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The Counterintuitive Consequences of Birth Control

A bit of recent research appears to confirm something I’ve been arguing from theoretical grounds for decades:

Access to the birth control pill in the U.S. has increased the births of children outside of marriage, especially among poor and minority women, according to a new study of the contraceptive’s historic effects.

“Our findings add to a growing literature which documents the power of the pill to shape women’s lives in broadly heterogenous ways, with minority and less-well-educated women bearing the brunt of the losses, a phenomenon we call the paradox of the pill,” economics professors Andrew Beauchamp and Catherine R. Pakaluk said in their paper, “The Paradox of the Pill: Heterogeneous Effects of Oral Contraceptive Access.”

“We find robust evidence that access to the pill increased nonmarital childbearing and reduced the likelihood of high-school graduation,” they said.

There are two important principles coming into view, here.  The first is something I wrote about in a 2004 post about the trajectory that our thoughts about sex, marriage, and family have been on, as a culture.  The relevant point, here, is that contraception intellectually and culturally separates sex from procreation.

Consequently, regardless of whether a particular couple is using contraception (or using it correctly), people begin behaving sexually as if children aren’t really a consideration.  When one is conceived, therefore, the tendency will be to blame the contraception, or its lack of availability, or whatever reasons one might have for not using it.  The pregnancy therefore seems unfair, increasing the demand for abortion.

The second principle is one that I expressed frequently when same-sex marriage was still a matter of public debate.  Namely, that people who don’t necessarily need marriage in order to have healthy relationships or to raise children reasonably well are actually investing in a culture of marriage that benefits more-vulnerable people.

We see the same thing with contraception.  More-privileged groups of people will not only have more access to contraception but also stronger cultural guides for the regulation of their behavior.  Yet, their view of sex will define the culture and affect the behavior of those who are less privileged and less responsible.

One aspect of the abortion debate with which one really must contend is the deception of those who advocate for abortion as a right, starting with the idea that legislation to preserve women's ability to kill their unborn children in the womb is about "reproductive health care."  Reproductive of what?

The Strange Assertions of Abortion Advocates

One aspect of the abortion debate with which one really must contend is the deception of those who advocate for abortion as a right, starting with the idea that legislation to preserve women’s ability to kill their unborn children in the womb is about “reproductive health care.”  Reproductive of what?

So much of the pro-abortion argument requires distortion of the language and concepts that are involved.  Why that is should be obvious.  The other day, a progressive state senator from Providence, Gayle Goldin, and Providence Journal reporter Katnerine Gregg responded to news that a judge had struck down an Iowa law restricting abortion when the baby’s heartbeat can be detected, implying that it’s a concern because it may give the U.S. Supreme Court an opportunity to address the question of abortion.

Think of the underlying issue.

This law that is, at the moment, arguably unconstitutional essentially states that if an unborn child is so provably unique from the mother as to have his or her own heartbeat, a doctor can’t suck out his or her brain, tear him or her limb from limb, or otherwise kill the child (presumably except to save the life of the mother).  When that’s the fact of the act, the only way to maintain support has got to be to misdirect attention some other way.

Activists at the Rhode Island State House, the other day, emphasized minorities’ access to abortion, but starting from a different perspective paints a very different picture.  Something around 8% of Rhode Island’s population is black, but they account for some 16% of abortions.  Abortion kills black babies at about twice the rate that it kills white babies in the Ocean State.

A chart from the Guttmacher Institute shows that minorities, especially black non-Hispanics, have much higher abortion rates than white non-Hispanics, yet the claim of the chart is that “lack of access to health insurance and health care plays a role, as do racism and discrimination,” in abortion rates that vary by race.   Is Guttmacher, which is associated with Planned Parenthood, suggesting that racism leads to the higher rates, or is it suggesting that, but for racism and discrimination, the United States would have even higher rates for killing black babies.

That’s what the Providence activists would seem to be suggesting when they talk about “access.”  Pursuing policies that would keep a significant portion of a minority population alive is a strange kind of bigotry.

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Learn the Lesson, Rhode Island: Doctor Shortage

It’s anecdotal, to be sure, but add Ellen Lenox Smith’s letter in the Providence Journal to the evidence that Rhode Island has a worsening doctor problem:

Just last week, I had an appointment with my pulmonologist, who shared that out of the four doctors in his practice, only two are now left. This poor doctor is expected to take on the work of the two that are now gone along with his original patients, and they are not intending to replace those gone. I am so concerned that he will decide it isn’t worth it and leave, too.

This is not the type of medicine he planned of doing: overstretched, overtired and not able to care for his patients in the manner he was first hired to do.

Rhode Island imposes a high number of mandated coverages on health insurance, driving up the cost.  We’ve pushed nearly one-third of our population into Medicaid.  And our laws are restrictive when it comes to occupational licensing, regulations, and taxation.

This environment of massive government control puts a lot of pressure on the prices that providers can charge customers, which has an effect on how much time they can afford to spend with them, meaning that the job may not be what they wanted it to be.

We need to learn this lesson, because ideological and motivated activists are trying to push our state even farther down this road.  Market forces allow us to match up the things that people want done (and can afford) on one hand and the things that other people are willing to do (for an income they are willing to accept) on the other.

Messing with that freedom-derived balance means that something else is determining who gets what from whom.  Then, the incentives of politics will make it more beneficial to promise the moon to the getters at the expense of the providers.  Even if the current providers tough that out and don’t cross the border, we’ll inevitably see fewer new ones as time goes forward, and everybody will suffer.

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“Choice” is Clear in Upcoming Furious Healthcare Debate

A federal judge recently ruled that Obamacare is unconstitutional because the individual mandate, repealed in the 2017 federal Tax Cuts and Jobs Act, is no longer in force. Even though existing federal health-care laws will remain in effect during the appeals process, states should not panic and codify Obamacare into state law, as it is not certain how long federal subsidies will remain intact.

While the courts hear the appeals, and with Democrats winning back control of the U.S. House of Representatives largely on the health-care issue, another furious debate is about to unfold.

Democrats will probably introduce some kind of government-centric plan, while Republicans are poised to introduce their own free-enterprise solution. What we all want are simply more choices at lower net costs.

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When Public Policy Squeezes Out Providers

The aptly named Stanley Bleecker foresees a problem for Rhode Islanders needing health care in the future:

Can you imagine a time when sick people will not have access to a doctor when they are in need of treatment and medical advice? I can. Recently, because of my primary doctor’s retirement, I had to find an internist and also a specialist. It was not easy. After some effort, I did secure an appointment for an annual physical with a new internist, but the earliest appointment I could get was scheduled for 12 months down the road. Subsequently, I learned my new doctor (whom I still have not yet met) has closed his practice to new patients.

The shortage is a result of many Rhode Island doctors taking early retirement or leaving to practice in other states where insurance payments are higher. Practicing doctors tell me that young doctors are not interested in practicing in Rhode Island because of low insurance payments.

Mr. Bleecker might be somewhat encouraged to learn that Rhode Island has legalized the provision of telemedicine, whereby patients don’t have to be physically present in the office to receive care.  Of course, this being Rhode Island, there’s a catch:

Rhode Island providers, however, may not use telemedicine to deliver health care services across state borders. This limitation is subject to change if Rhode Island lawmakers choose to enter the Interstate Medical Licensure Compact (“IMLC”).

In some respects, Rhode Island is moving in the wrong direction:

Similarly, Rhode Island nurses may not deliver health care services via telemedicine to patients across state borders. This was not always the case. For nearly a decade, Rhode Island was a member of the Nurse Licensure Compact (“NLC”), which permitted Rhode Island registered nurses and licensed/practical vocational nurses to use telemedicine to provide health care in 24 other states across the country.

Attentive readers might recall that Donna Cook pointed this out back in September, as a problem for professional nurses.

This shouldn’t be such a hard lesson.  When government makes it more difficult to pursue a profession or creates artificial markets with near monopolies for insurers, people will stop finding it worthwhile to go into that line of work, here.  Too often, those who craft our laws imagine that the targets of their impositions will not react.

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Where Would Excess Health Insurance CEO Pay Go

So, socialist Senator Bernie Sanders is on Twitter highlighting the pay of health insurance CEOs:

What insurance company CEOs made in 2017:
-Leonard Schleifer (Regeneron): $95.3 million
-Dave Wichmann (UnitedHealth): $83.2 million
-Mark Bertolini (Aetna): $58.7 million

We need a system that provides health care for all, not massive compensation for a few CEOs.

Putting aside Regeneron, which is not an insurance company and is therefore a different conversation, I agree with Sanders that these pay amounts are excessive, but the senator skates by an important point:  The reason insurance companies can do this sort of thing is that government insulates them from competition.  It also forces market-distorting policies on them, like requiring less-costly insurance customers to pay more to reduce the gap in prices.

For context, the pay for Wichmann that Sanders cites equates to around $2.25 from each of the company’s members, so as an isolated expense, it doesn’t mean much by way of price competition.  Still $83 million is a lot of money that could be put toward some other benefit or organizational improvement that would be salable.  Government has shaped the market landscape that allows that money to pool in executive compensation.  Naturally, the socialist’s solution to this problem is… more government!

Let’s imagine, then, what would happen to this money if the government even more-fully ran our health insurance industry.  With no competition, the government would have little incentive to ensure that the CEO’s wages were redistributed in the way that would attract more customers.  Would it reduce prices by $2.25 for everybody?  That seems useless.  If you say it would hire more doctors, do the math, and you’ll find that the United CEO’s pay would maybe allow for another 400-500 for a nation of well over 300 million people.

Two areas in which some significant portion of the money would surely go are predictable based on other government activities:  More administrators and bureaucrats would be hired, and targeted special interest groups would receive enhanced benefits or cost savings, to be distributed based on the political value of their support.

This likelihood should lead anybody who thinks the CEOs make too much money and that it ought to fund, instead, an improved healthcare system to the conclusion that we need more market force in health care rather than less.  That would squeeze the pay of the top employees and distribute it where the market finds the most value.

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Expressing the Value of Our Health Care

Health care and medicine in the United States can be expensive, but think of what we’re getting. The solution to our problems is more openness about costs and value and more-direct decision making, which is the opposite of single-payer and other big-government policies.

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Looking for Common Ground in Booker’s New Handout Plan

Of course, the idea of making the federal government something like everybody’s rich uncle, endowing every baby with a $1,000 savings account with annual deposits at taxpayer expense, strikes all the wrong chords for a conservative like me.  The details of legislation that U.S. Senator Cory Booker (D, New Jersey) has submitted don’t really help:

The accounts would be federally insured, and the funds could only be used for homeownership and “human and financial capital investments that [change] life trajectories,” according to the summary. …

The program would cost roughly $60 billion if implemented in 2019, a Booker aide told The Hill, and would be funded by increasing the capital gains tax rate by 4.2 points, increasing the estate tax to its 2009 level and raising taxes on multimillion-dollar inheritances.

So, the federal government would create and help fund individual investment accounts and then pay for it by increasing the cost of investing as well as taxing those who are able to change their “life trajectories” enough to ensure that their own children don’t need rich Uncle Sam.  That doesn’t sound like the most efficient policy design.

All of that said, Booker’s concept does have some similar features to my long-standing proposal for health care:  Set everybody up with a health savings account, which government could use as its Medicaid/Medicare mechanism, which employers could use to provide their health care benefits, which charities could use to offer assistance to the poor, and which would bring market mechanisms into health care.

That would be a better use of money than buying houses.  Moreover, some significant part of the funding could be found in government health care savings (as all of the funding for any new program should be found in the existing budget).

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We Must Stand Up to the Ideological Gestalt Targeting Children

Wesley Smith catches more evidence of our society’s descent into madness:

When I read Jane Robbins’ piece in The Federalist reporting that doctors were actually performing mastectomies on girls as young as 13 who identify as boys, I couldn’t believe my eyes. But sure enough. Not only is it happening, but a medical study published in JAMA Pediatrics recommends that children not be precluded from such radical body-altering surgery based simply on their youth …

A doctor need not be a religionist or disagree with the concept of gender dysphoria generally to be morally opposed to cutting off the healthy breasts of adolescents (or inhibiting the onset of a child’s normal puberty) as a form of “doing harm” in violation of Hippocratic ideals. But if Emanuel and his ilk have their way, in the not too distant future, a surgeon approached to perform a mastectomy on a girl who identifies as a boy could be forced into a terrible conundrum: either remove the child’s healthy body parts–or risk being charged with transphobic discrimination, investigated by medical authorities, and possibly forced out of the profession.

Now factor in the fact that “guidance” in public education generally takes the tone that teachers and school administrators should help students move in this direction — even to the point of conspiring to deceive their parents if they might have a different view.  What’s coming into shape is a culture that encourages children to experiment with their sense of identity, which experimentation is then hustled along from youthful exploration to physical expression through the school system and then solidified into irreversible medical steps through drugs or surgery.

Smith makes an important point when he brings into the discussion the silencing of Brown University researcher Lisa Littman, who found evidence that transgenderism spreads faddishly among peer groups.  Based on public outcry, the university disappeared the study and apologized for it.  As Smith suggests, this episode illustrates that the medical consensus on which we’re being told to base radical child-abusing policies cannot be taken as trustworthy on its face, but is very probably contaminated with ideology.

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When Patients Become Costs in a Socialized System

While we should keep in mind that we’re getting one person’s understandably self-interested perspective on an ongoing series of interactions, Roger Foley’s experience is not exactly out of keeping with other anecdotes or the incentives of socialized medicine:

A Canadian man suffering from an incurable disease claims that despite asking for home care, the medical team at an Ontario hospital would offer him only medically assisted suicide.

Roger Foley, a 42-year-old from Ontario, has cerebellar ataxia, a rare disorder that limits his neurological abilities, restricting mobility in his arms, legs, as well as the performance of other daily tasks.

Dissatisfied with being bedridden in a hospital for two years, Foley asked for another option, and according to some recordings that he has released, people in the hospital system offered him an exit to the graveyard.

We don’t know whether these conversations were just two out of many, the rest of which were much more life-affirming, but without the home-care solution that Foley wanted.  We also don’t know what explanations were given for denial of that service.

Still, when government takes over the health care for an entire society, relationships and the standing of patients change.  We cease to be customers and become costs.  Even in a system in which government provides health care for just a segment of the population — the poor, the elderly, veterans — the patients are still customers, but with somebody else paying.

It is mystifying that so many people assume benevolence and competence within a system that is able to take its resources by force of law.  When such a system hits the ceiling for what taxpayers and central planners are willing to pay, it still has massive power over the recipients of its services, even if that power consists mainly of offering a choice between staring at a hospital ceiling and death.

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Unions: Doing to Our Hospitals What They Did to Our Schools

One of the advantages of living on the East Bay is our easier access to Massachusetts for things like hospitals.  In a pinch, a while back, my family went to Rhode Island Hospital/Hasbro, and it turned out to be one of the most terrible decisions we’ve ever made, with lifelong consequences.  In the years since, we’ve heard from others with similar stories.

I don’t want to be unfair, though.  It’s all too easy for a bad employee or unfortunate circumstances to create a uniquely bad experience.  Especially in our time of social media, these isolated instances can come together to create a misleading impression.  Some people will swear by Apple versus PC or Verizon versus AT&T and vice versa and so on.  I don’t think this caveat applies to my take on Providence hospitals, but it might.

Let’s just say that the recent public theatrics of the nurses’ labor union in Providence don’t contradict my feelings:

Unionized nurses and other health care professionals at Rhode Island Hospital and Hasbro Children’s Hospital on Thursday voted no confidence in Lifespan’s CEO, Tim Babineau, and Rhode Island Island Hospital’s president, Margaret Van Bree, and called on Lifespan’s board “to take immediate, corrective action to restore the public’s trust in Rhode Island’s only Level One Trauma Hospital.”

Ray Sullivan, a spokesman for United Nurses and Allied Professionals Local 5098, which represents 2,400 nurses, technologists, therapists and health professionals at the two hospitals, said members also authorized union leaders to issue a 10-day strike notice if negotiations break down.

Obviously, I can’t speak for “the public,” but my lack of trust in this system has to do with people who work (or worked) there, not the management… except to the extent that management is to blame for the employees.  The union organizers from United Nurses and Allied Professionals Local 5098 definitely are to blame for enabling employees who’ve made devastating mistakes.

The unions are doing for our hospitals what they’ve done for the public school system.  That Bishop Hendricken alum Ray Sullivan is the union lead for the nurses as well as an organizer with the National Education Association of Rhode Island only drives home the point.  Among the incidents that made labor unions so distasteful to me was a plan by Tiverton teachers to picket a hospital where a school committee member worked.  Picketing a hospital — where people are suffering, grieving, and panicking — is no more acceptable when the union represents its workers than when it doesn’t.

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Blue Cross Executive Compensation and Social Lunacy

For some reason, WPRI’s Ted Nesi tacked a political ad for far-left progressive Democrat Aaron Regunberg to the end of an article about a massive parting gift from Blue Cross & Blue Shield of Rhode Island to its departing CEO:

Aaron Regunberg, a Democratic candidate for lieutenant governor, quickly criticized Blue Cross over the pay packages, and argued it shows the state needs to move to a single-payer health system.

“Every day I meet Rhode Islanders who are struggling to pay outrageous health care bills,” he said. “It feels like each year, insurance costs more and covers less. So why is Blue Cross seeking 10% rate hikes while handing their top executives immoral payouts of millions of dollars?”

It’s always strange for a news article to end with a question, which is more appropriate to commentary pieces, so let’s take a stab at an answer:  Blue Cross is seeking 10% rate hikes while handing its top executives payouts of millions of dollars because it can.  Thanks to government regulations, consumers’ options for health insurance are very limited, meaning that competitors can’t take advantage of indulgences like massive payouts to executives, and thanks to ObamaCare, the product that this limited number of providers are selling is mandatory for all Americans.

I realize that Regunberg was in high school in a distant state when Blue Cross was among the leading lights of Rhode Island corruption a decade ago.  Still, it shouldn’t take direct experience for him to understand that creating monopolies and intimate relationships between major corporations and government can lead to corruption.

That the story of Blue Cross Blue Shield of Rhode Island’s corporate pay structure could be turned into a pitch for a single-payer health system shows how far into lunacy our public discourse has drifted.  Consolidating power helps the powerful, who will quickly find that they have more incentive to work together than to enthusiastically fulfill their roles as representatives for battling factions.

Rhode Island has built this truism into the organizing principle of our entire government.  One suspects that Regunberg is not ignorant of this reality but, rather, is looking for his path to the narrow end of its funnel.

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All We Need for Single-Payer Health Care: A Few Magic Beans (and an Emperor)

Far-left gubernatorial candidate Matt Brown is all in on some generic, unspecified, to-be-determined idea of a Medicare for All scheme, and if Rhode Islanders fall for this, we deserve every consequence we get.  I mean, here’s a guy putting forth a proposal that would radically alter our entire society, and…

Brown relied on his belief that savings from unnecessarily high administrative costs, sky high executive salaries — and lack of bargaining power — will help pay the tab.

Beyond that, he said: “The commission we will put together will explore ways to fund it.”

This is not serious thinking, and Matt Brown is not a serious candidate.  Like the progressive candidate for lieutenant governor, Aaron Regunberg, who has zero professional experience outside of far-left activism, Brown is merely jumping on a bandwagon and doing what politicians do: telling people what they want to hear.  Their ideas are little more than a local echo of some national icon — in this case, Bernie Sanders, whose own claims about saving money with Medicare for all Charles Cooke nicely summarizes, here:

… the Sanders “Plan” is going to save money. And all we need to do to get to that happy state of affairs is:

  • Force every doctor and hospital in America to accept Medicare reimbursement rates for all patients — these are 40 percent lower than the rates paid by private insurance — while assuming that this would have absolutely no effect on their capacity or willingness to provide services
  • Raise taxes by 10 percent of GDP — overnight
  • Explain to the 150 million people with private insurance that the rules have been changed so dramatically that (a) they can no longer keep their plans, and (b) henceforth, tens of millions among them will be paying more in taxes than they were previously paying in both premiums and out-of-pocket costs

Easy!

Here’s the bottom line: The villain in Matt Brown’s health care tale is “monopoly prices,” and his solution is to create an opposing monopoly.  As with most progressive policies, the core request is for voters to make the politician more powerful than people he or she insists are too powerful.  This will work out because progressives say so.

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Differences in Union Negotiations

Two separate instances of difference are notable in stories about labor negotiations ongoing with Lifespan and the United Nurses and Allied Professionals.  The first is a sort of hypocrisy of rhetoric.  Lifespan has spent $10 million preparing to keep its operation going in the face of a threatened strike starting July 23, and the organization has said its final offer to the union is now reduced by that amount.  In response, union organizer and former RI representative Raymond Sullivan states:

“UNAP’s dedicated nurses and caregivers have no intention of negotiating with a gun to their heads,” Sullivan said. “As of now, there are no plans to resume talks until Lifespan ceases its attacks on the union’s protected rights to collectively bargain and strike.

So when the union threatens to deprive the hospitals of the workers they need to operate, that’s just fair labor negotiations, but when management says it’ll have to hire temporary employees and make the cost up in the contract, that’s “a gun to their heads.”

The second notable difference is that between Lifespan’s actions and those of public-sector management.  Sullivan, for example, used to work for the National Education Association of Rhode Island, an industry in which a hard line from management looks quite different.  Far from facing a reduction in management’s final offer, in public schools, the union can usually expect to get multiple years of retroactive pay if it takes that long to come to an agreement.

This turn of events can leave taxpayers with the impression that school committees aren’t so much negotiating with the unions for that long as they are waiting for some turn of events to make it possible to take from taxpayers what both “sides” want.  One can hardly imagine a school committee’s taking retroactive pay off the table, let alone reducing an offer.  The union rhetoric (and media coverage) would be apocalyptic, and drag the school committee members through an agonizing time.

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A Predictable Scandal with Socialized Medicine

Anecdotes are generally unfair as markers of an entire system, but less so when they are in line with expectations.  Such is the case with Rupert Darwall’s Wall Street Journal commentary about fatalities in the British National Health Service (NHS).  Apparently, the latest scandalous report about parts of the system reveals one hospital’s “unlawful killing” of 650 patients and ensuing cover-up.

What makes this an indictment of the entire system is how precisely in line with the incentives of socialized medicine it is:

The report explains the almost identical dismissal of relatives’ concerns as a result of the “coincidence of interests” rather than conspiracy. When the state is a monopoly provider of health care, there is a political interest in suppressing bad news. In discussing whether to prosecute, one police officer noted the “perceived plight” of the NHS ahead of the 2001 general election. At a pivotal meeting of prosecutors closer to polling day, a government lawyer attacked Dr. Livesley and sabotaged the emerging prosecution case.

Proponents of socialized medicine condemn profit in health care, but a for-profit hospital does not have a financial interest in killing its patients. In the NHS, patients are a cost and troublesome ones can be put on a syringe driver, something a nurse told the police happened at Gosport.

When our society shifts responsibility to government, it tends to focus on the possible up-sides and assume that everybody involved will make genuinely selfless decisions, but what we really ought to watch is the change in incentives. Human beings find it all too easy to determine that something in their own interest is in the interest of everybody, by way of “the system” of which they are a part, even deceiving families while killing their loved ones.

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RI Middle of the National Pack for Life Expectancy

Compared to our usual experience on national rankings, Rhode Island’s having the 19th-best ranking for life expectancy is good news, although that puts us second to last in New England, before Maine.  Writes Bill Murphy:

People in Minnesota live the longest in the United States: 78.7 years old on average. Mississippi ranked 51st (the study includes Washington, D.C.). Live expectancy there is just 71.8 years. That’s a 9.6 percent difference.

It should be noted that the leading causes of death are lifestyle-related, such as smoking, drinking, and eating poorly, so this is another area in which the best prescription may be a healthy economy.

Given the hot topics of the day, however, this bit from the underlying research is interesting:

Other notable findings seen in Table 1 are declines in deaths [from 1990 to 2016] from self-harm by firearm (13.2%) and physical violence by firearm (28.5%) but an increase in self-harm by other means (16.9%).

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UPDATED: Latest Stunning Display of Incompetence by Raimondo Involving our Most Vulnerable May Cost Taxpayers Tens of Millions

Both the Providence Journal‘s Kathy Gregg and WPRI’s Ted Nesi are reporting today that the State of Rhode Island, more specifically, the Executive branch’s Office of Health and Human Services (the Rhode Island Executive Branch being currently occupied, we should note, by Gina Raimondo), missed a critical court deadline to appeal a court ruling and thereby may have put state taxpayers on the hook for “$8 million annually for each year starting in 2016-17″. From Ted Nesi’s story about this disturbing and jaw-dropping situation:

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Well, This Is… Depressing

Ashley Welch reports in CBS News:

The highest rate of depression was in Rhode Island at about 6 percent, while the lowest was in Hawaii at 2 percent. Every state except Hawaii experienced rising diagnosis rates of depression over the course of the study period.

The report notes that a variety of factors contribute to depression rates as calculated using insurance data.  Obviously, areas in which doctors screen for depression more often will have higher rates, as will areas in which people are more likely to seek a doctor’s help when they’re feeling low.

To have the worst rate in the country, though, Rhode Island must surely have more going on than these technical reasons.  One suspects a healthier economy with more opportunity (that doesn’t require insider schmoozing) would help, as would freedom from the sense that powerful people are always trying to take advantage of you.

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UHIP Catastrophe: Governor Once Again Blaming Deloitte as “Real” Problem (Also, Chafee)

Yesterday on NBC 10’s Connect to the Capitol, Dan Jaenig asked Governor Gina Raimondo, among other topics, how the state dropped the UHIP ball. The governor started her response by taking a swipe at former Governor Lincoln Chafee, saying he signed a terrible contract with Deloitte. She then continued,

Under my watch, we hit the go button before it was ready. But I will say the real problem here is the company sold us a product that didn’t work.

This is not to defend Deloitte, which apparently has a mixed record with regard to such systems. But let’s be clear. It was you, Governor Raimondo, who gave the catastrophic order, for your own selfish political reasons, to launch an unready system. Accordingly, DO NOT BLAME FORD MOTORS FOR DELIVERING A DEFECTIVE CAR WHEN YOU ORDERED THEM TO REMOVE IT FROM THE ASSEMBLY LINE ONLY HALF WAY DOWN. And similarly for the aspersions you cast at Governor Chafee: the contract, good, bad or indifferent, is completely irrelevant if the manager who takes over the contract inexplicably orders production to be shut down well before the product is finished.

Everyone else – taxpayers and UHIP clients – but you, Madame Governor, is paying the high price for your catastrophic action. Please at least stop casting blame for it in desperate and absurd directions.

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Will We Wake When Treated by Woke Doctors?

This, from a Weekly Standard article by Devorah Goldman, is terrifying:

In 2015, the Association of American Medical Colleges revised the Medical College Admissions Test (MCAT) for the first time in nearly 25 years, stretching the full exam-day experience from around five hours to eight or more. The test drew attention at the time for its sheer length; less widely noted was the explicitly ideological bent of the new exam.

The AAMC occupies a curious place in the world of medicine. It forms one-half of the only government-approved accrediting entity for U.S. medical schools, and it is solely in charge of administering both the MCAT and the national standardized medical school application. Unlike the American Medical Association, which represents physician groups without exercising much direct control over doctors, the AAMC has immediate and significant authority over its constituent medical schools and academic health centers. And in recent years, it has used this leverage to fundamentally alter the way medical schools assess applicants. …

In that address and others, [Dr. Darrell Kirch, president and CEO of the AAMC,] described the AAMC’s “Holistic Review Project,” which the organization launched in 2007 with the goal of “redefining what makes a good doctor.” The project’s objectives included revising the MCAT and a wide range of other reforms. A series of new guidelines (some of which have yet to be implemented) called on medical school admissions teams to place less emphasis on applicants’ grades, changed the requirements for letters of recommendation, and altered the standardized application by requesting a great deal more information about students’ upbringing and life experiences. The AAMC is also planning to add “situational judgment tests”—carefully crafted interviews in which applicants will be presented with a variety of hypothetical scenarios involving ethical conflicts—to the current admissions requirements. Along with the new MCAT, these changes are part of Kirch’s plan to shift the focus of medical-school admissions toward a “new excellence,” a standard based less on test scores and more on “the attitudes, values, and experiences” of applicants.

Sorry, but I’m much more concerned with whether my doctor knows how my body functions and how to fix it when things go wrong than what his or her attitude and values might be.  Basically, if he or she values my business and my health, I’m good with whatever else he or she might believe.

As progressivism seeks to turn everything in our society to the single goal of political ends, it will seek not only to ensure that progressive doctors and other professionals are available to those who value them, but that no other options exist.

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The Herd of Rhode Islanders Can Afford to Allow Some Freedom

Some families don’t believe that the fact that their children go to school with other children gives the government the right to force them to take drugs related to sexually transmitted diseases.  Many become more suspicious when they hear of terrible side effects that some appear to experience and observe the overlapping financial interests of state government and company behind the drug.

Mind you:  If the government simply recommended the drug, there would be no problem.  But as it is, dedicated families feel the need to become activists and testify in pursuit of legislation to return their freedom.  On the other end are bureaucrats whose social concern is difficult to entangle from the pursuit of metrics:

Among her arguments against the “personal belief” exemption that some lawmakers are seeking: “The proposed legislation, if enacted, will potentially decrease our state’s vaccination coverage rates, putting people at risk … [especially] those who cannot be vaccinated″ for medical reasons. …

In one letter to the lawmakers, [Director of Health Nicole] Alexander-Scott wrote: “Most vaccine-preventable diseases are transmitted from person to person. When a sufficiently large proportion of individuals in a community are immunized, those persons serve as a protective barrier against transmission of the disease in the community thus indirectly protecting those who are not immunized … This phenomenon is referred to as ‘herd immunity.’”

Good of the government to have such concern about the “herd.”  One doubts that Alexander-Scott highlighted the fact that Rhode Island’s HPV vaccination rate was already high, and that the mandate increased it almost not at all.

That is, acting of their own free will — not as herded cattle — Rhode Islanders were already doing what the government wanted.  Knowing that, one can reasonably infer that making us do things is the point, establishing the principle that we have to go where they think we should.

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