About Author: neoavatara


Posts by neoavatara


Child Immigrant Surge Shows Fundamental Flaw in Democrat Logic


The recent surge of illegal immigrant children across our southern border is a humanitarian tragedy that is only now being understood.  Almost 50,000 children, without adult supervision, have been captured since October, and most project that number will rise to 90,000 by September.

Note that this is not some small variation; that is a 100% increase over the same period last year.

This surge did not occur in a vacuum.  President Obama has before and after his re-election promised the loosening of immigration rules on deportation, and has widely announced that he wanted to sign executive orders furthering those ideals.  He first signed the Deferred Action for Childhood Arrivals memorandum in June 2012, which directs US Immigration officials to practice ‘prosecutorial discretion when it comes to illegal undocumented youth immigrants.

These moves, unsurprisingly, have not gone unnoticed south of the border.  In fact, in many countries in Central and South America, there are editorials and TV broadcasts that have touted this change.  This has often been misinterpreted as a true amnesty, and thus many uneducated families have made the decision that if the door has swung wide open for their children, they can’t miss the opportunity to jump through that door.

And that has resulted in a change of behavior across the board.  Unaccompanied minors now are surging the border, in hopes to benefit from Obama’s DACA, even if this is an incorrect understanding of the rules the President signed into force.  But even more so, those children are purposefully being apprehended by immigration officials. This from USA Today:

One key difference the recent arrivals are displaying from their predecessors: They’re not bothering to sneak deeper into Texas, opting instead to turn themselves in and allow U.S. policy toward immigrant youth decide their fate, said Chris Cabrera, a McAllen-based Border Patrol agent and vice president of the local chapter of the National Border Patrol Council.

“We’re seeing record numbers of children coming across,” he said. “We’re dealing with so many of them turning themselves in that it makes it hard for our agents to focus on anything else.”

Legally of course this is not what President Obama intended.  But the logical result of his policies is not surprising whatsoever. Uneducated, non-English speaking people across the world heard what they wanted to hear; a President basically removing the major blockade for their children to enter the United States.  Did Mr. Obama really expect a different result?

This of course puts the President and his Democrat allies into a bind.  Hillary Clinton, who is on her ‘Throw Obama Under the Bus” Book tour, didn’t miss the opportunity to…throw Obama under the bus.

“They should be sent back as soon as it can be determined who responsible adults in their families are, because there are concerns whether all of them should be sent back,” Clinton said. “But I think all of them who can be should be reunited with their families.”

This is a major quandary for the Obama Administration, who has made the ‘virtual’ DREAM act one of their second term priorities.  Furthermore, there are practical realities: once we allow the children across the border, our laws give them specific protections.  Here from Frank Sharry of America’s Voice, via Greg Sargent:

“It’s easy to say they should all be sent home. But that’s really hard to do. The law requires them to get their day in court, and many will qualify for some form of relief. You have to make sure these kids have an opportunity to present their situation in court, because they are more like refugees than immigrants. Making sure they show up would require holding all these kids in huge detention centers — rather than releasing them to family — and a massive infusion in judges to relieve the backlog of the courts, neither of which is possible under current budgetary and political restraints.”

We all agree with this.  There is a balance between the law and being humane.  The problem here is…Obama shifted the balanc, and therein lies the basic problem with the entire episode.

Democrats have long believed that loosening immigration rules, followed by enforcement of hiring and border protections, would stem the tide of illegal immigration.

This story shows the fundamental flaw in their logic, and why their plan will never work.  Once you loosen the rules on illegal immigrants, foreigners who are desperately poor and have no other choices will make the choice that has now open to them.  In this case, President Obama’s order, unintentionally but still forcefully, shifted the dynamic in such a way to make it worthwhile for hundreds of thousands of parents to send their children unaccompanied across the US border, in hopes that Mr. Obama’s administration would largely keep their promise of not deporting the majority of them, and thus, giving them a backdoor legal status into the United States.

Furthermore, because of the laws already existing, we must give those children due process.  In other words, because of the already existing backlog of cases, many of these minors could spend months, if not years potentially, in holding camps. Is that humane?

Liberals will argue that was never Obama’s intent.  Maybe so, but the results are the same.

This goes to the heart of the matter on comprehensive immigration reform.  I support immigration reform, and even support the DREAM act in theory, but the entire system will fail until you secure the border.  No legalization process or amnesty will long survive the reality that our border is quite open.  If you don’t secure the border…the surge of immigrants is the result.

This entire episode in liberal experimentation with social engineering proves that.


We Are Losing The War On Terror


First, if you think this is going to be a hit piece on Barack Obama…keep reading, because that is precisely not what this.

What this is, fundamentally, is an analysis of where our global fight against existential terror groups stands.

It is not a pretty picture.

Even before this weeks events in Iraq, we have seen a resurgence of Islamists all over the world.

In African, numerous groups have seen a comeback, most famous being that Baku Haram in Nigeria, who kidnapped several hundred young girls, and led to a Twitter phenomenon that so far has failed to find and return those girls safely.

In Libya, the West’s strategy has failed completely, as the majority of the country is now controlled by rebels, and the Capital itself has come under attack several times; Libya is on the verge of being a failed state.

Syria has long been a failed state, as the Civil War rages on. Thousands have died since the West signed a chemical weapons deal with Assad.  The chemical weapons deal is a nice public relations coup, but will not change the killing one iota.

In Afghanistan, the Taliban are apparently biding their time until the US leaves, so they can restart their Jihad against everyone.  And they staged one of their biggest coups in years, by receiving 5 key leaders back from Guantanamo Bay, at the price of one single American Soldier.

And the Taliban, along with the Hiqqani network, staged an underreported attack on Karachi airport in Pakistan, which signals new trouble for that nuclear state.

Iraq’s troubles, with ISIS and other Islamist groups, marching toward Baghdad is just another symptom of the larger problem.

Now, people’s instincts are to do one of two things: blame George W. Bush for everything and do nothing; or blame President Barack Obama for everything, and bomb everyone.

Both are incorrect and illogical.

Let us stipulate, at least in Iraq, that George W. Bush shares a lion’s share of the blame. I don’t want to get into the larger fight about the historical record of the war; but Bush owns this, for all time.

That said, that doesn’t mean Mr. Obama should simply play the tit-for-tat game, point at Bush, and say he wins the game. This is no game. This is not a time for political theater.

Let us put this into perspective, shall we? ISIS is a group that Ayman al-Zawahiri, Al Qaeda’s titular leader, thought was too extreme for him, and thus he severed ties with that organization. He once thought the group was a liability…the the ‘Al Qaeda brand’.  Think about that for a second.  To allow them to just walk into Baghdad would be a horrible failure of U.S. foreign policy.

Furthermore, let us recall that Osama Bin Laden’s key strategic goal was not to attack the United States. His key goal, all along, was to create a caliphate in the Middle East, that can grow and then present a true threat to the West. ISIS is on the verge of accomplishing just that.

The question now becomes, as we look at this global surge of islamic terror rising, and then see one event in which we could, at the very least, stem that tide in the hopes that more moderate and democratic forces can take charge, should we just ignore it because it is inconvenient?

Obama has only limited tools at his disposal.  Putting troops on the ground is not an option anyone is considering, nor should they.  There is much debate about whether drone or air strikes would do the trick.  That is a military question I cannot answer.

I think the war in Iraq was a mistake. I think we should be far more non-interventionist in our foreign policy as time passes.  But ignoring the threat posed here is foolish as well…9/11 taught us that.

I for one hope the President takes decisive, albeit limited, action here. He has a host of terrible choices, and many if not most of the problems in this specific case were not of his making. However, that should not excuse him from having to make the choice that is needed now, nor should it do so in the future.

Additionally, I hope the country quickly unites and backs the President if he takes quick action. This is a moment for unity, not for politics.  There are real costs to failing here; and people who don’t understand that have learned nothing from the last two decades of foreign policy failures.




What will GOP learn from Cantor’s defeat?


What will GOP learn from Cantor’s defeat?

Likely, not much.

The establishment has a difficult time analyzing and adapting to such ground shifting events. And make no mistake: Eric Cantor’s defeat was earth shattering.  He becomes the first Majority leader ever to lose a primary race.  EVER.  And he is the highest ranking party member to lose a primary race since 1899.

In my lifetime, there is not really an analogous primary result.  People have compared this to then Senate Majority leader Tom Daschle’s Senate election loss, but that was a general election race…a whole different ballgame.

Fundamentally, Cantor was not a bad conservative.  I still believe he is a good man, and a good Republican.  In fact, he had terrific ratings from conservative groups.  He was for lower taxes, smaller government…generally a pretty strong conservative.

What Cantor lost in recent years was any connection to the base…and his own constituents. And ultimately…that matters.  For years, people in his district felt he spent far more time catering to Washington D.C. interests than their own.  Even before this cycle, Cantor was no loved in the district, because…he made no effort TO be loved.

My faith in the Republican Party’s leadership is at an all-time low, and the voters of VA-7 seemed to agree with my assessment.  This is a party that spends an inordinate time worrying about what Democrats, the media, and others say about it…instead of listening it its own members, and actually moving the needle on conservative policies to move the country forward.

If the GOP leadership walks away from this event with only excuses why Cantor lost, it will further deepen the divide in the party, and furthermore, will do nothing to further the conservative cause.  The party doesn’t necessarily need to move right or center to win elections.  More than anything, it needs to listen to the American people, focus on the few issues people care about…and then fight.

I don’t see that happening, because we still require a leadership purge within the party.  There are many things our party must help the country transform on, whether it be the economy, taxes, immigration or health care.  But our current leadership cadre might be out of their depths on those issues. And fundamentally, Cantor’s loss was simply a symptom of that larger problem.



Why Do We Have A Veterans Administration?


Why do we have a Veterans Administration?

Fundamentally, this is the key question we should be grappling with, since it became public that dozens of Veterans died waiting to get health care in the Phoenix VA system.  And this is far from an isolated incident; this is an epidemic that exists in facilities all across the nation.  VAs have long been unresponsive, uncaring, and unwilling to our nation’s military veterans.

President Obama campaigned on this issue in 2007.  In his 2008 platform, he stated the following, among other things:

  • Allow All Veterans Back into the VA: Reverse the 2003 ban on enrolling modest-income veterans, which has denied care to a million veterans.

  • Strengthen VA Care: Make the VA a leader of national health care reform so that veterans get the best care possible. Improve care for polytrauma vision impairment, prosthetics, spinal cord injury, aging, and women’s health.

Has this been the case?

Of course not.  Although Obama and Democrats have focused on health care reform, they did little to change the fundamental broken system within the Veterans Administration. In fact, if anything, letting the problem largely fester has worsened issues, while blindly increasing funding, likely has led to more morbidity and mortality in some dysfunctional facilities.

The problem with all of Obama’s promises at this point is that none of it accepts a fundamental, basic fact: the VA has long been broken.  These problems existed long before Barack Obama rose to the Presidency.  It is a system whose internal dysfunction cannot simply be fixed by added funding or minor reforms.  And it is highly unlikely that the bureaucrats in this administration are going to fix a long-standing problem without massive changes that other bureaucrats in other administrations failed to accomplish.

I do believe the VA could be fixed.  It would take an extensive, persistent effort to change the management, culture, philosophy, and underlying tenets of warped system.

I fundamentally don’t believe this administration is willing take on that challenge.

Are they willing to accept that public sector unions have been a major source of the dysfunction? Are they willing to accept the payment model breeds inefficiency?  Do they understand that there is layer after layer of administrators in the system whose only job is self survival in the bureaucratic mire that is the VA?

That is why I ask a simple question:  Why do we have a Veterans Administration?  The original cause was to provide health care access to our military heroes, because there was no other easy access.  However, with the Affordable Care Act, we now have another method to provide that care, do we not?

So then, why do we maintain a duplicate system that, as can easily be demonstrated, not working?

Surely, there are some portions of the VA that will have to be maintained.  Special units that focus on battlefield injuries, as stated in Obama’s platform, which no private hospital would be able to deal with, must be maintained.  I am sure there are other examples.

But for the vast majority of our nation’s Veterans, access to the private sector would be far more responsive and sufficient for their needs.  The VA could simply provide them ample vouchers (on top of the subsidies already available through the ACA) to fund the maximum coverage on the Obamacare exchanges…and allow them to enjoy the fruits of our private sector health care system.

So why do we have a Veterans Administration? I bet this question has never been asked or answered in the West Wing or Oval Office. And that fundamentally is why this administration will never succeed in fixing this problem.


Memorial Day: Freedom is not Free




Time For Radical Changes At The VA


I feel sorry for former General Eric Shinseki.  By all accounts, he was an excellent military man, competent, stalwart, and honest.  And because of that, he was chosen to head the Veterans Administration.

The place where political careers go to die.

Shinseki came to the VA in Obama’s first term with a lot of pomp and circumstance; those days are long gone.  With a myriad of scandals plaguing VA hospitals and medical centers across the country, the Obama Administration is now in full crisis mode, and things are likely to get far worse.

Although Press Secretary Jay Carney tried to make the ridiculous argument that the President only found out about these problems from ‘media reports’, the reality is Senator Obama was quite aware of these problems.  In fact, one of his first attacks on then President Bush as ‘candidate Obama’ was regarding the VA.  Here is Mr. Obama in 2007:

“When a veteran is denied health care, we are all dishonored,” Obama said. “When 400,000 veterans are stuck on a waiting list for claims, we need a new sense of urgency in this country.” He also promised more resources and better management to fix the problems seen at the VA. “As president, I won’t stand for hundreds of thousands of veterans waiting for benefits. We’ll hire additional claims workers.”

Well, the utter failure is quite clear.  The waiting lists that Obama referred to 7 years ago have grown, not shrunken.

Funding does not appear to be a issue. Spending has increased all but one year since Obama spoke so eloquently.  Since FY2008, the VA budget has grown by 78 percent in six budget cycles, to $150.6 billion. On than 2012 when spending slightly decreased because of the sequester, the VA budget has averaged a 8% increase yearly.

However, the most recent revelations that started in Phoenix, and have now permeated through out the VA system, cannot be ignored.  In Phoenix alone, 40 deaths are attributed to the long, unresponsive waiting lists.  The number of deaths are sure to grow as we get more evidence and transparency.

I feel bad for Gen. Shinseki.  The VA was a bloated, destructive government bureaucracy long before he walked into the quagmire.  And initially, I was opposed to his firing over this.

That is no longer the case.  His failure, either because of lack of competence or simply because the Herculean task of fixing a fundamentally broken government health care system is an impossible task, is quite clear at this point.  He should step aside in any case.  His retirement would at the very least provide the media attention necessary to force the Administration to act decisively. And possibly, with the right type of reformer, we could see actual productive improvements to the VA.  Hope springs eternal.

It is time for real action at the Veterans Administration.  We have as a country waited too long; and our Veterans are still waiting.


Now Modi Must Deliver



Narendra Modi and the BJP appear to be headed for a landslide victory in national elections in India.  As polls have showed for months, the ruling Congress Party is headed for its largest defeat in history.

As of this monring, the BJP and its allies were leading with 326 of 543 seats, according to India’s Press Information Bureau, giving the party and its partners in the center-right National Democratic Alliance (NDA) a clear mandate in the next government.

And that mandate came with a massive turnout.  A record number of voters participated in world’s largest election, a mammoth five-week process that ended on May 12. Over 66% of eligible voters cast their ballots, compared with 58% in the last vote in 2009.

Modi faces numerous challenges from the start.  The first is the lagging economy.  India continues to grow, but at a pace far too slow to raise its hundreds of millions of poor into the middle class.  Inflation, along with stagnant foreign investment, are key issues the BJP must face in coming months.

Politically, Modi must move past his obvious issues with the large Muslim population.  Appointing Muslims to some key positions may cause some internal political strife, but would display a willingness to procede in a purely secular manner.

Because of the massive electoral success, Modi will not have to placate to numerous troublesome local apparatchiks as much as expected.  His power of strength hopefully will force the various factions to unite, or choose to leave the ruling coalition all together.

Whether Modi is successful may largely be decided by small, but important, political decisions in the coming weeks.  His relationship with Muslim, his relationship with the West, and whether the financial climate improves because of faith of business leaders in the political process will all depend on it.


Liberals Losing The Climate Change Argument


President Obama on Tuesday released a wide-ranging report on the effects of climate change on the nation.  In it, the administration claims that Americans are already feeling the impact of global warming, through changes in ranging rom hurricane damage worsened by rising seas, to allergies prolonged by extended pollen seasons, to corn and soybean yields depressed by hotter-than-average summers.

I find many of their claims dubious.  In fact, their claims actually directly contradict many of the findings in the newest United Nations IPCC report.

Nigel Lawson, in an excellent piece in the National Review, spells out the IPCC findings:

The latest (2013–14) IPCC Assessment Report does its best to ramp up the alarmism in a desperate, and almost certainly vain, attempt to scare the governments of the world into concluding a binding global decarbonization agreement at the crunch U.N. climate conference due to be held in Paris next year. Yet a careful reading of the report shows that the evidence to justify the alarm simply isn’t there.

On health, for example, it lamely concludes that “the world-wide burden of human ill-health from climate change is relatively small compared with effects of other stressors and is not well quantified” — adding that so far as tropical diseases (which preoccupied earlier IPCC reports) are concerned, “Concerns over large increases in vector-borne diseases such as dengue as a result of rising temperatures are unfounded and unsupported by the scientific literature.”…

The IPCC does its best to contest this by claiming that warming is bad for food production: In its own words, “negative impacts of climate change on crop yields have been more common than positive impacts.” But not only does it fail to acknowledge that the main negative impact on crop yields has been not climate change but climate-change policy, as farmland has been turned over to the production of biofuels rather than food crops. It also understates the net benefit for food production from the warming it expects to occur, in two distinct ways…

Moreover, as the latest IPCC report makes clear, careful studies have shown that, while extreme-weather events such as floods, droughts, and tropical storms have always occurred, overall there has been no increase in either their frequency or their severity. [Bolded added] That may, of course, be because there has so far been very little global warming indeed: The fear is the possible consequences of what is projected to lie ahead of us. And even in climate science, cause has to precede effect: It is impossible for future warming to affect events in the present.

Now, this gets to the heart of the matter as I see it.  The White House’s shrill report does not appear to be based on solid science.  Even the IPCC, which clearly believes in the global warming thesis, doesn’t support the wide-ranging claims of the administration.  Numerous well-regarded reports have not demonstrated the type of causation that President Obama claimed yesterday.  But the goal of the administration was not to promote further understanding of the science behind their argument; no, their goal was to scare people into agreeing with them, regardless of the science.

Let us even put aside the science for a moment.  The politics of global warming are a perfect example how to politicize a movement that could potentially gain traction, and force it into submission. The Left has for the better part of three decades (at least) made this a war of ‘us vs. them’.  There is no compromise or middle ground for the extremist progressives on climate change.  They require full capitulation, or claim the end of the world is upon us.  And as such, what you develop is a religious type of fanaticism that cannot be reasoned with.

In turn, such extremism begets extremism.  The political Right now opposes virtually any solution that begins with the words ‘climate change’.  For good reason or not, when your opponents compare you to Holocaust deniers, it is highly unlikely you are going to agree with them on anything.

Even worse, the entire concept of ‘settled science’ bandied about by Obama and other Democrats is demeaning to…well, to ‘Science’ itself.  Science by definition is NEVER SETTLED. It is a continuing search for truth; real truth.  Even if anthropogenic global warming is a scientific truth, its effects on our world still is not a settled science. To claim so shows a lack of understanding of what science truly is.

Any science whose modeling is so incorrect on a regular basis should not be so arrogant as to claim they have ‘settled’ the debate.  Whether it is global cooling from the 1970s, Ted Danson saying we have 10 years to live…20 years ago, or Al Gore in 2008 claiming the polar ice cap would melt by 2013, claims from the left repeatedly fall short, and make their position look ludicrous.


Sean Davis of The Federalist points out the reason for this shrill debate:

As the old legal adage goes: When you have the facts, argue the facts; when you have the law, argue the law; when you have neither, just accuse your adversary of hating science and hope that nobody will listen to what they have to say about your consistently wrong forecasting models. And if that doesn’t work, blatantly manipulate and torture the English language and hope that nobody will notice.

The real problem with all of this? There is certainly a chance that the Left is right.  I am a skeptic, but I by no means reject the possibility that man-made global climate change could prove to be catastrophic.  There is plenty of data that, if causation proves to be accurate, show that we are unalterably changing the planet. I personally think that the chance of the catastrophic changes most progressives believe is quite small, but I fully accept that the probability is greater than zero.

Frankly, I honestly believe even LIBERALS think that chance is small.  In a world where liberals claim that we are facing Armageddon, but the most powerful liberal voices continue to live in enormous mansions and burn carbon at an astronomical rate while driving fancy cars or flying all over the planet, it is somewhat difficult to take their claims seriously.  They would have far more credibility if they gave up their luxuries, lived in a small home with renewable energy, and made wholesale sacrifices.  You don’t see many liberals doing that; which makes me believe that their own true beliefs on the facts of ‘warming’ are far less  determined than they first appear.

I do think that conservatives opposition to many of the environmental policies is wrong as well.  Absolute opposition to any policy debate is almost always incorrect. Instead, conservatives should propose their own solutions to maintain the environment, based on conservative values.  That would further the debate far more than vehement opposition.

Conservatives have potential solutions that can make a difference. I have, for more than two decades now, been an advocate for promoting a 0% tax on green technologies, similar to the 0% sales tax on internet sales that promoted the web boom.  Guarantee 0% federal taxes (instead of inefficient subsidies) on solar, wind, etc., including on capital gains investments into such ventures.  Nothing would promote capital flow and innovation into those fields, and then let the market do its job.  I think most conservatives could support a ‘Green’ policy such as this.

There are other conservative answers that could make things better. Expansion of nuclear power, with ‘smarter’ regulations that could reduce the cost of production; a push for cleaner coal, because coal will continue to be a major producer of electricity in this country and around the world for decades to come; tax incentives to power companies to produce less CO2, instead of regulatory penalties for producing too much; and a slow, steady march of improving efficiency through out the country.  This doesn’t even discuss the more controversial topics, such as how frakking and our natural gas boom has decreased America’s carbon footprint over the past decade.

Compromise positions on any of these could make progress; maybe slow progress, as far as the Left is concerned, but progress nonetheless.

If liberals really want to make progress on climate change, they will have to agree with a few ground rules. One, no wholesale rapid change to the economy will occur, because…that is not how this country works.  Sorry, the ‘Tom Friedmans’ of the world, you are not going to get your huge carbon tax.  Two, your conservative opponents may not agree with you, but they are not the enemy; either we work together, or don’t work at all. Three, there are significant, practical small changes we can make that will make a difference, that conservatives would agree too, if they were not so vilified. And four, don’t make the science out to be more than it truly is, because it does more to demean your position than strengthens it.

I am sure liberals have far more complaints about the conservative position; fair enough. I stipulate to the fact that I am attacking liberals here more than my own conservative brethren. I leave it to my liberal colleagues to do that yeoman’s work.

But liberals continuing these scare tactics and extremist positions that require full adherence to their belief system is clearly a loser in the eyes of the American public.  They will accept progress, but they will not accept extremism.  I believe it is fair to say that liberal unscientific positions and extremist rhetoric is hurting, not furthering, the cause of advancing greater environmental action and awareness.  We all should do better.  We really can do better.


Health Care Saves Lives, But What’s Next? The Oregon vs Massachusetts Conundrum


A new study in the Annals of Internal Medicine will help reopen the discussion about what extent health insurance decreases mortality and morbidity.  What the underlying meaning and importance of these results will long be debated.

Well respected researchers Benjamin Sommers, Sharon Long, and Katherine Baicker evaluated the mortality rates in Massachusetts in the period after the passage of Romneycare, and compared the health results to similar surrounding Northeastern states.

They estimate that overall mortality in Massachusetts declined 2.9 percent relative to control counties between 2007 and 2010.  Additionally, death from causes that are ‘amenable’ to health care (such as cancer, heart disease, etc, which potentially can be treated by the health care system) declined 4.5 percent.

This ultimately translated to the saving of 1 life out of every 830 people in the population. As expected, the populations that had the greatest increase in health insurance access showed the greatest improvement. 

There has been past debate about whether expansion of health care coverage saves lives. There were mixed results from various studies over the past few decades regarding this subject, but overall, I have never doubted that adequate access to health care should improve health care outcomes.

Jonathan Cohn does point out the obvious quandary: what about the Oregon Medicaid study? If you recall, the Oregon study was a randomized study that showed that those that received Medicaid did not show better health outcomes than those that received no insurance coverage at all. How could this possibly correlate with the findings of this new Massachusetts study?

There are several possibilities that arise.  The first is that the improvements in mortality in Massachusetts did not come from the Medicaid population at all, but from those that purchases private insurance.  The Massachusetts study does not discriminate between the two populations, so we simply don’t know where the mortality benefits came from, or if they were truly equal across the board, regardless of the type of insurance obtained.

A second possibility (one that researchers Aaron Carroll and Austin Frakt have argued) is that the Oregon study sample size was too small to draw any firm conclusions about demonstrable health effects, and that if the study was large enough, we would have seen these same demonstrable positive effects.

The problem with both of these guesses is that they are central (albeit minor) deficiencies in these two excellent studies, as the authors of both studies themselves readily admit.

My guess (and right now it is only a guess because we have limited evidence at hand) is that health insurance of all types likely decreases morbidity and mortality…even Medicaid.  However, I also would guess that the efficiency of those types of insurance in providing adequate care varies greatly; that would correlate with the findings of the Oregon Medicaid study as well.

However, as we go forward, I think there will be a larger issue that we will have to face, one that Austin Frakt mentioned and I seconded on Twitter:  what is the cost/benefit ratio of these expenditures?

One thing that the Massachusetts study fails to tell us is if there is a demonstrable difference between Medicaid and other private insurance, as the Oregon study seems to imply. We simply don’t know the answer to that, because the evidence is lacking, other than the Oregon study itself.  Why is this important?  Currently our data on the ACA expansion of insurance coverage shows that the largest decrease of the number of uninsured likely came from placing people on the rolls of Medicaid; if this is the case, will we see a similar effect as that in Massachusetts, where a higher percentage of people received private insurance?

Secondly, there is a horrible, utilitarian, actuarial question in all this:  How much does the Massachusetts study suggest is the cost of saving a single life?  As stated above, the improvement would theoretically save 1 life out of every 830 people in the population.  If the average cost of health insurance for every person is approximately $4,000, then the cost of saving that single life, per year, is $3,320,000.  Is that worth it? Don’t ask me; that is a question for people in a much higher pay grade than mine.

Let me provide another actuarial puzzle to think about.   There have a myriad of articles regarding the utility and cost efficiency of mammography, with many of the opinions today saying mammography is not worth the cost, both in dollars and in unnecessary procedures and testing.  However, the cost of saving a single life through mammography is approximately similar or even less than the cost of saving a single life through the Massachusetts insurance expansion, if you take this study at face value.  Those calculations can vary depending on which mammography study you utilize, I fully admit. However, the controversy over the actual numbers and specifics really is not the point here; the point is, the cost of saving a single life is expensive, both using mammography, as well as in the wider health care arena.

Again, putting a dollar value on ‘a life saved’ is something I don’t want to be personally responsible for…but if we are going to have the debate, someone will have to take a stand on the question.

On a political note, I don’t think this really moves the needle in either direction.  Conservative health policy experts such as Avik Roy, Philip Klein, Scott Gottlieb and others all agree that we have to find ways to expand universal access to health care for all; fundamentally, in the many discussions we have had, what is clear is that we all believe access to HEALTH CARE decreases morbidity and mortality.  The method of obtaining that access remains in dispute.

So the problem here is not that health care makes people healthier.  Dear God, as physician myself, I hope that is the case…or I should go and find another profession. 

What all of these experts, myself included, are arguing is fundamentally a different question:  what is the most cost efficient and patient-centric method of providing that access?  The central question is how to use our limited dollars in the most efficient way to provide the maximal effect of those dollars.

Is expanding Medicaid the most efficient use of those dollars?  Are we better off moving those patients into the private market?  Are we better off moving to single payer?  Would a more patient-centric approach provide better or worse outcomes? All of these questions largely remain unanswered.

I do think that this Massachusetts study, along with the data from the Oregon study, significantly expands our understanding of how health insurance, as it currently exists in the U.S., affects mortality and other factors.  Neither study is perfect, and each has its limitations.  However, both are well done, and have been conducted brilliantly by well respected researchers; the data is sound.  The question really becomes what is the significance of that data, how does it effect the reality of health insurance as it exists today, and furthermore, how do we maximize those effects for the least amount of cost?


Piketty And Retread Of Marxism


I am no economist, nor would even claim to be an expert on economic theory.  I read a lot, and as such, did pick up Thomas Piketty’s “Capital in the 21st Century.” It is, after all, what ‘elites’ are talking about, and I like to be ‘in the know’.  I am also a glutton for punishment; at almost 700 pages, and stuffed full of loads of economic data, it is not necessarily a leisurely read.

First of all, I think Piketty’s book is quite good.  My conservative brethren may be surprised by that.  However, if for nothing else, the book is worth reading for its extensive yet very approachable history of wealth inequality over the centuries.

For those that are unable or unwilling to read Piketty’s tome, I think this quote, which has been travelling the internet, summarizes his beliefs accurately:

When the rate of return on capital exceeds the rate of growth of output and income, as it did in the nineteenth century and seems quite likely to do again in the twenty-first, capitalism automatically generates arbitrary and unsustainable inequalities that radically undermine the meritocratic values on which democratic societies are based.

This ‘r>g’ equation is at the heart of Piketty’s thesis of the future of the world economy.  I won’t go into depth on it here, but suffice it to say…it is overly simplistic and largely ignores major factors that effect the world economy.

Of course, Paul Krugman is leading the charge of the greatness of Piketty. That is no surprise; not because Krugman is an economic genius, but precisely because he is a political hyperpartisan. Krugman argues that there is no substantial retort to Piketty’s predicions in his most recent New York Times piece; of course as is generally the case, Krugman is wrong.

Tyler CowenJames Pethokoukis, and a myriad of others have had thoughtful and productive responses to Piketty.  Krugman largely dismisses them without actually, you know, providing a logic case against them.

Cowen extensively talks about the historical similarities of Piketty’s work to others, such as British economist David Ricardo. Note Krugman never counters Cowen’s concerns, such as this one:

Of course, since Ricardo’s time, the relative economic importance of land has plummeted, and his fear now seems misplaced. During the twentieth century, other economists, such as Friedrich Hayek and the other thinkers who belonged to the so-called Austrian School, understood that it is almost impossible to predict which factors of production will provide the most robust returns, since future economic outcomes will depend on the dynamic and essentially unforeseeable opportunities created by future entrepreneurs. In this sense, Piketty is like a modern-day Ricardo, betting too much on the significance of one asset in the long run: namely, the kind of sophisticated equity capital that the wealthy happen to hold today.

For Krugman, these issues are ancillary to his central political faith, and thus, not worthy of retort.  The ultimate issue with Piketty’s and Krugman’s thesis is this unanswerable question: is there an example a state with increasing wealth asymmetrically favoring the top 1% is more unstable or inherently non-viable as a free nation than one where the state imposes its moral will by using political force to reallocate that wealth in such a way to fit its world vision?

I do not think Krugman nor Piketty can actually answer that question.  As is common with liberals, history and evidence is less relevant than intent; and their intent, like a religious crusade, cannot be countered with logic. Ultimately, their answer to this simple question is, “Does not matter; we will do it right this time.”

Sounds somewhat like faith in a spiritual power; that seems less than satisfying in our quest for knowledge.

Piketty’s central policy belief revolves around taxing people making over $500,000-$1 million at a 80% tax rate.  Now, what was the logical reason for this?  It is not to use that money to benefit the poor; in fact, Piketty acknowledges that because the rich will adapt to such a tax  increase, that in the end such a policy will not raise much revenue.  No, the reason is a moral, faith based one: he simply thinks it is immoral for people to be making so much money. No, he doesn’t state that in such clarity as I do here, but the meaning is still apparent to all who have read the book.

As Megan McCardle points out, none of these taxes on the rich ultimately change the reality that middle and lower classes around the world face. Their daily lives and struggles are about getting to a job that pays them enough to sustain and grow their family wealth. Taxing the rich, as history has shown, actually proves to be a detriment to these goals, because the rich will adapt to any such punitive tax structure by decreasing their productive value; and in turn, that means that they produce less innovation and technology, which is essential for the growth of the job sector that the middle class requires to thrive.

The core problem that Piketty’s thesis has is the same problem that Krugman and the central core of progressive thinkers on economic thought have today:  they believe that government would be better at determining the ‘value’ of an individual than the marketplace.

As for the ‘Marxist’ label.  Piketty never fully adopts Karl Marx’s vision.  But he does, for the most part, lean far closer to Marx than Milton Friedman.  Take this quote from the book:

“Do the dynamics of private capital accumulation inevitably lead to the concentration of wealth in ever fewer hands, as Karl Marx believed in the nineteenth century? Or do the balancing forces of growth, competition, and technological progress lead in later stages of development to reduced inequality and greater harmony among the classes, as Simon Kuznets thought in the twentieth century?”

Is there any question which economist is closer to Piketty’s thinking here? I think not.  Progressives for obvious reasons do not like the comparison to Marx, but the comparison is nonetheless inescapable.

Piketty’s work is still well worth a read for any economist or layman who has delved into the fundamental philosophy of economics.  This book expanded my base of knowledge and made me rethink many of my views of inequality and wealth, and for that I have to thank Piketty greatly; so few authors really provide a new way of viewing the reality of the world.

But ultimately, Piketty’s work is much like Thomas More’s Utopia; a thoughtful excercise, that philosophers can discuss in length, but ultimately does little to help anyone in the real world.  Cowen summarizes the problems here:

The simple fact is that large wealth taxes do not mesh well with the norms and practices required by a successful and prosperous capitalist democracy. It is hard to find well-functioning societies based on anything other than strong legal, political, and institutional respect and support for their most successful citizens. Therein lies the most fundamental problem with Piketty’s policy proposals: the best parts of his book argue that, left unchecked, capital and capitalists inevitably accrue too much power — and yet Piketty seems to believe that governments and politicians are somehow exempt from the same dynamic.

A more sensible and practicable policy agenda for reducing inequality would include calls for establishing more sovereign wealth funds, which Piketty discusses but does not embrace; for limiting the tax deductions that noncharitable nonprofits can claim; for deregulating urban development and loosening zoning laws, which would encourage more housing construction and make it easier and cheaper to live in cities such as San Francisco and, yes, Paris; for offering more opportunity grants for young people; and for improving education. Creating more value in an economy would do more than wealth redistribution to combat the harmful effects of inequality.

So although this is a thoughtful and valuable intellectual excercise, Piketty’s vision of the future, and his solutions to the problems that he sees ailing the world, seem to be nothing more than a retread of Marx, with a few slightly modernistic twists.  And as such, the book is interesting as coffee table conversation, and will be the center of much discussion among the elite for good reason, but of minimal use for true economic and political policy in the world we live in today.

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