Category: Uncategorized

Physician and Nurse Incomes Have Increased Tremendously

by  Alex Tabarrok in

There has been a lot of ink spilled over the rising cost of health care and in Why Are the Prices So D*mn High? Helland and I do not cover every theory and cannot satisfy every objection. Our goal is more modest. We can say that one major factor in rising health care costs is the rising price of skilled labor.

We argue that there is a direct, obvious, and measurable cause of higher costs in healthcare—namely, the price of skilled labor. No profession other than physicians has seen such large increases in incomes over the past 50 years. Figure 19 shows the real income of physicians from 1960 to 2016, indexed to 100 in 1960. Since 1960 the real income of physicians has increased by a factor of three. By comparison, barbers and bus drivers have seen essentially no increase in real incomes. Median incomes are up only modestly whereas mean incomes, which are pulled up by outliers, are up by only 50 percent.

Moreover, nurse incomes have risen in lock-step with those of physicians.

At the same time, we have hired more physicians and more nurses per capita. As Figure 20 shows since 1960 the number of physicians and the number of nurses has more than doubled.

With more physicians and more nurses each making more, it’s not surprising that the cost of medical care would increase.

Addendum: Other posts in this series.

Tuesday assorted links

by  Tyler Cowen

1. The technologies that are Canada: “Audible hockey puck could revolutionize the sport for blind players.”  Note: “[It] sounds pretty much like a smoke detector,” Francois Beauregard, who helped come up with the idea for the puck prototype…”It is not made to be harmonious or pleasant.”

2. Was Leonardo da Vinci ADHD? (speculative)

3. Professional football is also much riskier for subsequent heart attacks.

4. Paul Keating, former Australian Prime Minister, on classical music.

5. Homeopathy in the French health care system, but much more than that too.

China fact of the day

by  Tyler Cowen in

We find that party members on average hold substantially more modern and progressive views than the public on issues such as gender equality, political pluralism, and openness to international exchange.

That is from Chengyuan Ji and Junyan Jiang, via the excellent Kevin Lewis.  Of course this may partly explain why China’s rising middle class is not so outright enthusiastic for democratization.

*Range: Why Generalists Triumph in a Specialized World*

by  Tyler Cowen in

That is the new book by David Epstein, the author of the excellent The Sports Gene.  I sometimes say that generalists are the most specialized people of them all, so specialized they can’t in fact do anything.  Except make observations of that nature.  Excerpt:

In an impressively insightful image, Tetlock described the very best forecasters as foxes with dragonfly eyes.  Dragonfly eyes are composed of tens of thousands of lenses, each with a different perspective, which are then synthesized in the dragonfly’s brain.

I am not sure Epstein figures out what a generalist really is (and how does a generalist differ from a polymath, by the way?), but this book is the best place to start for thinking about the relevant issues.

State and local policy is the real immigration policy

by  Tyler Cowen in

That is the central claim of my latest Bloomberg column, here is one excerpt:

State and local governments are making immigration policy all the time, mostly for the worse, and often Democrats are more restrictionist than Republicans.

Obviously the law can deter potential illegal migrants from entering the U.S. But so can the high cost of living. Even though there are much higher wages in the U.S. than in its neighbors to the South, a lot of those higher wages are eaten up by much higher rents — especially if the immigrant moves to a major city, as is often the case. I once wrote a book based on fieldwork in rural Mexico, and I found that, for those who had migrated temporarily to the U.S., high rent was typically their biggest complaint. It therefore follows that policies which raise rents tend to discourage immigrants, particularly poorer immigrants.

And:

The minimum wage is another tool of anti-immigration policy, at least for less skilled immigrants. Say a city sets a minimum wage of $15 an hour. That means a potential migrant whose work is worth only $12 an hour won’t be able to get a legal job in that city. That will deter migration, both legal and illegal. Furthermore, a worker in, say, Honduras may not find it possible to improve his or her skills to be worth $15 an hour, at least not without arriving in the U.S.

Thursday assorted links

by  Tyler Cowen

1. Negative emotional contagion in ravens.

2. “As it turns out, NBA players make only 40 percent of their shots between 8 and 9 feet from the rim, and that number drops to only 35 percent between 25 and 26 feet from the rim. When it comes to field-goal percentage on jump shots, the effect of shot distance is pretty minor.”  Link here.

3. Claims about Fortnite.

4. How making chocolate is like mixing cement (NYT).

5. Victor Shih’s public choice theory of Xi’s China.

6. “Goats are glamorous, and super popular on social media now…“

My Conversation with Ezekiel Emanuel

by  Tyler Cowen in

Very much a fun one, here is the audio and transcript, here is part of the opening summary:

Do we overrate the importance of doctors? What’s the importance of IQ versus EQ in the practice of medicine? What are the prospect for venture capital in biotech? How should medical training be changed? Why does he think the conventional wisdom about a problem tends to be wrong? Would immortality be boring? What would happen if we let parents genetically engineer their kids?

Tyler questions Emanuel on these topics and more, including the smartest thing his parents did while raising him, whether we have right to medical self-defense, healthcare in low- versus high-trust institutions, and much more.

Here is one excerpt:

COWEN: How can we improve medical education?

EMANUEL: Cut it down. Make it shorter.

COWEN: Cut it down? Why does that make it better? Or does it just make it cheaper?

EMANUEL: No, I think it will make it better. So, we have a lot of memorization, a lot of . . . So, let’s go back to the start. The four years of medical school: two years of preclinical in the classroom learning about biochemistry, genetics, anatomy, microbiology; and the two years of clinical time in the hospital, on the wards.

That dates from 1910. We haven’t really updated it much, except in this one way: we’ve cut down the preclinical time because — less of it — and it changes so fast, by the time you learn it in medical school, get out as a doctor, it’s out of date, A; and B, it’s more or less irrelevant to managing most patients…

And then, by the way, in med school, spending your time in a hospital is not the future. The future of American medicine is out of the hospital. So we need more rotations, more experiences for students out of the hospital.

No med school has made that big shift, and those are the shifts that are going to have to happen over the next 15 or so years.

And:

COWEN: Is there a right to medical self-defense that should override FDA bans on drugs and medical devices? I want to try something that’s not approved —

EMANUEL: No. I don’t like that.

COWEN: I’m saying it’s my body. But why don’t you like it?

EMANUEL: No, no, no, no, no, no, no, no, no, Tyler.

Finally:

COWEN: Now, you’ve written a much-misunderstood article about how hard you would try yourself to live past the age of 75. Would not the suspense of world and national history always keep you wanting a bit more extra time?

So, say I’m 75. I’ve decided I agree with you, but the NBA Finals aren’t over yet. I want to see game seven. I want the Mueller report to come out. Isn’t there always something?

And then, it’s kind of intransitivity of indifference. Every day there’s something, and you just keep on hanging on, even if one accepts your arguments in the abstract. Can you talk me out of that?

EMANUEL: No, no, Tyler, I think you’re exactly right. That’s why people do hang on. It’s because . . . you know, so I talked to my father, who — he says, “Zeke, you’re absolutely right. I’ve become slower, physically slower, mentally slower. My life” . . . what ends up happening is your life cones down, and you begin to overvalue certain small things. Like the NBA Finals. Like what’s in the Mueller report.

We all know, from any cosmic standpoint — even not a cosmic standpoint, just a 2,000-foot standpoint — most of those things are not irrelevant. It’s really cool to know.

You often ask — and this happens to me all the time. I teach undergraduates. Pretty smart undergraduates. Very smart undergraduates. MBA students, nurses, doctors, right? They have no understanding of history. So, whoever finishes in the NBA Finals, in five years, people have forgotten.

Recommended, interesting throughout.