CDC Quarantines Children

The Covid pandemic is nearly into its third year and schools are still quarantining children. An Oregon high school ordered all 2,680 of its students to stay home for a week and a half in September – two days of complete shutdown, followed by a week of online classes. Parents received a “flash alert message” at 5:35 a. m. informing them that their children wouldn’t be allowed in school that day.

Dr. Leslie Bienen and Eric Happel tell us this tale in The Wall Street Journal. They say that Oregon Public Broadcasting reports “875 high school students and staff members . . . had to quarantine” before the shutdown. What precipitated this emergency intervention into the education of all these students? Four positive tests of Covid-19.

The Centers for Disease Control and Prevention (CDC) is responsible for these draconian measures. Despite the disease’s low risk to young people and the widespread vaccination of adults, the CDC continues to recommend seven-to-fourteen-day quarantines for schoolchildren who are suspected of having been exposed to the virus.

Fortunately, thirty states have set aside the CDC guidelines, dismissing them as unreasonable and lacking scientific basis. In fact, the CDC itself has published studies suggesting that such measures are unnecessary. Yet the CDC has dragged its feet in considering a less-restrictive alternative known as “test to stay.” Most likely, the reason is the White House doesn’t approve.

During the 2020-21 school year, a study from Salt Lake County, Utah, published in the CDC’s own Morbidity and Mortality Weekly Report, found only four positive cases among 735 students tested while in quarantine, a transmission rate of just 0.7%. A study from St. Louis County, Mo., also published in MMWR, found no positive cases among quarantined students at a time when the total countywide two-week case count was 711 per 100,000 people. (The CDC classifies a one-week rate of 100 per 100,000 as “high.”) Los Angeles Unified School district reported a transmission positivity rate of only 0.2% after testing 30,000 students.

In response to these numbers, Los Angeles Unified School district changed its policy to “test-to-stay”: Asymptomatic students suspected of exposure may remain in school, subject to testing every few days for a week, along with other restrictions. Parents are still directed to keep them at home outside school hours. (No sense in going outside and enjoying themselves where it is safest for them to be!)

The authors say “test-to-stay” reduces dramatically the educational costs of quarantine. Utah reported it saved 109,742 school days across 13 high schools from November 2020 thru March 2021. Yet many states are sticking with the CDC guidelines. It would not surprise you to know that most voted for President Biden. The CDC Director Rochelle Walensky has sidestepped questions regarding this policy and responded only that “masks are working.”

Not surprisingly, Oregon doesn’t allow “test-to-stay” and has rigidly followed the CDC guidelines, even adding restrictions not in the guidelines like requiring outdoor masking at recess and 10 to 14 days of quarantine for all exposed students who haven’t been vaccinated – even if the potential exposure occurred outside, where transmission is so rare that it is almost undocumented. Oregon has mandated vaccination for teachers, other school staff and volunteers, so any danger to adults in school is minimal.

Naturally, all these restrictions have a greater impact on low-income students, whose parents cannot afford alternative educational resources, including hiring tutors to make up for educational deficits.  Allowing “test-to-stay” would ameliorate, but not eliminate, some of this damage.  Other countries, like Denmark, Norway, and Sweden, have eliminated quarantines of schoolchildren with no resulting rise in Covid-19. Dr. Bienen says, “The CDC’s current quarantine policies keep children out of school and provide no meaningful reduction in Covid-19 transmission.”

Minimum Wage Arguments that Fail

 

This is supposed to be a healthcare blog, but sometimes I can’t resist talking about other issues that concern me. Please keep reading because you might learn something.

John C. Goodman, economist writing in Forbes, asks a simple question. Suppose Congress were considering a bill that would do the following: either your employer must double your wage or fire you. Is that the kind of law you would like to see passed? Most people would say no, yet that’s the same threatening edict politicians are willing to inflict on those at the bottom of the income ladder.

Goodman gives us three arguments used to justify this thinking he calls “the three worst arguments for the minimum wage.” These arguments are not explicit – they are implicit. They are so profoundly ingrained in the thinking of advocates of doubling the minimum wage that they don’t think verbalizing them is even necessary.

The Three Arguments:

  • Costs don’t matter
  • Prices don’t matter
  • Economics doesn’t matter

 

One of the fundamentals of adult thinking is realizing that “there is no such thing as a free lunch.” I learned that lesson the hard way when I went off to college and tried to buy my first new car, but that’s a story for another time.

Goodman says if Congress does something to increase someone’s income, someone somewhere has to bear that cost. Already you can see how the current occupant of the White House failed to learn this lesson since he wants us all to believe the cost of a $3.5 Trillion spending package is “zero.” There is definitely a cost and we must know who is going to pay that cost before imposing it.

Suppose the minimum wage is paid for by raising product prices and the work is done in low-income neighborhoods where low-income customers shop. Low-income households tend to spend a high percentage of their income on low-wage products, such as fast foods. To the extent this happens, a higher minimum wage doesn’t increase family income – it just recycles income.

The Congressional Budget Office (CBO) says 40% of minimum wage workers live in households with incomes more than three times the federal poverty level (FPL). Many of these are teenagers. In this case, a higher minimum wage shifts income from low-income households who pay more for the goods they buy to higher-income households where the teenage workers live.

Other studies find that the wage hike is paid for when employers reduce other benefits, such as health insurance and job training. Non-wage benefits make up about 30% of total compensation. If that happens, the wage hike doesn’t increase employee income, it just changes the composition of that income. In many cases, the aggregate costs may exceed the benefits, making the intended beneficiaries of the wage hike worse off than they were before.

Economics teaches us that prices play a vital social function. Artificially changing them creates unintended social consequences. But there are a great many people who don’t believe that, or choose to ignore it. They believe that if a price is judged too low, government can increase it and nothing bad will happen. If a price is judged too high, the government can lower it and nothing bad will happen.

What are the unintended consequences of the minimum wage?

Goodman says minimum wages lead to greater unemployment, loss of non-wage benefits, disproportionate impact on low-income youth, more racial discrimination, lost entitlement benefits if family income rises, and increased criminal activity when legal work is priced out of reach. Yet those who advocate for higher minimum wages pretend to be looking out for the poor!

Goodman says “Failing to get to the bottom of these effects before blindly legislating is worse than negligence on the part of politicians. It is public policy malpractice.”

ObamaCare is Failing

 

ObamaCare has slipped from the news because more important issues, like parents scolding school boards and SEALS refusing to be vaccinated, have dominated the headlines. Yet, healthcare is still an important issue to most Americans. The RealClearPolitics latest polls show 60.8% of Americans believe the country is on the wrong track – and healthcare is one of the reasons why.

GOP attorneys general tried to get the U.S Supreme Court to rule ObamaCare is unconstitutional, but they declined to review the case. That leaves it up to Congress to make the needed changes that will give Americans the healthcare they need. The Trump administration tried to repeal and replace ObamaCare, but fell just shy of the needed votes. Since then, they created several alternatives including health sharing plans, limited benefit insurance, and short term, limited duration health plans (STLD).

John C. Goodman, healthcare economist writing in Forbes, says critics of these alternatives call them “junk insurance.” Goodman responds, “But if people are choosing them over insurance offered in the exchanges, what does that say about ObamaCare?”

ObamaCare was supposed to protect people who enter the individual market with pre-existing conditions. But people who leave an employer plan and shop for insurance in the individual market today will face three unpleasant surprises: higher premiums, higher out-of-pocket costs, and more limited access to care than a typical employer plan provides. What went wrong?

The Affordable Care Act (ObamaCare) was flawed from the beginning. It triggered a race to the bottom by giving health plans perverse incentives to attract the healthy and avoid the sick. By demanding every qualified plan to include unnecessary services, like mammograms for men and prostate exams for women, the costs of these plans became artificially high. To compensate, insurers demanded high deductibles, which favor the healthy who don’t have to use the insurance often. Goodman says the most successful ObamaCare insurers are Medicaid contractors. The plans that have survived in the exchanges look like Medicaid managed care with a high deductible.

I am one of very few orthopedic specialists in our area accepting some of these plans. These patients can afford the insurance premiums, which are heavily subsided by the government, but they can’t afford the high deductibles associated with surgery or physical therapy. Often, they have to forgo treatments needed due to their inability to pay the deductibles.

Goodman says ObamaCare enrollees are often denied access to the best doctors and facilities. In Dallas, Texas, for example, no individual insurance plan includes Southwestern Medical Center, which may be the best medical research center in the world. Cancer patients with these plans don’t have access to MD Anderson Cancer Center in Houston. This pattern is common all over the country.

The solutions are well known, says Goodman, but hampered by political stagnation. He says in an ideal health care system, health plans would compete to attract patients with medical problems, instead of trying to avoid them as ObamaCare does. Plans would be allowed to specialize and become centers of excellence in such diseases as diabetes, heart disease, and cancer instead of being required to be all things to all patients.

There are two exchanges in our healthcare system currently, that give us plenty of insight into what works and what doesn’t – the ObamaCare Exchange and the Medicare Advantage Exchange. In both systems, consumers choose among competing health plans during an open enrollment period. Buyers pay community-rated premiums regardless of health status, supplemented by government subsidies. So far they are about the same. But one is doing much better than the other. Enrollment in Medicare Advantage has been steadily growing. About 40% of all Medicare enrollees are in Medicare Advantage plans and the Congressional Budget Office projects the share will exceed 50% by the end of the decade.

In contrast, before Covid hit, enrollment in the ObamaCare exchange was steadily falling. In the unsubsidized part of the market – with 40% of potential participants – enrollment dropped almost in half between 2016 and 2019.

What makes the difference?

The Medicare Advantage system works as well as it does because it uses a sophisticated risk-adjustment system to compensate healthcare providers for their participant’s pre-existing conditions. Medicare Advantage is the only place in our entire healthcare system where doctors who discover a worsening of a health condition in a patient can send the information to the insurer (Medicare) and get a higher premium payment for their health plan.

Goodman says if ObamaCare health plans were allowed to specialize and if the Medicare Advantage approach to risk adjustment were adopted in the ObamaCare exchanges, health plans would have greatly improved incentives to care for the sick – instead of the current system that incentivizes them to avoid the sick. With these changes, those on ObamaCare could have the same options and quality of care now reserved for Medicare beneficiaries.

What about those high deductibles?

Current ObamaCare deductibles can be as high as $8,550 per individual and $17,100 per family. The average family of four, without a subsidy, faced an annual bill of $25,000 before any benefits kicked in. This is worthless insurance and declining enrollment figures show people have figured this out. The solution is letting families purchase the coverage they need – without the government making those decisions for them. Instead of paying for emergency room visits for people who can’t afford the out-of-pocket expenses for primary care, public funds could be used instead to pay for very large expenses – those that are rare and unusual and difficult to insure for in the private marketplace. People need the freedom to choose what works for them.