Medicine

Swiss voters on Sunday rejected a plan to ditch the country’s all-private health insurance system and create a state-run scheme, exit polls showed.

Some 64 percent of the electorate shot down a plan pushed by left-leaning parties who say the current system is busting the budgets of ordinary residents, figures from polling agency gfs.bern showed.

Going public would have been a seismic shift for a country whose health system is often hailed abroad as a model of efficiency, but is a growing source of frustration at home because of soaring costs.

“Over the past 20 years in Switzerland, health costs have grown 80 percent and insurance premiums 125 percent,” ophthalmologist Michel Matter told AFP.

There is more here, and for the pointer I thank Samir Varma.

What it is like to be struck by lightning

by on September 28, 2014 at 7:43 am in Medicine, Science | Permalink

To some survivors, these more outlandish claims only serve to reinforce the idea that their very real issues are suspect, too. “I have met people who say they have been struck three times and say the can see the future, play the piano, fuck all night long,” says Utley. “It’s all bullshit.”

Utley’s own case is not so fortunate:

After leaving the hospital, Utley spent months relearning to swallow, move his fingers, and walk. Rehab was just the first chapter of his ordeal, however. In his previous life, Utley was a successful stockbroker who often went skiing and windsurfing. Today, at 62, he lives on disability insurance in Cape Cod. “I don’t work,” he says. “I can’t work. My memory’s fried, and I don’t have energy like I used to. I aged 30 years in a second. I walk and talk and play golf—but I still fall down. I’m in pain most of the time. I can’t walk 100 yards without stopping. I look like a drunk.”

There is much more here, by Ferris Jabr, interesting throughout, hat tip goes to Vic Sarjoo.

It’s one thing for parents to shell out for cram schools or private tutors for their children, but parents in China’s Zhejiang province are taking it a step further. There, parents can give their own blood to earn some extra points on their child’s zhongkao, or high school entrance exam.

Four liters of donated blood will get your child one extra point; 6 liters adds two points; and 8 liters, three. One 28-year-old man on Weibo, China’s version of Twitter, posted that he had surpassed the 4-liter mark, a gift to his unborn child: “[I] want to tell my future son: No worries with the high school entrance exams, Dad has already got you bonus marks!” the man said, quoted in the South China Morning Post. The policy began this July, but parents are able to take into account the blood they donated in the past. The 28-year-old had started donating when he was 18.

That is from Jeanne Kim, there is more here.

Logistics firm DHL is using a drone to fly parcels to the German island of Juist, in what it says is the first time an unmanned aircraft has been authorized to deliver goods in Europe.

The company, owned by Germany’s Deutsche Post, joins the likes of Amazon.com and Google in testing the potential for drones to deliver parcels and packages.

Its drone – the “parcelcopter” – can fly at up to 65 km (40 miles) an hour. It will deliver medication and other urgently needed goods to the car-free island of Juist, off Germany’s northern coast, at times when other modes of transport such as flights or ferries are not operating.

There is more here, via Eli Dourado.

I say yes.  A number of you have been asking me for comments on this now-famous Atlantic piece by Ezekiel Emanuel.  You should read his whole argument, but here is one bit:

…here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.

Ezekiel basically wishes not to live beyond age 75.  Not that he will do himself in, but he regards that as a limit past which it is probably not desirable to go.  Just to be clear, I don’t read Emanuel as wishing to impose or even “nudge” this view on others, he is stating a personal vision.  Still, it strikes me as a somewhat strange approach to understanding the value of a life or estimating when that value ends.  The value of an individual life is to be sure somewhat ineffable, but for that same reason it is difficult for a life to lose so much of its value.

It is easy for me to see how a person could be a valuable role model for others past the age of seventy-five.  I expect Ezekiel in particular to fulfill this function superbly.  I still think frequently of the late Marvin Becker, the Princeton (later UM) Renaissance historian, who for me was an important role model at the age of seventy-seven.  Marvin often used to say “Oh, to be seventy again!”  He had more than his share of aches and pains, but he was always a comfort and joy to his wife Betty, and most likely to his children and grandchildren as well.

Or visit the list of words in Emanuel’s paragraph, cited above.  Many people are “disabled” to begin with, and many other lives are “deprived” to begin with, for one thing most of the lives in the world’s poorer countries.   But they are still, on the whole, extremely valuable lives.  I don’t just mean that external parties should respect the rights and lives of those persons, but rather internally and individually those lives are of great value.

To pick another word from that paragraph, “creativity” is overrated and most of us do not have it in the first place.  And if one does have it, perhaps its passing is in some ways a liberation rather than a personal tragedy.

I would rather be remembered as “that really old guy who hung on forever because he loved life so much” than as vibrant.  At some points I felt this piece needed a…marginal revolution.

And to sound petty for a moment, I don’t want to pass away during the opening moments of a Carlsen-Caruana match, or before an NBA season has finished (well, it depends on the season), or before the final volumes of Knausgaard are translated into English.  And this is a never-ending supply.  The world is a fascinating place and I fully expect to appreciate it at the age of eighty, albeit with some faculties less sharp.  What if the Fermi Paradox is resolved, or a good theory of quantum gravity developed?  What else might be worth waiting for?

I cannot help but feel that Emanuel is overrating some key aspects of what are supposed to be making his current life valuable, and thus undervaluing his future life past age seventy-five.  (See David Henderson too on that point.)

It was Dan Quisenberry who once said: “The future is much like the present, only longer.”

More to the point, and coming from the marginalist camp, there is Art Buchwald, who noted: “Whether it’s the best of times or the worst of times, it’s the only time we’ve got.”

The Obama administration on Thursday announced measures to tackle the growing threat of antibiotic resistance, outlining a national strategy that includes incentives to spur the development of new drugs, tighter stewardship of existing ones and a national tracking system for antibiotic-resistant illness. The actions are part of the first major federal effort to confront a public health crisis that takes at least 23,000 lives a year.

The full story is here.

The Hill has more detail.  It is an executive order:

The president’s directive creates the Task Force for Combating Antibiotic-Resistant Bacteria, co-chaired by the secretaries of Defense, Agriculture and Health and Human Services.

The group is charged with implementing a plan to track and prevent the spread of antibiotic-resistant bacteria, promote better practices for the use of current drugs and push for a new generation of antibiotic medications.

To that end, the White House on Thursday announced a $20 million prize “to facilitate the development of rapid, point-of-care diagnostic tests for healthcare providers to identify highly resistant bacterial infections.”

The added incentive and the timeframe given to the task force indicate the urgency with which the administration is acting, said Dr. Eric Lander, who co-chairs the President’s Council of Advisors on Science and Technology.

“This is a pretty tight timeline to now come up with a national game plan,” Lander said.

There is also this:

In December, the Food and Drug Administration (FDA) unveiled a plan to phase out the use of antimicrobials for the purpose of fattening chickens, pigs or other animals destined for human consumption. But the plan relies in part on voluntary industry cooperation, and advocates argue the government’s efforts are lagging behind even some industry players.

Here is the new full 78 pp. report to the President on antibiotic resistance (pdf).

This initiative — or its failure — is potentially a more important health issue than Obamacare, yet it will not receive 1/1000th of the attention.  Without reliable antibiotics, a lot of now-routine operations would become a kind of lottery.

Here are previous MR posts on antibiotic resistance.  I would note it is difficult to judge such a plan at the current level of detail.  It is better than nothing, but any initial plan is going to be not nearly enough, relative to an ideal.  By the way, Alex tells me there is also a British prize, discussed here.

Black ebola markets in everything

by on September 15, 2014 at 2:21 am in Economics, Medicine | Permalink

A black market for an Ebola treatment derived from the blood of survivors is emerging in the West African countries experiencing the worst outbreak of the virus on record, the World Health Organization said.

The United Nations health agency will work with governments to stamp out the illicit trade in convalescent serum, WHO Director-General Margaret Chan told reporters today in Geneva, where the organization is based. There is a danger that such serums could contain other infections and wouldn’t be administered properly, Chan said.

The WHO is encouraging the use of properly obtained serum to treat current patients and said last week it should be a priority. A third U.S. missionary worker who was infected with Ebola in Liberia and flown to the U.S. for medical care was treated with blood transfusions from another American who recovered from the virus last month. Doctors hope the virus-fighting antibodies in the blood help the 51-year-old physician, Rick Sacra.

There is more here, and for the pointer I thank John Chilton.

The National Football League, which for years disputed evidence that its players had a high rate of severe brain damage, has stated in federal court documents that it expects nearly a third of retired players to develop long-term cognitive problems and that the conditions are likely to emerge at “notably younger ages” than in the general population.

There is more here, all of it a bit gruesome.

Matt Yglesias writes:

…the Kaiser Family Foundation is out today with new reporting on employer benefit costs that reveals the slowdown is visible in this slice of the market. Premium costs rose by just 3 percent, a number much lower than they routinely rose by in the recent past. So how about those wage rises? Well — let’s just say there’s no evidence that they’re happening.

In other words, there is still downward pressure on real wages, even when we don’t always see real wage cuts.

This also means that the monetary policy argument “there can’t be a build up inflationary pressures because we don’t see real wages rising” is highly unreliable or at the very least a non sequitur (NB: I am not in fact extremely worried about inflationary pressures these days).

South Korea markets in everything

by on September 10, 2014 at 1:20 pm in Medicine, Uncategorized | Permalink

Fake casts for pretending you have an injured arm to evade having to help prepare holiday meals have become brisk sellers in South Korea ahead of the Chuseok festival.

“We have been selling this for 10 years now, but sales increased drastically starting last week,” said a sales manager at an online vendor who declined to be identified.

Both men and women were buying the bogus casts, he said.

During Chuseok, a three-day thanksgiving holiday, women traditionally do most of the work in preparing and cooking elaborate ceremonial dishes while the men of the family chat, drink and watch television.

The holiday gender divide is so entrenched that it has spawned the term “daughter-in-law holiday syndrome”, with many young women suffering post-holiday stress and fatigue.

But getting away with the phoney cast ruse may be difficult this year after several media outlets reported on brisk sales of the devices in the run-up to the holiday starting on Sunday.

Data from the Ministry of Gender, Equality, and Family in 2010 showed only 4.9 percent of people surveyed said both genders shared holiday chores, while the rest said women do most of the work.

There is more here, and for the pointer I thank David Lee.

Robert Laszewski writes:

The 2015 rate increases have been largely modest. Does that prove Obamacare is sustainable? No. You might recall that on this blog months ago my 2015 rate increase prediction was for increases of 9.9%.

You might also recall my reason for predicting such a modest increase. With almost no valid claims data yet and the “3Rs” Obamacare reinsurance program, insurers have little if any useful information yet on which to base 2015 rates and the reinsurance program virtually protects the carrier from losing any money through 2016. I’ve actually had reports of actuarial consultants going around to the plans that failed to gain substantial market share suggesting they lower their rates in order to grab market share because they have nothing to lose with the now unlimited (the administration took the lid on payments off this summer) Obamacare reinsurance program covering their losses.

We won’t know what the real Obamacare rates will be until we see the 2017 rates––when there will be plenty of valid claim data and the Obamacare reinsurance program, now propping the rates up, will have ended.

The post has other interesting points.

I did not expect to be reading this within my lifetime, and yet here it is:

Medicare spending isn’t just lower than experts predicted a few years ago. On a per-person basis, Medicare spending is actually falling.

That is from Margot Sanger-Katz, there is more here.  Do please note that the program still faces fiscal pressures, in part due to the ongoing rise in “n,” namely future program beneficiaries.

1. Bolivia became a semi-stable democracy in the early 1980s and it has stayed that way.

2. For all the rhetoric to the contrary, the current regime is a mix of 1990s-era market-oriented reforms and Evo Morales.  Probably you like one of these, though perhaps not both.

3. Many more Bolivian children go to school than before, and the incidence of malnutrition has been plummeting, with longer-run benefits for IQ.  You will read many fabricated or non-causally-backed claims about the connection between inequality and growth, but for Bolivia I believe these arguments.

4. Bolivia has done so many things wrong in the past, there is a lot of low-hanging fruit through purely internal improvements.  For instance the country is a fantastic tourist destination, but would not at this moment be experienced that way by mainstream American tourists, due to language, hotel, and infrastructure shortcomings.  Eventually those problems can be and will be solved.  Eventually.

5. Bolivia does not have much export exposure to China, and does not face much geopolitical risk.

6. Of all commodities, hydrocarbons may be relatively protected in price through the forthcoming global turmoil, because the Middle East implosion will make Bolivia’s current main resource more valuable.

7. Bolivia’s fiscal situation is surprisingly sound.

The three main reasons to be pessimistic about Bolivia are:

1. Most of their economic policy is quite bad, especially when it concerns the nationalization of foreign direct investment.  The FDI future of Bolivia will be extremely unfavorable.  The rhetoric and indeed the behavior of the government sometimes is like a villain from an Ayn Rand novel.

2. Their main trading partner is Brazil, a country which will have gone from eight percent growth to near-zero growth in but a few years time.  Argentina is either the number two or number three trade partner, along with the U.S., depending on the year in question.

3. Bolivia hasn’t done that well in the past.

Of those three reasons, #1 probably matters a bit less than you might think, and #3 a bit more.

It is much debated in Bolivia whether corruption is going up or down.  I believe it is going up, but partially for good reasons.  For instance the construction sector is doing well, and construction tends to be corrupt in many countries, for reasons intrinsic to the activity itself (e.g., lots of big contracts, easy to claim invisible expenses, etc.).  That means higher corruption but also a better corruption than the penny ante bribes of a shrinking economy.

Right now Bolivia is growing at a rate of above six percent.

Hannes Schwandt of Princeton has a new paper (pdf) on this topic:

Do wealth shocks affect the health of the elderly in developed countries? The economic literature is sceptical about such effects which have so far only been found for poor retirees in poor countries. In this paper I show that wealth shocks also matter for the health of wealthy retirees in the US. I exploit the booms and busts in the US stock market as a natural experiment that generated considerable gains and losses in the wealth of stockholding retirees. Using data from the Health and Retirement Study I construct wealth shocks as the interaction of stock holdings with stock market changes. These constructed wealth shocks are highly predictive of changes in reported wealth. And they strongly affect health outcomes. A 10% wealth shock leads to an improvement of 2-3% of a standard deviation in physical health, mental health and survival rates. Effects are heterogeneous across physical health conditions, with most pronounced effects for the incidence of high blood pressure, smaller effects for heart problems and no effects for arthritis, diabetes, lung diseases and cancer. The comparison with the cross sectional relationship of wealth and health suggests that the estimated effects of wealth shocks are larger than the long-run wealth elasticity of health.

You can read more by Hannes Schwandt here.

In Beijing, I met Benjamin Liebman, a professor at Columbia Law School, who has published a study on “malpractice mobs” in China. He told me that protests consistently extract more money from hospitals than legal proceedings do. Family members can even hire professional protesters. One report in Shenzhen mentioned an average price of fifty yuan a day for the service of a protester. The radiologist in Shanghai told me, “If your mother dies in the hospital, there will be an agency that comes to you and says, ‘We can help you. We can have twenty guys who can come to the hospital, blackmail them, and share fifty per cent of the profits.’ They’re very professional.”

The article, by Christopher Beam in The New Yorker, is interesting throughout.