Archives: June, 2011

NEJM Study: ObamaCare’s Main Coverage Vehicle Makes Kids Wait for Care

The New York Times reports on a study published in today’s New England Journal of Medicine:

Children with Medicaid are far more likely than those with private insurance to be turned away by medical specialists or be made to wait more than a month for an appointment, even for serious medical problems, a new study finds…

Sixty-six percent of those who mentioned Medicaid-CHIP (Children’s Health Insurance Program) were denied appointments, compared with 11 percent who said they had private insurance…

In 89 clinics that accepted both kinds of patients, the waiting time for callers who said they had Medicaid was an average of 22 days longer.

“It’s very disturbing,” [study author] Dr. [Karen V.] Rhodes said. “As a mother, if I had a kid who was having seizures or newly diagnosed juvenile diabetes, I would want to get them in right away.”…

Another physician not connected with the study…said: “It’s interesting to think you even need a study to prove that. It’s pretty much common knowledge.”…

This month, Dr. Rhodes and her colleagues had a similar study published in the journal Pediatrics, finding that dentists were far less likely to accept children with public insurance than those with private coverage, even for an urgent problem like a broken front tooth. Another study of hers uncovered patients’ difficulties in obtaining psychiatric care.

Here’s a graph from the study, showing how often kids with private insurance and Medicaid got appointments with various specialists:

Half of ObamaCare’s projected coverage gains (16 million out of 32 million U.S. residents) comes from expanding the Medicaid program.

Sorry About Your Burning Village, But You Released the Dragon

There’s a lot of consternation over Education Secretary Arne Duncan’s threat that if Congress doesn’t quickly create and pass a new No Child Left Behind Act he will do it himself, issuing waivers galore for states that adopt as-yet unspecified, administration-dictated reforms. As Andy Rotherham writes in Time, everyone from AEI’s Rick Hess, to angry-teachers’ hero Diane Ravitch, seems to be outraged over the notion that the executive branch would simply bypass Congress because it thinks the legislators are moving too slowly.

What did they expect when they ignored the Constitution to begin with, forgetting that it gives Washington just a few, enumerated powers, and that meddling in education (save prohibiting discrimination and controlling the District of Columbia) is not among them? When they pushed for, or acquiesced to, Washington doing all sorts of things that it has no constitutional authority to do? When they essentially accepted that the Federal Government has unlimited powers? Did they expect federal politicians to suddenly remember they are supposed to be constrained only when they want to do things the educationists don’t like?

Unfortunately, most people in education policy pick and choose when they’ll invoke the Constitution based on whether or not they like what the Feds are doing or are proposing to do. In contrast, if in their presence you consistently state that education policymaking is not among Washington’s few and defined powers, and that the Feds must get out of education, they typically either ignore you; dismiss you with a rhetorical pat and smile like you are a cute, idealistic child; or condemn you as someone who hates children, the poor, teachers, enlightenment, the nation’s economic future, progress, or some combination thereof.

Well here’s the reality: Far too many educationists have helped let the dragon out of its cage. They have only themselves to blame when it burns down their village.

Nobel Prize Winner Analyzes the Obama Growth Gap

I’ve explained before that one of the most damning pieces of evidence against Obamanomics is that the economy is suffering from sub-par growth, something that is particularly damning since normally one expects to see faster-than-average growth following an economic downturn.

In a recent presentation, Robert Lucas of the University of Chicago included a couple of graphs that illustrate this phenomenon. This first chart shows the history of U.S. economic growth over the past 140 years. As you can see, the growth rate was remarkably constant over time, and there were always periods of rapid growth following economic downturns.

Lucas, who won the Nobel Prize in economics in 1995, then looks at the data for the recent downturn and recovery. As you can see, we have been struggling to get back to average growth rates and we have not enjoyed any of the above-average growth that normally follows a recession.

The key question, of course, is why growth has been anemic, resulting in (what seems to be) a permanent loss of output. In his presentation, Lucas warns that bad government policy is playing a big role. He says that “the problem is government is doing too much,” and he specifically highlights the “likelihood of much higher taxes, focused on ‘the rich’” and a “large increase in the role of government” in the healthcare sector.

In his conclusion, Professor Lucas is not overly optimistic about recovering lost output. He doesn’t make any flamboyant claims, but he does note that “European economies have larger government role and 20-30% lower income level than US.”

The obvious connection, as I’ve pointed out on many occasions, is that America is becoming a European-style welfare state and it is unavoidable that we will suffer from European-style economic malaise.

P.S. It should be noted that America’s anemic economic performance in recent years is not solely Obama’s fault. As the White House repeatedly points out, he inherited a downturn. That is completely accurate. My complaint, however, is that Obama promised hope and change but instead has exacerbated the big government policies of his predecessor.

The Myth of the Senior Transit Rider

According to Transportation for America — which is largely a shill for the transit industry — the nation is about to face a new crisis: a shortage of mobility “options” for retiring baby boomers. According to a report published by the group on June 14, “By 2015, more than 15.5 million Americans 65 and older will live in communities where public transportation service is poor or non-existent.”

The appropriate answer to that, of course, is “So what?” Most seniors don’t ride transit. Census data show that more than 12.5 percent of all Americans are over 65, yet data from the American Public Transportation Association show that only 6.7 percent of transit trips are taken by senior citizens. The average American rides transit less than 34 times a year; the average senior citizen less than 18 times a year.

Putting that into perspective, the 2009 National Household Travel Survey says Americans over 65 take an average of 1,168 trips per year, nearly all by automobile. Transit serves only 1.5 percent of those trips. This survey of the travel habits of more than 300,000 people also found that senior citizens travel an average of 8,250 miles a year by car. Transit carries seniors an average of less than 100 miles a year, or about 1.1 percent of the total of transit and auto travel.

Despite this, Transportation for America joins the American Public Transportation Association in using the supposed needs of senior citizens to justify more transit subsidies. They say additional federal subsidies are needed to give seniors “options.”

But think about it. Baby boomers have driven cars for almost their entire lives. Nearly all of them will keep driving until they are physically or mentally unable to do so. At that point, they are probably not going to be capable of walking the quarter mile to the nearest bus stop or the half mile to the nearest rail stop that Transportation for America defines as “transit accessible.”

Those baby boomers who prefer transit over driving can do what everyone else does who prefers one set of services over another: locate to where the services they prefer are the greatest. In the case of transit riders, that generally means dense central cities.

Instead, Transportation for America wants transit agencies to extend frequent bus or rail service to every remote suburb where there might be a few people over 65 — not because those people want to ride transit, but to simply give them “options.” In order to pay for service extensions to suburbs, many transit agencies have reduced transit service in the central cities where most transit riders are actually located. As a result, since 1985, per-capita transit ridership has plummeted in such major urban areas as Los Angeles, Chicago, and Atlanta.

Congress expects to pass legislation this year that will decide how to spend $40 billion in annual federal gas tax revenues over the next six years. In recent years, 20 percent of those gas taxes have been spent on transit. Transportation for America’s goal is to further increase that share. But after decades of huge transit subsidies, per-capita transit ridership today is no greater than it was in 1970 — mainly because the subsidies have focused on extending transit service to those who don’t need it rather than providing better service to those who do.

Americans will be better off by privatizing transit. Private operators will provide better service to those willing to live in denser, transit-friendly neighborhoods without wasting a lot of money trying to attract a few suburbanites out of their cars.

DeMint on the Economic Development Administration

Last week, I wrote about reauthorization of the Economic Development Administration, which is currently being debated on the Senate floor. Sen. Jim DeMint (R-SC) wrote an op-ed in today’s Wall Street Journal that cites Cato’s work on the EDA.

DeMint correctly notes that the mistaken rationale behind the EDA’s creation during the Great Society is the same as the Obama administration’s $814 billion stimulus bill: government programs can solve economic problems. Instead, both have been massive wastes of taxpayer money.

After doing an able job of listing some of the EDA’s faults — and acknowledging that he was wrong to have supported the program in the past — DeMint concludes that members of Congress should be “actively finding ways to reduce spending” given the mounting debt problem. He’s absolutely right, although the EDA should be abolished even if the federal budget were in surplus.

Republicans in particular need to put more effort into targeting specific agencies and programs for termination instead of, say, just issuing constant press releases complaining about the Senate Democrats’ lack of a budget proposal. Note that the EDA reauthorization bill passed out of the Senate Environment & Public Works Committee on a voice vote. That means that all of the committee’s Republicans went along with it. See here for a list of the EPW committee’s members.

A Hospital Drug Shortage Made In Washington

As readers may know, I’ve been beating the drum for a while on the increasingly dangerous shortages that doctors are encountering in the availability of common, off-patent drugs used in hospital and clinical settings, including drugs that are important in chemotherapy, anesthesia, and infection control. Among the reasons for the shortages: the Food and Drug Administration has toughened its regulation of pharmaceutical makers in ways that lead to manufacturing line shutdowns and withdrawals from production.

John Goodman has a must-read blog post at Health Affairs Blog on the mounting crisis, amplified by a post by George Mason economist Alex Tabarrok at Marginal Revolution, getting into further specifics. In particular:

• 246 drugs are now considered to be in shortage, a record high, and the number has been rising for years. Rationing of scarce chemotherapy drugs is now making a difference in which patients have a chance at survival. In the absence of familiar compounds, doctors are falling back on inexact substitutes, sometimes more dangerous and less effective.

• After “tainted drugs” scares a few years ago, the FDA stepped up its Good Manufacturing Practice regulations, which control the production of pharmaceuticals. In particular, it now proclaims zero tolerance, barbed by tough fines, for many technical infractions whose actual impact on patient risk is at best doubtful, and it is unafraid of shutting down production lines again and again for retooling until its regulations are satisfied to the letter. It also changes its formulation and manufacturing requirements often, with scant forgiveness for makers who have trouble retooling to the new specifications quickly.

• Remarkably, the feds have inserted themselves into the role of central planners of drug output. Goodman:

For example, a drug manufacturer must get approval for how much of a drug it plans to produce, as well as the timeframe. If a shortage develops (because, say, the FDA shuts down a competitor’s plant), a drug manufacturer cannot increase its output of that drug without another round of approvals. Nor can it alter its timetable production (producing a shortage drug earlier than planned) without FDA approval.

That the results might include many unpleasant surprises will surprise only those unfamiliar with the record of a century of central planning failure.

• Pre-1938 drugs are suffering particular disruptions because of a separate FDA program, long demanded by consumer groups, to subject these “grandfathered” compounds to regulatory oversight just as tough as newer drugs. The dictates of the Drug Enforcement Administration also contribute to problems with some controlled substances.

• Several leading professional organizations, including the American Society of Anesthesiologists and the American Society of Clinical Oncology, collaborated on a meeting last November to raise the visibility of the issue and seek possible solutions. You can read its summary report here. Objectively, it’s a damning indictment, but be warned that — rather typically in a field where many key players live in fear of offending the FDA — the report refrains from outspoken criticism of the agency and in fact proposes widening the agency’s funding and powers.

Wouldn’t this make a good subject for hearings at the newly Waxman-liberated House Commerce Committee?

Magna Carta Day

The liberties we Americans enjoy were hard-won over the centuries. Today we mark a major event in that struggle, the day in 1215 when English barons presented King John with a written list of rights they demanded he recognize. Known ultimately as Magna Carta, the Great Charter, it was a compact between the barons and their king, a political effort by subjects to secure their liberty by placing their ruler under the rule of law, thus limiting arbitrary power.

The charter has gone through several iterations, but it drew in part from the common law rights, especially rights of property, that judges in the king’s courts had been finding from reason and custom as they decided controversies the king’s subjects brought before them. What Magna Carta did was bring those same rights against the king. Most important for us today was the promise found in clause 29:

No freeman shall be taken or imprisoned or deprived of his freehold or of his liberties or free customs, or outlawed, or exiled, or in any manner destroyed, nor shall we go upon him, nor shall we send upon him, except by a legal judgment of his peers or by the law of the land.

Note first the broad terms of clause 29: that enabled it to apply not just to the issues at hand but to varied future situations. Second, notice that only “freemen” were protected. The barons came to realize, however, that if their rights were to be maintained against the king, they would need the cooperation of all classes. Thus, the charter came in time to protect “common” liberties.

Each of those issues has informed the American experience. First, Magna Carta itself inspired our Founders to limit power through a written document, our Constitution. Second, clause 29 is captured in the Fifth Amendment, which provides that no person shall be deprived of life, liberty, or property, without due process of law. And third, Magna Carta’s capacity to grow is reflected by the post-Civil War inclusion of the Due Process Clause in the Fourteenth Amendment. That brought the Bill of Rights to bear not only against the federal government, its original limit, but against the states as well. We owe much to this English inheritance.

Cross-posted at the National Constitution Center’s Constitution Daily.