Rational Arguments

And I’m having trouble feeling bad about it:

The sun hasn’t exactly set on Solar Planet, but anxiety over the fate of the Arlington tanning salon has been running high ever since a “tan tax” took effect last Thursday.

One of the less-publicized measures in the new health-care law, the tax imposes a 10 percent surcharge on the use of ultraviolet indoor tanning beds.

Supporters — including the Obama administration, congressional Democrats and dermatologists — have argued that the tax will raise an estimated $2.7 billion toward the cost of expanding health coverage to the uninsured, while discouraging a practice that increases the risk of skin cancer by as much as threefold in frequent users, according to scientific research.

But outraged owners of tanning salons worry that the levy could deal a death blow to an industry already reeling from the recession.

Look, we tax cigarettes at a much higher rate than other things.  Alcohol, too.  And other stuff that’s unhealthy.  Tanning is really bad for you.  Plus, go out in the sun if you want to save money.

It’s not that I don’t understand why some of you are upset about this; it’s just that I can’t get that worked up about it.

An eagle-eyed reader let me know that the Kaiser Family Foundation has a nice subsidy calculator up that you can play with.  You enter information about your income and situation, and you get to see how much health insurance and care will cost you in 2014.

It’s not all good news.

Let’s say you are a 60 year old divorcee in 2014.  You make $46,136, which is 401% of the poverty line.  You are therefore eligible for NO subsidy from the government.  Your premium will be $10,162.  Should you actually need care, your out of-pocket costs will be capped at $6250.

So in a best case scenario, your health insurance/care will cost you 22% of your income.  In a bad year (or a regular year if you have a chronic illness) your health insurance/care will cost you 36% of your income.  Um… that’s not affordable.

Granted, the cost is so high that you would likely not be subject to the mandate.  Great.  So you continue to have the option to be uninsured.

The people who are going to be hit hardest by this are those making just over 400% of the poverty line.  Because, ironically, if you make just a little bit less – say $45,906 (399% of the poverty line), then – due to subsidies – your premium will cost you $4361.  That’s less than 10% of your income.  And your out-of-pocket costs are capped at $4167.  So the most you could pay in a year would be 19% of income.

That’s still a lot.  But it’s WAY less than if you make just over the 400% line.

I have yet to see a good answer for what the government is going to do when people start asking for pay cuts to get under the 400% line.  I don’t see why it won’t happen.

A reader sent me the following tweet from a prominent conservative ex-politician:

Press Corps-pls do your job as Obama sneaks in Berwick appt;pls cover his mission:socialized healthcare&rationing based on”quality of life”

This kind of thing makes my head explode.  Look, I’m not going to get into the politics of the Berwick appointment.  But who oppose him see his “mission” to be twofold:

1. He’s for increasing government paid/run health care
2. He’s for decreasing spending on government paid/run health care

Ok.  You can’t be angry at him for both of these.  You can be angry at him because you believe he will increase the amount of money that government spends on health care or you can be angry at him because he will limit the amount of money that government spends on health care, but you can’t be angry at him for both.  For that matter, he really can’t do both.

Moreover, you, yourself, can hate one of these things, but you can’t hate both.

So, please, rail against increases in health care spending or against them.  Choose.  This is sort of silly.

I was going to take the weekend off, but this had to go up.  NSFW.  Go iPhone!

Happy Fourth, everyone!

The language in this is extremely NSFW.  You’ve been warned.

That said, watching it had me in stitches.  And I say that knowing I clicked the mouse every five minutes all day on June 15th so I could be one of the first to get an iPhone 4.  It worked.  I got mine a day before the official release date.  And I don’t regret it one bit.

(h/t Goldblog)

You may have noticed the following graph all over the Internet recently. Yes, obesity is on the rise.  Is there anyone left who doesn’t know?

I’m getting a little concerned about how we are talking about obesity, though. It’s an “epidemic”. A medical problem. A disease. This implies that somehow we will find the “cure”. Some medicine. Some medical intervention.

Obesity is a complex problem. And I think by medicalizing it, we may be missing larger issues. All problems should not be treated the same.  We keep talking about obesity like it is a health care issue;  it is, but it’s also a public health and societal issue.

I’ve been trying to get a number of papers out the door, so I’ve been immersed in statistics the last week or two.  Let’s put those skills to use.  Here, I took the obesity data from 2009 and plotted it against poverty. Here’s what you get:

Each dot represents a state in the US.  The size of the dot is its relative population.  The x-axis is the percent of the state in poverty, and the y-axis is the percent of the state that is obese. As you can see, there is a direct correlation between poverty and obesity state by state. In fact, for each percent increase in a state’s population in poverty, the population’s average BMI increases by 0.6.  This may come as a surprise to readers who assume that obesity is from having too much food. It’s not. It’s from having too much of the wrong food.

Obesity doesn’t have a simple fix.  It’s tied up in socio-demographic factors. We can’t fix something like poverty in a doctor’s office alone. We need to change society.

I know, I know. This will tick off about half of you. You think that obesity should be left to families and not the government. You think it shouldn’t be a public health issue; you think it’s an issue of personal responsibility. That’s a perfectly valid political philosophy, and it’s certainly not uncommon. One problem – that philosophy may also be associated with obesity.

Here’s another chart.  As a proxy for a more conservative mentality, I used the percent of the state voting for the Republican ticket in the 2008 presidential election:

For each percent increase in support of the McCain/Palin ticket in 2008, the BMI of a state is almost 0.2 higher.

I’m not saying these analyses are perfect.  They are completely exploratory and are no more a single explanation for obesity than any other factor.  The point is, obesity is complex.  It’s tied up in public health and societal norms and culture and families and even politics.

I have a rule of thumb I tell parents when I’m playing my pediatrician role: you shouldn’t expect a disease to go away in less time than it took for it to develop.  Maybe it’s time for all of us to stop watching this problem develop and start doing something about it.

* DISCLAIMER: These are simple analyses here.  They are uncontrolled and would never pass peer-review as explanations for obesity.  But part of me feels that hypothesis-generating data like these are what the blog is for.  I want to stimulate discussion.  My hope is that analyses like these force you to question your assumptions, not provide you with definitive answers.

I’m not a lawyer, but this is interesting:

Today, in Free Enterprise Fund v. Public Company Accounting Oversight Board, the Supreme Court invalidated a provision of the Sarbanes-Oxley Act without voiding the entire law.

This matters for the legal fight against Obamacare, as Sarbox did not have a “severability clause”—standard language that would ensure that, if one part of Sarbox was ruled unconstitutional, that part could be “severed” from the rest of the law, which would remain standing.

The Patient Protection and Affordable Care Act also lacks a severability clause. Some have therefore hoped that, if PPACA’s individual mandate is eventually ruled unconstitutional, the entire law would necessarily be voided along with it.

Today’s ruling by the Court, however, suggests that a severability clause is not needed in order to strike down one provision of a larger law…

Most of the effort to claim the ACA is unconstitutional focuses on the individual mandate.  Regulation isn’t unconstitutional.  Tax subsidies (and taxes) aren’t unconstitutional.  The exchanges aren’t unconstitutional.  It’s the (unpopular) mandate.

The thinking is that if the mandate is ruled unconstitutional, then the whole law must be scrapped; that seems to be because there is no “severability clause” in the ACA.  But today’s ruling appears to say that individual parts of laws can be struck down leaving the rest of the law standing.  That’s bad news to those attacking the individual mandate.

I still don’t think the mandate will be found unconstitutional.  But even if it is, it won’t destroy the ACA.  Sure, it will make it ridiculously more expensive and allow for free riders, but I’m not convinced that will stop people from taking the ACA to court anyway.

Austin Frakt acknowledges me (and this blog) in his latest Kaiser Health news column:

[T]he volume of [Medicare] health care services remains unconstrained. As it grows, so do costs. …

The SGR problem is now so large it offers an opportunity for political leverage on the issue of volume. The American Medical Association and other physician groups may want it fixed badly enough that they’ll accept some payment system changes in return. …  As an illustration of the political power of a full SGR fix, the AMA supported health reform on the promise of one.

What should Congress seek in exchange for scrapping the SGR methodology?

To find out, go read the whole thing.

Usually, I’d stay away from something like this.  But this can’t be right.

Dave Weigel is out from the Washington Post.  There’s no way I’m going to recap the whole thing, and I’m not going to venture an opinion on the whole ordeal. But I have two things to say.  The first is that I am baffled by people who think that never venturing an opinion or showing your colors is something to be lauded.  I get that there is a difference between a reporter and a pundit.  But to pretend that someone who reports must never, ever hold an opinion is, well, ludicrous.  Are they supposed to be Vulcans?  I would so much rather someone who was intellectually honest, acknowledged his or her own shortcomings, and then tried to give an unbiased, truthful report.

I feel the same way about financial conflicts of interest.  We don’t demand that people never, ever have a conflict.  We demand that they honestly report them to us along with their research.  That way, we can judge for ourselves how much the conflict comes into play; moreover, it forces the author to reflect and admit that biases exist to that they can be overcome.

So I don’t get all this huffing and puffing from “real” reporters who obviously purged all their emotions in kholinar so long ago.  Give me a break.  I’d be less likely to trust them.

The second involves this:

Andrew Klein writes in in reference to the matter of Dave Weigel:

I want to say first that I disagree with your assessment as it relates specifically to this scenario (as a young journalist myself, I do think there’s way too much coddling going around); that being said, the following question is meant in earnest, not sarcasm: Why do you think the list serv in question is “semi-public” (your words) or “public” (your friend’s words)? The guest list is a high water mark of masturbatory insider media, I’m sure, but it is in fact private and off the record. A place to vent and chat frankly and all that shit. Just because those involved are very public journalists doesn’t make their own off the record remarks any less so.
I concede that journalists should be cautious when putting such frank thoughts to paper, electronic or otherwise. But for me that’s not the bulk of the issue. Someone purposely took Dave’s obvious off-the-record remarks and made them public. The moral equivalences are manifold, and without condoning what he said my first reaction was a big ol new media WTF. Not much is sacred anymore, but can we at least say that publishing off the record remarks, no matter how silly or ill advised, is the first issue, not the second?

The answer is simple and unfortunate: Nothing is really off-the-record. No conversation between more than two people is ever really off-the-record, and no e-mail is ever, ever off-the-record.

Huh?  “Nothing is really off-the-record?”  If there’s one thing I though was true of REAL journalists it was that rules were in play that were inviolable.  I thought “off-the-record” meant “OFF-THE-RECORD”.  I thought journalists would go so far as to go to jail to protect a source.

I guess not. I guess that “off-the-record” means “off-the-record as long as it doesn’t please me to screw you”.  Unless I’m missing something.

I wonder if this real journalist tells his sources this fact when he’s getting them to tell him stuff, off-the-record.