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Tag Archives: health care costs

Industries afflicted with Baumol's Disease have slower productivity growth.

The price system is rather amazing.

Please imagine for a moment that you heard a gallon of gasoline was $1.50. First you would think, “cheap!” Then you might rush to fill your tank. Or, told that a diamond ring was $50, you might not buy it.

Price fluctuations are called a system by economists because they move predictably in markets. Prices can be incentives and quality barometers and used to measure productivity and profitability. Just one number, a price can say so much. But not always.

And that takes us to hips.

What if you were told that a hip replacement could cost $11,000, $125,000, or somewhere in between? Sort of like learning that a wagon could be purchased for 1000 Continentals, you would not really know that those prices mean.

Recently, several college students called 102 hospitals to see how much a hip replacement would cost for their fictitious grandma without insurance. Not getting many price requests, most hospitals were not sure how to respond. When the students finally got the information, the disparity was massive. Not only did price range from $11,000 to $125, 000 but also there seemed to be no normal tie to demand, supply or quality.

In another study, researchers found appendectomies could cost anywhere from $1529 to $182,955. As for the emergency room, a study revealed that a visit for a headache could cost anywhere up to $17,797 but as little as $17. A sprained ankle? $4 to $24,110.

You know where this is going. Lacking the normal signals of the price system, medical care creates alternative incentives. And therein lies our problems.

Emergency Room Charges

Sources and Resources: Interesting Washington Post articles here, here and here discussed each of the three studies. Gated, here, here for hips and appendectomies and not gated here for emergency room visits, are the formal articles with all of the details. Connecting the US health care system to moral hazard, this econlib article explains the incentives that artificially low prices create.

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Given a huge tub of stale popcorn, people eat it.

In a 2005 study, when 158 Philadelphia moviegoers received either 14-day old or freshly popped popcorn in a huge tub or a medium size container, those with the big bucket ate more. A lot more… 33% extra if they disliked the popcorn and 45% if they liked it.

The conclusion? Even when we dislike the food, portion size impacts intake because it conveys the appropriate amount to ingest.

I don’t know whether NYC Mayor Mike Bloomberg knew about the popcorn study but he certainly agrees with its implications. He just announced that he would propose to the Board of Health on June 12 that restaurants, delis, stadiums, street carts, movie theaters–any vendor the city regulates–cannot sell larger than 16-ounce sugary drink servings. If approved, there will be a 3-month comment period, a 6-month waiting period, and then the regulation would be implemented during March 2013. Sodas sold at grocery and convenience stores, drinks that are more than 50% dairy, diet sodas, coffee, are among the drinks that are not included.

There are so many economic issues:

  • Is obesity a negative externality that society has the right to “regulate?” Saying that obesity costs the city $4 billion, Mayor Bloomberg identified (and was challenged about validity of the statistic) one externality.
  • Is individual liberty the opportunity cost of the mandate? Purchased by its opponents, there was a full page Sunday NY Times ad picturing Mayor Bloomberg dressed as a nanny.
  • Which unintended consequences will be created by the regulation’s incentives?
  • Will government distort market driven demand and supply?
  • Should government be larger or smaller?

This article from Cornell has additional details about the popcorn study and here and here are more facts about the mayor’s proposal.

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In a recent WSJ interview, Nobel laureate Gary Becker tells us that, “Markets are tough to appreciate.” The reason, he says, is people feel government can better care for them than a profit seeking individual. Calling markets counterintuitive, Becker sees why people question the benefits of a system that seems to harm the unfortunate. For him though, the key is economic growth which only a market can create.  

Becker also comments on the cost of health care. Implying that incentives rather than government provide the solution for cutting health care costs, he compares health care spending in Switzerland and the United States. Yes, the Swiss spend close to 11% of GDP on health care and we spend approximately 17%. However, for him, insight comes from asking who does the spending. In Switzerland, 31% of the total is from individuals;  for us, only 12% of total health care spending is an “out-of-pocket” expense. 

Hearing Gary Becker’s ideas reminds me of a quote from William Bradford about Plymouth Plantation in 1623: “So they began to think how they…could…obtain a better crop than they had done…At length…the Governor…so assigned to every family a parcel of land…This had very good success, for it made all hand very industrious…”

The Economic Lesson

Whether your bias is more government or less, still we always can conclude that the incentives created by a decision will determine its outcome.

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