Nearly Half of All Americans Avoid Health Care Due to Costs

Courtesy of Forbes comes a depressing yet not entirely surprising report:

Cost continues to be a barrier to treatment with 40% of Americans who say they “skipped a recommended medical test or treatment in the last 12 months due to cost.”Another 32% were “unable to fill a prescription or took less of a medication because of the cost,” the West Health/NORC poll of more than 1,300 adults said.

“The high cost of healthcare has become a public health crisis that cuts across all ages as more Americans are delaying or going without recommended medical tests and treatments,” West Health Institute chief medical officer Dr. Zia Agha said in a statement accompanying the poll results. The survey is being released at this week’s American Society on Aging 2018 Aging in America Conference in San Francisco.

The West Health-NORC poll is the latest national survey showing Americans continued frustration with high healthcare costs even as the U.S. spends more than $3.3 trillion annually on healthcare.

Note that those who skipped doctor’s visits and medication did so despite being sick or injured — such is the state of both the U.S. healthcare system and the national economy.

Also consider the following comparative analysis of maternal healthcare from The Economist:

In 2015, the Lindo Wing [where the third royal baby was born] charged £5,670 ($8,900) for 24 hours in a deluxe room and a non-Caesarean delivery. A survey in the same year by the International Federation of Health Plans found that the average fee for such a delivery in the United States was $10,808. That rises to roughly $30,000 after accounting for care given before and after a pregnancy, according to Truven Health Analytics. Insurers cover most of the cost, but parents are still left with an average bill of about $3,000. In many European countries, free maternity care is available.

A visual of this disparity really drives the point home:

With all the wealth and economic potential of our $18 trillion-plus economy, one would think we could figure out a way to make having a baby, or getting routine treatment at a clinic, more accessible and affordable.

The World’s Most Canny Politician

Running an emerging global power and vibrant democracy would be hard enough without having one of the world’s most oppressive, erratic, and brutal states next door.

Yet South Korean leader Moon Jae In, less than a year into his presidency, has not only governed his prosperous country fairly well (if his stellar approval ratings are any indication), but he’s pulled off an amazing feat virtually no one though possible (much less any world leader): getting North Korea to tone down its bellicose rhetoric, suspend its nuclear program, and express willingness to participate in an historic summit between his nation and the North’s archenemy the United States — the two nations are even setting up a direct hotline between their leaders, which will not only mitigate the likelihood of an escalating conflict, but is a big symbol of the potential for normal relations (and one would hope, eventually reunification). Continue reading

Our Globally Centered Economy

Believe it or not, there is a lot to celebrate about the economy as of late, both here and elsewhere.

The U.S. stock market is going strong, with the S&P 500 at an all-time record. But the German and Japanese markets are up by more, and markets in the U.K., Canada, South Korea, Taiwan, and elsewhere are also seeing record growth.

While the U.S. unemployment rate is the lowest in almost two decades, Japan’s is also the lowest since then, with the U.K. and Germany seeing the lowest rate since the 1970s.

Although America’s GDP growth is above expectations this year, so is Japan‘s and the eurozone’s (the 19 European Union countries that use the euro). In fact, the eurozone grew faster than the U.S. economy, contrary to popular belief about its imminent collapse.

The point of this isn’t to make light of our well needed economic gains, but to point out that our success is part of a broader global trend, and that we depend on numerous other countries and trading blocs to stay afloat.

Without having global partners to serve as our suppliers, consumers, and labor force, we would not be doing so well, and our economy would not be as large and diversified in the first place.

Nowadays, all our biggest and most innovative companies are multinational in character, relying on talented people from across the world to design or create their products (if not run the companies entirely). In such a globalized era, diplomacy is paramount.


How Other Countries Handle Taxes

As I join my fellow Americans in dreading tax day, it is worth reflecting on whether it needs to be this way. Fortunately, the rest of the world provides us with plenty of alternatives and counterexamples.

In an interview with PBS NewsHourT.D. Reid, a former Washington Post columnist, shared insights from his travels across the world in search of a better tax system. (About which he has published a book, A Fine Mess: A Global Quest for a Simpler, Fairer, and More Efficient Tax System.

He starts with New Zealand’s “BBLR” policy: broaden the base, lower the rates. Basically, the government makes everything taxable — from the free parking covered by your employer, to the mortgage you take out for a house, it all counts as income to you and thus you get no tax breaks.

As it turns out, making just about everything potentially taxable end up being a win-win for everyone: because it isn’t losing revenue through various tax breaks and loopholes, the New Zealand government can afford a lower than rate (half that of the U.S.) while bringing more money per capita. Hence it can fund education, universal healthcare, and other public goods without burdening businesses and individuals.

Reid also observed that most New Zealanders subsequently had an easier and quicker time doing taxes: it wasn’t something they had to dread every year.

The blase attitude towards taxes was seen elsewhere as well:

I was in the Netherlands on March 31, the day before their taxes are due.

I was with an executive who makes $200,000 a year, two mortgages, a lot of investments. He’d have to fill out 12 forms in America. I said, Michael, how do you pay your taxes? He pops a beer. He goes online. The government’s filled in every line. If the numbers look right, he clicks OK. It takes five minutes.

And, in Japan, you get a postcard from the IRS that says, we think you made this much. We withheld this much. We owe you a refund of that much. We will put it in your bank on April 1. It takes one minute, if you think the numbers are right.

And I said to my friend Togo, you know, in America, people spend hours, days filling out these forms. And he said to me, why would anybody want to do that?

Reid also points out that the U.S. government could easily do our taxes for us, a proposition that seems unthinkable even though it makes sense upon further reflection. After all, IRS does have the same financial information we do. Dylan Matthews over at expands on this argument further:

Here’s the thing about [tax] forms: The IRS gets them too. When Vox Media sent me a W-2 telling me how much it paid me in 2017, it also sent an identical one to the IRS. When my bank sent me a 1099 telling me how much interest I earned on my savings account in 2017, it also sent one to the IRS. If I’m not itemizing deductions (like 70 percent of taxpayers), the IRS has all the information it needs to calculate my taxes, send me a filled-out return, and let me either send it in or do my taxes by hand if I prefer.

This isn’t a purely hypothetical proposal. Countries like Denmark, Sweden, Estonia, Chile, and Spain already offer “pre-populated returns” to their citizens. The United Kingdom, Germany, and Japan have exact enough tax withholding procedures that most people don’t have to file income tax returns at all, whether pre-populated or not. California has a voluntary return-free filing program called ReadyReturn for its income taxes.

It is interesting how countries most Americans regard as socialist and bloatedly statist actually impose fewer tax burdens on businesses and individuals. It goes to show that you can have it both ways: promote prosocial state policies without sacrificing entrepreneurial freedom — provided you do not have powerful special interests who benefit from the status quo:

So why hasn’t return-free filing happened yet? The short answer is lobbying, and in particular lobbying by companies like Intuit. In 2013, ProPublica’s Liz Day wrote an incredible exposé on just how hard Intuit has lobbied to stop return-free filing from becoming a reality:

[In 2007] a bill to limit return-free filing was introduced by a pair of unlikely allies: Reps. Eric Cantor, R-Va., the conservative House majority leader, and Zoe Lofgren, D-Calif., a liberal stalwart whose district includes Silicon Valley.

Intuit’s political committee and employees have contributed to both. Cantor and his leadership PAC have received $26,100 in the past five years from the company’s PAC and employees. In the last two years, the Intuit PAC and employees donated $26,000to Lofgren.

…In 2005, California launched a pilot program called ReadyReturn. As it fought against the program over the next five years, Intuit spent more than $3 million on overall lobbying and political campaigns in the state, according to Dennis J. Ventry Jr., a professor at UC Davis School of Law who specializes in tax policy and legal ethics.

They haven’t stopped; in 2014, Day reported that Intuit was involved with an astroturfing effort meant to manufacture the appearance of grassroots opposition to automatic filing. Intuit spent $13 million lobbying Congress from 2011 to 2015, with 41 lobbying reports relating to taxes in 2015 alone. Most of the reports reference lobbying to “enhance voluntary compliance” — a euphemism for opposing automatic filing.

In this, Intuit and other tax prep companies had a powerful ally: Grover Norquist. The anti-tax crusader vehemently opposes automatic filing on the grounds that it makes tax season insufficiently nightmarish, which might reduce people’s aversion to taxes and make it easier for politicians to pass tax increases. So even though Ronald Reagan himself supported automatic filing, Norquist has helped make the idea dirt in the eyes of conservative legislators.

All this despite both conservatives and liberals alike supporting return-free tax filing. We can only hope that Americans will soon reach a breaking point after a few more stressful tax days. Then again, maybe our famously anti-tax political culture is, ironically, too used to hating taxes to actually consider streamlining them.

Mexico’s Forgotten World War Two Posters

Mexico hardly comes to mind when one thinks of the Allied powers. But it was one of dozens of countries that joined together to defeat the Axis, doing so just months after the United States.

Following the losses of several ships — most notably the Potrero del Llano and the Faja de Oro, which are referenced in the propaganda — to German U-boats, Mexico declared war on the Axis on May 22, 1942 Though most of Latin America joined the Allied cause, Mexico was one of only two Latin American countries (along with Brazil) to send troops overseas to fight the Axis.

According to, like most countries that participated in the conflict, Mexico sought to mythologize its role with hundreds of posters and political cartoons. To that end, the government commissioned an existing artistic, Taller de Gráfica Popular, which had been founded in 1937, to glorify its role in this just war.

The most famous Mexican contribution was “Escuadrón 201“, also known as the Aztec Eagles, a group of more than 300 volunteer pilots who trained in the United States to fight against Japan. It was the first Mexican military unit trained for overseas combat, and it partook in close to 100 combat missions and nearly 800 sorties.

Mexico also signed a series of agreements with the U.S., known as the Bracero Program, which sent much-needed Mexican labor to the U.S. to support the war economy.

Even though its contributions were small in the grand scheme of things, the efforts of Mexican artists were creatively outsized.

America’s Most Successful Intelligence Agency You Never Heard Of


Compared to the likes of the NSA, CIA, and FBI, the State Department’s Bureau of Intelligence and Research (INR) is hardly a household name.

Of the 16 intelligence agencies that make up the U.S. Intelligence Community (IC), it is the oldest civilian member (created in 1947), yet also smallest and least imposing: it has only 300 staff, lacks satellites and spies, and does not engage in espionage or counterintelligence. INR analysts are typically in their forties and fifties and highly educated (close to three quarters have advanced degrees, of which a quarter hold PhDs). It main duties are to provide diplomats with information and analysis to help facilitate U.S. foreign policy — in other words, the sort of eggheaded, academic stuff most Americans would dismiss as globalist fluff.

Yet the INR is perhaps the most effective and reputable intelligence agency in the country. It originated in the Second World War as the Research and Analysis Branch of the Office of Strategic Services, the precursor to the CIA. Its job was to scour all available sources of information — from academic texts to newspapers — to determine the strengths and weaknesses of the Axis power. It was made up of scholars, historians, anthropologists, political scientists and diplomats — hardly the sort of people that come to mind as militarily useful. (Indeed, its veterans included several presidents of the American Historical Association and the American Economic Association, as well as two Nobel Laureates.)

The R&A proved so pivotal to the war effort, and was held in such high esteem, that when the OSS was disbanded at the end of the war, it was one of the few components to be retained and thereafter transferred to the State Department.

In spite of its small size — a fifth of the 1,500-plus analysts at the CIA, and about a tenth of the 3,000 or so at the Pentagon’s Defense Intelligence Agency — the INR also has the best track record when it comes to the accuracy of its reports. Its bomb damage assessments during the Vietnam War were more accurate than the Pentagon’s; it was skeptical about the U.S. strategy in Vietnam; it warned that allowing the deposed Shah of Iran to enter the U.S. for medical treatment would lead to trouble (the U.S. Embassy was ultimately seized); and it cautioned that a bombing campaign in the former Yugoslavia would not succeed in forcing the Serbs out of Kosovo.

Moreover, the INR was virtually the sole dissenter in the intelligence community regarding the claim that Iraq had an active nuclear weapons program. It also criticized the theory that the Iraq War would bring democracy to the Middle East, warned that Turkey would not allow U.S. troops to cross into Iraq, and casted doubt on the British claim that Iraq was trying to precure uranium from Niger — all of which proved correct.  (Though the INR was still wrong, along with other intelligence agencies, in asserting that Iraq possessed chemical and biological weapons.)

Consequently, the agency escaped the most scathing criticism in the Senate Intelligence Committee’s 2004 report of the IC’s prewar intelligence on Iraq. The Committee also commended the organization as a model for its bigger and better-resourced counterparts. A New York Times piece published at the time noted the small size yet elite nature of the INR’s Iraq team:

Altogether, the team of State Department analysts most directly involved in assessing Iraq’s political structure, economy, conventional military forces and supposed illicit weapons numbered no more than 10 people, said State Department officials, but many had more than a decade of experience in the subjects on which they were focusing.

Those officials refused to identify the analyst whose dissent on Iraq’s nuclear program proved particularly prescient, but said the official had worked on the subject for more than 12 years under a supervisor who had twice as many years of expertise.

Too bad the Secretary of State at the time, Colin Powell, chose to side with the CIA’s (ultimately erroneous) position rather than that of his own bureau.

Remarkably, the INR is also one of the few federal government bureaucracies — especially in the often bloated, unaccountable military-intelligence apparatus — to have shrunk significantly since the 1960s. Its success, in spite of its small size, can be chalked up to the following observation by David Ignatius over at The Washington Post:

But INR’s success story suggests that small is sometimes beautiful. Because it is little, INR tries to maintain an elite reputation. And because it is intimately connected with State Department policymakers, it never loses sight of what the consumers of intelligence actually want: sound judgment.


What the State Department bureau lacks in numbers it makes up in expertise. The average analyst has 11 years of experience in his area of expertise, four times as long as the CIA average, according to a State Department official. Many INR veterans have several decades of experience in their areas of specialization. The Near East South Asia section chief has been analyzing that area for 25 years; the European chief has spent 24 years studying his region. And because the bureau is so small, each analyst has broad responsibility; one person covers all the German-speaking countries in Europe; another has responsibility for all the Scandinavian countries.

The reason INR has been so effective, State Department officials say, is that it has maintained a culture that supports dissent — and demands expertise. “We’d rather be right than quick,” says one State Department official. Within the intelligence community, the State Department’s analysts say they are seen as “malcontents” who demand hard evidence before they sign off on estimates. Their style is to ask: “What are the facts? How much do we know? Does the evidence all point in one direction?”

Indeed, the fact that the INR is one of the few intelligence agencies not to report directly to either the White House or the Pentagon arguably gives it a lot more freedom. As a solely analytical agency, it owes no allegiance to the powers that be, nor to any particular agents; it seeks only to provide the information it has gathered and reviewed, which, as of 2005, included up to two million reports and 3,500 written assessments annually.

Granted, as happened with the Iraq War, this means the INR can easily be ignored for its inconvenient truths. But that does not stop it from at least trying to make U.S. foreign policy an informed and sound enterprise. Plus, it does contribute to the Presidential Daily Briefings, and regularly conducts an honest (if not always heeded) review of other intelligence activities and operations to make sure they conform to U.S. foreign policy interests (such as making sure an espionage action abroad does not damage our relations or destabilize the foreign nation).

It goes to show that for all of Americans’ usual dismissiveness of “Ivory Tower” intellectuals and “globalist” diplomats, they can and do play a useful role for our national interests, and often do a better job than the tougher and “sexier” agencies like the CIA.

To be sure, the INR, like any government institution — and certainly like any member of the U.S. security apparatus — has its flaws and vested interests. Yet its record of being right — and very often ignored — shows that it is something of a freethinking rebel within the IC, willing to say the hard truths regardless of their reception. For what that is worth, more of that is needed in our military-intelligence community.

When Helping People Isn’t “Sustainable”

Count on America’s venal financial class to engage unironic self parody.  According to a recent CNBC report, Goldman Sachs, one of the largest financial institutions in the world, asked whether the use of cutting-edge genetic therapy to cure patients is a “sustainable business model”: Continue reading

Immigrants in U.S. Largely Law Abiding

According to one of the largest and most comprehensive studies of its kind, immigrants in the United States are not only overwhelmingly law abiding, but their increased presence in many communities has mostly correlated with a reduction in crime. From the New York Times:

According to data from the study, a large majority of the areas have many more immigrants today than they did in 1980 and fewer violent crimes. The Marshall Project extended the study’s data up to 2016, showing that crime fell more often than it rose even as immigrant populations grew almost across the board.

In 136 metro areas, almost 70 percent of those studied, the immigrant population increased between 1980 and 2016 while crime stayed stable or fell. The number of areas where crime and immigration both increased was much lower — 54 areas, slightly more than a quarter of the total. The 10 places with the largest increases in immigrants all had lower levels of crime in 2016 than in 1980.

And yet the argument that immigrants bring crime into America has driven many of the policies enacted or proposed by the administration so far: restrictions to entry, travel and visas; heightened border enforcement; plans for a wall along the border with Mexico. This month, the Justice Department filed a lawsuit against California in response to the state’s restrictions on local police to assist Immigration and Customs Enforcement officers in detaining and deporting undocumented immigrants charged with crimes. On Tuesday, California’s Orange County signed on in support of that suit. But while the immigrant population in the county has more than doubled since 1980, overall violent crime has decreased by more than 50 percent.

There’s a similar pattern in two other places where Mr. Trump has recently feuded with local leaders: Oakland, Calif., and Lawrence, Mass. He described both cities as breeding grounds for drugs and crime brought by immigrants. But Oakland, like Orange County, has had increasing immigration and falling crime. In Lawrence, though murder and robbery rates grew, overall violent crime rates still fell by 10 percent.

In general, the study’s data suggests either that immigration has the effect of reducing average crime, or that there is simply no relationship between the two, and that the 54 areas in the study where both grew were instances of coincidence, not cause and effect. This was a consistent pattern in each decade from 1980 to 2016, with immigrant populations and crime failing to grow together.

Continue reading

Executive Bonuses as Motivation

As much of the country laments the demise of Toys R Us — a source of much nostalgia for generations of Americans since the late 1950s — it is worth taking a look at one way the company tried to climb out of bankruptcy just a few months prior: giving its top executives millions of dollars. Quoting a December 2017 article of USA Today: Continue reading

The Fateful Franco-American Alliance

Depiction of the signing of the treaties by Charles E. Mills

On this day in 1778, the United States and France signed two treaties – the Treaty of Alliance and the Treaty of Amity and Commerce – that established strong and perpetual military, economic, and political ties. As the Revolutionary War grinded on, the Patriots realized that they needed diplomatic and military support from abroad to succeed. France was the natural choice, as it was a longstanding rival to Great Britain and the only country that rival its power. Continue reading