Monday, July 24, 2017

Cruising the Web

Avik Roy reports that nearly three-quarters of the losses in coverage under the Republicans' health care proposals comes from repealing the individual mandate. In other words, if people weren't required to buy health insurance, the CBO estimates that around 16 million people wouldn't be buying it. The CBO bases that number on an estimate of what would happen if the individual mandate were repealed and nothing else was done.
And there’s a more fundamental question: if Obamacare’s insurance is so wonderful, why do millions of Americans need to be forced to buy it? By definition, you haven’t been “kicked off” your insurance if the only reason you’re no longer buying it is that the government has stopped fining you.
Suspiciously, the CBO isn't making it public what is the basis of their estimates.
You’d think that, but CBO has refused to disclose that breakdown. The end result is a lot of misleading commentary about how Republican plans “take coverage away” from 22 million people.

This week, I obtained from a congressional staffer the CBO’s estimates of the coverage impact of repealing the individual mandate, separate from the Senate bill’s other provisions. The estimate was built out of earlier work CBO did to model how repealing the mandate would affect the federal deficit. CBO projected then that repealing the mandate alone would lead to 15 million fewer insured U.S. residents in 2018, and 16 million fewer by 2026, though they did not publish those estimates.

16 million represents nearly three-fourths of the CBO’s estimate of the coverage difference between the GOP bills and Obamacare in 2026. That’s despite the fact that, as I noted in March, even Jonathan Gruber—one of Obamacare’s most famous advocates—believes Obamacare’s individual mandate is having little effect. In a 2016 article for the New England Journal of Medicine, Gruber and two co-authors wrote, "When we assessed the mandate’s detailed provisions, which include income-based penalties for lacking coverage and various specific exemptions from those penalties, we did not find that overall coverage rates responded to these aspects of the law.”
It does seem interesting that the CBO doesn't want to make public the basis for their analysis. If the purpose of the CBO is to help lawmakers, wouldn't lawmakers be interested in knowing what needs to be changed in order to insure more people?

And, as Roy points out, the rest of the CBO's analysis is also built on a flawed analysis.
To be clear, even if one excludes the CBO’s exaggerated view of the impact of the individual mandate, CBO scores the Senate bill as covering 6 million fewer people than Obamacare in 2026: 2 percent of the U.S. population. But even that number can be partially explained by CBO’s outdated March 2016 baseline, which assumes that enrollment in Obamacare’s exchanges peaks out at 19 million, when it’s more likely to end up below 9 million, if Obamacare stays on the books and premiums continue to rise. (That's the difference between the red and green curves in the above chart.)

Even if we assume that half the difference between the March 2016 exchange enrollment projections and the real world is accounted for by the exaggerated mandate effect, the net result is that the CBO’s projection of the difference in health coverage under Obamacare and the GOP bill—the pink bars in the below chart—amounts to statistical noise. (See the article for his graph.)
These are not inconsequential points. The Democrats have been able to fling about the accusation that the GOP plans would throw 22-23 million of people out of health care. Nowhere do they acknowledge that 16 million of those people are those who voluntarily choose not to buy insurance and almost all the result is built on a false baseline number. But those accusations are powerful, because few people know the reality. And the accusations have been strong enough to frighten GOP moderates.
The CBO’s love affair with the individual mandate is the reason why there’s really nothing Republican senators can do to improve the CBO’s coverage score of their bill. It doesn’t matter how much money Republicans throw at the problem; if you don’t have an individual mandate, CBO assumes 16 million fewer people will have coverage right off the bat. It doesn't matter if you keep nearly all of Obamacare's spending and most of its taxes, as Sens. Bill Cassidy (La.) and Lindsey Graham (S.C.) propose: CBO assumes 16 million fewer people will have coverage right off the bat.

So, the choice for Republicans is this. Do you support repealing Obamacare's individual mandate, or preserving it? If you support repealing it—whatever other policy details you prefer—the CBO is going to generate misleading headlines about 16 million people being “kicked off” their insurance.

If you support repealing the mandate, you're going to need to surpass those headlines and do what you were elected to do: replace Obamacare with market-based policies that show that patient-centered health reform is better than government-centered health reform.
Yeah, that's not happening. But just inhabit an alternate universe where the President, instead of using up all the political oxygen out there by tweeting at everyone he's ticked at and, instead, was making substantive speeches publicizing these points and defending the GOP efforts instead of throwing around vague statements about how they have a great plan or threatening GOP congressmen publicly for opposing it. Imagine what a Ronald Reagan or even Barack Obama would have done if there were a policy proposal they supported and one of the arguments against it was a skewed CBO analysis. Can't you just picture Reagan making jokes about how the CBO is counting people's voluntary decisions as actual losses. Reagan would be bringing up people to the podium to talk about why they wouldn't buy insurance without the mandate. Obama would go around making speeches every few days in support of the bill and talking about those people who would have more choice and freedom under the bill. Not that Obama was ever worried about choice and freedom under the health care bill. But the point is that they would have been in the arena. All throughout the campaign, Trump supporters would be touting his candidacy because "He fights." But it turns out that all he fights for is himself, not any particular policy or goal.

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Matt Lewis reminds us how American politics has often been ugly. The insults, however, have been more erudite.
We might lament negative campaigning and the lack of civility in politics, but during the election of 1800, Thomas Jefferson’s supporters referred to President John Adams as a "hideous hermaphroditical character, which has neither the force and firmness of a man, nor the gentleness and sensibility of a woman." Meanwhile, backers of Adams called Vice President Jefferson "a mean-spirited, low-lived fellow, the son of a half-breed Indian squaw, sired by a Virginia mulatto father."

This makes “Low Energy Jeb” and “Lyin’ Ted” sound tame.

Teddy Roosevelt publicly excoriated his successor William Howard Taft as a “puzzlewit” and a “fathead.” Taft blasted his former mentor and friend as a “honeyfugler,” “demagogue,” and “hypocrite.” Warren Harding compared Roosevelt to Aaron Burr (“the same overbearing disposition and ungovernable temper [as Burr], the same ruthlessness… the same tendency to bully and browbeat”). He condemned Roosevelt as “utterly without conscience and regard for truth, the greatest fakir of all times… selfish, intolerant, unstable, violently headstrong, vain and unstably ambitious of power.” Taft, Roosevelt, and Harding were all Republicans. Imagine what they thought about the Democrats....

According to First Amendment scholar Geoffrey Stone's book Perilous Times, free speech has been suppressed “in six historical periods from the Sedition Act of 1798 to the Vietnam War.” Consider JFK famously cancelling the White House’s subscription to the New York Herald-Tribune. Consider the Nixon administration’s criticism of the press, including Vice President Spiro Agnew’s famous line about the “nattering nabobs of negativism.”

....Worried about the rise of crazy bloggers? Consider James Calendar, the infamous scribbler for hire who threw away Hamilton’s shot at the presidency and then flipped on Thomas Jefferson and revealed the Sally Hemings affair. Think the problem is the uptick in anonymous internet trolls? Consider Hamilton, John Jay, and James Madison, who employed pseudonyms for The Federalist Papers.

Don’t like the optics of Trump family members Ivanka Trump and Jared Kushner in the White House? Recall the nepotism charges against John Adams, Ulysses S. Grant, Franklin Roosevelt, and Bill Clinton (just to name a few). Woodrow Wilson’s son-in-law was his Secretary of the Treasury. JFK’s Attorney General was his brother Bobby; his director of the Peace Corps was his brother-in-law Sargent Shriver.
Concerned about allegations that Trump’s team colluded with the Russians? Again, this is nothing new. For liberals, there’s reason to believe that Richard Nixon might have colluded with South Vietnam’s president to stymie LBJ’s peace plan. For conservatives, there’s reason to believe that then-Senator Ted Kennedy tried to work with the Soviets against Ronald Reagan.

Didn’t like the “Lock her up” chants aimed at Hillary Clinton? Woodrow Wilson had Eugene Debs, his presidential competitor, locked up for opposing U.S. entry into World War I. Debs ran again in 1920 from his cell in an Atlanta prison.
Of course, people are so ignorant of history these days so they don't realize that everything old is new again. We survived all these moments; we'll survive Trump.
This is all to say that America has been through a lot in our history—and we have managed to endure.
Granted, it seems that for every oddity in American history that there seems to be a modern Trumpian parallel. Still, we should take solace in America’s colorful history—and I’m just scratching the surface (Lincoln suspended habeas corpus, FDR tried to pack the courts, JFK’s FBI spied on Martin Luther King).

Now this sort of story is enough to make one wonder what sort of education someone needs to be a news host on TV. Joy Reid of MSNBC tweeted this out the other day.

Well, Ivana, the mother of Trump's three older children and his first wife was born in the Czech Republic which is not Slovakia and is not part of Yugoslavia. Hence, the name of the former country as Czechoslovakia. Slovenia, the home of Melania Trump was indeed part of Yugoslavia, but Yugoslavia was never part of the Soviet bloc. If Joy Reid knew anything about the Cold War or Soviet history or Eastern Europe, she should have known that Tito kept Yugoslavia out of the Soviet bloc, much to Stalin's anger.

And then to demonstrate how ignorant she is, Joy Reid doubled down on her ignorance. When someone corrected her that Ivan was from Czechoslovakia, not Slovakia, Reid responded "Melania is from Slovenia (which plus Slovakia used to be Yugoslavia). Er, no. Still wrong. Hasn't this woman heard of Wikipedia? Irony alert - Reid highlights her Twitter page with this quote from James Baldwin: “Ignorance, allied with power, is the most ferocious enemy justice can have.”

I'm not sure why she decided to point out that Trump has had two foreign-born wives. I thought Democrats liked people from other countries. But if you're setting yourself to criticize Trump, the birthplaces of his wives should be so far down on the list that it doesn't even burble up on the Twitterverse.

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David Harsanyi bemoans the diminishing of the freedom of speech as social justice warners are upset that Britain is banning ads that "perpetuate gender stereotypes," but we don't have any such policy here in the U.S.
Why would a feminist — or anyone, for that matter — celebrate the idea of empowering bureaucrats to decide how we talk about gender stereotypes? Because these days, foundational values mean less and less to those who believe hearing something disagreeable is the worst thing that could happen to them.

Sometimes you need a censor, this Jezebel writer points out, because nefarious conglomerates like “Big Yogurt” have been “targeting women for decades.” She — and the British, apparently — don’t believe that women have the capacity to make consumer choices or the inner strength to ignore ads peddling probiotic yogurts.

This is why the U.K. Committee of Advertising Practice (and, boy, it takes a lot of willpower not to use the cliché “Orwellian” to describe a group that hits it on the nose with this kind of ferocity) is such a smart idea. It will ban, among others, commercials in which family members “create a mess, while a woman has sole responsibility for cleaning it up,” ones that suggest that “an activity is inappropriate for a girl because it is stereotypically associated with boys, or vice versa,” and ones in which “a man tries and fails to perform simple parental or household tasks.”

If you believe this kind of thing is the bailiwick of the state, it’s unlikely you have much use for the Constitution. I’m not trying to pick on this one writer. Acceptance of speech restrictions is a growing problem among millennials and Democrats. For them, opaque notions of “fairness” and “tolerance” have risen to overpower freedom of expression in importance.

You can see it with TV personalities like Chris Cuomo, former Democratic-party presidential hopeful Howard Dean, mayors of big cities, and the U.S. Patent and Trademark Office. It is Senator Dianne Feinstein arguing for hecklers’ vetoes in public-university systems. It’s major political candidates arguing that open discourse gives “aid and comfort” to our enemies....

When I was young, liberals would often offer some iteration of the quote misattributed to Voltaire: “I disapprove of what you say, but I will defend to the death your right to say it.” This was typically in defense of artwork that was offensive to Christians or bourgeoisie types — a soiled painting of Mary, a bad heavy-metal album, whatnot.

You don’t hear much of that today. You’re more likely to hear “I disapprove of what you say, so shut up.” Idealism isn’t found in the notions of enlightenment but in identity and indignation. And if you don’t believe this demand to mollycoddle every notion on the Left portends danger to freedom of expression, you haven’t been paying attention.
Why are people so fragile these days? If an ad is offensive, just don't buy that product. If women think a yogurt ad is demeaning and don't buy it, the company will get the message pretty quickly and change the ad. Why do we need government to step in and protect people from being offended? Why does censorship always seem to be people's go-to solution?

Ah, just what I've always suspected. - those expiration dates on drugs aren't all that definitive.
The box of prescription drugs had been forgotten in a back closet of a retail pharmacy for so long that some of the pills predated the 1969 moon landing. Most were 30 to 40 years past their expiration dates — possibly toxic, probably worthless.

But to Lee Cantrell, who helps run the California Poison Control System, the cache was an opportunity to answer an enduring question about the actual shelf life of drugs: Could these drugs from the bell-bottom era still be potent?

Cantrell called Roy Gerona, a University of California, San Francisco, researcher who specializes in analyzing chemicals. Gerona had grown up in the Philippines and had seen people recover from sickness by taking expired drugs with no apparent ill effects.

“This was very cool,” Gerona says. “Who gets the chance of analyzing drugs that have been in storage for more than 30 years?”

The age of the drugs might have been bizarre, but the question the researchers wanted to answer wasn’t. Pharmacies across the country — in major medical centers and in neighborhood strip malls — routinely toss out tons of scarce and potentially valuable prescription drugs when they hit their expiration dates.

Gerona and Cantrell, a pharmacist and toxicologist, knew that the term “expiration date” was a misnomer. The dates on drug labels are simply the point up to which the Food and Drug Administration and pharmaceutical companies guarantee their effectiveness, typically at two or three years. But the dates don’t necessarily mean they’re ineffective immediately after they “expire” — just that there’s no incentive for drugmakers to study whether they could still be usable.
Having finally gotten around to cleaning out the cupboard with drugs in it and thrown out all sorts of aspirin and cold medicine products because they were way past their expiration dates and my kids were making fun of me. The findings from this story could help prevent millions of dollars in waste at health care facilities around the country.
Cantrell and Gerona knew their findings had big implications. Perhaps no area of health care has provoked as much anger in recent years as prescription drugs. The news media is rife with stories of medications priced out of reach or of shortages of crucial drugs, sometimes because producing them is no longer profitable.

Tossing such drugs when they expire is doubly hard. One pharmacist at Newton-Wellesley Hospital outside Boston says the 240-bed facility is able to return some expired drugs for credit, but had to destroy about $200,000 worth last year. A commentary in the journal Mayo Clinic Proceedings cited similar losses at the nearby Tufts Medical Center. Play that out at hospitals across the country and the tab is significant: about $800 million per year. And that doesn’t include the costs of expired drugs at long-term care pharmacies, retail pharmacies and in consumer medicine cabinets.

After Cantrell and Gerona published their findings in Archives of Internal Medicine in 2012, some readers accused them of being irresponsible and advising patients that it was OK to take expired drugs. Cantrell says they weren’t recommending the use of expired medication, just reviewing the arbitrary way the dates are set.

“Refining our prescription drug dating process could save billions,” he says.

But after a brief burst of attention, the response to their study faded. That raises an even bigger question: If some drugs remain effective well beyond the date on their labels, why hasn’t there been a push to extend their expiration dates?

It turns out that the FDA, the agency that helps set the dates, has long known the shelf life of some drugs can be extended, sometimes by years.

In fact, the federal government has saved a fortune by doing this.
It turns out that the government has been stockpiling huge quantities of drugs and vaccines as a defense in case of some sort of attack or emergency. There is little incentive for drug companies to expand the expiration dates since they benefit from increased sales when people have to buy new stocks of drugs that have supposedly expired. How about the government doing something useful and moving back these expiration dates so people, hospitals, and nursing homes would stop throwing away perfectly good drugs.

This story from Aspen, Colorado is why people hate elected officials
and bureaucrats.
Here in Aspen, our City Council has announced that the taxpayers who decided to elect them are too stupid and lazy to decide properly how to spend their own tax money. Here's the story.

City bureaucrats for years have wanted to spend tens of millions of dollars on lavish new offices. The most recent price tag is over $23 million. This is for a city with a population of only 6,500 people.

Do the math: These nice new offices for the government bureaucracy would cost over $3,000 per resident — or over $12,000 per family of four residents. That's on top of a city budget that exceeds $100 million a year, or about $15,000 per resident and $60,000 per family of four.

Part of the reason the building is so expensive is that they want to put it right in the middle of town, naturally, because that's where the action is. Most of the rest of us can't afford the middle of town because real estate there costs thousands of dollars per square foot. But it's easier if someone else is paying for it.

Just to make sure this monument to themselves is sufficiently monumental, it will rise to 46 feet in an area where other development is capped at 28 feet in order to preserve the mountain views. Obscuring the view is evidently OK if the rule-makers do the obscuring.
The Aspen City Council didn't want to put the plan to a vote because they knew that people might vote down because they just don't like taxing and spending and the Council knows better. Gosh, don't you hate it when hoi polloi want to block the plans of their betters?

John Hinderaker points to a revealing example of a headline from the Associated Press. This was the headline: “3 Palestinians, 3 Israelis killed in violence over holy site.” Actually, a Palestinian snuck into an Israeli house on the Westbank and stabbed two men and a woman having dinner. THen several thousand Palestinians rioted in Jerusalem and the Westbank throwing Molotov cocktails and other missiles at the security forces. Three people died in those riots. But for the AP headline writer, these six deaths are equivalent.

And this was the response of the leader of Hamas to the murder of the three Israelis.

And people wonder why Israel won't go to the peace table with Hamas.

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Ah, ESPN telling readers what they really needed to know: "Where do athletes go when they need to go?"