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The policy implications of America’s Ebola response

Puneet Kollipara

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Oct. 3, 2014

Welcome to Wonkbook, Wonkblog’s morning policy news primer by Puneet Kollipara (@pkollipara). To subscribe by e-mail, click here. Send comments, criticism or ideas to Wonkbook at Washpost dot com. To read more by the Wonkblog team, click here. Follow us on Twitter and Facebook.

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Wonkbook’s Number of the Day: 2,610. That's the number of hospitals penalized under the Affordable Care Act for excessive readmissions, a new record.

Wonkbook’s Chart of the Day: Mapping the marriage market for young adults.

Wonkbook's Top 4 Stories: (1) Side effects in the Ebola response; (2) Happy Jobs Friday!; (3) the Supreme Court's fresh docket; (4) the close linkage between birth control policy and abortions.

1. Top story: Some side effects in the Ebola response

As many as 100 people are being screened for Ebola in US... "The number of people in Texas who are being screened for potential exposure to Ebola expanded Thursday to roughly 100, as health officials cast a wide net to try to prevent the one confirmed case of the disease from sparking an outbreak....The 100 people being screened represent a 'very wide net,' including some who possibly had brief encounters with Mr. Duncan, Texas health officials said. They added that the number is likely to drop as they narrow the list to those actually at potential risk of infection." Ana Campoy, Drew Hinshaw and Dan Frosch in The Wall Street Journal.

Timeline: An overview of the Ebola outbreak. Sarah Ferris in The Hill.

...but that doesn't mean they all came into direct contact. "It takes direct contact with bodily fluids to transmit Ebola....Direct contact means that the fluids splash or spray into someone else’s mouth, eyes or nose, or enter the bloodstream through cuts or breaks in the skin. People can also contract the disease by touching infected fluids and then touching their eyes or mouth. The virus does not spread through the air, unlike measles or chickenpox. And Ebola does not invade healthy skin, so merely touching secretions does not mean an infection will follow. But washing hands or using an alcohol-based hand sanitizer is essential after any potential contact, to avoid spreading the virus to other people or to one’s own eyes or mouth." Denise Grady in The New York Times.

The epidemiological math that shows how Ebola isn't as contagious as other diseases. "It boils down to something called 'R0.' The reproduction number, or 'R nought,' is a mathematical term that tells you how contagious an infectious disease is. Specifically, it's the number of people who catch the disease from one sick person, on average, in an outbreak.* Take, for example, measles. The virus is one of the most contagious diseases known to man. It's R0 sits around 18....At the other end of the spectrum are viruses like HIV and hepatitis C...between 2 and 4. They're still big problems, but they spread much more slowly than the measles. And that brings us back to Ebola. Despite its nasty reputation, the virus's R0 really isn't that impressive. It typically sits around 1.5 to 2.0." Michaeleen Doucleff in NPR.

Children in Dallas schools aren't likely to pass along Ebola. "None of the children have symptoms, and the chances that they passed the virus to other people at the school are extremely low, health officials said. Even when people are infected with Ebola, they are not contagious until they get develop symptoms. And even then, the virus can be transmitted only through bodily fluids and close physical contact. Still, some parents decided to keep their children home Wednesday, according to news reports, while many others warily accepted the reassurances of public health officials — even if they planned their own improvised protective measures." Manny Fernandez, Kevin Sack and Marc Santora in The New York Times.

One complication of the U.S. case: Disposing of Ebola waste at the hospital... "It's a confusing issue for state health officials, hospitals and companies charged with hauling medical waste, because federal regulations on the process contradict each other. That's why advocates for emergency preparedness are urging Texas health officials to ensure that the Dallas hospital has its own waste sterilizer on site....This step would help the hospital maintain safety while federal health and transportation officials work to reconcile the rules, advocates said. In their current form, regulations order hospitals to discard Ebola waste like any other biohazard while effectively preventing waste management companies from transporting the materials. This leaves doctors and hospital executives in a bind. " Elise Viebeck in The Hill.

...and at home — a job that no one wants to do. "Towels and sweat-ridden bedclothes remained for two days in the Dallas apartment where an undiagnosed Ebola sufferer — Liberian citizen Thomas Eric Duncan — was staying because health officials in Texas struggled to find a waste management company willing to accept them....A company with experience of dealing with medical waste was finally due to clean the apartment on Thursday afternoon, but only after the patient’s girlfriend told CNN that the materials had not been disposed of." Tom Dart and Lauren Gambino in The Guardian.

Also, in Liberia, U.S. treatment centers still long way off. "The beds for the first field hospital, flown in by the military from Kelly Air Force Base near San Antonio, remained in a hangar at Liberia’s main international airport, wrapped in plastic alongside the tents, generators and the medical equipment needed to set up the facility. Military planners say it will probably be another 10 days before even this first 25-bed treatment center is up and running. And that unit is meant to be used solely by health care workers who become infected — not for the hundreds of new Ebola cases that have sprung up in this country in recent weeks. They will have to be served by the other 17 centers further back in the pipeline." Helene Cooper in The New York Times.

Public service announcement: How to help in efforts to stem Ebola's tide. The New York Times.

And Dallas-area Africans confront Ebola taunts and fears. "In the days since a West African man traveled to the Dallas area, fell ill and eventually tested positive for the deadly Ebola virus, Carolyn Woahloe and other Liberians have heard the taunts....'Go back to Liberia.' Woahloe, a registered nurse, gathered recently with Liberian community leaders to spread the word: Please don't blame Liberians....The anxiety has spread even to local Liberians themselves. Even though many have Ebola-infected relatives or friends back in West Africa, until now the fear of infection was a continent away. Now many are afraid to come to church for fear of contracting the disease." John M. Glionna and Molly Hennessy-Fiske in the Los Angeles Times.

Yet another side effect: Ebola is disrupting oil drilling for Exxon. "Exxon Mobil Corp has seen some of its oil and gas activities in West Africa disrupted by the Ebola outbreak, including plans to drill offshore Liberia, the company's chief executive officer said on Thursday. Exxon, the world's largest publicly traded oil company which has operations in Nigeria and Liberia, is prohibiting some employees from traveling to the countries directly affected by the disease, and is taking precautionary measures related to workers' families, executive said." Anna Driver in Reuters.

Chart: On the other hand, Malaysia’s rubber-glove industry could see profits in the Ebola outbreak. Ylan Q. Mui in The Washington Post.

Meanwhile, the politicking over Ebola has picked up. "Airline passengers arriving in the U.S. from West African nations gripped by an outbreak of Ebola are only getting a fact sheet about the deadly disease. What they don’t get are detailed questions from agents at the U.S. airport to determine if they had contact with an Ebola victim or specific screening to see if they have a high fever or other signs of the disease....Lawmakers are urging more aggressive action and some said they would convene hearings. Senator Rob Portman, an Ohio Republican, renewed a call for the U.S. to check travelers for Ebola symptoms." Mark Drajem in Bloomberg.

Related: Ebola turns into political fight. Sarah Ferris in The Hill.

Yes, the Ebola patient flew through two U.S. airports. No, you still shouldn’t worry.. "Airplanes are not exactly the cleanest of places....That has resulted in fearful reporting like this, which frantically tracked all of the cities where these planes have gone....They went to San Francisco! And Chicago! And Los Angeles! They’re right behind you, watching you read this post. In reality, though, officials continue to say that there is no danger posed by these flights or by Duncan’s presence in the airports. Here’s why: Duncan, who was diagnosed with Ebola on Tuesday, arrived in the country on Sept. 20. He did not start showing any symptoms until four days later....And Ebola is contagious only when the person is experiencing active symptoms." Mark Berman in The Washington Post.

Video: Jon Stewart has a message for TV media: Stop trying to scare people about Ebola. Reena Flores in National Journal.

Nigeria may have beaten its Ebola outbreak back. "It's a rare upbeat Ebola story: Nigeria, the most populous country in Africa, may have contained its outbreak after only 19 confirmed cases and seven related deaths. The outbreak began in July. But the country hasn't seen a new case since Aug. 31....A region or country is considered Ebola-free after 42 days without any new cases. That means Nigeria can formally declare success on Oct. 12, which would truly be cause for celebration." Linda Poon in NPR.

A Liberian doctor is using HIV drugs to treat Ebola victims. Don't get excited just yet, though. "Gorbee Logan, a doctor in rural Liberia, has given at least 15 Ebola patients lamivudine....All but two of them survived, Logan told CNN last week. Since that interview, Logan has been in contact with Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, about the treatment....Fauci said National Institutes of Health researchers have tested lamivudine's reaction to Ebola in test tubes. There was no response; but Fauci said researchers will adjust some levels and try it again 'to see if there's even slight activity against Ebola.'" Elahe Izadi in The Washington Post.

GAWANDE: The Dallas wake-up call shows we can stop Ebola. "With the announcement of the Dallas case, hospitals across the country are now scrambling to get their procedures in place. Doctors’ offices should do so, too. They need to download the C.D.C.’s checklists. And they need to do what other high-risk professions have done for years and train people immediately in 'closed-loop communication' — confirming verbally that critical information has been received and understood. The diagnosis of the first U.S. case is not the sign that we need to shut patients out. It’s the sign that we need to bring more help in. The Ebola epidemic is stoppable." Atul Gawande in The New Yorker.

SZABO: Ebola risks in perspective. "Is it possible that we will see more cases of Ebola, either in contacts of the Dallas patient or in additional travelers who fly here from abroad? Yes. But the USA has safely treated five people with Ebola-like viruses without any mass outbreak. These deadly viruses were here, in the USA, unbeknownst to most of us, and we all survived just fine....The Ebola epidemic is heartbreaking. I've covered it for months, hoping that my stories will move people to help. Many reputable charities have been on the scene in West Africa since the first days of the outbreak in March. Americans who are concerned about Ebola should consider making a donation. People might also want to consider protecting themselves from diseases that pose far greater risks in the USA. Half of Americans skip the flu shot, even though influenza kills up to 49,000 Americans a year." Liz Szabo in USA Today.

Top opinion

SLAUGHTER: The free-trade way to job growth. "America needs more high-wage jobs—and in a report being released Thursday I explain why such jobs are often connected to international trade. Pro-trade policies could create 10 million new high-paying trade-connected jobs in the U.S. over the next decade. Research by Andrew B. Bernard at Dartmouth and J. Bradford Jensen at Georgetown, as well as my own, has long documented that workers at globally engaged companies tend to earn more than workers at purely domestic companies: about 15%-20% more in companies that export or import, and about 25%-30% more in multinationals. At least in manufacturing, trade also boosts incomes progressively." Matthew J. Slaughter in The Wall Street Journal.

ISAAC AND PINTO: Creating more homeowners without building a crisis. "Sales of existing homes in August were down 5.3% year-over-year. The housing lobby says credit is too tight. The commissioner of the Federal Housing Administration and the director of the Federal Housing Finance Agency (regulator of Fannie Mae and Freddie Mac ) have called for lenders to further loosen lending standards. While the housing market needs a shot in the arm, the financial crisis in 2008 taught us the extreme danger that loose lending standards—poor underwriting, risky loans and government-backed credit expansion — pose to homeowners and the economy. We think there is another way." William M. Isaac and Edward Pinto in The Wall Street Journal.

WEISSMANN: Why can't states do more to protect patients from surprise medical bill? "In a sane health care system, this wouldn’t happen. But in the U.S., it can and does. Americans regularly visit doctors’ practices and hospitals that accept their insurance, only to find themselves ambushed by surprise medical bills from out-of-network physicians who somehow played a role in their treatment, as Elisabeth Rosenthal’s recent reporting in the New York Times has detailed. It happens in operating rooms and emergency rooms. And there’s not much that patients can do about it. But can’t lawmakers do something about it?" Jordan Weissmann in Slate.

YGLESIAS: Inequality really is rising. "The bottom line is that while there is lots of room for arguing about the details of data selection, the conclusion that inequality is growing is not an eccentric discovery made by two French economists working with a particular source of income data. The broad trend is clear from a diverse set of data. Median household income growth has badly lagged per capita GDP growth, corporate profits as a share of national income have risen, and stock markets have reached record highs....If you think that America is slipping into a doom loop of oligarchy then naturally you will want to dramatize the trend. Tcherneva's chart does that very well, which is exactly why it's so controversial." Matthew Yglesias in Vox.

BLOOMBERG VIEW: Doubt climate change? Then support a carbon tax. A series of editorials.The Editors.

GoPro interlude: How people really use their GoPros.

2. Happy Jobs Friday!

5 mysteries of the job market waiting to be solved. "How many people who have stopped looking for work — or never started — will start looking if the economy improves further?...What's happened to 3.8 million people who had been unemployed for over six months but no longer are?...What does it mean that so many people — 7.3 million — who want full-time jobs can find only part-time work?...Companies are advertising lots more jobs. So why aren't they filling more of them?...Why has job growth fallen for women?" Christopher S. Rugaber in the Associated Press.

Survey: Upward trek in job creation continued in September. Justin McCarthy in Gallup.

Explainer: A guide to Jobs Friday. Lorraine Woellert in Bloomberg.

Something else worth keeping an eye on: wages. "Federal Reserve officials have said they believe wages will steadily rise as the labor market firms up and returns to 'normal.' Other data suggest that might be happening — hires and job openings are climbing....One reason for tepid wage growth is the mix of jobs being added during the recovery — many are temp jobs or in lower-paying sectors such as retail and leisure and hospitality. A pickup in other sectors such as construction and manufacturing could hint at sturdier underlying growth in the economy. Manufacturing employment was unchanged in August, and Wednesday’s report from the industry’s Institute for Supply Management suggested job creation in the sector slowed considerably last month." Josh Mitchell in The Wall Street Journal.

Looking ahead: Jobless claims down unexpectedly. "The number of Americans filing new claims for unemployment benefits unexpectedly fell last week, a sign the labor market may be tightening. Still, other data on Thursday showed weaker factory orders in August even after stripping out volatile transportation figures....The claims data will have no bearing on Friday's government report on monthly employment during September because the hiring survey was conducted earlier in the month....A separate report from the Commerce Department showed new orders for U.S. factory goods posted their biggest decline on record in August, although the 10.1 percent drop was payback for an aircraft-driven jump a month earlier." Jason Lange in Reuters.

Mark your calendars: Lew, Lagarde, Videgaray will debate America's economic outlook on Wednesday, Oct. 8. Matthew Bristow in Bloomberg.

Consumer confidence down to four-month low. "The Bloomberg Consumer Comfort Index declined to 34.8 in the period ended Sept. 28, the lowest reading since May 25, from 35.5. Views of the economy were also the weakest in four months, and the personal finances gauge dropped to its lowest reading since early August. The recent setback in sentiment has been concentrated among lower-income households, underscoring the need for faster wage gains as the labor market recovers. Last week’s drop in confidence capped the strongest quarter since the recession, indicating consumers see halting progress in the economy." Danielle Trubow in Bloomberg.

Does unemployment hurt society more than modest inflation? "Unemployment is much more damaging to society than moderate levels of inflation, making central bankers’ disproportionate focus on the level of consumer price growth misguided, a former Bank of England rate-setter now at Dartmouth College writes in a new paper. Along with three co-authors, David Blanchflower, known for his view that policy makers should make aggressive efforts to bring down unemployment, tries an unusual statistical tack for macroeconomist — he tries to break down happiness surveys of European individuals to see just how deeply, and differently, they are affected by unemployment and inflation, respectively." Pedro Nicolaci da Costa in The Wall Street Journal.

As Fed ratchets back stimulus, other central banks ratchet up theirs — at expense of Americans. "The Obama administration and the Federal Reserve have watched quietly in recent years as foreign governments and central banks have chipped away at the dollar value of their currencies, strengthening their export industries in the hope of stimulating their economies. The trend is likely to intensify over the next year as the Fed retreats from its own stimulus campaign while the European Central Bank and the Bank of Japan expand their efforts. Mario Draghi, the head of the European Central Bank, said on Thursday that it would begin a new round of bond purchases this month." Binyamin Appelbaum, Jack Ewing and Neil Gough in The New York Times.

Fed to release new labor-market gauge. "The LCMI is a composite that draws on 19 indicators, from broad measures like the unemployment rate itself to narrower indicators like surveys of business hiring plans. The aim is to produce a single measure to gauge whether labor markets are on the whole improving or not....Much of the recent debate at the Fed has centered around whether single indicators...give an accurate picture of the state of the labor market. Though the unemployment rate has been falling, for example, wages have remained fairly stagnant, leaving many officials at the U.S. central bank convinced that labor markets remain slack." Howard Schneider in Reuters.

Workers in part-time limbo point to slack. "Forty-nine percent of people working less than 35 hours a week in 2012 and desiring full-time work were able to find such a position within a year, according to research by the Federal Reserve Bank of Atlanta. That’s down from 61 percent in 2006. In addition, the almost 3 million Americans unemployed for at least 27 weeks are more likely to accept part-time jobs than counterparts out of work for shorter periods, according to a Chicago Fed paper. That means underemployment, a hallmark of the slow and uneven recovery from the recession, won’t quickly dissipate, backing policy makers such as New York Fed President William C. Dudley who counsel patience in removing stimulus." Jeanna Smialek in Bloomberg.

Other economic/financial reads:

Falling energy prices point to weakening global economy. Henning Gloystein in Reuters.

"Earnings stripping": The next tax-dodging strategy in Obama's crosshairs? Emily Stephenson in Reuters.

Millennials don't like big banks. That could disrupt the financial world. Nancy Cook in National Journal.

Romantic interlude: A long-distance surprise marriage proposal.

3. Supreme Court starts to load up its docket for a new term

No same-sex marriage case for now, but SCOTUS takes up hot-button housing and discrimination cases... "The Supreme Court granted 11 new cases for review Thursday, agreeing to rule on controversial topics such as housing discrimination, religious freedom, child abuse, immigration, congressional redistricting and campaign fund-raising by judicial candidates. While they delayed any decision on same-sex marriage, the justices filled out their docket through January and into February with civil rights cases and others likely to command attention." Richard Wolf in USA Today.

The housing case could be a biggie. "The justices today said they will hear an appeal from Texas officials sued under the U.S. Fair Housing Act over tax credits for low-income building projects. The question is whether people can sue by showing a practice had a 'disparate impact' on racial minorities, or whether they must meet a higher standard by proving intentional bias. The court will consider jettisoning the disparate-impact theory, which has helped the Obama administration get hundreds of millions of dollars in fair-lending settlements....The court has twice before granted review on the issue, only to have settlements scuttle the case. President Barack Obama’s administration and civil rights advocates have sought to steer the issue away from the Supreme Court." Greg Stohr in Bloomberg.

Long read: How SCOTUS could scuttle fair-housing rule. Nikole Hannah-Jones in ProPublica.

...and plenty of touchy political matters. "The court agreed Thursday to decide whether state legislatures can be removed from the process of drawing congressional lines, as was done by voter initiative in Arizona. Republicans there want that power back. Already scheduled for oral argument in November is another case in which Democrats and black state legislators in Alabama claim the GOP-controlled Legislature drew district lines that intentionally packed African Americans into some districts, so others would be more accommodating to Republicans. Both of those cases came to the court on direct appeal, rather than through the normal petition process — meaning the justices had little choice but to get involved." Richard Wolf in USA Today.

One such touchy matter that some want court to review now: Wisconsin voter ID. "Opponents of Wisconsin's voter photo identification law asked the U.S. Supreme Court on Thursday to take emergency action and block the requirement ahead of the Nov. 4 election, arguing there isn't enough time to implement the new rules. The request comes less than five weeks before an election involving the closely watched race between Republican Gov. Scott Walker, who supports the law, and Democratic challenger Mary Burke. State elections officials have been scrambling to prepare since the 7th U.S. Circuit Court of Appeals ruled last month that the law should be in effect while the court considers the latest legal challenge." Scott Bauer in the Associated Press.

After silence on same-sex marriage, now what? "So, after the silence on Thursday, the focus now turns to Monday. The new list of orders, mostly denials, will emerge first and, before the end of the day, the Court will indicate whether it is rescheduling the same-sex marriage cases for another look, at a private Conference set for next Friday morning. After that Conference, it is expected, any orders granting new cases probably will not be publicly announced until the following Tuesday, October 14 (after a federal holiday the day before). But, even after a second look, there would still be no guarantee that the Justices were ready to grant review." Lyle Denniston in SCOTUSblog.

Charts: Is support for gay marriage dropping? Don't count on it. Robert P. Jones and Daniel Cox in The Atlantic.

Why the court probably will take up same-sex marriage at some point. "Those who study the court and even the lawyers making the requests have said they expect that it could be weeks or months before the justices decide whether to hear the issue....If the court accepts the question, it has to then decide which of the cases provides the best vehicle for a decision....The justices could also simply let the appeals court decisions stand, although that is considered unlikely. The Supreme Court has not allowed marriages authorized by those rulings to take place, indicating justices want to have a say in the matter." Robert Barnes in The Washington Post.

Helping hand interlude: Elephant helps up baby elephant at the zoo.

4. The close linkage between birth-control policies and abortion

Want to reduce teen pregnancy and abortion? Start with long-term birth control. "Earlier this week, an influential pediatrics group offered a pretty significant new recommendation: that teenagers use long-acting contraceptives, like intrauterine devices and hormone implants, as the 'first line' of defense in preventing pregnancy pregnancy. And a new study released Wednesday night helps illustrate why the physicians group offered its endorsement. Teenage girls who were offered these types of contraceptives at no cost were significantly much more likely to use them, and they had substantially lower rates of pregnancy, birth and abortion when compared to U.S. teens, according to the study." Jason Millman in The Washington Post.

Chart: Pregnancy, abortion rates drop with free birth control. Sarah Kliff in Vox.

Not all forms of birth control work the same. "The most effective choices turned out to be the hormone implant and the copper IUD, both of which had perfect records over a combined 690.6 teen-years of use. As for the others: The hormone-releasing IUD had 5.1 failures per 1,000 teen-years of use; The hormone injections resulted in 5.2 failures per 1,000 teen-years of use; The contraceptive ring produced 51.8 failures per 1,000 teen-years of use; Birth control pills resulted in 56.8 failures per 1,000 teen-years of use; and The transdermal patch had 60.8 failures per 1,000 teen-years of use." Karen Kaplan in the Los Angeles Times.

The policy angle: The ACA impact. "The Affordable Care Act, which generally guarantees coverage for all forms of contraception with no co-pay, makes providing teenagers with free, long-acting contraceptives more achievable, social policy experts said. But there are practical obstacles. Many pediatricians are not trained to insert implants or IUDs. Isabel Sawhill, a senior fellow at the Brookings Institution, noted that insurance provided low rates for counseling, which could affect some doctors’ willingness to spend time doing it. And the idea that doctors should recommend long-acting contraception to teenagers is almost certain to inflame the political and cultural debate." Pam Belluck in The New York Times.

Republicans face a contraception puzzle. "Republican candidates are hoping to do a better job of appealing to women voters....To make inroads, the party has tried out a variety of talking points. Recent calls for better access to contraceptives are not among the more convincing....It's not as simple as a change of heart: Gardner continues to cosponsor federal legislation that's very similar to the state legislation he's denounced....Republicans do truly appear to be doing something new in openly embracing certain forms of, and ways of accessing, contraception. Could it be they're open to some kind of grand bipartisan compromise? Dan Grossman, a doctor and spokesman with the American Congress of Obstetricians and Gynecologists, isn't so sure." Lucia Graves in National Journal.

Appeals court decision will close all but 7 abortion clinics in Texas. "The ruling by a three-judge panel of the U.S. 5th Circuit Court of Appeals stays a lower judge's ruling and allows Texas to put into effect restrictions that were part of its abortion law passed last year and pushed by Republican Gov. Rick Perry....The decision follows a ruling in August by U.S. District Judge Lee Yeakel that part of the Texas law requiring clinics to spend millions on hospital upgrades was aimed at making access to abortions more difficult rather than ensuring patient safety. Texas has appealed that decision." William M. Welch in USA Today.

Related: Alabama law putting teens on trial for abortion fought. Andrew Harris in Bloomberg.

Why American babies die: Part of it stems from reporting differences. "New research, in a draft paper...offers up some clues. They note that the infant mortality gap between the U.S. and other wealthy nations has been persistent — and is poorly understood. One factor, according to the paper: 'Extremely preterm births recorded in some places may be considered a miscarriage or still birth in other countries. Since survival before 22 weeks or under 500 grams is very rare, categorizing these births as live births will inflate reported infant mortality rates (which are reported as a share of live births).' Oster and her colleagues found that this reporting difference accounts for up to 40 percent of the U.S. infant mortality disadvantage relative to Austria and Finland. This is somewhat heartening." Christopher Ingraham in The Washington Post.

Poverty is also killing American babies. "The US currently ranks 56th internationally when it comes to infant mortality. We're doing worse than just about every other rich country, and a bunch of non-rich ones too. Cuba, Poland, Bosnia, and Serbia are beating us, for example. Explanations for this vary*, and a new working paper by USC's Alice Chen, MIT's Heidi Williams, and University of Chicago's Emily Oster provides a nice overview of them. But the paper's most striking finding isn't about the precise causes of the mortality gap between the US and peer countries. It's about who bears the cost of that gap" Dylan Matthews in Vox.

Earlier this week: The recession's baby bust. "There’s a reason why 'boom times' and 'baby boom' both contain an onomatopoeic signifier of the procreative act. In developed countries, fertility rates tend to go up and down with GDP. What does that mean in real terms? A study published Monday in the Proceedings of the National Academy of Sciences by Princeton researchers Janet Currie and Hannes Schwandt quantifies just how many fewer babies were born because of the Great Recession. Their answer: at least a half a million." Olga Khazan in The Atlantic.

Other health care reads:

Insurers poised to cancel health plans that don’t comply with Affordable Care Act. Julie Appleby in Kaiser Health News and The Washington Post.

Financial ties between doctors, health care firms revealed. Katie Thomas and Rachel Abrams in The New York Times.

Medicare fines record number of hospitals for excessive readmissions. Jordan Rau in Kaiser Health News and NPR.

Caught on video interlude: Amazing drone footage above Iceland volcano.

Wonkblog roundup

How hard is it to refinance? Just ask Ben Bernanke. Dina ElBoghdady.

Digital health firms are raising a ton of money in the Obamacare era. Jason Millman.

Oil prices are falling — and that’s good for the U.S. and bad for Russia. Steven Mufson.

Can Europe’s mini-QE save it from a lost decade? Matt O'Brien.

Americans have no idea how the government spends money. Christopher Ingraham.

Global economic growth keeps getting downgraded. Ylan Q. Mui.

Want to do what you love and get paid for it? Choose one of these majors. Christopher Ingraham.

Want to reduce teen pregnancy and abortion? Start with long-term birth control. Jason Millman.

Malaysia’s rubber glove industry could see profits in the Ebola outbreak. Ylan Q. Mui.

4.4 billion people around the world still don’t have Internet. Here’s where they live. Roberto A. Ferdman.

The share of Americans driving to work is declining for the first time in decades. Emily Badger.

Et Cetera

Clean-energy spending at $175 billion globally on Chinese rise. Justin Doom in Bloomberg.

Oil prices continue their decline. Stanley Reed in The New York Times.

Next Secret Service chief faces uphill climb. Andrew Grossman in The Wall Street Journal.

President Obama to Hispanic lawmakers: Executive action on immigration before year’s end. Seung Min Kim in Politico.

Push for new tax math seen if Republicans win control of Congress. Kevin Drawbaugh and Richard Cowan in Reuters.

Firms urge FDA to adopt e-cig rules quickly. Duane D. Stanford and Anna Edney in Bloomberg.

In effort to end veteran homelessness by 2015, this $270M doesn't hurt. Emily Wax-Thibodeaux in The Washington Post.

Got tips, additions, or comments? E-mail us.

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