Op-ed

In what is sure to be supreme irony. My op-ed on changing the nature of the debate was cut from about 750 to around 500 words. Given that one of my main points was that we do not take time to make the complicated arguments, I think I've proved my point. As for how we change the nature of the debate? I'm at a loss. I guess we as consumers of information have to change our demands. Here is the full op-ed with links.

Changing the Nature of the Debate. 2/21/11 Taggert J. Brooks, PhD

I have to admit the last week has been quite an emotional roller coaster for me. As a state employee who will be receiving a large pay cut, my morale is low. As someone who is teaching health economics I can hardly think of a more salient example of the struggles we face with rising health care expenditures. But as an economist I’ve been infuriated by the level of debate. I’ve spent too much of my time trying to raise the level of discussion on both sides in the comments section of this newspaper, or the Facebook walls of my friends and former students.

We need to change the nature of the debate.

In December Congress moved to extend unemployment insurance benefits to another group of recipients to an unprecedented 99 months . Republicans claimed that this would only delay recipient’s job search and inflate an already high unemployment rate . Republicans were right. Unemployment Insurance (UI) artificially reduces the incentives to find work by increasing the cost of taking up employment. Larry Katz finds a one week extension typically increases unemployment duration by 0.2 weeks. This is supported by ample economic research. But Democrats cried foul. They argued that failure to extend benefits would throw thousands off UI resulting in painful decreases in their family’s income, and it would cause the ensuing macroeconomic consequences associated with falling consumption . Democrats were right too, and there is plenty of research to back their argument. Why the seemingly contradictory conclusions? The reason is unemployment insurance is a blunt policy tool.

But the debate shouldn’t be about extending or not extending UI. The debate should be about how we sharpen the blunt tool, about how we get the good things out of UI without creating the bad things? Sadly we seem far from that type of discussion. Maybe because it would never fit on a bumper sticker.

Wisconsin’s current troubles provide us with other examples of how we need to change the nature of the debate. Unions are complicated entities – and much like UI - they do both good things and bad things. Looking specifically at the K-12 teachers union, since they appear to be Governor Walker’s primary target, we hear about their resistance to change and their protection of bad teachers. Unions are blunt instruments. They are designed to protect worker’s rights, but in so doing they often protect bad behavior and bad workers. The debate should be about how we reduce the bad things that they do, and improve the good things they do. How do we sharpen the tool? The Governor’s actions have circumvented that conversation.

One of Governor Walker’s examples for wanting to eliminate collective bargaining comes from the Milwaukee Teachers' Education Association (MTEA). He decries the union’s attempt to reinstate Viagra coverage with their health insurance . The implication is that the union is defending a bunch recreational drug users. I’m quite sure there is some of that, but I’m also sure there are prostate cancer survivors in that same mix. I think we can all agree their desire to have intimate relations with their spouses is a legitimate health issue. But we can’t blame the union entirely for the bluntness of their defense, we should also blame the insurance company. Why can’t they cover the medicine for the cases we all think are legitimate, and not cover it for the cases some of us might find frivolous? We need to sharpen our tools, the debate should be about how we do that, not about avoiding the conversation. We should not abandon our teachers nor our prostate cancer survivors.

Our current health care system guarantees this will continue to be a problem. But we need to end the winner take all mentality. There is a third way. Honest discussion, debate and a willingness to wrestle with complicated ideas, that can’t be reduced to sound bites. It will take leadership on both sides. But more than that, politicians will have to become educators, because the problem really is us. We want our cake and want to eat it too. Edmund Burke had it right. Politicians should not be mere puppets for the majority of their constituents; they should be advocates for the public trust. Otherwise we are doomed to painfully oscillate between extreme world views.

Teacher Compensation

Teacher compensation data is here. Here are two plots of total average compensation (salary plus fringe) for the top 40 school districts and the bottom 40, of the 425 districts. Its important to remember that this is not starting salary, but includes all teachers, even those with 30 years of experience.

Race and Voting

Here is a discussion of a fascinating and uncomfortable conversation we might have.

Section 5 of the Voting Rights Act is, indisputably, an unusual piece of legislation. It does not apply, as the rest of the law does, to the whole country. Rather, it requires nine southern states and parts of another (40 of North Carolina’s 100 counties) to submit any change in voting procedure, from redistricting an entire state to moving a single polling place from one location to another, for “preclearance” by the Department of Justice or a three-judge federal court in Washington.

But is it constitutional? Maybe not.

Twins

The Problem with Twin Studies.

And here is Richard A.:

The Body-Mass Index of Twins Who Have Been Reared Apart

We conclude that genetic influences on body-mass index are substantial, whereas the childhood environment has little or no influence. These findings corroborate and extend the results of earlier studies of twins and adoptees. (N Engl J Med 1990; 322:1483–7.)

IOWs, the reason why white kids of today are much fatter than white kids of the 50s and 60s is due to genetic influences and environment has little or no influence

This shows that the twin studies are flawed.

Because genetic changes are far less than can explain the changes in weight.

But remember that the changes in weight are a result of small changes in behavior 10 lbs of steady state weight comes from just 150 calories extra per day. Thats 10 minutes walking. 3 oreos, one coke? Seems small too, and maybe a small drift on a single gene can achieve that end?

For the average american male every 1 point of BMI is about 3.2 kg, or about 7 pounds. Since 1970 we have probably added about 3 points to our average BMI, but maybe less for the median. So we are trying to explain 21 lbs.

Changing Behavior

I think I've mentioned that recessions as deep and long as the one we experienced can have lasting effects on behavior. These changes might very well be temporary, but some might be more permanent for this age cohort. From the NYT on Walmart:

Company executives and analysts said consumers seemed to have changed their ways during the recession, and that has persisted into the sluggish recovery. New shopping habits, like using less credit, relying more on month-to-month cash and buying in smaller packages, have hampered Wal-Mart’s ability to climb out of the sales slump.
...
In the fourth quarter of 2010, the problems stemmed from several areas. Toy sales were down in American stores, though Wal-Mart had aggressively promoted prices and added back toys to its aisles. Apparel continued to be a problem.

And in consumables — basics like toilet paper and soap — Wal-Mart said its prices and sizes were a problem for shoppers who continued to be on tight budgets.
“It’s not a case that we’re not correctly priced,” Mr. Holley said. For example, he said Wal-Mart’s price-per-ounce for laundry detergent was usually lower than competitors’, but competitors like dollar stores often sold smaller bottles or boxes that were cheaper.

“Some of our customers at the end of the month may have only a fixed amount left,” he said, “and even if it’s more per ounce, if the price point is more attractive at a competitor, at the end of the month that’s all they can spend.”

It seems to be a liquidity/financing problem for their customers.

The Enemy

The enemy is US.

Those Darn Polls

Rasmussen Reports released a new poll the other day, which found:

A new Rasmussen Reports national telephone survey finds that 48% of Likely U.S. Voters agree more with the Republican governor in his dispute with union workers. Thirty-eight percent (38%) agree more with the unionized public employees, while 14% are undecided.

The wording can be found here.

1* How closely have you followed news reports about the Wisconsin governor’s effort to limit collective bargaining rights for most state employees?


2* Does the average public employee in your state earn more than the average private sector worker in your state, less than the average private sector worker in your state or do they earn about the same amount?


3* Should teachers, firemen and policemen be allowed to go on strike?


4* In the dispute between the governor and the union workers, do you agree more with the governor or the union for teachers and other state employees?


5* Would you favor or oppose reducing your state government payroll 1% a year for 10 years, either by reducing the number of state employees or by cutting the pay of state workers?

As Nate Silver points out that it probably suffers from and order bias due to the question framing in prior questions.

The issue is clearest with the third question, which asked respondents whether “teachers, firemen and policemen” should be allowed to go on strike. By invoking the prospect of such strikes, which are illegal in many places (especially for the uniformed services) and which many people quite naturally object to, the poll could potentially engender a less sympathetic reaction toward the protesters in Wisconsin. It is widely recognized in the scholarship on the subject, and I have noted before, that earlier questions in a survey can bias the response to later ones by framing an issue in a particular way and by casting one side of the argument in a less favorable light.

The Rasmussen example is more blatant than most. While many teachers have been among the protesters at the State Capitol in Madison, obliging the city to close its schools for days, there have been no reports of reductions in police or fire services, and in fact, uniformed services are specifically exempted from the proposals that the teachers and other public-sector employees are protesting. So bringing in the uniformed services essentially makes No. 3 a talking point posed as a question.


As an analogy, imagine a survey that asked respondents whether they believed the Democrats’ health care overhaul included “death panels” before asking them whether they approved or disapproved of the bill over all.

Randomizing the order of questions can address this issue, or working harder to ask questions which use language free from this type of bias.The AFL-CIO had their own poll here.

Free Market Health

Please, please, can't we have sensible policy when it comes to compensating donors? People are dying.

MPS Teachers Have Tons of Sex

I'm sure you've heard this bandied about by the Walker camp:

Example #2 Viagra for Teachers
The Milwaukee Teachers' Education Association (MTEA) tried to use a policy established by collective bargaining to obtain health insurance coverage that specifically paid for Viagra. Cost to taxpayers is $786,000 a year.

Its astonishing. I didn't realize sex was a "lifestyle". Only Republicans would view that as an inessential part of life. Anyhow. Lets leave aside the argument about whether sexual health is a health issue or a lifestyle.

The health insurer claims it will save $786,000 dollars per year if its approximately 1,000 enrollees can no longer get Viagra. By my estimate, thats approximately 786 dollars in viagra a year, or about 7 bottles of 6 100mg pills. Now I'm not sure - but I've heard - you can break those into 50mg pills and do quite well.

So that means the average enrollee is getting 84 doses. Assuming they can never have sex without a help from their little blue friend that means they are having sex 84 times a year.

A majority of Americans married, partnered, single, any age have sex less than weekly. So we either have some fishy numbers, some hypersexual teachers (and their covered partners), or they are selling/providing them to friends.

Demanding Viagra is not the problem, having a system that allows you to get more than you could plausibly use is a problem. But the problem isn't directly with the teachers union, it with the incentives of the insurer. It needs to curb demand another way.

Wisconsin 2010-2011 General Fund Appropriations

This is data from Table 10 from Act 28.

This link which takes you to the "Many Eyes" website in order to have a bit more room to play around with it.

Unions and ACT/SAT Scores

I saw this "fact" posted on FB:

Only 5 states don’t have collective bargaining for educators. Their ACT/SAT rankings: SC-50th/NC-49th/GA-48th/TX-47th/VA-44th.

I wanted to investigate, so I tried to dig into the data (SAT here, ACT here) but noticed instantly that Wisconsin ranks highly for the SAT, but has only 6% participation. That is suspiciously low to infer too much from.

Then I ran into this post. I thought I would share my comment here along with the paper I found.

Its a difficult thing to determine from simple descriptive stats. States with low participation in a particular test are likely to suffer from a selection bias. In Wisconsin you take the SAT if you are planning to go out of state. You go out of state if you are smarter, richer, etc. Which is why our SAT scores are high. You need to combine ACT, and SAT (through some conversion) then adjust the state's data for race, income, education, and percent going to college, along with union penetration. That will give you a better handle on the union’s effect. Unions definitely have very bad aspects too them, but they also have good aspects to them as well. The question is in part about the net effects. I would think their ability to get higher pay for union members, and better benefits relative to the non-union setting results in them attracting better teachers (on average) and results in greater stability. Again, we all know situations where this does not work well, but on average it might make for better teachers. That's not to say you couldn’t create the same environment without unions. Or to say you couldn't work with the unions to minimize their negative effects. When I graduated from Madison I knew people with teaching degrees who went to Texas, because of the lower standards and the ease of getting a teaching job there. The good ones eventually moved back to Wisconsin, and the bad ones left teaching. Wisconsin skims the cream as it were. It lets Texas do the work of separating the good from the bad teachers. Texas students lose, Wisconsin students win.

This paper looks like it might do a better job of identifying these issues:

Title: Do Teacher Unions Hinder Educational Performance? Lessons Learned from State SAT and ACT Scores.
Authors: Steelman, Lala Carr; Powell, Brian; Carini, Robert M.

From a quick read I think it does a reasonable job addressing the issues I highlighted above. Their conclusion, with a very thoughtful discussion of its implications is below:

They find a significant and positive relationship: that is, the presence of teacher unions appears to be linked to stronger state performance on these exams. These findings challenge the position that teacher unions depress student academic performance, and in so doing invite further empirical scholarship on this topic from a range of academic disciplines.

Our finding that teacher unions are positively linked to state average SAT and ACT scores prompts the question of why. Clearly, our study challenges the "rent-seeking" view outlined earlier, which envisions teacher unions at odds with what parents desire from schooling, namely, the educational advancement of their children. The zero-sum orientation that permeates much research on unions and assumes that worker gains inevitably result in production losses appears misguided, at least with respect to teacher unions. Still, our data cannot distinguish among the previously outlined explanations for the positive relationship between unions and state-level SAT and ACT scores. However, in supplementary analyses (available from the authors), we were able to test one possibility: that teacher unions are positively related to lower average class size (i.e., student-teacher ratios), higher per ca¬pita expenditures on education (adjusting for interstate variation in the cost of living), and higher salary (also adjusting for cost of living) . Although these variables are linked to state SAT and ACT scores, their inclusion in our models did not significantly reduce the effect of teacher unionization. Other mechanism (s) (i.e., better working conditions; greater worker autonomy, security, and dignity; improved administration; better training of teachers; greater levels of faculty professionalism) must be at work here. Future scholarship should be directed at unraveling why teacher unions appear to favor¬ably influence academic outcomes.

Finally, this study cannot tell us if there is an overall net benefit of teacher unions, at least with respect to cost effectiveness. Because we examined the link between teacher unions and productivity but not costs, we cannot gauge whether the higher test scores are enough to offset the purportedly higher costs of unionization. Whether there is a net benefit of teacher unions hinges not only on the impact of teacher unions on economic (and non¬economic) costs, but also on the specific costs deemed acceptable (by the public, policymakers, or academe) for a unit increase in educational productivity — an assessment for which consensus may be difficult to reach. Moreover, even if, through some mechanism, unionization raises test scores, teacher unions may be a relatively inefficient vehicle of educational reform: for example, states might raise scores more with an identical investment in school infrastructure, additional teacher training, or special programs.

Cities

Ed Glaeser talks about his new book Triumph of the City. He makes a few important points. Actually many, but two i want to focus on. Living in cities now improves life expectancy rather than making it worse. And he also makes a point about how technology such as facebook makes living closer together ever more valuable. It is a paradox I've mentioned before. But its also why we will not see the end of Universities as we know them. All the new technology is still just a complement to face to face learning and sharing, not a substitute for it.

The Daily Show - Edward Glaeser
Tags: Daily Show Full Episodes,Political Humor & Satire Blog,The Daily Show on Facebook

Wisconsin's Budget Problems

This is going to be a long post, but I've been asked by a fair number of former students and friends, from both sides of the political aisle to comment on what is happening in Wisconsin.

First, lets look at the budget problem. The State of Wisconsin has had a structural deficit since days of  Tommy Thompson (current issues here). They are largely the result of large increases to K-12 spending, tougher sentencing laws (map here), and tax cuts in early 2000. To be sure, there are other factors (such as rising healthcare expenditures) contributing to our current problems. But those three changes were the genesis.While they did occur under a Republican Governor, every Governor since has kicked the can down the road. And now the healthcare expenditures are starting to bite as well. Doyle was the most creative in using temporary tricks and one time money to close the gap. Even raiding a fund we will have to pay back. Andrew Reschovsky discusses efficient tax policy and proposes some tax altering policies which might be used to close the gap. If you are interested in understanding why Wisconsin taxes are higher than other states, read this excellent piece by Todd Berry and Dale Knapp. Higher taxes are in part to fund higher spending, and in part due to less efficient taxing. The reasons for the higher spending are clearly outlined, in the piece but include paving roads no one else paves, K-12 benefits packages, and subsidizing higher education tuition. (although this last one has obviously declined substantially recently).

Looking more specifically at the current budget repair bill. It appeared it was only made necessary by the tax expenditures (yes that is spending too) that happened at the end of January. Read Bob Lang's Legislative Fiscal Bureau's (LFB) Jan 31st report.

Our analysis indicates that for the three-year period, aggregate, general fund tax collections will be $202.8 million lower than those reflected in the November/December reports.  More than half of the lower estimate ($117.2 million) is due to the impact of Special Session Senate Bill 2 (health savings accounts), Assembly Bill 3 (tax deductions/credits for relocated businesses), and Assembly Bill 7 (tax exclusion for new employees). 

Tax expenditures are bad public policy and bad tax policy. However, closer inspection reveals that in fact the tax expenditures affect the 11-13 budget only.  Interestingly the tax expenditures add  up to about 140 million, which is 50% of the projected 11-13 savings from higher health and pension contributions from state employees. Money is fungible, but passing tax spending, then three weeks later screaming about rising deficits, strikes me as a little intellectually dishonest, or at least inconsistent. 

On the question of public sector compensation. Yes, my non-wage benefits and the non-wage benefits of all state employees are very good. And they will still be very good even after the proposed concessions. But when making comparisons you can't merely look at non-wage benefits without considering the wage side as well. Total compensation is the economically relevant concept. As this Heritage document explains, it is about the incidence.

Incidence of labor Taxes. The relatively elastic demand for labor, coupled with the assumption of a highly inelastic supply of labor, means that labor bears most of the initial economic incidence of taxes on labor income. It has become common to assert that all taxes on labor income fall on the worker, including the employer's share of the payroll tax, the employers; share of the payroll tax, the unemployment compensation tax, and the portion of the income tax that falls on wages and salaries.

In other words, labor bears the burden of income taxes, and both sides of the payroll tax, along with any benefits. So we should compare total compensation, and not look merely at pieces of the compensation pie. It is akin to watching someone try to lose weight. What matters is total calories consumed. If you merely look at the breakfast someone has consumed you might be led to the wrong conclusion. They might have a large breakfast, but a far smaller lunch and dinner. There are other reasons simply comparing benefits is problematic, and challenging. The Minneapolis Fed talks about the case of pensions here. And by the way, Wisconsin pensions are not underfunded like Minnesota's.

One of the challenges in the discussion is that talking about public versus private sector includes large swaths of very different people, different jobs, different skills, different education. So saying things like "public sector workers are over paid", are useless statements, just like saying public workers are underpaid is useless. That is true for some and not true for others. Relative to what? This EPI paper does a good job of addressing the case for Wisconsin. It uses a wage equation to adjust our salaries for inputs such as age, education and experience, etc. It also correctly adjusts our salaries for the fact that public employees work fewer hours (on average), but it is missing some things, like the fact that our jobs are generally more secure. Given that public employees generally have increased job security (although that doesn't look to be the case in the next budget) one would expect a lower salary. The conclusion of the paper:

On an annual basis, full-time state and local employees and school employees are under-compensated by 8.2% in Wisconsin, in comparison to otherwise similar private-sector workers. When comparisons are made for differences in annual hours worked, the gap remains, albeit at a smaller percentage of 4.8%.
...
Furthermore, average annual total compensation for a full-time worker without a high school education is 14% greater in state and local government ($36,935) than in the private sector ($32,415). High school graduates approach earnings and compensation equivalency between the private and public sector.

So, some workers appear to be overpaid, based on the wage equations and some underpaid. On average, we are underpaid. But as I said, we probably should be a little underpaid.

A former student sends me this cato paper which talks about public sector unions and the rising cost of employee compensation. I don't have time to dig in to the national trends on unions and public sector employment now, but I will comment on unions below. I did want to include the reading for future reference.

In terms of the rest of the proposal I have two comments, first on Walker's tactics as the relate to the budget, and second on collective bargaining and unions.


I think Walker's tactics are ill thought out. In the case of high speed rail, not only did he give back 810 million to the feds (which by the way was not remitted to WI tax payers but spent elsewhere, like CA), but that maneuver also cost us money, since we were committed to some expenditures that were covered by the 810 million, that we can not get out of. I am not a fan of highspeed rail. But I'm less of a fan of returning money to the Feds. As they say when you are hungry, you eat what is given to you. He did the same thing with 23 million in broadband money from the Feds, and who can be against improved broadband? And now this budget repair bill is likely to cost us another 47 million in federal money. I understand the argument that we should not take the money. But as I've said before, it is unwise to unilaterally disarm. The federal government is not reducing our taxes by the amount we give back, rather it is being spent in other states. To hand back money is foolish. Wisconsin already receives far less than its share of federal money. We get back 82 cents for every 1.00 we send to Washington. I fully understand that we have a budget issue at the federal level, but unilaterally disarming will not solve the problem. It will only make us relatively poorer. To use another metaphor it is equivalent to showing up to a gun fight, and out of principle putting the gun down. Not a bright idea. We need the politicians in Washington, Republicans and Democrats to solve the Medicare/Medicaid/Healthcare conundrum. We need them to set the priorities of the nation. They are failing. And no, the Tea Party is not offering a solution. Shooting down random spending bills is hardly a method of establishing priorities. Bowels/Simpson proposal was an attempt to start the conversation. Look at how quickly everyone fled the conversation.

On to the issue of collective bargaining. Maybe Scott Walker is a genius. The debate seems to be about collective bargaining rights, and not the 8% pay cut. Everyone has already offered to give up the benefits. Yet, the fight over collective bargaining continues. Which means this isn't entirely about repairing this budget, but the fight over collective bargaining is really the fight about future cuts. As in the future cuts that will occur in the 11-13 budget. Walker needs to break the union in order to cut State Aids by 900 million. Now I'm not a fan of unions. I think there are millions of examples of how they do bad things (faculty example here).


That said, we should understand the role of unions. As I mentioned I am no fan of unions. But remember they are merely a monopolist (for another view see this), meant to - at times - counterbalance a monopsonist. Why do the NFL and MLB have players unions? In part they counteract the State sanctioned monopoly of the owners (at least in the case of the MLB). And in the case of the NFL it is just to counteract the monopsony power of the owners. Since local government's educate 90% of the K-12 kids, they might be viewed as a monopsonist. 

Stripping away the collective bargain rights in this fashion has unfortunately put us on a path of confrontation and contentiousness. I now have no hope that we will be able to collectively address the budget problems going forward. Rather than negotiating a smooth path to a different equilibrium we collectively bargain, we will be stuck in a political seesaw where we bounce from the Republican vision of the future to the Democrat's vision, back and forth. The pain is in the dynamics. This increases the pain, it doesn't reduce it. Make no mistake in 4 years we will have a Democrat in the capital and he will pull the same shenanigans to payoff the public sector employees.

I also think its enormously hypocritical to exempt the police, firefighters, and the troopers. Not only did he exempt them he requires in the budget repair bill that funding for their departments be kept at 2009 levels or above. Therefore Walker further protects them from the cuts coming to state aids.

UW Faculty have not, until recently been able to collectively bargain. Doyle gave us the right to vote on it, and there has been a large push on UW-L's campus. Faculty have decided to go ahead with the vote, which is now guaranteed to pass. (Even many who would have voted against it might vote for it because they really hate having their rights taken away).

I am a bit offended by the tenured faculty that walk around campus claiming we need a union. They complain that we need more rights to negotiate our working conditions. I teach 9 credit hours. Other than being in the classroom for those hours and holding office hours, I have near complete autonomy over how I do my job. I can think about what I want, I can work on what I want. We set our own curriculum, we decide on our own research agendas, we hire and fire our colleagues, and provide input into the hiring or our leaders, who in the end will have very little influence on what we do. We - at least some of us - have tenure. We are the last people that need a union to bargain our work rules. We write them!  We do not work in a coal mine or a steel mill, and complaining as if we do makes us sound like we are divorced from reality, and insults those union workers who do not have it as well as we do.

But my job is very different than most other state workers.

A few parting shots. Politicians in Madison like to control the UW-System, but they currently provide less than 18% of the funds for our operation. How many private sector firms do you know where the 18% share holder calls all the shots?

For those of you that say "get a job in the private sector". I could, far easier than many. After all the unemployment rate for PhDs is quite low. And it would pay more (bls). Or I could just get a higher paying job in another state (AAUP data). Or maybe I'll just figure out a way to make a little money on the side.

For some more background on State and Local Taxes. The Tax Foundation is a wonderful non-partisan source. Here is the history of state and local tax burden in Wisconsin. Here is a wealth of data on all states.

Update: Here is a Chicago Fed symposium on the public v private compensation issue. 

Age of Consent

Age of consent laws around the world. Clearly we are a sexually mixed up lot. Ages vary from 9 to 21, and depend on your sexual preference. WTF. At home we have technology generating further problems for our legal definitions of what is sexually permitted.

A teenager who was charged with possession of child pornography after taking nude photos of herself and sharing them with another teen will not face sanctions under a deal worked out last week with the Marquette County District Attorney's office.

Obesity: Who Pays?

In the latest issue of JEP:

Who Pays for Obesity? Jay Bhattacharya and Neeraj Sood

Adult obesity is a growing problem. From 1962 to 2006, obesity prevalence nearly tripled to 35.1 percent of adults. The rising prevalence of obesity is not limited to a particular socioeconomic group and is not unique to the United States. Should this widespread obesity epidemic be a cause for alarm? From a personal health perspective, the answer is an emphatic "yes." But when it comes to justifications of public policy for reducing obesity, the analysis becomes more complex. A common starting point is the assertion that those who are obese impose higher health costs on the rest of the population—a statement which is then taken to justify public policy interventions. But the question of who pays for obesity is an empirical one, and it involves analysis of how obese people fare in labor markets and health insurance markets. We will argue that the existing literature on these topics suggests that obese people on average do bear the costs and benefits of their eating and exercise habits. We begin by estimating the lifetime costs of obesity. We then discuss the extent to which private health insurance pools together obese and thin, whether health insurance causes obesity, and whether being fat might actually cause positive externalities for those who are not obese. If public policy to reduce obesity is not justified on the grounds of external costs imposed on others, then the remaining potential justification would need to be on the basis of helping people to address problems of ignorance or self-control that lead to obesity. In the conclusion, we offer a few thoughts about some complexities of such a justification.

Do What You Are Told

That is the lesson I take from this.

WTF

Greg Mankiw echoes my thoughts on Obama's SOTU speech.

Food

Here is a tortured but interesting discussion of the USDA's new nutrition guidelines. In particular he paints a good picture of the conflicting goals of the USDA. Promote agriculture, but reduce obesity. Eat more, Weigh less? Sounds like the book Run less, Run faster. However, Eat more, Weigh less is only possible if eat more is not measured in calories, but volume. That would require a movement towards lower calorie higher volume fruits and vegetables and away from the more dense higher calories lower volume, meat, poultry and dairy.

Leave the Lymph Nodes

New research in breast cancer suggests, just leave the lymph nodes and hit them with chemo.

Now, researchers report that for women who meet certain criteria — about 20 percent of patients, or 40,000 women a year in the United States — taking out cancerous nodes has no advantage. It does not change the treatment plan, improve survival or make the cancer less likely to recur. And it can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling.

Removing the cancerous lymph nodes proved unnecessary because the women in the study had chemotherapy and radiation, which probably wiped out any disease in the nodes, the researchers said. Those treatments are now standard for women with breast cancer in the lymph nodes, based on the realization that once the disease reaches the nodes, it has the potential to spread to vital organs and cannot be eliminated by surgery alone.

So fewer surgical interventions is better medicine. Is it a surprise that docs are slow to embrace?

But Dr. Carlson said that some of his colleagues, even after hearing the new study results, still thought the nodes should be removed.

“The dogma is strong,” he said. “It’s a little frustrating.”

And for the research methods students who just discussed Tuskegee there is this:

The complications — and the fact that there was no proof that removing the nodes prolonged survival — inspired Dr. Giuliano to compare women with and without axillary dissection. Some doctors objected. They were so sure cancerous nodes had to come out that they said the study was unethical and would endanger women.

Malaria and IQ

Another reason to improve public health.

Further evidence on causality is given by Atheendar Venkataramani in Early Life Exposure to Malaria and Cognition and Skills in Adulthood. Venkataramani finds that men born after widespread malaria eradication began in Mexico in the late 1950s have higher IQs (Raven scores) and are more likely to work in white collar jobs than men born shortly before eradication efforts began. Importantly, the effect is larger for men born in those states that began with high exposure to malaria.

Global Rise in Obesity

Check out this interactive chart. It plots changes in average BMI across the globe. A few things to note about changes in the average BMIs. They have been increasing almost universally, though the variance in the rates of increase are large. They have been increasing disproportionately among women*.

* After playing through the data, hover over one of the bubbles to see the "trails" of the countries. Notice that most of the trails have a slope which is steeper than the 45 degree line, ie steeper than 1.

The Case of Tonsillitis

A couple of nights ago I started to get a sore throat. I thought it was merely the onset of my usual winter sinus infection. However it quickly became an acute tonsillitis (though not as bad as that photo). A friend who is an RN suggested it might be strep, and I should get it checked out. Now the interesting thing is that if it is strep, they don't really treat the strep, as it would resolve on its own quickly, and they don't feel the need to use antibiotics to speed that up. However, they do proscribe antibiotics, because in some rare cases it leads to nastier things like rheumatic fever.But if its viral, like Epstein-Barr or something else, then antibiotics are definitely ineffective. But here again, they are part of standard practice, because it is a good idea to give antibiotics prophylactically in case the tonsils develop a secondary infection or abscess. Its highly unlikely to be EB since I've had it twice, and I'm a bit too old to get it. Plus they wouldn't treat it even if I did.  

So what do we have here. I have a bad sore throat, which has a very high probability of being nothing more than a bad sore throat that resolves on its own, in fairly short order. And I have a prescribed antibiotic, regardless of the outcome of the rapid (though less accurate) strep A test.

Option 1: So if I never went to urgent care, I'd probably be ok. Cost = $0 (actually 2.89 for some Ricola)

Option 2: If I was able to write my own antibiotic script, I would almost certainly be ok. Cost $5

But here is what I did to figure out.

Option 3: I went to urgent care, because the ER would have cost me a $60 co-pay (I know, ridiculously cheap but still enough of a disincentive to wait for the urgent care to open in the morning). I met with a triage nurse, who took my vitals and swabbed my tonsils. The rapid strep A test was run, followed by a meeting with a Doc, who explained the protocol to me and answered my questions. Then he came back in and gave me the rapid results and order a follow-up long strep A test. Cost $ 200* (my actual out of pocket cost is $0)

A lot more money was spent for an outcome that 98% (a guess) of the time is identical to the the do nothing case, and 99% of the time identical to the self prescribed antibiotics. I leave room for that 1% of cases where I may have had other symptoms they noticed that lead to a problem, and the fact that he explained what to watch for that would require me to come back in (more acute pain...really? no shit.).

I view our expensive system as a sort of insurance against catastrophic outcomes.

* This is purely a guess at the moment, I think the Urgent care visit is around 86 bucks and I'm guessing the tests are around $114 or so. I'll try to remember to update it when I get the statement of benefits, which usually takes about 2 months.

Update: Just got the bill. The billed amount was for $224.00, but I'm unclear if this includes the labs or if it is just the doctor's time. The preferred provider  discount brings it down to $168.00. My cost was $5.00 co-pay for the antibiotics. 

Nuff Said

What could I possibly add?

Relationships

Being an athlete in a relationship is tough, but this guy is a selfish ass.

And I love the fact that there is a book on economics applied to relationships, but really can't we have a book that doesn't have "onomics" in it.