Is There A Democratic Message For Red America?

Morgan Carroll and Jeffrey Feldman made back to back posts on my Facebook feed today posing the same basic question: 

What can Democrats do to win back people in Republican safe zones like the rural Upper Midwest and rural Colorado?

Both acknowledge that the current Democratic party's message isn't reaching people in these places and proceed with humility to figure out if there are ways that Democrats can improve their appeal in Red territory without contradicting their core values. These posts and more importantly, the comments they spawned are worth reading. This is Democratic soul searching at its most sincere.

Nuclear Power Still Safer Than Fossil Fuels and Biomass

Contrary to widespread intuition, nuclear power is still safer than any form of fossil fuel or biomass. This is even worse when global warming related harm is considered. Here's a blurb:

Discussions with regards to energy safety often incite the question of: how many died from the nuclear incidents at Chernobyl and Fukushima? We addressed this question in a separate blog post. In summary: estimates vary but the death toll from Chernobyl is likely to be of the order of tens of thousands. For Fukushima, the majority of deaths are expected to be related to induced stress from the evacuation process (standing at 1600 deaths) rather than from direct radiation exposure. 

As stand-alone events these impacts are large. However, even as isolated, large-impact events, the death toll stands at several orders of magnitude lower than deaths attributed to air pollution from other traditional energy sources—the World Health Organization estimates that 3 million die every year from ambient air pollution, and 4.3 million from indoor air pollution.15 As so often is the case, single events that make headlines overshadow permanent risks that result in silent tragedies.

In fact, coal is worse than nuclear even if one considers only accidental death and non-air based pollution. For example, coal waste which contains trace amounts of radioactive substances, exposes the environment to more radiation than nuclear waste does. Another huge factor in accidental deaths is that the energy density of nuclear fuel is so profoundly greater than fossil fuels that the volumes of materials that have to be extracted and transported for nuclear power plants is much, much lower.

Image from xkcd.

The study does not evaluate hydropower, wind or solar energy sources, each of which produces very little air pollution (mostly just associated with manufacturing these energy sources), but none of which is entirely accidental death free. Many solar energy resources also involve toxic compounds whose production and manufacturing can lead to pollution related deaths.

Making Sour Beer

The science of yeast fermentation in sour beer production is sophisticated stuff explored in a new preprint. There are hundreds of strains of beer yeast and some are particularly well suited to the task.

Mortgage Defaults At Post-Financial Crisis Low

Calculated Risk reports that serious mortgage delinquency is at its lowest level since April 2008, before the Financial Crisis. These rates still haven't quite returned to normal, but they are close:

Maybe the rate will decline another 0.2 to 0.3 percentage points or so to a cycle bottom, but this is pretty close to normal.

The current rate is 0.85%.

The Economy Has Lots Of Money And Few Ideas

One of the strongest signs that our economy is stagnating is that our big businesses are sitting on hundreds of billions of dollars of cash that they can't figure out anything worthwhile to invest in. Tax incentives explain why that money is being held abroad rather than repatriated. But, it doesn't explain why that money is being held in cash instead of being used for direct foreign investment.

Apple, Google and Microsoft are sitting on a mountain of cash -- and most of it is stashed far away from the taxman. Those three tech behemoths held a total of $464 billion in cash at the end of last year, according to a Moody's report published Wednesday. Apple (AAPL, Tech30) alone had a stunning quarter-trillion dollars of cash thanks to years of gigantic profits and few major acquisitions. That's enough money to buy Netflix (NFLX, Tech30) three times. It's also more cash than what's sitting on the balance sheet of every major industry except tech and health care. All told, non-financial U.S. companies studied by Moody's hoarded $1.84 trillion of cash at the end of last year. That's up 11% from 2015 and nearly two and a half times the 2008 level. 

Roughly $1.3 trillion -- 70% of the total -- is being held overseas, where the money isn't subject to U.S. taxes. Apple, Google owner Alphabet (GOOGL, Tech30), Microsoft (MSFT, Tech30), Cisco (CSCO, Tech30) and Oracle (ORCL, Tech30) hold 88% of their cash overseas. Moody's said the tower of money stashed abroad reflects the "negative tax consequences of permanently repatriating money to the U.S." . . .

[C]orporations' reluctance to spend that money is holding the recovery back. Cash sitting on the balance sheet is money that isn't being put to work on job-creating investments like new factories. Despite their swelling coffers, capital spending by U.S. companies plunged by 18% last year to $727 billion, according to Moody's. Much of that decline was because of a downturn in the oil industry, which forced energy companies to preserve cash by delaying investments. Spending on dividends, stock buybacks and even acquisitions also declined last year, Moody's said.

What Do Baby Mamas See In Ex-Cons?

The Typical Colorado Former Inmate

Consider a typical Colorado former prison inmate.

Like 90% of Colorado prison inmates, he is male. Like a plurality of Colorado prison inmates, he is white. All three racial/ethnic categories are common in Colorado prisons. "Colorado's inmates are 45% Anglo, 32% Hispanic, 20% African American, 3% Native American and 1% Asian. Colorado as a whole is 71% Anglo, 20% Hispanic, 4% African American, 1% Native American and 3% Asian." But, he is a United States citizen who was born in the United States.

Most Colorado prison inmates aren't just people who committed a crime, they are actually criminals. Like most male Colorado prison inmates, he was convicted of some sort of crime of violence or sex offense. He pleaded guilty to the offense and has probably spent at least five years of his adult life in prison. He has been incarcerated more than once, although some of his prior periods of incarceration were as a juvenile and in a local jail for a misdemeanor. And, he has spent some time on probation and parole. 

Like 40% of Colorado prison inmates (and a larger percentage of male inmates) he is associated with a criminal gang and like many "marginal" gang members first joined it while incarcerated when he needed the protection from other inmates that it offered.

His anti-social behavior isn't new. It has a lot to do with why he didn't graduate from high school and was already discernible when he was in middle school. 

Like 82% of Colorado prison inmates of both genders, he has a moderate to severe substance abuse problem (i.e. he is an alcoholic and/or a drug abuser). He was probably under the influence of marijuana or cocaine when he was arrested. He experienced a traumatic brain injury that has had a negative impact on his behavior at some point. 

His family wasn't affluent or well educated. His parents were briefly married, but they aren't married now. He's never been married himself.

Like the median Colorado inmate, he has a few minor job skills but they are inadequate in the current job market. He did not graduate from high school but did earn his GED while in prison. He was a below average IQ but not low enough to count as developmentally disabled. He isn't registered to vote, even though he's now eligible to register to vote because he completed his most recent parole. He is not a military veteran. He is frequently and intermittently unemployed, in part due to poor behavior on the job, and he doesn't get paid much when he does work. Economically, as men in Colorado go, he is one of the worst providers there is.

What Is Remarkable About The Typical Colorado Former Inmate?

The point of all of this is not to beat an old drum. The point of this is to highly something that is remarkable.

What is it? 

This typical Colorado inmate will have, on average, as many children over the course of his lifetime as the average man in Colorado with no criminal record, although he will have his children either too early to be socially acceptable, or in middle age, after he has "aged out" of the criminal justice system, or both. Demographers talk about "make up fertility" on the part of released felons.

In all likelihood he won't marry the mother of his children, and if he does, he will in all likelihood end up divorced in fairly short order. But, despite the fact that about 15% of men never have children, he isn't any more likely to be one of them than anyone else.

It is hard to imagine a less attractive mate for a woman than a typical, middle aged ex-con, yet these men nonetheless manage to find women who are willing to bear their children on a very consistent basis. And, there is no reason to think that this is anything other than an at least tacit choice of a mother who chose to bear a child when she get pregnant in an era when a variety of birth control methods are available, there is a "day after pill" that can prevent conception if there is an "accident" and abortion is also available. The instantly observable social and interpersonal tells of social class are also strong enough that few women are going to deeply mismeasure the fact that they are entering into a relationship with a "bad boy" even if they don't know all of the details of his sordid past and all of his personal idiosyncratic flaws.

There are a few saints who go to prison based upon wrongful convictions or who make a horrible, uncharacteristic, once in a lifetime mistake for understandable but unjustified reasons. But, for the most part, the path to prison is paved with a lot of personal baggage that also makes a typical ex-con both a criminal and a pretty undesirable partner in many other respects. 

Not only is he not the model partner and likely to leave her, in addition he often puts his baby mama or her children at risk of becoming victims of domestic violence, of being collateral damage inflicted by others against his loved ones as a result of his criminal activity, and may drag her into criminal liability herself from actions that flow mostly from the fact that she is in a relationship with him. If you want to absorb those risks in a presentation unclouded by racial confounds, go see the movie Baby Driver.

Yet, nonetheless, these men find girlfriends and those girlfriends have their children, although usually in a fairly short relationship (perhaps because that makes it less likely that she will discover the less desirable aspects of his character). The young male protagonist in Baby Driver in involved in a lot of violent criminal activity and gets a deserved (but mild as a result of his youth and virtues) punishment, but he still manages to win over a down on her luck young woman anyway.

In my mind, the fact that this happens anyway is a pretty remarkable mystery that doesn't have an adequate answer yet in the social science. 

There is a cad v. dad debate in the social sciences, which suggests some reasons that those baby mamas tend to be young. And, some researchers blame it on irrational hormonal motivations (also here). But, those debates hinge on assuming that the cad is sexy and exciting, and while some "original Gs" may be able to pull that off, there are also many typical former Colorado inmates for whom you'd be putting lipstick on a pig to call sexy and exciting. As one paper in the field summarized the hypothesis:

Recent studies indicate that for long-term relationships, women seek partners with the ability and willingness to sustain paternal investment in extended relationships. For short-term relationships, women choose partners whose features indicate high genetic quality.

It is hard to characterize the typical former inmate described above as someone of "high genetic quality" in the modern world where brains, self-discipline and an ability to play well with others is everything. Yet, somehow, women don't steer clear of these men and trust them to be fathers of their children anyway. Somehow, hormones steer a significant number of women towards bad boys even when they aren't of high genetic quality by modern standards.

Perhaps the best answer may be the evolutionary psychology hypothesis that today's brutes, while highly dysfunctional in modern society, are the kind of men who were selectively fit in the less civilized past when our instincts and hard wired predispositions were established. In our dim evolutionary pre-history, violent and ruthless men survived, while wimps, no matter how smart and well socialized, died.

But, it is hard to know if this is a real reason or merely a "just so story."

An alternative possibility is that assortive mating is a powerful social force and that in a highly stratified market for partners and prospective co-parents, for women at the bottom of the heap themselves who have only everyone else's left overs to pick from, a bottom of the heap man who manages to stay out of prison may not be all that much more desirable as a partner than one who goes to prison, so the marginal comparison she faces may not be as steep as the profile above, implicitly comparing the typical former prison inmate to the "average" man in the community would suggest.

The trouble with this hypothesis is that it is somewhat implausible to think that even if men are picky in choosing their primary partner, that it is so much harder to a low status woman to be a mistress of a much higher status man than to be the abandoned lover of a very low status former inmate. And, why should it matter to her if she will probably end up as a single mother either way? But, perhaps a perceived greater possibility that she might win permanent status as the primary partner of the lower status man makes it worthwhile for her to settle for him, even if often doesn't work out with him either, and perhaps she might feel she has more in common with him as a fellow inhabitant of the lowest social stratum.

An Aside For Another Day

It is also worth noting, as an aside for another day, that the people who end up becoming criminals are overwhelmingly the least economically fit members of our society, and that in the lion's share of cases, the motivations for crime are economic ones.

Criminal gangs exist and are so common among criminals, in addition to serving as a means of mutual self-defense in under-regulated prison environments, because they act as firms that make most of their money these days selling vice in unsavory black markets (usually illegal drugs and prostitution), as alternatives like theft and extortion has grown less profitable, gambling has been legalized, and loan sharking is less attractive because there are legitimate alternatives.

Military Service Rate By Age In The United States

Age	Veterans	Population	Percentage
15-19	9,336	22,040,343	0.0%
20-24	274,267	21,585,999	1.3%
25-29	727,317	21,101,849	3.4%
30-34	947,542	19,962,099	4.7%
35-39	1,029,734	20,179,642	5.1%
40-44	997,732	20,890,964	4.8%
45-49	1,335,345	22,708,591	5.9%
50-54	1,552,125	22,298,125	7.0%
55-59	1,822,557	19,664,805	9.3%
60-64	1,892,668	16,817,924	11.3%
65-69	2,308,351	12,435,263	18.6%
70-74	2,593,253	9,278,166	28.0%
75-79	1,568,156	7,317,795	21.4%
80-84	1,287,067	5,743,327	22.4%
85+	1,653,351	5,493,433	30.1%

Population figures from the Census Bureau (2010). Veterans from the Veteran's Administration (September 2016). There is a modest error introduced by the lack of time matching of the population cohorts to the veteran cohorts, although it does not have much effect on the percentages.

The populations shown are for men and women combined. The rate for men is roughly 1.7 time the total in younger cohorts. The rate for women is roughly 0.3 times the total in younger cohorts. In older cohorts, the proportion of veterans who are men is higher and the male share of the total population is lower.

The rate of military service for men under age 45 is less than 10%, while a majority of men age 70 and older served in the military.

Are There Really 15,500 Transgender Individuals In Current Military Service?

A Denver Post story in reaction to President Trump's ban on transgender individuals serving in the military states that:

Transgender people are banned from the military, yet an estimated 15,500 are serving.

This is probably greatly exaggerated and is probably at least an order of magnitude too high. The Denver Post's source, however, is disclosed and can be examined. The basic problem is that neither of its core data sources, Gates (2011) for the overall prevalence of transgender individuals in the general population, and the National Transgender Discrimination Survey (NTDS) from 2008 (whose respondents are all gender non-conforming and are part of a large convenience sample with no demographic information on respondents' ages), are particularly precise sources of data. The NTDS Survey isn't really designed to provide information that fits the needs of the Williams Institute, although isn't a horrible place to look for a rough estimate.

The Denver Post's estimate is based upon this report from the Williams Institute, which clarifies that this is out of activity duty, reserves and national guard. This is broken out as:

7,300 Active Duty (assigned male)
1,300 Active Duty (assigned female)
5,300 Guard/Reserves (assigned male)
1,400 Guard/Reserves (assigned female).

As I noted in a previous post on the topic (relying on data cited here):

The DSM-IV (1994) quotes prevalence of roughly 1 in 30,000 assigned males and 1 in 100,000 assigned females seek sex reassignment surgery in the USA. The most reliable population based estimate of the incidence occurrence is from the Amsterdam Gender Dysphoria Clinic. The data, spanning more than four decades in which the clinic has treated roughly 95% of Dutch transsexuals, gives figures of 1:10,000 assigned males and 1:30,000 assigned females. 

In September 2007 however, Olyslager and Conway presented a paper at the WPATH 20th International Symposium demonstrating that the data from this and similar studies actually implies much higher prevalence rates, with minimum lower bounds of 1:4,500 assigned males and 1:8,000 assigned females across a number of countries worldwide. They also present other evidence suggesting the actual prevalence might be as high as 1:500 births overall.

My source has been updated since my last post to add this point:

The most recent (2016) systematic review of prevalence, leading to a meta-analysis of 27 studies, found estimates per 100,000 population of 9.2 (95% CI = 4.9–13.6) for surgical or hormonal gender affirmation therapy and 6.8 (95% CI = 4.6–9.1) for transgender-related diagnoses. Of studies assessing self-reported transgender identity, prevalence was 871 (95% CI = 519–1,224); however, this result was influenced by a single outlier study. After removal of that study, the figure dropped to 355 (95% CI = 144–566). Significant heterogeneity was observed in most analyses.

This is 1 per 114 people with the outlier study, and one per 288 people without the outlier study, and with the self-reported surveys producing much higher estimates than estimates based upon therapy or third-party diagnostic related estimates.

The Williams Institute relies on "Gates (2011) estimates that approximately 700,000 adults in the US are transgender.", and on the NTDS survey result that "this group is 60% male assigned at birth and 40% female assigned at birth". The adult U.S. population in 2011 was 237,801,767. So, Gates is estimating that 1 in 340 adult Americans is transgender, which is probably significantly too high. Likewise, the assigned male to assigned female ratio of 60-40 in NTDS is probably low relative to other more reliable estimation efforts. 

The Williams Institute footnotes this conclusion from Gates (2011) as follows:

Estimates of the size of the transgender population from national population-based surveys do not exist. This estimate is based on two state-level population-based surveys in which questions regarding transgender status implied a gender transition or at least discordance between sex at birth and current gender presentation.

There are currently 1,219,510 personnel classified as male in active duty U.S. military service and 210,485 personnel classified as female in active duty U.S. military service.

If the Williams Institute figures are correct then 1 in 167 people assigned as male in the U.S. active duty military is transgender and 1 in 162 people assigned as female in the U.S. active duty military is transgender. This is about 3 times the rate at which individuals are transgender in the highest credible estimate for the general population. It is a rate 27 times higher for assigned males and 49 times higher for assigned females than a more conservative minimum lower bound for prevalence of transgender individuals in the general population.

The Williams Institute estimate is also notable for showing no assigned gender disparity, when all of the conservative estimates show that assigned males are two to three times as likely to be transgender as assigned females.

Now, admittedly, the military is not a random sample of the general population. For example, the number of high school graduates enroll in higher education is about ten times as great as the number of people who will ultimately enlist in the military for any given cohort of high school graduates (admittedly the numbers do not fully overlap). This is about 4-5 to one for men and about 30-1 for women.

Since the military is one of the most traditionally masculine pursuits, it makes sense that transgender individuals assigned as female who are not able to medically transition would enlist at higher rates than similarly situated transgender individuals assigned as male, so the lack of the prevalence distinction in the Williams Institute report between assigned males and assigned males that is found in the general population isn't necessarily something that discredits its data.

But, given that the military is also well known to be an institution that has been hostile to LGBT individuals and that the active duty service affords the least opportunity to conceal one's gender identity, it is surprising to see a prevalence of transgender presence in the active duty military that is three times the highest credible estimate of prevalence in the general population. Naively, one would expect a lower prevalence than in the general population with a rate of 1 per 1,000 or so, which would imply that there were about 1,220 assigned males and 210 assigned females in the U.S. military who were transgender, for a total of about 1,430 or less than 10% of the numbers estimated by the Williams Institute.

The methodology suggests that the estimate is overstated because the survey is not a random sample and is probably biased towards people who LGBT gender identities. According to the Williams Institute:

The primary data source for the estimates of transgender military service is the NationalTransgender Discrimination Survey (NTDS), which was conducted by the National Gay and Lesbian Task Force and the National Center for Transgender Equality. This 70-item survey was distributed in cooperation with over 900 organizations across the United States and also was announced through listservs and online communities. It was made available both online and on paper in English and Spanish. The survey was fielded over six months beginning in fall 2008 and resulted in 6,546 valid responses, which is the largest sample of transgender people in the US to date. . . . 

As a purposive sample of transgender adults in the US, estimates derived directly from the NTDS could be biased if the true demographic characteristics of the transgender population differ from the characteristics of transgender respondents to the survey. For example, relative to the US population, NTDS respondents are younger and report higher levels of education. Both factors would be associated with lower levels of lifetime military service. Given the lack of demographic data on the transgender population derived from population-based sources, it is not possible to determine if the age and educational attainment levels of NTDS respondents are different from the general US population because younger and more educated transgender individuals were more likely than others to have completed the survey (known as selection bias) or if transgender individuals are, in fact, younger and more likely to have higher levels of education compared to the general population.  

More than 93% of NTDS respondents provided information using an online web-based survey. 

The primary risk is that survey respondents to a 70 question online survey announced on listservs and online communities in the fall of 2008 overstates has a higher proportion of LGBT respondents than the general public. Indeed, this is almost certainly the case.

The report goes on to state that:

In the US, approximately 5.8% of all adults who have ever served in the armed forces are currently on active duty and 4.4% are now serving in the Guard or Reserve. An estimated 86.8% are veterans who served on active duty in the past and 3.0% are retired from Guard or Reserve service.  

The number of transgender adults in each category is estimated by applying these same proportions to the estimated number of transgender individuals who report any service in the armed forces. 

Transgender military service 

Analyses of the unadjusted NTDS data show that 29.6% of respondents assigned male at birth reported that they have served in the armed forces along with 6.0% of those assigned female at birth. In total, 20% of NTDS respondents reported some type of military service. Assuming NTDS reported rates of military service are true of the transgender population in the US, Figure 2 shows adjusted estimates of military service for the transgender population (separated by sex assigned at birth) and for adult men and women in the US. When figures are adjusted such that the age and educational patterns of the US adult male and female population are applied to the NTDS sample, an estimated 21.4% of transgender individuals have served in the military. The adjusted estimates suggest that 32.0% of those assigned male at birth and 5.5% of those assigned female at birth have served.

By comparison, in the general population "1.4 percent of all female Americans have ever served in the armed services, compared to 13.4 percent of all male Americans." (The Williams Institute study claims that 19.7% of adult men and 1.7% of adult women have served, with a combined 10.4% of all adults, and does not make an age adjusted comparison of military service rates to its sample's demographics despite the fact that military service rates for people under age 45 who are disproportionately represented in their data source are less than half as likely to have served in the military.) It is also surprising giving the educational level of the respondents which significantly exceeds that of the general population since people with college educations are less likely to have served in the military than members of the general public.

Thus, if the Williams Institute data is accurate, transgender individuals assigned as male at birth are about 2.2 times as likely to serve in the military as members of the general population and transgender individuals assigned as female at birth are about 4 times as likely to serve in the military as members of the general population.

Keep in mind that for most of the period from 1940 to 1973, there was a draft in place for men, so many people served in the military involuntarily. For example, about 2.2 million of the men who served in the Vietnam War were drafted, 1.5 million of the men who served in the Korean War were drafted, and 10 million of the men who served in World War II were drafted. There were also significant numbers of interwar conscripts. These numbers compare to 22 million people alive today who are military veterans, although, of course, some people who were conscripted for military service from 1940 to 1973 are no longer living.

Conscription makes it relatively less likely that there would be a huge difference between the likelihood that transgender individuals assigned as male who served in the military than non-transgender individuals during the period from 1940 to 1973.

Also, the NTDS sample is younger than the gender public, yet the percentage of young people who have served in the U.S. military is significantly lower than the percentage of all people who have served in the U.S. military.

Using data from the Census and the Veteran's Administration it is clear that rate of military service for men under the age of 45 is well under 10%. So, the NTDS survey suggests that transgender individuals assigned as male have an age adjusted military service rate about three times as great as members of the general public.

In its defense, the Williams Institute does offer some corroboration of its counterintuitive conclusion that transgender individuals are much more likely to enlist in the military than the general population. It states:

There is other evidence that transgender individuals represent a larger portion of those in the military than their proportion among adults in the US population. In a survey of transgender people assigned male at birth, Shipherd et al. found that 30 percent had served in the military, which is similar to military service among transgender people assigned male at birth in the NTDS. A recent study by Blosnich et al. reviewed all health records of veterans receiving health care through the Veterans Health Administration (VHA) from 2000 through 2011 and found a prevalence of Gender Identity Disorder (GID) five times that of the US general population. Though individuals with GID diagnoses may or may not identify as transgender, the substantially higher prevalence of GID among veterans in the VHA system provides further evidence that transgender people are overrepresented in the US military. 

But, even if the enlistment rate is much higher for transgender individuals than for non-transgender individuals, the estimated prevalence of transgender individuals in the general population from Gates (2011) is almost surely an overestimate.

While this is not impossible, it is very unlikely that there are really 15,500 transgender individuals serving in the active duty military today. It is far more likely that respondents are either atypical of the gender population with regard to military service, perhaps due to the way that survey respondents were recruited, or that they are simply not accurate in their reporting of their military service (as over reporting of all kinds of events is a common problem in survey based studies).

Thus, to get to a 15,500 active duty transgender soldiers in the U.S. military, you need to assume somewhat more than the highest credible estimate of the prevalence of transgender people in the general population and a military enlistment rate for transgender individuals that is three times that of the general population for individuals of a comparable age, as the NTDS sample suggested.

Neither of these assumptions is likely to be true, and while this makes the decision to bar transgender individuals from military service look like it harms more people than it actually does, it also dramatically exaggerates the likely cost of accommodating transgender individuals in military service. 

The estimate also fails to distinguish between individuals who are transgender but "in the closet" and those who are "out". The number of "out" transgender soldiers in the U.S. military appears to be much lower (e.g. there appears to be only one "out" transgender soldier in all of Fort Carson in Colorado). Realistically, there are probably several dozen to a couple hundred "out" transgender individuals serving in the U.S. military. Obviously, military policies on whether transgender individuals are allowed to serve in the military influences this (and they were only allowed to do so late in the Obama Administration).

Ireland Leads U.S. In Some Technologies

Witness A Recent Picture of a Vending Machine In Belfast, Ireland and Weep

California On Brink Of Adopting Model Rules Of Professional Responsibility

Currently, California and Maine are the only states in the United States not to have legal ethics rules based on the American Bar Association's Model Rules of Professional Conduct, or on the predecessor Model Code.

But, a replacement has been prepared and vetted through almost all of the proper authorities as of this past March of 2017, and all that stands between California replacing its legal ethics rules with a version based on the Model Rules of Professional Conduct now is a final vote of the California Supreme Court. Some provisions of the new rules are California specific but they are placed in the context of a national framework of ethical rules for lawyers.

The West Is Losing Faith In Democracy

Citizens in a number of supposedly consolidated democracies in North America and Western Europe have not only grown more critical of their political leaders. Rather, they have also become more cynical about the value of democracy as a political system, less hopeful that anything they do might influence public policy, and more willing to express support for authoritarian alternatives. The crisis of democratic legitimacy extends across a much wider set of indicators than previously appreciated. 

From the Journal of Democracy.

About 75% of Americans born in the 1930s think that it is essential to live in a country that was governed democratically (the comparable number is a bit over 50% in Europe). As people in the U.S. get younger this support wanes, with only 30% of people born in the 1980s agreeing. In Europe, support for democracy peaks in people born in the 1950s at about 57% (which is identical to the U.S. figure), and is about 45% for Europeans born in the 1980s.

Distrust of democracy is significantly higher as of 2011 than it was in the mid-1990s in both Europe and the United States. Now, almost a quarter of adults under 25 years old in the U.S., and about one in eight adults under 25 years old in Europe, actively believe that "Having a democratic political system" is a "bad" or "very bad" way to "run the country."

Support for authoritarianism increased among low and middle income respondents in the U.S. from 1995 to 2000, but then stayed fairly steady from 2000 to 2010 (it is currently about 32%). But, support for authoritarianism has steadily soared among upper income respondents in the U.S. from 1995 to 2010 from 20% to 35%.

STEM, Attrition and Readiness

Barbie wasn't wrong. Math is hard. Weak mathematics background is the greatest barrier to successful completion of a college education at all levels, and STEM classes are failed at a higher rate than any other kind of course in the college curriculum. This post lays out those facts without engaging in the question that naturally follows: "Should mathematics and STEM requirements be waived for students in non-STEM fields, at least at the community college level?"

It is a question about which I have a lot of ambivalence, particularly because it is possible to remediate poor mathematics instruction, which involves a very narrow set of information and skills, to a much greater extent that it is to remediate weak reading and writing skills, which involve a broader base of knowledge and abilities.

Algebra is one of the biggest hurdles to getting a high school or college degree — particularly for students of color and first-generation undergrads. It is also the single most failed course in community colleges across the country. . . . At American community colleges, 60 percent of those enrolled are required to take at least one math course. Most — nearly 80 percent — never complete that requirement.

From here.

Only about 25% of community college students in Colorado receive a degree (typically a two year program) or certificate (often a less than two year program) in three years, despite the lower achievement threshold involved than a bachelor's degree, and at the Community College of Denver the graduation rate is half that. Most community college students need remedial work before advancing to college level work, and their ultimate prospects of getting a degree are particularly low.

From an October 7, 2016 post at this blog.

The predominant reason that high school graduates are unprepared for college level work is that they need remedial mathematics instruction.

Many who do go to college need remedial work when they get there (a long standing issues that has been discussed before at this blog). The numbers describing Colorado students who started college in the fall of 2008 tell the story. 

Of those starting two year college: 

52.7% needed remedial help in math, reading or writing.

40% needed remedial help in math.

17% needed remedial help in math, reading and writing. 

Of those starting four year college: 

19% needed help in math, reading, or writing.

16% needed help in math. 

Thus, math is the dominant subject in which high school graduates need remedial work. While 40% of those starting two year college need remedial work in math, just 12.7% of those starting two year college need remedial work in reading and/or writing but not math . . . . While 16% of those starting four year college need remedial work in math, just 3% of those starting four year college need remedial work in reading and/or writing, but not math.

From a February 9, 2010 post at this blog. See also a February 15, 2011 post at this blog covering in depth the following year's similar remediation report, and a December 31, 2008 post on the subject of remedial courses for college students.

Students who need remedial work in mathematics are much, much less likely to graduate than those who do not, in part, because of the remediation requirement which slows down the process of getting into real college work and is simply insurmountable for some students, and in part, because it is a litmus test for poor preparation for college and low academic ability in general.

But, it certainly isn't entirely about IQ. For example, in the early 2000s, among students identified as "gifted and talented" (i.e. in the 98th percentile of better on standardized tests) by the Denver Public Schools, some high schools sent almost all to college without needing remediation, while others had less than 19% of its gifting and talented students achieve this feat. Weak high school instructional opportunities did hold back even gifted and talented students.

The likelihood that a student will meet a community college math requirement is closely tied to how far along a student was before attending community college.

In four year colleges, calculus, physics and chemistry are probably the two most failed classes, with failure rates for students enrolled in those courses often at around 50%. Many students who are interested in pursuing STEM careers when they leave high school ultimately abandon that idea: about 40% of incoming students who plan on entering science and engineering majors at the outset, and about 60% of pre-med students change majors or don't graduate.

STEM is hard. There are right and wrong answers. There is no room for the benefit of the doubt. And, there is empirical evidence that below a certain threshold of ability (however acquired) at the outset of a college career that hard work doesn't help enough to allow you to succeed as a STEM major.

Linking To Infringing Materials Is Not A Copyright Violation

The record is clear that Defendant neither stored nor posted the videos on its website. Instead, third party websites self-evidently did so: the first video is stored on YouTube and the other two on www.elocallink.tv website. Defendant merely linked to those videos on its website, and the links, when clicked, direct users to YouTube and www.elocallink.tv websites. Defendant does not copy, display, or encourage the users to share the videos on its website; although the third party websites appear to do so. More critically, and relatedly, Plaintiffs cannot establish on the facts adduced here that, by merely linking to those videos, without anything more, Defendant displayed the videos publicly.

Nakada + Associates, Inc. v. City of El Monte, 2017 WL 2469977 (C.D. Cal. June 2, 2017).

Americans Are Having Sex Less Often

According to a recent study published in the Archives of Sexual Behavior, a large general social survey found that American adults had sex about nine fewer times per year in the early 2010s than they did in the late 1990s, a decline that wasn't explained by longer work hours or increased use of pornography.

From CNN.

The theories about why this is happening in the linked article are basically rubbish.

A more plausible theory is that (1) there is lots of empirical evidence to show that married people have sex much more frequently than people who are not married, and (2) marriage rates have been falling significantly in the relevant time period (divorce rates have fallen too in that time period, but less quickly). This hypothesis is supported by the fact that the magnitude of the reduction in the rate at which people are having sex is consistent with what one would expect from this hypothesis.

Why do married people have more sex? 

Mostly, because a lot less effort goes into making it happen. You have a partner and a place to have sex lined up all the time when you are married. But, when you aren't, considerable effort has to be expended to do so. Cohabiting couples may be similarly situated, but cohabitation is less stable than marriage, on average. So, people who aren't married spend a smaller percentage of the time, on average, not cohabiting with a sexual partner than married people do.

Presidential Obstruction Of Justice

What does it mean for a President to obstruct justice?

Federal obstruction of justice statutes bar anyone from interfering with law enforcement, including official investigations, based on a “corrupt” motive. But what about the president of the United States? 

The president is vested with “executive power,” which includes the power to control federal law enforcement. A possible view is that the statutes do not apply to the president because if they did they would violate the president’s constitutional power. However, we argue that the obstruction of justice statutes are best interpreted to apply to the president, and that the president obstructs justice when his motive for intervening in an investigation is to further personal or narrowly partisan interests, rather than to advance the public good.

Daniel Jacob Hemel and Eric A. Posner, "Presidential Obstruction of Justice" SSRN (July 18, 2017) (emphasis and paragraph break added).

Another concept that really ought to enter constitutional law is that the executive branch is not unitary (something also well established in French political theory that conceptualizes the civil service as one of the major branches of government).

There are independent agencies designed by Congress with the consent of the Presidency that are insulated, by design, from the direct control of the President. There is also a division between the political leadership made up of Plum Book officials and the civil service that is made up of employees and contractors selected on a merit system who can only be removed from office for cause or via impeachment. And, there are ethical obligations owed by all public officials, to the entity, the United States government and the United States Constitution, and not to the individual, the currently incumbent President of the United States.

Once the executive branch of the United States government is disaggregated in this fashion, the notion that a President can obstruct justice by taking efforts to interfere with the criminal justice functions of the civil service, not as a matter of policy, but for personal or partisan gain, becomes much more clear and free of paradoxes.

Trump And Mainline Christians

The evidence is reasonably clear that places with more mainline Christians supported Trump more than they supported Romney, while places with more Roman Catholics supported Romney more than they supported Trump.

The trends were not monolithic, however.

Denominations whose members favored Trump more than Romney:

1. ELCA Lutherans (1.85)

2. Missouri Synod Lutherans (1.26)

3. Disciples of Christ (1.14)

4. Nazarene (0.81)

5. American Baptists (i.e. Northern Baptists) (0.76)

6. United Methodist Church (0.64)

7. Southern Baptists (0.28)

Denominations whose members favored Romney more than Trump:

1. Mormons (-10.61)

2. Presbyterian Church in American (Southern Presbyterians) (-2.01)

3. Non-Denominational Christians (-1.49)

4. Roman Catholics (-0.98)

5. Assemblies of God (-0.56)

6. Presbyterian Church USA (Northern Presbyterians) (-0.50).

The Mormon case is fairly clear. Romney was a Mormon and Mormon leaders mobilized around Trump's immorality, in part, by offering a third-party candidate who was a Mormon establishment Republican.

Roman Catholics had the comfort of knowing that Romney had been a Governor of a state with a large Roman Catholic population who was a moderate who created the model for Obamacare, while the Pope himself offered cues that Trump was a man to avoid.

What is going on with Lutherans? More plausibly, Lutherans are heavily concentrated in the Rust Belt and in rural areas, as are Disciples of Christ, Nazarenes, Baptists (of all types) and Methodists (although less intensely).

The Romney v. Trump leanings of Non-Denominational Christians and Assemblies of God and to a lesser extent Presbyterians may reflect church groupings that are less likely to be in the Rust Belt and more likely to be urban or at least suburban.

Non-Denominational Churches are something of a cypher, tending to organize in suburban megachurches, tending to de-emphasize any denominational-like creed, favoring contemporary music, and not very prominent in politics. Perhaps equally important, non-denominational churches may be less distant from day to day life and have members less prone to see themselves as culturally marginalized by elites. They didn't share the tribal cultural resentment that motivated other Trump voters (such as the rural Ohio voters near where my father grew up which was thick with Trump signs at every little family farmhouse). Non-denominational churches may lean Evangelical in their theology (and disproportionately made up of former Evangelical denomination members), but they tend to emphasize the prosperity Gospel more than derision of gays and anti-abortion causes, for example.

Still, I would have been hard pressed to predict the actually observed patterns which aren't a good match to the traditional division of white Christians into mainline, Roman Catholic and Evangelical factions. Likewise, there is no coherent "high church, low church" pattern. Many denominations historically split into mainline and Evangelical denominations (Lutherans, Presbyterians, Baptists, and arguably Nazarene/Disciples of Christ) spoke with one voice in the 2016 election, rather than following the liberal or conservative lead of their denomination.

Overall, in the 2016 election, religious affiliation looks like an ancestrally informative marker illuminating other factors that were really driving electoral choices, rather than a cause for how people voted, with the clear exception of Mormons. And, indeed, sliced and diced this way, it is even hard to see the trend so obvious in other examinations of voting statistics that show racist attitudes as a critical factor in Trump support.

At a minimum, however, the linked article's conclusion that the left might benefit from more mainline church attendance seems to spit in the face of the data collected, which would seem to show that the many mainline Christians far preferred Trump to Romney. At best, one could argue that the widespread abandonment of mainline denominations in favor of a non-religious worldview, has left those who remain in mainline denominations more conservative on average (something offset by the consistently very liberal political leanings of the non-religious people who leave mainline Christianity).

CFPB Bars Bans On Class Actions In Consumer Financial Products Arbitration Agreements

Administration efforts to stop new regulations promulgated under the Obama Administration failed to stop a major new Consumer Financial Protection Board regulations limiting arbitration clauses. It also requires disclosures about consumer financial products arbitrations to be shared with the CFPB.

Today the Consumer Financial Protection Board issued its final rule on arbitration agreements. Here’s the full 775-page document (the text of the regulation itself begins at p.747). 

From the summary: 

First, the final rule prohibits covered providers of certain consumer financial products and services from using an agreement with a consumer that provides for arbitration of any future dispute between the parties to bar the consumer from filing or participating in a class action concerning the covered consumer financial product or service. Second, the final rule requires covered providers that are involved in an arbitration pursuant to a pre-dispute arbitration agreement to submit specified arbitral records to the Bureau and also to submit specified court records. The Bureau is also adopting official interpretations to the regulation.

From the Civil Procedure and Federal Courts blog on Monday, July 10, 2017.

Colorado and U.S. Supreme Courts On Vacation

The Colorado Supreme Court will not be releasing any case announcements until Monday, July 31, 2017, no later than 10 a.m. However, no new opinions will be announced on that date.

From here.

The U.S. Supreme Court has also finished its most recent time and won't be issuing any opinions for a while, except for emergency stay motions.

Cancer Takes Leading Mathematician At Age 40

Maryam Mirzakhani, the world's first female Fields Medal winner and Persia's first winner of that award, died of breast cancer at an American hospital [on July 15, 2017].     . . .  

Her medal was mostly for her work on the moduli spaces of Riemann surfaces, especially for her 2007 proof of a formula for volumes of the moduli spaces (previously conjectured by Witten, Kontsevich, guys of this caliber are normal in that field). However, she has done lots of related mathematical work that was usually focusing on the modular group, moduli spaces, and geodesics – which were sometimes shown to be ergodic, sometimes very regular and not chaotic, and similar issues were relevant.

- An obituary post from an acquaintance of her and her Czech husband who survives her is here.

Belated Birthday

This blog turned 13 years old earlier this month.

The Religions Of Game Of Thrones

Game of Thrones is the ultimate world building fantasy series, and religion is no exception. In honor of it opening of a 7th and penultimate season, here is a link to an explanation of the religions of this world. The article identifies eleven of them.

An Alternative Reconstruction

The Reconstruction period after the Civil War was mostly a failure. It failed to reform the American South into a society that renounced its past. Could it have been done better?

What if everyone who had owned a slave forfeited all of his real estate and livestock for reparations and was disenfranchised for life? What if every freed slave family had been given 40 acres and a mule paid for with those reparations?

What if every Confederate military officer, elected official, political appointee, and judge was executed and forfeited all of his property? What if most of their widows had ended up married to carpet baggers who put down roots for good in the South?

What if every Confederate soldier who was not executed, forfeited all of his real estate, was disenfranchised, barred from owning firearms for life and barred from receiving any form of government benefit for life from any level of government, no matter how severely disabled her was?

What if every church that had preached in support of slavery was burned to the ground and every minister that had preached that hate was exiled to the Utah desert on foot in an undernourished long march?

What if Plessy v. Ferguson, had held that separate was inherently unequal and the Slaughter House Cases had not gutted the privileges and immunities clause?

Would that have been enough to end the poisonous culture that continues to be a blight on the United States and the world? Surely, our nations future would have been more auspicious, if we had taken a harder line.

Nutjob Runs For Colorado Governor On Unity Party Ticket

Colorado's latest third party, the Unity Party, is apparently intent on winning the vote of people who are higher than kites given their nominee in the Governor's race this year.

He wants to abolish Colorado's income tax, bring back firing squads, and conquer part of Mexico, and Bill Hammons could be the third name on your ballot for Governor in November. 

Hammons is the head of Colorado's newest political party: The Unity Party. Secretary of State Wayne Williams made it official last month, once it passed the 1,000-voter mark and gave them party status. 

Part of his plan includes having Colorado secede from the Union, join New Mexico and California to form a new nation, and then take over parts of Mexico. That is not a party priority, but it is Hammons' position.

On the upside, he's so obviously far out in ways that neither Republicans nor Democrats are at peace with, that he'll probably insure that the third party vote doesn't impact the outcome of the Governor's race in 2018.

Second Quote Of The Day

Sometimes the best thing an academic can do is admit that a project is never going to amount to anything and pull the plug. When that happens, I recommend permanent file deletion of all relevant materials so as to eliminate the temptation to try to resuscitate it. Shred any paper documents. 

Kill it. Burn the carcass.

And move on.

- Professor Bainbridge.

Quote Of The Day

The wheezes used to avoid paying the tax are, of course, manifold.

From this article by Andrew Gilligan writing for The Telegraph newspaper on October 24, 2014.

Scent Of Marijuana Does Not Constitute Probable Cause In Colorado

There are three judges on a panel of the Colorado Court of Appeals, in a somewhat complicated ruling, hold that bringing a trained drug dog to sniff a car requires reasonable suspicion (the same level of belief that a crime is committed necessary for a traffic stop) and that if the dog is trained to detect marijuana, which is legal in Colorado, that a dog alert is not sufficient to constitute probable cause.

¶ 1 Since 2012, it has not been a violation of Colorado law for people who are at least twenty-one years old to possess up to one ounce of marijuana for personal use. Colo. Const. art. XVIII, § 16(3)(a) (Amendment 64). To be clear, such possession is neither a criminal violation nor a civil violation.

¶ 2 This case presents two questions arising from our state’s marijuana laws and law enforcement’s use of dogs trained to detect marijuana and other controlled substances. First, does deploying a dog trained to detect marijuana to sniff a legitimately stopped vehicle constitute a “search” for purposes of the constitutional prohibitions of unreasonable searches? If so, law enforcement may not deploy such a dog without reasonable suspicion of criminal activity. Second, did the dog’s alert in this case give police probable cause to search Kevin Keith McKnight’s truck given that the dog was trained to alert if he detected either legal or illegal substances?

¶ 3 Two of us (Dailey and Berger, JJ.) agree with McKnight in answer to the first question, that is, that under our state constitution, the deployment of the dog here was a “search” requiring reasonable suspicion of criminal activity. And because the totality of the relevant circumstances did not give police 2 reasonable suspicion to conduct a dog sniff of his truck, we conclude that the district court erred in denying his motion to suppress evidence found in the truck.

¶ 4 But two of us (J. Jones and Berger, JJ.) would also agree with McKnight in answer to the second question, that is, that the dog’s alert, in combination with the other relevant circumstances, did not give the police probable cause to search his truck, and, for that reason, the district court erred in denying his motion to suppress evidence found in the truck. 

¶ 5 Because all of us agree that the court’s error in denying McKnight’s motion to suppress was not harmless beyond a reasonable doubt, we reverse the district court’s judgment of conviction and remand the case for further proceedings.

From here.

Judges Bailey and Berger are closer to agreement in substance than it appears, because the default rule under both state and federal law is that a dog sniff that detects only illegal contraband is not a search. Judges Bailey and Berger find that the dog sniff is a search because it can detect both legal and illegal substances now that marijuana is legal.

Judge Jones looks at the matter with a different analytical lens which causes her to reach a similar conclusion for similar reasons at the probable cause stage of the analysis, rather than at the stage of whether a dog sniff constitutes a search.

None of the Judges found that other circumstances present added to the totality of the circumstances sufficiently to provide probable cause or even reasonable suspicion to support a search (at paragraph 23 from the link to the Court's opinion above):

Here, the pertinent circumstances known to the police before the dog was called upon to sniff McKnight’s truck were that (1) McKnight had sat parked for fifteen minutes outside a house in which illegal drugs had been found seven weeks before and (2) McKnight had a passenger in the truck who had used methamphetamine “at some point in the past.” Those circumstances did not raise a reasonable suspicion that evidence of illegal activity would be found in McKnight’s truck. The officer observed no one approach the truck from the house or approach the house from the truck. The officer had no objective basis, then, for suspecting that the truck’s occupants had taken drugs into the truck from the house or from anywhere else for that matter.

For what it is worth, I'm inclined to agree with Judge Jones that the lack of probable cause for a search, even after the dog sniff, is a stronger argument that the lack of reasonable suspicion to conduct a dog sniff, if a dog sniff of the exterior of the vehicle even constituted a search.

Given the significant consequences of this ruling and the fractured support for the ruling, I wouldn't be surprised if the Colorado Supreme Court grants certiorari to more clearly set forth the law regarding these common place search and seizure issues that are likely to recur repeatedly in Colorado.

Since the rights litigated arise under Colorado's state constitution, the U.S. Supreme Court is very unlikely to provide any further review.

At a practical level, this ruling seriously discourages police from making random stops to look for drugs in people's cars using drug dogs or based upon the "smell of marijuana" in a car that is stopped.

Quote of the Day

Movements like WTF embrace the pernicious myth of populism that beneath elite squabbles there exists widespread unity of principles. 

- Julia Azari at Mischiefs of Faction (July 12, 2017).

The key word there is pernicious. I share Julia Azari's view that this piece of the Populist (and Progressive) movements' worldview is fundamentally wrong and that this inaccurate belief leads to misguided policy choices.

DARE Is A Bad Program

D.A.R.E. is the abstinence education program of the war on drugs. It is well meaning and is what lots of people (especially conservatives) think should work, but it simply doesn't deliver the goods.

D.A.R.E. [the federal Drug Abuse Resistance Education program] is listed under “What doesn’t work?” on our Review of the Research Evidence.

Rosenbaum summarized the research evidence on D.A.R.E. by titling his 2007 Criminology and Public Policy article “Just say no to D.A.R.E.” As Rosenbaum describes, the program receives over $200 million in annual funding, despite little or no research evidence that D.A.R.E. has been successful in reducing adolescent drug or alcohol use. As Rosenbaum (2007: 815) concludes “In light of consistent evidence of ineffectiveness from multiple studies with high validity, public funding of the core D.A.R.E. program should be eliminated or greatly reduced. These monies should be used to fund drug prevention programs that, based on rigorous evaluations, are shown to be effective in preventing drug use.” 

A systematic review by West and O’Neal (2004) examined 11 published studies of D.A.R.E. and reached similar conclusions. D.A.R.E. has little or no impact on drug use, alcohol use, or tobacco use. They concluded that ““Given the tremendous expenditures in time and money involved with D.A.R.E., it would appear that continued efforts should focus on other techniques and programs that might produce more substantial effects” (West & O’Neal, 2004: 1028). 

Recent reformulations of the D.A.R.E. program have not shown successful results either. For example, the Take Charge of your Life program, delivered by D.A.R.E. officers was associated with significant increases in alcohol and cigarette use by program participants compared to a control group (Sloboda et al., 2009).

From Marginal Revolution (emphasis added).

Kaiser Permanente's Impact On The Health Care Debate

There are basically two models for private sector health insurance in the United States.

Traditional Health Insurance

In one of them, a health insurance company locates a number of independently owned and operated private health care providers and enters into a contract with them to provide various services to its insureds at a negotiated contract rate rather than the higher or different rate applicable to uninsured or government insured patients.

Sometimes, the providers that negotiate a contract with the insurance company to be in its network are a small as a single doctor's office. Sometimes, the providers are as large as a major pharmacy chain or a large consolidated group of hospitals, clinics, laboratories, pharmacies and doctor's office that are operated as a single entity for insurance network purposes. In reality, even though they are treated as a single entity for insurance coverage purposes, the providers in a large consolidated group may be independently owned and operated themselves and form the provider's group solely for the purposes of negotiating with insurance companies on contract rates and sharing medical records within the group.

The health insurance company then enters into contracts with its insureds. In these contracts, the insured pays a fixed monthly insurance premium to cover the primary insured, the primary insured's spouse or domestic partner, and one or more children of either of them aged 26 or younger.

In exchange, the health insurance company pays part of the amounts owed by the insureds for medical goods and services, and the insureds pay some combination of co-pays (a modest, fixed in advance dollar amount for a particular type of service in lieu of a deductible, and $0 for a few preventative care services), or the entire uninsured part of the bill for that medical goods and services which  is called a deductible.

When there is a co-pay, the insurance company typically pays all of the charges not covered by the co-payment amount. Deductibles come in three main categories: (1) a dollar amount that must be paid per insured or per insured family (whichever is exhausted first) before the insurance company will pay for any non-copay medical goods or services, (2) a percentage of the provider's bill for medical goods and services in excess of the initial dollar amount, or (3) the entire provider's bill for medical goods and services that are not covered by the insurance plan. In addition, there is typically an annual limit on how much the insured must pay out of pocket for covered medical goods and services, after which the insurance company pays all further provider charges.

The obligation of the insurance company to pay depends upon whether or not the provider is in the insurance company's network or not. There are also some kinds of medical goods or services that are only covered if obtained from a provider in the insurance company's network.

If the provider is in the insurance company's network a more generous to the insureds set of co-pays, initial out of pocket dollar amounts, and percentage of remaining bills that the insurance company pays applies.

If the provider is outside the insurance company's network, a less generous to the insureds set of co-pays (typically only for emergency or urgent care services and prescription drugs, if there are any co-pays at all), initial out of pocket dollar amounts, and percentage of remaining bills that the insurance company pays applies.

Typically, an insurance program will offer a variety of plans with higher premium plans offering progressively lower initial dollar amounts that must be paid, higher insurance company percentages of bills, and lower co-pays which are available in lieu of a percentage of the bill coverage.

At one extreme, called a catastrophic plan, the insurance policy has a high initial dollar amount that must be paid by the insured and only kicks in when the insured has a major illness or injury.

Kaiser Permanente

Kaiser Permanente is the dominant and almost singular exception the traditional health insurance model. It is vertically integrated and is organized on a non-profit basis.

With a narrow exception of emergency out of network care, Kaiser requires all of its insureds to receive their care from within their network, in which all providers except a few hospitals, alternative medicine providers and scarce specialists are owned and operated by Kaiser itself in which everyone who works in the network is an employee of Kaiser, typically at compensation significantly less than what the owners of an independently owned and operated provider would charge.

In addition to paying people who would otherwise own independent health care providers less in exchange for freeing them from the risks and hassles of being a business owner as well as a health care provider, this model affords Kaiser a variety of other advantages.

* Kaiser can unilaterally set the amount that it charges for medical goods and services, subject to its need to cover its wholesale costs for providing those medical goods and services, so it has much less uncertainty regarding how much it will receive from insureds for particular medical services and how much it will pay for those goods and services (which are mostly part of a monthly payroll and overhead expense that isn't directly tied to how much care its insureds need). This also makes it easier for Kaiser to provide more services on a co-pay basis than other providers without facing the risk that provider costs will grow uncontrollably.

* Kaiser insureds receive medical goods and services at a much smaller number of locations than providers in a traditional health insurance plan, allowing it to secure economies of scale and to have much more direct, hands on management of their providers by senior health care administrators.

* Kaiser providers share a single medical records database that facilitates better coordination of providers and allows it to automate tools to monitor the heath care that patients are receiving.

* Kaiser eliminates a lot of the paperwork associated with traditional health insurance and associated billing difficulties by eliminating the need for providers to request insurance payments for the services that they have provided.

Kaiser's radically different business model allows it to provide comparable health care at a lower price than many its competitors which has won it a disproportionate share of the Obamacare insurance exchange markets for people who don't have employer provided group health insurance plans, despite the reduced choice of doctors that it affords its insureds.

But, Kaiser has a quite limited geographic scope. It does business in only eight states and the District of Columbia: four Pacific states (California, Oregon, Washington State and Hawaii), Colorado, Georgia, Maryland, Virginia and the District of Columbia. In Virginia, moreover, it only operates in the Northern Virginia area which is a suburb of D.C., while in Maryland it only serves the D.C. and Baltimore metropolitan areas. Similarly, in Georgia, it provides services only in the greater Atlanta and Athens areas.

There is only one Red State (Georgia) and one Purple State (Virginia) in Kaiser's entire portfolio (at this point I count Colorado is "Blue" and not "Purple") and in both cases Kaiser's operations are limited to some of the bluest parts of those states.

Kaiser has no operations in the other 42 U.S. states, both limiting its political clout and denying residents of these states an alternative business model for health care. This also makes Kaiser not a viable option for employers or insureds who routinely find themselves away from home. And, even in the areas that it does serve, it has few providers in rural areas away from major metropolitan areas.

The lack of alternatives to traditional health insurance in most of the United States and essentially all of rural America is one of the reasons that people in different states perceive health care issues differently.