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COVID Politics and Collateral Damage

26 Sunday Jul 2020

Posted by pnoetx in Pandemic, Public Health

≈ 2 Comments

Tags

American Journal of Epidemiology, Andrew Cuomo, Anthony Fauci, Banality of Evil, CDC, City Journal, CMS, Donald Trump, Elective Surgery, Epidemiological Models, FDA, Gavin Newsom, Gretchen Whitmer, Harvey Risch, Hydroxychloraquin, Import Controls, Joel Zinberg, Lockdowns, Newsweek, NIH, Phil Murphy, Politico, PPE, Price Gouging, Prophylaxis, Quarantines, Steve Sisolak, The Lancet, Tom Wolf, Yale School of Public Health

Policymakers, public health experts, and the media responded to the coronavirus in ways that have often undermined public health and magnified the deadly consequences of the pandemic. Below I offer several examples of perverse politics and policy prescriptions, and a few really bad decisions by certain elected officials. Some of the collateral damage was intentional and motivated by an intent to inflict political damage on Donald Trump, and people of good faith should find that grotesque no matter their views on Trump’s presidency.

Politicized Treatment

The smug dismissal of hydroxychloraquine as Trumpian foolishness was a crime against humanity. We now know HCQ works as an early treatment and as a prophylactic against infection. It’s has been partly credited with stanching “hot spots” in India as well as contributing strongly to control of the contagion in Switzerland and in a number of other countries. According to epidemiologist Harvey Risch of the Yale School of Public Health, HCQ could save 75,000 to 100,000 lives if the drug is widely used. This is from Dr. Risch’s OpEd in Newsweek:

“On May 27, I published an article in the American Journal of Epidemiology (AJE) entitled, ‘Early Outpatient Treatment of Symptomatic, High-Risk COVID-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis.’ That article, published in the world’s leading epidemiology journal, analyzed five studies, demonstrating clear-cut and significant benefits to treated patients, plus other very large studies that showed the medication safety. …

Since [then], seven more studies have demonstrated similar benefit. In a lengthy follow-up letter, also published by AJE, I discuss these seven studies and renew my call for the immediate early use of hydroxychloroquine in high-risk patients.”

Risch is careful to couch his statements in forward-looking terms, but this also implies that tens of thousands of lives could have been saved, or patients might have recovered more readily and without lasting harm, had use of the drug not been restricted. The FDA revoked its Emergency Use Authorization for HCQ on June 15th, alleging that it is not safe and has little if any benefit. An important rationale cited in the FDA’s memo was an NIH study of late-stage C19 patients that found no benefit and potential risks to HCQ, but this is of questionable relevance because the benefit appears to be in early-stage treatment or prophylaxis. Poor research design also goes for this study and this study, while this study shared in some shortcomings (e.g., and no use of and/or controls for zinc) and a lack of statistical power. Left-wing outlets like Politico seemed almost gleeful, and blissfully ignorant, in calling those studies “nails in the coffin” for HCQ. Now, I ask: putting the outcomes of the research aside, was it really appropriate to root against a potential treatment for a serious disease, especially back in March and April when there were few treatment options, but even now?

Then we have the state governors who restricted the use of HCQ for treating C19, such as Gretchen Whitmer (MI) and Steve Sisolak (NV). Andrew Cuomo (NY) decided that HCQ could be dispensed only for hospital use, exactly the wrong approach for early stage treatment. And all of this resistance was a reaction to Donald Trump’s optimism about the promise of HCQ. Yes, there was alarm that lupus patients would be left without adequate supplies, but the medication is a very cheap, easy to produce drug, so that was never a real danger. Too much of the media and politicians have been complicit in denying a viable treatment to many thousands of C19 victims. If you were one of the snarky idiots putting it down on social media, you are either complicit or simply a poster child for banal evil.

Seeding the Nursing Homes

The governors of several states issued executive orders to force nursing homes to accept C19 patients, which was against CMS guidance issued in mid-March. The governors were Andrew Cuomo (NY), Gretchen Whitmer (MI), Gavin Newsom (CA), Tom Wolf (PA), and Phil Murphy (PA). This was a case of stupidity more than anything else. These institutions are home to the segment of the population most vulnerable to the virus, and they have accounted for about 40% of all C19 deaths. Nursing homes were ill-prepared to handle these patients, and the governors foolishly and callously ordered them to house patients who required a greater level of care and who represented an extreme hazard to other residents and staff.

Party & Protest On

Then of course we had the mayor of New York City, Bill De Blasio, who urged New Yorkers to get out on the town in early March. That was matched in its stupidity by the array of politicians and health experts who decided, having spent months proselytizing the need to “stay home”, that it was in their best interests to endorse participation in street protests that were often too crowded to maintain effective social distance. That’s not a condemnation of those who sought to protest peacefully against police brutality, but it was not a good or consistent recommendation in the domain of public health. Thankfully, the protests were outside!

Testing, Our Way Or the Highway

The FDA and CDC were guilty of regulatory overreach in preventing early testing for C19, and were responsible for many lives lost early in the pandemic. By the time the approved CDC tests revealed that the virus was ramping up drastically in March, the country was already behind in getting a handle on the spread of the virus, quarantining the infected, and tracing their contacts. There is no question that this cost lives.

Masks… Maybe, But Our Way Or the Highway

U.S. public health authorities were guilty of confused messaging on the efficacy of masks early in the pandemic. As Joel Zinberg notes in City Journal, Anthony Fauci admitted that his own minimization of the effectiveness of masks was motivated by a desire to prevent a shortage of PPE for health care workers:

“In discouraging mask use, Fauci—for decades, the nation’s foremost expert on viral infectious diseases—was not acting as a neutral interpreter of settled science but as a policymaker, concerned with maximizing the utility of the limited supply of a critical item. An economist could have told him that there was no need to misinform the public. Letting market mechanisms work and relaxing counterproductive regulations would ease shortages. Masks for health-care workers would be available if we were willing to pay higher prices; those higher prices, in turn, would elicit more mask production.”

Indeed, regulators made acquisition of adequate supplies of PPE more difficult than necessary via compliance requirements, “price gouging” rules, and import controls.

Bans on Elective Surgery

Another series of unnecessary deaths was caused by various bans on elective surgeries across the U.S. (also see here), and we’re now in danger of repeating that mistake. These bans were thought to be helpful in preserving hospital capacity, but hospitals were significantly underutilized for much of the pandemic. Add to that the fright inspired by official reaction to C19, which keeps emergency rooms empty, and you have a universe of diverse public health problems to grapple with. As I said on this blog a couple of months ago:

“… months of undiagnosed cardiac and stroke symptoms; no cancer screenings, putting patients months behind on the survival curve; deferred procedures of all kinds; run-of-the-mill infections gone untreated; palsy and other neurological symptoms anxiously discounted by victims at home; a hold on treatments for all sorts of other progressive diseases; and patients ordinarily requiring hospitalization sent home. And to start back up, new health problems must compete with all that deferred care. Do you dare tally the death and other worsened outcomes? Both are no doubt significant.”

Lockdowns

The lockdowns were unnecessary and ineffectual in their ability to control the spread of the virus. A study of 50 countries published by The Lancet last week found the following:

“Increasing COVID-19 caseloads were associated with countries with higher obesity … median population age … and longer time to border closures from the first reported case…. Increased mortality per million was significantly associated with higher obesity prevalence … and per capita gross domestic product (GDP) …. Reduced income dispersion reduced mortality … and the number of critical cases …. Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people.”

That should have been obvious for a virus that holds little danger for prime working-age cohorts who are most impacted by economic lockdowns.

Like the moratoria on elective surgeries, lockdowns did more harm than good. Livelihoods disappeared, business were ruined, savings were destroyed, dreams were shattered, isolation set in, and it continues today. These kinds of problems are strongly associated with health troubles, family dysfunction, drug and alcohol abuse, and even suicide. It’s ironic that those charged with advising on matters pertaining to public health should focus exclusively on a single risk, recommending solutions that carry great risk themselves without a second thought. After all, the protocol in reviewing new treatments sets the first hurdle as patient safety, but apparently that didn’t apply in the case of shutdowns.

Even as efforts were made to reopen, faulty epidemiological models were used to predict calamitous outcomes. While case counts have risen in many states in the U.S. in June and July, deaths remain far below model predictions and far below deaths recorded during the spring in the northeast.

One last note: I almost titled this post “Attack of the Killer Morons”, but as a concession to what is surely a vain hope, I decided not to alienate certain readers right from the start.

 

 

3 Cheers, No Tears for Strike on Master of Iranian Terror

08 Wednesday Jan 2020

Posted by pnoetx in Middle East, War

≈ Leave a comment

Tags

AL Monitor, Al-Quds, Anderson Cooper, Avi Melamed, Bloomberg, Charles De Gaulle, Decapitation, Deterrence, Donald Trump, Iran, Iranian Mullah Regime, Iraq, Kataeb Hezbollah, Politico, Qassim Soleimani, Regime Change, Retaliation, Reuters, Saudi Arabia, Self-Defense, Syria, Terrorism, Tyler Cowen, Victor Davis Hanson, World War III

Note: As I finish this post, Iran has fired missiles at U.S. bases in Iraq, so we know a bit more about their response to the killing of Qassim Soleimani. Tonight’s response by Iran looks to have been impotent. There are risks of other kinds of action, of course. We shall see.

Last week’s killing of Iranian General Qassim Soleimani was not prompted solely by the attack on the U.S. embassy in Iraq by Kataeb Hezbollah, the Iranian-backed militia. Iran, perhaps the largest state-sponsor of terrorism in the world, has been guilty of provocation and aggression in Iraq, Syria, Saudi Arabia and elsewhere under Soleimani’s direction for many years. And he was reviled for his ruthless treatment of protestors within Iran’s borders. In recent weeks there had been a series of rocket attacks on U.S. bases, and there was “chatter” that much more was planned. It’s been noted that the presence of so-many high-level officials in one place at the time of the attack on Soleimani indicated that something big was in the works. This Reuters article gives some insight into Soleimani’s suspicious activities in the weeks prior to his death, of which the U.S. was surely aware. While the attack on the U.S. embassy provided additional pretext (as if it was needed), all of this indicates that Soleimani’s assassination was not an impulsive decision, but deliberated, contrary to assertions by critics of President Trump’s decision to act. It was both retaliatory and preemptive. Soleimani’s travels and whereabouts were well known, and it’s highly likely that a “decapitation” had been planned as a contingency for some time. This report in Politico provides details of the decision making leading up to the strike. The attack was executed brilliantly by all accounts.

The U.S. had retaliated to earlier rocket attacks with strikes against Kataeb Hezbollah positions. That the strike on Soleimani was more than retaliation and an act of self-defense against additional threats is, I believe, the flaw in arguments against the strike like the one Tyler Cowen seemed to make in Bloomerg (though his main point was different). The value of the strike goes far beyond retaliation. This was not intended to be another volley in an ongoing series of “tits-for-tats”.

In addition to Soleimani, several other high-level Iranian military personnel were killed. This undoubtedly disrupted plans that would have threatened U.S. soldiers and assets, yet some describe the strike as an “impulsive” act on Trump’s part, and an “act of war”, as if unprovoked. And as if Iran had not been warring on the U.S. for the past 40 years. What to make of those who take this position?  Of course, most are reflexively anti-Trump, refusing to evaluate the decision on it’s own merits. They pretend that Soleimani and the Iranian overseers of the stooge government in Iraq have legitimacy. Anderson Cooper actually compared Soleimani to Charles De Gaulle. It would be more accurate to compare him to the murderous Che Guevara, but then again, many on the Left worship Che’s memory as well! These fools will tell you that Soleimani was “worshipped” in Iran. In fact, there are a great many Iranians who are quietly celebrating his death.

Middle East analyst Avi Melamed does not mince words in describing the impact Soleimani has had on the Middle East (emphasis his):

“Some argue that the assassination of Soleimani will increase tensions in the Middle East. This outlook confuses cause and effect: Tensions in the Middle East have intensified over the past decade because of the violent Iranian aggression which Soleimani spearheaded. Aggression which has led to Syria’s destruction and the disintegration of Lebanon and Iraq. Aggression that threatens maritime routes and safe passage in the Arab (Persian) Gulf and the Red Sea, a direct attack on Saudi Arabia’s oil facilities that spiked oil prices and compromised the world’s oil supply. Aggression that has fueled and intensified tensions – including direct military confrontations – between Iran and its proxies and Israel.

General Soleimani and the Al-Quds force led the escalation in the region in the service of the hegemonic vision of the Iranian Mullah regime. Their actions have so far claimed the lives of hundreds of thousands of people, led to the destruction of states, the disintegration of cities, and caused a wave of millions of refugees. Killing Soleimani is not the cause of the escalation – but the result.”

Malamed expected Iran to take retaliatory actions in Iraq, where it already has a strong military presence and good reconnaissance. Missiles have now been fired at U.S. bases from Iran (as of tonight), but with few or no casualties. It remains to be seen how effective a response the Iranians can mount. Any short-term U.S. casualties should probably not be viewed as incremental, given the high likelihood of casualties had Soleimani lived. Perhaps Iran will fire missiles at Israel from western Iraq or Syria, or at Saudi Arabian oil assets, as it did last September. Or it might make a bold military intervention in Iraq to strengthen its control there, which Iran considers crucial to its own security.

Al Monitor believes the assassination “leaves Iran with very few options to retaliate” with any strength, at least in the short-run:

“… the economic hardship in Iran — in addition to the challenges the government is facing internally — would not allow Tehran to increase the tension. Iran’s past conduct against Israel strikes on Iranian bases in Syria also shows it will not seek revenge if its national security and interests are in danger. … This all indicates that Iran and its proxies in the region most likely would not seek revenge in the near future and — in regard to Iraq, in particular — would not lead Iraq to fall into a civil war or mass destruction, because it would lose even more in Iraq if it takes such a risk.”

So despite the brash talk, Iran is weak and spread thin across commitments outside its borders, and the regime has real fear of retaliation by its enemies that can only have been reinforced by the strike against Soleimani. Of what other retaliatory actions is Iran capable, assuming the regime can survive in the longer run? And assuming the Mullah regime itself is willing to take existential risks? It has threatened actions against civilians in the West. Can it bring down planes? Can it bomb targets in the U.S.? Can it develop or buy a small nuclear device? It can try any of those things, of course, but with uncertain odds and with risks it might not want to take. Survival is of the utmost importance to the regime, and it is already on shaky ground.

Trump’s critics claim that he authorized the “decapitation” without a plan for its aftermath. Trump has made clear his intent to “punch back twice as hard”, as it were, in response to any additional force from Iran. This is, first and foremost, a game of deterrence. Beyond that, however, and despite talk of “changing the Iranian regime’s behavior”, it appears that the larger plan pursued by Trump is to continue undermining the regime with sanctions and targeted strikes, if necessary. “Maximum pressure”. But there will be no World War III. The markets seem pretty comfortable about that as well, including the oil market.

I do take issue with Trump’s mention of the possibility of striking “cultural sites” in Iran, though he seems to have retracted it. On that point, however, I fully agree with Tyler Cowan (linked above). The only plausible rationale for such a statement is to frighten Iran’s leadership, especially if it has located military and intelligence functions within cultural sites.

Trump still maintains that our ultimate goal should be withdrawal from Iraq. That assumes stabilization in the region and fair elections, which would be well-served by a weaker Iran or a regime change there. As Victor Davis Hanson explains, the Middle East is of declining importance in world energy markets and trade generally. That’s one reason we’re unlikely to ever again send a huge ground force to the region, and it’s a good reason to scale back our presence in the Middle East generally.

Trump Flaunts Shape-Shifting Powers

06 Thursday Aug 2015

Posted by pnoetx in Government, Liberty, Tyranny

≈ 4 Comments

Tags

Andy Kroll, Common Core, Donald Trump, eminent domain, FreedomFest, Immigration policy, Jeffrey Tucker, On the Issues, Peter Suderman, Politico, Populism, Reason, Trump campaign, Trump Policies, Trump Policy Positions, Trumpism, Wealth Tax

trump characature

Donald Trump could take just about any position on any issue and defend it with conviction and blustery passion… until he changes his mind. At this point in his presidential bid, there is nothing on his campaign web site in the way of specific policy statements. Here is an “On The Issues” post showing the evolution of Trump’s positions in a number of policy areas. Just about anyone on the left or the right should be able to get a few chuckles out of this list. It’s truly astonishing.

A few of Trump’s current policy positions are discussed below, but before getting into that, it’s interesting to consider the overall tenor of his rhetoric. Most observers will happily admit that they find his bombast entertaining, and I do too. He’s outspoken and unapologetic, confronting his critics head-on, often to powerful effect. Many are drawn to this sort of candidate, and his popular image as a skilled businessman doesn’t hurt. But while all politicians are capable of disappointing supporters, Trump fans do not know, and cannot know, what they’re getting.

Trump is almost always critical but rarely suggests actual solutions, making it difficult to discern whether he really has policy positions. So much so that it’s incredible to hear praise for his “clarity”. For a more sober take, read Andy Kroll’s account of frustrated attempts to get direct responses on a few policy issues from the Trump campaign, and of Trump’s bizarre tour of Laredo, Texas. A related piece by Peter Suderman appears at Reason.com. Politico has emphasized the same point in “Will the real Donald Trump please stand up?“. Kroll says this:

“I have zero to report about Trump’s plans for actually being president—except that, from all available evidence, he hasn’t given it a moment’s thought.“

An interesting piece on Trump comes from Jeffrey Tucker in “What is Trumpism?“. A longer version appeared as “Trumpism: The Ideology“. Here is one bit from Tucker, written after hearing “The Donald” speak at FreedomFest:

“The speech lasted an hour, and my jaw was on the floor most of the time. I’ve never before witnessed such a brazen display of nativistic jingoism, along with a complete disregard for economic reality. It was an awesome experience, a perfect repudiation of all good sense and intellectual sobriety. …

His speech was like an interwar séance of once-powerful dictators who inspired multitudes, drove countries into the ground, and died grim deaths.“

Here are a few examples of Trump’s “nativism”, as described by Tucker:

“I did laugh as he denounced the existence of tech support in India that serves American companies (‘how can it be cheaper to call people there than here?’ — as if he still thinks that long-distance charges apply). 

When a Hispanic man asked a question, Trump interrupted him and asked if he had been sent by the Mexican government. He took it a step further, dividing blacks from Hispanics by inviting a black man to the microphone to tell how his own son was killed by an illegal immigrant.“

Two issues on which Trump has been outspoken are international trade and immigration. As an aside, I note that he is always quick to qualify any aggressive statements he makes on these topics with a quick “I love the Chinese”, or “I love the Mexicans”. Tucker, at the link above, highlights Trump’s backward views on trade, which focus almost exclusively on U.S. producers without considering the benefits of trade to U.S. consumers. He sees big ships coming into port, and thinks only of cash flowing abroad: “What do we get?” Well, we get nice foreign goods, thank you very much. But Trump blames foreign trading partners for many ills, despite the fact that his Trump-label ties are made in China! Are we somehow being cheated on those ties? Trump says we need smarter people negotiating “these deals”. Okay… is that a policy?

We don’t need trade wars if we want to avoid a much weaker economy. Yet Trump’s trade rhetoric suggests that he would be tempted to employ trade restrictions like tariffs as a bludgeon. For example, consider one of his other big talking points: illegal immigration (despite the fact that the inflow of illegals has slowed to a trickle over the past few years). Trump wants to build a wall across the length of the U.S.-Mexican border, and he says he’ll make Mexico pay for it. To get a wall built, Trump might well decide that he can raise tariffs on Mexican goods to prohibitive levels as a way of twisting Mexican arms. That sort of action is likely to be very costly for U.S. consumers, and ultimately producers as well.

Trump’s latest pronouncements on immigration policy have been described as confusing. In a nutshell, he wants to deport “the criminals” (and not just those already doing time) and deport all other undocumented aliens; create an expedited process whereby we can let “the good ones” back into the country with legal status; “maybe” create some sort of path to citizenship (because “who knows what’s going to happen”), but not right away; and “we’re going to do something” for the “DREAMers”. Trump says he’ll know how to identify the “good ones”. If he’s so confident of that, then why would he, a smart “business guy”, allow the country to incur the expense of deporting millions of them?

Who knows what Trump will propose in terms of tax reform, health care and gun control? Ditto on welfare policy, defense, the drug war, foreign policy and energy. He wisely spoke against the drug war in 1990, but I’m not aware of any recent statements on the issue. Also in his favor, he does not accept the “consensus” on climate change and opposes Common Core. He has criticized crony capitalism but has undoubtedly benefited from cronyism, enlisting governments in the pursuit of eminent domain action. He is said to favor cuts in federal spending, but he has opposed cuts in Social Security and Medicare. He opposes an increase in the minimum wage, but he has proposed a wealth tax in the past.

Trump has not offered many specifics in this campaign, and the GOP debate this Thursday night will not provide a decent forum for articulating policy. In general, his positioning is a very mixed bag. One gets the sense that he is doing his best to appeal to a sort of populist conservatism. Unfortunately, his signature “positioning” on trade and immigration qualify him as something of a statist. He has certainly held a number of other statist views in the past, though he has disavowed at least some of those.

In closing, here are two more quotes from Jeffrey Tucker about Trump that I found both ominous and plausible:

“What’s distinct about Trumpism, and the tradition of thought it represents, is that it is not leftist in its cultural and political outlook (see how he is praised for rejecting “political correctness”), and yet still totalitarian in the sense that it seeks total control of society and economy and demands no limits on state power.“

“These people are all the same. They purport to be populists, while loathing the decisions people actually make in the marketplace (such as buying Chinese goods or hiring Mexican employees).“

Obamanomics and Opportunity Knocked Off

10 Wednesday Jun 2015

Posted by pnoetx in Regulation

≈ 1 Comment

Tags

Coyote Blog, Department of Labor, Effective wage, Exempt employees, Non-exempt employees, Obama administration, Overtime rules, Politico, the administrative state, Warren Meyer

find-govt-worker

Another Obama fallacy and a new, binding constraint on voluntary private arrangements: in the latest example of administrative rule-making gone berserk, the Obama Administration (via The Department of Labor) is proposing a drastic change in the definition of an exempt employee, increasing the salary threshold for the exemption from $23,660 to as much as $52,000. This is likely to change the status of a large number of workers, but as Warren Meyer explains, not in the way the administration hopes.

Obama and his advisors imagine that this change will actually increase the incomes of a large number of workers — that employers will begin paying overtime to hard-working supervisory and administrative employees. Meyer quotes Politico‘s headline: “Barack Obama poised to hike wages for millions.” But employers are not indifferent to the cost of a given labor input.

As Meyer asserts, currently exempt employees who now earn a salary between the current and the new thresholds may well be converted to hourly, non-exempt employees. And those now working extra hours are likely to be working fewer hours under the new rules. In fact, they may well see their hours and incomes reduced. Some employers will be able to automate certain tasks to compensate for the reduction in labor input, as Meyer suggests. Or perhaps more part-time workers will be hired.

There is another issue at stake, however, in addition to the mere calculation of workers X hours X the wage rate. Meyer expresses disgust at the way the new threshold could change relationships between employers and certain employees. As he tells it, the change will convert ambitious young managers into clock-punchers. In case that sounds too much like a negative personality change, a more sympathetic view is that many workers do not mind putting in extra hours, even as it reduces their effective wage. They have their reasons, ranging from the non-pecuniary, such as simple work ethic, enjoyment and pride in their contribution to reward-driven competitiveness and ambition. Hours worked gives exempt employees an additional margin along which to prove their value to the enterprise. Obama’s proposal takes that away, which may penalize employees with less talent but strong ambition. Opportunity’s knock is getting softer.

Fifty Ways To Wreck Your Health Care

29 Thursday Jan 2015

Posted by pnoetx in Obamacare

≈ 1 Comment

Tags

ACA, central planning, EHR mandate, Electronic Health Records, health care rationing, John Boehner, Matt Battaglioni, Medicare payments, Mises Daily, Obamacare, Obamacare exchange subsidies, Politico

health care wait times

It’s getting to be a challenge to keep track of the myriad ways in which Obamacare is screwing up the medical insurance and health care markets. This is a government initiative, after all, but was there ever a law so rife with unintended consequences, or a law implemented with such stunning incompetence? I’ve posted on the fallout from the so-called Affordable Care Act (ACA) a number of times in the past, but there’s always some new revelation at which to marvel. Here’s one you might not have heard, but it actually contains a bit of good news: some people are refusing Obamacare exchange subsidies, despite the sometimes strange fact that they qualify at all, which of course is the bad news.

“… some people who qualify for subsidies based on their income could afford to pay their own way. ‘There is no question that we are enrolling  people through these programs who would otherwise be considered middle-class or even affluent,’ says Ed Haislmaier, a senior research fellow for health policy studies at the right-leaning Heritage Foundation think tank. ‘We are seeing people with enrollment in these programs that have significant assets, but for whatever reason – usually a temporary reason – fall below the income line.’ Those reasons could range from early retirement to a midcareer job change. But whatever the case, some of those who are turning down subsidies are aware others are gaming the system, and they think it’s wrong.”

Well, apparently there is still some honor in the world, even in the face of seduction by the welfare state.

Obamacare contained provisions on electronic health records (EHRs) and was expected to leverage a separate federal initiative on EHRs in the 2009 economic stimulus bill. This too is proving disastrous. Beyond the privacy implications of making medical records accessible to the prying eyes of government bureaucrats and potential hackers, the mandate faced by providers to convert to the EHR system necessitates an extremely time-consuming and costly effort. And the penalty for failing to meet deadlines is a cut in Medicare payments to the provider. No one seems to have considered the supply-side incentive this might create:

“It would thus appear that one method for avoiding the fine would be to stop serving Medicare patients altogether. Well, that’s one way to ration care for the elderly.”

So, in the fashion typical of central planners, the bureaucrats have failed to consider the effects of their policies on real market conditions. The author quotes a recent piece in Politico on the EHR mandate:

“Rather than saving physicians and health care money, the program in effect has created a new industry — the medical scribe. About 100,000 of these glorified typists are expected to be working for doctors by 2020. ‘After five years I can’t really do anything I couldn’t do before the program started,’ says Martin O’Hara, a cardiologist who practices in northern Virginia. Computers make everything more legible, O’Hara says, but otherwise the payoff has been slim. At one hospital in the D.C. area, administrators were pulling their hair out over the huge fees charged to transmit data including routine lab and radiology tests. ‘I talk to EHR vendors all day long and many of them have these criminal-like practices of setting whatever price tag they want because they can,’ said a medical informatics officer who spoke on condition he not be named. … The slow progress of health IT has also put a drag on research.”

Finally, in a post on some basics of good (and bad) health care reform appearing in Mises Daily, Matt Battaglioli discusses the unavoidable reliance on arbitrary methods of rationing in centrally-planned health care systems. (I like that cartoon above, but it’s no joke.) That need is created by a mis-pricing of services. Subsidies prevent consumers from seeing the real cost of routine and non-catastrophic medical services as well as the ex ante, actuarial cost of catastrophic services. Then, unfortunately, the resultant excess demand tends to push costs upward without the natural restraint of a well-functioning market price mechanism. Battaglioli also bemoans the obstacles to competition in the medical field due to licensing requirements and their impact on the supply of care.

Obamacare is under threat on several fronts, including Congress, the courts, consumers, providers, and it’s own clumsy architecture. Apparently congressional Republicans will soon reveal their “one plan” (as described by John Boehner) for health care reform to replace Obamacare. We’ll see if they can do much better.

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Blogs I Follow

  • TLCCholesterol
  • Nintil
  • kendunning.net
  • DCWhispers.com
  • Hoong-Wai in the UK
  • Marginal REVOLUTION
  • CBS St. Louis
  • Watts Up With That?
  • Aussie Nationalist Blog
  • American Elephants
  • The View from Alexandria
  • The Gymnasium
  • Public Secrets
  • A Force for Good
  • ARLIN REPORT...................walking this path together
  • Notes On Liberty
  • troymo
  • SUNDAY BLOG Stephanie Sievers
  • Miss Lou Acquiring Lore
  • Your Well Wisher Program
  • Objectivism In Depth
  • RobotEnomics
  • Orderstatistic
  • Paradigm Library
  • Scattered Showers and Quicksand

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TLCCholesterol

The Cholesterol Blog

Nintil

To estimate, compare, distinguish, discuss, and trace to its principal sources everything

kendunning.net

The future is ours to create.

DCWhispers.com

Hoong-Wai in the UK

A Commonwealth immigrant's perspective on the UK's public arena.

Marginal REVOLUTION

Small Steps Toward A Much Better World

CBS St. Louis

News, Sports, Weather, Traffic and St. Louis' Top Spots

Watts Up With That?

The world's most viewed site on global warming and climate change

Aussie Nationalist Blog

Commentary from a Paleoconservative and Nationalist perspective

American Elephants

Defending Life, Liberty and the Pursuit of Happiness

The View from Alexandria

In advanced civilizations the period loosely called Alexandrian is usually associated with flexible morals, perfunctory religion, populist standards and cosmopolitan tastes, feminism, exotic cults, and the rapid turnover of high and low fads---in short, a falling away (which is all that decadence means) from the strictness of traditional rules, embodied in character and inforced from within. -- Jacques Barzun

The Gymnasium

A place for reason, politics, economics, and faith steeped in the classical liberal tradition

Public Secrets

A 93% peaceful blog

A Force for Good

How economics, morality, and markets combine

ARLIN REPORT...................walking this path together

PERSPECTIVE FROM AN AGING SENIOR CITIZEN

Notes On Liberty

Spontaneous thoughts on a humble creed

troymo

SUNDAY BLOG Stephanie Sievers

Escaping the everyday life with photographs from my travels

Miss Lou Acquiring Lore

Gallery of Life...

Your Well Wisher Program

Attempt to solve commonly known problems…

Objectivism In Depth

Exploring Ayn Rand's revolutionary philosophy.

RobotEnomics

(A)n (I)ntelligent Future

Orderstatistic

Economics, chess and anything else on my mind.

Paradigm Library

OODA Looping

Scattered Showers and Quicksand

Musings on science, investing, finance, economics, politics, and probably fly fishing.

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