I found this item at the Chicago Tribune by Lisa Schenker on the views of the American Medical Association on “Medicare For All” somewhat misleading:

Doctors gathered in Chicago for the American Medical Association’s annual meeting this week are increasingly finding themselves at the uncomfortable center of a national debate over “Medicare for All.”

A group of doctors, nurses and medical students protested the meeting, criticizing the association’s opposition to Medicare for All — the idea of expanding Medicare to cover all Americans. And on Monday, the doctors at the meeting heard a speech by Seema Verma, head of the federal Centers for Medicare & Medicaid Services, a Trump appointee who devoted a chunk of her talk to what she sees as problems with the proposal.

She told the audience, to applause, that Medicare for All would lead to higher taxes, lower payments for doctors and rationing of health care, among other things.

“We are deeply committed to helping those who need it, but while doing that, we must put the patients and their doctors in the driver’s seat to make decisions about their care, not the government,” Verma said.

So far the AMA has stood by its opposition to Medicare for All, also sometimes referred to as a single-payer system, even as it’s become a hot topic ahead of the 2020 presidential race. Democratic candidate Sen. Bernie Sanders, I-Vt., unveiled a bill earlier this year to move to a single-payer health care system. About 56 percent of Americans surveyed earlier this year by the Kaiser Family Foundation said they would favor all Americans getting their insurance from a single government plan.

I think it’s factually accurate but doesn’t really put the matter into perspective. Opposition to health care reform from the AMA in the 1960s almost prevented Medicare and Medicaid from being enacted. Opposition to reform by the AMA in the 1990s sunk the Clinton Administration’s attempt to reform health care as well. The Obama Administration succeeded in getting the Affordable Care Act passed, not the least reason being the payments to physicians written into the act. Paying for reform was instrumental in getting Medicaid passed in 1965, too.

But the AMA is not the powerhouse it was. In the 1950s 75% of physicians belonged to the organization; now 25% do. Ironically, the number of members has not changed a great deal. What has changed is the total number of physicians. In 1960 nearly all U. S. physicians were born and trained in the U. S. Now many are what are called “internationally trained physicians”, many from South Asia.

The other source of the AMA’s power is its custodianship of the Physician Specialty Codes and that it is relied on heavily by the Medicare system to determine the relative value of different procedures. You didn’t think those were determined solely by the federal government or the workings of the market, did you?

I would speculate that physicians are divided on M4A and will remain so. The devil will, of course, be in the details. A version of the plan which cuts reimbursement rates to the Medicare reimbursement rate will probably meet with greater opposition than one that doesn’t but I don’t believe any projection that has shown savings from M4A has ever assumed that reimbursement rates would be left alone.

I wouldn’t be surprised if there isn’t some internecine warfare among different medical specialties as specialists seek to preserve their proportionally higher reimbursement rates, one of the factors that distinguishes the U. S. health care system from European systems.

You know, they say there’s nothing more dangerous than a cornered rat but I can’t help but think that when each of the opposing sides both think they’re winning it’s even more dangerous.

I was going to link to an excellent backgrounder at Mining.com on how China captured the rare earths market. The article is highly critical of China for its methods and the U. S. for becoming dependent on China for strategic materials. The article doesn’t articulate it this way but we’re very much in the position that Germany or Japan was in with respect to oil in the 1930s. From a strategic standpoint Germany had to invade the Soviet Union and Japan had to invade Malaysia. Fortunately, we don’t need to invade anybody to correct our position we just need to get our priorities in order and the article makes some fine, practical suggestions for doing that.

Unfortunately, the site is down. Funny, that.

I’ll link to it if and when it comes back up again.

In the second piece at The Atlantic Peter Beinart is concerned that the Democratic presidential candidates are essentially standing mute on the subject of China:

Trump and Xi Jinping may be leading the world into an era in which money, goods, information, and people flow less freely across national borders than they have for the past quarter century. The headline of a recent op-ed by former German Foreign Minister Joschka Fischer calls this “The End of the World as We Know It.”

How do the major Democratic presidential candidates feel about this potentially epic shift? We don’t really know. They rarely bring it up on their own. Bernie Sanders says nothing about China on his website. Neither do Elizabeth Warren, Pete Buttigieg, Beto O’Rourke, Cory Booker, or Kirsten Gillibrand. All Joe Biden says about China on his website is that it’s “rising.” On hers, Amy Klobuchar pledges to “invest in diplomacy and rebuild the State Department and modernize our military to stay one step ahead of China.” Kamala Harris’s website says the United States should “work in lockstep with our partners” to confront “China’s unfair trade practices.” That’s about as substantive as it gets.

The reason they don’t talk about it is obvious—Democratic voters aren’t interested in it:

To be fair, presidential candidates tend to talk about what voters want them to talk about. And despite Trump’s trade war, Democratic voters are most concerned about health care, education, the environment, and abortion.

The office of the presidency has essentially four responsibilities: chief diplomat, command in chief of the military, managing director of the federal government, and signing bills into law. Democratic voters are primarily interested in that last role, an effective trompe-l’Å“il on the part of the Congress and the media. It is the least important role of the president, the area in which he or, potentially, she is least powerful. The reason for Congressional inaction isn’t mostly the president. It’s bitter factionalization and that the Congress likes it that way.

I was dissatisfied with Donald Trump’s filling of all of the roles of president including as diplomat in chief. So far I think he’s been pursuing the right goals but the results aren’t in yet. Maybe his maximalist, threaten and bluster approach will work. The Democrats need to take stands. It isn’t enough just to do everything the opposite of what your predecessor did.

I’ve run across two articles at The Atlantic that I wanted to bring to your attention. In the first Nick Hanauer confesses that the scales have fallen from his eyes and he no longer believes that education is the solution to all of the United States’s social problems:

However justifiable their focus on curricula and innovation and institutional reform, people who see education as a cure-all have largely ignored the metric most predictive of a child’s educational success: household income.

The scientific literature on this subject is robust, and the consensus overwhelming. The lower your parents’ income, the lower your likely level of educational attainment. Period. But instead of focusing on ways to increase household income, educationists in both political parties talk about extending ladders of opportunity to poor children, most recently in the form of charter schools. For many children, though—especially those raised in the racially segregated poverty endemic to much of the United States—the opportunity to attend a good public school isn’t nearly enough to overcome the effects of limited family income.

As Lawrence Mishel, an economist at the liberal-leaning Economic Policy Institute, notes, poverty creates obstacles that would trip up even the most naturally gifted student. He points to the plight of “children who frequently change schools due to poor housing; have little help with homework; have few role models of success; have more exposure to lead and asbestos; have untreated vision, ear, dental, or other health problems; … and live in a chaotic and frequently unsafe environment.”

There is no amount of spending on education that will make up for those deficits. If your objective, like Mr. Hanauer’s is a more equal society, you should adopt strategies that will result in achieving that. Without making this post booklength let me sugggest two of the most important steps in doing that.

This is the kernel of the piece:

The job categories that are growing fastest, moreover, don’t generally require a college diploma, let alone a STEM degree. According to federal estimates, four of the five occupational categories projected to add the most jobs to the economy over the next five years are among the lowest-paying jobs: “food preparation and serving” ($19,130 in average annual earnings), “personal care and service” ($21,260), “sales and related” ($25,360), and “health-care support” ($26,440). And while the number of jobs that require a postsecondary education is expected to increase slightly faster than the number that don’t, the latter group is expected to dominate the job market for decades to come. In October 2018 there were 1 million more job openings than job seekers in the U.S.

First, remember the rule of holes: when you’re in a hole stop digging. If you have a strategy for a more equal society that can level the society (other than by pushing everyone else down) while as high a percent of the people here have an inadequate command of the English language, have not graduated from high school or the equivalent, and do not have skills that can command a middle class wage as is presently the case, propose it. I would submit that there is none. We must limit the number of self-selected immigrants coming into this country which means changing our immigration laws to a skills-based system and enforcing the border.

Second, keep substitution in mind. In 1830 you and your family could survive with a strong back, the willingness to work, a mule, and a plow. You still can but it won’t support a middle class lifestyle and very few people aspire to that—I would speculate a number approaching zero.

Nowadays a bank can have people with only minimal skills sort their checks or they can invest in automation and the people to run the machines. That’s true in practically every sector of the economy. Jobs can be performed by workers with low skills for which they will receive low wages or they can be performed by fewer workers with higher skills who will be paid more.

The most respected study of the effect of immigrants on wages acknowledged that immigrants compete with the lowest-paid workers, pushing their wages down, but it did not address the issue of substitution at all. The consequence of an endless supply of workers willing to work for minimum or sub-minimum wage is that companies align their workforces accordingly.

Practically speaking, the objective of those who don’t want to control our borders or adopt a skills-based immigration system is a sharply divided class society based on race. Don’t believe them if they say otherwise. They are either fools or knaves.

The second but related thing is that we need to devote more attention and resources to the most basic responsibility of government. Education and health care are very nice things. Preserving order in our cities and enforcing the laws are essential.

At RealClearPolitics Frank Miele complains that Congress’s powers have been stretched beyond anything actually found in the Constitution:

the Constitution does not make clear anything about oversight responsibility. The theory of oversight responsibility in entirely the creation of the judicial branch and is not found anywhere within the four corners of the Constitution. Article I, Section 8, of the Constitution spells out the affirmative powers of Congress, mostly in rather restrictive, finite terms. Congress can borrow money. Congress can establish Post Offices. Congress can punish piracy. Congress can declare war. That sort of stuff. Nothing remotely close to oversight.

That’s because oversight is a so-called “implied” power — not to be confused with an “imaginary” power. It derives, we are told, from the “necessary and proper” clause included at the end of Article I, Section 8. That is also called the “elastic clause” because it has been stretched every which way to expand the power of Congress beyond recognition. Here is the full foundation on which the “oversight powers” of Congress rests:

“To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.”

Search as you will through the “foregoing powers,” however, you will not find any reference to anything remotely like oversight of the executive branch. As a matter of fact, there is absolutely no reference to the executive branch or the president in any of the preceding 17 clauses. Therefore, it cannot be “necessary and proper” for Congress to exercise oversight, nor ultimately does the power “to make all laws” needed to enforce congressional authority have any relevance to the desire of Congress to investigate the president’s private life and business.

and that’s true. Congress’s powers have been stretched beyond anything recognizable. So have presidential powers. The power to declare war does not belong to the president but to the Congress. Additionally, most federal “laws” aren’t laws at all but regulations decided on by executive branch departments. Congress has, unconstitutionally some might say, delegated those powers to the executive branch.

The judicial branch, too, has arrogated powers to itself that the Constitution does not bestow on it. Examples of that include reviews of state laws to determine Constitutionality and extending the Court’s power to areas beyond the federal government’s enumerated powers, areas which have been controversial since the Court rendered its decisions.

Where is all of this power coming from? The answer, uncomfortable as it may be, is that centralized power comes at the expense of state power and individual freedoms. Basically, it’s at our expense.

Okay, a 16 year old kid is pulled over in Manitoba for driving 170km/h in a 100km/h zone. His excuse? Chicken wings:

This 16-year-old’s excuse for going 170 km/h in a Camaro? “Too many hot wings & needed a bathroom”. Fined $966 for speeding + $203 for driving w/o a supervising driver. Absolutely #noexcuses for that kind of speed. #rcmpmb pic.twitter.com/oXe78AAUgc

— RCMP Manitoba (@rcmpmb) June 6, 2019

Offhand I suspect he was probably worse off after having gone to the bathroom. The grand in fines probably didn’t help, either.

ZME Science reports the results of a new paper by Laura Lara-Castor of Tufts’s School of Nutrition Science and Policy on the geographical distribution of beverage preferences:

Some results were pretty intuitive. For instance, consumption of milk was highest in northern Europe — high-income areas in which dairy has traditionally played an important role in the diet, and where a large percentage of the population isn’t lactose intolerant. Juice consumption was highest in Latin America, especially in Colombia (where adults drink an average of 1.4 cups per day) and the Dominican Republic (1.3 cups per day).

Other things, however, left more room for discussion.

Researchers were particularly interested in a particular set of drinks, one which is increasingly being considered a health hazard: sweetened drinks. Intriguingly, Latin America also had the highest consumption of this sort of beverage, with the average Mexican adult drinking 2.5 cups per day, followed by Suriname and Jamaica at 1.8 cups per day. The lowest intake was in China, Indonesia, and Burkina Faso.

Unfortunately, the article doesn’t link to the paper itself, have much more in the way of details, or include a map showing the distribution of beverage preferences. That Latin America has considerable consumption of sweetened beverages doesn’t surprise me. The prevalance of obesity is pretty high there, too.

Michael Bloomberg is an engineer. He should know better. As you may know the former New York mayor has pledged to devote a half billion of his own money to making the U. S. 100% “clean energy”. From his address to the MIT graduating class:

Which is why today I’m announcing that, with Bloomberg Philanthropies, I am committing $500 million to launch a new national climate initiative, Beyond Carbon. Our goal is to move the U.S. toward a 100% clean energy economy as expeditiously as possible, beginning right now. We intend to succeed not by sacrificing things we need but by investing in things we want: more good jobs, cleaner air and water, cheaper power, more transportation options, and less congested roads.

To do it, we will defeat in the courts the Environmental Protection Agency’s attempts to roll back regulations that reduce carbon pollution and protect our air and water. But most of our battles will take place outside of Washington. We are going to take the fight to the states and cities — and directly to the people. And the fight will take place on four main fronts.

First: We will push states and utilities to phase out every last U.S. coal-fired power plant by 2030 — just 11 years from now.

The Chinese authorities have already announced their intention of increasing the number of coal-fired power plants by 43%. That means that no matter what we do carbon emissions will rise. Rather than going to war with domestic coal our efforts should be dedicated to reindustrializing the United States and encouraging our other trading partners to do the same and stop buying from China. Short of actual shootin’ war it’s the only course of action that would achieve the objective of reducing emissions in the timeframe under discussion. Have I mentioned that there is no such thing as a “clean” ocean freighter?

And his next target is natural gas:

Second: We will work to stop the construction of new gas plants. By the time they are built, they will be out of date because renewable energy will be cheaper.

Other than nuclear energy and fuel cells there are presently no ways to generate enough electricity to power an industrial economy other than with coal and/or natural gas.

That’s where the analogy with the Apollo program founders. The physics of sending a man to the moon was known. We developed the engineering skill to do it through the Apollo program. It’s the opposite with so-called “clean energy”. It’s the physics that’s the problem.

We don’t know how to store enough hydrogen to make fuel cells really practical at scale. We have pushed battery technology very nearly to its physical limit.

Fundamental breakthroughs in physics are not like city buses. They don’t run on a schedule. It may not be possible to make fuel cells practical at scale or achieve the improvements in battery technology that would be required.

Let me ask this. At the present rate of adoption, how long would it take for the entire U. S. passenger vehicle fleet to be plug-in electrics? The answer is never. If 100% of vehicles sold were electrics, it would take 20 years for the fleet to turn over. The present number of electrics in use is 2% of the fleet. Between 2017 and 2018 the number purchased annually increased 80%. IMO that was almost entirely driven by the Tesla 3. In 2019 it’s increased by 10%, the smallest increase since the number actually declined a few years back.