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The Drunkard’s Walk

November 26, 2010 in Books | 1 comment

The Drunkard’s Walk is not about drinking.  Instead, as the subtitle states, the book discusses ‘How Randomness Rules our Lives.’  Although I personally didn’t enjoy this book, I highly recommend it to most people.

There are two categories of people who should not read this book: economists (me) statisticians, or mathematicians.  These people will likely already know most of the fundamental concepts which are outlined (in a very entertaining manner) in this book.  In addition, you should not read the book if you’ve read the History of Statistics (me).  The Drunkard’s Walk has a lot of neat anecdotes about the lives of statisticians and what problems they were trying to overcome wen they developed new statistical methods.  These anecdotes, however, are more thoroughly documented in the much denser, much slower, but also much more informative History of Statistics.

To see if you should read this book, check out the following excerpts below:

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Medicaid Overview

September 26, 2010 in Books, Medicaid | 2 comments

“If you’ve seen one Medicaid program, you’ve seen one Medicaid program.”

This week, I will review some of the findings from a wonderful book titled The Politics of Medicaid.  Author Laura Katz Olson writes a well-researched book that evaluates Medicaid from the points of view of its various stakeholders including beneficiaries, providers (esp., physicians and nursing home), managed care organizations (MCOs), and the state and federal governments.  This post provides a general overview of the Medicaid program.

Enrollment

  • In 2001, it’s enrollment surpassed that of Medicare.
  • Roughly 70 of adult Medicaid participants are women, generally mothers or as frail elders in need of LTC.
  • Blacks compose 12.8% of the U.S. population, but 1/4 of the Medicaid population.
  • Latinos compose 15% of the U.S. population, but  1/5 of the  Medicaid population

Spending

  • Medicaid is the 4th largst program in the federal budget (behind Social Security, national defense, and Medicare).
  • Medicaid spending in 1966 was $1.2 billion.  In 2007, spending was $333 billion.
  • Medicaid spending is almost as high as Medicare spending ($375 billion)
  • Medicaid accounts for 15% of all American’s spending on health care.
  • Although the majority of individuals that Medicaid covers are pregnant women and children, one-third of program costs are dedicated to long-term care (LTC) services.
  • Although Medicare-Medicaid dual-eligible beneficiaries make up only 15% of Medicaid enrollment, they account for 42% of all Medicaid spending.

CHIP

  • Children’s Health Insurance Program (CHIP) provides health insurance to a large share of American children.
  • CHIP is sometimes integrated into a state’s Medicaid program and sometimes administered as a separate program.

Popularity

  • According to one study, 47% of adults would increase Medicaid funding and 46% would maintain current funding levels.
  • Medicaid had more support than most welfare programs (AFDC, TANF) but less than Social Secuirty, Medicare or SSI.
  • According to this KFF study, “Nearly three-quarters (74%) of adults say Medicaid is a “very important” government program, ranking it close to Social Security (88%) and Medicare (83%) in the public’s mind, equal to federal aid to public schools (74%), and above defense and military spending (57%). About 8 in 10 Democrats (82%) and Independents (79%) view Medicaid as an important government program, while fewer, but still 6 in 10 Republicans (61%) express that view.”

Benefits

  • Initially, the federal government required state Medicaid programs to provide five benefits: inpatient hospital care, outpatient hospital treatments, laboratory and X-ray work, skilled nursing home care for individuals age 21 and older, and physician services.

Laura Katz Olson admits at the end of the book that she believes that “a single payer is a necessary component of any restructuring of medical insurance, including Medicaid itself.”  Despite this admission, the book is thoroughly research and well-written.  For anyone interested in what really happens in the Medicaid program, I highly recommend The Politics of Medicaid.

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Book Review: This Time is Different

August 20, 2010 in Books, Economics - General | No comments

What is the history of financial crises?  Why to they occur?  Are they common?  In the book This Time is Different, authors Reinhard and Rogoff assiduously review the history of government defaults and crisis of the financial system. Their data on government default is truly astounding.  They document instance of government default in multiple ways: renegotiating the terms of a loan, failing to pay investors, and reducing the value of their debt through inflation or devaluation.  Although defaults on external debt (from foreign investors) grab the of the headlines of the international media, default on domestic debt occurs as well.

Like most bubbles, the reason for these crisis is the delusion is that “this time is different.”  Astronomical house prices relative to rent are interpreted as evidence of that past ideas of sound fundamentals are obsolete; highly leveraged investments of all types become more and more prevalent.

This is a book of economic history, but one where the last 5 chapters specifically examine how the conclusions drawn from centuries of historical data can be brought to bear to analyze the current Great Contraction.  One of the points I found most interesting is that government debt almost always booms directly after a crisis, however, not for the reasons conventional wisdom ascribes.  It is true that bailouts do add to this debt, but the main short term driver of booming U.S. debt is decreased tax revenues.  During a financial crisis, the economy slows and tax receipts drop precipitously; hence the States’ recent request for more funding from the Feds.

This book is very worthwhile for economic historians and macroeconomists.  The amount of evidence presented is overwhelming.  The key points, however, are repeated over and over; after the first 100 pages, I felt I had already digested  the main points.  This is a book that I do recommend, even if I can’t say it was a page turner.

  • Carmen M. Reinhart and  Kenneth Rogoff (2009) This Time is Different, Princeton University Press, 463 pages.

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Penile Exorcism

July 29, 2010 in Books | No comments

Here is one more excerpt from the book, The Spirit Catches You and You Fall Down. The book often discusses the intersection between Westernized medicine and more traditional healing arts.  Since mental/spiritual well-being often affects physical well-being, it should be no surprise that more traditional ritual ceremonies should offer some health improvement.  This is one of the more “interesting” cases where traditional healing arts improved both spiritual and physical outcomes.

  • Complaint/Symptomatology: The client’s penis had been swollen for about a month.  He reported that he’d been treated by licensed physicians, but that the treatment had only given intermittent relief from pain and swelling.
  • Assessment: The Neng determined that the client had offended the stream spirits.
  • Treatment Plan: The Neng called upon the Neng spirits to effect a cure and release the pain.  The Neng used a bowl of water to spray from the mouth over the infected area.  The offended spirits were offered payment of five sticks of incense to release the pain and relieve the swelling.
  • Result: The client got better after the ceremony.

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Maximum Empathy

July 27, 2010 in Books | 2 comments

I just completed reading a very interesting book about cross-cultural medical care.  The book, The Spirit Catches You and You Fall Down, and deals with the problems physicians face when treating one Hmong girl in Merced and the problems the parents of this child face when dealing with Western medicine.  One interesting describes the progression of physician empathy levels over time.

The desnsitization starts on the first day of medical school, when each student is given a scalpel with which to penetrate his or her cadaver: ‘the ideal patient,’ as it is nicknamed since it can’t be killed, never complains, and never sues.  The first cut is always difficult.  Three months later, the students are chucking pieces of excised human fat into a garbage can as nonchalantly as if they were steak trimings.  The emotional skin-thickening is necessary–or so goes the conentional wisdom–becuase without it, doctors would be overwhelmed by their chronic exposure to suffering and dispair.  Dissociation is part of the job…

At Stanford Medical School, in an admirable attempt to fight this trend, students are informed during the first semester that their empathy may already have peaked; if they succumb to the norm, it will plunge steadily during their four years of medical school and their first year of residency.

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Travellers in your Cab

May 28, 2010 in Books | No comments

“Reading is human contact, and the range of our human contacts is what makes us what we are. Just imagine you live the life of a long-distance trucker.  The books that you read are like the travellers you take into your cab.  If you give lifts to people who are cultured and profound, you’ll learn a lot from them. If you pick up fools, you’ll turn into a fool yourself.”

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Applying the Toyota Production System to Healthcare

May 21, 2010 in Books | 4 comments

Until their most recent quality stumbles, Toyota’s production techniques were the darlings of the management consulting world.  The Toyota process is embodied by the concept of kaizen, a Japanese notion of continuous improvement. The latest gurus have even applied the production techniques to the health care arena (see Designed to Adapt). A Health Affairs article by John Toussaint (2009) shows how Wisconsin has used Toyota-style production techniques to improve quality.

Some of the problems an improved production process could solve include:

  • A large fraction of steps in the health care process have no apparent value for the patient.  Touissaint estimates that this figure is currently 90%-95%.
  • A lack of trust of less-qualified peers.  Cardiologists often do not trust ED physicians to accurately diagnose a heart attack, resulting in a repetitious diagnosis process.
  • Most physicians are “…more loyal to their specialty than to the team with whom they work every day.”

Some of the solutions the Toyota production system offers include:

  • Decreasing wasted time can increase quality.  ”In 2002, for instance, our morality rate for coronary bypass surgery was nearly 4 percent.  After several kaizen projects in this area, typically removing 40 percent of the waste each time, mortality dropped to 1.4 percent in 2008 and has been 0 percent through six months of 2009.”
  • Making medical care more collaborative can improve care. For instance, in one hospital’s Collaborative Care wing, the nurse owns the care process. “The nurse remains in contact with the doctor but does not wait for instruction. Often, it is the nurse who instructs the physicians about a needed step or a critical time in the patient’s care.”

This quality improvements are sound good on paper, but take serious efforts to implement in practice.  In addition, current insurance payment schemes are not conducive to collaborative care.  Touissaint claims that Medicare pays $2,000 less per patient on average in Collaborative Care than in a traditional medical wing.

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The Boids and the Bees: A Book Review

February 19, 2010 in Books | 1 comment

The book The Boids and the Bees by A.H. Jones and Jerry Bozeman can be summarized in one acronym: CASY.  This stands for Complex Adaptive Systems.  The point of the book is that CASYs are more complex than we think and that most of life is make up of CASYs.

Let us take the example of your car (which is not a CASY).  If you have a problem with a cracked part in your engine, by replacing the part, the engine will be as good as new.

However, if you address the problem in such a direct manner for a CASY, the effect may not be what was intended.  For instance, antibiotics kill bacteria.  One would think that the use of antibiotics will make humans healthier.  However, bacteria adopt to the antibiotics through evolution.  The strong survive and then the most prevalent bacteria strains becomes the ones that are drug resistent.  Using antibiotics may, in the long-run, make humans more susceptible to disease.

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World War I’s Greatest Killer

February 12, 2010 in Books, Contagious Disease | No comments

“It is sometimes called the Great Swine Flu epidemic and sometimes the Great Spanish Flu epidemic, but in either case it was ferocious.  World War I killed twenty-one million people in four years; swine flu did the same in its first four months.  Almost 80 percent of American causalities in the First World War came not from enemy fire, but from flu.  In some units the mortality rate was as high as 80 percent.”

This passage is from an interesting book I am currently reading called A Short History of Nearly Everything by Bill Bryson.  An (unfortunately) prescient passage in the book describes a certain flu virus we all became familiar with last summer:

“From time to time certain strains of virus return.  A disagreeable Russian virus known as H1N1 caused severe outbreaks over wide areas in 1933, then again in the 1950s, and yet again in the 1970s.  Where it went in the meantime each time is uncertain.  One suggestion is that viruses hide out unnoticed in populations of wild animals before trying their hand at a new generation of humans.  No one can rule out the possibility that the Great Swine Flu epidemic might once again rear its head.“

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Three Cups of Tea

January 9, 2010 in Books | 1 comment

I just finished reading Three Cups of Tea, an interesting book chronicling of an amazing man dedicated towards bringing schools to rural areas of Pakistan and Afghanistan.  The book describes Greg Mortenson’s single minded purpose and reinforces the saying that the pen is mighter than the sword.  In fact, according to one Pakistani Brigadier General, Mortenson’s work can also have an effect on the war on terror.

“Osama is not a product of Pakistan or Afghanistan.  He is a creation of America.  Thanks to America, Osama is in every home.  As a military man, I know you can never fight and win against someone who can shoot at you once and then run off and hide while you have to remain eternally on guard.  You have to attack the source of your enemy’s strength.  In America’s case, that’s not Osama or Saddam or anyone else.  The enemy is ignorance.  The only way to defeat it is to build relationships with these people, to draw them into the modern world with education and business.  Otherwise the fight will go on forever.”

To donate to Greg Mortenson’s Central Asia Institute, please visit this website.

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