A Nobel Laureate’s Disappointing Policy Advice

We reported previously on the research by Nobel laureate Angus Deaton and his wife Anne Case showing that the death rate has been increasing for the white working class, the only socioeconomic group for which that is true. This finding, which some have dubbed The White Death, has become perhaps the most talked-about recent finding in all of social science.

Deaton and Case are to be commended for their statistical analysis, which appears to be solid. The White Death seems to be real. The question therefore becomes: What can be done about it?

The Washington Post’s Wonkblog wanted to know, so they published a very good interview with Deaton and Case. Their most fundamental argument is that the labor market for unskilled labor has deteriorated badly, and this development has had an adverse impact on the lives of millions of people. I agree with Deaton and Case on this basic point. But Deaton’s specific policy recommendations left me very disappointed.

First, Deaton apparently believes that we need to get more people into college.

Anne and I, I think, differ a little bit on how much education is a solution for this. But it’s certainly clear there are lots of people who are not getting BAs who are capable of it. So we need to do a much better jobs [sic] of getting these into school.

Well, as someone who has spent more than 20 years in the university classroom, I can state with confidence that the problem in higher education is more nearly the exact opposite–too many, not too few, people pursuing BAs. America must have, at Deaton says, at least a few people “not getting BAs who are capable of it.” But there are vastly more people in the opposite situation; pursuing BAs who are not really capable. Higher education is already massively subsidized and over-expanded. Rather than expanding further, higher education needs to contract. More people should consider learning a trade or going to coding school.

On education, Deaton’s wife is more sensible:

Case: But it’s also the case here that there are people who don’t want a four-year BA. We’ve been around this block many times: We do need to think about how we want to train people to enter the 21st century labor force.

Deaton also wants to expand the welfare state.

Deaton: We haven’t really talked about how none of this is happening in Europe…The obvious difference is that the safety net is enormously more generous in Europe. And lot of people in their 50s who lose their jobs can go on retirement. You get a doctor’s certificate and you get paid pretty much your salary until you die.

Wait, if you’re in your 50s and you lose your job for economic reasons, then you can just talk a doctor into saying you’re disabled and collect your check for life, and Deaton thinks that’s a good thing? Am I misreading this, or did Deaton endorse disability fraud?

Deaton and Case also seem to believe that Americans are too reluctant to accept welfare.

Case: The other thing that makes it harder in America rather than Western Europe is that there really is a difference for a large swath of the population in how they feel about receiving government transfers. We’ve all been trained up on the idea that we are individuals and we take care of our families and our neighbors take care of theirs, and that’s the way we like it. It’s very hard to give somebody something when they see it as handout that they don’t want.

What Case says was true about America in the 1950s and 1960s. In those days, there was a strong conscientious aversion, as well as considerable social stigma, to accepting welfare. But I don’t think that’s true today. Half of American households receive some kind of government check, and 30 percent receive a “means tested” benefit, i.e., welfare. When I was a kid, that latter figure was only 7 percent.

Moreover, unlike Deaton and Case, I don’t believe the primary reason why working-class people are dying in America but not Europe is Europe’s somewhat more generous welfare state. Another obvious and possibly more relevant difference is that Europeans do not drink sugary Cokes in 30-ounce servings, nor do they consume Little Debbie Snack Cakes by the box. Maybe before we put millions more on the disability rolls, we should first try to get them to cut back on carbs.

There’s one other policy recommendation that I’ve been pushing. We’re spending about three trillion dollars a year on health care. And our life expectancy is going down. Whereas all these other countries are spending way less, and their life expectancy is going up. For me the implication is if we implemented single payer, we’d get rid of a lot of these costs. Not without screaming and yelling, of course, and not without goring a lot of oxen.

But the crucial thing is recognizing the extent to which these rising health care costs are responsible, at least in part, for the stagnant wages for people without a college degrees. If they’ve got an employer and they’ve got health care, their wages are getting pushed down by the employer paying for that health care. People don’t even realize this. They think it’s for free.

No doubt, the cost of health care is a huge problem, and we need reform. But single-payer is not the way to do it. Those single-payer countries that report lower costs are leaving out a lot of hidden costs. In particular, they don’t count the costs to individuals of suffering due to rationing of health care. They also don’t count the negative impact on the economy of taxes needed to fund the system.

I’m not a left-wing nut pushing for single-payer! It’s not because I like socialized medicine. It’s just because I think this is eating capitalism alive, and if we want a healthy capitalist society in America, we’ve got to get rid of this monster.

Shorter Deaton: “I’m for single-payer, but just don’t call me a left-wing nut!”

So to summarize, Deaton wants to expand higher education, make welfare more generous, and pay for nearly everybody’s health care. This amounts to a massive expansion of government. Deaton intends to help the ‘little guy,’ but as Dennis Prager likes to say, the bigger the government, the smaller the individual.

And Deaton wants all this additional spending when the federal government is already exposed to a $200 trillion fiscal gap. Where will the money come from?

As I said, Deaton’s policy advice is very disappointing.

Beware Big Pharma

As I reported previously, considerable evidence suggests that the most common medications in America are crocs–they either don’t work, or cause more harm than good. Among the dubious classes of medications are anti-cholesterol drugs, anti-depressants, and antacids.

Apparently, I’m not the only one with a jaundiced view of the best-selling products of the pharmaceutical industry. Dr Peter Gøtzsche, a Danish physician and author, argues that medicines kill 200,000 people in the U.S. every year, with approximately half of those deaths occurring even though the medication is used correctly.

One of the drugs that Dr. Gøtzsche strongly argues against is NSAIDs (non-steroidal anti-inflammatories) like ibuprofen. There’s actually quite a bit of evidence that use of ibuprofen–at least in the long-term–can significantly increase the risk of heart attack.

NSAIDs aside from aspirin, both newer selective COX-2 inhibitors and traditional anti-inflammatories, increase the risk of myocardial infarction and stroke.[30][31] They are not recommended in those who have had a previous heart attack as they increase the risk of death and/or recurrent MI.[32] Evidence indicates that naproxen may be the least harmful out of these.[31][33]

NSAIDs aside from (low-dose) aspirin are associated with a doubled risk of heart failure in people without a history of cardiac disease.[33] In people with such a history, use of NSAIDs (aside from low-dose aspirin) was associated with a more than 10-fold increase in heart failure.[34] If this link is proven causal, researchers estimate that NSAIDs would be responsible for up to 20 percent of hospital admissions for congestive heart failure. In people with heart failure, NSAIDs increase mortality risk (hazard ratio) by approximately 1.2–1.3 for naproxen and ibuprofen, 1.7 for rofecoxib and celecoxib, and 2.1 for diclofenac.

On 9 July 2015, the FDA toughened warnings of increased heart attack and stroke risk associated with nonsteroidal anti-inflammatory drugs (NSAID). Aspirin is an NSAID but is not affected by the new warnings.

Dr Gøtzsche argues that Big Pharma is putting profits ahead of people’s health, and that the industry basically has paid off everybody–doctors, researchers, regulators, politicians. Gøtzsche calls Big Pharma essentially a form of organized crime. That rhetoric seems a bit overheated, but I suspect it’s true that the pursuit of profit has caused drugs to be oversold, and that doctors often don’t fully understand the effects and interactions of the drugs they prescribe.

Are Prescription Drugs All Crocs?

Ok, not all drugs are crocs, but a lot. An astonishing 70 percent of Americans take at least one prescription drug. How many of those drugs are useless or even harmful?

Consider the two most prescribed classes of drugs: anti-cholesterol agents (statins) and anti-depressants. The scientific theories underlying both drug classes have more or less been debunked.

The theory underlying statins is the so-called lipid hypothesis of heart disease. This theory has been around for 60 years, but was never supported by very much scientific evidence. The latest and best evidence generally contradicts the lipid hypothesis. Simply put, there is no correlation between cholesterol and heart disease. Heart patients admitted to hospitals have an average cholesterol level no higher than the population as a whole. The overall correlation between cholesterol and life expectancy is positive–people with higher cholesterol live longer on average. Yet reducing serum cholesterol is the intent of the number one class of drugs in America.

The number two class of drugs consists of anti-depressants called selective seratonin-reuptake inhibitors (SSRIs). These drugs are supposed to reduce depression by regulating seratonin in the brain. The problem is that the scientific evidence totally contradicts the seratonin theory of depression.

One of the leading myths that unfortunately still circulates about clinical depression is that it’s caused by low serotonin levels in the brain (or a “biochemical imbalance”). This is a myth because countless scientific studies have specifically examined this theory and have come back universally rejecting it.

So let’s put it to rest once and for all — low levels of serotonin in the brain don’t cause depression.

Regarding SSRIs, there is a growing body of medical literature casting doubt on the serotonin hypothesis, and this body is not reflected in the consumer advertisements. In particular, many SSRI advertisements continue to claim that the mechanism of action of SSRIs is that of correcting a chemical imbalance, such as a paroxetine advertisement, which states, “With continued treatment, Paxil can help restore the balance of serotonin…” [22].

Yet […] there is no such thing as a scientifically established correct “balance” of serotonin. The take-home message for consumers viewing SSRI advertisements is probably that SSRIs work by normalizing neurotransmitters that have gone awry. This was a hopeful notion 30 years ago, but is not an accurate reflection of present-day scientific evidence.

As we reported previously, SSRIs might effectively reduce depression, but only through a placebo effect. Sugar pills also reduce depression, but with the sugar pill you wouldn’t get the nasty SSRI side effects, including increased risk of suicide, stroke, and death. Yet doctors keep handing this stuff out like candy. Perhaps part of the problem is that SSRIs can be prescribed by general practitioners, even though they have no qualifications in psychiatry.

So much for the top two classes of drugs. Just a bit further down the list are antacids known as proton-pump inhibitors (PPIs). Some of the familiar marketing names include Nexium, Prevacid, and Prilosec. As noted in the latest issue of Scientific American, long-term use of these drugs is now being linked to kidney problems as well as dementia.

[T]wo studies linked the regular use of proton-pump inhibitors to conditions that were seemingly unrelated to the acid levels of the stomach. One of the studies, published in JAMA Neurology, found that the drugs increased the risk of developing dementia, including Alzheimer’s disease; the other, published in JAMA Internal Medicine, suggested a greater risk of kidney problems.

The studies reported in 2016 grew out of earlier hints that such chronic use could affect the brain and kidneys. One 2013 study in PLOS ONE, for instance, found that proton-pump inhibitors can enhance the production of beta-amyloid proteins, a hallmark of Alzheimer’s. Three years later the JAMA Neurology study, which included 74,000 Germans older than 75, found that regular PPI users had a 44 percent higher risk of dementia than those not taking PPIs.

Similarly, worries about kidneys emerged from evidence that people with sudden renal damage were more likely to be taking PPIs. In one 2013 study in BMC Nephrology, for example, patients with a diagnosis of kidney disease were found to be twice as likely as the general population to have been prescribed a PPI. The 2016 study of PPIs and kidney disease, which followed 10,482 participants from the 1990s through 2011, showed that those who took the drug suffered a 20 to 50 percent higher risk of chronic kidney disease than those who did not. And anyone who took a double dose of PPIs every day had a much higher risk than study subjects who took a single dose.

Gotta wonder how many of those people who are risking their health by popping purple pills could easily get relief by taking just a relatively harmless Tums.

So statins, antidepressants, and antacids–three of the top eight classes of prescription drugs appear to do more harm than good. How many others?

What a disgrace. The medical profession and the pharmaceutical industry should be ashamed of themselves.

Obamacare: Finally, a Journalist Asks the Right Questions

At this point it is now seven years too late, but a journalist finally asked the right questions about Obamacare. That journalist was Tucker Carlson, and he asked the man who should know the answers as well as anybody–Jonathan Gruber, the MIT economist who was the ‘architect’ of Obamacare.

Tucker Carlson Destroys Obamacare Architect Jonathan Gruber

Carlson specifically asked two good questions that go to the heart of what is objectionable about Obamacare. Here is one of them.

Why should I be forced to buy a plan that offers things that don’t pertain to me in any way?…They’re forcing people to buy things they don’t want and that don’t help them…things that do not apply and will never apply to me such as breastfeeding, prenatal care, substance abuse counseling…why should I have to buy those plans?

Indeed, one of the most objectionable, maybe the most objectionable, provision of Obamacare is that it empowers unelected federal bureaucrats to decide the terms of my health care plan–what it covers and what it does not cover. In a free society, the terms of my insurance policy should be determined through agreement between me and my insurance company. Gruber calls this a “small issue,” but it’s actually an outrageous encroachment on the freedom of the people.

After first dodging the question and forcing Carlson to ask a second time, Gruber offered the following response.

The answer is that basically as a society we have to decide what is going to define fair insurance.

This is another way of saying that people–you and I–should not be free to decide, and so ‘society’ should decide for us. But it turns out that the group of people who decide is not ‘society’ but rather those aforementioned unelected federal bureaucrats. Gruber’s response provides no rational justification for the policy, just an assertion of his belief that people should not be free to decide for themselves. Every time choices and decisions get taken away from individuals and turned over to ‘society,’ it means that the people have less freedom.

Why should it be necessary for ‘society’ to define “fair insurance,” anymore than for ‘society’ to define a “fair golf course,” a “fair gym membership,” or “fair supermarket shopping”? These are all just contractual relationships voluntarily agreed upon by buyers and sellers. Would Gruber propose that federal bureaucrats insure “fair” grocery shopping by dictating to supermarkets which products they should and should not offer for sale?

Carlson’s second fundamental question (although it comes up first in the video) is this one.

Who are the victims? Who’s been hurt by Obamacare?

This is a crucial question, because the great con run by the political class is that they talk only about the benefits of their policies but not the costs. They don’t want to talk about all the people who will be hurt by the policy, because those people might then wake up and go into political opposition.

Gruber in reply identified only two categories of people hurt by Obamacare: “the wealthiest Americans…the top two percent,” and young, healthy people who, prior to Obamacare, benefited from “a discriminatory insurance market.”

What Gruber means by “a discriminatory insurance market” is actually just “an insurance market.” In a free and efficient insurance market, policy premiums are priced according to the risk of the individual. Healthy people with healthy habits therefore pay less than people with unhealthy habits. That’s how insurance is supposed to work–the market prices the risk. Gruber, however, believes that having an actual insurance market is unfair. When it comes right down to it, he is fundamentally opposed to the idea of health insurance. That’s why Obamacare is NOT health insurance, but an abolition of health insurance. Obamacare replaces the insurance market with an elaborate government scheme for rationing care and redistributing wealth.

I’ve always said that a one-line argument against big government is that it always ends up rewarding bad behavior and punishing good behavior. And that is precisely what Gruber advocates. He thinks smokers should be taxed to subsidize non-smokers, that those who eat healthy and exercise should be taxed to subsidize couch potatoes who overeat. As the saying goes, if you tax anything, you get less of it, and if you subsidize anything, you get more of it.

But in any event, Gruber’s list of Obamacare’s losers is far too narrow. In no particular order, the list needs to include all those young white women who go to tanning salons, because Obamacare put a 10% tax on indoor tanning. Other losers include millions of people who purchase insurance on the individual market but who are not eligible for Obamacare subsidies. Those people have seen their premiums soar. And speaking of those subsidies, they consist of tens of billions of dollars of taxpayer money that are needed to (barely) keep Obamacare afloat. So really, the losers also include basically anybody who pays federal taxes. That’s a lot of losers.

Obamacare’s losers also encompass all those who cherish the Constitution and constitutional government. Because in order to save Obamacare, the Supreme Court had to re-write the Constitution by ruling that the government is free to regulate inactivity so long as the penalty is called a ‘tax.’

Gruber’s reaction to the point that Obamacare has created many losers was somewhat fatalistic.

As with any law, the law creates winners and losers.

Sure, but the idea of a free society is that political insiders–in this case, industry lobbyists and Congressional aides–shouldn’t be able to get together and decide to make me a loser.

Gruber is right that the law creates both losers and winners. But he neglected to mention one of the biggest winners from Obamacare: himself. The man has made hundreds of thousands of dollars off of Obamacare.

Socialism Empowers the State, Not the Individual

The Economist, a British publication, recently ran a review of a new book about prostate cancer, written by an American doctor. Reading the review, I was struck in particular by the following paragraph that appeared near the end of the review.

The book is clearly for the patient as consumer. There are repeated calls throughout to check your doctor’s credentials and experience. Have your biopsy results checked by another medical centre, Dr Scardino advises. Be sure that you are treated in a centre that deals routinely with prostate disease. Check how often your surgeon does a radical prostatectomy. All of which is sound advice, if awkward for men who live in countries, such as Britain, where there is still little real choice about where they can receive treatment.

Ah, so the doctor, writing from an American perspective, embarrassed the Brits by presuming that the patient still retained some control over his own healthcare. For most Brits, patient control was long ago extinguished by the socialist system. The patient is no longer a consumer, but merely a supplicant, desperately hoping to receive whatever treatment the state might deign to offer.

Many people still cling to the mistaken notion that socialism is somehow empowering for the individual. The reality is that socialism transfers power from the individual to the state. As Dennis Prager likes to say, whenever the state is big, the individual is small.

Obama’s Legacy

What Obama and his media myrmidons think (or want you to think) his legacy is:
fake2

What Obama’s legacy really is:

vascandas

Four staff at the Oklahoma Department of Veterans Affairs resigned after maggots were found in the wound of a Vietnam veteran who died in October. Another VA staff member insisted that the maggots did not cause his death.

Raymie Parker identified the man as his father, 73-year-old Owen Reese Peterson. “During the 21 days I was there … I pled with the medical staff, the senior medical staff, to increase his meds so his bandages could be changed,” Parker told the Tulsa World. “I was met with a stonewall for much of that time.”

Guess which word is missing from this article on just the latest appalling scandal at the VA? The word is “Obama.” All of these VA scandals are happening on his watch, but he is ultimately never held responsible. The buck always stops short of his desk. How many rounds of golf has Obama played while veterans have suffered and died from mistreatment? No matter what happens, he’s never responsible. He must be the most protected president in history.

Death by Regulation: Organ Transplants

Federal law prohibits people from selling their organs. You can donate, say, a kidney, any time you want. But for you to receive any compensation is illegal. This law effectively imposes a price of zero on organs. That price is lower than the price that would clear a free market in organs. The resulting shortage of organs costs thousands of lives every year.

Lifting the prohibition on organ sales could not only save thousands of lives, but would give poor people an opportunity to make money. Selling a kidney might keep an unemployed guy off the street and put him in his own condo.

But the privileged elites who run America say no.

organs

Source:

without-limits

Phony ‘Fact Checkers’

Gotta love those phony ‘fact check’ sites that are run by the media presstitutes who lie to us about everything else. Here’s a classic from shortly before the 2012 election, published to make sure that voters got properly misinformed.

class2012

And here’s a headline from this week.

premiums

Oh, and here’s more ‘fact checking’ on behalf of the gigantic lie that is Obamacare.

jghgn

Here at Yet, Freedom!, we devised an analog meter that’s more accurate.

bullshitdetector

Obamacare: No Free Lunch

Milton Friedman liked to point out that “there’s no such thing as a free lunch,” which means that government spending must be paid for, and for the government to bestow benefits on one person it must impose costs on somebody else.

The website Vox, a mouthpiece for the establishment, recently succumbed to the free lunch fallacy in its defense of Obamacare. One of the goals of Obamacare was to reduce insurance prices for older people by charging them less than their costs. But if old folks pay less than cost, somebody else must make up the difference by paying more. That somebody else was young, healthy people, who would be forced to pay more than their costs.

Obamacare attempted to effect the transfer of wealth from young to old by imposing a ‘3-to-1 age band,’ which means that insurers can not charge older people any more than 3 times as much as they charge young people. If old people cost insurers 4 or 5 times as much, insurers by law have to keep the ratio down to three by charging old people less than cost and young people more than cost. The young thereby effectively subsidize the old.

Whether or not you approve of this transfer of wealth from young to old, there’s no doubt that it’s the young who get fleeced. Yet Vox’s slippery rhetoric suggests that Obamacare is win-win for both old and young; in other words, a free lunch.

The talking point that individual market premiums have skyrocketed…is only true for young people, with no medical problems, who purchased catastrophic coverage plans that cover less than 60 percent of expenses.

Yes, they pay more today. But they are getting plans that cover more of their costs (at least 60 percent), have an out-of-pocket maximum of $7,500 per year, cover more things, have no lifetime maximum benefits, and offer free preventive care. Older people, because of 3-to-1 age bands (the allowable ratio of premiums paid by the oldest members relative to those paid by the youngest) are often paying less. And providing more affordable coverage to older people who are more likely to need coverage is a good thing.

Win-win!!

Sorry, but to switch metaphors, Vox can’t have their cake and eat it too. Young people are not better off with those admittedly “skyrocketing” premiums, and being forced to purchase plans they really don’t want. If people want to pay for insurance plans that “cover more things,” that choice should be theirs and not something the government forces on them. That “free preventive care” that Obamacare offers has very little value to people who are young and healthy.

But the salient point is that Vox cannot tout the benefit of the 3-to-1 age band to older people while at the same time eliding the corresponding cost to younger people. That is just plain intellectually dishonest.

I do, however, have to admire Vox’s chutzpah. They entitled their piece “Republican criticisms of Obamacare are extremely misleading.”

Now You Can’t Even Keep Your Obamacare Plan

While peddling Obamacare, the president famously and repeatedly lied to the American people by saying “If you like your doctor, you can keep your doctor. If you like your plan, you can keep your plan.” Four years later, Obamacare caused people to lose their plans. Several million Americans who purchased health insurance on the individual market, and who (according to surveys) were happy with their plans, were prohibited from renewing those plans because they did not fully comply with the arbitrary coverages of Obamacare. After losing their plans, people were forced to purchase Obamacare or pay a fine.

Now it turns out that you can’t even keep the Obamacare plan you were forced to buy, because insurers are losing money and pulling out.

A growing number of people in Obamacare are finding out their health insurance plans will disappear from the program next year, forcing them to find new coverage even as options shrink and prices rise.
At least 1.4 million people in 32 states will lose the Obamacare plan they have now, according to state officials contacted by Bloomberg. That’s largely caused by Aetna Inc., UnitedHealth Group Inc. and some state or regional insurers quitting the law’s markets for individual coverage.

For the people losing plans, there are fewer and fewer choices. One estimate by the Kaiser Family Foundation predicts that for at least 19 percent of the people in Obamacare’s individual market next year there will be only one insurer to choose from.

In North Carolina, for example, a BlueCross BlueShield insurer will be the only option in 95 of the state’s 100 counties after Aetna and UnitedHealth said this year that they would leave. That will leave 284,000 people looking for a new plan, according to the state.

And BlueCross only agreed to remain after the state allowed them to increase rates by 25%. So BlueCross is now effectively the Obamacare monopolist in North Carolina. You don’t like the BlueCross plans or service? Tough luck, because in North Carolina you have no other Obamacare option.

In theory, government is supposed to be protecting consumers from monopolists. The Department of Justice even maintains an anti-trust division that goes after companies for monopolistic practices. Yet in North Carolina, the federal government is now forcing people to purchase from a monopolist under threat of a fine. Good job!

Of course, if BlueCross had left the North Carolina market, there would be no way to purchase Obamacare in that state. And yet federal law says that if you don’t have coverage you must pay a fine. Would the IRS still enforce the fine? Does the law call for suspending the fine in the event that no insurers offer Obamacare plans? Has Obama given this question any thought in between filling out his NCAA bracket and his summer music playlist?

Nationwide, it looks like about one out of eight people on Obamacare will this year need to find a new provider. So it turns out you can’t even keep the plan you were forced to buy when the government abolished the plan you liked after telling you that you could keep it. Awesome job.

By the way, based on projections made in 2010 when Obamacare was enacted, the program was supposed to have 26 million enrollees by now. This year, Obamacare will have about 11 million people enrolled. Heckuva job.