At U. S. News & World Report Brian Riedl does a darned good job of explaining why we must cut health care spending in an op-ed that is largely a series of one-liners, e.g.

The problem is not tax revenues (they will continue growing above historical averages), nor other spending programs (Social Security is the only other major category growing as a share of the GDP).

Rather, health care is devouring the budget.

[…]

For context, the entire federal budget has remained around 20 percent of GDP for the past 50 years. Each percentage point of the GDP translates into $190 billion, or $1,500 per household. So that overall growth from 3 to 9.3 percent of GDP would eventually require a permanent tax increase of $9,450 per household – a figure that would rise with incomes each year.

Federal spending cannot grow faster than the economy indefinitely. At some point, something has to give. And the “easy solutions” are fool’s gold:

Cut defense? It is already on track to fall from 4.7 to 2.7 percent of GDP between 2010 and 2027 – leaving it at 1930s levels.

Tax the rich? The amount of annual income earned over the $1 million threshold currently totals 4.4 percent of GDP – one-third of which is already paid in federal taxes. At most, an additional one percent of GDP could be extracted before exorbitant marginal tax rates begin changing taxpayer behavior, harming the economy and costing revenue.

Single-payer health care? Sen. Bernie Sanders’ 2016 proposal was scored as adding $32 trillion in new costs over the decade, in part because American proposals avoid the sacrifices and limitations that other countries mandate.

Just keep borrowing? According to the CBO baseline, the resulting national debt would bring crushing interest costs that eventually bankrupt the federal government.

[…]

Finally, lawmakers should not forget a Medicare system that currently collects $140,000 in lifetime taxes from the typical retiring couple and then provides them with $422,000 in benefits (all adjusted into net present values).

Unfortunately, his implicit proposals for lowering the costs don’t accomplish that. What would accomplish that? A single-payer system might reduce costs by trimming administrative costs. Then again they might not. I think that administrative costs are higher here than anywhere else in the world because of low social cohesion, lack of trust, and general acquisitiveness, none of which will be changed by a single-payer system. In other words I think our administrative costs are higher because our administrative costs are higher.

What would cut costs? Abandoning the fee for services system, making providers accountable for outcomes, and cutting total payrolls within the health care sector would do it. Very few have shown any enthusiasm for any of those measures let alone all of them at once.

A fully market-driven health care system would accomplish it, too, but lack of willingness to accept that is what got us into the fix in which we find ourselves in the first place. It would mean that the poor receive little health care and the elderly would be penurized by their care.

At this point the greatest likelihood is that every single one of the bad consequences that Mr. Riedl lists in his op-ed will actually come to pass. That will continue as long as patients demand more care than they’re able to pay for and providers demand more money than we can afford.

I found this backgrounder by Ankit Panda at The Diplomat on the several border disputes between India and China very interesting. You might as well.

This marks the first in a series of articles I’ll be authoring for The Diplomat outlining the various elements of this standoff. Though I’ll elaborate in successive articles, the dispute began in early June when Chinese People’s Liberation Army (PLA) engineers began constructing a road near the Indian border on a piece of territory disputed between China and Bhutan. India, perceiving this as an unacceptable change to the status quo with potentially serious strategic ramifications, crossed a settled and undisputed international border with its troops to block the PLA contingent from proceeding. The Chinese government was apoplectic about what it saw as an Indian incursion across a settled border into Chinese territory (in reality, disputed with Bhutan) and has given an ultimatum to New Delhi that no diplomatic solution can be found until Indian troops unilaterally withdraw from what Beijing sees as Chinese territory. India, in the meantime, is not budging. Both sides are gridlocked and tensions are rising.

I don’t believe that the most likely dispute that could result in the use of nuclear weapons is between North Korea and the United States. I think it’s either a dispute between India and Pakistan or between India and China.

far away from us. According to this article by Scott Clifford and Spencer Piston in the Washington Post, that’s the explanation for the approach that cities like Los Angeles, Seattle, and Portland have taken towards the homeless. Rather than being motivated by compassion they are motivated by disgust:

In the spring, voters in Los Angeles decided to raise their own sales taxes to alleviate homelessness. Other large American cities — including not just Los Angeles, but also Seattle and Portland — have joined in declaring homelessness a state of emergency in the past couple of years.

But that concern is complicated by a quite different attitude: disgust. In a recent article, we show that disgust helps explain why even though many Americans support increased government aid to homeless people, they also support laws that effectively make homelessness a crime. What’s more, the news media’s approach to reporting on homeless people can activate disgust, increasing public support for policies that make it difficult for the homeless to pull themselves out of poverty and get off the street.

What would policies actually structured to deal with the problems of homelessness be like? I would suggest a four-pronged attack. First, we need a very different attitude towards mental illness. Something between a quarter and a half of the homeless are mentally ill. The mentally ill poor need safe, humane residential settings where they can receive treatment. The deinstitutionalization movement began about 50 years ago and was one of those rare confluences between compassion and cost savings. It’s time to recognize that we made a mistake and rectify it. The streets are a less humane solution than asylums not a more humane one.

The second prong is economic activity. We need more economic activity and the jobs that it brings.

The third prong is zoning. Zoning should be changed to require all new high rise construction to include some defined proportion of residential space. The cities that have done so, e.g. Toronto, have seen increases in the availability of affordable housing.

The fourth prong is demanding that every able-bodied adult of sound mind should work. Some proportion of the homeless are people who just like living rough and don’t want to work. That should not be tolerated.

It wasn’t lost on me that the New York Times published a hit piece on macaroni and cheese on National Mac and Cheese Day. In other news there’s a National Mac and Cheese Day? The blog of the American Council on Science and Health has sharply criticized the piece. Basically, the article had nothing to do with mac and cheese; it was alarmist, exaggerated unscientific criticism of the product’s packaging and the same thing could have been written about kale:

The New York Times really stepped in it yesterday.

An article on the “dangers” of macaroni and cheese was so insanely wrong that it’s hard to believe it was in the paper at all.

But the author was Roni Caryn Rabin, who, although not a scientist, has written about health issues for more than 20 years. And she has done a lot of fine work. But this article was so deeply flawed and filled with scare tactics that it comes across as little more than an anti-chemical screed against a group of ubiquitous chemicals called phthalates.

This incident serves as a point of departure into any number of topics. For example, what the piece makes clear is the harm that hiring J-school grads has done to newspapers. When I was in college before the glaciers descended and dinosaurs ruled the earth, journalism majors were required to take arts and sciences minors. Nearly all took minors in either English or political science. There were no math or science requirements. In fact J-school is where you went if you wanted to avoid not just math and science but anything with even the slightest hint of rigor (like history). Why would you have a J-school grad write about health or science?

I could also jog into technocracy. It’s a bizarre sort of technocracy that avoids actual expertise in favor of faux expertise.

But where I want to land is on why newspapers are losing the confidence of the American people. When every conceivable subject is saturated with propaganda, ideology, and scare tactics, what in the world do you expect?

I encourage you to read the article at Snopes.com, “The Lies of Donald Trump’s Critics, and How They Shape His Many Personas”. Half-truths, grotesque exaggerations, and flat out lies are doing more harm to Trump’s critics than they are to Trump. They’re shaking our confidence in our system more than the Russians ever could.

On top of it why lie? Isn’t the truth bad enough?

Speaking of junk status, S&P has reduced the city of Hartford, Connecticut’s bond to junk status. The Hartford Courant reports:

Standard & Poor’s downgraded Hartford debt to junk bond status late Tuesday, less than a week after the financially troubled capital city hired a New York law firm with expertise in restructuring municipal finances.

The Wall Street ratings agency downgraded most city of Hartford outstanding debt to BB, a level that’s classified as speculative, also known as non-investment-grade, or junk, from BBB-. That reflects a strong possibility that Hartford could default on its debt or renegotiate it to pay bondholders less money.

That’s bad news for the erstwhile Insurance City. Moody’s reduced its credit rating to junk back in October. Both ratings agencies continue to have the city on credit watch.

Can bankruptcy or whatever the equivalent for cities in Connecticut is be far away?

The irony of this should not be ignored. On a per capita basis Connecticut is the richest state in the Union.

It’s alive! This article at IEEE Spectrum on a project to synthesize videos of Barack Obama using a neural net along with video and audio clips from President Obama’s speeches highlights a point I’ve been making for years. The time when it becomes practical to make new movies starring deceased actors isn’t that far away.

Want to see Ronald Reagan playing Rick in Casablanca? Believe it or not that was the original casting. Groucho Marx as Rhett Butler (purportedly author Margaret Mitchell’s vision of the character)? Meryl Streep as Ripley in Alien? She was considered before Sigourney Weaver.

Or a new Star Wars sequel featuring the late Carrie Fisher as Leia? The ability to do any of these is just on the horizon. It’s been more than ten years since the image of the late Laurence Olivier appeared in Sky Captain and the World of Tomorrow.

you had heard of all of the threats to European peace, one you hadn’t been watching emerges. Check out this piece at RealClearWorld on how a Greater Albania, yes Albania, threatens Eastern European peace.

I recommend you read George Friedman’s analysis of Chinese policy at RealClearWorld. Note in particular his map of China which highlights factors of which too few Americans are aware, in particular the relatively narrow slice of the country along the coast where its population is concentrated. Here’s a snippet:

In the event there was an economic falling out with the U.S., China had to consider the possibility of a military confrontation. But the key issue was the ability to guarantee China’s access to sea lanes. In this, China had a major geographic problem. The South and East China seas are ringed with small islands, spaced in such a way that passage between them can be blocked with relative ease. The U.S. Navy is far superior to the Chinese navy, and the Chinese were concerned that in some unforeseen crisis the U.S. would block access to their much needed sea lanes. Those small islands were now at the center of Chinese national interest. The Chinese could claim the entire region, but they were not in a position to seize it.

At the same time, the Chinese devised a political solution to their strategic problem. If a country like Indonesia or the Philippines aligned with China instead of with the United States, access to the global sea lanes would be assured without having to confront the United States. The problem here is that the two strategies undermined each other. Aggressive assertion of Chinese power in the regional waters and finding accommodation with regional powers were inconsistent approaches. What’s more, they could only work if the United States was not present. And, of course, it was.

China had one other option for getting around potential U.S. actions: creating an alternative export route through Asia to Europe. This was the One Belt, One Road concept. But it, too, was flawed. First, the cost of building the requisite infrastructure was staggering. Second, it would run through countries that were unstable and, for the Chinese, unimportant customers. Add to that the speed with which One Belt, One Road needed to be enacted, and this was more posturing than policy.

China, therefore, is caught in a set of interlocking problems. Its economic miracle has matured into more normal growth rates. It has a vast population that lacks the ability to consume all that it produces. It has to contend with global stagnation and competition from other producers – and competing with high-tech producers is no small task. It is therefore afraid of internal instability and has imposed a dictatorship designed to maintain a vibrant economy without social costs.

Read the whole thing. These are the sorts of things that I’ve been referring to when I write about China’s internal contradictions and why I’m not overly concerned about China. China has plenty of problems of its own to deal with. The One Child policy has meant that their military is composed largely of only children who are the sole support of their elderly parents. It’s a military much better suited for projecting power internally than externally. The rapid industrial development without adequate civil infrastructure, i.e. political and legal, has resulted in air, soil, and water pollution of resources that are vitally needed. And so on.

But that also explains why the Chinese are inclined to ignore the North Koreans. They have so many problems of their own.