Archive for the ‘economics’ Category

More Obamacare news

Saturday, January 18th, 2014

UPDATE: More News.

This is supposed to be reassuring.

Obamacare contains a $25 billion federal risk fund set up to benefit health insurance companies selling coverage on the state and federal health insurance exchanges as well as in the small group (less than 50 workers) market. The fund lasts only three years: 2014, 2015, and 2016.

The government’s risk management program for the insurers has three parts (the “3Rs”):
A revenue neutral Risk Adjustment System designed to level adverse claim costs between health plans.
A Reinsurance Program that caps big claim costs for insurers (individual plans only).
A Risk Corridor Program that limits overall losses for insurers.
Of the $25 billion, $20 billion is earmarked for the Reinsurance Program and $5 billion goes to the U.S. treasury.

First, the Reinsurance Program caps big individual claim costs for insurers––in 2014, 80% of individual costs between $45,000 and $250,000 are paid by the government, for example.

Then comes the Risk Corridor program. Participating health plans will receive payments from the federal government in any of the following circumstances:
The plan’s costs for any benefit year are more than 103% but not more than 108% of the health plan’s targeted amount. The feds will reimburse 50% of all costs in excess of 103% of the medical cost target.
If the plan’s costs are more than 108% of the annual target, the feds will first pay the health plan a flat 2.5% of the target and then reimburse the plan for 80% of their claim costs above the targeted amount––with no upside limit.
Target cost is simply defined in the new law as a health plan’s “total premiums (including any subsidies) reduced by the administrative costs of the plan.” It is whatever the health plan projected its premium needed to be to pay medical costs.

The CMS has a new contractor for Obamacare, not just the web site. The previous contractor, CGI Federal, has been replaced rather suddenly.

“Accenture, one of the world’s largest consulting firms, has extensive experience with computer systems on the state level and built California’s large new health-insurance exchange. But it has not done substantial work on any Health and Human Services Department program.
“The administration’s decision to end the contract with CGI reflects lingering unease over the performance of HealthCare.gov even as officials have touted recent improvements and the rising numbers of Americans who have used the marketplace to sign up for health coverage that took effect Jan. 1.”

CGI Federal is the company connected with Michelle Obama through her classmate, a fellow Princeton alumna.

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The curtain is briefly drawn aside.

Sunday, December 15th, 2013

I try not to be too pessimistic but, these days, it hard to be too pessimistic. Recently, we had a preview in Cyprus. Cyprus banks had served as money laundering devices for Russian and other oligarchs.

Cyprus and its international lenders have agreed to convert 47.5 percent of deposits exceeding 100,000 euros in Bank of Cyprus to equity to recapitalize it, banking sources said on Sunday.

Under a programme agreed between Cyprus and lenders in March, large depositors in Bank of Cyprus were earmarked to pay for the recapitalisation of the bank. Authorities initially converted 37.5 percent of deposits exceeding 100,000 euros into equity, and held an additional 22.5 percent as a buffer in the event of further needs.

This means that, if you had a large deposit in a Cyprus bank, you were assumed to be a money launderer. Of course, if you are a small depositor, your bank account is not safe.

Shannon Bruner of Indianola logged on to her checking account Monday morning, and found she was almost 800 dollars in the negative.

“The first thing I thought was, ‘I got screwed,’” she said.

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Science and Politics

Tuesday, December 10th, 2013

The usual theme on the left is that Republicans are opposed to science. Usually this is accompanied by some link to a GOP legislator talking about the Bible. A typical example is seen in this thread on Powerline, The original post refers to this article about the coldest temperature ever recorded.

A commenter says: “First of all, this is a bit of a joke. Mr. Hayward is not a scientist by any reasonable stretch. He has never done research on climate change; rather, if you read his blog writings, he represents an extreme ideological view which is not supported by fact. Any reputable scientist at NOAA would be embarrassed to debate someone like this. Scientists debate all the time in the literature. That is where ideas are tested against data. Mr. Hayward doesn’t participate in that debate, it is likely he is unable to. In fact, a debate against someone like Mr. Hayward would look great for his resume but (as I stated before) be embarrassing for a real scientist. You can see that we would never send such a debate request to one of our members. Sorry.”

That was from John Abraham (who, by the way, does not work for NOAA or accept money for his work on climate change).
http://en.wikipedia.org/wiki/John_Abraham_(professor)

Conservative peer-reviewed scientific thinking here: http://www.politico.com/news/stories/1110/44958.html

(We still think it would be cool to see Hayward flail in front of a real scientist. Maybe Hayward can contact NOAA himself…? Propose a debate…? All ya gotta do is call! Go for it! It would look great on your resume!)
http://www.boulder.noaa.gov/?q=node%2F4

The “Conservative peer-reviewed scientific thinking ” is, of course, a link to a Congressman saying something foolish. “Rep. John Shimkus is standing by a controversial comment that global warming isn’t something to worry about because God said he wouldn’t destroy the Earth after Noah’s flood. ”

Ha ha ha. Stupid Republicans.

I see no mention of the state of science in the Democrats’ public statements. For example:

Georgia Congressman Hank Johnson is worried that stationing more Marines on Guam could cause the island to capsize. Guess what party he belongs to.

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Here comes 1933.

Saturday, November 23rd, 2013

images

The Depression did not really get going until the Roosevelt Administration got its anti-business agenda enacted after 1932. The 1929 crash was a single event, much like the 2008 panic. It took major errors in economic policy to make matters worse. Some were made by Hoover, who was a “progressive” but they continued under Roosevelt.

James Taranto has a good take and quotes a couple of lefty commentators. Like Ezra Klein.

There’s a lot of upside for Republicans in how this went down. It came at a time when Republicans control the House and are likely to do so for the duration of President Obama’s second term, so the weakening of the filibuster will have no effect on the legislation Democrats can pass. The electoral map, the demographics of midterm elections, and the political problems bedeviling Democrats make it very likely that Mitch McConnell will be majority leader come 2015 and then he will be able to take advantage of a weakened filibuster. And, finally, if and when Republicans recapture the White House and decide to do away with the filibuster altogether, Democrats won’t have much of an argument when they try to stop them.

As Taranto puts it:

“”The political problems bedeviling Democrats” is a marvelous bit of understatement. The abject failure of ObamaCare has made the prospect of a Republican Senate in 2015 and a Republican president in 2017 much likelier. Thus even from a purely partisan standpoint, rational Democrats would have been more cautious about invoking the nuclear option when they did than at just about any other time in the past five years.”

The filibuster maneuver by Reid is not a demonstration of strength. It is an admission of weakness. The idiots at HuffPo and the LA Times are beating their chests in joy at the prospect of eternal Democrat majorities that can ignore those pesky Republicans.

In fact, what Reid is acknowledging is that the Democrat majority in the Senate is going away and now is the time to pack the courts and regulatory agencies with ideologues and get all the anti-business regulations in place while they can. The hard left, which believes in magic and Cargo Cults, is cheering them on.

Bloomberg sees what happened, too.

“Under any administration, federal agencies seek to implement the president’s policies by developing regulations,” Jeff Holmstead, a lawyer at Bracewell & Giuliani LLP in Washington who has represented coal-heavy utilities, said. “But in most cases, the judges on the D.C. Circuit are the people who decide whether those regulations comply with federal law.”

I fully expect to see anti-fracking regulations roll out soon, once the Obama appointments get confirmed by the rump Senate. However, what goes around, comes around.

It is our understanding that the Supreme Court exception was included to satisfy pro-abortion extremists, the most active and basest part of the activist base. The Wall Street Journal’s Laura Meckler reported yesterday that the two biggest such groups, Planned Parenthood Federation of America and NARAL Pro-Choice America, both declined comment on the nuclear move, “leaving it unclear whether they are concerned about their ability to block future objectionable”–i.e., Republican–“nominees.”

The abortion lobby sees the future better than giddy leftists who think government creates wealth and jobs.

What happens now ?

Wednesday, November 13th, 2013

healthcaregal

The Obamacare web site now has lost its happy photo of the Obamacare girl. The fact that she is a non-citizen seems appropriate. The web site is supposed to be fixed by November 30. Will that happen ? Well, maybe not.

On Friday, the man tasked with the digital fixes said the site “remains a long way from where it needs to be” as more and more problems emerge.

“As we put new fixes in, volume is increasing, exposing new storage capacity and software application issues,” Jeff Zients told reporters on a conference call.

And at Tuesday’s White House Press Briefing, Press Secretary Jay Carney again said there was “more work to be done” on repairing HealthCare.gov.

Carney, along with Zients and other administration officials, have repeatedly said the November 30 deadline is to get the health care website working for a “vast majority” of Americans looking to enroll in the Obamacare exchanges.

So, what happens December 2, the Monday after the “glitches” are fixed ? First, they won’t be fixed. The contractor that designed the program, not just the web site, has a terrible record.

CGI Federal’s parent company, Montreal-based CGI Group, was officially terminated in September 2012 by an Ontario government health agency after the firm missed three years of deadlines and failed to deliver the province’s flagship online medical registry.

The online registry was supposed to be up and running by June 2011.

Officials at the U.S. government’s Centers for Medicare and Medicaid Services awarded six technology contracts worth $87 million to CGI Federal for Obamacare website work, according to the U.S. Government Accountability Office.

So, assuming the program isn’t working, what next ?

First, Democrats are jumping ship already.

Sen. Dianne Feinstein (D-Calif.) has decided to co-sponsor legislation from Sen. Mary Landrieu (D-La.) that would require insurance companies to continue offering their existing health care plans, becoming the most high-profile non-red state Democrat to buck party lines on the Affordable Care Act.

I don’t think that approach will work.

the “Keeping the Affordable Care Act Promise Act” would “grandfather” in all health insurance plans that existed as of Dec. 31, 2013, not March 23, 2010, meaning that insurers could continue to offer a number of plans that they have been forced to cancel under the Affordable Care Act.

The insurance industry is not going to change all this for a temporary and uncertain law change.

Even Bill Clinton is jumping ship, no doubt in the interest of Hillary’s 2016 campaign. I doubt that will help except among her most devoted followers. After all Hillarycare is the grandmother of Obamacare.

I have previously speculated on what might come next and that was early in the disastrous rollout, which I anticipated. I wasn’t the only one.

Moreover, data from existing surveys indicates that employers are quickly moving to high-deductible plans with health savings accounts, away from more expensive plans with high premiums, but low deductibles and co-pays. Notably, when employees are offered a “defined contribution” – a fixed amount of money from their employers with which to shop – they also (although not always) opt for more high-deductible options.

I think this may be the way the country copes with the ongoing disaster of Obamacare. Allow the system of high deductible insurance and health IRAs to expand. Legislation can do this. No Congress can bind another Congress.

What to do about those with pre-existing conditions ? Well, maybe the problem was slightly exaggerated.

12 million people purchased private direct purchased health insurance on the eve of Obama Care. Insurance industry studies show that one in eight applicants for private health insurance have preexisting conditions that affect their eligibility or premiums. This gives a total of 1.5 million Americans who were denied health insurance or paid higher premiums due to pre-existing conditions.

The Washington Post, of course, bought the Obama administration lie without a blink.

But must we change our whole health care system to handle a problem that affects one half of one percent? If we gave a $10,000 subsidy to each person denied coverage or paying a higher premium, we could keep our existing health-care system and solve pre-conditions for one tenth the projected cost of Obama Care.

There are other questions about motives.

You tout the Affordable Care Act as a triumph over special interests, but the stock prices of the insurance industry have enjoyed a huge run-up. Isn’t this because your program, boiled down, just throws more tax dollars at an unreformed health-care system that every analyst, including you, says spends resources inefficiently?

Insurance companies have never been enthusiastic about health insurance. I’ve worked in the insurance industry. They were co opted by Obama because they were promised (with a wink and a nod) that they would be administering a government funded program and would have “no skin in the game.” That’s what the employer health plans are and that’s what they understood to be the plan. The recent vilification of insurers risks some getting off the reservation.

Later, in discussing how he would pay for expanding health-insurance coverage, he alluded to his plan to cut the subsidy payments private insurers receive for administering Medicare advantage plans. “I would rather be giving that money to the young woman here who doesn’t have health insurance than giving it to insurance companies that are making record profits”

Then, a man who said he makes a living selling individual health-insurance plans asked Obama, “Why is it that you’ve … decided to vilify the insurance companies?”

We know he was lying. His lips were moving.

What about the poor ? Most of those signing up on the exchanges are, in fact, signing up for Medicaid.

More than 55,000 people in Washington state enrolled in health coverage in October — most in Medicaid . In fact, almost all of the people who have “signed up” for Obamacare have signed up for expanded Medicaid. They will not contribute to the risk pool; they will only draw more tax payments. Is Medicaid the best choice for the poor ? Avik Roy doesn’t think so. I have reviewed his book on the site and disagree with his proposed solution but his data is correct.

I have previously suggested the French system as a model for us. France is a large country, larger than most of the other European examples, and its system, unlike the British NHS, works well. It has been put under enormous pressure by the French unemployment problem but it still does a better job than any other I know of. The German system is older and more bound up in German traditions.

I doubt that this sort of reform is an option any longer. I think the catastrophic insurance and health IRA is the best choice for a transition now.

Why healthcare is in trouble.

Friday, November 8th, 2013

Our health care system has been built up over the years in a jury-rigged, ramshackle fashion. Before World War II, there was very little health insurance and what there was often was the product of labor union contracts. The early years were concerned with accident insurance and workers compensation laws.

The American life insurance system was established in the mid-1700s. The earliest forms of health insurance, how­ever, did not emerge until 1850, when the Franklin Health Assurance Com­pany of Massachusetts began providing accident insurance, to cover injuries re­lated to railroad and steamboat travel. From this, sickness insurance covering all kinds of illnesses and injuries soon evolved, but the first modern health insurance plans were not formed until 1930.

The Baylor program for school teachers was the first in 1929.

Medical insurance took stride in 1929 when Dr. Justin Ford Kimball, an administrator at Baylor University Hospital in Dallas, Texas, realized that many schoolteachers were not paying their medical bills. In response to this problem, he developed the Baylor Plan – teachers were to pay 50 cents per month in exchange for the guarantee that they could receive medical services for up to 21 days of any one year.

In those days, the concern was lost wages more than hospital care.

In 1939, the American Hospital Association (AHA) first used the name Blue Cross to des­ignate health care plans that met their standards. These plans merged to form Blue Cross under the AHA in 1960. Considered nonprofit organizations, the Blue Cross plans were exempted from paying taxes, enabling them to maintain low premiums. Pre-paid plans covering physician and surgeon services, includ­ing the California Physicians’ Service in 1939, also emerged around this time. These physician-sponsored plans com­bined into Blue Shield in 1946 and Blue Cross and Blue Shield merged into one company in 1971.

The modern insurance plans were very recent in origin. I was there for much of it. The commercial insurers fought the status of Blue Cross, which was not required to have reserves. Blue Cross asserted that it promised hospital care, not payment, so reserves were not necessary.

The 1940s and 1950s also saw the proliferation of employee benefit plans, and the included health insurance pack­ages became more and more compre­hensive as strong unions negotiated for additional benefits. During the Second World War, companies competing for labor had limited ability to use wages to attract employees due to wartime wage controls, so they began to compete through health insurance packages. The companies’ healthcare expenses were exempted from income tax, and the resulting trend is largely responsible for the workplace’s present role as the main supplier of health insurance.

The war produced much of this as wage limitations were in force but fringe benefits, like health insurance, were permitted. A lot of this history is contained in Paul Starr’s book The Social Transformation of American Medicine.

From the first, commercial insurers focused on employer plans while Blue Cross and Blue Shield (which was founded by the California Medical Association to pay doctor bills) were individual plans.

In 1954, Social Security coverage included disability benefits for the first time, and in 1965, Medicare and Medicaid pro­grams were introduced, in part because of the Democratic majority in Congress. In the 1970s and 1980s, more expen­sive medical technology and flaws in the health care system led to higher costs for health insurance companies. Responding to higher costs, employee benefit plans changed into managed care plans, and Health Maintenance Organizations (HMOs) emerged. Man­aged care plans are unique in that they involve a particular network of health­care providers that have been verified for healthcare quality and that have agreements with the insurer about price and related issues. HMOs were originally primarily nonprofit, but they were quickly replaced by commercial interests, and managed care only suc­ceeded in temporarily slowing the growth of healthcare costs.

Two major changes came in the 1970s. In 1978, the federal government established what were called Professional Standards Review Organizations or PSRO. All doctors had to receive training in how to do these reviews and it was immediately apparent that cost was the only consideration, not quality of care.

I decided to educate myself and took a course from an organization called “The American Board of Quality Assurance and Utilization Review Physicians. I took the exam and passed, then attended the annual meeting. This was about 1986. People I met at that meeting informed me that the exams were graded by throwing them up in the air. Any that landed balancing on one edge were flunked. Nonetheless, the experience was valuable because I could see what was coming.

I was president of the Orange County Medical Association that year and had served for eight years on the Commission on Legislation of the CMA, now called The Council on Legislation. This gave me an opportunity to meet many legislators, many state level and some federal. The impression they made on me was that few knew anything about medicine and most were not very intelligent.

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The rolling catastrophe

Monday, November 4th, 2013

Obamacare debuted on October 1. It is now November 4 and the mess is worse. I have been posting about it, here, and here, and here, and even here.

The political left is trying very hard as can be seen here.

keep-your-plan-flowchart

It’s kind of complicated so I will summarize. You are screwed !

There are accusations that insurance companies are using this to drop high risk subscribers. Maybe that is true but it is the consequence of ignorant people designing Obamacare. Did these guys ever set up a new business ? As Casey Stengel once said to the Mets , “”Can’t anybody here play this game?”

I guess not.

The New York Times has done what it can.

We are also told that “in all the furor, people forget how terrible many of the soon-to-be-abandoned policies were. Some had deductibles as high as $10,000 or $25,000 and required large co-pays after that, and some didn’t cover hospital care.” Never mind that we have seen cancellations of insurance policies with deductibles much lower, and customers forced to purchase replacement policies with higher deductibles, and with premium increases of 100%, if not higher.

Then there is this argument.

Why can’t people opt out of mental health coverage if there is not a reasonable chance that they will need that coverage? Why can’t they get mental health coverage when it is needed? After all, pre-existing conditions can no longer be denied, so in the event that mental health coverage is needed down the line, it can be obtained and the insurance companies cannot deny people who already have pre-existing mental health conditions. The Times assures us that over-coverage–and the high premiums that come with it–is “one price of moving toward universal coverage with comprehensive benefits.” They don’t explain why having unnecessary coverage is a step towards social justice, but as we saw from the beginning of this intelligence-insulting, repulsively dishonest op-ed, the New York Times is less about explaining, and more about covering up a disastrous rollout with disastrous policy consequences for the country.

Weak attempts at best.

Peggy Noonan, who has frustrated me with her obtuseness at times, gets it now.

Politically where are we right now, at this moment?

We have a huge piece of U.S. economic and social change that debuted a month ago as a program. The program dealt with something personal, even intimate: your health, the care of your body, the medicines you choose to take or procedures you get. It was hugely controversial from day one. It took all the political oxygen from the room. It failed to garner even one vote from the opposition when it was passed. It gave rise to a significant opposition movement, the town hall uprisings, which later produced the tea party. It caused unrest. In fact, it seemed not to answer a problem but cause it. I called ObamaCare, at the time of its passage, a catastrophic victory—one won at too great cost, with too much political bloodshed, and at the end what would you get? Barren terrain. A thing not worth fighting for.

So the program debuts and it’s a resounding, famous, fantastical flop. The first weeks of the news coverage are about how the websites don’t work, can you believe we paid for this, do you believe they had more than three years and produced this public joke of a program, this embarrassment?

She assumed that it wasn’t worth it if it worked !

The problem now is not the delivery system of the program, it’s the program itself. Not the computer screen but what’s inside the program. This is something you can’t get the IT guy in to fix.

They said if you liked your insurance you could keep your insurance—but that’s not true. It was never true! They said if you liked your doctor you could keep your doctor—but that’s not true. It was never true! They said they would cover everyone who needed it, and instead people who had coverage are losing it—millions of them! They said they would make insurance less expensive—but it’s more expensive! Premium shock, deductible shock. They said don’t worry, your health information will be secure, but instead the whole setup looks like a hacker’s holiday. Bad guys are apparently already going for your private information.

This is the worst that could be imagined. The New York Times is trying.

We are also told that “in all the furor, people forget how terrible many of the soon-to-be-abandoned policies were. Some had deductibles as high as $10,000 or $25,000 and required large co-pays after that, and some didn’t cover hospital care.” Never mind that we have seen cancellations of insurance policies with deductibles much lower, and customers forced to purchase replacement policies with higher deductibles, and with premium increases of 100%, if not higher. Really ?

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Conservatives and the health care mandate ssue.

Monday, October 28th, 2013

The latest meme I’ve noticed on the Obamacare implosion is that the Republicans are to blame. After all, it’s Romneycare, or it’s the idea of the Heritage Foundation.

In fact, the mandate was promoted by Hillary in 2008 and opposed by Obama. Of course, he doesn’t know much about what is going on so we can understand. In fact, the entire website fiasco, slipped by him, unnoticed.

President Barack Obama didn’t know of problems with the Affordable Care Act’s website — despite insurance companies’ complaints and the site’s crashing during a test run — until after its now well-documented abysmal launch, the nation’s health chief told CNN on Tuesday.

Of course he may just rewrite the code himself. After all, he is so talented that he is bored.

David Remnick, editor of The New Yorker, quotes White House senior adviser and longtime Obama friend Valerie Jarrett: “I think Barack knew that he had God-given talents that were extraordinary. He knows exactly how smart he is. … He knows how perceptive he is. He knows what a good reader of people he is. And he knows that he has the ability — the extraordinary, uncanny ability — to take a thousand different perspectives, digest them and make sense out of them, and I think that he has never really been challenged intellectually. … So what I sensed in him was not just a restless spirit but somebody with such extraordinary talents that had to be really taxed in order for him to be happy. … He’s been bored to death his whole life. He’s just too talented to do what ordinary people do.”

Oh well, at least we know if we really get in trouble, we have someone who can bail us out. I don’t doubt the comment about him never being challenged intellectually.

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Obamacare is coming next month

Tuesday, September 24th, 2013

UPDATE: So far, as October 4, there is no evidence that anyone has enrolled in Obamacare. The one person alleged to have done so has now been shown to have been lying and the details he offered to the eager press, were phony. It appears the IT collapse is continuing.

UPDATE #2 There appears to have been 1% or less of applicants who negotiated the maze actually signed up. The web site is closed for the weekend to fix “glitches.” I still suspect it would have been better strategy to allow the October 1 rollout of this mess and focus on the debt ceiling for a potential shutdown.

UPDATE #3: Here is an informed discussion of Obamacare and the IT mess that created it.

To add insult to injury, the administration outsourced the building of this costly contraption to CGI Group, a Canadian firm. CGI, whose U.S. operations are based in Northern Virginia, “just so happened” to increase the number of H-1B visas it requested from 172 in 2011 to 299 in 2012. It seems more than a little likely that the Obamacare project gave jobs to foreigners while needlessly leaving fully dozens or perhaps even hundreds of qualified citizen IT professionals on the unemployment line.

It gets even worse. CGI was “officially terminated in September 2012 by an Ontario government health agency after the firm missed three years of deadlines and failed to deliver the province’s flagship online medical registry.”

Oh well.

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The War on Drugs

Thursday, August 15th, 2013

My sentiments on the whole drug question have been influenced by some experience with the medical aspect of the problem. Drugs are slipping out of any control due to developments in synthetic variations of older substances that stimulate brain chemistry, sometimes in unknown ways. The traditional drugs, if we can use that term, are also slipping out of control with Mexican drug wars replacing the Columbian cartels even more violent than their predecessors.

What about marijuana ? It is widely used by the younger generation and, while I do think there are some harmful consequences, especially in potential schizophrenics, the fact is that the laws are widely ignored and do little good and much harm. First, what about the link to psychosis ?

Epidemiological studies suggest that Cannabis use during adolescence confers an increased risk for developing psychotic symptoms later in life. However, despite their interest, the epidemiological data are not conclusive, due to their heterogeneity; thus modeling the adolescent phase in animals is useful for investigating the impact of Cannabis use on deviations of adolescent brain development that might confer a vulnerability to later psychotic disorders. Although scant, preclinical data seem to support the presence of impaired social behaviors, cognitive and sensorimotor gating deficits as well as psychotic-like signs in adult rodents after adolescent cannabinoid exposure, clearly suggesting that this exposure may trigger a complex behavioral phenotype closely resembling a schizophrenia-like disorder. Similar treatments performed at adulthood were not able to produce such phenotype, thus pointing to a vulnerability of the adolescent brain towards cannabinoid exposure.

This suggests that adult use may be less harmful.

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