In The News

Current Issue

1.5 Million Missing Black Men

For every 100 black women not in jail, there are only 83 black men.

The remaining men – 1.5 million of them – are, in a sense, missing.

17 missing black men for every 100 black women. “Missing” menAmong cities with sizable black populations, the largest single gap is in

Ferguson, Mo.

40 missing black men for every 100 black women

North Charleston, S.C., has a gap larger than 75 percent of cities.

25 missing black men for every 100 black women

This gap – driven mostly by incarceration and early deaths – barely exists among whites.

1 missing white man for every 100 white women

Figures are for non-incarcerated adults who are 25 to 54. 

In New York, almost 120,000 black men between the ages of 25 and 54 are missing from everyday life. In Chicago, 45,000 are, and more than 30,000 are missing in Philadelphia. Across the South — from North Charleston, S.C., through Georgia, Alabama and Mississippi and up into Ferguson, Mo. — hundreds of thousands more are missing.

They are missing, largely because of early deaths or because they are behind bars. Remarkably, black women who are 25 to 54 and not in jail outnumber black men in that category by 1.5 million, according to an Upshot analysis. For every 100 black women in this age group living outside of jail, there are only 83 black men. Among whites, the equivalent number is 99, nearly parity.

African-American men have long been more likely to be locked up and more likely to die young, but the scale of the combined toll is nonetheless jarring. It is a measure of the deep disparities that continue to afflict black men — disparities being debated after a recent spate of killings by the police — and the gender gap is itself a further cause of social ills, leaving many communities without enough men to be fathers and husbands.

Perhaps the starkest description of the situation is this: More than one out of every six black men who today should be between 25 and 54 years old have disappeared from daily life.

“The numbers are staggering,” said Becky Pettit, a professor of sociology at the University of Texas.

And what is the city with at least 10,000 black residents that has the single largest proportion of missing black men? Ferguson, Mo., where a fatal police shooting last year led to nationwide protests and a Justice Department investigation that found widespread discrimination against black residents. Ferguson has 60 men for every 100 black women in the age group, Stephen Bronars, an economist, has noted.

The distributions of whites and blacks

Most blacks live in places with a significant shortage of black men. But most whites live in places with rough parity between white men and women. . .

Histogram, With Ferguson noted

The gap in North Charleston, site of a police shooting this month, is also considerably more severe than the nationwide average, as is the gap in neighboring Charleston. Nationwide, the largest proportions of missing men generally can be found in the South, although there are also many similar areas across the Midwest and in many big Northeastern cities. The gaps tend to be smallest in the West.

Incarceration and early deaths are the overwhelming drivers of the gap. Of the 1.5 million missing black men from 25 to 54 — which demographers call the prime-age years — higher imprisonment rates account for almost 600,000. Almost 1 in 12 black men in this age group are behind bars, compared with 1 in 60 nonblack men in the age group, 1 in 200 black women and 1 in 500 nonblack women.

Higher mortality is the other main cause. About 900,000 fewer prime-age black men than women live in the United States, according to the census. It’s impossible to know precisely how much of the difference is the result of mortality, but it appears to account for a big part. Homicide, the leading cause of death for young African-American men, plays a large role, and they also die from heart disease, respiratory disease and accidents more often than other demographic groups, including black women. . .

The gender gap does not exist in childhood: There are roughly as many African-American boys as girls. But an imbalance begins to appear among teenagers, continues to widen through the 20s and peaks in the 30s. It persists through adulthood. . .


The disappearance of these men has far-reaching implications. Their absence disrupts family formation, leading both to lower marriage rates and higher rates of childbirth outside marriage, as research by Kerwin Charles, an economist at the University of Chicago, with Ming-Ching Luoh, has shown.

The black women left behind find that potential partners of the same race are scarce, while men, who face an abundant supply of potential mates, don’t need to compete as hard to find one. As a result, Mr. Charles said, “men seem less likely to commit to romantic relationships, or to work hard to maintain them.”

The imbalance has also forced women to rely on themselves — often alone — to support a household. In those states hit hardest by the high incarceration rates, African-American women have become more likely to work and more likely to pursue their education further than they are elsewhere. . .

Since the 1990s, death rates for young black men have dropped more than rates for other groups, notes Robert N. Anderson, the chief of mortality statistics at the Centers for Disease Control and Prevention. Both homicides and H.I.V.-related deaths, which disproportionately afflict black men, have dropped. Yet the prison population has soared since 1980. In many communities, rising numbers of black men spared an early death have been offset by rising numbers behind bars.

It does appear as if the number of missing black men is on the cusp of declining, albeit slowly. Death rates are continuing to fall, while the number of people in prisons — although still vastly higher than in other countries — has also fallen slightly over the last five years.

But the missing-men phenomenon will not disappear anytime soon. There are more missing African-American men nationwide than there are African-American men residing in all of New York City — or more than in Los Angeles, Philadelphia, Detroit, Houston, Washington and Boston, combined.

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In The News

Previous Issue

Unanticipated Medical Outcomes

Isn’t it a physician’s duty to be perfect in clinical outcomes?

The Kansas legislature has introduced SB 96. The disclosure of unanticipated medical outcomes and errors act was introduced in 2015 and has been scheduled for a hearing in Senate Judiciary this week. This bill imposes a duty on health care providers to make mandatory disclosures to patients and licensing agencies of any unanticipated outcomes and medical errors. Failure to disclose such events is punishable by a $10,000 fine per event.

It also requires hospitals to develop and implement disclosure policies, and mandates meetings and discussions between patients and providers about these events. It also mandates disclosure of unanticipated outcomes or medical errors to past patients if they weren't previously informed of the event. It also prohibits confidential settlements in medical liability claims which arise from unanticipated outcomes or medical errors. Though the intent of the bill is to encourage communication and disclosure between providers and patients, the bill is overly prescriptive and complex and would be difficult, if even possible, to comply with. KMS has submitted testimony in opposition to SB 96.

Overheard in the courthouse attorney’s lounge:

If we can get SB 96 passed, that should be a gold mine.
No, it would be a diamond mine.
You really think that much?
Every doctor I know makes mistakes every day.
At $10,000 for each mistake, we should easily find at least a hundred in each physician. 
That’s a million dollars from each doctor.

When are we as Physicians going to understand the huge amount of ill will out there? The attorneys in practice and in the legislature, despite what they say, will continue to harass us. The doctors that go through law school are no help. They are neither fish nor fowl. They also fail to understand the underlying issues. Quality has always been our middle name. Why do we put up with the lay folks asking us to improve quality? The best quality will always include unanticipated outcomes which the litigious public views as mistakes. They expect us to be perfect.

I guess that takes us back to the old days when even we thought we were gods.


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In The News

Past Issue

Kamala Harris, AG, State of California: I will fight for... I will fight for...

The Fight for Barbara Boxer’s California Senate Seat on her retirement in 2016

“Let me take just a moment to tell you what makes Kamala Harris so special,” Sen. Elizabeth Warren of Massachusetts blogged, encouraging her national donor base to give to Harris.

“She’s exactly the kind of leader we need in the Senate,” Sen. Kirsten Gillibrand of New York, another prodigious fundraiser, said in an email urging her contributors to pivot toward Harris.

“So Excited about ‪@KamalaHarris campaign for California US Senate seat,” New Jersey Sen. Cory Booker tweeted, inviting his 1.52 million followers to donate to Harris’ campaign.

By the end of the first week, Harris had become the frontrunner to replace Sen. Barbara Boxer, who is retiring in 2016. Harris’ aides worked hard to spin an air of invincibility. Enthusiastic press coverage fed into it.

“She has been dubbed the female Obama. She cooks. She goes to the gym in a hoodie,” The Guardian of the U.K. wrote. “She views lawyers as heroes and takes on mortgage companies the way Elizabeth Warren takes on Wall Street.”

There was, however, the question of issues. 

Harris, sworn in for her second term as attorney general on Jan. 5, announced her Senate candidacy on Jan. 13 in a vacuous 240-word blurb in which she asked for money, and made no other public statements.

In the plea for money, Harris promised to fight crime, fight for consumers, fight for equal rights, fight for “the next generation,” fight for “middle class families who are feeling the pinch of stagnant wages,” fight “for our children,” and “fight relentlessly to protect our coast, our immigrant communities and our seniors.”

She listed many fights, but missed a few. There was no talk of fighting for the right to privacy or for national defense, or combating climate change, which many Democrats see as the defining issue of our time. Water policy evidently was not snappy enough.

Harris did her best to have a shock-and-awe opening, while Tom Steyer, the San Francisco billionaire environmentalist, toyed with entering the race by subjecting himself to an AMA, also known as an ask-me-anything, on Reddit.

Steyer was, indeed, asked all sorts of questions, from his choice of jelly with his peanut butter to his opinion of Mariah Carey, and his quirky choice of wearing the same plaid tie, day after day.

More to the point were the snarky and unscripted questions: When would he release his tax returns? How much money did he make from oil and coal when he ran Farallon Capital, the San Francisco hedge fund that made him rich? He answered some but not all the questions. It was a tough crowd, made tougher by its trollish anonymity.

Steyer gets points for engaging with whoever participates in such chats. He also got a glimpse into the flaming that awaits him if he enters the race.

Former Los Angeles Mayor Antonio Villaraigosa and Rep. Xavier Becerra, D-Los Angeles, also are contemplating a candidacy. Each could be formidable. A few Republicans have raised their hands, too, though California is Democratic territory.

Republican consultant Fred Davis, who has been involved in several presidential, Senate and gubernatorial races, said a Republican candidate would need $100 million and be able to campaign on the level of Ronald Reagan, or maybe Arnold Schwarzenegger, before he soiled his image.

Republicans won’t spend money in California in 2016, when they must defend Senate seats in several less expensive states. Whoever the Republican presidential candidate ends up being won’t spend a dime here after the primary.

“Nonstarter for Republicans,” Davis said.

Perhaps the race will turn into a free-for-all, and Harris will spend the next two years battling a half-dozen serious opponents. Certainly, many politicians would love to be one of 100 senators. But a Senate campaign is no small undertaking.

Boxer raised $29 million in her last race. A contested race in 2016 could cost $40 million, or more. It must be raised in increments of $2,600, the current federal cap on the amounts that individual donors can give.

Harris has been building toward high office for years. Making all the right friends, she presented Willie Brown with the cap that read “Da Mayor” on the night in 1995 when he was elected San Francisco mayor. She spent December 2007 knocking on doors in frigid Iowa for Sen. Barack Obama, when most political experts assumed Hillary Clinton would be the Democratic nominee.

Harris is hoping to scare off any opponents, at least those who aren’t billionaires. She’s clearly willing to ask for money, though the $14.2 million she has raised since her first run for attorney general is not nearly sufficient for a Senate race.

It doesn’t hurt that she comes from San Francisco. San Francisco is her largest source of money, $2.9 million, plus $830,000 from the Silicon Valley.

Harris, who is married to a Los Angeles lawyer, spends much of her time in Los Angeles, which pays off. Los Angeles and Beverly Hills account for $2.4 million of her money. She has friended Hollywood, taking no less than $1.4 million from entertainers and corporations involved in “The Industry,” by my count.

Issues matter, too.

Bill Carrick, who has managed U.S. Sen. Dianne Feinstein’s campaigns, noted that a candidate needs to be prepared to face questions on as many issues as a presidential candidate: defense, trade, the Middle East, the debt ceiling, climate change, the right to privacy, wealth disparity, plus complex California issues such as water delivery.

“There are a lot of people displaced by the current economy,” Carrick said. “Income inequality, middle-class challenges, I think those issues are going to be really big.”

There will be time to talk about all those issues and more between now and Election Day 2016. There should plenty of debate, but only if there is a campaign, not a coronation.

Follow Dan Morain on Twitter @danielmorain.

Dan Morain has been a columnist at The Bee since 2010 focusing on state government and politics. He previously worked for The Los Angeles Times covering the California Supreme Court when Rose Bird was chief justice, the Legislature when Willie Brown was speaker and the governor's office during Gray Davis' tenure. Dan Morain can be reached at or 916-321-1907. Twitter: @DanielMorain.

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In The News

Past Issue

Doctors will go two weeks without pay next month




CMS will hold 2015 Medicare payments for 2 weeks

By: GREGORY TWACHTMAN, Internal Medicine News Digital Network

Doctors may have to wait a few extra days to get paid for Medicare services they administer, the Centers for Medicare and Medicaid Services announced.

Claims submitted during the first 14 days of 2015 and dated within that time period will be held to allow for the corrections of errors in the 2015 physician fee schedule. Claims submitted during that time but dated in 2014 will be processed normally. Contractors are expected to process the early 2015 claims beginning Jan. 15. 

CMS expects minimal impact to physicians, as it is not required to pay clean electronic claims sooner than 14 days under law.

“I think this will have minimum impact,” American Academy of Family Physicians President Robert Wergin said in an interview. “It does affect your cash flow, but it has happened in the past, particularly around the time with SGR patches.”

With that kind of leadership, it will happen in the future and only get worse.

See Internal Medicine News . . .





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In The News

Past Issue

The financial pain of Electronic Health Record transition



Subsidies aren’t enough to ease the financial pain of EHR transition for some docs. We’d all like to think that regulating electronic health records (EHR) is a good thing for everyone involved, patients and doctors, but it turns out that it’s not that simple.

Dr. Oliver Korshin is an ophthalmologist in Anchorage, Alaska, and after three decades in his small office, he’s seen patients move into Medicare coverage – he’s doing the same himself.

For Korshin and his practice, having patient’s medical records transitioned into an online database just isn’t practical because it will cost too much to install and maintain, according to him, and he’s pretty close to retirement anyway.

Unfortunately for him, the federal government will penalize Korshin for not using EHR starting next year by withholding 1 percent of his payments, and he’ll lose an additional 1.5 percent for failing to enroll in a federal program that requires doctors to digitally keep track of (and report) quality data about how their patients fare under their care.

That’s not all:

And then there’s the new coding system, also set to take effect in the fall of 2015 — an overhaul of the standard method of classifying diseases and conditions. Medicare and other insurers require the proper use of these codes if doctors want to get paid for the treatments and procedures they perform. A cost study sponsored by the American Medical Association earlier this year estimated that depending on “variable factors such as specialty, vendor and software,” implementing the new coding system alone could cost a small medical practice between $56,639 and $226,105. . .

This story is part of a reporting partnership that includes NPR, Alaska Public Media and Kaiser Health News

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In The News

Past Issue

Obama’s ‘Horrible Bosses 3’ Audition

The president’s playbook when things go wrong: Deny knowledge, blame hapless subordinates

Announcing Defense Secretary Chuck Hagel’s resignation. Reuters

Potomac Watch | By Kimberley A. Strassel | The Wall Street Journal | Opinion

Vice President Joe Biden lamented earlier this year that there were too many Americans stuck in a “dead-end job.” If only he had noted how many work near his office. 

Of all the reputations Barack Obama has built over these years, the one that may figure most into his struggling presidency is the one that has received the least attention: He is a lousy boss. Every administration has its share of power struggles, dysfunction and churn. Rarely, if ever, has there been one that has driven more competent people from its orbit—or chewed up more professional reputations.

The focus this week is on Chuck Hagel, and the difficulty the White House is having finding the next secretary of defense. The charitable explanation is that lame-duck executives always have a challenge finding a short-termer to mop up the end of a presidency. The more honest appraisal came from a former Defense official who told Politico that Michèle Flournoy—a leading contender who removed herself from consideration—didn’t “want to be a doormat” in an administration that likes its failed foreign policy, and is keeping it.

“Doormat” has been the job description for pretty much every Obama employee. The president bragged in 2008 that he would assemble in his cabinet a “Team of Rivals.” What he failed to explain to any of the poor saps is that they’d be window dressing for a Team of Select Brilliant Political Types Who Already Had All the Answers: namely, himself and the Valerie Jarretts and David Axelrods of the White House.

These days, what able-minded Democrat would want to work for a boss who asks hires to check their brains at the door and then read from the talking points? Respected economist Christina Romer came in as Mr. Obama’s first head of his Council of Economic Advisers; she left after 18 months, tired of putting out imaginary numbers in support of the stimulus. Former Marine Commandant Jim Jones lasted about the same duration as national security adviser, until he wearied of saluting the political gurus.

The experienced Bill Daley came in 2011 as the chief of staff tasked with repairing Mr. Obama’s relations with the business community. He left a year later, having been stripped of many duties and trashed by the White House to the press. The sage Leon Panetta stepped up as defense secretary in 2011; he too left after 20 months of getting his head patted. The folks who look smartest now are those who fled early, while the fleeing was still relatively good—Rahm Emanuel, Austan Goolsbee, Larry Summers, Peter Orszag, Vivek Kundra.

Who would want to work for a boss who micromanages everything but takes no responsibility when things don’t work out? This president’s playbook for controversy: Deny knowledge, blame subordinates. Mr. Obama fails to recognize the threat of ISIS; it’s the fault of Director of National Intelligence James Clapper. The administration cancels White House tours to ratchet up the pain of the sequester, then blames the Secret Service for the uproar. The ObamaCare website fails; Mr. Obama faults the Department of Health and Human Services (run then by Kathleen Sebelius ) for not telling him of the problem. Veterans Affairs wilts under the scandal of waiting lists; the president claims he read about it in the news.

Who would want to work for a boss whose experiments in big government all but guarantee their reputation will be ruined in the aftermath of a bureaucratic collapse? Ms. Sebelius was once the governor of Kansas. She will be remembered as the woman who oversaw the most disastrous government rollout in history. Steven Miller will always be the guy who was running the IRS when the targeting scandal broke. Eric Shinseki was awarded three bronze stars and two purple hearts in Vietnam. He’ll be remembered for the waiting list cover-up at Veterans Affairs, an agency that is the model for ObamaCare.

And who wants to work for a boss who doesn’t have your back? . . . As Mr. Hagel was kicked to the curb this week, an anonymous White House campaign heaped the administration’s foreign-policy failures on the departing Republican.

Not that Ms. Sebelius or Mr. Shinseki and others didn’t deserve to have to resign; they oversaw disasters. The question so many potential nominees have about working for this White House goes to that very point: Is it possible to have any other experience working for Mr. Obama—a boss who doesn’t listen, views everything politically, always thinks he’s right, and whose policies are a recipe for a lost reputation? Hey Washington: Don’t all put your hands up at once.

Read the entire report in the WSJ . . .

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In The News

Past Issue

War on Poverty Turns 50: Are We Winning Yet?

by Michael D. Tanner and Charles Hughes

The War on Poverty is 50 years old. Over that time, federal and state governments have spent more than $19 trillion fighting poverty. But what have we really accomplished?  In a new paper, Cato scholars Michael D. Tanner and Charles Hughes argue that while the War on Poverty achieved some initial success, the programs it spawned have long since reached a point of diminishing returns.

Although far from conclusive, the evidence suggests that we have successfully reduced many of the deprivations of material poverty, especially in the early years of the War on Poverty. However, these efforts were more successful among socioeconomically stable groups such as the elderly than low-income groups facing other social problems. Moreover, other factors like the passage of the Civil Rights Act, the expansion of economic opportunities to African Americans and women, increased private charity, and general economic growth may all have played a role in whatever poverty reduction occurred.

However, even if the War on Poverty achieved some initial success, the programs it spawned have long since reached a point of diminishing returns. In recent years we have spent more and more money on more and more programs, while realizing few, if any, additional gains. More important, the War on Poverty has failed to make those living in poverty independent or increase economic mobility among the poor and children. We may have made the lives of the poor less uncomfortable, but we have failed to truly lift people out of poverty.

The failures of the War on Poverty should serve as an object lesson for policymakers today. Good intentions are not enough say Tanner and Hughes. We should not continue to throw money at failed programs in the name of compassion.

Read the entire article in Cato . . .

Did you know that today there are still 126 separate federal anti-poverty programs?

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In The News

Past Issue

A Tax-limiting Amendment

What If Congress Raised Taxes And Nobody Cared -- Or Even Noticed?

Joseph Thorndike, Forbes Contributor

Two years ago, Congress raised taxes on almost every working American – and nobody cared. In fact, a lot of people didn’t even notice. That tells us something important about the way Americans view taxes. But it also tells us something important about how we collect them.

In 2011 and 2012, Congress cut the Social Security payroll tax by two points. More specifically, lawmakers reduced the portion of the tax levied on employees from 6.2% of taxable wages to 4.2%. (The portion paid by employers remained at 6.2%; most economists believe that this other half of the tax is also ultimately borne by workers in the form of lower wages.)

The payroll tax cut was explicitly designed to be temporary – a one-year shot in the arm for the struggling economy. After a year, lawmakers agreed to extend the cut for another 12 months. But on January 1, 2013, the payroll cut expired, and workers began paying the full 6.2% again.

And hardly anybody noticed. 

Asked in early 2013 whether their payroll taxes had changed, 55.6% of respondents to a Google Consumer Survey said they didn’t know. Only 28.9% had actually noticed the increase. (To round things out, 8.3% said the tax had remained the same and 7.1% thought it had fallen.)

Dean Baker of the Center for Economic and Policy Research, which commissioned the survey, found these results illuminating. “Let’s face it,” he said. “The public cannot be too upset by tax increases if they don’t even notice when they take place.” Baker suggested that the poll results might even point the way toward a long-term fix for the (eventual) shortfall in the Social Security funding:

These survey results suggest that the public may not be especially adverse to a modest increase in the payroll tax, since they may not even notice it. This supports the findings of other polls that indicate that most Americans favor strengthening Social Security through revenue increases, such as raising the payroll tax rate or the cap on taxable wages.

Baker is probably right. As he noted, the 2013 tax increase was especially dramatic, implemented in a single large jump rather than a series of small increases. If that sort of hike didn’t raise hackles, then smaller, phased-in increases would probably be even less controversial.

In addition, the payroll tax has always been relatively well tolerated by Americans. In surveys asking Americans to rank various levies by their desirability, the payroll tax places near the middle of the pack – below “sin taxes” on alcohol and tobacco but above property, sales, and individual income taxes. (For a great roundup of popular opinion on taxes, take a look at the American Enterprise Institute’s “Public Opinion on Taxes: 1937 to Today.”)

The relative popularity of the Social Security tax probably derives from the popularity of Social Security benefits. Unlike most elements of the federal tax system (and especially unlike other big-money revenue raisers), the payroll tax makes a clear connection between taxes paid and benefits received. Indeed, that tight connection leads some people to view the payroll tax (incorrectly, in my view) as a sort of insurance premium.

But there’s another element of the payroll tax that also contributes to its popularity — its invisibility. For most people, the tax is automatically withheld rather than consciously paid. That’s no small thing. Withholding makes taxpaying a lot less painful – as anyone who makes estimated tax payments can readily attest. When you have to sit down and write the government a check every quarter, you start paying attention to the cost of government – and who’s paying for it.

Small-government conservatives are well aware of this. Mark C. Schug, an emeritus professor at the University of Wisconsin-Milwaukee, recently made the case for abolishing withholding entirely (he focuses on individual income taxes, but the argument applies equally well to the Social Security levy).

When people have their taxes withheld from their paychecks, Schug wrote for The Hill, they’re less inclined to get mad about paying them. And that leads to passivity and (eventually) the inexorable growth of government:

Taxpayers are inclined to look at the bottom line and pay little attention to how much of their salary or wages are actually taken by government. It’s like money they never saw. The pain comes in one or two drops at a time – not in a torrent each quarter.

Schug argued for keeping taxpayers on the hot seat. “Once people see how much they actually owe the government each quarter, there will be a tax rebellion that will make the Tea Party look like child’s play,” he predicted.

That’s almost certainly true. But it’s also true that withholding is not going away. It’s a fundamental element of the American state – and a key explanation for its growth. And while that makes it a tempting target for anti-state ideologues, it also makes it entirely secure.

Invisible taxes are the life blood of the Tax – Spend – Regulate members of our society that abhor the liberties enumerated in our Declaration of Independence and Guaranteed by our Constitution.

The T – S – R’s
more likely than not represent approximately 70-80% of the Democratic Party and 20-30% of the Republican Party and 0% of the Libertarian Party.

What is a fair tax structure? The T-S-Rs have no limit. The Reader’s Digest once published a poll on this. It came back as the total tax structure for a combination of the Federal, State and local taxes should never exceed 25% of your earnings. That was in the ERA of a marginal tax rate of 91%. I asked one of my patients who always felt that the rich should pay more. It looks like you think the rich can pay 100%? He said “absolutely.” I then asked him if he thought the rich should pay 200%? He said “absolutely.” So there will never be a limit that the T-S-Rs will accept. So we have to have a Constitutional Amendment to limit taxes.

How about each level of government having a limit of two taxes? The Feds could have an income tax of 15% and an excise tax on interstate and import commerce of 10%.

How about giving the states a 5% income tax limit and a 5% sales tax limit?

How about giving the city and local government a 1% property tax and 5% sales tax limit?

I know that’s more total than the 25% poll from Reader’s Digest of yesteryear? But wouldn’t that be a good start and maybe a good ending also?

State after state would approve this. It may have to start in the states and thus work back to the Feds which would then have to abide by it.

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In The News

Past Issue

Ebola virus fact sheet for physicians

by: SMCMA Admin

  The Dallas County Medical Association and the Texas Medical Association have assembled this information about how physicians can protect themselves from the Ebola virus.

Remember: You can only get Ebola from direct contact with a person who has symptoms.

Signs and Symptoms

Symptoms appear 2 to 21 days after exposure and include:

· Fever greater than 100.4F
· Headache
· Muscle pain
· Weakness
· Diarrhea, sometimes bloody
· Vomiting, sometimes bloody
· Stomach pain
· Unexplained bleeding or bruising  

If You Have Symptoms 

· Stay in place to minimize contact with others.
· Contact your doctor for advice.
· Call your doctor immediately if you have symptoms AND have been in direct contact with a person (here or abroad) who has been diagnosed with or is at risk of contracting Ebola.
· If you can’t get in touch with your doctor, call 9-1-1.

Protect Yourself

Ebola can enter the body through broken skin or unprotected mucous membranes, such as the eyes, nose, and mouth.

· Wash your hands often with soap and water or alcohol-based hand sanitizer. 
· Avoid contact with the body fluids (blood, vomit, pee, poop, spit, sweat, semen, etc.) of a person with Ebola. 
· Avoid contact with items (clothes, linens, needles, syringes) that have come in contact with the blood or body fluid of a person with Ebola.

Ways You CAN’T Get Ebola

 · You can’t get Ebola from a person who does not show symptoms.
 · You can’t get Ebola through the air.
 · You can’t get Ebola though water.
 · You can’t get Ebola through food.

Click here for a handy printout.

Information obtained from the Centers for Disease Control and Prevention and U.S. Department of Health and Human Services.

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In The News

Past Issue

Scandinavia says same sex marriage is not a right, but a privilege

Strasbourg rules again: there is no human right to same-sex marriage and enshrines the traditional concept of marriage as being between a man and a woman [and] cannot be construed as imposing an obligation on the Contracting States to grant access to marriage to same-sex couples

There is no human right to a same-sex marriage; human rights law does not require countries to “grant access to marriage to same-sex couples”, and the state acts lawfully in seeking to defend the traditional understanding of marriage as between a man and a woman, according to a ruling by Europe’s highest human-rights court last week.

The judgement handed down by the European Court of Human Rights (ECHR) at Strasbourg both reiterates and reinforces a previous 2012 ruling which made clear that same-sex couples did not have a human right to enter marriage. Strasbourg’s consistent view is noteworthy because it has a clear remit to uphold anti-discrimination and human rights laws, and vigorously pursues the rights of gay among other minority groups.

Last week’s ruling is the final stage of a case first brought in Finland, where, uniquely in Scandinavia, there is no same-sex marriage (SSM) law, but where gay couples can access legal privileges through a civil union law similar to the UK’s 2004 civil partnership scheme. 

The judgement handed down by the European Court of Human Rights (ECHR) at Strasbourg both reiterates and reinforces a previous 2012 ruling which made clear that same-sex couples did not have a human right to enter marriage. Strasbourg’s consistent view is noteworthy because it has a clear remit to uphold anti-discrimination and human rights laws, and vigorously pursues the rights of gay among other minority groups.

Last week’s ruling is the final stage of a case first brought in Finland, where, uniquely in Scandinavia, there is no same-sex marriage (SSM) law, but where gay couples can access legal privileges through a civil union law similar to the UK’s 2004 civil partnership scheme.

The case involved a man, Heli Hämäläinen, who fathered a child with his wife of ten years, then (in 2009) had gender-reassignment surgery to acquire the anatomy of a woman. When she (as she regards herself) changed her first names in June 2006, she was told that she could not be registered as female while remaining married unless her wife consented to the marriage being turned into a civil partnership, which she refused to do; or unless the couple divorced, which they said they would not do.

Heli Hämäläinen took her case to Strasbourg after a six-year battle in the Finnish courts. She argued that her religious beliefs prevented her from seeking a divorce and that a civil union did not offer the same as marriage in terms of benefits and security to them and their child. The judges found however that

it was not disproportionate to require the conversion of a marriage into a registered partnership as a precondition to legal recognition of an acquired gender, as that was a genuine option which provided legal protection for same-sex couples that was almost identical to that of marriage.

Significantly, the judges also said that the European Convention on Human Rights cannot be interpreted “as imposing an obligation on Contracting States to grant same-sex couples access to marriage”. Only ten of the 47 signatories to the Convention have legalised SSM.

The Court had previously found no right to same-sex marriage exists in the Convention. This time it went further and explicitly stated that Article 12 of the Convention (dealing with marriage)

enshrines the traditional concept of marriage as being between a man and a woman [and] cannot be construed as imposing an obligation on the Contracting States to grant access to marriage to same-sex couples (§ 96).

Strasbourg has rightly read its human rights charter as stating that, while a state has the power to redefine marriage, it cannot create a human right by fiat (human rights should be recognized, not created, by the law of states.) The constant understanding of marriage as a conjugal institution based on sexual complementarity is what lies behind the universal human right to enter it, a right that can only be exercised by those able (an adult man and a woman, who are free to do so, and capable of consenting to its requirements) to fulfil its conditions.

This unambiguous clarification is also important for those who opposed, and continue to oppose, the UK government’s redefinition of marriage rushed through Parliament last year. The refuseniks were told at the time, and are increasingly told, that their opposition reflects “homophobia” or that they don’t respect gay peoples’ “human rights”. In fact, as the eminent judges at Strasbourg have made clear, their opposition upholds the human rights spelled out in the great international charters which laid the postwar foundation of western pluralistic democracies.

[Austen Ivereigh]

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Your total assets are truly amazing

Five Big Investments You Don't Know You Have

For Most Households, They Matter More Than Stocks, Bonds or Mutual Funds

By Jack Hough | WSJ | May 11, 2014

When you hear the word investment, you probably think of your home, stocks and mutual funds, your retirement account, maybe your baseball-card collection. But how often do you think of your job?

You should, because for all but the wealthiest, your job is probably your No. 1 investment. Just think of your wages as the equivalent of a portfolio's income stream. The median household income in the U.S., about $51,000, equals the income of a stock-and-bond portfolio worth more than $1.2 million—assuming sustainable withdrawals of 4% a year.

Most U.S. households don't have anything close to $1.2 million saved. Among households with financial assets like stocks and bank certificates of deposit, the median portfolio was barely $30,000 as of 2010, according to Federal Reserve data. Or, to put it in corporate accounting terms, most Americans are all income statement and no balance sheet. 

So while everyone should learn the basics of investing, most workers should treat their ability to earn and save as their biggest asset. With that in mind, here are some hot investments that you probably don't think of as investments. But for most households, they matter more for growing wealth than the fine details of portfolio management.

1. Your benefits.

There are many ways to save, but for typical families, one seems to be working better than others. Between 1989 and 2010, the share of household financial assets held in retirement accounts nearly doubled to 38%, according to the Federal Reserve.

Not coincidentally, the number of active 401(k) participants has also ballooned, from 7.5 million in 1984 to 73.7 million last year. Few savings vehicles can match the 401(k) on features that promote long-term success. Workers typically add money automatically from their pay and get a tax break on their contribution, plus, more often than not, a matching contribution from their employer.

Even a middling 401(k) experience can pay off handsomely. A Congressional Research Service study in 2007 projected that a median-income household could stash away $468,000 after inflation in a retirement account by age 65 simply by starting at age 35, contributing 8% of pay and earning typical stock and bond returns. . .

Group life insurance can be a money saver too. . . Also, don't forget health insurance, tuition reimbursement, corporate travel discounts and credit unions.

Then there's Social Security, which is basically like a lifetime annuity from an insurance company. Some couples retire with Social Security income equivalent to that generated by investments worth over $1 million.

2. Your body.

Workers who exercise regularly earn 9% higher pay, on average, than those who don't, according to a 2012 study published in the Journal of Labor Research.

By scoring subjects on their propensity to exercise, based on factors like age, education level and school sports involvement, the study showed a cause-and-effect relationship between working out and earning more. Other studies have documented an obesity penalty to earnings, which seems to hit women hardest.

The financial benefits of fitness extend well beyond earnings. The fit pay less for life insurance than the fat, and spend less on health care.

Plus, the benefits to employers of worker fitness—fewer sick days, higher productivity and so on—are enough to make companies want to chip in.

Put it all together, and for a typical household the return on investment for getting in shape over the next year dwarfs the likely gains from financial assets

3. Your marriage.

Married couples gain financial leverage by sharing things like expenses, assets and health-care coverage. As a result, they increase wealth by 4% a year simply as a result of being married, according to a 2006 study by the Center for Human Resource Research at Ohio State University.

For couples who divorce, the same study found, wealth a decade later is three-quarters lower than for couples that remain married.

Considering the stakes, unhappy couples should view $100 a pop for weekly visits to a marriage counselor as a wise investment.

4. Your spending.

Small savings here and there can add up to meaningful wealth come retirement, for those who start early. For each $5 trimmed from daily expenses and invested at 6% yearly returns, the result after 40 years is nearly $300,000.

Discovering that $5 starts with tracking expenses, but fewer than one in three Americans prepares a detailed budget, in writing or on a computer that tracks income and expenses each month, according to a Gallup poll last year.

For the other two thirds, creating a budget can generate an extraordinarily high return on investment. Some personal-finance sites, such as, are free and automatically download information from financial institutions. . .

5. Your community.

Homes are the biggest nonfinancial asset for most households, and 70% of home-owning households have a mortgage. The median amount was $112,000 in 2010. That means that, since location is a key determinant of home values over time, many households are making a leveraged bet on the health of their communities.

Unlike with stocks, a little market manipulation here is encouraged. Show up for the Saturday school cleaning. Press the town to fill in nearby potholes. Help a sick neighbor mow her lawn.

Worst case, your efforts bring only personal satisfaction. Best case, others follow your lead and gradually increase neighborhood home values.

Write to Jack Hough at

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WSJ: Notable & Quotable: Mike Bloomberg at Harvard

Intolerance of ideas—whether liberal or conservative—is antithetical to individual rights and free societies.

From former New York City Mayor Michael Bloomberg's commencement address at Harvard University

Repressing free expression is a natural human weakness, and it is up to us to fight it at every turn. Intolerance of ideas—whether liberal or conservative—is antithetical to individual rights and free societies, and it is no less antithetical to great universities and first-rate scholarship.

There is an idea floating around college campuses—including here at Harvard—that scholars should be funded only if their work conforms to a particular view of justice. There's a word for that idea: censorship. And it is just a modern-day form of McCarthyism.

Think about the irony: In the 1950s, the right wing was attempting to repress left wing ideas. Today, on many college campuses, it is liberals trying to repress conservative ideas, even as conservative faculty members are at risk of becoming an endangered species. And perhaps nowhere is that more true than here in the Ivy League. 

In the 2012 presidential race, according to Federal Election Commission data, 96% of all campaign contributions from Ivy League faculty and employees went to Barack Obama.

Ninety-six percent. There was more disagreement among the old Soviet Politburo than there is among Ivy League donors. . .

When 96% of Ivy League donors prefer one candidate to another, you have to wonder whether students are being exposed to the diversity of views that a great university should offer.

Diversity of gender, ethnicity, and orientation is important. But a university cannot be great if its faculty is politically homogenous. In fact, the whole purpose of granting tenure to professors is to ensure that they feel free to conduct research on ideas that run afoul of university politics and societal norms.

When tenure was created, it mostly protected liberals whose ideas ran up against conservative norms.

Today, if tenure is going to continue to exist, it must also protect conservatives whose ideas run up against liberal norms. Otherwise, university research—and the professors who conduct it—will lose credibility.

Great universities must not become predictably partisan. And a liberal arts education must not be an education in the art of liberalism.

The role of universities is not to promote an ideology. It is to provide scholars and students with a neutral forum for researching and debating issues—without tipping the scales in one direction, or repressing unpopular views.

Requiring scholars—and commencement speakers, for that matter—to conform to certain political standards undermines the whole purpose of a university.

This spring, it has been disturbing to see a number of college commencement speakers withdraw—or have their invitations rescinded—after protests from students and—to me, shockingly—from senior faculty and administrators who should know better.

It happened at Brandeis, Haverford, Rutgers, and Smith. Last year, it happened at Swarthmore and Johns Hopkins, I'm sorry to say.

In each case, liberals silenced a voice—and denied an honorary degree—to individuals they deemed politically objectionable. That is an outrage and we must not let it continue.

If a university thinks twice before inviting a commencement speaker because of his or her politics, censorship and conformity—the mortal enemies of freedom—win out.

And sadly, it is not just commencement season when speakers are censored.

Last fall, when I was still in City Hall, our Police Commissioner was invited to deliver a lecture at another Ivy League institution—but he was unable to do so because students shouted him down.

Isn't the purpose of a university to stir discussion, not silence it? What were the students afraid of hearing? Why did administrators not step in to prevent the mob from silencing speech? And did anyone consider that it is morally and pedagogically wrong to deprive other students the chance to hear the speech?

. . . As a former chairman of Johns Hopkins, I strongly believe that a university's obligation is not to teach students what to think but to teach students how to think. And that requires listening to the other side, weighing arguments without prejudging them, and determining whether the other side might actually make some fair points.

If the faculty fails to do this, then it is the responsibility of the administration and governing body to step in and make it a priority. If they do not, if students graduate with ears and minds closed, the university has failed both the student and society.

Read the entire address at WSJ: Notable & Quotable . . .

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Map of State Tax Collections

New York collected $2,289 per person in individual state and local income tax collections in 2011, according to a new map from the Tax Foundation's Liz Malm and Richard Borean.

Using 2011 figures, the most recent tax data available, Malm and Borean calculated each state's per capita income taxes, including both state and local collections. The average collection -- which included wage and salary taxes as well as investment income taxes -- was $918 per person. 

·         Six states (Alaska, Florida, Nevada, South Dakota, Texas, Washington, and Wyoming) do not have an individual income tax, while New Hampshire and Tennessee only tax investment income.

·         New York collected the most of all the states, at $2,289 per capita. Behind New York was Maryland (at $1,823 per capita), Connecticut ($1,806), Massachusetts ($1,761), Oregon ($1,426), Minnesota ($1,404), Delaware ($1,360), California ($1,347), New Jersey ($1,204), and Virginia ($1,182).

·         Tennessee collects just $30 per person, and New Hampshire collects only $63, as the states only tax investment income. Of the states with broader income taxes, Arizona collects the least amount of taxes, at $445 per capita. Mississippi ($470), Louisiana ($527), and New Mexico ($529) follow behind Arizona.

·         Ninety-one percent of state and local tax collections are state-level taxes. Only 13 states collect local income taxes, including Maryland, where local income tax collections represent 30.4 percent of local tax revenue.

The National Center for Policy Analysis has developed a State Tax Calculator that allows an individual to calculate his personal tax burden and determine whether he would save or lose money by moving to another state.

Source: Liz Malm and Richard Borean, "Map: State and Local Individual Income Tax Collections Per Capita," Tax Foundation, May 8, 2014.

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What Doctors Can Learn From Business Leaders - Forbes

Physicians of the future will require a very different skill set and a lot more creativity.

The first time I set foot on my medical school campus, I realized I would have to check my creativity at the door. For the majority of medical students and residents in training today, that experience remains unchanged.

The goal of medical education is to teach aspiring doctors “the right way” to provide medical care. For most patients – and for many physicians – there is comfort in the definitive answers doctors are taught to provide. But the world is changing.

Knowledge creation is speeding up and medical problems are becoming more complex. Physicians of the future will require a very different skill set and a lot more creativity.

To better understand these needs, let’s compare medical education to the business school approach. I have the privilege to teach at both the Stanford School of Medicine and the Stanford Graduate School of Business. These two schools are very close in geographic proximity, but their cultures are worlds apart.

Medical students learn by rote – memorization based on repetition. But for business students, education happens through case study, analysis and discussion.

In business school, stories about a particular company or leader force students to analyze a dilemma and provide their own solutions. Diversity of thought is valued and back and forth discussions are common. Students point to their own prior experiences and knowledge as the basis for their claims. They’re challenged by classmates to defend their solutions – and there is rarely just one right solution.

The class I teach in the business school, “Leading Strategic Change in the Healthcare Industry,” encourages students to think big and without boundaries. I spend minimal time presenting students with “the facts.” Students can read about those on their own time. Instead, students push each other to develop new ideas that could transform the health care industry.

Business students understand that the entrepreneurial path is entirely merit based. Only knowledge, hard work and creativity matter. Failure is accepted and even embraced. The heroic stories are often about people who founded several startups that went bankrupt before creating a successful one. That’s how industry-changing companies like Nike, Sun Microsystems and StubHub were formed.

Medical school couldn’t be more different. The learning process during the first two years predominantly involves memorization. One day, students memorize the bones of the wrist. The next day, they memorize the steps in the Krebs cycle. There is a solid rationale for this. Medical students need this information to provide the best care for patients. No one would be comfortable with a beginning surgeon who decides to employ a new, “creative” surgical approach that hadn’t been tested.

But the singular focus of this instruction model inhibits alternative thinking. And the hierarchical system of medical educations ensures that yesterday’s truths remain tomorrow’s answers. Failure is not tolerated, creativity is discouraged and aspiring doctors are taught to protect themselves by accepting the wisdom handed down by their professors. Medical students know they can’t go wrong by adhering to “community standards.”

The process by which professors teach medicine stifles creativity. Decades after their schooling, doctors are influenced as much by their institution as by advances in their field of specialty. Worse, this process stifles the innovative spirit required to transform health care. It is no wonder few physicians are comfortable “thinking outside the box.” . . . .

Read more . . .

See HHK Section 10 below:

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The Supreme Court Ruling: Putting religion into a Civil Right Paradigm

Upholding Marriage: God’s Plan and Gift

A statement by the Rev. Bart Day, executive director, Office of National Mission

June 26, 2013

Today the Supreme Court issued its ruling, striking down Section 3 of the Defense of Marriage Act (DOMA), allowing for federal benefits for legally married gay couples and potentially allowing for gay marriage in all of California with regard to Proposition 8. Though the ruling is not a surprise, we are saddened for our nation, even as we call our fellow Christians to faithfulness and prayer.

As Christians, we believe and confess that God Himself instituted marriage as the life-long union of one man and one woman.  Same-sex unions are contrary to God’s will, and gay marriage is, in the eyes of God, no marriage at all.  As Christians, we proclaim this truth, no matter what the courts or legislatures may say. We are called not to popularity but to truth.  Therefore, we call on our fellow Christians to be faithful first to God’s Word, knowing that another court is ultimately supreme.

Marriage is a fundamental building block of society, binding parents to their offspring.  Every child benefits from the nurture of a mother and the leadership of a father.  While having one mother is a blessing, having two mothers or two fathers is confusing for the child and detrimental to her well-being.  The divorce culture has done great harm to the institution of marriage as well, and The Lutheran Church—Missouri Synod (LCMS) has and will continue to respond to that heartache with Christ’s comfort while simultaneously working to restore a culture where marriage is upheld.

While this occasion reminds us that Scripture calls homosexuality sinful (see Lev. 18:22; 20:13; Rom. 1:24–27), the Bible also says plainly that those who “hunger and thirst for righteousness,” that is to say, those who repent and show genuine sorrow over their sin, are forgiven and loved by Christ.

And so as Christ’s Church, we forgive and love too, following His lead with compassion and humility.  We forgive and love because we are all sinners in need of His grace and mercy; because no matter the sin, we have all rebelled against our Creator and fallen prey to unbelief; because He has justified us by grace through faith, freely given and joyfully received (Rom. 3:23–24); because Christ has reconciled us to the Father; because He has declared us righteous and we are.

In love, we will continue to teach marriage according to God’s plan and gift. We will continue to proclaim marriage as a picture of Christ’s love for His bride, the church.  And we will continue to be a place of forgiveness, mercy and healing for all people, even as we will continue to proclaim God’s truth in love.  As we move forward, we offer up our prayers for the nation and particularly for marriage, family and children.

Rev. Bart Day, executive director
LCMS Office of National Mission

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Misdiagnoses are harmful and costly

The Biggest Mistake Doctors Make are harmful and costly. But they're often preventable.

WSJ Health Care Reports

by Laura Landro

A patient with abdominal pain dies from a ruptured appendix after a doctor fails to do a complete physical exam. A biopsy comes back positive for prostate cancer, but no one follows up when the lab result gets misplaced. A child's fever and rash are diagnosed as a viral illness, but they turn out to be a much more serious case of bacterial meningitis.

Such devastating errors lead to permanent damage or death for as many as 160,000 patients each year, according to researchers at Johns Hopkins University. Not only are diagnostic problems more common than other medical mistakes—and more likely to harm patients—but they're also the leading cause of malpractice claims, accounting for 35% of nearly $39 billion in payouts in the U.S. from 1986 to 2010, measured in 2011 dollars, according to Johns Hopkins. 

The good news is that diagnostic errors are more likely to be preventable than other medical mistakes. And now health-care providers are turning to a number of innovative strategies to fix the complex web of errors, biases and oversights that stymie the quest for the right diagnosis. . .

Part of the solution is automation—using computers to sift through medical records to look for potential bad calls, or to prompt doctors to follow up on red-flag test results. Another component is devices and tests that help doctors identify diseases and conditions more accurately, and online services that give doctors suggestions when they aren't sure what they're dealing with. . .

"Diagnostic error is probably the biggest patient-safety issue we face in health care, and it is finally getting on the radar of the patient quality and safety movement," says Mark Graber, a longtime Veterans Administration physician. . .

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Europeans appear to be more closely related than previously thought

Europeans had common ancestors 1,000 years ago

By FRANK JORDANS, Associated Press, BERLIN

Scientists who compared DNA samples from people in different parts of the continent found that most had common ancestors living just 1,000 years ago.

The results confirm decade-old mathematical models, but will nevertheless come as a surprise to Europeans accustomed to thinking of ancient nations composed of distinct ethnic groups like "Germans," "Irish" or "Serbs."

"What's remarkable about this is how closely everyone is related to each other," said Graham Coop of the University of California, Davis, who co-wrote the study published Tuesday in the journal PLoS Biology.

Coop and his fellow author Peter Ralph of the University of Southern California used a database containing more than 2,250 genetic samples to look for shared DNA segments that would point to distant shared relatives. 

While the number of common genetic ancestors is greater the closer people are to each other, even individuals living 2,000 miles (3,220 kilometers) apart had identical sections of DNA that can be traced back roughly to the Middle Ages.

The findings indicate that there was a steady flow of genetic material between countries as far apart as Turkey and Britain, or Poland and Portugal, even after the great population movements of the first millennium A.D. such as the Saxon and Viking invasions of Britain, and the westward drive of the Huns and Slavic peoples.

The study did find subtle regional variations. For reasons still unclear, Italians and Spaniards appear to be less closely related than most Europeans to people elsewhere on the continent.

"The analysis is pretty convincing. It comes partly from the enormous number of ancestors each one of us have," said Mark A. Jobling, a professor of genetics at the University of Leicester, England, who wasn't involved in the study.

Since the number of ancestors each person has roughly doubles with each generation, "we don't have to go too far back to find someone who features in all of our family trees," he said.

Jobling cited a scientific paper published in 2004 that went so far as to predict that every person on the planet shares ancestors who lived just 4,000 years ago. . .

"Although, as the authors note, the approach is inherently 'noisy' (i.e. error-prone), it still does give results for European populations that are in reasonable agreement with historical expectations," said Mark Stoneking, a professor evolutionary anthropology at the University of Leipzig, Germany, who also wasn't involved in the study. "It would be interesting to see this applied in situations where we don't have such good historical information."

Coop and Ralph said the findings might change the way Europeans think about their neighbors on a continent that has had its fair share of struggle and strife.

"The basic idea that we're all related much more recently than one might think has been around for a while, but it is not widely appreciated, and still quite surprising to many people, even scientists working in population genetics, including ourselves," they said in an email to The Associated Press. "The fact that we share all our ancestors from a time period where we recognize various ethnic identities also points at how we are like a family - we have our differences, but are all closely related."

Just don't expect news of closer family ties to prompt a surge of brotherly love in Europe or elsewhere.

"There have been many studies that we've been involved in showing that groups which are fighting each other furiously all the time are actually extremely closely genetically related. But that's never had any impact on whether they continue to fight each other," Jobling said.

"So for example Jewish and non-Jewish populations in the Middle East are extremely similar genetically, but to tell them they are genetic close relatives isn't going to change their ways."

Read more here:

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ObamaCare Tax Increases: Onward and Forever Upward

Tax Prof Blog: ObamaCare Tax Increases Are Double Original Estimate

The Joint Committee on Taxation recently released a 96 page report on the tax provisions associated with Affordable Care Act. The report describes the 21 tax increases included in Obamacare, totaling $1.058 trillion – a steep increase from initial assessment, according to the Tax Prof Blog. The summer 2012 estimate is nearly twice the $569 billion estimate produced at the time of the passage of the law in March 2010. 


2010 Estimate, 2010-2019, $billion



2013-2022, $billion

0.9% payroll tax on wages and self-employment income and 3.8% t tax on dividends, capital gains, and other investment income for taxpayers earning over $200,000 (singles) / $250,000 (married)



“Cadillac tax” on high-cost plans *



Employer mandate *



Annual tax on health insurance providers *



Individual mandate *



Annual tax on drug manufacturers/importers *



2.3% excise tax on medical device manufacturers/importers* 



Limit FSAs in cafeteria plans *



Raise 7.5% AGI floor on medical expense deduction to 10% *



Deny eligibility of “black liquor” for cellulosic biofuel producer credit 



Codify economic substance doctrine



Increase penalty for nonqualified HSA distributions *



Impose limitations on the use of HSAs, FSAs, HRAs, and Archer MSAs to purchase over-the-counter medicines *



Impose fee on insured and self-insured health plans; patient-centered outcomes research trust fund *



Eliminate deduction for expenses allocable to Medicare Part D subsidy



Impose 10% tax on tanning services *



Limit deduction for compensation to officers, employees, directors, and service providers of certain health insurance providers



Modify section 833 treatment of certain health organizations



Other Revenue Effects



Additional requirements for section 501(c)(3) hospitals



Employer W-2 reporting of value of health benefits



Total Gross Tax Increase:



* Provision targets households earning less than $250,000.

** Includes CBO’s $216.0 billion estimate for “Associated Effects of Coverage Provisions on Tax Revenues” and $6.0 billion within CBO’s “Other Revenue Provisions” category that is not otherwise accounted for in the CBO or JCT estimates.

Source: Joint Committee on Taxation Estimates, prepared by Ways and Means Committee Staff

Donna Andrews March 13, 2013 at 9:28 AM

And who, exactly, did NOT see this coming?


  1. Bud Mathis March 13, 2013 at 9:58 AM

2.       Who???? Me for one. I thought it would be much more than double

  1. Paul March 13, 2013 at 12:33 PM

4.       It will Bud, just wait a little longer.

  1. Donna Andrews March 13, 2013 at 11:11 AM

6.       Anyone who ever thought that Obamacare was about health care is an idiot. This was never about your healthcare....NEVER. From its very conception, this was about nothing more than control and money. Obama and Company couldn't care less about your health. They just want to control how you live. I challenge anyone to name for me one thing, just ONE thing, that the government cannot force you to do in the name of "healthcare". Just one little thing!   It's time for Atlas to shrug.

Onward and Forever Upward!

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The Real Star War

Asteroid defense

Something useful for America’s underemployed space agency to do

The Economist | From the print edition | Feb 23rd 2013

GEOGRAPHY matters. In 1908 a rock the size of a city block hit the Earth’s atmosphere at 15km (9 miles) a second. The explosion flattened an area the size of London. But the land in question was in Siberia, so few people noticed and those who did had little influence. Suppose, though, it had devastated a city in Europe or North America. The history of the 20th century would have been different, as the best scientific and engineering brains were brought to bear on the question of how to stop it happening again. 

Well, it has happened again, albeit less spectacularly. By chance, Siberia bore the brunt once more, when a meteor crashed in the Urals on February 15th, injuring more than 1,000 people. It could just as easily have hit Germany or Guangdong. Moreover, on the same day another, larger rock called 2012 DA14 passed within 27,000km of Earth. By astronomical standards, that is a hair’s breadth. It is time to think seriously about stopping such incidents by building a system that can detect space rocks with sufficient warning, and then either blast them or push them out of the way. It would be costly, of course, and would require the development of new technology. But, as luck would have it, there is a tool lying around that has both the money and the nous to do it, and which is currently underemployed and in need of a new mission.


NASA, America’s space agency, has become a curious hybrid. Part of it is one of the world’s leading scientific research organisations. This NASA sends robot probes to the planets, runs space telescopes and has already sponsored projects devoted to looking for large asteroids—the ones that would blow humanity to kingdom come if their orbits ever intersected that of the Earth. If such a large, “planet-killing” asteroid were discovered, though, the chances are that earthlings would have decades, or centuries, to act; a small nudge, judiciously applied by rocket motor or nuclear explosion (see article), would be enough to send it off course.

The real problem is “city-killers”—things too small for existing surveys to see, but large enough to do serious damage. And it is here that the other NASA might be brought into play. The non-scientific bit of the agency, the bit that brought you the Apollo project, has been looking for a proper job since 1972, when Apollo was cancelled. It thought it had found it in the Space Shuttle, but building a cheap, reliable orbital truck proved impossible. It thought it had found it in the International Space Station, but that has turned into a scientifically useless tin can in the sky. The latest wheeze is to build a rocket that might one day, many administrations hence, go to Mars.

In a well-ordered world, this bit of NASA would have been closed down years ago. That it has not been is due, in large measure, to the lobbying power of aerospace companies which see the agency as a way to divert money from taxpayers’ pockets into those of their shareholders. This pocket-picking would be less irksome if something useful came of it. Why not, therefore, change this part of NASA’s remit to protecting the planet from external attack, not by evil aliens but by an uncaring universe?

Two things would be needed. One is a bigger system of telescopes, either on the ground or in orbit, to give notice of a threat. The other is a way to counter the threat. That might be done with lasers, or with controlled explosions that would shift the incoming object’s orbit sufficiently to make it miss altogether, or (if that is not possible) hit an unpopulated area.

Developing all this would be a technological challenge worthy of NASA’s engineers. It would keep the agency’s bureaucrats in their jobs. It would keep the money flowing to the aerospace companies. It would probably cost no more than the space station (about $100 billion). And, if it worked, it would provide something that benefited not just America, but the world—precisely the sort of thing a rich country which often claims the moral high ground ought to be doing.

When Apollo 11 took off from the Moon on July 21st 1969, its crew left behind a plaque that read, “They came in peace, for all mankind”. What an opportunity both America and NASA now have to prove that they meant it.

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