Hospital Price Insanity

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Almost nothing is less transparent than hospital pricing. If you’re shopping for a procedure, you probably won’t hear about the negotiated prices worked out with large insurers…. you’re likely to be quoted something much higher. A high price is billed to an insurer, but the excess above their negotiated prices is “disallowed” via contractual adjustment. You and/or your small insurer might not get the same deal. As Robert Laszewski says:

The chargemaster is complete nonsense that really doesn’t matter — unless you are an uninsured person and you’re getting these huge bills driving you toward bankruptcy. The biggest irony of the U.S. healthcare system is that only the uninsured — often people who don’t have a lot of money — are the only ones the hospital expects to pay these incredibly inflated prices!”

An uninsured patient might be billed at the higher rate, but of course few end up paying. But there is harm in this arrangement, and it extends well beyond the uninsured. You might not be surprised to learn that the government is right in the middle of it. Read on…

What a Racket!

There’s some slight of hand going on in hospital pricing that creates perverse incentives. Who has something to gain from a huge gap between the full price and the hospital’s allowable charge? The answer is both the hospital and insurers, and that’s true whether the hospital is for-profit or nonprofit. When the list price and the size of the discount increase, the insurer gets to brag to employers about the great savings it negotiates. In an episode on EconTalk, Dr. Keith Smith, a partner in the ultra-competitive and cash-only Surgery Center of Oklahoma, says (only partly in jest) that the conversation might go something like this:

Now, what the insurers actually do is ask the hospital administrators, ‘Can you do a brother a favor and actually charge $200,000 for that, so that our percentage savings actually looks larger?‘”

This does two things for the insurer: it impresses employers as prospective plan sponsors, and it might also earn them a bonus known as Claims Repricing, whereby the employer pays a commission on the discounts the insurer “negotiates”.

What about the hospitals? How do they benefit from this kind of arrangement? By inflating the “list price” of procedures, the hospital creates the appearance of a write-down or loss on a substantial share of the care it provides, despite the fact that its real costs are far below list prices and usually below the discounted “allowable amounts” negotiated with insurers as well. The appearance of loss serves to benefit the hospitals because they are compensated by the government on that basis through so-called Disproportionate Share Hospital (DSH) payments. These are, ostensibly, reimbursements for so-called uncompensated care.

This would not be such a travesty if the prices approximated real costs, but the arrangement creates incentives to inflate. The DSH payments to hospitals are used in a variety of ways, as Smith notes:

Yeah; and before we get to feeling too sorry for the hospitals, all of the ones I know of claiming to go broke have a crane in front of them building onto their Emergency Room. …

So, I don’t know: again, the hospitals that are complaining about this, they are buying out physician practices, they’re buying out competitors. They seem to have a whole lot of money. They’re not suffering. Now, what they have done is used the situation you described–the legitimate non-payer–they’ve used that as a propaganda tool, I would argue, to develop a justification for cost shifting where they charge us all a whole lot more to make up for all the money that they’re losing. But they really need a lot of this red ink to maintain the fiction of their not-for-profit status.”

Non-profit hospitals are also entirely tax-exempt (income and property taxes), despite the fact that many use their “free cash flows” in ways similar to for-profit hospitals. The following describes a 2015 court ruling in New Jersey:

The judge stated ‘If it is true that all non-profit hospitals operate like the hospital in this case… then for purposes of the property tax exemption, modern non-profit hospitals are essentially legal fictions.’ Judge Bianco found that the hospital ‘operated and used the property for a profit-making purpose’ by, in part, providing substantial loans, capital, and subsidies to for-profit entities, including physician groups.

The bad incentives go beyond all this. Smith adds the following:

Waste in a big hospital system is actually encouraged, many times because hospitals are paid based on what they use…. So, to the extent that the hospital uses a lot of supplies, that typically raises and increases the amount of revenue that they receive.”

Hospitals have been shielded from competition for years by the government. As Chris Pope explains, hospital pricing is designed “to accommodate rather than to constrain the growth of hospital costs“. This encourages hospitals that are inefficient in terms of costs, quality of care, and over-investment in equipment. Conversely, duplicated facilities and equipment simply add costs and don’t encourage competition given the cost-plus nature of hospital pricing and government efforts to prevent entry by more efficient operators. These restrictions include “Certificates of Need” for new entrants, and the ban on physician-owned hospitals in the Affordable Care Act (ACA). At the same time, the ACA encouraged hospital consolidation by rewarding the formation of so-called Accountable Care Organizations, which are basically exempt from anti-trust review. In the end, any reductions in administrative costs that consolidation might offer are swamped by the anti-consumer force of monopoly power.

Mandated Transparency?

The lack of price transparency really isn’t the root problem, in my view, but it is undesirable. Can government action to create transparency foster a more competitive market for the services hospitals offer? A recent Trump Administration Executive Order would require that hospitals publicly post prices for 300 “stoppable” services or procedures. The effective date of this order was recently delayed by a year, to January 2021. Hospital trade groups have challenged the order in court on the grounds that the First Amendment protects private businesses from being compelled to reveal details of privately-negotiated deals for complex services. I am a faithful defender of constitutional rights, but I find this defense rather cynicical. I’m not sure the First Amendment was intended to aid in concealing dishonest schemes for private benefit at the expense of taxpayers and consumers.

Avik Roy likes the price transparency rule. It would require the posting of gross charges for procedures as well as specific negotiated prices. The executive order would also require Medicare to pay no more to hospital-owned clinics than to independent clinics for the same procedure, which is laudable. Roy is sanguine about the ability of these rules to bring more competition to the market. He predicts a more level playing field for small insurers in negotiating discounts, and he thinks it would spur development of on-line tools to assist consumers.

John C. Goodman is mildly skeptical of the benefits of a transparency mandate (also see here). Consumers with decent levels of coverage aren’t terribly motivated to make hospital price comparisons, especially if it means a delay in treatment. Also, Goodman points out a few ways in which hospitals try to “game” transparency requirements that already exist. John Cochrane worries about gaming the rules as well. Competition and price discipline are better prescriptions for price transparency. They might be better addressed by eliminating the incentives for third-party payment arrangements, like the unbalanced tax deductibility of health insurance premiums, but that kind of reform isn’t on the horizon. Goodman concedes that many procedures are “shoppable”, and he does not minimize the extent to which pricing varies within local hospital markets.

Conclusion

The most insane thing about hospital revenue generation is its reliance on fictitious losses. And hospitals, profit and non-profit, have a tendency to spend excess cash in ways that fuel additional growth in cost and prices. Sadly, beyond their opacity, hospital prices do not reflect the true value of the resources used by those institutions.

In my view, the value of price transparency does not hinge on whether the average health care consumer is sensitive to hospital prices, but on whether the marginal consumer is sensitive. That includes those willing to pay for services out-of-pocket, such as those who seek care at the Surgery Center of Oklahoma. Third-party payers lacking significant market power would undoubtedly prefer to have more information on pricing as well. Mandated price transparency won’t fix all of the dysfunctions in the delivery and payment for health care. That would require more substantial free-market reforms to the insurance and health care industries, which ideally would involve replacing price subsidies with direct payments to the uninsured. The transparency mandate itself might or might not intrude on domains over which privacy is protected by the Constitution, a question that has already been brought before the courts. Nonetheless, transparency would lead to better market information for all participants, which might help rationalize pricing and encourage competitive forces.

 

Mean, Humorless Profs By Gender

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Do college kids disrespect female professors and cut male professors extra slack? Or do female professors act in ways that earn disrespect relative to their male counterparts? The data described here don’t answer those questions, but they do show that consistent asymmetries exist. The results summarize certain features of student evaluations by gender of professor, and while seemingly incredible, they deserve further scrutiny.

The Study

The study in the Chronicle of Higher Education covered 14 million evaluations housed at RateMyProfessor.com. Word frequencies from student evaluations indicate that female professors are perceived less frequently as “brilliant” and “funny” than male professors, and more frequently as “mean” and “rude”. Directionally, the result applied to every area of study without exception. What could be driving such a gap?

First, the scale of measurement needs a closer look. If evaluations average 50 words, let’s say, then 500 single uses of a word per million words would amount to once in every 20 evaluations. That’s a little easier to digest. It’s clear from the charts that “funny” and “rude” are used more frequently than “brilliant” and “mean”, regardless of the professor’s gender. But the bulk of evaluations do not use any of those words. That’s an important qualification, and yet the results are so strikingly consistent that it’s hard to deny that differences exist, at least between extremes within the male and female faculty cohorts.

Explanations

For the moment, suppose the students’ perceptions are accurate in some objective sense. If so, perhaps some women in academia overcompensate in an effort to be taken seriously in a world dominated by males. Males don’t dominate all subject areas, however, and even in areas of study more likely to have high female representation. females are still evaluated more harshly on these criteria. In fact, a perusal of the subject areas might even suggest that some of these particular gender gaps are smaller in STEM fields, which are traditionally dominated by males. Still, the overcompensation hypothesis might have a grain of truth, even if “overcompensation” by female profs is merely a form of ongoing rebellion against traditional gender roles. For the same reason, maybe “severe” female personalities self-select for academic jobs in greater proportion than males, though I’m not sure that holds up.

If the student perceptions are incorrect, what’s driving them? Are expectations for women in academia simply more demanding? Such that many female profs fail to live up across a broad range of dimensions? There is strong support for the proposition that student evaluations are biased against female profs. If students are somehow conditioned to think that a female prof will be inferior, she might have to outperform her male counterparts along various dimensions simply to stay even. That might well explain the regular patterns of words used by some students.

Other Qualifications and Contradictions

The word frequencies described above aren’t definitive by any means, even if you put great stock in student evaluations. In fact, using the interactive tool provided by the authors of the study, the word “nice” appears relatively often and in consistently higher numbers for female than for male profs. And, with consistent but very low frequency, the word “moron” is used to describe more male profs than females. Maybe there’s greater variance across female professors in the “niceness” dimension, and more variance across males in the “smarts” dimension (and some research suggests that the latter is true). I’m not so sure about the “funniness” dimension, but I know some very funny women!

It would be helpful to know the breakdown of word frequencies by student gender. What I often hear from female acquaintances is that women are harder on other women than on men. In relationships involving asymmetric power, this is the so-called “Queen Bee Syndrome“, a phenomenon having some empirical support.

There could be other biases baked into the study, such as a predominance of angry reviewers, but I’m not sure that would explain a bias against female profs. Finally, it’s possible the RateMyProfessors site attracts more male reviewers. A rough (and amusing) feel for the proportion of male and female reviewers might be gleaned by entering the word “hot” into the tool (!). As expected, the mostly male engineers are much more likely to use that expression as a description of female profs, but reviewers in most fields are fairly balanced in their choice of that word.

Conclusion

The word frequencies may well reflect the adoption of harsher standards by some students for female profs relative to male profs, and there may be female profs who “overcompensate”. And maybe more women with relatively “thick-skin” are attracted to the ranks of the professoriate. College students can be a tough crowd, but it’s important to remember that they are mostly young. Teachers can and should refine their approach in ways that might produce greater learning and satisfaction. But more than anything else, the results reinforce the conclusion that institutions should be cautious about the weight they place on student evaluations in assessing faculty performance.

 

 

Statists Might Like To Vaccinate Against Many Things

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The vaccine debate illustrates a widespread misunderstanding about the meaning of an “advanced society”. It does not mean that difficult social problems must be dealt with always and everywhere in a uniform way, as supporters of vaccine mandates seem to assume. Instead, it often means that society can respect differences in the preferences of individuals by allowing varied approaches to problem-solving across jurisdictions, as well as across public and private institutions. This latter notion of advancement respects individual freedom and facilitates experiential social learning. But is that varied approach wise in a world of communicable diseases?

One standard of “community” protection assumes that vaccines work with a high degree of certainty within groups of individuals, especially with a second booster. The share of the population vaccinated against most common childhood diseases is fairly high. In fact, these shares mostly exceed their respective “community protection thresholds” — the percentage required to prevent a particular disease from spreading. That means achieving so-called “herd immunity”. Of course, that will not be true across many local subgroups. Nevertheless, if one accepts this standard, a runaway contagion in the U.S. is an extremely remote possibility, affording some flexibility for respecting preferences for and against vaccination.

My Friend, the Vaccine Resistor

One of my best friends is a passionate vaccine resistor (VR). I won’t say he’s “vaccine hesitant” because that doesn’t come close to his position. I won’t call him an “anti-vaxxer” because he doesn’t mind if others avail themselves of vaccines (and besides, the term has taken on such derogatory connotation. He’s a fine fellow, very smart, lots of fun to be with, and we have plenty of mutual interests. We’ve argued about vaccinations before, and a few other medical and nutritional issues, but we mostly stay out of each others’ ways on these topics.

But I recently witnessed my pal get into a “debate” on social media with a mutual acquaintance and some of her connections. She happens to be a nurse. She’d posted a photo of an attractive young woman in a t-shirt imprinted, “Vaccines Cause Adults”. My buddy spoke up and said “Not for everyone!’, and he posted a link to an article that he felt supported his position. Of course, a number of barbed responses came his way. Okay, some of those were fair debate points, though barbed, but others were quite derisive, ad hominem attacks on him. He responded by posting links to more articles and research, which might not have been productive. It’s usually a waste of time to argue with people on social media. But to his great credit he maintained his equanimity. The episode made me feel a bit sad. People can be such assholes on social media. I was put off by the nurse’s refusal to moderate . That’s a typical pattern: posters allow their other friends to hurl terrible insults at anyone who disagrees, even when it’s an old friend. Mind you, I stayed on the sidelines in this case, except that I originally “liked” the nurse’s meme.

Later, I had a private exchange with my friend. I’m on board with vaccinations. I believe that widespread immunization contributes to public health, but I told him there are certain points on which I can sympathize with VRs. Without knowing the details, he encouraged me to write a blog post on the subject. I’m not sure he’ll like the results. However, as noted above, I’m willing to make a few concessions to my buddy’s side of the argument, and I wish we could identify a path that would settle the debate.

My Standpoint

This is one part my pal won’t like. Are VRs anti-science? First, VR’s come in several varieties. Some might resist only some vaccines and not others. But VRs do not disavow empiricism, as they claim their own set of empirical findings to support their position, however one might regard the research quality. 

I believe many VRs are misled by a serious post hoc ergo propter hoc fallacy: after this, therefore because of this. For example, for many observers, the purported link between autism and the measles, mumps and rubella vaccine was put to rest when the British medical journal Lancet retracted the original article supporting that claim as faulty. That doesn’t wash with more radical VRs, many of whom seem to have someone on the autism spectrum in their own families. They are understandably sensitive, but please forgive me: that suggests a need to find some external explanation, a source of blame not related to genetics.

Radical VRs are selective proponents of the precautionary principle: any risk of harm from a vaccine delivered in any amount is too great a risk. They seem reluctant to acknowledge the reality of a dose-response relationship, which bears on the risks of exposure to certain compounds often present in vaccine formulations. VRs will not acknowledge that vaccines present a manageable risk. And then there are the misleading references to disease incidence counts, as opposed to disease incidence rates, that are all too common (though my friend is almost certainly innocent on this count).

Vaccine resistance is not a new phenomenon, as the cartoon above from 1802 illustrates. Certain people will always find the idea of injecting germs into their systems deeply unsettling. Of course, that’s a very natural basis of resistance. A person’s body is their own property, after all. My default position is that an individual’s control over their own body is inviolable, and parents should always be the first authority over decisions about their children. The real issue, however, is the question of whether unvaccinated children inflict external costs on others.

Points of Contention

The major objections of VRs fall into several categories: 1) preservatives; 2) multiple viruses; 3) vulnerable infants; 4) contra-indications; 5) inefficacy; and 6) free choice. There may be others, but I’ll go with those.

Preservatives: Some vaccines still use a form of mercury, but a much more innocuous variant than the one VRs found so objectionable a few decades ago. Still, they object. And they object to many other compounds used in minute quantities as preservatives, such as formaldehyde, which occurs naturally in our bodies. I think the following test is helpful: if it were proposed that VRs take new versions of the vaccines that had zero preservatives, many would still refuse, especially if they were asked to pay the additional cost of providing them in that form. Thus, preservatives are revealed to be something of a side show.

Multiple Viruses: VRs object to the administration of vaccines that inoculate against several viruses in one dose or within a short window of time. This objection has some plausibility, since an injection of several different “bugs’ at once might place excessive stress on the body, even if the risk is still small. But again, would VRs volunteer to take single strain vaccines in a schedule over a lengthier period of time? Probably not.

Vulnerable Infants: VRs say it’s too risky to vaccinate infants in their first few months of life. This too is a plausible objection, and it would seem like a relatively easy concession to make in the interests of compromise … except, it won’t ever be good enough. Radical VRs will not agree to having their children vaccinated at any age.

Contra-Indications: There are undoubtedly genetic factors that pre-dispose certain individuals to an adverse reaction to certain vaccines. These might be rare, so an effort to compromise by requiring a thorough genetic profile before vaccination would be costly. I believe profiling is a reasonable demand for individuals to make, however, provided they pay the cost themselves.

Inefficacy: My friend posted an intriguing article about the drastic declines that occurred in the incidence of various diseases before the introduction of vaccines to prevent those diseases. This might not be the same link, but it makes the same argument. That doesn’t mean vaccines don’t work, of course. There is a vast literature that shows that they do. Bing it! And in cases such as smallpox, the use of “folk applications” of puss to a small scratch in the skin were in use long before the vaccine was available. Nevertheless, the VRs contend that the historical rates of disease incidence provide evidence against vaccinating. They also contend that diseases like measles are not serious enough to warrant precautions like vaccines. Measles can be deadly, though not as deadly as the flu.

Free Choice: This is the point on which I’m most sympathetic to VRs. Again, we own our own bodies and should have authority over our own minor children, yet communicable diseases seem to be a classic case of externality. Susceptible individuals may inflict a cost on others by refusing vaccination or segregation. Other people own their bodies too, and they have a right to avoid exposure. They too can isolate themselves or take precautions as they deem necessary. If both parties wish to participate in society, then both hold rights they allege to be threatened by the other. That complicates the task of reconciling these interests in private, voluntary ways, and yet they often are reconciled privately.

Solutions?

The debate today often revolves around mandatory vaccination, which would be an extreme measure relying on the coercive power of the state. The rationale is that even a vaccinated majority would be subject to an unnecessarily high risk of infection when in frequent contact with an unvaccinated minority. It’s difficult to endorse such broad intrusiveness when we’re dealing with a negative externality of such minute probability. And such a policy is not at all defensible without exceptions for individuals for whom a vaccine is contra-indicated.

Tolerating differences in vaccination rules across cities, school districts, or even states, may be a reasonable approach to settling the debate in the long run. These variations allow empirical evidence to accumulate on the efficacy of different vaccine regimes. It also allows individuals and families to “vote with their feet”, migrating to jurisdictions that best suit their preferences. These are the basic foundations of federalism, a principle of great usefulness in preserving freedoms while addressing regional differences of opinion on contentious issues.

Michigan has a policy allowing unvaccinated children to attend schools, but a waiver must be obtained requiring the child’s parents to attend a vaccine education program. The policy is credited with increasing vaccination rates. The problem is that VRs tend to view this requirement as an infringement on their rights. Advocates of the policy might argue that the situation should be viewed as an arms-length, voluntary exchange between two parties, in this case a family and a public entity. The vaccine education program is just the price one must pay in lieu of vaccination. The exchange is not arms length, however, as it would be if the school were a private entity. The VR parents who refuse the waiver are not rebated for taxes paid for local schools. In fact, like all taxes, the payment is coerced.

It’s not always necessary to appeal to some form of government action, even at local levels. For example, private schools may require vaccination among enrollees, and private businesses, especially health care providers, may require staff to be vaccinated. Life and health insurers may wish to price risk differently for the unvaccinated. VRs might object that they are subject to discrimination by institutions requiring immunization, or who price discriminate in favor of the immunized, but VRs are free to form competitive institutions, even on small scales or as mutual companies. To the extent that such private rules are unjustified, the institutions who discriminate are likely to learn or lose eventually. That’s the beauty of market solutions. In these ways, non-coercive private governance is far preferable to action by the state.

Dr. Jeffrey Singer is an advocate of immunization who opposes mandatory vaccine laws, as he explained a few years ago in “Vaccination and Free Will“. He suggested elsewhere, in “Seeking Balance In Vaccination Laws“, that schools, instead of requiring immunization, could mitigate the risk of a contagion by insisting that unvaccinated children be held out of school when a particular threat arises and remain out until it passed. That’s a reasonable idea, but I suspect many pro-vax parents would fear that it doesn’t go far enough in protecting against the introduction of a disease by an unvaccinated child.

Conclusion

Recent increases in the incidence of diseases such as measles, mumps and whooping cough are extremely troubling. Whether these outbreaks bear any relationship to patterns of vaccination in the population is certainly a valid question. To the extent that more families and individuals wish to be immunized, and that private institutions wish to take action to increase vaccination rates within their sphere of influence, I’m all for it. Vaccination laws are a different matter.

Political action at the local level might mean that school districts and other public entities will require vaccinations or vaccine education programs. Alternatives exist for those refusing to vaccinate, but broad mandatory vaccination is too coercive. Such measures carry significant costs, not least of which is a loss of liberty and normalization of losses of liberty. It’s not clear that a vaccination mandate at the national level, or even a state vaccination mandate, can offer benefits sufficient to justify those costs. Nudges are irritating and may be costly, but forcible intrusions are way out-of-bounds. Unfortunately, there are parties that simply can’t resist the temptations of behavioral control, and that’s worthy of resistance. Let’s continue to muddle through with an essentially federalist approach to vaccination policy. I regard that as a hallmark of an advanced society.

 

Rx Drug Prices Are Falling, But You’re Aging

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Ask anyone on the street about prescription drug prices, or ask anyone in the press, and you’ll probably hear they are out of control. That contention is false. The conventional wisdom is typified by this exaggerated BS about insulin pricing … actually, you can find a vial of the kind I used for many years for about $25 without much difficulty.

Individual experience differs, of course. Yes, there are new drugs on the market that are exorbitant; there are older drugs still under patent that are pricey too. Those represent a fairly small part of the total market, however, and one on which policymakers should tread lightly if they hope to foster the development of new, life-saving drugs. Newer insulin varieties are not in that class, and those varieties don’t always incorporate meaningful improvements for patients.

Getting Old Is Hell

In fact, prescription drug prices have been declining for a number of years. The real problem is we’re always getting older! In a report from the Progressive Policy Institute, Michael Mandel describes what he calls the prescription drug escalator. Alex Tabarrok has a good summary of the article. The chart at the top of this post, from Mandel, shows that the number of drugs prescribed rises steadily with one’s age. The total bill rises along with age, which may create the perception that you’re paying higher prices. Unsurprisingly, more of each health-care dollar spent out-of-pocket  (OOP) goes to prescribed medications as you age, and more goes to prescription drugs as health declines. As Mandell says, the increases experienced by individuals are a matter of utilization as opposed to pricing..

Generic Dominance

Tabarrok notes that generic drugs account for somewhere between 80-90% of all prescriptions, and generic costs have been falling for some time. He links to one of his earlier posts on generics and to this study by the National Bureau of Economic Research, which states:

“… direct-out-of-pocket CPI for generic prescription drugs decline[d] by about 50% between 2007 and 2016 …”

Average OOP prescription costs peaked in 2006, according to Mandel’s data. Tabarrok quotes Mandell:

May 2019 research report from the Agency for Healthcare Research and Quality reported that average out-of-pocket spending for prescribed medications, among persons who obtained at least one prescribed medication, declined from $327 in 2009 to $238 by 2016, a decrease of 27 percent. Data from the Bureau of Labor Statistics Consumer Expenditure Survey shows that average household spending on prescription drugs fell by 11% between 2013 and 2018.

Moreover, OECD data shows that average out-of-pocket spending on prescribed medicines in the United States ($143 per capita in 2017) is actually lower than countries such as Canada ($144), Korea ($156), Norway ($178), and Switzerland ($215).”

The declines in OOP drug costs came despite a shift in health-care payment responsibilities from insurers to consumers in recent years — OOP costs would have declined much more had the shift not occurred, according to Mandel. As he says, consumers now have more “skin in the game”, and apparently they act on it.

Another basis of the misperception about escalating drug prices has to do with the way they are reported. Mandel says:

List prices are the published prices that manufacturers charge to wholesalers. Net prices reflect the revenues that drug manufacturers receive, net of rebates and discounts to prescription benefit managers, insurance companies, and hospitals.

Studies of list prices invariably show very strong growth. For example the IQVIA Institute for Human Data Science found that the list price of the average brand rose from $364.92 to $657.08 since 2014, an 80% increase. Similarly, a widely cited recent study based on list prices found that from 2008–16, the costs of oral and injectable brand-name drugs increased annually by 9.2 percent and 15.1 percent, respectively. … By contrast, net prices and net pharma revenue have been growing much more slowly, once rebates and discounts are accounted for.” 

The Pricey Segment

There are a variety of circumstances that bear on the pricing of individual drugs. Clearly, non-generic drugs are subject to more upward price pressure and give rise to anecdotes that feed misperceptions about the overall trajectory of drug prices. These are either new drugs or older ones sold under extended patents, which are sometimes granted for even minor changes in a drug’s chemical makeup.

Some new drugs are life-saving breakthroughs targeting rare diseases. The unfortunate truth is that drug development is a very costly enterprise, often stretching well over a decade in the U.S. under the FDA’s approval process. Moreover, U.S. consumers actually subsidize the cost of drugs for European consumers, where drugs are typically subject to price ceilings or are directly negotiated by government. By the time drugs go to market, development is treated as a fixed cost; even the low prices in Europe cover the marginal cost of production, so pharmaceutical manufacturers don’t mind selling there as long as their development overhead is paid by someone. That’s the rub.

Drug development costs are heavily influenced by public policy, often to the detriment of consumers. The FDA’s drug approval process is in dire need of reform, and patent extensions should be severely curtailed. As an advocate of free trade, I also favor a lifting of restrictions on imports of drugs to the U.S.

Conclusion

You’re likely to see more physicians as you age, they’re likely to prescribe more drugs, and you’re likely to pay more for prescriptions OOP. That’s the escalator in action. You can minimize the slope of your personal prescription escalator by taking good care of yourself and using generics when possible, but the slope is often beyond a person’s control. Nevertheless, over the past 13 years in the U.S.,  most of those experiencing higher OOP costs have this escalator, i.e., aging, to thank… it’s drug utilization, not pricing.

A relatively small but important share of the market has experienced price escalation. Newer, highly specialized drugs can carry high price tags. Patents give drug manufacturers considerably more pricing power, and drug companies have sought to maintain “evergreen” patents by manipulating their formulations. U.S. import quotas and restrictive pricing abroad have left consumers in the U.S. holding the bag for a large share of drug development costs. These shortcomings can be addressed via streamlined drug approval, patent reform, and lifting import restrictions.

A critical policy prescription is to liberate market forces and foster competition in the pharmaceuticals industry. Price controls in the U.S. would eliminate all incentives for new breakthroughs, leading progress in many areas of treatment to a stand-still. Price controls merely substitute the arbitrary decisions of politicians and bureaucrats for the market’s ability to balance dynamic consumer needs, medical expertise, and the costs faced by sellers.

 

 

HyperBoondoggle

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The hyperloop: if you think the Delmar Loop Trolley in St. Louis, MO was a boondoggle, just wait till the state starts hemorrhaging cash for the proposed hyperloop test track, and later a possible route connecting St. Louis, Columbia, and Kansas City. The hyperloop would rely on magnetic levitation (maglev) technology that has been used for trains in some parts of the world, though always on relatively short routes. For a hyperloop, however, the maglev system keeps carrier “pods” suspended in a near-vacuum tube extending the length of the route, eliminating friction and air resistance. Proponents say the pods will move at top speeds of 700 miles an hour, traversing the state in about 30 minutes. And they say it will be a very green machine.

Richard Branson’s Virgin Hyperloop One wants to build the 15-mile test track, which is projected to cost $300 – $500 million. That range is centered just a bit higher than the cost of the Loop Trolley on a per-mile basis, and for a project with major technological uncertainties, that leaves me just a bit wary. The 250-mile cross-state route is now pegged at between $7.3 and $10.4 billion, according to the recent report issued by the state’s “Blue-Ribbon Panel on Hyperloop”. It’s likely to cost much more by the time they get around to building it, if they do at all, and if it actually works.

Hyperbole?

My skepticism about hyperloops is based in part on the hucksterism that often characterizes appeals for public funding of large projects, and hyperloop hucksterism has already taken place. For example, in 2013 Elon Musk estimated that a Hyperloop system would cost about $11.5 million per mile. By 2016, the mid-point estimate for a route in the San Francisco Bay Area was over $100 million per mile. A friendlier route in Dubai is expected to cost $52 million per mile. So to be conservative, we saw 5x to 10x higher costs in a matter of three years. But now, Virgin One says it can construct a route in Missouri for less than the per-mile cost of the Dubai line. Well, the state Department of Transportation already owns the rights of way over significant stretches of the route (but not everywhere because the tube must be straighter than the highway).

The hyperbolic claims for hyperloop technology include speed, projected passenger fares, and ridership. According to Innovation Origins, the so-called feasibility study for the Missouri hyperloop did not assess the technology or even address the fact that no working hyperloop has ever been built or proven at full scale over any distance longer than a kilometer or so. The consultants who prepared the “study” merely assumed it would work. No test pod within a vacuum tube has achieved more than a fraction of the promised speed. The tubes were not long enough to achieve top speeds, they say, but that raises another issue: creating near-vacuum conditions in a sizable tube over very long distances. At the Innovation Origin link above, they estimate that the Missouri tube would occupy over 1 million cubic meters of space, which is at least 30 times larger than the most expansive man-made vacuum space now in existence.

The Ride

As for the passenger experience, 30 minutes to traverse the state of Missouri would be impressive, but what about comfort? First, expanding the tube’s circumference and the girth of the pods would have a disproportionate impact on cost, so conditions might either be more cramped than the promotional photos would have you believe, or the number of passenger seats per pod might be reduced. Second, rapid acceleration from zero to 700 mph would subject humans to fairly large G-forces over several minutes. Deceleration at the end of the trip might be even worse. Negotiating even mild curves would also require reduced speed and subsequent re-acceleration to avoid uncomfortably high radial G-forces. All that means the ride could be a bit uncomfortable. That also means the average speed between Kansas City and St. Louis would be significantly less than 700 mph, especially with a stop in Columbia. G-forces might not be much of a concern for freight traffic, unless it’s fresh produce.

Safety

Then there’s the vulnerability of the system. Willis Eschenbach goes into detail on some technical problems that make the hyperloop risky, such as the pressure on the tubes themselves. It would be about 20,000 pounds per square meter of tube surface, all subject to significant thermal expansion and contraction over the course of a day, with large pods racing through joints and rounding curves. Any fault or crack at any point in the tube surface would cause catastrophic deceleration of pods along the entire length of the tube. The integrity of the pressurized pods themselves is also a safety issue. And what about an earthquake? Or a loss of control and fiery pile-up of vehicles traveling on I-70 near the tubes. Or any number of other foolish or intentional sources of damage to the tube along its route?

Throughput

One of Eschenbach’s most interesting critiques has to do with passenger throughput. Musk’s original plan called for 28-passenger pods departing every 30 seconds: 3,300 passengers per hour. That would represent a substantial addition to total cross-state transportation capacity. At full utilization (which of course is unlikely), that would exceed current estimated totals for daily travel between St. Louis, Columbia, and Kansas City. And while that capacity might reduce pressure to expand other modes, such as adding an extra lane to I-70, it would not offer an excuse to eliminate highway, rail, or airport infrastructure, nor would it eliminate the need to maintain it.

Musks’s assumption might be too optimistic, however: for safety, the time between pod departures might have to be longer. than 30 seconds. Eschenbach asserts 80 that seconds would be more reasonable, which would slash capacity by about 60% relative to Musk’s estimate. And that doesn’t account for potential bottlenecks at stops where pods must be depressurized and repressurized. And if substantially heavier freight pods are intermingled with passenger pods, as anticipated, the required intervals between departures might have to be longer.

Economics

Few large transportation projects are self-funding. Typically, user fees fail to cover operating costs, let alone capital costs. The projected fares quoted by proponents of the Missouri hyperloop are low: “cheaper than the price of gas to drive” cross-state. Perhaps we could say about $25, based on that statement. That won’t make much of a dent in the cost of construction.

The hyperloop’s economic viability for freight traffic is questionable as well, though freight traffic seems to be a fallback position among boosters when confronted with the uncertainties of passenger travel via hyperloop. The Blue-Ribbon report says the expected cost of freight via hyperloop might range from $1.40 per mile to $2.80 on the high end, putting the mid-point well above the $1.69 per mile average cost of shipping by truck. Will speed make the hyperloop a competitive alternative for shippers? In fact, freight via hyperloop might be much worse than rail or truck in solving the “last mile” problem. That’s because the speeds that are its presumed advantage also mean fewer terminals are possible. The system would have to rely as heavily on integration with other modes of transportation as any other form of long-distance carriage, and perhaps more.

The last-mile problem eats into hyperloop’s presumed environmental advantages, which are not as clear cut as its enthusiasts would have you believe. Maintaining a vacuum in a gargantuan tube will not be a low-energy proposition, nor will powering the magnetic levitation/propulsion system, with or without a vacuum. Pressurized, climate-controlled pods will require still more power, and that’s to say nothing of the energy required to fabricate one-inch thick steel cylinders, huge magnets, and the rest of the support infrastructure. Reassurances that hyperloop will be powered exclusively by “green” technologies should be taken with a grain of salt. 

Virginia Postrel believes that regulation might be the biggest threat to the success of hyperloop, though she seems a bit optimistic about the actual economics of the technology. Safety will be a major concern for regulators. The technology will be subject to common carrier rules, and there will be other hurdles at the federal, state and local levels. And what of the health effects of prolonged exposure to those powerful magnetic forces? They may be insignificant, but the question will come up and possibly litigated.

Conclusion

A hyperloop cannot be built and operated without a significant and ongoing investment of public funds. The hoped-for public-private partnership needed to build the system would require major investors, and brave investors. Promoters say the project is not unlike efforts to build the railroads in the 19th century, which must have seemed like a daunting task at the time, and one involving huge financial risk. Fair enough, but the railroads stood to benefit in that age from a huge pent-up desire to exploit distant resources. The Missouri hyperloop is not quite comparable in that respect. It might be attractive mainly as a novelty, much like the Loop Trolley. Moreover, it didn’t take long for the railroads to become desperate rent-seekers, unable to profit from their heavily-subsidized investments without further public intervention on their behalf.

The hyperloop is a truly seductive idea. It’s the sort of thing that even small government types find irresistible, but there is little doubt that taxpayers will pay dearly. It’s not clear to me that the project will create meaningful social benefits or address compelling social risks. Therefore, let’s be cautious about making huge public commitments until this technology is farther along in development and the benefits can be estimated with greater certainty.

Yes, The Left Eats Its Own

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Here’s a piece worth reading, published this weekend in The NY Times: “Those People We Tried To Cancel? They’re All Hanging Out Together“, by John McDermott. It provides some great illustrations of caretakers of “woke” culture forming circular firing squads. That’s exactly where social justice warriors have led themselves.

One very sore victim of cancellation is a conservative named David Marcus who, in his life before cancellation, worked in the New York theatre scene for years. Marcus  writes in The Federalist that he found McDermott’s article disgusting because it doesn’t convey the real damage done by this sort of treatment. I’m not sure that’s a fair criticism of the article, though it’s true that McDermott can’t resist taking swipes at a few individuals, including Dave Chappelle and Scarlett Johansson (“provocative or clueless or callous“).

The article adds value, however, in showing that there’s life after intellectual tyranny, speech suppression, and “othering”, especially if you just don’t give a damn about the self-annointed thought police. Many of them will have their own days of reckoning just around the corner. It doesn’t take long in that sort of poisoned environment. Of course, they might go after poor McDermott first!

Buttinskies Get Vapours Over Vapes, Rx Pain Killers

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Every now and then I have to grind my axe against reflexive prohibitionism and the misplaced blame for health issues that runs along with it. This time, my outburst is prompted first by a recent study of opioid deaths, and by developments in the vastly less horrifying vaping scare. Both of these issues are like red meat to the busy-bodies of the world, who just can’t stand to sit by knowing that someone might be doing something into which they might affect an heroic intervention.

Pain Is the Price

Pharmaceutical companies have been settling opioid lawsuits brought against them for failing to provide adequate warnings with opioid painkillers about the potential for addiction, for allegedly distributing quantities in areas with “vulnerable” populations, and for other aggressive marketing tactics. Purdue Pharmaceuticals filed for bankruptcy after agreeing to $12 billion in settlements. Many more cases remain for these companies. Settlements, of course, are not admissions of guilt. Rather, they are the least costly way for these companies to extract themselves from situations in which they have been scapegoated by the grieving families of victims, plaintiffs’ attorneys with instincts for deep pockets, and naive reporting by an uninformed news media.

This week came reports of a new study in Massachusetts that found only a small percentage of opioid deaths in which decedents had been prescribed an opioid. According to the researchers:

The major proximal contributors to opioid-related overdose deaths in Massachusetts during the study period were illicitly made fentanyl and heroin. … The people who died with a prescription opioid like oxycodone in their toxicology screen often don’t have a prescription for it.”  

And as Jacob Sullum notes at the last link, this is in line with a number of other studies:

A 2007 study found that 78 percent of OxyContin users seeking addiction treatment reported that they had never been prescribed the drug for any medical reason. Other studies have found that only a small minority of people treated for pain, ranging from something like 1 percent of post-surgical patients to less than 8 percent of chronic pain patients, become addicted to their medication. A 2015 study of opioid-related deaths in North Carolina found 478 fatalities among 2.2 million residents who were prescribed opioids in 2010, an annual rate of 0.022 percent.”

Most people who become addicted to opioids, and most people who OD, begin their use in pursuit of a high. There are issues over which the pharmaceutical industry can be criticized, but it does not deserve much blame for abuse of the medications it produces. Providing pain medications to health care providers for patients with legitimate needs should not be subject to such severe legal risk. This fraught legal environment has a chilling effect on the willingness of manufacturers to meet those needs, not to mention risk-averse physicians. You, too, are likely to suffer severe pain one day, and your plight will be made worse by these effective prohibitionists.

The Vaping Panic

The dangers of vaping are vastly exaggerated, and the tremendous benefits of vaping for those wishing to quit smoking cigarettes have seemingly been forgotten. Vaping products are far less dangerous than cigarettes, but it matters little to prohibitionists at the federal and state levels. This includes the Trump Administration and such Democrats as Rashida Tlaib and Debbie Wasserman-Shultz, who have jumped on the anti-vaping bandwagon with an opportunistic fervor.

Vaping has increased dramatically among teenagers. Flavored or otherwise, it is likely to have substituted for cigarettes among teens to some extent. Many adult vapers seem to like flavored vaping products as well. As others have noted, a ban on flavored vaping products will make little difference: vapers like the nicotine! And like any form of prohibition, vaping bans will lead to more dangerous varieties of product as buyers turn to the black market for vaping supplies, or simply smoke more cigarettes.

A recent proposal in the House Ways and Means Committee to tax e-cigarettes is also terribly misguided. If we’re going to “nudge” anyone, which in this case is to follow the traditional economic prescription to tax things that harm, then surely we ought to consider where the greater harm lies. Cigarettes are already taxed. Introducing a tax on a relatively new alternative constituting a far lesser harm is sure to have undesirable effects on public health.

Summary

It must be cathartic to identify someone or something to blame for tragedies for which the victims themselves are largely at fault. We know too that the enterprise of bringing legal action against corporate scapegoats is financially rewarding. Unfortunately, those scapegoats can have little confidence in the courts’ ability to reach objective decisions, so they feel compelled to settle with plaintiffs at still great expense. It’s a racket that leads to stunted development of new drugs and under-prescription of painkillers. Tort reform, potentially to include caps on damages and financial risks to plaintiffs attorneys, can mitigate these effects, and it is as important now as ever.

Alarmism over vaping creates risks of a different nature. Vaping is not free of risk, but neither is it a massive threat to public health. It is, in fact, a less harmful alternative than cigarette smoking. Authorities should be cautious in their approach to regulating vapes and e-cigarettes, lest they discourage attractive and safer alternatives to smoking.

Regulation, Crowding Out, and Malformed Capital

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Expanding regulation of the private sector is perhaps the most pernicious manifestation of “crowding out”, a euphemism for the displacement of private activity by government activity. The idea that government “crowds out” private action, or that government budget deficits “crowd out” private investment, has been debated for many years: government borrowing competes with private demand to fund investment projects, bidding interest rates and the cost of capital upward, thus reducing business investment, capital intensity, and the economy’s productive capacity. Taxes certainly discourage capital investment as well. That is the traditional fiscal analysis of the problem.

The more fundamental point is that as government competes for resources and absorbs more resources, whether financed by borrowing or taxation, fewer resources remain available for private activity, particularly if government is less price-sensitive than private-sector buyers.

Is It In the Data?

Is crowding out really an issue? Private net fixed investment spending, which represents the dollar value of additions to the physical stock of private capital (and excludes investments that merely replace worn out capital), has declined relative to GDP over many decades, as the first chart below shows. The second chart shows that meanwhile, the share of GDP dedicated to government spending (at all levels) has grown, but with less consistency: it backtracked in the 1990s, rebounded during the early years of the Bush Administration, and jumped significantly during the Great Recession before settling at roughly the highs of the 1980s and early 1990s. The short term fluctuations in both of these series can be described as cyclical, but there is certainly an inverse association in both the short-term fluctuations and the long-term trends in the two charts. That is suggestive but far from dispositive.

Timothy Taylor noted several years ago that the magnitude of crowding out from budget deficits could be substantial, based on a report from the Congressional Budget Office. That is consistent with many of the short-term and long-term co-movements in the charts above, but the explanation may be incomplete.

Regulatory Crowding Out

Regulatory dislocation is not the mechanism traditionally discussed in the context of crowding out, but it probably exacerbates the phenomenon and changes its complexion. To the extent that growth in government is associated with increased regulation, this form of crowding out discourages private capital formation for wholly different reasons than in the traditional analysis. It also encourages malformation — either non-productive or misallocated capital deployment.

I acknowledge that regulation may be necessary in some areas, and it is reasonable to assert that voters demand regulation of certain activities. However, the regulatory state has assumed such huge proportions that it often seems beyond the reach of higher authorities within the executive branch, not to mention other branches of government. Regulations typically grow well beyond their original legislative mandates, and challenges by parties to regulatory actions are handled in a separate judicial system by administrative law judges employed by the very regulatory agencies under challenge!

Measures of regulation and the regulatory burden have generally increased over the years with few interruptions. As a budgetary matter, regulation itself is costly. Robert Higgs says that not only has regulation been expanding for many years, the growth of government spending and regulation have frequently had common drivers, such as major wars, the Great Depression of the 1930s, and the financial crisis and Great Recession of the 2000s. In all of these cases, the size of government ratcheted upward in tandem with major new regulatory programs, but the regulatory programs never seem to ratchet downward.

While government competes with the private sector for financial capital, its regulatory actions reduce the expected rewards associated with private investment projects. In other words, intrusive regulation may reduce the private demand for financial capital. Assuming there is no change in the taxation of suppliers of financing, we have a “coincidence” between an increase in the demand for capital by government and a decrease in the demand for capital by business owing to regulatory intrusions. The impact on interest rates is ambiguous, but the long-run impact on the economy’s growth is negative, as in the traditional case. In addition, there may be a reallocation of the capital remaining available from more regulated to less regulated firms.

The Costs of Regulation

Regulation imposes all sorts of compliance costs on consumers and businesses, infringing on many erstwhile private areas of decision-making. The Mercatus Center, a think tank on regulatory matters based at George Mason University, issued a 2016 report on “The Cumulative Cost of Regulations“, by Bentley Coffey, Patrick A. McLaughlin, and Pietro Peretto. It concluded in part:

… the effect of government intervention on economic growth is not simply the sum of static costs associated with individual interventions. Instead, the deterrent effect that intervention can have on knowledge growth and accumulation can induce considerable deceleration to an economy’s growth rate. Our results suggest that regulation has been a considerable drag on economic growth in the United States, on the order of 0.8 percentage points per year. Our counterfactual simulation predicts that the economy would have been about 25 percent larger than it was in 2012 if regulations had been frozen at levels observed in 1980. The difference between observed and counterfactually simulated GDP in 2012 is about $4 trillion, or $13,000 per capita.”

In another Mercatus Center post, Tyler Richards discusses the link between declining “business dynamism” and growth in regulation and lobbying activity. Richards measures dynamism by the rate of entry into industries with relatively high profit potential. This is consistent with the notion that regulation diminishes the rewards and demand for private capital, thus crowding out productive investment.

Regulation, Rent Seeking, and Misallocation

Some forms of regulation entail mandates or incentives for more private investment in specific forms of physical capital. Of course, that’s no consolation if those investments happen to be less productive than projects that would have been chosen freely in the pursuit of profit. This often characterizes mandates for alternative energy sources, for example, and mandated investments in worker safety that deliver negligible reductions in workplace injuries. Some forms of regulation attempt to assure a particular rate of return to the regulated firm, but this may encourage non-productive investment by incenting managers to “gold plate” facilities to capture additional cash flows.

Regulations may, of course, benefit the regulated in certain ways, such as burdening weaker competitors. If this makes the economy less competitive by driving weak firms out of existence, surviving firms may have less incentive to invest in their physical capital. But far worse is the incentive created by the regulatory state to invest in political and administrative influence. That’s the thrust of an essay by Wayne Brough in Real Clear Markets: “Political Entrepreneurs Are Crowding Out the Entrepreneurs“. The possibility of garnering regulations favorable to a firm reinforces  the destructive focus on zero-sum outcomes, as I’ve gone to pains to point out on this blog.

Crowding out takes still other forms: the growth of the welfare state and regulatory burdens tend to displace private institutions traditionally seeking to improve the lives of the poor and disenfranchised. It also disrupts incentives to work and to seek help through those private aid organizations. That is a subject addressed by James Whitford in “Crowding Out Compassion“.

Just Stop It!

President Trump has made some progress in slowing the regulatory trend. One example of the Administration’s efforts is the two-year-old Trump executive order demanding that two regulatory rules be eliminated for each new rule. Thus far, many of the discarded regulations had become obsolete for one reason or another, so this is a clean-up long overdue. Other inventive efforts at reform include moving certain agency offices out of the Washington DC area to locales more central to their “constituencies”, which inevitably would mean attrition from the ranks of agency employees and with any luck, less rule-making. The judicial branch may also play a role in defanging the bureaucracy, like this case involving the Consumer Financial Protection Bureau now before the Supreme Court. Unfortunately, tariffs represent taxation of consumers and firms who use foreign goods as inputs, so Trump’s actions on the regulatory front aren’t all positive.

Conclusion

The traditional macroeconomic view of crowding out involves competition for funds between government and private borrowers, higher borrowing costs, and reduced private investment in productive capital. The phenomenon can be couched more broadly in terms of competition for a wide variety of goods and services, including labor, leaving less available for private production and consumption. The growth of the regulatory state provides another piece of the crowding-out puzzle. Regulation imposes significant costs on private parties, including small businesses that can ill-afford compliance. The web of rules and reporting requirements can destroy the return on private capital investment. To the extent that regulation reduces the demand for financing, interest rates might not come under much upward pressure, as the traditional view would hold. But either way, it’s bad news, especially when the regulatory state seems increasingly unaccountable to the normal checks and balances enshrined in our Constitution.

Ideology and the Public School Monopoly

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I toured our local public high school not long ago after some renovations. It’s my old school and my kids attended there as well, though it’s been largely stripped of its old character. Our sweet tour guide, when asked about school security and whether any staff are armed, said no, and then proudly informed us that the temperament of the school was “pretty progressive”, and that sort of thing would not go over well. Later, as I stepped into the new library, I happened to notice a table right up-front intended to showcase several books. The first title I laid eyes on was “Social Justice”, a topic emphasizing all manner of grievances, current and historical, the identification of culpable parties (and their unworthy descendants), and presumed correctives. The latter include reparations, redistribution, control of speech, criminalization, and often shaming. At best, these correctives deliver palliatives to the aggrieved that must be forcibly extracted by the state from others, with little consideration for the predictably disastrous second-order effects they engender.

The prominent display of the social justice book and our tour guide’s attitude regarding security were unsurprising manifestations of the educational emphasis our kids get today: the public schools have become indoctrination camps. Of course, a good class in American history will leave no doubt about the injustices that have occurred in our nation over 250 years. There were many individual victims and many groups were victimized. We could say the same about a good class in European history, or the history of events in any region of the world. However, the social justice doctrine being peddled to our children today assigns blame for victimhood to anyone deemed not to be a victim, as well as the growth and very success of western civilization, including capitalism, this despite the unprecedented comforts available today across the socioeconomic spectrum. It’s as if the SJWs wish to convince our children that all economic gains are of the zero-sum variety.

The politicization of the curriculum in our schools is an extremely dangerous phenomenon. Many schools are banning literature, distorting history, subverting science in favor of politicized orthodoxy, and teaching social justice math“, which I’m sure is heavy on zero-sum word problems. And how about this “Run from the cop” worksheet given to first graders in a Pittsburgh school! Federal and state education authorities are taking an active hand in much of this. For example, a new ethnic studies curriculum for California high schools proposed by the state Department of Education takes a notably anti-Israel perspective. At the federal level, there is the Common Core initiative (and see here) which, in addition to educational inefficacy, is a source of many of the same concerns cited above. President Obama’s school discipline policy, heavy in its emphasis on “disparate impact”, was perhaps even more disastrous (and see here).

Social studies textbooks today are increasingly written by leftist authors who distort U.S. history, present anti-science viewpoints on environmental topics, and promote the divisive tenets of multiculturalism. The U.S. history covered in this prominent textbook is subject to a variety of left-wing biases, but it is not unique in that regard. And it’s not only a matter of bias in favor of collectivist philosophy and leftist interpretations of historical events. For example, it’s way over the top to teach public school children that Christians are bigots.

But God bless the teachers, many of whom are indeed wonderful people, and many of whom are very good at what they do (my daughter being a prime example!). There is little doubt, however, that leftism dominates the faculty in most public schools. John Hinderaker writes of the political activism practiced by the faculty at a high school in Edina, Minnesota, where lessons about “white privilege” are part of the curriculum even in the feeder schools. It’s a travesty that many of our nation’s public school teachers are products of university schools of education with extremely low academic standards relative to other academic divisions within those universities. And these schools of education have been thoroughly politicized. Needless to say, a good many of their graduates are easily cowed by the typical “feel-good”, free-lunch, social justice arguments made by the Left.

In a sense, these civil servants are a local counterpart to the army of federal bureaucrats sometimes known as the “deep state”. They are funded by taxpayers and are often represented by powerful unions. Under-performing teachers are difficult to dismiss, and they are able to exercise great discretion in the messages they deliver to students. As Darleen Click writes, “The ‘woke’ want your children“.

The leftist thrust of public education today descends from a long evolution shaped by “progressive” education reforms, and most reforms receiving attention within today’s education establishment fail to address the single biggest problem: the public school monopoly. That inattention is reinforced by attempts to maintain ideological purity among participants in the debate over school reform. Social studies teachers Mike Margeson and Justin Spears, writing for the Foundation for Economic Education on the motives for establishing public education, say the following about historical reforms:

The objective was to nationalize the youth in a particular mold. … From Luther to Fichte, the idea to use the coercive power of the state to force kids into schools and indoctrinate them was clear. Horace Mann became instrumental in importing this system and helping it spread throughout the United States.”

Breaking the public education monopoly is imperative to improving both the quality and cost of education. That means choice, in all it’s liberating glory. J.D. Tuccille has a great take on this issue: choice is the only way we can assure that our children are taught from a perspective that parents most prefer. Many parents know that they must take an active part in educating their children. That includes their role in selecting the school they believe will be best for their kids, as well as ongoing scrutiny of the school’s performance. A simple by-product of choice is that schools and their faculties might be more circumspect about shading their instruction with their own political agendas.

 

 

Another Flop at the Impeachment Playhouse

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Listen, President Trump drives me crazy. His policy instincts often strike me as dangerous: trade protectionist, inflationist, and cronyist. I’m still suspicious that he might play ball with statists left and right on critical issues, when and if he perceives a political advantage in doing so. And Trump is hopelessly inarticulate and belligerent. Nevertheless, I will almost certainly vote for him in 2020 for several reasons, not least because the feasible alternatives are completely unacceptable. That view is reinforced by the behavior of the Democrat party in their effort to fabricate “high crimes and misdemeanors” on Trump’s part. That effort is not just dishonest, it is foolish, and they have a lot to lose. Their machinations are likely to blow up in their faces.

For one thing, the Democrats don’t seem to have much of a case. This time they are focused on a May 2019 phone conversation that took place between Trump and the recently-elected Ukrainian President Volodymyr Zelenskiy. The Democrats contend that Trump held up military aid in order to pressure Zelenskiy to investigate the Biden family’s activities in the Ukraine, a charge flatly denied by Zelenskiy. In fact, at the time of the call, the Ukrainians has no idea that military aid had been suspended, a fact first reported by The New York Times.

The Trump Administration released a transcript of the Zelenskiy call, which offers no evidence that a quid pro quo was offered by Trump. Even the text messages released this morning fail to support the claim. Joe Biden’s name came up during the call in connection with potential interference by the Ukraine in the 2016 U.S. presidential campaign. That’s reasonable in light of the events reported to have taken place, and it is certainly within the scope of presidential powers, as were Trump’s efforts to discuss election interference with Australia, the U.K., and other countries.

If you don’t know it already, a successful impeachment in the House of Representatives will not remove Trump from office. It will constitute a referral of charges to the Senate, which is controlled by Republicans, and a conviction requires a two-thirds majority. Ain’t gonna happen.

In the meantime, there really is no formal “impeachment” underway, despite what you think you’ve heard. This is a “proceeding” that House Speaker Nancy Pelosi really had no authority to initiate, and there is no set of rules or procedures guiding the spectacle. An impeachment investigation requires a House vote, but Democrats voted to table a resolution calling for such a vote because they really don’t want one, not yet anyway. Why? Because it would force them to go on record before they’re quite sure they want to, but more importantly it would demand due process for the accused. A House vote for an impeachment investigation would give House Republicans subpoena powers, something Democrats don’t want to take a chance on.

Again, the whole effort by the Democrats will ultimately be futile, and the trial proceedings in the Senate might be very ugly for them as well. It is likely to shed light on several matters that offer unflattering context for the impeachment effort and might well lead to criminal charges against prominent Democrats and their operatives:

These are all troubling questions that should be investigated. We may or may not get to the bottom of it before the impeachment vote in the House, if it ever occurs. Senate Republicans will undoubtedly be interested in pursuing many of these areas of inquiry, and Joe Biden will not come out of this unscathed. There is likely considerable evidence to support claims that he used political influence to gain his son Hunter favor in the Ukraine and China. 

This month, DOJ Inspector General Michael Horowitz is expected to release his report on the origins and conduct of the Russia investigation into Trump’s 2016 presidential campaign. including potential corruption of the FISA process. His report will reflect the findings of two U.S. attorneys conducting separate inquiries into various aspects of the matter. These reports are a potential disaster for Democrats. Perhaps the distraction of impeachment theatre seems desirable to them, but the longer they continue the fruitless effort to “get Trump”, which began well before he was elected, the more incompetent they look. They don’t seem to have noticed that the whole spectacle is strengthening Trump’s base of support.

Which brings me back to Trump’s belligerence, which I briefly decried above. And it’s true, I often wince, but then I often laugh out loud as well. His political opponents and the media are constantly aghast at his every unapologetic response to their attacks. I will readily admit that it’s deeply satisfying to witness him hurling the crap right back at them, right on the schnoz. In the case of the impeachment drama, his base of support and many others in the middle know the Dems richly deserve it.