Thursday, December 12, 2013

I Agree with Rick Santorum's comparison of the ACA and Apartheid, Sort Of (Cross Post with PUSH)

Former Sen. Rick Santorum actually compared the Affordable Care Act (or Obamacare as he calls it) to Apartheid South Africa.  Here is his quote as he was paying tribute to Nelson Mandela on Fox News was fighting against some great injustice. I would make the argument that we have a great injustice going on right now in this country with an ever-increasing size of government that is taking over and controlling people’s lives — and Obamacare is front and center in that.



The Colbert Report
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On the face of it this seems to ridiculous to comment on but ol' Rick might be on to something here. First lets look at the word apartheid,  In Dutch and it's dialect Afrikaans it means apartness.  Our pre ACA health care system definitely resembled an apartheid system with access to healthcare tied to employment, ability to pay, eligibility for Medicare or Medicaid, veterans status, and charity.  For decades the US was paired with South Africa as the only industrialized nations without a universal healthcare program and also with the death penalty. 


After Mandela was released, the right to access to medical care was affirmed in their constitution and the death penalty was abolished.  While leading almost all African nations, South Africa still lags behind the US and other developed nations in life expectancy and infant mortality due to low per capita income and other factors such as the AIDS epidemic as can be seen here. A description of their health system can be seen here.

The US system has passed and is in the process of implementing the Affordable Care Act.  It does some to alleviate the apartness of our health care system with the individual mandate and Medicaid expansion.  However in Pennsylvania and other states, some governors are refusing to expand Medicaid or expanding it with strings attached.  Those who are still not eligible have to purchase insurance or pay a fine. There are subsidies for low income buyers who do not qualify for medicaid expansion but if they do purchase they will still be burdened copays and deductibles.  Single payer levels the playing field so everyone is no longer apart.  Until then apartheid remains in a modified form. Sen. Santorum does raise some important issues just not in the way he intended.

**Related Posts**. 



The Affordable Care Act Having an Impact in Some States but not Pennsylvania



The Affordable Care Act (ACA) having little effect on PA's Uninsured Rate So Far





Sunday, December 1, 2013

The Month of December is Now Upon Us


As Black Friday is now past and Cyber Monday is tomorrow.  Right now I am busy with school and am unable to do large posts on this blog.  I will repost things on the Facebook page and may do small posts if they are relevant to what is going on in the world.  

Now that the anniversary of the Kennedy assassination is past, I'm sure there will continue to be stories on the Affordable Care Act (aka Obamacare) as well as the anniversary if the Newtown shooting. Who knows (if you're religious you could say God knows) what else will come up?  

I do have links to amazon products that are relevant to previous posts that you are welcome to consider for your special one this holiday season.  Happy Holidays to all.  Buon Natale a` tutti. 


Saturday, November 23, 2013

Cosmos Redux?


When I was 10, the TV series Cosmos captured my imagination about the universe and our place in the natural order of things.  Above is Carl Sagan's last interview on Charlie Rose when he promoted his book on the dangers of pseudoscience.  There is plenty of pseudoscience and false scientific beliefs around today be they in UFO's, astrology, and in rejecting climate change or evolution.


A sequel to this classic series is coming out next year on the Fox Network (trailer below).  It is hosted by astrophysicist Neil DeGrasse Tyson and is produced by Seth MacFarlane (of Family Guy) and Sagan's widow Ann Druyan.  



I must say that I will be very disappointed if the new series does not live up to the original.   It takes more that dazzling special effects to make it informative.  Rupert Murdoch networks (especially Fox News) are not known for disseminating reliable information.  Fox News viewers were more likely to believe that weapons of mass destruction, Iraq had a 9/11-al Qaeda link, and that the world supported the US invasion were found in Iraq following the 2003 invasion.  Jon Stewart and Stephen Colbert have made most of their careers on lampooning media outlets like Fox News.


**Update**

The Cosmos premier was aired on 8 Fox Networks but not their news or business network.  In Oklahoma City, when Neil DeGrasse Tyson discussed evolution, the local Fox affiliate cut away just at that point.  They claimed it was accidental.  In episode 2 evolution is discussed in depth.  Will it be shown in it's entirety in OKC?


**Related Posts**





Tuesday, November 12, 2013

Save Dollars. Save Lives: An evening with Dr. Gerald Friedman

With all of the shenanigans of the government shutdown, the debt ceiling, and the Affordable Care Act (aka Obamacare) over and the debates over the Affordable Care Act website underway, it is now time to talk about the dollars and cents of healthcare. Healthcare for All PA will be hosting UMASS economist Dr. Gerald Friedman to discuss what a single payer system could save the state of PA.  A clip of him can be seen below.







Save Dollars. Save Lives. 

The Economic “Cents” Behind Single-Payer Health Care Reform 
An evening with Dr. Gerald Friedman 
Tuesday, November 19th from 7-9 PM 
First Unitarian Church of Pittsburgh 
605 Morewood Ave. 
Pittsburgh, PA 15213 

This event is brought to you by Health Care 4 All Pa, The University of Pittsburgh School of Social Work and the First Unitarian Church of Pittsburgh. Dr. Friedman earned a PhD in Economics from Harvard University. He is a Professor of Economics at the University of Massachusetts - Amherst, and the author of “The Pennsylvania Health Care Plan: Impact and Implementation” Come learn more about: Key features of the Pennsylvania Health Care Plan (Established by SB 400, introduced to State Senate by primary sponsor Jim Ferlo) The findings of Dr. Friedman’s Economic Impact Study & current developments in health care reform Please bring your questions! For more information contact Bob Mason: bmasona@gmail.com Or visit healthcare4allpa.org

Friday, November 8, 2013

A Geographical Representation of the Mode and Ethnicity


The Daily Mail in the UK came out with this map showing the pattern of the most frequently cited ethnicity (or the mode in statistical lingo, in political lingo it is called a plurality if not a majority) in each county and State from the 2000 Census.  Overall German ancestry (colored light blue) is most often cited by respondents followed by African Americans.  20 million (mostly in the Appalachian southeast) say American because they do not know their ancestry.

In Pennsylvania, where I am from, German is the most common ancestry in all but three of the 67 counties.  The Amish speak a German dialect.  Of course 13 years later the map could look very different with Latino Americans making a larger portion of the population.  I know the map is hard to read I made it as bid as I could.  Surprisingly, Mississippi has all but a few counties colored purple for African Americans being the most stated ethnicity while it is a state that voted solidly against Obama twice.  The Caucasian population must live in more populated areas.  Connecticut, where I lived for two years, has a large Italian population

**Update**


Colin Woodard of Tufts University produced a county level map with 11 different political regions which seems to have some correlation to the ethnic map at the top such as many (but not all) of the counties of Greater Appalachia describing themselves as American.  He uses his model to explain the failure of the Obama Administration and the families of the Newtown, CT victims to pass an assault weapons ban that Sens. Pat Toomey R-PA and Joe Manchin D-WV proposed.  Manchin of West Virginia represents a state in the Greater Appalachia region.  Southwestern PA, where I grew up, is also included in Appalachia though it is ethnically different from the rest of the region.  The central part of the state that Toomey represents, while ethically similar, is placed in the Midlands region (Pittsburgh where I live now is right on the border with Appalachia and is sometimes called the Paris of Appalachia) while the upper row of counties is placed in the Yankee region.  According to Woodard Manchin took a bigger risk making the deal than Toomey.

**2nd Update**

I had a big response to this post.  Yet another map has been produced politically classifying the 3,100 counties into 15 categories which are described in the Washington Post.  This map is interactive.  If you move your arrow key over each county you can see how its classified. Below the interactive version is embedded.  Is there more correlation with the map at the top than there is with the second map?
**Related Posts**


Deep South Primaries


Latino rates in Pennsylvania's Uninsured (Cross Post with PUSH)




Thursday, October 31, 2013

Multiple Comparisons, Margins of Error, and the Affordable Care Act Census Data

In my last post I looked at changes in the census rates in 51 states (50 plus DC) since parts of the act have come into effect.  I found 14 with a significant change from 2010 to 2011 (the most recent years available since the ACA was passed).  Each individual state was classified as changed if the difference in their rates were outside of the 95% probability margin of error (MOE) for both years.  That means that we are 95% certain that the actual rate is between an upper and lower limit.

For example Texas had a MOE of +/- 0.2%, that means it's estimated rate for 2010 of 26.3% is between 26.5% and 26.1% with 95% probability while it's estimated rate for 2011 of 25.7%  is between 25.9% and 25.5% with 95% probability.  Because the intervals for both years do not overlap, we can be confident that the change in the rate is real across the years.


Contrary to his claims, the results suggest that Ted Cruz's Texas so far has had a real but small decrease in the uninsured rate since the ACA or Obamacare has been enacted. In the graph above, California and Vermont have had significant decreases while Missouri was the only one that increased.  Massachusetts and Pennsylvania stayed the same.  The other states are summarized in my previous post.  

Statistician critics may argue that repeating 51 comparisons inflates the chance that at least one state has been significantly different by pure chance.  The 95% confidence interval means that there is a 5% chance or 0.05 probability that each individual comparison is significant by pure chance.  Repeated 51 times means that the expected number of chance differences is 51(0.05)=2.55.  Because there were 14 significant differences which is well above the expected number of chance differences.     I can be confident that almost all of changes in the rates are real.

Looking at the county level rates for Pennsylvania there were zero significant changes either positive or negative out of the 67 counties.  Counties with small populations have very large MOEs however.

**Related Posts**

The Affordable Care Act (ACA) Having Little Effect on PA's Uninsured Rate So Far (Repost with PUSH)



Sunday, October 27, 2013

The Affordable Care Act Having an Impact in Some States but not Pennsylvania

In my post on Pennsylvania's uninsured, I wrote that the Affordable Care Act (ACA) was having little effect in Pennsylvania's rate of uninsured.  I wrote in another post that I received skeptical comments on my first post. I said in that post that I would look at changes in the rates in other states.  I couldn't then because the government shutdown also shutdown the US Census Bureau site.  The Advisory Board has come out with an image that can be updated on how many sign up for the state exchanges which are different from the federal.

Now that the shutdown is over I can look at the Census Data for the Small Area Health Insurance Estimates (SAHIE) for states from 2008 thru 2011.  To determine which states had a significant decline in the uninsured rate from 2010 to 2011 (the period where portions of the ACA have taken effect such as the one allowing parents to keep their kids on their insurance until age 26), I marked a state as declined if it had a rate that declined outside its margin of error (MOE).  There were 14 states with a significant change in their rates and 37 (including DC) that either stayed the same or increased.   States with larger populations have smaller margins of error.  

Five of the states are summarized in the graph above, California, Massachusetts (which has it's version of the ACA), Pennsylvania, Texas (with the largest rate in the US), and Vermont (which is the first in the US to pass a single payer plan).  California, Texas, and Vermont had significant decreases in the rates while Pennsylvania and Massachusetts remained within the margin of error (MOE) for both years.  Missouri was the only state that showed a significant increase from 15.3% to 16.0% which was outside the MOE of 0.3%.

ACA Decrease in uninsured * Medicaid Expansion Crosstabulation

Medicaid Expansion
Total
not participating or considering not participating
participating or leaning
expanding through alternate means or considering
ACA Change in uninsured
No
16
15
6
37
yes
6
8
0
14
Total
22
23
6
51

I tried to see if there was any association between decreases in the rates and other state level variables but there was none.  The table above shows that there is no relationship between a significant decrease in the rate and whether or not the state is participating in Medicaid Expansion (p=0.254).  PA Gov. Corbett has proposed a draconian version of Medicaid expansion which Lloyd Stires has written extensively about.   Below is a table showing where each state stands on the ACA decrease and Medicaid expansion.  I added this clip from The Daily Show to give somewhat amusing background on Medicaid expansion.




State
ACA Decrease in uninsured
Medicaid Expansion
1
Alabama
No
not participating or considering not participating
2
Alaska
No
not participating or considering not participating
3
Arizona
No
expanding through alternate means or considering
4
Arkansas
No
expanding through alternate means or considering
5
California
yes
participating or leaning
6
Colorado
No
participating or leaning
7
Connecticut
No
participating or leaning
8
Delaware
No
participating or leaning
9
District of Columbia
No
participating or leaning
10
Florida
No
not participating or considering not participating
11
Georgia
No
not participating or considering not participating
12
Hawaii
No
participating or leaning
13
Idaho
yes
not participating or considering not participating
14
Illinois
yes
participating or leaning
15
Indiana
No
expanding through alternate means or considering
16
Iowa
No
expanding through alternate means or considering
17
Kansas
yes
not participating or considering not participating
18
Kentucky
No
participating or leaning
19
Louisiana
No
not participating or considering not participating
20
Maine
No
not participating or considering not participating
21
Maryland
yes
participating or leaning
22
Massachusetts
No
participating or leaning
23
Michigan
yes
participating or leaning
24
Minnesota
No
participating or leaning
25
Mississippi
No
not participating or considering not participating
26
Missouri
yes (increase)
not participating or considering not participating
27
Montana
No
not participating or considering not participating
28
Nebraska
No
not participating or considering not participating
29
Nevada
yes
participating or leaning
30
New Hampshire
No
not participating or considering not participating
31
New Jersey
No
participating or leaning
32
New Mexico
No
participating or leaning
33
New York
yes
participating or leaning
34
North Carolina
No
not participating or considering not participating
35
North Dakota
No
participating or leaning
36
Ohio
No
participating or leaning
37
Oklahoma
No
expanding through alternate means or considering
38
Oregon
yes
participating or leaning
39
Pennsylvania
No
expanding through alternate means or considering
40
Rhode Island
No
participating or leaning
41
South Carolina
yes
not participating or considering not participating
42
South Dakota
No
not participating or considering not participating
43
Tennessee
No
not participating or considering not participating
44
Texas
yes
not participating or considering not participating
45
Utah
No
not participating or considering not participating
46
Vermont
yes
participating or leaning
47
Virginia
No
not participating or considering not participating
48
Washington
No
participating or leaning
49
West Virginia
No
participating or leaning
50
Wisconsin
yes
not participating or considering not participating
51
Wyoming
No
not participating or considering not participating

**Related Posts**


National, State, and County Uninsured Estimates