The Health and Happiness of Nations

David Blanchflower and Andrew Oswald, two researchers at NBER, found that happiness of nations, regardless of the number of physicians or a particular choice of survey used, is associated with lower levels of hypertension. The study adds yet another interesting, yet surely to be controversial, argument for continuing to expand the field of behavioral economics to better understand economic and consequently political individual behavior. Their article is available on the NBER site, and here is the abstract:

A modern statistical literature argues that countries such as Denmark are particularly happy while nations like East Germany are not. Are such claims credible? The paper explores this by building on two ideas. The first is that psychological well-being and high blood-pressure are thought by clinicians to be inversely correlated. The second is that blood-pressure problems can be reported more objectively than mental well-being. Using data on 16 countries, the paper finds that happier nations report lower levels of hypertension. The paper's results are consistent with, and seem to offer a step towards the validation of, cross-national estimates of well-being.

Clinton unveiled the highly-anticipated health care plan: $110 billion/year

Clinton unveiled her new health-care plan in Iowa. The New York Times reported the story here. As expected, the plan builds on the successful experience of Medicare, and in addition tries to help accommodate fears of those currently receiving high-quality private insurance. The plan will offer a wide degree of choice and offer a combination of subsidies for employer-provided insurance, private insurance, and government health insurance.

Two other Democratic candidates have different health care programs as a part of their campaign platform. Barack Obama's plan focuses on requiring employees to provide insurance and on expanding insurance for those worse off. John Edwards' program is similar to Clinton's in that it focuses on giving people the choice, but in addition promises to fund the new plan by increasing taxes on those at the top of the income distribution.

Epidemiology, trials and medical knowledge

While there is an increasing attention on monitoring drugs for safety after being approved by the FDA -- including large registries to study drug use and its effects in the 'real world setting' -- it is still remarkable how much confidence we put in the present-day state of medical knowledge. An analysis piece in the New York times points to the interesting dynamic of establishing then refuting, or revising scientific knowledge that affects the medical treatment of millions of Americans. Here is an excerpt from the article by Gary Taubes:
Many explanations have been offered to make sense of the here-today-gone-tomorrow nature of medical wisdom — what we are advised with confidence one year is reversed the next — but the simplest one is that it is the natural rhythm of science. An observation leads to a hypothesis. The hypothesis (last year’s advice) is tested, and it fails this year’s test, which is always the most likely outcome in any scientific endeavor. There are, after all, an infinite number of wrong hypotheses for every right one, and so the odds are always against any particular hypothesis being true, no matter how obvious or vitally important it might seem.
You can access the New York Times article here.

How expansion of state insurance can harm some children

Gruber and his colleagues at NBER found that for every 100 children who start receiving public health insurance about 60 lose their private insurance. They write about this new form of "crowding out" in their newest paper, published as an NBER working paper. The question then arises on how advocates of expanding state insurance can ensure that families affected are compensated for this welfare loss. Here is the abstract of their new paper:
he continued interest in public insurance expansions as a means of covering the uninsured highlights the importance of estimates of "crowd-out", or the extent to which such expansions reduce private insurance coverage. Ten years ago, Cutler and Gruber (1996) suggested that such crowd-out might be quite large, but much subsequent research has questioned this conclusion. We revisit this issue by using improved data and incorporating the research approaches that have led to varying estimates. We focus in particular on the public insurance expansions of the 1996-2002 period. Our results clearly show that crowd-out is significant; the central tendency in our results is a crowd-out rate of about 60%. This finding emerges most strongly when we consider family-level measures of public insurance eligibility. We also find that recent anti-crowd-out provisions in public expansions may have had the opposite effect, lowering take-up by the uninsured faster than they lower crowd-out of private insurance.

The paper can be accessed on the NBER website here.

Bush White House vs. Children Insurance

It seems that President Bush is determined to make it more difficult for uninsured children in California and New York to get their state's help in obtaining health insurance. The New York Times reports on the story:
The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.

The politics of Medicaid funding allocation

The new expansion of health insurance for children in the US provides an excellent example of how Congressional politics influences the distribution of government funding across the US, and down to the regional and even city-wide level. Through political negotiation and bargaining, the legislators are able to funnel directed funding to specific hospitals, under the auspices of a universal legislation such as the Children's Health Insurance Program. Here is an excerpt a recent article by the New York Times describing the process in more detail:

One hospital, Bay Area Medical Center, sits on Green Bay, straddling the border between Wisconsin and the Upper Peninsula of Michigan, more than 200 miles north of Chicago. The bill would increase Medicare payments to the hospital by instructing federal officials to assume that it was in Chicago, where Medicare rates are set to cover substantially higher wages for hospital workers.
Lawmakers did not identify the hospital by name. For the purpose of Medicare, the bill said, “any hospital that is co-located in Marinette, Wis., and Menominee, Mich., is deemed to be located in Chicago.” Bay Area Medical Center is the only hospital fitting that description.

Guiliani's health plan

Yesterday, the NYT had a good feature about Guiliani's helath care plan. While it is difficult to compare the GOP and Democratic plans at this stage of the campaign, it is refreshing to see health care discussed in detail on the GOP side as well.