December 2008

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Bernard Madoff operated one of the biggest Ponzi schemes in history.  He has not only defrauded rich investors, but charities and university endowments as well.  If smart, Wall-street types were fooled by Madoff, can you realistic expect to avoid these Ponzi schemes?  It may surprise you but the answer is YES.

If you are a loyal reader of this blog, you know that I am a huge advocate of index fund investing (see these posts).  I have tauted the low expense ratios and diversification benefits of index funds.  Now, there is one additional benefit: transparency.

If you invest in an S&P 500 Index Fund at Vanguard, you are fairly certain that the fund’s performance will track very closely (within 1-2 percentage points) of the underlying index.  If you see the S&P 500 drop 30% in a year, and your stock broker claims that you have made a 10% positive return, you know to be suspect.  Similarly, if you buy a small cap index fund and small caps rose by 20%, but your fund only went up by 5%, you should be suspect of the returns as well.

Thus, by investing in index funds, you can validate whether or not your returns seem reasonable by comparing them to the underlying benchmark indices.

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“Adequate credit is to trade what altitude is to aircraft; without it, the odds of coming to grief over preilous commercial terrain are great.  All merchant enterprises sooner or later lose cargoes or encounter soft markets.  Without ample capital reserves and the ability to borrow at low rates of interest, bankruptcy is inevitable.”

~ William Bernstein (2008) on the importance of credit to the East India Company, in A Splendid Exchange.

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This American Life has a very interesting show about the San Diego measles outbreak.  Outbreaks decades ago were due to the fact that poor individuals often could not afford to get vaccinated or see a doctor.  Now, this is not a problem since vaccines are generally made available for free for those who cannot pay.  It was rich parents in San Diego who did not get their child vaccinated.

Most parents who do not get their child vaccinated fail to do so because they are worried about the side effects. An 1998 article in the journal Lancet claimed that there was a connection between between MMR vaccination and autism; however, this claim has been refuted and the article has been retracted.  Still, I do sympathize somewhat with these parents.  Even if there is no scientific evidence that vaccination and autism are linked, I understand the parents concern.  Further, I am sympathetic to the attitude that you shouldn’t always just do what people tell you.  However…

The story also shows the side effects of what happens when all kids aren’t vaccinated.  This American Life recounts the story of parents who’s child got the measles.  Most kids receive the MMR vaccine around 1 year of age, so babies younger than twelve months are susceptible to the disease.  The parents recount their harrowing tale of how they help their child in their arms for hours at a time, afraid if they led him lay down his heart would stop beating.  They said that they could not comment in any vaccination related debate since they would become so enraged at the individuals who did not vaccinate that they would lose their friendship.

Overall, I believe that it is right to compel parents to vaccinate their children.  Even if vaccinating would confer some small risk to individual children, the overall benefit to society from the reduction in contagious diseases far outweighs the individual costs.

This American Life Synoposis: “When they decided not to vaccinate their son against measles, two San Diego parents thought they were making the best decision for their child. But when the 7-year-old came home from an overseas trip suffering from the disease (pictured at left: measles virus), his family’s personal decision became a whole community’s problem. The resulting outbreak infected 11 children and endangered many others.

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How would you like to run a major city?  With the economic economic slowdown, would you raise taxes?  If so, on what?  If you would cut spending, what programs would you cut?

The City of Los Angeles has a survey that let’s you decide allocate the taxpayers dollars.  More information can be found at the L.A. Times.

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A health policy expert named Jim dies and goes to heaven.  God greets the recently deceased and tells Jim that he will answer one question before entering heaven.  Jim asks: “Will we ever have universal health insurance coverage in the United States?”

God answers: “Yes, but not in my lifetime.”

I was recently read the book Free Market Madness by Peter A. Ubel.  The book may be interesting for those who are unfamiliar with recent work by behavioral economists, but overall I was not overly impressed.  The main thesis is that individuals do not always act rationally (duh) and that the government can do some things–but not too much–to improve individual’s happiness.

The book reviews the work of Kahneman and Tversky,  Cass and Sunstein, Laibson, Rabin and others.  For instance, Ubel summarizes economic studies on addiction and problems with self control.  For instance, if I was at a movie theater, I likely would thank my fiancee for not buying popcorn because I know she bought it, I would eat it.  A neo-classical economist might wonder, however, if limiting our choices improve utility?

The book asks an important philosophical question: “When a sixty-year-old diabetic man purchases a pound of beef from a butcher, a six-pack of beer from the liquor store, and a dozen donuts from the bakers, how convince would any of us be that he has just maximized his best interests.”  Should the government “help” individuals to maximize their happiness?  Dr. Ubel seems to agree with Cass and Sunstein’s libertarian paternalism espoused in Nudge.  Generally, small steps such as changing the default contribution for a worker’s 401(k) or mandating the disclosure of calorie content in chain restaurants may be useful but their application, in my opinion, are limited.  Ubel suggests capping interest rates on pay-day loans makes sense, but I tend to agree with the N.Y. Times that Pay Day loan businesses are not as bad as they seem.

The book also focuses on the problem of obesity.  It notes that the cost of food–especially processed food–has dropped.  Further, with the increase in the percentage of office jobs compared to manual labor positions, the cost to exercise has increased.  Can we solve ‘obesity?’  Dr. Ubel offers a few suggestions, but most are unsatisfactory.  Further, the book has a condescending air: the author can exhibit self-control but others can not and need help.  ”…I recognize it’s easier for me, a wealthy doctor, to exert self control over my health than it is for a single mother working a low wage job.”

Dr. Ubel does a good job of showing how individuals are irrational and often act in ways that do not seem to maximize their utility.  The question, however, is whether or not the government would do a better job of maximizing and individual’s utility.  In some circumstances (i.e., the 401(k) default), it seems that the government could relatively unobtrusively improve utility.  Nevertheless, I remain unconvinced that, in general, the government superior job of  improving individual happiness.  Ubel believes that “Because the free market fails to protect consumer interests, a good government should find appropriate ways to protect us from ourselves.” Even if individuals fail to maximize their happiness, I would prefer to give individuals the freedom to choose their own path.

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NPR’s Fresh Air has an interesting interview with bioethicist Arthur Caplan, a professor from my alma matter the University of Pennsylvania.  One key point was that Dr. Caplan said, to paraphrase, that if we can all agree that health care is a right than it will be easier to move forward with health care reform.  

The question remains, is health care a right?  If it is a right, how much health care is each person entitled to?  Who’s responsibility is it to supply this right?  

Health care can not be an absolute right; by that I mean it is unreasonable to hold that everyone has a right to unlimited medical care.  That line of reasoning would bankrupt the country.  However, most “rights” are not absolute.  

For instance, the right to free speech is also not absolute; you can not yell “fire” in a movie theater and defamation is not always legal.

So what do you think about the following ideas?

  1. Is health care a right?  Why or why not?
  2. If it is a right, how much health care is each person entitled to?  

I look forward to hearing your responses.

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NPR’s All Things Considered has an interesting report on health care in Russia.  A few items that caught my eye ear:

  • Russia offers birth bonuses of $9,500.
  • In Russia each year, there are more abortions than live births.
  • The wait for an MRI in Russia can be over 2 months.
  • Doctors are often-well trained, but Russian hospitals often do not make capital improvements or even basic maintenance.  According to one individual, overall conditions were “horrible.”
  • Health care in Russia is free…sort of.   Individuals often bribe doctors to move to the head of the medical care queue.  Medical care is free but medicines are not. “You have to go to a pharmacy and buy everything — stitching, cotton wool. Everything you need during the birth, you buy and pay for. We were told to bring our own sugar. If you are a patient in a hospital, you better have a friend who can bring you food.”
  • Private physician practices are becoming popular.  The clinics are better maintained and additional services are offered.  For instance, in the state health care system, mammograms are not routine and are done only when a problem arises.   
  • These private clinics are more lucrative for physicians: “At the state hospital, I earn $200 a month, $400 with overtime,” Bogdashov says. “Here, I can make $200 in three hours of work, without the mess, the pressure and the horrible conditions.”

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PPO?  COBRA?  HEDIS?  SCHIP?  ESRD?  Are these monsters from a foreign land?  No, there are just one of the many acronyms you’ll find in the healthcare industry.

Wikipeida has a nice listing of some of the most frequently used healthcare acronyms that readers may find a useful reference.

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Accidental injuries kill more than 2,000 children per day worldwide.  The December 22, 2008 edition of Time lists the leading causes of accident-related childhood deaths worldwide:

  • Other unintentional: 31.1%
  • Road-traffic injuries: 22.3%
  • Drowning: 16.8%
  • Fire-related injuries: 9.1%
  • Homicide: 5.8%
  • Self-inflicted injuries: 4.4%
  • Falls: 4.2%
  • Poisoning: 3.9%
  • War: 2.3%

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