July 2010

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In my job, I spend nearly my entire day staring at a computer screen.  Whether this is writing computer code, compiling a report, reading papers, or checking my email, I am constantly in a seated position.  I do, however, exercise six mornings per week.  Does this mean that I am an active, healthy person since I exercise religiously or that I am a health risk since I spend so much time sitting?

The N.Y. Times Well blog describes a May 2010 paper which found the following:

Men who spent more than 23 hours a week watching TV and sitting in their cars (as passengers or as drivers) had a 64 percent greater chance of dying from heart disease than those who sat for 11 hours a week or less. What was unexpected was that many of the men who sat long hours and developed heart problems also exercised. Quite a few of them said they did so regularly and led active lifestyles. The men worked out, then sat in cars and in front of televisions for hours, and their risk of heart disease soared, despite the exercise. Their workouts did not counteract the ill effects of sitting.

The extremeness of our sedentary lifestyle is to blame.  Doing things such as cooking and cleaning is not heavy exercise, but it does burn some calories and get your heart moving much more than just sitting in front of the T.V.  Chasing after toddlers after work–while potentially a stressful activity–could also help improve your heart’s condition.

The article recommends decreasing the amount of extreme physical inactivity in your day.  For instance, stand up more and sit less.  Pace around your office.  Do housework while you are watching T.V. Read your favorite blog on a mobile device while going for a walk.  Your heart will thank you.

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While at work last week, I began to spoon coffee grounds to make coffee.  How many coffee grounds should I scoop?  Too few and the coffee will be watery.  To many and the coffee will taste like mud.  Then it hit me, coffee making is a perfect example of a number of economic concepts.  So today I will use coffee brewing as a vehicle to discuss 3 key economic concepts .

OPTIMIZATION

What is the optimal number of scoops of coffee?  The answer to this question depends on the function you are trying to maximize.  Let us assume you want to maximize taste.  The relationship between taste and scoops is:

  • Taste = 10-(Scoops-9)2

By taking the derivative of this function and setting it equal to 0, we can quickly see that the ideal number of scoops is 9.  But what about cost?  If you buy coffee, you know that the supermarket isn’t giving it away for free. Instead, your goal may be to minimize cost.  If each scoop costs $0.15, the the cot function is as follows.

  • Cost = $0.15 * Scoops

To minimize cost, the the ideal number of scoops is 0 (i.e., just drink water).

Most people, however, are concerned with both taste and cost.  Foodies will care more about taste, but frugal individuals may care more about cost.  One way to balance these two concepts is through a utility function.  Assume that your utility function is as follows:

  • Utility = Taste/80 – Cost
  • Utility = [10-(Scoops-9)2]/80 – 0.15*Scoops

Because this function is also strictly convex, we can also take the derivative and set it equal to 0 to determine the optimal number of scoops.  When taking into account both taste and cost, the optimal number of scoops is 3.

CONSTRAINED OPTIMIZATION

In life, you can’t always get what you want.  In these cases, constrained optimization must be used.  For instance, let us assume that you want to maximize taste subject to a constraint that the cost of the coffee has to be less than $1.  The optimal taste level is 9 scoops.  However, you cannot afford 9 scoops since this will cost $1.35.  Instead, what you can afford is 6 scoops ($0.90).  If we were being precise, you could afford 6 2/3 scoops.  If you had a constraint of a $15, however, you wouldn’t want to use 100 scoops of grounds (your coffee would taste like mud).  In this case, the constraint is not binding and you would choose the unconstrained optimal number of scoops (i.e., 9).

PUBLIC GOODS

Let us return to the case where you care about both taste and cost in your utility function.  If you spend more money on coffee you’ll have less money to use for other goods or services.  At my job, however, the kind folks at Acumen supply us with free coffee.  Employees should view this free coffee supply as a public good.  By using more scoops, you do not take away coffee from someone else because there is always more.  Further, because the coffee is readily available, no one is prevented from drinking it.  Thus, free coffee at work is in essence a public good since it is non-rivalrous and non-excludable.

Because I personally do not pay for the coffee, I always choose the number of scoops of grounds to maximize taste.  [In my example, this was 9 scoops].  If I am brewing my own coffee I might hedge towards using slightly less than optimal number of scoops of grounds.

The following spreadsheet gives the numerical calculations behind all the optimizations stated in this blog post.

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National Health Expenditures reached $2.3 trillion, or $7,681 per person. This means that health care services made up 16.2% of the economy. Where did these dollars go? The CBO summarizes where America spends these funds.

Source: CBO Long Term Budget Outlook, June 2010.

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CoR #109

The 109th edition of the Cavalcade of Risk is up at Disease Management Care Blog (DMCB).

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For Part B services, Medicare pays physicians based on the services they provide.  The American Medical Association (AMA) developed Current Procedural Terminology (CPT) codes to create a taxonomy of procedures that physicians perform.  Does the Centers for Medicare and Medicaid Services (CMS) use these codes for payment?

The answer is yes and no.  Officially, CMS uses Healthcare Common Procedure Coding System (HCPCS) codes.  These codes are used to classify about 6,700 distinct services. Although CMS does not officially use CPT codes, the HCPCS are closely related to CPT codes.  In fact, there are two sets of HCPCS codes. “The first set, HCPCS Level I, are based on and identical to CPT codes…Level II HCPCS codes are used by medical suppliers other than physicians, such as ambulance services or durable medical equipment.”

The Medicare Administrative Contractor (MAC) actually process the payment for these claims.  There are 4 MACs for durable medical equipment claims and 15 MACs for processing Part A and B claims.

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Spain won the World Cup championship on Sunday with an overtime goal from Andrés Iniesta.  Were the Spanish announcers of Canal + excited at the prospect of their country winning the world cup?  Listen to this.

More coverage:

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Although Medicaid is currently one of the largest programs in any state’s budget, Congress enacted this welfare health insurance scheme as almost an afterthought.

Consider the news coverage for Medicaid at the time.  According to the chart below, the New York Times didn’t even mention Medicaid an any article in 1965 and Medicaid was mentioned in less than a third of the articles that Medicare was.  For comparison, the coverage did not nearly approach the media coverage in the 1930s after Social Security was enacted.

Source: Laura Katz Olson (2010), The Politics of Medicaid, Columbia University Press, New York, 426 pages.

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This can no longer be a profession of craftsmen individually brewing plans for whatever patient comes through the door. We have to be more like engineers building a mechanism whose parts actually fit together, whose workings are ever more finely tuned and tweaked for ever better performance in providing aid and comfort to human beings.

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