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Posts Tagged ‘Legislation’

There are many sad tales appearing on the internet which present people who are angry because they feel mistreated by their insurance company. Those personal anecdotes are designed to raise an individual’s ire and natural desire to do something about it. The reader may notice that conveniently attached to such stories are mentions of a solution to the problem: healthcare reform as being debated into law by Congress.

The setup seems almost too easy. David, the little man (or woman, or child, or family) gets beaten on by a Goliath (big insurance company) who treats them as mere numbers in a soulless quest for ever increasing profit, only to have Congress and others swoop in to save the day. Someone should create a comic book about that story because it would be entertaining – and fictional.

Yes, we are cynical and skeptical at heart and are willing to wager that many of our readers who come across such saccharine tales of heartache also immediately think “what are they selling?“. Being cynical and skeptical to a degree one notch below annoying is a trait commonly found in scientists because it is an important part of the scientific process. Not all of you are like that (yet), so for those of you who are new to all this, buckle up and hang on for an interesting ride.

Why would insurance companies do silly things, like deny coverage to an unusually heavy baby, if the bad publicity is so damaging to their reputation?

The answer is because insurance companies use statistical tables to make decisions, and anyone caught at the tail end will have a rough time. Here is the most interesting quote from the story of baby Alex Lange:

The frustrated parents said their child was the odd infant out in a cruel numbers game. A chart by the Centers for Disease Control and Prevention used by insurers puts Alex in the 99th percentile for weight and height for babies his age.

The BMI chart is an example of flawed statistics being used, but it is also not entirely inaccurate for a population wide assessment. In general, someone who has a BMI above 30 is far more likely to be unhealthy than to be an athlete. The problem is for those in the middle, in between normal and obese, who are merely considered overweight.

One flaw in the system is that while most people in the obese range are unhealthy, the same cannot be said for those in the overweight range. Pay close attention the next time you are at the park or the gym to those chunky guys who can outrun you. In fact, someone with low body fat who is athletic in that range between casual Frisbee player and professional athlete can often be classified as overweight.

Insurance companies can get away with using the BMI to classify people into broad categories, which then affects their premiums or if they are eligible for insurance at all because the government continues to use it, even though it is flawed. According to the CDC:

BMI is a fairly reliable indicator of body fatness for most people.

If the BMI chart is based on an illogical formula concocted over 200 years ago and can only give a general assessment of obesity in a population while failing on an individual level, why is it still in use by the government?

The answer is because government loves to create problems for which it is the solution. Pay close attention to what is happening here because this is a pattern that repeats over and over again.

First, the CDC called more than one million people between 2006 and 2008 and collected their information. The fact that the data are suspect because people routinely lie about their height and weight should be obvious even to a non-scientist. Second, after the data was gathered and processed, a conclusion was reached:

Experts believe there are several reasons for the differences. People with lower incomes often have less access to medical care, exercise facilities and more expensive, healthier food. In many places, minorities are disproportionately poor.

“Poverty is a very strong driver of obesity,” said Kelly Brownell, director of Yale University’s Rudd Center for Food Policy and Obesity

The differences being referred to are the differences between the African-American communities and other communities in terms of obesity. We already know the reason for those differences, and it is the reason the BMI chart is racist. So, where does that conclusion lead to?

The only way to deal with our “obesity epidemic” is to address the “poverty epidemic” — of course, as measured by yet another government psuedo-science statistic called the “poverty line”. And how do we deal with that? You guessed it, create more entitlement programs, programs to be run by the very same government that is funding the study, a study based on a statistical measure that is meaningless, where the statistics are unreliable and unverifiable but all point to the same convenient conclusion — the government needs more of your money.

And the media will now happily play along, running b-roll footage of some fat dude at Disney shoving ice cream in his pie hole or a fat mother and her fat kids waddling along through Frontierland, their butts bouncing up and down, as they stroll through the theme park in too-tight shorts and too-short t-shirts.

Laugh if you want but this is the same government that wants to ration your health care. Guess what? Fat people move to the back of the line under such a government-run health care system. Still laughing?

Although baby Alex Lange’s story inspires outrage, it is the insurance company taking all the heat, rather than the government. If the government banned the use of the BMI chart because of its flaws the insurance companies would be forced to evaluate everyone on an individual basis leading to fairer premiums. Individualized healthcare is one result of a market based system because a fair market needs to distinguish between a healthy 200 lb. person and a 200 lb. couch potato. Currently, they are both considered equally risky to insure and such a system does not foster individual responsibility.

People are even angrier today according to newspapers because a report which concluded that the healthcare reform bill recently approved by the senate finance committee would end up costing everyone more money is false – at least according to certain members of Congress and economist from MIT.

After an insurance industry report said that premiums would rise sharply with the passage of comprehensive health care legislation, Jon Gruber, a health care economist at the Massachusetts Institute of Technology, said he evaluated the report Monday at the request of Senate Democrats and found it deeply flawed.

Coming from a prestigious academic institution does not guarantee that Jon Gruber is telling the truth but it does lend him a lot of credibility, so he will be taken seriously. We are skeptics and our site is geared towards teaching non-scientists, so how can a non-expert determine if someone with fancy credentials is telling the truth when what they are saying goes against logic and common sense?

In this instance the answer is amazingly simple.

Mr. Gruber, who helped Massachusetts with its effort to provide universal health insurance coverage, said that the industry report failed to take into account administrative overhead costs that he said will “fall enormously” once insurance polices are sold through new government-regulated marketplaces, or exchanges.

We need to examine the situation in Massachusetts since they implemented universal health insurance in a way very similar to the proposals in the Baucus bill. Depending on how the situation turned out, it will either serve as a model for the current bills in Congress or a dire warning against them and will establish the reader establish Mr. Gruber’s real level of credibility.

The Wall Street Journal talks about the situation in Massachusetts (and other states, so go read the whole thing):

Guaranteed issue alone, the argument goes, results in slightly more expensive premiums, which drives healthier individuals out of the risk pool, which in turn further drives up premiums. The end result is that many healthy people opt out, leaving a small pool of sick individuals with very high premiums. An individual mandate, however, would spread those premium costs across a larger, healthier population, thus keeping premium costs down.

The experience of Massachusetts, which implemented an individual mandate in 2007, suggests otherwise. Health-insurance premiums in the Bay State have risen significantly faster than the national average, according to the Commonwealth Fund, a nonprofit health foundation. At an average of $13,788, the state’s family plans are now the nation’s most expensive. Meanwhile, insurance companies are planning additional double-digit hikes, “prompting many employers to reduce benefits and shift additional costs to workers” according to the Boston Globe.

And health-care costs have continued to grow rapidly. According to a Rand Corporation study this year, the growth now exceeds state GDP by 8%. The Boston Globe recently reported that state health-insurance commissioners are now worried that medical spending could push both employers and patients into bankruptcy, and may even threaten the system’s continued existence.

That certainly paints a cheery picture. There is more wonderful news from The Boston Globe:

The state’s major health insurers plan to raise premiums by about 10 percent next year, prompting many employers to reduce benefits and shift additional costs to workers.

Increases will range from 7 to 12 percent, capping a decade of consecutive double-digit premium increases, according to a Globe survey of the state’s top health insurers. Actual rates for 2010 will depend on the size of the employer and the type of coverage, with small businesses and individuals expected to be hit hardest. Overall, premiums are more than twice as high as they were 10 years ago.

The higher insurance costs undermine a key tenet of the state’s landmark health care law passed two years ago, as well as President Obama’s effort to overhaul health care. In addition to mandating insurance for most residents, the Massachusetts bill sought to rein in health care costs.

The failure of the Massachusetts system is far from hidden. Who is Jon Gruber hoping to fool by flashing his academic pedigree? Is the general population reading the news so incapable of examining the issues in any depth such that Mr. Gruber can brag about the wonderful state of universal health insurance in Massachusetts without the rubes bothering to check and see how things actually turned out?

Many newspapers and other outlets reporting on this situation are in favor of universal healthcare becoming law, damn the facts, and so reports on the subject tend to be biased by omission of key details which would entirely change the outcome of the story. The real anger is by citizens who are frustrated at being ignored by their elected officials and maligned by some members of the media.

When a layperson expounds about a subject in a way that it is clear they are out of their depth, we excuse the ignorance or quickly sniff out the agenda. However, we must hang our heads in shame when a fellow scientist abuses their position of trust and respect to mislead the general public. Jonathan Gruber’s motivation for lying is not important, simply because such lying is unacceptable. Studying science is about shedding light on the world’s mysteries, and so we have fulfilled our responsibility by illuminating this situation with sunlight, the best disinfectant.

Exit question: What are you going to do about it?

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UPDATE: See below, at the end of the article.

The Wall Street Journal reports that the Senate finance committee has approved a healthcare reform bill today.

The vote was 14-9, with Sen. Olympia Snowe of Maine the only Republican to join the 13 Democrats on the panel. Ms. Snowe indicated earlier in the day that she would support the measure.

The Senate Finance panel, led by Chairman Max Baucus, becomes the last of five congressional panels to act on a health-overhaul bill, and it marks the biggest step forward yet for President Barack Obama’s top domestic priority. The Baucus-proposed 10-year, $829 billion plan would require all Americans to purchase insurance and aims to hold down spiraling medical costs over the long term.

The legislation that passed the other House and Senate committees did so without a single Republican vote.

Unfortunately for Congress, a non-partisan report has come to the conclusion that costs will go up if the proposed legislation is made into law.

On Monday, insurers ratcheted up concerns about the sweeping Finance Commitee bill. A report released Monday by America’s Health Insurance Plans, an industry trade group, said the Finance bill would impose stiff costs on consumers. Among other things, the report said a family health-insurance policy that costs $12,300 today would increase to $25,900 on average by 2019 under the bill, more than under current law.

The analysis in the report was conducted by PriceWaterhouseCoopers, certainly not a slacker, no-name entity without a reputation for accuracy on the line. Even though they did not release the underlying statistical data with the report, it does not take an advanced degree to understand the logical problems inherent in the bill’s design.

PWC is stating the issue politely, to say the least. What is meant by a “weak mandate” is that, in the current version of the Baucus bill, there is no requirement to buy health insurance at all until after 2013, and by 2017 the penalty for failing to buy health insurance still amounts to only about 15% of the cost of the insurance. Now, think about it: if you know that you don’t have to buy health insurance when you are young and healthy, but if you should get sick, or just get older, you can apply for health insurance at any time and it will be illegal for the insurance company to turn you down, what would you do? Obviously, you would defer buying insurance unless and until you get sick. This means that the pool of those who are insured will be lower quality, and the cost therefore higher for everyone who buys insurance. It is as though you could wait until you die, and then your heirs can buy life insurance on you.

This isn’t reform, it is stupidity.

Trying to force everyone to have health insurance in the manner proposed by this bill may technically solve the problem of millions of Americans being uninsured. It is also logically impossible to do so without lowering quality, increasing costs, or both.

Some people are skeptical, so we will present a current example to prove the point. In this case we will examine the healthcare system in Massachusetts.

So let’s look at the closest model we have for this system in the United States:  the state of Massachusetts.  Massachusetts has all the goodies in the Baucus bill:  subsidies, guaranteed issue, community rating, an individual mandate, and employer penalties.  Indeed, the Massachusetts program is probably to the left of where we’re going to end up, on things like empowering the exchanges to negotiate with insurance companies and the size of the penalties for failing to procure insurance, two measures which are supposed to be critical for holding costs down.

Instead, costs have exploded.

Go take a look, they have a few charts up and detailed analysis of the cost increases. This whole sordid affair raises plenty of good questions:

So I’ll turn it around on reformers:  why do you think that we can control costs, given that we couldn’t at the state level?  Massachusetts is a very liberal state, a very rich state, and it started out with a relatively low proportion of its citizenry uninsured.  Proponents of reform often say it has to be done at a national level because states can’t borrow money in downturns, but this doesn’t explain why the spending side is headed through the roof.

Some people would say that Congress is choosing the complicated and expensive way versus the simple and cheap way because the former presents opportunities for graft, unlike the latter. Here is one such simple reform idea:

All we have to do is allow insurance companies to compete nationally instead of state-by-state and eliminate all mandates that limit consumer choice. It has been estimated that these simple reforms–which are not part of any of the Democrats’ “reform” bills, for obvious reasons–would reduce health care costs by one-quarter to one-third. Instead of such common-sense reforms, the Dems are proposing Rube Goldberg measures that will make health care more expensive. Instead of eliminating mandates, their measures, including the Baucus bill, increase them–in effect making cheaper health insurance illegal.Once more: this isn’t reform, it is stupidity.

Thanks to the power of the internet you can now fax senators about the healthcare reform bill and let them know what you think. Now is a great time to let your voice be heard.

It’s important that this blast fax campaign reaches every citizen who is opposed to this irresponsible legislation, especially in the states of MT, IN, AK, CO, PA, ND, NC, SD, AR, FL, PA, VA, MO, UT, IA, NH, ME and OH. Our best chance to stop this government healthcare takeover is to let our legislators know, whether they are home or in Washington, we are watching closely.

The Washington Examiner has an interesting two part op-ed discussing The Truth About The Baucus Bill (Part one, part two):

There is another reason why the CBO’s preliminary analysis should be taken with a grain of salt, though this one wasn’t mentioned in the report. Whatever the content of the Baucus bill once it is voted out of the finance committee, it will disappear into a legislative black hole as Senate Majority Leader Harry Reid, House Speaker Nancy Pelosi, and their key aides do what they did on the economic stimulus package back in February — huddle together behind closed doors to write the final bill, which will then be presented as a fait accompli in the form of a conference report.

Governor Tim Pawlenty (R-MN) clearly shows that the bill being brought forth is strange because there are good ideas for reform being ignored. He also lays to rest the popular misconception that there are no good ideas for healthcare reform being suggested other than what is present in the current bill:

There are many bipartisan ideas that would actually cut health care costs, like medical liability reform, allowing employees to keep their insurance when they switch jobs, standardizing health information technology, and allowing consumers to purchase insurance across state lines.  In Minnesota, we’ve passed reforms that made price and quality more transparent for patients, moving the health care system towards paying for and achieving better health care outcomes, and empowering patients themselves to help drive down costs.

You can read here how Governor Pawlenty is implementing those ideas for healthcare reform right now in Minnesota. Although we are proud of Governor Pawlenty putting his money where his mouth is on healthcare reform, we are not comfortable with him promoting creationism in public schools.

MR. BROKAW: In the vast scientific community, do you think that Creationism has the same weight as evolution, and at a time in American education when we are in a crisis when it comes to science, that there ought to be parallel tracks for Creationism versus evolution in the teaching?

GOV. PAWLENTY: In the scientific community, it seems like intelligent design is dismissed — not entirely, there are a lot of scientists who would make the case that it is appropriate to be taught and appropriate to be demonstrated, but in terms of the curriculum in the schools in Minnesota, we’ve taken the approach that that’s a local decision. I know Senator Palin — or Governor Palin — has said intelligent design is something that she thinks should be taught along with evolution in the schools, and I think that’s appropriate. My personal view is that’s a local decision —

MR. BROKAW: Given equal weight.

GOV. PAWLENTY: — of the local school board.

MR. BROKAW: And you would recommend it be given equal weight?

GOV. PAWLENTY: We’ve said in Minnesota, in my view, this is a local decision. Intelligent design is something that, in my view, is plausible and credible and something that I personally believe in but, more importantly, from an educational and scientific standpoint, it should be decided by local school boards at the local school district level.

In conclusion, as we have discussed here before at length, there are many very good ideas for healthcare reform which should be given a chance to succeed, especially because mandatory government healthcare runs contrary to American principles of liberty. As always, when it comes to Congress (or any government officials for that matter) judge them based on their actions, not their words. Ok, sometimes by their words.

UPDATE: Recent news reports are publicizing claims by MIT economist Jon Gruber that the PWC report is false. Unfortunately, Mr. Gruber is lying. We discuss the issue at length here.

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The article we published recently, Smoking Bans Reduce Heart Attacks: Lying By Omission, was posted for discussion on LinkedIn. Since the discussion and comments are only viewable to members of the Cornell network, we cannot address any issues which are being raised directly on LinkedIn.

A member of the network forwarded some of the comments to us and we will address them here. Please take a moment to register and comment on our site if you would like to join in the discussion. We are willing to answer your questions but we have to know the questions exist in the first place.

Since a few commenters made multiple points and because there is overlap on some of the issues raised, we will first post the comments in full and then address the individual points.

Vernon C.:

Do you deny that smoking causes heart and lung disease? Do you deny that we, as a society, pay higher health insurance premiums when there is a higher incidence of disease? Then why is it questionable for society to limit smoking by any method it chooses in order to reduce our costs?

Bonnie F.:

The article is focusing on the smoking issue and the specific way in which scientific data about secondhand smoke has been manipulated to promote indoor smoking bans. The larger point seems to be that letting public officials with pretty fundamentalist agendas get away with lying to the public about the science in order to get laws passed is setting a bad precedent.

Steve K.:

And this makes the public officials different from the ‘I had no idea nicotine was addictive’ Tobacco CEOs in WHAT way? Secondhand smoke is DISGUSTING. I do not CARE what the science says, it is DISGUSTING, and I have absolutely no problem with smoking being banned EVERYWHERE.It is also a public health risk, and if the health issues are not enough for you, look at the fire statistics. The only likely supporters of smoking are people in the tobacco business and firefighters – depending on whose numbers you want to use, tobacco is responsible for 40% to 80% of house fires.. which keeps them employed.

Mark C.:

A implies B, and I believe B, so A must be true. This fallacy is the foundation of public support for bogus science. People like the conclusions so they accept any rationale that comes their way. They really don’t care if the science is bogus, so long as the conclusion is what they want to hear.

But, just because A is bogus, doesn’t mean B is false. Matter of fact it is easier to get bogus A’s accepted when B is true.

Eric S.:

Hi there. Tobacco is a known carcinogen. I would anticipate that, since the smoking bans have only recently gone into effect, it’s a bit soon to be able to trace benefits to reduction in disease from second hand smoke. Are you aware of any studies that measure the reduction in carcinogenic material that occurs by retention/conversion in the smoker’s lungs and blood stream?

Please be careful about charging fraud in the discussion of the health effects of tobacco ingestion (smoke, chew, etc.) when the obscene fraud practiced by the tobacco companies and their allied state representatives has been well documented.

Marc M.:

>>The larger point seems to be that letting public officials with pretty fundamentalist agendas get away with lying to the public about the science in order to get laws passed is setting a bad precedent.<<

I don’t even know where to start with this comment, but let me start by saying I live in Texas, a state well known for folks with fundamentalist agenda’s lying to the public about science to get laws passed, albeit in quite a different manner than you might be thinking. That said, Mark makes an excellent point that notwithstanding the possible misinterpretation of allegedly bogus science (where the general scientific consensus is fairly consistent in favor of anti-smoking activists, however), there is still an extremely strong case in favor of indoor smoking bans on just the yuck factor, amongst other reasons.

And it is interesting that the 3 Monkeys also repeat the mantra about the alleged economic catastrophe that would occur with indoor smoking bans, which has repeatedly been show to be bogus (including in several places here in Texas!).

And Steve, firefighters are never in favor of things that actually start fires. I wold rather take my training and sit on my rear in the fire station than make a fire – fires are tragedies in terms of both potential for lives lost AND for the loss of personal history and memories when it is damaged by smoke, water and fire.

Steve K.:

Re: Fire prevention – what I was trying to convey is that I have never heard of a fire department advocating a ban on indoor or unenclosed flame sources. (maybe someone has done so, but I have not heard of it) There must be commerical fire suppression systems that could be installed over gas stoves. Beyond that, ban all unenclosed flame sources, and if a fire is found to have been started by an unenclosed flame source, send the person responsible a bill for the full cost of fighting the fire.
Fires started by cigarettes are NOT accidents, they are acts of stupidity. Why should firefighters have to risk their lives to put out such fires? How many fewer firefighters would a community need if cigarettes were simply banned?

Marc M.:

Steve, you were on the hill about the same time (OK, a few years earlier, but not much) as I was – don’t you remember the ban of candles in campus residence halls? And that was back in the 80’s.

Gas stoves are relatively contained flames and there are codes which govern the installation of such objects – only in commercial occupancies are there rules requiring fire suppression systems. These codes are promulgated for fire prevention reasons and supported by the fire service through the NFPA and other organizations.

Re: fires started by cigarettes – the problem with a fire is that you don’t always know what caused the fire before you put it out – often you don’t know what started it. They get put out, then we determine cause. But there would probably be little decrease in the number of firefighters required because staffing and deployment patterns are governed by time and distance more than by actual numbers of events. Plus, most fire departments now are actually EMS delivery system that provide fire suppression as an ancillary service, so decreases in numbers would impact those services more than the fire suppression services.

And no doubt fires caused by cigarettes are acts of stupidity (or drunkenness, actually, but that may be the same thing).

Here is a distillation of the points raised above, and the answers:

  • Tobacco smoking is a major cause of house fires and indoor smoking even at home should be banned.

Factually incorrect. According to the CDC and the NFPA, cooking fires are the number one cause (40%) of house fires. However, it is worth noting that although under 12% of fires (4% of fires originate in the living room, family room, or den; 8% in the bedroom) can be attributed to smoking, it is responsible for more (25%) of the fatalities.

It seems likely that many of the people who were involved in fatal fires with smoking as a cause were impaired by alcohol at the time. By logical extension, we should advocate a ban on drinking alcohol at home. We are sure an intrepid researcher can unearth a strong connection between drinking at home and all sorts of preventable physical and property damage.

We pay for the fire department through taxes and we are required by law to have fire insurance. On on unrelated note, health insurance should be like fire insurance – covering catastrophes, not routine medical expenses.

  • Big Tobacco lied about the extent of the dangers associated with their products, therefore claiming that there is fraud involved in research supporting indoor smoking bans is probably a lie supported by Big Tobacco.

Even if Big Tobacco were directly funding research showing how data is being manipulated to support indoor smoking bans, it in no way changes the fact that data is being manipulated. Aside from the lack of direct funding from Big Tobacco, those sources arguing for an examination of the underlying research have been proven right by the original research.

The primary justification for curtailing the freedom of businesses to choose to allow their customers to smoke indoors and for customers to choose to support such businesses is based on the health risks posed to the employees by the secondhand smoke. According to the Surgeon General’s report the actual correlation between secondhand smoke (aka ETS, Environmental Tobacco Smoke) and things like cardiovascular disease, ischemic heart disease, and arrhythmic heart failure or coronary arrest mortality is low enough to be attributable to statistical noise.

Here’s a bit of perspective: the highest risk ratio is for cardiovascular disease, at 1.25. The risk ratio of dying from a traffic accident (for women) on Friday the 13th is 1.38 according to research published in the American Journal of Psychiatry. Therefore it is safe to bet that traffic will be light on November 13th, 2009 because all our female readers will have opted to take the bus or train to work instead.

  • Many people simply find tobacco “yucky” and therefore it should be banned anywhere it may come into contact with others. Also, smoking is really bad for you.

Smoking tobacco is bad for you and there is no great controversy in saying so. However, it is not the issue we are dealing with here. To reiterate: the issue is that the science shows no ill effects from secondhand smoke, therefore the justification for banning smoking indoors in the name of protecting employees is nonexistent.

The “yucky” argument is flat out childish and sophomoric. Try to defend against it when used as an argument against something you like, which other people abhor.

  • People making out on TV is “yucky” and against my religious values, therefore it should be banned from being broadcast.

There is no law forcing anyone to own a television, watch particular shows, or derive spiritual sustenance from it. Turn it off, change the channel, or don’t buy a TV in the first place since broadcasters are providing their audience with what they want. You can affect change by not being part of the audience.

  • Small dog breeds are ankle biting terrorists and should be banned. They are a menace to everyone with ankles, and creating something called a “dog” which can get its butt whooped by a 10 lb. house cat is an affront to the basic dignity afforded to every living creature.

No law forces anyone to buy a small dog or hang out at the dog park. In the rare instance you are bitten by one, call the police and file a report.

Now we would like you to imagine that an individual with such a view was in a position of power – say as mayor of Big Major City – and used some shady statistics to justify banning certain breeds of small dogs. Due to the importance of Big Major City, many other cities followed suit and banned those breeds as well. Then a report is issued citing selected cities in which banning those small dogs improved quality of life. In fact, the report is so positive that the mayor of Big Major City and others begin pushing to expand on the success of the original ban by extending it to include all dogs.

All that, because some nutter thinks dogs are “yucky”.

  • The reports indicating an economic decline after smoking bans were put into effect are false and misleading.

We came across research which clearly showed an economic decline as a result of indoor smoking bans. To argue otherwise you must show a flaw in the research or provide some other source of data to back up that claim.

Absent a smoking ban, how can someone who finds secondhand smoke “yucky” go about creating change? By choosing with whom you do business. Whether it is a restaurant, bar, or bowling alley, by choosing to direct your business to places with a smoke free environment your actions are causing them to be more successful and thereby encouraging more of that type of business.

The fact that many nightlife places were environments which encouraged smoking shows that the majority of people voted with their hard earned money to keep those places thriving. It means that many of the people who participated in nightlife either liked having a cigarette with their drink or did not mind that others did. To argue that bars and clubs did not suffer economically after smoking bans were put into effect is to ignore the huge support they were receiving from locals and to ignore that people respond to incentives. Furthermore, if only a small percentage of nightlife participants are non-smokers and/or cannot tolerate secondhand smoke, where are all the extra people coming from to replace the smokers who choose to stay at home?

Freedom is what is at stake here. Smoking is dangerous and bad for you, but so are many other things. The indoor smoking bans in effect are the result of the minority imposing their views and beliefs on the majority by lying. The economics show that the majority of the public impacted by ban were against it.

Exit question: If the indoor smoking ban cannot be justified based on science, are supporters of the ban essentially guilty of “we’re just trying to do what’s best for you” paternalism? If that is true, what can citizens do to prevent something like this from happening in the future?

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Steven Perlstein has a good article in The Washington Post explaining some of the problems with health insurance as it exists today.

There is a part of health insurance that is meant to protect us from unpredictable or unavoidable “catastrophes,” such as getting cancer or having a heart attack. But there is also a part of health insurance that covers fairly predictable and routine medical expenses — the annual physical, a kid’s ear infection or a colonoscopy for a 55-year-old. In those cases, health insurance is not so much protection from catastrophe as it is a mechanism to “prepay” what is likely to be the bill for your own care.

Simply giving people more insurance without addressing the fundamental issues in the existing system is precisely the reason we feel Congress is not serious about reforming healthcare.

Here are a few other interesting points he discusses:

Then there are those who are demanding that Medicare pay more to doctors and hospitals in areas with high medical costs. In reality, this is nothing more than requiring the rest of us to subsidize the inefficient lifestyles and cost structures in rural communities and big cities.

Those who want to prohibit insurance companies from charging higher premiums to people who smoke, drink heavily, abuse drugs or have unhealthy diets apparently take the position that these behaviors should be subsidized by those who take better care of their health.

And those who rail against limits to end-of-life care are effectively saying that patients willing to follow the best medical evidence about what works and what is cost-effective should be required to subsidize those who don’t.

In a free country, people have the right to decide what to buy, where to live, what to eat and drink, and how much medical care to buy. They’re even free to negotiate for health benefits instead of wage increases. What they don’t have is the right to expect that everyone else should pay for their choices through higher taxes and higher health insurance premiums.

People respond to incentives. If regular, planned treatment continues to get covered by insurance (like using insurance to pay for groceries) then prices will remain high, unevenly distributed and opaque. If there is no penalty for making poor choices, then poor choices will abound.

Go read the whole thing.

Over a year ago Bill Whittle wrote an excellent essay which explains why government healthcare (especially in guise of the “public option”) is a terrible blow against freedom.

There’s a scene in Bowling For Columbine where Michael Moore interviews a typically decent and friendly Canadian as he emerges from a health clinic. The poor fellow had, as I recall, some serious injury, and Mssr. Moore wanted to know what it had cost him for treatment.

The man couldn’t reply. They hadn’t charged him. This took Michael Moore’s carefully rehearsed breath away! No charge? You mean, you got that medical attention for free?

That’s right, eh.

Cut to beatific look on directors face, as if he had just been handed a clean plate at a Shoney’s Breakfast Bar.

Folks, Canadians are great people. They are not a stupid people. So can we not, please, not ever again, call this Free Health Care? It is Pre-paid Health Care. That Canadian fellow paid for that treatment every week, for the past twenty years. It was taken out of every paycheck he made. He paid for that medical care, and much, much more. He paid for it whether he needed it or not. And he not only paid for the doctor, he paid for the bureaucrats and administrators in the National Health Service or whatever it’s called. It was not free. It was paid for. Whether he needed it or not. When he has fully recovered, years from now, he will still be paying for it. Every week, from every check. That car or vacation he couldn’t afford, got eaten up by health care he paid for but did not need.

So the question is, who better decides what kind of health care you and your family need: you, or Hillary Clinton? I understand that not all poor people can afford health insurance. Again, being a decent sort of fellow beneath my strikingly handsome exterior, I don’t mind paying a little extra for Medicare for people who need help. I can even live with my insurance rates being higher to cover the cost of caring for the uninsured at the Emergency Room.

But! What I most assuredly DO NOT need is for someone taking my money to give me a health care system I do not need or want. As my all-time idol P.J. O’Rourke once said, if you think health care is expensive now, just wait till you see what it costs when it’s free.

This is a great example of the seduction of the state, because “Free Health Care” sounds like a great deal. It’s Caring! It’s Healthy! And it’s Free!

It’s not free. And not only do I object to being told what I need and don’t need, I also object to the idea that some dim-witted Student Council dork thinks he knows what’s better for me than I do.

P.J. Again: if you think that Public is an altar to worship at, put the word “public” in front of these words and tell me how you feel: Restroom. Swimming pool. Transportation. Here’s another: Take the words Decision, Officer, Appointment, and then add the word “political” to the front end and watch them drop in value.

So, look around. Look at how people feel about government, and ask yourself, does this or that person think of themselves as an adult or as a helpless child? Freedom is not for children. Freedom means responsibility. It means making tough decisions yourself. Freedom is not government. Almost all government is the enemy of freedom; the bigger the government, the more powerful the enemy.

This is an excerpt from a longer essay which makes several other worthwhile points, so go read the whole thing.

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Two studies were recently published which showed a correlation between a community adopting a smoking ban and a subsequent reduction in heart attack rates. The results are based on aggregated data from several other studies. Unfortunately, we do not have access to the original reports so we cannot question their methodology directly.

Report #1:

The research — which incorporated data from a total of 24 studies of smoking bans across the country — found at least a 17 percent reduction in heart attacks one year after the bans had been enacted.

Report #2:

The other study, published in the Sept. 21 issue of Circulation, found a 17 percent drop in heart attack rates after one year and about a 36 percent drop three years after smoking restrictions had been enacted.

It incorporated data from 13 studies in the United States, Canada and Europe. Meyers’s research effort analyzed data from 11 studies of 10 public smoking bans in the same geographic regions.

We will examine the motivation for presenting the public with false information by exposing the agenda behind it later. First, we will take a close look at how this type of fraud occurs.

The crime in this case is one of omission. Both studies show impressive results based on data from multiple sources. One of these reports used data from 24 other studies and the other used 13. How many studies have been left out which don’t support their conclusions?

It would be very inconvenient for the authors and proponents of these studies if some communities experienced an increase in heart attacks after a smoking ban was put into effect, and they conveniently left those out of their research. The most conclusive study would be one which examined the data on a national level.

In fact, such a study exists and was published a few months ago.

A new study by researchers from the RAND Corporation, Congressional Budget Office, University of Wisconsin, and Stanford University is the first to examine the relationship between smoking bans and heart attack admissions and mortality trends in the entire nation, using national data. All previous U.S. studies only examined one particular city. In contrast, this study examined data from the Nationwide Inpatient Survey (NIS), which is nationally representative and includes 20% of all non-federal hospital discharges in the United States. The study has been published as Working Paper 14789 of the National Bureau of Economic Research Working Paper Series.

The study came to a completely different conclusion than the ones recently published.

The most important finding of this study is that there are just as many smoking ban communities in which heart attack admissions and mortality have increased in comparison with control communities as there are smoking ban communities in which heart attacks have decreased relative to control communities. The mean difference was found to be zero.

Thus, the study not only fails to find a short-term effect of smoking bans on heart attacks, but it also explains the positive findings of previous studies. What appears to be going on is what is referred to as publication bias.

Another major problem with studies being touted by the media and pushed by anti-tobacco activists is the level of harm attributed to second hand smoke.

Epidemiologists use “relative risk” (RR or Risk Ratio and informally including the similar Odds Ratio computation) as a means for measuring the severity of risk. The U.S. Surgeon General stated the relative risk for secondhand smoke is between 1.20 to 1.30. This is far below the minimum level at which any meaningful risk might be indicated. Both the World Health Organization and the National Cancer Institute have clearly stated that RRs below 2.0 are too low to be relied upon. The same is true of the federal Reference Manual on Scientific Evidence and textbooks such as Breslow and Day’s Statistical Methods in Cancer Research. A report by the independent health consulting firm Littlewood & Fennell characterizes RRs below 2.0 as “dancing on the tiny pinhead of statistical insignificance.”

The Surgeon General’s report went out of its way to make a claim which ran counter to the evidence. It had to be explicitly pointed out after the report’s publication that there is no justification for banning indoor smoking.

The 1992 report Revised Comments on the 1986 Surgeon General’s Report…EPA…and NIOSH states: “Risk estimates below 2.0 or 3.0 are described as ‘weak’ and thus any conclusions drawn from them are unreliable.” The summary of this 47-page document concludes: “…these reports [Surgeon General’s, EPA, and NIOSH] do not provide a defensible basis for regulation of smoking in the workplace.” Comments in the report are supported by 113 references in the scientific literature.

Even with that censure, the Surgeon General’s office continues to be promote nonsense for the anti-tobacco crusade. It is shameful for a governmental organization to promote political agendas using scare tactics which run counter to the scientific data.

The 2006 SG’s report claims 46,000 deaths annually due to heart disease from secondhand smoke. But the American Heart Association website lists the following RRs for ETS: 1.25 for Cardiovascular disease, 1.18 for ischemic heart disease, and 1.13 for arrhythmic heart failure or coronary arrest mortality. None of these suggests credible risk. Death estimates are derived from relative risk. If a RR is meaningless, so are the estimates of deaths based upon it. So the big scary estimate of 46,000 deaths has no validity. It is simply a phony number put out to scare people and panic them into political action. If such death estimates were valid, the new study would not have found that smoking bans have zero effect on heart attack mortality.

The EPA (Environmental Protection Agency) also helped to promote this madness. The Surgeon General’s report relied on data from a 1992 EPA study, which concluded that 3,000 deaths per year are attributable to secondhand smoke.

The U.S. House of Representatives then held a Congressional Investigation of EPA’s findings. It concluded: “EPA could reach that conclusion [3,000 lung cancer deaths] only by ignoring or discounting major studies, and deviating from generally accepted scientific standards.” Further, it found EPA guilty of “conscious misuse of science and the scientific process to achieve a political agenda that could not otherwise be justified.” It also stated: “The agency [EPA] has deliberately abused and manipulated scientific data in order to reach a predetermined, politically motivated result.” (emphasis added.) Over the next seven years, five similar studies (meta-analyses) of secondhand tobacco smoke were performed by other researchers who, unlike EPA, followed correct scientific standards. The RRs of these studies showed a range of 0.98 to 1.03 and an average RR of 1.01, compared to EPA’s RR of 1.19. Levois and Layard performed a meta-analysis of all the original studies utilized by EPA and came up with a RR of 1.00. Furthermore, these studies all had the standard 95% confidence level. The EPA study did not qualify for that. Instead, EPA used a degraded confidence level of only 90 percent, thus doubling the likelihood that its results were mere chance.

The motivation behind this shady business comes from several fronts. The strongest force are the absolutists, the prohibitionists, the fundamentalists who would like tobacco to be eliminated from the face of the Earth. Some of them become politicians and work towards achieving that goal incrementally. Their motivation is “the ends justify the means”. Others are the media and do-gooders who are not intelligent enough or simply too lazy and ignorant to examine the background science and automatically assume people they look up to are working in everyone’s best interests.

A steep price is paid for this stupidity. First, indoor smoking bans cause economic losses. Second, they promote the kind of “save me from myself” paternalism which is a way of expanding the power of government in the name of helping people who cannot handle the responsibility that comes with freedom. There are eerie similarities between those who wish to ban tobacco and the prohibitionist war on drugs.

In case it was not clear until this point, smoking is bad for you, and you should use whatever means necessary to quit. However, it is a legal product and adults should be allowed to enjoy it even without big government nanny approbation. The danger from tyranny is far greater than the dangers of indoor smoking.

Exit question: If the general public knew how much of the science being used to push for banning tobacco was nonsense, would such legislation continue to receive support?

UPDATE: The answers to a few critiques raised by this article can be found here: Where There’s Smoke, There’s Fire.

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If the public option is so fantastic, why has Congress already exempted itself? Mark Tapscott looks into the issue in The Washington Examiner:

Members of Congress presently get health insurance coverage through the Federal Employee Health Benefits Program (FEHBP), which offers enrollees nearly 300 choices among a variety of plans, coverages and costs.

The FEHBP covers federal employees and retirees, as well as Members of Congress, though the latter have additional perks of office that make their health coverage far better than that available – or affordable – for the vast majority of working Americans.

Public anger may explain why the White House is now insisting that Congress has not exempted itself from the Public Option, most notably in this new “Reality Check” video on the White House web site featuring former ABC reporter Linda Douglas, who now flaks for Obama as communications director for the White House Office of Health Care Reform.

The problem is, according to The Heritage Foundation’s Robert Moffitt, the White House assertion is “incorrect.”

And in this video Moffit points to an amendment offered by Rep. Dean Heller, R-NV, during a House Ways and Means Committee meeting just before the recess began that would have required Members to be covered by the Public Option plan if they approve it for private citizens.

Predictably, however, the Heller amendment was defeated, with all 21 committee Democrats voting against it. That vote is indicative of the reality that any bill requiring Congress to be covered by the same health care as the public has the proverbial snow ball in Hades’ chances of being enacted.

As always, watch what the politicians do, not what they say. Take a minute to watch the video again, as the communications director for the White House Office of Health Care Reform lies to your face.

There are more videos at the Fix Health Care Policy site dedicated to fact checking:

Rather than debate the substance, the White House is in full campaign mode in order to label any opposition to its government-heavy health reform agenda as “misinformation” or “myths you’ve heard.” Case in point: The White House now has a taxpayer-funded Web site to “reality check” credible criticisms and arguments. Problem is the videos “debunking” each “myth” are low on facts.

We would not trust government (regardless of political affiliation) with our nation’s healthcare even if they were well intentioned, and this shows they certainly are not.

Here’s some background reading on the issue of reforming healthcare in the United States:

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There are a number of doctors who prescribe a high volume of commonly abused pain medications, sometimes to clients who turn around and sell the pills on the street. It is the responsibility of the Drug Enforcement Agency to stop flagrantly illegal behavior. Clinics run by such doctors are called “pill mills”.

People seek pain relief for all sorts of conditions and as individuals may have different levels of pain tolerance. Someone who is on a particular medication for awhile may need to have the dosage increased because their body gets used to it. Certain medications may also cause chemical dependency.

Judging how much pain medication a patient needs is a fundamental part of a physician’s job, and that decision should be free from interference by the government. Unfortunately, should someone at the DEA decide that you, as a doctor, are prescribing too much medication to a patient, you will face arrest, fines, loss of license, and imprisonment. The overzealous attitude of those in government are creating the conditions today in which patients suffering from chronic pain are routinely under medicated.

The problem is not limited to the DEA. Local prosecutors working for the Department of Justice are the ones actively pursuing these cases, even though it doesn’t make any sense. Harry A. Silverglate writes in Forbes about a particularly egregious case:

The current contretemps in Wichita has its roots in 2002 when Sean Greenwood, who for more than a decade suffered from a rare but debilitating connective tissue disorder, finally found a remedy. William Hurwitz, a Virginia doctor, prescribed the high doses of pain relief medicine necessary for Greenwood to be able to function day-to-day.

Shortly thereafter, Dr. Hurwitz was arrested and shut down by federal agents. Greenwood couldn’t find any other doctor willing to risk the wrath of the DEA, so he suffered for 3 years before dying. High blood pressure, caused by years of untreated pain, was likely a strong factor in his untimely death.

Improprieties galore marked the prosecution of Dr. Hurwitz. Before his trial in federal court in Virginia in 2004, the DEA published a “Frequently Asked Questions” (FAQ) pamphlet for prescription pain medications. In a remarkable admission, the DEA wrote that confusion over dependence and addiction “can lead to inappropriate targeting of practitioners and patients for investigation and prosecution.” Yet on the eve trial, the DEA, realizing that Hurwitz could rely on this government-published pamphlet to defend his treatment methods, withdrew the FAQ from its Web site. Winning the case proved more important than facilitating sound medical practice. Hurwitz was convicted.

Sadly, Dr. Hurwitz is not alone, and his case is not nearly the most egregious.

The litany of abusive prosecutorial tactics could fill a volume. A “win-at-all-costs” mentality dominates federal prosecutors and drug agents involved in these cases. After a Miami Beach doctor was acquitted of 141 counts of illegally prescribing pain medication in March 2009, federal district court Judge Alan Gold rebuked the prosecution for introducing government informants–former patients of the doctor who were cooperating to avoid their own prosecution–as impartial witnesses at trial.

Greenwood’s wife, Siobhan Reynolds, decided to do something about a situation she saw as outrageous.

In 2003 she founded the Pain Relief Network (PRN), a group of activists, doctors and patients who oppose the federal government’s tyranny over pain relief specialists.

Somehow, the arrogant fools in power decided that having a concerned citizen shed light on their abusive practices is a bad thing to be stopped.

Now, the PRN’s campaign to raise public awareness of pain-doctor prosecutions has made Reynolds herself the target of drug warriors. Prosecutors in Wichita have asked a federal grand jury to decide whether Reynolds engaged in “obstruction of justice” for her role in seeking to create public awareness, and to otherwise assist the defense, in an ongoing prosecution of Kansas pain relief providers. The feds’ message is clear: In the pursuit of pain doctors, private citizen-activists–not just physicians–will be targeted.

An attorney for the government should know better than to try and squash op-ed pieces. Even if it were Reynolds opinion that everyone in the United States should get cases of whatever pain pills they desire for no particular reason, it is still her 1st Amendment protected right to express her opinion.

In Kansas, it appears that zealous prosecutors are targeting not only the doctors, but also their public advocates. When Reynolds wrote op-eds in local newspapers and granted interviews to other media outlets, Assistant U.S. Attorney Tanya Treadway attempted to impose a gag order on her public advocacy. The district judge correctly denied this extraordinary request.

Having learned nothing up until this point, Treadway is still going in for the kill with a new subpoena.

“Obstruction of justice” is the subpoena’s listed offense being investigated, but some of the requested records could, in no possible way, prove such a crime. The prosecutor has demanded copies of an ominous-sounding “movie,” which, in reality, is a PRN-produced documentary showing the plight of pain physicians. Also requested were records relating to a billboard Reynolds paid to have erected over a busy Wichita highway. It read: “Dr. Schneider never killed anyone.” Suddenly, a rather ordinary exercise in free speech and political activism became evidence of an obstruction of justice.

On Sept. 3, a federal judge will decide whether to enforce this subpoena, which Reynolds’ lawyers have sought to invalidate on free speech and other grounds. The citizen’s liberty to loudly and publicly oppose the drug warriors’ long-running reign of terror on the medical profession and its patients should not be in question. Rather, the question should be how the federal government has managed to accumulate the power to punish doctors who, in good faith, are attempting to alleviate excruciating pain in their patients.

Harvey A. Silverglate is the author of Three Felonies A Day: How The Feds Target The Innocent. Glenn Reynolds writes about it here:

Some years ago I started on a project entitled Due Process When Everything Is A Crime. The gist was that since criminal law has expanded to the point where everyone is some sort of a felon, the real action is in the area of prosecutorial discretion — in choosing whom to prosecute from among this population-wide mass of the guilty — where, in fact, due process basically doesn’t apply. That suggests that maybe there should be some due-process limits on decisions to prosecute. I never got to it (my scholarly rangetop has so many back burners it must be a half-mile deep) but the issue continues to deserve attention.

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