201404

April 30, 2014 4:21PM

Cost‐​Benefit Analysis in Nurse Practitioner Regulation

Yesterday, the New York Times ran an op-ed by Sandeep Jauhar questioning the New York state legislature’s passage of a bill allowing more independence for nurse practitioners. The author, a doctor himself, claims that allowing nurse practitioners to work independently would not save money and would result in lower quality care. In his opinion, the answer to the question of too few primary care doctors is not to allow competition from those with less education, but to raise their pay.

My forthcoming Working Papers column in the Summer issue of Regulation will describe a paper by occupational licensing expert Morris Kleiner et al. that disputes these claims. In his September 2013 paper, Kleiner et al. find that in states that allow nurse practitioners to independently practice and write prescriptions, the fees charged for services are lower while health care quality, as measured by changes in the infant mortality rate and malpractice insurance premiums, is not affected.

For more of coverage of Kleiner’s work, see here and here.

April 30, 2014 1:26PM

The Politics of Personal Destruction — Campaign Finance Version

The Washington Post’s Radley Balko had a great tweet this morning—“Rich progressives hold secret meeting to discuss how we can ban rich conservatives from holding secret meetings.” He linked to a long morning POLITICO piece by Kenneth P. Vogel, “Big donor secrecy: ‘Irony, but it’s not hypocrisy,’” about a gathering in Chicago this week of major Democratic Party donors that’s raised more than $30 million for liberal groups—a meeting that included a bit of strong-arming to keep unwanted reporters at bay, Vogel reports.

Secrecy aside, one of the issues I found most interesting among the many interesting things in Vogel’s piece was his discussion about what motivates big political donors—and the different perceptions liberals and conservatives have about that question. Both sides argue, he writes, that “their donations are animated by a desire to right a country headed down the wrong path.” But,

The liberal strain of the argument is usually sprinkled with a heaping helping of moral superiority. Their most generous backers are giving to candidates and causes that could hurt their bottom line by raising taxes on the denizens of their elite tax bracket, the argument goes, whereas conservative big donors are seeking to pad their pockets by trying to slash taxes and regulations that impinge on their business.

“The people who are giving money into politics here are interested in changing the system. They’re not interested in getting return on investment,” said former Stride Ride president Arnold Hiatt, who donated $1.9 million to Democratic super PACs in 2012, not including gifts to nonprofits that aren’t required to disclose their donors. “You can focus on the irony, but it’s not hypocrisy because we’re not trying to get something for our donations.”

There you have it: white hats and black, and we know which side’s hats are black. It will surprise no one that the Koch brothers played a prominent role in the moral narrative that surrounded this gathering. What is hard to believe, however, is that these Democratic donors believe their own rhetoric. Yet they’re asking the rest of us to believe that the Kochs and the Sheldon Adelsons and the rest of the conservative and libertarian big-money donors are in it for the money.

The argument doesn’t pass the straight-face test, but of course it’s part of the class-warfare tack that Progressives took when they first teamed up with Populists at the end of the 19th century. It’s not enough to rebut your political opponent’s arguments. You’ve got to vilify him as well—what has come to be called the politics of personal destruction—and that’s especially important when you can’t rebut his arguments. In no area of our public life today do we find this politics practiced more zealously than campaign finance.

Fortunately, Vogel gives us a few facts that undermine the morality play unfolding this week in Chicago:

Of course, there are some examples where liberal donors’ causes overlap with their economic interests. San Francisco hedge fund billionaire Tom Steyer, whose aides delivered a Tuesday morning presentation to [Democracy Alliance] donors on his plan to spend $100 million in the 2014 midterms boosting environmentally minded candidates, has invested in renewable energy initiatives that could be boosted by his advocacy. And DA partners Amber and Steve Mostyn, who declined an interview request in Chicago, have spent heavily against advocates of tort reforms in Texas that could crimp their legal business.

Meanwhile, there are plenty of examples of top conservative donors whose giving is animated by causes unrelated to their bottom lines. While Adelson would undoubtedly benefit from GOP tax policies, he donates mostly on the basis of a single issue—the defense of Israel—that is detached from the casino empire that built his $40 billion fortune. And the Kochs often cite their opposition to ethanol subsidies that benefit their sprawling industrial empire as an example of a political stance that could hurt their bottom line.

So do the liberal donors gathered in Chicago this week really believe their own rhetoric? Of course not. If we’re talking about morality, then, let’s do so. Repairing to the title of Vogel’s piece, it’s not irony; it’s hypocrisy. Let’s put the black hats on the proper heads.

 

April 30, 2014 11:11AM

Colorado Isn’t Having a Cultural Revolution

In news that will surprise exactly no one, music and cannabis can be pretty nice together:

The cultural revolution that is making marijuana part of everyday Colorado life conquers another established front Tuesday as the Colorado Symphony Orchestra announces a series of performances sponsored by the cannabis industry.

The concerts, organized by pro-pot promoter Edible Events, will start May 23 with three bring-your-own marijuana events at the Space Gallery in Denver's Santa Fe arts district and culminate with a large, outdoor performance at Red Rocks Amphitheatre on Sept. 13. The events are being billed as fundraisers for the CSO, which will curate a themed program of classical music for each show.

But that's hardly a cultural revolution: The earliest written mention of marijuana was by the ancient Greek historian Herodotus, who described its users dancing and singing. The rest, as they say, is history.

What's revolutionary here is the law, which has finally begun treating Coloradans like responsible adults rather than criminals. At least about cannabis: Our laws ought to do the same for all illegal drugs. Doing so will encourage responsible drug use, better scientific research, and better treatment for addicts.

Yes, legal cannabis means we will have to make a few adjustments. But many of them aren't so bad: "Are drivers sober?" is not a new question, after all. Only now, it's a question to be answered a little more honestly, and with better treatment from the law. On the whole, that's clearly for the best.

April 30, 2014 10:19AM

New Frontiers in Regulatory Overreach

In most cases, excessive regulation doesn't surprise me all that much.  It usually focuses on familiar industries, such as automobiles.  So, for example, when the National Highway Traffic Safety Administration came up with a rule mandating that all cars and light trucks sold in the United States have rearview cameras, it wasn't a great shock.

But every now and then, regulators do something that catches me off guard.  This is from the Economist:

Vancouver’s ban on doorknobs in all new buildings, which went into effect last month, ... has provoked a strong reaction from the door-opening public and set off a chain reaction across the country as other jurisdictions ponder whether to follow Vancouver’s lead. 

Wait, what?? They are banning doorknobs? I confess that this threw me when I first read it. Were they going to require some sort of Star Trek-like eyeball scanning device, along with an automatic door?

Turns out it wasn't anything quite so techonoligcally advanced. They just want "levered doorhandles" instead. Here's their rationale:

The war on doorknobs is part of a broader campaign to make buildings more accessible to the elderly and disabled, many of whom find levered doorhandles easier to operate than fiddly knobs. Vancouver’s code adds private homes to rules already in place in most of Canada for large buildings, stipulating wider entry doors, lower thresholds and lever-operated taps in bathrooms and kitchens.

I would have thought doorknobs were pretty easy to deal with, but OK, maybe levers are easier. But I'm not sure how you go from "some people find levers easier" to "everyone must use levers!"

Furthermore, perhaps levers are too easy:

True, elderly and disabled people find it easier to operate doors with handles. But so do bears. In British Columbia, bears have been known to scavenge for food inside cars—whose doors have handles, knob advocates point out. Pitkin County, Colorado, in the United States, has banned door levers on buildings for this very reason. One newspaper columnist in the pro-knob camp has noted that the velociraptors in “Jurassic Park” were able to open doors by their handles.

Obviously, bears don't vote (nor do velociraptors), so we probably can't attribute these developments to regulatory capture by the bear lobby, which wants easier access to people food (are campers getting more careful with their "pic-a-nic" baskets these days?). Nevertheless, something seems a little off in the regulatory process in Vancouver.

April 30, 2014 9:54AM

Adaptation to Extreme Heat

Global Science Report is a feature from the Center for the Study of Science, where we highlight one or two important new items in the scientific literature or the popular media. For broader and more technical perspectives, consult our monthly “Current Wisdom.”

Last fall, the press pounced on the results of a new study that found that global climate change was leading to an increasing frequency of heat waves and thus resulting in greater heat-related mortality. Finally a scientific study showing that global warming is killing us after all! See all you climate change optimists have been wrong all along, human-caused global warming is a threat to our health and welfare.

Not so fast.

Upon closer inspection, it turns out that the authors of that study—which examined heat-related mortality in Stockholm, Sweden—failed to include the impacts of adaptation in their analysis as well as the possibility that some of the temperature rise which has taken place in Stockholm is not from “global” climate change but rather local and regional processes not at all related to human greenhouse gas emissions.

What the researchers Daniel Oustin Åström and his colleagues left out of their original analysis, we (Chip Knappenberger, Pat Michaels, and Anthony Watts) factored in. And when we did so, we arrived at the distinct possibility that global warming actually led to a reduction in the rate of heat-related mortality in Stockholm.

Our findings have just been published in the scientific journal Nature Climate Change as a Comment on the original Oustin Åström paper (which was published in the same journal).

We were immediately skeptical because the original Oustin Åström results run contrary to a solid body of scientific evidence (including our own) that shows that heat-related mortality and the population’s sensitivity to heat waves was been declining in major cities across America and Europe as people take adaptive measures to protect themselves from the rising heat.

Contrarily, Oudin Åström reported that as a result of an increase in the number of heat waves occurring in Stockholm, more people died from extreme heat during the latter portion of the 20th century than would have had the climate of Stockholm been similar to what it was in the early part of the 20th century—a time during which fewer heat waves were recorded. The implication was that global warming from increasing human greenhouse gas emissions was killing people from increased heat.

But the variability in the climate of Stockholm is a product of much more than human greenhouse gas emissions. Variations in the natural patterns of regional-scale atmospheric circulation, such as the Atlantic Multidecadal Oscillation (AMO), as well as local impacts associated with urbanization and environmental changes in the direct vicinity of the thermometer are reflected in the city’s temperature history, and the original Oudin Åström et al. publication did not take this into account. This effect is potentially significant as Stockholm is one of Europe’s fastest growing cities.

But regardless of the cause, rising temperatures spur adaptation. Expanded use of air conditioning, biophysical changes, behavior modification, and community awareness programs are all examples of actions which take place to make us better protected from the dangers associated with heat waves. Additionally, better medical practices, building practices, etc. have further reduced heat-related stress and mortality over the years.

The net result is that as result of the combination of all the adaptive measures that have taken place over the course of the 20th century in Stockholm, on average people currently die in heat waves at a rate four times less than they did during the beginning of the 20th century. The effect of adaptation overwhelms the effect of an increase in the number of heat waves.

In fact, it is not a stretch to say that much of the adaptation has likely occurred because of an increased frequency of heat waves. As heat waves become more common, the better adapted to them the population becomes.

Our analysis highlights one of the often overlooked intricacies of the human response to climate change—the fact that the response to climate change can actually improve public health and welfare.

Which, by the way, is a completely different view than the one taken by the current Administration.

References:

Knappenberger, P., Michaels, P., and A. Watts, 2014. Adaptation to extreme heat in Stockholm County, Sweden. Nature Climate Change, 4, 302-303.

Oudin Åström, D., Forsberg, B., Ebi, K. L. & Rocklöv, J., 2013. Attributing mortality from extreme temperatures to climate change in Stockholm, Sweden. Nature Climate Change, 3, 1050–1054.

April 29, 2014 5:04PM

The Legalization Juggernaut

Former Drug Czar Bill Bennett has co-authored an article in the Weekly Standard, "The Legalization Juggernaut."  Bennett is upset about voter approval for the marijuana legalization initiatives in Colorado and Washington and recent polls showing "for the first time that a clear majority of Americans (58 percent) support marijuana legalization."  Bennett can hardly believe that we have reached this "dangerous and absurd moment."   It is absurd because, to Bennett, the policy question boils down to this: "Do we need a dumber country?"   If the debate can be framed that way, Bennett and his co-author, Christopher Beach, are convinced that "this headlong rush into disaster can be stopped."  If.

Some readers of Cato@Liberty might need reminding that when Bennett was a high-ranking government official, he once said executing drug dealers was morally justifiable. Given that stance, it must bewilder him to see marijuana stores opening in Denver, Seattle, and other cities.  For the moment, all Bennett wants are a few political leaders to "speak out on marijuana."   Hmm.  That's another telling indication of the changing political climate with respect to drug policy.

More here, here, and here.

April 29, 2014 2:38PM

All Aboard the Privatization Train

With the expiration of the current federal highway bill in a few months, the infrastructure issue is heating up. Newspapers are ginning up interest with stories about deficient and falling down bridges (e.g. here and here).

Diane Rehm kindly invited me to her NPR show this morning to discuss how we should move ahead with financing infrastructure. I pointed to the advantages of devolving funding to state governments and the private sector. America should embrace the global movement towards privatization and public-private partnerships for highways, bridges, airports, and other facilities.

Even Japan—previously known for its pork-barrel infrastructure spending—is beginning to embrace privatization, notes this piece at NextCity.org (h/t Nick Zaiac):

Over a 15-year period starting in 1987, the Japanese government undertook one of the most ambitious privatizations in history, moving its most heavily traveled railways from public ownership into private hands. The privatization of Japanese National Railways – whose assets on Honshu (Japan’s main island) were split into three separate companies (JR East, Central and West, each centered around one of Japan’s three major metropolitan areas) – was a roaring business success. JR East, which runs commuter, intercity and Shinkansen lines in Tokyo and the surrounding region, doubled its revenue over the 15-year period, cut its payroll by a third, upped its per-capita passenger-miles by two-thirds, all while cutting the number of accidents by nearly 60 percent and keeping fares more or less flat.

Now Osaka, Japan is looking to repeat the magic, but this time on its city subway network – which, if successful, would be the first government subway system in the country to be sold off.

. . . The move follows on the heels of the sale of another one of the prefecture’s railways, the . . . Semboku Rapid Railway.

. . . Not to be outdone, the Tokyo Metropolitan Government is considering selling its 46.6 percent stake in Tokyo Metro.