Quick hits

1) So far Ken Burns new Vietnam War documentary is fabulous.  Just watch it.

2) The science of the Impossible Burger.  Can’t wait to eat one of these.  Especially looking forward to a time where most of our “meat” actually comes from plants.  Also, an interesting look at how to regulate new food ingredients.

3) Definitely going to have to read Tim Harford’s new book on 50 inventions that shaped the modern economy.  Nice interview with Derek Thompson.

4) Everybody still raving about this Cincinnati Enquirer feature on a week in the heroin epidemic.

5) The US Air Force has a real problem with encouraging the worst kind of Christians.

A U.S. Air Force chaplain who ministers to thousands of men and women at an Ohio base is asserting that Christians in the U.S. Armed Forces “serve Satan” and are “grossly in error” if they support service members’ right to practice other faiths.

6) Speaking of the Prince of Darkness, “Trump Nominee Said Transgender Children Evidence of ‘Satan’s Plan.'”  And just what plan is this?!

7) Very nice piece from Yglesias on what happened in the 2016 election.

Democrats did better with white women, worse everywhere else

Comparing exit polls from 2016 (left) to 2012 (right) we see that while Clinton did worse with voters overall than Barack Obama, she did gain 1 percentage point more of the white women’s vote — rising from 42 percent to 43 percent. Most white women, however, preferred Trump. And though Trump did no better with white men than Romney had, Clinton did considerably worse than Obama.

Perhaps more surprisingly, though Clinton carried all nonwhite groups she seems to have done decidedly worse here than Obama had.

8) So the story of the scientist who discovered the BCRA1 gene and the worst week of her life definitely deserved to go viral.  Trust me and read it.

9) How regulators end up serving those they regulate– deer urine edition.

10) Nice NYT feature, “How Big Business Got Brazil Hooked on Junk Food

The story [of growing worldwide obesity] is as much about economics as it is nutrition. As multinational companies push deeper into the developing world, they are transforming local agriculture, spurring farmers to abandon subsistence crops in favor of cash commodities like sugar cane, corn and soybeans — the building blocks for many industrial food products. It is this economic ecosystem that pulls in mom-and-pop stores, big box retailers, food manufacturers and distributors, and small vendors like Mrs. da Silva.

In places as distant as China, South Africa and Colombia, the rising clout of big food companies also translates into political influence, stymieing public health officials seeking soda taxes or legislation aimed at curbing the health impacts of processed food.

For a growing number of nutritionists, the obesity epidemic is inextricably linked to the sales of packaged foods, which grew 25 percent worldwide from 2011 to 2016, compared with 10 percent in the United States, according to Euromonitor, a market research firm. An even starker shift took place with carbonated soft drinks; sales in Latin America have doubled since 2000, overtaking sales in North America in 2013, the World Health Organization reported.

11) Really enjoyed this Wired feature on “Blade Runner 2049.”   I so hope this movie doesn’t disappoint me.

12) If I could only have one person to listen to about China, it would be Evan Osnos:

In recent years, overly hopeful U.S. politicians and commentators have repeatedly misunderstood China’s views of North Korea and assumed that Beijing was, at last, turning against its irksome ally. In private meetings with President Obama, and later with President Trump, Xi has repeated a bottom-line principle about North Korea: “No war. No chaos. No nukes.” A former U.S. official, who was at several of those meetings, told me, “Every American senior official that I know hears, ‘Blah, blah, blah—no nuclear weapons.’ And thinks, ‘Oh, we agree! Excellent!’ So the Chinese ought to be willing to limbo under this bar for us. But, no, that’s third in the list of three strategic priorities. The first two are avoiding war on the Korean Peninsula, and avoiding chaos and collapse.” In that spirit, China has sought to limit the scope of U.S.-backed sanctions in the U.N. Security Council. In the latest round, earlier this month, China succeeded in forcing the U.S. to drop its pursuit of a full oil blockade, which China fears would drive North Korea to collapse.

Nothing worries Chinese officials more than the following scenario: the U.S. uses harsh sanctions and covert action—and possibly military strikes—to drive North Korea close to the point of regime collapse. In turn, Pyongyang lashes out with violence against America or its allies, sparking a full-blown war on China’s border, just as China is trying to maintain delicate economic growth and social stability. Xi, in separate sessions, has offered Obama and Trump the same Chinese adage in reference to North Korea: “When a man is barefoot, he doesn’t fear a man with shoes.” In other words, even if attacking America would be suicide for North Korea, if it sees nothing left to lose, it just might do the unthinkable. For that reason, China, above all, wants the U.S. to avoid backing Kim into a corner from which he has no exit.

13) These “hacks to fix your marriage” generally sound like pretty good advice.  I’m especially inclined to thinking about attribution and gratitude.

14) Can being more honest make you happier?  So says some research.  As for me, I am pretty happy and pretty happy with my (imperfect) level of honesty.

15) Seriously, Tom Price is just the worst.

16) Though, EPA head Scott Pruitt does not take a back seat to many in absurd waste of taxpayer dollars.

17) How Harvard helps it’s richest and most arrogant get ahead.

18) Speaking of Harvard, so happy to finally hear an interview with the brilliant creator of Bojack Horseman, Raphael Bob-Waksberg.

19) Must read for the day– Nate Silver on how the media (and people) mis-understand probability.

 

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Follow the money (health care version)

A million things to say about health care this week, but it’s been really busy, so I’ve stuck to writing a dozen blog posts in my head, rather than on the computer.  Among the angles I’ve loved is how much smarter Jimmy Kimmel is on health care policy than your typical Republican Senator.  Now, one thing that political neophytes too readily do is blame everything on the money, e.g., Kimmel here:

“Listen: Health care is complicated,” he said. “It’s boring. I don’t want to talk about it. The details are confusing — and that’s what these guys are relying on. They’re counting on you to be so overwhelmed with all the information [that] you just trust them to take care of it. Well, they’re not taking care of you. They’re taking care of the people who give them money.”

But, here’s the thing.  Kimmel is absolutely right.  This bill is 1) clearly, a policy disaster.  Few Republicans even try and defend it on the merits; and, 2) absurdly unpopular.  So, why push and push?  Follow the money:

WASHINGTON — As more than 40 subdued Republican senators lunched on Chick-fil-A at a closed-door session last week, Senator Cory Gardner of Colorado painted a dire picture for his colleagues. Campaign fund-raising was drying up, he said, because of the widespread disappointment among donors over the inability of the Republican Senate to repeal the Affordable Care Act or do much of anything else.

Mr. Gardner is in charge of his party’s midterm re-election push, and he warned that donors of all stripes were refusing to contribute another penny until the struggling majority produced some concrete results.

“Donors are furious,” one person knowledgeable about the private meeting quoted Mr. Gardner as saying. “We haven’t kept our promise.”

The backlash from big donors as well as the grass roots has panicked Senate Republicans and is part of the motivation behind the sudden zeal to take one last crack at repealing the health care law before the end of the month.

Well, there you go.  When the rich guys say “jump,” politicians (especially Republican ones), say “how high?”

Also, on the policy disaster front, this Upshot piece from Margot Sanger-Katz has stuck with me.  The title gets it, “The G.O.P. Bill Forces States to Build Health Systems From Scratch. That’s Hard.”  And “hard” is an understatement.  And, if you want more details on why it’s so bad, Ezra, of course, takes care of that.

Of course, I’ll not believe this is dead dead until October 1, but, as I’ve said before, the fact that the GOP is anywhere close to passing such shockingly horrible legislation really tells you all you need to know (okay, just a lot, doesn’t really hit white ethnocentrism) about the modern Republican party.  Oh, also, don’t want to forget– the lies, my God, the lies.

We have got to change high school start times

I was meaning to write a post based on a recent Rand analysis that finds there’s a huge economic benefit to moving school (mostly high school) start times later.  I was slow in writing that up, but did have a great email discussion with an NC State Chemistry professor, Jim Martin, who is on our local school board.  Then, Aaron Carroll had a great piece in the Upshot summarizing all the evidence.  Instead of blogging that, I decided I’d write an Op-Ed for the N&O based on the data and my discussion with Jim Martin on all the political opposition this would bring.  Just maybe, this can help get the local political conversation going a bit.  I particularly wanted to address the fact (elided by Carroll and the Rand summary), that the benefits accrue to the general fund, but the costs are borne almost exclusively by education budgets.  Yep, that damn tyranny of separate budgets.  So, because it’s mine, here’s the whole Op-Ed:

The evidence is clear – it is time for North Carolina high schools to move back their start times for the vast majority of high school students and many middle school students. Here in Wake County, most high schools and some middle schools begin their day at 7:25 a.m. (and, in the extreme case of Apex High, 7:10 a.m.). Such early start times necessitate students getting up at 6 a.m. or even earlier. The research on school start times is compelling – early start times and wake-up times have negative impacts on our students and our communities.

Many blame modern life and smartphones, and question, “Well, can’t they just go to bed earlier?” The answer is no. Adolescent biology is different, and the truth is that teens’ natural biological clocks favor a later bedtime. Add a high-school wake-up time of 6 a.m. to that and all of a sudden the broadly-recommended nine to 10 hours of sleep for an adolescent becomes a literal impossibility. Studies have shown that when school start times become later, students respond not by staying up later but by getting more sleep.

As pretty much everybody knows, a well-rested human is a better-performing human, and the same goes for high school students. Perhaps the quickest, easiest way to achieve improved student performance across the board is not by addressing controversial issues like teacher pay or Common Core (though these are important issues), but actually letting our kids get enough sleep. The data are clear that districts that have shifted to later start times have better student performance.

Surely changing when high school starts would be expensive, with additional transportation and other logistical costs. Ahh, but there’s the rub. The latest systematic research from the highly-respected Rand Corporation says that later start times will actually result in considerable savings – where the economic benefits substantially outweigh the costs. While additional buses and drivers cost more, these costs are more than offset by the increased future economic productivity of well-rested students, as well as avoiding the costs (including loss of life) of early morning, fatigue-induced automobile accidents. The benefits Rand calculated did not even include the positive benefit of lower juvenile crime, which criminologists agree would decrease with fewer unsupervised hours in the afternoon.

With so many compelling arguments for later start times, it should be an easy change – right? How can people oppose healthier, more productive high school students while saving the state money? If only politics were that simple. The reality is, unfortunately, far more complicated.

 The first complicating factor – always a key source of friction in politics – is who pays the costs and who receives the benefits. In this case, the costs would come out of county school budgets. Alas, those same county school budgets will not reap the financial reward that comes from more productive (and alive, having avoided fatal car accidents) future citizens. While this clearly makes economic sense on the state level, it is hard to see school boards taking steps to increase their short-term costs when the benefits are long-term and do not even directly accrue to the county.

The second major complicating factor is status quo bias. People and organizations do not like major change and push back hard against it unless given a compelling reason. And this is a big change. All the evidence-based arguments of student health and economic benefit will come crashing up against the reality that this represents a major adjustment for teachers, administrators and families.

So, how to overcome these problems and bring about the change that will so clearly benefit our adolescents and our communities? This is a case where real political leadership is needed. If evidence for the benefits to young people and society outweighing the costs were enough, our high school students would already be starting at 8:30 a.m. We need politicians and intellectual leaders to clearly and prominently make the case that the difficulties of change are more than worth bearing and that counties will not be financially penalized for doing right by their students.

OK, then, politicians: time to step up and show us you are willing to listen to the evidence and take some concrete steps to benefit our students, schools and communities.

 

Stand up already

I’ve mentioned before that I generally rely on my high lunchtime liquid consumption plus my small bladder to keep from sitting for long periods of time.  And, at home, I rely on my ever-demanding children.  Also, at work, I rely on an app on my desktop that reminds me to stand up every 20 minutes.  This works very well for me and I hope it keeps me healthy because I really prefer sitting to standing and have no desire for a standing desk.

And, hooray, the latest research suggests this really may be the ticket.  NYT Well column (of course):

The scientists then found strong statistical correlations between sitting and mortality. The men and women who sat for the most hours every day, according to their accelerometer data, had the highest risk for early death, especially if this sitting often continued for longer than 30 minutes at a stretch. The risk was unaffected by age, race, gender or body mass.

It also was barely lowered if people exercised regularly.

But interestingly, the risk of early death did drop if sitting time was frequently interrupted. People whose time spent sitting usually lasted for less than 30 minutes at a stretch were less likely to have died than those whose sitting was more prolonged, even if the total hours of sitting time were the same. [emphasis mine]

In essence, the data showed that “both the total hours spent sitting each day and whether those hours are accrued in short or long bouts” of physical stillness influenced longevity, says Keith Diaz, an assistant professor of behavioral medicine at Columbia University, who led the new study.

The results also indicate that if you must be chair-bound for much of the day, moving every 30 minutes or so might lessen any long-term deleterious effects, he says, a finding that adds scientific heft to the otherwise vague suggestion that we all should sit less and move more.

This is just correlational and there’s plenty more work to be done, but some encouraging validation for my approach.

And, just because.

 

The chart to keep in mind for 2018

Love this from Pew that compares people who vote consistently in presidential and midterm elections with those who just vote in the presidential years.  It makes it pretty damn clear we have had a recent pattern of Democrats performing well in presidential years (and, let not forget the 2016 popular vote) and getting various levels of creamed in the midterm years.

In large part, because Democrats rely so heavily on young voters and minority voters, they disproportionately suffer from the drop-off in midterm years.  For example, the youngest cohort is only 6% of consistent voters, but 20% of drop-off voters.  Even more dramatically, non-white voters are only 20% of consistent voters, but 38% of drop-off voters.  Now, the Democrats are almost surely more likely to drop off more, again, in 2018, but the key is to have dramatically less drop-off.  And, I actually think there’s a decent chance of that.  Regardless, this is the baseline to keep in mind.

Single payer cognitive dissonance

So, Ezra Klein says Bernie pushing for single payer is actually a good thing, despite it being largely fantasy:

Jonathan Chait, at New York magazine, says Bernie Sanders’s Medicare-for-all bill “gets America zero percent closer to single payer.”

Chait’s argument, which I largely agree with, is that “single payer has always been, and remains, a political dilemma that nobody has been able to resolve, and there is no evidence the resolution has grown any easier.” But his conclusion — that Sanders “has accomplished approximately zero percent of the necessary work” — misses what I think Sanders is trying to do, and what a reasonable definition of success looks like.

Sanders’s bill stands very little chance of ever being enacted, or of getting America to single-payer. As I’ll explain, it solves precisely none of the problems that have foiled every other single-payer plan in American history. But it stands an excellent chance of getting the country quite a lot closer to single-payer.

What Sanders has achieved here is remarkable. A policy that used to be tentatively embraced by elected officials on the party’s left is now being enthusiastically embraced by key leaders from its mainstream, including the party’s most promising 2020 contenders. Even Joe Manchin, the Senate’s most conservative Democrat, is proclaiming himself open to the idea. Sanders has thrown a rock through the Overton window.

At the same time, it’s important to recognize what Sanders hasn’t achieved, and in fact hasn’t even tried to achieve: He has not solved or even admitted any of the very real challenges to implementing single-payer health care in the United States.

Sanders’s bill has 16 co-sponsors, including most of the Senate Democrats most often mentioned as possible 2020 presidential contenders. In one fell swoop, he has taken single-payer from an ideal on the margins of the Democratic Party to a goal endorsed by its likeliest standard-bearers.

The Democratic Party could’ve oriented itself around a number of health care goals in the coming years. It could’ve simply sought to improve Obamacare. It could’ve focused on cutting costs, or lowering premiums, or getting closer to universal coverage. But Sanders, I think, has preempted all that: He’s made the goal single-payer.

Most of Ezra’s post, though, is about how the goal of single-payer is virtually infeasible policy-wise and politics-wise.  Hmmm.  I love the goal of universal coverage.  To insist on the means of single-payer in the United States that has  a unique history and politics working against single payer, strikes me as unwise.  If the single-payer goal actually gets us closer to a good system of universal coverage, then, hey, I’m for it.  I’m just not sure that it does.  I worry that it sets up entirely unrealistic expectations.

Chait:

The barrier to single payer is that the American health-care system has been built, by accident, around employer-based insurance. The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writesSanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare…

That is not a detail to be worked out. It is the entire problem. The impossibility of this barrier is why Lyndon Johnson gave up on trying to pass a universal health-care bill and instead confined his legislation to the elderly (who mostly did not get insurance through employers), and why Barack Obama left the employer-based system intact and created alternate coverage for non-elderly people outside it…

There is nothing in Sanders’s rhetoric that indicates he even recognizes the shape of the political problem. Instead he employs the classic populist technique of imagining the people as a whole standing united around an obvious solution, and only the machinations of an invidious elite can thwart them…

Evil corporations are the only impediment he acknowledges. At no point does he grant that the most important source of opposition will come from actual American voters concerned about losing their current plan or paying higher taxes…

Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’s single-payer bill is vague enough that the Democrats co-sponsoring it are really doing nothing more than saying the same thing Obama did: A single-payer plan would be nice, in a world that looks nothing like the one we inhabit. [emphases mine]

And Chait’s response to Ezra:

Among center-left health-care analysts, there is very little disagreement that Bernie Sanders says a lot of things on the subject that are misleading or wrong, and that his bill stands little chance of enactment even if Democrats win full control of government. His defenders instead make a different argument: By taking extreme positions, they say, Sanders creates more political room for rational reforms to take hold…

There is a virtual consensus among progressives that the United States would be much better off if it had implemented single-payer insurance, or some other national health-care plan used by industrialized democracies, many decades ago. Instead, the American health-care system grew up around the malformed incentives created by employer-sponsored insurance and fee-for-service medicine. The astronomical cost of medical care, the deep fear of change among the insured, and the entrenched interests of providers have all made the system nearly impervious to systemic reform.

Sanders has not cracked this problem. Nobody really claims he has, or even claims that he has grappled with it. His alleged contribution is to refuse to acknowledge the problem at all. He assumes implausibly large savings, and dismisses fiscal estimates of the cost of his plan as rigged by crooked drug companies. He tells a different, much simpler story than other Democratic politicians. In his words, the only important question is a conviction about the morality of universal insurance, and only obstacle to progress is the profits of the insurance and drug industry. (He omits doctors and hospitals, not to mention change-averse voters themselves.)…

The theory also dismisses the possibility that the candidates who endorse the Sanders plan open themselves up to the attack that they favor a large middle-class tax hike. The Sanders plan attempts to deflect this vulnerability by leavings its financing mechanism open-ended as a list of suggested revenue-raisers. It will work if candidates can get away with attaching themselves to the promised benefits of his plan without committing themselves to the pay-fors it requires. Republican politicians often get away with this kind of legerdemain — but only because they benefit from a partisan right-wing media ecosystem. Democrats need to run the gauntlet of an independent news media that is unlikely to let them run around promising trillions of dollars in new spending without trillions of dollars in new taxes.

Meanwhile, Catherine Rampell is having none of it:

Thanks to the Grand Old Party’s demagoguery, Democrats have for a little while enjoyed a virtual monopoly on facts, evidence and experts. Dems — or some of them, anyway — embraced serious, solutions-based, often technical policymaking and the hard choices that went along with it.

But the lesson the Democrats seem to have taken from the 2016 electoral trouncing is that they need to become more like Republicans. Meaning: Abandon thoughtful, detail-oriented bean-counting and attempts to come up with workable solutions grounded in (occasionally unpopular) reality, and instead chant virtue-signaling catchphrases.

Such as “single-payer.”…

But we’re not starting from scratch. We live in our patchwork world, which means if we want single-payer — an ill-defined catchall, by the way — we need to figure out how to get from here to there. This involves painful political choices, sharp tax hikes and some degree of buy-in from the many stakeholders who are going to get shafted in the transition.

The goal should be universal health care, however we get there. And we’re much likelier to get there if we start from a baseline of reality than if both parties hand-wave away inconvenient truths. There is no courage in saying everyone should have health care. The courage is in staking out a plan to pay for it.

Okay, maybe not so much dissonance.  I think this marks one of the times I just disagree with Ezra Klein.  I’m more persuaded by both Rampell and Chait.

And, to reiterate the key point– Democrats absolutely need to be for genuine universal coverage that reduces overall system costs.  If advocating for single payer gets us to that goal, well, alright, then.  But single payer is a pipe dream given where we are.  Yet, there are other approaches, e.g., gradual Medicaid buy-in, that are far more feasible as policy and politics that reach the same end.  Seems to me, that should be where we put our focus and not lose sight that the goal is the key, not the means.

——

Okay, you know what, I thought about this more after queuing it up to post and I’m even more frustrated by this.  It would be one thing if Sanders actually understood the realities and complexities of health care policy (the way in which he so readily elides the many complexities suggests he either doesn’t know or doesn’t care) and saw advocating for single payer as the most effective way to improve our health care system.  But, instead, it seems that Sanders really doesn’t understand or care about these complexities and has a doctrinaire commitment to single payer that ignores so much reality.  That’s frustrating and I don’t like seeing the Democratic party follow him down that path.

One chart (on teaching) to rule them all

This whole article in Quartz on what America does wrong on teaching is excellent.  Pretty sure this will make it into the Public Policy syllabus.  Now, of course, there’s so much more to school performance around the world than relative teacher pay, but this depressing chart really tells us a lot:

What this chart tells us in stark terms is that the United States simply doesn’t value teachers.  So many of our other problems flow from that.  If we valued teachers we’d invest more in them and get more of America’s best and brightest in in the profession and take more seriously what it takes for them to succeed.  Do all that, and America’s schools get noticeably better.  These two paragraphs capture a lot:

Money and prestige matter. The highest performing education systems always prioritize the quality of teachers says Andreas Schliecher, head of the education directorate at the OECD. “Wherever they have to make a choice between a smaller class and a better teacher, they go for the latter. Rather than putting money into small classes, they invest in competitive teacher salaries, ongoing professional development and a balance in working time.”

US teachers spend 38% more time in front of the classroom than their international peers: 981 hours compared to an OECD average of 712 per year. This is time that they are not collaborating with peers, honing their knowledge of their subject or the practice of teaching.

It’s somewhat of a chicken and egg problem in that we don’t pay teachers enough because we don’t value them enough.  And one reason we don’t value teaching is that we (accurately) see it as a low-paying profession.  I’d love it for some forward-thinking school system to find a way to blow this up and just start paying teachers a ton more and let all the benefits flow from that.

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