As noted in this earlier post, the distributional consequences of the House Tax Cuts and Jobs Act should include the spending cuts. According to CBO, there will be a $25 billion cut to Medicare unless independent legislation is passed. From TPM:
…automatic cuts spring into action anytime Congress passes a bill that balloons the federal deficit, as the tax bill would. The approximately $136 billion in cuts spurred by the GOP tax bill would hit a number of government programs—including farm subsidies and the Border Patrol—but would cut most deeply into Medicare. Medicaid, Social Security, and food stamps are protected.
[FY 2016 net Medicare outlays were $588 billion]
Even then, PAYGO requirements won’t be met given limits on how much can be cut in a given year. From CBO:
Given that the required reduction in spending exceeds the estimated amount of available resources in each year over the next 10 years, in the absence of further legislation, OMB would be unable to implement the full extent of outlay reductions required by the PAYGO law.
So at least limited slash-and-burn on discretionary spending.
In any case, the bottom line: the distributional consequences of the bill which reduces the tax burden on the very high income and raises the tax burden on the low (ten years out) is likely to include additional hits to low income on the spending side.
In other news, JCT has released its analysis of the Senate bill, which is not better in terms of its distributional consequences (unless one wants a more regressive tax code, in which case it’s just dandy).
Source: Bump/WaPo.
Study: Giving People Government Health Insurance May Not Make them Any Healthier
https://www.thedailybeast.com/study-giving-people-government-health-insurance-may-not-make-them-any-healthier
From the article:
[A] large-scale randomized controlled trial (RCT) of what happens to people when they gain Medicaid eligibility shows no impact on objective measures of health. Utilization went up, out-of-pocket expenditure went down, and the freqency of depression diagnoses was lower. But on the three important health measures they checked that we can measure objectively–glycated hemoglobin, a measure of blood sugar levels; blood pressure; and cholesterol levels–there was no significant improvement.
Here’s the net result [of the study]:
“We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant ef- fect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (−9.15 percentage points; 95% confidence interval, −16.70 to −1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures.”
No statistically significant treatment effect on any objective measure: not blood pressure. Not glycated hemoglobin. Not cholesterol. There was, on the other hand, a substantial decrease in reported depression. But this result is kind of weird, because it’s not coupled with a statistically significant increase in the use of anti-depressants. So it’s not clear exactly what effect Medicaid is having. I’m not throwing this out: depression’s a big problem, and this seems to be a big effect. I’m just not sure what to make of it. Does the mere fact of knowing you have Medicaid make you less depressed?
For that matter, I’m not sure what the policy implication is. If you wanted a program to cure depression, Medicaid is probably not what you’d design.
So back to cholesterol and blood pressure, which are exactly the sort of thing Medicaid is supposed to take care of. What does this study tell us? That Medicaid–or health insurance more generally–is useless at curing physical disease?
Not quite. Oh, to be sure, Slate is right that this is not good news for Obamacare–which, you may recall, got half of its coverage expansion by putting more people into Medicaid.
There’s been a bit of revisionist history going on recently about what, exactly, its supporters were expecting from Obamacare–apparently we always knew it wasn’t going to “bend the cost curve”, or lower health insurance premiums, or necessarily even reduce the deficit, and now it appears that we also weren’t expecting it to produce large, measurable improvements in blood pressure, diabetes, or blood sugar control either. In fact, maybe what we were always expecting was a $1 trillion program to treat mild depression.
A couple of things you should highlight. First, the article was written by noted scholar Megan McArdle. That alone should give you pause. Second, the Daily Beast article is well over 4 years old. The Oregon study was designed by MIT economist (and John Bates Clark Medal winner Amy Finkelstein), who is one of the gurus on health economics. I actually read her paper several years ago and the study’s conclusions were not nearly as downbeat nor as firm as Megan McArdle would have you believe. The study also found other benefits besides the primary metrics. And you should think long and hard about what it means when the study finds little improvement in blood sugar and cholesterol numbers despite increased use of prescribed medications. Is that really an indictment of Medicaid?
The principal aim of Obamacare was always to provide people with some kind of access to healthcare. There is some mixed evidence that it did in fact bend the cost curve, although admittedly it’s not clear if the data is picking up a downward “level shift” or a change in the slope. For those of us who get our health insurance through employers there’s no question that Obamacare has slowed the rate of premium increases.
Uhhh. It did bend the cost curve.
I thought to myself as I saw that link “I wonder if it’s the Oregon Medicaid study?”
Here’s another perspective:
https://www.washingtonpost.com/news/wonk/wp/2013/05/02/heres-what-the-oregon-medicaid-study-really-said/
Klein says exactly what McCardle says: Better access to healthcare, less financial stress, some improvement in mental well-being, not much improvement in key health indicators (blood pressure, cholesterol, diabetes, etc.).
The point I was making is that you can spend a lot of money for comparatively little benefit. It’s not that the spending doesn’t help, it’s that it destroys most of the capital involved.
This is why the west so badly lags Singapore. Western governments are mostly about being PC and making people feel good — whether on the right or left — rather than maximizing the benefits of tax dollars taken. Over a period of thirty years, you end up a lot poorer than you would have been.
To wit, a German worker produced about 1.2x that of a Singapore worker in 1985; today, a Singapore worker produces almost twice as much as a German. It’s a damning indictment of western governance.
It is the type of food people can buy makes or breaks the health of the person. So a person in the low income area will find few good option for healthy food at a convenience store because they don’t sell much compared to a grocery store. There have been news coverage about it effect forcing many to commute quite away from their home just to buy healthy food to eat.
The whole purpose of the Obamacare is to provide health care for people unable to afford it which is much a better option to have a primary physician diagnose your health rather going to the ER.
You also admit that it reduced out-of-pocket expenditure.
Adding in the overpayments for standard Medicare programs, the tally for last year approaches $60 billion — which is almost twice as much as the National Institutes of Health spends on medical research each year.
https://www.publicintegrity.org/2017/07/19/21011/fraud-and-billing-mistakes-cost-medicare-and-taxpayers-tens-billions-last-year
So, quick math here… let’s see, $60 billion minus $25 billion still leaves $35 billion for waste/fraud/overpayments.
Bruce Hall So it sounds like you’re on board with my recommendation that we start holding doctors accountable. We should make an example of those doctors and hospital administrators who do commit fraud. As the inquisitors used to say in medieval times, “Show them the instruments!” Of course, doctors and hospitals that defraud Medicare are also likely to defraud private health insurance companies, so waste & fraud are not uniquely government problems. The fraud isn’t on the government side with Medicare; it’s all coming from dishonest doctors and hospital administrators.
Yes, there should be auditing and recovery processes for mistakes and auditing and criminal penalties for fraud… and the government should have them running real time rather than several years after the fact.
Meanwhile, https://www.washingtonpost.com/politics/va-improperly-spent-6-billion-on-care-for-veterans-senior-agency-leader-says/2015/05/13/ab8f131c-f5be-11e4-b2f3-af5479e6bbdd_story.html?utm_term=.68732478f3cb . That’s government owned, operated, and controlled.
Getting to one of the causes: https://www.kevinmd.com/blog/2016/02/pay-primary-care-doctors-theyre-worth.html
About the VA – its not all “waste” as you might imagine.
We moved my inlaws closer to us. He had been drafted and served 2 years, like my dad, in the 50s. He was in the hospital several times in 2016. He uses the VA for some things that his Medicare advantage plan won’t pay for fully. (Let that sink in.)
I will say this about the VA. They are very, very concerned that all of his medical needs are met and that he gets care how, when, and in the manner he prefers. He gets a lot of free things. Hearing aids, glasses, drugs that have a copay if accessed through his other plan. They call him if they haven’t heard from him for a few months.
If there is a wait at the VA clinic, they send him to a private specialist. Fast.
He is constantly contacted for surveys and follow ups and asked about his experience, to rate his doctors, rate the time in the waiting room, etc.
I’m pretty impressed. It’s very responsive service. But it’s not cheap for the government.
randomworker,
That may have been your father’s experience, but certainly not my father’s experience. But I’ll agree that your anecdotal tale and mine are not general proof. That’s why I provided a link.
2slug,
Obviously you haven’t had to the deli-line “take a number” faux system at the VA. We spent a frustrating year taking my father to the VA hospital several times a weeks for basically nothing more than for them to check off boxes and accomplish nothing. The University of Michigan doctors were appalled when we finally got them to see him and they learned about his “treatment”.
As my long dead grandmother used to say, “It’s better than nothing.” But not a lot for may veterans.
http://www.cnn.com/2015/09/02/politics/va-inspector-general-report/index.html
bruce, how long ago were you taking your father to the VA? you seem to be describing what i heard the VA was like many years ago.
Bruce Hall Regarding the VA, the problem isn’t that the VA provides crappy healthcare. Exactly the opposite. The reason wait times are so long is because veterans know that they are more likely to get better care at a VA hospital than they would at a private hospital. No one forces veterans to go to VA hospitals. They always have the option of going somewhere else, but for cost and quality of care reasons they don’t. That said, we clearly need to devote more resources to the VA, but that’s not the kind of capacity you just crank up overnight. And devoting more resources to the VA will be especially difficult if the Trump tax cuts go through. And isn’t that the point of Menzie’s post?
Regarding the 2015 WaPo story…my advice is to be very, very skeptical of stories like that. Almost all of the supposed $6B in “waste” was due to procedural technicalities and not what most people would consider “waste.” And the numbers don’t even pass the smell test. You’d have to believe that 30% of the VA’s procurement budget was totally wasted. If you’re an auditor those are the kinds of “findings” that will get you attention, but no one takes them seriously. But the ordinary person on the street has no experience or interaction with auditors and GAO types, so they’re pretty gullible when it comes to these kinds of studies.
As to paying more primary care doctors, I suspect that a better approach would be to make specialization less lucrative. US doctors already make about double what their counterparts make in western Europe, and there’s no evidence that they are any smarter or more effective. But there are all kinds of financial incentives that drive med students into specialized fields; e.g., costs of student loans, doctors owning test labs, lack of competition from abroad, and price discrimination that allows doctors to capture consumer surplus rents.
Gratuitous note. There was a time when GAO auditors really knew their stuff, but that was a long time ago. Over the last 20 years or so the quality of work coming from GAO has gone steadily downhill. Gone are the days when you could work with a white-headed experienced GAO auditor. Now you get twentysomethings with an accounting degree and six months experience before they move on to some congressional staff office. There was a time when you could describe bordered hessian matrices and Hamiltonian optimization models and GAO auditors could follow along and provide useful insights. Today’s auditors just write things up as a negative finding if they don’t understand the math. Within the technical community that’s become a common complaint about today’s GAO. And now I’ll go yell at the kids to get off the lawn.
They do audits and investigation for recovery. However it comes down to reimbursement rate they provide to doctors and it is not much to cover their cost of providing service and paying off their medical education debt.
Finally, note the article you cite says”that doesn’t mean Medicaid has no effect on health. It means that Medicaid had no statistically significant effect on three major health markers **during a two-year study.** . . And in fact, all three markers moved in the right direction.” Emphasis mine.
Notably, two years is actually a pretty short time when you have to factor in people identifying a general practitioner, making appointments, filling prescriptions, modifying their lifestyle, and then in the case of blood pressure and glycated hemoglobin waiting six months or more for the changes in medication and lifestyle to have any likelihood of showing any measurable effect.
Well, according to Kopits, we should do rich people a favor and pass a law to take away their health insurance because they are obviously throwing away money. Hey, we’re doing it for their own good.
RIP Malcolm Young.
all the best are leaving …
VA hospitals have the same problem as socialized medicine — long wait times.
“Some of the causes of prolonged wait times are inefficiencies in operation, in care coordination, and in health care organizational culture that result in flow disruption, the underuse of resources, and an imbalance between the demand of patients to be seen and the supply of providers, facilities, and alternative strategies to care for them at any given time (Mazzocato et al., 2010; Young and McClean, 2008).”
Moreover, time spent on administration work, rather than patient care, is high.
Of course, in the free market, limited resources are deployed in the best way to balance supply and demand, a poor working culture is eliminated through competition, and unnecessary costs are whittled away. Therefore, consumers receive better health care at lower costs.
Only catastrophic health care insurance is needed and insurance companies can compete with each other to provide the best plans for consumers. All other health care needs can be acquired through the free market without insurance companies at much lower costs. The huge amount of savings can be used for a stronger safety net, since consumers will spend less on health care and health care costs will be much lower.
PeakTrader: A free market is not the same as a competitive market.
“Of course, in the free market, limited resources are deployed in the best way to balance supply and demand,”
then please explain how a monopoly exists?
“All other health care needs can be acquired through the free market without insurance companies at much lower costs. ”
i am having significant cheat pains, shortness of breath, and light headedness. do i call various ambulance and emergency rooms to inquire about their costs and survival outcomes before choosing my doctor and hospital in this free market nirvana? since it is sunday, perhaps i should wait until monday morning and call the doctor, perhaps i can negotiate a better deal when he is in the office?
peak, your free market ideology should be considered extremism. and dangerous.
Baffling, it’s you who is the extremist and dangerous to the well-being of people, since you support enormous waste, and unnecessarily kill and harm patients. There are anti-trust laws – government has a limited role. Your catastrophic insurance should cover emergency room visits, if it’s an emergency, not for something like an ear infection or a skin rash. We need a consumer-driven economy. Consumers should be free to make choices at reasonable prices, rather than force taxpayers to borrow to pay ridiculous prices, ration healthcare, or just price them out.
“Your catastrophic insurance should cover emergency room visits, if it’s an emergency, not for something like an ear infection or a skin rash.”
is my cough a cold, bronchitis, or pneumonia? i guess i get to find out if my condition is covered after i visit the emergency room and get billed. very sensible health care model you have peak trader!
peak, you have an irrational and unrealistic view of how a modern society and economy works. too much ayn rand and conservative echo chambers has created your extreme ideological outlook on politics and economics. you do not even see it. but considering you harbor racist and elitist viewpoints in general, and yet deny such behavior, it is understandable. no wonder you find such comfort in the world of trump.
You forgot, baffling, you’ll need time for haggling. You know, get bids from three doctors and play them against each other.
Maybe one can offer more perks (free car washes, casino comps, steak knives) to persuade you.
In baffling and noneconomist world, when their car seems to need a repair, they drive to the centralized government monopoly repair shop and two weeks later it’s repaired. And, when they get a flat tire in the middle of nowhere, it’s two days later, the government tow truck shows up. Of course, they need insurance for gas, oil changes, car washes, etc.. It’s a great deal, because it’s subsidized insurance, while the taxpayer’s insurance is very expensive. At the Marxist meetings, they tell their fellow Stalinists, universal automotive care is great, because you pay nothing.
You can find the centralized government monopoly repair shop between the DMV and the post office across the street from the public school that costs $10,000 per student for a 12% math and science score.
peak trader, i do not subscribe to marxist ideology. that is you making straw man arguments, as usual. but you do subscribe to an ayn rand extreme ideology. not surprising coming from somebody born with a silver spoon in their mouth, and mistaking that for hard work. you have never met a poor person you wouldn’t look down upon.
Ah, PT, it appears even the simpleminded noneconomist understands markets better than the self-styled economic know-it-all who will always rely on ideological surety where none obviously exists.
See, in my mid-sized community, there are perhaps 400 mechanics toiling in well over 100 shops. Most–if not all– of these shops have the necessary diagnostic equipment, most as up-to-date as needed. Unless your vehicle is very specialized, most mechanics can perform most needed services. The consumer has plenty of choices. This market is competitive.
Conversely, there are about 100 (or so) physicians. Many are GP’s, fewer are specialists. Most–because of cost-do not have their own diagnostic equipment, relying instead on specific centers where such technology is available. Including THE local hospital, there are three of those. This market is very limited and, as you might–or should– expect, is far less competitive than the automotive one.
In an vehicle breakdown, there are numerous choices for tow and repair. In a body breakdown, that’s not the case.
In the event of a heart attack, it would. of course, be quite foolish to call three ambulance services to see who could give you the best price for a trip to the hospital. Even more foolish when arriving to haggle with the doctor on call over which heart specialist you’d like to see, especially since the one on call is one of three in the area with the other two unavailable. Something about a party and the necessity of “sleeping it off.”
So, I’ll continue to work within the available markets with a fairly decent understanding of those that are competitive and those that are not. I might add that I will continue to praise the socialists who build and maintain the highway system, the safety officers who patrol those highways, and those who respond to accidents quickly to keep those highways flowing productively.
I won’t, however, be looking for a cheaper orthopedist to perform a necessary knee replacement. I need the best for the job at hand, and fortunately he’s in my network. Nor will I be asking the hospital to cut corners during my surgery and my stay. We Stalinists are picky that way.
Excellent, we need to reduce subsidies to drive down costs whenever we can.
Yes, people want the best health care they can’t afford, like a ridiculously overpriced and overloaded Cadillac. It’s cheaper to give them a reasonably priced Cadillac with just the essentials. If you have no money, the government should provide catastrophic health care insurance, until you start earning money to pay for the insurance. If it’s a non-emergency, you can get a referral to a private doctor or a health clinic, if you need a referral, and if you have no money, you can get a referral and a voucher. Also, a health care savings account, e.g. 5% of your income, will help you pay for any healthcare needs.
And, my mom, for example is retired and pays something like $400 a month for Blue Cross/Blue Shield. She complains there’s little money left over after paying other bills, although she has expensive tastes, is rich in assets, and her retirement income is pretty high. I think, she can still get high quality health care at a lower price in a free or competitive market.
peak trader, how much do you think it costs monthly to insure an elderly person living in the united states today, without any government assistance such as medicare or medicaid? you think $400 a month is expensive?
I think, that’s supplemental insurance.
i will ask again peak, how much do you believe it costs monthly to insure an elderly person in the united states today?
I think the question raised by this post is whether massively cutting medical programs via the backdoor of massive tax cuts for the rich is morally defensible. It’s not.
You mean socially defensible. I’d like to see people make moral choices, like choosing to work, doing a good job, or learning a skill for higher income. I’ve shown income taxes are very progressive and corporate taxes are high. The goal should be more taxpayers and less transfer payments rather than more taxes from fewer workers and more transfer payments.
Even low-skilled workers can achieve the American dream through work:
“Cesar Martinez, a 37-year-old fork lift operator, has worked at a Costco in North Carolina for 19 years. He makes $22.82 an hour, gets health benefits and a pension plan. He manages to save, and doesn’t worry about hospital bills for his daughter, who suffers from asthma.”
And, when the compensation cost for health care is lower, workers can be paid more per hour or receive greater other compensation.
I meant morally indefensible. Massive cuts to health programs will harm many people.
Perhaps you are correct that there is a better way forward, that there is a cheaper and better way to provide health care.
Go for it! But bring it in by the front door. Have an open discussion of the issues.
To do it in a way that looks like the cuts are needed to give rich people and rich corporations massive tax cuts is and will always remain morally indefensible.
So, reducing the rewards of good choices and reducing the consequences of bad choices creates greater morality to you. Forcibly taking property from one person and giving it to another person, simply because one has too little and the other has too much, according to you, for whatever reason is moral to you. A moral case can be made to help those, who cannot help themselves, but cannot be made for those, who make bad choices. A social case can be made by government for good or bad.
America: the land of pro-cyclical fiscal policy. America, the land where educated, informed voters reject conservative Keynesian macroeconomic policy and prefer accentuating the booms and busts.
Why? Perhaps it is easier to privatize social wealth and in general get-rich-quick ‘n easy in a boom ‘n bust economy?
I listened to a Reuters interview with Paul Ryan the other day. I came away completely and utterly impressed with his ability to knowledgeably talk around issues. For example, Ryan points out that the US corporate tax rate is higher than other countries but explicitly fails to mention that most other countries have much higher consumption taxes.
I must admit that I am most impressed with the ability of astute American voters to ignore American tax experts.
“America: the land of pro-cyclical fiscal policy. America, the land where educated, informed voters reject conservative Keynesian macroeconomic policy and prefer accentuating the booms and busts.”
It isn’t just Republicans. One of Obama’s great failures was to begin talking about government “tightening its belt” just like families in his very first State of the Union address in 2010. Likewise his director of the OMB, Jack Lew used the very same phrase of “tightening our belts” in 2010.
Democrats seemed to wash their hands — “our work is done” — after passing the inadequate stimulus bill of 2009. It’s sad when centrist Democrats begin adopting toxic Republican talking points. Especially so when the fact is that Republicans don’t really give a damn about deficits — except when a Democrat is in the White House.
In 2010, the Democrat controlled House and Senate were complaining of “spending fatigue.” It wasn’t a spending problem, which I explained before, except there was too much spending. Another Democrat controlled government worsened the economy, for different reasons:
http://newsroom.ucla.edu/releases/FDR-s-Policies-Prolonged-Depression-5409
Reducing taxes is the best stimulus in a downturn (along with raising taxes when a sustainable expansion is underway). A $5,000 per worker tax cut (rather than small and slow tax cuts) and a boost in unemployment benefits (rather than extensions) in 2009, would’ve likely closed the output gap in 2011.
Also, after a sustainable recovery is the time to impose new regulations.
The stimulus package included numerous unemployment benefits extensions, which tended to push back employment, money for failed solar power companies, with additional regulations that kept fossil fuel prices high, cash-for-clunkers, paying people with taxpayer money to destroy their older cars, driving up used car prices, etc.. Robert Barro called Obama’s stimulus bill “garbage” and “the worst bill since the 1930s.”
peak trader, you can complain about the obama response to the great recession all you want. but do not overlook the republican controlled government that led to the great recession to begin with. please quit complaining about how somebody else did not clean up the mess to your satisfaction, when your republicans created the mess to begin with.
Baffling, you’re still trying to pin the blame on Republicans, although they weren’t effective in stopping it. The housing bubble did replace the Nasdaq bubble. Here’s what Mortimer Zuckerman, another billionaire leftist, said:
“Fannie and Freddie had been buying risky loans since 1993 to meet the “affordable housing” requirements established by Congress. No one in successive administrations effectively monitored the consequences, especially the workings of the 1977 Community Reinvestment Act, which was designed to make loans available in poorer communities. Obsessed by this political objective, Democrats would not support regulations suggested by the Republicans in the Senate Banking Committee.”
Stating facts is not complaining. And, Zuckerman, like Bloomberg, blame politicians more than Wall Street:
“The disastrous subprime market was thus the creature not so much of Wall Street as of our political leaders, who created the subprime market by pressing banks to make riskier loans and then virtually compelling Fannie and Freddie to liquefy these toxic assets by putting more and more of them on their own balance sheets.”
Oh well then, since noted expert Mortimer Zuckerman said so then it must be true. BTW, if Zuckerman is your idea of a “leftist” then you must be somewhere to the right of Mussolini.
And in your magical world the ratings agencies and corrupt banks had absolutely nothing whatsoever to do with the collapse of the housing market.
“Stating facts is not complaining. And, Zuckerman, like Bloomberg, blame politicians more than Wall Street”
but economists who studied the financial crisis are pretty clear that a lack of regulation coupled with poor risk analysis were significant contributors to the bank buildup of leveraged debt and the subsequent collapse. as a former banker who contributed to the problem, i can understand your reluctance to admit fault. but your lack of accountability is pathetic.
Bankers gave in to the hairbrain ideas of idealistic politicians to help the poor and economy, and made the best of it, which didn’t bother those politicians. So, stop your whining and don’t be so Baffled.
peak trader, i have yet to encounter a banker who did not prioritize making money. and the faster the better. those idiots at lehman brothers were not making bets on the subprime mortgages because the government asked them to help the poor. that is a pathetic excuse. they made the bets because they failed to understand the risk, and thought they were making easy money for low risk bets.
peak, i find it baffling how conservatives like yourself preach personal responsibility, and the poor should make better decisions if they no longer want to remain poor. but apparently personal accountability does not apply to oneself, like you as a banker, and the stupidity of your financial decision making leading up to the financial crisis is not your fault, but the GOVERNMENT’S FAULT!
peak, it is about time you mature and take responsibility for your own actions and how detrimental it was to the country. quit blaming others for your failures. too much of a lifetime of privilege has rotted your brain.
joseph: The balanced budget rhetoric/misleading propaganda is used by many parties and not only in the USA.
I suspect that most politicos deploying this rhetoric are just as ignorant as their voters. Though for some, perhaps it is another great way to set up fiscal policy to ‘starve the beast’.
So when will the USA:
1) adopt a federal VAT?
2) substantially increase excise taxes on gasoline and diesel fuel?
Before or after Canada starts conducting joint military exercises with the Chinese?