Later On

A blog written for those whose interests more or less match mine.

Archive for October 27th, 2013

Helping Russ Douthat explain the ACA

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Russ Douthat has a cautionary column in the NY Times today in which he discusses whether the Affordable Care Act, once HealthCare.gov is up and running, will turn out to be popular and a good deal. He does show that some very inexpensive plans have some huge gaping loopholes that make the plans not such a good deal, but he also omits some relevant information. Andrew Sprung has a good post at Xpostfactoid that adds more information. From Sprung’s post:

  • Those cheap 2013 plans have already been improved by the ACA. The law bans lifetime coverage caps and has already severely constrained annual coverage caps, which are completely banned as of Jan. 1, 2014. In 2013, they could not be lower than $2 million for the year.  Pre-ACA, many plans on the individual market did not even offer real catastrophic coverage, which Douthat suggests might be a preferable alternative for many.  Also, the ACA has banned the wanton use of policy rescissions imposed on the flimsiest of pretexts, a notorious industry practice pre-ACA.
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  • The ACA does offer bare-bones catastrophic plans to adults under 30 and others exempt from the individual mandate, e.g., those who can show that buying plans on the exchanges would impose financial hardship. Such plans are not eligible for coverage subsidies, however. Conservatives could plausibly argue that that’s a mistake and, in a sane political environment, attempt to fix it.
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  • Granting in full that prices for medical treatment are “opaque, arbitrary and inflated,” Douthat, like most conservatives, would happily delegate the burden of imposing consumer discipline to less wealthy Americans, who are likely to “reduce healthcare costs” by denying themselves essential or preventive care.  Nor does he address the impossibility of individuals doing effective comparison shopping or cost-benefit analyses in the current insanely opaque market, where you can’t get price estimates if you try. It’s true that insurers can in some instances create conditions in which plan members have the information they need to comparison shop, and reasonable incentives to choose reasonably priced providers. But the kind of unregulated insurance market that conservatives favor won’t encourage such arrangements.  Moreover, the ACA lowest-level “bronze” plans only cover an estimated 60% of members’ likely medical costs and can have deductibles as high as $6350 for an individual. Coverage at that level (or the silver plans’ 70% coverage, for that matter) hardly encourages frivolous use of medical services.
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  • With regard to public sector priorities “undercut by rising health care costs”: the ACA pays for itself, with an array of taxes on industry providers and the wealthiest Americans and Medicare payment cuts and reforms. The CBO projects that it will reducethe federal budget deficit, modestly in the first ten years, far more dramatically in the next ten.  The package of pilot payment reforms, including performance incentives for hospitals and accountable care organizations, represents the most serious government attempt to date to contain healthcare inflation. If enough of those pilot programs prove successful, or if any are successful enough, they will do more to secure the nation’s long-term fiscal health and free up money for other priorities than all the Republicans’ favored entitlement cuts combined.

Written by LeisureGuy

27 October 2013 at 10:27 am

People shifting from cars to bikes…

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Very interesting report by Krishnadev Calamur. Here’s a chart from the article:

new-passenger-car-and-bicycle-sales-2012-_chartbuilder_custom-52ce0e51cc669b1c7267930f2f65dda1c5ceb3ba-s2-c85

Written by LeisureGuy

27 October 2013 at 8:08 am

Marijuana turns out to be an exit drug, not a gateway drug

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Drug warriors have many untested beliefs about various drugs—untested because it’s difficult to do large-scale studies of illegal drugs, particularly of a Schedule I drug like marijuana. A Schedule I drug is one that satisfies the following criteria:

  1. The drug or other substance has a high potential for abuse.
  2. The drug or other substance has no currently accepted medical use in treatment in the United States.
  3. There is a lack of accepted safety for use of the drug or other substance under medical supervision.

Of course, marijuana fails all three criteria:

  1. Marijuana is much less addictive than alcohol or tobacco—less addictive than coffee, in fact—and has caused zero deaths from overdose. So far as experience shows, it has low potential for abuse.
  2. Obviously, marijuana provides medical benefits for many, thus the use of medical marijuana: to ease nausea for cancer patients, to ease pain for various ailments such as arthritis, to prevent seizures in epileptics, and so on.
  3. Marijuana is an extremely safe drug, with no reported deaths from overdose. It is safer than aspirin.

Still, the facts often are irrelevant to the law, and so it is here: Marijuana remains a Schedule I drug (though the DEA’s own administrative judge long since called for reclassification).

With years of experience now with medical marijuana, so facts are becoming clear.

As noted in this NY Times article by Adam Nagourney and Rick Lyman, people use marijuana as a substitute for alcohol—a good choice, since marijuana is not so harmful as alcohol and is also less addictive than alcohol. Instead of being a “gateway drug” that leads to greater drug use, marijuana turns out to be an exit drug that leads people away from alcohol—and so far as statistics show, the true “gateway drug” is alcohol.

As the article states, many expectations regarding legalization of marijuana have turned out not to be the case:

California’s 17-year experience as the first state to legalize medical marijuana offers surprising lessons, experts say.

Warnings voiced against partial legalization — of civic disorder, increased lawlessness and a drastic rise in other drug use — have proved unfounded.*

Instead, research suggests both that marijuana has become an alcohol substitute for younger people here and in other states that have legalized medical marijuana, and that while driving under the influence of any intoxicant is dangerous, driving after smoking marijuana is less dangerous than after drinking alcohol.

Although marijuana is legal here only for medical use, it is widely available. There is no evidence that its use by teenagers has risen since the 1996 legalization, though it is an open question whether outright legalization would make the drug that much easier for young people to get, and thus contribute to increased use.

And though Los Angeles has struggled to regulate marijuana dispensaries, with neighborhoods upset at their sheer number, the threat of unsavory street traffic and the stigma of marijuana shops on the corner, communities that imposed early and strict regulations on their operations have not experienced such disruption.

Imposing a local tax on medical marijuana, as Oakland, San Jose and other communities have done, has not pushed consumers to drug dealers as some analysts expected. Presumably that is because it is so easy to get reliable and high-quality marijuana legally.

* I was raised in a dry state: alcoholic beverages were illegal in Oklahoma. But in 1956, liquor became legal (and regulated and taxed), and I happened to be in my hometown on the summer day that the (sole) liquor store opened for business. There was an uneasy feeling in the town that we would see wild car rides, shootouts, broken windows, fights, people reeling down the street, etc. That was what the “drys” had long prophesized. But it was a totally calm day. Those who actually wanted alcohol had long had access through bootleggers, and indeed the state had been kept dry though a powerful alliance of bootleggers and Baptist preachers, both of whom wanted alcohol to remain illegal.

But it didn’t, and the result was little change except that the bootleggers went out of business.

Alcohol can indeed cause serious problems, but the approach to preventing and solving those problems is not, we learned, to make alcohol illegal: that simply compounds the problems, as we found during Prohibition. It turned out to be better to have alcohol legal, regulated, and taxed and to deal with problems of alcoholism as medical problems.

 

Written by LeisureGuy

27 October 2013 at 4:42 am

Posted in Drug laws

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