“In the Netherlands, people who don’t sign up for their universal private coverage during the annual enrollment period are automatically enrolled in a plan and have to pay a premium 20 percent higher than what they would have paid if they signed up voluntarily. The Dutch have achieved 99 percent coverage under such a system, which shares other features with Obamacare (like subsidies and the ban on preexisting conditions).”
“for medical services, other wealthy countries are often paying half the price — or less — as private insurers in the United States.
The Netherlands, consistently ranked as one of the best health care systems in the world by advanced metrics, spends a quarter of what American insurers do on hip and knee replacements. A CT scan costs $1,100 in the United States and $140 in Holland. There are only a handful of isolated instances — childbirth in the United Kingdom, an angiogram or cataract surgery in New Zealand — where the cost of a particular service even approaches the US price.”
…
“The US is still the wealthiest country in the world. It’s home to the world’s leading biopharmaceutical industry. It tends to have the most cutting-edge treatments. All this contributes to higher prices here than elsewhere. But one big and unavoidable culprit is the lack of price regulation.
Private insurers, which cover more than half of Americans, negotiate with private providers and drug companies to set their prices. They do have some leverage (by denying a provider or drugmaker access to their patients) but it is more limited than in other countries. There is certainly significant price variation within the United States (with CT scans, for example, can cost anywhere from $250 to $1,500 depending on the location), but on average, prices for US private insurance are significantly higher than those seen under other kinds of health systems.
In some of the countries studied by the Health Care Cost Institute, like the UK, the government actually employs doctors and owns hospitals. Others, like Australia, have a universal public insurance program.
Even the Netherlands, which has a fully privatized insurance scheme, has placed more government controls on prices than the United States. Insurers there use global budgets, also common in single-payer systems, to pay providers, capping the amount they’re willing to pay per year to cover all of the services their customers need. It’s a hard limit on health care spending for the coming year, and then providers and payers negotiate prices for individual services based on that budget cap. It’s very different from private insurance in the United States, which is generally open-ended depending on how much medical care is used in a given year — and the price for those services.
Because of America’s high prices, there is a $3.5 trillion industry invested in the status quo.”
“Medications like methadone, as well as buprenorphine and naltrexone, are considered the gold standard of care for opioid addiction. Studies show that the medications reduce the mortality rate among those patients by half or more, and keep people in treatment better than non-medication approaches.
Yet rehab facilities in the US often treat medications with skepticism or even scorn, while embracing approaches with little if any peer-reviewed scientific evidence”
…
“Medication isn’t the only effective way to treat opioid addiction. Other approaches, including cognitive behavioral therapy, motivational interviewing, and contingency management, also have evidence backing up their ability to treat addiction.
Still, for opioid addiction, medications “should be the first-line option,” Keith Humphreys, a drug policy expert at Stanford, told me. “Not forced, but every single person should be offered that in any decent program treating opioid addiction.””
…
“despite their effectiveness, the available medications are often stigmatized with a common trope that they “replace one drug with another.” On its face, this is literally true: The medications do substitute, say, heroin or alcohol.
But the context matters. The issue with addiction is not just drug use. Most people use some kind of drug — caffeine, alcohol, or medications. Some people are even dependent on these drugs, whether someone needs coffee to get going in the morning or insulin to survive.
What makes addiction a medical disorder is not just drug use or even dependence, but continued, compulsive use despite negative consequences. So someone would be unable to stop using heroin even when it poses serious risks to his health, career, or family. It’s only then that drug use becomes a drug use disorder.
The medications alleviate those problems, turning a drug use disorder back into just drug use. That’s why they reduce all sorts of drug-related problems, including the risk of death.”
…
““No other medication is prescribed in this way,” Sue, of the Harm Reduction Coalition, said.
Buprenorphine can be prescribed in a traditional health care setting, but it too faces unique restrictions. Doctors have to go through an eight-hour training course to get certification to prescribe it, and nurse practitioners and physician assistants have to go through a 24-hour training course. The restrictions are one reason that, according to the White House opioid commission’s 2017 report, 47 percent of US counties — and 72 percent of the most rural counties — had no physicians who could prescribe buprenorphine as of 2016.
Since methadone and buprenorphine are opioids themselves, the rules are meant to make it harder to get and illegally sell the medications for misuse. (Naltrexone, the non-opioid option, doesn’t face similar restrictions.) But the laws and regulations have also helped create an environment in which rehab facilities are more likely to try unproven methods than medication-based treatments with decades of scientific evidence.”
“black women across the country are 320 percent more likely to die from pregnancy-related complications than white women. In Buncombe County, where Asheville is located, black babies were nearly four times as likely as white babies to die before their first birthday. These woeful statistics cut across economic and educational lines, as pregnant black women with a college degree die at five times the rate of their white counterparts. Experts say the causes are complex and bound up with the stress of living in a society that discriminates against people of color—from a lack of diversity in the medical profession to implicit bias in the way providers treat patients. In 2017, the American College of Obstetricians and Gynecologists said maternal health disparities “ cannot be reversed without addressing racial bias,” adding that “structural and institutional racism contribute to and exacerbate these biases.””
“”In a 2012 paper, economists Carmen Reinhart and Kenneth Rogoff define a “debt overhang” as a situation in which the debt-to-GDP ratio exceeds 90 percent for five or more consecutive years. After looking at 26 debt overhangs in 22 advanced economies since 1800, they conclude that “on average, debt levels above 90 percent are associated with growth that is 1.2 percent lower than in other periods (2.3 percent versus 3.5 percent).” These overhangs last a long time—in their sample, the average lasted 23 years—creating a cumulative loss in economic growth that’s “nearly a quarter below that predicted by the trend in lower-debt periods.”
That work has been validated by left-wing economists associated with the University of Massachusetts, who were critiquing an earlier version of Rinehart and Rogoff’s work that had mistakenly found that debt overhangs reduced growth below zero. The critics conclude that “the average real GDP growth rate for countries carrying a public-debt-to-GDP ratio of over 90 percent is actually 2.2 percent.””
We crossed that Rubicon back in 2010″
…
“You don’t have to believe there’s something magical about a 90 percent threshold to grok the idea that unpayable government debt has a negative effect on growth. The people who comprise markets recognize that a day of reckoning will eventually come and government will do some combination of raising taxes, reducing services, or inflating currency. None of those outcomes, and especially the unpredictability they promise, is good for economic growth. Which helps explain why the CBO predicts that average annual growth between 2019 and 2029 will be 1.9 percent. That figure compares to 3.2 percent average annual growth between 1950 and 2018.”
“”When the Justice Department’s Inspector General finds significant concerns regarding flawed surveillance applications concerning the president’s campaign advisors, it is clear that this regime lacks basic safeguards and is in need of serious reform. While the report found that there wasn’t an improper purpose or initiation of the investigation, it also found significant problems that are alarming from a civil liberties perspective. For instance, the litany of problems with the Carter Page surveillance applications demonstrates how the secrecy shrouding the government’s one-sided FISA approval process breeds abuse. The concerns the Inspector General identifies apply to intrusive investigations of others, including especially Muslims, and far better safeguards against abuse are necessary.
The system requires fundamental reforms, and Congress can start by providing defendants subjected to FISA surveillance the opportunity to review the government’s secret submissions. The FBI must also adopt higher standards for investigations involving constitutionally protected sensitive activities, such as political campaigns.””
“the report by Michael Horowitz found 17 “serious performance failures” relating to warrants obtained by the FBI through the Foreign Intelligence Surveillance Amendment (FISA) courts for the purposes of monitoring Page. The FISA warrant, which was reauthorized three times, contained false and misleading information about Page. It omitted that he had previously disclosed his Russian contacts to a government agency; it overstated the government’s confidence in the Christopher Steele dossier and ignored Steele’s own doubts about one of his sources; it declined to mention that Page had said he and Paul Manafort had “literally never met”; and in general it ignored information that rendered unlikely the theory that Page was a Russian asset.
These are alarming failures. They undercut the government’s position that FISA courts are a sufficient guardian of Americans’ civil liberties, and that the FBI is capable of responsibly exercising the vast powers granted to it. No one should feel confident that a court would block the FBI from engaging in surveillance, even if the information was flawed or faulty.”
“the USMCA is an agreement that will increase barriers to trade across North American borders and will impose more managed trade. All trade deals are a form of managed trade, of course, but relative to the standards set by NAFTA, the USMCA seems like a step backward.
The main way the USMCA reduces free trade is in the so-called “rules of origin” that will apply to cars built in North America. In order to cross borders tariff-free, 75 percent of the value of materials within a car or truck will have to be produced in North America. Additionally, 40 percent of the steel used in auto production will have to come from U.S. steel plants. The deal also gives the U.S. government the ability to impose quotas on imported cars from Canada and Mexico. That combination of protectionism and increased federal power over the decisions of private businesses is a major black mark against the deal.”
…
“The intended consequence of several components of the USMCA is to encourage businesses to shift production from Mexico into the United States.”
…
“the unintended consequence of those new rules might be a reduction in manufacturing across all of North America. When it comes to cars, for example, companies might find it cheaper to simply pay the 2.5 percent import tax rather than comply with the new standards to be able to trade duty-free.”
“”I want people to come into our country in the largest numbers ever, but they have to come in legally,” said President Donald Trump during his 2019 State of the Union address. But migrants need a way to do that. At present, those opportunities are few and far between: A low-skilled immigrant from Mexico would have to wait an average of 131 years to successfully immigrate to the U.S.
“If we want illegal immigration to end, Congress has to guarantee farmers a better way to follow the law,” writes Daniel Bier, an immigration policy analyst at the Cato Institute.”
…
“While some worry that these visas displace American workers, U.S. farmers are required by law to offer H-2A positions first to people who can already legally work in the U.S. They seldom find enough takers. The Cornell Farmworker Program found that dairy farmers rely on undocumented workers because they cannot identify a sufficient amount of U.S.-born employees to fill the positions. This might explain why approximately 50 percent of all farmworkers are undocumented immigrants, according to the Department of Agriculture.”