The Sad Cancer Of Third Party Pay Medical Care

As noted in my previous post a couple of days ago, almost all of the commentary about the recent defeat in Congress of the American Health Care Act proposal is about the immediate blow-by-blow of the ongoing political battle.  President Trump has suffered a huge defeat!  Paul Ryan is a loser and must be replaced immediately!  The Republicans can't govern!

Can we look at this with a little perspective?  Here's my perspective:  Third party pay for health care, whether it be government pay (Medicare, Medicaid), or near-universal insurance-company pay for ordinary and routine expenses, or a combination of both, cannot work for the long pull.  Unfortunately, like it or not, scarcity is the essential unavoidable condition of human existence.  No-questions-asked third party pay for healthcare ignores the fundamental grinding reality of scarcity.  We pretend that healthcare can be demanded and consumed in whatever infinite amounts somebody might want, without downside.  It's the usual illusion of socialism, seemingly confined to one small area of the economy; so, really, how much destruction can it wreak?  Unfortunately, the amount of destruction it can wreak is vast, and may only have begun.

Somehow it has become a shibboleth of the Left that third party pay for all or nearly all healthcare expenses is some kind of moral necessity of a decent society.  The official line is that without some form of universal "healthcare," some people will be stuck worrying about whether they can afford a treatment that may be important or even necessary; some people might lose most of their net worth or even be bankrupted by a health crisis; some people might forego necessary treatment.  Some people might even die!  (The part about excess deaths has proved remarkably difficult to demonstrate empirically.) 

But for these purposes, assume that all of these things are true, or at least somewhat true.  Meanwhile, in pursuit of the mirage of perfect cost-free healthcare for all, health spending has gone from about 7% of the economy in 1965 when Medicare and Medicaid were launched, to almost 18% today.  The incremental amount represents around $2 trillion per year to today's economy -- enough, for example, to cure all defined "poverty" about 6 times over.  The costs are buried all over the place -- some in insurance premiums paid by households, more in insurance premiums paid by employers that therefore never turn up in take-home pay, and still more in taxes at all different levels of government -- so that nobody can ever get a handle on how much they are paying and who gets the money.  And let's not kid ourselves that the "rich" do or can be made to pay all or even most of this mushrooming healthcare spending.  $2 trillion is more than the total income of the top 1% of taxpayers according to the most recent IRS data from the Tax Foundation!  There is no getting around the fact that medical spending has become a tremendous drag on the incomes of the middle class.  If you want to find the one main reason why middle class incomes do not go up, and why middle class families are angry at their inability to get ahead, this is it.

And they are right to be angry.  The moral necessity of universal third party pay healthcare is generally sold by presenting a small number of hardship cases to tug at the emotional heartstrings of the public.  OK, how much of the $2 trillion would actually be needed to take care of the bona fide sympathetic cases, and nothing for the bureaucrats and rent seekers?  5%?  Maybe 10%?  Unfortunately a socialist-model system has no ability to find the real need and spend only on that.  There is no known example of a socialist-model system not being taken over by the unproductive bureaucrats and rent seekers and run for their benefit.    

Among the dozens of articles during the last few days on this subject, I have managed to find just a couple that get past the immediate blow-by-blow and show a little perspective.  First, here is one from thezman.com, titled "The Truth About Health Care."   It is definitely worth your time to read the whole thing, but I'm going to incorporate some significant quotes:

This is an iron law of economics. All goods and services are rationed. This is true for health care too. There are no exceptions to this law. Thus, the First Truth of Health Care: No health care plan or system can ever be taken seriously unless it addresses, up front, how it will say “No, you cannot have it” to people who want it. At some point, someone has to tell the patient they cannot have whatever it is they want or need. . . .  

Thus, the Second Truth of Health Care: The current insurance model is just a wealth transfer from the middle-class to the health care industry, in order to cover the cost of poor people and the metastasizing layer of people who live off the system. Th[is] is really just a tax. Most people use about 5% of their plan for themselves; the rest is used to pay for poor people and the army of people who work in the system. . . .  

Thus, the Third Truth of Health Care: Health services are a massive skimming operation. Today, the one area of the economy that “grows” is the health care industry. Every year, more and more people pile into that wagon, mostly in administrative roles. The number of nurses and doctors does not grow very much, but the number of bureaucrats grows like a weed.

Then you have the pill makers, machine makers, research people and lawyers. There are always lots and lots of lawyers. The health care industry is massive and government dependent. It’s why rub rooms are now called message therapy centers. They are angling to get it on the racket, by having their service declared an essential health care service. . . .  

Third party pay health care is why the price of lasik surgery for your eyes (not covered by insurance) drops like a stone, while newly approved drugs that come to market (covered by insurance) now get priced at $50,000 or $100,000 for a course of treatment.  Hey, how are the government or insurers going to say no to the price if the drug might save somebody's life?  The government and insurers have infinite deep pockets -- otherwise known as what could and would have been increasing middle class incomes, now diverted to the parasites by the genius of socialism.

Returning from court today on the subway, I came across this ad, representing the dead end into which our healthcare system is headed by the irresistible incentives of third party pay:

You too can now get in on the racket!

A second article today with some sense of perspective on the situation is from Myron Magnet of the Manhattan Institute, appearing in the LA Times, titled "The original mistake that distorted the health insurance system in America."  That original mistake was the establishment, during World War II, of first-dollar or near-first-dollar healthcare "insurance" as a pre-tax employee fringe benefit.  With that foundational error, consumer cost-consciousness was banished from the medical arena, and the cancerous tumor got its start.  Tumor growth has proceeded from there.  Medicare and Medicaid represented the metastatic phase.  We are now well into Stage IV of the terminal disease.

Is there any possible cure at this point?  The only one I can see is a massive return to the states of responsibility for the healthcare issue.  If this occurs, those states brave enough to return to consumers the individual responsibility for low dollar health expenses will see a clear competitive advantage over those states that indulge in the socialist illusion.  Barring such a reform, the (now multiple) tumors continue their growth.  CMS here projects that healthcare expenditures in the U.S. will reach about 20% of GDP in the early 2020s.  I suspect that the growth will be even faster.  Don't count on much real growth of middle class incomes until this issue is addressed.   You will not find any organ of progressive journalism ever discussing this trade-off.

Obamacare: Is There Any Bipartisan Compromise Possible?

On Friday afternoon, Speaker Paul Ryan pulled the so-called American Health Care Act shortly before a scheduled vote in the House of Representatives.  From reading the press over the weekend -- both liberal and conservative -- you would have to think that this is a huge disaster for Speaker Ryan, for President Trump, and for all Republicans.  The Republicans can't govern!  They're hopelessly divided!  Paul Ryan is a loser and should resign immediately!  Trump has suffered a huge defeat!

Time for a new narrative.  Seems to me like this is something that is complex and may take a few tries.  Meanwhile, here are a few points that should be obvious, but that nobody seems to be making:

• This particular bill was carefully engineered to meet the tests for "reconciliation," so that it would be immune to filibuster.  A bill immune to filibuster can therefore pass the Senate with only 51 votes, not to mention not requiring any Democratic support in either house.  But that constraint severely limited the scope of what could be covered in this bill.  Here's a suggestion:  If the filibuster can be done away with for judicial nominations by a bare majority vote, then why not go a step further?  I suggest doing away with the filibuster for any bill that seeks to repeal prior legislation.  The filibuster was designed to slow the pace of new legislation that might have unintended consequences; but there's no reason to have a filibuster when the issue is getting rid of destructive prior legislation, of which Obamacare is just the most obvious example among thousands.
• Meanwhile, without this bill, Obamacare lives for another day.  But for how long?  The failure to schnooker the affluent young and healthy into signing up becomes more painfully obvious with every passing day and month.  Result: soaring premiums on the Obamacare "exchanges," and an accelerating death spiral.  From Time Magazine (no enemies of Obamacare) last October:  "[F]or Americans who don't get insurance through work, and who make too much money to qualify for federal subsidies, the cost of health coverage is about to soar dramatically. . . ."  They report average premium increases for the 2017 year in various states as: Alabama 36%, Georgia 32%, Illinois 44%, Minnesota 50-67%, Nebraska 35%, Oklahoma 76%, Pennsylvania 33%, Tennessee 44-62%.  Is it any wonder that people are angry?  
• It seems to be a given that no Democrat will support any effort to redo Obamacare, whether that means full repeal, or for that matter any significant reform in the direction of reducing federal control or spending.  Somehow, I can't find any article that even mentions this subject.  But without the passage of some Republican-backed reform, the law in place is the one passed by Democrats without a single Republican vote in support.  Is this where Democrats want to find themselves as premiums continue to accelerate?   

I for one will be very surprised to see Obamacare survive in anything like its present form all the way through to the next election in 2018.  What we just had is only round one.

But here's the interesting question:  Is it even remotely possible to come up with some reform that some Democrats will consider supporting?  There is nothing complicated about the partisan divide as currently constituted.  The Republicans (appropriately, in my view) are only willing to consider reforms that reduce government control and government spending.  The Democrats are only willing to consider reforms that increase government control and government spending.  There is literally no basis for compromise between those two positions.

So the Republicans have some tinkering to do before they can come up with a bill that will get the majorities that they need to pass it.  Meanwhile, isn't the real narrative the staunch refusal of even a single Democrat to participate in any way in a reform of Obamacare that might reduce, even slightly, government control or spending?         

The Weird Obsession With Russia Just Won't Go Away

A few weeks ago, when I wrote the post titled "What Is With This Weird Obsession With Russia?", I was getting the impression that all progressives, and for that matter the movement itself, had completely lost their minds.  Really, this would have to fade away in short order.  And yet here we are, most of a month later, and the narrative seems to be going as strong as ever.

And so, the day before yesterday, we had FBI Director Comey called before Congress (the House Permanent Select Committee on Intelligence) for what was reported as over five hours of testimony.  Not that Comey himself got to say much -- it was mostly Congressmen grandstanding for as long as they could get the mic and the TV cameras focused on them.  (Don't worry, I didn't watch the whole thing, or even significant amounts; just enough to get a flavor.)  The hearing got the New York Times sufficiently excited yesterday to gin up an article in the lead position covering about a third of the front page.  According to that article, Comey confirmed the existence of an investigation into efforts by the Russians to "interfere" in the election, including contacts between Russians and members of the Trump campaign:

“The F.B.I., as part of our counterintelligence effort, is investigating the Russian government’s efforts to interfere in the 2016 president election,” [Comey said], adding that the investigation included looking at whether associates of Mr. Trump were in contact with Russian officials, and whether they colluded with them. 

And for how long has the investigation been going on?

Mr. Comey told lawmakers that the investigation began in July. . . . 

The guy who got to carry most of the water for the Democrats was a fellow from California that you've probably never heard of before, Adam Schiff.  Meanwhile, outside the hearing room, Senate Minority Leader Schumer took the opportunity to intone to the New York Times how really, really important this subject is:

Senator Chuck Schumer of New York, the Democratic leader, responded: “The possibility of coordination between the Trump campaign and Russian officials is a serious, serious matter. The investigation must be fair, independent, and impartial in every way, and the F.B.I. must be allowed to follow the facts wherever they may lead.”

Now, I'm just trying to imagine the most damning conversation I can think might conceivably have happened between some Trump campaign aide (or maybe Trump himself!) and either Putin or one of his right-hand men, like Ambassador Kislyak, or maybe even Dmitri Medvedev.  I'm imagining something like this:

Trump aide (or Trump):  "On all these issues, but particularly missile defense, this, this can be solved but it’s important for him to give me space."

(Kislyak or Medvedev): "Yeah, I understand. I understand your message about space. Space for you…"

Trump aide (or Trump): "After my election I have more flexibility."

Kislyak or Medvedev: "I understand. I will transmit this information to Vladimir, and I stand with you."

Now there's some real collusion, right?  But we know that this particular collusion was completely OK.  We know that, because this is the actual transcript of a conversation between ex-President Obama and Dmitri Medvedev on March 26, 2012.  Obama and Medvedev met in Seoul, South Korea, and Obama didn't realize that he was speaking on an open mic.  Anyway, if there were a transcript remotely this damning involving Trump or one of his aides, you can be sure that it would have been leaked by now.

And then there is the $64,000 question:  If the FBI was investigating "the possibility of coordination" between Trump campaign aides (or Trump himself) and the Russians, doesn't that necessarily mean that the FBI was wiretapping the conversations of at least some senior Trump campaign aides, if not Trump himself, during the heat of the campaign?  After all, Comey has confirmed that the investigation went back at least to July.  How could the FBI conduct such an investigation without wiretapping telephone conversations?  Or, to put it another way, if the FBI was not tapping telephone conversations of senior Trump aides and/or Trump, was it even a real investigation?

Somehow Trump himself managed give the Democratic press the chance to divert all attention away from those obvious questions with his famous March 4 tweet ("Just found out that Obama had my 'wires tapped' in Trump Tower . . . .")  And thus the New York Times et al. have had the opportunity to quibble over whether Obama personally gave the order for the tapping, whether it was of Trump personally, and whether it included conversations held in Trump Tower.  None of which quibbles go to the heart of the matter, which is whether the FBI -- which, like all government agencies, consists 95% of partisan Democrats -- was wiretapping senior members of the Trump campaign during the thick of the election contest.  I guess Trump has no one but himself to blame for the diversion.  But one of the senior Republican Congressmen in the investigation, Devin Nunes, confirmed the obvious in a press release today:

• I recently confirmed that, on numerous occasions, the Intelligence Community incidentally collected information about U.S. citizens involved in the Trump transition.
• Details about U.S. persons associated with the incoming administration  -- details with little or no apparent foreign intelligence value -- were widely disseminated in intelligence community reporting.

Meanwhile, am I the only one who thinks that the whole "Trump is in bed with the Russians" story makes no sense?  Actually I'm not, because Richard Fernandez of the Belmont Club has a post from Monday titled "Red Herring," with a roundup of many reasons why the whole thing doesn't hang together.  Fernandez's main point is that everything Putin does is for Russian domestic consumption to begin with, so he wouldn't go out of his way to help either candidate.  

But, getting to the next point, if Putin were to care about one thing in U.S. affairs, you would have to think that he would want our energy production hobbled.  I mean, the Russian government is completely dependent on revenues from oil and gas production, and our frackers are absolutely killing him, capping the world price of oil and gas at a level where he can't pay his bills.  The sustained low price of oil and gas has recently forced a massive 25% cut in Russia's defense budget.  That just has to be eating away at Putin, since using an outsize military to throw weight around on the international stage is what gives him his reason to exist.  Now, as between Clinton and Trump, which was the candidate who might conceivably get conned into hobbling U.S. energy production?

And then there's the tough talk of Nikki Haley at the UN.  And Trump's exhorting the Europeans to spend more on their own defense and on NATO.  Is any of this where Hillary would have gone?  Can Putin like any of it?

Really, I wouldn't mind a bit getting proved wrong on this subject.  But as of now, all I can see in the endless conspiracy theories about Russia is a weird obsession.

A Compendium Of Climate Laughingstocks

At a very basic level there is nothing funny about the climate alarm movement.  After all, climate alarmists are people who have as a goal keeping the poorest of the world's poor -- the 2 billion or so people who lack even access to reliable electricity -- forcibly trapped in their state of crushing poverty.  And then as another goal these people want the living standards of the next lowest tiers of world income earners, the low and lower middle classes, to be drastically reduced through multiplying costs of things like electricity and gasoline by factors of around three, or maybe five, or even ten.  (This goal often goes by the deceptive euphemism of "cap and trade.")  These goals are deeply immoral and troubling; they are no laughing matter.

But, I'm sorry to say, many times I still just can't help laughing at these people.  I mean, their goals may not be funny, but they are.  We're talking about a collection of preening, supercilious elitists, often with fancy university degrees and credentials, big houses, fancy cars, even private jets, pretending to be a morally superior form of human being because, based on fake science whose flaws they do not understand, they have convinced themselves that they are "saving the planet."  And then, time after time, their arrogance and ignorance leads them into major blunders -- getting totally fleeced in international agreements, or making commitments to energy systems that can't possibly work for anything remotely approaching reasonable cost (in ways that are completely obvious if you can do basic arithmetic).

I got on to this topic a few days ago with this post that covered the Paris climate agreement signed last year by ex-President Barack Obama.  (Have I mentioned anything yet about "preening, supercilious elitists with fancy university degrees and credentials"?)  He and his people are such geniuses that they supposedly committed the United States to achieve a (completely impossible without crippling the economy) 25 - 28% cut in our "greenhouse gas" emissions within the next 8 years, while exacting from China the "promise" to maybe think about not growing their own emissions any more after 2030, unless they change their mind in the meantime.  Talk about laughingstocks!

And then there is the joke that is California, where my wife and I have been spending the past week.  This is the state that loves to lecture the rest of the country about climate virtue.  Their Air Resources Board has put out the ultimate "Climate Plan" ("to reduce greenhouse gases and move forward toward a clean, green economy").  Supposedly their greenhouse gas emissions are going to plummet by the early 2020s.  But get here and all you see are massive freeways everywhere.  Back in New York we have a number of big six-lane expressways.  Here, any freeway worth its salt has at least 10 lanes, and some have up to 16.  And they are always jammed with big gas guzzlers.  Sometimes there is one "high-occupancy" lane, which here is defined as two people and up in a car.  We made a small game of seeing how many cars we could count with only a single occupant before seeing any with a second; sometimes it was several dozen.  They have a subway that goes almost nowhere, and it's impossible to conceive how it could ever make more than a few percent of the city accessible, given the vast sprawl of the region.  But don't worry, all of this is going to be transformed within about 8 years!  Sure.  And if they could actually accomplish the transformation, and assuming that the IPCC's worst-case warming models are right, they might be able to reduce future world warming by a completely unmeasurable 0.02 of a degree or so.

But is California more ridiculous than Germany?  Germany has supposedly agreed to cut its greenhouse gas emissions by an incredible 95% by 2050.  Shall we check in on how that's going? They've now built enough solar and wind capacity that, if the darned things worked all the time, they would supply 100% of Germany's electricity needs.  Unfortunately, they don't work most of the time.  According to Environmental Progress in January, Germany's greenhouse gas emissions actually increased in 2016 -- and it was for the second year in a row!  Here's how the effort to transition to solar and wind generation is going:

Not only did new solar and wind not make up for the lost nuclear, the percentage of time during 2016 that solar and wind produced electricity declined dramatically.  Germany added a whopping 10 percent more wind turbine capacity and 2.5 percent more solar panel capacity between 2015 and 2016, but generated less than one percent more electricity from wind and generated one percent less electricity from solar.  The reason is because Germany had significantly less sunshine and wind in 2016 than 2015.

That's right, with solar and wind, you can add more and more capacity and get no more (or even less) electricity.  But can you at least get rid of some of the fossil fuel backup?  The opposite!  They shuttered some more nuclear capacity in 2016, and had to add new coal capacity to provide the steady backup that wind and solar cannot provide.  Oh, and their cost to consumers per kWh is about triple the U.S. average.  Keep it up guys!

And then there is South Australia.  SA wants its electricity generation to be 100% renewable.  What would that take?  At the link, a couple of guys named Paul Miskelly and Tom Quirk do some detailed calculations.  At present, South Australia has average electricity usage of around 1700 MW, and peak usage of around 2500 MW.  It has 1575 MW of generation capacity in wind farms.  Does that sound like they are close to getting all of their electricity from wind?  Don't be ridiculous.  The generation from wind regularly goes way below usage (when things are relatively calm) and frequently goes right down to around zero.  Miskelly and Quirk calculate that to have enough wind generation to provide the total amount of electricity that they use in a year, they would need to increase the current capacity by a factor of 3.58 -- and then come up with sufficient battery capacity to store excess electricity in all cases until it is needed, without ever running out.  Here is a chart of what SA's generation and usage would have looked like hour by hour in the first 3 months of 2016 with 3.58 times the generation capacity that they actually had.

Note that the amount of electricity being generated regularly swings wildly between three or so times usage at some points, and right around zero at other points.

So first they will need about 4000 MW of additional wind farm capacity -- close to triple what they have already, and bringing their "capacity" to about 4 times their average usage.  And then there's the storage.  M&Q calculate the maximum storage they would have needed during this period as around 270 GWh.  Better to get 300 GWh to be safe.  Now, how much would that cost? With some variations depending on whether you want (cheap) lead acid batteries or (superior) lithium ion batteries, M&Q calculate that it will run in the range of $60 to 90 billion.  And by the way, South Australia has all of about 1.7 million people.  

And that doesn't include the cost of the extra capacity, nor the cost of whatever new technology might be needed to make these wind turbines and batteries into a stable grid.  I'd say that multiplying the cost of electricity by a factor of 10 will be at the way, way low end of the range that you might expect.

Really, it's hard to know which of these is the funniest.

More From The Central Newsroom Beneath Times Square: Starving The Elderly

A couple of days ago the official talking point from the central newsroom beneath Times Square was that the Obamacare revision bill coming from the House of Representatives is "cruel."  Then on Thursday a preliminary budget outline came down from the White House, and suddenly for yesterday and today, the new official talking point is that the proposed Trump budget outline is "immoral" and will result in "starving the elderly."  Don't ask me why, but somehow a huge amount of attention seems to be focused on the so-called "Meals on Wheels" programs, a group of several thousand local organizations nationwide that provide home-delivered meals for the elderly.  

Meals on Wheels is not even a federal program, and most of the many local organizations are mostly privately funded, although the feds do provide substantial funding for many of the programs.  Of that federal funding, the large majority comes from something called the Older Americans Act (OAA), and a much smaller amount (if anything) comes from another program called Community Development Block Grants.  A piece in National Review here says that about 35% of the overall funding for the nationwide Meals on Wheels programs comes from the OAA.  The Trump budget outline did not mention anything about cutting the funding for OAA.  That outline did propose to eliminate CDBG.  CDBG -- funded through the Department of Housing and Urban Development -- is about a $3.26 billion per year program of no-strings-attached handouts to the states and localities to do with as they please.  Although the federal government does not so direct, some of the states apparently give some small part of that money to Meals on Wheels.  The Meals on Wheels programs weren't even mentioned by name in the budget outline. 

Actually, do ask me why the Meals on Wheels programs are suddenly a big focus of attention in the central newsroom.  This isn't difficult.  The idea is to come up with something -- anything -- to declare that the budget proposal is "immoral" and to maximize the emotional impact of the blowback, all in the service of the real goal, which is to prevent any reductions in federal funding for any and all handout programs, no matter how wasteful and useless.  If that's the game, accusing the administration of "immorality" and "starving the elderly" is exactly the talking point you need.

And thus we have, for example, in Time, "Trump's Budget Would Kill Funding For A Program That Feeds 2.4 Million Senior Citizens."   In the Hill, we have "Trump Proposed Budget Eliminates Funds For Meals On Wheels."  ("President Trump’s proposed budget blueprint eliminates funding for Meals on Wheels, a program that provides meals for the poor, elderly and veterans.")  Or consider the piece from the Huffington Post titled "A Budget Is a Moral Document.  The One Trump Produced Is Dark."  Subtitle: "It targets the elderly and the poor."  How could they be so mean and heartless!  Excerpt:

A presidential budget isn’t so much a policy proposal as a statement of an administration’s moral vision for the country. The budget presented by President Donald Trump on Thursday is a document fundamentally unconcerned with the government’s role in improving the plight of its most vulnerable citizens. . . .  [At a press briefing, Budget Director Mick Mulvaney discussed] the popular Meals on Wheels program, which delivers food to elderly people and others with disabilities who have trouble leaving their home. Trump’s budget calls for the program’s funding to be slashed as, Mulvaney insisted, the program doesn’t work.  “We look at this as $140 billion spent over 40 years without the appreciable benefit to show for that type of expenditure,” he said.  Mulvaney is just wrong ― unless you believe that feeding the indigent is of no value. 

Of course, although HuffPo does what it can to confuse the issue, the $140 billion over 40 years that Mulvaney talks about refers to the Community Development Block Grant program as a whole, not to the small part of it, if any, that may go to Meals on Wheels, let alone "feeding the indigent."  Does doing away with CDBG really mean that funding for Meals on Wheels will be "slashed" as HuffPo alleges?  To try to get a handle on that, let's try to find out how much funding for Meals on Wheels comes from the CDBG.  As a start, you can go to this link, an HUD site with the name CDBG Expenditure Reports; and there you will find a link titled "All CDBG Disbursements," which is an Excel file with a line by line breakdown of the entire amount of CDBG expenditures by year, going all the way back to FY 2001.  By the way, back in 2001, the program disbursed some $4.65 billion, but by 2016 the annual total has been reduced to $3.26 billion.  Go through the list of disbursements for FY 2016, and you will be hard pressed to find anything that might be going to Meals on Wheels or any other form of "feeding the indigent."  The biggest items in the list comprising the $3.26 billion are for: General Program Administration ($396.5 million -- no surprise there!); Rehabilitation: Single Unit Residential ($397.5 million); Water/Sewer Improvements ($357.9 million); Street Improvements ($220.4 million); Public Services General ($120.7 million); Rehabilitation Administration ($111.6 million); and so on to smaller amounts.  The only item that might conceivably contain anything for Meals on Wheels or "feeding the indigent" is something called "Food Banks," and the amount is a big $5.6 million.  You read that correctly.

So all the hyperventilating over the past couple of days about the "immoral" budget and "starving the elderly" is about at most $5.6 million deeply buried in the otherwise useless $3.26 billion CDBG program?  As far as I can determine, that's right.

And now that we're on this subject, why don't we look more broadly at the federal government's various nutrition programs and their effectiveness, or lack thereof.  I have previously covered this subject in multiple posts, notable "Ridiculous Campaigns Of Government Self-Promotion, DOA Edition" (September 5, 2013) and "How About The Food Insecurity Scam?" (September 5, 2014).

As background, here are a few things you should know.  Federal government spending on nutrition programs for the allegedly poor and needy come to well over $100 billion per year, of which the (maybe) $5.6 million buried in the CDBG grants are a puny and almost unnoticeable crumb.  The biggest pieces of the nutrition programs are the food stamp or "SNAP" program, the Child Nutrition Program (CNP), and the Women, Infants and Children (WIC) program, all of which are in the Department of Agriculture.  Those three together account for over $100 billion right there.  Other things like OAA add even more.  The just released budget outline proposes cutting the "discretionary" portion of the Department of Agriculture budget by $4.7 billion -- but the nutrition programs aren't in the "discretionary" part.  I have found no mention of any effort yet to cut those programs.

Although almost the entire time of the Obama administration was a time of supposed economic expansion, the federal nutrition programs exploded in that period (although the numbers fell back somewhat in the last few years).  The Obama Agriculture Department and state welfare agencies aggressively advertised and promoted to increase enrollment and dependency on government nutrition programs to the maximum extent possible.  (See this post from April 2013 on those efforts.)

The government's main metrics to determine the effectiveness (or lack thereof) of its various nutrition programs are found in its annual surveys of what it calls "food insecurity."  Here is a link to the latest survey, covering 2015.

With that background, I'm going to reprise some of the things I have said in the prior posts.  From September 5, 2013:

In the 4+ Obama years, supposedly a period of economic "recovery," Food Stamp spending has about doubled, from about $40 billion to about $80 billion per year.  Before Obama Food Stamp spending tended to increase during recessions but go down during recoveries.  It has been widely reported that in recent years Federal and state governments have hired recruiters to pressure people to get onto Food Stamps.  Also, eligibility rules have been revised, particularly to eliminate most asset restrictions (million dollar home? no problem!) and to make automatically eligible for Food Stamps all people who are eligible for any other Federal welfare program. . . .  

[W]e spend $100 billion a year for nutrition assistance to the needy,  with well over 50 million recipients, and yet there are still almost 50 million "food insecure" people in the United States.  Isn't this saying that the existing programs, at $100+ billion per year, aren't having any effect whatsoever on alleviating the problem that you yourself define?       

And from September 2014:

The whole idea of using "food insecurity" as the metric is to have something that is completely impervious to going down no matter how much is spent to solve the problem. . . .  [T]he whole design of the food stamp program is that it forces poor people, who may not be the most together people in the world, to manage a monthly budget and make it last to the end of the month.  Of course they are going to feel "food insecure" at some point!  You could double, or triple, or quadruple the spending on food stamps, and this would still be true. . . .  [T]he same organization, the DOA . . . both runs the food stamp program and puts out the "food insecurity" surveys.  Don't you think they would be ashamed that their massive $80 billion per year program of food distribution (food stamps, aka SNAP) didn't ever make a dent in the problem they claimed to be trying to solve, namely "food insecurity"?  Shouldn't they be saying, "OK, we blew it.  It's time for somebody else to take over with a new approach"?

So here's a summary of where we are.  We have an unimaginably vast federal "nutrition program" apparatus, spending well over $100 billion per year and disbursing food to over 50 million people -- something like a sixth of the population and way, way more than any possible idea of who might be fairly described as "indigent."  The government creates a completely fake and fraudulent metric called "food insecurity" to gin up vast numbers of people who can falsely be claimed to be going "hungry" and to make it such that the numbers of such people can never go down no matter how much the government spends.  The whole apparatus of the programs, the spending, and the metrics is in desperate need of a complete overhaul to reduce unneeded dependency on handouts and limit the programs to those who really need them.  And, whatever else the Trump administration may be up to that you may or may not like, as far as can be determined from its budget outlines, it hasn't proposed to touch any of this, except maybe a figure of some $5.6 million, some of which might be going to Meals on Wheels programs.  

And for this the central newsroom has gone completely nuts.  I can't wait to see what happens when somebody actually tries to rationalize these ridiculously bloated programs.     

Here's What's "Cruel": Trapping The Poor In A Lifetime Of Dependency

Have you ever noticed that all Chinese menus are remarkably the same?  Moo shu pork.  General Tso's Chicken.  Beef with broccoli.  Sweet and sour pork.  In New York, everybody knows that it's because all the Chinese food is prepared in one massive central kitchen located beneath Times Square.  Of course it's all the same!

What hasn't been as widely recognized is that there is also one massive central newsroom, equally located just beneath Time Square (right next to the central Chinese kitchen), that prepares the progressive news talking points each day and distributes them to dozens of seemingly separate televisions networks, newspapers and websites.  How else to explain that you can go to literally any one of the so-called "mainstream" sites on any given day, and find not only the same stories, but generally also expressed in the exact same words?  Recently -- by which I mean, since January 20 -- the selected words always have been chosen to maximize the degree of evil attributed to the new President and Congress.

And thus, with the unveiling last week of the first proposal from the Republican Congress to start undoing Obamacare, we find the immediate emergence of the official progressive talking point clearly emanating from the central newsroom:  This is "cruel."  The CBO has estimated a likely increase in the number of people without healthcare "coverage."  Go literally anywhere, and you find this circumstance described with the same word -- "cruel" -- repeated, over and over. At the New Republic on March 14 it's "The Incredible Cruelty of Trumpcare" (subtitle "Republicans are willing to cause a humanitarian crisis just to give permanent tax cuts to millionaires").  At New York Magazine, it's "Trumpcare Is The Culmination of All the GOP's Healthcare Lies" ("they instead rushed out a plan that is shambolic and cruel").  At the Washington Post on March 8, it's "the ultra-conservative Freedom Caucus . . . is terribly distressed by the fact that the Ryan bill is insufficiently cruel to poor people."  Paul Krugman of the New York Times put it in a tweet on March 14: "The first and most important legislative initiative [of the new Congress] is stupid as well as cruel . . . ."  There are dozens of other examples.

You get the idea.  The little people are incapable of facing any downside risk of life on their own.  Any failure of the federal government to accept and provide for any and all downside risks of life, right down to a couple of aspirin to help with a headache, is "cruel."  It's "heartless."  It's "a humanitarian crisis."  Government's job is to make sure that all people have free or affordable "healthcare," so that any healthcare issue that arises in their lives can be promptly treated, at public expense.   

Of course, it is a given that government-provided health care is a moral imperative.  Without it, people who are poor and of low income will go without needed medical treatment.  They will suffer, and then die.  Right?  I mean, everybody knows that people who go without healthcare "coverage" have a higher death rate than people who are "covered."  Everybody knows that because, back in 2002, the Institute of Medicine estimated 18,000 excess deaths per year among the "uninsured," based on an assumption that uninsured people had a mortality rate higher than that of the insured.  In 2009, in the run-up to enactment of Obamacare, a Harvard "study" upped the estimate of annual excess deaths among the uninsured to some 45,000, again based upon an assumption that the "uncovered" must have higher mortality.

And yet.  First came that controlled study in Oregon where thousands of people were randomly assigned to Medicaid and non-Medicaid groups.  The results were reported in the New England Journal of Medicine in 2013:

This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes . . . .    

But here is what is even more significant.  Look at reports of health data among high-Medicaid recipient populations of poor people.  What you will find is that their health outcomes are universally inferior to national or city norms on any measure you can think of.  As discussed here several days ago, last year New York City published health data for 2015 broken down by neighborhood.  Look up the data for the poor and majority-black neighborhoods, where Medicaid is pervasive, and you can see how well Medicaid is working -- or not.  After 50+ years of massive and ever-growing spending, has Medicaid succeeded in bringing health outcomes among the poor up to national norms, or are the poor stuck in a rut of persistently inferior health outcomes?  It's not even close.  Here is the report for Central Harlem; here's the one for Mott Haven/Melrose in the Bronx; here's the one for Bedford-Stuyvesant in Brooklyn; and here's the one for Ocean Hill-Brownsville in Brooklyn.

  A sample of some of the results:  

• U.S. life expectancy in 2016 was 78.8 years.  But in Harlem it was 75.1 years; in Mott Haven/Melrose 76.1 years; in Bed-Stuy 75.1 years.  And in the ultimate public housing, Medicaid, and food stamp dependency utopia of Ocean Hill-Brownsville, life expectancy was just 74.1 years, almost five full years less than the national norm.  
• Obesity and diabetes rates are far higher in these neighborhoods than elsewhere in New York City.  In the four cited neighborhoods, obesity rates range from 28% of the population in Central Harlem to 33% in Bed-Stuy, against a city norm of 24%.  Diabetes rates are 50% above the city-wide norm of 10% of the population in all of Mott Haven/Melrose, Bed-Stuy, and Brownsville, and 30% above in Harlem.
• These neighborhoods far exceed city norms for drug and alcohol-related hospitalizations.  Brownsville is again the "leader," with 2,285 alcohol-related hospitalizations per 100,000 population in 2015, and 2682 drug-related hospitalizations per 100,000, as against city-wide norms of 1019 and 907 per 100,000 respectively.  The best of the four is Bed-Stuy, with "only" 1713 alcohol-related hospitalizations per 100,000, and 1830 drug-related.
• Medicaid beneficiaries supposedly have infinite free pre-natal care and obstetrical services.  Yet somehow, infant mortality is far higher in all of these neighborhoods than city-wide norms.  The city-wide norm for infant mortality per 1000 births is 4.7.  But the rate is 8.1 in Central Harlem, 8.0 in Brownsville, and 6.6 in Mott Haven/Melrose.  Only Bed-Stuy, at 5.0 is near the city norm.
• In the category of "premature mortality," where the city-wide rate is 198.4 per 100,000, Brownsville leads the city with a rate of 367.1.  Bed-Stuy ranks third at 309.2, and Mott Haven/Melrose fourth at 305.7.  Central Harlem is closest to the city norm -- not very close -- at 293.1.

Do you maybe get the idea that something is not working here?  While no association of Medicaid "coverage" with better health outcomes can be demonstrated, it is glaringly obvious that what can be demonstrated is an association between widespread dependency on government programs for the poor (of which Medicaid is the largest and most widely available) and worse health outcomes.  Much worse health outcomes.

I don't know why high dependency on government programs in general, and Medicaid in particular, is so closely associated with much higher rates of drug and alcohol abuse, higher death rates and shorter life spans.  But the best hypothesis is that no-questions-asked handouts take away human independence and act as a "subtle destroyer of the human spirit."  (The phrase comes from the 1935 Address to Congress of Franklin Roosevelt.)  If you can't improve your life by working hard, why not just take drugs? 

Anyway, if we are to take it as established that subjecting the poor to worse health outcomes is "cruel," then the path forward is obvious.  The thing to do is to lower rates of dependency.  Get as many people as possible off of Medicaid, and for that matter food stamps and subsidized housing.  Bring back some striving to the lives of the poor!  Anything else is "cruel"!

Somehow, I don't think that anyone has yet written this story in the central newsroom beneath Times Square.