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Censorship Kills

Censorship Kills

Authored by Barry Brownstein via The American Institute for Economic Research,

Whenever I write an essay critical of expert opinion on Covid, I immediately receive indignant replies. Some assume I must be a bleach-drinking..

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Censorship Kills

Authored by Barry Brownstein via The American Institute for Economic Research,

Whenever I write an essay critical of expert opinion on Covid, I immediately receive indignant replies. Some assume I must be a bleach-drinking supporter of President Trump. Others label me a dangerous libertarian since, in their view, I challenge the “best” source of expert opinion.

Among my critics are well-meaning people who see no alternative but to follow the policy prescriptions of their favored experts. They do not see they are on the path of illiberal, anti-science, authoritarian thinking that is endangering the well-being of so many people today.

Karl Popper helps us understand why an “authoritarian attitude to the problem of human knowledge” hinders scientific progress. His essay “On the So-Called Sources of Knowledge” appears in his collection In Search of a Better World.  

Popper explains, “The question of the sources of our knowledge, like so many authoritarian questions, is a question about origin. It asks for the origin of our knowledge, in the belief that knowledge may be legitimate itself by its pedigree.”

Popper explains how the mistaken belief that knowledge has a pedigree leads us to seek the “‘best’ or the ‘wisest’” to be our political rulers. We make the mistake of assuming there are ultimate authorities best suited to rule because of the knowledge they possess. Popper explains that there are no such ultimate authorities, and “uncertainty clings to all assertions.”

Popper argues that instead of focusing on who should rule, our focus should be on “How can we organize our political institutions so that bad or incompetent rulers can do the minimum amount of damage?”

Since “ideal and infallible source of the knowledge” is as impossible as “ideal and infallible rulers,” Popper proposed a better question: “Is there a way of detecting and eliminating error?”

Dr. Fauci claims that to criticize him is to criticize science. Popper would challenge this authoritarian assertion since “pure, untainted and certain sources do not exist.”  

To detect error, Popper advises a mindset of inquiry that criticizes “the theories and conjectures of others.” Importantly, Popper suggests training ourselves to criticize “our own theories and speculative attempts to solve problems.”

Of course, human beings don’t do very well criticizing themselves. Popper says that in a free society that will not be an issue because “there will be others who will do it for us.”

What happens when we don’t criticize our theories? What happens when others are prohibited from criticizing our theories? Without critical inquiry, errors compound since “there are no ultimate sources of knowledge.”

Humility to acknowledge our ignorance motivates inquiry. Popper writes, 

“The more we learn about the world, and the deeper our learning, the more conscious, clear and well-defined will be our knowledge of what we do not know, our knowledge of our ignorance. The main source of our ignorance lies in the fact that our knowledge can only be finite, while our ignorance must be necessarily infinite.” 

Authentic scientific inquiry is impossible when criticism is prohibited.

Covid Censorship

Evolutionary biologist Brett Weinstein is a modern-day Popper. Weinstein first came to prominence in 2017 when he was a professor at Evergreen State College in Washington State. A progressive supporter of Bernie Sanders, Weinstein became an early victim of the cancel culture when he refused to support a campus event requiring white people to stay off-campus. Evergreen State’s college president, George Bridges, declined to protect Weinstein and his wife Heather Heying, then a biology professor at Evergreen, from a campus mob. 

Run out of Evergreen State, Weinstein and Heying now produce the YouTube podcast DarkHorse and depend, in part, on advertising revenue for their livelihood. As the audience of DarkHorse has grown they have become independent media stars.

Today, Big Tech is after Weinstein and Heying. Prominent free-speech advocate Matt Taibbi writes, “Weinstein is on the verge of becoming one of the more prominent casualties to a censorship movement that it’s hard not to see as part of a wider Evergreening of America.” 

Why are Weinstein and Heying so dangerous to the orthodoxy? Throughout the Covid crisis, they have considered alternative views. They were among the first to consider the hypothesis that the virus was manufactured. They have considered Ivermectin treatments. Now they are considering the evidence that Covid vaccines are more dangerous than political authorities, the media, and their anointed experts are portraying. Importantly, they have not hesitated to question the integrity of officials such as Dr. Facui.  

Consider Weinstein’s Popperian assertion that “a movement opposes science when it doesn’t want assertions tested, challenges arithmetic when its claims don’t add up, ridicules ‘merit’ when it wants to triumph by other means, seeks to censor when it fears discussion.” 

Weinstein adds, “Those who coddle such demands sow the seeds of our undoing.” Censorship means risking our economies and our lives. 

To reject scientific inquiry, Weinstein argues, “is effectively an invitation to a dark age, which means an age where progress comes to a halt… We must at all costs prevent this shift in our mindset.”

Recently YouTube removed a DarkHorse podcast panel discussion featuring Dr. Robert Malone. The podcast is now viewable at Odysee, which runs on LBRY, a blockchain file-sharing decentralized platform.  

Malone is the creator of the mRNA technology used in Covid vaccines. Malone warns that the spike proteins may be responsible for various unpredictable side effects, including blood clots and myocarditis. The latter being especially prevalent in children and young adults for whom the risk from Covid is very low. Exhibiting Popperian humility, the panelists allowed their conjectures might not be entirely accurate. Malone and Weinstein have earned this right, not to be obeyed, but to present their ideas without censorship. 

If there is evidence that the spike protein mechanism was not fully understood, to believe in science would mean that you examine the warnings of eminent physicians and scientists. 

One doesn’t have to deny the benefits of the vaccine—and Weinstein does argue the vaccine has saved lives—to realize that the costs and benefits of any medical intervention can only be assessed accurately with uncensored information. Appearing on Tucker Carlson, Malone said of the vaccines’ risks: “We don’t have the information we need to make a reasonable decision.” Malone put it this way:

“One of my concerns is the government is not being transparent with us. I’m of the opinion that people have the right to decide whether to accept vaccines or not, especially since these are experimental vaccines. This is a fundamental right having to do with clinical research ethics.”

Dr. Joseph Ladapo and Dr. Harvey Risch are medical professors at UCLA and Yale. They too are concerned that vaccine side effects are not being fully explored. Evidence points to risks of “low platelets (thrombocytopenia); noninfectious myocarditis, or heart inflammation, especially for those under 30; deep-vein thrombosis; and death.” This failure to examine risk is being fueled by a strategy of ridiculing those who question the Covid orthodoxy. They write, 

One remarkable aspect of the Covid-19 pandemic has been how often unpopular scientific ideas, from the lab-leak theory to the efficacy of masks, were initially dismissed, even ridiculed, only to resurface later in mainstream thinking. Differences of opinion have sometimes been rooted in disagreement over the underlying science. But the more common motivation has been political.

Another reversal in thinking may be imminent. Some scientists have raised concerns that the safety risks of Covid-19 vaccines have been underestimated. But the politics of vaccination has relegated their concerns to the outskirts of scientific thinking—for now.

Ladapo and Risch warn that “political partisanship and science” don’t mix:

Public-health authorities are making a mistake and risking the public’s trust by not being forthcoming about the possibility of harm from certain vaccine side effects. There will be lasting consequences from mingling political partisanship and science during the management of a public-health crisis.

The results of such partisanship have been deadly even for groups of people supposedly receiving the most benefit from vaccines. Lapado and Risch point to the rare honesty of a report issued by the Norwegian Medicines Agency having “reviewed case files for the first 100 reported deaths of nursing-home residents who received the Pfizer vaccine.” The vaccine’s impact was not salutatory: “The agency concluded that the vaccine ‘likely’ contributed to the deaths of 10 of these residents through side effects such as fever and diarrhea, and ‘possibly’ contributed to the deaths of an additional 26.”

The CDC has acknowledged the reality of vaccine-induced myocarditis. The acknowledgment has come with a statement that the CDC believes the vaccine’s benefits exceed the costs. The FDA has issued a myocarditis warning label.

For some the CDC is the gold standard for medical guidance; for others, their guidance is dangerously flawed. Dr. Vinay Prasad, professor of epidemiology at the University of California wrote about the latest CDC guidance, “The current CDC guidelines are so poor they would recommend a 15-year old boy who recovered from documented covid19 and who got pericarditis from dose 1 go on to get dose 2.” He adds, “Can we pause a minute to contemplate how staggeringly negligent that is?” Dr. Prasad is clear, “Covid vaccines for children should not get emergency use authorization.” 

Faced with censorship in the marketplace of ideas, and faced with cronyism driving public policy, how can a parent weigh the costs and benefits of the vaccine for their child?

Dr. Martin Kulldorff, professor of medicine at Harvard, and Dr. Jay Bhattacharya, professor of medicine at Stanford write, “The idea that everyone must be vaccinated against COVID-19 is as misguided as the anti-vax idea that no one should. The former is more dangerous for public health.”

Kulldorff and Bhattacharya are particularly concerned about “intense [vaccination] pressure on young adults and children. They write: “Under such uncertainty [about side effects from vaccines], vaccine mandates are unethical. University presidents or business leaders should not mandate a medical intervention that could have dire consequences for the health of even a few of the people in their charge.”

Kulldorff’s and Bhattacharya’s conclusion are like those of Lapado and Risch:

Universities used to be bastions of enlightenment. Now many of them ignore basic benefit-risk analyses, a staple of the toolbox of scientists; they deny immunity from natural infection; they abandon the global international perspective for narrow nationalism; and they replace trust with coercion and authoritarianism. Mandating the COVID-19 vaccine thus threatens not only public health but also the future of science.

Weinstein, Heying, Lapado, Risch, Malone, Prasad and many more disagree with a blanket endorsement for Covid vaccinations. 

In the absence of vaccine mandates issued by colleges and schools, those who disagree with the CDC would be free to do so. The CDC/FDA position is akin to issuing a warning label on cigarettes and then mandating smoking. 

Dr. Francis Christian is a clinical professor of general surgery at the University of Saskatchewan. A self-described “very pro-vaccine physician,” he was fired for issuing a statement urging parents to exercise “informed consent” about Covid vaccines. Christian writes:

The person by whom the drug, vaccine, treatment or intervention is administered must always make the patient fully aware of the risks of the medical intervention, the benefits of the intervention and if any alternatives exist to the intervention. This should apply particularly to a new vaccine that has never before been tried in humans.

He adds, “I have not met a single vaccinated child or parent who has been adequately informed and who then understands the risks of this vaccine or its benefits.”

Dr. Christian points to alternatives. From the outset of this pandemic, Fauci, Bill Gates, and others told us that life could not get back to normal until we achieved herd immunity via vaccinations. For the FDA to issue an Emergency Use Authorization (EUA) for Covid vaccines, there must be “no adequate, approved, and available alternatives.” 

Manufacturers of Covid vaccines are indemnified from liability, and the government has made sure they are also protected against competition. It seems to be a law of cronyism that crony greed is maximal and concern for others is minimal.

Consider Ivermectin, a generic drug with a long history of safety. Weinstein and others argue Ivermectin is not only an effective treatment but a potential prophylactic against Covid. Weinstein, Heying, and their guests have advocated for further study of IvermectinMatt Taibbi recently documented how the consideration and use of Ivermectin has become a political issue. 

Big Tech routinely censors reports of vaccine harm and alternatives to vaccines. Censorship is the product of an illiberal, anti-science, authoritarian mindset. Censorship kills because decision-making is distorted. 

Consider the knowledge of the disinfecting properties of soap and water. In a world where that knowledge was censored in favor of antibiotic treatment for all wounds, people would die needlessly, and antibiotics would be overused. 

Our Responsibility

Popper interprets Kant’s principle of autonomy as the “realization that we must never accept the command of an authority, however exalted, as the basis of ethics. For whenever we are faced with the command of an authority, it is always up to us to judge, critically, whether it is morally permissible to obey.” 

Popper allows, “The authority may have the power to enforce its commands, and we may be powerless to resist.” 

Today we are not yet powerless to resist the censors. We can acknowledge our ignorance and engage in inquiry. We can still seek out and find alternative views and consider disconcerting evidence. We can resist the urge to self-censor and instead share what we are observing and learning. We can reject authority as the basis for our personal ethics. Popper writes, “If it is physically possible for us to choose our conduct then we cannot escape the ultimate responsibility.” 

Lex Fridman is a research scientist at MIT and the host of a popular podcast. Recently he had Weinstein on his show to talk about censorship. Fridman said this: “Science is the striving of the human mind to understand and solve the problems of the world, but as an institution, it is susceptible to flaws of human nature, to fear, to greed, power, and ego.” To reduce uncertainty about the best solutions to Covid, Fridman argues, “No voices should have been silenced, no ideas left off the table. Open data, open science, open scientific communication, and debate is the way, not censorship.”

Censors claim the moral high road; they assure us they are coercing others for our own good. Fridman dismantles their authoritarian hubris: “There are a lot of ideas out there that are bad, wrong, dangerous. But the moment we have the hubris to say we know which ideas those are is the moment we lose our ability to find the truth, to find solutions.” The conversation he had with Weinstein is larger than Weinstein’s ideas. Fridman warns that at stake is “the very freedom to talk, to think, to share ideas.” Fridman believes, “This freedom is our only hope.”

Censorship distorts decision-making and destroys hope. For some, Covid is a matter of life or death. Censorship challenges our ability to make responsible health choices for ourselves and those in our care.

In 1644 John Milton wrote, “He who destroys a good book, kills reason itself.” Today, acknowledge the destructive consequences of censorship. Speak out now or we risk allowing Big Tech’s algorithms and community guidelines to continue to destroy reason, hinder science, and undermine hope for humanity.

Tyler Durden Wed, 06/30/2021 - 18:20

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The most potent labor market indicator of all is still strongly positive

  – by New Deal democratOn Monday I examined some series from last Friday’s Household survey in the jobs report, highlighting that they more frequently…

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 - by New Deal democrat


On Monday I examined some series from last Friday’s Household survey in the jobs report, highlighting that they more frequently than not indicated a recession was near or underway. But I concluded by noting that this survey has historically been noisy, and I thought it would be resolved away this time. Specifically, there was strong contrary data from the Establishment survey, backed up by yesterday’s inflation report, to the contrary. Today I’ll examine that, looking at two other series.


Historically, as economic expansions progress and the unemployment rate goes down, average hourly wages for nonsupervisory workers improve at an increasing rate (blue in the graph below). But eventually, inflation (red) picks up and overtakes that wage growth, and a recession occurs shortly thereafter. Not always, as we’ll see in the graph below, but usually:



As you can see, there have been a number of exceptions to the rule, chiefly where inflation outstripped wage growth, but no recession happened anyway. Typically this has occurred because of the entry of so many more people (like women in the 1980s and early 1990s) into the labor force.

And we certainly see that inflation outstripped wages in 2022, not coincidentally when there were several negative quarters of real GDP. But with the decline in gas prices, in 2023 inflation subsided much more sharply than wage growth, and the economy improved more substantially. That has remained the case in the first two months of 2024.

But an even more potent indicator is one I have come to rely on even more: real aggregate payrolls for nonsupervisory workers. Here’s its historical record up until the pandemic:



There’s not a single false positive, nor a single false negative. If YoY aggregate payroll growth is stronger than YoY inflation, you’re in an expansion. If it’s weaker, you’re in a recession. Period.

And here is its record since the pandemic:



Real aggregate nonsurpervisory payrolls are positive, and they got more positive in 2023 compared with 2022. Currently they are 2.6% higher YoY than inflation.

In addition to the YoY comparison, real aggregate nonsupervisory payrolls have always declined, at least slightly, from their expansion peaks before every single recession in the past 50 years except for when the pandemic suddenly shut down the economy:



Not every slight decline means a recession is coming. But if real aggregate payrolls are at a new high, you’re not in a recession, and one isn’t likely to occur in the next 6 months, either.

And in case it isn’t clear from that long term graph, here’s the short term graph of the same thing:



Real aggregate nonsupervisory payrolls made a new all-time high in February. Despite the negative metrics in the Household survey, this is *very* potent evidence that not only are we not in a recession, but one isn’t likely in the immediate future either.


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Spread & Containment

KIMM finds solution to medical waste problem, which has become a major national issue

A medical waste treatment system, which is capable of 99.9999 percent sterilization by using high-temperature and high-pressure steam, has been developed…

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A medical waste treatment system, which is capable of 99.9999 percent sterilization by using high-temperature and high-pressure steam, has been developed for the first time in the country.

Credit: Korea Institute of Machinery and Materials (KIMM)

A medical waste treatment system, which is capable of 99.9999 percent sterilization by using high-temperature and high-pressure steam, has been developed for the first time in the country.

The Korea Institute of Machinery and Materials (President Seog-Hyeon Ryu, hereinafter referred to as KIMM), an institute under the jurisdiction of the Ministry of Science and ICT, has succeeded in developing an on-site-disposal type medical waste sterilization system that can help to resolve the problem caused by medical waste, which has become a national and social issue as the volume of medical waste continues to increase every year. This project was launched as a basic business support program of the KIMM and was expanded into a demonstration project of Daejeon Metropolitan City. Then, in collaboration with VITALS Co., Ltd., a technology transfer corporation, the medical waste treatment system was developed as a finished product capable of processing more than 100 kilograms of medical waste per hour, and was demonstrated at the Chungnam National University Hospital.

Moreover, the installation and use of this product have been approved by the Geumgang Basin Environmental Office of the Ministry of Environment. All certification-related work for the installation and operation of this product at the Chungnam National University Hospital has been completed, including the passage of an installation test for efficiency and stability conducted by the Korea Testing Laboratory.

Through collaboration with VITALS Co., Ltd., a corporation specializing in inhalation toxicity systems, the research team led by Principal Researcher Bangwoo Han of the Department of Urban Environment Research of the KIMM’s Eco-Friendly Energy Research Division developed a high-temperature, high-pressure steam sterilization-type medical waste treatment system by using a high-temperature antimicrobial technology capable of processing biologically hazardous substances such as virus and bacteria with high efficiency. After pulverizing medical waste into small pieces so that high-temperature steam can penetrate deep into the interior of the medical waste, steam was then compressed in order to raise the boiling point of the saturated steam to over 100 degrees Celsius, thereby further improving the sterilization effect of the steam.

Meanwhile, in the case of the high-pressure steam sterilization method, it is vitally important to allow the airtight, high-temperature and high-pressure steam to penetrate deep into the medical waste. Therefore, the research team aimed to improve the sterilization effect of medical waste by increasing the contact efficiency between the pulverized medical waste and the aerosolized steam.

By using this technology, the research team succeeded in processing medical waste at a temperature of 138 degrees Celsius for 10 minutes or at 145 degrees Celsius for more than five (5) minutes, which is the world’s highest level. By doing so, the research team achieved a sterilization performance of 99.9999 percent targeting biological indicator bacteria at five (5) different locations within the sterilization chamber. This technology received certification as an NET (New Excellent Technology) in 2023.

Until now, medical waste has been sterilized by heating the exposed moisture using microwaves. However, this method requires caution because workers are likely to be exposed to electromagnetic waves and the entrance of foreign substances such as metals may lead to accidents.

In Korea, medical waste is mostly processed at exclusive medical waste incinerators and must be discharged in strict isolation from general waste. Hence, professional efforts are required to prevent the risk of infection during the transportation and incineration of medical waste, which requires a loss of cost and manpower.

If medical waste is processed directly at hospitals and converted into general waste by applying the newly developed technology, this can help to eliminate the risk of infection during the loading and transportation processes and significantly reduce waste disposal costs. By processing 30 percent of medical waste generated annually, hospitals can save costs worth KRW 71.8 billion. Moreover, it can significantly contribute to the ESG (environmental, social, and governance) management of hospitals by reducing the amount of incinerated waste and shortening the transportation distance of medical waste.

[*Allbaro System (statistical data from 2021): Unit cost of treatment for each type of waste for the calculation of performance guarantee insurance money for abandoned wastes (Ministry of Environment Public Notification No. 2021-259, amended on December 3, 2021). Amount of medical waste generated on an annual basis: 217,915 tons; Medical waste: KRW 1,397 per ton; General waste from business sites subject to incineration: KRW 299 per ton]

As the size and structure of the installation space varies for each hospital, installing a standardized commercial equipment can be a challenge. However, during the demonstration process at the Chungnam National University Hospital, the new system was developed in a way that allows the size and arrangement thereof to be easily adjusted depending on the installation site. Therefore, it can be highly advantageous in terms of on-site applicability.

Principal Researcher Bangwoo Han of the KIMM was quoted as saying, “The high-temperature, high-pressure steam sterilization technology for medical waste involves the eradication of almost all infectious bacteria in a completely sealed environment. Therefore, close cooperation with participating companies that have the capacity to develop airtight chamber technology is very important in materializing this technology.” He added, “We will make all-out efforts to expand this technology to the sterilization treatment of infected animal carcasses in the future.”

 

President Seog-Hyeon Ryu of the KIMM was quoted as saying, “The latest research outcome is significantly meaningful in that it shows the important role played by government-contributed research institutes in resolving national challenges. The latest technology, which has been developed through the KIMM’s business support program, has been expanded to a demonstration project through cooperation among the industry, academia, research institutes, and the government of Daejeon Metropolitan City.” President Ryu added, “We will continue to proactively support these regional projects and strive to develop technologies that contribute to the health and safety of the public.”

 

Meanwhile, this research was conducted with the support of the project for the “development of ultra-high performance infectious waste treatment system capable of eliminating 99.9999 percent of viruses in response to the post-coronavirus era,” one of the basic business support programs of the KIMM, as well as the project for the “demonstration and development of a safety design convergence-type high-pressure steam sterilization system for on-site treatment of medical waste,” part of Daejeon Metropolitan City’s “Daejeon-type New Convergence Industry Creation Special Zone Technology Demonstration Project.”

###

The Korea Institute of Machinery and Materials (KIMM) is a non-profit government-funded research institute under the Ministry of Science and ICT. Since its foundation in 1976, KIMM is contributing to economic growth of the nation by performing R&D on key technologies in machinery and materials, conducting reliability test evaluation, and commercializing the developed products and technologies.

 

This research was conducted with the support of the project for the “development of ultra-high performance infectious waste treatment system capable of eliminating 99.9999 percent of viruses in response to the post-coronavirus era,” one of the basic business support programs of the KIMM, as well as the project for the “demonstration and development of a safety design convergence-type high-pressure steam sterilization system for on-site treatment of medical waste,” part of Daejeon Metropolitan City’s “Daejeon-type New Convergence Industry Creation Special Zone Technology Demonstration Project.”


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Government

Buyouts can bring relief from medical debt, but they’re far from a cure

Local governments are increasingly buying – and forgiving – their residents’ medical debt.

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Medical debt can have devastating consequences. PhotoAlto/Odilon Dimier via Getty Images

One in 10 Americans carry medical debt, while 2 in 5 are underinsured and at risk of not being able to pay their medical bills.

This burden crushes millions of families under mounting bills and contributes to the widening gap between rich and poor.

Some relief has come with a wave of debt buyouts by county and city governments, charities and even fast-food restaurants that pay pennies on the dollar to clear enormous balances. But as a health policy and economics researcher who studies out-of-pocket medical expenses, I think these buyouts are only a partial solution.

A quick fix that works

Over the past 10 years, the nonprofit RIP Medical Debt has emerged as the leader in making buyouts happen, using crowdfunding campaigns, celebrity engagement, and partnerships in the private and public sectors. It connects charitable buyers with hospitals and debt collection companies to arrange the sale and erasure of large bundles of debt.

The buyouts focus on low-income households and those with extreme debt burdens. You can’t sign up to have debt wiped away; you just get notified if you’re one of the lucky ones included in a bundle that’s bought off. In 2020, the U.S. Department of Health and Human Services reviewed this strategy and determined it didn’t violate anti-kickback statutes, which reassured hospitals and collectors that they wouldn’t get in legal trouble partnering with RIP Medical Debt.

Buying a bundle of debt saddling low-income families can be a bargain. Hospitals and collection agencies are typically willing to sell the debt for steep discounts, even pennies on the dollar. That’s a great return on investment for philanthropists looking to make a big social impact.

And it’s not just charities pitching in. Local governments across the country, from Cook County, Illinois, to New Orleans, have been directing sizable public funds toward this cause. New York City recently announced plans to buy off the medical debt for half a million residents, at a cost of US$18 million. That would be the largest public buyout on record, although Los Angeles County may trump New York if it carries out its proposal to spend $24 million to help 810,000 residents erase their debt.

HBO’s John Oliver has collaborated with RIP Medical Debt.

Nationally, RIP Medical Debt has helped clear more than $10 billion in debt over the past decade. That’s a huge number, but a small fraction of the estimated $220 billion in medical debt out there. Ultimately, prevention would be better than cure.

Preventing medical debt is trickier

Medical debt has been a persistent problem over the past decade even after the reforms of the 2010 Affordable Care Act increased insurance coverage and made a dent in debt, especially in states that expanded Medicaid. A recent national survey by the Commonwealth Fund found that 43% of Americans lacked adequate insurance in 2022, which puts them at risk of taking on medical debt.

Unfortunately, it’s incredibly difficult to close coverage gaps in the patchwork American insurance system, which ties eligibility to employment, income, age, family size and location – all things that can change over time. But even in the absence of a total overhaul, there are several policy proposals that could keep the medical debt problem from getting worse.

Medicaid expansion has been shown to reduce uninsurance, underinsurance and medical debt. Unfortunately, insurance gaps are likely to get worse in the coming year, as states unwind their pandemic-era Medicaid rules, leaving millions without coverage. Bolstering Medicaid access in the 10 states that haven’t yet expanded the program could go a long way.

Once patients have a medical bill in hand that they can’t afford, it can be tricky to navigate financial aid and payment options. Some states, like Maryland and California, are ahead of the curve with policies that make it easier for patients to access aid and that rein in the use of liens, lawsuits and other aggressive collections tactics. More states could follow suit.

Another major factor driving underinsurance is rising out-of-pocket costs – like high deductibles – for those with private insurance. This is especially a concern for low-wage workers who live paycheck to paycheck. More than half of large employers believe their employees have concerns about their ability to afford medical care.

Lowering deductibles and out-of-pocket maximums could protect patients from accumulating debt, since it would lower the total amount they could incur in a given time period. But if the current system otherwise stayed the same, then premiums would have to rise to offset the reduction in out-of-pocket payments. Higher premiums would transfer costs across everyone in the insurance pool and make enrolling in insurance unreachable for some – which doesn’t solve the underinsurance problem.

Reducing out-of-pocket liability without inflating premiums would only be possible if the overall cost of health care drops. Fortunately, there’s room to reduce waste. Americans spend more on health care than people in other wealthy countries do, and arguably get less for their money. More than a quarter of health spending is on administrative costs, and the high prices Americans pay don’t necessarily translate into high-value care. That’s why some states like Massachusetts and California are experimenting with cost growth limits.

Momentum toward policy change

The growing number of city and county governments buying off medical debt signals that local leaders view medical debt as a problem worth solving. Congress has passed substantial price transparency laws and prohibited surprise medical billing in recent years. The Consumer Financial Protection Bureau is exploring rule changes for medical debt collections and reporting, and national credit bureaus have voluntarily removed some medical debt from credit reports to limit its impact on people’s approval for loans, leases and jobs.

These recent actions show that leaders at all levels of government want to end medical debt. I think that’s a good sign. After all, recognizing a problem is the first step toward meaningful change.

Erin Duffy receives funding from Arnold Ventures.

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