March 2009

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A recent report from Cover the Insured.org reviews the how health insurance trends have evolved over the last ten to fifteen years.  The percent of uninsured individuals has increased from 16.0% of the population in 1995 to 17.5% of the population in 2006.  The increase is entirely due to the increase in uninsurance among working aged adults (i.e., aged 18-64).  Among children, uninsurance rates dropped from 13.7% of children in 1995 to 11.7% of of children in 2006.  SCHIP expansions likely played a large role in the increase in childhood insurance coverage.

Why are more and more working-aged adults left without insurance?  The reason is that health insurance costs are increasing faster than income.  Let us look at the following table:

Between 1996 and 2006, overall health insurance premiums for employer-provided plans increased by 4.87% for single coverage and 5.98% for family coverage.  These are average annual increases above secular inflation (i.e., CPI).  However, median real income increased by only 0.76% per year between 1994 and 2006.  Is there really a 5% gap in between income and health insurance premium growth?

The answer is yes and no.  There is still a large gap between income and health insurance premium growth, but the gap is not 5%.    Using salary as the only measure of workers compensation does not take into account the fact employer contributions towards health insurance plans has increased over time. While salary has increased only by 0.76%, employer health insurance contributions have increased by 4.62% (single) and 6.03% (family) per year.  After taking into account employer health plan contributions, we see that the true increase in real worker compensation ranges between 1.01% and 2.02% per year.

Even after taking into account the increased employer contributions, we still see that real health insurance premiums have outpaced real labor compensation by about 3.9%.  In order to decrease the number of uninsured, we need to bring down the cost of health insurance.  This means either increased cost-sharing or enacting more limitations on medical services provided.  If we do not want to increase cost-sharing or limit care coverage, premiums will continue to increase.  Whether these premiums are paid by individuals, the employer or the government, they represent a real cost to society that needs to be spent efficiently.

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More evidence that although preventive may improve patient health, it may also increase costs.  (See also my post from 12 Feb 2008).

  • Afschin Gandjour (2009) “Aging diseases – do they prevent preventive health care from saving costs?”  Health Economics, v18(3): 355-362.

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Let us say you have 10 observations of 2 different variables.  How do you determine which of the observations to use?  Should you throw out the outliers?  Should you only include the most similar values?  Does more observations increase or decrease the amount of measurement error?

These problems can be answered by the discipline of Statistics.  An interesting book by Stigler recounts The History of Statistics.  Astronomers lead many of the statistical advances in the seventeenth and eighteenth centuries.  Accurate measurement is very important to astronomers.  Further, observations with respect to the circumference and oblateness of the earth were made at different times and places throughout history.  This leaves a conundrum of  how best to combine these observations.

Mayer, Boscovich, and others contributed to the development of the idea of least squares, but Stigler credits Legendre with the invention of least squares.  Legendre came up with the idea in his attempt to measure the length of the median quadrant (the distance from the equator to the North Pole) through Paris.  

To demonstrate some of his ideas, I will use a simpler example.  Let us assume that a drug can have a dosage level between 0 and 5 and we want to find it’s impact on health (measured from a 0-10 scale).  Let us look at the following data.  The goal is to find the parameters m (slope) and b (intercept) that accurately measure the relationship between drug dosage and health (ignore any questions of endogeneity).  Should we include all 10 observations?

Although Euler recognized that including more observations increases the maximum possible error, Legendre realized that adding more observations also greatly increased the probability of getting close to the true value of the parameters of interest.  

In my example, we need to fit a line to measure the parameters m and b.  How do we set up the errors so that we have the most accurate calculations.  Laplace believed that the following two conditions would need to hold:

  1. Σi Dosagei*ei = 0
  2. Σi |Dosagei*ei| = minimum

The first condition basically says that the errors are uncorrelated with the independent variables on average.  The second condition hopes to minimize the errors.  Legendre extended Laplace’s second condition to minimize the sum of the squared errors rather than just the absolute error level.

Another key point is that this regression line must go through the “center of gravity.”  In my example, the average dosage for the ten observations is 2.2 and the average health level is 5.9.  This means the center of gravity is at the coordinates (2.2, 5.9).  In the solution in my example is to set m=1.1456 and b=3.3797.  We see that if we plug 2.2 into the equation, the output is 5.9; thus, the regression line does indeed go through the center of gravity.

Understanding the historical development of modern statistical techniques is an interesting task, and Stigler’s book enlightens the reader with much detail.

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“I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult.” — E.B. White

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Denver’s Rocky Mountain News: closed.  Seattle’s Post Intelligencer: closed.  San Diego’s Union Tribune: sold to a private equity firm.  The demise of the newspaper has been reported across different media.  The question is, do we really need newspapers or can the internet do just as good a job?  Below, I look at all the sections of the newspaper and see if their content is still relevant in the Internet Age.

  • World News: World news is important, but one would think that there are economies of scales in world reporting.  Most newspapers in small and medium sized markets get their world news content from the Associated Press or Reuters.  As long as these two organizations continue to be strong, one would guess that the quality of world news would not suffer.  Further, the internet allows individuals to read and view different electronic media from around the world.
  • National News: Similar to world news, only the most prestigious newspapers are really contributing any new news stories beyond editorials.
  • Editorials: With so many blogs, the Internet does not lack opinionated men and women.  On the Internet, readers have a much wider variety of choice of who’s opinions they seek out to read than would be the case in a local newspaper.
  • Local news/Investigative Journalism:  This is where newspapers have a competitive advantage and where they will be sorely missed.  David Simon writes in the Washington Post about how newspapers’ disappearance will leave no one to police public officials and the police.  Conducting a high quality investigative report is a full time job.  Someone who blogs from their home an hour a day will not be able to uncover corrupt police practices or the behind-closed-doors dealings of politicians.  Who will fill this void?  This is a question that still needs to be answered.
  • Business: Again, local business stories are an important service that newspapers provide.  Social networking sites such as LinkedIn help people connect, but how do you know about the news of the biggest employers in your local area?  Maybe there are blogs about this, but I would guess that many of the blogs are devoted to single firms or sectors.  On the other hand, if you are looking for the opinion of famous economists, now is a great time to be alive.  Famous economists Greg Mankiew, James Hamilton, Tyler Cowen, enlighted readers daily with their words of wisdom
  • Stock quotes.  Yahoo!, Finance, Morningstar, and Bloomberg all have up to the second stock and mutual fund quotes from all over the world.  
  • Health.  Who needs a health section of the newspaper when you’ve gotten Healthcare Economist!  There’s also WebMD and Mayo Clinic.com for medical information, and so many health policy wonks that they’ve got their own review.
  • Movie Reviews: Rotten Tomatoes does a better job than your local newspaper.  If you want ‘expert’ critics rather than just the wisdom of the masses, famous critics such as A.O. Scott and Roger Ebert have their reviews on their own websites or you can find their reviews individually on Rotten Tomatoes as well.
  • Restaurant Reviews: For wisdom of the masses, see Yelp.  For “expert” opinion, there’s Zagat.  Again, the Internet wins over local newspapers.
  • Travel News: The photos and reviews on Tripadvisor trump almost any newspaper’s travel section.
  • Sports: ESPN, Yahoo! Sports, all do a better job than your local newspaper.  They have up-to-the-second score updates, team and player statistics, and editorials.  There’s a sports blog for nearly every team.  If you’re a Brewers fan interested in Sabremetric and statistical analysis go to BrewCrewBall.  If you prefer to have your sports analysis served up by economics professors, go to the Wages of Wins Journal.

So overall, the demise of the newspaper is does not mean the end of news.  People will get their news not only faster, but from a wider variety of sources.  The main drawback of the demise of the newspaper is the void left for investigative reporters.  Who will police the police?  Who will monitor public officials?  The monitoring of public officials is a hard job, that likely requires full-time reporters.  Who the new generation of investigative reporters will be has not yet been answered.

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Percent of books published in each country that were translated works:

  • South Korea: 29%
  • Spain: 25%
  • Italy: 22%
  • China: 4%
  • U.S. (adult fiction): 3.5%
  • U.S. (total): 3%

Kushner, Aviya (2009) “McCulture” Wilson Quarterly, Winter 2009, 33(1):22-29.

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David Harlow’s Health Blawg is hosting the “Spring has just about sprung” edition of the Health Wonk Review.

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If you have $50, would you rather lose $30 or keep $20.  After a little bit of thought, you probably realize that these are the same thing.  Experimental economists, however, have generally found that individuals will go to great lengths to avoid the $30 loss.   This phenomenon is named  loss aversion.   In prospect theory, loss aversion refers to people’s tendency to strongly prefer avoiding losses to acquiring gains.

The Wilson Quarterly reviews research by Benedetto De Martino and colleagues using an experimental framework to see if individual with autism spectrum disorder (i.e., ASD or autism) were less influenced by how gambles were framed.

“More than the contrl group, [individuals with autism] seemed to recognize the ‘lose’ and ‘keep’ options as the same.  Defiiciencies in emotional processing apparently have an upside, safeguarding people with ASD from at least some forms of emotion-driven irrationality.”

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No matter the price, John Keesecker of Food and Water Watch argues that selling water for profit is a bad idea.

Keesecker: ”I think when folks see water being privatized, they see a price being put on something that’s essential.” - Marketplace.

Should water be free?  Water is a necessity.  Without it, you cannot live.  In an egalitarian society, is giving away water for free the best way to ensure that poor people receive the water they need to survive?

No.  Free water is a horrible idea.  Water is a scarce resource.  When water is free, individuals will not have an incentive to invest in water saving technologies.  For instance, if fixing a leaky pipe in your house costs $1000, you’re much more likely to pay to fix the leak if you also have to pay for the wasted water.  When water is free, you may put off fixing the pipe perhaps indefinitely.

If price of water rises and becomes unaffordable for some poor people, do we just leave them ‘out to dry’?  

If we want to redistribute money to the poor, giving cash transfers would be preferable to selling water at a 0 price.  With cash transfers, the poor could choose whether they wanted to spend their money on water or other necessities such as food and shelter.  If cash transfers are not feasible, a voucher program could be instituted.  Poor individuals already receive vouchers for food and a “water stamps” program could be similarly successful.  

A significant, positive price on water combined with some form of redistribution system should please most parties.  Environmentalists will be happy that a positive price on water will compel individuals and businesses to conserve water; social liberals will be happy that the poor will be able to purchase the water they need; and fiscal conservatives will be happy that the “water stamps” program will have a fixed budget as opposed to an open-ended program of handing out water for free.

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Soares (2009) examines the relationship between income and life expectancy around the world and particularly with respect to Latin America.  Table 1 shows GDP growth per capita and life expectancy increases around the world.  Table 2 decomposes the gains in life expectancy by age group.  Some notable findings are:

  • We see significant progress in East Asia.  East Asia had the largest increase in income (330%) and life expectancy (49%) between 1960 and 2000.  
  • Sub-Saharan Africa is still lagging behind other regions.  Income in 2000 was only 10% higher in Sub-Saharan Africa than was the case in 1960.  Further, life expectancy increased by only 15% from 1960 to 2000, from 41 years to 47 years.
  • Within Latin America, Haiti was the poorest country in 1960.  
  • Both Bolivia and Haiti had a life expectancy of 43 years in 1960.  By 2000, however, Bolivian life expectancy increased to 63 years whereas for Haiti life expectancy increased to only 53 years over this time period.
  • Barbados is the richest Latin American country.  Argentina is the richest large Latin American economy.  
  • Nicaraguan income per capita decreased by 48% between 1960 and 2000.  
  • Overall life expectancy increased in Latin American increased by 23%.
  • In Latin America, 58% of the increase in life expectancy is due to decreased mortality among individuals aged 0-19 years.

What is the cause of the increased longevity across Latin America between 1960 and 2000.  Soares claims the following:

The available evidence suggests that improvements in public health infrastructure – such as provision of treated water and sewerage services – and large-scale immunization programs may have been the key factors behind the mortality reductions observed in the period.

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