Is Breast Cancer Overtreatment a Problem?

A report in the scientific journal Health Affairs estimates that the U.S. spends $4 billion a year “on unnecessary medical costs due to mammograms that generate false alarms, and on treatment of certain breast tumors unlikely to cause problems,” the AP reports.

The study “breaks the cost down as follows: $2.8 billion resulting from false-positive mammograms and another $1.2 billion attributed to breast cancer overdiagnosis. That’s the treatment of tumors that grow slowly or not at all, and are unlikely to develop into life-threatening disease during a woman’s lifetime.”

“Breast cancer is the second most common cause of death from cancer among American women, claiming nearly 41,000 lives a year. Annual mammograms starting at age 40 have long been considered standard for preventive care, because cancer is easier to treat if detected early. But recently there’s been disagreement about regular screening for women in their 40s. It parallels the medical debate about the pros and cons of prostate cancer screening for men.”

However, the Breast Cancer Research Foundation notes that regular mammography “has long been an issue of debate in the medical community. While mammograms are not perfect tests, BCRF’s scientific leadership… join the large majority of the scientific community in recommending that women of average risk take current screening guidelines—including annual mammograms starting at age 40—seriously.”

Has Trump Solved the Riddle of the Disappearing White Voter?

Washington Post: “White voter participation — meaning the actual share of those who turn out and vote in presidential and congressional elections — has been declining since about the mid-2000s. And in 2012, that pattern produced a first: African Americans participated in the presidential election at the highest rate, and white voters lagged behind in second place.”

“Look closely: Something is eating white voters and has been for years.”

“This begins to explain why, in the 2016 GOP primary season, a collection of men and one woman who have never held public office — businessman and reality TV star Donald Trump, retired neurosurgeon Ben Carson and former tech executive Carly Fiorina — are outperforming more conventional candidates with more campaign resources.”

“In the crowded Republican field, the candidate who can figure out the Trump Secret Sauce might have a shot at attracting some of Trump’s supporters if and when Trump is out.”

“But solving the riddle of the disappearing white voter is, for every GOP contender, critical.”

Trump Is Rich Because His Father Was Rich

Vox: “A new analysis suggests that Trump would’ve been a billionaire even if he’d never had a career in real estate, and had instead thrown his father’s inheritance into a index fund that tracked the market. His wealth, in other words, isn’t because of his brains. It’s because he’s a Trump.”

“It’s hard to nail down Trump’s precise net worth, but Bloomberg currently puts it at $2.9 billion, while Forbes puts it at $4 billion. So he’s worth about as much as he would’ve been if he had taken $40 million from his dad and thrown it into an index fund.”

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Could Plummeting Oil Prices Cause the Next Recession?

A. Gary Shilling, in Bloomberg View: “Oil-importing countries are obvious winners from falling crude prices. That includes the U.S., where — despite a surge in domestic production — imports still account for nearly 50 percent of petroleum consumption.”

“Lower oil prices, however, could come with a downside. As they work their way through the system, deflation could follow … The risk is that deflationary expectations could follow, encouraging consumers to withhold purchases in anticipation of even lower prices.”

“If that happens, excess capacity and inventories would build, forcing prices down more. When buyers’ suspicions are confirmed, they further delay consumption, in a vicious downward cycle. The result is little if any economic growth, as deflation-prone Japan has seen over the last two decades.”

“I believe the Fed will hold off on a rate hike until next year, at the earliest. But if it does move this year, and commodity prices tumble, China slumps and deflation sets in, it could soon wish it hadn’t.”

Birthright Citizenship Is Not New Issue for GOP

Washington Post: “Donald Trump has reignited the immigration debate in the United States.  But while this is one of the more radical elements of Trump’s broader immigration reform proposals, the issue of birthright citizenship is not new.”

“Between 1993 and 2015, 247 representatives in the House sponsored or co-sponsored legislative efforts to deny birthright citizenship. These efforts have been highly partisan. Out of these 247 representatives, 96 percent were Republican.”

“Let’s look at this using one of the most widely used measures of left-right political ideology, the DW-Nominate score. The higher the score, the more ideologically conservative the representative. The median score for GOP representatives who have supported changes to birthright citizenship is 24 percent higher—that is, more conservative—than the median score for all other Republican representatives in the House. Figure 1 illustrates the ideological differences between legislators who have and have not sponsored or co-sponsored legislative efforts to deny birthright citizenship, for both Republicans and Democrats.”


“But here’s what we do know. Policymakers who have sponsored or co-sponsored legislative efforts to deny birthright citizenship represent districts that, demographically, resemble a bygone America—this version of America may very well be what GOP presidential candidates are appealing to.”


Small Student Debts, Big Problems

Susan Dynarski, in the New York Times, explains how “borrowers who owe the most are least likely to default. The reason for this strange pattern? The biggest borrowers tend to become the highest earners.”

“This fact about loan defaults is one way in which the national conversation about student debt is at odds with the data. In many people’s minds, the so-called student-debt crisis revolves around graduates of selective colleges or graduate programs who run up six figures in debt.”

“But such borrowers aren’t the real source of trouble. The vast majority of bachelor’s degree recipients do very well. Only 2 percent of undergraduates borrow more than $50,000, and they also aren’t the ones who tend to have problems with their debt.”

“Defaults are concentrated among the millions of students who drop out without a degree, and they tend to have smaller debts. That is where the serious problem with student debt is. Students who attended a two- or four-year college without earning a degree are struggling to find well-paying work to pay off the debt they accumulated.”

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“The United States also has income-based repayment options, but relatively few student borrowers — currently 19 percent of Direct Loan borrowers — are enrolled in them. The people who need these programs the most are not taking them up.”

The GOP Has a Bigger Problem Than Trump

Jamelle Bouie, in Slate, notes that Trump and Carson “will eventually fade from view—or at least the Republican nominating process—as voters start the more serious search for a nominee. The problem, this time, is that there isn’t a Romney—an obvious choice for consolidation who is on the steady march to inevitability. Instead, there’s a collection of ‘plausible’ candidates who all seem too flawed to succeed.”

“If a ‘plausible’ nominee needs to be acceptable to conservatives, Kasich is at a serious disadvantage … New Jersey Gov. Chris Christie—a relative moderate—is in the same boat, with the added anchor of scandal. He’s trying, though; on Saturday, in an awkward pitch to conservative voters, he promised to ‘track‘ unauthorized immigrants like FedEx packages, if elected president.”

Like Scott Walker, Jeb Bush “has stumbled over Trump and his attacks, with ineffectual pushback that leads to more mistakes.”

“The only ‘plausible’ candidate left—someone to bridge the gaps among all party factions—is Florida Sen. Marco Rubio. What he lacks in Bush’s money or Walker’s electoral success he has in raw talent: Rubio is the most gifted communicator of the field, with enough savvy to avoid Trump’s traps. He doesn’t engage Trump on immigration or try to swat him away. Instead, he talks policy, tries to distinguish himself with substance, and marches toward his goal.”

Is Obama a Climate Hypocrite?

Eric Holthaus in Mother Jones argues that President Obama’s calls for action on climate change “fall flat when compared with Obama’s mixed record on climate. The widely publicized trip comes at a delicate moment for the president. Barely two weeks ago, his administration gave Royal Dutch Shell final approval to drill for oil offshore from Alaska’s northwest Arctic coast—not exactly the sort of thing you’d expect from someone who professes to be ‘leading by example.'”

“One progressive activist group, Credo Action, has called the unfortunate juxtaposition of Obama’s words and actions his ‘Mission Accomplished’ moment, in reference to Bush’s declaration of victory in the Iraq war. I agree.”

“For many environmental activists, Obama’s approval of Shell’s Arctic drilling permit is the icing on an extremely hypocritical cake.”

“What the president seems to miss is that environmental activists aren’t as concerned with the potentially devastating impacts of an oil spill in the Arctic as the message it sends to the rest of the world: Bold action on climate change doesn’t look so different from the status quo. In reality, the scale of action that climate science demands is far beyond what Obama has put in place. America can’t solve climate change on its own, but it could offer a truly heroic leader. It just doesn’t seem like Obama is the person for the job.”

Fewer Americans Forego Medical Care

Washington Post: “During the first three months of the year, just 1 in 20 Americans said they did not get medical care they needed because they could not afford it, according to the U.S. Centers for Disease Control and Prevention.”

“The findings, from the federal National Health Interview Survey, show that 4.4 percent of people interviewed from January through March said they had skipped medical care in the previous year because of its cost — the lowest percentage in 16 years.”

“The survey, conducted with people of all ages, does not explain the reason why fewer people are avoiding treatment because of its cost, but the improvement coincides with two big changes: Health insurance has become more common under the Affordable Care Act as government exchanges began nearly two years ago to sell private insurance policies for people who cannot get coverage through a job and as Medicaid for low-income people expanded in some states. At the same time, the economy has been recovering from the Great Recession of 2008-09, so more people are working.”

Poll: Republicans Fail Birther Quiz

Think Progress: “Sen. Ted Cruz (R-TX), was born in Calgary, Alberta in Canada in 1970, according to the birth certificate he released two years ago. But a Public Policy Polling poll released on Monday found that 40 percent of Republican voters falsely believe Cruz was born in the United States — compared to just 29 percent who believe the same of Hawaiian-born Barack Obama. Just 22 percent of Republicans said they believe Cruz was born abroad.”

“The poll indicates that a misinformation campaign by Donald Trump and other prominent Republicans has successfully convinced a large plurality of Republicans — 44 percent of those polled — that President Obama was born outside of the United States.”

Among Trump supporters “61 percent said Obama was not born in the U.S., while a mere 21 percent concede that he was American born. The poll also found that a 54 percent of Republican voters believe the president is a Muslim, versus just 14 percent who believe him to be a Christian.”

A Win for Public Health: Smoking Rate at a New Low

Jonathan Cohn: “New survey data, which the U.S. Centers for Disease Control and Prevention released Tuesday morning, suggests that just 15.2 percent of American adults are now using cigarettes on a regular basis. That smoking rate is nearly 2 percentage points lower than what the same survey reported for calendar year 2014. ”

“This year’s reduction is part of a long-term trend that dates back at least 50 years, to when the surgeon general published a landmark report identifying smoking as a health hazard. Since that time, officials and public health advocates have been waging the policy equivalent of a full-court press against smoking.”

“Of course, some portion of the people who no longer smoke cigarettes have probably switched to using electronic cigarettes, the health effects of which remain the subject of intense debate even among scholars and anti-smoking activists.”