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Premium Increases Under Obamacare Have Stayed Really Low

| Wed Apr. 13, 2016 8:27 PM EDT

The Department of Health and Human Services has issued a report on 2016 premium increases under Obamacare. This is useful information if you want to answer the following question:

How much do actual Obamacare users have to pay for coverage?

Of course, if this is the question you're interested in then you have to take into account all the data. You can't cherry pick just one or two providers; you can't focus on just the states with the highest increases; you can't ignore the fact that lots of people shop around for the best price each year; and you can't pretend the federal subsidies don't exist. You have to take a look at the nationwide average of what users actually paid. When you do, it turns out that premiums increased about 4 percent this year in the federal marketplace.

But that's not the only question you might want to ask. There's also this one:

How has Obamacare affected the cost of health coverage more generally?

You can't answer this by looking only at Obamacare because there's nothing to compare it to. You can't compare Obamacare premiums to premiums in the individual market prior to 2013, because the individual market excluded sick people. Naturally premiums used to be lower. Nor can you compare Obamacare premiums to premiums for employer health care. The coverage is completely different. It's apples to oranges.

But there are other things you can look at. For example, you can look at the cost of employer coverage over the past decade or so. If Obamacare has devastated the insurance market or jacked up the cost of health care, it will show up here. And this is a nice, clean series for the entire period that provides an apples-to-apples comparison. You can see it on the right.

Long story short, nothing much has happened. The annual increase in premiums declined to about 5 percent in the mid-aughts, and since Obamacare passed it's been about 3 percent. Nothing to see here.

Now, we only have two years of data since Obamacare passed, so this is still pretty tentative. And you might also be interested in how coverage has changed and what kind of out-of-pocket costs workers are bearing these days. Those are all worthwhile things to look at depending on what questions you're asking.

But if you want to know about the cost of health care coverage, the answer is pretty simple. Since Obamacare has gone into effect, its users have seen modest premium increases. This year it's around 4 percent in the federal marketplace. And employer premiums have stayed steady too. Over the past couple of years, they've increased about 3 percent annually.

Maybe this will change as time goes by. But for now, Obamacare doesn't look like it's done any damage at all to the price of health insurance. In fact, it might have helped. That's what you see if you take a fair look at all the data.

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Health Update

| Wed Apr. 13, 2016 3:39 PM EDT

More good news this month: My M-protein level has declined again, from 0.43 in March to 0.37 in April. Overall, it's gone down by about a third since the start of the year, so apparently the dex is doing some good. And speaking of dex, with the dosage reduced from 20 mg to 12 mg, I'm no longer staying up all night on Friday and I'm sleeping better the rest of the week. A few other annoying side effects are still hanging around, but nothing too bad. Hooray!

Hillary Clinton Wants to Eliminate Lead Within Five Years

| Wed Apr. 13, 2016 3:05 PM EDT

In a speech on environmental justice today, Hillary Clinton made a bold proposal:

Be still my heart! Hillary's plan has eight parts, and the first one is all about lead poisoning:

Eliminate lead as a major public health threat within five years....For every dollar invested in preventing childhood exposure to lead, between $17 and $200 is saved in reduced educational, health, and criminal justice expenses and improved health and economic outcomes—but the few federal programs that exist are inadequate to address the scope of the problem and have seen significant budget cuts and volatility in recent years.

....Eliminating lead as a major public health threat to our children is a goal we can and must meet as a nation. Clinton will establish a Presidential Commission on Childhood Lead Exposure and charge it with writing a national plan to eliminate the risk of lead exposure from paint, pipes, and soil within five years; align state, local and philanthropic resources with federal initiatives; implement best prevention practices based on current science; and leverage new financial resources such as lead safe tax credits. Clinton will direct every federal agency to adopt the Commission’s recommendations, make sure our public water systems are following appropriate lead safety guidelines, and leverage federal, state, local, and philanthropic resources, including up to $5 billion in federal dollars, to replace lead paint, windows, and doors in homes, schools, and child care centers and remediate lead-contaminated soil.

I don't think five years is anywhere near feasible—it's more like a 10-20 year project—but that's a nit. I'm especially happy to see Hillary acknowledge the importance of remediating lead in soil, which usually doesn't get much attention. But that's where all the lead from automobile emissions settled, and it's worst in low-income urban neighborhoods that are dense with traffic.

Unfortunately, it's also the most difficult to address. Replacing lead water pipes is expensive, but we know how to do it. Getting rid of lead paint in old houses is a little less expensive, especially if we concentrate on doors and window sills, but we know how to do that too. That leaves lead in soil, which is tough because there's so damn much of it. The first step is to map the highest concentrations of lead in soil around the country, and we haven't even done that yet. Next we have to figure out the best way to get rid of it. There are lots of different methods, and they differ a lot in cost. You can, for example, simply haul away the top few inches of soil. That's expensive. Alternatively, there's a lot of buzz around the idea of seeding contaminated soil with phosphates, which combine with lead to produce harmless pyromorphite. This can be done using fish bones, which contain calcium phosphates. And fish bones are cheap.

But does this really work? It looks like a promising approach, but it still needs more research. Either way, though, it's nice to see a presidential candidate take lead seriously. We've been making progress on lead contamination for decades, but we've never truly made it a consistent priority. It's time to do that.

Harvard’s All-Male Club Says it Can’t Let in Women Because They’d Be Sexually Assaulted

| Wed Apr. 13, 2016 1:38 PM EDT

The elite gentlemen of the Porcellian Club, Harvard's centuries-old social club that boasts the likes of Teddy Roosevelt and the Winklevoss twins among its alumni, emerged from years of silence on Tuesday to reject the university's calls for clubs to join the 21st century and include women into its exclusive ranks.

"To the best of my knowledge, this is the first time an officer of the PC has granted an on-the-record statement to a newspaper since our founding in 1791," Charles Storey, a graduate from the class of '82 and the club's graduate board president, wrote to Harvard's student newspaper the Crimson. "This reflects both the PC's abiding interest in privacy and the importance of the situation."

Storey goes on to argue that by forcing clubs to invite female members, the change would "potentially increase, not decrease the potential for sexual misconduct"—essentially making the case that instead of broadening women's access to the benefits of these social clubs, the university's efforts could actually jeopardize a woman's safety.

"Given our policies, we are mystified as to why the current administration feels that forcing our club to accept female members would reduce the incidence of sexual assault on campus," Storey continued.

Storey isn't alone in his staunch resolve to remain stuck on the wrong side of history. Another Porcellian Club member, who wished to remain anonymous, told the Washington Post that the university's efforts would disrupt the club's intention to develop "deep male friendships."

"We don't want to be involved in anyone else's business, we just want to be left alone to carry on our 225-year traditions in peace," he noted.

Last year, a similar conflict erupted when women fought to perform in Harvard's Hasty Pudding theatrical group, which has been all-male since its founding in 1795. Despite their attempts, none of the 17 women who auditioned were accepted into the troupe.

"I want to say that it's unsettling that there will be no women on stage tonight,’’ Amy Poehler said when accepting the group's "Woman of the Year" award last January. "You know it's time for a change when the Augusta National Golf Club has lapped you in terms of being progressive."

The Wall Street Journal Cons Its Readers Yet Again

| Wed Apr. 13, 2016 1:08 PM EDT

Every once in a while I get suckered into reading a Wall Street Journal op-ed. I'm not sure why. They're all the same, after all. Today the clickbait (or is it hatebait?) was "History of a Climate Con" from Holman Jenkins:

A little history is in order to appreciate the cynical nadir of climate politics in the U.S. You wouldn’t know it from media coverage, but the closest the U.S. Congress came to passing a serious (if still ineffectual) cap-and-trade program was during the George W. Bush administration in early 2007. Then, within days of Barack Obama’s election in 2008, Al Gore announced a revelation: the “climate crisis” no longer required such unpleasant, de facto energy taxes. The problem could be solved with painless handouts to green entrepreneurs.

Hooray! Everybody loves a handout. The activist duo Michael Shellenberger and Ted Nordhaus noted that the shift in Mr. Gore’s thinking was “highly significant.” “He knows that cap-and-trade, and most any new regulation, would raise energy prices—a political nonstarter during a recession.”

A proposed oil tax swiftly disappeared from the Obama transition website. With control of all three branches of government in hand, the imminent climate threat to humanity suddenly appeared not so urgent after all—passing a “signature” health-care law did. Democrats, it turned out, were in favor of climate root canal only when Republicans were in charge.

George Bush! Who knew he was such a climate change advocate?

He wasn't, of course. The 2007 bill was introduced by Joe Lieberman and opposed by George Bush. It eventually failed to overcome a Republican filibuster and went down 48-36. There were a grand total of 7 Republicans who voted to proceed and 4 Democrats against. In other words, it failed because nearly the entire Republican Party opposed it and a handful of Democrats joined them.

Fast forward to 2010. A cap-and-trade bill supported by President Obama passes the House with strong Democratic support and nearly unanimous Republican opposition. This is the most serious cap-and-trade effort of the past decade. But in the Senate, after considerable debate, Harry Reid eventually pulls the plug because he can't find 60 votes to overcome a Republican filibuster. As in 2007, a cap-and-trade bill fails because nearly the entire Republican Party opposes it and a handful of Democrats join them. Neither the urgency of climate change nor Democratic control of the Senate had anything to do with it.

Nor did Al Gore change his mind on anything after the 2008 election. In the context of a massive recession and the promise of a stimulus bill from the Obama administration, it's true that he favored spending lots of money on incentives to fund clean energy initiatives. Why wouldn't he? However, in the same breath he maintained that "the United States should lead the way by putting a price on carbon here at home, and by leading the world’s efforts to replace the Kyoto treaty next year in Copenhagen with a more effective treaty."

I continually wonder why Wall Street Journal readers enjoy paying good money to get lied to so routinely. There's almost literally nothing true about that passage above. And yet, apparently this is what the Journal's audience craves. Why?

Donald Trump Complained to the Mayor of New York About Hot Dogs

| Wed Apr. 13, 2016 12:11 PM EDT

Donald Trump is counting on a hometown boost in Tuesday's New York primary showdown against Ted Cruz. The Texas senator has taken heat from prominent Republicans there, such as Rep. Peter King and ex-Mayor Rudy Giuliani, for his comments about "New York values" and his campaign positions. ("Any New Yorker who even thinks of voting for Ted Cruz should have their head examined," King told an interviewer last week.) When Cruz visited the Bronx, he was heckled repeatedly.

But perhaps no candidate has done more to offend the sensibilities of New Yorkers over the years than Trump, a tabloid fixture who was once sued by the Department of Justice for housing discrimination in Brooklyn and Queens and who spent $85,000 on advertisements demanding the state "bring back the death penalty" after the arrest of the (wrongfully convicted) Central Park Five.

Trump sought to use his influence in the city on more pedestrian matters, too. In a 1985 letter, Trump complained to then-Mayor Ed Koch about the blight of hot-dog vendors leaving ketchup and mustard stains on his sidewalk.

Dear Ed:

While I usually agree with your decisions and philosophy (except as they concern me), I cannot understand how you can allow once one of the truly great streets of America, Fifth Avenue, to be overrun by peddlars [sic] and food vendors. They have created such a blight that shoppers and visitors alike are appalled to see the decline of this historic avenue. Having ketchup and mustard splattered all over the sidewalk by vendors who "couldn't care less" is disgraceful. I only wish I had their political muscle—they really need it in order to keep this outrage going.

I know that you must have your reasons and also know that you won't change your mind, but it is a shame. As the filthy food carts come in, the Guccis, Jourdans, et cetera will leave, and with them both prestige and taxes will be lost to the City forever.

After signing off, he added one last shot. "P.S. The new 'act' on Fifth Avenue is the humongous vegetable stand which operates at Fifth Avenue and 57th Street," Trump wrote. "It does wonders for increasing the value of real estate on Bond Street in London and the Champs Elysses [sic] in Paris."

The correspondence with Koch was included in the personal papers of former New York Times executive editor A.M. Rosenthal at the New York Public Library.

Trump's beef with street vendors was not a one-time thing. In The Art of the Deal, his best-selling memoir, he lamented the "peddlers" who were "degrading" Fifth Avenue. "I learned a lesson from Walter Hoving," he wrote, referring to another New York developer. "I now employ some very large security people who make absolutely sure that the street in front of Trump Tower is kept clean, pristine, and free of peddlers."

Update: This was a really longstanding beef. The New York Daily News reported that Trump also complained about the Fifth Avenue food vendors in 2004 to then-Mayor Michael Bloomberg. Evidently the problem wasn't fixed.

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Here's How to Apologize to a Smart 20-Year-Old

| Wed Apr. 13, 2016 11:48 AM EDT

According to a bit of research from the Ohio State University, the best apologies contain two elements:

  • Acknowledgment of responsibility
  • Offer of repair

That's it. It's also nice—but not really necessary—to express regret, explain how you screwed up, and say you're sorry. Asking for forgiveness can be tossed in the ash can. Nobody cares.

This is good to know. However, it's also good to know that this is your typical SocSci study, conducted with some folks online and then repeated with a bunch of undergrads. So this is basically a study of what kind of apology your typical high-IQ 20-year-old appreciates most. Whether this says anything about the rest of us I couldn't say.

Feeling Hungry? Have a Deep-Fried Butter Ball.

| Wed Apr. 13, 2016 11:09 AM EDT

Nutritional research is really hard. To do it right, you need a large sample of people; you need to randomly assign them to different diets; they need to actually stick to the diet; and they have to be followed for years. In real life, this is almost impossible.

However, back in the 60s we had different ideas about how we were allowed to treat mental patients, and that led to a large-scale study of cholesterol and saturated fat at a mental institution in Minnesota. Whatever you think of the ethics of an experiment like this, it's pretty much ideal from a research point of view. The patients can be fed whatever you want; they have no choice but to stick with the diet; and physically they're fairly typical. So the study got done, and the researchers concluded that a low-fat diet was a good thing.

But it turns out the researchers were pretty dedicated to finding that result in the first place. Recently, the full results of their study were unearthed and analyzed, and it turns out their conclusions were wrong. Totally wrong:

The fuller accounting of the data indicates that the advice is, at best, unsupported by the massive trial. In fact, it appears to show just the opposite: Patients who lowered their cholesterol, presumably because of the special diet, actually suffered more heart-related deaths than those who did not.

The higher rate of mortality for patients on the special diet was most apparent among patients older than 64....“Had this research been published 40 years ago, it might have changed the trajectory of diet-heart research and recommendations” said Daisy Zamora, a researcher at UNC and a lead author of the study.

....“What this research implies is that there is not enough evidence to draw strong conclusions about the health effects of vegetable oils” Christopher Ramsden, a medical investigator at NIH and a lead author of the study, said in an interview.

Ramsden and colleagues discovered the missing data during their research examining the potentially harmful effects of linoleic acid — a key constituent of most vegetable oils — on human health.

Their paper notes that before the advent of agriculture, humans got 2 to 3 percent of their calories from linoleic acid; today most Americans, awash in cooking oils and oils added to snack foods, get much more. Preliminary research suggests a link between linoleic acid and diseases such as chronic pain, Ramsden said.

I've mentioned before that I'm semi-convinced that nutritional advice for the past half century has been wildly off base. It's quite possible that the rise in obesity and other health problems in America is due not to saturated fats, but to our enormous intake of vegetable oil. That, after all, is what's new in American diets since 1900. Before then, we barely used vegetable oil at all and we were pretty healthy. Now we use it by the tanker car and we're in pretty sad shape.

To know for sure, we need two things. First, researchers with an open mind. Second, reliable nutritional studies. Unfortunately, since forcing mental patients to be saturated-fat guinea pigs is no longer on the table, it's as hard as ever to conduct reliable studies. Still, keep in mind that the weakness of nutritional studies works both ways: all the evidence that saturated fats are bad and vegetable oil is good is pretty thin too. Go ahead and smear some butter on that toast.

The World’s Largest Coal Company Just Filed for Bankruptcy

| Wed Apr. 13, 2016 11:04 AM EDT

These are truly dark days for coal. The year started off badly for the industry when Arch Coal, the second-biggest coal producer in the United States, filed for bankruptcy. That announcement was swiftly followed by more: China said it plans to close 1,000 coal mines, US coal production dipped to its lowest level in three decades, and the Obama administration laid out plans to raise the cost coal mining on federal land.

On Wednesday, the slow and steady die-off of coal claimed its biggest victim. Peabody Energy, the world's largest coal company, filed for Chapter 11 bankruptcy protection in the US. The company won't close, but will have to reorganize and borrow new funds to pay off its existing debts. According to Reuters, the bankruptcy is the end result of crushing debt brought on by Peabody's multi-billion dollar acquisition in 2011 of a major Australian coal producer. That move was meant to offer Peabody greater access to Asian markets but, because of plummeting prices and demand, turned out to be a devastating financial burden.

Conditions at home in the US certainly didn't help. In addition to new climate change regulations from Obama that are designed to severely curtail the nation's coal consumption, coal has been getting hammered by competition from natural gas made cheap by the fracking boom. The Peabody announcement means that companies accounting for nearly half of the country's coal production have filed for bankruptcy in the current downturn, Reuters reported.

Of course, the coal industry isn't going away anytime soon:

While coal use has also stalled globally, largely because of China's economic slowdown and its efforts to protect domestic miners and rein in rampant pollution, most analysts expect consumption of the fuel to remain stable or rise in the future.

Some 500 coal-fired power stations are currently under construction, 80 percent of which are in the Asia-Pacific region, where emerging markets as well as developed economies such as Japan and South Korea are still seeing consumption grow.

In any case, the Peabody bankruptcy was quickly celebrated by environmentalists as a big win for the climate. Peabody came under fire late last year, when an investigation by the New York State Attorney General found the company had misled its shareholders about the risks climate change could pose to its bottom line.

"Perhaps if [Peabody] had spent more time and money diversifying their business rather than on lobbying against climate action and sowing the seeds of doubt about the science, they might not have joined the long (and ever growing) list of bankrupt global coal companies," 350.org co-founder Bill McKibben said in a statement.

Disturbing New Evidence About What Common Pesticides Can Do to Brains

| Wed Apr. 13, 2016 6:00 AM EDT

For defense against the fungal pathogens that attack crops—think the blight that bedeviled Irish potato fields in the 19th century—farmers turn to fungicides. They're widely sprayed on fruit, vegetable, and nut crops, and in the past decade they've become quite common in the corn and soybean fields. (See here and here for more.) But as the use of fungicides has ramped up in recent years, some scientists are starting to wonder: What are these chemicals doing to the ecosystems they touch, and to us?

A new paper in the peer-reviewed journal Nature Communications adds to a disturbing body of evidence that fungicides might be doing more than just killing fungi. For the study, a team of University of North Carolina Neuroscience Center researchers led by Mark Zylka subjected mouse cortical neuron cultures—which are similar in cellular and molecular terms to the the human brain—to 294 chemicals "commonly found in the environment and on food." The idea was to see whether any of them triggered changes that mimicked patterns found in brain samples from people with autism, advanced age, and neurodegenerative diseases like Alzheimer's.

"What's most disturbing to me is that we've allowed these chemicals to be widely used without  knowing more about their potential effects."

Eight chemicals fit the bill, the researchers found. Of them, the two most widely used are from a relatively new class of fungicides called "quinone outside inhibitors," which have surged in use since being introduced in US farm fields in the early 2000s: pyraclostrobin and trifloxystrobin.

Now, it's important to note, Zylka told me in an interview, that in vitro research like the kind his team conducted for this study is only the first step in determining whether a chemical poses risk to people. The project identified chemicals that can cause harm to brain cells in a lab setting, but it did not establish that they harm human brains as they're currently used. Nailing that down will involve careful epidemiological studies, Zylka said: Scientists will have to track populations that have been exposed to the chemicals—say, farm workers—to see if they show a heightened propensity for brain disorders, and they'll have to test people who eat foods with residues of suspect chemicals to see if those chemicals show up in their bodies at significant levels. 

That work remains to be done, Zylka said. "What's most disturbing to me is that we've allowed these chemicals to be widely used, widely found on food and in the environment, without knowing more about their potential effects," he said.

How widely are they used? The paper points to US Geological Survey data for pyraclostrobin, a fungicide that landed on the UNC team's list of chemicals that trigger "changes in vitro that are similar to those seen in brain samples from humans with autism, advanced age and neurodegeneration." It's marketed by the German chemical giant BASF's US unit under the brand name Headline, for use on corn, soybeans, citrus fruit, dried beans, and more. BASF calls Headline the "nation's leading fungicide." The USGS chart below shows just how rapidly it has become a blockbuster on US farm fields.

Use of pyraclostrobin in the United States has spiked since 2002.

 

Then there's trifloxystrobin, which also made the UNC team's list. Marketed by another German chemical giant, Bayer, trifloxystrobin, too, boasts an impressive USGS chart, reproduced below.

US Trifloxystrobin use has boomed since 1999. USGS

 

In an emailed statement, a BASF spokeswoman wrote that cell tissue studies like Zylka's "have not demonstrated relevance compared with results from studies conducted on [live] animals." She added, "While the study adds to the debate of some scientific questions, it provides no evidence that the chemicals contribute to the development of some diseases of the central nervous system. This publication has no impact on the established safety of pyraclostrobin when used according to label instructions in agricultural settings." A Bayer spokesman told me that the company's scientists are looking into the Zylka study and "don't have any initial feedback to offer right now." He added that "our products are rigorously tested and their safety and efficacy is our focus."

As Zylka's team points out, both of these chemicals turn up on food samples in the US Department of Agriculture's routine testing program. Pyraclostrobin residues, according to USDA data compiled by Pesticide Action Network, have been found on spinach, kale, and grapes, among other foods, in recent years, while trifloxystrobin has been detected on grapes, cherry tomatoes, and sweet bell peppers. Again, there hasn't been sufficient research to establish whether these traces are causing us harm, Zylka stressed, but since they are entering our bodies through food, he thinks more research is imperative.

Meanwhile, a disturbing picture of the ecosystem impacts is emerging. These same chemicals also leave the farm via water. A 2012 US Geological Survey study found pyraclostrobin in 40 percent of streams in three farming-intensive areas. In another 2012 USGS study, researchers looked for a variety of pesticides in the bed sediments of ponds located within amphibian habitats in California, Colorado, Georgia, Idaho, Louisiana, Maine, and Oregon. Pyraclostrobin was the most frequently detected chemical of all, turning up in more than 40 percent of tested sites.

Pyraclostrobin turned up in 40 percent of streams in three farming-intensive areas.

Studies suggest that as the fungicides leach out into the larger environment, they're harmful to more than just fungi. Oklahoma State researchers found BASF's pyraclostrobin-based fungicide Headline deadly to tadpoles at levels frequently encountered in ponds. And a 2013 study by German and Swiss researchers found that frogs sprayed with Headline at the rate recommended on the label die within an hour—a stunning result for a chemical meant to kill funguses, not frogs. I wrote about the study when it came out. "These studies were performed under unrealistic laboratory conditions," a BASF spokeswoman told me at the time. "The study design neither reflects conditions of realistic agricultural use in practice nor the natural behavior of the animals."

Then there are honeybees. In a 2013 study, a team of USDA researchers found pyraclostrobin and several other fungicides and insecticides in the pollen of beehives placed near farm fields—and that bees fed pyraclostrobin-laced pollen were nearly three times more likely to die from common gut pathogen called Nosema ceranae than the unexposed control group (more here).

Meanwhile, the industry is enthusiastically marketing these products. "Headline fungicide helps growers control diseases and improve overall Plant Health. That means potentially higher yields, better ROI and, ultimately, better profits," BASF''s website states. "It can help secure a family's future, fund a college education, finance an equipment upgrade, or maybe buy just a bit more of a vacation for the whole family." Such supposed benefits aside, I wish we knew more about the environmental and public-health costs of these increasingly ubiquitous chemicals.