Medical care without third party payment: the autism example
It's a common claim that health care would be more efficient and cheaper if not for third party payment. Sometimes, yes, but often these claims are overstated, especially when the link between treatment and improvement is murky.
To consider one example, for the most part autism-related services are not covered by private health insurance. Government aid is often scarce as well. Also in Canada medical benefits for autism-related services are quite limited. So when it comes to autism, this is a fee for service setting for the most part.
And what does this world look like?
1. Services are not especially cheap nor do they seem to be falling in price.
2. Market participants are not well informed about what works. Many parents of autistic children pursue hopeless treatments or unvalidated or even refuted theories. Some of the treatments, such as chelation, are harmful in many cases and yield no benefits.
3. There is lots of innovation — in terms of advertised methods of treatment — but it is unclear, to say the least, what percentage of these innovations succeeds. Very often it is parents "buying hope."
The point is not that insurance coverage would solve all these problems. Third party coverage would slant the relative prices toward more mainstream treatments and away from the fads; how good or bad this would be depends on your point of view as to what brings better (worse) outcomes.
Overall I don't view the autism example as a good selling point for the view that third party payment is the basic problem behind U.S. health care. Nor do I see critics of third party payment citing autism services as a model example for their ideas. (By the way, it is an open question how much autism should be an education issue and how much it should be a health care issue; de facto it is often a health care issue but this should not be taken for granted.)
Another lesson is this: the more emotional the issue, the less effective any health care system will be. Policy discussions of "health care" often require more disaggregation.
Addendum: There is, by the way, a movement afoot to require that private insurance cover some autism-related services, such as ABA. Given the costs of the treatment, and the unclear link between treatment and results, I would be curious to hear if "universal coverage" advocates would include this in their ideal public policy. I would say they should admit that any notion of "universal coverage" is value-laden rather than purely descriptive.
New issue of Econ Journal Watch
Find it here. The contents are described as follows:
Occupational Misfeasance of Labor Textbooks: Frank
Stephenson and Erin Wendt report that textbooks neglect occupational
licensing.
Do Economists
Believe American Democracy Is Working? A new survey by William
Davis and Robert Figgins indicates that Democratic, Republican, and
Libertarian economists are all of but little faith.
Adam Smith’s Invisible
Hand–Is That All There Is? Gavin Kennedy argues that it was
just a casual metaphor; Dan Klein dissents.
Guns and Crime, Round 2: Carlisle Moody and Thomas
Marvell rejoin, and Ian Ayres and John Donohue reply.
Intellectual Hazard:
97 quotations about our wanton ways.
Assorted links
1. Financial opposites attract.
2. The new Robert Wright book on the evolution of God.
3. Screenshots from WolframAlpha.
4. Subordinated debt for banks.
5. Rename Las Vegas "Atlantis".
6. Wave of the future?: Lubbock is double-wired (for electricity).
“Administration plans to strengthen antitrust rules”
That's the headline and Greg Mankiw comments. My point is a simple one: if this administration is so pro-science, should they not attempt to move major antitrust trials away from the jury system?
Some commentators are suggesting that the demonstrated political clout of the banking lobby suggests a growing need for antitrust enforcement. Yet the pre-crash banking system was not a prime candidate for legal strictures on the grounds of competition policy. Citigroup arguably is too big in absolute terms, and had too many contacts in high places, but antitrust policy, and the underlying theory and legal precedents, puts far more emphasis on relative market share. In fact the unfolding of the crisis is an object lesson in how antitrust policy doesn't target the real competitive abuses much at all. Furthermore the sin of Citigroup has been to lose money and become insolvent (or nearly so), not successful monopolization. Those are close to being exact opposites.
Cultures of sleep, and which is the “most awake” nation?
There is plenty of talk in the blogosphere on who spends the most time eating, but other takes on the new OECD leisure time study focus on who spends the most time sleeping:
France is the industrialized country where people spend the longest
periods sleeping, according to a series of surveys on social habits
conducted by the Paris-based Organization for Economic Cooperation
& Development.
The French sleep a daily average of 530 minutes, compared with 518
for Americans and 469 for Koreans — the OECD's "most awake" nation,
according to the study.
The most sociable OECD nation is considered to be Turkey. Some of the New Zealand stereotypes are wrong (they don't play so much sport) and:
Young British girls drink the most for their age. Austrian teens smoke the most.
Look under "Risky Behavior" for information on teenage drunkenness but for teenage boys the U.S. has the lowest rate. Here is a brief summary with a link to the main study.
Standard dishes for testing the quality of a restaurant
Joshua Johnson, a loyal MR (and TCEDG) reader, asks:
If you are going to a new ethnic
restaurant, what staple items do you order that for you, let you know
if the restaurant is worth coming back to and trying more of their
offerings? It would be nice if you could make some sort of list for
Chinese, Vietnamese, Japanese, Thai, Turkish, etc.
Here goes:
Japanese: One bite of the tempura tells all.
Chinese: Ma Po Tofu, or for some kinds of Chinese places Hainan Chicken with Rice.
Thai: Almost any dish shows the true colors of a Thai restaurant immediately.
Turkish: Doner Kebab, taking special care to ponder the tanginess of the yogurt and how it interacts with the meat.
Vietnamese: Anything with lemon grass, which is hard to use well.
Ethiopian: Kitfo or barring that lamb tibs.
Peruvian: Lomo saltado, taking special care to check for the right amount of cilantro in the sauce and the correct sogginess of the french fries.
Bolivian: Silpancho, and check the liquidity and consistency of the egg on top.
Afghan: Kadu (pumpkin) and is it too sweet?
Korean: Seafood pancake and in general the quality of their kimchees.
Indian: Most dishes will do (see "Thai"), although avoid the Butter Chicken as a metric of quality. Lamb with spinach is my do-or-die default judgment dish for an Indian restaurant, if only because you get to taste both the lamb (less likely to be tender than the chicken) and the spinach.
Restaurant, general: How's their chili crab? If it's not outstanding, or not on the menu, press eject immediately and get yourself to a different country.
Can you think of others?
Assorted links
2. Health and safety fears: stepladders banned from Oxford's Bodleian library. Book still are kept on very high shelves, however.
4. Is setting goals counterproductive?
5. Beauty, education, and caste trade-offs in Indian marriage markets.
6. Critique of Paul Collier on causation; and here is Easterly on causation and foreign aid.
Logical
I never read Maureen Dowd's column but the picture today is great.
Hail Lord Monboddo
Who says we are losing expertise in engineering?:
An Australian zoo was evacuated after an "ingenious" orang-utan
escaped from her enclosure by short-circuiting an electric fence today.
Staff
at Adelaide zoo said 137lb (62kg) Karta used a stick to short-circuit
the electric wires around her enclosure before piling up some more
sticks to climb out.
But the 27-year-old ape only ventured as far
as a surrounding fence, still metres from members of the public, during
her 30 minutes of freedom.
The zoo's curator, Peter Whitehead,
said she seemed to realise she was somewhere she was not supposed to be
and returned to her enclosure.
Here is the story. I was intrigued to read this:
Burnett also examined feral children and was the only thinker of his
day to accept them as human rather than monsters. He viewed in these
children the ability to achieve reason.
Congress opts out
Here is my latest column. Excerpt:
It’s not that anyone is behaving illegally or unconstitutionally,
but rather that Congress seems to want to be circumvented and to
delegate more power to the executive branch as well as to the Fed, at
least temporarily.
While Congressional leaders are consulted on
the major policies, Congress is keeping its distance, perhaps to
minimize voter outrage. This way, Congress can claim credit if a
recovery comes, but deny responsibility if the price tag ends up higher
than advertised or if banks seem to be receiving unfair benefits from
the government.
The Fed and the FDIC have become the major tools for enhancing executive power and working around Congress:
The traditional division of labor among policy makers was that the Fed
determined the quantity of money in the economy – it set monetary
policy – and Congress decided precise government expenditures – it
handled fiscal policy. These new programs blur that distinction and, in
essence, the Fed is running some fiscal policy.
The FDIC issues guarantees under the expectation that Congress will have to ratify them ex post but ex ante the executive branch is calling the shots.
Is this all good or bad? For any single choice, it is probably good. Congress does not, in general, improve the quality of economic policy, relative to the executive branch. But it is also a kind of deficit spending on the quality of future governance. The more Congress is accustomed to being allowed to punt, the worse Congress will become in the longer run. The executive branch will overreach more and also voters will apply successively more cynical standards to evaluating Congress, leading to a self-fulfilling prophecy.
To put it more concretely, this Congress shies away from accepting responsibility for the various bailouts, yet we think it will somehow solve far tougher problems? I, for one, am worried.
Why is it so hard to hug?
Gretchen Rubin reports:
After I looked at my list, however, I realized that I’d never made a
specific resolution to “Kiss more, hug more, touch more.” So I’ve added
that to my ever-growing list of resolutions.
This is intriguing, precisely because it strikes a chord with so many people. Why exactly do so many people need a "nudge" to hug more? There is evidence that hugging is both fun and good for us. What is it about hugging that is so often resisted?
Oddly, many people wish to be hugged by Florence Henderson.
I am reminded of my old post on why people don't have more sex with each other than they do. Fortunately, I have solved this problem and if you keep on reading MR for enough years you will learn my answer.
Assorted links
The personality traits of stand-up comedians, and owners of vicious dogs
They don't quite fit the stereotype:
Stand-up comedians are a vocational group with unique characteristics:
unlike most other entertainers with high creative abilities, they both
invent and perform their own work, and audience feedback (laughter or
derision) is instantaneous. In this study, the Big Five personality
traits (NEOFFI-R) of 31 professional stand-up comedians were compared
to those of nine amateur comedians, 10 humor writers and 400 college
students. All four groups showed similar neuroticism levels.
Professional stand-up comedians were similar to amateur stand-up
comedians in most respects. However, compared to college students,
professional and amateur stand-up comedians on average showed
significantly higher openness, and lower conscientiousness,
extraversion, and agreeableness. Compared to stand-up comedians, comedy
writers showed higher openness, conscientiousness, extraversion, and
agreeableness. These results challenge the stereotype of comedians as
neurotic extraverts, and suggest a discrepancy between their stage
persona and their true personality traits.
The paper is here. Here is another paper on personality profiles, for owners of vicious dogs, summarized as follows:
Findings revealed vicious dog owners reported significantly more
criminal behaviors than other dog owners. Vicious dog owners were
higher in sensation seeking and primary psychopathy. Study results
suggest that vicious dog ownership may be a simple marker of broader
social deviance.
I thank BPS Research Digest for the pointers.
What I’ve been reading
1. Brian Boyd, On the Origin of Stories: Evolution, Cognition, and Fiction. If you've read Geoffrey Miller, Karen Dissanayake, Denis Dutton, and Comeuppance, this is the next book in line. It's well-written and intelligent, but also a little underwhelming. The main point is that the arts are an extension of the play instinct. Blog audiences, who expect rapid delivery of the main points, may be especially frustrated.
2. Richard Goldthwaite, The Economy of Renaissance Florence. Dull for some, definitive for others. If the thesis about commerce sounds a little late to the party, it is only because of Goldthwaite's own previous work.
3. John Reader, The Potato: A History of the Propitious Esculent. Not as good as his excellent book on Africa, but I liked the sections on potatoes in the Incan empire. This book could have been great, it isn't, but it is still above average.
4. Portfolios of the Poor: How the World's Poor Live on $2 a Day, by Daryl Collins, Jonathan Morduch, Stuart Rutherford, and Orlanda Ruthven. A good overview of how the world's poor intersect with financial institutions at the micro level.
5. Twenty Thousand Roads: The Ballad of Gram Parsons and His Cosmic American Music, by David N. Meyer. A serious and excellent book, noting that every now and then the reader is hit by a strange sentence like: "Of course the temptation to get all bourgeois on Gram's a** is irresistible." Meyer underrates the album Burrito Deluxe, however.
Star Trek, II
The key line is about non-rivalry and non-excludability. I didn't like that Harold played Sulu or that Bones sounded just like Sawyer. Young Kirk and Spock were superb. Sadly, there was no information about the progress of monetary institutions. Bryan Caplan complained that the implied rate of economic growth was so low. I've long wondered why there is not more technology transfer to Vulcan. The soundtrack was poor. Everything Alex says is true. The best part was Uhuru but I won't say more on that.
