Healthcare and Bankruptcy

Last night I linked to story about a new study showing that medical bills contributed to 62% of all personal bankruptcies in 2007.  According to the authors, that's up 50% from 2001, once you adjust the numbers to compare apples to apples.

Megan McArdle is skeptical.  Objection 1: could slowly but steadily rising healthcare costs really cause such a huge increase in the bankruptcy stats in just six years?  It's hard to say without more data, but it sounds plausible to me given the fact that bankruptcies are outliers to begin with.  Objection 2: other studies have come to different conclusions.  That's addressed here.  Objection 3: why do the subjects of the study themselves self-report at different levels?  That's also addressed here.

But this is all just throat clearing.  Megan's real objection is this:

[Elizabeth] Warren and her co-authors have obscured important and obvious facts that call the integrity of the work into serious question.

....What Warren et. al. neglect to mention is that bankruptcies fell between 2001 and 2007.  In fact, they were cut in half.  Going by the numbers Warren et. al. provide, medical bankruptcies actually fell by almost 220,000 between 2001 and 2007, a fact that they not only fail to mention, but deliberately obscure.

Are Warren, et. al. unaware that bankruptcies fell by half?  No bankruptcy analyst could possibly be unaware of this fact; it has been the most talked-about phenomenon in the bankruptcy area since the 2005 law was passed.

....What's left out here?  That in 2001, 1.45 million households filed for bankruptcy.  In 2007, that number was 727,167.   Had their paper done the basic arithmetic, readers would easily have seen that their own numbers imply a decrease in medical bankruptcies, from about 750,000 to slightly over 500,000.  Yet their paper does not merely ignore this fact; it uses language that seems deliberately designed to conceal it.  I invite any of my readers to scan the paper for any hint that medical bankruptcies had fallen significantly over 6 years.

For my money, this is an important point that should have been addressed directly in the study.  At the same time, it's not clear that it's nearly as sinister as Megan suggests.  If I move out the fences in every baseball stadium in the country, the fact that fewer home runs are hit at Dodger Stadium isn't very interesting.  What is interesting is whether the proportion of home runs per at-bat goes up or down at Dodger Stadium more than it does elsewhere.

Likewise, the authors of the bankruptcy study faced a change in the law that affected all bankruptcies and made it impossible to compare raw numbers. The fences had been moved out, and a large number of people who once would have declared bankruptcy because of, say, a $20,000 medical bill, couldn't do so anymore.  Naturally the absolute number of medical bankruptcies went down, but that doesn't really tell us much.

It's impossible to say anything with certainty since the change in the law was so sweeping, but other data in the study suggests that bankruptcies with a medical component are similar to the overall population of bankruptcies, both demographically and otherwise.  They aren't systematically either better or worse off than average.  This in turn suggests that if you compare the better-off half and the worst-off half of all pre-2005 bankruptcy filers, their medical components probably matched pretty closely.

Why do we care?  Because bankruptcy filings after 2005, when the law made it harder to file, were probably similar to the worst-off half of the pre-2005 bankruptcy filings.  This means the group in the 2007 study is probably similar to the worst-off half of the group in the 2001 study — which makes a direct comparison impossible.  However, since the proportion of medical bankruptcies in that group likely mirrors the proportion in the entire pre-2005 population, it means that if the law hadn't changed and the total population of bankruptcies had stayed large, the proportion of medical bankruptcies probably still would have increased.  This is all very rough and tentative, and better data would be helpful.  Still, even though I agree that this is something the authors should have addressed head on, they probably did about as well as they could with the hand they were dealt.

What Will People Do For Free?

Barron YoungSmith remarks on the fact that Craigslist actively avoids making a profit:

As Paul Starr has explained, newspapers only flourished during the past few centuries because they functioned as intermediaries between readers and advertisers — fundamentally, they survived because they were institutions that stood between people.

Now, along comes Craigslist, which sees cutting these sorts of intermediaries out of the equation as a form of public service. It considers that mission so important that it is willing to forego huge potential profits and compete against classified pages everywhere while charging virtually nothing for what it offers. In that kind of environment, it's pretty ludicrous to think that newspapers could survive.

Probably so.  Especially since Craigslist works better than newspaper classified advertising.  I've got some old darkroom equipment that's been sitting in my garage for ages, and if I had to go through the hassle of taking out a newspaper classified ad to sell it, it would still be there.  But last night at about 6 pm I suddenly decided to advertise it on Craigslist.  Two hours later I got a response from a guy in Long Beach.  This morning he came by, took a look at the whole setup, and hauled everything off.  I'm a few dollars richer, he's excited at the prospect of setting up a darkroom, and the whole transaction took less than 24 hours.  Amazing.

(Also amazing: using a darkroom must be like riding a bicycle.  You remember how to do it forever.  It's been 20 years since I used this stuff, but as I was showing him how to operate everything and what all the various parts were for, I realized I hadn't forgotten a thing.  I could have set up the entire kit, mixed up the chemicals, and been back in business in an hour.  I can't really think of anything else from so far in my past that I can say that about.)

Anyway: Ten years ago, I remember ruminating over the open source movement and wondering what its limits were.  What kind of stuff would people do for free, and what kind of stuff wouldn't they?  Since open source software is mostly produced by obsessive nerds, the obvious answer is that they'll work for free on the kind of things that obsessive nerds themselves like to use: operating systems, editors, compilers, etc.  Then, at the other end of the spectrum, you have, say, the firmware for controlling GM's assembly line robots.  Nobody in their right mind would do that for free.

But where's the line?  The interesting answer is: if it's the kind of thing that one person (or a small set of people) can do, then it's wherever one competent person draws it.  I'd guess that very few people feel that classified advertising (!) is so important to a vibrant society that they want to dedicate their lives to making it available for free, but it turned out that it didn't take very many people.  Just one guy named Craig.

So now I think about this stuff a little differently.  Sure, some things are just more fun than others, and thus more likely to attract people to do them for free.  But just as important is: how many people does it take?  Once something gets to the point where it only takes a person or three to do it, then there's a pretty good chance that someone, somewhere will start offering it for free.  Even if it's something that most sane people think is boring as hell, there's almost bound to be at least one person who's obsessed by it.  Like classified advertising.

Estrogen Kills Fish

Estrogen is bad for fish. In more ways than we thought.

We know that estrogen and estrogen-mimicking chemicals known as endocrine disruptors cause intersex fish—that is, males with immature female egg cells in their testes.

New research finds that fish exposed to estrogen produce less immune-related proteins, making them more susceptible to disease. This suggests why fish in the Shenandoah and Potomac Rivers are simultaneously afflicted by mass kills, lesions, and intersex fish.

US Geological Survey researchers suspected that estrogens were causing fish kills and fish lesions as well as intersex fish in the two river systems. So they exposed largemouth bass to estrogen and found the fish produced less hepcidin—an iron-regulating hormone of mammals, fish, and amphibians.

Exactly what hepcidin does to boost immune systems is unclear. But it may act as an antimicrobial peptide, the first line of defense against disease-causing bacteria, fungi, and viruses. Or it might affect the iron balance in infected vertebrates. Or both.

We do know we're loosing megatons of synthetic chemicals into waterways every year. Most are plastics additives, surfactants, birth control agents, antimicrobials, pharmaceuticals, personal care products, or controls for insect, weed, and fungal populations.

But all too many wind their way from industry, livestock, irrigation, sewage, and storm run-off into lakes, ponds, oceans, marshes, streams, rivers, and groundwater—eventually into fish.

And from there into humans, perhaps accounting for the alarming rise of human male reproductive disorders in recent years, including birth defects of the penis, undescended testes, reduced sperm production, and testicular cancer.

You think that might slow down the chemical pipeline. Especially in rivers so close to Washington, DC. But apparently money is worth more than masculinity.
 

USNWR: Clemson Can't Fool Us

Earlier today, Clemson University tried desperately to save face by claiming it had not tried to manipulate the U.S. News and World Report ranking system after all. Now, USNWR's trying to unsully its own reputation by saying it's up to Clemson's tricks, particularly the one where they rate other universities lower than themselves on the reputation survey:

In terms of the reputation survey, U.S. News has safeguards in place to prevent strategic voting from affecting the results. We subtract a few of the highest and lowest scores from respondents before the results are calculated in order to prevent downgrading or upgrading from altering the results. We are confident that such voting practices by respondents are not affecting the results of the reputation survey in any meaningful statistical way.

But Inside Higher Ed quoted Catherine Watt, Clemson's director of institutional research, as saying everyone cheats on the reputation surveys:

And to actual gasps from some members of the audience, Watt said that Clemson officials, in filling out the reputational survey form for presidents, rate "all programs other than Clemson below average," to make the university look better. "And I'm confident my president is not the only one who does that," Watt said.

If everyone does it, then simply throwing out the highs and lows won't fix the problem, right?

Update: Could the Clemson scandal kill USNWR?

The Appearance of Corruption

Still don't believe that money buys results in Washington? Take a look at this chart from the Sunlight Foundation. This is what Larry Lessig and Change Congress are talking about when they talk about "the appearance of corruption":

Since Monday, the Brazilian navy and air force have been focused on finding what's left of Air France Flight 447. But in trying to get government officials to comment on the crash, I've been met with only one answer: According to international regulations, it is France’s responsibility to determine the cause of the accident, not Brazil's. Was it caused by the storm? An equipment problem? Answering that is France’s job, Brazilian officials repeat over and over again.

Frustratingly, France doesn’t have any leads either. Air France has ruled out the possibility of the plane having left Rio with some kind of technical problem. Other than that, there seems to be no information. The black boxes could be as far as three miles down into the water, in an area full of rock formations and subject to unpredictable weather. The head of France’s accident investigation agency Paul-Louis Arslanian says they may never be found.

But the optimistic Brazilian president Luiz Inacio Lula da Silva disagrees. “A country that can find petroleum at a depth of six thousand meters (3.7 miles) can find an airplane at two thousand meters (1.2 miles),” he said from Guatemala City.

Let's hope he's right.

Guest contributor Gabriela Lessa is a journalist and blogger spending the summer in her native Brazil. Watch for her regular dispatches over the next few months on MotherJones.com.

 

More Smoke and Mirrors from the GOP

Today House Republican leaders proposed a bold new plan to save $375 billion over the next five years.  So what did they come up with?

Well, according to this document, $317 billion comes from every budget coward's favorite gimmick: an across-the-board spending cap that (a) they know perfectly well will never happen and (b) allows them to avoid mentioning any actual specific cuts.  Another $45 billion comes from devoting returned TARP funds to deficit reduction — something that's going to happen over the next five years anyway.  That leaves $13 billion in actual targeted cuts.  For the arithmetic challenged among you, that's $2.6 billion per year out of a budget of about $3.5 trillion.

That's a reduction of 0.07%.

Every little bit helps, I guess, but for a bunch of fiscal watchdogs they seem curiously unable to find very much in the way of actual wasteful programs that they're willing to stand up and take some lumps for opposing.  Instead it's just the usual smoke and mirrors.  How tedious.

UPDATE: Actually, looking at this more carefully, something doesn't add up.  The GOP brain trust claims to save $317 billion from the cap, $45 billion from TARP, and about $25 billion in targeted cuts.  But that comes to $387 billion, not $375 billion.  So I guess they can't add either.

Still, if the targeted numbers are correct, they're proposing cuts of 0.14%, not 0.07%. I'll leave it up to you to decide if you're impressed by their budget slashing bona fides.

Yesterday, we reported on Clemson University's basically admitting that it manipulates U.S. News and World Report's college rankings. Now, the university has done an about face and denied any pandering, calling the accusations "outrageous" and "untrue." From a statement issued by Clemson today:

 

Geithner Plan is Dead

The New York Times reports that Tim Geithner's plan to buy up toxic assets from the banking system is dead.  Basically, even at the subsidized prices the program would have offered them, banks weren't willing to sell because it would have forced them to recognize big losses, and recognizing big losses would have been bad.  Ezra Klein comments:

There are two ways of understanding what happened here. The first is that banks couldn't sell their assets at current prices because doing so would have rendered them effectively insolvent. In this scenario, PPIP fails to fulfill its intended function: Saving the banks. The toxic assets survive and the banking system remains hollow and unhealthy.

The second is that banks no longer need to rush their troubled assets off their books because they're increasingly able to raise private capital, operate in a restored financial market, and wait out the last vestiges of the storm. They can, in this world, let the value of the assets rise naturally, and sell them off later. In this scenario, PPIP is no longer necessary.

I'll take door #1.  It's at least arguable that the banks were justified in not wanting to sell toxic securities at the fire sale prices on offer from vulture funds and others.  But Geithner's plan would have offered them considerably more than that — and they're still unwilling to sell.  That means they're completely dedicated to the proposition that all their mortgage-backed junk is worth exactly what they say it's worth.

Maybe this will work out in the end.  But history suggests that we'd all be better off if banks were forced to honestly account for their losses, take their lumps, and then move on.  Instead, Geithner's stress tests have persuaded everyone that things are fine and losses on these securities aren't as bad as everyone thinks.  Maybe so.  But if Geithner and the banks are wrong, doing it this way is likely to drag the pain out over years, producing a long period of sluggish semi-recovery and slow, fragile growth.

That's basically my fear at this point.  I sure hope Geithner knows what he's doing.

Chevron or Chevwrong?

If you believe Chevron's ubiquitous ad campaign, it's an icon of corporate responsibility. According to environmental and human rights groups…not so much.

Organizations including CorpWatch, Global Exchange, and EarthRights International released "The True Cost of Chevron: An Alternative Annual Report" last week. And not surprisingly, it tells a different story than the oil giant. To wit: