In general, it is not a good idea to panic about anything. The panic itself often causes more harm than the original threat.
Crisis situations, real or contrived, lead to new intrusive laws that the public would never accept otherwise. We supposedly cherish freedom, but if we believe that the world will end if we don’t act NOW, then we may clamor for the government to save us. Cynical politicians bent on increasing their power never let a crisis go to waste.
Something like the Green New Deal—the end of our comfortable, prosperous lifestyle—takes a truly apocalyptic threat. But to eliminate our freedom to decline a medical treatment, the threat that “millions will die” of measles is evidently enough. Or if not millions (most older people had measles and recovered fully), a few especially vulnerable children, who can’t be vaccinated themselves, might catch measles and die.
There are several hundred cases of measles nationwide, more than in 2014, and bills are being pushed through state legislatures to eliminate all but very narrow exemptions to the 60 shots now mandated for school attendance.
In New York City, people are receiving summonses based on Mayor Bill de Blasio’s emergency order. Everybody, adult or child, who lives in four ZIP code areas must get an MMR shot or prove immunity, or face the prospect of a $1,000 fine ($2,000 if you don’t appear as ordered). Your religious exemption is overridden. The threat of 6 months in prison and the prospect of forcible vaccination were removed before a hearing on a lawsuit brought by five mothers. The judge dismissed the case.
Health Commissioner Oxiris Barbot said that the purpose of the fines is not to punish but to encourage more people to proclaim the message that vaccines are safe and effective. Get it? If you say something to avoid a fine, that makes it true.
It’s about the need for herd immunity, they say. We need a 95 percent vaccination rate for herd immunity to measles. With only 91 percent or so we are having outbreaks! If we could just vaccinate another 4 or 5 percent!
Mayor De Blasio has a point about vaccinating everyone. Adults are getting measles because their shots have worn off. It is likely that we have survived for decades with a large part of the adult population vaccinated—but not immune. So where do the mandates stop?
Outbreaks have occurred in populations with a near-100 percent vaccination rate. Was it vaccine failure? Or was the vaccine not refrigerated properly? Or was a claimed outbreak real? One in Ann Arbor, Michigan, was called off when a special test, a reverse transcriptase polymerase chain reaction (RT-PCR) showed a vaccine-strain measles virus rather than a wild-strain measles virus. Some 5 percent of vaccinees may get an illness that looks like measles, but it is just a “vaccine reaction.” Can they shed live virus? Yes. Should you keep your immunocompromised child away from recently vaccinated people? Just asking.
Like all medical treatments, vaccines are neither 100 percent effective, nor 100 percent safe. Read the FDA-required, FDA-approved package inserts. Arizona defeated a law that would have required making these available to parents in obtaining informed consent. (You can get them on the internet.) Vaccine Court has paid out about $4 billion in damages—recently for two children with severe brain damage from encephalopathy (that’s brain inflammation) after a fight lasting about 15 years. Just incidentally, they had an autism diagnosis also. Parents bring their severely injured children to hearings. You won’t see these children on tv, only pictures of babies with measles. No “fear-mongering” allowed about “rare,” possibly coincidental problems from vaccines.
There are trade-offs with vaccines: risks and benefits. But in the panic about measles, the right to give or withhold informed consent—fundamental in medical ethics as well as U.S. and international law—is being sacrificed. And so is free speech. The AMA wants to censor “anti-vaccine” information on social media. I happened on a factual article by investigative reporter Sharyl Attkisson, but was not able to retweet it because it had been removed.
The threat of infectious diseases is real and increasing. We need more robust public health measures, better vaccines, and improved public knowledge and awareness. Deploying vaccine police and shutting down debate will erode trust in health authorities and physicians, although more people may get their shots. But such heavy-handed measures will not defeat the enemy—measles and worse diseases.
Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. Her views and opinions, if expressed, are her own and do not necessarily reflect the opinions of GCN. Her column can often be found at www.pennypressnv.com. Her column has been reprinted in full, with permission.
A Peek into How Doctors Think – An Introduction to “Columns”
Anyone who is on their path to becoming a successful physician needs to be able to take a good history and perform a thorough physical. However in this day and age, patient care is performed in a very speedily process and thus the boards test a medical student on how succinctly they can perform a patient history.
Thus students and licensed medical providers need to be adept at “data gathering” no matter what the patient presents with. Our job is to figure out what’s going on, no matter how difficult the task, and do so quickly. So how do we accomplish this?
We start by looking at the cause and then breaking down what could be occurring resulting in that cause, or in other words, forming a differential diagnosis. So if someone has chest pain, one may form a differential consisting of heart attack, pericarditis and costochondritis. But other issues may be at play such as a pneumonia or an esophagitis.
So when we look at a person with chest pain, we consider all the body parts or causes that could be causing the symptoms.
Hence with a patient presenting with chest pain, one would consider a cardiovascular cause, pulmonary cause, gastrointestinal cause, musculoskeletal cause, and even psychiatric cause.
This is the basis of forming one’s columns. For every chief complaint we form columns either mentally or on paper and then ask associated symptoms (or pertinent positives or negatives) to determine which column we’re in. Usually a few “power questions” will help discriminate which column you are in. Once you hit the correct column you will ask further questions along that line.
True there are many more questions we could ask than just the “power questions,” but during a time crunch we need to ask very specific ones to determine if we are on the right track. If we receive multiple “no”s along a column, we know to move onto the next column.
Hence if a patient with chest pain denies dizziness and diaphoresis or sternal pain upon palpation but admits to cough, shortness of breath and sputum production, we have just narrowed down the chest pain patient to a pulmonary cause as opposed to assuming it was cardiac in nature. Then we would continue down the pulmonary column, thinking our differential may be a pneumonia/bronchitis/pulmonary embolism, and ask about hemoptysis, fever, chills, etc.
So for each patient one must create columns depending on the chief complaint and then ask power questions to help focus down your differential.
Now these columns can also assist with the physical exam component of data gathering. If the above patient presenting with chest pain could have a cardiac/pulmonary/GI/musculoskeletal condition, one would examine his heart, lungs, upper abdomen and palpate the sternum and ribs.
For an added bonus, the columns can additionally assist one in forming their differential for the SOAP note.
Chest pain r/o
If a case involves a not so clear-cut symptom, columns could be used as well.
For example a patient presenting with hair loss. If one complains of hair loss, a variety of differentials could be at play. One column could be an endocrinology source (such as hypothyroidism or diabetes), another could be psychological (such as stress or trichotillomania), a third could be medications (such as chemotherapy agents), and a fourth could include genetics. Narrowing these down with power questions could exclude non-contributing columns.
So whether it’s a direct body system or cause, columns help one focus down the differential and allow an easy visual that enables one during a timed test to think quickly and know which questions to ask.
Again these columns are instituted after the History of Present Illness in which a student obtains onset/chronology, palliative/provocative factors, quality of symptoms, radiation, severity and timing (OPQRST).
They will be written down in the SOAP note after the HPI.
Example: Mary is a 25-year-old female presenting with acute onset right foot pain. It began 6 hours ago after she went for a job. Ice provides some relief but walking on it worsens the pain. The pain is sharp, constant with a severity of 7/10. She denies fever, chills, open wounds, swelling, redness, temperature changes, numbness or tingling.
Since during this step in the history most medical students find it challenging to know “which questions to ask.” The columns and power questions simplify this.
To learn this method to improve one’s data gathering skills click here.
Last month in the United Kingdom, more than 5,000 people stood in line in the rain - for hours, to see if they were a potential stem cell match for a young boy battling cancer. You see, back in December 2018, 5 year old Oscar Saxelby-Lee had been diagnosed with “acute lymphoblastic leukaemia” when the family took him to Birmingham Children’s Hospital over Christmas. Oscar was just feeling, “unwell.” The family was certainly not expecting to hear that Oscar had leukemia.
But he did. And it was a particularly rare and aggressive kind of cancer, too. Only a few hundred people, in the UK (where all of this took place) per year are afflicted. Oscar underwent four weeks of successful chemotherapy but then the doctors said he would need a stem cell transplant within a few months.
Oscar's community and school reached out via social media and told the UK about Oscar and his cause. Tens of thousands of people reached out to help including the aforementioned 5,000 that stood in the rain. Usually in these circumstances, a family member would donate stem cells but neither of the parents were a close match. Thankfully, three people, out of several thousand - were found to be a perfect match for Oscar.
From the Hand in Hand for Oscar Facebook page:
"We have the best news to share! Oscar has a match!!!! Absolutely thrilled to announce Oscar has finally got a stem cell match, not just one but three and will be undergoing transplant very soon!! What an emotional rollercoaster it's literally been a journey of heartache and dread continuously, but...WOW!!! What a feeling of relief and positivity to help Oscar kick cancer's butt!! It's been so so traumatic but we are over the moon with being given a chance to tackle the next step in treatment. Thank you, thank you, thank you, from the bottom of our hearts to all of you out there who have registered, supported and continued to spread the word for our beautiful boy and those in need of wonderous bone marrow cells. We could never have done this without you all!!”
Before the transplant could happen, Oscar needed four days of radiotherapy, which he received, and last week - Oscar was found to be free of leukaemia blast cells. The stem cell transplant is the only thing left.
I’ll update more on Oscar as soon as I hear.
Pollsters love to do general election matchup polls early in the process to figure out which candidates would fare the best against a sitting incumbent president like Donald Trump. The idea is to give primary voters of one party or another an idea of which candidate is the most “electable.”
For example, in April 2011, Democracy Corps published a poll that showed Mitt Romney could defeat then-President Barack Obama, 48 percent to 46 percent. In Oct. 2011, another CNN-Opinion Research poll showed Romney leading 50 percent to 45 percent.
But we all know how it turned out. Even after showdowns with House Republicans over the debt ceiling in 2011 — which resulted in budget sequestration that helped reduce the deficit — Obama went on to comfortably win re-election in 2012.
So, how much stock should we put in the Politico-Morning Consult poll that shows former Vice President Joe Biden at 42 percent versus President Donald Trump at 36 percent? Almost none.
The question, particularly for first term presidents, is whether voters think it is time for a change, or if they are willing to be patient while the incumbent party finishes what it started.
In modern history, since 1952, that has yielded a fairly high re-election rate for incumbent parties in their first terms. Dwight Eisenhower was re-elected in 1956, Lyndon Johnson won John Kennedy’s second term in 1964, Richard Nixon was re-elected in 1972, Jimmy Carter was ousted in 1980, Ronald Reagan was re-elected in 1984, Bill Clinton was re-elected in 1996, George W. Bush was re-elected in 2004 and Barack Obama was re-elected in 2012.
All told, in modern history, in 87.5 percent of the cases where the incumbent party had served one term it tended to be re-elected.
Readers will note that George H.W. Bush is not included in that listing. The reason for that is he won Reagan’s third term — that is, the third consecutive term that Republicans had held the White House. So, his being ousted in 1992 was less surprising because it came after 12 years of uninterrupted Republican rule in the White House. The same applies to Gerald Ford, who in 1976 was running for essentially Nixon’s third term, and Lyndon Johnson and then Hubert Humphrey in 1968 running for a third Democratic term.
But even if you include Bush and Ford in the mix as far as how sitting presidents have fared in a general election, in 70 percent of cases they have won since 1952. If you want to go back to World War II, Harry Truman won election in 1948 as a sitting president, and the number jumps up to about 73 percent.
If you look as far back as the beginning of the republic, sitting presidents who have stood for re-election in the general election have won about 70 percent of the time, although it is worth noting that until the 1800s, state legislatures generally chose electors.
So, there’s a distinct incumbency advantage, especially for first-term presidents that should give Trump an edge in 2020 no matter who the candidate is.
Particularly when it comes to presidents, in modern history, the American people, particularly independents, do not aspire to one-party rule. Swing voters tend to decide elections nowadays, and after just one term, they are still a lot more likely to give the incumbent the benefit of the doubt.
Where the rubber meets the road, and what separates one-term presidents from two-term presidents, will be the primaries. Biden or whoever is going to win the Democratic nomination must first compete and win the nomination, and do so in commanding fashion (rather than being bloodied along the way), to have a good chance to oust the incumbent.
Simultaneously, whoever the Democrat nominee is would need President Trump to have a bruising primary contest for the nomination to even out the odds. If Trump is vulnerable, it should be revealed in the primaries. But is William Weld really a credible threat to Trump? We’ll find out soon.
In modern history, unchallenged incumbents have tended to cruise to reelection. The likelihood of unseating an incumbent in the primary is close to zero, but real damage can be wrought to harm to his re-election chances. For more information, check out Stony Brook University Professor Helmut Norpoth’s primary model, which offers a guide to some of these trends. (Disclosure: I took his class!)
President Trump and Republicans have been in power for just two years and change. Is it already time for a change? History says the odds are - not yet.
Robert Romano is the Vice President of Public Policy at Americans for Limited Government. He
Recently, the outstanding economist Richard Vedder penned a column in the Wall Street Journal on the problems of higher education in America. He titled it: “College Wouldn’t Cost So Much If Students and Faculty Worked Harder.”
The piece was a preview of his book on the subject, Restoring the Promise: American Higher Education Today to be published May 1. From his summary and from reading his previous writings on the subject, I’m certain the book will be outstanding
His analyses have coincided with my own as a Nevada legislator, higher education regent, college teacher and state controller, and he has brought good data to illustrate issues I have observed in those roles. So, here, I’ll present a summary of his WSJ piece, and in future column I’ll detail from my experience and his book some major issues and solutions to the serious challenges U.S. higher education faces.
Vedder begins: “One reason college is so costly and so little real learning occurs is that college resources are vastly underused. Students don’t study much, professors teach little, few people read most of the obscure papers the professors write, and even the buildings are empty most of the time.”
As a regent and part-time community college instructor for four years, I observed all these phenomena and more first hand. They are some key reasons higher education costs have increased faster in real terms than the incomes of students and their families while those students are being ever more poorly prepared for life and the job market. And taxpayers are shorted.
His first observation is that surveys show college students today spend about 27 hours a week in class and studying, while taking classes only about 32 weeks a year. Or, fewer than 900 hours a year on academics – “less time than a typical eighth-grader and perhaps half the time their parent work to help finance college.”
He notes other researchers have found that in the middle of the 20th Century students spent 50 percent more time – around 40 hours weekly. Grade inflation has vitiated their incentives to work hard because the average grade received has risen from B-/C+ in 1960 to B/B+ now.
Vedder notes that on some campuses students study much more. And, “Engineering majors probably work much harder than communications or gender studies majors.” Ditto, law and medical students. As a sometimes engineering major at Illinois, recipient of a masters from Stanford in Engineering Economic Systems and later law student, I know all that’s not new.
But neither he nor I are suggesting that students responding to the changing incentives is the only problem. Vedder confesses: “I’m part of the problem: I’ve been teaching for 55 years, and I assign far less reading, demand less writing, and give higher grades than I did two generations ago.” Most other professors are less demanding and productive in teaching and useful research than he is, while mostly hard-sciences instructors put in similar teaching and productive research time.
When I taught 15 years ago, I told my community college students at the start of the semester I would teach them just as I would at any four-year college, including the same reading, writing, homework and testing. However, I felt guilty because I succumbed to the grade inflation trend. On the other hand, because a third of them needed remedial English, writing and math skills (having been shorted by their grade and high schools), I provided that service.
Another point he makes is that objective measures show the results of college education today are underwhelming. Similarly, I noted in my controller’s annual reports that American K-12 students’ achievement scores in international tests are in the middle ranks of those for advanced countries, while our per-student spending is among the highest.
A major point I learned as a regent is that much of higher education’s problem is the proliferation of administrative and other non-teaching staff relative to all instructors. Because colleges and universities work hard to cover up this phenomenon, I had trouble getting data on it, and I look forward to his book for more information here.
When we understand the full dimensions of the problem, we can begin crafting remedies. Stay tuned.
So, Sunday morning, I opened the electronic version of the only local newspaper I subscribe to and trust, the Las Vegas Review Journal, and I see, buried on page A8, a story headlined “Poll shows Democrats more trusted with health care”
Which was true…sort of. Because I’m pretty sure the story reported the numbers of the poll accurately.
The “poll” was an “Associated Press-NORC Center” poll which, you had to read seven paragraphs to the bottom of the story—by the Associated Press—to find out that “The poll of 1,108 adults was conducted April 11-14 using a sample drawn from NORC’s probability-based AmeriSpeak Panel. The margin of sampling error for all respondents is plus or minus 4.1 percentage points.” Let me be the first to ask the question: If that factoid had been in the headline or in the first paragraph, would anyone take this seriously? What if the story read like this:
“A poll of 1,108 adults paid for by the company selling this story to news outlets says that Democrats are more trusted to handle healthcare in the United States. The pollsters say that the 1108 adults can predict the sentiments of the 128,824,246 voters who cast a ballot in 2016 with a margin of error of 4.1 percent.”
Would anybody actually believe—especially after the 2016 election—that a sample of .0000086 percent of the voting electorate has a margin of error of 4.5 percent? But, in my favorite local newspaper, it is presented as fact. If this kind of polling were accurate, why did virtually every pollster predict Hillary by 7 points on the day of the 2016 election.
Polling used to be easier because, for most purposes, you could at least get a sample which was demographically sound. We could tell roughly where you lived by your telephone number and who you were. Today, with the advent of cell phones and cheap VOIP services, we cannot even tell with certainty what state you are in. Further, there is the built-in bias of many news organizations which sponsor such polls. If you believe that the AP is some kind of neutral news behemoth, guess again. Ditto for CBS, NBC, CNN, ABC and, yes, even Fox. They all come at stories from a predominately liberal viewpoint (with the occasional exception of Fox) so why would you believe that their polling selections would be much different?
Then, there’s the “if you see it in the media it must be true” school of thought. It’s today’s version of Hitler’s propaganda minister Joseph Goebbels’ Big Lie theory which, simply stated, says if you tell a lie big enough, many people will have to believe it. Inevitably, these “polls” are presented by the same people who populate organizations like the White House Correspondents Association and are soooo offended by the term Fake News and the President’s assertion that those who willfully present Fake News are the enemies of the people.
But the truth is not only is President Trump correct, but the average voter knows bullcrap when he or she sees it. Journalists have a tendency to see themselves as more knowledgeable and more important than average voting citizens. Many times, in conversation, journalists use terms like “them” and “those people” to describe and differentiate average voters. As if journalists, somehow, fall into a different category. Like Hillary and the word deplorable.
Want some proof? Watch those panels on FNC and CNN. Watch the Sunday morning shows.
It’s that sort of hubris which allows them to write headlines and lead paragraphs like the one I referred to above—even in my favorite local newspaper. (And I’m not kidding about that.) I’ve been in this business since I was 12. But I live about 2,600 miles from Washington and my neighbors remind me daily that I’m pretty average. I would hate for it to be any other way.
Earlier this week, news erupted about the Boy Scout’s “Perversion Files.” The Perversion Files (which the Scouts call, “ineligible volunteer files,”) detail as many as 12,000 boys that, while participating in scout programs - were sexually abused by Scout leaders.
Now, portions of the Perversion Files have leaked before, so the general information is nothing new. What has recently come forward is that the number of abused boys and abusers is much, much higher than previously reported.
The way I understand it is that the Boy Scouts of America (BSA) hired someone to do a five year internal investigation and that investigation concluded the number leaders who sexually assaulted boys in the program is not the 3,000 as had been previously reported, but is actually closer to 8000.
Let that sink in for a moment. That’s eight thousand men - volunteer leaders in the BSA, that have been accused of molesting more than 12,000 boys. So the “Ineligible Volunteer Files” is a detailed list of all the men who have “had their registration with the Boy Scouts revoked - because of reasonable allegations of child sex abuse.”
This all came to light when attorney Jeff Anderson released sworn testimony from Janet Warren, a psychiatry professor at the University of Virginia. Warren had been hired by the Boy Scouts to conduct the above mentioned study of the sex abuse files. Warren found that the evidence in the files was actually much worse than what the BSA imagined. She found the number of abused boys and abusers was thousands more than initially thought. Warren also made it clear that she found no evidence of a cover up by the BSA to hide this information and that she will present a more detailed report sometime during the summer.
Unlike the Catholic church, who just shuffles abusers around to new parishes and/or different cities - at least the Boy Scouts fired the abuser and didn’t allow them to work with youth ever again. I mean, it’s not much, but at least it’s that.
With something like two and a half million children participating in the Boy Scouts, if there are thousands of victims who come forward (and hundreds and hundreds of them are coming forward - some as young as 15, and one as old as 75) - this could be a financial disaster the BSA. As a non profit organization, they would not be able to financially handle thousands of lawsuits and would probably declare bankruptcy, which would shield them from lawsuits but allow them to continue operations.
Michael Surbaugh, the Chief Executive of the Boy Scouts said this at a lengthy press conference:
"I want to reiterate our steadfast support for victims of abuse. We are outraged that there have been times when individuals took advantage of our programs to abuse innocent children … We care deeply about all victims of child abuse and sincerely apologize to anyone who was harmed during their time in scouting. We believe victims, and we pay for unlimited counseling by a provider of their choice, and we encourage them to come forward. At no time have we ever knowingly allowed a perpetrator to work with youth, and we mandate that all leaders, volunteers and staff members nationwide immediately report any abuse allegations to law enforcement. Throughout our history, we have enacted strong youth protection policies to prevent future abuse, including mandatory youth protection trainings and a formal leader-selection process that includes criminal background checks. Since the 1920's, we have maintained a Volunteer Screening Database to prevent individuals accused of abuse or inappropriate conduct from joining or re-entering our programs, a practice recommended in 2007 by the Centers for Disease Control for all youth-serving organizations."
Okay. Well, I do believe him. I doubt BSA leadership “knowingly allowed” predators to work with youth. Again, the Perversion Files clearly state that abusers were fired after “reasonable evidence.” Which suggests that the BSA knew about the allegations, believed the victim and fired the alleged abuser. But, and here’s the sticky point - didn’t contact authorities. Which might have been a problem.
Interestingly enough, I just read that the Boy Scouts filed suit against several of their insurers for “refusing to cover its sex abuse legal liabilities.” But, like insurance companies everywhere, said insurance agents found a way not to pay a cent of coverage for the BSA by claiming, “the Boy Scouts neglected to take meaningful precautionary action.”
Hrmmm. Okay. Maybe. The Boy Scouts claim they have a screening process and a “protection system” in place. Which makes sense. Clearly, their process doesn’t work as well as they thought, but it certainly suggests they are “taking meaningful precautionary action,” so I don’t know what the F those insurance companies are talking about. I even found a part of their screening process / protection system listed in a CNN story:
Sounds like meaningful precautionary action to me. Anyway, - the courts will work all that out. Until then, more and more victims continue to come forward.
The latest challenge sweeping social media is the “Shell On” challenge in which teens Snapchat videos of themselves eating through fruit skin, cardboard boxes and plastic bags containing their food.
Although this appears to not be as dangerous as the Tide Pod or Boiling Water Challenge, it can cause choking and asphyxiation.
In the video linked on the front page the teen takes bites out of fruit with their peel, and then bites through a cereal box.
Last year we learned of the “Boiling Water Challenge” in which kids drink boiling water from a straw or have it poured all over their body. Then they topped it off with a more dangerous challenge, the “Fire Challenge.”
The Fire Challenge is executed by pouring rubbing alcohol on one’s body and then setting oneself on fire. A video records the victim running into a tub or shower to wash it off, and this trend has gone viral.
Unfortunately it’s one of the most dangerous. A 12 year-old girl from Detroit who participated in this challenge is undergoing multiple surgeries to repair burns afflicting close to 50% of her body.
Multiple cases of the “Fire Challenge” have been reported over the years, including a 12 year-old boy from Georgia.
One would think children, especially teens, innately know that fire is dangerous but maybe the younger generation has been so protected that they haven’t experienced the basic concepts of danger and inadvertently underestimate its force.
Challenges that involve dangerous stunts have been around for some time. The Choking Challenge induced children to suffocate themselves for the high of feeling asphyxiated. The Tide Pod Challenge tempted kids to put colorful cleaning packets in their mouths, hoping they wouldn’t burst.
The Cinnamon Challenge sparked thousands to inhale the common kitchen spice and cough till they puked. Then the Condom Challenge offered two options where one dropped a condom filled with water on a friends face, or snorted one through the nose.
We adults can’t for the life of us figure out what the reward is in performing these challenges, but presume it's fame and awe among friends and social media followers. But these challenges prove dangerous and in some cases deadly. Unfortunately the YouTube Clips never show the after effects of these pranks…maybe they should.
Intensified by the early fight for money and backers among Democratic presidential hopefuls, Medicare for All and similar single-payer insurance programs have been promoted with increased volume. While there are differences among the “I’ll give you more for less” sales pitches, they share the common central premise that such plans have far lower administrative costs than private insurance, so their version of reform will produce a massive infusion of available resources.
However, the “proof” offered for those administrative cost savings claims mainly consists of constant repetition, with candidates then quickly moving on to the free lunches they would supposedly enable. But given that claim’s central place in their proposals, we must question that premise and with it, the glib answers claimed for it.
How Should We Measure Administrative Efficiency?
For health care plans, the standard measure of efficiency is administrative costs as a percentage of total costs. And in those comparisons, Medicare appears substantially more efficient. But that does not mean there would be savings if people were moved from private insurance to Medicare for All.
The primary reason is that Medicare beneficiaries are far older and less healthy than the population. That makes health care costs far higher per Medicare beneficiary. In fact, before Obamacare, medical expenditures per Medicare beneficiary were routinely more than double those for the privately insured. However, nonmedical administrative costs are only slightly related to total medical expenditures. They are primarily related to the number of persons covered. This causes the standard measure to grossly exaggerate Medicare’s relative administrative efficiency.
Consider an example. Say both Medicare and private insurance beneficiaries had identical administrative costs of $500 each, but the Medicare patient received $5,000 in benefits, while the private patient received $2,500 in benefits. Medicare would show a 10 percent share of administrative costs, and private insurance would show a 20 percent share. In other words, despite the same administrative cost per beneficiary—that is, the same actual efficiency—the standard measure makes private insurance administrative costs look twice as expensive as Medicare.
Simply ask what would happen to administrative expenses if one private insurance beneficiary was moved into Medicare in the example above. Despite Medicare supposedly being half as costly in that regard, administrative costs would not change. No resources would be freed up. And given that the administrative cost per Medicare beneficiary is actually higher than for private insurance, the shift of someone into Medicare would increase administrative costs—leaving fewer resources, rather than more—available for medical care.
What Should Be Included in Medicare’s Administrative Costs?
The public-private comparison also typically compares the administrative costs of private insurance to those that show up in Medicare’s budget. But many of the administrative costs do not show up there. They appear in other agencies’ budgets. The costs of collecting taxes appear in the IRS budget. The costs of collecting premiums appear in Social Security’s budget. Many of the accounting, building, and marketing expenses appear in the Health and Human Services budget. Including those costs would roughly double Medicare’s reported administrative costs.
How Should We Count Taxes on Private Insurance?
Private insurance administrative costs are generally defined as premiums paid in minus claims paid out. However, that means everything except claims payments are counted as administrative costs whether or not they have anything to do with administration. For example, many states impose a premium tax (averaging about 2 percent) on health insurers, and those tax payments are incorrectly categorized as administrative costs. This also makes Medicare, which is exempt from such taxes, look relatively more efficient than it really is.
How Should We Count Disease Management and On-Call Consultation Services?
As with taxes, counting private insurance administrative costs as total premiums minus claims paid introduces other measurement distortions, as well. Insurance companies offer disease-management and on-call nurse consultation services. However, those services do not generate insurance claims. Consequently, those costs are also counted as administrative rather than medical.
How Should We Count Fraud and Fraud Prevention Efforts?
Waste, fraud, and efforts at their prevention also complicate administrative efficiency comparisons. Consider what happens if Medicare (estimates of whose excess spending exceed $50 billion yearly) spent less on prevention efforts. It would look more efficient because its administrative costs would be lower and because undetected excess spending would be counted as medical expenses, not waste. In contrast, insurance companies, whose bottom lines are at stake, are much more diligent about eliminating such excess spending. But those efforts, even though they can generate very large overall savings ($1 of fraud prevention has been estimated to reduce those costs by as much as $15), raise their measured administrative cost percentage, making them look less efficient.
How Should We Treat the “Excess Burden” Caused by Switching to Single Payer Systems?
In addition to all these biases exaggerating private insurance administrative costs and understating Medicare’s administrative costs, another large difference should be noted. When people pay more to get better private insurance coverage, they don’t treat it as a tax, but as part of their employee compensation. Under Medicare for All, however, higher payments into the system will not provide greater benefits. That means that Americans will rationally start treating those payments as taxes in exchange for nothing.
It will, therefore, act as a large income tax increase with correspondingly large economic distortions. Those distortions, created by the wedges taxes impose between what buyers pay and what sellers keep, reflect the wealth destroyed by the reduction in mutually beneficial market arrangements that result, which economists call excess burdens. While not incorporated in official comparisons, they are very large added costs of single-payer systems compared to private medical insurance.
One study found that even the “lowest plausible assumption about the excess burden engendered by the tax system raises the true costs of delivering Medicare benefits to about 20-25 percent of Medicare outlays,” imposing costs far higher than any supposed private insurance administrative cost deficiency.
It is striking how much single-payer promoters rush past their repetitions of administrative cost savings claims before quickly turning to their vote-buying promises in large part funded by them. It almost seems that they don’t want voters to think carefully about those claims. And that might reflect an accurate judgment. If people questioned the basis of those promised solutions, it would reveal supposed administrative cost savings to be the opposite once the compounded mismeasurements are deciphered, and it would not be anyone’s ticket into the White House.
Gary M. Galles is a professor of economics at Pepperdine University and a guest columnist to the Penny Press. His recent books include Faulty Premises, Faulty Policies (2014) and Apostle of Peace (2013). This piece was originally published on fee.orgm then pennypresslv, reprinted here in full, with permission.
36 lots of losartan potassium and losartan potassium/hydrochlorothiazide have been initiated by Torrent Ltd Pharmaceuticals due to a detection of N-Nitroso-N-methyl-4-aminobutyric acid (NMBA). NMBA, according to Toronto Research Chemicals, is a known carcinogen in a wide range of animal species. There have been no reports of users becoming ill and the recall is being done out of precaution.
N-Nitroso-N-methyl-4-aminobutyric acid (NMBA) was the third chemical detected resulting in the latest two recalls of losartan, an angiotensin receptor blocker commonly used to treat hypertension (high blood pressure). It is believed to have been created during the manufacturing process of the generic drug.
The FDA reports:
Earlier this Fall, ScieGen Pharmaceuticals, Inc. recalled certain lots of irbesartan, a similar angiotensin receptor blocker used in blood pressure management.
The recalls initially began last summer when FDA recalled a number of lots of valsartan due to an “impurity,” N-nitrosodimethylamine (NDMA) that is known to cause cancer in animals. Weeks later they additionally found traces of N-nitrosodiethylamine (NDEA).
According to Reuters, earlier last summer, the MHRA, Medicines and Healthcare Products Regulatory Agency, located in the UK, said the appearance of the impurity, NDMA, came after a change in the process for making valsartan at one facility owned by Zhejiang Huahai Pharmaceuticals, a company in Linhai, China.
In animals, NDMA is known to cause liver and lung cancer. In humans its carcinogenic risk is unknown, however the CDC states it may cause liver function impairment and cirrhosis.
With NDEA, data is limited, but due to its classification as a nitrosamine and its prevalence in tobacco smoke it is classified as a probable human carcinogen.
According to New Jersey Department of Health’s website, NDEA has been linked to liver, lung and gastrointestinal tract cancer in animals.
Losartan, valsartan and irbesartan are medications in the class of angiotensin receptor blockers (ARBs) used for high blood pressure and congestive heart failure.
Those taking either tablet for their blood pressure are urged to not abruptly stop their medication but rather check with their medical provider and pharmacy to see if their particular prescription is involved in the recall.
I suspect more recalls will follow as processes may be similar across multiple pharmaceutical facilities and NMBA, NDMA and NDEA are byproducts that may not be individually unique to just one “brand” of medication manufacturing.
One joy of studying history, especially the 20th Century, is to see how life has changed. To my great satisfaction, our daughter Karyn has a fondness for the subject and especially the aspect of it that shows how people lived then versus now, particularly as reflected in popular culture.
As some folks know, I still collect sports and non-sports cards. I believe in the adage that he who dies with the most baseball cards, wins. Such cards and related ephemera are a great reflection of the times when they were produced and a deep insight into the real history and culture of their eras.
Recently, I acquired a reprint set of the first issue of football cards, which included 35 National Football League players and the immortal Knute Rockne, who had coached at Notre Dame and shaped much of the early game.
The original set, produced in 1935 by the National Chicle Co. of Cambridge MA is too expensive for a non-corrupt former elected official, because it includes the most valuable football card ever, number 34 Bronko Nagurski, as well as number 9 Rockne. They can command five-figure prices in near-mint condition. My reproductions, easily distinguished from the real items, cost a few dollars.
Among other things, all the players are pictured in actual football poses, not with fur coats, bling and shades as some stars have been in recent years. The front sides are art, not photographs, and they use very bright colors, attractive compositions and simple designs with football backgrounds.
The text on the back of the cards, written by Eddie Casey, then coach of the Boston Redskins and formerly Harvard, shows how real sports and life were then as compared to today.
A few things really struck me. The first was the line in Nagurski’s biography on the back that said: “A product of the wheat farm country, he stills works the soil between action on the football field and professional wrestling mat.” This is a great example of a feature of many cards even into the middle-1950s: the discussion of the player’s off-season job.
Their pay was so modest that many had to hold an off-season job for a decent living. Quite the opposite of the sometimes multi-million-dollar guaranteed levels even for rookies in some professional leagues now and the long-term contracts with mid-eight-figure annual pay for some stars.
After baseballer Carl Furillo won the National League batting crown in 1953, he returned to his winter job as an elevator repairman for Otis Elevators, according to one of his cards. Perhaps more than any other fact, that illustrates what I mean about life being real then.
Another item is that the text on the first 27 cards is essentially a tutorial for kids and adults on how to play certain positions and actions, as depicted by the player on the front. From all aspects of kicking, passing, receiving and handling the ball both in the open field and when plunging into the line to the need for defensive ends on kickoffs to stay in their lanes and turn the ball carrier to the middle of the field, etc.
These cards were meant for real fans of the time, not for kids ripping open packs to find a rare insert or special card.
A third aspect of how real everything was then is the height and weight statistics. Only one of the 35 players tipped the scales above 220 pounds (number 11 Turk Edwards at 250) and none were taller than 6’ 3.” Some colleges today have all their starting linemen at 300 pounds plus.
Perhaps the most endearing thing is that coach Casey knew his football, as shown in the final text on Nagurski: “He is as much a tradition to [his alma mater] Minnesota football today as Red Grange is to Illinois.”
The text on the next card ends: “Now, reaching the end of his professional career as a player he is following the footsteps of Red Grange in becoming an assistant coach to the bears.”
Illini fans then and now have always known that Grange was the greatest college football player ever.
Now, if only my daughter Karyn would develop a taste for card collecting.
Ron Knecht is a contributing editor to the Penny Press - the conservative weekly "voice of Nevada." You can subscribe here at www.pennypressnv.com. His column has been reprinted in full, with permission.
Governor Jimmy Davis must be rolling over in his grave right now. Louisiana’s internationally acclaimed official state song is under attack by the Louisiana Legislature. There is an effort by some south Louisiana legislators to designate the Cajun classic Jambalaya as an official public ballad. And them’s fightin’ words for those who have embraced You are my Sunshine as the sanctioned formal melody.
The Sunshine defenders point out that it could be the most recognized American ballad worldwide. Go to a small Asian community where little or no English is spoken. Start humming, You Are My Sunshine. More likely than not, the locals will join in singing the song in English. Everybody knows the words to a down-home tune written by a Louisiana country singer and movie star. And he was sworn in as Louisiana Governor seventy-five years ago this month.
A few years back, I was in Cambodia at the Golden Triangle, where Burma and Thailand converge. I was having breakfast in a rural village at an outdoor café, and the young waitress who knew a few words in English said, “You American. I love America. I sing about America.” Then, with a big grin on her face, she broke out in song and danced around the dirt floor singing You Are My Sunshine.
That’s in no way meant to belittle the Cajun tune played in dance halls and musical venues all over Louisiana and much of the south. But there is a vast difference between the two songs. Sunshine was written and sung by a Louisiana native who happened to end up as governor. Jambalaya was written by Hank Williams, who was born, raised and is buried in Alabama. Haven’t we here in the Bayou State been humiliated enough by Alabama football to have to have our state song written by another Roll Tide advocate?
Actually, Jambalaya’s melody is basically the same tune taken from the song Grand Texas, about a lost love; a woman who left the country singer to go with someone else to “Big Texas,” where ever that’s supposed to be. So we have an Alabama song written off a Texas tune that may end up as the Bayou Nation’s new state song.
And what about some of the Jambalaya lyrics? A line in the song is “For tonight, I’m-a gonna see my ma cher a mi-o.” OK. I get ma cher. Even us uneducated rednecks know that ma cher means “my dear.” But what about this a mi-o. The word doesn’t exist. I’ve checked slang dictionaries in French and Spanish. No such word.
Now I’ll admit it’s a bit hard to defend some of the lyrics in Sunshine. Take the stanzas:
You told me once, dear, you really loved me
And no one else could come between
But now you’ve left me and love another
You have shattered all my dreams
I’ll concede such verbiage doesn’t set the best example for our young folks to aspire to greater heights. But hey, it’s only a song. Just like the partying words of Jambalaya, I guess it really doesn’t make much of a difference. Outside of a bar or dancehall, when was the last time you heard either song being sung? So maybe it’s just as well to have two state songs.
Being a redneck and having gotten to know Gov. Jimmie Davis back in the 1970’s, I’m just partial to You are my Sunshine. And just who was Sunshine? A past lover? A devoted family member? No. Sunshine was Jimmie Davis’s horse. The palomino mare is buried up on the Davis family farm above my old home of Ferriday. I pass that way occasionally and remember back on my conversations with the Governor. And yes. I do hum a few bars of what will always be my favorite Louisiana song, You Are My Sunshine.
Here is a message to Democrat dim bulbs everywhere who, after the Mueller report’s release, cannot, as one of their favorite organizations is so aptly named - move on.
On November 8, 2016, Donald John Trump whupped your collective ass.
On April 18, 2019, your collective ass got whupped again—this time by your own designated agent, Robert Mueller.
You still don’t understand that the average American voter thinks you are full of crap. That the reason Hillary lost was not the Russians but that she called half of America, “deplorable.”
No, you want to get rid of the President by any means possible - or impossible.
Go ahead and impeach the President. Please. Let cocky little jerks like Jerrold Nadler and Adam Schiftless rule the day with their pseudo-intellectual bullcrap. Paraphrasing the immortal words of the late George Wallace, I’ll bet they couldn’t even park a bicycle straight. Both of these clowns are like the freshman in college who got beat up every day by the seniors and now, they’re going to show us.
Meanwhile, we DO have a crisis at the border.
And the economy IS doing quite well.
A classic episode of a TV show, WKRP in Cincinnati, ends with the station manager saying, “As God is my witness, I swear I thought turkeys could fly.”
Who would have thought that the writers in 1978 could have imagined today’s Democrats 41 years later.
We know a few things.
One is that turkeys CANNOT fly.
Two is that Democrats in the House of Representatives are auditioning to be turkeys.
In 448 pages, (available on pennypressnv.com) you see a President who has little or no patience for fools and has never been afraid to say so to anyone who paid attention.
The fact is that Donald Trump is the President of the United States. If the President wishes to fire anyone in the executive branch at any time for any reason, it may be a political firestorm, but not a legal one. Richard Nixon fired Archibald Cox. The firing stuck because Nixon was the President and in charge of the executive branch.
Had Trump fired Mueller or Jeff Sessions, it might have caused him political agita, but I’d put money on this Supreme Court ruling out obstruction of justice if it ever got that far.
And, as far as these clowns - yes, clowns - who chair various committees in the House go, if I were the Attorney General I would not answer their demands with nice letters. I would call a press conference and tell them to blow it out their…anal orifices. Or something like that. But that’s just me.
Although, I would observe that many of my fellow average American voters tend to feel the same way and use the same or similar language in their unguarded moments.
And as far as impeachment goes, the aforementioned clowns are playing with the possibility of going years before Democrats ever win an election in many places again. If they’re that stupid.
First, we know for a fact that impeachment would just be a symbolic gesture. There is NO WAY they get 67 votes in the Senate to remove the President. And if Indian imposter Elizabeth “Pocahontas” Warren thinks her call for impeachment will help her run for the Democratic nomination, we sure hope the Democrats ARE that stupid.
Having spent 20 years of my life in Las Vegas, I wouldn’t put any money on either side of that proposition.
A man in an Easter Bunny costume jumped to the defense of a woman involved in a bar brawl. It’s not clear how the fight began but, Sunday evening (on Easter) outside Orlando’s Underground Public House the unidentified man and woman started hitting each other. To me, they both look clearly drunk and so it was more of a lame drunk slap fest than an actual brawl. Which, is probably why no one was actually hurt.
Anyway, the man and woman were fighting and, typical of soulless a-holes everywhere these days - no one bothered to help her or break up the fight - instead everyone just took out their phones and recorded it!
That is - until the Easter Bunny stepped in. As you can clearly see in the linked video (on the front page) a man in an Easter Bunny costume hopped in and started throwing punches at the man involved in the brawl. Much to the delight of the crowd, who stood by and recorded the event.
The brawl doesn’t last long and within a minute a bike cop on patrol shows up and breaks everything up. No arrests were made and according to a witness or two, the cop shook the Easter Bunny’s hand and thanked him for helping.
Everyone went home.
Turns out - the man in the costume is Antoine McDonald - wanted felon. McDonald has a record a mile long (as they say) and an outstanding warrant in New Jersey. His rap sheet is littered with armed robbery, car burglary, harassment and identity theft. After the bar he told various social media outlets that he was the person in the costume and that he, typically wasn’t a violent person.
According to cops in his former home state, McDonald fled New Jersey after the arrest warrant was issued and so never appeared in court. New Jersey police even, “thought he fled to Florida.”
Turns out - they were right! McDonald was in Florida. In an Easter Bunny costume. Breaking up brawls. As of Wednesday, his whereabouts are unknown. But it does go to show that people are complex. Someone can be a felon wanted for burglary, and armed robbery and still make good decisions to help people.
And other people, who are probably generally good - can stand around and record people helping other people while they themselves, do nothing to assist.