Saturday, August 1, 2009

Friday, July 31, 2009

Life Expectancy Arguments

Data coming out is convincing me more and more that we do get better quality health care in the US. For example, Tyler Cowen at MR cites a study comparing life expectancy at birth and life expectancy conditional on reaching age 65 for the US and the Netherlands:

At birth, someone living in the Netherlands can expect to live 2.35 years longer than someone born in the US, but at age 65, the difference is reversed, and someone living in the US can expect to live 0.4 years longer than someone living in the Netherlands. This difference can be explained by assuming that semi-socialized health care is better for young and worse for old people, or, at least as likely, different policies are not the main cause of the difference

Sources: CDC national vital statistics 2004, www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_09.pdf and RIVM 2007 levensverwachting, www.rivm.nl/vtv/object_document/o2309n18838.html (in Dutch)

So, the question still remains on distribution. Is it better to increase the likelihood that citizens are able to reach the age of 65 or that those who do (either because they are congenitally wealthier or healthier) live even longer? There are a lot of interesting tradeoffs in the debate, and the politicians are not focusing on any of them because the old conflicts over class and culture play better to less affluent voters (remember more than half of all Americans have below-average incomes).


Credibility problem

There's no such thing as a free lunch, folks. You must choose: higher taxes, fewer public services (roads, education, health care, military), or higher deficits.

Thursday, July 30, 2009

Today's reason neither politicians nor doctors want to lower costs

From Marginal Revolution and the New York Times:

From a very good piece in the NYTimes on lobbying:

One of the largest sources of campaign contributions to Senate Democrats during this year’s health care debate is a physician-owned hospital in one of the country’s poorest regions that has sought to soften measures that could choke its rapid growth.

According to the Times, the hospital has been quite successful in its efforts. And where is this powerful hospital with all the lobbying money located? Why in the metropolitan area of McAllen, Texas. McAllen, Texas? Hmmm...now where I have heard that name before?

Hint: McAllen Texas has the highest health care costs in the country.

Hmmm.

This article in the Chronicle of Higher Education purports that "There's no Power in Power Point" and advises teachers to "Teach Naked" (without technology). Then there's this:
It's worth pointing out that PowerPoint presentations are generally better than many older classroom technologies, like slate chalkboards or overhead transparencies filled with hand-scrawled notes that students struggled to decipher. So computers have probably led to a slight improvement in teaching.
So, as usual, it's not really so much the technology as much as it is how you use it. Technically, I use "smart boards" and "Power Point" but I almost never use pre-made slides anymore. I use the laser pen and palatte to draw and write the main points while I mention them. Over the last couple of semesters, students who complained about "boring power point" lectures were usually ones who had other issues with the difficulty of statistics generally or their grade specifically.

Also, I've been reading some studies on so-called "active learning." Much of it finds that active learning does not improve mastery of concepts. However, it does improve student perceptions (and teaching evaluations), and thus I have been investigating various gimmicks to introduce more "active learning" in my classes.

Wednesday, July 29, 2009

From Economix and according to The 2009 Small Business Economy:
Small businesses also pay more for health insurance than large companies. According to the Commonwealth Fund, small businesses now pay 18 percent more than large businesses pay to obtain comparable insurance.
Adverse selection?

Kenneth Arrow

Another in a set of interviews with great economists by Conor Clarke at Atlantic Monthly:
Part one: Economics and business cycles
Part two: Health Care
I guess this is one of my favorite quotations from it:
One point was that health is a random event. It's not like buying automobiles. Whether you're sick or not is hard to predict. Some get sick and some don't. That uncertainty makes it an ideal scenario for insurance. Some houses burn and some don't, but you know whose. So you have fire insurance. (And by the way, financial problems have the same characteristics, and I was always interested in the subject -- the uncertainty.)
Later,
But in the case of health care there are three players: the insurance company with the health plan, the physician, and the patient. The physician presumably has a better knowledge of what the patient needs -- at least better than the insurance company does. So the insurance company could never put together a bill. There is also a Physician and patient relationship, but the physician knows more than the patient.

There are information asymmetries in this story. Health insurance is limping along. It's limited in scope, and then you other consequences. Insurance companies have high premiums to protect themselves. The ones who come to the insurance company are sicker and the people have to pay more. You have adverse selection. You have moral hazard. And the doctor does what's on the safe side -- defensive medicine -- without regard to cost. These are fundamental conditions that make health insurance difficult.
In other words, even if a 2 quart bottle of ketchup costing twice the price of a 1 quart bottle shows market efficiency for ketchup, insurance (and financial) markets work much differently. Of course, I've made these points about adverse selection and moral hazard casually myself, too, but getting them from a Nobel (who isn't Krugman) probably adds more weight.

On the policy side, Arrow had a nice result in his 1951 Ph.D. thesis known as the impossibility theorem.

Life Expectancy Math by Bill O'Reilly

I thought yesterday was funny. Bill-O shows his complete lack of statistical literacy in this clip.

Tuesday, July 28, 2009

Rational Explanation for Hating Meetings

From Paul Graham via Freakonomics. Here's a quotation that didn't make the summary:

I find one meeting can sometimes affect a whole day. A meeting commonly blows at least half a day, by breaking up a morning or afternoon. But in addition there's sometimes a cascading effect. If I know the afternoon is going to be broken up, I'm slightly less likely to start something ambitious in the morning. I know this may sound oversensitive, but if you're a maker, think of your own case. Don't your spirits rise at the thought of having an entire day free to work, with no appointments at all? Well, that means your spirits are correspondingly depressed when you don't. And ambitious projects are by definition close to the limits of your capacity. A small decrease in morale is enough to kill them off.

Each type of schedule works fine by itself. Problems arise when they meet. Since most powerful people operate on the manager's schedule, they're in a position to make everyone resonate at their frequency if they want to. But the smarter ones restrain themselves, if they know that some of the people working for them need long chunks of time to work in.

Emphasis added by me (for no particular reason).

Health Care Quality is Better in the US

According to Becker, who cites enough careful research for it to be believable. There might be some bias in the choice of which diseases to study, and how the empirics of those studies are conducted, but I'm pretty convinced. But then, Becker does a cocktail-napkin calculation of a year of life versus the cost of 'providing' it through high-quality care. I don't think he really uses realistic numbers, and I certainly don't think he compares the quality of life well by not considering the number and value of years that would be provided to younger adult uninsured Americans to the number and value of years that are already being publically 'provided' through Medicare (or other uses of those public dollars). Of course, it would be easy to say how crass it is to think about it this way, but a health insurance bureaucrat already does, for profit.

What People Don't Know Could Fill the Oceans

HT to Marginal Revolution's "Funniest Sentence I Read Today."
At a recent town-hall meeting in suburban Simpsonville [SC], a man stood up and told Rep. Robert Inglis (R-S.C.) to "keep your government hands off my Medicare."

"I had to politely explain that, 'Actually, sir, your health care is being provided by the government,'" Inglis recalled. "But he wasn't having any of it."