Biden Presidency: Wins and Pinches

It’s time to evaluate the Biden presidency.

Economics

1 Reduced quarterly inflation rate (CPI) from peak 8.6% in 2Q, 2022 to 2.7% in 4Q, 2024.
2 Doubled the federal budget deficit from $0.75T to $1.5T per year.
3 Inflation grew to 9%, partly reflecting excess government spending initiated by the president.
4 Added 15M jobs; added jobs every month!!!!!!!
5 Cut the Black unemployment rate from 10.0% to 6.1%. Cut the Hispanic unemployment rate from 9.3% to 5.1%.
6 Increased per capita real disposable income by 5.6%.
7 Increased prime age labor force participation to near record 83.9%, last seen in 2001.
8 Reached pre-Covid employment in 28 months. Great Recession recovery took 3 times as long (77 months).
9 Real wages grew significantly in each year.
10 Record low unemployment rates quickly achieved and maintained after pandemic.
11 Reduced unemployment rate from starting 6.7% to 3.7% average for 2022-24. Pre-Covid 2017-19 was 4.0%.
12 Increased real GDP by $2.8T, 13.1% total, 3.2% annual. Trump pre-Covid gain was $1.7T, 2.8% annual.
13 Bloomberg reported a 26% increase in net household wealth between December 2020 and 2024.
14 Increased household wealth by 20%.
15 Recorded 24% increase in median home sales price from December 2020 to 2024.
16 Stockmarket value increased by 50% from December 2020 to 2024, building upon 50%+ rise in prior 4 years.

Outstanding economic results. The majority of inflation was due to pandemic and supply chain issues. Nonetheless, the growing budget deficits were an “own goal” that should have been avoided for economic and political reasons.

Governing

17 Appointed record number of federal judges, including record share of women and minority judges.
18 Postal Service Reform Act – reset reasonable debts, compensation and service levels.
19 Misevaluated and misresponded to declining personal health risks.
20 Democratic party exceeded expectations in 2022 midterm elections.
21 Negotiated spending limits in order to increase debt ceiling and avoid government shutdown.
22 Failed to overhaul Democratic party position as leaders of states and cities.
23 Failed to take advantage of the January 6, 2021 insurrection to remove Trump from politics.
24 Oversaw continued weakening of Democratic Party appeal to working class, minorities, men and independents.
25 Oversaw continued weakening of Democratic Party power, brand and results.
26 Promised to govern for all of the people but slipped into anti-MAGA politics.
27 Ran for second term and failed to withdraw in time for the party to field an effective platform and candidate.
28 Republicans were able to make DEI and wokeness a winning issue at all levels, without counter-leadership.
29 Unable to offer a new framework to reset politics outside of the win/lose polarization approach.
30 Increased IRS budget to reduce tax evasion and increase revenues.
31 Inflation Reduction Act – set minimum 15% corporate tax rate.
32 Electoral Count Reform Act – clarify presidential election processes.
33 Speech and legislation on threats to democracy, voting rights.
34 Support Voting Rights and Freedom to Vote legislation, enforced laws, opposed new state restrictions.
35 President and Democrats were unable to make progress on voting reforms despite opportunities.
36 American Rescue Plan – extra funding to cut child poverty in half.
37 Increased Pell Grant funding for lower income college attendees.
38 PACT Act – covers veterans exposure to toxic chemicals.
39 Provided new or lower cost internet access to 5M.
40 Provided student loan debt relief to 5 million borrowers.
41 American Rescue Plan – reduced medical insurance premiums

Some “good government” initiatives and results. Biden was unable to address the basic challenges of polarization, skepticism, social media, rule of law and personal integrity. He was elected as a “placeholder” to avoid Trump in 2020 and filled the “placeholder” role. He was unable to reframe the debates.

Public Health

42 Inflation Reduction Act – allows Medicare to negotiate top 10 drug prices,
43 Inflation Reduction Act – capped annual drug costs, reduces insurance costs
44 Negotiated agreement with pharmaceutical companies to reduce drug prices.
45 Doubled number enrolled in Affordable Health Care from 12M to 25M. 8% uninsured is record low.
46 Inflation Reduction Act – increases Affordable Care Act access to medical insurance.
47 American Rescue Plan – 500M covid vaccinations
48 American Rescue Plan – funding for individuals, businesses, governments and NFPs to survive pandemic.
49 Management of Covid-19 pandemic health care, communications and economic recovery strategy.
50 Failed to capitalize on his pandemic recovery and economic successes in the public eye.
51 Some pandemic decisions were overly restrictive, not based upon science, cost/benefit or value of freedoms.
52 Legislative, funding and regulatory changes to energize the Cancer Moonshot initiatives.
53 Rejoined the World Health Organization.

The pandemic mitigation and recovery should have been celebrated as a once in a century victory for the American people, science, business and government. And for the world! The results were amazing, if imperfect. Biden’s team was unable to stake out the high ground and frame the real results in this manner, allowing partisan politics to infect and undermine even this situation.

International Relations

54 Created QUAD security relations with Australia, India and Japan.
55 Facilitated improved relations between Japan and South Korea.
56 Increased support from citizens and leaders in NATO nations to the US.
57 Recommitted the US to NATO, encouraged defense investments, welcomed Finland and Sweden.
58 Signed AUKUS deal with the United Kingdom and Australia for Indo-Pacific security.
59 Unable to renegotiate new bargain with allies to pay for US defense, police, trade, shipping, legal umbrella.
60 Was unable to delivered principle leadership for the liberal international model on trade and global affairs.
61 Failed to reset US-China relations despite shared interests in global commerce, climate, security and health.
62 Supported Trump’s anti-free trade and anti-China actions without proposing effective alternatives.
63 Reduced US reliance of Chinese imports by 10%, increased US exports to China by 15%.
64 US dollar increased in value by 15%.
65 US inbound foreign investment averaged twice as high from 2021-24 versus 2020.
66 US outperformed other nations in achieiving pre-Covid levels of GDP and employment.
67 US stocks increased in value by 50%, more than in other markets.
68 Supported the bipartisan 2024 immigration reform bill that was rejected by candidate Trump and Republicans
69 Failed to take emergency action to secure the US-Mexico border, protect and process immigrants.
70 Responsible for 3 years of 175,000 monthly migrant apprehensions versus 25,000 baseline.
71 Ended Afghanistan war within negotiated plan.
72 Protected the US from terrorist attacks, authorized surgical anti-terrorist attacks.
73 Recorded zero domestic deaths from international terrorist activities during 2021-24.
74 Support for Israel after Hamas attack, ceasefires, prisoner exchanges and hostage releases.
75 Afghanistan withdrawal was poorly planned and executed, costing lives, equipment and US stature.
76 Hamas attacked Israel, killing 1,200 citizens and taking 300 hostages, confident of Israel/US limits.
77 Israel invasion of Gaza has continued without resolution, highlighting the US’s lack of influence/leadership.
78 Economic, intelligence and military support to Ukraine, which has stopped Russia’s invasion progress.
79 US and allies imposed sanctions on Russia for Ukraine war.
80 Russia invaded Ukraine, confident that the US and allies would not respond effectively.
81 Russia’s invasion of Ukraine has continued, without effective opposition or a negotiated solution.

Biden was able to mend relations with our allies and improve the strength of these alliances and the global power of the US economy. His team fumbled the Afghanistan withdrawal, failed to prevent the Russian and Hamas invasions and was unable to drive these situations to better solutions. US power has been undermined by these failures. The spike in illegal immigrants also portrayed the US and the Biden administration as a weak protector of our essential interests.

Resources

82 Inflation Reduction Act – $369B clean/green energy investment incentives.
83 Invested in wind, solar, battery and electical vehicle technologies.
84 US increased position as world’s largest oil producer and LNG exporter.
85 Expanded the US portfolio of national monuments.
86 Invested $4B in superfund environmental cleanup.
87 Rejoined Paris Agreement to address climate change.
88 Infrastructure Investment and Jobs Act – $1.2T.
89 New investments in domestic manufacturing, adding 750,000 jobs.
90 CHIPS and Science Act – incentives for domestic semi-conductor production.
91 Executive order on Artificial Intelligence outlines potential risks.

Big wins in managing energy, infrastructure and the environment.

Social Issues

92 20% reduction in violent crime rate after pandemic increases.
93 Renewed the Violence Against Women Act.
94 Repositioned marijuana classified substance rating, reduced federal criminal enforcement.
95 Respect for Marriage Act – required states to recognize the decisions of other states.
96 Responded to Supreme Court reversal of Roe v. Wade with Executive Orders on reproductive health services.
97 Revised asylum seeker options, added green card options for spouses of US citizens.
98 Safer Communities Act – gun controls, screenings, red flags.

Some small wins for the left.

Wins and Pinches

3 wins for every pinch! A decent number of achievements for a one-term president in a very polarized age.

Overall

Public Health A

Economy A-

Resources B+

International C+

Social Issues C

Govern/Politics C-

Biden did an outstanding job on the “blocking and tackling” in a very difficult situation. He “treaded water” in the international arena. He did not advance liberal social causes effectively. He failed to effectively address the Trump/populist threat to our democracy. For this, the overall grade is a D. 😦

Left, Right and Center

Biden was a moderate. He only tilted far left on 4 of the 98 items. Student loan relief was for the university crowd. The failure to address border security administratively was due to minority and progressive politics. Doubling the budget deficit undercut 30 years of Democratic Party “fiscal discipline” following Clinton’s “third way”. Not trying to reposition Democratic politics as centrist, moderate, adult, opportunity, American, scientific, effective, growing, universal, creative, tolerant, professional, metropolitan, ecumenical, big tent, majority, community, emerging, aspirational, progressive, etc. for fear of displeasing the postmodernist crowd and/or special interests was a huge lost opportunity in a time that called for leadership.

His greatest success was in managing the pandemic threat and growing the economy. He managed crime and terrorists. He enhanced American global power. He was a moderate president, just like Obama and Clinton.

Trump

I’m not a fan of Trump. His first term delivered more results than expected, but his existential threat to our system was already very clear.

Modern History Index

257 items pulled from all arenas of life. Technology dominates, especially in the last century.

Grouping events into 40-year blocks shows 1940-79 as twice as dynamic as other eras.

1450 – 1779 20

1780 – 1819 12

1820 – 1859 16

1860 – 1899 31

1900 – 1939 47

1940 – 1979 99

1980 – 2025 32

Modern History: Biology and Life

1676 – Microscopic World

https://en.wikipedia.org/wiki/Antonie_van_Leeuwenhoek

1846 – Anesthesia / Modern Surgery

https://en.wikipedia.org/wiki/Anesthesia

https://en.wikipedia.org/wiki/Surgery

1859 – Darwin’s Theory of Evolution

https://en.wikipedia.org/wiki/On_the_Origin_of_Species

1865 – Germ Theory of Disease / Public Health

https://en.wikipedia.org/wiki/Germ_theory_of_disease

https://en.wikipedia.org/wiki/Louis_Pasteur

1896 – Psychoanalysis

https://en.wikipedia.org/wiki/Louis_Pasteur

1918 – Spanish Flu

https://en.wikipedia.org/wiki/Spanish_flu

1928 – Penicillin

https://en.wikipedia.org/wiki/Penicillin

1943 – Modern Drug Development

https://en.wikipedia.org/wiki/Streptomycin

1953 – Structure of DNA – Watson & Crick

https://en.wikipedia.org/wiki/History_of_molecular_biology

1956 – https://en.wikipedia.org/wiki/Chemotherapy

1959 – Horizontal Gene Transfer described as complement to evolution

https://en.wikipedia.org/wiki/Horizontal_gene_transfer

1959 – Modern Synthesis of Evolution and Genetics – Mayr

https://en.wikipedia.org/wiki/Modern_synthesis_(20th_century)

1960 – Oral Contraceptive Pill

https://en.wikipedia.org/wiki/Oral_contraceptive_pill

1961 – Antibiotic Resistant Bacteria – public health concern

https://en.wikipedia.org/wiki/Methicillin-resistant_Staphylococcus_aureus

https://en.wikipedia.org/wiki/Antimicrobial_resistance

1963 – Mood Altering Drugs (legal)

https://en.wikipedia.org/wiki/Diazepam

1965 – Medicare Program

https://en.wikipedia.org/wiki/Medicare_(United_States)

1965 – US Life Expectancy Reaches 70

https://www.ssa.gov/OACT/TR/TR02/lr5A3-h.html

1967 – Heart Transplant

https://en.wikipedia.org/wiki/Heart_transplantation

1970 – Magnetic Resonance Imaging Scanner

https://en.wikipedia.org/wiki/Magnetic_resonance_imaging

1973 – Biotechnology / Recombinant DNA

https://en.wikipedia.org/wiki/Recombinant_DNA

1978 – IVF conception

https://en.wikipedia.org/wiki/In_vitro_fertilisation

1980 – Smallpox Eradicated

https://en.wikipedia.org/wiki/Smallpox

1981 – HIV/AIDS new disease and treatments

https://en.wikipedia.org/wiki/HIV/AIDS

1996 – Cloned Mammal

https://en.wikipedia.org/wiki/Dolly_(sheep)

1997 – Global Warming

https://en.wikipedia.org/wiki/Kyoto_Protocol

2003 – Human Genome Project

https://en.wikipedia.org/wiki/Human_Genome_Project

2010 – Affordable Care Act

https://en.wikipedia.org/wiki/Affordable_Care_Act

2012 – Designer Genes Possible

https://en.wikipedia.org/wiki/CRISPR_gene_editing

2019 – Covid Pandemic

https://en.wikipedia.org/wiki/COVID-19_pandemic

Summary

Microbiology, DNA, biochemistry. Miracles.

Our Hamilton County: 40 Weekend Hikes

https://www.arcofappalachia.org/highlands-nature-sanctuary/

Hamilton County is in the middle of the Wisconsin glaciated till plains region. The nearby landscape is relatively flat and contains a limited number of state parks, forests or nature preserves. Yet, for the weekend hiker willing to drive 1-3 hours away, the hiking options are unlimited. The 3-hour radius extends far into Ohio, Michigan, Illinois and Kentucky. Think of Chicago, Bloomington, IL, Champaign-Urbana, IL, Vandalia, IL, Terre Haute, Evansville, Owensboro, KY, Louisville, Elizabethtown, KY, Frakfort, Lexington, Cincinnati, Hillsboro, OH, Columbus, Dayton, Fort Wayne, Findlay, OH, Toledo, Coldwater, MI, Kalamazoo, South Bend, and South Haven, MI.

A 3-hour driving radius covers 100,000 square miles and 200 counties. Indiana is the 38th largest state with 36,000 square miles, so we cover almost 3 Indiana’s. This is equal to the combined land area of Michigan and Ohio or the combined land area of Illinois and Kentucky! Indianapolis is deemed the “Crossroads of America” due to its central location and direct access to national highways in all 8 directions away from the city. Chicago, Peoria, St. Louis, Evansville, Louisville, Cincinnati, Columbus and Lansing. US 31 provides a ninth limited access highway north to South Bend and Grand Rapids. The abundance of highways offers 3-hour access up to 210 miles away.

During the pandemic I hiked in all 200 counties within 3 hours of Hamilton County. I summarized the top 40 hikes in 3 blog posts based upon distance away and an extra one for honorable mentions. Let’s organize them below based upon their primary attraction for hikers.

Forests (6)

Hoosier National Forest / Pioneer Mothers Memorial Forest (121 S)

Great Seal State Park (205 SE) Ohio

Morgan-Monroe State Forest (61 S)

Jackson-Washington State Forest (93 S)

John James Audubon State Park (196 SW) Kentucky

Lawrence Woods State Nature Preserve (184 NE) Ohio

https://www.fs.usda.gov/detailfull/hoosier/about-forest/?cid=fsbdev3_017499

https://www.greatsealstatepark.com/

https://www.in.gov/dnr/forestry/properties/morgan-monroe-state-forest/

https://stateparks.com/jackson-washington_state_forest_in_indiana.html

https://parks.ky.gov/parks/find-a-park/john-james-audubon-state-park-7815

https://ohiodnr.gov/go-and-do/plan-a-visit/find-a-property/lawrence-woods-state-nature-preserve

Hills and Streams (6)

Spring Mill State Park (90 S)

Clifton Gorge State Nature Preserve (144 E) Ohio

Cedar Line Nature Preserve (151 SE) Kentucky

McCloud Nature Park (40 W)

Versailles State Park (75 SE)

Portland Arch Nature Preserve (80 W)

https://ohiodnr.gov/go-and-do/plan-a-visit/find-a-property/clifton-gorge-state-nature-preserve

https://pendletoncounty.ky.gov/Pages/CedarLineNaturePreserve.aspx

https://www.visithendrickscounty.com/listings/mccloud-nature-park/186/

https://www.in.gov/dnr/state-parks/parks-lakes/versailles-state-park/

https://www.nature.org/en-us/get-involved/how-to-help/places-we-protect/portland-arch-1/

Waterfalls (6)

Clifty Falls State Park (90 SE)

Charleston Falls Preserve (122 E) Ohio

Cove Spring Park (186 SE) Kentucky

Highlands Nature Sanctuary (196 SE) Ohio

Hoosier National Forest – Yellow Birch Ravine (142 S)

Williamsport Falls (83 NW)

https://www.miamicountyparks.com/parks/charleston

https://www.frankfort.ky.gov/751/Cove-Spring-Park

https://www.arcofappalachia.org/highlands-nature-sanctuary

https://www.hoosierhiking.com/the-blog/yellow-birch-ravine-nature-preserve

https://en.wikipedia.org/wiki/Williamsport_Falls

Rivers (4)

Devou Park (138 SE) Ohio

Harmonie State Park (206 SW)

Battelle Darby Creek Metro Reserve (175 E) Ohio

Providence Metro Park (186 NE) Ohio

https://www.exploredevoupark.org/

https://www.in.gov/dnr/state-parks/parks-lakes/harmonie-state-park/

https://metroparkstoledo.com/explore-your-parks/providence-metropark/

Lakes (2)

Patoka Lake (142 S)

Pokagon State Park (158 NE)

https://www.in.gov/dnr/state-parks/parks-lakes/patoka-lake/

Prairie/Flatlands (5)

Hooper Branch Savannah (125 NW) Illinois

Kickapoo State Recreation Area (100 NW) Illinois

Midewin National Tallgrass Prairie (176 NW) Illinois

Ouabache State Park (110 NE)

Pumpkinvine Trail (150 N)

https://dnr.illinois.gov/inpc/area.area3iroquoishooperbranchsavanna.html

https://dnr.illinois.gov/parks/park.kickapoo.html

https://www.fs.usda.gov/midewin

https://www.in.gov/dnr/state-parks/parks-lakes/ouabache-state-park/

Nature Preserves/Small Gems (5)

Ott Biological Preserve (205 NE) Michigan

Spicer Lake (143 N)

Gallagher Fen Nature Preserve (147 E) Ohio

France Park (80 N)

Calli Nature Preserve (70 SE)

https://www.calhouncountymi.gov/departments/parks/ott_biological_preserve.php

http://www.sjcparks.org/591/Spicer-Lake

https://ohiodnr.gov/go-and-do/plan-a-visit/find-a-property/gallagher-fen-state-nature-preserve

https://www.co.cass.in.us/departments/e-i/france-park/home

Arboretums (6)

Allerton Park (150 W) Illinois

Gabis Arboretum (146 NW)

Bernheim Arboretum and Forest (157 S) Kentucky

Boone County Arboretum (130 SE) Ohio

Yew Dell Botanical Garden (144 S) Kentucky

Pyramid Hill Sculpture Park (115 SE) Ohio

https://bcarboretum.org/

https://www.pyramidhill.org/

Our Hamilton County: Cost of Living

https://www.firstib.com/about-us/new-headquarters/

Metro Indy Cost of Living is 7% Below Average

https://www.stats.indiana.edu/about/coli.asp

https://www.bankrate.com/real-estate/cost-of-living-calculator/

In general, Hamilton County’s costs are similar to those of the Indy metro area. It’s 357,000 residents account for just 17% (1 in 6) of the formal Indy metro area’s 2,075,000.

Solid county level data is not available for all areas, but limited comparisons helped to identify goods and services that might differ between Hamilton County and the Indy average.

https://www.bestplaces.net/cost_of_living/county/indiana/hamilton

https://www.epi.org/resources/budget/?gclid=Cj0KCQjwxuCnBhDLARIsAB-cq1rnk521GaWh6Evp4LUs2TaA2Tgx_oufafn9ywPIV32tpToZ0f0FVpwaAhnMEALw_wcB

Housing

Hamilton County’s housing is 8% more expensive than the national average rather than 15-17% lower as seen in metro Indianapolis. The housing stock is also newer, larger and higher quality. The full housing price difference would increase the total cost of living measure by 7%. Considering one-half being due to age/quality and one-half due to prices adds 3.5% to 93.1% to yield a revised 96.6% cost of living ratio.

https://www.towncharts.com/Indiana/Housing/Marion-County-IN-Housing-data.html

https://www.towncharts.com/Indiana/Housing/Hamilton-County-IN-Housing-data.html

The median Marion County house was built in 1971. The median Hamilton County house was built in 2000.

Taxes

Indiana local taxes average 9.3% of income versus 10.2% nationally. This 10% savings on a 10% cost factor reduces the overall cost of living measure back down to 95.6%. State sales and income taxes do not vary by county. Hamilton County’s property and income taxes are lower than its large population peer group in Indiana.

Food Prices

Historically, Indianapolis has been a competitive grocery market. Kroger has a leading market share. Cub Foods and Marsh have left the market, but Meijer’s, Trader Joe’s, Whole Foods, Fresh Thyme, Fresh Market and Market District now compete with the others.

https://www.indystar.com/story/money/2014/03/22/grocery-store-wars-indianapolis-shoppers-profit-foodie-fight/6715177/

https://www.axios.com/local/indianapolis/2023/05/02/indianapolis-grocery-stores-kroger

5% of low-income Hamilton County residents do not live near a grocery store, versus 6% nationwide. The supply of grocery stores is adequate.

https://www.countyhealthrankings.org/explore-health-rankings/indiana/hamilton?year=2023

Hamilton County’s retail sales per capita figure is 14% above the national average, despite the very high concentration of retail stores in Marion County along 82nd/86th Street. The county is well served by retailers of all kinds.

https://www.census.gov/quickfacts/fact/table/US/SBO001217

https://www.census.gov/quickfacts/fact/table/US,marioncountyindiana,hamiltoncountyindiana,hendrickscountyindiana,johnsoncountyindiana,hancockcountyindiana/HSG860221

Food away from home makes up almost 5% of the consumer price index. No restaurant food index is publicly available. However, the Big Mac price in Hamilton County is $4.59 versus the $4.39 national average price, a 5% premium. If this applied to all restaurant prices, the overall cost of living index would be 0.3 higher, 95.9. The average Indiana Big Mac price was just $4.11.

https://worldpopulationreview.com/state-rankings/big-mac-index-by-state

https://pantryandlarder.com/mccheapest

The Economic Policy Institute provides “modest income” food prices that are 19% higher in Hamilton County than in Marion County. Given the proximity of the counties and the long-standing coverage of “food deserts” in Indianapolis contrasted with nearly none in Hamilton County, this indicator is suspect.

https://www.epi.org/resources/budget/?gclid=Cj0KCQjwxuCnBhDLARIsAB-cq1rnk521GaWh6Evp4LUs2TaA2Tgx_oufafn9ywPIV32tpToZ0f0FVpwaAhnMEALw_wcB

Health Care

Hamilton County has 1.8 hospital beds compared with the national average of 1.9 and the Indiana average of 3.3. It has 1.5 primary care physicians versus 1.0 nationally and 1.3 in Indiana. 10% of Hamilton County households have medical bills in collections compared with 17% nationally and 19% in Indiana. Access to health care is adequate.

https://www.usnews.com/news/healthiest-communities/indiana/hamilton-county

The Best Places website uses a simple index of a standard hospital bed night, a doctor’s visit and a dentist’s visit indicating that Hamilton County health care costs are equal to the national average (100).

https://www.bestplaces.net/cost_of_living/county/indiana/hamilton

A Rand Corporation study indicates that Indy metro hospital rates are 25% higher than the national average. This is driving Indiana statehouse political battles with claims and counterclaims. Professional services fees were 25% below the national average.

https://www.rand.org/pubs/research_reports/RRA1144-1.html

https://www.wfyi.org/news/articles/why-are-indianas-health-care-costs-so-high

Although health care is as much as 18% of GDP in the US, the share in the consumer price index is only 5%. If Hamilton County consumer costs are the same as the nation, this would increase the cost-of-living index by 0.6 points to 96.5.

Utilities

Best Places pegs Hamilton County’s utility costs at 93 rather than 107.

Indiana natural gas prices are more than 20% below the 50 state median.

https://www.chooseenergy.com/data-center/natural-gas-rates-by-state/

Indiana and Hamilton County electricity prices are 10% below the national average.

https://www.eia.gov/electricity/monthly/epm_table_grapher.php?t=epmt_5_6_a

https://www.electricitylocal.com/states/indiana/noblesville/

https://www.energysage.com/local-data/electricity-cost/in/

Local utilities are probably at least 10% lower than in the summary statistics, so the COL index should be reduced by 0.9 points based on their share of spending, reducing the index to 95.6.

Transportation

Indiana used car prices are the lowest in the nation, 11% below the average.

https://www.iseecars.com/used-car-buying-by-state-study

Indy fuel prices match the US average.

https://www.axios.com/local/indianapolis/2023/08/11/gas-prices-down-below-average

Indiana auto insurance rates are 40% less than the national average. Hamilton County rates are a little lower.

https://www.bankrate.com/insurance/homeowners-insurance/states/#home-insurance-rates-by-state

https://www.policygenius.com/homeowners-insurance/home-insurance-rates-by-zip-code/

The US Census Quick Facts tool reports that Hamilton County’s average commute time is the same as the country’s.

The 94 score may be high, but no specific change is indicated.

Other Goods and Services

Home insurance prices for Indiana and Hamilton County are variously reported as 10% below, equal to and 10% above the national average.

https://www.bankrate.com/insurance/homeowners-insurance/states/#home-insurance-rates-by-state

https://www.policygenius.com/homeowners-insurance/home-insurance-rates-by-zip-code/

https://www.insurance.com/home-and-renters-insurance/home-insurance-basics/average-homeowners-insurance-rates-by-state

Indiana’s state university tuition rates match the US average.

https://www.collegetuitioncompare.com/state/

Indiana has very high childcare prices.

The Economic Policy Institute and Indiana Family and Social Services Administration indicate that Hamilton County childcare costs are 13% higher than in Marion. Because childcare accounts for just 0.6% of spending, no adjustment is indicated.

https://www.epi.org/resources/budget/?gclid=Cj0KCQjwxuCnBhDLARIsAB-cq1rnk521GaWh6Evp4LUs2TaA2Tgx_oufafn9ywPIV32tpToZ0f0FVpwaAhnMEALw_wcB

https://www.in.gov/fssa/carefinder/provider-reimbursements/

Summary: Hamilton County Costs are 4% Lower than the National Average

County level housing, health care and grocery costs added more than 4% while lower taxes and utility costs subtracted almost 2% for a final score of 95.6, more than 4% below the national average.

Our Hamilton County: Healthy Behavior

https://www.practicematch.com/employer/iu-health-north-hospital/48077/

Healthy Behaviors

For each measure, we’ll list the Hamilton County rate, the Indiana rate and a letter grade primarily comparing Hamilton County with the Indiana average but also considering the national average.

Annual flu vaccinations: 64% vs 54%, A.

Infants with recommended immunizations: 66% vs 67%, C.

Mothers receiving pre-natal care in first trimester: 84% vs 72%, A.

Mammography screenings: 47% vs 39%, A.

Adults with recent preventive care visit: 78% vs 75%, B.

Adults reporting excessive drinking: 18% vs 18%, C.

Alcohol impaired driving deaths: 24% vs 19% (US avg is 27%), C.

Adult smoking: 11% vs 20% (US avg is 16%), A.

Preventable hospital stays (by outpatient services) per 100K Medicare enrollees: 1,850 vs 3,174, A.

Adults without leisure-time physical activity: 17% vs 26% (US avg is 22%), A.

Adult obesity: 29% vs 37% (US avg is 32%), B.

Adult diabetes rate: 8% vs 11% (US avg is 9%), B.

Diabetes deaths per 100K: 12 vs 30, A.

Heart disease prevalence: 4.4% vs 6.0%, A.

Heart disease hospitalizations per 1K Medicare beneficiaries: 48 vs 62 (US avg is 57), A.

Sexually transmitted disease (chlamydia) cases per 100K: 216 vs 480, A.

Existing HIV cases per 100K: 82 vs 193, A.

Some medical experts dispute classifying measures (above and below) as being strongly related to individual behaviors or as social indicators. They are grouped as conventionally done by others reporting on public health.

Social Indicators

Emergency room injury visits per 10K: 532 vs 850, A.

Injury deaths per 100K: 43 vs 85 (US avg is 76), A.

Drug overdose deaths per 100K: 12 vs 28 (US avg is 23), A.

Opioid ER visits per 100K: 31 vs 75, A.

Deaths of despair per 100K: 31 vs 53, A.

Teen births per 1K females: 4 vs 17, A.

Births, mother smoked during pregnancy: 1% vs 11%, A.

Infant deaths per 1K live births: 4.7 vs 6.7 (US avg is 5.4), B.

Deaths per 100K under age 18: 30 vs 60 (US avg is 50), A.

Children in single parent households: 13% vs 25%, A.

Disconnected ages 16-19, not working or in school: 5% vs 6% (US avg is 7%), B.

Juvenile arrests per 1K: 8 vs 19, A.

Summary

Hamilton County earns summary A grades for both behaviors and social indicators. US News & World Report rates Hamilton County as 8th best nationally of the counties it tracks. County Health Rankings lists it as the healthiest county in Indiana. 

http://indianaindicators.org/dash/overview.aspx

https://www.usnews.com/news/healthiest-communities/indiana/hamilton-county

https://www.countyhealthrankings.org/explore-health-rankings/indiana/hamilton?year=2023

https://nccd.cdc.gov/DHDSPAtlas/Reports.aspx

https://www.hamiltoncounty.in.gov/254/Health-Department

Our Hamilton County: Health Resources and Outcomes

https://www.structurepoint.com/engineering-and-infrastructure/project/riverview-health-westfield-hospital

Health Resources

For each measure, we’ll list the Hamilton County rate, the Indiana rate and a letter grade primarily comparing Hamilton County with the Indiana average but also considering the national average.

Primary care physicians per 100K: 140 vs 67, A+.

Hospital beds per 1,000: 1.8 vs 3.3, (US avg is 1.9), B.

Population per “other” (nurse practitioner) primary care providers: 920 vs 830, C-.

Population per mental health care provider: 580 vs 530 (US avg is 340): D.

Population per dentist: 1,350 vs 1,700 (US avg is 1,380), B.

Access to park or physical recreation facilities: 90% vs 77%, A-.

Uninsured adults: 5% vs 10%, A+.

Food insecurity: 7% vs 11%, A.

Limited access to healthy foods: 5% vs 9% (US avg is 6%), B.

Health Outcomes

Life expectancy: 81.6 vs 76.5 (US avg is 78.5), A.

Deaths per 100K: 710 vs 965, A+.

Premature deaths per 100K: 215 vs 420, A+.

Reporting poor or fair health: 9% vs 15%, A.

Poor physical health days per month: 2.5 vs 3.3 (US avg is 3.0), B.

Poor physical health one-half of the time: 7% vs 10%, A.

Low birth weight: 7% vs 8%, B.

Arthritis hospitalizations per 10K: 33 vs 33, C.

Hip fractures per 10K aged 65+: 56 vs 62, B.

New lung cancer cases per 100K: 46 vs 72, A+.

Total cancer rate per 100K: 442 vs 457, C+.

Total cancer death rate per 100K: 126 vs 163 (US avg is 144), A-.

Mental Health

Poor mental health days per month: 3.9 vs 4.9, A.

Frequent mental distress: 13% vs 16%, B+.

Medicare beneficiaries with depression: 20% vs 21% (US avg is 18%), C-.

Insufficient sleep: 27% vs 36%, A.

Suicide deaths per 100K: 9 vs 15, A+.

Summary

Subjectively, health resources combine for a solid B+ or A-. Health outcomes are clearly rated A. Mental health is A. US News & World Report rates Hamilton County as 8th best nationally of the counties it tracks. County Health Rankings lists it as the healthiest county in Indiana. Hamilton County operates Riverview Health. Its health department effectively managed several rounds of covid vaccines.

https://www.countyhealthrankings.org/explore-health-rankings/indiana/hamilton?year=2023

https://www.usnews.com/news/healthiest-communities/indiana/hamilton-county

http://indianaindicators.org/dash/overview.aspx

https://www.hamiltoncounty.in.gov/254/Health-Department

Mostly Good News Since the 2008 Great Recession

https://content.time.com/time/specials/2007/article/0,28804,1733748_1733756_1735278,00.html

Real, after inflation, Gross Domestic Product is up by one-third, despite the pandemic. That’s 2% annually, despite the Great Recession and the pandemic. The US economy is very solid.

A 21% increase in per capita income during this time. Quite solid and constant growth.

Inflation averaged a bit less than 2% before the pandemic, spiked to 8%, and has since declined to 4%. Experts disagree on whether it will return to 2% soon.

Gas prices are the most obvious component of inflation. They are largely driven by global supply and demand. Prices today are the same as in 2011-14, despite the general inflation increase of more than 20% since then.

Despite the pandemic, US unemployment is at a 50 year low!

Job seekers today encounter 3 times as many job openings.

Core age labor force participation has snapped back after the pandemic.

Investment values have doubled.

The number of millionaires and billionaires in the US has continued to increase.

Personal savings rates rose from 6% to 9% before the pandemic, shot up and fell back down to just 4% recently.

Housing values have doubled since the Great Recession.

Mortgage rates averaged 4% after the Great Recession, dropped to 3% and then increased to 6%+ as the Federal Reserve raised interest rates.

US exports have nearly doubled in 14 years.

Despite the Trump tariffs, which Biden has maintained, imports have also nearly doubled.

Despite historically slower growth rates, higher budget deficits and looser monetary policies, the US dollar is more highly valued today than in 2008.

Foreign countries still see the US as a positive ally, despite their concerns during the Trump era.

Obama returned the budget deficit to a “reasonable” 3% by 2016. Trump expanded it to 5% and then 15% as the pandemic struck. Biden drove some recovery to 5% by 2022, but has not driven further reductions.

US coal production is in a long-term decline.

Natural gas production has nearly doubled in 14 years.

Net farm income has been significantly above the base for 6 of the last 14 years, despite lavish Trump farm subsidies.

Manufacturing employment has continued to rise slowly in the last 14 years against the headwinds of international competition.

It’s difficult to put the pandemic in perspective, but here we see a 2-year reduction in expected lifespans. Opioid deaths and so-called “deaths of despair”, alcohol, drugs, suicide, also play a role.

Birth rates continue to drift lower as seen in all regions of the world.

The number of retirees has increased by more than 50%.

Retiree incomes are up by one-third, matching inflation.

Prospective retirees have doubled their cumulative savings.

The abortion rate has continued to fall in the last 30 years.

Church attendance has dropped from 40% to 30%.

Summary

The US economy recovered slowly after the Great Recession and then very quickly after the pandemic. Real, after inflation, output and per capita output increased. The labor market became very tight. Asset prices (investments and housing) rose for intrinsic and monetary reasons. The US remained a competitive international producer. The federal budget deficit was better at the end of the Obama period but worse for Trump and Biden. The pandemic reduced life expectancy and households had fewer children. Successful retirements grew and will grow. Social trends continue, uninterrupted by political positioning and policies.

Perceptions of the country and the economy are increasingly shaped by partisan political party views. Nonetheless, the US economy continues to grow and thrive.

Good News: Emergency Medical Services (EMS) Today (1972-2022)

Positive Media Coverage

https://www.imdb.com/search/keyword/?keywords=medical-drama

Since the pioneering 1972 drama Emergency! there have been dozens of TV shows highlighting the critical role of emergency medical services (EMS) personnel.

https://www.imdb.com/search/keyword/?keywords=medical-drama

Vehicles

Modern Emergency Medical Services (EMS) vehicles today are designed to help EMS medical professionals provide world class care. They now meet national standards (1974, 1990) for space, equipment, supplies and client care. These vehicles are stocked with supplies and equipment to meet all typical emergency care needs.

https://www.nremt.org/about/history

Air Medical Services

Helicopter based emergency services started in 1974 in Baltimore, Jacksonville, Pittsburgh, Seattle and Denver leveraging the equipment and pilot experiences of the Vietnam War. Emergency helicopters are staffed with qualified personnel and equipment to handle the most extreme situations. Emergency personnel are staged across the country to respond to emergency situations.

In 2020, there were more than 1,600 helicopters and 700 fixed wing aircraft participating in emergency medical services in the US, making more than 200,000 responses to service requests.

https://www.hmpgloballearningnetwork.com/site/emsworld/article/1223054/air-medical-services-then-and-now

Emergency Medical Profession

The National Registry of Emergency Medical Technicians (NREMT) was established in 1970. This organization has driven the development of a true profession.

https://www.nremt.org/about/history

In 1975 the AMA recognized emergency medicine as a physician specialization and recognized paramedics as allied health professionals. Prior to this time, the training, skills, employers, supervision, equipment and medical protocols of the emerging profession were so varied that initial efforts to define and enhance the professional identity and roles of paramedics and EMTs were often opposed by physicians, nurses, lawyers and hospital administrators. In the 1970’s states began to pass legislation that defined the legal roles which paramedics and EMTs could play without concern for lawsuits from their customers. Specialized emergency physician training was also developed during the 1970’s highlighting the role of paramedics, immediate care, transport care, triage issues, communications and the emergency room admitting and medical services. Emergency medical dispatching programs started in the 1980’s. Military paramedics/EMTs adopted national standards in 1986, aligning the two groups. Paramedic manager standards for training have been defined for most states.

Paramedics and EMTs are regulated at the state level. Definitions of roles, titles, allowable drugs/procedures, supervision requirements, certifications, examinations, renewals and education programs varied widely in the 1970’s. The role of national certification as an option or requirement grew throughout the 1980’s and 1990’s. Today, differences between states remain, but most states (45+) largely conform to recommended national standards for all dimensions.

While most people think of paramedics and EMT’s as specialized staff or extra skills held by first responders, the profession now includes military personnel, dispatchers, air staff, emergency room, jail, blood bank, medical labs, education and interhospital transportation roles. This increased breadth of experiences has helped the profession to improve the content of its services, education, certification and allowable procedures.

https://en.wikipedia.org/wiki/Paramedics_in_the_United_States

Professional Certification

As states defined various paramedic and EMT legal roles, they created state professional certification agencies. The first national EMT exam was administered in 1971 to 1,500 applicants. By 1984 one-half of states required the national exam for certification. By 2005, 46 states recognized or used the standardized national exams.

The national exams incorporated American Heart Association standards in 1986. Major national standards changes were implemented in 1994-95 to include 2 decades of lessons learned, a systems approach to paramedic/EMT roles and a dual focus on theory and practice.

A single national organization (NREMT) sets national standards and reviews those states and programs which adopt them. Certification standards are defined for 5 typical levels in each state and at the national level. A majority of states simply adopt the national standards and almost all accept candidates who met the national standards rather than specific state standards. The “level” of skills, training and experience in states that do not adopt the national standards are generally comparable, with a few exceptions. A national standard curriculum is available which is aligned with the testing requirements. Candidates are evaluated on theory and practice, individual diagnosis/treatment and situation/scenario evaluation. Certification requires a period of field internships. A majority of firefighters earn some level of EMT certification. Almost all states recognize certifications from other states. The national agency accredits training programs and agencies.

https://www.emsmemorial.org/ems-history

https://indianahealth.care/history-of-ems

https://wvde.state.wv.us/abe/Public%20Service%20Personnel/HistoryofEMS.html

Professional Education

Ambulance staff training was first defined in the late 1960’s. The first EMT curriculum was nationally recognized in 1969. Prior to this time, ambulance staff had basic first aid training. National training standards were set in 1973 together with the emerging certification exams. A full national paramedic curriculum was released in 1977. A comprehensive “emergency care” manual was published in 1979. Early training was largely done by individual hospitals in urban areas. Training soon moved to universities and community colleges where it is focused today. While associates and bachelor’s degrees are not required for most paramedic/EMT licenses, they are now commonplace. The number and variety of procedures provided by paramedics and EMTs has grown throughout the period. As emergency room physicians became commonplace and their confidence in EMS staff increased, they supported this growth in “standing procedures” to be taken without physician coordination. With increased experience, documentation, best practices and scientifically based standards improved. The medical profession adopted a “systems approach” to health care beginning in the 1990’s and EMS staff have adopted this approach.

Cardiac Care

Prior to 1972, CPR training was defined and more broadly offered in the US. Portable defibrillators were invented but not broadly available. Emergency cardiac treatment programs were rare.

In the 1970’s heart resuscitation guidelines were published, more portable defibrillators were available and related EMT training began.

Cardiac care has been a key curriculum and certification exam component for paramedics/EMTs since the 1980’s.

The American Red Cross introduced defibrillator training into its first aid course in 1999.

The easier to use AED defibrillator was approved for sale in 2004 and is now widely placed in many communities and millions have been trained to use them.

Pediatric Care

Pediatric care was upgraded in the 1984 curriculum and exam standards for EMS staff. Specialized pediatric care hospitals were clearly established.

Emergency Rooms

Hospitals invested in emergency room space, equipment and staff after 1975 when emergency room physicians became a specialty. In 1983 Level 1 trauma centers and pediatric critical care centers were defined and began to be implemented. Disaster resource centers were defined in 2004. Stroke centers were defined in 2009. While these specialty care centers were defined, a wide variety of immediate care centers were established in many areas, providing additional options for EMS services.

Medical Protocols

EMS professionals have benefitted from the global “process revolution” of the 1980’s. Health care professionals view each patient and situation within a “process framework”. This has allowed paramedics and EMTs to increase the variety and depth of first response diagnosis and treatment which they can legally and effectively provide. Evidence based medical standards replaced the previous “trial and error” standards in the 1990’s. Standard operating procedures were defined for most situations. This allowed EMS staff to act immediately without emergency physician approval in more situations. “Standing field treatment protocols” were widely defined and adopted in 1997 clarifying the roles of paramedics/EMTs. EMS standards were further revised in 2000 using the “medical systems” approach. Standardized EMS data recording and sharing began in 2000 and has expanded since then, allowing improved systems, evidence and medical based changes to accumulate. States generally approve both procedure and medical treatment options for individuals holding each level of EMT/paramedic certification.

Communications

In 1972, police and fire vehicles had basic special purpose radio communications and dispatchers as did taxi fleets. Improved medical dispatching skills accompanied the growth of EMS resources. Revised EMS radio communication standards were adopted in 1973. EMS staff benefitted from the expansion of cellular phone services. 911 emergency call services began in 1968 and expanded nationally throughout the 1970’s. Dedicated EMS to hospital communications as increasingly adopted in the 1990’s. Video services were added after 2000.

Funding

In 1966 a National Academy of Sciences study titled “Accidental Death and Disability” highlighted the comparatively high casualty rates of domestic vehicle accident victims versus those with war injuries! Thousands of Americans were disabled, mistreated and died each year versus the standard treatment offered by the military in combat zones. Congress responded by moving lead responsibility for EMS from the US DOT to US HEW in 1972. 5 demonstration EMS programs were funded in 1972. Further federal investments were made in the 1970’s. However, by 1980, Congress and the president decided that states should manage and fund this component of the health care system.

EMS Professional Skills

Today, when you dial 911 in an emergency, you can expect a nationally certified, trained and supervised team to quickly arrive and provide a high-quality level of services.

Assessment of incident, accident, patient situation.

Compliance with standard care protocols and escalation to physicians.

Triage in mass casualty situations.

Safe movement and extraction of patients from accident situations.

First aid treatment.

Intravenous fluid administration.

ECG, EKG administration and defibrillation (manual and electric).

Intubation.

Drug administration.

Acute asthma treatment.

Heart rhythm assessment and rate correction.

Spinal immobilization.

Transportation to the best next level care facility.

One Million EMS Professionals!

There are 1 million certified emergency medical system (EMS) personnel in the US today, up from basically ZERO in 1972. One-fourth are highly skilled paramedics. A little more than one-half are certified EMTs.

https://www.nremt.org/maps

About one-half of the total were certified at the national level.

Pre-1972

Emergency Medical Services (EMS) Really Didn’t Even Exist in 1972 for Most of America

The TV show Emergency! premiered in 1972, highlighting the paramedic services provided in Los Angeles for exciting situations. In the “rest of the world” (ROW), you dialed the operator or called the police. They dispatched an ambulance, typically from a funeral home or a police car or a hospital. The ambulance was staffed by largely untrained personnel or volunteers. They focused on transportation, which they were legally allowed to do, not medical care which they were not allowed to do. These unlicensed individuals typically did have basic first aid training, but no medical equipment, procedures, drugs or right to administer any immediate medical care. Their only job was to rush you to the nearest hospital.

Some Emergency Medical Services (EMS) progress was made in the 1950’s, 1960’s and early 1970’s.

1916 powered ambulances and signal boxes to summon care widely used in WWI.

1950 Air ambulance services available in Los Angeles and the Korean War.

1957 Portable defibrillator available. Mouth to mouth CPR techniques used.

1959 Bell Huey helicopters used in Vietnam Conflict.

1966 Medicare coverage for ambulance services. Federal ambulance design standards.

1967 AMA outlines first ambulance training. EMT’s trained to serve Black neighborhoods in Pittsburgh.

1969 911 calls first made in Alabama. Mobile coronary care units in New York City. Nationally recognized curriculum for EMT-ambulance.

1970 Legal rights for paramedics in California. Emergency cardiac training in Portland. First paramedic training program. Mobile intensive care training in LA. Miami and Seattle start paramedic programs.

1971 National standardized EMT exam taken by 1,500 students.

1972 Emergency room physician training begun at University of Cincinnati. Emergency! TV program begins. Citizen CPR training in Seattle. LifeFlight helicopters start in Baltimore, Jacksonville, Pittsburgh, Seattle and Denver. US Dept of HEW assumes control of EMS from DOT. US Dept of HEW provides funding for 5 EMS demonstration programs.

50 years ago, if you had a life-threatening emergency, you could call the operator, police, fire, hospital or local funeral home and get a ride to the nearest hospital. You could not expect to receive ANY immediate medical care.

https://en.wikipedia.org/wiki/Paramedics_in_the_United_States

https://time.com/6215072/first-paramedics-black-men-history/

https://www.hmpgloballearningnetwork.com/site/emsworld/article/219388/timeline-modern-american-ems

https://wvde.state.wv.us/abe/Public%20Service%20Personnel/HistoryofEMS.html

https://www.bloomberg.com/news/articles/2015-03-03/pittsburgh-the-birthplace-of-america-s-emt-services
https://www.emsmemorial.org/ems-history