RUTHFULLY YOURS

As part of the Affordable Care Act, the federal government adjusts reimbursements to health-care providers up or down based on the quality and cost-effectiveness of their services, as measured by a set of standards established by the Centers for Medicare and Medicaid Services (CMS). The standards use metrics such as how long emergency-room patients must wait to be seen and how long it takes heart-attack victims to get stents placed in their blocked arteries. The intention is to encourage savings and sound practices and enhance patient satisfaction.

The problem is that these requirements have not only increased costs but also may promote poor practices. For example, the CMS goal of stenting a blocked coronary artery within 90 minutes of a heart attack has not been shown to decrease mortality. Moreover, rushing a chest-pain patient to surgery to meet an arbitrary time goal may increase the odds of misdiagnosing other life-threatening conditions such as tears in the aorta, the main artery carrying blood from the heart. Before the imposition of the 90-minute rule, doctors routinely took x-rays of patients with chest pain looking for an aortic rupture. Its presence is a contra-indication to the blood thinners routinely given to heart attack victims. Chest x-rays are no longer recommended by some cardiologists because they prolong the work-up by a few minutes, making it more difficult to meet the 90-minute goal. “Sometimes I just need five more friggin’ minutes,” said one presenter at a medical conference.

Said another practitioner, “It is likely that these CMS quality metrics of . . . door-to-balloon times less than 90 minutes have physically harmed patients and dramatically increased costs for unnecessary cath lab initiations.” Medicare’s Hospital Readmissions Reduction Program assumes that hospital readmissions within 30 days are evidence of poor care somewhere in the system and that the hospital should be the responsible party. Hospitals at the top of the curve for readmissions are penalized financially. No allowance is made for underserved areas that generally have sicker populations, with fewer options for outpatient care. “Many readmissions occur because hospitals are extra-vigilant when patients who’ve had scary episodes, such as heart attacks or severe pneumonia, have setbacks and turn up again in the emergency room,” according to a 2016 report in the Annals of Internal Medicine.

Following introduction of the ACA guidelines, readmissions did go down, but mortality went up, according to a study published in November in JAMA Cardiology. “It’s possible that doctors may have made treatment decisions designed to avoid readmissions rather than to give patients the best possible care,” said UCLA’s Gregg Fonarow, the study’s senior author. Doctors might, for example, have postponed sending patients back to the hospital until after the 30-day window for readmission penalties had passed, allowing heart failure to worsen and decreasing survival odds. “Nationwide, there may have been thousands to tens of thousands of extra deaths in patients with heart failure resulting from this policy,” Fonarow said.

If the story hadn’t been verified by virtually every mainstream-media outlet in the country, you’d think it came straight from conspiratorial fever dreams of the alt-right. Yesterday, news broke that Robert Mueller had months ago asked a senior FBI agent to step down from his role investigating the Trump administration. This prince of a man was caught in an extramarital affair with an FBI lawyer. The affair itself was problematic, but so was the fact that the two were found to have exchanged anti-Trump, pro-Hillary Clinton text messages.

Here’s where the story gets downright bizarre. This agent, Peter Strzok, also worked with FBI director James Comey on the Clinton email investigation. In fact, he was so deeply involved in the Clinton investigation that he is said to have interviewed Cheryl Mills and Huma Abedin, and to have been present when the FBI interviewed Clinton. According to CNN, he was part of the team responsible for altering the FBI’s conclusion that Clinton was “grossly negligent” in handling classified emails (a finding that could have triggered criminal liability) to “extremely careless” — a determination that allowed her to escape prosecution entirely.

After the Clinton investigation concluded, Strzok signed the documents opening the investigation into Russian election interference and actually helped interview former national-security adviser Michael Flynn.

In other words, it looks like a low-integrity, reckless, biased bureaucrat has played an important role in two of the most important and politically charged criminal investigations of the new century. Yes, it’s good that Mueller removed Strzok when he discovered the text messages. No, Strzok is not solely responsible for the conclusions reached in either investigation. But his mere presence hurts public confidence in the FBI, and it does so in a way that further illustrates a persistent and enduring national problem: America’s permanent bureaucracy is unacceptably partisan.

A terrific catch by the Daily Caller’s Chuck Ross, whose story you should read in full. It was widely known that Peter Strzok, the FBI agent dismissed by Mueller from the Russiagate probe due to anti-Trump bias, had had a lead role in the Hillary Emailgate investigation. But I hadn’t realized until now that he was one of the agents who interviewed top Clinton cronies Huma Abedin and Cheryl Mills.https://hotair.com/archives/2017/12/05/werent-huma-abedin-cheryl-mills-charged-lied-peter-strzok-fbi/

Or, more importantly, that they pretty clearly lied to his face about when they found out that Hillary had her own email server.

Strzok is the same agent who reportedly replaced “grossly negligent” with “extremely careless” in Comey’s statement on Emailgate after the probe ended, and he’s also one of the agents who conducted the interview with Mike Flynn that earned Flynn a charge of making false statements to federal officials. One agent with a bias, even a supervisor, doesn’t discredit an entire investigation with dozens of people involved, especially after he’s been kicked off by the top prosecutor because of it. But the question remains: If Mike Flynn’s lies were sufficient to warrant being charged, why weren’t Abedin’s and Mills’s?

Summaries of the interviews, known as 302s, were released by the FBI last year.

A review of those documents conducted by The Daily Caller shows that Mills and Abedin told Strzok and Laufman that they were not aware of Clinton’s server until after she left the State Department…

But undercutting those denials are email exchanges in which both Mills and Abedin either directly discussed or were involved in discussing Clinton’s server.

“hrc email coming back — is server okay?” Mills asked in a Feb. 27, 2010 email to Abedin and Justin Cooper, a longtime aide to Bill Clinton who helped set up the Clinton server.

Comey was asked about Abedin’s and Mills’s lies during congressional testimony last year and spun his decision not to recommend charges by claiming that, hey, sometimes people misremember things and sometimes those things aren’t essential to a case. You don’t want to charge everyone who says something factually incorrect in an FBI interview with lying to a federal official. But the server wasn’t a peripheral matter and the Clinton cronies’ knowledge of it wasn’t immaterial. Comey’s rationale for not charging Hillary with mishandling classified information was that, while she may have been grossly negligent — sorry, I mean “extremely careless”! — there was no evidence that she intended to mishandle it. But setting up a private server which Team Clinton *knew* was destined to route classified information through it comes very close to intent, and Abedin and Mills would have been well positioned to speak to that knowledge. Putting some pressure on them by threatening to lock them up for false statements might have led to some interesting admissions about what Hillary Clinton imagined the purpose of her email server to be. The same charge helped convince Mike Flynn to play ball with Mueller. Why wasn’t similar pressure put on Abedin and Mills?

CNN could hardly contain its joy — or its exaggerations — in discussing Mike Flynn’s guilty plea. The cable channel provided wall-to-wall coverage, with barely a glance at the other big news: the first major tax bill in decades. The only thing missing was a Bronco chase on the L.A. Freeway.

President Trump’s apologists and his lawyers were spinning just as hard in the other direction. “Nothing to see here. Move along.”

In the days since the news broke, both sides have stuck to their talking points and turned the volume up to 11.

Let’s strip away the partisan hyperbole and sort out what we really know.

First, with Flynn’s plea alongside Paul Manafort’s indictment, Robert Mueller and the Office of Special Counsel have now snagged the two biggest fish they could catch, outside the Trump family itself. They are using every lure and net a prosecutor has. Manafort and Flynn have every incentive to cough up whatever dirt they have, and Flynn’s deal promises to do so. If that doesn’t worry the White House inner circle, they must be in a bunker.

Ah, but what dirt does the prosecutor have? Only Mueller, Trump and their inner circles know. Only they know whether senior Trump aides have committed underlying crimes or given false testimony. CNN doesn’t know. Fox doesn’t know. ABC doesn’t know and had to withdraw an incorrect report that the president himself was implicated. (The stock market was not amused.) Rep. Adam Schiff (D-Calif.) doesn’t know, even though he was smiling from ear to ear on TV and doing everything short of dancing and waving a “Mission Accomplished” banner.

What should worry the Trump team most is that Mueller presumably would not offer Flynn such a sweet plea deal if he didn’t have valuable information to proffer on higher-ups. And there aren’t many people above the national security adviser.

The quest for collusion is over. Special counsel Robert S. Mueller III’s Russia investigation has not — either through leaks or announced indictments — revealed any collusion, and Democrats and their allies in the liberal mainstream media know that it never will. This reality is setting in among the president’s clearer-thinking foes, and they are transitioning to an obstruction of justice claim in an effort to sustain the fight with President Trump.

Mueller’s investigation has been looking into Russian meddling in the 2016 election since May. His team has made a number of consequential findings, but none of them establish collusion between the Trump campaign and Russia. We would know by now if anyone close to Trump had actually colluded with Russia to impact the 2016 campaign. The only thing we know for certain is that Paul Manafort, Rick Gates, George Papadopoulos and Michael Flynn have been indicted for or admitted to things that fall short of collusion and have nothing to do with the president.

The Democrats know their faux-outrage over collusion is hollow and spent. Given that Mueller’s investigation hasn’t found the holy grail or produced anything that rises to the level of criminality on the part of Trump, liberals in Congress and in the media are now transitioning to an obstruction of justice story-line. Mueller is not talking, so the president’s critics are creating a new line of attack based on the notion that the firing of former FBI director James B. Comey was somehow a criminal act.

The problem with the Democrats’ claim is that the president can fire the FBI director for any reason or no reason at any time. Never mind that, they say. The Democrats believe the president’s motive was to end an investigation into Flynn and that doing so was somehow outside the bounds of his authority — and therefore criminal. That’s right: The liberals want to take us into a mind-numbing legal netherworld where the president committed a legal act with a corrupt mind-set and should therefore be impeached. I can’t imagine how this convoluted reasoning will lead to an indictable charge against Trump, but it is becoming the Democrats’ latest obsession.

Observers look for some sort of common denominator that would make sense of the daily news blasts of nonconsensual sexual escapades of media, political, and Hollywood celebrities.

No sooner are these lists of the accused compiled than they have to be updated, hourly. Long hushed, covered-up, or even forgotten sexual IEDs suddenly go off without warning and blow up a career.

Weirder still, the now-outraged often overnight can become the outrageous.

One moment Richard Dreyfuss expressed furor when he learned that gay actor Kevin Spacey long ago had groped his own son under the table (while the three were working on a script). The next minute, Dreyfuss himself was accused of an earlier repulsive unwanted sex act or advance toward a female subordinate.

New York Times reporter Glenn Thrush condemns the bad behavior of journalist Mark Halperin — and then finds himself accused of similar coerced sexual behavior. Senator Al Franken’s often sanctimonious outrages over the Fox News harassers would soon apply just as easily to his own behavior. We forget that the original context of Juvenal’s famous quip “Who will police the police?” was the insidiousness of sex.

Note these latest scandals are different from the age-old stories of consensual adultery. They are mostly not consensual affairs in the workplace, supposedly initiated by grasping subordinates or by oppressive bosses in midlife crises. Nor are they the connivances in dating and courtship — all the sort of consenting unions gone awry that are the stuff of novels and films.

Instead, in nearly all these examples of sexual harassment, there is inherently a beauty-and-the-beast asymmetry, male arrogance — and spitefulness. What repels is not just unwanted or coerced sex acts — but the gratuitous cruelty that so often surrounds them.