Pandering To Xenophobes

On 60 Minutes last night, the President vowed to take ownership of the health care legislation and its consequences. But he will then need to own the crippling of access to reproductive services for women. And you see a similar dynamic with the arguments over the immigration provisions in the bill. The President was not wrong when he said any bill would not insure undocumented immigrants - he's just wrong to carry out such a spiteful, shortsighted threat.

Consider a few statistics. According to a July article in the American Journal of Public Health, immigrants typically arrive in America during their prime working years and tend to be younger and healthier than the rest of the U.S. population. As a result, health-care expenditures for the average immigrant are 55 percent lower than for a native-born American citizen with similar characteristics. With the ratio of seniors to workers projected to increase by 67 percent between 2010 and 2030, it stands to reason that including the relatively healthy, relatively employable and largely uninsured illegal population in some sort of universal health-care system would be a boon rather than a burden. "Insurance in principle has to cover the average medical cost of all the people it's serving," explains Leighton Ku, a professor of health policy at George Washington University. "So if you add cheaper people to the pool, like immigrants, you reduce the average cost." More undocumented workers, in other words, means lower premiums for everyone.

The actuarial advantages don't end there. As it is now, undocumented workers (and others) who can't pay their way receive free emergency and charitable care—a service that costs those of us with health insurance an additional $1,000 per year, as Obama noted. But if illegals were covered, this hidden tax would decrease, further lowering our premiums and "relieving some of the financial burden on state and local governments," says Harold Pollack, a University of Chicago professor who specializes in poverty and public health. What's more, employers currently have a clear economic incentive to hire undocumented immigrants: they don't require coverage. A plan that mandates insurance for native workers but not their illegal counterparts actually makes life harder on the blue-collar Americans competing for jobs (and railing against immigrants) because it means that hiring them will cost more than hiring a recent transplant from Mexico City. As The Washington Post's Ezra Klein recently explained, "If you're really worried about the native-born workforce, what you want to do is minimize the differences in labor costs between different types of workers. A health care policy that enlarges those differences—that makes documented workers more expensive compared to undocumented workers—is actually worse for the documented workers."

I'd add to this that blunt enforcement mechanisms like what is used in Medicaid cost millions of dollars for almost no material benefit, which even George Stephanopoulos was inclined to point out this weekend. Such systems also tend to weed out legal US citizens without proper documentation. And not letting immigrants participate in the exchanges with their own money, as was floated by the White House over the weekend, completely cuts them off from the individual market and further strains emergency rooms, who will be the doctors of last resort, making this whole spite-based policy grossly more expensive.

(By the way, when some legal resident gets denied coverage because of immigration enforcement provisions, I fully expect Republicans to be the first in line to usher him to a press conference as proof of how government doesn't work.)

Meanwhile, Amanda Marcotte notes that the entire wasteful enterprise to make sure that some alien other never ever gets one dime of the hardworking Murcan taxpayer money ever is a totally moot point:

Mexican migrants working in the United States may soon have their own affordable health insurance program. According to Mexico’s Health Department, it is launching a pilot program designed to encourage migrants who work in the states to sign up for the Mexican government’s Seguro Popular health insurance plan.

In 2003, Mexico set out to achieve universal health care, and from what I understand, they’re on track to reach their goal of doing so by 2012. They’ve done such a remarkable job because they have---you guessed it---a public option that everyone who has a job can buy into. (Except public sector workers, who are covered by a separate insurance system.) They also have a system of federally run clinics to administer to basic health care needs, regardless of employment status. It would be this public insurance that would reach out to migrant workers in the U.S. and encourage them to buy in. Of course, covering bills incurred by Mexican citizens who go to U.S. providers will be very expensive for Mexico, especially since they’ve kept internal health care costs so low. (About 1/3 of what the same procedures cost in the U.S.) Still, it’s both the humane and fair thing for Mexico to do, because migrant workers in the U.S. are good for the Mexican economy, putting billions of dollars into their economy every year. Unfortunately, the economic crisis in America has significantly reduced the average income levels of migrant workers in the U.S., which has impacted the remittance income tremendously. So the Mexican government is starting this pilot program even as immigration is making them less money.

Mexican health care is not an optimal model for the US, but the philosophy behind it is light years beyond what our brigade of idiots in Washington can fathom. Instead, we're jumping through hoops and implementing costly verification systems when Mexican workers can sign up for their home country's public option and never touch any American system to begin with.

If the President wants to "own" these stupid and petty political compromises which benefit his opponents but make no sense from the standpoint of economics or human decency, he'd better be prepared with some good arguments about them. From what I see, naked fear of Republican extremism is leading him to act against the interests of the public.

Both Overreacting And Underreacting

While the WHO raised their pandemic alert to Level 5, the second-highest level, they also significantly lowered the confirmed number of deaths in Mexico from the H1N1 (swine flu) virus.

30 April 2009 -- The situation continues to evolve rapidly. As of 17:00 GMT, 30 April 2009, 11 countries have officially reported 257 cases of influenza A (H1N1) infection.

The United States Government has reported 109 laboratory confirmed human cases, including one death. Mexico has reported 97 confirmed human cases of infection, including seven deaths.

The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (19), Germany (3), Israel (2), Netherlands (1), New Zealand (3), Spain (13), Switzerland (1) and the United Kingdom (8).

Further information on the situation will be available on the WHO website on a regular basis.

In that context, Joe Biden's comments about not allowing his own children to fly on planes or ride on subways seem hyperbolic. But Ezra Klein makes a compelling case that we SHOULD overreact to this possible pandemic.

It's true that the flu is, as of now, not especially deadly. Survival rates are quite high. That's a very good thing. And there's some evidence that this flu will prove mild. Possibly even more mild than a bad flu season. But it's not the end of the story. Influenzas mutate. The question is whether it mutates out of existence or towards lethality. "Towards lethality" becomes more likely if more people catch the flu and thus more mutations emerge. So being aggressive in stopping the spread of the largely non-lethal variant is important if we want to avert the development of a more lethal strain. It's not about stopping this flu. It's about stopping what this flu can become.

But if the flu isn't currently very lethal, it does appear to be extremely infectious. The reason is simple enough: It's a new strain of flu that human beings don't have resistance against. Not only can it spread very quickly, it is spreading very quickly. We've hit five on the World Health Organization's flu threat level. It only goes up to six. Six denotes a pandemic: The flu has spread to two or more WHO regions. And most experts expect we'll be there in days.

It's true that people shouldn't panic in the sense of stockpiling ammunition and duct taping windows. But this is a situation in which a short-term overreaction might be the best strategy. That would mean that people really curtail the sort of activities that abet the spread of infection: They cancel non-essential travel, bike rather than take the subway, wash their hands obsessively, etc. It's not crazy stuff. And unlike in financial crises or recessions, where cutting spending worsens the downturn, the sensible actions for fearful individuals will actually improve the probable outcomes.

I think the media has a responsibility to deliver realistic information, not conservative scaremongering that over-hype the threat and unjustifiably blame illegal immigrants and not what appears to be the central cause, factory farms. And I think there is a responsibility to keep this virus in perspective. At the same time, Klein's warning seems eminently reasonable. We don't have enough information to blow this off completely.

As The Swine Flu Turns

Let's move from Specter, donkeys and elephants, over to swine flu. We're up to 68 cases in the United States and 98 cases outside of Mexico in the rest of the world. We've seen hospitalization here but not as virulent a sickness as in Mexico, where reports show up to 150 dead. The expert at the WHO said yesterday that the spread of the virus cannot be contained, and now we need to work on mitigating its worst effects. And considering that we're starting to see new cases in new countries, that seems correct.

While the WHO has raised the global pandemic alert, they're also keying in on the source of the outbreak.

In Mexico, where the only related deaths have been reported, state health authorities looking for the initial source of the outbreak toured a million-pig hog farm in Perote, in Veracruz State. The plant is half-owned by Smithfield Foods, an American company and the world’s largest pork producer.

Mexico’s first known swine flu case, which was later confirmed, was from Perote, according to Health Minister José Ángel Córdova. The case involved a 5-year-old boy who recovered.

But a spokesman for the plant said the boy was not related to a plant worker, that none of its workers were sick and that its hogs were vaccinated against flu.

Tom Philpott has been all over this since Friday. The Smithfield farms in Perote are thought to have infected the water supply and the atmosphere. Drinking pig shit will tend to do that. Can we finally have this debate about factory farming?

The latest news is that the LA County Coroner is investigating two deaths that may have resulted from swine flu. Obviously this is concerning, but at the same time, the large majority of strains here have been less virulent, and we have no confirmation on this case in LA.

...It's amusing to hear media types talking about how people should stay home from work if they're sick when nearly half of private-sector workers don't have paid sick days. I'm one of them. As a freelancer, I only get paid if I come to work. So if you want to keep America prepared in the event of an outbreak, you have to set up ways for Americans to be able to stay home from work without threatening their financial livelihood. Not to mention the 47 million without health insurance. This highlights the need for a bigger public health safety net.

...John Barry, author of a great book about the deadly 1918 influenza that killed 670,000 in the United States, has a good piece about where the swine flu will strike next.

Why Obama on Legalization Bugs

Just to show that I'm not some drug-addled hippie looking for a safe toke (in fact I've never smoked pot more than once or twice in my life), let's have a slightly more scholarly discussion about reforming our nation's drug laws than the President wants to have. You can even do it without snickering!

I don't think it takes much to convince everyone that the nation's current drug laws have failed, and failed utterly. Don't take my word for it, take the word of the Secretary of State.

Secretary of State Hillary Rodham Clinton traveled to Mexico on Wednesday with a blunt mea culpa, saying that decades of U.S. anti-narcotics policies have been a failure and have contributed to the explosion of drug violence south of the border.

"Clearly what we've been doing has not worked," Clinton told reporters on her plane at the start of her two-day trip, saying that U.S. policies on curbing drug use, narcotics shipments and the flow of guns have been ineffective.

"Our insatiable demand for illegal drugs fuels the drug trade," she added. "Our inability to prevent weapons from being illegally smuggled across the border to arm these criminals causes the deaths of police, of soldiers and civilians."

Let's be extremely clear about what Clinton means by failure. At home we have a policy focused on decreasing demand through law enforcement and incarceration. This has only sent the industry underground, made it more violent, increased the ranks of the jailed in our prisons, which typically provide college-level courses in how to commit violent crime instead of rehabilitation and treatment, and done nothing toward the central task. Abroad, we have a policy of interdiction and eradication, which inflames local populations, again sends the industry underground, makes it more violent, and does nothing toward the central task of decreasing supply.

Charles Lemos links to a CNN report by Jeffrey Miron that goes into this subject in greater detail.

Prohibition creates violence because it drives the drug market underground. This means buyers and sellers cannot resolve their disputes with lawsuits, arbitration or advertising, so they resort to violence instead.

Violence was common in the alcohol industry when it was banned during Prohibition, but not before or after.

Violence is the norm in illicit gambling markets but not in legal ones. Violence is routine when prostitution is banned but not when it's permitted. Violence results from policies that create black markets, not from the characteristics of the good or activity in question.

The only way to reduce violence, therefore, is to legalize drugs. Fortuitously, legalization is the right policy for a slew of other reasons.

Prohibition of drugs corrupts politicians and law enforcement by putting police, prosecutors, judges and politicians in the position to threaten the profits of an illicit trade. This is why bribery, threats and kidnapping are common for prohibited industries but rare otherwise. Mexico's recent history illustrates this dramatically.

Prohibition erodes protections against unreasonable search and seizure because neither party to a drug transaction has an incentive to report the activity to the police. Thus, enforcement requires intrusive tactics such as warrantless searches or undercover buys. The victimless nature of this so-called crime also encourages police to engage in racial profiling.

Prohibition has disastrous implications for national security. By eradicating coca plants in Colombia or poppy fields in Afghanistan, prohibition breeds resentment of the United States. By enriching those who produce and supply drugs, prohibition supports terrorists who sell protection services to drug traffickers.

Prohibition harms the public health. Patients suffering from cancer, glaucoma and other conditions cannot use marijuana under the laws of most states or the federal government despite abundant evidence of its efficacy. Terminally ill patients cannot always get adequate pain medication because doctors may fear prosecution by the Drug Enforcement Administration.

Now that is the argument for legalization. It is not ridiculously popular and I don't think the data even show much of a generational shift yet. But it's not an unserious argument. It's not worthy of snickering. The truth is that, even while opposing the eventual argument for legalization, there are a host of issues that the Obama Administration could tackle, and indeed says they are tackling, to reduce the worst effects of the failed war on drugs. Eliminating mandatory minimum sentencing for nonviolent offenders, as they are moving toward in New York with the repeal of the Rockefeller drug laws, is a start. So would increasing funding for treatment centers, and decriminalizing low-level drug crimes, and ending the raids on perfectly legal medical marijuana centers in the states. While the Obama Justice Department has vowed to do the latter, they forgot to tell someone at the DEA today:

Drug Enforcement agents yesterday raided a medical marijuana dispensary in San Francisco, a week after US Attorney General Eric Holder said federal authorities would no longer prosecute providers that are not otherwise in violation of state laws.

Yesterday, agents raided Emmalyn's California Cannabis Clinic, hauling out plants and growing equipment. The dispensary, which gives out free marijuana to the poor once a week, had a temporary city permit allowing it to operate.

The DEA special agent in charge told the San Francisco Chronicle that Emmalyn's was skirting state laws as well. According to Holder's remarks last week, that would make it a candidate for federal legal action. Also:

A source in San Francisco city government who was informed about the raid said the DEA's action appeared to be prompted by alleged financial improprieties related to the payment of sales taxes. DEA Special Agent Casey McEnry, spokeswoman for the local office, would not comment on that information.

I don't remember the DEA raiding any other business that had a state sales tax issue, ever, in history.

My point is that advocates for legalization, and I'm not entirely one (I believe that there would be a similar issue with advertising and sales to minors as you have with cigarettes), have an argument to make, and it can be handled entirely seriously, with the pros and cons weighed and the final judgment reached. The dismissiveness of the President today is the problem, not his verdict.