A Shopworn Lie

One of the louder voices opposing Gov. Haslam’s Medicaid expansion plan is the libertarian Beacon Center of Tennessee, which has just launched a new radio ad running in the Knoxville media market. The ad, framed as a conversation between a senior citizen and her daughter, resurrects one of the right’s most dubious (but nonetheless durable) canards on this issue:

DAUGHTER: “In fact, the Medicaid expansion will be paid in part by $716 billion in cuts to seniors’ Medicare benefits.”

MOM: “To give health insurance to able bodied adults?”

DAUGHTER: “You got it.”

It’s always good practice to begin a factually debunked assertion with the words “in fact.” This claim has been fact-checked so many times it should take up residence in the fact-checking hall of fame. But since Beacon thinks the way to build opposition to health insurance for the working poor is to recycle a lie, let’s go at it once more, with feeling.

The origin of that $716 billion number is an analysis by the Congressional Budget Office back in 2012 in response to a request from House Speaker John Boehner for an estimate of the cost of repealing Obamacare. On page 13 of its 22 page analysis, the CBO said that “Spending for Medicare would increase by an estimated $716 billion over the 2013-2022 period.”

Does that sentence mean, as the Beacon ad claims, that Medicaid expansion will be paid for by $716 billion in cuts to Medicare benefits? As the highly respected Annenberg Public Policy Center’s FactCheck.org has noted, the $716 billion is an estimate of the decline in future growth of Medicare spending owing to reductions in growth of payments to hospitals and providers, diminished subsidies for Medicare Advantage plans, and savings anticipated as a result of reimbursement system changes. The claim that projected declines in future spending growth represent cuts of Medicare benefits to seniors, they conclude, is “misleading and shameful.”

Don’t like the pinkos at Annenberg’s FactCheck.org? Fine. Let’s go to the roster of fact checkers:

Politifact.com: “Obamacare does not literally cut funding from the Medicare budget, but tries to bring down future health care costs in the program….There is reduction in spending to Medicare outlays, but it’s fueled by finding savings in the program, a move that Republicans actually supported in the Ryan budget. Medicare spending still increases in the coming years.”

Los Angeles Times Fact Check: “The president’s healthcare law does reduce future spending on Medicare, but those savings are obtained by reducing federal payments to insurance companies, hospitals and other providers, and do not affect benefits for people in the Medicare program.”

Washington Post Fact Check: “While it is correct that anticipated savings from Medicare were used to help offset some of the anticipated costs of expanding health care for all Americans, it does not affect the Medicare trust fund….Spending does not decrease in Medicare year after year; the reduction is from anticipated levels of spending in future years. Moreover, the “cuts” did not come at the expense of seniors.”

TIME Fact Check: “As for the cuts, they come from eliminating a massive subsidy to private insurers and gradually reducing the rate of growth in payments to some providers….The idea, however, that the Affordable Care Act struck a dangerous blow to Medicare that will change the program in fundamental ways is untrue.”

Beacon describes itself (humbly) as an organization that “empowers Tennesseans to reclaim control of their lives, so that they can freely pursue their version of the American Dream.” Reclaim control of their lives? Or of their lies?

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.


And I Mean the Left

NashvilleBroadcastingHistory.com

NashvilleBroadcastingHistory.com

This post appears at the Nashville Scene’s Pith in the Wind blog along with those of others who appeared on “The Round Table,” the long-time radio enterprise hosted by the great Teddy Bart, who passed away a few days ago.

Growing up in New York I fed an early nerdy talk-radio addiction using a bedside clock radio to catch the pompous erudition of the great Barry Farber, the offbeat weirdness of Long John Nebel, and even occasionally (yes I’ll admit it) the original semi-unhinged conservative radio mouthpiece Bob Grant. Whatever the politics and eccentricities of a particular host, the appeal was (mostly) civilized conversation about ideas with smart people for a loyal radio audience.

Each place I’ve lived after leaving the northeast for college always brought me in short order to cruising the radio dial for good local talk — surely I can find a version of this conversation almost anywhere. Landing on planet Nashville in the early 1990s I happened upon this Teddy Bart guy and his morning Round Table of … what, exactly? It felt like an odd mix: one minute serious journalists are kicking around city and state politics, the next minute Teddy is tickling the ivories of an electric piano in the studio and pivoting into sports and weather. So this is Nashville, I thought: You get a talk show only if you can play an instrument and sing.

Once I’d been spewing opinions in outlets like the Scene for a while, Teddy invited me to be on the Round Table from time to time as a panelist “on the left” (“and I mean the left,” he would always add with a smile). It was great fun, as it would be for any card-carrying political junkie, to chew the fat on issues of the day with other smart humans of diverse viewpoints. But it was serious fun: it was a great privilege to be part of conversations that were informed and constructive, that mattered (without taking themselves too seriously), and that were heard.

The show in its later years may have aired on obscure AM radio stations with obscure cable-access replay — hard to find unless you were looking for it, but it turns out a lot of people were looking for it. Almost nobody turned down an invitation to be on the show, and nine years after it ended I still run into people who recall my minor involvement and lament that Nashville has had no similar outlet for regular meaningful civic dialogue ever since.

He was plenty good with that keyboard, but thoughtful, civilized discourse turned out to be the instrument Teddy Bart played virtuoso.


Hero or Traitor? Or Something in Between?

snowdenThe sensational new documentary on Edward Snowden, CITIZENFOUR, opens here in Nashville at the Belcourt Theater next week. I reviewed the film for the Nashville Scene in this week’s issue. A snippet:

The film’s center, dramatically and chronologically, is the middle hour focusing on the fateful encounter of Snowden, the Guardian’s Glenn Greenwald, and documentarian Poitras (behind her camera, occasionally heard but never seen) in a Hong Kong hotel room for eight days in June 2013. Poitras’ camera was rolling from the start, giving us a front-row (bedside?) seat as history unfolds. Columbia Journalism School dean Steve Coll likens it to having footage of Bob Woodward’s first parking-garage meeting with Deep Throat.

From this seemingly mundane procedural footage, we learn that extended sequences of a few people talking in a hotel room, working on laptops, watching television, munching on room service and taking an occasional phone call can be downright spellbinding.

For anyone who cares about civil liberties in a free society, unmissable.


Can It Happen Here?

It — Ferguson — can theoretically happen anywhere, obviously. But there are some structural differences between metro St. Louis and metro Nashville in the way local and satellite governments are configured that are important to understand. An insightful New York Times op-ed today by political scientist Jeff Smith (previously a Missouri state senator from St. Louis) explains some of the history behind the geographic and demographic configuration of inner suburbs in St. Louis — history that is quite different from ours here in middle Tennessee:

Back in 1876, the city of St. Louis made a fateful decision. Tired of providing services to the outlying areas, the city cordoned itself off, separating from St. Louis County. It’s a decision the city came to regret. Most Rust Belt cities have bled population since the 1960s, but few have been as badly damaged as St. Louis City, which since 1970 has lost almost as much of its population as Detroit.

This exodus has left a ring of mostly middle-class suburbs around an urban core plagued by entrenched poverty. White flight from the city mostly ended in the 1980s; since then, blacks have left the inner city for suburbs such as Ferguson in the area of St. Louis County known as North County.

This governmental fragmentation, Smith notes, translates into large numbers of small towns with independent police forces and too much reliance on traffic stops for revenue:

St. Louis County contains 90 municipalities, most with their own city hall and police force. Many rely on revenue generated from traffic tickets and related fines….Ferguson receives nearly one-quarter of its revenue from court fees; for some surrounding towns it approaches 50 percent. Municipal reliance on revenue generated from traffic stops adds pressure to make more of them.

Ninety! And that’s in a county whose population outside of the city of St. Louis is roughly the same as Davidson County. As Smith explains, because the white-to-black shift in racial demographics in many of these suburbs has occurred only fairly recently, “fewer suburban black communities have deeply ingrained civic organizations,” which is part of how it comes to be that places like Ferguson have majority white power structures (city council, school board, police force) in majority black communities.

Smith sees a remedy, one that should sound vaguely familiar to Nashvillians: consolidation.

Consolidation would help strapped North County communities avoid using such a high percentage of their resources for expensive public safety overhead, such as fire trucks. It could also empower the black citizens of Ferguson. Blacks incrementally gained power in St. Louis City in part because its size facilitates broader coalitions and alliances. Another benefit of consolidation is the increased political talent pool. Many leaders just aren’t interested in running a tiny municipality….Consolidation could create economies of scale, increase borrowing capacity to expand economic opportunity, reduce economic pressures that inflame racial tension, and smash up the old boys’ network that has long ruled much of North County.

Obviously the kind of consolidation that might bring surburban communities together in 21st century St. Louis County doesn’t mimic the experience or the experiment Nashville and Davidson County launched 50 years ago. And certainly there are other factors that make St. Louis and Nashville very different places. But it is instructive during a period of searing civic tension in a metro area that in many ways qualifies as a peer city to think about structural similarities and differences when pondering the inevitable question: can it happen here?

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.


Who Are These Folks Moving Here?

We know that Nashville’s hot, and that as a result people want to move here. And we know from Census Bureau data that they are moving here, the numbers putting Nashville among the fastest growing large metro areas both in the last few years and since 2000. That’s great … we love newcomers, right? But who are these mooks relocating here?

Demographers don’t call it relocating; they call it migration, and The Atlantic‘s CityLab project is out with a nifty new analysis of migration in and out of U.S. cities — specifically, a look at the education level of people coming and going. So are we attracting smart, educated humans to Nashville? Can’t really speak to “smart,” but here’s what the analysis says about the education level for domestic migration to Nashville (which means it excludes immigrants):

citylab_nashville_500x282

It’s data from a single year, so just a snapshot, but that snapshot suggests that Nashville is losing its most educated residents, with the inflow of newcomers looking like a balanced mix of college educated and non-college folks. How does this compare with other cities, especially those with whom we like to compare ourselves?

Here are two sets of comparison cities. The first is a set of three sunbelt metro areas we often either compare Nashville to or benchmark against:

cityset1

These pictures show two big things that separate Austin and Charlotte from us. First, those cities are attracting more highly educated migrants — large net inflows of people with bachelor’s and postgraduate degrees. And second, although those two metro areas are similar in size to Nashville, look at how much bigger their raw numbers are: Charlotte’s net domestic migration is three times Nashville’s, and Austin’s almost four times. Atlanta, by contrast, is attracting a markedly less educated influx of new residents than Nashville, and is actually may be having problems holding on to its educated workforce.

The second set of comparison cities are tech-centric metro areas out west:

cityset2

These comparisons show just how far out of the big leagues Nashville remains in attracting the kind of very educated talent influx that some cities are enjoying. Putting together the two sets of comparison cities, we can see that Austin and Charlotte are approaching this level of well-educated migration; Nashville isn’t.

A prior CityLab post broke down flows of population in and out of metro areas in 2013 into their international (inflow of immigrants) and domestic components. Nashville, like most cities, showed net inflows in both categories. The exceptions were the largest cities: net migration was negative — more people leaving than coming — in New York, L.A., Chicago, Philadelphia, and Miami.

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.


The Ring of Neurofire

JC_and_RMN2From the world of medicine, and specifically the academic journal Frontiers in Behavioral Neuroscience, comes news that a successful neurological treatment for severe obsessive-compulsive disorder can trigger a curious side effect of the Nashville kind. From the published paper’s abstract:

Recently, neuroscientists have discovered that music influences the reward circuit of the nucleus accumbens (NAcc), even when no explicit reward is present. In this clinical case study, we describe a 60-year old patient who developed a sudden and distinct musical preference for Johnny Cash following deep brain stimulation (DBS) targeted at the NAcc.

The patient, identified as “Mr. B,” is said by the team of Dutch neuroscientists who published the paper to have had broad musical tastes before the treatment, “covering Dutch-language songs, the Beatles and the Rolling Stones.” After making no progress with conventional treatment, he was treated with deep brain stimulation, which is known for its use with Parkinson’s patients. Months after the DBS procedure Mr. B. happened to hear “Ring of Fire” on the radio and that’s when the man in black made neuroscience history:

Mr. B. reported that he felt good following treatment with DBS and that the songs of Johnny Cash made him feel even better. From this moment on, Mr. B. kept listening simply and solely to Johnny Cash and bought all his CD’s and DVD’s. When listening to his favorite songs he walks back and forth through the room and feels like he finds himself in a movie in which he plays the hero’s part. He reports that there is a Johnny Cash song for every emotion and every situation, feeling happy or feeling sad and although Mr. B. played almost simply and solely Johnny Cash songs for the following years, the music never starts to annoy him.

Okay, maybe a little lingering OCD there. Side benefit for the docs who wrote the case up: best academic journal article title ever — A case of musical preference for Johnny Cash following deep brain stimulation of the nucleus accumbens.

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.


Right Track? Nation’s Worst? What’s the Diff?

CFCoverTennessee state house speaker Beth Harwell picked an odd week to write an op-ed (in this morning’s Tennessean) declaring that “Tennessee is on the right track” — unless she equates “on the right track” with “among the nation’s worst.” Because “among the nation’s worst” is precisely and appropriately how Tennessean reporter Shelley DuBois sums up the state’s standing in a new Commonwealth Fund report comparing states on dozens of measures of health care access, quality, costs and outcomes.

The report titled Aiming Higher (full text pdf here), which covers the period 2007-2012, finds widespread gains among states in areas that were getting a lot of policy attention, such as child immunizations and hospital readmissions, but on the down side rising costs and declines in access to care. In comparisons of states, Tennessee comes out rather badly. Skimming through the report’s various charts and graphs (pdf), this is easy to see.

Exhibit 12: Percent of adults who went without care because of cost, Tennessee ranks 10th from the bottom, unchanged from 2007.

Exhibit 16: Mortality amenable to heath care, Tennessee is in the bottom 10 for both black and white residents (they do that one by race).

Exhibit 8: Tennessee has the 16th highest rate of Medicare 30-day readmissions.

Exhibit 3: An overall state scorecard summary of health system performance across five dimensions (access and affordability; prevention and treatment; avoidable hospital use and cost; health lives; equity) ranks Tennessee’s 40th, in the bottom quartile.

Two bright spots: Exhibit 6 shows Tennessee ranks 11th in percent of children receiving all recommended vaccine doses, and Exhibit 11 shows Tennessee in top third of states in percent of children with insurance.

Perhaps these weak results mask improvement, making it possible to couch them in Harwell’s “on the right track” optimism. Is that plausible? Not so much. The CF report captures trends in Tennessee on 34 indicators, and finds improvement on 12 of them, worsening on 10, and no change on the rest — pretty much a wash. With the state’s ongoing stubborn refusal to entertain Medicaid expansion, it’s hard to look at the data here and predict upward movement in Tennessee’s health care quality and outcomes anytime soon.

“Right track” indeed.

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.


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