Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts

Thursday, October 1, 2015

Does Immigration Make US Healthier?

There are two common barriers cited in discussing what prevents Americans from eating healthier: cost, and convenience. This issue takes an interesting twist in the face of immigration reform and who is allowed to work in the United States. It's possible that migrants play a positive role in the consumption patterns of Americans, and limiting their presence would make us an even larger (waist-wise) nation.

While the statement "they do the jobs Americans won't" is largely correct, it requires an addendum: Americans won't do those jobs at the wages those jobs offer. If picking cherries offered $15/hour and health insurance, college graduates would be sending in their resumes to the orchards of northern Michigan. But that's not what menial farmwork pays. And if it did, the cost of produce would rise. This is a second-level consequence of further constraining immigration we generally recognize.

Low-cost produce obviously doesn't help with the convenience issue - supersodium frozen dinners and fast food meals will always be more convenient than steaming your own vegetables. But as long as those vegetables are affordable, more people will buy them.

Would the Great Trump Wall and tightening of legal immigration actually make the county less healthy? Probably not any more than a marginal degree. It's still an interesting unintended consequence to consider.

Sunday, September 20, 2015

Another Health Insurance Market Failure

I remember during the conversations during Obamacare's construction, one of the more obscure issues was how insurance companies don't have clients for that long, so insurance companies do a poor job of encouraging long-term health (I couldn't find the statistic, but I believe the average person has the same company for somewhere in the area of three or four years).

This seemed to be a reasonable criticism of America's state of health affairs, and I could argue it in the abstract. After all, approaches that achieve long-term health benefits are investments that save money in healthcare coverage down the road, but if the insurance company isn't likely to reap the benefits, why should it make the investment? This is obviously a market failure, because the market could operate more efficiently, but providers (justifiably) are acting in their self-interest (in this sense, public health is arguably a tragedy of the commons our system has manufactured). However, I never had an explanation of how this works in practice.

I've now encountered my example, and it's frustrating experiencing how it works. I recently completed the final physical therapy session my insurance company will allow me to partake in, although my ankle has never fully healed. There's a decent chance that with another month of work I'll be much better off, but my policy doesn't allow for it. The hell of it is, spending some extra money now should pay off in the long-term, as the current state of my ankle leaves me in line for arthritis and other issues down the road.

No one refutes this. My physical therapist is the expert saying it will happen, on a logical level I agree with him based on my limited understanding of how joints work, and the insurance company likely understands. But I'm unlikely, statistically, to be with Blue Cross of New York in 20 years when my ankle becomes a real problem, so there's no rational reason to invest in therapy now. It will be someone else's responsibility at that point. Even if future surgery is way more costly than extra PT sessions this year, someone else will foot the bill.

I get the contra - if my insurance company allowed me unlimited visits, my physical therapist would be inclined to continue scheduling sessions even after they were no long necessary in order to make more money. Some providers would resist this temptation, some would be bad actors, and some would schedule unnecessary visits merely for the sake of erring on the side of caution. So even in a  system that pays for preventative care, there would still be concerns. Answers may be difficult to definitively determine, but our system is undeniably prejudiced against long-term economic decision-making.

Wednesday, July 15, 2015

The Biggest Winners of Last Week's Supreme Court Decisions

Obama may be taking a victory lap over the final determinations of the U.S. Supreme Court this session, but he wasn't the biggest winner. Obama may have been happy, but in keeping an eye toward 2016, Charles and David Koch took home the ultimate prize. A quick look at each decision, and the impact, with a score from 10 to -10 to track the points the Koch Camp scores with each decision:

Lethal Injection (-1)
In a 5-4 decision, SCOTUS ruled that a drug linked to three different botched executions could continue to be used. This didn't favor the Koch Camp, but you can't win them all. Liberals seeking to paint the brothers as pure evil would be surprised (on this and a list of other issues) that there's more agreement than not on criminal justice policies between the two sides. The Kochs have spent millions promoting criminal justice reform - including donations to (GASP!) the ACLU.

The Kochs are much more rational actors than they're given credit for, and disprove of criminal justice as it's practice in America. And while they'd never promote additional services to help the poor, they're opposed to actively punishing them for their socioeconomic status. Sure, they're appalled by the government spending billions to incarcerate people because those prisons are funded via taxes, but they've also been aligning with groups outright opposed to the death penalty.

Do they really care that much about the death penalty itself, or just the system's treatment of minorities committing low-level drug offenses? Hard to say, but the Charles Koch Institute is definitely devoted to reforming the system. Ergo, we rate this a -1, because I've no better score to argue for.

Same Sex Marraige (+7)
This victory is two-fold. The first is that gay marriage initiatives are major wins for Democrats. States putting the issue on the ballot in elections turns out the liberal vote, and colors elections blue. Depriving more States the opportunity to vote on the issue prevents this scenario. Additionally, while Koch Enterprises is headquartered in Kansas, the Kochs are New York City residents. They're not prejudiced people who discriminate based on skin color or sexual orientation.

Health Care Subsidies (+4)
Most people aren't aware of what the ACA decision actually did. The impact was the decision that the  federal government may subsidies to individuals in states that opted not to provide marketplaces for insurance coverage (in those instances, the feds came in and set up insurance exchanges sans state support). There are 6.4 million people in 34 states receiving $1.7 billion monthly who would be effected.

On the surface, the Koch Camp hates this decision. It deprived the country of the opportunity to take a nice bite out of Obamacare and makes future reforms to the law more difficult. However, significant writing has been devoted to the pressure such a result would put on officials in swing districts. The biggest conservative fear of Obamacare was that, once you give someone something, it's hard to take it away. Those receiving healthcare assistance now expect to continue receiving it, and if you don't promise to return, they'll vote for someone who will. The ruling Republicans wanted could have very well precipitated a blue wave that actually strengthened the ACA. This ruling, considering everything, may have been the best outcome.

Pollution Limits (+10)
This was the win no one is talking about. The decision wasn't earth-shattering, but did rule the EPA was failing to properly conduct cost-benefit analysis in setting emissions limits. The EPA was headed down a path of requiring more expensive scrubbers and other technology that significantly impacted the bottom line of polluting industries. Given the portfolio of Koch Industries, the brothers' wallets will be larger in future years as a direct result of this outcome.


Monday, January 19, 2015

Anti-Vaccine Movement as Class Conflict

A small measles outbreak at Disneyland (for more information, turn to this reporting) could reinject (or provide the first injection of) real talk into the anti-vaccine movement currently sweeping the nation. Maybe. Maybe it changes nothing. What's true is that the movement is racist and classist. Truth.

Two groups of people fail to fully vaccinate their children. According to the New England Journal of Medicine, the first type have kids that are more likely "to be white, to belong to households with higher income, to have a married mother with a college education, and to live with four or more other children." Suburban housewives? A nice portion of the equation. They also cluster, and probably hate science ($5 says if you know an anti-vaccer, they either don't believe in evolution, or know GMO corn causes cancer. Or both). Why should we care? Aside from the child endangerment they're wantonly engaging in, there's a second group of people who don't vaccinate: poor, predominantly minority families.

Aside from Michelle Bachmanns' crazy ramblings (does she have any other kind?), I was largely unaware that there was actually an anti-vaccination movement. Then this winter I started following IMGUR, and noticed a lot of posts seeking to disprove fallacies pushed by this anti-vaccination agenda. So I started looking into it, discovered these enclaves of anti-vaccer mothers in hippie dippie enclaves like Boulder, Portland, and Seattle, and became frightened. And frustrated. Low-income families have traditionally had issues with proper vaccination. There are a list of problems: low information, cost, transportation access, and a lower likelihood to follow up for a missed appointment due to additional life burdens not found in the cul-de-sacs of Boulder.

When someone brings measles onto a playground, two kids are going to get sick. One has anti-vaccer parents screaming, "bring it on!" Then they take their kid to a well-financed hospital and receive appropriate medical care in a sterile environment. The other kid has access to shit medical care, lives in an unhygienic and overcrowded community, and suffers greater harm. Generally speaking, rich people not vaccinating their kids doesn't put other rich kids at risk. Just the poor ones. Class conflict.

Sunday, January 4, 2015

Tragedy of the Commons in State Tobacco Revenue

Following years of battle that consumed millions of dollars in legal fees, "Big Tobacco" signed an agreement with the states in 1998 that promised money to state governments as compensation for the health care costs associated with smoking. The fascinating aspect of the agreement was that it didn't merely cover costs already incurred and some static agreement about the future. Rather, it promised payments to states in perpetuity. An escrow account currently receives 18.8482 cents per cigarette sold, divided among the signatories to the Master Settlement Agreement. Forever.

Here's where your classic tragedy of the commons kicks in: the more cigarettes sold nationwide, the more money an individual state accrues. Yet states often rely on tobacco taxes to help backfill their general funds. And because cigarettes are easily vilified in the political and media spheres in the 21st century, this is just about the easiest tax lawmakers can impose. These taxes, combined with increased health concerns, legally curtailed advertising avenues, and a general shift in societal attitudes, have greatly reduced the incidence of tobacco use in the United States.

It's impossible to know what impact cigarette taxes alone have played in the decline of active smokers. And some of the tobacco tax revenues are dedicated to anti-smoking campaigns. But peel away everything else, and you're left with a classic bit of game theory:
A state can heighten its tobacco revenue by increasing taxes, but but in doing so reduces cigarette sales. A reduction in cigarette sales decreases overall payments to the national escrow account that pays out to signatories of the Master Settlement Agreement. Of course, reduced escrow payments can be compensated for by further increasing cigarette taxes, which further reduces cigarette sales, which reduces escrow payments...

Some lawmakers truly wish to see the elimination of smoking. This desire has led to the proliferation of smoking bans, advertising restrictions, and commercials with people talking through holes in their throats. Others prefer to use tobacco as a cash cow. For these policymakers, there's a fascinating intellectual exercise out there just waiting to be picked: Is there a cigarette tax that maximizes revenues (escrow account receipts plus individual state remittances)? Variations in smoking rates among the states would complicate such a calculation, but there could be an answer. And if every state signed on to an agreement not to raise taxes by more than this amount, they could all be profit maximizers. Of course, it just takes one financial crunch to make a lawmaker in New Jersey propose a $1/pack increase, and then the tragedy rears its ugly head.

*A fascinating development in the public bond market has rendered this idea mute. Several states immediately went out and sold their future revenues for some upfront cash in agreements that made about as much sense as calling J.G. Wentworth as soon as you win the lottery. They've already spent their escrow payments, and have little concern for what happens in the future. Tobacco bonds truly are fascinating - and ProPublica has done a solid job covering them. Click here if you have even the faintest interest in learning more.

The prospectus Bear Stearns sent New Jersey to acquire their tobacco settlement funds.

Friday, May 20, 2011

Absolute Genius

While disengenuous, it's hard to deny the political mastery of this mailer (note: they use the individual name of the specific mail recipient on the card. That's pretty clutch):
SEIU_NY26_Mailer1 (3)

Wednesday, December 15, 2010

Actions v. Words

The best 'satirical segment used as commentary' I've ever seen on the Daily Show (and they've had some damn good ones):

The Daily Show With Jon StewartMon - Thurs 11p / 10c
Lame-as-F@#k Congress
www.thedailyshow.com
Daily Show Full EpisodesPolitical Humor & Satire BlogThe Daily Show on Facebook

(note: Facebook refuses to transfer html codes from here to my Facebook notes whenever it randomly trawls around my RSS feed and won't convert the video. You can, however, view the clip here (self-promotion) or here.

I was big supporter of Obama's decision not to wear a flag lapel during the primaries. I rooted on Cantor being taken to the woodshed regarding the platitude of 'freedom,' and how often politicians use it to attack opponents in crass and pathetic ways. Yet the royalties observation is the most spot on thing ever. I'm open to conversations regarding what (if any) additional benefit level is appropriate. However, it's worth noting this isn't the first time the health risks of the dust around the Trade Center have been obfuscated - the Bush administration previously lied about the health risks these responders face, and it's not up for debate. It's not a 'did Bush really lie about WMDs?' question. They were definitely, deliberately lying about health impacts of asbestos in the dust. Which may lead us to understand the real reason so many Senators despise the idea of paying for these benefits - it relies on informed medical and environmental understanding. Which comes from scientific understanding. Which means someone's using science. Which, as we know, is the platitudinal Republican's greatest fear.

Tuesday, May 18, 2010

Democrats are Wrong, but Republicans are Wronger, and the Senate's Wrongest

There's nothing more fun in politics than pointing out the other side's hypocrisies. Although this does little to further intellectual inquiry, it makes for great political theater. In comparing healthcare and market reform, I will attempt to provide the facade of doing both.
I'm of the personal opinion that Chris Dodd's reform package is about the best you could expect of the Senate. While not perfect, it has some important components. The one component Republicans contend it lacks is eliminating the concept of 'Too Big to Fail.' What's interesting is that few (if any) Republicans are pushing for size restrictions. Rather, they clamor for a provision that says we will not bail out any financial institutions in the future - thus eliminating the moral hazard created by our rush to mollify AGI's asshattery as the sky's falling down.
This pie in the sky fancy is about as disingenuous as the healthcare budget numbers Democrats were peddling earlier this year. A quick recap of what's bothersome: the current tax exemption for health insurance means that, as a general rule, we have an incentive to overconsume health insurance. This is why you end up with the so-called 'gold-plated' health insurance policies. The Senate was too scared to tackle this issue today, and instead wrote in the bill that they would be taxed starting in the year 2018. This tax was then used to calculate the long-term budget impacts of the healthcare bill.
I call this disingenuous because it doesn't take a policy degree to guess the likely future. Come 2017, Congress will come under pressure to amend the legislation and prevent new taxes, it will, and the financial solvency touted by Obama will be thrown out the window.
The same applies with McConnell going to the Senate floor and screaming about the 'institutionalization of bailouts.' It really doesn't matter how much power you give regulators - when shit hits the fan, they'll be on Capitol Hill demanding the power to prevent Citigroup from going under, and (assuming the President has a lick of sense) it will be done. When faced with the prospect of disaster, policy will be amended (regardless of long-term consequences).
I may be giving McConnell too much credit here in pretending he's merely disingenuous - he's lying to advance his party's standing while hurting America. When you look at what happens under the Dodd bill, no institution is saved. The government may take it over and chop it up into little pieces, but it is an entirely different company in which the stockholders lose their shirts. And that's really the crux of the matter - when you understand you'll lose your investment if a company goes under, you'll either search for a safer investment or demand a greater rate of return. Which is what this bill does. Which makes McConnell wrong. Again. Upon review, nothing too earth-shattering in this paragraph.
I still contend derivatives trading contributes absolutely nothing to the economy.