October 2009

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To Boo or Not to Boo

October 31, 2009 in Miscellaneous | No comments

Sunday marks a historic day…Brett Favre returns to Lambeau Field.  Many Packers fans are conflicted about whether or not to boo the legend.  

Former Packer LeRoy Bulter advises: “But if you’re going to stand up wearing Packer clothing or a Packer uniform and cheer when Brett Favre comes out, you should bring a bag and put it over your head. You don’t cheer for somebody to beat your team, I don’t care who it is. You don’t cheer for another quarterback.”

Writer Garry Howard disagrees: “Stand up in front of your seat, put your hands together and clap. And whistle. And then clap some more. Forcefully. And cheer. Loud. Louder. The loudest you have ever screamed in your life.”

What would you do?

As a life-long Packers fan, I’ll follow the advice of my favorite Packer of all-time, William Henderson.  ”As much of a friend, as I would consider myself to Brett, a teammate for life when he was with the Packers, I’m gonna boo like I hope the rest of the fans do.”

Why Environmentalists should NOT support Organic Farming

October 30, 2009 in Economics - General | 4 comments

Currently, organic farming supplies less than 3% of America’s food, but this figure is on the rise.  Does organic farming provide a “sustainable” of how to grow food in the next millennium?  

Paul Roberts thinks not.  Eliminating chemical fertilizers and pesticides would reduce crop yields.  Thus, the amount of additional farmland that would be needed to be brought online to replace lost productivity would be immense.  Vaclav Smil claims that an expansion of organic farming would “require complete elimination of all tropical rainforests, conversion of a large part of tropical and subtropical grasslands to cropland, and the return of a substantial share of the labor force to field farming.”   

“Local” farming is viable either.  Most eaters live in cities while most growers are on distant farms.  Growing massive amounts of food in urban areas is not economically viable.  Columbia Professor Dickson Dispommier claims that a 30-story glass skyscraper using nonsoil farming could produce enough food on a single city block to feed 50,000 people, but the farm would cost $200 million to build.

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Urban Institute: Reform Plan’s affect on the Number Uninsured in the U.S.

October 29, 2009 in Health Insurance | 1 comment

Currently there are about 45 million uninsured individuals in the United States.  The Urban Institute predicts would happen to the number of individuals uninsured under the following of reforms.

  • Expand Medicaid to individuals with incomes up to 133 percent of the federal poverty line (FPL): 17 million uninsured would receive insurance
  • Provide subsidies to individuals with incomes between 133% and 400% FPL to purchase health insurance: 16.3 million uninsured would receive insurance.
  • Enact an insurance mandate: 4.3 million uninsured persons  would not be eligible for Medicaid or subsidies because they have incomes of at least 400 percent of the FPL,  but would be required to purchase coverage due to the individual mandate.
  • Number left uninsured: 6.3 million, these are the unauthorized or recently authorized immigrants.

Under these proposals, only immigrants would not have insurance.  However, these reforms do not solve to problem of expensive health care or low quality health care.  One can make everyone insured by enacting an individual mandate, but if health insurance costs $12,000 for a family, there is little hope that family earning $20,000 will be able to afford the premiums–regardless of whether there is a mandate or not.

Expanding insurance is a laudable goal, but it should not be the only one.  Making health insurance more affordable would allow more people the option of purchasing health insurance.  Further, spreading best practices across physicians would improve health care quality and may even reduce costs.

Source:  Dubay, Cook, Urban Institute “How Will the Uninsured Be Affected by Health Reform?“

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Mid-week Links

October 28, 2009 in Current Events | No comments

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Tips on Patient Care

October 28, 2009 in Quality | 1 comment

In an article called “That Loving Feeling,”  Judy Capko gives some tips for providers on how to treat patients.  Some gems include:

  • “A sign in sheet is an excuse to ignore patients.”
  • Nurses and receptionists need to introduce themselves.  Otherwise, patients just feel if they are another name in the schedule.
  • Ambience makes a difference.  An NBER working paper found that practice amenities make a big difference in perceived quality.
  • Each new patient arrival should be assisted within 60 seconds.

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“Health care, at any level, cannot be equated in dollars and cents.”

October 27, 2009 in Economics - General | 6 comments

Dr. Bruce Douglas’s perspective on taking money out of health care:

“Health care is a ‘service,’ provided by health care practitioners, that does not belong in the competitive, so-called free enterprise marketplace. Of course, doctors have to be paid, but the payment should not come directly from the patient. Reception areas in doctors’ offices should be places where patients register for care, provide their insurance information, fill out a history form, and wait to be seen by their doctor. Receptionists should enter the information in a computer and be fed all the information that has been stored, privately, about that patient, that the doctor needs in order to give the patient undivided, preventive-oriented attention.  Money should not be mentioned, directly or indirectly, because health care, at any level, cannot be equated in dollars and cents.“

Is this a realistic view for an effective health care system?  The patient doesn’t pay and the doctor doesn’t worry about cost?  Actually, yes…if the insurer limits the phyisicans choices regarding what is insurable.  In other words, this is managed care.  The patient pays nothing or little, the physicians can prescribe whatever they want regardless of price, but the physician choice is limited to treatments that are approved by the managed care organization.  However, Dr. Douglas does not support significant limitations on the physicians treatment choices.  He describes the the growth of HMOs as “rationing raised its ugly head.” 

If on the other hand, the doctor means that insurance should pay for whatever they want, doctors should prescribe whatever they want, and patients shouldn’t pay anything, well then this is a  recipe for significant cost inflation.  When insurance only covered severe hospital stay, patients would pay for most of medical care out of their own pocket.  If this was the case, then the doctor’s recommendations would be accepted or rejected by the patient based on affordability and other factors.  

Dr. Douglas’s solution is for a single payer system.  However, even a Medicare-for-all system will face the same dilemma.  Either, the single payer system will limit cost, but will have to ration care, or it will decide to cover all services but the cost of health care will increase.  

Swine Flu Emergency Declared

October 26, 2009 in Contagious Disease | 2 comments

As I predicted, the H1N1 influenza virus has returned to the U.S. this fall.  FluTracker gives a visual representation of the spread of the disease.  

In response to the spread of H1N1, President Obama declared the H1N1 outbreak a national emergency.  The declaration will  ”allow a hospital to set up a make-shift satellite facility for swine flu patients in a local armory or other suitably spacious location, or at another hospital, to segregate such cases for treatment.”  Without the waiver, “[u]nder federal law, if the patients are sent off site …the hospital could be refused reimbursement for care as a sanction.”

However, the national emergency declaration won’t help increase the speed of production for the H1N1 vaccine. The state of New York had previously declared that all health care workers must be vaccinated for against H1N1.  However, the state recently waved this mandate, not because of a change of opinion but because of vaccine shortages.  The FDA has approved an experimental intravenous use of peramivir against H1N1 in emergency cases.  The FDA approval states that “peramivir can be used when other drugs have failed or when delivery by a route other than intravenous is not expected to be feasible.” 

Should people with flu-like symptoms go to the doctor?  The answer is yes.  However, you may have H1N1 even if your test gives a negative result.  The rapid-test version will only give a positive test result for  11 out of every 100 people who actually have the H1N1 virus (at best).

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Links

October 24, 2009 in Uncategorized | No comments

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Genetic Adverse Selection

October 23, 2009 in Health Insurance | No comments

“…individuals who carry the [Huntington Disease] genetic mutation are up to 5 times as likely as the general population to own long-term care insurance…relatively limited increases in genetic information may threaten the viability of private long-term care insurance.”

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Why Public-Private Partnerships are attractive: Renegotiations

October 22, 2009 in Public Policy | No comments

Public-Private partnerships (PPP) are becoming increasingly popular.  In Europe, the annual value of PPP is 22.9 billion Euros.  In the United States, where until recently PPPs played a smaller role than in many European countries, financing of transportation infrastructure via PPPs increased almost tenfold, on an annual basis, between 2006-2008 and the preceding decade (1996-2005).

Why are PPPs so popular?  One reason is that they allow the government to work with private firms without incurring the political stigma of “privatizing.”  A paper by Engel, Fischer and Galetovic (2009), however, believes that the main reason is soft budgets.  Governments can defer costs to future administration with the PPP.  “Essentially, because PPP arrangements bundle finance and construction, the firm can ‘lend’ to the government by renegotiating the contract in return for payments made by future administrations.”  The Engel-Fischer-Galetovic model generates four predictions:

“(i) in a competitive market, firms lowball their offers, expecting to break even through renegotiation, (ii) renegotiations compensate lowballing and pay for additional expenditure, (iii) governments use renegotiation to increase spending and shift
the burden of payments to future administrations, and (iv) there are significant renegotiations in the early stages of the contract, e.g. during construction.”

Using data from Chile, the authors find that 30% of all contracts between the mid-1980s and 2000 were renegotiated.  Renegotiation was especially prevalent for transportation and water projects.  Total investment in PPP contracts was initially $8.4 billion over this time.  However, after renegotiation, the ex-post cost increased to $11.3 billion, a one-third increase.

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