Painkiller problem hits hard in workers’ comp

Rough Notes

Tighter monitoring of opioid prescribing is key to reining in costs

The dramatic increase in overdose deaths and emergency department visits related to the class of narcotic painkillers known as opioids has drawn national attention to the rise in abuse of the drugs as well as inappropriate prescribing by physicians.

But the problem, dubbed an “epidemic” by Centers for Disease Control and Prevention Director Dr. Tom Frieden, is not limited to teens looking for a cheap high by raiding their parents’ medicine cabinets. Rather, it is being felt in a big way by employers. Companies are seeing their workers’ compensation costs skyrocket to a reported $1.4 billion annually due to injured workers prescribed opioids such as OxyContin and subsequently experiencing a pronounced delay in return to work.

Experts say that a coordinated effort among all the key stakeholders – politicians, regulators, medical authorities and the general public – is needed to comprehensively address the opioid epidemic. But they note that there are some steps that employers and their insurers can take to discourage improper prescribing, help injured workers return to work more quickly and help rein in workers’ compensation costs.

“The majority of people misusing prescription drugs are employed,” Terry L. Cline told an audience of health and safety professionals at a keynote session of the National Safety Council’s annual meeting in Chicago in September.

“These are the people working at all of our companies. We all have a big stake in this. That’s the challenge in front of us,” said Cline, Oklahoma’s health commissioner and president of the Association of State and Territorial Health Officials. The organization has pledged to slash the rate of opioid abuse and overdose deaths by 15% by 2015.

The CDC estimates that about 16,000 Americans die of opioid-related overdoses each year. The epidemic extends much deeper, Cline said.

“For every one opioid-related death, 10 people are treated for abuse, 32 go to the emergency room, 130 abuse or are opioid dependent, and there are 825 nonmedical users,” he said, drawing on CDC data.

Impact on workers’ comp

The cost figures within the workers’ compensation world also are setting off alarm bells. It is estimated that more than half of claimants receive opioids for chronic pain relief. Narcotics now account for a quarter of work comp drug costs, and nearly half of those narcotics are medicines that contain oxycodone as an active ingredient, said a research brief released in September by the National Council on Compensation Insurance.

Of the top 20 drugs that cost workers’ comp plans the most nationwide, nine are opioid analgesic medications such as Fentanyl, Opana ER and Percocet. And the narcotic cost per medical claim is on the rise, growing by 51% since 2003. Meanwhile, more work comp claims involve injured workers who rely on narcotics over a longer period of time.

“The share of claimants who are getting five or more narcotic prescriptions has been growing over the last few years,” said John Robertson, who co-wrote the research brief and is the council’s director and senior actuary.

In 2005, 4.3% of claimants received five or more narcotic prescriptions in the year following their injury. That rose 30% to 5.6% by 2010, the most recent year of data available for this measure.

As if this steady growth in painkiller prescription drug costs were not enough cause for concern, it represents only a small slice of how the rising use of these medications is increasing workers’ compensation outlays, said Dr. Constantine J. Gean, regional medical director at Liberty Mutual Insurance.

A 2002-2003 study of more than 8,000 workers’ compensation claimants with disabling low back pain found that those prescribed opioids within the first two weeks of their injury saw their disability prolonged by as much as 69 days longer. These workers were six times likelier to use narcotics later on and had triple the likelihood of needing surgery even after controlling for illness severity, Dr. Gean said during his talk at the National Safety Council’s keynote session.

“We really need to do something about what’s becoming a national disgrace,” he said. “Opioids are not for low back pain and neck pain. And there’s no evidence that they work over the longer term.”

Painkillers tied to catastrophic claims

Subsequent research supports Dr. Gean’s argument. A 2008 study issued by the California Workers’ Compensation Institute found that patients getting high doses of opioids took three times longer to return to work than injured workers who got lower doses.

And it is not just high doses of opioids that are problematic, according to an analysis of more than 12,000 workers’ compensation claims in Michigan between 2006 and 2010. After controlling for age, sex, illness severity and legal problems, claimants who got short-acting opioids such as Oxycodone were 76% likelier to have total comp costs exceeding $100,000.

The injured workers prescribed a long-acting painkiller such as Fentanyl were four times likelier to have catastrophic claims surpassing the $100,000 mark, said the August 2012 study published in the Journal of Occupational and Environmental Medicine.

“There is this even bigger public health matter of injured workers taking opioids and that being a leading contributor to disability,” said Dr. Gary M. Franklin, lead author of the study and medical director of the Washington State Department of Labor and Industries. “It’s not the cost of the drugs. It’s the cost of sending somebody down the tubes because they’re on chronic opioid therapy.”

Many experts cite Washington as one of the bright spots at the state level in addressing the opioid epidemic. In 2007, Dr. Franklin’s department collaborated with other state agencies to develop guidelines on the use of opioids. Among other things, the guideline – updated in July 2013 – said that doctors should consult with pain specialists before prescribing daily morphine-equivalent doses of 120 mg or more to injured workers.

“It wasn’t an absolute cap, but the guideline did say that if you’d gotten to that dose and you’re not seeing improvement then don’t keep pushing the dose up,” Dr. Franklin said. “In most doctors’ minds, they were taught 10 or 15 years ago that there was no ceiling on opioid dosing. Putting in place a threshold puts an anchor in doctors’ minds.”

The average opioid dose among injured workers has fallen by 27% since the guideline was enacted, and the share of claimants on daily morphine-equivalent doses of 120 mg or greater has dropped by 35%. The number of deaths fell by half, said an April 2012 study published in the American Journal of Industrial Medicine.

Few states get policy right

Other states are starting to get the message. Ohio enacted a similar policy setting an 80 mg opioid dosing threshold, while also cracking down on so-called pill mills in the same manner that Florida, Kentucky and other states also have done.

But according to an October National Safety Council report, only Washington, Kentucky and Vermont fully meet the group’s standards for implementing good prescription drug monitoring programs, encouraging responsible opioid prescribing and enacting overdose education and prevention programs. Thirteen states and the District of Columbia are graded as not meeting the standards at all. Another 35 states are partially meeting these benchmarks for helpful public policy, said the report, “Prescription Nation: Addressing America’s Prescription Drug Abuse Epidemic.”

In lieu of state action to help address the cost impact of the nation’s opioid epidemic, there are steps that can be taken in isolation by employers and insurers. They should take a hands-on approach to work with physicians to ensure that their prescribing of opioids is appropriate, said Liberty Mutual’s Dr. Gean.

Claims should be monitored to see whether the prescribing of narcotics falls within the acceptable standard for the area, and physicians should be encouraged to seek the free training that the Food and Drug Administration now requires makers of long-acting opioids to offer to doctors and other prescribers.

“It’s important to give doctors feedback,” Dr. Gean said.

Advice to seek this kind of collaboration with physicians is not limited to Liberty Mutual. Chicago-based insurer CNA is urging employers to “build a stronger relationship with their occupational health provider,” said Shari Falkenburg, the company’s assistant vice president of risk control.

“Employers are starting to ask questions of doctors,” she added. These questions cover territory such as physicians’ narcotic prescribing approach, how they screen patients with a potential to abuse painkillers, and their willingness to use nonnarcotic alternatives including physical rehabilitation or nonsteroidal anti-inflammatory drugs such as ibuprofen.

CNA is now training its workers’ compensation claims administrators to evaluate the care provided against the official disability guidelines and scrutinize the duration of disability claims and how opioid prescribing may be prolonging it. The company also is bringing representatives from underwriting, risk control and claims together to examine the accounts of insureds who have higher costs related to opioid prescribing to evaluate how these employers can improve training, education or other programs to address the problem.

Injured workers’ initiative

There are limits to what employers and insurers can do, experts say. The unfortunate link between painkiller prescribing and extended disability is one that Dr. Donald Teator has seen many times in his Waynesville, N.C., practice as a specialist treating opioid dependence.

“These medications work on your brain more than on the pain,” said Dr. Teator, medical adviser to the National Safety Council. “People get the meds and it makes them feel relaxed and takes away a lot of their drive to get back to work. They just kind of mellow out taking these pills and don’t get up and do the exercises they’re supposed to or follow up with their doctors the way they’re supposed to.”

For the injured worker, the hard change of shifting away from opioids and back to work only occurs when that individual patient is prepared, Dr. Teator added.

“They have to really want to get back to that normal life.”

The next patient safety target: misdiagnosis

A 36-year-old woman recently presented with flu-like symptoms at Shonan Kamakura General Hospital in Kamakura, Japan. Just a week earlier, her son had been diagnosed with influenza, leading her doctors to think that might be the cause of her fever, fatigue, sore throat and dry cough.

But she tested negative for flu, so she was diagnosed with an upper respiratory infection, prescribed 1,200 mg of acetaminophen daily and sent home. The woman returned the next day, reporting symptoms of vertigo. Testing showed she had suddenly become anemic. Within days she was dead, felled by acute promyelocytic leukemia, which has a 5-year survival rate surpassing 70% when correctly diagnosed and treated.

The tragic case of delayed diagnosis, presented at the Diagnostic Error in Medicine 6th International Conference in Chicago in September, was one of those extremely rare “white zebras” that every physician dreads, expert diagnosticians said.

“These are tough cases at every level,” said David E. Newman-Toker, MD, PhD, associate professor of neurology and otolaryngology at Johns Hopkins University School of Medicine in Baltimore.

But new research shows that it’s not just the one-in-a-million diagnoses that get missed, Dr. Newman-Toker noted. Diagnostic errors are responsible for more patient deaths, disabilities and medical liability costs than any other kind of medical mishap.

My latest is in the December issue of ACP Hospitalist, a holdover from when I was still freelancing. Read the whole shebang.

Outreach to Latinos on health coverage faces obstacles

Valentin Torres is the kind of resident Illinois officials know they need to reach if their effort to vastly expand health insurance coverage under the Affordable Care Act is going to succeed.

Torres, a truck driver and the sole provider for his wife and three children under 18, said his family has gone uninsured since 2005 when he lost the coverage he had through an employer.

At a state-organized outreach event he heard about on Spanish-language radio, Torres learned the family would be eligible for Medicaid under the health law’s expanded income rules. He planned to complete his application from home through, a site for Medicaid applicants separate from the troubled federal website where private insurance plans are sold.

“I came here to get health coverage for me and my family,” said Torres, 44, who is bilingual but spoke to a counselor in Spanish. “Without insurance, you can’t afford to get sick.”

Federal health officials estimate that Latinos make up nearly a quarter of Illinois’ uninsured population, inspiring a special effort by state officials to spread the word about options available under the health law. To help raise awareness, Illinois is partnering with nearly 50 community-based organizations with close ties to immigrant populations.

My latest is in the Chicago Tribune. Read the whole shebang.

FDA Refuses to Set Dosage, Duration Limits on Opioid Labels

After more than a year of research, public hearings, and consideration of nearly 3,000 comments filed by physician organizations, patients, and others, the U.S. Food and Drug Administration in September altered the labeling of extended-release and long-acting opioid analgesics to place a greater emphasis on the medications’ safety risks. The action falls far short of the strict limits on the dosage and duration of opioid therapy for patients’ noncancer pain that were proposed by advocacy groups last year.

My latest, published in the American Academy of Pain Medicine’s Pain Medicine Network newsletter. Read the whole shebang.

In childhood obesity battle, BMI-tracking by schools is losing policy

As schools around the country wrap up their first month back in session, parents soon may start receiving the first reports on how their children are shaping up — literally.

Public schools in 19 states now track students’ body mass index numbers and report the fat metrics back to parents. There may, indeed, be more schools tracking students’ BMI than there are schools teaching kids the arithmetic needed to do such calculations on their own. To some, this would seem like the prudent step to take given that childhood obesity has nearly tripled since 1990. The Centers for Disease Control and Prevention says about one in five American children is obese, and one in three is overweight or obese.

There are only a couple of problems with this increasingly popular nanny-state tactic: There’s not much evidence that BMI-tracking reduces obesity, and it may harm the very children it’s meant to help.

My latest, for the R Street Institute. Read the whole shebang.

Seeking sunshine in Wisconsin

I wrote an op-ed on the lack of disclosure on Wisconsin school district websites that was published today by the Milwaukee Journal Sentinel. I drafted the essay on behalf of Sunshine Review, a pro-transparency group.

My lede:

When it comes to transparency, Wisconsin school districts are like the kids who spent all night playing video games and the next morning pray that their teachers won’t call on them in class. They are falling behind, offering few of the answers that parents and taxpayers deserve.

Wisconsin’s 442 school districts have earned an overall grade of D on disclosure, according to an analysis conducted by Sunshine Review. The analysis tests the information publicly available on district websites against a 10-point transparency checklist in areas ranging from budgets to criminal background checks on employees.

Read the whole shebang.

Goin’ to the chapel

Here’s my latest policy spotlight column for Free-Market.Net, this time on the gay marriage issue.

It begins:

Yet another government institution has come upon hard times lately. While this particular institution’s skyrocketing failure rates have plateaued in the last couple of decades, no one in his right mind thinks it is succeeding. In most cases of a failing government program, conservatives would call to abolish it. This time, though, they want to federalize it.

The failing government program is marriage and the solution proposed by some conservatives is an amendment to the Constitution, which would set an alarming precedent for the federal government’s role in defining what constitutes a marriage.


Toot, toot

My latest story to see print in Insurance Journal is on the much-ballyhooed do-not-fax rule.

A little news on the IJ front, by the way, is that the magazine is “going national” beginning January 2004. This national presence will include three new regional editions — Northeast, Southeast and Midwest. Yours truly has been named managing editor of the Midwest edition, meaning I’ll be in charge of the regional “wrap” around the national content shared across all editions.

It should be fun and a challenge. It will keep me busy, but that’s a good thing.

I’ve also tentatively agreed to revive the Free-Market.Net Policy Spotlight, formerly written by the very talented J.D. Tuccille, on a freelance basis. I’m doing it on a monthly basis to start, and my first spotlight takes aim at the federal government’s “Budget Bulge.”

Press coverage

This story by Eric Krol in the Daily Herald highlights some of the work we’ve done researching campaign contributions to the Illinois gubernatorial by O’Hare contractors.

Surprise, surprise — Democrat Rod Blagojevich, who is gung-ho for expansion, is receiving eight times as much in contributions and O’Hare-related donors make up 8 percent of his total take. Then again, he’s raised a lot more money than Ryan to begin with. And he’ll win. The question is whether he’ll give Daley a headache by asking for a piece of the action at an expanded O’Hare.

Of course, Blagojevich’s biggest mistake — at least as far as entertainment value goes — is forsaking what should be his campaign slogan: “In Rod We Trust.”

Patrick Corcoran of the Elk Grove Times wrote a very favorable piece about our report, “The O’Hare Scandal: Hijacking the System.” I’m even mentioned in the story — undeservedly so, of course. What’s funny is that two people who’ve been with AIP since the beginning (Bryan Doyle and Drew Adamek) had their names misspelled, while I — the newcomer — had his name spelled perfectly. Fortune smiles upon me.

The sports stadium scam: What is seen and what is not seen

The Fund for American Studies’ Institute on Political Journalism

The local sports franchise is in trouble. The owner says the old stadium is economically obsolete and the taxpayers must rush in to save the day, or else he will be forced to move the team elsewhere.

The voters, scared to lose the team they love, give in. A new stadium is built and the area around the stadium is revitalized. Restaurants, bars and shops pop up. The city retains its identity as a “major-league city,” and through the magic of the multiplier effect the local economy grows as a whole.1

Voila. The owner wins. The fans win. The city wins. Heck, sometimes the team even wins — games!

It’s a great story, but — like the notion of a Cubs‘ world championship — it’s largely a pipe dream. The real story is that taxpayer subsidization of professional sports facilities is almost always a losing bet, economically speaking.2

The economic impact studies employed by politicians, the news media, and pro sports owners to support government-financed facilities are beset by methodological problems and don’t count all the relevant costs.3

The real story is that taxpayer-financed sports facilities are a boon to owners and players, the news media and especially politicians, but average taxpayers — particularly those too poor to afford to attend sporting events regularly and those who don’t follow sports to begin with — wind up on the losing end.4

The construction of sports facilities has skyrocketed in the last 15 years. According to economists Roger Noll and Andrew Zimbalist, thirty-one new stadiums and arenas were built between 1989 and 1997 alone.5 They also estimate that $7 billion will be spent on new facilities before 2006, and most of that money will come from public sources.6

The idea that taxpayers should pay to build a sports facility and then let the team owner reap most of the profits seems a little far-fetched.7 How has this happened? Sports owners claim poverty (relative to other owners) because as ticket and broadcast revenue-sharing in sports leagues has increased, one area where owners can still keep most of their gains is from team memorabilia, concessions, parking, hotels, luxury boxes and all the other amenities associated with live sports nowadays.8

Other owners use these newfound profits to buy higher caliber talent, which leads to better on-field performance, which leads to yet another round of profits. Without taxpayer subsidies for a new facility that will allow them to extract these non-shared income streams, owners say they cannot compete. But as economist Mark Rosentraub has written, “It is difficult to find any real evidence that team owners or players need subsidies or welfare support.”9 Still, a team’s threat of leaving often proves too much for politicians to bear, which will be explored more in-depth later.

We know why owners want new facilities, but what arguments are put forth to justify them to the public at large? It is usually argued that a new facility will actually prove to be not just a subsidy for an ailing sports franchise but a boon to the local economy as a whole. This is usually done through the economic impact study, and a key economic theory expounded in these studies is the multiplier effect.

“The theory is supported by a simple observation,” explains economist William J. Hunter. “When an individual purchases goods or a business pays salaries, the recipients of these funds will in turn spend the money. This additional spending tends to increase income and employment, which in turn generates still more spending, and so on.”10

Hunter goes on to add, “While it is no doubt true that this process takes place, the common belief that the results of this process can be accurately measured and manipulated by the government is mistaken — and genuinely dangerous.”11 One major problem, Hunter explains, is the “local production fallacy,” where the “local economy is presumed to benefit from all the jobs, primary and secondary, ‘created’ by the public works project.”12

Much of the money that is spent both in the construction of facilities and in the operation of the facility and the franchise winds up going elsewhere. “A multiplier might appear to some to be the magical mystery tour of any economy,” says Rosentraub, providing an example to prove his point. He and a friend go out to dinner in Indianapolis, but how much of the money they spend actually stays in town?13

The food was purchased from farms or ranches in other states. The money that was invested probably came from multinational banks not even based in town. So to assume that all the money put into a project multiplies locally is to deny the reality of a modern economy.

Furthermore, what is most overlooked in economic impact studies is the opportunity cost of the project. What could have been produced by alternative uses of the same capital and land in the private sector?14 Indeed, if the multiplier theory made sense, almost no public project would be a net loss, Hunter argues. “By increasing public expenditures, even greater increases in community income can be effected through the multiplier’s ripple effect … Certainly if one bridge can generate far more community income than additional cost, several bridges connected by new highways will bring even more income.”15

The truth is, Hunter says, that “government spending does not ripple through the local economy, and does not swell private incomes.” Why? Because of the opportunity cost of the consumption and production “forgone by citizens who must pay taxes to support public spending.”16 Indeed, there is a deadweight loss from taxation that also goes uncounted by most economic impact studies. According to Noll and Zimbalist, “the social cost of taxation exceeds tax collections by about 25 percent.”17 This means that the true cost of, say, a $200 million sports facility would actually be $250 million.

So economic impact studies are seriously flawed, but what does the empirical research tell us about the actual economic effects of taxpayer-subsidized sports facilities? First, while sports get a great amount of media attention, they are a very small part of any local economy. Most franchises have annual budgets of $60 to $100 million, and while that’s certainly a valued contribution to the local economy, Rosentraub explains, “businesses of this size are quite small when compared to other organizations in urban areas.”18

How small a contribution do sports franchises make to a local economy? Rosentraub’s got the data. As of 1992, pro sports make up only .06 percent of total private-sector employment in all U.S. counties with 300,000 or more residents.19 The U.S. county with the largest concentration of direct employment in 1992 was Georgia’s Fulton County, where the Braves, Hawks and Falcons play — a mere 0.32 percent.20 Here’s another stunning figure, again courtesy of Rosentraub: As of 1997, Sears Roebuck & Co. reported annual sales approximately 30 times the revenues of all of Major League Baseball.21

While it’s true that the evidence seems to indicate that many sports facilities are not attractive private investments (since 1953, approximately 71 percent are publicly owned), there may be a crowding-out effect at play, argues economist Robert A. Baade.

“Subsidization by the public sector of stadium construction is one rendition of an old saw,” Baade writes. “Do not spend your private funds when the government will financially accommodate your private ambition. It is quite plausible that the private sector has not often invested in stadium construction because it has not needed to.”22 The empirical results of taxpayer-subsidized sports facilities, however, are crystal clear.

Noll and Zimbalist deliver one of many death blows: “A new sports facility has an extremely small (perhaps even negative) effect on overall economic activity and employment. No recent facility appears to have earned anything approaching a reasonable return on investment. No recent facility has been self-financing in terms of its impact on net tax revenues.”23 They do not stand alone in their harsh judgment.

According to Baade and Richard F. Dye, “Independent research has not supported the notion that direct economic benefit exceeds cost.”24 Their regression analysis of sports facilities built from 1965 to 1983 concluded, “The presence of a new or renovated stadium has an insignificant impact on area income for all but one of the metropolitan areas.”

The exception was Seattle, which also gained a new football franchise.25 Economist Dean V. Baim concluded in 1990 that “stadium construction is not a low-risk investment.”26 In fact, Beam found that for the years 1953 to 1986, teams received an “aggregate subsidy of $139.3 million to play in municipal stadiums.”27

Baade and many others argue that sports facilities do not increase economic activity but merely divert entertainment spending from one source to another. “The leisure budget of a family or an individual is limited, in terms of both money and time,” Baade writes. “It seems likely, then, that a dollar spent at the Spectrum in Philadelphia may well be a dollar less spent at a movie theater in Bucks County.”28 Rosentraub redoubles the argument, saying, “If the economic activity would have taken place if the team did not exist, then there is NO overall economic impact, just a transfer of economic activity.”29

So sports facilities lose money and merely divert economic activity from one item to another, but that’s not all. Analysis has shown that sports facilities actually worsen the local economy, because they result in seasonal, low-wage, low-skill service sector jobs. “An area development strategy which concentrates on these types of jobs could lead to a situation where the city gains a comparative advantage in unskilled and seasonal labor,” write Baade and Dye.30

There’s nothing wrong with such a comparative advantage, but it could probably be achieved without massive taxpayer subsidy, and what remains unknown is what kind of jobs and industries would have developed had taxpayer dollars not been taken in the first place.

The only argument left in favor of taxpayer-subsidized sports facilities is that they help enhance the city’s image, thus attracting businesses to the area. But sports alone will not be a determining factor in a corporation’s decision to relocate to the area.31 It is only one of many factors, and since it has been shown that in many ways these facilities make cities worse off economically, it would be wiser to let taxpayers keep their money and stay away from these high-risk public investments.

It should be clear by now that taxpayer subsidization of sports facilities makes little economic sense. The question that remains is how these projects get approved by the voters when the evidence is so damning. Public choice theory tells us that when one small group has a lot to gain from a given government action and a large, diffuse group has only a little to lose individually, the former group will prevail.32 In June 1997, for example, both San Francisco and Washington held referenda on new sports facilities.

Both won by the barest of margins. San Francisco’s supporters of the stadium deal outspent their opponents 25 to 1, while Washington’s pro-stadium groups outspent their opponents 80 to 1.33 Even if stadium proponents lose the first time around, they come back again and again, because the potential profits of rent-seeking are huge.

The news media also have much to gain from new sports facilities, especially if they are built to retain or attract franchises. “Sports are a critical asset for the mass media and directly contribute, in several ways, to the profitability of newspapers, television stations, and radio stations,” explains Rosentraub.34 Sports make up as much as 20 percent of what appears in newspapers, and firms such as the Tribune Co. and Turner Broadcasting (now part of AOL-Time Warner) have even bought franchises (the Cubs and the Braves) in order to provide content for their broadcasting outlets.

For politicians, the short-term benefits of supporting taxpayer-subsidized facilities are great. They reap the rewards of an extremely visible project usually gracing the heart of downtown where tourists are likely to visit. They are hailed as saviors for keeping the local team in town or attracting a new one after the old one has left. The long-term losses don’t begin to sink in until well after they’ve left office.

When a team demands a new stadium only 20 years after its last stadium was built with taxpayer dollars, the mayor or governor who helped shepherd that deal has long gone on to greener pastures. But the taxpayers have no such escape.

Furthermore, the losses are largely invisible and hard to calculate. Whatever investment might have taken place in the stadium deal’s absence surely would not have been as concentrated and visible as the domed monstrosities that are constructed in the hearts of cities. The sports stadium scam is a classic case of what is seen and what is not seen, as the 19th century French economist Frederic Bastiat explained in his famous essay.

“This explains the fatally grievous condition of mankind,” Bastiat wrote. “Ignorance surrounds its cradle: then its actions are determined by their first consequences, the only ones which, in its first stage, it can see. It is only in the long run that it learns to take account of the others.”35 The accounting has been done, and taxpayers are on the losing end, while wealthy special interests, politicians and the news media are better off.

The wonders of government never cease to amaze.

1 Rosentraub, Mark S. “Major League Losers: The Real Cost of Sports and Who’s Paying for It.” New York: Basic Books, 1997, p. 25.

2 Noll, Roger G. and Zimbalist, Andrew S. “Sports, Jobs, and Taxes.” Washington: Brookings, 1997, p. 88.

3 Hunter, William J. “Economic Impact Studies: Inaccurate, Misleading, and Unnecessary.” Heartland Policy Study No. 21, July 21, 1988. Available:

4 Noll and Zimbalist, supra note 2, p. 87.

5 Ibid., p. 5.

6 Noll, Roger G. and Zimbalist, Andrew S. “Sports, Jobs, and Taxes,” The Brookings Review, Summer 1997, p. 35.

7 Rosentraub, supra note 1, pp. 90-100.

8 Ibid.

9 Ibid., p. 15.

10 Hunter, supra note 3, p. 1.

11 Ibid.

12 Ibid., p. 2.

13 Rosentraub, supra note 1, p. 162-163.

14 Bast, Joseph L. “Sports Stadium Madness: Why It Started and How to Stop It.” Heartland Policy Study, February 23, 1998, p. 5. Available:

15 Hunter, supra note 3, p. 7.

16 Ibid.

17 Noll and Zimbalist, supra note 2, p. 61.

18 Rosentraub, supra note 1, p. 139.

19 Ibid., p. 143.

20 Ibid., p. 144.

21 Rosentraub, Mark S. “Are Tax-Funded Sports Arenas a Good Investment for America’s Cities?” Insight, September 22, 1997, p. 27.

22 Baade, Robert A. “Is There an Economic Rationale for Subsidizing Sports Stadiums?” Heartland Policy Study No. 13, February 23, 1987, pp. 1-2. Available:

23 Noll and Zimbalist, supra note 2, p. 36.

24 Baade, Robert A. and Dye, Richard F. “The Impact of Stadiums and Professional Sports on Metropolitan Area Development.” Growth and Change, Spring 1990, pp. 1-14 (p. 2).

25 Ibid., p. 10.

26 Baim, Dean V. “Sports Stadiums as ‘Wise Investments’: An Evaluation.” Heartland Policy Study No. 32, November 26, 1990, p. 4. Available:

27 Ibid., p. 5.

28 Baade, supra note 22, p. 11.

29 Rosentraub, supra note 1, p. 155. Italics not mine.

30 Baade and Dye, supra note 24, p. 7.

31 Rosentraub, supra note 1, pp. 170-171.

32 Olson, Mancur. “The Logic of Collective Action.” Boston: Harvard University, 1971.

33 Noll and Zimbalist, supra note 2, p. 85.

34 Rosentraub, supra note 1, pp. 49-50.

35 Bastiat, Frederic. “That Which is Seen, and That Which is Not Seen.” 1850. Available: