Wednesday, July 25, 2012

Does Research and Statistics Support Gun Control?

Author’s note: I reached out to a respected expert on gun control statistics, Dr. Gary Kleck, professor of criminology at Florida State University.  He was kind enough to send me the chapter The Great American Gun Debate:What Research Has to Say  from The Criminal Justice System, 10th edition, Edited by George F. Cole and Marc G. Gertz. Wadsworth. (Published January 2012). [Note: this paper had been hacked at one point and nasty, unrelated stuff added, I'm working on a new link.]   He also sent me a copy of National Vital Statistics Reports Volume 60, Number 3  which is the final report for 2009 which he says “provides the most recent final mortality data, showing numbers of deaths from all causes, with separate counts for gun deaths.”

Update: 11/21/14 (revised 10/4/15 and 6/12/16): The problem isn't guns, it's mental health, insane people will do insane things. Criminals don't follow laws. If someone is going to commit murder, a crime that has the death penalty/life imprisonment, do you really think gun laws will deter them? The way to prevent these types of incidents isn't to regulate or ban guns, it's to help identify and treat those with mental illness who are a danger to themselves and others.  The people are the problem, not their weapons of choice. 

"Mental health is still not adequately diagnosed or treated in the United States, and especially not among young people...not delivered in a very effective manner.”

In fact,  a Connecticut state review panel has concluded "Medical professionals and school staff missed multiple opportunities to help Adam Lanza with his severe emotional and psychiatric disorders."


Updated: 1/1/13: At the risk of making this insufferably long, I have added one more video that I think needs to be here. It is found underneath #6.

Updated 12/21/12:

Last week we witnessed the horrible shootings in Newtown, Connecticut. I am deeply saddened and brought to tears by the deaths of the 27 people including 20 small children.  While I would prefer not to speak about gun control while people are mourning the loss of their loved ones, there are those who immediately and disgustingly took advantage of the situation to politicize it and tout their gun control agenda.  Therefore, I must respond to them with what I know is true:

1. Gun control doesn't work.  Connecticut has strict gun control laws and that did not prevent the tragedy in Newtown.

2. Guns are not the problem, evil is the problem and evil is what we must fight, not guns. Everyone has a propensity for evil. There are ways to minimize (not eliminate) the ability of vil to take a foothold.

3. The public school systems are failing our children. Schools don't know what to do with smart kids who don't fit the social 'norms' even though they are required, by law, under The Individuals with Disabilities Education Act (IDEA) , to identify and "provide early intervention, special education and related services to infants, toddlers, children and youth with disabilities." This includes not only those with physical disabilities, but also mental and emotional disabilities.  School systems are failing to do this.  

4. Most importantly, our children must not be left unprotected.  Parents are calling for students to be protected by armed security/police as is the case in Orange County, FL.  It is not feasible for police to be posted permanently at schools.  What is feasible and what would be the best way to protect our children is volunteer teachers/school staff properly trained and armed like they do in Israel.
Israeli Elementary School
We train teachers and staff how to perform first aid/CPR and use an AED to save kids, why not train them to use firearms? this is just another way to protect our precious children.

5. I abhor the term "assault rifle." Anything can be used in an assault. There is a specific type of rifle that is called an "assault rifle," it is fully automatic illegal for most people other than military or police and a few select people to possess.  Media, either intentionally or because they are ignorant, mistakenly call rifles used in the recent crimes "assault rifles."

The department of Defense has long defined assault rifles as “fully automatic rifles used for military purposes.”

Here is an explanation:

Some have included semi-automatic weapons that are capable of switching to automatic in the definition of "assault rifle" but they all have the characteristic of being able to fire automatically.  Guns that are strictly semi-automatic are not "assault rifles."  Some people also confuse "assault rifles" with "Assault Weapons" which are something completely different.

6. What does research and statistics say about gun control?

In the wake of the Colorado theater shootings and the tragic shooting in Newtown, CT, many people have called for stricter gun control laws, while others stand by the second amendment right to own and posses guns.  Those who want stricter control believe it will prevent deaths, many gun advocates state guns help prevent injury and death.  I was interested to find out more information in two areas, the first being the comparison of guns used for violence versus gun use for protection and secondly, mortality rates related to gunshot wounds as compared to mortality rates by other mechanisms.

Choose your own crime stats:





“Perhaps what is most striking about the patterns of gun ownership in the US is that ownership is generally highest in those groups where violence is lowest.” (Kleck 1997, Chapter 3).  “It is well known that guns are used in many violent crimes in the US. [However] The best available evidence indicates that guns are used by victims in self-protection considerably more often than crimes are committed by offenders using guns.  For example, victims used guns defensively about 2.0-2.5 million times in 1993, compared to fewer than 600,000 violent crimes committed by offenders with guns (Kleck and Gertz 1995).”

 
“Defensive gun use is effective in preventing injury to the victim and property loss.  Research based on interviews with large nationally representative samples of crime victims consistently indicates that those who use guns during crime incidents are less likely to be injured or lose property than those who either adopt other resistance strategies or do not resist at all. These effects are usually produced without shooting the gun or wounding a criminal -  only 24 per cent of gun defenders even fired the gun (including warning shots), only l6 per cent tried to shoot the perpetrator, and at most 8 per cent wounded the offender (evidence summarized in Kleck and Kates 2001, Chapter 7).”




“There is also evidence indicating that some criminals may be deterred from making some criminal attempts in the first place by the prospect of victim gun use against them. Criminals interviewed in prison indicate that they have refrained from committing crimes because they believed a potential victim might have a gun, and crime rates have dropped substantially after highly publicized instances of prospective victims arming themselves or being trained in gun use, or victims using guns against criminals. (research summarized in Kleck and Kates 2001, Chapter 7).”




Information I had not even considered, “that when criminal aggressors possess guns in a crime incident, they are substantially less likely to attack and injure their victims in the first place. At least nineteen studies have found that offenders possessing guns are less likely to injure their victims than offenders with other weapons or no weapons. The explanation appears to be that possession of a lethal weapon enables aggressors to intimidate victims without actually attacking them, in crimes where the offender’s goal is not to kill the victim.” Kleck 2011

Many gun control proponents state that having stricter gun control laws that restrict who can purchase guns will prevent criminals from obtaining guns.  Studies show that most criminals do not obtain their guns from a conventional retail dealer of guns. 


Eight four percent, of 943 felon handgun owners surveyed,
did not purchase the gun from a conventional retailer.


Another question that has surfaced is: why do people focus more on gun injury related deaths? Why guns when more people have died from poisoning and motor vehicle accidents individually and followed closely by falls? There are restrictions on some types of poisons, but that didn’t prevent 41,592 deaths by poison in 2009. There are even less restrictions on motor vehicles which caused 34,485 deaths in 2009.Both of these cause more deaths than guns. All of these can be used by in the commission of murder.




According to: National Vital Statistics Reports Volume 60, Number 3 December 29, 2011Deaths: Final Data for 2009 (Table 18) in 2009, a total of 177,154 deaths were classified as injury related Four major mechanisms of injury in 2009— poisoning, motor-vehicle traffic, firearm, and fall— accounted for 75.1 percent of all injury deaths.





Mechanism
Number of Deaths 2009
Percentage
Poisoning
41,592
23.5%
Motor-vehicle traffic  
34,485
19.5%
Firearm
31,347
17.7 %
Fall
25,562
14.4 %





If you want to see more statistics, you can check out the Explore the Wallstreet Journal's interactive murder database of killings committed in the U.S. from 2000 to 2010 (h/t Adam Baldwin) where can limit your search by criteria.  For example: There were 28 drowning murders in 2009.   I'm not sure how accurate the interactive database is, the database  does not include Florida.  The CDC's 2009 vital statistics report, Table 18, says 41 drowning murders in 2009. If the interactive database is correct, 13 occurred in Florida.  That seems a little high to me, but it's possible. Still the interactive database lets you get a feel for the numbers and gives you the ability to compare different categories.

Why then are guns singled out as needing restriction or banned? Could it be, perhaps, a matter of politics? Though there are gun proponents and gun control advocates on both ends of the political spectrum, it seems as though it is mostly the liberals and progressives that want gun control and the conservatives and moderates that defend the second Amendment right to bear arms. That this topic has become entrenched in people’s political belief system, it is difficult, but not impossible, for people’s minds to be changed on the topic of gun control.

Research shows that gun control will not help prevent gun related crimes, nor will it prevent people from obtaining guns. In fact, stricter gun control would cause an increase in crime, increase gun related crime, and victim injury/death.
In response to the question:  What is the defense of those that would try to discredit this study?

Dr. Kleck responded: "I have thoroughly rebutted all of the criticisms of my and others' survey estimates of the frequency of defensive gun use in one convenient source, a chapter in the 2001 book Armed, by Gary Kleck and Don B. Kates."

Dr. Kleck stands by the data in the study. 

Thank you Dr. Kleck!



REFERENCES


Kleck, Gary. 1997. Targeting Guns: Firearms and their Control. N.Y.: Aldine de Gruyter.

Kleck, Gary, and Marc Gertz. 1995. “Armed resistance to crime: the prevalence and nature of self-defense with a gun.” Journal of Criminal Law and Criminology 86:150-187.

Kleck, Gary, and Don B. Kates.  2001.  Armed: New Perspectives on Gun Control.  Buffalo, NY: Prometheus.


Wednesday, July 18, 2012

America Needs to Return to the Basics

Common sense dictates that the founding fathers were intelligent men who knew what they were doing; after all they created the greatest nation on earth. They set up the government in a very sensible way. It is, therefore, senseless to stray from the path they put us on, yet this is what has happened. Our nation no longer resembles the nation that was started by our founding fathers. It is not the nation we once knew. To repair the damage that has been done, we need to go back to the basics found in the Declaration of Independence, The Constitution and the Bill of Rights

Our founding fathers stated in the The Declaration of Independence, "all men are created equal, that they are endowed by their Creator with certain unalienable Rights," rights that are given by God and cannot be altered by law (versus inalienable rights which are subject to be changed by the laws of man) "that among these are Life, Liberty and the pursuit of Happiness." This is frequently misinterpreted to mean everyone has the right to be happy. “Pursuit” is in there for a reason, everyone has the right to “pursue happiness” this does not meant that everyone guaranteed happiness.  The government is not responsible for your happiness.

The Preamble to the Constitution and article I, section 8 states "promote" (not provide) "the general Welfare." "Welfare" meaning "Exemption from any unusual evil or calamity; the enjoyment of peace and prosperity, or the ordinary blessings of society and civil government" (Webster’s American Dictionary of the English Language, 1828 and is the same definition as when the Constitution was ratified). It does not mean that the government must provide everything for the people as supported by James Madison in Federalist Papers #41: "It has been urged and echoed, that… provide for the common defense or general welfare of the United States," amounts to an unlimited commission to exercise every power which may be alleged to be necessary for the common defense or general welfare. No stronger proof could be given of the distress under which these writers labor for objections, than their stooping to such a misconstruction."

Amendment I tells us "congress shall make no law respecting an establishment of religion." This means national religion, or prohibiting the free exercise thereof; The federal government should not be involved in religion, They cannot tell religious institutions what they can do or what services they provide and Congress will "make no law prohibiting the free exercise of religion." Religious organizations are free to practice their religion as they see fit.

Amendment II says that "A well regulated Militia," meaning organized armed forces, "to the security of a free State," to protect one’s home, and one’s local area, and country "the right of the people," the individual, "to keep and bear Arms, shall not be infringed by the Government." Government cannot prevent individuals from owning arms (guns).

An outline of the responsibilities of each branch, legislative, judicial and executive is found in Articles I-III of the Constitution. No branch, including the executive branch (President) is more important than the other. Each branch has a purpose and a job to do and each is equally important. It is for each branch to fulfill its own duties. It is not the place of one branch to fulfill the job of the other or to take on the jobs of the states. The rest falls, as relayed in Amendment X, to the states "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people" as clarified by Madison in Federalist Papers #14 and Federalist Papers #39 "...is to be remembered that the general government is not to be charged with the whole power of making and administering laws. Its jurisdiction is limited to certain enumerated objects…leaves to the several States a residuary and inviolable sovereignty over all other objects." 

The federal government has taken over too much, pays for far too many programs that should be left to the state and local governments and to the people. Communities, should they choose to have these types of programs, would have to raise the money and provide the programs, thus taking the burden off the federal government. I guarantee they would also find a way to help the people become more self-sufficient. This would help everyone, including the federal government and their ever increasing debt problem. It is unlikely that the government would pay off the unimaginable debt it has incurred, at least not in my lifetime. Following the Constitution, as was intended, would, put the nation back on the right path.


Monday, July 9, 2012

Obamacare Will lead to Loss of Jobs and Lower Quality Health Care


There are many articles and reports on how Obamacare is bad for America. Most of these reports focus on how it's bad for doctors and bad for patients and is a costly tax and a waste of money. What most people don't realize is that Obamacare will lead to the loss of nursing and ancillary jobs and will lower the quality of health care in America.

Facilities such as hospitals, nursing homes, and rehabilitation centers have the basic costs of running a business. There are the costs of the upkeep and maintenance of the facility. There are the costs involved in the housing of the patient, bed, food etc. There are the costs of the health care and ancillary personnel that need to be provided. The facility must take in enough money to cover their costs.

Looking at the financial world of health care, it’s important to realize that it’s more complicated than simply a service offered and then either the patient or the insurance pays for it. There is much more to it than that. Insurance companies work out deals, what is covered by the insurance and what it costs for the insured. Most of you get a taste of this when you compare programs, what is covered and how much you pay. The insurance company sets limits and defines what they will cover. Facilities who accept their insurance must abide by what is covered. This works well if you only need it for what is covered under the insurance. In addition to coverage, there are co-pays and deductibles, additional amounts the insured must pay for care.

With Obamacare, many will opt for the cheapest insurance they can get rather than pay the high fines involved with not being insured. “El Cheapo” insurance likely will have minimum coverage with high deductibles. People who need health care will find they are not saving money and most will find they are spending more between paying for the insurance and paying for services due to high deductibles.

A person who is paying for El Cheapo insurance because they cannot afford the higher fines for not having insurance, will undoubtedly not have the extra money lying around for co-pays or deductibles, may not readily seek out medical attention. Many doctors have cash discounts for those who pay themselves and this cost usually ends up being less than a person, particularly a young, healthy person, would pay annually, even for treatment of a chronic condition. These people would have better care if they would pay for the care themselves even if they needed to ask for charity in order to pay for it. This is why many would rather save their own money and pay for their medical expenses outright rather than have insurance.

Why then is it more detrimental for a facility, such as a rehab center or hospital, to accept El Cheapo insurance as mandated by Obamacare than it would be for her to have no insurance at all and how does this lead to a reduction in jobs? This is complicated, as there are many aspects of the case that come in to effect.

Insurance is not equal. Facilities can make more money from people paying out of pocket, even if it’s in installments, than they can by accepting insurance with poor, El Cheapo, coverage. We already see this with Medicaid, which is fine for certain things but has poor coverage for other things and therefore the facilities have to pick up much of the cost of caring for these patients. It will be similar with the El Cheapo insurances that many will be forced to choose. The patient is less likely to pay for that which isn’t covered by insurance because she will have no extra money because she was forced to buy El Cheapo insurance. She would have been better off having no insurance and being able to choose what care she needs.

El Cheapo insurance isn’t going to give people better care and would even limit care to what is covered by the insurance. El Cheapo insurance, because it is a business, wants to try not to pay for anything they don’t have to. This makes it difficult for the facility to get paid as El Cheapo will question everything so as not to pay. The facility will then have to eat the cost of that which is not covered and, because of contracts to accept El Cheapo insurance, cannot charge the patient for the difference as the facility has to go by what is covered by the insurance. The patient either does not receive the care, or the care is provided and the facility will eat the cost. This would not be the case with private pay as the patient would be able to be charged for all services provided and the patient would be able to have a say in her own treatment above the bare minimum that is required. The facility and the patient would be able to work out a payment plan that is both acceptable to the patient and the facility. The patient would, in fact, frequently end up paying more with insurance because with high deductibles, the patient is not only paying for the care up to the deductible, but also for the insurance. The cheaper the insurance, the higher the deductible to cover in hospital or other facility costs. It is unlikely the patient would reach the deductible for the insurance plan to be of benefit. The patient, should she not have the money, is also free to seek out charity to pay for the cost. The patient not only would likely spend less paying for services herself than she would have on El Cheapo insurance and would also have individual choice for care.

In review: Under Obamacare the El Cheapo will cover the bare minimum care and not provide for more and the patient cannot choose the care provided. The facility will eat any costs that El Cheapo refuses to cover. Under private pay, the patient will be provided minimum care and then will be able to choose what other care is provided and is able to arrange payments for the care without having paid for El Cheapo insurance that doesn’t cover what the patient needs and will only pay for bare minimum of care and the facility must, already, provide the minimum of care. El Cheapo will pay the facility less for the same care that a person would pay out of pocket for the same care and that the person would likely pay less out of pocket for service than she would on El Cheapo at a likely less amount of money than she spent on El Cheapo. The patient is not getting as much for their buck, as well as not being able to make their own health care choices, as they would paying themselves.

How does this lead to a reduction in staff and decrease of quality health care? Health care facilities are businesses that have expenses they must cover. If a facility does not take in enough money to cover expenses they must close. If facilities close, the result would be fewer beds available for those who need it. This would cause people to forgo necessary medical care because they are unable to secure a bed in the facility. It would also increase waiting times including Emergency rooms. Therefore, facilities do whatever it takes to reduce costs and increase income. With Obamacare, the income will be diminished because they will no longer have the self-pay patients, but rather patients with El Cheapo insurance which decreases income. Decreased income means a decrease in staff.

Let’s look at an example, a rehabilitation center in Florida. Each state has a minimum of care they must provide for their patients in a rehabilitation center. In Florida that is currently 1.0 hours of nursing care per patient per day and Certified Nursing Assistant (CNA) 2.5 hours a day per patient. It is likely that with the implementation of Obamacare, the 2.5 and also the 1.0 hours of nursing care will need to be decreased even further. Facilities that cannot stay in the black will close, it has happened before, in 2011, shortly after Obamacare was signed and due to the poor economy during the Obama Administration. At that time, the minimum number of CNA hours had been reduced from 2.7 to 2.5 hrs./pt./day. I predict, with the implementation of Obamacare, a 2.3 and 0.8 or less respectively to allow for facilities to remain solvent and to prevent closures of facilities. In addition, other ancillary departments, which do not have legally set minimums, will be decreased even further. Ancillary jobs will be combined to reduce costs. Positions will be combined; staff will be spread out thinly. Facilities will provide only the minimum care as required by law due to poor coverage by poor insurance such as Medicaid and El Cheapo insurance. All of this decreases the level of care in order for the facility to remain solvent and open.

Here’s the numbers. The number of CNAs per day (8 hour shifts), for 100 patients, has reduced from 33.75 (optimum 2.7 hours of care per patient, per day) to 31.25 (adequate 2.5 hours per patient, per day) and, if decreased to 2.3 hours of care per day the number of CNAs needed per day for 100 patients would decrease to 28.75. That is a decrease in 2.5 staff members per day. That’s 2.5 more people unemployed. The numbers are similar for nurses. With 100 patients, nurses must provide 1 hour of care per patient, that’s 100 hours per day. With 8 hours shifts that comes out to 12. 5 nurses a day. With a decrease to 0.8 hours/day, it reduces to 80 hours per day or 10 nurses, again a drop of 2.5 nurses per day. For 100 bed facility, that would be a total of 5 unemployed people. The decrease in staff also equates to a decrease in the quality of care. Staff must care for more patients. No longer will staff have the leisure to sit and talk with patients, they will become automated machines trying to care for their patients without the time to provide for extras that, while not absolutely necessary, would improve care. An example is patient bathing, 3 times a week used to be the norm, soon 2 times a week will become the standard. Some staff will fatigue and burn out, unable to keep up with the increasing demands others will take shortcuts, diminishing care in order to finish what needs to be done.

The Obamacare mandate will lead to a decrease in health care jobs due to the increase in people with El Cheapo insurance with poor coverage which in turn causes facilities to cut staff to stay in the black and remain open. The decrease in staff can equate to a decrease in the quality of care for patients.


Update 7/9/12: 

A comment was made (see below) that there is "a provision in the law that in order to avoid the penalty tax, a person must purchase a policy 'approved by the Secretary' of HHS. I can imagine the Department refusing to approve policies of the 'El Cheapo' type you describe. HHS may in fact demand that all policies sold be of the gold-plated Cadillac type, covering all sorts of things the owner would never need."

Medicaid would be/is already approved and everyone knows that Medicaid is king of the "El Cheapo" insurance. Call around and try to find a doctor, especially a specialist, or rehabilitation center that accepts it. If they do, they limit the number of patients they accept.

Also, they would have to approve "El Cheapo" because no insurance company would/could write a policy that could be affordable to those with lower/no income without bankrupting themselves. If the Sec. of HHS did demand insurance companies write those types of policies, many insurance companies would fold and that would mean more loss of jobs.