Mass Transit Doesn't Move Me
The Illinois Department of Transportation says that the next stage of transportation improvements in the far western suburbs of Chicago is three to five years away. It expects the area (US 59 to I-39) to double in population by 2030. One of the most sensible steps is one of the mostly hotly contested (by a minority of anti-auto activists): building a new road between I-88 and I-80. (Take a look at a map and you'll see a space just crying out for a road, especially given the population growth in the region.)

Of course, some will want more money on mass transit. But, as the Daily Herald notes, "though the Chicago area has the second highest usage of public transportation in the nation, over 90 percent of traffic is passenger vehicles."

Meanwhile, bus drivers in metropolitan Minnesota are on strike, and have been for over a week. (It's the usual culprit: disputes over pay, including health insurance plans.) The Taxpayers League of Minnesota has run a brief fact sheet/commentary on mass transit during the strike. Some examples:

Low income individuals, for whom transit is often seen as a vital service, make less than 5 percent of their trips by transit.

Mass transit wastes energy. Per-passenger mile, autos are 16 percent more efficient.

How about "social costs" of pollution, noise, and so forth? Cars win again, with a cost of 7 cents per passenger mile. A bus costs 40 cents a mile, and light rail--what captures the most imagination of transit advocates--costs up to $1.09 a mile.

American cities have nowhere near the population density required to make transit cost-effective.
(permalink)

Cheap Drugs, Here!
Being on the popular but wrong side of an issue has served Minnesota's governor, Tim Pawlenty, pretty well. A robust proponent of importing price controls (excuse me, prescription drugs) from Canada, Pawlenty has gotten favorable press, including this article carried on the AP wire. Meanwhile, Senator Norm Coleman is attacking the idea of drug importation on safety grounds. Fair enough. But even more important than the short-term danger of buying bogus Vioxx from Venezuela is the threat to the health of pharmaceutical companies, who don't work for free. Gradually imposing price controls, as we have done in various ways (including attempts to help in the illegal importation of drugs) is shaping the incentive structure of the pharmaceutical industry in ways we can't fully understand. But it's not going to be good.

It's issues like this that take me to moments of despair; it's a lot easier to say "Why yes, Mrs. Smith, it's outrageous that your drugs cost $600 a month. Let's do something about it" than to explain the abstract yet real principles of economic incentives that (for the moment) make such wonder drugs possible.
(permalink)

Politicians Discover Blogs
Howard Dean's 15 minutes of fame (before the scream) hinged a lot on his use of blogging to attract attention and build a community of supporters. Now state legislators are getting into the act.

A story in Stateline lists several state legislators who are using blogs. But unlike most things hyped on the Internet, their usefulness is limited. At least that's the view of one reporter who got semi-famous for being one of the first newspaper journalists to write these quickly-published web sites.

“Blogs are best when they are chatty and casual and spontaneous,” says Daniel Weintraub, a columnist for the Sacramento Bee. "Politicians are none of the above.” Still, they may be of use to some people. One legislator in Maryland reports "I’ve heard more from constituents on these journals than anything else I’ve done in public life."
(permalink)

Word for the Day: Statist Quo
In the previously mentioned article I wrote for OCPA (Oklahoma Council of Public Affairs), the editor changed some of my text from "status quo" to "statist quo." I had not thought of that expression. (It appears to be fairly new; a google search found fewer than 300 uses of the term.) That's why there are editors.
(permalink)

Medicaid Expansion: Up in Smoke?
Here's a rule that guides government programs: once it's started, a program will expand in scope beyond all initial promises. Such is the case with government health care programs. States have added to Medicaid by two means: increasing the number of people in the program (by lowing income thresholds and adding new categories of people who qualify) and by increasing the number of services covered over time (chiropractic, etc.)

In Oklahoma, Medicaid has been customized as SoonerCare, and it's a problem with a long history of trouble. Now, the governor, Brad Henry, has proposed raising the state's cigarette tax to bring in new money--and people--into SoonerCare. To his credit (on both policy and political grounds) he has talked of using a chunk of the money to subsidize private-sector insurance plans rather than dump new people into Medicaid.

(Cliche alert). The devil's in the details, and they don't look good. Steve Anderson says that the plan would lead the state down the path of every-increasing costs, supported by an ever-shrinking revenue base. He makes a very smart point that the rate of uninsurance--often quoted as nearly 20 percent--is grossly overstated. Of course, some people without insurance are young and reasonably healthy, and so it's not surprising they choose to forgo insurance. But a more Sooner-specific fact is that nearly 8 percent of the state population qualifies for treatment by Indian Service Units. Take out the Native American population--its percentage of the population is higher in Oklahoma than anywhere else--and the state's uninsured percentage drops below the national average.

Of course, the fact that some people can qualify for a government program isn't necessarily a good thing, a point I make in a companion piece for the Oklahoma Council of Public Affairs. I call for revisions to the tax code, the promotion of Health Savings Accounts, and greater use of vouchers for Medicaid patients.
(permalink)

I Like that Old Time Rock 'n' Roll
You may have missed it, but in Michigan, yesterday was Bob Seger Day. What would we do without government proclamations?
(permalink)

Middle Class Says: We Want Our Medicaid
There are many ways in which health care is already socialized in this country. There are, for example, two very large government programs that threaten to consumer the national budget, as well as all state budgets. They are Medicare and Medicaid.

Medicare, which gets all the press, is for people aged 65 and older. Then there's Medicaid, which is for low-income people, as well as some other individuals who fall into certain categories.

It's easy to confuse the two. If you're over 65, Medicare (that is, taxpayers) pays for a lot of your expenses, except if you go into a nursing home for an extended time. If you're going to need that, then Medicaid picks up the tab.

But there's a catch. You have to be poor to get Medicaid benefits. And after a lifetime of working hard, saving, paying off mortgages and accumulating pensions, many people can afford to pay for their nursing home care (at least for a while) by drawing down their assets.

Naturally, this is an unpleasant prospect, both for parents (who would like to have something left over to give heirs) and children (who would appreciate the boost of a tidy inheritance check).

Given current tax laws, we rely on employers to provide health insurance, but there is little incentive to purchase the kind of insurance that would pay for long-term care. Given the fact that Medicaid is out there, there's a strong temptation to think that anyone who pays for his own long-term care is a sucker. A small (and growing) industry has grown up of accountants and lawyers who will help the elderly, and their children, hide assets from the government. It's all an attempt to ensure that taxpayers pay for Mom and Pop's nursing home care rather than the family.

Many states try, with much futility, to stop this practice, with "look back" periods and other techniques. One such technique is "asset recovery," or going after the estates of people after their die, in an attempt to partially repay taxpayers with the proceeds of the estate. Sounds cruel, of course, but the alternative is a financially unsustainable system that breeds a culture of dependency.

The Detroit Free Press reports the incredible news that Michigan is one of two states that do not use "asset recovery." Governor Granholm is hoping to start that up, as a way of getting some revenues to plug an expected budget deficit.

State Sen. Toni Harp, a Democrat, puts the issue this way:
It has become an entitlement. The problem is, we have this huge bubble in the baby boom generation that's growing older . . . I don't know if we, as a country, can continue thinking about this in this way.

She's got that right.
(permalink)

Will government-organized online drug purchases increase drug addiction?
The Daily Herald of suburban Chicago runs an article affirming the ability of the Internet to increase consumer choice and deliver a wider pool of suppliers from which people can make purchases. In this case, the product in question is prescription drugs, often from outside the U.S.

My chief concern with drug importation is its affect on the economics of pharmaceutical research in the U.S. Since Europe, Canada, and just about everyone else imposes price controls on prescription drugs, importation of drugs--especially if done as official policy--threatens the health of research in this country. (The U.S. is almost alone in producing breakthrough drugs these days.)

But the Daily Herald article takes a different angle. Here, they're talking about the potential for drug abuse. When web sites advertise "No prescription needed!," it's easy to see how someone addicted to pain killers, for example, could order bottle after bottle of pills.

"Today's addicts don't fear recognition or being caught in a lie. Gone is the barrier to addiction for the timid or time-pressed," says staff writer Tona Kunz. A member of Pills Anonymous tells Kunz 'Thank God I got sober before [easy access to web-based pill dispensers.]" Given the nature of the activity, it's hard to say just how widespread it is; an official from the Drug Enforcement Agency simply says that it's gaining ground.

That's certainly a problem for the people involved, and perhaps for health care consumers as a whole. But does government bear any responsibility for encouraging this trend? With a bipartisan push for state agencies to allow residents to meet up with foreign-based drug sellers, government is encouraging the public to purchase on-line. By getting people used to the idea of buying drugs anonymously, perhaps it will also indirectly encourage web-based drug abuse.

It's a fanciful theory, and not a very good one at that. But given what passes for logic in political discourse these days, not such a horrible one after all.
(permalink)