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Home elevators have killed and injured kids for decades. Safety regulators won’t order a simple fix.

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The government is not doing its job. Todd Frankel reports in the Washington Post:

It was lunchtime when 2 1 /2-year-old Fletcher Hartz opened the door to the elevator at his grandparents’ home in Little Rock.

His mother, Nicole Hartz, stood a few feet away in the kitchen making peanut butter and jelly sandwiches. She didn’t see him walk into the hallway and pull open the elevator door, which looked like an ordinary closet door. But she heard him cry.

She thought Fletcher, a curious little boy with thick brown hair, was upset because he couldn’t reach a light switch. She went to check on him and found Fletcher trapped behind the door to the elevator, which her in-laws had installed a few years earlier to accommodate their own elderly parents at the two-story home.

Nicole yanked on the door. It was locked, automatically secured by a safety device after being closed. But she could pull it open a crack. She could see Fletcher was caught in the narrow gap behind the outer door and just in front of an accordion door that closed off the elevator car, a no-man’s land where the floor ended and the edge of the elevator car began. The space was only a few inches wide, just enough for his tiny body.

She didn’t panic. He wasn’t hurt. It’s going to be okay, she recalled telling him that day in February 2017.

But she didn’t know what many in the elevator industry had known for more than 70 years: that children caught between the doors had been killed and injured before, crushed by moving elevators when their tiny bodies collided with the door frame above or fell into the elevator shaft below — a danger allowed to exist all these years by companies and regulators despite a simple solution, according to interviews with 28 officials, parents and regulators, plus a review of hundreds of documents from courts, companies and government agencies.

Corporate memos going back to at least 1943 highlighted the hazard. Lawsuits filed on behalf of dead and injured children since 2001 further spelled out the risk. In 2005, several elevator experts tried to change the nation’s elevator safety code to shrink the door gap — and were rejected. After more accidents, the elevator code finally changed in 2017, but it applied only to new installations. Nothing was done to fix hundreds of thousands of existing residential elevators, despite a problem that could be solved with a $100 space guard, according to elevator experts.

“It’s a hazard with an urgency that’s second to none,” said Bob Shepherd, executive director of the National Association of Elevator Safety Authorities, which certifies elevator safety inspectors.

But the Consumer Product Safety Commission — the federal agency responsible for regulating safety in 15,000 consumer products, including residential elevators — has done little to address the problem, despite knowing about child fatalities since 1981 and having studied the issue closely since 2013. The agency’s inaction highlights how a lack of urgency by regulators and resistance from companies can combine to stop the CPSC from warning the public or demanding a recall, even when a hazard poses a particular threat to children.

“What is the safety agency there for if not this?” said a frustrated senior agency official who spoke on the condition of anonymity to discuss internal deliberations.

CPSC spokesman Joe Martyak said the agency is working “to come up with a solution to the complex issues involved.”

Industry officials have argued to the CPSC that the problem is complicated and, in some cases, overblown in scale and not their responsibility, according to interviews. It was an argument they made during two recent private meetings with the CPSC as the agency faces renewed pressure from victims’ families to take action.

The elevator industry’s plan for dealing with regulators was laid out in an email accidentally sent to The Washington Post. Alesa McArthur, executive director of the National Association of Elevator Contractors, wrote that industry representatives had agreed that during a meeting with the CPSC last month they would argue “they did not think a recall would be a good idea or even all that useful” because of the “difficulty in reaching” elevator owners and because the industry believes the size of the door gap was “appropriate.” McArthur did not respond to additional requests for comment.

Another industry official who attended the private talks with the CPSC cautioned that the agency needed to appropriately evaluate the risks.

“There are many risks in the home,” Mark Townsend, a director of the residential-elevator trade group Accessibility Equipment Manufacturers, said in an interview. “You don’t stick your knife into your toaster to get the toast out, and you don’t play around with an elevator as a little kid.”

So far, the industry’s arguments against a recall have prevailed, over the objections of some in the agency’s leadership.

“No parent should have to experience this,” said Elliot Kaye, a CPSC commissioner who wants the agency to require the elevator industry to fix the problem. “There are just some things we should be beyond as a society.”

In Little Rock, as Nicole struggled to free Fletcher, she phoned her mother-in-law for help unlocking the door, according to police reports and interviews. A friend of hers . . .

Continue reading.

Written by LeisureGuy

18 July 2019 at 4:46 pm

These thoughts from Herodotus seem timely these days

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Read this post from a decade ago (31 December 2009). A propos, wouldn’t you say?

Written by LeisureGuy

18 July 2019 at 12:02 pm

When Facebook’s Bill Lumbergh Tries to Start a Currency

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Matt Stoller publishes a very interesting on-line column (and newsletter) about monopolies in the US and the power they wield. Today is about Facebook, and I’ll quote just some from the column, but do read the whole thing.

There are many ways to describe the governing regime under which Western commerce and politics has operated since the late 1970s. But the most visceral way is to understand that the basic goal, not necessarily by design, was to put men like the fictional character Bill Lumbergh from the movie Office Space in charge of everything.

I was reminded of Lumbergh yesterday while watching Facebook’s VP in charge of their new crypto project, David Marcus, testifying before the Senate Banking Committee to try and justify the company’s attempt to create a global parallel currency.

Lumbergh is one of the most brilliant and iconic characters of 1990s era cinema. He runs Initech – the generic technology company – through fear, extending control over every aspect of his employees’ lives. He’s a passive aggressive bully to everyone around him, except for the notable exception of the “Bob’s,” two management consultants brought in to lay off employees. Both are named Bob, and are equally greedy, manipulative, and repugnant. Management’s short-sightedness and penchant for micro-management humiliates the engineers, leading to bad engineering choices. One such choice creates an opening for the attempt to steal large sums of money, which animates the plot. An equally passive aggressive manager runs the chain restaurant who humiliates the love interest of the main character. The Bob’s, and Lumbergh, are cultural touchstones today for a reason. Characters like them run our institutions and businesses, and our lives.

It’s not too hard to imagine how Office Space analogizes to Boeing, a company run by engineers taken over by Lumbergh-types in the 1990s. The engineers were pushed aside and humiliated, repeatedly, not just over pay, but over what they really care about, which is the engineering and safety integrity of the machines they create. Short-sighted control-freak management can boost stock in the short-term, but ultimately, planes fall out of the sky. This is true for Hollywood as well, where creativity is slowly being drained out of films as the suits dominate the creatives. Which brings me back to the Libra experiment, and the hearings yesterday and today.

I was reminded of Bill Lumbergh because Facebook’s David Marcus sounded like what I imagine Lumbergh would sound like if he were testifying to Congress (though Marcus has an unspecified European accent.) Marcus was polite, smooth, evasive, and passive aggressive. Such powerful executives are common in D.C., and usually Congress treats them with deep respect, even reverence.

Though Marcus is clearly talented, and normally such a man from such a powerful company would have Congress eating out of the palm of his hand, the hearings did not go well for Facebook. Senator Sherrod Brown started out by saying that Facebook was like a toddler playing with matches, and has a record of committing “arson,” calling each instance of arson a “learning experience.” It got worse from there. Republican Senator Martha McSally was openly angry and sarcastic over Facebook’s gall in launching the project, and Republican Senator John Kennedy meticulously went through Facebook’s litany of lies around data. Senator Pat Toomey, who is quite friendly to Facebook, asked how it is that the Libra Reserve, which may pay large dividends to investors, is chartered as a nonprofit.

Democratic Senator Bob Menendez got from Marcus that the Libra Association may not enforce U.S. sanctions. Jon Tester pressed on the potential for bank runs. Senator Mark Warner spent time asking about whether Facebook would exclude competitors from the payments space, and Marcus, while he said Facebook would support other wallets, implied Facebook would probably be embedding its own wallet into its services. As everyone involved in consumer-oriented network systems knows, such defaults are a key way to dominate markets.

Marcus had no answer to any Congressional concerns. The utter disaster of the Senate hearing is being repeated today in the House Financial Services Committee, where members are deeply unhappy about Facebook’s project. The virtually unanimous wall of frustration will empower and press regulators to become far more aggressive in dealings with Facebook. I suspect the Federal Reserve got the message, and will slow walk the Libra project to an ultimate quiet death.

But I thought the most interesting moment of the hearing was when Hawaii Senator Brian Schatz noted the private conversation he’s had with some of the other 27 members of the Libra Association. This association includes companies like Uber, Mastercard, and VISA, as well as nonprofits like MercyCorps. Facebook has portrayed the Libra Association as a collective, as if Facebook is just one of many voices in this venture. But as Schatz revealed, Facebook’s voice is more like the godfather’s voice in the family. It’s true that it’s just one voice among many, but, you know, it’s also the only voice that matters. Here’s what Schatz said: . . .

Do read the column. The US is rapidly changing in directions that I believe the majority do not want.

Later in the column:

I’ve written before about the wave of terror in American commerce. From low-paid workers to coders to aerospace engineers to venture capitalists all the way to large companies like VISA, fear is now pervasive. Earlier this month, Bloomberg reported on the wave of tech IPO’s, and how the market power of Amazon and Google loomsover basically of them. This fear is coming from the concentrated market structures that allow these kinds of companies to set the terms and conditions for all businesses that use their essential services.

Both parties, starting in the late 1970s, decided to place power over our industrial commons into the hands of financiers, because leaders and Americans broadly believed, for good reason, that our corporate structures were faltering and needed radical change. Part of this project involved allowing financiers to structure markets into monopolies, part of it involved transferring the power to set market rules from public institutions to private monopolies.

We are now forty years into this experiment. And the shift of sovereignty from democratic bodies to autocratic ones was on display in the hearing over Facebook’s Libra in a particularly overt way. And that is why Marcus reminded me so much of Bill Lumbergh. He was polite and disdainful, passive aggressive and dishonest, untrustworthy yet all-powerful.

The question is no longer whether we want Bill Lumbergh-types running our corporations. It’s whether they will start governing every facet of our society.


Written by LeisureGuy

17 July 2019 at 7:39 pm

How Detained Children Are Treated Around the World

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Isaac Chotiner writes in the New Yorker:

The past two weeks has seen a surge in reporting on how U.S. Customs and Border Protection treats immigrants as they enter the country. On Monday, July 1st, lawmakers toured border-patrol facilities in El Paso and Clint, Texas, and spoke with women who were detained there. The women recounted that their children had been taken from them; they were being held in cramped cells with little access to fresh water and had been told to drink from the toilet. That day, ProPublica reported on a secret Facebook group for Border Patrol agents, with nearly ten thousand members, who posted vulgar insults of immigrants and of the lawmakers who visited them in Texas. On Sunday, the New York Times and the El Paso Times published an investigationinto the Border Patrol facility in Clint, where hundreds of children, many of them separated from family members, have been held in unsanitary, cruel, and overcrowded conditions. In response, the Trump Administration claimed that the border-patrol facilities were adequate, and President Trump called the Times piece a “hoax.”

In order to place this ongoing crisis into a broader international and historical context, I recently spoke by phone with Michael Garcia Bochenek, who is the senior counsel to the Children’s Rights division of Human Rights Watch. Bochenek, who previously served as the director of law and policy for Amnesty International’s London secretariat, has extensive experience visiting child detainees in the United States and around the world. During our conversation, which has been edited for length and clarity, we discussed what he learned from seeing detained children abroad, the attitudes of guards at border facilities, and why America makes it so difficult for human-rights advocates to visit detained children.

As this largely self-imposed humanitarian crisis has been developing on the border, what have you made of the images and reports you have been seeing, especially given your international experience?

“Self-imposed” is really the right word, not only in terms of a manufactured emergency. This is something that, numerically speaking, isn’t very unusual, something that in terms of capacity isn’t that much of a challenge, in a country with considerable resources. Anytime we are looking at deficiencies in terms of conditions of detention, lack of access to needed programming, lack of attention to mental-health and other health services—the cause of that is not that there is not money, or there is no capacity, or there is no expertise, as has been the case in some places that I have been. It’s a policy choice. It’s a choice to inflict these kinds of conditions on people, and in this case on children.

Can you discuss those other detention centers that you have seen around the world, where the conditions stem from a lack of expertise, or the country is overwhelmed?

The closest contexts that I can think of are primarily in the juvenile and criminal settings. These are kids, and sometimes adults, who are charged with crimes or convicted of crimes and who are going through a criminal process as opposed to an administrative immigration situation. For example, kids held in Brazil, or kids held in many other Latin American countries, are often held in overcrowded conditions. There is often a severe lack of access to necessary health care. Sometimes the quality of food is an issue. Rarely, in the case of Brazil, are education or other kinds of activities wholly unavailable, although sometimes there is a significant gender difference in terms of who gets offered what. Boys might get access to sporting activities, and girls are expected to sit quietly and do needlework. There are problems in that regard.

But, significantly, it’s not really a question, in a place like Brazil, that kids should have access to education. The question that often arises there is what curriculum should they follow, given that people are coming in and out all the time. In the United States, in contrast, particularly with these immigration holding cells, there’s absolutely no pretense of offering education. Even though, in some cases, we’re talking about having kids for weeks. If there are standards with relation to activities, they’re certainly observed in the breach.

In terms of caring for detained kids, is this something that democratic countries have always been much better about? Or is that distinction not helpful?

I think the answer to that probably has less to do with the form of government and more to do with other decisions. European Union countries have very few kids in detention, whether that’s juvenile justice or immigration detention, as compared to the United States. The United States is kind of a standout in the world, in the worst sense possible, around detention. When European countries do detain kids, they often do so with lots of support services.

In fact, at one point, I taught children’s rights at Georgetown Law School, and I took the law students, who were both U.S. students and foreign students, into the D.C. juvenile-detention center. A lot of the students from countries other than Europe were shocked by how clean U.S. facilities were. The U.S. students were appalled at the conditions. And the European students couldn’t believe what they were seeing. For the European students, particularly those from Scandinavia, Germany, Holland, and so on, what they were used to from their home countries was a far more nurturing environment than what they were seeing in this institutional setting that could well have been, in their mind, an adult correctional facility. Possibly for very, very serious offenders.

So are you saying democratic traditions and values do matter, just not in the United States?

If you ask me to contrast countries that most people would describe as democratic, those are the two obvious ends of the spectrum that come to mind. But—just to name a few places where I’ve gone into detention centers—Angola, Liberia, Brazil, Mexico, and Guatemala have significant degrees of repression, or certainly have targeted people for speaking out. Including kids. But, in all of those places, there’s some recognition that kids should be held in a way that is consistent with furthering their development. There is the idea of offering them rehabilitation, the idea of giving them a second chance, even if, in practice, that isn’t available because of the conditions in which they’re held. What is often lacking is the wherewithal to carry that out.

In many of the countries that I’ve been to, they have infrastructure that’s falling apart, staff that is going unpaid for periods of time—again, largely, it seems, because of resources. And there is an effort in some of these places to put real limits on the time that kids are held. So kids in Liberia, when I was there—very, very few of them are locked up, for very little time, even though in the adult system it was very common for people to be held without charge for the maximum time that was permitted.

I was going to say, one irony of this, if it’s an irony, is that it takes incredible resources to lock these kids up.

It takes a lot of money to do this. We’re talking about seven hundred and fifty to seven hundred and seventy-five dollars per day, per child. That’s a lot of money that could be used to do something else. We know that the other options—such as to place them with other family members, in foster-care facilities, in child facilities that are, in fact, living up to court orders or U.S. government settlement agreements—are cheaper. [In other words, the U.S. government is willing to pay extra to treat children like this. – LG]

What have you made of the debate about the term “concentration camp”? . . .

Continue reading.

Written by LeisureGuy

11 July 2019 at 2:19 pm

Americans Shouldn’t Have to Drive, but the Law Insists on It

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Gregory H. Shill writes in the Atlantic:

In a country where the laws compel the use of cars, Americans are condemned to lose friends and relatives to traffic violence. My childhood neighbor was a varsity student-athlete, the president of the junior class, and the most popular girl in school. One day in September 1995, a car crash took her life. She had been driving home on the freeway when her car went across the median and collided with one going the opposite direction, killing both drivers. A third vehicle was said to have struck her car moments before, causing her to lose control. The police put out a call for information, apparently without success.

My neighbor’s passing was shocking and heartbreaking. But at the time, it felt like a basically unavoidable tragedy. In our small city in Michigan—like almost everywhere in America—driving is the price of first-class citizenship. We never stopped to ask whether a different bargain was possible. Since her passing, approximately 1 million more Americans have been killed in car crashes.

In America, the freedom of movement comes with an asterisk: the obligation to drive. This truism has been echoed by the U.S. Supreme Court, which has pronounced car ownership a “virtual necessity.” The Court’s pronouncement is telling. Yes, in a sense, America is car-dependent by choice—but it is also car-dependent by law.

As I detail in a forthcoming journal article, over the course of several generations lawmakers rewrote the rules of American life to conform to the interests of Big Oil, the auto barons, and the car-loving 1 percenters of the Roaring Twenties. They gave legal force to a mind-set—let’s call it automobile supremacy—that kills 40,000 Americans a year and seriously injures more than 4 million more. Include all those harmed by emissions and climate change, and the damage is even greater. As a teenager growing up in the shadow of Detroit, I had no reason to feel this was unjust, much less encouraged by law. It is both.

It’s no secret that American public policy throughout the 20th century endorsed the car—for instance, by building a massive network of urban and interstate highways at public expense. Less well understood is how the legal framework governing American life enforces dependency on the automobile. To begin with, mundane road regulations embed automobile supremacy into federal, state, and local law. But inequities in traffic regulation are only the beginning. Land-use law, criminal law, torts, insurance, vehicle safety regulations, even the tax code—all these sources of law provide rewards to cooperate with what has become the dominant transport mode, and punishment for those who defy it.

Let’s begin at the state and local levels. A key player in the story of automobile supremacy is single-family-only zoning, a shadow segregation regime that is now justifiably on the defensive for outlawing duplexes and apartments in huge swaths of the country. Through these and other land-use restrictions—laws that separate residential and commercial areas or require needlessly large yards—zoning rules scatter Americans across distances and highway-like roads that are impractical or dangerous to traverse on foot. The resulting densities are also too low to sustain high-frequency public transit.

Further entrenching automobile supremacy are laws that require landowners who build housing and office space to build housing for cars as well. In large part because of parking quotas, parking lots now cover more than a third of the land area of some U.S. cities; Houston is estimated to have 30 parking spaces for every resident. As the UCLA urban-planning professor Donald Shoup has written, this mismatch flows from legal mandates rather than market demand. Every employee who brings a car to the office essentially doubles the amount of space he takes up at work, and in urban areas his employer may be required by law to build him a $50,000 garage parking space.

For those who didn’t get the message from the sprawling landscape that zoning has created, the tax code sharpened it by lavishing rewards on those who drive and punishing those who don’t. On its own terms, the mortgage-interest tax deduction is neutral as to the type of home financed, but—given the twin constraints of zoning and mortgage lending—the deduction primarily subsidizes large houses in car-centric areas. Those who walk or bike to work receive no commuter tax benefit, while those who drive receive tax-deductible parking. Another provision of the tax code gives car buyers a tax rebate of up to $7,500when their new vehicles are electric or hybrid; buyers of brand-new Audis, BMWs, and Jaguars can claim the full $7,500 from the American taxpayer. Environmentally, these vehicles offer an improvement over gas-powered cars (but not public or active transit). Even so, 85 to 90 percent of toxic vehicle emissions in traffic come from tire wear and other non-tailpipe sources, which electric and hybrid cars still produce. They also still contribute to traffic, and can still kill or maim the people they hit. Why are we taxing bus riders to pay rich people to buy McMansions and luxury electric SUVs?

Drivers are subject to traffic regulations and vehicles to crashworthiness tests. But even in these areas, governments have prioritized motorists’ convenience over other goals, including the lives of people who aren’t driving.

The National Transportation Safety Board has determined that speed is a top risk factor in motor-vehicle crashes. Yet the most prominent way of setting and adjusting speed limits, known as the operating-speed method, actually encourages faster driving. It calls for setting speed limits that 85 percent of drivers will obey. This method makes little provision for whether there’s a park or senior center on a street, or for people walking or biking.

As a matter of law, the operating-speed method is exceptional. It enables those who violate the law—speeding motorists—to rewrite it: Speed limits ratchet higher until no more than 15 percent of motorists violate them. The perverse incentives are obvious. Imagine a rule saying that, once 15 percent of Americans acquired an illegal type of machine gun, that weapon would automatically become legal. Other legislation amplifies the harm from this method. In California, for example, cities are sometimes obligated by law to raise speed limits against their will, and local governments are barred from lowering them even for safety reasons. This occurs against a backdrop of radical under-enforcement of the speed limit nationally, and the widespread banning of proven but unpopular lifesaving technologies such as automated speed cameras.

Just as telling as what activities the law regulates is whose interests it seeks to protect. Dozens of our peer nations require carmakers to mitigate harm to pedestrians caused by their products. U.S. design regulations, however, require only measures that enhance the safety of car occupants. Just as SUVs are becoming taller, heavier, and more prevalent—and pedestrian fatalities are surging—U.S. regulators have not required carmakers to embrace those more comprehensive design standards. Instead, they’ve launched campaigns baselessly blaming pedestrians for their own deaths.

States don’t require drivers to carry enough insurance to fully compensate people they hit. The most common amount of required bodily-injury coverage is just $25,000; in some states, it’s zero. A number of states also employ no-fault systems associated with increased fatality risks. This all lowers the up-front cost of driving, but those who lack the protection of a vehicle suffer disproportionately.

Tort law is supposed to allow victims to recover for harms caused by others. Yet the standard of liability that applies to car crashes—ordinary negligence—establishes low expectations of how safe a driver must be. Courts have held that a higher standard—strict liability, which forces more careful risk taking—does not apply to driving. Strict liability is reserved for activities that are both “ultrahazardous” and “uncommon”; driving, while ultrahazardous, is among the most common activities in American life. In other words, the very fact that car crashes cause so much social damage makes it hard for those who are injured or killed by reckless drivers to receive justice.

In a similar spirit, criminal law has carved out a lesser category uniquely for vehicular manslaughter. Deep down, all of us who drive are afraid of accidentally killing someone and going to jail; this lesser charge was originally envisioned to persuade juries to convict reckless drivers. Yet this accommodation reflects a pattern. Even when a motorist kills someone and is found to have been violating the law while doing so (for example, by running a red light), criminal charges are rarely brought and judges go light. So often do police officers in New York fail to enforce road-safety rules—and illegally park their own vehicles on sidewalks and bike facilities— that specific Twitter accounts are dedicated to each type of misbehavior. Given New York’s lax enforcement record, the Freakonomicspodcast described running over pedestrians there as “the perfect crime.”

Since the dawn of the automobile, governments have been slow to address its downsides. “We have gloated too much over the usefulness of the motor car,” said The New York World in a 1913 editorial. “We put it into reckless hands. We make no effective laws against its misuse.”

In the years since, American government at all levels crossed a line. Instead of merely accommodating some people’s desire to drive, our laws essentially force driving on all of us—by subsidizing it, by punishing people who don’t do it, by building a physical landscape that requires it, and by insulating reckless drivers from the consequences of their actions. To page through the law books today is to stumble again and again upon evidence of automobile supremacy. The range and depth of legal supports for driving is bewildering. But these laws, which are everywhere we look, are also opportunities. . .

Continue reading.

Written by LeisureGuy

9 July 2019 at 12:47 pm

Big money means bad food and little control

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This video presents material that is shocking but not surprising. It shows the degree to which the US government is controlled by business interests. Worth watching:

Written by LeisureGuy

8 July 2019 at 9:29 am

Democrats Obsess Over Health Insurers When They Should Fight Doctors and Hospitals

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Josh Barro writes in New York:

Nobody likes health insurers, but the Democratic candidates’ fixation on them as an all-purpose bogeyman for any problem with health care, as demonstrated at this week’s debates, is a demonstration of why single payer in the U.S. wouldn’t work like its supporters see it working abroad and would like it to work here.

One of the key arguments for a single payer system is that it’s cheaper than a system with private payers. That has generally been true around the world, but it’s not a law of nature. Single payer is cheaper because governments use their leverage as the sole buyer of health care to push prices down. They pay doctors and hospitals less, because they can. The savings don’t come from the single-payer system itself; they come from the choice to pay less.

So, what will happen if the U.S. adopts a single payer system? Providers like doctors and hospitals will make the same arguments Senator Michael Bennet did at Thursday’s debate: That they depend on the higher rates from private insurers to offset the lower rates they get from Medicare and Medicaid. If every patient’s insurer paid like Medicare, they’d close.

In a lot of cases, the hospitals aren’t bluffing: Hospitals need to charge patients more than in other countries to make their finances work, because they pay their doctors more than in other countries. Achieving costs like in countries that have single payer would require cramming through unit cost savings so our costs align with those countries. And that path runs straight through doctors and hospitals, which are a lot more profitable than insurers.

Senator Kamala Harris noted – correctly – that American emergency room costs are outrageous, leading patients to hesitate before they seek care they might need. But while Harris framed this as a problem with health insurance, it’s hospital systems that set those high prices; insurers increasingly pass those costs through to patients, but if they didn’t, premiums would be even higher than they are now.

Former Vice President Biden, bizarrely, threatened to put health insurance executives in jail “for their misleading – their misleading advertising, what they’re doing on opioids – what they’re doing paying doctors to prescribe.” That’s not chiefly an insurance issue, either – it’s an issue with pharmaceutical companies.

And at Wednesday’s debate, Senator Elizabeth Warren objected that health insurers had made $23 billion in profits last year. $23 billion is a lot of money, but total U.S. health expenditure – public and private – was $3.5 trillion as of 2017, the most recent year with available data. Since we spend about twice what our peer countries in the OECD tend to spend for approximately the same outcomes, our excess health spending is about $1.8 trillion. Abolishing health insurer profits would take us roughly 1 percent of the way to getting in line with our peers on costs.

I understand the impulse not to name the key villain, the key element in our health care system that’s making it unaffordable, which is providers and the payments they require. People feel positively about doctors and hospitals; they do not feel positively about insurers. But when you try to implement a single payer system, you will have two options: Fight the providers, or pay them whatever they want, in which case the shift to single payer won’t save much money and will require enormous tax increases.

I would also note that, while cost saving through monopsony buying power is not an ironclad consequence of adopting single payer, it is also possible to achieve that end without adopting single payer at all. The government can control payment rates to providers without actually making all the payments if it regulates prices. That is, it is possible to take on the providers first, which would save money for the government, employers, and individuals – making money available for all sorts of things, including expansions of health coverage.

While this approach would also require fighting the powerful provider lobby, it would make available allies you would not have with you for a fight to expand government spending and implement single payer. You could tell employers  . . .

Continue reading.

The US healthcare system is a mess. From

Written by LeisureGuy

1 July 2019 at 8:49 pm

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