Category Archives: BUHealth

US health spending and global burden of disease

I want to thank Veronica Vargas for sending me the following link from the Institute for Health Metrics and Evaluation (IHME) , which features innovative ways of displaying different cuts of US and international data from a massive data files. Viewing this site will perhaps take you fifteen minutes or more to get a feel. It is staffed by the University of Washington, but appears to be funded largely by the Gates Foundation. It has been around for a while, but they are making a big push on its features this fall.

The first link decomposes spending in the US by  disease, by broad type of service (pharmacy, IP, OP, Dentist, ER).

They document the well-known result that about half of the US increase is due to price increases, not intensity or illness, although aging and pop growth contribute.US costs are higher than the rest of the world largely because our prices paid for all types of care are much higher than elsewhere. And increasingly so.

 

Here is a direct link to the interesting interactive figures. Try the four different tabs across the top if you are curious. (Is a little slow on my wireless laptop.)

https://vizhub.healthdata.org/dex/

It allows you to drill down to questions such as how much was spent on individual disease for certain ages, on emergency department.

If you click on “visualizations“ in the upper right, you get different views that can be plotted, which are very extensive.

Or start here http://www.healthdata.org/results/data-visualizations

 

Below is a link to the article originally posted, along with a sample figure.

 

Factors associated with increases in US health care spending, 1996–2013

Here is one that lets you choose one or compare two or more countries disease burdens along multiple dimensions.

https://vizhub.healthdata.org/gbd-compare/

The say that their mission includes sharing data for researchers. Here is a link to various data that they support and document with a nice search tool.

http://ghdx.healthdata.org/data-by-type

 

Global Burden of Disease module lets you answer questions as specific as how many people die of air pollution in India in 2013.

Here is how they describe it.

September 14, 2017

GBD Compare

Data Visualization

Learn more

Analyze updated data about the world’s health levels and trends from 1990 to 2016 in this interactive tool. Use treemaps, maps, arrow diagrams, and other charts to compare causes and risks within a country, compare countries with regions or the world, and explore patterns and trends by country, age, and gender. Drill from a global view into specific details. Compare expected and observed trends. Watch how disease patterns have changed over time. See which causes of death and disability are having more impact and which are waning.

This is not a site oriented toward hypothesis testing, although it does include confidence intervals on many estimates (which seem to only reflect sampling precision, not other sources of uncertainty such as the quality of the underlying data.) For me, the main use will be in writing in the introduction of a paper so as to summarize how large a problem is, or how many people have a given condition, or how it is growing etc. The international breadth is stunning. At a different level, it is a good example of how big data can be manipulated using “cubes” and different cuts of the data to show fascinating patterns (girls less than 1 year cost $11,000 each on average, which drops to $1,600 age 5-9, and it is not until age 65 in the US that female mean cost is again over $11,000. It peaks at $31,000 per year over age 85.)

 

Be forewarned: you can spend a lot of time playing around…

 

 

The quintessential challenge of our time

"...the quintessential challenge of our time: the ascendance of belief over fact, outrage over thoughtful debate, and the accessibility of an endless supply of “information” that confirms our preexisting beliefs, whatever they may be. In a sociopolitical climate in which disgust often substitutes for disagreement, many people recognize the futility of using evidence to establish common ground, but few seem to know what to do about it."

 

From Lisa Rosenbaum, M.D. Understanding the Planned Parenthood Divide — Albert Lasker and Women’s Health

New England Journal of Medicine, November 1, 2017DOI: 10.1056/NEJMp1713518

ACA premiums are reasonable, grew modestly in 2016, and risk scores are stable.

Here are the results from CMS reports from June 30, 2017 and 2016:

2016 National average premium in the ACA Marketplace: $414.54 (CMS, 2017, page 9.)

This is less than the (employee plus employer) premiums offered where I work. This number includes the cost of the subsidies that are not paid by the enrollee.

2015 to 2016 Percentage changes in enrollment weighted monthly premium for ACA Marketplace plans:

  • 7.4% change in Individual market
  • 2.0 % small group market
  • 0.9 % change in catastrophic plans
  • 5.8 % change in national average ACA premiums

(Sources:  CMS, 2017, Table 3 and CMS 2016, Table 3.

The high growth rates that have been featured in the media are not representative of changes in the averages, or are distorted by calculations using only the consumer share of premiums, which are often heavily subsidized.

“Risk scores were stable in the individual market and decreased by 4 percent in the small group market.“  CMS, 2017, page 5.

There was no evidence of a death spiral nationally, or that the exchanges are unsustainable nationwide, even if some states are in trouble because they did not allow the Medicaid expansion or promote the exchange.

Sources:

Summary Report on Transitional Reinsurance Payments - CMS.gov

https://www.cms.gov/CCIIO/.../Summary-Reinsurance-Payments-Risk-2016.pdf

https://www.cms.gov/.../June-30-2016-RA-and-RI-Summary-Report-5CR-063016.pdf

Instead of the national averages, the media has generally been discussing outliers. Plus this data shows that the average health status in the plans was stable, not exploding last year. There is no evidence nationally of a death spiral.

These national average monthly premiums ($414) are lower than the total premiums for single coverage plans offered at Boston Unviersity (currently $636 and $599 for employer+employee contributions).

The following July 21 2017 report from the Wakely Consulting Group ( a consulting firm) is the most up to date analysis  I have seen.

A Preliminary Analysis of the 2016 Summary of ACA Risk Adjustment Transfers and Reinsurance Payments

ACA versus GOP plans side-by-side

This article from the LA Times by columnist Noam Levey links an update on earlier postings online that does a side-by-side comparison of ACA versus the GOP’s replacement AHCA plan. That posting provides the best concise overview I have seen of the latest GOP AHCA proposal. It will take 10 minutes to review/read. Randy

Here is the comparison

http://www.latimes.com/projects/la-na-pol-obamacare-repeal/

 

Here is the new article, which features specific effects.

http://www.latimes.com/la-na-pol-obamacare-repeal-chaos-20170625-story.html

 

From: Levey, Noam [mailto:Noam.Levey@latimes.com]
Sent: Sunday, June 25, 2017 9:44 PM
To: Levey, Noam
Subject: ICYMI: New article on the disruptive impact of the Senate repeal bill

Good day,

In case you missed it, I wanted to share my latest piece examining the potentially devastating impact of the recently released Senate legislation to roll back the Affordable Care Act.

The Republican architects of the bill, like their House counterparts, hail their legislation as a remedy for ills caused by the current law. But across the country, in physicians’ offices and medical centers, in state capitols and corporate offices, there is widespread fear the unprecedented cuts in the GOP bills would create even larger problems in the U.S. healthcare system, threatening to not only strip health coverage from millions, but also upend insurance markets, cripple state budgets and drive medical clinics and hospitals to the breaking point. As Tom Tom Priselac, chief executive of Cedars Sinai Health System in Los Angeles, told me: “These reductions are going to wreak havoc.”

Here is the link: http://www.latimes.com/la-na-pol-obamacare-repeal-chaos-20170625-story.html

I hope you find the piece interesting. Thank you, as always, for reading. All best,

-N

Noam N. Levey

National healthcare reporter

Los Angeles Times Washington Bureau

Tel: 202-824-8317

Cell: 202-247-0811

noam.levey@latimes.com

twitter: @NoamLevey

Performance Timer is excellent App

I was at a conference last week and learned about a terrific timer for my iPhone called Performance Timer. It counts down your specified time, and then changes from green to red as you go over.

What makes it superior to the default iPhone timer is its large font, there is no alarm when time is up, and your screen never goes blank, so you can read it for your entire talk. Really easy interface for the stressful time that you are setting it up. Or, if you are the timekeeper for someone else, they will be able to read it from 20 feet.

It is free in the Apple App store.  I looked but did not find the Android version.

Here is a review from the web.

Performance Timer on the App Store - iTunes - Apple

https://itunes.apple.com/us/app/performance-timer/id957648886?mt=8

Rating: 5 - ‎9 reviews - ‎Free - ‎iOS - ‎Utilities/Tools

Description

Performance Timer is a large-display countdown timer developed to be used to monitor the time remaining in a performance, presentation, etc. Performance Timer does not sound an alarm when the time runs out. Rather, when the timer reaches zero, the numbers turn red and the timer starts counting up so that you can see how long you've gone over your target time. The time can be set from 1 to 99 minutes.

Excellent articles about machine learning and replication

There is a wonderful article about Machine learning in the spring 2017 issue of the Journal of Economic Perspectives, and there is also a series of four fine articles in the AER May 2017. I decided to share as a BUHealth blog to all.

Whether you are curious, newly interested or an expert working in the area, I recommend the JEP one to you. The AER series is for more serious work. Here are the links (They should all be free to access, since they are all at the AEA.) Also see below for links on replication.

Machine Learning: An Applied Econometric Approach

Download Full Text PDF
(Complimentary)

 

Machine Learning in Econometrics (May, 2017)

Double/Debiased/Neyman Machine Learning of Treatment Effects

Victor Chernozhukov, Denis Chetverikov, Mert Demirer, Esther Duflo, Christian Hansen and Whitney Newey

(pp. 261-65)

Testing-Based Forward Model Selection

Damian Kozbur

(pp. 266-69)

Core Determining Class and Inequality Selection

Ye Luo and Hai Wang

(pp. 274-77)

Estimating Average Treatment Effects: Supplementary Analyses and Remaining Challenges

Susan Athey, Guido Imbens, Thai Pham and Stefan Wager

(pp. 278-81)

 

The series in the AER on Replication in microeconomics will also be of interest.  This article title speaks for itself.

A Preanalysis Plan to Replicate Sixty Economics Research Papers That Worked Half of the Time

Replication in Microeconomics

Assessing the Rate of Replication in Economics

James Berry, Lucas C. Coffman, Douglas Hanley, Rania Gihleb and Alistair J. Wilson

(pp. 27-31)

Replications in Development Economics

Sandip Sukhtankar

(pp. 32-36)

Replication in Labor Economics: Evidence from Data, and What It Suggests

Daniel S. Hamermesh

(pp. 37-40)

A Proposal to Organize and Promote Replications

Lucas C. Coffman, Muriel Niederle and Alistair J. Wilson

(pp. 41-45)

Replication and Ethics in Economics: Thirty Years after Dewald, Thursby, and Anderson

What Is Meant by "Replication" and Why Does It Encounter Resistance in Economics?

Maren Duvendack, Richard Palmer-Jones and W. Robert Reed

(pp. 46-51)

Replication and Economics Journal Policies

Jan H. Höffler

(pp. 52-55)

Replication, Meta-analysis, and Research Synthesis in Economics

Richard G. Anderson and Areerat Kichkha

(pp. 56-59)

A Preanalysis Plan to Replicate Sixty Economics Research Papers That Worked Half of the Time

Andrew C. Chang and Phillip Li

(pp. 60-64)

 

 

Economist article about end of life planning

One of my students today just sent me this link to an article in this week’s Economist about end-of-life planning.

How to have a better death

http://www.economist.com/news/leaders/21721371-death-inevitable-bad-death-not-how-have-better-death

It led me to also view its link about conversations about serious illness by one of my favorite authors.

“Serious Illness Conversation Guide” drawn up by Atul Gawande

I also found these slides targeting providers informative as well.

Using the Serious Illness Conversation Guide - HealthInsight

I found it informative that CMS (Medicare) created two new Advance Care Planning (ACP) codes. It will be interesting to see how often they are used.

Two new codes created in 2015, allowed for payment by Medicare in 2016.

  • 99497 ACP 30 minutes $85.99
  • 99498 ACP additional 30 minutes $74.88

CPT describes eligible services as being performed by a physician or “other qualified health professional” which means a physician, NP or PA.

We could save a lot of money and improve happiness and quality of life if more doctors, nurses, families and patients talked about these issues.

 

#stupideconomics and Healthcare Triage on the AHCA

Two interesting links related to the recent Republican health care proposal called the AHCA.

The first is a serious but also humorous Forbes article by my BU colleague Larry Kotlikoff in his series about Stupid Economics, this one targeting Tom Price and the AHCA bill. (A 3-minute read.)

Tom Price's Liver And 'The Coverage They Want'

The second is an excellent Youtube summary of the CBO forecasts (called “scoring”) of the effects of the AHCA by pediatrician Aaron Carroll.

Healthcare Triage: Results Are In! Congressional Budget Office Scores the American Health Care Act

Posted: 17 Mar 2017 06:09 AM PDT  Text of the report here.

(Broadcast is eight minutes.)

Facts about Tom Price, HHS nominee

Health economists and every concerned citizen should disseminate the facts in this NEJM article about Donald Trump’s nominee of Tom Price to be the next secretary of HHS.
Coauthor Richard Frank is also a BU Ph.D. alum!

Randy Ellis

 

Care for the Vulnerable vs. Cash for the Powerful — Trump’s Pick for HHS

Sherry A. Glied, Ph.D., and Richard G. Frank, Ph.D.

New England Journal of Medicine

December 21, 2016DOI: 10.1056/NEJMp1615714

http://www.nejm.org/doi/full/10.1056/NEJMp1615714#t=article

 

Since there is no abstract, here are the first two paragraphs.

Representative Tom Price of Georgia, an orthopedic surgeon, will be President-elect Donald Trump’s nominee for secretary of health and human services (HHS). In the 63-year history of the HHS Department and its predecessor, the Department of Health, Education, and Welfare, only two previous secretaries have been physicians. Otis Bowen, President Ronald Reagan’s second HHS secretary, engineered the first major expansion of Medicare, championed comparative effectiveness research and, with Surgeon General C. Everett Koop, led the fight against HIV–AIDS.1 Louis Sullivan, HHS secretary under President George H.W. Bush, focused his attention on care for vulnerable populations, campaigned against tobacco use, led the development of federally sponsored clinical guidelines,2 and introduced President Bush’s health insurance plan, which incorporated income-related tax credits3 and a system of risk adjustment. In their work at HHS, both men, serving in Republican administrations, drew on a long tradition of physicians as advocates for the most vulnerable, defenders of public health, and enthusiastic proponents of scientific approaches to clinical care.

Tom Price represents a different tradition. Ostensibly, he emphasizes the importance of making our health care system “more responsive and affordable to meet the needs of America’s patients and those who care for them.”4 But as compared with his predecessors’ actions, Price’s record demonstrates less concern for the sick, the poor, and the health of the public and much greater concern for the economic well-being of their physician caregivers.

Since the NEJM full article  requires a subscription, here is a summary what they document:

Price has sponsored legislation that

  • supports making armor-piercing bullets more accessible
  • opposes regulations on cigars
  • Repeals and replaces the ACA (see details below)

Voted  

  • Against the Affordable Care Act (ACA)
  • Against regulating tobacco as a drug
  • Against the Domenici–Wellstone Mental Health Parity and Addiction Equity Act
  • Against funding for combating AIDS, malaria, and tuberculosis
  • Against expansion of the State Children’s Health Insurance Program
  • In favor of allowing hospitals to turn away Medicaid and Medicare patients seeking nonemergency care if they could not afford copayments
  • Against reauthorization of the Violence Against Women Act
  • Against legislation prohibiting job discrimination against lesbian, gay, bisexual, and transgender (LGBT) people
  • Against enforcement of laws against anti-LGBT hate crimes.
  • Against expanding the NIH budget
  • Against the recently enacted 21st Century Cures Act

Price stated views:

  • Favors converting Medicare to a premium-support system
  • Favors changing the structure of Medicaid to a block grant program
  • Favors amending the Constitution to outlaw same-sex marriage
  • Opposes stem-cell research
  • Inconsistent in supporting investments in biomedical science.

His proposal for repealing and replacing the ACA is H.R. 2300, the Empowering Patients First Act,5 which would

  • Eliminate the ACA’s Medicaid expansion and
  • Replace ACA subsidies with flat tax credits based on age, not income
  • Be regressive, with larger subsidies for high than low incomes.
  • Credits would pay only about one third of the premium of a low-cost plan
  • Credits proposed are smaller than those proposed by President Bush in 1992, and will not be sufficient to get most people to buy health insurance
  • Eliminate the guaranteed-issue and community-rating requirements in the ACA, with ineffective substitutes.
  • Withdraw almost all the ACA’s federal consumer-protection regulations, including limits on insurer profits and requirements that plans cover essential health benefits.
  • Allow the sale of health insurance across state lines, effectively eliminating all state regulation of health insurance plans
  • Fund his plan by capping the tax exclusion for employer-sponsored health insurance at $8,000 per individual or $20,000 per family, caps that are lower than the unpopular Cadillac tax in the ACA, which Price himself has voted to repeal, and hence is unlikely to ever be approved
  • Directly advance physicians’ economic interests by permitting them to bill Medicare patients for amounts above those covered by the Medicare fee schedule and allowing them to join together and negotiate with insurance carriers without violating antitrust statutes.
  • Oppose strategies for value-based purchasing and guideline development,
  • Oppose the use of bundled payments for lower-extremity joint replacements and
  • Propose that physician specialty societies hold veto power over the release of comparative effectiveness findings.

Consider what you can do to make sure that these facts are widely known. Perhaps ask your legislators which of these views they support.

I am sorry

Dear BUHealth friends, alumni, students and colleagues.

Like most of the people I know, I am immensely saddened by the results of the US presidential elections, which have elected Donald Trump as president and elected republicans to run both houses of congress.

My view is that hate and party loyalty won out in the end over any reasoned comparisons of the two presidential candidates.

I hope to try harder to understand the views of the those who voted for Donald Trump and why they fell for such a clever salesman.

A good place to start is to reread the blogs I posted by and about Scott Adams who alone was consistently supporting and predicting the victory of Donald Trump for over a year. Sadly, Adams was right and the rest of us, driven by incorrect polling predictions, were wrong.

http://blogs.bu.edu/ellisrp/2016/09/why-trump-is-going-to-win-the-us-presidency/

Austin Frakt (at TheIncidentalEconomist.com) has already posted a very useful blog on what health reforms and directions are mostly likely under Donald Trump.  It is linked here if you are interested or if you are asked to discuss this with your family or colleagues..

The next health reform

http://theincidentaleconomist.com/wordpress/the-next-health-reform/

I am lucky that I live and work in a state and occupation that hopefully will not experience the brunt of the pain that I predict is ahead.

Some people may take solace in the fact that Marijuana was legalized for possession, home growing, and recreational use in Massachusetts starting this December 15 2016 (although not to be legally sold in dispensaries for another year).

I for one plan to try to add to our sadly lacking civility by calling him Donald Trump, or president-elect Trump, rather than simply Trump.

Randy

Recent Marketplace Premium Increases are No Big Deal

By Randall P. Ellis, Boston University, Department of Economics October 28, 2016

A great deal has been made recently about the large increases in certain Health Insurance Marketplace premiums  announced for 2017. I present here five arguments for why these increases are no big deal, and are not the right thing to focus on when evaluating the success of the 2010 Affordable Care Act (ACA).

Argument 1: The Marketplace exchanges in which premiums are increasing are very small part of the US Health Care Market. 97% of Americans are not in them. And 80% of the enrollees who are in the Marketplace get government subsidies for their premiums. (Thomas G. McGuire, unpublished figure).

TM US Market Composition 2014

Argument #2: When the ACA Marketplace was started in 2014, its premiums were unexpectedly low, not high, in most markets. Everyone commented on this. The same thing happened when Medicare Part D was introduced. Many economists believe this was because health plans were trying to capture market share by offering low premiums. Such low premiums were not sustainable. Two years into the Marketplace, plans are trying to catch up with the much higher employer sponsored premiums. This should not be treated as a failure of Obamacare.

Argument #3: Many health insurance markets in the US are already highly concentrated. For example Blue Cross Blue Shield of Alabama has a 90 percent market share. (kff.org, 2014)  We cannot expect competitive premium pricing with such market power. As I discuss in Ellis (2012): Leemore Dafny, Mark Duggan, and Subramaniam Ramanarayanan in the American Economic Review 2012, using data from the American Medical Association (AMA), show that 94% of 314 US market areas have “highly concentrated” insurance markets. This concentration cannot be blamed on the ACA, since it predated it.

Argument #4: The main goal and achievement of the ACA has been that it has reduced the number of uninsured. The data clearly show this, and the largest percentage increase has been in private insurance, not government insurance programs.

Recent Health Insurance coverage

Argument 5: The unexpected wonderful cost impact of the ACA has been favorable: lowering the average rate of increase in health care spending throughout the country. (Barack Obama, JAMA, 2016)

obamatrend2

This has been particularly true for the Medicare program. US government statistics (CBO and OMB) show enormous savings in Medicare since 2010.

2016_EllisMcGuire_UpdateonUS_RA_20161005_Page_09

While the ACA has not eliminated uninsurance or solved the US cost containment problem, it has made important improvements in both directions. Recent large premium increases in the Health Insurance Marketplace, which happen all the time in the employer sector without much attention, are part of a bigger problem still in need of solutions.

The US Should Ban or Heavily Tax Weapons Designed for Mass Shootings

Boston University Working Paper

Randall P. Ellis
Boston University,
Department of Economics
August 22, 2016
Abstract

This paper presents four arguments for why the US should ban or at least heavily tax the sale or transfer to civilians of weapons designed for mass shootings (WDMS), which would include most semi-automatic guns and weapons with large capacity magazines.

  1. The Supreme Court has repeatedly validated that second amendment protections of the right to bear arms do not apply to particularly dangerous weapons where protection of public safety overrides constitutional protections; this exclusion should apply to WDMS just as it does to machine guns and short-barreled shotguns.
  1. To make gun owners pay for the annual cost of deaths in the US due to guns, we should be taxing each gun owned at $1000 per year, or tax all gun sales (new or used) at $15,000 per gun sold. Given their higher killing power we should tax WDMS at $60,000 per gun sold. Or just ban them.
  1. In the last 36 months, there have been 5,399 people in the US killed or injured at mass shootings (where four or more people are shot, although not necessarily killed). Unless action is taken, the most recent trends suggest that there will be twice as many mass shootings in the US in five years.
  1. Current federal law for duck hunting bans the use of shotguns that hold more than three shells. If we care enough to ban four-bullet capacity guns to preserve ducks, then we should be willing to ban even higher capacity guns designed to kill people.

The full paper is linked here.

http://blogs.bu.edu/ellisrp/files/2016/08/Banning-or-heavily-taxing-WDMS-20160822.pdf

Obama’s JAMA article is a must read for all professionals

There is a very important  article in this week’s JAMA - Internal Medicine, written by Barach Obama.

It highlights the effects of the ACA/Obamacare.  It is free on-line.

United States Health Care Reform: Progress to Date and Next Steps

http://jama.jamanetwork.com/article.aspx?articleid=2533698

If you are short on time, then the following link to just the figures provides many of the key results.

http://jama.jamanetwork.com/article.aspx?articleid=2533698

To me the highlights of the article are that it documents:

The decline in the uninsured (no surprise, but well presented) now down to 9.1 percent from over 16
Declines in teen smoking from 19.5% to 10.8% due to the Tobacco Control Act of 2009 (Wow)
Much slower rates of decline in the uninsured in states that refused the Medicaid expansion (no surprise)
The decline in the underinsured among privately insured as measured by the near disappeance of unlimited exposure (new to me)
Lower rates of individual debt sent to a collection agency (great to see)
Negative rates of real cost growth in Medicare and Medicaid since 2010, with drastically lower growth in privately Insured
Constant share of out of pocket spending as a fraction of total spending among the employer based insurance
(new to me, he cites increases in deductibles offset by decreases in copays and coinsurance.)
Forecast Medicare spending in 2019 is now 20% LOWER than when he took office.
Decline in Medicare 30 day, all hospital readmission rates as well as improvements in other measures.
This information is important to understand to counter the repeated false claims that Obamacare is a failure, or has increased health care spending, or is bankrupting the government, all of which are shown to be false in the evidence presented here.

Here is the link again.

http://jama.jamanetwork.com/article.aspx?articleid=2533698

Press Interviews and Quotes

Partly just to keep track of them for my BU annual report, this post links to my press interviews and quotes.

Meeting basic needs under Trump

Fed funds key for landlords, affordable tenants; Trump’s health secretary opposes Obamacare

Bay State Banner Jule Pattison-Gordon | 12/7/2016, 1:13 p.m.

Effects of Brexit on the world economy and Iran.

Tasnim News Agency Interview, Iran (translated into Persian), June 28, 2016.

Farm Animal Ballot Initiative.

posted on Youtube. By  Brittany Comak, BU School of Communication. November 29, 2015

Inspector General criticizes Red Sox, BRA deal

Massachusetts Inspector General Glenn Cunha criticized a 2013 deal by Boston Redevelopment Authority that granted the Boston […]

by · October 29, 2015 · 0 comments · City, News
According to a New England Economic Partnership report released Thursday, Massachusetts is creating jobs at the fastest pace in 15 years. GRAPHIC BY KATELYN PILLEY/DAILY FREE PRESS STAFF

Mass. experiencing economic boom, study finds

In the past year, Massachusetts has seen an economic boom unlike any since the 1990s, a […]

by · October 20, 2015 · 0 comments · City, News
Massachusetts Gov. Charlie Baker signed a bill Friday authorizing $200 million in transportation funds. PHOTO BY STUX/PIXABAY

$200 million in extra funding approved for infrastructure repairs

Massachusetts Gov. Charlie Baker approved an additional $200 million in funding for infrastructure contributing to a […]

by · April 14, 2015 · 0 comments · City, News
Massachusetts lawmakers announced their support Friday for a bill that would allow the legalization and taxation of marijuana. PHOTO BY SARAH SILBIGER/DAILY FREE PRESS STAFF

Mass. lawmakers support bill that would legalize and tax marijuana

Fifteen Massachusetts lawmakers are supporting a bill, pushed by the Marijuana Policy Project, that would regulate […]

by · March 18, 2015

MBTA late-night service threatened by lack of sponsorship Daily Free Press. by Paige Smith · January 27, 2015

Part time BU employees now eligible for health, dental benefits Daily Free Press. by Rachel Legon · October 30, 2014

Student loan report shows complaints, problems with private lenders Daily Free Press by Meiling Bedard · October 21, 2014

Greater Boston GDP declining, report finds Daily Free Press. by Mina Corpuz  September 18, 2014

Small businesses get extension for ACA in Massachusetts by Daily Free Press Admin · April 27, 2014

STUDY: Grad student loan debt on the rise. by Daily Free Press Admin · March 26, 2014 

College worthwhile investment, study suggests by Daily Free Press Admin · February 26, 2014

Bitcoin ATM installed in South Station by Daily Free Press Admin · February 23, 2014

Cost of student loan programs difficult for federal government to determine, study suggests  by Daily Free Press Admin · February 4, 2014

Universities see an increase in endowments, study suggests by Daily Free Press Admin · January 29, 2014

"South Shore Hospital, Partners HealthCare defend merger plan" The Patriot Ledger. by Christian Schiavone.  1/17/2014

"The Healing Begins for Healthcare.gov"  TechNewsWorld By Erika Morphy 12/04/13 4:12 PM PT

"Financial squeeze awaits W.Pa. hospitals", TribLive. By Alex Nixon. Thursday, Oct. 24, 2013.

"Wenermaar aan, Obamacare blijft", Trouw Buitenlandredactie. (Article on ObamaCare in Dutch Newspaper) In Dutch. October 4. 2013

Menino plans to build about 30,000 housing units by 2020. Daily Free Press, Boston University, Sep 11, 2013

"Boston welcomes startups, entrepreneurship, despite study results" Daily Free Press, Boston University, Sep 11, 2013

Mass. residents driving less since 2004, study suggests. Daily Free Press, Boston University, Sept 4, 2013.

Medical Costs Register First Decline Since 1970s. Wall Street Journal Blog.  June 18, 2013,

Employers fear economic climate, fail to make hires, new study suggests. Daily Free Press, Boston University, April 24, 2013.

Outside spending in Senate race tops $1.25 million. Daily Free Press, Boston University, April 9, 2013.

New delayed-start loan repayment plan may help grads.Daily Free Press, Boston University, April 3, 2013.

Years after recession, Mass. job numbers finally bounce back. Daily Free Press, Boston University, April 2, 2013.

Popeye’s President Unconcerned About Obamacare, Says Health Insurance ‘Just Not Affordable’ Huffington Post. March 28th, 2013

Tax-based aid needs reform, report suggests. The Daily Free Press. Boston University. Feb 27, 2013.

Minimum wage-earners face hardship paying rent. The Daily Free Press, Boston University, Feb 5, 2013

Gas prices in Mass. shoot up 14 cents a gallon. The Daily Free Press, Boston University. Feb 5, 2013

Freshmen see college as necessary to riches, study suggests. The Daily Free Press, Boston University. Jan 30, 2013.

College debt high despite lower credit card, general debt. The Daily Free Press, Boston University. Dec 3, 2012

Government officials demand sales tax for items bought online. The Daily Free Press, Boston University. Nov 27, 2012

Interview with ASHEcon President Randy Ellis. American Society of Health Economists (ASHEcon) Newsletter Vol. 4 Fall 2010.

 

 

Insurers are doing well under ObamaCare

Much was made recently about how UnitedHealth decided to drop out of the ACA Federal Exchange in several states. It is important to realize that far from being a failure to large insurers (UnitedHealth is the largest insurer in the US), health insurance remains extremely profitably under ObamaCare. Below is a bar chart of the percentage change in stock prices of the five largest publicly traded health insurers in the US from March 23, 2010 when the ACA was signed to today (6/6/2016).

Top Five Health Insurer Stock Prices under ObamaCare

 

Congratulations to BU’s Class of 2016 Economics graduates!

Please celebrate the students who earned 498 Boston University degrees in Economics at Commencement this May.

This year the program mentions:

22 Ph.D. recipients

203 Master’s degree recipients (MA, MAPE, MAEP, MAGDE MA/MBA, BA/MA)

273 BA recipients (including BA/MA)

This total of 498 degrees is up from 482  in 2015.

These numbers undercount the total for the year since it may exclude students who graduated in January 2016 and chose not to appear at Commencement.

The number of graduate degree recipients 225 is way up from last year when we had 177, with most of the growth in MAs.

In 2015 there were 22 PhDs, 155 Master's degree recipients, and 305 BA recipients.

In 2014 there were 17 PhDs, 207 Master’s degree recipients, and 256 BA recipients.

Altogether 24 Ph.D. students obtained jobs this year (versus 19 last year).

To see the Ph.D. placements visit the web site linked here.

http://www.bu.edu/econ/gradprgms/phd/placements/

The department’s  website now lists 38 regular faculty (down two from last year) with titles of assistant, associate or full professors, a number which is two below the number of professors in 2012.

http://www.bu.edu/econ/people/faculty/

 

Congratulations to all!

Top 100 Economics Blogs of 2016

I just got an email from Prateek Agarwal <prateek@intelligenteconomist.com>

He has compiled a list of the Top 100 Economics Blogs of 2016. I am of course not on it since I blog infrequently and do not archive (and make public) on my web site all of my blogs, but I thought I would share the link he provided.

https://www.intelligenteconomist.com/top-economics-blogs-2016/

Lots of interesting links, including The Incidental Economist, which is the only one I subscribe to. Be warned that reading blogs can be a major time waster..

I plan to archive this one on my web site blog.

Hope to see many of you at ASHEcon. (Not too late to sign up for the dinner)

Best.

Obamacare reality: It is working

At a time in the US when all of the Republicans presidential candidates are declaring Obamacare a failure which needs to be undone, it is worth noting the REALITY that it is succeeding in its primary purpose of covering more American with health insurance. It does not mandate insurance coverage, but the subsidies and tax penalties for not having insurance are motivating more people to get insurance. 20 million more people now have health insurance than did before. (Click on graphs for a clearer image.)

 20 Million Gained Health Insurance From Obamacare, President Says
The Huffington Post

Uninsured rate Gallop-HealthwaysEven though cost containment was not its primary goal, Obamacare is also reducing, not increasing, costs of health care.
Since many people don’t trust the government, here are some private sector slides.
PriceWaterhouseCoopers, an actuary firm not known for being political, forecasts that health expenditure
cost growth in 2016 will continue to slow down.

http://www.pwc.com/us/en/health-industries/behind-the-numbers/assets/pwc-hri-medical-cost-trend-chart-pack-2016.pdf

Here are my two favorite slides from their chart pack. Note the changes since 2010.

pwc trends gdpand nhe

My view is that the above figure is misleading, since the decline in rates of growth did not start in 1961, but still the slow growth since 2010 is clearly evident.

 

spending growth rate PWC 2016

Obamacare is working. We just don’t have enough leaders and media telling us this.

 

Note: I sent this blog to my BUHealth email list.

Let me know if you would like to be added as a BUHealthFriends subscriber by emailing ellisrp at bu.edu

Denmark’s Social Capitalism and Switzerland’s Federal Democracy

With Democratic presidential candidates Hillary Clinton and Bernie Sanders both mentioning Democratic Socialism in Denmark, it is interesting to read about what it actually is.

Here is one link with one persons discussion.

Denmark sounds pretty wonderful to me

Switzerland

I just returned from Switzerland which is not democratic socialism, but rather a federalist direct democracy centered on capitalism much like the US.

The Swiss seem to be doing many things right.

SOLOTHURN

The small city of Solothurn (pop 16,000) we stayed at had the following features. (Based on my visit, augmented by https://en.wikipedia.org/wiki/Solothurn)

A train, at least six bus lines and an electric trolley - for a city of 16,000!

Trains that runs on weekends almost as regularly as weekdays. Twice an hour on its two lines on Sunday mornings.

Hundreds (thousands?) of locals from the town using trains to get to the local cable car and go for hikes in the Alps on a Sunday morning in November.

23% foreign national residents

No driving in the center of the city. Only pedestrians or local residents and deliveries.

At least seven museums: art museum, rock carving museum, castle arsenal museum, nature museum, pinball museum, puppet museum, history museum

Trash containers every 100 feet along most public sidewalks.

Two pedestrian-only bridges across the Aare river (good crossword answer)

Bicycle parking for over 100 bikes at the train station.

No large supermarkets or malls that I saw.

 

WORK?

Unemployment rate of 4.6% in 2010.

Minimum wage of $20 to $25 depending on canton. In May a national referendum to raise it to the equivalent of $24.70 narrowly failed.

Only 40.3% of the people use a car to get to work (40% walk or ride a bike, while 20% use public transport).

Considered the richest country in the world.

 

TAXES?

Median tax rate for a single person earning > $150,000 is 22% in 2011.

8% value added tax (national) plus a canton rate.

.3 to .5% property tax (national) (notice the decimal point)

Corporate profit tax of 8.5 (national) with some more by cantons (= states)

Overall fiscal rate for Switzerland was 38.5% in 2002.

Health (from Wikipedia on 11/12/15) https://en.wikipedia.org/wiki/Switzerland

Swiss citizens are universally required to buy health insurance from private insurance companies, which in turn are required to accept every applicant. While the cost of the system is among the highest it compares well with other European countries in terms of health outcomes; patients who are citizens have been reported as being, in general, highly satisfied with it.[151][152][153] In 2012, life expectancy at birth was 80.4 years for men and 84.7 years for women[154] — the highest in the world.[155][156] However, spending on health is particularly high at 11.4% of GDP (2010), on par with Germany and France (11.6%) and other European countries, and notably less than spending in the USA (17.6%).[157] From 1990, a steady increase can be observed, reflecting the high costs of the services provided.[158] With an ageing population and new healthcare technologies, health spending will likely continue to rise.[158]

 

Like Denmark, Switzerland seems to run on trust.

This all sounds pretty attractive to me. Why can’t we look at successes in Europe more and imitate them?

Tax to rise on the uninsured next year.

This is why enrollment in health insurance will continue to rise in the US from the ACA.

For 2016: Max of  $695 or 2.5 percent of taxable income if uninsured.

http://www.bostonglobe.com/news/nation/2015/10/19/health-law-fine-uninsured-will-more-than-double/76FbuARARxAmaT9H4nN66K/story.html

Full text is below.

Health law fine for uninsured to rise

Boston Globe

Associated Press  October 19, 2015

WASHINGTON — The federal penalty for having no health insurance is set to jump to $695, and the Obama administration is being urged to highlight that fact in its new pitch for health law signups.

That means the 2016 signup season starting Nov. 1 could see penalties become a bigger focus for millions of people who have remained eligible for coverage but uninsured. They’re said to be squeezed for money and skeptical about spending what they have on health insurance.

Until now, health overhaul supporters have stressed the benefits: taxpayer subsidies that pay about 70 percent of the monthly premium, financial protection against sudden illness or an accident, and access to regular preventive and follow-up medical care.

But in 2016, the penalty for being uninsured will rise to the greater of either $695 or 2.5 percent of taxable income. That’s for someone without coverage for a full 12 months. This year the comparable numbers are $325, or 2 percent of income.

Marketing usually involves stressing the positive. Rising penalties meet no one’s definition of good news. Still, that may create a new pitch:

The math is pretty clear. A consumer would be able to get six months or more of coverage for $695, instead of owing that amount to the IRS as a tax penalty. (That is based on subsidized customers now putting in an average of about $100 a month of their own money.)”