Health Related Links

1. Mandatory minimums lead to competing increasing drug purity. When there is a per unit tax, people switch from the taxed margin (quantity) to the untaxed margin (quality).

2. A racial gap in condom use. This is tricky. More condom use among African American males does not lead to less disease. It may in fact be a response to higher disease incidence. They also have a higher degree of concurrent partners.  Make no mistake, this has only very little to do with race, and a lot to factors correlated with race, such as sex ratios, education, etc.

3. Beware of substitution effects. When the price of one drug goes up, addicts substitute.

4. Technology and health. Even as technology promises to improve our health outcomes, it has a dark side. At worst it can kill the patient. Or it can cure the patient of an ailment that would never have killed the patient (by killing a slow growing tumor), thus making its marginal efficacy in terms of increasing life zero, yet its cost is far from zero. Still at other times the technology might just be overused.

What do practitioners need to know about regression? - Statistical Modeling, Causal Inference, and Social Science

From Andrew Gelman:

What do practitioners need to know about regression? - Statistical Modeling, Causal Inference, and Social Science:

"More specifically, here are some tips:

- The difference between 'significant' and 'non-significant' is not itself statistically significant.

- Don't just analyze your variables straight out of the box. You can break continuous variables into categories (for example, instead of age and age-squared, you can use indicators for 19-29, 30-44, 45-64, 65+), and, from the other direction, you can average several related variables to create a combined score.

- You can typically treat a discrete outcome (for example, responses on a 1-5 scale) as numeric. Don't worry about ordered logit/probit/etc,, just run your regression already.

- Take the two most important input variables in your regression and throw in their interaction."

Greg Mankiw's Blog: The Tax Deal

Here is the breakdown on the payroll tax deduction. Greg Mankiw's Blog: The Tax Deal. If it was permanent, then whether it came from the employers share or the employees share would not make a difference. In the short run a temporary cut makes a big difference. This one is clearly weighted towards boosting consumption.

Rational Addiction

A funny video, skewering the idea of "rational addiction"

History

Krugman makes an important point in response to Pence and Ryan calling for a discussion of the gold standard.

In other news, Republicans have demanded that doctors consider reintroducing the practice of treating illness by bleeding their patients.

I love the sarcasm. But my issue with Krugman occurs further up in the entry when he says:

There’s a widespread impression that Keynesian fiscal policy has failed. I would argue that this impression is wrong — that the truth is that it was never tried.

Yeah Paul that is exactly what the monetarists said after the experiment in the 80s. And I'm sure you'd skewer them for such a weaselly response. The truth is dogmatic adherents to some ideology will always claim we just didn't quite try hard enough to follow it.

Finding Happiness

In the econ literature there is a pretty well known U shaped relationship between age and happiness, with happiness being at its lowest around middle age. So I thought that meant my happiness had nowhere to go but up.

It turns out that it is probably not true.

The inclusion of the usual socio-economic variables in a cross-section leads to a U-shape in age that results from indirectly-age-related reverse causality. Putting it simply: good things, like getting a job and getting married, appear to happen to middle aged individuals who were already happy. . . . The found effect of age in fixed-effect regressions is simply too large and too out of line with everything else we know to be believable. The difference between first-time respondents and stayers and between the number of years someone stays in the panel doesn't allow for explanations based on fixed traits or observables. There has to be either a problem on the left-hand side (i.e. the measurement of happiness over the life of a panel) or on the right-hand side (selection on time-varying unobservables).

But maybe I should just listen to Penelope Trunk and stop trying to be happy. Of course maybe I shouldn't take her advice, even if I wouldn't mind having sex with her - it would be different. Speaking of sex, I hear that helps improve happiness.

Previous musings on happiness.

A New Country

Located somewhere close to kerplakistan, the NYT finds a new country. My secondary residence: LAPTOPISTAN

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Competition

When class bores, texting soars. Wow, it is a good thing my class isn't boring.

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Worldbank Data Visualizer

Another Data visualizer.

You Suck

At PowerPoint. Good lessons.

YOU SUCK AT POWERPOINT!

View more presentations from @JESSEDEE.

Statistics

Statistical Zombies and other misleading statements often made. Good quick read.

I Want A PhD

Pew Research on Marriage

Marriage is declining. Wow. That is a relief. I now feel less societal pressure to get married. Though I wonder if the Pew's research fully addresses Wolfers usual concerns? Thanks to the wonderful blog Chart Porn for the tip.

Wolfers on Marriage

Justin Wolfers sets the record straight on the recession's affect on marriage.

Immigration

A more nuanced view of immigration than the one painted by a simple solow model.

OKtrends

I love the work done at OKtrends.

QE2 in Cartoon

Happiness

Today means so little for your future happiness. Mostly because we are bad at predicting our future happiness. Here is a snippet from PT:

The evidence is pretty clear, though, that big positive and negative events don't have an enormous impact on people's happiness. In a 1998 paper in the Journal of Personality and Social Psychology, Dan Gilbert, Tim Wilson, and their colleagues found that college faculty being evaluated for tenure believed they would be quite unhappy if they were denied tenure. Several months after their tenure decision, though, college faculty who had been denied tenure were no less happy than those who had gotten tenure.

This finding, that we believe future positive and negative events have a bigger impact on our future happiness than they do, is called an affective forecasting error. One thing about these errors that is not well understood: Why don't they go away over time? We all have experience with these errors. As a kid, I remember toys that I really wanted because I had seen them in a catalog. When I actually got one of those toys, though, it was never quite the life-changing experience I expected. So, why don't examples like this get rid of affective forecasting errors?

This question was explored in a November 2010 paper in the Journal of Experimental Psychology by Tom Meyvis, Rebecca Ratner, and Jonathan Levav.

These researchers find that people have difficulty remembering their initial prediction for how they would feel after a positive or negative event. In one study, they asked voters in the 2008 election how they would feel a week after the election if Barack Obama won. Supporters of John McCain rated that they would be quite unhappy. A week after the election, these same voters were contacted again and asked how happy they were. They were also asked to recall how happy they said they would be before the election. These voters were significantly happier than they predicted they would be (that is the affective forecasting error). They also remembered their prediction as being less extreme than it was. That is, they did not remember predicting that they would be very unhappy.

The researchers demonstrated that this poor memory for previous predictions makes it hard for people to learn to predict better in the future. In this study, some people were reminded of their initial prediction, and those people who were reminded of what they actually predicted showed smaller affective forecasting errors in the future.

Love and Hate

From SMBC Comics:

Calories In - Calories Out

Its that simple. I once lost 10 pounds eating only McDonalds. Take that Morgan Spurlock. Here a nutrition professor tries twinkies. He seems shocked that he lost weight. Really? As a first approximation economists have known this for a long time.

Decriminalizing Drugs

Portugal provides a good case study. Some predictable conclusions from a recent study:

In the Portuguese case, the statistical indicators and key informant interviews that we have reviewed suggest that since decriminalization in July 2001, the following changes have occurred:

* small increases in reported illicit drug use amongst adults;
* reduced illicit drug use among problematic drug users and adolescents, at least since 2003;
* reduced burden of drug offenders on the criminal justice system;
* increased uptake of drug treatment;
* reduction in opiate-related deaths and infectious diseases;
* increases in the amounts of drugs seized by the authorities;
* reductions in the retail prices of drugs.

Alienating 2%

According to Seth Godin:

Do the math. Every time Apple delights 10,000 people, they hear from 200 angry customers, people who don't like the change or the opportunity or the risk it represents.

If you have fans or followers or customers, no matter what you do, you'll annoy or disappoint two percent of them. And you'll probably hear a lot more from the unhappy 2% than from the delighted 98.

It seems as though there are only two ways to deal with this: Stop innovating, just stagnate. Or go ahead and delight the vast majority.

What does this mean for Student Evaluation of Instructors? Shouldn't we expect faculty to piss off some of the students? Shouldn't all 5's on a 5 point scale mean something about the innovation of the instructor?

Data and FB

The cool things you can discover with data available on the web. Among them, you can discover when people breakup. Check out the seasonality.

Election Forecasts

Get out and vote. Here are some current election predictions.

World Statistics Day

In case you missed it, yesterday - 20/10/2010 - was World Statistics Day.

Music Economics

The Economist runs a nice article on what is and is not working in the music industry. The live performance can't be displaced by the internet.

The longest, loudest boom is in live music. Between 1999 and 2009 concert-ticket sales in America tripled in value, from $1.5 billion to $4.6 billion (see chart 1). Ticket sales wobbled in America during the summer of 2010, but that was partly because some big-selling acts took a break. One of the most reliable earners, Bono, U2’s singer, was put out of action when he injured his back in May. Next year many of the big acts will be on the road again, and a bumper year is expected.


It is not that more people are going to concerts. Rather, they are paying more to get in. In 1996 a ticket to one of America’s top 100 concert tours cost $25.81, according to Pollstar, a research firm that tracks the market. If prices had increased in line with inflation, the average ticket would have cost $35.30 last year. In fact it cost $62.57. Well-known acts charge much more. The worldwide average ticket price to see Madonna last year was $114. For Simon & Garfunkel it was an eye-watering $169. Leading musicians have also, by roundabout means, seized a larger share of the mysterious “service” charges that are often tacked onto tickets.

Budding artists, like Sean Fournier realize giving away the music might lead to ticket sales in the future. Download his album, rip, share, burn. Of course this strategy might be a bit more productive if I could find out where he is playing.

Context

You data needs context. Its your job to provide it.

Prison

An absolutely riveting account of prison. Its not for the feint of heart. Everything from the types of food, to drug use, to gay sex is covered. There is even a good dose of economics:

5. The Economy


I joked to my cell mate on the first day that at least the GFC couldn't fuck us inside. He'd been done for assaulting a cop when his house got taken by the bank. But within months 'GFC Nigger' became the standard reply to any query as to how black market prices were suddenly going through the roof. The price of a deck of smokes tripled. There was an actual economic reason about this. I went away in Michigan, where a lot of people lost their houses, mostly poor people already. When they had to move away from the prison, it meant they couldn't bring their loved ones as much contraband group, which meant the price of what there was sky rocketed. And the worse things got, the more the people who worked in the store would wonk and take home with them, which meant stocks ran low which fucked us even further.


Bet you didn't read about that one in the Wall Street Journal.

Plus a whole lot more. There are some interesting insights on porn as well.

Output Gap

The Washington Post presents an excellent dynamic graphic on the current Output Gap.

GPI

Inflation Google Style.

Economic Misconceptions.

Students are not the tabula rasas we wish them to be. The come to us with preconceptions and even misconceptions. Here are some Economic Misconceptions.

Psychologists and Economists

We are very different types of social scientists. Seth Roberts does a good job of discussing how our approaches to data differ:

5. Psychologists rarely use observational data at all. To get them to appreciate sophisticated analysis of observational data is like getting someone who has never drunk any wine to appreciate the difference between a $20 wine and a $40 wine.

Atheists

Atheists know more about religion, than the religious. So reports the NYT.

On average, people who took the survey answered half the questions incorrectly, and many flubbed even questions about their own faith.

Those who scored the highest were atheists and agnostics, as well as two religious minorities: Jews and Mormons. The results were the same even after the researchers controlled for factors like age and racial differences.

I recently shocked a WELS friend when I mentioned that St. Paul's views on marriage, and celibacy are obvious attempts by him to ignore or squelch his homosexual desires. His so called "thorn in his side". She had never heard that interpretation, or that Paul even had a thorn in his side.

Texting Bans

The don't reduce crashes.

Love at First Sight

Penelope hits another one down the middle. This post "Love at first sight" reminds me of missed anniversaries.

We are genetically predisposed to fall in love with someone not like us—it keeps the gene pool safe. So when you want someone to fall in love with the idea of working with you, focus on personality characteristics you offer them that they don’t already have.

I guess opposites attract? Sometimes.

Story Telling

Holy Crap!

My favorite reporter sent me a text last night, tipping me off to this:

Council decriminalizes pot possession

I can hardly believe it. Kudos to them for trying to restore some sense to drug policy. The police continue in their defense of harsh laws with an inability to apply any economics to the situation:

"It's part of a very violent equation ... Anything we do to reduce the penalties helps those drug cartels," Kondracki said Tuesday. "It's almost like subsidizing them.

Actually Ed, its the making it illegal, and reducing the supply that causes price to rise and therefore induces violence. Its supply and demand and you are the one subsidizing the dealers, by catching and incarcerating some of their competition. You don't see people killing each other over aspirin do you? Maybe we send the wrong message by making that legal too?

Competition

Make a video. Win money.

5 Myths About Prostitution

5 Myths About Prostitution:

1. Prostitution is an alleyway business.
2. Men visit sex workers for sex.
3. Most prostitutes are addicted to drugs or were abused as children.
4. Prostitutes and police are enemies.
5. Closing Craigslist's "adult services" section will significantly affect the sex trade.

ECO120 Misc

1. The Economist's (mis?)interpretation of the effects of fiscal austerity. Alesina's correction.

2.  If China's Currency Rose, Would U.S. Get Jobs Back?: [NPR Audio]

3.  Some 3,000 Millionaires Claim Jobless Benefits, IRS Data Show. [Bloomberg]

4.  Study Finds the Mortgage Interest Deduction to be Ineffective at Increasing Ownership. [Tax Foundation]

Healthcare

An excellent series of blog posts on our healthcare expenditures in this country. A snippet from the poignant conclusion:

But there are a few things we all have to own up to. The first is that most of the “extra” spending is in areas of care. So, please, let’s stop pretending that cost containment can be painless or unnoticed. The second is that, to make cost reform feasible, we will need to have all these sectors share in the pain. That won’t be popular, but at least it might be fair. Moreover, it will increase the chances of success.

Got Game?

Got Game?

Chinese Manipulation?

House Passes Bill Aimed At Chinese Currency: Listen here and read article here.

"The Chinese ought to be aware that Congress is serious about confronting their currency manipulation," Schumer said in a statement.

Apparently when China engages in active monetary policy it is called manipulation. What is it when the US does it? I do not believe currency interventions can persistently affect the real exchange rate for long periods. If the Chinese currency is truly undervalued, the process of selling RMB and buying dollars has to dramatically increase domestic Chinese inflation.

But maybe the currency isn't really that undervalued? Here is one paper which suggests that its not. Here is a more recent paper by Menzie and others. Their conclusion:

To sum up, absolute PPP suggests (log) undervaluation of about 50% (67% using Mac
parity). The Penn Effect suggests essentially no misalignment (our estimates), or between 13.5% to 38.8% undervaluation (according to Subramanian). The Goldman Sachs BEER implies slight undervaluation against the dollar, and 23.1% against the euro. The Cline-Williamson FEER based estimate implies a 33% undervaluation, while the Goldstein-Lardy estimate is for 22.3% to 28.8% (for zero current account surplus), or 12.8% to 17.4% (for halving the surplus). These estimates are summarized in Figure 3.

The real test? If you think the RMB is undervalued have you mortgaged your house to go long on it?

The Onion or NYT?

I thought this was a headline pulled from the Onion.

Segway Owner Dies in Segway Crash

Bank Failures

Tracking bank failures.

Semantics

Definitions matter. Talking about levels versus changes, or why economists are often misunderstood. NYTimes: Most Americans Don’t Think Recession Is Over

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Darwinian Marriage

Alison Schmauch (28) and Ilya Somin (37) were recently married. And Tyler Cowen delivers a eulogy speech by citing Darwin.

It being proved necessary to Marry

When? Soon or Late?

The Governor says soon for otherwise bad if one has children— one’s character is more flexible—one’s feelings more lively &; if one does not marry soon, one misses so much good pure happiness.—

But then if I married tomorrow: there would be an infinity of trouble & expense in getting & furnishing a house,—fighting about no Society—morning calls—awkwardness—loss of time every day. (without one’s wife was an angel, & made one keep industrious). 11 Then how should I manage all my business if I were obliged to go every day walking with my12 wife.— Eheu!! I never should know French,—or see the Continent—or go to America, or go up in a Balloon, or take solitary trip in Wales—poor slave.—you will be worse than a negro— And13 then horrid poverty, (without one’s wife was better than an angel & had money)— Never mind my boy— Cheer up— One cannot live this solitary life, with groggy old age, friendless & cold, & childless staring one in ones face, already beginning to wrinkle.— Never mind, trust to chance—keep a sharp look out— There is many a happy slave—

Cost Effective?

Cost effective? NYTimes: Medical Journal Challenges a Study

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Here Comes More Money

NYTimes: Fed Stands Pat and Says It Is Still Ready to Buy Debt

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Miscellaneous

1. When taxes are too high, and when they vary dramatically by region, a bloody black market is not far behind.

2. The Price of Weed. Wow that makes cigarettes look cheap.

3. Structural changes in employment. Embrace the digital age.

Organ Donation

Iran leads the way in market principles. More here.

Apple CEO Steve Jobs' move to Tennessee, where waits are short, from California, where waits are long, to get a liver transplant served as a boldface reminder last year of the enduring problem. "There's no question there are patients chasing organs rather than the organs coming to the patients," Dr. James Pomposelli, a transplant surgeon told the Wall Street Journal at the time.


Now, would you believe that Iran may have cracked the problem by paying living donors a modest amount, practically eliminating kidney shortages. The Iranian government pays living donors the equivalent of about $1,200 and throws in a year of some health coverage. Recipients give the donors a few thousand dollars more through a sanctioned, nonprofit intermediary.

Wording Matters

Wording choice matters.

Debt

Here is a good opportunity to learn a little about the debt.

Series of forums on national debt begin Sept. 28

Find out about national debt at a series of three forums beginning Tuesday, Sept. 28.

Forum I will be held from 6-9 p.m. Tuesday, Sept. 28, in 102 Wing Technology Center.

Study Habits

From the NYT:

Take the notion that children have specific learning styles, that some are “visual learners” and others are auditory; some are “left-brain” students, others “right-brain.” In a recent review of the relevant research, published in the journal Psychological Science in the Public Interest, a team of psychologists found almost zero support for such ideas. “The contrast between the enormous popularity of the learning-styles approach within education and the lack of credible evidence for its utility is, in our opinion, striking and disturbing,” the researchers concluded.

Cognitive scientists do not deny that honest-to-goodness cramming can lead to a better grade on a given exam. But hurriedly jam-packing a brain is akin to speed-packing a cheap suitcase, as most students quickly learn — it holds its new load for a while, then most everything falls out.

When the neural suitcase is packed carefully and gradually, it holds its contents for far, far longer. An hour of study tonight, an hour on the weekend, another session a week from now: such so-called spacing improves later recall, without requiring students to put in more overall study effort or pay more attention, dozens of studies have found.

Foreclosures

Two Maps. Click for larger versions.

Cheaters

I'm getting back to my research on cheating, at the behest of my patient co-author. Time magazine had a write up of some new research presented at the American Sociological Association's annual meetings by Christin Munsch. Here is a blurb from her website:

Study 2, uses panel data from the 1997 National Longitudinal Survey of Youth (NLSY97) to examine the role of economic dependency on infidelity. I argue that, for men, making less money than a female partner may threaten men’s gender identity by calling into question the traditional notion of men as breadwinners. I find that economically dependent men are more likely to engage in infidelity, although this relationship disappears once individual and institutional mechanisms are controlled. I also find that the more economically dependent a man’s female partner is on him, the more likely he is to engage in infidelity.

Blogging

I'm gonna make a commitment today to regular blogging, if only short links like the previous. I need to get back in the habit of writing.

Teachers

Some are really bad. They need to go.

And some can make a large impact, particular as early on as kindergarten. And here are some additional comments by Mankiw.

That Looks Good

Ovulating women unconsciously buy sexier clothing.

Nice

Free Wi-Fi coming to one of my favorite work locales.

Being Short

Another reason it sucks:

Being short isn't easy. Short people make less money, have a harder time finding a mate, and are less likely to be elected to public office, statistics show.

A new study suggests that it gets worse: The shortest short people -- men under 5 feet 5 inches and women under 5 feet -- are roughly 50 percent more likely than the tallest people to have a heart attack or die from heart disease, according to an analysis published in the European Heart Journal.

Asker or Guesser?

I think in many ways I am more of a "Guesser" than an "Asker", particularly when it comes to relationships.

This terminology comes from a brilliant web posting by Andrea Donderi that's achieved minor cult status online. We are raised, the theory runs, in one of two cultures. In Ask culture, people grow up believing they can ask for anything – a favour, a pay rise– fully realising the answer may be no. In Guess culture, by contrast, you avoid "putting a request into words unless you're pretty sure the answer will be yes… A key skill is putting out delicate feelers. If you do this with enough subtlety, you won't have to make the request directly; you'll get an offer. Even then, the offer may be genuine or pro forma; it takes yet more skill and delicacy to discern whether you should accept."

Neither's "wrong", but when an Asker meets a Guesser, unpleasantness results. An Asker won't think it's rude to request two weeks in your spare room, but a Guess culture person will hear it as presumptuous and resent the agony involved in saying no. Your boss, asking for a project to be finished early, may be an overdemanding boor – or just an Asker, who's assuming you might decline. If you're a Guesser, you'll hear it as an expectation. This is a spectrum, not a dichotomy, and it explains cross-cultural awkwardnesses, too: Brits and Americans get discombobulated doing business in Japan, because it's a Guess culture, yet experience Russians as rude, because they're diehard Askers.

Lies, Damn Lies, and Statistics: BP Edition.

BP is busted lying with charts.

Extreme Makeover

Altruism with negative consequences.

Each week, an average 9.4 million viewers tune in to ABC-TV for what, over seven seasons, has become a classic formula: Find a struggling family with a heart-tugging story and send them on vacation as an army of volunteers work frantically to replace an existing home with a much nicer and bigger one in just 106 hours. Each episode ends with a dramatic tear-filled tour of the new home, packed with donated furnishings, and outsize extras like a carousel or bowling lanes.

But after the cameras have gone, another trend has been developing: Homeowners struggle to keep up with their expensive new digs. In many cases, the bigger, more lavish homes have come with bigger, more lavish utility bills. And bigger tax assessments. Some homeowners have tapped the equity of their super-sized homes only to fall behind on the higher mortgage payments.

The show's producers say they are aware of the problem and are making changes appropriate to current economic reality: downsizing.

Gruber on Healthcare

Cspan video here.

Also an excellent study on the source of cancer survival gains. Its not increased testing, it better treatment. Gruber makes the point about 38 minutes into the above video the better doctors do less testing.

Our baseline analysis found that treatment advances account for the vast majority of survival gains for all the cancers examined: breast cancer (83%), lung cancer (85%), colorectal cancer (76%), pancreatic cancer (100%), and non-Hodgkin’s lymphoma (96%).

Ignorance

We have much to learn about Parkinson's.

Height

A solution to a problem I've discussed before.

The Last Mile

Sendhil talks about the last mile challenge to health and other areas of the economy.



Maybe his ideas can be applied to achieve these gains:

Porn for Women

Order Bias

A great example of order bias in survey questions.

Tony Judt

This is my first brush with the writing of Tony Judt. He is an excellent writer, even for a blog entry the prose is juicy. His blog entry entitled "Girls! Girls! Girls!" is an excellent look into the vagaries of student professor interactions.

History was a fast-feminizing profession, with a graduate community primed for signs of discrimination—or worse. Physical contact constituted a presumption of malevolent intention; a closed door was proof positive.

Shortly after I took office, a second-year graduate student came by. A former professional ballerina interested in Eastern Europe, she had been encouraged to work with me. I was not teaching that semester, so could have advised her to return another time. Instead, I invited her in. After a closed-door discussion of Hungarian economic reforms, I suggested a course of independent study—beginning the following evening at a local restaurant. A few sessions later, in a fit of bravado, I invited her to the premiere of Oleanna—David Mamet’s lame dramatization of sexual harassment on a college campus.

How to explain such self-destructive behavior? What delusional universe was mine, to suppose that I alone could pass untouched by the punitive prudery of the hour—that the bell of sexual correctness would not toll for me? I knew my Foucault as well as anyone and was familiar with Firestone, Millett, Brownmiller, Faludi, e tutte quante. To say that the girl had irresistible eyes and that my intentions were…unclear would avail me nothing. My excuse? Please Sir, I’m from the ’60s.

Read the comments. You'll no doubt notice we still exist in a world of punitive prudery.

Surprising Conclusions

From a recent AER paper on Medicare part D:

Our paper provides evidence for what we consider a surprising outcome: in the case of the new prescription drug program for Medicare enrollees, moving consumers from cash-paying status to membership in an insured group lowers optimal prices for branded prescription drugs below what they otherwise would be. This is surprising because the standard effect of insurance is to create inelastic demand and therefore elicit higher prices from a seller with market power (Duggan and Scott Morton 2006). However, the insurers that we study bundle insurance with a formulary and other mechanisms to create elastic demand. An individual consumer typically does not know which drugs are acceptable therapeutic substitutes; the consumer’s physician typically has poor knowledge of prices, especially negotiated prices; and any one consumer is too small a share of demand to negotiate with a pharmaceutical company. A prescription drug plan can potentially surmount all three hurdles.

Our evidence leads us to conclude that the formulary and other mechanisms perform the special role of allowing buyers to move market share among drugs with patent protection, thereby raising cross-price elasticities and lowering purchase prices (or reducing price increases) for branded drugs. This result contrasts with the common intuition that an uninsured consumer, paying at the margin for her own purchases, is the best tool with which to create competition in the market and impose pricing discipline on sellers. Certainly, this reasoning is at least part of the rationale behind many current policies in health care such as tax-free health care savings accounts (R. Glenn Hubbard, John F. Cogan, and Daniel P. Kessler 2005). Our evidence suggests that this picture is incomplete; for maximum effect, the consumer also needs to be part of a group that can substitute one provider for another.

Health Links

The AP covers the Health care proposals.

The food pyramid and the food subsidy pyramid.

Comparative Effectiveness vs. Cost Effectiveness

Comparative Effectiveness vs. Cost Effectiveness:

Many supporters of comparative effectiveness research contend that there is little need to confront cost-effectiveness in order to contain costs. Some clinical practices, once subjected to rigorous evaluation, have been found to be of no benefit, if not harmful. Moreover, there is considerable variation in health care expenditures and a weak or even negative association between spending and outcomes, such as mortality at the regional level4 and quality measures at the state level.5 This evidence has been interpreted to mean that cutting back on these putatively useless or harmful services would simultaneously reduce cost and improve health.4,6 In contrast, several cross-sectional studies that have shown positive associations between spending and outcomes have been interpreted to show that more spending leads to better outcomes.7

We question whether these associations — either negative or positive — are being interpreted correctly. An association between higher spending and poorer outcomes does not imply causality. Such negative associations may result if physicians and hospitals in lower-cost areas are more skilled — or if they use resources for more cost-effective services.

Whether additional spending yields improved outcomes depends critically on what the money is spent on. Clinical trials of treatments such as coronary reperfusion in patients with acute myocardial infarction, implantable cardioverter–defibrillator therapy, fusion surgery for spinal stenosis, and new drugs for patients with cancer or the AIDS have established their comparative benefits.8,9,10,11,12,13 Several of the cost-effectiveness ratios for these treatments are well under $100,000 per quality-adjusted life-year (QALY) gained, indicating good value for the money (Table 1).

But cost-effectiveness studies reveal a stunning range of incremental cost per QALY gained, ranging from a negative net cost to millions of dollars per QALY gained.14 Preventive services are no more and no less likely to save money than treatments.15 For example, annual screening for cervical cancer costs about $800,000 more for every life-year gained than does biennial screening.16 Small variations in the mix of utilization across the spectrum of therapeutic, diagnostic, and preventive technologies could produce large geographic variations in overall costs and health outcomes.

As long as there are opportunities to substitute more cost-effective clinical strategies for less cost-effective ones, costs can be lowered without adversely affecting health. But at some point, difficult choices must be made. Should the Medicare program continue to pay for cancer drugs that improve survival by a median of 10 days and have cost-effectiveness ratios of up to $500,000 per QALY added?12,17

Infographic on Porn

As is always the case with data on the porn industry, this should be viewed with a healthy dose of skepticism. Same is true for the youtube video below. The video is risque, but no nudity. However it might not pass your employer's test, so in that case consider it NSFW. It is a unique way to view data. I wonder if I did this with my power point slides for class what would happen? They probably would still miss the message.

Think Like A Statistician

Think Like A Statistician

A Mystery

So here is a bit of an economic mystery:

Less expensive, lower-quality innovations abound in every economic sector—except medicine

Whereas all this fancy theory plus a token can get you on the subway, might there be practical applications of “decrementally” cost-effective innovation? To explore this, working with colleagues at the Tufts Center for the Evaluation of Value and Risk (who maintain a comprehensive database of cost-utility studies), we enlisted Aaron Nelson, then a medical student, to help us sort through more than 2,000 cost-utility comparisons for any potential examples that might be decrementally cost-effective. We found that about three-quarters of published comparisons described new technologies or treatment strategies that increase both costs and benefits, and that most of these (about 65 to 80 percent) were cost-effective by conventional criteria (depending on which conventional threshold was used, $50,000 or $100,000 per QALY gained). Less often, published analyses described innovations that are either dominant or dominated (about 10 percent and 15 percent of the time, respectively), but only very rarely were innovations both cost- and quality-decreasing. Indeed, fewer than 2 percent of all comparisons were classified in the cost- and quality-decreasing “southwest quadrant”, and only 9 (involving 8 innovations) were found to be decrementally cost-effective (0.4 percent of the total)—that is, they saved at least $100,000 for each QALY relinquished.

Examples of these cost-saving interventions include using the catheter-based percutaneous coronary intervention in place of bypass surgery for multivessel coronary disease, which on average saves about $5,000 while sacrificing a half day of perfect health (for a cost-savings of more than $3 million for every QALY lost) and using repetitive transcranial magnetic stimulation instead of electroconvulsive therapy for drug-resistant major depression, which avoids the need for general anaesthesia and saves on average over $11,000 but sacrifices about a week of perfect health (for a ratio of more than $500,000 for every QALY lost). Nearly all the remaining innovations involved the tailored withholding of standard therapy, including watchful waiting for selected patients with inguinal hernia, withholding mediastinoscopy for selected patients with lung cancer, and abbreviated physiotherapy or psychotherapy for patients with neck pain or deliberate self-harm, respectively. Finally, the cost-saving innovations included the sterilization and reuse of dialysate, the chemical bath used in dialysis to draw fluids and toxins out of the bloodstream—a degree of thrift even the late Sheldon Kravitz would have to admire.

That decrementally cost-effective innovations are so rarely described in the health-care literature suggests that medicine is distinct from most other markets, in which cost-decreasing, quality-reducing products are continuously being introduced—think IKEA, Walmart and the Tata car. Several reasons may explain this “medical exceptionalism.” First, there is fundamentally a lack of incentives both for physicians to control costs, especially under a fee-for-service regime, and for patients to demand less expensive treatment when insurance shields them from the direct costs of care. Second, medical “bargains” frequently come with health risks, and trading health for money strikes some as vulgar, regardless of ratio. The inherent ethical unease that decrementally cost-effective innovations can elicit poses a serious public relations and marketing challenge.

Marginal Revolution has a link to the actual article.

Brain Rules

A post on brain research by Tyler, has this great line:

As the authors put it, experienced value and decision value are not the same. The main test involves heterosexual men looking at the faces of women and thus one concrete implication, or so it seems to me, is that the pornography men enjoy the most is not necessarily what they are willing to pay the most for.

Budget Forecasts

The NYT recently had a good graphic on the budget deficits and Presidential forecasts. I've recreated it below. There are two striking facts. The first is how every, and I mean every 5 year budget forecasts calls for decreasing deficits if not in the first or second year, definitely by the third through fifth year, yet that is rarely the case. Forecasts are clearly not rational as the errors are biased, averaging almost 1% above actual. Notice the other striking thing, how much of a surprise the boom of the late 1990's was for the public coffer.

PSA

Thats stands for Prostate-Specific Antigens rather than Public Service Announcements. PSA screenings are a common test performed in the US, whose efficacy is still disputed. Our local paper has a good article covering some of the issues.

The American Cancer Society is urging doctors to make clearer to men that the test used to screen for prostate cancer has limits and may lead to unnecessary treatments that do more harm than good.

American men long have been urged to have prostate cancer screenings, but over time studies have suggested most cancers found are so slow-growing that most men could have avoided treatments that can lead to incontinence or impotence.

New Guidelines include:

Doctors should discuss the pros and cons of testing with their patients, including giving them written information or videos that discuss the likelihood of false test results and the side effects of treatment; stop giving the rectal exam as a standard screening tool because it has not clearly shown a benefit, though it can remain an option; and use past PSA readings to determine how often follow-up tests are needed and to guide conversations about treatment.

You might want to bring these into to the doctor. It will be your get out of jail free card should you see him go for the rubber gloves and vaseline. Interestingly there is some evidence that PSA tests have had some sort of effect on mortality. Looking at the US and UK this study, came to the following conclusions:

The striking decline in prostate-cancer mortality in the USA compared with the UK in 1994–2004 coincided with much higher uptake of PSA screening in the USA. Explanations for the different trends in mortality include the possibility of an early effect of initial screening rounds on men with more aggressive asymptomatic disease in the USA, different approaches to treatment in the two countries, and bias related to the misattribution of cause of death. Speculation over the role of screening will continue until evidence from randomised controlled trials is published.

Fewer New Cars

A permanent decline in new vehicle registrations?

MADISON, Wis. - New vehicle registrations in Wisconsin are nearly half of what they were in 2000.

Registrations dropped 46 percent - a hit that's felt well beyond the state's auto dealerships.

Thousands of jobs have disappeared as auto plants and their suppliers deal with the fractured auto industry.

The auto statistics service Cross-Sell shows the number of new vehicles registered in
Wisconsin in 2009 was nearly 172,000 - down from nearly 320,000 in 2000.

Since 2000, 107 auto dealerships have closed in Wisconsin, including 56 in 2008 and 2009.

The Journal Sentinel reports state employment in auto parts manufacturing fell 44 percent from 2000 to 2009. Parts factories such as Tower Automotive and Delphi in Milwaukee and Lear and SSI in Rock County closed.

Linkfest

1. The future is here, and it involves analyzing data. In this case, predicting movements with cell phones.

2. An awesome visualization, well audio-ization of the time differences in Olympic sports.

3. The problems with the GOP.

4. The challenges facing employment growth.

Working at Starbucks

There are a few things I hate about Starbucks. For starters I hate the sometimes forced interest in my life the baristas display. I'm a regular and even though I prefer to be anonymous, I'm not. But I still return. Unlike the other coffee shops in town, this isn't filled with annoying 20 year-old girls chatting about their drinking escapades. Well, not at 6am anyway.  But Starbucks does create a nice atmosphere with their musical choices. They seem to hit my work tempo just right, and help me discover new music.  This morning I heard the Sade tune "Soldier of Love" and they turned me on to the new Kate Earl CD. Here is the video for "Melody".

Life Expectancy in the Rich Countries

Living in a rich country helps to reduce your chance of dying from a natural disaster. One of the many reason life expectancy tends to be higher in rich countries.

Using a new data set on annual deaths from disasters in 57 nations from 1980 to 2002, this paper tests several hypotheses concerning natural disaster mitigation. While richer nations do not experience fewer natural disaster events than poorer nations, richer nations do suffer less death from disaster. Economic development provides implicit insurance against nature’s shocks. Democracies and nations with higher quality institutions suffer less death from natural disaster. The results are relevant for judging the incidence of a Global Warming induced increase in the count of natural disaster shocks.

More Misc Links

Here are some more miscellaneous good links from my new favorite blog:

1. Apparently I should stop being such a "debbie downer", it doesn't pass cost benefit analysis.

2. Turns out others might know you better than you know yourself. For my BUS 230 students what does this imply for surveys that require self reporting of intended behaviors?

3. So it looks like I'll need to incorporate this into my extra-marital sex paper. Keeping a romance secret doesn't make it more exciting.

4. What distinguishes women who have had a lot of sexual partners? Not childhood, attractiveness, or other "mate value" related things. They are just more like men in certain domains.

5. In a relationship, but want to boost your testosterone? Look to cheat.

Mastering Skills

From my new favorite blog, "barking up the wrong tree" we have this gem about the importance of experiencing stress while trying to improve ones competency:

Contrary to previous research, the study found that people who engage in behaviors that increase competency, for example at work, school or the gym, experience decreased happiness in the moment, lower levels of enjoyment and higher levels of momentary stress. Despite the negative effects felt on an hourly basis, participants reported that these same activities made them feel happy and satisfied when they looked back on their day as a whole. This surprising find suggests that in the process of becoming proficient at something, individuals may need to endure temporary stress to reap the happiness benefits associated with increased competency.

I think this explains why I'm so frustrated with how bad I suck at swimming right now. But it looks like there is a happiness payoff around the corner.

Economic Development Spam

Here is an email (read span) I recently received (here is a similar link):

DPC Special Report & Video | Promoting Travel and Tourism Will Create Jobs


Hello All, I wanted to alert you to the fact that the DPC has released a one-pager on the Travel Promotion Act (link and full text below), outlining the significance in passing this importance piece of legislation. As the Senate continues to debate a series of bills in the coming weeks that will create jobs for the American people that need it most, as part of its jobs agenda, it is important to keep in mind that this bill is a jobs bill—as the U.S. Travel Association projects it will create nearly half a million jobs. Moreover, the Congressional Budget Office estimates it will reduce the federal deficit by $425million over the next decade. It is not often that we see both of these things accomplished, in one piece of legislation. I encourage you to take a look at this report, as it quite clearly lays out exactly what this bill will do. In addition, I have included a clip from Senator Dorgan, who has been very active on this issue. While speaking on the Senate floor, he focuses on the idea that by passing this bill and funding a national campaign that will promote travel to the U.S., it could ultimately strengthen America’s standing around the world—an idea that is truly tough to put a price tag on. As always,please be in touch if you would like to discuss in more detail. Many thanks.--Kati

Really? So If I travel to your state and spend 1,000 dollars that I would have spent in my own state, on something like home improvements, and you travel to my state and spend 1,000 you would have spent in your home state on home improvements, we will create jobs? Wow, that is literally the dumbest thing I have ever heard, its not even beggar-thy-neighbor. It creates ZERO net change in economic activity, thus it creates ZERO net jobs.Oh, but maybe this line gives us a hint as to who thinks its a good idea:

as the U.S. Travel Association projects it will create nearly half a million jobs...

And they don't care about the half a million jobs which will be lost in the home improvement sector. The fetish with gross "job creation" needs to end. If we care about jobs it is about NET jobs.

Yet More Happiness Research

The blogs are a flurry with happiness research of late. Here is another link on how to make yourself happy.

The authors hypothesized that thinking about the absence of a positive event from one's life would improve affective states more than thinking about the presence of a positive event

So if you want to be happy, don't think about how you met the love of your life, think about what life would be like had you not met them.

Update: Penelope thinks she overemphasizes happiness and has decided to dump it as a topic for posting. However if you read her here, you might get happy.

Other things you didn't know about happiness research here.

Freedom Fighters

Education and Happiness

What makes you happy? The study of happiness is really picking up in economics. See for example, here and here. The NYT Economix blog recently had a post on the correlation between education and happiness.

But the variable they looked at that showed the strongest relationship with happiness was “human capital,” measured as the share of the population with a bachelor’s degree or higher:

I think it probably works something like this. Education pushes ones intellectual maturity to a point where they realize and enjoy the complexity and diversity in the world. They understand happiness to be something different than those without the benefits of more education. The are happy because they are interesting and interested in the world around them, even if they can't control it or understand it. It isn't the trade-off that Penelope Trunk suggests. Of course since this is only a bivariate correlation, education likely also has effects through the other channels, like increases in income, marriage, better sex lives, etc.

More Health Links

Marginal Revolution has some more health related links.

1. A new book on the FDA.

2. Ezra Klein on the new push for health care.

3. Price Controls on Insurance.

Good Advice

DSM V

The DSM (Diagnostic and Statistical Manual of Mental Disorders) is on version IV, but they are preparing changes for version V.  It turns out this manual is very important for diagnosing mental disorders, both to the clinician, and to the insurance and pharmaceutical companies. Given the money involved, you would expect economists to to be interested in the political economy of how disorders are defined. There is an excellent discussion of the changes being made to the diagnostic criteria for Autism here: 

5. The headline-making but most predictable--and most predictably responded to--change is the loss of Asperger's and PDD-NOS, which have both always been considered part of the autistic spectrum, as distinct-from-autism diagnoses. Whatever their shortcomings, the loss of these diagnoses is another signal that autism is, officially and more so than ever, merely a series of deficits in overt typical behaviour.

6. At the very least, the DSM-V strongly discourages any view of autism as an atypical cognitive phenotype involving relative (to nonautistics) cognitive strengths and weaknesses.

7. The changed criteria, which collapse the DSM-IV social and communication domains, overlook any role for manual and oral motor abilities in these two areas. And whose definition of the now-mandatory social reciprocity criterion will prevail? Here is John Constantino'sone-way-street definition:

Reciprocal social behavior refers to the extent to which a child engages in emotionally appropriate turn-taking social interaction with others.

The closer-to-equal time, so to speak, now granted the previously-relegated RIRB (restricted interests and repetitive behaviours) domain could be seen as progress, ditto the disappearance of the "nonfunctional" assumption. But autistics will no longer have DSM-IV unusually focused and intense interests (a strength), we will instead be pathologically fixated.

And here is a discussion of some suggestions that appear to be making it into the proposed changes being made to female sexual dysfunction (FSD). I received an email from the SSSS, looking for people to comment on the following proposals:

Currently the FSD subcommittee has proposed four changes from the DSM IV-TR as follows:


Change 1: deletion of sexual aversion disorder and capturing it as an anxiety disorder


Change 2: redefining female orgasmic disorder as delay in or absence of orgasm and/or markedly reduced intensity of orgasm that must be present for at least 6 months and experience on at least 75% of occasions of sexual activity that causes distress


Change 3: merging desire and arousal diagnosis into one entity, replaced by SIAD, sexual interest arousal disorder. SIAD would be defined as a lack of sexual interest/arousal for 6 month duration as manifested by at least 4 fo the following:
a. absent/reduced interest in sexual activity
b. absent/reduced sexual/erotic thoughts and fantasies
c. no initiation of sexual activity and not receptive to partner's attempts to initiate
d. absent/reduced sexual excitement/pleasure during sexual activation at least 75% of occasions of sexual activity
e. desire not triggered by sexual/erotic stimulous
f. absent/reduced genital or non-genital physical changes during sexual activity at least 75% of occasions of sexual activity
which causes distress and is not due to a physiological substance or general medical condition.


Change 4: merge vaginismus and dyspareunia into genito-pelvic pain disorder defined as persistent or recurrent difficulties for 6 months or more with at least one of the following:

This obviously increases the standards to get a diagnosis, thus reducing the demand or potential insurance coverage for those marginal patients. You can imagine who would be against this, those clinicians who serve the marginal patients. (By marginal here I mean the people that met the DSM IV criteria but will not meet the DSM V criteria.)

Chart Selection

As they suggest, it is both art and science.

Drinking

Marginal Revolution channels Malcolm Gladwell who points us to some interesting research on drinking:

Put a stressed-out drinker in front of an exciting football game and he’ll forget his troubles. But put him in a quiet bar somewhere, all by himself and he’ll grow mare anxious. Alcohol's principal effect is to narrow our emotional and mental field of vision.


It causes, “a state of short- sightedness in which superficially understood, immediate aspects of experience have a disproportionate influence on behavior and emotion." Alcohol makes the thing in the foreground even more salient and the in the background disappear. That’s why drinking makes you think you are attractive when the world thinks otherwise: the alcohol removes the little constraining voice from the outside world that normally keeps our self-assessments in check. Drinking relaxes the man watching football because the game is front and center, and alcohol makes every secondary consideration fade away. But in a quiet bar his problems are front and center and every potentially comforting or mitigating thought recedes. Drunkenness is not disinhibition. Drunkenness is myopia.

But this article was more intriguing. Apparently drinking helps to reduce dissonance. In other words, you really can drink some troubles away. 

Many Wives

Many wives apparently reduce the spread of HIV/AIDS.  

The story: Africans don’t have more sex than Americans; both have roughly the same number of partners in a lifetime. But Americans are more likely to be serial monogamists, while Africans are more likely to have concurrent partners (outside marriage). These networks allow HIV to spread more easily. Polygyny, it seems, is the exception.

R&D

Below is a graph on health related R&D. The punchline from the blog post is:

It appears that to some degree,  we have gambled our economy on the success of life sciences innovation.

Interesting or Happy?

Penelope Trunk says you are one or the other. I scored a zero. I guess I'm neither happy, nor interesting? Or maybe I'm balanced between the two? I did just read that planning a trip makes you happy so I think I'm going to make plans to head to the Caribbean and sit on the beach. Or maybe I'll head out west and climb a mountain. Or maybe I'll just plan a bunch of different trips and see who I can sucker in to joining me.

Medical Mistakes

Whoops. Did anyone see where I put that instrument? [Story]

It took five long months for a Czech woman to discover the reason for her pain: Doctors had left a foot-long medical tool inside her abdomen. This month, doctors at a clinic in the southeastern town of Ivancice discovered their colleagues had forgotten to remove a spatula-like surgical instrument from the woman following gynecological surgery in September.

Presentations

Deliver a great presentation like Steve Jobs. And while you are at it use some color theory when creating your slides.

The Presentation Secrets Of Steve Jobs

View more presentations from Peter Walker.

Shocked

It takes a lot to shock me. A lot. However I had no idea abortion was as common as this data suggests. But it looks to be true. The CDC report and data are here. On average there are 236 legally induce abortions for every 1,000 live births. That of course doesn't count "back alley" abortions, which I would guess are relatively infrequent these days. Of course abortion can also occur naturally, it is then more commonly known as a miscarriage. It appears that about half of all fertilized eggs are terminated by spontaneous abortion. However many of those women never even know they are pregnant. About 15-20% of women who know they are pregnant miscarry. I guess this should make God a bigger target for the anti-abortion crowd than planned parenthood? On a related note, here is a good graph on global condom use, or should I say lack of use?

Budget Data

Visualizations of the federal budget from various sources:

The Washington Post.
The New York Times.
The Wall Street Journal.

Update.

I missed:
The Guardian.

Health Care Outcome Equality

Pulled from Marginal Revolution:

What will result from the intersection of two possible trends: insistence on a greater equality in health care outcomes, and the development of new technologies -- some at the genetic level for the individual -- which will lead to a greater inequality of health care outcomes?

Keeping Them Honest

Both sides of the political aisle are prone to exaggeration and convenient amnesia. Recent discussions of Obama's plan to allow the Bush tax cuts to expire have included references to socialism. Below you will find the historical top marginal income tax rates, color coded by party. Another take is here. [Data Source].

Wording Matters

Choice of wording matters.

V-day

BPS summarizes the state of knowledge of psych research for those looking for a Valentine. I must confess to apparently the wrong approach.

When wooing a woman, use chat-up lines that demonstrate your helpfulness, generosity, athleticism, ‘culture’ and wealth. Don't bother with jokes, empty compliments and sexual references.

I once went to Europe to ride my bike, and while there I helped an old lady get on the train. Does that count?

Andrew Gelman posts some nerdy V-day poems here. My favorites:

I'm aiming for a p-value less than .01
That you and me together could have lots of fun
The R2 of those before you were really quite poor
But the multiple comparisons problem we'll just ignore
-+-
I may know all things statistical
But how to win your love is far more mystical
I could derive and integrate with great flair
And we could make a perfectly correlated pair
-+-
H0: All is lost, our love is not mean to be
Ha: Oh happy day, you really like me
Our favorite test statistic says p=0.053
That's a little high but it's good enough for me
-+-
I've suffered through dates that were very extreme
When all I was hoping for was closer to the mean
Their knowledge of boring facts was encyclopedian
When it would have been better to be on the other side of the median
And eventually even their manners did erode
With scores for politeness nowhere near the mode
So I apologize for being so informal
But I'm so glad I finally found someone normal

Positive versus Normative

A false dichotomy.

Relationship Scholar Dies

The academic community lost an important researcher, Caryl Rusbult. From her obit in Science News:

Caryl Rusbult was the queen of close relationships. For more than 30 years, and for the past six years at Vrije University in Amsterdam, she studied how some men and women form lasting, supportive marriages. Rusbult’s work led her to conclude that close partners are interpersonal artists, sculpting one another’s strengths and weaknesses so as to bring out the best in each other. She called this the Michelangelo Phenomenon, a reference to the great Renaissance sculptor who said that he used a chisel to release ideal figures from blocks of stone in which they slumbered.
......
And the discussion would have been lively. Shortly after meeting one another in the early 1980s, Reis and Rusbult got into a fierce debate at a psychology conference about what people really want in close relationships. Reis championed emotional intimacy. Rusbult insisted that partners want to coordinate their behavior so they can achieve goals that each holds dear.

“Ten years and much research later, I was convinced that she was right,” Reis says.
......
Real-life dating and married couples provided her team with glimpses of the Michelangelo Phenomenon in action. Time and again, romantic pairings succeeded if each partner detected the other’s self-reported dreams and aspirations and found ways to guide him or her toward those goals. This process hinged on identifying and working with a partner’s personal flaws, just as a sculptor incorporates irregularities in a block of stone into a masterpiece.

Dating Markets

I've always said the sex ratio is an important aspect of any dating market. Here is an article from the New York Times on the ramifications of the shift to more females in college. It is clearly a better time to be in college than when I was there. Alex Taborrak discusses it here, and here he provides a good example of how small differences with large opportunity costs can dramatically alter the "power" in a relationship.

Casual observation here on campus suggests males would be wise to lock up their significant other with a ring now, because they won't be able to do better after school is out.