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Health Care: Equity Vs. Efficiency

In my blog post yesterday arguing that health care is a commodity, I noted that Rashi Fein, one of the architects of Medicare, argued that health care needed to emphasize equity over efficiency.  I claimed that “a system that emphasizes equity over efficiency will end up with neither, while a system that emphasizes efficiency over equity will end up with a good deal of both.”

Here are some examples:

Medicaid: Equity over Efficiency.  One purpose of Medicaid is providing the poor with access to care similar to that available to the middle and upper classes.  But it doesn’t seem to be achieving this goal very well.

Among all physicians, nearly one-third are no longer seeing new Medicaid patients and that number may well be over 45 percent for some specialists. The most likely reason is that Medicaid’s reimbursement rates are among the lowest. This creates access problems.  Medicaid patients have more difficulty getting timely appointments with primary care physicians, specialists and ambulatory clinics than patients with private insurance.  

There is research showing that access to health care for Medicaid patients is as good as it is for those with private insurance.  However, if Medicaid patients didn’t have access problems to physicians and clinics, why do so many go to the emergency room for care versus patients with private insurance?  And, for the most part, they are going because they need the care, not because they are there for some minor ailment. 

Medicaid doesn’t come close to achieving care equitable with those who have private insurance. How does it do on efficiency?  Well, the U.S. spends over $415 billion on Medicaid, and according to the Oregon health experiment, Medicaid has no noticeable impact on patient health.  Other research suggests that children at hospitals that are more reliant on Medicaid funding have more adverse events, and that patients with Medicaid are more likely to receive a diagnosis of late-stage cancer than patients with private insurance who are more likely to receive diagnoses at earlier stages.  Such results probably don’t satisfy any reasonable definition of efficiency.

Minute Clinics: Efficiency over Equity.  Minute clinics are walk-in clinics, usually located in a pharmacy like CVS or Walgreens, that employ physician assistants and nurse practitioners to provide primary care.  (I’m using the term “minute clinic” generically here, even though that is what they are called at CVS.  Walgreens calls them Healthcare Clinics and Wal-Mart calls them Care Clinics.)  The companies that run minute clinics want to make a profit, and thus they were created with efficiency in mind—that is, to make it more convenient, in terms of both time and money, for patients to receive care. More patients increases the likelihood of profitability.

Their efficiency is partially reflected in how much they have grown. The first one was launched in 2000 by CVS and there were 1,400 by 2012.  Accenture anticipates that (1) the number will grow to 2,800 by 2015 due to increased demand brought on by ObamaCare and (2) they will save the health care system about $800 million.

But are they making care more equitable?  Well, prices are relatively cheap, with most visits at CVS costing $79-$99 with some going as low as $59.  At Walgreens they are about $60 and at Wal-Mart some visits are as low as $40.  Those are prices that are affordable, even for many low-income people.  (Also see this study on the costs of more involved health care cases—minute clinics still were the cheapest.)

Minute clinics reduce another cost that is a barrier for the poor: time.  As a recent article from Health Affairs shows, poor people often have a big “time cost” in getting to a physician’s office—taking time off work, setting up transportation, etc.  Minute clinics reduce that cost by offering evening and weekend hours, something that physicians offices don’t do, at least not with the frequency of minute clinics.  Moreover, easier access to such care results in fewer emergency room visits.

In short, minute clinics are creating a great deal of both efficiency and equity.


We Have No Liberty: Now the Government is Coming for Our Hobbies

California lawmaker wineThe state of California has fined a hobbyist winery $115,000 because some of the people working at the --- let me use this word again -- HOBBYIST winery were volunteers.

National Center Senior Fellow R.J. Smith, who knows as much about wine as he does about the benefits of liberty (and that's saying something), has this comment:

Outrageous example of out-of-control government tyranny. Just what California needs, fewer wineries and small businesses. One of the great joys of wines has been the ability to volunteer during harvest season and also grape stomping. All over the world. Widely spreads the enjoyment and love of wine. And sometimes interests young people in a career in wines.

So the government says we can't have volunteers and interns any longer. Who are they to say?

What was that that Mr. Jefferson wrote in 1776 -- about the people facing a government that is no longer protecting life, liberty and property: " is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security."

Say a prayer for [Westover & Palomares Vineyards President and Winemaker] Bill Smyth -- his wife, family, employees and volunteers.

The state of California, which opposes liberty, has made it illegal for business to accept the help of volunteers. Across the board.

So if you love model trains and want to hang about a California-based model train shop on Saturday afternoons, answering kids' questions, don't. That's illegal.

If a California business seeks volunteers to transport food to a community event or food pantry, don't volunteer. It's illegal.

If a someone in your California church or synagogue is confused about how to do the tax forms for his small business, don't help unless you charge him. You'd be breaking the law.

Heck, by the standards of this law it is illegal to drive your own daughter to her babysitting job, unless you charge her. The law doesn't have exceptions for family members.

As R.J. (and T.J.) noted, we have a duty to throw off governments such as this.

It's difficult to imagine who the idiotic lawmakers who voted for this thought they were helping. Do they really presume hordes of Californians are going to persuaded to work for free for multitudes of businesses, unless they think it is worth their while? And if it is worth it to them, then why should government stop them?

Sadly, even if California lawmakers wise up, the story ends unhappily for this winery, which will close this year, thanks to the state of California. And lest you think, good, these people were taking advantage of their volunteers to make money, be aware: This winery did not sell its wine in stores. It served it to visitors. This was a place where people socialized, picked grapes, made wine and had fun.

Until the government we should overthrow said they couldn't.

More news stories here and here.


Health Care IS A Commodity

Rashi Fein, one of the most important people in the development of Medicare and Medicaid, passed away two weeks ago Monday.

Via his obituary, I discovered that he had written the following in the New England Journal of Medicine back in 1982:

A new language is infecting the culture of American medicine. It is the language of the marketplace, of the tradesman, and of the cost accountant. It is a language that depersonalizes both patients and physicians and describes medical care as just another commodity. It is a language that is dangerous.

Unfortunately, Fein’s view has infected much of health care policy in the last 30-plus years.  That type of wrongheaded thinking leads to removing health care from the discipline of market processes and into the control of government.

But the fact is, health care is a commodity.  Health care, like all commodities, is a marketable item produced to satisfy wants or needs.  

Given that, the only question is in what type of system will a commodity be produced and consumed?  Do we want health care to be bought and sold via markets or via government?  

Fein also urged physicians to “be more vigorous spokesmen for the human values in medicine.”  Medical care, he claimed, wasn’t measured just by the number of treatments administered “but also by the amount of comfort, concern, and compassion provided.”

It’s hard to see how treating health care like a commodity is inhumane.  Subjecting health care to markets is what will reduce its cost while improving its quality.  Making health care more affordable and better for everyone is indeed a very humane result.

Finally, Fein complained that physicians had adopted the language of “a narrow economics the emphasizes efficiency more than equity,” and encouraged them to “speak the language that addresses the unfinished agenda of equity and decency in the distribution of health care.”

Clearly Fein favored equity over efficiency.

But to crib a little from Milton Friedman (at 28:09), a system that emphasizes equity over efficiency will end up with neither, while a system that emphasizes efficiency over equity will end up with a good deal of both.

Are there examples of this?  Yes, but that will be tomorrow’s blog post. 


Health Care Odds & Ends

1. Did ObamaCare Increase The Number of Uninsured?  The American Enterprise Institute’s Joe Antos has a great piece on both the recent health insurance surveys from the Center for Disease Control (CDC) and the Census Bureau.  According to Antos the CDC survey “received a great deal of attention [and] said there were 3.8 million fewer uninsured. The other, which was hardly noticed, found that there were 1.3 million more uninsured.”  So why, possibly, did the number of uninsured rise?  The most likely explanation is that of the 4 to 6 million people who lost their insurance last year, about 1 million of those have not bought new insurance. More on this in a later post.  

As for the lack of media coverage of the Census Bureau survey, I’m at a loss to explain it. No, really.

2. Visual Aid.  Phil Kerpen put this image together comparing the 2013 Census Bureau Survey with the one for the first quarter of 2014:

The number of uninsured rose from 13.4 percent to 13.8 percent, which is roughly 1.3 million people.  The 2013 Census Bureau survey is here and the Q1 2014 is here.  

3. Another Reason ObamaCare Is Cancelling Your Plan.  If you don’t understand the concept of “actuarial value,” you should because it can result in the cancellation of your health insurance.  Thankfully, there is this video from the Mercatus Center that explains it all in layman terms:


4. A Rant, But A Pretty Good One.  Bruno Korschek goes through the ObamaCare insured vs. uninsured numbers and then gives an update on some of things that have gone wrong with ObamaCare recently.  If you have some time, give it a look.

5. Something Non-Health Care:  Catfish Crony Capitalism.  The FDA already regulates Catfish, but buried in the 2008 farm bill was a new regulatory program to be carried out by the USDA.  As the Daily Signal reports:

The program actually is a protectionist scheme for domestic catfish farmers. Foreign exporters won’t be able to sell their catfish that Americans already consume until the USDA works with other countries to establish an equivalent regulatory system. This could take several years, assuming other countries even decide to move forward with such a system.


ObamaCare's ACOs Saving Medicare A Pittance

Accountable Care Organizations (ACOs) are supposed to be one of the great innovations in ObamaCare that will save money for Medicare and improve quality for beneficiaries.  There are two ACO programs under Medicare, the Pioneer Program and the Medicare Shared Savings Programs (MSSP).  Under these programs, ACOs that generate enough savings for Medicare also get to share in some of the savings.  Thus far, 360 medical organizations have signed up to be ACOs covering about 5.6 million beneficiaries.

Last week the Department of Health and Human Services released the results for 23 Pioneer ACOs and 220 MMSP ACOs, and despite the triumphant tone of the press release, the results are underwhelming.  These ACOs “generated over $372 million in total program savings,” according to the release.  That seems like a lot of money, but it’s a pittance when compared to Medicare’s total $492 billion budget in 2013.  $372 million is about .08 percent of that.

It isn’t much better if we assume that ACOs would generate that same rate of savings even if all beneficiaries were in an ACO.  There are about 4.1 million beneficiaries* in the 23 Pioneer and 220 MMSP ACOc.  If $372 million in savings is generated for 4.1 million beneficiaries, then a rough calculation shows that $4.7 billion in savings would be generated if all 52.3 million Medicare beneficiaries were in an ACO.  That’s about one percent of Medicare’s total budget.  

Then there is the question of whether future ACOs would save at the same rate of the current ACOs.  It’s possible that the organizations that entered the program early did so because they figured they had the right patient mix needed to generate savings.  If that’s the case, then ACOs that join later might not generate much savings.

Regardless, it’s unlikely that one percent in savings is going to make much of a dent in Medicare’s $37.4 trillion unfunded liability.

*Here is how I determined that there are 4.1 million beneficiaries in the 23 Pioneer and 220 MSSP ACOs (actually, HHS determined it for me—thanks for the help.)  Anyway, there are 5.6 million total beneficiaries in ACOs.  To get the total number of enrollees in Pioneer ACOs, subtract the total number of enrollees in ACOs, 5.6 million, from the number in the MSSP ACOs, 4.9 million, which equals 700,000.

Next, there are 338 MSSP ACOs in total.  118 of those began earlier this year, and enrolled 1.5 million.  So, the number in the other 220 MSSP ACOs are 4.9 million – 1.5 million which equals 3.4 million.  And 3.4 million plus 700,000 is 4.1 million.


How Many Are Still Enrolled In The ObamaCare Exchanges? People Who Care About The Truth Would Like To Know

Here is one of my not-so-good predictions:

[Various] factors will cause the eight million figure [of enrollees in the ObamaCare exchanges] to be revised downward as the year goes on.

Each time that happens in the coming months, the media will hark back to the President’s victory dance.  For a public that doesn’t much trust Obama on health care, each revision will likely erode that trust a little further.  They will also provide his political opponents with more opportunities to claim Obamacare isn’t working as well as the President claimed.


Unfortunately, I didn’t count on the Obama Administration stopping the enrollment reports once the open enrollment period was over.  And I don’t really have any excuse since I had previously noticed how fast-and-loose the Administration had played with the data.  It makes perfect sense, though, since it allows ObamaCare supporters and other assorted nitwits to continue using the 8 million enrolled as a talking point through November:

But yesterday we learned from the Administration that enrollment is down to 7.3 million. According to The Hill, the 7.3 million enrollees “reflect those who had paid their premiums through Aug. 15.”

But is it really 7.3 million?  The first reason to be skeptical is the folks in the Administration have always used a slippery definition of enrollee.  During the open enrollment period, they defined enrollee as someone who had signed up for a health insurance plan, while insurance companies didn’t count someone as an enrollee until the first premium had been paid.  The Administration’s definition, of course, let it inflate the numbers.

So what definition are they using this time?  Since enrollees aren’t dropped until they have failed to pay their premiums for three consecutive months, does paid through Aug. 15 really mean that it also includes people who last paid on June 15?  Who knows?

Another reason to be skeptical:  In August, Jed Graham of Investor’s Business Daily reported that Aetna, the “nation’s third-largest health insurer[,] had 720,000 people sign up for exchange coverage as of May 20, a spokesman confirmed to IBD. At the end of June, it had fewer than 600,000 paying customers.” 

So, of the 700,000 who have dropped out of the exchanges, 120,000 of them—17 percent—are accounted for by one company?  That dog won’t hunt.  Either the Administration is playing with the numbers or Graham got it wrong.  Since I worked with Graham at IBD for over four years and will gladly vouch for his integrity and competence, my money is on the Administration.

Finally, the drop of 700,000 does not yet include the 115,000 exchange “enrollees” who have not yet confirmed their immigration status nor the 360,000 who have received subsidies but have not confirmed their income. This is not a criticism of the Administration since these people still have until the end of this month to get the requisite information to the government.  We don’t yet know how many of those people will end up losing or dropping coverage.

But we can guess as to when the Administration will tell how much those factors impacted enrollment.  If the number is in the 50,000 range, they will release it in mid-October.  If it is 250,000 or more, the best bet is after the November election.


Until Now, I've Been Sneezing In My Hands And Touching Every Doorknob I Could Find

Thanks goodness for our elected officials!  Without them, we’d be so much more unsanitary!

At a press conference yesterday, Senator Dean Heller (R-NV) and Majority Leader Harry Reid (D-NV) reminded us to wash our hands.

“It’s amazing how such a small thing can make such a big difference,” Senator Heller said.

Yes it is!  I’m sorry that my mom never told me to do that.

Senator Reid added his two cents: “The fact is, simply washing your hands can cut down the transmission of flu, for example, by 50 percent. If you wash with water, it’s better than nothing, but it’s not as good as if you have soap.”

With soap?!  Ah, now I get it.

With all of the annoying distractions that Senators face, like the massive deficit, sluggish economy, unaffordable entitlements and a president who has made a mess of foreign policy, just to name a few, it’s good to see that they have time to spend on really pressing matters like informing the great unwashed about proper hygiene.

I also have to wonder if those evil Koch brothers intentionally DON’T wash their hands.  I’m sure Senator Reid will let us know soon.


Meet Pam Hopmann--ObamaCare Made Her Coverage Worse

I followed up my study on the quality of policies on the ObamaCare exchanges with an op-ed in RARE.  It began with the story of Pam Hopmann:

Like millions of Americans, Pam Hopmann of Chesterfield, Missouri received a notice cancelling her insurance in September 2013. Her experience after that is a textbook example of the problems caused by Obamacare late last year.

“My husband and I started trying to sign up for insurance on the exchange,” she said of her experience in getting a new plan, “but we never got through. We ended up using an insurance agent.”

Then came the rate shock. The plan she chose had a higher premium—$544 per month versus $400 for her old plan. Her new plan also required more cost-sharing. Her old plan had a deductible of $1,000; the new one had a deductible of $1,750.

She would soon experience the phenomenon that became known as the “skinny network.”

“In the fall of 2013 I started receiving letters from my physicians, including my ob/gyn and cardiologist, saying that they wouldn’t be taking insurance on the exchange because the reimbursement rates were too low,” Pam said.

“I just really feel like it was shoved down our throats—like I had no choice. Obama said we could keep our plans and keep our doctors, and I couldn’t do either of those. I think that’s wrong because if you had something you liked, you should have been able to stick with it.”

Despite the claims of some the law’s supporters, there are real people who suffer because of ObamaCare.

Read the entire op-e here.  More on Mrs. Hopmann in the study.



ObamaCare Has Harmed The Quality Of Insurance

Most of you remember late last year when millions of people were losing their insurance plans in the individual market.  At the time, many ObamaCare apologists, including the president himself, tried to excuse the cancellations by saying that the health plans that people were losing were “substandard.”  MSNBC host Ed Schultz referred to the lost plans as “crappy” but only because he couldn’t “use the S-word.” 

However, ObamaCare supporters never produced a shred of evidence that plans in the individual market in 2013 were inferior in quality to the plans on the ObamaCare exchanges.  The study we are releasing today shows that plans on the ObamaCare exchanges are in fact inferior in quality when compared to the plans on the individual market via and

Entitled “Despite ObamaCare Supporters’ Claims, Health Insurance Plans Prior to ObamaCare Exchanges Were Neither ‘Crappy’ Nor ‘Substandard, it compared the cost-sharing — i.e., the deductibles and the out-of-pocket maximums — of plans on the individual market in 2013 and on the ObamaCare exchanges in ten major metropolitan areas for a 27-year-old single person and a 57-year-old couple. It also examined the provider networks, comparing the number of health maintenance organization (HMO) plans to preferred provider organizations (PPO) plans in the individual markets and ObamaCare exchanges.  

Here are the highlights:

  • There was an average of 33 plans in each area for a 27-year-old on the individual market that had lower premiums and lower or equal deductibles and out-of-pocket maximums than the cheapest plans on the ObamaCare exchanges. Milwaukee, Wisconsin had the most such plans with an average of 68.

  • For a 57-year-old couple there was an average of 10 policies in each area that had lower premiums and lower or equal cost-sharing in the 2013 individual market than the cheapest plans on the ObamaCare exchanges. Louisville, Kentucky had the most with an average of 26. 

  • The ObamaCare exchanges had many more of the restrictive HMO networks in their plans relative to the individual market, an average of 16 more HMO plans for both 27-year-olds and 57-year-olds.

  • The less restrictive PPOs were more common in the individual markets, with an average of 32 more plans with PPOs for 27-year-olds and 25 more for 57-year-olds.

While “quality” is often a very subjective concept, this study focused on cost-sharing and provider networks because they are the least subjective dimensions of quality of health insurance plans. Regarding the relationship of the premium to the deductible and out-of-pocket maximum, few people, if any, would consider it good value for the money to change to a policy with a higher premium and a higher deductible and out-of-pocket maximum than a policy they previously owned. In other words, looking solely at the aspect of premium relative to out-of-pocket costs, almost no one would rationally consider it an improvement in quality to pay a higher premium and get less out-of-pocket coverage. 

The quality of the network of physicians, hospitals and other health care providers available through an insurance plan is a bit more subjective.  While HMOs are more restrictive than PPOs, there are HMOs like Kaiser Permanente and Group Health Cooperative that get high marks from consumers. Nevertheless, data from the employer-based market shows that people tend to prefer less restrictive networks. The Kaiser Family Foundation shows that at the height of HMO coverage in 1996, about 31 percent of employees with employer-provided health insurance were in an HMO plan. By 2013, that had dropped to 14 percent. At the same time, PPOs grew from 28 percent to 57 percent of covered employees. Based on actual consumer choice, most of those consumers appear to consider the less restrictive networks of PPOs to be higher quality than HMOs. 

Unfortunately, as this study demonstrates, quality has declined in these areas in the plans on the ObamaCare exchanges.  This is due to the regulations that ObamaCare places on exchange plans, such as the benefit mandates.  Those regulations cause premiums to increase.  To keep premiums anywhere close to reasonable on the exchanges, insurers had to skimp on cost-sharing and provider networks.

There is nothing wrong with doing that—provided that’s what consumers want.  Yet consumers no longer get to make that choice. They no longer have the option of foregoing some benefits for lower out-of-pocket costs and broader networks.

So, not only has ObamaCare reduce insurance quality, it has reduced our choices as well.


Thank you, Oklahoma Daily, for Sowing Discord and Inaccuracy

RacistBraUnderwearLingerieDFC AMR

How much whining should the world have to put up with?

This article, by the editorial board of the Oklahoma Daily, complains that calling a bra's color "nude" is "racist."

Please, people. In other countries, children are being buried alive by Islamist radicals, starved to death by North Korean's evil dictatorship, dying of curable diseases because of ignorance and superstition, married off in childhood to ancient putrid lechers -- we all know I could go on and on.

If this rises to the level of a problem in your life, get on your knees and thank God for your good fortune.

Furthermore, Oklahoma Daily: Lazy reporting is inexcusable. As a commentator to your own article had to point out for you, "nude" bras are called "nude" because they can't be seen through light-colored shirts. This is true regardless of the skin tone of the woman.

As the commentator said:

As someone who used to work in a high end lingerie store, let me explain to you the point of a nude bra. It's really quite simple and has absolutely nothing to do with skin color. A nude bra is made in a light beige color because it's the only color that won't show through a lightly colored shirt. A white bra, for example, will show through a white shirt, so of course a dark colored bra would show through a white shirt. I sold nude bras to women of every skin color, because they understand the purpose of owning one. A nude bra is simply about making sure a woman's outfit is what's on display, rather than her undergarments.

The example of "racism" was ridiculous even if it had been true, and it wasn't even true.

Another banner day for the nation's media, sowing discord and inaccuracy and making the world a worse place than it found it.


Never Forget

Today is the 13th Anniversary.


Tribute here.


Project 21's Kevin Martin: "The Strategy Laid Out by the President is Nothing New"

Kevin Martin

Project 21's Kevin Martin has some strong thoughts about President Obama's ISIS speech tonight:

The strategy laid out by the President is nothing new outside the application of United States air power.

President Obama and former Secretary of State Hillary Clinton, Senators McCain and Graham were advocates of arming so-called 'moderate Muslims' inside Syria back in 2010 over the objections of conservative voices, who factually stated that there more radical elements within the opposition forces to Syrian President Bashar al-Assad. These radical elements were allowed to gain power and influence within the opposition before breaking with them and forming what we know as ISIS today.

I find it difficult to accept the President's plan to arm these so-called moderate forces when it failed the first time and produced ISIS, a group of radicals that now have nearly a billion dollars in assets. These assets include military equipment looted from the governments of both Syria and Iraq, including heavy weapons, MANPADS and aircraft. This makes the policy of limited airstrikes inside Syria a difficult task.

As a veteran, I find it most difficult to support the President's strategy of arming these supposed moderates in light of the fact that the White House cannot confirm if these same moderate forces within Syria sold American Journalist Steven Sotloff to the forces of ISIS that later beheaded him.

It is time for the President to go before the American people and Congress to put forth a real strategy that completely destroys ISIS and does not create another Son of Al-Qaeda by contracting out our national security to so-called 'moderates.'

Kevin Martin is a member of the National Advisory Council of the Project 21 black leadership network. An environmental contractor in the Washington-Baltimore area and a long-time public policy commentator, Kevin frequently appears on the Fox News Channel and typically is interviewed by radio talk shows over 70 times each year on behalf of Project 21.


Great Moments In Single-Payer Health Care

1. Will It Be A Best Seller? Angela Johnson, president of Medical Confidence, Inc., has just released a new book entitled “Step by Step Guide to Navigating your way through Canada’s Health Care System and Minimizing Your Wait Time.”  The press release states that the book is “a first of its kind and must read for Canadians, providing them with 14 valuable tips to overcome these issues and minimize their wait times.”  I wonder if the book instructs patients to go to this website for British Columbia that enables people to see wait times for surgery by clicking on a body part?

2. The Psychiatrist Will Not See You Soon.  In Canada’s capital, Ottawa, “1,195 children and youth are waiting for mental health outpatient and outreach services at CHEO and the Royal, up 10 per cent from 1,082 a year ago,” according to an article in the Ottawa Citizen.  The wait time for mental health treatment could be up to a year.  Young people are recommended to plan their bouts of depression in advance.

3. A Cancerous System.  Britain’s National Health Service (NHS) recommends that no cancer patient should wait more than 62 days to start treatment.  Yet the Daily Mail reports just over 9,900 British cancer patients waited longer than that in the first six months of 2014.  It would be interesting to know just where the NHS came up with the 62 day standard, because the longer one waits for treatment, the odds increase that the cancer will recur.  According to an article in the journal Radiotherapy and Oncology, for breat cancer there is an “increase in the risk of recurrence of 1.0% per month of delay” and for head and neck cancer there is an “increase in the risk of recurrence of 3.7% per month of delay” (p. 12).

4. Records Are Made To Be Broken! The Daily Mail reported last month that the “number of patients languishing on NHS waiting lists for operations is at its highest for six years…There are 3.2 million people awaiting surgery – a rise of 700,000 compared with 2010.”  Not only are there 3.2 million people on the wait list for surgery, 809,000 patients were waiting for a diagnostic test and 15,600 operations were cancelled at the last minute in the second quarter of 2014. To top it off, these numbers may be an undercount due to errors and incomplete records.


9 + 6 = Our Friend '10' Because 6 Is 1 + 5 And If You Take The 1 And Add It To 9 You Get 10 And Then Add In That 5 = 15

Is that headline a wee bit confusing?  Welcome to Common Core math!  Enjoy the decline of our education system:

Hat tip:


Opponents of E-Cigarettes "Neo-Puritan" in Refusing Science and Logic

Despite a being a “boon” to public health that has won the approval of many health experts as a means of “reduc[ing] the harm from smoking,” there are still “entrenched” nanny state activists acting in a “neo-puritan” fashion who refuse to accept science or logic showing that e-cigarettes are a viable tool in helping people quit using tobacco.

On the 8/29/14 edition of “Byline” on Canada’s Sun News Network, National Center Risk Analysis Division director Jeff Stier bluntly said the “nanny state is focused on controlling how we live.”  He added that the opposition to e-cigarettes as an alternative to cigarettes and other tobacco products have changed the terms of their crusade from “improv[ing] public health” to “reducing dependence on nicotine.”  In particular, the United Nation’s World Health Organization is calling for a ban on the use of e-cigarettes indoors — at least until more research can be done on e-cigarette vapor.

On the issue of international control of e-cigarettes, Jeff said the U.N. agency is “kind of running the show now” because 168 countries have signed onto an international treaty governing tobacco control and are thus obligated to “implement[ing] the rules” that the WHO hands out.


"American People Expect" Obama to Work with Congress on Illegal Immigration

Project 21 co-chairman Horace Cooper says the only way to defuse the current immigration crisis is for the “White House and Congress to come together” and “work collaboratively” to achieve a solution.  This is opposed to President Obama’s threat to use his executive power to unilaterally declare amnesty or something similar that will change the status of possibly millions of illegal aliens residing in the United States.

On internationally-broadcast Voice of America television on 8/30/14, Horace reminded views:

That’s the process the founders intended.  That’s what the American people expect.  And that’s the normal way to proceed…


Obama Employment Numbers Lackluster, Underperforming

Vacation is over — it’s time for the President to get back to work.

And it’s all uphill for President Obama.  Abroad, he openly revealed he has no strategy on dealing with the growing problem of ISIS (but didn’t he announce the terrorists were on their heels back in 2012?) and he seems powerless to stop Putin’s march on Ukraine.  At home, he is beset by scandal, a “humanitarian situation” along our southern border and an economy that he just can’t seem to turn around.

Today’s jobs report news doesn’t help.  The official unemployment rate fell slightly to 6.1 percent, but only 142,000 jobs were reportedly created.  Experts were deflated, as they were looking for at least 75,000 more jobs to be created.  And the total unemployment rate — the one that includes the underemployed and disengaged — was still almost double the rate that gets the headlines at 12 percent.

As he does every month, Project 21 member Derryck Green provides his analysis of the jobless statistics in particular and the state of the Obama economy in general.

To follow is this month’s installment of Derryck Green’s “About Those Jobs Numbers” as reported for August of 2014:

Listening to the President’s speech at the Milwaukee Laborfest earlier this week, it’s clear that he would have the nation believe the economy is booming — or, at the very least, it is strong enough to give Americans more confidence in his stewardship.

Among other things, Obama bragged that his administration created around ten million jobs and that the country is stronger because Americans now have “quality, affordable health insurance that [we] can count on.”  He also claimed that, because of his economic policies, the American economy is stronger now than when he took office back in 2009.

But, also according to Obama, the main reason more people don’t realize how well the economy is doing is because of the media.  The media!  Yes, he’s talking about the same media that has effectively defended his poor economic policies and appears to have willingly spun the jobs report for him month in and month out no matter how gloomy the details past the official unemployment rate have been over the years.  It is now apparently at fault, however, for not spinning more economic news in his favor.

Unfortunately for the President, the actual jobs numbers and other economic indicators paint a much different and less optimistic picture of the economy under his leadership — regardless of good or bad media input.

The initial estimate of the second-quarter GDP growth rate of four percent was revised upwards to 4.2 percent.  Now that does seem like good news considering that the first quarter contracted by 2.1 percent.  But, when averaged with the first quarter, the economy has grown slightly – to above one percent.

As for jobs numbers, payroll processor ADP estimated 204,000 jobs were added in August.  Though down from the previous month’s job additions, August was the seventh month that private job creation exceeded 200,000.  The federal Bureau of Labor Statistics, the President’s job-counter, says there were a scant 145,000 jobs created last month.  So much for that streak.  Digging deeper into their report, the number of people stuck in part-time employment is 7.3 million (down 200,000), while those Americans out of the labor force altogether rose from 741,000 to 775,000.

In August, the national unemployment rate did go down ever so slightly to 6.1 percent.  That is the official unemployment rate — the rate that’s reported by the allegedly biased media.  The U-6 rate, the more accurate indicator of unemployment — which includes discouraged workers, workers marginally attached to the labor force and those working part-time but prefer full-time work — is 12 percent.  This is yet another month in which the U-6 rate has been at or above 12 percent.

Then there are the broken dreams of the President’s core constituencies.

The unemployment rate for blacks remained steady at 11.4 percent, while black teenage unemployment was extremely high at 32.8 percent.   The unemployment rate for the coveted Latino demographic fell slightly to 7.5 percent

The labor force participation rate for all Americans went slightly further down (and that’s not a good decline) to 62.8 percent.

But that’s not all the recent news.

Other economic indicators show:

  • Every month for the last 36 months, according to the U.S. Department of Agriculture, at least 45 million Americans have been enrolled to receive food stamps (the Supplemental Nutrition Assistance Program).  In May 2014, the last month in which the data is known, more than 46 million people received food stamps.
  • The Bureau of the Fiscal Service’s Monthly Treasury Report, 2013 saw over $2 trillion in benefits and entitlements paid out by the federal government.   Almost 70 percent of this amount was paid out in non-means tested programs.  This is program eligibility that isn’t tied to income.
  • According to Census Bureau data, more than a third of Americans are receiving some form of government assistance.
  • Data recently released by Sentier Research shows that the median household income is more than three percent lower now than it was when the recession was declared over in June 2009.   It is almost five percent lower than it was in December, 2007.
  • The Pew Charitable Trust shows that no state in America could claim employment gains between 2007 and 2014.
  • The Congressional Budget Office recently revised an April 2014 report on the potential effects of ObamaCare on the economy over the next ten years.  Not only does the CBO project a smaller labor force participation rate than pre-recession levels, but it expects the labor force participation rate to be further reduced because ObamaCare subsidies are tied to income.  After a certain level (400 percent of the federal poverty level), the higher the income means the fewer subsidies that are available for increasing premiums — a clear incentive not to work.

With statistics like these, it’s no wonder why the majority of Americans — 54 percent — are disappointed in the job President Obama is doing on the economy.  Then again, he is “doing a job” on the economy!  It’s also no surprise that almost half of Americans — 49 percent — think the economy is still in recession.

But, according to Obama, this isn’t the real news to pay attention to.  This is just stuff brought up by a media that doesn’t have his best interest, or the best interest of the nation in mind.


Don’t Talk About Race

In a recent New Visions Commentary, my colleague Demetrius Minor addressed the need for increased dialogue regarding racial issues. 

To wit, he wrote: “Because of the hypersensitivity to which our world has succumbed, race is a frightening or taboo subject for many.  Nonetheless, we should all talk about it.” 

I would add alter his last sentence to read, “[n]onetheless, we should all [be able] to talk about it.”

I would advise many Americans to avoid talking about race at all costs.  Doing otherwise may place their livelihoods in jeopardy.  But corporate America could go a long way to fixing this problem.   

One logical place to have earnest discussions about race is at work.  Indeed, President Obama suggested in a 2010 speech that: 

We should all make more of an effort to discuss with one another, in a truthful and mature and responsible way, the divides that still exist — the discrimination that’s still out there, the prejudices that still hold us back — a discussion that needs to take place not on cable TV, not just through a bunch of academic symposia or fancy commissions or panels, not through political posturing, but around kitchen tables, and water coolers (emphasis added).

But having a water cooler discussion about race is currently a dangerous proposition for many public and private sector employees that is fraught with the specter of demotion or even firing. 

As law professor Eugene Volokh noted after President Obama’s 2010 speech: 

I certainly agree that it would be good for people to discuss racial issues in a truthful, mature, and responsible way.  But I’m pretty sure that discussing such issues around “water coolers” is pretty dangerous advice, at least if one really wants a discussion in which people aren’t afraid to air their views. 

To begin with, any arguments that some might see as racist could lead to complaints and even lawsuits about a supposedly “racially hostile work environment”; and while such lawsuits are hard for plaintiffs to win, no employer wants to have to fight them, and no employee should want to have his speech be the subject of such suits.

The legal standards at play here are very vague, giving the arbiter of such complaints (be it a judge, jury or mediator) tremendous latitude in interpreting the offending party’s speech.  But the problem is that employees should also be wary of what they say and do outside of the workplace – even if it is constitutionally-protected speech.  

Only about half of American workers live in a jurisdiction that provides statutory protection against employer retaliation for engaging in First Amendment activities.  And some of these laws are weaker than others.  Furthermore, many corporations do not offer this protection as a condition of employment.  

Racial discussions can be fraught with peril for workers.  Whether at the water cooler or not, consider the following:  

  • Are you against affirmative action on the grounds that it discriminates against whites and Asians?  You might be deemed a racist. 
  • Are you white and think you can talk about inner-city violence?  You might be deemed a racist. 
  • Do you support common sense voter protection measures such as voter identification laws?  You might be deemed a racist. 
  • Do you support the presumption of innocence for criminal defendants as well as for police officers accused of a crime?  You might be deemed a racist
  • Do you think it is a tragedy that black babies are aborted at a higher rate than other babies?  You might be deemed a racist (and also hostile to women).  
  • Do you think it is unseemly for President Obama to interject himself into local matters such as the arrest of a black Harvard professor, the mess in Ferguson, Missouri or Trayvon Martin’s death?  You might be deemed a racist. 

That last example isn’t theoretical.  It happened, and an employee was demoted because of it. 

In the very recent case of DeMay v. Richmond County Dep’t of Social Servs., 2014 WL 4206296 (N.C. Office of Admin. Hearings), an individual was demoted because of comments she made during a staff meeting.  

Again, the indelible Eugene Volokh has culled the important facts of the case, which are available here.  But, essentially, the employee – who was a governmental employee in a supervisory role – during a break in a staff meeting, read a Facebook post aloud so her fellow employees could hear.   Written from the imagined vantage point of a white, 13-month old baby who had been murdered, the post said, among other things: 

My family made the mistake of being white in a 73% non-white neighborhood, but my murder was not ruled a Hate Crime.  Nor did President Obama take so much as a single moment to acknowledge my murder.

President Obama has no children who could possibly look like me — so he doesn’t care and the media doesn’t care because my story is not interesting enough to bring them ratings.

So while you are seeking justice for Trayvon, please remember to seek justice for me too. Tell your friends about me, tell you [sic] families, get tee shirts with my face on them and make the world pay attention, just like you did with Trayvon.  

From the discussion of the office’s rules for personal conduct, it is clear that the employee broke plenty of protocols for both using her phone and Facebook in inappropriate manners.  Also, government employers have the latitude to restrict speech that injures morale – as the employee’s actions arguable did here.  So her demotion on those grounds appears perfectly reasonable.  However, the disposition of the case presents potentially troubling precedent for other workers. 

That’s because the decision also said that the employee created a “hostile work environment.”  

As Professor Volokh explains, 

in the hearing officer’s opinion, this sort of “racially and politically provocative” speech would be legally actionable even if it was said in a private workplace, even when the employer itself had no desire to restrict it.  That would not be justifiable under the special rules applicable to the government acting as employer.  That would be the government restricting political speech even on private property, based on its content and viewpoint.

And while this case involved speech said by a supervisor in a mandatory meeting, hostile environment harassment law can likewise impose massive liability based on speech by co-workers, and speech outside such mandatory meetings.  To be sure, it’s less likely that co-worker speech or speech in the lunchroom or around the water cooler would be found to be actionable by itself.  But, as I argue here, harassment law inherently pressures employers to restrict even such individual instances of speech.

This is a bridge too far.  Hostile work environment (harassment) laws are often decidedly vague and, in many instances, likely unconstitutionally contravene the First Amendment.  

Certainly, actual instances of hostility and harassment should be swiftly and judiciously handled.  But having a frank discussion about race should not fit into that category. Yet, as racial agitators stir tensions and decide the parameters of corporate America’s acceptable group think, there will likely be more cases like this in the future, not less.  


Did George W. Bush Deregulate?  No.

One of the other points of contention between Ben Cohen and myself on Thom Hartmann’s show the other night was whether President George W. Bush deregulated. Cohen claimed there was a “massive binge of deregulation” under Bush. When I insisted there wasn’t, Cohen replied, “Just saying there wasn’t doesn’t make it so.”  (The discussion starts at about 35:20, below.)

No, my saying it doesn’t make it so.  But the evidence does:


The first figure shows the accumulation over time of restrictive words in the Federal Register such as “shall,” “must,” or “required.”  The year before Bush became president, there were 856,209 such words.  In his last year of 2008 there appears to be about 960,000, an increase of over 100,000.

The second shows the number of pages in the Code of Federal Regulations. I’m eyeballing it here, but it appears there were about 130,000 pages in 2000 and 150,000 in 2008.  Regardless, it’s clear the number of pages and, hence, regulations increased during Bush’s tenure.

(Hat tip, James Pethokoukis.) 

Further, Bush’s regulations may have been more costly than his predecessors.  A few years ago Veronique de Rugy claimed that, while the number of new rules from the Bush Administration had slowed, 

the new regulations’ cost to the economy will be much higher than it was before 2001. Of the new rules, 159 are “economically significant,” meaning they will cost at least $100 million a year. That’s a 10 percent increase in the number of high-cost rules since 2006, and a 70 percent increase since 2001. And at the end of 2007, another 3,882 rules were already at different stages of implementation, 757 of them targeting small businesses.

She also noted, correctly, that “Some people still seem to think Republicans take a hands-off approach to regulation, probably because the party is always quick to criticize the burdens regulations place on businesses. But Republican rhetoric doesn’t always match Republican policy.”

Unfortunately, some people still think that.


Does Britain Have Medical Bankruptcies? Yes.

Score one for this side of the pond!  

Last night I was on Thom Hartmann’s “The Big Picture” with Ben Cohen of the Daily Banter.  Cohen, who is from Great Britain, suggested that I didn’t know how his home country’s single-payer health care system works because I claimed that there were bankruptcies due to medical bills in the U.K.  The exchange begins at about 22:49:

The link I was referring to in that exchange is a report from Britain’s Insolvency Service entitled “Causes of Failure in Bankruptcy and Compulsory Liquidation.” Here’s Table 2 from page 10:

Additionally, a report from the World Health Organization also cites research that “within the United Kingdom, sickness or disability accounted for 5% of households in financial difficulties in 2002.”

The idea that single-payer systems don’t have medical bankruptcies is based on the fact that health care is “free” at the point of service in such systems.  After all, if people don’t have to pay for health care (at least not directly), how could they have a bankruptcy due to medical bills?

For starters, medical bills are not the only way a medical bankruptcy can occur.  For example, if you have an illness that requires a major operation in Britain, you are likely to end up on a long waiting list.  And if the illness renders you unable to work, then the longer you are on the waiting list the more your finances will be strained.

Consider Torron Eeles, a British plumber who broke his upper left arm in a fall. While he waited for an operation, his arm twisted into a … well … just take a look at the photo. As the article stated, Eeles’s arm “twisted out of shape, hangs limply by his side, meaning he cannot work for a living and now faces the prospect of losing his home.”  At one point Eeles had waited 12 months because his operation had been cancelled four times. He called the wait “disgusting” and said “I wish I’d had the money to go private.”  I can’t find any information on how long Eeles had to wait for an operation or how precarious his finances became, but it’s not hard to see how a situation like his could result in bankruptcy.

Eeles is far from alone.  Britain’s National Health Service estimates that, as of June, at least 3 million patients were waiting for treatments such as surgery, while over 15,600 operations were cancelled at the last minute in the second quarter of 2014.  Another 809,000 patients were waiting for a diagnostic test. With so many people waiting for care, and some of those people unable to work because of it, some bankruptcies are inevitable.

It’s a myth that there are no medical bankruptcies in single-payer systems.  But as Ben Cohen showed, such myths die hard.

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