Showing posts with label Health Care. Show all posts
Showing posts with label Health Care. Show all posts

22 April 2026

Quick Health Hits

* Fatty liver disease drugs found.

* A blood test to detect Alzheimer's disease early developed.

* A breakthrough in stopping the Epstein-Barr virus, which is found in 95% of people and causes mono, MS, and lupus.

* Bread, rice, and wheat make you gain more weight with the same amount of calories, by changing your metabolism.

* A new toothpaste would kill gum disease causing bacteria while leaving the rest of the mouth's good microbiome in place.

* A new biochemical cause of aging has been discovered.

* Guinea worm infections have been virtually eliminated. In 1986, there were 3.5 million people infected worldwide, and there is still no cure.

16 April 2026

Affordability

What are the easiest policies to make life more affordable?

* Unilaterally end tariffs.

* Legalize car imports from China and reduce trade barriers to importing smaller cars from Europe. This would greatly increase choices and competition for basic cars.

* Support the infrastructure to shift to electric vehicles making us less vulnerable to global petroleum prices and less incentivized to go to war over oil.

* Eliminate fares for high volume transit routes.

* Encourage renewable energy sources like solar and wind which are now cheaper than coal and are not subject to natural gas price fluctuations.

* Remove barriers to building affordable housing, especially zoning that restricts density and rules out multi-family housing, parking mandates, lot size limitations, and aesthetic building code requirements. Encourage high quality manufacturing of homes and large components of homes in lieu of stick building everything on site.

* Encourage the Fed to take a more gradual approach to increasing interest rates when economic conditions call for it to do so, so that housing markets have time to adjust to higher mortgage rates which decrease affordability until housing prices transition to adjust to the ability to pay.

* Tax unoccupied housing more heavily to discourage hoarding of empty housing that reduces housing supply and drives up housing prices.

* Enact policies that financially penalize profitable companies for the burden that they impose on government when a significant share of their workers need welfare to make ends meet, in part, by increasing the minimum wage.

* Shift revenue sources for ECE (early childhood education)-12 education from property taxes to income taxes. This makes the taxes more progressive. It increases funding equity between places with large property tax bases per student (like rich suburbs and resorts) and places with small property tax bases per student (like low income municipalities and rural areas). This also reduces housing costs.

* Make free meals for all part of the standard ECE-12 education package.

* Make access to ECE and kindergarten and afterschool programs universal.

* Encourage international students at colleges and universities who basically subsidize domestic students by paying full tuition.

* Publicly fund higher education, without significant student loans, with all students with a reasonable chance of completing their degrees, while limiting admissions for students who have a high probability of failing. This makes access to higher education possible for working class and middle class kids increasing their future incomes and class mobility while making the economy more productive, and reduces the squeeze on families at the low end of upper middle class who don't easily qualify for need based grant financial aid, but still pay higher shares of their income than others.

* Reinvigorate vocational programs at high schools and community colleges for students for whom a traditional liberal arts college curriculum or four year degree isn't a good fit.

* Establish new medical school and medical professional school capacity to increase the supply of doctors and other medical professionals.

* Welcome foreign medical professionals, thus increasing the supply of medical professionals whose compensation is driven up by a limited supply, especially in rural areas where domestic medical professionals are least likely to prefer.

* Medicare for all or similar universal health care financing, that cuts out health care billing and insurance company administration costs and profits, ends barriers to health care for the self-employed and unemployed and those with jobs providing only second rate health insurance with high deductibles, funds health care in proportion to ability to pay, ends medical debt and bankruptcies, takes pressure off high cost ER care, and improves the bargaining power over drug costs and other provider costs. Health care expenses of employers also reduce wages more or less dollar for dollar.

* Broaden access to long term care, including home health care and assisted living, on a basis similar to universal healthcare, and finance it with estate taxes.

26 December 2025

New Almanac Data Points

I have my 2026 World Almanac now and there are some statistics I keep a close eye on.

* As of March 31, 2025, the U.S. had 1,307,679 active duty military personnel. This is as small as the U.S. military has been by that measure since before World War II. At its peak, it was more than 50% bigger. Roughly 55% of U.S. active duty military personnel are non-Hispanic white men (with significant variation from one military service to another).

* Birth rates for women in all age categories under age 25 were at their lowest for all of recorded history and prehistory in North America.

* Infant mortality has increased each year since 2020. The anti-vax movement and the impact of the ban on abortions in many states could be factors.

22 December 2025

U.S. Health Care Spending Still Rising Because Our System Is Broken

Americans pay a huge amount for healthcare, while getting results that are below the developed world norm. Partially this is because a mixed government-private sector system leaves no one controlling costs, so we pay more to all forms of health care providers than any other health care system on Earth. And, partially, we pay much more for administrative costs. Further, the way we finance health care leaves many people either with no access to health care, or facing bankruptcy if they get seriously hurt or sick.

The best evidence we have shows that rising health spending in the United States since 1975 can explain roughly the same share of the growth in income inequality as increased trade, outsourcing or automation. It has pushed down wages, fueled inequality and left families drowning in unaffordable medical bills. Rising health care spending is killing the American dream.

Despite devastating out-of-pocket costs, Americans are generally insulated from the true cost of health care premiums. However, the expiring subsidies on the Affordable Care Act marketplaces, where more than 20 million Americans get their insurance, show just how exorbitant premiums have become. Consider a 60-year-old couple earning $85,000 a year. Without subsidies, their health insurance premiums next year will approach $32,000 (akin to buying a new Toyota Camry).

Those of us who get health care insurance from our employers — some 160 million Americans — may be breathing a sigh of relief. But our health care premiums are also staggering (an average of $27,000 a year for a family of four), and the fact that our employers pay part of the tab isn’t much of a reprieve. That’s because decades’ worth of research shows that, even though employers pay most of workers’ premiums, those costs are passed on to workers in the form of lower wages and fewer jobs. That’s why the rise in health spending above the rate of inflation over the past decade has depressed wages by nearly 10 percent, according to my calculations. And because premiums are a bigger share of total pay for lower-income workers, the job cuts triggered by rising health care spending fall disproportionally on low- and middle-income workers and fuel income inequality.

Americans spend more on health care than other countries because we pay higher prices for identical goods and services, are quicker to adopt new and costly medical technology (whether or not it is cost effective) and have higher administrative costs in our complex, decentralized system. Health care markets have consolidated so much that in many regions, hospitals and other providers can charge near-monopoly prices. The fact that we pay providers per service delivered (rather than a fixed salary) also plays a role.

Next year insurance premiums will increase 10 percent for employer-sponsored plans and 18 percent for individual plans on the exchanges compared with 2025. In both markets, they’re going up because the price of medical care is rising (think hospital mergers, staffing shortages and tariffs that make drugs and devices more expensive) and Americans are increasingly using expensive weight loss and diabetes drugs known as GLP-1s. The exchange plans are seeing a sharper increase than employer plans because of the uncertainty lawmakers created over whether the Affordable Care Act subsidies would be extended. Insurers had to factor in the risk that healthier people would be less likely to buy insurance if the subsidies expired, which would lead to a sicker insurance risk pool and higher costs. . . .

One person’s health care spending is another person’s health care income — profits, jobs and paychecks for the tens of millions of people who work in the health care sector. And some higher spending does lead to better care. As long as they’re in competitive markets, higher-priced hospitals deliver higher quality care

. . . [A]s a result of Medicare payment rules created in the 1980s, the government program pays more (sometimes double) for care delivered in a hospital or hospital-owned doctor’s practice versus in an independent doctor-owned practice, even if the care is identical. That makes it more profitable for doctors to merge their practice with hospitals than remain independent. These mergers give doctors and hospitals bargaining power and drive up prices and insurance premiums.

From the New York Times (Opinion).

The loss of ACA subsidies will more than double premiums for people who get their health insurance on the health insurance marketplace, which is mostly made up of self-employed people and early retirees. That's an important reason that I moved back to being a W-2 employee this year after twenty years of being self-employed.

The change disproportionately hurts small businesses, including farms, and because of this, together with massive cuts to Medicaid and immigration changes that make it much harder for hospitals to hire foreign doctors (who disproportionately serve rural areas where U.S. doctors prefer not to work), rural healthcare in the U.S. is on the brink of collapse, with many rural hospitals expected to close and fewer doctors serving rural areas. Red states that banned abortion are also seeing a huge exodus of obstetrics and gynecology doctors, with new graduates also reluctant to take positions in these states.

Indeed, the MAGA base will be hit harder by GOP healthcare changes, and other Trump 2.0 policies from tariffs to reduced access to government benefits than Democrats in blue states, who tend to live in more resilient cities which are buffered by more caring state and local governments, while many of the Trump 2.0 tax cuts will help more upper middle class Democrats than working class Republicans.

11 December 2025

Physicians' Specialties And Their Political Identity

Draw whatever conclusions you wish. I suspect that lawyers would also show wide variation based upon the nature of their practice.

19 November 2025

Empirical Tests Of Economic Theories

Experience tells us which economic theories are right and which are not, often with unexpected results.

* In theory, a higher minimum wage should greatly increase unemployment. In reality, the effect is almost immeasurable at U.S. levels.

* The evidence from Brexit and from Trump 2.0 and the Smoot-Hawley tariffs demonstrate that globalism is very important for a healthy economy and that departing from free trade does great harm, as does discouraging immigration.

* While a shallow microeconomic analysis would suggest that immigration hurts the job market for native born Americans, experience shows that immigration has the opposite effect, improve the job market and prosperity.

* The evidence from Eastern Europe in the post-Cold War era illustrates that securities laws to reduce the likelihood of things like Ponzi schemes are actually very important even when other protections of property laws and contract laws are in place.

* Economic development studies tend to show that economic development is quite localized and culture driven, rather than being primarily driven by national laws, although national laws do matter quite a bit as shown by comparing the economies of communities on either side of a national boundary where the laws are quite different.

* Notably, lots of the litmus tests for economic development: municipal water quality, roads in good repair, regular trash collection, effective legal enforcement of debts, unambiguous real estate ownership, good quality K-12 education, and the availability of trauma center hospitals, are mostly provided at the local government level, rather than at the regional or national level.

* During the Financial Crisis, two different methods of managing the risk of high loan to value residential loans were compared which have very different regulatory regimes. 

One approach was to make a conventional mortgage at 80% loan to value, and then to have a second mortgage for the next 10-15% of loan to value that was subordinate to the conventional mortgage. This is subject to securities regulation of mortgage backed securities, with risks assessment mostly delegated to thinly regulated and thinly capitalized bond rating agencies (which are basically just credit reporting agencies for the bond market).

The other approach was to issue a single mortgage for the entire loan and to secure mortgage insurance, paid for by the borrower to protect the lender, which covered the lenders' losses if the value of a foreclosed home resulted in a deficiency judgment. This was subject to state insurance regulation.

In the financial crisis, insurance regulation was decisively proven to be superior, with no mortgage insurance firms going out of business, while essentially all of the subprime lenders, mortgage backed securities firms that packaged second mortgages for investors, and investment banks that organized this activity either ceased business entirely, underwent bankruptcy reorganization, or were saved only by bailouts with purchases of the failed firms by healthy large financial companies.

03 July 2025

The GOP Budget In Charts

The Republican budget passed today passed the House initially by 215-214, passed the Senate in a 51-50 VP tie breaking vote, and passed the House the second time around by 218-214 with no amendments from the Senate version (which was slightly better than the original House version, mostly because bad non-budgetary riders were stripped from the bill). These razor thin majorities, however, have made immense changes to U.S. tax laws and federal spending that are unrivaled since the War on Poverty during LBJ's administration.

This will do irreparable harm in the next couple of years, at least, disproportionately suffered by Republican controlled areas and Republican voters, and the bill's provisions are wildly unpopular with the American public.

The big question is whether this bill, along with Trump's other horrible steps in governing, will lead to a catastrophic defeat for Republicans in the 2026 midterm elections as backlash, or whether the usual partisan tendencies will remain unchanged. Have Republicans committed political suicide? Or will the MAGA cult remain strong after encountering the "find out" part of the FAFO adventure.

I can't imagine how any decent person could sleep at night backing this proposal, and struggle to discern any values other than massively transferring wealth from the poor to benefit the rich, are served by it. But Republicans never cease to surprise me.

The big messages about the budget are that: 

(1) the tax cuts in Trump's budget are driving up the national debt immensely (more than any other bill in the Biden or Trump Administrations by a lot) and will drive up interest payments as a drain on tax revenues, 

(2) the number of people without health insurance will grow from about 25 million (out of a U.S. population of about 340 million) to more than 35 million due mostly to Medicaid changes and there will be a massive disinvestment in health care, 

(3) student loan payments for new college graduates will soar, 

(4) the clean energy investments that are eliminated will mostly hurt people in Republican Congressional districts, 

(5) the bottom 20% are much worse off, the next 20% break even very rich are much better off, while the poor are much worse off, the next 59% are modestly better off, and the top 1% and big businesses are vastly better off, and

(6) any improvements to economic growth are exceedingly small.

One key impact that the charts don't note is that many hundreds of rural hospitals (maybe more than a thousand), almost all in Republican dominated areas, will close. 

It also doesn't really capture how deep cuts to federal spending programs will be, except for defense and funds to carry out mass deportations which get big budget boosts.

The charts via the New York Times:

01 May 2025

Quick Observations On Taxes And The Social Welfare System

Some important provisions of the U.S. tax code that are substantively trying to do the right thing are just way too complex. Some examples:

* The taxation of tip income.
* The Earned Income Tax credit.
* The Obamacare tax credit for people who don't have employer provided health insurance, and the closely related taxation of health insurance for self-employed people
* Medicaid eligibility.
* Eligibility for other means tested programs like TANF, SNAP, and WIC.
* Public housing subsidies.
* The unemployment insurance system.
* The Social Security disability and SSI programs.
* The way that deductibles and co-pays and maximum coverage limits are handled with private health insurance.

Simple is better, for example:

* The standard deduction.
* The per child tax credit.
* Social Security retirement and survivors insurance programs.
* Medicare.
* HMO structures for most out-of-pocket health insurance expenses.
* India's right to show up to work and receive guaranteed paid employment.
* New Zealand's comprehensive no fault national insurance for all accidental injuries.

Accepting a certain amount of rough justice by making the bureaucracy of daily life for low income people simpler is well worth it, because this group of people is least capable of dealing effectively with paperwork and bureaucracy and complex rules. Reduced barriers to access and administrative costs can fund somewhat more generous benefits.

If you are going to have complex rules and bureaucratic systems they should be reserved for sophisticated, affluent individuals and entities.

10 April 2025

Simple Solutions To Big Problems

I'm a "Fox" and not a "Hedgehog". I know many things and focus on details rather than "one big thing" that solves every problem. 

But, I'm going to try to put on my hedgehog hat and come up with ways to address some of the biggest problems facing the U.S. today if forced to suggest just three solutions to each of them. The point of this exercise is partially to force prioritization of lists of proposals that can get bogged down with good ideas to solve small problems or to make lower priority reforms to big problems.

Affordable Housing and Homelessness

Housing prices in major metropolitan areas are high. What is the single biggest thing we can do to address that?

Eliminate virtually all zoning regulations of residential density, parking requirements,  minimum lot sizes, and regulation of the purposes for which buildings can be used. This primarily reduces the land value part of housing costs which is the main factor that makes housing in big cities so much more expensive. 

What is another big thing that we can do to address that?

End all property tax funding of public schools and replace the lost revenue, dollar for dollar, with increased state income taxes. This will typically reduce property taxes by more than 50% freeing up income for making principal and interest payments. It would also reduce inequities in school funding and would be more progressive as a tax source.

What is a third big thing we can do to address that?

Spend whatever it takes to provide basic housing first, immediately, to every single homeless person in the United States. Housing first is cheaper than letting people live on the street and paying the costs of that. This is less burdensome on the health care system, reduces crime, and improves quality of life for both the people who would be homeless and the people that their being homeless in their neighborhoods would impact.

Health Care

The U.S. pays far more per person for healthcare than any other country on the planet and gets poor results for its money, while inflicting great financial hardship on people. What is the single biggest thing we can do to address that?

Adopt "Medicare for All" financed with a higher Medicare payroll tax and a higher Obamacare tax on investment income. Roll in long term care coverage currently paid for, for many people, with the Medicaid long term care program. 

End Medicaid. End the Medicaid Estate Recovery System (i.e. the poor man's death tax). End private health insurance. End worker's compensation coverage of medical expenses. End the separate veteran's healthcare programs. End Obamacare insurance premium subsidies. End health insurance tax deductions and employer health insurance mandates and private health insurance mandates. End lawsuits by private individuals to pay for medical expenses. End casualty insurance policies designed to cover liability for medical expenses in lawsuits. This would greatly reduce administrative cost waste, bad debt, denial of care, linkage of health care to employment, would reduce health insurance and worker's compensation and CGL insurance expenses for businesses, would simplify tax returns for individuals, and would facilitate more effective cost control on provider payments. It would also increase use of preventative care thereby reducing more expensive acute care and would shift expensive ER care for the currently uninsured to more appropriate lower cost providers. This would especially help working class people who are mostly likely to have inadequate health insurance and to struggle with paying medical bills.

In round numbers, the U.S. federal and state governments spend about $2 trillion a year on Medicare, Medicaid, and VA health care, private health insurance policy premiums are about $1.5 trillion a year, and out of pocket health care expenses are about $0.5 trillion a year, for a total of $4 trillion a year of spending on health care, which still leaves about 27 million people without health insurance (in a country with about 336 million people). Cutting administrative costs, profits, marketing, provider level health insurance claim processing, bad debt expenses for providers, shifting ER care for the uninsured as a last resort to primary care and urgent care, price negotiation with providers from drug providers to hospitals to physicians and nurses, since the U.S. pays higher prices for everything than anyplace else in the world, substitution of preventative care that is foregone for cost reasons for later acute care, reduced worker's compensation, car insurance, homeowner's insurance, and other casualty liability insurance premium rates since they don't have to cover health care expenses, state and local public hospital funding, public employee health care funding, and reduced personal injury litigation costs associated with shifting payment obligations for medical expenses, could cut that $4 trillion to $3 trillion (about 25%). So, public expenditures for health care at all levels of government combined would increase by about 50% over current levels (some of which would be covered by eliminating tax exclusions, tax deductions and credits for health care under existing tax law) while largely eliminating household level and business level health care expenses, ending medical expense driven bankruptcies and collect litigation costs, and lower other household and business insurance premiums, and covering all 27 million of the uninsured. Tax bills for households and businesses would go up, but a lot of wasted time in households and businesses dealing with health insurance and medical bill related issues would disappear.

What is another big thing we can do to address that?

Legalize "recreational" drugs in a highly regulated and controlled manner similar to Colorado's marijuana legalization to reduce harm, while providing strong support for substance abuse treatment including drug based therapies and inpatient treatment funded with Medicaid for All resources. This would dramatically reduce the overdose epidemic, and would improve recovery rates for alcoholics and drug addicts, something that takes a particular toll on the poor and working class. This would also dramatically reduce gang crime and organized crime and would cripple cartels, and would reduce crime by addicts and would reduce incarceration costs associated with controlled substance users and jail deaths from drug withdrawal. The reduced demand would also dramatically reduce crime abroad from Columbia to Mexico, which would reduce the flow of refugees and migrants to the U.S. and would reduce corruption in the affected governments.

What is a third big thing we can do to address that?

Double the number of medical student slots for educating physicians by expanding medical school capacity and building new medical schools. We shouldn't have the same number of MD education slots as we did fifty years ago, with twice the population, and there is no shortage of highly qualified premed graduates to fill those slots. Limited supply also drives ups provider costs. Ending student loans for medical students and Medicaid for All ending bad debt issues and administrative costs for self-employed doctors and lowering malpractice insurance coverage due to not having to pay for malpractice related medical bill compensation would also allow reduced MD charges without undue hardship for MDs.

Higher Education

It is very expensive to go to college and many people leave college with large student loans that can't be discharged in bankruptcy. Many kids who are ready for college don't go, but many kids who aren't ready for college go at great expense in public funds and for themselves. What is the single biggest thing we can do to address that?

Provide 100% grant based funding for tuition, room, board, and books to students pursuing higher education whose grades and test scores and other factors show that they have at least a 50% chance of completing the higher educational program that they are enrolled in. Do not fund higher education for people who have a low chance of completing the higher educational program that they are enrolled in. End government sponsored or guaranteed student loans. This would much better utilize our nation's supply of academically competent students while reducing dropouts and failures by people who aren't currently ready for college at great expense and undermining personal self-worth. The status quo of indiscriminate state subsidies to in state students and very low admission thresholds that insure that huge percentages of students admitted at public and for profit colleges drop out without degrees is wasteful while still excluding poor and working class students at high levels from the system. Some of the political alienation towards higher education also comes from people who tried and had bad experiences since they weren't ready and dropped out and from people who were shut out of the system when they were prepared and take a sour grapes attitude towards it.

What is another thing we can do to address that?

Improve apprenticeship systems and vocational education programs, both for high school aged students whose academic performance indicates that traditional liberal education programs in a four year program don't make sense for them, and through community colleges. Adopt occupational specialty identification and training approaches used by the U.S. military for enlisted recruits for civilians. This would provide a path to missing middle occupations and recognize that not going to college doesn't have to mean that there is no path to the American dream.

What is a third big thing we can do to address that?

Forgive all existing federally guaranteed or federally provided student loans, and end the prohibition on discharging student loans in bankruptcy for all other student loans ten years after the repayment period begins if a degree is earned and professional certification is obtained in a pre-professional program, and after five years in all other cases. This would provide intergenerational justice to struggling Millenials and Gen Xers and Gen Z. These students could then better afford the American dream and could better afford to get married and have kids.

Poverty

Lots of people, especially children and single parents, but also many older adults with little education or skills, are poor and struggling. What is the single biggest thing we can do to address that?

Make the large, per child tax credit, that was available during the pandemic, permanent, and replace the complicated and audit prone earned income tax credit with a simple income tax credit equal to Social Security taxes (for both employers and employees) up to the minimum wage times thirty hours a week (or an equivalent amount of credit against self-employment taxes - reflected in not having those taxes withheld. The usefulness of the child tax credit in reducing child poverty in a simple way was demonstrated in the pandemic, and the EITC is far too complicated and has bad incentives for people trying to climb out of low income jobs and is too expensive to administer. This would make it more affordable for Millennials and Gen Z to marry, have kids, and achieve the American Dream.

What is another big thing that we can do to address that?

Reduce the regular Social Security retirement age to 55 years to people who do not have college degrees, without a reduction in benefits, and pay for any shortfalls in social security from existing obligations or new coverage, by increasing the payroll tax cap by however much is necessary to pay for it. Consider this payback for not imposing higher education costs on the public, and well as a rough justice categorical recognition that jobs that require less education are frequently more physically demanding and harder to continue to perform in late middle age. This would particularly help the Trump demographic. Many people in this demographic are already voting with their feet by leaving the work force and often applying for disability benefits which wouldn't be necessary with this categorical benefit that is much cheaper to administer and has better incentives.

What is a third big thing we can do to address that?

Provide paid maternity leave, at public expense, from six months of pregnancy to fifteen months after birth, as a short form, temporary, Social Security disability benefit. Add an additional six months to this time period for twins. Pay for this as well with an increased payroll tax cap. This greatly reduces the need for infant daycare, and increase the health of mothers and babies especially for working class families without unduly burdening employers. The pandemic proved that not being at work in late pregnancy out of economic necessity increases maternal and infant health. This would make it more affordable for Millennials and Gen Z to marry, have kids, and achieve the American Dream.

Transportation

Internal combustion engines are polluting and make up dependent upon oil. What is the single biggest thing we can do to address that?

Reduce trade barriers to importing foreign EVs and batteries, and subsidize high speed charging networks. There are lots of good EVs out there that aren't being exported to the U.S. due to trade barriers, especially from China. EVs reduce pollution and reduce fossil fuel dependency with petroleum dependency creating national security issues.

What is the second biggest thing we can do to address that?

Build dedicated high speed rail in interstate highway corridors where there is high traffic volume on medium distance routes (and upgrade medium speed rail corridors that already exist like the one in the Northeast Corridor), and use that high speed rail not only for passengers but for mail and package delivery by the USPS. Pay for this, in part, by shutting down low speed AMTRAK routes with the heaviest subsidies per passenger-mile. This could reduce pressure to expand highways, is environmentally sound, reduces highway maintenance costs, and provides mutual support between the rail system and the postal system. It would improve speed on these routes relative to both cars and to commercial flights. But it only makes sense where it makes some sort of economic sense based upon cost and demand. Medium distance, high volume routes are the sweet spot for high speed rail. Reducing petroleum dependency in addition to being environmentally and climate sound would increase national security and economic stability by reducing exposure to global oil production shocks.

What is a third big thing we can do to address that?

Convert short haul government fleet vehicles like garbage trucks, intracity and school buses, and urban postal delivery vehicles to EVs. This is a perfect niche for EVs even before charging networks are built out, reducing pollution and reducing oil demand with the benefits described above.

08 December 2024

The World Turns

You take a week off and the world turns.

South Korea has an attempted self-coup a.k.a. autogolpe, which failed within hours, probably irrevocably dooming the President's conservative leaning party. The attempt failed because in South Korea, even conservatives have some morals and respect the rule of law. Heads are starting to roll (figuratively) at high levels in the South Korean government, although the President has so far postponed an immediate impeachment or resignation. The brief and illegal imposition of martial law was trigged when the majority in parliament tried to impeach several corrupt prosecutors, challenged the President's personal scandals, and wouldn't agree to his budget proposals and the President wanted to shut down his legislative opposition. I fear that the U.S. will not perform as well in the near future when faced with a similar challenge. Republicans are spineless and no longer care about democracy or the rule of law.

In Syria, the thirteen year civil war has ended with the sudden collapse of the Assad regime, now that his two key sponsors, Russian and Iraq, are distracted, ending half a century of dictatorship. The U.S. continues to bomb ISIS forces in parts of Syria that neither the Assad regime, nor the main rebel groups, control.

Russia's economy is starting to seriously stumble two and three-quarters years after it restarted it war with Ukraine.

The Prime Minister of the Bahamas has rejected a request by President-elect and convicted felon awaiting sentencing, Donald Trump, to receive people he wants to deport from the U.S.

Trump has also admitted that his tariff plan will cause U.S. prices to surge, even though he was elected with a central campaign tenant of reducing inflation, and that he plans to carry out many baseless federal criminal prosecutions as a way of securing revenge against his enemies (something that President Biden could short circuit with preemptive pardons). 

Biden, of course, pardoned his son who was convicted of a federal charge, now that he is a lame duck, which is less honorable than trying to thwart Trump. If he has the guts he will commute the sentences of everyone on federal death row to life in prison, thwarting Trump's efforts to execute more people has he did in the final days of his first term. Of course, Trump won't officially be the President elect until the Presidential electors vote on December 17, 2024, although the outcome is a foregone conclusion.

Also, UnitedHealthcare's CEO was murdered in Manhattan. Murder is bad, but he surely deserved it. Behind every great fortune is a great crime.  Big health care companies murder people by spreadsheet every day.

Netflix has a new show called Jentry Chau vs. the Underworld described as follows:


But since Texas is basically hell already, and is already fully of creatures more terrifying than those in any myth, this appears to be basically an evil v. evil conflict, so it might not be all that interesting.

27 November 2024

Red County And Blue County Realities

The realities of life in conservative leaning (red) parts of the United States are different than in liberal leaning (blue) parts of the United States. Roughly speaking, these distinctions play out not so much at the state level as at the county level. This post explores some of the differences in lived realities for people in blue counties compared to red counties that helps to explain their stark political differences in the U.S. as part of a more cohesive narrative that can help build understanding about their true causes. Of course, even this rather lengthy list is far from comprehensive.

Economic Productivity and Population Density

Per capita GDP in blue countries is roughly twice what it is in red counties. This is huge!

The population density in the inhabited parts of blue counties is much higher than the population density of red counties and "purple counties" which are evenly balanced between liberal and conservative leanings, tend to have intermediate population densities which are often suburban.

Ski resort towns and other counties with tourism based economies (e.g. greater Las Vegas) often have low population densities when crudely comparing permanent residents to the land area of the county, but have large swaths of land where no one lives with small dense resort style housing areas which house many seasonal residents in addition to permanent residents.

The link between economic productivity per capita and population density isn't accidental. One of the most consistent empirical laws of economics is that higher population density leads to greater productivity which makes it possible to pay higher wages and necessary to do so in a competitive employment marketplace. It holds true across cultures, across geographical regions, and across thousands of years. It has been true all of the way back to Jericho and Sumer and the Nile River Valley and the Indus River Valley to the present. It was true in the pre-Columbian Americas in North America, in Mesoamerica, and in South America.

Transit and Electric Vehicles

Public transportation is more cost effective and provides better service in higher population density blue counties than in lower population density red counties.

Red counties also have longer average motor vehicle trips than blue counties, because people are spread out further from each other, and longer average trip lengths (and longer peak monthly and annual trip lengths) disfavor all but the very latest electric vehicles relative to gasoline and diesel vehicles.

Housing, the Cost of Living, and Wages

The cost of living is much lower in red counties than in blue counties. This is mostly driven by lower housing costs in red counties (both renting and owning) than in blue counties relative to median wages, and by lower business real estate costs in red counties relative to blue countries that indirectly impact retail prices.

Lower housing prices in red counties mean that homelessness is much less of a crisis in red counties than in blue counties.

The pressure to increase the minimum wage is greater in blue counties where the cost of living is higher than it is in red counties where the cost of living is lower. A "living wage" in a blue county is higher than the "living wage" needed to maintain the same standard of living in a red county. 

Slower home price appreciation in red counties than in blue counties also means slower property tax increases over time.

Lower home prices in red counties also mean that red county homeowners who have owned their homes for many years have much less wealth in the form of home equity than blue county homeowners who have owned their homes for comparable periods of time.

A lower cost of living also places less pressure on red county residents to set aside savings that build wealth, than blue state residents who know that they need to save money to be able to afford a security deposit or down payment for a home, to afford education for their children which is critical for a blue county child's future income, and to afford other major purchases. Of course, lower incomes also make it harder to save money.

But with little home equity if they sell their homes, and less savings, and a higher cost of living in blue counties relative to incomes for less educated and less skilled worker wage premiums in blue counties, many residents of red counties are basically trapped there. They can't afford to move to a blue county even if they'd like to do so. The jaws of the trap are even tighter for red county residents with no blue county residents who are no longer working and are on fixed incomes.

Blue counties have higher housing costs because their populations tend to grow faster than the housing supply as people move their for their larger number of jobs that pay better than in red counties. 

About half of red counties, if not more, are losing population while their housing stock remains more or less the same, and even those red counties that have growing populations are growing slower than blue counties, so it is easier for the construction industry to increase the supply of housing enough to keep up with the slowly growing population. Moreover, in many red counties, populations have been declining, stagnant, or at least below the national average, relentlessly, for decade after decade pretty much starting in 1960s and almost every decade since in the last sixty years. Indeed, the percentage of the population engaged in farming has declined for almost every single decade from the 1790s until into the 2000s. These long slow declines undermine even hope for an eventual recovery or stabilization.

Since housing prices in red counties seem likely to fall, or at least only keep up with inflation, this also makes investing in maintaining and improving homes in red counties a bad investment. In contrast, in blue counties with every soaring real estate prices, keeping a home well-maintained and up to date with renovations and improvements can yield disproportionate returns, causing the existing housing stock in blue counties to be in better shape and more up to date.

More educated and skilled workers make much more income in blue counties than in red counties, which more than makes up for the higher cost of living there. Less educated and skilled workers also make more income in blue counties than in red counties, but not enough to make up for the higher cost of living there.

Tighter economic circumstances and economic stagnation in a community, also fosters zero sum game thinking, and eats away at empathy as taking care of your own becomes your priority. All potential forms of competition, from international trade, immigration, female workers competing with male workers, and non-white workers competing with white workers, all starts to look like a threat in this mindset, whether or not this is true. And, older white men without college educations, in particular, who are the core of the MAGA movement have seen their demographic's economic prosperity decline in relative terms to lots of other groups (even if it has not actually meaningfully declined even after adjusting for inflation and their own costs of living are low), through events taking place mostly in their own lifetimes.

Fertility

It is more expensive to raise children in a blue county with its higher cost of living, than in a red county. So, families in blue counties are smaller, with fewer children in response to those realities. Blue county children are also more likely to need and benefit from expensive higher education (which red county voters don't want to support funding for since higher education confers a much smaller benefit to them than it does to the children of their blue county peers).

The expansion of economic opportunities for women also greatly increase the opportunity costs for all women, in blue counties and red counties alike, of having more children. This opportunity cost has caused the number of children per woman per lifetime to fall particularly fast for less educated women who previously weren't qualified to be teachers or nurses, and had few options other than being house wives, but can now work in a variety of less skilled jobs previously held predominantly by men.

This has made the "trad wife" ideal unattainable for most families, but especially those consisting of non-college educated couples with lower incomes who need two incomes just to support themselves and one or two kids. But when women are less economically dependent upon their husbands and often have steadier and better paying work than their husbands, then families are less tight economic glue holding them together, and a provider man's position as "head of the household" is undermined.

Nostalgia

In a red county that has been stagnant or in decline for half a century or more, nostalgia for the "good old days" can be intense. High school educated people used to have incomes proportionately much closer to those of college educated workers and managers, even if the absolute buying power of those workers hasn't actually fallen, and this has gotten steadily worse since the early 1970s. In contrast, blue county college educated men have seen uninterrupted prosperity (and a lot more men have college educations now than in the 1970s). Women have seen their access to higher education and to more remunerative employment in non-traditional professions soar. Minority members are much less shut out of the top levels of the career ladder than they were in the 1960s even if they haven't reached parity, improving in relative terms. High school educated men have stagnated, in part, because of the structure of the economy (it is important to recognize that the two and a half decades after World War II were a remarkable one time only exception that can't be reproduced for the most part, and not the norm), and in part, because the average was being pulled up by smart, socially functional men who had no access to college educations then and now have gained college educations leaving their less bright and more difficult peers behind in a new economy. 

Civil rights aren't a zero sum game, but it is easy for a high school educated man prone to feeling aggrieved for economic reasons to see it that way, and women and minorities have secured a lot of civil rights that they once lacked. 

Smaller and less stable families for all but billionaires or near billionaires, it seems, has also undermined and narrowed the role of men as fathers of many children, something was was commonplace for middle class men in the Baby Boom era (although people forget that this time period was also one with much higher poverty rates than those of today until the "War on Poverty" rebalanced the status quo a bit).

The patriarchy has weakened, and they are the heirs of the patriarchy. So, of course, they yearn for the good old days, even though that was facilitated by key factors that can't be recreated with new policies.

Unions

The union narrative of the left is that unions brought us the weekend, the 40 hour work week, overtime, workplace safety, employer provided health care, and more. And, this isn't wrong. But it is incomplete.

Unions facilitate turning the economic power of workers into concrete economic gains for them in an efficient manner. But this facilitation and negotiation and political action related role only works at times when the demand for the labor of the unionized workers is great and the supply is smaller.

When there is a glut of less skilled, less educated workers, because the economy has been transformed to be less labor intensive, through automation, for example, and because other countries long ago restored the manufacturing capacity that was destroyed in World War II and no longer need to import manufactured goods to the same extent, unions don't provide workers with much in the way of concrete benefits because they don't have much to negotiate with. 

Likewise, part of the shortage of workers during the Baby Boom was because women left the work force en masse to have kids (a desire deferred during the Great Depression and World War II which were times of great scarcity), reducing the supply of workers and leaving the men who  re-entered the work force after World War II in greater demand with more economic power. This also won't recur. The many men who died or were seriously injured in World War II also shrunk the supply of able bodied adult male workers in the U.S., which is certainly not something we would like to repeat.

This, in a nutshell, is why private sector labor unions have declined steadily until just a few years ago (when worker economic power and demand was near a prolonged record high also accompanied by prolonged record low unemployment). For decades they couldn't deliver. And, since the labor market is weaker in the less productive red county economies, unions are even less effective in red counties than they are in blue counties.

Employers never like unions, but in red states, there isn't an intense worker desire to protect unions because they provide minimal benefits there, so the legal balance has tipped against unions in red states with things like "right to work laws", while in blue states, where the strong economy gives workers more power and unions more to bargain with, the balance between unions and management legally and politically has been more stable, because unions in blue states can deliver more to workers who therefore have a more intense desire to support them politically against employer attacks.

Religion

Being religious provides few economic and educational benefits to college educated upper middle class people, and can be a hinderance. And, it provides only modest economic and educational benefits to working class girls. But it provides great economic and educational benefits to working class boys (both black and white).

Religiosity is also strongly associated with uncertainty in life, especially economic uncertainty. Less educated people, on average, are at much higher risk of unemployment and prolonged unemployment during their working years. Farmers and fishermen are also subject to great uncertainty in their economic prospects due to factors like weather and the availability of fish from year to year than even "middle skilled" workers in blue counties and "urban farmers" (who work in truck gardens or indoor marijuana grows).  So, people in red counties are more likely to see religion as more important in their lives even controlling for whether they are religiously affiliated or not.

Red counties (especially in the South, in Utah, and in other Mormon dominated counties) have a far greater percentage of Christians with far less denominational variation than blue counties. Red counties are far fewer religious non-Christians (e.g., Jews, Muslims, Hindus, Sikhs, and Buddhists) than blue counties do. So, religious diversity is not part of the everyday experience of residents of red counties.

Family Stability

The same economic instability and uncertainty, and lack of economic prosperity that makes red county residents more religious also dramatically influences their family stability.

The biggest predictor of whether a cohabiting couple will not marry, or whether a married couple will divorce, in basically every culture, is whether the woman in the couple earns more in the cash economy than the man. And, men without college educations, who make up a disproportionate share of men in red counties, are much more likely to have sustained periods of unemployment and to have mediocre earnings that have been stagnant, adjusting for inflation, for decades, than men with college educations (or even "mid-skilled jobs" and some college) in blue counties.

Also, high school educated women who leave the work force to have kids for a while receive few, if any, economic penalties to their earning capacity when they return to the work force, while college educated women who do that see their earning capacity when they return to the work force plummet. And women in red counties are much more likely to obtain some level of post-high school education than men. Indeed, programs to help women improve their education and skills often succeed in improving the economic well being of women, while programs to help men do the same rarely attract interest from men or have much of an impact.

As a result, couples with high school educations are failing to marry (the average high school educated couple has a child two years before getting married while the average college educated couple has a child two years after getting married and does so at an older age), and getting divorced when they do marry, at unprecedented high rates (in white couples echoing trends that started to appear with black couples without college educations in the late 1960s, as discussed for example, in the Moyihan report at the time).

In these breakups and divorces, where the inability of the man in the couple to be the stronger economic provider in the relationship is a key cause of the breakup, the man also has little if any ability to pay child support and alimony, or to provide a significant property division settlement (i.e. the legal rights a woman gains from being married).

The economic struggle that high school or less educated couples have to stay employed and earn a decent income after decades of wage stagnation for high school educated workers, also makes these families much more vulnerable to situations where they neglect or abuse their children, often resulting in a termination of parental rights or just child protective service intervention.

Both unstable couples, and neglect/abuse situations, means that many red county children often grow up without their father as part of the household for prolonged periods of time (echoing the experience of African-American children half a century earlier).

These trends are also exacerbated by the trend towards assortative marriage. There are fewer marriages in which one member of a couple is college educated and higher earning and the other is not college educated and has lower earning capacity. In part, this is because people have long tended to marry people of similar IQ, but now higher IQ women obtain college educations, while historically, this was much less common.

So, red county families are vastly more fragile than blue county families. This has led to a perennial state of moral panic in red counties about masculine identity and "family values" which when viewed as a moral problem prompts an attack on perceived sources of immorality and lost of masculine identity, which has led red county men to try to express their insecurity about their masculinity by trying to display that in ways other than being an economic providers, and by scapegoating LGBT people.

In contrast, college educated couples, who are much more common in blue counties, are much more likely to marry before having children, and have divorce rates that are falling to levels not seen since the 1960s.

Higher Education

In blue counties, higher education programs at all levels from certificates to associate's degrees to four year college degrees greatly increase your earning potential and pay for themselves in as little as a year or two, and usually in less eight years for all but the least qualified students in the least technical programs.

In red counties, higher education programs other than four year college degrees are a net money loser even at low community college tuitions when living at home, and even a four year degree can take as much as twenty-four years to pay for itself with higher earnings.

This is fundamentally because urban areas with healthy economies have productive ways to utilize the skilled and abilities developed in college, while rural and small town economies don't have jobs that productively utilize what someone learns from a college education.

See here and here.

Immigration

Blue counties have greatly disproportionate shares of immigrants and, in particular, disproportionate shares of immigrants who are settled residents of their communities rather than migrant workers living semi-nomadic lives. Due to their familiarity with immigrants in their daily lives, residents of blue counties are much less afraid of immigrants, who they know from experience to be good community members (at least to the same extent or more than native born members of the community) and who they know from experience are not disproportionately likely to commit crimes.

Red countries have a disproportionately smaller share of immigrants, who are often limited primarily to medical professionals and migrant farm workers. Due to their lack of familiarity with immigrants and the lack of a healthy economy, red county residents are much more likely to fear immigrants. Attitudes towards immigrants and globalization is also influenced by the reduced likelihood of red county residents to have had any higher education (as discussed above), or to have travelled abroad or to have lived in very different places within the United States (as discussed below).

Travel and Migration

Residents of red counties are much less likely to have a passport or to have traveled abroad than residents of blue counties. They are also less likely to have spent significant amounts of time living in places in the United States other than the vicinity of the place that they grew up, and even when they have lived elsewhere are likely to have lived somewhere else quite similar to the place that they grew up.

Studies of cousin marriage have shown that people in cousin marriages are less economically successful on average, primarily as a consequence of being less likely to leave the community where they grew up to move to larger cities.

Race

Some counties are overwhelmingly white, and those counties tend to be red counties that are rural or small town settings, especially in Appalachia, the rural Midwest, and much of the mountain states. The main exceptions are in New England (e.g. rural and small town areas in Vermont and Maine and Western Massachusetts) and counties defined by college towns.

Counties that are majority non-white tend to be blue counties even if they are similar to red counties in other respects, these include most of New Mexico and parts of Southern Colorado, counties with Indian Reservations (from Oklahoma to Arizona to North Dakota), and much of rural Hawaii and Alaska.

Quite a few red counties, however, are biracial. They have a white majority, and a non-white minority, usually black in the South and the Rust Belt, usually Hispanic in the Southwest, and sometimes Native American in countries near Indian Reservations and in Alaska (in the case of Alaska Natives) that don't actually have Indian Reservations or Alaskan Native communities. Few red countries, in contrast, and many blue counties, are genuinely multiracial, with significant numbers of people from more than two races or ethnicities.

Age, Health Care, Disabilities, and Credit

Residents of red counties tend to be older than residents of blue counties (except that Mormon dominated red counties tend to have younger residents).

Blue counties have more specialized and higher quality medical care available, and more medical professionals per capita than red countries which have a greater need for medical care due to their older populations. Blue states also tend to have fewer people who are uninsured since unlike some red states, they don't intentionally turn away free federal funds for Medicaid expansion and mostly don't provide state funding for health care beyond the federal minimum contribution. 

Red county residents have less interaction with medical professionals, especially medical doctors, than blue county residents, and a greater proportion of medical doctors in red counties are foreign born than in blue counties, which can impair the quality of doctor-patient interactions and communication.

Red county residents are less likely to have good health care outcomes following trauma incidents and strokes than blue county residents since they are less likely to reach a trauma center or top quality hospital during the "golden hour." More generally, red county residents have less first hand experience with what top quality modern health care can accomplish, on average, than blue county residents.

Red county men in the work force are much more likely to be employed in jobs with highly elevated rates of occupational injuries (like farming, fishing, timber work, mining, and construction) than blue county men in the work force.

A greater proportion of workers in red counties have physically demanding jobs that make it far more common for these workers to become disabled or forced to retire at younger ages than in blue counties.

Higher percentages of the population that are uninsured, and general lower levels of economic security among high school educated people who are more common in red counties also mean that average credit ratings are much lower in red counties than in blue counties, and that a very substantial proportion of the population in red counties have money judgments outstanding that can cause their wages and bank accounts to be garnished and their property seized, which can build animosity towards the legal system, and distrust of law enforcement officers who enforce judgments and of financial institutions in red counties. In blue counties where economic prosperity is more often uninterrupted and adequate health insurance is more common, in contrast, credit ratings are higher, money judgments are much more rare, and trust in the civil courts and financial institutions is much greater. Lack of health insurance also breeds justifiable fear of interactions with the medical establishment which can lead to financial ruin for many red county residents, while it rarely has that effect for blue county residents.

Self-Respect and Fragile Self-Esteem

The non-college educated white men at the core of the MAGA movement have taken immense blows to their self-esteem in many cases, and if they haven't have seen friends and neighbors who have.

The fact that they didn't go to college or went and didn't graduate brands them as a failure. They have failed to be reliable and prosperous economic providers. They have often failed to hold together intimate relationships and marriages. They have often failed to fulfill the expectations of society for fathers. They are often reliant on government payments, perhaps disability payments or SSI or Social Security, even if they earned them, rather than earning money from meaningful work.

In the MAGA heartland of West Virginia, 20% of the state's entire GDP consists of federal spending in the state less federal taxes paid from the state, and this is true of basically every county. Even if some of this is subtle, like Medicare and Medicaid provided health coverage, or a Social Security disability pension that was someone's only option to survive, a disabled man of working age who worked in physical labor all of his life, still sees receiving this support as a blow to his sense of self-respect which leaves his self-esteem as something fragile to prop up by means other than being an economic provider. Receiving government aid can feel bad even when you need it and it makes you better off because it is a constant reminder of your own failures.

Cursing the federal government and claiming you can be independent of it, reality be damned, can help compensate for the blow to one's self-esteem and self-respect that flows from being dependent upon it, even though it is counterproductive (at least in the short term) to do so.

Veterans, Hunters, Dangerous Animals, Law Enforcement Response Times, Firearms, And Crime News

Men in red countries are much more likely to be military veterans, than men in blue counties.

Men in red counties are much more likely to have engaged in recreational hunting than men in blue counties.

The higher proportion of men in red counties who are military veterans and/or have engaged in recreational hunting, means that men in red countries are much more likely to be gun owners than men in blue counties, and in particular, are much more likely to own firearms other than handguns.

Due to lower population densities in rural America, where the vast majority of counties are red counties, the average red county resident is a much greater distance from the average law enforcement responder than the average blue county resident, and as a result law enforcement response times to 9-1-1 calls are longer in red counties than in blue counties. Encounters with dangerous wildlife are also much more common in red counties than in blue counties. These circumstances creates a greater perceived need to own firearms for self-defense and the defense of others in red counties than in blue counties.

Also, while blue county news reporting typically covers a whole metropolitan area, resulting in a constant stream of news about violent crime, red county news reporting is typically hyperlocal, covering only a portion of the county around a small town, resulting in fewer reports of violent crimes near the people reading it, even though their crime rates per capita are actually higher. So, red counties tend to be perceived as less crime ridden than they are, while blue counties tend to be perceived as more crime ridden than they actually are. This interferes with the ability of people in red counties to see the connection between their high rates of firearm ownership and lax gun control enforcement and the rates of suicide and homicide and police use of firearms that they experience. In contrast, the connection seems stronger than it is in blue counties, because there is so much crime to cover in a populous metro area that only the most serious violent crimes which often involve firearms, receive news coverage, creating the perception that this is the most typical kind of crime in blue counties even though this isn't the case.