Daily Archives: 15 November 2017

PRC Censorship

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…is reaching into other nations to deprecate their free speech.

Clive Hamilton, Professor of Public Ethics at Australia’s Charles Sturt University has written a book, Silent Invasion, that details the breadth of influence the People’s Republic of China has achieved within Australia.  His publisher, Allen & Unwin, has decided to “delay” release of the book because the PRC is threatening “defamation action” against the publisher.

What defamation, exactly (and how does a private citizen defame a foreign government, anyway)?  Hamilton says his book is

“very factual, very deeply researched,”…the “first comprehensive national study of Beijing’s program of exerting influence on another nation.”

He said he had documented the influence of the Chinese Communist Party on Australian political parties, universities and cultural organizations, as well as on Chinese living in Australia.

Apparently, on private enterprises, as well.

As Hamilton put it, Allen & Unwin’s decision to acquiesce to the PRC’s threats is

a watershed moment in Australia, when Beijing can suppress free speech.

Hamilton has said he’ll get another publisher, and it would seem he has another instance of PRC “influence” within Australia to describe.  Along the way, I have to wonder why, in future, any author would want to do business with so unreliable a publisher.

Death Panels?

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The Affordable Care Act required Medicare to penalize hospitals with high numbers of heart failure patients who returned for treatment shortly after discharge. New research shows that penalty was associated with fewer readmissions, but also higher rates of death among that patient group.

Because sometimes readmission is necessary for quality care—whether that readmission was driven by later complications, by too-soon original discharge in the Medicare (which is to say Government) pressure to hold down costs first, or by some other factor—but that Government pressure to push the patient out the door also pushes against the patient’s return.  Even when necessary.

Here are a couple of numbers from a study soon to be published in JAMA Cardiology:

One in five heart failure patients returned to the hospital within 30 days before the ACA passed. That dropped to 18.4% after the penalties. Mortality rates increased from 7.2% before the ACA to 8.6% after the penalties….

In other words, an 8% drop in readmissions is associated with a 19% rise in death rates for heart patients.  That’s not a favorable trade-off.

There is a legitimate interest in improving the quality of care for all patients, including those for whose care us taxpayers are paying, but readmission rate is not an accurate measure of that quality.  Readmission rate can only measure…readmission rate.  That metric addresses neither the reasons for readmission nor the reasons for the prior discharge.

Government pressure to hold down readmissions doesn’t quite amount to death panels, but the outcomes seem dismayingly similar.  To be clear, the results of the study do not establish a causal relationship, for heart patients, between the lowered readmission rate and the higher death rate.  However, the magnitude of the apparent association between the two desperately wants further investigation.