Immigration and the New American Reality

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“I don’t want my child to grow up in the US.”

That’s a simple and direct statement from a financial professional who moved to Europe earlier this year. Her child will grow up learning between four and six languages and without the attitude/belligerence she sees in US schools. Plus college and healthcare are free.

Europeans pay high taxes. However, because so many expenses are included in those taxes, they have more money available to spend than most Americans do. That’s driving a faster economic recover in Europe than the US is seeing.

That prompted me to look at the data on migration. What are the trends? You might be surprised.

  1. Both legal and illegal immigration peaked prior to the recession in late 2008. The trends since are downward. The declines started during the Obama administration.
    • The illegal immigrant population peaked at 12.2 million in 2007.(2)
  2. Most illegal immigrants living in the US have been in the US for more than ten years. They are homeowners and taxpayers.
  3. Mexico no longer accounts for a majority of illegal immigrants. The majority now from from a combination of Central America and Asia.
  4. Mexico provides the largest number of LEGAL immigrants to the US. (1) Most Hispanic residents in the US are legal residents. (3)
  5. Recent immigrants from Mexico tend to work in the US for a few years and then return to Mexico. Pew reported in 2012 that net immigration from Mexico was zero, with the number of people leaving the US matching the number entering.
    • This “breakeven” has little to do with US immigration enforcement. People are leaving for a lower cost of living and better social services.

FT_17.04.17_unauthorized_update_2015-1The State Department estimates that 9 million US (non-military) citizens are now residents of other countries. That’s up from 4 million in 1999. However, the government has no formal mechanism for tracking citizens who move overseas. The actual number could be lower or much higher.

  • Seniors are part of the out-migration. Financial advisors recommend considering moves to places like Costa Rica in order to be able to maintain a reasonable standard of living on Medicare. (5)

The US is changing relative to other countries. There are a growing number of valid reasons for not wanting to live here, and that will have an impact on the economy and employment in the future — probably driving more jobs and business investment offshore. Don’t expect driving people and money out of the US to improve job prospects and the economy here. That’s naive in the extreme.


Sources:

  1. Homeland Security, “Yearbook of Immigration Statistics 2015.” https://www.dhs.gov/immigration-statistics/yearbook/2015/
  2. Jeffrey Passel and D’Vera Cohn, “As Mexican share declined, U.S. unauthorized immigrant population fell in 2015 below recession level,” Pew Research Center, 25 April 2017. http://www.pewresearch.org/fact-tank/2017/04/25/as-mexican-share-declined-u-s-unauthorized-immigrant-population-fell-in-2015-below-recession-level/
  3. Jie Zong and Jeanne Batalova, “Frequently Requested Statistics on Immigrants and Immigration in the United States,” Migration Policy Institute, 8 March 2017. http://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states
  4. US State Department, “CA by the Numbers,” updated June 2016.  https://travel.state.gov/content/dam/travel/CA_By_the_Numbers.pdf
  5. “Retire Overseas . . . and Live Better for Less . . . ” International Living, undated.  https://www.internationalliving-magazine.com/?gclid=COyAv7-tytQCFYWNswodZNkMcw

The [State] Politics of Health Insurance

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In the rush to repeal the Affordable Care Act, the Trump Administration has been repeating the mantra that the individual insurance marketplaces are “failing.” Like most statements made by politicians these days, the facts seem to be a little different.

Clearly, Iowa is in crisis. With the withdrawal of Aetna from the individual marketplace, there is a real risk they may have no insurers offering individual coverage through the marketplace in 2018.

My suspicion is that Aetna’s withdrawal has more to do with its stock price and financial liabilities after a failed merger attempt than with the ACA itself. Aetna has also stopped writing small group insurance in some states.

However, Pennsylvania has six carriers committed to the marketplace for 2018. The only concern is what the Trump administration might do the mess things up.

Further, another insurer, Centene, has announced that it is expanding individual marketplace coverage into three new states — Kansas, Missouri and Nevada.

So what’s the real story with Iowa? If the fault were with ACA, it would be impacting every state and every carrier, and that’s not the case. What have state officials done to mess things up?

If you know the story, please reply. I’d like to know, both about Iowa and about other states where local officials are whining about Obamacare. Let’s get the full story out into the open.

 

Parenting and Risky Sexual Behavior in Teens

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

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.


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

Brain Tumor Options

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Brain tumors are pernicious. How do you know when a headache is just due to stress or a sign of something more serious? Right now, 1 in every 161 cancer diagnoses involves a brain tumor, but these tumors can be a natural follow-on to other cancers. Glioblastoma is the most deadly form of brain tumor, killing 83% of the youngest patients it infects within five years.

Medicine is changing rapidly, and that brings both benefits and problems. Obviously, new treatment methods can improve outcomes for patients. However, it is a challenge to keep up with developments and know what’s best. It’s a challenge for doctors, and worse for patients.

The traditional approach has involved surgery, chemotherapy and radiation therapy to remove and kill cancer cells.  These approaches have met with varied success. The five year survival rates for various brain tumors are shown in the chart below:

Five-year survival rates, selected brain tumors (2)

Five-year survival rates Age of patient
Tumor type 20-44 45-54 55-64
Low-grade (diffuse) astrocytoma 65% 43% 21%
Anaplastic astrocytoma 49% 29% 10%
Glioblastoma 17% 6% 4%
Oligodendroglioma 85% 79% 64%
Anaplastic oligodendroglioma 67% 55% 38%

New research is finding that radiation treatment can affect brain function, possibly producing the cognitive impairment seen in many patients after treatment. (3,4)

There are a number of options, but your local doctor may or may not know what they are, or have access to them.

The NIH National Cancer Institute highlights three categories of research under way:

  • Therapeutic vaccines
  • CAR T-cell therapy (taking patient cells, re-engineering them, and reinjecting them in the patient)
  • Checkpoint inhibitors that allow the patient’s immune system to attack tumor cells (5)

These approaches fall under the broad label of immunotherapy.

Where are clinical trials happening?

  • Duke is a leader in brain tumor research and has a number of clinical trials underway testing treatments for brain tumors involving immunotherapy and the manipulation of T and B cells. (6)
  • Other centers with clinical trials include:
    • The University of Florida
    • The University of Texas Southwestern Medical Center, also featuring clinical trials with imunotherapy
    • The Dana Farber Cancer Center, Boston, Massachusetts
    • Cedars-Sinai Medical Center, Los Angeles, California
    • University of California, Irvine, California
    • Mayo Clinic, Rochester, Minnesota
    • University of Alabama
    • MD Anderson Cancer Center, Univ. of Texas, Houston
    • Provident Cancer Center, Portland, Oregon
    • City of Hope Medical Center, Duarte, California
    • NIH Clinical Center, Bethesda, Maryland

The bulk of innovative work is happening on the east and west coast, leaving people in the North Central, Midwest, Plains and much of the South and Southwest without ready access to advanced medical treatment. Even with access, doctors in these areas will have little experience dealing with side effects, and that could be fatal for a patient.

This explains in part why, as discussed in prior blog posts, where you live in the US effects your life expectancy.

How prepared are you to relocate for three or six months for treatment?


Sources:

  1. American Brain Tumor Association. http://www.abta.org
  2. American Cancer Society, “Survival Rates for Selected Adult Brain and Spinal Cord Tumors.” https://www.cancer.org/cancer/brain-spinal-cord-tumors-adults/detection-diagnosis-staging/survival-rates.html
  3. University of California – San Diego. “Radiation therapy vital to treating brain tumors, but it exacts a toll: Researchers say treatment alters neural networks and may cause long-term cognitive impairment.” ScienceDaily. ScienceDaily, 9 June 2017. <www.sciencedaily.com/releases/2017/06/170609133810.htm>.
  4. Carrie R McDonald et al. Altered network topology in patients with primary brain tumors after fractionated radiotherapy. Brain Connectivity, June 2017 DOI: 10.1059/brain.2017.0494
  5. Duke Neurosurgery, “Research Initiatives.” https://neurosurgery.duke.edu/research/basic-research/duke-brain-tumor-immunotherapy-program/research-initiatives.
  6. UT Southwestern Medical Center. “New approach to destroying deadly brain tumors.” ScienceDaily. ScienceDaily, 13 June 2017. <www.sciencedaily.com/releases/2017/06/170613102056.htm>.
  7. Musella Foundation, “Clinical Trials and Noteworthy Treatments for Brain Tumors,” last updated 5 February 2017. https://www.virtualtrials.com/Immunotherapy_treatments.cfm

The Fiduciary Rule: What’s the Fuss?

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Many people may say, “I don’t have any investments. This doesn’t affect me.” ben_franklin

Well, not exactly.

Most people aren’t financial experts. If you don’t have investments now, you hopefully will be saving money for retirement in the future. (If you plan to live on Social Security, well, the only way Social Security covers retirement living costs today is if you move out of the US to a lower cost country like Costa Rica. How’s your Spanish?)

Even if you’re counting on winning the lottery to cover you old age or breaking the house in Vegas, there will be times when you’ll need financial advice. It may be about where to put your money, or whether to buy or rent, or how to finance a home or car. Almost everyone has something on which they need financial advice. You’re probably no exception.

That’s why understanding the idea of “fiduciary” and who is and who isn’t is important.

How do you know you’re getting the best advice? How do you know you’re getting good advice? How do you know the person you are asking for advice has the knowledge to help you and isn’t lying to you for his own profit? Who’s responsible for keeping him (or her) honest?

It’s a problem. Remember Bernie Madoff and all the harm he did? A lot of money simply disappeared. And he wasn’t the first.

Most fraud doesn’t involve Ponzi schemes (what Madoff did). A more typical scenario is: “Investment X is better for this client than investment Y, but I get $100 for selling X and $200 for selling Y, so I’ll recommend Y to him.” The advisor gets a little more money; the client gets an inferior product. Will it make a huge difference for the client? Maybe, maybe not. Is it the right way to do business? No.

In fact, the Feds think that people are giving $17 billion in “excess fees” to retirement advisors now.

Giving sales people incentives to sell specific products is common throughout retail, not just something that happens with investments. How about the person who sold you a home theater set-up? Or your computer system?

“Spiffs” are bonuses paid to retail salespeople for selling a specific product. The term isn’t usually applied to financial products, although the underlying idea is relevant. Companies run competitions with potentially significant awards based on sales volume.

The Department of Labor (DOL) Fiduciary Rule is simple: it requires retirement advisors to act as fiduciaries.  That is, they must place client interests ahead of their own profit motives. To me, that’s the way advisors should behave, all the time. It shouldn’t require a regulation to make it so.

Fiduciary (legal term): An individual in whom another has placed the utmost trust and confidence to manage and protect property or money. The relationship wherein one person has an obligation to act for another’s benefit.
http://legal-dictionary.thefreedictionary.com/fiduciary

The problem with the DOL rule is the general problem with government regulation. The government enforces rules through

  1. Licensing requirements for sales people
  2. Regulation of investment companies, and
  3. Surprise inspections and tedious paperwork.

The extra bookkeeping and storage involved in the latter adds to overhead cost for the advisor.

In the Medicare insurance sector, salespeople have to keep records of every sales call for ten years and be able to produce those records for inspection when asked. Think about what that means.

My problems with the DOL rule are:

  1. Can’t we find a better a more efficient and effective approach to enforcement?
  2. We should impose the rule on all forms of financial advisor, not just investment and retirement advisors. That means including bankers, insurance agents, credit union managers, tax advisors, etc. Anyone who can affect your finances should be covered by the rule.

What you need to know:

  • The fiduciary rule as now written doesn’t apply to everyone from whom you may see advice on financial decisions. Buyer beware.
  • One guide to consider: Is the advisor open about what they earn from the different products they sell? Are they willing to recommend products they don’t sell? Are they willing to explain the reasons for their recommendations to you in plain English?

Sources:

  1. Eversheds Sutherland. http://www.dolfiduciaryrule.com/
  2. Investopedia, “DOL Fiduciary Rule Explained as of May 23, 2017.” http://www.investopedia.com/updates/dol-fiduciary-rule/
  3. Li Skinner, “Figuring Out Fiduciary,” Investment News, 9 May 2017. http://www.investmentnews.com/article/20160509/FEATURE/160509939/the-dol-fiduciary-rule-will-forever-change-financial-advice-and-the
  4. Federal Register, 8 April 2016, v. 81, no. 68, Part V. Department of Labor, Employee Benefits Security Administration, “Definition of the Term ‘Fiduciary’; Conflict of Interest Rule — Retirement Investment Advice.”
  5. Heidi Shierholz and Ben Zipperer, “Here is what’s at stake with the conflict of interest (‘fiduciary’) rule,” Economic Policy Institute, 30 May 2017. http://www.epi.org/publication/here-is-whats-at-stake-with-the-conflict-of-interest-fiduciary-rule/?utm_source=Economic+Policy+Institute&utm_campaign=8817421bab-EMAIL_CAMPAIGN_2017_06_02&utm_medium=email&utm_term=0_e7c5826c50-8817421bab-58834721&mc_cid=8817421bab&mc_eid=0541ad0f29

Economics and Crime

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The old saying is that “crime doesn’t pay.” However, crime flourishes where people don’t ben_franklinget paid.

Published earlier this year, the list of fifteen cities with the most rapid growth in violent crime is instructive on several points:

  • They’re medium size or smaller cities
  • They have poverty and lower economic growth
  • They’re primarily in the South and Midwest
    • Alabama (Anniston-Oxford-Jacksonville)
    • California (El Centro, San Luis Obispo-Paso Robles-Arroyo Grande)
    • Iowa (Waterloo-Cedar Falls)
    • Louisiana (Alexandria, Houma-Thibodaux, Monroe)
    • Missouri (St. Josephs, Springfield)
    • Montana (Missoula)
    • Ohio (Mansfield)
    • South Dakota (Sioux Falls)
    • Texas (Abilene, Odessa)
    • Wisconsin (Milwaukee-Waukesha-West Allis)

Monroe is the worst city on the list; violent crime has increased there by more than 80% in the last five years.

Note that the Census combines smaller communities for reporting purposes.

Milwaukee is the largest city on the list, but it also ranked No. 2 on the list of poorest large American cities in 2015. (2) Milwaukee ranked 44th on a list compiled by Wallethub for quality of education; the other cities listed here fell outside the top 150).

The argument — imperfect, of course — is that people who have goals and hope don’t commit violence. Those who think they “can’t lose” due to social status or have nothing to lose, do. Education and job prospects matter.


Sources:

  1. Michael Sauter and Samuel Stebbins, “Cities Where Crime Is Soaring,” 24/7 Wall St., 9 February 2017. http://247wallst.com/special-report/2017/02/09/cities-where-crime-is-soaring-3/
  2. Bruce Kennedy, “America’s 11 Poorest Cities,” Moneywatch, 18 February 2015. http://www.cbsnews.com/media/americas-11-poorest-cities/12/
  3. Richie Bernardo, “2016’s Most and Least Educated Cities,” WalletHub, 25 July 2016. https://wallethub.com/edu/most-and-least-educated-cities/6656/#main-findings

Healthcare Rate Increases: Guidance from Pennsylvania on What to Expect

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At this moment, Pennsylvania has a fully functional Healthcare Marketplace.ben_franklin

  • All five of the insurers in the PA market have said they will stay in the market for 2018
  • Assuming the requirement for coverage and Federal subsidies stay in place, the insurers have asked for an average rate increase of 8.8% for 2018.

The requested increase in PA is much lower than the requests in every other state. In some, like Connecticut and Virginia, insurers have requested increases of more than 50% due to uncertainty about what Trump will do.

Insurers have said that the rate increase in PA would rise from the requested 8.8% to

  • 23.3% if the individual mandate is repealed (the requirement that individuals have insurance)
  • 20.3% if Federal subsidies are terminated or
  • 36.3% if both take place.

According to a spokesperson

“This proves what we already know—instability caused by adverse action from the federal government will do nothing but hurt consumers who are stuck in the middle,” Miller said. Enrollees “deserve single-digit rate increases like the ones most people will see if Congress and the Trump Administration choose not to risk consumers’ health and financial well-being by jeopardizing the stability of these markets.” (1)

Given other recent actions, it’s probably best to assume that the administration will drive health insurance costs much higher and budget accordingly. The increase of 36.5% in PA and more in other states is the most likely outcome at this time.

The relative calm in Pennsylvania also points to how much of the health insurance chaos is due to state level politics. Other states have health insurance marketplaces that are much less functional, and their residents are seeing much higher rate increases.

Old Ben would be proud of  his state.


Sources:

  1. Shelby Livingston, “Pennsylvania insurers buck trend for giant rate hikes with single-digit bump request,” Modern Healthcare, 1 June 2017. http://www.modernhealthcare.com/article/20170601/NEWS/170609996?utm_source=modernhealthcare&utm_campaign=am&utm_medium=email&utm_content=20170601-NEWS-170609996