Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts

Thursday, January 17, 2013

Putting Armed Guards in All the Schools is Nuts



Putting armed guards in all the schools is nuts.  There's like 100,000 public schools in the US, which, with (just) two guards apiece, at say $60,000 per year comes to $1.2 Billion.  This is a cold calculation, but this investment would have to stop the killing of about 300 people, children, valued at $4 Million a person, a child, each year to be worth the cost to the economy.  Note the phrase: "would have to stop the killing of."  Even with this security there is no guarantee of efficacy.  Besides, there's the school buses, too, which would have to be protected.  And then there are shopping malls, public parks, and all kinds of public events where people gather.  A society is simply a soft target, which is why societies have traditionally sought to fight their wars somewhere else besides their home turf.   
 The $4 Million figure is roughly the economic contribution made by a person to society (in the US) during his lifetime. Figure 150 Million people actually working in a $15 Trillion per year economy makes the average of each person’s contribution $100,000 per year. Figure 40 years effective working life, $4 Million total contribution.  The actual average contribution is probably a little less, (although one can argue also considerably more, as much of an individual’s contribution to society is not measured,) so even this overvalues the economic value of a life. This site gives a figure of $5 Million, depending:
The EPA in 2010 said $9.1 Million as the value of a life, but that’s too much, and overvaluing life is as harmful as undervaluing it. If you spend too much money trying to save lives you don’t spend enough money living life.   Suppose you valued people’s lives at $1 Trillion dollars each.  Then you would spend that much money keeping each person from getting killed. But you’ve only got $15 Trillion to spend, so you could only keep 15 people per year from dying. You and everyone you knew would spend your entire labor insuring those 15 people didn't die. And then you wouldn’t have any money for anything else.  
About 2,500,000 people die each year in the US, and gun violence, especially when you subtract out gangs, is not more than a blip. Deaths due to medical error is about (at least, either about 100,000 or 200,000, depending on who you ask) 10 times as much, and one can argue that 'guns to protect people’s rights' is, like medicine, a necessity, despite the unfortunate statistics, for both the gun industry and medicine.

Homicide of all sorts came in at number 16 in leading causes of death in the entire population, in 2011, firearms accounting for 11,100 or so.  But... If you tease the data a little bit, homicide is 3rd or 4th leading cause of death up to age 34, comparable to suicide, ahead of cancer, and only clearly behind unintentional injury, (ie accidents, I suppose,) compared to which rate it is about a third.  This will get you to the site:
http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html  About 4/5ths of these homicides are gun related.  So for that age group at least, gun control advocates have an issue.
But I don't think it is worth the cost, given history and the culture.  Although I also think gun advocates are off a little, too.  Organization, not individual gun ownership, is necessary to protect against tyranny.  And here, for instance, the effective destruction of labor unions, which many gun owners favored, has removed one of the people’s great barriers to tyranny .  Militias?  As long as the government can concentrate force, and is the corrupted captive of Finance...

Also, there is a certain amount of hypocrisy behind the gun lobby’s proposal.  It is often the same people who argue against universal health care.  If they really valued those children’s lives, they would favor universal health care, since the denying of insurance is effectively a devaluing of life.  They propose to spend $40 Million per saved life due to gun violence, ( and expand the government’s police force by 200,000,) but they won’t spend the thousands per life, and save the many thousands of lives, to reduce the death rate of the not so well to do to one or another possible medical problem. 

Tuesday, June 26, 2012

Regulating Oligopoly and Oligopsony



Regulating Oligopoly and Oligopsony

Having concluded there was a need to regulate oligopoly and oligopsony, ( http://anamecon.blogspot.com/2012/03/on-need-for-regulation-of-oligopoly-and.html ) we discuss some ways how it might be done. Other suggestions are welcome.

The problem is the oligopolist produces less than the competitive equilibrium, and at a higher price, while the oligopsonist buys less than the competitive equilibrium, and at a lower price.
 
In dealing with oligopy we wish to decide which oligopies are most damaging.  Those in elastic markets, for instance, would be naturally limited in their ability to extract rents, while those in inelastic markets would have greater opportunity, and given the situation, inclination, to do so.  Similarly, the costs of entry to a market would also set limits on how much extra normal profit could be collected. Low entry costs would limit the extra normal profits to low levels, since higher profits would encourage the entry of other firms into the market.

With damaging oligopy, one way is simply to tax the results. A problem here is getting the receipts back to the damaged parties.  Another problem with this solution is that it would not affect the oligopist’s equilibrium, to produce at higher prices and lower quantity produced than at competitive equilibrium for oligopoly, and to buy at lower prices paid for and a lower quantity than at competitive equilibrium for oligopsony. That is, it would not eliminate bottlenecks in an economy. As may be, this approach would be to tax extra normal profits at a punitive rate, say, 90% of profits over 6% (allowing for a 3% inflation rate.)  The point is, by the time oligopy is manifest, the market is relatively fixed in proportion to the economy as a whole. Yet because of the price scheme of the oligopy, the market is defective in size to the economy, and the rent collected goes into the bank, ie taken out of the economy at large, or goes into buying up assets in the economy at large, increasing the proportion of ownership of the oligop, at the expense of the other members of the economy.  So one would wish to force the oligopy to grow to proportion of and at the growth rate of the economy as a whole.  (This is a mature market problem, not a growing market one.  It is not a problem of a company expanding into an open market, such as Apple, with its product innovations.  Extra normal profits here can still be a problem to an economy, and lead to alterations in the distribution of wealth and power.  But the reinvestment of extra normal profits in plant is also necessary to expand production to meet the demand a smaller company cannot reasonably fulfill.) 

What is desired is that normal profits are allowed to be reinvested in the oligopy, while extra normal profits are returned to the economy at large.  In oligopoly, one might gear the tax to be scaled at 6% on profit per unit produced, (with a 3% nominal rate of inflation, and a 3% rate of growth.). This would be effectively a progressive VAT, or value added tax, on the ologopoly.  This would incentivize the oligopolist to produce to competitive equilibrium, since the maximum profit would then be proportional to quantity produced. (Actually this by itself wouldn’t quite work, as the oligopolist would just be encouraged to internalize costs, so as to reduce his ‘profit’ to the 6%.)   

Another is to institute price floors in the case of oligopsony, or price ceilings in the case of oligopoly, at what one would hope to be nearer the equilibrium price for a perfectly competitive market. One example of price floors, with oligopsonies, is with minimum wage laws.

A problem here seems to be that one loses the use of price signals, although this is actually not a problem with oligopy, since the quantity traded is no longer responsive to prices anyhow.  Or more correctly, the price becomes fixed, and unresponsive over a large variation of economic conditions. In any case, over a large variation, price and quantity do not respond to the demands of the economy. While these price levels could just be legislated, probably a more efficient method would be a competitive buyer, in the case of oligopsony, or a competitive producer, in the case of oligopoly.  In the case of oligopoly, another option might be to subsidize production.  This option, subsidizing production, would fail, however, in all cases but the mildest kinks, that is, where there were numerous competitors in the oligopoly, (or hardly like an oligopoly at all.)  This is because, with a severe kink, the vertical part of the Marginal Cost MC curve extends through the price axis, or at least very close, and thus all or most of the cost of production would have to be subsidized in order to encourage an increase in quantity produced.  Otherwise, the quantity for profit maximization would not change. This would still be useful, in cases like health care, where the goal was universal coverage.  See: http://anamecon.blogspot.com/2010/03/real-problem-with-health-care-in-us.html

Similarly, just buying up large quantities from the oligopoly would be very expensive, since you would be buying at the oligopolist’s price, and providing him his extra normal profit, as is in fact the current US government policy with respect to the health care industry.  Policy should be to force the oligopolist to sell at a price nearer the equilibrium price.  Again, the situation with health care is different, since if you want universal coverage, you want to drive the oligopolist’s price to near zero, and to do so must effectively subsidize the entire production.  That is, make health care a public good. 

In the case of oligopsony, by competitive, we mean a buyer who buys sufficient goods to drive the price up to what it would be under competitive equilibrium.  This buyer would constitute a regulator.  And what would the signals be, that this regulator would look for?  He would seek a normal profit for suppliers. (This assumes that for firms facing the oligopsony, there is no barrier to entry.  If there were such a barrier, we would expect the situation to evolve into one of oligopoly facing oligopsony. Does such a market exist at a competitive equilibrium?  It would seem to depend on the relative elasticities of the supply and demand.)

One way this might be shown would be an equilibrium in firms entering and leaving the market.  This shows how the quantity of suppliers might also be regulated. By increasing the price and quantity bought, firms would be encouraged to enter the market.  By reducing the price and quantity bought, firms would be encouraged to exit the market.

The idea of government being a last resort buyer of labor suggests an alternative to minimum wage laws.  The government would enter the labor market and act as a monopsonist, and bid up wages until the unemployment rate was down to desired levels.  Private industries would have to pay this rate also, or lose employees to the government.

The situation would seem to be more difficult with oligopoly.  The problem with the government producing to competitive equilibrium is that governments are notorious for producing inferior products.  Another problem, as in agriculture and education, is what the government actually does.  That is the government subsidizes production into the face of oligopsonies.   This results in producing a surplus of goods into a buyers market, driving down the prices.  (Indeed, the prices have been driven down so low, in the case of education, that buyers, the institutions of higher education, must be paid to accept most of the production of public education. The prices are negative.  This is an alternative way of looking at the distribution of pricings and cost burdens in education.  On the other end, businesses refuse to pay the universities for the production of the universities, their graduates.  They do not send clear signals as to what they want, except in a few career specific employment and unemployment rates. 

One way to rein in oligopoly is to promote the production of substitute goods.  The development and subsidy of alternative energy sources, for instance, would moderate the action of oil and coal oligopolists, which is one of the reasons they oppose alternative energy sources so fiercely.
   
As another alternative, the government could employ the aggressive use of anti-trust legislation, to prevent the formation of oligopoly. Probably a figure of providing 20% of the market would constitute a member of an oligopoly.  Thus, keeping firms below that size would prevent the kink from becoming too pronounced.  A problem arises, when the oligopoly faces oligopsony, or monopsony, as in retail supermarket chains, with their limited shelf space.   By hindering one, one encourages the other, and oligopsony can be as socially destructive as oligopoly.   

Another possible solution is to separate the functions of the oligopy, making one part into a quasi-utility, and eliminating costs of entry to the other function.  Thus, for instance, (as was done with British rail) providers of cable TVcould be separated into parts, one which merely operated and maintained the cable, and the other which provided the content, paying the operators of the cable a fee.  The operator would be a regulated monopoly, and the content providers would be competitive, the costs of entry, one of the prerequisites for oligopoly, minimized.  The same could be done with cell phones, the towers being regulated, and selling their bandwidth, which they would seek to maximize, for a fee.

Health care in the US is an instance of oligopoly. Actually it is an instance of several different oligopolies.  One is medical equipment supply.  Another is pharmaceutical supply.  Locally hospitals form oligopolies.  (Hospitals are an obvious choice for regulated utility.)  Finally, a limited supply of doctors and other medical personnel creates an effective oligopoly to health care consumers.   Production of health care is restricted, driving up prices. Buying from the oligopoly will not change this, and indeed can be expected to further drive up prices. 

For industries requiring a high level of maintenance of resources, such as farming, further regulation might be required of producers, to prevent depletion of assets in efforts to temporarily acquire extra normal profits.  Progressive taxation would be helpful here, since it increases the present value of future returns, rather than exploitation of the resource for immediate returns.

Wednesday, June 13, 2012

Milton Friedman: "The Social Responsibility of Business is to Increase its Profits," is Wrong


Milton Friedman, "The Social Responsibility of Business is to Increase its Profits," is wrong.

In his famous article, “The Social Responsibility of Business is to Increase its Profits,” (originally published in the New York Times Magazine September 13, 1970, see eg:http://www.colorado.edu/studentgroups/libertarians/issues/friedman-soc-resp-business.html) Milton Friedman quotes himself from his book Capitalism and Freedom:

"there is one and only one social responsibility of business–to use it(s) resources and engage in activities designed to increase its profits so long as it stays within the rules of the game, which is to say, engages in open and free competition without deception or fraud.”

This is his concluding line in an article dedicated to denigrating the idea of “social responsibility” in businesses, and in particular by corporate executives. For a corporate executive to act in a “socially responsible” manner, Dr. Friedman posits that “it must mean that he (the corporate executive) is to act in some way that is not in the interest of his employers.”  That is, any act, (not geared to maximizing profits,) in excess of the minimum required by law and custom is not in the interests of his employers. 

His conclusion is at least naïve.  Clearly, a business can increase its profits if  “it stays within the rules of the game, which is to say, engages in open and free competition without deception or fraud."  How much easier, though, to maximize its profit by externalizing all costs, by capturing and corrupting government, and altering the rules of the game to its convenience?  How much easier to profit by eliminating free and open competition, and legalizing deception and fraud? 

Dr. Friedman criticizes the 'socially responsible' postures taken by executives in and prior to 1970.  He further condemns socially responsible behavior by smearing it with the ‘socialist’ paint brush:   ”This is the basic reason why the doctrine of "social responsibility" involves the acceptance of the socialist view that political mechanisms, not market mechanisms, are the appropriate way to determine the allocation of scarce re­sources to alternative uses.”  Here Dr. Friedman makes no compromise. He essentially claims that market mechanisms are the only way to determine the allocation of scarce resources, denying any limitation to or failure of markets, or any use for political mechanisms of allocation.  But pollution control, and work place safety, are political allocations of resources, and ones which would be opposed by market mechanisms.  The failure of the market in the US to provide universal health care is another case in point, assuming universal healthcare is desired by a majority of the people.  


Milton Friedman's claim that the sole social responsibility of business is to increase its profits, places businesses into an adversarial relation to society.  That is, businesses become the enemies, the exploiters, of the society of which they are a part.  The logical conclusion of Dr. Friedman’s statement is that it is not a part of the social responsibility of business to behave in a socially responsible manner.  His implication, although I don’t think he realized this, is indeed quite the opposite, that a business should behave in a socially irresponsible, and even socially destructive, manner, if this increases its profit. This position is schizophrenic.  It is as if the hand was encouraged to act against the interests of the body of which it was a part.


There are ways of increasing a business’ profits which are damaging to the society of which it is a part. Indeed, it is a tendency of business to seek to externalize all costs. Thus, to pollute, to ignore worker safety regulations, to engage in mis-representation if not fraud, etc. If the business is in competition, and these things are permitted, it must do them, since its competitors, similarly situated, will also do these things.  Its competitors, if allowed to externalize costs by polluting, will do so, and so it must also.  Its competitors, if allowed to externalize costs by skimping on worker safety, will do so, and so it must do so also.  Further, business will seek subsidies by the government, and taxes by the government on its competition.

The conclusion of Dr. Friedman’s position implies the necessity that the corporate executive act without conscience.  This is necessary, since any operation of conscience within the confines of the executive’s office would be contrary to the profit maximization principle under which the executive, as an employee of the owners, is obliged to operate.  Indeed, profit maximization obligates the corporate executive to pollute and otherwise externalize all costs, so far as practically permitted, and to undertake the corruption of the regulating bodies, that is the corruption of government. 

But where is the root of his error?  Consider this quote from the article: “Society is a collection of individuals and of the various groups they voluntarily form.”  Society is hardly a mere collection.  It is dynamic, and its dynamic is non-linear. Society is not merely the collection of individuals, or even the mere collection of their actions.   The effect of everybody doing a thing, is quite different from the effect of just one or a few persons doing that thing.  Society is more than the sum of its parts. A business is more than the sum of its parts.  And the actions of businesses, and the other parts of society, combine in non-linear, and synergistic ways. There are returns of scale, and greater returns on the scale of integration of an entire society.  A business unconcerned with these interactions does society, and itself, disservice.  Dr. Friedman’s conception serves to atomize and divide, and reduce those social returns to scale, impoverishing society.  This is what we have seen, in the triumph of his error, and the rise of those who subscribe to it.


Consider instead a purely operational, and self-interested, definition of conscience: seeking to do that which is ultimately best for one’s self:  Seeking the larger good, with the expectation that one’s own welfare will be improved if that larger good is enhanced.  We do assume that the executive is interested indeed in maximizing the profits of his company. Then a goal of the business executive is the optimization of his society, (and by optimizing we can here mean purely maximizing the economy's growth rate,) since in an optimum society, his corporation itself is optimized, and in the long run, its profits maximized.  Thus, the executive with conscience will seek to participate in, and encourage the development of, a well regulated market, one which will enhance the value of his business to society, since in such a market growth is optimized for all businesses.  Therefore, rather than corrupting the regulators, he will seek regulation which maximizes the efficiency of resource allocation. Rather than competing in a race to the bottom, he will seek effective regulation that will encourage all businesses to good behavior. The business man of conscience, therefore, will speak out against corruption, and the capture of government by other businesses. As this will be in his own long term best interest.

The corporate executive’s duty to his employers is not uncritical obedience to the principle of short term profit maximization. Long term maximization requires the long term survivability of the society of which it is a part. 

Neither do the owners enjoy all incidents of property.  Ownership of property in any society is not an absolute.  It entails duties.  Society, and its government, retain the most important incidents of property, and this implies the obligation of the owners to ”socially responsible” behavior.   All individuals in society, by voluntary agreement, undertake this. 

While it is beneficial for each business to pursue its narrow interests, even to act in an unethical manner, (which Dr. Friedman in the larger sense implies is OK as long as it is within ‘the ‘rules of the game,’) it is bad for each business if all businesses act so.  Where all businesses sacrifice the larger good, sacrifice their ‘responsibility to society,’ for their narrower interests, all are poorer, and all lose. Where all businesses sacrifice the larger good, the larger good contracts.   

Even the winners lose. Therefore, it is in the interests of each business, to see that other businesses act in an ethical manner.  Thus, that the business exists in a well regulated market, and not a corrupt, environment.


We take Dr. Friedman to his logical conclusion, and that business indeed exists in an adversarial relationship to society, that its ultimate interests are contrary to the interests of society.  Then there is no intrinsic restriction to its activities in that society:  There is no limit on the things it can, or should, do, to gain profit. So business should seek to capture government,  and seek to ‘free’ itself from the constraints of regulation, and mitigate or corrupt that regulation.  Then when business captures government, and corrupts regulation, it must be that the government also acts contrary to the interests of society.  Therefore, it is in the interests of society, that the separation of business and state remain inviolate.  The Supreme Court’s decision Citizens United, therefore, must be considered inimical to society, at the least a terrible mistake, and those who support it, and profit by it, society’s enemies.

Clearly, it is in the interests of failing executives, and failing businesses, to corrupt government, and to legitimize deception and fraud.  Failing at production, they seek success through corruption.  Instead it is in the interests of successful executives and businesses to seek a well-regulated environment, and good government.

Society is captured by men who do not believe that the larger good is to their benefit, and therefore seek their own narrower self-interests, to the destruction of the larger good, and ultimately their own.

That our government is captured by executives and businesses, many of which would otherwise fail, that is to say, are not producers in any real economic sense, and so could not compete in a free and open market, bodes ill.   

Executives and corporations have taken Dr. Friedman's statement to heart.  His prescriptions have, so far as they have been carried out, done untold damage to the economy.

Monday, September 19, 2011

Links 9-19-11: Corporate Salaries; Health Care

Some links: First: http://blogs.reuters.com/david-cay-johnston/2011/09/16/shrinking-corporate-officer-pay/

“Since 1994, business receipts have grown about 50 percent faster than profits, tax data show. Since corporate officers are supposed to run companies efficiently, the narrowing margin on sales is an indicator of poorer performance and thus may partially explain why overall their pay is smaller than in the 1990s, a fact nobody knew until just now.”

These would seem to be the top 5% minus the top 1% guys. We would also expect this as a result of increased foreign competition that is, though indirectly for most corporations, the equalization of factor prices brought about by that foreign competition.

Not so much health care and education, (defense?) though, as these are most insulated from direct foreign competition. So we would expect these to become relatively more expensive, but see also: Baumol’s cost disease, at eg: http://prescriptions.blogs.nytimes.com/2010/01/17/an-economist-who-sees-no-way-to-slow-rising-costs/ for another explanation. But that doesn’t explain the difference between US and Europe.

So next: http://economix.blogs.nytimes.com/2011/09/16/the-role-of-prices-in-health-care-spending/

Seems on of the reasons healthcare in the US is more expensive is because the prices are higher than elsewhere! Everything costs more! Well, yeah, that’s what cartels and monopolists do: drive up prices by restricting access to goods and services. An aside on the government role in all of this: http://www.boston.com/Boston/whitecoatnotes/2011/09/journalist-groups-decry-removal-online-doctor-discipline-data/mRYBMGSUQYNyJb5vChPJsO/index.html

See: http://anamecon.blogspot.com/2010/03/real-problem-with-health-care-in-us.html
for my description and prescription.

Wednesday, July 27, 2011

What is a life worth?

Well, on the one hand, it is priceless. But from an economic point of view, a life is only worth about $4,000,000. Of that, $2,000,000 is the person’s worth to himself, and any others he provides for. The other $2,000,000 is the person’s worth to the rest of the economy. How much the rest of the economy benefits from his life’s labor. These figures are very rough, the mean, and of course vary greatly from person to person.


But how do we figure? First, we figure a person is only worth to an economy what he contributes to society. So we figure from a labor force of 150 Million we have a GDP of 14 Trillion. Round that to make the annual contribution to the economy per worker an even $100,000. Times say 40 years labor, about the number of years we suppose the average worker to work in a lifetime. $4,000,000. About half of that goes to the worker, about half to the rest of the economy. That’s the mean. The median worker only gets about$1.4M, but the median worker also probably contributes less than $4M. But what about the people who don’t contribute to the GDP? Well, here we’re counting them the same. Perhaps we shouldn’t. After all, someone who is compensated more than he contributes to society has a negative value to society. But we can also figure not all contributions to an economy show up in the GDP.


This has important ramifications. Such a heartless calculation actually suggests important ways individuals, and society, benefit. It means, for instance, that it is beneficial to individuals if we don’t spend too much saving a life. For instance, we wouldn’t want to spend $1 Trillion to save one life. Everyone else would be that much poorer. The economy would be out $999,996,000,000. That’s just dollars, but the equivalent in lives (valued at $4,000,000) is 249,999. It is 499,999 lives if we take the value a life is worth to the rest of the economy. We would be trading that many lives for one life. This is a bad deal for an economy. If it did this too much, it would literally kill itself.

What about pain and suffering? People are not just economic mechanisms. They have feelings. They feel pain. Can we put a dollar value on that? Sure. Let’s say $1 Trillion on a person’s feelings. Would we want to spend $1 Trillion on a person’s life? We just went through that calculation, and the point is the same. It would overvalue that life, and be a bad deal for the rest of the economy, which is to say, everyone else. It wouldn’t be fair. You can spend $1 Trillion to save one life, but you can’t spend $1 Trillion per person on everybody else, to save their lives. In fact, it works out you can only spend less than $100,000 per year per person. On average.

We can look at it this way: The economy exists to save, and is essentially saving, everybody’s lives, all the time. We’re all on life support. And since the average each worker contributes is less than $100,000 per year, that is all we can spend, on average, per person, per year.

This shows that it is important not to overvalue life. A society which takes excess precautions against the loss of life is the poorer for it. In a sense, it is literally killing more people to prevent the loss of fewer.

Hospitals already often use a rule of thumb. Their guideline is, (often) for spending up to $100,000 per year of life extension. This is equal to our total annual contribution to the economy per worker. For instance, consider extending the life of an elderly person. On the one hand, society typically does not gain any benefit. On the other, the elderly person has already contributed his share to society, and in a sense has earned this consideration, as a kind of savings. And it provides an incentive for people to keep working. But the figure of $100,000 per year is probably too high, considering the limits of the current health care system’s ability to supply health care, and the high rents already collected from it, and contributes to the high costs of medicine today. The rents imply that the benefits to the patient are far less than the $100,000 expended, so the actual value of life is lower than the nominal one. Indeed, if we consider the rent to be 40% of the system, that is, 40% is ‘wasted’ compared to the health care systems of other advanced economies, then the actual value of a person-year is $60,000. This suggests an economic value of $2.4M for a life, lower than our calculated value of $4M.


One interesting, if perverse, example of the extreme is the California death penalty, reinstituted in 1978, which has cost $308M per person (13) executed. Indeed, its total cost $4B, is a substantial share of the California deficit. We can make this calculation: $308M divided by $4M is the total destruction of the lifetime production of 77 people. In this case, the state is effectively killing (the productive capacity of) more people than the criminal ever did. From another perspective, the annual cost of $184M is equal to the total annual contribution of 1840 workers to the economy, almost twice as many as are actually on death row. The work of 1840 workers, wasted.

The EPA, now, gives a figure of $7.9 Million for the value of one life, almost twice the total economic value we calculated, or 4 times the net value of a life to the economy. http://thenewamerican.com/tech-mainmenu-30/environment/6013-epa-reevaluates-the-value-of-human-life

Not a very good trade off. Of course, there is also quality of life. Clean air is better than polluted air, even if the polluted air doesn’t kill you.

Regulations impose costs on producers. By not permitting the externalization of costs, (pollution of one sort or another for the EPA) which by the EPA’s calculations, would cause an increase in death (and disease,) things cost more to produce, and these costs are passed on to consumers. But it also results in less of those things being produced, and since resources are consumed in all production, less being consumed. So in the case of environmental regulations, other benefits accrue than just the saving of lives. Resources are conserved, other things which might be expensive to remedy are reduced. Such things might be considered to be included when the value of a life is overestimated.

Undervaluing life has its own costs. Negative externalities, excess pollution, is encouraged. Overproduction of stuff is encouraged. (This could be an argument for undervaluing life, where increasing the amount of stuff is equated to economic progress!) There are more accidents, as insufficient precautions are taken. There is loss of life and quality of life.

Note, when an economy is poorer, the capitalization per person, and what depends on it, the individual’s ability to contribute to society, thus the value of life, is less. Kenya for instance has a GDP per capita of $1600, $66B/41M but a labor force of 18M, so the average economic contribution per worker is about $3700, times 40 years or about $150K over a lifetime, (average life expectancy about 60, but do they have retirement?) so that is the mean economic value of a life, there.

Back to the US:
A child, on the other hand, has the potential to contribute $4,000,000 to society. But society has not yet invested in him. In fact, (our) society, on the average will invest somewhere around $350,000 in raising a child to adulthood, not counting the opportunity cost of parenting. Most of this cost is born by the family, so does not subtract from the $2,000,000 net contribution. A six year old, for instance, has about $70,000 invested in him, by his family: $60,000 direct costs, and $10,000 or so for his first year of schooling, which one way or another is borne by taxes. Now families are not the only ones to pay these taxes, so there is some subsidy of education by the rest of society. This omits cost- the opportunity cost to the self for his education, when, instead of capitalizing in himself, he could be doing something else.

In fact, it could be argued that the only real loss to society is this investment, and not the inferred profits society takes from his labor. And this investment is all society should be insured against. (This argument is also carried out in: http://en.wikipedia.org/wiki/Value_of_life )

Of course, the actual capitalization may be more or less than that figure, depending on the efficiency of parenting and the educational system, and the social system of the community. Much of the cost of the educational system now seems to be going to rent, judging from the reported decline in results. So the actual capitalization is less.

Further consideration indicates that the health care system may be considered part of the capitalization of individuals. Consider a child who needs a $50,000 surgery to survive and be productive. He is capitalized, by age 20, to $400,000, and so similarly for all medicine. Currently about $2.4T total health care expenditure per year, or $8K per person per year. This ups the capitalization for our six year old to about $120K. (There seems to be some double counting here, unless the family is fully covered from other, social, sources. One might also consider the fact that, except for young children, the expenditure on health up to middle age is probably less than $8K per year, and higher than $8K afterward.) Anyway, the capital investment per person would be $600K ($8K x 75years) + $350K or essentially $1M invested by society in each person, over their lifetime. On an annual basis about $13 K per year per person..

Other considerations enter in. For instance the average life is that of a 38 year old, round off to 40 year old. He has cost $670K capitalization by society, and produced about $2M. Net contribution $1.33M to society. Should we make this the average economic value of a life?

Suppose we were to nuke a city of 1M people. Which would be the loss to society?
Well, the fixed assets would be $180B ($54T/300M x 1M.) But the total loss of human capital would be about $670K x 1M = $670B. So the total is $850B (Compare this calculation with: http://anamecon.blogspot.com/2010/03/nuclear-equivalent-to-war-on-terror.html)
Here we are just counting what we have invested in the city, rather than the loss of any potential gains we had hoped to obtain from it. Just by the way, The wars in Afghanistan and Iraq have cost $1.2T since 2001, the equivalent, in terms of capital investment, of a city of 1.4M people, or larger than San Antonio, the 7th largest city in the US. Estimates of the total costs of the War on Terror run to $4T, but a figure of $2.4T (http://www.homelandsecurityresearch.com/2008/05/cost-of-war-on-terror/) places the cost at slightly more than Chicago, 3rd largest city in US. (If we were just counting physical structure, no loss of life, it would be almost 5 times the city of Chicago, more than the entire state of Illinois, leveled. This is equivalent to the 28 million houses of my earlier post.) Annualized, we are nuking the equivalent, inhabitants included, of Newark, NJ (pop 277K), or Greensboro, NC, (pop 270K) every year. 40 Years of the War on Drugs has cost about $1T, or by this calculation a city almost 1.2M population, or about the size of Dallas, the 9th largest city in the US. (If it helps with the imagination, you can imagine slightly larger cities just depopulated, since the actual physical destruction of buildings, homes and factories just adds on about a quarter of the value of destruction.)

One thing we see is that the value of a life depends on the calculation we are performing with it.

There is an implied social/moral choice in undervaluing or overvaluing a life. When you overvalue a life, you are sacrificing society for the individual. When you undervalue a life, you are sacrificing the individual for society. But sometimes society pays, anyway, when many individuals are sacrificed.

But of course, society is just made up of individuals. Or, individuals make up society.

Friday, March 26, 2010

The real problem with Health Care in the US

Well now that health care reform has passed, it's time to look at the real problem with health care. The real problem, and the reason that health care in the United States is so expensive, and takes a larger share of our GDP than that in other industrial nations, is that the United States does not provide adequate health care to its people.

With health care, an inadequate supply will show up in things like reduced life expectancy, higher infant mortality, use of emergency rooms by the poor because there are not enough clinics, shortages of doctors in some areas, especially rural ones, and higher prices than in countries that have adequate or better than adequate care for their people. These things we see. Also, the mere fact that payment is such an issue suggests there is demand among those who cannot pay for it.

With health care, people only need so much, but that much they need. They are willing to pay high prices if they have to, and if they can. But even with low prices, they are not, individually, going to buy that much more health care than they need. ( Unless they are sold more. We have heard of some places where they are sold more, driving up expenses still further.)

If our health care is inadequate, why is it also so expensive? The paradox of a nation paying more and getting less is explained by elementary economics. Health care is an
example of what in economics is called a service with inelastic demand. (More properly the equilibrium point of supply and demand for health services is in the inelastic region of the demand curve.) The demand for such a service, or such a good, like oil, does not change much, no matter what, within reason, is the price. If the supply decreases, the quantity demanded does not change much, but the price goes up a lot. An inadequate supply will lead to excessive prices.

Conversely, increasing the supply a comparatively small amount will lead to a dramatic decline in prices. The paradox arises because, if the health care system supplied enough services to meet or exceed demand, the share of the nation’s resources consumed by the health care system would be less than it is now. Competition would drive the price down. (Down to zero, in fact. The role of government would be to keep compensation up to cover costs, despite prices being insufficient to cover those costs. But the total cost would still be less.)

The calculation is simply quantity of services provided times the costs of those services. This equals the burden the health care system places on the economy. For an inelastic service like health care, a small increase in that service, times the large decrease in price, would bring about the reduction in total costs, reducing that burden on the economy.

And clearly health care is an inelastic service, because other industrialized nations provide their people more health care, and usually more than adequate healthcare, for a smaller share of their countries’ GDP than ours. If instead the demand for health care were always elastic, no matter how low the price, no country could afford a nationalized health care system. Then the nominal prices charged by many national health care systems, which are much less than the costs, would lead to an uncontrollably greater demand, and the total costs to an economy would be impossibly large.

On the contrary, it is the cost of the US’ privatized system that is becoming impossibly large. Already 17 percent of GDP, it is estimated to increase to 20 percent of GDP, an incredible burden that the rest of the economy perhaps cannot even bear. This is happening because a privatized system is unlikely to provide adequate, and thus inexpensive care, or even to restrain its costs. It simply cannot be expected. Since adequate care will drive down prices, and thus drive down profits and force down costs, it is in the interests of a privatized health care sector to keep health care inadequate. That is, to keep it in short supply. It is rather unreasonable to expect private health care providers to act altruistically, and contrary to their own interests. Indeed, the future may well correspond to the delivery of an even more inadequate service, especially with reform expanding demand, but not supply.

Many would claim competition is in fact keeping the price of health care down. However, by this principle, we would expect competition to keep prices lower than the non-competitive nationalized health care systems in other countries. It does not. Therefore the amount of competition in the health care industry is simply not enough to restrain its prices. The sheer cost of privatized health care, as it is in the United States today, justifies its replacement.

If the United States had adequate health care, it would cost less for individuals, however they paid, and take up a smaller share of our GDP. It would be more efficient. This would increase the efficiency of the entire economy, free up resources for other, more vital, uses, and increase the competitiveness of American industry in the world market.







.