State of the Art: Tablets Are Hot Holiday Gifts, but Which One to Buy? - Review

From left: J. Emilio Flores for The New York Times, Jim Wilson/The New York Times, Everett Kennedy Brown/European Pressphoto Agency

From left, the Kindle PaperWhite, the iPad Mini and the  Nexus 7.

The other day, I joined NPR for a segment about high-tech holiday gifts. I was ready for the calls from listeners. I’d brushed up on cameras, phones, laptops, music players and game consoles. I was prepared to talk about limiting screen time, digital addiction, cyberbullying. I knew where to get the best deals.

But all six callers had the same question: “What tablet should I get?”

There were variations, of course. “— for my kid?” “— for my elderly father?” “— just for reading?” “— for not much money?” But in general, it was clear: the gadget most likely to be found under the tree this year is thin, battery-powered and flat.

No wonder people are confused. The marketplace has gone tablet-crazy. There’s practically a different model for every man, woman and child.

There’s the venerable iPad, of course. And now the iPad Mini. There are new tablets from Google, also in small and large. There are Samsung’s Note tablets in a variety of sizes, with styluses. There are $200 touch-screen color e-book/video players. There’s a new crop of black-and-white e-book readers. There are stunningly cheap plastic models you’ve never heard of. There are tablets for children (and I don’t mean baby aspirin).

So how are you, the confused consumer, supposed to keep tabs on all these tablets? By taking this handy tour through the jungle of tablets 2012. Keep hands and feet inside the tram at all times.

DIRT-CHEAP KNOCKOFFS You can find no-name tablets for $100 or even less. You can also find mystery-brand Chinese tablets in toy stores, marketed to children.

Don’t buy them. They don’t have the apps, the features, the polish or the pleasure of the nicer ones. The junk drawer is already calling their names.

E-BOOK READERS The smallest, lightest, least expensive, easiest to read tablets are the black-and-white e-book readers. If the goal is simply reading — and not, say, watching movies or playing games — these babies are pure joy.

Don’t bother with the lesser brands; if you’re going to get locked into one company’s proprietary, copy-protected book format, you’ll reduce your chances of library obsolescence if you stick with Amazon or Barnes & Noble.

Each company offers a whole bunch of models. But on the latest models, the page background lights up softly, so that you can read in the dark without a flashlight. (These black-and-white models also look fantastic in direct sun — now you get the best of both lighting conditions.)

The one you want is the Kindle PaperWhite ($120), whose illumination is more even and pleasant than the equivalent Nook’s.

Of course, plain, no-touch, no-light Kindles, with ads on the screen saver, start as low as $70. But the light and the touch-screen are really worth having.

COLOR E-READERS/PLAYERS Amazon and B.& N. each sell a seven-inch tablet that, functionally, lands somewhere between an e-book reader and an iPad. They have beautiful, high-definition touch screens. They play music, TV shows, movies and e-books. They can surf the Web. They even run a few handpicked Android apps like Netflix and Angry Birds.

They’re nowhere near as capable as full-blown, computerlike tablets of the iPad/Nexus ilk, mainly because there are so few apps, accessories and add-ons. But they cost $200; you’re paying only a fraction of the price.

The big two here are, once again, Amazon and B.& N. If you’re not already locked in to one of those companies’ books and videos because you owned a previous model, the Nook HD is the one to get. It’s much smaller and lighter than the Kindle Fire HD. It has a much sharper screen. And the $200 price includes a wall charger (the Fire doesn’t) and no ads (the Fire does). Or get the classy Google Nexus 7, also $200. Although its book/music/movie catalog is far smaller, its Android app catalog is far larger (but see “iPad versus Android,” below).

BIG COLOR READERS/PLAYERS This year, both Amazon and B.& N. have introduced jumbo-screen (9-inch) versions of their HD tablets. Here again, B.& N. offers a better value than its 9-inch Kindle Fire HD rival. For $270, the Nook HD+ offers a sharper screen, lighter weight, no ads, a memory-card slot and a wall charger.

E-mail: pogue@nytimes.com

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Alleged WikiLeaks source says he was illegally punished in jail

A key pretrial hearing for Pfc. Bradley Manning, accused of giving classified material to the website WikiLeaks, which then made it public, began Tuesday in a case that highlights the government’s resolve to keep war and diplomatic material secret.

Manning, who has been charged on 22 counts, faces life in prison if convicted of aiding the enemy, the most serious charge. His court-martial is scheduled for February.

A former intelligence analyst in Baghdad in 2009 and 2010, Manning is accused of sending hundreds of thousands of logs about the wars in Iraq and Afghanistan and more than 250,000 diplomatic cables to WikiLeaks.

The hearing at a military court at Ft. Meade outside Baltimore is scheduled to run through Sunday. Manning is expected to testify at some point. It would be the first time he has spoken publicly about the case and the conditions of his detainment since his arrest in 2010.

The defense will argue that all charges should be dismissed because Manning was subjected to “unlawful pretrial punishment,” according to a post on the website of his supporters, the Bradley Manning Support Network.

Manning will get a chance to testify about his treatment. His lawyers argue that he was illegally punished by being put alone in a cell for nine months at the Marine Corps brig in Quantico, Va. Military judges can dismiss all charges if pretrial punishment is particularly egregious, but that rarely happens, though the time in incarceration can be credited toward the sentencing.

“At this extremely important hearing, Bradley’s lawyer David Coombs ... will present evidence that brig psychiatrists opposed the decision to hold Bradley in solitary, and that brig commanders misled the public when they said that Bradley’s treatment was for ‘Prevention of Injury,' " his supporters said.

Manning has offered to take responsibility by pleading guilty to reduced charges. The military has not ruled on that offer.

Manning was in the brig from July 2010 to April 2011. The military argues the treatment there was proper since he classified as a maximum-security detainee. He was later moved to Ft. Leavenworth, Kan., where he was reevaluated and given a medium-security classification.

A United Nations investigator called the conditions of Manning's imprisonment cruel, inhuman and degrading, but stopped short of calling it torture.

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Nintendo to Launch $99 'Wii Mini,' But Only in Canada. Why?

The good news: After six years on the market, Wii now has a price of under $100. Bad news: in Canada.

Well: I guess it’s not bad news if you’re Canadian. Wii Mini, announced today by the gamemaker’s northern subsidiary, sports a radically different form factor and color scheme than the original motion-controlled console. It’s a dual-tone matte finish of textured red and black, something that looks like it came from the toy aisle rather than the electronics department. It’s the first version of Wii to not have that cool slot-loading automatic drive; instead, the top pops up and you put the disc on the spindle manually.

Wii, with its innovative motion controls, was a colossal success for Nintendo. Since its launch in 2006, it has sold over 95 million units worldwide, eclipsing sales of Xbox 360 and PlayStation 3. Wii’s massive popularity meant that Nintendo could maintain its launch price of $250 through September 2009. A successor machine, Wii U, which keeps Wii’s motion controllers and adds GamePad, a controller with a built-in touchscreen, launched this month.

Nintendo launched a slight revision of the Wii hardware in 2011 that eliminated the now barely used backward compatibility with the GameCube console. Wii Mini goes a step farther and removes the internet connectivity. So now it’s strictly for playing Wii game discs, of which Nintendo of Canada says 1,300 are available.

So the big question on everyone’s lips is, of course: Why Canada? Is Nintendo unsure of whether consumers will want Wii Mini, and therefore test-marketing it in Canada first?

I think it’s the wrong question. The right question is: Why not the United States?

Two potential reasons spring to mind. Perhaps Wii, bundled with games at $130-150, is just doing too well in the U.S. for Nintendo of America to want to introduce a new model right now. CNET reported on Monday that Nintendo had sold 300,000 Wii systems and 400,000 Wii U last week. Many of those were at discounted rates, some cheaper than the Wii Mini. Perhaps Nintendo of America has every intention of releasing Wii Mini here, but surmised that the old Wii had one more Christmas left in it at prices as high as $150. (It has not yet responded to Wired’s request for comment.)

Or maybe for America, the removal of the Internet functionality was a step too far?

We know two things for sure: One, as of last year 25 percent of Netflix subscribers used Wii to access the streaming video service. Two, Netflix isn’t nearly as big a deal in Canada: The Globe and Mail reported in October that growth has “plateaued,” it doesn’t have nearly as much content as the U.S. version does, and extra charges for bandwidth in Canada can make streaming video a very expensive proposition.

“The problem in Canada is… they have almost third-world access to the internet,” said Netflix’s chief content officer in September, as reported by GigaOm.

So perhaps it’s the case that Nintendo of Canada doesn’t mind nearly as much that Wii Mini has no connectivity.

By removing GameCube compatibility, removing all the networking hardware and replacing the cool slot-loading disc drive with an uncool but presumably much cheaper hinged-door, Nintendo has surely lowered the Wii’s cost of goods to rock bottom with the Mini. With well over 1000 games (and, you know, ten or eleven fantastic ones), a super-cheap Wii could continue to live on and on as a bargain console. With Xbox 360 and PlayStation 3 still hovering around $250, it’s doubtful that Microsoft or Sony would ever bother creating models this inexpensive, so Mini could be the only option for families looking for dirt-cheap TV gaming.

In Canada.

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‘Two and a Half Men’ actor not expected on set

NEW YORK (AP) — The teenage actor who stars in “Two and a Half Men” and called the CBS comedy “filth” may have some time before he faces the show’s producers.

Angus T. Jones wasn’t expected at rehearsal Tuesday because he is not going to be in the episode they are filming, according to a person close to the show who spoke on condition of anonymity because producers were not commenting publicly.

Jones, 19, has been on the show, which used to feature bad-boy actor Charlie Sheen and remains heavy with sexual innuendo, since he was 10 but says in a video posted online by a Christian church that he doesn’t want to be on it anymore.

“Please stop watching it,” Jones said. “Please stop filling your head with filth.”

The person familiar with the production schedule said Jones does not appear in either of the two episodes filming before the end of the year, so he wouldn’t be expected back at work until after the New Year.

His character has been largely absent because he has joined the Army.

CBS and producer Warner Bros. Television have not commented.

“Two and a Half Men” survived a wild publicity ride less than two years ago, when Sheen was fired for his drug use and publicly complained about the network and the show’s creator, Chuck Lorre.

Jones plays Jake, the son of Jon Cryer’s uptight divorced chiropractor character, Alan, and the nephew of Sheen’s hedonistic philandering music jingle writer, Charlie. Sheen was replaced by Ashton Kutcher, who plays billionaire Walden.

In the video posted by Forerunner Chronicles in Seale, Ala., Jones describes a search for a spiritual home. He says the type of entertainment he’s involved in adversely affects the brain and “there’s no playing around when it comes to eternity.”

“You cannot be a true God-fearing person and be on a television show like that,” he said. “I know I can’t. I’m not OK with what I’m learning, what the Bible says, and being on that television show.”

The show was moved from Monday to Thursday this season, and its average viewership has dropped from 20 million an episode to 14.5 million, although last year’s numbers were somewhat inflated by the intense interest in Kutcher’s debut. It is the third most popular comedy on television behind CBS’s “The Big Bang Theory” and ABC’s “Modern Family.”

The actors on “Two and a Half Men” have contracts that run through the end of the season.

Entertainment News Headlines – Yahoo! News

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Global Update: Investing in Eyeglasses for Poor Would Boost International Economy

BSIP/UIG Via Getty Images

Eliminating the worldwide shortage of eyeglasses could cost up to $28 billion, but would add more than $200 billion to the global economy, according to a study published last month in the Bulletin of the World Health Organization.

The $28 billion would cover the cost of training 65,000 optometrists and equipping clinics where they could prescribe eyeglasses, which can now be mass-produced for as little as $2 a pair. The study was done by scientists from Australia and the Johns Hopkins Bloomberg School of Public Health.

The authors assumed that 703 million people worldwide have uncorrected nearsightedness or farsightedness severe enough to impair their work, and that 80 percent of them could be helped with off-the-rack glasses, which would need to be replaced every five years.

The biggest productivity savings from better vision would not be in very poor regions like Africa but in moderately poor countries where more people have factory jobs or trades like driving or running a sewing machine.

Without the equivalent of reading glasses, “lots of skilled crafts become very difficult after age 40 or 45,” said Kevin Frick, a Johns Hopkins health policy economist and study co-author. “You don’t want to be swinging a hammer if you can’t see the nail.”

If millions of schoolchildren who need glasses got them, the return on investment could be even greater, he said, but that would be in the future and was not calculated in this study.

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Dark Warnings About Future of Internet Access

PARIS — A commercial and ideological clash is set for next week, when representatives of more than 190 governments, along with telecommunications companies and Internet groups, gather in Dubai for a once-in-a-generation meeting.

The subject: Control of the Internet, politically and commercially.

The stated purpose of the World Conference on International Telecommunications is to update a global treaty on technical standards needed to, say, connect a telephone call from Tokyo to Timbuktu. The previous conference took place in 1988, when the Internet was in its infancy and telecommunications remained a highly regulated, mostly analog-technology business.

Now the Internet is the backbone for worldwide communications and commerce. Critics of the International Telecommunication Union, the agency of the United Nations that is organizing the meeting, see a dark agenda in the meeting. The blogosphere has been raging over supposed plans led by Russia to snatch control of the Internet and hand it to the U.N. agency.

That seems unlikely. Any such move would require an international consensus, and opposition is widespread.

Terry D. Kramer, the former Vodafone executive who is the United States ambassador to the conference, has vowed to veto any change in how the Internet is overseen.

Analysts say the real business of the conference is business. “The far bigger issue — largely obscured by this discussion — are proposals that are more likely to succeed that envision changing the way we pay for Internet services,” Michael Geist, an Internet law professor at the University of Ottawa, said by e-mail.

Hamadoun Touré, secretary general of the I.T.U., has repeatedly said that the U.N. group has no desire to take over the Internet or to stifle its growth. On the contrary, he says, one of the main objectives of the conference is to spread Internet access to more of the four and a half billion people around the world who still do not use it.

And yet, groups as diverse as Google, the Internet Society, the International Trade Union Confederation and Greenpeace warn that the discussions could set a bad precedent, encouraging governments to step up censorship or take other actions that would threaten the integrity of the Internet.

“This is a very important moment in the history of the Internet, because this conference may introduce practices that are inimical to its continued growth and openness,” Vinton G. Cerf, vice president and chief Internet evangelist at Google, said in a conference call.

Google set up a Web site last week, “Take Action,” encouraging visitors to sign a petition for a “free and open Internet.” The campaign is modeled on the successful drive last winter to defeat legislative proposals to crack down on Internet piracy in the United States.

More energy is expected to be spent on how companies make money off the Internet. In one submission to the conference, the European Telecommunications Network Operators’ Association, a lobbying group based in Brussels that represents companies like France Télécom, Deutsche Telekom and Telecom Italia, proposed that network operators be permitted to assess charges for content providers like Internet video companies that use a lot of bandwidth.

Analysts say the proposal is an acknowledgment by European telecommunications companies that they cannot hope to provide digital content. “The telecoms realize that they have lost the battle,” said Paul Budde, an independent telecommunications analyst in Australia. “They are saying, ‘We can’t beat the Googles and the Facebooks, so let’s try to charge them.’ ”

The European lobbying group says that without the new fees, there will be no money to invest in network upgrades needed to deal with a surge in traffic. Regulators have required European telecommunications operators to open their networks to rivals, and the market for broadband is fiercely competitive, with rock-bottom prices.

In the United States, by contrast, most telecommunications companies have been permitted to maintain local monopolies — or duopolies, with cable companies — in broadband, keeping prices higher. And American regulators have ordered broadband providers to give equal priority to all Internet traffic. Such “network neutrality” is incompatible with charging content providers for moving their bits of data.

Analysts say this may explain why American telecommunications companies have not joined the European call for a new business model. “Models that try to force payment terms between nations and telecom operators run a huge risk of cutting off traffic,” Mr. Kramer said in an interview. “Liberalized markets are the only way to expand the success of the Internet.” People who have been briefed on the conference submissions say that not a single European government delegation has endorsed the telecommunications operators’ proposal, and the European Parliament has passed a resolution denouncing it. Only governments, not private groups or companies, can put items on the meeting agenda.

While many documents prepared for the conference remain secret, several people who have seen submissions say there is broad support for Internet connection fees in French-speaking Africa and among Arab nations — countries in which many telecommunications companies are still owned or heavily regulated by governments.

Much of the attention before the 12-day conference has focused on a proposal from Russia that would effectively remove control of the Internet’s infrastructure from a collection of decentralized and apolitical organizations, mostly based in the United States. “Member states,” Russia proposed, “shall have equal rights to manage the Internet, including in regard to the allotment, assignment and reclamation of Internet numbering, naming, addressing and identification resources.”

Those functions are performed by the Internet Corporation for Assigned Names and Numbers, a private organization with an international board that operates under contract with the United States government.

The Russian proposal was widely interpreted as a call to legitimize domestic censorship of the Internet. Yet analysts note that governments inclined to filter the Web, like China and Iran, have not waited for consensus in an international meeting to do so.

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Congress returns as 'fiscal cliff' talks slow

WASHINGTON – Congress returned in a lame duck session with no signs of quick compromise to prevent a tax hike for most Americans early next year.

Talks between the White House and Republican leaders in the House continued behind closed doors. Current tax rates expire Dec. 31.

Emboldened by his re-election, President Obama took his case for raising taxes on the wealthiest Americans to the public on Monday. He warned that the threat of higher taxes on middle-class Americans could dampen the Christmas shopping season.

"The President has called on Congress to take action and stop holding the middle class and our economy hostage over a disagreement on tax cuts for households with incomes over $250,000 per year," the White House said in a statement.

Quiz: How much do you know about the fiscal cliff?

The White House got a boost from billionaire investor Warren Buffett, who said the wealthy – himself included – should pay more. Noting the nation’s growing gap in income disparity, Buffett dismissed the Republican argument that tax hikes would hamper investments.

“In recent years, my gang has been leaving the middle class in the dust,” Buffett said. “So let’s forget about the rich and ultrarich going on strike and stuffing their ample funds under their mattresses if — gasp — capital gains rates and ordinary income rates are increased.”

Key Republicans, including House Speaker John A. Boehner, have signaled they are willing to put new tax revenues on the table, creating the outlines of a possible deal. Several Republican lawmakers used the Sunday talk shows to distance themselves from their party’s anti-tax pledge, publicly breaking with conservative stalwart Grover Norquist, although they insisted any agreement must include spending cuts.

A so-called grand bargain of tax hikes and spending cuts has eluded Washington in the past, but both political parties are wary of rattling the financial markets and sparking a crisis in consumer spending. Wall Street has signaled a bold deficit-reduction plan is needed to prevent a credit downgrade.

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No talks between the president and congressional leaders have been scheduled. The parties had agreed to meet this week to put the framework of a two-part deal on the table.

If Republicans continue to fight higher tax rates for the wealthy, Boehner will face pressure to propose an alternative way to raise new revenue – either by closing individual loopholes or capping deductions in a way that produces new money.

“Congressional and White House staff continue to work to find common ground that is consistent with the ‘balanced approach’ the White House says it wants – with significant spending cuts, and without job-killing small business tax hikes,” said a senior House leadership aide.

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Lisa.Mascaro@latimes.com

CParsons@latimes.com

Twitter: @LisaMascaroinDC

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Peter Jackson Races to Complete <em>The Hobbit</em> in Time for Premiere

Peter Jackson makes epic films, and epic films take an extraordinary amount of time to produce. In the case of The Hobbit: An Unexpected Journey, the trek to completion is coming down to the wire.

Jackson has been working on The Hobbit, which opens next month, at the Park Road Post Production facility in Wellington, New Zealand, for weeks to complete every last VFX trick, CGI shot and sound effect in time for the film’s opening.

“It’s due to be completed literally two days before the premiere. Hopefully,” Jackson says in the film’s latest production video (above). “You’re going to see a lot of sleep-deprived people in this blog — everybody’s working around the clock to get the film finished.”

The clip, which is as funny and fascinating as the eight other production diaries Jackson has released online, shows every last detail going into the film’s final push: Jabez Olssen and Jackson editing the film together, final construction of hundreds of CGI shots, and final sound effects for the movie.

There’s also a wonderful look into the “Department of Internal Beard-Hairs” — the motion-capture wing dedicated to the facial hair worn by the movie’s fantastic characters. “We’ve advanced the art of motion caption quite substantially on The Hobbit, including the detail of motion-capturing the individual hairs of dwarves’ beards,” Jackson says. Judging by the work displayed by his crew in this short clip, digital beards may never be the same.

Finally, there is the music soundtrack, which has been (is being?) recorded at the legendary Abbey Road Studios in London. It’s being played, on the day of the video diary at least, by a 93-person orchestra and it sounds, well, amazing. But even once it’s done and laid down in the final film, it’s just the beginning, notes re-recording mixer Michael Semanick.

“We’ve got another three weeks … and then another couple films,” he says. “The journey’s long from over, it’s just really starting.”

Check out the full video diary above. The Hobbit: An Unexpected Journey hits theaters Dec. 14.

[via io9]

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Actor: CBS comedy ‘Two and a Half Men’ is ‘filth’

NEW YORK (AP) — The teenage actor who plays the half in the hit CBS comedy “Two and a Half Men” says it’s “filth” and through a video posted by a Christian church has urged viewers not to watch it.

Nineteen-year-old Angus T. Jones has been on the show since he was 10 but says he doesn’t want to be on it. He says, “Please stop watching it. Please stop filling your head with filth.”

The video was posted by the Forerunner Christian Church in California, where Jones says he went to meet his spiritual needs.

Show producer Warner Bros. Television has no comment. CBS hasn’t responded to a request for comment left Monday.

The show stars Jon Cryer as Jones’ uptight dad and originally featured Charlie Sheen as his hedonistic philandering uncle, but Sheen was replaced by Ashton Kutcher.

Entertainment News Headlines – Yahoo! News

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Hospitals Face Pressure From Medicare to Avert Readmissions

After years of gently prodding hospitals to make sure discharged patients do not need to return, the federal government is now using its financial muscle to discourage readmissions.

Medicare last month began levying financial penalties against 2,217 hospitals it says have had too many readmissions. Of those hospitals, 307 will receive the maximum punishment, a 1 percent reduction in Medicare’s regular payments for every patient over the next year, federal records show.

One of those is Barnes-Jewish Hospital in St. Louis, which will lose $2 million this year. Dr. John Lynch, the chief medical officer, said Barnes-Jewish could absorb that loss this year, but “over time, if the penalties accumulate, it will probably take resources away from other key patient programs.”

The crackdown on readmissions is at the vanguard of the Affordable Care Act’s effort to eliminate unnecessary care and curb Medicare’s growing spending, which reached $556 billion this year. Hospital inpatient costs make up a quarter of that spending and are projected to grow by more than 4 percent annually in coming years, according to the Congressional Budget Office.

The readmission penalties will recoup about $300 million this year. But the goal is to pressure hospitals to pay attention to what happens to their patients after they walk out the door. The penalties have captured the attention of hospitals, and many are trying to improve their supervision of discharged patients’ recoveries.

“I’ve been doing this for over two decades and talking to hospital leaders about readmissions, and I used to get polite but blank stares,” said Dr. Eric Coleman, a professor at the University of Colorado Anschutz Medical Campus who has devised widely adopted methods to reduce hospitalizations. “Now they’re paying attention.”

With nearly one in five Medicare patients returning to the hospital within a month — about two million people a year — readmissions cost the government more than $17 billion annually.

Hospitals’ traditional reluctance to tackle readmissions is rooted in Medicare’s payment system. Medicare generally pays hospitals a set fee for a patient’s stay, so the shorter the visit, the more revenue a hospital can keep. Hospitals also get paid when patients return. Until the new penalties kicked in, hospitals had no incentive to make sure patients didn’t wind up coming back. The maximum penalty is set to double next October and then reach 3 percent of reimbursements in October 2015. Medicare also is expanding the list of conditions it will assess in setting punishments.

Right now it only evaluates readmissions of heart attack, heart failure and pneumonia patients, counting every rebound, even ones not related to the original reason for hospitalization. The penalties are based on readmission rates in the past and applied to future payments for all Medicare patients.

Researchers say that while some readmissions are unavoidable, many are caused by the short shrift hospitals have given patients on their way out.

Jonathan Blum, principal deputy administrator for the Centers for Medicare and Medicaid Services, said the penalties had helped galvanize hospitals’ efforts to avoid readmissions. “We’ve seen a small but significant reduction,” he said. “That tells me we’ve focused the industry on improvement.”

Medicare’s tough love is not going over well everywhere. Academic medical centers are complaining that the penalties do not take into account the extra challenges posed by extremely sick and low-income patients. For these people, getting medicine and follow-up care can be a struggle.

At Barnes-Jewish Hospital, Dr. Lynch said physicians from all over the Midwest referred their sickest heart patients to his facility for transplants and other major interventions. But those patients can skew his hospital’s readmissions numbers, he said: “The weaker your heart, the more advanced your emphysema, the more likely you are to be readmitted to the hospital.”

Dr. Lynch said Barnes-Jewish set up follow-up appointments for patients who didn’t have their own doctors. But about half of the patients never showed up, he said, even after the hospital made reminder phone calls and arranged for free rides. Sending nurses to see patients at home did not significantly reduce readmission rates either, he said.

“Many of us have been working on this for other reasons than a penalty for many years, and we’ve found it’s very hard to move,” Dr. Lynch said. He said the penalties were unfair to hospitals with the double burden of caring for very sick and very poor patients.

“For us, it’s not a readmissions penalty,” he said. “It’s a mission penalty.”

Various studies, including one commissioned by Medicare, have found that the hospitals with the most poor and African-American patients tended to have higher readmission rates than hospitals with more affluent and Caucasian patients. But the studies also determined that some safety-net hospitals performed better than average, showing that hospitals can overcome the challenges posed by the kinds of patients they treat.

In some ways, the debate parallels the one on education — specifically, whether educators should be held accountable for lower rates of progress among children from poor families.

“Just blaming the patients or saying ‘it’s destiny’ or ‘we can’t do any better’ is a premature conclusion and is likely to be wrong,” said Dr. Harlan Krumholz, director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, which prepared the study for Medicare. “I’ve got to believe we can do much, much better.”

Some researchers fear the Medicare penalties are so steep, they will distract hospitals from other pressing issues, like reducing infections and surgical mistakes and ensuring patients’ needs are met promptly. “It should not be our top priority,” said Dr. Ashish Jha, a professor at the Harvard School of Public Health who has studied readmissions. “If you think of all the things in the Affordable Care Act, this is the one that has the biggest penalties, and that’s just crazy.”

With pressure to avert readmissions rising, some hospitals have been suspected of sending patients home within 24 hours, so they can bill for the services but not have the stay counted as an admission. But most hospitals are scrambling to reduce the number of repeat patients, with mixed success.

A few days after Eda Laurion was discharged from the Banner Del E. Webb Medical Center near Phoenix after treatment for her congestive heart failure in August, a nurse showed up at her house.

“She helped explained the medicines I’m taking, the side effects, what they do for you,” said Ms. Laurion, 91, of Sun City West.

Still, readmissions can’t always be prevented. The nurse, Sue Koner, sent Ms. Laurion back to the hospital after two weeks for dangerously low sodium caused by an undiagnosed kidney problem. However, Ms. Laurion avoided re-hospitalization in October when Ms. Koner deduced that her hallucinations were a reaction to an antibiotic.

Overseeing former patients is expensive and time-consuming, so many hospitals are relying on financing from community health organizations and foundations. Ms. Koner works for Sun Health, a foundation-supported nonprofit. Since Sun Health started its program in November 2011, only nine of 213 patients have been readmitted.

Dr. Krumholz said hospitals should think of readmissions as a challenge to overcome. “One day, we’ll look back,” he said, “and we’ll be incredulous that one out of every five patients ended up back in the hospital.”

This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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