Category Archives: Economy

Access to Electronic Medical Records

Here’s an interesting debate:

Epic Systems, one of the largest medical records companies, emailed the chief executives of some of the largest hospitals in the U.S. on Wednesday, urging them to oppose proposed regulation designed to make it easier to share medical information.

The email, which was written by Epic CEO Judy Faulkner and addressed to CEOs and presidents of hospital systems, urges recipients to sign a letter alongside Epic that voices disapproval for rules the Department of Health and Human Services proposed in 2019. These rules aim to make it easy for patients to access their health information at no cost, and make it more challenging for companies to block access to that information.

The proposed rules have pit patient advocates against some doctor groups and companies, like Epic. Critics say they don’t have enough provisions to protect patients’ privacy. Epic’s Faulkner has been vocal in her criticism of the rule, which she believes will result in app makers having access to patient data without consent.

On the other side, patient advocates have spoken out in favor of the rules, which aim to make medical records accessible through application programming interfaces (APIs). The rules are also designed to make it easier for hospitals to share patient records with other medical offices or hospitals. That’s been a big challenge for years, and studies have shown that it has a negative impact on patient’s health.

Patient groups have criticized medical record vendors, like Epic and its chief rival Cerner, for failing to do enough to support health data interoperability. Both companies have stressed that they’re doing more to fix the problem, although progress has been slow.

As always… follow the money. Epic and some other EMR companies are notoriously closed systems. The reason is simple. If Epic controls access to the data and the integrations, they can charge for it. This is a revenue stream for them. Of course they do not want to be required to provide APIs unless it is on their terms.

That being said, their concerns about data privacy are valid. The more you expose the underlying data through APIs, the more potential data breaches are possible. This has been a concern with EMR in general. While electronic medical records are convenient and helpful to share complete patient data across multiple medical specialties, they are also subject to hacking and manipulation. But that ship has sailed. We have culturally decided that the rewards outweigh the risks.

Everything depends on the implementation of a law like this. It could be beneficial by offering patients greater visibility and control of their records. It could also be a security nightmare with millions of people’s medical records being leaked for the purposes of extortion, predatory violence, discrimination, and, worst of all, targeted robocalls.

Union Membership Stagnant in Wisconsin

It appears that we have reached an equilibrium.

According to data from the U.S. Bureau of Labor Statistics, an estimated 219,000 workers in the state were union members last year, up from 218,000 in 2018. The percentage of workers in unions was unchanged at 8.1%.

The number of workers represented by a union increased from 233,000 in 2018 to 245,000 last year. The percentage of workers represented by unions went from 8.6% to 9.1%. The increases in union representation in 2019 brought the state back to the level it was at in 2016 and 2017.

Wisconsin’s union membership and representation has been relatively steady in recent years after a tumultuous early portion of the decade that saw the passage of Act 10 and right-to-work legislation.

Thanks to Right to Work and Act 10, we know that people who want to be in a union are in a union. Those who don’t want to be in a union don’t have to be. I expect that that makes or healthy, vibrant unions full of people who want it.

“The Bill Clinton of Cities”

Ouch.

“San Francisco has squandered its place in the sun,” said John Price, CEO of the genetic engineering company Greffex Inc. “San Francisco is the Bill Clinton of cities. It squandered itself with its flaws.”

Corporations Bring Profits Home

Excellent.

WASHINGTON — American corporations brought back more than $1.04 trillion of overseas profits to the U.S. since Congress passed the 2017 Tax Cuts and Jobs Act (TCJA). The bill overhauled the international tax system and encouraged U.S. companies to bring back offshore profits to the U.S.

The number fell short of the $4 trillion President Donald Trump projected when he pitched the 2017 tax law.

According to the third quarter account deficit report released by the Bureau of Economic Analysis (BEA), repatriation numbers topped $1.1 billion during the July-to-September period to $124.1 billion.

Investment banks and think tanks have estimated that U.S. corporations held $1.5 trillion to $2.5 trillion in offshore cash at the time the law was enacted, Bloomberg News reports. Before the TCJA, the corporate tax was 35 percent. Companies were incentivized to keep profits overseas to avoid the tax. The new law established a one-time 15.5 percent tax rate on corporate cash and 8 percent on corporate noncash or illiquid assets.

 

Company Move from Illinois to Wisconsin

Excellent!

“Leaving Illinois was not an easy decision for us,” said James Merlo, Trifinity’s founder and CEO, adding that his family has been doing business in Illinois for 90 years since his grandfather immigrated from Sicily.

Merlo said it was a meeting with Kenosha Mayor John Antaramian that convinced him to move operations over the border, adding that Kenosha is a “business-friendly atmosphere” where “Trifinity can grow.”

Trolley in Memphis

I was in Memphis for a couple of days this week and noticed a couple of things. I stayed downtown near the convention center on main street. My hotel was about a mile from Beale Street and the entertainment district. I enjoy getting out of the hotel to explore, so I headed down the Beale Street a couple nights for dinner.

Memphis has a trolley that runs down a good length of Main Street from the transit center north of the convention center to a block north of Beale Street. It’s one of those trolleys on rails that is powered by overhead wires. The trolley is just a dollar to ride, but I chose to walk from my hotel to Beale Street twice because I enjoy walking. It also gave me the chance to observe the trolley in action and make a few observations.

  1. It was weeknights without much going on. Downtown was sparsely populated in the evenings, so I don’t think ridership was reflective of a busy time with a convention or something in town. Still, I only saw one family ride it. It was empty the rest of the time.
  2. Each trolley was driven by a driver. Plus, there was a guy who say in a Gator. Every time the trolley passed him, he got out and used a tool to shift the tracks. All told, they were paying at least 5 guys to run the system at any given time.
  3. The trolley did move faster than walking, but with the stops and waiting to board, it was still faster to walk.
  4. As it happens, the convention center was empty because it is currently undergoing a massive renovation (perhaps something to watch to see if it was worth it before Milwaukee spends money redoing theirs). This caused them to close a block of Main Street and block the tracks.

What that means is that to ride the rail trolley to the end of the route, you had to ride the rail trolley to the end of the block, get off, board a wheeled trolley, and then that trolley would take you around the detour to the other side.

In other words, while the railed trolley might be interesting, the infrastructure and personnel to run it are far more expensive than the wheeled version AND the wheeled version (A.K.A. decorated bus) is far more practical because it can adjust to circumstances on the road.

I wonder how much this system is costing the good taxpayers of Memphis per rider. Someone else can try to look that up.

Population Shifts

Interesting data from the BizTimes.

Most of Wisconsin’s population gain in the last year came from its natural increase with 63,712 births outpacing the state’s 50,393 deaths. Total net migration added another 1,903 people with a net gain of 3,341 internationally offsetting the net loss of 1,438 people domestically.

Since 2010, Wisconsin has seen a net loss of 12,755 people through migration with the loss of 72,006 residents domestically outpacing a gain of 59,251 from outside the U.S.

Every Midwestern state except North and South Dakota has seen a net loss off domestically. Illinois has lost 865,873 residents to other states while adding 242,945 from outside the U.S.

 

2020 is nigh

Here is my full column that ran in the Washington County Daily News yesterday. Of course, 2020 is no longer nigh. It is here. Happy New Year!

Whenever the end of something is upon us, whether it be a day, year, or a decade, it is a natural time to reflect. As a child, I could swear that someone promised me a flying car by 2020. We have not quite made it to that utopian transportation option, but we have come a long way since this decade began.

The state of Wisconsin was a completely different place in 2010. Democrats had controlled both houses of the Legislature for two years and the governor’s office for eight years. The state was facing yet another multibillion-dollar budget deficit. Taxes had been increasing for years. The state economy was stagnant. The crushing regulatory burden was driving businesses out of the state, public employee unions pulled the strings in Madison, and citizens were denied their Second Amendment rights. It was a dark time for the state.

The people of Wisconsin had had enough and swept Republicans into legislative majorities and elected Gov. Scott Walker. Republicans would remain in power for the next eight years and ushered in a bevy of conservative reforms. They cut taxes, reduced the spending increases (unfortunately, they did not cut spending), reduced regulations, empowered people over unions, and expanded the exercise of civil rights. The results speak for themselves. Compared to 2010, Wisconsin has lower unemployment, higher labor participation, higher wages, more businesses investing in the state (including a rejuvenated tech sector), lower taxes, more protections of civil rights, and has knocked off its “Rust Belt” national reputation. The teen years were very good to Wisconsin.

At the national level, the decade began with a political upheaval. After ramming through Obamacare in late 2009, the public responded by sweeping Republicans into control of the House of Representatives, thus mitigating the damage of President Obama’s administration. By the second half of the decade, the improbable election of President Donald Trump ushered in a new era of populist antiestablishment governance that has upended the old political order. As we closed the decade with the unjust impeachment of the president, we are beginning the new decade in as much upheaval as we began the previous decade.

In the lives of everyday Americans, the decade was pretty good to most people. The Dow Industrial Average was hovering around 10,500 when the decade began, but will finish this decade at

around 28,500. Home values are up, inflation has been virtually nonexistent, wages are finally rising after years of stagnation, and jobs are plentiful. Technological advances have made life more convenient than ever. It is safe to say that as 2020 begins, Americans enjoy the most affluent, safest, comfortable, highest quality of life in the history of our species.

On a personal level, much has changed over the decade. I began the decade with four kids in the house, a busy bleacher schedule, and a full head of hair. I begin the next decade on the cusp of an empty nest, a grandchild, and the fading memory of owning a comb. It seems that nothing can resist the withering assault of time.

Looking back gives on the benefit of perspective. The further one looks into the past, the fewer things rise to the level of importance. One might consider several events in a previous decade to be important, but only one in a long-ago century. Some centuries seem to elude any level of importance altogether except that they are wedged as a bridge between more important centuries. Perhaps it is only when the lens is pulled back that the important things can come into focus.

I keep a quote by Goethe on my desktop that says, “life is the childhood of our immortality.” It is a reminder that this instant; this time; this life; is merely the foreword of a much longer, much more important story. We should laugh for no reason (or any reason), eat the candy, love without reserve, get dirty, play with the bubble wrap, make the stupid joke, and enjoy each moment. Yesterday does not hold dominion over us and tomorrow is not promised. Today is a gift to be opened with childlike joy.

Extreme Poverty Halved in Past Decade

Wow. Amazing.

Data shows that inequality has increased over the last decade with an increasing number of rich people in the global one per cent who have generated more wealth, while extreme poverty has halved.

Extreme poverty measured by the World Bank as those living on less than $1.90 per day has halved over the past decade

Extreme poverty measured by the World Bank as those living on less than $1.90 per day has halved over the past decade

Statistics from the World Bank and World Poverty Clock show that rates of extreme poverty have been halved over the past ten years, from 15.7% in 2010 to 7.7% now.

They also show extreme poverty in China has almost been entirely eradicated.

The number of people living on less than $1.90 per day, which is the World Bank’s threshold for ‘extreme poverty’, in areas including South Asia and Latin America have fallen dramatically, according to the data.

The trend does not hold true in sub-Saharan Africa, however, where overall poverty rates have risen to higher than a decade ago, partially due to a rapidly-growing population.

2020 is nigh

My column for the Washington County Daily News is online and in print. It is difficult to let a decade end (don’t start with me about the decade not actually ending until next year) without a bit of retrospective and reflection. Here’s a bit of navel gazing.

Looking back gives on the benefit of perspective. The further one looks into the past, the fewer things rise to the level of importance. One might consider several events in a previous decade to be important, but only one in a long-ago century. Some centuries seem to elude any level of importance altogether except that they are wedged as a bridge between more important centuries. Perhaps it is only when the lens is pulled back that the important things can come into focus.

I keep a quote by Goethe on my desktop that says, “life is the childhood of our immortality.” It is a reminder that this instant; this time; this life; is merely the foreword of a much longer, much more important story. We should laugh for no reason (or any reason), eat the candy, love without reserve, get dirty, play with the bubble wrap, make the stupid joke, and enjoy each moment. Yesterday does not hold dominion over us and tomorrow is not promised. Today is a gift to be opened with childlike joy.

Foxconn Pays the Tax Man

Good to see.

Mount Pleasant, Wis. – The Village of Mount Pleasant has received 2019 property tax payment from Foxconn Technology Group in the amount of $1,071,899.55, making Foxconn the largest taxpayer in the Village.

In addition, Foxconn also paid its first Special Assessment payment in the amount of $7,325,050. Foxconn is responsible to pay Special Assessments to cover the cost of all land acquisitions in the project area, in addition to the $60 million it paid the Village in 2017. To-date, 850 acres of land in Area I have been conveyed to Foxconn, and a total of $110 million in Special Assessments are in place on the approximately 2,600 acres of land in Areas I, II, and III.

“Ahead of schedule, Foxconn Technology Group has paid its 2019 property tax and special assessment payments to the Village of Mount Pleasant. These payments, totaling more than $8.4 million, establish the company as the largest taxpayer in the Village,” said David DeGroot, Mount Pleasant Village President. “We continue to see tremendous progress at Foxconn’s campus in the Village. These advance payments are one more example of Foxconn’s commitment to our area and to its obligations under the local development agreement.”

California’s New Gig Law Pushes Companies Out

At precisely the point in our technological development when it is becoming feasible for many jobs to be performed from anywhere in the world, California is making it harder and harder for people to actually work in their state.

Marisa Vallbona has transitioned a contractor who has worked for her in California into an employee, and is being more selective about the work she takes on in the state. Vallbona, who recently moved the headquarters of her public relations firm, CIM, to Houston from California, is now using only Texas-based contractors.

“I don’t work with freelancers in California anymore because of the gig economy problems,” she says.

Other companies inside and out of California are likely to follow suit. The increase in remote working over the past two decades has made it easier for companies to find workers anywhere.

It’s a shame, really. Homelessness and underemployment are real problems in that state.

Governor Seeks to Welch on Foxconn Deal

He seems determined to kill this economic engine.

MADISON, Wis. (AP) — Gov. Tony Evers’ top aide warned Foxconn Technology Group last month that a scaled-down factory in Wisconsin won’t qualify for tax credits unless the Taiwanese electronics giant renegotiates with the state, letters Evers’ administration released Friday show.

The letters underscore a deepening schism between Evers and the world’s largest electronics provider. Foxconn counts Apple, Google and Amazon among its customers.

Foxconn originally proposed building a massive flat-screen plant in Mount Pleasant that would eventually employ 13,000 people. Enamored with the thought of a monumental economic boost going into the 2018 elections, then-Gov. Scott Walker and Republican legislators approved an unprecedented $3 billion state incentives package in 2017 for the factory. Democrats complained at the time that Walker and the GOP were giving away too much for a project that might never materialize.

House Finally Moves Forward on USMCA

Excellent. But let’s be honest here… Pelosi dragged her feet on this for months for domestic political and personal benefit at the same time she is planning to impeach the president for allegedly leveraging public policy for domestic political and personal benefit.

House Democrats and the Trump administration have reached an agreement to move forward with the White House’s replacement for the North American Free Trade Agreement, top Democrats said Tuesday.

The two sides had worked for more than a year to resolve Democratic concerns about enforcement tools for labor and environmental standards under the new deal, known as the United States-Mexico-Canada Agreement. House Democrats, President Donald Trump, top Senate Republicans and labor leaders all cited progress toward a deal this week.

The Trump administration needs to submit ratifying legislation to Congress for the House to move forward with approving the agreement. Once the White House submits text — it could do so in the coming days — a 90-day window to approve USMCA starts.

The three countries’ representatives — U.S. Trade Representative Robert Lighthizer, Canadian Deputy Prime Minister Chrystia Freeland and Mexican Deputy Foreign Minister Jesus Seade — signed the revised deal on Tuesday afternoon in Mexico City.

Wisconsin Gets High Marks for Transparency for Economic Development

Good news!

Wisconsin has received the second-highest marks in the nation for economic development-related transparency and online access to information, according to a new report — a major boost for a state whose job-creation agency faced numerous problems in its early years.

The latest ranking from Wisconsin Public Interest Research Group Foundation and Frontier Group, both liberal advocacy organizations, underscores efforts at the Wisconsin Economic Development Corp. to increase transparency when taxpayer dollars are used to fund economic development subsidies.

While the state was criticized for a severe lack of spending transparency in a 2012 WISPIRG report, this year’s analysis found Wisconsin is second only to Ohio for providing online access to the state’s use of taxpayer dollars to subsidize business projects or economic development.

Jobs Surge

Wow. I didn’t expect this.

The jobs market turned in a stellar performance in November, with nonfarm payrolls surging by 266,000 and the unemployment rate falling to 3.5%, according to Labor Department numbers released Friday.

Those totals easily beat the Wall Street consensus. Economists surveyed by Dow Jones had been looking for solid job growth of 187,000 and saw the unemployment rate holding steady from October’s 3.6%.

The jobs growth was the best since January. While hopes already were up, much of that was based on the return of GM workers following a lengthy strike. That dynamic indeed boosted employment in motor vehicles and parts by 41,300, part of an overall 54,000 gain in manufacturing.

With unemployment already being so low, it is really challenging to have this much job growth. There just aren’t enough people in the workforce to fill the jobs. This means that more people are coming off the bench to fill jobs.

This is also encouraging:

Average hourly earnings rose by 3.1% from a year ago, while the average work week held steady at 34.4 hours.

Jobs up. Earnings up. Good stuff.

Wisconsin Is Adding Higher-Paying Jobs

Excellent news from the Wisconsin Policy Forum.

Generally speaking, jobs have grown more in Wisconsin in higher-paying occupations than in lower-paying ones since 2008. In fact, employment in the 11 highest-paying occupational groups—which each pay median wages of at least $42,000 annually—has grown by a combined 114,870 statewide during that time. Meanwhile, employment in the 11 lowest-paying occupational groups paying median wages of less than $42,000 has declined by a combined 42,990.

Four of the five occupational groups that have added the most jobs pay median annual wages of at least $60,000 per year: business and financial operations, computer and mathematical, healthcare practitioners and technical, and management. (See Figure 1 and our interactive charts.) These occupations also typically require higher levels of education and training than many of the occupations in decline.

One notable exception to this trend was personal care and service occupations, which have shown the most growth overall and which pay relatively low wages. Personal care and service occupations include personal care aides, barbers/hairstylists, and child care workers. Employment in that group grew by both the largest number (42,240) and percentage (56.2%) statewide during the 10-year period. At $23,870, personal care and service occupations paid the second-lowest median wage of the 22 groups in 2018 behind only food preparation and serving jobs.

Wisconsin’s Grade Inflation

It’s not just for kids anymore. This from Dr. Will Flanders at WILL, writing for RightWisconsin.

A Lake Wobegon Effect? Wisconsin is a state, according to the latest report cards, where (almost) everyone is above average.Despite proficiency rates in that hover around 40% in both math and reading, 87% of schools in the state meet or exceed expectations.

A part of the explanation for this is that growth and proficiency make up different shares of a school’s overall achievement score depending on the number of low income kids in the school. Because low income kids start from behind in many cases, growth makes up a bigger share of the score when a school has more low income kids.

It is laudable to account for student growth, but we should recognize that it makes comparisons between schools more difficult. When a school like Kluge Elementary in Milwaukee “Meets Expectations” with proficiency rates of 4.1% in math and reading, something is unbalanced.

If proficiency rates are 40% and 87% of schools are considered to meet or exceed expectations, then our expectations are woefully low. The soft bigotry of low expectations isn’t very soft anymore.

Taxes Up. Ranking Falls.

Progress?

Wisconsin’s state and local tax ranking has fallen over the prior year but remains a little higher than the year before that, the latest data from the U.S. Census Bureau show.

Taxes took up 10.3% of Wisconsinites’ income in 2017, a slight increase from 10.2% in 2016. Despite that uptick, the state took a modest step forward compared to its peers around the country, with Wisconsin’s ranking dropping to 19th highest in 2017 from 16th highest in 2016.

The public should be cautious, however, about reading too much into the 2017 data alone since not much has changed since 2015. That year, the state’s taxes took up 10.4% of personal income and ranked 22nd highest.

 

Time to let college athletes be compensated

Here is my full column that ran yesterday in the Washington County Daily News.

I had occasion last week to visit my alma mater, Texas A&M University, to celebrate the 125th anniversary of the Fightin’ Texas Aggie Band, in which I marched. The days were filled with old friends, old stories, and meeting with legions of Aggies past, present, and future.

As part of the activities, we were offered a tour of the newest addition to Kyle Field, now the largest stadium in the state of Texas. Opulent does not begin to describe it. The Hall of Champions, luxury suites, amenities, training facilities, locker rooms, etc., are truly superb. A look to the west at the baseball field, track facilities, soccer field, basketball arena, etc., will find equally magnificent facilities. Many of these facilities, including the newest addition to Kyle Field, were built mostly with private money, but they really show how much money flows through college athletics.

While I could use any university as an example, the numbers from Texas A&M are a good example. Last year, Texas A&M Athletics took in $212.4 million in revenue against $165.8 million in expenses, resulting in a 22% profit of $46.6 million. Many private companies would be delighted to see such positive financial performance. On any given home football game day, 60,000-plus people flood into town. They stay at hotels, eat at restaurants, buy merchandise, rent cars, and have a staggering economic impact on the little city. Jimbo Fisher, the football head coach, is being paid $75 million over 10 years. The media companies make millions broadcasting the games on television and radio. Companies like Nike, Adidas, and Under Armor make millions selling athletic gear with college logos on them.

Everybody is making money — big money — in college athletics except the athletes playing the games. That needs to change.

For years, it has been forbidden for college athletes to earn or accept money. The rationale is that the purpose of college athletics is to be an extracurricular activity that attracts kids to college and provides some of those kids with access to higher education through scholarships. If college athletes can earn money for playing a sport, then they blur into professional athletes competing for a school instead of an amateur college kid just playing while he or she is earning a degree. Such notions seem almost quaint when college sports has become a multibillion-dollar industry.

While much of the attention is focused on the tiny number of high-profile athletes who are destined for national fame in professional leagues, the vast majority of college athletes do not fit that mold. In all of Division I athletics, only 69% of athletes receive some kind of scholarship, and a smaller percentage receives a full scholarship. Even then, the scholarship does not cover expenses outside of school. For athletes from financially disadvantaged backgrounds, the prohibition from being able to earn money if they play a sport might keep them from playing the sport at all.

Furthermore, only a handful of college athletes will ever go on to compete at a professional level, and only some sports even have a professional league where athletes can earn good money. Most college football, baseball, basketball, and hockey players never make it to the pros, and the average track, volleyball, or lacrosse player will never be able to earn a living competing in their sport.

College athletes are adults. It is fundamentally unjust for thousands of people to make money off of their talent while they are prohibited from doing so. This is especially true considering that the athlete is assuming all of the risk. How many times, for example, has a star college athlete destined for the pros suffered a career-ending injury before they were ever able to earn a single dollar for all of their work and talent?

Whether universities should actually pay athletes a salary outside of scholarships is certainly questionable. Universities are not in the business of sports and public universities, in particular, should not use tax dollars to pay athletes. But if a local car dealership, law firm, or restaurant wants to pay a prominent college athlete to use their likeness in their advertising, why should that be prohibited? Who is harmed by that transaction? Nobody.

Several states and the NCAA are already moving to allow college athletes to earn money for themselves as they are earning money for everyone else. Wisconsin should be the next state to do so.