Linky Friday #35
Housing:
[H1] Enterprising folks are working on replacing the FEMA trailers with nicer amenities. I am all about cheap housing, so I wonder about the non-FEMA applications.
[H2] Step one, get people to move into cities. Step two, turn out the lights?
Money:
[M1] A stripper’s guide to North Dakota. In some ways, the perspective sounds positively Republican.
[M2] According to the WSJ ($), young rebels become entrepreneurs.
[M3] Dave Schuler, and Howard Dean, are skeptical of claims of easy cost savings. Without an overhaul, anyway.
Education:
[Ed1] Data systems may be able to predict who will drop out of the school… by looking at them in the first grade.
[Ed2] Private education in Britain is becoming more egalitarian.
Entertainment & Technology:
[ET1] It’s been discussed recently at Not a Potted Plant, but here’s a rundown of why ebooks are so expensive. I would argue that while ebooks may cost as much as regular published books, I am less sure that they have to. That they are working towards a particular price point does not actually mean that the price point is unavoidable. (I’d also add it’s funny to hear about how production and distribution costs aren’t actually all that much, after hearing for years and years about how the rising cost of paper was responsible for the rise in prices of comic books.)
[ET2] Copyright protections may be killing art. Honestly, I doubt this is a case where correlation equals causation. But the ostensible reason we have copyright law does not appear to be panning out.
[ET3] How BitTorrent downloads so fast. It’s truly amazing how much faster BT is at downloading free software than are dedicated servers.
Learning:
[L1] Walter Hickey thinks pie charts are useless. I was prepared to disagree because there are narrow circumstances in which a pie chart is better than the alternatives, but he addresses that. He spends a lot of time pointing out to examples where pie charts are particularly opaque to make his case.
[L2] Those unimaginative, killjoy left-brainers are arguing that there’s no such thing as left-brainers (and right-brainers).
[L3] It will be a sad day when redheads are no more, if this comes to fruition.
[L4] I might be more comfortable with premarital cohabitation if we could more easily nail down what level of commitment it implies. But we haven’t.
Energy:
[En1] Oil, oil everywhere, but not a drop of water to drink. Also, a look at the US groundwater supply, in map form.
[En2] This seems so intuitively incorrect: iPhones use more energy than some refrigerators. If true, another indication that if global warming is as real and as bad as they say, we’re doomed.
[En3] BusinessWeek has a piece on the dire state of nuclear power in this country. Which some will celebrate, because even though global warming threatens imminent ecological catastrophe, we can’t have nuclear power because something bad might happen. Which isn’t to say, of course, that bad things don’t happen. Albeit not on the apocalyptic scale.
[En4] But if the economics can’t support nuclear, the economics can’t support it. There’s always coal. According to the EIA, by 2040 nuclear will only be supplying 7% of our energy. Renewables? 15%! Yay.
America:
[A1] Connecticut should have a strong economy. Why doesn’t it?
[A2] In Green Bank, West Virginia, you can’t use wireless signals. Which is a draw for some.
[A3] The sad story of the fall of Tommy Morrison, who died last week.
Reader-Generated:
[RG1] From Greginak: I thought this! was interesting. I relates back to the discussions of inequality and my suggestion our rates of ineq. relate to the rules being written to favor the rich and the increasing dominance of the financial sector in our economy. Anyway its an interesting link. I would think lots conservatives and some libertarians would dislike it as much as many liberals although the solutions would differ.
Shouldn’t a strippers’ guide to North Dakota be a map to Vegas?Report
North Dakota is probably more lucrative territory right now, actually.Report
Sure, it’s summertime.Report
This is the joy of the tech boom. Lotta IT workers with the attendant gender disparity, lotta oil workers with the attendant gender disparity, lotta IT money and lotta oil money going into a lotta genderly disparate pockets.Report
IT workers?Report
That’s some of the buzz going on here. If you can handle the move, there are IT jobs at all of those oil companies out there.Report
Interesting! I am always keeping an eye out for “If something happens to Clancy” opportunities. I’d specifically been wondering if there were IT positions in some of those boomtowns.Report
I remember a story a year or two ago about how North Dakota and Montana were desperate for strippers, and how much money the strippers who were there were making. Better than Vegas for sure.Report
Considering what fast food workers are allegedly making, it makes sense to me.Report
M3- I’m not at all sure Dean is correct that rate setting has always failed. In fact i think rate setting works pretty well in many countries. (Insert generic complaint that other countries data is of no use to us.) I don’t think anybody disagrees we could use all sorts of other changes but that is a separate point and certainly impossible with the current state of HC debate.
EN3- yup, definitely unfortunate.
I thought this! was interesting. I relates back to the discussions of inequality and my suggestion our rates of ineq. relate to the rules being written to favor the rich and the increasing dominance of the financial sector in our economy. Anyway its an interesting link. I would think lots conservatives and some libertarians would dislike it as much as many liberals although the solutions would differ.Report
[M3] I think rate-setting abroad has been successful. I am one of those prone to say “We shouldn’t look at the experiences of Country X and assume they’re replicable here”… but in this case, we already have a track record trying and failing. I think Dean stands on pretty firm ground.
The issue here is that, more generally, fee-for-service has been considered to be a disaster in this country (the administration has talked a lot about it in this context). To tie it back to international comparisons, fee-for-service is what a lot of countries do. If we didn’t do FFS, we could look at Canada and say “See? Of course fee-for-service would work in the US!”
[RG1] I agree. It’s not unlike how it’s usually libertarians and conservatives who say things like “Don’t just work for your money, make your money work for you!” … which is, to my mind, one of the most damning statements of capitalism around.Report
En1: Way back in Nine Nations of North America, Joel Garreau correctly pointed out that for the vast majority of the US from the Great Plains west, there were three things people wanted to do with water — wilderness, agriculture, and industry (broadly defined) — but only enough water to do one, or at most two, of the three. Still true today.Report
I’m not sure about Texas, but I used to argue on another site that the water Alberta uses to extract its oil is more valuable than the oil. It’s really unaccounted expense like when little one doesn’t have to factor in the cost of me buying the lemons for her summer lemonade stand.
I suppose every region has their problems. I’ve got a bunch of 12 gauge shells packed with rock salt. Have to clear out some of the larger slugs hiding behind the garage.Report
It’s interesting just how far-ranging the one or two of three applies in unexpected places in the US West. It’s fun to look at the Willamette Valley, which most people figure is really wet. Portland is drier in the critical July/August period than Denver or Phoenix (no NA monsoon in Portland), and land with existing irrigation rights there is considerably more valuable than land without. And of course, there’s that whole thing about how damming the Columbia (for industrial purposes, defined to include both industries like aluminum smelting as well as large urban areas in general) has affected the salmon runs, one of the preeminent aspects of wilderness in the area.Report
@michael-cain You’re absolutely right. Cascadia has conflicting interests in power/nature. There are areas where water is at a premium. Even in BC you’ll find dwindling supplies of water for the burgeoning vineyards in the Okanogan valley. We are protective of our salmon runs. Even though it rains 360 days a year here, we are still aware of the limits of our water supply limits. You will find very few people that are interested in selling this resource.Report
I wish the Guardian’s video came with a better explanation of what the graphics mean, but it’s enough to get the idea.
Water is what the future will be all about — although it may not be as overt as fighting a war for water, water and not food or oil will be what finally imposes limits on population growth and urban sprawl. And California’s economic comeback this year is in large measure the result of a relatively wet winter. If the 2013-2014 winter is dry, we’ll have harder times next summer.Report
@burt-likko The graphics weren’t detailed enough. Watching the changing colours through the video I just kept saying, “yup, el nino year, la nina year, been going on forever.”Report
Oh, NOAA is predicting ENSO neutral this winter.Report
If we have the energy, we’ll have the water. Well, most of the country will.
I think it was Patrick who pointed out that if we simply stopped using our water stupidly (lawn care, farming where farming shouldn’t be, etc.) we would have a lot more of it than we think about now.
Much of the Mountain West could be in trouble, though, if droughts get bad enough. It’s expensive to pipe desalinated water uphill.Report
@will-truman I think the only hope is that boomers die off and aren’t replaced. I would think that Colorado would be able to squeak by but I have no idea how the Phoenix SW Sunbelt is going to be able to maintain their populations. I read that for the first time the Colorado flow to the southern states will be cut back. Recycling will help in the short term. I’m not sure how sustainable it is. Palm Springs solved their problem many years ago, seeing the future, by building water bunkers to store water that used to shut the city down with flooding.Report
From what Michael Cain says, Colorado should be fine. It’s the downriver states that might have a tougher time of it. Many of the states may be looking at depopulation or just a stagnant population while people settle on the coast.
Whether it’s a good thing or a bad thing that we’re going to have trouble replacing the boomers is a contentious credit. I’m working my way through No One’s Expecting again, and will have a post or two on the book soon.Report
@will-truman I don’t think anyone here has an old school family of six but we do seem to be breeding.Report
Right now we’re hovering around replacement rate. There’s more reason to believe it will go down rather than up (the current plateau notwithstanding).Report
http://naturalresourcereport.com/2013/09/california-drought-worsens/
I didn’t realize Cal had such a bad water year last year. Things could get grim.Report
Right now we’re hovering around replacement rate. There’s more reason to believe it will go down rather than up (the current plateau notwithstanding).
that’s common perception but i think its wrong becuase
A, cohort fertility rates have been raising
B,using the Bongaarts-Feeney method, the tempo adjusted TFR has been close to 2.3 since the year 2000.
C, according to the GSS there has been significant increase in ideal number of children among young people, <a href='http://postimg.org/image/tofkiv5w7/'<here's the ideal number of children among 20-26 from 1972-2012Report
here’s the chart i was trying to link to showing the ideal number of children among 20-26 year olds from 1972-2012
http://postimg.org/image/tofkiv5w7/Report
Dand, it’s going to take a markedly large rise in fertility rates to compensate for the plummeting fertility rates of Americanization. Which is to say, our current fertility rates is propped up in large part by immigrants*. Except that their children tend towards less remarkably fertility rates.
Higher ideal fertility rates are good (if you’re concerned about this), though one of the problems (if you think it’s a problem) has been the gap between desired fertility and actual fertility. Further, a lot of the things that depress fertility (urbanization, lower marriage rates, cost of raising living, cost of raising children) are either climbing or remain high.
Which isn’t to say that you’re wrong. You might be right. But there is a lot to be concerned about, if you are concerned about such things.
* – That said, our native fertility rates are actually reasonably high for a developed country. Just not at replacement level.Report
Dand, it’s going to take a markedly large rise in fertility rates to compensate for the plummeting fertility rates of Americanization. Which is to say, our current fertility rates is propped up in large part by immigrants*. Except that their children tend towards less remarkably fertility rates.
The high immigrant period TFR is mostly due to a statistical anomaly in the way TFR is calculated. This is one of the reasons why period TFR is flawed measure; another reason is that it’s subject to tempo distortions giving a rate lower than the actual fertility rate. Cohort fertility rate is an accurate measure however the problem with it is that it can’t be calculated until after the fact. The cohort fertility rate for immigrants while still higher than for the native born is much closer to the native born rate. The projected cohort fertility rate for women born in 1975 is 2.25 and there is no way that the rate for immigrants is the only reason it’s above replacement.
Higher ideal fertility rates are good (if you’re concerned about this), though one of the problems (if you think it’s a problem) has been the gap between desired fertility and actual fertility.
The gap between ideal and realized fertility is mostly the result of the fact that it is socially unacceptable to give an answer of less than 2 ideal children,
Here is what people born between 1950 and 1959 said was their ideal number of children when asked between the ages of 20 and 26:
<img src='http://s17.postimg.org/civb6kjwv/chldidel19501959.png'
here is the number of children that same cohort said they had after the age of 45:
<img src='http://s14.postimg.org/npjm5itep/childs1950_1959.png'
The vast majority of the failure the realize ideal fertility comes from the fact that people are unwilling to say anything less than 2, the number of people who said they wanted more than 3 children was very close to the number that ended up with more than 3 children.
Here is the ideal number of children for people born in 1985 or later when asked between 20-26:
<img src='http://s17.postimg.org/n788ww8nj/chldidel1985.png'
notice how many more say a family size of 3 or more is ideal.
Which isn’t to say that you’re wrong. You might be right. But there is a lot to be concerned about, if you are concerned about such things.
Since you care about this issue I recommend reading The Twilight of Parenthood by Enid Charles, the book makes many of arguments that are being made by people concerned about low fertility rates today. It’s available used from Amazon for under $20.
Alternatively here’s a paper summarizing what people were thinking about fertility rates between 1925 and 1950. This isn’t directed at you but I wish the people currently making noise about low fertility rates would acknowledge the fertility panic that occurred across the developed world in the 30s and 40s.Report
here’s the paper i was attempting to link to at the end of my post, would it be possible for whoever is moderating replies to edit the link? http://iussp2009.princeton.edu/papers/90388Report
sorry for the multiple posts but i forgot to link to this paper explaining what tempo distortions are;
http://www.oeaw.ac.at/vid/download/pce/dec01/am/PCB05-Bongaarts.pdfReport
The fact that the TFR distorts the immigrant birth rate is actually an example of our birth rates not being as healthy as they appear. It’s not clear to me that the tempo effect will compensate for it.
The concerns about fertility prior to the baby boom were not illegitimate. As it happened, though, the Baby Boom came along and it ceased to be a concern for a while. The Baby Boom is an aberration, though. There hasn’t been an ebb and flow in fertility. It has, with that one exception, trended ever-downward. And that bend arguably prolonged the slide, rather than structurally disrupting it.
We could be in the exact same situation now as we were then, with delayed fertility rather than foregone fertility. But there are reasons to believe that this isn’t the case. For example, it’s not clear to me that we’re dealing with a transition from young motherhood to older motherhood. The delay of motherhood has already been in place for some time. You can get some shifting around due to situation-specifics (like the current economy), but that will only take us so far.
Pushing in the direction of continued lower fertility are the things I mentioned. The markers of lower fertility are, for the most part, ascendant. Irreligiosity, urban living, increased education for women, increased cost of living and raising children, and so on.
There are some things pushing in the other direction, of course. States with higher fertility rates are gaining people (which is important because states with higher fertility rates have economic and social environments that promote families and larger families). Last is concerned that high-fertility rates may start replicating their low-fertility brethren. He has credible reasons for his concern, but honestly I don’t see that that happening because those states are going to lack the economic factors for the foreseeable future.
I don’t think you’re right about the ideal fertility skew. But if you look at expected fertility, the results are interesting. Expected fertility and actual fertility rates are about the same. However, that’s a statistical oddity that fails to take into account the group of people having more children than they intend. Those that don’t have children by 24 are significantly likely to miss their expected/desired fertility mark.
It’s here, perhaps, where I am biased. I am at the age where my peers that want children don’t already have them (and aren’t on the road to) are likely not going to. That applies to a distressingly large number of them. And my wife and I have already downsized our early goal by one. So the gap between ideal fertility, expected fertility, and actual fertility resonated with me.
Thanks for the recommendation. As mentioned, I am reading No One’s Expecting. Which will probably exhaust me on the topic for a while.Report
The fact that the TFR distorts the immigrant birth rate is actually an example of our birth rates not being as healthy as they appear. It’s not clear to me that the tempo effect will compensate for it.
Cohort fertility rates which aren’t subject to distortions indicate that fertility rates are above replacement level for women born between 1965 and at least 1975. The tempo effects have already made up for a large portion of the sub replacement fertility, white period TFR bottomed out at 1.76 the lowest cohort fertility rate was 1.98.
The concerns about fertility prior to the baby boom were not illegitimate. As it happened, though, the Baby Boom came along and it ceased to be a concern for a while. The Baby Boom is an aberration, though. There hasn’t been an ebb and flow in fertility. It has, with that one exception, trended ever-downward. And that bend arguably prolonged the slide, rather than structurally disrupting it.
It hasn’t been ever downward
1) The cohort fertility rate has steadily raisin for cohorts born after the mid 50s.
2) The cohort fertility rates for women born in the 50s were higher than those for women born between 1900-1910 once child mortality is accounted for.
We could be in the exact same situation now as we were then, with delayed fertility rather than foregone fertility. But there are reasons to believe that this isn’t the case. For example, it’s not clear to me that we’re dealing with a transition from young motherhood to older motherhood. The delay of motherhood has already been in place for some time. You can get some shifting around due to situation-specifics (like the current economy), but that will only take us so far.
Between 2003-2007 the mean age at first birth showed signs that it was plateauing, during this time period TFR was also above replacement. Since 2008 virtually the entire decline in birth rates has occurred among women under 30 with the decline under 25 especially strong this indicates postponement, if remains to be seen if it also leads to a reduction in family size.
In theory there is still plenty of room for further postponement, the US mean age at first birth is still several years younger than other developed nations; this includes nations with similar fertility rates like France and Sweden as well as countries like Ireland and New Zealand that have high fertility rates. Having said that I don’t see the mean age first birth raising much once the economy improves in the European parts of the US it’s already at rates similar to Europe and I don’t see places like Texas and Utah adopting European like patterns.
Pushing in the direction of continued lower fertility are the things I mentioned. The markers of lower fertility are, for the most part, ascendant. Irreligiosity, urban living, increased education for women, increased cost of living and raising children, and so on.
Those things have been going on for year yet fertility rates for women born in the 70s are higher than rates for women born in the 50s.
There are some things pushing in the other direction, of course. States with higher fertility rates are gaining people (which is important because states with higher fertility rates have economic and social environments that promote families and larger families).
One thing to keep in mind is that gaining people will cause a state’s TFR to raise, on average people will start families after they move rather than before. The reverse is also true bucking all stereotypes West Virginia has one of the lowest TFRs in the country in large part because people leave West Virginia before they start their families.
The utility of TFR for subnational subdivisions is not particularly strong.
Last is concerned that high-fertility rates may start replicating their low-fertility brethren. He has credible reasons for his concern, but honestly I don’t see that that happening because those states are going to lack the economic factors for the foreseeable future.
There are a number of things that are behind the difference in TFRs between states, I already mentioned migration patterns another is differences in Tempo distortions; in Massachusetts the average age at first birth was 5.2 years higher in 2006 than it was in 1970 while in Utah the difference was 2.5 years this means that the tempo distortions in Massachusetts are much stronger than in Utah. This is part of the reason for the lower birth rate. In Hawaii the average age at first birth in 1970 was unusually high and as a result the change has been smaller and the TFR higher than other states.
However, that’s a statistical oddity that fails to take into account the group of people having more children than they intend. Those that don’t have children by 24 are significantly likely to miss their expected/desired fertility mark.
I wasn’t claiming that everyone has the number of children they were planning on just that those who have more and those who have less cancel each other out. I also think the increase in ideal family size is not something that should be ignored.
It’s here, perhaps, where I am biased. I am at the age where my peers that want children don’t already have them (and aren’t on the road to) are likely not going to. That applies to a distressingly large number of them. And my wife and I have already downsized our early goal by one. So the gap between ideal fertility, expected fertility, and actual fertility resonated with me.
Based on what I assume your age to be it seems your peer group are outliers among your cohort. According the CDC cohort fertility tables women born in the 70s have noticeably more children than women born in the 50s or 60s did. (See table 2 and table 2 update for the details).Report
This is pretty awesome, Dand. Thanks for the data and narrative. It’s given me a lot to consider and you’ve likely already changed the post I was going to write on this.
Out of curiosity, what is your background in this?Report
This is pretty awesome, Dand. Thanks for the data and narrative. It’s given me a lot to consider and you’ve likely already changed the post I was going to write on this.
Out of curiosity, what is your background in this?
I’d been hearing about the problem of low fertility rates off and on for years, a year and a half ago I had a professor go on and on about fertility rates and I finally decided to research the issue myself and determined that it wasn’t a problem in the United States (it is arguably a problem in parts Europe and the developed parts of Asia).
While this doesn’t apply to you, many of the Americans who complain about fertility rates seem to have a problem with either non-traditional roles for women or relative decline in the non-Hispanic white population in the US. In Europe there is concern from across the political spectrum.Report
…but I have no idea how the Phoenix SW Sunbelt is going to be able to maintain their populations.
Even in the states in the Lower Colorado Basin, the very large majority of the diversions from the river go into single-pass agricultural use (ie, pour the water on the land and let almost all of it evaporate, directly or through plant transpiration, with no recycling possible). The more-or-less obvious answer to the problem of city water shortfalls in Arizona will be that the cities, with large voting majorities and much larger economies, will change the rules and price the farmers out business. Or at least some of the farmers. IIRC, about half of the agricultural diversions in the lower states are used to grow feed for livestock.Report
M3: Until we see actual price tags on medicine, reform is pointless. Basically, the current cost scheme goes like a high-end jeweller: if you have to ask how much that diamond costs, you can’t afford it anyway.
The one aspect of medicine featuring actual menus and price tags are procedures insurance won’t cover.Report
I may have a post on that next week, actually. It’s written, just not sure if I’m going to post it.Report
Our Libertarian friends have a point which cannot be gainsaid: until there’s a market at work, until buyer meets seller on the open floor of what they call a Free Market (and I would call a Well-Regulated Market), until producer and consumer are having the discussion, without some overweening middleman/regulator/market distorter, we can’t hope for Gummint to save us.
Price disparities between various hospitals for the same damned procedure. Even the most trivial stuff, completely price-opaque. The one thing the Gummint can do, ought to do, is to expose the true prices of health care to the salutary effects of competition.Report
Many, many years ago my suggestion for health care was that we’d gotten into the same boat the British did regarding car maintenance. A very large number of British don’t own their own cars, their company does (it’s a usual employment perk like health care is here). As a result they have the highest maintenance costs in the world, because they just take it in, the mechanic does a bunch of extra stuff and charges a ton, and the bill goes to the driver’s employer, who writes it off as a business expense. Mechanics don’t even like bothering with private car owners because they question everything and dicker over the bill.
Second, as you point out, nobody has any idea what things cost here versus over there. If there was an iPhone Ap connecting into hospital billing computers so you could have Siri or PriceLine find you the cheapest procedure, there would be tremendous downward pressure on costs.
But my oddest, but perhaps best idea, was to address the common problem to both cars and health (fixing things is fixing things). The guy doing the diagnosis is the same guy who’s going to bill you for the repair, so he has a big incentive to over-diagnose.
It’s probably too complicated, but what if you had a market regime where you went to somebody for a diagnosis, and they make some money up front (flat fee), and then kind of “owned” a percentage of your malady? Their diagnosis then goes out for bid by “treaters”, who look at the diagnosis and offer to address it. If, during the treatment, they find the malady was under-diagnosed (they have to do more), the extra cost gets billed to the “diagnoser” who screwed up, up to some preset limit. The diagnoser can either eat the cost as a learning experience (an incentive to do better next time), or he can conclude that the particular treater is a greedy scam artist and drop him from future bidding, or he could perhaps sue him for medical overtreatment, or some such.
In car terms, this would be like getting a diagnosis, an estimate on repairs, and then actual service, while trying to split those functions apart in a way that creates an incentive regime that would tend to maximize accurate diagnoses, estimates, and efficient maintenance and repair procedures, by trying to take advantage of human nature. You might also add in some way where the patient can come out ahead in certain cases, or has some extra financial stake in play so their incentive works toward the most favorable outcome for the least cost.Report
@george-turner We’re not going to agree often but that was an interesting reply. I’m sure there’s real life problems bringing it to fruition but it makes a great deal of intuitive sense.Report
George, that was one of the things that PPACA tried to do, in a way. Basically, they try to prevent the doctor making the request for an expensive test from having an ownership (or financial) stake in the equipment that runs the test.Report
Interesting Will, and somewhat of a related idea.
My focus was not that the person could bill you for tests, and thus basically be in the business of testing people for everything and billing them for it, but a bit downstream of that, where the test results in some kind of medical intervention, or not.
A thought related to that is that testing, although we’ve succeeded in making it hideously expensive, will also become extremely cheap due to the nature of testing, which is merely applying technology and automation because a human can’t actually construct a 3-D image from X-ray slices (in their heads) or taste HIV antibodies. Over time, the actual “testing” becomes the function of a cheap do-hickey, or should. Of course you’ve got people supporting the patient interface side of the testing, but the testing itself becomes a thing in a black box.
So if testing got cheap enough, the actual testing could get paid for by a percentage of the treatment costs, making the tests all essentially free, except perhaps for paying the guy who interprets them, and his job might be crucially important to subsequent costs, because he’s what takes things from a set of data to a diagnosis, which leads to a recommended course of action. And of course we don’t want that person in a position from profiting from picking really, really expensive courses of action. Thus the idea of him being a “diagnoser”.
The accuracy of the estimates you might get on treatment costs will reflect the accuracy to which doctors can determine their treatment costs on any patient (with statistics, etc), and the accuracy to which they can correctly predict the required treatment based on the available diagnostic data. So we’d want accuracy at those steps to maximize their rewards (profit).
To try and bring market forces (competition) into play, we of course want quite a few such estimates, perhaps dozens, or even hundreds, from different doctors, clinics, and hospitals, and we want all those estimates based on the best, most detailed, and most accurate information available.
With high-bandwidth data, you could have each doctor stare at MRI charts and computer readouts, but then instead of one doctor looking at the data, you’ve got dozens, and that is increasing the amount of skilled labor and costs required.
Ideally, you’d really only want zero or one doctor to have to see that raw data (can’t get cheaper than “none”), so somehow “runny nose” or MRI and blood data needs to bounce itself off the dedicated computers in a whole bunch of doctors offices, in some form or another, instead of having to impinge on the eye-balls of dozens of different doctors.
That raises the problem of informational complexity, throwing the burden back to the original diagnoser to the findings in a form that could generate a meaningful, coherent, and plausible answer from the automatic servers in all those doctors offices, and that’s where there has to be a critical financial incentive for the diagnosis to trigger the right set of estimates, however quirky the estimating code might be.
Meanwhile, along with the estimates, schedules come back, where the servers are juggling time slots based on accepted bids. So to the user poking on their iPhone, it’s like hunting an airline flight. Prices, gates, and departure times.
Anyway, those are some rough notions from some stabs at the problem. It’s been many years since I’ve given it much thought. I do think that applying some fundamentals about human nature (as we did with the Constitution, separation of powers, etc), economics (how people really behave in making decisions), and a bit of out-of-the-box speculations can produce some useful insights into alternative methods and structures of care delivery.
It’s also kind of fun to look at the what-ifs and game the results. For example, suppose the diagnosis automatically dumped some certain amount of money in your “Palincare” account (accessible with your iPhone), and then you went and did your own doctor shopping? What if the Palincare was real cash, so you had an incentive to economize on it? What if a diagnostic doctor set up next to a liquor store and a strip club and promised everyone as many brain cancers as they wanted?
All sorts of possibilities, if you can just figure out better ways to better apply market forces and self-interest to the staggering complexity of injuries and illness.Report
@george-turner
An imperfect analogy, but if we want to hook into the local sewer system, we have to hire an engineer to draw up the plans and get approval. We then have to hire a separate contractor to actually execute them. We can shop around once we have the plans in place and get the best price. The engineer simply gets paid to draw up a good set of plans that will gain approval. They have no incentive to overdo it, especially since there is a check in place.
Something similar in the health care world would be interesting.Report
A backgrounder on health care cost disparities.Report
…until buyer meets seller on the open floor of what they call a Free Market (and I would call a Well-Regulated Market)
And of course, economists talk about competitive markets. Interesting that the first of the several assumptions that economists require for competitive markets to deliver their benefits is that buyers and sellers be price-takers — that no one has sufficient market power to get a better price than anyone else. Which is far from true for health services requiring hospitalization. Insurance companies have sufficient power to get a much better price than I can as an individual; typically, about one-third of the price the hospital would charge me.
In other developed economies that retain a role for private insurance companies for their universal coverage scheme, at least the ones that I’m familiar with, the insurers and providers negotiate a single price that applies to all the insurers and all the providers (eg, all hospitals where appendectomies are performed), with the government stepping in if they can’t come to terms. Or if the government feels the price is too high, which acts as an incentive for insurers and providers to act reasonably.Report
Do you have a source for that one third figure?Report
A1: Probate? Really? Hack article is hackish. (see also, the data points the author chose for city population)Report
Regarding EN2: This seems more like a testament to the engineering marvel that is a modern refrigerator. If I’m reading it correctly (i.e., unless they’re adding in more watts than just what the phone itself uses) then it means that refrigerators are so damn efficient you could run one off of a cell phone battery that you recharge once a day or so.
(And they’re so cheap that even poor people have them, which is why poor people aren’t really poor and all that…)Report
L2: What this story tells me is just how persistent the right-brain/left-brain myth is, because researchers debunked it a long time ago, but still feel they need to come up with more evidence so that people will finally be convinced.
L3: This is another story that surfaces every few years. I remember having a conversation with Razib about it maybe 6 years ago, and it was apparently something that had popped up several years before that as well. These redheads are takin’ their sweet ass time!Report
L3, yeah, this isn’t the first time I’ve read about this. I hadn’t heard about L2 before.Report
With L2, what basically happened is that researchers started to realize that a.) the forebrain, while it definitely has bilateral functional asymmetries, isn’t quite so different across the hemispheres as the myth implies, and b.) there was no clear evidence that people had a dominant hemisphere in the forebrain (we do, of course, have dominance in sensorimotor areas further back and down). The myth arose because of those real functional asymmetries, but there was never any actual science behind the idea of hemispheric dominance outside of handedness (and footedness, and just general dominance of one side of the body and the related neural differences that both cause and result from that). If you look up popular myths in psychology, it’s generally one of the first you’ll see listed.Report
The linked redhead extinction article is from 2007, but I too have heard the bit before then.Report
L3 – It’s an elementary fact of Mendellian genetics that the proportion of people carrying two copies of a recessive gene will be the same in subsequent generations as in previous generations outside of some selection pressure. I’m not sure how they get around that.
There’s also the question as to why it’s a problem.
Oh, and what about the Weasley’s?Report
Vikram, I don’t think anyone worries about Mendel’s genetics anymore. He died childless, so his genes are medically irrelevant except perhaps to obscure historians.
Thanks. I’ll be here all day.
Try the peas. I hear they’re excellent. 🙂Report
Oh, and ET1 is a really clear explanation.
As always, thank you for these links.Report
[En2] This seems so intuitively incorrect: iPhones use more energy than some refrigerators. If true, another indication that if global warming is as real and as bad as they say, we’re doomed.
The factoid is probably incorrect; the strongest case for the claim goes something like: iphones and data centers, using over a certain threshold amount of data per month (particularly on slower 2G and 3G networks), consume more energy than some (of the most efficient) refrigerators. First heard a challenge on NPR’s Marketplace program. MSN News similarly doesn’t find this claim very credible. One criticism is the claim overestimates the amount of energy a phone uses, though some underscore the point that data center energy usage is an important issue setting this particular iphone-fridge claim aside (MSN).
The paper at the center of the controversy The Cloud Begins with Coal: Big Data, Big Networks, Big Infrastructure, and Big Power (pdf) and rebuttal .Report
L1: This is the best pie chart in the world. I’ve had months of conversation that couldn’t communicate what this chart does. This wouldn’t be a good candidate for a pie chart, according to the article. And sure, it would drive you crazy if you looked at the same information over time and had to figure out changing slice sizes. And sure, it would be just as bad if it had all those tiny slices on it – although if it forced people to understand how tiny our foreign aid or education spending is, it might be worth the eye strain. But it does exactly what it sets out to do.Report
Wrong, this is the best pie chart in the world:
http://rajivbhardwaj.com/wp-content/uploads/2008/10/pie_chart_the_real_on.jpgReport
ET2: Copyright protections may be killing art? That’s a wild overstatement. More like, they may be killing the availability of books on Amazon. And I’m not altogether sure that the die-off isn’t natural. What may be going on is that Amazon has created a false increase in the pre-copyright years.
Books aren’t booming. We know that. There are art forms that are, though, and they’re copyright-protected. I know that there are a lot of gamers on this site: that’s an industry that’s doing very well. As for music and books, they’re spreading in spite of copyright laws. So I don’t know if that’s an argument one way or another.
Secondly, the decline in titles strikes me as perfectly normal. Literary styles change. People don’t read Pearl S. Buck or Saul Bellow anymore, and there might be a good reason for that. Stephen King may have written a few classics, but only a few, and I’d expect to see an asymptotic decline in his readership over time. There may be an inflation in the number of titles available just outside the copyright law, but that could easily be an attempt to make a few extra bucks rather than a reflection of demand.Report
If a book isn’t available on Amazon, does it exist?
More seriously (though the above is only half-joke, at most), the whole idea behind extended copyright is that it promotes more works of art. Correlation isn’t causation, but it’s still an inverse correlation from what we should be seeing.Report
It doesn’t matter if it’s on Amazon if it’s an anthology. The aliens still won’t read it.Report
Space opera awesome.Report
L3
Dude, that article was from ’07. And I’m pretty sure it has since been debunked.
Though, if red heads are extinct in 2060, that means only 47 years until I’m back on the market!Report
Yeah, sometimes a dud slips by me.Report
L1, Pie charts. While I agree with the overall argument, there is one use of a pie chart that’s very educational. Ask someone to draw a pie chart of the Federal Budget. Just what they think are the four or five biggest expenditures.
I have only met one person who could do something anywhere near remotely close. (In honest disclosure, I, when asked to do it, was very close.)
You do, of course have to follow this up with a few differing pie charts for them to actually see.
But after that, yes, charts that provide accurate information are more useful for conveying that information.Report
L1: Yeah, pie charts help us understand fractions, and that’s all their good for.
But the whole point of a chart is to help us understand numbers of various sorts and put them into context. That’s equally true of a bar graph. You could always just give people numbers and forget about the chart. But the chart translates the numbers we understand in our civilized, calculator brain into something we understand in our lizard brain.
And when it comes to communicating portions of a whole, a pie chart is really the best way of doing that. Bar graphs easily communicate proportions of relative things compared to each other–but suck at showing people proportions relative to the whole pie.Report