The hugely expensive household survey detects only about 6% of heroin users. For about a fifth as much money, the ADAM program (interviewing and drug-testing a sample of arrestees) detects the other 94%. Guess which program the federal government just cancelled (again)? Beau Kilmer and Jon Caulkins explain why this is folly bordering on madness.
In his closing contribution to the New York Times, Bill Keller laments President Obama’s unwillingness to invest in drug addiction treatment. It’s a common jab, made by many commentators (see for example here and here).
It is also embarrassingly, verifiably, wrong.
I am sure Mr. Keller and all the other journalistic critics of Obama’s drug treatment record have heard of The Affordable Care Act. Why don’t they know that it expands access to care for over 60 million Americans by mandating that drug treatment coverage be included in every plan and be at parity with that for other disorders? How can they further not know that the Obama Administration’s regulations for the Mental Health Parity and Addiction Equity Act provide benefit parity to more than 100 million Americans with employer-provided health insurance? More generally, how can they not know that independent analysts at CMS consider the current public policy environment the most dramatic improvement in the quantity and quality of addiction treatment in U.S. history?
I submit that Keller and his fellow critics would never confidently make such data-free assertions about cardiology, oncology or indeed any other area of the health care system. But drug treatment, like drug addiction, is a target of great stigma and ignorance. So why bother to take it seriously enough to check your facts like you would with health care for any other group of patients?
I take Keller at his word that he doesn’t want drug treatment to be a third-class part of our health care system. That’s why I feel comfortable asking him to please start taking it seriously himself. Rather than use his platform to make assertions that are demonstrably inaccurate, I hope he will in the future engage in the due diligence any other area of health care would receive from a serious journalist.
After finishing Fawlty Towers, John Cleese set to making a string of feature-length comedies, each with varying degrees of success. This week’s movie recommendation is the finest of those efforts, for which he earned an Academy Award for his screenplay co-written with Charles Crichton: A Fish Called Wanda (1988).
A gang of four criminals pulls off a near-perfect diamond heist. Only one witness and hefty doses of internecine mistrust survive the crime. Unfortunately, neither of these problems is as easily surmountable as the gang members had planned. On one hand, Michael Palin plays Ken, the animal loving getaway driver with an inveterate stutter who is tasked with eliminating that pesky witness. However, each of his attempts to silence the lady is stymied by her protective entourage of pet dogs that he desperately wants to leave unharmed. On the other hand, the mistrust between the other three members of the gang is even less tractable: Kevin Kline plays Otto, the trigger-happy American with a loud mouth, an insecurity about his intelligence, and an unshakeable contempt for Englishmen; Jamie Lee Curtis plays Wanda, the nubile and manipulative con artist; and Tom Georgeson plays the gang’s leader George. After the heist, Otto and Wanda double-cross George and land him in jail to maximize their share of the loot. However, the double-cross doesn’t work out to plan, as George has executed a double-cross of his own, by hiding the stash before he’s nicked.
Wanda therefore befriends George’s barrister Archie (played by John Cleese), in an effort to discover whatever information George has chosen to divulge about the diamonds’ possible whereabouts to his counsel. As the rest of the film plays out, Archie develops a forbidden and exciting connection to Wanda that provides a welcome reprieve from the stuffy and restrictive upper-middle class English lifestyle to which he’s become inured.
As far as heist films go, the premise of this one is fairly straightforward. Criminals steal diamonds, but can’t trust one another enough to make off with the winnings. However, the joke of the film isn’t really about the heist as much as it is about what happens when English propriety (read: pomposity) meets American forthrightness (read: obnoxiousness). The heist is nothing more than a vehicle to propel Cleese’s comedy of manners forward.
The screenplay drags a little in parts (the storyline in which Ken tries to dispatch the surviving witness gets old fairly quickly), but the dialogue overall is tight. When coupled with some magnificent performances, especially by the three main cast members Cleese, Curtis, and an Oscar-winning Kline, the jokes land exquisitely. Cleese and Kline in particular are both equally well-suited to verbal as well as physical comedy, so they handle farcical scenes (trying to make sure Otto isn’t seen by Archie’s wife by hiding behind furniture, à la Noises Off) as adroitly as they do witty repartee. In one of my favorite interchanges, Otto is fed up with Archie’s patronizing tone, and when Archie impugns Otto by saying that “You really are an utter vulgarian, aren’t you?” Otto’s response is just perfect: “You are the vulgarian, you fuck!”
The script deftly hops from one low-brow joke to another, but the experience doesn’t feel as though it’s descended into a wearisome sequence of toilet humor gags – this remains one of Cleese’s gifts – instead, the prevailing sentiment is that low-brow humor is itself bearing the brunt of the joke. The worst parts of English and American mannerisms are on show, and yet no-one watching the film ends the experience feeling too severely chastened by the experience. It’s light hearted fun.
I was walking aimlessly down St. James street in London recently and discovered a plaque noting that the Texas Legation had been based in the building on the corner of Pickering Place in the 1840s (They were trying to establish themselves as an independent republic, so why not send diplomats to the capitals of the world’s great powers?). This is one of the many things I love about London: The past is utterly alive everywhere you turn, sometimes in ways you appreciate and sometimes in ways you don’t.
The Museum of London instantiates this reality with clever blends of old and new photos of the same locations. The one below is of Cheapside. There’s 15 more to enjoy as a slide show on the website of the Telegraph.
The Los Angeles City Council just voted for a complete ban on e-cigarettes wherever real cigarettes are banned, including parks, beaches, and bars. (UCLA adopted a similar policy campus-wide a few months ago.) Seems to me like a bizarre choice, and likely to retard the movement from cancer sticks to e-cigs that, if not interrupted, might save hundreds of thousands of lives per year. This morning on KPCC I debated the issue with a member of the city council majority.
Can anyone tell me how?
[Feel free to post conjectures as comments. Answer at the jump.]
A few people have asked why I didn’t blog about the release of Rep Ryan’s House Budget Committee poverty report that came out on Monday. I did tweet this Monday:
Quick read of the health care chapter (p103-124) of GOP Poverty report is mostly one sided + incomplete lit review http://t.co/xoX9U25zlX
— Don Taylor (@donaldhtaylorjr) March 3, 2014
For example: Medicaid section, the phrase Dual Eligible only appears once! Ignores ground zero of cost+qual problems http://t.co/xoX9U25zlX
— Don Taylor (@donaldhtaylorjr) March 3, 2014
I didn’t blog about it because the Medicaid portion of the document is really quite bad given that the report was hyped as the precursor to a major policy push by Rep Ryan and House Republicans. It is essentially a poorly done annotated bibliography that would get about a C- in my intro U.S. health system course. The biggest problem with the Medicaid portion of the document is not even the one-sided summary of the literature that is cited that could be forgiven in such a document, but ignoring the issue of the dual eligibles almost completely in something that is meant to set up the need for Medicaid reform is quite a big miss. So, the document is not serious enough on the Medicaid issue to warrant much blogging time.
I didn’t read the remainder of the report (on other federal poverty programs) after looking at the Medicaid parts. Here is a blog tag on the many things I have written about the dual eligibles and the need for reform.
cross posted at freeforall
After rising inexorably for more than three decades, the U.S. prison population has declined three years in a row. Few people see this as anything other than an extremely positive development. But will it last? Some prison policy watchers are more optimistic than others.
Mike Konczal is one of many smart people who has raised the worry that as The Great Recession disappears into the rear-view mirror, states will return to fiscal health and consequently lose interest in slashing prison budgets.
I don’t share Konczal’s anxiety, for two reasons. First, because the general pattern in U.S. history is for prison populations to grow rather than shrink during economic downturns, I am not convinced that The Great Recession was very important to the reversal of the 30+ year mass incarceration trend. Second, states like South Dakota whose public finances are already in rude health are nonetheless taking major steps to reduce incarceration.
A different case for pessimism, among some liberals at least, is that now that some prisons are privatized, the powerhouse lobbyists of that industry will prevent further de-incarceration. Some people on the political right are too reflexively fearful of government and too trusting of the private sector. Prison policy is a case where the opposite set of biases afflicts some analysts on the left. Over 90% of U.S. inmates are in public prisons. The political power of public sector unions on incarceration-related issues thus dwarfs that of the small private sector. If the private prison operators and public sector prison employees unions allied in the cause of preventing de-incarceration, it could be a significant political problem, but that’s not very likely because they hate each others’ guts.
Less crime leads to declining incarceration in two ways. First, and most obvious, there are fewer law-breakers to lock up. Second, safer streets reduce the public’s demand for tough “law and order” policies – like the stiff mandatory minimum sentences that helped drive the U.S. rate of incarceration up in the 80s and 90s.
Kevin Drum is even more upbeat based on his analysis of lead exposure research. He argues that the generation that grew up in the leaded gasoline era was uniquely violent. As they age out and are replaced by non-exposed generations, Kevin expects crime and incarceration rates to continue their fall.
You don’t have to accept the lead explanation to make an equally positive projection about the future. Prisoners tend to have long criminal histories that began when they were teenagers. As a result, the current size of the prison population reflects the crime rate of a decade or two ago better than it does that of the present moment. Ten years from now, the prison population will better reflect the low crime rate we have been enjoying in recent years, which translates into many fewer people serving hard time.
The cover package in the current issue of Washington Monthly includes articles on cannabis legalization by Jonathan Caulkins, Jonathan Rauch, and me, under the heading “Saving Marijuana Legalization.” Mine has the wonderful title (which I think Paul Glastris gets credit for) “How Not to Make a Hash of Marijuana Legalization.”
All three pieces consider how to legalize cannabis rather than whether to legalize it. Caulkins and I both distrust the trend toward a commercial system on the alcohol model, and I’m also unhappy both about a pure states’-rights approach and about legislation by initiative. I also float the idea of user-set monthly purchase quotas, a “nudge” strategy that I claim might do some good and couldn’t hurt.
Michael Hilzik gives the whole thing a very nice write-up on the LA Times business page.
Footnote Depressingly, none of the LA Times commmenters makes a point that is either original or cogent. It’s like hearing from the Romneybots in the fall of 2012.
Shatterproof is a new organization intending to do for substance abuse disorder what the American Heart Association does for cardio-vascular disease: combining collective self-help, research support, and policy advocacy. What excites me is that the policy advocacy will be relentlessly aimed at reducing the damage, rather than at fighting the culture war (from either side). They had me at “addiction to alcohol and other drugs.”
I don’t have a clue whether they can bring it off, but after several long conversations with Gary Mendell, the founder, I’m willing to give it a shot.
And that’s where your part comes in. As a fundraiser, Shatterproof is organizing a group of us to rappel from the Westin in Pasadena a week from Wednesday. If you’re one of the countless people who would love to see me break my neck, you now have a chance to contribute to the cause. Of course, it’s entirely possible that I will get to the bottom in one piece, but that’s just the risk you take.
Angela Hawken will also be doing the reverse Rope Trick. I tried to explain that it would work better if people could contribute to prevent Angela from courting disaster, but it’s hard to fight organizational Standard Operating Procedure, so just go ahead and support her effort.