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Health

Obamacare Needs Clearer Guidelines About The Health Coverage That Could Help Smokers Quit

One of Obamacare’s major approaches to tackling skyrocketing health care costs is by encouraging a healthier citizenry through a combination of healthy-living incentives to doctors and patients and free preventative care services for Americans. Smoking cessation efforts have been a major part of those preventative efforts — and with good reason, since cardiovascular disease is the number one cause of death in America, and localities that engage in aggressive anti-smoking efforts tend to see a substantial return on their investment.

But a recent study by the public health advocacy group Tobacco Free Kids finds that there is a large amount of confusion over the rules governing smoking cessation in qualifying health plans, as Kaiser Health News reports:

[W]hen researchers at Georgetown University’s Health Policy Institute examined 39 health plans in six states, they found that coverage for smoking cessation was often confusing. Many contracts didn’t clearly state that the coverage was available, didn’t cover recommended treatments and/or didn’t provide it without cost-sharing.

“The study points out the need for the Department of Health and Human Services to provide much more specific guidelines,” Myers says.

Insurers offer a different perspective. “The final rules [for preventive services] recognized that there wasn’t necessarily a one-size-fits-all approach,” says Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group. “So we would expect to see variation around the methods that plans are using.” In addition, she said AHIP’s own survey of plans found that nearly all offer some type of intervention for tobacco users.

It isn’t surprising that AHIP is content with the current fragmented coverage. Covering smoking cessation programs as preventative care, without charging Americans a co-pay, ultimately translates into higher costs for the insurance companies that AHIP represents. Fortunately, though, the health care reform law is less interested in guarding insurers’ profits and more interested in reducing Americans’ medical costs by encouraging them to improve their health. So better guidelines should naturally follow.

Especially considering the fact that recent Obamacare rules also allow insurance companies — to an extent — to charge American smokers higher premiums than non-smokers, it would be unfair to Americans if the federal government did not offer clearer guidelines on the preventative services that smokers will receive in return for their health care payments.

The designation of anti-smoking programs as freely available preventative services has also been extended to the seniors on Medicare.

Alyssa

84 Percent Of Kickstarter’s Top Projects Are Shipping Late

AslanMedia, via Flickr

I’m all for viable funding mechanisms for projects, artistic and otherwise, that couldn’t get greenlit through conventional means. But as a CNN Money analysis of the top fifty most-funded projects on Kickstarter has discovered, enthusiasm for an idea doesn’t remotely translate to the ability to deliver on promises:

CNNMoney contacted the creators of the 50 highest-funded Kickstarter campaigns with estimated delivery dates of November 2012 or earlier to determine their shipping status. We found that only eight of those 50 projects hit their deadline. Sixteen of the 50 projects haven’t yet shipped. Among the 26 projects that shipped but went out late, the median delay was two months, although some outliers took much longer. The most delayed project in our data set, a home espresso machine being developed by ZPM Espresso, is nine months overdue and doesn’t expect to ship until mid-2013.

“To say we’ve learned a lot about engineering, design, manufacturing, marketing and customer service is … well … an understatement so extreme as to be laughable,” ZPM Espresso’s founders wrote in a recent update to their Kickstarter backers.

I’d hate to see donors start to turn away from the project of investments after getting burned, and I wonder if it’s time to start considering some restrictions that could lower the failure rate. In addition to setting a floor for the amount of money projects have to raise to go forward, maybe Kickstarter could offer an option to set a ceiling on the number of donations or donors a project will allow. That would both create a sense of urgency to get investors in the door, and set certain limits on the number of products that a producer, like the people behind the Oculus Rift virtual reality headset, who intended to produce them by hand and had to figure out alternate, larger-scale production when they were deluged by orders that have lead to significant delays, can be required to deliver.

It’s probably also important to consider the question of refunds. If producers are about to blow deadlines, either a voluntary notification system that gives donors the option of withdrawing their investment, or a more structured appeals system that requires producers to justify the delays or be forced to refund donations to investors who want them. I’m sure these are not processes Kickstarter is interested in getting involved with, given the manpower they’d required, the fact that enforcement would probably scare some users off the site, and the dilution of the simplicity of the site in connecting inventors to investors. But preserving user confidence on the donor side may require that Kickstarter do some work to make sure the people pitching projects on it are actually capable of delivering.

NEWS FLASH

Lead House Republican On Guns: No Gun Regulation | Rep. Bob Goodlatte (R-VA) ruled out any support for new gun control legislation Tuesday afternoon. The legislator, who received an A rating from the National Rifle Association, told CQ Roll Call that “gun control is not going to be something that I would support.” Goodlatte chairs the House Judiciary Committee, which is responsible for legislation on guns.

NEWS FLASH

Defense Budget Advances With Watered-Down ‘License To Bully’ Provision | As expected, the defense budget bill has advanced out of conference with a watered-down version of Rep. Todd Akin’s (R-MO) “license to bully” amendment, which protects anti-gay servicemembers from discipline. According to the Washington Blade, the new version of the “conscience protections” clarifies that actions and speech can still be disciplined, but anti-gay beliefs themselves cannot be used to justify adverse personnel actions. The precise new language has not yet been made public. Rep. Adam Smith (D-WA) says the language was unnecessary because beliefs are already protected, but doesn’t believe the change will have negative consequences.

Economy

4 Key Tax Provisions That Expire At The End Of The Year

Most of the ink spilled over negotiations surrounding the so-called “fiscal cliff” — the year-end set of tax increases and spending cuts — has covered the impending demise of the Bush tax cuts. But several other important tax provisions will also expire, some with severe impacts for the middle-class:

1. The payroll tax cut. A two point hike in the payroll tax — which affects every working American — would deliver one of the fiscal cliff’s biggest hits to economic growth. The Economic Policy Institute estimated that allowing the payroll tax cut to expire will lessen GDP by nearly one full percentage point.

2. The American Opportunity Tax Credit. Included in the 2009 American Recovery Act, this credit helps middle-class and low-income families pay for higher education. As CNN Money explained, this $2,500 annual credit ‘is scheduled to revert to the Hope Credit. At that point, the maximum credit will drop to $1,800. Also, families will only be able to claim the credit for two years and it will no longer be refundable.”

3. The Mortgage Forgiveness Debt Relief Act. This expiration of this provision would force homeowners who receive debt forgiveness on their mortgages — like that included in the $25 billion foreclosure fraud settlement — to count that relief as income, and thus pay taxes on it. As Firedoglake’s David Dayen explained, “all principal forgiven will count as earned income for those underwater homeowners. This will kick them into higher tax brackets, and introduce a tax burden upon them that they are overwhelmingly likely not to be able to afford.”

4. The Child Tax Credit. Included as part of the Bush tax cuts and then expanded under President Obama, the child tax credits reverts to its 2001 level at the end of the year. Allowing that to happen would cut the credit in half and take it away from lower-income Americans.

Negotiations over the fiscal cliff have barely grappled with some of these issues, and completely ignored others.

Climate Progress

Halfway To Hell (And High Water): 333rd Month In A Row Global Temperatures Exceed Long-Term Average

Okay, NOAA’s State of the Climate Report for November isn’t the Mayan meteorological forecast. And the Apocalypse isn’t quite “now.” But this part of the NOAA report is kind of ominous:

Including this November, the 10 warmest Novembers have occurred in the past 12 years. The 10 coolest Novembers on record all occurred prior to 1920. November 2012 also marks the 36th consecutive November and 333rd consecutive month with global temperature higher than the long-term average. The last month with a below average temperature was February 1985, nearly 28 years ago.

As Grist noted last month, “If you’re 27 or younger, you’ve never experienced a colder-than-average month.” In Minnesota’s fictional Lake Wobegon, “all the children are above average.” But with warming, it’s more like Wobegun, because it’s only going to get hotter and hotter — at an accelerating pace if we don’t reverse carbon pollution trends ASAP (see “We’re Already Topping Dust Bowl Temperatures — Imagine What’ll Happen If We Fail To Stop 10°F Warming“).

This is the temperature map for the first 11 months of the year:

Record warmth — easy to find (see “Record-Smashing Early December Assures 2012 Will Be Hottest In U.S. History“). Record cold, not so much.

As Grist dryly noted (and noting things dryly is how Grist made its bones):

August 2040 will (possibly) be the 666th straight month with higher-than-average global temperatures (somewhat undermining the concept of average). The map for that month will likely be a pure splotch of red, as Earth will have been consumed by hellfire. Please prepare appropriately.

So we are halfway to Hell (and High Water). Can’t say we weren’t warned.

H/t Scott Brophy

Health

Australia’s Gun Control Law Caused A Drop In Gun-Related Deaths, And An Even Bigger Drop In Suicides

In the renewed debate over gun control sparked by the mass shooting in Newtown, CT, one of the most widely discussed data points has been the case study in Australia — where, following the worst mass shooting in the nation’s history, gun control policy may have effectively suppressed gun-related suicides.

On April 28, 1996, a gunman shot and killed 35 people in Port Arthur, Tasmania. In response, Australian Prime Minister John Howard — a close alley of President George W. Bush — oversaw the passage of sweeping new gun control legislation. Semiautomatic and automatic rifles and shotguns were banned, and a mandatory government buyback program was enacted to collect those weapons. The results, rounded up by the Washington Post’s Dylan Matthews and Slate’s Will Oremus, were striking:

[H]omicides by firearm plunged 59 percent between 1995 and 2006, with no corresponding increase in non-firearm-related homicides. The drop in suicides by gun was even steeper: 65 percent. Studies found a close correlation between the sharp declines and the gun buybacks. Robberies involving a firearm also dropped significantly. Meanwhile, home invasions did not increase, contrary to fears that firearm ownership is needed to deter such crimes. But here’s the most stunning statistic. In the decade before the Port Arthur massacre, there had been 11 mass shootings in the country. There hasn’t been a single one in Australia since.

Since there was no corresponding rise in homicides or suicides not involving firearms, individuals weren’t simply shifting to other methods to harm themselves or others. They were actually deciding against committing acts of violence in the absence of easy access to guns. Researchers found that a buyback of 3,500 guns per 100,000 people reduced the firearm suicide rate by as much as 74 percent:

This isn’t the first time that public health researchers have pointed out the relationship between gun possession and suicide. For instance, when Israel stopped allowing its soldiers to take their guns home and had them leave them on base, suicides on weekends dropped 60 percent among the country’s soldiers. The impulse to commit suicide is temporary — so if the density of guns within a population goes down, then so does the chance that any person’s momentary desire to take their own life will intersect with access to a firearm.

Here in the United States, however, the suicide rate and the instances of gun-inflicted wounds have both been on the rise. Some reports suggest the Great Recession increased the U.S. suicide rate fourfold, since economic downturns put an outsized strain on mental health — but that time period also coincided with widespread cuts to mental health services across state budgets.

Justice

Virginia Governor McDonnell Wants More Guns In Schools

Gov. Bob McDonnell (R-VA)

Gov. Bob McDonnell (R-VA)

Virginia Gov. Bob McDonnell (R) became the latest anti-gun control figure to embrace the notion that the best way to protect against future tragedies like Newtown, Connecticut, is to put more guns in public schools. In his monthly “Ask the Governor” segment on WTOP radio, McDonnell endorsed the idea of arming adults in schools.

Asked about allowing school officials to have guns, McDonnell said it is a “discussion that is probably timely.” He explained:

McDONNELL: I know there has been a knee-jerk reaction against that, I think there should at least be a discussion of that. If people were armed, not just a police officer, but other school officials who were trained and chose to have a weapon, certainly there would be an opportunity to stop aggressors trying to come into the school, so I think that’s a reasonable discussion that ought to be had.

Listen to the audio (h/t: ProgressVA):

While several pro-gun lawmakers have indicated that they will reconsider gun control in the wake of Friday’s tragedy, some are using the tragedy to push for even more guns. McDonnell joins Gov. Rick Perry (R-TX) and Republican legislators in Oklahoma, Nevada, and South Dakota in embracing the idea of arming adults in schools.

NEWS FLASH

NRA To Hold ‘Major News Conference’ Friday | Since the mass school shooting in Newtown, Conn. on Friday, the National Rifle Association has been entirely silent, refraining from any comment on the ensuing debate on gun control. Late Tuesday afternoon, the gun lobbying group announced it would hold a “major news conference” in Washington, D.C. on Friday. The statement said the NRA has refrained from commenting thus far “out of respect for the families, and as a matter of common decency” and plans to offer “meaningful contributions to make sure this never happens again.”

Alyssa

Primrose Everdeen, “Double Tap” Drone Strikes, And Whether Fiction Influences The Real World

Primrose Everdeen, sister of Hunger Games trilogy protagonist Katniss Everdeen, was killed using similar tactics to those employed in some U.S. drone missile strikes

Note: This post discusses plot points from the Hunger Games trilogy, Harry Potter, and Song of Ice and Fires series.

The death of Katniss’ sister Prim is the emotional climax of the Hunger Games trilogy: She dies a martyr, caught in a wave of explosives designed to target first-responders while working as a medic on the front lines of the final clash between the rebellion and the government in the Capital City. While there’s some dispute about who was behind her death, and whether it was necessary, there is no question left in most readers mind’s that the tactic used was monstrous. And yet outside the realm of young adult fiction, U.S. drone strikes uses a very similar tactic known as the “double tap,” against terror targets.

 

A joint report from Stanford/NYU on U.S. Drone policy released in September noted:

“There is now significant evidence that the US has repeatedly engaged in a practice sometimes referred to as “double tap,” in which a targeted strike site is hit multiple times in relatively quick succession. Evidence also indicates that such secondary strikes have killed and maimed first responders coming to the rescue of those injured in the first strike.

The same pattern emerged in @dronestream’s tweets of U.S. drone strikes from 2002-2012. So, while whether or not the double tap is official U.S. policy remains unclear due to the secrecy surrounding much of the U.S. drone policy, all of the evidence suggests the U.S. repeatedly employed a tactic that results in first-responder casualties. And it’s not just a questionable tactic: UN special rapporteur on extrajudicial killings Christof Heyns calls the second strike in a double tap akin to a war crime. But while there are efforts to bring armed drone strikes “out of the shadows” for a larger conversation and widespread disapproval of U.S. strikes in the global community, there’s no sign of major changes to U.S. drone strike strategies on the horizon.

Of course, it’s not hard to understand why it’s easier to see the inhumanity of using tactics that hit first responders when the person in question is the protagonist of your favorite series’ sister (whose protection was the catalyst for the entire trilogy’s plot) than when those rescuers are people you’ve never heard of half a world away. By its very nature literature builds empathetic bonds between readers and sympathetic characters; we get to know them, care about them, and mourn for them if they’re lost. But literature can also explore our own humanity and help us have challenging discussions about the morality of the world we live in and the policies formalizing that morality.

And “double tap” is just one of many examples of the disconnect between the ideal morality we hold high (and try to teach our youth through young adult fiction) and the policies that define our culture. In the Harry Potter series using the torture curse, Cruciatus, carries one of the harshest penalties in the Wizarding world (though one that doesn’t appear to apply to our protagonist when he uses it in the name of good). But in our real world, the U.S. government used extraordinary rendition tactics a European Court recently said “amounted to torture” against a terror suspect and relied on “enhanced interrogation tactics,” the nasty euphemism for torture, throughout much of the war on terror.

Straying out of young adult fiction, A Song of Ice and Fire’s Gregor “The Mountain” Clegane is a brutal character living in a brutal world, but one of his most well known atrocities is the murder of two royal children during the collapse of House Targaryen. Even in this context, the moral characters such as Ned Stark think of the murder of the children (and the rape of their mother) as an ugly stain on Robert Baratheon’s rebellion, even if they acknowledge it as politically expedient. In our real world, most people’s gut reaction is that there is no context when the wholesale slaughter of children can be justified. And yet there are rumblings that children are being considered legitimate targets by U.S. forces in Afghanistan after a current military officer was quoted in a piece published in The Military Times titled “Some Afghan Children Aren’t Bystanders.”

There’s no question that these characters, and these bad acts, all provoke powerful moral reactions in readers. But it’s not clear yet whether these stories shape their fans’ opinions off the page as well as on it. As a generation of young adults grows up both on protracted American involvement in ugly conflicts abroad and fiction that tries to outline moral laws of war, it’ll be fascinating to see whether their moral imaginations stay fired after they close books and walk out of movie screenings.

Update

The author of the Military Times piece titled “Some Afghan Children Aren’t Bystanders” said today that he believes quotes from his article have been misconstrued, and that the military officer quoted in his piece was referencing targeting children for intelligence gathering rather than engaging children militarily.

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