At The Moderate Voice Ron Chusid points out another brewing problem in the Obama Administration’s plans for reforming the healthcare system:

The original stimulus package after Barack Obama took office included a program to provide funds to medical practices to be used for conversion to electronic medical records. In order to qualify for the incentive payments, physicians and hospitals have to follow a set of Meaningful Use requirements which have increased requirements for each stage. Initially there would be incentive payments (which turned out to be far less than the costs of conversion to electronic medical records), and subsequently there are penalties for failing to comply. The first stage was successful in terms of getting large numbers of doctors to adopt electronic medical records, but it is more questionable as to whether this is really resulting in the desired cost savings.
Stage 2 was initially required by October 2014. This would have greatly increased the use of electronic medical records, possibly resulting in more medical cost savings, but the requirements were unrealistic. The law originally required that physicians comply with the requirements of Stage 2 for a 90 day period in 2014, which essentially meant that we could wait until October 1 to implement them. When it was apparent that most physicians could not comply with this, the government postponed this until January 2015.
It was quickly apparent that this was no solution, partially as the new requirements required a full twelve months of compliance with the Stage 2 rules. By requiring compliance by this January, this only gave an additional three months. The same problems which prevented compliance with the rules by October 2014 are still present this January.

Electronic medical recordskeeping has always been a slender reed on which to base dreams of reducing the cost of healthcare and the problems have been apparent since the very outset. A major problem has always been provider compliance and it remains a problem but not the only one.

I disagree with Ron, however, that the EMR matter is a greater problem than Healthcare.gov falling on its face at its debut. That was so public, so visible, and so highly publicized I believe that it’s hard to overestimate the damage that did to the notion of the competence of the federal government.

Not to put too fine a point on it but the EMR systems suck. As is all too common with computerized information systems the systems conform more to developers’ notions of what such systems should do and how they should operate than to providers’ needs. Furthermore, the standards for such systems are completely inadequate.

There has been a drastic change in the role of the federal government since the end of World War II. Seventy-five years ago the federal government actually provided goods and services and contributed to GDP, other than by expanding the money supply, of course. Little by little that role has transmuted into providing the funds by which individuals and corporations produced goods and services. That this might provide even greater vehicles for waste, fraud, and abuse than the federal agencies the approach has replaced does not seem to have occurred to anyone.

In theory you could produce a heckuva web application or hosted application for $10 billion. In practice we’ve lost the knowhow. So we pay providers to purchase systems that they can or won’t use from vendors who may or may not be in the electronic medical records business next year or five years from now.

I’ve just published a foreign policy-related post at Outside the Beltway:

Syriza Wins Greek Elections

The anti-“austerity” party Syriza, characterized as “leftist”, has won a decisive victory in the Greek parliamentary elections. IMO this can only be interpreted as another crack in the Euro.

I find myself in complete agreement with Felipe Calderon, fomer president of Mexico:

Calderon said he believes U.S. lawmakers should consider adding provisions to proposed immigration legislation that would permit “temporary work in a massive way,” but without giving immigrants automatic citizenship.

“I don’t believe that most of the Mexican workers looking for a job in the United States are wanting to be American citizens,” Calderon told IBTimes. “They are looking for an opportunity to get economic benefits and actually thinking when they are leaving [Mexico] what will be the way in which they can go back to their own home.”

Calderon argued American political groups opposed to undocmented immigration — the kind that have backed statutes to toughen immigration enforcement, as reported by Reuters — are prompting those already in the U.S. to stay and seek citizenship, even if that was not their initial goal.

“The American society, even the more conservative people, are getting exactly the contrary results that they were looking for,” he said. “In other words, anti-immigration laws are provoking millions of people living in the States that are unable to go back to their own countries. And they start to think, ‘Well if I need to stay here, it is better to do that all the way.’”

As additional support for this view, consider that the majority of those eligible for U. S. citizenship under the 1986 immigration reform act never sought citizenship. We need a policy that fits the conditions on the ground rather than one that’s tuned for the imaginings of a few activists who, coincidentally, might achieve political power through the policies they’re promoting.

Speaking of language when I read this op-ed by Jared Bernstein in the Washington Post, titled “Technocrats know how to fix the economy. And they did”, I could only think in what what is he using the word “fix”? In the same sense that you have your dog fixed? That is, something that’s convenient for you but not necessarily for the dog?

What he seems to mean is that the ARRA (the “stimulus package”) ended the recession, that QE put the banks on a sound footing, and that the PPACA (“healthcare reform”) did something or other that he doesn’t elaborate on. Dr. Bernstein is an economist and I’m not but surely he must know that’s arrant nonsense. The recession ended before the first dollar was disbursed under the ARRA. If Keynesian pump-priming ended the recession, it was necessarily the stimulus put into place under the Bush Administration. That’s what the timing says.

As it works out I don’t believe that federal action had a lot to do with the recovery one way or another, that the banks are still in shaky shape, and that what we’re seeing right now is largely the result of lower energy prices. We certainly haven’t solved our economy’s many problems.

As I read this post in The Economist, about Britain’s large number of Muslims residents, many of whom are poor and isolated from the mainstream culture, my immediate reaction was does England really have ghettos? Or has the word been debased to refer to any urban slum mostly inhabited by members of some single, poor, indentifiable group? Does even that dilution of the term apply in England?

Doyle McManus complains about the failure of U. S. foreign policy in Syria:

In 2011, the U.S. ambassador to Syria, a mild-mannered diplomat named Robert S. Ford, became the face of American support for the Arab Spring when he boldly visited opponents to the brutal regime of Bashar Assad in the northern city of Hama.

In 2014, Ford quit, saying he could not defend the Obama administration’s inconstant support for Syrian rebels. “More hesitation … [will] simply hasten the day when American forces have to intervene against Al Qaeda in Syria,” he warned.

Now, a year later, Ford’s warning has come true. U.S. warplanes bomb jihadists in Syria week after week. Northern Syria has become a base for both Islamic State, which invaded Iraq last year, and an Al Qaeda franchise that trains European terrorists.

But Ford thinks U.S. policy has moved backward, not forward. “We’re seeing Syria divide into four countries,” he told me last week. “and I’m not sure it can be put back together.”

It’s the most conspicuous failure of U.S. foreign policy today. The Assad regime that President Obama declared dead remains in power, and roughly half its territory is held by jihadists. The moderates the U.S. said it would support are mostly scattered and defeated.

Okay, I’ll bite. What is America’s foreign policy in the Middle East? As best as I can tell for the last 14 years America’s foreign policy in the region has been regime change and it has preponderantly been successful. Since 2001 the governments of Afghanistan, Iraq, Lebanon, Libya, Tunisia, Egypt, and Yemen have fallen (arguably Pakistan as well). The troublesome governments of Syria, the Kingdom of Saudi Arabia, and Iran remain.

IMO the policy has been reckless and foolhardy. what is Mr. McManus’s complaint? That it hasn’t been foolhardy and reckless enough?

I thought this scene from the 1940 Gable-Tracy-Colbert movie Boom Town might change some views about what people were thinking about oil 75 years ago.

With all of the fulmination about President Obama’s declining to attend the anniversary of the liberation of Auschwitz, I don’t think there’s enough consideration of why some of the countries whose heads of state will be in attendance are commemorating the event at all. After all, it was the Red Army that liberated Auschwitz. Putin has declined to attend because of his busy schedule. I can understand why Israel might want to commemorate the liberation.

However, Germany, France, Belgium, the Netherlands, and Italy (among others) all sent their own citizens to the death camps. Those murdered at Auschwitz were mostly Germans, Poles, and Russians. I know that the prevailing view in Europe is that “the Nazis” were responsible for the murders in death camps. Quite to the contrary I think that France and the Netherlands in particular eagerly sent their Jewish fellow citizens to die in them. I’m not sure why they would be commemorating the liberation. So that they don’t forget? They’ve already forgotten.

The Latin phrase that forms the title of this post is usually translated “Carthage must be destroyed”. That doesn’t really convey the force or conviction of the Latin phrase. According to Livy, Plutarch, and Pliny the Elder, in the 2nd century BC when Rome contended with Carthage for control of the Mediterranean (or, as the Romans humbly called it mare nostrum, “our sea”), Cato the Elder ended every speech with the phrase.

And, ultimately, Rome did destroy Carthage, completely and finally.

My point is that repeated rhetorical flourishes have power and meaning and should be taken seriously. Keep that in mind the next time you hear a report that some Iranian leader declared that Israel will be destroyed, presumably accompanied by the editorial disclaimer that he didn’t say that they would destroy it. The Romans didn’t say that they would destroy Carthage, either.