More Data on Hospital-Acquired Infections, Please

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Pneumonia is among the more common hospital-acquired infections. The public deserves more transparency.

Hospitals are dangerous places. Americans acquired 722,000 infections in a hospital setting in 2011, the most recent year cited by the Center for Disease Control and Prevention. About one out of twenty-five patients fell victim to preventable hospital-acquired infections.

In the interest of controlling infectious disease, health care officials have begun tracking the data more closely in recent years. In November the Virginia Department of Health published its Virginia-specific findings for 2015. Overall, hospitals in the Old Dominion compare fairly favorably with their peers nationally based on a methodology that adjusts for the acuity of patients and other relevant factors.

But that conclusion is tempered by (a) significant weak spots in Virginia hospital performance, and (b) the fact that the methodology compared only five categories of common infections, not all infections.

That said, here follow the statewide conclusions from the consumer version of the study based on 2015 data. Virginia hospitals exhibited:

  • Fewer bloodstream infections than predicted based on the national experience in 2006-2008.
  • Fewer urinary tract infections than predicted based on the national experience from 2009.
  • More infections following abdominal hysterectomies and about the same number following colon surgeries based on the national experience from 2006-2008.
  • Fewer methicillin-resistant Staphylococcus aureus bacteremia laboratory-identified events than predicted based on the national experience from 2010-2011.
  • About the same number of hospital-onset Clostridium difficile laboratory-identified events as predicted based on the national experience from 2010-2011.

Bacon’s bottom line: As I argued previously, Virginia consumers/patients should have full transparency into the risks they are taking when they enter a hospital. When I wrote previously, I was unaware that the Virginia Department of Health collected the data. The department deserves kudos for publishing its report in a form comprehensible to the public. But it should go further.

The report lists every hospital in the state and gives it a green star (better than expected compared to national norms) a red X (worse than expected), an equal sign or a “No Conclusion.” This really isn’t very helpful. Does the Depaul Medical Center, to pick a random example, outperform national norms for bloodstream infections by a razor-thin margin or a wide margin? Do Virginia Commonwealth University patients undergoing colon surgeries experience many more infections or just a few?

More to the point, why doesn’t the health department tell us the total of all hospital-acquired infections at each institution and how the numbers compare to national norms?

It also would be helpful to get a sense of what’s happening to hospital-acquired infections over time. To pick an example, it’s nice to know that Virginians incurred fewer bloodstream infections in 2015 compared to the national baseline of 8- to 10-years previously. But that’s a long period of time. How much progress has been made? How rapid has the progress been — have Virginia hospitals made big gains, or are they doing only marginally better than a decade previously?

The cost of health care poses one of the greatest challenges to 21st-century American society. Eliminating hospital-acquired infections should be low-hanging fruit for controlling costs and improving medical outcomes. While Congress argues over Obamacare and the zero-sum question of who subsidizes whom, Virginia needs to take the lead in driving down costs and improving medical outcomes to the benefit of all. Greater transparency can help by making hospitals more attentive to patients’ concerns and by shining a spotlight on under-performers. If  hospital managements fear looking bad in the eyes of the public and its board of directors, they will make the control of infections a top priority.

(This First ran in Bacon’s Rebellion on Jan. 3, 2017)


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Severe Mental Illness and the Death Penalty

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The U.S. Supreme Court has ruled that juveniles and people with intellectual disabilities should not be executed due to their diminished culpability.

However, it remains legal to execute people who suffered from severe mental illness (SMI) at the time of the offense.  While our understanding of mental illness improves every day, it is surprising that people with severe mental illnesses, like schizophrenia, can still be subject to the death penalty in Virginia.

I firmly believe that anyone who commits a crime should face very serious consequences for it.  However, in light of our increased understanding of the severe impairments brought by mental illness, I believe that life in prison without parole is the appropriate punishment for those with documented severe mental illness at the time of their crime.

Severe mental illness is characterized by psychotic episodes, which affect one’s ability to exercise rational judgment. A severe mental illness can also lead to wrongful conviction; several studies show a link between mental illness and false confession.

In addition, the money saved by not sentencing someone to death in these cases could be used to solve cold cases, train and staff police forces, fund victims’ services, or expand mental health programs.

Many organizations agree that the time for reform has come. The American Psychiatric Association, the American Psychological Association, the National Alliance on Mental Illness, Mental Health America and the American Bar Association have all expressed their opposition to the use of the death penalty for those with severe mentally illness.

In our state, the National Alliance on Mental Illness Virginia, Virginia Counselors Association, Mental Health America of Virginia, the disability Law Center, VOCAL and the National Association of Social Workers Virginia Chapter have endorsed legislation to exclude those with severe mental illness from the death penalty.

I find it unconscionable that the Commonwealth can and does execute people who suffer from severe mental illness. Severely mentally disabled defendants are not the “worst of the worst” for whom the death penalty is intended, and no purpose is served by their execution.

While it is difficult to know how many people would be affected by the SMI exemption in Virginia, the requirement of the presence of a severe mental illness with significantly impaired capacity at the time of the offense ensures that this would remain a limited exemption. Mental Health America estimates that 5 to 20 percent of inmates currently on death row in the United States have a severe mental illness.

The legislation sponsored by Del. Jay Leftwich (HB 1522) has a restrictive definition that includes only the most serious forms of mental illness.  Many diagnoses — and many people with any given diagnosis — would not meet the requirements of this proposed legislative exemption.

It is time that Virginia stops sentencing people with severe mental illness to death.  Life in prison without parole is a more appropriate sentence for offenders with SMI who have a diminished culpability for their actions. 

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Economic Impact: President-elect Trump’s plans should support economic growth

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Based on the increase in stock prices since the election, investors believe the Trump administration is going to usher in faster economic growth.

Are they being too optimistic?

Tax cuts for individuals and corporations, which is a key component of President-elect Donald Trump’s campaign promises, should support economic growth.

Since consumer spending makes up about 70 percent of U.S. gross domestic product, reductions in individual income taxes will support growth.

Not all of the tax cut will translate into spending, however, because some households likely will use the tax savings to pay down debt or increase savings.

Even so, the proposed Trump policies call for tax cuts in various degrees for all income groups.

Based on an estimate by the Urban Institute and the Brookings Institution, the plan would cut taxes by an average $2,940 in 2017 for households. The plan also calls for the elimination of the alternative minimum tax, the estate tax, and the gift tax.

Increasing productivity growth is critical to boosting the potential growth rate of the U.S. economy and improving living standards. This is where Trump’s promises of lower corporate tax rates and reduced regulation can make a big difference in GDP growth.

Cutting the corporate tax rate from the existing 35-percent rate to a 15-percent rate and repatriating overseas profits should boost profits to domestic firms.

These changes, combined with other policies allowing businesses to expense investments rather than depreciate them over a long period, should increase business investment in plant and equipment that will lead to productivity gains.

Promised reductions in business regulations, including key environmental and financial ones, also can increase productivity growth as increased regulations are generally associated with lower productivity growth. Many analysts expect changes to the Dodd-Frank law regulating financial institutions and the Clean Power Plan that affects energy companies.

Relaxing environmental regulations also will allow for more domestic energy exploration and production. This will increase the domestic energy supply and keep oil prices down. Lower oil prices can dampen future inflation, while increasing business investment and personal consumption at the same time.

On government spending, the new administration has promised to increase spending on military and infrastructure, which should stimulate economic growth.

On the other hand, Trump also vows to decrease the size of government agencies, which tends to reduce overall government spending.

The net effect of these policies will depend on whether some or all the plans are implemented.

Incorporating these policy changes into Chmura Economics & Analytics’ macroeconomic model indicates the proposed economic policies of the new administration can boost 2017 GDP growth by 0.6 percentage points, from 2.4 percent under the pre-election forecast to 3.0 percent.

For 2018, the new policies can increase GDP growth to 3.9 percent, up from 2.7 percent under the pre-election forecast.

In the new forecast, we assume that Trump’s trade policies impact both exports and imports, with a larger reduction in the growth rate of imports that reduces the U.S. trade deficit thereby increasing GDP growth.

With the presidency and both chambers of Congress under the control of the Republican Party, big shifts are likely regarding future economic policy. The longer-term effects of a Trump administration depend on whether economic activity increases enough to offset tax cuts and new spending as well as how other countries react to Trump’s trade policies.

And, of course, the midterm election in two years may impact the Trump administration’s ability to put in place new policies in the second-half of his term.

(This Column first appeared in the Richmond Times Dispatch on Jan. 2, 2017)

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Environmentalist Insurance Policies

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Many liberals went into denial, outrage and riot mode after November 8. Now they’re having meltdown over President-Elect Donald Trump’s cabinet nominees with climate and environmental responsibilities:

Former Texas Governor Rick Perry at Energy, Oklahoma AG Scott Pruitt for EPA, Alabama Senator Jeff Sessions for Attorney General, ExxonMobil CEO Rex Tillerson at State, Montana Congressman Ryan Zinke at Interior. As Department of Agriculture secretary and multiple assistant, deputy assistant and other senior level positions are filled, the meltdown will likely raise sea levels by several feet.

It’s even worse than “white supremacists” and “Russian hackers” rigging and stealing the election. Having these people at the helm will be an “existential threat to the planet,” say meltdowners.

A typical over-the-top reaction came from an aptly named spokesperson for radical pressure groups and five-alarm climate scientists that feed at the trough of taxpayer and tax-exempt foundation funding “This is the wealthiest, most corporate, most climate-denying cabinet in history,” snorted Kiernan Suckling, director of the anti-development Center for Biological Diversity.

After eight years of anti-fossil-fuel, anti-growth, anti-job, anti-blue-collar policies – and the Left’s fervent wish for eight more years under Hillary Clinton – any Trumpian shift is bound to look that way to them.

So we’re likely to get a bellyful of bombast from like-minded (or ill-informed) office and neighborhood partygoers, especially if they’re too much imbued with holiday spirits. At the risk of offending those who do not share an NRA perspective on gun control (stance, grip, sight alignment, trigger control), here’s a little intellectual ammunition that conservatives may find helpful during those “spirited” discussions.

The United States needs to reduce taxes and regulations that have hobbled energy development and job creation – threatening to put federal bureaucrats firmly in control of our states, communities, livelihoods and living standards. However, as I noted recently, these essential, long overdue changes will come with no reduction in air, water or overall environmental quality standards that ensure our health and welfare. They will address rogue agency actions that actually impair our living standards, health and wellbeing.

Indeed, nearly all these autocratic government actions are based on some variation of the infamous “precautionary principle.” This infinitely malleable pseudo-guideline says chemicals and other technologies should be restricted or banned if there is any possibility (or accusation by radical activists) that they could be harmful, even if no cause-effect link can be proven.

Even worse, the bogus principle looks only at often-inflated risks from using chemicals, energy systems or other technologies that activists or regulators dislike – never at the risks of not using them; never at risks that could be reduced or eliminated by using them. Sustainability “guidelines” are very similar.

Just as perversely, if the Powers that Wannabe like a technology, they ignore or actively suppress any harmful impacts. For instance, since wind turbines can supposedly replace fossil fuels, they ignore bird and bat deaths, human health damage from infrasound, and the fact that essential metals are mined and processed under horrendous conditions by men, women and children in African and Asian countries.

Those environmental, health, human rights, and child labor violations are far away (literally not in their backyards), and thus can be conveniently ignored.

So can the poverty, disease, malnutrition and early death perpetrated and perpetuated by extremist groups that campaign tirelessly to shut down industries in developed nation communities – and prevent the poorest nations on Earth from gaining access to modern technologies that improve and save lives.

Eco-extremists claim they can save lives by preventing higher temperatures, rising seas, and more storms, droughts and crop failures due to “dangerous manmade climate change” decades from now. So they block fossil fuel power plants that provide reliable, affordable energy for modern homes, hospitals, schools and factories that improve health and living standards – and end up killing millions right now, year after year.

Climate change has been real throughout history. Sometimes beneficial (moderately warm, with ample rainfall), sometimes destructive (decades-long droughts or cold spells, glacial epochs with mile-thick ice sheets crushing entire continents), it is driven by solar, cosmic ray, oceanic and other powerful natural forces that humans cannot control. Carbon dioxide may play a role, but only a minor one, and rising atmospheric CO2 levels make crops, grasslands and forests grow faster and better.

The “unprecedented” manmade climate cataclysms that Al Gore and Barack Obama promised are not happening. For example, we were supposed to get more frequent, powerful and destructive storms; instead, a record 11 years have passed without one category 3-5 hurricane making landfall in the USA. 

To attack fracking and natural gas use, bureaucrats claim methane is 86 times more potent than CO2 as a greenhouse gas – but won’t admit that it is 1/235th as prevalent in Earth’s atmosphere (0.00017%), and at least 1/600,000th as prevalent as water vapor (1-4%), the most important GHG.

Their “social cost of carbon” schemes assign ever-higher monetary impacts to every climate and weather problem they can possibly attribute to using carbon-based fuels – but totally ignore the enormous and undeniable benefits of utilizing oil, natural gas and coal that still provide 82% of US and global energy.

They’re convinced their anti-energy diktats will “save the planet,” by shutting down US power plants and factories, despite vastly greater emissions from China, India and a hundred other nations that are rapidly expanding their fossil fuel use, to lift billions more people out of abject poverty, disease and malnutrition.

The same anti-technology activists and bureaucrats also detest biotechnology and genetically modified crops that require less water and can battle insect predators with a tiny fraction of the insecticides required for conventional grains and vegetables. They equally despise another GM marvel, Golden Rice, which prevents Vitamin A Deficiency that blinds and kills hundreds of thousands of children every year.

Instead of applauding the reduced blindness, malnutrition, starvation and death these crops can bring, precautionary and sustainability extremists obsess about imaginary risks of eating them, allowing more millions to die unnecessarily, year after year. It’s not their kids, after all. Why should they be concerned?

The same callous, phony ethics prevail on the disease front. Eco-activists support bed nets – but not insecticide spraying to kill malaria-carrying mosquitoes, and certainly not DDT, the most powerful, longest-lasting mosquito repellant ever invented. Sprayed once every six months on the walls of mud or cinderblock houses, DDT keeps 80% of mosquitoes from entering, irritates those that do come in, so they don’t bite, and kills any that land. 

But radical ideologues focus on trivial, irrelevant side effects that “some researchers say could be linked” to DDT use – and let 600,000 parents and children die excruciating deaths every year from malaria.

Every one of these anti-technology, “precautionary” attitudes is the environmentalist equivalent of protecting American kids from powerful chemicals, fatigue, nausea, hair loss, and increased risk of illness and infection – by banning chemotherapy drugs, and just letting the little cancer patients die.

They are the equivalent of requiring you to carry a $10,000-a-year insurance policy that covers you only if you are killed by a meteorite – or by a raptor or tyrannosaur. At least meteorite risks are real, if extremely remote.

Raptors and T rexes exist only in our imaginations, special effects computers and movie theaters – much like the manmade climate chaos and other precautionary extremism that come from computer models and PR hype, and drive too many of our policies, laws and regulations.

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Energy Facts and Figures for Dummies Part XI

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(This is part XI of this series on energy. We hope it helps the reader better understand the issues facing our country and our state as we endeavor to tackle the problem of providing our citizens and our businesses with their energy needs.)

Taxes

* From 2007 to 2012, companies in the S.&P. 500 paid an average of 29% in federal, state, local, and foreign corporate income taxes.[1016] [1017] Among large oil companies in the S.&P. 500, the average corporate income tax rate was 37%.[1018]

* The burden of corporate income taxes falls upon: (1) business owners in the form of decreased profits, (2) workers in the form of reduced wages, and (3) possibly consumers in the form of higher prices.[1019] [1020]

* The Congressional Budget Office (CBO) estimates that 75% of corporate income taxes are borne by owners/stockholders and 25% are borne by workers.[1021] Other creditable sources estimate that owners/stockholders bear anywhere from 33% to 100% of this tax burden.[1022] For more detail, see Just Facts’ research on tax distribution.

* Excise taxes are similar to sales taxes, except that they are imposed on specific goods and services.[1023] [1024]

* In addition to raising government revenue, excise taxes are sometimes levied to discourage or penalize certain activities.[1025] [1026] [1027] Per the U.S. Energy Information Administration:

Energy excise taxes are disincentives to the production and consumption of the fuels on which they are levied. Excise taxes increase fuel prices and reduce volumes consumed.[1028]

* In 2016, federal and state excise taxes on gasoline averaged 39 cents per gallon.[1029]

* In 2003, the federal government collected about $35 billion in energy-related excise taxes.[1030] This equates to 5% of all energy expenditures in the U.S. that year.[1031]

* The economic burden of excise taxes primarily falls on retail customers in the form of higher prices. Per the Congressional Budget Office:

The effect of excise taxes, relative to income, is greatest for lower-income households, which tend to spend a greater proportion of their income on such goods as gasoline, alcohol, and tobacco, which are subject to excise taxes.[1032] [1033] [1034] [1035]

* To reduce greenhouse gases, government officials and scientists have proposed increasing taxes on electricity,[1036] gasoline,[1037] crude oil,[1038] steel and aluminum,[1039] flying and driving,[1040] [1041] or any activity that emits carbon dioxide.[1042]


Regulations

* Per the U.S. Energy Information Administration (EIA):
  • “The regulation of energy markets can have the same consequences for energy prices, production, and consumption as the direct payment of a cash subsidy or the imposition of a tax.”
  • “Regulation is the most consequential form of federal intervention in the energy industries. … Many of these interventions are designed to yield environmental benefits.”
  • “Regulations more often explicitly penalize rather than subsidize the targeted fuel.”
  • “There are so many Government regulations concerning energy that it is difficult to identify and analyze all of them.”[1043]

* Regulatory costs for hydroelectric power plants increased from 5% of the total costs of generating hydroelectricity in 1980 to 25-30% of the costs in 2010.[1044] [1045] [1046]

* Regulations on the sulfur content of diesel fuel have played a role in raising the price of diesel above that of gasoline.[1047]

* Regulation of hydropower plants has sometimes reduced output from wind farms.[1048]

* During a January 2008 interview with the San Francisco Chronicle, Barack Obama stated:

Let me sort of describe my overall policy. What I’ve said is that we would put a [greenhouse gas] cap-and-trade system in place that is as aggressive, if not more aggressive, than anybody else’s out there. …
[U]nder my plan of a cap and trade system, electricity rates would necessarily skyrocket, regardless of what I say about whether coal is good or bad, because I’m capping greenhouse gasses: coal power plants, natural gas, you name it, whatever the plants were, whatever the industry was, they would have to retrofit their operations. That will cost money. They will pass that money on to consumers.[1049]

* In June of 2009, the U.S. House of Representatives passed a bill that would have capped most sources of greenhouse gas emissions in the U.S. at 17% below 2005 levels by 2020 and at 83% below 2005 levels by 2050.[1050] This bill passed the House by a vote of 219-212, with 82% of Democrats voting for it and 94% of Republicans voting against it.[1051] The bill was then forwarded to the Senate and never voted upon.[1052]

* In December of 2009, the Obama administration Environmental Protection Agency (EPA) issued a finding that greenhouse gases “threaten the public health and welfare of current and future generations.” This finding allows the EPA to regulate greenhouse gases under the Clean Air Act.[1053] [1054]

* In May of 2013, the Obama administration made a regulatory decision that a metric ton of carbon dioxide (CO2) has a “social cost” of $38. This figure is used by EPA and other agencies under the authority of the President to assess and justify regulations on greenhouse gases.[1055] [1056] [1057]

* Per EIA projections made in 2013, a CO2 tax of $25 per metric ton that begins in 2014 and grows to $37 in 2022 would increase gasoline prices by 11% and electricity prices by 30% in 2022. These increases are relative to a situation in which no government greenhouse gas reduction policies are enacted and “market investment decisions are not altered in anticipation of such a policy.”[1058]

* The U.S. Department of the Interior (DOI), which is under the authority of the President, manages 500 million acres or about one fifth of all U.S. surface land and more than three times as much acreage in offshore areas. DOI leases some of these lands for energy projects such as oil drilling and solar energy facilities.[1059] [1060] [1061]

* From 2003 through 2014, energy from fossil fuels produced on federal and American Indian lands declined by 20%, and the portion of U.S. energy from fossil fuels produced on these lands declined by 35%:

Fossil Fuels Produced on Federal, Indian Lands

[1062]

* A 2013 paper in the journal Wildlife Society Bulletin estimated that 888,000 bats and 573,000 birds are killed each year by wind turbines in the U.S. Approximately 83,000 of the bird fatalities are raptors such as hawks, eagles, owls and falcons, which are protected under federal and state laws.[1063] [1064]

* An investigation published by the Associated Press in May 2014 found that:

  • wind farms in Converse County, Wyoming, “have killed more than four dozen golden eagles since 2009….”
  • “The Obama administration has charged oil companies for drowning birds in their waste pits, and power companies for electrocuting birds on power lines. But the administration has never fined or prosecuted a wind-energy company, even those that flout the law repeatedly.”
  • “Getting precise figures is impossible because many companies aren’t required to disclose how many birds they kill. … When companies voluntarily report deaths, the Obama administration in many cases refuses to make the information public….”[1065]

* In November 2013, the Associated Press reported that the Obama administration:

for the first time has enforced environmental laws protecting birds against wind energy facilities, winning a $1 million settlement from a power company that pleaded guilty to killing 14 eagles and 149 other birds at two Wyoming wind farms.[1066]

* In December of 2013, the Obama administration issued a regulation that allows it to give permits to wind farms to accidentally kill eagles for periods of up to 30 years.[1067]

* In June 2014, the Obama administration gave a permit to a California wind farm that allows it to kill up to five golden eagles over five years.[1068]

…………….To Be Continued………………….

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