Thursday, December 13, 2018

Subtle History Could Have Lasting Impact

This was recently reported:
A case before the Supreme court has enormous implications for the state of Oklahoma, as a murder case has courts realizing that Congress never, in fact, explicitly disestablished the Creek Nation’s reservation in the years leading up to Oklahoma’s statehood in 1907. In 2017, the Tenth Circuit of Appeals wrote in a 133-page analysis stating that since Congress never actually disestablished the reservation, half the state — some 44 counties and municipal jurisdictions of Oklahoma — is, in fact, under tribal jurisdiction. This reality has enormous implications for criminal justice and taxation. Justice Gorsuch has recused himself, so it would require five of eight justices to overturn the state court’s ruling in favor of the tribes. 
If you look back, Texas was given the ability to split into five states at its own choosing when given statehood. It could effectively have undue influence, particularly in the US Senate, if it did so by adding 8 additional Senators. If they voted as a bloc, they’d have 10 of 108 votes in the Senate.

I was also reading “The Color of Compromise” by Jemar Tisby and reminded that conscious or subconscious racism led to “white flight”—the ‘migration’ of wealthier whites to the suburbs. This then led to more jobs being created in the suburbs—because of close proximity to the business owners, a majority of whom are white—abandoning talented people in the inner city. This also led to higher commuting costs from the suburbs (and exurbs) to downtown for white collar work, which put pressure on wages, etc. and public subsidy of express bus, light rail and other public transportation modes. But then that sometimes doesn’t work for those companies who move from downtown to a suburb: example, a large bank headquarters moved from downtown to a suburb and lost 80% of its workforce because public transportation wasn’t available in that direction at the appropriate times of the day.

Wednesday, December 12, 2018

Medical Debts...and Their Forgiveness

This item was recently published through FiveThirtyEight’s newsletter:
Two New Yorkers in Ithaca raised $12,500 and sent it to a charity, which then purchased $1.5 million in medical debts for less than a penny on the dollar, and forgave them — 1,284 New Yorkers have had their debts forgiven thanks to these efforts. That’s wonderful and very nice and very Christmassy and all, but begs some larger questions, I think, about the state of health care in this country. [The New York Times]
If the claims have been ‘sold’ for a ‘penny on the dollar’, the seller considers them the least likely to be collected and at a high risk of not collecting any money to pay anything towards the debt.

What this also shows is that uncollected medical debts averaged $1,168 per person. This doesn’t seem like a huge amount, and if you’ve had any experience with medical bills, it seems really minuscule. Average medical expenditures are $10,000/person—and that’s why insurance premiums average about that amount. That’s the average, so the distribution of these debts is most likely that a majority are far less, and a minority of them are quite large. For example, we know most of the medical expenditures happen at end-of-life, which is less than 1 percent of all residents in the US.

If the majority of these uncollected medical debts are less than $1,000, why are they uncollected? According to the Kaiser Foundation, a third of the debt is based on chronic conditions and have built up over time and two-thirds is one-time (like end-of-life). Even so, the lower the household income, the less is its ability to pay from savings (and discretionary income if any considering the relatively low level of savings). Households with less than $25K income (about 25% of all households) had a median savings of $500–half of the average medical debt. Households in the next tier up to $45K (not quite 50% of all households) had a median savings of $1,500–about equal with the average medical debt. Even if the medical debt seems relatively small—or minuscule—it does mean that a significant portion of US households would struggle to pay them. The Federal Reserve Bank shows that 40% of adults couldn’t pay a $400 medical, car repair, house repair (and so on) bill.