Tag Archives: Reason Magazine

Coronavirus Controversies

11 Saturday Apr 2020

Posted by in Health Care, Leftism, Pandemic

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The coronavirus and the tragedy it has wrought has prompted so many provocative discussions that it’s hard to pick just one of those topics for scarce blogging time. So I’ll try to cover two here: first, the question of whether coronavirus deaths are being miscounted; second, the politically-motivated controversy over the use of hydroxychloraquin to treat severe cases of Covid-19.

Counting Deaths

I’ve been suspicious that Covid deaths are being over-counted, but I’m no longer as sure of that. Of course, there are reasons to doubt the accuracy of the death counts. For example, there is a strong possibility that some Covid deaths are simply not being counted due to lack of diagnoses. But there are widespread suspicions that too many deaths with positive diagnoses are being counted as Covid deaths when decedents have severe co-morbidities. Members of that cohort die on an ongoing basis, but now many or all of those deaths are being attributed to Covid-19. A more perverse counting problem might occur when public health authorities instruct physicians to attribute various respiratory deaths to Covid even without a positive diagnosis! That is happening in some parts of the country.

To avoid any bias in the count, I’ve advocated tracking mortality from all co-morbidities and comparing the total to historical or “normal” levels to calculate “excess deaths”. One could also look at all-cause mortality and do the same, though I don’t think that would be quite on point. For example, traffic deaths are certainly way down, which would distort the excess deaths calculation.

Despite the vagaries in counting, there is no question that the coronavirus has been especially deadly in its brief assault on humans. New York has experienced a sharp increase in deaths, as the chart below illustrates (the chart is a corrected version of what appeared in the Reason article at the prior link). The spike is way out of line with normal seasonal patterns, and it obviously corresponds closely with deaths attributable to Covid-19. It is expected to be short-lived, but it might taper over the course of several weeks or months, Once it does, I suspect that the cumulative deaths under all those other curves in the chart will exceed Covid deaths substantially. Also note that the yellow line for the flu just stops when Covid deaths begin, suggesting that the red line probably incorporates at least some “normal” flu deaths.

Once the virus abates, we’ll be able to tell with a bit more certainty just how deadly the pandemic has been. It will be revealed through analyses of excess deaths. For now, we have the statistics we have, and they should be interpreted cautiously.

Hydrochloraquin

A more boneheaded debate centers on the use of the anti-malarial drug hydroxychloraquin (HCQ) to treat coronavirus patients. There have been many successes, particularly in combination with a Z-Pak, or zinc. Guidelines issued by the American Society of  Thoracic Surgeons last week call for HCQ’s use in advanced cases of coronavirus infection. These and other therapies are being tested formally, but many are prescribed outside any formal testing framework. Remdesivir has been prominent among these. Plasma therapy has been as well, and several other possible treatments are under study.

With respect to HCQ, it’s almost as if the Left, much of the media, and a subset of overly “prescriptive” medical experts were goaded into an irrational position via pure Trump Derangement. Just Google or Bing “Hydroxychloraquine Coronavirus” for a bizarre list of alarmist articles about Trump’s mention of HCQ. To take just two of the claims, the idea that Trump stands to earn substantial personal profits from HCQ because he holds a few equity shares in a manufacturer of generic drugs is patently absurd. And claims that shortages for arthritis, lupus, and malaria patients are imminent are unconvincing, given the massive stockpiles now accumulated and the efforts to ramp-up production.

So much lefty hair is on fire over a potential therapy that is both promising and safe that the media message lacks credulity. But more ominously, the Democrat governors of Michigan and Nevada were so petulant that they banned HCQ’s use in their states, though at least Nevada’a governor rescinded his order. It’s almost as if they don’t want it to work, and don’t want to give it a chance to work. Or do I go too far? No, I don’t think so.

Victoria Taft has a good summary of the media backlash against President Trump’s hopeful statements about HCQ. Not only was the FDA’s authority over the use of HCQ misrepresented, there was also a good bit of smearing of various researchers who’d found preliminary evidence of HCQ’s effectiveness. Let’s be honest: the quality of medical research is often inflated by the research establishment. And the media eat up any study with findings that are noteworthy in any way. Over the years, a great deal of medical research has been based on small samples from which statistical hypothesis tests are shaky at best. That’s one reason for the legendary replication problem in medical research. In the case of HCQ, there has been widespread misuse of the term “anecdotal” in the media, prompted by experts like Dr. Anthony Fauci, who should know better. The term was used to describe clinical tests on moderately large groups of patients, at least one of which was a randomized control trial.

Every day we hear stories from individual patients that they were saved by HCQ. These are properly called anecdotal accounts. But we also hear from various physicians around the country and world who claim to be astonished at HCQ’s therapeutic efficacy on groups of patients. This link gives another strong indication of how physicians feel about HCQ at this point. These are not from RCTs, but they constitute clinical evidence, not mere “anecdotes”.

By virtue of state and federal right-to-try laws, terminally ill patients can choose to take medications that are unapproved by regulators. Beyond that, FDA approval of HCQ specifically for treating coronavirus was unnecessary because the drug was already legal to prescribe to cover patients as an “off-label” use. That’s true of all drugs approved by the FDA: they can be prescribed legally for off-label uses. When regulators like Dr. Fauci, and even practicing physicians like Dr. Jeffrey Singer (linked below) claim that the FDA hasn’t approved HCQ specifically for treating Covid, it is a technicality: the FDA can certainly “approve” it for that specific use, but it’s already legal to prescribe!

While it won’t end the silly argument, which is obviously grounded in other motives, Dr. Singer brings us to the only reasonable position: treatment of Covid with HCQ is between the patient and their doctor.

 

 

White House Spins Weak Obamacare Enrollments

24 Monday Aug 2015

Posted by in Markets, Obamacare

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obamacare-humor-Screw

The Obama Administration is trying desperately to burnish the record of the President’s signature “achievement”, the Affordable Care Act (ACA), a.k.a. Obamacare.  That’s a tall order, unless the subject is the ACA’s remarkable triumph for excellence in high cronyism. Otherwise, little wonder that they tell only part of the Obamacare story. Robert Laszewski recently examined ACA’s enrollment in more detail and found the record rather dismal. He notes the following:

“… the Obama administration is just reporting the good news and a good share of the press appears to be happy to pass these numbers along–albeit in a technically correct but hardly complete way.“

Here are two examples provided by Laszewski:

  • The Rand Corporation reported that a net total of 16.9 million people were newly enrolled through February 2015. This was picked up by the press, which attributed the increase to Obamacare. But only 4.1 million of those newly insured came from the individual marketplaces (as noted by Rand). Most of those eligible for coverage through the marketplaces have not enrolled. Most of those who have enrolled were qualified for subsidies. Another 6.5 million came from Medicaid, which is free to those who qualify for that program. 9.6 million came from employer-provided plans, which has much to do with improved hiring over the past two years, as opposed to the ACA.
  • There were almost 950,000 new enrollees during the “special enrollment period” (after open enrollments ended) this year. This was heralded by the media, but little was said about the 1.3 million who dropped off the Obamacare rolls by the end of March. That number will grow once the administration comes clean on the number who have dropped coverage since then.

From Laszewski:

“The Obamacare insurance exchanges aren’t enrolling anywhere near the number of people they were supposed to. And, there is no proof Obamacare has grown since the close of open enrollment. In fact the anecdotal and historical evidence would suggest it is now shrinking.“

Going forward, the prospects for ACA enrollment are not good. As Slate belatedly reported last month, substantial premium increases are expected for 2016. The Heartland Institute‘s “Somewhat Reasonable” blog reports that “Millions of Americans Refuse to Buy Obamacare, Prefer to Pay Penalty“. The total who have refused is 7.5 million, much more than expected, while another 12 million people have claimed that they are exempt from the ACA’s requirements. Obamacare pricing and subsidies contain perverse incentives. It remains to be seen whether the insurers dominating the exchanges will have a sufficient number of young, healthy individuals enrolled and paying inflated premiums to offset the claims of more heavily-subsidized, high-risk enrollees.

There are many other problems plaguing Obamacare, including limited access to health care providers for many enrollees. Reason.com recently asked whether Obamacare is simply too complex to work, a question based largely on the findings of an HHS Inspector General’s report. There are massive issues related to verification of eligibility for subsidies and back-end payment systems for compensating insurers:

“Think of it this way: Before Obamacare, the U.S. health system was like a giant tangled knot. If you’ve ever tried to untangle a big knot, you know that it can take a while, and that the trick is to patiently loosen one bit at a time.

Obamacare’s designers, in contrast, saw that they couldn’t undo the knot, so they added more string, and tied it into the knot that was already there. Now it’s an even bigger mess.“

The so-called Obamacare success story is wishful thinking and shameless propaganda. It has failed to accomplish its goals in terms of coverage and especially cost, it has resulted in lost coverage to millions in the individual market who “liked their plans”, and it has caused millions of others who “liked their doctors” to lose their doctors. Things are not looking any rosier as we approach the implementation of the employer mandate (which was delayed twice) in 2016.

There are many ideas in play for improving health care coverage and access post-Obamacare. Here are summaries of the plans floated so far by Republican Presidential candidates Scott Walker and Marco Rubio. Though neither plan is a detailed as I’d like, some of the proposed high-level features are promising, at least relative to the ACA. There will be more proposals from other candidates before long. I’m hopeful that they will all remember to let markets work.

Balancing Gay Rights and Religious Rights

08 Wednesday Jul 2015

Posted by in Liberty

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Government boot

Gay marriage rights are considered a big win among libertarians, but there are thorny issues on the horizon as LGBT activists contest certain liberties of other groups. Last month’s landmark Supreme Court decision in Obergefell v. Hodges established that same-sex marriage is protected by the 14th Amendment to the Constitution. Unfortunately, the established rights of different groups are sometimes in conflict; recognition of one individual right under the Constitution does not invalidate the established rights of others. Rather, these rights exist pari-passu unless some intractable conflict exists. Any challenge to a right of one party by another must be resolved based upon whether the courts find a compelling reason, under the circumstances of the case, to favor one right over another. Depending on the details, the result may establish a narrow or a broad precedent.

Last week, Reason carried a good discussion of several areas of possible conflict between the positions of certain LGBT activists and the libertarian view: “Is This Where Libertarians and the Gay Community Part Ways?“, by Scott Shackford, covered each of the general issues listed below, which I’ll attempt to summarize. The libertarian resolution to most of these issues is dependent upon whether the challenge is against a government entity or a private party. This dichotomy follows from a constitutional philosophy under which the powers of government are strictly enumerated and the presumed rights of private individuals are broad and unenumerated. Many libertarians, Shackford included, believe that conflicts are often easily resolved when all alternatives for both parties are considered. For that reason, simply allowing private social arrangements to evolve is superior to intrusion by government aimed at righting perceived wrongs.

Employment Nondiscrimination: Shackford is skeptical that congressional passage of the long-debated federal Employment Non-Discrimination Act (ENDA) would accomplish much because there has already been such a significant shift in the cultural acceptance of homosexuality. Nevertheless, he is supportive of laws prohibiting anti-gay discrimination by government employers.

The ENDA would grant gay and transgender individuals the same status as other protected classes under federal law. With certain exceptions, it would require private employers to offer employment and benefits to LGBTs and same-sex married couples on the same basis as heterosexuals. This is meaningless unless gay individuals self-identify on job applications. It would also require that employers collect data on sexual preference and transgender status, which is costly, likely to be somewhat unreliable and disturbingly intrusive. But the most vexing aspect of federal law prohibiting discrimination by private employers against LGBTs is the potential conflict with the employer’s religious convictions.

The ENDA exempts religious organizations. The real challenge is balancing the rights of homosexuals with those of private employers having deeply-held religious beliefs opposing homosexuality. Should the rights of gays take precedence over the religious rights of private employers? There should certainly be no presumption that gays are dependent upon religious private employers for work. And there should be no presumption of “hate” on the part of a religious employer who does not wish to offer  any pecuniary support to homosexuals. Thus, it is difficult to argue that the employment rights of gays trump the religious rights of private employers, and because alternatives exist for gays, many libertarians see this as a simple issue of live and let live.

Religious Freedom Exemptions: This is about the asserted freedom to decide not to do  business with LGBTs based on religious convictions. Examples are the Muslim baker and the Christian photographer who do not wish to take business related to same-sex weddings. As I noted in “Suit Me or Face a Lawsuit: Adventures in Litigation Land“, compulsion to practice an art or to engage in any act of expression against one’s religious convictions is not acceptable from a libertarian perspective. That does not justify discrimination in a business’s public accommodations, however, where the doors of the business are open for purchases by the general public. The public at large, protected groups and otherwise, should have the freedom to transact there.

Shackford makes some good points in this section, including a rebuttal of the argument that to be engaged in “doing business” somehow disqualifies an individual from refusing an order based on religion:

“This argument flips the idea of civil liberties completely on its head and attributes the source of our rights to the government, a contradiction of the spirit of our own Constitution.“

Transgender Recognition: Most libertarians believe that individuals should have the right to identify publicly as the gender with which they identify privately:

“Fundamental to liberty is the right to personal identity and expression. This includes gender. Transgender citizens have the same right as everybody else to live their lives as they please without unnecessary government interference.“

Shackford again draws the crucial distinction between government and private sector accommodation for the needs of transgender individuals:

“In the private sector, it’s all a matter of cultural negotiation and voluntary agreements. The law should not be used to mandate private recognition of transgender needs, whether it’s requiring insurance companies cover gender reassignment surgeries or requiring private businesses to accommodate their bathroom choices. The reverse is also true: It would be inappropriate for the government to forbid insurance coverage or to require private businesses to police their own bathrooms to keep transgender folks out.“

Adoption: Shackford notes that gay couples can now adopt children in any state, including a partner’s child. But conflicts arise involving religious adoption agencies that are unwilling to work with homosexuals wishing to adopt. Activists would like to stop the flow of public funds to these institutions, but that position is indefensible on several grounds: adoption is foremost about helping children, and it is counter-productive to undermine an agency with a track record of positive performance. There are secular alternatives for adoption as well. Second, placing children in homes undoubtedly provides benefits to taxpayers that exceed the funds supporting these agencies. Finally, the activist position is indefensible as an attack on religious liberty.

Bullying in Schools: Cultural acceptance of gays or any other difference might not extend readily to the schoolyard. Bullying should always be dealt with firmly, but new legal protections for gays should not give way to policies that may be excessively harsh:

“… whatever is done to try to curtail bullying needs to be managed with the understanding that we are dealing with children on both sides of the issue…. 

The libertarian concern here is, just as with the other issues, using the state or the law to punish people—in this case, children—when there are better social tools for this battle… before considering new policies or laws with the intention of fighting bullying, activists need to remind themselves that public schools now have … oppressive disciplinary policies that they use to discard students at the first sign of trouble. The last thing we need is more ‘zero tolerance’ policies. As it stands, we have children and teenagers being arrested by police for common school misconduct and their families forced to deal with costly and time-wasting court systems. It is an absurd outcome that actually threatens children’s futures.“

Shackford closes with a few thoughts about the usefulness of school choice for helping parents find the most hospitable school environment for their children.

Libertarians have been consistent supporters of gay marriage rights, nondiscrimination by public institutions and in the public accommodations of private businesses. However, libertarians are unlikely to support LGBT activists in attempts to curtail religious liberties. This includes the liberty to run a business in a manner consistent with one’s religious beliefs, whether or not that conflicts with the ideals of the LGBT community. Conflicting rights must be balanced in a way that is most neutral and least harmful. Libertarians generally believe that there is no remedy for a violation of religious rights. When the religious rights of private business owners are protected with respect to their non-public accommodations, any imposition this might inflict on other parties is usually mitigated by the existence of willing competitors. Alas, there is no right to a life free of insults, unintended or otherwise.

Major Mistake: The Minimum Opportunity Wage

06 Saturday Jun 2015

Posted by in Price Controls

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City leaders in St. Louis and Kansas City are the latest to fantasize that market manipulation can serve as a pathway to “economic justice”. They want to raise the local minimum wage to $15 by 2020, following similar actions in Los Angeles, Oakland  and Seattle. They will harm the lowest-skilled workers in these cities, not to mention local businesses, their own local economies and their own city budgets. Like many populists on the national level with a challenged understanding of market forces (such as Robert Reich), these politicians won’t recognize the evidence when it comes in. If they do, they won’t find it politically expedient to own up to it. A more cynical view is that the hike’s gradual phase-in may be a deliberate attempt to conceal its negative consequences.

There are many reasons to oppose a higher minimum wage, or any minimum wage for that matter. Prices (including wages) are rich with information about demand conditions and scarcity. They provide signals for owners and users of resources that guide them toward the best decisions. Price controls, such as a wage floor like the minimum wage, short-circuit those signals and are notorious for their disastrous unintended (but very predictable) consequences. Steve Chapman at Reason Magazine discusses the mechanics of such distortions here.

Supporters of a higher minimum wage usually fail to recognize the relationship between wages and worker productivity. That connection is why the imposition of a wage floor leads to a surplus of low-skilled labor. Those with the least skills and experience are the most likely to lose their jobs, work fewer hours or not be hired. In another Reason article, Brian Doherty explains that this is a thorny problem for charities providing transitional employment to workers with low-skills or employability. He also notes the following:

“All sorts of jobs have elements of learning or training, especially at the entry level. Merely having a job at all can have value down the line worth enormously more than the wage you are currently earning in terms of a proven track record of reliable employability or moving up within a particular organization.“

The negative employment effects of a higher wage floor are greater if the employer cannot easily pass higher costs along to customers. That’s why firms in highly competitive markets (and their workers) are more vulnerable. This detriment is all the worse when a higher wage floor is imposed within a single jurisdiction, such as the city of St. Louis. Bordering municipalities stand to benefit from the distorted wage levels in the city, but the net effect will be worse than a wash for the region, as adjustments to the new, artificial conditions are not costless. Again, it is likely that the least capable workers and least resourceful firms will be harmed the most.

The negative effects of a higher wage floor are also greater when substitutes for low-skilled labor are available. Here is a video on the robot solution for fast food order-taking. In fact, today there are robots capable of preparing meals, mopping floors, and performing a variety of other menial tasks. Alternatively, more experienced workers may be asked to perform more menial tasks or work longer hours. Either way, the employer takes a hit. Ultimately, the best alternative for some firms will be to close.

The impact of the higher minimum on the wage rates of more skilled workers is likely to be muted. A correspondent of mine mentioned the consequences of wage compression. From the link:

“In some cases, compression (or inequity) increases the risk of a fight or flee phenomonon [sic]–disgruntlement culminating in union organizing campaigns or, in the case of flee, higher turnover as the result of employees quitting. … all too often, companies are forced to address the problem by adjusting their entire compensation systems–usually upward and across-the-board. .. While wage adjustments may sound good for those who do not have to worry about profits and losses, the real impact for a company typically means it must either increase productivity or lay people off.“

For those who doubt the impact of the minimum wage hike on employment decisions, consider this calculation by Mark Perry:

“The pending 67% minimum wage hike in LA (from $9 to $15 per hour by 2020), which is the same as a $6 per hour tax (or $12,480 annual tax per full-time employee and more like $13,500 per year with increased employer payroll taxes…)….“

Don Boudreaux offers another interesting perspective, asking whether a change in the way the minimum wage is enforced might influence opinion:

“... if these policies were enforced by police officers monitoring workers and fining those workers who agreed to work at hourly wages below the legislated minimum – would you still support minimum wages?“

Proponents of a higher minimum wage often cite a study from 1994 by David Card and Alan Krueger purporting to show that a higher minimum wage in New Jersey actually increased employment in the fast food industry. Tim Worstall at Forbes discussed a severe shortcoming of the Card/Krueger study (HT: Don Boudreaux): Card and Krueger failed to include more labor-intensive independent operators in their analysis, instead focusing exclusively on employment at fast-food chain franchises. The latter were likely to benefit from the failure of independent competitors.

Another common argument put forward by supporters of higher minimum wages is that economic theory predicts positive employment effects if employers have monopsony power in hiring labor, or power to influence the market wage. This is a stretch: it describes labor market conditions in very few localities. Of course, any employer in an unregulated market is free to offer noncompetitive wages, but they will suffer the consequences of taking less skilled and less experienced hires, higher labor turnover and ultimately a competitive disadvantage. Such forces lead rational employers to offer competitive wages for the skills levels they require.

Minimum wages are also defended as an anti-poverty program, but this is a weak argument. A recent post at Coyote Blog explains “Why Minimum Wage Increases are a Terrible Anti-Poverty Program“. Among other points:

“Most minimum wage earners are not poor. The vast majority of minimum wage jobs are held as second jobs or held by second earners in a household or by the kids of affluent households. …

Most people in poverty don’t make the minimum wage. In fact, the typically [sic] hourly income of the poor appears to be around $14 an hour. The problem is not the hourly rate, the problem is the availability of work. The poor are poor because they don’t get enough job hours. …

Many young workers or poor workers with a spotty work record need to build a reliable work history to get better work in the future…. Further, many folks without much experience in the job market are missing critical skills — by these I am not talking about sophisticated things like CNC machine tool programming. I am referring to prosaic skills you likely take for granted (check your privilege!) such as showing up reliably each day for work, overcoming the typical frictions of working with diverse teammates, and working to achieve management-set goals via a defined process.”

Some of the same issues are highlighted by the Show-Me Institute, a Missouri think tank, in “Minimum Wage Increases Not Effective at Fighting Poverty“.

A higher minimum wage is one of those proposals that “sound good” to the progressive mind, but are counter-productive in the extreme. The cities of St. Louis and Kansas City would do well to avoid market manipulation that is likely to backfire.

Court Strength In The Constitution

30 Friday Jan 2015

Posted by in Judicial Branch

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santorumandi

An important function of the judicial branch of government is to defend the U.S. Constitution and the constitutional rights of individuals. In my view, deference on the part of courts to legislative decisions or to court precedent should be viewed with skepticism. The plain text of the Constitution should always come first. Beyond that, however, judges should not interject their personal opinions into decisions. Does this position support so-called “judicial activism”, or “judicial restraint”? Many legal thinkers reject that dichotomy because it embodies contradictions, failing to reliably categorize my position combining constitutional precedence with a rejection of political preference in jurisprudence. The pairing seems natural enough to me.

“Judicial activism” is often used as a pejorative, as Randy Barnett says at the link above, quoting a Boston Globe article that quotes him:

” ‘Most people who use the term don’t provide a coherent definition of it. It typically means judicial opinions with which they disagree,’ says Randy E. Barnett, a law professor at Boston University who considers himself a libertarian and a defender of ‘original intent’ in Constitutional matters. [He should have written ‘original meaning’ not “original intent” –RB.]”

According to Reason‘s Damon Root, Rand Paul calls himself a judicial activist. It would be interesting to hear exactly how he defines it, but he also purports to be something of a strict constitutionalist. In “Why Rand Paul’s Case for ‘Judicial Activism’ Scares Both Liberals and Conservatives“, Root discusses the interesting coincidence that contrary to Paul, both traditional conservatives and progressives seem to believe in judicial restraint. His explanation:

“What these two views share in common is that they each support what amounts to virtually unchecked majoritarian rule over certain aspects of American life. For conservatives, judicial deference means that lawmakers get the last word when it comes to banning birth control and prohibiting ‘homosexual conduct.’ For liberals, judicial deference means that lawmakers get the last word when it comes to bulldozing private property in the name of eminent domain. Each approach demands judicial passivity in the face of its preferred forms of government action.”

Of course, there are lovers of government power on both the left and the right. Rand Paul wants to distance himself from their kind, but many libertarians do not believe he will stick to principles of limited government as he campaigns for the GOP nomination.

Land of the Lock-Up

26 Thursday Jun 2014

Posted by in Uncategorized

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This chart may astound you. It shows that the U.S. and most individual states lead the rest of the world in terms of incarceration rates. At 0.7% of the population, the U.S. is ahead of all other countries, including Cuba, Russia, and other nations to which we’d otherwise not wish to compare ourselves. Again, most individual states finish ahead of all other nations, well ahead. States at the top of the list have incarceration rates 2-3 times higher than Cuba, the next highest country. According to this article, “The United States has about 5% of the world’s population yet it accounts for about 25% of the world’s prisoners.” The failed war on drugs in the U.S. is one obvious factor behind our large prison population. Land of the free? 

Reason Magazine has a special issue, linked here, on the topic of mass incarceration.