Predatory Public Finance and the Evolution of the War on Drugs

June 5, 2018

US drug policy has a long history of providing revenue for federal, state, and local governments. Before the War on Drugs, opium and cocaine were legal and medical professionals who prescribed these substances had to pay extra taxes to do so. This chapter explains how, as the federal government began enforcing outright bans on drugs, law enforcement agencies took advantage of their newly acquired authority to profit. Today, civil asset forfeiture related to drug crimes provides officers with incentives to use and abuse their authority and increase their revenue by making more drug arrests. Key takeaways: (1) Drug policy has a long history of providing law enforcement with increased revenues and authority over time. (2) Law enforcement agencies may be targeting the crimes that present the opportunity to raise revenue for their departments rather than the most serious public safety threats.

via Predatory Public Finance and the Evolution of the War on Drugs by Bruce L. Benson, Brian Meehan :: SSRN

The Effects of DACA on Health Insurance, Access to Care, and Health Outcomes

June 1, 2018

This paper studies the effects of the 2012 Deferred Action for Childhood Arrivals (DACA) initiative on health insurance coverage, access to care, health care use, and health outcomes. We exploit a difference-in-differences that relies on the discontinuity in program eligibility criteria. We find that DACA increased insurance coverage. In states that granted access to Medicaid, the increase was driven by an increase in public insurance take-up. Where public coverage was not available, DACA eligibility increased individually purchased insurance.Despite the increase in insurance coverage, there is no evidence of significant increases in health care use, although there is some evidence that DACA increased demand for mental health services. After 2012, DACA- eligible individuals were more likely to report a usual place of care and less likely to delay care because of financial restrictions. Finally, we find some evidence that DACA improved self-reported health, and reduced depression symptoms, indicators of stress and anxiety, and hypertension. These improvements are concentrated among individuals with income below the federal poverty level.

via The Effects of DACA on Health Insurance, Access to Care, and Health Outcomes by Osea Giuntella, Jakub Lonsky :: SSRN

Evidence and Issues Concerning Drug Consumption Rooms

May 29, 2018

Problematic and chaotic drug use (particularly by persons who inject drugs) carried on in public places such as streets and parks, creates an environment of high risk to personal and public health (including drug-related deaths and contaminated drug litter). Such use frequently gives rise to wider social problems, but it is also indicative of underlying issues and causes such as homelessness, chronic medical conditions, absence (or loss) of adequate harm-reduction services, and financial hardship. As part of a system of interventions to address these issues, a number of cities in Europe and elsewhere have established supervised drug consumption facilities. None yet exists in the UK. This paper details the evidence and issues concerning Drug Consumption Rooms discussed at a one-day conference hosted by the Criminal Justice Centre, School of Law, Queen Mary University of London (in collaboration with Volteface) on March 27, 2018.

via Evidence and Issues Concerning Drug Consumption Rooms by Rudi Fortson, Liz McCulloch :: SSRN

Driving While Stoned: Issues and Policy Options

May 17, 2018

THC is the intoxicant most commonly detected in US drivers, with approximately 13% of drivers testing positive for marijuana use, compared to the 8% that show a measurable amount of alcohol (NHTSA, 2015). (The two figures are not strictly comparable because cannabis remains detectable for much longer than alcohol, and also for long after the driver is no longer impaired; therefore, the difference in rates does not show that stoned driving is more common than drunk driving.) Cannabis intoxication has been shown to impair reaction time and visual-spatial judgment.

Many states, including those where cannabis sales are now permitted by state law, have laws against cannabis-impaired driving based on the drunk-driving model, defining criminally intoxicated driving as driving with more than a threshold amount of intoxicant in one’s bloodstream—a per se standard—as opposed to actual impairment. That approach neglects crucial differences between alcohol and cannabis in their detectability, their pharmacokinetics, and their impact on highway safety.

Cannabis intoxication is more difficult to reliably detect chemically than alcohol intoxication. A breath alcohol test is (1) cheap and reliable; (2) sufficiently simple and non-invasive to administer at the roadside; and (3) a good proxy for alcohol in the brain, which in turn is (4) a good proxy for subjective intoxication and for measurable driving impairment. In addition, (5) the dose-effect curve linking blood alcohol to fatality risk is well-established and steep.

None of those things is true for cannabis. A breath test remains to be developed. Oral-fluid testing can demonstrate recent use but not the level of impairment. A blood test requires a trained phlebotomist and therefore a trip to a medical facility, and blood THC levels drop very sharply over time-periods measured in minutes. Blood THC is not a good proxy either for recency of use or for impairment, and the dose-effect curve for fatality risk remains a matter of sharp controversy. The maximum risk for cannabis intoxication alone, unmixed with alcohol or other drugs, appears to be more comparable to risks such as talking on a hands-free cellphone (legal in all states) than to driving with a BAC above 0.08, let alone the rapidly-rising risks at higher BACs. Moreover, the lipid-solubility of THC means that a frequent cannabis user will always have measurable THC in his or her blood, even when that person has not used recently and is neither subjectively intoxicated nor objectively impaired. That suggests criminalizing only combination use, while treating driving under the influence of cannabis (however this is to be proven) as a traffic offense, like speeding.

via Driving While Stoned: Issues and Policy Options by Mark A.R. Kleiman, Tyler Jones , Celeste Miller, Ross Halperin :: SSRN

Paternalistic Taxation of Unhealthy Food and the Intensive Versus Extensive Margin of Obesity

May 13, 2018

This paper shows that if an individual’s health costs are U-shaped in weight with a minimum at some healthy weight level and if the individual has both self control problems and rational motives for over- or underweight, the optimal paternalistic tax on unhealthy food mitigates the individual’s weight problem (intensive margin), but does not induce the individual to choose healthy weight (extensive margin). Implementing healthy weight requires a further distortion (e.g. subsidy on other goods), which may render the tax on unhealthy food inferior to the option of not taxing the individual at all. In addition, with heterogeneous individuals the optimal uniform paternalistic tax may have the negative side effect of rendering otherwise healthy individuals underweight.

via Paternalistic Taxation of Unhealthy Food and the Intensive Versus Extensive Margin of Obesity by Zarko Yordanov Kalamov, Marco Runkel :: SSRN

The Rationality of Literal Tide Pod Consumption

May 9, 2018

via Press This!

Birth Conflicts: Leveraging State Power to Coerce Health Care Decision-Making

May 9, 2018

In 2006, a pregnant woman in labor went to Saint Barnabas Hospital in New Jersey; upon admission, she consented to administration of IV fluids, antibiotics, oxygen, fetal heart rate monitoring, an episiotomy, and an epidural, but she declined to consent to other invasive treatment, including a cesarean or fetal scalp stimulation. The hospital staff urged her to sign the consent form “in the event of an emergency,” but there was no medical indication that a cesarean was necessary. She experienced a high degree of pressure from her care providers and had her mental state questioned to determine whether she was competent to refuse treatment, which the hospital psychiatrist concluded she was. She eventually had a healthy baby by vaginal delivery without complication. Nevertheless, the hospital reported her to the Division of Youth and Family Services (DYFS) based on her refusal to consent to a cesarean. DYFS put the newborn into foster care and ultimately secured termination of her parental rights, a decision that was upheld on appeal.

Although the appellate court technically avoided answering the question of whether a cesarean refusal can be grounds for a finding of neglect and abuse in family court — concluding instead that other evidence supported terminating the woman’s parental rights — it is clear that her cesarean refusal triggered the investigation by child welfare authorities. This woman’s experience adds an additional factor to the balancing of risks involved in deciding whether to choose a cesarean delivery: possible intervention by child welfare authorities and loss of one’s child. The potential chilling effect of this type of state intervention on women’s decision-making in childbirth is troubling, as some women are likely to submit to an unwanted cesarean or other unnecessary medical treatment out of fear of similar consequences. The stakes are particularly high for poor women, women of color, and young women, as they are more likely to have their parental fitness, good judgment, and even the appropriateness of their pregnancies called into question and scrutinized by third parties in positions of authority. Threatened with state intervention, such women face difficult decisions about whether to accept unwanted treatment — and an increased risk of physician and emotional harm, as well as greater financial burden — in order to avoid the risk of losing their children.

A number of scholars have examined the use of court orders to compel pregnant women to undergo medical treatment, examining constitutional questions related to religious liberty and reproductive freedom. Others have critiqued the way that pregnancy seems to create exceptions to established legal norms governing consent and the right to refuse unwanted medical treatment. This paper adds to the existing scholarship by considering the threat of state involvement in maternity care with a focus on health care providers. The paper uses the example of health care providers relying on health-based justifications to threaten involvement of child welfare authorities in order to examine how coercing consent violates physicians’ legal and ethical responsibilities and may also have broader negative public health implications. Ultimately, the paper challenges the pregnancy exceptionalism that tolerates coercion in the provider-patient relationship and identifies several interventions in research and advocacy to help shape efforts to eliminate coercion in maternity care decision-making.

via Birth Conflicts: Leveraging State Power to Coerce Health Care Decision-Making by Elizabeth Kukura :: SSRN