Monday, May 29, 2017

Why the Custom of Eating Dairy Food on Shavuot?

Shavuot is approaching quickly. In a matter of hours, Jews celebrate the moment when the Israelites received the Torah at Mount Sinai. What is interesting about this holiday is that there is not a ritual that particularly defines the holiday. With Rosh HaShanah, you have the blowing of the shofar. Yom Kippur comes with a fast. Sukkot comes with both the Four Species and the sukkah. Passover has the seder and matzah. But Shavuot, nothing......well, sort of nothing. Shavuot was one of the three festivals for which one made a pilgrimage to the Temple. We have no Temple anymore, so it would be more accurate to say that there is no biblical-era ritual that exists for Shavuot. The explanation I have heard is that there is no particular ritual because the holiday is supposed to be about Torah. The Torah is the main focus of Shavuot. Even so, there are some relatively minor rituals and traditions that have evolved, such as studying Torah all night, as well as the tradition I would like to focus on today: eating dairy food.

This tradition is mentioned in the fourteenth century in Rabbi Yitzchak Tyranu's text, Sefer HaMinhagim (although some think it was mentioned in the thirteenth century). This legalistic work does not explain the meaning or significance behind the text. Here are a few reasons for the practice that have evolved over the years:

  1. Multiple sources, including R. Aharon HaCohen and R. Meir of Rothenberg, opine that we celebrate the Torah on Shavuot, and as such, there are verses in the Song of Solomon that allude to Torah: "Like honey and milk, [the Torah] lies under your tongue (Song of Solomon, 4:11)." There are some that use this verse as a basis to eat honey on Shavuot, as well as dairy products. 
  2. The Chofetz Chaim suggests that the practice comes from Mount Sinai itself. At Mount Sinai, the Jews were given the laws of separating meat and dairy. With these new laws, they did not have kosher dishes. Since dairy food does not require the same extent of preparation, that is what was eaten during the first Shavuot, and we thus take on that tradition. The problem with this explanation is that the explanation came well after the practice came, which creates an anachronism. 
  3. R. Yechiel Michel Epstein noted that Numbers 28:26 talks about a meat offering for Shavuot (מנחה חדשה להי בשבעתיכם). This phrase works out as an abbreviation for "from milk" (מחלב), and therefore we eat milk.
  4. According to gematria (Jewish numerology), the Hebrew word for milk (חלב) adds up to 40. The 40 corresponds to the 40 days Moses spent on Mount Sinai. To commemorate that event, we eat dairy products (R. Yitzchak Lipietz; R. Menachem Mendel of Ropshitz). 
  5. Milk was historically kept in simple vessels, such as clay or glass. If milk were kept in something fancy like silver or gold, it would spoil. If we go back to the metaphor that Torah is like milk, then Torah is meant for those who are humble, not for the haughty (R. Elyakum Dvorkas). 
  6. At the end of Pirkei Avot, there is a list of 48 ways to acquire Torah. One of the ways on the list is through not [excessively] indulging oneself. Meat is considered an indulgence in traditional Judaism, and as such, we teach ourselves the lesson that Torah is not acquired through physical and material indulgence (R. Avraham Hershovitz). 
  7. The Zohar states that each of the 365 negative mitzvahs corresponds to a day on the solar calendar. Which mitzvah corresponds to Shavuot, asks the Zohar? The mitzvah to not mix a kid with its mother's milk. In Exodus 34:26, the verse starts off by bringing the first fruits to the Temple. The verse finishes with the prohibition on mixing meat with dairy. On Shavuot, we eat two meals (one meat and one dairy) and are mindful not to mix the two together. Since two loaves are eaten for the two meals, the two loaves correspond to the offerings given on Shavuot (Rema, OC, 494:3).
  8. According to the Talmud (Bechorot 6a), honey is made from the bee, and milk is a byproduct of cow. These products could be construed as non-kosher because they come from a live animal, which is a violation of one of the seven Noahide laws (FYI: neither honey nor milk are considered non-kosher). While the source of these products would be considered spiritually unclean, the end-product is considered spiritually pure. Upon receiving the Torah, milk became kosher to the Jews. This is analogized to the fact that the Torah has the ability to take something impure and render it pure (R. Shlomo Kuger). I'm not a fan of this homily for a few reasons, most notably being that the Torah does not render everything pure, and that there are still items considered non-kosher, but I digress.
  9. Another reason is that it is a reminder that Moses was saved from being slaughtered by the Egyptians when he was a baby. What does Moses' infancy have to do with Shavuot? According to the Talmud (Sotah 12b), Moses' mother placed Moses in the basket of reeds and sent him along the Nile. None of the Egyptian women were able to nurse Moses. The Pharaoh's daughter found one woman, Moses' biological mother, to nurse Moses. The eating of dairy food is supposed to commemorate the miracle that took place in Moses' live on the sixth of Sivan, which is the same date on the Jewish calendar as Shavuot (Yalkut Yitzchak).
  10. Another name for Mount Sinai is Mount Gav'nunim (הר גבנונים; see Psalms 68:17). The name גבנונים is etymologically similar to the Hebrew word for cheese (גבינה). More to the point, the gematria for the word גבינה adds up to 70, which alludes to the "70 faces of Torah" (Rebbe of Ostropole).
  11. The Jerusalem Talmud (Chagigah 2:3) provides another reason. According to the Talmudic passage, King David passed away on Shavuot. When a king passes away, the entire community is in a mourning state, and back in those days, it meant not eating the sacrificial meat offering, which meant eating dairy only. This argument is tenuous because one does not mourn on yom tov, not to mention that this is not a widely accepted reason for the practice. 

The fact that I was able to cite so many reasons for this practice (and I'm pretty sure this doesn't even cover all of the reasons) implies that we really don't know the reason why the practice of eating dairy on Shavuot exists in the first place. On the other hand, it shouldn't matter. Why? Because one of the many beauties of Jewish tradition is that we can come up with multiple, spiritually meaningful explanations for the practice. Whichever speaks to you, may it bring you a sense of purpose as you eat your dairy meal this Shavuot.

Thursday, May 25, 2017

The New GOP Obamacare Replacement Plan: Same as the Old?

The Republican Party has been struggling with passing a plan to replace Obamacare. The Republicans attempted it back in March, but did not receive enough votes (even from its own party!) to pass the American Health Care Act (AHCA). Earlier this month, they released a modified version of the AHCA, and on May 4, the AHCA passed the House. The Senate indicated that they are writing their own version of a repeal-and-replace bill. Yesterday, the Congressional Budget Office (CBO) released their report on the effects the new AHCA that the House passed earlier this month. The main questions on everyone's mind are a) "Is this AHCA an improvement over the previous AHCA?", and b) "Is the new AHCA an improvement over Obamacare?"

I conducted my analysis of the initial AHCA a couple of months ago, which you can read here. Since I performed a previous analysis already, I will keep this shorter by explaining the differences between the new AHCA and the initial one, followed by a comparison of the numbers and a brief conclusion.

The new AHCA maintains a lot of the previous AHCA's provisions. However, there are some changes. The one with the biggest budgetary effect was delaying the repeal of the payroll tax increase (CBO, p. 11). States can also waive the requirement of establishing "essential health benefits," as well as the community rating. Community rating is prohibiting insurers from setting premiums on the basis of such demographics as age or gender (CBO, p. 12). There are some other more minor provisions, but that covers the major ones. What ended up being the difference?

  • Impact on Coverage. In the initial AHCA, there would have been an additional 24 million uninsured. In the new version? 23 million (CBO, p. 3). This might sound like a lot, but as the American Action Forum pointed out how the "additional 24 million uninsured" claim was misleading: about half of those "losing" insurance are those who were forced by Obamacare to purchase insurance, but no longer want insurance. 
  • Impact on the Federal Budget. Over the next decade, the new AHCA is supposed to reduce the budget deficit by $119 billion (CBO, p. 1; see below). How much was the budget deficit reduction beforehand? $337 billion over ten years. That means the new version of AHCA is $218 billion more expensive than the initial version.

  • Impact on Premiums. In the initial AHCA, premiums were supposed to be higher in 2018 and 2019 than in the ACA (aka Obamacare). However, over the next decade on average, the AHCA was supposed to cause a smaller increase in premiums than the ACA. For the new AHCA, the CBO had a more difficult time making predictions about premium increases (CBO, p. 6-7). The reason for this ambivalence is because it is unclear which states will accept the waivers that are part of the new AHCA. The CBO predicts that the new version of the AHCA will cause premiums to rise more than Obamacare in 2018 and 2019 (the same as it did for the estimate on the initial AHCA), but the CBO did state that premiums would decline on average over the next decade, regardless of whether the given state accepts the waivers. However, the CBO did add the caveat that some individuals could experience an increase in services depending on how each state defines essential health benefit (EHB), as well as which EHBs patients consume. The CBO selects that maternity care and mental health services could increase depending on how the individual state reacts. Even with this caveat, premiums will decrease on the whole, which is an improvement from when Obama lied about how Obamacare was going to lower premiums. This is important because the CBO admitted that Obamacare caused premiums to skyrocket (CBO, p. 4), not to mention the Department of Health and Human Services released a report on Tuesday finding that premiums have doubled since 2013 in 24 states. 
  • Healthcare Market Stability. Under the current law (i.e., Obamacare, ACA), the subsidies have kept non-group market participants largely insulated from price increases. This does not negate the fact that subsidies for demand [in healthcare] cause artificially high prices or that someone ultimately has to pay the bill. The CBO also admits that Obamacare has caused limited options of health care providers (CBO, p. 4), which is unsurprising because a) Obamacare literally made catastrophic coverage and other forms of less generous coverage to be illegal, and b) a majority of the health care exchanges have proven to become unprofitable because Obamacare disincentivizes younger and/or healthier individuals to participate in the Obamacare exchanges. What about under the new AHCA? Generally, the CBO predicts market stability. There is, however, a sixth of the market that the CBO surmises will become unstable due to the waivers. Community-based premiums would rise for those with pre-existing conditions. Those in non-group markets will experience higher-than-average costs (CBO, p. 5). Like with other policies, the AHCA has its tradeoffs, but most states will have stable markets.

In the previous paragraphs, we see issues with the status quo of Obamacare: premiums are too high, healthy individuals are being deterred from buying health insurance, and options are limited for patients. Something needs to be done to undo the harm caused by Obamacare's insurance regulations. On the whole, not much has changed since the modification of the AHCA. Since the modified AHCA does not undo the essence of Obamacare, it can only be considered at best a moderate improvement over Obamacare, and that depends on which metrics you're using to compare. Regardless of whether the AHCA passes or not, the lack of free-market reforms signals that state of health care in the United States does not look good.

Monday, May 22, 2017

Yom Yerushalayim at 50: The Religious and Political Meaning of Jerusalem

About fifty years ago on the Jewish calendar, the state of Israel experienced an amazing event, one that can arguably be described as a miracle. Once the state of Israel was created in 1948, relations were not particularly normalized. There was, and still is, tension between Israel and its Arab neighbors. In 1967, the state of Israel was entangled in what is known either as the Six-Day War or the 1967 Arab-Israeli War. It was the third day of this war that the Israeli army annexed eastern Jerusalem from its former illegal Jordanian occupation. As a result of creating a unified Jerusalem, a new holiday was created: Yom Yerushalayim (יום ירושללים), also known as Jerusalem Day. The Israeli army annexed other land in the Six Day War, so what makes Jerusalem so special?

Politically speaking, the city of Jerusalem remains contentious. There are some religiously liberal Jews, who are usually politically liberal as well, who feel uncomfortable with a Yom Yerushalayim because of the ongoing political conflict surrounding the city. There are also non-Jews who feel uncomfortable about it, as well. In the 1947 United Nations Partition Plan (Resolution 181) felt uncomfortable enough where they created Jerusalem as a separate international regime that is really not under Israeli or Arab rule. That changed when the Jordanian army illegally occupied it, but that's another story. It's so contentious that Israel is the one country that does not have a U.S. embassy located in its capital. While the Israeli government traded land for peace with the Egyptians by giving them back Mount Sinai, there was some land the Israeli government continues to legally hold. Why Israel keeps the Golan Heights is obvious: from a military strategist standpoint, it helps Israel better protect its northern border. Jerusalem provides no geopolitical or economic advantage. Quite the contrary. Given the political headache it causes, it probably would be easier for the Israeli government to give up a unified Jerusalem (although let's be honest, that wouldn't make Palestine formally recognize Israel, let alone allow for peace in the Middle East). The city of Jerusalem is worth the headache because of its non-geopolitical significance. From a historical perspective, it symbolizes a significant step in Jewish statehood and a step towards political independence for the Jewish state. That argument has its limitations since the Jewish state was already created back in 1948. Even so, the historical significance also has limitations without understanding the religious significance of Jerusalem for the Jewish people.

Jerusalem has been considered the eternal capital of the Jewish people for nearly 3,000 years. The significance of the city of Jerusalem goes back to the Bible when it is first mentioned in the Book of Joshua (Joshua 12:10). The city Jerusalem is mentioned well over 100 times in the Hebrew Bible, and when you count references to the city of Salem (שלם) or implied references, that turns into nearly 700 references to Jerusalem. Since the biblical days, Jerusalem has been attacked, captured, besieged, and destroyed on more than one occasion. The Jewish people lost sovereignty over the city when the Romans captured it in 70 C.E. Jews have lived in the city since then, but Jerusalem has had multiple sovereign rulers over it up until 1967.

Even during the years in which the Jewish people were in exile, the Jewish people never forgot about Jerusalem. In Psalms (137:5), King David says that "if I forget you, Jerusalem, may my right hand forget its skill." The vigor of the Jewish people has been and continues to be symbolized by how much we remember and yearn for Jerusalem.

It can also be a vision for the future. While the etymology of the word Jerusalem is debated, the Talmud says that the word Jerusalem can be divided into two parts: ירא (from the infinitive "to see") and שלם (peace, completeness). Jerusalem is about a vision of peace and represents how we approach a more perfected world.  This insight can help explain why we still pray for Jerusalem, even though there is a unified Jerusalem under Israeli sovereignty. The reason why a prayer for Jerusalem is still included in our daily liturgy, as well as why we should celebrate Yom Yerushalayim (and arguably recite Hallel), is because we have not received that level of perfection or peace. On the one hand, Yom Yerushalayim represents what we have accomplished. On the other hand, there is still work to be done, and until that work is done, we pray for Jerusalem. Why? Because Jerusalem is not just a city. It is an idea. We keep up the vigor and the hope that one day, the world as a whole can reach spiritual perfection and peace.

Thursday, May 18, 2017

Parsha Bechukotai: Our Homes as a Sanctuary for Holiness

Some think that to find holiness, you have to venture halfway across the world to a monastery to seek solitude or some other holy site to feel inspired. For others, going to a house of worship is what gets the spiritual juices flowing. This week's Torah portion suggests something different:

יאיש כי יקדש את ביתו קדש להי והעריכו הכהן בין טוב ובין רע.
-When a man consecrates his house to be holy unto G-d, the priest will valuate it, whether it be good or bad. - Leviticus 27:14

What we observe here is an ancient practice of valuation for someone who wants to donate their property to the sanctuary as a form of thanks. The priest (Kohen) would come by to inspect the house and conduct an assessment. If the owner of the property wants his property back, not only does the property owner have to pay the amount for which it was assessed, but they have to add an extra twenty percent to the price (Leviticus 27:15). With the sacrificial system no longer in place and a non-existent Third Temple, this verse seems to be irrelevant to anything in modern times.

The Kotzker Rebbe thought differently, and viewed the passage more homiletically. For the Kotzker Rebbe, the true sign of one's holiness is not found in the holiest of synagogues because it's easy for someone to pursue holiness in a sanctified setting. Based on this passage, the Kotzker Rebbe commented that "true holiness sanctifies the seemingly mundane activities of running a household. One who behaves in an elevate manner in one's own house is truly a holy person." There are a few takeaways from the Kotzker Rebbe's homily.

  1. True spirituality is found in our daily lives in the most seemingly mundane of places.
  2. The home is meant to be a true center of spirituality and holiness. It is the place we keep a kosher kitchen and take something as mundane as food and elevate it to holiness. The Jewish home is the place where we have guests over, have Shabbat and holiday meals, and fulfill the mitzvah of hospitality. As Pirkei Avot brings up (1:4-5), it is the place open for Torah scholars, i.e., the Jewish home is a center of Torah study and good deeds to help others in need. The home acts as a fulcrum for many mitzvahs and Jewish events. 
  3. The home tends to be a more private place than the synagogue or the work office. It is easier for anger, impatience, sloth, or other shortcomings to be concealed in the home. By being able to improve upon one's shortcomings in a place where it is easy to hide one's flaws is all the more praiseworthy.
  4. We've heard the phrase "My house, my rules." The house is meant to be one's dominion. It is easy to let the sense of ego and entitlement that comes with that territorial dominion come into play. There is a good parable from R. Salanter regarding this idea. R. Salanter was on tour, and went to someone's home for Shabbat. The host berated his wife for not covering the challah. The wife was embarrassed and ran to the kitchen. R. Salanter then asked the host, "Do you know why we cover the challah?" The host said that we cover the challah so they are spared the "embarrassment" of having the ritual attention be focused on the wine first. After that explanation, R. Salanter gave him grief because the host was more concerned with the metaphorical feelings of two loaves of bread (which are inanimate) instead of the actual feelings of his wife. If it weren't for the fact that the man went to the kitchen to beg his wife for forgiveness, R. Salanter would have left the house. The moral is that while the house can give us a sense of entitlement or ego, we should remind ourselves that our domain does not exempt us from good character
  5. The Kotzker Rebbe brings up how it is seemingly mundane activities that are the holy ones. If that is true for getting ready for Shabbat dinner or cooking kosher food, all the more it is for something as mundane as vacuuming, doing the laundry, or making the bed. 
The house is a reflection of our holiness. It is a particular test because how we behave in our homes opens us up to certain vulnerabilities that do not exist when we are at work or at shul (synagogue). The Kotzker Rebbe not only reminds us that holiness is to be pursued in all facets of our life, but also that true holiness is to be found where we least expect it: in our homes. 

Monday, May 15, 2017

Solving the Opioid Crisis Actually Requires Some Government Intervention

The opioid epidemic. It is considered the United States' worst drug crisis. In 2015, 52,404 Americans died from drug overdose (33,091 of whom from opioids), a figure that is higher than the number of deaths of the U.S.' HIV/AIDS epidemic at its peak. The epidemic's annual cost to society ranges from an estimated $53 billion (Fudin, 2015) to $78.5 billion (Florence et al., 2016). The United States consumes more opioids per capita and is responsible for consuming 80 percent of the global opioid supply. This epidemic has gotten the attention from the Drug Enforcement Administration (DEA) and Department of Health and Human Services (HHS) alike. This brings up two major questions: how can we solve the epidemic, and how much government do we need involved?

Let's start with the second question first. The "hardcore libertarian" position on drugs is that of full legalization of all drugs. This position is often contrasted with criminalization, although there are gray areas in which certain degrees of regulation exist. The "hardcore libertarian" position argues that problems associated with drugs will not go away, regardless of legalization or criminalization. The "hardcore libertarian" position posits that while legalization of drugs will harm certain lives, the harm caused by legalization is nowhere near the cost of criminalization or excessive regulation.

From 1919 to 1933, alcohol was prohibited in the United States. The Prohibition led to underground markets, powerful criminals, and increased crime. It was such a stupid move that we have a constitutional amendment reversing that poor life choice. A similar argument can be made about marijuana. It is true that there are individuals who struggle with marijuana addiction, and it is also true that marijuana can cause harm. At the same time, the costs of marijuana prohibition and enforcing marijuana laws decidedly exceed the costs of legalization. Looking at the evidence, it is clear that prohibition of alcohol was a bad idea, and that marijuana prohibition is a bad idea. The evidence for alcohol and marijuana legalization are relatively cut and dry. I cannot say the same for the opioid epidemic, and I am not the only libertarian who is doubting a strictly "free-market" drug market for opioids.

Opioids are some of the world's oldest drugs, so it's not as if opioids are a new phenomenon. The United States as a country has struggled with opioids since the Civil War. Civil War veterans needed pain relief. The solution? Morphine. In the early 20th century, they were being used as general pain management until the 1920s when doctors became aware of its addictiveness. Opioid usage reemerged in WWII to help veterans cope with pain. In the 1970s, drug use was becoming a huge problem, so the DEA greatly limited opioid usage. Doctors were hesitant to prescribe opioids until greater medical consensus developed in the 1980s and 1990s that it was not that harmful. The release of Oxycontin in 1996, as well as its subsequent success, helped boost prescription opioid consumption (see Pain and Policy Studies Group 1985-2015 consumption data of by opioid type here; Oxycodone numbers provided below).

Here is where the problem gets more complicated. Yes, there are thousands of opioid-induced deaths in the United States. There are thousands upon thousands of Americans who legitimately need pain relief. According to the National Institutes of Health, 11.2 percent (or 25 million) of Americans have daily pain, while 23 million suffer from a lot of pain. The American Pain Association estimates that as much as 50 million Americans have chronic pain. The response of using opioids as pain management was to a legitimate problem. Evidence also gets complicated in that opioids seem to do a better job at acute pain relief than chronic pain relief (Chou et al., 2015Chaparro et al., 2014).

Let's complicate the matter further by looking at all opioids, and not just prescription opioids (see below). Prescription opioid overdose deaths are gradually increasing over time. When we include heroin and fentanyl, the more abrupt upward swing for heroin and fentanyl does not take place until the late 2000s and early 2010s.

Looking at death rates (see CDC data below), prescription drugs level off in the 2010s while heroin and fentanyl increase. Why the discrepancy between prescription opioids and the other two?

As the Economist succinctly describes the phenomenon, it is a matter of supply and demand. The prescription overdose deaths make more sense because like other substances or other medical procedures, it does not come risk-free. 2012 was a peak consumption year with 259 million opioid prescriptions filled out. 16,007 people died from prescription opioid use in 2012. Based on those figures, one in 16,180 people die from opioid abuse. Even for those who use opioid prescriptions on a long-term basis, the CDC estimates in a 2016 study that one in 550 die from opioid abuse. Odds of death from opioids are small, but when so many Americans are taking them, the numbers add up. The number of opioid deaths increase because of the growing popularity of prescription opioids.  

Increased demand of prescription opioids is only part of the equation. Since prescription opioids were heavily abused in the 2000s, the response of the DEA was production quotas (see DEA data dating back to 2007). Take a look at Florida as an example. In the 2000s, Florida developed a reputation for being America's pill mill capital. In 2010, nine out of ten Oxycontin prescriptions were being written by doctors in Florida. Florida Governor Rick Scott wanted to put a stop to the drug abuse. In 2011, Scott teamed up with the DEA and cracked down on prescription opioid distribution, thereby cutting off a major supply of prescription opioids. The DEA is making the same mistake for the year 2017 by reducing the opioid production quota by 25 percent. The reason I call this a mistake is because when a production quota is enacted (see below), there is not simply an increase of prices. There is also a shortage of the good, which means that the production quota is not fulfilling demand.

When price or income changes (or in this case, both supply and price), then the substitution effect kicks in. In layman's terms, what this means is that if prescription opioids become more expensive or in rarer supply, there is a good chance that the consumer is going to look for another good similar to the oxycontin. This is where heroin and fentanyl enter the scene. I am not here to say that these other opioids didn't exist prior to the U.S.' uptick in prescription opioid production in the late 1990s and early 2000s. The consumption patterns of heroin and fentanyl (see in previous figures above) don't show that it was a clear substitute effect, at least not in the late 1990s or early 2000s.

Something else happened to cause an uptick in heroin and fentanyl consumption, aside from heroin getting cheaper (see below). That something else was the Mexican drug cartels. As the Economist points out, the Mexican drug cartels were struggling with selling cocaine and marijuana. In the United States, demand for cocaine had dropped and marijuana had become increasingly legalized. The Mexican drug cartels saw heroin as an opportunity and increased heroin production tenfold in the 2000s.

Why does Mexico's heroin production matter? For one, Trump was actually right when he said that heroin was coming in from the Southern border. In 2012, 45 percent of heroin seized by the DEA came from Mexico. By 2015, that figure increased to 75 percent of seized heroin. This is all the more important because heroin and oxycontin are both opioids. Oxycontin is an FDA-approved, Schedule II drug while heroin is an illicit, Schedule I drug. At the same time, both come from the same poppy plant, both give a similar sense of euphoria, and both have similar pain relief properties. The other main difference is that heroin is more potent. There is very little room for error in dosage, which helps explain the uptick in heroin overdose deaths.

To summarize these economic trends: Since the 1990s, there has been an increased demand for prescription opioids, a potent drug that has 32 percent of prescriptions abused and is prone to addiction much more than alcohol or marijuana. Those who are taking prescription opioids and have developed an addiction are more prone to heroin, particularly when the Mexican drug cartels started its major increase of heroin distribution in the United States during the late 2000s and early 2010s. As a result of flooding the American market with heroin as a substitute good (especially one that is cheaper than prescription opioids), heroin becomes cheaper and more readily available to those already susceptible to heroin. On top of that, the DEA makes the situation worse by limiting the supply of legal prescription opioids, thereby making the illegal ones all the more attractive. What we have is a risky product on the market, and its presence is made all the worse with the Mexican cartel and the DEA's response to prescription opioids. What does the solution involve?

Some might argue that either this is not a big deal or that this is a price of freedom. As I pointed out in a previous paragraph, an estimated one in 16,180 people (0.006 percent) die from opioid abuse, which is 35 times lower than dying of heart disease. That probability goes up to one in 550 (1.8 percent) if it is prolonged opioid use. Even if you're facing prolonged prescription opioid use, is the 1.8 percent risk of dying worth mitigating or eliminating pain in your life? None of this gets into opioid abuse. According to a 2016 study from Castlight Health, 4.5 percent of prescription opioid users are abusers, and account for 32 percent of prescriptions consumed. Plus, heroin users are less likely to be addicted to heroin, but more likely to die from it. Justifying inaction in such a matter is not going to make the problem go away, especially in light of upcoming DEA production quotas that will be even more restrictive. So what can be done?

The Drug Policy Alliance provides a good policy brief (see here), but to summarize, the plan would entail treatment for current opioid abusers and mitigating future opioid abuse. Here is elaboration on some policy alternatives:
  • Drug courts versus treatment alternative diversion (TAD). The American Enterprise Institute (AEI) suggests "benign paternalism" in the form of drug courts because recovery is a challenge, especially when considering dropout. Since prescription opioids are legal, this alternative would be more appropriate for heroin users. Wisconsin provides a good example of how a TAD program works (I actually did grad school work on Wisconsin's TAD program). Essentially, instead of dealing with drug courts and a felony a charge, a non-violent drug offender that completes treatment has their records expunged. TAD is a preferable alternative to incarcerating and throwing the book at people who need help.  
  • Harm Reduction. Harm reduction is a set of policies used to mitigate and lessen the consequences of addiction and substance abuse, particularly for those for whom abstinence does not work. E-cigarettes are an example of harm reduction for those who are dealing with tobacco addiction. Sure, e-cigarettes do not completely eliminate nicotine consumption, but a) it removes other carcinogens, and b) it is healthier than regular cigarettes. Harm reduction examples for opioids include the clean needles exchange, safe injection facilities, bupeKraton, and Naloxone. Naloxone is interesting because Naloxone access has reduced opioid deaths by 9 to 11 percent (Rees et al., 2017). Even better, it was found to not increase drug injection, use, or drug-related crime in the area (Potier et al., 2014).
  • Marijuana Legalization. Much like heroin has a substitution effect, so does marijuana. Not only does marijuana not deserve a Schedule I label by the DEA, it does not deserve to be criminalized, especially in this context. Those who have allowed for medicinal marijuana have seen a drop in opioid addiction and overdosages (Powell et al., 2015).
  • Trump's Border WallI covered this topic a few months ago, but essentially, Trump's border wall is not going to impede heroin inflows all that much because as most security analysts point out, smugglers will simply find a way around it. 
  • Stopping Mexican Drug Cartels. I hesitate with this policy alternative not because I side with the drug cartels. They are peddling a dangerous product into the United States, and it needs to be stopped. The DEA has played a role in making this a worse problem with its production quotas and other regulations, which is why I hesitate in prescribing them as part of the solution. On the other hand, it is not like the Mexican drug cartels will suddenly decide to stop distributing in the United States. Although the "gateway drug" argument is ridiculous when it comes to marijuana, it actually plays out in the context of opioids: prescription opioids often lead to heroin consumption. This gateway gives reason for the cartels to continue distributing their heroin. Unless there is some way market forces can remove Mexican drug cartels in the United States, I have to concede that DEA intervention is the least worst option to stop the cartels. If they are going to go after the drug cartels with full force, they need to lighten up on their prescription opioid production quotas. 
  • Decrease Criminalization. Similar to the rest of the War on Drugs, criminalization and production quotas exacerbated the situation. Research shows that increased incarceration and punishment for drug-related charges increases overdose rates and does not have a deterrent effect. Additionally, when you restrict supply of prescription opioids and further stigmatize it, users go to the underground market, which leads to users obtaining opioids for which they do not know the dosage or composition, e.g., heroin laced with fentanyl that raises risk of overdose. What this would mean for opioid reform policy is, among other things, not pursuing minimum mandatory sentences, which is the opposite of what Attorney General Jeff Sessions is doing as of last week. 
  • Effective Treatment Access. According to federal data, 89 percent of those struggling are not getting the treatment they need. While there are multiple reasons, affordability was at the top of the list (see below). There is definitely a market failure for those who want treatment. A market failure does not automatically necessitate a government solution, but the reality is that there will be at least some government intervention. 

The opioid epidemic is a complex phenomenon that is much less straightforward than Prohibition or marijuana criminalization. It has made me question certain aspects of drug legalization that I previously took as a given. As much as I tried, my coverage today does not entail all policy options or all the nuance that I hoped to capture. For example, it does not fully get into some other phenomena, such as whether unemployment leads to higher opioid consumption or whether being in pain leads to higher opioid consumption and subsequent unemployment (Kreuger, 2015).

However, what I can say is this: our policy solutions need to be focused much more on treatment, not criminalization. Although Trump promised to end the opioid crisis, his administration has yet to do anything meaningful about it. Whether or not the Trump administration (or any of the state-level governments) carry out some or all of the effective policy options remains to be seen. Let us hope that the Trump administration can prioritize the opioid crisis in a way that actually results in a reduction of opioid overdoses.

Thursday, May 11, 2017

Five Ways In Which Government Policy Screws Over Millennials

I was talking with a friend yesterday, and she brought up how "our generation makes a lot less than our parents." It is true that we Millennials are making less than our parents, the Baby Boomers, made. A 2017 report from Young Invincibles used Federal Reserve data to find that while Millennials made $40,581 on average in 2013, the Baby Boomers were making about $50,910 at the same age in 1989. That means that Millennials are making about 20 percent less than the Baby Boomers did at the same stage of life. This wage disparity helps put off other major life events for Millennials, including getting married, buying a house, and having children.

There are those who think the problems are inherent within the Millennial generation. Some stereotypes include Millennials being lazy, self-entitled, narcissistic, and spoiled. I know plenty of Baby Boomers who fit that description, as well as plenty of Millennials who do not. Millennials aren't making less because we aren't trying hard enough. Millennials are more educated than previous generations, not to mention that Millennials are working more hours. While people of all ages who were alive during the Great Recession were hit, Millennials also had to deal with more because being young adults with little to no wealth makes it challenging to withstand the greatest financial crisis since the Great Depression.

I have another theory of what is screwing over the Millennial generation, and it's not culture or even a financial crisis, the latter of which can have its causes debated heavily. Looking at the situation, a major culprit is the government. Don't believe me? Let's list off a few ways in which government policy has presented Millennials with challenges that are not what their parents faced.

1. Government Debt. As the debt-to-GDP ratio rises (see below), economic growth lags. The economy is not some abstract concept, but a system in which each of us interacts. When we spend more money adding to the debt and paying off federal government debt, it means that money is worth less and that there are fewer opportunities than previous generations had.

Source: CBO

Since Millennials are the younger generation, what this means is that Millennials will disproportionately shoulder that debt because we'll be around longer. Government debt might not be a policy per se, but is rather the accumulation of past generations' poor fiscal planning and results of poor government policy. Millennials will be around to pay not only the higher interest on the debt, but also for all the wars fought by previous generations, all the Medicare and Medicaid, and all the Social Security consumed by previous generations. Speaking of Social Security.......

2. Social Security. Social Security is a pay-as-you-go system, which means that you don't have a retirement account with your money in it collecting interest so you have a nest egg. What it means is that those of us currently working are paying for benefits of current beneficiaries. This matters because in order to keep the system going, you need enough money to go into Social Security to keep it solvent.

When Social Security first started, there were 159.4 workers for each beneficiary. Now, there are only 2.8 workers for each beneficiary (Social Security Administration). With the Baby Boomers retiring, the worker-to beneficiary ratio will decrease, which will put strain on the system. The Social Security Trust Fund is supposed to be depleted by 2030, but let there be no mistake that Baby Boomers will receive more money while Millennials end up paying more into the system while getting little benefit.  That makes sense because a) Social Security taxes have increased over time, b) the retirement of Baby Boomers will leave less employers in the workforce, and c) once the Social Security Trust Fund runs out of money [in 2030], there is an automatic 21 percent reduction in benefits that takes place.

Millennials are helping to pay for Baby Boomers' retirement. Social Security doesn't help Millennials, but rather screws over Millennials.

3. Federal Subsidies for College Loans. Looking at data from the National Center of Education Statistics, Baby Boomers were less likely to go to college than Millennials, which means they were less likely to deal with college debt. I can hear some Baby Boomer saying, "I went to college, and I paid off my debt just fine." Fortunately for you, federal subsidies for loans were not as prevalent. You might think to yourself that subsidies are good because they provide money to those who need it. What people don't mention is that low-cost, low-interest federal subsidies have driven up the price of college tuition since federal subsidies really made their mark in the 1980s. A study from the National Economic Bureau of Research estimates that 78 percent of the tuition increase from 1987 to 2010 was due to federal subsidies.

The United States has also developed a cultural stance that everyone should go to a four-year college, and that anything less is unsatisfactory. This cultural expectation, combined with federal subsidies, has driven up both the price and the fact that 42 percent of students drop out of college. Millennials have dealt with certain pressures in postsecondary education that previous generations simply did not face.

4. Health Care Policy. Ballooning health care costs are nothing new. They date back at least to 1965 when Medicare and Medicaid came on the scene (read this fascinating piece on the history of government policy and healthcare here). Medicare and Medicaid are two examples of how healthcare costs ballooned. Those two programs, which are driving the federal budget in an unfortunate, upward fashion, are combined with the WWII-era relic of the employer-sponsored health insurance tax credit, which exacerbates healthcare costs and income inequality. And in the event that those policies were not enough, then there's Obamacare.

Obamacare puts a cap on age rating, which means that insurance companies can only charge three times more for the more elderly than the young. I understand that there is a mere correlation between age and health (e.g., not all young people are healthy, and vice versa). At the same time, it plays a role because means is that Millennials are paying a disproportionate amount under Obamacare. This creates what is known as an adverse selection, which means that Millennials are more likely to go without insurance (Census, 2016, p. 9) or take on the cost of paying skyrocketing premiums that Obamacare has wrought.

Who knows what will happen as Congress dukes it out with attempts to replace Obamacare? What I do know is that Obamacare has made healthcare more expensive for Millennials relative to other generations, and I know that much like with Social Security, Millennials will foot more and more of the bill for Medicare as Baby Boomers enter retirement. Another way of phrasing this sub-section is the culmination of healthcare policy over the years has screwed Millennials over in a way that their parents never experienced.

5. Occupational Licensing. Occupational licensing causes harm by making consumer prices to increase and making it more difficult to enter a certain profession. Occupational licensing generally hurts young adults the most, but wait, there's more. The rate at which occupational licensing is required has nearly quintupled since the 1950s. In 1950, only 5 percent of jobs required occupational licensing. In the late 1980s and into the early 1990s, this figure was less than 20 percent (Kleiner and Kruger, 2008, p. 10). Most recent estimates put that figure at 29 percent. Occupational licensing is more likely to screw over a Millennial than it did a Baby Boomer or a Gen-Xer.

Conclusion: There are more than five types of government policy that have screwed over Millennials in a general sense or have done so in a worse fashion than it has done to previous generations. I can go into further detail about the ones I have covered, and I can extend this list (for example, add housing and mortgage policy or how public-sector pensions are driving state-level debt). What I can conclude with is that Millennials are having a harder time succeeding not because they are supposedly whiny or fainthearted. They are having a harder time in no small part due to government policy. I don't know whether the Trump administration or the current Congress will enact laws that will help Millennials with these obstacles. However, I will say that Trump should do whatever he can to help Big Government get out of the way so that Millennials, and indeed all Americans, can live the American dream.

Monday, May 8, 2017

Why Jews Are Supposed to Say 100 Blessings a Day

From when a Jew wakes up to when a Jew goes to sleep, blessings play a pivotal role in daily, traditional Jewish life. They play such a pivotal role that Jews are supposed to say 100 blessings a day. But why one hundred? Before answering this question, a brief synopsis on the Jewish concept of blessings:

The Jewish word for "blessing," ברכה, comes from the same root as the word "wellspring" (בריכה). The imagery of the wellspring shows how bountiful and renewing a blessing can be, and how it brings additional good to the world. The word ברכה also has the same root as the Hebrew word "knee" (ברך). The knee imagery shows that we metaphorically bend down to give recognition and show appreciation for G-d's kindness. Combined together, a blessing is the Jewish way we thank G-d for all that He provides. With that out of the way, why 100 blessings? Why not 5, 20, or 250? What is special about the number "100?"

  1. In Deuteronomy 10:12, Moses tells the Jewish people, "What (מה) does G-d ask of you?" In the Talmud (Menachot 43b), R. Meir tells us to read the word "what"  (מה) as "one hundred" (מאה), i.e., the verse reads "100 [blessings] G-d requires of you." This is to instruct us in the mandatory 100 blessings a day in order to help us cleave to, love, and fear G-d (Orach Chaim 46:3).
  2. Midrash Rabbah (Leviticus 18:17) said that in the time of King David, there was a plague that was killing 100 people a day. King David's anecdote? 100 blessings a day. Afterwards, the plague stopped. 
  3. In the Book of Exodus (38:27), there are 100 sockets used in the Tabernacle, which correspond to the 100 blessings (Ba'al HaTurim). Functionally speaking, sockets hold other objects in place, whether we are talking about eye sockets, tooth sockets, or light bulb sockets. We can take this metaphor that blessings, much like the sockets on the Tabernacle, hold our relationship with G-d in place. 
  4. In his commentary Reishit Chochma, sixteenth-century Sephardic rabbi Eliyahu de Vidas used the Zohar to use gematria (Jewish numerology) on the word צדיק (righteous person). He took the letter ק, which has the value of 100 in gematria, from the word צדיק, and opined that part of being a righteous person is saying a hundred blessings a day. 
What is interesting is that there is a debate of whether the practice of saying 100 blessings a day is an obligation or a practice of the particularly pious. What I find even more interesting is the wisdom behind saying blessings and being grateful, which you don't have to be Orthodox, or even Jewish for that matter, to appreciate. Psychologists have found the social, psychological, and health benefits of giving thanks. Those working with positive psychology and cognitive-based therapy came to the same conclusion that the rabbinic sages came to centuries ago: we should count our blessings. Whether or not counting 100 blessings is mandatory is secondary to the fact that reciting 100 blessings is desirable, not only for our wellbeing, but for our relationship with G-d. By being mindful and creative enough to come up with 100 blessings a day, we realize just how much good we have in our lives, and for that, we thank G-d for each and every blessing.

Thursday, May 4, 2017

Hate Speech Is Free Speech: Why It Should Be Protected

Last week, conservative speaker Ann Coulter met her match at the University of Berkeley in California. She was supposed to speak there last week, but because the University could neither provide security nor a venue, she was unable to speak there. Coulter's controversial statements are nothing new in American conservatism. Some on the Left view Coulter's speech as hate speech. Upon hearing about the speech cancellation, former Democratic presidential candidate Howard Dean went as far as saying that Berkeley was right because "hate speech is not protected by the First Amendment." Fortunately, not all of those on the Left agree. Robert Reich and the ACLU came to her defense. Why is this significant? Why should we care about protecting speech we deem to be "hateful?"

First, let's define hate speech. Hate speech is commonly perceived as speech that offends, threatens, or insults groups, usually those considered to be minorities or disenfranchised. Coulter has made comments about Jews, Mexicans, African-Americans, and immigrants. With such a broad definition, anything she has said over the years could be considered as hate speech. The problem with that, though, is that anything we find disagreeable could be construed as hate speech. This level of subjectivity makes it all to easy to silence speech that is out of the norm, that is unpopular, or is off-putting, even if it is in the name of promoting tolerance and inclusivity.

Now for the legal argument. As Politifact pointed out in its response to Dean's comments, the Constitution most certainly does protect hate speech, not to mention that there is not even a legal definition of hate speech. The First Amendment explicitly states that there is to be no abridgment of the the freedom of speech. The Supreme Court has upheld the First Amendment and favored hate speech, including Ku Klux Klan members, depicting animal crueltyflag burning, and the Westboro Baptist Church's despicable protest of military funerals. We can talk about America's imperfections, but it has historically done a fine job at protecting the freedom of speech. More to the point, it defends hate speech up to the point where it crosses the line of targeted harassment or where hateful speech turns into hateful action.

There are a number of arguments to defend hate speech, but why do I ultimately defend it? I find the speech of racists and bigots to be offensive, to be sure. I believe it has no place in civil society. At the same time, that is why we should allow everyone the ability to speak their mind. At that point, I know who the racists, bigots, anti-Semites, and homophobes are. At that point, I can use my freedom of speech in turn not only to express my moral outrage, but also to speak out and convince others that they are wrong (which is not difficult, all things considered). I would rather have their views out to be discredited than festering in an underground market so that humanity can make progress.

The flip side is that the ability to offend can lead to progress. Take gay rights as an example. Speech advocating for gay rights had to offend many individuals, most notably those on the Religious Right. At least in the United States, the gay rights movement didn't win by silencing preachers who have a problem with homosexuals. It was done by gay people being brave enough to come out and tell their story. It was done by those who knew someone who was gay, and realizing that gay people are people, just like everyone else. Changing minds and hearts. That's how it was done, and it was in no small part due to the freedom of speech. Allowing for all views to be expressed, whether popular or not, is how we make progress.

These points are all the more important to remember when considering that freedom of speech is indivisible. The same hypothetical hate speech laws that could be used against racists or bigots could also be turned on civil rights activists and LGBT individuals. Restricting one group's freedom of speech risks the freedom of speech for all. Freedom and tolerance come hand in hand, and are two sides of the same coin. For those who love freedom and the ability to dissent to enhance the marketplace of ideas, a trend towards abusing power for purposes of censorship should worry anyone who has thoughts, beliefs, or viewpoints.

Monday, May 1, 2017

Trump, Steel Imports, and Tariffs: Why the National Security Argument for Protectionism Falls Flat

During his campaign, then-presidential candidate Donald Trump warned about the dangers of China, bemoaned the raw deal the U.S. was getting on free trade agreements, and how we should use more American products. Trump has moved closer and closer to advancing his protectionist agenda on international trade. On April 20, President Trump signed a memorandum authorizing the Department of Commerce to investigate whether steel imports affect national security. By using a 1962 law (Section 232) to turn steel imports into a national security issue, Trump could potentially put broad limits on steel imports under the guise of national security. This would be one of the Trump administration's first major act of protectionism. Let's ask some important questions here. Do steel imports pose a security threat to the United States? Is invoking national security a reason to impose trade restrictions? Is the steel industry that fragile that it needs government intervention to save it? Here are some points to consider when answering these questions:

1. Burden of proof. Much like with any policy issue, the burden of proof falls on the individual claiming that there is an issue. Any industry can claim that their industry is vital national security. No joke here: angora goat wool was protected vis-à-vis the National Wool Act of 1954 because their fleece is "necessary" to produce military uniforms, which is an example that shows how susceptible the U.S. can be to such an argument.

For Trump to be able to justify the restrictions on steel imports, he would first need to show how steel is vital for national security. He would then need to show how the U.S. is facing a heightened enough threat where such additional precautions are necessary in the first place. Afterwards, he would need to prove that we do not produce enough steel, especially if none of our allies want to export steel to the U.S. anymore. The last time the U.S. Department of Commerce conducted a Section 232 study to assess national security issues surrounding steel, was in October 2001. The Department of Commerce not only found that the U.S. military would only need 300,000 tons of steel for military purposes (p. 13), but also found that steel imports are not a threat to national security (p. 2). This report was written shortly after 9-11, took into account increased military spending due to 9-11, and still concluded that there was no national security threat.

Trump would finally need to show how a tariff or other trade restriction would not only improve national security, but improve economic conditions. Considering how freer trade makes for greater economic prosperity and how tariffs hinder economic progress, Trump would have an even more difficult time with that last one. Even Leo Gerard, who is the international president of the United Steelworkers, has testified in front of Congress admitting that tariffs for the steel industry have been insufficient at "leveling the playing field."

2. U.S. Steel Production. In the past decade, U.S. steel production has generally oscillated between 78 and 98 million tons. The International Trade Administration (ITA) puts 2016 consumption at 93.8 million metric tons. The capacity utilization rate is only at 72 percent, which is a metric showing that the U.S. economy is not even producing steel at full capacity. Another fun fact is that according to the American Iron and Steel Institute (AISI), only 3 percent of steel was used for national defense. Based on production numbers, the United States produces far more steel than it requires for national security reasons. 

3. Role of Steel Imports in U.S. Market. In 2016, the U.S. on average imported 2.496 million metric tons per month, which comes out to about 30 million metric tons for a given year. The importance that imports play a role is a metric known as the import penetration rate. The higher the ratio, the more important of an influence that imports have played. Looking at data collected from Trump's International Trade Administration, we see below that the import penetration rate has been on the decline for the past two years, which means that steel imports are playing less of a role in American steel consumption.

4. Imagining a National Security Crisis. I want you to imagine a national security crisis for a moment, whether it's something like a full-out war with Russia or China. I want you to imagine one not because I want one (G-d forbid), but because I want to present a scenario in which a) we should legitimately be worried about national security, and b) one that would require more steel for national defense than normal. As previously stated, we used about 3 percent of steel for national defense in 2015. In 2016, the United States spent $611B on its military, which is about $325B more than Russia and China combined. Even if the U.S. military were to quadruple its demand for steel to produce even more weapons and equipment than we already have, that would only be 12 percent of U.S. steel consumption given current production levels, which are high to begin with.

Worst-case scenario would be that the U.S. would solely rely on its own production because it doesn't have any allies or it is fighting its former allies. If this were the case, speculators would stockpile large amounts in anticipation. However, this has historically not been the case, and it would be safer to assume that the United States would have allies with which it would be trading. Looking at steel import data from the U.S. Census Bureau [Exhibit 3], major exporters of steel to the U.S. are Canada, Brazil, South Korea,  Mexico, and Turkey. It is believable that we would have at least some allies supplying steel. The main point here is a scenario in which we would need to solely or heavily rely on domestic steel production for national security purposes is very implausible.

5. Economic Implications. Trump might be using this pretext to also protect steel manufacturing jobs.  If so, he will be disappointed because manufacturing employment has been on the decline for quite some time. But if Trump wants to make America great again or improve our economy, he should think twice before imposing a tariff on steel. Tariffs drive up the price of a good or commodity. If the tariff were substantial enough, it would drive the price of steel up substantially, which would put U.S. manufacturers at a disadvantage to imports. Other countries would then be able to manufacture goods more cheaply, which would be all the more pronounced considering how many industries rely on steel as an input for production. There are far more individuals that use steel as an intermediate good to produce final goods than there are producers of steel, so whatever modest benefit to steel producers would be outweighed by the losses by manufacturers that use steel as an immediate good.

This is not mere economic theory. As a result of a Section 201 tariff on steel enacted in 2002, nearly 200,000 jobs in steel-related industries were lost within the first year as a result of this tariff (see study here). Not only do these tariffs make manufacturing more expensive for U.S. manufacturers, but it also makes it more of a struggle for Americans to buy washing machines, microwaves, lawn mowers, or any number of products that require steel.

Conclusion: Based on presented information about the U.S. steel market, there is scant evidence that U.S. steel production or consumption is facing a national security threat. Even in the off-chance that it were, Trump would need to prove that a tariff is the most cost-effective way to ensure steel supply, which he cannot. Not only is there a lack of evidence that steel imports are a threat to national security, we have evidence that tariffs and other trade restrictions on steel imports can and do cause negative effects.

Trump's naïveté on commerce ignores other realities about international trade. Much like I explained last week with Trump's "Buy American and Hire American" executive order, consumers are most concerned with finding a balance between price and quality. Sometimes, that requires manufacturers to purchase foreign steel. This leads to another axiom: those who trade together stay together. When trading with one another, countries prosper from international trade. Going to war not only increases military expenditures, but also stymies economic growth for both sides.

Take China as an example. China might be tempted to provoke in the South China Sea or in some other territorial dispute, but China also benefits greatly from trading with the United States and Japan. If China were to enter into a war and agitate its major trading partners, it stands to lose a lot more from war. I hope that Trump can see the benefits of international trade and how trade barriers do not make America great. However, his actions so far do not leave me hopeful. If Trump continues on the voodoo path of protectionism, it is going to a costly next four years for the American people.