5 questions every presidential candidate should answer: ISIS edition

While the roots of the Islamic State of Iraq and the Levant (ISIL, ISIS, Daesh) may predate the Iraq War, it was its rapid conquest of Mosul, Tikrit and other Sunni Arab-populated areas in Iraq that brought it to the forefront of the policy debate. At first, the White House dismissed ISIS as “the jayvee team.” As, however, the group consolidated control, forced the Christian community to flee their homes, enslaved Yezidis, declared a caliphate and threatened both Baghdad and Erbil, US policymakers refined their policy. On September 10, 2014, President Obama announced a new strategy “to degrade and ultimately destroy” the Islamic State. Nearly a year later, however, ISIS remains in control of large swaths of both Iraq and Syria, and will probably continue to control significant territory into the next administration. How candidates answer the following questions should elucidate how they understand the Islamic State, the threat it poses, and what strategy the United States should pursue:

 

An Iraqi helicopter flies over a soldier in Husaybah, in Anbar province July 22, 2015. Iraqi security forces and Sunni tribal fighters launched an offensive on Tuesday to dislodge Islamic State militants and secure a supply route in Anbar province, police and tribal sources said. Reuters

 Who was responsible for the rise of the Islamic State?

Foreign fighters might have flocked to Iraq and Syria, but were they alone responsible for the rapid rise of the Islamic State inside Iraq? Would the Islamic State have taken hold had the United States not precipitously withdrawn from Iraq? At the same time, could the Islamic State have succeeded in seizing Mosul, Tikrit, and other territories without the buy-in of some Sunni tribesmen, Baathists, and veterans of the Saddam-era Iraqi army? Subject to debate, however, is this: whether Prime Minister Nouri al-Maliki’s sometimes sectarian policies precipitated the Sunni Arab Iraqis’ rejection of Baghdad, or whether ideological refusal to accept the empowerment of Shi‘ites preordained Sunni cooperation with the Islamic State. The question of motivation is important. To believe political grievances to be responsible for the rise of the Islamic State implies that the resolution of those grievances, for example with a more magnanimous policy in Baghdad, would undercut Sunni support for the Islamic State. However, it would not explain the rise of the Islamic State in an exclusively Sunni country like Libya, nor the resonance that Abu Bakr al-Baghdadi’s call for a caliphate has had with foreign fighters from more than 90 countries. Regardless, should Baghdad make concessions to Sunnis under fire?

Likewise, while sectarianism is an issue, is the root of sectarian discord Shi‘ite discrimination against Sunnis, or rather Sunni rejection of Shi‘ite political power? Who, for example, has been responsible for dozen of car bombings in Baghdad, both before and after the rise of the Islamic State? Could cooperation between senior Baathists and the Islamic State suggest that Iraqi Shi‘ite leaders were right all along that re-integrating Baathists into the government would pose a security risk? The Sunni tribes might not have been alone in having enabled the rise of the Islamic State. The Kurdistan Regional Government (KRG) may have provided some weaponry to the Islamic State,  in order to use them as a means to weaken the Maliki government (with whom the KRG was locked in contentious negotiations.) This raises a broader question about whether the KRG is committed to defeating the Islamic State entirely, or merely driving it out of territory the Kurds hold or seek. The answer to this impacts the nature of US aid and assistance.

 Should the United States directly arm the Kurds and the Sunni tribes?

After the Iraqi Army withdraw from Fallujah in the face of a withering Islamic State assault, Secretary of Defense Ashton Carter suggested the problem was that the Iraqi army lacked the “will to fight.” That may not have been accurate, but critics are right to point out that, after the United States spent upwards of $20 billion training a new Iraqi army, many of its top officers not only initially fled the advance of the Islamic State but they also abandoned their equipment to it. Against the backdrop of the Iraqi Army’s failures, the rise of the often sectarian Hashd al-Shaabi (Popular Mobilization Forces), and the accusations (often false) that the Iraqi government has prevented supply of weaponry to the Kurds, many analysts and US politicians argue that the United States should directly arm Sunni tribes and the Kurdish Peshmerga.

So, would you supply weaponry directly to the Sunni tribes and Peshmerga? How would you ensure that Sunni tribes and Kurdish political parties actually use the weaponry for its intended purpose? After all, the Kurdistan Regional Government has largely stockpiled the weaponry it has received for political reasons, the reason why many Sunni tribes have defected to the Islamic State. What would this mean for Iraqi unity? And what impact would such a strategy have on the willingness of the Iraqi central government to work with the United States? Otherwise put, might direct provision of weaponry to Sunni tribes actually exacerbate sectarianism by giving pro-Iranian factions in Baghdad a populist advantage? Just as important, what strategies would you suggest for decommissioning the newly-armed tribal and Kurdish units (or Shi‘ite volunteers) after fighting ends?

 Is Iran a partner?

Increasingly, U.S. airpower seems to support with Iranian-backed militias fighting the Islamic State. While the defeat of the Islamic State might be a noble goal, is it wise to coordinate with Iranian-backed militias as opposed to the more centralized Iraqi army? While the United States and Iran might share the goal of the Islamic State’s defeat, at what point do their interests and vision diverge for a post-Islamic State order in Iraq? What are the disadvantages of working with Iran in Iraq?

 Will ground troops be necessary to defeat the Islamic State?

Air power has been central to President Obama’s strategy to defeating the Islamic State, but it has failed to achieve its goals. While the Islamic State has suffered some setbacks, the territory under its control is now larger than when the president announced the beginning of an air campaign. Will US ground troops be necessary to defeat the Islamic State? If so, how many and what types of ground forces should return to Iraq, and what should their mission be? Should an Authorization for the Use of Military Force in Iraq be written narrowly to prevent mission creep, or should it provide American forces re-inserted in Iraq with expansive powers?

 Can the United States live with the Islamic State?

This may sound like a ridiculous question , but in many ways it represents the elephant in the room. So, under your administration, would you seek to eradicate the Islamic State in its entirety and, if so, under what time frame? Or would you be satisfied with containing the Islamic State? Would your goal be to eradicate the Islamic State in Iraq only, or would any comprehensive strategy also have to address the safe-haven the Islamic State has found in Syria? In other words, is victory in Iraq possible without also addressing the chaos emanating from within Syria?

 

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Lessons for Social Security reform from Canada: Part 2

Canadian parents save less for retirement than Canadians without kids. And it’s probably deliberate.

In my previous column, I focused on a new study from Canada’s Fraser Institute, which found that when taxes were increased to help fund the Canada Pension Plan (CPP), Canadian households reduced their own personal saving on a nearly dollar-for-dollar basis. That result implies that expanding Social Security, or simply even raising taxes to keep it solvent, might reduce the non-Social Security savings that Americans put aside to help support themselves in retirement. If so, expanding Social Security won’t necessarily mean expanding retirement incomes.

But the Fraser Institute paper, authored by Charles Lammam, François Vaillancourt, Ian Herzog and Pouya Ebrahimi, shows something else interesting, with regard to gauging Americans’ overall readiness for retirement: how households with children save for retirement compared to households without kids.

As I recently argued, the broad goal of retirement saving is to allow a person to enjoy the same standard of living in retirement as they had during their working years. In this context, parents should save less for retirement than non-parents, because part of parents’ pre-retirement incomes goes toward supporting their kids. In other words, you don’t need to replace a standard of living that you never had.

I pointed to research from two University of Wisconsin economists showing that a household with two kids will hold about 10% less wealth than a similar household without kids, and other research from the RAND Corporation’s Suzanne Rohwedder showing that in retirement, people who’d had kids report being just as financially secure as retirees who didn’t have kids. Together, these results indicate that parents may be rationally saving less than non-parents. Studies that don’t account for how children affect retirement saving will find parents to be disproportionately under-prepared for retirement and help foster the perception of a “retirement crisis.”

The Fraser paper adds to that argument. In analyzing how Canadian households’ personal saving reacts to changes in pension tax rates, the authors had to control for a number of factors – including whether the household had children. The Fraser study finds that, all other things equal, for each child a household’s saving rate drops by about 3.5 percentage points. That’s a pretty big difference, but if parents saving for retirement are seeking only to replace their own pre-retirement consumption, not the income that was consumed by their children, it’s a difference that doesn’t matter very much.

Again, this hints at the possibility is that many of the Americans who we believe are causing a retirement crisis through their inadequate saving are doing precisely what they should do and will end up satisfied with the results. If so, a massive overhaul of the U.S. retirement system, such as by expanding Social Security or setting up government-run retirement plans, isn’t what we need. Instead, policymakers should focus on targeted policies for the groups that truly do seem to be underprepared for retirement – such as single, less-educated women. I’ll talk more about what we can do for such groups in a future piece.

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Middle-class incomes haven’t been flat for 30 years. In fact, here’s why they may have doubled

When economists — and the Obama White House — talk about middle-class income stagnation, they are often referring to Census Bureau data showing median household income — adjusted for inflation — rose less than 10% from 1984 through 2013, just less than 0.3% per year. That stinks.

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But those statistics just don’t pass the smell test. Anyone over the age of 35 or so knows Americans are substantially better off than they were 30 years ago. Economist (and former head of the National Bureau of Economic Research) Martin Feldstein helpfully digs into the data:

The official Census estimate suffers from three important problems. For starters, it fails to recognize the changing composition of the population; the household of today is quite different from the household of 30 years ago. Moreover, the Census Bureau’s estimate of income is too narrow, given that middle-income families have received increasing government transfers while benefiting from lower income-tax rates. Finally, the price index used by the Census Bureau fails to capture the important contributions of new products and product improvements to Americans’ standard of living. … With the traditional definition of money income, the CBO found that real median household income rose by just 15% from 1980 to 2010, similar to the Census Bureau’s estimate. But when they expanded the definition of income to include benefits and subtracted taxes, they found that the median household’s real income rose by 45%. Adjusting for household size boosted this gain to 53%.

So 53% is a lot more than 10%. But even that number may underestimate the rise in American buying power due to how we measure inflation:

The authorities arrive at their estimates by converting dollar incomes into a measure of real income by using a price index that reflects the changes in the prices of existing goods and services. But that price index does not reflect new products or improvements to existing goods and services. Thus, if everyone’s money incomes rose by 2% from one year to the next, while the prices of all goods and services also rose by 2%, the official calculation would show no change in real incomes, even if new products and important quality improvements contributed to our wellbeing. Indeed, the US government does not count the value created by Internet services like Google and Facebook as income at all, because these services are not purchased. No one knows how much such product innovations and improvements have added to our wellbeing. But if the gains have been worth just 1% a year, over the past 30 years that would cumulate to a gain of 35%. And combining that with the CBO estimate of a gain of about 50% would imply that the real income of the median household is up nearly 2.5% a year over the past 30 years.

If I am mathing this out right, real median incomes rising 2.5% a year for 30 years means real median incomes have more than doubled. If you invested $100,000 for 30 years at 2.5% interest, the investment would be worth $210,000 three decades hence. And here is more on how our productivity and inflation measures are having a hard time with America’s IT economy.

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Think about this: The US ranks 46th in how easy it is to start a company

The White House this week gave some welcome focus to the unhelpful rise of job licenses. In “The land of free markets, tied down by red tape,” the FT’s Gillian Tett notes that issue but also highlights the difficulty in starting a business here:

Every nation needs a unifying idea. Americans love to see themselves as champions of free markets and entrepreneurial zeal — and have long been more welcoming to entrepreneurs than has most of the western world. But the 2008 financial crisis tarnished America’s self-image (with, for example, the eyesore of state support for mortgages). The entrepreneurial halo is starting to slip, too, since increasing quantities of red tape are making life harder for start-ups, relative both to the past and to the rest of the world. …  The process of securing these licences is often so costly and cumbersome that one recent study estimated costs for consumers at $200bn a year. More importantly, licences deter many would-be workers — and entrepreneurs.

A separate World Bank report is even more sobering. Last year it ranked countries according to their levels of support for the corporate world. This placed America in seventh place in terms of overall ease of doing business. But the US was ranked 46th — yes, 46th — in terms of how easy it is to start a company. This is worse than Estonia, Malaysia, Georgia and even France.

One important reason for this dismal position is that in America entrepreneurs need, on average, to navigate six different legal and regulatory hurdles to start a company. In New Zealand and Canada, which top the league, there is just one procedure. The complexity faced by Americans means that it takes them on average about six days to create a start-up; in many other countries the process is much faster and cheaper.

Of course, this World Bank league does not tell the whole tale. The American national average conceals significant geographical variations because it is municipalities that set many of the business rules. Thus research by Thumbtack, a West Coast website that connects consumers with local businesses, and the pro-entrepreneurship Kauffman Foundation shows that it is much easier to start a company in Texas than, say, California. Moreover, red tape is only one factor that determines start-up activity; what also matters is whether there is access to capital and a culture of respect for entrepreneurs.

I address the issue of startups and US economic dynamism in my new “Room to Grow” monograph, “Startups and Entrepreneurship.”

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Iran deal aftermath: Wolfowitz on Fox Business Network’s ‘Cavuto Coast to Coast’

Scholar Paul Wolfowitz discusses the next steps for the Iran deal and more Clinton emails being released on Fox Business Network's 'Cavuto Coast to Coast.'

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Lost Decade? The US is about to have its first 10-year period since World War II with at least one year of 3% growth

Two views of the anemic US economy. For starters, you have the Labor Department’s employment-cost index, a broad measure of workers’ wages and benefits. It rose just 0.2% in the second quarter from the first quarter. That marked the smallest quarterly gain since record keeping began in 1982. On a year-over-year basis, the ECI increased 2.0% in 2Q, “the softest gain in about a year,” notes JPMorgan. And the private sector was particularly weak, not rising at all. Gains could only found in government work.

Moreover, real GDP growth in the first half rose at a mere 1.5% annual pace. (Also, the economy’s annual growth rate over the past two years was downgraded to 2% from 2.3%.) The economy would have to experience a pretty powerful surge to hit 3% growth for the year, something it has not done since 2015. Yup, a Lost Decade — at least as measured by not hitting 3% growth, about the postwar average. Bloomberg: “The economy would have to grow at a 4.75-percent rate during the final two quarters of 2015 to reach 3 percent for the year. A recent Bloomberg survey of 70 economists found that the median forecast for the remainder of the year was for GDP of 3 percent.”

Just another sign that 2015 is not shaping up to be the Year of Acceleration, as many economist anctipated. Same-old, same-old stagnation. Bloomberg reporter Peter Gosselin offers three reasons: First, recessions driven by financial crisis and housing collapse produce weak recoveries. New home sales are still only at a third of 2005’s level. Second, the economy is less efficient as evidenced by lackluster productivity growth. “Labor Department figures show that productivity growth peaked in 2002, well before the economy slowed and contracted.” Third, there’s the decline in entrepreneurship, which may be affecting productivity growth. Census data  show “that among U.S. firms, the share that are young — less than a year old and with at least one employee — has fallen from 11 percent in the early 1990s to 10 percent early in the last decade to 8 percent early in this decade. Meanwhile, the fraction of firms that are 16-years-old or more has gone from 23 percent to 29 percent to 35 percent.”

But, but, but … what if there is more this story, as I explore in my new The Week column:

Think about it: Month after month, the economy is generating about a quarter million net new jobs. The unemployment rate is close to 5 percent. Corporate profit margins are at record highs, with stock values not far behind. And Silicon Valley is on fire. A new TechCrunch analysis finds that the number of unicorns — technology startups valued at over $1 billion — has more than doubled since 2013. Europe would love to have a “stagnant” economy like America’s. …

It’s a puzzle for which Goldman Sachs has a simple answer: We are measuring productivity wrong, and therefore we are measuring GDP wrong. A metric devised for America’s 1930s “steel-and-wheat” economy, in the words of economic historian Joel Mokyr, doesn’t work so well for a rapidly growing digital economy. In a recent report, Goldman economist Jan Hatzius and Kris Dawsey note that prices of tech hardware — adjusted for quality improvements — have fallen a lot faster than those for software. This suggests software isn’t improving much. But Goldman thinks this gap is a “statistical mirage” reflecting the “amorphous” nature of software improvements.  …

As the Goldman economists reckon, then, U.S. inflation is lower than we think due to sharply falling, “quality adjusted” IT hardware and software prices — and thus real economic growth and productivity are higher. GDP growth might actually be close to 3 percent right now, which would be more in sync with what’s happening in labor markets and the tech sector. Oh, and it also means real incomes are growing faster than we think, which is why the economists are “skeptical of confident pronouncements” that American living standards aren’t improving as fast as they used to. By the way, new analysis by the Peterson Institute suggests worker incomes have pretty much been keeping up with productivity gains. So perhaps more good news for the 99 percent.

Goldman could be wrong, of course. It is a debate I have been blogging about (see below). And either way, we hardly have policy that is optimal for innovation, productivity, and growth. To  make sure we avoid the Great Stagnation, we need the Great Optimization.

Is America really suffering a ‘great stagnation’? Why Goldman Sachs is skeptical

Why JPMorgan says the US economy is stuck in ‘the slow lane’

Is there really a Great Stagnation? The problem of measuring economic growth in America’s digital economy

Goldman Sachs says the US economy could be growing a lot faster than GDP stats say. Here’s why

 

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Hedge fund snake oil for Puerto Rico

The prospects for an early resolution to Puerto Rico’s debt crisis do not appear to be good. For judging by this week’s report commissioned by hedge fund owners of Puerto Rican bonds, the hedge funds seem to be arguing that Puerto Rico does not have a government debt problem. Indeed, they appear to be arguing that all that Puerto Rico needs to do is to fully implement the budget austerity and structural reform measures suggested by the recent Krueger report (commissioned by the Puerto Rican government) and all would be well on the island.

The hedge fund report, commissioned from a group of former International Monetary Fund (IMF) economists and entitled with the misnomer “For Puerto Rico, There is a Better Way,” is seriously flawed. It bases its conclusions on its idiosyncratic interpretation of the Krueger report. It does so by asserting that if that report’s recommendations of severe budget austerity and structural reform were fully implemented, Puerto Rico’s government deficit problem would disappear and its government debt problem would be resolved.

Yet somehow the hedge fund report overlooks the fact that the Krueger report found that even if all of its recommendations would be strictly implemented, Puerto Rico’s government would still have a very large unfunded financing gap. Indeed, the Krueger report estimated that over the next 10 years, even if all of its recommendations were to be implemented to the letter, Puerto Rico’s financing gap would amount to around 30 percent of the government’s debt servicing obligations. That finding led the Krueger report to explicitly state that debt restructuring would have to be part of the solution to the island’s government debt problem.

Full text of this article can be found at TheHill.com.

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America’s economy is doing much better than you think

You could be forgiven for thinking that America’s disappointing economic recovery is even worse than we thought.

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After all, GDP growth, adjusted for inflation, increased at an annual average of just 2 percent over the past two years, according to revised government figures released Thursday. That’s down from the prior 2.3 percent estimate, which itself was pretty lousy. And so far this year, growth has been even weaker, just a 1.5 percent pace.

By comparison, average GDP growth since World War II has been just over 3 percent, and 4 percent for the average post-1960 recovery. No wonder some economists think the Great Recession has given way to the Great Stagnation.

Unless it hasn’t. What if things are actually a lot better than we think — or at least better than GDP figures suggest?

Learn more:

• 100 years later, here’s how to make the Fed stop wrecking the US economy

Think about it: Month after month, the economy is generating about a quarter million net new jobs. The unemployment rate is close to 5 percent. Corporate profit margins are at record highs, with stock values not far behind. And Silicon Valley is on fire. A new TechCrunch analysis finds that the number of unicorns — technology startups valued at over $1 billion — has more than doubled since 2013. Europe would love to have a “stagnant” economy like America’s.

So why then do the all-important GDP numbers — the broadest measures of economic activity — show a perpetual funk? As The Week’s Ryan Cooper explained earlier this week, measured U.S. productivity growth has been terrible during the recovery. And if output per worker isn’t rising much, if at all, GDP growth is bound to be weak, too. Even worse, productivity growth has been subpar since 2004, giving little sign that the supposed IT revolution — apps, big data, digital content, social networks — is having much economic impact.

Learn more:

• Here's a bit of good news about the US economy -- and some really bad news

It’s a puzzle for which Goldman Sachs has a simple answer: We are measuring productivity wrong, and therefore we are measuring GDP wrong. A metric devised for America’s 1930s “steel-and-wheat” economy, in the words of economic historian Joel Mokyr, doesn’t work so well for a rapidly growing digital economy. In a recent report, Goldman economist Jan Hatzius and Kris Dawsey note that prices of tech hardware — adjusted for quality improvements — have fallen a lot faster than those for software. This suggests software isn’t improving much.

But Goldman thinks this gap is a “statistical mirage” reflecting the “amorphous” nature of software improvements. Hatzius and Dawsey ask: “How much better are the inventory management systems that retail companies contract out or develop for their own account compared with those of 20 years ago? How much better is Grand Theft Auto V than Grand Theft Auto IV? And how much more value do we now derive from our internet connection compared with a decade ago?”

Learn more:

• America's increasingly irrelevant 'unemployment rate'

As the Goldman economists reckon, then, U.S. inflation is lower than we think due to sharply falling, “quality adjusted” IT hardware and software prices — and thus real economic growth and productivity are higher. GDP growth might actually be close to 3 percent right now, which would be more in sync with what’s happening in labor markets and the tech sector. Oh, and it also means real incomes are growing faster than we think, which is why the economists are “skeptical of confident pronouncements” that American living standards aren’t improving as fast as they used to. By the way, new analysis by the Peterson Institute suggests worker incomes have pretty much been keeping up with productivity gains. So perhaps more good news for the 99 percent.

Now, even if Goldman’s analysis is dead on, it doesn’t mean policymakers should sit on their hands. For the U.S. economy to grow as fast in the future as it did in the past, it will require even faster productivity growth to offset slowing population growth. That means deep reform of our tax, regulatory, and education systems. It means more public investment in infrastructure and science. And a lot more of those unicorns.

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New York Times: The right minimum wage is $0.00 per hour

From the New York Times editorial “The Right Minimum Wage: $0.00“:

There’s a virtual consensus among economists that the minimum wage is an idea whose time has passed. Raising the minimum wage by a substantial amount would price working poor people out of the job market. A far better way to help them would be to subsidize their wages or – better yet – help them acquire the skills needed to earn more on their own.

An increase in the minimum wage would restore the purchasing power of bottom-tier wages. It would also permit a minimum-wage breadwinner to earn almost enough to keep a family of three above the official poverty line. There are catches, however. It would increase employers’ incentives to evade the law, expanding the underground economy. More important, it would increase unemployment: Raise the legal minimum price of labor above the productivity of the least skilled workers and fewer will be hired.

If a higher minimum means fewer jobs, why does it remain on the agenda of some liberals? A higher minimum would undoubtedly raise the living standard of the majority of low-wage workers who could keep their jobs. That gain, it is argued, would justify the sacrifice of the minority who became unemployable. The argument isn’t convincing. Those at greatest risk from a higher minimum would be young, poor workers, who already face formidable barriers to getting and keeping jobs.

The idea of using a minimum wage to overcome poverty is old, honorable – and fundamentally flawed. It’s time to put this hoary debate behind us, and find a better way to improve the lives of people who work very hard for very little.

MP: In case you’re in shock hearing the NY Times editorialize against the minimum wage, check the publication date of the editorial. It was back in an era when even the NY Times editorial board had a grasp of basic economics.

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Huckabee’s Hitler comparison that wasn’t

It’s been a hard time for politicians not named “Trump” to get any attention, but Mike Huckabee managed it. He did it by comparing Barack Obama to Adolf Hitler.

Republican presidential candidate Mike Huckabee speaks to the 42nd annual meeting of the American Legislative Exchange Council in San Diego, California July 23, 2015. Reuters

At least that’s what I gathered from headlines like this one from Gawker:

“Mike Huckabee Compares Obama to Hitler”

I don’t put huge amounts of stock in Gawker headlines (or really any headlines on the Internet), but then I saw that CNN’s Wolf Blitzer said Huckabee had “essentially likened [Barack Obama] to Adolf Hitler.” National Journal’s Ron Fournier went on a tear on Twitter, insisting that Huckabee apologize for comparing Obama to Hitler. And of course, Hillary Clinton and Obama himself denounced Huckabee for making a Hitler comparison. Clinton even said she was “really offended personally,” as if her feelings are what really matters.

Here is what Huckabee said in full during an interview with Breitbart News:

This president’s foreign policy is the most feckless in American history. It is so naive that he would trust the Iranians. By doing so, he will take the Israelis and march them to the door of the oven. This is the most idiotic thing, this Iran deal. It should be rejected by both Democrats and Republicans in Congress and by the American people. I read the whole deal. We gave away the whole store. It’s got to be stopped.

Now, I’ve never been a big fan of Huckabee’s style of politics — or policy. But a remotely fair reading of the statement strongly suggests that Huckabee was comparing Obama to Neville Chamberlain or some other member of the “Hitler is a man we can do business with” school. That’s the point of calling Obama “naive” for trusting the Iranians — the Hitler in Huckabee’s analogy.

Learn more:

• 5 questions every presidential candidate should answer: Iran deal edition

We can parse more deeply if we must. Hitler didn’t march Jews to the doors of the ovens, but into them. The Iranians are the ones with sinister intentions in Huckabee’s description, not Obama, who, again, is described as naive and feckless, not sinister and evil. Huckabee probably shouldn’t have used the word “march” because it muddies his point. “Delivered to” or “abandoned at” would have worked better.

I think, as a general rule, one should pretty much always avoid talking about Jews and ovens unless discussing the actual Holocaust. And one could argue that Huckabee, who insists he never compared Obama to Hitler, was cynically hoping to be misconstrued in order to get some media attention — which he got.

But on the merits, Huckabee isn’t saying anything that lots of serious people haven’t said, albeit more eloquently. In countless speeches, Bibi Netanyahu and other Israeli leaders have stressed that the legacy of the Holocaust is such that Israel cannot take a chance on Iran having a nuclear weapon.

Learn more:

• A lousy Iran deal

In his address to Congress in March, Netanyahu movingly singled out Holocaust survivor and Nobel Prize–winner Elie Wiesel from the audience. “Elie, your life and work inspires to give meaning to the words, ‘never again,’” Netanyahu said to bipartisan applause. “And I wish I could promise you, Elie, that the lessons of history have been learned. I can only urge the leaders of the world not to repeat the mistakes of the past.”

What mistakes? Precisely the mistakes Huckabee says Obama is making. It’s the same argument.

And it’s not a dumb argument. At least it’s not a dumb argument if you listen to the Iranians. As my National Review colleague David French recently catalogued, Iranian civil, military, and religious leaders have for years vowed to “wipe Israel off the map,” deliver a new Holocaust (while denying the first one happened), etc.

Learn more:

• Congressional Republicans have already capitulated on Obama’s disastrous Iran deal

Hassan Nasrallah, the leader of Iran’s pet terrorist group, Hezbollah, has said, “If all the Jews gathered in Israel, it will save us the trouble of going after them worldwide. . . . . It is an open war until the elimination of Israel and until the death of the last Jew on earth.” Until that time, Hezbollah has had to make do with killing Jews where they find them.

Barack Obama, Hillary Clinton, and John Kerry don’t take the Iranians at their word when they say they want to kill Jews, no matter how clearly and consistently they say it. But they trust the Iranians to stick to their word on this nuclear agreement (which would be a bad agreement even if Iran could be trusted).

George W. Bush was routinely compared to Hitler with a fraction of the outcry Huckabee has received. Perhaps that’s because Huckabee’s real sin has nothing to do with Hitler analogies and everything to do with Iranian reality.

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Quote of the day from ‘The Conservative Heart’

As he concludes his book, “The Conservative Heart,” AEI President Arthur C. Brooks calls on his fellow conservatives to show America their true colors and — by winning hearts, elections, and debates — to promote free enterprise in our nation and the world:

The world needs us to stop losing. There are too many people in America who are being left behind. There are too many people overseas who don’t enjoy the benefits of democratic capitalism and free enterprise. There are too many people everywhere who have been denied the happiness that comes with earned success. Those people need us. If we want the chance to help them, we’ve got to improve the way we make our case to the American people.

We have to share what is written on the conservative heart.

Natalie Runkle is an AEIdeas intern.

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New polling problems for Hillary Clinton: Thiessen on Fox News’ ‘The Kelly File’

Fellow Marc Thiessen discusses Hillary Clinton's email scandal on Fox News' 'The Kelly File'

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NBCUniversal is expected to make big investments in BuzzFeed and Vox Media

You might have heard: Comcast’s NBCUniversal was scouting out several new media companies as it tries to reach younger audiences who watch less traditional television (Wall Street Journal)

But did you know: NBCUniversal is close to a deal to invest $250 million in BuzzFeed. It’s also expected to invest in Vox Media in a deal that could value Vox at $850 million. The investments in BuzzFeed and Vox Media are part of an effort by NBCU CEO Steve Burke to invest in digital outlets that reach Millennial audiences that aren’t paying attention to NBCU’s TV networks. Kara Swisher and Peter Kafka write: “The idea is that NBCU can get a crash course on digital content and distribution from its new investments — and that those companies may want to distribute some of NBCU’s content as well.”

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How news organizations integrate Slack into their workflow

Work chatroom software Slack is breaking down walls in newsrooms between editorial and product teams, Laura Hazard Owen writes. Vox Media product director Lauren Rabaino says that using Slack keeps everyone’s workflows and projects transparent, but it also fosters a sense of camaraderie across teams. Fusion editor-in-chief Alexis Madrigal says: “You can get immediate feedback on something, but if someone comes into the room later, they might be able to add something, whereas if you didn’t go to a [physical] meeting, you’re not going to be able to contribute later.”

+ Our plan for enabling innovation through newsroom culture changes includes creating virtual spaces through internal chat systems such as Slack that create greater accessibility and shared awareness

The post How news organizations integrate Slack into their workflow appeared first on American Press Institute.

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Trinity Mirror tests an ad format that asks users to interact with an ad halfway through an article

Trinity Mirror is experimenting with “FreeWall,” an ad format that asks users to interact with an ad halfway through an article before they can read further. Users on both desktop and mobile will be asked to interact with the FreeWall ads, and they can continue reading free of charge afterward. FreeWall ads will be shown to users once a month in exchange for free access to content for the next month. Trinity Mirror’s strategy director Piers North says one of the goals of FreeWall is to monetize its mobile audience better.

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Why Vine became part of the entertainment industry rather than ‘Instagram for video’

When Vine launched two years ago, it was expected to be the “Instagram for video,” but it’s ended up more as part of the entertainment industry as it attracts content creators who are looking to entertain rather than share parts of their life. With that shift, Vine has changed its focus to support those creators as well as users who are interacting with Vines rather than posting their own. Among the changes Vine has released that focus on viewers’ experience is a feature called “favorites” that sends users push notifications when accounts they follow publish new Vines and optimizing the app for high-quality video despite the upload times.

+ Earlier: How newsrooms used Vine in its first year

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Why NPR is having an internal debate over cursing on-air

While many news organizations wrestle with how to deal with coarse language, NPR is in the midst of an internal debate on how to handle vulgar or profane language. Its use of profane language could not only upset listeners but get it into trouble with the FCC, Paul Farhi writes. NPR’s basic rules say to avoid using obscene language on-air or in podcasts except when it’s conveying something newsworthy and only then when it’s fully bleeped out, but some at NPR have objected to the policy. Nina Totenberg says in a memo to NPR staff: “In life and death battles, it really would distract and sound stupid to bleep out such language. We expect it in such situations.”

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Why NPR is having an internal debate over cursing on-air

While many news organizations wrestle with how to deal with coarse language, NPR is in the midst of an internal debate on how to handle vulgar or profane language. Its use of profane language could not only upset listeners but get it into trouble with the FCC, Paul Farhi writes. NPR’s basic rules say to avoid using obscene language on-air or in podcasts except when it’s conveying something newsworthy and only then when it’s fully bleeped out, but some at NPR have objected to the policy. Nina Totenberg says in a memo to NPR staff: “In life and death battles, it really would distract and sound stupid to bleep out such language. We expect it in such situations.”

The post Why NPR is having an internal debate over cursing on-air appeared first on American Press Institute.

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How mobile ad blocking in iOS 9 may force a shift by web advertisers and publishers

When print advertising began to change, print newspapers were forced to evolve, Charles Arthur writes, and web publishers may be forced to do the same once mobile ad blocking is available in Apple’s iOS 9. Arthur says the future of digital advertising may be in the form of sponsored content: “If the site generates the ad, it’s suddenly a lot harder to block.”

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Need to Know: July 31, 2015

Fresh useful insights for people advancing quality, innovative and sustainable journalism

OFF THE TOP

You might have heard: Comcast’s NBCUniversal was scouting out several new media companies as it tries to reach younger audiences who watch less traditional television (Wall Street Journal)

But did you know: NBCUniversal is expected to make big investments in BuzzFeed and Vox Media (Re/code)
NBCUniversal is close to a deal to invest $250 million in BuzzFeed. It’s also expected to invest in Vox Media in a deal that could value Vox at $850 million. The investments in BuzzFeed and Vox Media are part of an effort by NBCU CEO Steve Burke to invest in digital outlets that reach Millennial audiences that aren’t paying attention to NBCU’s TV networks. Kara Swisher and Peter Kafka write: “The idea is that NBCU can get a crash course on digital content and distribution from its new investments — and that those companies may want to distribute some of NBCU’s content as well.”

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+ Noted: Gannett’s new CEO says it’s “aggressively pursuing” large-market acquisitions, as well as smaller markets of at least 500,000 people if part of a purchase of a larger media group (Wall Street Journal); Shorenstein Center report says conservative media pushes the Republican Party further to the right (Shorenstein Center); NowThis’s new app Tap for News eliminates the need to decide what news to read by showing users a red button that they can tap to watch “a collection of very lightly curated 15- to 30-second videos on topics ranging from breaking news to science to entertainment” (Nieman Lab)

API UPDATE

The week in fact-checking
As part of our fact-checking journalism project, Jane Elizabeth highlights stories worth noting related to truth in politics and on the Internet. This week’s round-up includes how a newspaper learned to appreciate its eagle-eyed fact-checking reader, creative ways that fact-checking organizations are bringing in money, and a Twitter fact-checker who corrects bad information when he has some free time.

TRY THIS AT HOME

How news organizations integrate Slack into their workflow (Nieman Lab)
Work chatroom software Slack is breaking down walls in newsrooms between editorial and product teams, Laura Hazard Owen writes. Vox Media product director Lauren Rabaino says that using Slack keeps everyone’s workflows and projects transparent, but it also fosters a sense of camaraderie across teams. Fusion editor-in-chief Alexis Madrigal says: “You can get immediate feedback on something, but if someone comes into the room later, they might be able to add something, whereas if you didn’t go to a [physical] meeting, you’re not going to be able to contribute later.”

+ Our plan for enabling innovation through newsroom culture changes includes creating virtual spaces through internal chat systems such as Slack that create greater accessibility and shared awareness

OFFSHORE

Trinity Mirror tests an ad format that asks users to interact with an ad halfway through an article (The Drum)
Trinity Mirror is experimenting with “FreeWall,” an ad format that asks users to interact with an ad halfway through an article before they can read further. Users on both desktop and mobile will be asked to interact with the FreeWall ads, and they can continue reading free of charge afterward. FreeWall ads will be shown to users once a month in exchange for free access to content for the next month. Trinity Mirror’s strategy director Piers North says one of the goals of FreeWall is to monetize its mobile audience better.

OFFBEAT

Why Vine became part of the entertainment industry rather than ‘Instagram for video’ (Fast Company)
When Vine launched two years ago, it was expected to be the “Instagram for video,” but it’s ended up more as part of the entertainment industry as it attracts content creators who are looking to entertain rather than share parts of their life. With that shift, Vine has changed its focus to support those creators as well as users who are interacting with Vines rather than posting their own. Among the changes Vine has released that focus on viewers’ experience is a feature called “favorites” that sends users push notifications when accounts they follow publish new Vines and optimizing the app for high-quality video despite the upload times.

+ Earlier: How newsrooms used Vine in its first year

UP FOR DEBATE

Why NPR is having an internal debate over cursing on-air (Washington Post)
While many news organizations wrestle with how to deal with coarse language, NPR is in the midst of an internal debate on how to handle vulgar or profane language. Its use of profane language could not only upset listeners but get it into trouble with the FCC, Paul Farhi writes. NPR’s basic rules say to avoid using obscene language on-air or in podcasts except when it’s conveying something newsworthy and only then when it’s fully bleeped out, but some at NPR have objected to the policy. Nina Totenberg says in a memo to NPR staff: “In life and death battles, it really would distract and sound stupid to bleep out such language. We expect it in such situations.”

SHAREABLE

How mobile ad blocking in iOS 9 may force a shift by web advertisers and publishers (The Overspill)
When print advertising began to change, print newspapers were forced to evolve, Charles Arthur writes, and web publishers may be forced to do the same once mobile ad blocking is available in Apple’s iOS 9. Arthur says the future of digital advertising may be in the form of sponsored content: “If the site generates the ad, it’s suddenly a lot harder to block.”

FOR THE WEEKEND

+ “Death of a young black journalist”: Charnice Milton was a 27-year-old local journalist in D.C. who was killed on her way home from an assignment by a bullet aimed at someone else, remembered as a shy but intrepid journalist committed to covering her native southeast D.C. community (New Yorker)

+ Why science can’t trust journalism: Felix Salmon writes that the science world is extremely open about how they come to their conclusions and collect their data to allow replication, but no one in journalism is transparent about how their articles are created and no one tries to replicate anything (Fusion)

+ “The illusion of audience ownership is becoming harder to sustain”: John Herrman says as a single Facebook video can get more traffic than a week’s worth of a news site’s content, it’s becoming clear who audiences really belong to (The Awl)

+ A laid-off journalist started a Facebook group to help other journalists in similar situations figure out their “Plan B,” and it now has more than 2,600 members who share job openings, news of coming layoffs, and stories of how they’ve moved on from journalism (Poynter)

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Medicare beyond age 50: Lessons for the future

As Medicare reaches age 50, we see periodic signs of limited efforts to move beyond its youthful exuberance as a full-fledged pay-as-you-go, fee-for-service, universal entitlement program and toward a somewhat more market-oriented direction. Most notably, the last decade since the passage of the Medicare Modernization Act of 2003 has produced rapid growth in enrollment in Medicare Advantage private plan options. Over 30% of Medicare beneficiaries are enrolled in these more market-based alternatives to the traditional Medicare fee-for-service program. Give or take 50 years, that might be considered modest progress in moving back toward a path not taken by Medicare’s original architects, even as they needed to maintain more of a “private market” face to cover such an unprecedented expansion of the federal government’s role in health care financing and regulation.

A 40^th anniversary article on Medicare in the winter 2005-2006 issue of Health Care Financing Review by Edward Berkowitz of George Washington University provides an excellent summary of the key history, including several options discarded along the way to final enactment of Medicare:

• In somewhat earlier congressional efforts to enact a Medicare compromise proposal in 1962, Senator Jacob Javits (R-NY) helped to negotiate a feature, accepted by the Kennedy administration, which allowed elderly people with private health insurance coverage to keep their coverage. Medicare would reimburse the private carriers for benefits that coincided with those covered by the program.
• In 1964, Representative Wilbur Mills (D-AR), the chairman of the Ways and Means Committee and chief legislative architect of the final Medicare law, asked the Social Security Administration to develop a plan that allowed the use of the Blue Cross^® plans to administer hospital insurance and Medicare’s billing operations as “fiscal intermediaries.” This served the initial political objective of keeping the federal government removed from getting involved in the routines of health care finance. (But not for long!)
• In further debate over proposed Medicare legislation in 1964, Javits also proposed the creation of what he termed “complementary private health insurance” for elderly individuals. His goal was to limit the federal role to covering the costs of hospitalization and skilled nursing home care, while covering doctors’ bills and outpatient care through what he described as “…low-cost private insurance plans to be developed on a nonprofit, tax-free basis with special provision for concerted selling and risk pooling.”
• Under another consumer-choice proposal by then-Representative and future New York City mayor John Lindsay (R-NY), elderly beneficiaries could either accept government health insurance, to be run by the States, or a private health care plan. If they chose the private health plan, they would receive an increase in their social security benefits.
• Some portions of these concepts actually were incorporated in the Johnson administration’s Social Security proposals at the end of 1964 and the beginning of 1965, but they faced opposition from many Democrats. They ultimately took the more limited form of a “voluntary” Medicare Part B program for non-hospital medical costs, funded equally by beneficiary premiums and general revenues.

The final Medicare legislation of 1965 delivered a comprehensive public entitlement program for almost everyone age 65 and above, instead of more targeted assistance to more vulnerable seniors that might have relied primarily on subsidized private markets. Younger taxpayers were conscripted to cover most of the higher costs that followed. As they say, the rest is history. It offers some useful lessons in comparing Medicare’s past with the possible future of the five-year-old Affordable Care Act (ACA) version of “Obamacare.”

First, temporary supermajorities in Congress can have a longer lasting impact by enabling enactment of unique legislation that institutionalizes sweeping changes in national policy and then becomes hard to modify significantly for decades. The 89^th Congress of 1965 and the Johnson administration had far greater leeway to overcome past resistance to the role of the federal government in health policy and the practice of medicine after winning landslide victories in the 1964 election. Even though those supermajorities in Congress and popular support for Great Society initiatives eroded substantially within a few years (see, e.g., Vietnam War, civil unrest, etc.), the key elements of a vastly expanded welfare state fueled by entitlement programs – including Medicare – took root and largely remain (in somewhat modified form) five decades later.

Lesson: Repealing and replacing Obamacare is not going to happen quickly or easily, or even substantially, without much more concerted effort and detailed strategy than opponents have displayed thus far.

Second, economic cycles are not simplistically predictive of political ones, but big swings in either direction matter. Medicare was propelled ahead during an optimistic era of rapid economic growth that assumed few limits to future prosperity. Obamacare was pushed through the national political arena in the midst of the Great Recesssion and economic pessimism about the future of the USeconomic system.

Lesson: Economic cycles can drive political change when they accentuate major electoral swings that favor incumbent officeholders (during good times) or depose them (during suddenly disruptive downturns). The Obama administration did not “let a good crisis go to waste,” even if doing so subsequently cost it control of both houses of Congress.

Third, opportunities to address chronic national policy problems in more market-based directions need to be advanced more aggressively and positively before the effective window for action closes. Just saying no and minimizing concerns eventually loses out to the political impulse to do something, even if it’s not well-designed or effective. A sad reflection on the stance of conservative political leaders in the early 1960s is that only the limited efforts of a handful of more moderate/liberal Republicans serving in Congress at that time tried to deflect the full force of a government-centric mass entitlement program like Medicare, rather than just offer what became largely rearguard resistance that failed to offer anything more attractive.

Lesson: The time to provide better alternatives when major health policy issues are framed for national debate is sooner, not later. Next time, critics of the ACA must bring something more than shallow alternatives to Obamacare to the national debate and insist on earlier, consequential votes on them on Capitol Hill. Just winning subsequent elections and then finding excuses for further delay and inaction won’t ever accomplish substantial policy reversals when it comes to health care entitlement programs.

Fourth, states failed to step up the plate in the early 1960s after passage of the Kerr-Mills program, which then added strength to the case for a more nationalized Medicare program approach. It’s 50 years later and conservatives are still counting on (red) state governments to help fill national policy vacuums and handle complex issues that Washington policymakers can’t, or won’t, resolve. How much has changed since 1965?

Lesson: Delegation to state government officials and decentralized decision making will need to become more realistic and accountable, and less rhetorically evasive, to succeed.

Fifth, we are no longer living with all of the illusions of the 1965 Great Society vision. Even the ACA debate of 2009-2010 acknowledged some of the limits of taxpayer resources and the federal government’s administrative machinery. (But not all of them, to be sure). Obamacare discarded early gestures toward a public option. The ACA targeted its still-massive subsidies to only the relatively lower-income portion of the population, rather than spread them across the board. ACA dollars primarily flowed through privately owned entities, albeit in hopes of coopting them politically. The ACA even pretended to achieve budget neutrality. Unfortunately, it tried to achieve this balancing act through accounting tricks, regulatory coercion, poorly disguised tax hikes, and improvisational administrative rewrites of the law that transcended past legal bounds.

Lesson: American political culture still seems to prefer choice and competition – even in health care matters – that is channeled more comfortably through mechanisms that look more private than public, and recognize that resources are not unlimited. However, establishing clear alternatives to Obamacare will require a stronger case for less generous, needs-based targeting of public subsidies and development of robust market alternatives that work better and more transparently. Those elements were not sufficiently on hand when Medicare was enacted.

Finally, our political system not only takes a long time to enact major policy changes that implement national programs like Medicare and the ACA. It then also takes far too long to reconsider and modify them substantially, let alone fully replace them. But we really don’t have any more years left to truly begin fixing more comprehensively the chronic problems and imbalances first launched in 1965, as well as those started in the ACA just five years ago.

I’m still looking forward to celebrating the first anniversary of that more important achievement, hopefully far sooner than today’s milestone took to reach.

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Double standard for e-cigarettes vs. medical marijuana

Did you read about the new review paper on medical marijuana published in the prestigious Journal of the American Medical Association? In case you missed it, the paper gave a less-than-ringing endorsement of marijuana’s therapeutic benefits.

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I was surprised by the anemic media coverage. It should be of national interest given that 23 states, in addition to the District of Columbia, have legalized medical marijuana. According to the JAMA findings, many of the conditions for which medical marijuana is being officially used, from spasticity associated with multiple sclerosis to sleep disorders, are supported at best by either “moderate quality” data — as the report put it — or “low quality” data across the 79 randomized, placebo-controlled trials reviewed by researchers.

I found only CBS News and Reuters covered the report as hard news and the Denver Post published an editorial (“Moment of Truth for Medical Marijuana”). These are big outlets, to be sure, but they are conspicuously modest in number. By contrast, the media can be relied upon to cover potentially harmful effects of vaping. In January, for instance, the New England Journal of Medicine published a report entitled “Hidden Formaldehyde in E-Cigarette Aerosols.”

Media coverage ensued: “E-cigarettes Can Churn out High Levels of Formaldehyde,” read the NPR headline. “E-cigarettes can Produce More Formaldehyde than Regular Cigarettes,” warned the Los Angeles Times. “Before You Vape: High Levels of Formaldehyde Hidden in E-Cigarettes,” cautioned NBC News. “Study Links E-Cigarettes to Formaldehyde, Cancer Risk,” said The Wall Street Journal. The Baltimore Sun, Associated Press (appeared in Washington Post), Reuters (appeared in Scientific American), and CBS News also picked up on the NEJM report.

The NEJM authors’ notable conclusion was that vapers are endangered by formaldehyde in the course of normal use. More specifically, the authors showed that when a vaping device was heated at high voltage settings – that is, overheated — the emitted vapor contained the carcinogen formaldehyde at five to 15 times the concentration found in cigarette smoke.

But – and this is key — no user would ever actually heat an e-cigarette high enough to produce the recorded levels of formaldehyde in the study. The resultant vapor (known as a “dry puff”) would be intolerably irritating to the throat. Indeed, when the NEJM researchers tested the same device at a voltage level normally used by vapers, they detected no formaldehyde.

Then, in May, a study in Addiction confirmed that formaldehyde in vapor poses no danger at normal heat settings. Toast is a handy analogy here. “Most toasters have a setting which burns the toast to a crisp,” wrote Peter Hajek of the London School of Medicine and Dentistry in Addiction. “Although burned toast contains carcinogen, it is highly unlikely that New England Journal of Medicine would publish a paper demonstrating this and warning people that toasts are carcinogenic.”

I could find no mention in the mainstream media of the Addiction study, however, apart from the comment sections of specialty medical or vaping blogs. Like the unfashionable JAMA paper on medical marijuana, which ran counter to the generally benign national attitude towards marijuana, the reassuring article on formaldehyde did not jibe with the growing view that vaping is somehow harmful. While no strong, organized lobby opposes medical marijuana, such vocal and visible entities as the Centers for Disease Control, the California Department of Health, the American Lung Association and the Campaign for Tobacco Free Kids routinely denounce e-cigarettes, insisting that the devices will renormalize smoking in society and serve as a “gateway” to smoking for teens. To date, the vast bulk of evidence regarding smoking and vaping patterns suggests that neither fear has materialized.

And it’s not just a media double standard for medical marijuana and e-cigarettes that exists. The government has just made it somewhat easier for researchers to explore the effects of medical marijuana use, while nothing has been done to make clear a path to conduct randomized clinical trials on difficult e-cigarettes as therapeutic (i.e., smoking cessation) devices.

In mid-July, the Obama administration moved to facilitate randomized clinical trials research on medical marijuana by lifting the burdensome requirement that researchers submit study proposals to the U.S. Public Health Service for review. This step in the four-step research-approval process, it turns out, added another layer of review that contradicts an FDA review requirement. The streamlining will help a bit, although other hurdles (e.g. obtaining marijuana samples for the study from the National Institute on Drug Abuse ) do remain.

Meanwhile, the route to randomized clinical trials research on e-cigarettes remains blocked.

Let’s say, for example, a researcher wants to learn if people with schizophrenia, a population which smokes at triple the rate of the general population, succeed in switching partially or completely to vaping. The researcher is stuck. Why? Because in order to compare e-cigarettes to other forms of cessation interventions, the FDA requires an Investigational New Drug (IND) application. And completing the application requires the researcher to submit information on the chemistry of e-liquid as well as manufacturing and control information. Gathering these data is time consuming, if doable at all, given the scores of producers, many of whom are based overseas.

If researchers cannot investigate e-cigarettes as a smoking cessation tool, experts cannot definitively respond to one of the major objections of critics who claim e-cigarettes have no demonstrated therapeutic effect. There is massive evidence from individual smoker self-reporting that e-cigarettes enable users to quit smoking or to cut down markedly–a recent example is here–but few rigorous or realistic head-to-head comparisons with patches and gum.

Last February, a group of four research organizations, including the American Association for Cancer Research and the International Association for the Study of Lung Cancer, wrote a letter to then-FDA Commissioner Margaret Hamburg protesting this Catch-22. “This regulatory hurdle makes clinical research with most if not all commercially available products impossible because scientists do not have access to the required information that would allow them to obtain IND applications,” they wrote. Studies already approved by NIH review committees and in some cases funded by the NIH or FDA, cannot move forward.

So we find ourselves in an environment where research on e-cigarettes, a technology with the potential to spur a transformation in tobacco smoking is being stymied, and where news of its promise is considerably less headline-worthy than dubious evidence of its harm. Yes, marijuana, too, may have therapeutic value–we simply need better quality evidence. Too bad e-cigarettes don’t enjoy the same good will and favorable press coverage that, for better or worse, has been bestowed on marijuana.

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Medicare at 50: Did it solve the right problems without creating new ones?

Today’s 50^th anniversary salutes to the enactment of the Medicare program on July 30, 1965 will emphasize how much Medicare changed the world of health insurance coverage and medical care for Americans over age 65. A closer look at the program’s origins and early history certainly confirms its primary accomplishments. However, it also suggests how improving necessary care for older Americans might have proceeded differently without producing some of Medicare’s chronic long-term problems that we continue to avoid dealing with today. (Part two of this post will examine how this history also offers some lessons to would-be repeal-and-replace critics of the five-year-old Affordable Care Act).

The standard history for Medicare’s origins usually begins with highlighting the inadequacies of existing insurance coverage for the elderly in the early 1960s. The most extreme pro-Medicare claims assert that only one-quarter of Americans over age 65 had “meaningful” private health insurance coverage. However, that calculation stacks the deck by setting the coverage bar fairly high. It uses either Blue Cross hospital insurance coverage of the time, or any other insurance paying 75% or more of hospital bills as its minimum threshold for providing adequate “comprehensive” coverage.

A higher, and more frequently cited, measure of insurance coverage for the elderly in the early 1960s comes from the 1963 National Health Survey. It found that 54% of Americans age 65 and above had some type of hospital insurance, compared to 71% for the general population over age 17. Even this difference between access to care for older versus younger Americans in the years immediately before Medicare can be reduced further, to some degree. The federal government’s survey excluded seniors who were covered under various government health and wealth programs. However, a large portion of the potential health care assistance to most older Americans under the Kerr-Mills program (enacted in 1960) or hospitals still under Hill-Burton grant obligations, was needs-based, and it often remained more hypothetical than immediately accessible. Federal assistance for the health care needs of the indigent elderly under Kerr-Mills in particular was implemented very slowly, if at all, by most states in the early 1960s.

Looking at most of these limited coverage numbers 50 years later often fails to place them, and related problems of access to health care for older Americans, in their proper context. First, health insurance coverage for retirees between age 65 and 74 roughly doubled in the 10 years from 1952 to 1962. According to 1965 congressional testimony by H. Lewis Rietz (representing several large insurance associations), by 1962, 60% of the non-institutionalized aged had some form of voluntary health insurance. On the other hand, health coverage for the non-aged also was growing rapidly and it tended to be more comprehensive and less expensive. In any case, health care (and health insurance) of the early 1960s cost much less compared to today in large part because medicine’s capabilities were more limited, and a much larger share of health spending (roughly 45%) was paid for out of pocket rather than through third-party insurance coverage.

The biggest problem for elderly Americans in purchasing health insurance in the early 1960s was their relatively low family incomes. The analytical section of the 1963 National Health Survey noted that the two lowest income groups at the time (under $2000, and between $2000 and $3999, in annual family income) had disproportionately large numbers of elderly persons. After adjusting hospital and surgical insurance coverage rates first by age, and then by income, the Survey’s researchers concluded that “income is a more important factor than age in determining health insurance coverage.”

Subsequent decades of much more generous social security benefits, along with improved private retirement benefits and appreciation of home values, substantially changed the relative income distribution ranking of the elderly and freed many seniors from poverty, even without the additional income enhancements provided by Medicare’s protection against large medical costs.

In a series of influential research articles about a decade ago, MIT economist Amy Finkelstein provided a more nuanced analysis of Medicare’s effects on the health care economy, as well as the health and economic well-being of seniors. One of her most notable findings was that, at least in its first 10 years of operation, Medicare and the near-universal coverage it provided to seniors somewhat surprisingly played essentially no role in the dramatic decline in mortality rates for the elderly that began in the late 1960s. One reason for this lack of any discernible impact on this most basic measure of health outcomes was that, prior to Medicare, individuals with life-threatening, and treatable, health conditions sought care even if they lacked insurance, as long as they had legal access to hospitals. Individuals without insurance paid out-of-pocket, or relied on charity care.

However, this issue of legal access to care highlights the seminal importance of Medicare as an essential national program administered by the federal government during the 1960s struggles over civil rights. It must be saluted in particular for achieving substantial progress in extending access to hospitals for non-whites in segregated parts of the South.

In one study with co-author Robin McKnight of the University of Oregon, Finkelstein focused more on the economic risk-protection benefits (in other words, its value as “insurance”) that Medicare provided to the elderly during its initial years. They estimated that Medicare was associated with a substantial reduction in the elderly’s exposure to the financial risks of out-of-pocket health spending. The greatest such effects were for the top 25% of the out-of-pocket health spending distribution among seniors. Medicare’s introduction was associated with a 40% decline in their personal out-of-pocket spending.

Of course, those economic benefits to seniors produced both gains in expanded health care services and higher costs to finance them. Medicare’s introduction in 1965 represented the single largest change in health insurance coverage in American history. It triggered substantial new entry into the hospital sector, leading to a 37% increase in hospital spending within its first five years. Medicare powered much more rapid and extensive adoption of new medical technologies, and it fundamentally altered the practice of modern medicine. Finkelstein’s broader conclusion is that evidence from the early effects of Medicare’s enactment and implementation suggests that the overall spread of all health insurance coverage in the US between 1950 and 1990 may explain half of the six-fold increase in real per capita spending over this period.

Enthusiastic boosters of Medicare may view the massive expansion in health spending due to Medicare as a historic legacy worth saluting on its 50^th anniversary. It certainly has relieved much suffering, extended lives, and protected the financial resources of millions of seniors. If you value health care highly and believe we haven’t reached a point of diminishing returns at the margins of its highest spending levels, light up some more birthday candles and look forward to more decades of such growth.

But the more elusive calculation involves balancing the most visible gains claimed by Medicare advocates against the less visible offsetting costs Medicare also produced. They include medical inflation that caused health care spending to consistently outpace growth of the overall economy for most of the years since the program’s introduction (with the exception of a few recent ones). Other long-term costs include the mounting overhang of Medicare’s long-term unfunded liabilities still ahead to be underwritten by younger and future generations, as well as the program’s already sizable and growing claims on societal resources that might be directed toward other competing priorities. By one accounting measure, built on unrealistically favorable policy assumptions, the present value of the additional non-dedicated resources that would be necessary to meet projected Medicare expenditures from a 75-year “budget” perspective amounts to at least $27.8 trillion.

Aside from the basic numbers of budgetary imbalances and continuing fiscal pressures, Medicare’s institutionalization as the dominant payer in US health care also has locked in the worst features of a costly and inefficient fee-for-service delivery system that still rewards providing more volume, instead of better value, in most health care decisions. The mismatch between Medicare’s claims on the economy and our political willingness to pay for them in turn has produced an ever-more complex web of reimbursement rules and health care regulations in response that are far more successful in hiding or transferring costs than in reducing them. Moreover, although elderly Americans achieved substantial gains in insurance coverage and financial security through Medicare, younger ones fared far less well.

More on what this implies for where Medicare might have developed instead, and the future course of the Affordable Care Act, is ahead in part two.

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The week in fact-checking: Hey, how much for that fact check?

The American Press Institute presents a roundup from the world of fact checking, debunking and truth telling — just in case you haven’t been paying as much attention as we do.

Quote of the week

“I’ll summarize my prescription in four words: Less speed. More transparency.” — New York Times public editor Margaret Sullivan on an error-ridden Hillary Clinton story.

Behind the fact check
Many reporters have an Alan Gingras amongst their fans. You know, that eagle-eyed reader who sends you notes like: “Dear obit people: In 1960, Comfort moved his family to Tanganyika, not Tanzania. Tanzania did not exist then. In 1964, Tanganyika and Zanzibar merged to form Tanzania.” Here’s how one newspaper learned to appreciate its biggest fact-checking fan. Read it.

What? Something is fake on the internet?
A study by API researcher Andy Guess shows that misinformation on Twitter outpaces any attempts to correct it by a sad ratio of 3 to 1. So we wish Paulo Ordoveza had a little more time on his hands. The brains behind @PicPendant researches and corrects bad information on Twitter only “when he has down time, or is bored,” reports Columbia Journalism Review. Read it.

Behind the fact check
Many reporters have an Alan Gingras amongst their fans. You know, that eagle-eyed reader who sends you notes like: “Dear obit people: In 1960, Comfort moved his family to Tanganyika, not Tanzania. Tanzania did not exist then. In 1964, Tanganyika and Zanzibar merged to form Tanzania.” Here’s how one newspaper learned to appreciate its biggest fact-checking fan. Read it.

The business of fact-checking

Accountability journalism can be expensive, and charging for the service is one way to fund it. Fact-checking organizations have come up with creative ways to keep the bills paid. Read it.

Fact-checking tips
Here’s a tip as we plunge into the 2016 election season: If a candidate’s TV ad, statement or talk-show rhetoric seems designed to scare the pants off you (“Today is some of the darkest 24 hours in our nation’s history”), be afraid. Not of the candidate, but of a potential lack of facts. Writing for The Conversation, historian Tony Ward reminds us that “dire warnings” can indicate a fact-less agenda. Read it.

Fact-checking science
When politics get mixed up with crustaceans, you get a fact check on the sex life of crabs. After Gov. Terry McAuliffe stated this week that Virginia actually is the birthplace of the so-called “Maryland crab,” PolitiFact Virginia treated us to a lesson on the mating habits of crabs. And used every crab-sex pun they could get away with. Read it.

Fact-checking Hollywood
If you like a little shade with your facts, you go right ahead and believe “Shady Music Facts” when it tweets that Paris Hilton makes $1 million per night as a DJ. And don’t read BuzzFeed’s analysis of the popular Twitter account, whose motto is: “Our tweets are 100% facts and we are completely unbiased.”  Don’t read it.

Fact-checking around the world
“Falsehoods come in many languages. Now, so does the truth.”  Students at Duke University’s Reporters Lab have created a video that shows the impressive (and sometimes entertaining) efforts by journalists around the globe who are working to improve accountability in their government. Watch it.

Do you teach journalism, politics or communications? Join the American Press Institute and panelists for a workshop in San Francisco next week. Read more and sign up here. 

The post The week in fact-checking: Hey, how much for that fact check? appeared first on American Press Institute.

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Happy 103rd birthday, Milton Friedman

Tomorrow is Milton Friedman’s birthday — he was born on July 31 in 1912 and would have been 103 years old tomorrow. Unfortunately, Milton died on November 16, 2006 when he was 94 years old. In an editorial in the Wall Street Journal following Professor Friedman’s death, they reported his loss with the same tribute Milton used when Ronald Reagan died, saying “few people in human history have contributed more to the achievement of human freedom.” In honor of his legacy and birthday, here are some of my favorite Milton Friedman quotes:

1. There is nothing as permanent as a temporary government program.

2. Inflation is always and everywhere a monetary phenomenon.

3. Inflation is caused by too much money chasing after too few goods.

4. Sloppy writing reflects sloppy thinking.

5. All learning is ultimately self-learning.

6. I’m in favor of legalizing drugs. According to my values system, if people want to kill themselves, they have every right to do so. Most of the harm that comes from drugs is because they are illegal.

7. Nobody spends somebody else’s money as carefully as he spends his own. Nobody uses somebody else’s resources as carefully as he uses his own. So if you want efficiency and effectiveness, if you want knowledge to be properly utilized, you have to do it through the means of private property.

8. The government solution to a problem is usually as bad as the problem.

9. The Great Depression, like most other periods of severe unemployment, was produced by government mismanagement rather than by any inherent instability of the private economy.

10. The high rate of unemployment among teenagers, and especially black teenagers, is both a scandal and a serious source of social unrest. Yet it is largely a result of minimum wage laws. We regard the minimum wage law as one of the most, if not the most, anti-black laws on the statute books.

11. Industrial progress, mechanical improvement, all of the great wonders of the modern era have meant relatively little to the wealthy. The rich in Ancient Greece would have benefited hardly at all from modern plumbing: running servants replaced running water. Television and radio? The patricians of Rome could enjoy the leading musicians and actors in their home, could have the leading actors as domestic retainers. Ready-to-wear clothing, supermarkets — all these and many other modern developments would have added little to their life. The great achievements of Western capitalism have redounded primarily to the benefit of the ordinary person. These achievements have made available to the masses conveniences and amenities that were previously the exclusive prerogative of the rich and powerful.

12. President Kennedy said, “Ask not what your country can do for you — ask what you can do for your country.”… Neither half of that statement expresses a relation between the citizen and his government that is worthy of the ideals of free men in a free society. “What your country can do for you” implies that the government is the patron, the citizen the ward. “What you can do for your country” assumes that the government is the master, the citizen the servant.

13. On the difference between public vs. private education: “Try talking French with someone who studied it in public school. Then with a Berlitz graduate.”

14. ‘Fair’ is in the eye of the beholder; ‘free’ is the verdict of the market. The word ‘free’ is used three times in the Declaration of Independence and once in the First Amendment to the Constitution, along with ‘freedom.’ The word ‘fair’ is not used in either of our founding documents.

15. What most people really object to when they object to a free market is that it is so hard for them to shape it to their own will. The market gives people what the people want instead of what other people think they ought to want. At the bottom of many criticisms of the market economy is really lack of belief in freedom itself.

16. The great achievements of civilization have not come from government bureaus. Einstein didn’t construct his theory under order from a bureaucrat. Henry Ford didn’t revolutionize the automobile industry that way. In the only cases in which the masses have escaped from grinding poverty, the only cases in recorded history are where they’ve had capitalism and largely free trade. If you want to know where the masses are worst off, it’s exactly in the kinds of societies that depart from that, so that the record of history is absolutely crystal clear: that there is no alternative way so far discovered of improving the lot of the ordinary people that can hold a candle to the productive activities that are unleashed by a free enterprise system.

17. The problem of social organization is how to set up an arrangement under which greed will do the least harm; capitalism is that kind of a system.

18. With some notable exceptions, businessmen favor free enterprise in general but are opposed to it when it comes to themselves.

19. The case for prohibiting drugs is exactly as strong and as weak as the case for prohibiting people from overeating.

20. The government has no more right to tell me what goes into my mouth [including illegal drugs] than it has to tell me what comes out of my mouth.

Bonus: You’ll find a great collection here of more than 30 Milton Friedman videos (the “Milton Friedman Speaks” lectures) on a variety of topics including “What is America?”, “Is Capitalism Humane?”, free trade, energy policy, the role of government in a free society, education and vouchers, the rights of workers, consumer protection, equality and freedom, and the future of our free society.

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