Hamilton County residents are well served by 5 nearby general aviation airports. The county owns and operates Indy Executive Airport which recently expanded its main runway to 7,000 feet, the longest general aviation runway in the state, now capable of landing all private jet aircraft. The airport hosts 100 aircraft, including 20 jets and conducts more than 40,000 operations per year. It is the fourth busiest non-towered airport in the US. The airport hosted private jet flights from around the country for the 2012 Super Bowl. It was awarded “Indiana Airport of the Year” recognition in 2007.
Indianapolis Metro Airport is located in Fishers near the Marion County border and operated by the Indianapolis Airport Authority as a “reliever airport”. It has 110 based aircraft and conducts 25,000 operations each year. It has a single 4,000-foot runway and is actively developing half of its 400 acres for aviation-related uses.
Eagle Creek, Anderson and Indy Regional airports to the southwest, north and southeast also offer general aviation services to Hamilton County residents.
Indianapolis boasts main runways of 11,200 and 10,000 feet and a cross-wind runway of 7,200 feet. Indy is home to one of the nation’s 22 FAA control districts. Indianapolis has 40 direct flight destinations. Due to its Fed Ex hub status, it joins its neighbors Chicago, Louisville and Cincinnati as “top 10” US air cargo carriers, ensuring that the airport receives priority FAA funding and maintenance.
Historically, Indy residents took advantage of the US Air hub in Dayton (74th largest metro area) and the Delta hub in Cincinnati (30th largest metro area) within 2 hours, but those attractions have expired. Louisville (43rd largest metro area) is also within 2 hours but has never had preferred flight options.
Similarly, Detroit, St. Louis, Cleveland, Nashville, Milwaukee and Columbus are large metro areas within 5 hours of Indy, but typically do not have super attractive air travel options worth a long drive.
Chicago’s Midway (31st busiest) and O’Hare (4th busiest) airports DO provide solid air travel options for Hamilton County residents, just 3 hours away.
Despite its relatively small size, Indy has attracted all national carriers and many discount carriers. Its average ticket is $396, just above the $392 national average. Among top 50 metro areas, it ranks 20th at $396, just above the median of $390.
Hamilton County has several top-quality general aviation options. The Indianapolis International Airport is a national leader in quality and service. Prices are roughly average. Indy has a relatively low number of direct flights, so travelers often need to connect through major hubs or drive to Chicago, especially for international destinations.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
Since the pioneering 1972 drama Emergency! there have been dozens of TV shows highlighting the critical role of emergency medical services (EMS) personnel.
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.
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.
The National Registry of Emergency Medical Technicians (NREMT) was established in 1970. This organization has driven the development of a true profession.
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.
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.
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.
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.
Ongoing defects dropped by 60% from 2001 to 2011 and then dropped by another 20% from 2011 to 2021. The compounded reduction is 68%, a little more than two-thirds of the defects disappearing in 20 years.
JD Powers started its initial quality surveys in 1987 and its Vehicle Dependability surveys in 1990. The summary results are not easily found on the internet. The Consumer Reports defect rates are similarly restricted to paying customers.
In the 1980’s, Toyota and Honda offered significantly higher vehicle quality. Other manufacturers essentially “caught up” in the next 20 years. A snapshot from 1985 illustrates the gap that was closed by 2000-5, before the Vehicle Dependability improvements shown above.
The very disappointing 2022 results are inconsistent with the downward defect trend of the last 20 years, reflecting the pandemic production, supply chain sourcing and vehicle prep problems of the last 2 years.
For each measure of produce prices, I’ve provided a 5- or 10-year framework of annual inflation AND a 5 year view of prices indexed to Jan, 2020 before the pandemic began. We did have 2% inflation before the pandemic.
This traditional measure of ongoing inflation pressures peaked at 7% annual rate in 4Q, 2021. In total, just 12% in 2+ years.
Grand total PPI reached 10% annual inflation by the end of 2021 and has remained at that level. This provides pressure for CPI to be higher than 7% for a few more months.
Commodities pressure has been strong only recently, so the total PPI is just 3% higher than the measure excluding the volatile components.
Annual commodity inflation rocketed from 0% in Dec, 2021 to 20% by Jun, 2022 as the global economy was recovering from the pandemic and the extraordinary increase in durable goods demand was registered in supply chain purchasing decisions. Commodities are historically most volatile, but this increase in demand and prices was historic. Note this is way before the Ukraine invasion.
Energy prices were below the pre-pandemic level as late as Jan, 2021 (-3%). They increased exponentially to 50% higher by Apr, 2021. Energy prices have continued to increase at 35-40% annual rates as increased demand, mothballed assets and the Ukraine invasion effects combined to change the global markets. This is one measure where continued very high inflation is possible.
Food prices were a little slower to accelerate. Zero increase at Dec, 2020. 4% annual inflation at May, 2021. 13% inflation at Aug, 2021. Again, this is pre-Ukraine. The 13% ish inflation rate has continued, supported by Ukraine issues. Historically, food prices do not remain elevated for long periods.
Another subtotal, excluding 2 more volatile sectors shows 8-9% inflation peaking.
Business services inflation has remained tame, supporting the notion that cost-push inflation due to wage increases is not yet a major threat.
Transport and warehouse prices were also slow to “take off”, remaining below pre-pandemic level through Feb, 2021. Energy prices drive the transportation sector, so these prices also increased. The 20% annual increase seems to have peaked.
Wholesale and retail trade also lagged a bit, still at the historical average 2.5% inflation rate as of Mar, 2021. But, inflation grew to 10% by Aug, 2021 and a peak of 18% in Mar, 2022. The annual rate of inflation has receded to 15%, but that still offers some risks to the CPI for the next 6 months.
Six of the nine measures have peaked or are declining. The other three remain at worrying levels without clear signs of retreat. The “core” PPI inflation measure at 7% is not accelerating, so CPI should be able to decline in the second half of 2022. On the other hand, commodities inflation, mostly driven by energy inflation, remains very high without evidence of a meaningful decline in the near-term. Historically, energy and commodity prices fall back after a sharp increase. The general weakening in the global economy also points to a somewhat softer market for energy and commodities.
There is no evidence yet of labor-based cost-push inflation or accelerating/spiraling/self-reinforcing inflation.
“Price gauging” claims are always in the eye of the beholder/customer/politician. When I see relatively low historical price increases, followed by sharp increases, I imagine that business leaders are taking advantage of the situation to drive price increases that were impossible to propose and make stick during the less dynamic past. These can be spotlighted during a period of high inflation, but appear to be more reasonable across the whole business cycle. The food and energy price changes look similar to historical levels of volatility so are less easily questioned.
Big picture, IMHO, this looks like a global commodities “squeeze” due to the faster than expected recovery from the pandemic, especially the 50% growth in demand for durable goods as in-person services were less attractive and available. Loose fiscal and monetary policy in the US and other nations may have been a significant driver of the faster than expected global recovery, but this does not look like a classic case of excessive fiscal and monetary stimulus.
In hindsight, the slow response of the US Federal Reserve Board to the very rapid change in price levels from Jan, 2021 to Jun, 2021 looks like malpractice. Market prices quickly adapted to the current and expected disconnect between supply and demand.
Producer and consumer price increases are likely to remain in the 7-8% range during the 3rd quarter of 2022, but should begin to drift back to the 5-6% range in the 4th quarter of 2022, and still lower in 2023, especially if the Fed increases interest rates by the expected 3-3.5% and businesses slow their inventory, hiring, project and capital spending decisions accordingly.
The baby boomers have caused the relatively higher death rate aged 55+ groups to almost double their share of total workers. While the death rate for EACH age group has gone down in the last 20 years, the blended average has been flat for the last decade.
Covid Provided Special Challenges and the Results Could Always Be Even Better
Japanese corporations produce about one-third of US output in the US. They export 400,000 vehicles from the US. Three-fourths of Japanese brand cars sold in the US are produced in the US. Japanese cars, on average, have more US (domestic) content than so-called American made cars.
6-month time limit. A dozen or less bipartisan dignitaries. Retired ambassadors, investors, CEO’s, federal reserve presidents, etc. Make Mitch Daniels the chair.
Assign 2 projects. One to cut government waste. The other anti-inflation policies. No more than a dozen recommendations in each half. Presented to congress for simple yes/no vote, without major amendments allowed.
2. Spend Less Government Money
Fiscal spending is too expansionary for the current situation. Back off. Reduce infrastructure spending for now, spend it in the next recession. Reduce marginal defense programs that only have political reasons. Cut state government spending by 3%, which is budgeted to increased by 9%.
Increase immigration to improve labor supply. Cut tariffs to reduce supplies costs. Lean on local regulators to reduce zoning restraints and one size fits all building codes. Strategically require a higher share of affordable housing and multifamily permits annually in each metropolitan region. Phase-out the mortgage interest tax deduction for second homes.
Loosen regulations for 5 years to encourage increased “all of the above supplies” energy through drilling, coal, oil and nuclear. Suspend federal gas tax for 3 years. Negotiate oil price minimums/maximums between US/Europe/Japan and OPEC.
Reducing inflation is a complicated policy area. The solutions proposed by “experts” are rarely politically appealing. Competing political parties hesitate to provide “wins” to the other. However, 8% inflation after a 2-year pandemic while the US faces Russian war actions is a “national emergency”, worthy of an FDR like approach to “try a few things”. It is an opportunity to overcome individual industry opposition to things that make sense for the country. It is an opportunity to try some left and right solutions.
Good News 