February 2007 – Page 2 – artdiamondblog.com

In Health Care the “Zeal to Treat and Spend May Actually Hurt Patients”

Source of graphic: online version of the NYT article cited below.

EXPERTS have long been puzzled by the existence of large regional disparities in medical care in the United States. Even for diseases for which the appropriate treatment is widely accepted, doctors across the country take vastly different approaches, often leading to enormous expense without making any appreciable improvement in their patients’ health.

Consider heart attacks. Prescribing beta blockers immediately after a heart attack is a well-established, cheap and efficient treatment. In Iowa, nearly 80 percent of victims in 2000 received the drugs within 24 hours of a heart attack. In Alabama or Georgia, by contrast, fewer than 6 out of 10 patients received the drugs.

“What makes the lag in beta-blocker adoption puzzling is that the clinical benefits have been understood for years,” wrote Jonathan S. Skinner and Douglas O. Staiger, economists at Dartmouth, in a recent study about these regional patterns.

Congress has decided that some treatment decisions may be best taken out of doctors’ hands. In one of their last acts this year before adjourning, lawmakers passed a bill entitling doctors to a bonus from Medicare if they report data on the quality of their care, using criteria like whether they prescribe aspirin or beta blockers to heart attack victims. In the future, this data would permit Medicare to reward doctors who followed government guidelines.

. . .

. . . , much spending on health care provides enormous benefits. A study published this year by Mr. Skinner, Mr. Staiger and Dr. Elliott S. Fisher of Dartmouth Medical School found that Medicare spending on hospital care for heart attack victims surged two-thirds from 1986 to 1996, after accounting for inflation. But the percentage of victims who were alive a year after their attacks also increased, though by just 10 percentage points, to roughly 68 percent.

The relationship — rising costs bringing increased benefits — has broken down recently. From 1996 to 2002, Medicare spending on treatments for heart attack victims increased about 14 percent, after inflation. But there was virtually no improvement in survival rates.

There is mounting evidence that the zeal to treat and spend may actually hurt patients. The study by Mr. Skinner, Mr. Staiger and Dr. Fisher found that hospitals in regions where spending grew fastest from 1986 to 2002 had some of the worst practices, in terms of providing tried-and-true therapies, and recorded the smallest gains in survival rates.

Treatment of heart disease underscores the deeply idiosyncratic nature of many choices made by America’s doctors and hospitals. Coupled with a fee-for-service system that encourages aggressive treatment, these choices stimulate health spending that provides little benefit to patients. “A lot of the innovation and spending growth are going into gray areas that are not helping people that much,” Mr. Skinner said.

For the full commentary, see:

EDUARDO PORTER. "ECONOMIC VIEW; The More You Pay, the Better the Care? Think Twice." The New York Times (Sun., December 17, 2006): 5.

(Note: ellipses are added.)

Union Decline Continues in United States

Source of graphic: online version of the NYT article cited below.

Union membership dropped sharply last year in the United States, as the percentage of manufacturing workers in unions fell below the percentage of American workers in unions for the first time in modern history.

The Bureau of Labor Statistics reported Thursday that union membership fell by 326,000 in 2006, to 15.4 million workers, bringing the percentage of employees in unions to 12 percent, down from 12.5 percent in 2005. Those figures are down from 20 percent in 1983 and from 35 percent in the 1950s.

Work force experts said the decline in union membership was caused by large-scale layoffs and buyouts in the auto industry and other manufacturing industries, together with the labor movement’s difficulties in organizing nonunion workers fast enough to offset those losses.

For the full story, see:

STEVEN GREENHOUSE. "Sharp Decline in Union Members in ’06." The New York Times (Fri., January 26, 2007): A11.

Bertrand Russell: Think or Die

I heard a great Bertrand Russell quote, a couple of days ago. (Sometime I’ll try to verify it.) It is:

"Some people would rather die, than think. And they do."

(attributed to Bertrand Russell)

House Hearing on Global Warming Canceled Due to Severe Winter Weather

Wolf Blitzer, the host of CNN’s "Situation Room" program. Source of photo: http://www.mediabistro.com/tvnewser/cnn/inside_the_situation_room_24403.asp

Yesterday afternoon (2/14/07) on CNN’s "Situation Room" program, host Wolf Blitzer reported something close to the following:

‘A House of Representatives hearing on global warming was canceled today, because of the severe winter weather.’

Fed Chairman Bernanke’s Omaha Speech

Bernanke in Omaha addressing the Chamber of Commerce (left) and after receiving a plaque officially appointing him as an "admiral" of the Nebraska Navy (right, ha, ha). Source of the left photo: http://www.omaha.com/neo-images/photos/large/ap-nenh10102061909.jpg Source of the right photo: online version of the NYT article cited below.

Last week, on 2/6/07, I attended a large Chamber of Commerce luncheon at which Federal Reserve Chair Ben Bernanke was the featured speaker. The talk was subtle and restrained, but interesting. Apparently it was one of the first speeches by Bernanke, since becoming chair, to address an economic issue broader than the macro policy issues that the fed usually addresses. The headlines in the Omaha World-Herald and the Wall Street Journal missed the main point, I think.

The main point was not to criticize the inequality of the United States economy, but to praise its dynamism. He pointed out the extent to which living standards have improved as a result of that dynamism. And he wanted mainly to suggest that when we adopt policies aimed at reducing inequality, we be careful to be sure that the policies do not have the unintended consequence of reducing the dynamism.

In particular, he suggested that much of the inequality was driven by an increasing skill premium, and that the most constructive way to reduce inequality would be to reduce the skill premium by increasing the supply of skilled labor. This implies that individuals, and government, invest in increasing skills through increased access to community colleges, universities, online education, and the like.

For the full NYT article, see:

"Bernanke Suggests How to Narrow Wage Gap." The New York Times (Weds., February 7, 2007): C13.

For the full WSJ article, see:

DAVID WESSEL. "Fed Chief Warns of Widening Inequality; Bernanke Urges Steps That Avoid Harm to Economy." The Wall Street Journal (Weds., February 7, 2007): A6.

For the full Omaha World-Herald article, see:

STEVE JORDON. "Fed chief says income gap poses problems." Omaha World-Herald (Wednesday, February 7, 2007): 1D & 2D.

(Note: the online version of the article had the slightly different title "Growing income gap poses problems, Fed chief says" and is dated 2/6/07. The article may have first appeared in the paper’s evening edition on 2/6/07. My copy was the morning edition of 2/7/07.)

For the text of Bernanke’s "The Level and Distrubution of Economic Well-Being" presentation, see: http://www.federalreserve.gov/boarddocs/Speeches/2007/20070206/default.htm

Source of graphic: online version of the WSJ article cited above.

Investment Firms’ Advice Biased Towards Over-Saving

Graphic on optimal savings. Source of graphic: online version of the NYT article cited below.

Could it be possible that you are saving too much for your retirement?

. . .

. . . , a small band of economists from universities, research institutions and the government are clearly expressing the blasphemy that many Americans could be saving less than they are being told to by the financial services industry — and spending more — while they are younger. The negative savings rate, they say, is wildly distorted.

According to them, the financial industry, with its ostensibly objective online calculators, overstates how much money someone will need in retirement. Some, in fact, contend that financial firms have a pointed interest in persuading people to save much more than they need because the companies earn fees on managing that money.

The more realistic amount could be as little as half the typical recommendation made by Fidelity, Vanguard or any number of other financial institutions.

For a middle-income couple, that could mean trading $400,000 in retirement money for about $3,000 a year more during prime working years to spend on education or home improvement. “For a middle-class household, that’s a lot of money,” said Laurence J. Kotlikoff, a Boston University economics professor, who is on the forefront of this research into spending and savings, and is selling his own retirement calculator.

. . .

Nevertheless, the loose confederation of well-regarded economists, who have not been working in concert, say their research points to the startling conclusion that many Americans are saving too much, not too little. Indeed, their studies of the savings and spending habits of the generation born between 1931 and 1941 revealed that at least 80 percent had accumulated more than enough wealth for retirement. While they have not studied the baby boom generation as closely, they believe that the greater wealth of that generation should also leave those retirees secure.

A study last October by another group of economists, including two working for the Federal Reserve Board, found 88 percent of retirees age 51 and older had adequate wealth.

“Even the most casual reading of the popular press will have you convinced that Americans are heading like lemmings over a cliff,” said John Karl Scholz, an economics professor at the University of Wisconsin at Madison. “Going into this, I had no idea that we’d find any results anything like this.”

. . .

Mr. Scholz said he and his co-authors of a study, “Are Americans Saving ‘Optimally’ for Retirement?” found oversaving across all economic and education levels and most ethnic or racial groups as well. (It found that Hispanics tended to save less.) Those who were not saving enough were usually missing their target by only a small amount.

The one exception to this optimism involves people who enter retirement single, either because their spouse died early, they divorced, or they never married. The studies found this group did not save enough.

For the full story, see:

DAMON DARLIN. "Your Money; A Contrarian View: Save Less and Still Retire With Enough." The New York Times (Sat., January 27, 2007): ??.

(Note: ellipses added.)

Al Gore Freezes

Al Gore. Source of image: http://drinkingliberally.org/blogs/louisville/archives/2006/01/

For the past couple of weeks, much of the country has been suffering from non-stop frigid weather. So on "Weekend Update" on NBC’s Saturday Night Live (2/10/07), something close to the following was reported:

‘And in an ironic note: this week while lecturing on global warming, Al Gore froze to death.’

Toy Boats, Johnny Astro, and the Free Market

Screen capture from eBay’s "Toy Boat" ad.

A few years ago, eBay created a wonderful ad in which a young boy is at the beach playing with his toy boat. His mother tells him that it’s time to go; he leaves the beach forgetting his boat; the boat washes out to sea and sinks in a huge storm. A fisherman hauls up the boat in his fishing net. He brushes it off and puts it up for sale on eBay. The next scene is of a 20-something young man looking stunned at a computer screen, with a picture in the background of himself as a boy with the toy boat. On his PC screen is the eBay page with the boat for sale.

The point is how wonderful free markets can be when they help consumers find and obtain what consumers desperately want.

Of course this is just an ad. But it rings true. See the story excerpted below:

My husband, for example, still hankers for a certain flying toy he played with as a child.

For years, I have heard stories about this lost talisman of youth, an almost mythical toy that had an inflated balloon that could be launched into the air and propelled through a room by a whirring fan.

But my husband could never remember its name — until the other day.

“I FOUND IT! I FINALLY FOUND IT!” he wrote in an instant message that popped up on my computer.

. . .

“IT’S CALLED THE JOHNNY ASTRO.”

Johnny Astro. With a name like that, a name that evokes rocket ships, moon walks and the glory of the technological future hurtling our way, you can see why such a toy would linger in the memory of a boy who grew up in the 1960s.

“GET ME ONE FOR MY BIRTHDAY,” he typed. “PLEASE.”

How could I refuse?

. . .

I turned to eBay. A set was for sale with seven bidders so far, with a high bid of $76. An hour before the auction closed, I placed a bid authorizing eBay to go as high as $207 on my behalf. (I calculated I would get the set for a much lower price, however, given Ms. Grant’s price range.)

In the last minutes of the auction, the number of bids climbed to 21. But in the end I got the set — for $204.49.

My husband acted shocked.

“You paid how much?” he asked.

“You said you wanted it for your birthday,” I said.

He thought about it for a minute.

“If I got two,” he said, “we could fly them together and exchange balloons in the air.”

For the full story, see:

MICHELLE SLATALLA. "ONLINE SHOPPER; A Toy That Sends Grown Men Into Orbit." The New York Times (Thurs., January 25, 2007): E6.

The link for the Toy Boat ad is: http://www.thepowerofallofus.com/flash.html (click "TV Spots" and then "Toy Boat")

Drawing of Johnny Astro toy. Source of drawing: online version of the NYT article cited above.

Milton Friedman’s School Vouchers Pass Utah Senate

I received an email mailing yesterday (2/9/07) from Robert Fanger, who is the Communications Director of the Milton and Rose Friedman Foundation. He wrote: "By a vote of 19 to 10, the Utah Senate passed the universal school voucher bill this afternoon."

On Wednesday, the Wall Street Journal ran an editorial on the issue that is excerpted below:

Proving that the best reforms often pass by the slimmest of margins, Utah’s house voted 38-37 late last week to create a state-wide voucher program that will allow students to escape failing public schools.

Union opponents can be expected to mount a furious assault in the state senate, and then head to court. But the senate is likely to pass the reform supported by GOP Governor Jon Huntsman Jr., so Utah may soon become the first state with a universal school choice plan. It would offer students who attend private K-12 schools from $500 to $3,000 in tuition reimbursement based on family income.

Meanwhile, South Carolina could be next. Legislation is now being drafted to allow nearly 200,000 poor students to opt out of failing public schools by giving them up to $4,500 a year to spend on private school tuition. Middle class parents would be eligible for a $1,000 tax credit.

Reference for editorial:

"Choice Advances." The Wall Street Journal (Weds., February 7, 2007): A14.

Real-Time Pricing Results in More Efficient Electricity Generation

Real-time electricity meters in a building in Central Park West behind resident Peter Funk, Jr. Source of photo: online version of the NYT article cited below.

The article excerpted below gets some of the story right. It should emphasize more that the main benefit from real-time pricing would be that it would reduce the peak load. Generation plants need to be built to handle peak-load. The last generating plants to go on line are the least efficient. if the need for such inefficient, peak-load, plants can be reduced, the costs of generating electricity can be enormously reduced.

There is talk of market competition in the states that have deregulated their electric utility industries. But it should be remembered that even where most deregulated, the result is a long way from a paradigmatic free market. The main point is hinted at in the article below. The ultimate suppliers of electricity to the home remain government-protected monopolies.

If we wanted a truly free market, maybe we should actually allow multple companies to connect to homes, the way we allow multiple television and internet companies to connect their cables to the home. Then some low-cost Wal-Mart of electricty would arise, and blow the stick-in-the-muds away.

(p A1) Ten times last year, Judi Kinch, a geologist, got e-mail messages telling her that the next afternoon any electricity used at her Chicago apartment would be particularly expensive because hot, steamy weather was increasing demand for power.

Each time, she and her husband would turn down the air-conditioners — sometimes shutting one of them off — and let the dinner dishes sit in the washer until prices fell back late at night.

Most people are not aware that electricity prices fluctuate widely throughout the day, let alone exactly how much they pay at the moment they flip a switch. But Ms. Kinch and her husband are among the 1,100 Chicago residents who belong to the Community Energy Cooperative, a pilot project to encourage energy conservation, and this puts them among the rare few who are able to save money by shifting their use of power.

Just as cellphone customers delay personal calls until they become free at night and on weekends, and just as millions of people fly at less popular times because air fares are lower, people who know the price of electricity at any given moment can cut back when prices are high and use more when prices are low. Partici-(p. A14)pants in the Community Energy Cooperative program, for example, can check a Web site that tells them, hour by hour, how much their electricity costs; they get e-mail alerts when the price is set to rise above 20 cents a kilowatt-hour.

If just a fraction of all Americans had this information and could adjust their power use accordingly, the savings would be huge. Consumers would save nearly $23 billion a year if they shifted just 7 percent of their usage during peak periods to less costly times, research at Carnegie Mellon University indicates. That is the equivalent of the entire nation getting a free month of power every year.

. . .

Under either the traditional system of utility regulation, with prices set by government, or in the competitive business now in half the states, companies that generate and distribute power have little or no incentive to supply customers with hourly meters, which can cut into their profits.

Meters that encourage people to reduce demand at peak hours will translate to less need for power plants — particularly ones that are only called into service during streaks of hot or cold weather.

In states where rates are still regulated, utilities earn a virtually guaranteed profit on their generating stations. Even if a power plant runs only one hour a year, the utility earns a healthy return on its cost.

In a competitive market, it is the spikes in demand that cause prices to soar for brief periods. Flattening out the peaks would be disastrous for some power plant owners, which could go bankrupt if the profit they get from peak prices were to ebb significantly.

. . .

The smart metering programs are not new, but their continued rarity speaks in part to the success of power-generating companies in protecting their profit models. Some utilities did install meters in a small number of homes as early as three decades ago, pushed by the environmental movement and a spike in energy prices.

For the full story, see:

DAVID CAY JOHNSTON. "Taking Control Of Electric Bill, Hour by Hour." The New York Times (Mon., January 8, 2007): A1 & A14.

(Note: ellipses added.)

Graph showing the range of variation in hourly electricity rates in different months. Source of graphic: online version of the NYT article cited above.