Chipping Humans

To paraphrase Franklin, the person who would sacrifice liberty for safety will have neither.

We put microchips in pets so we can locate them. We can attach chips to keys so we know where they are.

Now a company in Wisconsin is microchipping employees.

At this point, the employees are volunteers and the benefits for doing this  include:

• Ease of accessing computers,
• Ease of access to secure areas, and
• Making purchases and vending machines using the chips.

The drawbacks?

• The employer can know where the  employee is 24×7. Spend too long at lunch? The company will know. Privacy? Forgetaboutit.
• The technology represents another level of electronic radiation exposure, and we don’t know about the long term effects of that.

The chips are tiny and can be injected under the skin with a syringe developed by a Swedish firm.

Obviously, the manufacturer wants to see this technology in widespread use.

“Eventually, this technology will become standardized allowing you to use this as your passport, public transit, all purchasing opportunities,” and more . . . . (2)

It’s easy to see where this is going. We can expect a push to implant chips in children, hospital patients and the elderly. That would make kidnapping obsolete and reduce medical errors. It also would make it easy to locate lost hikers and wandering dementia victims. However, it would also mean that with two generations, virtually the entire population would be chipped. Go to a political rally or demonstration? People will know where you are. Criminals will be able to know when a home is empty or when someone is visiting a bank or ATM. Of course, the police will be able to identify and locate the person who robs you.

Further, chips aren’t secure. Any technology can be reversed engineered — meaning that you could create a chip with someone else’s code and use it in a crime.

How do you feel about being chipped?

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Sources:

1. Megan Trimble, “Wisconsin tech company to implant microchips in employees,” USNews, 24 July 2017. https://www.aol.com/article/finance/2017/07/24/wisconsin-tech-company-to-implant-microchips-in-employees/23045620/?brand=finance&ncid=txtlnkusaolp00002412
2. Angela Moscaritolo, “Wisconsin Company to Microchip Employees,” CNET, 24 July 2017. https://www.pcmag.com/news/355140/wisconsin-company-to-microchip-employees?utm_source=email&utm_campaign=dailynews&utm_medium=title

 

Air Pollution and Life Expectancy

A new study led by Prof. Mikael Skou Andersen of Aarhus University in Denmark finds that an increase of 10 micrograms per cubic meter in air pollution reduces an individual’s life expectancy by between 9 and 11 years. This is more than previously thought, although there is a debate about the “economic value” of those years.(1)

“Economic value” translates into an estimate of the amount of spending that is economically justified to reduce air pollution.  While life itself might have infinite value, no one wants to spend infinite money to preserve it. So we try to define how much money value there is in living to 90 as opposed to dying at 79. Under the theory, spending less than that money value to reduce air pollution is justified; spending more isn’t.

The challenge is that the European Union has set standards for air pollution reduction that some of its members are going to have difficulty meeting.

Needless to say, the European standards are more stringent than those in the US.

US rules:  The US has standards for two types of particulate matter air pollution:

• PM₁₀ : inhalable particles, with diameters that are generally 10 micrometers and smaller. Maximum of 150 micrograms per cubic meter of air in any 24 hour period. This may be exceeded once per year on average over a three year period.
• PM_2.5 : fine inhalable particles, with diameters that are generally 2.5 micrometers and smaller.(2) While the goal is 12 micrograms per cubic meter of air, there may be readings of up to 35 micrograms per cubic meter in any 24 hour period.(3)

European rules:

• PM₁₀: 40 micrograms per cubic meter of air, although there may be readings of up to 50 micrograms in any 24 hour period.
• PM_2.5 : 25 micrograms per cubic meter, no exceptions.

The difference in standards between the US and Europe exceeds the amount required to reduce life expectancy in Professor Andersen’s study. Life expectancy is greater in Europe than in the US. The residents of Monaco have a life expectancy that exceeds everyone else on Earth, and exceeds the US by more than 10 years.

What is 10 years of your life worth to you? Air pollution is yet another factor inflating US healthcare costs and the costs of your health insurance.

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Sources:

1. Mikael Skou Andersen. Co-benefits of climate mitigation: Counting statistical lives or life-years? Ecological Indicators, 2017; 79: 11 DOI: 10.1016/j.ecolind.2017.03.051
2. US Environmental Protection Agency, “Particulate Matter Pollution.” https://www.epa.gov/pm-pollution/particulate-matter-pm-basics
3. US EPA, “NAAQS Table.” https://www.epa.gov/criteria-air-pollutants/naaqs-table
4. European Commission, “Air Quality Standards.” http://ec.europa.eu/environment/air/quality/standards.htm

ACA Repeal: The Latest

The Senate proposal is out. The proposed law is 142 pages of (perhaps unnecessary) complexity, and, given the rushed nature, probable errors. But it’s out.

It’s not out in time to prevent damage for 2018.

• Withdrawal of insurers: Aetna notified agents that it will be withdrawing from individual markets in 18 states. Notices to policy holders will be sent on or about July 1st. Other firms have announced withdrawals from a few states, most particularly Iowa and Indiana.
• Heavy rate increases: Insurers in the individual market in Virgina have asked for a 30% rate increase for 2018, based on uncertainty about whether the Federal government will continue subsidies for health insurance. Insurers in NY State have asked for a 16.6% increase. Most other states will be in that range.

The proposal represents a mixed signal for consumers.

• Pre-existing conditions: The Senate version conforms with the House version in requiring insurers to cover people with pre-existing conditions. HOWEVER . . .
• Coverage: States can apply for waivers allowing insurers to reduce the coverage they provide. Services required by people with pre-existing conditions may not be covered.
• Medicaid: The bill supports a contraction of Federal Medicaid funding, but delays the start of cutbacks until 2021. The House version started cuts in 2020, an election year. The Senate version of the cuts are later and deeper.
  • The Medicaid expansion was an increase of the income limit for eligibility from 100% of poverty level to 138%.
  • Under the Senate version people making more than 100% of poverty level would be prevented from enrolling in Medicaid starting in 2020.
  • All Federal funding for the expansion would be limited in 2023.
  • The impact on the Medicaid program for children, CHIP, is unclear at this time.
  • Inflation adjustments for Medicaid funding would be changed from an index based on medical costs to the overall Consumer Price Index (CPI), which would reduce annual increases in funding in all future years. (See graph.) (4) The focus of this change is strictly on reducing Federal spending, not helping consumers. Federal payments would lag behind increases in medical costs — who pays the difference?
• Tax credits to help pay for insurance: The House version based subsidies on age; the Senate version reverts to income as the basis, consistent with the existing ACA rules. However,
  • The Senate version reduces the maximum income eligible for these subsidies, making some people now receiving subsidies ineligible for them in the future. On low low end, the Senate version makes subsidies available for people earning below below poverty level who might not be eligible for Medicaid in their state. The Senate version maintains cost-sharing subsidies for insurers through 2019.
  • The Senate version reduces the amount of subsidy people receive, increasing out of pocket costs for everyone, and especially for those between age 50 and 64.
• Planned Parenthood: Both House and Senate versions remove funding for Planned Parenthood.
• Tax reductions for affluent households: The Senate and House versions are in agreement on this; the reductions remain intact.
• Individual mandate: Penalties for not having insurance are eliminated.

Sticking points:

• For conservatives: Treating healthcare as a human right. They would rather see the ACA eliminated without replacement.
• For moderates and those in competitive districts

Collateral damage:

• Insurance coverage: There’s a debate as to how many people will not have insurance coverage with this law.  Estimates vary between 13 and 23 million.  The reasons for the variance in estimates include:
  • Time frame — loss of coverage will build over time as insurance costs increase and subsidies don’t.
  • Medicaid — how many people will lose coverage under Medicaid. That impacts more people than you would expect. Most people don’t have Long Term Care insurance, and Medicaid has become the prime vehicle for paying for home health aides and nursing home costs. Since nursing home costs average nationally more than $9,000 per month and Medicare pays for only the first 100 days, there are a lot of middle income families that will be in trouble. Even some moderately affluent families will be affected, and the poor . . . forget about it.
• Tax increases: Healthcare for the uninsured will fall back on emergency rooms, largely of public hospitals. That will drive costs and budget increases and increases in local taxes. Tax savings for the rich will mean tax increases for everyone else.
• Economic stagnation: The US is a consumer economy. I’ve argued previously that money siphoned from consumers for education, housing and healthcare is money they can’t spend for anything else. One analyst sees 1.1 million jobs disappearing by 2020 with passage of the AHCA. (3)

 

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Sources:

1. M. J. Lee, Tami Luhby, Lauren Fox, Phil Mattingley, “Senate GOP finally unveils secret health care bill; currently lacks votes to pass,” CNN, 22 June 2017. http://www.cnn.com/2017/06/22/politics/senate-health-care-bill/index.html
2. Stephanie Armour, Kristina Peterson and Louise Radnofsky, “Battle Lines Drawn on Health Care,” The Wall Street Journal, 23 June 2017, P. A1.
3. Josh Bivens, “Millions of people have a lot to lose under the AHCA,” Economic Policy Institute, 21 June 2017. http://www.epi.org/publication/millions-of-people-have-a-lot-to-lose-under-the-ahca/?utm_source=Economic+Policy+Institute&utm_campaign=50e819bfcb-EMAIL_CAMPAIGN_2017_06_23&utm_medium=email&utm_term=0_e7c5826c50-50e819bfcb-58834721&mc_cid=50e819bfcb&mc_eid=0541ad0f29
4. Federal Reserve Bank of St. Louis, Economic Research. Chart downloaded 25 June 2017. https://fred.stlouisfed.org/graph/?id=CPIMEDSL,
5. Bob Bryan, “Unveiled: The Secret Senate Healthcare bill,” Business Insider, 22 June 2017. http://www.businessinsider.com/senate-healthcare-bill-trumpcare-ahca-details-2017-6

A Different Perspective on Mexico

The monologue on Mexico focuses on those crossing the border into the US. In fact, that’s a very narrow view of the relationship between the two countries.

According to the State Department, there are one million US citizens living in Mexico. However,

• That figure was first reported in 2014. The number has been increasing since. The US government doesn’t  track residents living out of the country as long as they pay their taxes.
  • One US expat realtor reports a 40% increase in home sales in one US expat enclave just in the last year.
  • A commentator in The Guardian estimates the number of Americans living in Mexico as closer  to two million.
• A number of the US citizens living in Mexico aren’t there legally (estimates vary from 50 to 90 percent). The Mexican government isn’t particularly good about tracking them, and doesn’t deport them. In fact, Mexico abolished a mandatory prison sentence for undocumented immigrants in 2008. Those who have not committed a crime are simply allowed to stay.

CNN reports that there are four reasons that Americans give for moving to Mexico:

• Climate
• Culture
• Cost of living
• Escaping the US political climate

One American comments that doctors in Mexico are more helpful and enjoyable to visit than are doctors in the US.

It’s cheap. It’s very patient-oriented. It’s like my father practiced in Illinois about 50 years ago, without all the paperwork.

Many Americans, including some in Congress, view Mexico through the prism of an out-dated stereotype. Of course, if that changes, more Americans might move there.

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Sources:

1. Instituto Nacional de Estadística y Geografíca. http://www.inegi.org.mx/\
2. Adam Taylor, “Mexico has its own immigration problem: American retirees,” The Washington Post, 21 November 2014. https://www.washingtonpost.com/news/worldviews/wp/2014/11/21/mexico-has-its-own-immigration-problem-american-retirees/?utm_term=.dc11626a341f
3. Leyla Santiago and Traci Tamura, “South of the border, US expats have a different take on Mexico,” CNN 24 June 2017.  http://www.cnn.com/2017/06/24/americas/mexico-american-expats/index.html
4. “News Report: 91.2% of All Americans Who Live in Mexico Are Living There Illegally,” Latino Rebels, 5 March 2017. http://www.latinorebels.com/2017/03/05/news-report-91-2-of-all-americans-who-live-in-mexico-are-living-there-illegally/
5. Aristóteles Sandoval Díaz, “Millions of Americans live in Mexico. Can we continue to coexist?” The Guardian, 23 January 2017. https://www.theguardian.com/commentisfree/2017/jan/23/trump-futures-mexico-us-interlocked-wall-border

Parenting and Risky Sexual Behavior in Teens

It may sound obvious, but parents matter. Both parents matter.

However, when it comes to risky sexual behavior in teen daughters, the spotlight is on the father.

A new study from the University of Utah relates the “quality of fathering” with teen behavior.

• High quality fathering is associated with setting standards for behavior and consistent monitoring of how the teen spends her time and money. It affects with whom the teen associates and reduces the likelihood of risky behavior.
• Low quality fathering does just the opposite.

The study strongly suggests that having a low quality father out of the home may be better for daughters than keeping the family intact.

The study may in fact underestimate the negative effects of low quality fathering. In some cases, parents or other family members are the source of risky behavior.

According to an The Atlantic article from 2013,

One in three-to-four girls, and one in five-to-seven boys are sexually abused before they turn 18, an overwhelming incidence of which happens within the family. These statistics are well known among industry professionals, who are often quick to add, “and this is a notoriously underreported crime.” (2)

Another review of the research literature suggests a 40% rate of molestation among girls and 30% among boys in the US. (4) In all cases, the figures are subject to some disagreement about definitions.

For those of us who know victims  of family abuse, this incidence is quite plausible. In my own conversations, I’ve been flabbergasted by the people who reveal histories of abuse — people I would never have suspected. It comes out in conversations after a certain level of trust is in place. And it surfaces too many times with too many people.

Ultimately, the statistics we have are unreliable, because too many people won’t talk about this. The statistics are incomplete, as they tend to focus on father-daughter abuse and not on mother-son or sibling relations (or on abuse by authority figures other than priests).

Traditional studies have focused on “broken” families and the importance of having two parents in the home. The truth seems to be a bit more complex. There are many cases in which the “intact” family is broken and dysfunctional, and breakup represents improvement.

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Sources:

1. Danielle J. DelPriore, Gabriel L. Schlomer, Bruce J. Ellis. Impact of Fathers on Parental Monitoring of Daughters and Their Affiliation With Sexually Promiscuous Peers: A Genetically and Environmentally Controlled Sibling Study. Developmental Psychology, 2017; DOI: 10.1037/dev0000327
2. Mia Fontaine, “America Has an Incest Problem,” The Atlantic, 24 January 2013. https://www.theatlantic.com/national/archive/2013/01/america-has-an-incest-problem/272459/
3. Margaret Ballantine and Lynne Soine, “Sibling Sexual Abuse — Uncovering the Secret,” Social Work Today Vol. 12 No. 6 P. 18. http://www.socialworktoday.com/archive/111312p18.shtml
4. Rational Skepticism.org. “Just how common is incest?” 11 July 2010. http://www.rationalskepticism.org/social-sciences/just-how-common-is-incest-t9841.html

ACA Repeal: Update

I’ve been quiet about the recent AHCA legislation. Frankly, the House bill isn’t good for most Americans, but the assumption is that the Senate will heavily revise the bill before it has a chance for passage. So it’s hard to say what the final legislation will be at this point.

Then it goes to conference committee and the result will return to each chamber for a vote.  So this is a long way from being done.

There are a number of articles enumerating the problems in the House bill. The major issues are

• Loss of health insurance for millions of Americans
• Impact on the solvency of hospitals and clinics serving rural areas — where most of the poor live
• Reductions in Medicaid coverage, especially for children
• Allowing states to reduce coverage standards in insurance (depart from the ACA’s Minimum Essential standards) — reducing what the insurance buyer gets for their money
• Raising costs drastically for consumers between the ages of 50 and 64 (1)

With all of these issues, we are still expecting the repeal bill to result in sharply higher premiums for health insurance.

The only positives in this bill are tax reductions for the wealthy.

My major concern is with health screening and checkups. The ACA recognized that the main way to reduce health care expenditures is through early detection and treatment of disease. Removing access to doctors means later detection and much higher costs.

Example: breast cancer, cost of treatment by tumor stage

Stage

0                                         $71,909

I/II                                      $97,066

III                                      $159,442

IV                                      $182,655 (2)

Reduction is access to health care is a commitment to higher medical spending or to reduction of life expectancy.

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Sources:

1. Harris Meyer, “15 quick facts from CBO report on Obamacare repeal bill,” Modern Healthcare, 24 May 2017. http://www.modernhealthcare.com/article/20170524/NEWS/170529946?utm_source=modernhealthcare&utm_medium=email&utm_content=20170524-NEWS-170529946&utm_campaign=mh-alert
2. Helen Blumen, Kathryn Fitch, Vincent Polkus, “Comparison of Treatment Costs for Breast Cancer, by Tumor Stage and Type of Service,” Am Health Drug Benefits. 2016 Feb; 9(1): 23–32.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822976/

Bullying and Depression

A new study from researchers at the University of Delaware shows links between victimization and depression, and subsequent smoking and alcohol abuse.

The study involved 4,297 students from Birmingham, Houston and Los Angeles, following their journeys from 5th through 10th grade.

The findings: Children who were bullied in 5th grade are more likely to show symptoms of depression in 7th grade and to be users of alcohol, tobacco and marijuana by 10th grade. It seems to be a simple and direct causal relationship, and shows that victimization as a child has lasting impact.

My read of the article is that while bullying has to stop, victims need help. Victims may be reluctant to identify themselves. Parents and caregivers need to practice active surveillance, and not assume that all is well. Assumptions can kill.

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Sources:

1. Valerie A. Earnshaw, Marc N. Elliott, Sari L. Reisner, Sylvie Mrug, Michael Windle, Susan Tortolero Emery, Melissa F. Peskin, Mark A. Schuster. Peer Victimization, Depressive Symptoms, and Substance Use: A Longitudinal Analysis. Pediatrics, 2017
2. University of Delaware. “Bullying’s lasting impact: Peer victimization in fifth grade increases health risks a few years after the incidents.” ScienceDaily. ScienceDaily, 8 May 2017. <www.sciencedaily.com/releases/2017/05/170508144650.htm>