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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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The Irrational Assumptions Allowing Elimination of Down Syndrome

George Will writes powerfully against the West’s efforts to “eradicate” Down Syndrome:

An Iceland geneticist says “we have basically eradicated” Down syndrome people, but regrets what he considers “heavy-handed genetic counseling” that is influencing “decisions that are not medical, in a way.” One Icelandic counselor “counsels” mothers as follows: “This is your life. You have the right to choose how your life will look like.” She says, “We don’t look at abortion as a murder. We look at it as a thing that we ended.” Which makes Agusta and Lucas “things” that were not “ended.”

Because Iceland’s population is only about 340,000, the problem (again, see the photos of problem Agusta and problem Lucas) is more manageable there than in, say, the United Kingdom. It has approximately 40,000 Down syndrome citizens, many of whom were conceived before the development of effective search-and-destroy technologies. About 750 British Down syndrome babies are born each year, but 90 percent of women who learn that their child will have — actually, that their child does have — Down syndrome have an abortion. In Denmark the elimination rate is 98 percent.

For many — maybe most— political or ideological positions with which I disagree, I can imagine my way around to understanding how reasonable differences about assumptions can lead people to conclusions with which I disagree.  Especially with improved medical imaging technology, the reach of my imagination cannot make a pro-abortion stance reasonable.  (I’ll also acknowledge that my thinking was objectively unreasonable back when I held that monstrous view in my youth.)

Aborting a pregnancy because a screening is suggestive of Down Syndrome is tantamount to saying, “My child will have a developmental disease; let me kill him or her before it becomes more morally complicated for me to do so.”  The underlying assumptions that make such a statement seem rational must be either irrational or morally repugnant.

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Medicaid Expansion Not Working Out as States Had “Predicted”

Encouraging Virginians not to expand Medicaid to able-bodied, childless adults, Brooklyn Roberts looks at some results from states that have moved forward with the change:

As an example, let’s look at Oregon, a state that began expanding Medicaid in 2008. Officials there lacked funding for the total number of applicants, so they conducted a random lottery and selected enrollees from a waiting list, thus making Oregon an ideal state for study. What they found was that gaining Medicaid coverage increased health care usage and costs across a wide range of settings, and emergency room visits increased by 40 percent in the newly covered group. Proponents of the expansion argued the initial spike in ER visits was due to pent-up needs and would decrease as time went on.

That has not been the case. Oregon’s growth in Medicaid spending between 2012 and 2016 was 83.1 percent. A follow-up study in the New England Journal of Medicine concluded the value of expansion for recipients was quite low — 20 to 40 cents per dollar of government spending.

So, the expansion increases health-care usage in ways that weren’t predicted by the officials who’ve implemented the expansion, and those officials have proven even more egregiously incorrect when it comes to predicting how many people would sign up.  (We could argue about whether that was a flaw in their methodology or something more like deception; after all, they’ve ushered a lot of people into Medicaid by rerouting them through health benefits exchanges that were supposed to sell plans for actual money.)

In Rhode Island, our government officials signed up for the expansion almost before it was officially offered.  We should force them to reconsider how they do things.

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The Prioritization of Free Birth Control

This story is utterly unremarkable, in this case reported by Jacqueline Tempera of the Providence Journal:

Two female lawmakers stressed the importance of protecting women’s access to birth control on a state level in a press conference Tuesday afternoon.

Rep. Katherine Kazarian, D-East Providence, and Sen. Dawn Euer, D-Jamestown, introduced matching bills this session that would protect a woman’s access to birth control in Rhode Island, regardless of any changes at the federal level….

A key provision in the ACA allows women to access birth control pills, as well as long-term options such as intrauterine devices, known as IUDs, or other implants, for a $0 co-pay.

In the past, I’ve mainly let this sort of rhetoric go with a simple question about why lawmakers want to forbid people from buying less-expensive insurance that only includes coverage for things that they need.  That’s really what’s going on, here.  Kazarian and Euer want men to pay for women’s birth control.  (Note: The legislation explicitly leaves out coverage of male condoms and sterilization for men.)  They want older women to pay for younger women’s birth control.  They want people who aren’t having sex to pay for the birth control of people who are.  They want Catholics and others who don’t use birth control because of their religious beliefs to have to pay for the very same products being used by other people.

Lately, I’ve been thinking of what the elevation of this particular type of health care fundamentally means.  Every now and then, I’ll come across a request from some Rhode Island family asking people to donate to help them stay afloat while dealing with the sudden onset of a child’s life-threatening disease.  Throughout Rhode Island, parents with children who have genetic diseases have no choice but to find some way to afford the copays for life-preserving treatments that will never become unnecessary, unless some miraculous cure is found.  And of course, neither of these challenges goes away when the children become adults.

Perhaps Kazarian and Euer would insist that they’d support socialized health care that claims to make all medicine “free.”  Put the wisdom of that proposal aside.  What they’re pursuing right now is to make sure that women don’t have to pay for products that let them have sex while minimizing the chance of pregnancy.  That’s their priority, and it tells us a whole lot about what they believe.

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RI Government Can’t Prevent Erosion Without Looking for Causes

This statement by East Bay Democrat Senator Lou DiPalma, quoted in a WPRI article, struck a note worthy of elaboration:

“We have never seen a proposal where one of Rhode Island’s largest hospital systems would be acquired by a hospital network that is located in a state adjacent to Rhode Island,” DiPalma said in a statement. “The potential for patients, jobs and services to migrate to Massachusetts is a serious concern.” He added, “This proposal presents a unique risk to Rhode Island’s hospitals and health care system.”

Here’s the thing: That migration is already happening.  For reasons I won’t go into, I’ve had reason to hear Rhode Islanders’ candid thoughts about medical care in the area, and just as “everybody knows” you need a federal judge for justice in the legal system, folks also know that you need a Boston hospital for top-notch care.

Some of that is just inevitable, because Boston is a higher-tier city than Providence, but that’s been true for a long time.  But these mergers aren’t under consideration because Rhode Island hospitals are doing great and represent a great buy for an expanding corporation.   Memorial Hospital in Pawtucket hasn’t been doing the dance of closing hospital because people aren’t using it.

As usual, Rhode Island’s government officials are looking to use the power of government to stop erosion when they should be evaluating what it is they are doing that starts the process.  We need freedom and innovation, but that takes power away from political insiders, so… there you go.

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Encouraging Bad Behavior by Curing a Consequence

Sometimes the legislation flowing through the Rhode Island General Assembly each year takes the form of series, with tweaks and additions to particular areas of law building on each other.  One such series involves opioid abuse and overdose, with a subset for increasing (even mandating) the availability of emergency drugs to save people from overdoses.  Unfortunately, Robert VerBruggen reports for National Review that this trend may have an undesired outcome:

Are Anti-Overdose Drugs Backfiring?

Yes, says an incredibly depressing new study. It suggests that opioid abuse rises when overdose-reversing drugs are easily accessible.

This could happen through two different mechanisms: “(1) saving the lives of active drug users, who survive to continue abusing opioids, and (2) reducing the risk of death per use, thereby making riskier opioid use more appealing.” (1) isn’t a bad thing, even though we would obviously prefer that addicts quit after nearly dying. But (2) is a serious problem, as it could mean that overdose-reversing drugs don’t actually save lives on balance.

Obviously, this finding (if further study validates it) doesn’t prove that we shouldn’t strive to save lives, but it should lead us to be humble as we attempt to use government to fix society’s problems.  I mean, think of the choices that pile on each other:  We decide that we’re going to use government to make anti-overdose drugs more readily available, and that increases drug abuse.  This can get very expensive for other people very quickly, whether through taxes or health insurance premiums.  Those resources necessarily have to come from elsewhere.

Perhaps to mitigate the financial and human cost, somebody will propose that anybody whose life is thus saved must be committed to a facility for recovery.  Now, suddenly, we’re saving lives only to institutionalize people who may relapse once they’re let out, and when they do, they’ll have incentive to take their drugs in a more concealed environment.  What then?  Further erode their privacy?  Or create safe places in which they can do their drugs, thus increasing the ease of drug usage?

Frankly, I’m not sure where I land on this series of questions, but it wouldn’t be irrational or inhumane to go back to the start of it and suggest keeping government out altogether.  At least that would focus our attention on the social arena in which the solution to the problem ultimately lies.

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Pharma Fumes and Socialism

This, from Clifton Leaf in Fortune, is one reason I find socialized medicine schemes (including, broadly, ObamaCare) so disturbing:

What the chart above shows is simply the percentage of 2017 revenue that derived from products launched in the previous five years. In other words, how much of each company’s sales are coming from drugs fresh out of the pipeline versus how much are coming from older meds?

In that regard, the picture above is worth a thousand words: Nearly all of Big Pharma is riding on fumes, it seems.

Now, a number of open questions make this analysis insufficient.  Historically, for example, what has been the revenue mix?

But those questions aside, the reality is that profit motives spur risk and innovation.  A balance must still be struck, but the class envy and central planning of socialism inevitably force a society to coast on fumes.

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Government’s Taking Children Based on Flawed Test Is a Warning Sign

As we consider empowering law enforcement and judges to infringe on Constitutional rights based on things they think people might do in the future, and as we hear of parents’ losing custody of their children because the government has decided to enforce transgender ideology as law, and as progressives continue to push for socialized medicine despite British illustrations of what that means for parents’ rights, we must pay careful attention to warning signs like this:

Whiteman’s situation was not an isolated error but part of a scandal ripping through the Canadian child welfare system. The injustice was put in sharper focus this week with an independent commission report showing more than 50 custody cases like Whiteman’s were tainted by flawed drug and alcohol testing from the same Toronto lab. …

The commission found the lab’s testing did not meet international forensic standards and test results were “frequently misinterpreted.” Looking specifically at 1,271 cases handled by the lab between 1990 and 2015 in Ontario, the commission determined Motherisk’s flawed testing played a critical role in 56 cases.

… the commission was blunt about the irreparable damage done. Many of the children who were uprooted based on the tests are now in new living situations. Some have even been adopted. So far, children have been reunited with parents in only four instances, according to the Star.

As we come to put all-consuming faith in testing and planning and government’s ability to fix every problem, we may find ourselves in a nightmare that used to be only imaginable to novelists.

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