Topic: Health Care & Welfare

Government Gold-Plating

Sen. Tom Coburn (R-OK) released his annual Wastebook this past week. It contains a laundry list of doozies. The U.S. government’s gold-plating operations included $190,000 to study compost digested by worms, $297 million for the purchase of an unused mega blimp, and $1 million on a Virginia bus stop where only 15 people can huddle under a half-baked roof. These questionable (read: absurd) expenditures only represent the tip of the iceberg.

Just consider the following: the Speaker of the House currently receives an annual salary of $223,500, and will receive a payment of roughly that amount, depending on the years of service, for life. An annual payment of this magnitude amounts to about five times the average annual wage in the United States. But that’s not all. For those who have had different positions in Congress, their retirements can be augmented. For example, Nancy Pelosi will not receive $223,500 for life, but roughly double that. Why? Because she is a member of Congress, currently the House of Representatives’ Minority Leader, and a retired Speaker of the House. For purposes of computing retirement pay, Congress adds and accumulates. They do not net.

In addition to supporting members of Congress and civil servants, U.S. taxpayers support welfare recipients. And they support them lavishly, too. Hawaii, Massachusetts, and D.C. residents receive sizeable welfare payments (read: salaries). Indeed, the magnitude of these payments exceeds the average salary of an American teacher, as well as a soldier deployed in Afghanistan, by at least $10,000 per year.

The public can forget all the clap-trap they are hearing about austerity. Indeed, a fairly dull knife could cut billions of dollars from the U.S. government’s largess. 

Send The International Nanny Packing

As many of us have noted lately, the federal Centers for Disease Control, known originally for their work against infectious and communicable diseases, have shifted focus in recent years to supposed public health menaces like beltless driving, gun ownership, social drinking, and suburban land use patterns. CDC director Thomas Frieden came recommended to President Obama because of his national fame as Mayor Michael Bloomberg’s health commissioner, in which capacity he oversaw portion sizes and donut recipes, restaurant smoking policies and anti-salt campaigns, as well as the occasional infectious disease issue. 

If national nannyism strikes you as bad enough, get ready for the international kind. As the Wall Street Journal noted the other day

The United Nations-run WHO has long been a growing irrelevance, as director-general Margaret Chan spent the week not in Monrovia but Moscow, pontificating at a WHO conference aimed at raising global tobacco taxes. … Since the 1990s, the WHO has gradually transformed itself from a disease fighter to what Dr. Chan calls “a normative agency” that makes international public health rules and promotes political goals like universal coverage. 

The ideology behind this is driven by ideas fashionable in the West, particularly that of rolling out the “tobacco control” model to other consumer goods like food and alcohol. This summer in Nature, for example, much-quoted Georgetown law prof Lawrence Gostin outlined such an agenda under the headline “Healthy Living Needs Global Governance.” According to the abstract of his article, “researchers have identified a suite of cost-effective NCD [non-communicable disease] prevention measures” and now it is time for international regulatory bodies to step forward to impose them.  

Stronger global governance could spur national action by providing funding, creating stronger norms and holding states accountable. The UN’s comprehensive review on progress in NCD prevention, held in July 2014, offered an opportunity for the international community to take concrete steps in strengthening global prevention efforts. This article proposes four concrete steps for a long-term solution: creating a dedicated fund for NCD control and prevention; regulating industry to improve nutrition and restrict alcohol and tobacco marketing; altering the built environment to promote physical activity; and prioritizing prevention in all sectors of government and in the global regimes that govern NCD risk factors.

Barriers to quick adoption of such measures, Gostin laments, include “philanthropic action favoring swift wins in infectious disease control, and the framing of NCDs as an individual rather than collective problem.” That second point you might be right to interpret as annoyance at libertarians and individualists who keep arguing that people choose, and should have a right to go on choosing, what they eat. But pause for a moment to take in Gostin’s first point about how narrow-minded philanthropy is to favor “swift wins in infectious disease control.” The rest of us may see it as inspiring, even heroic when a tech billionaire donates a zillion dollars to roll back the scourge of malaria, Ebola, or some less familiar tropical disease. If you were truly advanced, however, you would see this as a distraction from the task of organizing to regulate pretzel consumption. 

Agencies like WHO promoted their mission to skeptics as a way of addressing communicable diseases that, like Ebola, can quickly jump borders. Why let it arrogate more power to itself than it would need for that purpose?

Bill Gates Recognizes the Improving State of Humanity

With the newspapers full of crises, it can be hard to maintain a proper perspective on the progress humanity has made, and to remember that there are individuals striving every day to make the world a better place. In a recent interview, businessman and philanthropist Bill Gates discussed the improving state of humanity, and the work that he is doing through private charity to help those in need.  He said,

I think the idea that people are worried about problems, like climate change or terrorism or these challenges of the future, that’s okay. But boy, they really lose perspective of what’s happened over the last few hundred years. And how science and innovation have been a central factor of that. And I think that’s too bad, because people are lucky to live now. And they should see that progress is actually taking place faster during their lives than at any time in history.

One of the major initiatives of the Gates Foundation, for example, aims to eliminate polio. The data bear out how much progress has already been made towards that end:

Blog chart 1

In 1980, about half of all children received the polio vaccine. Today, around 90% of children receive the vaccine, and eradication of the condition is in sight – just as people eradicated smallpox in 1979.

Gates is also among the many caring individuals working to eliminate malaria and malnutrition, areas where humanity has already made great strides. Insecticide-treated mosquito nets, for example, protect more children from malaria in Sub-Saharan Africa:

blogchart2

Malnutrition among children is also declining. In populous developing  regions, such as East Asia and the Pacific, malnutrition affected about 20% of children in 1990. More must be done, but today malnutrition affects fewer than 6% of children in those areas.

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Even one child afflicted by polio, malaria, or malnutrition is too many, but the dramatic improvements the world has made on these fronts should be celebrated. Like Gates, while working to make the world better we must not lose a proper perspective on the progress humankind has already made.

Ebola Travel Restrictions – Marginal Measures

The recent story of a Liberian man in Dallas who had Ebola sparked a political conflagration around travel restrictions for countries where there are Ebola cases. The virus does not appear to have spread from him to anyone that did not come into direct contact with him in the Dallas hospital.

Many are arguing that his arrival in the United States means that all travel from the affected West African countries should be shut immediately. Others are arguing that travel should remain as open as it currently is – which is still heavily restricted. 

What happened to policy responses on the margin

Fortunately, the federal government took a marginal action yesterday. Fliers from Guinea, Liberia, and Sierra Leone will have to enter through one of five ports of entry and undergo an interview as well as a temperature check once they arrive in the United States. These restrictions are far less than the total ban sought by some folks and still more restricted than the current system  These checks do not interrupt the flow of aid to these West African countries either and will affect roughly 150 travelers per day.

Immigration or movement restrictions for legitimate health concerns are proper and already written into law. Travel restrictions to contain viruses different than Ebola have not been successful in the past. Ebola is far less communicable than the flu so the comparison to previous travel bans might not be appropriate.  

Americans have a very low chance of contracting Ebola while in the United States, let alone dying from it. The only person to die from Ebola in the United States contracted it in Liberia. I took a bigger risk of dying from a traffic accident this morning commuting to the office than I will ever face from Ebola.

More Americans are killed every year from their furniture than all Americans who have died from that dreaded hemorrhagic fever.

Those Americans who worry about Ebola focus on the freakishly high death rates for those who contract the virus – 50 percent for most strains of the virus (only 20 percent of Americans who have contracted Ebola have died.) But the death rate is not the most important figure; the chance of contracting the virus in the first place is the most important factor. 

So far, two American nurses who treated the Liberian man contracted Ebola from him. Both nurses are recovering. For the rest of us, that means the chances of contracting Ebola is about zero. No matter the death rate, a zero chance of contracting the disease means we will not die from it.     

Still, a few marginal precautions, like those put in place by the federal government, will impose a very small temporary cost and likely stop any future Ebola patients from coming to the United States on a commercial flight.    

The Cost of Ebola and the Misery Index

For a clear snapshot of a country’s economic performance, a look at my misery index is particularly edifying. The misery index is simply the sum of the inflation rate, unemployment rate, and bank lending rate, minus per capita GDP growth. 

The epicenter of the Ebola crisis is Liberia. As the accompanying chart shows, the level of misery, as measured by the misery index, has decreased since Charles Taylor ruled Liberia.

That said, the index was still quite elevated, at 19.4, in 2012. Yes, 2012; that was the last year in which all the data required to calculate a misery index were available. This inability to collect and report basic economic data in a timely manner is bad news. It simply reflects the government’s lack of capacity to produce. If it can’t produce economic data, we can only imagine its capacity to produce public health services.

With Ebola wreaking havoc on Liberia (and neighboring countries), the level of misery is, unfortunately set to soar.

How ObamaCare’s Victories Count Against It In Sissel v. HHS

Randy Barnett has an excellent post at the Volokh Conspiracy about his recent amicus brief requesting the D.C. Circuit grant en banc review of Sissel v. HHS. (Sound familiar?Sissel challenges the constitutionality of ObamaCare’s individual mandate – which the Supreme Court ruled could only be constitutional if imposed under Congress’ taxing power – on the grounds that this, ahem, tax originated in the Senate rather than the House, as the Constitution’s Origination Clause requires.

A three-judge panel of the D.C. Circuit ruled against Sissel. The panel’s rationale was that the Patient Protection and Affordable Care Act was not the sort of “Bill[] for raising revenue” that is subject to the Origination Clause, because the purpose of the PPACA is to expand health insurance coverage, not to raise revenue. Barnett explains why this reasoning is nutty. Under the Sissel panel’s ruling, no bills would ever be considered revenue measures because all revenue measures ultimately serve some other purpose.  The panel’s interpretation would therefore effectively write the Origination Clause out of the Constitution. Barnett argues instead that the courts must recognize the PPACA as a revenue measure subject to the Origination Clause because the Supreme Court held the taxing power is the only way Congress could have constitutionally enacted that law’s individual mandate.

A shorter way to describe Barnett’s argument is that he turns ObamaCare supporters’ own victory against them: “You say the individual mandate is constitutional only as a tax? Fine. Then it’s subject to the Origination Clause.”

Barnett again corners the D.C. Circuit with another sauce-for-the-gander argument on the procedural question of whether that court should grant en banc review of its panel decision in Sissel:

Of course, en banc review is rarely granted by the DC Circuit, but given that it recently granted the government’s motion for en banc review of the statutory interpretation case of Halbig v. Burwell presumably because of the importance of the ACA, the case for correcting a mistaken constitutional interpretation is even more important, especially as the panel’s reasoning has the effect of completely gutting the Origination Clause from the Constitution…

Or, the shorter version: “You guys think Halbig is worthy of en banc review? Fine. If the Sissel panel erred, the downside is even greater.”

We’ll see whether the D.C. Circuit thinks the Constitution is as worthy of its protection as ObamaCare.

(Cross-posted at my comment-friendly blog, Darwin’s Fool.)

Cato Conference: “Pruitt, Halbig, King & Indiana: Is ObamaCare Once Again Headed to the Supreme Court?”

On October 30, the Cato Institute will host a conference featuring leading experts on four legal challenges that critics understandably yet mistakenly describe as “the most significant existential threat to the Affordable Care Act”:

PruittHalbigKing & Indiana: Is ObamaCare Once Again Headed to the Supreme Court?

Thursday, October 30, 2014, 9:00AM – 1:30PM. 

Luncheon to follow.

Featuring: Oklahoma Attorney General Scott Pruitt; Indiana Attorney General Greg ZoellerRobert BarnesThe Washington PostJonathan Adler, Case Western Reserve University School of Law; David Ziff, University of Washington School of Law; Brianne Gorod, Constitutional Accountability Center; James Blumstein, Vanderbilt University; Michael F. Cannon, Cato Institute; Len Nichols, George Mason University; Tom Miller, American Enterprise Institute; and Robert Laszewski, Health Policy and Strategy Associates, LLC.

In Pruitt v. Burwell and Halbig v. Burwell, federal courts have ruled that the Internal Revenue Service is misinterpreting the Patient Protection and Affordable Care Act, unlawfully paying billions of dollars to private health insurance companies, and unlawfully subjecting more than 50 million individuals and employers to the Act’s individual and employer mandates. In King v. Burwell, another federal court found the IRS’s interpretation is permissible. A fourth lawsuit, Indiana v. IRS, is due a ruling at any time.

While these cases attempt to uphold the ACA by challenging the Obama administration’s interpretation, supporters and critics agree they could have as large an impact on the law as any constitutional challenge. Is the IRS acting within the confines of the law? Is the ACA unworkable as written? Is it inevitable that the Supreme Court will hear one of these cases, or a similar challenge yet to be filed? What is the impact of the IRS’s (mis)interpretation? What impact would a ruling for the plaintiffs have on the health care sector and the ACA? Leading experts, including the attorneys general behind Pruitt v. Burwell and Indiana v. IRS, will discuss these and other dimensions of this litigation.

To register to attend this event, click here and then submit the form on the page that opens, or email events [at] cato [dot] org, or fax (202) 371-0841, or call (202) 789-5229 by 9:00 a.m. on Wednesday, October 29, 2014.

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