Aaron Carroll (among other things, a Professor at the IU School of Medicine) has a good column at The Incidental Economist entitled “Why the U.S. Still Trails Many Wealthy Nations in Access to Care.” He acknowledges that many people are unhappy with Obamacare. But, he notes that it has been successful in its primary objectives: expanding the safety net, reducing the number of uninsured, and regulating the non-employer provided private insurance market.

Other countries provide their citizens with much better access to health care. Most of their citizens were better able than Americans to get care promptly and do so without having to go to the emergency room. Those countries had far more primary care physicians per capita than the U.S., and their citizens were less likely to skip necessary care due to expense. And, maybe most telling, citizens in those countries were more likely than Americans to be happy with their country’s health care system.

I’m not a huge fan of how Obamacare is structured, but I have not forgotten that the pre-Obamacare system was awful as well. As Carroll says:

Perhaps most telling, when adults were asked about their views of the health care system in 2013, 75 percent of Americans said that it needed fundamental change, or that it needed to be completely rebuilt. This percentage was higher than for any other country surveyed, Canada included. Primary care physicians feel similarly. Yet years after the Affordable Care Act was passed, Americans are still litigating whether to return to the previous system.

Access was a problem before. Access is a problem now. Americans can’t seem to have a discussion on how to make that better. Without that, it’s hard to see how things will improve.

Other countries have figured this out. A better health care system is possible. We need to identify the problems with Obamacare, see how other countries have addressed similar problems, and pass legislation to make those changes. For the moment, many lawmakers are choosing not to make things better.

It’s ridiculous that, wealthy as our country is, healthcare is in such a state (and has long been in such a state) that — in Indiana’s campaign for governor, John Gregg is being attacked for having state-paid insurance due to his having been a legislator for many years. We regard health insurance as some kind of decadent luxury that a legislator could obtain only through the rankest corruption.

Like I said, it’s not just pie-in-the-sky wishful thinking that we should have a system where health insurance is affordable and actually provides access to health care. It’s being done with greater and lesser success in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the U.K., should we choose to study them.

This one hurts. Cowboy Bob has passed away at the age 0f 73, apparently of a heart attack. There was a time, probably when I was 4 or 5, when Cowboy Bob’s corral was my favorite show.

From 1970 to 1989, Bob hosted the afternoon cartoon show on WTTV Channel 4. He appeared first as the host of the “Chuck Wagon Theatre” before it became known simply as “Cowboy Bob’s Corral.”

For a generation of Hoosiers, Cowboy Bob was an after-school companion who entertained with his cast of TV characters. Cowboy Bob also educated and engaged his audience subtly on issues like fire safety.

I remember one time my family and I were on vacation in Maryland. I didn’t really understand about how channels worked when you when you traveled far away. (Nor, apparently, had I learned to be polite). Family members were sitting in my aunt and uncle’s house watching football. At 3:00 (I think), I went to the TV and changed it to channel 4. No Cowboy Bob! (And not a lot of happiness from the people watching the game.) It was a bad day. That’s when I learned that Cowboy Bob didn’t play on every TV around the world. The world’s loss. And our loss now that Bob Glaze has passed away.

Here on the fifteenth anniversary of the attacks of September 11, 2001, I thought I’d repost my thoughts from the occasion of the tenth anniversary.

With our cultural fixation on numerology, it seems especially obligatory to comment on the anniversary of 9/11 because it is the tenth.

I was every bit as shaken by the event as everyone else; struck by the juxtaposition of gratuitous destruction and peaceful cool, blue fall skies of that morning. After that, there was the chaotic nature in which information flowed in. The Internet was a little different then than it is today; not quite as opaque as it was in, say, 1995; but you still had to know where to go for quick information. I got a lot of my information from The Well; a bulletin board system of sorts with a lot of reliable posters from all around the country, primarily on the coasts.

The drive home was a little surreal. I confess I cried a little bit. I forget what all moved me that much – probably, it wasn’t the death of strangers. I’ve seen that on any number of news reports over the years and read about even greater numbers of deaths in history books without feeling the least bit emotionally involved. I think it was more a sense that things in this country were bound to change for the worse. But, I don’t know how much of that sense is actual memory and how much of that is memory colored by the fact that things did change for the worse. Aside from getting emotional, the rest of what I recall from the drive home was that the roads were pretty quiet — but, that’s not unusual in the back country roads from Lafayette to Monticello — and, before I got out of Lafayette, the Family Express on North 9th Street had jacked up its prices in response to the attacks.

When I got home, I was given a lesson in media consolidation. Every channel had coverage of the attacks; and, each channel would use the feed from its parent company’s news division. So, I found out that MTV and CBS were tied together, for example. Up and down the channel list, you would probably get one of five or six news broadcasts.

Shortly after the attacks, I also remember being uneasy about the number of people on the news programs saying some variant of “everything changed” on 9/11. Or, maybe, “irony died” on 9/11. Kind of weird stuff from, I suspected, people who wanted irony to die or everything to change and were projecting their desires on the event. But, aside from that, there was this incredible unity. I remember having hopes that we, as a country, would use the event to get behind something god almighty big and make our generation memorable. I don’t think I had anything specific in mind; but something on the scale of the moon landing was probably bouncing around in there.

I recall being extremely touched by the gift of 14 cattle by Kenyan Maasai herders. More than anything, that demonstrated that the World was almost entirely on our side following those attacks. I also recall being moved by Jon Stewart’s speech when the Daily Show came back on the air. We were starting to shake off the stunned reaction.

It’s hard telling what, if anything, might have been possible with Americans unified and the World in our corner; but I think it’s fair to say that we squandered the moment. We all wanted vengeance; but the just thing to do isn’t always the smart thing to do. In the end, our response to 9/11 hurt us far worse than the event itself did or than al Qaeda had the power to. Pearl Harbor represented the tip of Imperial Japan’s spear. 9/11 was al Qaeda going all-in and sucker punching us.

I supported the invasion of Afghanistan; though, in retrospect, that might not have been the height of wisdom. We’re still there. We wouldn’t be the first empire that went to Afghanistan to die. But, it was Iraq that was the height of monstrous stupidity. Without 9/11, you couldn’t sell the invasion of Iraq to the American people.

So, here we are, ten years later; economically spent and lacking optimism. It’s hard to remember how things were prior to 9/11. During the late 90s, the Internet boom made us feel like we were creating something phenomenal. Energy was high. Jobs were easy to come by. Infrastructure was not crumbling.

We can’t blame 9/11 for everything, of course. The dotcom buble was bursting; the housing bubble was still inflating, but the trajectory was pretty well set. Wall Street was stacking its house of cards higher and higher. Our industrial base was already being hollowed out. But, it seems to me, our reaction to 9/11 was a force multiplier. We increased our expenses enormously without bothering to budget for them. Government credibility, not at a high water mark anyway, was demolished. “Weapons of Mass Destruction” and “War on Terra” became punchlines.

It’s entirely appropriate that we honor the first responders of 9/11 as brave and regard the deaths of the folks in the Pentagon and World Trade center as tragic. But, for me, the nobility of the people who acted that day and the solemnity of the occasion is tainted by all that followed.

Think Progress has a piece indicating that East Chicago is “poised to become the next Flint.” The EPA says soil in the area has been contaminated with toxic levels of lead and arsenic since at least 2014. According to the piece, it’s more likely that this problem, or at least its origins, is more like 50 years old.

In 1920, U.S.S. Lead set up shop along the town’s central Calumet River and began churning lead dust, arsenic, and other chemicals into the atmosphere. Around the same time, Anaconda Lead Products opened a few blocks north of U.S.S. Lead and did the same.

In 1973, U.S.S. Lead began dismantling car batteries to recover lead parts. Discarded materials saturated the soil with battery acid. Anaconda Lead has a shorter legacy?—?after shutting down in 1936, the factory’s buildings were demolished and cleared, leaving only lead-rich soil in its wake.

Low income housing was then put in the area. In 1985, the Indiana Department of Environmental Management tested former Anaconda locations and found places with lead levels at 11,000 parts per million. The EPA’s maximum level is 400. In the early 90s, U.S.S. Lead declared bankruptcy. In 1992, the EPA proposed that the area be declared a Superfund site. No action was taken on this proposal until 2009.

It appears that the low income housing facility is now being shut down due to environmental contamination. The shutdown is related to a change in the CDC’s threshold for acceptable lead levels in children.

Occasionally, I feel compelled to take random shots at libertarians. This is one of those times. I think I’m hardest on them because I used to consider myself one. The philosophy is superficially alluring, and I think I’m angry that it doesn’t hold up in the real world. So, what’s the libertarian solution to this situation? For years, it appears, U.S.S. Lead was externalizing the costs of its activity — not necessarily because of anything malicious; just because that’s how business was done back then. Maybe we didn’t really even appreciate the danger. But, the fact remains that its commercial activity resulted in lead contamination — contamination that reduces the value of the real estate and impairs the health of the community. The contamination is a cost. But, because the company was able to impose that cost on unwitting members of the community and on future generations, it did not have to incorporate that cost into the price of its product. The company and its consumers enjoyed a windfall — essentially receiving a subsidy from the community and future generations.

Broadly speaking, I suppose some libertarians might consider that sort of contamination and involuntary subsidy a form of theft; a deprivation of liberty for the people who get sick. But, I think it’s more common for libertarian-minded people to rail against the EPA, regulations, and the heavy hand of government. What’s the solution here? Screw the future? Let people get sick and die?

As a practical matter, I think environmental concerns are a good example of why regulatory schemes are necessary. Safeguards that work well with more traditional property concerns (e.g. court proceedings for trespass) just don’t work that well with environmental situations where boundaries are more porous and damages are more insidious. (The corporate form is another issue at work here. Libertarians ought to hate the corporate form — it’s a government fiction designed to limit personal responsibility. But, mostly I don’t see libertarians speaking out on this issue. And, in this case, we see it at work — the individuals who profited from the transgressions of the lead company will be able to retain those profits while cleaning up the contamination and dealing with the health consequences will be someone else’s problem.)

I don’t have a good solution to this problem but felt like I ought to highlight it. I saw these two stories in close proximity, and they struck me as related:

1. Who Lies More: Clinton or Trump? The answer is Trump. In fact, it’s so clearly Trump that the headline is a problem. But the reader is not provided the answer until the 17th paragraph. The headline should have said “Trump lies more than Clinton.”  (I went to the comments section on WLFI’s Facebook page, and it was clear that no one commenting there had read anything but the headline.) The story should have then led with the news that the Trump assertions vetted were false 85% of the time while Clinton’s was in line with “a typical politician” (and that number should have been provided). Trump’s statements received the lowest truthfulness rating 63% of the time compared to 14% for Clinton. But, this was buried below roughly equivalent amounts of ink (or pixels, I guess) on various challenges to truthfulness about the candidates in the news. And then the article went on to state that, despite the huge disparity in dishonesty by the candidates, the public perception was that the two were approximately equal in their dishonesty.
2. The Summer of the Shill by Matt Taibbi. He argues that media loses credibility when they appear to be in the tank for one candidate or the other. He laments that practically all non-conservative cable last week was consumed by stories that aren’t favorable to Trump. He argues that the media’s job “is to grope around promiscuously for stories on all sides, like dogs sniffing fire hydrants.” When you lose independence, you lose credibility

It seems very difficult for the media to convey independence while, at the same time, being able to avoid projecting a false equivalence. And I think the problem has to do with traditional media not being able to convey emphasis very well. You see the first story about the public perceiving Clinton & Trump as being roughly equivalent in terms of honesty but, if you run the numbers, Trump is lying constantly, egregiously, and without compunction. Meanwhile, Clinton’s lies are more sporadic, less dramatic, and more often defensible. You’re not going to get that sense if your news outlet is determined to be independent or objective by devoting similar amounts of time or column inches to stories critical of both sides. Under that model, you’ll hear about Clinton’s e-mails again along with as many of Trump’s outrages of the day as they can squeeze in. Perversely, you might think that Clinton’s lies are *more* serious because (having nothing else very interesting to report), the media outlet reports on the e-mail problems again and again and again. Meanwhile, Trump is giving the media a fire hose of material, meaning that no one thing gets as much attention.

So, what to do? It’s no secret that I think Trump would be catastrophic for the country while I think that Clinton has more ordinary political flaws. That’s my bias, and it helps me be comfortable with the media’s recent approach to hammer Trump and not be too concerned about devoting equal time to Clinton criticism. But, I do recognize the problem.

I tend to think the answer has something to do with media outlets being explicit about their biases while, at the same time, being as honest as they can about the facts they report. The pretense of pure objectivity is too easily exploited by our political system.

Branko Milanovic has an article in VoxEU discussing a graph depicting worldwide income gains and losses between 1998 and 2008. If one looks at the overall graph, it shows that, worldwide, people from near the first percentile through about the 75th percentile and those above the 98th percentile have seen gains in their income during that 10 year period.

Cumulative real income growth between 1988 and 2008 at various percentiles of the global income distribution

Meanwhile, however, those between the 75th and 98th have seen a notable drop in their income. Milanovic notes that incomes in the richer, OECD countries (including the U.S.). Incomes in those countries start at about the 70th percentile. (Particularly rich and particularly egalitarian countries, such as Denmark, start at more like the 80th percentile). To be in the top 1% on this global graph, a family has to have a before-tax income of about $300,000 per year.

The people at point “A” where the graph hits its apex are almost entirely in Asia. People in India and China have seen increases in their incomes. In 1998, the median urban Chinese person was at the global median. By 2011, that person had jumped to the 70th percentile.  However, the biggest winners globally are still relatively poor by Western standards. The “global middle class,” as Milanovic puts it, would be at the poverty line in the rich OECD countries.

The good news is that something like 1/5 of the world’s population (those between the 45th and 65th percentiles) saw their income double. “It is their real income growth that has driven the first decline in global inequality since the Industrial Revolution.” The bad news is that the folks who lost ground are not likely to take such a philosophical view of matters.

Milanovic suggests that the complexity of economics makes it difficult to be certain that there is a causation between the gains of the globally poor and the losses of those who are relatively poor in the richer western countries (the folks at point “B”). However, the fact that one went up at the same time the other went down makes it a compelling narrative and easy to believe for those at point “B.” The folks at point “B” are not likely to be concerned with their relative standing in the world. Rather, their sense of well being is going to be a function of how they compare to the other people in their own countries. They see themselves losing ground and the folks at the top of the national distribution making out like bandits. They are only dimly aware of the masses outside their countries. This may explain the embrace of things like Brexit and Trump.

So, a friend had a Facebook post observing that black Americans will talk about being invisible and powerless and, all too often, white Americans will respond by arguing or trying to tell them that their complaints are not real. I chimed in, mentioning that for some white Americans, it doesn’t feel like they’re privileged. They are privileged, but they have a lot of problems of their own and, so, it doesn’t feel like privilege. I cited my older post where I used the Shawshank Redemption as a metaphor. Andy Dufresne was wrongly convicted and crawled through a river of shit to escape and go to Mexico. He might be excused for not thinking he was the beneficiary of privilege. But, he absolutely was. His black friend, Red would have been killed by the guards for the same antics and never would have been allowed anywhere near the warden’s financial documents.

Another person on the discussion thread responded by asking the very legitimate question about why so many people whose lives aren’t (not even in their own opinion) that river of shit still refuse to believe they are privileged. My response to that grew longer than I anticipated and felt like something that might have some value to post here — the perspective of a guy such as myself who enjoys most of the structural privileges you can name and why there was a period in my life when I would have resented the implication that I got where I was through something other than hard work and good choices:

I can only offer dimly remembered memories from my early 20s: white, male, very educated, upper-middle class background. I felt like I was where I was through hard work. I remember getting picked on in middle school and high school for being a nerd. I felt intimidated by the poor kids in school who acted in ways that were rougher than I was accustomed to. I felt like they didn’t value education, didn’t work very hard in school, and made fun of those who did. When they struggled later on in life, I felt like it was going to be because of the bad choices they made right now. And, because they made me feel angry, fearful, or resentful at the time, their future struggles were going to be no more than they deserved. (I see parallels sometimes in the very religious who are especially concerned and angry about the moral failings of others and seem almost happy about the eternal damnation those people are going to endure.)

So, when I got to college and I started to hear about diversity and privilege from a bunch of ivory tower types, it grated. I remember Dennis Miller had a bit about how, because he was a white guy, he was everybody’s asshole. I really identified with it.

There was a lot of individual resentment, fear, and lack of perspective that blinded me to the structural realities of what was going on in society. Of course I had a ton of help getting where I was. Of course those other kids weren’t pursuing education the way I was because they didn’t have the background I did. And their perceived deficiencies were magnified in my mind because of my own fears, anxieties, and resentments. So I wasn’t inclined to listen to any of it.

I’m not defending any of that. I’m not proud of it. But, that’s what I recall about why I felt the way I did when I was one of those guys who had a pretty good life and very much resisted messages about privilege.

The turning point, as I recall it; was that one day I was holding forth bitterly about political correctness or whatever, and my sister asked me bluntly, “what are you so angry about?” I probably offered up some response justifying my tirade. But, I chewed on that question, ultimately concluding that I didn’t have a lot to be truly angry about. Whatever people were saying about white guys or privilege or political correctness was in the abstract. Regardless of how those messages felt to me, nobody was blaming me directly. So, I shouldn’t be mad about that. And, when you got right down to how my life was going, it was pretty damn good. Being angry was gratuitous on my part. My resentment didn’t turn off like a light bulb or anything, but that’s when I think I started heading in the other direction.

So, anyway, one guy’s perspective. I’m not sure how much it applies to the dynamic in our culture generally.

I came across an interesting article by Olav Muurlink in the Sydney Morning Herald. (I really want to go to Australia, but it’s not happening any time soon, so I compensate a little by including some Australian papers in my news reader.) The jumping off point had to do with penalty rates that, I infer, require employers to pay higher rates to have employees work nights and weekends. It has apparently become a political issue in the Australian campaign cycle. The author says:

Penalty rates are often cast as a roadblock to business or employment but public health researchers see penalty rates as a deterrent against employing workers in ways that risk workers’ health.

It’s pretty easy to predict how such a measure would be cast here. “Let the market decide!” “You’re only hurting workers!” Etc. The thing is that an efficient market requires arms’ length transactions where each participant in a contract is making rational decisions without coercion. The need for things like food and shelter means that a potential employee isn’t as free to walk away from a deal or sit on the sidelines until opportunities improve. The invention of property laws means that a person has more limited opportunities to satisfy the need for food and shelter without dealing with other people. But we put up the property law fences so long ago, we forget that they are artificial restraints on liberty. (I’m not some wild-eyed radical suggesting that we get rid of property laws, but I do like to remind people that our laws put a heavy thumb on the scale in favor of property ownership, and we should give that thumb some consideration when reviewing the options of those with less property.)

In any event, Murlink points out that these penalty rates were *meant* to discourage work at odd hours. Work is not the end all and be all.

This is not an argument he makes, but obviously there is a point of unacceptable return, where the cost of labor does not justify the wage paid for it. We don’t permit contracts for perpetual servitude in exchange for food and shelter. That gets dangerously close to involuntary servitude even though an individual could theoretically enter into such an agreement “voluntarily.” We have to ask ourselves, when does the need for food and shelter make an employment agreement less than truly voluntary?

Murlink’s arguments center on the research that shows the costs of irregular work hours and the physical and mental toll imposed upon workers when they lack (or perceive that they lack) control over their work conditions.

A large and well-conducted Hungarian study was able to predict heart disease by simply asking “how much can you influence what happens in your work group”. Of the work variables in this study “sense of control” was the single most powerful predictor of ischaemic heart disease in women, and not far behind for men.

So what is “in your head” is important, and what we find consistently is that blue collar workers not only are more likely to work hours they can’t control, but they feel less in control of other aspects of their work and life.
. . .
[T]there are other ways working time factors pose risks to your health. When time we would normally spend on self-care or even essentials like eating is lost, we buy it back in unhealthy ways – skipping exercise and buying fast food, for example.
Ironically, overwork or unusual hours – even working on weekends – makes us fat. The human body is not designed for constant work. In fact, the eight hour day and the five day week very roughly mark the boundaries at which humans can safely work. The risk of an occupational injury on a ten hour day for example, exceeds that of an eight hour day by 41%, while even higher increases in risk have been observed on the sixth and seventh day of consecutive work.

As a society, we’re working more Saturdays, more Sundays, more nights, and more unusual shifts than ever before, and one way or another, we’re paying penalties. Either businesses pay them in cash, individual workers pay with health, or society pays through health care.

Let’s reiterate that. There is a cost for this kind of work. The question is not whether there is a cost, the question is who will bear the cost. If the cost is externalized onto taxpayers or individual workers, then it won’t be reflected in the price. Purchasers of these services are, in effect, receiving a subsidy — and, therefore, the demand for the weekend and overnight work will be artificially high. The penalty rates are an effort to internalize the costs such that the costs are reflected in the price. When the price internalizes all of the costs of a product, the laws of supply and demand can allow the market to work efficiently. When subsidies are involved, things get skewed.