Sinking SCHIP: A First Step toward Stopping the Growth of Government Health Programs

Federal lawmakers are considering legislation that could result in millions more middle income families obtaining health insurance from government. Unfortunately, the debate over expansion of the State Children's Health Insurance Program is divorced from the reality of who truly needs assistance and the forces that are making health insurance increasingly unaffordable. SCHIP and its larger sibling Medicaid currently enroll many people who do not need government assistance, including some families of four earning up to $72,000 per year. That is a direct result of federal funding rules that reward states for making more Americans dependent on government for their health care. Rather than expand SCHIP, Congress should (1) make private health insurance more affordable by allowing consumers and employers to purchase less expensive policies from other states, and (2) fold federal Medicaid and SCHIP funding into block grants that no longer encourage states to open taxpayer-financed health care to nonneedy families. With more Americans able to afford private insurance and no incentive for states to expand government programs beyond the truly needy, federal and state governments could reduce spending on those programs

Does Barack Obama Support Socialized Medicine?

Democratic presidential nominee Sen. Barack Obama (IL) has proposed an ambitious plan to restructure America's health care sector. Rather than engage in a detailed critique of Obama's health care plan, many critics prefer to label it "socialized medicine." Is that a fair description of the Obama plan and similar plans? Over the past year, prominent media outlets and respectable think tanks have investigated that question and come to a unanimous answer: no. Those investigations leave much to be desired. Indeed, they are little more than attempts to convince the public that policies generally considered socialist really aren't. A reasonable definition of socialized medicine is possible. Socialized medicine exists to the extent that government controls medical resources and socializes the costs. Notice that under this definition, it is irrelevant whether we describe medical resources (e.g., hospitals, employees) as "public" or "private." What matters-what determines real as opposed to nominal ownership-is who controls the resources. By that definition, America's health sector is already more than half socialized, and Obama's health care plan would socialize medicine even further. Reasonable people can disagree over whether Obama's health plan would be good or bad. But to suggest that it is not a step toward socialized medicine is absurd

A Better Way to Generate and Use Comparative-Effectiveness Research

President Barack Obama, former U.S. Senate majority leader Tom Daschle, and others propose a new government agency that would evaluate the relative effectiveness of medical treatments. The need for "comparative-effectiveness research" is great. Evidence suggests Americans spend $700 billion annually on medical care that provides no value. Yet patients, providers, and purchasers typically lack the necessary information to distinguish between high- and low-value services. Advocates of such an agency argue that comparative- effectiveness information has characteristics of a "public good," therefore markets will not generate the efficiency-maximizing quantity. While that is correct, economic theory does not conclude that government should provide comparative-effectiveness research, nor that government provision would increase social welfare. Conservatives warn that a federal comparative- effectiveness agency would lead to government rationing of medical care -- indeed, that's the whole idea. If history is any guide, the more likely outcome is that the agency would be completely ineffective: political pressure from the industry will prevent the agency from conducting useful research and prevent purchasers from using such research to eliminate low-value care. The current lack of comparative-effectiveness research is due more to government failure than to market failure. Federal tax and entitlement policies reduce consumer demand for such research. Those policies, as well as state licensing of health insurance and medical professionals, inhibit the types of health plans best equipped to generate comparative-effectiveness information. A better way to generate comparative-effectiveness information would be for Congress to eliminate government activities that suppress private production. Congress should let workers and Medicare enrollees control the money that purchases their health insurance. Further, Congress should require states to recognize other states' licenses for medical professionals and insurance products. That laissez-faire approach would both increase comparative-effectiveness research and increase the likelihood that patients and providers would use it

Pay-for-Performance: Is Medicare a Good Candidate?

According to one prominent study, adults in the United States receive the generally accepted standard of preventive, acute, and chronic care only about 55% of the time. The likelihood that patients will receive recommended care varie[s] substantially according to the particular medical condition, ranging from 78.7 percent of recommended care . . . for senile cataract to 10.5 percent of recommended care ... for alcohol dependence. Evidence of low-quality care appears in Medicare, the federal health program for the elderly and disabled. Quality of care does not appear to be higher in areas where Medicare spending is higher. In fact, some studies point to the somewhat paradoxical conclusion that Medicare patients are often less likely to receive recommended care in regions where Medicare expenditures are highest. Third-party payment is a potential contributor to the under-provision of quality health care. Most health care payments in the United States are made by third parties, usually employers, insurers, or government. Those purchasers typically reimburse health care providers on the basis of the volume and intensity of the services provided, rather than the quality or cost-effectiveness of those services. The result is a financing system akin to paying academics on the basis of the volume and intensity of footnotes

King v. Burwell and the Triumph of Selective Contextualism

King v. Burwell presented the question of whether the Patient Protection and Affordable Care Act of 2010 (ACA) authorizes the Internal Revenue Service (IRS) to issue tax credits for the purchase of health insurance through Exchanges established by the federal government. The King plaintiffs alleged an IRS rule purporting to authorize tax credits in federal Exchanges was unlawful because the text of the ACA expressly authorizes tax credits only in Exchanges “established by the State.” The Supreme Court conceded the plain meaning of the operative text, and that Congress defined “State” to exclude the federal government. The Court nevertheless disagreed with the plaintiffs, explaining that “the context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.” The Court reached its conclusion by disregarding portions of the ACA’s text and considering only selected elements of the ACA’s structure, context, and purpose. The King majority’s selective contextualism embraced an unexpressed congressional “plan” at the expense of the plan Congress actually enacted

King v. Burwell and the Triumph of Selective Contextualism

King v. Burwell presented the question of whether the Patient Protection and Affordable Care Act of 2010 (ACA) authorizes the Internal Revenue Service (IRS) to issue tax credits for the purchase of health insurance through Exchanges established by the federal government. The King plaintiffs alleged an IRS rule purporting to authorize tax credits in federal Exchanges was unlawful because the text of the ACA expressly authorizes tax credits only in Exchanges “established by the State.” The Supreme Court conceded the plain meaning of the operative text, and that Congress defined “State” to exclude the federal government. The Court nevertheless disagreed with the plaintiffs, explaining that “the context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.” The Court reached its conclusion by disregarding portions of the ACA’s text and considering only selected elements of the ACA’s structure, context, and purpose. The King majority’s selective contextualism embraced an unexpressed congressional “plan” at the expense of the plan Congress actually enacted

The Amateur Sky Survey Mark III Project

The Amateur Sky Survey (TASS) is a loose confederation of amateur and professional astronomers. We describe the design and construction of our Mark III system, a set of wide-field drift-scan CCD cameras which monitor the celestial equator down to thirteenth magnitude in several passbands. We explain the methods by which images are gathered, processed, and reduced into lists of stellar positions and magnitudes. Over the period October, 1996, to November, 1998, we compiled a large database of photometric measurements. One of our results is the "tenxcat" catalog, which contains measurements on the standard Johnson-Cousins system for 367,241 stars; it contains links to the light curves of these stars as well.Comment: 20 pages, including 4 figures; additional JPEG files for Figures 1, 2. Submitted to PAS

Reaction Rates Uncertainties and the Production of F19 in AGB Stars

We present nucleosynthesis calculations and the resulting 19F stellar yields for a large set of models with different masses and metallicity. We find that the production of fluorine depends on the temperature of the convective pulses, the amount of primary 12C mixed into the envelope by third dredge up and the extent of the partial mixing zone. Then we perform a detailed analysis of the reaction rates involved in the production of 19F and the effects of their uncertainties. We find that the major uncertainties are associated with the 14C(alpha,gamma)18O and the 19F(alpha,p)22Ne reaction rates. For these two reactions we present new estimates of the rates and their uncertainties. The importance of the partial mixing zone is reduced when using our estimate for the 14C(alpha,gamma)18O rate. Taking into account both the uncertainties related to the partial mixing zone and those related to nuclear reactions, the highest values of 19F enhancements observed in AGB stars are not matched by the models. This is a problem that will have to be revised by providing a better understanding of the formation and nucleosynthesis in the partial mixing zone, also in relation to reducing the uncertainties of the 14C(alpha,gamma)18O reaction rate. At the same time the possible effect of Cool Bottom Processing at the base of the convective envelope should be included in the computation of AGB nucleosynthesis. This process could in principle help matching the highest 19F abundances observed by decreasing the C/O ratio at the surface of the star, while leaving the 19F abundance unchanged.Comment: 40 pages, 8 figures, accepted for publication on the Astrophysical Journa

ASIME 2018 White Paper. In-Space Utilisation of Asteroids: Asteroid Composition -- Answers to Questions from the Asteroid Miners

In keeping with the Luxembourg government's initiative to support the future use of space resources, ASIME 2018 was held in Belval, Luxembourg on April 16-17, 2018. The goal of ASIME 2018: Asteroid Intersections with Mine Engineering, was to focus on asteroid composition for advancing the asteroid in-space resource utilisation domain. What do we know about asteroid composition from remote-sensing observations? What are the potential caveats in the interpretation of Earth-based spectral observations? What are the next steps to improve our knowledge on asteroid composition by means of ground-based and space-based observations and asteroid rendez-vous and sample return missions? How can asteroid mining companies use this knowledge? ASIME 2018 was a two-day workshop of almost 70 scientists and engineers in the context of the engineering needs of space missions with in-space asteroid utilisation. The 21 Questions from the asteroid mining companies were sorted into the four asteroid science themes: 1) Potential Targets, 2) Asteroid-Meteorite Links, 3) In-Situ Measurements and 4) Laboratory Measurements. The Answers to those Questions were provided by the scientists with their conference presentations and collected by A. Graps or edited directly into an open-access collaborative Google document or inserted by A. Graps using additional reference materials. During the ASIME 2018, first day and second day Wrap-Ups, the answers to the questions were discussed further. New readers to the asteroid mining topic may find the Conversation boxes and the Mission Design discussions especially interesting.Comment: Outcome from the ASIME 2018: Asteroid Intersections with Mine Engineering, Luxembourg. April 16-17, 2018. 65 Pages. arXiv admin note: substantial text overlap with arXiv:1612.0070

High-resolution mass models of dwarf galaxies from LITTLE THINGS

We present high-resolution rotation curves and mass models of 26 dwarf galaxies from LITTLE THINGS. LITTLE THINGS is a high-resolution Very Large Array HI survey for nearby dwarf galaxies in the local volume within 11 Mpc. The rotation curves of the sample galaxies derived in a homogeneous and consistent manner are combined with Spitzer archival 3.6 micron and ancillary optical U, B, and V images to construct mass models of the galaxies. We decompose the rotation curves in terms of the dynamical contributions by baryons and dark matter halos, and compare the latter with those of dwarf galaxies from THINGS as well as Lambda CDM SPH simulations in which the effect of baryonic feedback processes is included. Being generally consistent with THINGS and simulated dwarf galaxies, most of the LITTLE THINGS sample galaxies show a linear increase of the rotation curve in their inner regions, which gives shallower logarithmic inner slopes alpha of their dark matter density profiles. The mean value of the slopes of the 26 LITTLE THINGS dwarf galaxies is alpha =-0.32 +/- 0.24 which is in accordance with the previous results found for low surface brightness galaxies (alpha = -0.2 +/- 0.2) as well as the seven THINGS dwarf galaxies (alpha =-0.29 +/- 0.07). However, this significantly deviates from the cusp-like dark matter distribution predicted by dark-matter-only Lambda CDM simulations. Instead our results are more in line with the shallower slopes found in the Lambda CDM SPH simulations of dwarf galaxies in which the effect of baryonic feedback processes is included. In addition, we discuss the central dark matter distribution of DDO 210 whose stellar mass is relatively low in our sample to examine the scenario of inefficient supernova feedback in low mass dwarf galaxies predicted from recent Lambda SPH simulations of dwarf galaxies where central cusps still remain.Peer reviewe