An Ounce of Prevention

...is expensive, says CBO:

the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.

Coverage of the issue here and here.

Close, but no cigar

Click here to read my column in tomorrow's NY Times.

British healthcare is great

...as long as you walk on four legs:

In the last few years, I have had the opportunity to compare the human and veterinary health services of Great Britain, and on the whole it is better to be a dog.

As a British dog, you get to choose (through an intermediary, I admit) your veterinarian. If you don’t like him, you can pick up your leash and go elsewhere, that very day if necessary. Any vet will see you straight away, there is no delay in such investigations as you may need, and treatment is immediate. There are no waiting lists for dogs, no operations postponed because something more important has come up, no appalling stories of dogs being made to wait for years because other dogs—or hamsters—come first.

The conditions in which you receive your treatment are much more pleasant than British humans have to endure. For one thing, there is no bureaucracy to be negotiated with the skill of a white-water canoeist; above all, the atmosphere is different. There is no tension, no feeling that one more patient will bring the whole system to the point of collapse, and all the staff go off with nervous breakdowns. In the waiting rooms, a perfect calm reigns; the patients’ relatives are not on the verge of hysteria, and do not suspect that the system is cheating their loved one, for economic reasons, of the treatment which he needs. The relatives are united by their concern for the welfare of each other’s loved one. They are not terrified that someone is getting more out of the system than they.

The latter is the fear that also haunts Americans, at least those Americans who think of justice as equality in actual, tangible benefits. That is the ideological driving force of health-care reform in America. Without manifest and undeniable inequalities, the whole question would generate no passion, only dull technical proposals and counterproposals, reported sporadically on the inside pages of newspapers. I have never seen an article on the way veterinary services are arranged in Britain: it is simply not a question.

Nevertheless, there is one drawback to the superior care British dogs receive by comparison with that of British humans: they have to pay for it, there and then. By contrast, British humans receive health care that is free at the point of delivery.

Continue reading here.

The Recession in Nantucket

I am vacationing now with my family on Nantucket, the 17th year we've been coming out to this beautiful island. The economy here reflects what is going on in the rest of the nation:

New construction averaged over 200 houses per year until the slowdown started in 2006, providing a high level of income and steady year-round employment in the construction trades.... In 2007 the annual rate was slower than in recent years, at 127. The construction slowdown continued in 2008, with just 64 new homes, the lowest number since building permits were first required in 1972. Thus far in 2009 the rate is less than half that of last year, with 12 permits issued through June.

Free Market Healthcare Reform

Jeffrey Flier, pictured here, is now dean of Harvard Medical School. Little did I know, until recently, that he is also a thoughtful writer about health economics. Here is an amazingly prescient article of his from 1994, in which Dean Flier anticipates many of the key issues people are still debating today. (It is a slow-loading pdf, but be patient; it is well worth the wait.)

Career Advice

I agree with Hal:

“I keep saying that the sexy job in the next 10 years will be statisticians,” said Hal Varian, chief economist at Google. “And I’m not kidding.”

The Envelope, Please

Here is a piece of news I am sure you all have been waiting for: the latest winners of the Australian Awards for Excellence in Educational Publishing.

Congratulations to Joshua Gans, Stephen King, and Robin Stonecash for winning the Tertiary (Adaptation) Teaching and Learning Category for for the Australian adaptation of my Principles book.