Im-Politic: Race and the Virus

Tags

African Americans, CCP Virus, CDC, Centers for Disease Control and Prevention, coronavirus, COVID 19, ethnicity, healthcare, Hispanics, hospitalization, Im-Politic, Latinos, mortality, Omicron variant, race, senior citizens, Wuhan virus

What role, if any, should race play in medically treating Americans who have contracted the CCP Virus or could be likely victims? The question has gotten awfully important given that the virus’ highly infectious Omicron variant is greatly multiplying the number of cases (though because of asymptomatic spread and a shortage of reliable tests, no one knows how greatly); because for reasons ranging from those much higher case (and therefore hospitalization) numbers to the impact of illness and vaccine mandates on healthcare workers, the hospital system is strained; and because of shortages in treatments.

And the answer that seems best supported by the data is “some role” – because the most comprehensive data does show that race (along with ethnicity) does significantly affect the odds of suffering the most serious infection outcomes (symptoms severe enough to require hospitalization, along with of course death). But by no means should race or ethnicity play a major role – because so many other factors, and above all age, are much stronger determinants of the worst virus consequences.

The argument for prioritizing age begins with the aggregate data – which comes from the U.S. Centers for Disease Control and Prevention (CDC). Here’s what’s shown by the latest numbers measuring weekly CCP Virus deaths per 100,000 Americans for the week of January 15 by age group (for the most vulnerable) and by race and ethnicity for non-hispanic whites, non-hispanic blacks, and hispanics (the country’s three largest groups according to this typology).

By age group:

75-plus: 3.00

65-74: 0.79

50-64: 0.37

By race/ethnicity

non-Hispanic whites: 0.22

non-Hispanic blacks: 0.35

Hispanics: 0.41

As is obvious, senior citizens (65 and over) of all racial and ethnic groups are by far the most likely to die from the virus – which argues strongly for focusing prevention and treatment tightly on them.

The same holds for CCP Virus-related hospitalizations (keeping in mind what should be the well-known qualification that the government does a lousy job of making the critical distinctions between deaths and hospitalizations caused by the virus, and deaths and hospitalizations of infected victims that were caused by something else).

In this case, the CDC offers not weekly admissions figures per 100,000, but total statistics for the period March 1, 2020 to January 8, 2022 per identical numbers of Americans belonging to these categories. And helpfully, breakdowns are provided for both age and race/ethnic group. Here are the results:

non-Hispanic whites 65-plus years: 1,938.5 

non-Hispanic whites 50-64 years: 811.9

non-Hispanic whites 18-49 years: 287.4 8

non-Hispanic whites 0-17 years: 46.9

non-Hispanic blacks 65-plus years: 3,835.4

non-Hispanic blacks 50-64 years: 2,165.0 

non-Hispanic blacks 18-49 years: 886.3 

non-Hispanic blacks 0-17 years: 126.7

Hispanic or Latino 65-plus years: 3,550.1

Hispanic or Latino 50-64 years: 2,053.3

Hispanic or Latino 18-49: 924.6 6

Hispanic or Latino 0-17: 115.0

The clear conclusion is that a national public health policy focused on preventing CCP Virus-related hospitalization would focus not on any single racial or ethnic group as a whole, but on the following groups in this (descending) order: Non-hispanic blacks over 65, hispanics and latinos over 65, blacks between 50 and 64 years, hispanics and latinos between 50 and 64 years, and non-hispanic whites over 65.

But these figures make another, comparably important point: The differences between blacks over 65 and hispanics and latinos over 65 are pretty modest. So even between these highly vulnerable groups, targeting treatment or prevention strategies according to race and ethnicity doesn’t seem to provide very useful advice. The differences between blacks among blacks from 50 to 64 years of age, hispanics and latinos of the same age group, and white 65 and over are even smaller, and therefore focusing on racial and ethnic considerations seems that much less warranted.

The CDC has also presented mortality data by age and racial/ethnic group simultaneously, but in a slightly different way – with these statistics showing how their virus-related deaths as a percentage of all deaths for these categories compare with that group’s share of the U.S. population overall. Groups whose shares of virus-related deaths are higher than their shares of the population as a whole are more vulnerable than average, and groups whose shares of virus-related deaths are lower than their shares of the total population are less vulnerable than average. Here’s that breakdown for senior citizens (the over 65s), drawn from Figure 3b in the link above) along with their total numbers as of 2019 (from the Census Bureau according to Table 1 in this link):

85-plus years: 5.89 million

non-Hispanic whites: 0.6 percent below

Hispanics: 1.3 percent higher

non-Hispanic blacks: 1.0 percent higher

75-84 years: 15.41 million

non-Hispanic whites: 7.6 percent below

Hispanics: 5.0 percent above

non-hispanic blacks: 3.8 percent above

65-74 years: 31.49 million

non-Hispanic whites: 14.60 percent below

Hispanics: 8.5 percent above

non-Hispanic blacks 6.7 percent above

As should be obvious, when it comes to the oldest seniors, non-Hispanic whites, non-Hispanic blacks, and Hispanics are experiencing CCP Virus-related deaths closely related to their shares of the overall population, there’s little if any reason to discriminate along racial and ethnic lines for virus-fighting policymakers.

The spreads are wider for Americans between 75 and 84, but mainly for non-hispanic whites. The difference between Hispanics and non-Hispanic blacks is anything but dramatic.

The situation changes more dramatically for the younger seniors, but again, mainly for non-hispanic whites. Hispanics’ and non-Hispanic blacks’ seem in the same ballpark.

Interestingly, if you look at the charts, black over-vulnerability stays level from there on for the 55-64 and 45-54 age groups, but keeps rising for Hispanics until the 25-34-year cohort . Non-Hispanic whites’ under-vulnerability stabilizes at the same point.

Even more interesting – for a change, the (rightly) embattled CDC seems to have gotten it about right.  Although the agency notes urge healthcare providers and the state governments that regulated them to “carefully consider potential additional risks of COVID-19 illness for patients who are members of certain racial and ethnic minority groups,” it specifies that “Age is the strongest risk factor for severe COVID-19 outcomes” and its relevant guidance on major risk factors for severe virus outcomes concentrates on medical conditions.

CDC also recommends paying some attention to those who “live in congregate settings, and face more barriers to healthcare,” among other “social determinants of health” that can influence risk, and that “include neighborhood and physical environment, housing, occupation, education, food security, access to healthcare, and economic stability.” 

Such Americans of course are disproportionately black and Hispanic. At the same time, the agency also admits that “we are still learning about how conditions that affect the environments where people live, learn, and work can influence the risk for infection and severe COVID-19 outcomes.” Plus, there’s no shortage of whites facing similar challenges.

Given those uncertainties, the aforementioned healthcare provision shortages, and given that Census pegs the numbers of Americans over 65 at nearly 53 million, it’s clear that protecting the elderly – whatever they look like – should be the unquestioned Job One for U.S. healthcare policy and healthcare providers.              

(What’s Left of) Our Economy: Will Government Keep (Indirectly) Driving U.S. Job Creation?

Tags

Employment, healthcare, Jobs, Labor Department, Occupational Outlook Handbook, private sector, social assistance, subsidized private sector, {What's Left of) Our Economy

Predicting almost anything about the economy ten years or so out is a pretty risky business – which is why I rarely make such forecasts and don’t obsessively follow those made by others. But for many years, I’ve been tracking the growth of what I call the subsidized private sector in the U.S. employment picture. And the U.S. government just came out with a study taking the story out to 2030. So my curiosity was piqued, and because the ever greater importance of such employment speaks volumes about the strengths and weaknesses of the American economy, its workers, and their prospects, I hope yours will be, too.

The big takeaway? According to the U.S. Labor Department’s new Occupational Outlook Handbook, jobs in the healthcare and social assistance sectors will keep rising through the end of the decade as a share of all U.S. jobs – and this shouldn’t be seen as good news.

As I’ve pointed out repeatedly (e.g., here), this isn’t to say that healthcare or social assistance aren’t important for any number of reasons that should be obvious. Economically speaking, however, they’re problematic for two related reasons. First, although they’re technically classified as private sector jobs, their employment levels are largely determined by decisions made by politicians to provide funding, not market forces.

And that funding – or subsidization – is massive. A think tank called the Tax Policy Center pegged federal spending on healthcare alone (by far the biggest industry in the subsidized private sector) at $1.2 trillion in fiscal year 2019. A related research organization, the Urban Institute, reported that state and local governments poured $301 billion into health and hospitals during the previous fiscal year. (That’s the latest such data I could find.) If the state and local figure stayed the same in 2019, this public spending would have added up to just over seven percent of the entire U.S. economy and more than 40 percent of all government outlays that year.

The second reason to be concerned about outsized job growth in this subsidized private sector is that typically, the real private sector is the economy’s main source of innovation and productivity growth, which in turn area major foundations of sustainable prosperity – and therefore of the ability to pay for government in a financially responsible way, as opposed to more and more borrowing. A subsidized private sector punching above its job-creation weight is a sign that the real private sector’s economic role is shrinking in relative terms.

And the Occupational Outlook Handbook says that these trends will continue through 2030. Specifically, whereas other Labor Department data show that subsidized private sector jobs accounted for 16.11 percent of all U.S. non-farm jobs (the Labor Department’s definition of the American employment universe, which includes government jobs at all levels as such) in February, 2020 (just before the CCP Virus pandemic arrived in force), the Handbook‘s figures indicate that this figure will rise to 16.86 percent by the end of the decade.

In addition, subsidized private sector jobs will have climbed from 18.94 percent of all real private sector jobs in February, 2020 to 19.80 percent in 2030.

For some perspective, in June, 2009 (the end of the Great Recession that followed the global financial crisis), the subsidized private sector represented only 14.97 percent of jobs in the non-farm sector and 18.09 percent of those in the real private sector.

Conseqently, it should be no surprise that the Handbook‘s projections indicate that real private sector jobs will have fallen from 68.92 percent of all non-farm jobs in February, 2020 to 68.29 percent.

These shifts may look like small beans. But economies and workforces as massive as America’s don’t change much overnight (unless they’re hit by an outside shock like the pandemic). Also, the Labor Department could be wrong, even if the next few years are relatively tranquil. Yet its predictions track well with recent (pre-CCP Virus) trends.

So even though I haven’t been monitoring subsidized private employment developments during the virus period (because like pretty much all other economic statistics, they’ve been so distorted), I’ll resume checking them periodically again and hoping the trend lines start moving in different directions.

Im-Politic: The Case Against Sweeping Vaccine Mandates and Passports

Tags

CCP Virus, coronavirus, COVID 19, Delta variant, healthcare, hospitalizations, Im-Politic, immunity, mortality, natural immunity, Nature, public health, unvaccinated, vaccination, vaccine hesitancy, vaccine mandates, vaccine passports, vaccines, Worldometers.info

It’s approaching the status of a reliable rule of thumb: The longer the CCP Virus pandemic lasts, the weirder, and more unnecessarily harmful on balance, the actual and potential official responses get. The most important example nowadays has to do with the ever lengthening lists (a) of vaccine mandates and passports that have already been created by governments and businesses and universities around the country; and (b) increasingly irate calls for more – including demands that the unvaccinated be denied medical care or (seemingly more reasonably) affordable health insurance.

Given the large numbers of Americans remaining unvaccinated, and apparently likely to stay unvaccinated, the risks of mandates and passports per se should be obvious. Despite the U.S. economy’s strong recovery so far from the initial virus- and lockdowns-induce recession, new laws denying, say, employment to this population and barring them from patronizing businesses could deeply depress demand and output, and put the economy uncomfortably close to Spring, 2020 square one.

More troubling, even though these restrictions are still far from common, virus uncertainties generated by the highly contagious Delta variant seem to have already undercut hiring dramatically, and are widely forecast to weaken growth going forward. (See, e.g., here.)

But even if the virus was remotely as lethal or otherwise dangerous healthwise as Ebola or the Black Death (which it’s not), today’s insistence on universal vaccination and penalties for holdouts badly flunks the common sense test. The main reason: It completely ignores the existence of both natural and acquired immunity.

In fact, not only has the phenomenon of immunity not exactly been a secret to “The Science” – at least ever since disease began to be systematically studied. It’s likely reached gargantuan scale in the United States today. For example, a study just published in the respected science journal Nature and funded in part by the U.S. National Academy of Sciences contended that as of the end of last year, 103 million Americans had been infected with the virus. That’s about a third of the total population, and about five times the numbers of recorded cases at that point. Also during 2020, according to the reliable Worldometers.info website, just shy of 366,000 had succumbed to the disease.

Therefore, as of the end of 2020, more than 102 million Americans acquired immunity by recovering from infections that were either asymptomatic or too mild to report. And an unknown (but surely large) number of Americans were never infected to begin with because they were naturally immune.

All of these figures, of course, cover the period months before Delta arrived. Since it’s so infectious, the numbers of those with natural or acquired immunity nowadays must still be at least as big and possibly much bigger. The full vaccination of nearly 177 million Americans as of this latest CDC update of course complicates the estimation process, because so many with natural immunity undoubtedly have gotten such protection.

Another big complication: Vaccines have only been available since the very end of last year, and the numbers of fully vaccinated Americans took a while to become significant both because of roll-out delays and vaccine hesitancy. As a result, there’s not much data yet on whether either form of immunity is more protective than that offered by the jabs – which of course bears vitally on the core assumption behind the calls for vaccine mandates and the like.

After all, if either natural or acquired immunity is comparably effective to vaccination in warding off the virus (the study described here indicates they’re at worst not far off), or if both are, the case that the jabs are medically necessary for all the unvaccinated – either to safeguard the health of the unjabbed themselves, or to prevent them from spreading the malady – simply falls apart.

In addition, the paucity of great data is a problem in and of itself. Unquestionably, there could still major risks, especially long-term, to leaving the unvaccinated unvaxxed. But as noted, the risks of indiscriminate mandates and penalties are impressive as well. Consequently, what should be foremost on Americans’ minds when it comes to mandates-like questions is that in these circumstances, barreling ahead with sweeping measures and sanctions – many of whose effects, particuarly like joblessness and lost income, won’t take long to appear – would be the height of recklessness. As for those who would deny medical care to all of the unvaccinated on this fatally flawed basis (except those who can cite medical exemptions?), that seems the height of arrogance and self-righteousness – not to mention morally disgusting.

And in case you think that the common observation that the unvaccinated comprise nearly all recent CCP Virus-related deaths and hospitalizations clinches the case for mandates, these immunity points shred that idea, too. The problem is not with the claim of high correlation between unvaxxed status and mortality and  hospitalization. The problem is with assuming that a noteworthy share of these virus victims – or even the vast majority – had any form of immunity. In principle, large numbers of the unvaccinated immune could be coming down with dangerous virus infections anyway, or are likely to – and consequently should be coerced into getting jabbed and punished for refusing. But I haven’t seen that argument made; have you? And it’s surely missing in action because immunity is undeniably a thing.

So absent evidence to the contrary, the only reasonable conclusions are that getting the non-immune unvaxxed vaccinated should be a top priority, and that vaccination campaigns should be focused tightly on them. The immune unvaxxed, however, should be allowed to continue their lives as normal.

More than enough American live have been lost or ruined during the pandemic. Unless and until it’s discovered that all of the unvaccinated pose dangers to themselves and/or to others – whether because natural or acquired immunity is completely mythical, or is much weaker than the vaccines-produced variety – indiscriminate vaccine mandates, passports, and penalties will only needlessly lengthen the list of casualties.

Glad I Didn’t Say That! Mass Medical Immigration Urged on Eve of Glutted Medical Job Market

Tags

CCP Virus, coronavirus, COVID 19, doctors, emergency rooms, Glad I Didn't Say That!, healthcare, immigrants, Immigration, Jobs, labor market, physicians, residents, Wuhan virus

“Removing Barriers for Immigrant Medical Professionals Is Critical

To Help Fight Coronavirus”

– Center for American Progress, April 2, 2020

 

Many “emergency medicine physicians — young doctors, called

residents, who are training in this specialty — are struggling to find

full-time employment, even while they work on the front lines

treating covid-19 patients.”

– The Washington Post, January 4, 2021

 

(Sources: “Removing Barriers for Immigrant Medical Professionals Is Critical To Help Fight Coronavirus,” by Silva Mathema, Center for American Progress, April 2, 2020, https://www.americanprogress.org/issues/immigration/news/2020/04/02/482574/removing-barriers-immigrant-medical-professionals-critical-help-fight-coronavirus/ & “Young ER doctors risk their lives on the pandemic’s front lines. But they struggle to find jobs,” by Ben Guarino, The Washington Post, January 4, 2021, https://www.washingtonpost.com/health/2021/01/04/er-doctors-covid-jobs/)

(What’s Left of) Our Economy: Green Shoots of Recovery in New York City?

Tags

(What's Left of) Our Economy, CCP Virus, consumer spending, coronavirus, COVID 19, election 2020, healthcare, Jobs, New York City, restaurants, stimulus package, subsidized private sector, The Partnership for New York City, Wuhan virus

Since I’m a New York City native, I’m a New York City fan. (At least I think that logically follows!) Therefore, one of the most disturbing trends I’ve followed in the CCP Virus era concerns the especially serious troubles the City has suffered this year, economically as well as medically.

I still haven’t made up my mind about whether New York has been pushed by the virus into a period of long-term decline, or whether we’ll see a return to normal once the pandemic has been brought under control (insert your own definition of this goal).

Yet for the last two months, whenever the case for pessimism seems to become conclusive (see, e.g., so much of the evidence in this recent New York Times piece), an email appears in my inbox from a friend who sends me the regular updates on the City’s economy from the Partnership for New York City.

The organization, comprised of hundreds of New York’s most prominent business leaders, says it seeks to “build bridges between the leaders of global industries and government, drawing on the resources and expertise of business to help solve public challenges, create jobs and strengthen neighborhoods throughout the five boroughs.”

Whatever you think of its sincerity or effectiveness or overall objectivity, the data it regularly releases tracks with statistics I monitor from other sources, so it seems reliable to me. And some of the figures it’s presented lately have been major stunners.

For example, as early as late July, the Partnership reported, consumer spending in the City had nearly returned to 2019 levels. In late March, it had plunged to 53 percent below them. Just as unexpected – the big laggards were New York’s wealthiest boroughs, Manhattan and Brooklyn (although maybe the Manhattan results weren’t so surprising, given its dependence on business from office workers, so many of whom weren’t commuting to their offices).

According to a late-September bulletin from the Partnership, not only had New York’s private sector employment increased on month, but “the city has outpaced U.S. private sector job growth for three consecutive months.” The leader here was the healthcare sector – which RealityChek regulars know are only partly private sector jobs, given the industry’s massive dependence on government subsidies. (See, e.g., here.) But the same problem distorts the national figures, so this finding still legitimately counts as a pleasant surprise.

Even more surprising: “209 business licenses were issued in September, up 11% from 189 licenses issued in August. The number of new business licenses has increased for four consecutive months and is up 260% since May.”

Of course, this number of businesses is less-than-tiny for such a gargantuan metropolis. But any signs of entrepreneurship these days are encouraging, and support the even more encouraging possibility that the City remains a powerful magnet for individuals with talent and drive.

No one can doubt that New York still faces massive challenges going forward, especially since the onset of winter, and the growth of lockdown fatigue, means that a second virus wave may hit. Moreover, the colder the weather gets, the greater the struggles of a hugely important restaurant sector that’s been able collectively to hang on with its fingernails thanks to regulatory reforms that helped eateries expand outdoor dining since late spring.

The fiscal situation seems dire as well – unless Democrats sweep to power in next week’s national elections and approve the kind of big aid package for cities and states that Republicans have generally resisted. (The continuing deadlock over a broader relief bill, which could drag on if Republicans retain the White House and/or Senate, obviously could remain a big problem, too.)

Even then, the City will be hard-pressed going forward to fund needed services adequately without the kinds of tax increases that tend to drive taxpayers away, cuts in more controversial outlays that tend to antagonize powerful constituencies like public employee unions, or some combination of both.

For now, however, these Partnership reports have been revealing impressive resilience in the New York City economy. And it bears remembering that, over any significant period of time, so far no one has ever made any serious money betting against it.

Im-Politic: VP Debate Questions That Should be Asked

Tags

1619 Project, African Americans, Barack Obama, Biden, budget deficits, CCP Virus, censorship, China, Confederate monuments, Constitution, coronavirus, COVID 19, education, election 2020, Electoral College, filibuster, Founding Fathers, free speech, healthcare, history, history wars, Im-Politic, inequality, investment, Kamala Harris, Mike Pence, national security, Obamacare, police killings, propaganda, protests, racism, riots, semiconductors, slavery, spending, Supreme Court, systemic racism, Taiwan, tariffs, tax cuts, taxes, Trade, trade war, Trump, Vice Presidential debate, Wuhan virus

Since I don’t want to set a record for longest RealityChek post ever, I’ll do my best to limit this list of questions I’d like to see asked at tonight’s Vice Presidential debate to some subjects that I believe deserve the very highest priority, and/or that have been thoroughly neglected so far during this campaign.

>For Vice President Mike Pence: If for whatever reason, President Trump couldn’t keep the CCP Virus under control within his own White House, why should Americans have any faith that any of his policies will bring it under control in the nation as a whole?

>For Democratic candidate Senator Kamala Harris: What exactly should be the near-term goal of U.S. virus policy? Eliminate it almost completely (as was done with polio)? Stop its spread? Slow its spread? Reduce deaths? Reduce hospitalizations? And for goals short of complete elimination, define “slow” and “reduce” in terms of numerical targets.

>For Pence: Given that the administration’s tax cuts and spending levels were greatly ballooning the federal budget deficit even before the virus struck, isn’t it ridiculous for Congressional Republicans to insist that total spending in the stimulus package remain below certain levels?

For Harris: Last month, the bipartisan Congressional Problem Solvers Caucus unveiled a compromise stimulus framework. President Trump has spoken favorably about it, while stopping short of a full endorsement. Does Vice President Biden endorse it? If so, has he asked House Speaker Nancy Pelosi to sign on? If he doesn’t endorse it, why not?

For Pence: The nation is in the middle of a major pandemic. Whatever faults the administration sees in Obamacare, is this really the time to be asking the Supreme Court to rule it un-Constitutional, and throw the entire national health care system into mass confusion?

For Harris: Would a Biden administration offer free taxpayer-financed healthcare to illegal aliens? Wouldn’t this move strongly encourage unmanageable numbers of migrants to swamp U.S. borders?

For Pence: President Trump has imposed tariffs on hundreds of billions of dollars’ worth of Chinese exports headed to U.S. markets. But U.S. investors – including government workers’ pension funds – still keep sending equally large sums into Chinese government coffers. When is the Trump administration finally going to plug this enormous hole?

For Harris: Will a Biden administration lift or reduce any of the Trump China or metals tariffs. Will it do so unconditionally? If not, what will it be seeking in return?

For both: Taiwan now manufactures the world’s most advanced semiconductors, and seems sure to maintain the lead for the foreseeable future. Does the United States now need to promise to protect Taiwan militarily in order to keep this vital defense and economic knowhow out of China’s hands?

For Pence: Since the administration has complained so loudly about activist judges over-ruling elected legislators and making laws themselves, will Mr. Trump support checking this power by proposing term limits or mandatory retirement ages for Supreme Court Justices? If not, why not?

For Harris: Don’t voters deserve to know the Biden Supreme Court-packing position before Election Day? Ditto for his position on abolishing the filibuster in the Senate.

>For Pence: The Electoral College seems to violate the maxim that each votes should count equally. Does the Trump administration favor reform? If not, why not?

>For Harris: Many Democrats argue that the Electoral College gives lightly populated, conservative and Republican-leaning states outsized political power. But why, then, was Barack Obama able to win the White House not once but twice?

>For Pence: Charges that America’s police are killing unarmed African Americans at the drop of a hat are clearly wild exaggerations. But don’t you agree that police stop African-American pedestrians and drivers much more often than whites without probable cause – a problem that has victimized even South Carolina Republican Senator Tim Scott?

For Harris: Will Biden insist that mayors and governors in cities and states like Oregon and Washington, which have been victimized by chronic antifa violence, investigate, arrest and prosecute its members and leaders immediately? And if they don’t, will he either withhold federal law enforcement aid, or launch such investigations at the federal level?

For Pence: Why should any public places in America honor Confederate figures – who were traitors to the United States? Can’t we easily avoid the “erasing history” danger by putting these monuments in museums with appropriate background material?

For Harris: Would a Biden administration support even peacefully removing from public places statues and monuments to historic figures like George Washington and Thomas Jefferson because their backgrounds included slave-holding?

For both: Shouldn’t voters know much more about the Durham Justice Department investigation of official surveillance of the Trump campaign in 2015 and 2016 before Election Day?

For both: Should the Big Tech companies be broken up on antitrust grounds?

For both: Should internet and social media platforms be permitted to censor any form of Constitutionally permitted speech?

For Pence: Doesn’t the current system of using property taxes to fund most primary and secondary public education guarantee that low-income school children will lack adequate resources?

For Harris: Aren’t such low-income students often held back educationally by non-economic factors like generations of broken families and counter-productive student behavior, as well as by inadequate school funding – as leading figures like Jesse Jackson (at least for one period) and former President Obama have claimed?

For Pence: What’s the difference between the kind of “patriotic education” the President says he supports and official propaganda?

For Harris: Would a Biden administration oppose local school districts using propagandistic material like The New York Times‘ U.S. history-focused 1619 Project for their curricula? Should federal aid to districts that keep using such materials be cut off or reduced?

Now it’s your turn, RealityChek readers! What questions would you add? And which of mine would you deep six?

Following Up: Why the Economy Shutdown vs Restart Debate is Still Idiotic

Tags

CCP Virus, Centers for Disease Control and Prevention, coronavirus, COVID 19, drug abuse, Following Up, healthcare, Im-Politic, infant mortality, mortality, opioids, poverty, restart, suicide, Tim Mullaney, Trump, Wuhan virus

The heated debate over whether it’s more important to open the economy relatively quickly, or wait until the CCP Virus really is under control slogs on. And I mean slogs on, since once it became clear that the pandemic wasn’t going to be even close to a Black Death-like catastrophe, everyone with a working brain should have recognized that immense uncertainties are all around, and that both approaches therefore entail terrible risk.

One built-in complication, though, continues to muddy the waters. And even though decisive clarity can’t be gleaned from the available data, it’s worth pointing out: CCP Virus deaths are relatively easy to calculate – even if not perfectly identifiable, because single causes of death tend to be difficult and controversial to pinpoint for victims with important underlying health problems, and therefore different U.S. states have (not surprisingly) come up with different standards for counting them.

Deaths from a prolonged economic slump like the one into which America has been plunged are much harder to determine, and data are therefore more controversial. But no one should doubt that they’re noteworthy, and worth taking into account in any economy restart decisions.

As commonsensical as these observations sound, however, they continue being vigorously disputed, and one of the few such arguments I’ve seen that try to quantify relative rates of loss has come from economics journalist Tim Mullaney. Full disclosure: I’ve criticized Mullaney here before, finding him to be an extreme hater even by Never Trumper standards. But I hope you’ll trust me when I say I’m singling out his latest article simply because it makes the “restart later” argument in such data-dependent terms.

According to Mullaney, President Trump and other prominent conservatives are blowing the most deceitful smoke imaginable by insisting “You have to reopen the economy despite the ongoing Covid-19 pandemic, quickly, lest a wave of suicides, domestic battery and the like overwhelm even the death toll from coronavirus.”

His evidence? The CCP Virus daily U.S. death toll when he wrote his article (2,763) dwarfs the numbers of lives lost each day in the United States to economic-related causes (like many suicides), as well as the numbers lost daily during the nation’s wars. (As of yesterday, daily national CCP Virus deaths hit a much higher 4,591.) * SEE CORRECTION BELOW

The war comparisons are sobering – no doubt about it. But if you look at them realistically, so is what we know of the death toll from various forms of economic privation. For example, it’s true that “only” 132 Americans took their lives each day in 2018 (the last year for which statistics are available, as is the case with all the following numbers). And there’s no way to know how many were due to the victims’ economic circumstances. But it’s also true that, as of 2017, 1.4 million Americans tried and failed to commit suicide. There’s no way to know the reason for each one, but the daily figure comes to 3,865. Surely economics had something to do with many of them.

The clear implication: If not for circumstances unrelated to the economy, the numbers of  suicides and of economy-related suicides would be much higher. Therefore, economic-induced extreme despair is undoubtedly much more widespread than the actual suicide rates indicate. And they signal the presence of huge economy-related mental health problems. Further, given the stigma society still attaches to suicide, it’s fair to assume that the attempt numbers in particular are undercounted.

That same year, 192 Americans each day died of drug overdoses. Of these, 130 came from opioids – the category most likely influenced by worsening economic circumstances and prospects. And just as with suicides and attempted suicides, the numbers of overdose deaths are dwarfed by the attempted overdose numbers. The Centers for Disease Control and Prevention don’t provide absolute annual figures, but they do note that “For every drug overdose that results in death, there are many more nonfatal overdoses….” Chalk lots of them up to economic despair, too.

You can also learn a lot from estimates of annual lives lost to poverty as such. In 2011, a Columbia University study pegged them at 671 per day in 2000 – not a matter of thousands, but not bupkis, either. And here’s another poverty-related mortality statistic: In 2018, about 59 newborn American babies died each day. Were all due to poverty? Of course not. But they’re most heavily concentrated in racial and ethnic minority groups with the highest poverty rates, so that’s pretty revealing.

Infant mortality, moreover, points to another health and death rate reality that’s strongly affected by the state of a national economy: the state of its healthcare system.

Given America’s vast wealth and annual healthcare expenditures, and its continuing major healthcare problems, there’s no doubt that money is no panacea for better health and lower death rates. Structures of national healthcare systems matter critically. At the same time, does anyone seriously believe that the U.S. healthcare system is going to do a better job on mortality and other fronts the worse the economy fares and the longer the current downturn lasts?

Which brings up a related question: What’s likelier to happen first? Indeed, much likelier to happen first? The kinds of major economic and social policy reforms needed to alleviate American poverty significantly, or to cure what ails the healthcare system? Or finding anti-CCP Virus vaccine or cure? If you’re not sure, you just haven’t been paying attention.

Those wanting a substantial economy restart sooner rather than later can legitimately point out that the above economy-related mortality numbers overlap a great deal. And that’s true. Second and even third waves, as they warn, seem all too likely as well. But it’s also true that, when you add them all up, they’re significant, and at best can’t be too far away from the CCP Virus death figures in which much more confidence is justified.

How far away? Honestly, why should anyone care? They’re clearly close enough to warrant concern that, as Mullaney’s conservative targets contend, a prolonged mandated economic slump will exact terrible human health costs – and that the longer it lasts, the higher it will grow. It’s also crucial to remember that the CCPVirus death toll shows signs of trending down – however horrific it will ultimately be – and that absolutely no one who anyone’s listening to is urging a total national economy restart all at once. 

All of which reinforces conclusions I’ve been pushing since the CCP Virus became a genuine crisis: It confronts Americans will trade-offs as tragic as they are difficult to figure out, and that anyone arguing to the contrary is more interested in taking cheap, invariably partisan, shots than in finding solutions.

*CORRECTION.  The 4,591 U.S. deaths figure I reported here was not for April 17, but for April 16.  The April 17 figure was actually 3,856, and today’s figure is only 1,891.  Moreover, as explained here, “The spike in mid-April is due to New York City authorities adding probable cases to the city’s death tally.”  So this is the kind of correction that clearly works in favor of my argument, since these numbers indicate even more strongly that this still terrible daily figure is on the way down, and that any gap between it and comparable figures due to economically-induced mortality is even smaller than previously apparent.

(What’s Left of) Our Economy: When Washington Slept on America’s Dangerous Dependency on Foreign Healthcare Products

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active pharmaceutical ingredients, Bureau of Industry and Security, China, China virus, Commerce Department, coronavirus, COVID 19, globalization, health security, healthcare, India, medical devices, national security, Office of Technology Evaluation, offshoring, pharmaceuticals, supply chains, surgical equipment, Trade, {What's Left of) Our Economy

Last week I wrote that no one in American politics, in either party, deserves blame for failing to anticipate the China Virus outbreak (in the sense of being ready for a genuine pandemic), and especially the Trump administration’s flawed response to its spread within the United States (as opposed to its timely decision on January 31 to start curbing inbound travel from overseas – initially from China). 

But there’s one big aspect of coronavirus-related public policy where potentially calamitous and avoidable mistakes have been made, and where identifying responsibility is essential (largely to prevent repetition). That’s the growth of America’s dependence on pharmaceuticals, their active ingredients, and other healthcare-related goods from foreign sources, especially from China.

It should have been obvious long before the virus broke out in Wuhan (at least as far as we know) that health security is national security, and that the blithe approval of trade and related policies that encouraged the offshoring of production in this crucial sector was as dangerous as the offshoring of crucial defense and defense-related (because so many inputs to weapons and platforms aren’t weapons themselves) products. Even louder alarm bells should have sounded once it became clear that a leading offshoring destination was China – a dictatorship that has challenged U.S. national security interests long before the rise of current leader Xi Jinping, and whose role in medical supply chains inevitably created the threat of supply cutoffs (as has recently been threatened in the Chinese government-controlled press).

And indeed American policymakers had all the evidence they needed as early as 2011. That’s when a small office at the Commerce Department called the Bureau of Industry and Security (BIS) issued a report called – yup – “Reliance on Foreign Sourcing in the Healthcare and Pubic Health (HPH) Sector: Pharmaceuticals, Medical Devices, and Surgical Equipment.”

For many years, BIS’ Office of Technology Evaluation (OTE) has been issuing reports on sectors of the U.S. defense industry and other portions of the economy critical to the nation’s security and their use of foreign parts, components, materials, and other inputs whose availability shouldn’t be taken for granted. And fortunately, the Office and the various acts of Congress that have defined its mission have long understood that, as suggested above, national security-related industries are by no means restricted to those that turn out products that go bang and boom.

Notably, the study was requested by the Obama administration’s Department of Homeland Security (DHS), which shows commendable foresight. And the main results make jaw-dropping reading today:

>“There is a significant amount of U.S.-based manufacturing for critical healthcare-related commodities.” At the same time, “There is…a very high degree of foreign sourcing and dependency for components, materials, and finished products.”

>“Exposure to supply disruptions is widespread, but many respondents consider it a cost of doing business in the healthcare industry.”

>As a result, “Only 34 percent of respondents are taking steps to reduce their exposure to foreign sourcing and dependency issues.”

>When it comes to the chemical ingredients for drugs, where heavy China dependency has attracted so much attention today, in 2011, pharmaceutical companies reported “difficulty limiting their exposure to foreign dependencies primarily because most of the APIs [active pharmaceutical ingredients] are produced outside the United States.”

>Medical device producers stated that they were “vulnerable primarily due to their reliance on other countries for electronic parts.” Japan was the main concern, due at least in part to the earthquake that year that disrupted many industries’ supply chains. But China has become an even more important supplier since then.

Sadly, however, the record also demonstrates that once the findings came in, no serious follow-through was undertaken.

OTE surveyed 161 companies – 70 pharmaceutical producers, 75 manufacturers of medical devices and surgical equipment, and 16 companies that turned out both kinds of products. Roughly three fourths of these companies were headquartered in the United States and roughly one-fourth were foreign owned.

All told, these firms produced 868 individual pharmaceuticals and 833 kinds of medical devices or surgical equipment. Of these, in turn, 290 pharmaceuticals and 128 types of devices and equipment were deemed by OTE “critical to effective healthcare services in the United States,” meaning “needed in various emergency scenarios.” The bureau also looked into the chemical ingredients and parts and components comprising these products.

As for the specific information sought, here it is:

“Survey respondents were asked to identify the pharmaceuticals and medical devices/surgical equipment they manufactured, integrated/assembled, and/or sold for use in the United States. For each product area selected, companies were then asked to provide the top three company proprietary products they make and the location of manufacture. Finally, companies identified, to the best of their knowledge, whether they were the sole U.S.-based manufacturer, sole global manufacturer, or not the sole manufacturer of each product.”

Some of the above results in greater detail:

More than 73 percent of the total surveyed companies depended on suppliers located abroad for at least one critical component, manufacturing material, or actual finished good. And the average number of such foreign-sourced goods per company surveyed was 11.4. Seventy-nine percent of pharmaceutical firms surveyed reported themselves in this situation versus 63.7 percent of the device and equipment manufacturers, and the average number of foreign-sourced products was 11.4 for the drug companies versus 9.8 for their device and equipment manufacturers.

Interestingly, even at this point, China loomed pretty large large in the picture at that time – especially for medical devices and surgical equipment. Its entities represented 13.8 percent of the total number of foreign suppliers to U.S.-based producers. For pharmaceutical companies, they accounted for 9.1 percent – less than leader Italy (15.7 percent), India (12.8 percent), and Germany (10.6 percent). Not that this result should be especially comforting, as India – a major global producer of generic drugs – has recently announced to restrict exports because it’s experiencing difficulty getting chemicals from China and (surprise?) wants to make sure it can provide for its own population.

The OTE survey, in other words, found that, in 2011, healthcare products companies operating in the United States relied on a diverse global supply chain. But significant vulnerabilities were reported, too. Principally, for pharmaceuticals, “there was no U.S.-based source for at least 65.5 percent of [total goods] identified by survey respondents.” And for medical devices and surgical equipment, the figure was at least 60.5 percent. More troublingly, in the device and equipment sectors, the greatest dependencies tended to be in complex products.

Moreover, when thinking about the safety of imported healthcare goods, keep in mind BIS’ finding that only 60.3 percent of the companies in total could identify the suppliers of their suppliers.

Nor were significant supply disruptions unknown by healthcare products companies. Thirty percent of these businesses reported experiencing at least one of these events between 2007 and 2010, 40 percent of these came from foreign suppliers, and 17.5 percent came from China – the biggest share for any single country. Both domestic- and foreign-origin disruptions lasted an average of 155 days. Nonetheless, these figures are surely way too low, as only 18.3 percent of responding companies said they tracked foreign supply disruptions.

Even so, the study oddly found that “Only 16.6 percent of companies foresee a risk of supply disruptions from outside of the United States” but that 29 percent “believed their company was vulnerable to serious and/or prolonged supply chain disruptions from events or dependencies outside the United States.” For pharmaceuticals, the top concern again was lack of API availability domestically.”

OTE made several policy recommendations to strengthen America’s health security. For example, various major relevant federal agencies should “further examine [the] survey data to prioritize the foreign sourcing and dependencies that could have the greatest impact on the healthcare supply chain in an emergency situation.”

In addition, these agencies, “in coordination with DHS and the Department of Commerce, should assess whether the use of Defense Production Act authorities, such as the Defense Priorities and Allocations System (DPAS), could provide the ability to rapidly expand or surge capacity of U.S.-based pharmaceutical and medical device/surgical equipment facilities to meet demand in an emergency situation.” As made clear, however, by the continued sky-high levels of the healthcare industry’s China and other foreign dependencies, the problem was promptly ignored.  

Such measures, along with many others in the trade, tax, and regulatory fields will no doubt be crucial to rebuilding the kind of domestic healthcare industry so many Americans and even their leaders finally recognize is essential. But if the nation really is seriously behind the idea that health security is national security, it’s going to need updated detailed information on foreign dependencies. In other words, time to put the OTE to work again.

Following Up: Why Many of America’s Widest Divides Aren’t What You Think

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college-educated, Democrats, education, Following Up, Gallup, healthcare, inequality, minorities, non-college, opportunity, partisanship, polling, polls, race relations, Republicans, whites

“An anxious and divided nation cast its first votes,” the headline in the Washington Post moaned this morning.

As yesterday’s RealityChek post reported, though, some impressive evidence came out last week showing that the nation isn’t all that anxious, or fatally divided in the most general terms, after all. At the same time, diving into that evidence’s internals shows no shortage of divisions – only many of the dividing lines are pretty surprising.  (See the PDF linked at the bottom where it says “View complete question responses and trends.”)

For not only is the most important division by far the partisan split between Democrats and Republicans. It’s a gap that tends to be considerably wider than those between groups where divides in the last few years are supposed to have been especially and worrisomely gaping – between blacks and whites, between rich and poor, between the better educated and the less well educated.

For me, the big takeaway is that when Americans are in political moods, they get carried away by their emotions, with Republicans feeling awfully chipper about the state of the nation, and Democrats correspondingly gloomy. When they’re not preoccupied with politics, Americans seem more level-headed – and their outlooks are sunnier. But the unexpected findings scarcely stop there!

For example, let’s look at the internals of the headline satisfaction finding, which shows Americans’ feelings about the quality of their lives. A lofty 84 percent of all Americans told Gallup that they’re satisfied on this score, and 37 percent said they were “very satisfied.”

Republicans were the most satisfied Americans by a wide margin – an astonishing 96 percent called themselves satisfied, and 60 percent considered themselves “very satisfied.” The least satisfied group? Democrats. Their satisfaction levels were 77 percent satisfied and only 25 percent very satisfied.

But here’s what really grabbed my attention – and should grab yours. Keep in mind that the various groups of respondents overlap considerably (for example, both Democrats and Republicans include the wealthy and the poor, and the college-educated and the high school grads; and the both the wealthy and the poor include those identifying with both political parties).

The Democrats’ satisfaction levels were lower than those for non-whites (79 percent) and for Americans with a high school education or less (84 percent). That doesn’t sound very consistent with the notion that non-whites and those with relatively modest education levels are feeling especially downtrodden lately. But these readings definitely point to special degrees of unhappiness among Democrats. So does the fact that the “very satisfied” results for both these groups (31 percent and 34 percent, respectively) topped those for Democrats as well.

The partisan divide is even bigger, in both absolute and relative terms, for satisfaction levels regarding whether working hard can get a person ahead in America these days. In toto, 72 percent of respondents were satisfied and 43 percent were very satisfied with this situation. Non-whites’ overall satisfaction and very satisfied levels weren’t too far off those figures (71 percent and 37 percent, respectively). And the figures for those holding a high school degree at most were notably higher (77 percent and 51 percent, respectively).

But the Democrats’ results were completely in the dumps (only 47 percent and 19 percent, respectively).

Also interesting – non-whites, and Americans lacking college degrees are all more convinced than the college grads (68 percent) about the payoff of working hard, with respondents with a high school degree or less expressing the highest (77 percent) satisfaction level.

Satisfaction levels are much lower in absolute terms (43 percent overall) over the distribution of income and wealth in America – which should surprise no one. But again, those lacking a high school degree were more satisfied, and by a wide margin (49 percent), while the least satisfied (also by a wide margin) were the Democrats (21 percent).

The least educated were also more satisfied with the current rich-poor gap than college graduates (40 percent). But on this issue, non-white satisfaction levels were lower than the average (38 percent).

Gallup respondents were even less satisfied with the availability of healthcare in the United States, with only 37 percent expressing such views. Yet a familiar pattern emerges from the internals. The biggest gap was between Republicans (53 percent satisfied) and Democrats (27 percent). These also represented the highest and lowest levels of all the groups examined.

In addition, non-whites (41 percent) were more satisfied than whites the overall total (37 percent), and much more satisfied not only than the Democrats but than college grads (31 percent). The same held for Americans without high school diplomas (also 41 percent satisfied).

Finally, let’s look at a particularly explosive issue – race relations. Or at least it’s supposed to be particularly explosive. But according to the Gallup survey, there’s much more dissatisfaction than polarization – except among Democrats and Republicans.

Overall satisfaction levels are low – coming in at 36 percent. But the widest gap by far is between followers of the two parties, with 51 percent of Republican identifiers declaring themselves to be satisfied compared with only 24 percent of their Democratic counterparts. (Actually, Gallup also measured satisfaction levels according to political ideology – liberals, moderates, and conservatives. I’ve left these findings out due to the assumption because these results closely track the political parties’ results – which include independent voters. But according to this gauge, the conservative-liberal gap is somewhat wider, at 52 percent-17 percent.)

Most significantly, this partisan divide is far wider than the racial divide, with 35 percent of whites expressing satisfaction with the state of race relations and 39 percent of nonwhites so stating. Also doubtless significant: The next-least-satisfied group is college graduates, of whom only 28 percent expressed satisfaction. Further, their “very satisfied” levels (3 percent) were by far the lowest along with the Democrats’. And they were only one-third the nine percent “very satisfied” levels of non-whites.

Is the country indeed anxious?  To some extent, sure.  Is it divided?  That’s where the answer gets especially complicated.  And this complex picture indicates that, especially in this presidential campaign year, all Americans should beware of pundits and others bearing sweeping generalizations. 

(What’s Left of) Our Economy: Are Soaring Prescription Drug Prices Really a Thing?

Tags

2020 elections, Bureau of Labor Statistics, core inflation, Democrats, healthcare, inflation, prescription drugs, Trump, {What's Left of) Our Economy

Prescription drug prices keep skyrocketing outrageously – at least, that’s what’s constantly reported.  And much of the evidence looks especially impressive:  Politicians who normally agree on nothing have vowed to rein them in – including President Trump and Democrats of all stripes, including many of the party’s presidential candidates.

So imagine my surprise when I checked into these claims by examining the consumer price data issued by the U.S. Bureau of Labor Statistics each month. They show that these prices have actually fallen on net since December, 2017 (by 0.43 percent).

Moreover, these figures also show that prescription drug prices have fallen during the past year (through May, by 0.99 percent), and that they’re dropping even though the rate of overall inflation and core inflation (which strips out volatile food and energy prices) has been rising (year-on-year by 1.80 percent and two percent, respectively).

Nor has there been a notable increase in prescription drug prices during this calendar year. From January through May, they’ve risen by 0.16 percent. But that’s still considerably less than the overall inflation rate (0.98 percent) and the core rate (0.51 percent).

That’s not to say that there hasn’t been a prescription drug price problem. For example, from May, 2017 to May, 2018, their prices rose by 3.71 percent – much faster than the overall inflation rate (2.74 percent) and the core (2.22 percent).

Moreover, during the last 27 months of the Obama administration, prescription drug prices increased by 11.14 percent, versus 2.67 percent for overall inflation, and 4.78 percent for core inflation. During the first 27 months of the Trump administration, however, these numbers are 2.07 percent, 4.59 percent, and 4.37 percent.

Americans still pay lofty prices for prescription drugs, and especially compared with consumers in other wealthy countries. It’s also important to point out that drug pricing is complicated. (Here are some of the reasons.) And I confess to having no idea why this pricing has been weak lately, and whether the decline will continue.

But when one of the country’s leading measures of inflation is saying that prescription drug prices have been going down, that should be pretty newsy. Even if “everyone knows” they’re soaring.