Monday, January 17, 2011

Demographics Drive Health Care Costs Up

It is impossible to stop rising health care costs without cutting treatment. We can slow the growth of costs with competition and innovation, but the primary cost driver is and will remain the amount of medical treatment provided on a per capita basis.

People today see doctors more frequently than people did in prior generations, and they’re increasingly likely to get expensive, cutting edge tests and therapies that were not in existence a generation ago. Once they leave the doctor’s office, today’s patients are medicated with more drugs than ever before, and at much higher costs. And because they get all this expensive care, people live longer than ever before, reaching ages at which they require constant medication and treatment.

In a rapidly growing society, such as America after World War II, such increases in the amount of medical treatment provided may be sustainable since there are many healthy, young workers bringing down the average cost of insurance, be it public or private. In a stable or shrinking society, however, the rapid increase in treatment leads to rapid increases in the per capita cost of insurance. There simply are not enough healthy, young workers buying into group health insurance plans to offset the hordes of baby boomers on blood pressure medication, getting MRIs, having heart surgeries, or receiving diabetes treatment, etc. And so, each year the cost of a health plan goes up in proportion to the increased amount of care provided. Unless we cut back the amount of medical care, there is no way to stop the rise of health care costs. So what can be done?

In the 70s sci-fi movie “Logan’s Run,” a futuristic indoor city manages its population by putting everyone to death at age 30. That keeps the population from overgrowing the city, and would obviously prevent a lot of costs associated with an aging population. The idea of eliminating people at 30 is a bit naïve, though, since that leaves barely a decade of productive labor after two decades of expensive child rearing. Basing acceptable longevity on economic value, age 50 seems a more sound cutoff.

Of course, it’s hard to imagine we’ll ever reach a point where we’d implement such a horrifying policy. Rather, harsh economic realities will make the choice of life or death for us. Total life expectancy will decline as rationing leads to higher infant mortality, fewer preventive treatments, and deaths of people whose drug benefits are cut off, or who are too far down the waiting list for diagnostic tests, surgeries, etc. And eventually, enough older patients will die that the growth in medical costs will abate.

Other than death, only two things may stop the increasing per capita cost of medical care – a dramatic technological breakthrough, or lots of babies.

In terms of technology, it’s possible that science may find ever cheaper ways to provide the same or better treatments than we have today. Or perhaps we will discover cures for such maladies as cancer, diabetes, Alzheimer's, and other diseases that now require expensive treatment and drugs. Personally, I suspect that each technological breakthrough is likely to increase the cost of care, though. After all, once we eliminate each cause of death, we only push up life expectancy and force nature to find new ways to kill us – something nature seems very intent upon doing. New conditions become the leading cause of death, and we in turn search for new treatments and drugs to combat those. Until man becomes immortal, the cycle seems unlikely to end.

Making lots of babies, on the other hand, is a practical solution we can implement with a high degree of certainly for success – not to mention a good bit of fun. If each woman has an average of two children, that is not quite enough to maintain a stable population, owing to mortality prior to child bearing. To grow the population, and hence the number of young, healthy workers offsetting the expense of caring for older folks, women need to have an average of at least three children each. And really, four or five would be optimal. We’d still need to scale back certain entitlement programs, such as Social Security and Medicare, that need six or seven healthy workers for every beneficiary. But with a moderately growing population, at least we could continue to have such programs to care for the aged and infirm.

None of this is an argument to do nothing about the cost of health care. We can and should take measures to control the costs we can control so as to buy time before the day of medical treatment reckoning – the day we have to start cutting back on care because we have no other choice. We should allow a free market in health care, introducing competition into what has long been a closed, controlled system low on choice and high on expense. That means allowing insurance providers to create a multitude of competing plan options, and allowing them to sell these competing options across state lines. It also means requiring care providers to operate transparently, posting prices for treatments up front so as to allow consumers to shop around. And finally, it means opening up the medical professions to competition. Why should a person be required to complete medical school to set a broken bone or dress a wound? Military medics with months rather years of training have been doing these basic tasks effectively for centuries, freeing up doctors and nurses for more critical care. If we make doctors and clinics compete to be our care providers, we’re likely to receive better treatment and lower costs.

Still, each person’s health care costs, either directly paid to providers or to insurance companies, will continue to rise as long as fewer healthy workers are being asked to carry the load for more and more sickly ones who needs lots of care. Everything we do without addressing that essential fact is only tinkering around the edges of the issue.

Wednesday, August 11, 2010

California to Send Tax Revenue to Neighboring States, Create Black Market

Beginning in February 2011, gun shops and sporting goods stores in Arizona, Nevada and Oregon are likely to see a boom in sales of handgun ammunition as California’s draconian AB 962 goes into effect. The law bans Internet ammo sales to Californians and, more importantly, requires merchants within California to track consumers who purchase handgun ammunition, maintaining fingerprints for each.

The law infringes upon the federal government’s Constitutional primacy regulating interstate commerce, making the sale of a legal good across state lines a crime. On that basis, it’s likely to be overturned eventually. In the meantime, though, the law will encourage many gun owners to buy ammunition in neighboring states. Weekend trips to Reno, Vegas, and other nearby towns will now include bulk ammunition purchases as visiting Californians stock up there to avoid intrusive government monitoring here. And the sales tax revenue that would have been collected by California cities will go to our neighbors instead.

There will still be ammunition sales in California, of course. Folks who keep firearms strictly for home protection and rarely actually shoot their guns will probably buy the odd box in-state. But serious shooters are already planning to stock up on ammo from out-of-state. And criminals, whom the law presumably was intended to deny easy access to ammunition, will stop buying from legitimate retailers (where sales tax is collected) and buy instead from street peddlers trafficking in stolen or illegally imported ammunition.

We’ve seen this tragic comedy before. Governments impose tougher restrictions on guns and ammo claiming they’ll prevent gun violence, but actually just making life harder on law abiding citizens. Unable to buy guns from legit stores, criminals buy them instead out of the trunks of cars or under tables in bars, completely off the books. Now handgun ammunition will also trade hands underground, creating yet another racket for gangs to fight and kill over.

This gets at the actual root cause of violent crime – not the availability of guns or ammunition, or even poverty, but the creation of incentives to commit crime. In our efforts to control the behavior of others, society has imposed various restrictions that have had perverse consequences. Alcohol prohibition in the 1920s was supposed to promote social order and public welfare. Instead, it created the mob and murderous black marketers like Al Capone. For generations since, society has prohibited recreational drug use and prostitution, and these two underground activities continue to fuel gang violence to this day. In poor Mexico, drug cultivators and smugglers serving the American black market now threaten the very existence of the Mexican state, murdering police officers, judges, politicians and rival gang members in ever more violent massacres. Across Asia and Eastern Europe, young girls are sold into slavery or are kidnapped by black market traffickers equally ruthless in their use of violence.

By now, it really ought to be clear that the best way to interrupt this cycle of violent crime is not to give black marketers yet another lucrative incentive to kill, but rather to stop trying to control other people in the first place.

Monday, July 12, 2010

Uncertainty in Afghanistan

I’m no longer certain that we’re doing the right thing in Afghanistan. For the past nine years, I’ve supported an American-led nation-building project there on the premise that failed states were incubators of terrorists and other enemies of democracy. Now I’m not so sure.

After 9/11, President Bush did precisely the right thing in deposing the evil Taliban regime and chasing its al Qaeda allies out of the cities. That decisive action devastated the terrorist network and probably did much to keep us safe. The most important question now, however, is whether we can expect to go beyond that security success to establish a functioning civil society in the long-troubled land. And if we can, at what cost and to what end?

Certainly, well functioning, peaceful societies are preferable to illiberal, threatening regimes. And Afghanistan’s proximity to Pakistan, that nuclear-armed Islamic nation with its own Taliban and al Qaeda insurrectionists, makes the country more important to American security interests than other failed states. Unfortunately, it’s not clear that there’s much we can do to develop and reform Afghanistan under current military and economic circumstances. NATO has proven to be a hollow organization where Europe is not directly threatened – and as European dithering during the Balkan crises of the 1990s showed, the organization is weak even on its own soil. The project in Afghanistan, then, is an almost exclusively American effort.

Meanwhile, the strategically more important effort in Iraq necessarily consumes more American attention and resources. Iraq has superior existing infrastructure, fewer competing tribes to reconcile, greater potential wealth to fund development, and a well-establish secular tradition. The fact that Iraq is overwhelmingly Arab also makes it more important as a potential example of democracy for the people of Egypt, Syria and the Gulf States. Then there’s oil. Having that precious commodity makes Iraq important in the global economy in a way Afghanistan simply is not. Whether you’re a neo-con hoping to plant democracy in the heart of the Middle East, or a policy realist who just wants to manipulate the levers of power and wealth, Iraq is far and away more critical to your agenda – and to America’s.

So if we can’t leave Iraq to win the supposedly “good war” (according to President Obama) in Afghanistan, what do we do? Hamid Karzai and his corrupt friends and relatives stunt internal civil development, and we don’t have the troops or money to impose a large-scale solution from the outside. More and more, I’m beginning to think maybe the best we can do is to establish Taliban-free zones in the north and around Kabul. Such retrenchment would require fewer troops and less money, and would reduce combat losses. With well armed and organized forces occupying a smaller footprint in-country, we would still be able to execute lethal campaigns against Taliban and al Qaeda forces whenever they pop up.

At present, though, we seem to be pursuing the worst possible strategy – “surging” to a troop level that remains insufficient to actually succeed in a strategy that may be too ambitious. The result is more dead Americans for no clear benefit to our country. That truly is unsustainable.

Friday, April 30, 2010

Bravo Arizona!

What's left to say that hasn't already been said? Arizona has done what it had to do to protect its citizens and enforce the rule of law. If the federal government did its job, the state wouldn't have needed to pass its new law. But the federal government not only has failed to do its job, it is openly hostile to the task of protecting Americans from the drug cartels and smugglers that have turned our border into a bloody no man's land, and it has looked the other way as our communities have been flooded with people who ignored our laws and disrespected our sovereignty, and who make it harder and harder for less educated, less skilled American workers to get a job.

In the 1970s and 80s, a poor, uneducated black, Hispanic, white or other American had some hope of making an honest living as a janitor, cook, construction worker, etc. Today, forget it. All the manual labor jobs go to illegals who work for less pay and will accept less safe working conditions. This month, the Bureau of Labor Statistics released these statistics: While national unemployment stands at about 9.7%, among blacks the rate is 16.5%. Why is the rate so much higher for blacks? Because a greater proportion of blacks lack college degrees or high school diplomas, and so are in direct competition for jobs with illegals. And why on Earth would a small, independent contractor go to all the trouble of hiring a black American for framing, roofing, landscaping, etc., when he could pick up a truck load of illegals in front of any Home Depot without filling out any bothersome government forms, handling payroll deductions, or getting any attitude that he might expect from an American worker? Americans, after all, expect to be treated a certain way. An illegal is just happy to be making dramatically more money than they could dream of making in his homeland. He'll do whatever you ask and smile. Great for the contractor. Not so great for the poor black American citizen who just lost another opportunity to join the labor force and pull himself and his family out of the ghetto.

Sadly, race and ethnicity are still powerful influences over many people, so a lot of Hispanic Americans are willing to look the other way, or even applaud, while millions of people from Latin America break our laws and literally steal jobs from poor Americans. All because those invaders look like we do, and share a common ancestral culture. To folks with that attitude, I say it's time to choose sides. What matters more, America or your race? America is in the balance. Either our laws mean something, or they don't. And if they don't, what good is a Bill of Rights, and other laws written to protect our liberties? If your race and ethnic background puts you above the law, the law is worthless. When you cling to your racial and ethnic pride and identity politics, you are indirectly assaulting the rights and freedoms of everyone else.

I hope many other states, counties and municipalities will have the courage the follow Arizona's lead and enforce our laws.

Thursday, April 01, 2010

Settled Law from a Living Document?

The left likes to say that whatever gains they’ve made pushing the "progressive" agenda over the years are now “settled law.” That is, things such as the unfettered right to abortion and the authority of the federal government to essentially ignore the 10th Amendment are now set in stone, and anyone who disagrees should shut up since that’s all been settled already. Well sorry, in our democracy, the only settled law is the one the left so loves to subvert, challenge and distort at every opportunity by calling that law a “living document.”

By now it should be clear I mean the Constitution, which the left constantly attempts to bend to the leftist program. Forget that the amendment process provides a clear and specific way to actually alter the Constitution. To the left, the words and clauses already there are open to constant reinterpretation so that the Constitution means whatever they say it means “in the current context” or “in accordance with contemporary mores.”

Thirteen states so far have filed lawsuits against the federal government in response to the health care takeover Democrats have foisted upon the country. Apologists for big government retort now that the Commerce Clause empowers the federal government to do all contained in the health care bill and more, and that such empowerment has been settled once and for. No need belaboring the debate. Those of us who believe the Constitution sets strict limits on government power (as the Founders explicitly stated it does) ought to pipe down and accept that the “living document” has adapted to today’s realities – which includes the fact that unlimited federal power is now set in stone.

A living document that sets leftist ideas in stone. What a creation!

Friday, February 26, 2010

Best to San Diego

Today's move by the Chargers to let RB Darren Sproles test the free agent market, after letting LaDanian Tomlinson go last week, could make San Diego a much more likely destination for Cal's super-speedster Jahvid Best. The Chargers pick later in the first round and could certainly use a dynamic playmaker like Best. Of course, San Diego may yet re-sign Sproles as a free agent once the market sets a reasonable price for his services. Still, it's intriguing to consider Best in the blue and gold of the Bolts.

Tuesday, February 23, 2010

Jahvid Best's Next Team

I see Cal running back Jahvid Best as a complementary speed back in a two-back tandem with a power runner. Several teams have a need for such a back, and a handful just need any help they can get in the backfield.

Teams where Best would fit nicely with an established primary back:

Atlanta: Michael Turner has established himself as a fine NFL starter, but hasn’t ever really been expected to carry the load as the main man for a complete season. At 240-plus pounds, he’s a bruising runner who would set defenses up nicely for the lightning quick Best. And with Matt Ryan at QB, the Falcons could make use of Best’s solid pass catching skills to really keep defenses off balance. With Atlanta picking either 19th or 20th in the first round, Best would seem to be a great choice. However, the Falcons also need another wideout to free up Roddy White, as well as help on the O-line, while new blood is needed across the defense. As such, it’s hard to imagine the team taking Best in the first round.
Baltimore: If the Ravens part ways with Willis McGahee, Best would be an interesting addition to the running game. Having Ray Rice and Best in the game simultaneously would have defenders running every which way, and would create huge mismatches out of play action, on screen plays, and even running plays. Still, while Rice is a hard runner, he hasn’t been a weapon near the goal line. Adding Best would not help in that critical aspect of the offense, so this probably would not work out. Besides, Baltimore needs a legitimate No. 1 receiver to replace the aging Derrick Mason. That should be their top priority.
Buffalo: The simple fact that the Bills already have a former Cal running back in Marshawn Lynch is probably enough to guarantee that they will not select Best. But their high draft position might make it possible if Best lasts into the second round. Lynch and RB Fred Jackson are both strong runners, and neither has the burst, elusiveness and flat out speed that Best would bring. So it would be very exciting to see Best added to the mix. But the team would probably be better served taking a stud WR like Dez Bryant or an offensive tackle to fill the void left by Jason Peters’ free agent departure to Philadelphia before last season. And the defense remains mediocre at best. So while this would be an exciting combination to see, it’s not likely to happen.
Chicago: This definitely is not going to happen because the Bears don’t have the draft picks to get Best. But even if they did, the team has so many pressing needs (CB, DE, DT, WR) that they couldn’t afford the luxury of pairing Best with Matt Forte. But man would that be fun to see. Jay Cutler might even start checking down when deep coverage is heavy rather than throwing the ball up for grabs as he did in 2009. As a lifelong Bear fan who grew up watching Walter Payton for 13 seasons, I’d love to see the soft-spoken, hard-working Best wearing the navy and orange. And from articles I’ve read about Best’s uphill running regimen, which emulates Payton’s, it sounds like Best would appreciate the opportunity to follow in Sweetness’ footsteps. Different kind of runner to be sure, but similar heart and character. I wish the Bears could get Best, but they can’t.
Cincinnati: With the addition of Larry Johnson last season, the Bengals suddenly have a crowded backfield. But both Johnson and Cedric Benson are power runners. If I were in charge, one of the two would be traded to make room for Best. Indeed, the Cincinnati offense is close to being one of the really exciting ones in the league. Chad Johnson (after Darelle Revis shut him down twice in a row at the end of last season he should now be known as Johnson rather than Ochocinco since he said he’d change his name back if that happened) is still an elite receiver, but he won’t be for much longer. And the death of Chris Henry left a gaping hole opposite Johnson that the Bengals may choose to fill with the 21st overall pick. But Best would be a better option. He’d give them the lightning to the other RB’s thunder, and would be a legitimate receiving option for Carson Palmer, perhaps even pulling safeties up. Plus, after Bryant, the receiver class doesn’t really have anyone who looks like a sure-fire NFL starter. Since Cincinnati’s defense is already very good, the team can afford to focus on offense and take a shot on Best. It all hinges on what they do with Johnson and Benson between now and the draft.
Green Bay: Another spot that seems to make sense for Best is paired with Ryan Grant on the Packers’ roster. Green Bay picks 23rd, two spots behind Cincinnati, and already has excellent receivers, tight ends, and the best quarterback in the NFL, former Golden Bear Aaron Rodgers. The O-line was battered last season, but when Colledge and Clifton are both healthy, they do a fine job in pass protection. The possible monkey wrench in this scenario is the likely departure of Aaron Kampman in free agency. Kampman never fit into the 3-4 OLB role, and will probably be looking to sign his next big contract with a team that lets him cause havoc from his natural end spot. If so, the Pack may be looking to upgrade their linebacking or D-line corps.
Jacksonville: The Jags need help at several positions, most importantly QB, so they definitely won’t reach for Best with the 10th or 11th pick. And Best won’t be there by the time they pick again. It would be fun to watch Best working with the human bowling ball that is Maurice Jones-Drew. However, with the Jags’ glaring needs at QB and WR, not to mention every defensive position, Best again is a luxury the team cannot afford.
Pittsburgh: The only thing that makes me doubt the Steelers would take Best in the first round is their 18th overall slot. Best would be a fantastic complement to Rashard Mendenhall, and would be like a Heath Miller out of the backfield – a reliable outlet for Ben Roethlisberger when Hines Ward and Santonio Holmes are well covered. Pittsburgh can afford to take defensive players in later rounds since that squad is already pretty solid all the way around. But still, 18th seems higher than Best will go since there are likely to be some real beasts remaining available at tackle and guard, areas of somewhat greater need in light of Roethlisberger’s injuries the past couple years.
St. Louis: Needless to say, the Rams are not going to make Best the top overall pick in the draft. But the first pick of the second round? Maybe. In Round 1, the Rams have got to take Ndamukong Suh to set up a ferocious D-line to terrorize the NFC West for the next decade (Suh plus Chris Long, Leonard Little and that other Cornhusker DT Adam Carricker who should be back from injury). That will make their secondary better, and keep them in every game. That leaves the second round pick to use on offense. And Best would be a thrilling complement to the crushing style of Stephen Jackson. The only problem is that St. Louis desperately needs both a QB and a WR – most of all a receiver. As I mentioned earlier, I’m not totally sold on any of the receivers this year besides Bryant, but two or three fine QBs will be there at the top of the second round, and the Rams might just go for the best receiver they can get (Jordan Shipley is an exciting prospect who should still be on the board, and if Arrelious Benn falls this far, he might be too tempting to pass up). But WRs are notoriously difficult to project to the NFL level. If the Rams don’t go QB in Round 2, Best would be an excellent choice.

Besides the teams where Best would be a good complementary back, several teams just need whatever help they can get at running back. Suddenly, that group includes San Diego – my personal choice for Best since it would keep him on the West Coast and put him in cool threads that he’d look really, really fast wearing. Other teams that just need a RB include Cleveland, Detroit, New England and Tampa Bay. Only the Chargers or Patriots have first round picks that seem to make any sense in taking Best (28th and 22nd respectively). If Cleveland, Detroit or Tampa were to get him, it would be in the second round. And all seem to make as much sense as any other selections these needy teams might make. If Best went to Cleveland, he could run behind former teammate Alex Mack. In Detroit, he could play with Zach Follett once more (and fill the role once played by the elusive Barry Sanders).

Of course, team needs and individual player fit aren’t the only things that will determine where Jahvid Best may end up. Some teams believe in always taking the best available athlete regardless of immediate need, so he could end up going somewhere you’d never expect. And considering Al Davis’ fixation on raw speed and habit of having too many potential starting running backs on the roster, it wouldn’t be shocking to see Best in the silver and black. In fact, while it makes almost no sense at all, it would be awesome to have the kid stay right here in the Bay.

If I were betting (and I’m definitely not since I’m way too cheap), I’d say Best ends up in Cincinnati, St. Louis, Cleveland or Detroit.