Friday, February 22, 2008

Equity in health care: how far?

Yesterday's NY Times published an article about access to cancer-treating drugs in Britain's National Health Service (NHS) that really lays bare the challenges faced by public health insurance systems. The article tells of Brits with cancer who are denied access to certain pharmaceutical treatments by the NHS because they are too expensive.

But it doesn't stop there. The NHS funds a set level of care for all Brits, although effective standards can vary by region based on waiting times, etc. The article described how the NHS threatened to withhold payment for any other treatment if the patient purchased the drug of her choice on the open market.

Why? The argument is that the NHS functions by providing equal care to all, period. Apparently that means choosing a particular cost structure for the average Brit and sticking with it --- even though benefits and the valuation of those benefits could vary across individuals, as do income, wealth, and education. It is the latter point that presumably riles up the NHS; folks with more money or knowledge may demand more health care.

Tuesday, February 19, 2008

Trends in suicide?

U.S. vital statistics have measured suicide and all the other causes of death for quite some time. But physicians are always becoming better at categorizing causes of death, so the classification system is updated every decade or so.

As reported by the Times, data collected using the current ICD-10 system reveal an increase in suicide rates for most age groups under 65 between 1999, the first year of ICD-10 collection, and 2004. Rates among adults 45-54 rose by 20%, from 0.000139 to 0.000166.

Temporal fluctuations in mortality are certainly interesting; there is evidence that many causes of death are more prevalent during economic expansions, for example. Suicide, on the other hand, typically falls during expansions and rises during recessions. This is discussed in a 2005 article by Jose Tapia. Seen in this light, a rise in suicide between 1999 and 2004, two years of relative prosperity, is a little odd.

One wonders whether physicians need time to learn a new cause-of-death coding system.

Monday, February 18, 2008

Idle youths

Yesterday the Times reported on "Islamic fervor" among Egypt's young, who comprise a significantly larger share of Egypt's population than say, American youth. The story is that unemployment and deprivation seem to be linked with a rise in fundamentalist belief.

The article led off with an anecdote about a young man who couldn't raise the funds required by the families for him to marry. For me, this perspective echoes back to Richard Easterlin's relative-income hypothesis of the late 1970s, although whether it is lower income truly in a relative sense that is creating anomie, or just lower income in an absolute sense, is unclear.

What is causing what is, as usual, completely unclear. Many countries that are majority Islamic are also developing countries, with high fertility rates and family sizes. But there are vast differences in unemployment and per capita income, with the Gulf states typically being better off for a variety of reasons.

In the extreme case, of religious fervor resulting in violence or terrorism, Alan Krueger and others have found few links to economic deprivation. I think the story there is more one of political deprivation.

Friday, February 15, 2008

Educational attainment, growth, and demographic change

David Brooks wrote in his column today that

"The percentage of young Americans completing college has been stagnant for a generation. As well-educated boomers retire over the next decades, the quality of the American work force is likely to decline."

I do not think either statement is true. According to data from the Current Population Survey, the percentage of workers aged 25-34 with a college degree has risen from about 24% in the late 1970s to about 30% today. The data do reveal plateaus between about 1975 and 1995 and perhaps another one since 2000, but much intergenerational progress.

Meanwhile, about 30% of workers currently aged 55-64 have college degrees. While the boomers certainly were better educated on average than their predecessors, there is little evidence to support the idea they are any better educated than younger cohorts. Their looming retirement will be challenging, but not because of any impending decline in the average quality of the labor force.

Confidence and credit, 1930-style

Paul Krugman compares the current crisis in lending spurred by the crumbling subprime real estate market to what happened during the Great Depression, minus the photogenic lines of people trying to withdraw their cash from banks.

As he implied, the good news is that this time, the Federal Reserve is actively trying to keep credit from drying up, rather than wring the bad loans out of the system. In 1930 and 31, the big mistake was allowing the entire banking system to pay for the mistakes of a few.

Thursday, February 14, 2008

Bush signs fiscal stimulus package

The fiscal stimulus package, which will send you $600 in the mail by May, is officially signed sealed, and delivered. Now the big question is: what will you do with it? Pay off your credit card? Or buy a couple of iPhones?

Monday, February 11, 2008

Immigration and population change

As reported today by the Times, Jeff Passel and D'Vera Cohn wrote a report for the Pew Research Center that revealed a large role for immigration in U.S. population growth to 2050.

The direct effect of immigration on population growth is not particularly large; the flow of new immigrants into the U.S. every year accounts for perhaps one-third of the 1% annual rate of population growth. But new immigrants typically arrive young, with families, and their families tend to be larger than those of the native-born (i.e., immigrants' fertility rates are higher). So Passel and Cohn project immigration will account for 82 percent of the net increase in living U.S. residents, or about 117 million of the 143 million new people we will have by 2050.

This certainly adds perspective. The report also discusses trends in the "dependency" or support ratio --- the number of non-workers per worker. Immigration typically reduces it, meaning that immigrants help pay for Social Security and for kids' education. But the effects of immigration do not appear to be large relative to those of the retirement of the Baby Boom.

Great advice for grad students

I knew Darren Lubotsky when he was a graduate student at UC Berkeley. He has written a very useful, if a little dense, 4-page work on how to be a good graduate student. All of us "wish we'd thought of that" when we were graduate students!