May 19th, 2012

Drinkers Decide What Constitutes Unhealthy Drinking

by Keith Humphreys
Category: Health and Medicine, Health Care

Andrew Sullivan is concerned that the new DSM-V psychiatric classification system will define the 40% of college students who sometimes binge drink as alcoholic. He links to an angry critique by Russell Blackford, who sees the potential over-extension of the alcoholic label as misguided and oppressive.

As I outlined a few days ago, and Dr. Deni Carise elaborates on today at Huffington Post, the alarming 40% figure that keeps being quoted is misleading. If criteria are broadened, the purpose will be specifically to identify problem drinkers who are not what is commonly understood as alcoholic. Read the rest of this entry »

Posted: Saturday, May 19th, 2012 at 6:48 am
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1 Comment »

May 19th, 2012

Mein Solardach

by James Wimberley
Category: Climate change, Energy and Environment, Europe, France, Germany, Spain

Was it Matthew asking for ideas to get Europe’s economy moving?

It was a great insight of Keynes that spending doesn’t have to be useful to be effective in a slump (though he also said that useful was preferable). Helicopter drops of cash, banknotes buried in coal mines, and cheques mailed out randomly would work just fine, but clash with the Protestant ethic. Few Germans believe Keynes’ argument, and no German central bankers, so you really have to come up with Useful and Virtuous ideas.

At the risk of sounding like a one-subject crank, here’s mine. A part of my roof as it could be by Christmas:

What I suggest is a very large solar panel leasing scheme, funded or underwritten by the creditworthy members of the EU, meaning Germany. Taking a number out of a hat, 5 GW at €2.5 per installed watt would cost €12.5bn up front. That’s 2 million houses at 2.5 kw each, or €6,250; or 50,000 industrial roofs at 100kw, or any linear combination. Read the rest of this entry »

Posted: Saturday, May 19th, 2012 at 5:29 am
5 Comments »

May 18th, 2012

The Art of Ben Heine

by Keith Humphreys
Category: Arts and Cultural Policy

Heine creates images by combining pencil drawings with photographs. The one below is “Wheel Ruts”. Slideshow of his work available here

Posted: Friday, May 18th, 2012 at 11:43 pm
2 Comments »

May 18th, 2012

Weekend Film Recommendation: How to Succeed in Business (Without Really Trying)

by Keith Humphreys
Category: Film

A wonderful take on the life of corporate suits and their sexy secretaries in 1960s Manhattan, with Robert Morse as the star. No, it’s not Mad Men, but 1967′s toe-tapping, uplifting and funny “How to Succeed in Business (Without Really Trying)”.

Based on the smash Broadway hit, the heart of the film is of course the music. The songwriter is the great Frank Loesser, and some of his most enjoyable pieces are rendered with energy and talent by the cast (“Brotherhood of Man”, “The Company Way”, “I Believe in You”). Bob Fosse’s choreography is consistently creative and the colourful costumes by Micheline enliven every scene.

The wonderfully silly script tells the story of an ambitious window washer named J. Pierpont Finch (Robert Morse, whose bravura performance deserved an Oscar nomination) who climbs the corporate ladder with shocking speed, aided by the titular self-help book. He is pursued by Rosemary Pilkington (Cutely played by Michelle Lee), who is every bit as ambitious in love as he is in work. Many veterans of the stage production (including Rudy Vallee) contribute their comic and musical gifts.

David Swift, famous as a Disney animator and TV writer/director, seems an unlikely writer/producer/director for this film. In some ways, one could say it was an easy job because the choreography and cast had mostly been worked out already on Broadway. But on the other hand, adapting a beloved Broadway show to the screen is a big risk for a director because fans of the stage version can get upset at the inevitable changes in the film version. Here they were apparently delighted along with the rest of the movie-going population, so kudos to Swift for a smooth translation of play to screen, and congratulations on what was the high mark of his career as a film maker.

I am embedding one of my favorite numbers from the movie because it always picked me up when I was a lowly graduate student feeling stomped on and disrespected in a really demanding doctoral programme. Enjoy.

Footnote: There are two continuity goofs in the opening minutes of the film. Finch pays for his newspaper but grabs the self-help book impulsively without paying for it and the guy running the booth doesn’t react. A few moments later, when he starts from the roof down on the window washing platform, there is another window washer working the other side. But that guy is played by a different actor by the time Finch has descended to the window. Yes…noticing these things means I have seen this movie perhaps too many times. But. Can’t. Stop. Re-Watching. So. So. Entertaining.

Posted: Friday, May 18th, 2012 at 10:49 am
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7 Comments »

May 18th, 2012

Taylor v. Feldstein: Comparing Catastrophic Plans

by Don Taylor
Category: Affordable Care Act, Health Care

I have been blogging about the path to a health reform deal that I offer in my book: universal catastrophic coverage implemented via Medicare. Martin Feldstein, chair of the Council of Economic Advisors under President Reagan, offered a universal catastrophic coverage proposal in October, 2009, that would:

  • provide tax credits to purchase a catastrophic private health insurance policy, with catastrophic defined as costs above 15% of income (financed by ending the tax exclusion of employer paid insurance; people could purchase additional coverage with after tax dollars)
  • issue each person/family a “health care credit card” that could be used to purchase care in the deductible amount

A few quick comments about Prof. Feldstein’s proposal and how it compares to mine.

  • Defining catastrophic as a percentage of income makes conceptual sense, but introduces some technical challenges. All of the issues related to timing, what happens if your income changes, and perverse incentives related to loss of subsidy if your income increases that have been raised with respect to the income-based subsidies in the ACA apply to Prof. Feldstein’s proposal as well (and to just about any public policy that provides a differential government expenditure/subsidy based on income).
  • Prof. Feldstein’s proposal provides a guaranteed means of financing needed care if someone makes a bad choice in choosing catastrophic coverage only, while mine does not. A huge concern under my proposal is what will persons who choose to only have catastrophic insurance, but who get sick, actually do? Will some avoid the care they need? If so, this will likely increase the catastrophic costs that Medicare will incur down the road if they spend through the catastrophic coverage amount.

Read the rest of this entry »

Posted: Friday, May 18th, 2012 at 10:42 am
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2 Comments »

May 17th, 2012

More on High Deductible Health Plans and the ACA

by Don Taylor
Category: Affordable Care Act, Health Care

Yesterday I speculated about what form a health reform deal between Progressives and Conservatives might look take (Universal catastrophic coverage implemented via Medicare).

Like many of the complaints about the ACA, the idea that everyone is forced to purchase the same plan is untrue–it does not mandate a one size fits all policy. Below are actuarial estimates produced by 3 insurance companies commissioned by Kaiser Family Foundation of what various insurance options to be sold in ACA exchanges would look like.

Read the rest of this entry »

Posted: Thursday, May 17th, 2012 at 7:19 am
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33 Comments »

May 17th, 2012

Many Problem Drinkers are not Alcoholic

by Keith Humphreys
Category: Health and Medicine, Health Care

Ian Urbina of NY Times kicked off a big debate about addiction with his piece on how changes in the Diagnostic and Statistical Manual of Mental Disorders will affect diagnostic prevalence rates. The new diagnostic criteria aren’t yet finished, and I am not privy to the committee’s discussions. I can however correct one prevalent misunderstanding about how diagnostic criteria are used in the alcohol field.

A number of media stories have claimed that if diagnostic criteria are widened, everyone who drinks in an unhealthy fashion will be labelled an alcoholic. This is no more true that saying that if oncologists start diagnosing polyps then everyone who has one will be diagnosed with Stage IV cancer.

Many people who drink in an unhealthy fashion are not and will never be alcoholics. Recognizing this reality has no effect on the number of people who are diagnosed with alcoholism. In medicine, the typical term uses to describe unhealthy alcohol use isn’t alcoholism but — wait for it — unhealthy alcohol use.

All “unhealthy” means in this case is that there is a significant statistical relationship between the amount and/or frequency of the person’s drinking and some bad outcome, e.g., automobile accidents. Most people who drink in an unhealthy fashion aren’t aware that they are incurring some risk. The main intervention for unhealthy users is simple information and advice e.g., “You may not be aware that you drink more than 80% of the population and as a result have a higher risk of injuries, problems at work, and family problems than you would if you drank less. You might therefore want to consider drinking less”.

My colleague John Cunningham has shown that such information and advice processes can be done on-line by problem drinkers in the privacy of their homes. Given solid information, quite a few cut back to a healthier level of drinking. It’s just not that simple with alcoholics, who typically need more involved intervention in order to change.

I don’t know what term the diagnostic criteria committee will ultimately use for the non-alcoholic segment of the problem drinking population. They might call them problem drinkers, unhealthy alcohol users, people with mild alcohol use disorders or the like. But the new diagnostic system will not call them alcoholics; the people who are writing the criteria are too knowledgeable to confuse two such different populations.

Posted: Thursday, May 17th, 2012 at 1:20 am
8 Comments »

May 16th, 2012

What Would a Health Reform Deal Look Like?

by Don Taylor
Category: Affordable Care Act, Campaign 2012, Health and Medicine, Health Care

A central claim of my book Balancing the Budget is a Progressive Priority is that slowing the rate of health care cost inflation is a necessary, but not a sufficient condition to our ever achieving a sustainable budget down the road (it will also take a tax increase). Further, it will be virtually impossible to take the very hard steps to address health care cost inflation without both political parties coming up with a set of health care reform strategies that we will actually try, and which make both sides responsible for seeing to the hard work this will take. Health reform is far more difficult than Social Security reform (in a technical sense), for example, because mailing checks is much easier than purchasing health care. We will never be done with health reform and there will be many mid course corrections.

Even though we don’t know what all the steps will be, we desperately need to take some initial ones, and we will soon know what the Supreme Court will say about the ACA. This will be a landmark decision that will have profound political and policy consequences, but in one sense, regardless of what the Supremes say, the next step is to identify a bipartisan way forward on health reform (stop laughing; we have to do it).

Central to my book is a set of health reform policies that I claim represent the type of deal that would emerge if the two sides actually negotiated with one another. For such a deal to emerge, it would take both sides being clear about what their primary interest was in health policy. For Progressives, universal coverage has always been the holy grail and dream deferred, not just of health policy, but really of all social policy. As I noted in this debate with Jim Capretta, I don’t think Conservatives have an interest that is so clear and heartfelt as universal coverage is for Progressives, but if I had to take a stab, I would claim that it is their belief that people don’t have enough “skin in the game.” As an aside, this makes little sense to me, and when I look at empirical data on cost sharing with my more conservative friends, we see different things. In a similar way, when I say that I think the lack of a predictable, universal health insurance coverage scheme is an existential mark against our nation, they don’t get my degree of feeling.

Accepting such differences is an important step, because reaching a deal will mean abiding with one other to reach a compromise.

Read the rest of this entry »

Posted: Wednesday, May 16th, 2012 at 1:28 pm
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49 Comments »

May 15th, 2012

The Laxative Free Virtual Colonoscopy

by Matthew E. Kahn
Category: Uncategorized

The LA Times  reports on a new strategy that should encourage more people to get screened but may further increase our expenditure on health care.

Posted: Tuesday, May 15th, 2012 at 9:29 pm
12 Comments »

May 15th, 2012

This Island of England Breeds Very Valiant Creatures

by Keith Humphreys
Category: Britain

I have gone through a spate of watching British movies that show the country in the 1940s and 1950s (e.g., The Long Arm and Green for Danger). And also, as I always like to do, I have been spending hours over tea listening to friends in their 70s, 80s and 90s tell me about their experiences growing up here.

I was walking through Victoria Station today and it occurred to me how stunning it would be to a Londoner of 75 years ago. The quality of the construction, the cleanliness of the air, the computerized everything, the big screen television, the abundance of affordable food and drink. In material terms, it would be unimaginable luxury.

Here’s a photo taken not far from the one above, but in 1940: Read the rest of this entry »

Posted: Tuesday, May 15th, 2012 at 7:46 am
22 Comments »

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