Category Archives: Politics

Recent Marketplace Premium Increases are No Big Deal

By Randall P. Ellis, Boston University, Department of Economics October 28, 2016

A great deal has been made recently about the large increases in certain Health Insurance Marketplace premiums  announced for 2017. I present here five arguments for why these increases are no big deal, and are not the right thing to focus on when evaluating the success of the 2010 Affordable Care Act (ACA).

Argument 1: The Marketplace exchanges in which premiums are increasing are very small part of the US Health Care Market. 97% of Americans are not in them. And 80% of the enrollees who are in the Marketplace get government subsidies for their premiums. (Thomas G. McGuire, unpublished figure).

TM US Market Composition 2014

Argument #2: When the ACA Marketplace was started in 2014, its premiums were unexpectedly low, not high, in most markets. Everyone commented on this. The same thing happened when Medicare Part D was introduced. Many economists believe this was because health plans were trying to capture market share by offering low premiums. Such low premiums were not sustainable. Two years into the Marketplace, plans are trying to catch up with the much higher employer sponsored premiums. This should not be treated as a failure of Obamacare.

Argument #3: Many health insurance markets in the US are already highly concentrated. For example Blue Cross Blue Shield of Alabama has a 90 percent market share. (kff.org, 2014)  We cannot expect competitive premium pricing with such market power. As I discuss in Ellis (2012): Leemore Dafny, Mark Duggan, and Subramaniam Ramanarayanan in the American Economic Review 2012, using data from the American Medical Association (AMA), show that 94% of 314 US market areas have “highly concentrated” insurance markets. This concentration cannot be blamed on the ACA, since it predated it.

Argument #4: The main goal and achievement of the ACA has been that it has reduced the number of uninsured. The data clearly show this, and the largest percentage increase has been in private insurance, not government insurance programs.

Recent Health Insurance coverage

Argument 5: The unexpected wonderful cost impact of the ACA has been favorable: lowering the average rate of increase in health care spending throughout the country. (Barack Obama, JAMA, 2016)

obamatrend2

This has been particularly true for the Medicare program. US government statistics (CBO and OMB) show enormous savings in Medicare since 2010.

2016_EllisMcGuire_UpdateonUS_RA_20161005_Page_09

While the ACA has not eliminated uninsurance or solved the US cost containment problem, it has made important improvements in both directions. Recent large premium increases in the Health Insurance Marketplace, which happen all the time in the employer sector without much attention, are part of a bigger problem still in need of solutions.

Why Trump is going to win the US presidency

Everyone can see that Trump is surging in the polls, but few understand why. Like most professionals, I am appalled at this possibility. Why do I now think it is almost inevitable that Trump wins?

Democrats have not figured out how to affect how Trump appeals to his supporters. As I blogged on June 3, 2016, and as Scott Adams (creator of Dilbert) so brilliantly foresaw a year ago, Trump is appealing to voters on an emotional level. Facts don’t matter if you relate to people’s fears and hopes, and that is what Trump is a master at: Fear and Persuasion.

We can call Trump a liar all we want, but Trump has already established his defense: berating crooked Hillary and the lying media. Throughout the country, campaigns are going on over which candidate is the bigger liar (I see the ads for the New Hampshire senate race). But the degree of honesty seems not to matter once you are both (called) liars.

Last April I purchased a red “Make America Great Again” hat as a prop for a faculty skit. This put me on the list of Trump supporters and gives me a glimpse into his campaign to his supporters.

I was initially surprised that it took two months for the Trump organization to use that contact information to make their first request for my money and support (in June). Now I know it was part of his clever strategy of not burning out his audience. I am getting emails every other day from Trump. I pasted in one of the recent messages below.  It looks pretty simple and convincing to me. Focused on broad fears and not facts or specifics.

I just revisited Scott Adams’ blog site, which I highly recommend to you. Here is the key text from his August 10 blog, when Hillary’s polls were at their peak. I pasted in below the eight possibilities he listed there.

“If nothing changes, Clinton will win in November. But things rarely stay the same. Here are several ways Trump could still win from behind.

  1. Voters discover that Clinton has been hiding a major health issue.
  2. Wikileaks releases something damaging.
  3. Trump over-performs at the first debate, showing the world that he is willing and able to master the issues.
  4. Trump makes the case that the Clinton Foundation is really about selling influence to foreign concerns.
  5. Trump gives a speech or interview that is so effective in its empathy that he no longer appears to be crazy and racist.
  6. A new surprise revelation about Clinton that no one sees coming.
  7. Terror attacks push everything else out of the headlines in the final months.
  8. Someone assassinates Clinton because of Trump’s 2nd Amendment joke.

Scott Adams Trump Prediction Update, August 10 blog

I see many of these themes already panning out. He himself calls them spooky in his Sept 18th blog, and I agree.

I also benefitted from reading Scott Adams’ assessment of the risk of Trump in his blog from this weekend.

http://blog.dilbert.com/post/150603095761/assessing-the-risk-of-trump

Adams makes some interesting points about Trump, less scary than most others, since Adams views trump as a smart, and highly successful businessman, which he is.

Is Trump’s success inevitable? (Recall that my opening paragraph said it was almost inevitable.) Maybe not.

The debates could go better for Hillary than expected.

It seems too  late, but conceivably efforts to register and get out the vote of students and minorities could mean the polls are wrong. (I am appalled by how little effort is going on at BU to get students to register. Apathy is winning out.)

Money won’t really matter. Hillary is outspending Trump in ads by 10-1, but still losing ground.

Factual errors and scandals about Trump’s past seem not to matter.

More endorsements for Hillary seem not to matter. Trump can still gather a large group of generals and veterans at will, and his rallies are bigger, and recently better behaved.

Adams thinks that to offset the persuasion skills of Trump the best hope is effective fear mongering by the democrats (e.g. nuclear war or a new middle east war). Maybe Hillary’s handlers can pull it off. But I am not so sure.

The parallel I use for this election is that Trump is an incredible used-car salesman, and the quality of the car does not matter if you are a good enough persuader. Hillary will lose the race since she is a terrible used car salesman. Until recently she has felt constrained to tell the truth about each car, and spends her time defending her honor and honesty. Who do you think can sell more cars?

Read a Trump direct email below for more insight.

 

Randall P. Ellis, Ph.D.
Professor, Department of Economics, Boston University
ellisrp@bu.edu     Off: +1-617-353-2741       http://blogs.bu.edu/ellisrp/
BU Ph.D. job candidates: http://www.bu.edu/econ/gradprgms/phd/phdcandidates/

 

From: Donald J. Trump [mailto:contact@email.donaldtrump.com]
Sent: Sunday, September 18, 2016 10:35 AM
To: Ellis, Randall P
Subject: listen

 

Donald Trump is listening to the voices of millions of Americans who want a new direction in Washington. Add your voice and guide his campaign to victory over the Obama-Clinton liberals. |

Friend-

The politicians and liberal elites have not been listening to you.

But I hear you loud and clear. That’s why I am the people’s candidate for president with a rising movement of pro-America voters ready to take back our country.

As one of my best and most loyal supporters, you can do a lot to help finish this race strong and send Crooked Hillary down to defeat.

Please take a minute right now to complete our Listening to America Survey so I can hear your voice at this important moment in the race.

You have my word I will take action on YOUR concerns and speak up for YOUR interests.

That’s what I’ve been doing this whole time.

When I said we should not be letting tens of thousands of Syrian refugees into our country if we don't know who they are, the liberal elites screamed out against me, but they were not listening to you.

When I said we should build a real border wall because if you don’t have a border, you don’t have a country, they raged against me on TV, but they were not listening to you.

When I said China is ripping us off with all these stupid trade deals, the liberal elites screamed about their globalist economic theories, but they were not listening to you.

Well I have been listening to you, Friend. I have been taking you seriously. And I will not let you down.

So our campaign – our pro-America movement – is taking a new approach that hasn’t been tried before by the D.C. insiders. I am campaigning on a message that seeks to represent the American people only, NOT lobbyists, NOT the media, and NOT corporate elites. The reason I have surged in the polls from 'day one' of this race is because I have been listening to you – the great silent majority of Americans - and keeping you and other supporters engaged every step along the way.

With just two months to go before Election Day, I need you to stay engaged more than ever, so please complete our Listening to America Survey.

In addition to your valuable answers, I also hope I can count on you to make a special donation in support of our campaign at this critical time.

Crooked Hillary has tons of money from the liberal elites who have rigged everything against you. The media are in her corner too, and frankly I don’t think I’ve seen the media in this country behave in such a disgusting way as they have against me. So many lies!

So help me cut through the media nonsense and take our message right to the people. Complete our Listening to America Survey

Thank you,

Donald Trump

COMPLETE DONALD TRUMP'S LISTENING TO AMERICA SURVEY

 

Contributions to the Trump Make America Great Again Committee are not deductible for federal income tax purposes.
Paid for by Trump Make America Great Again Committee, a joint fundraising committee authorized by and composed of Donald J. Trump for President, Inc. and the Republican National Committee.

 

The US Should Ban or Heavily Tax Weapons Designed for Mass Shootings

Boston University Working Paper

Randall P. Ellis
Boston University,
Department of Economics
August 22, 2016
Abstract

This paper presents four arguments for why the US should ban or at least heavily tax the sale or transfer to civilians of weapons designed for mass shootings (WDMS), which would include most semi-automatic guns and weapons with large capacity magazines.

  1. The Supreme Court has repeatedly validated that second amendment protections of the right to bear arms do not apply to particularly dangerous weapons where protection of public safety overrides constitutional protections; this exclusion should apply to WDMS just as it does to machine guns and short-barreled shotguns.
  1. To make gun owners pay for the annual cost of deaths in the US due to guns, we should be taxing each gun owned at $1000 per year, or tax all gun sales (new or used) at $15,000 per gun sold. Given their higher killing power we should tax WDMS at $60,000 per gun sold. Or just ban them.
  1. In the last 36 months, there have been 5,399 people in the US killed or injured at mass shootings (where four or more people are shot, although not necessarily killed). Unless action is taken, the most recent trends suggest that there will be twice as many mass shootings in the US in five years.
  1. Current federal law for duck hunting bans the use of shotguns that hold more than three shells. If we care enough to ban four-bullet capacity guns to preserve ducks, then we should be willing to ban even higher capacity guns designed to kill people.

The full paper is linked here.

http://blogs.bu.edu/ellisrp/files/2016/08/Banning-or-heavily-taxing-WDMS-20160822.pdf

Obama’s JAMA article is a must read for all professionals

There is a very important  article in this week’s JAMA - Internal Medicine, written by Barach Obama.

It highlights the effects of the ACA/Obamacare.  It is free on-line.

United States Health Care Reform: Progress to Date and Next Steps

http://jama.jamanetwork.com/article.aspx?articleid=2533698

If you are short on time, then the following link to just the figures provides many of the key results.

http://jama.jamanetwork.com/article.aspx?articleid=2533698

To me the highlights of the article are that it documents:

The decline in the uninsured (no surprise, but well presented) now down to 9.1 percent from over 16
Declines in teen smoking from 19.5% to 10.8% due to the Tobacco Control Act of 2009 (Wow)
Much slower rates of decline in the uninsured in states that refused the Medicaid expansion (no surprise)
The decline in the underinsured among privately insured as measured by the near disappeance of unlimited exposure (new to me)
Lower rates of individual debt sent to a collection agency (great to see)
Negative rates of real cost growth in Medicare and Medicaid since 2010, with drastically lower growth in privately Insured
Constant share of out of pocket spending as a fraction of total spending among the employer based insurance
(new to me, he cites increases in deductibles offset by decreases in copays and coinsurance.)
Forecast Medicare spending in 2019 is now 20% LOWER than when he took office.
Decline in Medicare 30 day, all hospital readmission rates as well as improvements in other measures.
This information is important to understand to counter the repeated false claims that Obamacare is a failure, or has increased health care spending, or is bankrupting the government, all of which are shown to be false in the evidence presented here.

Here is the link again.

http://jama.jamanetwork.com/article.aspx?articleid=2533698

Press Interviews and Quotes

Partly just to keep track of them for my BU annual report, this post links to my press interviews and quotes.

Meeting basic needs under Trump

Fed funds key for landlords, affordable tenants; Trump’s health secretary opposes Obamacare

Bay State Banner Jule Pattison-Gordon | 12/7/2016, 1:13 p.m.

Effects of Brexit on the world economy and Iran.

Tasnim News Agency Interview, Iran (translated into Persian), June 28, 2016.

Farm Animal Ballot Initiative.

posted on Youtube. By  Brittany Comak, BU School of Communication. November 29, 2015

Inspector General criticizes Red Sox, BRA deal

Massachusetts Inspector General Glenn Cunha criticized a 2013 deal by Boston Redevelopment Authority that granted the Boston […]

by · October 29, 2015 · 0 comments · City, News
According to a New England Economic Partnership report released Thursday, Massachusetts is creating jobs at the fastest pace in 15 years. GRAPHIC BY KATELYN PILLEY/DAILY FREE PRESS STAFF

Mass. experiencing economic boom, study finds

In the past year, Massachusetts has seen an economic boom unlike any since the 1990s, a […]

by · October 20, 2015 · 0 comments · City, News
Massachusetts Gov. Charlie Baker signed a bill Friday authorizing $200 million in transportation funds. PHOTO BY STUX/PIXABAY

$200 million in extra funding approved for infrastructure repairs

Massachusetts Gov. Charlie Baker approved an additional $200 million in funding for infrastructure contributing to a […]

by · April 14, 2015 · 0 comments · City, News
Massachusetts lawmakers announced their support Friday for a bill that would allow the legalization and taxation of marijuana. PHOTO BY SARAH SILBIGER/DAILY FREE PRESS STAFF

Mass. lawmakers support bill that would legalize and tax marijuana

Fifteen Massachusetts lawmakers are supporting a bill, pushed by the Marijuana Policy Project, that would regulate […]

by · March 18, 2015

MBTA late-night service threatened by lack of sponsorship Daily Free Press. by Paige Smith · January 27, 2015

Part time BU employees now eligible for health, dental benefits Daily Free Press. by Rachel Legon · October 30, 2014

Student loan report shows complaints, problems with private lenders Daily Free Press by Meiling Bedard · October 21, 2014

Greater Boston GDP declining, report finds Daily Free Press. by Mina Corpuz  September 18, 2014

Small businesses get extension for ACA in Massachusetts by Daily Free Press Admin · April 27, 2014

STUDY: Grad student loan debt on the rise. by Daily Free Press Admin · March 26, 2014 

College worthwhile investment, study suggests by Daily Free Press Admin · February 26, 2014

Bitcoin ATM installed in South Station by Daily Free Press Admin · February 23, 2014

Cost of student loan programs difficult for federal government to determine, study suggests  by Daily Free Press Admin · February 4, 2014

Universities see an increase in endowments, study suggests by Daily Free Press Admin · January 29, 2014

"South Shore Hospital, Partners HealthCare defend merger plan" The Patriot Ledger. by Christian Schiavone.  1/17/2014

"The Healing Begins for Healthcare.gov"  TechNewsWorld By Erika Morphy 12/04/13 4:12 PM PT

"Financial squeeze awaits W.Pa. hospitals", TribLive. By Alex Nixon. Thursday, Oct. 24, 2013.

"Wenermaar aan, Obamacare blijft", Trouw Buitenlandredactie. (Article on ObamaCare in Dutch Newspaper) In Dutch. October 4. 2013

Menino plans to build about 30,000 housing units by 2020. Daily Free Press, Boston University, Sep 11, 2013

"Boston welcomes startups, entrepreneurship, despite study results" Daily Free Press, Boston University, Sep 11, 2013

Mass. residents driving less since 2004, study suggests. Daily Free Press, Boston University, Sept 4, 2013.

Medical Costs Register First Decline Since 1970s. Wall Street Journal Blog.  June 18, 2013,

Employers fear economic climate, fail to make hires, new study suggests. Daily Free Press, Boston University, April 24, 2013.

Outside spending in Senate race tops $1.25 million. Daily Free Press, Boston University, April 9, 2013.

New delayed-start loan repayment plan may help grads.Daily Free Press, Boston University, April 3, 2013.

Years after recession, Mass. job numbers finally bounce back. Daily Free Press, Boston University, April 2, 2013.

Popeye’s President Unconcerned About Obamacare, Says Health Insurance ‘Just Not Affordable’ Huffington Post. March 28th, 2013

Tax-based aid needs reform, report suggests. The Daily Free Press. Boston University. Feb 27, 2013.

Minimum wage-earners face hardship paying rent. The Daily Free Press, Boston University, Feb 5, 2013

Gas prices in Mass. shoot up 14 cents a gallon. The Daily Free Press, Boston University. Feb 5, 2013

Freshmen see college as necessary to riches, study suggests. The Daily Free Press, Boston University. Jan 30, 2013.

College debt high despite lower credit card, general debt. The Daily Free Press, Boston University. Dec 3, 2012

Government officials demand sales tax for items bought online. The Daily Free Press, Boston University. Nov 27, 2012

Interview with ASHEcon President Randy Ellis. American Society of Health Economists (ASHEcon) Newsletter Vol. 4 Fall 2010.

 

 

Insurers are doing well under ObamaCare

Much was made recently about how UnitedHealth decided to drop out of the ACA Federal Exchange in several states. It is important to realize that far from being a failure to large insurers (UnitedHealth is the largest insurer in the US), health insurance remains extremely profitably under ObamaCare. Below is a bar chart of the percentage change in stock prices of the five largest publicly traded health insurers in the US from March 23, 2010 when the ACA was signed to today (6/6/2016).

Top Five Health Insurer Stock Prices under ObamaCare

 

Hillary Clinton’s Memorial Day speech 2016 will be a classic.

My previous post was discouraging in that it was all about the techniques Donald Trump is using to build support. This one is much more upbeat.

I had heard about but not actually watched or listened to Hillary Clinton's Memorial day speech, which has been getting a lot of favorable reviews. I just finished listening to it while checking email and it was indeed very inspiring, hopeful, and the best speech year from Hillary. I recommend it very highly, even if it is 34 minutes long. Here is one link from the Daily Kos on which you can watch or listen to the entire speech.

http://www.dailykos.com/story/2016/6/2/1533764/-The-PRESS-responds-to-Hillary-s-EPIC-speech-today-and-it-is-awesome

I also like that they post links to how it was received from various sites. Choose your favorite one to get a perspective.

If enough voters could watch this clip, it would change the entire discussion.

 

Sobering Scott Adams interview about Trump on Real Time

This email will interest people who are closely following the US presidential election.

I invite you to watch the following four minute video on Trump and Hillary when you have time. It changed my thinking.

On the Friday June 2  Real Time with Bill Mayer, Scott Adams (who is the genius creator of the Dilbert comic strip) gave a very sober assessment of why Trump has been so successful. Adams is a trained hypnotist and has written several books on the art of persuasion.  Adams has a blog and LAST SUMMER he predicted Trump would win by a landslide. This, plus his careful comments were very real to me. According to Adams, Trump is not a fool, but rather he is a high IQ master persuader.

The Real Time clip was taken down on YouTube, where they want you to subscribe to Real Time, but it is still linked here.

http://lastnighton.com/2016/05/31/dilbert-creator-tells-bill-maher-why-trump-will-win-election/

Here is a link to his the Scott Adams blog.

http://blog.dilbert.com/tagged/RealTime

Here is  a link to his October 2015 blog where he predicted Trump will win in a landslide.

http://blog.dilbert.com/post/131749156346/the-case-for-a-trump-landslide-part-1

Here are the first three sentences from this blog from last October

“The latest poll out of Iowa shows Carson ahead of Trump. And you know what that means?

It means Iowa is about to become irrelevant. Here I am assuming evangelicals will band together to give Carson the win in Iowa before Trump goes on to run the table everywhere else.”

I also liked this review from the Washington Post in March 2016. It summarizes the six principles Trump is using to win.

https://www.washingtonpost.com/news/comic-riffs/wp/2016/03/21/donald-trump-will-win-in-a-landslide-the-mind-behind-dilbert-explains-why/

Here are his principles in list form.

  1. Trump knows people are basically irrational.
  2. Knowing that people are irrational, Trump aims to appeal on an emotional level.
  3. By running on emotion, facts don’t matter.
  4. If facts don’t matter, you can’t really be “wrong.”
  5. With fewer facts in play, it’s easier to bend reality.
  6. To bend reality, Trump is a master of identity politics — and identity is the strongest persuader.

Here are the final lines from that Washington Post article.

Writes Adams: “Identity is always the strongest level of persuasion. The only way to beat it is with dirty tricks or a stronger identity play. … [And] Trump is well on his way to owning the identities of American, Alpha Males, and Women Who Like Alpha Males. Clinton is well on her way to owning the identities of angry women, beta males, immigrants, and disenfranchised minorities.

“If this were poker, which hand looks stronger to you for a national election?”

http://lastnighton.com/2016/05/31/dilbert-creator-tells-bill-maher-why-trump-will-win-election/

Watch the Real Time interview. And think about how you can get your favorite politician - local, state or national - to be better at persuasion and the use of modern media.

Randy

Obamacare reality: It is working

At a time in the US when all of the Republicans presidential candidates are declaring Obamacare a failure which needs to be undone, it is worth noting the REALITY that it is succeeding in its primary purpose of covering more American with health insurance. It does not mandate insurance coverage, but the subsidies and tax penalties for not having insurance are motivating more people to get insurance. 20 million more people now have health insurance than did before. (Click on graphs for a clearer image.)

 20 Million Gained Health Insurance From Obamacare, President Says
The Huffington Post

Uninsured rate Gallop-HealthwaysEven though cost containment was not its primary goal, Obamacare is also reducing, not increasing, costs of health care.
Since many people don’t trust the government, here are some private sector slides.
PriceWaterhouseCoopers, an actuary firm not known for being political, forecasts that health expenditure
cost growth in 2016 will continue to slow down.

http://www.pwc.com/us/en/health-industries/behind-the-numbers/assets/pwc-hri-medical-cost-trend-chart-pack-2016.pdf

Here are my two favorite slides from their chart pack. Note the changes since 2010.

pwc trends gdpand nhe

My view is that the above figure is misleading, since the decline in rates of growth did not start in 1961, but still the slow growth since 2010 is clearly evident.

 

spending growth rate PWC 2016

Obamacare is working. We just don’t have enough leaders and media telling us this.

 

Note: I sent this blog to my BUHealth email list.

Let me know if you would like to be added as a BUHealthFriends subscriber by emailing ellisrp at bu.edu

Denmark’s Social Capitalism and Switzerland’s Federal Democracy

With Democratic presidential candidates Hillary Clinton and Bernie Sanders both mentioning Democratic Socialism in Denmark, it is interesting to read about what it actually is.

Here is one link with one persons discussion.

Denmark sounds pretty wonderful to me

Switzerland

I just returned from Switzerland which is not democratic socialism, but rather a federalist direct democracy centered on capitalism much like the US.

The Swiss seem to be doing many things right.

SOLOTHURN

The small city of Solothurn (pop 16,000) we stayed at had the following features. (Based on my visit, augmented by https://en.wikipedia.org/wiki/Solothurn)

A train, at least six bus lines and an electric trolley - for a city of 16,000!

Trains that runs on weekends almost as regularly as weekdays. Twice an hour on its two lines on Sunday mornings.

Hundreds (thousands?) of locals from the town using trains to get to the local cable car and go for hikes in the Alps on a Sunday morning in November.

23% foreign national residents

No driving in the center of the city. Only pedestrians or local residents and deliveries.

At least seven museums: art museum, rock carving museum, castle arsenal museum, nature museum, pinball museum, puppet museum, history museum

Trash containers every 100 feet along most public sidewalks.

Two pedestrian-only bridges across the Aare river (good crossword answer)

Bicycle parking for over 100 bikes at the train station.

No large supermarkets or malls that I saw.

 

WORK?

Unemployment rate of 4.6% in 2010.

Minimum wage of $20 to $25 depending on canton. In May a national referendum to raise it to the equivalent of $24.70 narrowly failed.

Only 40.3% of the people use a car to get to work (40% walk or ride a bike, while 20% use public transport).

Considered the richest country in the world.

 

TAXES?

Median tax rate for a single person earning > $150,000 is 22% in 2011.

8% value added tax (national) plus a canton rate.

.3 to .5% property tax (national) (notice the decimal point)

Corporate profit tax of 8.5 (national) with some more by cantons (= states)

Overall fiscal rate for Switzerland was 38.5% in 2002.

Health (from Wikipedia on 11/12/15) https://en.wikipedia.org/wiki/Switzerland

Swiss citizens are universally required to buy health insurance from private insurance companies, which in turn are required to accept every applicant. While the cost of the system is among the highest it compares well with other European countries in terms of health outcomes; patients who are citizens have been reported as being, in general, highly satisfied with it.[151][152][153] In 2012, life expectancy at birth was 80.4 years for men and 84.7 years for women[154] — the highest in the world.[155][156] However, spending on health is particularly high at 11.4% of GDP (2010), on par with Germany and France (11.6%) and other European countries, and notably less than spending in the USA (17.6%).[157] From 1990, a steady increase can be observed, reflecting the high costs of the services provided.[158] With an ageing population and new healthcare technologies, health spending will likely continue to rise.[158]

 

Like Denmark, Switzerland seems to run on trust.

This all sounds pretty attractive to me. Why can’t we look at successes in Europe more and imitate them?

Tax to rise on the uninsured next year.

This is why enrollment in health insurance will continue to rise in the US from the ACA.

For 2016: Max of  $695 or 2.5 percent of taxable income if uninsured.

http://www.bostonglobe.com/news/nation/2015/10/19/health-law-fine-uninsured-will-more-than-double/76FbuARARxAmaT9H4nN66K/story.html

Full text is below.

Health law fine for uninsured to rise

Boston Globe

Associated Press  October 19, 2015

WASHINGTON — The federal penalty for having no health insurance is set to jump to $695, and the Obama administration is being urged to highlight that fact in its new pitch for health law signups.

That means the 2016 signup season starting Nov. 1 could see penalties become a bigger focus for millions of people who have remained eligible for coverage but uninsured. They’re said to be squeezed for money and skeptical about spending what they have on health insurance.

Until now, health overhaul supporters have stressed the benefits: taxpayer subsidies that pay about 70 percent of the monthly premium, financial protection against sudden illness or an accident, and access to regular preventive and follow-up medical care.

But in 2016, the penalty for being uninsured will rise to the greater of either $695 or 2.5 percent of taxable income. That’s for someone without coverage for a full 12 months. This year the comparable numbers are $325, or 2 percent of income.

Marketing usually involves stressing the positive. Rising penalties meet no one’s definition of good news. Still, that may create a new pitch:

The math is pretty clear. A consumer would be able to get six months or more of coverage for $695, instead of owing that amount to the IRS as a tax penalty. (That is based on subsidized customers now putting in an average of about $100 a month of their own money.)”

Deflategate pressure drop is consistent with a ball air temperature of 72 degrees when tested initially.

Deflategate pressure drop is consistent with a ball air temperature of 72 degrees when tested initially.

I revised my original Deflategate posting after learning that it is absolute air pressure not pressure above standard sea level pressure that follows the Ideal Gas Law.  I also allowed for stretching of the leather once the ball becomes wet. And for the possibility that the cold rain was was colder (45 degrees F) below the recorded air temperature at 53 degrees F.  Together these adjustments make it even easier for the weather to fully explain the drop in ball pressure.

My Bottom Line: The NFL owes the Patriot Nation and Bob Kraft a big apology.

Correction #1: My initial use of the ideal gas formula did not recognize that it is absolute pressure, not pressure above the ambient air pressure that matters. Hence a ball with a pressure of 12.5 PSI is actually 12.5 PSI above the surrounding air pressure, which is about 14 PSI at sea level. So a decline from 12.5 PSI to 10.5 PSI is actually only an 8.2 percent decline in absolute pressure from 26.5 to 24.5 PSI. This makes it much easier for temperature changes to explain the difference in ball pressure. Only an 8.2 percent change in absolute temperature (approximately a 42 degree Fahrenheit drop) would be required it that were the only change needed.

Correction #2: It is well established that water allows leather to stretch. I found one site that noted that water can allow leather to stretch by 2-5% when wet.  It does not specify how much force is needed to achieve this.

https://answers.yahoo.com/question/index;_ylt=A0LEVvwgfs9UP0AAr40nnIlQ?qid=20060908234923AAxt7xP

It is plausible that a new ball made of leather under pressure (scuffed up to let in the moisture quickly)  might stretch 1 percent upon getting wet (such as in the rain). Since volume goes up with the cube of this stretching, this would be a (1.01)^3 -1= 3 percent increase in ball volume or decline in pressure. This amount would reduces the absolute temperature difference needed for the 2 PSI drop to only 5.2 percent (a change of only 27 degrees F.)

Correction #3: It was raining on game day, and the rain was probably much colder than the outside air temperature. So it is plausible that the game ball was as cold as 45 degrees Fahrenheit at game time when the low ball pressures were detected. This makes even lower initial testing temperatures consistent with the professed levels of underinflation.

A single formula can be used to calculate the ball temperature needed when tested initially to explain a ball pressure detected during the game that is 2 PSI lower, after getting colder (to 45 degrees F), .004 smaller (since ball volume shrinks when cold), and stretched 1% due to rain. It would be

Pregame testing temperature in F =(pressure change as a ratio)/(volume change due to cold)/(volume change due to leather stretching 1% when wet)*(45 degree ball temperature during game+460 degrees) - 460 degrees

(12.5+14)/(10.5+14)/(.996)/(1.01^3)(45+460) - 460 = 72 degrees Fahrenheit

Given this math, it would have been surprising if the ball pressure had NOT declined significantly.

Final comment #1: All of these calculations and hypotheses can be tested empirically. See the empirical analysis done by Headsmart Labs (http://www.headsmartlabs.com). They find that a rain plus a 25 degree drop is consistent with a 1.82 PSI decrease.

Final comment #2: Since the original game balls were reinflated by officials during halftime, the true ball pressures during the first half will never be known. Moreover there seems to be no documentary record of their pressures at the time they were re-inflated.

The XLIX Superbowl was a terrific game from the point of view of Patriots fans. Now it is time for the NFL  to own up to its own mistake in accusing the Patriots of cheating.  It was just a matter of physics.

Revised calculations

 

Various combinations of testing temperatures and PSI
A B C D E F G H I J K L M N O
Adjustments for temperature only, correcting for absolute pressure at 14 PSI at sea level Adjustments for changes in ball volume Adjusting for temperature and football volume
Temperature F Degrees above Absolute zero Temperature adjustment Various game time or testing PSI readings surface area sphere radius mean football radius volume Volume adjustment Various game time or testing PSI readings
Game time temperature 45 505 1.000 10.5 11 11.5 189 3.8782 3.81183 232 1.000 10.5 11 11.5
60 520 1.030 11.2 11.7 12.3 189.2427 3.8807 3.81427 232.447 0.998 11.3 11.8 12.3
70 530 1.050 11.7 12.2 12.8 189.4045 3.8824 3.81590 232.7451 0.997 11.8 12.3 12.8
Possibl e testing temperatures 80 540 1.069 12.2 12.7 13.3 189.5663 3.8840 3.81753 233.0434 0.996 12.3 12.9 13.4
90 550 1.089 12.7 13.2 13.8 189.7280 3.8857 3.81916 233.3418 0.994 12.8 13.4 13.9
100 560 1.109 13.2 13.7 14.3 189.8898 3.8873 3.82079 233.6403 0.993 13.4 13.9 14.5
110 570 1.129 13.7 14.2 14.8 190.0516 3.8890 3.82242 233.939 0.992 13.9 14.5 15.0
120 580 1.149 14.1 14.7 15.3 190.2134 3.8906 3.82404 234.2378 0.990 14.4 15.0 15.6
130 590 1.168 14.6 15.2 15.8 190.3752 3.8923 3.82567 234.5367 0.989 14.9 15.5 16.1
140 600 1.188 15.1 15.7 16.3 190.5370 3.8940 3.82730 234.8357 0.988 15.5 16.1 16.7
150 610 1.208 15.6 16.2 16.8 190.6988 3.8956 3.82892 235.1349 0.987 16.0 16.6 17.2
160 620 1.228 16.1 16.7 17.3 190.8606 3.8973 3.83054 235.4342 0.985 16.5 17.1 17.8
Temperature (Fo) at which ball would pass test. 2 PSI diff 1.5 PSI diff 1 PSI diff 88 77 67
Temperature only 86 75 65
Temperature and volume change from temp 88 77 67
temp, volume, and stretching from wetness 72 62 51
Last row calculated as (12.5+14)/(inferred test level+14)/(0.996)/(1.01^3)*(45+460)-460
Notes
Revised calculations allow for sea level temperature to be 14 PSI, so a change from 10.5 to 12.5 PSI (above this level requires only a (12.5+14)/(10.5+14)-1=8.2 percent change in absolute temperature.
See notes at the top, but final calculations also allow for the possiblities that ball temperature was 45 degrees, not 53 due to cold rain, and 1% stretching in leather due to rain.
Fields in first row and first column are input parameters, others are calculated

 

Original post

There is no mention of the temperature at which the footballs need to be stored or tested in the official NFL rule book. (Sloppy rules!)

The process of scuffing up the new balls to make them feel better no doubt warms them up. It would be impossible for it to be otherwise. An empirical question is how much did it warm them up and what temperature were they when tested?

Surface temps could have been below their internal temperature of the air, which is what matters for the pressure. Leather is a pretty good insulator (hence its use in many coats).

Anyone who took high school physics may remember that pressure and temperature satisfy

PV=nRT

Pressure*Volume=Number of moles*ideal gas constant*Temperature  (Ideal Gas Law)

Temperature needs to be measured in degrees above absolute zero, which is -459.67 Fahrenheit (sorry metric readers!). The temperature at game time was 53 degrees. So the right question to ask is:At what temperature,  T1, would the air in the ball have to be at the time the balls were tested such that once they cooled down to T0=53 degrees they measures two pounds per square inch (PSI) below the allowed minimum?

The lowest allowed temperature for testing was 12.5 PSI. We are told only vaguely that the balls were 2 PSI lower than this, but this is not a precise number. It could be it was rounded from 1.501 PSI. that would mean they  might have been 11 pounds PSI when tested during the game.  I examine 10.5, 11 and 11.5 as possible game time test PSI levels.The following tables shows possible combinations of game time testing temperature and half-time testing temperatures that would be consistent with various pressures.The right hand side of the table makes an adjustment for the fact that the leather/rubber in the ball would also have shrunk as the ball cooled down, which works against the temperature.Using the formulaPSI1=PSI0*((T1+459.67)/(T0+459.67). (See correction above!) Ignoring the volume change of the ball, it is straightforward to solve for what initial temperature the balls would have had to be for the observed game time temperatures.

Adjusting for a plausible guess at the small amount that the leather plus rubber bladder would have also changed makes only a small difference.

For a 1.5 PSI difference from testing to halftime , the air inside of them would have had to be at about 128 degrees at the time they were tested. (The leather skin could have been a lower temperature.) This would have made them feel warm but not burning hot to the hand.

Allowing the balls to be warm when tested is sneaky or perhaps accidental, but not cheating.

Go Pats!

Various combinations of testing temperatures and PSI
A B C D E F G H I J K L M N O
Adjustments for temperature only Adjustments for changes in ball volume Adjusting for temperature and football volume
Temperature F Degrees above Absolute zero Temperature adjustment Various game time or testing PSI readings surface area sphere radius mean football radius volume Volume adjustment Various game time or testing PSI readings
Game time temperature 53 512.67 1.000 10.5 11 11.5 189 3.8782 3.81183 232 1.000 10.5 11 11.5
Possibl e testing temperatures 80 539.67 1.053 11.1 11.6 12.1 189.4368 3.8827 3.81623 232.8048 1.003 11.0 11.5 12.1
90 549.67 1.072 11.3 11.8 12.3 189.5986 3.8844 3.81786 233.1031 1.005 11.2 11.7 12.3
100 559.67 1.092 11.5 12.0 12.6 189.7604 3.8860 3.81949 233.4015 1.006 11.4 11.9 12.5
110 569.67 1.111 11.7 12.2 12.8 189.9222 3.8877 3.82112 233.7001 1.007 11.6 12.1 12.7
120 579.67 1.131 11.9 12.4 13.0 190.0840 3.8893 3.82274 233.9988 1.009 11.8 12.3 12.9
130 589.67 1.150 12.1 12.7 13.2 190.2458 3.8910 3.82437 234.2976 1.010 12.0 12.5 13.1
140 599.67 1.170 12.3 12.9 13.5 190.4076 3.8926 3.82600 234.5965 1.011 12.1 12.7 13.3
150 609.67 1.189 12.5 13.1 13.7 190.5693 3.8943 3.82762 234.8956 1.012 12.3 12.9 13.5
160 619.67 1.209 12.7 13.3 13.9 190.7311 3.8959 3.82924 235.1948 1.014 12.5 13.1 13.7
Temperature (Fo) at which ball would pass test. 151 123 98 159 128 101
Notes
Fields in yellow are input parameters, others are calculated
Column C is temperature minus absolute zero
Column D is the ratio of column C to the game time temp in absolute degrees and shows how much higher PSI would have been than at game time.
Columns E through G show possible testing PSI for three possible game time PSI levels.
Columns H through L show adjustments to volume which tend to reduce the PSI as a ball is heated. Calculations use rate of expansion of hard rubber per square inch per degree.
Columns M through O show Balll PSI after adjusting for both air temperature and football volume
Parameters and formulas
absolute zero= -459.67 fahrenheit
hard rubber expansion 42.8 (10-6 in/(in oF))*) http://www.engineeringtoolbox.com/linear-expansion-coefficients-d_95.html
or 0.0000428 Used for column I expansion of surface area
Surface area assume to grow with the square of this proportion with temperature.
The approximate volume and surface area of a standard football are 232 cubic inches and 189 square inches, respectively.
http://www.answers.com/Q/Volume_and_surface_area_of_a_football
Surface of a sphere formula
4pr2 Used to calculate radius of sphere
volume of sphere formula
4/3*pi*radius3 Used to calculate volume of football. Volume adjusted downward by a fixed proportion because footballs are not spheres.

 

NFL rules

Rule 2 The BallSection 1BALL DIMENSIONSThe Ball must be a “Wilson,” hand selected, bearingthe signature of the Commissioner of the League, Roger Goodell.The ball shall be made up of an inflated (12 1/2 to 13 1/2 pounds) urethane bladder enclosed in a pebble grained, leather case(natural tan color) without corrugations of any kind. It shall have the form of a prolate spheroid and the size and weightshall be: long axis, 11 to 11 1/4 inches; long circumference, 28 to 28 1/2 inches; short circumference, 21 to 21 1/4 inches;weight, 14 to 15 ounces.The Referee shall be the sole judge as to whether all balls offered for play comply with these specifications. A pump is to befurnished by the home club, and the balls shall remain under the supervision of the Referee until they are delivered to theball attendant just prior to the start of the game.

From the Free Dictionaryideal gas lawn.A physical law describing the relationship of the measurable properties of an ideal gas, where P (pressure) × V (volume) = n (number of moles) × R (the gas constant) × T (temperature in Kelvin). It is derived from a combination of the gas laws of Boyle, Charles, and Avogadro. Also called universal gas law.

 

#6 Raise the minimum wage for jobs not offering health insurance

Time to change the policy discussion.

Congress has been unwilling to raise the minimum wage despite strong public support for doing so. This blog suggests a concrete approach for getting even broader public support and potentially reducing the need for federal taxes.

As of January 1, 2015 29 states and DC have minimum wages above the Federal minimum wage, which is still only $7.25 per hour. For a worker working 40 hours per week 50 weeks per year, the minimum wage yields only $14,500 per year, which is below the federal poverty level ($15,730) for a  family of two in 2014 in all states and DC. At these low income levels, even full time employees still cannot afford health insurance and will mostly be relying on large subsidies for health insurance  and the employee earned tax credit (EIT).  The insurance subsidy for a minimum wage worker enrolling in a private silver plan is currently at least $4,237 per year for an adult with one child, while the EIT is currently $3,359 for a single worker with one child if earning the minimum wage. Hence an employer paying only the minimum wage is counting on a subsidy from the government of at least $7596 per year for a worker with one child, which is $3.80 per hour.

A simple approach that will encourage more firms to offer health insurance is to raise the minimum wage required for any position that does not include any offer of subsidized health insurance. For concreteness I propose a minimum wage of $12 per hour without health insurance, versus $8 per hour with a job that includes subsidies for health insurance. (Those age 21 and under would also be eligible for the $8 per hour rate.) Whether the job is for 10, 30 or 40 hours per week does not matter, only whether there is subsidized health insurance. This four dollar per hour increment will encourage firms to bear the full cost of their workers, and reduce the burden on federal tax revenue and the budget.

In Massachusetts, the minimum wage just increased on January 1, 2015 from $8 to $9 per hour. The State's economy continues to do well, and I still see signs in retail windows showing help is still wanted. Plus we still have lots of low-cost food and retail stores and services. Reduced employment is not visible, and would likely be more than offset by the stimulatory effects of reduced taxes. I see no reason why we couldn't leave it up to states to decide whether they want to use the same or higher minimum wages for jobs with or without health insurance as long as the two minimums are reached.

In Australia, the minimum wage is US$ 13.84 (16.87 Australian dollars), everyone has national health insurance, and the unemployment rate is comparable to the US at 6.2 percent (November, 2014). We rather liked it when we were there in 2011 that our gardener and most restaurant workers were Australian citizens, who spoke English well, not low-paid foreigners and recent immigrants, as they are in the US.

As I write this blog, the US congress is debating whether to partially undo the employer mandate provisions of the Affordable Care Act by allowing firms to not have to pay any penalty for not offering health insurance for employees working less than 40 hours per week. The current standard is 30 hours per week. This would have a potentially disastrous effect since so many workers work about 40 hours and it would be easy for employers  to avoid the (modest) ACA penalties by reducing worker hours. Plus, without the employer mandate, many workers will remain uninsured. Having a higher minimum wage for jobs not offered health insurance will greatly weaken the incentive for firms to drop employee hours to avoid offering insurance coverage and eliminate the 40 versus 30 hours as an issue. In fact it would encourage firms to offer full- rather than part-time jobs with health insurance, reducing the need for public subsidies.

This minimum wage policy particularly makes sense if it is combined with the proposal in my next (future) blog #7 to eliminate all family health insurance policies, insure individuals not households, and have all children under age 21 be covered independently of their parent's insurance policy. Making all children eligible for the exchange coverage options regardless of their (parent's) income would be one possible approach.

Here are links to my four previous blogs from 2013 on Taxes and fiscal policies. Still the right direction.

#1 All Taxes and Budgets Should be Expressed as Dollars per Person

#2. Include Social Security and Medicare taxes when discussing tax burdens

#3 Tax Bads (or at least don’t subsidize them!)

#4 State Tax Rates are Not Related to State Income or Growth

#5 “Let the Children and Grandchildren Pay?”

 

 

 

Useful Data Links to US Government data

Websites for Federal Administrative Data sets:

US Administration for International Development:
Foreign aid from the U.S: Data and Tools

Department of Agriculture:
Economic Research Services: Supplemental Nutrition Assistance Program (SNAP) Data System
Food and Nutrition Services: Commodity Supplemental Food Program Data
Food Safety Inspection Services: Recalls and Quarterly Enforcement Reports
Forest Inventory Data
National Agricultural Statistics Service: Cropland Data
Natural Resource Conservation Service: Conservation Financial Assistance Programs' Enrollment Data
Risk Management Agency (RMA): Program Costs and Outlays Data
RMA: Actuarial Data
Web Based Supply Chain Management Reports Data

US Army:
Army Corps of Engineers: U.S. Waterborne Commerce Data

Department of Commerce:
Bureau of Economic Analysis (BEA): Foreign Direct Investments Data in the US
BEA: US National Income and Product Account (NIPA) Data
Economic Development Administration: Program Data
Census: Business Register Data and Longitudinal Business Database
Census: Longitudinal Employer-Household Dynamics
Census: County and Zip Code Business Patterns
International Trade Administration (ITA): U.S. Exporting Companies Data
ITA: Export-Supported Employment Data
ITA: Visitors Arrivals Program (Form I-94) Data
ITA: International Air Travel Statistics ( Form I-92) Program Data
National Climate Data Center: National climate and historic weather data
National Marine Fisheries Service: Recreational Fisheries statistics or Commercial Fisheries Statistics

Commodities Futures Trading Commission:
Filings, transactions, and other data
Market Report Data

Consumer Financial Protection Bureau:
Credit Card Agreement Database
Consumer Complaint Database

Consumer Product Safety Commission:
Injury Statistics

Department of Education:
Civil Rights Data for Public Schools
EDFacts Data for K-12 Educational Programs
National Center for Education Statistics: Common Core of Data on Public School
Federal Student Aid Data
National Reporting System Data for Adult Education
Nation’s Report Card System Data

Department of Energy:
Energy Information Administration (EIA): Energy Prices Data
EIA: Renewable Energy Market Data
EIA: Crude Oil Production and Stocks Data

Environmental Protection Agency:
Air Quality Data
Enforcement Dockets data
National Pollutant Discharge Elimination System (NPDES) permits and compliance data
Toxic Substances Control Act Chemical Substance Inventory
Superfund Sites (CERCLIS database)

Equal Employment Opportunity Commission
Enforcement and Litigation Statistics on Employment Discrimination

Federal Court System:
Bankruptcy Statistics

Federal Deposit Insurance Corporation:
Industry Data
Failed Bank Data

Federal Emergency Management Agency:
Assistance Record Data

Federal Financial Institutions Examination Council:
Financial and Structural Data for FDIC-insured Institution
Home mortgage loans data
Reinvestment Act Data

The Federal Reserve:
Consumer Credit data
Finance Companies Data
Foreign exchange rates
Government Receipts for Expenditures and Investments
Money Stock Measures
Treasury Account Series data

Federal Trade Commission:
Fraud and Identity Theft aggregates (Consumer Sentinel Network)

Fish and Wildlife Services:
Wetlands Data

General Services Administration:
Federal Procurement Report Data
FFATA Sub-award Reporting System (Data Reporting)
Small Business Goaling Report

Department of Health and Human Services:
Agency for Substances and Disease Registry (ASTDR): Environmental Health Webmap Data
ASTDR: Hazardous Substances Emergency Events Surveillance Report Data
ASTDR: National Toxic Substance Incidents Program Data
Center for Disease Control and Prevention (CDC): Community Water Fluoridation Statistics 
CDC: National Program of Cancer Registries Data
CDC: Surveillance Data
Center for Medicare and Medicaid Services (CMS): Medicare Claims Data or Microdata
CMS: National Health Expenditures Data
CMS: Provider of Service Data
National Directory of New Hires Data
National Center for Health Statistics: Vital Statistics: Births, Deaths, Marriages, Divorces
Temporary Assistance to Needy Families Administrative Records

Department of Homeland Security:
Immigration Statistics

Department of Housing and Urban Development:
Community Development Block Grants Expenditures Data
Family Data on Public and Indian Housing and Microdata
Fair Market Rents Data
Government Sponsored Enterprise Data
Metropolitan Area Quarterly Residential and Business Vacancy Report Data
National Low Income Housing Tax Credit Database
Neighborhood Stabilization Program Data
Program Income Limits Data

Department of Interior:
US Geological Survey (USGS): Biodiversity, Species data
USGS: Land Cover and Land Use data
USGS: Water Resources data
USGS: Water Quality Data

International Trade Commission:
Tariffs Databases

Department of Justice:
Bureau of Prison: Inmate, Population, and Staff Statistics
Bureau of Justice Statistics(BJS): Court Statistics Project Data
BJS: Federal Justice Statistics Program Data
BJS: Law Enforcement Management and Administrative Statistics
BJS: National Corrections Reporting Program Data
BJS: National Incident-Based Reporting System Data
BJS: National Prisoner Statistics Program Data
Federal Bureau of Investigation: Uniform Crime Reports Data

Department of Labor:
Bureau of Labor Statistics: Quarterly Census of Employment and Wages
Foreign Labor Certification Office: H-1B Data
Labor Retirement and Welfare Benefit Plan Data Set
(Form 5500)
Occupational Safety and Health Administration (OSHA): Work-Related Injury or Illness Data
OSHA: Enforcement Data (Inspection Data)
OSHA: Worker Fatalities/Catastrophes Report (FAT/CAT) 

National Aeronautics and Space Administration:
Urban Landsat

Patent and Trademark Office:
U.S. Patent and Trademark Office patent data

Department of Transportation:
Bureau of Transportation (BTS): Air Carrier Statistics
BTS: Intermodal Passenger Connectivity Database
Maritime Administration: Maritime Travel and Transportation Statistics

Department of Treasury:
Bureau of Fiscal Service: Public Debt Report
Financial Crime Enforcement Network: Mortgage and Real Estate Fraud Data Set
Interest Rate Statistics
Internal Revenue Service (IRS): Corporate Tax Statistics (Form 1120)
IRS: Employee Benefit Plans (Form 5500)
IRS: Individual Tax Statistics (Form 1040)
IRS: Quarterly Payroll Taxes (Form 941)

Securities and Exchange Commission:
Filings
Mutual Fund Fees and Expenses
Program and Market Data
Short Sale Volume Data 

Small Business Administration:
Small Business Lender and Loan Data
Social Security Administration:
Social Security Programs Data
Earnings and Employment Data for Workers Covered under Social Security and Medicare

Department of Veteran's Affairs:
Veterans Benefits Administration Reports
National Pollutant Discharge Elimination System (NPDES) permits and compliance data

Websites for Agency Procedures on Access to Restricted-Use Administrative Data Sets:

Bureau of Labor Statistics Confidential Data Sets Access
Census Bureau Restricted Restricted Data Sets Access
Agency for Healthcare Research and Quality Restricted Use Data Access
National Center for Health Statistics Restricted Use Data Access
National Center for Education Statistics Restricted Use Data Licenses
Bureau of Transportation Statistics Restricted-Release Airline Data Access
USDA's Economic Research Service Agriculture Resource Management Survey Data Access
National Institute on Aging Restricted Data Access
Center for Medicare and Medicaid Limited Data Access
Social Security Administration Health and Retirement Study Data Access
National Science Foundation/National Center for Science and Engineering Statistics Restricted-Use Data Access
Substance Abuse and Mental Health Data Archive

Re-envisioning Ebola, including updated story about Nigeria from Kas Nwuke

Arlene Ash, Professor and Division Chief, Biostatistics and Health Services Research, at UMass Medical School, has compiled a useful series of original thoughts, emails, and links about Ebola which I am broadcasting and reposting on my blog site here.

This posting repeats some of the information already posted in my earlier blog:

Ebola is being contained in Nigeria

The original article by Kas Nwuke is now linked (with permission) as a pdf and includes linked references on my web site. (It is 6 pages – updated to include two pages of references.)

Containing Ebola: A success story from an “unexpected” place?

From Arlene Ash:

Friends and Colleagues,

Here’s what I [Arlene Ash] sent previously with some updates.

I now have Mead Over’s permission to circulate his text that is included below, plus sharing the link to his Twitter log: @MeadOver.

Also, I have added the text from yesterday’s NYT editorial “Cuba’s Impressive Role on Ebola,” since non-subscribers may not be able to get it themselves on-line.  The full text, with links and commentary, is very interesting, and I think important.

These are, indeed, extraordinary times – and, I firmly believe, they offer an extraordinary opportunity to discard old, dysfunctional paradigms – if only we can seize it.

Arlene

_

Last weekend I [Arlene Ash] wrote:

Re-envisioning Ebola as an opportunity

Friends, If you like this idea as well as I do, perhaps you can help make it “go viral.”

  •  I believe it would be cheaper to stop Ebola in Africa than to try to seal our borders against it as it spreads unchecked.
  • I believe that taking a leadership role in stopping Ebola would do a great deal for our self-esteem as a nation, and for our regard in the world.
  • I believe that cost-effectiveness calculations could make a strong case for a “war on Ebola” as the best kind of war that we could wage. I propose we could do more to combat ISIS and protect America by working with the world community to prevent the spread of Ebola in Africa than by any level of commitment of troops and weapons to the enflamed Middle East.

I want America to re-envision Ebola as an opportunity to demonstrate what great things we can do when we bend ourselves to the task.

Of course we are all busy, but perhaps it takes only a little help from many people to spread a really good idea.

Thought for the day. Please grow it and pass it along.

_

I got back some very interesting feedback which I would like to share:

From Randy Ellis (a success story in Nigeria, with lessons for the rest of the world):

Amid so much negative and scary news about Ebola, this research paper on the experience of Nigeria where it has not spread widely after arriving by airplane gives great hope. I recommend it if you have time (It is 6 pages).

Containing Ebola: A success story from an “unexpected” place? [Now linked instead of attached as a pdf]

The author, Kasirim Nwuke  is a BU Ph.D. Here is his bio from one web site.

http://www.elearning-africa.com/profiles/profile_popup.php?address_id=595692&lang=4

_

Then a follow-on from Mead Over, author of a World Bank report (Twitter log  @MeadOver):

This is indeed a good story with details that go beyond the information our World Bank report (in the box on page 29) on the efforts of Senegal and Nigeria that I co-authored on October 7 and blogged on Friday:

http://www.cgdev.org/blog/understanding-world-banks-estimate-economic-damage-ebola-west-africa

http://documents.worldbank.org/curated/en/2014/10/20270083/economic-impact-2014-ebola-epidemic-short-medium-term-estimates-west-africa

The box on page 29 of the WB report was requested by JYK after he sat next to Goodluck Jonathan at the UNGA meeting last week and President Jonathan told him that 1,000 Nigerian public health workers were involved in the contact tracing including almost 300 Nigerian doctors.  This is remarkable not only for the level of effort, but also in comparison to Liberia, Sierra Leone and Guinea each of which had fewer than 100 doctors before the crisis.  In Nigeria I have heard that the polio eradication workers are the ones who were redeployed to do the Ebola contact tracing.  Other countries don’t have the polio program because they don’t have polio.  So even a relatively wealthy country like Ghana may have trouble emulating Nigeria’s success.

I like the point made in the article that Nigeria showed courage in announcing the danger far and wide and rolling out a massive public health effort to contain it.  This was before the rest of the world was taking the epidemic as seriously as they are today, and thus the measures could well have been opposed by economic interests.  (Parallel to HIV:  In the early days of the HIV epidemic, business interests in Thailand opposed the admission that HIV was a problem.  In “Confronting AIDS” we attribute Thailand’s energetic and remarkably successful “100% condom program” partly to the fact that the country was under a military dictatorship for 6 months and the “benevolent dictator” saw the wisdom of opposing the economic interests in order to start that program.)

When I spoke on Ebola at American University the other evening, one of the other panelists was an anthropologist who had recently returned from Sierra Leone.  She also reported the “Ebola handshake” and other “self-isolation behavior from that country.  Epidemiologists are hoping that such behavior, developing in response to the news and the public information campaign, will reduce the reproductive rate of the epidemic.  But we have not seen a deceleration in Liberia or Sierra Leone yet.

Another implication of the author’s account and of the Nigerian and Senegalese public health expenditure amounts reported in the box of the World Bank report is that several West African countries are increasing government spending in response to the outbreak (as is the US).  Our World Bank report does not include the possible stimulus effect of this spending on national economies.  This spending may offset some of the reduction in aggregate demand due to aversion behavior, and thus reduce the economic impact below our estimates.  However, as I say at the end of my blog, unless the epidemic begins to decelerate soon, our “High Ebola” estimate may fall short of estimating the total impact.  And I hope that when Charles Kenny and I join CDC and others in asserting this is still a small problem inside the US, we are not being overly optimistic.  As here:

https://www.youtube.com/watch?v=_jCWkDYwN2g; https://www.youtube.com/watch?v=113kLL3pZQQ

One frustrating aspect of the report by Kasirim Nwuke is the lack of references or hyperlinks [AA: they are now attached in a separate file.]  Even our World Bank report did better.  I agree totally with his conclusion that Nigeria is not yet “safe”.  Each day is another roll of the dice.  In one sense, Nigeria was lucky that they detected the first case on entry.  Next time they may not be so lucky.

_

In response, Kas Nwuke KNwuke@uneca.org wrote (on 10/18/14):

Going through the materials, I have come to know that Nigeria's preparations started much earlier. It started once the outbreak in Guinea and reached full steam after the July ECOWAS Heads of State Summit.  That Summit discussed Ebola in the sub-region and resolved that member States of ECOWAS should be prepared to contain it.  Nigeria according to the Health Minister made, after the Summit, the very first financial donation of $3.5 million US to the three countries.  Back home, the Health Minister briefed the Commissioners for Health in the 36 States of the Federation and asked for increased vigilance.

 

You will find this additional information in the references.

 

In my essay, I had given the number of Nigerians who have volunteered to go to Liberia and Sierra Leone as 200.  I have since learned that the number is actually 591.  In addition, Nigeria is also providing crash courses to health personnel from the three most affected countries.

 

I am sure that lots more will be written about Nigeria experience.  I hope that the lesson can be of value to resource constrained countries on how to handle/tackle epidemics in the future.

 

(I must with regret inform you that Nigeria's election politics has now entered the Ebola debate.  Rivers State and Lagos State are controlled by the opposition.  Electioneering campaign for next year's election has started and the ruling PDP and the opposition APC is each seeking to claim credit for the success in containing the spread of Ebola.  The Rivers State Governor has just disclosed - see the hyperlink - that the state spent N1.106 billion - more than $6 million - to tackle Ebola.)

 

With best wishes,

 

Kas

-

Also, some inspiring information about a UMass colleague (Steven Hatch) now in Liberia:

http://www.nytimes.com/2014/10/17/world/africa/pursuing-a-calling-that-leads-to-west-africa.html

http://www.nytimes.com/2014/10/17/world/africa/ebola-liberia-west-africa-epidemic.html

and a NYT “conspicuous success story” about Senegal, that points to the so far very positive Nigerian experience as well.

-

Also,

NYT, October 19 Op-Ed: “Cuba’s Impressive Role on Ebola” (http://www.nytimes.com/2014/10/20/opinion/cubas-impressive-role-on-ebola.html?_r=0)

Cuba is an impoverished island that remains largely cut off from the world and lies about 4,500 miles from the West African nations where Ebola is spreading at an alarming rate. Yet, having pledged to deploy hundreds of medical professionals to the front lines of the pandemic, Cuba stands to play the most robust role among the nations seeking to contain the virus.

Cuba’s contribution is doubtlessly meant at least in part to bolster its beleaguered international standing. Nonetheless, it should be lauded and emulated.

The global panic over Ebola has not brought forth an adequate response from the nations with the most to offer. While the United States and several other wealthy countries have been happy to pledge funds, only Cuba and a few nongovernmental organizations are offering what is most needed: medical professionals in the field.

The Cuban health sector is aware of the risks of taking on dangerous missions. Cuban doctors assumed the lead role in treating cholera patients in the aftermath of Haiti’s earthquake in 2010. Some returned home sick, and then the island had its first outbreak of cholera in a century. An outbreak of Ebola on the island could pose a far more dangerous risk and increase the odds of a rapid spread in the Western Hemisphere.

Cuba has a long tradition of dispatching doctors and nurses to disaster areas abroad. In the aftermath of Hurricane Katrina in 2005, the Cuban government created a quick-reaction medical corps and offered to send doctors to New Orleans. The United States, unsurprisingly, didn’t take Havana up on that offer. Yet officials in Washington seemed thrilled to learn in recent weeks that Cuba had activated the medical teams for missions in Sierra Leone, Liberia and Guinea.

With technical support from the World Health Organization, the Cuban government trained 460 doctors and nurses on the stringent precautions that must be taken to treat people with the highly contagious virus. The first group of 165 professionals arrived in Sierra Leone in recent days. José Luis Di Fabio, the World Health Organization’s representative in Havana, said Cuban medics were uniquely suited for the mission because many had already worked in Africa. “Cuba has very competent medical professionals,” said Mr. Di Fabio, who is Uruguayan. Mr. Di Fabio said Cuba’s efforts to aid in health emergencies abroad are stymied by the embargo the United States imposes on the island, which struggles to acquire modern equipment and keep medical shelves adequately stocked.

In a column published over the weekend in Cuba’s state-run newspaper, Granma, Fidel Castro argued that the United States and Cuba must put aside their differences, if only temporarily, to combat a deadly scourge. He’s absolutely right.

 

A model for US: $1 coins and no pennies

I just returned from a vacation in Ecuador (which is spectacular) but wanted to post about a wonderful feature of their monetary system.

Ecuador does not have its own currency but instead uses the US dollar as their only currency. US dollar bills and coins are used everywhere, which is very convenient for visitors. But they do two intelligent things.

* They do not use paper $1 bills, but instead rely almost solely on the US-minted Sacagawea dollar coins for transactions.

* They generally do not use pennies but instead round transactions to the nearest nickel.

(They do mint their own Ecuadorian US-size dimes, quarters and nickels to make up for their shortage, using the same front side but a different reverse. They must have imported millions of $1 dollar coins.)

Wouldn't be nice if the US adopted this system!

 

Read Flash Boys by Michael Lewis

I just finished reading the book Flash Boys by Michael Lewis (author of Moneyball and the Big Short). I highly recommend it to economists as a quick read (270 pages) in accessible prose. Or anyone.

http://www.amazon.com/Flash-Boys-Wall-Street-Revolt/dp/0393244660/

Every economist should be aware of the grossly unfair trading practices that the SEC and NASDAQ have allowed to dominate virtually all stock trades. Lewis documents a large number of explicit rip off techniques from High Frequency Traders (HFT) (which include most of the major money managers) that affect every mutual fund, stock broker and stock trade conducted in the world.   While true that HFT create liquidity in the market so that traders can instantly sell whatever stocks at "the market price"  in whatever quantities, they do this at the cost of a significant tax on all such transactions and result in billions of dollars of revenue for the HFT companies. Basically, the HFT can influence the market price. This is done in plain sight (the title of chapter 1), not hidden in the form of impenetrable documents such as the the unsecured and overrated mortgage securities.

Since many of you won't read the book, here is a flavor in my own words.

Your pension fund ABC, which manages a few billions of dollars of stocks, is constantly buying and selling stocks on your behalf to maintain its portfolio. Say it  wants to buy 10,000 shares of Microsoft "at the current price" which is $41.90 (the most recently traded price right now on 6/30/2014). The official NASDAQ ticker price shows more than 10,000 shares are offered at $41.90. But as soon as ABC's bid to buy "at market" is executed, essentially all of those available shares are purchased by HFT within a few microseconds (i.e., a few millions of a second) BEFORE ABC's purchase, thereby bidding up the price. It could be a penny or it could be much much more, depending on how volatile the stock price is. Today, Microsoft has already varied by .82%, so the variation WITHIN A FEW MICROSECONDS can easily be that amount and you would not even know. Your price at the end of the day would be within the low and high for the day.  ABC pays say $41.95, and the HFTs pocket the extra five cents per share on the trade since they were able to purchase at $41.90 before selling it back to you a few microseconds later at $41.95.

You think that it doesn't matter much because it was only a few pennies on the transaction, and you hold onto your assets for years. But your pension fund is constantly buying and selling as more funds are added, taken out, or market shares of different stocks change. All of these transactions are "taxed" by the HFT firms who buy at below your bid price and then sell the stock to ABC at NO RISK. According to the book, the best HFT firms have traded for years and never had a losing day, since they only bet on sure things.

Here is a second example. You may think there is only one market for each stock, but actually there are more than a dozen different prices since a majority of all trades happen in "dark pools" which are private exchanges organized by the large money managers. The official offer price may appear to be $10.05 but you don't know that some of these dark pools have offer to sell prices of as little as $10.00.  What the market is supposed to do is that if you bid "at market" then you get the lowest value price, which would be $10. What actually happens is that the HFT firms turn this into two transactions, buying at $10.00 and selling  to you at $10.05. Again, it doesn't sound like much until you realize how many millions of transactions there are.

What I found particularly unfair is that the SEC has allowed all kinds of sleazy types of stock sales practices, involving small lot transactions, and bids for shares at prices that need not be honored. This makes it very low cost/low risk for the HFT to figure out who is buying or selling, and take advantage of it.

There is a new exchange called IEX that is trying to become a fair exchange, with some success, but it is getting major push back from the big players. Read more here. http://en.wikipedia.org/wiki/IEX

Personal experience with the new Federal Exchange web site

Randall P. Ellis, Professor, Boston University Department of Economics and past president of the American Society of Health Economists.

Today, Tuesday Dec 3, I went on line to check out the new HealthCare.gov web site for selecting individual health insurance. I checked out options for enrolling in the Oxford County Maine. The web page now has a totally new feel and look to it. Most importantly, it allowed me to shop for different plan options without having to first pass through the extensive security barriers which used to prevent people from shopping until they established eligibility. Now, it is attractive and better than the Massachusetts exchange.

I clicked through 50 screens, and dozens of plans in the middle of Tuesday morning with no noticeable delays or glitches. (The Boston University benefits web site gave me more problems in recent weeks.)

The options look terrific to me, although I am covered at work and hence not eligible to enroll through the exchanges.

The premium in rural Oxford County Maine for a 20 year old in the lowest cost option is only $110 per month, without any government subsidy. That is astoundingly low compared to the overpriced policies that were previously available.

I also priced out a gold plan (Community Advantage) comparable to my coverage at Boston University for a family of three. Without any subsidy, that plan would be $1799 per month. The Anthem Blue Cross Blue Shield Gold Guided Access plan was $2013/month. At BU I am currently paying $1813 per month. So these two plans look reasonable to me in comparison. Of course my employer subsidizes my coverage, and many will be eligible for subsidies from the ACA or their employer.

Also new is the link to the Kaiser Family Foundation calculator, which allows the user to get an estimate of any savings that he or she is eligible for based on income and family size. I played with it for a while, and it worked well. I quickly used that calculator to calculate that a 39 year old in Oxford Maine earning $30,000 per year could expect to pay $3790 per year, and then receive a tax credit of $1278, bringing the total cost to $2512 per year which is 8.37%.

This new interface makes shopping on the exchanges simple and easy to understand.

Although terribly unpleasant, the flaws in the initial Healthcare.gov system promoted awareness and discussion in the media about the new exchanges, which is good. It also encouraged employers to step forward and offer coverage instead of relying on individuals. Both of these are very positive outcomes.

I predict that enrollments through the exchanges by the end of December will be below the initial, optimistic forecasts of the administration, but that millions more will enroll in early 2014 as people fill out their tax forms and are prompted to answer whether they have health insurance. In Massachusetts, that was a greater motivation to purchasing than the end of the calendar year.

Playing video games does not predict voilent behavoir in children

(Reposted from The Incidental Economist) This November 2013 UK study confirms what other studies have shown, which is that playing video games does not predict psychosocial adjustment problems in young children. Even watching 3 hours of TV per day in the UK has no meaningful association.

I also reposted my favorite graph about videos and gun violence from an earlier TIE posting.

Perhaps the 50th anniversary of  JFK's death, done with a $20 mail order rifle, is yet another good time to refocus on gun control.

Happy Thanksgiving!

Randy

The dangers of TV and video games
Posted: 25 Nov 2013 06:01 AM PST
From Archives of Diseases of Childhood, “
Do television and electronic games predict children’s psychosocial adjustment? Longitudinal research using the UK Millennium Cohort Study
“:

BACKGROUND: Screen entertainment for young children has been associated with several aspects of psychosocial adjustment. Most research is from North America and focuses on television. Few longitudinal studies have compared the effects of TV and electronic games, or have investigated gender differences.

PURPOSE: To explore how time watching TV and playing electronic games at age 5 years each predicts change in psychosocial adjustment in a representative sample of 7 year-olds from the UK.

METHODS: Typical daily hours viewing television and playing electronic games at age 5 years were reported by mothers of 11 014 children from the UK Millennium Cohort Study. Conduct problems, emotional symptoms, peer relationship problems, hyperactivity/inattention and prosocial behaviour were reported by mothers using the Strengths and Difficulties Questionnaire. Change in adjustment from age 5 years to 7 years was regressed on screen exposures; adjusting for family characteristics and functioning, and child characteristics.

RESULTS: Watching TV for 3 h or more at 5 years predicted a 0.13 point increase (95% CI 0.03 to 0.24) in conduct problems by 7 years, compared with watching for under an hour, but playing electronic games was not associated with conduct problems. No associations were found between either type of screen time and emotional symptoms, hyperactivity/inattention, peer relationship problems or prosocial behaviour. There was no evidence of gender differences in the effect of screen time.

CONCLUSIONS: TV but not electronic games predicted a small increase in conduct problems. Screen time did not predict other aspects of psychosocial adjustment. Further work is required to establish causal mechanisms.

Since we’re never going to have an RCT of TV or video games, these kinds of prospective cohort studies are important. In this one, they followed more than 11,000 children in the UK. They found that watching TV for three hours or more (a day!) at 5 years associated with a higher chance of having a conduct disorder at 7 years versus kids who watched less than an hour a day. How much of a difference? A 0.13 point increase in conduct problems. That corresponds, according to the article, to “0.09 of a SD [standard deviation] increase in age 7 years conduct score. Do you understand now? I don’t either.Anyway, the authors said it was a “small increase in conduct problems”.Video games? No effect.Yes, these are young kids, and it’s unlikely that they have been playing much GTA 5 or Battlefield 4. So I’ll look forward to more data. But that this point, it’s hard to point to a large study like this and find a smoking gun. Figuratively or literally.More on this topic here and here.@aaronecarrollShare

This is my favorite graph on this topic. From here

http://theincidentaleconomist.com/wordpress/wp-content/uploads/2012/12/video-game-chart-no-trendline.jpg