EclectEcon

Scarcity and Death Panels: the economics of medical care

We absolute must face the reality that because of scarcity, we will not all receive "the best medical care possible". There simply is not enough to go around. Jonathan Kay nails it:

 Even the wealthiest societies, no matter what the funding model for their health systems, have finite resources available to treat the human body’s potentially infinite medical needs. Someone, somewhere has to make a decision about where those finite assets go.

Such decisions seem horrifying to most of us because life, in most contexts, is too precious to be captured with dollars and cents, or even with the ordinal rankings used to assign transplantable organs. And utilitarianism can, indeed, be taken to monstrous extremes on the fringes of bioethics. But where the day-to-day business of critical-care medicine is concerned, some measure of soulless cost-benefit analysis is an absolute necessity — because every dollar (or organ) used on one patient within a public or private insurance network usually is, in effect, taken from another.

If we don't understand this simple truth, we are doomed to misallocating health resources.

A summary of too many people's view of the Canadian health care system is:

Better that one rich person be denied care so that 50 poor people can stand in line hoping to get it.

... which of course completely ignores both supply effects and the beneficial rationing effects of the price system.

Related articles

Scarcity, Economics, and Medical Care

Would I Look Younger with Dark Hair? (as if it matters)

People who have seen me with dark hair tell me it takes years off my appearance.  Here is one example:

So maybe there's hope? From Gabriel,

"For generations, numerous remedies have been concocted to hide gray hair," said Dr. Gerald Weissmann, the editor-in-chief of The FASEB Journal, "but now, for the first time, an actual treatment that gets to the root of the problem has been developed. While this is exciting news, what's even more exciting is that this also works for vitiligo. This condition, while technically cosmetic, can have serious socio-emotional effects of people. Developing an effective treatment for this condition has the potential to radically improve many people's lives."

I expect none of this stuff will be commercially viable while I'm alive. Or if it is, I'll probably be too old to care. Oh well, the rest of you have so much neato stuff to look forward to.

Related articles

Aging and Life Expectancy

Gray hair and vitiligo reversed at the root

Graying of hair can now be reversed - Zee News - Zee News

Germ Sites

With reports of new outbreaks of Avian Flu, this might be useful information (actually it is anyway). The 11 most common places that people are likely to pick up germs and viruses [h/t Jack] are listed here.

1. Handrails. I try not to use them, but nowadays I walk down stairs with my hand poised over the rail just as a precaution.
2. Elevator buttons. I use a knuckle instead of a fingertip. 
3. Grocery cart handles. 
4. Restaurant menus.
5. Money from cash registers (I once had a minor bout of something resulting from handling money in a foreign country and not washing my hands right afterward).
6. Light switches. Again I use knuckles or arms whenever possible in public places. 
7. Salt and pepper shakers in restaurants.
8. Salad bars. These places are scary, even with sneeze shields. I expect buffets in general can pose problems. 
9. ATMs. Maybe I'll start with the knuckles here, too, if possible.
10. Exercise equipment. No worries there! ;-)
11. Water fountain handles. I love the ones with a press bar.

The article concludes with this fairly sensible advice:

Makes you nervous, doesn't it? Relax. It takes just a little common sense and attention to protect yourself from public germs. Here are ways to keep germs at bay:

Handwashing. Always wash your hands before cooking, eating, or inserting your contact lenses. Wash your hands after cooking, using the toilet, petting an animal, handling garbage, blowing your nose, or coughing or sneezing into your hand. It doesn't matter if you wash with regular or antibacterial soap as long as you do a thorough job. 

Use hand sanitizer. Alcohol-based sanitizers that require no water are among the greatest health inventions of recent times. They're efficient at killing germs, whenever and wherever you encounter them, without the need of water or towels. 

Keep hands away from your face. No matter how many times you wash them, if you are in public, your hands will pick up germs. Germs will quickly enter your body if you rub your eyes or nose, stroke your chin, or touch your lips. [EE: This is a tough one for me]

Avoid the communal candy bowl or cookie jar. Given that only 67 percent of people who say they wash their hands actually do, and that only a third of those people use soap, you can imagine what's lurking in there. 

 

Related articles

Hand Washing Steps

Kids Health

Scarcity, Economics, and Medical Care

One of the first things we do in introductory economics courses is try to make the point that because humans seem generally to have unlimited wants but because there are limited productive inputs, we are condemned to live with scarcity. Like it or not, we cannot have all we want of everything. We must make choices somehow.

This fact of human existence is crucial for understanding the problems we will increasingly face in the realm of medical care. As we move toward increased use of gubmnt programmes to provide the care, not everyone will be able to receive all the care they might want. This problem of scarcity will most often be stated as a problem of not being able to afford the medical care, but it really stems from a problem of scarcity: when customers don't have to pay directly, they want more than they would otherwise, and getting all the productive inputs to provide all that care (i.e. attracting them from alternative uses) is extremely costly, involving painful trade-offs. 

So we have to have a mechanism for deciding who gets the medical care. We must have some sort of rationing scheme. Some people might urge the use of the market to make this decision. Others might urge the use of co-pays and limits on some types of insurance to decide. Others openly recommend letting doctors, committees, and bureaucrats decide (aka death panels?).  But we have to acknowledge that not everyone will ever get all they want. Choices must be made somehow.

You may not like that reality. You might think people should behave differently. But the sad fact is that scarcity necessitates our making such choices. There is no way around it.

We see this problem now with cancer patients in the US. From the Washington Post, 

Cancer clinics are turning away thousands of Medicare patients. Blame the sequester.

... Oncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive chemotherapy drugs while staying afloat financially.

Patients at these clinics would need to seek treatment elsewhere, such as at hospitals that might not have the capacity to accommodate them.

It may seem that the sequester and a cut in funding for medicaid/medicare have caused this problem, and I suppose in the short-run that's right. But in reality, the problem is a much greater quantity demanded at current prices (zero!) than is supplied. 

The problem is an old one that economists have presented endlessly: whenever the gubmnt sets a price of zero and tries to guarantee that everyone who wants something at that price can have it, then shortages emerge. And then, to try to fix the problem, the gubmnt must decide how to ration the product. 

In this case the rationing is left to medical facilities. And they, quite understandably, are choosing to decline to treat those patients for whom the costs of treatment are extremely high. 

Whether we want to acknowledge it or not, these are death panels. These are groups of people deciding who should or should not receive treatments. 

Pretty Much the Case These Days

and pretty much consistent with the Atkins diet. [h/t MA]

Stroke Warning Signs/Indications

I know I've blogged about this before, but it is so important and has been brought home again over the past two days.

Here are the stroke warning signs:

• Headache. Sudden severe and unusual headache, especially with no known cause. This is what happened to two friends who suffered strokes recently.
• Vision Troubles. Sudden trouble with vision in one or both eyes, even if temporary.
• Dizziness. Sudden loss of balance or trouble walking, especially when combined with any of the other signs listed here.
• Trouble Speaking. Sudden difficulty speaking or understanding; or sudden confusion, even if temporary.
• Weakness. Sudden loss of strength or sudden numbness in the face, arm, or leg, even if temporary.

One triage-type of diagnosis is the following. It's rough, but it might help. 

• Ask the person  
  • to smile
  • to raise both arms
  • to speak a simple sentence

There is some evidence that speedy recognition of the symptoms of a stroke (blood clot in the brain) will permit quick treatment with a much higher chance of survival. 

We keep these lists (above) on our fridge door.

addendum:

Jack's comments, which I included in my original post, really bear repeating:

There is an additional bit of information to be aware of: the possibility of reversing the impact of a stroke if one gets proper medical treatment within three hours of symptom onset. This applies to the majority of strokes which are caused by blockages in blood supply to part of the brain. It does not apply to those caused by bleeding into the brain. The steps required for possible stroke 'reversal' are:

1/ Get to a major hospital emergency department as soon as possible, and certainly within three hours of symptom onset.

2/ Bring up the possibility of administering clot-busting drugs to the emergency MD immediately; if he/she is on the ball and facilities permit, an emergency CT scan should follow very quickly. The CT is necessary to detemine if the stroke is caused by a blockage /clot (good) or a bleed (bad). If it is the former, then you should receive a clot busting drug intravenously. All of this ideally transpires within a three hour time frame of symptom onset.

Don't assume this will automatically happen. [There are instances when it hasn't.]

This link is an older statement for the public, but still applies.

And this link gives a broader context to treatment.

 

Related articles

10 stroke risks and warning signs for young and old alike

Don't ignore warning signs, top doctor says as he recovers from a stroke

Signs of stroke important to know

Calm and Peace

I am definitely saving this link. Very relaxing! Just close your eyes and do nothing for two minutes.

On Death and Dying

The other night, Ms. Eclectic and I were speculating about how long we expect to live. She's a cancer survivor, and both my parents died of heart disease; so we figured we'd both probably be below average. 

The sudden death of my friend, Alan Adamson, caused me to think more than just idly about the question. So I took this test. The results indicate I might live a little longer than I expected, but then the 50% confidence interval spans a tonne of years, too. Ms. Eclectic had similar results, so we are guessing we still have quite a few years together ahead of us. My results:

Life Expectancy Results

Life Expectancy: 88.47 years
Lower Quartile: 81.08 years (75% chance you will live longer than this)
Median Lifetime: 88.59 years (50% chance you will live longer than this)
Upper Quartile: 95.60 years (25% chance you will live longer than this)

Another life expectancy calculator, which insists on registration (and hence which seems likely to be more commercial) is this one. Unfortunately, it provides only a point estimate instead of a range, but it says I'll live 'til I'm 95. I took it a second time, giving slightly different answers, and it tells me I'll live to the age of 87. And Jack sent this one, which says I'll live until I'm 83.

With results like these, we'd better reorganize our spending to make our pension savings last a bit longer. And if I'm going to live that long, I sure hope low-cost, effective joint and muscle care/repair become available soon!

From a different perspective, my friend Jack says that at our age we must accept the fact that there is a non-negligible probability we can go at any time. I understand that, objectively. But I'm having so much fun, I'm really not ready to go yet.

More Costs Being Imposed on Younger Generations by us Oldsters

• Social Security in the US is completely shot and actuarially broke.
• Medicare/Medicaid are going to be massive drains on the public fisc as the baby boomers age.

And while the gubmnt-funded pensions are somewhat better funded in Canada, the medical commitment of the gubmnt will likely cause serious problems in the future.

And now this from the BBC [h/t Jack]. The abuse of alcohol by Baby Boomers is imposing even more costs on the health system:

More NHS money is spent treating alcohol-related illness in baby boomers than young people, a study says.

The Alcohol Concern report found the cost of hospital admissions linked to heavy drinking 55 to 74-year-olds in 2010-11 was more than £825m.

That was 10 times the figure for 16 to 24-year-olds.

Ten times! Holy cow! It appears that in addition to having to deal with the baby boomer effect on pension commitments and general aging-related health commitments, gubmnts will also be addressing the fact that we're all a bunch of lushes. 

Is it time, now, to raise the Pigou tax on alcohol even more? Please, no....

(aqua velva or anti-freeze anyone?)

Canadians' Right to Health Care: "The Right to Stand in Line"

David Henderson, in reviewing John Goodman's book on the economics of healthcare, takes a well-deserved swipe at the current Canadian health care system:

These data, plus the fact that Canadians wait so long to see a doctor and to get surgery, help to make another point that Goodman discusses: the supposed "right to health care." When I hear people say that people have a right to health care, I take on the moral issue with moral reasoning, questioning whether health care is something that a person can truly have a moral right to. Goodman does it differently--and effectively. He points out that Canadians don't have a right to health care. How can you say it's a right if people aren't guaranteed to actually receive the health care service they need? The right to get in line for care, which is really all that Canadians are guaranteed, is not much of a right.

When I first moved to Canada over 40 years ago, the health care system was much better for several reasons. We rarely had to wait very long for any service. Two important things happened, however:

1. In an effort to control costs and reduce what people feared would be supply-induced demand, the number of doctors put through the system was actually restricted. It should come as no surprise that we now have shortages of physicians, especially since present-day doctors tend to put in fewer hours, on average, than did physicians back then.
2. Extra billing was eliminated. When I first moved to Canada, doctors were allowed to charge more than the stated fee schedule if they wanted to. Some did (especially if they thought the patients could pay more -- a classic example of the improved efficiency that follows from price discrimination). The elimination of extra billing drove some physicians to the US and induced others, especially newer ones, into the specialties with more lucrative fee schedules, leaving shortages elsewhere. Surprise, surprise: when the price was pushed to zero by the gubmnt, the quantity demanded increased and the quantity supplied decreased.

 

Age and De-conditioning

I know better. At least intellectually/academically I know better.

I'm getting old. And I haven't maintained a state of physical fitness that I might imagine I have. 

So when I engage in physical activity, it is not unexpected that my expectations are sometimes way out of line with reality. I sometimes over-reach. A lot.

Example #1: last summer, I lifted a 150lb electric bike to put it into a storage unit. The first two lifts to get it into position were fine, but the third one involved twisting, and I wrenched my back. I'm still working on getting over that.

Example #2: As I slowly recovered from the back injury, I was unable to do as much walking as I had been used to doing, and so my weight began to creep up. Late this past winter and early this spring, I was delighted to be able to begin walking increased distances (e.g. 4-5 miles between Masonville and downtown London). A few weeks ago while doing that walk, I hoofed it along an uneven path at a "smartish pace", wrenched my knee, and was barely able to walk for a couple of weeks. Fortunately, the tendinitis seems to have eased considerably. Vitamin I* helps.

Example #3: As a result of not being able to walk much, I began swimming semi-regularly in the pool in our building. Vigourously. Of course, I overdid it, and now my shoulders are not just sore, but have minor strains.

What a doink! I'm such a slow learner.

So here's the lesson to me (and others who may need to [re]learn it):

• John, you are no longer 25 years old. You are not even as fit as you were when you were 40. 
• When you see young people engaging in physical activities and think to yourself, "I can do that", think twice: Odds are that you can't.
• Warm up slowly and considerably before doing strenuous things, especially those that you haven't done for awhile (e.g. I had a life-saving certificate nearly 50 years ago, and I just imagine/pretend I can still swim that well).
• Get your expectations and beliefs about your abilities back in line with reality.

and to all of you who see grumpy old men, there's a reason we're grumpy, and it isn't always all that funny.

*Vitamin I is our euphemism for ibuprofen.

Scarcity, Rationing, and Death Panels

One of the fundamental principles in economics is that goods and services are scarce. People want more than is available and therefore choices must be made. 

The question is NOT "should things be rationed?" Rather, it is "How should things be rationed?"

This distinction is made clear to us every day, but possibly no more so than in the area of health care. When individuals are not required to pay for medical care, we tend to ask for more, better, and more expensive care. But the system simply cannot provide all of what we want at a zero price. And so choices must be made.

In many instances, who gets the goodies will be determined by who you know, who you are politically connected with, what your politics are.

In other instances, medical care will be rationed by our ability and willingness to pay (somewhat crass but realistic digression: if a given procedure will extend my life by 4 years and cost the gubmnt/taxpayers, say $400,000, I'll want to receive it; but if my heirs could have the money instead, I might choose to forego the treatment). 

And in some instances, death panels composed of persons with medical training (and political connections?) will decide how to ration scarce health resources. 

I have enough trouble with physicians who like to play god as it is. Giving them the ability and power to decide who should receive a heart, a kidney, or a cancer treatment adds to my concerns. 

For example, consider this story [h/t Rebekkah]:

When Kenneth Warden was diagnosed with terminal bladder cancer, his hospital consultant sent him home to die, ruling that at 78 he was too old to treat.

Even the palliative surgery or chemotherapy that could have eased his distressing symptoms were declared off-limits because of his age...

Thanks to [his daughter's] tenacity, Kenneth got the drugs and surgery he needed — and as a result his cancer was actually cured. Four years on, he is a sprightly 82-year-old who works out at the gym, drives a sports car and competes in a rowing team.

But it wasn't just her tenacity that saved her father. It was also her willingness to spend her own time and money combined with the fact that in the UK a private option to the National Health Service is available. In Canada, the gubmnt does not permit a private option.... unless you are willing to pay to travel to some other country (e.g. the US). 

Everyone needs to understand that health care, like every other good or service, is being rationed and will always be rationed. The only question is how will it be rationed? And so long as we refuse to let people pay for their own health care, we will have death panels, like it or not.

I'm Tempted to Volunteer to Be a Human Test Subject for Potential Preventive Measures

Two of my four grandparents experienced varying degrees of dementia or Alzheimer's disease late in their lives. As I age, of course everytime I lose a word or forget a name or can't find something I have misplaced, I worry that dementia will afflict me, too. 

So I read this item (BBC News) with considerable interest.

Destructive plaques found in the brains of Alzheimer's patients have been rapidly cleared by researchers testing a cancer drug on mice.

The US study, published in the journal Science, reported the plaques were broken down at "unprecedented" speed.

Tests also showed an improvement in some brain function.

Specialists said the results were promising, but warned that successful drugs in mice often failed to work in people.

... 

After one dose in young mice, the levels of beta-amyloid in the brain were "rapidly lowered" within six hours and a 25% reduction was sustained for 70 hours.

In older mice with established amyloid plaques, seven days of treatment halved the number of plaques in the brain.

The study said there were improvements in brain function after treatment, in nest building, maze performance and remembering electrical shocks.

Researchers Paige Cramer said: "This is an unprecedented finding. Previously, the best existing treatment for Alzheimer's disease in mice required several months to reduce plaque in the brain."

... 

"We need to be clear, the drug works quite well in mouse models of the disease. Our next objective is to ascertain if it acts similarly in humans," he said.

His group is preparing to start trials in a small group of people to see if there is a similar effect in humans.

At this point, the limited human trials will be with victims of Alzheimer's disease. My guess is that it will be a long, long time before researchers are able to test using this or a related drug as a preventive measure.

However, it should be possible, using retrospective studies, to examine patients who used the drug as cancer patients to see whether the incidence of Alzheimer's disease has been lower for them than for a comparable group. I hope this study is done soon and done carefully.

One of the Best Health-Type Videos I've Seen

The message: being more active tends to reduce risks of health problems. 

http://www.cbc.ca/news/canada/toronto/story/2012/01/11/toronto-viral-video-doctor-health.html

People Respond to Incentives: Divorce, Part II

Earlier I wrote how some couples in China were getting divorced so they could engage in more real estate speculation (here).

Here is another example of how people respond to incentives and seek a divorce:

I know a young couple with several children. They have been separated for a few years, but hadn't bothered to get a divorce (essentially the transaction/legal costs, even in an amicable divorce, outweighed the expected benefits, so they hadn't bothered). 

Some years after their separation, they looked into providing orthodontic care for one of their children. It turns out that the conditions of their respective health/dental insurance policies will not let them use the benefits from both parents' policies to help defray the costs if they are married, so they are finally getting divorced so they can apply the partial benefits from both policies toward covering the costs. 

This is an odd situation. Most health insurance policies require that the insured submit a claim first to one company and, if that policy doesn't cover everything, then to the second company. Apparently that is not the case for the companies insuring these parents.

I haven't read about or heard about other types of responses to these health insurance policy conditions, but I have to wonder whether some parents might get divorced just to cover orthodontic and other health and dental care costs from their policies in this fashion. 

Tampon Shortage in Japan? at what price?

My friend, Scoop, writes that there is a desperate shortage of tampons in Japan following the Tsunami. But as I say to my students, "Shortage? At what price?"

If the prices of tampons rose, two things would happen:

1. The quantity demanded would decline. That's right. Even though tampons are perceived as necessities, as the price rose, some people would find substitutes  and others would change less often.
2. The quantity supplied would increase. At high enough prices, it would pay entrepreneurs to fly in caseloads of tampons. In fact, it is likely that one thing keeping these entrepreneurs from doing so is the uncertainty about how many tampons will be shipped in as part of the relief effort, thus thwarting their own possible efforts.

Note: I'm not saying that shipping tampons to Japan as part of the relief effort would necessarily be a bad thing. I am, however, trying to point out that prices, and especially expected prices serve as a signal. In this case, the signal induces people to use less and supply more. 

I should also point out that if tampons are shipped to Japan as part of the relief effort, there will have to be some rationing scheme in place. If prices are not used to ration the tampons, then some other rationing scheme will, of necessity, be in place. The criteria will likely be some combination of queuing, connections, and luck.

The Ten Warning Signs of Alzheimer's Disease

According to a recent NatPost article, 25% of aging baby-boomers cannot identify even one early symptom of Alzheimer's disease. Just so you know, here is the list of the ten early warning signs from the Alzheimer Society (be sure to read the details for each item):

1.  Memory loss that affects day-to-day function

It's normal to occasionally forget appointments, colleagues' names or a friend's phone number and remember them later. A person with Alzheimer's disease may forget things more often and not remember them later, especially things that have happened more recently.

2.  Difficulty performing familiar tasks

Busy people can be so distracted from time to time that they may leave the carrots on the stove and only remember to serve them at the end of a meal. A person with Alzheimer's disease may have trouble with tasks that have been familiar to them all their lives, such as preparing a meal.

3.  Problems with language

Everyone has trouble finding the right word sometimes, but a person with Alzheimer's disease may forget simple words or substitute words, making her sentences difficult to understand.

4.  Disorientation of time and place

It's normal to forget the day of the week or your destination - for a moment. But a person with Alzheimer's disease can become lost on their own street, not knowing how they got there or how to get home.

5.  Poor or decreased judgment

People may sometimes put off going to a doctor if they have an infection, but eventually seek medical attention. A person with Alzheimer's disease may have decreased judgment, for example not recognizing a medical problem that needs attention or wearing heavy clothing on a hot day.

6.  Problems with abstract thinking

From time to time, people may have difficulty with tasks that require abstract thinking, such as balancing a chequebook. Someone with Alzheimer's disease may have significant difficulties with such tasks, for example not recognizing what the numbers in the chequebook mean.

7.  Misplacing things

Anyone can temporarily misplace a wallet or keys. A person with Alzheimer's disease may put things in inappropriate places: an iron in the freezer or a wristwatch in the sugar bowl.

8.  Changes in mood and behaviour

Everyone becomes sad or moody from time to time. Someone with Alzheimer's disease can exhibit varied mood swings - from calm to tears to anger - for no apparent reason.

9.  Changes in personality

People's personalities can change somewhat with age. But a person with Alzheimer's disease can become confused, suspicious or withdrawn. Changes may also include apathy, fearfulness or acting out of character.

10. Loss of initiative

It's normal to tire of housework, business activities or social obligations, but most people regain their initiative. A person with Alzheimer's disease may become very passive, and require cues and prompting to become involved.

I'll leave it to those who know me to suggest which ones apply to me already...

I NEED a Prescription for Marijuana

I have quite a bit of joint pain at times, and sometimes I don't sleep so well. These symptoms are to be expected in my demographic cohort. But now there is hope for relief:

A team of Montreal researchers has lent scientific credibility to the view that smoking marijuana can ease chronic neuropathic pain and help patients sleep better....

The study, published Monday in the Canadian Medical Association Journal, found that pain intensity among patients decreased with higher-potency marijuana. It is one of a handful of scientific attempts to determine the medicinal benefits of the drug.

I keep telling my family physician that I need a prescription for marijuana because of my arthritis. I am told there are walk-in clinics in some areas of California where one can both obtain such a prescription and have it filled at the same time. I eagerly await their spread to Canada. 

But I'm a novice. I would really rather not smoke the drug. Is it possible to obtain the same therapeutic effects if I ingest the product with cookies or brownies instead of smoking it? 

 

Disappointing News for People in My Age Cohort(and many others, I'm sure)

From the NYTimes,

[T]he jury’s verdict was depressing and distressing. So far, nothing has been found to prevent or delay this devastating disease [Alzheimer's], which ceaselessly kills brain cells, eventually leaving people mute, incontinent, unable to feed themselves, unaware of who they are or who their family and friends are.

“Currently,” the panel wrote, “no evidence of even moderate scientific quality exists to support the association of any modifiable factor (such as nutritional supplements, herbal preparations, dietary factors, prescription or nonprescription drugs, social or economic factors, medical conditions, toxins or environmental exposures) with reduced risk of Alzheimer’s disease.”

Photos from Yesterday in Vienna

As I was wandering around near the Music Institute yesterday, I heard a horn player practicing and thought, "isn't this great! I get to listen to this horn player." I looked around to see where the sound was coming from, and saw this:

This guy was practicing his horn, in a parked (!) van, with the windows up, on a day when the temperature was about 28C! And if you look carefully at the horn, you can see that it is anything but a standard horn. The curves and tubing are quite different.

As I continued walking, I passed a very interesting sculpture. I assume it signifies or leads one to the Pfizer Vienna headquarters.

 

8-) 

Drinking Hoppy Beer Can Help Strengthen Bones

... but the effect likely has a low mean, a negative quadratic term, and a high variance.  At least beer wasn't lumped into this study warning of increased risk of pancreatic cancer from drinking fizzy drinks.

    I'll drink to these studies (but I don't really attach much significance to them).

[h/t JJ]

What Is the Price Elasticity of Demand for the H1N1 Vaccine?

Ms. Eclectic and I lined up with hundreds of other local residents last Monday when the county health authority came to town to provide swine flu shots for us. It was windy, cold, and there was mix of rain and snow blowing as we stood outside the Legion Hall, waiting to join the queue inside the hall.

Overall, people were in good spirits, and the organization was pretty slick. Nevertheless, the wait (especially when we were in the portion of the queue that was outside the building) was uncomfortable. From the time we arrived until the time we left, the total elapsed time was about an hour and a quarter, in contrast with about twenty minutes earlier in the fall when we received our seasonal flu shots. [note: both times included about a ten-minute waiting period following the shot].

As I proceeded from health bureaucrat to health bureaucrat at the H1N1 vaccination site, I asked each of them how long they thought the line would be if people were charged $5 each for the vaccine. Everyone I spoke with volunteered that they thought the line would be much shorter. The implication from this non-scientific survey is that the price elasticity of demand for the H1N1 vaccine is certainly greater than zero. Using arc elasticity calculations and rough guesstimates of the sizes, and supposing that charging $5 for the vaccine would reduce the quantity demanded from 2000 to 1500, then the price elasticity of demand would be approximately .143.

That's still a pretty small number, indicating that the quantity demanded would not be very responsive, in percentage terms, to a change in the price in this region. Nevertheless if 500 people (I know, it's a very rough guess) would give the vaccination a miss just because of a $5 charge, it is difficult to see how the vaccination can be thought of as a dire necessity.

Two additional notes:

1. Most of the health bureaucrats I spoke with didn't twig to the fact that I was asking about how much the quantity demanded would decline with the charge. They just thought that people receiving the vaccine ought to contribute to the costs of producing and providing the vaccinations. I don't have the numbers, but judging from the numbers of computers and health professionals involved, I suspect the cost of delivering the vaccinations was greater than the cost of producing the vaccine itself.
2. While receiving my vaccination, I overhear Ms. Eclectic say, "That's my husband. He turns everything into an economics question."

Three Shots a Day Keeps the Doctor Away

Ms. Eclectic says that now I have a justification for drinking scotch. As if I needed one. From the BBC (among many sources):

Drinking alcohol every day cuts the risk of heart disease in men by more than a third, a major study suggests.

The Spanish research involving more than 15,500 men and 26,000 women found large quantities of alcohol could be even more beneficial for men. 

... For those drinking little - less than a shot of vodka a day for instance - the risk was reduced by 35%. And for those who drank anything from three shots to more than 11 shots each day, the risk worked out an average of 50% less.

My preference: single malt Islay scotches, e.g. LaPhroaig, Lagavulin, and Caol Ila.

The Simple Economics of Health-Care Reform

While some politicians talk about programmes designed to bring more people under the health-care umbrella, others talk about making health care more affordable. The former (combined with an aging population) will shift the demand curve outward; the latter will cause a movement downward along that shifted demand curve (a lower price increases the quantity demanded).

But if the supply curve doesn't shift outward, the above two policies will create more shortages and longer waiting periods (and committees of death, due to the shortages, no matter what they are called).

The only way to shift the demand curve outward, lower the prices to the users AND avoid shortages is to increase the supply.

Starting now, without delay, gubmnts should be encouraging medical schools to admit more students. They should also be encouraging more use of nurse practitioners and prescribing pharmacists. But as the demand increases, the shortages will not go away so long as prices are fixed below the equilibrium level.

Fifty Forever?

Today is my birthday. And possibly in celebration, Jack sent me this link

Centenarians with the bodies of 50-year-olds will one day be a realistic possibility, say scientists.

Half of babies now born in the UK will reach 100, thanks to higher living standards, but our bodies are wearing out at the same rate.

To achieve "50 active years after 50", experts at Leeds University are spending £50m over five years looking at innovative solutions.

They plan to provide pensioners with own-grown tissues and durable implants.

New hips, knees and heart valves are the starting points, but eventually they envisage most of the body parts that flounder with age could be upgraded.

Translating Obama's Speech on Health Care and Deficits

Greg Mankiw does us all a favour by telling us what Obama really meant:

[T]his passage in the President's speech had me scratching my head:

I will not sign a plan that adds one dime to our deficits -- either now or in the future.(Applause.) I will not sign it if it adds one dime to the deficit, now or in the future, period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize.

At first, it sounds like the President is threatening to veto the bills being considered in Congress because, according to CBO, they will add significantly to deficits in the out years. If true, that would be a big story. But the provision he mentions in the next sentence seems to suggest he is just passing the buck.

Translation: "I promise to fix the problem. And if I do not fix the problem now, I will fix it later, or some future president will, after I am long gone. I promise he will. Absolutely, positively, I am committed to that future president fixing the problem. You can count on it. Would I lie to you?"

Hermaphrodite Runner

BenS has suggested that the runner from South Africa would attend classes in Middlesex College if taking classes here at the University of Western Ontario.

World 800-metre champion Caster Semenya of South Africa has male and female sexual organs, the Sydney Morning Herald reported Friday, posing an ethical and political quandary for world track and field's ruling body.

The Herald said extensive physical examinations of the 18-year-old runner ordered by the IAAF have shown she is technically a hermaphrodite.

Medical reports indicate she has no ovaries, but rather has internal male testes, which are producing large amounts of testosterone.

Jack suspects lawyers will have a field day with the case. I agree. And Ben adds, "What about 'he said, she said?'"

I'm very happy not to be on the International Olympic Committee or, in this specific case, on the IAAF. This would truly be a tough nut to crack.

Update: for more on the topic, see this in Salon. [h/t Shannon]

A Useful Book on Health Care

Ms. Eclectic tells us that interventions by her sister (a nurse) and support from the rest of us played an important role in her (comparatively) speedy recovery from surgery and cancer more than two decades ago. We have been fortunate since then, but we have ordered this book, The Essential Hospital Handbook: How to Be an Effective Partner in a Loved One's Care, just in case. Here is a brief description from the CBC:

Conlon, a journalist and [the] author who, indeed, became an active participant in [his partner,] Jim's eventually successful treatment, has used the experience to help people who might find themselves in the same situation he did.

His book, The Essential Hospital Handbook: How to Be an Effective Partner in a Loved One's Care, is a straightforward approach to handling a health-care crisis, a time when many people's common sense battles fears for their loved one's life.

The book offers a comprehensive look at emergency rooms, surgery, recovery and the hospice as it takes readers on a tour of the hospital.

Such things as living wills, drugs, hospital equipment and even slang are examined to give a well-rounded picture of what people might encounter.

While directed at caregivers and families, the book is just as helpful for patients.

...

Scotch Therapy!

Ms. Eclectic has long maintained that scotch therapy is the best way to deal with colds or the flu (see this, for example). And now we learn that Russian physicians are advising travelers to drink whiskey to deal with possible swine flu infections:

Russian soccer fans heading to Wales for next month's World Cup qualifier have been urged to take unique precautions to ward off swine flu: drink Welsh whisky

"Welsh whisky is on offer to Russian supporters as a disinfectant," Alexander Shprygin, head of the national team's fan club, said Monday. "This will relieve any symptoms."

We both concur with one of the comments on that story: is there some way to convince our drug plan to cover single-malt scotch if we get the flu?

More: But I guess it is possible to overdo it:

People who consume, on average, more than one alcoholic drink daily face a significantly higher risk of developing six types of cancer, according to sobering new Canadian research.

But as Ms. Eclectic also says, she had cancer before she started drinking much. So maybe the direction of causation is reversed? 8-)

Cannabis and Mental Health:correlation vs. causation

I was reminded of the adage, "Correlation does not imply causation," when I read this abstract.

This paper investigates whether cannabis use leads to worse mental health. To do so, we account for common unobserved factors affecting mental health and cannabis consumption by modeling mental health jointly with the dynamics of cannabis use. Our main finding is that using cannabis increases the likelihood of mental health problems, with current use having a larger effect than past use. The estimates suggest a dose response relationship between the frequency of recent cannabis use and the probability of currently experiencing a mental health problem. [emphasis added]

Many of the serious potheads I have known have struck me as people who would have had mental health problems with or without cannabis use.