nhaliday + healthcare   93

Behaving Discretely: Heuristic Thinking in the Emergency Department
I find compelling evidence of heuristic thinking in this setting: patients arriving in the emergency department just after their 40th birthday are roughly 10% more likely to be tested for and 20% more likely to be diagnosed with ischemic heart disease (IHD) than patients arriving just before this date, despite the fact that the incidence of heart disease increases smoothly with age.

Figure 1: Proportion of ED patients tested for heart attack
pdf  study  economics  behavioral-econ  field-study  biases  heuristic  error  healthcare  medicine  meta:medicine  age-generation  aging  cardio  bounded-cognition  shift  trivia  cocktail  pro-rata 
december 2017 by nhaliday
Relative Quality of Foreign Nurses in the United States
We find a positive wage premium for nurses educated in the Philippines, but not for foreign nurses educated elsewhere. The premium peaked at 8% in 2000, and decreased to 4% in 2010.
pdf  study  economics  labor  industrial-org  migration  human-capital  healthcare  usa  asia  developing-world  general-survey  compensation  econ-productivity  data  ability-competence  quality 
december 2017 by nhaliday
Understanding differences in life expectancy inequality - Marginal REVOLUTION
The life expectancy gap at age 40 between high income and low income individuals is substantial. I explore how medical expenditures and unhealthy behaviors account for the life expectancy gap. The data reveals the following. First, low income individuals tend to spend more on healthcare than high income individuals at all ages. Moreover, health disparities by income is salient due to differences in unhealthy behaviors such as heavy smoking. To answer how much dierences in access to medical services and unhealthy behaviors can explain in light of these stylized facts, I construct a life cycle model. The distinctive features of the model are that it flexibly incorporates unobserved, potentially correlated initial human and health capital stocks and embed unhealthy behaviors. Furthermore, the model includes two health systems: private health insurance and Medicare. The main findings are i) differences in access to medical care driven by income inequality potentially accounts for 12.5% of the life expectancy gap, ii) health insurance increases longevity for low income individuals, but modestly, iii) the health condition when young shapes the trend in average medical expenditures by income groups and iv) the impact of differences in unhealthy behaviors is predominant in understanding the life expectancy gap.

Health spending negatively correlated with health outcomes: http://www.arnoldkling.com/blog/health-spending-negatively-correlated-with-health-outcomes/
Pointer from Tyler Cowen. In the paper, Katera argues that the lower life expectancy of lower-income individuals reflects differences in their behavior rather than differences in access to medical services. My thoughts:

1. This seems consistent with Hansonian medicine, in which on average the benefits of more health care spending are about zero. But it also could suggest a counter to the Hanson view. That is, it could be that at the margin everyone benefits from more health care spending, but because the people who spend more tend to be people who behave in unhealthy ways, the benefits of more spending are difficult to tease out from the data. It is like trying to measure the relationship between policing and crime. If areas with a lot of crime tend to require more police, then a simple correlation analysis might suggest that adding police does not help to reduce crime.

2. Katera’s findings are not politically correct. I am on the record as saying that academic economics is headed toward a state in which findings like this will make one almost unemployable. Imagine trying to get Katera hired in a sociology department. Katera’s experience as a job candidate will be help to indicate how far along we are on this path.
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november 2017 by nhaliday
Emergency Medical Treatment and Active Labor Act - Wikipedia
The Emergency Medical Treatment and Active Labor Act (EMTALA)[1] is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospital Emergency Departments that accept payments from Medicare to provide an appropriate medical screening examination (MSE) to anyone seeking treatment for a medical condition, regardless of citizenship, legal status, or ability to pay. Participating hospitals may not transfer or discharge patients needing emergency treatment except with the informed consent or stabilization of the patient or when their condition requires transfer to a hospital better equipped to administer the treatment.[1]

EMTALA applies to "participating hospitals." The statute defines participating hospitals as those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program.[2] "Because there are very few hospitals that do not accept Medicare, the law applies to nearly all hospitals."[3] The combined payments of Medicare and Medicaid, $602 billion in 2004,[4] or roughly 44% of all medical expenditures in the U.S., make not participating in EMTALA impractical for nearly all hospitals. EMTALA's provisions apply to all patients, not just to Medicare patients.[5][6]

The cost of emergency care required by EMTALA is not directly covered by the federal government. Because of this, the law has been criticized by some as an unfunded mandate.[7] Uncompensated care represents 6% of total hospital costs.[8]
usa  government  policy  law  history  mostly-modern  cold-war  wiki  rot  healthcare  redistribution  welfare-state 
november 2017 by nhaliday
Health Services as Credence Goods: A Field Experiment by Felix Gottschalk, Wanda Mimra, Christian Waibel :: SSRN
A test patient who does not need treatment is sent to 180 dentists to receive treatment recommendations. In the experiment, we vary two factors: First, the information that the patient signals to the dentist. Second, we vary the perceived socioeconomic status (SES) of the test patient. Furthermore, we collected data to construct several measures of short- and long-term demand and competition as well as dentist and practice characteristics. We find that the patient receives an overtreatment recommendation in _more than every fourth visit_. A low short-term demand, indicating excess capacities, leads to significantly more overtreatment recommendations. Physician density and their price level, however, do not have a significant effect on overtreatment. Furthermore, we observe significantly less overtreatment recommendations for the patient with higher SES compared to lower SES under standard information. More signalled information however does not significantly reduce overtreatment.

How much dentists are ethically concerned about overtreatment; a vignette-based survey in Switzerland: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4474445/
Are Dentists Overtreating Your Teeth?: https://well.blogs.nytimes.com/2011/11/28/are-dentists-overtreating-your-teeth/
Have you had a rash of fillings after years of healthy teeth? The culprit may be “microcavities,” and not every dentist thinks they need to be treated, reports today’s Science Times.
How Dentists Rip Us Off: https://www.dentistat.com/ReaderDigestArticle.pdf

https://www.npr.org/templates/story/story.php?storyId=130356647
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october 2017 by nhaliday
Definite optimism as human capital | Dan Wang
I’ve come to the view that creativity and innovative capacity aren’t a fixed stock, coiled and waiting to be released by policy. Now, I know that a country will not do well if it has poor infrastructure, interest rate management, tax and regulation levels, and a whole host of other issues. But getting them right isn’t sufficient to promote innovation; past a certain margin, when they’re all at rational levels, we ought to focus on promoting creativity and drive as a means to propel growth.

...

When I say “positive” vision, I don’t mean that people must see the future as a cheerful one. Instead, I’m saying that people ought to have a vision at all: A clear sense of how the technological future will be different from today. To have a positive vision, people must first expand their imaginations. And I submit that an interest in science fiction, the material world, and proximity to industry all help to refine that optimism. I mean to promote imagination by direct injection.

...

If a state has lost most of its jobs for electrical engineers, or nuclear engineers, or mechanical engineers, then fewer young people in that state will study those practices, and technological development in related fields slow down a little further. When I bring up these thoughts on resisting industrial decline to economists, I’m unsatisfied with their responses. They tend to respond by tautology (“By definition, outsourcing improves on the status quo”) or arithmetic (see: gains from comparative advantage, Ricardo). These kinds of logical exercises are not enough. I would like for more economists to consider a human capital perspective for preserving manufacturing expertise (to some degree).

I wonder if the so-called developed countries should be careful of their own premature deindustrialization. The US industrial base has faltered, but there is still so much left to build. Until we’ve perfected asteroid mining and super-skyscrapers and fusion rockets and Jupiter colonies and matter compilers, we can’t be satisfied with innovation confined mostly to the digital world.

Those who don’t mind the decline of manufacturing employment like to say that people have moved on to higher-value work. But I’m not sure that this is usually the case. Even if there’s an endlessly capacious service sector to absorb job losses in manufacturing, it’s often the case that these new jobs feature lower productivity growth and involve greater rent-seeking. Not everyone is becoming hedge fund managers and machine learning engineers. According to BLS, the bulk of service jobs are in 1. government (22 million), 2. professional services (19m), 3. healthcare (18m), 4. retail (15m), and 5. leisure and hospitality (15m). In addition to being often low-paying but still competitive, a great deal of service sector jobs tend to stress capacity for emotional labor over capacity for manual labor. And it’s the latter that tends to be more present in fields involving technological upgrading.

...

Here’s a bit more skepticism of service jobs. In an excellent essay on declining productivity growth, Adair Turner makes the point that many service jobs are essentially zero-sum. I’d like to emphasize and elaborate on that idea here.

...

Call me a romantic, but I’d like everyone to think more about industrial lubricants, gas turbines, thorium reactors, wire production, ball bearings, underwater cables, and all the things that power our material world. I abide by a strict rule never to post or tweet about current political stuff; instead I try to draw more attention to the world of materials. And I’d like to remind people that there are many things more edifying than following White House scandals.

...

First, we can all try to engage more actively with the material world, not merely the digital or natural world. Go ahead and pick an industrial phenomenon and learn more about it. Learn more about the history of aviation, and what it took to break the sound barrier; gaze at the container ships as they sail into port, and keep in mind that they carry 90 percent of the goods you see around you; read about what we mold plastics to do; meditate on the importance of steel in civilization; figure out what’s driving the decline in the cost of solar energy production, or how we draw electricity from nuclear fission, or what it takes to extract petroleum or natural gas from the ground.

...

Here’s one more point that I’d like to add on Girard at college: I wonder if to some extent current dynamics are the result of the liberal arts approach of “college teaches you how to think, not what to think.” I’ve never seen much data to support this wonderful claim that college is good at teaching critical thinking skills. Instead, students spend most of their energies focused on raising or lowering the status of the works they study or the people around them, giving rise to the Girardian terror that has gripped so many campuses.

College as an incubator of Girardian terror: http://danwang.co/college-girardian-terror/
It’s hard to construct a more perfect incubator for mimetic contagion than the American college campus. Most 18-year-olds are not super differentiated from each other. By construction, whatever distinctions any does have are usually earned through brutal, zero-sum competitions. These tournament-type distinctions include: SAT scores at or near perfection; being a top player on a sports team; gaining master status from chess matches; playing first instrument in state orchestra; earning high rankings in Math Olympiad; and so on, culminating in gaining admission to a particular college.

Once people enter college, they get socialized into group environments that usually continue to operate in zero-sum competitive dynamics. These include orchestras and sport teams; fraternities and sororities; and many types of clubs. The biggest source of mimetic pressures are the classes. Everyone starts out by taking the same intro classes; those seeking distinction throw themselves into the hardest classes, or seek tutelage from star professors, and try to earn the highest grades.

Mimesis Machines and Millennials: http://quillette.com/2017/11/02/mimesis-machines-millennials/
In 1956, a young Liverpudlian named John Winston Lennon heard the mournful notes of Elvis Presley’s Heartbreak Hotel, and was transformed. He would later recall, “nothing really affected me until I heard Elvis. If there hadn’t been an Elvis, there wouldn’t have been the Beatles.” It is an ancient human story. An inspiring model, an inspired imitator, and a changed world.

Mimesis is the phenomenon of human mimicry. Humans see, and they strive to become what they see. The prolific Franco-Californian philosopher René Girard described the human hunger for imitation as mimetic desire. According to Girard, mimetic desire is a mighty psychosocial force that drives human behavior. When attempted imitation fails, (i.e. I want, but fail, to imitate my colleague’s promotion to VP of Business Development), mimetic rivalry arises. According to mimetic theory, periodic scapegoating—the ritualistic expelling of a member of the community—evolved as a way for archaic societies to diffuse rivalries and maintain the general peace.

As civilization matured, social institutions evolved to prevent conflict. To Girard, sacrificial religious ceremonies first arose as imitations of earlier scapegoating rituals. From the mimetic worldview healthy social institutions perform two primary functions,

They satisfy mimetic desire and reduce mimetic rivalry by allowing imitation to take place.
They thereby reduce the need to diffuse mimetic rivalry through scapegoating.
Tranquil societies possess and value institutions that are mimesis tolerant. These institutions, such as religion and family, are Mimesis Machines. They enable millions to see, imitate, and become new versions of themselves. Mimesis Machines, satiate the primal desire for imitation, and produce happy, contented people. Through Mimesis Machines, Elvis fans can become Beatles.

Volatile societies, on the other hand, possess and value mimesis resistant institutions that frustrate attempts at mimicry, and mass produce frustrated, resentful people. These institutions, such as capitalism and beauty hierarchies, are Mimesis Shredders. They stratify humanity, and block the ‘nots’ from imitating the ‘haves’.
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october 2017 by nhaliday
American income statistics aren't quite what people are saying they are — Adam Smith Institute
not very convincing rebuttal to wage stagnation, frankly (yes a few products have gotten cheaper/better, but do you have some sort of rigorous PPP adjustment via a representative basket of goods? healthcare is probably not all that much better...)
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september 2017 by nhaliday
A simple minded approach – spottedtoad
The Affordable Care Act was a famously complicated bill, but at a very simple level, its intent and effect were to drive more economic activity into the health care sector. Young people and the near poor, in particular, would get more treatment, because the bill would use carrots (the subsidies and Medicaid expansion) and sticks (the mandate) to get them insurance. In fiscal terms, the bill raised taxes on the rich to pay for the subsidies and Medicaid expansion.

So at a basic level, the question for everyone about the bill was (and is), was American economic activity in 2010 insufficiently focused on health care? Not whether any individual deserved more care, but whether in aggregate we were spending enough.

If you read what Peter Orszag or other wonks in the Administration were saying at the time, the intent of the bill was to bend the cost curve and reduce total expenditure by limiting what Medicare reimbursed, using various pilot programs to find out what kinds of treatments were ineffective, get some death panels up and running, and so on.

But that’s bullshit. You made more money available, so more money was going to get spent.

The death panels were real, of course, but they were mostly for young people instead of the old, as it turned out.
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september 2017 by nhaliday
Does Polarization Imply Poor Representation? A New Perspective on the “Disconnect” Between Politicians and Voters*
Broockman-Ahler 2015

immigration positions under B.2: http://www.dougahler.com/uploads/2/4/6/9/24697799/ahler_broockman_ideological_innocence.pdf#page=42
distribution: http://www.dougahler.com/uploads/2/4/6/9/24697799/ahler_broockman_ideological_innocence.pdf#page=53

https://twitter.com/tcjfs/status/904024125030756356
https://archive.is/BrnpJ
38% support immediate mass deportation of all illegals (Broockman 2015). This view has zero representation in either house of congress.

Do you understand the GOP play here by the way? I'm genuinely puzzled. Is it a moral conviction? Because it can't be a vote play.
In my view it's a mix of mindless sentimentality, the donor class, and existing in an hermetically sealed ideological bubble.

https://twitter.com/tcjfs/status/951989543653265408
https://archive.is/ya2sz
cheap labor lobby, public choice (votes), & subversive elites gripped by multiculti zealotry

https://twitter.com/tcjfs/status/911291455762845696
https://archive.is/dw6OO
In a 2014 radio interview, Paul Ryan was asked if "immigrants from the 3rd world are more or less likely to support conservative policies":
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september 2017 by nhaliday
Medicine as a pseudoscience | West Hunter
The idea that venesection was a good thing, or at least not so bad, on the grounds that one in a few hundred people have hemochromatosis (in Northern Europe) reminds me of the people who don’t wear a seatbelt, since it would keep them from being thrown out of their convertible into a waiting haystack, complete with nubile farmer’s daughter. Daughters. It could happen. But it’s not the way to bet.

Back in the good old days, Charles II, age 53, had a fit one Sunday evening, while fondling two of his mistresses.

Monday they bled him (cupping and scarifying) of eight ounces of blood. Followed by an antimony emetic, vitriol in peony water, purgative pills, and a clyster. Followed by another clyster after two hours. Then syrup of blackthorn, more antimony, and rock salt. Next, more laxatives, white hellebore root up the nostrils. Powdered cowslip flowers. More purgatives. Then Spanish Fly. They shaved his head and stuck blistering plasters all over it, plastered the soles of his feet with tar and pigeon-dung, then said good-night.

...

Friday. The king was worse. He tells them not to let poor Nelly starve. They try the Oriental Bezoar Stone, and more bleeding. Dies at noon.

Most people didn’t suffer this kind of problem with doctors, since they never saw one. Charles had six. Now Bach and Handel saw the same eye surgeon, John Taylor – who blinded both of them. Not everyone can put that on his resume!

You may wonder how medicine continued to exist, if it had a negative effect, on the whole. There’s always the placebo effect – at least there would be, if it existed. Any real placebo effect is very small: I’d guess exactly zero. But there is regression to the mean. You see the doctor when you’re feeling worse than average – and afterwards, if he doesn’t kill you outright, you’re likely to feel better. Which would have happened whether you’d seen him or not, but they didn’t often do RCTs back in the day – I think James Lind was the first (1747).

Back in the late 19th century, Christian Scientists did better than others when sick, because they didn’t believe in medicine. For reasons I think mistaken, because Mary Baker Eddy rejected the reality of the entire material world, but hey, it worked. Parenthetically, what triggered all that New Age nonsense in 19th century New England? Hash?

This did not change until fairly recently. Sometime in the early 20th medicine, clinical medicine, what doctors do, hit break-even. Now we can’t do without it. I wonder if there are, or will be, other examples of such a pile of crap turning (mostly) into a real science.

good tweet: https://twitter.com/bowmanthebard/status/897146294191390720
The brilliant GP I've had for 35+ years has retired. How can I find another one who meets my requirements?

1 is overweight
2 drinks more than officially recommended amounts
3 has an amused, tolerant atitude to human failings
4 is well aware that we're all going to die anyway, & there are better or worse ways to die
5 has a healthy skeptical attitude to mainstream medical science
6 is wholly dismissive of "a|ternative” medicine
7 believes in evolution
8 thinks most diseases get better without intervention, & knows the dangers of false positives
9 understands the base rate fallacy

EconPapers: Was Civil War Surgery Effective?: http://econpapers.repec.org/paper/htrhcecon/444.htm
contra Greg Cochran:
To shed light on the subject, I analyze a data set created by Dr. Edmund Andrews, a Civil war surgeon with the 1st Illinois Light Artillery. Dr. Andrews’s data can be rendered into an observational data set on surgical intervention and recovery, with controls for wound location and severity. The data also admits instruments for the surgical decision. My analysis suggests that Civil War surgery was effective, and increased the probability of survival of the typical wounded soldier, with average treatment effect of 0.25-0.28.

Medical Prehistory: https://westhunt.wordpress.com/2016/03/14/medical-prehistory/
What ancient medical treatments worked?

https://westhunt.wordpress.com/2016/03/14/medical-prehistory/#comment-76878
In some very, very limited conditions, bleeding?
--
Bad for you 99% of the time.

https://westhunt.wordpress.com/2016/03/14/medical-prehistory/#comment-76947
Colchicine – used to treat gout – discovered by the Ancient Greeks.

https://westhunt.wordpress.com/2016/03/14/medical-prehistory/#comment-76973
Dracunculiasis (Guinea worm)
Wrap the emerging end of the worm around a stick and slowly pull it out.
(3,500 years later, this remains the standard treatment.)
https://en.wikipedia.org/wiki/Ebers_Papyrus

https://westhunt.wordpress.com/2016/03/14/medical-prehistory/#comment-76971
Some of the progress is from formal medicine, most is from civil engineering, better nutrition ( ag science and physical chemistry), less crowded housing.

Nurses vs doctors: https://westhunt.wordpress.com/2014/10/01/nurses-vs-doctors/
Medicine, the things that doctors do, was an ineffective pseudoscience until fairly recently. Until 1800 or so, they were wrong about almost everything. Bleeding, cupping, purging, the four humors – useless. In the 1800s, some began to realize that they were wrong, and became medical nihilists that improved outcomes by doing less. Some patients themselves came to this realization, as when Civil War casualties hid from the surgeons and had better outcomes. Sometime in the early 20th century, MDs reached break-even, and became an increasingly positive influence on human health. As Lewis Thomas said, medicine is the youngest science.

Nursing, on the other hand, has always been useful. Just making sure that a patient is warm and nourished when too sick to take care of himself has helped many survive. In fact, some of the truly crushing epidemics have been greatly exacerbated when there were too few healthy people to take care of the sick.

Nursing must be old, but it can’t have existed forever. Whenever it came into existence, it must have changed the selective forces acting on the human immune system. Before nursing, being sufficiently incapacitated would have been uniformly fatal – afterwards, immune responses that involved a period of incapacitation (with eventual recovery) could have been selectively favored.

when MDs broke even: https://westhunt.wordpress.com/2014/10/01/nurses-vs-doctors/#comment-58981
I’d guess the 1930s. Lewis Thomas thought that he was living through big changes. They had a working serum therapy for lobar pneumonia ( antibody-based). They had many new vaccines ( diphtheria in 1923, whopping cough in 1926, BCG and tetanus in 1927, yellow fever in 1935, typhus in 1937.) Vitamins had been mostly worked out. Insulin was discovered in 1929. Blood transfusions. The sulfa drugs, first broad-spectrum antibiotics, showed up in 1935.

DALYs per doctor: https://westhunt.wordpress.com/2018/01/22/dalys-per-doctor/
The disability-adjusted life year (DALY) is a measure of overall disease burden – the number of years lost. I’m wondering just much harm premodern medicine did, per doctor. How many healthy years of life did a typical doctor destroy (net) in past times?

...

It looks as if the average doctor (in Western medicine) killed a bunch of people over his career ( when contrasted with doing nothing). In the Charles Manson class.

Eventually the market saw through this illusion. Only took a couple of thousand years.

https://westhunt.wordpress.com/2018/01/22/dalys-per-doctor/#comment-100741
That a very large part of healthcare spending is done for non-health reasons. He has a chapter on this in his new book, also check out his paper “Showing That You Care: The Evolution of Health Altruism” http://mason.gmu.edu/~rhanson/showcare.pdf
--
I ran into too much stupidity to finish the article. Hanson’s a loon. For example when he talks about the paradox of blacks being more sentenced on drug offenses than whites although they use drugs at similar rate. No paradox: guys go to the big house for dealing, not for using. Where does he live – Mars?

I had the same reaction when Hanson parroted some dipshit anthropologist arguing that the stupid things people do while drunk are due to social expectations, not really the alcohol.
Horseshit.

I don’t think that being totally unable to understand everybody around you necessarily leads to deep insights.

https://westhunt.wordpress.com/2018/01/22/dalys-per-doctor/#comment-100744
What I’ve wondered is if there was anything that doctors did that actually was helpful and if perhaps that little bit of success helped them fool people into thinking the rest of it helped.
--
Setting bones. extracting arrows: spoon of Diocles. Colchicine for gout. Extracting the Guinea worm. Sometimes they got away with removing the stone. There must be others.
--
Quinine is relatively recent: post-1500. Obstetrical forceps also. Caesarean deliveries were almost always fatal to the mother until fairly recently.

Opium has been around for a long while : it works.

https://westhunt.wordpress.com/2018/01/22/dalys-per-doctor/#comment-100839
If pre-modern medicine was indeed worse than useless – how do you explain no one noticing that patients who get expensive treatments are worse off than those who didn’t?
--
were worse off. People are kinda dumb – you’ve noticed?
--
My impression is that while people may be “kinda dumb”, ancient customs typically aren’t.
Even if we assume that all people who lived prior to the 19th century were too dumb to make the rational observation, wouldn’t you expect this ancient practice to be subject to selective pressure?
--
Your impression is wrong. Do you think that there some slick reason for Carthaginians incinerating their first-born?

Theodoric of York, bloodletting: https://www.youtube.com/watch?v=yvff3TViXmY

details on blood-letting and hemochromatosis: https://westhunt.wordpress.com/2018/01/22/dalys-per-doctor/#comment-100746

Starting Over: https://westhunt.wordpress.com/2018/01/23/starting-over/
Looking back on it, human health would have … [more]
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august 2017 by nhaliday
Is the economy illegible? | askblog
In the model of the economy as a GDP factory, the most fundamental equation is the production function, Y = f(K,L).

This says that total output (Y) is determined by the total amount of capital (K) and the total amount of labor (L).

Let me stipulate that the economy is legible to the extent that this model can be applied usefully to explain economic developments. I want to point out that the economy, while never as legible as economists might have thought, is rapidly becoming less legible.
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august 2017 by nhaliday
Scanners Live in Vain | West Hunter
Of course, finding that the pattern already exists at the age of one month seriously weakens any idea that being poor shrinks the brain: most of the environmental effects you would consider haven’t even come into play in the first four weeks, when babies drink milk, sleep, and poop. Genetics affecting both parents and their children would make more sense, if the pattern shows up so early (and I’ll bet money that, if real,  it shows up well before one month);  but Martha Farah, and the reporter from Nature, Sara Reardon, ARE TOO FUCKING DUMB to realize this.

https://westhunt.wordpress.com/2015/03/31/scanners-live-in-vain/#comment-93791
Correlation between brain volume and IQ is about 0.4 . Shows up clearly in studies with sufficient power.

“poverty affects prenatal environment a lot.” No it does not. “poverty” in this country means having plenty to eat.

The Great IQ Depression: https://westhunt.wordpress.com/2014/03/07/the-great-iq-depression/
We hear that poverty can sap brainpower, reduce frontal lobe function, induce the fantods, etc. But exactly what do we mean by ‘poverty’? If we’re talking about an absolute, rather than relative, standard of living, most of the world today must be in poverty, as well as almost everyone who lived much before the present. Most Chinese are poorer than the official US poverty level, right? The US had fairly rapid economic growth until the last generation or so, so if you go very far back in time, almost everyone was poor, by modern standards. Even those who were considered rich at the time suffered from zero prenatal care, largely useless medicine, tabletless high schools, and slow Internet connections. They had to ride horses that had lousy acceleration and pooped all over the place.

In particular, if all this poverty-gives-you-emerods stuff is true, scholastic achievement should have collapsed in the Great Depression – and with the miracle of epigenetics, most of us should still be suffering those bad effects.

But somehow none of this seems to have gone through the formality of actually happening.
west-hunter  scitariat  commentary  study  org:nat  summary  rant  critique  neuro  neuro-nitgrit  brain-scan  iq  class  correlation  compensation  pop-diff  biodet  behavioral-gen  westminster  experiment  attaq  measure  multi  discussion  ideas  history  early-modern  pre-ww2  usa  gedanken  analogy  comparison  time  china  asia  world  developing-world  economics  growth-econ  medicine  healthcare  epigenetics  troll  aphorism  cycles  obesity  poast  nutrition  hypochondria  explanans 
august 2017 by nhaliday
The debate about health care shows why viewpoint diversity is important
You also need to understand that the world is not as simple as John Oliver makes it sound when you watch his show. I know he’s funny and has a cool English accent, but he also has no fucking clue what he is talking about, only he doesn’t know that.
unaffiliated  right-wing  commentary  current-events  usa  policy  wonkish  healthcare  government  propaganda  twitter  social  tribalism  politics  culture-war  toxoplasmosis 
june 2017 by nhaliday
Biological Measures of the Standard of Living - American Economic Association
https://academic.oup.com/oep/article-abstract/66/2/349/2362600/How-have-Europeans-grown-so-tall
The evidence suggests that the most important proximate source of increasing height was the improving disease environment as reflected by the fall in infant mortality. Rising income and education and falling family size had more modest effects. Improvements in health care are hard to identify, and the effects of welfare state spending seem to have been small.

GROWING TALL BUT UNEQUAL: NEW FINDINGS AND NEW BACKGROUND EVIDENCE ON ANTHROPOMETRIC WELFARE IN 156 COUNTRIES, 18101989: https://pseudoerasmus.files.wordpress.com/2017/03/baten-blum-2012.pdf
This is the first initiative to collate the entire body of anthropometric evidence during the 19th and 20th centuries, on a global scale. By providing a comprehensive dataset on global height developments we are able to emphasise an alternative view of the history of human well-being and a basis for understanding characteristics of well-being in 156 countries, 1810-1989.

Bones of Contention: The Political Economy of Height Inequality: http://piketty.pse.ens.fr/files/BoixRosenbluth2014.pdf
- Carles Boix, et al.

Height in the Dark Ages: https://pseudoerasmus.com/2014/06/12/aside-angus-maddison/
study  economics  growth-econ  broad-econ  history  early-modern  mostly-modern  measurement  methodology  embodied  health  longevity  sapiens  death  wealth  pseudoE  🎩  multi  epidemiology  public-health  roots  europe  policy  wonkish  healthcare  redistribution  welfare-state  disease  parasites-microbiome  wealth-of-nations  education  top-n  data  world  pdf  political-econ  inequality  farmers-and-foragers  leviathan  archaeology  🌞  article  time-series  civilization  iron-age  mediterranean  medieval  gibbon  the-classics  demographics  gender  britain  evidence  traces 
june 2017 by nhaliday
Columbia | West Hunter
I remember this all pretty well: I’d still welcome the chance to strangle the key NASA players. I remember how they forbade lower-level people at NASA to talk to the Air Force and ask for recon assets – how they peddled ass-covering bullshit about how nothing could possibly have been done. A lie.

One of the dogs that didn’t bark was the fact that NASA acted as if relevant DOD assets did not exist. For example, if you could have put a package into a matching low orbit with those consumables in shortest supply, say CO2 absorbers and/or cheeseburgers, there would would have been considerably more time available to assemble a rescue mission. For some forgotten reason the Air Force has hundreds of missiles (Minuteman-IIIs) that can be launched on a moment’s notice – it wouldn’t be that hard to replace a warhead with a consumables package. A moment’s thought tells you that some such capability is likely to exist – one intended to rapidly replaced destroyed recon sats, for example. Certainly worth considering, worth checking, before giving up on the crew. Just as the Air Force has recon assets that could have been most helpful in diagnosing the state of the ship – but NASA would rather die than expose itself to Air Force cooties. Not that the Air Force doesn’t have cooties, but NASA has quite a few of its own already.

If we ever had a real reason for manned space travel – I can imagine some – the first thing you’d need to do is kill everyone in the NASA manned space program. JPL you could keep.

usefulness of LEO:
https://westhunt.wordpress.com/2016/02/01/columbia/#comment-75883
https://westhunt.wordpress.com/2016/02/01/columbia/#comment-75891

hmm:
Book Review: Whitey On the Moon: http://www.henrydampier.com/2015/02/book-review-whitey-moon/

https://twitter.com/AngloRemnant/status/960997033053171712
https://archive.is/DTyGN
Homicidal stat of the day: The US spends more in 1 year of providing Medicaid to hispanics than the entire inflation-adjusted cost of the Apollo program.
west-hunter  scitariat  speculation  rant  stories  error  management  space  the-trenches  usa  government  ideas  discussion  multi  poast  dirty-hands  the-world-is-just-atoms  cost-benefit  track-record  gnon  right-wing  books  history  mostly-modern  cold-war  rot  institutions  race  africa  identity-politics  diversity  ability-competence  twitter  social  data  analysis  backup  🐸  monetary-fiscal  money  scale  counter-revolution  nascent-state  attaq  healthcare  redistribution  welfare-state  civilization  gibbon  vampire-squid  egalitarianism-hierarchy  tradeoffs  virtu 
may 2017 by nhaliday
Singapore: A Fascinating Alternative To The Welfare State
But Singapore has done something even more remarkable than its economic accomplishments. It has built an alternative to the European style welfare state. Think of all the reasons why people turn to government in other developed countries: retirement income, housing, education, medical care etc. In Singapore people are required to save to take care of these needs themselves.

At times the forced saving rate has been as high as 50% of income. Today, employees under 50 years of age must set aside 20% of their wages and employers must contribute another 16%. These funds go into accounts where they grow through time until specific needs arise. For example, one of the uses for these savings is housing. About 90% of Singapore households are home owners – the highest rate of home ownership in the world.

In health care, Singapore started an extensive system of “Medisave Accounts” in 1984 – the very year that Richard Rahn and I proposed “Medical IRAs” for America in the Wall Street Journal. Today, 7 percentage points of Singapore’s 36% required savings rate is for health care and is deposited in a separate Medisave account for each employee. Individuals are also automatically enrolled in catastrophic health insurance, although they can opt out. When a Medisave account balance reaches about $34,100 (an amount equal to a little less than half of the median family income) any excess funds are rolled over into another account and may be used for non-health care purposes.
news  org:lite  org:biz  history  mostly-modern  lee-kuan-yew  polisci  asia  developing-world  policy  time-preference  temperance  healthcare  redistribution  welfare-state 
april 2017 by nhaliday
Putting federal spending in context | Pew Research Center
When thinking about federal spending, it’s worth remembering that, as former Treasury official Peter Fisher once said, the federal government is basically “a gigantic insurance company,” albeit one with “a sideline business in national defense and homeland security.”
news  org:data  data  visualization  analysis  monetary-fiscal  money  government  redistribution  healthcare  distribution  history  mostly-modern  usa  sequential  military  temperance  let-me-see  chart  defense  aphorism  welfare-state 
april 2017 by nhaliday
Health Insurance: Where are the Goal Posts? | askblog
Everyone is talking about how many households have insurance and acting as if the main challenge is to get healthy people to buy insurance. If Cutler is right, then health care policy boils down to:

1. Finding a fair way to share financial the burden of chronic illnesses. (Obviously, “fair” involves value judgments.)

2. Putting resources into public health measures and efforts to induce people to comply with behavioral advice that would help to prevent chronic illness.
econotariat  cracker-econ  healthcare  money  policy  medicine  links  quotes  commentary  summary  insurance  wonkish  current-events  justice  distribution  disease  pareto  epidemiology  public-health  chart 
march 2017 by nhaliday
Our Demographic Decline - The Daily Beast
https://twitter.com/ThomasHCrown/status/880926029027696640
http://quillette.com/2017/02/02/if-youre-reading-this-essay-you-should-probably-have-more-children/
https://twitter.com/toad_spotted/status/898520772632694785
https://archive.is/AoVcV
Hypothesis: to slow demographic/cultural transformation,no ideology will make any difference,only rich/powerful people having huge families.
You can keep one or two kids walled off from a decaying society,if you have enough money and connections. You can't do that with eight kids.
...
I don't worship Elon Musk,but it seems nonaccidental that only plutocrat with any kind of vital or inspiring vision of the future has 5 kids

Demographics, Robots, and AI | Elon Musk: https://www.youtube.com/watch?v=uA4ydDUsgJU
- TFRs about 50% of replacement throughout much of Europe. what's that gonna do to society?
- like the comment about people needing to develop a sense of duty to reproduce.

I think I think demographics is is a real issue where people are not having kids in a lot of countries and very often they'll say I'll solve it with immigration. Immigration from where?! If...Europe has an average of many plots...Europe have an average of of a 50 or six...you know they're only at fifty or sixty percent of what's needed for replacement or China for that matter they're at half replacement rate where exactly are we going to find six hundred million people to replace the ones that were never born. I think people are going to have to regard to some degree than the notion of having kids as almost a social duty. Within reason, I mean just if you can and you're so inclined you should, you should. You know it's like otherwise civilization will just die literally.

https://twitter.com/toad_spotted/status/869959152898117634
that's true of older generation of, eg, NYT writers but I think this new crop will just have fewer kids, be less hypocritical, more terrible

https://twitter.com/jeffgiesea/status/997126388086951937
https://archive.fo/7fk4a
Many of the smartest people I know are quietly giving up on America. They don't see viable future. Very troubling.
They are choosing "exit" instead of voice. Abandoning politics. This takes many forms:
>denialism - tuning it out; moving to the country or gated community
>localism - rebuilding at local levels
>futurism - embracing tech to build the future
>nihilism - not voting; drugs
People point to American resilience throughout history. They view this period of time as different for a variety of reasons: debt, demographics, cultural decline, destructive technology, etc. Late-stage empire decline.

that netouyo__ comment (deleeted) about 'The Sopranos' and how the subtext was that we're at the end of America, not the beginning
news  demographics  fertility  world  developing-world  usa  economics  stylized-facts  time-preference  individualism-collectivism  wonkish  org:lite  society  trends  douthatish  biophysical-econ  malaise  demographic-transition  current-events  population  econotariat  chart  nihil  zeitgeist  rot  journos-pundits  modernity  multi  twitter  social  discussion  rant  rhetoric  :/  healthcare  right-wing  unaffiliated  org:mag  org:popup  dysgenics  musk  barons  ratty  hypocrisy  media  video  presentation  interview  europe  the-great-west-whale  automation  prediction  legacy  duty  intervention  migration  china  asia  civilization  incentives  interests  self-interest  death  gibbon  sulla  prepping  the-watchers  noblesse-oblige  status  propaganda  backup  politics  stagnation  culture  culture-war  sv  tech  exit-voice  local-global  government  drugs  debt  race  technology  decentralized  elite  the-bones  techtariat  tv  gnon  🐸  venture  pessimism 
february 2017 by nhaliday
Considerations On Cost Disease | Slate Star Codex
ratty  yvain  ssc  economics  education  higher-ed  healthcare  efficiency  money  analysis  inequality  faq  trends  winner-take-all  multi  reddit  social  hn  commentary  data  visualization  rent-seeking  econotariat  2017  p:null  wonkish  malaise  cost-disease  news  org:mag  org:bv  noahpinion  org:biz  chart  zeitgeist  the-bones  housing  org:ngo  org:anglo  automation  labor  marginal-rev  scott-sumner  market-failure  gnon  counter-revolution  cracker-econ  techtariat  gray-econ  randy-ayndy  poast  list  links  supply-demand  government  policy  regulation  econ-productivity  planning  long-term  parenting 
february 2017 by nhaliday
The High-Cost, High-Risk World of Modern Pet Care : slatestarcodex
What's particularly interesting about pet healthcare is, besides the usual insanity of many pet owners, is what it says about human healthcare. Pet healthcare is a libertarian ideal: vets require next to zero malpractice insurance, the FDA regulates all animal drugs and procedures far less than humans, pets live short lives compared to humans so any benefits are easy to observe and research (and the research itself is inherently far easier), insurance and HMOs and government programs are barely involved as most buyers pay cash, veterinarians themselves are generally in oversupply, etc. It's as close to an ideal perfectly competitive free market of healthcare as we'll ever see. And what's the result in America?
> The cost of veterinary care has risen even faster than the cost of human health care, more than doubling since 2000, according to the U.S. Bureau of Labor Statistics.
ratty  ssc  reddit  social  commentary  healthcare  medicine  nature  usa  policy  gwern  insurance 
january 2017 by nhaliday
Are Women Overinvesting in Education? Evidence from the Medical Profession
We find that the median female (but not male) primary-care physician would have been financially better off becoming a physician assistant. This result is partially due to a gender-wage gap in medicine. However, it is mostly driven by the fact that the median female physician simply doesn’t work enough hours to amortize her upfront investment in medical school. In contrast, the median male physician work many more hours, easily enough to amortize his up-front investment.
study  economics  gender  labor  cocktail  comparison  pdf  healthcare  education  wonkish  efficiency  error  attaq  cost-benefit 
january 2017 by nhaliday
Female Doctors May Be Better Than Male Doctors - The Atlantic
study is linked in article

We examined the association between physician sex and 30-day mortality and readmission rates, adjusted for patient and physician characteristics and hospital fixed effects (effectively comparing female and male physicians within the same hospital). As a sensitivity analysis, we examined only physicians focusing on hospital care (hospitalists), among whom patients are plausibly quasi-randomized to physicians based on the physician’s specific work schedules. We also investigated whether differences in patient outcomes varied by specific condition or by underlying severity of illness.

You'll have to figure this one out for yourselves: http://andrewgelman.com/2016/12/21/youll-figure-one/
news  org:mag  study  summary  medicine  gender  natural-experiment  longevity  healthcare  diversity  intervention  endogenous-exogenous  multi  gelman  replication  critique  scitariat 
december 2016 by nhaliday
Childhood forecasting of a small segment of the population with large economic burden : Nature Human Behaviour
A segment comprising 22% of the cohort accounted for 36% of the cohort’s injury insurance claims; 40% of excess obese kilograms; 54% of cigarettes smoked; 57% of hospital nights; 66% of welfare benefits; 77% of fatherless child-rearing; 78% of prescription fills; and 81% of criminal convictions. Childhood risks, including poor brain health at three years of age, predicted this segment with large effect sizes. Early-years interventions that are effective for this population segment could yield very large returns on investment.
study  crime  class  policy  arbitrage  economics  anthropology  org:nat  health  stylized-facts  obesity  🎩  🌞  redistribution  pareto  low-hanging  biodet  epidemiology  sociology  distribution  healthcare  wonkish  society  objektbuch  s-factor  behavioral-gen  criminology  public-health  chart  welfare-state 
december 2016 by nhaliday
Eroom's Law - Wikipedia, the free encyclopedia
drug discovery is becoming slower and more expensive over time

While some suspect a lack of "low hanging fruit" as a significant contribution to Eroom's law, this may be less important than the four main causes, as there are still many decades worth of new potential drug targets relative to the number of drugged targets, even if the industry exploits 4-5 new targets per year.[2] There is also space to explore selectively non-selective drugs (or "dirty drugs") that interact with several molecular targets, and which may be particularly effective as central nervous system (CNS) therapeutics, even though few of them have been introduced in the last few decades.[4]
healthcare  medicine  concept  street-fighting  wiki  trends  drugs  pharma  hmm  meta:medicine  stylized-facts  low-hanging  stagnation  discovery  info-dynamics 
september 2016 by nhaliday
EpiPenomenon – Put A Number On It!
I am no longer confident that the FDA harms more lives than it saves, and thus I no longer endorse setting fire to it, pending further investigation. What changed my mind was not the commenters disparaging me as a “101 economist” in the comments. What changed my mind was my mom, a long-time professional in the pharmaceutics industry, explaining in detail the rules the FDA plays by and the exact procedures and standards they follow.
ratty  healthcare  drugs  regularizer  policy  len:long  ssc  FDA  regulation  pharma 
september 2016 by nhaliday
The Elephant in the Brain: Hidden Motives in Everday Life
https://www.youtube.com/watch?v=V84_F1QWdeU

A Book Response Prediction: https://www.overcomingbias.com/2017/03/a-book-response-prediction.html
I predict that one of the most common responses will be something like “extraordinary claims require extraordinary evidence.” While the evidence we offer is suggestive, for claims as counterintuitive as ours on topics as important as these, evidence should be held to a higher standard than the one our book meets. We should shut up until we can prove our claims.

I predict that another of the most common responses will be something like “this is all well known.” Wise observers have known and mentioned such things for centuries. Perhaps foolish technocrats who only read in their narrow literatures are ignorant of such things, but our book doesn’t add much to what true scholars and thinkers have long known.

https://nintil.com/2018/01/16/this-review-is-not-about-reviewing-the-elephant-in-the-brain/
http://www.overcomingbias.com/2018/01/a-long-review-of-elephant-in-the-brain.html
https://nintil.com/2018/01/28/ad-hoc-explanations-a-rejoinder-to-hanson/

Elephant in the Brain on Religious Hypocrisy:
http://econlog.econlib.org/archives/2018/01/elephant_in_the.html
http://www.overcomingbias.com/2018/01/caplan-critiques-our-religion-chapter.html
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august 2016 by nhaliday
Reverse Voxsplaining: Drugs vs. Chairs | Slate Star Codex
Let me ask Vox a question: when was the last time that America’s chair industry hiked the price of chairs 400% and suddenly nobody in the country could afford to sit down? When was the last time that the mug industry decided to charge $300 per cup, and everyone had to drink coffee straight from the pot or face bankruptcy? When was the last time greedy shoe executives forced most Americans to go barefoot? And why do you think that is?
medicine  critique  regularizer  drugs  policy  regulation  healthcare  ssc  unintended-consequences  nl-and-so-can-you  media  pharma  wonkish  meta:medicine  ratty  yvain 
august 2016 by nhaliday
Blue or Green on Regulation? - Less Wrong
The FDA prevents 5,000 casualties per year but causes at least 20,000-120,000 casualties by delaying approval of beneficial medications. The second number is calculated only by looking at delays in the introduction of medications eventually approved - not medications never approved, or medications for which approval was never sought. FDA fatalities are comparable to the annual number of fatal car accidents, but the noneffects of medications not approved don't make the evening news. A bureaucrat's chief incentive is not to approve anything that will ever harm anyone in a way that makes it into the newspaper; no other cost-benefit calculus is involved as an actual career incentive. The bureaucracy as a whole may have an incentive to approve at least some new products - if the FDA never approved a new medication, Congress would become suspicious - but any individual bureaucrat has an unlimited incentive to say no. Regulators have no career motive to do any sort of cost-benefit calculation - except of course for the easy career-benefit calculation. A product with a failure mode spectacular enough to make the newspapers will be banned regardless of what other good it might do; one-reason decisionmaking. As with the FAA banning toenail clippers on planes, "safety precautions" are primarily an ostentatious display of costly efforts so that, when a catastrophe does occur, the agency will be seen to have tried its hardest.
policy  government  drugs  medicine  rationality  arbitrage  regulation  lesswrong  healthcare  FDA  unintended-consequences  ratty  pharma  cost-benefit  incentives 
august 2016 by nhaliday
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