Is our government responsible for the opioid crisis?

The Des Moines Register recently reported that 36 Iowa counties have joined in a law suit against opioid makers.  (See link to Register article below.)  Two law firms are enlisting counties across the country to go after drug manufacturers and others for the costs of the opioid crisis.  There is no cost to the counties.  If successful, the “Lawyers will  be awarded a portion of the settlement, …”  (Interesting that the word “settlement” is used instead of “judgment”.)

What is often missing in much of the opioid crisis discussion is how our government’s policy of prohibition has made a bad situation even worse.  When a person becomes physically addicted to opioids, they will do almost anything to get the drugs they want.  If the drugs are not available legally, or if legal drugs cost too much, addicts will find illegal alternatives. According to the CDC, 60% of opioid deaths do not involve prescription opioids.  That is, in 60% of opioid deaths the person who died was using illegal opioids.  (See CDC reference below.)  A significant problem with illegal drugs is that is no way to assure the quality and potency of the drugs.  In the case of opioids, that leads to inadvertent over-doses because the illegal drug was much more powerful than thought.

If opioid addicts were able to readily get prescription methadone or other FDA approved opioids at reasonable costs, many deaths would be prevented.  That would also take the profit out of the illegal opioid drug trade.  If opioid addicts were treated under a medical model rather than a criminal model, it is likely that more opioid addicts would seek help to solve their addiction problem.  But as it is, under our drug war, prohibition policy, addicts have good reason to not seek help.

CDC reference: https://www.cdc.gov/drugoverdose/data/overdose.html

Link to Register article: https://www.desmoinesregister.com/story/news/crime-and-courts/2018/01/05/iowa-counties-file-lawsuits-against-opioid-manufacturers/1008522001/

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Many Iowa licenses protect existing businesses more than public safety

In today’s Des Moines Register, the guest opinion by Kollan Kolthoff was very vague in his call for “common sense reform” of the licensing of cosmetologists.  (See link below.)  He wrote, “…leaders from within the industry are uniquely aware that there are problems that need to be addressed.”   I presume the industry leaders he refers to are existing licensed cosmetologists and  licensed schools of cosmetology.  After a person has completed the 2,100 required hours of education and paid as much as $20,000, it is very understandable that they would not want to see license requirements significantly lowered – thereby indirectly lowering the value of what they have already paid for.  Similarly, licensed schools of cosmetology have a very strong financial incentive to maximize the number or hours of schooling required for a license.
He also wrote Iowa needs reform that, “…protects consumers against the deregulation of licensed beauty professionals.”  Deregulation does not and should not mean a lessening of regulation to keep consumers safe.  Deregulation should focus on removing regulations that have the primary purpose of protecting the income of existing cosmetologists and schools of cosmetology.
The same issues apply to a large number of occupations that require a license from the state.  Most calls for licensing, and opposition to deregulation, come from existing businesses and licensees, not from the general public.  Our elective representatives should establish a process to review and reduce licensing requirements in Iowa so that only public safety is is taken into account when requiring Iowans to get a license from the state before being able to work in any particular job.

Some of the rich are getting poorer, and some of the poor are getting richer.

The Des Moines Sunday Register published a lead article (Page 1) titled, “The rich keep getting richer”.  (See link below.)  Included were a number of misleading statistics or misleading conclusions based on the statistics.  For example, according the think tank, Iowa Policy Project, the median hourly wage in 2016 was $16.04 per hour.  37 years ago, the average wage, adjusted for inflation, which is fair, was $15.91.  The Register concluded, “This means a typical wage earner  working 40 hours per week for a full year would have seen a real increase of $270.40 over a 37 year span.”  While the statistics are technically true, you cannot logically conclude and that any specific person or group of people did not move themselves from a lower wage to a significantly higher wage.  I’m sure it is true some people moved down while some people moved up.  An interesting study would be to see how wages correlate to the number of years in the employment market.  It would be interesting to know the median starting hourly rate for a young inexperienced worker versus and an experienced worker who has been in the labor market to 30 years.  The fact that the average stays about the same my be a problem, but almost no one stays at the average wage for 37 years.

Another statistic was that the number of people who earned $1 million or more during specific years increased from 5,031 in 2010 to 8,325 in 2015.  Their “slice” of the state’s total adjusted gross income grew 37%.  Meanwhile, the number of Iowans claiming gross incomes of $40,000 to $99,999 climbed by 23%  while their slice of the state’s total adjusted gross income fell 2%.  First, I would venture to guess that a significant majority of the $1 million+ earners are people who sold their businesses or had other one-time income.  So, again,there is no logical reason to presume that the $1 million+ club is made up of the same people year-after-year.  At the same time, from 2010 to 2015 the Iowa economy was generally continuing to improve, so values and prices of businesses likely climbed.  Also, in the case of an “expanding pie”, the fact that any group gets a smaller percentage of the total does not mean that their real income is not increasing.

Finally, the Register reported that their analysis of U.S. Census data showed that the bottom fifth of earners saw practically no growth in household income – going from $13,798 in 2006 to $13,848 in 2016, again adjusted for inflation.  Here again, there is no logical reason to believe that the specific group of people who were in the bottom 20% in 2006 are the same people who were in the bottom 20% 10 years later.  It would be interesting to know what percent of the people in the bottom 20% in 2006 were still in the bottom 20% 10 years later.   My guess is there would be some, but not a majority.

As a society we need to make sure we don’t put hurdles in front of people who are trying to improve their lot in life.  In many cases this means removing government created regulatory barriers to entry into certain jobs.  The Register has done very good work exposing job licensing regulations that are in place more to protect existing businesses from competition and to protect the profits of licensing education businesses, than to protect the public.  Yet, the Iowa Legislature has done precious little to address this real problem for low income workers who are trying to work their way up in our economy.

Link to Register article:  https://www.desmoinesregister.com/story/money/business/2017/11/25/most-iowa-wages-have-stagnated-but-rich-keep-getting-richer/818770001/

 

Wellmark right to disclose cost of anonymous patient

The Des Moines Register recently reported that Wellmark Blue Cross Blue Shield has been accused of violating federal HIPAA privacy regulations in the case of a patient with severe hemophilia.  (See link to Register article below.)  As reported, a representative of Wellmark was discussing the high cost of health insurance at a Rotary Club meeting last March.  She gave an example of an extreme case that was costing $1 million per month.  (ACA – Obamacare – prohibits insurance companies from placing any limit on the amount it will pay for patients.)  She did not identify the patient by name, but described him as a 17 year old male with hemophilia.  Maybe she should not have mentioned the age or sex of the patient, but that information alone did not identify who the specific patient was, and should not be considered a violation of federal privacy regulations.

Wellmark and other insurance companies must be able to cite specific high cost cases that are causing health insurance premiums to rise to unaffordable amounts.  How can we openly debate ways to contain health care costs if we don’t know what is causing the high costs?  Can we really afford to require insurance companies to pay out unlimited amounts for any patient?  I recently heard that the last remaining company to offer individual health insurance policies in Iowa may charge more than $30,000 per year next year for a couple who are 55 years old.  Health care wants are unlimited.  Our ability to pay is not.  We need to debate whether or not government should prohibit health insurance policies from having limits on how much they pay out for individual patients.

Link to Register article: http://www.desmoinesregister.com/story/news/health/2017/08/21/wellmark-accused-violating-privacy-iowa-teen-severe-hemophilia-reportedly-costing-1-million-month/586702001/

 

 

Religious Freedom bill may be just fine.

I respectfully disagree with Kevin Pokorny’s letter to the editor in the Register yesterday.  (See link below.)  The State of Iowa does need to amend its civil rights laws to allow buyers and sellers of products and services to peacefully follow their conscience when they have reasonable disagreements.
To the extent that a product or service is personalized or customized, it does infringe on the rights of a seller to force him or her to provide the product or service in such a way that goes against the seller’s sincerely held religious beliefs. If the products or services are readily available from a multitude of sellers, and a buyer can reasonably find what he or she wants from another seller, then it is not unreasonable to allow some sellers to follow their conscience.
In Iowa and other states, florists, photographers, bakers, and wedding venue operators have been forced to provide customized products and/or services for gay couples’ weddings.  Governments should never discriminate against gay marriage, and I personally have and do support giving gay marriage the same government rights and privileges as any other marriage.  But, private individuals, and the businesses they operate, should not be forced to provide customized or personalized services or products against their will.
FYI – I am a libertarian-minded atheist, and believe it is better to have peaceful voluntary solutions whenever possible, rather than to use the force of government to decide who will be winners and who will be losers.

Checkoff programs for commodities should be ended.

The Des Moines Register recently reported that all Iowa cattle producers will soon be forced to pay $0.50 per head into a “checkoff program.  The funds will be used for beef promotion, research and other activities.  56% of the cattle producers voted for the “checkoff” program – forcing the other 44% to contribute to the scheme.  In any other setting, it would be called a tax.
There are many checkoff programs for a wide variety of commodities, both nationally and in various states.  They all work the same way.  If a majority of the producers want to tax themselves to promote their commodity, then they get to force all producers to pay into the program.
There is not the kind of activity that should be ruled by a majority.  I understand that if the programs were voluntary, which they originally were, that those who did not pay would get a “free ride” – they would get the benefits without paying for any of the costs.  That is not a sufficient reason to use the force of government.  There are an unlimited number of things that a majority of businesses might like to do, if they could force all competitors to help pay.
Both federal and state governments need to repeal the laws which allow checkoff programs to exist.
Link to Register article: http://www.desmoinesregister.com/story/money/2016/12/08/iowa-beef-checkoff-passes-with-56-percent-approval/95138020/

Trump should work with Obama to allay fears of dreamers

Some Democrats have suggested that President Obama pardon the 750,000 “Dreamers” who fear that President-elect Trump will deport them.  The Dreamers are young people who, while they were still young children, were brought into the U.S. illegally by their parents . President Obama used his executive power to grant them temporary legal status if they registered with the federal government through the Deferred Action for Childhood Arrivals program.

The dreamers, and their friends and family, fear that the registration information they provided to the government will now be used by President-elect Trump to find and deport them.  Surely, we should not penalize these children and young adults who have made a good faith effort to become legal residents.  For many of them, the United States is the only home they have ever known.  Maybe they should not be given a path to citizenship, but we should allow them to stay there legally.  I hope that President-elect Trump will support these young people, and announce his support publicly.  This good faith effort would very much help to allay the fears of many of those who have continued to protest the election of Trump.