In 2008 Medicare stopped reimbursing hospitals for treating eight avoidable hospital-acquired conditions. Using 2006 California data, we modeled the financial impact of this policy on six such conditions. Hospital-acquired conditions were present in 0.11 percent of acute inpatient Medicare discharges; only 3 percent of these were affected by the policy. Payment reductions were negligible (0.001 percent, or $0.1 million—equivalent to $1.1 million nationwide) and are unlikely to encourage providers to improve quality. Options to strengthen the incentives include further payment modifications for hospital-acquired conditions or expanding the hospital-acquired condition policy to exclude payment for consequences, additional procedures, and re-admissions.

Inequities in marriage laws and domestic partnership benefits may have implications for who bears the burden of health care costs. We examined a recent period in California to illuminate disparities in health insurance coverage faced by same-sex couples. Partnered gay men are less than half as likely (42 percent) as married heterosexual men to get employer-sponsored dependent coverage, and partnered lesbians have an even slimmer chance (28 percent) of getting dependent coverage compared to married heterosexual women. As a result of these much lower rates of employer-provided coverage, partnered lesbians and gay men are more than twice as likely to be uninsured as married heterosexuals. The exclusion of gay men and women from civil marriage and the failure of domestic partnership benefits to provide insurance parity contribute to unequal access to health coverage, with the probable result that more health spending is pushed onto these individuals and onto the public.

Recovery, or at least stabilization, may be the watch words on Wall Street and in private industry, but for municipalities in California, it’s still very much the darkest hour.  As Ryan Gabrielson of CaliforniaWatch reports that seven different L.A. County municipalities have approached the Los Angeles County Sheriff’s Department about having the sheriffs take over local policing duties.

That’s about double what’s considered normal in a tough economic period.

It’s expensive to run a police department and increasingly it’s becoming something of a luxury. As cities see revenues dry up, and state officials reshuffle finances back to Sacramento in hopes of filling their own $19 billion hole, things are getting worse.

Earlier this month in two of cities southeast of Los Angeles – Maywood and Cudahy – the county sheriff’s department had to frantically shift resources to pick up police services, as the city governments essentially shuttered and shed all law enforcement personnel.

The same step was taken by local leaders last month in the Silicon Valley community of San Carlos, according to the San Francisco Chronicle‘s Henry K. Lee. Outsourcing law enforcement to San Mateo County should save the city about $2 million, according to sources quoted by Shaun Bishop in the San Jose Mercury-News.

Across the Bay, the Associated Press reports that Oakland’s police chief, in the wake of laying off 80 officers, or about 10 percent of his force, will meet hat-in-hand with an alphabet soup of federal agencies in an attempt to get more money or manpower to police the city’s restive streets.

Cities are not alone, nor is the fiscal train wreck limited to urban areas. Rural Modoc County, in California’s extreme northeast corner are begging for a $12.5 million bailout from the state to stave off bankruptcy, according to Cathy Bussewitz of the Associated Press. True, Modoc’s problems stem not from law enforcement costs, but a creative accounting scheme involving the county hospital that recently became too big to hide.

After bailing out Wall Street and banks, paying for unemployment, and trying to stimulate the economy, there doesn’t appear to be much left in Washington that can trickle down to local governments.

Much of the landmark Affordable Care Act won’t kick in until 2014, but one big component starts this year: federal tax credits for small businesses that provide their employees health care.  Mike Colias of Crain’s Chicago Business relays a report by the D.C-based Families USA that 159,900 companies in Illinois are eligible for a federal tax credit of up to 35 percent. In order to qualify, businesses must have fewer than 25 workers and cover at least half of their employees’ health insurance. Generally, the smaller the business, the larger the tax credit, with companies employing less than 10 workers eligible for the 35 percent break.

Families USA reports that nationally, 46 percent of businesses with fewer than 10 workers provide their employees health care, while more than 95 percent of businesses with more than 50 workers offer health insurance. Liberals and conservatives both love to discuss the virtues of small business, evoking images of trustworthy hardware store owners and folksy diners.  But so far, it has been big businesses that have the money and incentives to give employees basic health care.

The policy success of this tax credit then rests on whether it will spur more small businesses to provide health insurance. Reducing government revenue simply to help small businesses isn’t enough if the hardware store owner on the corner doesn’t start giving her employees health care.

A critical part of the Chicago gun control debate is why so many weapons were
already in the city before handguns became legal to carry this month. The Chicago Tribune’s Becky Schlikerman reports one successful instance of the city teaming up
with the FBI to seize 60 unregistered and illegal guns from 25 city residents.
The FBI and Chicago Police Department arrested suspects who were going to use
guns for an armed robbery to get cocaine — but the FBI says the sting was about
guns, not drugs.

The Supreme Court effectively ended Chicago’s 28 year-old gun ban last month. The Chicago City Council
subsequently passed a law that allows a resident with a clean record to purchase one handgun a month. It is not clear how many guns are in Chicago or how far such police work can go in seizing unregistered guns. But this kind of coordinated federal/local action is increasingly important since Chicago has no money to hire more police officers.

“The effort to justify its budget often affects the way an agency does business.” That’s how Charles Peters explained the growth of federal bureaucracies in his book How Washington Really Works, a guide to politics and government in the nation’s capital.  Peters’ description is borne out by the Washington Post’s exhaustive series, “Top Secret America,” in which reporters Dana Priest and William M. Arkin try to get a handle on the enormous web of federal agencies and private contractors involved in national security in the post-9-11 world.

Priest, Arkin, and a dozen other reporters and researchers worked for nearly two years to nail down how many agencies and private contractors are working on national security and what that work entails.   While the size and scope of the defense sector is unique, the story echoes Peters’ description of how Washington typically operates: a well-intentioned government effort – in this case, to make us more secure – grows into an unwieldy bureaucracy so entrenched that changing it is as difficult, or more difficult, than creating it ever was.

Priest and Arkin report that there are a multitude of federal government agencies doing the same national security work.  These agencies are protective of their “turf” and are reluctant to defer to one another for fear of losing relevance — and funding.  So rather than cooperating and reducing the time and cost of piecing together information, they review the same information and write quite nearly the same reports.  (The Office of National Intelligence responds to the criticism of redundancy by pointing to the need for “competitive analysis.”)  This results in an overabundance of information to analyze. Thousands of reports are prepared – more information than one could read in a lifetime, according to former Director of the Office of National Intelligence, Dennis Blair.  Further complicating the situation is that the computer systems of the different agencies involved in national security do not “speak” to each other.

Some stories from government’s national security world could happen in any federal agency.  For example, Priest and Arkin report that often, the most critical analysis of data is performed by the lowest level, lowest-paid staff.  Meanwhile, priorities for a four-star general are different – he’s wrangling to get the same size security detail and eavesdrop-proof office as the other four-star generals.

When Congress began allocating enormous new sums of money for national security after 9/11, an already robust defense contracting industry grew larger and larger until it consumed almost thirty percent of the national security jobs, according to the Post.

As with other Washington bureaucracies, federal agencies and private contractors in the national security business have become important to local economies.  The Washington D.C. region’s economy has benefitted the most from the vast network of government and private contractors performing security work.  Large defense contractors like Northrop Grumman decided to move their headquarters to the Washington area in just the last year.  The Post‘s interactive map shows how other parts of the country have fared.

Ostensibly, the government out-sources so much of its national security work in order to save money.  But as Priest and Arkin report, private contractors have cost the government far more than if the work was done in-house. Priest and Arkin report that contractors can offer experienced federal workers twice as much in salary as they earned in government service, and some companies  offer BMW’s and $15,000 signing bonuses to lure those with security clearances.

The unchecked growth of the defense establishment – to the point where the extent of the bureaucracy and its effectiveness is unknowable – is a huge problem.  To their credit, Secretary of Defense Gates and CIA Director Panetta acknowledge the challenge and are trying to do something about it.

Still, this is a familiar pattern in Washington: a serious crisis (in this case, 9/11) leads Congress to allocate money without adequate oversight, and private industry sees an opportunity to make enormous sums.  In the end, the taxpayers get what they paid for when even the higher-ups can’t say definitively that the country is safer as a result of the enormous expenditures.

Much has been said and written in response to the Post’s series, which may be just the first step in deconstructing the national security state in America.  What’s clear is that the administration and Congress need to be just as bold in fixing a national security bureaucracy that has grown out of control as they were in calling for a new, post 9/11 approach to national security in the first place.

Hoping to generate badly needed tax funds, the City of Oakland has approved, in concept, four industrial-sized indoor marijuana gardens capable of filling rolling papers and bongs all over the Bay Area. It also appears geared toward drawing a federal backlash. According to John Hoeffel in the Los Angeles Times, officials hope to grab a bigger share of the $28 million dollars changing hands annually at Oakland’s pot clubs, which distribute the ‘medicine’ to qualified ‘patients.’ An earlier story by Lisa Leff of the Associated Press provides the details of the proposal. Winning applicants would have to pay $211,000 in annual permit fees, carry $2 million worth of liability insurance and be prepared to devote up to 8 percent of gross sales to taxes.

Locally, opposition has come not from those against marijuana in principle, but from small-scale growers upset that officially sanctioned industrial sized facilities (that they’re derisively calling ‘Walmart weed’) will undercut them. Advocates claim the projects will create jobs and tax revenue. Two council members pitched the issue as one of public safety. Making marijuana growing more above-board would cut down on the number of robberies, burglaries and murders associated with illegal grows, they said, and curtail the number of electrical fires caused by intense lighting and exhaust fans overloading circuits. With California’s Proposition 19 on November’s ballot ready to ‘legalize it’ for recreational use, and Oakland ready to provide a legal fig leaf, it seems only a matter of time before California collides with federal prohibitions.

Perspectives on Supporting Adolescents and Young Adults with Learning Disabilities: In the course of a 20-year longitudinal study of individuals with learning disabilities (LD), Goldberg et al. (2003) measured the relative success achieved by subjects in the following areas: employment, education, independence, family relations, social relationships….They found that individuals who were successful across these domains were able to identify specific factors that led to their success – including “self-awareness/self-acceptance of their learning disability…”

The Chicago Tribune’s Tim Jones reports on shortcomings in Housing and Urban Development’s Neighborhood Stabilization Program, a crucial component part of Washington’s push back against home foreclosures.

Chicago received $155 million from the $6 billion federal program, and proceeded to direct that money to neighborhoods most impacted by foreclosures in 2006 and 2007. Foreclosures have  since spread throughout the city and relatively prosperous neighborhoods like Rogers Park now bear witness to hundreds of suddenly abandoned properties. The HUD money, though, has already been allocated to neighborhoods like Austin and West Englewood that were hit by the subprime loan stage of the national foreclosure wave.

The Trib’s otherwise thoroughly reported article overly emphasizes this one HUD program — after all TARP set aside $75 billion nationally for the Making Homes Affordable foreclosure prevention plan. However, MHA has helped thousands fewer homeowners than it was expected to and has been ripped by the special Inspector General for TARP.

Regardless of the specific program, Congress and the Obama administration have not responded to the agonizing endurance of the foreclosure epidemic. The Trib reports that in the first six months of 2010 foreclosure filings were up 37 percent from last year in the Chicago metropolitan area. Yet the federal government has not unveiled any significant new homeowner assistance since President Obama outlined Making Homes Affordable in March 2009.

A federal judge has significantly changed how the the Illinois corrections system operates: inmates can now challenge orders sending them to the maximum security Tamms Correctional Center. According to George Pawlaczyk of the Belleville News-Democrat (a Southwestern Illinois paper that has done a series on conditions at Tamms), U.S. District Judge G. Patrick Murphy ruled that all prisoners must be told why they’re being sent to Tamms, the state’s only supermax prison facility. Also, prisoners have 48 hours to prepare for a hearing where they can challenge their transfer.  Inmates in the maximum security section of Tamms — which is right by the Kentucky border — must spend 23 hours of every 24 in solitary confinement. The News-Democrat series on the prison focuses on how mentally ill inmates were hastily being sentenced to solitary confinement, after which their condition worsened.

One side issue is how the ruling impacts the revitalization of the Thomson, Illinois correctional facility. The Thomson prison was first discussed as a possible site for Guantanamo Bay detainees, but now it is more likely to be a regular federal prison. In either case Thomson will be another maximum security facility.  So will prisoners also have a right to challenge a transfer to Thomson? Or do 14th amendment due process rights apply only when inmates challenge solitary confinement?

An FDA (Food and Drug Administration), USA Advisory Committee voted 25 to 10 against a proposal to reduce the abuse and misuse of long-acting narcotic painkillers, such as OxyContin or Vicodin. Although the Advisory Committee’s recommendations are not binding the FDA usually follows them when making a regulatory decision. The Committee’s main reason for turning the proposal down, they say, was because it did not insist that doctors undergo training in the proper use of long-acting narcotics.

A survey reveals that parents lose an average of six months’ sleep during the first 24 months of their child’s life. Approximately 10% of parents manage to get just two-and-a-half hours continuous sleep each night, the Silentnight survey found. Over 60% of parents with babies aged less than 24 months get no more than three-and-a-quarter hours sleep each night. Silentnight sleep expert, Iftikhar Mirza, said: An hour here and there doesn’t negate sleep debt. Mirza advises parents to “take regular, gentle exercise to release endorphins, which should lower the risk of mood swings.

This fact sheet from HealthCare.gov describes what the Affordable Care Act means for Americans with disabilities. The Act will stop insurance company discrimination based on a preexisting condition.  Beginning in 2014 the law will prohibit insurance companies from denying coverage or charging more to a person based on their medical history. It will also provide new choices for long-term supports and services, as well as accessible, quality and affordable health care for people with disabilities.

A non-profit organization started by parents of children with developmental disabilities who no longer had a place in their communities.  It provides programs that focus on improving social skills so that participants can build and sustain friendships, function appropriately in jobs and volunteer positions and integrate in meaningful and natural ways in their community.

EEOC has charged The Gap with violating the Americans with Disabilities Act (ADA), which prohibits employers from terminating employees because of such medical conditions. The employee took leave because of medical problems related to glomerolonephritis, a kidney disorder.  He returned to work and was then fired on the spot. EEOC is asking for back pay and compensatory damages for emotional distress and punitive damages.  EEOC filed suit after first attempting to reach a voluntary settlement.

This report provides information about the prevalence of mental disorders and use of mental health services for youth aged 12 to 17 and adults aged 18 or older.  It also looks at mental health, suicidal thoughts and behavior and the co-occurrence of mental illness and substance use. One of the report’s findings is that among the 45.1 million adults aged 18 or older with any mental illness in the past year, 19.7 percent (8.9 million adults) had substance dependence or abuse, compared with 6.5 percent (11.9 million adults) among those who did not have mental illness in the past year.  This link opens a 174 page PDF document.