A Stagnant Pool

That is what this blog has become in the past two weeks. Having failed to write anything on the passage of the House health care bill, recent debates about US fiscal policy, or even the elections, I feel left behind in the public debate.

To be fair, I have been working more hours and have had a number of midterms and papers due recently. Still, I feel rather apathetic concerning recent public policy debates. We have rehashed health care debates, debates on Afghanistan, and debates on partisan politics ad naseum.

So I am taking a step back to reconsider the purpose of this blog. What would you like to see on this blog, dear reader (if I still have any)? What are the policy issues that need discussion but have been largely avoided by me or others? What is the value added of this blog? What contribution is needed in the policy world?

I look forward to your input.

Demand, Supply

Economics made simple:

"Tradin’ this for that, call it tit for tat
We all face tradeoffs and that’s a fact because
Everything is in finite supply
That’s the reason why we all sell and buy


Next up is rule deuce, the next best use
Of money or time defines its true value
It’s more convoluted than just the simple cost
What else could you do? What opportunities are lost?


Decisions at the margin, yeah that’s the key
To understanding principle #3
Take your present situation and assume that it’s the best
If a change is worth more than it costs, then that’s your test."

Don't you just love economics?

HT: Greg Mankiw

Sarah Palin and Facebook

This blog entry is part of a class project I am working on concerning minority political parties and new media technologies. However, I thought this subject would also apply to the broader discussion here. Feel free to go to my new site, "The New Political Wilderness" to read this article in its entirety as well as other resources on the subject.

Sarah Palin has emerged as one of the most interesting case studies of how Republicans in opposition are using social networking and new media technologies to get their voices heard. The former governor has been extremely effective in broadcasting her policy stances on such alternative media sites such as Facebook and LinkedIn. Palin's Facebook page is now approaching 1 million supporters, putting her second place among all politicians behind Barack Obama. It is admittedly a distant second place (Obama has almost 6 million fans), but consider that Palin has no formal institutions of power at her disposal. While President Obama has the full weight of public and party power behind his efforts, the enduring Palin phenomenon is almost entirely driven by new media broadcasting. As Politico's Andy Barr writes, "While Palin isn’t the only major political figure to try alternative means of communication to bypass the media, her unique ability to remain in the headlines while avoiding the spotlight suggests she may be the first to pull it off successfully." [Read full article here.]

Service is Turning the US into Maoist China!

Thank you Glenn Beck for alerting us to the dangers of service, especially when that service is promoted by our President and others in Hollywood:

You have been warned! If you help your neighbor or serve others, you are undermining this country and empowering the President. After all, it was Mao's call to service that killed 40 million of his people through famine.

Offending the High Priests of Climate Change

Tomorrow, the new book Superfreakonomics is due out. Written by Steven Levitt and Stephen Dubner, the book is intended to be a followup to their wildly successful book Freakonomics. I have followed their work and blog in the intervening years and have always found their research interesting and insightful.

But now they have offended the high priests of the climate change movement.

The blogs on the left have been bursting with anger over the final chapter in the yet to be released book. (See here, here, and here just to get started.) Apparently (and I haven't read it yet since, well, the book is not even released until tomorrow) the authors look critically at the entire climate change movement. From what I can gather from the snippets of the chapter I have found, they suggest that there are alternative solutions to fighting climate change. Rather than just relying on reducing carbon emission-a difficult solution politically and perhaps somewhat infeasible if we wish to maintain our current standard of living-the authors suggest a number of possible alternative solutions.

Again, I cannot speak too much to the issue until I read the book. But what I find shocking is how commentators on the left have lambasted the renowned economists for the book that no one has read yet. And all because they did not conform exactly to the official doctrine on global warming. In their well-written defense here, the authors point out that they are not denying climate change or even trying to minimize the very real risks of rising global temperatures. Rather, they are suggesting a broader discussion of solutions and a more public and less polarized debate on the topic. But apparently, major figures involved in the fight cannot seem to allow that.

Frankly, the climate change movement seems to be behaving like a dogmatic religion rather than a scientific and political debate.

Europe? Yawn

My new article at the Atlantic Review is entitled, "Europe? Yawn." Check it out here and feel free the leave comments!

The Nobel Laureate

Imagine you are a small, stable Nordic country and you would love to invite the world's most powerful person to your country. How do you convince him to come? Answer: Give him your country's most prestigious award.

The major news this week has been the announcement that Barack Obama will win the Nobel peace prize. In those discussions, it strikes me that nearly everyone-on both sides of the political spectrum-feel the Nobel committee made a poor or at least premature decision. Clive Crook captures the feeling best here :

"Mr Obama was always going to struggle to gratify the hopes that got him elected. He knows this better than anybody. In office, a key task was to temper expectations, face uncomfortable facts and bring the country to a more sober understanding of its choices. This is not going well and the Nobel committee’s declaration of love has made it all a little harder."

I could not agree more. Running for president is always something of a popularity contest of course. But the Obama administration has the responsibility of tackling a number of serious policy issues, none of which have been fully resolved yet. In this context, turning down the peace prize would have sent a powerful message. Unfortunately, it looks like Obama is headed to Oslo after all. At least the Norwegians are happy.

Will Social Security be Around When I Retire?

I received a letter from the Social Security Administration this week that caught my eye:

Despite what the SSA says, I highly doubt that I will ever receive social security when I retire, and I am certainly not planning on receiving anything. What do you think?

Health Care Guest Post Series: We Are Actively Trying to Kill Ourselves

This is the second guest article in my series on health care (previous articles here, here, and here). Today's article is by Ryan Peterson, currently a Radiology Preliminary Year Intern at Emory Hospital in Atlanta, Georgia.

I understand that I’ve been only working in medicine for the last 5 years of my life, but that has been MY life. I write only from my perspective. I do not claim to have the definitive answers to the complex problems in health care. I only share what I see.

So, why has health care become so expensive? There are many reasons for this, but as I see it, the major problems are:
1) People are no longer responsible for their health
2) Expensive technology, medicines and treatments have become expected
3) Doctors are trying to cover their own ass (CYA).
4) We are afraid to allow natural death.

For today let’s just take #1. We are actively trying to kill ourselves. Our diets rely principally on fast food and “take out.” Coke has replaced water as our sole source of fluid intake. Our children sit in front of the TV or computer, playing video games, for hours. We drive everywhere we can. Smoking starts well before high school (at least down here in the South). Kids start having sex at earlier and earlier ages without proper education on protections from deadly preventable disease. Drinking alcohol and jumping in the car is not given a second thought. Americans don’t take responsibility for their own health.

The most common diseases that cause a person to come into the hospital are preventable diseases. Physicians in America do a horrible job at management of chronic diseases. Why? This is because physicians are only a small player in the health of an individual person.

Here are some examples:

- Heart disease is the number one killer in America (yes more than cancer). Heart disease is most commonly caused by plaque that builds up in the arteries supplying the heart. These plaques are mostly produced by our high fat diet, genetics and smoking. Doctors give people expensive surgeries (place stents in their heart), place them on 2-3 blood pressure medications, an aspirin a day and give them cholesterol lowering drugs. None of these things will ever replace proper diet, exercise and smoking cessation. ALL FREE. Instead of getting up off our butt, Americans wait for someone to give them a daily pill (which they take 50% of the time). We in America don’t want to put the work in to maintaining a healthy lifestyle. I would say that 65% of reasons people come into the hospital/ER are for chest pain related symptoms. Multiply that by millions of people = EXPENSIVE.

- Cancer is #2 on the list of causes of disease and death. Of cancers, the big front runner is lung cancer (30%). Think of all the cancers that could be possible, and then think that smoking leads to a cancer that accounts for1/3 of all known cancers. Only about 10% of smokers get cancer but that accounts for a huge chunk of medical resources. Emphysema (#3 or #4 on the mortality list) is caused only by smoking. While only 10% of smokers get cancer, 100% will get emphysema if they live long enough (most get it well before they die). Colon cancer is up there as well but we will leave that for people who do not like fiber in their diet or cameras placed up their rectum.

- Type 2 diabetes leads to multiple, repeated hospital admissions. It leads to sequential amputations, heart disease, and significantly increases the risk for stroke. No “pimped out” insurance plan will ever improve diabetes the way free diet and exercise would. I could give my patient the most expensive drug out there (helamonster saliva), weekly checkups with the doctor and nutritionalist counseling every week and not have any improvement in that person’s blood sugar. This “acquired” diabetes is 100% preventable but Americans cannot seem to give up their 44 ounce bottles of coke.

- Stroke is another expensive cause of significant morbidity and mortality. However, it is not always caused by our behavior. But just so you know, smoking, cholesterol, and high blood pressure all lead to strokes. Strokes lead to long term care and extremely high costs to the health care system.

My point is we are not taking responsibility for our own health. OUR CULTURE IS KILLING US. Everybody knows that a life of hamburgers, cigarettes, and TV are not healthy for us. Yet we still do it. We have cut physical education from our schools. Sexual education is now taught in schools and not in the home. Parents do not cook anymore or get their kids to “go play outside.” We do not eat our vegetables. As a physician, I cannot force you to go to a fat camp. I cannot even force you to take your medications or even go see your doctor when I discharge you from the hospital/ER. I do not want you to be a granola-eating, vegan, yoga master. I just want you to take responsibility for your life.

So, if you are unhealthy, that leads to disease. You go to a doctor. That doctor tries to treat you with the best evidence-based medicine and treatments (always starting out with improved diet and exercise=FREE). Then you are not compliant with your medications or follow-up appointments, and you continue living your unhealthy lifestyle. That leads to worsening of the disease and more complications, leading to exponential drugs, money, and resources needed. Your insurance company sees you as a risk (as well you are) and raises your premiums. Multiply that by millions and we get the astronomical numbers for health care cost (16% of GDP). This is why I think health care costs are increasing year by year.

There is no company giving large sums of money away to executives to equal that amount of increase. Physicians are not all buying an island out in the Caribbean. Americans are getting more preventable chronic disease and are not willing to make the changes needed to stop that disease. Premiums will continue to increase until the disease burden decreases. The system will continue to be ineffective until patients take responsibility for their own health. And by the way, if you think that the government will be more effective at regulating costs, look at the statistics for Medicare and Medicaid (socialized government run systems of which I am currently employed) - effectiveness is not much better.

In conclusion:
• Americans are actively trying to kill ourselves.
• Society has become addicted to fast food, cigarettes and computers.
• Twenty medications does not equal good health but does equal a lot of money.
• Diet and exercise are free and are the most effective things for a disease-less life.
• No government run health insurance plan (or any plan for that matter) will lead to improved health of the Nation.
• It is the RESPONSIBILITY OF THE PEOPLE to improve their own health.
• The system will continue to be ineffective until patients take responsibility for their own health.
• Government is missing the mark in their current health care revision plans- not enough focus on prevention, education, incentives for health. (I’ve read most of the bills out there.)

These are my thoughts and feel free to disagree.

George Washington on Debt

Sorry for the lack of posting recently. I am studying to take the Foreign Service Exam as well as working to keep on top of all my school work.

I have been reviewing early literature on the founding of the United States, including the Constitution, Tocqueville, and the Federalist Papers. It has been a fascinating experience and has renewed my respect for the Founding Fathers of this country and their novel application of democratic governance.

Today I was reading George Washington's inaugural address and this quote stuck out to me:

"As a very important source of strength and security, cherish public credit. One method of preserving it is to use it as sparingly as possible: avoiding occasions of expense by cultivating peace, but remembering also that timely disbursements to prepare for danger frequently prevent much greater disbursements to repel it; avoiding likewise the accumulation of debt, not only by shunning occasions of expense, but by vigorous exertions in time of Peace to discharge the debts which unavoidable wars may have occasioned not ungenerously throwing upon posterity the burthen which we ourselves ought to bear. The execution of these maxims belongs to your Representatives; but it is necessary that public opinion should cooperate."

I find that to be sound advice, and advice which is systematically ignored by both parties. And when I think about Social Security and the phrase, "ungenerously throwing upon posterity the burthen which we ourselves ought to bear," I feel a slight shiver.

The time when we will have to face our dependence on public debt is rapidly approaching I believe.

Health Care Guest Post Series: Five Reasons Obama Can't Fix The U.S. Health Care System

During the recent debate on health care reform I have written a bit (here and here) on my perspective and my ideas. But since I have little immediate experience within the health care industry, my ideas do not carry much weight. So, I have asked a few friends and colleagues in the health care industry to write guest articles discussing their perspective on the American health care system. Today's article is by Joshua Stacy, a health insurance consultant and insurance agent who has worked for United Health Care and Aetna.

Five Reasons Obama Can't Fix The U.S. Health Care System
by Joshua Stacy

Failure To Address The Rising Cost Of Obesity: It's no surprise to anyone that Americans are getting heavier and heavier, but the costs associated with those extra pounds are being ignored. According to the American Diabetes Association the annual costs of health care for people with diabetes is $11,744 per year, of which $6,649 is attributed to diabetes. Those were the 2007 numbers, and the costs go up every year along with the number of individuals who are diabetic. In addition to diabetes, there are other medical conditions that are expensive to manage. Americans eating better and getting some exercise could drastically lower the cost of health care. It doesn't help that a doctor is better off prescribing the prescriptions then telling their patients they really need to lose weight because they're killing themselves.

Using The Wrong Health Care Delivery Model: If the ultimate goal of providing health insurance to every American is to provide them access to health care, why not skip the middle step? Health insurance is nothing more than a way of financing the cost of an individual's health care. If we as a country want to make health care available to every American a more cost effective delivery model would be to make doctors and other medical providers available at clinics. Rather than paying for the cost of insuring the risk, this would allow the government to only fund the actual cost of health care delivery and avoid disrupting the entire health care system as it stands now. Implementing this program could be as painless as increasing funding to the current Federally Qualified Health Centers and allow more people to receive access to health care services. This wouldn't be a solution in it's entirety, but it's a step in the right direction.

Not Addressing Real Medicare Issues: By eliminating fraud, waste and abuse Medicare can only save a certain amount of funding. One program that Obama does not approve of is the Medicare Advantage Program, also referred to as "Medicare subsidies paid to private health insurance companies." Of the 45 million Americans on Medicare more than 20% of them are on these programs that give Medicare beneficiaries the option of enrolling in Medicare programs with private health insurance companies. When they enroll, the government pays at least $800/month to the insurance company that has the member and in exchange, the health insurer assumes all of the costs associated with the health care for that member. It's privatizing Medicare, which isn't intrinsically a bad idea, but the way it's being implemented now is almost as wasteful as possible.

In the private sector groups with as few as 500 employees will self-insure the risk. What that means is the employer will pay a private health insurance carrier to administer the plan benefits. If the employee goes to the doctor, the employee will show his ID card from the private health insurance company and the insurance company will pay the claim, but they'll use reserve dollars the employer gave them. What's happening is that all the carrier is doing is managing provider networks, answering customer service issues, handling case management, preventing fraud, preventing abuse, and cutting checks. If employers insuring as few as 500 lives save money by self insuring the risk, how much could the federal government save if they were self insuring over 10 million Medicare members?

It Was Here First: In the United States of America there are hundreds and hundreds of health insurance companies, thousands of hospitals, and almost one million physicians. Our health care system has been growing and developing since before Obama was born (whether it was in the U.S., Kenya, or the planet Krypton). The notion that any act of congress can address and remedy the majority of the problems with our health care system is absurd. Real change will take time and needs to be structured in a way that makes sense and won't create a financial burden on a country with an economy that is already struggling. It is projected that in less than 10 years the Medicare Hospital Fund will have it's funds completely exhausted. Add to that the fact that social security will be running in the red within the next 3 years and we have a recipe for disaster. The American people would be better served by the President focusing on those issues, rather than trying to compound them. Even if the savings to the Medicare program covered the entire cost of his plan, the whole thing is bankrupt before most high school freshmen will be able to finish a 4 year degree and interview for their first job out of college.

The Health Care Industry Is Too Profitable: In a country that has most of its politicians bought and paid for by multiple special interest groups, the industry that accounts for over 17% of our GDP has had their best interests protected for years. If change is going to happen, it needs to happen at a grassroots level. People need to stop asking their doctor about new drugs that are at best only marginally better than the old ones, eat less junk food, eat less food, and exercise more. In addition to that, they need to read the bill they get when the go to the doctors office. A few years ago I went to an urgent care facility because I had a serious reaction to poison ivy. I went to the pharmacy to have my prescriptions filled and had a $5 copay on each of the drugs. The first drug retailed for around $15 and the second for $75. Instead of just taking the drugs home, I asked the pharmacist what they were for. The first drug was a steroid which would help the rash go away more quickly, the second would make it itch less. I told him to put it back on the shelf, I could deal with being slightly more itchy.

Part of the real problem with our health care system (and government) is that too many people are asleep at the wheel and not asking questions. If American citizens would take more accountability for their own health care and make an attempt at making informed decisions, the cost of health care delivery could go down drastically which would limit the power of special interest groups and make meaningful change more possible.

Stay tuned to this blog and maybe Andrew will let me tell you all what some of my solutions to the current problems would be!

What to do About Afghanistan

Afghanistan is slowly rising again in America's consciousness. Take a look at the Google news items on Afghanistan over the past few years:

The trend is indicative of American foreign policy this decade: a rapid mobilization followed by a declining interest that turns around only as conditions deteriorate once again. In the past few weeks I have written about Afghanistan (here and here) and struggled to understand what can be done. After the elections (can we still call them elections?) I felt even more frustrated. Comedy Central has really captured the issue in a nutshell:



So what is to be done? And what do Americans feel about the issue? What is the proper policy towards Afghanistan when our allies are leaving in droves and fatigue is setting in?

I do not have any easy answers. I feel empowering the citizens is crucial, and I was hopeful that the elections would offer a tenuous start along that path. But as Jon Stewart highlights, we are not the first ones to get bogged down in the mountains of Afghanistan.

What would you recommend?

Why Am I in Graduate School?

 

To be fair though, I'm hoping for a future return on my investment. Just collecting unemployment benefits would not help future earnings much.

A Call to Action

In the midst of the health care debate, the stimulus debate, and the bailout debate, this headline seemed particularly striking to me:

"Poverty Rose, Median Income Declined, and Job-Based Health Insurance Continued to Weaken in 2008"

We likely already knew all of this. 46.3 million uninsured Americans, 13.2% of the US in poverty, and 19% of children living in poverty. What I find striking is how these data do not seem to play very prominently in the current public debate. This should be a call to action. One in five children are living in poverty! One in six Americans do not have health insurance!

Unfortunately, the human face of current policy debates seems to be lost (unless you count bad-mouthing South Carolina congressmen or goose-stepping Obamas). Now I understand different political parties have different perspectives on this issue. But I feel as though we should all be intensively engaged in alleviating this tragedy. Surely Republicans can acknowledge that the vast majority of Democrats honestly want to make good public policy that will help Americans provide for their basic necessities. And surely, Democrats can acknowledge that market mechanisms are an integral element to any successful public policy.

I am hopeful because I believe the majority of both parties want to enact change. I am hopeful that Obama's speech calmed the frantic forces of both parties, so that we can move forward. And it is valuable to remember that public debates make a real difference to millions of Americans.