Month: October 2023

The Shady Statistics Behind the War on Painkillers

Mary Pat Campbell

Link: https://reason.com/video/2023/10/11/the-shady-statistics-behind-the-war-on-painkillers/

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The attack on opioid prescriptions for non-cancer chronic pain began to advance around 2010, and intensified thereafter. The crackdown coincided with—and perhaps caused—a rapid growth in heroin overdose deaths, and later, an explosion in illegal synthetic opioid deaths, primarily fentanyl, an illicitly manufactured substance added to or substituted for heroin to meet the increasing demand for illegal opiates. This pattern of events is illustrated in a graphic put out by the Centers for Disease Control (CDC).

Indeed, overdose deaths from commonly prescribed opiates increased rapidly from 1999 to 2010, but the chart doesn’t tell us how many of the victims legally obtained the opiates. The chosen scale also omits the fact that drug overdose deaths have been increasing at a fairly steady rate since 1979, with no obvious changes associated with the rise and fall of opioid prescriptions for chronic pain. The chart does show how overdose death rates from commonly prescribed opiates did not decline much after 2010, although legal prescriptions went down dramatically. This suggests that these deaths may have involved individuals who bought illegally manufactured opiates, or that the people who lost pain medication as a result of official actions were not the ones liable to overdose.

The increase in deaths of despair obviously merits some policy attention, but labeling it an “opioid crisis,” as is common nowadays, profoundly misstates its nature, timing, and likely causes and solutions. To justify restricting opioids for non-cancer chronic pain patients requires specific evidence that people prescribed opioids for pain are the ones dying of overdoses. There’s quite a bit of negative evidence on this score, but public health officials have seized on a few positive studies to support their claims.

One influential and heavily cited 2011 study published in the Journal of the American Medical Association, “Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths,” uses a classic prohibitionist tactic. The authors use a sample of 750 Veterans Health Administration (VHA) patients who received opioid prescriptions for pain and later died of opioid overdoses, and compare them to a random sample of 155,000 other VHA patients who received opioid prescriptions and did not die of overdoses.

Author(s): Aaron Brown

Publication Date: 11 Oct 2023

Publication Site: Reason

Medicaid Enrollment and Unwinding Tracker – 11 Oct 2023

Mary Pat Campbell

Link: https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker/

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There is wide variation in disenrollment rates across reporting states, ranging from 66% in Texas to 11% in Illinois. Differences in who states are targeting with early renewals as well as differences in renewal policies and system capacity likely explain some of the variation in disenrollment rates. Some states (such as Texas and South Carolina) are initially targeting people early in the unwinding period that they think are no longer eligible or who did not respond to renewal requests during the pandemic, but other states are conducting renewals based on an individual’s renewal date. Additionally, some states have adopted several policies that promote continued coverage among those who remain eligible and have automated eligibility systems that can more easily and accurately process renewals while other states have adopted fewer of these policies and have more manually-driven systems.

Publication Date: last updated 11 Oct 2023

Publication Site: Kaiser Family Foundation

Without a College Degree, Life in America Is Staggeringly Shorter

Mary Pat Campbell

Link: https://www.nytimes.com/2023/10/03/opinion/life-expectancy-college-degree.html

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In the 1970s, American life expectancy grew by about four months each year. By the 1980s, it was similar to life expectancy in other rich countries. Since then, other countries have continued to progress, with life spans increasing by more than two and a half months a year.

But the United States has slowly, gradually and then precipitously fallen behind.

These ever-widening gaps have long troubled demographers and prompted three reports from the National Academy of Sciences. The gaps grew wider during the pandemic.

But even before, not only was life expectancy in the United States far from that of the best-performing countries (Japan and Switzerland), but it was also more than two years lower than that of the worst performers (Germany and Britain) among 22 other rich countries.

Public health authorities in the United States record educational qualifications at death so that, after 1992, we can calculate life expectancy by college degree, starting at age 25, when most people have completed their education. In new research using these individual death records, we have found startling results.

Life expectancy at age 25 (adult life expectancy) for those with four-year college degrees rose to 59 years on the eve of the pandemic — so an average individual would live to 84 — up from 54 years (or 79 years old) in 1992. During the pandemic, by 2021, the expectation slipped a year.

But we were staggered to discover that for those without college degrees, life expectancy reached its peak around 2010 and has been falling since, an unfolding disaster that has attracted little attention in the media or among elected officials.

Adult life expectancy for this group started out two and a half years lower, at 51.6, in 1992 — so an average individual would live to nearly 77 years old. But by 2021, it was 49.8 years (or almost 75 years old), roughly eight and a half years less than people with college degrees, and those without had lost 3.3 years during the pandemic.

The divergence of life expectancies on either side of the college divide — one going up, one going down — is both shocking and rare. We have found reference to only one other case in modern history, in the former Communist countries of Eastern Europe after the collapse of the Soviet Union. Like those countries, the United States is failing its less-educated people, an awful condemnation of where the country is today.

Author(s): Anne Case, Angus Deaton

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How U.S. Hospitals Undercut Public Health

Mary Pat Campbell

Link: https://undark.org/2023/10/05/hospital-emissions-deaths/

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The average energy intensity of U.S. hospitals is more than twice that of European hospitals, with no comparable quality advantage. In recent years, less than 2 percent of hospitals were certified as energy efficient by the U.S. Environmental Protection Agency’s Energy Star program, and only 0.6 percent, or 37 in total, have been certified for 2023. As a result, in 2018, the U.S. health care industry emitted approximately 610 million tons of greenhouse gases, or GHGs — the equivalent of burning 619 billion pounds of coal. This represented 8.5 percent of U.S. GHG emissions that year, and about 25 percent of global health care emissions.

If U.S. health care were its own country, it would rank 11th worldwide in GHG pollution. If every nation produced an equivalent per capita volume of health care emissions, it would immediately consume nearly the entire global carbon budget required to limit global warming to 1.5 degrees Celsius (2.7 degrees Fahrenheit) by 2030. Without even considering their global impact, air pollution from U.S. emissions accounts for an estimated 77,000 excess deaths annually in the U.S. alone. And according to one 2016 study, emissions from the U.S. health care system lead to the loss of more than 400,000 years of healthy life among Americans. This level of harm is commensurate with the tens of thousands of deaths attributable to medical errors each year, around which a massive patient safety movement has been organized in response. But despite these human costs — along with sizable financial costs — there has been no parallel policy movement to address the health care industry’s role in undermining health through its GHG emissions.

Author(s): DAVID INTROCASO & ERIC REINHART

Publication Date: 5 Oct 2023

Publication Site: Undark

Exxon, Apple and other corporate giants will have to disclose all their emissions under California’s new climate laws – that will have a global impact

Mary Pat Campbell

Link:https://theconversation.com/exxon-apple-and-other-corporate-giants-will-have-to-disclose-all-their-emissions-under-californias-new-climate-laws-that-will-have-a-global-impact-214630

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Many of the world’s largest public and private companies will soon be required to track and report almost all of their greenhouse gas emissions if they do business in California – including emissions from their supply chains, business travel, employees’ commutes and the way customers use their products.

That means oil and gas companies like Chevron will likely have to account for emissions from vehicles that use their gasoline, and Apple will have to account for materials that go into iPhones.

It’s a huge leap from current federal and state reporting requirements, which require reporting of only certain emissions from companies’ direct operations. And it will have global ramifications.

California Gov. Gavin Newsom signed two new rules into law on Oct. 7, 2023. Under the new Climate Corporate Data Accountability Act, U.S.- companies with annual revenues of US$1 billion or more will have to report both their direct and indirect greenhouse gas emissions starting in 2026 and 2027. The California Chamber of Commerce opposed the regulation, arguing it would increase companies’ costs. But more than a dozen major corporations endorsed the rule, including Microsoft, Apple, Salesforce and Patagonia.

Author(s): Lily Hsueh

Publication Date: 10 Oct 2023

Publication Site: The Conversation

Despite vehicle safety improvements, US pedestrian deaths soar

Mary Pat Campbell

Link: https://scrippsnews.com/stories/despite-vehicle-safety-improvements-us-pedestrian-deaths-soar/

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Samuel’s death is part of a growing trend in America, where pedestrian and cyclist fatalities are up 60% since 2011 to more than 8,000 last year.

In the past 25 years, the percentage of people who died in road crashes — while inside a vehicle — dropped from 80% of all road deaths to 66%. At the same time, the share of pedestrian and bicyclist deaths climbed sharply – making up 20% of all road deaths in 1997, to now accounting for 34% of all road deaths.

Nicole Brunet is with the nonprofits Bicycle Coalition of Greater Philadelphia and Families for Safe Streets. She says street design is part of the issue.

“If you’re somebody in a car, the street is designed perfect for you,” Brunet said. “The ideal street is balanced: A street that’s built for a pedestrian and a bicyclist, somebody that has mobility issues. We need to think about the most vulnerable user of the road.”

Author(s): Maya Rodriguez

Publication Date: 5 Oct 2023

Publication Site: Scripps

The Debt Crisis Is Getting Real

Mary Pat Campbell

Link: https://reason.com/2023/10/04/the-debt-crisis-is-getting-real/

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When Yglesias wrote that column for Vox in 2016, the federal government owed about $19 trillion. Today, it owes more than $33 trillion, and we just added another $2 trillion in a fiscal year with no major national emergencies.

In short, the federal government followed Yglesias’ advice. But it might be more accurate to say it went along with what was clearly a bipartisan consensus formed in the mid-2010s: that borrowing was cheap, debt was easy to afford, and deficit spending allowed everyone to enjoy “a better life” with none of the downsides of austerity.

Unfortunately, the downsides have arrived.

The yields on U.S. Treasury bonds are now hitting levels not seen in decades. The 10-year Treasury bond is nearing 5 percent, while the 20-year bond has already crossed that threshold—and some analysts expect higher yields to be coming, CNBC reported Tuesday.

Why does that matter? “We took out a mortgage thinking we’d be paying 2%, but now we’re paying 5%,” Marc Goldwein, director of policy at the Committee for a Responsible Federal Budget (CRFB) wrote on X (formerly known as Twitter) on Tuesday.

Unlike most mortgages, which have fixed interest rates, much of the U.S. government’s debt is tied up in short-term bonds which periodically “roll over” into new bonds with updated interest rates. As a result, higher interest rates mean higher interest payments—and those funds come directly out of the federal budget, leaving less revenue for everything else the government might aspire to do, whether funding welfare programs or buying more fighter jets.

“That debt, borrowed at low rates, is now being rolled over into Treasuries paying interest rates between 4.5 and 5.6 percent,” the CRFB explained last month. “Though borrowing seemed cheap during those periods, policymakers failed to account for rollover risk, and we are now facing the cost.”

Interest payments on the debt will be the fastest-growing part of the federal budget over the next three decades, according to the Congressional Budget Office’s (CBO) projections. In the shorter term, interest payments are set to triple by 2033, when they will cost an estimated $1.4 trillion—a total that will only grow higher if more unplanned borrowing takes place before then, or if interest rates rise higher than the CBO expects.

Author(s): Eric Boehm

Publication Date: 4 Oct 2023

Publication Site: Reason