apparatus in cities and in entire regions.

While the Syrian army, in its desperation, has been forced to combs jails for recruits, fighters join the militias of their own free will. Some of them, after all, pay up to three times the salary earned by regular soldiers and they have a lot more freedom. They can, for example, extort duties at checkpoints, sell drugs of their own accord, smuggle gasoline and loot conquered towns and villages.

Assad is nevertheless dependent on them. When his troops, supported by Russian units, took eastern Aleppo in December 2016, the Syrian soldiers featured prominantly in front of the television cameras. But the actual fighting was conducted by Iraqi, Afghan and Lebanese mercenaries under Iranian senior leadership -- and by the pro-regime militias, who also secured the conquered territory once the fighting had ceased. And they plundered it.

Regime-held territory today is similar to areas under rebel control -- splintered and characterized by shifting alliances. Hundreds of groups with competing loyalties have taken control, earning money from the war and controlling their territory through fear.

Posted by orrinj at 8:35 AM


Is Trumpcare Already Dead? : The Republican replacement for Obamacare is such a mess that it has united people from across the political spectrum. (ALEX SHEPHARD, March 8, 2017, New Republic)

The rollout of the GOP's long-awaited Obamacare replacement, the American Health Care Act, was a disaster. Instead of unveiling the bill with fanfare, it was leaked to the media on Monday night, which meant that there was precious little spin to help conservatives digest it. The following morning, Representative Jason Chaffetz of Utah went on TV to play pitchman, and ended up dominating headlines by telling poor people they have to choose between a smartphone and health insurance. President Donald Trump embraced the bill, but also left a lot of daylight, creating an opening for congressional Republicans and conservative activists to criticize it. Secretary of Health and Human Services Tom Price tried to patch things up by appearing at Press Secretary Sean Spicer's midday lie jamboree, but came across as squirrelly and unprepared--his main argument for the bill was that it was short, as he stood next to a very tall stack of papers meant to represent Obamacare/big government. By evening, prominent Republicans were proclaiming that the AHCA was DOA and conservatives in the House were in revolt. "I don't think it's ever going to arrive in the Senate," Kentucky Senator Rand Paul told CNN. "I think it's dead on arrival in the House." 

The AHCA has achieved one thing in its short and worthless life, however: It sucks so much that people have come together from across the political spectrum to proclaim just how much it sucks.

The GOP will ultimately make health care more universal with less choice (catastrophic/HSAs).

Posted by orrinj at 6:44 AM


New Israel Law Bars Foreign Critics From Entering the Country (LAURIE GOODSTEIN, MARCH 7, 2017, NY Times)

The measure, passed on Monday night, received little notice in Israel, but by Tuesday it set off alarms in the United States, where Israel's critics and some of its most loyal Jewish supporters alike warned that it would further isolate the country.

Rabbi Rick Jacobs, the president of the Union for Reform Judaism, the largest Jewish movement in North America, said in a telephone interview from Jerusalem: "It's going to be a giant sign up by the door of the Jewish state: 'Don't come unless you agree with everything we're doing here.' I don't know what kind of democracy makes that statement."

Posted by orrinj at 6:14 AM


WikiLeaks Releases Trove of Alleged C.I.A. Hacking Documents (SCOTT SHANE, MATTHEW ROSENBERG and ANDREW W. LEHRENMARCH 7, 2017, NY Times)

In what appears to be the largest leak of C.I.A documents in history, WikiLeaks released on Tuesday thousands of pages describing sophisticated software tools and techniques used by the agency to break into smartphones, computers and even Internet-connected televisions.

The documents amount to a detailed, highly technical catalog of tools. They include instructions for compromising a wide range of common computer tools for use in spying: the online calling service Skype; Wi-Fi networks; documents in PDF format; and even commercial antivirus programs of the kind used by millions of people to protect their computers. [...]

Unlike the National Security Agency documents Edward J. Snowden gave to journalists in 2013, they do not include examples of how the tools have been used against actual foreign targets. That could limit the damage of the leak to national security. But the breach was highly embarrassing for an agency that depends on secrecy.

Posted by orrinj at 6:08 AM


How will Trump's new travel ban order hold up in court? (TERRY CARTER, 3/07/17, ABA Journal)

Bob Ferguson, Attorney General for Washington State,0 also noted that, "By rescinding his earlier executive order, President Trump makes one thing perfectly clear: His original travel ban was indefensible--legally, constitutionally and morally," reported.

In that report, Harrison "Buzz" Frahn of Simpson Thacher & Bartlett, who has followed the cases, said the first order "was rushed and I've heard it described as a sitting duck," while the new one "maybe takes some more careful aiming," reports.

The new order, as part of its justification for national security reasons, notes two incidents in which foreign refugees later were convicted of terrorism-related crimes: two Iraqis received lengthy prison sentences in 2013, and a Somali was sentenced to 30 years in prison over a bombing plot at a Christmas tree lighting ceremony in Portland, Oregon.

Those refugees became radicalized while in the U.S., Frahn points out. "They've had six weeks since the original order came out to collect and collate data and all the alleged instances that could justify this, and this is the best they could come up with." [...]

Opponents say they still have a strong argument that the order targets members of a specific religion because they have Muslim majorities: Iran, Libya, Somalia, Sudan, Syria and Yemen. (Iraq was dropped.)

"That evidence is baked in; you can't change the past," Stephen Logomsky told Reuters. He was chief counsel at the U.S. Citizenship and Immigration Services in the Obama Administration and noted that Trump said early on that he wanted a ban on Muslims entering the country. But still, Logomsky said of coming legal challenges to the order, "It's not a slam dunk."

New York Attorney General Eric Schneiderman asserted Monday that he would joining those who bring the fight.

Schneiderman said that "while the White House may have made changes to the ban, the intent to discriminate against Muslims remains clear. This doesn't just harm the families caught in the chaos of President Trump's draconian policies--it's diametrically opposed to our values, and makes us less safe."

Posted by orrinj at 6:02 AM


Right revolts on ObamaCare bill (PETER SULLIVAN - 03/07/17, The Hill)

Conservatives in the House openly rebelled Tuesday against legislation backed by their leadership to repeal and replace ­ObamaCare, sowing doubts about whether the legislation can pass.

The rollout for the long-awaited healthcare plan, released Monday evening, was rocky. It was panned on the right as a retreat from full repeal, pilloried on the left as a tax giveaway to the rich, and criticized from the center as potentially stripping insurance from millions of people. [...]

After a meeting later Tuesday evening, Freedom Caucus members said leadership doesn't have enough support. 

"Right now the Speaker of the House does not have the votes to pass this bill unless he's got substantial Democratic support," Rep. Mo Brooks (R-Ala.) said. 
The conservatives vowed to reintroduce the same ­ObamaCare legislation that passed Congress in 2015 but was vetoed by then-President Obama. That bill would repeal all of ­ObamaCare's taxes and mandates and eliminate its Medicaid expansion.

The leadership-backed legislation also took heavy fire from outside conservative groups, including the Club for Growth, Heritage Action and Americans for Prosperity, which is backed by the billionaire GOP mega-donors Charles and David Koch. They saddled the plan with names like "RyanCare" and "­ObamaCare lite" and attacked centrist Republicans who fear the measure already goes too far.

...who believe health care is a right in a democracy and took Donald and Hillary at their word when they promised to deliver it.

Posted by orrinj at 5:53 AM


What if Trump took his wiretap story seriously? (Ramesh Ponnuru, March 7, 2017, Bloomberg View)

Some people greeted Trump's claim credulously. The president's cheering section believed him, of course. So did some of his most bitter foes. Former Democratic National Committee chairman Howard Dean took it as a given that Trump was right about being wiretapped, but said that it proved that a judge had "found probable cause that Trump was engaging in criminal activity."

But just because people with varying views have reasons to believe Trump doesn't mean he's right.

There was just enough in the news to buttress the story for the believers. Reports for Heat Street, the Guardian and the BBC over several months had suggested, with thin sourcing, that the FBI had sought to monitor transactions involving Trump aides. Of course, even if those reports are true, they do not establish what Trump alleged: that Obama had personally ordered the surveillance. They don't even establish that Trump himself was being surveilled, or that the surveillance took the form of wiretapping. [...]

Nothing Trump's own administration has said or done so far indicates that it takes his accusations seriously. And that starts at the top with the president himself. Trump explicitly accused his predecessor of misconduct on the level of "Watergate," and then moved on to tweeting about his feud with Arnold Schwarzenegger.

At the point where the Right is dancing to Assange's string-pulling it's hard to believe this administration is any more than a parody.

Posted by orrinj at 5:31 AM


The Road to Value in Health Care : For Medicaid and other programs, state policymakers can learn a lot from new payment models that are evolving. (MARC BERG, MARCH 8, 2017, Governing)

Two evolving approaches in particular are moving to the forefront as policymakers look for alternatives to the traditional and much-maligned fee-for-service system: "capitation," in which a health-care provider receives a fixed, per-person payment covering the broad needs of its patient population, and bundled payments, in which providers are paid for all of the care needed for an individual patient's particular medical condition.

One key lesson for leaders seeking a value-based payment (VBP) model is the importance of communicating a vision for a future operating framework. This should not be a mere top-down vision: Stakeholders will need to be engaged in multiple initiatives across services lines. Looking for synergy rather than yet more fragmentation is key. This begins with early conversations with stakeholders, gathering information concerning best practices, and anticipating challenges, while also engaging community-based organizations and Medicaid member advocacy groups.

New York State provides a prime example of how these conversations can unfold and have impact. During 2015, more than 500 stakeholders participated in 16 subcommittees and clinical advisory groups focused on the move to VPB. Throughout the implementation process, a core group of stakeholders, including managed-care organizations (MCOs), other providers, community-based organizations and patient advocates, met regularly to monitor progress, suggest improvements and new ideas, and ensure that objectives were being met.

A second important lesson is understanding the importance of flexibility when developing a payment framework. States need to decide where to require uniformity and where flexibility and freedom can better realize the long-term vision. Flexibility in the type of arrangements -- capitation versus bundled payments, for example -- can allow providers to focus on areas where they're best suited to provide care and manage risk.

Texas' Medicaid-CHIP program, for example, utilizes various payment methodologies across the 19 MCOs involved in value-based contracts. Generally, the payment structures in these contracts are represented by one of three methods: fee-for service with bonus payments, partial capitation, and shared savings, in which lowering the total cost of care results in reimbursement to providers that achieve that goal. By allowing for various payment structures, Texas has ensured that a greater number of Medicaid providers are able to participate in value-based contracts.

Posted by orrinj at 4:31 AM


Trump era's vicious partisanship born of small differences (Jonah Goldberg, March 7, 2017 | USA Today)

Consider Trump. His position on trade, his signature issue, represents not a sharp break from the left, but a closing of the gap with it. Protectionism and "fair trade" have been staples of the Democratic Party's base for a very long time, which is why both Bernie Sanders and Hillary Clinton opposed the Trans-Pacific Partnership.

Likewise on infrastructure spending and entitlement reform, Trump hasn't staked out some extreme libertarian stance, he's stolen the issues from Democrats. Just look at health care. The GOP just unveiled their plan to "repeal and replace" Obamacare. It's likely no Democrat in the House will vote for it, not because of its radicalism, but because it is an insult to Barack Obama's legacy. I can understand their frustration, but their anger isn't proof of a major ideological disagreement.

And this points to the source of the confusion. There is a natural human tendency to believe that those we hate must believe the opposite of what we believe. This is part of what psychologists call "the narcissism of small differences."

George W. Bush campaigned on "compassionate conservatism," triangulating against the libertarian rhetoric of (the old) Newt Gingrich and the dour pessimism of social conservatives. His first legislative priority was bipartisan education reform, supported by Ted Kennedy. Bush's prescription drug benefit constituted the largest expansion in entitlements since the Great Society (at least until Obamacare). He rejected the conservatism of William F. Buckley, arguing that, "When somebody hurts, government has to move."

And for these sins, Democrats instantly and continuously insisted he was some kind of radical.

Before Bush, Republicans denounced Bill Clinton as a left-wing extremist, even though he was a free trader, supported the death penalty and campaigned on -- and signed -- welfare reform.